Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

Clinical observation on efficacy of compound of warming yang, descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with Yin-Yang deficiency and blood stasis syndrome

Objective:To observe the clinical efficacy of compound of owarming yang,descending turbidity and dredging collaterals in the treatment of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome.Methods:Seventy-six patients of diabetic kidney disease with yin-yang deficiency and blood stasis syndrome were randomly divided into observation group and control group,thirty-eight cases in each group.The control group was given conventional western medicine treatment,while the observation group took compound of owarming yang,descending turbidity and dredging collaterals orally on the basis of conventional western medicine treatment.The course of treatment covered for one month.Before and after treatment,we observed the scores of traditional Chinese medicine symptoms,indicators of renal function[serum creatinine(Scr),blood urea nitrogen(BUN),microalbuminuria(MALB)],indicators of glucose metabolism[fasting plasma glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbAlc)],indicators of hemorheology[plasma viscosity(PV),platelet aggregation rate(PAR),fibrinogen(FIB)],Cystatin-C(Cys-C),C-reactive protein(CRP)in the two groups.Results:After treatment,the clinical effect of the observation group was significantly better than the control group(P<0.05).The scores of traditional Chinese medicine symptoms,indicators of renal function(Scr、BUN、UAER),indicators of glucose metabolism(FPG、2hPG、HbAlc),indicators of hemorheology(PV、PAR、FIB),Cys-C and CRP in the two groups were decreased significantly compared with those before treatment(P<0.05),and the decrease in the observation group was superior to that in the control group(P<0.05).Conclusion:Compound of warming yang,descending turbidity and dredging collaterals has remarkable efficacy in treating of diabetic kidney disease patients with yin-yang deficiency and blood stasis syndrome by alleviating clinical symptoms,glucose metabolism,renal function and microcirculatory disturbance,and the mechanism related to alleviation of microinflammation.

Proteomics analysis of IBS-D with spleen and kidney yang deficiency

Objective:To investigate the molecular mechanism underlying the development of diarrhea-predominant irritable bowel syndrome (IBS-D) with spleen and kidney yang deficiency (SKYD) using a proteomics approach.Methods:Male Sprague-Dawley rats (n =22) were divided into IBS-D (n =12) and normal control (n =10) groups.SKYD was then modeled in IBS-D rats by a combination of acetic acid enema,bondage,rectal dilation,tail stimulation,and Senna gavage.Colon tissue samples were subsequently collected and examined by Q Exactive mass spectrometry to identify differentially expressed proteins between the two groups.Results:The occurrence of SKYD/IBS-D was associated with ribosomal protein S23 (Rps23),protein phosphatase 2 catalytic subunit alpha (Pp2a),and growth factor receptor-bound protein 2 (Grb2),which are involved in the ribosome,neurotrophin signaling,and Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathways.Conclusion:These data suggest that SKYD/IBS-D pathophysiology likely involves inflammation,cell growth,apoptosis,stress granule formation,immune activation,loss of epithelial cell integrity,and visceral hypersensitivity.

Abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type

Objective:To explore the abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type.Methods:The 30 healthy individuals included in the method were from the Physical Examination Center of Anhui Provincial Hospital of Traditional Chinese Medicine,and the 60 rheumatoid arthritis patients included were from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine.The disease activity score of patients with rheumatoid arthritis was evaluated using VAS score and DAS28 score,joint symptoms and spleen deficiency syndrome score were evaluated using graded quantification method,immune inflammation indicators were detected using relevant instruments,inflammatory cytokines were detected using ELISA method,macrophage markers were detected using FCM method,and pathway gene expression was detected using RT-qPCR;Evaluate the predictive effect of circ-CBLB and miR-486-5p on disease activity in rheumatoid arthritis using ROC curves.Results:(1)miR-486-5p,CD14^(+)CD86^(+),ESR,CRP,RF,Anti CCP Ab,IL-6,TNF in patients with rheumatoid arthritis-αThe levels of circ-CBLB,CD14^(+)CD163^(+),IL-4,and IL-10 were significantly higher than those of healthy individuals;(2)The expression level of circ-CBLB in patients with rheumatoid arthritis is positively correlated with CD14^(+)CD163^(+),and negatively correlated with miR-486-5p and CD14^(+)CD86^(+);The expression level of miR-486-5p is negatively correlated with CD14^(+)CD163^(+)and positively correlated with CD14^(+)CD86^(+);There is a negative correlation between CD14^(+)CD86^(+)and CD14^(+)CD163^(+);ESR is negatively correlated with circ-CBLB,and positively correlated with miR-486-5p,CD14^(+)CD86^(+),CRP;CRP is negatively correlated with circ-CBLB,CD14^(+)CD163^(+),and positively correlated with CD14^(+)CD86^(+),ESR;(3)The expression level of circ-CBLB in patients with rheumatoid arthritis is negatively correlated with joint tenderness,morning stiffness,lack of qi and lazy speech,and postprandial abdominal distension score;The expression level of miR-486-5p is positively correlated with the scores of joint tenderness and decreased appetite.(4)The ROC curve shows that in terms of circ-CBLB,ESR,CRP,VAS,and DAS28 AUC are 0.662(P=0.032),0.658(P=0.035),0.516(P=0.830),and 0.791(P=0.000),respectively.In terms of miR-486-5p,ESR,CRP,VAS,and DAS28 AUC were 0.566(P=0.385),0.511(P=0.883),0.592(P=0.223),and 0.727(P=0.003),respectively.Conclusion:The abnormal expression of circ CBLB and miR-486-5p in peripheral blood mononuclear cell of patients with rheumatoid arthritis of spleen deficiency and dampness excess type is related to inflammatory polarization markers,immune inflammation,disease activity,joint symptoms and spleen deficiency syndrome of rheumatoid arthritis,and the low expression of circ CBLB and high expression of miR-486-5p have certain predictive value for disease activity of rheumatoid arthritis.

The Effect of Hormones of the Hypothalamic-pituitary-target Gland Axes in a Kidney-Yang Deficiency Syndrome Model

Kidney-yang deficiency syndrome(KYDS)is a diagnostic pattern in the traditional Chinese medicine.Studies have shown that KYDS is related to the functional disorder of hormones of the hypothalamic-pituitary-target gland axes.The standard procedure used to mimic KYDS is the injection of a high dose of exogenous glucocorticoid(hydrocortisone and corticosterone).Such a model showed symptoms such as exhaustion,body twists,cold limbs,lying crowded together,decreased rectal temperature,sexual dysfunction,decreased reaction speed,reduced spontaneous activity,hair loss,loss of appetite,and weight loss.Moreover,the model manifested an imbalance in mutual control among the hormones of the pituitary-target gland axes,including adrenocorticotrophic hormone,CORT,CRH,thyroid-stimulating hormone,triiodothyronine,thyroxine,T,E2,follicle-stimulating hormone,luteinizing hormone,and 17-OHCS.

Clinical treatment of myasthenia gravis with deficiency of spleen and kidney based on combination of disease with syndrome theory

OBJECTIVE: To study the use of Jianjining in the treatment of myasthenia gravis (MG) patients with a deficiency of both spleen and kidney via the theory on the combination of disease with syndrome. METHODS: Sixty MG patients with a deficiency of both spleen and kidney were randomly divided into an treatment group (n=30) treated with Jianjining granules and Western Medicine (prednisone or pyridostigmine bromide) and a control group (n= 30) treated with Jianjining granules. The dosage of the three drugs was reduced over the course of treatment. After 3 and 6 months of treatment, the curative effect was evaluated with the muscle weakness severity scale (MWSS). RESULTS: The MWSS score after treatment declined significantly in both groups. The score in the treatment group was much lower than that in thecontrol group (P<0.05). The total effective rate was 63.33% (19/30) in the treatment group and 36.67% (11/30) in the control group after 3 months of treatment, and 80.00% (24/30) and 50.00% (15/30), respectively, after 6 months of treatment. The obvious and total effective rates in the treatment group were much higher than those in the control group (P<0.05). After 6 months of treatment, there were no obvious differences (P>0.05) in the obvious and effective rates between the 2 groups. However, the total effective rate in the treatment group was much higher than that in the control group (P<0.01). CONCLUSION: Using the theory on the combination of disease with syndrome, we found that the curative effect of Jianjining and Western Medicine on MG patients with deficiency of both spleen and kidney is worth further exploration.

