Establishment and evaluation of a mouse model of bronchial asthma with Yin deficiency syndrome

Objective: To establish and evaluate a mouse model of bronchial asthma with Yin deficiency syndrome. Methods: The mouse model of bronchial asthma with Yin deficiency syndrome was established by the treatment with injecting ovalbumin(OVA) two times to sensitize, inhaling OVA 14 times to stimulate, and using thyroxin through lavage during late stimulation. This model was evaluated through body weight, asthmatic behaviors, respiratory function, autonomous activity, lung pathology, and pulmonary fluid clearance. Results: OVA combined with thyroxin was an appropriate method to induce the mouse model with increased food and water intake, autonomous activity, asthmatic behaviors score, and respiratory rate, decreased body weight, tidal volume, and wet/dry ratio of lung, and changed with pathology of lung tissue. The changes of the above mentioned parameters indicated that the model was the bronchial asthma with Yin deficiency syndrome. Conclusion: The OVA combined with thyroxin is a good pattern to establish a mouse model of bronchial asthma with Yin deficiency syndrome successfully, which can highly simulate the clinical symptoms of this disease.

Study on syndrome differentiation based on pharmacology of syndrome management system-a case of Qi and Yin deficiency syndrome

Taking the Qi and Yin deficiency syndrome as an example,the research method of pharmacology of syndrome management system was proposed.By means of text mining,systematic pharmacology and target analysis,to attempt to reveal the essence of the corresponding syndrome by studying the drugs and targets of Qi and Yin deficiency.Fourteen Chinese herbs treating Qi and Yin deficiency were retrieved and used more than 30 times,and 9,317 related targets were predicted.The common targets of action were 85.Topological analysis was carried out by using degree centrality,closeness centrality and betweenness centrality to confirm that estrogen receptor(ESR1),tumor necrosis factor(TNF),D(2)dopamine receptor(DRD2),vitamin D3 receptor(VDR),glucocorticoid receptor(NR3C1),acetylcholinesterase(ACHE)and endothelin-1(EDN1)were highly correlated with Qi and Yin deficiency syndrome.Through the target to find Qi and Yin deficiency syndrome corresponding to 17 categories of diseases.A new idea was provided for studying the biological essence of TCM clinical syndrome differentiation.

Study on blood pressure rhythm in hypertensive patients with Yin deficiency syndrome and a random forest model for predicting hypertension with Yin deficiency syndrome

