司维拉姆治疗透析患者高磷血症的快速评估

摘 要 目的：快速评估司维拉姆治疗透析患者高磷血症的有效性、安全性和经济性。方法：通过计算机检索PubMed、Embase、the Cochrane Library和专业卫生技术评估数据库收集司维拉姆治疗透析患者高磷血症的卫生技术评估报告、系统评价/Meta分析和经济学评价。按照纳入排除标准筛选文献、提取资料和评价质量,对研究结果进行全面分析后得出结论。结果：共纳入22项研究,其中5项卫生技术评估报告、7项系统评价/Meta分析和10项经济学评价。结果显示司维拉姆可有效控制血磷水平,同时不增加血钙水平和高钙血症的风险。此外,和含钙磷结合剂相比,司维拉姆组患者总胆固醇、低密度脂蛋白胆固醇及C反应蛋白水平较低,且司维拉姆治疗并没有过度抑制血清全段甲状旁腺激素水平。国内外的经济学研究显示,与含钙磷结合剂相比,司维拉姆用于透析患者具有成本效果优势。国内的经济学研究显示,与碳酸镧相比,司维拉姆可能更具有成本效果优势,但仍需进一步研究。结论：基于目前可获得的证据支持司维拉姆用于透析患者高磷血症的治疗。     

碳酸司维拉姆治疗血液透析患者的临床研究

目的 观察碳酸司维拉姆治疗维持性血液透析(MHD)患者矿物质及骨代谢紊乱(MBD)的临床效果及安全性.方法 将116例维持性血液透析患者随机分为试验组和对照组,每组58例.对照组给予碳酸钙咀嚼片1.25 g,每天2次,嚼服;试验组口服碳酸司维拉姆片0.8 g,每天3次.2组疗程均为6个月.检测2组治疗前后血磷、血钙、成...     

碳酸司维拉姆联合西那卡塞治疗血液透析患者继发高磷血症的临床评价

目的：分析碳酸司维拉姆联合西那卡塞治疗血液透析患者继发高磷血症的临床效果。方法：选择我院2021年2月至2023年3月收治的血液透析继发高磷血症患者70例,采用随机数字表法分为研究组及对照组,各35例。对照组给予碳酸司维拉姆治疗,研究组给予碳酸司维拉姆联合西那卡塞治疗,治疗2个月,对比两组患者治疗效果、治疗前后肾功能、血磷、血钙及iPTH水平。结果：治疗后研究组患者治疗总有效率高于对照组(P<0.05),治疗后两组患者BUN、SCr、血磷、血钙及iPTH水平均降低,与治疗前相比差异具有统计学意义(P<0.05),研究组BUN、SCr、血磷、血钙及iPTH水平均低于对照组(P<0.05)。结论：碳酸司维拉姆联合西那卡塞应用于血液透析患者继发高磷血症中,与单一碳酸司维拉姆治疗相比,在提升疗效、改善肾功能、血磷与血钙与全段甲状旁腺激素水平方面的效果突出。     

碳酸司维拉姆联合小剂量碳酸钙治疗尿毒症高磷血症的研究

目的:分析对尿毒症高磷血症行以碳酸司维拉姆联合小剂量碳酸钙治疗的临床效果。方法:从2018年6月~2019年1月择取54例尿毒症高磷血症患者,随机分成两组。对照组27例行以碳酸钙治疗,研究组27例行以碳酸司维拉姆联合小剂量碳酸钙治疗,对照分析两组临床效果。结果:从矿物质骨代谢指标来看,治疗前钙、磷、钙磷乘积、ALP以及iPTH对比无显著差异,治疗后研究组钙、磷、钙磷乘积均优于对照组,P<0.05,ALP以及iPTH组间无显著差异,P>0.05;从脂代谢指标来看,治疗前两组TC、TG、LDL-C、HLD-C对比无显著差异,治疗后研究组LDL-C、HLD-C均优于对照组,P<0.05,TC、TG组间无显著差异,P>0.05;从肾功能指标来看,治疗前两组Cr、BUN对比无显著差异,治疗后研究组Cr、BUN均优于对照组,P<0.05。结论:对尿毒症高磷血症行以碳酸司维拉姆联合小剂量碳酸钙治疗的临床效果确切,不仅可以使矿物质骨代谢指标得到改善,还可以使脂代谢指标以及肾功能指标得到改善,临床价值显著。     

多糖铁复合物胶囊在模拟人体环境下的降磷效果研究

目的 研究多糖铁复合物胶囊在模拟人体环境下的降磷效果。方法 以磷结合率为考察指标，采用单因素实验和正交试验筛选多糖铁复合物胶囊在模拟人体环境下的降磷方法；并且采用磷钼蓝法，对多糖铁复合物胶囊和磷结合剂（氢氧化铝片、碳酸钙片、碳酸镧咀嚼片和司维拉姆片）降磷效果进行比较。结果 多糖铁复合物胶囊在模拟人体环境下的最佳降磷条件是pH 3.0，水浴37 ℃，反应120 min。在相同条件和剂量下，多糖铁复合物胶囊降磷效果优于氢氧化铝片、碳酸镧咀嚼片（P＜0.01）和碳酸钙片（P＜0.05），但略差于司维拉姆片（P＜0.01）。结论 多糖铁复合物胶囊在模拟人体环境下可以显著降低磷酸盐含量。     

