BackgroundThe evidence supporting a connection between elevated serum uric acid (SUA) levels and diabetic peripheral neuropathy (DPN) is controversial. The present study performed a comprehensive evaluation of this correlation by conducting a systematic review and meta-analysis of relevant research.MethodPubMed, Web of Science (WOS), Embase, and the Cochrane Library were searched for published literature from the establishment of each database to January 8, 2024. In total, 5 cohort studies and 15 cross-sectional studies were included, and 2 researchers independently screened and extracted relevant data. R 4.3.0 was used to evaluate the included literature. The present meta-analysis evaluated the relationship between SUA levels and the risk of DPN in type 2 diabetes (T2DM) by calculating the ratio of means (RoM) and 95% confidence intervals (CIs) using the method reported by JO Friedrich, and it also analyzed continuous outcome measures using standardized mean differences (SMDs) and 95% CIs to compare SUA levels between DPN and non-DPN groups. Funnel plot and Egger’s test were used to assess publication bias. Sensitivity analysis was conducted by sequentially removing each study one-by-one.ResultsThe meta-analysis included 20 studies, with 12,952 T2DM patients with DPN and 16,246 T2DM patients without DPN. There was a significant correlation between SUA levels and the risk of developing DPN [odds ratio (OR) = 1.23; 95% CI: 1.07-1.41; p = 0.001]. Additionally, individuals with DPN had higher levels of SUA compared to those without DPN (SMD = 0.4; 95% CI: -0.11-0.91; p < 0.01).ConclusionT2DM patients with DPN have significantly elevated SUA levels, which correlate with a heightened risk of peripheral neuropathy. Hyperuricemia (HUA) may be a risk indicator for assessing the risk of developing DPN in T2DM patients.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42024500373.

目的:系统评价行体外受精-胚胎移植过程中针灸对卵巢低反应(POR)患者妊娠结局和卵巢功能有效性的疗效.方法:计算机检索国家知识基础设施数据库(CNKI)、中文科技期刊数据库(CCD)、中国生物医学文献数据库(CBM)、中国学术期刊数据库(CSPD)、PubMed、Cochrane Library数据库,检索针灸治疗POR的随机对照试验(RCT),检索时限为建库至2021年8月31日.采用RevMan 5.4软件对纳入研究进行偏倚风险评价和数据分析,并进行GRADE证据质量评价.结果:共纳入8个RCT,包括537例患者.Meta分析结果显示:与体外受精-胚胎移植(IVF-ET)组比较,针灸+IVF-ET组可提高POR患者临床妊娠率(RR=1.58,95％CI为1.03～2.42,P=0.04),增加获卵数(MD=1.16,95％CI为0.47～1.85,P=0.001)和窦卵泡数(MD=0.93,95％CI为0.06～1.8,P=0.04),降低促卵泡素(FSH)水平(SMD=-0.29,95％CI为-0.50～-0.08,P=0.007),但2组在提高受精率、优胚率、降低促黄体素(LH)水平、提高抗米勒管激素(AMH)水平、降低促性腺激素(Gn)用量上差异均无统计学意义.结论:现有证据表明,针灸可提高接受IVF-ET助孕的POR患者临床妊娠率,增加获卵数和窦卵泡数,降低POR患者的FSH水平.由于纳入研究数量较少且存在一定的偏倚风险,本研究结论后续仍需要高质量研究进行验证.

