Background: Primary Sjögren’s Syndrome (pSS) is an autoimmune disease, for which Traditional Chinese Medicine has shown significant therapeutic effects based on different syndrome types of Sjögren’s Syndrome. However, the research findings between it and related plant extracts are limited. Objective: To explore the symptoms of patients with yin deficiency syndrome and non-yin deficiency syndrome of Sjögren’s Syndrome and their relationship with plant extracts under the background of Traditional Chinese Medicine. Methods: Whole blood samples were collected from SS patients with yin deficiency syndrome (5), SS patients without yin deficiency syndrome (5), and healthy volunteers (5) for proteomic testing. Using healthy volunteers as the control group, the differential protein expression of SS with yin deficiency syndrome was screened for enrichment analysis and functional annotation; combining previous effective clinical cases and prescription drugs for data mining and network pharmacological analysis, potential effective plant extracts were screened and enriched. Finally, molecular docking was used to validate the results of network analysis, providing a highly probable new idea for the correlation between potential drug targets for SS patients with yin deficiency syndrome and potential effective plant extracts. Results: 1. By analyzing the proteomic data of clinical samples, the differential genes of healthy individuals versus Sjögren’s Syndrome with yin deficiency versus Sjögren’s Syndrome without yin deficiency were discovered. By overlapping the above data, it was found that the key target genes for treating Sjögren’s Syndrome are HBA1, MST1, PCSK9, and HBB. 2. Enrichment analysis of plant extracts (PE) through clinical data mining of effective cases revealed the tremendous potential of four Chinese botanical drug - β-sitosterol, quercetin, berberine, and kaempferol in treating Sjögren’s Syndrome patients with yin deficiency syndrome. 3. The pathogenesis and regulation of Sjögren’s Syndrome with yin deficiency syndrome may be related to interleukin-related pathways, DNA synthesis, and oxidative stress. 4. Molecular docking suggests that berberine has good binding activity with MST1. Conclusion: We believe that berberine and MST1 may have significant research value in the treatment of Sjögren’s Syndrome with Female Patients. This study provides valuable reference points for future research on Sjögren’s Syndrome with yin deficiency syndrome.

AIM:The aim of the study was to observe the effect of acupuncture on regulating interleukin (IL)-17, tumor necrosis factor (TNF)-ɑ, and aquaporins (AQPs) in Sjögren's syndrome (SS) on patients and on non-obese diabetic (NOD) models.METHODS:Levels of anti-AQP 1, 5, 8, and 9 antibodies, IL-17, and TNF-ɑ in the serum of SS patients were compared prior and following 20 acupuncture treatment visits during 8 weeks. While in murine model, five groups were divided to receive interventions for 4 weeks, including control, model, acupuncture, isoflurane, and hydroxychloroquine. The submaxillofacial gland index, histology, immunohistochemistry of AQP1, 5, salivary flow, together with IL-17, and TNF-ɑ expression in peripheral blood were compared among the groups.RESULTS:Acupuncture reduced IL-17, TNF-ɑ, and immunoglobin A levels, and numeric analog scale of dryness in 14 patients with SS (p < 0.05). The salivary flow was increased, and the water intake decreased in NOD mice receiving acupuncture treatments. IL-17 and TNF-ɑ levels in peripheral serum were down-regulated (p < 0.05) and AQP1, 5 expression in the submandibular glands up-regulated in mice.CONCLUSION:The effect on relieving xerostomia with acupuncture may be achieved by up-regulating the expression of AQP1. AQP5, down-regulating levels of IL-17 and TNF-ɑ, and a decrease in inflammation of glands.

This study explored similarities and differences among Chinese patients and rheumatologists in their attitudes towards and perceptions of traditional Chinese medicine (TCM) for Sjögren’s syndrome (SS), including analyzing factors that influenced their decision making. An anonymous questionnaire was used to conduct a multicenter survey among patients with SS at three tertiary care medical centers in Beijing and among rheumatology clinicians at several hospitals across China. Results were analyzed using descriptive statistics. There were 942 valid questionnaires from patients from 31 provinces and cities in China, with a male-to-female ratio of approximately 1:14, a mean age of 48.81 years, and a median disease duration of 7 (4, 10) years. There were 320 valid questionnaires from rheumatologists, covering 30 provinces and cities in China, with a male-to-female ratio of approximately 0.87:1, a mean age of 48 years, and a median work duration of 10.5 (6, 15) years. The rheumatologists treated a median of 15 (11, 50) SS cases per month, and the median proportion of SS to all rheumatic diseases was 6.66

