Post-infectious cough of different syndromes treated by traditional Chinese medicines:A review

The application of traditional Chinese medicines(TCMs)has a history of more than 2000 years,which have the characteristics of multi-component,multi-target,and high safety.Post-infectious cough(PIC)is a respiratory disease with high incidence.It belongs to subacute cough and accounts for as much as40%–50%.Cough is the main clinical manifestation of PIC.PIC seriously affects people’s life quality because of complex etiology,long-term course of disease,treatment difficulties and other characteristics.Western medicines are based on the principle of symptomatic treatment,so they are often difficult to control PIC fundamentally.These factors could due to that PIC is prolonged and unable to heal repeatedly.TCMs have obvious advantages in treating PIC,with accurate curative effects,less side effects and adverse reactions and are effective in improving PIC-related symptoms and indicators,enhancing patients’life quality and reducing pain.TCMs,guided by holistic concept and syndrome differentiation,advocate determine treatment on the basis of pattern types,and have remarkable clinical treatment effects.As for TCMs etiology,pathogenesis and syndrome types of PIC,TCM scholars have not yet reached a unified standard.However,most of them think that wind pathogen can cause PIC alone,or it can be combined with other evils,which might be the main mechanism of PIC.This paper discusses the advantages and limitations of TCMs in PIC treatment from etiology,pathogenesis,distribution of syndrome types and treatment of TCMs.This article focuses on the treatment methods and pharmacodynamic material basis of wind pathogen,providing ideas in treating PIC of TCMs clinically and innovative drug development.

Post-infectious irritable bowel syndrome:Mechanistic insights into chronic disturbances following enteric infection

Irritable bowel syndrome(IBS)is a commonly encountered chronic functional gastrointestinal(GI)disorder.Approximately 10%of IBS patients can trace the onset of their symptoms to a previous a bout of infectious dysentery.The appearance of new IBS symptoms following an infectious event is defined as post-infectiousIBS.Indeed,with the World Health Organization estimating between 2 and 4 billion cases annually,infectious diarrheal disease represents an incredible international healthcare burden.Additionally,compounding evidence suggests many commonly encountered enteropathogens as unique triggers behind IBS symptom generation and underlying pathophysiological features.A growing body of work provides evidence supporting a role for pathogen-mediated modifications in the resident intestinal microbiota,epithelial barrier integrity,effector cell functions,and innate and adaptive immune features,all proposed physiological manifestations that can underlie GI abnormalities in IBS.Enteric pathogens must employ a vast array of machinery to evade host protective immune mechanisms,and illicit successful infections.Consequently,the impact of infectious events on host physiology can be multidimensional in terms of anatomical location,functional scope,and duration.This review offers a unique discussion of the mechanisms employed by many commonly encountered enteric pathogens that cause acute disease,but may also lead to the establishment of chronic GI dysfunction compatible with IBS.

ICC density predicts bacterial overgrowth in a rat model of post-infectious IBS

AIM:To investigate the interstitial cells of Cajal(ICC) number using a new rat model.METHODS:Sprague-Dawley rats were assigned to two groups.The first group received gavage with Campylobacter jejuni(C.jejuni) 81-176.The second group was gavaged with placebo.Three months after clearance of Campylobacter from the stool,precise segments of duodenum,jejunum,and ileum were ligated in self-contained loops of bowel that were preserved in anaerobic bags.Deep muscular plexus ICC(DMP-ICC) were quantified by two blinded readers assessing the tissue in a random,coded order.The number of ICC per villus was compared among controls,Campylobacter recovered rats without small intestinal bacterial overgrowth(SIBO),and Campylobacter recovered rats with SIBO.RESULTS:Three months after recovery,27% of rats gavaged with C.jejuni had SIBO.The rats with SIBO had a lower number of DMP-ICC than controls in the jejunum and ileum.Additionally there appeared to be a density threshold of 0.12 DMP-ICC/villus that was associated with SIBO.If ileal density of DMP-ICC was < 0.12 ICC/villus,54% of rats had SIBO compared to 9% among ileal sections with > 0.12(P<0.05).If the density of ICC was < 0.12 DMP-ICC/villus in more than one location of the bowel,88% of these had SIBO compared to 6% in those who did not(P<0.001).CONCLUSION:In this post-infectious rat model,the development of SIBO appears to be associated with a reduction in DMP-ICC.Further study of this rat model might help understand the pathophysiology of postinfectious irritable bowel syndrome.

