Research Progress and Prospects on the Anti-liver Fibrosis,Blood Circulation-promoting and Stasis-resolving Effects of Curcuma kwangsiensis Based on W-P Bodies

Liver fibrosis is a necessary stage in the progression of chronic liver disease to cirrhosis.So far,no satisfactory drugs have been found to intervene in liver fibrosis.Liver microcirculation disorders are one of the important pathogenesis of chronic liver disease,and hepatic sinusoidal endothelial cells(HSECs)are the main cells that constitute the liver microcirculation barrier.In clinical practice,W-P bodies have been detected in HSECs of most patients with liver fibrosis.W-P bodies serve as a site for the synthesis and storage of vW factors,ET-1 and other cytokines that promote liver fibrosis.They can disrupt the structure and function of HSECs,cause liver microcirculation disorders,and exacerbate the progression of liver fibrosis.Previous studies have found that the Guangxi specialty ethnic medicine,C.kwangsiensis S.G.Lee et C.F.Liang,has definite effects in promoting blood circulation,resolving blood stasis,and resisting liver fibrosis.Based on this,a further research idea has been derived,stating that the blood circulation-promoting,blood stasis-resolving,and anti-liver fibrosis effects of C.kwangsiensis are produced by affecting the formation of W-P bodies,the synthesis and storage of contents in W-P bodies,and intervening in their exocytosis capacity.

Clinical Observation on Influence of Chinese Medicines for Promoting Blood Circulation to Remove Blood Stasis on FIB and DD in Plasma of Patients with Cerebral Thrombosis

to study the influence of Chinese medicines for promoting blood circulation to remove blood stasis on fibrinogen(FIB)and D-dimer(DD)in plasma of patients with cerebral thrombosis. Method:73 inpatients with acute cerebral thrombosis were randomly divided into a control group of 34 cases and a treatment group of 39 cases.The content of FIB and DD in plasma was detected before treatment and on the 7th and 14th days after treatment.Result:FIB content in plasma after treatment was lower than that before treatment in the control group(P<0.01)and more remarkable in the treatment group(P<0.001).There was an obvious difference in DD content before and after treatment in both groups.DD content on the 7th and 14th days after treatment in the treatment group was obviously higher than that in the control group(P<0.01 and P<0.05 respectively). Conclusion:Chinese medicines for promoting blood circulation to remove blood stasis can reduce the FIB content in plasma of patients with cerebral thrombosis,raise the DD content in plasma, cause the peak of DD content appear earlier and obviously improve hypercoagulability of blood in patients with cerebral thrombosis.

Research Progress and Research Ideas on Anti-hepatic Fibrosis and Promoting Blood Circulation and Removing Blood Stasis of the National Drug Plumbapin Based on TLR4 Signal Pathway

Hepatic fibrosis is a reversible pathological phenomenon in the early and middle stages,but but no satisfactory intervention drugs have been available so far.Recent studies have suggested that microcirculation disturbance of liver is one of the important pathogenesis of chronic liver disease,the improvement of microcirculation is beneficial to the recovery of liver function and the delay of liver fibrosis.Hepatic stellate cells are the core cells of hepatic fibrosis,and also the most critical cells that affect the microcirculation of the liver.While TLR4/MyD88/NF-κB and TLR4/MyD88/MAPKs which are based on the action of hepatic stellate cells are two pathways that have very important influence on the inflammatory response of liver,the proliferation and apoptosis of hepatic stellate cells,and the secretion of fibrogenic cytokines.It was found that Plumbapin,the active ingredient of Guangxi specialty ethnic medicine,has the definite effect of promoting blood circulation and removing blood stasis and anti-hepatic fibrosis,but its mechanism is not clear.In this study,the research progress of the above problems was reviewed,and further research ideas were derived as follows:the pharmacological effect of Plumbapin on anti-hepatic fibrosis,promoting blood circulation and removing stasis was based on the influence of TLR4/MyD88/NF-κB and MAPKs signal pathway.

