基于血管生成探讨补肾养精颗粒对早发性卵巢功能不全大鼠模型的影响＊

目的 基于血管生成及凋亡相关因子探讨补肾养精颗粒治疗早发性功能不全的机制。方法 选定动情周期正常的60只SD雌性大鼠，随机分为空白组、模型组、补肾养精颗粒组（低剂量组（1.75 g?kg^-1）、中剂量组（3.50 g?kg^-1）、高剂量组（7.00 g?kg^-1）、补佳乐组。通过阴道涂片观察动情周期的变化；ELISA检测大鼠血清E₂、AMH、NF-κB、MMP-2、Caspase-3、Caspase-9浓度；Western blot检测卵巢组织中MMP-2、MMP-9、VEGF、Caspase-3的表达；HE染色观察大鼠卵泡发育及血管分布情况。结果 ①模型组大鼠的动情周期明显延长，予补肾养精颗粒干预后明显缩短；②模型组的血清E₂、AMH、NF-κB、MMP-2浓度较低，予补肾养精颗粒干预后其表达升高（P < 0.05）；③模型组的Caspase-3、Caspase-9表达偏高，予补肾养精颗粒干预后其表达降低（P < 0.05）；④在卵巢组织MMP-2、MMP-9、VEGF的蛋白含量方面，模型组均低于空白组，予补肾养精颗粒干预后其表达升高；⑤在HE方面，模型组的卵泡数目及血管较少，予补肾养精颗粒干预后可改善。结论 补肾养精颗粒可通过升高血管生成相关因子NF-κB、MMP-2、MMP-9、VEGF的表达，降低凋亡相关因子Caspase-3、Caspase-9的表达，进而改善血清E2、AMH水平，促进卵巢血管的形成及卵泡的发育。     

基于网络药理学与分子对接技术探讨六味地黄丸抗骨质疏松症的机制研究

目的基于网络药理学及分子对接方法探讨六味地黄丸在治疗骨质疏松症(osteoporosis,OP)过程中的有效成分及作用机制。方法通过TCMSP数据库获得六味地黄丸组方的药物有效成分及其预测靶点;利用疾病数据库筛选骨质疏松症相关疾病作用靶点;将获得的关键靶点上传至STRING数据库完成PPI网络分析;利用DAVID数据库完成关键靶点的富集分析;通过Auto Dock Vina等软件完成化学有效药物成分与关键靶点的分析对接验证。结果共获得六味地黄丸组方化学有效成分69个、药物靶点蛋白128个及药物与骨质疏松症共同相关靶点81个;获得了IL6、TP53、VEGFA、TNF、JUN、MAPK1、EGF、EGFR、ESR1、CAT等PPI网络中的关键靶点。富集分析结果显示,其通过参与细胞增殖与凋亡过程、药物代谢、雌激素反应调节与细胞抗缺氧、抗衰老等生物学进程,调控TNF、药物代谢过程、HIF-1、VEGF、雌激素调节等信号通路,参与骨质疏松症的治疗过程;分子对接结果显示,调控网络中的关键靶点与相关有效成分之间具有较高的结合活性。结论借助生物信息学手段和分子对接技术,初步揭示了六味地黄丸抗骨质疏松症的作用机制,为后续进一步的机制研究及实验验证提供了目标与思路。     

援鄂医护人员急性应激反应的潜在剖面分析

目的对援鄂医护人员急性应激反应进行潜在剖面分析并探讨不同类别间人口学特征的差异。方法采用随机抽样方法选取山东、北京、福建、湖南、重庆及河南等6地区参与援鄂的医护人员627名。采用一般资料调查表、斯坦福急性应激反应量表对相关医护人员应激反应进行横断面调查,对结果进行潜在剖面分析,并探讨不同类别间人口学特征的差异。结果 627名援鄂医护人员分可为高急性应激反应(8.13%),中急性应激反应(30.62%)及低急性应激反应(61.24%)3个潜在类别。危险因素包括女性(OR=1.742)、援鄂一线医护人员(OR=3.228)、近期到过疫区(OR=2.206)、自我感觉疫情持续半年以上(OR=5.786)、年龄>60岁(OR=8.837)、援鄂一线医护人员(OR=24.315)、担心自己周围人感染的可能性(OR=13.843),均P<0.05;保护性因素为家中有医护人员(OR=0.579)、自己感染可能性比较大(OR=0.181)及感染可能性有一些(OR=0.266),均P<0.05。结论援鄂医护人员急性应激反应可分为3类,护理管理者及专业心理人员可根据其不同人口学特征实施个体化心理干预以激减轻其急性应激反应,防止过渡为急性应激障碍或创伤后应激障碍。     

