麝香保心丸联合瑞舒伐他汀对冠心病心绞痛病人血液流变学及血脂的影响

目的观察麝香保心丸联合瑞舒伐他汀治疗冠心病心绞痛的临床疗效及对病人血液流变学及血脂的影响。方法将120例冠心病心绞痛病人随机分为对照组和观察组,每组60例。两组予以常规治疗:休息、吸氧、硝酸酯类、β受体阻滞剂、利尿剂、钙拮抗剂、血管扩张剂等常规治疗。对照组病人加用瑞舒伐他汀进行治疗,疗程均为8周。观察组在对照组的基础上联合应用麝香保心丸,连续应用8周。观察两组治疗前后病人血清血液流变学、超敏C反应蛋白(hs-CRP)含量及血脂[三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)]水平变化。结果治疗后观察组总有效率为90.0%,优于对照组的78.3%,观察组疗效优于对照组,差异有统计学意义(P0.05);治疗后,两组病人TC、TG、LDL-C、hs-CRP均下降,HDL-C上升,观察组TC、TG、LDL-C、hs-CRP低于对照组,HDL-C高于对照组,差异有统计学意义(P0.05),治疗组TG、LDL-C的改善也明显优于对照组;治疗后两组病人全血黏度、血浆黏度、纤维蛋白原均下降,但观察组下降程度高于对照组(P0.05)。结论麝香保心丸联合瑞舒伐他汀治疗冠心病心绞痛,能够明显缓解病人心绞痛症状,改善心肌供血,且有抗炎、降低血脂、改善血液流变的作用。     

丁苯酞对慢性脑供血不足患者hs-CRP及脑血流量的影响

目的探讨丁苯酞对慢性脑供血不足(CCCI)患者超敏C反应蛋白(hs-CRP)、脑血流量及TC、LDL-C的影响,为其治疗CCCI提供依据。方法选择100例CCCI患者,随机分为治疗组、对照组各50例,均给予抗血小板聚集、活血化瘀等药物治疗,治疗组加用丁苯酞。分别检测两组治疗前后血清hs-CRP、TC、LDL-C及脑血流量。结果治疗8周后,治疗组hs-CRP、TC、LDL-C水平低于对照组(P均<0.05);脑动脉血流速度较对照组明显改善(P<0.05);临床疗效优于对照组(P<0.05)。结论丁苯酞可显著降低CCCI患者血清hs-CRP、TC、LDL-C水平,提高脑血流量,改善CCCI病情及预后。     

辛伐他汀对老年不稳定性心绞痛血清胆固醇及超敏C-反应蛋白的影响

目的观察辛伐他汀治疗老年不稳定性心绞痛对患者血清胆固醇及高敏C反应蛋白(high-sensitivityC-reactiveprotein,hs-CRP)的影响。方法将78例(73±7岁)老年不稳定性心绞痛患者,分为辛伐他汀组和对照组。辛伐他汀组(45例)给予辛伐他汀(20mg/天),治疗共4周;对照组(33例),常规(未经调脂)治疗。分别测定治疗前后的血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及hs-CRP,统计学比较两组治疗前后血清TC、LDL-C、HDL-C及hs-CRP水平。结果①治疗前两组血清TC、LDL-C、HDL-C及hs-CRP水平均无显著差异(P>0.05)。②辛伐他汀组治疗后TC、LDL-C显著下降(P<0.001),HDL-C升高(P=0.002)。对照组治疗前后TC、LDL-C、HDL-C均无显著性差异(P>0.05)。③辛伐他汀组与对照组治疗后hs-CRP均有下降,但辛伐他汀组下降值(2.91±2.62mg/L)显著大于对照组下降值(0.91±1.18mg/L)(P<0.001)。④辛伐他汀治疗4周后hs-CRP的降低与血脂改变TC(r=0.004P=0.977)、LDL-C(r=0.173P=0.256)、HDL-C(r=-0.223P=0.141)无相关性。结论辛伐他汀治疗老年不稳定性心绞痛患者4周,能安全有效调节血清胆固醇及降低hs-CRP水平,且降低hs-CRP水平独立于其调脂作用。     