大黄附子汤加减方对慢性肾衰竭患者血清miR-30a、miR-182表达水平的影响

目的:观察大黄附子汤加减方对慢性肾衰竭(CRF)患者血清微小RNA-30a(miR-30a)、微小RNA-182(miR-182)表达水平的影响。方法:选取109例CRF患者,按随机数字表法分为对照组55例及观察组54例,观察组脱落2例,纳入52例,对照组脱落3例,纳入52例。对照组采取常规治疗,观察组在对照组基础上应用大黄附子汤加减方治疗。2组均治疗12周。比较2组临床疗效及不良反应发生情况,比较2组治疗前后肾功能指标值[血肌酐(SCr)、尿素氮(BUN)、肾小球滤过率(eGFR)]、肾纤维化指标值[Ⅲ型前胶原(PC-Ⅲ)、层黏蛋白(LN)]、血清miR-30a、miR-182表达水平的变化,采用受试者工作特征曲线(ROC)分析miR-30a、miR-182表达水平对治疗效果的预测价值,采用Pearson检验分析miR-30a、miR-182表达水平与eGFR的相关性。结果:观察组临床疗效总有效率为86.54%,对照组临床疗效总有效率为67.31%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组血清BUN、SCr水平均较治疗前下降(P<0.05),eGFR水平较治疗前升高(P<0.05);观察组血清BUN、SCr均低于对照组(P<0.05),eGFR水平高于对照组(P<0.05)。治疗后,2组血清PC-Ⅲ、LN水平均较治疗前下降(P<0.05),观察组血清PC-Ⅲ、LN水平均低于对照组(P<0.05)。治疗后,2组miR-30a、miR-182表达水平均较治疗前降低(P<0.05),观察组miR-30a、miR-182表达水平均低于对照组(P<0.05)。观察组治疗总有效45例、无效7例。与有效者比较,无效者入院时血清miR-30a、miR-182表达水平均升高(P<0.05)。ROC曲线显示,血清miR-30a、miR-182联合预测治疗效果的AUC、灵敏度、特异度依次为0.808、85.71%、75.60%。Pearson检验显示,观察组miR-30a、miR-182表达水平与eGFR呈负相关(P<0.05)。用药过程中,2组未见严重不良反应。结论:大黄附子汤加减方治疗CRF的临床疗效较好,有助于促进肾功能恢复,延缓肾纤维化进展,下调血清miR-30a、miR-182表达水平,且miR-30a联合miR-182检测对于治疗效果有较高的预测价值。

砭石罐灸联合八部金刚功对炎症性肠病脾肾阳虚证患者疗效、疲劳及生活质量的影响

目的:探讨砭石罐灸联合八部金刚功对炎症性肠病脾肾阳虚证患者疗效、疲劳及生活质量的影响。方法:将104例炎症性肠病脾肾阳虚证患者随机分为观察组和对照组,每组52例。对照组采用基础治疗及护理,观察组在对照组基础上实施砭石罐灸联合八部金刚功,治疗12周。比较两组患者治疗前后中医症状评分、炎症因子、多维疲劳量表(MFI-20)、炎症性肠病患者生活质量问卷(IBDQ)变化及治疗后的总有效率。结果:共101例患者完成研究,观察组50例,对照组51例,治疗后观察组患者中医症状评分、MFI-20评分、炎症因子水平均低于对照组,差异有统计学意义(P<0.05);治疗后观察组患者IBDQ评分高于对照组,差异有统计学意义(P<0.05);治疗后观察组患者总有效率为94.00%(47/50)优于对照组的82.35%(42/51)(P<0.05)。结论:砭石罐灸联合八部金刚功可改善炎症性肠病脾肾阳虚证患者临床症状,降低炎症因子水平,缓解疲劳,提高生活质量。

Warm needling moxibustion versus electroacupuncture for simple obesity due to yang deficiency of the spleen and kidney: a controlled clinical trial

Objective: To compare the therapeutic efficacy between warm needling moxibustion and electroacupuncture (EA) in the treatment of simple obesity due to yang deficiency of the spleen and kidney. Methods: Seventy patients with simple obesity due to yang deficiency of the spleen and kidney were randomly divided into a warm needling moxibustion group and an EA group, with 35 subjects in each group. Same major acupoints were selected for the two groups, including Shuifen (CV 9), Guanyuan (CV 4), Daheng (SP 15), Shuidao (ST 28), Shousanli (LI 10), Zusanli (ST 36), Sanyinjiao (SP 6) and Taixi (KI 3). The warm needling moxibustion group received warm needling moxibustion, while the EA group received EA treatment. The interventions were performed once every other day, with 15 treatments as one course. The therapeutic efficacy, body weight and body mass index (BMI) were then observed and compared. Results: The total effective rate in the warm needling moxibustion group was 85.7% versus 77.1% in the EA group, and the between-group difference was statistically significant (P<0.05). The warm needling moxibustion was remarkably superior to the EA in weight loss and lowering BMI, both with statistical significance (P<0.05, P<0.01). At the three-month follow-up, the body weight and BMI further decreased in the warm needling moxibustion group (both P<0.05), and the levels were lower than those in the EA group (P<0.05, P<0.01). Conclusion: Warm needling moxibustion can produce reliable and consistent efficacy in the treatment of simple obesity due to yang deficiency of the spleen and kidney. Compared with EA, warm needling moxibustion shows advantage in both short-term and long-term efficacies, and thus is worth promotion in clinical practice.

