糖尿病患者应用他汀药物致肌病8例报告

目的 分析糖尿病患者应用他汀药物出现肌病的临床特点及发生原因. 方法 回顾性分析8例糖尿病患者应用他汀类药物致肌病的临床资料,并进行相关文献复习. 结果 8例患者均有肌肉酸痛,其中5例肌酸激酶(CK)升高.2例诊断为横纹肌溶解症,3例为肌炎,3例为较轻肌痛.引起肌病的药物主要为辛伐他汀、阿托伐他汀,1例为阿托伐他汀联用非诺贝特引起横纹肌溶解症,1例为氟伐他汀引起肌痛.2例横纹肌溶解病人合并多种疾病及多种合并用药. 结论 糖尿病患者尤其合并多种基础疾病及合并用药多的患者在应用他汀类药物时要严密观察临床症状及生化指标检测.     

辛伐他汀服用者并发急性横纹肌溶解症1例分析

本文在系统复习近5年辛伐他汀与肌不良反应文献的基础上,报道1例辛伐他汀服用者并发急性横纹肌溶解症,并探讨其发病相关因素及预防措施.指出他汀服用者,多种肌病危险因素的叠加是肌病发生的重要因素.西药的联合应用以及西药与植物药或中成药的合用,都存在肝脏细胞色素P450水平的药物相互作用,是导致他汀类血药浓度增高的重要因素,必须引起临床医生的足够重视.减少不必要的合并用药,采用合理的他汀类药物治疗剂量,以提高用药安全性.服用中成药应遵循中医辨证施治的原则.     

肝选择性他汀类药物研究进展

他汀类药物是临床广泛应用的降脂药,在多种心血管疾病的治疗中发挥重要作用.但2001年西立伐他汀的撤市加重了人们对药物引发的肌病和横纹肌溶解症的关注.降脂药物作用的靶器官是肝脏,如何利用药物的亲脂/亲水性来提高肝选择性,从而降低不良反应发生率是新型他汀类药物的研究重点.本文从药物的结构特征和脂水分配系数出发,综述近年来肝...     

调脂药物的分类与应用

目前,我国应用的调脂物可分为7类:他汀类:羟甲基戊二酰辅酶A(H M G-C o A)还原酶抑制剂,它抑制胆固醇在肝脏的合成,是降低T C、L D L-C最有效的药物,是当今应用最多的调脂药。我国现用的他汀类药物有5种:洛伐他汀、辛伐他汀、普伐他汀、氯伐他汀、阿托伐他汀。不良反应:全球l亿例以上患者应用他汀类药物,结果证明它是疗效好、比较安全的调脂药。有2%～3%患者有胃肠道功能紊乱及皮疹,2%的病人出现肝源性S GPT与CK酶升高,肌痛很少见,横纹肌溶解症罕见。贝特类:贝特类药物能增强脂蛋白酶活性,减少极低密度脂蛋白(VLDL)合成,降低T G,…     

临床药师参与1例阿托伐他汀致肌病的药学实践

目的分析他汀致肌病的影响因素,使临床更加合理的使用他汀类药物,减少不良反应的发生。方法对1例口服阿托伐他汀钙片治疗5天后出现双大腿肌肉酸痛伴CK升高患者的病理生理因素、联合用药等情况进行分析,探讨他汀致肌病的相关因素及药学监护要点。结果临床药师判断他汀导致肌病可能性大,提出治疗建议和监护计划,促进了患者病情好转。结论他汀类药物导致肌病的影响因素较多,临床药师参与患者的临床治疗过程并加强药学监护,可促进药物治疗的安全性和有效性。     

他汀类药联合其他药物用药致不良反应的临床特点分析

目的对他汀类药与其他药物联用导致药物不良反应的临床特点进行分析。方法选择的研究对象均为本院收治的他汀类药物与其他药物联用致药物不良反应发生的患者,时间段为2018年全年,共计选择患者100例,应用回顾性分析法归类分析全部患者的一般资料、用药情况、药物不良反应等情况。结果发生的主要不良反应:发生肌肉毒性的患者有32例,患者的主要临床症状为横纹肌溶解症。其次为肝毒性患者22例,消化系统不适20例,患者的主要临床症状为肝脏不适与消化不良。再次为神经系统症状8例,皮肤不适患者6例,呼吸系统症状4例与泌尿系统症状4例。最后为其他不良反应,有4例患者,患者的主要临床症状为高热。导致药物不良反应的他汀类药物主要包括:辛伐他汀的有46例患者;其次为阿托伐他汀28例;再次为普伐他汀14例,洛伐他汀8例;最后为氟伐他汀4例。导致药物不良反应的联合用药主要为抗心肌药物或降压药物,主要有32例患者,其中主要为卡托普利;其次为贝特类调脂药物、抗凝药物或抗血小板药物分别有20例、18例,主要分别为氯贝特、氯吡格雷;再次为抗菌药物、抗病毒药物、中成药或注射剂,分别有8例,主要分别为克拉霉素、利托那韦、丹参;最后为抗糖尿病药物为6例,其中主要为格列本脲。结论他汀类药与其他药物联用致药物不良反应发生率相对较高,临床用药时要格外注意。     

