120例甲状腺功能亢进患者心电图分析

目的探讨甲状腺功能亢进(甲亢)患者的心电图表现。方法 120例甲亢患者作为甲亢组(A组),120例性别、年龄匹配的健康体检者作为正常对照组(B组),对两组心电图资料进行分析对比。结果 A组心电图异常改变91例(75.83%),B组心电图异常改变为32(26.67%),差异有统计学意义(P0.05)。甲亢患者心电图改变以窦性心动过速(窦速)、房性早搏(房早)、ST-T改变、心房颤动(房颤)为主。结论甲亢患者心电图异常发生率较高,多表现为窦速、房早、ST-T改变、房颤。     

肌钙蛋白Ⅰ水平检测对急诊心房颤动患者的临床作用

目的:探讨肌钙蛋白I(TnI)水平检测对急诊心房颤动患者的临床作用及预测价值。方法:回顾性分析我院662例急诊心房颤动患者的临床资料,依据TnI水平将患者分为A组220例(TnI轻度升高)、B组283例(TnI正常)、C组159例(未检测TnI)。主要终点为1年内全因死亡及急性心肌梗死(AMI)。结果:A组患者复合终点事件、AMI发生率显著高于B组和C组(P0.01),但3组患者1年内总体病死率比较差异无统计学意义。结论:TnI轻度升高与冠状动脉疾病发生率及AMI发生率增加有关。     

浅析更年期女性动态心电图ST-T改变的临床意义

目的探讨更年期女性动态心电图ST-T改变的临床意义。方法选取2010年2月至2011年11月于信阳市第二人民医院进行动态心电图检查的130例患者,选取31例年龄45～57岁女性患者及同年龄阶段的男性患者26例,分为55～57岁、50～54岁、45～49岁三组进行对比分析。结果 ST-T改变特点:主要表现在aVF、Ⅲ、Ⅱ导联。更年期女性动态心电图ST-T段改变特点:睡眠中或安静状态中ST-T段基本正常,全部ST-T段改变均出现在日间活动或心率较快时。女性ST-T段无改变者有27例,平均心率为78次/min;女性ST-T段有改变者有9例,平均心率为74次/min,两组比较差异无统计学意义(P>0.05)。更年期女性动态心电图不同年龄段比较:55～57岁(2例,22.22%)、50～54岁(4例,44.44%)、45～49岁(3例,33.33%)三组,三组间比较差异无统计学意义(P>0.05);不同性别动态心电图比较:26例男性患者中有1例发生ST-T段改变,占3.85%;31例女性患者中有9例发生ST-T段改变,占29.03%,两组比较差异有统计学意义(P<0.05)。发生ST-T改变的女性患者进一步做心得安试验,有6例ST-T恢复正常。结论更年期女性动态心电图ST-T段改变多为功能性,应主要治疗自主神经功能及调节内分泌。     

全麻或硬膜外麻醉对高龄伴无症状心肌缺血患者循环系统的影响

目的观察全麻或硬膜外麻醉对高龄伴无症状心肌缺血行大隐静脉手术患者循环系统影响。方法术前24h行动态心电图(Holter)监测,选取年龄70-90岁,ASA分级:Ⅱ-Ⅲ级,择期行单肢大隐静脉手术的伴无症状心肌缺血患者80例,随机分为硬膜外麻醉组(A组)和全身麻醉组(B组),术后48h进行动态心电图(Holter)监测,记录两组患者术中各时间点的血流动力学变化及ST-T段变化情况,观察两组患者术后心血管事件的发生情况,研究两种麻醉方式对高龄伴无症状心肌缺血患者围术期循环影响。结果术前两组患者均检测出患有无症状心肌缺血,全身麻醉组平均动脉压在麻醉后20min内较麻醉前降低,但同一时段ST-T段比较无统计学差异(P0.05)。术后48h Holter监测显示术后A组心肌缺血及心律失常发生率明显低于B组(P0.05):术后第一天A组发生窦性心动过缓4例、阵发性室上速5例、房室传导阻滞4例;B组发生窦性心律不齐5例、阵发性室上速6例,房室传导阻滞4例,室早5例。术后第二天A组发生房室传导阻滞5例,房早4例;B组发生窦性心动过速5例,阵发性室上速4例,房室传导阻滞5例,窦性心律不齐2例。Holter示术后48h两组均未发生严重心血管意外事件。结论对于高龄伴无症状心肌缺血患者,硬膜外麻醉对围手术期患者循环影响较小,有利于维持术后患者血流动力学稳定。     

