Recovery of Adrenocortical Function during Long-term Treatment with Corticosteroids

The recovery of adrenocortical function during very slow withdrawal of corticosteroids was studied in a homogeneous group of patients suffering from sarcoidosis. All patients had been treated with gradually decreasing doses of prednisone for at least two years. The initial dose had been 40 mg. daily in all cases. Determination of the cortisol production rate and of plasma fluorogenic corticosteroids was done under basal conditions and after tetracosactrin stimulation. There was good correlation between cortisol production rate and plasma fluorogenic corticosteroids throughout all the tests. Cortisol production rate and plasma fluorogenic corticosteroids started to rise when the dosage of prednisone was lowered to 7·5 mg. daily and reached normal values when the dosage was reduced to 2·5 mg. The response to tetracosactrin began to increase at the same dosage level, but was not normal at 2·5 mg., or when prednisone treatment was stopped. At a dosage level of 7·5 mg. of prednisone plasma fluorogenic corticosteroids already showed a nyctohemeral rhythm.It may be calculated that even very low dosages of prednisone given during the last stage of a treatment schedule enhance total corticosteroid activity beyond the normal level, which would account for their therapeutic value.     

The Circulating Treg/Th17 Cell Ratio Is Correlated with Relapse and Treatment Response in Pulmonary Sarcoidosis Patients after Corticosteroid Withdrawal

Objectives

Pulmonary sarcoidosis is an immune-mediated disease, and some patients can be effectively treated with corticosteroids. However, nearly half of all sarcoidosis patients relapse after corticosteroid withdrawal. Different subsets of CD4+ helper T cells participate in the immunopathogenesis of sarcoidosis. Thus, the aims of our study were to investigate whether the circulating subsets of CD4+ helper T cells were associated with sarcoidosis relapse and with its remission after retreatment. Additionally, we identified a useful biomarker for predicting the relapse and remission of sarcoidosis patients.

Methods

Forty-two patients were enrolled in the present study who had previously been diagnosed with pulmonary sarcoidosis and treated with corticosteroids. The patients were allocated into either a stable group if they exhibited sustained remission (n = 22) or a relapse group if they experienced clinical or radiological recurrence after treatment withdrawal (n = 20). Peripheral blood cells were collected from these patients and analyzed to determine the frequencies of subsets of circulating CD4+ helper T cells by flow cytometry. The patients in the relapse group were retreated with corticosteroids and immunosuppressive agents and were then reevaluated to determine the frequencies of dynamic subsets of circulating CD4+ helper T cells after remission.

Results

The frequencies of circulating Tregs were significantly increased concomitant with a decrease in the circulating Th17 cell frequency in the relapsed patients compared with the stable patients. The Treg/Th17 ratio was negatively correlated with sarcoidosis activity and was sensitive to retreatment. In addition, the percentage of isolated CD45RO+Ki67+ Tregs was higher in the patients who were stable and in those who recovered after retreatment than in those who relapsed.

Conclusions

An imbalance between Tregs and Th17 cells is associated with pulmonary sarcoidosis relapse after corticosteroid withdrawal. The circulating Treg/Th17 ratio could serve as an alternative marker for monitoring pulmonary sarcoidosis relapse after the end of corticosteroid treatment and for rapidly predicting the response to retreatment.     

Beta-blocker use and COPD mortality: a systematic review and meta-analysis

Background

Diagnostic and treatment approaches for sarcoidosis have changed dramatically over the past decade. Yet, the most recent reports of trends in hospitalizations of sarcoidosis patients are over ten years old. The objectives of this study were to determine the incidence of sarcoidosis among hospitalized patients and to analyze recent trends and seasonality of hospitalizations in sarcoidosis patients.

Methods

We performed a retrospective cohort study of the Nationwide Inpatient Sample from 1998 through 2008. We identified all hospitalizations with a primary or secondary diagnosis of sarcoidosis (ICD-9-CM code 135). Incidence was modeled as a seasonal time series about a linear trend.

