介绍全国老中医药专家陈纪藩治疗痛风性关节炎的临床经验.陈纪藩教授认为痛风性关节炎脾阳亏虚为基本原因、湿浊内蕴为重要原因、外感病邪为诱因,指出该病治疗大法为温阳泄浊、活血通络.

目的 观察昆母汤醇提取物（KMT）对类风湿关节炎成纤维样滑膜细胞（FLS）增殖以及白细胞介素-1β（IL-1β）和基质金属蛋白酶-3（MMP-3）表达的影响。方法 将FLS用贴壁分离的方法分离纯化传代,培养同步化后加入含10%胎牛血清的培养液,分为6组,分别加入：（1）不含任何药物的培养液;（2）10 ng/m L的肿瘤坏死因子-α（TNF-α）;（3）10 ng/m L的TNF-α和1 mg/L的甲氨蝶呤;（4）10 ng/m L的TNF-α和100μg/m L的KMT;（5）10 ng/m L的TNF-α和200μg/m L的KMT;（6）10 ng/m L的TNF-α和400μg/m L的KMT。采用MTT法对FLS的增殖情况进行分析,通过RT-PCR法观察各药物干预对TNF-α诱导后IL-1β、MMP-3 mRNA表达的影响。结果 各药物对FLS增殖的抑制作用呈时间和剂量依赖性;TNF-α可诱导FLS IL-1β和MMP-3mRNA的高表达,KMT对TNF-α诱导高表达的IL-1β和MMP-3 mRNA均有抑制作用。结论 昆母汤可抑制FLS的增殖,通过下调FLS IL-1β、MMP-3 mRNA的表达从而发挥抗风湿作用。

Objective To investigate the effects of alcohol extract of Kunmu decoction on proliferation and apoptosis of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS). Methods Synovial tissues were obtained from patients with active RA received joint replacement or arthroscopy. The surface antigen and the amount of apoptotic cells were determined by flow cytometry. The inhibitive effect was detected by MTT assay. Results The CD90+surface antigen of synoviocytes was (94.78 ± 0.98)%. The inhibitive effect on the proliferation in all treatment groups were in a time-and dose-dependent manner. The apoptosis rate was increased in a dose-dependent manner among all dosage alcohol extract groups. Conclusion Kunmu decoction might inhibit proliferation and induce apoptosis of RA-FLS.

Objective To observe the effects of alcohol extract of Kunmu decoction(KMT)on the expression of B-cell lymphoma-2(bcl-2)and bcl-2 associated X protein(bax)in human rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS)in vitro,and to explore the possible therapeutic mechanism. Methods Synovial tissues were obtained from patients with active RA subjecting to the revised criteria of the American College of Rheumatology,who received joint replacement or arthroscopy. Real time-PCR was used for the expression of bax and bcl-2 mRNA in RA-FLS. Enzyme-linked immunosorbent assay(ELISA)was used to detect the expression of bax and bcl-2 protein. Results High-dosage KMT had obvious inhibitive effect on the expression of bax induced by tumor necrosis factor alpha (TNF-α)(P < 0.01). Compared with TNF-α group,methotrexate(MTX) and high-dosage KMT had obvious inhibitory effect on the expression of bcl-2(P < 0.05,P < 0.01). Compared with MTX group,high-dosage KMT had obvious inhibitory effect on the expression of bcl-2 mRNA and protein(P < 0.05,P < 0.01). Low-,moderate- and high-dosage KMT increased the ratio of bax/bcl-2 in a dose-dependent manner. Conclusion Kunmu decoction may promote the apoptosis of RA-FLS by regulating the expression of bcl-2, bax mRNA and protein and the ratio of bax/bcl-2,showing possible therapeutic effect for RA.

通过对<金匮要略>教研室青年教师的培养方法的介绍,探索一条符合教研室实际的青年教师培养方法,加大对青年教师的培养力度,为学科建设的发展和教育教学水平的提高夯实基础.

