中药疗效评价问题是长期制约中医药发展壮大及国际化的“卡脖子”问题。该文从医学认知的底层逻辑出发,在系统剖析中西医药诊疗理念、药效物质基础、研发范式、疗效认知和评价模式等方面客观差异的基础上,整合临床经验、实验研究和临床...中药疗效评价问题是长期制约中医药发展壮大及国际化的“卡脖子”问题。该文从医学认知的底层逻辑出发,在系统剖析中西医药诊疗理念、药效物质基础、研发范式、疗效认知和评价模式等方面客观差异的基础上,整合临床经验、实验研究和临床试验的证据要素,首次提出并建立中药有效性评价新策略和方法体系——中药有效性评价整合证据链法(integrated evidence chain-based effectiveness evaluation of traditional Chinese medicine,iEC-Eff),形成中药有效性“临床经验-实验研究-临床试验”一体化评价与确证模式。初步应用研究显示,该方法可使中药特别是流传千年、有口皆碑、至今临床常用的经典名方的有效性评价等级得到科学提升,使其有效性证据等级能够更加客观地反映其临床价值和地位,突破了当今中药有效性评价以随机对照试验(RCT)为唯一“金标准”的局面及局限,为破解中药有效性评价难题提供了具有原创性和引领性的策略和方法,为建立中医药理论、人用经验和临床试验相结合的中药注册审评证据体系提供了具有可操作性的新工具。该方法可用于中医药经典名方有效性评价、中药新药研发、上市后中成药有效性再评价等,亦可供国家医保药物目录、国家基本药物目录等中药品种遴选参考。展开更多
Objective:To assess the risk of aristolochic acid(AA)-associated cancer in patients with AA nephropathy(AAN).Methods:A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospit...Objective:To assess the risk of aristolochic acid(AA)-associated cancer in patients with AA nephropathy(AAN).Methods:A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospital from January 1997 to December 2014.Long-term surveillance and follow-up data were analyzed to investigate the influence of different factors on the prevalence of cancer.The primary endpoint was the incidence of liver cancer,and the secondary endpoint was the incidence of urinary cancer during 1 year after taking AA-containing medication to 2014.Results:A total of 337 patients diagnosed with AAN were included in this study.From the initiation of taking AA to the termination of follow-up,39 patients were diagnosed with cancer.No cases of liver cancer were observed throughout the entire follow-up period,with urinary cancer being the predominant type(34/39,87.17%).Logistic regression analysis showed that age,follow-up period,and diabetes were potential risk factors,however,the dosage of the drug was not significantly associated with urinary cancer.Conclusions:No cases of liver cancer were observed at the end of follow-up.However,a high prevalence of urinary cancer was observed in AAN patients.Establishing a direct causality between AA and HCC is challenging.展开更多
依据补骨脂“性本大燥”的药性理论,寻找补骨脂致肝损伤的易感证候及生物标志物。分别构建肾阴虚证、肾阳虚大鼠模型,所有动物实验操作和福利均遵循河南中医药大学第一附属实验动物伦理与动物福利委员会的规定(批号YFYDW2020017)。结果...依据补骨脂“性本大燥”的药性理论,寻找补骨脂致肝损伤的易感证候及生物标志物。分别构建肾阴虚证、肾阳虚大鼠模型,所有动物实验操作和福利均遵循河南中医药大学第一附属实验动物伦理与动物福利委员会的规定(批号YFYDW2020017)。结果发现补骨脂可显著降低肾阴虚证大鼠体质量、饮水量、尿量,并增加其肝、睾丸、肾上腺、脾脏脏器指数及谷丙转氨酶(alanine aminotransferase,ALT)表达;同时,补骨脂还显著增加了肾阳虚证大鼠尿量,并降低ALT、天冬氨酸氨基转移酶(aspartate aminotransferase,AST)表达;苏木素-伊红(hematoxylin and eosin,HE)染色显示补骨脂明显加剧肾阴虚证大鼠肝细胞炎症浸润,并减轻肾阳虚证大鼠肝损伤。超高效液相色谱-质谱(ultra-performance liquid chromatography-tandem mass spectrometry,UPLC-MS)检测血浆后共鉴定出17个补骨脂共同调控肾阴/阳虚证大鼠的具有显著差异的内源性代谢标志物。其中,谷氨酰胺、喹啉酸、胆绿素、乳糖基酰基鞘氨醇等8个代谢物呈相反变化趋势,主要涉及半胱氨酸和蛋氨酸代谢、酪氨酸代谢、色氨酸代谢、嘌呤代谢、鞘脂代谢、甘油磷脂代谢、谷氨酰胺代谢等通路。因此,本研究推测肾阴虚证与肾阳虚证可能分别是补骨脂发挥肝损害与肝保护的易感证候,这可能与其调控体内相关氨基酸代谢和鞘脂代谢等有关,可为中医临床补骨脂的安全精准使用提供一定的实验数据支撑。展开更多
