目的:基于数据挖掘技术分析穴位贴敷治疗冠心病心绞痛的取穴用药规律，以指导临床合理取穴及用药。方法:计算机检索中国学术期刊数据库(万方数据)、中国知识资源总库(CNKI)、中国生物医学文献服务系统(SinoMed)、中文科技期刊数据库(重庆维普)建库至2020年1月31日的穴位贴敷治疗冠心病心绞痛的临床研究文献。选用Microsoft Excel 2016、SPSS Statistics 21.0、SPSS Modeler 14.2统计软件为工具，对纳入的穴位和中药进行关联规则分析和聚类分析。结果:共纳入穴位贴敷治疗冠心病心绞痛的穴位处方102首，涉及腧穴38个，使用频次排名前5位依次为膻中、内关、心俞、足三里、至阳；穴对排名前5位依次是内关-三阴交、心俞-膈俞、膻中-膈俞、膻中-厥阴俞、膻中-膈俞和心俞。纳入中药处方102首，涉及中药88味，使用频次排名前5位依次为川芎、冰片、丹参、乳香、檀香，药对排名前3位依次为川芎-肉桂、薤白-瓜蒌、乳香-没药。结论:穴位贴敷治疗冠心病心绞痛常用单穴为膻中，常用配穴为内关、心俞，重视足太阳膀胱经穴的应用；用药以活血止痛药为主，体现了活血化瘀、通络止痛的治法。

目的:探讨丹蒌片联合奥马哈个案管理模式在慢性稳定性冠心病患者中的应用效果。方法:采用便利抽样法，选取2018年3月—2019年4月于吉林大学中日联谊医院心血管内科就诊的120例SCAD患者，采用随机数字表法分为常规组和联合组，各60例。两组均予以奥马哈系统的个案管理模式干预，常规组予以基础治疗，联合组则在此基础上予以丹蒌片治疗，两组均连续治疗和护理8周。观察比较两组治疗后的治疗效果，治疗前后的血管内皮功能指标、血清肌红蛋白（Mb）、肌钙蛋白I（cTnI）水平及治疗期间并发症发生情况。结果:联合组显效率、总有效率为53.33%（32/60）、98.33%（59/60），高于常规组的35.00%（21/60）、81.67%（49/60），差异有统计学意义（ P<0.05）。两组治疗后肱动脉血流介导性舒张功能、血清内皮素水平高于治疗前，且联合组高于常规组，差异有统计学意义（ P<0.05）。两组治疗后血清一氧化氮、高敏C-反应蛋白、Mb、cTnI水平低于治疗前，且联合组低于常规组，差异有统计学意义（ P<0.05）。联合组并发症发生率低于常规组，差异有统计学意义（ P<0.05）。 结论:丹蒌片联合奥马哈个案管理模式可改善SCAD患者血管内皮功能，有效降低血清Mb、cTnI及心肌酶水平，安全性高，临床疗效显著，值得推广。