Objective:To observe the effects of Himalayan Teasel Root(HTR)on infertility induced by Tripterygium Hypoglaucum Hutch(THH)in rats.Methods:54 SD male rats were randomly divided into 3 groups,18 in each group.The control group were given normal saline at a dose of 10 mL·kg-1·d-1.The treatment group were given THH at a dose of 2.5 g·kg-1·d-1 and Himalayan Teasel Root(HTR)at a dose of 7.5 g·kg-1·d-1,and the model group were given THH at a dose of 7.5 g·kg-1·d-1.After 60 days,half rats of each group were sacrificed randomly.The rest rats were continually raised until 72 days later,then sacrificed.The relative testis weight,testicle volume,sperm density and the total activity were comparatively analyzed.The pathological changes in testicular tissue were observed by optical microscope.Results:Compared with the model group,it was significantly higher of relative testis weight and sperm density in the treatment group after a 60-day treatment(P<0.01).72 days later,in treatment group sperm motility recovered and there was no testicular lesion in rats.In model group the motility of sperm from caudal epididymides dropped to zero,and diastrophic sperms were seen.The testicular lesion in rats caused by THH was serious.It was not found that epididymal lesion recovered after 72 days.Conclusion:It indicated that in male rats,HTR could relieve the reproductive lesions induced by THH.

Objective:To study anti-reproductive effects of Tripterygium Hypoglaucum Hutch(THH),and whether the effects are reversible at a large dose on testicle tissue in male rats.Methods:36 SD male rats were randomly divided into 2 groups,18 in each group.The control group were given normal saline at a dose of 10 mL·kg-1·d-1,while the experiment group were given THH at a dose of 22.5 g·kg-1·d-1.After 60 days,half rats of each group were sacrificed randomly.The rest rats were continually raised until 72 days later,then sacrificed.The relative testis weight,testicle volume,sperm density and the total activity were comparatively analyzed.The pathological changes in testicular tissue were observed by optical microscope.Results:Compared with the control group,a significant decrease in relative testis weight and sperm density were seen in the experiment group after a 60-day treatment(P0.01).In experiment group the motility of sperm from caudal epididymides dropped to zero,and diastrophic sperms were seen.The testicular lesion in rats caused by THH was serious.It was not found that epididymal lesion recovered after 72 days treatment.Conclusion:It indicats that for male rats,THH has obvious and irreversible toxic effect on the testicular tissue.

Objective To observe the effects of alcohol extract of Kunmu decoction(KMT) on RANKL /OPG system of fibroblast-like synoviocytes in patients with rheumatoid arthtitis(RA-FLS). Methods The proliferation of RA-FLS was measured by MTT method, and realtime-PCR was used to observe the expressions of RANKL and OPG mRNA and RANKL / OPG value in RA-FLS. Results The inhibiting effects on the proliferation of RA-FLS in all treatment groups were in time- and dose-dependent manner. The high-expressed RANKL mRNAs were inhibited in all treatment groups(P < 0.01). The low-expressed OPG mRNA could be promoted by MTX(P < 0.01), and be inhibited by moderate or high dosages of KMT(P < 0.05). RANKL /OPG value was significantly inhibited in all treatment groups(P < 0.01). Conclusion Kunmu decoction might inhibit RA-FLS proliferation and down-regulate RANKL / OPG value so as to inhibit the differentiation and the function of osteoclasts, and finally to treat RA.

Objective To investigate the safety and adverse effect of Radix Celastri Orbiculati Decoction.Methods A retrospective analysis was carried out in 90 rheumatism patients who had taken Radix Celastri Orbiculati Decoction orally.The data of their hepatic and renal function as well as blood analysis were investigated.Results In 90 patients,15 gave up medication,7 for the treatment being ineffective and 8 for the adverse effect.The adverse effect was epigastric discomfort(involving 4 cases),bone marrow depression(involving 3 cases),and reduced menstrual blood volume(involving one case).The differences of blood cells,and hepatic and renal function were insignificant before and after treatment(P>0.05).Conclusion The adverse effect of Radix Celastri Orbiculati Decoction covers sexual gland depression,bone marrow depression and epigastric discomfort,and has mild damage to hepatic and renal function.For the individual difference,it will still be necessary to monitor the data of blood analysis and hepatic-renal function during the first 3 months of medication.