OBJECTIVE: To investigate blood pressure rhythm(BPR)in Yin deficiency syndrome of hypertension(YDSH)patients and develop a random forest model for predicting YDSH.METHODS: Our study was consistent with technical processes and specification for developing guidelines of Evidence-based Chinese medicine clinical practice(T/CACM 1032-2017). We enrolled 234 patients who had been diagnosed with primary hypertension without antihypertensive medications prior to the enrollment. All participants were divided into Yin deficiency group(YX, n = 74) and non-Yin deficiency group(NYX, n = 160).Participants were professionally grouped by three experienced chief Traditional Chinese Medicine(TCM)physicians according to four examinations(i.e.,inspection, listening and smelling, inquiry and palpation).We collected data on 24 h ambulatory blood pressure monitoring(ABPM) and YDSH rating scale. We divided 24 h of a day into 12 two-hour periods [Chen-Shi(7:00-9:00), Si-Shi(9:00-11:00), Wu-Shi(11:00-13:00), Wei-Shi(13:00-15:00), Shen-Shi(15:00-17:00), You-Shi(17:00-19:00), Xu-Shi(19:00-21:00), Hai-Shi(21:00-23:00), ZiShi(23:00-1:00), Chou-Shi(1:00-3:00), Yin-Shi(3:00-5:00), Mao-Shi(5:00-7:00)] according to the theory of “midnight-midday ebb flow”. We used random forest to build the diagnostic model of YDSH, with whether it was Yin deficiency syndrome as the outcome. RESULTS: Compared with NYX group, YX group had more female participants with older age, lower waist circumference, body mass index(BMI), diastolic blood pressure(DBP), and smoking and drinking rate(all P < 0.05). The YDSH rating scores of YX group [28.5(21.0-36.0)] were significantly higher than NYX group [13.0(8.0-22.0)](P < 0.001), and the typical symptoms of YX group included vexing heat in the chest, palms and soles, dizziness, dry eyes, string-like and fine pulse, soreness and weakness of lumbus and knees, palpitations, reddened cheeks, and tinnitus(all P < 0.05). The ratio of non-dipper hypertension in YX group was higher than in NYX group(56.9% vs 44.4%, P = 0.004). Compared with NYX group, 24 h DBP standard deviation(SD), nighttime DBP SD, Si-Shi DBP, Si-Shi mean arterial pressure(MAP), Hi-Shi systolic blood pressure(SBP), Hi-Shi DBP, Hi-Shi MAP, Zi-Shi SBP, Zi-Shi DBP, Zi-Shi MAP, ChouShi SBP SD, Chou-Shi DBP SD, Chou-Shi SBP coefficient of variation(CV) were lower in YX group(all P < 0.05). Binary Logistic Regression analysis showed that the diagnosis of YDSH was positively correlated with age, heart rate, YDSH rating scores, and four TCM symptoms including vexing heat in the chest, palms and soles, string-like and fine pulse, soreness and weakness of lumbus and knees, and reddened cheeks(all P < 0.05), but was negatively correlated with smoking(P﹥0.05). In addition, the diagnosis of YDSH was positively correlated with daytime SBP SD, nighttime SBP SD, nighttime SBP CV, and Hi-Shi SBP CV, but was negatively correlated with 24 h SBP CV, daytime DBP SD, nighttime DBP SD, and Hi-Shi DBP(all P < 0.05). Hi-Shi SBP CV had independent and positive correlation with the diagnosis of YDSH after adjusting the variables of age, gender, course of hypertension, BMI, waist circumference, SBP, DBP, heart rate, smoking and drinking(P = 0.029). Diagnostic model of YDSH was established and verified based on the random forest. The results showed that the calculation accuracy, specificity and sensitivity were 77.3%, 77.8% and 76.9%, respectively. CONCLUSION: The BPR was significantly attenuated in YDSH patients, including lower 24 h DBP SD and nighttime DBP SD, and Hi-Shi SBP CV is independently correlated with the diagnosis of YDSH. The prediction accuracy of diagnosis model of YDSH based on the random forest was good, which could be valuable for clinicians to differentiate YDSH and non-Yin deficiency patients for more effective hypertensive treatment of TCM.

Summary and correlation analysis of TCM syndromes in 159 elderly patients with acute myeloid leukemia

Objective:To investigate the characteristics of TCM syndromes in elderly patients with acute myeloid leukemia(AML)at the onset,and to analyze the main syndrome types and their correlation with age,percentage of bone marrow blasts,and genetic prognostic stratification.Methods:A retrospective analysis was performed on 159 AML patients aged over 60 years who were diagnosed and treated in our hospital,and the clinical data were collected and analyzed statistically.Results:In 159 elderly AML patients,the main clinical symptoms were fatigue,poor appetite,conscious fever,and various hemorrhages.The main syndromes were Ying(42.01%),Wei(31.25%),Essential(14.81%)and Blood(11.69%);the syndromes are divided into Qi and Yin deficiency(32.70%),Qi and blood deficiency(30.19%),true Yin deficiency(28.03%)and Qi heat and blood(8.81%).The age difference between the two groups was statistically significant(P<0.001),and the multiple comparison results showed that the age of the Qi-blood deficiency group was younger than the true-Yin deficiency group and the Qi-Yin deficiency group;the percentage of bone marrow blasts was statistically significant in the three groups at the initial diagnosis(P<0.05),multiple comparison results showed that the percentage of bone marrow blasts in the true Yin deficiency group was higher than that in the Qi-blood deficiency group and the Qi-Yin deficiency group;the genetic prognostic stratification of the three groups was statistically significant(P<0.05),multiple comparisons.The results showed that the genetic prognosis of the true Yin deficiency group was poorer than that of the Qi and blood deficiency group and the Qi and Yin deficiency group.Conclusion:The most common clinical symptoms of elderly AML patients are fatigue,the disease is located in the bone marrow,and the disease is Ying,Wei,essence,and blood.With the increase in the patient's age,the TCM syndrome types tend to be more insufficiency of true Yin and deficiency of both Qi and Yin,and the prognosis of patients with insufficiency of true Yin is poor.It provides a directional scientific basis for the treatment of senile AML with integrated traditional Chinese and Western medicine.

