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疫情大流行!应当如何评价中医药在疫情期间的临床疗效价值?

文/火石创造 2020-03-20 11:39:20 来源:中国网大连娱网棋牌 频道

应当如何评价中医药在疫情期间的临床疗效价值?赶紧来看看这篇文章吧!

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疫情期间,中医药/中西医结合疗法临床应用广泛  中医药在各省确诊新冠肺炎病例中的实际临床参与率极高,根据各地新闻报道,各省中医药临床参与率基本高于90%,天津、吉林、湖南三省甚至达到100%。   疫情背后,中医药/中西医结合相关临床试验正在国内火热开展  中医药临床试验项目数量持续增长,成为国内登记临床试验主要内容,发起者主要为医院。
截至2020年3月10日,火石数智的战疫助手项目组通过中国临床试验注册中心和美国临床试验注册中心,分别检索到新型冠状病毒肺炎相关临床试验项目357项和78项。从干预措施分布来看,国外临床试验中抗病毒治疗研究数量最多(16项),免疫调节治疗紧随其后(11项),干细胞治疗(7项)和中医/中西医结合治疗(7项)数量相当;而国内登记的临床试验中中药/中西医结合项目占据首位(101项),在所有干预手段中占到45.50%,远超其他干预手段;随后才是抗病毒治疗(31项)、免疫调节治疗(24项)。45831584658948150 85651584658948193

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图表来源:火石数智AIMed平台
中医药/中西医结合临床试验项目主要为干预性研究,其中中药方剂辨证治疗和中成药(包括胶囊、颗粒、注射剂等)治疗为两大主要内容,项目数量基本持平,另含少部分非药物疗法(如针刺、推拿等)。
波克棋牌下载从临床试验的地域分布来看,中医药防治新冠肺炎临床试验项目主要分布在湖北(26项)、北京(13项)、浙江(10项)、上海(9项)、广东(8项)等地,这可能与累计确诊病例数量有关,但仍值得注意的是前五位均为较为发达地区。  

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ZHONGYIYAOZHILIAOXINGUANFEIYANCHUBUXIANSHILINCHUANGLIAOXIAO   DANSHIRENGQUEFAYOULIDEXUNZHENGYIXUEZHENGJU,TONGSHIMIANLINJICHULILUNYANJIUQUESHIDEKUNJING   

 一、中医药的疗效受到质疑的最重要原因是其缺乏循证医学的证据  面对此次疫情,国内不乏针对中医药防治新冠肺炎临床疗效观察的报道,其中几项设置对照观察的研究结果显示,中医药/中西医结合治疗可以有效改善新冠肺炎确诊患者的临床症状和实验室指标,缩短患者住院天数。然而受限于样本数量,不同文献报道在具体指标疗效上的结论存在差异;其他报道更多缺乏合理的设计,导致其结论的价值大大缩减。
一方面,中医药的临床应用涉及多类中成药和汤药,尤其是汤药组成成分的复杂性和多变性是中医药临床疗效评价面临的一大难点;另一方面,中医具有独特的“辩证治疗”理论基础,同一疾病的患者根据“症候”区分给药,在另一层面增加了临床研究设计的复杂性。    

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波克棋牌下载SHANGHAISHIGONGGONG网上棋牌中心LINCHUANGZHONGXINZHONGYIKEDUISHANGHAISHIGONGGONG网上棋牌中心LINCHUANGZHONGXINSHOUZHIDE67LIXINGUANFEIYANHUANZHE,HUIGUXINGGUANCHAZHONGXIYIJIEHEZHILIAOFEIWEIZHONGXINGXINXINGGUANZHUANGBINGDUFEIYAN(JIANCHENGXINGUANFEIYAN)HUANZHEDELINCHUANGLIAOXIAO,BINGYUDANCHUNXI大连娱网棋牌 FADUIBI。JIEGUOXIANSHI,YUXIYIZU(18LI)XIANGBIZHONGXIYIJIEHEZU(49LI)ZHUYUANTIANSHUGENGDUAN、RUYUANDI6TIANLINCHUANGZHENGZHUANGJIFENGENGDI(p<0.05);ERLIANGZUHUANZHEDEZONGBINGCHENG、TUIRESHIJIAN、RUYUANDI6TIANCTGAISHANLVBIJIAOCHAYIWUTONGJIXUEYIYI(p>0.05)。 

