基于Citespace的益气活血类方治疗心力衰竭临床研究的可视化分析

目的总结益气活血类方治疗心力衰竭临床研究的热点演变及研究不足,并且预测发展趋势。方法检索中国知网和Web of Science数据库(CNKI)建库至2022年11月1日期间有关益气活血类方治疗心力衰竭的相关临床研究文献,借助CiteSpace 6.1R4软件来完成文献研究作者、机构、关键词等可视化研究分析。结果1988—2022年有关益气活血类方治疗心力衰竭的文章整体呈波动上升趋势。发文最多的作者为张艳,辽宁中医药大学(含附属医院)、北京中医药大学(含附属医院)等机构的发文数量较多。根据高频关键词可知研究热点主要集中于证型(气虚血瘀等)、治法(益气活血、活血利水、益气温阳等)、疗效评价标准(心功能、生活质量、脑钠肽等)、合并疾病(冠心病等)。关键词突变、时间线图综合分析显示,益气活血类方治疗心力衰竭的治疗方式、评价标准都呈现多元化趋势。文献横向分析提示,目前临床报告规范仍存在较大的提升空间,疗效评价指标描述存在偏于主观等问题。结论益气活血类方治疗心力衰竭的相关临床研究领域,不同研究机构、团队间的合作仍需进一步加强,以便开展多中心大样本的高质量研究;心力衰竭的证型、治法、疗效评价标准以及合并疾病是目前的研究热点,但在临床报告规范方面仍有待完善,建议制定客观、科学的诊疗标准及报告规范,进一步探索中医或中西医结合治疗心力衰竭的临床优势。

清代医家王孟英应用瓜蒌治疗胸痹经验的数据挖掘和网络药理学探讨

目的基于数据挖掘,探究清代医家王孟英用瓜蒌治疗胸痹的特点,并通过网络药理学进一步探究其核心药物治疗冠心病潜在的作用机制。方法从王孟英的医案中筛选应用瓜蒌治疗有胸痹症状(如“胸闷”“心下拒按”等)者的医案,通过Excel 2019软件进行频数统计、SPSS Modeler 18.0软件进行关联规则分析。通过中药系统药理学数据库与分析平台(TCMSP)、GeneCard数据库筛选中药的有效成分、作用靶点及冠心病靶点,通过Cy⁃toscape软件、STRING数据库建立网络关系图,通过Metascape数据库进行KEGG富集和GO富集。结果纳入医案61例,常见便秘、胸闷、气逆等症,瓜蒌常配伍清热化痰理气的药物,性味苦寒最多,归肺经者最多,核心药物组为瓜蒌-半夏-黄连-竹茹。网络药理学分析得到瓜蒌-半夏-竹茹-黄连的活性成分43个,核心作用靶点8个,通路主要富集在TNF通路、IL-17通路、HIF-1通路、MAPK通路、PI3K-Akt信号通路。结论王孟英常用瓜蒌治疗胸痹,重视涤痰热与运枢机,核心药物为瓜蒌-半夏-竹茹-黄连,常配伍调畅肺胃气机之品。瓜蒌-半夏-黄连-竹茹通过括槲皮素、小檗碱、植物甾醇、黄芩甙元、羟基芜花素、香草醛等多种活性成分,作用于IL-6、TNF、AKT1、VEGFA、IL-1B、TP53、PTGS2、PPARG等靶点,可能通过TNF信号通路、IL-17信号通路、HIF-1信号通路、MAPK信号通路、PI3K-Akt信号通路,调控炎症反应、促进血管新生、调节糖脂代谢等多种途径调节冠心病。

