目的 定量分析体检人群肝脂肪变性与中医体质、BMI及实验室代谢指标的关系.方法 使用定量CT(quantitative computerized tomography,QCT)测量肝脏脂肪体积百分比(Fat％QCT),纳入肝脂肪变性程度≥5％的体检受试者158例.收集临床资料及中医体质结果,分析受试者的中医体质分布特点,观察Fat％QCT与中医体质、BMI及实验室代谢指标的相关性.结果 158例受试者的平均Fat％QCT为10.3±6.8％;肥胖组Fat％QcT值显著高于未超重组(11.7±4.1％VS 8.9±6.5％),糖尿病组Fat％QQCT值显著高于血糖正常组(14.2±11.4％VS 9.7±6.2％),两组组内均具有统计学意义.在中医体质方面,158例受试者中兼杂偏颇体质共124例(78.5％),前3位分别是痰湿质+湿热质、气虚质+痰湿质和气虚质+湿热质;单纯体质31例(19.6％),前3位分别是气虚质、湿热质和痰湿质.相关分析显示:受试者Fat％QCT与BMI、血糖及痰湿质显著正相关(rs=0.35、0.30、0.18,P＜0.05).结论 定量CT可以稳定评估脂肪肝,Fat％QCT值与BMI、血糖和中医体质相关.

目的:定量分析9 种单一中医体质的体积骨密度(volume bone mineral density,vBMD)及骨代谢指标差异,为骨量异常的临床管理提供参考.方法:纳入45～80 周岁的健康体检受试者 151 例,采集中医体质、vBMD及骨代谢指标,包括骨钙素(os-teocalcin,OC)、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、25-羟维生素D3[25-hydroxy vitamin D3,25-(OH)D3]、β-胶原降解产物(β-collagen degradation product,β-CTX)、总Ⅰ型胶原氨基端延长肽(total type Ⅰ collagen terminal extension peptide,Total-P1 NP)等.使用倾向性评分匹配控制年龄及性别等混杂因素后,观察 9 种体质不同骨量的分布特点及vBMD、骨代谢指标的定量差异.结果:特禀质组vBMD高于于非特禀质组(P＜0.05);平和质组OC、25-(OH)D3、β-CTX、Total-P1NP低于非平和质组(P＜0.05);阴虚质组iPTH低于非阴虚质组(P＜0.05),Total-P1 NP高于非阴虚质组(P＜0.05);阳虚质组Total-P1 NP高于非阳虚质组(P＜0.05);血瘀质组OC高于非血瘀质组(P＜0.05);特禀质组25-(OH)D3 低于非特禀质组(P＜0.05).相关分析显示:年龄与vBMD呈显著负相关(rs=-0.49,P＜0.001),与 25-(OH)D3 呈显著正相关(rs= 0.31,P＜0.001).结论:平和质、阴虚质、阳虚质、血瘀质及特禀质vBMD及骨代谢指标存在定量差异.

目的 观察千山活血膏穴位贴敷人迎穴治疗颈动脉斑块的有效性及安全性.方法 纳入2019 年9 月—2020 年11 月就诊于北京中医药大学东方医院脑病科门诊的颈动脉斑块患者60 例,采用随机双盲安慰剂平行对照的设计方法将患者分为试验组与对照组各30 例.2 组均口服阿托伐他汀钙片,试验组同时给予千山活血膏贴敷人迎穴,对照组给予千山活血膏安慰剂贴敷人迎穴,2 组均治疗90 d.比较2 组患者治疗后中医证候疗效、单项症状疗效、颈动脉超声指标.结果 试验组27 例,对照组24 例完成研究.中医证候疗效,试验组总有效率为51.9%(14/27),对照组为16.7%(4/24),试验组明显高于对照组(P<0.05).单项症状疗效,试验组头痛的总有效率为75.0%(9/12),对照组为 16.7%(2/12),头晕的总有效率分别为 59.1%(13/22)和 21.1%(4/19),试验组均明显高于对照组(P均<0.05).双侧颈动脉内膜中层厚度(IMT)、右侧颈内动脉血流速度呈现试验组较前降低,对照组较前升高的趋势.2 组均未见严重不良反应.结论 千山活血膏穴位贴敷人迎穴可改善颈动脉斑块患者的症状,有降低双侧颈动脉IMT的趋势,且未发生严重不良反应.

