Analysis on the Effect of Yiqi Huoxue Decoction Combined with Neuromuscular Electrical Stimulation in Improving ICU-Acquired Debility in Mechanically Ventilated Patients

Objective:To investigate the effect of Yiqi Huoxue decoction combined with neuromuscular electrical stimulation on improving intensive care unit(ICU)acquired debility in mechanically ventilated patients.Methods:50 patients who were admitted to the ICU and received mechanical ventilation treatment in our hospital from June 2022 to June 2023 and were complicated with ICU-acquired neurasthenia were selected,and randomly grouped using the randomized envelope method into two groups:control group with 25 patients who received neuromuscular electrical stimulation alone;observation group with 25 patients who received the traditional Chinese medicine Yiqi Huoxue decoction.Comparison indexes:treatment efficiency,degree of emotional recovery(APACHEⅡscore),muscle strength status(MRC score),motor status(FAC rating),and self-care ability(BI index score).Results:The treatment efficiency of patients in the observation group patients was higher as compared to those in the control group(P<0.05).There was no significant difference in the comparison of the results of the scores(ratings)of each index between the two groups before treatment(P>0.05).After the treatment,the APACHEⅡscores of patients in the observation group were significantly lower as compared to those in the control group,while the MRC scores,FAC ratings,and BI index scores were higher in the observation group than those of the control group patients(P<0.05).Conclusion:The combined application of Yiqi Huoxue decoction and neuromuscular electrical stimulation in the treatment of patients with ICU-acquired neurasthenia complicated by mechanical ventilation significantly enhanced the clinical efficacy,the patient’s muscle strength,motor status,and ability of self-care.Hence,it has high application value and is worthy to be popularized.

Effect of sitagliptin combined with Yiqi yangyin huoxue decoction on clinical efficacy and hemorheology in early diabetic nephropathy

BACKGROUND Early diabetic nephropathy(DN)is a complication of diabetes mellitus.It mainly affects kidney microvessels and glomerular function,and its timely and effective treatment is critical for early DN.However,the effects of treatments comprising simple Western medicine are not optimal.With the promotion and implementation of integrated Chinese and western medicine treatments,remarkable results have been achieved for many diseases.To this end,we explored the clinical efficacy of integrated traditional Chinese and western medicines for the treatment of early DN.AIM To investigate the effect of sitagliptin tablets combined with Yiqi yangyin huoxue decoction on clinical efficacy and hemorheology in patients with early DN.METHODS Through a retrospective analysis,123 patients with early DN were admitted to the endocrinology clinic of the Changzhou NO.7 People’s Hospital from January 2021 to October 2022 and were selected as study subjects.After rigorous screening,100 patients with early DN were enrolled.The control group(CG,n=50)and the observation group(OG,n=50)were divided according to the treatment method.The CG were treated with sitagliptin,and the OG were treated with sitagliptin plus the Yiqi yangyin huoxue decoction.Both groups were treated for 3 mo.For both groups,the baseline data and clinical efficacy were compared,and changes in blood glucose levels,lipid levels,renal function,and hematological indicators before(T0)and after(T1)treatment were assessed.RESULTS The total effective rate for the OG was 94.00%and that of the CG was 80.00%(P<0.05).After treatment(T1),the levels of fasting blood glucose,2 h postprandial glucose,total cholesterol,triacylglycerol,and low-density lipoprotein cholesterol in OG patients were obviously lower than those in the CG(P<0.05),and cystatin C,homocysteine,urinary microalbumin,and blood creatinine values in OG patients were also obviously lower than those in the CG(P<0.05);erythrocyte deposition,plasma viscosity,whole blood high shear viscosity,and whole blood low shear viscosity were markedly lower in OG patients than in the CG(P<0.05).CONCLUSION Sitagliptin combined with Yiqi yangyin huoxue decoction has a remarkable effect when used to treat patients with early DN.Further,it is helpful in improving hemorheological indices and controlling disease progression.

