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狼疮性肾炎是系统性红斑狼疮最常见且最严重的并发症,也是导致终末期肾病的重要原因。王耀光教授结合临床经验认为狼疮性肾炎的核心病机为本虚标实,即以脾肾亏虚、气化不利为本,水湿、瘀血、痰浊搏结成形为标。在整个病程演变过程中,可划分为急性活动期、迁延转化期及慢性硬化衰竭期三个阶段。各期病机侧重点不同,治疗时应遵循分期辨治、动态调整的原则:急性活动期以清热解毒,凉血散结为主;迁延转化期注重健脾益肾,活血利湿;慢性硬化衰竭期则强调温肾化气,削癥通络削坚散结、通络,并适时选用虫类药以增强通络化瘀之效,以期达到控制疾病活动、减少复发、延缓疾病进展的目的。本文总结并体现了本文中医药在狼疮性肾炎治疗中的优势,为临床提供了一套较为完整的诊疗思路。
Lupus nephritis(LN)is the most common and serious complication of systemic lupus erythematosus(SLE)and a significant cause of end-stage renal disease.Based on his extensive clinical experience,Professor Wang Yaoguang proposes that the core pathogenesis of LN is characterized by a deficiency-root and excess-manifestation pattern.This manifests as spleen and kidney deficiency with impaired qi transformation as the root deficiency,while the combination of water-dampness,blood stasis,and phlegm-turbidity coalescing constitutes the manifest excess.The disease progression can be divided into three stages:the acute active phase,the protracted transformation phase,and the chronic sclerosing and failure phase.The pathological focus differs at each stage,necessitating stage-differentiated pattern identification and treatment and dynamic therapeutic adjustments.During the acute active phase,the treatment principle focuses primarily on clearing heat and resolving toxicity,and cooling blood to disperse nodules.The protracted transformation phase emphasizes fortifying the spleen and tonifying the kidney,combined with activating blood and draining dampness.In the chronic sclerosing and failure phase,the strategy shifts to warming the kidney,transforming qi and softening hardness,dispersing nodules,and unblocking collaterals;the timely application of insect drugs is also adopted to enhance the effect of unblocking collaterals and transforming stasis.This approach aims to control disease activity,reduce relapse,and delay progression.This approach highlights the advantages of traditional Chinese medicine in managing LN and providing a relatively comprehensive diagnostic and therapeutic framework for clinical practice.
目的 合并肺纤维化的慢性阻塞性肺疾病(COPD)是COPD的特殊亚型,患者兼具气流受限与肺组织纤维化病理特征,临床症状更严重、肺功能下降更快,且现有单一治疗方案难以同时改善气流受限与纤维化进展,预后较差。基于此,本研究旨在分析尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD患者的效果及对肺功能的影响,为优化临床治疗方案提供依据。方法 选取2022年3月—2024年12月收治的96例合并肺纤维化的COPD患者,采用前瞻性随机对照研究设计,应用随机数字表法分为试验组与对照组。所有患者均采取常规治疗,对照组48例采取尼达尼布治疗,试验组采取尼达尼布联合格隆溴铵治疗。两组均治疗24周后,比较治疗前后症状评分、肺功能、纤维化指标、炎症指标,并分析两组治疗安全性。结果 治疗后,两组CAT评分、mMRC评分及VAS降低(P<0.05);且与对照组比较,试验组CAT评分、mMRC评分及咳嗽VAS评分较低(P<0.05)。治疗后,两组FVC、FEV1、DLCO及FEV1/FVC比值均较治疗前改善(P<0.05);且与对照组比较,试验组FVC、FEV1、DLCO及FEV1/FVC比值较优(P<0.05)。治疗后,两组血清KL-6、SP-D水平及CT纤维化评分均降低(P<0.05);且与对照组比较,试验组血清KL-6、SP-D水平及CT纤维化评分较低(P<0.05)。治疗后,两组血清IL-6、TNF-α及TGF-β1水平降低(P<0.05);且与对照组比较,试验组血清IL-6、TNF-α及TGF-β1水平较低(P<0.05)。试验组总不良反应发生率为8.33%(4/48),对照组为10.42%(5/48),两组比较差异无统计学意义(P>0.05)。结论 尼达尼布联合格隆溴铵治疗合并肺纤维化的COPD效果良好,可减轻患者临床症状,改善肺功能与肺纤维化,降低机体炎症反应,安全性较高。
Objective To analyze the effects of the combination of nintedanib and glycopyrrolate in treating chronic obstructive pulmonary disease(COPD)patients with associated pulmonary fibrosis and its impact on lung function,providing a basis for optimizing clinical treatment strategies.Methods Ninety-six COPD patients with pulmonary fibrosis admitted from March 2022 to December 2024 were selected,and divided into experimental group and control group using a random number table method.Using a prospective randomized controlled study design,all