Myocardial ischemia-reperfusion injury (MIRI) is a key factor affecting the prognosis of myocardial infarction patients. Currently, there remains a lack of specific drugs targeting MIRI, and it is unclear whether Piceatannol-3'-O-β-D-glucopyranoside (PG) improves MIRI through metabolic reprogramming. Therefore, this study takes a clinically oriented approach, using multi-omics technologies to investigate how PG regulates metabolic reprogramming to improve MIRI. The study focuses particularly on PG's regulation of lactate and lactylation. Results indicate that PG enhances LVEF and LVFS, reduces cTnI and CK-MB levels, decreases ROS, lactate, and LDH levels, and increases ATP expression, thereby improving cardiac function. Metabolomics results based on clinical serum samples indicate that PG can reduce lactate and pyruvate levels. The results of research conducted on animal subjects suggest that exogenous lactate supplementation has the capacity to attenuate the cardioprotective effects of PG. PG intervention significantly suppressed the expression of PDK4, MCT1, and ACSL4 proteins while enhancing GPX4 protein expression, inhibiting lipid peroxidation, and improving mitochondrial structure and function. However, the overexpression of PDK4 led to a diminution of the PG-mediated enhancement in MIRI. Overexpression of NDUFS1 K170 lactylation similarly impaired the PG-mediated improvement of MIRI. Therefore, we conclude that PG improves MIRI by inhibiting NDUFS1 K170 lactylation through metabolic reprogramming regulation. The present study provides novel targets and therapeutic agents for MIRI intervention, while also offering fresh insights into the pathogenesis of MIRI.

The association between immunocyte phenotypes and dilated cardiomyopathy (DCM) has been explored, however the exact pathogenesis of the relationship between immune cells and DCM is unclear. This bidirectional two-sample Mendelian randomization (MR) research aims to further validate the causal link between 731 immunocyte phenotypes and DCM. Summary statistics from a genome-wide association study data of individuals with European ancestry were utilized, including 1444 DCM cases and 353,937 controls, as well as 3757 European adults for the 731 immunocyte phenotypes. Causal effects were estimated using inverse variance weighted, MR-Egger regression, weight median estimator, weighted mode, and simple mode. Sensitivity analysis was conducted to confirm data robustness and feasibility. Based on the inverse variance weighted findings, 14 immunocyte phenotypes were risk factors for DCM ( P < .05, odds ratio [OR] > 1), while 15 immunocyte phenotypes exhibited a protective effect on DCM ( P < .05, OR < 1). The results of reverse MR analysis suggested evidence that DCM occurrence might elevate the levels of 17 immunocyte phenotypes ( P < .05, OR > 1) and decrease the levels of 9 immunocyte phenotypes ( P < .05, OR < 1). Our research indicated that CD28 on secreting regulatory T cell could mitigate the occurrence of DCM, and reciprocally, the progression of DCM could reduce the level of CD28 on secreting regulatory T cell. This study confirmed the bidirectional genetic predictive relationship between immunocyte phenotypes and DCM, underscoring the complex interplay between DCM and the immune system.

Introduction: In recent years, ShenSong YangXin capsule (SSYX) has gained widespread application in China as an adjunctive therapy for patients with chronic heart failure combined with atrial fibrillation (CHF-AF). However, its efficacy and safety profile remain subject to debate, and there is a notable lack of relevant systematic reviews and meta-analyses on this topic.Methods: A comprehensive search was conducted across seven databases up to August 25, 2025, identifying eligible randomized controlled trials (RCTs). Meta-analysis, subgroup analysis, and sensitivity analysis were performed using RevMan 5.4 and Stata 15.1. The Risk of Bias 2.0 tool was used to evaluate study quality, and publication bias was assessed with Egger’s test in Stata. Trial sequential analysis and the GRADE framework were utilized to assess the cumulative evidence and certainty of outcomes. The study protocol was prospectively registered with PROSPERO (CRD42023482018).Results: The meta-analysis included 17 RCTs comprising a total of 1756 patients from China. Results indicated that SSYX combined with conventional medication significantly improved clinical efficacy in patients with CHF-AF [RR 1.18 (95% CI 1.11, 1.25), p < 0.00001] and reduced the incidence of major adverse cardiovascular events (MACE) [RR 0.31 (95% CI 0.23, 0.41), p < 0.00001]. Statistically significant improvements were also observed in the following outcomes: B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide, left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, QT dispersion (QTd), ventricular rate, and AF duration. Adverse reactions were reported in 11 trials. According to the GRADE framework, one outcome (MACE) was supported by moderate-certainty evidence, three outcomes (clinical efficacy, QTd, and ventricular rate) were graded as low-certainty, and the remaining six outcomes were assessed as having very low-certainty evidence.Conclusion: The combination therapy incorporating SSYX showed potential benefits compared to conventional treatment alone in patients with CHF-AF. However, the overall certainty of evidence is limited. Therefore, these findings require careful interpretation and further large-scale, rigorously designed RCTs are warranted to provide more robust evidence regarding the efficacy and safety of SSYX.

