心房颤动是一种常见的快速性心律失常,对病人的生活质量和健康造成巨大影响.张京春主任通过分析宫廷医案,发现心悸与肝脾两脏存在相关性,同时在现代医学机制上存在一定联系.宫廷医学治疗心悸使用调肝健脾的治疗原则,从疏肝、养肝、健脾等方面组方用药,可作为现代临床中治疗心房颤动的一种参考.

Background Depression is an independent factor to predict the hospitalization and mortality in the chronic HF patients. Citalopram is known as an effective drug for depression treatment. Currently, there is no specific recommendation in the HF guidelines for the treatment of psychological comorbidity. In recent years, many studies have shown that the citalopram may be safe in treating of chronic HF with depression. Objective To evaluate the efficacy and safety of the citalopram in the treatment of elderly chronic HF combined with depression. Methods PubMed, EMBASE, Cochrane, Web of Science, CNKI, VIP, CBM, and Wanfang were searched from their inception to May 2022. In the treatment of elderly chronic HF combined with depression, randomized controlled studies of the citalopram were included. Independent screening and extraction of data information were conducted by two researchers, and the quality was assessed by the Cochrane bias risk assessment tool. Review manager 5.4.1 was employed for statistical analysis. Results The results of meta-analysis prove that the citalopram treatment for depressed patients with chronic HF has a benefit for HAMD-24 (MD: −8.51, 95% CI: −10.15 to −6.88) and LVEF (MD: 2.42, 95% CI: 0.51 to 4.33). Moreover, the score of GDS decreases, and NT-proBNP (MD: −537.78, 95% CI: −718.03 to −357.54) is improved. However, the comparison with the control group indicates that there is no good effect on HAMD-17 (MD: −5.14, 95% CI: −11.60 to 1.32), MADRS (MD: −1.57, 95% CI: −3.47 to 0.32) and LVEDD (MD: −1.45, 95% CI: −3.65 to −0.76). No obvious adverse drug reactions were observed. Conclusion Citalopram treatment for depressed patients with chronic HF has a positive effect on LVEF and NT-proBNP. It can alleviate HAMD-24 and GDS, but the relative benefits for LVEDD, HAMD-17 and MADRS still need to be verified. Systematic Review Registration : PROSPERO [CRD42021289917].

快速性心律失常是临床较为多发和常见的心血管疾病,可发生于任何年龄阶段,且随着年龄的增长患病率也增加.中医理论认为肝、心两脏功能均与情志活动密切相关,对心系疾病从肝论治已在古今医著中多有体现.张京春主任医师在研究清宫原始医药档案及临床治疗中发现从肝论治快速性心律失常可取得较好疗效,故创立调肝益气定悸方,并根据年轻人与老年人生理机能差异,在辨证中各有侧重.在此基础上通过分析肝与心律失常的相关性,探讨不同年龄人群快速性心律失常的诊治规律.

目的:利用网络药理学方法和分子对接探讨调肝益气定悸药对甘松-仙鹤草治疗常见心律失常室性期前收缩(PVCs)的物质基础和作用机制.方法:通过中药系统药理学数据库及分析平台(TCMSP)结合相关文献筛选甘松、仙鹤草的化学成分及其靶点.借助人类基因数据库(GeneCards),在线人类孟德尔遗传数据库(OMIM),DrugBank数据库寻找治疗PVCs的潜在靶点.通过STRING平台进行蛋白质相互作用分析.利用Metascape平台进行基因本体(GO)富集分析与京都基因与基因组百科全书(KEGG)通路富集分析.利用Cytoscape 3.8.0软件,构建甘松-仙鹤草药对化学成分-潜在靶点-信号通路网络.利用AutoDock 4.2.6将主要靶点蛋白与甘松-仙鹤草活性成分进行分子对接.结果:甘松-仙鹤草药对中槲皮素、山柰酚、金合欢素等9种活性成分治疗PVCs的靶点主要涉及肿瘤坏死因子(TNF),丝裂原活化蛋白激酶1(MAPK1),蛋白激酶B1(Akt1)等.其潜在靶点主要富集在癌症通路(pathways in cancer),高级糖基化终末产物/高级糖基化终末产物受体信号通路(AGE/RAGE signaling pathway in diabetic complications)等26条相关信号通路.分子对接结果显示该药对大部分活性成分(92.59％)与主要靶点蛋白TNF,MAPK1,Akt1的结合活性较好.结论:甘松-仙鹤草药对中多种活性成分可通过多靶点、多通路的干预,发挥调节心肌离子通道、抗炎症、抗氧化应激等作用以治疗PVCs,同时还可通过抑制单胺氧化酶活性、抗神经损伤等改善抑郁、焦虑相关症状.为进一步探索其治疗PVCs的物质基础及作用机制提供了研究思路和理论基础.

