一例房颤合并冠心病患者初始抗栓治疗策略及文献复习

目的 探讨房颤伴急性冠脉综合征的抗栓治疗策略。方法 1例46岁房颤合并冠心病的男性患者,房颤卒中风险低危,入院期间未给予抗凝治疗,后出现急性脑梗塞。通过提阅部分指南及文献,分析CHA₂DS₂-VAS_c评分为1分,并伴急性冠脉综合征患者的不同抗栓治疗策略方案及其优劣。结果 文献提示,CHA₂DS₂-VAS_c评分为1分出血低危患者,建议尽早服用抗凝药。双联抗栓（华法林+氯吡格雷）能够有效抗栓并且降低患者出血风险,因此需根据患者的具体情况,尽快将三联调整为双联抗栓（1~3个月内）,保证患者疗效的情况下,降低患者出血风险。结论 临床上遇到相关患者需充分评估患者的出血及血栓风险,制定个体化的抗栓治疗策略。     

肠内外营养对肺癌化疗患者营养状况及不良反应的影响

目的 研究对原发性肺癌化疗患者使用肠内外营养联合支持对其营养状况和化疗不良反应的影响。方法 选取2018年6月—2019年6月在我院接受化疗的原发性肺癌住院患者90例,随机分为对照组和观察组,各45例。两组均进行化疗治疗,对照组患者采用肠外营养支持,观察组患者进行肠内外营养联合支持。分别在每个化疗周期记录两组患者营养状况及不良反应并进行比较。结果 两组患者营养支持前（T₀）的营养状况无显著差异（P>0.05）。化疗T₁-T₄周期内,观察组的营养状况显著优于对照组,不良反应发生率显著低于对照组,差异均有统计学意义（P<0.05）。结论 肠内外营养联合支持能够改善原发性肺癌化疗患者的营养状态,减少化疗期间的不良反应,值得临床推广。     

重症脑卒中患者营养风险筛查与营养支持现状调查

目的 探讨营养风险筛查（nutritional risk screening,NRS）用于评估重症脑卒中患者营养状态的意义,比较肠内外营养支持治疗对该类患者的临床应用价值。方法 采用回顾性调查方法,对267例重症脑卒中患者根据营养风险筛查2002版[2002年欧洲肠外肠内营养学会（ESPEN）推荐的成人营养风险筛查方法,NRS 2002]进行营养评估,并根据营养支持类型分为3组,包括肠内营养（EN）组、肠外营养（PN）组和联合营养（EN+PN）组,通过比较使用前后各项指标的变化情况,对各组的临床疗效和不良反应进行评价。结果 通过比较患者入院第1天与第10天的营养状况、肝肾功能及并发症情况,发现EN组、EN+PN组相对用药前的总蛋白、白蛋白水平有显著性提高（P<0.05）,且EN组肝肾功能指标变化较小,合并感染的发生率为16.67%。结论 肠内营养支持能有效改善重症脑卒中患者的营养状况,降低患者感染及胃肠道并发症的发生率,明显改善患者预后。     

胃癌手术患者营养风险筛查及营养支持现况分析

目的 分析胃癌手术患者营养风险发生及其营养支持现状,为规范化营养支持提供指导。方法 对2014年2月至2014年7月150例胃癌住院患者术前采用NRS-2002营养风险筛查简表评估其术前营养风险状况。检测患者入院第1~2天和术后第7~10天的体质量、血红蛋白、血清总蛋白、血清清蛋白、血清前清蛋白、白细胞计数、淋巴细胞计数等营养指标以及调查其营养支持情况。结果 150例胃癌患者中,术前有营养不良者72例(占48%),无营养不良者78例(占52%);有营养风险者81例(54%),其中采取营养支持者66例(81.48%),无营养风险者69例(46%),其中采取营养支持者57例(82.61%)。患者术后营养指标除血红蛋白及血清前清蛋白外其他营养指标较术前差异均有统计学意义(P均<0.05)。结论 胃癌手术患者营养不良发生率及有营养风险者比例较高,临床医生对其营养支持不够规范,需采取规范的临床营养风险评估和基于证据的临床营养支持以改善营养状况。     

