耐药肺结核75例临床分析

近年来结核病出现全球性恶化趋势,其中耐药肺结核的增多是原因之一。耐药结核病,尤其是耐多药、广泛耐药结核病,治疗难度大、时间长、费用高,对结核病的控制提出了巨大挑战[1]。因此,本研究综合分析和评价了75例耐药肺结核患者的临床资料,现报告如下。     

卷曲霉素作用机制和耐药机制的功能基因组学研究进展

随着一线抗结核药物的长期和广泛使用，结核病耐药性亦不断增加，其中耐多药结核分枝杆菌和持留菌感染已经成为结核病有效防治的关卡。寻找新型抗结核药物迫在眉睫。卷曲霉素被认为是较理想的二线结核病治疗药物，也是开发新的肽类结核病药物的模板。本文综述了从功能基因组学角度研究卷曲霉素的生物合成基因簇、转录组水平的作用机制和细菌耐药新机制，为合理使用卷曲霉素和开发新一代肽类抗生素提供借鉴。     

联合应用卷曲霉素治疗耐多药肺结核疗效观察

<正>1990年我国第三次结核病流行病学抽样调查结果表明,我国是结核病疫情较高的国家,结核病患者初始耐药率高,患者复治比例亦高[1]。我国的结核病疫情有高耐药率的特点,2000年第四次全国结核病流行病学抽样调查显示,初始耐药率为18.6%,获得性耐药率为46.5%,获得性耐多药率为17.1%[2]。卷曲霉素(capreomycin,CPM)抗结核菌作用机制与其他氨基糖苷类抗生素一样,但产生继发耐药性少[3]。本文对85例耐多药复治病例,在住院条件下,对患者的化疗进展、检查指标进行全面临测,做前瞻性临床疗效和毒副作用观察,现报告如下。     

抗结核药物最新进展

结核病是病死率仅次于艾滋病的全球第二大感染性疾病。当前结核病的控制面临一系列挑战。世界卫生组织推荐的结核治疗方案疗程长,对敏感菌和耐药菌感染分别需6个月、20个月的持续治疗。现有抗结核一线化疗药仍为四十多年前所开发,品种有限,选择余地小。此外,多耐药结核病(MDR-TB)及广泛耐药结核病(XDR-TB)的流行,严重阻碍了结核病控制的进展。严峻的结核病防治形势急需抗结核新药的出现。近十年来,抗结核化疗新药研发在沉寂多年后取得了较明显进展。本文介绍了近年上市与处于临床及临床前研究阶段的抗结核新药。     

耐多药脊柱结核治疗进展

<正>据世界卫生组织(WHO)报告,我国是结核病负担第二高的国家,我国每年新增结核病患者约130万[1]。其中耐多药结核病例11.2万例约占全球结核病数20%[2]。耐多药结核病(multiple drug resistant tuberculosis,MDR-TB)是指结核分枝杆菌至少同时对异烟肼、利福平耐药的结核病[3]。MTB的出现绝非偶然,它形成原因的多样化,治疗效果差,传染性强的特点向全球的结核病防治工作施加了巨大的压     

抗结核病药物的现状与研究进展

结核病是由结核分枝杆菌引起的一类严重的传染病,近年来结核分枝杆菌耐药株的传播导致治疗选择逐渐缩小,全球结核病防治形势依旧十分严峻。药物是目前治疗结核的主要手段,新型抗结核药物的研发旨在为临床提供克服耐药、疗程更短、患者依从性更好的治疗方案。近年来该领域取得了重要进展,包括首个新机制抗结核药物贝达喹啉获批上市,以及多种新机制、新结构的抗结核候选药进入临床试验阶段,这为耐药结核病治疗开拓了新的前景。本文将对现有抗结核病药物及新药研究进展进行综述。     

不同雾化吸入方案治疗喉结核的临床效果与护理

结核病是临床中较为常见的一种传染病,具有较高致病性和传染性,近年来发病率呈现出上升趋势[1-3]。随着抗结核药物的广泛使用,结核菌对很多药物都产生了不同程度的耐药性,使得治疗效果大打折扣[4-6]。喉结核也是由结核杆菌引起的,以咽痛、声嘶为病症的结核病,多继发于肺结核病[7,8]。对     