Montezuma's revenge-the sequel: The one-hundred year anniversary of the first description of “post-infectious” irritable bowel syndrome

One-hundred years have passed since the original description of the commonly described phenomenon of persistent abdominal symptoms being triggered by an acute enteric infection. This first account was generated out of astute observations by Sir Arthur Hurst in World War I. Additional descriptions followed from military and non-military practitioners adding the evidence which has transitioned this recognized condition from association to causation. While mechanistic understanding is an area of active pursuit, this historical accounting of a centuries progress highlights important advances and contributions of military medicine and scientists to advances benefiting global populations.

Upregulated adenosine 2A receptor accelerates post-infectious irritable bowel syndrome by promoting CD4+T cells’T helper 17 polarization

BACKGROUND Post-infectious irritable bowel syndrome(PI-IBS)is generally regarded as a functional disease.Several recent studies have reported the involvement of lowgrade inflammation and immunological dysfunction in PI-IBS.T helper 17(Th17)polarization occurs in IBS.Adenosine and its receptors participate in intestinal inflammation and immune regulation.AIM To investigate the role of Th17 polarization of CD4+T cells regulated by adenosine 2A receptor(A2AR)in PI-IBS.METHODS A PI-IBS model was established by infecting mice with Trichinella spiralis.The intestinal A2AR and CD4+T lymphocytes were detected by immunohistochemistry,and the inflammatory cytokines were detected by enzyme-linked immunoassay.CD4+T lymphocytes present in the animal’s spleen were separated and cultured with or without A2AR agonist and antagonist.Western blotting and real-time quantitative polymerase chain reaction were performed to determine the effect of A2AR on the cells and intestinal tissue.Cytokine production was determined.The protein and mRNA levels of A2AR associated signaling pathway molecules were also evaluated.Furthermore,A2AR agonist and antagonist were injected into the mouse model and the clinical features were observed.RESULTS The PI-IBS mouse model showed increased expression of ATP and A2AR(P<0.05),and inhibition of A2AR improved the clinical features in PI-IBS,including the abdominal withdrawal reflex and colon transportation test(P<0.05).The number of intestinal CD4+T cells and interleukin-17(IL-17)protein levels increased during PI-IBS,which was reversed by administration of the A2AR antagonist(P<0.05).CD4+T cells expressed A2AR and produced IL-17 in vitro,which was regulated by the A2AR agonist and antagonist.The A2AR antagonist increased the production of IL-17 by CD4+T cells via the Janus kinase-signal transducer and activator of transcriptionreceptor-related orphan receptorγsignaling pathway.CONCLUSION The results of the present study suggested that the upregulation of A2AR increases PI-IBS by promoting the Th17 polarization of CD4+T cells.

SRC:Superior Robustness of COVID-19 Detection from Noisy Cough Data Using GFCC

This research is focused on a highly effective and untapped feature called gammatone frequency cepstral coefficients(GFCC)for the detection of COVID-19 by using the nature-inspired meta-heuristic algorithm of deer hunting optimization and artificial neural network(DHO-ANN).The noisy crowdsourced cough datasets were collected from the public domain.This research work claimed that the GFCC yielded better results in terms of COVID-19 detection as compared to the widely used Mel-frequency cepstral coefficient in noisy crowdsourced speech corpora.The proposed algorithm's performance for detecting COVID-19 disease is rigorously validated using statistical measures,F1 score,confusion matrix,specificity,and sensitivity parameters.Besides,it is found that the proposed algorithm using GFCC performs well in terms of detecting the COVID-19 disease from the noisy crowdsourced cough dataset,COUGHVID.Moreover,the proposed algorithm and undertaken feature parameters have improved the detection of COVID-19 by 5%compared to the existing methods.