Although the fibrosis-4 index (FIB‐4) was initially established as a liver fibrosis marker, recent studies have demonstrated its significant association with elevated risk of coronary artery disease(CHD). This study was conducted using data from five National Health and Nutrition Examination Surveys (NHANES) cycles between 2009 and 2018. Multivariable logistic regression analysis revealed a significant, positive relationship between FIB-4 and CHD.In sensitivity analyses, the highest FIB-4 quartile (Q4) showed a 4.22-fold increased CHD risk versus Q1 (OR = 4.22, 95

Introduction:Inflammatory bowel disease (IBD) includes Crohn's disease (CD) and ulcerative colitis (UC). Epidemiological studies have found that patients with IBD are more likely to suffer from cardiovascular diseases (CVDs) than the general population. However, so far, no exact causal association has been demonstrated between IBD and CVDs, and more research is needed to clarify this relationship. Material and methods:The two-sample Mendelian randomization (MR) method was used to explore the causal effect of IBD on CVDs. The exposure factor was IBD, including CD and UC. The outcome was CVDs, including chronic heart failure, atrial fibrillation, coronary heart disease, myocardial infarction and hypertension. The single nucleotide polymorphisms (SNPs) are all from the FinnGen genome-wide association study sample database. The CD samples included 210,300 controls and 807 cases, and the UC samples included 215,806 controls and 2701 cases. The samples included are all European samples. SNPs associated with Crohn's disease and ulcerative colitis were extracted from the IEUGWAS database and quality control and screening were carried out. Inverse variance weighted (IVW), MR-Egger, weighted median and other methods were used to study the causal relationship between them and CVDs. Finally, Cochrane's Q test, MR-Egger and the leave-one method were used for sensitivity analysis. Results:In this study, 4 SNPs strongly associated with Crohn's disease and 12 SNPs strongly associated with ulcerative colitis were screened. The IVW method of genetic prediction revealed a positive correlation between Crohn's disease and the risk of chronic heart failure (OR =1.02; 95% CI: 1.00-1.04), and there was a positive correlation between ulcerative colitis and the risk of chronic heart failure (OR = 1.03; 95% CI: 1.00-1.06). IVW, MR-Egger and weighted median showed that Crohn's disease and ulcerative colitis were not associated with the risk of atrial fibrillation, coronary heart disease, myocardial infarction or hypertension. Sensitivity analysis showed that the results are robust. Conclusions:Crohn's disease and ulcerative colitis are associated with an increased risk of chronic heart failure, but they are not associated with the risk of other CVDs.

