Discussion on the Prevention and Treatment of COVID-19 Causing Lung Disease and Heart Damage Based on Lei Zhongyi's Theory of Intermingled Phlegm,Blood Stasis and Toxin

Novel coronavirus infection not only damages lung function,but also causes myocardial injury,elevated myocardial enzymes and heart failure,especially for patients with basic heart diseases who develop COVID-19,the first consideration should be the protection of cardiac function.Based on the theory of intermingled phlegm,blood stasis and toxin of heart disease put forward by Master Lei Zhongyi,the dialectical treatment thinking of COVID-19 patients from the concept of damage of phlegm,blood stasis and toxin to the heart were discussed.During the diagnosis,critical stage and recovery period of COVID-19,expectorant and blood-activating agents,heat and detoxification agents can be added to promote lung and asthma,free Bizheng and remove blood stasis,calm the heart and calm the mind,and promote the recovery of cardiopulmonary functions.

Effect of programmed cell death factor 4 on the severity of coronary heart disease and coronary artery disease with blood stasis and toxin

Objective:To explore the diagnostic value of PDCD4 on the degree of arterial stenosis in"blood stasis"coronary heart disease.Methods:Select 80 patients with coronary heart disease in the Second Cardiovascular Zone of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine in April 2020,and divide them into the"phlegm toxin"group(n=40)and the"phlegm stasis"group(n=40)based on the dialectics of traditional Chinese medicine.).Record the gender,age,smoking,and alcohol consumption of the subjects between the two groups,and detect their white blood cell count,neutrophil count,platelet count,platelet volume,platelet distribution width,blood creatinine,uric acid,cystatin,and fibrin The expression levels of original,high-sensitivity C-reactive protein,D-dimer,total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,apolipoprotein a,apolipoprotein b,and PDCD4.Multivariate logistic regression analysis was used to screen out the risk factors that affect coronary plaque formation,and the receiver operating characteristic(ROC)curve of each index was established to evaluate the severity of coronary stenosis in patients with stasis coronary heart disease by each index and combined index Diagnostic efficiency.Results:The two groups of patients were tested in terms of gender,age,smoking,drinking,triglycerides,cholesterol,high-density lipoprotein,low-density lipoprotein,apolipoprotein-a,apolipoprotein-b,white blood cell count,neutrophil The cell count,platelet count,platelet volume width and platelet distribution width were not statistically significant(P>0.05);the expression levels of hypersensitivity-C-reactive protein,serum creatinine,cystatin,uric acid and PDCD4 were statistically significant between the two groups Difference(P<0.05),and the corresponding hypersensitivity-C-reactive protein,creatinine,cystatin,uric acid and PDCD4 expression levels in the blood stasis group were higher than those in the phlegm blood stasis group.After multivariate logistic regression analysis,the level of PDCD4 in peripheral blood[OR=31.088,95%CI(2.498,3.869)]was an independent influencing factor of the"stagnation"type of coronary heart disease,and PDCD4 was diagnosed as the"stagnation"type of coronary heart disease The area under the ROC curve(AUC)is 88.6%,95%CI(1.894,2.532)(P=0.29);the level of PDCD4 in peripheral blood is positively correlated with the number and severity of coronary artery disease,the number of coronary artery disease and stenosis The greater the degree,the higher the detection value of PDCD4,(P<0.05).Conclusion:The expression level of PDCD4 in peripheral blood is closely related to the subtype of"stasis toxin"and the severity of coronary vascular stenosis.It can be used as a quantitative diagnostic index for the diagnosis of"stasis toxin"coronary heart disease and the severity of coronary vascular stenosis.