Effect of Huoxue Yiqi recipe on proliferation,migration and tube formation of miR-484 overexpressed umbilical vein endothelial cells

Objective:To explore the possible mechanism of Huoxue Yiqi recipe promoting angiogenesis by targeting VEGF with miR-484.Methods:The model of miR-484 overexpressed in HUVEC was prepared and intervened with Huoxue Yiqi Recipe Freeze-dried powder.The effects of Huoxue Yiqi Recipe on proliferation,migration and tubular forming ability of HUVEC were separatly detected by CCK-8 method,cell scratch test and Matrigel three-dimensional forming test in vitro.The effect of Huoxue Yiqi Recipe on VEGFA mRNA expression was detected by real-time fluorescence quantitative PCR.Results:Compared with the control group,the proliferation and migration area of cells in miR-484 overexpression model group decreased,the length,number of branches and nodes involved in tube formation decreased,the tube formation ability decreased significantly,and the expression level of VEGFA mRNA decreased,with statistical significance.Compared with the model group,the cell proliferation ability,migration area,length,number of branches and nodes involved in tube formation,tube formation ability and expression level of VEGFA mRNA in the Huoxue Yiqi Prescription group were up-regulated,and the difference was statistically significant(P<0.05).Conclusion:MiR-484 inhibits the expression of VEGFA and the proliferation,migration and formation of HUVEC,and Huoxue Yiqi recipe has a certain negative regulation effect on this process,which may be a new target of Huoxue Yiqi recipe to promote angiogenesis.

Effect of Yiqi Huoxue (益气活血) Herbs on Vascular Endothelial Cells and Platelets in Patients with Chronic Cor Pulmonale

Objective: To observe the clinical effect of Yiqi Huoxue (益气活血, YQHX) herbs in treating the patients with chronic cor pulmonale and to explore its mechanism by determining the relationship of oxida-tion/antioxidation system and how such herbs change on the function of endothelial cells and platelets. Methods: Fifty-eight patients were divided into two groups: conventional therapy group (control group, 28 patients) and convention plus YQHX herbs group (treated group, 30 patients). The control group received conventional management. The treated group were treated with YQHX 150 ml, twice a day, plus the conventional treatment, and the clinical efficacy was recorded. The lipid peroxidation (LPO), superoxide dismutase (SOD), ot-granule membrane protein (GMP140), partial pressure of arterial oxygen (PaO2), partial pressure of carbon dioxide in artery (PaCO2) and circulating endothelial cells (CEC) were measured respectively before and after treatment, and the relationship between various parameters were analyzed. The results were compared with those of 10 healthy subjects got at the same period. Results: (1) The effective rate and PaO2 of the treated group was higher than that of the control group and there were no difference in PaCO2 between the two groups. (2) The levels of LPO, GMP140, CEC in all the patients before therapy were significantly higher than those of the healthy group, and there were marked decrease in the levels of those after treatment (all P<0. 01). On the contrary, the levels of SOD in all the patients before therapy were markedly lower than those in the healthy subjects and increased after treatment, P<0. 01. (3) The increase of SOD in the treated group was significantly more obvious than that of the control group. In the treated group, the decrease of LPO, GMP140, CEC were markedly more obvious than those in the control group (all P<0. 01). (4) The number of CEC, as well as GMP140, was negatively correlated to PaO2(P<0.01) and SOD (P< 0. 01), which was positively correlated to LPO (P<0. 01). There was a positive correlation between CEC and GMP140 (P<0.05). Conclusion: YQHX herbs in treating chronic cor pulmonale proved to be effective by balancing the oxidation and antioxidation, protecting the pulmonary endothelial cells and activated platelets and helpful in treating respiratory failure.

益气活血通络方对脊髓型颈椎病模型大鼠miR-126a-5p及VEGF信号通路的影响

目的探讨益气活血通络方对脊髓型颈椎病模型大鼠微小RNA-126a-5p(miR-126a-5p)及血管内皮生长因子(VEGF)信号通路的影响。方法30只健康雄性SD大鼠按照随机数字表法均分为假手术组、模型组和中药组。模型组、中药组均制备脊髓型颈椎病模型。中药组给予益气活血通络方灌胃,假手术组、模型组给予生理盐水灌胃,均为12周。各组干预结束后进行大鼠行为学测试,测定机械性刺激阈值和热刺激回缩时间。处死大鼠,HE染色观察各组椎间盘软骨终板结构的差异。TUNEL染色观察大鼠椎间盘纤维环细胞变化。实时荧光定量聚合酶链式反应检测大鼠椎间盘纤维环组织miR-126a-5p和VEGF mRNA。采用Western blot法检测大鼠椎间盘纤维环组织VEGF蛋白表达。结果与假手术组比较,模型组大鼠椎间盘血管芽数目减少,大鼠椎间盘纤维环细胞破坏明显、大量凋亡且细胞密度降低;模型组和中药组机械性刺激阈值降低,热刺激回缩时间缩短,miR-126a-5p水平降低,VEGF mRNA和蛋白表达水平升高(P<0.05)。与模型组比较,中药组大鼠椎间盘血管芽数目增加,大鼠椎间盘纤维环细胞破坏减轻,大鼠椎间盘纤维环细胞凋亡减少且细胞密度增加,机械性刺激阈值升高,热刺激回缩时间延长,miR-126a-5p水平增加,VEGF mRNA和蛋白表达水平降低(P<0.05)。结论益气活血通络方治疗脊髓型颈椎病的机制可能与上调miR-126a-5p、下调VEGF表达有关。

