中药复方治疗心力衰竭的研究进展分析

通过查阅中英文相关文献数据库及参考书目，对常用中药复方治疗心力衰竭的药理作用和潜在机制进行系统综述。中药复方在抑制心室重构，保护心肌、扩张血管，改善心肌缺血，降低室壁张力，抑制血清炎性因子的表达方面发挥重要作用。中药复方制剂具有抗氧化、抗凋亡、抗纤维化、抗炎、促血管生成、调节线粒体功能和能量代谢等作用，而这些生物通路相互关联，以多成分、多靶点、多途径的方式共同发挥作用。同时探讨了当前实验研究的局限性，导致中药复方治疗心力衰竭的功能信号网络模糊不清。期待学者们加大对中药复方治疗心力衰竭上游信号通路的实验研究。     

干细胞外泌体心肌保护作用的研究进展

由于各种致病因素(心肌缺血、缺氧、感染等)的存在,导致心肌收缩、舒张功能发生障碍,影响心脏功能。心肌细胞自身恢复其功能相对比较困难。干细胞移植用于心肌保护存在争议,而其外泌体可发挥有效作用,主要表现在促进新生血管形成、发挥抗凋亡和抗纤维化作用。本文就干细胞外泌体在心肌保护方面的研究展开综述。     

中药紫金砂的抗溃疡活性部位研究

目的:筛选中药紫金砂抗溃疡作用的活性部位。方法:系统溶剂法提取分离得到五个部位,通过阿司匹林-乙醇溶液所致小鼠胃溃疡模型筛选中药紫金砂抗溃疡作用的活性部位。结果:中药紫金砂的石油醚、氯仿、乙酸乙酯等脂溶性部位具有显著的抗溃疡作用。结论:脂溶性部位为中药紫金砂抗溃疡的活性部位。     

中药抗心肌细胞缺血再灌注损伤相关信号通路的实验研究进展

心肌缺血再灌注时,多种理化因素刺激细胞诱发信号介导的细胞损伤、凋亡是造成心肌缺血再灌注损伤的一个重要原因;中药通过调节MAPK信号通路、PI3K/Akt信号通路、JAK-STAT信号通路和NF-κB信号通路等多条信号通路发挥抗心肌缺血作用。综述中药及复方对心肌细胞缺血再灌注损伤的作用,为其临床应用提供实验依据。     

回心草心脏保护作用的活性部位筛选

目的探讨回心草各极性部位抗心律失常、抗心肌缺血及耐缺氧作用,初步筛选其活性部位。方法采用导联生理仪观察回心草不同极性部位对氯仿诱发小鼠室颤的作用;并采用常压耐缺氧、特异性心肌缺血、缺氧及小鼠断头模型,观察回心草各部位对小鼠存活时间的影响。结果回心草醋酸乙酯相低剂量和正丁醇相低剂量均可显著降低氯仿诱发小鼠室颤的发生率、延长心律失常出现时间;还可明显延长小鼠常压耐缺氧存活时间,并可使特异性心肌缺血、缺氧小鼠存活时间显著增加,其中醋酸乙酯相各剂量还可显著延长断头小鼠张口动作持续时间。结论回心草可提高小鼠耐缺氧能力,具有明显的抗心律失常、抗心肌缺血作用,其95%乙醇提取物的醋酸乙酯及正丁醇部分可能是有效活性部位。     

蜂胶与冠心病心绞痛

蜂胶（propolis）中含有多种黄酮类化学成分,具有明显的药理活性,药理研究表明蜂胶中的黄酮类化合物可以改善血管的弹性和渗透性,舒张血管、清除血管内壁积存物,增强心脏收缩能力,并可有效抑制血小板聚集。因此,蜂胶不仅有预防动脉粥样硬化的作用,具有明显的心脏药理活性（增强心脏抗心肌缺血的能力、缩小心肌缺血范围和缺血程度）,且可改善血液流变性、抑制体外血栓形成,因而可以认为蜂胶可用于冠心病心绞痛的治疗,并从多个角度发挥其药理作用,可达到防治结合的目的。     

小续命汤有效成分组的高通量筛选研究

目的:应用高通量筛选技术,建立新型的中药复方活性成分和作用机制研究模式,探讨中药复方小续命汤发挥药理作用的物质基础。方法:观察中药复方小续命汤240个连续组分的抗氧化、抗过氧化氢损伤、抗谷氨酸损伤活性以及对神经细胞内钙离子的影响。结果:中药复方小续命汤多模型筛选结果显示,连续组分L1~L40和A100~A120的综合作用效果较好。因此,可将这两部分的连续组分重新组合,作为小续命汤抗脑缺血损伤的有效成分组。结论:中药复方小续命汤可通过多组分、多靶点途径发挥其药理作用。     

中药抗血管生成机制研究进展

许多疾病都与血管超常增生有关,中药对血管生成性疾病有独特的疗效。研究表明,中药及其复方制剂主要通过影响血管生长因子的表达、阻滞血管生成因子受体的活性、抑制内皮细胞增殖、抑制基底膜降解和阻断内皮细胞特异性整合素等机制发挥抗血管生成作用。     

血府逐瘀汤治疗心脑血管疾病研究进展

目的:总结血府逐瘀汤治疗心脑血管疾病的研究进展。方法:通过收集整理血府逐瘀汤在心脑血管方面临床资料与实验文献,研究血府逐瘀汤在心脑血管疾病中的应用及其机理。结果:血府逐瘀汤可调节血脂代谢,改善动脉粥样硬化;改善心肌缺血,保护心肌细胞;调节血管内皮细胞功能;抑制血小板聚集和抗血栓形成的作用,扩张冠状动脉,改善血液流变性,防止血管重构。从而在心脑血管疾病的防治中发挥重要作用。结论:以血府逐瘀汤为代表的中医活血化瘀法对心脑血管疾病的有重要作用,为心脑血管方面的防治提供一定的治疗借鉴。     

川芎-赤芍药对差异性调节冠心病血管新生的研究进展

改善心肌缺血和抗动脉粥样硬化是冠心病防治的重点。血管新生对冠心病存在双面性作用,可促进缺血心肌侧支血管生长但又易导致动脉粥样硬化斑块破裂,中医整体观指导下的活血化瘀治法可能有效解决冠心病治疗中的这一矛盾。川芎-赤芍药对是活血化瘀经典药对,临床对动脉粥样硬化、冠心病心绞痛和PCI术后再狭窄等有较好疗效,可促进缺血心肌血管新生而改善心肌缺血、抑制斑块内血管新生而抗动脉粥样硬化,其差异性调节血管新生的机制可能是通过调节以缺氧或炎症为主导的不同微环境、同一分子与不同受体/亚型的结合、共同的血管新生靶点实现的,提示活血化瘀方药可同步实现“弱者彰之”“亢者承之”的差异性调节作用,最终在整体水平上改善冠心病。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.