百令胶囊联合川芎嗪对早期糖尿病肾病患者血小板活化及尿微量白蛋白的影响

摘 要 目的:探讨百令胶囊联合川芎嗪对早期糖尿病肾病患者血小板活化及尿微量白蛋白的影响。方法: 选取86例2型糖尿病患者观察其治疗前后血小板活化指标CD_62p、CD₆₃及UAER的变化。结果:治疗组治疗3周后,UAER、CD_62p、CD₆₃均较治疗前有显著改善（P<0.01）, 3个月后UAER水平进一步下降,CD_62p、CD₆₃水平略有升高仍较治疗前显著降低（P<0.01）。与对照组治疗后比较,差异有统计学意义（P<0.01）。结论:百令胶囊联合川芎嗪治疗早期糖尿病肾病能减少糖尿病患者的血小板活化,减少尿微量白蛋白,保护肾功能。     

二氢卟吩p6醚类光敏剂的合成及光动力抗癌活性研究

目的 基于前期研究表明二氢卟吩f的3-乙烯基成醚修饰具有更强的光敏抗肿瘤活性而设计合成二氢卟吩p₆醚类光敏剂（1）,研究其初步体外光动力抗癌活性。方法 以蚕沙叶绿素a粗提物酸水解产物脱镁叶绿酸a（5）经碱及空气氧化降解制得的紫红素-18（4）为先导物,通过碱水解和CH₂N₂甲基化制得二氢卟吩p₆三甲酯（2）,2与33% HBr加成后再和烷氧醇发生亲核取代反应生成目标化合物（1）,并评价其对黑色素瘤B16-F10细胞的光动力杀伤效应。结果 6个目标化合物1a-1f对黑色素瘤B16-F10细胞的体外光动力抗癌活性均优于同类阳性对照药他拉泊芬和维替泊芬,其结构经电喷雾质谱（ESI-MS）、氢谱（¹H NMR）、碳谱（¹³C NMR）及电喷雾高分辨质谱（ESI-HRMS）确证。结论 二氢卟吩p₆醚类光敏剂具有光动力抗癌活性强、治疗指数（暗毒/光毒比）高等优点,值得进一步开发研究。     

风湿性疾病患者营养状况对使用硫唑嘌呤所致血液学毒性的影响

摘 要 目的：探讨风湿病患者营养状况对使用硫唑嘌呤所致血液学毒性的影响。方法：对70例硫唑嘌呤服用患者应用营养风险筛查2002（NRS2002）进行筛查,比较两组患者各项营养指标,根据结果将患者分为无营养风险组（NRS2002<3 分,n=48）和有营养风险组（NRS2002≥3 分,n=22）,两组患者均给予硫唑嘌呤片50 mg,po,qd联用羟氯喹片0.2 g,po,bid,治疗3个月以上。观察两组患者血液学毒性发生情况。结果：无营养风险组患者前白蛋白、血红蛋白、淋巴细胞计数水平明显高于营养风险组（P <0.01）;无营养风险组骨髓抑制总发生率较有营养风险组明显降低（P<0.05）。结论：营养不良状况可能导致硫唑嘌呤服用患者血液学毒性发生,因此硫唑嘌呤治疗期间应加强患者营养干预。     

厄贝沙坦与缬沙坦对高血压伴蛋白尿患者肾脏的保护作用探讨

目的 探讨厄贝沙坦与缬沙坦对高血压伴蛋白尿的肾脏保护作用。方法 选择原发性高血压且伴有少量蛋白尿患者80例,随机分为两组,每组40例。观察组使用厄贝沙坦,对照组使用缬沙坦,均连续治疗1个月,比较治疗后α₁-MG、β₂-MG、cystatin C、24 h尿蛋白、及肾功能变化及不良反应。结果 治疗后,观察组患者α₁-MG、β₂-MG和cystatin C水平低于对照组(P<0.05),24 h尿蛋白少于对照组(P<0.05),两组患者出现咳嗽、头痛头晕、腹痛腹泻的比例差异无统计学意义(P>0.05)。结论 厄贝沙坦治疗高血压,能显著减少尿蛋白,改善肾功能,对高血压引起的早期肾功能损伤具有保护作用。     

肠内营养对营养不良的溃疡性结肠炎免疫功能及生存质量的影响

目的 探讨在活动期溃疡性结肠炎（UC）营养不良患者中应用肠内营养（EN）对其治疗期免疫功能及治疗后生存质量的影响。方法 回顾性分析2013年7月至2019年12月淮南朝阳医院收治的121例活动期且伴有营养不良的UC患者临床资料,并依据营养治疗方式不同将患者分为研究组（EN,n=82）及对照组[全肠外营养（TPN）,n=39]。比较两组患者治疗期内营养、免疫水平差异,以及出院后1周生存质量的不同。结果 两组患者入院时营养、免疫水平差异无统计学意义（P>0.05）,重复测量方差分析结果显示,研究组患者经营养治疗后清蛋白、前清蛋白,IgA、IgG水平均高于对照组（P<0.05）,补体C3、C4水平均低于对照组（P<0.05）。研究组在出院后1周炎症性肠病生存质量专用量表（IBDQ）及普适性简明健康调查问卷量表（SF-36）各维度评分均优于对照组,差异有统计学意义（P<0.05）。结论 EN能有效改善活动期UC患者营养状况,提高免疫功能进而有助于提高患者出院后生存质量。     

