OBJECTIVE:To analyze the efficacy of Biejiajian Pill (BJJP) on intestinal microbiota in patients with hepatitis B cirrhosis/liver fibrosis, and explore its relationship with liver fibrosis.METHODS:This was a prospective, randomized double-blind controlled trial. Using the stratified block randomization method, 35 patients with hepatitis B liver cirrhosis/liver fibrosis were randomly assigned (1:1) to receive entecavir (0.5 mg/d) combined with BJJP (3 g/time, 3 times a day) or placebo (simulator as control, SC group, simulator 3 g/time, 3 times a day) for 48 weeks. Blood and stool samples were collected from patients at baseline and week 48 of treatment, respectively. Liver and renal functions as well as hematological indices were detected. Fecal samples were analyzed by 16S rDNA V3-V4 high-throughput sequencing, and intestinal microbiota changes in both groups before and after treatment were compared, and their correlations with liver fibrosis were analyzed.RESULTS:Compared with the SC group, there was no significant difference in liver function, renal function and hematology indices in the BJJP group, however, the improvement rate of liver fibrosis was higher in the BJJP group (94.4% vs. 64.7%, P=0.041). Principal coordinate analysis (PCoA) based on weighted Unifrac distance showed significant differences in intestinal microbiota community diversity before and after BJJP treatment (P<0.01 and P=0.003), respectively. After 48 weeks' treatment, the abundance levels of beneficial bacteria (Bifidobacteria, Lactobacillus, Faecalibacterium and Blautia) increased, whereas the abundance levels of potential pathogenic bacteria, including Escherichia coli, Bacteroides, Ruminococcus, Parabacteroides and Prevotella decreased, among which Ruminococcus and Parabacteroides were significantly positively correlated with degree of liver fibrosis (r=0.34, P=0.04; r=0.38, P=0.02), respectively. The microbiota in the SC group did not change significantly throughout the whole process of treatment.CONCLUSION:BJJP had a certain regulatory effect on intestinal microbiota of patients with hepatitis B cirrhosis/liver fibrosis (ChiCTR1800016801).

目的 评价益气养阴解毒化瘀方加减联合西药治疗轻微型肝性脑病的临床疗效及安全性.方法 纳入经Stroop测试诊断为轻微型肝性脑病患者100例,采用随机对照试验方法,以1 ∶1比例分为益气养阴解毒化瘀方加减联合西医治疗组(中西医结合治疗组)和西医治疗组进行治疗,记录两种疗法对轻微型肝性脑病患者治疗前及治疗4周后的Stroop测试时间(包括总关闭阶段时间、正确完成关闭阶段的次数、总开放阶段时间、正确完成开放阶段的次数、总开放阶段时间+总关闭阶段时间)和中医证候积分,并评价疗效;分别于治疗前及治疗1、2、4周后记录患者终末期肝病模型(MELD)评分,并检测肝功能[包括血氨(BA)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、血清总胆红素(TBiL)]、凝血功能[包括凝血酶原活动度(PTA)、国际标准化比值(INR)]及粒淋比(NLR),并观察患者生命体征,检测血常规及电解质肾功能,记录不良事件.结果 治疗后,中西医结合治疗组Stroop测试结果的总关闭阶段时间[97.01(85.61,110.98)s]、总开放阶段时间[106.47(93.82,125.89)s]、总开放阶段时间+总关闭阶段时间[201.63(180.72,231.34)s]较本组治疗前缩短,且分别较西医治疗组的109.53(97.56,140.37)s、127.46(106.66,148.02)s、234.40(212.19,283.68)s缩短更明显(P＜0.05或P＜0.01).中西医结合治疗组有效率94％,优于西医治疗组的72％(P＜0.01).中西医结合治疗组治疗1、2、4周后ALT、AST、TBiL、BA、INR、NLR、MELD评分及中医证候积分逐渐下降,ALB、PTA上升,且除ALT外,其余指标改善均优于西医治疗组(P＜0.05或P＜0.01).中西医结合治疗组1例患者在治疗2周后出现腹泻,调整方药后好转.结论 益气养阴解毒化瘀方加减联合西药治疗轻微型肝性脑病能改善患者认知能力,提高治疗有效率,且安全性好.