This study systematically evaluated the efficacy and safety of different Chinese patent medicines combined with conventional western medicine in the treatment of heart failure with preserved ejection fraction(HFpEF) and ranked for the drug selection. Randomized controlled trial(RCT) on Chinese patent medicines in treatment of HFpEF were obtained from the CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, EMbase, Web of Science, and other databases from the inception to October 9, 2022. The included RCT was quantitatively analyzed using gemtc and rjags packages of R software for the network Meta-analysis. 74 RCTs were included, with a total of 7 192 patients enrolled, involving 11 different Chinese patent medicines(Shenfu Injection, Shenmai Injection, Qili Qiangxin Capsules, Shexiang Baoxin Pills, Xuezhikang Capsules, Salvia Miltiorrhiza Polyphenols Injection, Tanshinone Ⅱ_A Sulfonate Injection, Xinmailong Injection, Yangxinshi Tablets, Qishen Yiqi Dripping Pills, and Yixinshu Capsules). The results of network Meta-analysis are shown as followed.(1)In terms of improving clinical effective rate, for injection preparations, Xinmailong Injection + conventional western medicine was recommended. while for oral preparations, Shexiang Baoxin Pills + conventional western medicine, Qishen Yiqi Dripping Pills + conventional western medicine, and Qili Qiangxin Capsules + conventional western medicine were preferred.(2)In terms of improving the mitral ratio of peak early to late diastolic filling velocity(E/A), for injection preparations, Shenmai Injection + Salvia Miltiorrhiza Polyphenols Injection + conventional western medicine, Shenmai Injection + conventional western medicine, Shenfu Injection + conventional western medicine were preferred. While for oral preparations, Yixinshu Capsules + conventional western medicine was preferred.(3)In terms of reducing the ratio of early diastolic mitral inflow to early diastolic mitral annular velocity(E/e'), Shenfu Injection + conventional western medicine could be used as injection preparation, and Qili Qiangxin Capsules + conventional western medicine, Qishen Yiqi Dripping Pills + conventional western medicine for oral preparations.(4)In terms of improving 6-minute walking trail(6MWT), the injection preparations such as Shenmai Injection + conventional western medicine, Xinmailong Injection + conventional western medicine were suitable, while oral preparations like Qishen Yiqi Dripping Pills + conventional western medicine, Qili Qiangxin Capsules + conventional western medicine were recommended.(5)In terms of reducing N-terminal pro B-type natriuretic peptide(NT-proBNP), Qili Qiangxin Capsules + conventional western medicine were preferred.(6)In terms of reducing B-type natriuretic peptide(BNP), Xinmailong Injection + conventional western medicine could be used for injection preparation and Qili Qiangxin Capsules + conventional western medicine can be used for oral preparation. In terms of adverse drug reactions, there was no significant difference between Chinese patent medicine combined with conventional western conventional and traditional western medicine alone. The results showe that Chinese patent medicine combined with conventional western medicine in treating HFpEF is superior to conventional western medicine alone in reducing clinical symptoms, improving cardiac function, and improving exercise tolerance, which also has good drug safety. However, the existing evidence is still limited by the quality and quantity of included studies, so the above conclusion requires further validation through more prospective RCT.

BACKGROUND:Acute ST-segment elevation myocardial infarction (STEMI) is a severe form of coronary heart disease and a leading cause of mortality and morbidity. This can mainly be ascribed to adverse ventricular remodeling (VR). However, the efficacy of existing treatment strategies for STEMI is not entirely satisfactory. Tongmai Yangxin Pill (TMYX), a patented traditional Chinese medicine (TCM), has been approved for treating various cardiovascular diseases. PURPOSE:The purpose was to assess the effect of TMYX on VR in acute STEMI patients undergoing primary percutaneous coronary intervention (PPCI). STUDY DESIGN:A multicenter, randomized, double-blinded, and placebo-controlled trial conducted across 11 hospitals in China. METHOD:A total of 270 patients with acute anterior STEMI, undergoing PPCI within 10 days of symptom onset were enrolled and randomly assigned to receive either a placebo or TMYX, in addition to guideline-directed treatments for STEMI. The primary endpoint was a change in left ventricular end-diastolic volume index (LVEDVI) at 12 weeks. RESULT:Among the 270 randomized patients, 218 (TMYX: 109 and placebo: 109) were included in the per-protocol analysis. At 4 and 12 weeks, TXMY significantly improved LVEDVI than the placebo group ([-2.17(-9.24, 8.28) vs. 3.76(-2.38, 11.48), p < 0.05] and [-1.17 (-12.19, 12.88) vs. 4.46 (-2.89, 11.99), p < 0.05]). Changes in left ventricular end-diastolic volume (LVEDV) at 4 weeks were superior in the TMYX group than the placebo group (-4.37 (-17, 13.99) vs. 7.41 (-4.56, 21.79), p < 0.05). Cardiac magnetic resonance imaging (CMRI) showed that left ventricular ejection fraction (LVEF) was significantly greater in the TMYX group than in the placebo group at 4 weeks. There were no statistically significant differences between groups for left ventricular end-systolic volume (LVESV), left ventricular end-systolic volume index (LVESVI), 6 min walking distance (6MWD), and major adverse cardiac and cerebrovascular events (MACCEs) (p > 0.05). CONCLUSION:TMYX, as an adjunctive therapy in addition to STEMI guideline-directed treatments, significantly delayed VR in patients with acute anterior STEMI undergoing PPCI within 10 days of symptom onset.

