乌灵胶囊治疗伴有抑郁状态的胃食管反流病对照研究

目的：探讨乌灵胶囊治疗伴抑郁状态的胃食管反流病（GERD）患者的临床疗效。方法：选择Zung抑郁自评量表（SDS）评分≥50分的60例GERD患者,随机分为两组,研究组（n=30）给予乌灵胶囊和埃索美拉唑镁肠溶片,对照组（n=30）仅给予埃索美拉唑镁肠溶片;疗程8周。应用胃食管反流病症状分级及SDS的评分变化进行疗效评定。结果：治疗8周末,研究组中显效率、总有效率分别为69.23%和88.46%,对照组分别为40.00%和64.00%,有显著性差异。两组内治疗前与治疗后SDS评分均有显著性差异;治疗后第4、8周末研究组SDS评分与对照组相比有显著性差异。结论：乌灵胶囊联用埃索美拉唑镁肠溶片能安全有效治疗伴有抑郁状态的GERD患者。     

HPLC法测定埃索美拉唑钠的有关物质

目的建立HPLC法测定埃索美拉唑钠的有关物质。方法采用Capcell Pak C18色谱柱,流动相采用0.01mol·L~(-1)磷酸盐缓冲液(pH=7.6±0.2)4-乙腈梯度洗脱,流速为1.0mL·min~(-1),检测波长为280nm。结果在选定的色谱条件下,主成分与各已知杂质分离度良好。H431/41、H118/87、H168/66、埃索美拉唑钠、H193/61和奥美拉唑硫醚进样量分别在0.8~66.3ng(r=0.999 9)、2.0~59.1ng(r=0.999 5)、1.0~75.6ng(r=0.999 9)、0.5~149.7ng(r=0.999 9)、1.0~74.7ng(r=1.000 0)和1.4~94.8ng(r=0.999 5)范围内,与峰面积呈良好线性关系。RSD均在0.54%~0.82%范围内,精密度良好。供试品溶液在室温下不稳定,应临用新配。结论该法可用于检测埃索美拉唑钠的产品质量。     

Esomeprazole and rabeprazole did not reduce antiplatelet effects of aspirin/clopidogrel dual therapy in patients undergoing percutaneous coronary intervention: a prospective,randomized, case–control study

Objectives: Controversy has been prompted based on drug interaction between proton pump inhibitors (PPIs) and aspirin/clopidogrel leading to weakened effects. However, whether such interaction was drug-specific or class effect remains controversial. This study predicted the impact of esomeprazole and rabeprazole on efficacy of dual antiplatelet therapy (DAPT).

Methods: This study, involving 150 patients, evaluated the efficacy of DAPT upon concomitant use of esomeprazole (40 mg/d) or rabeprazole (20 mg/d). Platelet reactivity was assessed by value of ADP-induced light transmittance aggregometry (LTA) and vasodilator-stimulated phosphoprotein phosphorylation-platelet reactivity index (VASP-PRI) at day 1, day 3 and day 30 end points after initiation of DAPT.

Results: No significance were observed by post-hoc analysis of treatment-by-period interaction in LTA value and VASP-PRI value when compared with non-PPI users, which suggests no carryover effect in both PPIs over the 30-day treatment period. Moreover, no statistical differences was in LTA or VASP-PRI value in esomeprazole group while rabeprazole group showed decreased in antiplatelet function of DAPT at the day 3 and day 30 end points.

Conclusion: Although antiplatelet effect of DAPT were not affected upon concomitant use of both PPIs over the 30-day treatment period, esomeprazole exerts much more stable impact on antiplatelet effect than rabeprazole among respective end points.     

奥美拉唑治疗胃溃疡的有效性

目的探讨奥美拉唑治疗胃溃疡的有效性。方法观察对象为本院2018年全年医治的110名胃溃疡患者,经数字表法,把这些对象随机归入两组,对照组进行常规奥美拉唑治疗,研究组进行艾司奥美拉唑镁肠溶片治疗。比较两组患者疗效、钙素基因相关肽(CGRP)、白细胞介素-17(IL-17)、白细胞介素-10(IL-10)、高迁移率族蛋白B1(HMGB1)、幽门螺杆菌清除率。结果研究组疗效高于于对照组(P<0.05);研究组CGRP、IL-10水平高于对照组(P<0.05),研究组IL-17、HMGB1水平相较对照组偏低(P<0.05);在幽门螺杆菌清除率此项指标上,相较对照组,研究组偏高(P<0.05)。结论胃溃疡治疗中,艾司奥美拉唑镁肠溶片治疗效果显著,值得应用。     

Pharmacotherapy of gastro-oesophageal reflux disease in children: focus on safety

Gastro-oesophageal reflux (GOR) disease is very common and, in the majority of infants, is physiological. However, untreated GOR disease in infants and children is associated with a decrease in quality of life for the child and their parents. It may also cause sometimes more severe complications, such as oesophagitis, and causing, in rare cases, failure to thrive, oesophageal stricture, apnoea and even death. Every therapeutic intervention (non-drug treatment, medical treatment and surgery) is associated with morbidity and even mortality. Moreover, efficacy data of many medications in children are non-existing, limited or disappointing. The safety profile of cisapride is comparable to that of other therapeutic interventions or to the risk of non-treatment. Therefore, the therapeutic approach of GOR disease in infants and children needs to be well-balanced, considering therapeutic efficacy and side effects. This review will focus on the side effects of the different therapeutic options.     