Objective: To investigate the clinical efficacy of entecavir combined with Biejiajian pills and its influence on TCM syndrome scores during the treatment of chronic hepatitis B with hepatic fibrosis and blood stasis syndrome by prospective, randomized and controlled study. Methods: Patients with chronic hepatitis B with hepatic fibrosis and blood stasis syndrome were selected as the research subjects and randomly divided into a treatment group and a control group. Entecavir plus Biejiajian pills or entecavir plus a simulant of Biejiajian pills were given for 48 weeks. The changes in liver stiffness measurement (LSM) and TCM syndrome scores before and after treatment were compared between the two groups to analyze the correlation. The data between groups were analyzed by t-test/Wilcoxon rank sum test or χ(2) test. Pearson correlation coefficient was used to analyze the correlation between TCM syndrome scores and LSM values. Results: After 48 weeks of treatment, the LSM values of the two groups were significantly lower than those of the baseline (P < 0.001), liver fibrosis was significantly improved, and the LSM values of the treatment group were lower than those of the control group [(8.67 ± 4.60) kPa and (10.13 ± 4.43) kPa, t = -2.011, P = 0.049]. After 48 weeks of treatment, the TCM syndrome scores of the two groups were significantly reduced compared with the baseline (P < 0.001), and the clinical symptoms were significantly relieved, and the total effective rates of the improvement of the TCM syndrome scores in the two groups were 74.19% and 72.97%, respectively, but the differences between the groups were not statistically significant (χ(2) = 0.013, P = 0.910). Correlation analysis showed that there was no obvious trend between TCM syndrome scores and LSM values. There were no serious adverse reactions associated with the drug during the observation period of this study. Conclusion: Based on antiviral treatment with entecavir, regardless of whether it is combined with the Biejiajian pill, it can effectively reduce the LSM value, improve liver fibrosis, reduce TCM syndrome scores, and alleviate symptoms in patients with chronic hepatitis B with liver fibrosis and blood stasis syndrome. Compared with entecavir alone, the combined Biejia pill has greater efficacy in improving liver fibrosis and a favorable safety profile, meriting its implementation and widespread application.

目的 探讨安神醒脑汤治疗依非韦伦所致感染人类免疫缺陷病毒(HIV)/获得性免疫缺陷综合征(AIDS)患者失眠症的临床疗效.方法 选取2016年5月—2018年9月就诊于首都医科大学附属北京地坛医院的初次依非韦伦抗病毒治疗后出现失眠(肝郁化火兼痰热内扰证)的HIV/AIDS患者108例,采用随机数字表法分为治疗组与对照组,各54例.治疗组给予安神醒脑汤治疗,对照组给予艾司唑仑片治疗,疗程均为8周.比较2组治疗前后匹兹堡睡眠质量指数(PSQI)评分、中医证候积分,并依据中医失眠疗效判定标准评价疗效.结果 治疗4、8周,2组PSQI评分及中医证候积分均较治疗前减少,差异有统计学意义(P＜0.01);治疗4周,2组间PSQI评分差异无统计学意义(P＞0.05),中医证候积分差异有统计学意义(P＜0.01);治疗8周,2组间PSQI评分差异有统计学意义(P＜0.01),中医证候积分差异有统计学意义(P＜0.01);治疗8周,治疗组总有效率高于对照组(P＜0.01);2组未观察到严重不良反应.结论 安神醒脑汤可有效改善依非韦伦所致HIV/AIDS患者的失眠症.

元宵节过后,年味逐渐散尽,大街小巷开始出现玫瑰花的身影,一年一度的情人节来临啦. 玫瑰古老而神秘.据说在埃及一座金字塔的众多陪葬品中竟然发现了一个玫瑰花环,花朵虽然枯萎但是颜色却丝毫未改变.希腊神话中玫瑰是由司爱与美的女神阿佛洛狄忒从海水中诞生时,她身上的泡沫变成的,因此玫瑰成为了表达爱情的象征.

观察新型冠状病毒肺炎病程中腹泻一症,结合临床辨证,提出此症出现原因及对总体辨证的影响.腹泻的发生在该病的初期及临床治疗过程中比例及原因不同,需对疾病初期腹泻及治疗过程中药物不良反应问题区别对待.新型冠状病毒肺炎是感受疫疠之气致病,无论是病情所致或药物不良反应,腹泻症状在临床上相对常见,属湿浊所致,治疗以祛湿为要.