益气活血汤治疗不稳定型心绞痛老年患者的疗效及对其血流动力学和心电图的影响

目的探究益气活血汤对不稳定型心绞痛(Unstable angina pectoris,UAP)老年患者的疗效及对其血流动力学和心电图的影响。方法选取2019年5月-2022年6月期间大连市友谊医院老年医学中心老年病科收治的92例UAP老年患者,按随机数字表法分为对照组和观察组,每组各46例。对照组给予常规治疗,观察组在对照组基础上给予益气活血汤治疗,均持续治疗4周。观察比较两组患者临床疗效、心电图改善情况,治疗前后血脂[总胆固醇(Total cholesterol,TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白胆固醇(High density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)]水平、血流动力学(全血还原黏度、纤维蛋白原、红细胞聚集指数、血浆黏度)指标及不良反应发生情况。结果治疗后观察组临床总有效率91.30%(42/46)明显高于对照组73.91%(34/46),差异有统计学意义(P<0.05)。治疗后两组患者血脂TC、TG、LDL-C水平均较治疗前降低,HDL-C水平较治疗前升高,差异有统计学意义(P<0.05);且观察组TC、TG、LDL-C水平均明显低于对照组,HDL-C水平明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者全血还原黏度、红细胞聚集指数、纤维蛋白原、血浆黏度均较治疗前降低,差异有统计学意义(P<0.05);且观察组血流动力学指标明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组心电图改善总有效率86.96%(40/46)明显高于对照组67.39%(31/46),差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论益气活血汤治疗老年UAP的疗效显著,可有效改善患者血流动力学指标和心电图情况。

益气活血中药防治化疗心脏毒性的临床研究

目的探讨益气活血中药对恶性肿瘤患者心功能及化疗心脏毒性的影响。方法选取2019年1月至2023年1月泰安市肿瘤防治院收治的60例恶性肿瘤患者作为研究对象,按照随机数字表法分为治疗组与对照组,每组30例。对照组行氟尿嘧啶类+铂类化疗方案治疗,治疗组在对照组基础上给予益气活血中药治疗,比较两组治疗前后心肌酶谱[α-羟丁酸脱氢酶(α-HBDH)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、谷草转氨酶(AST)]、B型脑钠肽(BNP)、心肌肌钙蛋白(cTnI)水平及治疗后心电图异常改变、心血管不良事件发生情况和左心室射血分数(LVEF)。结果治疗后,两组AST、α-HBDH水平均高于治疗前,对照组CK、LDH、BNP水平均高于治疗前,治疗组BNP水平低于治疗前和对照组,差异有统计学意义(P<0.05),两组其他指标组间及组内治疗前后比较差异无统计学意义。治疗组治疗后心电图异常改变、心血管不良事件发生率均低于对照组,差异有统计学意义(P<0.05);治疗后,对照组LVEF水平低于治疗前,但治疗组LVEF高于对照组,差异有统计学意义(P<0.05);治疗组治疗前后LVEF比较差异无统计学意义。结论益气活血中药具有一定程度预防化疗心脏毒性的作用,可改善患者心功能,尤其在改善BNP、预防LVEF降低方面优势明显,心肌酶谱、BNP、LVEF可能作为化疗心脏毒性的早期预测指标。

