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Structure and function of the fecal-associated microbiome in qi stagnation constitution
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作者 Lu Zhao Pengfei Zhao +3 位作者 Jianhua Zhen Guangrui Huang Yini Li Anlong Xu 《Journal of Traditional Chinese Medical Sciences》 2021年第2期115-123,共9页
Objective:To clarify the structural and functional characteristics of the gut microbiota in individuals with qi stagnation constitution(QSC)and identify the potential biomarkers related to QSC.Methods:This cross-secti... Objective:To clarify the structural and functional characteristics of the gut microbiota in individuals with qi stagnation constitution(QSC)and identify the potential biomarkers related to QSC.Methods:This cross-sectional study involved individuals with QSC and balanced constitution(BC)confirmed by TCM clinicians.The clinical features were recorded,and fecal samples were collected for 16S rDNA sequencing.The structure of the fecal-associated microbiome(FAM)was described by the alpha-diversity indexes,beta-distances,and relative abundances of dominant taxa.The differences in FAM distribution were analyzed by the Wilcoxon rank-sum test,MetagenomeSeq,and LEfSe analysis.The 16S rDNA gene sequences were assigned to the KEGG dataset to predict the functional information of bacterial metabolic pathways by using PICRUSt.Differences in functional pathways between groups were assessed with the Wilcoxon rank-sum test.The ROC curve based on specific operational taxonomic units(OTUs)was constructed,and the AUC was calculated.Results:Twenty-two individuals with BC and 8 with QSC were recruited.Significant differences between the two groups were found in body mass index,health status,and low-density lipoprotein,etc.There was no significant difference in the alpha-diversity index.PCoA showed no evident clustering of bacterial communities according to constitutions.Bacteroidaceae,Lachnospiraceae,Ruminococcaceae,and Prevotellaceae were the four common bacteria with high abundances.Notably,MetagenomeSeq,LEfSe analysis,and the Wilcoxon rank-sum test identified significantly different distributions of 66,42,and 36 OTUs,respectively.Predictive function analysis showed that 13 metabolic pathways were significantly differentially distributed,including those related to fatty acid synthesis.Five specific OTUs were selected as potential biomarkers of a QSC,and the AUC was 0.94.Conclusion:Individuals with QSC have unique FAM structure and related functional characteristics.Five specific OTUs were identified to serve as potentially effective biomarkers related to QSC. 展开更多
关键词 Traditional Chinese medicine constitution Balanced constitution qi stagnation constitution Fecal-associated microbiome BIOMARKER
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Rules of Ren Shunping's prescription for trearing Spleen Deficiency and Qi Stagnation Syndrome of Functional Dyspepsia Based on Data Mining
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作者 Yan-Bo Liu Xin-Tong Wang Shun-Ping Ren 《Journal of Hainan Medical University》 2020年第24期53-59,共7页
Objective:To explore the medication rules of Professor Ren Shunping treating spleen deficiency and qi stagnation syndrome of functional dyspepsia,so as to provide reference for clinical prevention and development of n... Objective:To explore the medication rules of Professor Ren Shunping treating spleen deficiency and qi stagnation syndrome of functional dyspepsia,so as to provide reference for clinical prevention and development of new drugs.Methods:The 144 Chinese herbal formulas considered as active prescribed by professor Ren Shunping for the first time treating the patients with spleen deficiency and qi stagnation syndrome of functional dyspepsia were collected,entered into TCM inheritance auxiliary platform(V2.5),and then mined by some data mining methods of the software,such as the association rules and unsupervised entropy hierarchical clustering.Results:This study involved 144 Chinese herbal formulas,including a total of 56 Chinese herbal medicines.Of these Chinese herbal medicines,the herbs of cold and warm nature,and pungent,bitter and sweet in flavors were used in a quite high frequency,all of which act on spleen,stomach,lungs,large intestine,liver and gallbladder meridians.One core Chinese herbal formula was excavated,composed of patchouli,perilla stem,radix bupleuri,scutellaria,ginger pinellia,codonopsispilosula,magnolia bark,tangerine peel,large-headed atractylodes,immature bitter orange,wood incense,fructus amomi,inula britannica