patients received conventional treatment,with 48 cases in the control group receiving treatment with nintedanib and the experimental group receiving treatment with nintedanib combined with glycopyrrolate bromide.After 24 weeks of treatment in both groups,the symptom scores,lung function,fibrosis indicators,and inflammation indicators were compared before and post-treatment,and the drug safety of the two groups was analyzed.Results Post-treatment,CAT score,mMRC score and VAS decreased in both groups(P<0.05).Compared with the control group,CAT score,mMRC score and cough VAS score were lower in the experimental group(P<0.05).Post-treatment,FVC,FEV1,DLCO and FEV1/FVC ratio of both groups improved compared with that before treatment(P<0.05).Compared with the control group,FVC,FEV1,DLCO and FEV1/FVC ratio of the experimental group were better(P<0.05).Post-treatment,serum KL-6,SP-D levels and CT fibrosis scores of both groups decreased(P<0.05).Compared with the control group,serum KL-6,SP-D levels and CT fibrosis scores of the experimental group were lower(P<0.05).Post-treatment,serum IL-6,TNF-α and TGF-β1 levels in both groups decreased(P<0.05).Compared with the control group,serum IL-6,TNF-α and TGF-β1 levels in the experimental group were lower(P<0.05).The incidence of total adverse reactions in the experimental group was 8.33%(4/48),and that in the control group was 10.42%(5/48).There was no difference between the two groups(P>0.05).Conclusions The combination of nintedanib and glycopyrrolate has a significant effect on the treatment of COPD complicated with pulmonary fibrosis,which can alleviate its clinical symptoms,improve lung function and pulmonary fibrosis,reduce the body’s inflammatory response,which is relatively safe.
目的 探究单髁膝关节置换(UKA)联合注射布比卡因脂质体治疗老年孤立性内侧间室骨关节炎(OA)的效果,并分析其对患者术后长效镇痛的作用。方法 前瞻性选取2023年11月—2025年11月期间收治的80例老年孤立性内侧间室OA患者,分为对照组与研究组,各40例。两组患者均接受UKA手术治疗,研究组在术中于相同部位注射布比卡因脂质体,对照组于术中关节周围注射等体积的生理盐水混合物。比较两组术后疼痛强度,镇痛药物消耗与需求,早期膝关节功能恢复情况、早期膝关节功能,以及两组不良反应发生率。结果 研究组术后6 h、12 h、24 h及48 h VAS评分均低于对照组,术后48 h内,研究组中重度疼痛发生率较对照组低(P<0.05);研究组术后首次请求镇痛的时间晚于对照组,48 h内曲马多总消耗量及补救镇痛需求率均较对照组低(P<0.05);研究组在术后24 h、48 h、72 h的膝关节主动活动度较对照组大,研究组首次直腿抬高时间、术后下地行走时间及住院时间均较对照组短(P<0.05);术前两组膝关节协会评分(KSS)和牛津膝关节评分(OKS)评分无差异(P>0.05)。术后1周,两组评分均改善,且研究组优于对照组(P<0.05);两组不良反应发生率无差异(P>0.05)。结论 UKA术中联合应用布比卡因脂质体,能安全、有效地为老年孤立性内侧间室OA患者提供长效术后镇痛。且该方案不仅能显著减轻患者早期疼痛、减少阿片类药物依赖,更能有效促进膝关节早期功能恢复、缩短住院时间,并为患者获得更优的早膝关节功能奠定基础。
Objective To investigate the efficacy of unicompartmental knee arthroplasty(UKA) combined with injection of bupivacaine liposomes in the treatment of elderly isolated medial compartment osteoarthritis(OA),and analyze its long-term analgesic effect on patients after surgery.Methods A prospective study was conducted on 80 elderly patients with isolated medial compartment OA admitted between November 2023 and November 2025.They were divided into a control group and a study group,with 40 patients in each group.Both groups of patients received UKA treatment.The study group received injection of bupivacaine liposomes at the same site during surgery,while the control group received injection of an equal volume of physiological saline mixture around the joints during surgery.Postoperative pain intensity,analgesic drug consumption and demand,early knee joint function recovery,early knee joint function were compared between two groups,and the incidence of adverse reactions was compared between the two groups.Results The study group had lower VAS