Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

Network pharmacology-based exploration of molecular mechanisms underlying therapeutic effects of Jianpi Huatan Quyu recipe on chronic heart failure with spleen Qi deficiency syndrome

BACKGROUND Chronic heart failure is a complex clinical syndrome.The Chinese herbal compound preparation Jianpi Huatan Quyu recipe has been used to treat chronic heart failure;however,the underlying molecular mechanism is still not clear.AIM To identify the effective active ingredients of Jianpi Huatan Quyu recipe and explore its molecular mechanism in the treatment of chronic heart failure.METHODS The effective active ingredients of eight herbs composing Jianpi Huatan Quyu recipe were identified using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform.The target genes of chronic heart failure were searched in the Genecards database.The target proteins of active ingredients were mapped to chronic heart failure target genes to obtain the common drugdisease targets,which were then used to construct a key chemical componenttarget network using Cytoscape 3.7.2 software.The protein-protein interaction network was constructed using the String database.Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed through the Metascape database.Finally,our previously published relevant articles were searched to verify the results obtained via network pharmacology.RESULTS A total of 227 effective active ingredients for Jianpi Huatan Quyu recipe were identified,of which quercetin,kaempferol,7-methoxy-2-methyl isoflavone,formononetin,and isorhamnetin may be key active ingredients and involved in the therapeutic effects of TCM by acting on STAT3,MAPK3,AKT1,JUN,MAPK1,TP53,TNF,HSP90AA1,p65,MAPK8,MAPK14,IL6,EGFR,EDN1,FOS,and other proteins.The pathways identified by KEGG enrichment analysis include pathways in cancer,IL-17 signaling pathway,PI3K-Akt signaling pathway,HIF-1 signaling pathway,calcium signaling pathway,cAMP signaling pathway,NF-kappaB signaling pathway,AMPK signaling pathway,etc.Previous studies on Jianpi Huatan Quyu recipe suggested that this Chinese compound preparation can regulate the TNF-α,IL-6,MAPK,cAMP,and AMPK pathways to affect the mitochondrial structure of myocardial cells,oxidative stress,and energy metabolism,thus achieving the therapeutic effects on chronic heart failure.CONCLUSION The Chinese medicine compound preparation Jianpi Huatan Quyu recipe exerts therapeutic effects on chronic heart failure possibly by influencing the mitochondrial structure of cardiomyocytes,oxidative stress,energy metabolism,and other processes.Future studies are warranted to investigate the role of the IL-17 signaling pathway,PI3K-Akt signaling pathway,HIF-1 signaling pathway,and other pathways in mediating the therapeutic effects of Jianpi Huatan Quyu recipe on chronic heart failure.

Pharmacokinetics of traditional Chinese syndrome and recipe:a hypothesis and its verification(Ⅰ)