Results

Time series analysis of the monthly number of hospitalizations revealed a distinct positive linear trend. Over the study period, the number of hospitalized patients with sarcoidosis increased from 37,516 to 70,947 cases. Trends were most pronounced in patients older than 55?years (p?<?0.0001), African Americans (p?<?0.0001), females (p?=?0.0289), and non-Medicaid populations (p?<?0.0001). Hospitalizations are seasonal with highest incidence in January through March.

Conclusions

Hospitalizations among sarcoidosis patients have almost doubled during the past decade, with disproportionate rate increases in African Americans, women, and older patients. The rate also increases among patients with insurance other than Medicaid. This study indicates the need for heightened surveillance of sarcoidosis patients given the unknown consequences of evolving treatment approaches. Our results point to a need for research investigating risk factors for hospitalization, including medications, co-morbidities, demographics, and socioeconomic status.     

TNF-alpha and HLA-DR genotyping as potential prognostic markers in pulmonary sarcoidosis.

We have analyzed the HLA-DRB1 alleles and -308 TNF-alpha gene polymorphism in 78 sarcoidosis patients and 50 controls. The sarcoidosis group as a whole did not show any significant correlation with the TNF-A or the HLA-DR alleles compared to the control group. However, the patient subgroups of L?fgren and non-L?fgren sarcoidosis exhibited significant allele associations. In the L?fgren patient group, the TNF-A2 and the HLA-DR3 alleles were represented significantly higher, with a highly significant relative risk resulting from the presence of the TNF-A2 or the HLA-DR3 allele or both. In the non-L?fgren patient group, the phenotype expressing HLA-DR2 and lacking TNF-A2 was significantly higher than in the L?fgren patient group. Due to these significant genetic differences in the subgroups of L?fgren and non-L?fgren sarcoidosis patients, we conclude that the genotyping of these two loci (-308 TNF-alpha promoter polymorphism and HLA-DR) may be of prognostic value for the course of disease in sarcoidosis.     

后路减压椎弓根螺钉内固定治疗胸腰椎骨折疗效分析

目的:探讨后路减压椎弓根螺钉内固定治疗胸腰椎骨折的疗效。方法:本研究选取了90例胸腰椎骨折患者,按照入院时间顺序不同分为两组,前路组(46例)采取前路减压椎弓根螺钉内固定治疗,后路组(44例)采取后路减压椎弓根螺钉内固定治疗。观察并记录两组患者围手术期参数,术前术后下腰痛功能、神经功能恢复情况及随访12个月期间并发症发生情况,评价后路减压椎弓根螺钉内固定治疗胸腰椎骨折的疗效。结果:后路组在术中失血量、手术时间、住院时间上均明显少于或短于前路组(P0.05);与术前相比,术后两组Oswestry功能障碍指数(ODI)值均明显降低(P0.05)。与术后同时间前路组相比,后路组ODI值均明显低于前路组(P0.05);与术前相比,术后12个月两组神经功能分级整体有所提高(P0.05),但两组间相比,差异没有统计学意义(P0.05);随访12个月期间,两组并发症发生率比较,差异没有统计学意义(P0.05)。结论:采用后路椎弓根螺钉内固定治疗胸腰椎骨折,手术时间短,疗效显著,术中出血量少,预后较好,有利于患者腰椎功能的恢复。     

