复方丹参滴丸联合低分子肝素钙治疗不稳定型心绞痛的临床疗效及安全性评价

目的：观察复方丹参滴丸联合低分子肝素钙治疗不稳定型心绞痛的临床疗效及安全性。方法：171例不稳定型心绞痛患者随机分为两组,治疗组93例,对照组78例。对照组给予硝酸酯类药物、他汀类药物、阿司匹林、B受体阻滞剂或钙拮抗剂等常规治疗。治疗组在对照组常规治疗基础上应用低分子肝素钙500013／次,皮下注射,每日2次,连用7d;复方丹参滴丸10粒口服,每日3次,连用15d。结果：心绞痛疗效,治疗组总有效率为92．5％,对照组为67．9％;心电图疗效,治疗组总有效率为93．5％,对照组为71．8％。结论：复方丹参滴丸联合低分子肝素治疗不稳定型心绞痛安全有效、方便实用。     

HPLC法测定补肾调降丸中齐墩果酸的含量

目的用HPLC法测齐墩果酸的含量。方法以齐墩果酸对照品作对照，采用HPLC法测定补肾调降丸中的齐墩果酸含量。色谱柱：ODS HYPERSIL C18 5μ（4.6mm．I．D．×200mm）；检测波长：215nm；流动相：甲醇-水（84：16）；柱温：25℃；进样量：10μl，采用外标法。结果在优化色谱条件下，补肾调降丸中的齐墩果酸线性范围在1．0-40μg。回归方程为：Y=359．8524132X－2．148982，r=0．9999。含量测定的回收率为：97．72％，RSD=0．89％。结论所建立的方法专属性强，操作简便，结果准确，重现性好，适用于对补肾调降丸中的齐墩果酸含量的测定。     

定坤丹治疗子宫内膜薄型不孕的临床效果

目的 观察定坤丹治疗子宫内膜薄型不孕的临床效果,为优化子宫内膜薄型不孕的治疗方案提供参考。方法 选取187例子宫内膜薄型不孕患者,在保证组间基本特征匹配原则上,利用计算机软件产生的随机数,按照1∶1的比例分为对照组(93例)和观察组(94例)。对照组给予雌二醇+地屈孕酮干预,观察组在对照组的基础上加用定坤丹。比较治疗3个周期后两组患者的子宫内膜厚度、孕激素浓度及临床妊娠率。结果 观察组患者排卵期平均子宫内膜厚度显著高于对照组(P<0.01),黄体期孕激素浓度显著高于对照组(P<0.01),累计临床妊娠率显著高于对照组(P<0.05)。结论 定坤丹可以明显改善子宫内膜薄型不孕患者排卵期子宫内膜厚度,提高黄体功能,改善妊娠结局。     

Understanding HIV-Related Pill Aversion as a Distinct Barrier to Medication Adherence

Abstract

Pill aversion, defined as difficulty swallowing pills without identifiable medical cause, is a poorly characterized barrier to sustained viral suppression for many HIV-infected persons. We aimed to quantify the frequency of self-reported pill aversion, characterize its symptoms, and measure the association between self-reported pill aversion and missing antiretroviral doses. This is a prospective, observational, exploratory survey study of English-speaking persons living with HIV (PLHIV) at a single urban tertiary outpatient clinic. Participants completed anonymous questionnaires about their experiences of swallowing antiretroviral pills. The primary outcome was skipping pills due to pill aversion symptoms. Of 384 participants, a quarter (25.5%) skipped pills due to pill aversion symptoms. Younger age, being Non-Hispanic Black or Hispanic, not being married or partnered, having public insurance, not being employed, having less than a college education, and having a mental health diagnosis were associated with skipping pills due to pill aversion. On multivariable regression analyses, PLHIV who skipped pills were more likely to report symptoms of gagging, nausea at the time of swallowing, and heavy feeling in the stomach, as well as being bothered by the taste, smell, and size of the pills. PLHIV who skipped pills were also more likely to report negative and fear-based emotions about pill-taking than PLHIV who did not skip pills due to pill aversion. HIV-related pill aversion may represent a significant and frequent barrier to adherence in an adult HIV population.     

