Abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type

Objective:To explore the abnormal expression and significance of circ-CBLB/miR-486-5p in patients with rheumatoid arthritis of spleen deficiency and dampness excess type.Methods:The 30 healthy individuals included in the method were from the Physical Examination Center of Anhui Provincial Hospital of Traditional Chinese Medicine,and the 60 rheumatoid arthritis patients included were from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine.The disease activity score of patients with rheumatoid arthritis was evaluated using VAS score and DAS28 score,joint symptoms and spleen deficiency syndrome score were evaluated using graded quantification method,immune inflammation indicators were detected using relevant instruments,inflammatory cytokines were detected using ELISA method,macrophage markers were detected using FCM method,and pathway gene expression was detected using RT-qPCR;Evaluate the predictive effect of circ-CBLB and miR-486-5p on disease activity in rheumatoid arthritis using ROC curves.Results:(1)miR-486-5p,CD14^(+)CD86^(+),ESR,CRP,RF,Anti CCP Ab,IL-6,TNF in patients with rheumatoid arthritis-αThe levels of circ-CBLB,CD14^(+)CD163^(+),IL-4,and IL-10 were significantly higher than those of healthy individuals;(2)The expression level of circ-CBLB in patients with rheumatoid arthritis is positively correlated with CD14^(+)CD163^(+),and negatively correlated with miR-486-5p and CD14^(+)CD86^(+);The expression level of miR-486-5p is negatively correlated with CD14^(+)CD163^(+)and positively correlated with CD14^(+)CD86^(+);There is a negative correlation between CD14^(+)CD86^(+)and CD14^(+)CD163^(+);ESR is negatively correlated with circ-CBLB,and positively correlated with miR-486-5p,CD14^(+)CD86^(+),CRP;CRP is negatively correlated with circ-CBLB,CD14^(+)CD163^(+),and positively correlated with CD14^(+)CD86^(+),ESR;(3)The expression level of circ-CBLB in patients with rheumatoid arthritis is negatively correlated with joint tenderness,morning stiffness,lack of qi and lazy speech,and postprandial abdominal distension score;The expression level of miR-486-5p is positively correlated with the scores of joint tenderness and decreased appetite.(4)The ROC curve shows that in terms of circ-CBLB,ESR,CRP,VAS,and DAS28 AUC are 0.662(P=0.032),0.658(P=0.035),0.516(P=0.830),and 0.791(P=0.000),respectively.In terms of miR-486-5p,ESR,CRP,VAS,and DAS28 AUC were 0.566(P=0.385),0.511(P=0.883),0.592(P=0.223),and 0.727(P=0.003),respectively.Conclusion:The abnormal expression of circ CBLB and miR-486-5p in peripheral blood mononuclear cell of patients with rheumatoid arthritis of spleen deficiency and dampness excess type is related to inflammatory polarization markers,immune inflammation,disease activity,joint symptoms and spleen deficiency syndrome of rheumatoid arthritis,and the low expression of circ CBLB and high expression of miR-486-5p have certain predictive value for disease activity of rheumatoid arthritis.

Study on the correlation between CD80/CD163 and clinical prognosis and the syndrome differentiation in patients with colorectal cancer

