Intra-set correlation analysis of medical records of thyroid cancer treated by traditional Chinese medicine Master ZHOU Zhongying

Objective Based on intra-set correlation analysis, this paper deconstructs the clinical medical records of traditional Chinese medicine(TCM) Master ZHOU Zhongying in treating thyroid cancer, and analyzes the experience in “mechanism-syndrome-medicine-prescription” for thyroid cancer.Methods Through Medcase data processing platform, based on Frequent Pattern(FP)-Growth enhanced correlation analysis algorithm, the medical records of Professor ZHOU Zhongying for the treatment of thyroid cancer from June 1, 2001 to February 28, 2015 were analyzed within the set.Results This study involved 43 medical records, 43 patients, and 167 visits. After processing intra-set correlations, 28 groups of highly correlated symptoms, 21 groups of highly correlated tongue images, 10 groups of highly correlated pulse conditions, 28 groups of highly correlated pathogenesis, 34 groups of highly correlated herbs, and 26 groups of highly correlated western medicine diagnosis were selected. Professor ZHOU Zhongying treats thyroid cancer according to syndrome differentiation. Symptoms with more association rules included neck swelling, neck pain, cough, and dry mouth;tongue images with more association rules included dark purple tongue, dark red tongue, and fissured tongue;pulse conditions with more association rules were wiry pulse, thready pulse, small pulse, and slippery pulse;the pathogenesis with more association rules was phlegm and blood stasis, damp-heat accumulation,and impairment of both Qi and Yin;herbs with more association rules were Chaihu(Bupleuri Radix), Zeqi(Sun Euphoribiae Herb), and Tiandong(Asparagi Radix);western medicine diagnosis with more association rules included thyroid cancer, insomnia, and chronic gastritis.Conclusion Thyroid cancer mostly presents as deficiency in origin and excess in manifestations. The basic pathogenesis is phlegm and blood stasis, damp-heat accumulation, and impairment of both Qi and Yin, which are closely related to liver, kidney, and spleen. Professor ZHOU Zhongying adopts both attack and supplement approaches as the general treatment principle, with a strong emphasis on regulating Qi and relieving depression, eliminating phlegm and resolving stagnation, eliminating dampness and turbidity, clearing fire and destroying poison, moistening dryness and softening hard mass, invigorating Qi and nourishing Yin, and paying attention to nourishing liver and kidney, invigorating spleen and stomach,while protecting the heart and lungs.

The effect of traditional Chinese medicine──Tian Gui Recipeon obesity and anovulation in androgen-sterilized rats

