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.

Discussion on the application of Ginseng efficacy from"Treatise on Spleen and Stomach"

According to the original works of an ancient Chinese medicine book"Treatise on Spleen and Stomach"(Detailed Analysis of Spleen and Stomach Diseases;1249 C.E.)written by Li Dongyuan(1180-1251 C.E),and related explanations of later physicians,the efficacy and application of Ginseng(Ginseng Radix et Rhizoma)in related prescriptions were investigated from the aspects of dosage,usage and treatment methods.Ginseng appeared in 27 named prescriptions,including 20 decoctions,4 pill and 3 powder.In terms of dosage and usage,the common dosage of Ginseng is five points,mainly decoction.Most of the processing methods are"Fuju"(Bite up the medicine with your mouth so it can be taken.)and decoction with water.In terms of treatment methods,Ginseng is used in the sweet temperature and heat removing method and Nourishes Qi and Eliminates Evils Method(build your body to cure disease)in Li Dongyuan's"Treatise on Spleen and Stomach".Explaining Sweet Temperature Heat Removal Method(Use sweet and warm medicines to treat Qi-deficiency fever or Blood-deficiency fever;there are many reasons for fever,and cold and cooling medicines with heat-clearing effect are generally used for treatment.Use bitter cold medicine,so as not to consume the body's Yang.)takes Buzhong Yiqi Decoction(BYD)as an example,and explaining the Nourishes Qi and Eliminates Evils Method takes Mahuang-renshen-shaoyao decoction as an example.At the same time,"Treatise on Spleen and Stomach"matured in the Jin and Yuan Dynasties(1115-1368 C.E.).Its system of weights and measures,terminology and medical theory are quite different from those of modern Chinese medicine.Therefore,when researching the dosage,usage and treatment methods of Ginseng,we will explore the controversial points,and explain them by using modern Chinese medicine theory,so as to guide the clinical medication more accurately.

Interleukin-12 and interferon-γacting on damp-heat of spleen-stomach syndrome triggered by helicobacter pylori

OBJECTIVE: To investigate the expression of and interleukin-12(IL-12) and interferon-γ(IFN-γ) in relation to the pathology of damp-heat of spleen-stomach syndrome(DHSS) induced by Helicobacter pylori(H. pylori) infection.METHODS: In total, 114 individual gastric mucosal specimens including 83 DHSS, 19 spleen-qi deficiency syndrome(SQD) and 12 from healthy volunteers(CON) were collected by gastroscopy. To explore the relationship between the two syndromes and H. pylori infection, individual samples were tested using rapid urease and methylene blue tests. Hematoxylin and eosin stained sections were examined to grade for the degree of inflammation and inflammatory activity, and expression of IL-12 and IFN-γ was investigated by immunohistochemistry.RESULTS: Statistically significant differences in the degree of inflammation and inflammatory activity were observed between the groups of specimens:DHSS, SQD and CON(P < 0.05). Additionally, greater intestinal metaplasia(IM) and dysplasia were observed in the DHSS group, especially those with H.pylori infection. Expression of both IFN-γ and IL-12 was higher in DHSS samples infected with H. pylori than in uninfected samples and in the CON(P <0.05) but not in the SQD(P > 0.05) groups. Intriguingly, in gastric specimens exhibiting IM and dysplasia, IL-12 translocated from the nucleus into the cytoplasm.CONCLUSION: Our findings suggest that IL-12 and IFN-γ are involved in DHSS pathology, but not in SQD, acting as healthy-Qi. DHSS is not just the consequence of those two cytokines but results from the cross-talk between a number of cytokines and/or other proteins, which may warrant further investigation in DHSS patients infected with H. pylori.

