所谓抗癫痫“中成药”中暗地添加抗癫痫西药成分的调查

目的：调查所谓抗癫痫“中成药”制剂中是否有西药成分。方法：对北大医院癫痫门诊1995～2005年口服“中成药”制剂就诊的癫痫患者进行苯巴比妥、苯妥英钠、卡马西平、丙戊酸钠四种药物的血药浓度监测，并对结果进行分析。结果：在所监测的患者服用的76种“中成药”中，暗中都添加了上述4种西药成分，其中含有一种西药成分有45种，含有二种西药成分有22种，含有三种西药成分有7种，含有四种两药成分有2种。有44种中药添加了苯巴比妥，占的比例最大，其余依次为苯妥英钠、卡马西平、丙戊酸钠。结论：在所谓抗癫痫的“中成药”中暗地里加西药已成为较普遍的现象，严重地侵犯了患者的权益，妨碍抗癫痫的正规治疗，损害了患者的健康。     

癫癎的药物治疗

癫癎的药物治疗应分为西药治疗及中药治疗，西药又分为传统药物及新药，传统药物是指自１９３８年苯妥英钠问世以来，临床一直使用的抗癫癎药物包括苯妥英、苯巴比妥、朴癎酮、卡马西平、丙戊酸、乙琥胺、三甲双酮及一些安定类药物。自１９７８年若干抗癫癎新药上市，又为难治性癫癎的治疗提供了新的手段。祖国医学是伟大的宝库，开发有效的中医药制剂可能为抗癫癎药物治疗开辟新的纪元，科学地研究和使用中药是我们面临的重要课题。值得注意的是，在癫癎的中医药治疗中，有些将中药制剂中添加西药并冠以新药名的做法给癫癎的药物治疗造成了…     

安定、丙戊酸钠及拉莫三嗪对实验大鼠癫癎持续状态作用的研究

目的：研究安定、丙戊酸钠及拉莫三嗪对实验大鼠癫癎持续状态的治疗作用。方法：采用氯化锂-匹罗卡品癫癎持续状态鼠模型，癫癎持续状态2h后，分别给予上述三种抗癫癎药物治疗，观察比较癫癎持续状态的时间。结果：三种抗癫癎药物对癫癎持续状态有不同程度的控制作用，安定起效最为迅速，丙戊酸钠次之，拉莫三嗪较慢，但安定对意识状态有影响。结论：癫癎持续状态的治疗，安定仍然是首选，但丙戊酸钠及拉莫三嗪亦是有效的药物，早期联合长效抗癫癎药物治疗可能是最佳的选择。     

托吡酯转换治疗成人癫癎的研究

目的:评价托吡酯(妥泰)转换用药对成人癫癎的疗效和安全性.方法:对38例用卡马西平或丙戊酸钠治疗效果不佳的成人癫癎患者,加用托吡酯治疗,在加量时逐渐减少原来用药剂量,观察其有效性和安全性.结果:托吡酯转换治疗后,患者癫癎发作减少,其中无发作3例(7.9%),显效17例(44.7%),有效10例(26.3%),无效8例(21%),总有效30例(78.9%).结论:对用卡马西平或丙戊酸钠疗效不佳的患者转换用托吡酯是安全有效的治疗措施.     

难治性癫(癎)靶点学说研究进展

癫(癎)发病机制的研究在近30年内取得了极大的进展,尤其是在生理学和遗传学方面.1978年起,10种新型抗癫(癎)药物(antiepileptic drugs,AED):丙戊酸、托吡酯、拉莫三嗪、加巴喷丁、非氨酯、奥卡西平、氨己烯酸、唑尼沙胺、左乙拉西坦和普瑞巴林等在临床的应用,极大地改善了癫(癎)的治疗.但仍有约三分之一的癫(癎)患者在接受合理的药物治疗后,其发作不能终止,称之为难治性癫(癎)(refractory epilepsy,RE).     