Pathological Mechanism of “Phlegm, Blood stasis, Toxin ”in a Rabbit Model of Carotid Atherosclerosis Based on Gut Microbiota-host Metabolism Interactions

Background:In Traditional Chinese Medicine(TCM)theory,"phlegm,blood stasis and toxin"are the pathogenesis of carotid atherosclerosis(CAS).The rabbit carotid atherosclerosis(CAS),which is induced by high-cholesterol diet combined with carotid artery balloon injury,is a classic model for studying CAS.Many studies indicate that gut microbiota and host metabolic disorders are involved in the pathogenesis of rabbit CAS.However,the TCM pathological features and syndromes of this classic rabbit CAS model have not been reported.Objective:To explore the pathogenesis of the rabbit CAS model and its TCM syndrome types from the perspective of"phlegm,blood stasis,and toxin".Methods:Twelve male New Zealand white rabbits were randomly divided into NC group and CAS group according to their body weight,followed by feeding of basic feed and a 1%high cholesterol diet,respectively.After two weeks,the rabbits in the CAS group underwent common carotid artery(CCA)balloon injury,while the rabbits in the NC group underwent only CCA separation without balloon injury.The two groups received differential feed postoperatively for six more weeks,after which,changes in lipids,hemorheology,inflammation,oxidative stress,and CAS phenotypes were analyzed.In addition,the colon contents and serum were collected for 16S rRNA sequencing and ^(1)H-NMR metabonomic analysis.Results:The CAS rabbits were observed to form noticeable abnormalities in lipid metabolism and blood rhe-ology,a sharp increase in oxidative stress levels,excessive release of inflammatory factors and apparent CAS plaque formation.Furthermore,10 specific gut microbiota(such as Akkermansia muciniphila,Barnesiellaceae and Faecalibacterium)and 14 characteristic metabolites(such as trimethylamine oxide,acetic acid and L-carnitine)were identified in the CAS rabbits,which were significantly related to the CAS phenotypes.The pathway func-tion analysis showed that the gut microbiota and its metabolites mainly affected cholesterol metabolism,energy metabolism,inflammation and oxidative stress.Conclusion:The rabbit CAS model conforms to the“phlegm,blood stasis and toxin damage”theory.The gut microbiota and host metabolic disorders of the CAS rabbits interact and promote internal and external toxins,aggravating the progression of CAS.Our study provided experimental evidence for the application of this model in the TCM-based research of CAS.

Clinical Experience in the Treatment of Vitiligo by the Method of Invigorating Qi,Promoting Blood Circulation and Detoxification

Studies have shown that traditional Chinese medicines have clear curative effects in the treatment of vitiligo with few side effects.Through literature research and clinical observation,the study summarized the etiology and pathogenesis of vitiligo in traditional Chinese medicine as"deficiency,toxin,and stasis",formulated the method of invigorating qi,promoting blood circulation and detoxification,and prescribed Fuse Hexue Jiawei Decoction for the treatment of vitiligo.

Related factors of coronary no-reflow phenomenon and progress of traditional Chinese medicine treatment

Coronary no-reflow phenomenon belongs to a type of coronary microcirculation disturbance,and its main pathogenic factors are vascular endothelial cell injury,microembolism and inflammatory reaction,which are corresponding to the pathogenesis of choroid injury,blood stasis and heat toxin in traditional Chinese medicine,such as NO,ET-1,chemokine,IL and other cytokines.The degree of improvement of patients'symptoms and laboratory examination data provide a basis for traditional Chinese medicine compound prescription,monomer and traditional Chinese medicine characteristic therapy for the treatment of no-reflow phenomena(NRP).Combined with related factors,the author summarizes the research progress of traditional Chinese medicine treatment of NRP in recent years,in order to provide clinical reference.

从虚瘀毒辨治脓毒症急性肾损伤

脓毒症急性肾损伤,病位主要在肾,涉及心肺肝脾和膀胱、三焦等脏腑,以脏腑虚损、瘀毒互结为基本病机,虚、瘀、毒三者相互转化,据此确立了补虚化瘀解毒治疗原则,临床多采用炎调方加减,收效甚佳。附验案一则。

江泳教授病证结合分人分型分期辨治带状疱疹

带状疱疹以剧烈疼痛为其特点,严重影响患者生活。西医治疗虽起效较快但使疼痛降低至初始程度一半时较易产生不良反应,且在预防及控制其并发症方面效果不佳。江泳教授以病为纲,认为带状疱疹以肝络血虚,热毒湿浊瘀滞肝络为其共性核心病机,结合患者不同证型的个性病机进行分型论治。江教授以“柔肝泻火,解毒除湿,通络止痛”为基本治则,创制“泻毒通络”方为基础验方,分人分型分期加减治疗带状疱疹,她认为病证结合辨治带状疱疹,可以最大化地优化临床疗效,更能发挥中医特色优势。