芪葶利水方对冠心病心力衰竭患者临床疗效、生活质量及血清基质金属蛋白酶的影响

目的观察芪葶利水方对冠心病心力衰竭患者临床疗效、生活质量及血清中基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)水平的影响。方法选择2018年9月—2019年9月期间在首都医科大学附属北京中医医院心血管科住院的冠心病心力衰竭气虚水停证患者60例,随机分为对照组及治疗组,2组均采用西医规范化药物治疗,治疗组在此基础上加用芪葶利水方,治疗2周后对比2组患者N末端B型利钠肽原(NT-proBNP)水平、中医证候积分、生活质量变化以及治疗前后血清中MMP-2、MMP-9水平。结果2组患者治疗前NT-proBNP水平比较差异无统计学意义(P>0.05),治疗后2组NT-proBNP水平均较治疗前下降,差异有统计学意义(P<0.01),且治疗组低于对照组,差异有统计学意义(P<0.05),治疗组NT-proBNP下降率高于对照组,差异有统计学意义(P<0.01)。2组患者治疗前中医证候积分比较差异无统计学意义(P>0.05),治疗后2组中医证候积分均较治疗前下降(P<0.05),且治疗组低于对照组,差异有统计学意义(P<0.05)。2组患者治疗前生活质量评分比较差异无统计学意义(P>0.05),治疗后生活质量评分均较治疗前提高,差异有统计学意义(P<0.05),且治疗组高于对照组,差异有统计学意义(P<0.01)。2组患者治疗前MMP-2、MMP-9水平比较均差异无统计学意义(P>0.05),2组治疗后MMP-2、MMP-9均低于治疗前,差异有统计学意义(P<0.05),且治疗组治疗后MMP-2、MMP-9水平均低于对照组,差异有统计学意义(P<0.01)。结论芪葶利水方可以有效改善冠心病心力衰竭气虚水停患者的临床症状及生活质量,并降低NT-proBNP、MMP-2、MMP-9水平,提示其可能通过减轻细胞基质损伤和改善心室重构和预后。

基于数据挖掘(新角度)探讨刘红旭教授验方“心痛三两三”治疗稳定性冠心病的运用特点

目的探讨刘红旭教授验方“心痛三两三”在治疗稳定性冠心病中的运用规律。方法通过数据挖掘分析首都医科大学附属北京中医医院刘红旭教授门诊近10年诊治有效的稳定性冠心病处方数据。结果共纳入方剂3627首,涉及药物278味,药物使用频次61479次。“心痛三两三”方中延胡索、当归、鸡血藤、川芎用药频次分列第4、6、7、11位;“心痛三两三”方皆为温性药,五味属辛、甘、苦之类,归经以肝、心、脾为主,功效以活血化瘀为主,皆与整体方药体系相顺应;关联规则分析发现“心痛三两三”方中的其他4味中药同时出现时,川芎随之出现的概率为100%,鸡血藤出现的概率为96.73%,当归出现的概率为91.78%,延胡索出现的概率为83.01%,三七粉或水蛭出现的概率和为62.45%;显示三七粉出现时,水蛭随之出现的概率为41.18%,忍冬藤出现时,鸡血藤随之出现的概率为44.51%;“提升度”前20的药对中,与“心痛三两三”方或其常用加减药物相关的药对占14对;系统聚类分析显示当归、川芎、鸡血藤、三七粉4味药物单独为一聚类项。结论验方“心痛三两三”组成药物在整体方药体系中具有与整体方药体系相顺应,使用频次高,药物间关联性强,方中药物间主次分明及随症加减灵活变换的特点,是刘红旭教授治疗稳定性冠心病方药体系的核心方之一。

基于VOSviewer和CiteSpace知识图谱的水蛭可视化分析

目的分析破血消癥代表药水蛭在中医药领域相关研究文献,了解该药的研究脉络、热点和发展趋势。方法计算机检索中国知网(CNKI)、Web of Science,1963年1月1日至2022年8月5日收录的水蛭涉及中医药领域的中、英文文献。采用VOSviewer1.6.18绘制核心作者、机构合作网络及高频关键词排序,运用CiteSpace6.1.R3进行关键词共现、聚类及突现展示。结果共纳入中文文献943篇,英文文献43篇。结果提示核心作者较少,合作网络显示团队内部合作较多,缺乏团队间合作。中、英文关键词共现及聚类分析显示水蛭在中医药领域的研究热点主要为名医经验、临床研究、数据挖掘等,关键词突现提示冠心病、作用机制、数据库可能是未来发展的方向。结论近年来水蛭在中医药领域的相关研究热度不断上升,名医经验与临床研究、数据挖掘、制剂研发及对于各类疾病的作用研究为其主流研究热点。以冠心病为主的心血管病临床研究、水蛭的作用机制研究以及基因组数据库的构建可能是未来研究趋势。

Danhong Injection Up-Regulates miR-125b in Endothelial Exosomes and Attenuates Apoptosis in Post-Infarction Myocardium

