系统查阅和整理国内外相关文献资料,总结复发性流产的病因病机,尤以肾虚血瘀型为主.分析补肾活血化瘀法治疗复发性流产的作用机制,其作用机制主要涉及改善血栓前状态、改善子宫动脉血流、改善免疫功能、提高抗心磷脂抗体转阴率、改善血管内皮功能、改善子宫内膜容受性等方面.

非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是因机体代谢紊乱导致肝细胞脂肪变性、肝损伤的一种应激性代谢性疾病,发病率逐年升高,然而因缺乏一致性证据,迄今仍然难以明确安全有效的药物治疗方案.自噬是依赖于溶酶体功能的细胞内降解循环过程,通过降解、回收利用衰老或损伤的细胞器或蛋白等生物大分子来应对生存压力,维持细胞稳态.依据底物进入溶酶体方式,分为巨自噬、分子伴侣介导的自噬和微自噬.近年来研究表明自噬在NAFLD的发生发展病理过程中发挥重要作用,不仅影响肝细胞脂质积聚,还与胰岛素敏感性、肝细胞损伤、肝脏炎症等相关.抑制自噬促进了NAFLD的发生发展,提示促进自噬可望作为治疗NAFLD的方法,为NAFLD治疗提供新思路.随着研究进展,发现一些改善NAFLD的药物具有调节自噬的作用,包括传统西药、中药复方及中药材中提取的天然单体,可作为治疗NAFLD的药物的研发基础.

Objective To investigate the constitutional stypes in patients with non - alcoholic steatohepatitis in ShangHai ,and to provide some theoretical basic for preventing and treating non - alcoholic steatohepati‐tis by Chinese medicine .Methods There were 450 NASH cases categorized by questionnaires ,and investi‐gated its correlations with BMI ,WHR ,blood lipids and serological indexes .Results Among the 450 pa‐tients ,the cases of qi - deficiency type were 116 (25 .78% ) ,of yin - deficiency type 114 (25 .33% ) ,of phlegm - damp type 162(36% ) and of qi - stagnation type 98(23 .79% ) ,including single constitution and varied constitution .And the BMI had a significant positive relation with serum aminotransferase (ALT ) level(r= 0 .101) ,there was also a relationship between triglyceride levels and cholesterol levels .The re‐sults showed that ,as the WHR increased , the triglyceride level was decreased ,and the occurrence of NASH was strongly related to WHR .Conclusion The main constitutions of 450 NASH patients are phlegm - damp type ,qi - deficiency type ,yin - deficiency type and qi stagnation type in which varied con‐stitution takes account for some proportion .

Objective:To observe the curative effect of the traditional Chinese medicine or western medicine treatment combined behav-ioral intervention in treatment of abnormal glucose metabolism in non-alcoholic fatty liver.Methods: One hundred and nineteen patients with abnormal glucose metabolism in nonalcoholic fatty liver were randomly divided into behavioral intervention group (group A), pioglitazone group (group B), traditional Chinese medicine group (group C), were treated for 16 weeks.blood glucose levels, blood lipids, liver enzyme levels were observed before and after treatment.Results:Only HbA1c glucose levels were significantly decreased in Group A (P <0.05), FBG, 2hBG, HbA1c were statistically significantly decreased in group B and group C (P <0.05);Only HDL-c in group B had decreased sta-tistically significant ( P<0.05), only HDL-c decrease in group C was not statistically significant (P >0.05); liver enzymes to improve in the three groups were statistically significant (P <0.05).The decrease of lipids,2hBG and ALT in three groups was significant (P <0.05). The decrease of blood glucose levels in group B compared with in group A group A were significant (P <0.05); liver enzymes, TG in group C compared with group A decreased significantly (P <0.05); TC decrease in group C compared with group B was statistically significant (P<0.05).Conclusion: The behavioral intervention, pioglitazone and traditional Chinese medicine can be effective in improving glucose metab-olism in NAFLD,liver fat content and the liver enzyme; Traditional Chinese medicine compound is better than the other two groups in im-provement of blood lipid spectrum.