动态心电图诊断心律失常及ST-T改变与冠心病的关系

目的探讨动态心电图诊断心律失常及缺血性ST-T改变与冠心病的关系。方法将92例心律失常患者按有无心绞痛发作史分为A组48例和B组44例,分别进行24小时动态心电图检测。结果A组48例心律失常不伴有典型心绞痛及缺血性ST-T改变者,冠心病的阳性率为12.5%。B组44例心律失常伴有典型心绞痛及缺血性ST-T改变者,冠心病变的阳性率为91%。结论动态心电图诊断单纯心律失常及ST-T改变对于冠心病的相关性较差,不能单纯的把它们看作冠心病的表现而诊断为冠心病,需要结合其它情况综合考虑并排除其它相关疾病,才有可能把冠心病的误诊、漏诊率减少到最底限度,从而提高诊断的正确性,只有结合临床,有典型的心绞痛发作史及其它相关诊断阳性、动态心电图显示缺血性ST-T改变,且S-T压低>1.5mV者,作为临床诊断冠心病才有较大的价值。     

病毒性心肌炎动态心电图与临床表现相关性分析

选取2013年1月~2014年1月我院收治的60例具有临床症状的病毒性心肌炎患者的病例资料,根据患者的临床症状分为3组,23例发热患者为A组,31例心悸、胸痛、胸闷患者为B组,29例水肿患者为C组。分析60例患者的动态心电图资料,将患者动态心电图资料与其临床症状进行对比,并分析。结果 60例病毒性心肌炎患者中窦性心动过速32例(53.33%),窦性心动过缓5例(8.3%),ST-T改变42例(70%),窦性心律不齐18例(30%),传导阻滞35例(58.33%),期前收缩37例(61.66%),房室肥大13例(21.67%),肢体导联低电压11例(18.33%);A组患者中82.61%出现窦性心动过速,高于其他两组,差异具有统计学意义,B组患者中有80.65%出现ST-T改变,90.32%出现期前收缩,高于其他两组,差异具有统计学意义,C组患者中89.66%出现肢体导联低电压,与其他两组相比,差异具有统计学意义。病毒性心肌炎患者动态心电图与临床表现具有相关性,动态心电图可较好的反应患者的心肌受损情况,有助于临床诊断。     

丹参多酚酸盐治疗老年不稳定型心绞痛临床疗效观察

目的 观察丹参多酚酸盐治疗老年不稳定型心绞痛的临床疗效.方法 选择不稳定型心绞痛高龄患者共86例,随机分为两组各43例,对照组采用常规药物治疗,治疗组在常规药物治疗的基础上,给予丹参多酚酸盐200 mg,每日1次,共14 d.观察两组患者临床症状改善情况、硝酸酯类用量变化、心电图ST-T改变及治疗前后血小板聚集率、高敏C-反应蛋白、D-二聚体变化.结果 治疗组心绞痛症状改善38例(88％),心电图改善28例(65％)；对照组分别为30例(70％),16例(37％).两组比较差异有统计学意义.结论 丹参多酚酸盐能更有效改善老年心绞痛症状及心电图ST-T变化,减少心脏不良事件的发生.     

ST抬高型急性心肌梗塞溶栓后心电图改变分析与研究

目的 研究分析ST抬高型急性心肌梗塞溶栓后的心电图改变情况.方法 选取我院2018年1月至2020年12月施行冠状动脉介入溶栓手术治疗的ST抬高型急性心肌梗塞患者共48例,心电图ST段回落＜50％者17例(设为A组),ST段回落≥50％者31例(设为B组),对比两组患者各项指标检查情况.结果 B组术后12h TIMI血...     

