目的 了解颈内动脉超声联合经颅多普勒对产后抑郁症患者的检测效果,为临床产后抑制治疗提供有价值的线索。方法 收集本院于2018年3月—2020年2月收治的78例符合抑郁障碍诊断标准的产妇资料,对资料予以回顾研究,并设为研究组,同时另择选78例健康产妇为对照组,应用颈内动脉超声对两组产妇的颈动脉血流参数[颈动脉内径(D)、收缩期峰值流速(PSV)、舒张末期流速(EDV)以及阻力指数(RI)]进行检测,同时联合经颅多普勒超声(TCD)对两组产妇的左右大脑中(MCA)、脑前(ACA)及脑后(PCA)的动脉与椎基底动脉(VA-BA)血流速度进行监测,并分析两组产妇阻力指数(RI)与搏动指数(PI)变化,对以上数据统计分析并给予组间比较分析。结果 与对照组比较,研究组D、EDV水平明显下降,而RI值升高,差异有统计学意义(P＜0.05);两组产妇的PSV比较,差异无统计学意义(P＞0.05);研究组抑郁产妇的左右大脑中(MCA)、脑前(ACA)及脑后(PCA)的动脉血流速度均加快且差异均有统计学意义(P均＜0.05);研究组抑郁产妇的椎基底动脉(VA-BA)血流速度与对照组比较减慢,差异有统计学意义(P＜0.05);研究组抑郁产妇的阻力指数(RI)与搏动指数(PI)值与对照组比较,差异均无统计学意义(P＞0.05);78例抑郁产妇中,62例呈现脑动脉血流异常。检测异常率为79.49%(62/78)。结论 经颅多普勒检测,可见产后抑郁产妇的3条脑动脉血流速度明显加快,而椎基底动脉血流减缓,由此提示抑郁产妇脑动脉痉挛且脑供血明显不足,颈内动脉超声显示抑郁产妇的颈动脉血流参数有一定变化,能够为产后抑郁患者的治疗提供一定参考。

Objective To understand the detection effect of internal carotid artery ultrasound combined with transcranial Doppler on patients with postpartum depression, and to provide valuable clues for clinical postpartum depression treatment. Methods The data of 78 parturients who met the diagnostic criteria for depression in our hospital from March 2018 to February 2020 were collected. The data were reviewed and set as the study group. At the same time, 78 healthy parturients were selected as the control group.We used internal carotid artery ultrasound to detect the carotid blood flow parameters [carotid artery diameter (D), peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI)] of the two groups of parturients, and combined transcranial color Doppler ultrasound (TCD) to monitor the blood flow velocity of the arteries and vertebrobasilar artery (VA-BA), middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA) of the two groups of women. The changes in maternal RI and PI between the two groups were analyzed, and the above data were statistically analyzed and compared between groups. Results Compared with the control group, the D and EDV levels of the study group were decreased, while the RI value was increased, the difference was statistically significant (P<0.05). The comparison of PSV between the two groups was not statistically significant (P>0.05). The arterial blood flow velocity in MCA, ACA, and PCA of the depressed women in the study group were accelerated and the differences were statistically significant (P<0.05). The blood flow velocity of VA-BA of the depressed women in the study group was slower than that of the control group, and the difference was statistically significant (P＜0.05). RI and PI values of depressed women in the study group were compared with those of the control group. There was no statistically significant difference between the groups (P>0.05). Among 78 depressed women, 62 had abnormal cerebral artery blood flow. The abnormal detection rate was 79.49% (62/78). Conclusion Transcranial Doppler examination showed that the blood flow of the three cerebral arteries of the postpartum depressed women was increased, while the blood flow of the vertebrobasilar arteries slowed down, which indicated that the depressed women had cerebral artery spasm and the cerebral blood supply was obviously insufficient. The internal carotid artery ultrasound showed there were certain changes in carotid blood flow parameters of depressed mothers, which can provide a certain reference for the treatment of patients with postpartum depression.