Body composition and resting metabolic rate of perimenopausal women using continuous progestogen contraception

Objective The effect on body composition and in particular on fat mass (FM) of 12 months’ use of a desogestrel (DSG)-only contraceptive pill or the levonorgestrel-releasing intrauterine system (LNG-IUS) was evaluated in women in the perimenopause.

Methods An observational study comprised 102 perimenopausal women: 42 received a 75 μg DSG pill, 34 received the 52 mg LNG-IUS, and 26 received no treatment. Body composition, body weight and resting metabolic rate (RMR) were evaluated at baseline and again after 12 months.

Results FM did not change in the control group (? 0.5 ± 1.6%) but significantly increased in the LNG-IUS group (+ 1.1 ± 2.9%; p = 0.02 vs. controls) and in the DSG group (+ 2.8 ± 3.5%; p = 0.0001 vs. controls; p = 0.02 vs. LNG-IUS). Women treated with DSG or the LNG-IUS showed a non-significant increase in body weight, body mass index and waist circumference. RMR did not significantly vary in the control group (? 3.8 ± 292.9 kJ/ 24 h) and tended to decrease but not significantly in the LNG-IUS (115.5 ± 531.8 kJ/ 24 h) and DSG groups (305.9 ± 556.9 kJ/24 h).

Conclusions The results of this preliminary study seem to indicate that in perimenopausal women continuous use of the DSG-only pill and to a lesser extent the LNG-IUS may favour FM accumulation.     

Premenstrual syndrome and dysmenorrhea: Symptom trajectories over 13 years in young adults

Objectives

To ascertain the prevalence of premenstrual syndrome (PMS) and dysmenorrhea in Australia women and to examine whether there is population subgroups with distinct symptom trajectories.

Study design

A prospective cohort study, including 9671 young women random sampled from national Medicare database and followed up for 13 years, examined the prevalence, the trend and the symptom trajectories of the conditions.

Main outcome measures

Prevalence of PMS and dysmenorrhea over time, their symptom trajectories, and the probability of symptom reporting at follow-up.

Results

The prevalence of PMS varied between 33 and 41% and that of dysmenorrhea between 21 and 26%. The probabilities of reporting PMS and dysmenorrhea were 0.75 (95% CI, 0.73, 0.76) and 0.70 (95% CI, 0.68, 0.72), respectively, among women who reported them in three previous consecutive surveys. Four unique trajectories were identified for both conditions. PMS was experienced by 80% of women some time during the study period, with normative (22.1%), late onset (21.9%), recovering (26.5%) and chronic (29.5%) groups revealed. Dysmenorrhea occurred in 60% of women with normative (38.3%), low (28.0%), recovering (17.2%) and chronic (16.5%) groups identified.

Conclusions

PMS and dysmenorrhea are common among young women. Both have relatively stable prevalence over time, but exhibit considerable variation at the individual level. Four subgroups of women who followed similar symptom trajectories were identified. PMS was experienced by 80% of women during the study period and it tended to be a long-lasting problem in many. Although 60% of women experienced dysmenorrhea, only a small group continuously reported it. Smoking and illicit drugs use, and smoking and obesity were more common among women with persistent PMS and dysmenorrhea respectively.     

摩罗丹浓缩丸治疗慢性萎缩性胃炎(胃阴不足兼胃络瘀血证)的前瞻性随机对照临床试验

目的评价摩罗丹浓缩丸治疗慢性萎缩性胃炎(chronic atrophic gastritis,CAG)的安全性及有效性。方法采用随机阳性药物平行对照临床试验设计,共纳入48例CAG受试者,随机分为摩罗丹浓缩组(简称试验组n=24)和摩罗丹蜜丸组(简称对照组n=24),疗程3月。结果试验组与对照组疗效比较,胃脘胀满愈显率分别为40.9%vs27.3%,总有效率分别为72.7%vs68.2%(P均>0.05),胃脘痛愈显率分别为54.5%vs40.9%,总有效率分别为72.7%vs72.7%(P均>0.05);中医证候疗效比较,两组愈显率分别为9.1%vs0%,总有效率分别为86.4%vs81.8%(P均>0.05)。胃镜复查有效率为31.8%vs18.2%(P均>0.05),病理复查炎症、萎缩、肠化的有效率分别为36.4%vs36.4%;54.6%vs63.6%;18.2%vs27.3%(P均>0.05)。两组之间均无不良反应发生。结论摩罗丹浓缩丸治疗CAG(胃阴不足兼胃络瘀血证)安全有效。     

