目的:观察健脾益气汤联合针刺治疗脾气亏虚型慢性腹泻的临床疗效.方法:选取92例脾气亏虚型慢性腹泻患者,按随机数字表法分为研究组和对照组,每组46例.对照组给予蒙脱石散治疗,研究组在对照组基础上给予健脾益气汤联合针刺治疗,2组均连续治疗14d.比较2组临床疗效及治疗前后排便次数、大便性状、尿D-木糖排泄率、尿淀粉酶水平,监测2组血、尿常规及不良反应.结果:研究组临床疗效明显优于对照组(Z=2.070,P=0.041＜ 0.05).治疗后,研究组排便次数明显少于对照组(P＜0.01),大便性状明显优于对照组(P＜0.05),尿D-木糖排泄率、尿淀粉酶水平均明显高于对照组(P＜0.01).2组治疗期间均未出现血、尿常规异常及不良反应.结论:健脾益气汤联合针刺治疗脾气亏虚型慢性腹泻,可有效改善患者的临床症状及胃肠道消化、吸收功能.

目的 探究简化"六字诀"联合体外膈肌起搏在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者肺康复治疗中的应用效果.方法 选取2017年7月-2019年6月浙江中医药大学附属第三医院收治的120例COPD稳定期患者,按照随机数字表法分为4组,A组给予基础治疗,B组在A组基础上给予简化"六字诀"功法训练,C组在A组基础上给予体外膈肌起搏干预,D组在A组基础上给予简化"六字诀"功法训练联合体外膈肌起搏干预,每组30例,各组干预周期均为3个月.对比4组患者中医证候积分、BODE指数、生活质量、半年内急性加重次数.结果 干预后,4组患者中医证候积分[(6.82±1.57)分、(5.26±1.34)分、(5.63 ±1.28)分、(4.52±1.15)分]、生活质量各维度评分及总分[(44.21±9.07)分、(37.91 ±8.65)分、(39.92±7.83)分、(32.42±8.26)分]、半年内急性加重次数[(4.25±1.26)次、(3.32±0.87)次、(3.86±1.03)次、(2.62±0.79)次]等指标均较干预前降低,D组明显低于A、B、C组,差异有统计学意义(P＜0.05);干预后4组BODE指数均较干预前下降,D组BODE指数[(4.21±1.04)分]均低于A、B、C组[(5.32±1.67)分、(4.84±1.40)分、(5.23±1.35)分],与A、C组比较差异有统计学意义(均P＜0.05).结论 简化"六字诀"联合体外膈肌起搏用于COPD稳定期患者肺康复治疗中可有效缓解患者临床症状,增强肺功能,减少急性发作次数,降低BODE指数,提升生活质量.

目的:探讨益气活血汤(Yiqi Huoxue de-coction)对肺癌细胞恶性生物学行为的抑制作用及其机制.方法:以不同浓度益气活血汤含药血清(5％、10％、15％)处理人肺癌A549细胞,CCK-8(Cell Counting Kit-8)法、Transwell小室实验、流式细胞术、Western blot法和定量逆转录聚合酶链式反应(qRT-PCR)法研究益气活血汤含药血清对细胞增殖、迁移和侵袭能力、细胞凋亡、第10染色体同源丢失性磷酸酶-张力蛋白(phosphatase and tensin homolog deleted on chromosome ten,PTEN)蛋白和miR-21表达的影响.结果:与无药血清组相比较,不同剂量的益气活血汤含药血清处理后,A549细胞存活率降低、迁移和侵袭能力下降;细胞凋亡率上升、细胞内PTEN mRNA及其蛋白表达增加、miR-21表达下降,且10％ 含药血清组的效果最佳.转染miR-21 mimics后,A549细胞中miR-21表达上调,PTEN蛋白表达下调;10％含药血清处理后PTEN蛋白表达上调.结论:益气活血汤可有效抑制人肺癌A549细胞恶性细胞生物学行为,且可能与miR-21/PTEN信号通路的调控有关.