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。

黄连汤合柴龙逆萎汤联合四联疗法治疗慢性非萎缩性胃炎伴糜烂临床研究

目的:观察黄连汤合柴龙逆萎汤联合四联疗法治疗慢性非萎缩性胃炎(CNAG)伴糜烂的临床效果。方法:选取2020年6月—2023年6月于安阳市中医院治疗的144例肝胃不和兼脾胃湿热型CNAG伴糜烂患者,采用随机数字表法分为对照组和观察组各72例,2组均采用常规四联疗法治疗,观察组加用黄连汤合柴龙逆萎汤加减治疗。2组均治疗4周。治疗前后评估2组患者的中医证候评分,检测血清炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-8(IL-8)]水平及胃功能指标[胃泌素-17(G-17)、胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)],评估胃黏膜糜烂评分、慢性炎症评分,统计治疗期间不良反应发生情况。比较2组的临床疗效。结果:治疗4周后,观察组总有效率高于对照组(P<0.05)。2组中医证候主症积分、次症积分、总积分及胃黏膜糜烂评分、慢性炎症评分均较治疗前降低(P<0.05),观察组以上5项评分值均低于对照组(P<0.05)。2组TNF-α、IL-1β、IL-8、PGⅡ水平均较治疗前降低,G-17、PGⅠ水平均较治疗前升高,差异均有统计学意义(P<0.05)。观察组TNF-α、IL-1β、IL-8、PGⅡ水平均低于对照组(P<0.05),G-17、PGⅠ水平均高于对照组(P<0.05)。2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:在四联疗法基础上加用黄连汤合柴龙逆萎汤治疗肝胃不和兼脾胃湿热型CNAG伴糜烂患者能够有效缓解症状,提高临床疗效,减轻机体炎症及胃黏膜糜烂程度,安全性较高。

A Systematic Review and Meta-Analysis of Randomized Controlled Trials on Treating Ulcerative Colitis by the Integration Method of Heat-Clearing, Damp-Excreting, Spleen-Strengthening, and Stasis-Removing of Traditional Chinese Medicine with Western Medicine

Objective:The objective of this study was to systematically evaluate the clinical efficacy of the integration method of heat-clearing, dampness-excreting,spleen-strengthening, and stasis-removing from traditional Chinese medicine (TCM) combined with Western medicine for the treatment of ulcerative colitis(UC).Materials and Methods:The databases China National Knowledge Infrastructure,China Biology Medicinedisc(CBMdisc),WANFANG, VIP, and PubMed were searched for randomized controlled trials investigating the integration of the TCM methods of clearing heat,draining dampness, invigorating the spleen, and removing stasis, combined with Western medicine to treat UC from January 2009 to March 2019. Two reviewers independently conducted literature searches, screenings, data extractions, and literature bias evaluations. A meta-analysis was conducted using RevMan 5.3 and Stata 13.0 software. Results:In total, 15 studies involving 1289 patients were included. The results of the meta-analysis showed that the total effective rate of treatment in the experimental groups was higher than that of the control groups (relative risk [RR]=1.27, 95%confidence interval [CI]:1.21, 1.35, Z=8.74, P <0.00001). In the subgroup analysis, the total effective rate of oral TCM combined with Western medicine was higher than that of the control groups (RR=1.24, 95%CI:1.15, 1.33, Z=5.88, P <0.00001). The total effective rate of oral TCM with enemas combined with Western medicine was higher than that of the control group (RR=1.30, 95%CI:1.12, 1.50, Z=3.52, P=0.0004).The comparison between Western medicine alone and oral TCM combined with enteroscopy and Western medicine showed that the effective rate of enteroscopy (RR=1.18, 95%CI:1.05, 1.33, Z=2.86, P=0.004) and the symptom scores before and after treatment all improved more in the combined treatment groups than in those of the Western medicine group alone, with statistically significant differences (RR=-4.23, 95%CI:-4.93,-3.53, Z=11.84, P <0.00001). Conclusion:The integration of the TCM methods of heat clearing, dampness excreting, spleen strengthening, and stasis removing combined with Western medicine can significantly improve the cure rate of UC, and is an effective method to treat UC.