目的 探讨基于单个最大层面(2D)及体积(3D)感兴趣区(ROI)的ADC直方图参数在区分肺良性及恶性孤立性实性病灶的价值。方法 本回顾性研究共纳入69例肺部孤立性实性病变患者,其中恶性56例,良性13例。所有患者术前均采用MRI、DWI(b=600 mm/s²)检查,使用OK软件获取病灶最大截面面积(2D)及体积(3D)ADC直方图特征参数值。运用ROC曲线比较两种测量方法的鉴别效能。结果 2D、3D直方图大部分参数在肺良恶性病变组间差异具有统计学意义(P＜0.05),其中以ADC 50分位数(50^th)、75分位数(75^th)、90分位数(90^th)为著(P＜0.001)。2D直方图中的ADC 75^th 及3D直方图中的ADC 50^th有较好诊断效能(AUC分别为0.891、0.894)。当3D ADC 50^th取1.41×10^-3 mm²/s时,诊断的准确性最高,敏感度为80.00%,特异度为92.86%。ADC 最大值(maximum)、ADC 25分位数(25^th)及峰度组间差异无统计学意义(P＞0.05)。结论 2D及3D ADC直方图在肺部病变鉴别有一定价值,其中以3D直方图的ADC 50^th最佳。

Objective To investigate the value of ADC histogram parameters measured by 2D and 3D ROI in distinguishing benign and malignant solitary solid pulmonary lesions (SPL). Methods A total of 69 patients with SPL were included in this retrospective study, including 56 patients with malignant disease and 13 patients with benign disease. All patients underwent preoperative MRI and DWI (b=600 mm/s²) examinations. The ADC histogram parameters of the lesion from 2D and 3D ROI were obtained by OK software. ROC curve was used to compare the discriminative efficacy of these two methods. Results Most parameters of 2D and 3D histogram showed a statistically significant difference between benign and malignant pulmonary lesions (P<0.05), especially ADC 50 quantiles (50^th), 75 quantiles (75^th) and 90 quantiles (90^th) (P<0.001). The ADC 75^th in 2D histogram and ADC 50^th in 3D histogram had better diagnostic efficiency (AUC were 0.891 and 0.894, respectively). When the ADC 50^th of 3D histogram was 1.41×10^-3 mm²/s, the accuracy of diagnosis was the highest, with a sensitivity of 80.00% and a specificity of 92.86%. There were no significant differences in ADC maximum, 25^th and kurtosis among groups (P>0.05). Conclusion Both 2D and 3D ADC histograms had a certain value in the diagnosis of SPL, and ADC 50^th of 3D histogram showed the best efficacy.

目的 观察右美托咪定作为佐剂对罗哌卡因在锁骨上入路臂丛神经阻滞效果的影响。方法 将55例上肢择期手术的受试者随机分为右美组和对照组。右美组:30 μg右美托咪定(0.3 mL)＋0.5%罗哌卡因,对照组:生理盐水(0.3 mL)＋0.5%罗哌卡因。在臂丛神经阻滞操作后,按步骤评估和记录臂丛感觉、运动阻滞程度和起效时间。在术中定期监测和记录生命体征、不良事件的发生。手术后评估和记录术毕24小时生命体征、术后镇痛时间、臂丛神经感觉、运动阻滞的持续时间、术后恶心呕吐评分、补救镇痛药物用量和不良事件等数据。结果 在臂丛神经的感觉和运动起效时间、感觉和运动阻滞持续时间、术后镇痛时间方面,右美组长于对照组,存在统计学差异(P<0.05)。两组间在术后生命体征变化、补救镇痛药物用量、术后恶心呕吐评分、不良事件等数据的比较,未见明显统计学差异(P>0.05)。结论 右美托咪定(30 μg)作为佐剂能加快罗哌卡因在锁骨上入路对臂丛神经阻滞的起效时间,增加其术后镇痛时间和对臂丛神经的感觉、运动阻滞时间,同时较少影响患者生命体征,具备一定的有效性和临床安全性。