儿童静滴维生素K1注射液引起的17例药物不良反应分析

目的 通过探讨维生素K1注射液药物不良反应发生的影响因素及规律,为儿童安全、合理使用维生素K₁注射液提供依据。方法 通过对我院2012~2017年发生的17例维生素K₁注射液引起的不良反应病例进行统计分析。结果 维生素K1注射液发生药品不良反应与药物本身的质量、用药人群的生理特点及临床用药合理性等因素密切相关。结论 应加强维生素K₁注射液合理应用及管理,保证儿童用药安全。     

芬吗通连续序贯治疗121例更年期综合征临床疗效的观察

目的 探讨应用芬吗通连续序贯给药治疗更年期综合征的临床疗效与安全性。方法 以2014年1月-2015年10月本院专家门诊收治的121例更年期综合征患者为对象,采用芬吗通进行激素替代治疗24周,共6个疗程,以用药前后测定的Kupperman评分、血促卵泡激素（FSH）、雌二醇（E₂）、促黄体激素（LH）及子宫内膜厚度作为评价指标。结果 随着用药时间的延长,患者更年期症状逐渐缓解,Kupperman评分总分不断下降,至用药6个疗程时,主要症状完全缓解,Kupperman评分总分下降95.0%（P<0.01）,血FSH显著下降（P<0.05）,E₂显著升高（P<0.01）,LH水平明显下降（P<0.01）,子宫内膜厚度无明显变化（P>0.05）。结论 芬吗通连续序贯治疗能有效缓解女性更年期症状,较好地控制月经周期和内分泌水平,且对子宫内膜无过度刺激。     

序贯性与非序贯性早期肠内营养对食管癌术后患者临床疗效的比较研究

目的 观察食管癌术后序贯性早期肠内营养与非序贯性早期肠内营养的临床疗效,明确食管癌患者是否从序贯性营养支持疗法中获益。方法 将92例拟行食管癌根治术的患者分为序贯性早期肠内营养组（46例）和非序贯性早期肠内营养组（46例）,比较两组临床结局指标（胃肠道功能恢复情况、肠内营养耐受情况、术后并发症、术后住院时间）和营养指标（白蛋白、前白蛋白等）。结果 与非序贯性早期肠内营养组相比,序贯性早期肠内营养组首次肛门排气时间缩短,首次自然排便和肠内营养耐受性良好例数增加,差异均有统计学意义（P<0.05）。两组患者的术后营养指标、人体成分、术后并发症、术后住院时间比较,差异均无统计学意义（P>0.05）。结论 对于食管癌术后患者,序贯性早期肠内营养支持方案有利于胃肠道功能的恢复和肠内营养耐受性的提高,值得临床进一步推广。     

Dual antiplatelet therapy after coronary stenting

Introduction: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ receptor inhibitor represents the mainstay of pharmacotherapy in patients undergoing coronary stenting. Currently, three P2Y₁₂ receptor inhibitors are approved for clinical use, including clopidogrel, prasugrel, and ticagrelor, with the latter two being preferred in patients presenting with an acute coronary syndrome. The introduction into clinical practice of newer-generation drug-eluting stent (DES) with safer profiles (i.e. less stent thrombosis) compared with earlier platforms have led recent guideline updates to re-evaluate the optimal duration of DAPT therapy, which are now based on evidence of a multitude of randomized clinical trials, registries, and meta-analysis and take into consideration the ischemic and bleeding risk profile of the patients.

Areas covered: Most recent updates on DAPT duration from professional societies in the United States and Europe are discussed. Moreover, an assessment of clinical trials, registries, and meta-analysis leading to changes on practice guidelines analyzed.

Expert opinion: The widespread introduction into clinical practice of newer-generation DES allows for shortening DAPT duration as also endorsed by practice guidelines. However, the optimal duration of DAPT therapy varies according to the individuals’ risk of ischemic and bleeding complications, with longer or shorter durations of treatment, respectively, that may be considered.     