目的 探讨虎杖对慢性阻塞性肺病(COPD)模型大鼠肺组织基质金属蛋白酶-9(MMP-9)及基质金属蛋白酶抑制剂-1(TIMP-1)表达的影响.方法 SD雄性大鼠40只,随机分成正常对照组、COPD模型组、强的松组(6mg/kg)、虎杖组(6g/kg),各10只,相应药物干预28天.选用熏烟和气管内注入脂多糖(LPS)法建立大鼠COPD模型.Real-Time PCR方法检测肺组织MMP-9和TIMP-1表达.结果 与正常对照组[(0.47±0.04)、(0.46±0.04)]比较,COPD模型组[(0.92±0.06)、(1.06±0.03)]、强的松组[(0.60±0.05)、(0.63±0.05)]、虎杖组[(0.86±0.04)、(0.95±0.04)]大鼠MMP-9和TIMP-1表达水平均明显升高(P＜0.05);与COPD模型组相比,强的松组、虎杖组大鼠MMP-9和TIMP-1表达水平均显著降低(P＜0.05).结论 虎杖可降低COPD模型大鼠MMP-9和TIMP-1表达,对肺组织有一定保护作用,这可能与其控制气道炎症及抑制重塑的作用有关.

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)所造成的患者心理精神疾病越来越受到关注[1].研究[2-3]显示,COPD患者中抑郁焦虑的患病率高达50％,是普通人群患病率的3～5倍以上,对COPD合并抑郁患者的诊疗显得尤为重要.近年来,以王琦教授为代表的学者在前人的基础上提出中医体质学说[4],该学说以中医理论为指导,研究人类各种体质类型的生理病理特点,并以此分析疾病的状况、病变性质及发展趋向,从而指导疾病的预防和治疗[5].本文研究COPD合并抑郁症患者的中医体质特征,体质辨识与中医辨证相结合,观察其相关性.现将研究报道如下.

Objective To investigate the clinical effect of Jiawei Bufei decoction on chronic obstructive pulmonary disease (COPD) with depression and its influences on TCM syndrome score,depression status,serum inflammatory factors and immune function.Methods Two hundred and fifty-six cases of COPD with depression patients from January,2015 to June,2016 were randomly divided into two groups,with 128 cases in each group.he control group was treated with conventional western medicine,and the observation group was added with Jiawei Bufei decoction.Before and after treatment,the TCM syndromes scores,depression scores,serum inflammatory factors,and immune function of two groups were detected.And the clinical curative effect was accounted.Results After treatment,the TCM syndrome scores of two groups were significantly reduced(P ＜ 0.05),and the TCM syndrome scores of observation group were significantly lower than those of the control group (P ＜ 0.05).After treatment,HAMA and HAMD of two groups were significantly reduced (P ＜ 0.05),and HAMA and HAMD of observation group were significantly lower than those of control group(P ＜ 0.05).After treatment,TNF-α and IL-6 of two groups were significantly reduced(P ＜ 0.05),and TNF-α and IL-6 of observation group were significantly lower than those of control group (P ＜ 0.05).After treatment,IgM,IgG and IgA levels of two groups were significantly increased(P ＜ 0.05),and IgM,IgG and IgA levels of observation group were significantly higher than those of control group(P ＜ 0.05).The total effective rate of observation group was 89.7％,which was significantly higher than that of control group 77.0％ (P ＜ 0.05).Conclusion Based on routine western medicine treatment,Jiawei Bufei decoction could effectively reduce the serum inflammatory factors,improve immune function and alleviate the clinical symptoms of COPD with depression patients.

