目的:观察不同剂量祛痰通阳汤对慢性心衰大鼠心肌损伤的保护作用及可能机制。方法:将90只Wistar大鼠随机均分正常组、模型组、卡托普利组、祛痰通阳汤低、中、高剂量六组。为建立慢性心力衰竭模型,除正常组外的五组大鼠均以2ml/kg给予阿霉素腹腔,一周1次,共6周。注射造模成功后次日进行灌胃给予对应的不同药物,连续给药治疗四周后,应用ELISA法测定各组大鼠血浆脑尿钠肽(Brain natriuretic peptide,BNP)水平,称重计算心脏质量指数并采用投射电镜观察心肌细胞结构,通过实时荧光定量PCR法测定检测Kelch样环氧氯丙烷相关蛋白-1 (epoxy chloropro-pane Kelch sample related protein-1,Keap1)和核因子E2相关因子2(nuclearfactor erythroid-2 related factor 2,Nrf2)mRNA的表达。结果:1.电镜结果显示:正常组肌丝排列规则,肌节结构清晰,心肌细胞线粒体清晰且形态正常;细胞核发育良好,无空泡以及集块现象。模型组肌原纤维排列紊乱,心肌细胞线粒体形态异常,排列不齐,增生明显,有空泡现象形成。卡托普利组及祛痰通阳汤高剂量组电镜肌原纤维排列基本整齐,线粒体未见明显肿胀,线粒体嵴密集,优于中药低剂量组及中剂量组。2.卡托普利组、中药高剂量组大鼠血浆BNP水平较模型组显著降低(P<0.01)。3.与模型组相比,中药高剂量组和卡托普利组心脏质量指数均显著降低(P<0.05)。4.卡托普利组及祛痰通阳汤高剂量组心肌组织Keap1 m RNA表达与模型组相比显著降低(P<0.05);卡托普利组及祛痰通阳汤高剂量组心肌组织Nrf2 m RNA表达与模型组的相比显著提高(P<0.05)。结论:高剂量祛痰通阳汤可显著减轻慢性心衰大鼠的心肌损伤,可能与抑制Keap1 m RNA的表达及增强Nrf2 m RNA表达,进而抗心肌氧化损伤有关。
压力性尿失禁在我国人群中发病率较高,病程迁延不愈,易留下后遗症。本文查阅近5年相关文献发现,单一针刺疗法刺激量较小,对机体效应力弱,易于产生耐受。而针刺联合疗法可克服单一针刺治疗的这些缺点,高效、迅速的改善患者盆底肌肉的顺应性,促进盆底受损神经的恢复。本文就针刺联合中药、针刺联合灸法、针刺联合生物反馈电刺激、针刺联合盆底肌训练等针刺联合疗法进行评叙,以期拓宽压力性尿失禁的治疗思路,优化治疗方法。针对目前存在的治疗方法,笔者产生了一些思考,对不同患病人群提出了新的优化方向。Stress urinary incontinence has a high incidence rate among Chinese people, and the course of the disease is prolonged, which makes it easy to leave sequelae. This article reviewed relevant literature in the past 5 years and found that a single acupuncture therapy has a small stimulation amount, weak effect on the body, and is easy to develop tolerance. Acupuncture combined therapy can overcome the shortcomings of single acupuncture treatment, efficiently and quickly improve the compliance of pelvic floor muscles in patients, and promote the recovery of damaged pelvic floor nerves. This article reviews acupuncture combined with traditional Chinese medicine, acupuncture combined with moxibustion, acupuncture combined with biofeedback electrical stimulation, acupuncture combined with pelvic floor muscle training, etc., in order to broaden the treatment ideas and optimize the treatment methods for stress urinary incontinence. In response to the current treatment methods, the authors have generated some thoughts and proposed new optimization directions for different populations with different diseases.