AIM To propose a hypothesis defining theabsorption,distribution,metabolism andelimination of traditional Chinese recipe（TCR）-component in blood of healthy subjects andpatients,and estimate its correctness.METHODS The pharmacokinetics（PK）of samedose of drug was studied in the animal model oftraditional Chinese syndrome（S）and healthyanimals.The classification,terminology,concept and significance of the hypothesis wereset forth with evidence provided in the presentstudy.The hypotheses consisted of traditionalChinese syndrome PK（S-PK）and traditionalChinese recipe PK（R-PK）.Firstly,the observedtetramethylpyrazine（TMP）PK in healthy,chronically reserpinized rats（rat model ofspleen deficiency syndrome,RMSDS）andRMSDS treated with Sijunzi decoction（SJZD）forconfirmation were used to verify S-PK; secondly,the ferulic acid（FA）PK in healthy andhigh molecular weight dextran（HMWD）-inducedrabbit model with blood stasis syndrome（RDBSS）was also used to verify S-PK;andlastly,TMP PK parameters in serum of healthyrats after orally taken Ligusticum wallichii（LW）,LW and Salvia miltiorrhiza（LW&SM）decoctions were compared to verify R-PK.RESULTS The apparent first-order absorption[Ka,（13.61±2.56）h-1,area under the blooddrug concentration-time curve[AUC,（24.88±9.76）μg.h-1mL-1],maximum drug concentration[Cmax,（4.82±1.23）μg·mL-1]of serum TMP inRMSDS were increased markedly（P【0.05）compared with those[Ka=（5.41±1.91）h-1,AUC=（5.20±2.57）μg·h-1·mL-1,Cmax=（2.33±1.77）μg·mL-1]of healthy rats（HR）.Theapparent first-order rate constant for α and βdistribution phase[α=（0.38±0.09）h-1,β=（0.06±0.03）h-1,the apparent first-orderintercompartmental transfer rate constants[K10=（0.24±0.07）h-1,K12=（0.11±0.02）h-1,K21=（0.11±0.02）h-1]of serum TMP in RMSDS weredecreased significantly（P【0.01）comparedwith those[K10=（0.88±0.20）h-1,K12=（1.45±0.47）h-1,K21=（0.72±0.22）h-1]of HR.However,no apparent differences occurredbetween HR and RMSDS treated with SJZD.Theserum FA concentration and its AUC[（5.6690±2.3541）μg·h-1·mL-1] in RMBSS were also higherthan those[AUC=（2.7566±0.8232）μg·h-1·mL-1]of healthy rabbits（P【0.05）.The Ka（11.51±2.82）h-1,AUC（0.84±0.17）μg·h-1·mL-1of LW & SM-derived TMP in serum weremuch lower（P【0.05）than those[Ka=（19.58±4.14）h-1,AUC=（1.27±0.26）μg·h-1·mL-1]ofLW-derived TMP in serum after oral decoctions.CONCLUSION The SDS and blood stasissyndrome state could affect significantly thepharmacokinetic parameters of drugs and theabnormal SDS pharmacokinetic parameters couldbe normalized by SJZD.The combination ofChinese medicine in TCR could reciprocallyaffect the pharmacokinetic parameters of othercomponents absorbed into the systemiccirculation.These results support the S-and R-PK hypothesis.

Efficacy of Gastrosis No.1 Compound on Functional Dyspepsia of Spleen and Stomach Deficiency-Cold Syndrome:A Multi-Center,Double-Blind,Placebo-Controlled Clinical Trial

To assess the efficacy and safety of Gastrosis No.1 compound in the treatment of functional dyspepsia with Spleen （Pi） and Stomach （Wei） deficiency-cold syndrome. Methods： A randomized, double-blind, placebo-controlled trial was performed in 5 centers. Patients with functional dyspepsia （FD） of Spleen-deficiency and qi-stagnation syndrome （162 cases） were randomly assigned to groups given Chinese herbal medicine （CHM） Gastrosis No.1 compound or placebo in a 2：1 ratio. This trial included a 4-week treatment period and a 4-week follow-up period. The outcomes were the dyspepsia symptom scores （measured by total dyspepsia symptom scale and single dyspepsia symptom scale） and syndromes of traditional Chinese medicine score （measured by traditional Chinese medicine syndrome scale）. The outcomes were noted at weeks 0, 4 and 8. Results： Compared with patients in the placebo group, patients in the CHM group showed significant improvement in the dyspepsia symptom scores as rated by patients and investigators （P〈0.01）, and also showed improvement in syndromes of traditional Chinese medicine score （P〈0.01）. No serious adverse event was reported. Safety tests obtained after 4 weeks of treatment showed no abnormal values. Conclusion： CHM Gastrosis No.1 compound was effective and safe in the treatment of functional dyspepsia with Spleen and Stomach deficiency-cold syndrome.