丙戊酸和托吡酯治疗癫癎患者长程视频脑电图分析比较

目的:分析比较口服丙戊酸(Valproate,VPA)和托吡酯(Topiramate,TPM)对癫癎患者长程视频脑电图的影响。方法:对152例单独应用丙戊酸和129例单独应用托吡酯至少两年无发作的癫癎患者脑电图进行分析和比较,所有患者进行至少2次24小时长程视频脑电图检查,期间间隔至少2年。结果:结果:丙戊酸钠组,136例患者癫癎发作波明显减少或消失,15例患者癫癎发作波无明显减少,1例患者癫癎发作波增加;托吡酯组,112例患者癫癎发作波明显减少或消失,16例患者癫癎发作波无明显减少,1例患者癫癎发作波增加。两组比较,差异无统计学意义。结论 :丙戊酸钠和托吡酯均可使症状性癫癎或原发性癫癎的临床发作得到控制,与脑电图的改变基本一致。     

卡马西平致癫癎患儿脑电图呈持续癎样放电2例报告

卡马西平(CBZ)是公认的比较优秀的一线抗癫癎药,尤其是在治疗部分性癫癎发作方面,但有关其致脑电图(EEG)呈持续癎样放电者不多见、现将在我院就诊的2例癫癎患儿服用卡马西平后致EEG呈持续癎样放电报告如下.     

卡马西平对小儿癫痫患者血清钠的影响

目的探讨卡马西平、苯巴比妥、苯妥英钠和丙戊酸钠对癫痫患儿血清钠的影响。方法随机选取分别服用上述四种药物的癫痫患儿和成人癫痫患者各180例,并随机选取性别年龄匹配的儿童和成人健康对照,测定其血药谷浓度时的血清钠水平。结果服用卡马西平的患儿,其血药浓度谷水平时的血清钠浓度均显著低于小儿对照组、服用苯巴比妥的小儿癫痫组和服用卡马西平的成人癫痫组(P <0. 05)。服用苯妥英钠、苯巴比妥和丙戊酸钠的小儿癫痫患者,其血药浓度谷水平时的血清钠浓度与小儿对照组间无统计学差异(P>0.05)。服用卡马西平的患儿,其血药浓度谷水平时的血清钠阳性率(低于生物参考区间下限)均显著高于表面健康对照组和其他药物组和成年癫痫患者(P>0.05)。当血清钠离子浓度截断值为132.1 mmol/L时,对小儿癫痫的高血清卡马西平具有较好的诊断效率(灵敏度为83. 70%,特异性为87.65%)。结论本研究结果提示服用卡马西平的小儿癫痫患者,在用药期间,除应监控血药浓度外还应密切关注血清钠的变化趋势,以预防药物不良反应的发生。     

抗癫癎药物对儿童骨代谢的影响

癫癎是神经系统常见疾病之一,50%以上的患者起病于儿童时期,长期服用抗癫癎药物(AED)是治疗癫癎最常用的方法.儿科常用抗癫癎药主要是卡马西平(CBZ)、丙戊酸(VPA)以及近年来广泛应用于临床的新型抗癫癎药托吡酯(TPM).长期应用这些AED除了引起一些常见的不良反应如皮疹、肝脏毒性反应、胃肠道反应、骨髓抑制外,AED对儿童骨代谢的影响[1,2]越来越引起临床医师的关注,虽然这一影响过程较为缓慢,临床表现轻重不一,但长期作用会对儿童生长发育造成一定的影响,故本文就AED对儿童骨代谢的影响作一简述.     

癫(癎)的电刺激治疗

在癫癎患者中,约有1／3为难治性癫癎患者,尽管有很多新的抗癫癎药物可以供临床医生选择,但是难治性癫癎的发病率并没有下降。应用两种抗癫癎药物而无法有效控制发作者,即使再加用其它抗癫癎药物也不能控制发作。有研究表明,癫癎患者,尤其是难治性癫癎患者,其生活质量和社会功能都受到严重的损害,包括低自卑心理、严重的抑郁、生     

Performance characteristics of four immunoassays for antiepileptic drugs on the IMMULITE 2000 automated analyzer

