从肠道菌群及其代谢物探讨冠心病瘀毒理论

肠道菌群与宿主共生,既可看作一个整体,又是两个相对独立的个体。从整体角度出发,肠道菌群与人类共生可视为人体特殊的"器官"。笔者认为肠道菌群及人体内其他部位的菌群失调可视为中医"外毒"的范畴,而因菌群失调导致的脂代谢及代谢产物异常和促炎因子释放增加可视为"内毒"的范畴。对肠道菌群及其代谢物的进一步研究有助于深化瘀毒理论的内涵。     

医学人文——谈叙事医学与中国传统医学

正现代医学模式已经从单纯的生物医学模式转变为"生物——心理——社会"模式,将疾病与人、心理和社会相结合。医学人文精神存在于医学发展的始终,叙事医学的提出,是医学人文情怀的一种表达方式。笔者旨在通过叙事医学的产生与发展,从中国传统医学视角加以解读,以期为临床实践提供思路和参考。1 叙事医学的源起1910年,卡内基教学促进基金会(The Carnegie Foundation for the Advancement of Teachi     

肠道菌群与动脉粥样硬化的关系

动脉粥样硬化(As)是心血管疾病(CVD)的主要病理基础且其发病机制具有多样性。肠道菌群失调可通过代谢和免疫系统导致代谢失调和炎症反应,导致斑块形成和破裂,细菌感染在As形成和斑块的发展也具有一定的影响。同时肠道菌群失调可改变胆固醇代谢和菌群代谢物如氧化三甲胺(TMAO)、胆汁酸(BAs)和短链脂肪酸(SCFAs)水平影响As发病进程。目前以肠道菌群为靶点治疗As的研究逐渐深入,益生菌、益生元、粪菌移植、中药可能是未来As治疗的潜在方法并使CVD患者获益。     

基于陈可冀院士血瘀证辨证方法治疗冠心病稳定性心绞痛的实用性随机对照研究

目的评价基于"陈可冀院士血瘀证辨证方法"论治冠心病稳定性心绞痛的有效性及安全性。方法本研究为实用性随机对照试验,采用分层区组随机方法,将300例冠心病稳定性心绞痛患者分为试验组和对照组,每组150例。在西医常规治疗基础上,试验组接受"陈可冀院士血瘀证辨证方法"指导的治疗,对照组接受常规血瘀证辨治方法,疗程共4周。观察两组治疗前后主要指标(包括血瘀证计分、心绞痛计分)和次要指标(包括硝酸甘油停减情况、西雅图心绞痛量表评分、血液流变性各指标及其降低值)变化及不良反应。结果最终纳入253例患者进行评价分析,试验组127例,对照组126例。与本组治疗前比较,试验组与对照组的血瘀证计分、心绞痛计分和血液流变学各指标均降低,西雅图心绞痛量表评分改善(P0.05,P0.01);与对照组治疗后比较,试验组心绞痛计分、西雅图心绞痛量表评分、血液黏度(120.0 s-1)降低值均优于对照组(P0.05),治疗过程中未发现明显不良反应。结论基于"陈可冀院士血瘀证辨证方法"论治冠心病稳定性心绞痛安全有效,较常规血瘀证辨治方法具有一定优势。     

寒热并用攻补兼施法治疗心血管疾病

《黄帝内经》中提出治寒以热、治热以寒、虚则补之、实则泻之,张仲景《伤寒论》则提出了寒热并用、攻补兼施之法。寒热并用,攻补兼施是治疗动脉粥样硬化斑块取效的关键,益气温阳、活血祛痰为治疗心律失常的主要原则。采用寒温并用、攻补兼施方法,结合患者具体情况酌定温药、寒药的剂量与比例,患者可以长期耐受,尤其对一些现代难治病如房室传导阻滞的治疗效果甚佳。     

Systematic Review on Randomized Controlled Trials of Coronary Heart Disease Complicated with Depression Treated with Chinese Herbal Medicines

Objectives: This systemic review evaluated the efficacy and safety of Chinese herbal medicines (CHMs) in patients with coronary heart disease (CHD) complicated with depression. Methods: All databases were retrieved till September 30, 2014. Randomized controlled trials (RCTs) comparing CHMs with placebo or conventional Western medicine were retrieved. Data extraction, analyses and quality assessment were performed according to the Cochrane standards. RevMan 5.3 was used to synthesize the results. Results: Thirteen RCTs enrolling 1,095 patients were included. Subgroup analysis was used to assess data. In reducing the degree of depression, CHMs showed no statistic difference in the 4th week [mean difference (MD)=–1.06; 95% confidence interval (CI) –2.38 to 0.26; n=501; I2=73%], but it was associated with a statistically significant difference in the 8th week (MD=–1.00; 95% CI –1.64 to –0.36; n=436; I2=48%). Meanwhile, the combination therapy (CHMs together with antidepressants) showed significant statistic differences both in the 4th week (MD=–1.99; 95% CI –3.80 to –0.18; n=90) and in the 8th week (MD=–5.61; 95% CI –6.26 to –4.97; n=242; I2=87%). In CHD-related clinical evaluation, 3 trials reported the intervention group was superior to the control group. Four trials showed adverse events in the intervention group was less than that in the control group. Conclusions: CHMs showed potentially benefits on patients with CHD complicated with depression. Moreover, the effect of CHMs may be similar to or better than antidepressant in certain fields but with less side effects. However, because of small sample size and potential bias of most trials, this result should be interpreted with caution. More rigorous trials with larger sample size and higher quality are warranted to give high quality of evidence to support the use of CHMs for CHD complicated with depression.     

从代谢免疫角度谈病证结合防治冠心病

冠状动脉粥样硬化性心脏病（简称冠心病）是世界范围内具有高患病率和病死率的重大慢病。冠心病的发病过程中伴随着物质代谢紊乱和由此产生的慢性代谢性炎症，这提示代谢炎症有望成为防治冠心病的有效药物靶点。病证结合是中西医结合临床实践的重要模式，代谢免疫表型机制研究可帮助深入阐释病证结合的科学问题，深化病证结合和代谢免疫表型认识可为防治冠心病中药药效机制探索和创新药物研发提供新思路。