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 prescription rule analysis of the New Theory on Spleen Dampness Syndrome by Academician TONG Xiaolin

Objective To analyze the basic characteristics,drug features,prescription rules,and drug-symptom relationships of patients in the splenic deficiency and impairment stage,by data mining of medical records under the New Theory on Spleen Dampness Syndrome(Pi Dan Xin Lun,《脾瘅新论》).Methods Medical records listed in the“New Theory on Spleen Dampness Syndrome-Under-standing and Treatment of Metabolic Syndrome from the Perspective of Traditional Chinese Medicine”,and which were diagnosed with the spleen dampness syndrome at the splenic de-ficiency and impairment stage,during January 2004 and December 2016 were selected.These patients’data,including basic information,clinical symptoms,laboratory examination res-ults,traditional Chinese medicine(TCM)and western medicine diagnoses,treatment meth-ods,prescriptions,etc.,were collected.The collected data were subsequently compiled into a medical record database using the Epidata 3.1 data management software,followed by the use of Apriori algorithm provided in the SPSS Modeler 14.2 statistical software to investigate the association rules between drug-drug,drug-symptom,and drug-western medicine indices.Results(i)A total of 51 medical records were included,involving 17 types of syndromes.Among them,the top three with frequency≥3 included“Phlegm and blood stasis,and thoracic obstruction”“Deficiency-weakness of the spleen Qi,and static blood blocking collat-erals”,and“Deficiency-weakness of the spleen Qi,and static blood blocking collaterals”.Al-ternatively,of the 14 treatment methods,the top three treatments with frequency of≥3 in-cluded“Activating Yang and eliminating turbidity,and removing phlegm and dredging chan-nel blockage”“Strengthening the spleen and benefiting Qi,and eliminating phlegm to activ-ate the channels”,and“Warming Yang and benefiting Qi,and expelling cold to remove ob-structions”.Among the 15 prescriptions,the top three used with frequency≥3 included Huangqi Guizhi Wuwu Tang(黄芪桂枝五物汤),Gualou Xiebai Banxia Tang(瓜蒌薤白半夏汤),and Ganjiang Huangqin Huanglian Renshen Tang(干姜黄芩黄连人参汤).Lastly,of the 83 drugs used for a total of 476 times,those with frequency≥15 included Huanglian(Coptid-is Rhizoma),Huangqi(Astragali Radix),Jiudahuang(Wine-processed Rhei Radix et Rhizoma),Jixueteng(Spatholobi Caulis),Shengjiang(Zingiberis Rhizoma Recens),Huangqin(Scutellariae Radix),and Guizhi(Cinnamomi Ramulus).(ii)For the drug-drug associations,under the criteria of support≥15%and confidence=100%,seven second-order association rules,seven third-order rules,and six fourth-order roles were identified.The top-ranking rule of each was“Huangqin(Scutellariae Radix)→Huanglian(Coptidis Rhizoma)”“Ganjiang(Zingiberis Rhizoma)+Huangqin(Scutellariae Radix)→Huanglian(Coptidis Rhizoma)”,and“Baishao(Paeoniae Radix Alba)+Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatho-lobi Caulis)→Huangqin(Scutellariae Radix)”,respectively.Alternatively,the drug-symptom associations were analyzed under the criteria of support≥5%and confidence=100%,which derived eight second-order association rules,31 third-order rules,and 30 fourth-order rules.The top-ranking association rule of each order was“Huangqi(Astragali Radix)→Limb ed-ema”“Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatholobi Caulis)→Limb numbness and pain”,and“Guizhi(Cinnamomi Ramulus)+Jixueteng(Spatholobi Caulis)+Huangqi(As-tragali Radix)→Limb numbness and pain”,respectively.Similarly,the drug-western medi-cine index associations were investigated under the criteria of support≥5%and confidence=100%,and five second-order association rules,16 third-order rules,and 16 fourth-order rules were identified.In this category,the top-ranking association rule of each order was“Qinpi(Fraxini Cortex)→Uric acid”“Huanglian(Coptidis Rhizoma)+Ganjiang(Zingiberis Rhizoma)→Glycated hemoglobin”,and“Huanglian(Coptidis Rhizoma)+Ganjiang(Zing-iberis Rhizoma)+Huangqin(Scutellariae Radix)→Glycated hemoglobin”,respectively.Conclusion Through association rule mining,this study objectively and quantitatively demonstrated the drug-drug,drug-symptom,and drug-physicochemical index associations of patients with the spleen dampness syndrome at the splenic deficiency and impairment stage treated by Academician TONG Xiaolin.The results indicated that treatment for these patients adopted the“state-target”syndrome differentiation method.The drug combination was characterized by“small prescriptions”,targeting both the patient’s symptoms and signs(syndrome target)and western medicine indices(treatment target).This study could provide references for future research on the academic thoughts and medical experience of Academi-cian TONG Xiaolin.