chinensis,ginger,medicated leaven,fried rice and fried malt based on the association rules.And a total of 17 groups of core used drugs and 2 groups of new Chinese herbal formulas undiscovered were mined based on unsupervised entropy hierarchical clustering.Conclusion:In treating spleen deficiency and qi stagnation syndrome of functional dyspepsia,professor Ren is good at treating spleen deficiency and qi stagnation syndrome of functional dyspepsia from the perspective of"tong jiang",using the"five-in-one"strategy of strengthening the spleen,evacuating the liver,coming down qi from the stomach,dispersing lung,and bowel-reflexing to treat patients as a whole.And the herbal medicines were light in dose,lovely and mild in nature for the formulars.At the same time,he paid attention to the combination of syndromes and symptoms,and flexible arbitration. 展开更多
关键词 TCM inheritance support platfom Functional dyspepsia Spleen deficiency and qi stagnation SYNDROME Ren Shun-ping Rules of prescription
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Study on the relationship between syndrome characteristics degree and inflammatory factor and negative emotional scale in"double heart disease"patients with Qi stagnation blood stasis and heart gallbladder heat stagnation
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作者 Di Ma Jing Chen +1 位作者 Chao Ye Hai-Bin Zhao 《Journal of Hainan Medical University》 2021年第21期12-16,共5页
Objective:To Discuss the correlation between Hypersensitivity C-reactive Protein(Hs-CRP),Total Cholesterol(TC),Triglyceride(TG),negative emotion scale and TCM syndrome scores in“Double Heart Disease”patients with Qi... Objective:To Discuss the correlation between Hypersensitivity C-reactive Protein(Hs-CRP),Total Cholesterol(TC),Triglyceride(TG),negative emotion scale and TCM syndrome scores in“Double Heart Disease”patients with Qi stagnation blood stasis and heart gallbladder heat stagnation.Method:Fifty-two patients in Western Medicine Diagnosis of Double Heart Disease,in TCM syndrome identified as Qi stagnation blood stasis Heart gallbladder heat stagnation syndrome,detects it Hs-CRP,TC,TG levels by ELISA,use TCM Syndromes Scale to evaluate TCM Syndrome,use the Pittsburgh Sleep Quality Index(PSQI)and Self-rating symptom scale(SCL-90)to assess anxiety and sleep levels,analyze the correlation between TCM syndrome scores and Hs-CRP,TC,TG level,PSQI index,SCL-90 index.Result:There was a significant positive correlation between Hs-CRP,TG level and TCM Syndrome scores(P<0.05);TC level was postively correlated with TCM Syndrome scores,but there was no statistical significance(P>0.05);There was a significant positive correlation between PSQI index,SCL-90 index and TCM Syndrome scores(P<0.05).Conclusion:In“Double Heart Disease”patients with Qi stagnation blood stasis and heart gallbladder heat stagnation,there have characteristic syndrome changes in terms of inflammatory factor level,blood lipid level and negative emotion score;Which the above indexes can reflect the severity of TCM syndromes to a certain extent and provide the basis for the effective intervention treatment of TCM. 展开更多
关键词 Double heart disease qi stagnation blood stasis and heart gallbladder heat stagnation SYNDROMES Negative emotion scale High sensitivity C-reactive protein
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Evaluation of the Therapeutic Effect of Contrast-Enhanced Ultrasound on Different Types of Knee Osteoarthritis in the Elderly
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作者 Na Wen Yingcong Xiao 《Journal of Biosciences and Medicines》 CAS 2023年第5期1-8,共8页
Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast... Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast-enhanced ultrasonography, and to explore the application value of contrast-enhanced ultrasonography in knee joint diseases. Methods: A total of 57 patients diagnosed with knee osteoarthritis in Shaanxi University of Traditional Chinese Medicine from December 2019 to May 2021 were collected, and they were divided into qi stagnation and blood stasis type group (23 cases) and cold-dampness obstruction type group (34 cases) according to the traditional Chinese medicine method. All patients were given acupuncture combined with TCM fumigation and washing. All patients underwent musculoskeletal ultrasonography and contrast-enhanced ultrasonography before and after treatment, observed and recorded relevant data, and compared the treatment effects between the two groups. Results: 85.96% (49/57) of knee osteoarthritis (KOA) patients had suprapatellar bursa effusion, 42.1% (24/57) had iliotibial band bursae effusion, some of which had poor sound transmission, and thickened synovium was seen in most effusions, 33.33% (19/57) had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the Qi stagnation and blood stasis type group decreased after treatment (P Conclusion: Musculoskeletal contrast-enhanced ultrasonography was used to quantitatively evaluate the efficacy of TCM external therapy on KOA for different TCM constitutions. Dynamic observation of synovial lesions of knee osteoarthritis provides a valuable imaging method for evaluating the efficacy of traditional Chinese medicine. 展开更多
