To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. Among 1,196 patients (85.4

Journal Article Corrected proof Clavicle fracture in SAPHO syndrome Get access Yajing Xi, Yajing Xi Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Zhimin Lin, Zhimin Lin Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China https://orcid.org/0009-0002-6034-1942 Search for other works by this author on: Oxford Academic PubMed Google Scholar Naigang Chen, Naigang Chen Department of Medical Imaging, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Xiujuan Hou, Xiujuan Hou Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Yuelan Zhu, Yuelan Zhu Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Chen Li Chen Li Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China Correspondence to: Chen Li, Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, No.4, Baojian Road, Fangshan District, Beijing 102401, China. E-mail: casio1981@163.com https://orcid.org/0000-0002-8527-1680 Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, kead640, https://doi.org/10.1093/rheumatology/kead640 Published: 04 December 2023 Article history Published: 04 December 2023 Corrected and typeset: 09 December 2023

目的:基于网络药理学方法,研究"土茯苓-川牛膝"药对治疗痛风性关节炎的作用机制.方法:通过TCMSP平台收集"土茯苓-川牛膝"药对的主要活性成分及作用靶点,采用Swiss Target Prediction数据库预测主要活性成分靶点;通过OMIM、TTD、DisGeNET及CTD数据库获得痛风性关节炎相关靶点;通过韦恩图,得到疾病与药物的共同靶点;利用Cytoscape 3.7.2软件构建药物-化合物-靶点网络;将共同靶点上传至STRING数据库构建蛋白质相互作用(protein-protein interaction,PPI)网络图,分析后获得关键靶点;对关键靶点进行基因本体(gene ontology,GO)功能富集分析和京都基因与基因组百科全书(kyoto ency-clopedia of genes and genomes,KEGG)通路富集分析.结果:收集并筛选出"土茯苓-川牛膝"药对17个活性成分、220个靶点,痛风性关节炎疾病相关靶点1494个,"土茯苓-川牛膝"药对与痛风性关节炎的共同靶点72个,关键靶点28个.GO富集分析得到945条富集结果,KEGG富集分析得到111条相关信号通路,主要涉及白细胞介素17信号通路、肿瘤坏死因子信号通路、Toll样受体信号通路、NOD样受体信号通路、辅助性T细胞17细胞分化等.结论:预测了"土茯苓-川牛膝"药对治疗痛风性关节炎的作用机制,体现了中药多成分、多靶点、多途径的作用特点,为进一步研究提供了理论基础和研究方向.

纤维肌痛综合征是以周身弥漫性疼痛及睡眠障碍、疲劳、精神障碍等为核心症状群的身心疾病.《黄帝内经》病机十九条指出"诸痛痒疮,皆属于心",认为疼痛、瘙痒、疮疡类病症的病机与心有关.故本文以"诸痛痒疮,皆属于心"理论为基础,梳理条文含义,认为心与纤维肌痛综合征的发生关系最为密切.心失所养,血脉与心神失司为纤维肌痛综合征的发病关键;血与神之间的相互作用是疾病加剧的重要因素.在治疗上重视通络、养血、调和营卫,并将安神贯穿始终,时刻重视身心同调;同时由于五脏一体,治疗时还重视各脏腑之间的联系,整体调养.另外灵活运用中医外治疗法以增强治疗效果.

