目的:通过数据挖掘分析吕仁和教授治疗糖尿病肾病(DN)的用药经验.方法:筛选2016年01月—2021年07月就诊于吕仁和教授门诊DN患者的病案资料,建立数据库,采用数据挖掘方法分析吕仁和教授治疗DN的中医处方,挖掘用药特点及组方规律.结果:共纳入106个中医处方;涉及中药101味,其中常用中药39味,核心中药24味;常用中药类别7类;两药关联结果14条;两药聚类结果12条,11个中药聚类组合.结论:吕仁和教授用药攻补兼施,注重调理五脏,调补阴阳,常用活血、清热、理气、益气、养血等治法,并且在中药的选择与配伍使用中具有独到的经验.

慢性肾脏病(chronic kidney disease,CKD)发病率逐年上升,根据一项调查示我国18岁以上成年人中CKD的患病率达10.8％[1],终末期肾脏替代治疗正以每年11％的速率上升[2],探寻治疗CKD的新疗法日益紧迫.研究发现[3],CKD患者肾脏功能受损,肠道代偿性的排泄约80％的废物及毒素;而尿毒症毒素在肠道内积累,可能会引起肠道菌群失衡,黏膜免疫紊乱[4,5].

慢性肾衰竭患者住院期间受寒后突发冷凝集素病,表现肾功能进展,溶血性贫血,经过中西医结合治疗,患者转危为安.冷凝集素病在寒冷环境下可引起血液中红细胞凝集,基于《素问·调经论篇》曰:"血气者喜温而恶寒,寒则泣不能流,温则消而去之."中医认为该病的基本病机为寒凝血瘀,治疗需重视温阳活血治法,具体包括温阳散寒、温阳益气、活血化瘀、温阳利水,常用方如四逆汤、四逆加人参汤、茯苓四逆汤、当归四逆汤、真武汤等,并随病情发展,观其脉证,随证治之,如兼有脾虚者,要健脾和胃;兼有气血亏虚者,要益气养血;兼有湿热者,要清化湿热.

国医大师吕仁和教授在长期临床实践中,在中医整体观和辨证论治思想的指导下,结合西医对特发性膜性肾病的认识,总结并提出了辨治疾病的"六对论治"方法,具体包括对病论治、对病分期辨证论治、对病辨证论治、对症论治、对症辨证论治、对症辨病与辨证论治相结合."六对论治"方法体现了吕仁和教授重视辨病、分期辨证、病证结合、病-证-症并重的中医临床思维,运用"六对论治"方法辨治特发性膜性肾病,可优化临证思路,提高临床疗效.

Objective:To analyze the selection of outcome indicators measured in randomized controlled trials（RCTs） of uric acid nephropathy treated with integrated traditional Chinese and western medicine,thereby providing a reference for future clinical studies to select the appropriate outcome indicators.Methods:Ten databases were searched for RCTs involving uric acid nephropathy.The outcome indicators reported were extracted and analyzed.Results:A total of 162 research articles with 79 outcome indicators were included in the study.Of these indicators,creatinine,urea nitrogen,and 24-hour urinary protein excretion were measured mainly for the evaluation of renal function,and blood uric acid was commonly used in evaluating the level of uric acid.The rate of outcome indicators utilized for determining treatment effects was higher than 87 %.Adverse events were reported at a rate of41.3%.Sixty-four indicators had a utilization rate of less than 5%.Conclusion:So far,there are no uniform outcome indicators.Most studies on uric acid nephropathy use biochemical indicators as outcome measures.However,no hard endpoints or clinically important outcomes were selected.The number of included studies is small and further discussion is needed on how to select outcome indicators.