Objective To observed the effect of dexmedetomidine as an adjunction with ropivacaine in supraclavicularbrachial plexus block. Methods 55 subjects with elective upper extremity operation were randomly divided into two groups: DEX group and control group. The drugs in DEX group was 30 μg dexmedetomidine (0.3 mL) + 0.5% ropivacaine, 20 mL in total. And the one in control group was normal saline (0.3 mL) +0.5% ropivacaine, 20 mL in total. After the operation of brachial plexus block, the value of sensory and motor block of brachial plexus and the onset time were evaluated and recorded according to the protocol. Vital signs and adverse events were monitored and recorded regularly during the operation.Postoperative vital signs, postoperative analgesia time, duration of brachial plexus sensationsensory and motion block, postoperative nausea and vomiting score, dosage of remedial analgesics and adverse events were assessed and recorded in 24 hours after surgery. Results In terms of sensory and motor onset time of brachial plexus, duration of sensory and motor block and postoperative analgesia, DEX group was longer than the control group, with statistical differences (P<0.05).There were no significant statistical differences between the two groups in postoperative vital signs, the amount of remedial analgesic drugs, postoperative nausea and vomiting scores, adverse events etc(P>0.05). Conclusion As an adjuvant, dexmedetomidine (30 μg) can accelerate the onset time of ropivacaine in the supraclavicular approach of brachial plexus block.It can also increase the postoperative analgesia time and sensory and motor block time of brachial plexus.With less impact on the vital signs of patients, the efficacy and clinical safety of dexmedetomidinecan be found in our study.

目的 探讨miR-148a对大鼠急性胰腺炎细胞模型中细胞自噬的影响。方法 选取培养AR42J细胞,细胞分为4组,即正常对照组、模型组、miR-148a mimics组及miR-148a阴性对照组。利用Lipofectamine 2000转染miR-148a mimics及阴性对照miR-148a至AR42J细胞,继续培养48 h后,利用浓度为200 μmol的牛磺胆酸钠盐(TLCs)刺激以上两组及模型组AR42J细胞20 min,正常对照组不做处理,然后提取各组细胞蛋白及RNA。利用RT-qPCR检测各组细胞中miR-148a的表达;利用CCK8实验检测各组细胞的活性;利用ELISA法检测各组细胞培养液中炎性因子IL-6,IL-1β及TNF-α的含量;利用Western blot检测自噬相关的基因Beclin1、LC3Ⅰ、 LC3Ⅱ的表达。结果 RT-qPCR结果显示,与正常对照组相比较,模型组心肌细胞中miR-148a mRNA的表达降低,而miR-148a mimics组细胞中miR-148a mRNA的表达显著升高;CCK-8实验结果显示,转染miR-148a mimics至细胞后,可提高模型细胞的活性;ELISA实验结果显示,与模型组相比较,转染miR-148a mimics至细胞后,细胞培养液中炎性因子IL-6,IL-1β及TNF-α的含量显著降低;Western blot结果显示,与模型组相比较,转染miR-148a mimics至细胞后,可降低细胞中Beclin1的表达,降低LC3Ⅱ/LC3Ⅰ的比率。结论 利用miR-148a mimics提高TLCs刺激的细胞模型中的miR-148a表达后,细胞中Beclin1的表达降低,LC3Ⅱ/LC3Ⅰ的比率降低,抑制了细胞自噬,降低了炎性因子IL-6、IL-1β、TNF-α的释放,从而提高了细胞的活性,miR-148a可通过调节模型细胞的自噬而发挥细胞保护作用。

