他汀类药物治疗冠心病合并高脂血症的效果分析

目的 对他汀类药物治疗冠心病合并高脂血症进行观察与分析,以期控制血脂水平、延缓疾病进展.方法 参考《血脂异常防治建议》和《心血管药物临床试验评价方法的建议》给予50例冠心病合并高脂血症者他汀类药物20 mg/d,睡前服用,1个月为一疗程,共观察两个疗程,同时在观察期间对患者血脂水平以及心血管不良事件等进行统计与分析.结果 他汀类药物能够明显控制此类人群血脂水平且显著降低心血管不良事件发生率为14％.结论 他汀类药物治疗冠心病合并高脂血症效果显著,是一种行之有效的治疗方案.     

普伐他汀致横纹肌溶解症一例

他汀类药物是3-羟基-3甲基戊二酰辅酶A（HMG-CoA）还原酶抑制药,通过抑制HMG-CoA还原酶,减少肝脏胆固醇的合成发挥作用,具有显著的调脂作用.此外,他汀类药物还具有稳定斑块、改善内皮功能、减少炎症、抑制血栓形成等多种非调脂作用[1].目前临床上他汀类药物被广泛应用于冠心病的二级预防,常见的不良反应为肝功异常和横纹肌溶解症.后者虽然罕见,但可致急性肾功能衰竭,甚至死亡,值得关注.本文报告1例与他汀类药物相关的急性横纹肌溶解症.     

他汀类药物的抗炎作用研究进展

他汀类药物目前广泛应用于调脂治疗及冠心病治疗,作用肯定,在其他领域亦有应用价值。不良反应以横纹肌溶解症最为严重。本文综合近年公开发表的文章和资料,介绍他汀类药物在冠心病方面的应用进展、调脂以外的作用及不良反应。     

他汀类药物的不良反应

他汀类药物是治疗胆固醇高血脂症、动脉粥样硬化的常用药物 ,其不良反应亦有报道 ,应引起临床的重视。1　一般不良反应消化系统表现为 :恶心、腹泻、腹痛、消化不良、轻微胃肠道症状并有ALT或AST升高 ;神经系统表现为 :失眠、痛、视觉障碍、眩晕、感觉异常、外周神经病变。2　肌肉毒性一般来说肌病的发生率约为 0 1%～ 0 2 % ,且与剂量相关 ,若出现肌病后继续用药 ,则可进展为急性肾衰和横纹肌溶解。临床表现为 :肌痛、肌触痛、肌无力、肌病、跛行 ,严重者引起横纹肌溶解症。除肌肉症状外 ,还表现为 :血清肌磷酸激酶 (CK)升高达正常高…     

他汀药物对冠心病合并非瓣膜性心房颤动患者临床结果的影响

目的:探讨他汀药物对冠心病(CAD)合并非瓣膜性心房颤动(NVAF)患者远期临床结果的影响.方法:中国心房颤动注册研究于北京市31家医院前瞻性纳入心房颤动患者25 512例,排除瓣膜病性心房颤动,最终纳入冠心病合并NVAF患者2 783例.主要终点事件是心血管死亡;次要终点是全因死亡、血栓栓塞事件和心血管原因住院.结果...     

他汀类药物对Stanford B型主动脉夹层患者主动脉腔内修复术疗效的影响

目的观察他汀类药物对Stanford B型主动脉夹层患者行主动脉腔内修复术疗效的影响。方法回顾性分析2002年4月至2013年10月于沈阳军区总医院心血管内科住院治疗并行主动脉腔内修复术治疗的Stanford B型主动脉夹层患者388例,分析他汀组与非他汀组临床特点及主动脉腔内修复术后围手术期及3年随访的死亡率、再次行主动脉腔内修复术等事件的发生率。结果 (1)两组患者临床资料比较:两组患者的性别、年龄及体重指数等无统计学意义(P均0.05);他汀组与非他汀组患糖尿病、脑卒中的比例无统计学意义(P均0.05);他汀组高血压病、冠心病的比例明显高于非他汀组(P均0.05);他汀组服用阿司匹林肠溶片的比例明显高于非他汀组(P0.001);两组患者伴胸腔积液、心包积液的比例无统计学差异(P均0.05)。(2)围手术期情况:两组患者植入支架的数目、长度、近远端直径及内漏的发生等差异均无统计学意义(P均0.05);非他汀组完全封闭左锁骨下动脉的比例明显高于他汀组(P=0.020);两组患者围术期死亡、术后发热、脑卒中、肢体活动障碍及住院时间等差异均无统计学差异(P均0.05);他汀组合并PCI的比例明显高于非他汀组(P0.001)。(3)随访时间36个月,随访率为79.5%。随访期间两组患者死亡率、再次行主动脉腔内修复术、新发冠心病、脑卒中、截瘫等均无统计学差异(P均0.05)。结论单中心研究未显示他汀类药物可以改善主动脉夹层患者行主动脉腔内修复术的近远期生存率。     

