中药注射液防治蒽环类药物所致心脏毒性的系统评价

目的系统评价中药注射液防治蒽环类药物心脏毒性的作用,为中药注射液防治蒽环类药物心脏毒性的临床应用提供循证依据。方法检索中国知网、万方、维普、PubMed、CochraneLibrary和EMbase数据库,检索时限为建库至2020年8月31日,收集所有使用中药注射液防治蒽环类药物心脏毒性的临床研究,2名研究者严格按照纳入和排除标准独立进行文献筛选、数据提取,运用Cochrane系统评价手册的偏倚风险评估工具进行方法学质量评价,采用Rev Man5.3软件进行Meta分析。结果共纳入19项研究,1705例患者,所纳入研究总体质量一般。Meta分析结果显示:中药注射液可减少蒽环类药物所致心电图出现异常情况[OR=0.22,95%CI(0.17,0.29),P<0.000 01],降低心脏毒性[OR=0.26,95%CI(0.16,0.43),P<0.000 01],提高左室射血分数(left ventricular ejection fraction,LVEF)[MD=5.72,95%CI(4.16,7.29),P<0.000 01],降低肌酸激酶同工酶(creatine...     

中医药防治蒽环类抗肿瘤药物所致心脏毒性研究进展

综述中医药防治蒽环类抗肿瘤药物所致心脏毒性研究进展。蒽环类抗肿瘤药物是引起化疗后心脏毒性的最常见药物,通过文献检索,对目前中医药防治蒽环类药物心脏毒性的研究进展进行分析,发现单味中药、复方及中药注射剂均具有一定的防治蒽环类药物所致心脏毒性的作用。     

致心脏毒性中药的减毒及防治心脏毒性中药的研究进展

心脏毒性是药物临床应用的主要安全性问题之一。近年来,随着对中医药研究的重视与深入,关于对中药心脏安全性的评价与防治心脏毒性反应的研究日益增多,且研究方向集中在致心脏毒性中药的安全使用或靶向心脏的中药毒性成分的发现。关于中药心脏安全性评价的研究方法,该综述介绍了中药心脏安全性评价的临床指标、细胞与动物模型研究进展。关于提升中药心脏安全性的研究,该文回顾总结了常见致心脏毒性中药的毒性物质基础和作用机制,以及通过控制毒性物质含量、改变给药剂型、合理炮制、配伍等方式降低心脏毒性的研究。关于防治心脏毒性的方药与有效成分,该文归纳了近年来防治化疗药物诱导心脏毒性反应的方药及中药有效成分及其作用机制,以期对中药的心脏安全性评价与临床合理应用提供参考。     

基于CiteSpace对中医药治疗蒽环类所致心脏毒性的可视化分析

目的 通过文献计量学方法,评估中医药治疗蒽环类所致心脏毒性的研究趋势,并探讨机构合作、研究热点和前沿趋势。方法 计算机检索Web of Science、中国知网（CNKI）、万方、中国生物医学（CBM）和维普（VIP）数据库,检索2000年1月1日—2022年10月31日发表的关于中医药治疗蒽环类所致心脏毒性的中英文文献。运用文献计量学软件CiteSpace对国家、机构、期刊、作者、被引文献和关键词进行可视化分析。结果 检索到1134篇关于中医药治疗蒽环类所致心脏毒性的论文,其中英文文献237篇,中文文献897篇。该领域发文量逐年增加,发文量最多的国家是中国（117篇）;英文文献中发文量最多的机构是阿卜杜勒·阿齐兹国王大学（9篇）,中文文献发文量最多的机构是湖南中医药大学（45篇）。中医药治疗蒽环类心脏毒性主要以中成药研究为主,主要的治疗方向是蒽环类所致的心力衰竭和心肌病,心脏毒性早期更关注心肌损害,之后更关注心力衰竭。蒽环类心脏毒性研究分为临床研究和实验研究。该领域的早期研究主要集中在临床研究,近10年主要以分子机制研究为主;实验研究的早期主要以动物实验为主,近4年更关注细胞实验。氧化应激一直是该领域研究的主要趋势,氧化应激、凋亡和自噬分子机制及三者之间的关系研究将是该领域研究的主流趋势。结论 分子机制研究及氧化应激、凋亡和自噬机制之间的关系是中医药治疗蒽环类所致心脏毒性的研究热点和趋势,文献计量学分析结果为中医药研究人员提供了有价值信息,有助于研究者发现潜在的合作者和机构,发现该领域的热点问题和探索新的研究方向。     

中药对抑郁症模型动物作用的研究近况

动物抑郁症模型的建立是研究中药治疗抑郁症疗效、机理的前提和基础,许多中药在用于治疗抑郁症模型小鼠的实验研究中表现出较好的抗抑郁作用,因此近年来越来越受重视.本文对中药用于抑郁症动物模型的实验研究现状做一归纳.     

