Chinese herbal medicine for chronic heart failure: a multicenter,randomized, double-blind,placebo-controlled trial

ObjectiveThe purpose of this study was to assess the efficacy and safety of Chinese herbal medicine (CHM) in the treatment of chronic heart failure (CHF) patients according to syndrome differentiation.MethodsIn this multicenter, randomized, double-blind, placebo-controlled clinical trial, a total of 220 CHF patients were assigned to receive CHM or placebo granules without decoction according to syndrome differentiation in addition to their standard western treatment for 4 weeks. The change in the left ventricular ejection fraction (LVEF) was the primary outcome, and the changes in the TCM syndrome scores (TCM-SS) and New York Heart Association functional classification (NYHA-FC) were the secondary outcomes.ResultsAfter 4 weeks of treatment, the mean changes in the LVEF (13.1 ± 9.78 vs. 7.34 ± 7.40, P < 0.001) and the TCM syndrome scores (−34.2 ± 24.6 vs. −23.5 ± 25.2, P = 0.002) were better in the CHM group than in the placebo group. After two weeks of treatment, the mean changes in the LVEF (9.26 ± 7.83 vs. 4.72 ± 5.60, P < 0.001) and the TCM syndrome scores (−23.5 ± 18.6 vs. −14.0 ± 15.9, P < 0.001) were better in the CHM group than in the placebo group. In addition, repeated-measures analysis of variance (ANOVA) indicated significant time course effects of CHM versus placebo in the LVEF and TCM syndrome cores (P < 0.001 for all). The distention of the jugular vein (P = 0.021), expectoration (P = 0.044), abdominal distention (P = 0.004), and rib pain (P = 0.005) were significantly less in the CHM group than in the placebo group after two weeks of treatment. Fatigue (P = 0.001), less gas and lazy words (P = 0.001), dizziness (P = 0.003), gasping for breath (P = 0.027), abdominal distention (P = 0.011), nausea (P = 0.001) and emesis (P = 0.012) were significantly less in the CHM group than in the placebo group after treatment for four weeks. After four weeks of treatment, the change in the NYHA functional classification in the CHM group was better than that in the placebo group (P < 0.001). There was one death in the placebo group, and one patient in the CHM group experienced atrial fibrillation.ConclusionCHM treatment according to syndrome differentiation effectively improved the LVEF, TCM-SS, and NYHA-FC in patients with CHF and also appeared to be safe. Thus, CHM treatment could be used as an adjuvant therapy in the treatment of CHF (Clinical trial registration: NCT01939236).     

中医体质健康教育对不同运动习惯人群健康相关生命质量的影响

目的 研究中医体质健康教育对不同运动习惯人群健康相关生命质量的改善效果。方法 将509例样本按照不同运动习惯分为经常运动组（142例）、有时运动组（206例）和不太运动组（161例）,各亚组均根据个体的中医体质类型,给予基于中医体质的健康教育指导（包括情志调摄、饮食调节、起居方法、运动方法、经络按摩5个方面）,随访6个月,比较不同运动习惯者的健康相关生命质量评分变化情况。结果 干预6个月后,经常运动组躯体疼痛、一般健康2个维度和生理领域评分显著升高（P<0.05）;有时运动组一般健康维度和生理领域评分显著升高（P<0.05）;不太运动组在生理功能、躯体疼痛、一般健康、精力、社会功能、精神健康6个维度以及生理和心理2个领域评分均显著升高（P<0.05）。结论 中医体质健康教育对不同运动习惯人群健康相关生命质量的改善效果不同,对不太运动者的生命质量改善明显,改善效果优于经常运动者和有时运动者。     

Banxia Xiexin Decoction for patients with peptic ulcer or chronic gastritis infected with Helicobacter pylori