分析他汀类药物在冠心病合并糖尿病患者治疗中的应用

目的分析他汀类药物在冠心病合并糖尿病患者治疗中的应用效果。方法选取该院2017年1月-2019年1月收治的74例冠心病合并糖尿病患者作为研究对象,分为对照组(予常规治疗)和观察组(在常规治疗的基础上额外增加他汀类药物治疗),对比两组患者治疗前后的血糖血脂水平变化和心血管不良事件发生率。结果治疗后,观察组患者的PPG、TG、TC和LDL-C相较于对照组有明显的下降,HDL-C明显升高,且观察组的心血管不良事件发生率(8.1%)<对照组(27.9%),两组患者组间数据比较差异有统计学意义(P<0.05)。结论将他汀类药物应用于冠心病合并糖尿病患者的治疗中,效果十分显著,能够有效调节患者的血糖血脂水平,降低心血管不良事件发生率,值得临床推广。     

瑞舒伐他汀治疗老年心内膜下心肌梗死患者横纹肌溶解1例

目的分析瑞舒伐他汀治疗老年心内膜下心肌梗死患者横纹肌溶解的病因。方法回顾性分析我院2014年5月就诊的急性心内膜下心肌梗死患者1例的临床资料,对其进行瑞舒伐他汀治疗。结果服药后引起横纹肌溶解症,立即停用,采取补液水化治疗,辅酶Q10 20 mg,3次/d,口服,同时保肝治疗,一周后肌痛明显减轻,查生化全项:谷丙转氨酶51 IU/L,谷草转氨酶56 IU/L,其余指标均正常后出院。结论长期服用他汀类药物,要定期检查肝功能、肾功能、血清磷酸肌酸激酶(CPK),应根据个体状况进行合理谨慎的联用选择,剂量掌握以小剂量为好,以便更安全用药。     

依折麦布在高危动脉粥样硬化患者强化降脂治疗中的作用

血脂异常与动脉粥样硬化（AS）性疾病关系密切,血清TC升高是冠心病（CHD）和缺血性脑卒中的独立危险因素之一。循证医学证据表明,合理降脂治疗可预防CHD发生,强化降脂治疗可显著减少CHD事件发生。目前,最强有力的他汀类降脂药物虽能降低TC、LDL-C,但不能使所有患者达到治疗目标。他汀类与贝特类药物合用虽能提高他汀类降脂的疗效,但有发生肌病（表现为肌痛、肌炎和横纹肌溶解）的风险。依折麦布为TC吸收抑制剂,其与他汀类药物合用可有效地降低TC。为探讨依折麦布对高危AS患者的疗效及安全性,我们进行了相关研究。现报告如下。     

爱尔兰他汀类药物间相互作用情况

HMG-COA还原酶抑制剂(他汀)在冠心病一级和二级预防中的疗效已很明确。1998年GMS计划中他汀类药物处方超过175,000例,他汀占所有处方降脂药物的比例超过90％。总体上他汀类药物耐受性良好,不良反应发生率约为3％。 与他汀类药物相关的少见但很重要的严重不良反应包括肝脏毒性和肌病,后者可发展成为横纹肌溶解,可能导致肾功能衰竭。这些严重不良反应主要发生在他汀与其他降脂药物(比如贝特     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Intake of energy drinks in association with alcoholic beverages in a cohort of students of the School of Medicine of the University of Messina

BACKGROUND: Energy drinks (ED) are a widely used group of beverages known for their stimulant effects on central nervous system (CNS). The main components of ED are caffeine, taurine, carbohydrates, glucuronolactone, inositol, niacin, pantenol, and beta-complex vitamins. The studies evaluating the effects of ED describe improvements in attention and/or reaction times and indices of alertness. It has been also shown that combination of caffeine and glucose, fundamental constituents of ED, can ameliorate deficits in cognitive performance and subjective fatigue during extended periods of cognitive demand. Moreover, the associated ingestion of alcohol and ED has recently been observed to be becoming more and more widespread. METHODS: With the aim to know the habits and uses of students, we administered a questionnaire containing questions regarding ED drinking alone or in association with alcoholic beverages. Five hundred students of the School of Medicine of the University of Messina were interviewed, and 450 filled the questionnaire. RESULTS: A total of 56.9% of students declared using ED. A great part of users (48.4%) associate frequently ED and alcohol. In particular, 35.8% of ED + alcohol users have used ED + alcohol more than 3 times in the last month. Distinguishing the users into 2 groups (users of ED + alcohol and users of both ED and ED + alcohol), we observed in the second group a major use of cocktail containing a mix of ED and alcoholic beverages. This difference between the 2 groups is less represented about the ingestion of ED + alcohol in the night. CONCLUSIONS: Our data indicate that association of ED + alcohol is very popular among students. This behavior can be dangerous. In fact, the combination of ED + alcoholic drinks can reduce adversive symptoms of alcohol intoxication including the depressant effects. As consequence, users of ED + alcoholic beverages might not feel the signs of alcohol intoxication, thus increasing the probability of accidents and/or favoring the possibility of development of alcohol dependence.