HIV/AIDS患者不同寒热证候的热态数据分析及临床意义探讨

目的 运用红外热成像技术研究人类免疫缺陷病毒感染者/艾滋病患者(HIV/AIDS)寒证组45例、热证组45例和118例平和质人群的红外热图,结合中医理论对结果进行分析解释.方法 观察HIV/AIDS寒证组、热证组和平和质人群(对照组)的督脉、任脉、神阙、肾、命门、三焦、五脏六腑的热差值数据,运用T-test统计学方法进行分析.结果 ①HIV/AIDS患者寒证组与热证组督脉、中焦、下焦区域的热态与对照组相比有明显差异,均低于对照组.②寒证组还在任脉、神阙、肺等区域,热态与对照组有明显差异.③寒证组还在肝、神阙区域,热态明显低于热证组.结论 HIV/AIDS患者与平和质人群比较属于元阳不足.寒证组表现为下焦元阳亏虚,小肠能量代谢下降;热证组肾与命门能量下降,说明其真阴真阳耗伤.热证组肝区热态高于寒证组,推测存在炎症病理改变,是中医邪热盛病机的体现.     

慢性鼻咽炎中医证候分型的临床研究

目的 探讨慢性鼻咽炎患者的中医证候分型特点.方法 对300例慢性鼻咽炎患者按照中医辨证标准进行证候分型,观察各型患者主要症状分布及局部黏膜表现.结果 肝经郁热30例,占10.0%;肺胃蕴热66例,占22.0%;湿热蕴脾47例,占15.7%;肺肾阴虚12例,占4.0%;脾气虚弱95例,占31.7%:痰凝血瘀41例,占13.7%;其他9例,占3.0%.鼻咽不适为最常见症状,广泛分布于各型中.除脾气虚弱型外,其他各型黏膜充血均较明显.结论 慢性鼻咽炎以肝经郁热、肺胃蕴热、湿热蕴脾、肺肾阴虚、脾气虚弱、痰凝血瘀6型最为常见.     

72例慢性咳嗽患者中医相关病理因素及生活质量调查分析

目的 调查慢性咳嗽患者的中医相关病理因素、主要中医证候及生活质量.方法 收集符合纳入标准的72名慢性咳嗽患者的莱彻斯特咳嗽问卷(Leicester Cough Questionnaire,LCQ)评分结果、中医四诊信息,应用聚类分析、秩和检验,研究慢性咳嗽中医相关病理因素及主要中医证候,并比较不同证候慢性咳嗽患者LCQ各区域的得分差异情况.结果 慢性咳嗽对患者生理、心理、社会等方面均造成影响.主要病理因素有风邪、湿热、寒邪、痰湿、阴虚,主要证候类型为风邪伏肺、痰湿蕴肺、寒邪伏肺、湿热内蕴、肺阴亏虚5种,其中风邪伏肺的症状(咽痒、风冷油烟诱咳)发生频率最高.各证型LCQ得分在生理、心理2个方面及总分差异显著(P<0.05).结论 风邪是慢性咳嗽的主要病理因素,此外可见湿热、寒邪、痰湿、阴虚4种病理因素;5种主要证型中湿热内蕴、肺阴亏虚2种证型患者的生活质量相对较差,对具有相应临床表现者施以祛风宣肺、清热燥湿、养阴润肺等治疗,应可有效提高这些患者的生活质量.     

88例HIV感染者及AIDS患者的护理

总结了88例HIV感染者及AIDS患者的临床护理经验,包括患者的观察评估、基础护理、患者安全护理、各种机会性感染的观察及护理、心理护理及健康教育等.认为及时评估HIV感染者及AIDS患者的情况,针对病程的各个阶段及相应的护理问题,采取积极的护理措施,对提高患者的生存质量,防止交叉感染及疾病传播十分重要.     

Social support and psychological stability in HIV/AIDS patients

An explorative meta-analytic study analysed all published empirical studies on social support of HIV/AIDS patients (n = 57 studies with 347 data sets). Empirical and conceptual questions are addressed. The focus of the empirical questions is to identify meta-analytically confirmed correlates of social support. The conceptual question aims at differentiating the large-scale construct "social support". Results indicate that social support 1. is independent of objective physical parameters, 2. is positively correlated with approach coping and negatively with avoidance coping, 3. shows a substantial negative correlation with indicators of psychological distress, 4. is positively correlated with condom use. The conceptual analysis shows that 5. there is no consensus on how to operationalise the construct of "social support".     

