他克莫司胶囊和缓释胶囊预防肝移植急性排斥反应的效果和安全性

目的 研究稳定期的肝移植受者分别服用他克莫司缓释胶囊和他克莫司胶囊在预防急性排斥反应的效果和安全性方面的差异.方法 采用多中心、随机、开放、对照的研究方法.试验组和对照组入组的稳定期肝移植受者各86例.试验组受试者的年龄为(46±10)岁;对照组受试者的年龄为(49±9)岁.试验组口服他克莫司缓释胶囊,每天1次,根据血药浓度谷值调整药量,维持血药浓度谷值为2～10 μg/L;对照组口服他克莫司胶囊,每天2次,维持血药浓度谷值为2～10 μg/L.结果 试验组和对照组分别有1.20%和1.18%的受试者发生急性排斥反应,两组的95%可信区间分别为-3.25%～3.31%和-3.26%～3.34%,可信区间上限均低于10%的非劣效标准.试验组和对照组急性排斥反应的发生率分别为1.20%和1.18%,两组患者发生急性排斥反应的次数均为1次,患者及移植物的存活率均为100%,以上指标两组间的差异均无统计学意义(P＞0.05).试验组有15例(占17.65%)共发生16次与试验药物相关的不良反应,对照组有10例(11.63%)共发生10次与试验药物相关的不良反应;试验药物有关严重不良反应中,试验组有4例(占4.71%)共发生4次,对照组有2例(占2.33%)共发生2次.两组不良反应发生率的差异均无统计学意义.结论 稳定期肝移植受者服用他克莫司缓释胶囊和他克莫司胶囊在预防急性排斥反应的疗效和安全性方面无明显差异.

Abstract：

Objective To evaluate the efficacy and safety of tacrolimus exposure in stable liver transplant recipients converted from FK506 twice a day to Advagraf (tacrolimus extended-release capsules) once daily. Methods This was an open-label, random, control and multi-center study.Eligible patients were 19 to 70 years of age, 6 months post-transplant with stable renal and hepatic function and receiving stable doses of tacrolimus twice a day for 2 weeks prior to enrollment. There were 86 patients in the experimental group and the control group, separately. The average age of experimental group and control group was 46 ± 10 and 49 ± 9, respectively. Patients in experimental group received Advagraf, once daily, and the dose was adjusted according to the drug concentration,and the drug concentration was between 2 to 10 μg/L. The control group given tacrolimus, twice daily, and the drug concentration was between 2 to 10 μg/L. Results The incidence of acute rejection reaction was 1.20 % and 1.18 % respectively in experimental group and control group, and the 95 %confidence interval was -3.25% ～3.31 % and -3.26% ～ 3.34 %, individually. There was 1 case of acute rejection reaction in experimental group and control group, respectively. The patient and organ survival rate was 100%. Sixteen adverse events occurred in 15 patients (17.65 %) of the experimental group, and 10 adverse events occurred in 10 patients (11.63 %) of control group. Severe adverse events relating to the test drug in experimental group occurred in 4 patients (4. 71 %). and 2 patients (2. 33) in control group.Conclision Clinical trials indicated that Advagraf has efficacy and safety profiles similar to those of tacrolimus. The drug is safe and may improve patient compliance.     