血栓弹力图在肛痈患者中的临床意义及病机探讨

目的以血栓弹力图(TEG)作为客观化指标,探讨“瘀毒互结”病机在肛痈患者中的意义。方法收集2022年3—10月临沂市中医医院肛肠科肛痈及混合痔患者各100例,随机分为观察组和对照组,均进行血栓弹力图检测,计算R值、K值、MA值和Angle值,对比两组R值、K值、α角、Ma值和CI值,针对灵敏度绘制ROC图及ROC曲线,并计算曲线下面积(AUC)。结果血栓弹力图(TEG)各参数比较显示:观察组的R值、K值明显小于对照组,MA值、α角和CI明显大于对照组,均提示高凝状态;ROC曲线结果及AUC显示,R值、K值的诊断效能较高;α角、MA、CI具有一定的诊断效能。结论TEG可为肛痈的因毒致瘀病机提供客观依据,并可由此针对性制订治则治法。

Study on the Tongue Manifestations for the Blood-Stasis and Toxin Syndrome in the Stable Patients of Coronary Heart Disease

Objective： To explore the tongue manifestations for the blood-stasis and toxin syndrome in the stable patients of coronary heart disease （CHD） according to the acute cardiovascular events （ACEs） in one-year follow-up which based on the pathogenesis hypothesis of ＂blood-stasis and toxin causing catastrophe＂. Methods： Totally 254 stable CHD cases were enrolled after diagnosed by coronary angiography, their tongue appearances were recorded by the digital camera of uniform type, 29 cases with ACEs during one-year follow-up were assigned in ACEs group. The non-ACEs were matched in proportion of 2：1 according to the gender, age （± 2.5 years）, diabetes mellitus history and previous acute coronary syndrome hospitalization history in the non-ACEs group, and 54 cases were eligibly included. The differences of tongue appearance between the ACEs and non-ACEs group were compared. Results： Fifteen cases manifested with bluish tongue （including bluish-grounding or bluish purple tongue）, among which 11 cases （37.9%） in the ACEs group and four cases （7.4%） in the non-ACEs group, and there was significant difference （P〈0.002）. Twenty six cases showed yellow tongue coating in the non-ACEs group, which was significantly higher than that in the ACEs group （48.1 vs. 10.3%, P=0.001）. The tongue of sticky greasy coating was more frequently occurred in the non-ACEs group than that in the ACEs group （66.7% vs. 41.4%, P=0.026）. The proportion of purplish-red sublingual vessel was higher in the ACEs group than that in the non-ACEs group （41.4% vs. 20.4%, P=0.041）. Odd ratio （OR） analysis showed that the patients with bluish tongue, purplish-red sublingual vessel, dry-greasy or dirty greasy coating were more likely to experience ACEs during one- year follow-up （OR： 11.67, 95%CI： 3.34-40.81, P〈0.001; OR： 2.76, 95%CI： 1.02-7.44, P〈0.05; OR： 3.12, 95%, CI： 0.89-10.92, P=0.066）. Conclusions： The bluish tongue （including bluish-grounding or bluish purple tongue） and purplish-red sublingual vessel were potential tongue manifestations of blood-stasis and toxin. The tongue coating changing from sticky greasy to dry greasy or dirty greasy was also probably a tongue manifestation of ＂transforming toxin＂, which need demonstration by further study.

从“瘀毒”论治消渴肾病机制探析

糖尿病肾脏疾病归属于中医“消渴肾病”范畴,是消渴日久不愈所并发的疑难病症。本文通过对“瘀毒”理论分析以及对消渴肾病的发病机制探讨,认为“瘀毒”与消渴肾病关系密切,“瘀毒损伤肾络”是消渴肾病发生发展的主要病机。基于此,本文提出了消渴肾病“解毒化瘀通络”的治疗原则,并根据消渴肾病“本虚标实”的病性,祛邪不忘扶正,攻补兼施,辨证施治。同时附验案一则以佐证,以期为消渴肾病的中医治疗提供一定的借鉴。