干燥综合征是临床难治性疾病,其病变关键在于腺体损伤,与中医络脉不畅理论相通.腺体损伤是由表入里,由血入络的过程,可通过病理和影像两个方面诠释.姜泉教授通过对古籍的拓展,联合现代研究,并结合自身临床经验,凝练出红藤治疗干燥综合征腺体损伤的独特心得,指出其功效为通络祛瘀、清解火热、养阴润燥.此外,本文分享了姜泉教授的红藤相关应用心得,包括其用量特点、红藤经典配伍、经验方"芍藤颗粒"应用方法,并辅以一则典型医案供具体学习.红藤应用于干燥综合征腺体损伤具有重要价值,值得深入研究以改善临床疗效.

通过梳理国内外研究原发性干燥综合征(pSS)在神经、血液、呼吸、消化系统以及唾液腺、泪腺等组织病理变化中有意义的生物标志物,并在此基础上梳理总结pSS在不同病变系统下具有高度敏感、高度特异性及诊断意义的生物标志物,提出pSS诊断生物标志物研究的现有不足以及建议.以期为pSS的诊断前移,高效靶向治疗及改善预后等方面提供有力理论依据,成功构建pSS异质性细化分层下生物标志物诊疗体系.

Takayasu arteritis is a chronic, non-specific inflammatory disease mainly manifested by the involvement of large blood vessels.Professor Jiang Quan believes that this disease belongs to the category of vessel impediment in traditional Chinese medicine（TCM）,and the disease is located in the blood vessel and related to triple energizer.The core pathogenesis is considered to be mutual contention of blood stasis and heat, and the treatment mainly follows the principles of cooling blood, dispersing stasis, activating blood, and promoting qi flow in combination with protecting the spleen and stomach.In clinical practice, Simiao Yongan Decoction is used as the fundamental prescription, where Lonicerae Japonicae Flos, Scrophulariae Radix, and Angelicae Sinensis Radix were predominant, and the pungent drugs for dredging collaterals as well as rattan drugs were well used.

治未病思想起源于《黄帝内经》,是中医学的智慧与优势.文中基于治未病思想,结合风湿免疫病特点,阐述中医药在"未病先防、既病防变、瘥后防复"3个环节,以及日常调护中的应用,思考当前治未病思想在风湿免疫病中的不足之处,为临床工作、科研设计提供思路.

目的 了解中国风湿科临床医生对中医药治疗干燥综合征(SS)的态度,分析中医药应用面临的问题.方法 采用匿名问卷调查的形式,调查参加 2022 年"风云讲坛"的中国风湿科临床医生对中医药治疗SS的态度.结果 发放 347份调查问卷,回收有效问卷 320份,有效回收率为 92.22%.绝大多数医生肯定中医药疗效,希望其缓解SS患者干燥(88.41%)、乏力(68.12%)症状.logistic回归分析显示,具有中医教育背景及工作年限较长者更倾向于推荐中医药治疗SS(P＜0.05).多数医生(65.63%)临床中医药应用比例不足 40%,认为与缺乏中医指南、临床研究太少等有关.结论 中医药的优势和特色使得中国医生高度关注,但指南缺乏、循证依据不足等问题制约了中医药的应用与发展,亟须制订SS中医诊疗指南,加强中医药研究.