中药对抑郁症模型动物作用的研究近况

动物抑郁症模型的建立是研究中药治疗抑郁症疗效、机理的前提和基础,许多中药在用于治疗抑郁症模型小鼠的实验研究中表现出较好的抗抑郁作用,因此近年来越来越受重视.本文对中药用于抑郁症动物模型的实验研究现状做一归纳.     

中西医结合治疗视神经炎疗效评价的系统分析

目的系统评价中医中西医结合治疗视神经炎的临床研究质量、治疗方案与疗效。方法计算机检索中国生物医学文献数据库(CBM)和中国医院数字图书馆数据库(CHKD),收集有关视神经炎的中医或中西医结合治疗与西医对照组治疗疗效比较的随机对照试验文献,评价纳入研究的文献质量,并进行Meta分析。结果符合纳入标准的RCT共12个,但其方法学质量均欠佳(C级);与对照组相比,中西医结合治疗组有明显的增效作用(OR=5.30,95%CI[2.97,9.44],P<0.01)。结论目前有关中西医结合治疗视神经炎的临床研究在科研方法学的应用方面仍有差距。本研究提示,中西医结合治疗视神经炎可能具有一定的增效作用,但不排除与样本量偏少、试验方法学质量低下及发表性偏倚有关;现有资料未描述严重不良反应事件的发生。本文结论有待根据高质量随机对照临床试验结果进一步证实。     

病毒性肺炎中医病证结合动物模型研究进展

病毒性肺炎（viral pneumonia,VP）是一种严重危害人类健康的高发传染病。从中医角度看,VP属“风温”和“温病”。中药对VP具有良好的治疗效果,其作用机制可能与其对机体免疫平衡的调控、体内微生态的调控、炎症反应的抑制、肺纤维化的抑制、组织保护及直接抗病毒活性有关。动物模型是药物研发领域重要的实验手段。现有的VP动物模型多以西医为主,缺乏对中医证候的研究,不能反映中医辨证论治的特色。近年来,研究者一直在努力探索建立VP病证结合动物模型,使其能够更加准确地反映VP的不同中医证型和本质。通过对近年来中医疾病动物模型及相关肺炎病证模型进行分析,对其常见的建模方法、证型分类、证候研究及评价指标等进行综述,为建立符合中医辨证论治特点的VP动物模型提供参考。     

Association between metabolic syndrome and body constitution of traditional Chinese medicine: A systematic review and meta-analysis

BackgroundThe constitution theory of traditional Chinese medicine (TCM) states that body constitution and disease are associated; therefore, the identification of body constitution can provide reference for disease prevention and treatment. A series of clinical studies evaluating the association between TCM constitution and metabolic syndrome (MetS) have been conducted in recent years. The aim of this systematic review is to summarize and evaluate the clinical evidence of the relationship between constitution and MetS.MethodsThe PubMed, Embase, China National Knowledge Infrastructure (CNKI), Chongqing VIP, and Wanfang Data electronic databases were searched from April 2009 to July 2020. The search terms included “metabolic syndrome,” “constitution,” and “Chinese medicine.” Observational studies evaluating the relationship between body constitution of TCM and MetS were included. The primary outcome included the distribution of constitutional types in the MetS population, and odds ratio (OR) or relative risk (RR) between constitution and MetS. Effect size was expressed as proportion or OR with 95% confidence interval (CI). Methodological quality of included studies was evaluated by the Newcastle–Ottawa Scale (NOS) or the American Agency for Healthcare Research and Quality (AHRQ) criteria.ResultsThree case–control and 26 cross-sectional studies involving 30 435 cases were included. Phlegm-dampness, qi-deficiency, and damp-heat were the main constitution types in patients with MetS, accounting for 29% (22%–39%), 18% (13%–24%), and 12% (9%–17%) of the population, respectively; the risk of MetS in people with phlegm-dampness and qi-deficiency constitution was 1.74 [1.27, 2.38] and 1.29 [1.01, 1.65] times higher than that in those with other constitutions. There were sex- and age-related differences in the distribution of TCM constitution in patients with MetS.ConclusionPhlegm-dampness and qi-deficiency were associated with the occurrence of MetS. Well-designed cohort and case–control studies are needed to provide evidence for the use of TCM to prevent and treat MetS.     