加味半夏泻心汤联合盐酸西替利嗪片递减法治疗慢性自发性荨麻疹(脾虚湿热证)疗效观察

目的观察加味半夏泻心汤联合盐酸西替利嗪片递减法对慢性自发性荨麻疹(脾虚湿热证)的临床疗效。方法选取2021年1月至2022年6月达州市中西医结合医院确诊的慢性自发性荨麻疹(脾虚湿热证)70例,采用随机数字表分为治疗组与对照组,每组各35例。对照组给予西替利嗪片递减法治疗,治疗组在对照组基础上联用加味半夏泻心汤。两组总疗程为6周。在治疗第4周及第6周开始时,观察两组病人盐酸西替利嗪片使用情况,并于第6周治疗结束后,观察两组病例的临床疗效、西替利嗪片使用总量、荨麻疹活动度评分(UAS)及皮肤生活质量指数(DQLI)评分、血清总免疫球蛋白E(IgE)值、不良反应。并于治疗结束后8周统计复发情况。结果研究实际完成60例,两组各30例。治疗第4周及第6周开始时,治疗组盐酸西替利嗪片使用间隔时间明显高于对照组(治疗组西药减量速度高于对照组)(P<0.05)。6周后,治疗组治愈率为53.33%(16/30),对照组治愈率为20%(6/30);治疗组治愈率明显高于对照组(P<0.05);治疗组病人西替利嗪片使用总量明显低于对照组(P<0.05),治疗组UAS及DQLI评分比对照组低(P<0.05);不良反应两组无差异。疗程结束以后8周随访,复发率治疗组比对照组显著降低(P<0.05)。结论加味半夏泻心汤联合盐酸西替利嗪片递减法治疗慢性自发性荨麻疹(脾虚湿热证)临床疗效确切,可明显缩短病程,降低复发率。

中药复方与肠道菌群相互作用研究进展

中药复方与肠道菌群存在着交互作用,这种作用包括中药复方对肠道微生物结构和菌群代谢活性的调节,以及肠道菌群可进一步促进中药复方成分在人体内的吸收和转化。关于中药复方与肠道菌群关系的研究较多,但仍存在以下问题:(1)目前关于中药复方与肠道菌群相互作用的研究多集中在阐述中药复方通过调节肠道菌群而治疗疾病,整体的研究水平不够全面和深入;(2)动物与人体内的肠道菌群组成具有差异性,且目前中药复方与肠道菌群相互作用的实验载体多是动物,临床研究报道较少;(3)药效机制研究缺乏验证实验,仅有极少数的研究确认了中药复方和肠道菌群具有明确的因果关联,大多研究结果仅仅表明了中药复方对肠道菌群的影响是治疗作用的关联因素,不足以说明肠道菌群在药效机制中的因果关系;(4)中药复方成分复杂,肠道菌群介导中药复方成分转化方面的研究难度较大。今后需开展多中心、大样本、高质量的临床研究探讨中药复方与肠道菌群之间的相互作用,也应将研究方向多集中在“复方-肠道微生态-代谢物-疗效”的因果关系上,为进一步揭示中药复方治疗疾病的科学内涵提供新思路。