Objective: A traditional Chinese medicine Tian Gui Recipe (TGR) has been used to effectively treat clomiphene resistant anovulatory disease and obesity, especially in polycystic ovary syndrome (PCOS) cases with hyperinsulinemia. The effect of TGR on obesity and anovulation was investigated in androgen-sterilized rats (ASR). Methods: Female SD rats at the age of 9 days were divided into 3 groups. Group ASR (n=15): anovulation was demonstrated at the age of 70 days by vaginal smear in rats while 1. 25 mg of testosterone propionate was injected subcutaneously on its 9th neonatal day. Group A+H (n = 25): TGR were administered to ASR at the age of 80 days for 3 weeks. Rats with regular estrous cycle and ovulation after herbal treatment were included in this group. Group C (n = 15): normal ovulated rats were recruited. Around the age of 112 days or on proestrous day, all rats were sacrificed under anesthesia. Serum leptin, testosterone (T), estrogen (E2), follicular stimulating hormone (FSH), luteinizing hormone (LH) levels were measured with radioimmunoassay (RIA). Double immunofluorescent staining combined with confocal laser scanning microscope and dual in situ hybridization were carried out on sections through areas of arcuate nucleus (ARC) to determine whether estrogen receptor (ER) immunoreactivity (IR) or long form of leptin receptor (OB-Rb) mRNA were expressed in neuropeptide Y (NPY) immuno-and mRNA-containing neurons, and its relationship to proopiomelanocortin (POMC) mRNA-containing neurons. Immunohistochemistry and in situ hybridization were used to observe the levels of ER, NPY, gonadotrophin releasing hormone (GnRH) and gene expression levels on NPY, OB-Rb, POMC. Meanwhile, the criteria of energy state, including daily food intake, retroperitoneal fat depot pad and body weight, were measured and evaluated. Values of immunohistochemistry and in situ hybridization were expressed in mean optic density (MOD). Results: Seventeen out of the 25 rats (68%) in Group A+H were ovulated after herbal treatment. ASR characterized with significantly high metabolic rate, energy imbalance and obesity (P<0. 01, P<0. 01, P<0. 01). The mean serum leptin, T, E2 levels of group ASR were significantly higher than those of Group C and Group A+H (P< 0. 01,P<0. 01 ), while FSH, LH levels were lower (P<0. 01, P<0. 01 ). ERs were proved to be distributing in NPY-containing neurons, OB-Rb coexpressed in NPY-syn- thesizing neurons, and both NPY and POMC mRNA expressing neurons overlapped in ARC. Compared to Group C, levels of NPY mRNA and NPY, POMC mRNA expressions were increased (P<0. 01, P<0. 01, P<0. 01 ), OB-Rb mRNA, ER and GnRH immunoreactive expression were decreased significantly in the hypothalamus of ASR (P<0. 01, P<0. 01, P<0. 01 ). These dramatic neuroendocrine changes became normal in ovulated ASR after the herbal treatment (all P>0. 05). Conclusion: The elevated peripheral E2 caused by high T and leptin levels in ASR may down-regulate their corresponding receptors oriented on hypothalamic NPY- containing neurons respectively, therefore challenge the NPY mRNA and NPY, POMC mRNA overexpressions. The overexpression, of NPY, POMC gene transcription and translation stimulate food intake, promote the deposit of adipocyte tissue, and inhibit GnRH expression and GnRH/FSH, LH release, which contribute to the occurrence of obesity and anovulation in ASR. TGR may reverse these abnormal neuroendocrine cascades by lowering the levels of T, E2 and leptin.

Relationship between traditional Chinese medicine syndrome differentiation and imaging characterization to the radiosensitivity of nasopharyngeal carcinoma

Background and Objective: Traditional Chinese medicine (TCM) is a well established and time-honored practice in China, employing syndrome differentiation as a basis for the treatment of disease. According to different TCM syndrome typing findings, combining modern medical methods with TCM approaches can improve the quality of life and comprehensive effect on patients with nasopharyngeal carcinoma (NPC). This study investigated the relationship between TCM syndrome typing and imaging characterization to radiosensitivity as to provide objective evidence for the integration of Chinese and modern medical approaches in the treatment of NPC. Methods: Prior to treatment, TCM syndrome typing, computed tomography (CT) and magnetic resonance imaging (MRI) were performed on 147 patients pathologically classified with NPC. The status of tumor remission was radiologically evaluated at accumulated doses of 20 Gy, 40 Gy and 60 Gy, and at 3 months after completion of radiotherapy. Statistical results were analyzed by the Friedman and K-W test procedures. Results: Prior to treatment, TCM syndrome typing of NPC included Lung Heat, Blood Stasis, Phlegm Congealment and Blood Stasis-Phlegm Congealment. Lung Heat typing accounted for the highest proportion at 34.7% (51/147), followed by Phlegm Congealment at 32.7% (48/147), Blood Stasis at 17.0% (25/147) and Blood Stasis-Phlegm Congealment at 15.7% (23/147). Radiological imaging demonstrated a higher incidence of cervical lymph node metastases in Phlegm Congealment and Blood Stasis-Phlegm Congealment types (P < 0.05), while Blood Stasis and Blood Stasis-Phlegm Congealment types were more prone to skull base invasion (P < 0.05). Residual tumor size was larger in Blood Stasis and Blood Stasis-Phlegm Congealment types than in Lung Heat and Phlegm Congealment types after 3 months of treatment (P < 0.05). Conclusions: Different radiological manifestations were observed in TCM syndrome typed NPC patients, with lesser radiosensitivity demonstrated in the Blood Stasis and the Blood Stasis-Phlegm Congealment types relative to the Lung Heat and Phlegm Congealment types.