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湖北省中西医结合医院对2020年1月15日至2月8日出院的52例COVID-19患者分析发现,中西医结合治疗组(34例)的临床症状消失时间、体温复常时间、平均住院天数及中医证候量表评分均较西药组(18例)明显缩短 (p<0.05或p<0.01),其他伴随症状消失率、实验室各项指标恢复正常率、临床治愈率均明显高于西药组 (p<0.05或p<0.01) ,普通型转重型发生率及危重型发生率均低于西药组 ( p<0.05) 。而两组患者转院率、CT 影像好转率、死亡率及不良反应发生率差异均无统计学意义 ( p>0.05) 。  
 

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对2020年1月11日至1月30日在武汉科技大学附属华润武钢总医院就诊的42例符合新型冠状病毒肺炎诊断标准的疑似患者进行回顾性评价,纳入治疗组(21例,常规治疗联合连花清瘟颗粒)相较于对照组(21例,常规治疗),发热症状消失率85.7%(对照组57.1%),咳嗽症状消失率46.7%(对照组5.6%),咳痰消失率64.3%(对照组9.1%),气促症状消失率77.8%(对照组0),组间比较差异有统计学意义(P<0.05);治疗组发热持续时间(4.6±3.2)d,较对照组发热持续时间(6.1±3.1)d,缩短1.5 d。  
 

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DASHUJUHEJISUANJIFUZHUYAOWUSHEJI   WEIZHONGYIYAOLINCHUANGPINGJIAHELILUNYANJIUTIGONGLEXINDEKENENGLUJING   

  一、数据挖掘总结用药规律,推断核心药对和组方  中草药是我国特有的巨大天然化合物宝库,而经典名方是历史经验为之提供的索引。1967年,屠呦呦先生就是从葛洪的《肘后备急方》中获得灵感,最终提取获得了抗疟药物青蒿素,为世界公共网上棋牌中心事业做出了突出贡献。而现在,通过数据挖掘的手段研究者们可以更快速地总结古籍名方中的经验、筛选获得潜在的药物。
本次疫情中,各中医药研究团队通过数据挖掘的方法,对古籍文献中疫病防治、免疫调节、肺纤维化治疗等使用的药物进行用药规律总结,筛选获得对应的高频使用药材,进一步通过关联分析和聚类分析推断核心药对和核心组方;同时结合各地诊疗方案、临床治疗用药的数据挖掘结果,为中医药防治新冠肺炎策略制定和完善提供了支持。基于数据挖掘的中医药防治新冠肺炎用药规律总结相关文献 11821584658948546

波克棋牌下载ER、FENZIXUNIDUIJIEJISHUYUCEQIANZAIDEZHONGYAOYOUXIAOWUZHI

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48031584658948652 COVID-19初期轻型寒湿郁肺证和推荐方剂相关核心基因网络及功能诠释 数据来源:参考文献[9]     
   
波克棋牌下载河南中医药大学研究团队也通过网络药理学的方法初步探究清肺排毒汤在治疗新型冠状病毒肺炎的作用机制,通过数据库检索筛选清肺排毒汤的中药活性成分、预测筛选疾病靶点、构建蛋白互作网络和靶点-信号通路网络图,最终获得清肺排毒唐潜在活性成分槲皮素、木犀草素、山奈酚、柚皮素、异鼠李碱,并预测其通过抑制炎症反应达到治疗COVID-19的目的。   

写在最后  我国的网上棋牌中心健康工作一直坚持中西医并重的方针,为中医药现代化研究提供了大力的政策和财政支持,实际上中医药临床应用也具有持续的研究热度。然而,由于中医理论的特殊性、组方配伍的复杂性,中医药临床疗效评价和基础理论研究均面临方法和技术上的难点。
大数据分析和人工智能越来越多地参与到生物医学研究过程中,数据挖掘、分子对接、网络药理学这些新兴学科为高通量筛选、预测中药有效物质成分提供了可能,也为破解中医药作用靶点和药效机制提供了线索,尤其是大数据分析可以助力真实世界研究为中医药获得充分的临床循证医学证据提供强有力的支持。
波克棋牌下载中医药现代化研究仍然是“路漫漫其修远兮”,但是我们相信在不久的未来大数据分析和人工智能可以助力中医药临床评价和理论研究实现技术革新,获得重要突破。

CANKAOWENXIAN

[1]  SHIJIA,YANGZONGGUO,YECHEN,CHENCHICHI,LUYUNFEI,LVYING,XUQINGNIAN,TANGBOZONG,YINKESHAN,CHENXIAORONG.ZHONGXIYIJIEHEZHILIAOSHANGHAIDIQU49LIFEIWEIZHONGXINGXINXINGGUANZHUANGBINGDUFEIYANLINCHUANGLIAOXIAOGUANCHA[J/OL].SHANGHAIZHONGYIYAOZAZHI:1-6.