益气活血通络方联合针刺治疗脑梗死偏瘫临床研究

目的:观察益气活血通络方联合针刺治疗脑梗死偏瘫的临床疗效。方法:将100例脑梗死偏瘫患者以数字奇偶法分为对照组与治疗组各50例。2组均给予常规对症治疗,在此基础上,对照组给予针刺治疗,治疗组在对照组基础上加用益气活血通络方治疗。治疗1个月后比较2组临床疗效,比较2组治疗前后神经功能缺损程度、运动功能、实验室指标及颅内血流动力学指标。结果:治疗组临床总有效率92.00%,高于对照组76.00%(P<0.05)。治疗后,2组美国国立卫生研究院卒中量表(NHISS)评分降低(P<0.05),肢体运动功能量表(FMA)评分升高(P<0.05),且治疗组NIHSS评分低于对照组(P<0.05),FMA评分高于对照组(P<0.05)。治疗后,2组血清C-反应蛋白(CRP)、同型半胱氨酸(Hcy)、一氧化氮(NO)水平均降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组大脑前动脉(ACA)、大脑中动脉(MCA)及大脑后动脉(PCA)平均血流速度均升高(P<0.05),且治疗组高于对照组(P<0.05)。结论:针对脑梗死偏瘫患者采取益气活血通络方联合针刺治疗临床疗效显著,能有效减轻患者神经功能缺损,改善运动功能和颅内血流动力学状态,有效调节血清NO、Hcy水平,减轻机体炎症反应。

养阴益气活血方治疗原发性干燥综合征患者的临床效果

目的探究养阴益气活血方治疗原发性干燥综合征患者的临床效果。方法选取2021年5月至2022年5月收治的100例原发性干燥综合征患者为研究对象,依据不同治疗方式将其分为对照组和观察组,各50例。对照组给予硫酸羟氯喹片治疗,观察组在对照组基础上联合养阴益气活血方治疗。比较两组的治疗效果。结果治疗后,观察组的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均低于对照组(P<0.05)。治疗后,观察组的社会关系、躯体、环境、心理维度评分均明显高于对照组(P<0.05)。治疗后,观察组的匹兹堡睡眠质量指数量表(PSQI)评分低于对照组(P<0.05)。治疗后,观察组的降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、白细胞介素-18(IL-18)及白细胞介素-6(IL-6)水平均低于对照组(P<0.05)。治疗后,观察组的欧洲抗风湿联盟干燥综合征疾病活动度指数(ESSDAI)评分低于对照组(P<0.05)。观察组的治疗总有效率高于对照组(P<0.05)。结论养阴益气活血方治疗原发性干燥综合征的效果显著,可改善患者的心理状态、生活质量、睡眠质量、血清炎症因子水平及疾病活动度。

益气活血托毒方对慢性非细菌性前列腺炎大鼠Keap1/Nrf2/HO-1信号通路的影响

目的观察益气活血托毒方对慢性非细菌性前列腺炎(CNP)大鼠Keap1/Nrf2/HO-1信号通路的影响,探讨其治疗CNP作用机制。方法采用去势结合雌激素诱导法制备CNP大鼠模型。48只SD大鼠采用随机数字表法分为空白组、模型组、塞来昔布组和益气活血托毒方组,每组12只。塞来昔布组予塞来昔布混悬液0.035 g/kg灌胃,益气活血托毒方组予益气活血托毒方水煎剂8.64 g/kg灌胃,空白组和模型组灌胃等体积生理盐水,连续28 d。Von Frey纤维丝测痛仪测定大鼠机械痛阈值,HE染色观察前列腺组织病理变化并进行病理评分,化学荧光法检测前列腺组织活性氧(ROS)含量,比色法测定前列腺组织谷胱甘肽过氧化物酶(GSH-Px)活性和丙二醛(MDA)含量,Western blot检测前列腺组织Kelch样ECH相关蛋白1(Keap1)、核因子E2相关因子2(Nrf2)、血红素氧合酶-1(HO-1)蛋白表达。结果与空白组比较,模型组大鼠机械痛阈值、前列腺指数显著降低(P<0.01);前列腺组织腺腔大小不一,腔内分泌物消失,间质疏松、水肿,有大量纤维组织增生和炎性细胞浸润,病理评分显著升高(P<0.01);前列腺组织ROS、MDA含量显著升高,GSH-Px活性显著降低(P<0.01),Keap1、Nrf2蛋白表达显著降低,HO-1蛋白表达显著升高(P<0.01,P<0.05)。与模型组比较,益气活血托毒方组大鼠机械痛阈值显著升高(P<0.01);前列腺组织轻微损伤,有少量纤维增生和炎性细胞浸润,病理评分显著降低(P<0.01,P<0.05);前列腺组织ROS、MDA含量显著降低,GSH-Px活性显著升高(P<0.01),Keap1、Nrf2蛋白表达显著升高,HO-1蛋白表达显著降低(P<0.01,P<0.05)。结论益气活血托毒方可有效改善CNP大鼠前列腺组织病理形态,提高痛阈值,其作用机制可能与激活Keap1/Nrf2/HO-1信号通路,降低大鼠前列腺组织氧化应激损伤有关。