脾虚证大鼠模型胃组织cAMP-PKA信号传导通路变化的研究

目的:探讨脾气虚证和脾阳虚证大鼠胃组织的改变与c AMP-PKA信号通路的相关性。方法:将24只雄性SD大鼠按随机数字表法分为正常组、脾气虚组、脾阳虚组,脾气虚采用饱食1 d、禁食2 d、游泳15 d,脾阳虚采用脾气虚证加灌服番泻叶造模,造模后检测大鼠胃组织c AMP活性及PKA、CREB mRNA和蛋白的表达。结果:脾气虚组和脾阳虚组胃组织c AMP活性及PKA、CREB mRNA和蛋白表达均减弱。结论:脾气虚证和脾阳虚证大鼠胃组织的改变与c AMP-PKA信号传导通路有一定的相关性。

辨证施针对腹泻型肠易激综合征的疗效及血清5-羟色胺的影响

【目的】观察辨证施针治疗腹泻型肠易激综合征(IBS-D)的临床疗效。【方法】将符合纳入标准的180例IBS-D患者按1∶3比例随机分为对照组45例和治疗组135例(其中肝郁气滞组50例、肠道湿热组43例、脾肾阳虚组42例)。对照组给予酪酸梭菌活菌片和匹维溴铵片治疗,治疗组分别给予辨证施针治疗,2组患者疗程均为4周。观察各组临床疗效及治疗前后主要症状积分变化,并检测血清5-羟色胺(5-HT)水平的变化情况。【结果】(1)治疗组中3种证型组的总有效率分别为92.0%、88.4%、88.1%,均显著高于对照组的68.9%(P<0.05)。(2)治疗后,各组患者腹痛、腹泻、腹胀、大便急迫、肛门坠胀、倦怠乏力等症状均较治疗前显著改善(P<0.05);且治疗组中的3种证型组在腹痛、腹胀、倦怠乏力等症状积分的改善方面优于对照组(P<0.05);肝郁气滞组在改善腹痛、腹胀、肛门坠胀方面优于其他2种证型组(P<0.05)。(3)治疗后,各组患者血清5-HT水平均较治疗前显著降低(P<0.05);3种证型组患者血清5-HT水平均显著低于对照组(P<0.05),3种证型组间比较,肝郁气滞组较肠道湿热组、脾肾阳虚组显著降低(P<0.05)。【结论】辨证施针治疗腹泻型肠易激综合征疗效确切,能有效改善患者的临床症状,并抑制5-HT的过度表达。