阈下抑郁(SD)是抑郁症的前驱阶段,其发病率高,发展为重症抑郁的机率亦高,严重威胁着人们的身心健康,亟需安全有效的治疗方式.中医"形神合一"的整体观所阐释的形神之间生理、病理关系与SD患者心理悲观抑郁、躯体化症状的反应机制不谋而合,中医认为SD属"郁证"范畴,为形神失调,可将以形调神理论应用于SD的治疗,达到形神和谐的目的 ,文章将总结以形调神的一些方法为治疗SD提供新思路.

目的:探讨836例颈动脉粥样硬化(CAS)患者中医体质分布特点.方法:选取北京中医药大学东方医院体检科体检系统中自2013年1月至2019年12月行颈动脉彩超及中医体质辨识并诊断为CAS的体检者,记录受试者一般情况,分析其中医体质分布情况及其与性别、年龄及各类慢性病的关系.结果:CAS患者体质分布占比为痰湿质＞气虚质＞湿热质＞阳虚质＞阴虚质＞平和质＞特秉质＞气郁质＞血瘀质;本病不同性别与不同年龄的易感体质有所不同,男性湿热质、女性阳虚质、中青年湿热质以及老年痰湿质为本病的易感体质,且年龄越高,血管硬化程度越重;年龄和阳虚质是CAS斑块的独立危险因素;痰湿质患者合并糖尿病及高同型半胱氨酸血症、湿热质和阴虚质患者合并高脂血症的风险均高于其他体质类型(P＜0.05).结论:痰湿质、气虚质、湿热质是CAS的高发体质类型,年龄和阳虚质是CAP的独立危险因素,应在临床中早期纠正偏颇体质防止疾病进一步发展,使中医体质发挥"治未病"效果.

Background: Intractable epilepsy (IE) is still a major concern in neurology, and existing therapies do not adequately control symptoms. Chinese Herbal Medicine (CHM) has been widely used as an adjunct to antiepileptic drugs (AEDs) for IE. However, because of the contradictory findings reported in previous studies, it is uncertain if the present evidence is robust enough to warrant its usage. The purpose of this meta-analysis was to systematically evaluate the efficacy of the combination of CHM and AEDs for IE.Methods: From inception to September 2021, Medline, Ovid, Embase, Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database, and Wanfang Database were searched. Only randomized controlled trials (RCTs) that assessed the efficacy of the combination of CHM and AEDs for IE were included. We defined monthly seizure frequency as the primary outcome. The secondary outcomes included the abnormal rate of electroencephalogram (EEG), seizure duration, quality of life (QoL), and adverse events (AEs).Results: Twenty studies with 1,830 patients were enrolled. Most trials had poor methodological quality. The meta-analysis showed that the combination of CHM and AEDs was more efficient than AEDs alone in reducing monthly seizure frequency [MD = -1.26%, 95% CI (-1.62, -0.91); p < 0.00001], the abnormal rate of EEG [RR = 0.66%, 95% CI (0.53, 0.82); p = 0.0002], and improving the QoL [MD = 6.96%, 95% CI (3.44, 10.49); p = 0.0001]. There was no significant difference in seizure duration between groups. Moreover, the combination of CHM and AEDs significantly reduced the AEs [RR = 0.45%, 95% CI (0.32, 0.64); p < 0.00001].Conclusion: The combination of CHM and AEDs could improve seizure control by reducing monthly seizure frequency and abnormal rate of EEG with a decreased risk of adverse events in patients with IE. However, these findings must be interpreted carefully due to the high or uncertain risk of bias in the included trials. To provide stronger evidence for the use of CHM combined with AEDs in IE, high-quality RCTs will be urgently warranted in the future.

由于现代社会的复杂性,人群心理亚健康和心理疾病的占比激增,囊括全年龄和性别人群,有些甚至合并严重的心身疾病,但是其检出率和知晓率却较低,是我国国民健康的较大隐患.神经心理学从神经科学角度阐释脑、心理与行为的关系,神经心理学量表是研究神经心理学和临床实践的主要工具,其作为识别人群在认知及非认知功能方面异常表现的重要方法,已在临床诊疗中运用多年.健康体检是人们进行健康评估的有效方法,健康包含身体健康、心理健康和良好的社会适应性,将神经心理学量表运用于健康体检,可扩大健康识别的范畴,早期发现心理行为的异常并加以干预,为人群的全面健康做出积极的贡献.

探讨颈动脉斑块的中医病机,可为指导临床治疗提供思路.根据现代医学对颈动脉斑块的认识,结合"虚气留滞"理论对其病机进行探讨,揭示了颈动脉斑块的病机在于元气虚衰,导致气滞、血瘀、痰凝等流动性物质郁滞而阻滞脉络.内皮损伤为颈动脉斑块的始动环节,此阶段以元气亏虚为主,内皮的屏障作用、内分泌作用及功能衰退与元气的功能与衰减规律一致;斑块形成阶段与因元气亏虚而致痰瘀留滞一致,斑块导致的血管狭窄与易损斑块脱落导致脑血管事件与痰瘀阻滞脉络导致中风相符.根据疾病的病机特点,其治则当以培补元气为主,佐以行气化痰、活血通络等,各阶段的病机重点不同,治则也应有所不同.