目的 基于网状Meta分析方法对不同中成药改善痰瘀互结型冠心病患者血脂及微循环状态的有效性和安全性进行评估.方法 检索中国知网(CNKI)、万方数据库(Wanfang)、维普中文期刊(VIP)、中国生物医学文献数据库(SinoMed)、PubMed、EMbase、Cochrane Library、Web of Science等数据库自建库至 2023年 4月 3日有关中成药治疗痰瘀互结型冠心病患者血脂及微循环状态的随机对照试验(RCTs),采用Review Manager 5.4 和Stata 15.1 软件进行文献质量评价及网状Meta分析.结果 最终纳入 37 项RCTs,总样本量 4 064 例,包括15 种中成药.网状Meta分析综合结果提示中成药联合西医常规治疗冠心病的疗效优于单纯西医常规治疗,且未见严重不良反应.临床总疗效累积概率排前 3 位的中成药为冠脉再通膏、瓜蒌皮注射液、祛瘀消斑胶囊;在改善甘油三酯(TG)及低密度脂蛋白(LDL-C)方面,排前 3 位的中成药为瓜蒌皮注射液、护心康片、冠心舒通胶囊;在改善血浆黏度及纤维蛋白原方面,排前 3 位的中成药为银杏达莫注射液、瓜蒌皮注射液、冠心舒通胶囊;在改善内皮功能[一氧化氮(NO)及内皮素 1(ET-1)]方面,排前 3 位的中成药为银杏达莫注射液、丹蒌片、通脉愈心丸;在降低炎症超敏C反应蛋白(hs-CRP)方面,排前 3 位的中成药为银杏达莫注射液、护心康片、冠心舒通胶囊.结论 当前证据表明,痰瘀同治类中成药联合西医常规治疗冠心病在提高临床疗效、改善血脂及微循环状态方面具有较明显的优势,尤其是能兼顾治疗痰与瘀的中成药优势更明显,如冠脉再通膏、瓜蒌皮注射液,可作为中西医临床指导用药方案之一.但因纳入文献的数量少、质量不高,研究结果仍需要更多高质量、多中心、双盲随机试验加以验证,以提供更可靠的循证医学参考.

目的 系统评价单纯西药治疗冠心病与丹蒌片联合西药治疗的不同效果,为临床提供循证参考依据.方法 检索PubMed,Embase,Cochrane library,中国生物医学文献服务系统(Sinomed),中国知网(CNKI),维普(VIP),万方医学网(Wanfang)数据库,全面收集丹蒌片联合常规药物(治疗组)对比常规药物(对照组)治疗冠心病的随机对照临床试验(RCT),检索时间从2017年-2023年6月20 日.根据Cochrane风险偏倚评估工具对纳入的文献进行质量评价,采用RevMan 5.4软件进行分析.结果 共纳入14项随机对照试验,合计1292例患者,Meta分析结果显示,治疗组临床疗效[RR=1.24,95％CI(1.17,1.31),P＜0.000 01 ];改善心电图ST段压低[MD=0.66,95％CI(0.53,0.80),P＜0.000 01];T 波倒置[MD=0.25,95％CI(0.03,0.46),P=0.03];提高心电图改善有效率[RR=1.20,95％CI(1.02,1.41),P=0.03];提高硝酸甘油减停率[RR=1.34,95％CI(1.12,1.34),P=0.002];减少心绞痛发作次数[MD=1.43,95％CI(0.61,2.25),P=0.0007 ];降低心绞痛持续时间[MD=2.78,95％CI(1.79,3.76),P＜0.000 01 ];降低不良反应发生率[RR=0.42,95％CI(0.24,0.76),P=0.004];中医证候积分[MD=4.47,95％CI(1.75,7.18),P＜0.0001 ]等方面均优于对照组.结论 在常规治疗方案的基础上联合使用丹蒌片可提高大部分临床指标及症状的疗效,且具有一定安全性,但因所纳入研究的质量较低、样本量较小,今后仍需更多方案设计严密、实施科学的大样本、高质量的随机对照试验来进行进一步的评价和验证,以期提供更多可靠的循证证据,指导临床用药.

