Ethnopharmacological relevanceMoshen Fuyuan Formula (MSFY) is one of the representative Chinese medicine compound for Idiopathic membranous nephropathy (IMN), that originate from Fang Ji Huang Qi decoction in the Han dynasty. IMN is usually accompanied by different tongue coatings in traditional Chinese medicine (TCM), and tongue microorganisms are important factors affecting the formation of the tongue coating. Recently, oral microbiomes, including bacteria and fungi, have been identified as pivotal factors that contribute to disease development. However, the regulation of oral microbiomes by MSFY has not been defined.Aim of the studyIn this work, we explore the characteristics of oral bacteria and fungi in IMN patients with different tongue coatings, and clarify the therapeutic effect of MSFY based on oral microbiome.Materials and MethodsWe enrolled 24 patients with IMN, including 11 with white tongue (IMN-W) and 13 with yellow tongue (IMN-Y), and recruited an additional 10 healthy individuals. Patients with IMN were treated with the MSFY. The oral bacteriome and fungi before and after treatment were detected using full-length 16S rRNA and internal transcribed spacer gene sequencing.ResultsThe therapeutic effect of MSFY on patients with yellow tongue coating was more significant than that on patients with white tongue coating. In terms of oral bacteriome, Campylobacter bacteria were enriched in patients with yellow tongue and could be a promising biomarker for yellow coating. Enrichment of Veillonella parvula_A may partially account for the therapeutic effect of MSFY. As for oral fungi, Malassezia globosa was enhanced in patients with IMN-W and reduced in patients with IMN-Y. Notably, it was reduced by MSFY. We also found that mycobiome-bacteriome interactions were highly complex and dynamic in patients with IMN.ConclusionThe regulation of the dynamic balance between oral fungi and bacteria by MSFY contributes to the treatment of IMN. This study determined the oral bacteriome and mycobiome of patients with IMN with different tongue coatings before and after MSFY treatment, which aids in promoting personalized treatment in clinical TCM and provides direction for investigating the mechanism of Chinese herbal medicines.

Objective:To analyze the medication and compatibility law of TCM compound patents in the treatment of diabetic nephropathy (DN) based on data mining method; To provide basis for research and development of new drug in clinic.Methods:TCM compound patents for DN treatment were retrieved from national patent platform. Excel 2019 was used to conduct statistical analysis on drug frequency, property and taste and meridian. SPSS Modeler 18.0 and SPSS Statistic 26.0 were used for drug association rules and clustering analysis. The complex network of co-occurrence of core drugs was constructed with Cytoscape 3.9.0, and the potential of the correlation between new prescriptions and drugs was demonstrated.Results:A total of 261 TCM compound patents were included, including 438 kinds of Chinese materia medica. High-frequency drugs included Astragali Radix, Rehmanniae Radix, Salviae Miltiorrhizae Radix et Rhizoma, Lycii Fructus, etc. Drug categories were mainly deficiency tonic drugs. The properties and tastes were mainly cold and sweet, and the meridians were mainly liver and kidney meridians. The commonly used medicinal pair was Ganoderma-Rehmannine Radix. The commonly used triple medicinal combination was Notoginseng Radix et Rhizoma-Angelicae Sinensis Radix-Ganoderma. There were 7 groups of clustering medicines, including Notoginseng Radix et Rhizoma, Ganoderma, Angelicae Sinensis Radix, Euryales Semen, Rehmanniae Radix and Lycii Fructus. There were 5 groups of potential medicines, including Campsis Flos-Caulis Tinosporae Sinensis-Kalopanacis Radix-Fimbristylis Rigiduta Nees-Padicularisdis Dissectae Radix -Korshinsk Peashrub-Alismatis Fructus-Cynanchi Wallichii Radix. The core new prescriptions for treating DN were obtained through topological attribute analysis and screening.Conclusions:The national TCM compounds patents treatment for DN is based on the pathogenesis of this disease, which is characterized by deficiency in nature and excess in superficiality. It often uses methods such as tonifying qi and spleen, nourishing yin and tonifying kidney, promoting blood circulation and resolving blood stasis to improve clinical efficacy, providing ideas for the development of new drugs.

目的 探讨慢性肾脏病(CKD)3～5期非透析住院患者血钾与中医证型的相关性.方法 采用横断面调查,共纳入2018年10月—2021年10月在中国中医科学院西苑医院肾病科住院的CKD 3～5期非透析患者308例,采集患者一般资料、实验室指标及中医证型,分析中医证型与肾小球滤过率(eGFR)、CKD分期、血钾水平、高钾血症发生率的相关性.结果 因风动证及热毒证比例极少,故未纳入分析,纳入分析的患者298例.虚证中,脾肾气虚证70例、肝肾阴虚证41例、脾肾阳虚证57例、气阴两虚证93例、阴阳两虚证37例;阴阳两虚证患者eGFR和CKD3期所占比例均明显低于其他证型者(P均<0.05).脾肾气虚证和肝肾阴虚证患者血钾水平和高钾血症发生率均明显低于其他证型者(P均<0.05);阴阳两虚证患者血钾水平和高钾血症发生率均明显高于其他证型组(P均<0.05).兼实证情况中,无兼证28例,兼实证270例,其中湿浊证53例、湿热证45例、瘀血证43例、湿浊+瘀血证60例、湿热+瘀血证69例;不同兼实证情况之间eGFR及CKD分期比例差异均无统计学意义(P均>0.05);湿浊+瘀血证和湿热+瘀血证患者血钾水平和高钾血症发生率均明显高于无兼证者(P均<0.05);湿热证和血瘀证患者血钾水平明显高于无兼证者(P均<0.05).结论 血钾水平和高钾血症发生率与中医证型具有相关性,其中阴阳两虚证、兼湿热+瘀血证和兼湿浊+瘀血证患者血钾水平和高钾血症发生率更高,可能是受患者eGFR、胃肠功能和凝血功能因素影响所致,中医证型对于CKD早期预防高钾血症具有重要意义.