Objective To investigate the effect of miR-148a on autophagy in rat acute pancreatitis cell model. Methods AR42J cells were cultured and divided into 4 groups: normal control group, model group, miR-148a mimics group and miR-148a negative control group. miR-148a mimics and miR-148a negative control were transfected to AR42J cells with Lipofectamine 2 000, then cells were cultured for 48 h. The AR42J cells were stimulated with sodium taurocholate (TLCs) at a concentration of 200 μmol for 20 min, the normal control group was not treated, then the protein and RNA were extracted in each group. The expression of miR-148a was detected by RT-qPCR in each group. The activity of cells was detected by CCK8 assay in each group. The contents of IL-6, IL-1β and TNF-α in the cell culture medium were detected by ELISA. Western blot was used to detect the expression of autophagy related genes Beclin1, LC3Ⅰ and LC3Ⅱ. Results RT-qPCR results showed that the expression of miR-148a mRNA in model group was significantly lower than that in normal control group, while the expression of miR-148a mRNA in miR-148a mimics group was significantly higher than that in normal control group. The results of CCK-8 assay showed that miR-148a could significantly increase the activity of model cells stimulated by TLCs. The results of ELISA showed that the contents of IL-6, IL-1β and TNF-α in cell culture medium were significantly decreased after miR-148a mimics transfection, compared with the model group. Western blot showed that miR-148a mimics could significantly decrease the expression of Beclin1 and the ratio of LC3Ⅱ/LC3Ⅰ, compared with the model group. Conclusion miR-148a mimics was used to enhance the expression of miR-148a in cells model stimulated by TLCs, the expression of Beclin1 and the ratio of LC3Ⅱ/LC3Ⅰ were decreased, and the autophagy was inhibited. The release of IL-6, IL-1β and TNF-α was decreased and the activity of cells was increased. miR-148a plays a cellular protective role by regulating autophagy in model cells.

前列腺癌作为最常见的男性泌尿系统恶性肿瘤之一,目前常规治疗手段主要为手术、放化疗、内分泌治疗等,但后期并发症、治疗副作用等问题突出,且多转化为去势抵抗性前列腺癌,预后极差。既往研究已然证实,中医药在前列腺癌的治疗中可有效减少复发、减轻症状,提高患者生活质量。本文旨在总结近几年中医药对前列腺癌的研究,为往后的研究与临床治疗提供一些新的思路。

Prostate cancer(PCa) is one of the most common male urinary system malignancies.At present,conventional treatment methods are mainly surgery, radiotherapy and chemotherapy, endocrine therapy,etc.However, late complications, treatment side effects and other problems are prominent, and prostate cancer tends to develop as castration-resistant prostate cancer (CRPC), and the prognosis is very poor. Previous studies have confirmed that Chinese medicine can effectively reduce recurrence incidence, relieve symptoms and improve the quality of life of patients in the treatment of prostate cancer. This article summarizes the research of traditional Chinese medicine on prostate cancer in recent years, and provides some new ideas for future research and clinical treatment.

目的 研究探讨体质指数和体脂百分比与老年类风湿关节炎患者发生肌少症的相关性。方法 纳入2018 年1月— 2020 年 6 月我院治疗的230例RA患者以及110例正常体检人员,分别设为研究组与对照组。采用双能X线骨密度仪测定骨骼肌肉量,四肢骨骼肌总量,体脂百分比(PBF),计算骨骼肌质量指数(SMI),体质指数(BMI);根据SMI水平将RA患者分为有、无肌少症组,比较两间组指标差异,采用Logistics回归分析探讨RA患者合并肌少症的独立影响因素。结果 ①RA组患者肌少症发生率高于对照组(49.1％ vs 18.2％,χ²=29.927,P＜0.001)。RA组患者消瘦百分比高于对照组(20.9％ vs 8％,χ²=5.375,P=0.020), RA组与正常对照组间BMI分组构成比比较差异有统计学意义(χ²=8.157,P=0.043)。②RA组BMI、骨骼肌量及四肢骨骼肌量均低于对照组,差异有统计学意义(P＜0.05),体脂百分比高于对照组,差异有统计学意义(P＜0.05)。③RA消瘦组肌少症发生率高于正常组(χ²=10.716,P＜0.001)、超重组(χ²=28.073,P＜0.001)和肥胖组(χ²=11.601,P＜0.001);RA消瘦组、正常组、超重组、肥胖组间肌少症发生率差异有统计学意义(χ²=32.522,P＜0.001)。PBF分组肌少症发生率正常组高于超重组,差异无统计学意义(χ²=2.609,P=0.016)。④RA肌少症组BMI消瘦百分比高于无肌少症组(22.1％ vs 3.4％,χ²=40.593,P＜0.001),BMI正常百分比高于无肌少症组(60.1％vs 51.3％,χ²=1.843,P=0.175);BMI超重百分比低于无肌少症组(15.0％ vs 39.3％,χ²=33.895,P＜0.001), BMI肥胖百分比低于无肌少症组(2.6％ vs 6.0％,χ²=1.531,P=0.216)。两组间PBF构成比比较差异无统计学意义(χ²=2.609,P=0.106)。⑤RA消瘦组患者肌少症的发生风险高于正常组(OR=7.197,95％CI:3.103～23.614,P＜0.001),超重RA患者肌少症的发生风险低于正常组(OR=0.095,95％CI:0.036～0.268,P=0.026),年龄为RA患者发生肌少症的危险因素(OR=1.096,95％CI:1.015～1.390,P＜0.001)。结论 肌少症在老年RA患者中发病率高,与体质指数具有一定相关性。

