A clinical epidemiological study of the quantitative diagnosis scale of blood stasis syndrome

Objective  

To establish the diagnosis scale of blood stasis syndrome (BSS) and explore the idea and method of using scale to research the quantitative diagnosis of Chinese medicine (CM) syndrome.     

血瘀证研究进展

血瘀理论源自《内经》,在不断的丰富和发展中血瘀证研究已经成为中西医结合最紧密的研究领域之一。在气滞、气虚、痰凝、阳虚、血热、外伤等致瘀因素作用下,血瘀证患者会产生血液及血管两方面的病理变化,这些变化与肿瘤的形成和转移有一定的关系,基于这种关系衍生出了运用活血化瘀法抗肿瘤的临床与基础研究。目前血瘀证的造模方法主要有仿照病因病机造模和重复病理过程造模两种,但能够全面体现血瘀证四诊要点的复合模型暂时还未出现。舌诊是血瘀证诊断的一个核心环节,目前的研究主要集中在舌色、舌苔、舌质、舌下络脉等领域,但评价标准和方法尚在摸索当中。     

血瘀证患者实验室指标诊断贡献度比较研究

目的探讨血液黏稠度、血脂、一氧化氮等实验室指标在血瘀证诊断中的贡献度。方法分别运用回归分析、主成分分析、判别分析方法来分析各指标对于血瘀证诊断的贡献度。结果回归分析发现甘油三酯、高密度脂蛋白、低密度脂蛋白、全血黏度、血浆黏度、RBC压积、RBC变形、一氧化氮对于血瘀证诊断比较重要。主成分分析发现全血黏度、红细胞压积、甘油三酯、总胆固醇、低密度脂蛋白、内皮素、纤溶酶原激活物、红细胞变形性对于血瘀证诊断具有代表性。判别分析发现高密度脂蛋白、低密度脂蛋白、全血黏度、血浆黏度、血小板黏附性、血小板聚集性、红细胞压积、红细胞变形性、一氧化氮、甘油三酯对于血瘀证的诊断具有较好的区分能力。结论从不同角度来分析临床信息对于血瘀证诊断的重要性和贡献度,这对于血瘀证诊断具有一定的意义,尤其在制定证侯诊断量表中值得借鉴。     

血细胞参数与血液流变学指标对血瘀证诊断的比较

为了比较血细胞参数与血液流变学指标对血瘀证的诊断价值,为血瘀证的诊断提供新的参考指标,对９６例血瘀证患者和６０例健康人进行１１项血细胞参数和６项血液流变学指标的测定,结果显示：４项血细胞参数和５项血液流变学指标,血瘀证组显著高于对照组（Ｐ＜０．０１）;血细胞参数和血液流变学指标对血瘀证的阳性率分别为９１．７％和８７．５％,两者无显著差异（Ｐ＞０．０５）;两者对血瘀证诊断的特异性基本一致,而敏感性血细胞参数好于血液流变学指标,表明血细胞参数可作为诊断血瘀证的新参考指标。     

血瘀证量化诊断及病证结合研究

目的　探讨血瘀证量化诊断的方法和血瘀证证候实质。方法　对临床预试验血瘀证症状体征及客观指标进行t检验和回归分析。结果　 ( 1) 182例血瘀证与非血瘀证患者内皮素、一氧化氮、纤溶酶原激活物 t检验均有显著性差异。 ( 2 ) 170例血瘀证与非血瘀证患者血红蛋白、甘油三酯、总胆固醇、内皮素、一氧化氮、纤溶酶原激活物 6因素的逐步回归显示其贡献度的顺序为内皮素 >血红蛋白 >纤溶酶原激活物 >一氧化氮 ,甘油三酯及总胆固醇未能入选。 ( 3)对 6 0 1例患者血瘀证症状体征 4 0因素逐步回归分析 ,当F =6时选出的 18因素对血瘀证诊断贡献度最大 ,并得一回归方程。将数量化资料代入回归方程进行检验 ,总符合率为 94 .2 4 %。结论　通过多中心、前瞻性、大规模、随机对照的临床流行病学调查和临床试验 ,可以得出病证结合规范且量化的由症状、体征和客观指标构成的标准化中医证候。     

Clinical and experimental study on shenghong kangyan su in treating 144 cases of pelvic inflammation with blood stasis syndrome

Using the method of clearing up heat and resolving stasis, the authors treated 144 cases of pelvic inflammation with blood stasis syndrome (BSS) with Shenghong Kangyan Su. The total effective rate was up to 97.92%, cure rate up to 68.75%, without toxicity and side effects. Clinical and experimental study showed that the crux of pelvic inflammation with BSS had some relations with microcirculation obstruction. Inflammation may cause microcirculation obstruction and blood stasis, and is one forms of BSS. Therefore dull purple-tongue, undertongue vein dilated, abdominal pain in lower-part, pathologic mass can be regarded as the basis of diagnosis of pelvic inflammation with BSS The drug of clearing heat and resolving status has the functions of anti-inflammation, anti-pain, diminishing the obstruction of microcirculation, particularly in speeding up the blood flowing, lowering the aggregation of erythrocyte, P less than 0.001.     