通腑益气活血汤配合肺泡灌洗治疗肺炎脓毒症的疗效及对患者T淋巴细胞亚群、线粒体损伤指数的影响

目的观察通腑益气活血汤配合纤支镜肺泡灌洗治疗肺炎脓毒症的疗效,并探讨其对患者T淋巴细胞亚群、线粒体损伤指数的影响。方法选取2020年1月至2023年1月河南省第二人民医院收治的92例肺炎脓毒症患者作为研究对象,按随机数表法分为观察组和对照组各46例。对照组患者予以纤支镜肺泡灌洗治疗,观察组患者予以通腑益气活血汤配合纤支镜肺泡灌洗治疗,均治疗2周。比较两组患者治疗2周后的疗效,及治疗前、治疗1周后、治疗2周后的中医证候积分、血气指标[经皮血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、肺功能[第1 s用力呼吸容积(FEV_(1))、FEV_(1)/用力肺活量(FVC)、第1秒用力呼气容积占预计值百分比(FEV_(1)%)]、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))、线粒体损伤指数(CD3^(+)MDI、CD4^(+)MDI、CD8^(+)MDI)、临床肺部感染评分(CPIS)、Murray肺损伤评分(MLIS)及急性生理与慢性健康量表(APACHEⅡ)评分;随访2个月,统计两组患者的生存情况及CPIS、MLIS、APACHEⅡ评分。结果观察组患者的治疗总有效率为91.30%,明显高于对照组的76.09%,差异有统计学意义(P<0.05);治疗2周后,观察组患者的主症、次症积分及总积分明显低于对照组,差异均有统计学意义(P<0.05);治疗2周后,观察组患者的FEV_(1)、FEV_(1)%、FEV_(1)/FVC、PaO_(2)及SpO_(2)明显高于对照组,PaCO_(2)明显低于对照组,差异均有统计学意义(P<0.05);治疗2周,观察组患者的CD3^(+)、CD4^(+)明显高于对照组,CD8^(+)、CD3^(+)MDI、CD4^(+)MDI、CD8^(+)MDI明显低于对照组,差异均有统计学意义(P<0.05);治疗2周后,观察组患者的MLIS、CPIS及APACHEⅡ评分明显低于对照组,差异均有统计学意义(P<0.05);随访2个月,观察组患者的生存率为95.95%,略高于对照组的89.13%,但差异无统计学意义(P>0.05),而观察组患者的MLIS、CPIS及APACHEⅡ评分明显低于对照组,差异均有统计学意义(P<0.05)。结论通腑益气活血汤配合纤支镜肺泡灌洗应用于肺炎脓毒症,可有效调节患者的血气与免疫功能,缓解临床症状,减轻肺损伤、改善肺功能,临床应用效果显著。

益气活血解毒法促进卵巢癌由“冷”向“热”转化基于免疫-炎性微环境的理论探讨分析

卵巢癌是致死率高居首位的妇科恶性肿瘤,探索有效的治疗方法预防转移成为亟待解决的临床难题。免疫治疗是肿瘤治疗的新视野,然而卵巢癌由于普遍缺乏细胞毒性T细胞的浸润,并且浸润的T细胞并不能识别所有的肿瘤抗原,属于“冷肿瘤”范畴,对免疫治疗并不敏感。中医认为气虚血瘀毒浊是卵巢癌的关键病机,益气活血解毒法是重要治法,有必要在理论研究上进一步阐明。免疫抑制和慢性炎症构成肿瘤微环境两大核心特征,共同促进肿瘤发生、发展及转移。本文分析了免疫-炎性微环境与中医“阴阳”“毒邪”理论的高度契合性:阳化气不足,如同正性免疫细胞如细胞毒性T细胞不足;阴成形太过,一方面,如同过多的免疫抑制性细胞、因子、代谢产物浸润,另一方面,如同人体的因虚致毒,维持并放大了炎性微环境,炎症促进肿瘤进展,炎症反过来又可促进免疫抑制。从免疫-炎症的角度阐明该法的治疗思路:“温阳扶正,平衡阴阳”以激活正性免疫;“活血、化痰、散寒、清热”以驱散阴邪,解化毒滞,从而缓解免疫抑制,调控炎性微环境;“以毒攻毒”以抗炎治疗,完善了该法转化“冷”“热”免疫原性的理论基础,为进一步物质研究提供理论依据。

Effect of Bushen Yiqi Huoxue Recipe on Placental Vasculature in Pregnant Rats with Fetal Growth Restriction Induced by Passive Smoking