卷曲霉素和丁胺卡那霉素在耐药结核治疗中的疗效及安全性分析

目的探讨卷曲霉素和丁胺卡那霉素在耐药结核治疗中的疗效及安全性。方法选取我院就诊的240例耐多药肺结核患者,随机分为观察组(卷曲霉素)和对照组(丁胺卡那霉素)各120例。对比两组临床疗效。结果观察组总有效率95.00%显著高于对照组83.33%(P<0.05)。观察组痰菌转阴时间和症状改善时间显著短于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论卷曲霉素治疗耐药结核疗效优于丁胺卡那霉素,且安全性良好,值得临床推广。     

卷曲霉素治疗复治菌阳肺结核远期效果观察

目的:了解静脉滴注型卷曲霉素对复治菌阳性肺结核患者的治疗效果.方法:选复治菌阳肺结核病例,按2:1比例随机分为试验组和对照组,采用含卷曲霉素、异烟肼、利福平、吡嗪酰胺及乙胺丁醇等药物方案(2CHRZE/6H3R3E3)分别进行治疗.结果:静滴型卷曲霉素试验组强化期末与疗程结束时其痰结核菌阴转率分别为70.5%,83.3%,卷曲霉素对照组强化期末与疗程结束时痰菌阴转率为69.6%,80.8%;4年间试验组与对照组复发率分别为4.5%,5.1%;静滴型卷曲霉素组复发率低于对照组;不良反应发生比例分别为22.3%和50.6%.结论:静脉滴注型硫酸卷曲霉素治疗复治菌阳性肺结核临床效果肯定,复发率低,避免了注射部位的硬结、疼痛,减少了患者痛苦,是较好的治疗复治菌阳性结核病的药物.     

耐多药肺结核88例抗结核药物不良反应发生情况分析

<正>耐药结核病尤其是耐多药结核病(MDR-TB)和广泛耐药结核病(XDR-TB)的流行与传播使全球结核病控制工作面临严峻的考验。2007—2010年的临床研究结果表明,现有治疗耐药结核病的化学治疗方案效果差,治愈率和治疗成功率分别约为35%和50%[1]。而药物不良反应(ADR)是干扰结核病防治策略的重要因素之一[2,3]。耐多药结核病用药种类多,剂量大,疗程长,导致不良反应的可能性较一线抗结核药物更     

Theoretical π-π* absorption and circular dichroic spectra of cyclic dipeptides

The dipole interaction model, treated by the partially dispersive normal mode method, is used to calculate circular dichroic spectra of cyclo(Gly-Gly), cyclo (Ala-Gly), cyclo(Ala-Ala), cyclo(Pro-Gly), cyclo(Pro-Ala), cyclo(Pro-Val), cyclo (Pro-D-Val), and cyclo(Pro-Pro) in the amide π-π* absorption band near 190 nm. Assuming a standard backbone geometry, spectra which are in fair to good agreement wth experiment are obtained for these molecules. The spectra are predicted to be sensitive to conformations of Pro and Val side chains. The effects of dipeptide ring folding on calculated CD spectra are mostly consistent with those found by other workers, except that it is found that a planar ring conformation of cyclo (Ala-Ala) and cyclo (Ala-Gly) gives predicted spectra comparable to experiment. The same model gives theoretical absorption spectra consistent with available experimental data.     

Effects of Nitro-L-Arginine on Blood Pressure and Cardiac Index in Anesthetized Rats: A Pharmacokinetic-Pharmacodynamic Analysis

Purpose. Nitric oxide synthase (NOS) inhibitors such as Nitro-L-arginine (L-NA) are being considered for the management of hypotension observed in septic shock. However, little information is available regarding the pharmacokinetic and pharmacodynamic properties of these agents. Our objective was to examine the relationships between L-NA plasma concentration and various hemodynamic effects such as cardiac index (CI), mean arterial pressure (MAP), and heart rate (HR) elicited by L-NA administration in rats. Methods. L-NA was infused at doses between 2.5 – 20 mg/kg/hr in anesthetized rats over one hour. Hemodynamic effects and plasma L-NA levels were determined. Results. Infusion of L-NA resulted in dose-dependent increases in MAP and systemic vascular resistance (SVR), decreases in CI, and minimal change in HR. The relationships between the hemodynamic effects and plasma L-NA levels were not monotonic, and hysteresis was observed. Using nonparametric analysis, the equilibration half-time (t_1/2,keo) between plasma L-NA and the hypothetical effect site was determined to be 51.5 ± 6.6 min, 42.4 ± 10.1 min, 43.4 ± 9.0 min for MAP, CI, and SVR, respectively (n = 14). The E_max and EC₅₀ values obtained were + 32.5 ± 8.4 and 2.6 ± 1.3 g/ml for MAP and –52.9 ± 15.6 and 3.7 ± 1.8 g/ml for CI, respectively. Conclusions. Although L-NA can bring about beneficial elevation of MAP, such effect is always accompanied by a stronger effect on CI depression. Dose escalation of L-NA may bring about detrimental negative inotropic effect and loss of therapeutic efficacy.     