目的 探讨清热活血方对胶原诱导关节炎(collagen typeⅡ-induced arthritis,CIA)大鼠miR-140/Toll样受体4(toll-like receptors 4,TLR4)/核因子κB(nuclear factor kappa-B,NF-κB)信号通路的影响.方法 6周龄SPF级大鼠24只,随机分为正常组、模型组、甲氨蝶呤组(0.2 mg/kg)、清热活血方组(34 g/kg),每组6只,通过对大鼠尾根部注射Ⅱ型胶原乳剂构建类风湿关节炎动物模型,连续给药6周.连续监测大鼠关节肿胀程度,Elisa法测血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素1β(interleukin 1β,IL-1β)、IL-6含量白细胞介素6(interleukin 6,IL-6),TRAP染色观察破骨细胞(osteoclast,OC)数量,Western blot法检测大鼠骨组织中TLR4、NF-κB的蛋白表达,实时荧光定量PCR检测大鼠骨组织中miR-140、TLR4、NF-κB的mRNA表达.结果 与正常组比较,模型组大鼠造模开始后足趾容积逐渐增加,第21天起逐渐下降.模型组大鼠血清IL-1β、IL-6、TNF-α浓度上升,OC数量明显增多,TLR4、NF-κB的蛋白与mRNA表达增加,miR-140 mRNA表达下降;与模型组比较,甲氨蝶呤组和清热活血方组大鼠血清IL-1β、IL-6、TNF-α浓度下降,OC数量减少,TLR4、NF-κB的蛋白与mRNA表达下降,miR-140 mRNA表达增加;与甲氨蝶呤组比较,清热活血方组大鼠上述指标改善更明显,以上差异均有统计学意义(P<0.05,P<0.01).结论 清热活血方能够干预miR-140/TLR4/NF-κB信号通路,进而调控下游靶点分子,调节OC的成熟分化,从而达到延缓RA骨破坏的作用.

原发性干燥综合征( primary Sjögren's syn-drome,pSS)是一种以外分泌腺受累为主的慢性自身免疫病,临床主要表现为口干、眼干,常伴随并发症和多系统损害,严重威胁患者身心健康和生活质量.我国pSS患病率为0.29％ ～0.77％,且呈逐年上升趋势,其具体发病机制至今不明,限制了临床诊疗方案的制订[1] . 现代医学治疗 pSS 的作用途径已相对明确,能较好地控制疾病活动情况,但在局部症状及病情进展方面尚无高质量证据支持,且不良反应较多. 中医药治疗本病独具优势,可明显改善症状、延缓进展,奏身心同治之功,安全性亦能兼顾. 以往证据显示,T淋巴细胞亚群可通过分泌细胞因子、诱导B细胞活化等方式,导致机体免疫功能失调,参与pSS的发生发展[2] . 本病属中医"燥痹"范畴,燥毒血瘀与正虚交杂,祛邪扶正可明显改善患者免疫功能[3] . 本文拟基于T淋巴细胞亚群探析中医药治疗pSS的研究进展,为后续诊疗研究提供新的思路.

Notch信号通路在细胞发育、分化、凋亡等方面扮演重要角色，对免疫疾病也发挥广泛的调控作用。类风湿关节炎（rheumatoid arthritis，RA）的病理特征包括滑膜炎和血管翳，反复发作的活动性RA，可致成、破骨细胞失衡，形成骨破坏。研究发现Notch信号在活动性RA中影响滑膜样成纤维细胞增殖与迁移、巨噬细胞释放炎症因子、血管新生、骨破坏等多项病理环节，是RA治疗的重要靶点。综述近二十年Notch信号通路在活动性RA中的作用研究进展。

目的:观察复方雷公藤外敷剂对Ⅱ型胶原诱导型关节炎模型大鼠的骨形态学影响,探讨其可能的作用机制.方法:将50只雌性SD大鼠随机分为正常组(NOR组)、模型组(CIA组)、复方雷公藤外敷剂组(TWE组)、雷公藤多苷组(TWG组)、扶他林乳胶剂组(VOT组),每组10只.除NOR组外,对其余大鼠进行尾根部皮下注射Ⅱ型胶原诱导,7 d后加强免疫造模.TWE组以0.60 g/(kg·d)外用、TWG组6.25 mg/(kg·d)灌胃、VOT组乳胶剂0.016 mL/(kg·d)外用,NOR组与CIA组以生理盐水涂抹膝踝关节,连续给药28d.观察大鼠一般状态、双下肢肿胀程度;观察各组膝、踝关节病理形态,借助微型计算机断层扫描(micro-CT)观察骨质改变,采用酶联免疫吸附法(ELISA)测定、蛋白免疫印迹法(Western Blot)观察外周血及组织骨破坏与骨保护相关因子与蛋白表达.结果:与NOR组比较,CIA组一般状态不佳,关节炎评分与足趾容积均显著增高,micro-CT显示踝关节、跖趾关节破坏严重,血清MMP1、MMP13、RANKL显著增高,滑膜组织中RANKL/OPG显著升高.与CIA组相比,各治疗组随着给药时间的增加,关节炎评分与足趾容积均有下降,micro-CT显示踝关节、跖趾关节骨表面积/骨体积比值低于模型组,差异有统计学意义(P＜0.05),其中TWE组与VOT组改善最为明显,差异有统计学意义(P＜0.01);各治疗组血清MMP1、MMP13、RANKL、关节组织中RANKL/OPG均低于CIA组.结论:复方雷公藤外敷剂能够改善模型大鼠关节骨破坏,其作用机制可能与降低MMP1、MMP13、RANKL水平,抑制RANKL/OPG,调控骨平衡有关.

