补中益气丸对脾虚证大鼠血浆环核苷酸水平的影响

目的 观察补中益气丸对实验性脾虚证大鼠血浆环核苷酸水平的影响.方法 选用清洁级SD大鼠34只,随机分为正常对照组n=10)、脾虚模型组(n=12)、补中益气丸组(n=12),采用大黄水煎液复制脾虚证动物模型,补中益气丸组同时灌服补中益气丸,连续20天,观察各组动物血浆环磷酸腺苷(cAMP)、环磷酸鸟苷(cGMP)水平的变化,并观察各组动物体质量及脏器指数.结果 脾虚模型组大鼠血浆cAMP含量和cAMP/cGMP比值均比正常对照组显著升高(P＜0.01),cGMP含量比正常对照组显著降低(P＜0.01),脾脏、胸腺组织质量及脏器指数均比正常对照组显著性降低(P＜0.01).与脾虚模型组比较,补中益气丸能降低脾虚证模型组大鼠体内cAMP含量和cAMP/cGMP比值(P＜0.01),并使胸腺组织质量与其脏器指数升高(P＜0.05,P＜0.01).结论 补中益气丸能增强脾虚证大鼠的免疫机能,可能与调节环核苷酸系统有关.     

大剂量γ射线照射后小鼠脾脏淋巴细胞凋亡的病理形态学观察

目的　探讨大剂量60 Coγ射线照射后脾脏淋巴细胞的病理形态学改变。方法　小鼠经 6、9、12、15及 2 0Gyγ射线照射 ,于照后 8个不同时间点活杀取材进行光镜及电镜观察。 结果照射后脾淋巴细胞凋亡的发生高峰与照射剂量和照后时间有关 ,淋巴细胞数量显著减少。结论　照射后脾脏淋巴细胞凋亡的病理形态变化有明显的分期 ,而在不同剂量组中细胞的死亡方式是有区别的。     

靶向脐带间充质干细胞的构建及其在小鼠脾脏内的定位

目的 构建含小分子肽P1-GFP融合基因慢病毒载体, 用携带P1-GFP融合基因的慢病毒感染MSC, 使MSC具有靶向性, 将靶向MSC注入小鼠体内后观察MSC在小鼠脾脏的定位及与淋巴细胞的关系。方法 用组织片贴壁法培养健康人脐带间充质干细胞, 用基因工程技术构建含小分子肽P1-GFP融合基因慢病毒载体并感染人脐带间充质干细胞, 通过尾静脉将转入P1-GFP融合基因的MSC注入小鼠体内, 18 h后免疫组化染色观察GFP在小鼠脾脏的定位。 结果 培养的健康人脐带间充质干细胞生长良好, MSC感染含P1-GFP融合基因的慢病毒18 h后MSC开始出现绿色荧光, 随着培养时间的延长, 荧光强度逐渐增强, 72 h达高峰。靶向MSC表达髓系干细胞的表面标记 CD105(90.0%)/CD44(98%),CD73(85.0%)/CD90(98.5%)。将靶向MSC经尾静脉注入小鼠体内, 18 h后小鼠脾脏出现大量GFP阳性细胞, 并与脾脏淋巴细胞密切接触。结论 本研究成功构建了含P1-GFP融合基因的靶向MSC, 靶向MSC成功定向脾脏, 并与脾脏淋巴细胞密切接触, 可用于后续的实验研究。     

Effect of Soothing Gan (Liver) and Invigorating Pi (Spleen) Recipes on TLR4-p38 MAPK Pathway in Kupffer Cells of Non-alcoholic Steatohepatitis Rats