气血瘀滞型非小细胞肺癌患者“瘀毒”病机临床特征及补肺化瘀汤辅助治疗干预机制

【目的】探讨气血瘀滞型非小细胞肺癌(non-small cell lung cancer,NSCLC)患者“瘀毒”病机的临床特征以及补肺化瘀汤辅助治疗的干预机制。【方法】选取六安市中医院呼吸内科2021年1月至2022年9月收治的78例气血瘀滞型NSCLC患者作为NSCLC组,另选取71例同期健康体检志愿者为健康对照组,观察NSCLC组“瘀毒”病机的临床特征,比较2组凝血功能指标的差异。根据治疗方式的不同将NSCLC组患者分为补肺化瘀组40例和常规治疗组38例,常规治疗组采用常规化疗方案治疗,补肺化瘀组在常规治疗组的基础上加用补肺化瘀汤治疗,以3周为1个疗程,共治疗2个疗程。观察2组患者治疗前后中医证候积分、生活质量Karnofsky功能状态(KPS)评分、凝血功能、免疫功能、血清一氧化氮(NO)、血管内皮生长因子(VEGF)水平的变化情况,比较2组患者的临床疗效和治疗期间不良反应发生情况。【结果】(1)临床特征方面,NSCLC组患者临床分期为Ⅲ、Ⅳ期,病理类型为鳞癌、腺癌,KPS评分低于70分患者比例较高,中医证候积分较高,提示NSCLC患者病情较为严重;与健康对照组相比,NSCLC组患者的凝血酶原时间(PT)、凝血酶时间(TT)明显缩短,纤维蛋白原(FIB)、D-二聚体(D-D)水平明显升高,差异均有统计学意义(P<0.01)。(2)疗效方面,治疗6周后,补肺化瘀组的总有效率和总稳定率分别为32.50%(13/40)、85.00%(34/40),明显优于常规治疗组的13.16%(5/38)、60.53%(23/38),差异均有统计学意义(P<0.05)。(3)证候积分方面,治疗3周后,补肺化瘀组的各项中医证候积分(包括神疲乏力、胸闷气短、胸部刺痛、脉络瘀血等)和常规治疗组的神疲乏力、胸闷气短积分均较治疗前改善(P<0.05);治疗6周后,2组NSCLC患者的各项中医证候积分均较治疗前和治疗3周后改善(P<0.05);组间比较,除治疗3周后的胸闷气短外,补肺化瘀组在治疗3周和6周后对各项中医证候积分的改善作用均明显优于常规治疗组(P<0.05或P<0.01)。(4)凝血功能方面,治疗6周后,补肺化瘀组的PT、TT、FIB、D-D水平均较治疗前明显改善(P<0.05),而常规治疗组仅FIB、D-D水平较治疗前改善(P<0.05);组间比较,补肺化瘀组对PT、FIB、D-D水平的改善作用均明显优于常规治疗组(P<0.05)。(5)血清NO、VEGF水平方面,治疗6周后,2组患者的血清NO、VEGF水平均较治疗前明显降低(P<0.05),且补肺化瘀组的降低作用均明显优于常规治疗组(P<0.01)。(6)免疫功能方面,治疗6周后,补肺化瘀组的T细胞亚群CD3^(+)、CD4^(+)水平和CD4^(+)/CD8^(+)比值较治疗前升高(P<0.05)、CD8^(+)水平较治疗前降低(P<0.05),而常规治疗组的CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)比值较治疗前降低(P<0.05)、CD8^(+)水平较治疗前升高(P<0.05);组间比较,补肺化瘀组对CD3^(+)、CD4^(+)水平和CD4^(+)/CD8^(+)比值的升高作用及对CD8^(+)水平的降低作用均明显优于常规治疗组(P<0.01)。(7)生活质量方面,治疗6周后,2组患者的KPS评分均较治疗前明显升高(P<0.05),且补肺化瘀组的升高作用明显优于常规治疗组(P<0.01)。(8)不良反应方面,治疗过程中,2组患者的胃肠道反应、脱发的发生率比较,差异无统计学意义(P>0.05),而补肺化瘀组的肝肾功能损伤、骨髓抑制、口腔黏膜毒性的不良反应发生率均明显低于常规治疗组(P<0.05或P<0.01),表明补肺化瘀汤可一定程度上降低化疗所引起的不良反应。【结论】气血瘀滞型NSCLC患者普遍病情进展程度深,血液凝滞性高,契合中医“瘀毒”病机;针对“瘀毒”病机使用补肺化瘀汤治疗可明显改善患者中医证候积分和凝血功能,下调血清NO、VEGF水平,改善患者免疫功能,可提高患者临床疗效及生活质量,减少化疗所带来的不良反应,具有较高的安全性。