静息心电图ST-T慢性改变的患者冠状动脉造影分析

目的:分析冠状动脉血管病变与心电图慢性ST-T改变的关系.方法:对213例患者冠状动脉造影和心电图结果进行对比分析.结果:(1)135例患者心电图有慢性ST-T改变,其中冠状动脉造影阳性83例(61.48%),阴性52例(38.52%).(2)78例患者心电图ST-T表现正常,冠状动脉造影阳性46例(58.97%),阴性32例(41.03%),2组比较差异无统计学意义(P>0.05).结论;常规静息心电图慢性ST-T改变不能诊断冠心病.     

盐酸替罗非班对心肌梗死急诊PCI术后合并冠脉内血栓的疗效和安全性

[目的]观察盐酸替罗非班(欣维宁)对急性ST段抬高型心肌梗死(AMI)急诊经皮冠状动脉介入(PCI)治疗后合并冠脉血栓患者的疗效及安全性.[方法]本院AMI患者55例,冠脉造影显示均有冠脉内血栓形成,PCI治疗后血栓未能消失,远端TIMI血流1级或以下.55例患者分为三组:A组为本院尚未使用欣维宁治疗患者共16例,B组为术中开始静脉使用欣维宁患者共20例,C组为术中开始冠脉内注射欣维宁联合静脉使用欣维宁患者19例.观察患者术前、术后心电图ST段回落；住院期间主要心脏事件(Mace事件)发生率、出血发生率情况.[结果]术后心电图ST段回落≥50％发生率B组(45.0％)与C组(78.9％)显著高于A组(25.0％)；总的Mace事件发生率A组(37.5％)显著高于B组(10.0％)与C组(5.3％)；C组与B组比较有降低趋势,但差异无统计学意义(P＞0.05)；总的出血发生率B组(20.0％)、C组(15.8％)与A组(6.3％)相比有升高趋势,但差异无统计学意义(P＞0.05).[结论]欣维宁可改善急诊PCI中合并冠脉内血栓患者的心电图ST回落,冠脉内应用更为明显；可减少Mace事件发生率；不增加出血风险.     

CT阻塞指数对急性肺栓塞严重性的评价

【目的】研究CT阻塞指数评价急性肺栓塞（APE）严重性的价值。【方法】根据APE患者的临床表现,把45例APE患者分为两组：严重APE组（14例）和非严重APE组（31例）。在CT肺血管造影上,根据肺动脉内栓子阻塞部位和程度计算CT阻塞指数（Az值）。使用U检验法评价严重APE组和非严重APE组之间的CT阻塞指数的差异;使用ROC曲线分析CT阻塞指数诊断APE严重性的准确度。【结果】严重APE组的CT阻塞指数（中位数45％）高于非严重APE组的CT阻塞指数（中位数25％）（P〈0．01）。阻塞指数的Az值〉0．5。【结论】在CT上测量阻塞指数可以定量评价APE患者的严重性。     

老年心血管疾病伴焦虑抑郁障碍患者心电图对比分析

目的探讨老年心血管疾病伴焦虑抑郁障碍患者心电图改变的临床特征。方法对283例老年心血管疾病伴焦虑抑郁障碍患者（A组）和267例老年心血管疾病不伴焦虑抑郁障碍患者（B组）的心电图资料进行对比分析。结果老年心血管疾病患者心电图均以房性心律失常、室性早搏、窦性心律失常、各种传导阻滞、缺血性ST—T异常改变为主,尤其以房性心律失常最多见。A组窦性心动过速、室性早搏检出率显著高于B组（χ2=12．45、11．40,P〈0．01）。结论老年心血管疾病患者心电图主要以心律失常及缺血性ST—T异常改变为主,当心电图上以窦性心动过速、室性早搏为主要表现时,应加强其心理方面的重视,并结合临床表现予以有针对性的干预。     