A study on the clinical prediction model of the yin deficiency type of perimenopausal syndrome

Background:The yin deficiency type of perimenopausal syndrome(PMS)as a common category of PMS based on the theory of traditional Chinese medicine(TCM)has a high prevalence with severe symptoms and long course of disease.Therefore,it is necessary to construct a prediction model to assist in diagnosis.Objective:This study aimed to investigate the independent predictors of the yin deficiency type of PMS and to develop a clinical prediction model of this disease.Methods:PMS patients who attended the Third Affiliated Hospital of Zhejiang Chinese Medical University between February 2020 and August 2023 were selected and divided chronologically into training and validation groups.Logistic regression analysis was applied in the training group to clarify the independent predictors of the yin deficiency type of PMS,and a nomogram was plotted.Internal and external validations were performed in the training and validation groups to evaluate the model’s accuracy,goodness of fit,and clinical adaptability.Results:Hot flashes and sweating(≥10 episodes/day),palpitations,emotional fluctuations,and abnormal sexual activity were independent predictors of the yin deficiency type of PMS(P>0.05).Based on the clinical prediction model constructed,the area under the receiver operating characteristic curve(AUR OC)in the training group was 0.989(95%CI 0.980–0.998),and the AUR OC in the validation group was 0.971(95%CI 0.940–0.999).This demonstrates that the model has superior prediction performance.The Hosmer-Lemeshow test was used to evaluate the model’s goodness of fit with P=0.596 for the training group and P=0.883 for the validation group,indicating a good fit.The decision curve analysis(DCA)curve and clinical impact curve(CIC)indicated good clinical adaptability.Conclusion:The model can accurately predict the occurrence of the yin deficiency type of PMS,which may help clinicians identify such patients at an early stage.

300 CASES OF MENOPAUSAL SYNDROME TREATED BY ACUPUNCTURE

Caused by hypo-ovarianism, menopausal syndrome usually occurs in women aged from 45-55 years. With high incidence and various symptoms, the disease often severely jeopardize the health of the women. The authors had treated 300 cases of menopausal syndrome by acupuncture and obtained a good result.

Consensus on diagnostic criteria for Yin deficiency syndrome in hypertension:a modified Delphi study

OBJECTIVE:To reach consensus on the diagnostic criteria for Yin deficiency syndrome in hypertension(YDSH)patients by a modified Delphi method.METHODS:Our study was consistent with T/CACM 1032-2017.The methodology of RAND/UCLA appropriateness was used to develop consensus guidance statements.A nationwide panel of experienced clinical experts from 19 provinces was constructed.These experts were all prominent in Traditional Chinese Medicine(TCM)of cardiovascular diseases.This consensus process consisted of two rounds of questionnaires and a final round of consultation to analyze the weight score of each item.Moreover,the data extraction process is carried out independently by third-party researchers(LIANG Junya,SUN Yang,and DU Xiaona).When there is disagreement in all three rounds,the expert panel group(odd number)are invited to vote,and the one with more votes wins.In the questionnaires,participants were asked to rate the appropriateness of each syndrome item using a nine-point Likert scale.The consensus was defined as a panel median rating 1-3 or 7-9 without disagreement.And then the diagnostic criteria of YDSH were formed according to the weight score in the final round.RESULTS:Twenty-eight experts(84.8%)participated in the first round,and thirty-one(93.9%)finished the second round.After two rounds,the consensus of YDSH was reached on 11 items(25.6%),including symptoms,signs,and pulse condition.Twenty-one experts(63.6%)completed the final round in which they used a grading system for each item.Red tongue with scanty fur had the highest weighting(22.8%),followed by heat in the palms and soles(20.1%).CONCLUSIONS:The consensus-based diagnostic criteria for YDSH,formed by a modified Delphi method,can be widely incorporated in TCM.A further clinical study will be conducted to analyze the diagnosis value and cut-off score of our YDSH criteria.