Background:To analyze the expression of cluster of differentiation 80(CD80)/cluster of differentiation 163(CD163)in colorectal cancer(CRC)patients and their correlation with the syndrome of traditional Chinese medicine,pathology and prognosis.Methods:(1)The correlation between the pathological characteristics of 232 postoperative CRC patients and the deficiency and excess syndromes of traditional Chinese medicine was analyzed using the chi-square test,Spearman’s correlation,and Cox regression methods.(2)Immunohistochemistry and quantitative real-time PCR were used to detect the expression of CD80 and CD163 in cancer and paracancer tissues of CRC patients.(3)The relationships between the changes of CD80 and CD163 and the prognosis of CRC patients with deficiency syndrome.Patient survival were analyzed using cardinality and Cox regression proportional-hazards model regression.Results:(1)The degree of differentiation and tumor node metastasis stage of CRC were statistically different between patients with deficiency and excess syndromes(P<0.05);carcinoembryonic antigen and carbohydrate antigen 19-9 were highly expressed in the excess syndrome group,and both were significantly correlated with the distribution of traditional Chinese medicine syndromes(P<0.001);deficiency and excess syndromes,and carbohydrate antigen 19-9 were all independent factors affecting the postoperative survival of CRC patients.(2)The distribution of post-operative survival in CRC patients was significantly correlated with the distribution of the disease type(P<0.001).(3)The expression levels of CD163 protein and message RNA were significantly higher in CRC cancer tissues than in paraneoplastic tissues(P<0.001);whereas the expression of CD80 was significantly higher in paraneoplastic tissues than in cancer tissues(P<0.001).(4)The expression levels of CD80/CD163 were significantly different in different parts of the tissues of patients with deficiency and excess syndromes(P<0.001).(5)CRC patients with high CD80 expression and low CD163 expression had longer survival cycles(P<0.001).Conclusion:The malignant progression of CRC patients with deficiency syndrome is faster than that with excess syndrome.The correlation between deficiency and excess syndromes and the expression levels of CD80 and CD163 could be an independent risk factor for the survival prognosis of patients with CRC.

Treatment of insomnia by differentiation of yang deficiency syndrome

Insomnia has become one of the common clinical diseases.In recent years,it has been found that patients with insomnia of Yang deficiency type are more and more common,and the trend of rejuvenation gradually appears,which seriously affects the normal progress of people's life,work and study.Clinical treatment through syndrome differentiation,mainly from the heart,spleen,kidney three viscera yang deficiency,on the basis of the warm yang method to add Qianzhen tranquilizing products,and pay attention to multiple organs as diseases,add moisture,blood The qi thing,while not forgetting the psychological counseling,adjusting the body and mind,and achieving a certain clinical effect,can provide ideas for the treatment of this disease.

Biological basis of “depression with liver-qi stagnation and spleen deficiency syndrome”: A digital gene expression profiling study

Objective:To investigate the biological basis of“depression with liver-qi stagnation and spleen deficiency syndrome”.Methods:A digital gene expression profiling method was conducted to explore global changes in the mRNA transcriptome in a rat model of depression with liver-qi stagnation and spleen deficiency syndrome.Real-time quantitative polymerase chain reaction(q-PCR)was performed to verify the five genes most interest based on the Kyoto Encyclopedia of Genes and Genome(KEGG)analysis.Sini San,which disperses stagnated liver qi and strengthens the spleen,was administered to the model rats to observe whether it could reverse these genetic changes in the liver.Results:Forty-six differentially expressed genes were identified.Three of the five genes of most interestdHnf4a,Hnf4g and Cyp1a1dbased on KEGG analysis,were confirmed by realtime q-PCR.Sini San reduced the gene expression changes of Hnf4a,Hnf4g and Cyp1a1 in the rat model.Conclusions:Hnf4a,Hnf4g and Cyp1a1 are involved in“depression with liver-qi stagnation and spleen deficiency syndrome”.These findings indicate that depressed rats with liver-qi stagnation and spleen deficiency syndrome are at risk of liver diseases.Furthermore,our results will inform exploration of the etiology of depression and help in the development of effective therapeutic strategies.

Summary and correlation analysis of TCM syndromes in 159 elderly patients with acute myeloid leukemia