大肠息肉患者病例特点和中医证型分布及其与焦虑抑郁的关系

【目的】探讨大肠息肉患者的流行病学特征、中医证型分布及焦虑抑郁情况。【方法】选取2022年1月至2023年12月期间在广州中医药大学东莞医院内镜中心行结肠镜检查或治疗的大肠息肉患者200例(息肉组)和肠道未见异常者100例(非息肉组),收集2组患者的相关病历资料,对大肠息肉患者进行中医辨证分型,并对其流行病学特征包括性别、年龄、体质量指数(BMI)、烟酒史等进行问卷调查和记录,同时进行医院焦虑抑郁量表(HAD)评分,以评估其焦虑、抑郁状态。【结果】(1)流行病学特征方面,息肉组与非息肉组患者的性别、年龄、BMI、吸烟、饮酒等一般情况比较,差异均有统计学意义(P <0.05或P <0.01)。具体表现为,息肉组以男性为主(63.5%),而非息肉组以女性为主(58.0%),说明相比女性患者,男性患者更易患大肠息肉;年龄方面,息肉组以51~60岁年龄段为主(36.0%),非息肉组以41~50岁年龄段为主(38.0%),说明息肉组的平均年龄较非息肉组大;另外,息肉组的肥胖(BMI≥28.0 kg/m2)、吸烟、饮酒人数占比均较非息肉组高。(2)息肉情况方面,大肠息肉多发病于左半结肠,占息肉组的53.5%;腺瘤性息肉占所有息肉病理类型的57.0%;肠息肉大小以<1.0 cm为主,占所有息肉的81.5%;单发性肠息肉占45.5%,多发性肠息肉占54.5%,说明大肠息肉仍以多发为主。(3)中医证型分布方面,200例大肠息肉患者中,脾虚湿滞证93例(46.5%),大肠湿热证59例(29.5%),肝郁气滞证27例(13.5%),湿瘀阻滞证21例(10.5%)。不同性别、年龄、BMI和饮酒情况的大肠息肉患者中医证型分布比较,差异均无统计学意义(P> 0.05);而不同吸烟情况的大肠息肉患者中医证型分布比较,差异有统计学意义(P <0.05)。不同发病部位、息肉数目、病理类型的大肠息肉患者中医证型分布比较,差异均无统计学意义(P> 0.05);而不同息肉大小的大肠息肉患者中医证型分布比较,差异有统计学意义(P <0.05),其中,息肉大小<1.0 cm者脾虚湿滞证及大肠湿热证的比例明显高于≥1.0 cm者,湿瘀阻滞证的比例明显低于≥1.0 cm者。(4)焦虑、抑郁状态方面,息肉组患者HAD量表的焦虑、抑郁状态评分均高于非息肉组,差异均有统计学意义(P <0.01)。进一步分析发现,对于大肠息肉患者而言,除息肉大小的焦虑状态评分外,不同发病部位、发病数目、病理类型与焦虑状态、抑郁状态评分以及息肉大小与抑郁状态评分均无关,差异均无统计学意义(P> 0.05)。另外,不同中医证型的焦虑、抑郁状态评分比较,差异也均无统计学意义(P> 0.05)。【结论】(1)大肠息肉的中医证型分布以脾虚湿滞证、大肠湿热证为多,其中医证型分布与焦虑抑郁及肠息肉的发病部位、数目、病理类型无关,而与息肉大小具有一定的相关性;(2)焦虑抑郁可能是大肠息肉发病的危险因素,但大肠息肉的发病部位、发病数目、病理类型与焦虑抑郁无关,息肉大小可能与焦虑具有一定的相关性。(3)性别、年龄、吸烟、饮酒可能是大肠息肉发病的危险因素。