Exploration and Study of Jianpi Qushi Powder Combined with Standard Anti HP Quadruple Therapy in the Treatment of HP Infectious Gastritis of Spleen Deficiency and Dampness Stagnation Type

Objective: To explore the therapeutic effect of traditional Chinese medicine Jianpi Qushi powder combined with standard anti-HP quadruple therapy in the treatment of HP infectious gastritis with spleen deficiency and dampness stagnation. Methods: From January 2020 to December 2021, 223 patients with laboratory-confirmed HP infection who were admitted to the Outpatient and Inpatient Department of Internal Medicine in our hospital were selected as the research objects and randomly divided into two groups. 101 patients in the control group were given standard anti HP quadruple therapy;122 cases in the treatment group were given traditional Chinese medicine Jianpi Qushi powder combined with standard anti HP quadruple therapy. The two groups were rechecked carbon breath test after the designed course of treatment, and the curative effects of the two groups were compared. Results: 113 cases in the treatment group were cured by traditional Chinese medicine Jianpi Qushi powder combined with standard anti HP quadruple therapy, and the cure rate was 92.62%. 84 cases in the control group were cured by standard anti HP quadruple therapy, and the cure rate was 83.17%, χ2 = 4.7955, P = 0.0285, the difference was statistically significant (P < 0.05). Conclusion: Traditional Chinese medicine Jianpi Qushi powder combined with standard anti HP quadruple therapy in the treatment of HP infectious gastritis with spleen deficiency and dampness stagnation is one of the best treatment schemes for HP infection. The results of this study achieve the best clinical treatment effect, and provide a more valuable and reliable method for the treatment of gastropathy in clinical internal medicine, which is worthy of popularization and application.

Research Progress of Jianpi Qushi Powder Combined with Standard Anti Hp Quadruple Therapy in the Treatment of Hp Infectious Gastritis with Spleen Deficiency and Dampness Stagnation

Stomach Helicobacter pylori infection is one of the common gastric diseases. Helicobacter pylori infectious gastritis of spleen deficiency and dampness stagnation is a relatively intractable chronic disease. In recent years, traditional Chinese medicine methods have emerged one after another in the treatment of gastric Helicobacter pylori infection. By collecting references, the author reviewed the clinical characteristics of gastric Helicobacter pylori infection and the new progress of traditional Chinese medicine treatment.

Rat model for study of the essence of spleen deficiency and dampness in Chinese medicine

Objective:To explore the essence of spleen deficiency and dampness in Chinese medicine by successfully constructing a rat model with this syndrome.Methods:Rat models with the syndrome of dampness and spleen deficiency were established with the use of a high-fat,low-protein diet and excessive fatigue induced by loaded swimming.A total of 25 common clinical serological markers were tested.The T test,rank test,and partial least squares regression-discriminant analysis were used to analyze the data.Results:Total protein,albumin,motilin,interferon-γ,interleukin-2,immunoglobulin A,immunoglobulin G,and complement 3 levels in the model rats were lower than those in the control group(P=0.029,P=0.032,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,respectively).The serum creatinine,total cholesterol,aldosterone,antidiuretic hormone,gastrin,interleukin-4,somatostatin,atrial natriuretic peptide,and vasoactive intestinal peptide levels in the model group were higher than those in the control group(P<0.001,P=0.015,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,P<0.001,respectively).There was no statistical difference between the two groups in aspartate transaminase,alanine aminotransferase,globulin,albumin/globulin,blood urea nitrogen,high-density lipoprotein,and low-density lipoprotein.The model animal syndrome used two important variables in analysis with partial least squares regression-discriminant analysis.At the same time,the two dimensions were difficult to distinguish for each biological index.Conclusion:Spleen deficiency is often associated with dampness.The index that represents spleen deficiency can also represent dampness.Cytokines,immunoglobulins,and gastrointestinal hormones play a major causative role in both spleen deficiency and dampness.