Rivaroxaban in the contemporary treatment of acute coronary syndromes

Introduction: Rivaroxaban is the first orally bioavailable direct factor Xa inhibitor and its role in acute coronary syndrome is not fully understood. A significant residual risk of recurrent ischemia remains in patients with acute coronary syndrome despite optimal medical therapy. Warfarin has demonstrated modest benefit that is offset by the risk of bleeding and complexity in its management. Rivaroxaban may be an attractive agent for the treatment of acute coronary syndromes given its predictable pharmacodynamics and favorable safety profile.

Areas covered: The current guideline-based antithrombotic and adjunctive medical therapies in acute coronary syndrome are summarized in this review. Rivaroxaban's drug profile, its current applications, ongoing trials and experience in patients with acute coronary syndrome are also described.

Expert opinion: Current experience of rivaroxaban in acute coronary syndrome demonstrates its safety and a trend towards benefit when added to current optimal medical therapy. The benefits were observed primarily in patients receiving aspirin monotherapy and increased bleeding among those receiving dual anti-platelet therapy. This suggests that there may be a narrow window between the optimal clinically achievable antithrombotic effect and the point where bleeding risk outweighs the benefits. Though promising, it remains to be seen if this drug will achieve the right balance between efficacy and bleeding risk.     

Current pharmacotherapy options for cancer anorexia and cachexia

Introduction: Anorexia and cachexia syndrome represents a complex clinical picture that occurs in the late stage of several chronic inflammatory diseases, including cancer. Unless counteracted cancer-related anorexia and cachexia syndrome affects quality of life (QL) and survival. However, to date a standard effective treatment is lacking.

Areas covered: The aim of this review is to describe the current pharmacological approaches for anorexia and cachexia syndrome, focusing on cancer-related syndrome. The several pharmacological agents tested so far are discussed, distinguishing them in unproven drugs, effective drugs, and drugs under investigation. Moreover, a section is devoted to the promising use of nutritional supplements and nutraceuticals. The emerging role of a multitargeted combined treatment approach is exhaustively reviewed.

Expert opinion: Considering the complex clinical picture and the multifactorial pathogenesis of anorexia and cachexia syndrome, we believe that its clinical management requires a multidisciplinary and multipharmacological approach. In our opinion the anorexia and cachexia syndrome treatment should include drugs that target the following conditions: inflammatory status, oxidative stress, nutritional disorders, muscle catabolism, anemia, immunosuppression, and fatigue. The multidimensional therapies for anorexia and cachexia syndrome should ideally be introduced within a context of the “best supportive care,” which includes optimal symptom management and careful psychosocial counseling.     

奈玛特韦片/利托那韦片治疗COVID-19早期预后不良的危险因素及预测模型构建

目的 探讨奈玛特韦片/利托那韦片（Paxlovid）对新型冠状病毒肺炎（COVID-19）患者早期预后不良的危险因素并构建预测模型，以期为提高该类患者的救治效果提供参考。方法 回顾性分析2023年1月至2023年3月于闽南地区3家军队三甲医院使用Paxlovid治疗的COVID-19住院患者92例，收集临床指标进行单因素和多因素分析，筛选出Paxlovid早期预后不良的独立危险因素，对Logistic模型方程进行转换建立联合预测因子，采用ROC曲线确定联合预测因子的曲线下面积（AUC）及最佳临界值。结果 92例患者中，早期预后不良者31例（33.70%），其中，死亡11例（35.48%），危重型17例（54.84%），重型3例（9.68%）。多因素Logistic回归分析结果显示，发病天数、淋巴细胞计数、天门冬氨酸氨基转移酶（AST）、C反应蛋白（CRP）和联合呼吸机辅助通气是使用Paxlovid早期预后不良的独立危险因素。以上述独立危险因素构建联合预测因子（Y）的计算公式，Y_{联合预测因子}=7.875X_发病天数+126.188X_{淋巴细胞计数}+1.438X_AST+X_CRP+220.500X_{联合呼吸机辅助通气}，绘制ROC曲线，联合预测因子的ROC曲线下面积最大为0.939，预测价值最优，约登指数（Youden）最大时（0.756）对应ROC曲线最佳临界值为447.920，模型的理论准确度为89.10%。结论 发病天数、淋巴细胞计数、AST、CRP和联合呼吸机辅助通气是使用Paxlovid早期预后不良的独立危险因素，用药前可通过上述各危险因素计算联合预测因子，当预测结果大于447.920时，应采取更积极的治疗措施包括联合其他抗COVID-19药物等，以提高患者的救治效果。     