Study of establishing disease-syndrome combined with animal model for immune thrombocytopenic purpura without additional conditions

Objective:To explore the feasibility of establishing the disease-syndrome combined animal model for immune thrombocytopenic purpura(ITP)without additional conditions.Methods:Three batches of data related to the ITP model mice obtained by replication at different time were analyzed,and whether the APS-injected model mice replicated through the passive immune modeling method could simulate the pathogenesis and clinical characteristics of human ITP was evaluated according to the differentiation criteria for diseasesyndrome combined model.Results:The APS-injected replicated ITP model mice possessed the following traits:(1)Compared with the normal group,the platelet count was significantly decreased,and coagulation time was significantly increased in the model group(P<.01).(2)Compared with the normal group,the medullary thrombocytogenous megakaryocytes were significantly decreased(P<.05,.01,.001).(3)The APS-injected sites and other parts of the model mice had spontaneous hemorrhage.(4)Behavioral changing signs were observed 1 week after the modeling(i.e.low activity,delayed activity,poor appetite,skin petechia/hemorrhage and spontaneous hemorrhage at the injected sites or other parts),and were getting more and more severe.Conclusion:According to the syndrome differentiation criteria for disease-syndrome combined model of ITP,the APS-injected animal model of ITP replicated through the passive immune modeling method without additional conditions possesses the characteristics of disease-syndrome combined model.It provides an ideal tool for the development of traditional Chinese medicine pharmacology experiment.

益心泰颗粒对慢性心衰(心气虚兼血瘀水停证)大鼠AMPK、PGC-1α的影响

目的观察益心泰颗粒对慢性心力衰竭(CHF)(心气虚兼血瘀水停证)大鼠AMPK、PGC-1α的影响。方法采用丙硫氧嘧啶灌胃及阿霉素腹腔注射复制CHF(心气虚兼血瘀水停证)模型大鼠,将造模成功大鼠分为模型组与益心泰低、中、高剂量组和曲美他嗪组;另设正常对照组。灌胃4周后观察心肌组织病理结构,检测LVEF、血清NT-proBNP及心肌组织FFA、ATP/AMP、LAC、pAMPK、AMPK、PGC-1α水平。结果与模型组比较,益心泰颗粒低、中、高剂量组及曲美他嗪组LVEF、心肌组织ATP/AMP值、心肌组织p-AMPK、AMPK、PGC-1α相对灰度值均明显升高(P<0.05或P<0.01),血清NT-proBNP及心肌组织FFA、LAC明显降低(P<0.05或P<0.01)。结论益心泰颗粒能促进慢性心力衰竭(心气虚兼血瘀水停证)大鼠AMPK、PGC-1α表达,改善心肌能量代谢。

NFAT3在充血性心力衰竭气虚血瘀证患者舌苔液中的表达及意义

目的研究活化T细胞核因子3(nuclear factor of activated T-cells 3,NFAT3)在充血性心力衰竭(congestive heart failure,CHF)气虚血瘀证患者舌苔液中的表达及与临床指标相关性,初步拟定该证候的诊断界值。方法收集CHF气虚血瘀证患者及健康对照者各30例,酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)检测舌苔液中NFAT3的含量。结果NFAT3在CHF气虚血瘀证患者舌苔液的含量为(481.40±103.00)pg/mL,明显高于健康对照者舌苔液的含量[(237.90±156.50)pg/mL](P<0.01);且随着美国纽约心脏协会(New York Heart Association,NYHA)心功能分级的增加,CHF气虚血瘀证患者舌苔液中NFAT3含量不断升高(P<0.01);CHF气虚血瘀证患者舌苔液NFAT3与NYHA心功能分级呈正相关性(r=0.927,P<0.01),与B型脑钠肽(brain natriuretic peptide,BNP)(r=0.806,P<0.01)呈正相关性,与左室射血分数(left ventricular ejection fraction,LVEF)呈负相关性(r=-0.739,P<0.01)。绘制受试者操作特性曲线(receive operating characteristic,ROC)初步拟定舌苔液清中NFAT3诊断CHF气滞血瘀证的界值为363.37 pg/mL,曲线下面积为0.91。结论NFAT3能够反映CHF病情轻重程度,可为CHF气虚血瘀证提供客观化、量化的参考和依据。