Study on the Characteristics of Gut Microbiota in Chronic Hepatitis B(CHB)Patients with Damp Heat Syndrome and Liver Depression and Spleen Deficiency Syndrome

Objective:This study was designed to explore the characteristics of gut microbiota in CHB patients with two most common traditional Chinese medicine(TCM)Syndromes—damp heat syndrome and liver depression and spleen deficiency syndrome.Methods:According to the diagnostic criteria of Western medicine,TCM and screening exclusion criteria,65 cases of CHB with damp heat syndrome and 28 cases of CHB with liver depression and spleen deficiency syndrome were finally included in the study.All the basic information was gathered and the fresh fecal samples were collected for 16S rDNA sequencing.16S rDNA of gut microbiota was sequenced using Illumina hiseq 2,500 high-throughput sequencing platform.Based on the optimized sequence,Operational Taxonomic Units(OTU)clustering analysis and taxonomic annotation were carried out.Results:The difference in relative abundance of gut microbiota was significant between damp heat syndrome and liver depression and spleen deficiency syndrome in CHB patients.Cyanobacteria was only found in damp heat syndrome.The relative abundance of Erysipelotrichia and Subdoligranulum were higher in liver depression and spleen deficiency syndrome,while the relative abundance of Rhodospirillales,Alphaproteobacteria and Lachnospira were higher in the damp heat syndrome.LDA Effect Size(LEfSe)analysis showed that Lachnospira,Olsenella and Subdoligranulum had significant difference in species among the two TCM syndromes.Conclusion:The different characteristics of gut microbiota in the two TCM syndromes of CHB patients may play an important role in syndrome formation of TCM,which provides a new field of vision for the accurate diagnosis and treatment of TCM.

Study on the Expression of Organic Anion Transporting Polypeptide (oatp2a1) in Rat with Spleen Deficiency Syndrome and the Exploration of Clinical Significance

Objective: to explore the mechanism of transportation and transformation of dampness by the way of the expression of organic anion transporting polypeptide (oatp) superfamily member 2a1 (oatp2a1) mRNA in rat with spleen deficiency syndrome and the significance in transportation and transformation of dampness. Methods: 32 wistar male rats were divided randomly into four groups: normal group (n = 6), normal + AA group (n = 6), spleen deficiency group (n = 10), Spleen deficiency + AA group (n = 10). After reserpine-induced spleen deficiency model was made, intragastric administration of aristolochic acid (AA) was adopted for three days, the expression of oatp2a1 mRNA were detected in the tissues of lung, liver, kidney, stomach, small intestine and large intestine in four groups by using Fluorescent Quantitative-Polymerase Chain Reaction (FQ-PCR). Results: the expression of oatp2a1 mRNA in above six tissues could be detected. The ex-pression of oatp2a1 mRNA in liver tissue of rat with spleen deficiency syndrome was up-regulated compared to normal group (P = 0.035, P < 0.05), the expression of oatp2a1 mRNA in small intestinal tissue of rat with spleen deficiency syndrome was down-regulated compared to normal group (P = 0.004, P < 0.01), the expression of oatp2a1 in intestinal tissue in normal + AA group is down-regulated compared to normal group (P = 0.032, P < 0.05). Conclusions: oatp2a1 might be one of the material basis involved in transportation and transformation of dampness. The changes of expression of oatp2a1 mRNA in small intestine, liver tissue suggests that small intestine, liver might play an important role in the transportation and transformation of dampness in the state of spleen deficiency. We further concluded that the function of spleen’s governing transportation and transformation of dampness was not only including the function of the gastrointestinal, but also part of the liver function in some degree, which needs to be further studied.