附子理中丸灌胃后脾阳虚证大鼠海马组织β-EP、cAMP、PKA、神经元细胞μ受体表达观察

目的观察附子理中丸灌胃的脾阳虚证模型大鼠海马组织β内啡肽(β-EP)、环磷酸腺苷(c AMP)、蛋白激酶A(PKA)及神经元细胞μ受体的表达变化。方法 40只SPF级SD雄性大鼠随机分为空白组、模型组、中药组、自愈组,每组10只。模型组、中药组、自愈组采用饮食失节+劳倦等复合因素方法制作脾气虚模型,加用"苦寒泻下"法(连续灌服100%番泻叶)制作脾阳虚模型。空白组不做任何处理。造模后中药组予附子理中丸2 m L/(100 g·d)灌胃,1次/d,给药2周。(1)大鼠行为运动功能观察采用旷场实验检测各组大鼠行为学改变(水平运动距离、直立次数)采用YLS-13A大小鼠抓力测定仪检测各组大鼠前肢抓力。(2)分别于第2、4周处死各组大鼠,取海马组织,ELISA法检测海马组织β-EP、c AMP、PKA,免疫组化SABC法检测神经元细胞μ受体。结果与空白组比较,模型组、自愈组大鼠水平运动距离和直立次数均降低(P均<0. 01)。与空白组比较,模型组大鼠前肢抓力下降(P <0. 01);与模型组比较,中药组和自愈组大鼠前肢抓力增强(P均<0. 01)。与空白组比较,模型组及自愈组海马组织中β-EP含量升高、c AMP和PKA含量降低(P均<0. 05);与模型组比较,中药组c AMP和PKA含量升高,自愈组PKA含量升高(P均<0. 05);与自愈组比较,中药组海马组织中β-EP含量降低、c AMP和PKA含量升高(P均<0. 05)。与空白组比较,模型组、自愈组大鼠海马组织μ受体光密度升高(P均<0. 05);与模型组比较,中药组大鼠海马组织中神经元细胞μ受体光密度降低(P <0. 05);与自愈组比较,中药组大鼠海马组织中神经元细胞μ受体光密度降低(P <0. 05)。结论附子理中丸可改善脾阳虚证模型大鼠的脾阳虚证"神疲、乏力"表征,其机制可能降低海马组织β-EP含量、升高c AMP及PKA含量、增加神经元细胞μ受体表达。

四神丸对脾肾阳虚型IBS-D大鼠结肠CRF表达的影响

目的观察四神丸对脾肾阳虚型腹泻型肠易激综合征(IBS-D)模型大鼠脑肠肽促肾上腺皮质激素释放因子(CRF)的影响。方法将SPF级SD大鼠先随机分为空白组和造模组,造模组采用番泻叶灌胃加避水应激法制备脾肾阳虚型IBS-D大鼠模型,待模型复制成功后再将造模组随机分为模型组、得舒特组和四神丸组;灌胃14 d后,ELISA检测各组大鼠血清中CRF含量,免疫组化法检测结肠组织CRF的阳性表达,Western Blot、RTPCR法分别检测结肠中CRF的蛋白和mRNA表达。结果与空白组比较,模型组大鼠结肠组织CRF的阳性表达增加,血清中CRF的含量及其在结肠中的蛋白和mRNA表达均升高,差异有统计学意义(P<0.01);四神丸组血清中CRF的含量降低,结肠组织CRF的阳性表达减少,结肠中CRF的蛋白和mRNA表达降低,与模型组比较差异均有统计学意义(P<0.05或P<0.01);且四神丸组结肠CRF的蛋白表达明显低于得舒特组(P<0.05)。结论四神丸对脾肾阳虚型IBS-D大鼠的作用可能与降低血清中CRF的水平及其在结肠中的表达有关。

中医证候动物模型建立及评价方法研究

中医证候动物模型是揭示中医基础理论、促进中医药临床发展的重要载体,更是促进中医药现代化与国际化不可或缺的重要工具。目前,中医证候动物模型建立方法多样,评价标准不一。基于五脏的主要生理功能,以临床常见的心气虚证、肝郁证、脾气虚证、肺气虚证、肾阳虚证为代表,总结分析近年来最常用的中医证候动物模型的构建及评价方法,为建立更为科学客观的中医证候动物模型构建方法及评价体系提供参考。

自拟温阳消饮汤对脾肾阳虚证肝硬化合并肝肾综合征患者肝肾功能保护、血流动力学指标及外周血肿瘤坏死因子-α、一氧化氮、可溶性细胞黏附因子-1的影响

目的:观察自拟温阳消饮汤对脾肾阳虚证肝硬化合并肝肾综合征患者肝肾功能保护、血流动力学指标及外周血清肿瘤坏死因子-α(TNF-α)、一氧化氮(NO)、可溶性细胞黏附因子-1(sICAM-1)的影响。方法:选取2016年2月至2018年1月沧州市传染病医院收治的肝硬化合并肝肾综合征患者102例作为研究对象,按照随机数字表法分为对照组和观察组,每组51例。对照组患者给予前列地尔静脉滴注治疗,观察组患者则在对照组治疗基础上给予自拟温阳消饮汤经验方内服。对比临床效果,检测肝肾功能相关生化指标变化,观察门脉血流动力学变化,监测外周TNF-α、NO、sICAM-1水平。结果:观察组的有效率88.23%明显高于对照组的70.59%,差异有统计学意义(χ2=6.074,P<0.05);治疗后观察组患者的肝功能丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBiL)水平则较对照组明显降低,白蛋白(Alb)水平则明显升高,差异有统计学意义(P<0.05);肾功能其相关指标24 h尿蛋白定量、血尿素氮(BUN)、尿β2微球蛋白(β2-MG)、血肌酐(SCr)则较对照组明显降低,差异有统计学意义(P<0.05);观察组患者的门静脉、脾静脉血流动力学指标脾门处脾静脉的内径(SVD)、门静脉主干内径(PVD)、门、脾静脉血流量(PVQ、SVQ)水平则较对照组明显降低,差异有统计学意义(P<0.05);外周血TNF-α、NO、sICAM-1水平显著低于对照组,差异有统计学意义(P<0.05)。结论:加用自拟温阳消饮汤利于提高肝肾功能,使患者的门脉内径缩小、血流量减少,其机制与调控血清中TNF-α、NO、sICAM-1水平以减轻局部炎性损伤、改善肝脏内血流循环、降低门脉血管阻力、发挥肝肾保护作用有关。

