Objective:To investigate the protective effect of reduced glutathione (GSH) on diclo-fenac-induced acute kidney injury (AKI) in rats and its mechanism.Methods:Thirty-three male 8-week-old specified pathogen-free SD rats were randomly divided into control, model, and GSH groups (11 rats in each group) according to a random number table method. Diclofenac sodium solution (200 mg/kg) was intragastrically administered to rats in the model group and GSH group to establish the AKI model. Thirty minutes later, rats in the GSH group were treated with intragastric administration of GSH solution (500 mg/kg), while rats in the control and model groups were with 0.9% sodium chloride injection of equal volume. After 24 hours of administration, blood sample was collected and kidneys were isolated. Kidney function [blood urea nitrogen (BUN), serum creatinine (Scr)], kidney histopathology, and serum and kidney tissue oxidative stress indicators such as malondialdehyde (MDA), superoxide dismutase (SOD), and the inflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin 6 (IL-6) were examined. The results of each examination results among rats of the 3 groups were compared.Results:The BUN and Scr in rats of the model group were significantly higher than those in the control and GSH groups[BUN: (14.34±8.47) mmol/L vs. (7.89±2.20) and (8.46±3.58) mmol/L; Scr: (34.44±6.56) μmol/L vs. (24.77±9.50) and (29.28±4.33) μmol/L, all P<0.05]. Glomerular and tubular morphological changes were observed in both model and GSH rats, but the change in rats of GSH group was less severe than that of the model group. The mean levels of MDA, TNF-α, and IL-6 in both serum and kidney tissue in rats of GSH group were significantly lower than those of the model group[MDA: (9.5±0.2) nmol/ml vs. (10.2±0.6) nmol/ml, (3.6±0.3) nmol/ml vs. (4.0±0.2) nmol/ml; TNF-α: (2.9±2.5) pg/ml vs. (5.4±3.0) pg/ml, (420.9±40.3) pg/ml vs. (470.4±31.3) pg/ml; IL-6: (92.1±34.4) pg/ml vs. (123.9±16.6) pg/ml, (7 547±604) pg/ml vs. (8 047±470) pg/ml, all P<0.05], while the activity of SOD was significantly higher than that in the model group[(102.8±2.8) U/ml vs. (99.7±4.1) U/ml, (387.0±12.7) U/ml vs. (375.9±11.7) U/ml, all P<0.05]. Conclusion:GSH has a protective effect on diclofenac-induced acute kidney injury in rats, and its possible mechanism is to inhibit oxidative stress and inflammatory reactions.

目的:探索提高基层医疗机构中药服务能力的方法和途径.方法:以厦门市6个辖区内的社区卫生服务中心、乡镇卫生院的药师、医生护士为调查对象,对其所在基层医疗机构的中药服务开展现状与需求开展问卷调查.结果:在中药服务配备上,54.35％药师认为中药人员配备不足,中药配方颗粒均未配备但需求率较高,中药药学服务信息化薄弱,88.80％的被调查者希望政府投资统一搭建药学服务信息化平台.中药服务项目趋于多样化,均开展了中药饮片调剂,中药代煎代送服务得到医务人员普遍认可,临方加工虽呼声很高但受制于人才、场地、收费标准、政策解读分歧而未能开展.中药服务质量亟待提高,所有人均认为饮片质量、煎煮质量、调剂质量应重点关注,82.26％认为有必要统一厦门市中药饮片调剂给付标准,绝大多数人认为中药饮片质量、调剂质量、处方审核质量、中药煎煮质量应由本单位中药师把关.89.86％受访者认为基层缺乏人才,其中中药处方点评人才最紧缺.50.14％认为提高中药服务质量最关键在于人才培养.结论:合理配置中药专业人员,丰富中药使用形式,加大中药药学服务信息化建设,重视中药服务质量,重视中药人才培养,是提高基层医疗机构中药服务能力的方向.