OBJECTIVE:To investigate the potential pharmacological mechanism of Danlou tablet(丹蒌片,DLT)with a long-term clinical application in the treatment of myocardial ischemia/reperfusion(I/R)injury through network pharmacology,molecular docking and experimental verification.METHODS:The main chemical ingredients in DLT were retrieved from the Traditional Chinese Medicine(TCM)System Pharmacology Database,the TCM information database,the bioinformatics analysis tool for molecular mechanism of TCM,and HERB database.Disease targets of I/R were accessed from the databases of Online Mendelian Inheritance in Man,GeneCards,Therapeutic Target Database,and DisGeNET database.The overlaying genes of DLT and I/R were obtained from the Venny online platform.The core targets and protein-protein interaction network were constructed and analyzed via the Search Tool for the Retrieval of Interacting Genes Proteins database and Cytoscape software.Furthermore,Gene Ontology(GO)analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis were performed by the Metascape platform.Based on the results,the component-target-pathway network was constructed and drafted via the Cytoscape software and the platform of Bioinformatics.Furthermore,we performed molecular docking to predict the binding information between chemical molecules and target proteins.Finally,oxygen-glucose deprivation/recovery(OGD/R)-induced H9c2 cardiomyocytes were used to validate the results of network pharmacology in vitro.RESULTS:A total of 189 active chemical components in DLT and 849 correlative targets of I/R were screened.Of note,133 overlaying genes found from the Venny online platform were concentrated into 28 core genes.Furthermore,the GO and KEGG pathway enrichment analysis presented that DLT might participate in 42 types of GO molecular functions,747 types of GO biological processes,19 types of GO cellular components,and 140 kinds of pathways to treat I/R.In the component-target-pathway network,the indirect relationship between herbs and their possible effective pathways was clarified.Based on the molecular docking,we speculated that Baicalein-prostaglandin G/H synthase 2(PTGS2)with-3.24 kcal/mol,Luteolin-heat shock protein 90 alpha family class A member 1(HSP90AA1)with-3.22 kcal/mol,Baicalein-HSP90AA1 with-3.13 kcal/mol,and Quercetin-HSP90AA1 with-3.05 kcal/mol possessed the strongest binding force of less than-3 kcal/mol,sequentially.Experimental verification showed that Quercetin,Luteolin,and Baicalein could increase the relative cell viability of OGD/R-stimulated cardiomyocytes,probably by suppressing PTGS2,and activating HSP90AA1 and estrogen receptor 1 expression.CONCLUSIONS:We predicted the potential active compounds as the material basis of DLT that may provide a new approach to elucidate the novel pharmacological mechanism underlying the treatment of cardiac I/R damage.

基于chemerin/趋化样因子受体 1(CMKLR1)/过氧化酶体增殖物激活受体(PPAR)α信号通路研究瓜蒌薤白半夏汤(GXBD)对 2 型糖尿病合并急性心肌梗死(T2DM-AMI)模型大鼠的干预作用,探讨GXBD对改善T2DM-AMI早期糖脂代谢紊乱现象的潜在机制.实验分为空白对照组(Ctrl)、模型组(T2DM-AMI)、阳性对照组(复方丹参片,DS)、瓜蒌薤白半夏汤高剂量组(GXBD-H)和瓜蒌薤白半夏汤低剂量组(GXBD-L).采用灌胃高脂乳剂(HFE)和腹腔注射链脲佐菌素(STZ)的方法建立2 型糖尿病(T2DM)模型,然后冠状动脉结扎以诱导形成急性心肌梗死(AMI).空白对照组和模型组灌胃等量生理盐水,各给药组给予相应药物灌胃.通过 ELISA 和生化检测评估相关代谢指标的变化,Western blot 分析肝脏、腹腔脂肪和心脏中chemerin、趋化样因子受体 1(CMKLR1)、过氧化物酶体增殖物激活受体α(PPARα)的蛋白表达.实验结果表明GXBD改善了T2DM-AMI的心脏病理损伤,降低了血脂、心肌酶和炎性因子水平,但对血糖变化不明显.此外,与模型组相比,GXBD降低了外周血中chemerin的表达,升高了肝脏中环磷酸腺苷(cAMP)和蛋白激酶A(PKA)的水平,且经GXBD治疗后肝脏、腹腔脂肪和心脏中chemerin、CMKLR1 蛋白表达水平降低,肝脏和腹腔脂肪中PPARα蛋白表达水平上升.以上研究结果说明GXBD可显著改善T2DM-AMI的糖脂代谢紊乱,进而对受损心肌具有保护作用.其机制可能与干预chemerin/CMKLR1/PPARα信号通路有关.这为临床进一步研究GXBD防治T2DM-AMI提供新的理论依据,也是中药治疗胸痹"痰浊壅塞"证候在蛋白水平的体现.

