Effects of Zhenren Yangzang Decoction Combined with Modified Shenling Baizhu Powder on Immune Function and Intestinal Microecology of Diarrhea Patients with Deficiency and Cold Syndrome

OBJECTIVE: To observe the effects of Zhenren Yangzang Decoction combined with modified Shenling Baizhu Powder on the immune function and intestinal microecology of diarrhea patients with deficiency and cold syndrome. METHODS: A total of 60 diarrhea patients with deficiency and cold syndrome were randomly divided into observation group and control group, with 30 cases in each group. The control group was treated with conventional western medicine. The observation group was given the treatment of Zhenren Yangzang Decoction combined with modified Shenling Baizhu Powder on the basis of the same treatment for 4 weeks. The clinical symptoms, fecal flora and immunoglobulin content of the 2 groups were observed and the clinical efficacy was evaluated. RESULTS: After treatment, the symptoms scores of fecal diarrhea, aversion to cold, cold limbs, loss of appetite, cold and painful waist and knee, abdominal fullness, abdominal distension and abdominal pain, and intestinal bacilli contents were significantly decreased(P < 0.05). The contents of lactobacillus, bifidus bacilli, IgG, IgM and IgA were significantly increased(P < 0.05), and the improvement of the above indexes in the observation group was significantly better than that in the control group(P < 0.05). The total effective rate after treatment in the observation group was 93.3%, which was significantly higher than 73.3% of the control group(P < 0.05). CONCLUSION: The treatment of diarrhea patients with deficiency and cold syndrome with Zhenren Yangzang Decoction and modified Shenling Baizhu Powder can effectively improve the intestinal micro-ecological environment, improve the immune function of patients and promote the rapid recovery of patients.

Effects of Shenling Baizhu powder on endoplasmic reticulum stress related signaling pathway in liver tissues of nonalcoholic fatty liver disease rats

Background:According to our previous studies,Shenling Baizhu powder has an excellent preventive and therapeutic effect on nonalcoholic fatty liver disease,but the prevention mechanism is still not clear.In this study,we intended to explore the effects of Shenling Baizhu powder on the endoplasmic reticulum stress related signaling pathway in nonalcoholic fatty liver disease rats’liver tissues.Methods:After 16 weeks,the levels of serum total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,alanine transaminase and aspartate transaminase were evaluated by an automatic biochemical analyzer,and the levels of serum free fatty acid and hepatic total cholesterol and triglyceride were evaluated by commercial kits.Then,histological changes of the liver were observed by hematoxylin and eosin and oil red-O staining.Protein expression related to the liver unfolded protein response signalling pathway was assessed using Western blot analysis.Results:The results showed that Shenling Baizhu powder supplementation reduced serum total cholesterol,triglyceride,free fatty acid,alanine transaminase,and aspartate transaminase(P<0.05 or P<0.01),as well as the levels of hepatic total cholesterol and triglyceride(P<0.01).Pathological examination showed that Shenling Baizhu powder improved hepatic steatosis and lipid accumulation.The results of biochemical parameters and histological changes indicated that Shenling Baizhu powder administration exerted protective effects against nonalcoholic fatty liver disease.In addition,Shenling Baizhu powder decreased the protein expression levels of binding immunoglobulin protein,activating transcription factor 6,phosphorylation of eukaryotic initiation factor 2 alpha,protein kinase RNA-like endoplasmic reticulum kinase and X-box binding protein 1s in the liver(P<0.05 or P<0.01).Conclusion:Shenling Baizhu powder can ameliorate high-fat diet-induced liver lipid metabolism disorder in nonalcoholic fatty liver disease rats.The mechanisms may be related to the inhibition of the expression of proteins related to unfolded protein response signaling pathways in endoplasmic reticulum stress.