目的 分析慢性肾衰竭患者接受肾衰康方治疗对其血清微炎症状态的影响及肾功能的保护作用。方法 将2020年1月—2020年12月作为研究时间段,选取期间广东祈福医院接诊的50例慢性肾衰竭患者,另将随机数字表法作为分组依据,将全部病例分为对照组(行常规治疗,纳入25例)、观察组(加用肾衰康方治疗,纳入25例),对组间中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标展开分析。结果 组间中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标在治疗前无明显差异,P>0.05;观察组中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标在治疗后优于对照组,P<0.05。结论 肾衰康方对改善慢性肾衰竭患者血清微炎症状态、氧化应激水平、临床症状均有较好效果,且能保护肾功能,值得推广。

Objective To analyze the effect of Shenshuaikang decoction on serum microinflammation and renal function in patients with chronic renal failure. Methods From January 2020 to December 2020, 50 patients with chronic renal failure treated by Clifford Hospital were selected, and the random number table method was used for grouping. All cases were divided into control group (n=25) and observation group (n=25). The TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index were analyzed. Results There were no significant differences in TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index between the two groups before treatment, P>0.05; the TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index of the observation group were better than those of the control group after treatment, P<0.05. Conclusion Shenshuaikang decoction has good effect on improving serum microinflammation, oxidative stress level and clinical symptoms of patients with chronic renal failure, and also can protect renal function, which is worthy of promotion.

目的 探讨内镜黏膜下剥离术(ESD)治疗结直肠高级别上皮内瘤变(HGIN)的安全性及临床疗效。方法 回顾性分析2016年1月—2019年6月在南方医科大学附属小榄医院经肠镜活检诊断为结直肠HGIN并接受ESD治疗的56例患者的临床资料,记录每例病变的术后病理、整块切除率、治愈性切除率、手术并发症和随诊结果。结果 病灶平均直径为(2.28±0.76) cm。53例经ESD术完整切除,3例术中改用内镜下黏膜分片切除术切除,整块切除率为94.64％ (53/56)。术后病理51例HGIN,2例HGIN伴黏膜内癌,2例浸润性癌,术前活检与术后病理总符合率为92.86%(52/56),治愈性切除率为96.43%(54/56)。术中出血发生率为89.29%(50/56),术后迟发性出血发生率为3.57%(2/56)。术中穿孔发生率为5.36%(3/56),无术后迟发性穿孔病例。中位随访期为17个月,期间共1例患者复发。结论 ESD术治疗结直肠HGIN安全有效,但需警惕浸润性癌的可能。ESD术具有较高的术中出血和穿孔的风险,术者需具备熟练的操作技术及处理手术并发症的经验。