Carbamazepine, phenobarbital, phenytoin, and valproic acid are commonly used antiepileptic drugs that show complicated pharmacokinetic behavior Nonisotopic immunoassays are used routinely to monitor these drugs, and assay specificity is important to obtain accurate results. By using samples from subjects receiving each of these antiepileptic medications, competitive immunoassays for them were evaluated on an IMMULITE 2000 automated chemiluminescent analyzer (Diagnostic Products, Los Angeles, CA). Phenytoin assays were evaluated using an additional set of samples from patients with abnormal renal function. All 4 methods were linear, had imprecision of less than 10%, and compared well with other commercial immunoassays. A positive bias was observed for phenytoin measured in samples from uremic patients compared with a high-performance liquid chromatography reference method. The molar cross-reactivity of carbamazepine-10,11-epoxide was 12% in the carbamazepine assay. Phenytoin metabolites and fosphenytoin had substantial cross-reactivity in the phenytoin assay. All antiepileptic drug assays performed well and are suitable for use in monitoring patients receiving antiepileptic drug therapy. One possible exception is the phenytoin assay with samples from patients with renal insufficiency.     

Comparison of carbamazepine, phenobarbital, phenytoin, and primidone in partial and secondarily generalized tonic-clonic seizures

We conducted a 10-center, double-blind trial to compare the efficacy and toxicity of four antiepileptic drugs in the treatment of partial and secondarily generalized tonic-clonic seizures in 622 adults. Patients were randomly assigned to treatment with carbamazepine, phenobarbital, phenytoin, or primidone and were followed for two years or until the drug failed to control seizures or caused unacceptable side effects. Overall treatment success was highest with carbamazepine or phenytoin, intermediate with phenobarbital, and lowest with primidone (P less than 0.002). Differences in failure rates of the drugs were explained primarily by the fact that primidone caused more intolerable acute toxic effects, such as nausea, vomiting, dizziness, and sedation. Decreased libido and impotence were more common in patients given primidone. Phenytoin caused more dysmorphic effects and hypersensitivity. Control of tonic-clonic seizures did not differ significantly with the various drugs. Carbamazepine provided complete control of partial seizures more often than primidone or phenobarbital (P less than 0.03). Overall, carbamazepine and phenytoin are recommended drugs of first choice for single-drug therapy of adults with partial or generalized tonic-clonic seizures or with both.     

三黄汤、茵栀黄联合西药治疗新生儿黄疸168例临床观察

目的探讨中药三黄汤、茵栀黄联合西药、蓝光照射等联合治疗新生儿黄疸的临床疗效。方法轻度:三黄汤加鲁米那、强的松口服治疗三天,中重度:茵栀黄加白蛋白、强的松、维生素、鲁米那、蓝光照射等。结果 31例轻度患儿给予三黄汤加鲁米那治疗后黄疸消退时间3-4天23例,5-6天8例,血清总胆红素平均6天降到正常值;137例中重症患儿,茵栀黄加白蛋白、强的松、维生素、鲁米那、蓝光照射后嗜睡、呕吐消失,二便正常,皮肤及巩膜黄染6-20天消退,血清总胆红素平均6-8天(105例)、8-10天(24例)、10-18天(8例)降到正常。结论早期发现并早期应用中药配合西药综合治疗新生儿黄疸,可以明显缩短病程并预防核黄疸发生。     