Objective:To investigate the characteristics of TCM syndromes in elderly patients with acute myeloid leukemia(AML)at the onset,and to analyze the main syndrome types and their correlation with age,percentage of bone marrow blasts,and genetic prognostic stratification.Methods:A retrospective analysis was performed on 159 AML patients aged over 60 years who were diagnosed and treated in our hospital,and the clinical data were collected and analyzed statistically.Results:In 159 elderly AML patients,the main clinical symptoms were fatigue,poor appetite,conscious fever,and various hemorrhages.The main syndromes were Ying(42.01%),Wei(31.25%),Essential(14.81%)and Blood(11.69%);the syndromes are divided into Qi and Yin deficiency(32.70%),Qi and blood deficiency(30.19%),true Yin deficiency(28.03%)and Qi heat and blood(8.81%).The age difference between the two groups was statistically significant(P<0.001),and the multiple comparison results showed that the age of the Qi-blood deficiency group was younger than the true-Yin deficiency group and the Qi-Yin deficiency group;the percentage of bone marrow blasts was statistically significant in the three groups at the initial diagnosis(P<0.05),multiple comparison results showed that the percentage of bone marrow blasts in the true Yin deficiency group was higher than that in the Qi-blood deficiency group and the Qi-Yin deficiency group;the genetic prognostic stratification of the three groups was statistically significant(P<0.05),multiple comparisons.The results showed that the genetic prognosis of the true Yin deficiency group was poorer than that of the Qi and blood deficiency group and the Qi and Yin deficiency group.Conclusion:The most common clinical symptoms of elderly AML patients are fatigue,the disease is located in the bone marrow,and the disease is Ying,Wei,essence,and blood.With the increase in the patient's age,the TCM syndrome types tend to be more insufficiency of true Yin and deficiency of both Qi and Yin,and the prognosis of patients with insufficiency of true Yin is poor.It provides a directional scientific basis for the treatment of senile AML with integrated traditional Chinese and Western medicine.

Human immunodeficiency virus/acquired immune deficiency syndrome: Using drug from mathematical perceptive

Entry of acquired immune deficiency syndrome virus into the host immune cell involves the participation of various components of host and viral cell unit. These components may be categorized as attachment of the viral surface envelope protein subunit, gp120, to the CD4+ receptor and chemokine coreceptors, CCR5 and CXCR4, present on T cell surface. The viral fusion protein, gp41, the second cleaved subunit of Env undergoes reconfiguration and the membrane fusion reaction itself. Since the CD4+ T cell population is actively involved; the ultimate outcome of human immunodeficiency virus infection is total collapse of the host immune system. Mathematical modeling of the stages in viral membrane protein-host cell receptor-coreceptor interaction and the effect of antibody vaccine on the viral entry into the susceptible host cell has been carried out using as impulsive differential equations. We have studied the effect of antibody vaccination and determined analytically the threshold value of drug dosage and dosing interval for optimum levels of infection. We have also investigated the effect of perfect adherence of drug dose on the immune cell count in extreme cases and observed that systematic drug dosage of the immune cells leads to longer and improved lives.

肿瘤患者呼吸道多重耐药菌感染中医证型及易感因素研究

【目的】探讨呼吸道多重耐药菌感染肿瘤患者的中医证候分布特点及易感因素。【方法】采用病例对照研究方法,以痰细菌培养阳性的250例呼吸道多重耐药菌感染肿瘤患者为多耐组,以痰细菌培养阳性的250例呼吸道非多重耐药菌感染肿瘤患者为对照组,收集2组患者的年龄、性别、临床相关检查结果及既往抗菌药物使用状况等临床资料,分析呼吸道多重耐药菌感染肿瘤患者的中医证候分布特点和易感因素。【结果】(1)易感因素方面:单因素分析结果提示,2组间的高血压史、糖尿病史、冠心病史、化疗周期、抗菌药物使用时间、白蛋白、血红蛋白比较,差异均有统计学意义(P<0.05或P<0.01);多因素Logistic回归分析结果提示,以上变量均是肿瘤患者呼吸道多重耐药菌感染的危险因素,差异均有统计学意义(P<0.05或P<0.01)。(2)病原菌分布方面:肿瘤患者呼吸道多重耐药菌感染最常见致病菌排前3位的依次为鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌。(3)中医证候分布方面:实证方面,多耐组痰浊阻肺、热陷心包、痰热蕴肺的证型表现均较对照组严重,差异均有统计学意义(P<0.05或P<0.01);虚证方面,多耐组脾肾两虚、肺肾两虚、肝肾阴虚及心肾阳虚的证型表现均较对照组严重,差异均有统计学意义(P<0.05或P<0.01)。【结论】合并基础病、化疗周期长、抗菌药物使用时间长、低水平白蛋白及低血红蛋白为肿瘤患者发生呼吸道多重耐药菌感染的危险因素;相对于非多重耐药菌感染肿瘤患者,多重耐药菌感染肿瘤患者病情较重,中医证型以虚实夹杂型为主,而非多重耐药菌感染肿瘤患者以实证居多。