Objective: To investigate the therapeutic efficacy of Sanqi Lixuezhigan recipe in the rat model of non -alcoholic fatty liver ( NAFL) , as well as the underlying mechanism.Methods: Thirty-six male Wistar rats were randomly divided into normal control group ( C) , model group ( M) and Sanqi Lixuezhigan recipe group ( Y) .The rats of control group was fed with normal diet, M group and Y group with high-fat diet for 8 weeks, and from the fifth week rats of Y group were also administrated with Sanqi Lixuezhigan recipe once a day.Serum alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , triglycer-ides ( TG) , total cholesterol ( TC) , LDL-C, HDL-C, FFA and FBG were measured.Liver histopathology was observed through hematoxylin-eosin staining (HE stain) and oil red O staining.Liver TG and TC were also determined.In addition, the protein expression of liver CYP2E1 and UCP2 was detected by Western blot.Results: Serum ALT and LDL-C in the model rat increased obviously , while impaired again in the rat of Sanqi Lixuezhigan recipe treatment group.In the liver of M group , diffusing hepatic steatosis was observed in liver lobules , and the liver TG and TC level increased dramatically.Compared with model , less area and extent of steatosis were found in the rat liver of Y group.And serum FFA content also decreased in Y group.Western blot showed up-regulated expression of CYP2E1 and down-regulated expression of UCP2 in the liver of M group, while their expression tended to the normal levels in the liver tissue of treatment group.Conclusion: Sanqi Lixuezhigan recipe can effectively improve non-alcoholic fatty liver in the high fat diet induced rat model.The lipid-lowering and blood-regulating function for this complex recipe may enable it to ameliorate liver lipid accumulation and liver injury through inhibiting oxidative stress and improve lipid metabolism.

目的:探讨降脂颗粒是否对小鼠非酒精性脂肪性肝炎(NASH)有治疗作用及其机制.方法:利用蛋氨酸-胆碱缺乏(MCD)饲料饲养C57B L/6小鼠6周,建立NASH模型,药物组同时予以降脂颗粒干预.肝组织HE染色观察病理性变化,检测血清转氨酶以明确肝功能情况,并检测血清抵抗素水平及肝组织核因子-κB(NF-κB)表达水平.结果:MCD饮食模型小鼠出现肝脏严重脂肪变性和炎症坏死,血清转氨酶显著升高(P＜0.01).降脂颗粒组小鼠肝组织的脂质沉积明显减轻,炎性细胞浸润和坏死灶较少,血清转氨酶AST较模型组下调(P＜0.05).模型组小鼠血清中抵抗素含量较正常组小鼠明显升高(P＜0.05),降脂颗粒组较模型组其含量显著下调(P＜0.01).NF-κB表达在模型组升高(P＜0.05),在降脂颗粒组被改善(P＜0.05).结论:降脂颗粒可有效改善MCD饮食诱导的小鼠NASH病理损伤,对脂肪性细胞因子抵抗素及其相关分子的调节是其药效作用靶点之一.

Objective:To observe the the clinical efficacy with acupuncture point plaster therapy combining traditional Chinese medicine for treating liver depression and spleen deficiency type of patients with non-alcoholic steatohepatitis(NASH) and to evaluate quality of life of patients.Methods:Seventy-two patients with NASH were randomized into 2 groups.Combined treatment group with the acu-point plaster therapy and Chinese medicine treatment for 12 weeks;control group based on drug treatment for 12 weeks.Symptoms and signs such as body mass index,biochemical,imaging targets and changes in quality of life scale were observed before and after treatment.Results:After 12 weeks of treatment,the treatment group NASH clinical main symptoms and signs,including flank pain,weakness,bitter taste in the mouth were significantly improved;body mass index decreased significantly,down from 26.04 ± 2.03 to 23.62 ± 2.05,compared with the treatment,the difference was statistically significant(P0.05);serum biochemical parameters ALT,γ-GT,TC,TG than those before treatment significantly decreased,the difference was significant(P0.01 or P0.05);control group ALT,TG significantly decreased compared with before treatment,the difference was significant(P0.05).Ultrasound improvement rate in treatment group was 61.11%,control group 38.89%,difference between groups was significantly(P0.05);physiological function,bodily pain,vitality and mental health were significantly increased compared with control group and the difference was statistically significant(P0.05).Acu-point plaster therapy and Chinese medicine treatment could improve patient quality of life.Conclusion:The acu-point plaster therapy combined with traditional Chinese treatment of NASH is clinical efficacy,and can improve patient quality of life,safety,and is worth promoting in treatment programs.