毫火针联合清补化痤饮治疗脾虚湿热证痤疮的临床疗效观察

【目的】观察毫火针联合清补化痤饮治疗脾虚湿热证痤疮的临床疗效和安全性。【方法】将2023年5月至2024年3月于广州中医药大学第七临床医学院就诊的70例脾虚湿热证痤疮患者,按随机数字表法随机分为观察组和对照组,每组各35例。2组患者均给予健康宣教,对照组给予毫火针联合盐酸多西环素片口服治疗,观察组给予毫火针联合清补化痤饮口服治疗,疗程均为6周。治疗6周后,评价2组临床疗效,观察2组患者治疗前后痤疮综合分级系统(GAGS)评分与面部痤疮特异性生活质量量表(Qol-Acne)评分的变化情况,以及中医证候积分的情况。比较2组患者治疗前后皮肤屏障功能指标经表皮水分丢失(TEWL)含量、皮肤水分含量、皮脂含量的变化情况。并评价2组的安全性及不良反应的发生情况。【结果】(1)治疗后,2组患者的GAGS评分明显改善(P<0.05),且观察组在改善GAGS评分方面明显优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者的Qol-Acne评分均明显改善(P<0.05),且观察组在改善自我感知、情感功能、自我评估3个方面明显优于对照组,差异有统计学意义(P<0.05),观察组在改善社会功能方面稍优于对照组,但差异无统计学意义(P>0.05)。(3)治疗后,2组患者的TEWL、皮肤水分、皮脂含量均明显改善(P<0.05),且观察组在改善TEWL、皮肤水分、皮脂含量方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的中医证候积分明显改善(P<0.05),且观察组在改善中医证候积分方面明显优于对照组,差异有统计学意义(P<0.05)。(5)观察组总有效率为94.29%(33/35),对照组为74.29%(26/35)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(6)观察组和对照组的不良反应发生率比较,差异无统计学意义(P>0.05)。【结论】毫火针联合清补化痤饮治疗脾虚湿热证痤疮,能明显改善患者的临床症状,从而提高患者生活质量,疗效显著,且安全性好。

免疫治疗对晚期胃癌中医证型演变规律的影响

目的:观察免疫治疗对晚期胃癌(gastric cancer, GC)患者中医证型演变规律的影响。方法:共纳入58例晚期GC患者,其中腹膜转移组38例,无腹膜转移组20例,收集患者的一般资料、临床病理学特征及治疗前后中医证型。运用χ~2检验评估各项指标间的相关性,运用Kaplan-Meier法评估各种证型无进展生存期(progression-free survival, PFS)。结果:58例GC患者治疗前中医证型以痰湿凝结证、肝胃不和证为主,两种证型PFS比较,差异无统计学意义(P>0.05);治疗后以气阴两虚证、脾胃虚寒证为主,两种证型PFS比较,差异无统计学意义(P>0.05)。腹膜转移组治疗前主要证型为肝胃不和证、痰湿凝结证、气滞血瘀证;治疗后主要证型为脾胃虚寒证、气阴两虚证、气血亏虚证。无腹膜转移组治疗前主要证型为气阴两虚证、痰湿凝结证、脾胃虚寒证;治疗后主要证型为气阴两虚证、脾胃虚寒证、气血亏虚证。腹膜转移组治疗前肝胃不和证与痰湿凝结证肿瘤原发部位、分化程度、组织学、分期比较,差异并无统计学意义(P>0.05)。58例晚期GC患者PFS为(5.19±2.95)个月,其中腹膜转移组PFS为(4.22±2.77)个月,无腹膜转移组PFS为(7.02±2.40)个月,两组PFS比较,差异具有统计学意义(P<0.05)。将58例GC患者肝胃不和证、痰湿凝结证、气滞血瘀证归为实证,气阴两虚证、脾胃虚寒证、气血亏虚证归为虚证。实证与虚证PFS比较,差异无统计学意义(P>0.05)。结论:肝胃不和证和痰湿凝结证在晚期腹膜转移患者中多见,且生存期更短,免疫治疗可改善晚期GC患者中医证型的分布规律,加强对晚期GC患者中医证型的关注,并进行及早干预,有助于提高患者的生存期。