关键词 Contrast-Enhanced Ultrasound External Treatment of Traditional Chinese Medicine Knee Osteoarthritis qi stagnation and Blood Stasis Type Cold-Dampness Obstruction Type
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Effect of Zangfu ointment and massage therapy on functional constipation:a protocol for a randomised controlled trial
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作者 Xiao-Na Zhang Nai-Wei Zhang +4 位作者 Li-Bao An Bao-Tuan Zhao Wei-Fang Liu Bo-Yi Jia Hong-Jie Cheng 《Gastroenterology & Hepatology Research》 2023年第2期16-20,共5页
Introduction:Functional Constipation(FC)is a type of functional bowel disease that is in Clinically characterized by dysportia,decreased frequency of bowel movements,or incomplete bowel movements in the absence of irr... Introduction:Functional Constipation(FC)is a type of functional bowel disease that is in Clinically characterized by dysportia,decreased frequency of bowel movements,or incomplete bowel movements in the absence of irritable bowel syndrome syndrome,at least 6 months before diagnosis,and symptoms within the last 3 months.At present,commonly used drugs include enema and suppositories,laxatives,microecological preparations,gastrointestinal motility drugs and other treatments.However,the effect is limited.Traditional Chinese medicine(TCM)treatment of FC has advantages.Methods:In this randomized controlled study,244 eligible patients were randomly assigned in a 1:1 ratio to a treatment group(Zangfu ointment and massage therapy+Lactulose Oral Liquid)and a control group(Lactulose Oral Liquid)for 14 days.Number of spontaneous defecation per week and First defecation time will be used as primary outcomes,and Traditional Chinese Medicine(TCM)syndrome scores and syndrome scores,PAC-QOL form will be used as secondary outcomes.Blood routine,liver function,and renal function will be used as safety outcomes.The primary and secondary outcomes will be performed at 0th,7th,and 14th day,and the safety outcomes will be performed at 0th and 14th day.Ethics and dissemination:Ethical approval has been obtained from the Committee on Health Research Ethics of the Fangshan Hospital,Beijing University of Chinese Medicine,Beijing,People's Republic of China(FZY LK-2020-010)on September 18,2020.All patients will be provided oral and written information about the trial before screening.The study results will be disseminated by peer-review publications and conference presentations.Trial registration number:ChiCTR2000038754(registered on April 14,2021).This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial license,which permits others to distribute,remix,adapt,build upon this work non-commercially,and license their derivative works on different terms,provided the original work is properly cited,appropriate credit is given,any changes made indicated,and the use is non-commercial.STRENGTHS AND LIMITATIONS OF THIS STUDY(1)The efficacy of the Zangfu ointment and massage therapy is evaluated in a randomised,double-blind 2-week clinical trial in FC patients.(2)Form a complete and generalizable regimen for the treatment of FC(Qi stagnation)with the Zangfu ointment and massage therapy. 展开更多
关键词 functional constipation Zangfu ointment and massage therapy qi stagnation a randomized controlled clinical trial
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The Application of the Complementary and Alternative Therapies in Relieving Insomnia for Cancer Patients 被引量:1
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作者 Juan LIAO Bu-Xin HAN +2 位作者 Ling TANG Dong CAO Nan ZHAO 《Journal of Integrative Nursing》 2019年第1期21-26,共6页