ObjectiveTo compare the effectiveness and safety of Banxia Xiexin Decoction (BXD) as alternative therapy versus standard triple therapy or quadruple therapy for patients with peptic ulcer or chronic gastritis infected with Helicobacter pylori (H. pylori).MethodsDatabases including China National Knowledge Infrastructure, Chongqing VIP, Wanfang Database, PubMed, the Cochrane Library and clinicaltrials.gov were searched in December 2018 for relevant randomized controlled trials (RCTs). Two authors independently screened and selected studies, extracted data and checked data extraction. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Meta-analysis was performed by using RevMan 5.3.5 software.ResultsFourteen RCTs were included in our analysis involving 1300 patients. Thirteen RCTs compared the effects of BXD alone versus standard therapy, 11 involving triple therapy and 2 in quadruple therapy. The cure rate for both diseases were higher in the BXD alone group than in the standard therapy group (RR and 95% CI: 1.85 [1.07, 3.17] and 1.48 [1.24, 1.75], respectively). And also, the same result with effectiveness rate (RR and 95% CI: 1.18 [1.08, 1.29] and 1.14 [1.08, 1.20], respectively). However, there was no significant difference in the clearance of H. pylori one month after treatment, neither compared with quadruple therapy nor triple therapy (RR and 95% CI: 1.10 [1.00, 1.22] and 1.04 [0.97, 1.12], respectively). Adverse events appeared in 3 participants in the BXD group and 26 participants in the conventional therapy group. The quality of the trials included in this review was not very good.ConclusionBXD has a superior effect to standard conventional therapy in improving clinical symptoms and repair of the mucosal lesion, and a similar effect to standard conventional therapy in clearing H. pylori. We still need good quality trials, especially placebo-controlled trials, in the future to confirm this result.     

现代名老中医治疗巩膜炎的学术思想和病案举例

巩膜炎是眼科的疑难病，尤其是合并全身疾病的巩膜炎，临床病情复杂，但适宜的中医辨证论治具有较好的临床疗效。本文介绍了当代三位名老中医及导师韦企平对本病的辨证思路、临证经验以及相关典型病例．以供临床中医眼科医师参考。     

骨质疏松高风险人群中医症状辨识工具的初步探析

目的 通过应用骨质疏松高风险人群中医症状辨识工具，探讨不同骨量人群中医症状特点分布，为骨质疏松高风险人群的中医辨识提供依据。方法 于2020年9月至2021年6月招募受试者，收集受试者的临床资料以及骨质疏松高风险人群中医症状辨识问卷结果，录入建立数据库，采用卡方检验对中医症状发生频率进行比较，分析不同骨量人群中医症状分布差异。结果 ①对符合标准的293例受试者的资料和问卷结果进行分析，其中骨量减少124例，骨量正常137例，骨质疏松症32例。②其中腰膝酸软（40.32 % vs 27.74 %）、身高变矮（52.42 % vs 36.50 %）、下肢拘挛（35.48 % vs 17.52 %）、倦怠乏力（29.84 % vs 18.25 %）、多梦易惊（27.42 % vs 14.60 %）、失眠（37.10 % vs 21.90 %）、耳鸣（31.45 % vs 17.52 %）、健忘（54.03 % vs 32.85 %）、口燥咽干（39.52 % vs 25.55 %）、视物模糊（45.16 % vs 29.93 %）、目睛干涩（43.55 % vs 27.74 %）共11个中医症状在骨量减少组中出现的频率较骨量正常组高，差异具有统计学意义；③腰膝酸软（40.32 % vs 56.25 %）、畏寒（40.32 % vs 56.25 %）、耳鸣（31.45 % vs 46.88 %）、腰痛（48.39 % vs 62.5 %）、目眩（23.39 % vs 37.5 %）、发脱齿摇（29.84 % vs 43.75 %）、多梦易惊（27.42 % vs 40.63 %）、目睛干涩（43.55 % vs5 6.25 %）、夜尿多（21.77 % vs3 4.38 %）、纳呆（8.06 % vs 18.75 %）、足跟痛（14.52 % vs 25.00 %）、手足烦热（15.32 % vs 25.00 %）、毛发枯槁（6.45 % vs 15.63 %）、周身痛（19.35 % vs 28.13 %）、易怒（25.81 % vs 34.38 %）、体重减轻（8.06 % vs15.63 %）、背痛（37.9 % vs 43.75 %）、遇寒痛甚（37.9 % vs 43.75 %）、头晕（25.81 % vs 31.25 %）、下肢拘挛（35.48 % vs 40.63 %）、下肢困重（33.06 % vs 37.50 %）、健忘（54.03 % vs 56.25 %）、面黄肌瘦（4.03 % vs 6.25 %）、肢体麻木（17.74 % vs 18.75 %）共25个中医症状在骨量减少组中出现的频率较骨质疏松症组低，但差异无统计学意义；而气短（20.97 % vs 46.88 %）在骨量减少组中出现频率较骨质疏松症组低，差异具有统计学意义。结论 不同骨量人群发生的中医症状频率和频数不同，且在骨量正常、骨量减少到骨质疏松症的不同人群中呈现中医症状逐渐增多的趋势，可以用中医症状来辨识骨质疏松高风险人群，中医症状辨识工具对筛检骨质疏松高风险人群具有一定价值。     