文摘中药疗效评价问题是长期制约中医药发展壮大及国际化的“卡脖子”问题。该文从医学认知的底层逻辑出发,在系统剖析中西医药诊疗理念、药效物质基础、研发范式、疗效认知和评价模式等方面客观差异的基础上,整合临床经验、实验研究和临床试验的证据要素,首次提出并建立中药有效性评价新策略和方法体系——中药有效性评价整合证据链法(integrated evidence chain-based effectiveness evaluation of traditional Chinese medicine,iEC-Eff),形成中药有效性“临床经验-实验研究-临床试验”一体化评价与确证模式。初步应用研究显示,该方法可使中药特别是流传千年、有口皆碑、至今临床常用的经典名方的有效性评价等级得到科学提升,使其有效性证据等级能够更加客观地反映其临床价值和地位,突破了当今中药有效性评价以随机对照试验(RCT)为唯一“金标准”的局面及局限,为破解中药有效性评价难题提供了具有原创性和引领性的策略和方法,为建立中医药理论、人用经验和临床试验相结合的中药注册审评证据体系提供了具有可操作性的新工具。该方法可用于中医药经典名方有效性评价、中药新药研发、上市后中成药有效性再评价等,亦可供国家医保药物目录、国家基本药物目录等中药品种遴选参考。
基金Supported by National Key Technology R&D Program(No.2018zX09101002-001-002)Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine(No.ZYYCXTD-C-202005)the Science and Technology Project Affiliated to the Education Department of Chongqing Municipality(No.KJQN202215119)。
文摘Objective:To assess the risk of aristolochic acid(AA)-associated cancer in patients with AA nephropathy(AAN).Methods:A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospital from January 1997 to December 2014.Long-term surveillance and follow-up data were analyzed to investigate the influence of different factors on the prevalence of cancer.The primary endpoint was the incidence of liver cancer,and the secondary endpoint was the incidence of urinary cancer during 1 year after taking AA-containing medication to 2014.Results:A total of 337 patients diagnosed with AAN were included in this study.From the initiation of taking AA to the termination of follow-up,39 patients were diagnosed with cancer.No cases of liver cancer were observed throughout the entire follow-up period,with urinary cancer being the predominant type(34/39,87.17%).Logistic regression analysis showed that age,follow-up period,and diabetes were potential risk factors,however,the dosage of the drug was not significantly associated with urinary cancer.Conclusions:No cases of liver cancer were observed at the end of follow-up.However,a high prevalence of urinary cancer was observed in AAN patients.Establishing a direct causality between AA and HCC is challenging.
文摘依据补骨脂“性本大燥”的药性理论,寻找补骨脂致肝损伤的易感证候及生物标志物。分别构建肾阴虚证、肾阳虚大鼠模型,所有动物实验操作和福利均遵循河南中医药大学第一附属实验动物伦理与动物福利委员会的规定(批号YFYDW2020017)。结果发现补骨脂可显著降低肾阴虚证大鼠体质量、饮水量、尿量,并增加其肝、睾丸、肾上腺、脾脏脏器指数及谷丙转氨酶(alanine aminotransferase,ALT)表达;同时,补骨脂还显著增加了肾阳虚证大鼠尿量,并降低ALT、天冬氨酸氨基转移酶(aspartate aminotransferase,AST)表达;苏木素-伊红(hematoxylin and eosin,HE)染色显示补骨脂明显加剧肾阴虚证大鼠肝细胞炎症浸润,并减轻肾阳虚证大鼠肝损伤。超高效液相色谱-质谱(ultra-performance liquid chromatography-tandem mass spectrometry,UPLC-MS)检测血浆后共鉴定出17个补骨脂共同调控肾阴/阳虚证大鼠的具有显著差异的内源性代谢标志物。其中,谷氨酰胺、喹啉酸、胆绿素、乳糖基酰基鞘氨醇等8个代谢物呈相反变化趋势,主要涉及半胱氨酸和蛋氨酸代谢、酪氨酸代谢、色氨酸代谢、嘌呤代谢、鞘脂代谢、甘油磷脂代谢、谷氨酰胺代谢等通路。因此,本研究推测肾阴虚证与肾阳虚证可能分别是补骨脂发挥肝损害与肝保护的易感证候,这可能与其调控体内相关氨基酸代谢和鞘脂代谢等有关,可为中医临床补骨脂的安全精准使用提供一定的实验数据支撑。