Background: Acupuncture therapy (AT) is a widely used, alternative medicine in China. AT is an effective treatment for many diseases, but its efficacy in stable chronic obstructive pulmonary disease (COPD) remains controversial. Therefore, we performed the present meta-analysis to evaluate the efficacy of AT in stable COPD patients. Methods: Randomized controlled trials (RCTs) for AT efficacy in stable COPD patients were searched in literature databases from the inception to December 31, 2021. Pooled effect sizes of outcome measurements with respect to lung function (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], FEV1 in predicted value [FEV1%], FEV1/FVC), quality of life (St. George respiratory questionnaire [SGRQ]), exercise capacity (6-minute walking distance [6MWD]) and effective rate were estimated by calculating weighted mean difference (WMD) or odds ratio (OR) with corresponding 95% confidence interval (95% CI), respectively, by a random-effect model. Results: A total of 28 RCTs with 2130 COPD patients were included. AT group had significant improvement in FVC (WMD = 0.29 L, 95% CI: 0.22–0.36, P < .001), FEV1 (WMD = 0.33 L, 95% CI: 0.23–0.43, P < .001), FEV1% (WMD = 3.30%, 95% CI: 3.30–4.64, P < .001), FEV1/FVC (WMD = 5.45%, 95% CI: 4.41–6.49, P < .001), 6MWD (WMD = 45.48 m, 95% CI: 28.21–62.16, P < .001), SGRQ (WMD = −7.79, 95% CI: −12.34 to −3.24, P < .001), and a higher effective rate (OR = 3.71, 95% CI: 2.50–5.52, P < .001) compared to the control group. Subgroup analysis stratified by comparison model (AT combined with other treatments vs other treatments, AT alone vs sham AT) and treatment duration (≥8 weeks, <8 weeks) also showed more improvement in AT arm than control arm without significant between-subgroup difference. Adverse events were reported in a few studies and only mild reactions were observed. Conclusion: AT is effective in improving lung function, quality of life and exercise capacity, and can be used as an adjunctive treatment in patients with stable COPD.

肩胛上神经卡压综合征临床极易与颈椎病及肩关节部疾患混淆而延误治疗,导致后期出现冈上肌和冈下肌萎缩,肩功能受限.早期准确诊断并有效的干预,对于患者的肩关节功能的恢复,避免肌萎缩有很大的意义.本文基于"在筋守筋"理论,从"筋"论治,初期邪郁肌表,采用精准推拿手法松解局部筋结祛除神经卡压点,使阳气来复,邪从表散;中期病程较久血瘀气滞,还需配合运动牵伸手法以舒筋通络,柔筋助动;后期经脉亏虚,筋肉痿弱,通过自我锻炼,扶助正气,增加肌肉丰满度,为疾病的诊断及手法治疗提供新的思路.

目的 基于中国临床试验注册中心(ChiCTR)和美国临床试验注册中心(ClinicalTrials.gov)数据库,分析中医药治疗卵巢功能减退性疾病研究注册现状和不足,为今后相关临床试验注册和开展提供参考.方法 系统检索ChiCTR和ClinicalTrials.gov建库至2021年12月22日收录的中医药治疗卵巢功能减退性疾病注册临床试验,由专人进行试验筛选和数据提取,采用Excel2019录入数据并进行统计分析.结果 最终纳入41项中医药治疗卵巢功能减退性疾病注册临床试验,其中卵巢储备功能减退研究17项、早发性卵巢功能不全研究24项.注册地域涉及8个省级行政区,其中注册项数最多的是北京市和广东省,共占43.9％(18/41).经费资助来源主要为地方财政.注册试验以干预性研究为主(38/41,92.7％),研究设计以随机平行对照试验为主(32/41,78.0％).干预措施多为单纯针刺和中成药,结局指标以疗效指标为主,方法学质量有待提升.结论 中医药治疗卵巢功能障碍临床试验注册数量呈逐年上升趋势,但整体数量仍偏少.目前研究在注册细节和研究方案方面仍需优化,注册质量有待提升.

Diminished ovarian reserve (DOR) is the main cause of female infertility. Acupuncture has a significant clinical effect on DOR. This article reviews the signal pathways, e.g. PI3K/Akt, Nrf2/ARE, Bcl-2/Caspase-3 regulated with acupuncture in 3 aspects, i.e. the structure and signal transduction of each pathway,the relationship with ovarian reserve and the improvement of acupuncture in ovarian reserve. It is anticipated to provide a new approach to further exploring the mechanism of acupuncture on the improvement of ovarian reserve. Moreover, the evidences of acupuncture may be obtained for its clinical treatment of DOR and other reproductive endocrine diseases.