Correlation between constitution of Yin deficiency syndrome and polymorphism of HLADQA1 / treatment response of Peg-IFNα therapy in HBeAg positive chronic hepatitis B patients

Objective To observe the correlation between constitution of yin deficiency syndrome(YDS)and polymorphism of HLA-DQA1/treatment response of Peg-IFNαtherapy in HBe Ag positive chronic hepatitis B(CHB)patients,and to explore constitution of Chinese medicine(CM)in response to interferon therapy.Methods Totally 120 HBe Ag positive CHB patients who were

沈氏生芦润燥汤治疗肾阴虚型干燥综合征临床观察

目的 观察沈氏生芦润燥汤治疗肾阴虚型干燥综合征的临床疗效。方法 将126例SS患者按照随机数字表法分为治疗组和对照组,其中治疗组65例予沈氏生芦润燥汤,对照组61例予硫酸羟氯喹片治疗。2组疗程均为12周,比较2组前后泪液分泌试验、唾液含糖试验、干燥综合征疾病活动指数(ESSDAI)评分、干燥综合征患者自我报告指数(ESSPRI)评分(包括干燥、疼痛、疲劳3部分)及血沉(ESR)、免疫球蛋白(Ig)(包括IgG、IgM、IgA)、白细胞介素(IL)(包括IL-10、IL-6、IL-17)、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))变化情况。结果 共112例患者完成了临床试验,治疗组和对照组均为56例。治疗组总有效率83.93%(47/56),对照组总有效率60.71%(34/56),治疗组总有效率优于对照组(P<0.05)。与本组治疗前比较,治疗组对泪液分泌试验、唾液含糖试验、ESSDAI评分、ESSPRI评分(干燥、疲劳、疼痛)及IgG、IgA、IgM、CD3^(+)、CD4^(+)、CD8^(+)、IL-6、IL-10、IL-17水平有明显改善作用(P<0.05),对照组仅对泪液分泌试验、唾液含糖试验、ESSPRI评分(包括干燥、疲劳、疼痛)及IgG、IL-6、IL-17水平有明显改善作用(P<0.05),2组治疗前后ESR水平比较差异均无统计学差异(P>0.05)。组间比较,治疗组治疗后泪液分泌试验、ESSPRI评分(干燥、疼痛)评分及、gA、IgM、CD3^(+)、IL-6水平改善明显优于对照组(P<0.05)。结论 沈氏生芦润燥汤可有效改善干燥综合征患者的临床症状,疗效确切,其作用机制可能与调节机体免疫功能,抑制炎症反应有关。

不同滋阴补肾法干预去势大鼠破骨通路的机制

背景:六味地黄丸以“三补三泻”为配伍特点,补泻兼施以滋阴补肾;左归丸以“阳中求阴”为配伍特点,以阳促阴补肾。二者同属于滋阴补肾法,其在证候和细胞分子水平等都发挥较好的疗效。目的:观察六味地黄丸和左归丸在骨代谢中的作用,探讨其在破骨通路骨保护素(osteoprotegerin,OPG)/核因子κB受体活化因子配体(receptoractivatorofnuclearfactor-κBligand,RANKL)的作用机制。方法:将32只SD随机大鼠分为模型组、六味地黄丸组、左归丸组、假手术组,每组8只。除假手术组大鼠外,其余大鼠切除双侧卵巢制备骨质疏松模型。术后30 d开始六味地黄丸组大鼠灌胃六味地黄丸1.125 g/(kg·d);左归丸组大鼠灌胃左归丸2.25 g/(kg·d);假手术组和模型组灌胃生理盐水10 mL/(kg·d)。灌胃12周后,取大鼠胫骨检测骨密度,采用ELISA检测血清中雌激素E2、骨碱性磷酸酶、cAMP/cGMP水平,Westernblot法检测股骨中OPG/RANKL的表达情况。结果与结论:①与假手术组相比,模型组骨密度及雌激素E2、骨碱性磷酸酶水平降低(P<0.05),cAMP/cGMP水平升高(P<0.05)。②与模型组相比,六味地黄丸组和左归丸组骨密度显著提高(P<0.05);骨碱性磷酸酶均显著提高(P<0.05);左归丸组cAMP/cGMP水平明显降低(P<0.05)和上调OPG蛋白表达(P<0.05),六味地黄丸组上调OPG蛋白表达和下调RANKL蛋白表达均有作用(P<0.05);两组均不能显著提高雌激素E2水平(P>0.05)。③结果显示,“阳中求阴”的左归丸能够有效提高OPG表达,不能下调RANKL蛋白,而“三补三泻”的六味地黄丸能双向调节OPG和RANKL蛋白的表达,提示了六味地黄丸对抑制破骨功能方面可能比左归丸显著,此结论仍有待进一步的研究加以验证。