Mechanism of Shenling Baizhu powder in treating dextran sulfate sodium-induced colitis in rats

Objective: To investigate whether Shenling Baizhu powder can inhibit the inflammatory response of dextran sulfate sodium-induced colitis in rats by protecting the intestinal mucosal barrier. Methods: A total of 40 SD rats were randomly divided into normal control group (group A), dextran sulfate sodium model group (group B), middle-dose Shenling Baizhu powder group (group C), high-dose Shenling Baizhu powder group (group D) and sulfasalazine group (group E), with 8 rats in each group. In addition to group A, dextran sulfate sodium solution (40 g/L) was added to the drinking water of rats for free drinking. The treatment groups were also given the corresponding dose of Shenling Baizhu powder/sulfasalazine. Body weight, disease activity index(DAI), colon length and intestinal mucosal permeability were measured to evaluate the effect of Shenling Baizhu powder on colitis induced by dextran sulfate sodium. The content of interleukin-10(IL-10), interleukin-6(IL-6) and tumor necrosis factor(TNF-ɑ) in rat colonic homogenate were analyzed by using enzyme-linked immunosorbent assay. The protective effect of Shenling Baizhu powder on intestinal mucosa was discussed. Results: The levels of IL-6 and TNF-ɑ in group B were higher than those in group A (P<0.05), while IL-10 level of group B was lower than that of group A (P<0.05). The levels of TNF-ɑ in groups C, D and E were significantly lower than those in group B (P<0.01), and showed concentration dependence in groups C and D. The levels of IL-6 in groups D and E were significantly lower than those in group B (P<0.05). The levels of IL-10 in groups C, D and E were significantly higher than those in group B (P<0.01), and concentration dependence was observed in groups B and C. Conclusion: Shenling Baizhu powder can protect the intestinal mucosal barrier by regulating the function of cytokines such as IL-10, IL-6 and TNF-ɑ, which alleviate the inflammatory response in rats with dextran sulfate sodium-induced colitis.

Study on the mechanism of Shenling Baizhu Powder in the treatment of diarrhea-type irritable bowel syndrome based on network pharmacology and molecular docking

Objective:Explore the possible intervention mechanism of Shenling Baizhu Powder on IBS-D from network data through network pharmacology and molecular docking simulation technology.Methods:Establish a complete regulatory network of Shenling Baizhu powder on IBS-D after obtaining the active components and drug targets of Shenling Baizhu Powder on the TCMSP platform and obtaining the disease targets of IBS-D from GeneCards and OMIM databases.Then screen out the potential best target of Shenling Baizhu Powder in IBS-D intervention network combining with the PPI network constructed in the STRING database,and screen the potential core of compounds through the molecular docking simulation and comparison with pivecurium bromide.After that,the related gene ontology functions and pathways of Shenling Baizhu Powder in treating IBS-D will be obtained though gene ontology(GO)enrichment analysis through DAVID database and Kyoto encyclo-pedia of genes and genomes(KEGG)pathways enrichment analysis through Bioconductor database.Results:The number of IBS-D disease-related targets was 2,724.And there were 184 active compounds in Shenling Baizhusan,among which 175 could act on IBS-D.After screening,four potential best targets of PTGS2,ESR1,AR and MAPK14 were obtained,and four core compounds of quercetin,luteolin,kaempferol and isorhamnetin were obtained by molecular docking simulation.GO enrichment analysis results showed that there were 92 biological processes,18 cellular components and 21 molecular functions associated with shenling Baizhu Powder intervention IBS-D process.The results of KEGG pathway enrichment analysis showed that shenling Baizhu Powder had 172 pathways involved in the intervention of IBS-D.Conclusion:The intervention effect of Shenling Baizhu powder on IBS-D was better than pivecurium bromide in terms of the number of targets and the ease of binding to the targets.Its intervention process of IBS-D may be closely related to inflammation,cancer,endocrine disorders and other related reactions and pathways,among which quercetin,luteolin,kaempferol and isorrine are the most potential core compounds in the intervention network,and the four target proteins of PTGS2,ESR1,AR and MAPK14 are the potential best target options in the intervention network.

