益气养阴活血法治疗冠心病心律失常有效性和安全性的Meta分析*

[摘要]目的 系统评价益气养阴活血法治疗冠心病心律失常的有效性及安全性。方法 检索中国知网数据库（CNKI）、维普中文科技期刊全文数据库（VIP）、中国学术期刊数据库（万方）、Cochrane图书馆、Web of Science和PubMed中有关益气养阴活血法治疗冠心病心律失常的临床随机对照试验研究,提取纳入研究的相关数据并进行方法学质量评价。应用RevMan5.3软件进行Meta分析。结果 共纳入26个研究。Meta分析结果显示,益气养阴活血法治疗组在临床总有效率[OR=3.47,95%CI（2.68, 4.48）,P<0.00001]、24h心律失常事件数[WMD=-204.82,95%CI（-228.78, -180.86）,P<0.00001]、中医症候疗效[OR=3.08,95%CI（2.04,4.66）,P<0.00001]、心电图疗效[OR=2.50,95%CI（1.63,3.83）,P<0.0001]、血液流变学指标：全血高切黏度[WMD=-1.02,95%CI（-1.18,-0.85）,P < 0.00001]、全血低切黏度值[WMD=-1.66,95%CI（-2.00,-1.33）,P< 0.00001]、血浆比黏度[WMD=-0.42,95%CI（-0.50,-0.35）,P < 0.00001]、纤维蛋白原[SMD=-1.67,95%CI（-2.06,-1.28）,P <0.00001]及安全性[OR=0.41,95%CI（0.27,0.61）,P<0.001]方面均优于常规西医治疗组。结论 益气养阴活血法治疗冠心病心律失常具有更好的有效性及安全性。由于目前纳入文献数量及质量的限制,期望今后有更多高质量的随机对照试验支持。     

Gain Modulation of Cholinergic Neurons in the Medial Septum‐Diagonal Band of Broca Through Hyperpolarization

Hippocampal network oscillations are important for learning and memory. Theta rhythms are involved in attention, navigation, and memory encoding, whereas sharp wave‐ripple complexes are involved in memory consolidation. Cholinergic neurons in the medial septum‐diagonal band of Broca (MS‐DB) influence both types of hippocampal oscillations, promoting theta rhythms and suppressing sharp wave‐ripples. They also receive frequency‐dependent hyperpolarizing feedback from hippocamposeptal connections, potentially affecting their role as neuromodulators in the septohippocampal circuit. However, little is known about how the integration properties of cholinergic MS‐DB neurons change with hyperpolarization. By potentially altering firing behavior in cholinergic neurons, hyperpolarizing feedback from the hippocampal neurons may, in turn, change hippocampal network activity. To study changes in membrane integration properties in cholinergic neurons in response to hyperpolarizing inputs, we used whole‐cell patch‐clamp recordings targeting genetically labeled, choline acetyltransferase‐positive neurons in mouse brain slices. Hyperpolarization of cholinergic MS‐DB neurons resulted in a long‐lasting decrease in spike firing rate and input‐output gain. Additionally, voltage‐clamp measures implicated a slowly inactivating, 4‐AP‐insensitive, outward K⁺ conductance. Using a conductance‐based model of cholinergic MS‐DB neurons, we show that the ability of this conductance to modulate firing rate and gain depends on the expression of an experimentally verified shallow intrinsic spike frequency‐voltage relationship. Together, these findings point to a means through which negative feedback from hippocampal neurons can influence the role of cholinergic MS‐DB neurons. © 2016 Wiley Periodicals, Inc.     

知柏地黄汤通过调节ARE信号通路激活细胞抗氧化反应治疗阴虚火旺证的机制研究

[目的]通过研究知柏地黄汤对细胞抗氧化反应元件(antioxidant response element,ARE)信号通路的调节及其对大鼠血清代谢物的干预作用,探讨其治疗阴虚火旺证的可能机制。[方法]将人肝癌细胞系HepG2细胞分为对照组、知柏地黄汤低、中、高浓度组,分别以0、1、20和100mg·mL-1的知柏地黄汤干预24h,通过双萤光素酶报告基因实验筛选知柏地黄汤显著调控的信号通路;荧光定量PCR检测所筛选通路相关基因的表达,并利用磷钼酸比色法及氧化酶法检测细胞内三磷酸腺苷(adenosine triphosphate,ATP)含量、细胞耗氧率(oxygen consumption rate,OCR)、超氧化物歧化酶(superoxide dismutase,SOD)活性的变化。45只SD大鼠随机分成3组,空白组以0.9%氯化钠溶液灌胃21d,干姜组先以10g·kg-1干姜附子肉桂汤灌胃14d、再以0.9%氯化钠溶液灌胃7d,干知组先以10g·kg-1干姜附子肉桂汤灌胃14d、再以知柏地黄汤灌胃7d,灌胃体积为10mL/(kg·d),以液相色谱-质谱联用(liquid chromatography-mass spectrometry,LC-MS)技术检测血清中代谢物的改变。[结果]双萤光素酶报告基因实验显示,知柏地黄汤对ARE元件调控最为显著,荧光定量PCR结果显示知柏地黄汤可以促进核因子红细胞2相关因子2(nuclear factor erythroid-2-related factor 2,Nrf2)、小肌腱膜纤维肉瘤(musculoaponeurotic fibrosarcoma,Maf)的转录(P0.001,P0.05),同时抑制Kelch样ECH相关蛋白1(Kelch-like ECH-associated protein1,Keap1)的转录(P0.001)。与对照组比较,知柏地黄汤组细胞ATP含量(P0.05)、OCR(P0.001)及SOD活性(P0.05)均升高。动物实验证实,知柏地黄汤灌胃治疗可以改善阴虚火旺模型大鼠胆碱、甘胆酸及棕榈酰左旋肉碱(palmitoyl-L-carnitine,PALC)的紊乱,其中胆碱及PALC含量差异有统计学意义(P0.001)。[结论]知柏地黄汤能够通过ARE信号通路,抑制机体的氧化应激反应,进而改善阴虚火旺引起的代谢紊乱,这可能是知柏地黄汤治疗阴虚火旺证的作用机制之一。     