Revealing the material basis of MMP9-mediated activating blood and removing blood stasis drugs on Danshen-Ligusticum chuanxiong anti- vascular effect

Objective:Reveal the material basis and mechanism of angiogenesis effect of Danshen-chuanxiong herb-partners.Methods:The effective components of Danshen and chuanxiong were searched in the TCM System Pharmacology Database(TCMSP),and the drug targets were searched in the Swiss Target Prediction database;in the Disease-Gene Database(DisGeNET))Search for angiogenesis-promoting and inhibiting angiogenesis targets;use the protein interaction database(STRING)database and Cytoscape software to analyze the network core targets;use the DAVID database to enrich the drug-disease target intersection for GO and KEGG;RT-qPCR experiments verified the effect of luteolin on MMP9 gene expression;in vitro tube formation experiments analyzed the effect of luteolin on endothelial cell neovascularization.Results:After analysis,it is concluded that Danshen has 10 active ingredients and 50 angiogenesis targets;Chuanxiong has 2 active ingredients and 4 angiogenesis targets.The intersection of drug-taking targets yielded 9 targets,including AR,PARP1,MMP9,MMP2,MMP12,AKR1B10,ABCC1,CDK6,and STAT3.After analyzing the active ingredient-target network graph of Danshen/Chuanxiong,it was concluded that luteolin is the key chemical ingredient.After protein interaction(PPI)analysis,the results showed that MMP9 is the core target.The KEGG pathway is mainly enriched in 5 signaling pathways,the most important pathway is cancer-related pathways.There are 22 main biological processes of GO,which mainly involve collagen catabolism,protein extracellular matrix,metal endopeptidase activity,etc.The preliminary analysis of tubule formation experiment shows that luteolin inhibits angiogenesis and down-regulates the expression of MMP9 gene.Conclusion:Luteolin,the key chemical component of the Danshen-Ligusticum chuanxiong drug pair,inhibits angiogenesis by regulating the MMP9 target,and develops the reverse regulation of angiogenesis for the traditional Chinese medicine for promoting blood circulation and removing blood stasis on the basis of the known treatment of ischemic diseases.Provide a new perspective and theoretical basis for the use of Danshen and Chuanxiong medicine in clinical cancer patients.Reveal the material basis and mechanism of angiogenesis effect of Danshen-chuanxiong herb-partners.

中华跌打丸活血化瘀作用的实验研究

目的:观察中华跌打丸对大鼠急性血瘀模型的体外血栓形成、血液黏度、血小板聚集率和对小鼠微循环障碍模型耳郭微循环的影响,评价中华跌打丸活血化瘀的作用。方法:通过注射肾上腺素加冰水刺激的方法建立大鼠急性血瘀模型,测定体外血栓形成和血液黏度;按照Born氏比浊法加入诱导剂诱导聚集测定大鼠血小板聚集率;尾静脉注射15%高分子右旋糖酐造成微循环障碍,观察小鼠耳郭各时段微动脉和微静脉管血液流速和血管管径的变化。结果:中华跌打丸可降低血瘀模型大鼠的血液黏度,在切变率150 S^(-1)、60 S^(-1)及5 S^(-1)下的全血黏度均显著降低(P<0.05),明显缩短血瘀模型大鼠血栓长度,减轻血栓湿重和干重(P<0.05,P<0.01);中华跌打丸具有抑制血小板聚集的作用,各剂量均能明显降低ADP诱导的大鼠血小板聚集率(P<0.05,P<0.01);中华跌打丸对高分子右旋糖酐所致小鼠耳郭微循环障碍有明显改善作用,于造模10 min、20 min、30 min时增加血液流速(P<0.05,P<0.01),扩大微动脉、微静脉管径(P<0.05,P<0.01),减轻红细胞聚集(P<0.05,P<0.01)。结论:中华跌打丸可明显改善血液黏度,抑制血小板聚集,改善微循环障碍,有较好的活血化瘀作用。

