中医学的基本特点和核心内容是整体观念与辨证论治,已经成为学术界的定论.辨证论治,在诊治疾病的过程中灵活把握患者体质、疾病阶段性特征等信息,擅者可精细入微,法随证立,方从法出,是取得临床疗效的关键,也是中医学的优势方法所在.

BACKGROUNDLiver fibrosis is the early pathological manifestation of various chronic liver diseases (including schistosomiasis, alcoholic, viral, nonalcoholic, fatty liver, etc.), which can progress to cirrhosis and even liver cancer. Out of the 7.7 billion world population, approximately 2 billion individuals have evidence of hepatitis B virus (HBV) infection; of these, 350 to 400 million suffer from chronic HBV infection, accounting for about 5% of the global population. The global prevalence of hepatitis C is 3%. These figures indicate that liver fibrosis is quite common.METHODS98 patients with liver fibrosis were included in this study. The serum chitinase-3 Like Protein-1 (CHI3L1) level was measured by the double antibody Sandwich ELISA method.RESULTSSerum levels of CHI3L1 were significantly different between no-fibrosis and fibrosis groups (P < 0.01). There was a strong correlation between the levels of CHI3L1, elastometry, hyaluronan, CIV (P < 0.01) and age and sex, TBIL, DBIL, ALB, AST, ALT, GGT, ALP, PLT, LN, PIINP, FIB-4, and APRI (P < 0.05). The expression of CHI3L1 was different from fibrosis grades S1, S3, and S4 (P < 0.05, P < 0.001). The expression of CHI3L1 was significantly different between F1 and F4 (P < 0.05). Serum CHI3L1 expression level can be a valuable metric for diagnosing liver fibrosis, with an AUC value of 0.812. Out of the 98 patients who had undergone liver puncture, 79 patients (30.38%) had ALT ≤ 2ULN.CONCLUSIONSThe expression level of serum CHI3L1 was significantly higher in patients with liver fibrosis than that in patients without liver fibrosis. The expression levels of serum CHI3L1 were different in different grades of liver fibrosis and increased with the severity of liver fibrosis. Serum CHI3L1 can distinguish early stage (S1) of liver fibrosis from late stage (S3-4) of liver fibrosis. Serum CHI3L1 combined with HA is even more effective in the diagnosis of S2-4 hepatic fibrosis. The diagnostic efficacy of serum CHI3L1 in patients with ALT ≤ 2ULN was better than that of the other non-invasive diagnostic models.

目的 探讨HBV相关性肝癌患者血清中BRM相关长链非编码RNA(lncBRM)的表达及临床诊断价值.方法 选取2019年2月至2020年1月杭州市西溪医院收治的HBV相关性肝癌患者57例作为研究对象(肝癌组),另选取在杭州市西溪医院体检的年龄相仿的健康体检者20例作为健康对照组.采用qRT-PCR法检测两组受试者血清中lncBRM表达水平并作比较,分析血清中lncBRM表达水平与患者临床病理特征的关系.采用ROC曲线评估血清中lncBRM表达水平诊断HBV相关性肝癌的效能.结果 肝癌组患者血清中lncBRM表达水平为[1.03(0.44,2.07)]×10-4,明显高于健康对照组的[0.02(0.00,0.06)]×10-4,差异有统计学意义(P<0.01).TNM分期为III～IV期、有癌栓形成、有血管侵犯、肿瘤直径>5 cm的HBV相关性肝癌患者血清lncBRM表达水平分别高于TNM分期为I～II、无癌栓形成、无血管侵犯、肿瘤直径≤5 cm的患者,差异均有统计学意义(均P<0.05).ROC曲线显示血清lncBRM表达水平诊断HBV相关性肝癌患者的灵敏度和特异度分别为0.982和0.950.结论 HBV相关性肝癌患者血清中lncBRM高表达,对HBV相关性肝癌的临床诊断有一定价值.

目的:探讨lncRNA HOTAIR在肝癌患者血清中的表达及其临床诊断意义.方法:采用qRT-PCR法检测61例原发性肝癌(PLC)患者、20例肝硬化患者及20例健康体检者的血清lncRNA HOTAIR表达水平,并分析其与患者临床病理特征关系及肝癌诊断价值.结果:PLC患者血清lncRNA HOTAIR表达量高于肝硬化组和健康对照组(P<0.05).PLC患者血清lncRNA HOTAIR表达量与TNM分期、Child-Pugh肝功能分级标准、肝外转移、血管侵犯、癌栓形成、肿瘤大小有关(P<0.05).ROC分析结果显示血清lncRNA HOTAIR表达量诊断肝癌的AUC、敏感度和特异性分别为0.991、95.7％、95.0％;预测TNM分期的AUC、敏感度和特异性分别为0.708、78.3％、60.5％(P<0.001).结论:PLC患者血清lncRNA HOTAIR明显高于肝硬化组与健康组,lncRNA HOTAIR高表达PLC患者恶性程度高、肿瘤直径大、肝功能差,且lncRNA HOTAIR高表达与PLC的肝外转移、血管侵犯、癌栓形成有关,可能参与了肝癌的发生发展.血清lncRNA HOTAIR诊断PLC灵敏度、特异度、准确度高,对PLC临床诊断有一定价值.

Dysfunction of long noncoding RNA (lncRNA) is associated with tumorigenesis of various malignancies, including glioma. Previously, lncRNA ARRDC1 antisense RNA 1(ARRDC1-AS1) has been reported to be dysregulated in several tumors. However, the roles of ARRDC1-AS1 in glioma have not been investigated. In this study, we firstly reported that ARRDC1-AS1 expression was distinctly increased in both glioma specimens and cell lines, and high ARRDC1-AS1 expression was associated with advanced clinical progression and poor prognosis of glioma patients. Additionally, STAT1 could activate the transcription of ARRDC1-AS1. Functional studies revealed that knockdown of ARRDC1-AS1 suppressed the proliferation, migration and invasion of glioma cells. Mechanisms exploration indicated ARRDC1-AS1 served as a sponge of miR-432-5p to upregulate PRMT5 expressions. Rescue experiments indicated that knockdown of miR-432-5p reversed the inhibiting effects of ARRDC1-AS1 knockdown on glioma cells. Overall, our findings highlighted the importance of STAT1/ARRDC1-AS1/miR-432-5p/PRMT5 axis in glioma progression and offered novel strategies for glioma treatments.

新型冠状病毒肺炎(COVID-19)是由新型冠状病毒感染所致,以发热、乏力、干咳为主要临床表现,传染性强,病因为感受疫疠之气,属于中医"疫病"的范畴,病位在肺脾,发病多与"寒、湿、热、毒、瘀"等多因素有关,但疾病不同时期的侧重点不同,故需分期而论,分证而治.本文将探讨中医药对杭州市新型冠状病毒肺炎患者的分期辨证治疗,充分挖掘中医药对新型冠状病毒肺炎的治疗潜力.