稳心通脉方加减联合西药治疗不稳定型心绞痛心肾阴虚证临床研究

目的:观察稳心通脉方加减联合西药治疗不稳定型心绞痛心肾阴虚证的临床疗效。方法:选取2022年1月—2024年1月在北京中医药大学东直门医院洛阳医院/洛阳市中医院治疗的86例不稳定心绞痛心肾阴虚证患者,采用随机数字表法分为西医组和研究组各43例。西医组给予西药治疗,研究组给予稳心通脉方加减联合西药治疗,2组均连续治疗4周。比较2组临床疗效、中医证候积分、西雅图心绞痛量表(SAQ)评分、心绞痛发作次数、心绞痛持续时间、心输出量、左室射血分数、心脏指数,以及Notch1、Rho激酶1(ROCK1)、内皮细胞特异分子-1(ESM-1)、内皮微颗粒、单核细胞趋化蛋白-1(MCP-1)、超敏C-反应蛋白(hs-CRP)、脂蛋白相关性磷脂酶A2(Lp-PLA2)水平。结果:治疗4周后,总有效率研究组97.67%(42/43),高于西医组81.40%(35/43)(P<0.05)。2组胸痛、胸闷、心悸、腰膝酸软、不寐积分均较治疗前降低(P<0.05),研究组上述5项中医证候积分均低于西医组(P<0.05)。2组SAQ评分均较治疗前升高(P<0.05),研究组SAQ评分高于西医组(P<0.05)。2组心绞痛发作次数均较治疗前减少(P<0.05),研究组心绞痛发作次数少于西医组(P<0.05)。2组心绞痛持续时间均较治疗前缩短(P<0.05),研究组心绞痛持续时间短于西医组(P<0.05)。2组心输出量、左室射血分数、心脏指数均较治疗前升高(P<0.05),研究组心输出量、左室射血分数、心脏指数均高于西医组(P<0.05)。2组Notch1、ROCK1、ESM-1、内皮微颗粒、MCP-1、hs-CRP、Lp-PLA2水平均较治疗前下降(P<0.05),研究组Notch1、ROCK1、ESM-1、内皮微颗粒、MCP-1、hs-CRP、Lp-PLA2水平均低于西医组(P<0.05)。结论:稳心通脉方加减联合西药治疗不稳定型心绞痛心肾阴虚证,可改善心功能和血管内皮功能,抑制炎症反应,缓解病情,提高生活质量。

养阴运津方联合常规疗法治疗2型糖尿病伴非酒精性脂肪肝临床研究

目的:观察养阴运津方联合常规疗法治疗2型糖尿病(T2DM)伴非酒精性脂肪肝(NAFLD)疗效及对糖脂代谢的影响。方法:选择2022年1月—2023年1月安阳市中医院接受治疗的110例T2DM伴NAFLD气阴两虚证患者,按随机数字表法分为对照组及观察组各55例。过程中对照组和观察组中分别有3例、1例被剔除,最终分别纳入52例、54例。对照组采用常规现代医学治疗,观察组在对照组基础上加用养阴运津方治疗。比较2组治疗前后中医证候评分、糖脂代谢水平、肝功能水平、NAFLD超声分度情况的变化,比较2组不良反应发生情况。结果:治疗1个月及3个月后,2组神疲乏力、口渴多饮及气短自汗中医证候评分均较治疗前下降(P<0.05),观察组上述3项评分均低于同一时间段对照组(P<0.05)。治疗1个月及3个月后,2组空腹血糖、餐后2 h血糖及糖化血糖蛋白水平均较治疗前下降(P<0.05),观察组上述3项水平均低于对照组(P<0.05)。治疗1个月及3个月后,2组甘油三酯、胆固醇水平均较治疗前下降,高密度脂蛋白胆固醇水平均较治疗前升高,差异均有统计学意义(P<0.05);观察组甘油三酯、胆固醇水平均低于对照组,高密度脂蛋白胆固醇水平高于对照组,差异均有统计学意义(P<0.05)。治疗1个月及3个月后,2组谷草转氨酶、谷丙转氨酶、谷氨酰基转移酶水平均较治疗前下降(P<0.05),观察组上述3项水平均低于同一时间段对照组(P<0.05)。治疗3个月后,2组NAFLD超声分度重度比例较治疗前降低,NAFLD超声分度轻度比例均较治疗前升高,治疗后,观察组NAFLD超声分度轻度比例高于对照组、重度比例低于对照组(P<0.05)。对照组不良反应发生率为5.77%(3/52),观察组不良反应发生率为9.26%(5/54),2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:养阴运津方联合常规疗法治疗T2DM伴NAFLD可有效控制临床病情,改善糖脂代谢,保护肝脏功能,降低肝脏脂肪沉积,安全性良好。

