降糖联合他汀降脂疗法对混合型血脂异常的2型糖尿病患者血脂的影响

目的:探讨降糖联合他汀降脂疗法对甘油三酯(TG)水平介于2.3~4.5 mmol/L的混合型血脂异常的2型糖尿病(T2DM)患者血脂的影响。方法:将80例TG介于2.3~4.5 mmol/L的混合型血脂异常的T2DM住院患者,根据年龄、糖尿病慢性并发症情况以及预期寿命等,确定相应的降糖目标值,再根据相应目标值给予降糖(胰岛素联合口服降糖药物或者单用口服降糖药物)治疗,同时给予他汀类药物调脂治疗。治疗前测定糖化血红蛋白(HbA1c)、TG、胆固醇(TC)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)水平并计算患者的体质量指数(BMI)。治疗2周后复查血脂情况,比较治疗前后的差异性。结果:80例患者降糖达到相应目标值且联合他汀类药物治疗2周后,平均TG、TC、LDL-C水平较治疗前分别下降了50.28%、42.91%、44.37%,与治疗前比较差异有统计学意义(P<0.01)。在降糖方案的选择上,选择胰岛素联合口服降糖药物治疗可以更好地降低TG水平,与单用口服降糖药物比较,差异有统计学意义(P<0.05)。结论:对于TG介于2.3~4.5 mmol/L的混合型血脂异常的T2DM患者,给予降糖联合他汀类药物降脂治疗,可以显著降低TG、TC、LDL-C水平,并使TG水平降至2.3 mmol/L以下,甚至可以降至正常值。选择胰岛素联合口服降糖药物治疗与单用口服降糖药物相比,TG的达标率更高。     

诺和灵30R联合二甲双胍治疗2型糖尿病的临床研究

目的 探讨诺和灵30R联合二甲双胍治疗2型糖尿病(T2DM)的疗效及安全性.方法 采用诺和灵30R联合二甲双胍治疗55例T2DM患者,比较治疗前后BMI、FBG、2hPBG、HbA1c、TG、TC、HDL-C、LDL-C的变化,观察不良反应.结果 治疗4、8周BMI、FBG、2hPBG、HbA1c、TG、TC、LDL-C均较治疗前显著下降(P＜0.05),HDL-C较治疗前升高,但无统计学意义(P＞0.05),治疗8周45例(81.82％)FBG、2hPBG、HbA1c达标.17例出现轻度不良反应.结论 诺和灵30R联合二甲双胍治疗T2DM,能有效降低血糖及糖化血红蛋白,改善脂质代谢,不良反应少,安全有效.     

2型糖尿病患者糖化血红蛋白与血脂血糖间的关系研究

目的探讨2型糖尿病患者糖化血红蛋白水平与血脂、血糖之间的关系。方法采集来我院健康体检的2型糖尿病患者及健康人体检资料各200例,统计其糖化血红蛋白(HbA1c)、空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)及低密度脂蛋白(LDL-C)等各项指标,对两组的检测结果进行比较,分析糖化血红蛋白与各项检测结果是否具有相关性。结果 2型糖尿病组的HbA1c、FBG、TG、TC及LDL-C明显高于健康对照组,HDL-C则低于健康对照组,两组比较有统计学意义(P<0.05)。糖尿病组HbA1c与TC,LDL-C,HDL-C的关系不明显。结论 2型糖尿病患者血脂异常的发生率显著高于正常人,其血中HbA1c与FBG、TG存在正相关关系,与TC,HDL-C、LDL-C关系不明显。HbA1c、血糖和血脂联合检测对糖尿病及其并发症的早期发现和治疗有着重要意义。     

2型糖尿病患者糖基化血红蛋白水平与血脂的关系

目的 探讨2型糖尿病(T2DM)患者糖基化血红蛋白(HbAlc)水平与血脂的相关性.方法 检测949例住院的T2DM患者隔夜空腹10 h血HbAlc、空腹血糖(FBG)、餐后2-h血糖(PBG)、INt清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C).结果 女性T2DM患者TC、TG和HDL-C均高于男性T2DM患者(P＜0.01或p＜0.05).HbAlc与FBG、PBG有显著的相关性(P＜0.01).HbAlc与TC、TG、LDL-C呈显著正相关(P＜0.01).血糖控制差(6.5%＜HbAlc≤9%)和控制极差(HbAlc＞9%)组的TC、TG和LDL-C显著高于血糖控制好组(HbAlc≤6.5%).结论 T2DM患者血糖水平与脂代谢紊乱密切相关.HbAlc不仅是反映血糖控制的生化指标,而且也可以预示脂代谢的紊乱.     