糖尿病低血糖昏迷急诊救治的临床效果

目的探讨糖尿病低血糖昏迷患者采用急诊系统干预方案实施救治的临床效果。方法对我院收治的糖尿病低血糖昏迷患者120例,按随机分组方案分为对照组和观察组,每组60例。对照组采用常规急诊干预方案进行救治,观察组采用急诊系统干预方案进行救治,比较两组糖尿病低血糖昏迷患者的急诊救治效果、救治后苏醒时间和治疗总时间、急诊救治期间不良事件发生情况。结果观察组糖尿病低血糖昏迷的急诊救治总有效率达91.7%,高于对照组的71.7%,组间比较差异有显著统计学意义(P0.05);救治后苏醒时间和治疗总时间比较,观察组均短于对照组,差异均具统计学意义(P0.05);观察组急诊救治期间发生不良事件1例,对照组发生不良事件8例,差异亦有统计学意义(P0.05)。结论糖尿病低血糖昏迷患者采用急诊系统干预方案实施救治,能促使患者短时间内苏醒,维持血糖稳定,改善患者预后。     

地氯雷他定联合地塞米松鼓室内注射对分泌性中耳炎患者咽鼓管功能的影响

目的:观察地氯雷他定联合地塞米松鼓室内注射治疗分泌性中耳炎的效果及对咽鼓管功能的影响。方法:选择我院2013年6月-2014年6月收治的分泌性中耳炎患者116例,随机分为两组,对照组采用地塞米松鼓室内注射治疗,观察组在此基础上加服地氯雷他定。观察并比较两组临床疗效及咽鼓管功能的恢复情况。结果:治疗后,两组咽鼓管功能不良率较治疗前明显降低(P0.05),观察组咽鼓管功能恢复率高于对照组,观察组治疗前后气骨导差差值明显大于对照组(P0.05),观察组在治疗后1周及1月的总有效率均高于对照组(P0.05)。结论:地氯雷他定联合地塞米松鼓室内注射可减少渗出和中耳积液潴留,有效改善分泌性中耳炎患者的咽鼓管功能,促进听力恢复。     

Biphasic effect of ACTH on growth of rat adrenocortical cells in primary culture

Summary The proliferation rate of differentiating fetal rat adrenocortical cells was studied in primary culture. In this system, stimulation with ACTH induces differentiation of zona glomerulosa-like cortical cells into zona fasciculata-like cells. Incorporation of bromodeoxyuridine (BrdU) was studied immunocytochemically by use of anti-BrdU antibody, and the proliferation rate was counted from the monolayer colonies of adrenocortical cells. After 21 days of cultivation in the absence of ACTH, the proliferation rate of zona glomerulosa-like cells was 10%. The rate slowly declined to 1% at the age of 100 days during continuous cultivation in the absence of ACTH. Stimulation with ACTH induced a strong inhibition in the proliferation rate (down to 2% during the first 24 h). Treatment with ACTH during the following 48 h led to an extremely intense proliferation of adrenocortical cells at a proliferation rate of 25%. Continuous treatment with ACTH up to 100 days led to a persistent growth of adrenocortical cells, and a proliferation rate over 2-fold higher than in control cells cultivated in the absence of ACTH. Thus, ACTH is the principal growth-promoting factor also in vitro, as has been found in in vivo studies. This growth effect is mediated by a biphasic course; at the beginning of differentiation the effect is inhibitory and is followed by a persistent stimulation of the growth of adrenocortical cells.     

生长抑素联合双歧杆菌四联活菌治疗急性胰腺炎的效果及对肠粘膜屏障功能的影响

目的:探究生长抑素联合双歧杆菌四联活菌治疗急性胰腺炎的效果及对肠粘膜屏障功能的影响。方法:选取2015年8月～2018年8月我院收治的急性胰腺炎患者98例,根据患者入院先后顺序分为两组。对照组患者给予生长抑素治疗,观察组在对照组的基础上联合双歧杆菌四联活菌片治疗。比较两组患者的临床治疗效果,临床症状和指标的恢复时间及胃肠动力的恢复情况,治疗前后D-乳酸、二胺氧化酶(DAO)和尿乳果糖和甘露醇的比值(L/M)水平的变化。结果:治疗后,观察组患者的总有效率显著高于对照组(P0.05),腹痛、腹胀、腹膜刺激征、血淀粉酶和尿淀粉酶恢复正常时间均显著短于对照组(P0.05)。治疗后,两组患者的血清D-乳酸、DAO和L/M水平均较治疗前显著下降,且观察组以上指标均显著低于对照组(P0.05)。此外,观察组患者的腹内压显著低于对照组,肠鸣音恢复时间显著短于对照组,胃肠减压引流量显著低于对照组(P0.05)。结论:与单用生长抑素相比,生长抑素联合双歧杆菌四联活菌可更迅速缓解急性胰腺炎患者的临床症状及指标,恢复胃肠动力,并显著改善患者的肠粘膜屏障功能,利于患者的康复。     