目的:明确临床药师科普干预的重要性,探索儿科临床药师进行科普干预的有效方法,从而提高患者用药依从性,提升临床疗效,减少再住院率.方法:选取厦门市中医院2020年3-8月诊断为社区获得性肺炎住院患者,随机分为对照组和科普干预组各50例,其中科普干预组又进一步分为西药临床药师科普干预组25例和中西药临床药师联合科普干预组25例,分别进行临床疗效、用药依从性、科普知识知晓率、再住院率评价.结果:在提高临床疗效方面,科普干预组体温恢复正常时间、咳嗽及肺部体征明显好转时间、出院时间较对照组短,差异均有统计学意义(P＜0.05),西药科普干预组和中西药联合科普干预组比较差异无统计学意义(P＞0.05).在提高患者用药依从性方面,中西药联合科普1次即有明显效果,单纯西药科普2次有明显效果.随访6个月内对照组有2例患儿因肺炎再次入院,科普组无患儿因肺炎再次入院.结论:患儿的安全用药教育刻不容缓,临床药师的科普宣教在提升患者用药依从性、提高临床疗效方面成效显著.

目的 利用数据挖掘,分析某中医院(厦门市中医院)在发热观察科使用的中药组方规律,为厦门市发热患者防治工作提供地域特色的中医治疗方案.方法 从HIS系统导出2020年1月—2020年5月在某院发热观察科进行医学隔离观察的195位患者的中药处方,建立数据库,并使用Excel 2016软件及SPSS 21软件对患者的性别、年龄、处方用药频次、药物功效分类、高频中药聚类分析进行整理.结果 患者中男女比例差异无统计学意义,患者年龄相对集中在16～30岁,组方用药频率在60％以上的有3味中药,分别为甘草、陈皮、苦杏仁;方组以化痰止咳、解表、清热、补虚药为主;对高频中药聚类得出4类组合方组.结论 本次流感具有"湿、热、毒、瘀、虚"的病机特点,厦门市中医防治用药以清热解毒、解表除湿、补气固表为治疗原则.

[目的]探讨祛风解表中药干预过敏体质的分子机制.[方法]通过生物信息学方法中的网络药理学及多组学联合通路分析,将分别来自祛风解表中药靶点、GWAS catalog提取的过敏共病基因、基因芯片鉴定的过敏体质和平和体质差异基因(树突状细胞未成熟为imDEG,已成熟为mDEG)的不同基因集结果在通路水平进行相互印证,使用元分析加权合并P值并校正,综合检测过敏过程中靶蛋白可能参与的通路,构建蛋白-蛋白相互作用网络(PPI)筛选核心靶点.[结果]从15味有抗过敏作用的祛风解表中药筛选出545个活性成分,预测并筛选出226个靶点基因,与427个过敏共病基因、1240个imDEG、743个mDEG进行多组学联合通路分析,鉴定出24个多组学显著性通路,包括6个过敏相关通路,即白细胞介素(IL)-4和IL-13信号、T细胞受体信号通路、CD28家族的共刺激、脂多糖的细胞反应、转化生长因子-β(TGF-β)受体信号通路、抗原加工-交叉提呈.在过敏通路相关的28个靶蛋白中鉴定出11个核心靶点,即丝裂原活化蛋白激酶(MAPK8)、蛋白激酶B(AKT1)、MAPK1、SRC、MAPK14、HSP90AA1、LCK、PARP1、PDPK1、JAK3、基质金属蛋白酶(MMP3).[结论]上述通路及靶点主要反映了树突状细胞的提呈、T细胞受体信号转导、Th2型细胞因子分泌以及免疫耐受的过敏进程,揭示了祛风解表中药干预过敏体质的免疫学机制.研究为探索中药干预过敏体质的分子机制提供了一个方法学框架.

目的:探寻药师在多学科诊疗模式下医药协作的切入点.方法:通过对一例隐球菌性脑膜炎患者的两次会诊,药师在综合评估患者的用药史、动态检验指标等后发现了患者出现的两个药物不良反应—低钾血症和肝功能异常.结果:经过优化调整治疗方案后,患者低钾血症和肝功能异常都完全恢复正常.结论:药物不良反应易被临床医生忽视,可以作为药师与临床沟通的切入点,搭建起一座沟通医药的桥梁,为今后药学服务模式的探索提供参考.

