基于脑肠轴的理论,就脑梗死急性期借助脑肠肽与肠道之间的联系及通腑化瘀法对该疾病的干预作用进行综述.随着脑梗死疾病发病率不断增加,脑梗死带来的消极影响越来越大,该疾病已被作为全球性公共卫生问题为更多人所重视.脑梗死急性期为脑梗死的关键治疗时期,该时期多属于中医理论体系中中风病的痰热腑实证型.近年来,也有越来越多的证据表明处于脑梗死急性期的病人多有肠道菌群失调、便秘等肠道功能紊乱的情况,且临床上用调节脑肠肽的方法以及通腹泻下的方药对该病症有明显疗效.

偏头痛在临床中多发为一侧或两侧颞部疼痛,发作前时常有闪光、视物模糊、肢体麻木等前兆症状,以及可能会伴有恶心、呕吐、畏光、畏声、食欲不佳、身体不适等表现,周围刺激、饮酒、空腹饥饿、女性月经来潮或日常活动均可加重头痛,安静环境、休息可缓解头痛.偏头痛更可能发生在儿童和青少年时期,在青年和中年达到高峰,且主要以女性为主,而且慢性偏头痛具有高致残率,同时可伴有多种伴发病、继发病,对个人、家庭和社会产生非常沉重的心理和经济负担,是一个十分重大的世界性公共卫生问题.2013年世界卫生组织调查结果显示,人类最常见疾病中偏头痛已位列第三位[1].因此研究偏头痛的发病机制及相应治疗措施和药物尤为重要.

目的 通过Logistic分析,探究血管性认知障碍的证素特征.方法 将被调查对象分成血管性轻度认知障碍(VMCI)、血管性痴呆(VD)、认知正常3组,首先确定各组的高频症状,在因子分析的基础上确定病性和病位,通过Logistic分析对3组人群进行两两比较,阐述两类血管性认知人群的常见中医证素.结果 共收集有血管性危险因素疾病人群722例,其中VMCI患者253例,VD患者214例,认知正常255例.通过频数和因子结果分析,VMCI和VD主要病性为血瘀、气虚、阴虚和火热,认知正常病性为血瘀、火热、气郁、气虚、血虚和阴虚.3组人群两两之间Logistic分析:认知正常与VCMI比较,以气虚为参照,血瘀OR值小于1,以血瘀为参照,气虚、阴虚、火热OR值均大于1;认知正常与VD比较,以火热为参照,血瘀、气虚、阴虚OR值均小于1;以气虚为参照,火热OR值大于1;VD与VMCI相比,似然比检验P>0.05,差异无统计学意义.结论 VMCI、VD的病性主要为血瘀、气虚、阴虚和火热;与认知正常相比,VMCI病性血瘀较为多见;VD病性以血瘀、气虚、阴虚证素较为多见.

目的 探讨清眩汤在后循环缺血性眩晕中的应用效果及对脑血流量的影响.方法 选取山东中医药大学附属医院2017年9月—2019年7月收治的后循环缺血性眩晕患者60例,按照随机数字表法分为2组,对照组30例给予盐酸氟桂利嗪胶囊治疗,治疗组30例给予盐酸氟桂利嗪胶囊联合清眩汤治疗,治疗2周后比较2组临床疗效、中医证候疗效,观察治疗前后脑血流速度及搏动指数.结果 治疗组临床疗效总有效率为83.3％(25/30),对照组为60.0％(18/30),治疗组显著高于对照组(P<0.05);治疗组中医证候总有效率为86.7％(26/30),对照组为63.3％(19/30),治疗组显著高于对照组(P<0.05).2组治疗后左椎动脉、右椎动脉、基底动脉血流速度显著增快(P均<0.05);与对照组相比,治疗组治疗后2周后左椎动脉、基底动脉血流速度更快(P均<0.05).与治疗前相比,2组治疗2周后左椎动脉、基底动脉搏动指数明显降低(P均<0.05);治疗组和对照组治疗2周后PI比较差异均无统计学意义(P均>0.05).结论 在盐酸氟桂利嗪胶囊的基础上合用清眩汤可以增快左椎动脉、基底动脉血流速度,显著提高治疗后循环缺血性眩晕的有效率.

分水岭脑梗死是脑梗死的一种类型,其病情进展较快,且复发率高.本文回顾了络病理论的理论构建过程及基本概念,指出分水岭脑梗死的发生是血流动力学障碍和微栓子二者协同作用的结果,气络推动无力和血络瘀滞是分水岭脑梗死的主要病理机制,提出中医治疗分水岭脑梗死要遵循"络以通为用"的治疗原则,认为益气通络、活血通络是分水岭脑梗死的主要治法.本文丰富了分水岭脑梗死的理论体系及治疗方案,为分水岭脑梗死的防治提供了理论依据.