Therapeutic Effect of Shenling Baizhu Powder on Primary Nephrotic Syndrome Featuring Damp Abundance Due to Splenic Asthenia

[Objectives]To observe the clinical efficacy of Shenling Baizhu Powder in the treatment of primary nephrotic syndrome(PNS)featuring damp abundance due to splenic asthenia.[Methods]40 patients with PNS were randomly divided into treatment group(n=19)and control group(n=21).In the treatment group and the control group,methylprednisolone tablets were taken orally and cytoxan(CTX)was given intravenously for treatment;in the treatment group,based on oral administration of methylprednisolone tablets and intravenous drip of cytoxan(CTX),oral administration of traditional Chinese medicine(addition and subtraction of Shenling Baizhu Powder)was added.Urine routine,24-hour urinary protein,renal function and serum albumin were re-examined after 4 weeks of treatment.[Results]The total effective rate of the treatment group was significantly higher than that of the control group(89.47%vs 61.90%,P<0.05).After treatment,both groups could effectively reduce the levels of 24-hour urinary protein(P<0.05),serum creatinine(P<0.05)and urea nitrogen(P<0.05),and increase the level of serum albumin(P<0.05),but the degree of improvement in the treatment group was significantly higher than that in the control group(P<0.05),and the difference was statistically significant(P<0.05).[Conclusions]Methylprednisolone combined with addition and subtraction of Shenling Baizhu Powder could effectively reduce urinary protein,improve edema symptoms,shorten the course of hormone use and reduce adverse reactions in the treatment of PNS featuring damp abundance due to splenic asthenia.

Clinical observation of Shenling Baizhu Powder combined with triamcinolone acetonide in treating macular edema induced by retinal vein occlusion

Objective:to observe the clinical effica-cy of Shenling Baizhu Powder(SLBZP)combined with a subconjunctival injection of triamcinolone acetonide(TA)in treating macular edema(ME)induced by retinal vein occlusion(RVO).Method:there were 62 patients(62 eyes)with ME induced by RVO that were selected and divided into two groups in accordance with the ran-dom number table.Each group had 31 eyes.Group one,the control group,was treated with a single subconjunc-tival injection of TA;group two,the observation group,was treated with a single subconjunctival injection of TA(20 mg/0.5 mL)per eye and one month of SLBZP.To evaluate the clinical efficacy,both groups were checked(3×)with the best corrected-visual acuity(BCVA),cen-ter macular thickness(CMT),and intraocular pressure(IOP).The checks were before treatment,one month af-ter injection,and three months after injection.Results:there were 26 eyes(83.87%)in the observation group,and 17 eyes(54.84%)in the control group in which the BCVA was significantly improved.The ME obviously de-creased in 27 eyes(87.10%)the observation group and in 19 eyes(61.29%)the control group.The clinical effica-cy of the observation group was significantly better than that of the control group(P<0.05).Conclusion:as one method to treat ME induced by RVO,SLBZP combined with subconjunctival injection of TA is significantly more effective than a single subconjunctival injection of TA.Besides,the SLBZP had less side-effects.Based on the above,this method deserves in-depth research.

基于文献及计量学方法研究脾阴学说古今发展及参苓白术散滋补脾阴作用阐释

脾乃后天之本、气血生化之源,脾之阳气为脾脏功能的发挥提供了“动力”,而脾阴则提供了“物质基础”。脾阴学说成说较晚、论说较少,基于文献研究系统梳理了脾阴理论内涵及历史发展源流,认为“辅运化”“主滋养”和“和胃阳”是脾阴主要的生理功能;脾阴理论的发展主要经历了《黄帝内经》构建脏腑阴阳理论体系、《伤寒论》初识脾阴方证、“丹溪学派”首开滋阴法先河、缪希雍系统建立脾阴理论体系、吴澄引申“芳香甘平”治法5个历史时期。此外,通过文献计量学Citespace分析脾阴学说现代整体发展应用情况,对比古今常用11个滋补脾阴类中药复方发现:现代研究中对脾阴学说的认识主要传承自唐容川、叶天士、吴澄、李东垣、缪希雍、张锡纯几位医家;其理论主要应用在消渴(糖尿病)、泄泻、便秘、肉痿等疾病治疗中;用药偏以甘淡,兼顾养胃阴为特色;局方参苓白术散成方早,充分体现了“甘淡”补脾之滋补脾阴用药的基本法则,具有健脾气、滋脾阴、渗脾湿之功效,全方升降相因、散收并用、补行兼施,尤宜于脾气阴虚夹湿的患者,乃滋补脾阴理论应用的基础方。