四神丸治疗腹泻型肠易激综合征的作用机制研究进展

肠易激综合征是临床常见的胃肠道疾病之一,其发病率高,以腹泻型多见。中医认为脾肾阳虚是腹泻型肠易激综合征(IBS-D)的核心病机,四神丸是治疗脾肾阳虚型泄泻的经典方剂,且临床效果显著。四神丸在治疗IBS-D方面具有丰富的生物学基础,并通过缓解胃肠内脏高敏、调控脑-肠轴功能、调节肠道菌群、增强肠黏膜屏障功能、调节胃肠道动力、抑制肠道炎症反应等多重作用机制发挥治疗作用。本文系统综述四神丸治疗IBS-D的具体作用机制,旨在为后续的深入研究及临床应用提供更全面的理论支撑与参考。

高通量测序技术研究附子理中丸对脾阳虚IBS-D大鼠肠道菌群的影响

目的研究附子理中丸对脾阳虚腹泻型肠易激综合征(IBS-D)大鼠肠道菌群的影响和作用机制,同时探讨脾阳虚证与肠道菌群的关系。方法选取60只雄性SD大鼠随机平均分为空白组、模型组、附子理中丸低剂量组、附子理中丸高剂量组。空白组正常饲喂,模型组和附子理中丸低、高剂量组采用“饮食失节+劳倦过度+番泻叶灌胃”复合因素法造模21 d,建立大鼠脾阳虚IBS-D模型。造模成功后,附子理中丸低、高剂量组给予附子理中丸21 d。给药结束后采集粪便样本,提取粪便样本总DNA,根据细菌16S rRNA V3~V4区设计引物进行扩增,利用Illumina Miseq平台进行高通量测序。结果与空白组相比,模型组拟杆菌门(Bacteroidetes)、拟杆菌纲(Bacteroidia)、Muribaculaceae的相对丰度显著下降(P<0.05),梭菌科(Clostridiaceae)、狭义梭菌属(Clostridium_sensu_stricto_1)、苏黎世杆菌属(Turicibacter)、布劳特氏菌属(Blautia)、乳杆菌属(Lactobacillus)的相对丰度显著升高(P<0.01)。与模型组相比,附子理中丸给药组的拟杆菌门(Bacteroidetes)、拟杆菌纲(Bacteroidia)、Muribaculaceae的相对丰度显著升高(P<0.05),梭菌科(Clostridiaceae)、狭义梭菌属(Clostridium_sensu_stricto_1)、苏黎世杆菌属(Turicibacter)、布劳特氏菌属(Blautia)的相对丰度显著下降(P<0.01)。附子理中丸给药组乳杆菌属(Lactobacillus)相对丰度升高,附子理中丸高剂量组具有显著性差异(P<0.05)。结论附子理中丸可以促进益生菌乳杆菌的生长和拟杆菌、苏黎世杆菌、布劳特氏菌向正常组回调。对肠道菌群特别是与炎症/免疫反应密切相关菌群的调节,是附子理中丸治疗脾阳虚IBS-D腹泻的重要作用机制。