目的:通过制订更专业适用的肠外营养用药自定义审方规则,更有效完成肠外营养医嘱的审核,促进肠外营养处方合理、规范.方法:结合医院实际情况和存在的突出问题,由临床营养专业药师、营养师、临床医师、审核药师参与制订肠外营养自定义审方规则,并嵌入医院审方系统,实现更有效地审方干预.结果:启动自定义审方规则后,全院肠外营养医嘱点评扣分项明显下降;普遍存在的注射用脂溶性维生素不合理配伍和氨基酸、脂肪乳单瓶输注现象显著减少.结论:审方系统嵌入自定义规则后,药师对肠外营养医嘱审方效率提高,有效地解决实际存在的突出问题,使肠外营养处方得到进一步规范.

目的 建立超高效液相色谱串联质谱法(UPLC-MS/MS)同时测定参术散中4种成分(绿原酸、甘草苷、党参炔苷和甘草酸铵)的含量.方法 采用UPLC-MS/MS法,通过正负离子多反应监测(MRM)模式进行含量测定.色谱条件:采用Shim-pack XR-ODSⅢ(2.0 mm×75 mm,1.6μm)色谱柱,流动相选择0.1％甲酸5 mmol/L乙酸铵水溶液(A)-乙腈(B),梯度洗脱,流速0.30 mL/min,柱温40℃.结果 在上述色谱条件下,4种成分在各自的线性范围内呈现良好的线性关系(r≥0.9991),其精密度、稳定性、重复性考察的RSD均小于3％,符合分析要求;平均回收率98.93％～100.07％,RSD<3％.3批样品中4个化学成分的含量测定结果:绿原酸11.30～33.90μg/g;甘草苷18.10～23.60μg/g;党参炔苷102.00～199.00μg/g;甘草酸铵43.40～66.90μg g.结论 本研究所建立UPLC-MS/MS定量分析方法可同时测定参术散中4种成分(绿原酸、甘草苷、党参炔苷和甘草酸铵),快速准确、灵敏度高,为参术散的质量控制提供参考依据.

小柴胡汤疗效显著,临床应用非常广泛,但是由于成方年代已久,药材的品种来源、品质、炮制方法、剂量单位和常用剂量都已经发生变化,这些因素都会影响小柴胡汤的疗效.因此厘清这些影响因素,在尊重原方的基础上,根据现代中医药发展的新研究、新技术,科学合理地加以运用,才能使小柴胡汤的疗效得到更好的发挥.

目的:探讨扶正固本法对乳腺癌骨转移后骨破坏的抑制作用及可能的分子机制.方法:通过胫骨内注射乳腺癌细胞建立乳腺癌骨转移动物模型,给予扶正固本方药干预,给药后采用IVIS检测乳腺癌在骨环境中的生长情况,X-ray和TRAP染色分析骨破坏及破骨细胞活性情况,并采用ELISA检测小鼠血清中的TNF-α、IL-1β、IL-6、IL-17、PTHrP、RANKL、OPG、TGF-β、IGF、PDGF细胞因子的表达改变.结果:IVIS结果显示扶正固本方药可减缓乳腺癌在骨环境中的生长,X-ray和TRAP染色表明扶正固本方药可以减少乳腺癌骨转移引起的骨破坏及破骨细胞活性,ELISA结果显示扶正固本方药可以降低血清中TNF-α、IL-1β、IL-6、IL-17、PTHrP、RANKL、TGF-β、IGF、PDGF的表达水平,提高血清中OPG的表达水平.结论:扶正固本方药可通过调节多种细胞因子的表达,从而减缓乳腺癌细胞在骨环境中的生长,以及减轻乳腺癌细胞所引起的骨破坏.