早期理性情绪疗法对脊髓损伤患者心肺功能和日常生活能力的干预效果

目的:探讨早期理性情绪疗法对脊髓损伤患者心肺功能和日常生活能力的干预效果。方法:选择2013年1月到2015年1月我院132例脊髓损伤患者作为研究对象,根据康复治疗过程中有无介入早期理性情绪疗法,将患者分为治疗组(早期理性情绪疗法组)和常规组,5个月后观察两组患者的情绪状态、心肺功能、日常生活能力。结果:治疗5个月后,两组患者的汉密尔顿焦虑量表(HAMA)和贝克抑郁量表(BDI)评分均低于治疗前,且治疗组的HAMA和BDI评分低于常规组,差异有统计学意义(P0.05)。两组患者的血压和心率较治疗前升高,且治疗组的血压和心率高于常规组,差异有统计学意义(P0.05)。两组患者的肺活量(VC)、最大自主分钟通气量(MVV)和一秒用力呼气容积(FEV1)较治疗前增加,且治疗组的VC、MVV和FEV1高于常规组,差异有统计学意义(P0.05)。两组患者的巴塞尔指数(Barthel)评分较治疗前增加,且治疗组高于常规组,差异有统计学意义(P0.05)。结论:早期理性情绪疗法可以改善脊髓损伤患者的抑郁和焦虑状态,改善患者的心脏功能指标和肺功能指标,促进心肺功能康复,提高患者日常生活活动能力。     

人工髋关节置换术治疗高龄患者股骨粗隆间骨折的临床疗效研究

目的:探究人工髋关节置换术治疗高龄患者股骨粗隆间骨折的临床疗效。方法:选择40例高龄股骨粗隆间骨折患者并将其随机分为两组,观察组给予人工髋关节置换术治疗,对照组经股骨近端髓内钉内固定术治疗。观察比较两组L2-4椎体骨密度、疼痛程度、髋关节功能恢复情况及Harris评分。结果:治疗后,两组L2-4椎体骨密度均显著高于治疗前(P0.05),且观察组显著高于对照组(P0.05);观察组疼痛比例较治疗前明显降低(P0.05),且显著低于对照组(P0.05);观察组髋关节恢复优良率为95.0%,显著高于对照组(70.0%,P0.05);两组Harris评分均显著高于治疗前(P0.05),且观察组显著高于对照组(P0.05)。结论:采用人工髋关节置换术治疗高龄股骨粗隆间骨折的疗效明显优于经股骨近端髓内钉内固定术治疗,其可有效促进髋关节功能恢复,减轻患者疼痛。     

早期康复治疗在重度颅脑损伤患者中应用的临床疗效观察

目的：观察早期康复治疗在重度颅脑损伤患者中应用的临床疗效,探讨提高重度颅脑损伤患者临床疗效的治疗方法。方法：选择重度颅脑损伤患者72例,根据康复治疗的时间不同,分为早期组与非早期组,比较两组患者康复治疗3个月后Fugl-Meyer评分、Barthel指数和神经功能恢复情况。结果：早期组患者的,临床疗效好于非早期组患者,两者在上述方面比较,差异均具有统计学意5k（P〈0．05）。结论：对于重度颅脑损伤患者,应积极施行早期康复治疗,可促进患者神经功能恢复,提高l临床疗效。     