The effect of traditional Chinese medicine“Tian Gui Recipe (TGR)”on obesity and anovulation in androgen-sterilized rats(ASR)

Objectives: A traditional Chinese medicine “Tian Gui Recipe (TGR)” has been used to effectively treat clomiphene resistant anovulatory disease and obesity, especially in polycystic ovary syndrome (PCOS) cases with hyperinsulinemia. The effect of TGR on obesity and anovulation was investigated in androgen-sterilized rats (ASR).Methods: Female SD rats at the age of 9 days were divided into 3 groups. Group ASR (n=15): anovulation was demonstrated at the age of 70 days by vaginal smear in rats while 1.25 mg of testosterone propionate was injected subcutaneously on its 9th neonatal day. Group A+H (n=25): TGR were administered to ASR at the age of 80 days for 3 weeks. Rats with regular estrous cycle and ovulation after herbal treatment were included in this group. Group C (n=15): normal ovulated rats were recruited. Around the age of 112 days or on proestrous day, all rats were sacrificed under anesthesia. Serum leptin, testosterone (T), estrogen (E2), follicular stimulating hormone (FSH), luteinizing hormone (LH) levels were measured with radioimmunoassay (RIA). Double immunofluorescent staining combined with confocal laser scanning microscope and dual in situ hybridization were carried out on sections through areas of arcuate nucleus (ARC) to determine whether estrogen receptor (ER) immunoreactivity (IR) or long form of leptin receptor (OB-Rb) mRNA were expressed in neuropeptide Y (NPY) immuno- and mRNA-containing neurons, and their relationship to proopiomelanocortin (POMC) mRNA-containing neurons. Immunohistochemistry and in situ hybridization were used to observe the levels of ER-, NPY-,gonadotrophin releasing hormone (GnRH)-IR and gene expression levels of NPY, OB-Rb, and POMC in ARC. Meanwhile, the criteria of energy state,including daily food intake, retroperitoneal fat depot pad and body weight,were measured and evaluated. Values of immunohistochemistry and in situ hybridization were expressed in mean optic density (MOD).Results:Seventeen out of the 25 rats (68%) in Group A+H were ovulated after herbal treatment. ASR characterized with significantly high metabolic rate, energy imbalance and obesity (P<0.01,P<0.01,P<0.01).The mean serum leptin, T, E2 levels of ASR were significantly higher than that of Group C and Group A+H (P<0.01,P<0.01), while being contraryto that of FSH, LH levels (P<0.01,P<0.01). ERs were proved distributing in NPY-containing neurons, OB-Rb coexpressed in NPY-synthesizing neurons, and both NPY- and POMC- mRNA expressing neurons overlapped in ARC. Compared to Group C, levels of NPY mRNA and NPY, POMC mRNA expressions increased (P<0.01,P<0.01,P<0.01),OB-Rb mRNA, ER and GnRH immunoreactive expression decreased significantly in the hypothalamus of ASR (P<0.01,P<0.01,P<0.01).These dramatic neuroendocrine changes became normal in ovulated ASR after the herbal treatment (all P>0.05).Conclusion: The elevated peripheral estrogen caused by high testosterone and leptin levels in ASR may down-regulate their corresponding receptors oriented on hypothalamic NPY-containing neurons respectively, therefore challenge the NPY mRNA and NPY,POMC mRNA overexpression. The overexpression of NPY, POMC gene transcription and translation stimulate food intake, promote the deposit of adipocyte tissue, and inhibit GnRH expression and GnRH/FSH, LH release, which contribute to the occurrence of obesity and anovulation in ASR. “TGR” may reverse these abnormal neuroendocrine cascades by lowering levels of testosterone, estrogen and leptin.