活血化瘀治疗冠脉微循环障碍的研究进展

冠状动脉微循环障碍广泛存在于多种心血管疾病中,与左室重构、心血管事件密切相关。本病病机演变以血瘀为核心,活血化瘀法可改善患者冠状动脉血流储备及微循环阻力指数,对于冠状动脉微循环障碍具有良好的治疗效果。机制方面,活血化瘀诸法可调节冠状动脉微血管功能障碍的诸多关键病理生理环节:如,活血化瘀可有效抑制炎症、氧化应激及血栓形成;活血化痰可保护血管内皮;益气活血能改善能量代谢;补肾活血促进血管新生、建立冠脉侧支循环。应用现代科学深入挖掘活血化瘀诸法治疗本病的机制,或为解决本病治疗提供新的思路。

腰痛活血胶囊对强直性脊柱炎患者M1、M2型炎症因子的影响

目的探讨腰痛活血胶囊对强直性脊柱炎(AS)患者疗效及M1、M2型炎症因子的影响。方法选取2020年1月至2023年11月安徽中医药大学第一附属医院风湿科收治的60例AS患者,采用随机数字表法分为研究组、对照组各30例。研究组予腰痛活血胶囊(1.2 g,3次/d)联合沙利度胺口服(50 mg,每晚1次),对照组予沙利度胺口服(50 mg,每晚1次),2组均治疗4周。观察治疗前后疼痛视觉模拟评分法(VAS)评分、强直性脊柱炎疾病活动指数(BASDAI)评分、Bath强直性脊柱炎功能指数(BASFI)评分、Bath强直性脊柱炎计量学指数(BASMI)、Bath强直性脊柱炎总体指数(BAS-G)、中医临床证候积分及血清红细胞沉降率(ESR)、C反应蛋白(CRP)、M1型炎症细胞因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6]、M2型炎症细胞因子(IL-4、IL-10)的表达。结果2组治疗后,研究组和对照组的总有效率分别为90%及70%,研究组总有效率高于对照组,差异有统计学意义(P<0.05)。与治疗前相比较,研究组治疗后VAS、BASDAI、BASFI、BAS-G、BASMI、ESR、CRP、TNF-α、IL-6降低,腰骶脊背僵痛积分、腰脊活动受限积分、晨僵积分、夜间疼痛积分、关节肿痛积分及中医证候总积分降低,IL-4、IL-10表达升高(P<0.01)。与对照组治疗后相比较,研究组治疗后VAS、BASDAI、BASFI、CRP、IL-6、腰骶脊背僵痛、腰脊活动受限、夜间疼痛、中医证候总积分降低,IL-10表达升高(P<0.01)。结论腰痛活血胶囊联合沙利度胺可显著改善AS患者临床症状,通过上调M2型炎症因子表达,降低AS患者免疫炎症水平,改善患者临床症状且临床疗效安全。

李光荣活血化瘀学术思想治疗子宫内膜息肉探析

子宫内膜息肉可引起异常子宫出血、不孕,有恶变风险,术后易复发,影响女性的身心健康,属中医学“癥瘕”“不孕”范畴。李光荣教授认为女性多虚、多郁、多瘀,临床予活血化瘀学术思想治疗子宫内膜息肉。采用分级分时分类为原则的活血化瘀法,祛瘀求本、瘀湿同治、固护阴血,效果满意。

舌诊在慢性肝病中的应用刍议

舌诊作为中医特色诊法之一,在肝病的诊治与预防中具有重要意义。慢性肝病患者在不同的病理阶段有不同的舌象改变。舌色可反映肝病轻重缓急,如缓解期多见淡红舌,发作期多见红绛舌,而严重肝病多见青紫舌;舌形可反映肝病形气神,其中长条舌、圆柱舌是慢性肝病的常见舌形,舌缘肿大或者肝积舌多代表慢性肝病中的占位性病变;舌苔与肝病轻重及疾病预后有关,还可辅助诊断慢性肝病的细菌感染情况。此外,舌象在慢性肝病的临床用药指导中也具有重要意义,可多方面、多角度指导临床。