醒脑静联合高压氧对急性一氧化碳中毒患者脑功能、肝肾功能及血清氧自由基的影响

摘要 目的：探讨醒脑静联合高压氧对急性一氧化碳中毒（ACOP）患者脑功能、肝肾功能及血清氧自由基的影响。方法：选取2017年1月至2020年1月期间我院收治的ACOP患者60例,按照随机数字表法将患者分为对照组（n=30）和研究组（n=30）,在常规治疗的基础上,对照组给予高压氧治疗,研究组给予醒脑静联合高压氧治疗,对比两组疗效、脑功能、肝肾功能、血清氧自由基以及平均苏醒时间、平均住院时间、迟发性脑病发生率。结果：研究组的临床总有效率为93.33%（28/30）,高于对照组的70.00%（21/30）（P<0.05）。两组治疗后天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血肌酐(Scr)、血尿素氮(BUN)均较治疗前下降,且研究组低于对照组（P<0.05）。两组治疗后丙二醛 （MDA）较治疗前下降,且研究组低于对照组（P<0.05）;两组治疗后超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-PX）均较治疗前升高,且研究组高于对照组（P<0.05）。两组治疗后年龄相关性脑白质改变（ARWMC）分级量表、美国国立卫生研究院卒中量表(NIHSS)评分均较治疗前下降,且研究组低于对照组（P<0.05）;两组治疗后简易精神状态检查量表(MMSE)评分较治疗前升高,且研究组高于对照组（P<0.05）。研究组平均苏醒时间、平均住院时间均短于对照组,迟发性脑病发生率少于对照组（P<0.05）。结论：醒脑静联合高压氧治疗ACOP患者的疗效显著,有助于患者恢复,可有效清除其血清氧自由基,保护其脑功能、肝肾功能,减少迟发性脑病发生率。     

酪酸梭菌活菌胶囊对胆道结石患者术后肠功能紊乱的治疗作用

目的观察酪酸梭菌活菌胶囊(商品名:阿泰宁)对胆道结石患者术后肠功能紊乱的疗效及对术后消化吸收功能的改善作用。方法选取40例行胆总管切开探查术且术后出现腹泻、腹胀、消化不良等肠功能紊乱的胆总管结石患者。随机分为观察组和对照组,每组20例。两组患者均予以生理盐水补液、止泻药止泻和低脂饮食等常规治疗,观察组患者加服酪酸梭菌活菌胶囊,3粒/次,2次/d,连用28d。观察两组患者用药后的临床疗效及不良反应。结果观察组患者临床总有效率(100.0%)显著高于对照组(80.0%)(P0.05);腹泻和腹胀的时间显著短于对照组(P0.01);同时治疗后观察组患者总胆固醇、甘油三酯、球蛋白水平显著高于对照组(P0.05),电解质紊乱发生率低于对照组(P0.05)。治疗期间所有患者未见不良反应。结论酪酸梭菌活菌胶囊治疗胆道结石患者术后肠功能紊乱疗效显著,能够显著改善患者对脂质的消化吸收能力,对患者术后消化吸收功能的改善具有积极的作用,值得临床推广应用。     

Adrenocortical suppression in multiply injured patients: a complication of etomidate treatment.

Three patients admitted to the intensive care unit after multiple injury were observed to suffer episodes of adrenocortical insufficiency suggested by clinical manifestations and confirmed by appropriately low cortisol concentrations. This prompted a prospective study of pituitary-adrenocortical function in six multiply injured patients, three of whom showed evidence of adrenocortical suppression. The only factor common to the six patients with abnormally low adrenocortical function was an association between periods of adrenocortical suppression and intravenous infusion of etomidate; when the drug was stopped adrenocortical function was restored, and renewed administration of the drug caused further inhibition. Etomidate infusions lasting only six hours were found to cause low, flat responses to short tetracosactrin tests and grossly raised plasma concentrations of adrenocorticotrophic hormone, suggesting direct suppression of the adrenal cortex. Median plasma cortisol concentrations measured at 0900 were significantly lower and median plasma concentrations of adrenocorticotrophic hormone measured at 0900 were significantly higher in the three patients studied prospectively who were receiving etomidate infusions compared with the three patients who did not receive etomidate (p = 0.05).     