参苓白术散调节肠道菌群-上皮细胞相互作用改善幼鼠腹泻

目的:探讨参苓白术散对于改善幼鼠腹泻模型及调节肠道菌群-上皮细胞相互作用机制。方法:通过灌胃大黄水煎液建立幼鼠腹泻模型,参苓白术散按照临床折算剂量设20.0、10.0和5.0g药材/kg剂量灌胃给药2周。试验期间每周测定体重变化;检测指标包括:血浆D乳酸、内毒素水平;结肠组织形态和黏液状态(PAS染色);紧密连接蛋白分子(ZO-1,Occludin和Claudin)的mRNA和蛋白表达水平;肠道菌群分析(选择性培养基)。结果:参苓白术散高、中剂量组在改善腹泻症状同时显著抑制体重减轻。参苓白术散高、中剂量组可下调模型组血清内毒素和D-乳酸水平。结肠组织PAS染色病理学结果显示,参苓白术散各剂量组可改善模型大鼠肠道绒毛损伤,同时恢复杯状细胞和黏液量。参苓白术散高剂量组Occludin和ZO-1表达高于模型组,Claudin表达略微增高。参苓白术散高、中剂量组可减少盲肠内容物中肠杆菌、肠球菌数量,并使双歧杆菌、乳杆菌的数量接近正常数量。结论:参苓白术散改善模型大鼠肠道菌群失调,同时上调肠道紧密连接蛋白表达,恢复肠道上皮细胞屏障,进而改善腹泻模型肠道症状。

基于网络药理学和药理学实验探讨参苓白术散治疗脾气虚作用机制

目的基于网络药理学研究参苓白术散治疗脾气虚的作用机制,并结合动物实验验证。方法基于PubMed、中国知网等数据库分析脾气虚的现代科学含义,并采用GeneCards、BATMAN-TCM等挖掘参苓白术散治疗脾气虚的相关靶点;再结合动物实验,对网络药理学分析结果进行验证。结果共检索出脾气虚相关疾病靶点440个,去重后共得到126个,筛选出核心靶点16个,如C反应蛋白(CRP)、白细胞介素-6(IL-6)、前列腺素内过氧化物合酶2(PTGS2)等;通过京都基因和基因组百科全书(KEGG)通路处理分析,发现71个交集靶点主要富集在20条相关信号通路上。ELISA试剂检测显示,大鼠血清靶蛋白CRP、IL-6、PTGS2浓度均显著下降。结论参苓白术散通过各种途径、靶点和信号通路,调节细胞增殖、分化和凋亡以及免疫系统等过程,达到治疗脾气虚疾病的效果。

参苓白术散联合EGFR-TKIs靶向治疗非小细胞肺癌临床观察

目的 参苓白术散联合人表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)靶向治疗非小细胞肺癌(NSCLC)的临床效果。方法 将患者随机分为对照组(29例)和联合组(30例)。对照组采用EGFR-TKIs靶向治疗,联合组在对照组基础上予口服参苓白术散。治疗9周,比较2组临床疗效、中医证候积分、免疫功能指标及不良反应发生率。结果 联合组临床疗效优于对照组(P<0.05)。治疗后,2组中医证候积分下降,联合组偏低(P<0.05);2组CD4^(+)、CD4^(+)/CD8^(+)比率升高,联合组偏高(P<0.05),CD8^(+)水平则降低,联合组偏低(P<0.05)。联合组不良反应总发生率低于对照组(P<0.05)。结论 参苓白术散联合EGFR-TKIs靶向治疗NSCLC疗效显著,可改善免疫功能,减轻不良反应。