他克莫司胶囊和缓释胶囊预防肝移植急性排斥反应的效果和安全性

Objective To evaluate the efficacy and safety of tacrolimus exposure in stable liver transplant recipients converted from FK506 twice a day to Advagraf (tacrolimus extended-release capsules) once daily. Methods This was an open-label, random, control and multi-center study.Eligible patients were 19 to 70 years of age, 6 months post-transplant with stable renal and hepatic function and receiving stable doses of tacrolimus twice a day for 2 weeks prior to enrollment. There were 86 patients in the experimental group and the control group, separately. The average age of experimental group and control group was 46 ± 10 and 49 ± 9, respectively. Patients in experimental group received Advagraf, once daily, and the dose was adjusted according to the drug concentration,and the drug concentration was between 2 to 10 μg/L. The control group given tacrolimus, twice daily, and the drug concentration was between 2 to 10 μg/L. Results The incidence of acute rejection reaction was 1.20 % and 1.18 % respectively in experimental group and control group, and the 95 %confidence interval was -3.25% ～3.31 % and -3.26% ～ 3.34 %, individually. There was 1 case of acute rejection reaction in experimental group and control group, respectively. The patient and organ survival rate was 100%. Sixteen adverse events occurred in 15 patients (17.65 %) of the experimental group, and 10 adverse events occurred in 10 patients (11.63 %) of control group. Severe adverse events relating to the test drug in experimental group occurred in 4 patients (4. 71 %). and 2 patients (2. 33) in control group.Conclision Clinical trials indicated that Advagraf has efficacy and safety profiles similar to those of tacrolimus. The drug is safe and may improve patient compliance.     

他克莫司胶囊和缓释胶囊预防肝移植急性排斥反应的效果和安全性

Objective To evaluate the efficacy and safety of tacrolimus exposure in stable liver transplant recipients converted from FK506 twice a day to Advagraf (tacrolimus extended-release capsules) once daily. Methods This was an open-label, random, control and multi-center study.Eligible patients were 19 to 70 years of age, 6 months post-transplant with stable renal and hepatic function and receiving stable doses of tacrolimus twice a day for 2 weeks prior to enrollment. There were 86 patients in the experimental group and the control group, separately. The average age of experimental group and control group was 46 ± 10 and 49 ± 9, respectively. Patients in experimental group received Advagraf, once daily, and the dose was adjusted according to the drug concentration,and the drug concentration was between 2 to 10 μg/L. The control group given tacrolimus, twice daily, and the drug concentration was between 2 to 10 μg/L. Results The incidence of acute rejection reaction was 1.20 % and 1.18 % respectively in experimental group and control group, and the 95 %confidence interval was -3.25% ～3.31 % and -3.26% ～ 3.34 %, individually. There was 1 case of acute rejection reaction in experimental group and control group, respectively. The patient and organ survival rate was 100%. Sixteen adverse events occurred in 15 patients (17.65 %) of the experimental group, and 10 adverse events occurred in 10 patients (11.63 %) of control group. Severe adverse events relating to the test drug in experimental group occurred in 4 patients (4. 71 %). and 2 patients (2. 33) in control group.Conclision Clinical trials indicated that Advagraf has efficacy and safety profiles similar to those of tacrolimus. The drug is safe and may improve patient compliance.     

他克莫司胶囊和缓释胶囊预防肝移植急性排斥反应的效果和安全性

Objective To evaluate the efficacy and safety of tacrolimus exposure in stable liver transplant recipients converted from FK506 twice a day to Advagraf (tacrolimus extended-release capsules) once daily. Methods This was an open-label, random, control and multi-center study.Eligible patients were 19 to 70 years of age, 6 months post-transplant with stable renal and hepatic function and receiving stable doses of tacrolimus twice a day for 2 weeks prior to enrollment. There were 86 patients in the experimental group and the control group, separately. The average age of experimental group and control group was 46 ± 10 and 49 ± 9, respectively. Patients in experimental group received Advagraf, once daily, and the dose was adjusted according to the drug concentration,and the drug concentration was between 2 to 10 μg/L. The control group given tacrolimus, twice daily, and the drug concentration was between 2 to 10 μg/L. Results The incidence of acute rejection reaction was 1.20 % and 1.18 % respectively in experimental group and control group, and the 95 %confidence interval was -3.25% ～3.31 % and -3.26% ～ 3.34 %, individually. There was 1 case of acute rejection reaction in experimental group and control group, respectively. The patient and organ survival rate was 100%. Sixteen adverse events occurred in 15 patients (17.65 %) of the experimental group, and 10 adverse events occurred in 10 patients (11.63 %) of control group. Severe adverse events relating to the test drug in experimental group occurred in 4 patients (4. 71 %). and 2 patients (2. 33) in control group.Conclision Clinical trials indicated that Advagraf has efficacy and safety profiles similar to those of tacrolimus. The drug is safe and may improve patient compliance.     

