氨基末端脑钠肽对老年患者血液透析并心力衰竭再入院的预测意义

目的探讨维持性血液透析并充血性心力衰竭的老年患者出院前氨基末端脑钠肽（N terminal-pro brain nalriuretic peptide, NT-proBNP）水平对预测因心力衰竭再次入院的作用。方法选择维持性血液透析并充血性心力衰竭入院2次以上者30例为再入院组,选择维持性血液透析并充血性心力衰竭首次入院者32例为对照组,对其初次入院时以及出院前NT-proBNP水平比较,采用Logistic回归分析影响再入院的相关因素,采用偏相关分析影响出院前NT-proBNP 的相关因素,ROC 曲线评价出院前 NT-proBNP 对再入院的诊断效能。结果再入院组入院时NT-proBNP中位数为24600 ng/L,而对照组为21750 ng/L,二者比较差异无统计学意义（P＞0.05）;再入院组出院前NT-proBNP中位数为2600 ng/L,则明显高于对照组出院前NT-proBNP水平（中位数为1150 ng/L）,其差异有统计学意义（P＜0.05）。出院前NT-proBNP水平、左室EF值为影响再入院的主要因素;出院前NT-proBNP水平主要与透析间期体质量增加相关。再入院组出院前NT-proBNP的AUC值为0.923,NT-proBNP＞2250 ng/L作为界值（Cutoff值）的敏感度为73.3%,特异度为90.6%,阳性预测值为88%,阴性预测值为78.38%;对照组出院前NT-proBNP的AUC值为0.077,差异无统计学意义。结论老年维持性血液透析并充血性心力衰竭出院前NT-proBNP水平可作为预测因心力衰竭再入院的指标。     

高通量透析对维持性血液透析患者钙、磷代谢影响分析

目的分析高通量透析方式对维持性血液透析（MHD）患者的钙、磷代谢功能影响。方法选取2007年11月-2012年11月惠州市惠阳区人民医院收治的MHD患者70例,分为两组。观察组采用高通量方式透析,对照组采用低通量方式透析,对比两组透析前和透析1、6、12个月后的血钙、血磷水平及Scr（血肌酐）、ALB（血清白蛋白）和PHT（甲状旁腺腺激素）水平变化情况。结果透析前,两组在血钙、血磷水平及Scr、ALB和PHT水平上均无显著差别（P＞0.05）;透析后,观察组患者血钙水平升高更明显,血磷水平降低更明显;同时Scr、ALB和PHT的变化均更明显（P＜0.05）。结论高通量透析方式对MHD患者的钙、磷代谢功能改善效果更显著,透析更为安全有效,值得推广应用。     

维持性血液透析对尿毒症患者证候转化的影响

目的观察维持性血液透析(MHD)对尿毒症患者中医证候转化的影响,为中医药干预改善透析患者预后提供初步依据。方法对164例MHD患者进行12个月随访调查,自拟中医辨证量表每月对患者进行一次中医辨证以及全血细胞分析及透析治疗前后的生化检测,取与纳入及随访终点(随访至12个月或死亡)最近一次的中医辨证结果及实验室检查作为观察内容,对患者中医证候演变情况与随访期内的临床指标以及预后变化的关系进行分析。结果接受MHD治疗后,部分年轻患者转向无虚损证表现,而大多数MHD患者仍呈现"本虚标实"特点。新进入MHD治疗的患者中发生证候转变的比例较高,其中呈现从脾肾阳虚向其他证型转化的患者死亡率降低;长期MHD患者中肝肾阴虚证所占比例较高,肝肾阴虚证向阴阳两虚证转化的死亡率增高。不同虚损证患者在预后、透析充分性和营养状态方面存在差异(P<0.05),肝肾阴虚证患者优于脾肾阳虚证和阴阳两虚证患者(P<0.05)。结论尿毒症患者进入MHD后中医证候的演变伴随着预后发生变化,主动采取适当的中医药干预对提高MHD患者的生存率和生活质量有益。     

维持性血液透析患者抑郁患病相关护理干预

目的:探讨维持性血液透析(MHD)患者给予以病人为中心的整体心理护理干预后,减少抑郁患病率的发生。方法:对50例MHD患者随机分为治疗组(护理干预)25例和对照组(不进行护理干预)25例,均进行Zung抑郁自评量表(SDS)和一般性量表(SF-36)测试评分。结果:治疗组比对照组抑郁发病率下降8.14%(P<0.05);SF-36生活质量问卷治疗组明显高于对照组(P<0.05)。结论:以病人为中心的整体心理护理,能有效地减少MHD患者抑郁患病率的发生,从而提高MHD患者的生活质量。     

Regulation of type I procollagen and MMP-1 expression after single or repeated exposure to infrared radiation in human skin

Human skin is daily exposed to infrared (IR) radiation from natural sunlight. However, the effects of IR irradiation on collagen metabolism have not been investigated in human skin in vivo. Here, we examined whether single or repeated (three times a week for 4 weeks) exposure to IR irradiation changes the expressions of type I procollagen and interstitial collagenase (MMP-1). By using immunostaining, Western blotting, and semi-quantitative RT-PCR, we analyzed the protein and mRNA levels of type I procollagen and MMP-1 in young buttock skin. A single dose of IR to human skin increased the expression of type I procollagen within 24h, but did not change the expression of MMP-1. On the other hand, multiple IR doses reduced the expression of type I procollagen and increased the expression of MMP-1. We also found that TGF-betas may mediate type I procollagen synthesis in IR-irradiated human skin. Our results demonstrate that the regulations of the expressions of type I procollagen and MMP-1 differ in acute and chronically IR-irradiated skin. In particular, decreased collagen levels and increased MMP-1 levels in chronic IR-irradiated skin may be associated with connective tissue damage. Thus, we suggest that repeated exposure to IR irradiation might induce premature skin aging (photoaging) in human skin in vivo.     