Objective:To investigate the involvement of endothelial cells(ECs)-derived exosomes in the antiapoptotic effect of Danhong Injection(DHI)and the mechanism of DHI-induced exosomal protection against postinfarction myocardial apoptosis.Methods:A mouse permanent myocardial infarction(MI)model was established,followed by a 14-day daily treatment with DHI,DHI plus GW4869(an exosomal inhibitor),or saline.Phosphatebuffered saline(PBS)-induced ECs-derived exosomes were isolated,analyzed by miRNA microarray and validated by droplet digital polymerase chain reaction(ddP CR).The exosomes induced by DHI(DHI-exo),PBS(PBS-exo),or DHI+GW4869(GW-exo)were isolated and injected into the peri-infarct zone following MI.The protective effects of DHI and DHI-exo on MI hearts were measured by echocardiography,Masson's trichrome staining,and TUNEL apoptosis assay.The Western blotting and quantitative reverse transcription PCR(qR T-PCR)were used to evaluate the expression levels of miR-125b/p53-mediated pathway components,including miR-125b,p53,Bak,Bax,and caspase-3 activities.Results:DHI significantly improved cardiac function and reduced infarct size in MI mice(P<0.01),which was abolished by the GW4869 intervention.DHI promoted the exosomal secretion in ECs(P<0.01).According to the results of exosomal miRNA microarray assay,30 differentially expressed miRNAs in the DHI-exo were identified(28 up-regulated miRNAs and 2 down-regulated miRNAs).Among them,DHI significantly elevated miR-125b level in DHI-exo and DHI-treated ECs,a recognized apoptotic inhibitor impeding p53 signaling(P<0.05).Remarkably,treatment with DHI and DHI-exo attenuated apoptosis,elevated miR-125b expression level,inhibited capsase-3 activity,and down-regulated the expression levels of proapoptotic effectors(p53,Bak,and Bax)in post-MI hearts,whereas these effects were blocked by GW4869(P<0.05 or P<0.01).Conclusion:DHI and DHI-induced exosomes inhibited apoptosis,promoted the miR-125b expression level,and regulated the p53 apoptotic pathway in post-infarction myocardium.

Acute Myocardial Infarction in Chinese Medicine Hospitals in China from 2006 to 2013: An Analysis of 2311 Patients from Hospital Data

Objective:To assess the trends in characteristics,treatments,and outcomes of acute myocardial infarction(AMI)patients in tertiary Chinese medicine(CM)hospitals in China between 2006 and 2013.Methods:This retrospective study was based on two nationwide epidemiological surveys of AMI in tertiary CM hospitals during 2 years(2006 and 2013).Patients admitted to the hospital for AMI were enrolled.Hospital records were used as the data source.Case data were derived regarding baseline characteristics,treatments,and outcomes of patients to assess changes from 2006 to 2013.Logistic regression was used to analyze the relationship between prognosis,general influencing factors of disease,and various treatment measures.Results:Totally 26 tertiary CM hospitals in 2006 and 29 tertiary CM hospitals in 2013(18 were repetitive)were surveyed.A total of 2,311 patients with AMI were enrolled(1,094 cases in 2006 and 1,217 cases in 2013).From 2006 to 2013,the mean age did not significantly change,but the proportion of patients younger than 65 years increased.The prevalence of risk factors such as hypertension,diabetes,and hyperlipidemia also increased.Significant increases were observed in primary percutaneous coronary intervention[20.48%(2006)vs.24.90%(2013)]and revascularization[36.11%(2006)vs.52.42%(2013)].In-hospital mortality decreased from 11.15%in 2006 to 10.60%in 2013.A mortality logistic regression analysis identified reperfusion therapy[odds ratio(OR),0.222;95%confidence interval(CI),0.106–0.464],Chinese patent medicines(OR,0.394;95%CI,0.213–0.727),and CM decoctions(OR,0.196;95%CI,0.109–0.353)as protective factors.Conclusion:Reperfusion and revascularization capabilities of tertiary CM hospitals have improved significantly,but in-hospital mortality has not significantly decreased.Efforts are needed to improve medical awareness of AMI and expand the use of CM to reduce in-hospital mortality in China.

Pharmacological Effects of Botanical Drugs on Myocardial Metabolism in Chronic Heart Failure

Although there have been significant advances in the treatment of heart failure in recent years,chronic heart failure remains a leading cause of cardiovascular disease-related death.Many studies have found that targeted cardiac metabolic remodeling has good potential for the treatment of heart failure.However,most of the drugs that increase cardiac energy are still in the theoretical or testing stage.Some research has found that botanical drugs not only increase myocardial energy metabolism through multiple targets but also have the potential to restore the balance of myocardial substrate metabolism.In this review,we summarized the mechanisms by which botanical drugs(the active ingredients/formulas/Chinese patent medicines)improve substrate utilization and promote myocardial energy metabolism by activating AMP-activated protein kinase(AMPK),peroxisome proliferator-activated receptors(PPARs)and other related targets.At the same time,some potential protective effects of botanical drugs on myocardium,such as alleviating oxidative stress and dysbiosis signaling,caused by metabolic disorders,were briefly discussed.