降脂灵片联合辛伐他汀治疗高脂血症临床观察

目的观察降脂灵片联合辛伐他汀治疗高脂血症的临床疗效。方法 68例高脂血症患者,随机分为降脂灵片联合辛伐他汀治疗组和辛伐他汀对照组,观察两组临床疗效及治疗前后血脂变化。结果降脂灵片联合辛伐他汀可显著降低血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C),使高密度脂蛋白胆固醇(HDL-C)明显升高,治疗前后比较有统计学意义(P0.01);在降低TC、LDL-C,提升HDL-C水平方面,与对照组比较有统计学意义(P0.05)。结论降脂灵片联合辛伐他汀降脂作用明显,疗效稳定,是治疗高脂血症的理想药物。     

丹田降脂丸治疗老年高脂血症的临床疗效

目的探讨丹田降脂丸治疗老年高脂血症的临床疗效。方法选择112例老年高脂血症患者,按照随机数字法随机分为观察组和对照组各56例,两组均采取低脂饮食,对照组口服辛伐他汀治疗,观察组采用丹田降脂丸联合辛伐他汀治疗,两组均治疗8 w;记录对比治疗前后两组患者血脂各项指标及肝肾功能指标的变化及治疗后的临床疗效。结果所有患者治疗8 w后,高密度脂蛋白胆固醇(HDL-C)均较治疗前显著上升(P0.05),甘油三酯(TG)、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)均较治疗前显著降低(P0.05);且观察组治疗后HDL-C增加高于对照组(P0.05),而其TG、TC、LDL-C显著性低于对照组(P0.05)。与治疗前相比,观察组谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)和尿素氮水平(BUN)治疗后均显著下降(均P0.05),而对照组治疗后与治疗前相比无显著性差异(均P0.05)。治疗8 w后,观察组总有效率显著高于对照组(χ2=4.264,P0.05)。治疗期间,观察组有3例而对照组只有1例患者出现胃肠道不适反应(恶心呕吐),给予对症治疗后均好转;且两组发生不良反应比较无统计学差异(P0.05)。结论丹田降脂丸联合辛伐他汀用于治疗老年高脂血症可产生协同降脂作用,对肝、肾损伤也有一定的预防保护作用,值得临床推广。     

通心络、辛伐他汀对老年急性脑梗死患者TNF-α、hs-CRP和血脂的影响

目的观察通心络、辛伐他汀对老年急性脑梗死患者肿瘤坏死因子(TNF)-α、血清高敏C反应蛋白(hs-CRP)和血脂的影响。方法将134例老年急性脑梗死患者随机分为通心络组和辛伐他汀组,每组67例。通心络组在常规治疗基础上加服通心络,每次1 g,每日3次;辛伐他汀组在常规治疗基础上加服辛伐他汀,每次5 mg,每晚1次。正常对照组86例。观察患者治疗前后TNF-α、血清hs-CRP和血脂水平的变化。结果两个治疗组TNF-α、hs-CRP、低密度脂蛋白胆固醇(LDL-C)和总胆固醇(TC)均明显下降(P0.01);与通心络组比较,辛伐他汀组的HDL-C明显升高(P0.01)。结论辛伐他汀治疗老年急性脑梗死疗效显著。     