基于肿瘤相关巨噬细胞糖代谢重编程探讨胃癌“脾虚瘀毒”病机理论科学内涵

胃癌“脾虚瘀毒”病机理论认为,脾为气血生化之源,脾虚为致病内在依据,亦是胃癌病机根本,贯穿始终,瘀毒于脾虚基础上渐生,为重要病理因素。在胃癌病变过程中,肿瘤细胞与肿瘤微环境中多种代谢物质,以糖代谢重编程为主发生代谢改变,重构肿瘤相关巨噬细胞表型及功能,该过程与“脾虚瘀毒”病机理论相契合。本文聚焦肿瘤微环境糖代谢重编程驱动肿瘤相关巨噬细胞表型重塑,探讨胃癌“脾虚瘀毒”病机理论科学内涵,为中医药治疗胃癌的理论及临床研究提供参考。

国医大师南征教授从“瘀毒”论治消渴肾衰用药经验

国医大师南征教授提出消渴肾衰核心病机为毒损肾络、邪伏膜原。消渴肾衰之毒繁杂,风、热、水、湿、痰、瘀诸邪内外相引蕴结于肾,皆能积而化毒。然瘀毒者,久病多瘀,瘀久成毒,审毒治瘀,当以“解毒通络保肾,活血化瘀导邪”为大法。根据瘀毒所在部位与性质,总结为“痰瘀上犯者,当复其宣肃”“湿瘀困中者,当调其升降”“浊瘀下注者,当引而竭之”“气滞血瘀者,当行气化瘀”“瘀从寒化者,当温阳化瘀”“瘀与热合者,当清热化瘀”“气虚血瘀者,当补气活血”,故消渴肾衰之瘀毒应辨证求因,审因论治,治病求本。文章总结南征教授治疗消渴肾衰夹瘀毒的用药经验,供读者参考。

骨髓增生异常综合征中医证型与遗传学及预后的相关性研究

目的:探讨骨髓增生异常综合征(MDS)患者中医证型与分子生物学、细胞遗传学及预后的相关性。方法:采用非参数秩和检验或卡方检验的统计学方法,回顾性分析85例初诊MDS患者的中医证型、外周血指标、疾病分型、分子生物学情况、细胞遗传学情况、预后情况,并探讨中医证型与其后几项之间的相关性。结果:85例MDS患者的中医证型以气阴两虚、毒瘀阻滞证为主,其次为脾肾两虚、毒瘀阻滞证和邪热炽盛、毒瘀阻滞证。邪热炽盛、毒瘀阻滞证患者的中性粒细胞绝对值(ANC)水平显著低于脾肾两虚、毒瘀阻滞证患者(P<0.01),气阴两虚、毒瘀阻滞证患者的血红蛋白(HGB)水平显著低于脾肾两虚、毒瘀阻滞证患者(P<0.001)。3组证型间疾病分型分布比较,差异有统计学意义(P<0.05);邪热炽盛、毒瘀阻滞证患者的疾病分型全为原始细胞增多型(EB型)。3组证型间转录调节因子1(ASXL1)基因突变率、染色质重塑和转录调控基因功能组突变率、3种预后系统积分比较,差异有统计学意义(P<0.05),邪热炽盛、毒瘀阻滞证组转录调控基因功能组突变率和3种预后系统积分均高于其他两组(P<0.05)。在3个预后积分系统的较高危组中,邪热炽盛、毒瘀阻滞证患者占比均高于其他两种证型。结论:MDS病机以虚为本,临床患者以虚实夹杂证多见;邪热炽盛、毒瘀阻滞证预后较差,推测其机制可能与ASXL1基因突变、7号染色体的完全丢失和其长臂的部分缺失(-7/7q-)等遗传学情况相关。