目的:采用网络药理学探讨益气活血化痰方治疗动脉粥样硬化(AS)的作用机制.方法:利用中药系统药理学数据库分析平台(TCMSP)及文献检索,筛选出黄芪、丹参、全瓜蒌、黄连及水蛭的有效成分,借助有机小分子生物活性数据库(PubChem)、基因名片数据库(GeneCards)等获得本方及疾病靶点,绘制韦恩图后获得共同靶点,利用 SRTING数据库及 Cytoscape 3.9.1 软件构建药物-疾病靶点蛋白质互作(PPI)网络图,筛选出关键靶点.使用 David数据库对关键靶点进行基因本体(GO)功能富集分析及京都基因与基因组百科全书(KEGG)通路富集分析,以 Cytoscape 3.9.1行可视化分析.结果:获取益气活血化痰方与 AS的共同靶点 265个、关键靶点 36个,其中,蛋白激酶 B1(AKT1)、禽肉瘤病毒 17假定转化基因(JUN)、丝裂原活化蛋白激酶 1(MAPK1)、p38丝裂原活化蛋白激酶 14(MAPK14)、丝裂原活化蛋白激酶 3(MAPK3)、核因子 Kappa Bp65(RELA)、肿瘤坏死因子(TNF)等在益气活血化痰方抗 AS过程中尤为重要.获得 122条相关通路,主要包括癌症的通路、脂质和 AS通路、糖尿病并发症中的晚期糖基化终产物及其受体(AGE-RAGE)信号通路在糖尿病并发症中的应用、卡波西肉瘤相关性疱疹病毒感染、蛋白质聚糖在癌症中的应用等.结论:益气活血化痰方通过多靶点、多通路发挥抗 AS作用,可为益气活血化痰方治疗 AS的临床应用提供理论依据.

OBJECTIVE:To evaluate the clinical efficacy of Traditional Chinese Medicine prescriptions for resolving phlegm in the treatment of angina pectoris of phlegm-stasis coronary heart disease by a network Meta-analysis.METHODS:Randomized controlled trials(RCTs)on clinical efficacy of CHD angina pectoris with interaction of phlegm and blood stasis were searched in PubMed,Springer,the Cochrane Library and Chinese-language databases China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data from their inception to December 2021.Literature was screened and literature bias risk was assessed by RevMan5.4 software.The overall response rate,the duration of angina attack,the levels of serum lipids such as total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),and high density lipoprotein cholesterol(HDL-C),and expression of hypersensitive C-reactive protein(hs-CRP)were selected as outcome indicators for network Meta-analysis and mapped using Stata15.1 software.RESULTS:Totally,26 RCTs were included,involving 2098 participants.There were 6 TCM formulas with the effects of dispelling phlegm and removing blood stasis.Taking conventional Western Medicine as the common intervention measures,the results showed that the overall response improvement rate from high to low was displayed as modified Xiaoxianxiong decoction(小陷胸汤,MXD),Danlou tablet(丹蒌片,DT),modified Gualou Xiebai Banxia decoction(瓜蒌薤白半夏汤,MGXBD),modified Wendan decoction(温胆汤,MWD),modified Zhishi Xiebai Guizhi decoction(枳实薤白桂枝汤,MZXGD),and modified Erchen decoction(二陈汤,MED).The sequence of angina attack duration improvement from high to low was MZXGD,MGXBD,DT,MWD,MXD.The sequence of TC improvement from high to low was MZXGD,MED,DT,and MGXBD.Sequence of improving TG from high to low was MED,MZXGD,MGXBD,and DT.For LDL-C improvement,the effect from good to poor was MZXGD,MGXBD,DT,and MED.With regard to HDL-C improvement,the effect was ranked as MED,MZXGD,MGXBD,and DT from good to poor.hs-CRP expression from high to low was MZXGD,MXD,MED,MWD,and MGXBD.CONCLUSION:TCM formula with the effects of dispelling phlegm and removing blood stasis combined with conventional Western Medicine has obvious advantages in treating CHD angina pectoris with interaction of phlegm and blood stasis.MZXGD has great potential in increasing the overall response rate,reducing Duration of angina attack improving blood lipids,and reducing inflammatory factors.However,due to the limitations of extant studies,the conclusions of this study need to be confirmed by numerous reasonably-designed RCTs.