scores at 6 h,12 h,24 h,and 48 h postoperatively compared to the control group.Within 48 hours after surgery,the incidence of moderate to severe pain in the study group was lower than that in the control group(P<0.05).The time to first postoperative analgesic request in the study group was later than that in the control group,and the total tramadol consumption and the need for analgesia within 48 hours were lower(P<0.05).The active range of motion of the knee at 24 h,48 h,and 72 h postoperatively was greater in the study group compared to the control group.Additionally,the time to first straight leg raise,time to ambulation,and length of hospital stay were all shorter in the study group(P<0.05).Preoperatively,there were no differences between the two groups in the Knee Society Score(KSS) and the Oxford Knee Score(OKS)(P>0.05).One week postoperatively,both groups showed improved scores,with the study group showing greater improvement than the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions The combined use of bupivacaine liposomes during UKA can provide safe and effective long-term postoperative analgesia for elderly patients with isolated medial compartment OA.And this plan not only reduces early pain and opioid dependence in patients,but also effectively promotes early knee joint function recovery,shortens hospitalization time,and lays a solid foundation for patients to achieve better early knee joint function.
糖尿病肾病(DKD)是糖尿病首要的微血管并发症,亦是终末期肾病的主要病因,其进行性发展已严重威胁患者生活质量及生存结局。大量蛋白尿是糖尿病肾病的主要临床表现,西医治疗依赖抗炎药、糖皮质激素等,但副作用显著,亟需更安全有效的干预策略。基于《灵枢·阴阳清浊》中的 “清浊相干,命曰乱气”理论,提出DKD蛋白尿的核心病机为浊邪内生、清浊逆乱,从“肺激浊源”致邪气外侵,浊源始生;“脾酿浊邪”致湿邪内蕴,脂浊周流;“肾虚浊陷”致瘀浊损络,封藏失职三个方面阐述DKD的病机,确立“宣肺调水御浊”、“运脾转枢除浊”、“益肾守络绝浊”的治法,凸显中医药调节清浊、保护肾功能的优势,以期为DKD蛋白尿的中西医结合诊疗提供新的思路与方法。
Diabetic kidney disease(DKD) is a primary microvascular complication of diabetes and a leading cause of end-stage kidney disease.Its progressive development seriously threatens patients’ quality of life and survival outcomes.Massive proteinuria is the main clinical manifestation of DKD.Western medicine treatments rely on anti-inflammatory drugs,glucocorticoids,etc.,but they have significant side effects,highlighting the urgent need for safer and more effective intervention strategies.Based on the theory of “mutual interference of clear and turbid qi” mentioned in Ling Shu:Yin-Yang and Purity-Turbidity,the core pathogenesis of DKD proteinuria is proposed as the internal generation of turbid pathogens and the disordered reversal of clear and turbid.It is elaborated through three aspects:“lung activating turbid sources”,which leads to the external invasion of pathogenic qi and the initial generation of turbid sources;“spleen brewing turbid evil”,which results in internal retention of damp-evil and the circulation of greasy turbid factors;and “kidney deficiency causing turbid stagnation”,which leads to turbidity-induced stasis damaging the collaterals and impairment of storage function.Correspondingly,the treatment principles are established as “disseminate the lung and regulate water to control turbidity”,“transport the spleen to transform and remove turbidity” and “benefit the kidney and protect the collaterals to eliminate turbidity”.This highlights the advantages of traditional Chinese medicine in regulating clear and turbid qi and protecting kidney function,aiming to provide new ideas and methods for the integrated Chinese and Western diagnosis and treatment of DKD proteinuria.