Early treatment of migraine with rizatriptan: a placebo-controlled study

OBJECTIVE: To evaluate the efficacy of rizatriptan when administered early during a migraine attack. BACKGROUND: Several studies indicate that triptans are more efficacious when administered early during a migraine attack, when the pain is still mild. METHODS: One hundred and twelve rizatriptan-na?ve patients aged 20 to 64 years with a history of migraine with or without aura that progressively worsened when left untreated were instructed to treat a total of three migraine attacks with either rizatriptan 10 mg or placebo as early as possible during each attack. Seventy-four patients (68 women and 6 men) were assigned to use the active drug and 38 (35 women and 3 men) to placebo. The primary efficacy endpoint was pain-free response at 2 hours after administration of the study drug. Secondary efficacy measures were pain-free response at 1 hour and sustained pain-free response lasting between 2 and 24 hours. RESULTS: A total of 216 attacks were treated in the rizatriptan group and 109 in the placebo group. Pain-free response at 2 hours after early treatment was noted in 151 (70%) of attacks in the rizatriptan group and in 24 (22%) in the placebo group (P < .01). Pain-free response at 1 hour occurred in 97 (45%) and 9 (8%) attacks, respectively (P < .01). When the attacks were categorized by headache severity at the time of treatment, the pain-free response at 2 hours was higher for mild attacks than for moderate or severe attacks (P < .01). Sustained pain-free response after treatment was significantly higher for attacks treated with rizatriptan (60%) than for those treated with placebo (17%) (P < .001). Adverse events were observed in 62 patients in the rizatriptan group and 15 in the placebo group. Only 1 patient taking rizatriptan discontinued the study because of adverse events, and no serious adverse events were reported. CONCLUSIONS: Rizatriptan is significantly more likely than placebo to produce a pain-free response within 2 hours when the drug is administered early in the migraine attack, when pain is mild rather than moderate or severe.     

脉冲高容量血液滤过对脓毒症患者细胞免疫功能的影响

目的 探讨脉冲高容量血液滤过对脓毒症患者外周血辅助性T细胞(T helper,Th)17及CD4+ CD25+ 调节性T细胞(Treg)影响及其临床价值.方法 本研究为前瞻性对照研究,将2008年1月至2010年11月在安徽省立医院ICU住院的脓毒症患者40例(男/女=24/16),年龄25～75岁,按照疾病严重程度分为3组:脓毒症组14例(男/女=8/6);严重脓毒症组15例(男/女=9/6);脓毒症休克组11例(7/4).入选和疾病严重程度分级标准:根据1992年美国胸科医师学院(ACCP)/美国危重病医学会(SCCM)共识会议制定的脓毒症诊断标准.排除标准:患有自身免疫系统疾病、急性脑卒中、心肌梗死、病毒性肝炎、HIV感染的患者以及入院前3个月内使用过激素或免疫抑制剂的患者.其中入组5 d内未行血液净化治疗患者15例(男/女=8/7)入选为A组;5 d内行脉冲高容量血液滤过的25例患者(男/女=16/9)入选为B组.两组一般资料具有可比性.连续性血液净化以24 h为1周期,两次血滤之间间隔24 h.其中高容量血液滤过(70 mL·kg-1·h-1)治疗6～8 h后续行常规CVVH治疗16～18 h剂量(35 mL·kg-1·h-1).所有入选的40例脓毒症患者在入选当天和第5天清晨空腹抽外周血送检,行流式细胞术检测血中Th17细胞及CD4+ CD25+调节性T细胞的比例.计量资料采用t检验,配对t检验和One way ANOVA分析.小样本率的比较采用确切概率法.相关分析采用Peason相关分析.另选取本院体检中心的20例健康人为健康对照组.结果 健康对照组Th17表达率为(0.91±0.38)%,CD4+ CD25+ Treg细胞表达率为(0.39±0.23)%.40例脓毒症患者在第1天这两项指标明显升高(P<0.05):其中脓毒症组分别为(2.09±0.53)%,(1.72±0.59)%;严重脓毒症组(3.90±0.80)%,(2.72±0.22)%;脓毒性休克组(1.85±0.35)%,(3.55±0.51)%.Th17表达率,严重脓毒症组最高(P<0.05).而脓毒症休克组与脓毒症组比较差异无统计学意义(P>0.05).CD4+ CD25+ 调节性T细胞表达率则呈现:脓毒症休克组>严重脓毒症组>脓毒症组(P<0.05).B组与A组比较,脉冲高容量血液滤过能显著的下调脓毒症患者Th17[(1.87±0.43)vs.(2.48±1.05),P<0.05]和CD4+ CD25+ 调节性T细胞[(1.92±0.89)vs.(2.63±0.92),P<0.05]的表达.结论 脓毒症患者外周血Th17细胞和CD4+ CD25+调节性T细胞表达增加,提示Th17细胞和CD4+ CD25+调节性T细胞在脓毒症的免疫发病机制中可能起着重要作用.脉冲高容量血液滤过能有效的调整Th17细胞和CD4+ CD25+ 调节性T细胞的表达,可作为脓毒症免疫调节治疗的重要手段之一.