基于肠道菌群调节机制探讨加味半夏泻心汤对胃热脾虚型多囊卵巢综合征患者炎症因子的影响

【目的】基于肠道菌群调节机制探讨加味半夏泻心汤对胃热脾虚型多囊卵巢综合征(PCOS)患者炎症因子的影响。【方法】将86例胃热脾虚型PCOS患者随机分为对照组45例和观察组41例。对照组给予常规西药治疗,观察组在对照组的基础上给予加味半夏泻心汤治疗。1个月经周期为1个疗程,连续治疗3个月经周期。观察2组患者治疗前后中医证候积分、子宫内膜厚度、血清炎症因子[肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、白细胞介素6(IL-6)]、性激素[黄体生成素(LH)、雌二醇(E2)、卵泡刺激素(FSH)和LH/FSH]水平以及肠道菌群的变化情况,比较2组患者的临床疗效和妊娠率。【结果】(1)治疗3个月经周期后,观察组的总有效率为87.80%(36/41),对照组为68.89%(31/45),组间比较(χ^(2)检验),观察组的临床疗效明显优对照组(P<0.05)。(2)治疗后,2组患者的中医证候积分均较治疗前降低(P<0.05),且观察组的降低幅度明显优于对照组(P<0.01)。(3)治疗后,2组患者的子宫内膜厚度均较治疗前增加(P<0.05),且观察组的增加幅度明显优于对照组(P<0.01)。(4)观察组的妊娠率为92.68%(38/41),明显高于对照组的73.33%(33/45),差异有统计学意义(P<0.05)。(5)治疗后,2组患者血清E2、LH水平与LH/FSH值均较治疗前降低(P<0.05),而血清FSH水平均治疗前后变化不明显(P>0.05);组间比较,观察组对血清E2、LH水平与LH/FSH的降低幅度均明显优于对照组(P<0.01)。(6)治疗后,2组患者血清CRP、IL-6、TNF-α水平均较治疗前降低(P<0.05),且观察组降低幅度均明显优于对照组(P<0.01)。(7)治疗后,2组患者肠道菌群中的双歧杆菌、乳酸杆菌水平均较治疗前升高(P<0.05),粪肠球菌、拟杆菌水平均较治疗前降低(P<0.05),而肠杆菌水平均治疗前后变化不明显(P>0.05);组间比较,观察组对双歧杆菌、乳酸杆菌水平的升高幅度及对粪肠球菌、拟杆菌水平的降低幅度均明显优于对照组(P<0.05或P<0.01)。【结论】加味半夏泻心汤治疗胃热脾虚型PCOS临床疗效显著,可通过调节肠道菌群,改善患者临床症状,减轻炎症程度。

基于UPLC-QTOF-MS技术的藿香正气口服液治疗大鼠湿困脾胃证的血清代谢组学研究

目的基于超高效液相色谱-四极杆-飞行时间质谱联用(UPLC-QTOF-MS)技术的血清代谢组学方法寻找与湿困脾胃证相关的潜在生物标志物,探讨藿香正气口服液对湿困脾胃证的干预机制。方法采用综合物理造模方法建立湿困脾胃证大鼠模型。观测大鼠体质量、体长、尾长、腹围指数与自主活动次数;利用UPLCQTOF-MS方法对大鼠血清进行代谢组分析,结合正交偏最小二乘法-判别分析(OPLS-DA),寻找藿香正气口服液治疗湿困脾胃证大鼠后相关潜在生物标志物的变化及其相关代谢通路。结果与正常组比较,模型组大鼠的体质量、体长、自主活动次数明显减少(P<0.001),腹围指数明显升高(P<0.001);正离子和负离子模式下分别鉴定了与湿困脾胃证相关的15、10个血清潜在生物标志物,涉及磷脂代谢、氨基酸代谢、能量代谢等9条代谢通路。藿香正气口服液对湿困脾胃证模型大鼠的血清代谢表型能产生有效的干预,并使14个潜在生物标志物产生显著回调(P<0.05)。结论藿香正气口服液对大鼠湿困脾胃证的干预作用可能与调节磷脂代谢、氨基酸代谢、能量代谢等通路有关。

Discussion on the Theoretical Basis of Banxia Xiexin Decoction in the Treatment of Insulin Resistance Obesity

Through reading Chinese ancient book Huangdi Nejing,and summarizing and analyzing related literature,the basic pathogenesis of obesity have been found to be the stomach preponderance and spleen weakness,and the imbalance of ascending and descending.Banxia Xiexin Decoction not only has the functions of relieving heat to inhibit stomach intake,supplementing deficiency to assist spleen transport,regulate the ascending and descending,but also has the effects of improving insulin resistance and regulating glucolipid metabolism.Therefore,it is suggested that Banxia Xiexin Decoction can be used in the treatment of insulin resistant obesity,which provides ideas and methods for its treatment.