Objective: To systemically review the efficacy and safety about the method of enriching qi, activating blood circulation, clearing away dampness and heat combined with western medicine in the therapy of patients with idiopathy membranous nephropathy (IMN). Methods: We collected the randomized controlled trials (RCTs) of enriching qi, activating blood circulation, clearing away dampness and heat for the treatment of IMN from Pub Med, The Cochrane Library, Medline, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Data and Wiper Databases. Bias of risk of retrieval literature was evaluated according to Cochrane Collaboration standard, and Review Manager 5.3 software was used for statistical analysis. Results: Fourteen trials (836 participants) were included in the meta-analysis. This kind of traditional Chinese method combined with western medicine in the treatment of IMN exerted statistical differences in reducing 24-hour urinary protein [WMD=-0.97, 95％CI(-1.30,-0.65), Z=5.86(P<0.00001)] and elevating serum albumin [WMD=3.83, 95％CI(2.10, 5.57), Z=4.33, P<0.0001], lowering serum cholesterol [WMD=-0.82, 95％CI(-1.08, -0.56), Z=6.18, P<0.00001], triglycerides [WMD=-0.39, 95％CI(-0.67, -0.11), Z=2.77, P=0.006] and reducing the risk of adverse events[OR=0.29, 95％CI[0.16, 0.50], Z=4.35, P<0.0001] in the patients with IMN as compared with controls. However, there was no statistically significant difference between the method and controls when combining all trials in serum creatinine [WMD=-5.52, 95％CI(-18.06, 7.03), Z=0.86, P=0.39], when combining all trials in urea nitrogen[WMD=-0.90, 95％CI(-2.22, 0.41), Z=1.35, P=0.18]. Conclusion: The method of enriching qi, activating blood circulation, clearing away dampness and heat combined with western medicine exerts certain advantages and better safety in treating patients with IMN. However, for the inferiority of the included studies, the conclusion still needs high-quality and large-sample prospective randomized controlled trials to verify.

目的 分析白芍总苷研究现状和热点,为白芍总苷深入研究与应用提供参考.方法 计算机检索中国知识资源总库(CNKI)、中文科技期刊数据库(VIP)、中国学术期刊数据库(万方数据)建库至2021年7月31日收录的白芍总苷研究文献.采用NoteExpress3.4.0.8878软件去重及筛选后,绘制发文趋势图.根据普赖斯定律计算核心作者,采用VOSviewer1.6.17软件绘制核心作者密度视图,对高频关键词进行共现分析并构建可视化网络.采用CiteSpace5.8.R1软件对关键词进行聚类分析及突现分析.结果 纳入文献1465篇,其中1289篇来源于435种学术期刊,176篇为学位论文,涉及作者3200位,其中核心作者65位.该领域发文量经阶段性增加后趋于稳定.近年高频关键词有系统性红斑狼疮、银屑病、湿疹、有效性、中西医结合治疗、缺血性脑损伤、细胞凋亡、氧化应激、信号通路、炎症因子等.该领域早期研究以免疫调节等药理作用机制为主,之后研究集中于与其他药物联合应用,近年主要为治疗皮肤、风湿免疫性疾病的有效性、安全性及作用机制,此外还出现对缺血性脑损伤的保护机制研究.结论 白芍总苷治疗风湿免疫性疾病、皮肤黏膜疾病、糖尿病肾病、缺血性脑损伤的基础研究与临床应用是目前该领域研究热点.

刘渡舟教授将古方(经方)与今方(时方)合用的理论称之为"古今接轨论",该理论的提出是对张仲景"合方"思想的传承,更能适应病因繁多的杂病治疗."古今接轨论"经方与时方合用,具体包括经方接轨时方和时方接轨经方,临床运用需要把握四个原则:(1)方证相应,应对复杂病情;(2)方机相应,注意病机契合;(3)病证结合,不忘专病专方;(4)体证相合,重视体质从化.通过2则典型医案说明"古今接轨论"的必要性.