Objective To investigate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for colorectal high-grade intraepithelial neoplasia (HGIN). Methods Data of 29 patients diagnosed as colorectal HGIN and underwent endoscopic submucosal dissection (ESD) from January 2016 to June 2019 were retrospectively analyzed. Postoperative pathology, total en bloc resection rate, curative resection rate, complication and follow-up results were recorded. Results The mean diameter of the lesions was (2.28±0.76) cm. A total of 53 cases were successfully treated by ESD, 3 cases were changed using endoscopy piecemeal mucosal resection, the en bloc resection rate was 94.64% (53/56). Postoperative diagnosis confirmed 52 cases of HGIN, 2 cases of HGIN with intra-mucosal cancers and 2 case of invasive cancer,the overall consistency rate between preoperative biopsies and postoperative pathological diagnosis was 92.86% (52/56), the curative resection rate was 96.43% (54/56). The incidence of intro-operative bleeding and postoperative delayed bleeding was 89.29% (50/56) and 3.57% (2/56) respectively. The incidence of intro-operative perforation was 5.36% (3/56) and no delayed perforation occurred. The median follow-up period was 17 months and one case recurred. Conclusion ESD is a safe and effective treatment for colorectal HGIN, but invasive cancer must be cautioned. ESD has high risk of intro-operative bleeding and perforation, therefore, the surgeon must have skilled operation and treatment experience for complications.

目的 探讨肝硬化患者临床凝血功能检验中全自动血凝仪测定的应用及临床价值。方法 选取2018年1月—2020年1月我院收治的64例肝硬化患者(肝硬化组),并纳入同期来我院接受健康体检者64例(对照组),应用全自动血凝仪对肝硬化患者临床凝血指标检测。再将肝硬化组患者分为出血组与无出血组,比较对照组与肝硬化组、出血与无出血组、不同肝功能分级患者血小板参数与PT检测结果。结果 与对照组比较,肝硬化组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与肝硬化无出血组比较,肝硬化出血组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与Child-Pugh A级患者比较,肝硬化Child-Pugh B级与C级患者PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05)。结论 在肝硬化患者病情评价中凝血功能检验发挥重要作用,可为患者临床治疗提供有效理论依据,诊断准确率较高,有利于临床治疗措施制定。因此,凝血功能检验应在肝硬化疾病诊断中广泛应用。

Objective To explore the application and clinical value of automatic blood coagulation apparatus in clinical coagulation function test of patients with cirrhosis. Methods A total of 64 patients with cirrhosis admitted to our hospital from January 2018 to January 2020 (cirrhosis group) were selected, and 64 healthy subjects admitted to our hospital during the same period (control group) were included. The clinical coagulation indexes of patients with cirrhosis were detected by automatic blood coagulation apparatus. Patients in cirrhosis group were divided into bleeding group and non-bleeding group; platelet parameters and PT test results were compared between control group and cirrhosis group, bleeding group and non-bleeding group, and patients with different liver function grades. Results Compared with the control group, the levels of PDW, PT, MPV and INR in cirrhosis group were higher, and the levels of PCT and PLT were lower (P＜0.05). Compared with liver cirrhosis non-bleeding group, the levels of PDW, PT, MPV and INR were higher in liver cirrhosis with bleeding group, and the levels of PCT and PLT were lower (P＜0.05). Compared with Child-Pugh A patients, the levels of PDW, PT, MPV and INR in Child-Pugh B and C patients with cirrhosis were higher, and the levels of PCT and PLT were lower (P＜0.05). Conclusion The test of coagulation function plays an important role in the evaluation of patients with cirrhosis, and can provide effective theoretical basis for the clinical treatment of patients with high diagnostic accuracy, which is conducive to the formulation of clinical treatment measures. Therefore, the test of coagulation function should be widely used in the diagnosis of cirrhosis.