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。

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。

葛根芩连汤通过IRS-1/PI3K/AKT通路对胃肠湿热型2型糖尿病大鼠糖脂代谢的影响

目的探究葛根芩连汤通过胰岛素受体底物-1(IRS-1)/磷脂酰肌醇3激酶(PI3K)/蛋白激酶B(AKT)通路对胃肠湿热型2型糖尿病大鼠糖脂代谢的影响。方法将40只SD大鼠随机分为正常组(2 mL生理盐水灌胃)、造模组(2 mL生理盐水灌胃)、二甲双胍组(4.17 mg/100 g二甲双胍灌胃)和葛根芩连汤组(1 g/100 g葛根芩连汤灌胃),每组10只。采用高脂高糖饲料加腹腔注射链脲佐菌素(STZ)构建2型糖尿病大鼠模型,随后喂食油脂、42°白酒及蜂蜜水构建胃肠湿热型2型糖尿病大鼠模型。测量各组大鼠不同时间节点体质量,血糖仪测定空腹血糖(FBG);ELISA检测空腹胰岛素(FINS)、三酰甘油(TG)、总胆固醇(TC)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平变化、计算胰岛素抵抗指数(HOMA-IR);HE染色检测肝组织病理学变化;检测肝组织过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)及丙二醛(MDA)含量变化。Western blot检测肝组织IRS-1、PI3K、p-PI3K、AKT及p-AKT蛋白变化。结果与正常组比较,造模组大鼠体质量、FBG、FINS及HOMA-IR、GSH-Px、CAT、SOD、IRS-1、p-PI3K/PI3K及p-AKT/AKT水平均明显下降(P<0.05)、TG、TC、IL-6、TNF-α及MDA含量均显著升高(P<0.05),可见局灶性肝实质损失。与造模组比较,二甲双胍组及葛根芩连汤组大鼠体质量、FBG、FINS及HOMA-IR、GSH-Px、CAT、SOD、IRS-1、p-PI3K/PI3K及p-AKT/AKT水平均明显升高(P<0.05)、TG、TC、IL-6、TNF-α及MDA含量均显著降低(P<0.05),显示正常的肝实质。结论葛根芩连汤可明显改善胃肠湿热型2型糖尿病糖脂紊乱,可能是通过IRS-1/PI3K/AKT通路发挥作用。

杨春波国医大师“脾胃湿热理论体系”的构建

杨春波国医大师擅长诊治脾胃病,对脾胃湿热证的研究尤为深入,经过70余年的临证积淀,逐渐形成了完善的“杨氏脾胃湿热体系”。对于杨氏脾胃湿热体系的构建,笔者从湿热初涉缘起、脾胃湿热形成、脾胃湿热理论核心、脾胃湿热理论的发展及传承等方面阐述了杨老脾胃湿热体系构建的过程及内容,重点介绍了脾胃湿热的病因病机特点、诊断标准的设立及确定、特色治疗方药等理论核心内容。

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。

从中焦湿热论治原发性干燥综合征

原发性干燥综合征(primary Sjogren's syndrome,pSS)是一种常见的慢性自身免疫性疾病,主要累及唾液腺和泪腺,临床表现为眼、口干燥以及疲劳、关节痛等全身症状。pSS患者的治疗涉及多个不同的专业领域,治疗复杂,且缺乏特异性药物,疗效欠佳。中医将pSS归属于“燥痹”范畴,多数医家认为该病基本病机为阴液亏损、津液枯涸,治疗亦多以滋阴润燥,养阴生津法为主,但部分患者疗效不尽如人意。笔者在此领域积累了丰富的临证经验,发现pSS属中焦湿热证者占较大比例,从中焦湿热论治,采用健脾化湿,清热润燥法取得了良好效果。