小牛血清去蛋白提取物联合天麻钩藤饮对急性脑梗死患者神经功能及血液流变学的影响

目的:分析小牛血清去蛋白提取物联合天麻钩藤饮对急性脑梗死患者神经功能及血液流变学的影响。方法:选择2015年10月至2018年10月在我院治疗的急性脑梗死患者90例为研究对象,将其随机均分两组。对照组仅采取小牛血清去蛋白提取物治疗,实验组在对照组基础上联合采用天麻钩藤饮治疗。比较两组治疗的临床总有效率、治疗前和治疗20 d后的神经功能缺损评分、日常生活能力评分和血液流变学指标的变化以及治疗期间不良反应的发生情况。结果:治疗后,实验组的总有效率为95.56%,显著高于对照组(77.78%,P0.05)。两组治疗后的美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)和日常生活活动能力量表(Activities of Daily Living,ADL)评分均较治疗前显著升高,且实验组以上指标明显高于对照组(P0.05)。两组治疗后的全血高切黏度、全血低切黏、红细胞比容、血小板聚集率和纤维蛋白原较治疗前均显著降低,且实验组以上指标均显著低于对照组(P0.05)。结论:小牛血清去蛋白提取物联合天麻钩藤饮治疗急性脑梗死效果显著优于单用小牛血清去蛋白提取物治疗,其可更有效促进患者神经功能的恢复,提高患者生活质量,改善其血液流变学。     

分子吸附再循环系统治疗肝功能衰竭合并肝性脑病的临床效果观察

目的探讨分子吸附再循环系统在肝功能衰竭合并肝性脑病治疗中的临床应用效果。方法将我院2015年1月~2016年1月收治的肝功能衰竭合并肝性脑病患者100例,根据治疗方式的不同分为观察组和对照组,每组50例。对照组50例患者接受保肝、维持水电解质平衡以及营养支持等综合治疗,观察组50例患者在综合治疗基础之上接受分子吸附再循环系统治疗,并对两组患者的治疗效果,治疗前后肝功能改善情况、不良反应进行统计分析。结果两组患者治疗前的总胆红素、凝血酶原活动度、血氨以及Glasgow昏迷评分比较差异无统计学意义(P0.05)。观察组患者治疗3天后的总胆红素以及血氨明显低于对照组,两组比较差异有统计学意义(P0.05);而且治疗有效率明显高于对照组(P0.05),治疗后肝性脑病清醒率高于对照组(P0.05)。两组患者治疗期间均无严重不良反应。结论肝功能衰竭合并肝性脑病患者在综合治疗上采取分子吸附再循环系统治疗的效果显著,可明显改善患者肝功能,提高肝性脑病清醒率,且不良反应少,值得临床推广使用。     

参芪扶正注射液对急性淋巴细胞白血病化疗患者造血和免疫功能的影响

目的:观察参芪扶正注射液对急性淋巴细胞白血病化疗患者造血及免疫功能的影响。方法:收集96例处于初治诱导缓解治疗阶段的急性淋巴细胞白血病患者,并将其随机分为治疗组和对照组。治疗组48例患者在进行常规化疗的同时给予参芪扶正注射液250 m L,1次/天,共28天;对照组48例患者仅接受常规化疗,两组患者均给予相同的支持对症治疗。治疗结束后,观察两组患者的疾病缓解率、治疗前后造血系统、T和B淋巴细胞亚群的变化情况。结果:化疗结束后,治疗组患者的疾病缓解率为89.6%,对照组为83.3%,两组比较无统计学差异(P0.05);化疗14天及化疗结束后1周,治疗组患者的白细胞、红细胞计数和血红蛋白水平明显高于对照组(P0.05);且化疗结束后1周,治疗组患者的CD3+、CD4+及CD4+/CD8+含量均明显高于对照组(P0.05)。而两组患者治疗前后的血小板计数、CD3-CD19+含量比较均不具有统计学差异(P0.05)。结论:参芪扶正注射液辅助治疗不仅能够改善化疗所致的急性淋巴细胞白血病患者的骨髓抑制,而且能够提高其细胞免疫功能,有助于患者化疗后的恢复。     