晚期非小细胞肺癌患者免疫治疗所致甲状腺功能减退症的中医证候、证素特点研究

【目的】探索晚期非小细胞肺癌(NSCLC)患者接受免疫检查点抑制剂(ICIs)治疗后出现甲状腺功能减退症(以下简称“甲减”)的中医证候特点、证素分布与组合情况以及中医证型的分布规律。【方法】选择2020年1月至2023年6月就诊于广州中医药大学附属中山中医院,经病理确诊为ⅢB-ⅣB期、表皮生长因子受体/间变性淋巴瘤激酶(EGFR/ALK)阴性、并使用ICIs治疗后出现甲减的NSCLC患者,共168例。收集患者的四诊信息,运用聚类分析总结出晚期NSCLC免疫治疗后出现甲减的中医证候特点和证型分布规律,并对不同性别、年龄段和甲减分级的中医证型分布规律进行分析。【结果】(1)168例晚期NSCLC患者接受免疫治疗后出现甲减的中医证候以虚为主,表现为咳嗽、倦怠乏力、健忘、面色少华、自汗、皮肤干燥、痰色白、懒言、头晕、夜尿多、视物模糊、形体消瘦、皮肤弹性差、纳呆恶食、嗜睡、长期食少、水肿、失眠、声低、隐痛、指甲淡白、吐痰、经常畏冷、口渴、面色?白、喜温恶凉、渴欲热饮、气喘、经常便秘、大便干结、面睑浮肿、多梦、腹胀、腰痛、排便无力等;舌脉象主要包括:舌苔薄白、舌淡红、舌边齿印、舌淡胖、舌淡、脉沉、脉滑、脉虚、尺脉弱、脉细。(2)总体病位证素以肺、脾、肾多见,病性证素以气虚、阳虚、血虚、水停多见。(3)经聚类分析,得出以下3种证型,分布频次由高到低依次为肺脾气虚证、肾阳亏虚证和气虚水停证。(4)不同年龄段的中医证型分布比较,差异有统计学意义(P<0.01)。其中,60~69岁患者以肺脾气虚为主要证型,≥70岁患者以肾阳亏虚为主要证型,<50岁患者以气虚水停证为主要证型。而不同性别、甲减等级的中医证型分布比较,差异均无统计学意义(P>0.05)。【结论】晚期NSCLC免疫治疗所致甲减患者的中医证型以肺脾气虚、肾阳亏虚、气虚水停为主,正气亏虚是其变化、发展的主要病机。临床医师应及时关注患者的症状变化,监测患者甲状腺功能指标,避免发生严重免疫治疗相关不良反应。

基于“肠-脑互动”探讨温肾健脾方对脾肾阳虚型腹泻型肠易激综合征大鼠内脏敏感性及c-Fos表达的影响

目的观察温肾健脾方对脾肾阳虚型腹泻型肠易激综合征(IBS-D)大鼠粪便性状、肠道吸收功能、内脏敏感性及结肠组织、背根神经节和海马组织c-Fos表达的影响,探讨其作用机制。方法将32只SD大鼠随机分为正常组、模型组、匹维溴铵组和温肾健脾方组,每组8只。采用母子分离联合番泻叶灌胃建立脾肾阳虚型IBS-D大鼠模型。匹维溴铵组、温肾健脾方组和模型组分别予匹维溴铵混悬液、温肾健脾方溶液及0.9%氯化钠溶液灌胃,连续14 d。对乳鼠粪便性状进行评分,腹壁撤退反射(AWR)实验检测内脏敏感性,D-木糖吸收实验测定肠道吸收功能,HE染色观察结肠组织病理变化,qRT-PCR和Western blot检测结肠组织、背根神经节、海马组织c-Fos mRNA和蛋白表达。结果与正常组比较,模型组大鼠Bristol粪便性状评分显著增加(P<0.01),各压力水平下AWR评分均显著升高(P<0.01),血清D-木糖含量显著减少(P<0.01),结肠黏膜可见轻度水肿,上皮细胞排列紊乱,结肠组织、背根神经节、海马组织c-Fos mRNA和蛋白表达显著升高(P<0.01);与模型组比较,温肾健脾方组大鼠Bristol粪便性状评分显著减少(P<0.01),各压力水平下AWR评分显著降低(P<0.01),血清D-木糖含量显著增加(P<0.01),结肠黏膜完整,上皮细胞排列整齐、形态一致,结肠组织、背根神经节、海马组织c-Fos mRNA和蛋白表达显著降低(P<0.01,P<0.05)。结论温肾健脾方可调节脾肾阳虚型IBS-D模型大鼠内脏敏感性,改善肠道吸收功能,缓解IBS-D症状,其作用可能是通过下调结肠组织、背根神经节及海马组织c-Fos表达实现。