Objective To analyze the prescription formulation rules of traditional Chinese medicine（TCM） and the molecular mechanism of relevant traditional Chinese herbal medicines（TCHMs） for the treatment of gout based on a data mining analysis and a network pharmacology approach.Methods With Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine as the initiator, consultation data of gout patients from 22 hospitals in 10 provinces（including autonomous regions and municipalities directly under the central government） across China were retrospectively analyzed to extract information on the names, tastes, properties, meridian tropism and effects of traditional Chinese herbal medicines（TCHMs）. Microsoft Excel 2019 was used for analysis of frequency and relative frequency, and SPSS Modeler 18.0 and SPSS Statistics 20.0 were used for association rules and systematic cluster analysis of high-frequency TCHMs. Based on the data mining results, the active components of TCHMs were obtained from databases including Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP）, Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine（TCMIP）, Encyclopedia of Traditional Chinese Medicine（ETCM） and Herb, and they were filtered thereafter. The Canonical SMILES format of active components of TCHMs was obtained from PubChem and then imported into SwissTargetPrediction database to predict the target genes of the active components. The disease genes associated with gout were retrieved from databases including GeneCards, Therapeutic Target Database（TTD）, DisGeNET data, Online Mendelian Inheritance in Man（OMIM） and Pharmacogenetics and Pharmacogenomics Knowledge Base（PharmGKB）, and then intersect analysis was conducted to obtain common genes.Cytoscape 3.7.2 was used to obtain the core genes for the treatment of gout with TCHMs, perform pathway analysis and association analysis, and construct a “herb-component-gene-signaling pathway” network. Results（1）In this study, clinical data of 2,688 gout patients were collected, and 659 prescriptions involving 266 TCHMs were obtained, including 36 high-frequency TCHMs [Tufuling（Smilacis Glabrae Rhizoma）, Yiyiren（Coicis Semen）, Chuanniuxi（Cyathulae Radix）, Cangzhu（Atractylodis Rhizoma）, Huangbo（Phellodendri Chinensis Cortex）, Qinjiao（Gentianae Macrophyllae Radix）, Duhuo（Angelicae Pubescentis Radix）, and Weilingxian（Clematis Radix et Rhizoma）, etc.].（2）TCHMs for the treatment of gout were mainly sweet, bitter and pungent in taste, and cold, neutral and warm in nature, manifesting their therapeutic effects on the liver, lung, stomach, spleen and kidney meridians in preference, with the effects of clearing heat, tonifying deficiency, promoting diuresis and defusing dampness, activating blood circulation and resolving stasis and dispelling wind-dampness.（3） The association rules showed that the medicinal combinations commonly used in the clinical treatment of gout were Tufuling（Smilacis Glabrae Rhizoma）-Yiyiren（Coicis Semen） and Cangzhu（Atractylodis Rhizoma）-Huangbo（Phellodendri Chinensis Cortex）, etc. According to systematic cluster analysis, 6 new medicinal combinations were formed and the core prescription for gout might include Dilong（Pheretima）, Biejia（Trionycis Carapax）, Qinjiao（Gentianae Macrophyllae Radix）, Chuanniuxi（Cyathulae Radix）, Yiyiren（Coicis Semen） and Tufuling（Smilacis Glabrae Rhizoma）.（4）The results of the network pharmacological analysis showed that baicalin, wogonin, quercetin, and kaempferol might be the key components for the treatment of gout, which could act on genes such as tumor necrosis factor（TNF）, serine/threonine kinase 1（AKT1）, interleukin-6（IL-6） and sarcoma（SRC）, etc., and these components exerted their therapeutic effects through regulating apoptosis, transforming growth factor-β（TGF-β）, and other multiple pathways. Conclusions TCM treatment of gout follows the principle of treating both the manifestations and the root cause. The main method is clearing heat and tonifying deficiency, which is supported by promoting diuresis and defusing dampness, as well as activating blood circulation and resolving stasis. The treatment of gout with TCHMs is mainly achieved by acting on key genes such as TNF, AKT1, IL-6 and SRC and by regulating apoptosis, necroptosis, TGF-β and other signaling pathways.