中医体质与膝骨关节炎相关性研究系统评价与Meta分析

目的:总结中医体质与膝骨关节炎相关性研究现状,探讨膝骨关节炎患者中医体质分布规律。方法:检索Pub Med、Embase、Cochrane、CNKI、VIP、万方、CBM,采用Stata 12软件进行Meta分析。结果:共纳入十项研究(膝骨关节炎患者4161例)。结果表明,平和质、阳虚质、血瘀质占膝骨关节炎患者的比例分别为23%(14%～33%)、22%(21%～23%)、20%(13%～26%)。阳虚质是膝骨关节炎的危险因素,OR=2.43(1.49,3.95),而平和质和血瘀质人群膝骨关节炎发病风险的OR值分别为0.48(0.13,1.82)和0.70(0.50,0.98)。结论:本研究为中医药防治膝骨关节炎提供了临床证据,阳虚质与膝骨关节炎关系最为密切。     

中医药治疗特发性肺纤维化有效性和安全性系统评价和Meta分析

[目的]系统评价中医药治疗特发性肺纤维化(IPF)的有效性和安全性。[方法]两位评价者独立进行文献检索和筛选、资料提取及质量评价,根据干预措施分为试验组(中药或中药联合西药)和对照组(安慰剂或西药),评估肺功能[用力呼气量(FVC)、肺总量(TLC)、肺弥散功能(DLCO)]、动脉氧分压(PaO_2)、6 min步行试验(6MWD)、圣乔治呼吸问卷(SGRQ)评分、症状(咳嗽、呼吸困难)及不良反应发生率,采用Rev Man5.3软件进行Meta分析。[结果]纳入17篇随机对照临床试验(RCTs)文献(1 113例患者),汇总分析,与对照组比较,试验组可延缓肺功能(FVC、TLC、DLCO)下降,维持PaO_2和生活质量(SGRQ评分),改善咳嗽症状,不良反应发生率低(P0.05);但不能延缓6MWD下降,改善呼吸困难症状(P0.05);亚组分析,与西药治疗比较,中药联合西药治疗可延缓FVC、TLC、DLCO下降,维持PaO_2水平和SGRQ评分,单纯中药治疗仅能延缓FVC下降。[结论]观察疗程≥6月的研究结果显示,对比糖皮质激素或抗氧化剂,中药联合西药治疗≥6月可延缓IPF患者肺功能下降,维持氧合和生活质量,安全性较好,单纯中药治疗未能获益,但限于纳入试验的质量控制差异,本系统评价结论尚存在局限性。     

Examining patterns of traditional Chinese medicine use in pediatric oncology: A systematic review,meta-analysis and data-mining study

BackgroundTraditional Chinese medicine (TCM) is becoming a popular complementary approach in pediatric oncology. However, few or no meta-analyses have focused on clinical studies of the use of TCM in pediatric oncology.ObjectiveWe explored the patterns of TCM use and its efficacy in children with cancer, using a systematic review, meta-analysis and data mining study.Search strategyWe conducted a search of five English (Allied and Complementary Medicine Database, Embase, PubMed, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) and four Chinese databases (Wanfang Data, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and VIP Chinese Science and Technology Periodicals Database) for clinical studies published before October 2021, using keywords related to “pediatric,” “cancer,” and “TCM.”Inclusion criteriaWe included studies which were randomized controlled trials (RCTs) or observational clinical studies, focused on patients aged < 19 years old who had been diagnosed with cancer, and included at least one group of subjects receiving TCM treatment.Data extraction and analysisThe methodological quality of RCTs and observational studies was assessed using the six-item Jadad scale and the Effective Public Healthcare Panacea Project Quality Assessment Tool, respectively. Meta-analysis was used to evaluate the efficacy of combining TCM with chemotherapy. Study outcomes included the treatment response rate and occurrence of cancer-related symptoms. Association rule mining (ARM) was used to investigate the associations among medicinal herbs and patient symptoms.ResultsThe 54 studies included in this analysis were comprised of RCTs (63.0%) and observational studies (37.0%). Most RCTs focused on hematological malignancies (41.2%). The study outcomes included chemotherapy-induced toxicities (76.5%), infection rate (35.3%), and response, survival or relapse rate (23.5%). The methodological quality of most of the RCTs (82.4%) and observational studies (80.0%) was rated as “moderate.” In studies of leukemia patients, adding TCM to conventional treatment significantly improved the clinical response rate (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 1.49–4.36), lowered infection rate (OR = 0.23; 95% CI = 0.13–0.40), and reduced nausea and vomiting (OR = 0.13; 95% CI = 0.08–0.23). ARM showed that Radix Astragali, the most commonly used medicinal herb (58.0%), was associated with treating myelosuppression, gastrointestinal complications, and infection.ConclusionThere is growing evidence that TCM is an effective adjuvant therapy for children with cancer. We proposed a checklist to improve the quality of TCM trials in pediatric oncology. Future work will examine the use of ARM techniques on real-world data to evaluate the efficacy of medicinal herbs and drug-herb interactions in children receiving TCM as a part of integrated cancer therapy.     