MYD88, IRAK3 and Rheumatoid Arthritis pathogenesis: Analysis of differential gene expression in CD14 + monocytes and the inflammatory cytokine levels

Rheumatoid arthritis (RA) is a well-known chronic inflammatory disorder. Two molecular players act in the inflammation balance of the disease: MyD88 (Myeloid differentiation primary response 88) is related to TLR (Toll-like receptors) response and promotes the formation of myddosome complex resulting in increased inflammation; IRAK3 (Interleukin-1 receptor associated kinase 3) acts suppressing the myddosome complex thus decreasing inflammation. In this scenario, MYD88 and IRAK3 gene expression profile in RA patients and its correlation with clinical features is still partially known. So, we evaluated the MYD88 and IRAK3 gene expressions in CD14 + monocytes from RA patients and healthy controls and its relation with patients’ clinical features and cytokine plasma levels. CD14 + monocytes were isolated using positive selection by magnetic cell separation. The MYD88 and IRAK3 gene expressions were measured through real time relative quantitative PCR with specific primers; relative quantification was normalized to ACTB, GAPDH, 18S and RPLP0 reference genes. Cytokine levels were analyzed by CBA (cytokine beads assays). CD14 + monocytes from RA patients showed lower IRAK3 expression level compared to controls although with a borderline statistical significance (Fold change (FC) = -1.63; p = 0.054). Furthermore, RA patients with high disease activity had lower levels of IRAK3 when compared to patients with low/moderate activity measured by the CDAI index (FC = -1.78; p = 0.030). No significant differences were observed for MYD88 gene expression (FC = 1.20; p = 0.294) between patients and controls analyzed. Additionally, we did not we did not observe correlation between IRAK3 and MYD88 gene expression and TNF-α, IL-6, IL-2 and IL-10 levels. We suggested that IRAK3 gene expression in CD14 + monocytes appears to be relevant to the RA etiology and clinical activity, whereas, in this study, MYD88 does not play a role in RA onset and development.     

复发性口腔溃疡患者中医体质类型调查与分析

目的:对复发性口腔溃疡患者的中医体质类型进行调查,为临床防治复发性口腔溃疡提供客观依据。方法:借助"问卷星"网络调查平台,采用自制调查问卷,在全国范围内进行流行病学调研。结果:经调查670例复发性口腔溃疡患者中,平和质占19.25%;8种偏颇体质由多到少依次为:气虚质占21.64%、阳虚质占15.82%、阴虚质11.94%、气郁质占11.19%、湿热质占7.76%、痰湿质占5.22%、特禀质与瘀血质各占3.58%。结论:复发性口腔溃疡患者中医体质以气虚质、阳虚质、阴虚质多见,且复发性口腔溃疡患者体质分布与地域相关。     

张卫华教授“温通针法”治疗原发性痛经临床经验

The professor Wei-hua ZHANG's experiences in treatment of primary dysmenorrhea with “warming-unblocking needling method” was introduced in this paper. Prof. Zhang believes that obstruction is the crucial in pathogenesis of primary dysmenorrhea no matter of the excess or the deficiency syndrome. Warming and unblocking principle is the essential in treatment. Hence, an unique therapeutic method is innovated, named warming-unblocking needling method, including three-layer and two-direction warming needling technique at Sānyīnjiāo (三阴交 SP6), two-layer rotating warming- unblocking technique at Zhōngjí (中极 CV3) and one-layer and two-direction warming needling technique at Cìliáo (次髎 BL32). In this set of needling procedure, acupoint is viewed as a three-dimensional hierarchical structure. A layered and multidirectional needling technique is adopted at main acupoints to enhance the sensations of diqi and to generate heat effect in the local. Additionally, moxibustion is combined to intensify warming and unblocking effect. Simultaneously, the supplementary acupoints are used in response to symptoms. All of the acupoints coordinately warm up the uterus, promote meridian circulation and stop pain. Hence, this therapeutic method achieves relatively excellent effect and deserves to be promoted in practice.     