Traditional Chinese medicine integrated with chemotherapy for stage Ⅳ non-surgical gastric cancer: a retrospective clinical analysis

OBJECTIVE： Traditional Chinese medicine （TCM） is regarded as an important treatment for gastric cancer patients, especially for those in advanced stage. To evaluate the effects of TCM treatment on gastric cancer patients, the authors performed a retrospective study to report the result of the integrated treatment of TCM with chemotherapy for stage IV non-surgical gastric cancer. METHODS： In this study, 182 patients with stage IV and non-surgical gastric cancer were retrospectively analyzed to evaluate the effects of TCM integrated with chemotherapy. Among the 182 cases, 88 cases received integrated therapy consisting of TCM and chemotherapy, while 94 cases received chemotherapy alone. The overall survival and Karnofsky performance status （KPS） score were measured as the main outcome. RESULTS： The median overall survival of the integrated therapy group and chemotherapy group were 16.9 and 10.5 months, respectively. The 1-, 3- and 5-year survival rates of integrated therapy group vs. chemotherapy group were 70% vs. 32%, 18% vs. 4%, and 11% vs. 0%, respectively. There was a significant difference between the two groups （x2 = 42.244, P 〈 0.001 ）. After six-month treatment, KPS scores of the integrated therapy group and the chemotherapy group were 75.00 ± 14.78 and 60.64 ± 21.39, respectively （P 〈 0.001）. The Cox regression analysis showed that TCM treatment is a protective factor for patients＇ overall survival. CONCLUSION： This study demonstrated that TCM integrated with chemotherapy may prolong overal survival and improve survival rate and life quality of patients with stage IV non-surgical gastric cancer

Application of Traditional Chinese Medicine Four-diagnostic auxilia-ry apparatus in evaluation of health status and clinical treatment

OBJECTIVE: To evaluate the application of Traditional Chinese Medicine(TCM) Four-diagnostic Auxiliary Apparatus in disease diagnosis.METHODS: The liver cancer patients and healthy controls were recruited from Shanghai Integrated Chinese and Western Medicine Hospital and Beijing University of Traditional Chinese Medicine, respectively. Then, the included subjects were diagnosed by the Four-diagnostic auxiliary apparatus.RESULTS: Thirty liver cancer patients and 30 paired healthy controls were enrolled in this study. Based on the apparatus, the pulse wave velocity was significantly higher in patients compared with controls(P < 0.05). The number of patients with purple tongue and ecchymosis were more than controls(P < 0.05). The number of patients(10%) with yellow tongue coating were higher than the controls(0%). Patients were inclined to be with water type and fire type constitution.CONCLUSION: TCM Four-diagnostic auxiliary apparatus can be applied in clinical diagnosis of body constitution and health status of subjects. It promotes the accuracy and speed for disease diagnosis and TCM standardization.

Effects of Traditional Chinese Medicine on the survival of patients with stage Ⅰ gastric cancer and high-risk factors:a real-world retrospective study

OBJECTIVE:To investigate the benefits of Traditional Chinese Medicine(TCM) therapy for improving the survival of patients with stage I gastric cancer(GC) and high-risk factors in a real-world setting.METHODS:The clinical data of patients who were diagnosed with stage I GC from March 1,2012 to October 31,2020 were collected.Prognostic analysis was performed to explore the high-risk factors that affected the survival of the patients.A Cox multivariate regression model was used to compare the hazard ratios for the mortality risk of patients,especially those with high-risk factors.Kaplan-Meier survival curve and log-rank test were utilized to assess the survival time.RESULTS:Prognostic analysis demonstrated that female sex,tumor invasion into blood vessels,and Ib stage were independent risk factors.The 1-,3-,and 5-year survival rates of the TCM group vs those of the non-TCM group were 100.0% vs 91.0%,97.6% vs 64.5%,and 81.4% vs 55.5%,respectively.A significant difference in median overall survival(m OS) was found between the two groups(χ2 = 7.670,P = 0.006).Subgroup analysis showed that the m OS of female patients and stage Ib patients in the TCM group were longer than those in the non-TCM group (P ≤ 0.001 and 0.001,respectively).CONCLUSIONS:TCM treatment can improve the survival of patients with stage I GC and high-risk factors.

