中西医结合治疗肺心病急性加重期合并肝肾功能损害

目的 :观察中西医结合治疗肺心病急性加重期合并肝肾功能损害的临床治疗。方法 :选择肺心病急性加重期合并肝肾功能损害的患者 87例 ,随机分为治疗组和对照组 ,两组所用西药与疗程基本相同。治疗组在西药治疗基础上 ,根据中医辨证分型治疗。结果 :治疗组在治疗前后临床疗效、动脉血气分析结果及肝肾功能改善方面均优于对照组 ,两组间存在着显著性差异。结论 :中西医结合治疗肺心病急性加重期合并肝肾功能损害具有一定的疗效。

肝细胞生长因子对冠心病治疗作用的研究

晚期冠心病是西方国家最常见的致死性疾病之一,近年来在我国的发病率和死亡率也呈明显上升趋势。目前主要的治疗方法包括内科药物治疗以及外科手术,有其局限性。血管新生的基础研究取得了重大进展,为缺血性心脏病的治疗带来了新的思路。现就治疗性血管新生大背景下,肝细胞生长因子对冠心病的治疗作用机制、研究进展、尚存在的问题作一综述。

肝脂酶基因多态性与血脂及冠心病

肝脂酶是脂蛋白代谢的关键酶之一,主要水解各种脂蛋白中的甘油三酯和磷脂,活性受其基因多态性及其它多种因素的影响。肝脂酶基因多态性影响血脂谱,能明显增高血浆高密度脂蛋白浓度,但目前的研究发现其既有抗动脉粥样硬化的作用,又有致动脉粥样硬化的作用,故对冠心病发病的影响目前尚无定论。

心病治肝发微兼谈小柴胡汤加减治疗心绞痛

在五行中肝为木,心为火,木生火,肝为心之母,母病及子,治疗可用调肝治疗心之疾病。小柴胡汤方出张仲景,为调肝治疗少阳病主方。《伤寒论》第96条：＂伤寒五六日,中风,往来寒热,胸胁苦满,嘿嘿不欲饮食,

应用超声诊断冠心病合并肝脓肿的价值及美托洛尔联合小柴胡汤的临床治疗

探讨应用超声诊断冠心病合并肝脓肿的价值及美托洛尔联合小柴胡汤的临床治疗。方法:50例对照组给予临床常规药物美托洛尔治疗,观察组50例给予美托洛尔联合小柴胡汤治疗,2组用药疗程一致,以各组数据情况说明本次用药效果。结果:观察组治疗有效率为96.00%;对照组治疗有效率仅为78.00%;治疗后观察组患者心功能指标数据也显著优于对照组(P<0.05)。结论:使用美托洛尔联合小柴胡汤治疗超声诊断冠心病合并肝脓肿具有明显的临床效果,能够有效改善患者的心功能,提高临床治疗效果。

基于数据挖掘探讨陈镜合治疗冠心病用药规律

收集陈镜合2014年3月至2016年1月于广州中医药大学第一附属医院岭南名医门诊治疗的冠心病患者病案,提取患者处方药物,基于"中医传承辅助平台(V2.5)"软件,建立处方数据库;采用关联规则、改进的互信息法、复杂系统熵聚类等数据挖掘方法,分析其治疗冠心病的用药规律。分析结果表明:共纳入处方138首,涉及药物116味。使用频次居前3位的单味药物为炙甘草、川芎、白芍,使用频次居前3位的药物组合为"陈皮,炙甘草"、"炙甘草,枳壳"、"炙甘草,白芍",常用药物组合均为柴胡疏肝散和四君子汤的药物随机组合。结果提示陈镜合教授治疗冠心病多用理气、补气、祛痰、化瘀之品,体现其"心病治肝"的诊治思路及"疏肝健脾,化痰祛瘀"的治疗方法。

慢性肺原性心脏病的肝损害(附10例病理资料及临床分析)

本文报告10例慢性肺原性心脏病的肝脏病理资料。其主要病理改变是:肝窦扩张、淤血、出血,肝小叶中央静脉扩张,周围肝细胞性变、坏死,肝细胞脂肪性变。严重病例,肝细胞呈桥接坏死,纤维织组增生,纤维组织带从中央静脉伸入邻近中央静脉“反向小叶化”(reversed lobulation)。其发病机理:可能与心力衰竭心输出量降低、肝静脉压增高、严重低氧血症持续或暂短发作的休克有关。另外,亦与长期消耗、各种原因造成的营养不良有关。本文结合临床,对慢性肺原性心脏病患者检查肝功能的意义,肝损害与水、电解质平衡,以及肺性脑病昏迷与肝昏遥的鉴别诊断等问题,进行了讨论。