健脾固肾化瘀方治疗脾肾两虚夹瘀型糖尿病肾脏病的疗效及对相关生物标志物的影响

[目的]探讨健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型糖尿病肾脏病(DKD)的临床疗效以及其对患者血清基质金属蛋白酶-9(MMP-9)、单核细胞趋化因子-1(MCP-1)和血管内皮生长因子(VEGF)水平的影响。[方法]选择沧州中西医结合医院2019年1月—2021年5月纳入80例脾肾两虚夹瘀型DKD患者作为研究对象,采用随机数字表法分成观察组与对照组各40例。观察组给予健脾固肾化瘀方联合氯沙坦钾片治疗,对照组单用氯沙坦钾片治疗,连续治疗12周后观察两组临床疗效。治疗前后检测受试者血糖[空腹血糖(FPG)、餐后2 h血糖(2 h PG)和糖化血红蛋白(HbA1c)]、血脂[总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)]及肾功能指标[尿微量白蛋白/尿肌酐比值(UACR)、肌酐(SCr)和尿素氮(BUN)]。选用酶联免疫吸附法测定血清MMP-9、MCP-1和VEGF水平。并统计两组不良反应情况。[结果]观察组总有效率为92.50%(37/40),较对照组72.50%(29/40)有所提高(P<0.05)。两组治疗后FPG、2 h PG和HbA1c均较治疗前降低(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后血清TC、TG和LDL-C浓度均较治疗前下降(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后UAER和血清SCr、BUN水平均较治疗前降低(P<0.05),且均以观察组的改善更显著(P<0.01)。两组治疗后血清MMP-9水平均较治疗前升高(P<0.05),血清MCP-1、VEGF浓度均较治疗前下降(P<0.05);且治疗后,观察组对血清MMP-9水平的升高作用及对血清MCP-1、VEGF水平的降低作用较对照组更显著(P<0.01)。所有患者均无明显不良反应发生。[结论]应用健脾固肾化瘀方联合氯沙坦钾片治疗脾肾两虚夹瘀型DKD能安全有效地上调患者MMP-9表达水平,下调MCP-1、VEGF表达水平,改善肾功能,整体疗效确切。

慢性心力衰竭气虚血瘀证潜在亚组人群特征探索研究

目的探索慢性心力衰竭(CHF)气虚血瘀证潜在亚组人群,为心力衰竭的中医精准辨治提供客观依据。方法收集126例CHF气虚血瘀证患者的19种症状/体征指标和21种生化指标,利用R和Python软件进行K-mediods聚类算法分析,以轮廓系数确定最佳的聚类数目。组间比较,连续变量采用Kruskal-Wallis检验,分类变量采用Pearson's chi-squared检验或者Fisher's exact检验。结果CHF气虚血瘀证患者被聚类为3组,组间比较发现,气喘、不寐、颈脉怒张、纳差、畏寒5个症状/体征以及NYHA分级、氨基末端脑钠肽前体(NT-proBNP)、红细胞比容、尿素氮4个临床指标差异具有统计学意义(P<0.05)。第1组人群整体各症状/体征发生频率和临床指标严重程度相对较低;第2组人群以颈脉怒张发生频率较其他组高为特征,且促甲状腺激素、总胆固醇及低密度脂蛋白有偏高趋势,血小板有偏低的趋势;第3组人群以畏寒、纳差、不寐的发生率较其他组显著升高为特征,伴随尿素氮增高、红细胞比容降低。结论CHF气虚血瘀证潜在3种亚型,分别是气虚血瘀证本证型、气虚血瘀兼痰浊型、气虚血瘀兼阳虚型。

基于脾火论辨治原发性干燥综合征

基于脾火论辨治原发性干燥综合征(pSS)。论述了脾火论的理论内涵,并区分脾火与阴火及其他脏腑之火的差异。阐释了脾火论与pSS的相关性,认为脾气亏虚,运化无权,脾不升清,郁而化火是pSS病机关键;久而病及他脏,导致络脉瘀滞是pSS的病机转化特点。以健脾益气,除火润燥,生津通络为pSS的治疗大法,为pSS的中医辨治提供思路与方法。