Exploration of Syndrome Differentiation Patterns in Coronary Heart Disease Patients during Peri-Operative Stage of Coronary Artery Bypass Graft

Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG).Methods: One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre- or post-operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored.Results: In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri-operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation.Conclusion: TCM SD conducting in peri-operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri-operative complications and elevating success rate of operation.

Study on Molecular Mechanism of Liver Yang Ascending Syndrome in Hypertension

Objective: To investigate the molecular mechanism of Liver Yang Ascending Syndrome (LYAS) in hypertension. Methods: The plasma norepinephrine (NE), epinephrine (E) contents in patients with LYAS or Liver and Kidney Yin Deficiency Syndrome (LKYDS) of hypertension and normal controls were determined by high performance liquid chromatography-electrochemical detector (HPLC-ECD). The polymorphism of tyrosine hydroxylase (TH) gene in the three groups were analysed by Southern Blot assay. The polymorphism of TH and monoamine oxidation A(MAO-A), monoamine oxidation B(MAO-B) gene microsatellite in these groups were analysed by polymerase chain reaction (PCR)-SSCP. At the same time, the LYAS model was established by administering Aconitum preparation (AP) to spontaneous hypertension rats (SHR). The adrenal gland medulla of the experimental animal was examined for their TH expression at the protein level after ABC immuno-histochemical staining with the TH monoclonal antibody (McAb). The adrenal TH gene mRNA expression was demonstrated by in situ hybridization with the synthetized TH oligonucleic acid probe. The results of immuno-histochemistry and in situ hybridization were analyzed with the image analysis system (IAS). Results: The plasma NE and E contents in patients with LYAS were more obviously increased than those in LKYDS and normal controls. The TH gene amplified and the type A1 TH microsatellite D11S4046 was markedly higher in the LYAS group than those in the other groups. The TH mRNA protein expression in the adrenal tissue of the AP induced LYAS model in SHR elevated. Conclusion: The LYAS of hypertension has the characters as amplified TH gene and increased TH mRNA and protein expression, which suggested that the overexpression of TH is probably the mechanism of LYAS in hypertension.

Value of Traditional Chinese Medicine syndrome differentiation in predicting the survival time of patients with advanced cancer

OBJECTIVE:To prospectively study the accuracy of the palliative prognostic index(PPI)survival prediction model combined with Traditional Chinese Medicine(TCM)syndrome differentiation.METHODS:The PPI survival prediction model was used to predict survival time.Patients'real survival time was recorded.The survival time was calculated using the Kaplan-Meier method,and the logrank method was used to test the difference.RESULTS:The average PPI survival prediction score of 227 patients was 5.83(95%CI:5.29-6.37).There was a significant difference in the real-life period between the different PPI groups(P<0.05).PPI group Ⅰ(predicted survival of >6 weeks)showed the highest predictive sensitivity and PPI group Ⅱ(predicted survival of 3-6 weeks)showed the highest predictive specificity.According to TCM syndrome differentiation,82 cases(36%)were diagnosed with liver and kidney Yin deficiency(type Ⅳ).The actual survival time of type Ⅳ patients was significantly shorter than that of other types of patients(mean:21.85 vs 28.70,P=0.007).In group Ⅰ,the median survival time of type Ⅳ patients and other types was 25 and 34 d,respectively(P<0.001).The sensitivity and specificity of PPI prediction were improved in group Ⅱ by TCM syndrome differentiation.For patients in group Ⅲ whose predicted survival time was<3 weeks,the specificity of PPI survival prediction was higher in type Ⅳ patients.CONCLUSION:This study shows that the PPI predictive tool for survival rate has important value.TCM syndrome differentiation and typing has certain significance for further classification and survival prediction.

