精神分裂症患者CYP2D6基因多态性与阿立哌唑的治疗效应关系研究

目的探讨精神分裂症患者细胞色素P450酶CYP2D6基因多态性对阿立哌唑治疗效应的影响,为阿立哌唑的个体化应用提供依据。方法对53例符合ICD-10诊断标准的精神分裂症患者进行为期8周的阿立哌唑单药治疗。应用荧光原位杂交技术检测53例患者CYP2D6 exon I C/T100位点的基因多态性,在治疗第0、2、4、8周分别进行阳性与阴性症状量表(PANSS)评分。结果在53例患者中,C/C(野生型)9例(17.0%)、C/T(突变杂合子)32例(60.4%)、T/T(突变纯合子)12例(22.6%)。结论 CYP2D6exon I C/T100基因多态性可在治疗初期影响临床疗效产生影响,但随着时间的延长,其多态性可能不是影响临床疗效的主要因素。可根据患者的基因型采取不同的初始剂量,合理化用药。     

CYP2D6和DRD2基因多态性及其交互作用与阿立哌唑疗效的关联研究

目的探讨细胞色素P4502D6（CYP2D6）和多巴胺D2受体（DRD2）基因多态性及其交互作用与阿立哌唑治疗精神分裂症临床疗效的关联。方法选取120例接受单一阿立哌唑治疗4周的精神分裂症住院患者为研究对象,采用4周末阳性与阴性症状量表（PANSS）减分率评定药物疗效,其中有效（≥50%）组69例,无效（＜50%）组51例。采用多重高温连接酶检测反应技术检测CYP2D6（rs1065852、rs1135840）和DRD2（rs1799732、rs1800497）基因多态性;采用多因子降维法（MDR）分析基因-基因交互作用,多因素logistic逐步回归分析估计CYP2D6和DRD2基因多态性及其交互作用的效应。结果有效组与无效组rs1065852、rs1799732、rs1800497位点等位基因及基因型频率分布比较,差异均有统计学意义（均P＜0.05）;rs1135840位点等位基因及基因型频率分布比较,差异均无统计学意义（均P＞0.05）。rs1065852、rs1799732、rs1800497位点多态性之间存在交互作用。rs1065852、rs1799732、rs1800497多态性及其交互作用均可影响阿立哌唑治疗精神分裂症的疗效,其OR值（95%CI）分别为3.269（1.124~9.510）、0.188（0.048~0.738）、3.314（1.336~8.218）、3.395（1.047~11.001）。结论CYP2D6（rs1065852）和DRD2（rs1799732、rs1800497）基因多态性与阿立哌唑治疗精神分裂症疗效相关,其对阿立哌唑疗效的影响存在正交互作用。     

阿立哌唑与利培酮治疗精神分裂症的疗效与安全性

目的 探讨阿立哌唑治疗精神分裂症的疗效与安全性.方法 首次发病精神分裂症患者100例,随机分为啊立哌唑和利培酮组,观察时间为8周,于治疗前及2、4、6、8周末,采用阳性与阴性量表(PANSS)评定疗效,不良反应量表(TESS),血生化指标和心电图评价安全性.结果 阿立哌唑组利培酮组治疗第二周末阳性量表分均明显下降(p＜0.05),治疗8周末,阿立哌唑组与利培酮组PANSS减分率与治疗前比较均有统计学意义差异(p＜0.05).阿立哌唑组治愈28例,有效11例,无效2例,有效率78%.治疗中未发现阿立哌唑引起体重增加、心电图明显改变.结论 阿立哌唑对首发精神分裂症患者有很好的疗效,安全性更高.     

阿立哌唑和氯氮平治疗精神分裂症临床对照分析

目的:探讨阿立哌唑和氯氮平治疗精神分裂症的疗效与安全性.方法:将60例精神分裂症患者随机分成两组,阿立哌唑组30例,氯氮平组30例,于治疗前和治疗1、2、4、6、8周末用阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应.结果:阿立哌唑组与氯氮平组总的疗效差异无显著性;在认知因子和阴性症状方面以阿立哌唑组较好.阿立哌唑主要不良反应明显低于氯氮平.结论:阿立哌唑是一种安全、有效的非典型抗精神病药.     