作为胃肠道的常见疾病,慢传输型便秘近年来患病率逐年上升。关于该病的具体病因和病理机制目前仍未完全明确,部分患者保守治疗效果欠佳,症状难以彻底缓解。随着病程的延长,患者的生活质量受到显著影响。若长期治疗无效,还可能诱发胃肠道肿瘤、心脑血管疾病等疾病,进一步加重患者的经济与心理负担。在此背景下,外科手术为慢传输型便秘缓解症状提供了新的选择。多数就诊于外科门诊的患者已有数年的便秘病史,曾尝试口服泻药、开塞露刺激或灌肠等常规治疗,但效果均不理想,最终转向手术干预。目前的标准术式以全结肠切除或次全结肠切除为主。近年来,次全结肠切除联合盲乙状结肠吻合术的应用取得了良好疗效,而针对混合型便秘设计的金陵术式也展现出独特的优势。文章通过系统梳理近年来的相关文献,从病因学、发病机制、诊断方法、治疗现状及手术疗效等方面,对慢传输型便秘进行了全面阐述,旨在增进对该疾病的深入理解,从而为临床诊疗策略提供新的理论思路。
As a prevalent gastrointestinal disorder,slow transit constipation(STC) has demonstrated a steadily increasing incidence in recent years.The precise etiology and underlying pathological mechanisms of STC remain incompletely elucidated,with conservative management often proving inadequate for achieving complete symptom resolution in a subset of patients.Chronic disease progression significantly compromises patients’ quality of life,and prolonged ineffective treatment may predispose individuals to serious complications including gastrointestinal neoplasms and cardiovascular disorders,thereby imposing substantial economic and psychological burdens.Within this clinical context,surgical intervention has emerged as a viable therapeutic alternative for refractory STC.The majority of surgical candidates typically present with a multi-year history of constipation refractory to conventional therapies such as oral laxatives,rectal stimulants,and enema administration.Current standard surgical approaches predominantly involve total or subtotal colectomy.Notably,subtotal colectomy with cecosigmoid anastomosis has demonstrated particularly favorable outcomes in recent clinical practice,while the Jinling procedure,a novel surgical technique specifically designed for mixed-type constipation,has shown distinctive therapeutic advantages.This comprehensive review systematically evaluates contemporary literature to provide an integrated perspective on STC,encompassing its etiological factors,pathogenic mechanisms,diagnostic modalities,current treatment paradigms,and surgical outcomes.Through this scholarly synthesis,we aim to deepen the clinical understanding of this condition and propose innovative theoretical frameworks to inform future therapeutic strategies.
淋证是临床常见病证,病情易迁延、反复,现代医学以抗生素治疗为主,但面临耐药与易复发等困境,严重影响患者生活质量。中医认为,其核心病机在于“大气失转,枢机不利”,导致三焦水道壅滞,肾与膀胱气化功能失常,病位虽在下焦,实则与肺、肝、胆、心、脾、肾等多脏腑功能密切相关。治疗应以“疏利少阳,运转大气”为基本治则,以小柴胡汤为基础方和解枢机,并随证配伍清热利湿、温肾化气、健脾固本等法,旨在恢复三焦气化与水液代谢功能,以达到“大气复转,水道自通”之效。该治法体现了中医从整体出发、标本兼治的辨证思想,为淋证的临床诊治提供参考。
Strangury is a common clinical disease characterized by its persistent and recurrent course.Modern medicine primarily employs antibiotic therapy,yet challenges such as drug resistance and high recurrence rates remain,significantly affecting patients’ quality of life.In traditional Chinese medicine(TCM),its core pathogenesis involves “impaired movement of the Great Qi and obstruction of the pivotal mechanism”,which leads to stagnation of the Sanjiao water passages and dysfunction of qi transformation in the kidney and bladder.Although the disease is located in the lower Jiao,it is closely related to dysfunction of multiple organs,including the lung,liver,gallbladder,heart,spleen,and kidney.The treatment should follow the principle of “soothing and promoting Shaoyang,circulating Great Qi.” Xiaochaihu Decoction is used as the basic formula to harmonize the pivot mechanism,supplemented with therapies such as clearing heat and draining dampness,warming the kidney to promote qi transformation,and strengthening the spleen to consolidate the root,based on syndrome differentiation.This aims to restore the qi transformation function of the Sanjiao and water metabolism,thereby achieving the therapeutic goal of “restoring the movement of Great Qi and freeing the water passages.” This approach reflects TCM’s holistic concept and its dialectical thinking of addressing both root and branch,providing a reference for the clinical diagnosis and treatment of strangury.