分析在口服多巴丝肼片基础上加用中药风引汤和西药恩他卡朋治疗的丘脑梗死后Holmes震颤(HT)有效病案一则,并结合相关报道探讨左旋多巴治疗HT疗效各异的原因.认为对于应用多巴丝肼片治疗有效、但有效期较短的HT患者,加用恩他卡朋可延长多巴丝肼片药效;同时,中药风引汤对肝肾阴虚、风痰瘀阻型HT患者有育阴潜阳、平肝息风之功,中西医结合治疗HT疗效较好.

短暂性脑缺血发作(transic attack,TIA)根据受累血管分布不同,分为颈内动脉系统TIA 和椎- 基底动脉系统TIA[1] .椎基底动脉系统即后循环(posterior circulation,PI)系统,由椎动脉、颅外段、颅内段、基底动脉、大脑后动脉组成,主要给脑干、小脑、丘脑、枕叶、部分颞叶及上脊髓供血.后循环TIA 是椎- 基底动脉一过性供血不足引起的以眩晕为主要表现的疾病,可伴随视觉障碍、平衡障碍、共济失调、肢体麻木、眼球运动障碍等症状,常持续数秒钟或数分钟,多在1 h 内恢复,最多不超过24 h,不遗留神经功能缺损症状和体征,影像学检查(CT、MRI)无责任病灶.后循环缺血分为后循环的TIA和脑梗死[2] .后循环缺血中有四分之一为TIA.

肾上腺皮质功能减退症以肾上腺皮质激素分泌减少为主要表现,属中医学虚劳范畴,主要病机为脏腑亏损、气血阴阳不足.本病因临床较少见,症状缺乏特异性,容易误诊.报道1例以发作性四肢软瘫为主要症状的肾上腺皮质功能减退症患者的临床诊断及治疗过程,探讨肾上腺皮质功能减退症的临床特点与诊疗思路,为临床医师正确诊治本病提供借鉴.并结合病例的中医药治疗,探析中医药在治疗病因不明确的虚劳方面的优势.

目的:通过收集血管性认知障碍(Vascular Cognitive Impairment,VCI)人群的临床资料,比较分析其危险因素与中医证素分布的相关性.方法:通过收集患有血管性危险因素疾病且年龄≥50岁人群的一般资料,首先,归纳VCI患者的中医症状,通过因子分析提取代表整个VCI人群的中医证素,确定病位和病性;然后,分别比较分析危险因素与证素分布的相关性,从而为建立VCI的规范辨证标准提供参考和依据.结果:本次调查共筛选出患有血管性危险因素疾病的患者共计722例,其中VCI患者467例[血管性轻度认知功能障碍(Vascular Mild Cognitive Impairment,VMCI)组253人,血管性痴呆(Vascular Dementia,VD)组214人].首先,整理既往患有血管性疾病患者资料,通过因子分析明确病位和病性.病位证素与危险因素的相关性:既往有脑血管疾病史的病位在心、肾,既往有高血压病史的病位在心、肝,既往有糖尿病史的病位在肝,既往有高脂血症病史的病位在脾,既往有冠状动脉粥样硬化性心脏病(简称冠心病)病史的病位在心.病性证素与危险因素的相关性:既往有脑血管疾病史的病性为血瘀,既往有高血压病史的病性为阴虚、血瘀,既往有糖尿病史的病性为阴虚、火热,既往有高脂血症病史的病性在痰浊,既往有冠心病史的病性在气虚.结论:VCI的中医病位证素为心、肝、脾、肾,病性证素为阴虚、阳虚、气虚、痰浊、火热、血瘀;有冠心病的患者病位在心,病性多为气虚;有脑血管病史的患者病位在心、肾,病性多为血瘀;有高血压病史的患者病位在心、肝,病性为阴虚、血瘀;有糖尿病史的患者病位在肝,病性为阴虚、火热;有高脂血症病史的患者病位在脾,病性多为痰浊.

分水岭脑梗死与其他类型的脑梗死具有相似的起病形式和临床表现,特异性不强,必须借助影像学检查方可确诊,临床容易误诊和漏诊,且分水岭脑梗死病情进展较快、预后较差,复发率高,故临床应高度重视,本文综述了分水岭脑梗死的病因病机最新研究进展,探析了益气活血法的干预作用,旨在为分水岭脑梗死的有效预防与治疗提供参考.