孙伟护肾养阴法治疗慢性肾脏病

肾虚是慢性肾脏病发生发展的基础,由于先天不足、过食温燥、劳逸失度、情志内伤、久病迁延等因素,肾阴虚,乃至气阴两虚等证在临证中频频涉及。孙伟教授提出了护肾养阴法,在治疗上强调补益肾阴,兼顾五脏,弥补亏损之元阴。常用药有制黄精、山萸肉、旱莲草、女贞子、石斛、玉竹、黄芪、太子参等,慎用辛热之品以防劫阴太过,损耗肾阴。善用杜仲、川续断、菟丝子等平补肾阳之品,以期阳中求阴,并适当佐以活血化瘀药物,如当归、丹参、益母草、牛膝等,不致滋阴太过加重湿浊内蕴,使得补而不滞,养阴而不助邪。整体上更注重以养为护、养护并重,从而达到阴阳调和、延缓疾病进展的目的。     

白芍对酒精性肝损伤肝阴虚证的保护功效和机制

目的研究白芍对小鼠酒精性肝损伤肝阴虚证的保护功效和机制。方法将ICR小鼠随机分为空白组、模型组、一贯煎组、白芍组,每组10只,除空白组外,用Lieber-DeCarli酒精液体饲料加甲状腺激素灌胃制备小鼠酒精性肝损伤肝阴虚证模型。造模期第1天开始给药,一贯煎组灌胃一贯煎水提液9.07 g/kg,白芍组灌胃白芍水提液4.3 g/kg,空白组和模型组灌胃等量生理盐水。28 d后观察各组小鼠状态,测定体重、体温、心率,测定血清及肝组织转氨酶活性、细胞因子水平、乙醇及脂肪代谢相关酶活性、抗氧化酶活性并取肝脏进行冰冻油红、HE病理切片检查。结果与空白组相比,模型组小鼠体重明显减轻,体温升高,心率加快,且出现毛发无光泽、疲倦易困、烦躁易怒等症状;血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、甘油三酯(TG)、总胆固醇(TC)、环磷酸腺苷(cAMP)水平及肝组织丙二醛(MDA)、细胞色素P450同工酶E1(CYP2E1)、肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)、白细胞介素6(IL-6)水平明显升高;血清中环磷酸鸟苷(cGMP)水平及肝组织中超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、乙醇脱氢酶(ADH)、乙醛脱氢酶2(ALDH2)、白细胞介素10(IL-10)、白细胞介素1Ra(IL-1Ra)水平明显降低;肝脏出现脂质沉积及肝细胞坏死情况。与模型组相比,白芍组小鼠血清中ALT、AST、TG、TC、cAMP水平均明显降低(P<0.05),cGMP水平明显升高(P<0.05);肝组织中CYP2E1、TNF-α、IL-1β、IL-6水平明显降低(P<0.05),SOD、CAT、ADH、ALDH2、IL-10、IL-1Ra水平明显升高(P<0.05);肝组织脂质占比显著降低(P<0.05),肝细胞坏死程度改善。结论白芍具有明显的保护酒精性肝损伤肝阴虚证的作用,其机制与调节cAMP/cGMP水平及细胞因子水平、使肝细胞功能与代谢恢复平衡、增强肝组织中乙醇代谢关键酶及抗氧化酶活性、同时抑制脂质过氧化反应、减少脂质沉积有关。     