参芪地黄汤作为中医古籍中记载的经典方剂,由六味地黄丸化裁而来,现代医家多将其用于慢性肾脏病的治疗,并取得较好疗效.临床研究证实[1]参芪地黄汤可降低慢性肾脏病患者患者血肌酐、尿素氮,降低尿蛋白,提高肾小球滤过率,保护肾功能.现代药理的发展也为其能够有效的治疗肾脏病提供了分子学依据.现就其在中医学的认识、在肾病的中医治疗中的认识、现代药理研究及其在慢性肾脏病的治疗方面的研究进展进行综述.

目的:系统评价雷公藤多苷辅助治疗糖尿病肾病的有效性及安全性.方法:计算机检索知网、万方、维普、Si-noMed、Pubmed、Cochrane Library、Embase数据库中关于雷公藤多苷治疗糖尿病肾病的随机对照试验,时限为建库至2020年9月.采用RevMan5.3软件进行分析.结果:共纳入21篇文献,包括1955例研究对象.Meta分析结果显示:雷公藤多苷可提高临床有效率[OR=4.62,95％CI(3.32,6.42),P<0.00001]、减轻蛋白尿[MD=-1.03,95％CI(-1.23,-0.83),P<0.00001]、提升白蛋白[MD=3.42,95％CI(2.769,4.09),P<0.00001],对肌酐[MD=-3.30,95％CI(-7.51,0.90),P=0.12]、尿素氮[MD=0.05,95％CI(-0.15,0.25),P=0.64]、内生肌酐清除率水平[MD=0.69,95％CI(-0.99,2.36),P=0.42]的影响差异均无统计学意义,但不同程度增加了不良反应发生率[OR=3.61,95％CI(2.06,6.34),P<0.00001].结论:雷公藤多苷辅助治疗糖尿病肾病可提高临床有效率,减轻尿蛋白,但同时也存在一定的副作用,临床应用需权衡利弊.此次纳入研究数量不多,且受文献质量的限制,结论有待进一步验证.

This cross-sectional study aimed to investigate the association between plasma homocysteine (Hcy) and chronic kidney disease (CKD) in US patients with type 2 diabetes mellitus (T2DM). We used data from the 2003–2006 National Health and Nutritional Examination Surveys (NHANES). CKD was defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m2 and/or urinary albumin-creatine ratio ≥ 3 mg/mmol. This study included 1018 patients with T2DM. The mean Hcy value was 10.2 ± 4.6 μmol/L. Among the patients, 417 (40.96

目的:系统评价尿毒清颗粒联合RAAS系统阻滞剂治疗糖尿病肾病的疗效.方法:运用计算机检索CNKI、万方、VIP、Pubmed、Embase及Cochrane Library中关于尿毒清颗粒联合RAAS系统阻滞剂治疗糖尿病肾病随机对照试验(RCT)的研究文献.采用RevMan5.3软件对符合本次研究的文献中所需要的数据进行Meta分析.结果:最终收入15篇随机对照试验,共1063例患者纳入分析,其中联合治疗538例,对照组525例.Meta分析结果显示尿毒清颗粒联合RAAS系统阻滞剂组在临床缓解率[OR=2.92,95％CI(1.76-4.86)]、24 h尿蛋白定量[MD 0.71,95％CI(0.28-1.14)]、UAER[MD 41.13,95％CI(26.66-55.59)].但尿毒清颗粒联合RAAS系统阻滞剂观察组在降低血清尿素氮[MD-0.86,95％CI(0.05-1.68,P=0.02)]、降低空腹血糖[MD-0.03,95％CI(-0.15-0.09),P=0.61]方面无治疗优势.2组不良事件发生率差异无统计学意义[RR=2.34,95％CI(0.69-7.95),P=0.17].结论:尿毒清颗粒联合RAAS系统阻滞剂可能与单独使用RAAS系统阻滞剂一样安全,在提高总有效率、降低24 h尿蛋白定量及UAER方面具有优势.但由于此次纳入分析的文献质量偏低,未来更需要多中心,大样本,研究设计更严谨的随机双盲实验做进一步验证.