Objective:To observe the curative effect of the complementary and alternative therapies in relieving insomnia for cancer patients.Method:According to the principle of randomization,with meeting the inclusion criteria,... Objective:To observe the curative effect of the complementary and alternative therapies in relieving insomnia for cancer patients.Method:According to the principle of randomization,with meeting the inclusion criteria,the 60 patients who were diagnosed as insomnia caused by liver qi stagnation were randomly divided into the control group and the intervention group.The intervention group(30 individuals treated with mini-needle therapy combined with TCM five elements music),the control group(30 individuals who were treated with single mini-needle therapy),the body buried needle 24 hours/time,5 times for a course of treatment,interval of 2 days between 2 courses,a total of 8 needles embedded.Pittsburgh sleep quality index(PSQI)scores of 2 groups were analyzed using SPSS19.0 statistical software.Results:The total effective rate was 86.1%in the intervention group,and 75.9%in the control group,the difference was statistically significant between 2 groups(P<0.05).The comparison of the PSQI score between the 2 groups propost treatment showed that there were statistically significant differences(P<0.05).The reduction rate of PSQI in the intervention group was 31.7%,indicating that 31.7%was effective,while 23.1%in the control group was ineffective.Conclusion:The mini-needle therapy combined with TCM five elements music could relieve insomnia caused by qi stagnation of liver in patients with advanced cancer. 展开更多
关键词 TCM five elements music Mini-acupuncture INSOMNIA qi stagnation of liver Advanced cancer
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Study on the pharmacological mechanism of chaihu shugan powder in the treatment of hepatocellular carcinoma
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作者 Xun Sun Jin-Wen Chai 《Clinical Research Communications》 2021年第4期18-21,共4页
Liver depression and qi stagnation type liver cancer accounts for a high proportion of primary liver cancer,western medicine has no special treatment for this type of liver cancer in addition to routine treatment,whil... Liver depression and qi stagnation type liver cancer accounts for a high proportion of primary liver cancer,western medicine has no special treatment for this type of liver cancer in addition to routine treatment,while patients with this type of liver cancer often show pain in the right flank,mass under the right side,chest depression and other clinical symptoms seriously affect the quality of life of patients with liver cancer and bring great trouble to patients and their families.Chaihu Shugan San,which originated from the General order of Medicine in the Ming Dynasty,has a serious impact on the quality of life of patients with liver cancer and brings great trouble to patients and their families.It is the representative prescription of soothing the liver and regulating qi in traditional Chinese medicine.in recent years,its clinical application and pharmacological action in liver cancer have been studied more and more deeply,but the anti-tumor pharmacological research and effective components of Chaihu Shugan Powder are still lack of systematic summary.Based on the relevant studies at home and abroad,this paper summarizes the anti-tumor mechanism and possible effective components of Chaihu Shugan Powder,so as to provide further pharmacodynamic material basis and mechanism reference for the further clinical application of primary liver cancer. 展开更多
关键词 Chaihu Shugan Powder liver depression and qi stagnation primary liver cancer clinical application
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Observation on the Therapeutic Effect of Shangjinbitong Powder(伤筋痹痛散)on Improving Acupoint Plaster
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作者 赵玉清 吴贞 《World Journal of Integrated Traditional and Western Medicine》 2022年第4期17-21,共5页
Objective:To study the therapeutic effect of Shangjinbitong Powder(伤筋痹痛散)on improving acupoint plaster,in order to provide some scientific basis for clinical use.Methods:This project was carried out from June 202... Objective:To study the therapeutic effect of Shangjinbitong Powder(伤筋痹痛散)on improving acupoint plaster,in order to provide some scientific basis for clinical use.Methods:This project was carried out from June 2020 to January 2021,30 patients with low back pain in the outpatient department of orthopedics and traumatology in our hospital and 30 patients with low back pain in the rehabilitation department of Fuping County Hospital of Traditional Chinese Medicine were selected as the research objects.Patients with low back pain in our hospital were treated with Shangjinbitong Powder as the control group,and patients in rehabilitation department of Fuping County Hospital of Traditional Chinese Medicine as the research group were treated with acupoint plaster improved by Shangjinbitong Powder.After one week of treatment,the effective rates of the two groups were compared.Results:The effective rate of treatment in the study group was significantly higher than that in the control group(P<0.05).There were no adverse reactions such as infection,scald and bleeding in the study group and the control group during the treatment.Conclusion:Shangjinbitong Powder improved acupoint plaster has good curative effect,convenient use,certain safety and clinical popularization value. 展开更多