他克莫司缓释胶囊在肝移植中应用的优势

他克莫司缓释胶囊(商品名新普乐可复)是每天服用1次的新型制剂,它将进一步改善移植受者的依从性.已经使用环孢素A或使用2次/d他克莫司胶囊的肝移植受者可以转换为他克莫司缓释胶囊,初始肝移植受者也可以直接应用他克莫司缓释胶囊. 众所周知,器官移植受者中依从性不佳者非常普遍,而在供者器官短缺日益严重的今天,如何改善依从性,优化受者及移植物的中长期预后,成为大家更为关注的热点问题.不同的研究中心所报道的依从性差的发生率高达22％～55％.但实际工作中,依从性差所导致的移植物功能丧失常常被低估.研究提示[1],与依从性良好的受者相比,依从性差的受者急性排斥反应的发生率更高,移植物功能丧失的发生率更高.他克莫司缓释胶囊究竟是否能改善肝移植受者的依从性呢?Beckebau等[2]的一项研究中给出了答案.     

他克莫司缓释胶囊在心血管安全性方面临床价值的探讨

他克莫司(商品名:普乐可复)是强效免疫抑制剂,它的出现显著提高了移植受者的长期存活.随着移植存活时间延长,心血管事件对受者的影响越来越引人关注.他克莫司缓释胶囊(商品名:新普乐可复)为1次/d的他克莫司缓释剂型,旨在提高血药浓度稳定性和受者依从性,从而改善移植受者的长期结果.本文即将探讨他克莫司缓释剂型能否带来心血管方面的临床获益.     

他克莫司缓释胶囊在肾移植中的应用进展

他克莫司(Tac,商品名:普乐可复)由于其强大的免疫抑制效能,在移植领域具有非常重要的地位.美国国家器官获取和移植网络/移植受者科学登记处(OPTN/SRTR)2009年的年报显示,在美国,约80.1 %的肾移植受者采用以他克莫司为基础的免疫抑制方案.由于实体器官移植患者需要终生服用免疫抑制剂,故长期应用时,患者的依从性会对疗效产生一定的影响.为有效改善依从性,提高移植受者的长期存活率,安斯泰来公司研发了每天1次的他克莫司缓释胶囊(商品名:新普乐可复),目前已经在国内及国外许多国家和地区上市.现有的研究表明,它可以与每天2次的他克莫司胶囊等剂量转换,本文将结合最新文献,介绍他克莫司缓释胶囊在肾移植领域应用的最新进展.     

他克莫司颗粒临床转换应用进展

他克莫司是移植术后核心的基础免疫抑制剂.主要剂型为胶囊和缓释胶囊,到目前为止尚无获批的他克莫司液体制剂。对于无法吞咽胶囊的儿童人群.只能使用由他克莫司粉末制备的口服混悬剂.但这一用法并未获得批准。此外,0.5mg和1mg他克莫司胶囊不便于对小儿受者进行精准地剂量调整。2020年8月,0.2mg和1mg小包装的他克莫司颗粒在中国获批.用于预防儿童肝脏或肾脏移植术后的移植物排斥反应,也治疗儿童肝脏或肾脏移植术后应用其他免疫抑制药物无法控制的移植物排斥反应。他克莫司颗粒的上市将为我国儿童受者的免疫抑制剂应用提供新选择.以下对他克莫司颗粒的临床转换应用进展做简要介绍。     

他克莫司缓释胶囊在肝移植术后稳定期受者中应用的疗效和安全性

依从性是影响肝移植受者长期预后的因素之一.有研究表明,依从性差是儿童肝移植受者中排名第3位的死亡原因.他克莫司缓释胶囊做为肝移植术后使用最广泛的免疫抑制剂,每天只需服用1次,从而显著改善了移植受者的依从性,然而,随着剂型的转变,他克莫司缓释胶囊在肝移植受者中应用的疗效和安全性是否会受到影响?本文结合一系列最新的临床资料对这一问题做一综述.     

