甲氨蝶呤联合环磷酰胺治疗类风湿关节炎的临床研究

目的 评价甲氯燥呤(MTX)联合环磷酰胺(CTX)治疗类风湿关节炎(RA)的疗效和安全性.方法 将152例RA患者随机分为单用MTX组56例、单用CTX组40例及MTX联合CTX组56例,疗程24周,在0、6、12、24周进行疗效及安全性评估,以美国风湿病学会(ACR)疗效评价指标和欧洲抗风湿病联盟(EULAR)疗效指标等进行疗效评价.结果 在24周,联合组达ACR20改善的患者为42例(81%),高于MTX组30例(56%)(30/54)及CTX组12例(35%)(12/54),差异有统计学意义(P<0.05);联合组达ACR50改善的患者为22例(41%),高于CTX组4例12%(4/34),(P<0.05),与MTX组22例(41%)(22/54)之间差异无统计学意义(P>0.05).结论 MTX联合CTX治疗能显著改善RA的症状、体征和实验室炎性指标,疗效优于单用.     

阿达木单抗治疗类风湿关节炎的疗效和安全性

目的:评价肿瘤坏死因子α拮抗剂阿达木单抗短期治疗类风湿关节炎(RA)的临床疗效及安全性,同时检测治疗前后类风湿因子(RF)和抗环瓜氨酸肽抗体(抗CCP抗体)滴度的变化,为RA疗效评估寻找新的指标。方法:随机双盲平行试验,纳入40例活动性RA患者,按2∶2∶1的比例被随机分配到试验组或对照组,试验组分为80 mg阿达木单抗+甲氨喋呤(MTX)、40 mg阿达木单抗+MTX两组,对照组为安慰剂+MTX。受试者隔周接受皮下注射阿达木单抗或同等体积的安慰剂,并在试验第0,2,4,8,12周随访,评价疗效及不良事件收集。疗效采用ACR核心标准评定。次要疗效指标包括压痛和肿胀关节数、晨僵时间、疼痛视觉模拟评分(VAS评分)、健康评估问卷(HAQ)和CRP。基线时及12周治疗结束后检测RF、抗CCP抗体。结果:试验组32例,对照组8例。12周后试验组患者ACR20、ACR50和ACR70缓解的比例都显著高于对照组(P<0.01);试验组患者关节触痛数、关节肿胀数、晨僵持续时间、疼痛VAS评分及健康状况问卷(HAQ)、CRP等次要疗效指标均较基线时水平明显降低(P<0.05);试验组RF血清滴度和抗CCP抗体均较基线时水平显...     

99mTc-亚甲基二膦酸盐治疗类风湿关节炎近期临床疗效观察

目的 对99mTc -亚甲基二膦酸盐(商品名为云克,99mTc - MDP)联合甲氨蝶呤(MTX)治疗类风湿关节炎(RA)与单用MTX治疗RA的疗效和安全性进行临床比较观察.方法 将60例RA活动期患者,随机分为99mTc - MDP联合MTX治疗组、单用MTX治疗组各30例,分别给予99mTc - MDP联合MTX治疗、MTX治疗,观察治疗后0周、2周、12周两组临床表现、ACR评分与炎性指标的变化.结果 治疗2周后99mTc - MDP联合MTX组在改善晨僵、降低ESR、CRP等方面明显优于MTX组(P＜0.05);治疗12周后联合组在改善晨僵、降低关节压痛数、肿胀数,降低ESR、CRP均低于MTX组(P＜0.05).99mTc-MDP联合MTX组ACP20、ACR70缓解均高于MTX组,两组间差异有统计学意义(P＜0.05).结论 99mTc - MDP联合MTX 治疗RA较单用MTX可更明显改善RA患者的临床症状和实验室指标,且未增加不良反应.     