瑞舒伐他汀治疗前后的血糖血脂变化及相关性分析

目的观察瑞舒伐他汀治疗前后血糖血脂的变化,为糖尿病合并脂质代谢紊乱的临床治疗提供参考。方法选择我院2010年2月至2012年1月收治的糖尿病合并脂质代谢紊乱患者45例,给予瑞舒伐他汀治疗,比较治疗前后患者血糖血脂水平的变化,并观察血糖和血脂水平的相关性。结果与治疗前比较,患者空腹血糖水平明显下降;血清胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)水平明显下降;高密度脂蛋白胆固醇水平(HDL-C)明显升高,差异有统计学意义(P<0.05)。TC、TG、LDL-C与血糖水平呈正相关,HDL-C与血糖水平呈负相关。结论采用瑞舒伐他汀治疗后患者血糖血脂水平均明显改善,血糖血脂水平的变化具有一定的相关性。     

糖脉康治疗2型糖尿病合并血脂异常的临床观察

目的探讨糖脉康治疗2型糖尿病(DM)并血脂异常的临床疗效。方法2型DM并血脂异常患者120例,随机分为治疗组(糖脉康组)及对照组(辛伐他汀组),每组60例,分别测定两组患者服药前及服药后3个月的空腹血糖(FG)、餐后2h血糖(2hPG)、血胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,并进行比较。结果两组患者的血TC、TG、LDL-C都较服药前降低,HDL-C水平较服药前升高,差异有统计学意义(P<0.05)。治疗组空腹血糖、餐后血糖明显较服药前降低,差异有统计学意义(P<0.05),对照组空腹血糖、餐后血糖较服药前降低,但差异无统计学意义(P>0.05)。结论糖脉康与辛伐他汀都有明显的调节血脂作用,且糖脉康还有协助降糖的作用。     

秋茄枝乙醇提取物改善2型糖尿病大鼠血糖和血脂异常

目的研究秋茄枝乙醇提取物(EEK)对2型糖尿病(T2DM)大鼠血糖和血脂的影响。方法以高脂饲料喂养联合链脲佐菌素(STZ)制备2型糖尿病大鼠模型。EEK低、中、高剂量组(0.25,1,2 g.kg-1)给药4周后,测定空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、游离脂肪酸(FFA)和空腹胰岛素(FINS)。结果 EEK未能影响T2DM大鼠体重,但可降低FINS、FBG、TC、TG、FFA和LDL-C,同时升高HDL-C。结论 EEK能够通过减轻胰岛素抵抗,增加机体对胰岛素的敏感性,从而降低血糖和改善血脂异常。     

依折麦布对糖尿病高胆固醇血症患者血脂、血糖和炎症指标的影响

目的观察依折麦布对糖尿病伴高胆固醇血症患者的血脂、血糖和炎症指标的影响,为临床用药提供借鉴。方法选取2012年6月至2013年10月于我院就诊的2型糖尿病伴高胆固醇血症患者160例,将其按服用降脂药物的不同分为试验组和对照组,每组60例。试验组患者采用依折麦布及辛伐他汀联合降脂治疗;对照组给予加倍剂量的辛伐他汀降脂治疗。观察两组患者治疗后的总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、空腹静脉血浆葡萄糖(FBG)、餐后2 h静脉血浆葡萄糖(PBG)、C反应蛋白(CRP)的变化。结果两组治疗后TC、TG、LDL-C水平较治疗前明显降低,两组治疗后HDL-C水平较治疗前明显增加,差异有统计学意义(P<0.05)。试验组治疗后TC、TG、LDL-C水平显著低于对照组,试验组治疗后HDL-C水平显著高于对照组,两组比较差异有统计学意义(P<0.05)。两组治疗后FBG、PBG、CRP较治疗前显著降低,差异有统计学意义(P<0.05)。试验组治疗后FBG、PBG、CRP显著低于对照组,差异有统计学意义(P<0.05)。结论依折麦布可以有效改善糖尿病伴高胆固醇血症患者的血脂、血糖水平,降低患者的炎症反应,有效降低患者发生心脑血管并发症的风险。     

疏血通注射液辅助治疗2型糖尿病合并血脂异常的疗效观察

目的:观察疏血通注射液辅助治疗2型糖尿病(T2DM)合并血脂异常的临床疗效。方法:将68例T2DM合并血脂异常患者随机分为治疗组34例和对照组34例,对照组采用他汀类或贝特类药物治疗,治疗组在对照组治疗基础上加用疏血通注射液治疗。结果:治疗前,治疗组和对照组的甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和总胆固醇(TC)水平间比较,均无显著性差异(均P>0.05)。治疗后,2组的TG和LDL-C水平均较治疗前显著下降(P<0.05),但治疗组的TG和LDL-C水平均显著低于对照组(P<0.05)。结论:疏血通注射液能辅助降低T2DM合并血脂异常患者的TG和LDL-C水平。     

阿托伐他汀治疗老年糖尿病患者伴血脂异常的临床疗效观察

目的观察阿托伐他汀治疗老年糖尿病患者伴血脂异常的疗效及安全性。方法选取2010年6月至2010年12月收治的2型糖尿病伴血脂异常患者60例。所有患者给予阿托伐他汀(辉瑞制药有限公司)10mg,睡前顿服,治疗8周。在治疗前及治疗8周后分别测定总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及空腹血糖和餐后2h血糖,治疗8周后观察疗效。结果经过治疗,TC、TG、HDL-C、LDL-C水平与治疗前比较差异有统计学意义(P<0.05)。结论阿托伐他汀治疗老年糖尿病患者伴血脂异常疗效满意,无明显不良反应。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。