目的 按国际患者报告结局(Patient reported outcomes,PRO)量表研制规范,从信度、效度两方面评价非酒精性脂肪肝(NAFLD)中医PRO量表的科学性能.方法 临床纳入200例NAFLD患者,发放NAFLD中医PRO量表,并汇总数据结果.分别通过克朗巴赫系数(cronbach's alpha)法、分半信度法来考核量表的内部一致性信度和分半信度,从而评价量表的信度;分别通过相关系数法、因子分析法来考核量表的内容效度和结构效度,从而评价量表的效度.结果 回收量表198份,回收率99％.NAFLD中医PRO量表整体Cronbach's c系数为0.903,生理、心理、治疗三大领域分别为0.862、0.682、0.617,均大于0.6,具备合格的内部一致性信度;量表整体的分半信度系数(Spearman-Brown系数)为0.864,大于0.6,生理、心理、治疗三领域分别为0.862、0.659、0.497,除治疗领域外均具备合格的分半信度;量表所有条目及领域的Spearman系数均大于0.2,且P ＜0.01,表明量表具有良好的内容效度;因子分析结果显示能被公因子解释的变量达到61.858％,超过一半,表明量表结构效度良好.结论 NAFLD中医PRO量表具有较为良好的信度和效度,具备一定的可靠性和实效性,可应用于中医治疗NAFLD研究的临床疗效评价.

血浊是全国名中医王新陆教授提出的一种全新的中医病因病机学概念,是血的成分、运行与功能异常的高度概括.王新陆教授血浊理论是基于中医经典文献中关于血浊的提示,并结合西医认识以及临床实践经验发展而成.血浊产生的病因多种多样,而脾胃失调则是血浊出现的重要病机.脾胃在血浊生成过程中发挥重要作用,血浊的出现亦影响脾胃,从而出现相应临床表现.两者之间相互影响,恶性循环.在治疗上,王新陆教授提出从脾胃入手,以健脾清化为核心治法,临床辅以化湿、通腑、扶正等治法.通过恢复脾胃健运,促使血液恢复其清纯状态以及循行秩序,血浊乃去.

非酒精性脂肪性肝病(NAFLD)是指非酒精作用引起的、以肝实质细胞发生的脂肪累积和变性为主要特征的一种临床病理综合征.当下全球NAFLD在普通人群中的患病率高达20％～30％,且呈现逐年升高趋势[1].患者报告结局(PRO)是直接来源于患者的关于自身健康状况和治疗结果的报告,是在没有其他人或医生干预的情况下进行的一种患者对自身临床结局的测量[2].

危北海教授是首届全国名中医、全国名老中医传承工作指导老师、国家中医药管理局中医传承博士后导师、首都国医名师。1959年危北海教授响应党和国家号召投身于西医学习中医的伟大事业,并致力于开拓和建立中西医结合消化病学。他在中西医结合消化病学理论、基础与临床研究方面做出了卓越贡献和取得了丰硕成果。2019年为危北海教授西医学习中医、从事中西医结合消化工作60周年。危北海教授率先开展脾虚证本质研究,系统阐述脾虚理论的发展源流,发现脾虚证特异性指标

Objective To investigate the effect of the liver-regulating and spleen-strengthening method on the expression of Toll-like receptor 4 (TLR4) and occludin in the intestinal mucosal barrier of rats with nonalcoholic fatty liver disease (NAFLD) induced by high-fat and high-sugar diet. Methods A total of 50 male Sprague-Dawley rats were randomly divided into normal group, model group, liver-regulating and spleen-strengthening group, liver-regulating group, and spleen-strengthening group. A rat model of nonalcoholic steatohepatitis was established by high-fat and high-sugar diet for four weeks. The five groups were observed in terms of the degree of hepatic steatosis, the change in liver function, and the expression of the tight junction protein occludin in the intestinal mucosa and TLR4 in the intestinal epithelium. A one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. Results Compared with the normal group, the model group showed hepatic steatosis and had significant increases in the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (P＜0.05), as well as a reduction in the expression of the tight junction protein occludin in intestinal epithelial cells and an increase in the expression of TLR4 in the intestinal epithelium. Compared with the model group, the three treatment groups had a significant reduction in the degree of steatosis, a significant increase in the expression of occludin, and a significant reduction in the expression of TLR4 in the intestinal epithelium. Among the three treatment groups, the liver-regulating and spleen-strengthening group had the lowest degree of steatosis and significantly greater reductions in the serum levels of ALT and AST than the model group (P＜0.05), as well as significantly greater changes in the expression of occludin and TLR4. Conclusion The liver-regulating and spleen-strengthening method can improve intestinal mucosal barrier function by increasing the expression of the tight junction protein occludin in intestinal epithelial cells and reducing the expression of TLR4 in the intestine, with a better clinical effect than the liver-regulating method or the spleen-strengthening method alone.

目的:观察降逆清热化浊方对非糜烂性胃食管反流病(NERD)大鼠模型食管组织降钙素基因相关肽(CGRP)的影响.方法:选取SD雄性大鼠60只并将其分为正常组、模型组、西药组和中药组.以鸡卵清蛋白/氢氧化铝基础致敏联合食管酸灌注的方法制备NERD大鼠模型,药物干预14 d后,观察各组大鼠食管组织的病理改变及高敏感性相关信号分子CGRP的表达情况.结果:与正常组比较,模型组大鼠食管组织上皮细胞间隙增宽,有少量炎性细胞;与模型组比较,中药组、西药组大鼠食管组织CGRP表达明显降低,且中药组降低更为显著.结论:降逆清热化浊方通过抑制CGRP的表达,下调食管高敏感性,从而对NERD起到治疗作用.

[目的]观察健脾温肾巴布剂穴位贴敷治疗腹泻型肠易激综合征(IBS-D)的临床疗效.[方法]将146例脾肾阳虚型IBS-D患者随机分为观察组和对照组,观察组使用健脾温肾巴布剂穴位贴敷治疗,对照组使用安慰剂穴位贴敷治疗,疗程4周,随访4周.采用IBS症状严重程度量表(IBS-SSS)积分、中医证候积分评估2组患者总体症状疗效、证候疗效.[结果]治疗4周后,观察组患者IBS-SSS表中腹痛、腹痛天数、腹胀、排便满意度、肠道症状对生活的干扰积分较治疗前明显下降(P＜0.05)且较对照组下降更多(P＜0.05).治疗4周后观察组中医证候积分较治疗前明显下降(P＜0.05),且较对照组下降更多(P＜0.05).观察组、对照组IBS-SSS总有效率分别为93.24％和50.68％,中医证候总有效率分别为89.04％和42.46％.[结论]健脾温肾巴布剂穴位贴敷法治疗IBS-D能缓解临床症状,具有良好的临床疗效.