A systemaic review and meta-analysis of traditional Chinese medicine in the treatment of chronic cough

Objective: To systematically evaluate the safety and efficacy of traditional Chinese medicine (TCM) in the treatment of chronic cough. Methods: Databases CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, Cochrane Library from inception to February 2021 were electronically searched by two researchers, to collect randomized controlled trials (RCTs) of traditional Chinese medicine in the treatment of chronic cough, UACS/PNDS, CVA, EB, AC, GERD and other types of cough. Revman 5.3 software was used to analyze and summarize the collected literature, and the methodological quality of the included studies was evaluated by the bias risk assessment scale of Cochrance Collaboration Network. Results: A total of 26 articles involving 2 820 patients, with 1 420 in the experimental group and 1 400 in the control group were included. The results of meta-analysis showed that compared to the control group which was treated with western medicine alone, TCM significantly improved the clinical effective rate [RR=1.20, 95% CI(1.16,1.25), P<0.000 01], alleviated cough syndrome score [SMD=-0.83, 95% CI(-1.21,-0.44)], and enhenced the score of quality of life [MD=-2.18, 95%CI(1.63,2.74), P<0.000 01];at the same time, the experimental group was better than the control group in improving lung function and reducing the time of cough relief. In terms of safety, a total of 24 patients in 5 literatures had adverse reactions, but the symptoms were mild and could be relieved quickly. In addition, there was no significant difference in adverse reactions between the control group and the experimental group, showing good safety. Conclusion: TCM treatment can significantly improve the cure rate of cough, reduce cough score, improve systemic symptoms, relieve psychological anxiety, improve lung function, and improve cough symptoms rapidly, with good safety.

Efficacy ofβ2-adrenergic receptor agonist combined with corticosteroid in the treatment of children with cough variant asthma

BACKGROUND Cough variant asthma(CVA)is one of the most common respiratory diseases in children,which has a serious impact on the quality of life and daily activities of children.For severe CVA,immunomodulatory drugs are needed.AIM To evaluate the efficacy of salmeterol combined with budesonide in the treatment of pediatric CVA.METHODS 130 children with CVA from January 2020 to December 2022 were prospectively selected and randomly divided into an observation group(salmeterol combined with budesonide)and a control group(budesonide combined with a placebo).Compare the clinical efficacy of two groups before and after intervention.The evaluation parameters include cough frequency score,nocturnal cough arousal,and lung function indicators.Serum inflammatory markers,immune function markers and airway anatomical indicators were also measured.RESULTS After the intervention,the total effective rate of the observation group was significantly higher than that of the control group,and the cough frequency score and the night cough wake rate of the observation group were lower than that of the control group,with a statistically significant difference.In addition,the changes of lung function indicators,serum markers and immune function markers in the observation group were better than those in the control group.CONCLUSION The clinical efficacy of salmeterol combined with Budesonide in the treatment of CVA is better than that of Budesonide alone.

Superior laryngeal nerve block for treatment of throat pain and cough following laryngeal herpes zoster:A case report

BACKGROUND Herpes zoster is caused by reactivation of latent varicella-zoster virus infection within the sensory nerve ganglion of the spinal or cranial nerves.Laryngeal herpes zoster is rare and involves superior laryngeal nerve,which leads to several complications such as throat pain,and cough.CASE SUMMARY Patient concerns:A 52-year old woman presented with a 70 d history of throat pain and a 67 d history of non-productive cough.Three days after onset of pain,she was diagnosed with laryngeal herpes zoster.Flexible nasolaryngoscopy revealed multiple white ulcerated lesions on the left hemi epiglottis and the left supraglottic area.She was prescribed with 750 mg famciclovir a day for 7 d,and 150 mg pregabalin,100 mg tramadol and 10 mg nortriptyline a day for 67 d.However,despite of these medications,she complained of pain and persistent cough.Therefore,superior laryngeal nerve block under ultrasound guidance was performed.Three days after the intervention,the throat pain and cough disappeared.The patient remained symptom-free at 3 mo follow-up.CONCLUSION A superior laryngeal nerve block can be an effective option for treatment of pain and cough following laryngeal herpes zoster.