Treatment of exfoliative cheilitis with Traditional Chinese Medicine：a systematic review

OBJECTIVE:To systematically review treatments of exfoliative cheilitis based on symptom patterns in terms of Traditional Chinese Medicine.METHODS:Pub Med, Cochrane Central Register of Controlled Trials and Wanfang data were screened for case reports, case series or clinical trials that were published in English or Chinese from January,1973 to September, 2015.The keyword of "exfoliative cheilitis or scaling cheilitis or factitious cheilitis" was used.Effectiveness or ineffectiveness was investigated as outcome for Meta analysis, which is based on effective index in each study.Response to treatment was described for case reports or case series.RESULTS:From 38 screened studies, 17 were randomized controlled trials(RCTs), 5 were single-arm trials, and 16 were case reports or case series.Three RCTs were eligible for Meta analysis and all of them compared managements between Traditional Chinese Medicine and corticosteroids for exfoliative cheilitis, which involved 223 participants.Interestingly, data of Meta analysis showed similar effect of Traditional Chinese Medicine and corticosteroids for patients with exfoliative cheilitis [relative risk ratio:1.10; 95% CI(1.00-1.21), P = 0.06].CONCLUSION:Traditional Chinese Medicine might be a substitute for corticosteroids on exfoliative cheilitis.However, the evidence and recommendation of exfoliative cheilitis managements need to be taken with caution because of the low quality of evidence in the studies obtained.

Auricular therapy for chemotherapy-induced nausea and vomiting in cancer patients:Perspectives from the traditional zang-fu organs and meridians theory

This paper presents the theoretical background of using auricular therapy(AT)for managing chemotherapy-induced nausea and vomiting(CINV)from the perspectives of traditional zang-fu organs and meridian theory.The zang-fu organs of stomach,spleen and liver play a crucial role in regulating the gastrointestinal functions.The chemotherapeutic agents can significantly impede the gastrointestinal functions and subsequently contribute to various gastrointestinal symptoms including nausea and vomiting.Dysfunctions of the stomach,spleen and liver can correspond to specific auricular acupoints,while by stimulating those acupoints,the chaotic Qi movement can be reversed to its normal status,and the hyperactivities of the gastrointestinal system can also be alleviated to reduce the CINV symptoms.Clinical studies based on such theory have well supported the effects of AT on CINV.However,relationships between the traditional theory and the modern medicine understanding of the CINV mechanisms remain unknown and should be further explored in future research.

朱永康治疗分化型甲状腺癌术后并发症的经验

介绍朱永康教授治疗分化型甲状腺癌(DTC)术后并发症的临床经验。认为DTC术后的中医治疗分为早期和远期两个阶段,早期重在治“虚”,远期治疗除缓解其他治疗带来的毒副作用外,将“伏邪”理论引入治疗中,同时注重既病防变、已病防传和病愈防复。并附验案1则。

滋肾育胎丸联合贝米肝素钠治疗肾虚血瘀型复发性流产的临床观察

目的探讨滋肾育胎丸联合贝米肝素钠治疗肾虚血瘀型复发性流产(recurrent spontaneous abortion,RSA)的临床效果。方法选取2021年1月至2023年6月江西省妇幼保健院收治的98例肾虚血瘀型RSA患者,随机分为观察组和对照组,每组49例。对照组患者予贝米肝素钠治疗,观察组患者加用滋肾育胎丸治疗。比较两组患者的临床疗效、中医证候积分、性激素水平、子宫动脉血流参数、保胎情况及不良反应。结果治疗后观察组总有效率高于对照组(P<0.05);屡孕屡堕、腰骶酸痛、阴道流血、双膝酸软积分低于对照组(P<0.05);孕酮、人绒毛膜促性腺激素、雌二醇水平高于对照组(P<0.05);子宫动脉阻力指数、收缩期与舒张期流速比、脉搏动指数低于对照组(P<0.05);保胎成功率、活产率高于对照组(P<0.05);两组患者的不良反应比较,差异无统计学意义(P>0.05)。结论滋肾育胎丸联合贝米肝素钠可提高RSA患者的疗效,改善患者的性激素水平,利于保胎,提高最终活产率。