Interactions of vascular endothelial growth factor （VEGF） with receptors VEGFR1/Fltl and VEGFR2/Flk1, and those of angiopoietins （Ang-1, Ang-2） with receptor Tie2 play important roles in placental angiogenesis. This study investigated vascular morphology and expression of these angiogenic factors in rat placenta on the day 15, 18, 21 of gestation （D 15, D 18 and D21）. The rats were randomly assigned into 3 groups： normal group, model group [fetal growth restriction （FGR） model], and Bushen Tqi Huoxue （BYHR） recipe treatment group （BYHR group, the pregnant rats with FGR were treated with BYHR recipe）. Morphological analysis indicated that during initial villous formation, fetal nucle- ated erythrocytes （FNEs） appeared in maternal blood sinus （MBS）. Subsequently, FNEs were sur- rounded by endothelial cells to form fetal capillary （FC） and then by trophoblast cells to form villi. As pregnancy proceeded, FC density increased progressively with increasing endothelial identification staining （EIS） in normal and BYHR groups. Whereas, villous formation was suppressed, normal in- crease in FC density was impaired and EIS was weakened in model group. Quantitative PCR analysis showed that VEGF and Flkl mRNA increased over gestation in all groups, indicating that VEGF might play a pivotal role in FC growth during late gestation. VEGF mRNA was increased on D15, while de- creased on D21 in model group as compared with normal group and BYHR group. Immunohistochemi- cally, Ang-2 protein was highly expressed in FNEs, gradually disappeared as villi matured, and decreased over gestation in all groups, indicating that Ang-2 might play a pivotal role in villous formation, which was further supported by decreased Ang-2 mRNA and protein expression in model group on D 15. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio increased from D15 to D18 in all groups as placenta matured. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio were decreased on D18 in model group as compared with normal and BYHR groups, indicating delayed maturity of FGR placenta. Alterations in angiogenic factors may result in altered placental vasculature and cause placental insufficiency. BYHR recipe could balance the angiogenic factors to promote the formation and maturation of FGR placental vasculature.

益气活血化痰法在慢性阻塞性肺疾病中的应用

慢性阻塞性肺疾病(COPD)属中医学“肺胀”“喘证”等范畴。近年来,基于本病“虚-痰-瘀”的病理特征,采用益气活血化痰法治疗COPD取得了积极进展,但在具体治法上没有形成统一标准,导致该治法在疗效及安全性评价等方面存在较大差异。本文从益气法、活血法、化痰法、益气活血化痰法4种治法角度梳理中医药治疗COPD的研究现状,并针对临床应用益气活血化痰法治疗COPD提出展望,以期为COPD的临床治疗及后续深入研究提供参考。

益气活血汤联合艾灸治疗四肢骨折术后气虚血瘀证疗效研究

目的:探讨益气活血汤联合艾灸对四肢骨折术后气虚血瘀证患者的影响。方法:选取四肢骨折术后气虚血瘀证患者,随机分为对照组和观察组,每组60例,均连续治疗14 d。对照组接受常规康复治疗,观察组在对照组基础上联合益气活血汤和艾灸治疗。比较两组患者治疗前后的中医证候积分、患肢功能恢复情况、患肢肿胀度、骨代谢状态、凝血功能及并发症发生率。结果:治疗后,观察组患者中医证候评分各项数值低于对照组(均P<0.05)。观察组患者四肢功能恢复理想率高于对照组,观察组活化部分凝血活酶时间、凝血酶原时间、凝血酶时间长于对照组,差异有统计学意义(均P<0.05)。观察组骨碱性磷酸酶、骨钙素、碱性磷酸酶水平高于对照组,而Ⅰ型胶原羧基端肽低于对照组,差异有统计学意义(均P<0.05)。观察组术后相关并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论:益气活血汤联合艾灸治疗四肢骨折术后气虚血瘀证可有效改善患肢功能恢复状况,加速抗凝血作用,促进术后患者恢复,减少相关并发症发生。