An evidence map was established to comprehensively sort out the clinical research in the treatment of post-acute myocardial infarction heart failure(P-AMI-HF) with Chinese patent medicines, so as to reveal the distribution of evidence in this field. CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, and EMbase were searched for the randomized controlled trial(RCT), systematic reviews/Meta-analysis, and guidelines/consensus in this field. The evidence was analyzed and displayed in the form of a combination of text, charts, bubble charts, and bar charts, and the quality of RCT, systematic reviews/Meta-analysis, and guidelines/consensus were evaluated by RoB 1.0, AMSTAR2, and AGREE Ⅱ, respectively. A total of 163 RCTs, 4 systematic reviews/Meta-analysis, 1 network Meta-analysis, 2 observational studies, and 5 guidelines/consensus were included. In recent years, the total number of publications in this field has shown an upward trend. There were a variety of Chinese patent medicines in the treatment of P-AMI-HF, among which Shenfu Injection received the most attention. The clinical RCT and systematic reviews/Meta-analysis generally had poor quality, and the RCT mostly had a small size, a single center, and a short cycle. The outcome indicators mainly included cardiac function indicators, myocardial injury markers, total response rate, hemodynamic indicators, and safety indicators, while the characteristic efficacy indicators of TCM received insufficient attention. The development processes of some guidelines/consensus lack standardization, which compromised their authority and rationality. Chinese patent medicines have advantages in the treatment of P-AMI-HF, while there are also problems, which remain to be solved by more high-quality evidence. That is, more large-sample and multi-center clinical studies should be carried out in the future, and the formulation process of relevant systematic reviews/Meta-analysis and guideline/consensus should be standardized and the quality of evidence should be improved. In this way, the effectiveness and safety of Chinese patent medicines in the treatment of P-AMI-HF can be explored.

The efficacy and safety of Shenshao Capsules in combination with conventional western medicine for the treatment of angina pectoris in coronary heart disease were systematically evaluated. Computer search of seven databases, including CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, and Cochrane Library, was conducted to identify randomized controlled trial(RCT) on Shenshao Capsules for the treatment of angina pectoris in coronary heart disease up to December 2023. According to inclusion and exclusion criteria, articles were screened, and data was extracted. Cochrane bias risk assessment tool 2.0(RoB 2.0) was used to evaluate the quality of the included articles. Meta-analysis was performed by RevMan 5.4 and Stata/SE 15.1 software, and evidence quality was rated by the GRADE system. TSA 0.9.5.10 beta software was used for the trial sequential analysis(TSA). Twelve RCTs, with a total of 1 128 participants(567 in the experimental group and 561 in the control group), were included. Meta-analysis showed that Shenshao Capsules + conventional western medicine significantly improved clinical efficacy(RR=1.20, 95%CI[1.15, 1.26], P&lt;0.000 01) and electrocardiogram efficacy(RR=1.16, 95%CI[1.04, 1.30], P=0.01), reduced the frequency of weekly angina pectoris attacks(MD=-2.85, 95%CI[-5.27,-0.43], P=0.02), daily angina pectoris attacks(MD=-0.30, 95%CI[-0.57,-0.03], P=0.03) and the duration of angina pectoris attacks(RR=-2.28, 95%CI[-3.44,-1.12], P=0.000 1). There was no statistically significant difference in adverse reactions between the two groups(RR=1.33, 95%CI[0.71, 2.51], P=0.37). TSA indicated that the cumulative evidence for clinical efficacy exceeded the traditional boundary but did not exceed the TSA boundary, suggesting a potential false positive result. According to GRADE assessment, except for clinical efficacy, which was rated as low-quality evidence, the remaining outcomes were rated as very low-quality evidence. The results indicate that Shenshao Capsules + conventional western medicine may have certain advantages in improving clinical efficacy and electrocardiographic efficacy, reducing the frequency and duration of angina pectoris attacks. However, due to the limitations of this study, more rigorous and high-quality RCT is needed to validate its efficacy and safety.