基于网络药理学克银丸治疗银屑病作用机制的研究

目的运用网络药理学方法探讨克银丸治疗银屑病的功效物质基础和作用机制。方法使用中药系统药理学分析平台(Traditional Chinese medicine systems phannacology,TCMSP)检索克银丸全方4味中药的活性化合物和作用靶点,通过Online Mendelian Inheritance in Man(OMIM)、Genecards、PharmGkb以及Therapeutic Target Database(TTD)数据库查找银屑病的相关靶点,构建“药物-共同靶点-疾病”网络图,针对克银丸和银屑病的共同靶点,构建蛋白互作网络(Protein-protein interaction network,PPI),进而完成Gene Ontology(GO)、Kyoto Encyclopedia of Genes and Genomes(KEGG)富集分析。结果以口服生物利用度(Oral bioavailability,OB)≥30%且类药性(Drug likeness,DL)≥0.2为标准,筛选出克银丸的活性化合物共有42种,作用靶点有73个;以高相关性为标准,筛选出银屑病的高关联度靶点一共有1081个,药物与疾病的共同靶点一共有46个。构建蛋白互作网络(PPI),分析共同靶点之间的相互关系最多的靶点为白细胞介素(IL)-6、血管内皮生长因子(VEGF)A、表皮生长因子受体(EGFR)、重组人半胱天冬酶(CASP)-3、细胞周期蛋白(CCN)D1。GO富集分析共包含658条结果,显示共同靶点的功能主要表现在对氧感知相关通路,KEGG信号通路富集显示,共同靶点表达在112条信号通路中。结论以网络药理学为切入点,阐明了克银丸是通过多成分、多靶点发挥对银屑病的治疗作用,且作用机制主要集中在对氧感知相关通路的调控,为克银丸的临床应用和实验研究提供了科学依据。     

当归拈痛丸的鉴别及黄芩苷的测定

目的 建立当归拈痛丸的鉴别和含量测定的方法.方法 采用TLC法对处方中的当归、苦参、苍术、葛根、羌活等进行定性鉴别;采用HPLC法测定黄芩中黄芩苷的含量.结果 TLC能检出处方中当归、苦参、苍术、葛根、羌活等;HPLC测定时,黄芩苷0.080～0.401 μg与峰面积呈良好的线性关系(r=0.9998),平均回收率为98.28%,RSD:1.01%.结论 所建方法准确可靠,能有效控制药品的质量.     

复方丹参滴丸对不稳定型心绞痛患者血浆内皮素和血小板α-膜颗粒蛋白的影响

目的观察复方丹参滴丸对不稳定型心绞痛患者的临床疗效及血浆内皮素（ET）和血小板α-膜颗粒蛋白（GMP-140）水平的影响。方法168例不稳定型心绞痛患者分为常规治疗组（79例）和复方丹参滴丸组（89例）。所有入选患者均接受硝酸酯类、美托洛尔（或钙拮抗剂）及阿司匹林治疗,复方丹参滴丸组在上述治疗基础上加用复方丹参滴丸10粒,每日3次,连用8周。观察统计两组治疗前1周和治疗结束后1周心绞痛发作次数及自拟的疼痛强度及持续时间记分值,检测治疗前后患者血浆ET和GMP-140水平的变化。结果复方丹参滴丸组和常规治疗组比较,治疗后疼痛发作频率、疼痛强度及持续时间记分均有明显减少,而复方丹参滴丸组的降低程度比常规治疗组明显（P〈0．05）。两组可改善不稳定型心绞痛患者心电图ST段的偏移,而复方丹参滴丸组的疗效比常规治疗组显著（P〈0．05）。两组治疗后血浆ET和GMP-140水平均明显减低,而复方丹参滴丸组的疗效比常规治疗组显著（P〈0．01）。结论复方丹参滴丸治疗不稳定型心绞痛患者疗效明显高于常规治疗,可能与改善血管内皮功能、抑制血小板聚集密切相关。