一对双生子血瘀证糖尿病家系的调查报告

目的:从一对双生子先证者切入研究糖尿病的家族聚集性,为家系证候集约化的中西医结合研究提供新思路。方法:以双生子糖尿病先证者为核心,进行家系调查与中医证候症状评定分析。采用170项六纲辨证症状因子量表进行症状的四级评分,即无(0分)、轻(1分)、中(2分)、重(3分),同时运用血瘀证量表进行评定,然后使用糖尿病控制状况评价量表和糖尿病患者生存质量特异性量表进行问卷调查。结果:获得了包含26个成员的一个双生子的血瘀证糖尿病家系图,其中有9例可疑糖尿病患者,一对双生子(大双为糖代谢异常,小双为糖尿病),同时这两位双生子均有血瘀证(大双为轻度,小双为重度)。我们所调查的两位双生子都分别记载了六纲症状定性分、定量分和糖尿病控制状况评分。结论:从家系图可知,先证者糖尿病的一级亲属和二级亲属均有部分可疑糖尿病患者,从而可推知糖尿病具有明显的家族聚集性。由于两位双生子均有血瘀证,提示糖尿病与血瘀证可能有一定的相关性。虽然她们有肾虚倾向,但她们的六纲症状分太低,不足以诊断为肾虚证。     

中医心系问诊量表的研制及评价

目的：研制中医心系问诊量表,初步探讨中医问诊的规范化研究方法。 方法：运用量表制作方法,以中医理论为指导,在文献梳理的基础上,研制中医心系问诊量表。借助频次、Delphi法和卡方检验等多元统计学方法筛选症状,反复修改心系问诊量表,并进行重测信度、内部一致性信度和内容效度等评价。 结果：中医心系问诊量表主要包括基本信息、主诉、现病史（伴随症状）和既住史,并附望、切诊信息及中西医诊断结论。其中一般问诊包括寒热、汗、头身胸腹、饮食口味、二便、睡眠、情绪、妇女等8个维度,最终筛选出66个症状变量。经专家讨论,量表具有较好的内容效度;整个量表一致性检验的克朗巴赫系数。为0．82。同一专家前后两次诊断的一致性结果显示心气虚、心阳虚、痰浊和寒凝的辨证诊断一致性较高,同一医生前后两次测量的Kappa值均在0．74～1之间;评分者信度评价中心气虚、心阳虚、心血虚和心阴虚的诊断一致性较高,Kappa值分别为0．63、0．72、1和0．48,其余的诊断一致性较低或不能说具有一致性。 结论：运用量表制作方法对中医问诊进行规范化研究具有一定的可行性,心系问诊量表的研制,还可为其他脏腑问诊量表的研制提供参考。     

冠心病室壁运动检测技术新进展

在心血管疾病的诊断中,对局部心功能的定量诊断仍是一个难题。室壁运动分析是冠心病超声检查的重要组成部分。传统的超声心动图技术评价室壁运动是主观和半定量的。随着超声技术发展,室壁运动检测新方法不断出现。在过去10年中出现的组织多普勒技术和最近的斑点追踪技术都是评价左室功能的临床和实验室新技术。这些在标准二维灰阶基础上发展起来的新技术都是客观的新方法,为研究节段性室壁运动功能提供了直观、量化的诊断依据。     

Exploration on Significance of Platelet CD62p, CD63 Determination in Type 2 Diabetes Mellitus Patients with Blood Stasis Syndrome

Ｂｌｏｏｄｓｔａｓｉｓｓｙｎｄｒｏｍ （ＢＳＳ）ｉｓａｃｏｍｍｏｎｓｙｎｄｒｏｍｅｔｙｐｅｉｎｄｉａｂｅｔｅｓｍｅｌｌｉｔｕｓ（ＤＭ）．ＩｎｏｒｄｅｒｔｏｒｅｖｅａｌｔｈｅｍｏｄｅｒｎｍｅｄｉｃａｌｂａｓｉｓｏｆＢＳＳｉｎＤＭ,ｐｒｅｖｉｏｕｓｒｅｓｅａｒ     

血瘀证动物细胞损伤模型的研制

[目的]探索建立血瘀证细胞损伤模型的方法。[方法]用两种方法,即用血瘀证兔模型血管内皮细胞直接培养的方法和用血瘀证兔模型血清损伤培养的血管内皮细胞方法,研制血瘀证细胞损伤模型。[结果]第一种方法原代培养物血管内皮细胞出现了病理性损伤及内分泌功能的改变,初步表明能直接反映体内的病理状态,但其病理特征并未随细胞传代得以保留;第二种方法培养的细胞同样体现了类似前者的病理状态,且更易于复制。[结论]初步表明所建立的细胞损伤模型从功能和结构上都反映了务大辩论辛整体动物模型及部分临床病人的病理特征,可应用于探讨血瘀证实质和活血化瘀作用机理的研究。     

多普勒超声诊断特发性肺动脉扩张的评价

特发性肺动脉扩张系良性心血管畸形。本文20例超声研究分析认为多普勒超声不仅对特发性肺动脉扩张（IDPA）能定性分析;而且能定量测压,对明确诊断具有特异性;并有助于对临床听诊及X片鉴别困难的一组疾患提供鉴别论断依据。     

