阿托伐他汀联合法舒地尔治疗慢性肺源性心脏病心力衰竭的临床观察

摘 要 目的：探讨阿托伐他汀联合法舒地尔治疗慢性肺源性心脏病心力衰竭的疗效,为临床治疗提供理论依据。方法: 130例慢性肺源性心脏病合并心力衰竭患者随机分为对照组和他汀组,每组65例。对照组实施常规对症治疗,并给予法舒地尔注射液30 mg,ivd,bid。他汀组在对照组基础上加用阿托伐他汀片20 mg·d-1。两组均连续治疗12周。观察两组临床疗效和药品不良反应,比较两组治疗前后动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、血氧饱和度(SaO2)、肺动脉收缩压(SPAP)、右心室射血分数（RVEF）、右心室 Tei 指数及血浆内皮素 1（ET 1）、一氧化氮（NO）、脑钠肽（BNP）水平变化。结果: 他汀组治疗后总有效率为89.23％,明显高于对照组的75.38％（P＜0.05）。治疗后,他汀组PaO2、SaO2、RVEF、NO较治疗前明显增高（P＜0.05）,PaCO2、BNP、SPAP、Tei指数、ET 1则较治疗前明显下降（P＜0.05）,且以上指标均明显优于对照组（P＜0.05）。两组药品不良反应发生率差异无统计学意义（P＞0.05）。结论: 阿托伐他汀联合法舒地尔治疗慢性肺源性心脏病心力衰竭的疗效肯定,可有效降低患者的肺动脉压、改善右心功能。     

小剂量氨磺必利配合氯氮平治疗难治性精神分裂症

摘 要 目的： 探讨小剂量氨磺必利配合氯氮平治疗难治性精神分裂症的疗效与安全性。方法: 160例难治性精神分裂症患者随机分为观察组和对照组各80例。观察组予氯氮平+氨磺必利、对照组予氯氮平+安慰剂,治疗12周。用阳性和阴性症状量表(PANSS)和副反应量表(TESS)分别评定两组临床疗效和药品不良反应。结果: 在治疗后第4、8、12周末,观察组临床疗效均优于对照组(P<0.05);两组治疗后PANSS各因子积分和总分均较治疗前下降(P<0.01),但观察组减分幅度均大于对照组(P<0.05或P<0.01)。两组药品不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:小剂量氨磺必利配合氯氮平治疗难治性精神分裂症可显著提高疗效,且不增加不良反应。     

他克莫司与甲氨蝶呤联合治疗难治性类风湿关节炎效果观察

摘 要 目的：探讨他克莫司与甲氨蝶呤联合治疗难治性类风湿关节炎的临床效果。方法：80例难治性类风湿关节炎患者随机分为观察组和对照组,每组40例。观察组给予他克莫司与甲氨蝶呤联合治疗,对照组给予环磷酰胺与甲氨蝶呤联合治疗,两组均治疗24周。观察两组患者治疗前后关节疼痛指数、关节肿胀指数及晨僵时间的变化,采用视觉模拟评分（VAS ）对患者疼痛情况进行评估;评价两组临床疗效;比较两组患者治疗前后红细胞沉降率（ESR）、C 反应蛋白（CRP）、肿瘤坏死因子α（TNF α）、血管内皮生长因子（VEGF）等指标变化。结果：观察组总缓解率为100.00%,显著高于对照组的67.50%（P<0.05）。治疗后两组关节疼痛指数、关节肿胀指数、晨僵时间及VAS 评分均较治疗前显著降低（P<0.05）,且观察组各项指标均明显低于对照组（P<0.05）。两组治疗后ESR、CRP、TNF α、VEGF均较治疗前显著降低（P<0.05）,且观察组明显低于对照组（P<0.05）。结论：他克莫司与甲氨蝶呤联合治疗难治性类风湿关节炎临床疗效好,安全性高,其作用机制可能与降低患者体内炎症反应及下调VEGF水平有关。     