Experimental study on the regulation effect of Qiaoqin Qingfei agent on cough variant asthma based on airway neurogenic inflammation

Objective:To investigate the mechanism of regulation of airway neurogenic inflammation by Qiaoqin Qingfei agent in rats with cough variant asthma(CVA).Methods:48 SD rats were randomly divided into blank group,model group,montelukast sodium group(1.05 mg/kg)and high,medium and low dose groups(26,13,6.5 g/kg),with 8 rats in each group.The rat CVA model was established by the method of ovalbumin(OVA)combined with aluminum hydroxide(Al(OH)3)sensitization and repeated stimulation.From the second day of sensitization,the rat CVA model was given by gavage for 28 days.The pathological changes of lung tissue were observed under microscope by HE staining.The content changes of nerve growth factor(NGF)and substance P(SP)in alveolar lavage fluid(BALF)were determined by double-antibody sandwich ABC-ELISA,and the protein expression levels of NGF and SP in lung tissue were detected by immunohistochemistry.Results:Pathological findings showed significant inflammatory manifestations in the model group,and the inflammatory infiltration in the high-dose,medium-dose and low-dose groups of Qiaoqin Qingfei agent and montelukast sodium groups were alleviated to varying degrees.Compared with blank group,the protein expression levels of NGF and SP in lung tissue of model group were significantly increased(P<0.01).Compared with model group,the protein expression levels of NGF and SP in lung tissue and the contents of NGF and SP in alveolar lavage fluid in high-dose,medium-dose and low-dose groups and montelukast sodium group were significantly decreased(P<0.05).Conclusion:Qiaoqin Qingfei agent may reduce airway inflammation and relieve cough variant asthma by regulating the protein expression levels of NGF and SP in airway neurogenic inflammation.

Effect of glycyrrhetinic acid on Th1/Th2 balance in cough variant asthma mice

Objective:To evaluate the therapeutic effect of Glycyrrhetinic Acid on cough variant asthma(CVA)mice and to investigate the possible mechanism in reducing lung inflammation.Methods:48 young female Balb/c mice were divided into Control,CVA,Prednisone Acetate,Glycyrrhetinic Acid high-dose,Glycyrrhetinic Acid middle-dose and Glycyrrhetinic Acid lowdose groups randomly,with 8 mice in each group.The CVA mice model was established by ovalbumin(OVA)sensitization and OVA challenge,the animal asthma behavior was observed after drug administration,and the index of the lung of mice were recorded.The level of OVAsIgE in the bronchoalveolar lavage fluid(BALF)was tested by ELISA.The pathological changes of the lung tissue were observed by Hematoxylin and Eosin(H&E)staining.The protein expressions of T-bet,IFN-γ,Gata3,IL-4 and IL-13 in the lung tissue were determined by Western blot.Results:Compared with the CVA group,the index of lung of mice,the OVA-sIgE level in BALF and expression levels of Th2-related factor in the lung tissue of mice in Prednisone Acetate and Glycyrrhetinic Acid groups were significantly decreased(P<0.05 or P<0.01),the infiltration of inflammatory cells in the lung tissue was reduced,while expressions of Th1-related factor in the lung tissue was significantly increased(P<0.05 or P<0.01).Conclusion:Glycyrrhetinic acid has therapeutic effect on CVA mice,the underlying mechanism of Glycyrrhetinic acid alleviating lung impairment and airway inflammation may be associated with mediating the Th1/Th2 imbalance in the lung tissue.

丙泊酚复合低剂量艾司氯胺酮应用于无痛超声支气管镜检查的效果

目的:评估丙泊酚复合低剂量艾司氯胺酮应用于无痛超声支气管镜(EBUS)检查的效果。方法:纳入2022年4月至8月在郑州大学第一附属医院行无痛EBUS检查的96例患者(年龄18~65岁,BMI 18.5~28.0 kg/m^(2),ASAⅡ或Ⅲ级),随机分为艾司氯胺酮组和对照组,每组48例。对照组麻醉诱导方案为丙泊酚1.5 mg/kg+阿芬太尼30μg/kg+米库氯铵0.15 mg/kg,艾司氯胺酮组在此基础上加用艾司氯胺酮0.25 mg/kg;术中根据患者反应持续泵注瑞芬太尼0.25~4.00μg/(kg·min)和丙泊酚4~6 mg/(kg·h)。记录苏醒期呛咳程度和发生率,记录麻醉前、麻醉诱导后、超声支气管镜进入声门时、穿刺时和苏醒即刻的平均动脉压和心率,记录检查时间、苏醒时间、拔管时间及不良反应发生情况。结果:艾司氯胺酮组苏醒期呛咳程度及发生率均低于对照组(P<0.05);艾司氯胺酮组平均动脉压和心率波动幅度均小于对照组(P<0.05);艾司氯胺酮组低血压、心动过缓发生率低于对照组(P<0.05);两组检查时间、苏醒时间、拔管时间及不良反应发生率(包括心动过速、头晕、躁动、视力模糊)比较,差异均无统计学意义(P>0.05)。结论:丙泊酚复合低剂量艾司氯胺酮能降低无痛EBUS检查苏醒期呛咳的发生,且血流动力学更稳定。