基于免疫-炎症轴的化斑汤合参苓白术散预防放疗放射性肺损伤的临床效果

目的探讨化斑汤合参苓白术散对癌症放疗放射性肺损伤(RILI)的预防效果及对免疫-炎症轴的影响。方法将2021年1月—2023年1月收治的120例癌症放疗患者均分研究组和对照组。2组均持续放疗6周,放疗期间研究组予化斑汤合参苓白术散治疗,对照组予中药安慰剂治疗。比较2组放疗效果、RILI发生率,以及放疗前后血清炎性因子[白细胞介素-6(IL-6)、转化生长因子-β(TGF-β)、肿瘤坏死因子-α(TNF-α)],免疫指标(CD3+、CD4+、CD4+/CD8+)水平,肺功能指标[肺总量(TLC)、用力肺活量(FVC)],血浆外泌体miR-17-5p、miR-7-5p水平。结果研究组放疗总有效率[91.67%(55/60)]高于对照组[78.33%(47/60)],RILI发生率低于对照组(P<0.05);研究组放疗3周、6周后血清TNF-α、TGF-β、IL-6及血浆外泌体miR-17-5p、miR-7-5p水平低于对照组,CD3+、CD4+、CD4+/CD8+及TLC、FVC水平高于对照组(P<0.05)。结论化斑汤合参苓白术散对癌症放疗RILI有良好的预防效果,并可减轻炎症反应,改善免疫功能、肺功能,降低RILI发生率,其作用机制可能与抑制miR-17-5p、miR-7-5p表达有关。

参骨方对脾虚湿困型老年骨质疏松性骨折患者术后疗效影响研究

【目的】观察参骨方颗粒剂(以参苓白术散合四妙散为基础方进行加减)对脾虚湿困型老年骨质疏松性骨折患者术后疗效、中医证候、骨折愈合及骨密度的影响。【方法】将80例脾虚湿困型老年骨质疏松性骨折患者随机分为治疗组和对照组,每组各40例。对照组给予服用骨化三醇胶囊治疗,治疗组在对照组的基础上给予参骨方颗粒剂治疗,疗程均为8周。观察2组患者治疗前后中医证候积分、骨密度值及骨代谢指标的变化情况,并比较2组患者的骨折愈合时间及术后疗效。【结果】(1)疗效方面,治疗8周后,治疗组的总有效率为87.50%(35/40),对照组为67.50%(27/40),组间比较,治疗组的疗效明显优于对照组(P<0.05)。(2)中医证候积分方面,治疗后,2组患者的中医证候积分均较治疗前明显下降(P<0.01),且治疗组对中医证候积分的下降幅度明显优于对照组(P<0.01)。(3)骨代谢指标方面,治疗后,2组患者的血清骨钙素(OC)水平均较治疗前明显升高(P<0.05),血清Ⅰ型原胶原氨基端前肽(PINP)水平均较治疗前明显下降(P<0.05);而血清β-胶原交联羧基端肽(β-CTX)水平方面,治疗组患者较治疗前明显下降(P<0.05),对照组患者较治疗前有下降趋势,但差异无统计学意义(P>0.05);组间比较,治疗组对血清OC水平的升高幅度及对血清PINP、β-CTX水平的下降幅度均明显优于对照组(P<0.05)。(4)骨密度值方面,治疗后,2组患者的骨密度值均较治疗前明显升高(P<0.05),且治疗组对骨密度值的升高幅度明显优于对照组(P<0.05)。(5)骨折愈合时间方面,经过8周治疗后,治疗组患者的股骨骨折、桡骨骨折、胫骨骨折、肱骨骨折的骨折愈合时间均较对照组明显缩短(P<0.05)。【结论】参骨方颗粒剂可显著改善脾虚湿困型老年骨质疏松性骨折患者的术后临床症状和脾虚湿困症状,改善骨代谢,促进骨质疏松性骨折的愈合。