利妥昔单抗联合常规治疗自身免疫性溶血性贫血的疗效观察

摘 要 目的：探讨利妥昔单抗联合常规治疗自身免疫性溶血性贫血（AIHA）的临床疗效及对患者血清学特征的影响。方法：88例AIHA患者随机分为观察组和对照组各44例。将观察组再分为温抗体自身免疫性溶血性贫血（WAIHA）和冷凝集素病（CHD）两个亚组。对照组给予口服叶酸、泼尼松,大剂量静注丙种球蛋白等常规治疗;观察组在对照组基础上加用利妥昔单抗,每周静滴1次。两组均连续治疗4周。观察治疗前后观察组各亚组和对照组患者血常规及乳酸脱氢酶、胆红素水平变化,评估临床疗效及药品不良反应。结果：观察组总有效率和完全缓解率均显著高于对照组（P<0.05）,复发率显著低于对照组（P<0.05）。WAIHA亚组总有效率和完全缓解率显著高于CHD亚组（P<0.05）。治疗后两组患者血红蛋白、网织红细胞、乳酸脱氢酶、胆红素等指标均较治疗前显著改善(P<0.05),且观察组各项指标均优于对照组(P<0.05)。治疗前,WAIHA亚组血红蛋白、网织红细胞、乳酸脱氢酶、胆红素均显著低于CHD亚组（P<0.05）,治疗后WAIHA亚组上述指标改善程度优于CHD亚组（P<0.05）。两组药品不良反应发生率比较,差异无统计学意义（P>0.05）。结论：在传统治疗基础上联合利妥昔单抗治疗AIHA临床效果好,复发率低,且安全性高,对WAIHA效果更佳。     

神经节苷酯辅助治疗急性脑梗死患者的疗效及对其血清hs-CRP、TNF-α的影响

摘 要 目的： 探讨神经节苷脂钠治疗急性脑梗死患者的疗效及对其血清高敏C反应蛋白（hs-CRP）、肿瘤坏死因子α（TNF-α）的影响。方法: 急性脑梗死患者216例随机分为观察组与对照组,每组108例。对照组患者予常规治疗,观察组患者在对照组基础上加用神经节苷脂注射液100 mg加入0.9%氯化钠注射液250 ml,ivd,qd。两组疗程均为14 d。评价两组临床疗效,比较两组患者治疗前后神经功能缺损程度评分（NDS）、日常生活活动量评分,以及血清hs-CRP和TNF-α水平变化。观察两组药品不良反应发生情况。结果: 观察组治疗总有效率为90.7%,明显高于对照组的71.3%（P＜0.05）。治疗后,观察组NDS评分较前明显降低,而ADL评分较前明显提高（P＜0.05）,且与对照组比较,差异均有统计学意义（P＜0.05）;而对照组患者治疗前后NDS及ADL评分无明显变化（P＞0.05）。两组患者治疗后血清hs-CRP和TNF-α水平均较治疗前明显降低（P＜0.05）,且观察组血清hs-CRP和TNF-α水平明显低于对照组（P＜0.05）。治疗期间两组患者均未见药品不良反应发生。结论: 神经节苷脂钠辅助治疗急性脑梗死疗效良好,能显著降低患者血清hs-CRP和TNF-α水平,改善患者NDS及ADL评分,且安全性好,值得在临床上进一步推广应用。     

脑心通胶囊治疗后循环缺血眩晕46例回顾性分析

摘 要 目的:探讨脑心通胶囊在治疗后循环缺血（PCI）眩晕中的价值与治疗效果。方法： 采用回顾性研究方法,收集83例PCI患者病历资料,其中采用常规治疗加氟桂利嗪治疗的37例（对照组）;采用常规治疗加脑心通治疗的46例（观察组）,比较两组GCS评分、血液流变学指标、临床疗效,观察治疗过程中的不良反应。结果：治疗后,两组患者GCS评分与血液流变学指标均有一定改善,且观察组优于对照组（P<0.05）;观察组总有效率91.30%,明显高于对照组（P<0.05）;两组间不良反应发生率差异无统计学意义（P＞0.05）。结论：脑心通胶囊治疗PCI患者疗效显著。     

脾氨肽联合沙美特罗替卡松治疗小儿支气管哮喘疗效及对患儿免疫功能影响观察

摘 要 目的：探讨脾氨肽联合沙美特罗替卡松治疗小儿支气管哮喘的疗效，及对患儿免疫功能的影响。 方法：102例小儿支气管哮喘患者随机分为观察组和对照组，每组51例。两组患者都接受止咳化痰等对症治疗，对照组在此基础上给予沙美特罗替卡松气雾剂治疗，观察组在对照组基础上再加用脾氨肽口服冻干粉治疗，两组患儿均连续治疗2周。比较两组患儿的治疗效果和临床症状消失时间，观察两组患儿治疗前后肺功能及血清细胞免疫水平变化。结果：观察组患儿的咳嗽、哮鸣音及憋喘消失时间均短于对照组（P＜0.05）；治疗总有效率显著高于对照组（P＜0.05）。两组患儿FVC、FEV1、FEV1/FVC等肺功能指标，T细胞亚群及IgE水平均较治疗前显著改善（P＜0.05），且观察组上述指标均明显优于对照组（P＜0.05）。结论：脾氨肽联合沙美特罗替卡松可迅速改善小儿支气管哮喘患儿的临床症状，提升肺功能，临床效果较好，其作用机制可能与提高患儿的免疫功能有关。     