膝骨关节炎在临床中较为常见,主要症状为膝关节痛甚至畸形,各个方向活动均可受限.张振宇教授认为膝骨关节炎患者的局部疼痛等症可通过手法缓解,治疗的主要目标是消除膝关节痛及改善行走和蹲起功能,提高生活质量.膝关节的蹲起动作需要膝、髋、脊、腹等部位共同参与完成,反之膝、髋、脊、腹等部位因素均可造成膝关节功能障碍.所以,在治疗膝骨关节炎时要局部与整体相结合,四位一体多因调治,局部调膝,整体调髋、调脊、调腹等对改善膝骨关节炎有很好的效果.

目的:通过数据挖掘技术分析现代针灸文献治疗早发性卵巢功能不全(POI)的取穴选用规律.方法:检索自建库至2021年3月31日中国知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、PubMed、Cochrane Library以及Embase收录的针刺治疗POI的相关文献,收集处方中的穴位信息,应用中医传承辅助系统(V2.5)进行数据挖掘.结果:共纳入文献78篇,腧穴64个,累积使用频次478次,主要归经为膀胱经、任脉、脾经等;针刺治疗常用腧穴为关元、三阴交、肾俞、子宫、足三里、太冲、中极、血海、脾俞、次髎等;注重特定穴的应用,如交会穴、募穴;常选用的腧穴组合为关元-三阴交-肾俞;基于熵聚类算法获取候选新腧穴组合9个及新腧穴处方2首.结论:针刺治疗POI取穴经脉主要以膀胱经、任脉、脾经为主,以关元-三阴交-肾俞为组方核心腧穴,以调冲任、补肝肾、调气血、安神志为针刺治疗POI方法.

四边孔综合征病情初期症状表现不典型,临床就诊时仅靠问诊和简单触诊检查,加之临证极易被影像学检查所误导,无法做到迅速而精确的诊断而延误治疗,所以强调早期诊断和早期治疗,避免因腋神经卡压过久出现的纤维化和不可逆损伤.张振宇教授认为四边孔综合征主要由经筋痹阻所致,基于神经卡压理论采取六步舒筋法推拿治疗,具有精准定位、远近相配、动静结合、标本兼治的特点,取得较好的临床疗效,为该病诊断及手法治疗提供了新思路.

目的:探讨古代文献中针灸治疗闭经的选穴规律.方法:利用《中华医典》第5版数据库检索"不月""月事不来""闭经""血枯"等30个关键词,筛选并提取针灸治疗闭经的处方条文,对数据进行整理.利用文献计量学的方法,借助古今医案云平台(V2.3)对针灸治疗闭经的选穴方案进行频次统计、社团分析、关联分析和复杂网络分析.结果:共筛选出符合要求的202条穴位处方条文,其中27条为复方,余为单穴方,共涉及38个腧穴,268频次.治疗闭经使用频次排前15位的腧穴:中极、血海、水泉、阴交、气海、关元、照海、带脉、腰俞、中髎、气冲、太冲、三阴交、合谷、会阴.复杂网络分析显示核心处方为:足三里、三阴交、肾俞、中极、血海、合谷、照海、气冲、气海、阴交.结论:针灸治疗闭经的取穴具有规律性,本研究结果可为临床提供一定的参考性,且通过数据挖掘技术探讨古籍针灸文献具有可行性.

The application status of acupuncture and moxibustion therapy for assisted reproductive field in the United States was analyzed, and the existing problems and future development directions were discussed. According to the survey on the 456 websites of assisted reproductive clinic in the United States mentioned in the report of U.S. Centers for Disease Control and Prevention (CDC), 111 clinics among 456 assisted reproductive clinics recommend and used acupuncture and moxibustion therapy, accounting for 24.3%. Acupuncture and moxibustion therapy had obvious effect, good safety and low cost, and the assisted reproductive institutions in the United States had a high degree of application and recognition to acupuncture and moxibustion therapy. However, some problems, such as immature treatment scheme, unclear mechanism and imperfect insurance policies, still existed. In the future, the advantages of Chinese traditional acupuncture and moxibustion should combine with international modern assisted reproductive technology, and multi-center and large-sample clinical randomized controlled trials and basic experimental research on the mechanism of acupuncture and moxibustion for assisted reproduction should be carried out.