目的 建立薄层色谱法及高效液相色谱法测定栀子根、茎、枝中齐墩果酸含量的方法,对栀子根、茎、枝中齐墩果酸的含量进行比较.方法 将采集的栀子根、茎、枝样本处理后,采用薄层色谱法定性检测样本齐墩果酸成分;采用HPLC法测定样本中齐墩果酸的含量,并对数据进行综合分析处理.结果 薄层色谱法定性分析栀子根、茎、枝中均含有齐墩果酸成分;HPLC法含量测定栀子根、茎、枝3个部位中齐墩果酸的含量具有显著差异,其含量顺序为根>茎>枝.结论 栀子根、茎、枝中均含有齐墩果酸成分,栀子茎齐墩果酸含量较栀子根相对接近,可作为拓宽栀子根药材药用部位进一步研究的基础依据.

Gardeniae fructus acts on clearing heart fire,eliminating damp and cooling blood,detoxifi-cation.It is the effective herb for reducing fire of sanjiao,removing heat and heat of the liver and gallbladder, cooling blood and detoxification.It is extensively used in clinical practice from the ancient time to the pres-ent.But gardeniae fructus is bitter and cold herb and easily injures the spleen and stomach. The ancient scholar pays the great attention on the processing and proper application of it in clinical practice.In the pa-per,the literatures on the different processing methods,the medical scholars′discussion on the processing methods and the clinical precautions were analyzed so as to provide the evidence of gardeniae fructus in clini-cal application.The study results show that gardeniae fructus is apt to injure the spleen and stomach due to its bitter in taste and cold in nature and to damage yin due to its action of resolving dryness.The contraindica-tions of gardeniae fructus are qi deficiency of the spleen and stomach,deficiency cold syndrome,poor appe-tite,loose stool and yin and blood deficiency.It is especially contraindicated in yin excess,separation of yin from yang or the syndrome of true cold and false heat.This herb should be used carefully in clinical practice.

OBJECTIVE:To optimize water extraction and granulating technology of Tongmai granule. METHODS:Using the contents of notoginsenoside R1,ginsenoside Rg1,ginsenoside Re and ginsenoside Rb1 and yield of extracts as the index,L9(34)or-thogonal design was used to optimize and validate water extraction technology in preparation process of Tongmai granule. Decontam-ination,concentration and drying,diluent of granulating technology were investigated. RESULTS:The optimal water extraction technology was as follows as 8-fold water,soaking for 0.5 h,decocting 1.0 h each time,for 2 times. In validation test,the yield of extract was (28.38 ± 0.461)%(RSD=1.63%,n=3),and the content of total saponins was (5.029 ± 0.060) mg/g (RSD=1.20%,n=3). The optimized granulating technology was that extract was filtrated and decontaminated,and then concentrated un-der vacuum degree of 0.08 MPa and vacuum temperature of 60℃;the ratio of extraction powder-accessories(maltodextrin)was 3∶1,drying temperature was set at 85-90 ℃;the amount of diluent was 3%. Under this condition,the content of total saponins was (5.211 ± 0.207) mg/g (RSD=3.96%,n=3) . CONCLUSIONS:This technology is stable and feasible,and it is suitable for the preparation of Tongmai granule.

目的:建立通脉颗粒的质量标准.方法:采用薄层色谱法对方中黄芪、红参、三七、赤芍进行定性鉴别;采用HPLC测定通脉颗粒中三七皂苷R1,人参皂苷Rg1,人参皂苷Re及人参皂苷Rb1的总量.结果:本品TLC定性鉴别薄层色谱斑点清晰,专属性强,重复性好.HPLC测定三七皂苷R1,人参皂苷Rg1,人参皂苷Re及人参皂苷Rb1进样量分别在0.058 8 ～0.588 0,0.487 9 ～4.879,0.104 9～1.049,0.308 3 ～3.083 μg呈良好的线性关系,r分别为0.999 6,0.999 6,0.999 7,0.999 6,平均加样回收率为95.34％ (RSD 1.8％),95.42％(RSD 2.0％),98.99％(RSD 1.8％),102.13％ (RSD 1.8％).结论:该方法准确灵敏,简便,专属性强、重复性好,适用于通脉颗粒的质量控制.