中医适宜技术是中医药技术的重要组成部分,有着"简、便、廉、验"的特点,长期以来为中医治疗和预防疾病做出卓越贡献.治未病中心承担预防疾病的工作,中医体质辨识是中医治未病的切入点,在治未病中心推广以调理体质为核心的中医适宜技术,并选择有明确临床疗效且便于推广的项目,是中医"治未病"的新思路.

目的 探讨基于中医"治未病"理论的健康管理法干预高同型半胱氨酸血症的临床疗效.方法 自2018年1月-2019年9月,筛选出70例该院收治的高同型半胱氨酸血症患者,随机分为两组,即对照组和干预组,各35例,对照组给予常规西医治疗,干预组在对照组的基础上加用基于中医"治未病"理论的健康管理法进行治疗,疗程均为3个月.观察两组患者中医症状积分、治疗前后患者血同型半胱氨酸指标改善情况,并比较两组临床疗效.结果 对比治疗前后两组中医症状积分变化情况,相较对照组,治疗组患者症状积分降低幅度更大,结果差异有统计学意义(P＜0.05);治疗后,两组血同型半胱氨酸指标均有改善(P＜0.05),且较对照组,干预组改善更显著(P＜0.05);治疗后,干预组临床总有效率为94.29％(33/35),对照组临床总有效率为82.86％(29/35),干预组治疗效果更理想(P＜0.05).结论 基于中医"治未病"理论的健康管理法可显著消除高同型半胱氨酸血症患者临床症状和体征,降低血同型半胱氨酸指标,提高临床疗效,对多种疾病的预防均有意义,值得临床应用.

侧重治疗的疾病医学正向侧重预防、防治一体的健康医学转变,中医治未病尤显重要.作为中医治未病的重要适宜技术之一,刺络放血疗法历史悠久、理论体系完备、疗效确切,机制不断得到明确,不仅在疾病治疗中应用广泛,而且在疾病早期整体预防的调理体质、疏通经络等中医治未病领域也得到拓展性应用,且绿色无毒,无明显不良反应.科学认识、系统研究、挖掘提高、普及推广该疗法在中医治未病中的应用,可望对推动中医经络医学发展与健康促进、疾病预防发挥重要作用.

胸痹是临床常见症状,西医属冠心病范畴,是严重威胁人们身体健康的高发病率疾病.北京中医药大学陶晓华教授依据多年临床经验,总结出本病阳虚寒凝、痰浊阻滞、痰瘀互结的病机特点,化裁经典方剂,运用温阳化痰、宽胸散结、益气养阴、活血行气之法,组成加味瓜蒌薤白半夏汤,用于治疗本病,临床效果颇佳.本研究从病因病机、治疗思路、治法方药及验案举隅等方面,总结陶师的经验.

头痛是临床常见症状,其中偏头痛占比最高.偏痛汤1号是陶晓华治疗偏头痛系列协定方之一,针对本病风痰互结、瘀浊内阻、清阳失布的病机特点,运用祛风解痉、理气化痰、通络止痛的方法治疗.本文就本方的组方用药进行分析,总结陶晓华的用药经验及临床思路.

颈源性失眠是由于颈部疾患使交感神经受刺激,大脑兴奋性增高造成睡眠时间不足或睡眠不深的病症.可导致觉醒-睡眠中枢系统功能障碍,使大脑中枢的兴奋性增高或影响下丘脑的功能,同时可导致肩颈、背部的疼痛,疼痛的严重程度与睡眠障碍存在相关性[1].研究[2]发现,颈椎病中颈源性失眠发生率约为 40％～56％,其发病率很高,严重影响人们的生活和工作,对颈源性失眠进行及时有效的干预,将能显著提高人们的生活质量.笔者采用脊柱综合调理法治疗颈源性失眠 40 例,现报道如下.

体检中心的主要职责是对人群进行健康风险筛查及评估,部分受检者可通过体检发现体内的高危风险,规范体检中心各项检查的危急值数据指标,建立合理可行的危急值上报及回访流程,对高风险受检者进行及时的临床诊治,有利于预防重大疾病的发生.北京中医药大学东方医院体检中心依托于三甲医院的检验检查科室,技术力量雄厚,多年来总结出一系列健康体检所适用的危急值指标,包括实验室、影像学、心电图等检查项目的高危数值或报告,可及时发现重大疾病,突出体检的预防疾病优势,也是体检中心专业能力和优质服务的体现.