目的 系统评价八段锦对糖尿病患者的血糖血脂等辅助治疗效果.方法 计算机检索知网、万方、维普、PubMed、Embase、The Cochrane Library、web of science数据库中关于八段锦干预糖尿病的随机对照试验(RCT),检索时限均为从建库至2020年3月.2位评价者按纳排标准独立进行文献筛选、资料提取和质量评价,应用RevMan 5.3进行Meta 分析.结果 最终纳入18个研究,共1 009例患者.Meta分析结果显示,八段锦组在降低空腹血糖、餐后2h血糖、糖化血红蛋白胆固醇、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、BMI以及升高高密度脂蛋白胆固醇方面优于对照组,差异均有统计学意义.结论 习练八段锦能有效降低2型糖尿病患者血糖、血脂和BMI.但受纳入研究的数量和质量的限制,以上结论仍需开展大样本、多中心、高质量的RCT予以验证.

风本是自然界的六气之一,是一种由空气流动引起的自然现象.但当风气太过或机体抵抗力下降不能适应正常的风气时,风就变成了一种外来的致病邪气,即六淫中的一种.中医将其称为"风邪".风为百病之长,影响很多疾病的发生.西医学中免疫性疾病的起病,临床表现,发病机制等都与风邪的致病特点有一定的相似性.尤其是肾脏疾病多为自身免疫性疾病,更以IgA肾病为典型,其占原发性肾小球疾病的39. 7％ [1] ,约有5％ ～25％的患者可以发展为终末期肾病[2～4].以下为笔者查阅相关文献资料,并结合跟师临床的学习,从风论治IgA肾病的一点体会.

腰痛是由于感受外邪,邪气痹阻腰部经络或内伤劳倦,肾虚腰府失养所致的常见病证,另外作为症状也常见于其他病证.《伤寒杂病论》中涉及腰痛的条文共有7条,分别见于《伤寒论》太阳病篇,《金匮要略》虚劳病篇、五藏风寒积聚病篇、水气病篇、痰饮咳嗽病篇.其中有4条条文下载有方药.本文从治法的角度入手,探讨张仲景治疗腰痛的学术经验,张仲景在《内经》辨治腰痛的基础上,将腰痛的治疗更加具体化,具体有补益肾气法、散寒化湿法、解表散寒法和调和营卫,逐湿走表法,兹分别论述,并以名家验案加以阐释,以期提高现代中医临床辨治腰痛的水平.

To systematically evaluate the efficacy of urinary granules combined with RAAS system blockers in the treatment of diabetic nephropathy (DN). A meta-analysis of the data required in the literature in accordance with this study was performed using RevMan 5.3 software. Fifteen randomized controlled trials were analyzed in the present study to evaluate the clinical effect of Niaoduqing-angiotensin converting enzyme inhibitors/angiotensin receptor blocker (ACEI/ARB) in DN patients. A total of 1063 patients were involved, including 538 patients receiving the combination treatment and 525 patients in the control group. The results showed that the clinical efficacy of Niaoduqing granule combined with ACEI/ARB was significantly better than of the control group (odds ratio = 2.92, 95% confidence interval [CI] 1.76–4.86). The treatment combined with Niaoduqing granule decreased the 24-h urinary protein quantitation (mean difference [MD] 0.71, 95% CI 0.28–1.14) and urine albumin excretion rate (UAER) (MD 41.13, 95% CI 26.66–55.59) levels. However, the combination group had no treatment advantage on reducing serumurea nitrogen (MD 0.86, 95% CI 0.05–1.68, P = 0.02) and fasting blood glucose (MD −0.03, 95% CI −0.15–0.09, P = 0.61). And there was no significance in adverse events between two groups (risk ratio = 2.34, 95% CI 0.69–7.95, P = 0.17). Niaoduqing granule-ACEI/ARB combination group maybe as safe as ACEI/ARB alone, and the combination played an advantage in improvement in total effective rate, reduction of 24-h urinary protein quantitation and UAER.