活血化瘀法在慢性原发免疫性血小板减少症辨治中的循证探索

目的:基于临床和中西医理论的整合,探索中医活血化瘀法在慢性原发免疫性血小板减少症(Primary Immune Thrombocytopenia,ITP)治疗中的临床应用循证依据。方法:结合临床总结分析中西医对ITP的病机认知,结合临床辨证和研究结果进行综合比照分析。结果:①慢性ITP虽然是以出血为主要表现的疾病,但是临床中仍然有发生血栓的现象,即出血与血栓的发生并存;②由中医学理论和临床辨证对ITP出血与瘀血状态的认识可知两者互为影响,验证了“离经止血,虽为清血,亦为瘀血”“瘀血不去,新血不生”的理论;③ITP的发生、发展过程中病机演化对瘀血形成的认识,提示了“久病多瘀”的证据;④中医药辨证论治的过程中,不失时机地选择应用活血化瘀法,不仅有效地治疗了ITP的出血症状,而且通过活血化瘀法还能够预防血栓的发生,提供了临床疗效证据。结论:基于临床疗效和ITP病机、病程的综合分析,中医活血化瘀法在慢性甚至是难治性ITP的治疗中不仅可以改善临床症状,还能够预防血栓的发生,为临床广泛应用提供很好的循证依据。部分患者的血小板水平也有提升。至于提升血小板的机制还有待于进一步的临床研究。

王文萍从痰瘀论治肺癌经验

王文萍教授认为,肺癌病机为痰瘀互结,临证以活血化瘀、调畅气机为主,软坚散结、化痰祛瘀为辅,方用血府逐瘀汤合二陈汤化裁治疗肺癌,同时注重对患者进行心理疏导,减轻其精神压力,以达到标本兼治的目的。本文从病因病机、治法治则、遣方用药总结王文萍教授治疗肺癌的临证经验,并附验案一则,以期较为全面地分析王文萍从痰瘀论治肺癌的学术思想。

活血化瘀类中药饮片与口服抗凝血药联合应用的出血风险研究

目的:探讨联合应用活血化瘀类中药饮片与口服抗凝血药治疗疾病的出血风险。方法:回顾性研究2022年该院服用口服抗凝血药和活血化瘀类中药饮片的住院患者158例,根据是否联合应用活血化瘀类中药饮片分为联合组(80例)和对照组(78例)。对照组患者使用的口服抗凝血药包括华法林、利伐沙班、达比加群酯;联合组患者联合应用的活血化瘀类中药饮片包括丹参、川芎、牛膝等。观察两组患者的凝血功能相关指标如凝血酶原时间-国际标准化比值(PT-INR)、纤维蛋白原(FIB)、D-二聚体(D-D)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)和出血事件发生率等。结果:联合组与对照组患者PT-INR、FIB、D-D、APTT和TT的差异均无统计学意义(P>0.05);联合组患者的出血事件发生率为66.25%(53/80),高于对照组的42.31%(33/78),差异有统计学意义(P<0.05)。结论:患者联合应用活血化瘀类中药饮片与口服抗凝血药后,虽然相关凝血指标并未出现明显变化,但是出血事件发生率显著升高。临床用药时,需重点关注含有丹参、川芎、牛膝和红花等的活血化瘀类中药饮片或中药复方制剂与口服抗凝血药联合应用会增加出血的风险。本研究为中西药相互作用研究提供了一定的借鉴。

Research Progress in Chinese Medicine Preparations for Promoting Blood Circulation and Removing Blood Stasis for Cirrhotic Patients with Portal Vein Thrombosis Following Splenectomy

This article presented an overview of the therapeutic effects of Chinese medicine(CM)preparations for promoting blood circulation and removing blood stasis for patients with portal vein thrombosis(PVT)after splenectomy.Based on published clinical researches of CM preparations for PVT after splenectomy in patients with cirrhotic portal hypertension(CPH),this paper evaluated the incidence of PVT,and explored potential active components and mechanisms of CM preparations.Safflower Yellow Injection,Danshen Injection,Danhong Injection,and Compound Danshen Dropping Pill achieved good curative effect alone or combined with anticoagulant therapy.In addition,Compound Biejia Ruangan Tablet and Anluo Huaxian Pill can also significantly improve the hemodynamic disorders of portal vein system in patients with cirrhosis.Considering the role of CM preparations in ameliorating the incidence of PVT after splenectomy in patients with CPH,we suggested that future research should provide more attention to CM alone or CM combined with anticoagulant for cirrhosis with PVT.