补中益气五苓汤联合卡维地洛治疗老年慢性心力衰竭的临床疗效

摘 要 目的：探讨补中益气五苓汤联合卡维地洛治疗老年慢性心力衰竭（CHF）的临床疗效。方法: 2014年6月~2016年1月,68例老年CHF患者随机分为对照组和观察组各34例。在CHF标准化治疗的基础上,对照组给予卡维地洛治疗,观察组给予补中益气五苓汤联合卡维地洛治疗,疗程均为12周。比较两组患者治疗前后的中医症候积分、6min步行试验（6MWT）距离和血浆N端脑钠肽（NT ProBNP）水平、左射血分数（LVEF）、左室舒张末内径（LVEDD）和左心室收缩末期内径（LVESD）等指标的变化,观察两组患者治疗前后的临床症状和心功能改善情况以及不良反应发生情况,评估两组患者的临床疗效。结果: 观察组患者治疗后的中医症候积分和血浆NT ProBNP水平明显低于对照组,6MWT距离和LVEF明显高于对照组,LVEDD和LVESD明显低于对照组（P＜0.05）;观察组治疗总有效率为91.2%,明显高于对照组的70.6%（P＜0.05）。两组患者不良反应发生率无明显差异（P>0.05）。结论: 补中益气五苓汤联合卡维地洛治疗老年CHF,可有效改善患者的临床症状和心功能,提高运动耐量,且不良反应少,值得应用于临床。     

玻璃酸钠滴眼液联合重组人表皮生长因子滴眼液治疗白内障术后干眼症的疗效观察

摘 要 目的：观察玻璃酸钠滴眼液联合重组人表皮生长因子（rhEGF）滴眼液治疗白内障术后干眼症的临床疗效。方法：白内障术后干眼症患者80例（80眼）随机分为观察组和对照组,每组40例（40眼）。对照组给予玻璃酸钠滴眼液治疗,观察组在对照组基础上加用rhEGF滴眼液治疗,两组疗程均为4周。比较两组患者用药前及用药2周、4周的干眼症状评分,两组泪膜破裂时间（BUT）、泪液分泌试验（SIt）及角膜荧光素染色（FL）情况,评价两组疗效和药品不良反应。结果：观察组总有效率为97.5%,显著性高于对照组的75.0%(P<0.05)。治疗2周、4周后,两组干眼症状评分均较前显著下降（P<0.05）;且观察组评分明显低于对照组（P<0.05）。治疗后,两组BUT、SIt均较前显著上升,FL较前显著降低（P<0.05）;且观察组BUT、SIt明显高于对照组,FL明显低于对照组（P<0.05）。对照组药品不良反应发生率显著高于观察组（P<0.05）。结论：玻璃酸钠滴眼液联合rhEGF滴眼液可以显著改善白内障术后干眼症患者的临床症状,促进泪膜的稳定性,减少泪液分泌与角膜损伤,值得临床推广应用。     

大株红景天注射液联用单硝酸异山梨酯治疗顽固性心力衰竭疗效观察

摘 要 目的：评价大株红景天注射液联用单硝酸异山梨酯治疗顽固性心力衰竭的临床疗效和安全性。方法: 66例顽固性心力衰竭患者随机分为观察组和对照组,每组33例。对照组在常规治疗基础上给予单硝酸异山梨酯注射液25 mg,ivd,qd;观察组在对照组基础上加用大株红景天注射液10 ml,ivd,qd。两组疗程均为14 d。观察两组治疗前后临床症状改善程度、左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、心脏指数（CI）、每搏输出量（SV）和6 min步行距离（6 MWD）等指标变化,比较两组临床疗效与药物不良反应发生情况,以及随访6个月后再次因心力衰竭住院率和死亡率及6 MWD。结果: 治疗后,观察组显效率和总有效率均明显高于对照组（P<0.05）。两组患者LVEF、CI、SV及6 MWD均较治疗前显著提高,LVEDD显著降低（P<0.05）,且观察组各项指标均优于对照组（P<0.05）。随访6个月时,观察组患者6 MWD显著大于对照组（P<0.05）,心力衰竭再次入院率和死亡率比较,差异均无统计学意义（P>0.05）;两组均未发生药物不良反应。结论: 大株红景天注射液联用单硝酸异山梨酯能显著改善顽固性心力衰竭患者心功能,提高临床疗效,且安全性好。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.