同型半胱氨酸是多种慢性血管性疾病的独立危险因素,体内同型半胱氨酸含量越高,患血管性疾病的风险越大.中医体质学指出偏颇体质是疾病发生的内在因素,通过中医健康管理法给予患者体检、健康教育、药物等,纠正偏颇体质,降低血中同型半胱氨酸浓度,对预防慢性血管性疾病有重要意义.

目的 探讨甘草查尔酮A(LCA)对双氧水(H2 O2)诱导的心肌细胞损伤的保护作用及其机制.方法将原代培养的乳鼠心肌细胞随机分为空白组、模型组(H2 O2)、LCA低剂量组(10μmol/L)、LCA中剂量组(20μmol/L)、LCA高剂量组(40μmol/L).经LCA给药4 h后,与100μM的H2 O2共孵育24 h后检测细胞存活率,乳酸脱氢酶(LDH),脂质过氧化物丙二醛(MDA),活性氧自由基(ROS),Na+-K+-ATP酶,Ca2+-ATP酶活性,同时检测过氧化物酶体增殖子活化受体γ(PPARγ),核因子E2相关因子2(Nrf2),和血红素加氧酶-1(HO-1)mRNA的表达情况.结果LCA对H2O2所致心肌细胞损伤模型有保护作用,可抑制脂质过氧化MDA,ROS的生成,抑制Na+-K+-ATP酶活性,升高Ca2+-ATP酶活性,上调PPARγ,Nrf2和HO-1 mRNA表达(P<0.05,P<0.01).结论甘草查尔酮A对H2 O2所致心肌细胞损伤有显著保护作用,且其作用机制可能与激活PPARγ/Nrf2/HO-1通路,缓解线粒体氧化应激有关.

Objective:To study the constitution improvement and hypotensive effect of TCM early comprehensive intervention onpeople with high-normal blood pressure.Methods:A total of 293 people with high-normal blood pressure who were biased constitution were randomly divided into three groups,99 people in group A received TCM early comprehensive intervention,96 people in group B only received holistic health guidance,98 people in group C without any intervention.The constitution improvement and hypotensive effect was observed after a year.Results:The total effective rate of first biased constitution improvement:group A was better than group B and C (P＜0.05,P＜0.01),there was no significant difference between B and C group.The total effective rate of hypotensive effect:group A was better than group B and C (P＜0.01),group B was better than group C (P＜0.01).Conclusion:The holistic health guidance could effectively reduce high-normal blood pressure,while high early comprehensive intervention could improve the biased constitution reduce blood pressure which was better than holistic health guidance.The combination of TCM early comprehensive intervention and holistic health guidance was a better intervention scheme,which was an appropriate technology to prevent people from high-normal blood pressure,it was effective safety,easy to promote,and expected to radically reduce the incidence of hypertension.

Objective:To analyze the correlation between blood pressure of high-normal blood pressure people and TCM constitution features.Methods:Cross-sectional survey method was used,and 616 high-normal blood pressure people were collected to conduct constitution identification questionnaire,so that qualitative and quantitative data of constitutions can beretrieved for statistical analysis on the correlation between constitutions distribution characteristics blood pressure.Results:Biased constitution was common among high-normal blood pressure people,mostly yang deficiency constitution,dampness-heat constitution and phlegm-wetness constitution.Compound biased constitution was also common with the characteristics of intermingled deficiency and excess,opposition of yin-yang.There was sex and age difference in constitution distribution.Conclusion:High-normal blood pressure is related to a variety of biased constitutions.Regulating biased constitutions should be paid attention in treating high-normal blood pressure,focused on improving yang deficiency constitution,dampness-heat constitution,phlegm-wetness constitution and opposition of yin-yang,gave consideration to compound biased constitution with the characteristics of intermingled deficiency and excess and sex and age differences at the same time,in order to achieve early prevention of hypertension.

目的:观察调体中药方案对乳腺增生病的疗效.方法:乳腺增生病患者90例,中医体质分别属于气虚痰湿复合质、痰温血瘀复合质、阴虚阳虚复合质各30例,每种体质分为对照组和试验组.前者给予体质健康教育,后者加用中药调理方案3个月.结果:试验组体质、证候评分及乳腺腺体厚径等均有所改善,疗效优于对照组.结论:中药调体结合健康教育对乳腺增生病疗效显著,可以作为中医防治乳腺增生等慢性病的新方法.