Objective To investigate the value of tumor markers CYFRA21-1,CA125,NSE and CEA in the diagnosis and staging of lung cancer.Methods 65 patients with lung cancer diagnosed and treated in our hospital were enrolled as lung cancer group,65 patients with benign lung disease were enrolled as lung benign group,and 65 healthy people were enrolled as control group.The tumor markers [nerve specific enolase (NSE),sugar chain antigens 125 (CA125),cytokeratin 19 fragment (CYFRA21-1),carcinoembryonic antigen (CEA)] levels were collected.The CYFRA21-1,CA125,NSE and CEA levels of pathological types in lung cancer group were collected.The sensitivity,specificity and accuracy of tumor markers alone and combined in the diagnosis of lung cancer were analyzed.Results CYFRA21-1,CA125,NSE and CEA levels of lung cancer group were (15.49 ±4.52) μg/L,(88.80 ± 14.17) μg/L,(43.51 ±9.17) μg/L,(10.87 ± 4.33) μg/L,which were significantly higher than those of benign group [(3.85 ± 1.82) μg/L,(22.16 ± 4.12) μg/L,(12.38 ± 3.44) μg/L,(4.01 ± 1.12) μg/L] (P ＜ 0.05),and significantly higher than those of control group [(1.32 ± 0.52) μg/L,(13.11 ± 1.68) μg/L,(5.19 ± 2.11) μg/L,(1.04 ± 0.54) μg/L] (P ＜0.05).CYFRA21-1,CA125,NSE and CEA levels of benign group were significantly higher than those of control group (P ＜ 0.05).CA125 and CEA levels of adenocarcinoma group were (192.46 ± 9.67) μg/L,(19.15 ± 3.28) μg/L,which were significantly higher than those of squamous cell carcinoma group [(38.86 ± 8.82) μg/L,(7.33 ± 1.78) μg/L] (P ＜ 0.05),and were significantly higher than those of small cell carcinoma group [(41.66 ±8.45) μg/L,(6.21 ± 1.29) μg/L] (P ＜0.05).CYFRA21-1 and NSE levels of adenocarcinoma group were (6.28 ± 1.22) μg/L,(22.85 ±4.19) μg/L,which were significantly lower than those of squamous cell carcinoma group [(26.33 ±6.19) μg/L,(32.65 ±7.12) μg/L] (P ＜0.05),and were significantly lower than those of small cell carcinoma group [(9.25 ± 2.84) μg/L,(89.62 ± 11.37) μg/L] (P ＜ 0.05).The sensitivity and accuracy of combined detection of CYFRA21-1,CA125,NSE and CEA were 91.75％ and 94.87％,which were higher than those of single detection.Conclusion The serum CYFRA21-1,CA125,NSE,CEA levels are abnormally increased in patients with lung cancer.Individual detection can help diagnose lung cancer and pathological type and combined detection can improve the accuracy and sensitivity of early diagnosis of lung cancer.

Objective To investigate the distribution of the TCM constitution types in COPD patients with depression and its relationship with COPD exacerbation,providing evidence for the prevention and treatment of COPD and COPD exacerbation.Methods Five hundred cases COPD with depression patients in outpatient and hospitalization of the Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine and Hangzhou Zhoupu community health service center from June,2014 to December,2016 were selected.Patients were composed by 260 cases male and 240 cases female with age range from 40 to 85.Based on TCM constitution theory,questionnaire was designed and data were collected from 500 patients of COPD with depression to investigate the relationship with COPD exacerbation.Results In all 500 patients,gentleness type patients were 20 cases (4.0％) and biased constitution were 480 cases (96.0％) including 112 cases of Qi asthenia(22.4％),97 cases of phlegm-dampness(19.4％),88 cases of Yang asthenia(17.6％),73 cases of damp-heat(14.6％),42 cases of Yin asthenia,33 cases of blood stasis,24 cases of Qi Stagnation,and 11 cases of special inherited type.Among the nine types of TCM Constitution in COPD patients with depression,Qi asthenia,phlegm-dampness,Yang asthenia and damp-heat were significantly correlated.Conclusion Qi asthenia,phlegm-dampness,Yang asthenia and damp-heat were the predominant constitution types in COPD patients with depression.It conformed to the pathological characteristics of deficiency essence with virtual reality and to provide clinical basis for the practice of "treating disease" in TCM.