化痰通络颗粒治疗不同中医证型稳定型心绞痛的疗效观察

目的:探讨化痰通络颗粒治疗不同中医证型稳定型心绞痛(SAP)的疗效差异。方法:纳入219例瘀证SAP患者,并根据中医证型分为气虚血瘀组53例、痰瘀互结组63例、气滞血瘀组56例、痰浊闭阻组47例,另纳入50例瘀证SAP患者为对照组。所有患者均接受常规治疗,除对照组外,其余患者均在常规治疗基础上予化痰通络颗粒治疗,连续治疗4周。观察治疗前后中医证候疗效、心绞痛情况、心功能、脂代谢、凝血功能。结果:治疗后,气虚血瘀组、痰瘀互结组、气滞血瘀组、痰浊闭阻组患者疗效均优于对照组(P<0.05),且痰瘀互结组和痰浊闭阻组患者疗效均优于气虚血瘀组和气滞血瘀组(P<0.05)。治疗后,5组患者心绞痛症状积分均低于治疗前(P<0.05),且气虚血瘀组、痰瘀互结组、气滞血瘀组、痰浊闭阻组患者心绞痛症状积分均低于对照组(P<0.05),痰瘀互结组、痰浊闭阻组患者心绞痛症状积分均低于气虚血瘀组和气滞血瘀组(P<0.05)。治疗后,5组患者左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)均低于治疗前,射血分数(EF)、每搏输出量(SV)均高于治疗前(P<0.05),且痰瘀互结组、痰浊闭阻组患者LVEDD、LVESD均低于对照组,EF、SV均高于对照组(P<0.05)。治疗前痰浊闭阻组、痰瘀互结组患者总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)水平均高于气虚血瘀组、气滞血瘀组、对照组;治疗后,5组患者TC、TG、LDL均低于治疗前,HDL均高于治疗前(P<0.05)。治疗后,5组患者纤维蛋白原(FIB)、凝血酶时间(TT)均低于治疗前,活化部分凝血活酶时间(APTT)均高于治疗前,且痰瘀互结组、痰浊闭阻组患者FIB、TT水平均低于气虚血瘀组、气滞血瘀组和对照组(P<0.05)。结论:化痰通络颗粒治疗不同中医证型的稳定型心绞痛均有一定效果,联合西医治疗应用优于单独西医治疗,且其更适用于痰瘀互结证和痰浊闭阻证两种证型。

活血化瘀方治疗子宫肌瘤临床观察

目的分析活血化瘀方辨证对子宫肌瘤的治疗效果及安全性。方法选取2020年1月—2022年1月江西省乐安县人民医院收治的60例子宫肌瘤患者临床资料,分为对照组与治疗组,各30例。对比两组治疗3周后的临床效果、性激素水平[卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E_(2))、孕激素(P)]、中医证候积分、不良反应。结果治疗组总有效率为93.33%(28/30),对照组为80.00%(24/30),两组比较差异无统计学意义(P>0.05)。治疗前两组性激素水平比较差异无统计学意义(P>0.05);治疗后两组FSH、LH、E2、P均降低,且治疗组均低于对照组(P<0.05)。治疗前两组中医证候积分比较差异无统计学意义(P>0.05),治疗后治疗组经期异常、下腹胀痛、乳房胀痛、肛门下坠评分均低于对照组(P<0.05)。治疗组不良反应发生率为6.67%(2/30),对照组为16.67%(5/30),两组比较差异无统计学意义(P>0.05)。结论活血化瘀方辨证对子宫肌瘤的治疗效果好,可改善患者临床症状及性激素水平,用药安全性高。

单味中药有效成分治疗溃疡性结肠炎研究进展

研究表明,中药治疗溃疡性结肠炎不良反应少且复发率低,临床常用益气健脾、清热祛湿、活血化瘀、补血养阴类中药组方治疗,其主要药物的有效成分具有减轻炎症反应、修复黏膜损伤、调节肠道微生态、调节免疫反应等作用。本文对常用单味中药有效成分治疗溃疡性结肠炎的作用机制进行综述,为其临床治疗与中药新药研发提供参考。

脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效及转录组学研究

目的观察脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效,并通过转录组学方法初步阐明其可能的作用机制。方法将符合纳入标准的140例气虚血瘀型冠心病心绞痛患者依据随机数字法分为治疗组、对照组各70例,治疗期间对照组脱落3例。对照组予冠心病二级预防西医基础治疗,治疗组在对照组治疗基础上加服脉通君安汤,2组疗程均为8周。治疗前后评估2组患者中医证候积分、加拿大心血管学会(Canadian cardiovascular society,CCS)心绞痛分级、西雅图量表(Seattle angina questionnaire,SAQ)评分、焦虑自评量表(Self-rating anxiety scale,SAS)评分、抑郁自评量表(Self-rating depression scale,SDS)评分及不良反应,并基于性别、年龄、病程相匹配原则选取9例患者治疗前后外周血进行转录组学测序。结果治疗后,2组患者中医证候积分均明显下降(P<0.01),治疗组在改善胸痛、胸闷、气短、神倦乏力及总分方面优于对照组(P<0.05,P<0.01);治疗组CCS心绞痛分级总改善率优于对照组(P<0.05);2组治疗前后SAQ、SAS及SDS评分均显著改善(P<0.01),治疗组SAQ评分改善优于对照组(P<0.05,P<0.01)。转录组学结果显示,治疗前后具有显著差异表达的mRNA有862个,包括509个上调,353个下调;GO分析结果显示差异表达的mRNA生物学过程有666条,主要包括病毒基因表达、翻译启动、RNA分解代谢过程等,细胞组分112条,主要包括黏着斑、核糖体亚基、核斑点等;分子功能有94条,主要包括双链RNA结合、钙黏蛋白结合、转录共调节因子活性等;KEGG分析结果显示差异mRNA富集信号通路包括20条,主要包括甘油磷脂代谢通路、单磷酸腺苷激活的蛋白激酶(AMP-activated protein kinase,AMPK)信号通路、核糖体通路等。结论脉通君安汤能够改善气虚血瘀型冠心病心绞痛患者临床症状,其作用机制为多靶点多通路,可能与甘油磷脂代谢通路、AMPK信号通路、核糖体通路的调节相关。

颅痛宁颗粒对眶下神经缩窄环术诱导三叉神经痛大鼠的治疗作用研究

目的研究颅痛宁颗粒对三叉神经痛模型大鼠的治疗作用,为其临床应用提供参考资料。方法采用眶下神经缩窄环术(ION-CCI)制备大鼠三叉神经痛模型,大鼠随机分为正常组、假手术组、模型组、卡马西平阳性药组、颅痛宁高剂量组(2.70 g生药·kg^(-1)·d^(-1))、颅痛宁低剂量组(1.35 g生药·kg^(-1)·d^(-1))。Von Frey毛刷测定大鼠触须垫机械痛阈值,生化法检测血液血流变和凝血功能,HE染色观察眶下神经病理变化,Western blot技术检测三叉神经内P38和P-P38的蛋白水平。结果颅痛宁颗粒能提高模型大鼠的痛阈值(P<0.05,P<0.01)降低模型大鼠血浆黏度(P<0.05,P<0.01)和全血还原黏度(P<0.05,P<0.01),提高模型大鼠血流变能力;提高模型大鼠血液凝血酶原时间(prothrombintime,PT)、活化部分凝血活酶时间(activated partial thromboplatin time,APTT)和凝血酶时间(thrombin time,TT)水平(P<0.05,P<0.01),降低模型大鼠纤维蛋白原(fibrinogen,FIB)水平(P<0.01),改善凝血功能;改善模型大鼠眶下神经的病理改变;并降低模型大鼠三叉神经内P-P38的表达量(P<0.01)。结论颅痛宁颗粒具有改善三叉神经痛作用,可能与其活血化瘀功能有关。