针刺结合引火归元穴位贴敷治疗上实下虚型颈性眩晕临床观察

目的观察针刺结合引火归元穴位贴敷治疗上实下虚型颈性眩晕的临床效果。方法选取120例上实下虚型颈性眩晕患者,按随机数字表法分为针刺组、引火归元组、针刺+引火归元组与西药组并行相应治疗,每组30例。比较四组治疗前后颈性眩晕症状与功能评估量表评分、血清内皮型一氧化氮合酶(eNOS)及人降钙素基因相关肽(CGRP)水平变化,治疗结束后3个月进行回访比较复发率。结果治疗后,四组颈性眩晕症状与功能评估量表评分均较治疗前显著升高,且针刺+引火归元组升高幅度大于其余三组(P<0.05);四组血清eNOS、CGRP水平均较治疗前显著升高,且针刺+引火归元组升高幅度大于其余三组。治疗结束3个月后,针刺+引火归元组复发率为26.67%(8/30),低于其余三组。结论常规针刺、引火归元穴位贴敷、针刺结合引火归元穴位贴敷与口服甲磺酸倍他司汀片等方法对上实下虚型颈性眩晕患者均疗效确切,且针刺结合引火归元穴位贴敷效果最优、复发率最低,值得推广。

运用“虚气留滞”理论辨治糖尿病肾病

糖尿病肾病是糖尿病常见的并发症之一,“虚气留滞”指由于“虚气”日久,气血津液运行不畅,导致“气滞”“痰凝”“血瘀”等“留滞”,反过来“留滞”作为病理产物,阻滞气血津液运行,进一步加重“气虚”。“虚气留滞”理论和糖尿病肾病病因病机密切相关,“虚气”是消渴肾病发病之本,“留滞”为消渴肾病发病之标,治疗上当健脾益肾以治其本,活血化痰解毒以治其标。

逍遥散联合水飞蓟素胶囊治疗肝郁脾虚证非酒精性脂肪性肝病临床研究

目的:逍遥散联合水飞蓟素胶囊治疗肝郁脾虚证非酒精性脂肪性肝病(NAFLD)的疗效。方法:选取90例肝郁脾虚证NAFLD患者,按随机数字表法分为对照组及治疗组各45例。2组行非药物措施,对照组予以水飞蓟素胶囊口服,治疗组在对照组基础上加逍遥散治疗。2组均连续治疗12周。比较2组临床疗效,比较2组治疗前后肝功能指标[谷草转氨酶(AST)、丙氨酸转氨酶(ALT)、谷氨酰转肽酶(GGT)]值、血脂指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]值、血清TLR4/NF-κB信号通路相关蛋白水平[血清TOLL样受体4(TLR4)、髓样分化因子88(MyD88)、核转录因子-κB(NF-κB)]、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的变化。结果:治疗12周后,治疗组临床疗效总有效率为91.11%,对照组为73.33%,2组比较,差异有统计学意义(P<0.05)。治疗12周后,2组AST、ALT、GGT指标值均较治疗前下降(P<0.05),治疗组上述3项指标值均低于对照组(P<0.05)。治疗12周后,2组TC、TG、LDL-C水平均较治疗前下降(P<0.05),HDL-C水平均较治疗前上升(P<0.05);治疗组TC、TG、LDL-C水平均低于对照组(P<0.05),HDL-C水平高于对照组(P<0.05)。治疗12周后,2组血清TLR4、MyD88、NF-κB、IL-6、TNF-α水平均较治疗前下降(P<0.05),治疗组上述5项水平均低于对照组(P<0.05)。结论:逍遥散联合水飞蓟素胶囊对肝郁脾虚证NAFLD的疗效确切,可有效改善肝功能及血脂状况,调节血清TLR4-NF-κB信号通路,抑制炎症反应。

