基于中医药防治新型冠状病毒肺炎的用药探析

武汉市爆发新型冠状病毒肺炎(COVID-19)疫情,传染性强,传播速度快,影响范围广,引起了国内外高度关注。WHO宣布将COVID-19疫情列为国际关注的突发公共卫生事件。面对重大疫情,河南省郑州市中医院开展中医药预防治疗COVID-19用药调查研究分析,总结中医药诊疗方向及抗病毒中药、经典名方、中成药用药要点,以期能为医疗机构COVID-19诊疗以及药物合理选择提供参考依据。     

经典名方中“术”的本草考证

中药经典名方的研发是促进中医药继承创新和提高临床服务水平的重要途径,经典名方中药材基原的确定对其研发尤为重要,是保证质量、药效及安全性的源头。"术"入药历史悠久,《神农本草经》中列为上品,为经典名方中常用中药。但南北朝以前"苍术""白术"均可作为"术"入药,未做明确区分,致使本草考证是含"苍术""白术"经典名方研发中的难题。结合历代本草,从植株形态、产地、性味、功效等方面梳理"术"的历史变迁,以期为"术"的本草考证以及经典名方的研发提供参考借鉴。     

基于数据挖掘的吕英教授治疗自闭症语言障碍的用药规律分析＊

目的 基于中医传承辅助平台软件（TCMISS，V2.5）对吕英教授治疗自闭症语言障碍的处方进行数据挖掘，探索其病因病机及组方规律。方法 收集吕英教授治疗自闭症语言障碍的医案，将其方药信息录入TCMISS，借助该平台集成的关联规则、改进互信息法、复杂系统熵聚类法、无监督熵层次聚类法等分析方法探索吕英教授治疗自闭症语言障碍的药物组方规律。结果 共筛选出120个医案，包含处方共120首，涉及中药89味，其中使用频次前6味中药为桂枝、鸡蛋花、白术、泽泻、石膏、桔梗，药性以寒、温为主，药味以甘、苦居多，归经多属肺、脾、肝经。通过关联规则分析所得的用药模式中，使用频次最高的为桂枝与鸡蛋花、桂枝与泽泻、白术与桂枝，进一步分析得到的核心药物为泽泻、桂枝、白术，为五苓散的药物组成，并基于复杂熵聚类方法演化出6首新处方。结论 吕英教授治疗自闭症语言障碍以阳明“气血津”不足和三焦气化功能失常为主要病机线路，清解阳明伏火、加强阳明本体液津血的生化化生及恢复三焦气化功能正常为主要治法，其核心代表方剂为木防己汤和五苓散。     

香萱益神方对血管性痴呆模型大鼠神经元凋亡机制研究

目的:探讨香萱益神方治疗血管性痴呆(VD)模型大鼠认知功能作用及其对神经元凋亡机制的研究。方法:两血管阻断法建立VD大鼠模型,给予中药方香萱益神方灌胃治疗6周,分别于造模后、中药喂养6周后进行Morris水迷宫行为学检测,测试大鼠认知行为能力改变,行为学测试结束后,检测VD模型大鼠海马中海马组织脑源性神经营养因子(BDNF)表达水平的变化。结果:香萱益神方治疗6周后,血管性痴呆大鼠模型学习记忆能力得到改善,上调脑内海马组织神经营养因子水平,海马神经元凋亡率下降。结论:香萱益神方是治疗血管性痴呆的有效方剂,可以有效改善VD大鼠模型认知行为功能的障碍情况,起到减少海马神经元细胞凋亡,诱导海马神经元细胞修复的作用。香萱益神方可能是通过激活BDNF相关通路,起到保护海马神经元的作用。     

中药方与硝酸咪康唑栓治疗复发性霉菌性阴道炎的效果

目的中药组方联合硝酸咪康唑栓治疗复发性霉菌性阴道炎的临床观察。方法在2018年8月-2019年2月期间选择因复发性霉菌性阴道炎就诊于本科室的86例患者进行研究。以抽签方式将患者分为两组,每组患者43例。对比组采用西医传统常规治疗方式,即为硝酸咪康唑栓治疗。试验组采用中药组方与硝酸咪康唑栓治疗联合治疗方式,中药组方采用了我科室自拟经验方。分析两组最终治疗效果。结果试验组治疗有效率为97.67%高于对照组的76.74%,两组差异有统计学意义,χ²=8.443 6,P=0.003 6。结论复发性霉菌性阴道炎治疗中,中药组方与硝酸咪康唑栓联合治疗方式可以作为首选的治疗方案,此方式应用价值明显高于单独硝酸咪康唑栓治疗方案,可见此治疗方式有一定的治疗效果,值得临床应用。     

Short- and long-term outcome after alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Experience of a reference center

IntroductionIn obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study.MethodsWe analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years.ResultsA total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker.The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes.ConclusionASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause.