建立中医药网络心血管病学的思考

随着复杂网络理论研究的进展,对于复杂系统的认识和探索方法已经发生了革命性的变化。基于网络的方法应用在生物医学研究中,产生了网络生物学和网络药理学。心血管系统可以抽象为一个复杂网络,而心血管疾病则可以看作网络结构和功能的损伤所致。中医药治疗心血管疾病确有良好的临床疗效,而其相关机制至今仍未阐明。笔者提出在复杂网络理论、网络生物学和网络药理学指导下,应用网络的方法来研究中医药防治心血管疾病的机制,从而产生一门新的学科——中医药网络心血管病学。本文简单介绍了复杂网络理论、网络生物学和网络药理学,从网络的角度阐发了“病-证-方-药”相关的实质。将网络生物学用于分析心血管疾病和证候,网络药理学用于分析复方和中药,这种基于“网络一网络”的研究方法可以为阐明中医药机制提供新的视角。     

Metabonomics: A Useful Tool to Reveal Underlying Relationships between Altered Chinese Medicine Syndromes and Ultrafiltration in Treatment of Heart Failure

Objective:To reveal the underlying relationships between Chinese medicine(CM)syndromes and ultrafiltration(UF)in the treatment of heart failure based on a metabonomic approach.Methods:Seventeen acute decompensated heart failure(ADHF)patients were enrolled,and their CM syndromes before and after UF were collected.In addition,their venous plasma collected before and after UF was used for liquid chromatographmass spectrometer-based metabonomic analysis.Both reversed phase liquid chromatography and hydrophilic interaction liquid chromatography were used to analyze the plasma samples.Partial least-squares to latent structure-discriminant analyses were used for data analysis.Results:An obvious difference was observed preand post-treatment.A total of 17 potential biomarkers associating with alterd syndromes with UF including hypoxanthine,1-methylhistidine,phytosphingosine,O-decanoyl-R-carnitine,etc.were screened out,showing a significant change after UF.The major adjusted m etabolic pathways were purine metabolism,histidine metabolism,leucine and isoleucine metabolism,arginine and proline metabolism,carnitine shuttle,sphingolipid metabolism and phospholipid metabolism.Conclusions:Metabonomic approach is a useful tool to identify potential biomarkers of altered syndromes link to UF and could provide a theoretical basis for further research on the therapeutic mechanism of UF combined with CM.     

糖尿病患者中医证候特点及其相关因素探讨

目的 探讨糖尿病患者中医证候特点及其相关因素.方法 问卷调查糖尿病患者症状以判断中医证候,同时调查患者一般情况、多种生化检查结果及糖尿病相关问题并作统计分析.结果 糖尿病患者证候中肾虚证、痰湿证和血瘀证最多见,阴虚证和气虚证亦占有较大比例,相应地与之相关的多证候出现的几率亦较高,而传统所认为的燥热证并不多见.结论 糖尿病患者中医证候特点较之传统的认识已有很大的变化,应引起临床工作者的重视.     

Evidence-Based Therapies of Chinese Medicine for Chronic Urticaria: Where Do We Stand and Where Are We Going?

Chronic urticaria (CU) is characterized by repeated occurrence of wheals or itching for more than 6 weeks. When urticaria symptoms repeatedly occur despite taking Western medicines such as antihistamines, Chinese medicine (CM) has been shown to relieve symptoms and prevent recurrence. However, the lack of robust evidence from the evidence-based medicine perspective is hindering acceptance of CM by the Western medicine community. In recent years, more and more evidence-based studies of CU treatment by CM were report in English literatures, including acupuncture, herbs, and food, although some of evidence is still with low quality. These progress in CM treatment of CU will inspire high quality evidences via randomized, controlled trials assessing effificacy and safety of CM treatment of CU.     

量表在中医药研究中的应用现状与展望

分析了量表在中医药研究中的应用现状,提出了存在的问题及今后的研究思路。近年来,人们不仅将国际上通用的一些量表应用于中医的临床研究中,用于量化评定患者的心理状态、主观症状、中医药临床疗效及其与中医证候的关系等,而且还初步开始了一些与中医证候有关的量表制订工作,以期对某种证候的诊断与严重程度作出评定。这些工作对于中医药研究和证、症的规范化、标准化起到了积极的促进作用。进一步研制具有中医特色的量表是今后继续努力的方向,但要首先注意症状术语及其内涵的规范问题,同时要根据所研制量表的不同目的,注意借鉴心理测量的理论和量表的研究方法,探索各种类型中医量表的研究,并进一步规范中医量表的研究过程。     

Shen (Kidney)-Tonifying Principle for Primary Osteoporosis: to Treat Both the Disease and the Chinese Medicine Syndrome

Primary osteoporosis (POP) is one of the most common diseases in the elderly people resulting in high risk of fracture and poor quality of life. In addition to the pathological changes in bone mass, most of the POP patients also suffer from Chinese medicine (CM) syndromes of Shen (Kidney) essence deficiency. Shen essences are highly related to bone. Shen essence deficiency plays an important part in the development of POP and a better diagnosis of POP could be made by combining CM syndromes with Western medicine risk factors. Treatments of POP should aim at both increasing the bone mass and relieving the syndromes of Shen essence deficiency. Clinical study confirmed that treating POP patients with Shen-tonifying herbs could increase the bone mass and relieve the CM syndromes of POP patients. Basic researches clarified the mechanism by which Shen-tonifying herbs increased bone mass in animal models. The mechanisms by which Shen-tonifying herbs relieve the CM syndromes are still in investigation.     

Chinese medicine pattern diagnosis could lead to innovation in medical sciences

Chinese medicine(CM) pattern diagnosis(Bianzheng or syndrome differentiation),as another patient classification approach,has been incorporated with biomedicine diagnosis in clinical practice in China,and the clinical experience has proven that the integration of biomedicine and CM is better in the treatment of many diseases.CM pattern diagnosis is completely different from the diagnosis in biomedicine,and it must take an active role in innovation for medical sciences.This paper is trying to discuss how CM pattern diagnosis lead to innovations in basic research,clinical research and new drug discovery.Scientific basis of CM pattern in innovation of basic research,clinical efficacy and safety,CM pattern based clinical trial design,CM pattern and clinical practice guideline in innovation of clinical study, CM pattern based indication finding,and CM pattern based network pharmacology in innovation of new drug discovery have been discussed.     

Key Symptoms Selection for Two Major Syndromes Diagnosis of Chinese Medicine in Chronic Hepatitis B

Objective

To identify key symptoms of two major syndromes in chronic hepatitis B (CHB), which can be the clinical evidence for Chinese medicine (CM) doctors to make decisions.

Methods

Standardization scales on diagnosis for CHB in CM were designed including physical symptoms, tongue and pulse appearance. The total of 695 CHB cases with dampness-heat (DH) syndrome or Pi (Spleen) deficiency (SD) syndrome were collected for feature selection and modeling, another 275 CHB patients were collected in different locations for validation. Key symptoms were selected based on modified information gain (IG), and 5 classifiers were applied to assist with models training and validation. Classification accuracy and area under receiver operating characteristic curves (AUC) were evaluated.

Results

(1) Thirteen DH syndrome key symptoms and 13 SD syndrome key symptoms were selected from original 125 symptoms; (2) The key symptoms could achieve similar or better diagnostic accuracy than the original total symptoms; (3) In the validation phase, the key symptoms could identify syndromes effectively, especially in DH syndrome, which average prediction accuracy on 5 classifiers could achieve 0.864 with the average AUC 0.772.

Conclusion

The selected key symptoms could be simple DH and SD syndromes diagnostic elements applied in clinical directly. (Registration N0.: ChiCTR-DCC-10000759)

     

中西医结合治疗对尿微量白蛋白排泄的影响

目的观察以血管紧张素转换酶抑制剂（ACEI）加益气养阴、活血化瘀中药对非肾脏疾病早期肾损害患者尿微量白蛋白排泄的影响.方法入选糖尿病伴早期糖尿病肾病、高血压病及冠心病伴早期肾损害三组患者195例,再将各组随机分为二个亚治疗组,分别给予ACEI及ACEI加中药治疗.结果糖尿病组、高血压病组及冠心病组患者24 h尿微量白蛋白排泄量（UAE）高于正常老年对照组（P＜0.01）,亚组1经ACEI治疗后,尿微量白蛋白排泄率（UAER）均有不同程度下降（P＜0.01或P＜0.05）.亚组2经ACEI加中药治疗后,UAER比亚组1降低（P＜0.05）.结论 ACEI加益气养阴、活血化瘀中药能有效减少糖尿病肾病、高血压病及冠心病早期肾损害患者尿蛋白排出,延缓肾损害进展,中西医结合治疗效果优于单纯ACEI治疗.     

代谢组学在中药研究中的应用

In recent years, a novel analytical technology, metabolomics is widely used in the modernresearch of Chinese medicine （CM）. Metabolomics adopts a ＂top-down＂ strategy to reflect the function oforganisms from terminal symptoms of metabolic network and understand metabolic changes of a completesystem caused by interventions. As a holistic approach, metabolomics technology, including nuclear magneticresonance, gas chromatography-mass spectrometry, and liquid chromatography-mass spectrometry, favorableto express the meaning of basic theories of CM, CM syndrome and Chinese herb. Therefore, we believe thatmetabolomics technology will greatly benefit to development for the research of CM in the light of modernsciences.     

Toward Evidence-Based Chinese Medicine: Status Quo, Opportunities and Challenges

How to test the treatments of Chinese medicine(CM) and make them more widely accepted by practitioners of Western medicine and the international healthcare community is a major concern for practitioners and researchers of CM.For centuries,various approaches have been used to identify and measure the efficacy and safety of CM.However,the high-quality evidence related to CM that produced in China is still rare.Over the recent years,evidence-based medicine(EBM) has been increasingly applied to CM,strengthening its theoretical basis.This paper reviews the past and present state of CM,analyzes the status quo,challenges and opportunities of basic research,clinical trials,systematic reviews,clinical practice guidelines and clinical pathways and evidence-based education developed or conducted in China,pointing out how EBM can help to make CM more widely used and recognized worldwide.     

Chinese medicine approach in clinical practice for breast cancer survivors

A Chinese medicine(CM) approach,designed based on the clinical experiences of the West Los Angeles Center for Traditional Chinese Medicine,is a practical path for assessing and treating breast cancer survivors.The approach consists of balancing the body with deciphering the cause of the patient’s chief complaints by assessing and recognizing the six physiological dysfunctions that include gastrointestinal problems,sleeps problems,emotional imbalance,low body energy,menstrual change and pain.Muitifaceted interventions are used for eliminating various CM pathologies based on identifying the basic CM patterns (syndromes) differentiation.Watching to assess the above two situations dynamically is used for outcome evaluation and predicting prognosis.Therefore this approach is called BMW.It can serve as a reference for CM clinical practice and integrative clinical care.It also can be used to simplify the clinical interpretation of CM and provide an easier way for CM doctors to communicate with Western medical doctors and patients. Additionally,it can be used as a guide for patients to assess their own symptoms for self-monitoring and self-care.     

Statistical identification of syndromes feature and structure of disease of western medicine based on general latent structure model

<正>Syndrome differentiation is the character of Chinese medicine(CM).Disease differentiation is the principle of Western medicine(WM).Identifying basic syndromes feature and structure of disease of WM is an important avenue for prevention and treatment of integrated Chinese and Western medicine.The idea here is first to divide all patients suffering from a disease of WM into several groups in the light of the stage of the disease,and secondly to identify basic syndromes feature in a distinct stage,and finally to achieve the purpose of syndrome differentiation.Syndrome differentiation is simply taken as a classifier that classifies patients into distinct classes primarily based on overall observation of their symptoms.Previous clustering methods are unable to cope with the complexity of CM.We therefore show a new multi-dimensional clustering method in the form of general latent structure(GLS) model,which is a suitable statistical learning technique of latent class analysis.In this paper,we learn an optimal GLS model which reflects much better model quality compared with other latent class models from the osteoporosis patient of community women(OPCW) real data including 40-65 year-old women whose bone mineral density(BMD) is less than mean-2.0 standard deviation(M-2.0SD). Further,we illustrate a case analysis of statistical identification of CM syndromes feature and structure of OPCW from qualitative and quantitative contents through the GLS model.Our analysis has discovered natural clusters and structures that correspond well to CM basic syndrome and factors of osteoporosis patients(OP). The GLS model suggests the possibility of establishing objective and quantitative diagnosis standards for syndrome differentiation on OPCW.Hence,for the future it can provide a reference for the similar study from the perspective of a combination of disease differentiation and syndrome differe(?)on.     

带状疱疹的临床特征及与他汀类药物关系的回顾性研究

背景　带状疱疹作为常见病毒感染性疾病,在体内病毒重新复活时可引起皮肤丘疹水疱,并可伴有神经痛、带状疱疹眼病、继发感染等,严重影响患者生活质量。他汀类药物作为调脂药物,在临床中应用广泛。目前已有研究证实带状疱疹的发生与他汀类药物的使用存在联系。目的　分析带状疱疹的临床特征,探讨带状疱疹发病与他汀类药物使用的关系。方法　收集2014年11月—2016年11月于重庆医科大学附属第一医院住院并诊断为带状疱疹患者731例作为带状疱疹组,同期收集非带状疱疹患者731例作为对照组。收集研究对象的一般资料,包括性别、年龄、吸烟史、饮酒史、体质指数（BMI）、血脂水平、合并症、他汀类药物和抗血小板凝集药物使用情况、脂肪肝发生情况。分析带状疱疹患者的性别、年龄分布,带状疱疹与烟酒史、BMI、血脂水平、合并症、他汀类药物和抗血小板凝集药物使用情况的关系。将带状疱疹组根据患者年龄分为≤30岁亚组49例、31~60岁亚组261例、>60岁亚组421例,比较各亚组带状疱疹发病的特点。结果　带状疱疹组他汀类药物使用率高于对照组（P<0.05）。带状疱疹组患者中,有合并症患者446例（61.0%）,其中存在2种及以上合并症228例（51.1%）。常见的合并症是高血压242例（54.3%）及糖尿病134例（30.0%）。不同年龄亚组患者带状疱疹发生率比较,差异有统计学意义（P<0.05）。>60岁亚组合并高血压、除外高血压的其他心血管疾病、脑卒中发生率、他汀类药物使用率高于≤60岁亚组（P<0.05）;31~60岁亚组合并糖尿病发生率高于≤30岁亚组（P<0.05）;≤30岁亚组合并肿瘤发生率高于31~60岁亚组和>60岁亚组 （P<0.05）;31~60岁亚组合并结缔组织病发生率低于≤30岁亚组,但高于>60岁亚组,≤30岁亚组合并结缔组织病发生率高于>60岁亚组（P<0.05）。结论　带状疱疹的发生可能与年龄增长及服用他汀类药物有关。     

免疫耐受期慢性乙型肝炎病毒携带者的证型分布

Objective： To explore Chinese medicine （CM） syndrome distribution of chronic hepatitis B virus （HBV） carriers in immunotolerant phase （ITP）. Methods： One hundred and eighty-five chronic HBV carriers in ITP, seen in the Third Affiliated Hospital of Sun Yat-sen University from May 2009 to December 2010, were admitted in an observational study under the guidance of CM. Patients＇ CM symptoms and signs, demographics, liver biochemistries, and qualitative HBV DNA were recorded in the questionnaires. CM syndromes were then differentiated to 15 detailed types and analyzed by generalization. Lastly, the location, pathogenic factors and nature of the disease were also assessed. Results： When CM syndrome patterns were differentiated to 15 types, there were 27 （15%） no syndrome cases, 94 （50%） single syndrome cases and 64 （35%） compound syndromes cases. The main detailed syndromes included Liver （Gan）-qi depression （LQD）, Kidney （Shen）-qi deficiency （KQD）, Spleen （Pi）-qi deficiency （SQD） and Kidney-yang deficiency （KYAD）. After CM syndromes generalized to five types, their frequency was Spleen-Kidney deficiency （SKD）〉LQD〉inner dampness-heat retention （IDHR）〉Liver-Kidney deficiency （LKD）〉blood stasis blocking collateral （BSBC）. SKD and LQD occupied 64%. The disease location included Liver, Gallbladder （Dan）, Spleen, Stomach （Wei） and Kidney. The pathogenic factors were mainly qi stagnation, qi deficiency, yang deficiency, concurrently dampness-heat and blood stasis. The deficiency syndrome was more than excess syndrome in its nature. Conclusions： Most of chronic HBV carriers in ITP have their CM syndrome, and the most common types are SKAD, LQD. This study suggests that the natural history may be improved through breaking the state of immune tolerance or shorten the time of ITP by strengthening Spleen-Kidney and reliving Liver qi.     

Appraisal of the Quality and Contents of Clinical Practice Guidelines for Hypertension Management in Chinese Medicine: A Systematic Review

Objective: To evaluate the quality and consistency of recommendations in the clinical practice guidelines(CPGs) for hypertension in Chinese medicine(CM). Methods: CM CPGs were identified from 5 electronic databases and hand searches through related handbooks published from January 1990 to December 2013. Three reviewers independently appraised the CPGs based on the Appraisal of Guidelines for Research and Evaluation(AGREE Ⅱ) instrument, and compared the CPGs' recommendations on CM syndrome pattern classification and treatment. Results: Five CM CPGs for hypertension were included. The quality score of the evidence-based(EB) guideline was higher than those of the consensus-based with no explicit consideration of evidence-based(CB-EB) and the consensus-based(CB) guidelines. Three out of five patterns in the CPGs were recommended by the EB guideline. Tianma Gouteng Formula(天麻钩藤复方) in the EB guideline was recommended mostly for hypertension patients with pattern of ascendant hyperactivity of Gan(Liver)-yang and pattern of yin deficiency with yang hyperactivity in the CPGs. Acupuncture and massage were recommended for Grade Ⅰ and Grade Ⅱ hypertension with severe symptoms weakening the quality of life in the EB guideline. For Grade Ⅰ and Grade Ⅱ hypertension, CM could be used alone, while for Grade Ⅲ hypertension, they should be used in combination with Western medicines. Conclusion: The quality of EB guideline was higher than those of CB and CB-EB CPGs in CM for hypertension and CM should be prescribed alone or combined with Western medicines based on the grade of hypertension.     

Preliminary Research on Syndrome Types of Chinese Medicine in Children with Primary Nephrotic Syndrome

Objective

To provide an objective reference for the syndrome types of Chinese medicine (CM) associated with pediatric primary nephrotic syndrome (PNS).

Methods

A cross-sectional study was performed. Data on clinical symptoms, CM syndrome types, biochemical indices, and medications used were collected from 98 children with PNS. Then, the correlation between CM syndromes and biochemical indices, as well as medications used, was analyzed.

Results

The four most common symptoms in children with PNS were brown urine, red tongue, excessive sweating, and swelling of the face and limbs. The syndromes of qi deficiency of Fei (Lung) and Shen (Kidney) (FSQD) and yin deficiency of Gan (Liver) and Shen (GSYD) were the most common main CM syndrome types. FSQD syndrome score correlated significantly with the total cholesterol level, urine protein/creatinine ratio, and urine IgG and albumin levels (P<0.01 or P<0.05). The use of maintenance glucocorticoids combined with immunosuppressive agents correlated with FSQD syndrome, and the use of maintenance glucocorticoids alone correlated with GSYD syndrome (P<0.05).

Conclusion

Two of the most common CM syndrome types were FSQD and GSYD syndromes. FSQD syndrome may be caused by some factors related to lipid levels, protein loss, and the use of immunosuppressive agents. The use of maintenance glucocorticoids may cause GSYD syndrome