Advances in heroin addiction treatment with traditional Chinese medicine: a systematic review of recent Chinese language journals

The aim of this review is to critically examine the clinical trial research on Traditional Chinese Medicine (TCM) as an intervention in treating heroin addiction in People's Republic of China. This review examines Chinese-language-only publications for the patent medicines: Shenfu Tuodu, Fukang Pian, and Shifu Sheng. Other compound medicines will be reviewed in future publications. A systematic review of the literature was conducted in Western and Chinese databases. Most trials were excluded because they did not declare randomization and had poor methodology or reporting. The majority of clinical evidence in the random controlled trials demonstrates good evidence for TCM patent medicines in heroin addiction treatment. When compared to typical Western medications, TCMs demonstrate fewer side-effects, in addition to equal measures of treatment efficacy and safety.     

Therapeutic effect of Soshiho-tang,a traditional herbal formula,on liver fibrosis or cirrhosis in animal models: A systematic review and meta-analysis

Ethnopharmacological relevance

Liver fibrosis has been recognized as a major lesion of the liver that leads to liver cirrhosis at the end stage. Soshiho-tang (SST) has been used to improve liver fibrosis/cirrhosis by ameliorating fibrosis-specific markers. This study aimed to assess the efficacy of SST on liver fibrosis/cirrhosis through a systematic review of the literature and meta-analysis using animal models.

Materials and methods

Studies of SST treatment in liver fibrosis/cirrhosis-induced animal models were searched by electronic data bases. The quality of the studies included was assessed and the efficacy of SST was evaluated based on markers from liver tissues and serum.

Results

Among the 838 studies identified in the literature search, 20 studies that met the inclusion criteria were included in the analysis. SST significantly reduced the elevated levels of fibrosis markers, such as the degree of fibrosis, hydroxyproline, hyaluronic acid, transforming growth factor-β1, and procollagen III in liver tissues, and aspartate aminotransferase, alanine aminotransferase, procollagen III, tissue inhibitor of metalloproteinase-1, and type IV collagen in the serum.

Conclusions

SST was effective in decreasing pathologically increased markers in animal models of liver fibrosis/cirrhosis. A larger-scale of animals, well-designed animal study is expected to improve the methodological quality, heterogeneity, and potential biases of the meta-analysis.     

中药治疗慢性荨麻疹临床研究的系统评价

目的系统评价中药治疗慢性荨麻疹的临床研究。方法应用计算机系统检索PubMed、中国期刊全文数据库、中文科技期刊数据库、万方数据库,收集2002～2011年发表的国内外所有关于中药与新一代H1受体拮抗剂治疗慢性荨麻疹的随机对照研究(RCT)和临床对照研究(CCT)。纳入的文献通过Jadad量表评价方法学质量,采用Cochrane提供的Review Manager 5软件进行系统评价。结果共纳入10篇文献,8篇RCT和2篇CCT,共计827例慢性荨麻疹患者。10篇文献只有1篇描述了随机方法,均未提及随机化隐藏和盲法,只有1篇提到失访,却未阐明理由,属于低质量文献,文献之间存在异质性。结论中药在慢性荨麻疹的治疗中有较好临床疗效,尤其在改善不良反应和复发率上有明显效果。中药治疗慢性荨麻疹的疗效值得重视,但目前研究质量不高,治疗方案不统一,缺乏客观指标,根据现有证据不能得出肯定结论,需进一步开展设计严格的临床研究。     