Modulating effects of Astragalus polysaccharide on immune disorders via gut microbiota and the TLR4/NF-κB pathway in rats with syndrome of dampness stagnancy due to spleen deficiency

The syndrome of dampness stagnancy due to spleen deficiency(DSSD)is relatively common globally.Although the pathogenesis of DSSD remains unclear,evidence has suggested that the gut microbiota might play a significant role.Radix Astragali,used as both medicine and food,exerts the effects of tonifying spleen and qi.Astragalus polysaccharide(APS)comprises a macromolecule substance extracted from the dried root of Radix Astragali,which has many pharmacological functions.However,whether APS mitigates the immune disorders underlying the DSSD syndrome via regulating gut microbiota and the relevant mechanism remains unknown.Here,we used DSSD rats induced by high-fat and low-protein(HFLP)diet plus exhaustive swimming,and found that APS of moderate molecular weight increased the body weight gain and immune organ indexes,decreased the levels of interleukin-1β(IL-1β),IL-6,and endotoxin,and suppressed the Toll-like receptor 4/nuclear factor-κB(TLR4/NF-κB)pathway.Moreover,a total of 27 critical genera were significantly enriched according to the linear discriminant analysis effect size(LEfSe).APS increased the diversity of the gut microbiota and changed its composition,such as reducing the relative abundance of Pseudoflavonifractor and Paraprevotella,and increasing that of Parasutterella,Parabacteroides,Clostridium XIVb,Oscillibacter,Butyricicoccus,and Dorea.APS also elevated the contents of short-chain fatty acids(SCFAs).Furthermore,the correlation analysis indicated that 12 critical bacteria were related to the body weight gain and immune organ indexes.In general,our study demonstrated that APS ameliorated the immune disorders in DSSD rats via modulating their gut microbiota,especially for some bacteria involving immune and inflammatory response and SCFA production,as well as the TLR4/NF-κB pathway.This study provides an insight into the function of APS as a unique potential prebiotic through exerting systemic activities in treating DSSD.

Screening the effective components in treating dampness stagnancy due to spleen deficiency syndrome and elucidating the potential mechanism of Poria water extract

Poria is an important medicine for inducing diuresis to drain dampness from the middle energizer.However,the specific effective components and the potential mechanism of Poria remain largely unknown.To identify the effective components and the mechanism of Poria water extract(PWE)to treat dampness stagnancy due to spleen deficiency syndrome(DSSD),a rat model of DSSD was established through weight-loaded forced swimming,intragastric ice-water stimulation,humid living environment,and alternate-day fasting for 21 days.After 14 days of treatment with PWE,the results indicated that PWE increased fecal moisture percentage,urine output,D-xylose level and weight;amylase,albumin,and total protein levels;and the swimming time of rats with DSSD to different extents.Eleven highly related components were screened out using the spectrum-effect relationship and LC-MS.Mechanistic studies revealed that PWE significantly increased the expression of serum motilin(MTL),gastrin(GAS),ADCY5/6,p-PKAα/β/γcat,and phosphorylated cAMP-response element binding protein in the stomach,and AQP3 expression in the colon.Moreover,it decreased the levels of serum ADH,the expression of AQP3 and AQP4 in the stomach,AQP1 and AQP3 in the duodenum,and AQP4 in the colon.PWE induced diuresis to drain dampness in rats with DSSD.Eleven main effective components were identified in PWE.They exerted therapeutic effect by regulating the AC-cAMP-AQP signaling pathway in the stomach,MTL and GAS levels in the serum,AQP1 and AQP3 expression in the duodenum,and AQP3 and AQP4 expression in the colon.

Calibration of the DAMPE Plastic Scintillator Detector and its on-orbit performance

The DArk Matter Particle Explorer(DAMPE) is a space-borne apparatus for detecting the highenergy cosmic-ray-like electrons, γ-rays, protons and heavy ions. The Plastic Scintillator Detector(PSD)is the top-most sub-detector of the DAMPE. The PSD is designed to measure the charge of incident highenergy particles and it also serves as a veto detector for discriminating γ-rays from charged particles. In this paper, a PSD on-orbit calibration procedure is described, which includes the five steps of pedestal, dynode correlation, response to minimum-ionizing particles, light attenuation function and energy reconstruction.A method for reconstructing the charge of incident high energy cosmic-ray particles is introduced. The detection efficiency of each PSD strip is verified to be above 99.5%; the total efficiency of the PSD for charged particles is above 99.99%.