Ginkgo biloba extract EGb 761 possesses a variety of biological effects and has been proved to be beneficial in Alzheimer's disease. This study aimed to explore the anti-inflammatory mechanisms of EGb 761 on the Aβ1-42-induced BV-2 microglial cells. We analyzed the production and gene expression of proinflammatory cytokines by enzyme-linked immunosorbent assay and qRT-PCR, examined phosphorylation of MAPKs by western blot and measured nuclear factor-κB nuclear translocation. Compared with Aβ1-42-treated group, EGb 761 inhibited release and gene expression of tumor necrosis factor-α and interleukin-1β, suppressed nuclear translocation of nuclear factor-κB and attenuated phosphorylation of p38 MAPK in a concentration-dependent manner, but not ERK and JNK. In summary, the results suggested that EGb 761 could attenuate Aβ1-42-induced neuroinflammatory response.

结节性多动脉炎以急性中、小动脉的坏死性炎症为主要特征,病理学表现为血管壁纤维素样坏死及大量中性粒细胞浸润,为非肉芽肿性的坏死性血管炎,归属于中医脉痹范畴.回顾性收集1例结节性多动脉炎并多神经病变病例,患者四肢麻木疼痛,双足底疼痛剧烈伴蚁行感,双下肢活动不利,临床表现及辅助检查符合结节性多动脉炎诊断,经激素、免疫抑制剂联合应用及中医清热解毒、祛湿活血治疗,临床症状显著缓解,实验室指标转阴.长期疗效需随诊.

Qilong Capsules is the representative Chinese patent medicine of the theory of " invigorating Qi and activating blood circulation" in traditional Chinese medicine( TCM),with distinct characteristics of TCM in clinical application. Qilong Capsules indication on package insert is ischemic stroke( cerebral infarction),which is a complex disease and has many pathological links. The treatment principles and methods at various stages are different. Inappropriate time of intervention,dosage and course of treatment make it difficult to give full play to the efficacy,but also cause adverse reactions,such as bleeding. In order to promote the rational use of Qilong Capsules,the project team invited frontline clinical experts,pharmaceutical experts and methodologist of evidence-based medicine around China to develop the consensus. The consensus is based on a combination of clinical research evidence and expert experi-ence to give recommendations for clinical problems with evidence support and expert consensus suggestions for clinical problems without evidence support. The consensus recommends the indication,timing of intervention,dosage,course of treatment,combined medication and contraindications of Qilong Capsules in clinical application,and introduced its safety characteristics,in order to guide clinical medical workers( involving Chinese medicine,Western medicine,combining traditional Chinese and Western medicine) to use Qilong Capsules reasonably in the treatment of cerebral infarction.

综述青中年脑梗死与超敏C反应蛋白(hs-CRP)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(Hcy)、尿酸的相关性,分析化痰通络法对其各项指标的影响,以期为青中年脑梗死病人的早期预警、中医药早期干预提供理论依据.

目的 比较中风后痴呆与非痴呆患者二便的差异,尝试从二便角度分析中风后痴呆中医证候特点.方法 将2 996例中风患者根据认知功能障碍程度分为非痴呆组2 348例、痴呆组648例,采用项目统一制定的《中医周边症状、舌脉象观察表》采集2组患者二便信息并作比较,分析差异条目所蕴含的证候特点.结果 与非痴呆组比较,痴呆组小便清长、小便短赤、夜尿频多、尿后余沥、咳笑时遗尿、尿急、排便无力、便秘发生率高,2组差异有统计学意义(P＜0.01);其中,夜尿频多、便秘的发生率最高.在校正年龄、NIHSS评分因素后,发现尿急(OR=1.519,P＜0.05)、排便无力(OR=1.353,P＜0.05)与中风后痴呆具有相关性.结论 二便异常在中风后痴呆患者中发生率更高.尿急、排便无力与中风后痴呆具有相关性,提示在疾病复杂病机中脾肾气虚的重要性.

缺血性脑卒中缺乏有效的治疗措施,目前应用于临床的许多药物受到血脑屏障的限制,难以充分发挥疗效.EGb 761是银杏制剂的提取物,在改善心脑血管疾病方面积累了大量证据.为提高其局部血药浓度,我们采用侧脑室微量泵泵入EGb 761,并观察其对大脑中动脉缺血-再灌注(MCAO)大鼠脑区细胞凋亡的影响,探讨其作用机制及侧脑室注射途径的可行性.