Objective: To investigate the mechanism of inflammatory-mediated toll-like receptor 4(TLR4)-p38 mitogen-activated protein kinase(p38 MAPK) pathway in Kupffer cells(KCs) of non-alcoholic steatohepatitis(NASH) rats and the intervention effect of soothing Gan(Liver) and invigorating Pi(Spleen) recipes on this pathway. Methods: After 1 week of acclimatization, 120 Sprague-Dawley male rats were randomly divided into 8 groups using a random number table(n=15 per group): normal group, model group, low-dose Chaihu Shugan Powder(柴胡疏肝散, CHSG) group(3.2 g/kg), high-dose CHSG group(9.6 g/kg), low-dose Shenling Baizhu Powder(参苓白术散, SLBZ) group(10 g/kg), high-dose SLBZ(30 g/kg) group, and low-and highdose integrated recipe(L-IR, H-IR) groups. All rats in the model and treatment groups were fed with a high-fat diet(HFD). The treatments were administrated by gastrogavage once daily and lasted for 26 weeks. The liver tissues were detected with hematoxylin-eosin(HE) and oil red O staining. Levels of liver lipids, serum lipids and transaminases were measured. KCs were isolated from the livers of rats to evaluate the mRNA expressions of TLR4 and p38 MAPK by real-time fluorescence quantitative polymerase chain reaction, and proteins expressions of TLR4, p-p38 MAPK and p38 MAPK by Western blot. Levels of inflammatory cytokines including tumor necrosis factor α(TNF-α), interleukin(IL)-1 and IL-6 in KCs were measured by enzyme-linked immunosorbent assay. Results: After 26 weeks of HFD feeding, HE and oil red O staining showed that the NASH model rats successfully reproduced typical pathogenesis and histopathological features. Compared with the normal group, the model group exhibited significant increases in body weight, liver weight, liver index, serum levels of total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol, and aspartate aminotransferase as well as TC and TG levels in liver tissues, and significant decrease in serum level of high-density lipoprotein cholesterol(P0.05 or P0.01), while those indices were significantly ameliorated in the H-IR group(P0.05 or P0.01). Higher levels of TNF-α, IL-1 and IL-6 in KCs were observed in the model group compared with the normal group(P0.01). Significant decreases in TNF-α, IL-1 and IL-6 were observed in the H-SLBZ, H-IR and L-IR groups compared with the model group(P0.05 or P0.01). The m RNA expressions of TLR4 and p38 MAPK and protein expressions of TLR4, p38 MAPK and p-p38 MAPK in KCs in the model group were significantly higher than the normal group(P0.01), while those expression levels in the L-IR and H-IR groups were significantly lower than the model group(P0.05 or P0.01). Conclusions: Inflammation in KCs might play an important role in the pathogenesis of NASH in rats. The data demonstrated the importance of TLR4-p38 MAPK signaling pathway in KCs for the anti-inflammatory effect of soothing Gan and invigorating Pi recipes.     

谈旴江医家危亦林治疗脾胃病用药特点

目的:对危亦林《世医得效方》治疗脾胃病用药进行数据挖掘,探讨旴江医家危氏治疗脾胃病用药特点。方法:选用Excel软件建立中药性味、归经、功效数据库,运用"IBM SPSS Statistics23.0"、"SPSS Clementine 12.0"进行频数、关联分析。结果:按纳入标准后获418首方剂,频率较高的中药类别是:补益药(24%),理气药(13%),温里药(11%),解表药(11%),温性药所占比例达43%。药味以辛(36%)、甘(24%)、苦(23%)为主,药物归经排名前三的是脾(24%),胃(19%),肺(16%)。置信度在90%以上的关联药物组合模式有大枣、甘草+生姜;厚朴、陈皮+甘草;白术、人参+甘草。结论:危亦林治疗脾胃病重视补虚、散寒、除湿、理气。用药以补气药为主,常用理气药、解表药、化湿药。性味多辛甘苦而温。归经重脏轻腑,突出脾胃肺经。常用药组功效偏于调和脾胃、理气和中、益气健脾。     

敷和备化方联合肝动脉化疗栓塞术治疗肝郁脾虚型原发性肝癌患者的近期疗效及其对血浆血管生成因子水平的影响研究

背景　肝动脉化疗栓塞（TACE）术虽是目前中晚期不可手术的原发性肝癌患者的首选局部治疗措施,但TACE术后仍存在较多问题亟待解决,中医药治疗作为重要的辅助手段,联合TACE术能使原发性肝癌患者获得更大的治疗收益。目的　探讨敷和备化方联合TACE术治疗肝郁脾虚型原发性肝癌患者的近期疗效及其对血浆血管生成因子水平的影响。方法　选取2018年1-6月广西中医药大学第一附属医院肿瘤科及肝病科收治的肝郁脾虚型原发性肝癌患者90例,采用随机数字表法分为对照组和治疗组,每组45例。在常规对症支持治疗基础上,两组患者均行亚肝段动脉末梢水平TACE术,治疗组患者连续服用敷和备化方12周。比较两组患者近期（治疗12周后）疗效、无进展生存时间（PFS）及治疗前后血清甲胎蛋白水平、Karnofsky（KPS）评分、中医症候积分、血浆血管生成因子〔包括血管内皮生长因子（VEGF）、碱性成纤维细胞生长因子（bFGF）、血小板衍生生长因子（PDGF）〕,并观察两组患者毒副作用和/或并发症发生情况。TACE术后当天开始进行电话随访,随访截止时间为患者出现疾病进展或完成整个疗程（12周）。结果　两组患者均完成整个疗程及随访,无一例脱落或失访。两组患者总有效率（ORR）、疾病控制率（DCR）比较,差异无统计学意义（P>0.05）。平均随访（207.5±28.4）d,两组患者PFS的Kaplan-Meier生存曲线比较,差异有统计学意义（P<0.05）。治疗组患者治疗后血清甲胎蛋白水平,腹痛腹胀、纳呆食少、情志抑郁、恶心呕吐、神疲乏力、口苦咽干评分及中医症候积分,血浆VEGF、bFGF、PDGF水平均低于对照组,而KPS评分高于对照组（P<0.05）。两组患者毒副作用和/或并发症发生率比较,差异无统计学意义（P>0.05）。结论　敷和备化方联合TACE术能在一定程度上延长肝郁脾虚型原发性肝癌患者PFS,同时能有效改善患者临床症状及肿瘤相关血管微环境,降低血清肿瘤标志物及血浆血管生成因子水平,有利于提高患者生活质量,且安全性较高。     