基于GC-TOF/MS代谢组学技术探讨藿香正气滴丸干预湿困脾胃型大鼠的作用机制

目的通过基于气相色谱-飞行时间质谱联用(GC-TOF/MS)技术的代谢组学方法探讨藿香正气滴丸干预湿困脾胃型大鼠的作用机制。方法将雄性SD大鼠随机分为正常组、模型组和藿香正气滴丸组(1 g·kg^(-1))。采用综合物理模型复制方法结合饮食失节制备湿困脾胃大鼠模型。灌胃给药,每日1次,连续给药10 d。观察大鼠宏观体征和行为学指标(体质量、体长、尾长、腹围指数与自主活动次数)。利用GC-TOF/MS方法对大鼠血清和尿液代谢组进行分析,鉴定与湿困脾胃相关的潜在生物标志物,分析藿香正气滴丸干预湿困脾胃型大鼠的代谢通路。结果与正常组比较,模型组大鼠的体质量、体长、尾长、自主活动次数明显减少(P<0.05),腹围指数明显升高(P<0.05)。与模型组比较,藿香正气滴丸组大鼠的体质量、体长、自主活动次数明显增加(P<0.05),腹围指数明显降低(P<0.05)。在大鼠血清、尿液中分别鉴定了38、44个与湿困脾胃相关的潜在生物标志物。藿香正气滴丸对模型大鼠的血清和尿液代谢表型能产生有效的干预,并能使血清、尿液中的17、13个潜在生物标志物水平显著回调,共涉及7条代谢通路。结论藿香正气滴丸对湿困脾胃型大鼠的干预机制可能与调节色氨酸代谢、组氨酸代谢、谷氨酸-谷氨酰胺代谢、能量代谢及肠道菌群等有关。

固本化湿降脂汤调控STING-IRF3通路对脾虚湿阻型单纯性肥胖大鼠炎症细胞因子的影响

目的 探讨固本化湿降脂汤通过STING-IRF3信号通路对脾虚湿阻型单纯性肥胖大鼠炎症细胞因子的影响。方法 建立脾虚湿阻型单纯性肥胖模型后,将大鼠随机分成模型组、奥利司他阳性对照组(37.5 mg/kg)、固本化湿降脂汤高剂量组(34.4 g/kg)、中剂量组(17.2 g/kg)、低剂量组(8.6 g/kg)及正常组,每组8只,灌胃给药1次/d,连续4周。比较各组大鼠体质量、Lee’s系数、远红外热成像及脑部核磁共振成像(MRI),观察固本化湿降脂汤的减肥效果;比较各组大鼠炎症细胞因子如肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、C反应蛋白(CRP)表达变化;采用免疫组织化学法检测脂肪中STING的表达;采用RT-PCR法检测肝脏STING的mRNA表达,使用蛋白印迹法在蛋白水平测量IRF3的变化,观察其对大鼠STING-IRF3信号通路的影响。结果 固本化湿降脂汤干预脾虚湿阻型单纯性肥胖大鼠后体质量下降明显(P<0.05),脑部、腹部异常区域恢复,可有效降低大鼠TNF-α、IL-6、IL-1β、CRP等相关炎症细胞因子的表达(P <0.01),用药前后STING-IRF3通路变化差异明显(P <0.01)。结论 固本化湿降脂汤通过调控STING-IRF3通路,降低脾虚湿阻型单纯性肥胖大鼠体质量并调节相关炎症细胞因子的表达。

揿针疗法治疗脾虚湿阻型单纯性肥胖的效果及对血清中脂肪因子LEP、ADP、Ins水平的影响

目的研究揿针疗法治疗脾虚湿阻型单纯性肥胖(simple obesity,SO)的效果及对血清中脂肪因子瘦素(leptin,LEP)、脂联素(adiponectin,ADP)、胰岛素(insulin,INS)水平的影响。方法选取2019年8月—2021年8月医院诊治的108例脾虚湿阻型SO患者,随机分为对照组与观察组,各54例。对照组给予饮食调整和有氧运动干预,观察组在以上基础上实施揿针疗法。两组持续治疗8周后,比较两组疗效、中医证候积分、腰臀围与体质量指数、脂肪因子指标、血脂水平。结果两组治疗后具有一定疗效,且观察组有效率(96.30%,52/54)高于对照组(85.19%,46/54)(P<0.05)。两组治疗后较治疗前比较,中医证候积分显著下降,且观察组积分低于对照组(P<0.05)。两组治疗后较治疗前比较,腰围、臀围、体质量指数显著下降,且观察组水平低于对照组(P<0.05)。两组治疗后较治疗前比较,LEP、ADP、Ins水平下降,且观察组水平低于对照组(P<0.05)。两组治疗后较治疗前比较,总胆固醇、甘油三酯、低密度脂蛋白水平有所下降,且研究组水平低于对照组(P<0.05)。结论揿针疗法可有效改善脾虚湿阻型SO患者症状体征,提高疗效,降低血清脂肪因子与血脂水平,可推荐临床使用。