化浊对穴应用及其机制探析

文章是在血浊理论指导下对一类无明显自觉症状或体征的疾病如血管神经性头痛、隐匿性冠心病、2型糖尿病、原发性高血压等的特定证候明显有效的4对对穴遴选出来进行归类比较、理论探讨,结合实验室研究及临床验证,并从对穴角度对其临床机制进行深入探讨,进而推动具有理血化浊作用的对穴在临床的应用。     

绝经后骨质疏松症中医证型与握力的研究

目的探讨绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)患者中医证型与握力的关系。方法选取2017年11月至2018年10月在济南各社区及山东中医药大学附属医院骨质疏松门诊纳入的绝经后骨质疏松症女性142例(骨质疏松组)、绝经后非骨质疏松症女性39例(非骨质疏松组)。依照中医辨证分型将骨质疏松组患者分为肝肾阴虚、脾肾阳虚及肾虚血瘀三型,采集所有受试者一般指标,研究握力在绝经后骨质疏松症中医证型上是否存在差异。结果骨质疏松组年龄、绝经年限高于非骨质疏松组,差异有统计学意义(P<0.05),骨质疏松组身高、体重、体质量指数(body mass index,BMI)、握力和骨密度(bone mineral density,BMD)水平均低于非骨质疏松组,差异有统计学意义(P<0.05)。三组中医证型的年龄、绝经年限、身高、BMI比较差异无统计学意义(P>0.05),肝肾阴虚组体重大于脾肾阳虚组,差异有统计学意义(P<0.05)。三组中医证型的握力由大到小依次为肝肾阴虚组、肾虚血瘀组、脾肾阳虚组,三组之间两两比较均有统计学意义(P<0.05)。结论脾肾阳虚型骨质疏松症患者握力较低,脾肾对肌力的影响具有普遍性的意义。     

Nrf2:糖尿病防治新领域

糖尿病的发病率逐年增高,已成为严重危害人类健康的疾病之一。研究表明,氧化应激与糖尿病关系密切。转录因子NF-E2相关因子2（Nrf2）是体内调控氧化还原平衡的重要转录因子,通过结合抗氧化反应元件（ARE）激活Nrf2/ARE通路,调节下游保护性蛋白基因的转录,减少活性氧的释放,发挥其抗氧化应激和抗炎症反应的作用。作为迄今发现最为重要的内源性抗氧化应激因子,Nrf2已成为防治糖尿病的新领域。本文主要从氧化应激、Nrf2与氧化应激、Nrf2与糖尿病及其并发症的关系四个方面进行论述。     

试从痹证“五体合五脏”论述结缔组织疾病相关性间质性肺疾病的关系

中医学认为"风寒湿三气杂至合而为痹也",所谓"痹"即"痹证",由五体痹和五脏痹组成。结缔组织疾病(CTD),中医又称风湿病,属"五体痹"范畴。间质性肺疾病(ILD)为常见呼吸系统疾病,属中医学"肺痹"、"肺痿"、"咳嗽"、"肺胀"等范畴。肺脏受邪,气血失调,痰瘀互结,壅滞肺络,即可发为肺痹。虚、痰、瘀贯穿疾病始终。肺痹属五脏痹,为五体痹受邪深入发展而来。五体痹与五脏痹的发病关系以及证候表现体现了"五体合五脏"的理论思想,五体痹不愈,复感外邪,疾病传变入里,导致五脏痹。五体痹可导致五脏痹,五脏痹之间亦可相互传变。CTD是引起ILD的常见病因,五体痹不愈,内舍其合,继而引发多种呼吸系统损害,逐渐形成肺痹。近年来,随着社会工业化的进步,CTD相关ILD发病率明显上升。文章试从痹证"五体合五脏"论述CTD-ILD的关系,以求增强对CTD以及ILD的认识,为临床上诊疗开拓思路,提供指导。