注射用白眉蛇毒血凝酶联合埃嗦拉唑治疗老年性上消化道出血疗效观察

目的 观察白眉蛇毒血凝酶联合埃嗦拉唑治疗老年性上消化道出血的疗效。方法将116例老年性上消化道出血病人随机分为两组，对照组予埃嗦拉唑治疗；试验组予白眉蛇毒血凝酶联合埃嗦拉唑治疗。结果试验组治疗老年性上消化道出血的总有效率为96．5％，对照组总有效率为81．0％，两组间差异显著（P〈0．05）；两组患者的Prr、和APTT在用药前后及组间比较无明显变化，差异均无显著性（P〉0．05）。结论 注射用白眉蛇毒血凝酶联合埃嗦拉唑治疗老年性上消化出血疗效确切，安全可靠。     

High-dose versus low-dose intravenous proton pump inhibitor treatment for bleeding peptic ulcers

Evaluation of: Liu N, Liu L, Zhang H et al. Effect of intravenous proton pump inhibitor regimens and timing of endoscopy on clinical outcomes of peptic ulcer bleeding. J. Gastroenterol. Hepatol. 27(9), 1473–1479 (2012).

Peptic ulcer bleeding is a common medical emergency associated with significant mortality and healthcare costs. All recent guidelines agree on the beneficial role of proton pump inhibitor treatment, but there is still controversy regarding the optimal dose and route of administration of proton pump inhibitors. The evaluated article reports on a large, single-center randomized controlled trial that compared the clinical efficacy of a low-dose twice-daily intravenous bolus regimen with a high-dose continuous intravenous infusion regimen in 875 patients with acute bleeding from peptic ulcers. The high-dose regimen was associated with significant reductions in rebleeding, blood transfusion requirements and length of hospital stay. There was no demonstrable difference in mortality or the need for endoscopic hemostatic treatment or surgery. We discuss the strengths and limitations of the evaluated article, as well as the implications for clinical practice.     

埃索美拉唑治疗医源性胃溃疡的疗效观察

目的 探讨埃索美拉唑治疗内镜下黏膜切除术(endoscopic mucosalresect,EMR)后医源性胃溃疡的有效性.方法 40例行EMR治疗的患者随机分为两组,埃索美拉唑组23例,EMR术后给予埃索美拉唑40 mg静滴,每天1次,持续8周.法莫替丁组给予法莫替丁40 mg静滴,每天1次,持续2周.分别于EMR后1天,2周,4周,8周行胃镜检查,比较两组患者EMR后溃疡大小变化、愈合情况及有无出血.结果 EMR术后1天,埃索美拉唑组和法莫替丁组溃疡面积分别为(21.10±3.46)mm2、(20.28±3.41)mm2(P=0.991);术后2周,两组溃疡面积分别为(4.52±1.62)mm2、(7.95±2.40)mm2(P=0.043);术后4周,两组溃疡面积分别为(0.80±0.65)mm2、(3.71±1.71)mm2(P=0.001).术后1天,埃索美拉唑组创面出血发生率低于法莫替丁组,但差异无统计学意义(P=0.199).结论 埃索美拉唑对EMR术后医源性胃溃疡疗效确切.     

艾普拉唑7d三联疗法及10d序贯疗法根除幽门螺杆菌的临床疗效

目的观察艾普拉唑7 d三联疗法及10 d序贯疗法根除幽门螺杆菌（Hp）的临床疗效。方法 142例经电子胃镜、RUT检查证实Hp阳性的慢性胃炎患者,随机分成3组。A组予艾普拉唑5 mg+阿莫西林克拉维酸钾0.914 g+呋喃唑酮0.1g,bid,疗程7 d;B组予艾普拉唑5 mg+阿莫西林克拉维酸钾0.914 g,疗程5 d,继之艾普拉唑5 mg+克拉霉素0.5 g+呋喃唑酮0.1g,疗程5 d,共计10 d,每天均给药2次;C组予埃索美拉唑20 mg+阿莫西林克拉维酸钾0.914 g+呋喃唑酮0.1 g,bid,疗程7 d。疗程结束4周后行¹⁴C-尿素呼气试验(¹⁴C-UBT),观察Hp根除率、症状缓解率及不良反应发生情况。结果 A、B、C组患者症状缓解率比较差异无统计学意义（P>0.05）;Hp根除率分别为60%、58.54%和55.26%,经检验P均>0.05。3组患者均无明显不良反应发生。结论 3组用药方案虽能达到良好的症状缓解率,但Hp根除率均未超过60%,低于理想标准。     

埃索美拉唑防治非甾体类抗炎药所致老年人上消化道出血的疗效观察

目的探讨早期应用埃索美拉唑防治非甾体类抗炎药（NSAIDs）所致老年人上消化道出血的疗效。方法将80例服用NSAIDs的老年人分为埃索美拉唑组（40例）和法莫替丁组（40例）,观察2组患者上消化道出血的发生率,监测给药后第2、4、6天胃液pH值。结果在埃索美拉唑组,34例患者无明显上消化道出血发生,5例发生少量出血,显效率为85.0%,总有效率为97.5%;在法莫替丁组,8例患者发生明显出血,13例发生少量出血,显效率为47.5%,总有效率为80.0%,2组比较,差异有统计学意义（P〈0.01）。治疗第2、4、6天,埃索美拉唑组胃液pH值均明显高于法莫替丁组（5.44±0.67比4.18±0.72、5.61±0.71比4.85±0.85、5.74±0.63比5.13±0.79,P均〈0.01）。结论早期应用埃索美拉唑可显著降低NSAIDs所致老年人上消化道出血的发生率,明显提高其胃液pH值。