关键词 Shangjinbitong Powder(伤筋痹痛散) Acupoint plaster of traditional Chinese medicine Effective rate of treatment qi stagnation and blood stasis Pain assessment scale
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Summary of 32 Patients with Cardiac Syndrome X Treated by TCM Therapy of Regulating Qi Relieving Chest Stuffiness and Promoting Blood Circulation 被引量:8
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作者 毛静远 葛永彬 +13 位作者 王恒和 王强 张运 虞东玲 张宇 黄芪 赵志强 赵桂峰 王占武 马学鹏 张振鹏 李明 邵磊 赵春燕 《Chinese Journal of Integrative Medicine》 SCIE CAS 2007年第1期17-21,共5页
Objective: To evaluate the clinical effect of Liqi Kuanxiong Huoxue method (宽胸活血,LKH, traditional Chinese medicine, TCM therapeutic method for regulating qi, relieving chest stuffiness and promoting blood circul... Objective: To evaluate the clinical effect of Liqi Kuanxiong Huoxue method (宽胸活血,LKH, traditional Chinese medicine, TCM therapeutic method for regulating qi, relieving chest stuffiness and promoting blood circulation) in treating patients with cardiac syndrome X (CSX). Methods: The prospective, non-randomized controlled study was conducted on 51 selected patients with CSX, who were non-randomly assigned to 2 groups, the treated group treated with LKH in addition to the conventional treatment (32 patients), and the control group treated with conventional treatment (19 patients) like nitrate, diltiazem hydrochloride, etc. The treatment course was 14 days. The changes of such symptoms as angina pectoris, TCM syndrome and indexes of treadmill exercise test before and after treatment were observed. Results: After treatment, such symptoms as chest pain and stuffy feeling and palpitation in the treated group were improved more than those in the control group (P〈0.05); the total effective rate on angina pectoris and TCM syndrome in the treated group was better than that in the control group (P〈0.05). The treadmill exercise test showed that the maximal metabolic equivalent (Max MET), the time of angina onset and ST segment depression by 0.1 mV were obviously improved after treatment in both groups, but the improvement in the treated group was better than that in the control group respectively (P〈0.05). Conclusion: The LKH method could reduce the frequency of angina attacks and improve the clinical condition of patients with CSX. 展开更多
关键词 cardiac syndrome X qi stagnation phlegm obstruction and blood stasis regulating qi relieving chest stuffiness and promoting blood circulation method
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Research on the Progress of Treating Gastroesophageal Reflux Disease with Modified Classic Traditional Chinese Medicine Prescription
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作者 Haojie Fu Yahui Huang Xiaonan Shi 《Proceedings of Anticancer Research》 2024年第3期1-6,共6页
Gastroesophageal reflux disease (GERD) is a high-incidence digestive system disease. Western medicine mainly uses drugs such as proton pump inhibitors to inhibit gastric acid secretion, but some patients are accompani... Gastroesophageal reflux disease (GERD) is a high-incidence digestive system disease. Western medicine mainly uses drugs such as proton pump inhibitors to inhibit gastric acid secretion, but some patients are accompanied by symptoms such as non-acid reflux and gas reflux, which cannot effectively treat the disease. It is necessary to actively explore other treatment schemes. Traditional Chinese medicine (TCM) has a long history of research on gastroesophageal reflux disease, which emphasizes the treatment based on syndrome differentiation as a whole. Through the treatment of various and multi-component TCM prescriptions, the patient’s body condition can be adjusted, and the treatment effect on gastroesophageal reflux disease is reliable, which has obvious therapeutic advantages. To further clarify the treatment of gastroesophageal reflux disease, this study reviewed and analyzed the research progress of the treatment of liver disease with modified prescriptions, and the report is as follows. 展开更多