Objective: To systematically evaluate the clinical efficacy and safety of Tanreqing injection in the treatment of heart failure complicated with pulmonary infection. Methods: The database of CNKI, SinoMed, VIP full text database, Wanfang database, Cochrance Library, Web of Science and PubMed were searched. The retrieval time was from the inception to August 2021. Clinical randomized controlled trial of Tanreqing injection in the treatment of heart failure complicated with pulmonary infection was collected, and two researchers independently screened the document data. Meta-analysis was performed using RevMan 5.4.1 software. Results: A total of 10 documents were included, including 862 cases of heart failure complicated with pulmonary infection, including 431 cases in the test group, and 431 cases in the control group. The Meta analysis showed that compared to the control group, the test group increased clinical efficiency [OR=4.56, 95％ CI(2.79, 7.52), P<0.00001], reduced the value of C-reactive protein [MD =-7.55, 95％ CI (- 11.40, -3.69), P=0.0001], reduced the time required to correct heart failure [OR=-4.04, 95％ CI (-4.59, -3.49), P<0.00001], reduced the number of days of the average hospitalization [MD =-4.78, 95％CI (-6.67, -2.89), P<0.00001], and there were no statistically significant differences in the incidence of adverse reactions. Conclusion: Tanreqing injection, as an auxiliary treatment for heart failure complicated with pulmonary infection, has significantly effective effect on improving efficiency. Tanreqing injection has a certain advantage in reducing C-creative protein values, shortening the time of correcting heart failure, and reducing the number of days of the average hospitalization, and the adverse reactions are smaller. However, the overall quality of the included studies is low, and more high-quality randomized controlled trials are needed to increase the evidence-based basis.

BackgroundThe control of diseases related to atrial fibrillation (AF) may reduce the occurrence of AF, delay progression, and reduce complications, which is beneficial to the prevention and treatment of AF. An increasing number of studies have shown that AF is associated with depression. However, to date, there has not been a bibliometric analysis to examine this field systematically. Our study aimed to visualize the publications to determine the hotspots and frontiers in research on AF and depression and provide guidance and reference for further study.MethodsPublications about AF and depression between 2001 and 2021 were retrieved from the Web of Science Core Collection (WOSCC) database. CiteSpace 5.8. R1, VOSviewer 1.6.16, and Excel 2019 software tools were used to conduct this bibliometric study.ResultsIn total, 159 articles and reviews were analyzed. The number of publications has been increased sharply since 2018. David D. McManus had the largest number of publications. The most prolific country was the USA with 54 publications but the centrality was <0.1. The most prolific institution was Northeastern University. Three clusters were formed based on keywords: The first cluster was composed of atrial fibrillation, depression, anxiety, symptoms, ablation, and quality of life, et al. The second cluster were risk, prevalence, mortality, heart failure, association, et al. While the third cluster included anticoagulation, impact, stroke, management, warfarin, et al. After 2019, stroke and prediction are the keywords with strongest citation bursts.ConclusionResearch on AF and depression is in its infancy. Cooperation and exchanges between countries and institutions must be strengthened in the future. The effect of depression on prevalence and mortality in AF, depression on ablation in AF, and impact of depression on anticoagulation treatment in AF have been the focus of current research. Stroke prevention (including anticoagulant therapy) is the research frontier, which may still be the focus of research in the future.