益气活血类方对心肌梗死恢复期病人心功能、中医证候的影响

目的:观察益气活血类方对心肌梗死恢复期病人心功能、中医证候的影响。方法:选取2021年5月—2022年12月首都医科大学附属北京中医医院及北京中医医院平谷医院门诊及住院治疗的心肌梗死恢复期病人144例作为研究对象,采用随机数字法将病人分为补阳还五颗粒组(31例)、脑心通胶囊组(49例)、养阴通脑颗粒组(31例)、对照组(33例)。补阳还五颗粒组给予标准化治疗+补阳还五颗粒+胶囊模拟剂,脑心通胶囊组给予标准化治疗+脑心通胶囊+颗粒模拟剂,养阴通脑颗粒组给予标准化治疗+养阴通脑颗粒+胶囊模拟剂,对照组给予标准化治疗+颗粒模拟剂+胶囊模拟剂。连续治疗3个月。比较各组左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、N末端B型利钠肽原(NT-proBNP)水平、NT-proBNP变化率、中医证候积分及中医证候疗效。结果:治疗后,补阳还五颗粒组、脑心通胶囊组及养阴通脑颗粒组LVEF水平较治疗前升高,且优于对照组(P<0.05)。补阳还五颗粒组、脑心通胶囊组及养阴通脑颗粒组治疗前后LVEDD、LVESD水平比较差异无统计学意义(P>0.05)。治疗后,补阳还五颗粒组、脑心通胶囊组NT-proBNP水平均较治疗前下降(P<0.05)。以NT-proBNP下降30%为标准,补阳还五颗粒组NT-proBNP下降≥30%的病人较其他3组多(P<0.05)。治疗后,脑心通胶囊组及养阴通脑颗粒组胸痛积分均优于对照组(P<0.05);脑心通胶囊组出汗积分较治疗前下降(P<0.05);脑心通胶囊组面色紫暗积分及总分均优于对照组(P<0.05)。补阳还五颗粒能缓解病人神疲乏力的症状,脑心通胶囊能缓解病人胸闷、气短的症状且能更加全面地减轻病人临床症状。结论:补阳还五颗粒、脑心通胶囊、养阴通脑颗粒能够提高心肌梗死恢复期病人心功能水平,改善临床症状。

基于网络药理学及分子对接探讨益气活血方治疗冠心病的作用机制

目的:通过网络药理学方法分析益气活血方治疗冠心病的分子作用机制,并通过分子对接进行验证。方法:通过中药系统药理学数据库与分析平台(TCMSP)和中药分子机制的生物信息学分析工具数据库(BATMAN-TCM)进行检索并筛选出益气活血方中的药物活性成分及作用靶点;在人类基因名片数据库(GeneCards)、人类孟德尔遗传在线数据库(OMIM)、药品数据与药物靶点数据库(DrugBank)、治疗靶点数据库(TTD)检索冠心病对应疾病靶点;通过R语言“Venn”插件得到药物有效活性成分和冠心病的共同靶点基因,应用STRING数据库,获得蛋白质-蛋白质相互作用(PPI)网络图,利用Cytoscape 3.7.2软件中CytoNCA插件筛选候选核心靶点基因,并逆向获得相关有效成分;共同靶点通过R语言“ClusterProfile”等插件,完成基因本体(GO)与京都基因与基因组百科全书(KEGG)富集分析;Cytoscape 3.7.2软件绘制成分-靶点-通路,根据节点筛选核心靶点及成分;利用AutodockTool 4软件对所筛选的核心靶点及成分进行分子对接。结果:筛选得到益气活血方113个主要有效成分,经分子对接验证后,得到治疗冠心病的核心靶点有热休克蛋白90α家族A类成员1(HSP90AA1)、丝氨酸/苏氨酸蛋白激酶B1(AKT1)、雌激素受体1(ESR1)、核因子κB P65(RELA)和半胱氨酸天冬氨酸蛋白酶-3(CASP3),核心成分有槲皮素、山柰酚、木犀草素、异鼠李素和柚皮素。结论:益气活血方中的槲皮素、山柰酚、木犀草素、异鼠李素和柚皮素等有效化学成分,可能通过作用于HSP90AA1、AKT1、ESR1、RELA和CASP3等关键靶点,调节脂质和动脉粥样硬化、流体剪切应力和动脉粥样硬化、晚期糖基化终末产物(AGE)/糖基化终末产物受体(RAGE)信号通路、前列腺癌和白细胞介素(IL)-17信号传导途径等多条信号通路,发挥治疗冠心病的作用。

益气活血开窍法治疗缺血性脑卒中疗效Meta分析

目的 系统评价益气活血开窍法治疗缺血性脑卒中的临床疗效。方法 通过检索近10年(2008—2018年)有关缺血性脑卒中的中医药治疗文献,探讨分析益气活血开窍法及相关方药对缺血性脑卒中的治疗效果,评价缺血性脑卒中在益气活血开窍法及相关方药干预下的疗效。采用Rev Man 5.3软件进行Meta分析。结果 共计12篇随机对照试验符合纳入标准,纳入1252例患者。Meta分析结果显示益气活血开窍法治疗缺血性脑卒中总体疗效比单用西药及其他中药治疗效果明显;患者的神经功能缺损程度、日常生活活动能力、生活质量、血液流变学指标均得到改善,差异均有统计学意义。结论 在常规治疗的基础上加用益气活血开窍的方法可提高缺血性脑卒中的临床疗效。