Objective To investigate the clinical effect of classic prescriptions Shegan Mahuang decoction on cough after infection patients with wind-cold stay in the lung.Methods Sixty cases of cough after infection patients with wind-cold stay in the lung in our hospital from November,2014 to August,2015 were randomly divided into 2 groups,each 30 cases.The control group was given Fufang Methamidophos Capsule,while the treatment group was given Shegan Mahuang decoction.The clinical TCM syndrome score,Leslie cough quality of life questionnaire(LCQ),symptom improvement time and clinical effect of both groups were analyzed to evaluate the efficacy of Shegan Mahuang decoction.The inflammatory factors (TNF-α,IL-4),inflammatory mediators [substance P(SP) and neurokinin A (NKA)] in sputum of both groups were analyzed.Results Mter the treatment,the TCM syndrome score of the two groups were significantly reduced (P ＜ 0.05),and the TCM syndrome score of the treatment group was significantly lower than that in the control group(P ＜ 0.05).After the treatment,the LCQ indicators of the two groups were significantly increased(P ＜0.05),and the LCQ indicators of the treatment group was significantly higher than that in the control group (P ＜ 0.05).After the treatment,symptom onset time and symptom disappearance time of the treatment group were significantly lower than that in the control group(P ＜0.05).The total effective rate of the treatment group was 93.3％,which was significantly higher than 76.7％ in the control group (P ＜ 0.05).After the treatment,the TNF-α and IL-4 levels of the two groups were significantly reduced (P ＜0.05),and the TNF-α and IL-4 levels of the treatment group was significantly lower than those in the control group(P ＜0.05).After the treatment,the SP and NKA levels of the two groups were significantly reduced (P ＜ 0.05),and the SP and NKA levels of the treatment group was significantly lower than those in the control group(P ＜ 0.05).Conclusion Shegan Mahuang decoction could effectively improve the clinical symptoms and life quality of cough after infection patients with wind-cold stay in the lung,and its treatment mechanism might be related to the improvement of airway neurogenic inflammation.

目的 探讨穴位埋线结合适时御邪方案对慢性阻塞性肺疾病(COPD)稳定期患者免疫功能及运动耐量的影响.方法 将2015年5月—2016年5月就诊的COPD稳定期患者160例采用随机数字法分为2组,每组80例.对照组给予西医常规治疗,观察组加用穴位埋线结合适时御邪方案.对2组患者免疫球蛋白(IgA、IgG、IgM)、T细胞亚群(CD3+、CD4+、CD8+)、运动耐量(6 min步行距离、血乳酸浓度、PO2)、中医证候积分进行观察.结果 治疗后,2组患者IgA、IgG、IgM水平明显升高(P＜0.05),且观察组IgA、IgG、IgM水平明显高于对照组(P＜0.05).治疗后,2组CD3+、CD4+明显升高(P＜0.05),CD8+明显减少(P＜0.05),且观察组变化明显优于对照组(P＜0.05).治疗后,观察组6 min步行距离显著高于对照组(P＜0.05).治疗后,观察组PO2、血乳酸水平变化明显优于对照组(P＜0.05).治疗后,2组中医证候积分显著降低(P＜0.05),且观察组中医证候积分明显低于对照组(P＜0.05).结论 在常规西医基础上,穴位埋线结合适时御邪方案可显著改善COPD稳定期患者免疫功能、运动耐量及临床症状.

Objective According to the"Treat Lung and Colon Together"theory, we developed prescriptions for the treatment of lung, colon and both, respectively. This study aimed to observe the effectof these prescriptions on the level of metalloproteinase-9 (MMP-9), TIMP-1 (metallopeptidase inhibitor 1) and the ratio of MMP-9/TIMP-1 in lung tissue of rats with acute lung injury and to explore the underlying mechanism. Methods Fifty SD male rats were randomly divided into 5 groups with 10 in each group: sham operation group, model group, lung treat-ment group, colon treatment group, lung and colon treatment group. Cecal ligation and puncture (CLP) was used to generate sepsis in rats in all groups except sham operation group; the level of MMP-9 and TIMP-1 and the ratio of MMP-9/TIMP-1 in lung tissue and lung wet/dry weight ratio (W/D) were observed in 24h after CLP. Results Compared with sham operation group, the W/D ratio was increased in model group and lung, colon or lung and colon treatment groups (P<0.01); compared with the model group, the W/D ratio was decreasedin lung, colon or lung and colon treatment groups (P<0.01 or P<0.05). Compared with sham operation group, the level of MMP-9 and TIMP-1 wasregulated and the ration of TIMP-1/MMP-9 was decreased in treatment groups(P<0.01 or P<0.05);compared with model group, lung, colon or lung and colon treatment groups had lower levels of MMP-9 (12.56±0.76, 12.50±0.98, 10.50±0.71 vs 14.80±0.59) and TIMP-1(14.10±1.12, 14.30±1.30, 10.90±0.53 vs 17.70±1.06) and higher ration of TIMP-1/MMP-9(0.91±0.04, 0.90±0.04, 0.98±0.03 vs 0.84±0.03), with all P<0.05. Conclusion The prescriptions from the "Treat Lung and Colon Together" theory can reduce the level of MMP-9 and decrease TIMP-1 in rats with sepsis, which is benefit to ameliorating lung injury. The effect is more prominent in lung and colon treatment group.