中医肝病专家王融冰教授依据中医"肝与大肠相通"理论,结合临床多年对慢性重症肝炎症候学的研究,认为慢性重症肝炎至内毒素血症阶段为本虚标实之证,本为肝肾阴虚,标为浊毒泛溢,因此可通过"调肠治肝"治疗本证."调肠治肝"为中医药治疗慢性重型肝炎提供了新的思路.

结合传统中医疫病防控文献相关记载与现代研究成果,对中医药在新型冠状病毒肺炎疫情防控实践中的问题包括中医疫病防治的理论价值、存在问题及发展方向进行探讨.中医疫病防治理论具有特色及实践价值,其理论来自实践,而认识具有特色甚至超前性,如环境因素与疫病性质相关、不同属性的疫病会有不同发展规律等;中医疫病理论体系是一个比对数据库,其以经典理论为依托,以现场调研为基础,围绕核心病机配合个体化辨证的防治体系,对于新发传染病的防控是一种成功模式.目前传染病的中医预防理论缺乏完整体系,其方法众多但基础研究及系统评价不足;常见预防方法已经涵盖了传染病的基本要素,但存在缺陷;疫病预防理论基础需要再讨论,预服中药预防需要研究证据支撑.以现代传染病规律为基础,多学科协作,做好基础贮备,可提升中医疫病精准预防及治疗能力,而加强中医疫病理论内涵研究与多学科基础研究储备是中医疫病事业未来发展的方向.

目的 基于倾向性匹配分析淤胆汤联合西药治疗急性药物性肝炎合并高胆红素血症的疗效.方法 回顾性分析2008年8月-2019年8月作者所在医院收治的急性药物性肝炎伴高胆红素血症的患者118例,根据治疗过程中是否应用淤胆汤(服用2周以上)分为西药联合淤胆汤治疗观察组和单纯西药治疗对照组.应用倾向性匹配分析法将2组各匹配51例,分别评估治疗前及治疗6周后生化指标改善情况、有效率及安全性.结果 中西医结合治疗组与西药组比较TBIL、TBA、AST、GGT、ALP明显下降(P＜0.05);长期(＞4周)服用中药疗效较短期(＜4周)服用中药疗效更加显著(P＜0.01);中西医结合组治疗后HGB升高,WBC、PLT、CR、INR降低(P＜0.01),且治疗后以上指标均在正常范围内.结论 淤胆汤联合西药治疗急性药物性肝炎伴高胆红素血症疗效优于单纯西药治疗,且安全性高.

“阿胶一碗,芝麻一盏,白米红馅蜜饯.粉腮似羞,杏花春雨带笑看.润了青春,保了天年,有了本钱.”这是著名元曲作家白朴对阿胶的描述.在养生热愈演愈烈的今天,各类滋补品中阿胶无疑是翘楚,现在一盒品牌阿胶的售价甚至已经高于一瓶名酒了!

随着中国与世界各国的交流愈发频繁,输入性传染病不可避免,中医药如何应对输入性传染病面临新的挑战.笔者收集2016年北京地区4例输入性寨卡病毒病的临床资料并结合文献进行中医分析,提出寨卡病毒属于中医温病范畴,疾病性质属温热夹风、夹湿,轻症病位在上焦,在卫分、气分,主要病机是温热疫毒侵袭人体,导致风热犯肺、夹风上扰、夹湿下注,重症可伤及营血分,导致耗血动血、热入血室,可以使用清热解毒、祛风除湿、凉血类中药进行治疗.

Xiyanping Injection is widely used in the treatment of respiratory infectious diseases. However,its package insert is still less instructive for physicians in understanding the specific clinical application of Xiyanping Injection. To discover potential clinical advantages of Xiyanping Injection,the team invited clinical experts of traditional Chinese medicine and western medicine from the field of respiratory diseases,pharmacists and methodologists of evidence-based medicine to compile the consensus. The consensus was based on a combination of clinical research evidence and expert experience,involving recommendations for clinical problems supported by clini-cal evidence as well as consensus suggestions for clinical problems with no clinical evidence. The consensus recommended the indication,timing of intervention,usage,dosage,course of treatment,combined medication of Xiyanping Injection used for adults,and introduced the safety and precautions of its clinical application. It is suitable for guiding clinical medical workers to rationally use Xiyanping Injection in the treatment of adult&apos;s respiratory infectious diseases.