Abstract：

Objective To study the effects of pulse high volume hemofiltration (PHVHF) on the changes of Th17 cells (T helper 17 cells) and CD4 + CD25 + reguratory T cells (Treg cells) in peripheral blood of patients with sepsis and to evaluate the clinical value of this intervention. Methods The patients were included in this prospective study as per the criteria of sepsis set by America Chest Physicians College/America Society for Critic Care Medicine in 1992. The patients were excluded: ① immune system disorder, ② acute stroke, ③ myocardial infarction, ④ virus hepatitis,⑤ human immunodeficiency virus infection, ⑥ under immunosuppressive therapy. Forty patients (24 males, 16 females, aged from 25 to 75years) with sepsis in ICU were enrolled from January. 2008 to November. 2010. According to the severity of disease, the patients were divided into three groups; moderate sepsis group (n = 14, 8 males, 6 females) , severe sepsis group (n = 15, 9 males, 6 females) , and septic shock group (n = 11, 7 males, 4 females). The initially clinical data of three groups were comparable. Twenty healthy individuals served as controls. According to the mode of treatment, forty patients were also divided into two groups: conventional treatment group (group A, n= 15) in which patients were treated without PHVHF within 5 days after admission and trial group (group B, n=25) in which patients were treated with pulsed high volume hemofiltration (PHVHF) within 5 days after admission. In group B, high volume hemofiltration (70 mL · kg-1 · h-1) was given to patients for 6 ～ 8 hours, and then conventional continuous vein - vein hemofiltration (35 mL · kg-1 · h-1) for 16 ~ 18 hours. The total length of period for continuum blood scavenging was 24 hours as one cycle. The interval between two cycles of blood scavenging was 24 hours. The changes of Th17 cells and CD4+ CD25 + Treg cells of 40 patients were detected with flow cytometry on the 1st day and the 5th day after admission. The data were analyzed by using SPSS version 13. 0 software. Measurement data were analyzed with Paired-samples t-test, independent-samples t-test or one way ANOVA . Ratio of small samples was compared with fisher's exact test, and the correlation was analyzed by using Pearson correlation analysis. Results The rates of Th17 cells were( 0.91 ±0.38)%, (2.09 ±0. 53)% , (3.90 ±0. 80)% , and ( 1. 85 ±0.35)% in control, moderate sepsis, severe sepsis, and septic shock groups, respectively, while the rates of CD4+ CD25+ Treg cells were (0.39 ±0.23)%, (1. 72 ±0. 59)% , (2.72 ±0. 22)% , and (3. 55 ±0. 51)% , respectively. The rate of Thl7 cells on the 1st day was higher in severe sepsis group than that in other two groups ( P < 0. 05 ) without significant difference between septic shock and moderate sepsis groups ( P > 0. 05). Moreover , the rate of CD4+ CD25 + Treg cells was up - regulated on the 1st day in the following order from high to low: septic shock group > severe sepsis group > sepsis group (P < 0.05). The rates of Th17 cells and CD4 + CD25 + Treg cells in patients of group B decreased in greater degree than that did in patients of group A (P < 0.05 ). Conclusions The changes of Th17 cells and CD4 + CD25 + Treg cells may play an important role in pathogenesis of sepsis, and the pulsed high volume hemofiltration may be one of the effective treatments for the patients with sepsis by regulating the rates of Thl7 cells and CD4 + CD25 + Treg cells.     