目的 探讨桂枝甘草汤治疗心律失常的可能作用机制及配伍意义.方法 30只SD大鼠随机分为桂枝组(桂枝单煎液120mg/ml)、甘草组(甘草单煎液60mg/ml)、桂枝甘草单煎液混合组(桂枝单煎液+甘草单煎液混合180mg/ml)、桂枝甘草汤同煎液组(桂枝和甘草同煎液180mg/ml)、对照组(生理盐水),每组6只.各组每天灌胃相应药物1ml/100g,3天后腔静脉取血制备含药血清.分离豚鼠心室肌细胞,设桂枝血清组、甘草血清组、桂枝甘草单煎液混合血清组、桂枝甘草汤同煎液血清组、对照血清组,每组5个复孔;各组以体积比分别加入10％和15％浓度含药血清,培养24 h后分别检测各组在0、20、30、40、50mV条件下慢激活延迟整流钾电流(IKs)电流密度.HEK293细胞分组及干预方法同心室肌细胞,培养24h后分别检测各组在0、20、30、40、50 mV条件下快激活延迟整流钾电流(IKr)尾电流密度及IKr尾电流动力学参数(包括激活半电压、斜率因子).结果 在10％浓度药物干预下,0、20、30、40、50mV时各组IKs电流密度比较差异均无统计学意义(P＞0.05),20、30、40、50 mV时各组IKr尾电流密度比较差异均无统计学意义(P＞0.05).在15％浓度药物干预下,与对照血清组比较,甘草血清组和桂枝甘草单煎液混合血清组各电压IKs电流密度均降低,桂枝血清组30、40、50 mV时IKs电流密度降低,桂枝甘草汤同煎液血清组50 mV时IKs电流密度降低(P＜0.05);桂枝甘草汤同煎液血清组各电压IKr尾电流密度均降低,桂枝甘草单煎液混合血清组50 mV时IKr尾电流密度降低,甘草血清组0 mV时IKr尾电流密度升高(P＜0.05).在15％浓度药物干预下,与甘草血清组比较,桂枝甘草汤同煎液血清组30 mV时IKs电流密度升高,各电压IKr尾电流密度均降低(P＜0.05);与桂枝血清组比较,桂枝甘草汤同煎液血清组30、40、50 mV时IKr尾电流密度降低(P＜0.05).与对照血清组比较,在10％药物浓度干预下,各组IKr尾电流激活半电压均减小(P＜0.05);在15％药物浓度干预下,各组IKr尾电流激活半电压均减小(P＜0.05),甘草血清组、桂枝血清组斜率因子减小(P＜0.05).结论 桂枝甘草汤可在一定程度上抑制心室肌细胞IKs及HEK293细胞IKr,这可能是其治疗心律失常的作用机制之一,且方中桂枝和甘草配伍具有协同增效的作用.

急性心肌梗死(acute myocardial infarction,AMI)是最常见的死亡原因之一,主要由于心室构筑的改变导致心室重构,随后进行性发展为心力衰竭(heartfailure,HF).超声检查技术对梗死后心室重构进行影像学评价,可及时追踪到其变化,进而可以评估预防心室重构的疗效,本综述的目的是评价超声检查新技术在识别AMI后心室重构中的作用.

This study was designed to determine the inhibitory effect of astragaloside Ⅳ(AS-Ⅳ), a principal bioactive component extracted from the Chinese medicinal Astragali Radix, on the inflammatory response of vascular endothelial cells induced by angiotensin Ⅱ(Ang Ⅱ), the most major pathogenic factor for cardiovascular diseases, and to clarify the role of calcium(Ca~(2+))/phosphatidylinosi-tol-3-kinase(PI3K)/protein kinase B(Akt)/endothelial nitric oxide synthase(eNOS)/nitric oxide(NO) pathway in the process. To be specific, human umbilical vein endothelial cells(HUVECs) were cultured in the presence of AS-Ⅳ with or without the specific inhibitor of NO synthase(NG-monomethyl-L-arginine, L-NMMA), inhibitor of PI3K/Akt signaling pathway(LY294002), or Ca~(2+)-chelating agent(ethylene glycol tetraacetic acid, EGTA) prior to Ang Ⅱ stimulation. The inhibitory effect of AS-Ⅳ on Ang Ⅱ-induced inflammatory response and the involved mechanism was determined with enzyme-linked immunosorbent assay(ELISA), cell-based ELISA assay, Western blot, and monocyte adhesion assay which determined the fluorescently labeled human monocytic cell line(THP-1) adhered to Ang Ⅱ-stimulated endothelial cells. AS-Ⅳ increased the production of NO by HUVECs in a dose-and time-dependent manner(P<0.05) and raised the level of phosphorylated eNOS(P<0.05). The above AS-Ⅳ-induced changes were abolished by pretreatment with L-NMMA, LY294002, or EGTA. Compared with the control group, Ang Ⅱ obviously enhanced the production and release of cytokines(tumor necrosis factor-α, interleukin-6), chemokines(monocyte chemoattractant protein-1) and adhesion molecules(intercellular adhesion molecule-1, vascular cellular adhesion molecule-1), and the number of monocytes adhered to HUVECs(P<0.05), which were accompanied by the enhanced levels of phosphorylated inhibitor of nuclear factor-κBα protein and activities of nuclear factor-κB(NF-κB)(P<0.05). This study also demonstrated that Ang Ⅱ-induced inflammatory response was inhibited by pretreatment with AS-Ⅳ(P<0.05). In addition, the inhibitory effect of AS-Ⅳ was abrogated by pretreatment with L-NMMA, LY294002, or EGTA(P<0.05). This study provides a direct link between AS-Ⅳ and Ca~(2+)/PI3K/Akt/eNOS/NO pathway in AS-Ⅳ-mediated anti-inflammatory actions in endothelial cells exposed to Ang Ⅱ. The results indicate that AS-Ⅳ attenuates endothelial cell-mediated inflammatory response induced by Ang Ⅱ via the activation of Ca~(2+)/PI3K/Akt/eNOS/NO signaling pathway.