洛伐他汀对类风湿关节炎炎性因子的影响及治疗作用

目的研究洛伐他汀对类风湿关节炎(RA)患者血清炎性细胞因子的作用、临床疗效。方法 80例活动期RA患者,随机分为两组:甲氨蝶呤组、甲氨蝶呤+辛伐他汀组,MTX组做对照组,每组40例。分别于治疗前、治疗后24周记录患者压痛关节指数(TJI)、肿胀关节指数(SJI)、DAS28评分;检测IL-1β、IL-6、TNF-α。结果各组治疗后第24周疗效比较:甲氨蝶呤+辛伐他汀组能显著降低血清中升高的IL-1β、IL-6、TNF-α水平。甲氨蝶呤+辛伐他汀组达到EULAR有效的患者比例(72%),明显优于甲氨蝶呤组(65%)。结论联合应用甲氨蝶呤和辛伐他汀组治疗活动期RA,可以下调炎性因子,而且近期疗效显著优于甲氨蝶呤组。     

鸡Ⅱ型胶原双盲随机对照治疗类风湿关节炎的研究

目的观察口服鸡Ⅱ型(CCⅡ)胶原胶囊治疗我国活动性类风湿关节炎(RA)患者的疗效和安全性。方法采用随机、双盲双模拟、平行对照临床研究。共入选病例60例,口服鸡Ⅱ型胶原胶囊90μg/d,或甲氨蝶呤(MTX)10mg/周,疗程24周。其中5例患者被剔除,最后纳入统计共55例,MTX组29例,CⅡ组26例。结果口服CCⅡ能明显改善RA患者的休息痛、晨僵、压痛关节指数、肿胀关节指数、患者评价、日常生活能力、血沉和C反应蛋白(P<0.05),但对压痛关节指数、肿胀关节指数、关节功能、日常生活能力、血沉的改善不及MTX(P<0.05)。按国内抗风湿药疗效评价标准,两组在治疗12周时疗效差异无统计学意义,治疗18、24周时CⅡ疗效不及MTX(P<0.05)。ACR20%在12、18和24周时MTX组疗效较CⅡ组好(P<0.05);ACR50%在18周时MTX组疗效较CⅡ组好(P<0.05),但12和24周时两组差异无统计学意义。CⅡ组无因不良反应停药者,对肝、肾功能、血常规未见影响,胃肠道等不适反应明显低于MTX组(P<0.05),MTX组有1例患者因服药后转氨酶升高3倍以上而停药。结论口服CCⅡ治疗RA具有一定的疗效且不良反应较少,但总体疗效不及MTX。     

双氯芬酸二乙胺乳胶剂联合甲氨蝶呤治疗类风湿性关节炎疗效观察

目的 观察双氯芬酸二乙胺乳胶剂联合甲氨蝶呤(MTX)治疗类风湿性关节炎(RA)的疗效和安全性.方法 将70例RA患者随机分为治疗组和对照组各35例.2组均给予MTX片7.5～15mg口服,每周1次;治疗组加用1%双氯芬酸二乙胺乳胶剂外涂关节周围,每次0.01g/cm2,每天3次;对照组加用洛索洛芬钠片60mg口服,每天3次.治疗后比较2组休息痛、压痛关节指数、关节肿胀指数及28个关节疾病活动性(DAS28)评分情况,并比较2组不良反应发生率.结果 2组患者治疗1、2、3周后关节休息痛、压痛关节指数、关节肿胀指数及DAS28评分均有显著改善(P＜0.05或P＜0.01),2组治疗1、2、3周后休息痛、关节肿胀指数、关节压痛指数及DAS28评分优于治疗前(P＜0.05或P＜0.01);除治疗组疗后1周时DAS28评分高于对照组(P＜0.05)外,2组其余指标治疗后同时间比较差异无统计学意义(P＞0.05).治疗组不良反应发生率为5.7%低于对照组的11.4%(P＜0.05).结论 双氯芬酸二乙胺乳胶剂联合MTX治疗RA疗效与口服洛索洛芬钠联合MTX相当,不良反应发生率更低,值得临床推广应用.     