不同剂量辛伐他汀联合曲美他嗪对老年慢性心力衰竭患者心功能、血脂及炎性因子的影响

目的探讨不同剂量辛伐他汀联合曲美他嗪对老年慢性心力衰竭(CHF)患者心功能、血脂及炎性因子的影响。方法老年CHF患者60例根据辛伐他汀使用剂量分为对照组(n=30)和观察组(n=30)。对照组给予曲美他嗪联合常规剂量辛伐他汀20 mg治疗,观察组给予曲美他嗪联合大剂量辛伐他汀40 mg/d治疗,疗程均为6个月。观察并对比两组治疗6个月后的临床疗效及治疗前后心功能指标:左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)和左心室射血分数(LVEF)、6 min步行距离,炎性因子指标:超敏C反应蛋白(hs-CRP)、B型脑钠钛(BNP),血脂指标:血清总胆固醇(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)。结果观察组治疗后的总有效率为90.00%(27/30),显著高于对照组的63.33%(19/30),差异有统计学意义(P<0.05)。治疗后两组LVESD、LVEDD、TC、TG、LDL-C均较治疗前明显降低,且观察组TC、TG、LDL-C低于对照组(P<0.05);LVEF、6 min步行距离、HDL-C均较治疗前明显升高;且观察组明显高于对照组(P<0.05)。两组患者治疗后hs-CRP、BNP均较治疗前明显降低,且观察组明显低于对照组(P<0.05)。结论大剂量辛伐他汀联合曲美他嗪治疗老年CHF患者疗效较佳,可改善心室重构及心功能,并有效调节血脂、炎性因子水平。     

心脑舒通对高血压病伴高脂血症患者血脂及超敏C反应蛋白的影响

目的探讨心脑舒通胶囊对高血压病伴高脂血症患者血脂及超敏C-反应蛋白(hs-CRP)的影响。方法将100例高血压病伴高脂血症患者随机分为观察组(心脑舒通联合辛伐他汀滴丸)50例和对照组(辛伐他汀滴丸)50例,治疗前后分别测定血浆总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和hs-CRP,比较两组血脂及hs-CRP的情况。结果治疗3个月后观察组TC、TG、LDL-C、hs-CRP比对照组明显减低(P0.05),HDL-C明显增高(P0.05)。结论心脑舒通可明显降低高血压病伴高脂血症患者血脂,降低血浆hs-CRP水平。     

强化降脂治疗对急性冠状动脉综合征患者基质金属蛋白酶的影响

目的:比较40～60 mg阿托伐他汀的强化降脂与20 mg阿托伐他汀治疗相比,对急性冠状动脉综合征(ACS)患者血脂、高敏C反应蛋白(hs-CRP)、基质金属蛋白(MMP)的影响及其安全性。方法:选取ACS患者46例,随机分为较大剂量(40～60 mg)组和常规剂量(20 mg)组,观察服药前、服药后1 w、4 w时血脂:总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、hs-CRP、MMP-2、MMP-9水平的变化。结果:1.强化治疗组1 w时就出现TC、LDL-C水平的下降(P<0.05),4 w时下降更明显(P<0.01),且降脂效果较常规治疗组更显著(P<0.05);2.强化治疗组1 w时hs-CRP、MMP-2及MMP-9水平开始下降,4 w时下降更显著,其效果明显优于常规治疗组;3.强化降脂治疗与常规治疗组相比,肝、肾功能,肌酸激酶(CK)均无明显改变。结论:对于ACS患者,早期的强化降脂治疗能更显著的降低血脂、hs-CRP及MMP水平,能更好的发挥他汀的抗炎及稳定斑块的作用。     