芒针联合中医辨证干预肝郁脾虚型溃疡性结肠炎临床疗效观察

目的评价芒针疗法联合中医辨证干预肝郁脾虚型溃疡性结肠炎的有效性和安全性。方法选择肝郁脾虚型溃疡性结肠炎患者64例,按照随机数字表法将其分为两组,分别为治疗组和对照组,治疗组根据中医辨证,给予芒针治疗,配合培土疏郁汤口服;对照组口服美沙拉嗪缓释颗粒。比较两组治疗前后的中医证候积分及治疗后临床有效率。结果治疗后,治疗组中医证候积分低于对照组,差异有统计学意义(P<0.01);治疗组的临床总有效率高于对照组,差异有统计学意义(P<0.05)。结论芒针疗法联合中医辨证干预肝郁脾虚型溃疡性结肠炎较单纯西药口服更具有优势,值得临床推广。

围手术期中医证候虚实变化研究进展

证候是中医理论体系的基石,是中医临床研究的基础,证候的变化与转归又是中医临床疗效的重要评价指标,中医临床诊治基于整体观念,实施个体化辨证论治,注重改善患者的各类临床症状和体征,而手术为西方医学的治疗手段,中医药联合手术为患者提供综合性治疗,观察疾病围手术期证候变化,不仅为中西医结合治疗提供理论指导,同时作为临床疗效评价指标,能够切实评价临床干预手段的有效性以及判断疾病预后。现以心血管疾病、肿瘤疾病、骨伤疾病、脑血管疾病以及其他疾病五个方向,分别论述疾病围手术期证候的虚实变化情况,对手术干预方式与证候变化的相关性研究提供启发,为中西医结合证候研究提供切入点。

基于R语言探析吕晓东教授治疗喘证及从虚实辨证施治用药规律

目的基于R语言和IBM SPSS Statistics 23,整理并探析吕晓东教授治疗喘证处方的组方用药规律,并从虚实入手分析喘证辨证治疗异同,为喘证中药治疗提供新思路。方法筛选2019年11月—2022年11月就诊于辽宁中医药大学附属医院吕晓东教授门诊的喘证病例,采用R语言进行数据挖掘分析。结果筛选出133个处方,183味中药,累计使用总频次为2686次,使用频次排名前10的中药主要为解表药与化痰止咳平喘药,性味归经得出药性以寒、温为主,药味多为甘、苦、辛,主归肺、肝经。相关系数最高为温阳解表药对,关联分析得出核心药物为杏仁、桔梗、麻黄,其中杏仁-桔梗为最高频使用药对,聚类分析以疏肝理气药、宣肺平喘药、温阳滋肾药、散瘀祛邪药为主。结论吕晓东教授治疗喘证善于基于理肺加以辨证施治,如配合疏肝、滋肾、化里邪、调阴阳之法。以杏仁、桔梗、麻黄为核心药物组方,以解表药、化痰止咳平喘药为主,在此基础上实喘证加入平肝熄风药、清热药、活血祛瘀药,虚喘证加滋肾填阴药、温里补阳药,总结归纳出实喘善从表里同治调气机、虚喘善从阴阳入手补本虚,为临床治疗提供参考。

脾虚湿盛证动物模型构建方法探析

近年来,脾虚湿盛证动物模型的构建已成为中医证候研究的热点。脾虚湿盛证病位在脾,病性为虚与湿,因此模型的构建较为复杂,目前尚无公认的动物模型。现从脾虚湿盛证模型构建的思路方法及模型评价指标2个维度为核心对当前研究进行探析与总结,研究表明脾虚湿盛证动物模型常选用饮食失宜、久居湿地及劳倦过度等因素从病因角度进行模型构建,造模方法分为单因素、双因素与混合多因素;脾虚湿盛证模型评价指标常以症状及表证进行宏观与证候评价、多通过疲劳指标、胃肠功能指标及水液代谢指标进行客观评价;并从脾虚湿盛模型证候命名、模型证候评价标准及构建模型的方法剖析目前模型构建存在的问题、以此讨论并分析脾虚湿盛证动物模型未来的发展方向,以期为脾虚湿盛证动物模型的研究提供参考,为研究者提供便利。