柳国斌教授从“寒凝血瘀”论治血栓闭塞性脉管炎的经验

本文对柳国斌教授治疗血栓闭塞性脉管炎的学术思想进行总结。柳教授提出阳虚寒凝是血栓闭塞性脉管炎的始动病机,而后形成瘀血、脉络闭阻等病理环节,故将本病的病机概括为“寒凝经脉,瘀血阻络”,其提出以“温经散寒,活血通络”为治疗法则,遣方用药注重扶阳,认为机体的阳气充足后,气血得以运行顺畅,瘀血等病理因素随之消散。柳教授强调只有抓住病机才能抓住治疗的关键,在复杂的疾病中找出矛盾所在,才能取得良效。现将柳教授临证经验总结如下,并附验案1则,为治疗血栓闭塞性脉管炎提供思路。

活血化瘀类中成药辅助治疗神经根型颈椎病有效性的网状Meta分析

目的:系统评价不同活血化瘀类中成药辅助治疗神经根型颈椎病(cervical spondylotic radiculopathy,CSR)的临床疗效。方法:应用计算机检索中国知网、维普网、万方数据库、PubMed、Web of Science和Cochrane Library中关于活血化瘀类中成药辅助治疗CSR的随机对照试验,检索时限均为建库至2023年9月20日。对照组单纯采用常规非手术方法治疗,试验组在对照组的基础上联合活血化瘀类中成药口服治疗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用Stata18.0软件绘制网状关系图,对治疗有效率、颈部疼痛视觉模拟量表(visual analogue scale,VAS)评分、颈椎功能障碍指数(neck disability index,NDI)进行网状Meta分析,并根据累计概率排名曲线下面积(the surface under the cumulative ranking curve,SUCRA)对治疗方法的疗效进行排序。采用比较-校正漏斗图进行发表偏倚检验。结果:共检索到6768篇文献,通过逐层筛选最终纳入28篇文献,涉及颈痛颗粒、颈舒颗粒、脊痛消胶囊、痹祺胶囊、舒筋通络颗粒、颈复康颗粒共6种活血化瘀类中成药。网状Meta分析结果显示,在治疗有效率方面,不同活血化瘀类中成药辅助治疗CSR的疗效排序为颈痛颗粒联合常规治疗(SUCRA=78.4%)>痹祺胶囊联合常规治疗(SUCRA=71.6%)>颈舒颗粒联合常规治疗(SUCRA=62.1%)>舒筋通络颗粒联合常规治疗(SUCRA=53.7%)>脊痛消胶囊联合常规治疗(SUCRA=43.3%)>颈复康颗粒联合常规治疗(SUCRA=40.5%)>常规治疗(SUCRA=0.4%);在颈部疼痛VAS评分方面,不同活血化瘀类中成药辅助治疗CSR的疗效排序为舒筋通络颗粒联合常规治疗(SUCRA=96.3%)>痹祺胶囊联合常规治疗(SUCRA=86.2%)>颈复康颗粒联合常规治疗(SUCRA=51.6%)>颈痛颗粒联合常规治疗(SUCRA=50.8%)>颈舒颗粒联合常规治疗(SUCRA=37.4%)>脊痛消胶囊联合常规治疗(SUCRA=27.4%)>常规治疗(SUCRA=0.4%);在NDI方面,不同活血化瘀类中成药辅助治疗CSR的疗效排序为痹祺胶囊联合常规治疗(SUCRA=95%)>颈复康颗粒联合常规治疗(SUCRA=71.3%)>颈痛颗粒联合常规治疗(SUCRA=69.2%)>脊痛消胶囊联合常规治疗(SUCRA=38.7%)>颈舒颗粒联合常规治疗(SUCRA=20.8%)>常规治疗(SUCRA=5.0%)。结论:现有的证据表明,颈痛颗粒辅助治疗CSR的综合疗效最佳,舒筋通络颗粒在缓解颈部疼痛方面效果最佳,痹祺颗粒在改善颈椎功能方面效果最佳。但由于对照组采用的非手术疗法不尽相同及文献数量、质量等的限制,本研究的结论尚需进一步验证。