目的 了解干燥综合征(SS)患者中医药应用情况及需求,分析影响其选择的决策因素.方法 于2021年5月15日-8月15日对北京市3所三甲医院SS患者进行多中心调查.采取匿名问卷形式,运用描述统计方法进行分析.结果 共发放问卷630份,回收有效问卷626份.626例患者来自全国31个省市,男女比例约1:23,平均年龄50岁,中位病程7(4,10)年.患者中医药应用率为72.20％[95％CI(70.41,73.99)],中医药接纳率为90.26％[95％CI(89.07,91.45)].Logistic回归分析显示,年龄、病程是主要影响因素,40岁以上者应用中医药概率为年轻患者的2～3倍,病程超过4年者应用中医药概率为短病程者的2～15倍(P<0.05).多数患者认为,不良反应小/服用时间长为中医药的优/劣势,希望中医药能够彻底治愈疾病,最期待的疗法是中成药和药茶/代茶饮.结论 中医药在患群的接受度及疗效俱佳,但对疾病认知存在偏差,诊疗体系亟需指南规范.

目的 了解2010—2019年中医风湿免疫国家自然科学基金资助情况,并进行特点分析.方法 在2019年1月至2020年8月登录国家自然科学基金委员会网站"共享服务网"收集2010年1月至2019年12月近10年中医(中医内科和中西医结合)风湿免疫领域获得资助的国家自然科学基金面上项目、青年科学基金项目、地区科学基金项目和重点项目进行分析.结果 显示2010—2019年10年间共资助389项,资助金额16906万元.获得资助项目数靠前的机构分别是浙江、上海、江苏、福建、广东等地的中医药大学.获得两次以上项目资助的单位则以浙江中医药大学(9人,20项)、福建中医药大学(5人,14项)、中国中医科学院广安门医院(6人,13项)、北京中医药大学(5人,11项)、南方医科大学(4人,11项)等为前5位.资助项数排名前6位的病种是类风湿性关节炎、骨关节炎、系统性红斑狼疮、痛风和高尿酸血症、强直性脊柱炎、干燥综合征.结论 国家自然科学基金对中医风湿免疫领域的资助数量和金额不断增多,因部分中医药大学和医院基础深厚、重视学科发展而获得资助项目较多,受资助项目病种并不平衡.

AimWe sought to evaluate the efficacy of acupuncture in treating the main symptoms of primary Sjögren’s syndrome, specifically dryness, pain, and fatigue.MethodsA total of 120 patients with primary Sjögren’s syndrome were randomized in a parallel-group, controlled trial. Participants received acupuncture or sham acupuncture for the first 8 weeks, then were followed for 16 weeks thereafter. The primary outcome was the proportion of participants with a ≥ 30% reduction in ≥ 2 of 3 numeric analog scale scores for dryness, pain, and fatigue. The secondary outcomes included the European League Against Rheumatism (EULAR) Sjögren’s Syndrome Patient-reported Index (ESSPRI); the EULAR Sjögren’s Syndrome Disease Activity Index; the Schirmer test score; unstimulated saliva flow; serum immunoglobulin G, A, and M concentrations; the Medical Outcome Study Short Form 36 score; salivary gland ultrasound imaging; and the Hospital Anxiety and Depression Scale score.ResultsThe proportions of patients meeting the primary endpoint were 28.33% (17/60) in the acupuncture group and 31.66% (19/60) in the sham group, without a statistically significant difference (P = 0.705). The IgG concentration at week 16 and the homogeneity in ultrasonography of the salivary glands at week 8 showed significant differences between the 2 groups (P = 0.0490 and P = 0.0334, respectively). No other differences were observed between the 2 groups. ESSPRI and unstimulated saliva flow were improved in both groups compared to baseline, albeit with a significant difference between them.ConclusionIn patients with primary Sjögren’s syndrome, acupuncture did not satisfactorily improve symptoms compared to placebo. However, interesting discoveries and possible underlying reasons were demonstrated and discussed, which may be useful to studies in the future.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT02691377].