目的:采用德尔菲专家调查法对冠状动脉血运重建后双心疾病痰瘀互结兼气郁证的中医药临床应用情况进行探讨和评价,分析更优中医药用药方案,为中医药更好地干预冠状动脉血运重建后双心疾病提供思路和借鉴.方法:以从事中医及中西医结合临床心血管工作的副高级以上专家为调研对象,向各省、直辖市或自治区中医或中西医结合三级甲等医院投放问卷若干轮次,征询冠状动脉血运重建后双心疾病痰瘀互结兼气郁证用药意见,每轮依据专家意见及 SPSS分析得到的结果修订问卷内容,直至专家意见趋于一致时形成最终问卷.结果:共进行德尔菲专家调查问卷 2 轮,邀请专家 38 名,回收问卷 76 份,专家积极系数为 100%,权威系数为 0.90,甄别得出最佳单味药 13味、方剂 3首及中成药 4种.结论:冠状动脉血运重建后双心疾病痰瘀互结兼气郁证优选单味药为柴胡、香附、枳壳、郁金、川芎、延胡索、合欢花、瓜蒌、薤白、半夏、石菖蒲、远志、丹参,适宜方剂为血府逐瘀汤、柴胡疏肝散、瓜蒌薤白半夏汤,适宜中成药为丹蒌片、心可舒片、逍遥丸(丹栀逍遥丸、加味逍遥丸)、舒肝解郁胶囊.

目的:观察化痰消瘀方治疗慢性萎缩性胃炎伴肠上皮化生、或(和)者伴有低级别上皮内瘤变的临床疗效.方法:入选经胃镜及病理确诊为慢性萎缩性胃炎伴肠上皮化生、或(和)者伴有低级别上皮内瘤变的患者122例,按随机数字表法分为治疗组60例和对照组42例.治疗组采用化痰消瘀方加减治疗,具体方药:陈皮12 g,法半夏10 g,鸡内金10 g,丹参15 g,薏苡仁30 g,蒲黄粉10 g,半枝莲15 g,仙鹤草15 g,猫爪草15 g,白花蛇舌草15 g.随证加减:胃痛或腹痛甚者加娑罗子10 g,延胡索10 g;反酸甚者加锻瓦楞子20 g;腹胀甚者加木香10 g,砂仁(后下)3 g;饱胀者加焦山楂、焦神曲各10g,炒谷芽、炒麦芽各15 g,莱菔子10 g;心下痞满者加枳实10 g,瓜蒌皮10 g;嗳气者加降香6 g,旋覆花10 g;瘀血内阻明显者加莪术15 g;阴虚者加北沙参10 g,麦冬10 g;有低级别上皮内瘤变者加仙鹤草15 g,藤梨根20 g.每次100 mL,分早晚2次服用,治疗疗程为6个月.对照组42例,给予胃复春片治疗,每次3片,每天3次.治疗后比较两组患者的临床疗效.结果:治疗组痊愈9例,显效33例,有效13例,无效5例,有效率为91.67％;对照组痊愈3例,显效6例,有效21例,无效12例,有效率为71.43％.两组比较,差异有统计学意义(P＜0.05).结论:化痰消瘀方加减对逆转慢性萎缩性胃炎伴肠上皮化生,或(和)轻度上皮内瘤变这一癌前病变疗效显著.