他汀类药物相关性肌病研究进展

他汀类药物为3-羟基3-甲基戊二酰辅酶A（3-hydroxymethyl-3-methy lglutaryl coezymeA,HMG-CoA）还原酶抑制剂。自1987年上市以来,几项大型随机试验证实了他汀类药物在减少心血管死亡、非致死心肌梗死、中风等事件上起着重要作用。但是，他汀类药物最为严重的常见副作用是肝脏损害和肌病，其他表现包括胃肠不适、头痛、睡眠障碍、周围神经病变等。在他汀类药物广泛使用及2001年西伐他汀因横纹肌溶解副作用停止销售后，他汀类药物的安全性越来越受到人们的关注，而他汀类相关性肌病中的横纹肌溶解症，对生命影响最为严重。本文主要对他汀类药物相关性肌病的发病率、发病机制、防治措施等方面进行总结，以供临床参考。     

降脂药物治疗病人需住院肌溶解症的发生率

背景：在美国降脂药物已获广泛应用。但是对各种降脂药物发生肌溶解症的危险性目前尚缺乏可靠的估计。 目的：对门诊情况下，不同他汀及贝特类药物（单用或联用）治疗病人肌溶解症的发生率进行估计。 设计、地点及病人：根据全美11个卫生保健计划申报数据建立不同他汀和贝特类用药起始队列。人选本队列的病例为1998年1月1H至2001年6月30日人组保健计划前至少用药180天的病人。人-时间按照单药治疗或他汀-贝特类联合治疗分类。 主要结局指标：每治疗10000人一年肌溶解症的发生率、所需治疗例数以及发生肌溶解症的相对危险性。 结果：在252460例采用降脂药物治疗的病人中，24例于治疗期间发生住院的肌溶解症。采用阿托伐他汀、普伐他汀或辛伐他汀单药治疗平均每10000人一年肌溶解症的发生率为0．44（95％可信区间[confidence interval，CI]，0．20～0．84）；西立伐汀为5．34（95％CI，1．46～13．68）；贝特类为2．82（95％CI，0．58—8．24；P=0．056）。未用药者（unexposed person—time）肌溶解症的发生率为0（95％CI，0—0．48，P=0．56）。阿托伐他汀、普伐他汀与一种贝特联川肌溶解症的发生率增至5．98（95％CI，0．72～216．0），西立伐他汀与叭特类联用增至1035（95％CI，389—2117）。每治疗1年，发现1例肌溶解症的所需治疗例数他汀单药治疗为2272例，采用他汀和贝特类联合治疗的年龄较大的糖尿病人为484例，采用西立伐他汀加贝特类治疗的病人为9．7到12．7例。 结论：采用阿托伐他汀、普伐他汀及辛伐他汀单药治疗发生肌溶解症的危险相似而且很低；联合使用他汀及贝特类者危险增加，特别是在老年糖尿病病人。西立伐他汀联合贝特类每年治疗10例即可能有1例发生肌溶解症。     

他汀类药物与其他药物联用时所致的不良反应分析

目的:分析他汀类药物与其他药物联用时所致的不良反应。方法:回顾性分析2017年9月至2019年1月92例他汀类药物与其他药物联用所致不良反应患者的临床资料,分析患者不良反应的类型及具体表现、引起不良反应的他汀类药物种类及其作用、联合用药类型。结果:92例患者中,肌肉毒性不良反应发生率最高为38.04%,其次是肝毒性为21.74%;易引起不良反应的他汀类药物是辛伐他汀片为48.68%,其次是阿托伐他汀钙片为26.32%;联合用药中,与降压药或抗心律失常药联用的不良反应所占比例最高为41.30%,其次是降脂药为21.74%。结论:他汀类药物,特别是辛伐他汀片与阿托伐他汀钙片,联合降压、降脂及抗心律失常等药物连用时,容易出现不良反应,需引起重视。     

辛伐他汀致横纹肌溶解症1例报告

<正>他汀类药物(Statins)系3-羧基3甲基戊二酰辅酶A还原酶抑制剂。自上世纪80年代后期开始应用于临床,已成为调脂治疗的里程碑药物,其多向性效应也为本类药物在其他临床领域开拓了广泛的应用前景。然而,他汀治疗可诱发包括良性肌痛、更为严重的肌炎以及罕见的致死性横纹肌溶解症     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.