周期联合甲氨蝶呤环磷酰胺治疗类风湿关节炎的临床疗效及疗效预测因素分析

目的探讨周期联合甲氨蝶呤、环磷酰胺治疗类风湿关节炎(RA)的临床疗效和达到临床疗效的预测因素。方法本研究共纳入60例活动期RA患者,给予甲氨蝶呤(10～15mg/周)、环磷酰胺(400mg/2～3周)周期联合治疗。在第24周时对临床疗效进行评估。以治疗24周时达到美国风湿病学会(ACR)20为疗效标准,对基线时的14项参数[年龄、性别、病程、疼痛视觉模拟量表(VAS)评分、患者对疾病总体状况的评估(PGA)、医生对疾病总体状况的评估(PhGA)、压痛关节数、肿胀关节数、健康评估问卷(HAQ)、红细胞沉降率(ESR)、C反应蛋白(CRP)、激素的使用情况、类风湿因子(RF)和抗环瓜氨酸肽(CCP)抗体水平]进行Logistic单因素和多因素疗效预测分析。结果共58例RA患者完成24周疗效观察。在第24周时,79%(46/58)的患者达ACR20改善,55%(32/58)的患者达ACR50改善,21%(12/58)的患者达ACR70改善。24周时达到EULAR临床有效的患者比例为76%(44/58)。Logistic单因素和多因素分析显示:年龄、肿胀关节数是ACR20疗效的预测因素。结论甲氨蝶呤联合环磷酰胺治疗RA疗效显著,两者联合治疗能明显改善RA的症状、体征和实验室炎性指标;年龄和肿胀关节数是ACR20疗效的预测因素。     

双氯芬酸二乙胺乳胶剂联合甲氨蝶呤治疗类风湿性关节炎疗效观察

目的观察双氯芬酸二乙胺乳胶剂联合甲氨蝶呤（MTX）治疗类风湿性关节炎（RA）的疗效和安全性。方法将70例RA患者随机分为治疗组和对照组各35例。2组均给予MTX片7.5～15mg口服,每周1次;治疗组加用1%双氯芬酸二乙胺乳胶剂外涂关节周围,每次0.01g/cm2,每天3次;对照组加用洛索洛芬钠片60mg口服,每天3次。治疗后比较2组休息痛、压痛关节指数、关节肿胀指数及28个关节疾病活动性（DAS28）评分情况,并比较2组不良反应发生率。结果 2组患者治疗1、2、3周后关节休息痛、压痛关节指数、关节肿胀指数及DAS28评分均有显著改善（P〈0.05或P〈0.01）,2组治疗1、2、3周后休息痛、关节肿胀指数、关节压痛指数及DAS28评分优于治疗前（P〈0.05或P〈0.01）;除治疗组疗后1周时DAS28评分高于对照组（P〈0.05）外,2组其余指标治疗后同时间比较差异无统计学意义（P〉0.05）。治疗组不良反应发生率为5.7%低于对照组的11.4%（P〈0.05）。结论双氯芬酸二乙胺乳胶剂联合MTX治疗RA疗效与口服洛索洛芬钠联合MTX相当,不良反应发生率更低,值得临床推广应用。     

Outcomes of combined use of leflunomide and low-dose prednisone in the treatment of elder patients with rheumatoid arthritis

目的 评价来氟米特(LEF)联合小剂量糖皮质激素(GCs)治疗老年类风湿关节炎(RA)的有效性和安全性.方法 活动期RA老年患者68例,随机分为LEF治疗(LEF组,34例)和LEF联合小剂量GCs治疗(联合组,34例),治疗0、4、8、12周用美国风湿病协会(ACR) 20标准评价疗效,记录不良反应.结果 与LEF组比较,联合组治疗4周,晨僵时间、关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数、疼痛VAS、医生总体评价VAS、病人总体评价VAS、DAS28、C反应蛋白(CRP)均有更大改善(P＜0.05),治疗后12周医生总体评价VAS、病人总体评价VAS、血沉( ESR)均显著好转(P＜0.05);皮疹、肝损害较少(P＜0.05).结论 LEF联合小剂量GCs能迅速改善老年RA患者症状、体征和实验室炎性活动指标,不良反应少.     