内消连翘丸治疗甲状腺结节的临床疗效回顾性队列研究

目的 回顾性评价应用内消连翘丸治疗甲状腺结节的临床疗效。方法 选取2013年—2020年就诊于北京中医医院内分泌科诊断为结节性甲状腺肿的患者729例。暴露组符合纳排标准,应用内消连翘丸共421例;对照组符合纳排标准,未应用内消连翘丸共308例。疗程6个月及以上。观察甲状腺最大结节体积、甲状腺结节性质评分以及各风险指标、症状积分、甲状腺相关抗体。结果 治疗后治疗组甲状腺最大结节体积较治疗前降低,且治疗组均低于对照组(P<0.05)。治疗后治疗组甲状腺结节性质评分较治疗前降低,且治疗组均低于对照组(P<0.05);治疗后治疗组边缘不规则、点状强回声细小钙化灶、结节纵横比>1风险指标较治疗前降低,且治疗组均低于对照组(P<0.05);低回声实性结节、甲状腺被膜受侵状态差异无统计学意义(P>0.05)。治疗后治疗组症状积分均较治疗前降低,且治疗组症状积分均低于对照组(P<0.05)。治疗后治疗组TGAb、TPOAb较治疗前降低,且治疗组均低于对照组(P<0.05)。结论 内消连翘丸在治疗甲状腺结节上可降低甲状腺结节性质评分、缩小结节,改善结节性质及调节甲状腺免疫状态。

免疫检查点抑制剂导致甲状腺功能异常的中西医诊疗思路

随着免疫检查点抑制剂(immune checkpoint inhibitor,ICPi)治疗人群的不断扩大,以及临床上的应用,接受这些药物治疗的患者生存时间明显提高,免疫相关不良反应的发生也逐渐受到重视。免疫系统的过度反应会导致不良反应的发生,这些不良反应称为免疫相关不良事件(Immune related adverse events,irAEs)。irAEs可以影响多个器官系统,其中内分泌系统是最常受累的系统之一,而甲状腺功能减退和甲状腺功能亢进的发生率最高,现代医学经常通过适当的激素替代,硫代酰胺,皮质类固醇来治疗,但仍有部分患者未能完全缓解,中医药可展现出其独特的优势和价值,很好的改善这部分患者症状,提高生存质量。本文就中西医诊疗ICPi所致甲状腺irAEs进行综述。

中西医结合甲状腺外科发展现状与思考

手术是治疗甲状腺癌、甲状腺腺瘤、结节性甲状腺肿等疾病的主要方式。甲状腺疾病在中医学中被称为“瘿病”,中医以整体观、辨证论治思想通过内治及外治多种途径治疗瘿病,优势独特、效果显著。中西医结合甲状腺外科是在甲状腺手术全流程管理中倡导中西医结合、多学科协作的理念,实现中西医取长补短、优势互补。本文通过文献回顾的方式梳理、总结了中医药方法在甲状腺疾病围手术期及术后随访诊疗中的应用,分析中西医结合甲状腺外科的发展现状,同时对未来工作进行展望与建议,希望对外科、中医科、麻醉科、护理等多学科临床医护人员、科研工作者、医院管理工作者有所帮助。

子午流注开穴法预防生长激素激发试验不良反应临床观察

目的观察子午流注开穴法预防生长激素(GH)激发试验不良反应的临床疗效。方法选取2021年11月—2022年10月于广州中医药大学顺德医院进行GH激发试验的矮小症儿童80例,随机分为对照组、观察组,各40例。对照组给予常规护理及治疗,观察组在对照组的基础上加子午流注开穴法贴敷神阙穴。比较两组患儿不良反应情况。结果观察组不良反应发生率为7.5%(3/40),低于对照组的27.5%(11/40),差异有统计学意义(P<0.05);且观察组不良反应出现时间晚于对照组,持续时间短于对照组,差异均有统计学意义(P<0.05)。结论子午流注开穴法贴敷神阙穴,可降低GH激发试验不良反应发生率,减少患儿痛苦,提高家属满意度,保证激发试验顺利进行,值得临床推广。