国外新近批准主要新药（二十一）

美FDA批准碳酸司维拉姆用于控制正行透析之慢性肾病患者的血清磷水平 Genzyme公司2007年10月22日宣布．美国食品药品管理局（FDA）已批准其开发的碳酸司维拉姆（sevelamer carbonate／Renvela）．用于控制正接受透析、包括血液和腹膜透析治疗之慢性肾病患者的血清磷水平。碳酸司维拉姆实是Genzyme公司1998年获准上市的盐酸司维拉姆（sevelamer hydrochloride／Renagel）的改进型后继产品，而盐酸司维拉姆则是目前在美处方量最大的一种磷酸盐结合剂。     

盐酸左氧氟沙星及司氟沙星治疗沙门氏菌感染的成本-效果分析

目的：对盐酸左氧氟沙星注射液、司氟沙星片两种药物治疗沙门氏菌感染的成本-效果进行分析。方法：运用药物经济学成本-效果分析法对两种沙门氏菌感染的治疗方案进行回顾性分析评价。结果：盐酸左氧氟沙星注射液组与司氟沙星片组相比，虽成本较高，但较安全。结论：在治疗沙门氏菌感染方面．盐酸左氧氟沙星注射液组具有较好的安全性。     

碳酸司维拉姆治疗终末期肾脏病高磷血症临床效果观察

目的:观察碳酸司维拉姆治疗终末期肾脏病高磷血症临床效果.方法:我院2014年6月~2016年2月终末期肾脏病高磷血症患者60例,随机数字表法分组,各30例.观察组给予碳酸司维拉姆治疗,对照组给予醋酸钙治疗,两组均治疗8周.对比两组治疗前后血磷、血钙、钙磷乘积、血清低密度脂蛋白胆固醇(LDL-C)水平变化情况.结果:治疗前两组血磷、血钙、钙磷乘积、LDL-C水平比较,差异无统计学意义(P>0.05);治疗后观察组血磷、钙磷乘积、LDL-C水平均明显降低,血磷、血钙、钙磷乘积、LDL-C水平明显优于对照组,差异有统计学意义(P<0.05).结论:碳酸司维拉姆治疗终末期肾脏病高磷血症效果确切,能显著降低患者血磷水平和钙磷乘积.     

碳酸镧应用于高磷血症维持性血液透析患者的长期临床疗效和安全性

目的评估碳酸镧长期应用于高磷血症维持性血液透析(MHD)患者的临床疗效和安全性。方法 MHD患者56例,血清磷>1.78 mmol·L-1,随机分为两组。碳酸镧组35例,予碳酸镧咀嚼片,起始剂量750 mg,bid,总剂量<3 000 mg·d-1。碳酸钙组21例,予碳酸钙D3片,起始剂量600 mg,bid,总剂量<3 000 mg·d-1。根据血磷和血钙检测结果调整药物剂量,疗程均为36个月。观察两组治疗前和治疗1、3、6、12、24、36个月患者血清钙、磷、全段甲状旁腺激素(i PTH)、成纤维细胞生长因子23(FGF-23)水平变化情况和不良反应,并在治疗前和治疗36个月行心脏彩超和螺旋CT,评估左心室肥厚和冠状动脉钙化状况。结果共39例患者完成本次研究,碳酸镧组25例,碳酸钙组14例。与治疗前比较,两组血磷水平治疗1个月起即下降(P<0.05)。碳酸镧组治疗期间血钙水平无明显变化,而碳酸钙组于治疗6个月血钙开始增高(P<0.05)。碳酸镧组i PTH水平治疗6个月起下降(P<0.05),碳酸钙组治疗期间i PTH水平无明显变化。碳酸镧组FGF-23水平治疗1个月起即下降(P<0.05),碳酸钙组于治疗12个月起下降(P<0.05)。治疗36个月,碳酸镧组血磷、钙、i PTH、FGF-23水平均低于碳酸钙组(P<0.05)。治疗前后血磷水平变化值和血FGF-23水平变化值进行相关分析,两者呈正相关(r=0.605,P<0.01)。治疗36个月,两组左心室质量指数和冠状动脉钙化评分均较治疗前上升(P<0.05),但碳酸镧组两项指标的进展幅度均小于碳酸钙组(P<0.05)。两组均无严重不良反应发生。结论对于高磷血症MHD患者,碳酸镧降血磷效果优于碳酸钙,且能同时降低血FGF-23和i PTH水平,而不引起血钙蓄积,还能够延缓MHD患者左心室肥厚和冠状动脉硬化的进展。     

低钙透析液结合盐酸司维拉姆治疗肾衰竭的临床护理观察

目的：探讨应用低钙透析液联合盐酸司维拉姆治疗肾衰竭的临床疗效,并对其进行护理。方法：选取2013年4月～2014年4月在我院接受治疗的肾衰竭患者40例,按照随机原则均分为对照组（20例）和观察组（20例）。两组患者均采用低钙透析液结合盐酸司维拉姆治疗方式,对照组行常规护理,观察组行针对性护理,对比两组临床疗效。结果：治疗后,观察组血红蛋白及白蛋白水平均显著高于对照组,差异均有统计学意义（P<0.05）;两组患者的血红蛋白水平都比治疗前明显升高,白蛋白水平均降低,差异有统计学意义（P<0.05）。治疗前和治疗后两组患者血钾和血糖水平差异均无统计学意义（P>0.05）。结论：应用低钙透析液结合盐酸司维拉姆治疗肾衰竭,再行针对性护理,不良反应发生率低,值得临床推广。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.