华东制药产他克莫司在临床肾移植中的应用

目的 评估中美华东制药有限公司生产的他克莫司胶囊(赛氏Tac胶囊)在临床肾移植中应用的有效性及安全性.方法 采取多中心、随机开放性、前瞻性临床研究,按照入选标准和排除标准,来自9个移植中心的共计65例肾移植受者入选.人选受者的年龄为(36.53±5.71)岁,8例为亲属活体供肾,供肾冷缺血时间为(4.08±5.43)h,热缺血时间为(3.90±2.15)min,供、受者HLA抗原错配数为(2.1±0.8)个.受者肾移植后采用赛氏Tac胶囊+吗替麦考酚酯+皮质激素预防排斥反应,移植后48 h内给药,Tac的起始剂量为0.1～0.15 mg·kg-1·d-1,术后60 d内维持血Tac浓度谷值在8～12μg/L,之后维持在5～10μg/L,直至观察终点(术后12周).监测12周的治疗结果,并进行有效性和安全性的评价.主要有效性终点为发生经病理证实的急性排斥反应,次要有效性终点为移植肾或受者的存活情况以及肾功能(以血清肌酐水平评价).安全性评价指标为研究期间发生的感染、肝功能损害、高血压、高血脂、糖尿病、多毛或痤疮等不良反应.结果术后第1、2、4、8和12周的Tac用量分别为(6.54±1.69)、(6.39±1.45)、(6.73±1.25)、(6.25±1.02)和(6.03±1.16)mg,对应的血药浓度谷值分别为(8.24±2.09)、(9.39±1.35)、(9.93±1.87)、(7.23±1.16)和(6.43±1.26)μg/L.观察期内经活检证实的急性排斥反应发生率为12.3%(8/65),6例经冲击治疗逆转,移植肾存活率为96.9%(63/65).研究期内受者的肺部感染发生率为7.6%,肝功能异常发生率为7.7%,高血压发生率为7.7%,高血脂发生率为4.6%,糖尿病发生率为4.6%.结论 赛氏Tac胶囊用于肾移植受者是安全、有效的.

Abstract：

Objective To demonstrate the efficacy and safety of Hangzhou tacrolimus capsule(Saishi Tac capsule, Hangzhou Zhongmei Huadong Pharmaceutical Co. Ltd, China) in Chinese kidney transplant recipients. Methods Multicenter, randomized open-labeled, prospective controlled clinical trial was performed in de novo Chinese kidney transplant recipients. According to including and excluding criterions, 65 kidney recipients from 9 transplant centers were enrolled. The mean age of recipients was (36.53 ± 5.71 ) years, and 8 received living donor transplantion. The time of cold ischemia and warm ischemia was (4.08 ± 5.43) h and (3.90 ± 2.15) min respectively. The number of mismatched HLA was (2.1 ± 0.8). The recipients accepted Saishi Tac capsule + mycophenolate steroid 60 days, followed by 5-10 μg/L until the terminal observation time point (12 weeks after transplantation). The efficacy and safety were estimated during the period. The primary efficacy endpoint of the study was the incidence of biopsy-confirmed acute rejection. Graft survival and renal function (evaluated by serum creatinine) were the secondary endpoints. Safety was assessed by monitoring laboratory parameters and adverse events reported over the course of the study, such as infection, hepatic damage, hypertension, hyperlipema, diabetes mellitus and other adverse affairs.Results The dose of Tac at 1 st, 2nd, 4th and 8th week postoperation was (6.54 ± 1.69), (6.39 ±1.45),(6.73± 1.25), (6.25 ± 1.02) and (6.03 ± 1.16) mg, corresponding values to the C0 were (8.24±2.09),(9.39± 1.35),(9.93± 1.87),(7.23± 1.16) and (6.43± 1.26) μg/L. During 12weeks of follow-up, the incidence of biopsy-confirmed acute rejection was 12.3% (8/65), among which 6 cases were reversed by implosive therapy. The survival rate of graft kidney was 96.9% (63/65). The incidence of hypertension and hepatic damage was both 7.7% and morbidity of lung infection was 7.6%. There were 3 patients (4.6%) complicated with hyperlipema and diabetes mellitus respectively. Conclusion During the first 3 months of treatment Saishi Tac capsule was safe and effective to Chinese kidney transplant recipients.     