ObjectivesGalactose-deficient IgA1 (Gd-IgA1) is a critical effector molecule in the pathogenesis of IgA nephropathy (IgAN), a leading renal disease without noninvasive assessment options. This updated systematic review aimed to determine the diagnostic and prognostic value of Gd-IgA1 assessment in biological fluids in patients with IgAN.MethodsPRISMA guidelines were followed in this review. We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, VIP Information/China Science and Technology Journal Database, and WANFANG for studies published between database inception and January 31, 2023. Eligible studies that evaluated aberrant IgA1 glycosylation in IgAN patients relative to controls were identified, and random effects meta-analyses were used to compare Gd-IgA1 levels in different groups. The quality of the evidence was assessed using the Newcastle-Ottawa Scale. This study was registered on PROSPERO (CRD42022375246).FindingsOf the 2727 records identified, 50 were eligible and had available data. The mean Newcastle-Ottawa Scale score was 7.1 (range, 6–8). Data synthesis suggested that IgAN patients had higher levels of blood and/or urine Gd-IgA1 compared with healthy controls (standard mean difference [SMD]=1.43, 95% confidence interval [CI]=1.19−1.68, P<0.00001), IgA vasculitis patients (SMD=0.58, 95% CI=0.22−0.94, P=0.002), and other kidney disease patients (SMD=1.06, 95% CI=0.79−1.33, P<0.00001). Moreover, patients with IgAN had similar levels of serum Gd-IgA1 compared to first-degree relatives (SMD=0.38, 95% CI= -0.04−0.81, P=0.08) and IgA vasculitis with nephritis patients (SMD=0.12, 95% CI= -0.04−0.29, P=0.14). In addition, ten studies demonstrated significant differences in serum Gd-IgA1 levels in patients with mild and severe IgAN (SMD= -0.37, 95% CI= -0.64−-0.09, P=0.009).ConclusionsHigh serum and urine Gd-IgA1 levels suggest a diagnosis of IgAN and a poor prognosis for patients with this immunological disorder. Future studies should use more reliable and reproducible methods to determine Gd-IgA1 levels.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022375246, identifier CRD42022375246.

糖尿病肾病(diabetic nephropathy,DN)多为本虚标实之证,以脾肾亏虚为本,痰浊、瘀血为标,痰、瘀均属阴邪,同气相求,易相互搏结为患,"痰瘀互结"是DN的核心病机.脾肾亏虚是DN痰瘀互结发病之根本,脾虚则气血生化乏源,脾肾俱虚则失于运化温通,水液代谢失常,津停血聚而痰瘀内生.热化、寒化是痰瘀互结的基本病机演化,DN早中期多见热化(痰瘀挟热),及至晚期,久病及肾,损及肾中元阴元阳,肾阳衰惫,阳虚而寒,则多寒化(痰瘀兼阳虚).久病入络,痰瘀互结,痹阻肾络是DN的主要病理变化.痰瘀内停阻碍气机,壅滞经络,可加重痰瘀,又可困脾伤肾,脾肾亏虚又是痰瘀互结发生之根源,故痰瘀互结与脾肾亏虚互为因果,是DN不断进展、迁延难愈的关键.笔者从中医基础理论出发,结合课题组多年对DN患者的辨治经验,提出针对DN的"痰瘀同治,气血同调,治病求本,标本兼顾"的诊疗思路,强调分期论治DN痰瘀标证,灵活运用活血化瘀、化痰降浊、软坚散结、通络解毒诸法,同时标本兼顾,重视脾肾气化,以期为DN的中医药治疗提供参考.

原发性血小板增多症(essential thrombocythemia,ET)是一种费城染色体阴性骨髓增殖性肿瘤(myeloproliferative neoplasms,MPN),年发病率约为1.1～2/10万人口[1].2016年WHO将ET的诊断标准定义为[2]:主要标准:(1)血小板计数≥450×109/L;(2)骨髓活检示巨核细胞高度增生,胞体大、核分叶的成熟巨核细胞数量增多,粒系、红系无显著增生或左移,且网状纤维极少轻度增多;(3)不能满足BCR-ABL+慢性髓性白血病、真性红细胞增多症(polycythemia vera,PV)、原发性骨髓纤维化(primary myelofibrosis,PMF)、骨髓增生异常综合征和其他髓系肿瘤的WHO诊断标准;(4)两面神激酶 2(Janus kinase 2,JAK2)、钙网蛋白(calreticulin,CALR)或骨髓增殖性白血病病毒癌基因(myeloproliferative leukemia virus oncogene,MPL)突变.