奥卡西平片的人体相对生物利用度研究

目的:研究国产奥卡西平片的人体相对生物利用度和生物等效性.方法:健康志愿者20名,随机双交叉单剂量口服试验和参比的奥卡西平片,剂量为300 mg,剂间间隔为2周.分别于服药后48 h内多点抽取静脉血.用高效液相色谱法(HPLC)测定血浆中奥卡西平的活性代谢物MHD的浓度.结果:MHD的线性范围为0.10～10.00 mg/L,最低检测浓度为0.10 mg/L,方法的平均回收率为(99.4±4.2)%.20名志愿者随机交叉口服单剂量两种制剂后,MHD的cmax分别为4.61±0.57 mg/L和16.34±5.29 mg/L;tmax分别为4.65±2.74 h和4.20±2.02 h;t1/2(Ke)分别为16.57±4.01 h和16.34±5.29 h;AUC(0-48)分别为100.24±16.62 mg*h/L和97.97±19.01 mg*h/L;AUC(0-inf)分别为118.93±4.61 mg·h/L和115.43±4.64 mg·h/L.试验制剂与参比制剂的相对生物利用度F=(103.4±10.5)%.AUC (0-48),cmax,tmax均无显著性差异.结论: 该方法简便、准确、灵敏度高;两种制剂生物学等效.     

Oxcarbazepine: Clinical Development Program

Summary: Oxcarbazepine (OCBZ, Trileptal) is registered in several countries and has been well received by patients and physicians. However, newer standards in many other countries require additional data before registration can be achieved. For this reason, Ciba has implemented further clinical studies. OCBZ has a chemical structure that is closely related to carbamazepine (CBZ). In humans, OCBZ is not oxidatively metabolized, therefore causing little, if any, induction of hepatic enzymes. Because of this, and because of low protein-binding properties, OCBZ causes markedly fewer interactions with concomitant medications than most marketed antiepileptic drugs. OCBZ has been shown to have significantly fewer limiting side effects (described as side effects leading to discontinuation of treatment) than CBZ, while showing comparable efficacy. Many patients who are hypersensitive to CBZ can be treated with OCBZ. The usually administered dosage of OCBZ is approximately 50% higher than that of CBZ. However, better tolerability of OCBZ makes it possible to give higher dosages. The plasma concentration half-life of the active metabolite (monohydroxy derivative; MHD) makes it possible to administer OCBZ twice daily. No changes in dosage are necessary in patients with impaired renal function unless creatinine clearance is below 30 ml/ min. In patients with such severely reduced creatinine clearance, the dose of OCBZ should be halved. Specific questions e.g., such as whether OCBZ causes hepatic enzyme induction at higher doses and the effect of OCBZ on intrinsic sex hormones, will be answered in future studies. In addition, the tolerability and pharmacokinetics of OCBZ in specific target populations such as the elderly, children, and hepatically impaired patients will be addressed. This will enable a more complete delineation of the clinical profile of OCBZ, thereby helping physicians to decide how best to use OCBZ in their patients with epilepsy.     

Purification and characterization of ‘Trimarin’ a hemorrhagic metalloprotease with factor Xa-like Activity, from Trimeresurus malabaricus snake venom

In the present study, we describe the purification and characterization of a metalloprotease ‘trimarin’ from Trimeresurus malabaricus snake venom. Trimarin is a single-chain basic protein, with a molecular mass of 29.6 kDa. Trimarin showed proteolytic activity towards casein and fibrinogen, which was irreversibly inhibited by EDTA and 1,10-phenanthroline. The metal ion associated with trimarin was found to be Zn²⁺. Trimarin exhibited pharmacological activities including hemorrhage, myotoxicity, procoagulant and factor Xa-like activities. The hemorrhage and myotoxicity correlated with degradation of extracellular protein components type-IV collagen and fibronectin. Myotoxicity due to muscle tissue necrosis was substantiated with increased serum CK activity. Trimarin showed procoagulant activity with reduced re-calcification time of citrated human plasma. Trimarin shortened the activated partial thromboplastin time (aPTT) and prothrombin time (PT), suggesting its involvement in common pathway of blood coagulation. Trimarin coagulated the citrated human plasma in the absence of CaCl₂, but it was lacking thrombin like activity as it did not clot the purified fibrinogen. Remarkably, the enzyme clotted the factor X deficient human plasma, suggesting that trimarin has factor Xa-like activity. Thus, trimarin may play a key role in the pathophysiological conditions that occur during T. malabaricus envenomation, and may be used as a biological tool to explore many facets of hemostasis.