综合医院是中医药服务体系的骨干之一,是中西医结合的重要平台,是中医药传承创新的重要阵地.但因多种因素,综合医院中医学科发展迟缓.文章在深入调研基础上,从政府、医院、科室、医师及社会层面深入分析了综合医院中医学科发展的困境,并提出综合医院中医学科要"破壳""出圈",需政府用好"指挥棒"、医院当好"主力军"、科室做好"先锋队"、个人练成"狙击手",各方面负其责、齐发力、共努力,形成上下贯通、立体互补、有机系统的发展协同机制.

目的 系统评价通心络胶囊治疗H型高血压合并颈动脉粥样硬化的有效性与安全性.方法 计算机检索PubMed、The Cochrane Library、Embase、中国知网(CNKI)、维普中文期刊(VIP)、万方数据知识服务平台(Wanfang)、中国生物医学文献库(SinoMed).收集常规医疗方案联合通心络胶囊治疗H型高血压合并颈动脉粥样硬化的随机对照试验(RCT),检索时限均为建库至2021年03月.对纳入文献进行数据提取,采用Cochrane手册5.1.0推荐的偏倚风险评估工具对纳入文献进行质量评价,通过RevMan 5.3软件进行Meta分析.结果 共纳入12项RCT,合计病例1 274例,其中试验组642例,对照组632例.Meta分析结果显示,H型高血压合并颈动脉粥样硬化患者在常规方案基础上加用通心络胶囊可提高总有效率[RR=1.24,95％CI(1.09,1.42),P=0.002];降低颈动脉内膜-中层厚度[MD=-0.18,95％CI(-0.22,-0.15),P＜0.00001]、同型半胱氨酸水平[MD=-2.17,95％CI(-4.17,-1.24),P=0.000 3]、内脂素[MD=-4.22,95％CI(-5.10,-3.35),P＜0.000 01];降低收缩压水平[MD=-3.31,95％CI(-5.56,-1.07),P=0.004]和舒张压水平[MD=-2.82,95％CI(-4.28,-1.37),P=0.000 1];提高脂质运载蛋白型前列腺素D合成酶水平[MD=0.18,95％CI(-21.31,-7.82),P＜0.000 01].结论 在常规治疗的基础上联用通心络胶囊可进一步提高H型高血压合并颈动脉粥样硬化患者的临床疗效,且无严重不良反应,可推荐临床应用.

目的 系统评价通脉养心丸治疗冠心病的有效性及安全性.方法 检索中国知网、维普、PubMed、万方等数据库中通脉养心丸治疗冠心病的随机对照试验,检索时限为建库至2018年5月,筛选符合纳入标准的随机对照试验,采用RevMan 5.3软件进行Meta分析.结果 共检索到8篇符合标准的文献,涉及854例病人.Meta分析结果显示,通脉养心丸联合常规西药在改善心绞痛疗效[RR=1.29,95％CI(1.12,1.49)]、中医证候疗效[RR=1.56,95％CI(1.03,2.38)]、心电图疗效[RR=1.38,95％CI(1.22,1.56)]方面均优于单纯西药;少数病人出现消化系统不适,但在停药及改变服药时间后可很快消失.结论 现有证据表明,通脉养心丸在改善冠心病心绞痛临床疗效、中医证候、心电图方面效果较好,但由于纳入文献数量较少,结论有待进一步证实.