陈镜合论治病态窦房结综合征经验介绍

病态窦房结综合征（sick sinus syndrome,简称病窦）是内科急诊较常见的心律失常,临床以中老年人多见。随着人口老龄化及冠心病、动脉粥样硬化等心血管病发病率的增加,本病在国内的发病率呈上升趋势。陈镜合教授系国家名老中医,广州中医药大学首席教授,博士研究生导师,从事临床、教学、科研工作五十年余，主攻心脏内科急症，提出要先中后西、能中不西、中西结合，走以中医为主、中西医结合的现代中医之路及现代中医急症思维，在内科急症救治方面积累了丰富经验，临床疗效确切。兹将陈教授论治病态窦房结综合征经验介绍如下。

张耀临证经验述略

张耀主任医师运用旋覆代赭汤加减治疗肝胃郁热,肺失肃降证咳嗽;审症求因,辨治无疹型带状疱疹热蕴肝胆经络,正气不足证;采用清肝利胆除湿,行气活血化瘀法治疗冠状动脉粥样硬化性心脏病;衷中参西妙治盆腔器官失养,疗效显著。

周亚滨教授从整体与微观多向论治心脏神经官能症

周亚滨教授认为心脏神经官能症中医辨病应为心悸,病因病机为肝气不畅或心肝血虚。其病机关键为“表象为心脏之心发病,实则为心理之心发病”。临证从子病治母暨心病治肝理论角度提出从整体与微观多向论治,从肝对“心主血脉”和“心主神明”两方面入手,补心益肝、潜阳定悸贯穿治疗始终。方用柴胡桂枝龙骨牡蛎汤及归脾汤加减,坚持药物加减重视顾护脾胃原则,平调阴阳,安神定悸。

Psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy:A complementary approach to drug analgesia

AIM: To assess whether psychological intervention reduces postembolization pain during hepatic arterial chemoembolization therapy. METHODS: Two hundred and sixty-two patients, who required hepatic arterial chemoembolization for hepatic malignancy and postembolization pain, were randomized into control group (n = 46, receiving medication) and intervention group (n = 216, receiving psychological intervention and medication in turn). The symptom checklist-90 (SCL-90) was used to scale the psychological symptoms of the patients before operation. Pain was scored with a 0 to 10 numeric rating scale (NRS-10) before and after analgesia as well as after psychological intervention (only in intervention group). RESULTS: All psychological symptomatic scores measured with SCL-90 in the intervention group were higher than the normal range in Chinese (P < 0.05). The somatization, phobia and anxiety symptomatic scores were associated with pain numerical rating score before analgesia (r = 0.141, 0.157 and 0.192, respectively, P < 0.05). Patients in both groups experienced pain relief after medication, psychotherapy or psychotherapy combined with medication during the procedure (P < 0.01). Only some patients in the intervention group reported partial or entire pain relief (29.17% and 2.31%) after psychological intervention. The pain score after analgesia in the intervention group was significantly lower than that in the control group (P < 0.01).CONCLUSION: Severe psychological distress occurs in patients with hepatic malignancy. Psychological intervention reduces pain scores significantly during hepatic arterial chemoembolization therapy and is thus, highly recommended as a complementary approach to drug analgesia.

Are heat stroke and physical exhaustion underestimated causes of acute hepatic failure?

While cardiopulmonary symptoms are common in patients undergoing dassical or, due to physical exercise, exertional heat stroke, the failure of other organs is a rarely described phenomenon. Here we present two cases of acute hepatic failure, one due to classic heat shock, while the other occurred while the patient was doing a marathon-type running. Both cases presented with very high transaminases and significantly elevated international normalized ratio （INR）. No other causes for liver failure could be identified but physical exhaustion and hyperthermia.

Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease

AIM:To clarify whether nonalcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular disease.METHODS:We carried out a prospective observational study with a total of 1637 apparently healthy Japanese men and women who were recruited from a health check-up program.NAFLD was diagnosed by abdominal ultrasonography.The metabolic syndrome(MS)was defined according to the modified National Cholesterol Education Program(NCEP)ATP Ⅲ criteria.Five years after the baseline evaluations,the incidence of cardiovascular disease was assessed by a self-administered questionnaire.RESULTS:Among 1221 participants available for outcome analyses,the incidence of cardiovascular disease was higher in 231 subjects with NAFLD at baseline(5 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage)than 990 subjects without NAFLD(3 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage).Multivariate analyses indicated that NAFLD was a predictor of cardiovascular disease independent of conventional risk factors(odds ratio 4.12,95% CI,1.58 to 10.75,P = 0.004).MS was alsoindependently associated with cardiovascular events.But simultaneous inclusion of NAFLD and MS in a multivariate model revealed that NAFLD but not MS retained a statistically significant correlation with cardiovascular disease.CONCLUSION:Although both of them were predictors of cardiovascular disease,NAFLD but not MS retained a statistically significant correlation with cardiovascular disease in a multivariate model.NAFLD is a strong predictor of cardiovascular disease and may play a central role in the cardiovascular risk of MS.