急性缺血性脑卒中不同水平血压管理应用效果及其对近期预后及认知功能的影响

摘要 目的：急性缺血性脑卒中不同水平血压管理应用效果及其对近期预后及认知功能的影响。方法：选择我院2021年7月-2022年9月收治的急性缺血性脑卒中患者180例作为本次研究对象,分为对照组及观察1组、观察2组,对照组不进行降压治疗,将观察1组患者急性期血压控制120/80 mmHg,观察2组血压控制在140/90 mmHg,观察各组患者临床治疗效果、近期预后改善情况及对认知功能的影响。采用美国国立卫生研究院脑卒中量表对患者治疗效果和NIHSS测量评定。结果：治疗后各组NIHSS评分较入院时明显降低,且治疗期间NIHSS评分变化12 d＞8 d＞4 d,观察1组、观察2组患者治疗4 d、8 d、12 d后NIHSS评分较对照组明显降低（P＜0.05）;治疗后观察1组和观察2组总有效率较对照组患者显著提高（P＜0.05）,观察1组与观察2组相比无统计学意义（P＞0.05）;观察1组、观察2组患者治疗后MMSE和MoCA评分较对照组明显升高（P＜0.05）,观察1组和观察2组MMSE和MoCA评分差异无统计学意义（P＞0.05）。Logistic回归分析提示血压控制和入院NIHSS评分则与脑卒中患者近期预后显著相关（P＜0.05）。结论：急性脑缺血性脑卒中急性期对患者进行血压控制能够有效提高患者预后效果,促进患者神经功能恢复,但血压控制120/80 mmHg与140/90 mmHg血压管理方案效果相似。     

培元还五汤联合针灸治疗缺血性脑卒中恢复期患者的疗效及对血清细胞因子和睡眠质量的影响

目的:探讨培元还五汤联合针灸治疗缺血性脑卒中恢复期患者的疗效及对血清细胞因子和睡眠质量的影响。方法:选取北京王府中西医结合医院于2017年1月～2018年12月间接收的99例缺血性脑卒中恢复期患者,根据数表法将患者随机分为对照组(n=49,给予基础治疗和常规康复训练)和研究组(n=50,在对照组基础上给予培元还五汤联合针灸治疗),比较两组患者临床疗效、神经功能缺损情况、上肢运动功能、睡眠质量以及血清超敏C-反应蛋白(hs-CRP)、妊娠相关蛋白A(PAPP-A)、神经生长因子(NGF)、脑源性神经营养因子(BDNF)水平变化,记录两组治疗期间不良反应发生情况。结果:研究组治疗后临床总有效率为92.00%(46/50),显著高于对照组患者的71.43%(35/49)(P0.05)。两组患者治疗2个月后神经功能缺损(NIHSS)评分、睡眠质量评分降低,且研究组低于对照组(P0.05),Fugl-Meyer运动(FMA)评分则升高,且研究组高于对照组(P0.05)。两组患者治疗2个月后血清hs-CRP、PAPP-A水平降低,且研究组低于对照组(P0.05),血清NGF、BDNF水平则升高,且研究组高于对照组(P0.05)。两组不良反应发生率比较无差异(P0.05)。结论:培元还五汤联合针灸治疗缺血性脑卒中恢复期患者,疗效确切,可有效改善患者神经功能、上肢运动功能、睡眠质量,改善相关细胞因子水平,且不增加不良反应发生率,具有一定的临床应用价值。