基于网络药理学探究黄芪、红芪在益气活血通便方治疗慢传输型便秘中的作用机制差异

目的:在黄芪、红芪本草药用历史对比总结基础上,利用网络药理学探究黄芪、红芪在益气活血通便方治疗慢传输型便秘中的作用机制差异,利用分子对接进行验证。方法:利用TCMSP和PharmMapper数据库筛选益气活血通便方中当归、黄芪、肉苁蓉、火麻仁、红芪的活性成分及靶点;通过GeneCards、DrugBank、OMIM等数据库筛选慢传输型便秘相关靶点,利用Venny 2.1.0工具作图比较益气活血通便方Ⅰ和组方Ⅱ治疗慢传输型便秘的靶点;通过STRING数据库构建活性成分和关键靶点PPI网络;利用Metascape平台进行GO和KEGG通路富集分析,比较网络药理学差异。构建益气活血通便方的成分-靶点-通路网络图,利用AutoDock软件进行分子对接。结果:得到组方Ⅰ60个活性成分,501个作用靶点;组方Ⅱ50个活性成分,622个作用靶点。得到疾病作用靶点1035个,组方Ⅰ和组方Ⅱ与慢传输型便秘交集靶点分别为161个和201个。GO富集分析得到益气活血通便方Ⅰ553条生物进程或通路,组方Ⅱ899条生物进程或通路。KEGG富集分析预测组方Ⅰ126条信号通路,组方Ⅱ144条信号通路。分子对接结果显示槲皮素、木犀草素、花生酸、山柰酚、3,9-二-O-甲基尼森香豌豆紫檀酚与EGFR、SRC、CASP3、HSP90AA1、ESR1有良好的结合活性。结论:益气活血通便方通过多点显效、协同增效治疗慢传输型便秘,红芪可发挥与黄芪相似的作用,但能否替代黄芪还有待于结合药效学实验、临床试验进一步深入研究。

益气活血方对冠心病气虚血瘀证大鼠TLR4/MyD88/NF-κB信号通路的影响

目的探讨益气活血方对冠心病气虚血瘀证大鼠的影响。方法48只雄性SD大鼠随机分为假手术组、模型组、益气活血方组、单硝酸异山梨酯组。除假手术组外,所有大鼠行冠状动脉结扎术。术后7 d,除假手术组外,其余大鼠强迫游泳14 d,并控制大鼠的食量,同时益气活血方组和单硝酸异山梨酯组大鼠予灌胃给药28 d。心脏超声检测大鼠心功能;全血黏度检测大鼠的瘀血程度;苏木精-伊红(hematoxylin-eosin,HE)染色检测大鼠心脏病理形态改变;Masson染色检测大鼠心肌纤维化水平;荧光定量PCR和免疫组化检测大鼠心肌组织Toll样受体(toll-like receptor,TLR)4、髓样分化因子(myeloid differentiationfactor,MyD)88和核因子(nuclear-factor,NF)-κB p65的mRNA和蛋白表达量;ELISA检测大鼠血清中白细胞介素(interleukin,IL)-1β、IL-6、肿瘤坏死因子(tumor necrosis factor,TNF)-α的含量。结果与假手术组比较,模型组大鼠心功能下降(P<0.01),全血黏度升高(P<0.01),心肌组织排列紊乱,心肌损伤范围较大,心肌纤维化严重(P<0.01),心肌中TLR4、MyD88、NF-κB p65 mRNA及蛋白表达水平上调(P<0.01),血清中IL-1β、IL-6、TNF-α的含量升高(P<0.01);与模型组比较,药物干预后,大鼠心功能改善(P<0.05),全血黏度下降(P<0.01),心肌组织排列较整齐,心肌损伤范围缩小,心肌纤维化缓解(P<0.01),TLR4、MyD88、NF-κB p65 mRNA及蛋白表达水平下调(P<0.05),血清中IL-1β、IL-6、TNF-α含量减少(P<0.05)。结论益气活血方能通过抑制TLR4/MyD88/NF-κB p65信号通路介导的炎症反应发挥对冠心病气虚血瘀证大鼠的治疗作用。