目的:研究基于"心肾相关"的肾炎防衰液对糖尿病肾脏病(DKD)大鼠的治疗作用以及对肾脏及心脏病理的影响.方法:雄性SD大鼠40只,随机分出假手术组10只,余30只通过单侧肾结扎+链脲佐菌素(STZ)诱导成功建立DKD模型后,随机分为模型组、贝那普利组、肾炎防衰液组(n=10).治疗组分别予以贝那普利1.0 mg/kg·d-1、肾炎防衰液16.3 g/kg·d-1灌胃,余2组予以等量0.9％NaCl溶液.连续给药12周后,取血检测肌酐(Scr)、尿素氮(BUN)、血管紧张素Ⅱ(AngⅡ);用HE、PAS、Masson染色观察肾脏病理变化,HE、Masson染色观察心脏病理变化.结果:肾炎防衰液组和贝那普利组的Scr、BUN、AngⅡ水平相较于模型组均明显降低,差异均具有显著性(P<0.01,P<0.05).在肾脏病理中,与模型组相比,治疗组在HE、PAS、Mas-son染色中均体现出减轻肾病病理损害的作用;在心脏病理中,HE染色可见治疗组能减轻心脏病理损害,而Mas-son染色各组均未见明显纤维化组织.结论:基于心肾相关的肾炎防衰液能有效改善DKD大鼠肾功能,减轻其肾脏、心脏病理损害.

目的:系统评价猪苓汤联合西医常规疗法治疗慢性肾小球肾炎的临床疗效及安全性,为指导临床应用提供循证医学证据.方法:计算机检索五大常用数据库,检索时间截止至2019年7月1日,收录猪苓汤联合猪苓汤联合西医常规疗法治疗慢性肾小球肾炎的随机病例对照试验(RCTs),运用Cochrane协作网的偏倚风险评估量表评估纳入研究的方法学质量,运用RevMan 5.3软件进行数据分析.结果:本研究共纳入13篇符合最终标准的文献,共942例患者,Meta分析显示,与单用西医常规疗法相比,猪苓汤联合西医常规疗法能提高临床总有效率[RR=1.27,95％CI(1.19～1.35)],降低24 h尿蛋白[MD=-0.38,95％CI(-0.51,-0.26)],差异有统计学意义(P<0.05);不良反应的发生率[RR=0.25,95％CI(0.12～0.53)],差异有统计学意义(P<0.05).结论:猪苓汤联合西医常规疗法治疗慢性肾小球肾炎疗效确切,且在降低24 h尿蛋白和减少不良反应方面与单用西医常规疗法比较优势明显.但由于纳入研究质量低,样本量较少,猪苓汤加减联合西医常规疗法治疗慢性肾小球肾炎的临床疗效及安全性仍需设计良好、大样本的随机对照试验进一步支持.

Background Chronic kidney disease (CKD) is one of the major causes of renal damage. Shenyan Fangshuai Recipe (SFR), a modified prescription of traditional medicine in China, showed potent effects in alleviating edema, proteinuria, and hematuria of CKD in clinical practices. In this study, we aimed to investigate scientific evidence-based efficacy as well as metabolic regulations of SFR in CKD treatment. Materials and Methods The effect of SFR on CKD was observed in a rat model which is established with oral administration of adenine-ethambutol mixture for 21 days. Further, metabolites in serum were detected and identified with ultra-performance liquid chromatography-high resolution mass spectrometry (UPLC-HRMS). Metabolomics study was performed using Ingenuity Pathway Analysis (IPA) software. Results With H&E staining and Masson's trichrome, the results showed that chronic kidney damage is significantly rescued with SFR treatment and recovered to an approximately normal condition. Along with 44 differential metabolites discovered, the regulation of SFR on CKD was enriched in glycine biosynthesis I, mitochondrial L-carnitine shuttle pathway, phosphatidylethanolamine biosynthesis III, sphingosine-1-phosphate signaling, L-serine degradation, folate transformations I, noradrenaline and adrenaline degradation, salvage pathways of pyrimidine ribonucleotides, cysteine biosynthesis III (Mammalia), glycine betaine degradation, and cysteine biosynthesis/homocysteine degradation. Further, TGFβ-1 and MMP-9 were observed playing roles in this regulatory process by performing immunohistochemical staining. Conclusion SFR exerts potent effects of alleviating glomerular sclerosis and interstitial fibrosis in the kidney, mainly via integrated regulations on metabolism and production of homocysteine, L-carnitine, and epinephrine, as well as the expression of TGFβ-1. This study provides evidence for SFR's protective effects on CKD and reveals the metabolic mechanism behind these benefits for the first time.

口疮病是口腔黏膜病中最常见的一种,目前尚无根治性方案,一般采用局部对症治疗,难以痊愈.中医学具有"整体辨治"特色.本文采用调肝为主辨证施治治疗反复发作的口疮病1例,取得了满意的疗效.

目的:对肾痹汤干预慢性尿酸性肾病(CUAN)模型大鼠的血清代谢轮廓进行系统研究,在代谢组学水平上揭示肾痹汤干预CUAN的分子机制.方法:采用腺嘌呤联合乙胺丁醇诱导CUAN模型,模型成功后给予肾痹汤进行干预,对疗效进行评价,并取正常组、 模型组、 肾痹汤组和别嘌醇组大鼠血清进行代谢组学分析.结果:模型组大鼠血尿酸(SUA)、 血肌酐(SCr)、 尿素氮(BUN)值显著升高,超高效液相色谱-质谱联用(UPLC-MS/MS)血清代谢组学分析鉴定了13种潜在的病理标志物,包含前列腺素E2、 α-亚麻酸、 雌二醇等9种下调代谢产物,和乳糖神经酰胺(d18:1/12:0)等4种上调代谢产物;经肾痹汤干预后,模型大鼠的上述生化指标及生物标志物水平均有回调趋势.结论:CUAN大鼠体内存在花生四烯酸代谢、 类固醇激素生物合成、 α-亚麻酸代谢及鞘脂代谢的紊乱,肾痹汤可能通过调节紊乱的上述代谢途径,延缓CUAN的进展,保护残存肾功能.