目的 观察并比较阴虚津亏型与津液失布型原发性干燥综合征(pSS)患者口腔菌群的差异.方法 20例pSS女性患者辨证分为阴虚津亏组9例,津液失布组11例,另将8例健康女性设为正常组.收集各组受试者年龄及pSS患者病程等一般资料,采用口干视觉模拟评分(VAS)及简化版口腔干燥量表(SXI)评估患者口干严重程度;收取所有受试者口腔含漱液,抽提口腔含漱液样本细菌总DNA进行PCR扩增,针对16SrDNA基因的V3-V4区进行Illumina NovaSeq高通量测序,得到口腔菌群生物信息数据.基于有效数据进行组间可操作分类单元(OTU)分析;采用线性判别分析法分析组间群落差异;采用Chao1指数、Shannon指数、observed OTU指数分析物种Alpha多样性,并进行组间Beta多样性分析.结果 两组患者病程及各组受试者年龄比较差异均无统计学意义(P＞0.05).津液失布组口干VAS评分为(4.00±1.73)分,阴虚津亏组为(7.00±2.06)分;津液失布组SXI评分为(12.45±1.81)分,阴虚津亏组为(20.33±3.54)分,两组VAS评分、SXI评分差异均有统计学意义(P＜0.01).口腔菌群测序后获得有效序列2 366 361条,聚类后正常组、津液失布组、阴虚津亏组分别获得1288、1989、1770个特征OTU.与正常组比较,津液失布组、阴虚津亏组厚壁菌门丰度均升高,阴虚津亏组梭杆菌门、卟啉单胞菌属丰度降低,韦荣氏球菌属丰度升高(P＜0.05或P＜0.01);津液失布组与阴虚津亏组各菌门、各菌属水平比较差异均无统计学意义(P＞0.05).正常组优势菌门为梭杆菌门、螺旋体门、软壁菌门、互养菌门,优势菌属为梭杆菌属、密螺旋体属、卟啉单胞菌属、不动杆菌属;津液失布组优势菌门为GN02、SR1,优势菌属为链球菌属;阴虚津亏组优势菌门为厚壁菌门,优势菌属为韦荣氏球菌属、放线菌属.与正常组比较,阴虚津亏组Shannon指数明显下降(P＜0.05),Chao1指数、observed OTU指数差异无统计学意义(P＞0.05);与正常组及阴虚津亏组比较,津液失布组各指数差异均无统计学意义(P＞0.05).Beta多样性分析显示,正常组与津液失布组、阴虚津亏组口腔菌群组成结构差异均具有统计学意义(P＜0.05或P＜0.01),阴虚津亏组与津液失布组组成结构差异无统计学意义(P＞0.05).结论 不同证型的pSS患者口腔微环境各有其特征性优势菌,阴虚津亏型患者口腔菌群组成结构变化及优势菌丰度变化均较津液失布型患者更显著.

Sj?gren syndrome,a systemic autoimmune disease that is characterized by dry mouth and eyes,on which treatment decision remain challenging,while traditional Chinese medicine（TCM） has advantages and is widely used in China. However,the lack of consensus on standardized TCM patterns diagnosis and treatment based on evidence-based evidence,limits the further improvement of clinical efficacy and scientific research level. Rheumatology Branch, Chinese Academy of Chinese Medicine organized more than 50 experts from 48 hospitals across the country to form Expert Consensus for TCM Patterns of Sj?gren Syndrome:（ⅰ） pattern of yin deficiency and depletion of fluid;（ ⅱ） pattern of deficiency of both qi and yin;（ ⅲ） pattern of endogenous heat due to yin deficiency（pattern of yin deficiency and heat-poison,included）;（ ⅳ） pattern of intermingled dryness and blood stasis;（ ⅴ） pattern of intermingled dryness and dampness. According to the patterns, principles of treatment and prescriptions are also on the same page. The formation and promotion of this consensus is of importance in the TCM course of diagnosis and treatment of Sj?gren syndrome.