[2]  XIAWENGUANG,ANZHANGQING,ZHENGCHANJUAN,ZHANGJIXIAN,HUANGMIN,WANGYU,YANGFENGWEN,DUANCAN,LIZHENGLIANG,LIUQINGQUAN,ZHANGBOLI.ZHONGXIYIJIEHEZHILIAOXINXINGGUANZHUANGBINGDUFEIYAN34LILINCHUANGYANJIU[J].ZHONGYIZAZHI,2020,61(05):375-382.

波克棋牌下载[3]  YAOKAITAO,LIUMINGYU,LIXIN,HUANGJIHAN,CAIHONGBIN.ZHONGYAOLIANHUAQINGWENZHILIAOXINXINGGUANZHUANGBINGDUGANRANDEFEIYANHUIGUXINGLINCHUANGFENXI[J/OL].ZHONGGUOSHIYANFANGJIXUEZAZHI:1-7

[4]  LVRUIBING,WANGWENJU,LIXIN.ZHONGYAOLIANHUAQINGWENZHILIAOXINXINGGUANZHUANGBINGDUFEIYANYISIBINGLI63LILINCHUANGGUANCHA[J/OL].ZHONGYIZAZHI:1-5.

[5]  WANGRAOQIONG,YANGSIJIN,XIECHUNGUANG,SHENQILIN,LIMINQING,LEIXIAO,LIJIKE,HUANGMEI.QINGFEIPAIDUTANGZHILIAOXINXINGGUANZHUANGBINGDUFEIYANDELINCHUANGLIAOXIAOGUANCHA[J/OL].ZHONGYAOYAOLIYULINCHUANG:1-14.

[6]  MAQINGYUN,LIUCHEN,DUHAITAO,ZHANGGUISHENG,SUNQIHUI,LIUXIAOYUN,QIDONGMEI,YANGYONG,RONGRONG.JIYUGAOTONGLIANGFENZIDUIJIEXUNISHAIXUANSARS-CoV-23CLSHUIJIEMEIZHONGYAOXIAOFENZIYIZHIJIJIKANGCOVID-19XINXINGGUANZHUANGBINGDUFEIYANDEZHONGYAOJIQIFUFANGYUCE[J/OL].ZHONGCAOYAO:1-10.

波克棋牌下载[7]  WANGDENG,YANKANGKANG,CAOQING,WANGDI.JIYUSHUJUWAJUEGEDIQUZHONGYIYAOYUFANGXINXINGGUANZHUANGBINGDUFEIYANFANGANYONGYAOGUILVYANJIU[J/OL].ZHONGYAOCAI:1-9.

[8]  LIYANDA,ZHAOZHENYU,SUNJIAHUI.JIYUSHUJUWAJUEDEXINXINGGUANZHUANGBINGDUFEIYANYONGYAOGUILVYANJIU[J/OL].ZHONGGUOXIANDAIZHONGYAO:1-16.

[9]XUHAIYU,ZHANGYANQIONG,QINYUEWEN,ZHAOHAIYU,WANGPING,LIUFENG.JIYUTCMIP V2.0TANXIXINXINGGUANZHUANGBINGDUFEIYANQUANBINGCHENGZHONGYIZHENGHOUHETUIJIANFANGJIDEKEXUENEIHAN[J/OL].ZHONGGUOZHONGYAOZAZHI:1-12.

[10]XUDONGYU,XUYULONG,WANGZHIWAN,LVYALI,ZHUHONGLEI,SONGTING.JIYUWANGLUOYAOLIXUEYANJIUQINGFEIPAIDUTANGZHILIAOXINXINGGUANZHUANGBINGDUFEIYANDEZUOYONGJIZHI[J/OL].ZHONGYAOYAOLIYULINCHUANG:1-17.

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