干燥综合征(PSS)病因不明,临床治疗效果不理想,病机复杂.唐晓颇教授继承国医大师路志正的学术思想,临证经验丰富,指出气阴两虚是干燥综合征的核心病机,虚、热、瘀常相兼为病,演变为临床各种复杂的症状.干燥综合征与气阴两虚、瘀血阻滞、热邪均密切相关,且相互之间关系密切,可以相互兼夹转化.本文以此为切入点,探讨PSS的中医病机和西医发病机制,探索其理论相通之处,并以此为依据为临床诊治提供借鉴.

总结路志正教授从阴火论治干燥综合征的临证经验.干燥综合征属中医学"燥痹"范畴,《脾胃论》中所述阴火与燥痹之病机、病症相类似,病机均源于脾肾不足、瘀血内停,在发病中又有"火盛化燥伤阴蕴毒"之特点,虚、燥、瘀、毒四者之间相互影响,互为因果,终成虚实夹杂之证.在《脾胃论》基础上,承其治疗阴火之法,根据燥痹之特性,临证采用"持中健脾、顾护肾精,滋阴养血、生津润燥,行气通络、消瘀解毒"之法,对燥痹辨证施治.

目的 基于国家自然科学基金(NSFC)对干燥综合征(SS)项目的资助情况,分析研究现状及改进方向.方法 搜集NSFC官网及梅斯医学、LetPub、科研者之家数据库2000年1月至2021年12月所有标题、摘要或关键词中包含SS的资助项目,提取项目类型、资助金额、依托单位、负责人、学科代码、关键词、成果转化等信息,运用描述统计方法进行分析.结果 2000-2021年NSFC资助的SS课题88项,包含面上项目、青年科学基金项目、地区科学基金项目和应急管理项目4种类型.2003年SS领域第一次获得NSFC资助,此后资助项目数和经费虽有波动,但总体呈上升趋势.2010-2019年SS资助项目数、金额及成果转化情况均不及类风湿关节炎、系统性红斑狼疮.立项≥3次的11所依托单位中,北京大学的立项数目及经费均居于领先地位.SS课题研究方向广泛,切入角度多样,关键词重复率较低,高频词条为细胞、细胞因子、通路.结论 NSFC资助对SS意义重大,但当前临床需求较大,中医优势未完全体现.后续应注重创新性和多学科交叉,尽快落实指南共识和大数据平台,引领SS临床科研发展.

目的 通过分析2010-2020年国家自然科学基金(NSFC)对系统性红斑狼疮(SLE)相关立项情况,探讨该疾病研究现状.方法 通过NSFC项目查询(V2.0正式版)和LetPub最新科学基金查询系统,全面检索2010-2020年SLE相关项目,对立项项目类别、数量、金额、依托单位等进行回顾性分析.结果 2010-2020年SLE相关项目共计405项,资助金额15 984万元.依托单位以综合类院校和西医院校为主.立项数量前三的一级学科分别是医学免疫学、皮肤及其附属器、泌尿系统.关键词词云图显示,发病、间充质干细胞、微小RNA、信号通路、调节性T细胞为出现频率前5的关键词.结论 NSFC对SLE的资助力度稳定提升,围绕间充质干细胞、RNA组学和信号通路深入SLE发病机制研究,但存在学科交叉程度低、研究动物模型单一和中医药领域研究不足等问题.

干燥综合征合并胃食管反流病在临床上较为常见,现无特效药物治疗.干燥综合征以阴虚津亏为主要病机,胃食管反流病的发生多与食管失濡、胃失和降或肝气(肝火)犯胃、胃气上逆有关.根据二者病因病机,干燥综合征合并胃食管反流病的治疗应"益气养阴、生津润燥"滋养其体,"和胃降逆、疏肝理气"恢复其用,并配合制酸抑酸药物,同时注重生活调摄.附验案1则以佐证.