目的 分析对肺癌化学治疗(化疗)患者采取个性化营养干预联合分级步行运动方案的应用价值。方法 将郑州大学附属郑州中心医院2023年7月—2024年7月符合标准的198例肺癌化疗患者作为研究对象,通过随机数字表法分为观察组和对照组各99例。对照组仅采用个性化营养干预方案,观察组则联合分级步行运动方案,两组患者均在同一时间内入组并接受持续干预3个月。对两组干预前后癌因性疲乏[Piper疲乏修订量表(PFS-R)]、营养状况、睡眠质量[匹茨堡睡眠质量指数(PSQI)]、生活质量[生活质量评估量表(SF-36)]水平予以比较。结果 相较于对照组,干预后观察组PFS-R、PSQI评分较低,白蛋白、前白蛋白、血红蛋白、铁转蛋白水平和SF-36评分较高(P<0.05)。结论 对肺癌化疗患者采取个性化营养干预联合分级步行运动方案,有利于促进其癌因性疲乏的减轻和营养状态、睡眠质量及生活质量水平的提高。
Objective To analyze the effects of personalized nutritional intervention combined with graded walking exercise treatment on cancer-related fatigue and quality of life in lung cancer patients during chemotherapy.Methods A total of 198 lung cancer patients undergoing chemotherapy who met the criteria in our hospital from July 2023 to July 2024 were selected as the research subjects.They were divided into an observation group and a control group,with 99 cases in each group,by the random number table method.The control group only received individualized nutritional intervention,while the observation group received graded walking exercise additionally.Both groups of patients were enrolled at the same time and received continuous intervention for three months.Cancer-related fatigue(Piper’s Fatigue Scale-Revised[PFS-R]),nutritional status,sleep quality(Pittsburgh Sleep Quality Index[PSQI]),and quality of life(Quality of Life Scale[SF-36]) before and after the intervention were compared between the two groups.Results Compared with the control group,the observation group had lower PFS-R and PSQI scores and higher albumin,prealbumin,hemoglobin,transferrin levels and SF-36 scores after the intervention(P<0.05).Conclusions Adopting personalized nutritional intervention combined with graded walking exercise for lung cancer patients during chemotherapy is beneficial to promote the reduction of cancer-caused fatigue and the improvement of their nutritional status,sleep quality and quality of life.
目的 探讨放血疗法对小儿发热的疗效。方法 检索包括中国生物医学文献数据库(CBM)、CNKI、万方、维普、PubMed、Embase、Web of Science、Cochrane Library等8个中、英文数据库自建库至2025年5月所发表的放血疗法治疗小儿发热的随机对照试验研究(RCT),2名研究人员根据Cochrane系统评价手册(5.1.0版)推荐的偏倚风险评估表对所纳入文献进行质量评估,采用RevMan 5.4软件对纳入文献质量进行系统分析。结果 纳入19项RCT,共2 224例患儿,其中观察组1 118例、对照组1 106例。放血疗法能够提高小儿发热的临床疗效[OR=4.18,95% CI(3.00,5.38),P<0.001];降低患儿24 h内高热复发率[OR=0.12,95% CI(0.05,0.34),P<0.001];缩短平均退热时间[MD=-1.78,95% CI(-2.56,-1.00),P<0.001]。结论 放血疗法能够提高小儿发热的临床疗效,降低复发率,缩短退热时间,可作为小儿发热的辅助治疗方法。
Objective To explore the efficacy of bloodletting therapy treatment on pediatric fever by meta-analysis.Methods The randomised controlled trials(RCTs)examining bloodletting therapy for paediatric fever were retrieved from eight Chinese and English databases—China Biomedical Literature Database(CBM),CNKI,Wanfang,VIP,PubMed,Embase,Web of Science,and Cochrane Library—covering publications from the establishment of each database up to May 2025.Two researchers assessed study quality using the risk of bias assessment tool recommended in the Cochrane Handbook for Systematic Reviews(version 5.1.0).RevMan 5.4 software was employed for systematic analysis of included studies.Results Nineteen RCTs involving 2 224 patients were ultimately included,comprising 1 118 patients in the observation group and 1 106 in the control group.Results indicated that bloodletting therapy significantly improved clinical efficacy in paediatric fever(OR=4.18,95% CI[3.00,5.38],P<0.001),reduced the recurrence rate of high fever within 24 hours(OR=0.12,95% CI[0.05,0.34],P<0.001),and shortened the average time to fever resolution(MD=-1.78,95% CI[-2.56,-1.00],P<0.001).Conclusions Bloodletting therapy can improve the clinical efficacy of pediatric fever,reduce the recurrence rate and shorten the time of fever reduction,and can be used as an adjunctive treatment for pediatric fever.