HPLC法测定丝裂霉素C聚氰基丙烯酸正丁酯纳米粒中丝裂霉素C的含量

目的:建立高效液相色谱法测定丝裂霉素 C 聚氰基丙烯酸正丁酯纳米粒(MMC-PBCA-NP)中药物含量。方法:采用C_(18)柱(4.6 mm×150 mm,5 μm),以混合磷酸盐缓冲液-乙腈(85:15)为流动相,流速为1 mL·min~(-1),紫外检测器,检测波长为365 nm。结果:丝裂霉素 C(MMC)浓度在5～250 μg·mL~(-1)范围内与峰面积呈良好的线性关系,r=0.9998;平均回收率(n=6)为98.15%。结论:本法专属性强,操作简便,结果准确。适用于 MMC-PBCA-NP 的质量控制。     

洛美沙星体内外抗菌活性研究

洛美沙星对革兰氏阴性菌具有强的抑菌活力。对克氏肺炎杆菌的抗菌活性最强,MIC_(50)为0.12mg/L;对痢疾杆菌、产气杆菌、粘质沙雷氏菌、不动杆菌和枸椽酸杆菌的MIC_(50)分别为1和4mg/L。洛美沙星对肠细菌科细菌的活力比诺氟沙星和依诺沙星强2～16倍,明显地比丁胺卡那霉素、庆大霉素强。对金葡球菌MIC_(50)为1mg/L, MRSA对洛美沙星同样敏感。洛美沙星对表葡球菌、链球菌、粪链球菌及肺炎双球菌等的抗菌活性与地氟沙星相似,比诺氟沙星、依诺沙星、丁胺卡那霉素、庆大霉素和头孢三嗪分别强2～4倍。 洛美沙星对小鼠全身感染的疗效优于诺氟沙星。对大肠杆菌、克氏肺炎杆菌和绿脓杆菌感染小鼠iv的ED_(50)分别是0.74、0.13和3.45mg/kg, po的ED_(50)分别是0.94、1.46和6.20mg/kg。     

The pathogenesis of,and pharmacological treatment for,Canavan disease

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Protective role of exogenous α-lipoic acid (ALA) on hippocampal antioxidant status and memory function in rat pups exposed to sodium arsenite during the early post-natal period

The present work focussed on the effect of exogenous α-lipoic acid (ALA) administration on retention memory and oxidative stress markers in the hippocampus subsequent to early post-natal exposure of rat pups to sodium arsenite (NaAsO₂). Wistar rat pups were divided into the control groups receiving either no treatment (Ia) or distilled water by intraperitoneal route (i.p.) (Ib) and the experimental groups receiving either NaAsO₂ alone (1.5 and 2.0?mg/kg body wt.) (IIa, IIb) or NaAsO₂ (1.5 and 2.0?mg/kg body wt.) followed by ALA (70?mg/kg body wt.) (IIIa, IIIb) (i.p.) from post-natal day (PND) 4–15. The initial and retention transfer latency (ITL and RTL) was determined on PND 14 and 15 using elevated plus maze. The animals were sacrificed by cervical decapitation (PND 16) and the brains were obtained. The dissected out hippocampus was processed for estimation of oxidative stress markers, glutathione (GSH), and superoxide dismutase (SOD). NaAsO₂ exposure resulted in longer RTL in animal groups IIa and IIb, thereby suggestive of arsenic-induced impairment in retention memory. RTL was significantly shorter in animal groups (IIIa, IIIb) receiving ALA following NaAsO₂, thereby suggestive of improvement in retention memory. GSH and SOD levels were significantly decreased in animals receiving NaAsO₂ alone as against group Ib and administration of ALA following NaAsO₂ increased the levels of hippocampal GSH and SOD. These observations are suggestive of the role of exogenous ALA in ameliorating the adverse effects induced by NaAsO₂ exposure of rat pups on retention memory and oxidative stress markers.     