破格救心汤加减对心力衰竭合并室性心律失常患者生物标志物和近期不良心血管事件的影响

目的评价破格救心汤加减对心力衰竭合并室性心律失常患者生物标志物和近期不良心血管事件的影响。方法将88例心力衰竭合并室性心律失常患者随机分为对照组与观察组各44例。对照组进行抗心衰治疗,并口服美托洛尔缓释片和盐酸胺碘酮胶囊。观察组在对照组治疗的基础上口服破格救心汤加减治疗。比较治疗前后左室射血分数(LVEF)、每搏心输出量(SV)、左心室收缩末期内径(LVESD)、正常窦性心搏间期标准差(SDNN)、校正TP-Te间期(TP-Tec)每5分钟窦性心搏间期平均值的标准差(SDANN)、校正QT间期(QTc)和正常相邻R-R间期差值>50ms的百分比(Pnn50%);检测N末端B型利钠肽原(NT-proBNP)、生长分化因子15(GDF-15)可溶性肿瘤生成抑制因子-2(sST-2)和半乳糖凝集素-3(GAL-3)水平;记录近期不良心血管事件;进行治疗前后阳气亏虚血瘀证评分;比较心功能疗效和室性心律失常疗效。结果治疗后,观察组心功能疗效和室性心律失常疗效的总有效率均高于对照组(P<0.05);两组患者LVEF、SV升高,LVESD降低(P<0.05),均以观察组更明显(P<0.05);两组患者NT-proBNP、GAL-3、GDF-15和sST2水平下降(P<0.05),且观察组低于对照组(P<0.05);两组患者主要症状评分及阳气亏虚血瘀证总积分降低(P<0.05),且观察组低于对照组(P<0.05);两组患者QTc、TP-Tec减少,SDNN、SDANN和Pnn50%增加(P<0.05),且观察组改善明显(P<0.05)。观察组近期不良心血管事件累积发生率低于对照组(P<0.05)。结论破格救心汤加减方联合西医常规疗法治疗心力衰竭合并室性心律失常,能够抑制心室重构,提高心功能,减少不良心血管事件发生,临床疗效优于单纯的西医治疗。

Efficacy of Yangyin Yiqi Huoxue Granule (养阴益气活血颗粒) in Treatment of Ischemic Stroke Patients with Qi-Yin Deficiency and Blood Stasis Syndrome: A Randomized, Double-Blind, Multicenter, Phase-2 Clinical Trial

Objective To evaluate the efficacy and safety of Yangyin Yiqi Huoxue Granule(养阴益气活血颗粒,YYHG)in the treatment of ischemic stroke(IS)patients with qi-yin deficiency and blood stasis syndrome(QYDBSS),and to explore its effective dosage.Methods The total of 288 patients were randomly assigned to the YYHG high-dose,YYHG low-dose,positive control(administered Xiaoshuantong Granule,XSTG,消栓通颗粒),or placebo control(administered inert granule)groups(72 cases per group)by software-drived competitive block randomization.The trial was conducted for a 28-day period,with a 180-day follow-up period.The primary outcome was the comprehensive curative evaluation,and secondary outcomes were the National Institute of Health Stroke Scale(NIHSS)score,Barthel activities of daily living(ADL)index score,the quality of life index(QLI)score,and the Chinese medicine syndrome(CMS)score.All analyses were done on an intention-to-treat basis.The clinical safety was also assessed.Results The total of 288 participants were recruited between June 1,2008 and September 30,2009,and 287 patients received intervention;the treatment groups were well balanced at baseline.The comprehensive cure rates of YYHG high-dose,low-dose,positive and placebo control groups were 63.38%,31.94%,36.11%and 6.14%,respectively;there was a statistical difference between the two groups(P<0.01),while the high-dose YYHG treatment group was significantly higher than the other 3 groups(P<0.01).The improvement of NIHSS,ADL,QLI and CMS scores of the YYHG high-dose and low-dose groups was significantly better than that of the positive control group and the placebo control group(P<0.05).In terms of improving the classification of the NIHSS scale and the assessment of the ADL scale,the YYHG high-dose group was significantly better than the other three groups(P<0.05),and the YYHG low-dose group was better than the placebo control group(P<0.01).At the same time,except for the QLI score,the high-dose group was better than the low-dose group(P<0.05).In terms of safety,adverse reactions after YYHG treatment were generally mild(3.78%),and no serious adverse reactions have been reported.Conclusion YYHG is safe and effective in the treatment of IS patients with QYDBSS.

脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效及转录组学研究

目的观察脉通君安汤治疗气虚血瘀型冠心病心绞痛的临床疗效,并通过转录组学方法初步阐明其可能的作用机制。方法将符合纳入标准的140例气虚血瘀型冠心病心绞痛患者依据随机数字法分为治疗组、对照组各70例,治疗期间对照组脱落3例。对照组予冠心病二级预防西医基础治疗,治疗组在对照组治疗基础上加服脉通君安汤,2组疗程均为8周。治疗前后评估2组患者中医证候积分、加拿大心血管学会(Canadian cardiovascular society,CCS)心绞痛分级、西雅图量表(Seattle angina questionnaire,SAQ)评分、焦虑自评量表(Self-rating anxiety scale,SAS)评分、抑郁自评量表(Self-rating depression scale,SDS)评分及不良反应,并基于性别、年龄、病程相匹配原则选取9例患者治疗前后外周血进行转录组学测序。结果治疗后,2组患者中医证候积分均明显下降(P<0.01),治疗组在改善胸痛、胸闷、气短、神倦乏力及总分方面优于对照组(P<0.05,P<0.01);治疗组CCS心绞痛分级总改善率优于对照组(P<0.05);2组治疗前后SAQ、SAS及SDS评分均显著改善(P<0.01),治疗组SAQ评分改善优于对照组(P<0.05,P<0.01)。转录组学结果显示,治疗前后具有显著差异表达的mRNA有862个,包括509个上调,353个下调;GO分析结果显示差异表达的mRNA生物学过程有666条,主要包括病毒基因表达、翻译启动、RNA分解代谢过程等,细胞组分112条,主要包括黏着斑、核糖体亚基、核斑点等;分子功能有94条,主要包括双链RNA结合、钙黏蛋白结合、转录共调节因子活性等;KEGG分析结果显示差异mRNA富集信号通路包括20条,主要包括甘油磷脂代谢通路、单磷酸腺苷激活的蛋白激酶(AMP-activated protein kinase,AMPK)信号通路、核糖体通路等。结论脉通君安汤能够改善气虚血瘀型冠心病心绞痛患者临床症状,其作用机制为多靶点多通路,可能与甘油磷脂代谢通路、AMPK信号通路、核糖体通路的调节相关。

真武汤合血府逐瘀汤治疗慢性心力衰竭气虚血瘀证的临床效果

目的:探讨真武汤合血府逐瘀汤治疗慢性心力衰竭气虚血瘀证的临床效果.方法:选取2023年5—9月北海市第二人民医院收治的慢性心力衰竭气虚血瘀证患者73例作为观察对象,随机分为对照组(36例,西药治疗)与观察组(37例,在对照组基础上联合真武汤合血府逐瘀汤治疗).比较两组心功能指标、中医证候积分、血脂水平.结果:治疗后,观察组左室舒张末期内径、左室收缩末期内径、左室射血分数优于对照组,差异有统计学意义(P<0.05);观察组胸闷憋气、喘息、心悸和水肿评分低于对照组,差异有统计学意义(P<0.05);观察组甘油三酯、总胆固醇、高密度脂蛋白胆固醇水平优于对照组,差异有统计学意义(P<0.05).结论:应用真武汤合血府逐瘀汤联合西药治疗慢性心力衰竭气虚血瘀证患者,能够改善其心功能、血脂指标及临床症状.