基于虚实辨证的大肠癌血瘀证中医药治疗和作用机制研究进展

血瘀证是大肠癌患者常见的中医证型,血瘀贯穿于大肠癌发生发展的各个阶段,活血化瘀法是临床治疗大肠癌的常用方法。从因虚致瘀、由实成瘀两个角度探讨大肠癌血瘀证的病因病机和临床治疗,并从增殖凋亡、血管新生、细胞自噬、侵袭转移、免疫调节、微循环障碍等方面综述活血化瘀中药治疗大肠癌血瘀证的作用机制,以期为临床使用活血化瘀法治疗大肠癌提供依据。

白虎二至汤治疗热盛阴虚型糖尿病肾病Ⅲ期临床观察

目的 观察白虎二至汤对热盛阴虚型糖尿病肾病(DKD)Ⅲ期患者的临床疗效。方法 将66例DKD患者随机分为对照组和治疗组,各33例。对照组采用缬沙坦胶囊治疗,治疗组在对照组治疗上加用白虎二至汤,观察2组患者空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、尿蛋白/肌酐比(UACR)、尿素氮(BUN)、血肌酐(Scr)以及中医证候积分水平。结果 治疗组有效率显著优于对照组(P<0.05)。治疗后2组患者的2 h PG、HbA1c、UACR、BUN、Scr及中医证候积分水平均低于治疗前(P<0.05),且治疗组均低于对照组(P<0.05)。结论 白虎二至汤可显著改善早期糖尿病肾病患者的临床症状及中医证候,控制血糖水平,改善肾功能,延缓患者疾病进展,提高患者生活质量。

多系统萎缩中医认识及中医药治疗现状

多系统萎缩(MSA)是一种中枢神经退行性疾病,起病具有隐匿性、散发性、进行性加重的特点。现代医学对其病因及发病机制认识尚不清晰,且治疗方法较为匮乏,中医学对MSA治疗却具有显著优势。现梳理近五年中医药治疗MSA相关文献,从病因病机和辨证论治方面总结其中医药治疗现状,认为MSA多由情志内伤和正虚体弱所致,病机总属肝肾脾亏虚,气、血、水湿运化功能失调。中医药临床多从肝肾亏虚证、脾肾亏虚证和痰瘀互阻证论治,可有效改善自主神经功能障碍、认知功能障碍和躯体运动障碍,并能够延缓MSA中枢神经老化和调节脑内微环境异常,以期为今后中医药治疗MSA提供临床依据和参考。

基于高效液相色谱-质谱联用技术的脾阴虚糖尿病认知功能障碍大鼠血清代谢组学研究

目的从代谢组学层面上观察脾阴虚(Spleen-Yin deficiency,SD)糖尿病认知功能障碍(Diabetes-associated Cognitive Decline,DACD)大鼠的代谢产物变化,探究脾阴虚糖尿病认知功能障碍潜在标志物及其意义。方法建立SD、DACD及SD-DACD大鼠模型。采用高效液相色谱-四极杆-飞行时间质谱联用技术(High performance liquid chromatography-quadrupole time-of-flight mass spectrometry,HPLC-Q-TOF/MS)对大鼠血清样品的代谢产物进行分析。结果各组大鼠血清代谢存在显著差异。研究建立的代谢物分析方法可以区分SD组、DACD组、SD-DACD组与空白对照(blank control,BC)组,SD组与SD-DACD组,DACD组与SD-DACD组。其中,与BC组大鼠相比,吡哆胺(pyridoxamine)在SD组和SD-DACD组中分别上调约24倍和25倍,在DACD组中则下调约21倍,可将SD组与DACD组、SD-DACD组与DACD组大鼠相区别。吡哆胺可作为一个潜在的生物标志物用于诊断脾阴虚DACD。涉及的苯丙氨酸代谢通路的紊乱主要发生在SD组和SD-DACD组大鼠的差异代谢产物之间。结论吡哆胺和苯丙氨酸代谢途径参与脾阴虚糖尿病认知功能障碍的发病机制,并且可能是脾阴虚和糖尿病认知功能障碍之间相关性的基础。研究结果可为基于代谢组学的SD-DACD筛查及病因研究提供参考资料。