参苓白术散药味增减对溃疡性结肠炎模型小鼠的治疗效果

为了探寻参苓白术散药味增减对葡聚糖硫酸钠诱导的溃疡性结肠炎小鼠的治疗效果,试验将30只雌性C57BL/6小鼠(6~8周龄,体重为18~20 g)随机分成5组,分别为空白对照组、模型组及高、中、低剂量组,每组6只。第1周各组适应性饲养;第2周除空白对照组外,每组用3%葡聚糖硫酸钠水溶液自由饮水,连用7 d,建立急性溃疡性结肠炎模型;第3周更换正常饮水,空白对照组和模型组灌胃生理盐水,高、中、低剂量组按体重分别灌胃0.2,0.1,0.05 mL/10 g中药药液。观察并记录小鼠临床症状,采集全血分离血清,检测血清中免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、二胺氧化酶(DAO)、D-乳酸的质量浓度,同时制作小鼠结肠组织病理切片。结果表明:与空白对照组比较,模型组血清中IL-8、IgA、IgG、DAO、D-乳酸的质量浓度极显著升高(P<0.01),IL-10的质量浓度极显著降低(P<0.01);给药后,高、中、低剂量组小鼠的炎症均有不同程度缓解,IL-8、IgA、IgG、DAO、D-乳酸的质量浓度均有不同程度下降,IL-10的质量浓度上升。说明参苓白术散药味增减对葡聚糖硫酸钠诱导的溃疡性结肠炎有良好的治疗作用,在本试验条件下,按体重0.2 mL/10 g给药治疗效果最好。

参苓白术散加减治疗肺脾气虚津亏干燥综合征疗效及对Toll样受体4/核因子-κB水平的影响

目的探究参苓白术散加减治疗肺脾气虚津亏干燥综合征的疗效及对血清Toll样受体4(TLR4)和核因子-κB(NF-κB)水平的影响。方法选取2019年3月—2022年3月收治的107例干燥综合征患者为研究对象,采用信封法从密封箱子抽取带有数字的纸团,大于等于54的号码为观察组,小于54的号码为对照组。观察组54例,对照组53例。对照组给予硫酸羟氯喹片、甲泼尼龙片治疗,观察组在此基础上联合使用参苓白术散加减治疗。观察两组患者治疗前后中医证候评分、疾病活动指数(ESSDAI)和自我报告指数(ESSPRI)评分、γ-干扰素(IFN-γ)、白介素-17(IL-17)、免疫功能(CD_(8)^(+)、CD_(4)^(+)和CD^(+)_(4/)CD_(8)^(+))、血清TLR4和NF-κB水平。观察两组患者临床疗效。结果治疗前两组患者两目干涩、关节疼痛、口燥咽干、皮肤干燥、体倦乏力和唾液腺肿评分差异无统计学意义(P>0.05)。治疗后观察组两目干涩、关节疼痛、口燥咽干、皮肤干燥、体倦乏力和唾液腺肿评分显著低于对照组(P<0.05)。治疗前两组患者ESSDAI和ES⁃SPRI评分差异无统计学意义(P>0.05)。治疗后观察组ESSDAI和ESSPRI评分显著低于对照组(P<0.05)。治疗前两组患者IFN-γ、IL-17水平差异无统计学意义(P>0.05)。治疗后观察组IFN-γ、IL-17水平显著低于对照组(P<0.05)。两组患者治疗前CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD^(+)8水平差异无统计学意义(P>0.05)。治疗后观察组的CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平较对照组显著升高,而CD^(+)8水平较对照组显著降低(P<0.05)。两组患者治疗前TLR4/NF-κB水平差异无统计学意义(P>0.05)。治疗后观察组TLR4/NF-κB水平较对照组显著降低(P<0.05)。观察组总有效率为96.30%(52/54),显著高于对照组的84.91%(45/53)(χ^(2)=4.096,P=0.043)。结论参苓白术散加减能有效提高干燥综合征患者临床疗效、降低ESSDAI和ESSPRI评分、改善TLR4/NF-κB的水平,有利于提高患者免疫力。