温润辛金方治疗微寒恋肺型咳嗽变异型哮喘的临床疗效研究

目的:观察温润辛金方治疗微寒恋肺型咳嗽变异型哮喘(CVA)的临床疗效及安全性,为CVA的中医临床治疗提供依据和思路。方法:选取2017年6月~2019年12月期间于某院就诊的60例微寒恋肺型CVA患者,根据随机数字表法分为对照组和观察组,每组30例。对照组给予沙美特罗替卡松吸入粉雾剂,观察组给予温润辛金方,两组均治疗6周。观察两组患者的中医证候疗效以及不良反应,比较两组患者治疗前后呼出气一氧化氮(FeNO)及咳嗽症状积分的变化。结果:对照组和观察组分别脱落2例和4例。两组临床治疗总有效率比较无统计学差异(P>0.05)。治疗后,两组咳嗽症状积分、FeNO均较治疗前下降(P<0.05),且观察组咳嗽症状积分低于对照组(P<0.05),但两组FeNO水平比较无统计学差异(P>0.05)。观察组有2例患者在服药期间出现恶心等胃部不适,嘱其改为饭后服药后症状消失;对照组有2例患者出现轻微不良反应,但不影响后续治疗。结论:温润辛金方可有效改善微寒恋肺型CVA患者的临床症状和咳嗽症状积分,临床疗效较佳且安全性良好。

极低剂量右美托咪定对老年患者全身麻醉苏醒期呛咳的影响

目的探讨极低剂量右美托咪定对老年患者颈动脉支架置入术(CAS)全身麻醉苏醒期呛咳的影响。方法选择择期行CAS的无症状单侧重度颈动脉狭窄老年患者111例,男75例,女36例,年龄≥65岁,BMI 18~32 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:右美托咪定组(D组,n=55)和对照组(C组,n=56)。D组于麻醉诱导前给予右美托咪定0.2~0.5μg/kg,麻醉诱导后至手术结束前30 min静脉输注极低剂量右美托咪定0.1~0.2μg·kg^(-1)·h^(-1);C组不给予右美托咪定。两组麻醉方案及术中用药方案相同。记录麻醉诱导前15 min(T_(0))、麻醉诱导后5 min(T_(1))、支架置入前5 min(T_(2))、支架置入后5 min(T_(3))、气管拔管后5 min(T_(4))的MAP和HR。记录术中丙泊酚和瑞芬太尼用量、麻醉苏醒期呛咳、躁动、呼吸抑制(SpO_(2)<90%)、拔管时间以及术后穿刺处感染、术后24 h VAS疼痛评分、术后恶心呕吐的发生情况。结果与C组比较,D组T_(1)、T_(2)时MAP明显升高,T_(3)、T_(4)时MAP明显降低,T_(1)、T_(3)、T_(4)时HR明显减慢(P<0.05),术中丙泊酚和瑞芬太尼用量明显减少(P<0.05),麻醉苏醒期呛咳、躁动发生率明显降低(P<0.05)。两组呼吸抑制发生率、拔管时间、术后24 h VAS疼痛评分以及术后恶心呕吐发生率差异无统计学意义,两组均未发生术后穿刺处感染。结论极低剂量右美托咪定可有效维持术中血流动力学稳定性,降低麻醉苏醒期呛咳、躁动发生率,且不增加术后不良反应,提高全身麻醉苏醒质量。