基于“理法方穴术”探讨武连仲教授治疗儿童抽动秽语综合征经验

[目的]总结武连仲教授治疗儿童抽动秽语综合征的理、法、方、穴、术。[方法]通过跟师临证学习及整理医案,总结武老对儿童抽动秽语综合征的理解及辨证治疗思路,并举验案加以佐证。[结果]武老认为,儿童抽动秽语综合征的理为“实则阳明,虚则少阴”;法为“清泻阳明,补益少阴”;方常用黄连温胆汤合白虎汤加减以“清泻阳明”,六味地黄丸加减以“补益少阴”;形成了君臣佐使配伍合理的选穴处方;探索了提插捻转、补泻得当的针刺操作方法。治疗中时时注意小儿特殊的生理特点,临床疗效颇佳;所附验案属于“实则阳明”案,法、方、穴、术以“清泻阳明”为主,标本同治,获得了临床痊愈的理想效果。[结论]武老基于“理法方穴术”治疗儿童抽动秽语综合征,临床疗效肯定,扩展丰富了儿童抽动秽语综合征的辨治体系,值得临床推广学习。

老年高血压性脑小血管病患者的血压特点及与中医证型的相关性

【目的】探讨老年高血压性脑小血管病患者的血压特点及其与中医证型的相关性。【方法】采用回顾性分析方法,纳入老年原发性高血压患者189例,根据是否患有脑小血管病将患者分为脑小血管病组87例和非脑小血管病组102例。收集2组患者的血压相关检查参数及中医临床四诊资料,运用统计学方法分析血压特点及其与中医证型之间的相关性。【结果】(1)动态血压参数:脑小血管病组患者的24 h平均收缩压(24hSBP)、24 h平均舒张压(24hDBP)、日间平均收缩压(DSBP)、日间平均舒张压(DDBP)、夜间平均收缩压(NSBP)、夜间平均舒张压(NDBP)、24 h平均脉压(24hPP)、日间平均脉压(DPP)、夜间平均脉压(NPP)、最高收缩压、清晨收缩压、日间收缩压负荷值及夜间收缩压负荷值的平均值均高于非脑小血管病组(P<0.01)。(2)血压变异性:脑小血管病组患者的夜间收缩压标准差(NSSD)平均值高于非脑小血管病组(P<0.01)。(3)血压昼夜节律:2组患者的动态血压昼夜节律比较,差异有统计学意义(P<0.05)。其中,非脑小血管病组以非杓型(50例,49.02%)和杓型(31例,30.39%)为主,而脑小血管病组以非杓型(38例,43.68%)和超杓型(31例,35.63%)为主。(4)Logistic回归分析结果显示:24hSBP(OR=1.296,95%CI:1.112~1.511)、最高收缩压(OR=1.074,95%CI:1.006~1.146)、清晨收缩压(OR=1.064,95%CI:1.013~1.118)、异常血压昼夜节律(OR=3.736,95%CI:1.663~8.390)是脑小血管病的相关影响因素(P<0.05或P<0.01)。(5)中医证型分布:非脑小血管病组以痰湿壅盛证(58.82%)、阴虚阳亢证(21.57%)为主,脑小血管病组以阴虚阳亢证(51.72%)、痰湿壅盛证(21.84%)为主。(6)不同证型的血压特点:痰湿壅盛证脑小血管病组的DPP显著高于非脑小血管病组(P<0.01),阴虚阳亢证脑小血管病组的24hDBP、NDBP显著高于非脑小血管病组(P<0.01)。【结论】24hSBP、最高收缩压、清晨收缩压水平升高以及异常血压昼夜节律可能是导致老年高血压性脑小血管病发病的重要危险因素。痰湿壅盛型老年高血压患者更应关注日间平均脉压水平,阴虚阳亢型老年高血压患者更应注重舒张压水平的监测。老年高血压患者应动态观察血压各项相关指标,早期有效调控血压有助于脑小血管病的防治。