目的 系统评价注射用益气复脉(冻干)联合常规西药治疗心力衰竭的有效性及安全性.方法 检索PubMed数据库、维普数据库、中国知网、万方数据库等数据库自建库以来至2020年4月收录的关于注射用益气复脉(冻干)联合常规西药治疗心力衰竭的临床随机对照试验,根据纳入及排除标准筛选文献,使用Rev Man5.3软件进行Meta分析,TSA 0.9.5.10 Beta软件进行试验序贯分析,GRADE3.6进行GRADE证据质量评价.共纳入33项随机对照试验,合计2977例.结果 注射用益气复脉(冻干)联合常规西药在改善左室射血分数(MD =4.32,95％CI[0.92,7.72],P=0.01)、B型钠尿肽(MD=-228.29,95％CI[-361.74,-94.84],P =0.0008)、N 末端B 型利钠肽原(MD =-360.92,95％CI[-491.04,-230.80],P＜0.00001)、临床心功能疗效(RR = 1.21,95％CI[1.16,1.25],P＜0.00 001)、E/A 比值(MD=0.13,95％CI[0.07,0.18],P＜0.00 001)、心输出量(MD =0.30,95％CI[0.19,0.42],P＜0.00 001)、左心室舒张末期内径(MD =-3.08,95％CI[-5.43,-0.74],P = 0.01)、6 min 步行距离测试(MD =47.80,95％CI[35.92,59.67],P＜0.00 001)方面的疗效优于单纯西药组,亚组分析结果显示疗程大于等于14天的试验组在改善左室射血分数方面效果更好,不良反应差异无统计学意义(P=0.80),表明注射用益气复脉(冻干)联合常规西药的不良反应发生率与对照组无明显差别,均未出现肝肾功的损伤,试验序贯分析显示临床疗效累积纳入的研究穿过了传统界值和TSA界值,进一步肯定了其临床疗效.GRADE评价显示证据级别多为低级或极低级.结论 临床应用注射用益气复脉(冻干)联合常规西药治疗心力衰竭的疗效明确并且具有一定的安全性,推荐临床应用.

To systematically evaluate the efficacy and safety of sofren injection combined with conventional Western medicine in the treatment of angina pectoris. Randomized controlled trials (RCTs) on the treatment of angina pectoris with sofren injection combined with Western medicine were collected by searching PubMed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Database, Weipu Database, and China Biomedical Literature Service System (CBM) by computer with the retrieval time from establishment of database to August 2020. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies were extracted, and then, a meta-analysis was conducted with the RevMan 5.3 software. The results of meta-analysis showed that the combination of sofren injection and Western medicine improved the platelet aggregation rate of patients (MD = −5.53, 95% CI (−6.42, −4.64), P<0.00001), PAI-1 (SMD = −2.29, 95% CI (−2.57, −2.01), P<0.00001), TXB2 (MD = −11.91, 95% CI (−14.50, −9.32), P<0.00001), duration of angina attack (MD = −2.01, 95% CI (−3.14, −0.87), P=0.0005), ECG symptoms (RR = 1.29, 95% CI (1.20, 1.37), P<0.00001), whole blood viscosity (MD = −1.07, 95% CI (−1.66, −0.48), P=0.0004), plasma viscosity (MD = −0.27, 95% CI (−0.35, −0.20), P<0.00001), fibrinogen (MD = −0.67, 95% CI (−0.84, −0.50), P<0.00001), whole blood high shear viscosity (MD = −1.04, 95% CI (−1.30, −0.79), P<0.00001), whole blood low shear viscosity (MD = −2.03, 95% CI (−2.53, −1.53), P<0.00001), CRP (MD = −1.96, 95% CI (−3.01, −0.91), P=0.0003), IL-6 (MD = −2.79, 95% CI (−4.02, −1.55), P<0.00001), and TNF-α (MD = −17.34, 95% CI (−25.86, −8.81), P<0.00001) and better than the Western medicine group, and there was no statistical significance in the incidence of adverse reactions between the two groups (P=0.48). The clinical application of sofren injection combined with conventional Western medicine in the treatment of angina pectoris is clear and safe, so it is recommended for clinical application.

综合医院的中医学科既是中医药工作的重要组成部分,也是综合医院的重要专业组成,但综合医院在建设中仍存在西医学科群中中医专业发展受限的情况.本文就综合医院中医学科的发展模式进行分析,结合河南省人民医院中医院的建设管理经验,提出综合医院的中医专业应采用平台学科的形式广泛开展与西医学科的协作,由点及面,循序渐进,加深中西医的业务融合程度,逐步推进中医与西医各专业从MDT到联合查房、从专病到专科、从竞争到协同的演进路径,实现中医专业在综合医院的全面发展.