严氏苍山太阳炷燎穴位敷贴治疗阳虚血瘀型慢性心力衰竭的临床研究

目的观察严氏苍山太阳炷燎穴位敷贴治疗阳虚血瘀型慢性心力衰竭的临床疗效。方法将145例阳虚血瘀型慢性心力衰竭患者随机分为对照组73例、治疗组72例,两组均给予标准化西药治疗,对照组加用空白自发热贴膏,治疗组加用“严氏苍山太阳炷燎穴位敷贴”药物自发热贴膏,两组疗程均为90 d。观察临床疗效,比较中医证候积分、中医主次症与兼症分层、明尼苏达心力衰竭生活质量量表(MLHFQ)评分、纽约心脏病协会(NYHA)心功能分级、6 min步行试验(6MWT)距离以及B型钠尿肽(BNP)水平等指标的变化情况。结果①试验过程中,对照组脱落8例、治疗组脱落7例,最终完成试验者130例,其中治疗组65例、对照组65例。②治疗前后组内比较,两组中医证候积分均降低(P<0.05);组间治疗后比较,治疗组积分下降更为明显(P<0.05)。③治疗后,治疗组中医主次症与兼症分层得到改善(P<0.05),且治疗组的改善情况优于对照组(P<0.05)。④治疗前后组内比较,两组MLHFQ评分均降低(P<0.05);组间治疗后比较,治疗组MLHFQ评分较对照组显著降低(P<0.05)。⑤治疗后,两组NYHA心功能分级均得到改善(P<0.05),且治疗组的改善情况优于对照组(P<0.05)。⑥治疗前后组内比较,两组6MWT距离均较治疗前增加(P<0.05);组间治疗后比较,治疗组6MWT距离增加较对照组更明显(P<0.05)。⑦治疗前后组内比较,两组BNP水平均降低(P<0.05);组间治疗后比较,治疗组BNP水平显著低于对照组(P<0.05)。⑧两组各项安全性指标均未见明显异常。结论严氏苍山太阳炷燎穴位敷贴对阳虚血瘀型慢性心力衰竭患者临床症状与BNP的改善、运动耐量的提升及生活质量的提高都具有积极促进作用,且安全性好。

心力衰竭气虚血瘀证相关生物学标志物研究述评与展望

心力衰竭是全球发病率和病死率都很高的心血管疾病,气虚血瘀证是心血管疾病相关证候研究的热点之一,在心力衰竭的不同阶段均可有气虚血瘀的证候表现,找到证候的特异性标志物,并作为微观辨证依据,成为目前中医药防治心力衰竭研究的焦点。心力衰竭临床应用的常见生化标志物有B型利钠肽、N末端B型利钠肽原、心肌肌钙蛋白、炎症标志物、心肌纤维化标志物等。此外,基因组、蛋白质组、代谢组等“多组学”在生物标志物研究中应用广泛,为探索潜在标志物提供依据。文章总结了常见生化标志物、多组学标志物在心力衰竭气虚血瘀病证诊断、预后方面的研究现状,同时探讨“病证结合”生物标志物研究方法上存在的问题,以期进一步规范和优化中医证型生物标志物的研究。

柴郁清肝汤治疗非酒精性脂肪性肝病肝郁脾虚证患者的疗效观察及对Th17/Treg和相关炎症因子的影响

目的:观察柴郁清肝汤治疗非酒精性脂肪性肝病(NAFLD)肝郁脾虚证患者的临床疗效及对外周血Th17/Treg和相关炎症因子的影响。方法:将60例NAFLD患者随机分为观察组(30例)和对照组(30例),其中观察组给予柴郁清肝汤治疗,对照组给予维生素E软胶囊治疗,治疗8周评价疗效;分别观察2组患者治疗前后肝功、血脂、外周血T淋巴细胞Th17、Treg的百分比及其相关炎症因子(IL-17、IL-22、IL-10)的变化。结果:治疗8周,观察组显效16例,有效12例,对照组显效8例,有效13例,2组比较差异具有统计学意义(P<0.05)。与治疗前比较,2组患者ALT、AST、GGT、ALP、TC、TG、LDL-C、Th17、IL-17和IL-22明显降低,Treg明显升高,差异具有统计学意义(P<0.05),2组间比较观察组均明显优于对照组(P<0.05)。结论:柴郁清肝汤能够有效治疗NAFLD患者,改善肝功能和血脂,调节Th17/Treg平衡及其相关炎性因子分泌是其作用机制之一。