手术方式对炎性细胞因子和应激激素的影响

目的：探讨不同手术方式所致创伤对炎性细胞因子和应激激素的影响及其临床意义。方法：分析胃癌根治术（Ａ组,１３例）、低位直肠癌会阴腹联合根治术（Ｂ组,１３例）和开胸食管贲门癌根治术（Ｃ组,１１例）患者术后白细胞介素６（ＩＬ６）、ＩＬ８、促肾上腺皮质激素（ＡＣＴＨ）和皮质醇的变化特点,并与１０例同期行阑尾炎和腹股沟疝小手术患者（Ｄ组）作比较。结果：①Ａ、Ｂ、Ｃ３组患者术后２小时ＩＬ６和ＩＬ８含量均显著升高（Ｐ均＜０．０１）,但Ａ、Ｂ、Ｃ组上升幅度不同,术后１日均显著下降;②Ａ、Ｂ、Ｃ、Ｄ４组患者术后２小时ＡＣＴＨ浓度均显著升高（Ｐ均＜０．０１）,术后１日均显著降低,但Ａ、Ｂ、Ｃ３组间比较无显著性差异（Ｐ＞０．０５）;③Ａ、Ｃ组术后２小时皮质醇显著升高（Ｐ均＜０．０１）,术后１日则显著下降;④术后１日ＩＬ６与ＩＬ８含量显著相关（Ｐ＜０．０５）,术后２小时ＡＣＴＨ与皮质醇水平显著相关（Ｐ＜０．０１）。结论：按照一定时间要求监测围手术期细胞因子和应激激素的变化,有利于判断手术创伤程度和预后。     

慢性阻塞性肺疾病患者12导联动态心电图的改变

目的研究慢性阻塞性肺疾病患者12导联动态心电图的改变。方法选取已住院并明确诊断为COPD,且不同时患有其他老年性疾病的患者共98例为病例组,选择同期无明显症状体征及慢性病史的门诊就诊的68例患者为对照组,比较病例组与对照组的心律失常检出率与严重心律失常发生率、心率变异性。结果病例组患者心率失常的诊出率(100%比91.8%)和严重心律失常的发病率(68.4%比8.2%)明显高于对照组,差异有统计学意义(χ2=4.082,χ2=4.378,P0.05);两组患者的ST-T改变发生率比较,差异无统计学意义(P0.05)。病例组男女患者严重心率失常及ST-T改变的发生率比较,差异无统计学意义(P0.05)。病例组患者心率变异性的指标:SDDN、SDNNI、SDANN、r MSDD、PNN50与对照组相比均变化明显,差异有统计学意义(P0.05)。结论有合并症的慢性阻塞性肺疾病患者严重心律失常的发生率较高,心率变异性指标变化明显。     

糖尿病酮症酸中毒患者心肌酶谱与心电图变化临床研究

目的：探讨心肌酶谱及心电图改变对糖尿病酮症酸中毒（DKA）患者病情评估的意义。方法：检测并比较50例DKA患者急性期及缓解期的心肌酶谱和心电图变化。结果：DKA患者急性期心肌酶谱均升高,与缓解期比较有显著性差异（P〈0．05）,重症DKA患者心肌酶较轻症DKA患者明显升高（P〈0．05）;DKA急性期患者均有不同程度的心电图异常,其中窦性心动过速38例（76％）,ST—T改变30例（60％）。结论：心肌酶谱及心电图改变可作为反映DKA患者病情变化及严重程度的指标。     

Electrocardiographic and cardiovascular effects of the 5-hydroxytryptamine3 receptor antagonists