目的 探讨四君寿胎汤对地中海贫血孕妇贫血状况的改善效果,以期指导地中海贫血孕妇的中药治疗。方法 选择2019年5月—2020年10月期间我院诊治的200例地中海贫血孕妇,根据随机数字表法将其分为两组,观察组与对照组,各100例,观察组患者给予四君寿胎汤,1剂/d,连续治疗3个月,对照组患者给与安慰剂,1剂/d,连续治疗3个月;治疗前、治疗3个月后,比较两组血液检测指标[血红蛋白(HGB)、红细胞(RBC)、红细胞比容(HCT)、平均红细胞体积(MCV)、平均血红蛋白含量(MCH)]、中医症候积分、肝肾指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cre)、尿素(ure)、总胆汁酸(TBA)],记录两组孕妇妊娠结局、新生儿情况并比较。结果 治疗前,两组HGB、RBC、HCT、MCV、MCH比较,差异无统计学意义(P＞0.05);治疗3个月后,两组均升高,且观察组高于对照组(P＜0.05);治疗前,两组食少纳呆、体倦乏力、食后或午后腹胀、大便异常症候积分比较,差异无统计学意义(P＞0.05);治疗结束后,两组症候积分均较治疗前降低,且观察组低于对照组,差异有统计学意义(P＜0.05);治疗前后,两组ALT、AST、TBA、Cre、Ure差异无统计学意义(P＞0.05)。两组胎儿宫内窘迫、宫内生长受限发生率、产妇产后出血率比较,观察组较对照组发生率低,但差异无统计学意义(P＞0.05)。观察组早产发生率较对照组明显下降,差异有统计学意义(P＜0.05);观察组孕妇分娩孕周大于对照组,剖宫产率低于对照组,差异有统计学意义(P＜0.05);两组新生儿窒息率、转PICU率比较,差异无统计学意义(P＞0.05);观察组新生儿出生体重、HGB高于对照组(P＜0.05)。结论 四君寿胎可以改善地中海贫血孕妇的整体贫血状况,对肝肾功能无不良影响,中医证候得到改善,且有利于减少早产发生风险,降低剖宫产率,改善新生儿情况。

Objective To investigate effect of Sijun Shoutai decoction in improving anemia status of pregnant women with thalassemia, and to guide the Chinese medicine treatment of thalassemia in pregnant women in the future. Methods Two hundred pregnant women with thalassemia who were diagnosed in the hospital from May 2019 to October 2020 were divided into observation group and control group randomly, with 100 cases in each group. The observation group was treated with Sijun Shoutai decoction,1 dose/d, with continuous treatment for 3 months. The control group was given placebo,1 dose/d, with continuous treatment for 3 months. The indicators of blood test [hemoglobin (HGB), red blood cell (RBC), hematocrit value (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH)], TCM symptom scores, hepatic and renal indicators [alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cre), urea (Ure), total bile acid (TBA)] were compared between the two groups before and after treatment for 3 months. The maternal pregnancy outcome and neonatal condition in the two groups were recorded and compared. Results There were no statistical difference in the HGB, RBC, HCT, MCV and MCH between the two groups before treatment (P>0.05); after 3 months the indicators above of two groups increased, and those in observation group were higher than those in control group (P<0.05). There were no statistical differences in the symptom scores of poor appetite, fatigue, abdominal distension after eating or after noon and fecal abnormalities between the two groups before treatment (P<0.05). The levels of ALT, AST and TBA in the two groups decreased after treatment for 3 months, while the Cre and Ure increased, but the differences were not statistically significant (P>0.05). There were no statistical differences in the rates of intrauterine fetal distress, intrauterine growth restriction, and postpartum hemorrhage between the two groups (P>0.05), though the results of observation group were lower than control group.The rate of premature birth was lower than that of control group(P<0.05) ; the gestational week of observation group was more than control group, and the cesarean section rate of observation group was lower than that of control group (P<0.05). There were no statistical differences in the rates of neonatal asphyxia and transfering to PICU between the two groups (P>0.05); the neonatal birth weight and HGB in observation group were higher than those in control group (P<0.05). Conclusion Sijun Shoutai decoction in the treatment of pregnant women with thalassemia can improve anemia status, with no adverse effect on liver or kidney function, improve TCM syndrome, reduce the risk of premature birth,reduce the rate of cesarean,and improve the neonatal condition.