目的 研究自身免疫性肝炎(AIH)中医体质分布特点,以指导其中医药治疗与调护.方法 按性别、年龄、肝硬化分组分析247例AIH患者中医体质类型分布及衍变.结果 AIH中医体质分布比例:阴虚质(25.1％)、气郁质(21.1％)、气虚质(15.0％)、平和质(13.0％)、湿热质(10.5％)、痰湿质(8.1％)、血瘀质(3.2％)、阳虚质(3.2％)、特禀质(0.8％);性别不影响中医体质类型分布,而年龄和肝硬化对中医体质类型分布有影响.结论 自身免疫性肝炎患者主要为偏颇体质,以阴虚质、气郁质及气虚质为主;随着年龄的增长,平和体质逐渐减少,而阳虚质及血瘀质逐渐增多;随着疾病进展,气郁、血瘀、阴虚、阳虚体质逐渐增多,而平和、气虚、痰湿、湿热体质逐渐减少.

Objective To expl re the factors influencing traditional Chinese medicine (TCM) treatment of HIV-related chronic diarrhea (HRCD).Methods Two hundred and two HRCD patients treated with TCM were included in the study.According to the therapeutic efficacy,133 cases (65.84％) were classified into effective group,69 cases (34.16％) were classified into inefficacy group.Leukocyte and erythrocyte in stool routine examination (SRE),pathogens in stool samples and inflammation by colonoscopy were recorded.Unconditioned logistic regression analysis was used to explore the possible related factors influencing the treatment of HRCD.Results Logistic regression analysis showed leukocyte in SRE (OR=0.286,95％CI:0.138-0.595),CD4 cell count (OR=1.003,95％CI:1.003-1.006),diarrhea score (OR=-1.185,95％CI:1.185-1.378),pathogen culture positive rate (OR=0.332,95％CI:0.332-0.691)were related risk factors of therapeutic efficacy in TCM treatment of HRCD.Conclusions TCM could obtain better therapeutic efficacy for patients with non-infectious HRCD,obvious diarrhea symptoms and poor immune function,indicating the advantages of TCM.

目的 探讨轻微型肝性脑病患者的临床特征、发病危险因素及中医证候特点.方法 对2017年6月-2018年10月首都医科大学附属北京地坛医院中西医结合中心住院部收治的120例肝硬化患者的临床资料进行分析,并对患者的中医证候特征进行研究.结果 轻微型肝性脑病患者52例,占43.3％,其中男32例,女20例;非轻微型肝性脑病患者68例,占56.7％,其中男41例,女27例.与非轻微型肝性脑病组比较,轻微型肝性脑病组失代偿期患者明显增多(P＜0.05),child分级明显增高(P＜0.05),白蛋白水平明显降低(P＜0.05).经Logistic回归分析发现,白蛋白和child分级是轻微型肝性脑病发生的危险因素(P＜0.05).肝肾阴虚证和瘀血阻络证为轻微型肝性脑病患者的最主要证候.结论 轻微型肝性脑病患者多发于肝硬化失代偿期,肝脏损害越严重,轻微型肝性脑病发生率越高.

外感病证发病与否与体质有关,体质强则不易发病,且不同体质对某些特定外邪具有易感性.外感病证病机传变的性质和部位与体质有密切关系,从阳化热、从阴化寒,中气强实易燥化归阳明,中气虚赢易湿化归太阴.外受邪攻,若体质强则易于痊愈,否则易内传出现复杂多样的变证、坏证.对外感病证的治疗要增强体质、顾护体质,外感病证辨治中应高度重视中医体质思想.