Objective: To observe the clinical curative effect of compound Zhibai Yangyin Decoction and hormone on systemic lupus erythematosus.Methods: 60 cases of patients were randomly divided into control group and treatment group with 30 cases in each group.The control group was treated with standard hormone therapy,the treatment group was given Zhibai Yangyin Decoction in addition to standard hormone therapy.The symptoms,syndrome scores and curative effect of two groups were compared after 4 weeks of treatment.Results: The irritable heat in the five centers and spontaneous and night sweating in the treatment group were significantly improved,the difference was statistically significant(P<0.05) compared with the control group.TCM symptom scores of two groups were significantly decreased after the treatment,but the treatment group was more significant(P<0.05),the total efficiency of the treatment group was obviously superior to that of the control group,there was significant difference between the two groups(P<0.05).Conclusion: Zhibai Yangyin Decoction and hormone can improve the symptoms and syndrome scores of patients with systemic lupus erythematosus,and improve the curative effect.

《金匮要略》经典理论是诊治类风湿关节炎(RA)的基础。在其理论指导下,课题组对该病进行了历经20余年的临床和基础研究,认为RA主要病因病机是肝肾气血虚弱为本,风寒湿痰瘀为标;痰瘀互结是贯穿始终的基本病理环节;寒热错杂,阴阳失衡,虚实相兼是其主要证候特点。对其治疗,在桂枝芍药知母汤的基础上,研制了通痹灵片、通痹合剂和通痹合剂2号,提高了临床疗效;探索了经典名方治疗RA的作用机理,诠释了经典理论指导RA治疗的科学性和有效性。

目的：研究昆仙胶囊对胶原诱导关节炎大鼠滑膜组织白细胞介素-8（IL-8）及干扰素-γ诱导蛋白10（γIP-10）mRNA表达的影响。方法：将54只SPF级Wistar大鼠随机分为正常组、模型组、甲氨喋呤（MTX）组和昆仙胶囊低、中、高剂量组各9只。采用尾根部皮下注射胶原蛋白建立胶原诱导关节炎大鼠模型,检测各组关节滑膜细胞与软骨的病理变化,R T-PCR法检测各组滑膜组织IL-8及γIP-10 mRNA的表达水平。结果：MTX组和昆仙胶囊各剂量组大鼠关节滑膜损伤较模型组明显改善（P〈0.05,P〈0.01）。与模型组比较,MTX组、昆仙胶囊各剂量组大鼠的IL-8 mRNA、γIP-10 mRNA的表达明显降低（P〈0.05,P〈0.01）;随着昆仙胶囊剂量的增加,关节滑膜组织IL-8 mRNA、γIP-10 mRNA的表达有下降的趋势;与MTX组、昆仙胶囊低、中剂量组大鼠比较,昆仙胶囊高剂量组大鼠的IL-8 mRNA、γIP-10 mRNA的表达明显降低（P〈0.05）。结论：昆仙胶囊可能通过抑制大鼠滑膜组织IL-8及γIP-10 mRNA基因表达,减轻大鼠滑膜细胞增生及软骨破坏来实现其治疗滑膜炎的目的。

The real pathogenesis of Xiexin Decoction syndrome is the hepo-activity of stomach fire and disordered blood circulation.The heart-qi deficiency may be the theoretical generalization of the symptoms such as irritability,palpitations,red face or pale complexions,abdominal distension.At the same time,rhubarb should not be included in Xiexin Decoction.

目的:评价昆仙胶囊治疗AS的有效性及安全性,探讨昆仙胶囊与柳氮磺吡啶联合用药的增效作用。方法:采用随机、平行对照方法,将90例AS患者分为昆仙胶囊组(昆仙组)、昆仙胶囊与柳氮磺吡啶联合用药组(联合组)、柳氮磺吡啶组(SSZ组)各30例,治疗12周。治疗第2、4、8、12周时,记录3组患者临床症状的改善情况,观察不良反应的发生情况。结果:与SSZ组比较,治疗4、8、12周时昆仙组及联合组患者达ASAS20、ASAS40的比例较高,夜间疼痛VAS评分、ESR、CRP水平较低,晨僵时间较短,其中联合组优于昆仙组(P<0.05或0.01)。3组患者治疗前后血、尿常规,肝、肾功能均无明显改变。结论:昆仙胶囊治疗AS疗效确切,优于柳氮磺吡啶,且起效时间短,安全性高,与柳氮磺吡啶联合治疗AS有协同作用。

目的:观察强直性脊柱炎(AS)患者的焦虑抑郁程度与中医证候的相关性.方法:162例AS患者设为AS组,另取54例健康人设为对照组.采用焦虑自评量表(SAS)和抑郁自评量表(SDS)进行临床评价,分析中医证候与患者焦虑抑郁程度的相关性.结果:2组SAS、SDS评分分别比较,差异均有显著性意义(P＜0.05).以SAS加SDS总分等于80分为界,将AS组分成焦虑抑郁亚组与非焦虑抑郁亚组,单一瘀血痹阻证和兼杂瘀血痹阻证在焦虑抑郁亚组比例明显较大.结论:患者的中医证型与焦虑抑郁程度有一定的相关性,单一瘀血痹阻或兼杂瘀血痹阻的患者焦虑抑郁倾向较高.