针灸联合多种方法治疗骨质疏松的网状Meta分析

文题释义： 网状 Meta 分析：是传统Meta分析的扩展,可以同时比较3个或者3个以上的干预措施的疗效。但是目前对网状Meta分析的定义相对混乱,按照“国际药物经济学和结果研究协会”的报告,网状Meta分析包括调整间接比较和混合治疗分析。混合治疗分析是在直接比较的基础上合并间接比较的证据,从而提高分析结果的精确性,但是这种方法主要是应用于干预措施可以形成具有闭合环路(loop)时。网状Meta分析的最大优势就是可以对治疗同类疾病的不同干预措施进行量化比较,并按照某一结果指标效果好坏进行排序,进而选择最优治疗方案。 针灸：是一门独具特色的传统医学学科。临床上,常将针灸作用于经络腧穴以防治疾病的方法和技术,称之为针灸疗法。针灸具有适应证广、疗效明显、应用方便、经济安全等优点。 背景：针灸及其联合其他疗法与标准西医疗法之间比较治疗骨质疏松有效性的研究结论存在争议,现有的原始研究和 Meta 分析多为单一针灸治疗、针灸联合西药治疗与标准西医疗法间的比较,缺乏针灸联合其他疗法之间的直接比较,使人们难以对针灸疗效有较清晰、全面的认识。 目的：采用网状Meta分析技术,比较针灸联合其他疗法治疗骨质疏松疗效的差异。 方法：在CNKI、维普、万方、SinoMed、PubMed、Cochrane Library数据库上进行检索,纳入不同针灸疗法对比治疗骨质疏松的临床随机对照试验(RCT)。根据相关纳入与排除标准对文献进行筛选后提取相关资料,并对纳入文献进行质量评价。运用Stata 14.0软件进行文献数据分析及作图。 结果与结论：最终纳入34篇随机对照试验,共涉及7种干预措施,包括：单一针灸治疗,单一西药治疗,单一中药治疗,针灸+西药联合治疗,针灸+中药联合治疗,中药+西药治疗,针灸+中药+西药联合治疗。①在治疗有效率上,针灸+中药的疗效最佳,且针灸+中药、针灸+西药以及针灸+中药+西药,均显著比中药+西药治疗的有效率高(P < 0.05);②在增加患者骨密度方面,针灸+中药、针灸+西药以及针灸+中药+西药,均优于单一中药或西药组(P < 0.05);③在缓解患者疼痛方面,与单一西药治疗相比,针灸+西药治疗能缓解患者的疼痛(P < 0.05),但其余治疗方式之间,并无明显的差异(P > 0.05)。在纳入的研究中,有极少数患者出现针刺后穴位瘀血现象,但均未出现晕针或未报道,也未发现其他毒副作用。提示：针灸联合其他疗法,可以提高有效率、增加骨密度、缓解患者疼痛。 ORCID: 0000-0001-7755-5563(岑卓灏) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Increased P-glycoprotein function and level after long-term exposure of four antiepileptic drugs to rat brain microvascular endothelial cells in vitro

To investigate whether long-term exposure to four typical antiepileptic drugs (AEDs): phenobarbital (PB), phenytoin (PHT), carbamazepine (CBZ) and valproic acid (VPA) can increase P-glycoprotein (P-gp) level and function in primary cultured rat brain microvascular endothelial cells (rBMECs) in vitro, the rBMECs were incubated in culture medium containing indicated drugs (PB, PHT, CBZ, VPA and rifampin) for 60 days in a gradient concentration manner. Age-matched cells were incubated in normal culture medium. After a 60-day exposure to the indicated drugs, P-gp function and level in cells were measured using rhodamine 123 (Rho123) accumulations and Western blot analysis, respectively. Lower Rho123 accumulation in drug-treated cells was found than that in age-matched cells. Cyclosporin A (CsA) and verapamil (Ver) increased Rho123 accumulation both in drug-treated cells and age-matched cells. The magnitude of increased Rho123 accumulation in drug-treated cells was larger than that in age-matched cells. Higher P-gp levels were found to be consistent with decrease of Rho123 accumulation in drug-treated cells. The results verified the hypothesis that long-term exposure to the four antiepileptic drugs can induce P-gp function and level in rBMECs.     

凉血活血法治疗肝炎高胆红素血症36例临床疗效观察

目的 观察凉血活血法对肝炎高胆红素血症（TBIL）的临床疗效。方法 72例肝炎高胆红素血症患者随机分为治疗组36例,对照组36例,治疗组在常规西药综合治疗的基础上给予凉血活血中药煎剂,1剂／d,分2次日服,疗程4周,对照组在常规西药综合治疗的基础上加用促肝细胞生长素80-120mg,10％葡萄糖250ml静脉滴注,1次/d,疗程4周,治疗4周后比较两组患者肝功能高胆红素（TBIL）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血清白蛋白（ALB）的变化。结果 治疗组显效率80．55％,对照组显效率50％,两组比较差异有统计学意义（P〈0．05）。结论 凉血活血法治疗病毒性肝炎高胆红煮血症疗效肯定,无毒副作用。     