Cardiopulmonary,complications in chronic liver disease

Patients with cirrhosis and portal hypertension exhibit characteristic cardiovascular and pulmonary hemodynamic changes. A vasodilatatory state and a hyperdynamic circulation affecting the cardiac and pulmonary functions dominate the circulation. The recently defined cirrhotic cardiomyopathy may affect systolic and diastolic functions, and imply electromechanical abnormalities. In addition, the baroreceptor function and regulation of the circulatory homoeostasis is impaired. Pulmonary dysfunction involves diffusing abnormalities with the development of the hepatopulmonary syndrome and portopulmonary hypertension in some patients. Recent research has focused on the assertion that the hemodynamic and neurohumoral dysregulation are of major importance for the development of the cardiovascular and pulmonary complications in cirrhosis. This aspect is important to take into account in the management of these patients.

Detection of hepatitis C virus core antigen for early diagnosis of hepatitis C virus infection in plasma donor in China

AIM： To evaluate the efficacy of a new hepatitis C virus （HCV） core antigen assay developed in China. METHODS： After the determination of HCV infection, 49 serial samples were selected from II regular plasma donors in 5 different plasma stations. To compare the performance of HCV core antigen detection and HCV PCR, these samples were genotyped, and each specimen was analyzed by ELISA for the detection of HCV core antigen and by qualitative HCV PCR. RESULTS： Among all of the sequential samples, the original 23 specimens were HCV RNA-negative, and 36 samples were HCV RNA-positive. Twenty-seven samples （75%） were HCV core antigen-positive from these HCV RNA-positive specimens. Conversely, 27 samples （93.2%） were found HCV RNA-positive in HCV core antigen- positive samples. Intervals between HCV RNA and HCV core antigen-positive, as well as between HCV core antigen-positive and HCV antibody-positive were 36.0 and 32.8 d, respectively. CONCLUSION： This HCV core antigen assay, developed in China, is able to detect much of anti-HCV-negative, HCV RNA-positive preseroconversion window period （PWP） plasma donations.

Clinical features and natural history of cryptogenic cirrhosis compared to hepatitis C virus-related cirrhosis

To characterize natural history of cryptogenic cirrhosis (CC) and compare its clinical features and outcomes to those of hepatitis C virus (HCV)-related cirrhosis.METHODSA prospective cohort of 102 consecutive patients at their first diagnosis of CC were enrolled in this study. The clinical data and outcomes were compared to an age- and Child-Pugh class-matched cohort of 110 patients with HCV-related cirrhosis. Diagnosis of cirrhosis was based on compatible clinical and laboratory parameters, ultrasound/endoscopic parameters and, whenever possible, on histological grounds and transient elastography. All cases of cirrhosis without a definite etiology were enrolled in the CC group. The parameters assessed were: (1) severity of liver disease at the time of first diagnosis; (2) liver decompensation during follow-up; (3) hepatocellular carcinoma (HCC); (4) orthotopic liver transplantation; and (5) death. The independent associated factors were evaluated by multiple logistic regression analysis, and survival and its determinants by the Kaplan-Meier model, log-rank test and Cox regression.RESULTSAt the first observation, median age was 66 and 65 years and male gender was 36% and 58% for CC and HCV cirrhosis, respectively. CC showed Child-Pugh class A/B/C of 47%/31%/22%, respectively. Compared to HCV cirrhosis, CC exhibited a significantly higher prevalence of metabolic syndrome (12% vs 54%, respectively), overweight/obesity, high BMI, impaired glucose tolerance, high blood pressure, dyslipidemia, hyperuricemia, cardiovascular diseases, extrahepatic cancer, and gallstones. Over a median period of 42 mo of follow-up, liver decompensation, HCC development and death for CC and HCV-related cirrhosis were 60.8%, and 54.4%, 16.7% and 17.2%, 39.2% and 30%, respectively. The median survival was 60 mo for CC. Independent predictors of death were age and Child-Pugh class at diagnosis. CC showed an approximately twofold higher incidence of HCC in Child-Pugh class A.CONCLUSIONUndiagnosed nonalcoholic fatty liver disease has an etiologic role in CC that is associated with a poor prognosis, early HCC development, high risk of cardiovascular disease and extrahepatic cancer.