癌性发热病因病机及论治的研究进展

基于大量中西医文献研究,癌性发热为恶性肿瘤发生发展及治疗过程中癌组织本身释放的多种病理因子所致的非感染性发热,病情演变与肿瘤的消长相关,控癌是治疗的关键。中医病机为郁、虚、毒、瘀等或交织为病,郁多为气郁、湿郁,前者治以调畅肝气、清热泻火;后者结合虚实清热利湿、通腑泻浊或健脾升阳、化浊除湿。因虚发热,以气虚、阴虚或气阴两虚多见,治以甘温除热、滋阴清热、益气养阴。正虚内生癌毒,侵袭流注、耗伤正气,湿、瘀互结成痰形成实质肿块,脏腑功能失调蒸酿而成痰毒,毒邪内蕴,耗气伤血损津,“毒”既是致病因素也是病理产物。手术、化放疗、靶向及免疫治疗的不良反应以“外邪”与癌毒相裹挟,加重毒聚之势,耗正气伤精血,治以清热解毒、扶正祛邪。瘀分虚实,实则气血瘀滞于经脉化热,治以活血祛瘀清热;虚则阴血亏虚,瘀滞经脉,治以养阴化瘀退热。基于病机辨证也可辅以针刺、中药穴位贴敷等疗法,控制热势后要着眼于癌病本身以防病复。

基于“虚损瘀毒”探讨阿尔茨海默病的病机与治疗

阿尔茨海默病(Alzheimer's disease,AD)是老年期痴呆最常见的一种类型,表现为多个认知领域的进行性衰退。课题组提出虚损是AD发生发展的基础,因虚致瘀、因瘀化毒、毒损脑络是AD病情进展和恶化的关键。针对AD“虚损瘀毒”的核心病机演变特点,临床以补虚益智、活血解毒为主要治法,为中医学治疗AD提供理论基础和实践指导。

刘丽坤教授从“伏毒-络病”角度分期辨治紫杉醇诱导的周围神经病变

周围神经病变是紫杉醇药用后常见的不良反应,其症状缠绵难愈且容易复发。结合其临床表现,刘丽坤教授从中医学的“伏毒-络病”角度进行论治,认为药毒损络致络脉失和是核心病机,毒、瘀、虚是其发生、发展的内在病理因素。治疗上根据络病传变规律和不同阶段的伏毒病机特点分期辨治:急性发作期通达气络,调和营卫;慢性难愈期通阳化瘀,益气解毒;渐进肌痿期填益骨络,扶阳托毒,临床疗效明显。

吴伟基于“瘀毒致悸”辨治房颤思路探讨

吴伟教授在辨治房颤过程中,创新性地提出“心-血-脉三位一体论”与“瘀毒致悸”论。认为房颤由瘀毒所致,其病位在心-血-脉,核心病机为“气滞血瘀毒成”。治法当紧扣病机,提倡“从瘀论治,兼以解毒,缓消其毒”,且认为理气活血化瘀便是解毒。方拟桃仁红花煎加减,主要组成药物有桃仁、红花、川芎、延胡索、生地黄、赤芍、丹参、大枣、葛根、甘松、牡蛎、茯苓、玉竹等,并根据岭南之气候与房颤多影响情志之特点,去方中辛烈之品,而加特色解毒药对葛根-甘松以辨病而治。吴伟教授治疗房颤还常配合沐足、针灸、导引等中医外治法和保健法,全面调理,缓消其毒,以复其元。吴伟教授治疗房颤采用中医药精准干预,综合调理,可达到促进症状消失及恢复窦性心律、改善体质等目的,其辨治思路可为房颤的中医药治疗提供参考。