对儿童视神经炎病因的再认识

儿童视神经炎和成人视神经炎比较,其病因、临床表现、预后及转归多有重叠和交叉,也有其特殊性和差异。随现代流行病学谱系的变化和神经眼科跨学科交流的增强,已认识到儿童视神经炎和成人类似。对初诊为视神经炎或疑似神经炎的儿童患者,在排查眼部或其比邻病因,以及遗传性疾病的基础上,应更关注其潜在的和中枢神经系统或其他系统相关的自身免疫性疾病。本文重点围绕和中枢神经系统脱髓鞘疾病密切相关的儿童视神经炎进行讨论。     

益气活血法治疗青光眼视神经病变的临床观察

目的探讨益气活血法对眼压控制理想的青光眼视神经病变患者的治疗效果。方法利用中医的气血理论,应用灯盏花和生脉注射液静脉滴注,并服补阳还五汤治疗40例眼压控制理想的青光眼视神经病变患者,观察治疗前后视力、眼压、视野的变化。结果治疗后纳入观察患者的视野平均光敏感度及平均缺损较治疗前改善,差异有统计学意义(P<0.05);视力及眼压与治疗前比较,差异无统计学意义(P>0.05)。结论益气活血法可以改善眼压控制理想青光眼患者的视野平均光敏感度及平均缺损值。     

消核片相关肝损害的国内文献回顾与分析

目的：调查消核片相关肝损害的临床特点及发生原因,为临床合理用药提供参考。方法：以＂消核片＂为检索词,检索《CHKD期刊全文数据库》（1994-2009）,《中国生物医学文献数据库（CBM）》（1978-2009）,收集分析消核片相关肝损害的病例报告。结果：共收集到194例,均为女性患者,年龄17～55岁。68例标明用药剂量,2～7片/次,3次/d,用药时间为14～180d。患者用药50d左右出现恶心、腹胀等消化道症状;用药30～141d出现皮肤、巩膜黄染;生化检查示：丙氨酸转氨酶（ALT）68～1700U/L;天冬氨酸转氨酶（AST）40～1260U/L;总胆红素（TBil）8.0～795.4μmol/L;直接胆红素（DBil）2.3～391.8μmol/L。194例中有10例行肝组织病理检查,呈不同程度的肝细胞肿胀、胞质疏松、气球样变及肝细胞坏死。大多数患者在停药后10d至4个月内逐渐恢复正常,其中190例（97.9%）临床痊愈,3例（1.5%）好转,1例（0.5%）急性肝衰竭患者死于感染性休克。结论：消核片可引起肝损害,多为可逆性;其发生可能与用药剂量及疗程有关;肝病患者应避免使用该药;用药过程中应密切监测肝功能。     

重视干燥综合征的毒邪辨治

通过现代医学及中医学病因病机的角度探讨毒与干燥综合征的关系,以及毒邪在干燥综合征发病过程中的存在形式,即毒邪以燥毒,瘀毒,虚毒等不同形式。由于毒邪的存在,导致干燥综合征病情顽固,缠绵难愈。因此,在临床辨治上应当注重辨识毒邪、祛除毒邪,运用甘寒解毒等治法,选用适当的药物,藉以提高临床疗效。     

月经过少的超声诊断相关因素

目的调查月经过少的相关因素,进一步探讨月经过少的超声表现。方法纳入月经过少患者53例,同期监测排卵健康育龄女性46例。采用最大似然估计对排卵当日各项超声指数进行Logistic逐步回归分析,筛选出月经过少的主要相关因素。对回归参数估计值采用Waldχ~2检验,对整个模型的拟合情况采用似然比检验,并用ROC曲线法评价Logistic回归模型的预报能力。结果月经过少与子宫内膜下血管数（OR=0.06,95%CI 0.01～0.35）、子宫内膜血流分型（OR=0.15,95%CI 0.02～0.90）、Salle评分（OR=0.19,95%CI 0.05～0.72）等因素相关。建立回归模型能很好地区分月经过少患者及正常人。结论月经过少可能与子宫内膜血流缺乏有关;多数月经过少患者存在子宫内膜容受性低下,为潜在的不孕症患者。