他克莫司缓释胶囊用于儿童器官移植受者研究进展

目前,关于儿童器官移植受者使用长效他克莫司制剂的临床数据有限。中华医学会2020年器官移植学年会(CSOT2020)于2020年12月25日至27日在上海召开。大会邀请了国内外著名器官移植及相关学科专家,共同探讨了当前移植领域的热点和难点问题。在此,特整理了此次大会中及近期他克莫司缓释胶囊用于儿童器官移植术后免疫抑制的相关研究进展。     

他克莫司缓释胶囊在肾移植中的应用进展(续)

2.对肾功能的影响:有报道显示,肾移植后10年时,约90 %的受者存在移植肾功能不全,如何改善移植肾功能一直是临床关注的课题之一.最近Tinti等[3]观察了将每天需口服2次的他克莫司胶囊(Tac,商品名:普乐可复)转换为每天仅口服1次的他克莫司缓释胶囊(商品名:新普乐可复)对移植肾功能的影响,共有31例肾移植后3~5年、服用Tac时间大于6个月、且肾功能稳定的受者纳入研究.     

肾移植术后他克莫司缓释剂型不同转换方案101例临床经验

目的回顾性分析肾移植术后稳定期受者他克莫司普通剂型转换为缓释剂型的不同转换方案的疗效和安全性, 为肾移植受者他克莫司转换策略提供参考。方法收集2020年1月至2020年6月中山大学附属第一医院术后稳定期他克莫司普通剂型转换为他克莫司缓释剂型的101例肾移植受者资料, 男性62例, 女性49例, 年龄19～69岁, 转换时按照等剂量转换和增加剂量转换两种方案进行分组, 先对比他克莫司普通剂型转换为缓释剂型后的变化, 再根据他克莫司普通剂型转换为缓释剂型不同转换剂量, 将受者分为两组:按照1∶1转换组受者55例;按照>1∶1(1∶1.2～1∶1.4)转换组受者46例。比较两组间转换后各项临床指标, 如血清肌酐(serum creatinine, Scr)、血尿素氮(blood urea nitrogen, BUN)、丙氨酸氨基转移酶(alanine aminotransferase, ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase, AST)、碱性磷酸酶(alkaline phosphatase, ALP)、血清白蛋白(albumin, ALB)、...     

Study of drug control over postoperative hemorrhage after selective caesarean section

Objective: To compare the efficacy and safety of carbetocin and oxytocin in the prevention of postpartum hemorrhage after selective caesarean section. Methods: Two hundred and sixteen pregnant women who were going to deliver by caesarean section were randomly divided into two paralleled and controlled groups, of which the oxytocin group(group A) contained 105 women and the carbetocin group(group B) 111 women. 20 IU of oxytocin was administrated during operation for both groups, 10 IU directly into uterus and 10 IU intravenously. When the operation was over, 20 IU of oxytocin was dripped for group A lasting for 8 hours, while for group B 100μg of carbetocin was immediately injected intravenously for 1 minute. Blood loss as well as hemoglobin alteration was measured for the comparison of the effect of the two drugs. Blood biochemical indicators were introduced for the evaluation of the safety of carbetocin including the function of liver and kidney and the fasting glucose.Results: No significant difference was revealed between the two groups concerning the postpartum hemorrhage within 24 hours, the postpartum hemorrhage incidence and the changes of hemoglobin. There was no significant difference in the change of liver and kidney function, fasting glucose and electrolyte changes as well.Conclusions: Carbetocin has a similar effect and safety of oxytocin in controlling the blood loss of selective caesarean section.     