基于“因病致郁”与“因郁致病”探讨胃癌伴抑郁状态的诊疗思路

[目的]从中医“因病致郁”和“因郁致病”角度论述胃癌伴抑郁状态的产生和加重,以期为其中医治疗提供理论支撑。[方法]通过查阅中医古籍和现代文献资料,搜集部分医家关于胃癌“因病致郁”和“因郁致病”理论的学术观点,并结合临床实践经验总结,探讨胃癌伴抑郁状态的诊疗。[结果]胃癌伴抑郁状态的病因病机可归纳为以下方面:中气失运,升降乖戾为其根;瘀毒胶结,七情失常为其本;瘤结局部,毒溢血脉,病郁交夹为其标,据此胃癌伴抑郁状态的治疗应斡旋中气,畅脾胃之气化;调气开郁,调人体之升降出入;化瘀解毒,通人体之气血津液;形神同调,复人体五脏之元真。[结论]瘀、毒、郁均是影响胃癌伴抑郁状态发生、发展与转归的重要病理因素,这三个因素常常互相影响,互为因果。从“因郁致病”和“因病致郁”的角度对胃癌伴抑郁状态进行探讨,不仅有助于完善胃癌伴抑郁状态的病因病机理论,也有助于为其临床治疗提供理论参考。

急性缺血性脑卒中瘀毒互结证大鼠模型“脑-脾炎症耦联”机制探讨

目的探讨急性缺血性脑卒中瘀毒互结证大鼠模型脑损伤与脾损害的相关性,分析对MCP-1/CCR2趋化因子信号轴的影响。方法40只雄性SD大鼠随机分为假手术组(sham)、角叉菜胶联合干酵母菌瘀毒互结证(Carrageenan/Yeast,CA/Y)组(单纯证候组)、大脑中动脉阻塞(middle cerebral artery occlusion,MCAO)组(单纯疾病组)、大脑中动脉阻塞瘀毒互结证(MCAO+CA/Y)组(病证结合组),每组10只。CA/Y组与MCAO+CA/Y组于造模首日经腹腔注射角叉菜胶10 mg/kg、第2日背部皮下注射干酵母悬液2 mg/kg,MCAO组及MCAO+CA/Y组于第2日采用线栓法建立大脑中动脉阻塞模型。脑梗死模型术后24 h,对各组大鼠进行神经功能缺损评分,采用TTC染色法观察脑梗死面积百分比,取脾测定脾重量,采用Spearman相关系数分析脑梗死面积百分比与脾重量的相关性,苏木素-伊红(HE)染色法观察脑组织及脾组织病理形态,酶联免疫吸附实验(ELISA)检测大鼠血浆中单核细胞趋化蛋白-1(monocyte chemotactic protein 1,MCP-1)、干扰素-γ(interferon-γ,IFN-γ)含量,Western blot法检测缺血侧脑组织趋化因子C-C-基元受体2(chemokine C-C-motif receptor 2,CCR2)蛋白表达。结果与sham组比较,MCAO组和MCAO+CA/Y组的神经功能缺损评分、脑梗死面积、血浆中MCP-1与IFN-γ含量均显著升高(P<0.01),脾重量显著下降(P<0.01),脑组织中CCR2蛋白表达明显上调(P<0.05);与CA/Y组比较,MCAO组和MCAO+CA/Y组的神经功能缺损评分、脑梗死面积显著升高(P<0.01),脾重量显著下降(P<0.01),脑组织和脾组织中CCR2蛋白表达均明显上调(P<0.05);与MCAO组比较,MCAO+CA/Y组的脑梗死面积显著升高(P<0.01),脾重量明显下降(P<0.05)。Spearman相关分析显示,脾重量与脑梗死面积百分比呈负相关(P<0.01,r=-0.9711)。病理形态学观察结果显示,MCAO+CA/Y组病理改变最为严重,脑组织皮层中可见大脑液化坏死灶,病灶中神经元细胞排列稀疏、紊乱,体积萎缩,少部分空泡化和核固缩,大部分神经元细胞红色变性、坏死,小胶质细胞增生明显,小血管明显增多,间质脂质变性;脾组织部分动脉周围淋巴鞘细胞密度减低,边缘区增宽。结论急性缺血性脑卒中瘀毒互结证大鼠模型脑损伤与脾损害存在相关性,可能与MCP-1/CCR2趋化因子信号轴参与“脑-脾炎症耦联”机制有关。