中药汤剂联合西药口服治疗痛风性关节炎预后的Meta分析

目的 从有效率及复发率对中药汤剂联合西药治疗GA进行分析,以期为中药汤剂联合西药治疗GA 提供更新的、全面的循证医学证据。方法 以“痛风性关节炎”或“痛风”自由组合“中西医”“中药联合西药”“中医”“中药”为检索词在CNKI、万方、维普,以“gouty arthritis”或“gout”自由组合“chinese medicine”“herb”为检索词在PubMed、Science Direct、Springer Link数据库中检索相关的随机对照试验（RCTs）,2名研究者分别独立进行文献筛选、质量评价和数据提取,使用Rev Man5.3软件依据cochrane系统评价方法进行Meta分析。结果 共纳入5篇RCTs文献,542例患者。Meta分析结果提示,中药汤剂联合西药口服的临床有效率优于西药对照组,复发率低于西药对照组（P<0.05）。结论 口服中药汤剂联合西药在治疗痛风性关节炎方面存在一定优势,与西药治疗相比,复发率较低。     

Nerve conduction velocity in patients under long term treatment with antiepileptic drugs

Motor and sensory nerve conduction velocity (NCV) of median nerve and motor NCV of peroneal nerve were measured in 548 epileptic patients, aged 20 to 40 years, under long term treatment with antiepileptic drugs. Compared with a control collective of 70 healthy persons in the same age the epileptics showed a reduction of all NCVs. 19 percent of the epileptic collective had at least 1 diminished NCV. Negative correlations with total amount and average daily dose of antiepileptic drugs were found in both sexes for sensory NCV of median nerve and motor NCV of peroneal nerve, only in males also for motor NCV of median nerve. Only in females, duration of therapy correlated negative with sensory NCV of median and motor NCV of peroneal nerve. In patients under monotherapy the group with carbamazepine treatment showed the lowest NCV values, the difference being significant for motor NCV of median nerve in comparison to phenytoin and valproate sodium. It is concluded, that NCV generally is lowered under long term treatment with antiepileptic drugs and that phenytoin has no specific influence compared with the other drugs.     

中西医结合治疗对肺心病急性发作期血液流变性的影响

慢性肺源性心脏病（肺心病）,由于反复肺部感染,缺氧,易出现弥散性血管内凝血（ＤＩＣ）,从而导致肺血管阻力增加、肺动脉高压,而加重心衰和呼衰。为此我们于１９９２～１９９６年采取中西医结合方法治疗慢性肺心病急性发作期患者６０例,设对照组进行疗效对比,并对二组治疗前后的血液流变性改变及其与疗效的关系进行了分析。１　资料与方法１．１　临床资料肺心病急性发作期患者１０８例,病程２至２４年,均系住院病人。全部患者根据我国第二次肺心病专业会议制定的诊断标准［１］确诊。１０８例患者入院检测血液流变学指标均呈异常…     

STUDY AND PREPARATION ON “PAIN TAN NING” AND ITS CLINICAL APPLICATION AND STUDY ON BRAIN ATLAS

Objective:To observe clinical effect of combined mixture of traditional chineses and western medicine " PIAN TAN NING" in treatment of ischemic cerebrovascular diseases and change of brain atlas. Methods: In 6660 patients with ischemic cerebrovascular disease, the curative effect of "PIAN TAN NING" and brain atlas were observed and other 30 cases were compared with treatment of Dextran. Results: After treatment,patient's clinical symptoms and recovered degree of myodynamia and brain atlas improved significantly. Total effective rate was 96.7%. But the contral group was 80.0%. There was a significant difference between them ( p < 0. 05). Conclusion: The " PIAN TAN NING" produced a good clinical curative effect in treatment of ischemic cerebrovascular diseases and the side effect was only a few. So it can be applied very well in patients with ischemic cerebrovascular disease. The applied value of brain atlas was very good.