目的 观察揿针联合毫针治疗单纯性面瘫临床疗效.方法 研究纳入单纯性面瘫患者72例,按1∶1随机分为观察组和对照组,剔除脱落后最终纳入68例,2组各34例.观察组局部分期用针,发病第1周及第4周予局部揿针配合毫针远取浅刺,发病第2～3周局部毫针透刺配合毫针远取;对照组局部毫针配合远取,常规针刺.2组均隔日治疗1次,每周3次,总疗程为4周,在治疗前后对2组患者进行面神经功能House-Brackmann(H-B)评分,根据H-B评分对临床疗效进行判定.结果 2组H-B评分均较治疗前降低,差异有统计学意义(P＜0.05);观察组总有效率为97.1％、对照组94.1％,2组间差异无统计学意义(P＞0.05).结论 基于经筋理论揿针联合毫针治疗单纯性面瘫疗效确切,与常规毫针针刺疗效相当,对面神经功能的恢复、临床症状都有较明显的改善,且操作简便,安全性高.

原发性痛经是临床常见病,很多女性饱受困扰.张振宇教授在临床工作中,从肌筋膜疼痛理论出发,认为腹部的肌筋膜疼痛触发点与痛经相关性最为密切,治疗多选取腹部,从腹部核心肌入手,运用"一点四法"推拿手法灭活肌筋膜疼痛触发点,以治疗原发性痛经取得良好临床疗效,为原发性痛经的治疗提供了新的研究思路.

扶正补虚和辨证论治是肺养护推拿治疗的基本原则,"通鼻窍、利咽喉、宣肺气、排痰浊、宽胸胁、健脾运、固元气"七部手法,是推拿进行肺养护的基本手法,临床使用时须根据实际情况辨证使用,可选2～3个手法治疗,也可根据病情变化,采用多种手法组合治疗,操作时可打乱治法的顺序,按部位治疗,一般先头面,次上肢,然后是胸腹、腰背、下肢.通过七部推拿法加强膈肌运动,提高肺活量,增加有效肺泡通气量,减少残气量,改善肺功能.

目的 基于数据挖掘分析推拿手法治疗腰腿痛的选穴配伍规律.方法 检索中国知网(CNKI)数据库、万方数据知识服务平台(万方)、中文科技期刊全文数据库(维普)、PubMed以及EMBASE以推拿手法为主治疗腰腿痛的文献,检索时间为从建库至2019年12月22日,应用中医传承辅助平台V2.5分析推拿处方中使用穴位及其频次、各穴位间的关联规则和产生的新处方等.结果 最终纳入文献104篇,其中穴位归经主要集中在足太阳膀胱经、足少阳胆经、督脉;使用频次较高的穴位为肾俞、委中、环跳、大肠俞、承山等;高频穴位配伍依次为委中-环跳,肾俞-委中,肾俞-大肠俞等;核心组合有大肠俞-上髎-气海俞、大肠俞-气海俞-中髎等;形成新处方包括大肠俞、上髎、气海俞、中髎、承扶、承山、殷门、昆仑、风市、环跳等穴.结论 基于数据挖掘分析认为,推拿手法治疗腰腿痛以整体观念为指导,以膀胱经为重点.

体位性高血压在临床越来越多见,改善其症状减少血压波动,对于防治外周动脉疾病、心脑血管疾病有着重要意义.张振宇教授认为体位性高血压的发生与下肢肌肉薄弱、心脏水平以下静脉回流障碍密切相关,通过颈肩、下肢、腹部三部推拿结合自主锻炼,可以有效改善体位性高血压.并详细介绍其医体结合治疗体位性高血压的经验,为临床治疗体位性高血压提供新思路.