Combined liver-kidney transplantation for rare diseases

Combined liver and kidney transplantation(CLKT)is indicated in patients with failure of both organs,or for the treatment of end-stage chronic kidney disease(ESKD)caused by a genetic defect in the liver.The aim of the present review is to provide the most up-to-date overview of the rare conditions as indications for CLKT.They are major indications for CLKT in children.However,in some of them(e.g.,atypical hemolytic uremic syndrome or primary hyperoxaluria),CLKT may be required in adults as well.Primary hyperoxaluria is divided into three types,of which type 1 and 2 lead to ESKD.CLKT has been proven effective in renal function replacement,at the same time preventing recurrence of the disease.Nephronophthisis is associated with liver fibrosis in 5%of cases and these patients are candidates for CLKT.In alpha 1-antitrypsin deficiency,hereditary C3 deficiency,lecithin cholesterol acyltransferase deficiency and glycogen storage diseases,glomerular or tubulointerstitial disease can lead to chronic kidney disease.Liver transplantation as a part of CLKT corrects underlying genetic and consequent metabolic abnormality.In atypical hemolytic uremic syndrome caused by mutations in the genes for factor H,successful CLKT has been reported in a small number of patients.However,for this indication,CLKT has been largely replaced by eculizumab,an anti-C5 antibody.CLKT has been well established to provide immune protection of the transplanted kidney against donor-specific antibodies against class I HLA,facilitating transplantation in a highly sensitized recipient.

子午流注择时电温针联合双补增津汤治疗结肠慢传输型便秘气阴两虚证的疗效观察

目的:观察子午流注择时电温针联合双补增津汤治疗结肠慢传输型便秘(STC)气阴两虚证的临床疗效。方法:选择符合纳入标准的152例STC气阴两虚证患者,按随机抽取法分为对照组(枸橼酸莫沙必利治疗)、电针组(枸橼酸莫沙必利+子午流注择时电温针治疗)、中药组(枸橼酸莫沙必利+双补增津汤治疗)和结合组(枸橼酸莫沙必利+子午流注择时电温针+双补增津汤治疗),每组各38例,均治疗4周。观察比较4组患者治疗前后中医症状积分和总积分、结肠传输试验标志物含量、肠道菌群数量、焦虑自评量表评分(SAS)、抑郁自评量表评分(SDS)、慢性便秘严重度评分(CSS)的变化情况,比较临床疗效及随访6个月复发率。结果:4组患者治疗后中医症状积分和总积分、结肠传输试验标志物含量和SAS、SDS、CSS评分均较治疗前比较均明显下降(P<0.05),肠道内大肠埃希数量与治疗前比较明显减少(P<0.05),双歧杆菌、乳酸杆菌数量与治疗前比较明显增多(P<0.05);结合组临床疗效明显优于其他3组(P<0.05),随访期复发率明显低于其他3组(P<0.05)。结论:子午流注择时电温针联合双补增津汤治疗STC气阴两虚证的疗效显著,二者可发挥协同增效作用,能有效缓解便秘症状,调节肠道菌群,恢复肠道运动功能,改善焦虑、抑郁心理状态,降低复发率。

补中益气汤合增液汤加减治疗功能性便秘气阴两虚证疗效评价

目的探讨补中益气汤合增液汤加减治疗功能性便秘气阴两虚证的临床疗效。方法将该院于2019年1月—2021年12月收治的80例功能性便秘气阴两虚证患者纳入研究,采用随机对照法将所选患者进行分组,分为治疗组及对照组各40例。其中治疗组患者应用补中益气汤合增液汤加减治疗,150 mL/次,每日2次。对照组予以枸橼酸莫沙必利分散片5 mg/次口服,每日3次。2组均以4周为1个疗程,比较治疗前后便秘主要症状评分、便秘患者症状自评量表(PAC-SYM)评分变化情况,并比较两组患者的临床疗效。结果药物干预前,两组患者临床症状包括大便性状、排便间隔、排便困难、排便不尽症状评分及腹部症状、直肠症状、大便症状、PAC-SYM量表总分评分对比,差异无统计学意义,均P>0.05;经药物干预后,两组患者大便性状、排便间隔、排便困难、排便不尽症状评分及腹部症状、直肠症状、大便症状、PAC-SYM量表总分评分均明显低于治疗前,且观察组明显低于对照组,均P<0.05。观察组的总有效率明显高于对照组(P<0.05)。结论补中益气汤合增液汤加减治疗功能性便秘气阴两虚证具有较好临床效果,能够显著缓解大便干燥症状,改善患者生存状态,且具有不良反应小、患者认可度高等优势,是值得广泛应用的方案之一。