Hyperhomocysteinemia, endoplasmic reticulum stress, and alcoholic liver injury

Deficiencies in vitamins or other factors(B6,B12,folic acid, betaine)and genetic disorders for the metabolism of the non-protein amino acid-homocysteine(Hcy)lead to hyperhomocysteinemia(HHcy).HHcy is an integral component of several disorders including cardiovascular disease,neurodegeneration,diabetes and alcoholic liver disease.HHcy unleashes mediators of inflammation such as NFκB,IL-1β,IL-6,and IL-8,increases production of intracellular superoxide anion causing oxidative stress and reducing intracellular level of nitric oxide(NO),and induces endoplasrnic reticulum(ER)stress which can explain many processes of Hcy-promoted cell injury such as apoptosis, fat accumulation,and inflammation.Animal models have played an important role in determining the biological effects of HHcy.ER stress may also be involved in other liver diseases such as α_1-antitrypsin(α_1-AT)deficiency and hepatitis C and/or B virus infection.Future research should evaluate the possible potentiative effects of alcohol and hepatic virus infection on ER stress-induced liver injury,study potentially beneficial effects of lowering Hcy and preventing ER stress in alcoholic humans,and examine polymorphisrn of Hcy metabolizing enzymes as potential risk-factors for the development of HHcy and liver disease.

Genes transactivated by hepatitis C virus core protein, a microarray assay

AIM: To explore the new target genes transactivated by hepatitis C virus (HCV) core protein and to elucidate the pathogenesis of HCV infection. METHODS: Reverse transcribed cDNA was subjected to microarray assay. The coding gene transactivated by HCV core protein was cloned and analyzed with bioinformatics methods. RESULTS: The expressive vector of pcDNA3.1(-)-core was constructed and confirmed by restriction enzyme digestion and DNA sequencing and approved correct. mRNA was purified from HepGZ and HepG2 cells transfected with pcDNA3.1(-)-core, respectively. The cDNA derived was subjected to microarray assay. A new gene named HCTP4 was cloned with molecular biological method in combination with bioinformatics method. CONCLUSION: HCV core is a potential transactivator. Microarray is an efficient and convenient method for analysis of differentially expressed genes.

Sonographic fatty liver, overweight and ischemic heart disease

AIM: To demonstrate the prevalence of sonographic fatty liver, overweight and ischemic heart disease (IHD) among the male workers in Taiwan, and to investigate the possible association of these three factors.METHODS: From July to September 2003, a total of 2 088 male aircraft-maintenance workers aged from 22to 65 years (mean 40.5) underwent an annual health examination, including anthropometrical evaluation, blood pressure measurement, personal medical history assessment,biochemical blood analysis, abdominal ultrasonographic examination and digital electrocardiography (ECG). The Student's t-test, x2 test and multivariate logistic regression analysis were utilized to evaluate the relationship between IHD and salient risk factors.RESULTS: The all-over prevalence of overweight was 41.4%, and that of fatty liver was 29.5% (mild, moderate and severe fatty liver being 14.5%, 11.3%, and 3.7%,respectively); while the prevalence of ischemic changes on ECG was 17.1% in this study. The abnormal rates for conventional IHD risk factors including hypertension,dyslipidemia, hyperglycemia and overweight increased in accordance with the severity of fatty liver. Overweight and severity of fatty liver were independently associated with increased risks for developing IHD. Overweight subjects had a 1.32-fold (95%CI: 1.01-1.73) increased IHD risk. Participants with mild, moderate, and severe fatty liver had a 1.88-fold (95%CI: 1.37-2.6), 2.37-fold (95%CI: 1.66-3.37) and 2.76-fold (95%CI: 1.62-4.72)increased risk for developing IHD. The prevalence of ischemic ECG for the fatty liver-affected subjects with or without overweight was 30.1% and 19.1%, while that of overweight subjects free from fatty liver was 14.4%.Compared to the subjects without fatty liver nor overweight,IHD risk for the three subgroups above was as follows:OR: 2.95 (95%CI:2.31-4.09), OR: 1.60 (95%CI: 1.07-2.39)and OR: 1.11 (95%CI: 0.78-1.56), respectively.CONCLUSION: The presence of fatty liver and its severity should be carefully considered as independent risk factors for IHD. Results of the study suggest the synergistic effect between fatty liver and overweight for developing IHD.Abdominal sonographic examination may provide valuable information for IHD risk assessment in addition to limited report about liver status, especially for overweight males.