阿立哌唑与奥氮平治疗精神分裂症对照研究

目的:比较阿立哌唑与奥氮平治疗精神分裂症的疗效与安全性。方法:将100例精神分裂症患者随机分为两组,每组50例。分别予以阿立哌唑和奥氮平治疗8周,采用阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定。结果:治疗8周后两组PANSS总分较治疗前显著下降(P<0.01),阿立哌唑组有效率86%,奥氮平组有效率88%。治疗2周末阿立哌唑组的显效率低于奥氮平组,疗效相比存在差异(P>0.05);阿立哌唑组引起的嗜睡和体重增加明显低于奥氮平组,两者存在差异(P<0.01)。结论:阿立哌唑与奥氮平治疗精神分裂症疗效相当,阿立哌唑的副反应更小,可以临床推广使用。     

阿立哌唑与利培酮治疗慢性精神分裂症的对照研究

目的探讨阿立哌唑与利培酮治疗慢性精神分裂症的疗效及安全性.方法将60例慢性精神分裂症患者随机分为两组,分别给予阿立哌唑和利培酮治疗8周,采用阳性和阴性症状量表(PANSS)及副反应量表(TESS)在治疗前及治疗后2、4、8周末分别进行评定.结果阿立哌唑组和利培酮组间疗效差异无显著性.TESS评定阿立哌唑组副作用小于利培酮组(P＜0.01).结论阿立哌唑与利培酮对慢性精神分裂症均有较好疗效,阿立哌唑具有较小副作用 ,尤其在月经紊乱、体重增加及记忆力下降方面优于利培酮.     

阿立哌唑与舒必利治疗精神分裂症对照研究

目的:比较阿立哌唑与舒必利治疗精神分裂症的疗效和不良反应。方法:将68例精神分裂症患者随机分为阿立哌唑组和舒必利组。疗程6周。采用阳性与阴性症状量表(PANSS)及副反应量表(TFSS)在治疗前及治疗2、4、6周末分别评定疗效及不良反应。结果:阿立哌唑显效时间较快,阳性症状和一般病理减分率较高,不良反应较少。结论:阿立哌唑总体疗效优于舒必利,且不良反应较少,依从性及安全性较好,可作为治疗女性精神分裂症的首选药物之一。     

阿立哌唑与氯氮平治疗精神分裂症临床对照研究

目的:验证阿立哌唑对精神分裂症的疗效和不良反应。方法:将60例精神分裂症患者随机分为两组,即阿立哌唑组(30例)和氯氮平组(30例),分别用阿立哌唑和氯氮平治疗8周,用阳性症状和阴性症状量表(PANSS)与副反应量表(TESS)评定疗效和药物的不良反应。结果:阿立哌唑显效率为86.7%,与氯氮平(90%)相当(P>0.05);治疗2周末开始PANSS总分和各因子分与疗前比较均显著下降(P<0.01),与氯氮平组比较无显著差异(P>0.05)。阿立哌唑不良反应与氯氮平相比少而轻。结论:阿立哌唑治疗精神分裂症疗效好,不良反应轻,是一种安全有效的治疗精神分裂症药物。     

氯氮平和阿立哌唑治疗精神分裂症60例的对照研究

目的:比较氯氮平与阿立哌唑治疗精神分裂症的疗效和安全性。方法:将60例符合CCMD-3诊断标准的精神分裂患者随机分为两组,分别给予氯氮平和阿立哌唑治疗6周。于治疗前和治疗后2、4、6周末采用阳性症状和阴性症状量表(PANSS)评定临床治疗效果,副反应量表(TESS)评定不良反应。结果:氯氮平有效率90.00%,显效率83.33%;阿立哌唑有效率93.33%,显效率86.67%,两组治疗后与治疗前PANSS评分比较差异有显著性,两组间疗效比较无显著性差异,阿立哌唑不良反应少于氯氮平。结论:阿立哌唑治疗精神分裂症疗效确切,不良反应少。     

齐拉西酮和阿立哌唑治疗精神分裂症的临床对照研究

目的:比较齐拉西酮胶囊和阿立哌唑治疗精神分裂症的疗效和安全性.方法:将80例符合ICD-10的精神分裂症患者随机分为两组,分别给予齐拉西酮和阿立哌唑治疗8周.于治疗前和治疗后2,4、6、8周末采用阳性症状与阴性症状量表(PANSS)评定临床疗效.副反应症状量表(TESS)评定不良反应.结果:治疗8周后两组疗效近似(P>0.05),两组有效率差异无显著性(P>0.05);阿立哌唑组的副反应发生率高于齐拉西酮组,但差异无显著性(P>0.05).两药引起的副反应一般为轻度或中度,患者耐受性较好.结论:齐拉西酮和阿立哌唑治疗精神分裂症均有较好疗效,疗效相当,不良反应较小.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.