目的:将干燥综合征(SS)模型小鼠颌下腺细胞凋亡促进因子Smac的表达作为靶点,探究活血解毒润燥方对SS模型小鼠颌下腺组织形态、腺体功能、细胞凋亡的影响及其干预机制.方法:实验选取雌性BALB/c57小鼠为正常对照组,自发性雌性非肥胖型糖尿病(NOD/Ltj)小鼠为SS模型并随机分为模型组、白芍总苷胶囊组和活血解毒润燥方低、中、高剂量组,每组各15只.各组小鼠给药量按照人与动物体表面积比计算等效剂量,正常对照组、模型组小鼠灌胃10 ml/kg蒸馏水,白芍总苷胶囊组(0.234 g/kg)和活血解毒润燥方低剂量组(15.6 g/kg)、中剂量组(31.2 g/kg)、高剂量组(62.4 g/kg)分别灌胃给药,每日1次.药物干预8周后,无菌分离颌下腺,观察各组小鼠颌下腺形态、功能的改变,并分别应用免疫组化法(IHC)、蛋白免疫印迹法(Western blot)、逆转录聚合酶链式反应(RT-PCR)测定细胞凋亡促进因子Smac的表达.结果:与正常对照组比较,模型组唾液流量及颌下腺指数均显著降低(P＜0.01),颌下腺组织病理学评分显著升高(P＜0.01),IHC和Western blot检测Smac表达明显升高(P＜0.05),RT-PCR检测Smac表达显著升高(P＜0.01).治疗结束后,与模型组比较,活血解毒润燥方各剂量组和白芍总苷胶囊组唾液流量及颌下腺指数均显著升高(P＜0.01),颌下腺组织病理学评分显著降低(P＜0.01).运用IHC和Western blot检测活血解毒润燥方高剂量组和白芍总苷胶囊组Smac表达明显降低(P＜0.05),运用RT-PCR检测活血解毒润燥方高剂量组与白芍总苷胶囊组Smac表达显著降低(P＜0.01).结论:活血解毒润燥方可以改善SS模型鼠颌下腺腺泡的分泌功能,提高其颌下腺指数,增加SS模型鼠的唾液分泌量;其作用机制与下调SS模型鼠颌下腺细胞凋亡、促进因子Smac的表达水平有关.

间质性肺病是类风湿关节炎最常见的并发症之一,预后不良,严重危害患者的健康.中医认为该病属于"肺痹""肺痿"的范畴."痹痿统一论"由国医大师李济仁首次提出,从病因、病机、病程规律、治则治法四个角度论述了痿痹合论的可行性.本文立足于"痹痿统一"理论,认为类风湿关节炎相关间质性肺病的发病根本是肺气不足而致痹,继而因痹致痿,痹与痿在疾病中同时体现.痰瘀痹阻为疾病转变的核心.治疗上应注意补肺宣肺,化痰通络贯穿始终;同时由于病情复杂,痹痿同在,还应外祛虚邪,内调肝肾.治疗时应时时立足于整体,把握好正虚与邪实之间的动态变化关系.

目的 观察活血解毒方对HSG细胞凋亡及自噬表达的影响.方法 活血解毒方中药冻干粉干预IFN-γ+TRAIL联合诱导的HSG细胞凋亡,以白芍总苷(total glucosides of paeony,TGP)作为阳性对照组,实时荧光定量(quantitative real-time fluorescence,PCR)及蛋白印迹法(Western blotting)检测细胞凋亡内源性途径中及自噬相关蛋白与mRNA的表达、激光共聚焦检测自噬情况.结果 与空白组比较,模型组Bax、LC3B蛋白相对表达量明显升高(P＜0.01),而Bcl-2蛋白相对表达量明显降低(P＜0.01);与模型组比较,两治疗组Bax、LC3B蛋白相对表达量明显降低(P＜0.01),Bcl-2蛋白相对表达量明显升高(P＜0.01);与TGP组比较,中药组LC3B蛋白相对表达量降低(P＜0.05);与空白组比较,模型组Bax mRNA相对表达量明显升高(P＜0.01),Bcl-2 mRNA相对表达量明显降低(P＜0.01);与模型组比较,两治疗组Bax mRNA、LC3B mRNA相对表达量明显降低(P＜0.01),Bcl-2 mRNA相对表达量均有不同程度的升高(PTGP组＜0.05,P中药组＜0.01);与TGP组比较,中药组Bcl-2 mRNA相对表达量明显升高(P＜0.01);空白组呈现正常的自噬过程,模型组表现为大量的自噬溶酶体和自噬体聚集物,两治疗组表现为相对较少的自噬体和的自噬溶酶体聚集物,且中药组自噬程度更低.结论 活血解毒方可以通过调节内源性途径延缓细胞凋亡及自噬的发生.