依折麦布联合辛伐他汀对冠心病及糖尿病患者的血LDL-C达标和安全性观察

目的 观察依折麦布联合辛伐他汀对冠心病及糖尿病患者血LDL-C达标率和安全性。方法选择血LDL-C未达标的冠心病及糖尿病患者46例,随机分成依折麦布（10mg/d）联合辛伐他汀（20mg/晚）组（联合治疗组）24例和他汀加倍治疗组22例（给予辛伐他汀40mg/晚）。观察两组患者降脂药物治疗后血脂水平变化及第4周、8周、12周时患者血LDL-C达标率、药物不良反应等。结果在降脂治疗第4、8和12周,联合用药组血LDL-C达标率均高于他汀加倍治疗组,第8、12周时两组患者达标率比较有显著统计学差异（P〈0.01）。药物治疗12周时,两组患者血脂水平较治疗前均有改善,血LDL-C和TC水平与同组治疗前比较差异有统计学意义（P〈0.01～0.05）;两组患者药物治疗12周后血LDL-C和TC水平比较亦有显著统计学差异（P〈0.01）。联合用药组患者均能耐受降脂治疗,他汀加倍治疗组中有2例（9.1%）患者因不良反应出现减量或停药。结论依折麦布联合辛伐他汀治疗较单纯加大辛伐他汀剂量治疗更能提高患者血LDL-C达标率,且具有良好耐受性。     

ERCP and MRCP--when and why

Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP) in the 1970s, gastroenterologists have a wide spectrum of diagnostic and therapeutic options in the biliopancreatic ductal system at their disposal. With its arrival in the 1990s, magnetic resonance cholangiopancreatography (MRCP) developed as a potent diagnostic tool in biliopancreatic pathology. Currently, MRCP is widely replacing diagnostic ERCP and thereby avoiding complications related to endoscopic technique.We summarize evidence-based data and demonstrate indications and differential indications for MRCP and ERCP in pancreatic disease. Complications related to the procedures and possible medical prevention are discussed. The feasibility of interventional endoscopy in pancreatic disease is reported in detail. The role of gastroenterologists in performing MRCP is outlined on the basis of practical examples.     

Convection and permeation and albumin between plasma and interstitium.

Nonequilibrium thermodynamics is combined with compartmental analysis to interpret albumin sieving and tracer experiments in terms of a permeability-surface product PS (permeation) and a solvent drag reflection coefficient σ_f (convection) for various blood-tissue barriers. The human whole-body albumin data of Lassen, Parving, and Rossing (Lassen, Parving, and Rossing, Microvasc. Res.7, i–iv (1974)), modified for nonliver tissues by Johnson and Levitt (Johnson &; Levitt, Microvasc. Res.9, 141 (1975)) lead to P ～ 1.8 × 10^?8 cm sec^?1 (based on a surface area per unit plasma volume of 700 cm^?1) and to σ_f ～ 0.9, which imply, in agreement with Johnson and Levitt, that permeation is the dominant nonliver blood-tissue transport mechanism for albumin in the normal resting human. Similar values are derived from the dog paw muscle data of Garlick and Renkin (Garlick and Renkin, Amer. J. Physiol.219, 1595–1605 (1970)). The Casley-Smith (Casley-Smith, Microvasc. Res.9, 43–48 (1975)) mechanism of uphill albumin transport is verified as possible. It is tentatively inferred that lymph formation in resting tissue does not result from a small difference between a large fluid (volumetric) filtration and an almost equally large fluid reabsorption, either in the same capillary (Starling) or between different capillaries (Zweifach) (Zweifach, Circ. Res.34, 858–866 (1974)). Rather, reabsorption is negligibly small relative to filtration, and lymph flow is comparable to volumetric filtration.     

Micronutrients and infection: interactions and implications with enteric and other infections and future priorities

Symposium presentations have focused on the elegant molecular science and the biologic mechanisms by which micronutrients play critical roles in cellular and humoral immune responses, cellular signaling and function, and even in the evolution of microbial virulence. The concluding session examined the practical issues of how best to evaluate the nutritionally at-risk host, especially in the areas of greatest need-an analytical model of nutrient-immune interactions, implications of nutritional modulation of the immune response for disease, and the implications for international research and child health. This overview illustrated how malnutrition may be a major consequence of early childhood diarrhea and enteric infections, as enteric infections may critically impair intestinal absorptive function with potential long-term consequences for growth and development. The potentially huge, largely undefined DALY (disability-adjusted life years) impact of early childhood diarrheal illnesses demonstrates the importance of quantifying the long-term functional impact of largely preventable nutritional and infectious diseases, especially in children in developing areas.