The active components from Ficus erecta were extracted by solvent separation methods, and their Prevent Arthritis effects on AA rat model. Among the extracts from Ficus erecta, ethanol and ethanol-water extract has good Prevent arthritis effect, ethanol-water ex-tract better, the parts with medium polarity from Ficus erecta have the best Prevent arthritis.

近年来中国心脑血管病发病率、死亡率和危险因素仍呈直线上升趋势,构成我国的死亡头号杀手,心脑血管疾病发病的机制和防治方法研究亟待取得突破.研究认为,内皮功能不全是心脑血管疾病的早期敏感指标,而痰湿体质者是代谢综合征及心脑血管并发症的高危人群,并存在内皮功能不全的分子机制.由此提出,早期关注痰湿体质人群内皮功能状态,并运用调体理论早干预早治疗,可将心脑血管疾病的防治关口前移,为心脑血管疾病的防治提供新的思路.

探讨“辨体-辨病-辨证”诊疗模式在针灸治疗过敏性疾病中的应用.提出在辨病辨证论治的基础上,调理体质方面应采用扶正法为主,兼以清透伏邪.扶正取穴可取背俞穴、原穴、任脉、督脉穴等,并多采用灸法;清透伏邪采用清热的腧穴及刺络放血、拔罐等疗法.临床针灸治疗过敏性疾病在预防和治疗缓解期时重用辨体,以治本为主,再次用辨病、辨证;在发作期时以辨病、辨证论治为主,辨体为辅,灵活运用三辨模式.

目的:探讨佩乐能导致甲状腺功能检验指标异常的临床处理方法.方法:收集2012年11月-2013年9月临床药师发现佩乐能抗HBV-DNA治疗中出现甲状腺功能检验指标异常的16例病例资料,并进行分析总结.结果:未采取任何干预措施下,10例指标恢复正常;1例补充硒酵母片,1个月后指标恢复正常.其它5例指标均未恢复正常,继续给予佩乐能治疗.其中1例佩乐能减量20 μg,给予丙硫氧嘧啶片与普萘洛尔片治疗,4个月后,各项指标均有所改善.转向其它甲状腺检验指标异常2例:1例促甲状腺素(TSH)降低转为甲状腺球蛋白抗体(Tg-Ab)升高,1例游离甲状腺素(FT4)升高转为三碘甲腺原胺酸(T3)降低.患者均无临床症状,未采取处理措施.1例TSH降低,无临床症状,未干预,11个月后TSH较前改善.1例TSH升高有临床症状的患者,佩乐能减量20 μg,3个月后,TSH有所下降,症状改善.结论:佩乐能诱导的甲状腺功能检验指标异常大部分具有自限性、可逆性.临床应结合患者症状体征、合理的分析检验结果,采取针对性处理措施.

Sharing the same origin,Japanese Kampo medicine and traditional Chinese medicine both pay great attention to the constitutional differences between individuals.Extensively studied in Japan,constitutional medicine has a lot of schools and classifications,in which Yi Guan Tang medicine is a typical representative of Japanese constitutional research.Both constitutional medicine of traditional Chinese medicine and Yi Guan Tang medicine believe that constitution is associated with the development of diseases;however,there are differences in theoretical origin,classification,pathogenesis,and diagnosis and treatment between the two systems.These two systems are closely related to each other,and mutual communication and reference should be enhanced in the future.

气郁质是临床上常见的九种体质之一,研究发现气郁质易患郁证、失眠、惊恐等病证.《灵枢·经脉》记载了这些病证的相关经脉病变,如“胆足少阳之脉,起于目锐眦......是动则病口苦,善太息,心胁痛不能转侧.”此外手阳明大肠经病变也会出现郁证;烦心失眠可由手心主之别络、足少阴肾经、足太阴脾经病变所致;足少阴肾经、足阳明胃经病变会出现惊恐,故可选取相应的经络穴位治疗,如治疗郁证可选取太冲、阳陵泉、膻中、血海等穴;同样,治疗失眠可选取少府、内关、足三里、三阴交等穴;选取灵道、神门、涌泉、太冲等穴可治疗惊恐.根据“体病相关”的理论,疾病通过相应的经络穴位治疗而改善,体质也会改变.