目的 运用网状Meta分析方法评价口服中成药联合常规治疗慢性肾衰竭的临床疗效及安全性.方法 计算机检索知网、万方、维普、中国生物医学文献服务系统、PubMed、EMbase、Cochrane Library等数据库中口服中成药治疗慢性肾衰竭的随机对照试验,检索时间为自建库至2021年5月1日.依据Cochrane偏倚风险评估对纳入文献进行质量评价,使用GeMTC软件、Stata 13.0进行分析.结果 最终纳入39个随机对照试验,6种中成药,样本量为3446例.网状Meta分析结果显示,在有效率方面,排名前3的中成药分别为百令胶囊+肾衰宁胶囊、肾衰宁胶囊、金水宝胶囊;在降低血肌酐方面,排名前3的中成药分别为百令胶囊+肾衰宁胶囊、海昆肾喜胶囊、尿毒清颗粒;在降低尿素氮方面,排名前3的中成药分别为百令胶囊+肾衰宁胶囊、海昆肾喜胶囊、尿毒清颗粒;在降低24 h尿蛋白定量方面,排名前3的中成药分别为黄葵胶囊+肾衰宁胶囊、百令胶囊+肾衰宁胶囊、黄葵胶囊.结论 口服中成药联合常规治疗可提高慢性肾衰竭的临床疗效,且安全性良好,其中百令胶囊+肾衰宁胶囊在所有疗效指标中均排名靠前,具有良好的临床应用价值.但受到研究质量及数量限制,仍需要大样本量、多中心、高质量随机对照试验对结果进一步验证.

Ethnopharmacological relevance: Aconitine, a C19-norditerpenoid alkaloid, derives from many medicinal plants such as Aconitum carmichaelii Debx. (Chinese:), Aconitum kusnezoffii Reichb (Chinese:(sic)), which were used to rheumatic fever, painful joints and some endocrinal disorders.& nbsp;Aims of the review: The present paper reviews research progress relating to the pharmacokinetics, physiological and pathological processes of aconitine, while some promising research direction and the detoxification of aconitine are also discussed.& nbsp;Materials and methods: The accessible literature on aconitine, from 1990 to 2020, obtained from published materials of electronic databases, such as SCI finder, PubMed, Web of Science, Science Direct, Springer and Google Scholar was systematically analyzed.& nbsp;Results: In this review, we address the pharmacokinetics of aconitine, as well as its pharmacological effects including anti-cancer, anti-inflammatory, anti-virus, immunoregulation, analgesic, insecticide and inhibition of androgen synthesis. Further, we summarize the toxicity of aconitine such as cardiotoxicity and neurotoxicity, on which we strikingly focus on the ways to reduce the toxicity of aconitine based.& nbsp;Conclusions: Aconitine plays an vital role in a wide range of physiological and pathological processes and we can reduce the toxicity of aconitine by compatibility and hydrolysis. Although some issues still exist, such as the correlative relationship between the dose and toxicity of aconitine not being clear, our review may provide new ideas for the application of aconitine in the treatment of related diseases.

To improve the single type of the existing clinical diagnosis and treatment decision support system, this paper proposes an intelligent medical diagnosis model of integrated TCM and Western medicine based on data mining. The scheme mainly inputs the diagnosis data into two subsystems for training and testing, according to the characteristics of the clinical diagnosis support information environment. Firstly, the improved Apriori algorithm is used to mine the TCM diagnosis and treatment data to obtain more perfect diagnosis information; then the BP neural network optimized by GA is adopted to process the real samples to improve the medical diagnosis speed. Finally, a clinical diagnosis prototype system combining the two methods is designed by customs clearance development, which is applied in the specific decision support and achieves good mining effect, and the prediction data is basically consistent with the clinical practice. Therefore, the scheme has been proved to be feasible and helpful to reduce clinical medical errors.

目的:观察复方积雪草颗粒积芎解毒方对糖尿病肾病大鼠模型血液生化指标及对肾组织单核细胞趋化因子(MCP-1)、补体C5b-9、血管紧张素-Ⅱ(Ang Ⅱ)水平的影响,探讨积芎解毒方对糖尿病肾病大鼠的肾保护作用和可能机制.方法:60只雄性SD大鼠随机分为正常对照组、模型对照组、中药高剂量组、中药中剂量组、中药低剂量组、福辛普利组.每组10只,除正常对照组外采用高脂饲料喂养加STZ腹腔注射制作糖尿病肾病大鼠模型,治疗8周后,检测大鼠24h尿蛋白定量(UTP),血清总蛋白(TP)、白蛋白(Alb)、尿素氮(BUN)、肌酐(Scr)、谷丙转氨酶(ALT)、谷草转氨酶(AST)的变化;Real time PCR法检测各组大鼠肾组织MCP-1、C5b-9、Ang Ⅱ的表达情况.结果:与正常对照组比较,模型对照组大鼠肾组织MCP-1、C5b-9、Ang Ⅱ mRNA水平显著升高(P＜0.01);与模型对照组比较,各治疗组24 h尿蛋白定量(UTP)明显下降;TP、Alb均明显升高;MCP-1、C5b-9、Ang Ⅱ mRNA水平均明显降低,其中中药高剂量组小于低剂量组(P＜0.05),与福辛普利组相似(P＞0.05),中药低剂量组与中剂量组结果差异无统计学意义(P＞0.05),高剂量组与中剂量组差异有统计学意义(P＜0.05).各组ALT、AST、BUN、Scr变化不明显.结论:积芎解毒方高剂量对糖尿病肾病大鼠的肾保护作用可能与通过降低炎症反应从而延缓肾功能发展有关.

Professor ZHAO thinks the location of renal proteinuria is mainly in kidney,with deficiency mixed with excess and the common syndrome is deficiency-excess complication.The treatment should pay attention to the treatment based on syndrome differentiation and combination of syndrome and disease differentiations.He emphasizes the importance of spleen and kidney,pays attention to the whole,distinguishes the primary and secondary contradictions,and advocates traditional Chinese and Western medicine treatment.At the same time prevention is also be emphasized.