腹腔镜结直肠癌根治术疗效分析

Objective To investigate the efficacy of laparoscopic radical resection for colorectal cancer. Methods From September 2000 to December 2004, 99 patients with colorectal cancer underwent laparoscopic radical resection (laparoscopic group) and 198 patients with colorectal cancer underwent open radical resection (open group) at the Union Hospital of Fujian Medical University. The differences in local recurrence and survival between the two groups were compared. The local recurrence of tumors and survival of patients in the two groups were calculated by the life-table method, and were compared by the Wilcoxon (Gehan) test, chi-square test and Fisher's exact test. The recurrence interval and survival time of the two groups were compared by non-parametric Wilcoxon rank sum test. Results The 2-and 3-year local recurrence rates in the laparoscopic group were both 3.0% and the overall local recurrence rate was 3.0% (3/99). The 2-and 3-year local recurrence rates in the open group were 2.6% and 4.0% , respectively, and the overall local recurrence rate was 3.5% (7/198), with no significant difference between the two groups (χ2 =0.002, P > 0. 05). The median survival time of patients with local recurrence was 15 months (range, 7-24 months) in the laparoscopic group and 11 months (range, 2-28 months) in the open group, with no significant difference between the groups (U = 15. 500, P >0. 05). The 1-year survival rate was 33.3% in the laparoscopic group and 42.9% in the open group. The 2-year survival rate was zero in the laparoscopic group and 42. 9% in the open group. There were no significant differences between the groups for the 1-and 2-year survival rates (χ2 =0.120, P>0.05). Conclusions The efficacy of laparoscopic radical resection for colorectal cancer is similar to that of open surgery. Laparoscopic radical resection for colorectal cancer is safe and feasible, and does not increase the recurrence rate of cancer.     

腹腔镜结直肠癌根治术疗效分析

Objective To investigate the efficacy of laparoscopic radical resection for colorectal cancer. Methods From September 2000 to December 2004, 99 patients with colorectal cancer underwent laparoscopic radical resection (laparoscopic group) and 198 patients with colorectal cancer underwent open radical resection (open group) at the Union Hospital of Fujian Medical University. The differences in local recurrence and survival between the two groups were compared. The local recurrence of tumors and survival of patients in the two groups were calculated by the life-table method, and were compared by the Wilcoxon (Gehan) test, chi-square test and Fisher's exact test. The recurrence interval and survival time of the two groups were compared by non-parametric Wilcoxon rank sum test. Results The 2-and 3-year local recurrence rates in the laparoscopic group were both 3.0% and the overall local recurrence rate was 3.0% (3/99). The 2-and 3-year local recurrence rates in the open group were 2.6% and 4.0% , respectively, and the overall local recurrence rate was 3.5% (7/198), with no significant difference between the two groups (χ2 =0.002, P > 0. 05). The median survival time of patients with local recurrence was 15 months (range, 7-24 months) in the laparoscopic group and 11 months (range, 2-28 months) in the open group, with no significant difference between the groups (U = 15. 500, P >0. 05). The 1-year survival rate was 33.3% in the laparoscopic group and 42.9% in the open group. The 2-year survival rate was zero in the laparoscopic group and 42. 9% in the open group. There were no significant differences between the groups for the 1-and 2-year survival rates (χ2 =0.120, P>0.05). Conclusions The efficacy of laparoscopic radical resection for colorectal cancer is similar to that of open surgery. Laparoscopic radical resection for colorectal cancer is safe and feasible, and does not increase the recurrence rate of cancer.     

关注他克莫司缓释胶囊在药物经济学方面的价值

对于终末期肝病和肾病患者而言,器官移植是较好的一种治疗选择.从社会经济学角度分析,因为经济资源有限,供者器官稀缺,且受者术后需要终身服用免疫抑制剂,所以,如何使有限的资源得到最优的配置和利用,如何以较少的成本获得最大收益,是移植医生在制定综合治疗方案时必须考虑的问题. 2010年美国器官资源共享网络(UNOS)数据表明,他克莫司胶囊在肝移植受者术后1年的使用率为89.3％,肾移植受者术后1年的使用率则达到90.0％.他克莫司已经取代环孢素A,成为肝移植和肾移植后应用最广泛的钙调磷酸酶抑制剂.     