参苓白术散对2型糖尿病Zucker大鼠甜味觉受体的影响

目的探讨参苓白术散对于2型糖尿病Zucker大鼠甜味觉受体相关蛋白的影响。方法SPF级5周龄的瘦型对照Lean Zucker(LZ)雄性大鼠4只作为对照组,将自发型2型糖尿病肥胖Zucker(Zucker Diabetic Fatty,ZDF)大鼠雄性大鼠16只,随机分为模型组,低、中、高剂量参苓白术散治疗组。低、中、高剂量参苓白术散治疗组分别给予生药浓度为6、12、24 g·kg-1·d-1。对照组和模型组每日予同中药给药剂量超纯水灌胃,连续灌胃给药28 d。定期测量大鼠的体质量、摄食量、随机血糖,实验末期进行口服葡萄糖耐量试验(Oral glucose tolerance test,OGTT)。运用蛋白质印迹(Western blot,WB)技术检测舌组织、空肠组织及回肠组织样本检测葡萄糖转运蛋白-2(Glucose transporter 2,GLUT2)以及甜味觉受体1型成员2和3(Taste receptor 2 and 3,T1R2、T1R3)、α-gustducin的蛋白表达。结果2型糖尿病模型组Zucker大鼠的体质量增长、随机血糖值、食物摄入量水平明显高于瘦型对照组,葡萄糖耐量显著低于瘦型对照组。经治疗后,参苓白术散3个剂量组均能不同程度降低2型糖尿病Zucker大鼠的血糖、体质量增长及食物摄入量,并改善2型糖尿病Zucker大鼠葡萄糖耐量。干预4周后,参苓白术散3个剂量组均可以使2型糖尿病Zucker大鼠舌、回肠、空肠的GLUT2、T1R2、T1R3、α-gustducin蛋白表达水平不同程度恢复。结论参苓白术散剂量依赖性地降低2型糖尿病Zucker大鼠血糖,其作用可能与调控舌和肠道甜味感知和葡萄糖代谢有关。

老年肌少症患者接受参苓白术散联合营养支持和运动干预的临床评价

目的探讨老年肌少症患者接受参苓白术散联合营养支持和运动干预的安全性、有效性和经济性,为临床合理用药提供参考。方法将237例老年肌少症患者随机分为观察组(118例)和对照组(119例)。2组患者均给予营养支持和运动干预;观察组患者在此基础上加用参苓白术散,每次6 g,每天3次;3个月后比较2种方案的安全性、有效性和经济性。结果2组患者均顺利完成随访。干预前,2组患者的骨骼肌质量指数(SMI)、握力和6 m步速比较,差异均无统计学意义(P>0.05)。干预后,观察组患者的握力显著大于对照组(25.05 kg vs.23.18 kg,P<0.01);肌少症治疗有效率、SMI和6 m步速虽高于或大于对照组,但差异均无统计学意义(P>0.05)。观察组患者的不良反应/事件发生率虽低于对照组(14.41%vs.16.81%),但差异无统计学意义(P=0.611)。与对照组方案相比,观察组方案的成本较高(981.25元vs.913.94元)、效果较好(有效率0.6186 vs.0.5630),增量-成本效果比为1210.61元。敏感性分析结果与成本-效果分析结果一致。结论老年肌少症患者接受参苓白术散联合营养支持和运动干预后,可显著增强握力,且不会提高不良反应/事件的发生率;与对照组方案相比较,观察组每增加1例肌少症治疗有效患者需多花费1210.61元。

朱智宇教授治疗脾虚气陷型混合痔的临证经验

痔作为肛肠疾病中的一种常见病、多发病,其主要症状为便血、便时肛门肿物脱出等,在临床上有不同的治疗方式,中药治疗也发挥着重要作用。朱智宇教授师从福建名老中医余天泰,从“脾虚湿阻,气虚下陷”角度上,以益气健脾渗湿为主要治疗方法,将补中益气汤合参苓白术散为主方治疗脾虚气陷型混合痔,取得不错的疗效,此文附上医案1则以佐证。

HPLC法测定参苓白术散中三种成分的含量

目的:建立参苓白术散中苍术酮、白术内酯Ⅰ和甘草苷的定量检测方法。方法:采用HPLC法,以C_(18)色谱柱(5μm,4.6 mm×250 mm),乙腈作为流动相A,测定了参苓白术散中苍术酮、白术内酯Ⅰ、甘草苷的含量。结果:苍术酮在0.0082~0.1308 mg/mL浓度范围内线性关系良好,平均加样回收率97.8%(RSD=0.7%,n=6);白术内酯Ⅰ在0.0016~0.0256 mg/mL浓度范围内线性关系良好,平均加样回收率103.4%(RSD=1.8%,n=6);甘草苷在0.0153~0.2444 mg/mL浓度范围内线性关系良好,平均加样回收率104.2%(RSD=0.5%,n=6)。结论:本研究成功建立了参苓白术散中苍术酮、白术内酯I和甘草苷的检测方法,且方法专属性强,精密度、重复性良好。