To evaluate the efficacy and safety of Songling Xuemaikang Capsules combined with conventional Western medicine in the treatment of essential hypertension. PubMed, VIP, CNKI, Wanfang and other databases were retrieved from the establishment of the database to February 2020 for clinical randomized controlled trial(RCT) about Songling Xuemaikang Capsules combined with conventional Western medicine in the treatment of essential hypertension. The literatures were screened out according to the inclusion criteria, and RevMan 5.3 software was used for Meta-analysis. A total of 3 100 patients in 27 RCTs were enrolled. According to Meta-analysis, Songling Xuemaikang Capsules combined with conventional Western medicine could effectively reduce systolic blood pressure(MD=-7.88,95%CI[-9.68,-6.08],P<0.000 01) and diastolic blood pressure(MD=-7.85, 95%CI[-9.07,-6.62], P<0.000 01), triglyceride(MD=-0.46, 95%CI[-0.66,-0.26], P<0.000 01) and total cholesterol(MD=-0.92, 95%CI[-1.49,-0.35], P=0.001), but increase HDL cholesterol(MD=0.51, 95%CI[0.28, 0.73], P<0.000 01), with a better effect than the Western medicine group alone. The results of LDL-C analysis showed that there was no significant difference between the two groups(MD=-0.91, 95%CI[-1.82, 0.01], P=0.05). The subgroup analysis suggested that reduced systolic blood pressure may be related to the use of ARB. There was a close correlation between CCB drugs and the decrease of diastolic blood pressure. In addition, there was no significant difference in the compliance and the incidence of adverse reactions. Clinical application of Songling Xuemaikang Capsules combined with Western medicine in the treatment of patients with essential hypertension has clear efficacy and certain safety. More clinical randomized controlled trials are needed for verification in the future.

To systematically evaluate the efficacy and safety of Yangxue Qingnao Granules combined with conventional Western medicine in the treatment of essential hypertension and its accompanying symptoms. PubMed, EMbase, Cochrane Library, VIP, CNKI, Wanfang, and China biomedical database(CBD) were searched to screen out from the establishment of the database to April 2020 about the clinical randomized controlled trials of Yangxue Qingnao Granules combined with conventional Western medicine in the treatment of essential hypertension and accompanying symptoms. The articles were selected according to the inclusion and exclusion criteria. RevMan 5.3 software was used for Meta-analysis. TSA 0.9.5.10 Beta software was used for sequential analysis, and GRADE 3.6 was used for evidence quality evaluation. A total of 4 532 patients were included in 34 randomized controlled trials. Meta-analysis results showed that: Yangxue Qingnao Granules combined with conventional anti-hypertensive agents reduced systolic blood pressure(MD=-10.56, 95%CI[-13.63,-7.50], P<0.000 01) and diastolic blood pressure(MD=-8.21, 95%CI[-10.84,-5.59], P<0.000 01), improved total effective rate(RR=1.21, 95%CI[1.14, 1.29], P<0.000 01), improved patients dizziness(RR=1.29, 95%CI[1.21, 1.37], P<0.000 01), insomnia(RR=1.66, 95%CI[1.44, 1.91], P<0.000 01), headache(RR=1.32, 95%CI[1.21, 1.43], P<0.000 01), chest distress(RR=1.26, 95%CI[1.12, 1.42], P=0.000 1), memory loss(RR=1.24, 95%CI[1.10, 1.40], P=0.000 4), palpitation(RR=1.28, 95%CI[1.17, 1.41], P<0.000 01), and improved traditional Chinese medicine symptom scores(MD=-4.24, 95%CI[-5.25,-3.23], P<0.000 01) and headache symptom improvement scores(MD=-2.02, 95%CI[-2.51,-1.53], P<0.000 01) as compared with Western medicine group alone. Subgroup analysis results showed that Yang-xue Qingnao Granules combined with ACEI drug had more obvious effects in lowering systolic blood pressure and diastolic blood pressure. There was no statistically significant difference in the incidence of adverse reactions, and no abnormal liver and kidney function was observed in each study. Trial sequential analysis showed that the total effective rate was cumulative across the traditional and TSA thresholds, further confirming its clinical efficacy. The evidence level was mostly low or extremely low in GRADE evaluation. The clinical application of Yangxue Qingnao Granules combined with conventional Western medicine in the treatment of essential hypertension and its accompanying symptoms is clear and safe, so it is recommended for clinical application.