Exploration on significance of platelet cd62p, cdp63 determination in type 2 diabetes mellitus patients with blood stasis syndrome

Objective: To study the relationship between blood stasis syndrome (BSS) and platelet activation and its influencing factors in type 2 diabetic mellitus (DM).Methods: Platelet CD_62p, CD₆₃ expressions were determined in 30 type 2 DM patients with BSS, 27 type 2 DM patients without BSS and 20 normal controls by flow cytometry.Results: CD_62p, CD₆₃ levels were significantly higher in type 2 DM group with BSS than those in the type 2 DM group without BSS and in the normal controls. CD_62p was positively correlated with CD₆₃, while positive correlation existed between HbA₁c, LDL-C and CD_62p in DM patients with BSS.Conclusions: The increased level of platelet activation was the primary molecular basis of BSS in type 2 DM. It was important to perform the syndrome differentiation of BSS and treatment of activating blood flow to remove BSS in type 2 DM.     

冠心病血瘀证：从现代医学视角理解

The medical community as a whole is attempting to start preventive therapy for coronary heartdisease （CHD） patients earlier in life. However, the main limitations of such interventions are drug resistanceand adverse reactions. Additionally, traditional biomarker discovery methods for CHD focus on the behavior ofindividual biomarkers regardless of their relevance. These limitations have led to attempting novel approachesto multi-dimensionally investigate CHD and identify safe and efficacious therapies for preventing CHD. Recently,the benefit of Chinese medicine （CM） in CHD has been proven by increasing clinical evidence. More importantly,linking CM theory with modern biomedicine may lead to new scientific discoveries. According to CM theory,all treatments for patients should be based on patients＇ syndromes. A recent epidemiological investigation hasdemonstrated that blood stasis syndrome （BSS） is the major syndrome type of CHD. BSS is a type of complexpathophysiological state characterized by decreased or impeded blood flow. Common clinical features ofBSS include a darkish complexion, scaly dry skin, and cyanosis of the lips and nails, a purple or dark tonguewith purple spots, a thready and hesitant pulse, and stabbing or pricking pain fixed in location accompaniedby tenderness, mass formation and ecchymosis or petechiae. The severity of BSS is significantly correlatedwith the complexity of coronary lesions and the degree of stenosis, and is an important factor affecting theoccurrence of restenosis after percutaneous coronary intervention. The mechanisms of BSS of CHD patientsshould be investigated from a modern medicine perspective. Although many studies have attempted toexplore the biomedical mechanisms of BSS of CHD, from hemorheological disorders to inflammation andimmune responses, the global picture of BSS of CHD is still unclear. In this article, the current status of studiesinvestigating the biomedical mechanisms of BSS of CHD and future perspectives are discussed.     

中医证候量表研制方法概述

辨证论治是中医的精髓,但长期以来证候的客观化、标准化在一定程度上成为中医理论体系继承和发展的桎梏。借鉴现代医学、心理学的量表制订方法,根据中医辨证的特色和思维规律,研制出符合中医基本理论和临床实际的中医证候量表,逐渐成为中医临床诊治的一个量化评价的重要手段。本文基于目前中医证候量表研究的成果,阐述中医量表研制的具体方法,并且提出在中医证候量表研制过程中需注意的关键问题。     

Differential Expression of MicroRNA in Endothelial Cells Incubated with Serum of Hypertension Patients with Blood-Stasis Syndrome

Objective:To screen out blood-stasis syndrome(BSS)-associated microRNA and therefore determine the possible target for treating hypertension.Methods:A high-energy sequencing method and digital gene expression sequencing theory were adopted to sequence microRNA(miRNA) and messenger RNA(mRNA),and to determine differential expression in human umbilical vein endothelial cells incubated with serum samples from hypertension patients with or without BSS,and healthy controls.The results were confirmed using gene prediction software.Results:A total of 13 miRNAs and 11 mRNAs showed statistical difference both in the BSS/normal groups and BSS/non-BSS groups,respectively.Four pairs of target mRNA/miRNA were identified:FRMD4A/hsa-miR-34 a,MAP3K14/hsa-miR-34 a,PER1/hsa-miR-34 a,and FGF2/hsa-miR-132.Conclusion:Four mRNA/miRNA pairs mentioned above seem to be involved in pathogenesis and maintenance of hypertension with BSS.     

试论中医临床科研中引入定性研究的必要性

目前中医学领域的研究评估体系模式是参照了经典的西医学的研究模式建立的,定量研究方法的引入确实对中医现代化的进程起到了巨大的推动作用,把中医学中可以量化的部分以现代科研方式开发出来.但是中医是具有深刻哲学、文化背景的医学,纯粹用定量研究的方法不能把中医的优势领域表现出来,相反,相当部分的中医学的内容更适用定性研究的方法.在中医临床科研中,应充分发掘中医治疗的优势,采用定性研究的方法对中医诊断标准、治疗结果进行研究,并将定性研究和定量研究相结合,制定出具有中医特色的疗效评估体系.