基于真实世界数据分析的中医药治疗甲状腺结节的用药规律研究

目的基于真实世界数据挖掘技术分析中医药治疗甲状腺结节的用药规律。方法收集2018年8月—2023年8月就诊于青岛市中医医院甲乳外科的临床第一诊断为甲状腺结节患者的中药处方,运用中医传承辅助平台(V3.0)分析其用药规律。结果共筛选出治疗甲状腺结节的中药处方1206首,涉及中药291味;用药频次居于前5位的是浙贝母、夏枯草、柴胡、茯苓、半夏;药物功能类别以清热、补虚、化痰、活血、理气类为主;药性以寒为主,药味以苦、甘、辛为主,归经以肺、肝、脾经为主;关联规则分析得到17个高频药物组合,浙贝母-夏枯草药对出现频率最高;16条关联规则中,玄参→浙贝母、香附→柴胡置信度最高;聚类分析发现6个核心药物组合。结论中医临床治疗甲状腺结节以化痰散结、行气活血、益气养血为主要思路;常用浙贝母-夏枯草药对清热化痰散结,并以消瘰丸为基础方化痰软坚散结。

中医药治疗甲状腺结节的现状与展望

甲状腺结节是临床上常见的内分泌系统疾病,以良性结节多见。西医治疗甲状腺结节主要采用定期随访、药物及手术治疗,但存在副作用多、患者依从性差等问题。依照本病的临床症状及发病特点,中医将其归属“瘿病”“瘿瘤”范畴,中医治疗在缩小结节体积、纠正甲状腺激素水平以及改善患者症状等方面均有较明显的作用。在中医理论指导下,结合现代药理研究,中医治疗本病的优势日益明显。本文对甲状腺结节的中医病因病机、中医选方用药、中医外治等方面进行分析,总结中医治疗经验,以期为甲状腺结节的中医药治疗提供参考。

癌因性疲乏的中医证候特征及其与甲状腺功能水平的相关性研究

背景 中西医结合下的多学科参与是癌因性疲乏(CRF)未来诊疗模式的发展方向。然而,缺乏辨证选方的标准和依据限制了中医药在西医和国际范围内的应用。CRF患者的疲乏感常伴随着代谢和能量平衡的异常,甲状腺功能在机体能量代谢和调节方面扮演着重要角色。目的 分析CRF的中医证候特征并探讨其与甲状腺功能水平之间的相关性,为CRF的中西医结合诊疗和机制研究提供参考。方法 纳入2021年就诊于中国中医科学院西苑医院肿瘤科门诊及病房的肿瘤患者为研究对象,收集患者一般资料。采用中文版Piper疲乏修订量表(RPFS-CV)评估患者疲乏情况。收集入组患者当日或次日的甲状腺功能检测结果,包括三碘甲状腺原氨酸(T_(3))、甲状腺素(T_(4))、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素、抗甲状腺过氧化物酶抗体(TPO-Ab)、甲状腺球蛋白抗体。由自拟CRF中医四诊信息表收集CRF患者中医证候特征。采用Spearman秩相关分析探讨RPFS-CV疲乏评分与甲状腺功能指标的相关性,采用点二列相关分析探讨RPFS-CV疲乏评分和甲状腺功能指标与CRF中医证候的相关性。结果 纳入159例CRF患者,常见的肿瘤种类依次为肺癌(50例,31.4%)、乳腺癌(23例,14.5%)、头颈部肿瘤(21例,13.2%)、直肠癌(21例,13.2%)、结肠癌(18例,11.3%);中位确诊年限为2.15(3.16)年;88例(55.3%)患者发生了复发转移,40例(45.5%)患者为局部复发,38例(43.2%)患者为寡转移,中位转移年限为1.50(2.83)年;91例(57.2%)为晚期患者,101例(63.5%)患者接受过抗肿瘤治疗,57例(35.8%)患者接受化疗。中医证候中,虚证频率超过10%从高到低分别为气虚证、心虚证、脾虚证;实证中出现频次超过20次的从高到低分别为气滞证、寒湿证。RPFS-CV疲乏评分中位数超过4分的证候从高到低分别为寒湿证、气滞证、脾虚证、心虚证、肝虚证、湿热证、气虚证。RPFS-CV疲乏评分与气虚证、脾虚证、心虚证、肝虚证、寒湿证、气滞证呈正相关(P<0.05)。RPFS-CV疲乏评分与FT_(3)、T_(3)呈负相关(P<0.05)。气虚证与T_(4)、肾虚证与TPO-Ab、气滞证与FT_(4)呈正相关(P<0.05),湿热证与T_(3)、T_(4)呈负相关(P<0.05)。结论 CRF患者疲乏情况与中医证候及甲状腺功能水平密切相关,进一步的研究将有助于深入理解这些关联,并促进中医和西医在CRF疾病管理中的协同发展。