Sjögren's syndrome (SS) is the second most common autoimmune rheumatism. Huoxue Jiedu Recipe (HXJDR) is a kind of traditional Chinese medicine with a variety of pharmacological functions; however, its biological function in SS has not been studied yet. Peripheral blood mononuclear cells (PBMCs) and serum samples were isolated from healthy controls and patients with SS. NOD/Ltj mice were used for developing the SS mouse model. The levels of inflammatory cytokines and NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome-related markers as well as dynamin-related protein 1 (Drp1) were determined by ELISA, quantitative real-time PCR, and western blot analysis, respectively. Hematoxylin and eosin and TUNEL staining detected the pathological damage. A transmission electron microscope was used to observe the mitochondrial microstructure. Inflammatory cytokines IL-18, IL-1β, B-cell activating factor (BAFF), BAFF-receptor (BAFF-R), IL-6, and TNF-α in serum samples and NLRP3 inflammasome-related makers (NLRP3, cysteinyl aspartate-specific proteinase 1 [caspase-1], apoptosis-associated speck-like protein containing a caspase-1 recruitment domain [ASC], IL-1β) in PBMCs were greatly upregulated in patients with SS. Furthermore, cytoplasmic phosphorylation of Drp1 and mitochondrial Drp1 level were significantly increased in PBMCs, while mitochondrial swelling and fuzzy inner ridge were observed in PBMCs of patients with SS, suggesting increased mitochondrial fission. Compared with control mice, SS mice showed decreased salivary flow rate, increased submandibular gland index, and more severe inflammatory infiltration and damage as well as mitochondrial fission in submandibular gland tissues. After HXJDR administration, these effects were significantly reversed. HXJDR treatment could alleviate the inflammatory infiltration and pathological damage in submandibular glands of SS mice by inhibiting Drp-1-dependent mitochondrial fission.

目的 通过真实世界方法研究,运用数据挖掘探索痛风达标治疗人群的治疗特点和规律,并评价其安全性.为临床痛风的达标、安全治疗及管理提供指导依据.方法 本研究基于医院信息系统(HIS)中临床真实世界数据,收集多家医院风湿免疫科2015年1月至2021年12月以痛风为诊断的门诊治疗患者,将其在门诊治疗中产生的临床数据建立数据库.使用SPSS及Excel软件,采取频数分析、聚类分析、因子分析,总结经治疗后达标的痛风患者的治疗措施特点及规律.记录治疗过程中的不良事件(AE)发生情况.结果 共纳入痛风患者3 287例,随访诊次9 861个.其中治疗后血清尿酸(SUA)达标诊次占比为7.01％(691/9 861),关节疼痛表现视觉模拟评分(VAS)达标占比为59.81％(5 898/9 861).治疗后SUA控制达标诊次691个,降尿酸药物中使用频次最高的是非布司他,其次为苯溴马隆.高频治疗措施中,使用系统聚类分析的方法进行挖掘分析,发现6组治疗方案:①中药饮片-中医技术-生活干预措施-中成药,②阿魏酸哌嗪片-NSAIDs,③别嘌醇-碳酸氢钠,④苯溴马隆,⑤激素-秋水仙碱,⑥非布司他.同时,采取因子分析,提取5个公因子.关节疼痛表现VAS评分控制达标诊次共5 898个,使用频次最高的控制症状药物为NSAIDs.高频治疗措施中,使用系统聚类分析的方法进行挖掘,发现5组治疗方案:①中成药-中药饮片-中医技术-生活干预措施,②NSAIDs-秋水仙碱-激素,③别嘌醇,④苯溴马隆,⑤非布司他.整体治疗过程中共有59例AE发生.结论 本次研究显示痛风患者的SUA达标率很低,关节炎控制欠佳,治疗中降尿酸药物使用率偏低,降尿酸治疗和抗炎处方模式均与国际指南存在较大差异,因此需加强痛风患者规范管理.同时生活干预措施在有限的达标人群治疗方案中均占有一席之地,需要进一步深入探索.