基于Meta和网络药理学分析参苓白术散治疗糖尿病肥胖的作用机制

目的:采用文献荟萃分析法(Meta)评估参苓白术散对糖尿病型肥胖的治疗作用,再结合网络药理学和动物实验方法分析参苓白术散治疗糖尿病肥胖的作用机制。方法:纳入国内外相关文献,以身体质量指数(BMI)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h PG)、空腹血糖(FBG)、胰岛素抵抗指数(Homa-IR)、腰臀比作为结局指标,评估参苓白术散对糖尿病型肥胖的治疗作用。从GEO数据库中下载糖尿病肥胖的相关基因,在中药系统药理学数据库与分析平台(TCMSP)、中医药综合数据库(TCMID)和中药分子机制生物信息学分析工具(BATMAN-TCM)中下载参苓白术散的作用靶点,对两者的交集靶点进行蛋白质-蛋白质相互作用分析,再根据拓扑分析筛选出核心靶点蛋白质;制备糖尿病肥胖小鼠的模型,分组后进行参苓白术散的灌胃治疗,2周后测量各组小鼠体质量、血糖、Lee's指数,采用苏木精-伊红(HE)染色法分析各组小鼠的脂肪细胞体积变化,测量小鼠血清中的胆固醇、三酰甘油及核心靶点蛋白质的浓度。结果:共纳入9篇文献,数据完整,未发现发表偏倚,评估为low risk。患者服用参苓白术散后,BMI、HbA1c、2 h PG、Homa-IR和腰臀比均得到明显改善;参苓白术散-糖尿病肥胖的交集靶点共59个,核心靶点为载脂蛋白E(APO-E)、胰岛素生长因子-1(IGF-1)、纤溶酶原激活物抑制物-1(PAI-1),参苓白术散主要通过影响细胞对油酸的反应(GO:0071400)、转化生长因子β1生产的正调控(GO:0032914)和纤溶酶原激活的负调控(GO:0010757)等生物学功能,影响不饱和脂肪酸的生物合成(hsa01040)、脂肪酸代谢(hsa01212)等信号通路来治疗糖尿病肥胖;动物实验结果表明,经过参苓白术散灌胃治疗后的小鼠血糖变化不显著,体质量和Lee's指数呈现明显下降趋势,脂肪细胞直径明显缩小,胆固醇、三酰甘油浓度及APO-E、IGF-1、PAI-1水平均呈现下调趋势。结论:结合Meta分析和动物实验的结果,参苓白术散对糖尿病肥胖具有明显的治疗作用,其作用机制可能与影响不饱和脂肪酸、脂肪酸的合成,减少糖和脂肪的转化,纠正机体能量代谢失衡,调控自噬促进脂肪组织的分解有关。

参苓白术散联合运动干预对糖尿病合并肌少症患者的效果评价

目的探讨给予老年2型糖尿病(T2DM)合并肌少症患者参苓白术散联合运动干预的有效性、安全性和经济性。方法140例老年T2DM合并肌少症患者随机分为对照组和干预组,每组70例。对照组给予常规诊疗方案,干预组在常规诊疗方案基础上增加参苓白术散联合运动干预,2组患者均干预3个月,比较两种方案的有效性、经济性和安全性。结果2组患者均顺利完成了随访,干预前,2组基线比较差异无统计学意义(P<0.05)。干预后,干预组糖化血红蛋白低于对照组(t=2.279,P=0.024);握力高于对照组(t=-2.205,P=0.029);6 m步速高于对照组(t=-2.638,P=0.009);随访周期内,干预组未发生运动损伤,药品不良反应发生率低于对照组(χ^(2)=0.061,P=0.805),骨折发生率低于对照组(χ^(2)=2.786,P=0.095),跌倒发生率低于对照组(χ^(2)=5.079,P=0.024);干预组成本低于对照组,效果优于对照组,为绝对优势方案,敏感性分析与成本效果分析结果一致。结论给予老年T2DM合并肌少症患者参苓白术散联合运动干预安全性较好,可降低糖化血红蛋白、提高握力和6 m步速,降低跌倒不良事件发生率;与常规诊疗方案相比,成本低、效果好,具有经济性。