关键词 Addition and subtraction of classic TCM prescriptions Gastroesophageal reflux disease Research progress Liver and stomach stagnation heat qi stagnation and phlegm obstruction
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针刺联合血府逐瘀汤治疗睫状视网膜动脉阻塞1例
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作者 杜福生 段燕萍 平洁洁 《World Journal of Acupuncture-Moxibustion》 CSCD 2023年第2期184-187,共4页
The report presented a case of cilioretinal artery occlusion. A 22-year-old woman, with a complain of reduced visual acuity of the right eye for 4 days, presented with blurred vision and inferior visual field defect a... The report presented a case of cilioretinal artery occlusion. A 22-year-old woman, with a complain of reduced visual acuity of the right eye for 4 days, presented with blurred vision and inferior visual field defect at the time of visit. Acupuncture combined with herbal medication of Xuefu Zhuyu Decoction was applied for the patient. Main acupoints included Jingming (BL1), Qiuhou (EX-HN7), Sizhukong (TE23), Yuyao (EX-HN3), Sibai (ST2), Fengchi (GB20), Hegu (LI4), Guangming (GB37) and Taichong (LR3). The needles were remained for 30 min in each session, which was given once daily for 10 days. The modified Xuefu Zhuyu Decoction (Semen Juglandis [10 g], Flos Carthami [10 g], Rhizoma Chuanxiong [10 g], Radix Paeoniae Rubra [10 g], Radix Rehmanniae [15 g], Radix Angelicae Sinensis [10 g], Radix Bupleuri [10 g], Fructus Aurantii [5 g], Radix et Rhizoma Glycyrrhizae Praeparata cum Melle [6 g], Fructus Crataegi [20 g], Endothelium Corneum Gigeriae Galli [10 g], Scorpio [5 g], Herba Leonuri [15 g], Radix Astragali [35 g] and Ramulus Cinnamomi [10 g]) was applied one dose daily for 7 days. After 7 days of treatment, the visual acuity of the patient was increased from 0.04 to 0.6 in the right eye with spectacles, the retinal fundus edema disappeared and the inferior vision field defect relieved. With acupuncture treatment for another 10 days, it was observed that the visual acuity of the patient's right eye was improved and the inferior vision field defect reduced. There was no symptom recurrence and the visual acuities in both eyes of the patient were 1.0 with spectacles till the latest follow-up. This therapy provided a new idea and approach to treat cilioretinal artery occlusion. 展开更多
关键词 Xuefu Zhuyu decoction Kinetic acupuncture technique qi and blood stagnation Cilioretinal artery occlusion
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Relationship between Two Blood Stasis Syndromes and Inflammatory Factors in Patients with Acute Coronary Syndrome 被引量:19
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作者 MA Cai-yun LIU Jing-hua +11 位作者 LIU Jian-xun SHI Da-zhuo XU Zhen-ye WANG Shao-ping JIA Min ZHAO FU-hai JIANG YUE-rong MA Qin PENG Hong-yu LU Yuan ZHENG Ze REN Feng-xue 《Chinese Journal of Integrative Medicine》 SCIE CAS CSCD 2017年第11期845-849,共5页
Objective: To investigate the relationship between inflammatory factors and two Chinese medicine(CM) syndrome types of qi stagnation and blood stasis(QSBS) and qi deficiency and blood stasis(QDBS) in patients w... Objective: To investigate the relationship between inflammatory factors and two Chinese medicine(CM) syndrome types of qi stagnation and blood stasis(QSBS) and qi deficiency and blood stasis(QDBS) in patients with acute coronary syndrome(ACS). Methods: Sixty subjects with ACS, whose pathogenesis changes belongs to qi disturbance blood stasis syndrome, were divided into 2 groups: 30 in the QSBS group and 30 in the QDBS group. The comparative analysis on them was carried out through comparing general information, coronary angiography and inflammatory factors including intracellular adhesion molecule-1(ICAM-1), chitinase-3-like protein 1(YKL-40) and lipoprotein-associated phospholipase A2(Lp-PLA2). Results: Compared with the QSBS group, Lp-PLA2 and YKL-40 levels in the QDBS group showed no-significant difference(P〉0.05); ICAM-1 was significantly higher in the QDBS group than in the QSBS group in the pathological processes of qi disturbance and blood stasis syndrome of ACS(P〈0.05). Conclusion: Inflammatory factor ICAM-1 may be an objective basis for syndrome typing of QSBS and QDBS, which provides a research direction for standardization research of CM syndrome types. 展开更多
关键词 coronary heart disease Chinese medicine qi deficiency and blood stasis syndrome qi stagnation and blood stasis syndrome inflammation intracellular adhesion molecule-1 chitinase-3-like protein 1 lipoprotein-associated phospholipase A2
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