OBJECTIVE: To review the electrocardiographic (ECG) and cardiovascular effects of 5-hydroxytryptamine(3) (5-HT(3)) receptor antagonists preclinically, in healthy volunteers, and in patients undergoing chemotherapy or surgery. DATA SOURCES: A MEDLINE search was performed of clinical trials and preclinical data published between 1963 and December 2002 assessing the ECG and cardiovascular effects of 5-HT(3) receptor antagonists, supplemented with reviews and secondary sources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified were evaluated and all information deemed relevant was included in this review. DATA SYNTHESIS: There are no clinically relevant differences in efficacy and safety among the available 5-HT(3) receptor antagonists for prevention and treatment of chemotherapy-induced and postoperative nausea and vomiting. As a class, they have well-defined electrophysiologic activity. Changes in ECG parameters (PR, QRS, QT, QTc, JT intervals) are small, reversible, clinically insignificant, and independent of the patient population studied, and patients are asymptomatic during these changes. ECG changes are most prominent 1-2 hours after a dose of dolasetron, ondansetron, and granisetron and return to baseline within 24 hours. Clinically important adverse cardiovascular events associated with these changes are rare. No serious cardiac events (including torsade de pointes) arising from ECG interval changes have been attributed to 5-HT(3) receptor antagonist use. CONCLUSIONS: Clinical data demonstrate that ECG interval changes are a class effect of the 5-HT(3) receptor antagonists. Theoretical concern regarding cardiovascular adverse events with these agents is not supported by clinical experience. The significant benefits of these agents outweigh the theoretical small risk of meaningful cardiovascular events.     

以奥沙利铂为主联合化疗晚期胃癌的研究

目的比较奥沙利铂、亚叶酸钙及氟尿嘧啶与顺铂、亚叶酸钙及氟尿嘧啶联合化疗对晚期胃癌的疗效和不良反应.方法 108例患者被随机分入两组,A组56例,B组52例.A组：奥沙利铂130 mg/m^2,静脉滴注4小时,第1天;亚叶酸钙200 mg/m^2,静脉滴注2小时,第1～5天;氟尿嘧啶300 mg/m^2,静脉滴注4小时,第1～5天.B组：顺铂80 mg/m^2,静脉滴注2小时,第1天;亚叶酸钙200 mg/m^2,静脉滴注2小时,第1～5天;氟尿嘧啶300 mg/m^2,静脉滴注4小时,第1～5天.3周为1周期,3周期为1疗程.结果 A组有效率60.7%,中位生存时间13.0个月,B组有效率53.8%,中位生存时间11.5个月（P〉0.05）.有效患者的中位缓解期分别是7.8个月和5.5个月,差异有统计学意义（P＜0.05）.A组较B组消化道反应、血液毒性有明显的下降（P＜0.05）.A组中神经毒性出现较多（P＜0.05）.结论奥沙利铂、亚叶酸钙及氟尿嘧啶联合化疗方案治疗晚期胃癌临床疗效肯定,值得进一步研究.     

卡泊芬净经验性治疗粒细胞减少伴持续发热患者的安全性、耐受性和疗效的非对照、开放、多中心临床研究

目的评价卡泊芬净注射剂经验性治疗粒细胞减少伴持续发热患者的安全性、耐受性和疗效。方法本研究为非对照、开放、多中心临床试验，患者因化疗或接受造血干细胞移植出现中性粒细胞绝对值计数〈500×10^6／L，持续至少96h，入选前接受胃肠外广谱抗菌药治疗至少96h，并且在入选前24h内体温〉38．0℃者可入选本研究。统计用药人群发生的严重不良事件、不良事件及其总有效率。结果共入选131例，其中安全性分析集（SS）131例，全分析集（FAS）129例。SS131例中，18例受试者发生24例次临床严重不良事件，均与研究药物无关，发生1例次实验室严重不良事件（血钾降低），与研究药物肯定有关。SS131例中发生与药物有关的非严重不良事件者35例，包括5例同时发生临床不良反应和实验室异常；其中16例发生临床不良反应，多见皮疹、发热、呕吐等；24例发生实验室异常，多见ALT等肝酶升高、血钾降低等。总不良反应发生率为26．7％（35／131），其中临床不良反应发生率为12．2％（16／131），实验室异常发生率为19．1%（25／131）。临床不良反应中91．3%为轻、中度。入选病例中9例（12例次）因不良反应而中止治疗，占6．9％（9／131）。其中6例（9例次）被评价为与试验药物有关，发生率为4．6％（6／131）。FAS和符合方案数据集（PPS）中的总体有效率分别为36．4％（47／129）和40．2％（47／117）。结论卡泊芬净经验性治疗粒细胞减少伴持续发热患者临床不良反应多为轻、中度，患者对其耐受性良好，因药物不良反应中止治疗者少见。卡泊芬净用于经验性治疗粒细胞减少伴发热可获一定疗效。