加味升降散对早期糖尿病肾病患者肾小管功能的影响

目的:观察加味升降散对早期糖尿病肾病(DN)患者肾小管功能的影响及其作用机制。方法:选取2018年3月至2019年10月河北省中医院肾内科门诊及住院部收治的早期DN患者92例作为研究对象,中医辨证属气阴两虚、浊毒郁热证。用简单随机化法分为对照组和观察组,每组46例。对照组给予基础治疗;观察组在基础治疗上加服加味升降散,疗程均为2个月。记录2组患者治疗前后中医证候积分;临床指标:糖化血红蛋白(HbA1c),低密度脂蛋白(LDL),总胆固醇(TC),尿微量白蛋白排泄率(UAER),肾小球滤过率(GFR);肾小管功能标志物:β2-微球蛋白(β2-MG),肝型脂肪酸结合蛋白(L-FABP),α1-微球蛋白(α1-MG);氧化应激指标:NADPH氧化酶4(NOX4),超氧化物歧化酶(SOD),总抗氧化能力(T-AOC)。结果:治疗后,观察组总有效率为92.68%,对照组为81.40%,差异有统计学意义(P<0.05);2组患者中医证候积分、HbA1c、TC、LDL、UAER均较前下降,且观察组下降更为显著(均P<0.05);2组患者治疗前后GFR变化不明显,α1-MG、β2-MG、L-FABP水平均较前降低,且观察组下降更显著(均P<0.05);2组患者NOX4表达受到抑制,T-AOC、SOD水平回升(均P<0.05),观察组患者NOX4表达的下降以及T-AOC、SOD水平的回升更显著(P<0.05);2组患者均未出现不良反应。结论:加味升降散能够改善早期DN患者临床症状,调节氧化-抗氧化失衡,减轻氧化应激,缓解肾小管损伤。

自拟参芪地黄汤治疗终末期肾病维持性血液透析患者顽固性透析相关性低血压的临床研究

目的观察自拟参芪地黄汤治疗终末期肾病接受维持性血液透析(Maintenance hemodialysis,MHD)患者顽固性透析相关性低血压(Intradialytic hypotension,IDH)的临床疗效。方法选取2022年1月—2023年10月期间于陕西省宝鸡市中医医院实施MHD过程中出现顽固性IDH的终末期肾病患者81例,按随机数字表法分为观察组40例和对照组41例。对照组接受常规西医干预,观察组在对照组基础上给予自拟参芪地黄汤干预。治疗8周后,观察比较两组患者临床疗效,治疗前后中医证候积分、血压指标[收缩压(Systolic blood pressure,SBP)、舒张压(Diastolic blood pressure,DBP)、动脉压(Mean arterial pressure,MAP)]、统计两组患者透析期间IDH、肌肉痉挛、提前终止透析和透析后直接起床的比例;并评估两组患者透析充分性。结果治疗后观察组临床总有效率90.00%(36/40)明显高于对照组的68.29%(29/41),差异有统计学意义(P<0.05)。治疗后两组患者中医证候评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组中医证候评分较对照组明显降低,差异有统计学意义(P<0.05)。治疗前两组患者透析前、透析中SBP、DBP和MAP水平比较,差异无统计学意义(P>0.05)。治疗前两组患者透析中SBP、DBP和MAP水平均较透析前下降,差异有统计学意义(P<0.05)。治疗后观察组透析中SBP、DBP和MAP水平均高于治疗前同期水平,差异有统计学意义(P<0.05);且观察组明显高于对照组同期水平,差异有统计学意义(P<0.05)。治疗后观察组IDH、肌肉痉挛、提前终止透析发生率均低于对照组,透析后直接起床的比例高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者Kt/V、URR、超滤量指标均较治疗前升高,差异有统计学意义(P<0.05);且观察组Kt/V、URR、超滤量指标均较对照组明显升高,差异有统计学意义(P<0.05)。结论自拟参芪地黄汤可显著降低终末期肾病维持性血液透析患者顽固性IDH的发生率,能够改善症状,维持透析中的血压稳定,从而有利于提高透析充分性,改善透析效果。