Treatment of refractory H.pylori by Chai Ping Decoction:two case reports

Objectives:Helicobacter pylori(H.pylori)infection is one of the most common infections,for which wellestablished medical treatments have been widely used,such as quadruple therapy and sequential therapy.However,some patients still suffer from the infection after multiple treatment.Traditional Chinese medicine(TCM)has been widely used to treat the H.pylori infection.Whether the combination of TCM therapy and antibiotic treatment is effective for these patients with repeated infection with H.pylori needs clinical observation.Methods:In this study,we reported two cases with refractory H.pylori infection.One is a 60-yearold Chinese woman with diagnoses of chronic atrophic gastritis and H.pylori infection,who has an uncomfortable feeling in her stomach with a poor appetite,depression and irregular defecations.The other is a Vietnamese woman aged 46,who had abdominal pain for 11 years.We treated the two patients with Chai Ping Decoction,combined with sequential therapy.Results:Both patients had pain relieved and H.pylori infection eradicated after treatment.Conclusion:TCM therapy may eliminate H.pylori infection well with sequential therapy.Based on the TCM theory,the patients who were diagnosed as spleen deficiency and dampness with abdominal uncomfortable symptoms could be well treated.

止痛如神汤在腰骶部带状疱疹后神经痛(脾虚湿蕴)患者中的应用及对疼痛程度的影响

目的:观察止痛如神汤在腰骶部带状疱疹后神经痛(脾虚湿蕴)患者中的应用及对疼痛程度的影响。方法:本研究纳入2020年1月—2023年1月于彭州市人民医院就诊的60例腰骶部带状疱疹后神经痛(脾虚湿蕴)患者作为研究对象,根据随机数表法将患者分为观察组和对照组,各30例。对照组给予基础治疗,观察组给予基础治疗联合口服止痛如神汤。比较两组临床疗效、疼痛程度[视觉模拟评分法(visual analogue scale,VAS)]、睡眠质量[匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)]及不良反应发生情况。结果:观察组总有效率高于对照组,差异有统计学意义(χ^(2)=8.822,P=0.003)。治疗前,两组VAS评分比较,差异无统计学意义(P>0.05);治疗后3周、4周、12周,两组VAS评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组PSQI评分比较,差异无统计学意义(P>0.05);治疗后3周、4周、12周两组PSQI评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。两组整个研究过程中均治疗顺利,治疗期间无过敏、皮肤感染等不良反应发生。结论:腰骶部带状疱疹后神经痛(脾虚湿蕴)患者在基础治疗基础上加用止痛如神汤,具有镇痛效果好,安全性高,对睡眠质量改善作用明显。

田耀洲教授辨治慢性萎缩性胃炎经验采撷

慢性萎缩性胃炎(CAG)是消化系统常见病,具有病情反复、缠绵难愈的特点。病理主要以胃腺体的萎缩、伴或不伴有肠上皮化生或异型增生为特征。肠上皮化生和异型增生属于癌前病变,与胃癌的发生关系密切,积极控制CAG患者的临床症状,延缓其病理进展或逆转其病理变化,有利于改善患者的生活质量、减轻经济负担及预防胃癌发生。田耀洲教授认为此病属本虚标实,脾胃虚弱是本,气滞、湿郁、瘀血为标,虚、滞、湿、瘀相互胶结推动着疾病的进展,在辨证上推崇微观与宏观相结合,用药上推崇中西医结合,并擅用经方与药对,精准辨治与用药。田教授开创的自拟方剂芪芝方,疗效显著,可有效改善脾胃湿热型CAG的临床症状。今将田教授辨治CAG之经验及自拟方剂分享给大家,以期为临床辨治CAG提供参考借鉴。