目的:明确针灸拔罐综合疗法治疗脾虚湿阻型单纯性肥胖的临床疗效及安全性,以探讨临床治疗单纯性肥胖的有效方案并为其提供较可靠的证据.方法:将60例符合纳入标准的单纯性肥胖受试者按随机数字表法分为试验组和对照组各30例,试验组采取针灸拔罐+饮食运动综合干预疗法,对照组采取单纯饮食运动干预疗法,4周为1个疗程,连续观察3个疗程,以临床有效率、体质指数(BMI)、腰围、体质量下降率、腰围下降率作为疗效评价指标,以血、尿常规,肝、肾功能及不良反应表作为安全性性评价指标,明确针灸拔罐综合疗法治疗脾虚湿阻型单纯性肥胖的临床疗效及安全性.结果:总纳入病例60例,脱落3例,最终纳入分析有效病例57例,试验28例,对照组29例,总体疗效组间比较,试验组总有效率96.43％,对照组总有效率68.97％,试验组总体疗效较对照组为优,差异有统计学意义.2组治疗前后体质量、BMI组内比较均呈显著下降,但组间比较差异无统计学意义;2组治疗前后组内腰围比较均呈下降趋势,组间比较差异无统计学意义.腰围差值比较,试验组改善程度均优于对照组,差异有统计学意义.2组治疗后体质量下降率组间比较,在疗程1、2结束时差异无统计学意义,在疗程3结束时差异有统计学意义.2组治疗后腰围下降率组间比较,在疗程1结束时差异无统计学意义,在疗程2、3结束时差异有统计学意义.结论:针灸拔罐综合疗法在改善脾虚湿阻型单纯性肥胖的体质量和腰围上疗效明确、安全,值得临床推广.

目的:对单纯性肥胖患者针灸减肥效果进行Meta分析.方法:系统性检索中文和英文文献数据库,获取以伪针灸为对照的针灸减肥效果随机对照试验.通过计算肥胖相关人体测量指标、激素指标以及生化指标的加权均数差(WMD)和95％ CI评估干预效果差异.结果:纳入16项研究共计1 109名单纯性肥胖患者.合并分析表明,针灸比伪针灸能更有效降低体质量(WMD=-1.44,95％ CI=-2.26to-0.63,P＜0.001)、BMI(WMD=-0.61,95％CI=-2.26to-0.63,P＜0.001)和腰围(WMD=-2.03,95％CI=-3.26 to-0.79,P=0.001).针灸还可显著降低瘦素水平(WMD=-2.78,95％CI=-5.13 to-0.43,P=0.021),但对其他肥胖相关激素无显著影响.针灸仅产生少量轻微不良反应,无严重不良反应.亚组分析表明,耳针、针刺和穴位埋线法均具有减肥效果.结论:本研究仅纳入以伪针灸为对照的临床随机对照试验,降低了安慰剂效应.与伪针灸相比针灸减肥效果更有效,但其长期治疗效果还需进一步研究.

目的 基于数据挖掘技术分析推拿手法在肺康复中的选穴配伍规律.方法 检索中国知网、万方、维普网从建库以来至2020年3月1日以推拿手法为主在肺康复中应用的文献,并通过中医传承辅助系统V2.5,确定推拿处方中穴位的使用频次、穴位之间的关联规则及形成的新处方等.结果 最终纳入文献17篇,有效处方22首,其中穴位归经主要集中在任脉、足太阳膀胱经、手太阴肺经、督脉、足阳明胃经;使用高频次穴位为肺俞、肾俞、定喘等;高频次穴位配伍为肺俞-肾俞、肺俞-定喘等;核心组合有阴谷-定喘-天突、阴谷-定喘-膈俞等;形成新处方包括阴谷、定喘、天突、太溪、肺俞、膈俞等穴位.结论 基于数据挖掘技术分析认为推拿手法在肺康复中整体治则以扶正、改善肺功能为主,为新型冠状病毒肺炎恢复期患者的早期肺康复提供了冶疗思路.