Fatigue in cancer and HIV/AIDS

Fatigue is a common and troubling symptom in patients with cancer or HIV/AIDS, resulting in significant disability and adverse effects on quality of life. Its etiology remains complex and is most likely multifactorial. Despite its impact and prevalence, fatigue is often overlooked and undertreated in these patient populations. The general perceptions of fatigue are that its etiology cannot be determined, it is an inevitable manifestation that must be endured, and few interventions are available. Efforts are ongoing to better understand the etiology, characteristics, and consequences of fatigue in patients with cancer or HIV/AIDS. New practical methods of assessing it in cancer patients are now available. In order to improve the quality of life in these patients, physicians need to reassess their perceptions of fatigue and their approach to its diagnosis and management. There are recognizable causes and correlates for which interventions can be beneficial. These include anemia, pain, infection/fever, hormonal or nutritional deficiencies, depression/anxiety, sleep disturbances, and excessive inactivity or rest. Physicians should fully evaluate patients to identify the factors amenable to management. Fatigue is also seldom discussed by patients and their physicians. Improved communication with and counseling of patients and their caregivers can play an important role in the effective assessment and management of fatigue in patients with cancer or HIV/AIDS. Many patients may benefit from wider implementation of recent advances in the understanding and treatment of fatigue in these oncologic and infectious conditions.     

Research ethics and HIV/AIDS

The effect of 2-chloroadenosine (2CA), an adenosine receptor agonist, on the activation status of mouse natural killer (NK) cells was determined. Splenic lymphocytes incubated with 2CA exocytosed an NK cell-associated granzyme with N alpha-CBZ-L-lysine thiobenzyl ester (BLT) esterase activity in a dose- and time-dependent manner. Selective depletion of NK cells by anti-asialoGM1 antibody plus complement pretreatment confirmed that NK cells were the source of the BLT esterase activity. 2CA-induced granule exocytosis was not reduced in the presence of the nucleoside uptake blockers NBTI, dilazep, or dipyridamole, indicating the involvement of an extracellular receptor. However, adenosine or other A1, A2, or A3 cell-surface adenosine receptor agonists failed to trigger the exocytotic process. Furthermore, the nonselective adenosine receptor antagonist theophylline, as well as the selective A1 receptor antagonist DPCPX and the selective A2 receptor antagonist DMPX, did not interfere with 2CA-induced BLT esterase secretion. These data suggest that 2CA acts on NK cells via a novel (non-A1/A2/A3) cell-surface receptor. Genistein, a protein tyrosine kinase inhibitor, and calphostin C, a protein kinase C inhibitor, both interfered with 2CA-induced granule exocytosis. Pertussis toxin, an ADP-ribosylating toxin to which certain GTP-binding proteins are sensitive, also inhibited 2CA-stimulated BLT esterase release. In addition, 2CA-induced granule exocytosis was reduced in the presence of cyclosporin A, an inhibitor of Ca(2+)-dependent signaling pathways, and the Ca(2+)-chelating agent EGTA. We conclude that 2CA, acting through a novel extracellular receptor on mouse NK cells, triggers granule exocytosis via a Ca(2+)-dependent signal transduction pathway that is coupled to GTP-binding proteins and involves protein tyrosine kinase and protein kinase C activation.     

Colour vision in AIDS patients without HIV retinopathy

Patients suffering from AIDS develop ocular complications, the most frequent being HIV retinopathy. It is however not clear, if functional visual impairments can be observed as early indicators of ocular complications, before clinical diagnosis of HIV retinopathy is made at fundus examination. To address this issue, we measured colour vision in a group of 49 AIDS subjects with normal clinical fundi using the 'two equation method'. This method, combining red-green Rayleigh and the blue-green Moreland metameric matches, enables more complete and quantitative assessments of colour vision than those based on pigmentary tests. Data were collected on our computer controlled colorimeter and compared to those of normal subjects. While most AIDS subjects without HIV retinopathy demonstrated normal colour vision, a significant portion of them had wider matches than normal subjects (11% for the Rayleigh equation and 16% for the Moreland equation). Furthermore, matching ranges of the Moreland equation were significantly correlated with CD4 lymphocyte counts. Patients with low CD4 values tended to produce larger matching ranges than the patients with high CD4 values. A within subject study on 17 patients confirmed this trend and showed that the patients who increased/decreased their CD4 blood counts generally improved/impaired their colour discrimination in the Moreland match. No such correlation was found between the matching ranges of the Rayleigh equation and the CD4 counts. These results show that colour discrimination is slightly reduced in some AIDS subjects, although there are no detectable ocular complications. They also suggest two different types of colour vision impairments in AIDS patients without retinopathy: one reversible process affecting colour discrimination in the blue-green range; and another irreversible process affecting colour discrimination in the red-green range.     

The specialist nurse in HIV/AIDS medicine

The management of patients with human immunodeficiency virus infection requires a multidisciplinary holistic approach. Hospital-based specialist nurses can both co-ordinate and facilitate their hospital care, and also ensure early and effective discharge back into the community.