铁死亡在非小细胞肺癌中的作用及中药干预进展

非小细胞肺癌(non-small celllung cancer,NSCLC)是全球发病率和死亡率较高的恶性肿瘤之一。铁死亡是铁依赖性活性氧(reactive oxygen species,ROS)异常堆积导致脂质过氧化而引起的新型细胞程序性死亡方式,涉及铁代谢、脂质代谢、氧自由基反应与脂质过氧化之间的平衡。近年来研究发现铁死亡与NSCLC发生发展密切相关。由于NSCLC治疗过程中化疗耐药及放疗抵抗等的出现,迫切需要开发新的有效药物和治疗策略,中药具有靶点多、副作用小等特点,在防治NSCLC方面有独特的优势。本文综述了铁死亡在NSCLC中的作用机制,探讨中药活性成分、单味药及中药复方通过铁死亡干预NSCLC的研究现状,以期为铁死亡通路研究及中药靶向铁死亡防治NSCLC提供新的理论依据。

桥本甲状腺炎并发甲状腺毒症人群临床症状及证型分布规律研究

背景中国传统医学对桥本甲状腺炎并发甲状腺毒症的发生、发展和诊疗已经有了系统的认识,但是目前关于本病人群中医临床症状和证型分布情况研究甚少,国家行业标准中亦缺乏关于本病的证型分布及证候诊断标准的描述。目的运用因子分析联合聚类分析探讨桥本甲状腺炎并发甲状腺毒症人群临床症状及证型分布规律,为临床辨证提供依据,促进桥本甲状腺炎并发甲状腺毒症证候标准化研究。方法收集2020年12月—2021年12月就诊于北京中医药大学东直门医院东城院区、通州院区、北京中医药大学孙思邈医院甲状腺病科门诊符合诊断标准的171例桥本甲状腺炎并发甲状腺毒症患者,使用《桥本甲状腺炎并发甲状腺毒症中医四诊信息采集表》对症状/体征、舌、脉等四诊信息进行采集,基于因子分析和聚类分析研究桥本甲状腺炎并发甲状腺毒症的症状及证型分布规律。结果171例桥本甲状腺炎并发甲状腺毒症患者中男17例、女154例,平均年龄(39.98±13.30)岁,其中20~60岁患者占87.72%。症状分布方面出现频率较高的症状有神疲乏力、心慌心悸、烦躁或急躁易怒,体征有颈前肿大、手指震颤,频率较高的舌象有舌红、舌瘦薄和舌有齿痕,苔质为苔白和苔薄,脉象是脉弦、脉数。收集调查表的82个四诊条目因子分析,提取出25个公因子,累计方差贡献率为70.562%,筛选出具有意义的症状62项。利用因子分析得到的25个公因子结果作为变量对其进行R型系统聚类分析,共得到5类证候分型,分别是:肝郁痰凝证、阴虚火旺证、脾肾阳虚证、肝郁气滞证、气阴两虚证。结论桥本甲状腺炎并发甲状腺毒症的基本中医证候可分为肝郁痰凝证、阴虚火旺证、脾肾阳虚证、肝郁气滞证、气阴两虚证。