乙酰吉他霉素临床前药理学研究

乙酰吉他霉素对临床分离的革兰氏阳性球菌有较好的抑菌活力，其对金葡球菌、β－溶血性链球菌、表葡球菌的ＭＩＣ_（５０）分别为１、０．２２和４ｍｇ／Ｌ，对耐红霉素、青霉素的金葡球菌、表葡球菌半数以上较敏感，与吉他霉素相似，但其对革兰氏阴性菌无明显作用。乙酰吉他霉素对小鼠实验性细菌感染有明显保护作用。对金葡球菌、肺炎双球菌感染小鼠口服用药的ＥＤ_（５０）分别为７９．６和２５．１ｍｇ／ｋｇ。其疗效与吉他霉素、麦白霉素、乙酰螺旋霉素相似。乙酰吉他霉素小鼠１次口服的ＬＤ_（５０）＞１５ｇ／ｋｇ，与吉他霉素相比毒性无差异。     

大鼠溃疡性结肠炎模型的实验研究

目的对不同剂量的三硝基苯磺酸（ＴＮＢＳ）引起的大鼠溃疡性结肠炎（ＵＣ）模型进行观察和评价。方法采用一次性直肠注入大鼠ＴＮＢＳ（２５～１５０ｍｇ·ｋｇ－１）的３０％乙醇溶液，引起慢性炎症性肠疾病（ＩＢＤ），３ｗｋ后外死动物对各剂量下动物结肠的重量、髓过氧化物酶（ＭＰＯ）活性及组织形态学变化进行观察和评价。结果ＴＮＢＳ在１００～１５０ｍｇ·ｋｇ－１剂量下引起的ＵＣ肠壁明显增厚，炎症和溃疡至少维持７ｗｋ时间，ＭＰＯ活性值显著性升高，组织学检查发现粘膜及粘膜下层有大量中性粒细胞及淋巴细胞、巨噬细胞、纤维细胞浸润，肉芽组织及隐窝脓肿形成，５０ｍｇ·ｋｇ－１剂量时有一较轻度的损伤。２５ｍｇ·ｋｇ－１时对结肠的重量、ＭＰＯ活性及损伤指数都没有显著性改变（Ｐ＞０．０５）。结论用ＴＮＢＳ引起大鼠实验性ＵＣ，其溃疡和炎症维持一较长时间，这一病理特征为炎症性疾病防治药物的研究提供了条件；本模型的最佳剂量为１００ｍｇ·ｋｇ－１左右     

Dinoflagellate polyether within the yessotoxin, pectenotoxin and okadaic acid toxin groups: Characterization, analysis and human health implications

Diarrhetic Shellfish Poisoning (DSP) is a specific type of food poisoning, characterized by severe gastrointestinal illness due to the ingestion of filter feeding bivalves contaminated with a specific suite of toxins. It is known that the problem is worldwide and three chemically different groups of toxins have been historically associated with DSP syndrome: okadaic acid (OA) and dinophysistoxins (DTXs), pectenotoxins (PTXs) and yessotoxins (YTXs). PTXs and YTXs have been considered as DSP toxins because they can be detected with the bioassays used for the toxins of the okadaic acid group, but diarrhegenic effects have only been proven for OA and DTXs. Whereas, some PTXs causes liver necrosis and YTXs damages cardiac muscle after intraperitoneal injection into mice. On the other hand, azaspiracids (AZAs) have never been included in the DSP group, but they cause diarrhoea in humans. This review summarizes the origin, characterization, structure, activity, mechanism of action, clinical symptoms, method for analysis, potential risk, regulation and perspectives of DSP and associated toxins produced by marine dinoflagellates.     

Latent role of in vitro Pb exposure in blocking Aβ clearance and triggering epigenetic modifications

Both β-amyloid (Aβ) catabolism and epigenetic regulation play critical roles in the onset of neurodegeneration. The latter also contribute to Pb neurotoxicity. The present study explored the role of epigenetic modifiers and Aβ degradation enzymes in Pb-induced latent effects on Aβ overproduction in vitro. Our results indicated that in SH-SY5Y cells exposed to Pb, the expression of NEP and IDE remained declined during the recovery period, accompanied with abnormal increase of Aβ_1-42 and amyloid oligomer. A disruption of selective global post-translational histone modifiers including the decrease of H3K9ac and H4K12ac and the induction of H3K9me2 and H3K27me2 dose dependently was also showed in recovery cells. Moreover, histone deacetylase inhibitor VPA could attenuate latent Aβ accumulation and HDAC activity induced by Pb, which might be by regulating the expression of NEP and IDE epigenetically. Overall, our results suggest sustained reduction of NEP and IDE expression in response to Pb sensitizes recovery SH-SY5Y cells to Aβ accumulation; however, administration of VPA is demonstrated to be beneficial in modulating Aβ clearance.