弥漫性结缔组织病多归属于中医痹病范畴.在中医整体观认识下,痹病的传变具有由表及里、由肢体至五脏的传变特点,《素问·痹论》言:"诸痹不已,亦益内也",是痹病总的传变趋势.弥漫性结缔组织病多系统受累特点符合痹病的传变规律.膜原与现代医学结缔组织结构相似,是痹病伏邪所在,亦是传变通路.痹病的预后与传变紧密相关,总的来说五体痹易愈,五脏痹难医,因此痹病防传防变是治疗的重点.文章从《黄帝内经》痹病传变趋势出发,基于伏邪是传变基础、膜原为痹病传变通路,启发弥漫性结缔组织病的防治思路.

目的 探讨加味芍甘附子汤调控磷脂酰肌醇3激酶/蛋白激酶B(phosphatidylinositol 3 kinase/protein kinase,PI3K/Akt)信号通路控制炎症反应,进而延缓类风湿关节炎相关间质性肺病进展的机制.方法 选用清洁级雌性Wistar大鼠48只,随机分为空白组、模型组、雷公藤组[雷公藤多苷6.25 mg/(kg·d)]、中药大、中、小剂量组[加味芍甘附子汤17.70 g/(kg·d)、8.85 g/(kg·d)、4.43 g/(kg·d)],每组8只.除空白组外,其余五组建立关节炎寒证模型.造模成功后,除空白组、模型组外,其余各组连续4周给与相应药物灌胃治疗.治疗后,观察肺组织病理状态,免疫组化法检测肺组织中PI3K、Akt、核因子κB(nuclear factor kappa-B,NF-κB)蛋白的表达.结果 与空白组相比,模型组大鼠肺组织病理结构大面积破坏,肺泡结构塌陷,肺泡间隙充血水肿,肺泡壁增厚,出现大量纤维瘢痕.与模型组相比,中药中、大剂量组及雷公藤组肺泡结构较为清晰,伴有轻微炎症反应及少量纤维增生.肺泡炎评分显示,模型组与空白组炎症反应有明显差异(P<0.01);中药中、大剂量组与模型组相比,肺泡炎症和纤维化有显著下降,差异有统计学意义(P<0.01);雷公藤组与模型组相比也有明显差异(P<0.01).与空白组相比,模型组中PI3K、Akt、NF-κB蛋白的表达明显增多.各治疗组PI3K、Akt、NF-κB蛋白的表达与模型组相比均不同程度降低.荧光光密度值对比结果显示,模型组吸光度值较空白组明显升高,差异具有统计学意义(P<0.05);各治疗组较模型组吸光度值均有降低.与模型组相比,PI3K、NF-κB在中药中、大剂量组与雷公藤组中降低更明显(P<0.05).结论 加味芍甘附子汤通过调节PI3K/Akt信号通路进而干预其下游NF-κB信号通路抑制炎症反应,可能是减少肺泡炎及肺纤维化的重要机制.

干燥综合征是以外分泌腺受损为主,并累及皮肤、肌肉、骨骼、肺、肾等多个脏器的系统性自身免疫性疾病,归属于中医燥痹.阴虚为本,燥毒为标是近代学者的主流观点,然而临床应用滋阴清燥之法往往不能取得满意的效果.作者认为干燥综合征患者阴虚燥盛,久则气血痹阻、燥毒随经流窜四肢百骸,形成燥、毒、瘀胶着互结之势,同时存在气的升降相因失调.故文章将从升降相因理论出发探讨干燥综合征患者的病机,以期为干燥综合征的诊治提供思路和借鉴.