中医"身心"综合方案治疗气阴两虚型重度混合型便秘的临床观察

  目的：观察中医“身心”综合方案(中药方剂、生物反馈、认知疗法)治疗气阴两虚型重度混合型便秘的临床疗效。  方法：将64例气阴两虚型重度混合型便秘患者随机分为治疗组、对照组,每组32例,对照组口服琥珀酸普芦卡必利片与乳果糖口服液,治疗组采用中医“身心”综合方案治疗。两组疗程均为4周,治疗后随访3个月,观察临床疗效,比较便秘症状积分、便秘患者生活质量自评量表(PAC-QOL)评分的变化情况,并进行安全性评价。  结果：①治疗组脱落1例,对照组脱落2例,最终完成试验者61例,其中治疗组31例、对照组30例。②治疗4周后,治疗组、对照组总有效率分别为58.1%、50.0%,差异无统计学意义(P＞0.05);治疗后3个月,治疗组、对照组总有效率分别为74.2%、66.7%,治疗组临床疗效优于对照组(P<0.05)。③治疗4周、治疗后3个月组内比较,两组便秘症状总积分及各分项(粪便性状、排便困难、排便频率、下坠不尽感、腹胀)积分均较治疗前降低(P<0.05);治疗4周、治疗后3个月组间比较,治疗组粪便性状、排便困难积分及便秘症状总积分低于对照组(P<0.05)。④治疗4周、治疗后3个月组内比较,两组PAC-QOL总分及各分项(生理状态、社会心理、担忧状态、满意度)评分均较治疗前降低(P<0.05);治疗后3个月组间比较,治疗组担忧状态、满意度评分及PAC-QOL总分低于对照组(P<0.05)。⑤对照组有5例患者出现不良反应,治疗组无不良反应发生,治疗组不良反应发生率低于对照组(P<0.05)。  结论：中医“身心”综合方案治疗气阴两虚型重度混合型便秘疗效满意,与西医常规治疗(促动力药、缓泻剂)相比,能更好地缓解便秘症状,提高患者的生活质量,且作用持久、安全性好。     

Effect of detoxification, removing stasis and nourishing yin method on corticosteroid-induced hyperlipidemia in patients with systemic lupus rythematosus

Objective:To observe the effect of TCM therapy for detoxification,removing stasis,and nourishing yin on corticosteroid-induced hyperlipemia in patients with systemic lupus erythematosus (SLE),and to investigate its mechanism.Methods:One hundred and seventy patients with SLE were randomly assigned to the integrative medicine group (IM group) and the Western medicine group (WM group),85 in each group.Also,30 healthy subjects selected from blood donors were enrolled in the normal control (NC) group.All patients were treated mainly with prednisone, while those in the IM group were given TCM therapy additionally,and the therapeutic course for both groups was 6 successive months.The changes of serum total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-G),low density lipoprotein cholesterol (LDL-C),very low density lipoprotein cholesterol (VLDL-C) and apolipoprotein A (ApoA) were determined and observed.A 2-year follow-up study was carried out in 16 patients of the WM group and 25 of the IM group.Results:Before treatment,no significant difference had been found among the three groups in the serum levels of lipids and lipoproteins.After the 6-month treatment,as compared with the WM group,the IM group showed lower levels of TC,TG,LDL-C,and VLDL-C (P<0.05 or P<0.01) and higher levels of HDL-C and ApoA (P<0.05).A similar effect was also shown by the follow-up study in the IM group (P<0.05 or P<0.01). Conclusion:TCM therapy for detoxification,removing stasis,and nourishing yin can effectively regulate the levels of serum lipids and lipoproteins in preventing and treating SLE patients with corticosteroid- induced hyperlipemia.     

祛风益气养阴治疗小儿咳嗽变异性哮喘

目的 观察祛风益气养阴治疗小儿咳嗽变异性哮喘的临床疗效,探究小儿咳嗽变异性哮喘的中医病因病机实质.方法 将90例患儿随机分为3组各30例.治疗组口服祛风止咳汤剂加养阴益气合剂;对照1组口服祛风止咳汤剂;对照2组口服西药美普清加养阴益气合剂.服药2个月后观察疗效.结果 3组疗效有显著性差异(P＜0.05),治疗组疗效明显优于对照1组(P＜0.05)、2组(P＜0.01).结论 祛风益气养阴治疗小儿咳嗽变异性哮喘具有良好的临床疗效.     

李东垣升阳顺气汤浅析

升阳顺气汤为李东垣的《内外伤辨惑论》中自创方,此方宗升清阳、补中气、泻阴火3个原则,针对病症特点,亦用温中和胃顺气之法治疗脾胃内伤疾病,体现了李东垣擅以疾病的共同点找到其特异点,文章从方证、方药、治则方面探讨升阳顺气汤,以期从常法与变法中浅析此方,更好地应用于临床。     

张珍玉从燮理阴阳辨治心悸探析

张珍玉提出治疗心悸应"勿执养心安神,唯务燮理阴阳"的学术观点,认为饮食劳倦、体质虚弱、七情六淫以及痰饮瘀血等均可导致气血阴阳亏损,心失所养、心脉不畅而发为心悸,其病位在心,与肝、脾、肺、肾四脏密切相关。实证治以祛痰化饮、清火行瘀,使邪去正安,心神得宁;虚证治以补气养血、滋阴温阳,以补气血之不足,调阴阳之盛衰,常应用炙甘草汤加减燮理心之阴阳。