健脾活络方治疗脾虚络瘀型的糖尿病远端对称性多发性神经病变的临床研究

目的探讨健脾活络方治疗脾虚络瘀型的糖尿病远端对称性多发性神经病变(DSPN)的临床疗效。方法将80例脾虚络瘀型的DSPN患者随机分为治疗组和对照组,各40例。两组均给予基础治疗配合甲钴胺片治疗(500μg,3次/d,口服),治疗组在对照组治疗基础上加用健脾活络方煎服治疗。治疗8周后,观察比较两组治疗前后多伦多临床评分(TCSS)、震动感觉阈值(VPT)检查结果、生活质量评分及疗效。结果治疗后,两组TCSS评分、VPT检查结果、生活质量评分均明显改善,差异有统计学意义(P<0.05),两组之间比较,差异有统计学意义(P<0.05)。临床疗效方面,治疗组总有效率85.00%、对照组60.00%,两组之间比较,差异有统计学意义(P<0.05)。结论健脾活络方明显改善脾虚络瘀型DSPN患者神经功能和生活质量,提高疗效。     

脾脏对大鼠肝癌形成过程中肝细胞增殖周期及增殖细胞核抗原表达的影响

目的：探讨大鼠实验型肝癌形成过程中,脾脏对肝细胞的增殖水平及病理变化的影响。以期了解脾脏在肝癌形成过程中的作用和地位,方法：以二乙基亚硝胺（DENA）诱导的大鼠肝癌模型为对象,采用免疫组化,流式细胞术等方法对切脾（45只）组和未切脾组（45只）的肝细胞增殖周期,增殖细胞核抗原（PCNA）表达病理学特点等进行研究。结果：（1）切脾组肝硬化形成早于未切脾组,肝细胞变性变明显高于未切脾组,（2）2组肝细胞增殖水平均随诱癌时间延长而增高,18周后达最高,（3）切脾组肝细胞增殖水平在诱癌中期明显低于未切脾组（t=4.76,P＜0.05)停用DENA后到18周,2组增殖水平相近。结论：诱癌过程中,脾与肝细胞的增殖水平密切相关,脾脏对肝细胞的再生具促进作用。     

Use of fibrin glue (Tissucol) as a hemostatic in laparoscopic conservative treatment of spleen trauma

Background This study aimed to evaluate the effect of fibrin glue in laparoscopic spleen-preserving procedures for traumatic rupture. Methods From January 2002 to December 2005, six laparoscopic spleen-preserving procedures were performed for traumatic rupture using fibrin glue. Two of the cases had previous middle and lower abdominal surgery. Survey of the abdominal cavity was performed by inserting two 5- to 12-mm trocars, one 5-mm trocar, and a 30° scope. A complete survey of all the patients was performed. Results None of the patients required laparotomy, and no postoperative bleeding occurred. The fibrin sealant achieved immediate hemostasis, and all the patients recovered without further splenic bleeding. The mean postoperative stay was 4.3 days (range, 4–5 days). All the patients were followed up for 3 to 12 months. Postoperative immunoglobulin scanning, ultrasonography, and computed tomography (CT) results were normal. Conclusions Laparoscopic management of spleen trauma can be used once a positive diagnosis has been made. It is useful for assessing the degree of splenic injury. A laparoscopic spleen-preserving procedure can be used safely for patients with stable vital data. It is an effective procedure for the evaluation and treatment of hemodynamically stable patients with splenic injuries for whom nonoperative treatment is controversial. The topical application of a fibrin sealant in splenic trauma achieves definitive hemostasis safely, rapidly, and reliably. It also is simple to use in either laparoscopic or open procedures. An erratum to this article can be found at