Objective To investigate the mechanism of acute pulmonary injury in sepsis rats. Methods Colon ligation perforation was applied to rats to establish sepsis model. Forty-eight healthy adult male SD rats were ran-domly divided into sham group and sepsis group(n=24 in each group). At 3, 12, 24h after surgery, every 8 rats in each group were sacrificed to obtain lung tissue for determination of xanthine oxidase(XO), malonaldehyde(MDA), superoxide dismutase(SOD), and glutathione peroxidase(GSH-Px). Pathological changes of lung tissue was observed with light microscopy. Results At 3, 12, 24h after surgery in sham group, XO were 2.4±0.3U/g, 2.3±0.5U/g, and 2.4±0.4U/g, MDA were 15.7±2.7nmol/mg, 15.2±2.9nmol/mg, 15.6±2.6nmol/mg, SOD were 58.8±8.0U/mg, 58.1±10.1U/mg, 58.7±9.5U/mg, and GSH-Px were 33.2±5.4U/mg, 32.5±7.0U/mg, 33.1±6.3U/mg; in sepsis group, XO were 4.2±0.6U/g, 5.5±0.7U/g, and 5.7±0.5U/g, MDA were 29.3±5.7nmol/mg, 36.3±6.6nmol/mg, 41.4±7.3nmol/mg, SOD were 43.3±7.0U/mg, 41.8±6.9U/mg, 38.2±7.4U/mg, and GSH-Px were 27.9±4.0U/mg, 26.4±3.9U/mg, 24.3±3.3U/mg. Com-pared with sham group, the concentration of XO and MDA were significantly increased and SOD and GSH-Px were significantly decreased in sepsis group(P<0.01). Conclusion Sepsis rats suffer from acute pulmonary injury, which may be related to oxidative stress.

Objective To Explore the influence of Fanggan decoction on TNF alpha and IL-6 in the mice infected by influenza a virus (H1N1),to learn more about Fanggan decoction curative effect mechanism. Methods Choose clean level 96 male ICR mice,were randomly divided into 4 groups:normal control group,model control group,Chinese medicine in Chinese medicine dosage group and positive control group. Sense of Chinese traditional medicine group to prevent decoction medium dose to fill the stomach,positive control group to tamiflu lavage,normal control group and model control group with saline lavage. In for 3 days with the flu virus droplets nasal H1N1 virus infection of animal model is set up. In building 1,5,9,13 days after the random death 6 mice in each group,the serum and lung tissue collection,TNF alpha and IL-6,such as secretion and function. Results 1,Fanggan decoction group is better than the model group in general condition of mice. 2,Fanggan Decoction group had lower H1N1 virus content in lung tissue of mice than those in the model group (P<0. 05). 3,drug intervention group mice blood serum tumor necrosis factor (TNF alpha),IL -6,level significantly decreased,compared with the model group had significant difference (P<0. 01). Conclusion Fanggan decoction can depress the replication of the H1NI virus,depress expression of cytokines TNF-α,IL-6,thereby reducing the excessive release of inflammatory mediators by immune pathological injury caused by inflammation,thus Fanggan decoction can regulate the immune function and improve symptoms.