瑞舒伐他汀对类风湿关节炎伴血脂异常患者的疗效观察

目的观察瑞舒伐他汀对类风湿关节炎(RA)伴血脂异常患者的疗效。方法选取2013年3月至2014年3月我院风湿科就诊的RA伴血脂异常患者80例,随机分为A、B组,每组40例。A组联合应用甲氨蝶呤、白芍总苷、硫酸羟氯喹治疗,B组在A组治疗基础上加用瑞舒伐他汀。分别于治疗前、治疗后28周记录患者胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、关节肿胀数、关节压痛数、血沉(ESR)、C-反应蛋白(CRP)、DAS28的变化,比较2组不良反应情况。结果治疗28周后,2组患者TC、TG、LDL-C均显著低于治疗前,HDL-C显著高于治疗前(P<0.05或P<0.01);2组患者DAS28、ESR、CRP、关节压痛数、关节肿胀数与治疗前比较均显著降低(均P<0.01)。B组治疗后DAS28、ESR、CRP改善显著优于A组(P<0.05或P<0.01)。2组不良反应发生率无显著差异(P>0.05)。结论 RA患者存在血脂水平异常,瑞舒伐他汀对RA有直接治疗作用。     

Degraded and undegraded carrageenans and experimental gastric and duodenal ulceration

The prevention of histamine-induced gastric and duodenal ulceration in the guinea-pig has been examined using a series of undegraded and degraded carrageenans. Undegraded carrageenans were active at lower doses than degraded carrageenans. The high viscosity of the undegraded carrageenans in solution prevented their use in larger doses. Degradation of carrageenan without serious loss of sulphate, gives a product which allows the dose to be increased to an extent that its effect more than offsets the slight loss in activity caused by the degradation. No single feature of carrageenan structure can be related to anti-ulcer activity although degradation, and hence reduction of molecular size, generally reduces activity. Sulphate contents over 30% have little apparent effect on activity; κ-carrageenans were not consistently different in anti-ulcer activity from Λ-carrageenans. This contrasts with the antipeptic activity of carrageenans where κ-carrageenans are less active than their Λ-counter-parts. As with antipeptic activity, the degree of anti-ulcer activity is probably determined by a combination of structural features which includes molecular size and polyanionic properties.     

Affective and Anxiety Disorders and Alcohol and Drug Dependence:

Depression and anxiety frequently coexist in patients with substance use disorders. This clinically-oriented article examiens the relationship between these conditions and emphasizes data showing that substances of abuse can cause signs and symptoms of both depression and anxiety. These substance-related syndromes appear to have a different course and prognosis than uncomplicated, independent anxiety and major depressive disorders, and clinicians should consider the role of alcohol and other drugs in all patients presenting with these complaints. The authors will also outline an approach for diagnosing and managing patients with the combination of a substance use and depressive or anxiety disorder.     

Alcohol and Substance Use and Abuse in Women and Children

No abstract available for this article.     

Excretion and biotransformation of alfentanil and sufentanil in rats and dogs

The excretion and biotransformation of alfentanil (ALF) and sufentanil (SUF), two recent analogues of the synthetic opioid fentanyl, were studied after single iv administration of the tritium-labeled drugs in male rats and dogs. The drugs were almost completely metabolized in the two species, which resulted in a large number of metabolites. The excretion of the metabolites was rapid and exceeded 95% within 4 days, except for that of ALF metabolites in dogs (about 85%). For ALF, excretion of the radioactivity with the urine (73% in rats, about 76% in dogs) exceeded that with the feces. For SUF, excretion of the radioactivity with the urine amounted to 38 and 60% and that with the feces to 62 and 40%, in rats and dogs, respectively. Bile-cannulated rats excreted 68% with the bile within 24 hr after SUF dosing, and about 22% of this biliary radioactivity was subjected to enterohepatic circulation. After an ALF dose, the biliary excretion amounted to 24%, and the enterohepatic circulation was minimal. The main metabolic pathways of the two drugs were the oxidative N-dealkylation at the piperidine nitrogen and at the amide nitrogen, oxidative O-demethylation, aromatic hydroxylation, and the formation of ether glucuronides. N-[4-(Hydroxymethyl)-4-piperidinyl]-N-phenylpropanamide (M6) was the main metabolite of both ALF and SUF in rats. In dogs, the glucuronide of N-(4-hydroxyphenyl)propanamide (M5) was the main metabolite of ALF. After SUF dosing in dogs, N-[4-(methoxymethyl)-4-piperidinyl]-N-phenylpropanamide was more abundant than M5.