目的:系统评价痰热清注射液辅助治疗心力衰竭合并肺部感染的临床疗效及安全性.方法:检索中国知网、中国生物医学文献数据库、中文科技期刊全文数据库、万方数据库、Cochrance Library、Web of Science和PubMed数据库,检索时间从建库至2021年8月,收集痰热清注射液治疗心力衰竭合并肺部感染的临床随机对照试验,由2位研究员独立筛选录入文献数据,运用RevMan5.4.1软件进行数据分析.结果:共纳入10篇文献,包含862例心力衰竭合并肺部感染患者,其中试验组有431例,对照组有431例.Meta分析结果显示,试验组与对照组相比,可提高临床总有效率[OR=4.56,95％CI(2.79,7.52),P<0.00001],降低C-型反应性蛋白数值[MD=?7.55,95％CI(?11.40,?3.69),P=0.0001],缩短纠正心衰的时间[OR=?4.04,95％CI(?4.59,?3.49),P<0.00001],减少平均住院的天数[MD=?4.78,95％CI(?6.67,?2.89),P<0.00001],两组不良反应发生率差异无统计学意义(P>0.05).结论:痰热清注射液辅助治疗心力衰竭合并肺部感染,可提高临床总有效率,在降低C-型反应性蛋白数值、缩短纠正心衰的时间、减少平均住院的天数方面具有一定的优势,不良反应较小.但纳入研究数据总体质量偏低,尚需开展更多高质量的随机对照试验以增加循证依据.

目的 系统评价调控肠道菌群的中药口服制剂干预脂代谢紊乱的有效性与安全性.方法 计算机检索PubMed、EMbase、The Cochrane Library、中国知网(CNKI)、万方数据库(WangFang Data)、维普网(VIP)有关调控肠道菌群的中药口服制剂干预脂代谢紊乱的随机对照试验(RCT),检索时限均为各数据库建库至2020年12月,利用RevMan 5.4.1软件对纳入研究结果 进行Meta分析.结果共纳入12项研究,涉及1260例脂代谢紊乱相关疾病病人.Meta分析结果显示:试验组三酰甘油(TG)水平[MD=-0.38,95％CI(-0.49,-0.27),P<0.00001]、总胆固醇(TC)水平[MD=-0.64,95％CI(-0.88,-0.41),P<0.00001]、低密度脂蛋白胆固醇(LDL-C)水平[MD=-0.47,95％CI(-0.65,-0.29),P<0.00001]均明显低于对照组,高密度脂蛋白胆固醇(HDL-C)水平[MD=0.21,95％CI(0.09,0.33),P=0.0005]高于对照组.试验组有20例出现腹泻、腹痛、泌尿系感染等不良反应.结论 现有证据表明,调控肠道菌群的中药口服制剂可改善血脂代谢紊乱相关疾病病人血脂水平,且安全性良好,有望广泛应用于血脂异常病人的一级、二级预防.

治疗心脏疾病的药物多种多样,有很多药物都标明要舌下含服,用于急救. 治疗心血管疾病的舌下含服的药物常见如硝酸甘油、速效救心丸、复方丹参滴丸、麝香保心丸、宽胸气雾剂等.也曾有舌下含服硝苯地平用于紧急降压治疗的做法,但由于其降压幅度与速度难以掌控,可能会对患者产生不利影响甚至导致严重后果,所以《中国高血压防治指南(2009年基层版)》取消了这一方法,指出高血压急症患者慎用或不用舌下含服硝苯地平.

慢性间歇性低氧(CIH)是阻塞性睡眠呼吸暂停综合征(OSAS)的核心病理特征,OSAS与血脂异常能协同促进动脉粥样硬化的发生发展.实验研究发现CIH能诱导血脂异常及肠道微生物群紊乱,并且长时间CIH解除后血脂异常和微生物紊乱亦不能完全恢复,临床报道持续气道正压通气不能完全逆转血脂异常,剩余的血脂异常可能与肠道微生物群紊乱未得到完全纠正有关.OSAS合并血脂异常的主要证候属气虚血瘀痰凝,具有益气活血化痰作用的中药可改善呼吸暂停低通气指数,并对肠道微生物产生不同的影响以实现降脂目的,可为治疗OSAS合并血脂异常提供有益补充.