老年非心脏手术患者术前高敏C反应蛋白与术后心脏不良事件相关性的研究

Objective To investigate the relevance between level of preoperative high-sensitivity C-reactive protein(hsCRP) and the occurrence of postoperative adverse cardiac events in elderly patients underwent noncardiac surgery. Methods 49 patients of more than 65 years that had undergone elective noncardiac surgery were enrolled in the study. And all patients were conformed to the standards of "classification of risk factors for clinical history", content of "Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery" established by the ACC/AHA .The patients were divided into two groups based on the preoperative hsCRP level:A group:hsCRP ≤ 3mg/L group (n=21) and B group: hsCRP>3mg/L group (n=28). General clinical characteristics of patients were recorded before operation, and 24 hours dynamic ECG was monitored a week prior to and after the operation. All patients taken measures of analgesia after surgery. The incidence of postoperative adverse cardiac events and the hospitalized days was recorded. The distinctions between two groups were analyzed regarding the occurrence of adverse cardiac events and hospitalized days after operation. Results 19 patients had postoperative myocardial ischemia; 4 cases in A group and 15 cases in B group. 7 patients suffered other postoperative adverse cardiac events, including 1 case in A group and the others in B group. There was statistically significant difference considering morbidity of myocardial ischemia in postoperation between the two groups, but there was no statistically significant difference about incidence of other adverse cardiac events and the length of stay in postoperation. Indexes about serious degree of myocardial ischemia:total depression time is(43.5±5.82 )min in A group, is( 135.0±81.2)min in B group. The depression times is(5.2±2.5 )in A group, is( 8.8±3.0)in B group.The longest depression time is( 23.7±9.2)min in A group, is( 84.3±54.1 )min in B group.Total ischemia burden is( 170.1 ±88.8 )mm· min-1 ·24h-1 in A group, is (311.3± 118.8 )mm· min-1 ·24h-1 in B group.There was statistically significant difference between the two groups. Conclusion Level of preoperative hsCRP>3 mg/L was relevant to the incidence of the most common postoperative adverse cardiac events--myocardial ischemia in elderly patients and level of preoperative hsCRP >3 mg/L was one of the risk factors of postoperative myocardial ischemia;Determination of preoperative hsCRP level may improve cardiovascular risk scoring system.     

采用以他克莫司为基础的免疫抑制方案的肝移植受者长期预后评估

他克莫司被批准用于肝移植已有十多年的历史.它对肝移植受者的疗效已经得到了大量循证医学证据的支持.目前肝移植受者的治疗方案中,以他克莫司为基础的免疫抑制方案占90%以上[1].随着临床数据的积累,接受以他克莫司为基础免疫抑制剂的肝移植受者的长期预后也越来越清晰的浮出水面.     

急性下肢深静脉血栓形成局部置管溶栓与外周静脉溶栓的比较

Objective To investigate the efficacy of anticoagulation and thrombolysis for deep venous thrombosis via local vein approach and peripheral vein approach to guide clinical treatment. Methods There were 225 patients with deep venous thrombosis admitted from January 2001 to May 2008. The cases were divided into two groups by therapy procedures. The patients in group A were treated by deep femoral vein catheter-directed anticoagulation and thrombolysis, including a total number of 71 patients, with right lower extremity in 20 patients, left lower extremity in 47 patients and bilateral lower extremities in 4 patients. One hundred and fifty-four patients were included in group B with anticoagulation and thrombolysis through peripheral vein, among them right lower extremity in 27 patients, left lower extremity in 121 patients and bilateral lower extremities in 6 patients. The efficacy was evaluated and compared by observing clinical symptoms and measuring of changes in limb circumference. Results Symptoms were alleviated in all patients in 3 d after the treatment, but the efficacy of group A was better than group B (94. 4% vs. 69. 5% ,P＜0. 01). The efficacy of group A was also better than group B in 7 days after treatment, but with no significant difference (85. 9% vs. 75. 3% , P ＞0. 05). A mean follow-up period was (43 ±18) months.There was no significant difference in incidence of complication and recurrence between two groups.Conclusions The earlier efficacy of anticoagulation and thrombolysis via femoral vein approach is better than via peripheral vein approach in earlier period of deep venous thrombosis. While peripheral intravenous therapy has also good results after long-term treatment.