目的:观察知柏养阴汤联合激素治疗系统性红斑狼疮的临床疗效。方法:将60例入选患者随机分为对照组和治疗组各30例。对照组予以标准激素疗程,治疗组在此基础上予以知柏养阴汤,于治疗2、4周后测定形体评分和狼疮活动指数(SLEDAI)、血清总胆固醇(CHOL)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、空腹血糖(GLU)、C反应蛋白(CRP)、补体(C3、C4)及总补体(CH50)等。结果:在治疗4周后,治疗组患者在形体评分、LDL-C、GLU、CRP、SLEDAI等方面均明显低于同期对照组,治疗组C3、C4、CH50等较治疗前均明显升高。结论:中西医结合治疗可以改善系统性红斑狼疮患者症状及实验室检查指标,有效防治服用糖皮质激素的副作用。

AIM OF THE STUDY:TBL-II is the water extract of an anti-arthritic Chinese herbal formula Tongbiling (TBL), which has been used to treat rheumatoid arthritis (RA) for many years. We herein aimed to confirm its anti-arthritic effect and explore the potential mechanism of action on collagen-induced arthritis (CIA) in mice. MATERIALS AND METHODS:Four weeks after the first collagen immunization, mice were treated with TBL-II orally at a lower dose of 100mg/kg/d and higher dose of 300 mg/kg/d for 2 or 8 weeks. The severity of arthritis was evaluated by symptoms, radiological scores and histological assessment. Levels of IL-1β, IL-6, TNFα and IgG2a type anti-collagen II (CII) antibody in serum were measured by ELISA. Competitive RT-PCR and immunohistochemical analysis were used to investigate MMP-2, -3, -9 mRNA and protein expression. RESULTS:Our results revealed treatment with higher dose of TBL-II for 2 weeks attenuated significantly acute inflammation, and decreased the amounts of IL-1β and TNFα in serum; treatment for 8 weeks could obviously suppress chronic inflammation, ameliorate cartilage and bone destruction, and reduce the levels of matrix metalloproteinase (MMP)-2, -3, -9 mRNA and protein expression in joints. The levels of IgG2a type anti-CII antibody in serum were significantly reduced by treatment with higher dose of TBL-II for either 2 or 8 weeks. In contrast, treatment with lower dose of TBL-II for 8 weeks had no effect on articular destruction. CONCLUSIONS:Our results suggested that TBL-II at higher dose not only ameliorated symptoms but also modified disease of CIA. TBL-II would be a potent candidate as a novel botanical drug for further investigation.

ObjectiveTo observe the effect of Zhibai Yangyin Decoction on glucose and lipid metabolism of rats with Yin-deficiency induced by glucocorticosteroid. MethodsThirty SD rats were randomly divided into three groups: normal control group,model group and TCM treatment group(n=10).The Yin deficient model was induced by glucocorticosteroid,and the TCM group were administered intragastrically with Zhibai Yangyin Decoction.After 8 days,all rats were executed the concentrations of total cholesterol(CHOL),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein-cholesterol(LDL-C) and blood sugar(BS) were determined. ResultsCompared with the normal control group,the concentrations of GLU,TG,CHOL,HDL-C were higher in the other groups(P0.05).Compared with the model group,the concentration of GLU,CHOL,TG,HDL-C,LDL-C were decreased in the TCM group while GLU、CHOL were more significantly decreased(P0.05). ConclusionThere are some degree disorders of glucose and lipid metabolism in rats with Yin-deficiency induced by glucocorticosteroid.Zhibai Yangyin Decoction can improve the symptoms of Yin-deficiency,and lower the glucose and lipid metabolism of rats with Yin-deficiency caused by glucocorticosteroid.