目的 基于痛风(gout)真实世界研究数据,对不同证型痛风患者的中医证候疗效评价、尿酸达标率和安全性进行统计学分析,总结痛风不同证型下中医治疗的证治规律.方法 回顾性统计3287例痛风患者的临床数据,然后进行中医药治疗疗效、安全性、中药关联规则和系统聚类分析.结果 最终符合纳入标准的患者有330例,按辨证划分为湿热蕴结证224例、痰瘀互结证67例和脾虚湿阻证39例.3种证型在性别、体质量指数(body mass index,BMI)、血尿素氮(blood urea nitrogen,BUN)、血尿酸(blood uric acid,BUA)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C 反应蛋白(C-reactiveprotein,CRP)、中医证候疗效评价、尿酸达标率和安全性上差异无统计学意义(P＞0.05).关联规则和聚类分析显示湿热蕴结证痛风常用土茯苓、薏苡仁、苍术等中药治疗,并形成苍术-黄柏、土茯苓-威灵仙等药物组合和苍术、黄柏、川牛膝、土茯苓、薏苡仁这一新核心药方;痰瘀互结证痛风常用土茯苓、薏苡仁、茯苓等中药,形成薏苡仁-秦艽、土茯苓-威灵仙等药物组合和新核心药方为山茱萸、葛根、土茯苓、独活、防风、杜仲、威灵仙、赤芍、地龙、秦艽、川牛膝、薏苡仁、绵萆薢;脾虚湿阻证痛风常用茯苓、苍术、土茯苓等药物和苍术-威灵仙、茵陈-虎杖等药物组合,并形成伸筋草、茵陈、虎杖、陈皮、茯苓这一新核心药方.结论 在多中心真实世界研究背景下,系统阐述了中医药治疗痛风的中医证候疗效评价、安全性和证治规律,为中医药辨证论治痛风提供了一定的指导和临床应用价值.

干燥综合征病机复杂,病情顽固,迁延难愈,且可累及其他系统,与伏毒凶猛、顽固、难治、痼结、杂乱的证候特点相合,可从伏毒论治.正虚毒伏是干燥综合征的基本病机,燥、痰、瘀互结成毒,伏于体内暗耗气血为干燥综合征发病的关键,治疗上通过采用扶正托毒、祛湿化痰消毒、活血化瘀散毒、滋阴清热解毒、调理阴阳等方法扶助正气,祛除伏毒.从伏毒论治干燥综合征能够执简驭繁,便于临床推广应用.

目的 观察芍甘附子汤加味对胶原诱导性关节炎(CIA)大鼠肺间质病理及血清KL-6、IL-6与IL-17表达水平的影响.方法 60只SPF级雌性Wistar大鼠随机分为空白组10只,造模组50只.空白组予以正常饮食喂养,直至试验结束.造模组复制胶原诱导性关节炎模型.造模持续2周,将造模成功的40只大鼠随机分为5组,每组8只,分别为对照组、大、中、小剂量中药组及雷公藤组.空白组与对照组蒸馏水灌胃,其余4组分别给予相对应的药物进行灌胃.灌胃持续4周后即实验第6周末后将所有大鼠处死.选大鼠血清用ELISA法检测IL-6、IL-17、KL-6水平.取大鼠肺组织HE染色观察肺间质病理变化.结果 血清细胞因子IL-6、IL-17、KL-6在对照组中均显著升高(P<0.01).IL-6在中剂量组与对照组相比差异具有统计学意义(P<0.01);IL-17在中剂量组与对照组相比差异具有统计学意义(P<0.01);KL-6在各治疗组与对照组相比差异均具有统计学意义(P<0.05,P<0.01).中大剂量中药组与雷公藤组对比,差异无统计学意义(P>0.05).空白组大鼠肺组织结构及肺泡壁完整,未见明显炎性细胞浸润;对照组大鼠肺组织结构大面积破坏,肺泡结构塌陷,肺泡间隙充血水肿,肺泡壁增厚,出现大量纤维瘢痕;中药小剂量组肺泡炎仍然较为明显,肺泡结构紊乱,肺泡间隙仍较宽,较对照组有所改善;中药中、大剂量组及雷公藤组肺泡结构较为清晰,伴有轻微炎症反应及少量纤维增生,与对照组相比有较明显的改善.结论 芍甘附子汤加味可以显著抑制IL-6、IL-17、KL-6的高表达,这可能是其延缓RA-ILD进展的有效作用机制之一.

基于清热化湿、透毒逐瘀法为治疗原则,运用四妙勇安汤加减内服联合三黄粉外敷治疗1例典型Sweet综合征(Sweet's syndrome)患者,取得显著临床疗效.旨在结合中医古籍和文献探究清热化湿、透毒逐瘀法方药治疗Sweet综合征的临床应用,为中医药治疗Sweet综合征提供新的理论依据.