目的 观察超声引导下针刺蝶腭神经节治疗过敏性鼻炎的临床疗效。方法 将80例过敏性鼻炎患者随机分成干预组(40例)和对照组(40例),干预组采用超声引导针刺蝶腭神经节,对照组采用常规方法针刺蝶腭穴,每周2次,持续4周。结果 治疗4周后,干预组和对照组均显示出良好疗效。干预组的总有效率为92.50%,对照组的总有效率为82.50%,差异有统计学意义(P<0.05);干预组在鼻症状总分(TNSS)、非鼻症状总分(TNNSS)、视觉模拟量表(VAS)和鼻结膜炎生活质量问卷(RQLQ)等指标上的改善均优于对照组(P<0.05)。结论 超声引导下针刺蝶腭神经节治疗过敏性鼻炎能有效改善患者的临床症状。
Objective To investigate the main clinical effect of acupuncture of pterygopalatine ganglion on patients with allergic rhinitis under the guidance of ultrasound.Methods A total of 80 patients with allergic rhinitis were randomly divided into intervention group and control group.The intervention group was treated with ultrasound guided acupuncture of the sphenopalatineganglion,the control group was treated with conventional acupuncture at sphenopalatine point.The clinical efficacy was determined after the course of treatment.Results The total effective rate was 92.50% in the intervention group and 82.50% in the control group.The improvement of total nasal symptom score,total non-nasal symptom score,VAS and Arhinoconjunctivitis Quality of Life Questionnaire scores in the treatment group was significantly better the control group Conclusions Ultrasound-guided acupuncture of the sphenopalatine ganglion can improves clinical symptoms of patients with allergic rhinitis.
目的 观察桂枝加芍药汤个体化干预治疗儿童功能性腹痛的临床疗效。方法 选取2023年100名在广东省妇幼保健院门急诊就诊确诊为儿童功能性腹痛患儿。100名儿童随机分为两组,益生菌组50名、益生菌+中药个体化干预组50名。连续治疗1周。记录两组患儿卧立位心率、卧立位血压、Rutter 儿童行为量表和中医临床症状的改善情况。结果 益生菌+中药个体化干预组患儿治疗后卧立位心率和Rutter儿童行为量表中N行为评分比益生菌组下降,中医临床症状评分的有效率优于益生菌组。结论 桂枝加芍药汤个性化干预治疗儿童功能性腹痛疗效显著。
Objective To observe the clinical efficacy of individualized intervention with Guizhi plus Shaoyao Decoction in children with functional abdominal pain disorders(FAPDs).Methods A total of 100 children diagnosed with FAPDs at the outpatient and emergency departments of Guangdong Women and Children Hospital were selected.These children were randomly divided into two groups:the probiotics group(50 cases)and the probiotics+traditional Chinese medicine individualized intervention group(50 cases).Both groups received continuous treatment for 1 week.Parameters including supine/upright heart rates,supine/upright blood pressure,Rutter Children’s Behavior Questionnaire,and improvements in traditional Chinese clinical symptom scores were recorded.Results The probiotics+traditional Chinese medicine individualized intervention group exhibited significantly greater reductions in supine/upright heart rates and N-behavior scores compared to the probiotics group.The effective rate of Chinese clinical symptom scores was also significantly higher in the individualized intervention group.Conclusions Individualized intervention of Guizhi plus Shaoyao Decoction has a remarkable efficacy in treating FAPDs in children.