中医药治疗免疫性血小板减少性紫癜的概况

免疫性血小板减少性紫癜(ITP)是一种较为常见的出血性疾病。现代医学应用大剂量丙种球蛋白、环孢素A及血浆置换等方法,亦取得一定疗效,但存在着不良反应大、费用高及远期疗效差等问题。中药治疗本病远期疗效较好,且不良反应少。综合近几年中医药治疗ITP的文献,从ITP的病因病机,分型论治,专方专药及中西医结合等方面探讨该病最新研究进展,并阐述中医在治疗方面疗效可靠,可减少单纯西药治疗导致的不良反应。     

Effects of South African traditional medicine in animal models for depression

Ethnopharmacological relevance

The four South African medicinal plants Agapanthus campanulatus (AC), Boophone distica (BD), Mondia whitei (MW) and Xysmalobium undulatum (XU) are used in traditional medicine to treat depression.

Aim

To evaluate the effect of ethanolic extracts of the plants in models for depression.

Materials and methods

The extracts were screened for affinity for the serotonin transporter (SERT) in the [³H]-citalopram-binding assay. The inhibitory potency of the extracts towards the SERT, the noradrenalin transporter (NAT) and the dopamine transporter (DAT) were determined in a functional uptake inhibition assay. Antidepressant-like effects of the extracts were investigated using the tail suspension test (TST) and the forced swim test in both rats (rFST) and mice (mFST).

Results

All four plants showed affinity for SERT in the binding assay. AC and BD showed functional inhibition of SERT, NAT and DAT, MW affected SERT while XU showed no effect. BD showed significant effect in the TST and in the mFST/rFST, AC showed significant effect in mFST, MW showed significant effect in the rFST and XU showed significant effect in the mFST.

Conclusion

In this study we have demonstrated the antidepressant activity of four South African medicinal plants in vitro and in vivo, supporting their rational use in traditional medicine.     

基于临床中西医病症特点的中医药动物模型评价新方法

随着中医药研究的需要,各种类型的动物模型被广泛地用来研究人类疾病,动物模型已在中医药领域发挥了不可替代的作用,尤其是对疾病发病机制解析、预防、药物筛选与治疗评价、诊断标志物的发现等做出了巨大的贡献,是生物医学乃至整个生命科学研究的基础和重要组成部分,动物模型建立是否成功、有哪些指标体系等缺少必要的评价方法,这是一个极具价值的关键性问题。本文全面梳理了动物模型的研究以及动物模型评价现状,基于临床中西医病症特点,并将动物模型的表征指标进行量化分级,由此提出了评价动物模型的新方法,以期使动物模型的评价方法更趋于标准化、客观化、规范化,促进中医药研究事业的跨越式发展。     

基于中药系统毒理学数据库探讨中药致心脏毒性的作用特点及规律

目的 基于中药系统毒理学数据库分析探讨中药致心脏毒性的作用特点及规律,为中药增效减毒和临床应用提供一定依据。方法 检索中药系统毒理学数据库收录的252味中药,汇总数据库中收录的文献,研究探讨中药致心脏毒性的作用特点,采用频数算法分析致心脏毒性中药的功效、四气五味、归经、毒性等级及毒性成分,总结分布规律。结果 筛选并纳入致心脏毒性药物共74味,同时具有其他脏器毒性的中药共65味,其中兼有肝毒性的中药最多,肾毒性、神经系统毒性次之。祛风湿药占比最高（除其他类）,活血化瘀药、外用药次之;药味以苦为主,辛、甘次之;药性以温为主,寒、平次之;归经主入肝、肺、脾经;毒性以中毒为主。致心脏毒性的活性成分主要为生物碱类,其次为甾体类、萜类。结论 中药致心脏毒性临床病理表现主要为心肌细胞损伤;临床毒性表现主要为心律失常、心力衰竭、心肌梗死等;机制研究多以细胞能量代谢、离子通道为主;减毒方法包括炮制、配伍、针刺等;致心脏毒性中药多性温,味苦,归肝、肺、脾经,毒性等级多为中毒;心脏毒性物质基础以生物碱类成分为主。