扶阳益心方治疗气虚血瘀型射血分数保留心力衰竭患者临床疗效研究

目的探究扶阳益心方治疗气虚血瘀型射血分数保留心力衰竭(HFpEF)患者的临床疗效。方法选择安徽省中西医结合医院心血管内科2020年1月—2022年12月间收治的68例气虚血瘀型HFpEF患者并以随机数字表法分为对照组(34例,给予常规西药治疗)与观察组(34例,在对照组基础上服用扶阳益心方治疗)。对比两组患者中医证候疗效及心功能疗效、中医证候积分、Lee氏心衰积分、运动耐量试验、超声心动图指标[舒张早期/晚期二尖瓣血流峰值(E/A)、左房容积指数(LAVI)及左室质量指数(LVMI)]。结果治疗后观察组中医证候总有效率为97.06%,高于对照组76.47%(P<0.05);治疗后两组均未见恶化者,观察组心功能总有效率为91.18%,高于对照组70.59%(P<0.05);治疗后两组患者主症和次症积分及Lee氏心衰积分均降低,且观察组低于对照组(P<0.05);治疗后观察组和对照组6 min步行距离分别为(336.47±41.95)m及(285.73±38.72)m,观察组明显长于对照组(P<0.05);治疗后两组患者LAVI和LVMI均降低,E/A均升高,且观察组各心功能指标升高或降低的幅度高于对照组(P<0.05)。结论扶阳益心方治疗气虚血瘀型HFpEF患者可有效改善患者中医证候,提高患者心功能和运动耐量,值得临床推广应用。

慢性心力衰竭患者阳虚血瘀证与心功能及血清NT-proBNP表达的相关性及二者对预后的影响

【目的】探究慢性心力衰竭患者阳虚血瘀证与心功能及血清B型氨基端利钠肽原(NT-proBNP)表达的相关性以及二者对患者预后的影响。【方法】选取2019年1月至2021年1月期间唐山市中医医院收治的320例慢性心力衰竭患者作为研究对象,根据中医辨证分型结果,将辨证为阳虚血瘀证的160例患者作为观察组,将辨证为气虚血瘀证或气阴两虚证的160例患者作为对照组;并对慢性心力衰竭阳虚血瘀证患者出院后进行为期1年的随访,根据随访结果,将患者分为良好预后组104例和不良预后组56例。采用Spearman相关性分析患者中医证型与血清NT-proBNP水平及心功能指标左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、每分钟搏出量(SV)、心排血量(CO)之间的相关性;采用多因素Logistic回归分析探讨影响患者不良预后的危险因素。【结果】(1)观察组患者的血清NT-proBNP水平及LVEDD值均明显高于对照组,LVEF、SV、CO值均低于对照组,差异均有统计学意义(P<0.05或P<0.01)。(2)Pearson相关性分析结果显示,慢性心力衰竭患者中医证型与血清NT-proBNP水平及LVEDD值呈正相关,与LVEF、SV、CO值呈负相关,差异均有统计学意义(P<0.01)。(3)慢性心力衰竭阳虚血瘀证患者不良预后组血清NT-proBNP水平及LVEDD值均明显高于良好预后组,LVEF、SV、CO值均低于良好预后组,差异均有统计学意义(P<0.01)。(4)血清NT-proBNP联合心功能指标对预后不良评估的曲线下面积(AUC)为0.942。Logistic回归分析结果显示,血清NT-proBNP高水平、LVEDD高水平均为影响慢性心力衰竭阳虚血瘀证患者发生不良预后的危险因素(P<0.01),而LVEF高水平、SV高水平、CO高水平均为保护因素(P<0.05或P<0.01)。【结论】慢性心力衰竭阳虚血瘀证患者血清NT-proBNP水平升高,阳虚血瘀证与血清NT-proBNP水平及心功能关系密切,且NT-proBNP水平及心功能与患者预后有关。

从抗抑郁角度论治肛门坠胀感

现代医学从炎症角度将肛门坠胀感与抑郁的发病机制联系在一起。中医理论则认为,出现肛门坠胀感或因肝失疏泄,气机不畅,气滞血瘀;或因心脾两虚,中气下陷。抑郁的发病病机与肛门坠胀相通。因此肛门坠胀可从心、脾、肝辨证论治,发挥抗抑郁作用,并加强心理干预及患者自我关怀,体现中医学整体观念与异病同治的理论特点,拓展肛门坠胀诊疗思路,为提升肛门坠胀的中医临床疗效、探寻肛门坠胀感心身同治的方式作出有益尝试。