Ramipril/amlodipine single pill – Effectiveness,tolerance and patient satisfaction with antihypertensive therapy in relation to nutritional status

BackgroundOverweight and obesity decrease the effectiveness of antihypertensive therapy despite the more frequent use of polytherapy. One method for improving therapy effectiveness is by decreasing non-compliance with the use of fixed-dose combinations (FDC).The aim of this study was to assess the effectiveness, tolerance, and satisfaction with ramipril/amlodipine FDC antihypertensive therapy in relation to nutritional status.MethodsThe survey enrolled 24,240 hypertensive patients recently switched to ramipril/amlodipine FDC (EGIRAMLON) at the same doses as previously prescribed separate pills.ResultsThe effectiveness of antihypertensive therapy increased during follow-up from 32.9% to 76.5%. Overweight and obesity were associated with the increased risk of not attaining the recommended BP values [adjusted for age OR = 0.74 (95% CI 0.67–0.83) and 0.70 (0.61–0.81) for overweight; 0.54 (0.47–0.60) and 0.49 (0.42–0.57) for obese, at the first and the second examination, respectively].“Very good” or “good” the FDP tolerance was reported by 98.8%, 97.6% and 96.4%, respectively.Adverse events (AE) were reported in 0.35% of patients regardless of nutritional status.High levels of satisfaction with the FDC were reported by 57.0% of patients with normal weight, 54.5% of overweight, and 50.6% with obesity. Effectiveness and convenience were the most important for patients.ConclusionsThe effectiveness of therapy with ramipril/amlodipine FDC in the study population was high, but slightly lower in overweigh and obese. This FDC was well tolerated and a significant number of patients satisfied with the therapy regardless of nutritional status. Although the perceived tolerance and satisfaction with treatment were lower in obese and overweight than in normal weight patients; the incidence of AE and perceived benefit from the use of a single-pill, compared to multiple tablets, were comparable irrespective of nutritional status.     

Statins as potential treatment for cholesterol gallstones: an attempt to understand the underlying mechanism of actions

Introduction: Statin therapy is widely used across the globe for the treatment and prevention of cardiovascular disease (CVD). It is well established that statin therapy is associated with significant decreases in low-density lipoprotein cholesterol (LDL-C) and plasma cholesterol levels. Cholesterol gallstones are a common problem, resulting in hospital admission and surgery, throughout western healthcare systems.

Areas covered: This review describes the mechanisms, and addresses the potential, for statins to be used as a treatment for gallstones. Medline was searched for the risk factors and treatment of cholesterol gallstones.

Expert opinion: Obesity, metabolic syndrome, non-alcoholic fatty liver disease (NAFLD), insulin resistance and high-fat diets (unsaturated fats) rich in cholesterol are all associated risk factors for cholesterol gallstones. In view of the high prevalence of cholesterol gallstones, there is an urgent need to understand whether pharmacological therapies can be harnessed for the treatment of cholesterol gallstones. Gallstones are shown to be associated with an increased risk, not only of mortality, but also of CVD. Statins, widely used in prevention of CVD and hypercholesteremia, have been shown to dissolve cholesterol gallstones in animal models and human studies, highlighting the potential for a pharmacological therapy for gallstones. More studies are required to understand the role of statins in the treatment of gallstones and for comparison with current treatment strategies.     

An update on adjuvant systemic therapy for elderly patients with early breast cancer

Introduction: Elderly women with early breast cancer require an individualized approach to risk assessment and treatment. Unfortunately, there are limited data to inform optimal adjuvant therapy decisions in this population. Cytotoxic chemotherapy, biologic treatments and endocrine agents, while important in reducing breast cancer recurrence and mortality, are associated with the potential for adverse effects that may be of particular significance to elderly patients.

Areas covered: In this review, we summarize the evidence for geriatric assessment in elderly patients with early breast cancer, outline special considerations for the use of chemotherapy and trastuzumab in older adults, and describe the age-specific risks of endocrine therapy in the adjuvant breast cancer setting.

Expert opinion: The treatment of elderly women with early breast cancer should take into account cancer risk, life expectancy, comorbidities, functional status, physiologic changes, and patient values. Formal geriatric assessment may better inform treatment recommendations for individual patients. In general, there is no strong evidence to suggest that older women benefit less from standard adjuvant therapies than do their younger counterparts. When choosing between endocrine therapies, the differential risks associated with each agent should be considered and particular attention to the fracture risk on aromatase inhibitors (AIs) is warranted. Enrolment of women over 70 years of age into breast cancer clinical trials should be encouraged to better inform treatment guidelines.