苍术健脾、燥湿的作用机制及研究进展

综述苍术健脾、燥湿的作用机制及研究进展。古代医家常用苍术治疗多种疾病的脾胃湿证。苍术有效成分能改善胃排空及小肠推进率;可增加胃泌素、胃动素等,促进胃酸分泌,增加胃肠动力;可降低血管活性肠肽水平,抑制肠蠕动亢进。苍术能双向调节胃肠功能紊乱,且还能改善胃黏膜的异常形态,减轻胃组织损伤,改善肠组织异常结构。苍术燥湿的主要有效成分为挥发油,可导致体液丢失,血黏度增加,影响唾液腺分泌,引起口干,降低肾脏水通道蛋白2的表达量。苍术及其提取物能降低大鼠胃、大肠、尿液中水通道蛋白含量,通过多脏器调节体内水液代谢。故苍术能从影响脏器形态、胃肠道激素水平、水通道蛋白表达等多方面达到健脾、燥湿的功效。

国医大师杨春波辨治脾胃湿热证胃肠病经验

杨春波教授为全国第3届国医大师,擅长运用“脾胃湿热”理论诊治胃肠系统疾患。杨老认为,脾胃湿热由内外因素共同作用而成,应从“三因制宜”角度辨识脾胃湿热证胃肠病的个体化病因病机及临床特征。针对脾胃湿热证胃肠病的辨治用药,杨老以清化湿热、调气舒络为总治则,创制“清化饮”为基本方,并结合辨析寒热、分利三焦、顾护正气、扶正防邪等辨治心得立方。作者结合杨老临床验案,阐述杨老辨治脾胃湿热证胃肠病的临证经验,以期对指导临床诊治有所裨益。

2型糖尿病湿热困脾证合并血脂紊乱胰岛功能变化及其影响因素分析

目的探讨2型糖尿病湿热困脾证合并血脂紊乱患者胰岛功能变化及其影响因素。方法选择2020年1月—2020年12月医院收治的2型糖尿病湿热困脾证患者100例,根据美国ATPIII评估标准将其分为血脂紊乱组62例与血脂正常组38例。比较各组SF-36积分、胰岛素分泌功能(Homeostasis model assessment-β,HOMA-β)、胰岛素抵抗水平(Homeostasis model assessment-IR,HOMA-IR)、胰岛素敏感指数(Insulin sensitivity index,ISI)、空腹C肽和空腹胰岛素。应用单因素和多因素分析法研究血脂异常的相关因素。结果高甘油三酯组与混合型高脂组空腹胰岛素水平显著高于高胆固醇组与血脂正常组,差异有统计学意义(P<0.05)。高甘油三酯组空腹C肽水平显著高于高胆固醇组,差异有统计学意义(P<0.05)。混合型高脂组与高甘油三酯组的ISI水平低于高胆固醇组(P<0.05)。高甘油三酯组HOMA-β水平明显高于高胆固醇组与血脂正常组,差异有统计学意义(P<0.05)。高甘油三酯组及混合型高脂组HOMA-IR水平显著高于高胆固醇组,差异有统计学意义(P<0.05)。两组患者在躯体疼痛、整体健康、活力、社会功能和精神健康维度方面比较,差异有统计学意义(P<0.01)。多因素Logistic分析显示,喜食油腻、吸烟史、腰围和空腹胰岛素是2型糖尿病湿热困脾证患者血脂异常的危险因素,有氧运动是2型糖尿病湿热困脾证患者血脂异常的保护因素(P<0.05)。结论不同血脂紊乱类型对胰岛功能的影响并不相同,应针对相关因素积极预防,降低胰岛分泌负担,促使胰岛功能恢复。

益元宣肺汤对25例新冠肺炎CT值的影响

目的分析深圳地区2022年新型冠状病毒肺炎患者的舌象、症状及用药史,多辨为三焦壅滞、肺脾肾虚,拟益元宣肺汤,观察其对CT值恢复的临床疗效。方法选取25例符合益元宣肺汤证型者进行治疗观察,选同期对照组25例,观察益元宣肺汤对CT值的影响。结果治疗前对照组的N基因(31.99±1.16)、O基因(33.49±1.94)与治疗组的N基因(31.45±2.85)、O基因(33.40±3.96)比较,差异无统计学意义(P>0.05);对照组治疗到CT值符合出院标准所需时间为(4.28±1.88)d,治疗组为(2.80±1.26)d,差异有统计学意义(P<0.05)。结论治疗组通过服用益元宣肺汤,CT值恢复明显比对照组快,表明以调动肺脾肾之气、疏通三焦气机为主的益元宣肺汤效果明显。扶正补肺脾肾、通宣三焦的治疗方法,在促进病情好转,加快人体清除病毒的速度方面作用明显,利于新型冠状病毒肺炎患者康复。