孟鲁司特钠单用、布地奈德/福莫特罗单用及两者联用治疗对儿童咳嗽变异型哮喘的疗效比较

目的本研究旨在比较孟鲁司特钠(Mon)单用、布地奈德/福莫特罗(BF)单用及两者联用治疗儿童咳嗽变异型哮喘(CVA)的疗效。方法选取2021年6月至2023年6月北京市海淀医院诊治的CVA患儿为研究对象。根据治疗方案,将CVA患儿分为Mon组、BF组和联合组。观察治疗8周后的治疗总有效率(TER)、不良反应发生率(TAER)、咳嗽症状评分[日间咳嗽症状评分(DCSS)和夜间咳嗽症状评分(NCSS)]、免疫功能[肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)和免疫球蛋白E(IgE)]、肺功能[第1秒用力呼出气体容量(FEV_(1))、肺活量(FVC)和呼气峰值流速(PEF)]和血清嗜酸性粒细胞计数(EOS)。结果共选取180例CVA患儿,Mon组62例,BF组60例,联合组58例。治疗后,3组TER、TAER、DCSS、NCSS、血清TNF-α、血清IL-4和血清IgE水平差异无统计学意义(P>0.05)。联合组患儿FEV_(1)、FVC和PEF显著高于Mon组和BF组(P<0.05),EOS显著低于Mon组和BF组(P<0.05);而Mon组和BF组FEV1、FVC、PEF和EOS学差异无统计学意义(P>0.05)。结论Mon或BF可有效改善CVA患儿咳嗽症状和免疫功能,其镇咳作用和抗炎作用同Mon和BF联用相似。此外,Mon和BF联用可进一步改善CVA患儿肺功能,减少血清EOS水平。

加味芎蝎散对咳嗽高敏综合征大鼠神经源性炎症的影响

目的探讨加味芎蝎散对咳嗽高敏综合征大鼠咳嗽及神经源性炎症的影响。方法取雄性SD大鼠36只,随机选取6只作为正常组,剩余大鼠采用密室烟熏法建立咳嗽高敏综合征模型。将造模成功大鼠随机分成5组,每组6只。加味芎蝎散高、中、低剂量组分别给予加味芎蝎散12 g/(kg·d)、6 g/(kg·d)、3 g/(kg·d)灌胃,磷酸可待因组给予磷酸可待因10 mg/(kg·d)灌胃,正常组及模型组给予等量蒸馏水灌胃,均连续灌胃3周。分别在灌胃1周、2周、3周末进行咳嗽反应检测,记录3 min内的咳嗽次数;灌胃3周后,HE染色观察肺组织病理形态,尼氏染色观察大脑皮质神经元尼氏体,免疫组化法检测支气管组织中P物质(SP)、降钙素基因相关肽(CGRP)、瞬态电压感受器阳离子通道(TRPV1)蛋白和大脑皮质中白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)表达情况。结果与正常组比较,模型组大鼠咳嗽次数明显增多(P<0.05);支气管黏膜上皮变性,平滑肌层排列紊乱、增生,管壁大量炎性细胞浸润;神经元细胞形态不规则,尼氏体减少;支气管组织中SP、CGRP、TRPV1蛋白表达积分光密度值和大脑皮质中IL-6、IL-1β表达积分光密度值均明显升高(P均<0.05)。与模型组比较,加味芎蝎散高、中剂量组大鼠咳嗽次数明显减少(P均<0.05),病理变化均有不同程度的减轻,支气管组织中SP、CGRP、TRPV1蛋白表达积分光密度值和大脑皮质中IL-6、IL-1β表达积分光密度值均明显降低(P均<0.05)。结论加味芎蝎散可以明显减轻咳嗽高敏综合征大鼠气道上皮及大脑皮质神经元病变,抑制咳嗽反射,机制可能与抑制神经源性炎症有关。