癫痫,中医称"痫证",是一种反复发作性神志异常病证,最常见的神经系统疾病之一,病情顽固,难以治愈.在临床上,常见的抗癫痫西药虽然可使大多数患者的病情得以控制,但长期服药带来的毒副反应太大,病情得到控制的同时也给患者带来很大的困扰.中医以其独特的治疗方法,副反应少、对肝肾、胃肠道刺激小、疗效稳定而被广大人民群众所接受.我通过查阅大量的文献资料,在于总结中药治疗癫痫配伍和方法,进一步提高中医中药治疗癫痫的临床疗效.

Objective:To study the cognitive impairment characteristics and TCM symptom factors of lacunar infarction (LI) cognitive impairment with hypertension.Methods:A total of 713 cases of lacunar infarction patients were divided into two groups:the LI cognitive impairment with hypertension group(501patients) and the LI cognitive impairment without hypertension group (212 patients).Cognitive impairment characteristics and TCM symptom factors were analyzed.Results:LI cognitive impairment with hypertension group have lower MMSE and MoCA scores (P＜0.01,P＜0.05),and worse visuospatial ability and executive ability,attention and calculative ability,delayed memory than LI cognitive impairment without hypertension group.Qi deficiency (30.7％),phlegm (16.4％),fire (16.0％),blood stasis (14.4％),endogenous wind (6.6％),yin deficiency (5.8％),qi stagnation (5.2％)and yang deficiency (5.0％) are the symptom factors of LI cognitive impairment with hypertension group.Conclusion:LI cognitive impairment with hypertension group had worse visuospatial ability and executive ability,attention and calculative ability and delayed memory,and a larger proportion of symptom factors of qi deficiency,phlegm and fire.

Objective To investigate the correlation between cognitive functions and the Chinese medicine syndrome factors of vascular mild cognitive impairment (VMCI) in order to provide the theoretical evidence of making differentiation and treatment for VMCI.Methods A total of 803 subjects with VMCI were recruited from the clinic and wards of 7 hospitals from February 2008 to December 2011 and also the nearby community.The correlation between the cognitive functions and syndrome factors of TCM in these VMCI patients was analyzed.Results Among the VMCI patients,phlegm damp and yin deficiency were the most common syndrome factors followed by qi deficiency,yang deficiency,qi stagnation,blood deficiency,blood stasis and fire-heat;the syndrome factor of blood stasis showed negative correlation with the scores of MoCA (P =0.001).The scores of MoCA in the patients with blood stasis were significantly lower than those with non-blood stasis (P =0.005);visuoconstructional and executive function and naming was negatively correlated with phlegm damp syndrome (P =0.002,P =0.009);language function was negatively correlated with qi deficiency,blood deficiency,yang deficiency,fire-heat,blood stasis,yin deficiency,qi stagnation syndromes(P ＜ 0.001,P =0.004,P =0.001,P =0.001,P =0.035,P =0.001,P =0.006);the score of abstract tests was negatively correlated with blood deficiency,yang deficiency,blood stasis,yin deficiency,qi stasis syndromes (P =0.002,P =0.014,P ＜ 0.001,P =0.004,P =0.007);the score of delayed recall test was negatively correlated with fire-heat (P =0.002);the score of orientation test was negatively correlated with qi deficiency,blood deficiency,yang deficiency,yin deficiency(P =0.040,P =0.013,P ＜0.001,P ＜ 0.001).Conclusion Phlegm dampness and kidney deficiency syndromes are the very important syndrome factors in etiology and pathogenesis of VMCI,and blood stasis maybe the key syndrome factor which make VMCI worse.The severity of phlegm dampness can indicate the impairment of visuoconstructional and executive dysfunction.The syndrome factor of fire-heat can influence the recall function of patients.The more serious deficiency syndromes are,the more decreased oricntation function is.Abstract and language function can be both influenced by some syndrome factors.

目的 探讨血管性认知障碍(VCI)患者中医体质的内在关系和规律.方法 以患有脑血管病或具有血管性危险因素的人群366例为研究对象,通过收集临床资料,根据MMSE、MoCA、ADL、CDR等量表评分进行认知功能程度分组,运用《中医体质分类与判定表》判定体质类型.结果 N-VCI组中医体质主要为平和质;VCI-ND组中医体质前四位依次为:气虚质、痰湿质、平和质、血瘀质;VD组中医体质依次为:气虚质、痰湿质、血瘀质、平和质.平和质、气虚质、痰湿质、血瘀质组间差异具有统计学意义.结论 VCI的患病情况与中医体质类型具有一定的联系,VCI患者偏颇体质居多,气虚质、痰湿质、血瘀质、平和质是其主要体质.