Hugan Tablets is a Chinese patent medicine,it has the function of anti-inflammation and reducing transaminase. Based on questionnaire investigation of doctors and a systematic review of research literature on Hugan Tablets,using international clinical practice guidelines' developing methods,with the best available evidence and fully combining expert experience,and following the principle of " evidence-based,consensus-based and experience-based",Expert consensus statement on Hugan Tablets in clinical practice was developed by more than 30 multidisciplinary experts from the nationwide,aimed at guiding and standardizing the rational use of Hugan Tablets by clinicians and to improve clinical efficacy and safety. The expert consensus adopts internationally recognized recommendation criteria for classification of evidence: GRADE. The formation of expert consensus adopts the nominal group technique. Six main considerations are quality of evidence,curative effect,safety,economical efficiency,patient acceptability and other factors. If there is sufficient evidence,a " recommendation" is formed,using GRADE grid voting rule. If there isn' t sufficient evidence,a " consensus opinion" is formed,using majority counting rule. Focus on the indication,usage and dosage,drug use in special population and safety of Hugan Tablets,two recommendations and eight consensus opinions were put forward. Through expert meetings and correspondence,a nationwide consultation and peer review was conducted. This consensus applies to clinicians in hospitals and grass-roots health services,to provide guidance and reference for the rational use of Hugan Tablets.

目的:初步探讨轻微型肝性脑病患者的临床特征及中医证素分布规律.方法:对首都医科大学附属北京地坛医院中西医结合中心住院部收治82例肝硬化患者的临床资料进行分析,并对患者的中医证素规律进行研究.结果:轻微型肝性脑病患者36例,占比43.9％,其中男性患者21例,女性患者15例;非轻微型肝性脑病患者46例,占比56.1％,其中男性患者28例,女性患者18例,轻微型肝性脑病患者的黄疸水平明显增高(P<0.05),白蛋白及血小板水平明显低下(P<0.05),经过logistic回归分析发现,PTA和血小板是轻微型肝性脑病发生的危险因素(P<0.05).结论:轻微型肝性脑病患者多发于中老年男性,多为肝硬化终末期,肝脏损害的严重程度直接影响轻微型肝性脑病的发生,气阴两虚证为轻微型肝性脑病患者的最主要证素特征之一,轻微型肝性脑病早期诊断、早期治疗应引起足够重视.

目的:通过原发性胆汁性肝硬化(PBC)与慢性乙型病毒性肝炎(CHB)的文献证素比较研究,探析PBC的证素分布特征及病机特点.方法:基于万方及中国知网文献数据库,结合人工筛选,获取2000年1月至2014年6月公开发表的非重复PBC中医研究文献,参照CHB证素研究方法建立PBC证素数据库.通过与CHB的对比显示PBC证素分布规律与特点.结果:①文献特征:纳入56篇文献,病例1368例,研究快速增加,高质量研究主要集中于三级甲等中医院.②证型分布特征:析出证型56个,依次为肝肾阴虚等10个高频证型,按照证素聚合后形成6大核心证素群依次为:血瘀、脾虚、阴虚、肾虚、湿热及肝郁,与CHB中湿热、肝郁、血瘀、毒、阴虚有所不同.③证素分布特征:PBC病位证素依次为肝、脾、胆、肾;CHB为肝、脾、肾、胆、络.PBC中胆为高频病位,胆络、肝络为特有病位.PBC中病性证素依次为气虚、血瘀、气郁、湿、热;CHB为气郁、湿、热、阴虚、血瘀、阳虚;与CHB相比,PBC中气虚、血瘀为高频证素,气郁、热、阴虚、阳虚为低频证素.结论:PBC中瘀、气虚(脾虚)等6大核心证素群值得重点关注;胆、肝络及胆络是特有病位,应在实践中丰富关于胆系的中医治法;气虚、血瘀是PBC绝对优势证素,早期使用补气活血治法可能有助于改善预后.结合前期研究,提出PBC三阶段演变假说,气虚血瘀为核心证型,毒损胆络是关键推动机制.

Influenza is an acute respiratory infectious disease caused by influenza virus.WHO,governments and health and epidemic prevention departments attached great importance to its epidemic,monitoring and prevention.Traditional Chinese Medicine had unique efficacy in prevention and control of influenza,having roles in relieving symptoms,and regulating the immune function.With the develapment of Chinese Medicine on influenza pathogenesis and mechanism of Traditional Chinese Medicine and so on,offered abundant in Traditional Chinese Medicine treatment of influenza prevention and control.In the process of treatment,emphasis should be placed on both Chinese and Western Medicine.On the basis of Western Medicine's anti-virus,we should use TCM syndrome differentiation and comprehensive treatment to relieve symptoms and reduce the incidence of criticalillness.