咳嗽变异性哮喘患儿血清25(OH)D_(3)、IL-6水平变化与T淋巴细胞免疫平衡的关系及预测预后的价值分析

目的分析咳嗽变异性哮喘(CVA)患儿血清25-羟维生素D_(3)[25(OH)D_(3)]、白介素-6(IL-6)水平变化与T淋巴细胞免疫平衡的关系及预测预后的价值。方法选取98例CVA患儿作为研究组,49例健康儿童作为对照组。比较两组一般资料、血清25(OH)D_(3)、IL-6水平、T淋巴细胞免疫平衡指标,分析研究组血清25(OH)D_(3)、IL-6水平与免疫平衡指标的相关性,比较治疗4周后不同预后患儿治疗前后血清25(OH)D_(3)、IL-6水平及变化值(以△表示治疗前后变化值的绝对值),分析△25(OH)D_(3)、△IL-6与预后的相关性及治疗前血清25(OH)D_(3)、IL-6预测预后的价值。结果研究组血清25(OH)D_(3)水平、外周血CD4^(+)T淋巴细胞百分比低于对照组,血清IL-6水平高于对照组(P<0.05);研究组血清25(OH)D_(3)水平与外周血CD4^(+)T淋巴细胞百分比呈正相关,血清IL-6水平与外周血CD4^(+)T淋巴细胞百分比呈负相关(P<0.05);预后不良患儿治疗前、治疗后血清25(OH)D_(3)水平低于预后良好患儿,IL-6水平高于预后良好患儿,△IL-6小于预后良好患儿(P<0.05);研究组△IL-6与预后呈正相关(P<0.05);治疗前血清25(OH)D_(3)、IL-6单独预测CVA患儿预后不良的曲线下面积(AUC)分别为0.784、0.764,与单独预测比较,联合预测的AUC(0.926)明显增大,NRI、IDI均>0(P<0.05)。结论CVA患儿血清25(OH)D_(3)、IL-6水平变化与T淋巴细胞免疫平衡失调有关,且各指标联合在预测患儿预后方面具有良好应用价值。

基于网络药理学探讨紫苏子—杏仁药对治疗咳嗽变异性哮喘的作用机制

目的 基于网络药理学探讨紫苏子—杏仁药对治疗咳嗽变异性哮喘(CVA)的潜在分子作用靶点及机制。方法 采用中药系统药理学数据库和分析平台(TCMSP)数据库对紫苏子—杏仁药对的有效活性成分进行筛选,并采用SwissTargetPrediction网站进行靶点预测。采用GeneCards数据库检索CVA相关靶点,借助Venny 2.1.0获取交集靶点,对交集靶点分别运用Cytoscape 3.9.1软件和STRING数据库构建主要活性成分—潜在治疗靶基因网络图和PPI蛋白互作网络,并筛选出关键有效活性成分和核心靶蛋白,通过DAVID数据库对交集靶点进行GO功能及KEGG通路的富集分析。结果 筛选出紫苏子—杏仁药对有效成分19个,与CVA相关靶点224个,核心靶点为AKT1、IL-6、TP53、SRC、MAPK3、EGFR、JUN、PTGS2、HSP90AA1、ESR1。GO功能富集分析显示分子功能165个、细胞组分79个、生物过程630个。KEGG通路富集分析显示得到信号通路155条,主要涉及cAMP信号通路、PI3K-Akt信号通路、癌症通路、化学致癌—受体激活通路、神经活性配体—受体相互作用等。结论 紫苏子—杏仁药对可通过多成分、多靶点、多通路的协同作用抗CVA。

名中医杨毅从“以平为期”理论探讨中医治疗肺癌思路

总结杨毅教授治疗肺癌的临床思路,临证时注重外感祛邪宣肺为要,因势利导。内伤调理脏腑为主,以平为安,辨证施治,匠心独运,验效颇丰。现择取杨师验案进行分析,为治疗肺癌拓宽思路,提高临床疗效。

宣肺化湿止咳汤联合西药治疗咳嗽变异性哮喘临床观察

目的研究宣肺化湿止咳汤治疗咳嗽变异性哮喘的临床效果及对呼出气一氧化氮(FeNO)数值的影响。方法选择2018年7月—2019年12月收治的120例咳嗽变异性哮喘患者作为研究对象,40例采用沙美特罗替卡松粉(舒利迭)吸入治疗作为西药组,40例采用宣肺化湿止咳汤治疗作为中药组,最后40例采用二者联合治疗作为联合组。观察三组治疗效果、咳嗽症状积分、FeNO水平、咳嗽生活质量以及不良反应情况。结果联合组的治疗总有效率为97.5%(39/40),明显高于西药组的80.0%(32/40)、中药组的82.5%(33/40),差异有统计学意义(P<0.05);治疗后联合组FeNO水平低于西药组和中药组,莱切斯特咳嗽问卷(LCQ)评分高于西药组和中药组,日间积分与夜间积分均低于西药组和中药组,差异均有统计学意义(P<0.05);西药组和中药组FeNO水平、LCQ评分、日间积分与夜间积分对比,差异无统计学意义(P>0.05)。结论宣肺化湿止咳汤联合西药治疗咳嗽变异性哮喘,效果较好,能明显减轻患者临床症状,提高生活质量,降低炎症反应,值得临床应用及推广。