托吡酯加治难治性癫癎均期1年的临床观察

目的　对经典抗癫　药（ＡＥＤｓ）治疗效差的４２例难治性癫　（ＩＥ）,包括部分性发作及／或全身强直阵挛性发作,少量Ｌｅｎｎｏｘ－Ｇａｓｔａｕｔ综合征和Ｗｅｓｔ综合征等,加用托吡酯（ＴＭＰ）观察其较长时期的临床疗效和副反应。方法ＴＰＭ加治均期１年（６－１９个月）,用量５０－５００　ｍｇ／ｄ（中位数为　２００　ｍｇ　）,将每例最后　３个月的平均月发作频率和中位数与基线进行比较,并观察副反应。结果　总有效率（发作减少５０％或以上）以６４．３％（Ｐ＜０．００１）,末次随诊有２３．４％的病人发作控制３个月以上,副反应轻,多为一过性（７１．２％）,６例病人因不能耐受副反应或疗效欠佳退出（退出率为１４．３％）。结论　本研究提示ＴＭＰ添加治疗ＩＥ疗效稳定,未见明显抗药性,是适于长期应用的新的有效ＡＥＤｓ之一。常见副反应与中枢神经系统有关。     

ACNU和三尖杉酯碱分别联合MTX超选择性脑动脉灌注治疗恶性脑瘤的疗效比较

比较超选择性脑动脉灌注嘧啶亚硝脲（ＡＣＮＵ）加氨甲喋呤（ＭＴＸ）（Ａ组）以及三尖杉酯碱加ＭＴＸ（Ｂ组）治疗恶性脑胶质细胞瘤的疗效。方法将ＡＣＮＵ２～３ｍｇ／ｋｇ，三尖杉酯碱０１～０５ｍｇ／ｋｇ，ＭＴＸ０１～０２ｍｇ／ｋｇ按Ａ、Ｂ两组各１２例方案，采用超选择性脑动脉联合灌注化疗，并于化疗后１～１５个月以ＣＴ检查评定疗效。结果Ａ组肿瘤体积缩小４８３２％，Ｂ组缩小４６２１％；Ａ组有效者占４／１２，Ｂ组占３／１２；平均生存期分别为２５３个月和２３３个月；两组治疗前后肿瘤体积变化均有显著性差异，但两组疗效则无明显差异；并均无眼部及严重脑部并发症。结论ＡＣＮＵ加ＭＴＸ以及三尖杉酯碱加ＭＴＸ超选择性脑动脉灌注对恶性脑胶质细胞瘤的疗效相似，毒副作用小。     

氯氮平治疗精神分裂症及血药浓度研究

目的：探讨氯氮平治疗的适宜剂量及血药浓度与临床效应的关系。方法：氯氮平治疗精神分裂症６周共６２例（１５０ｍｇ／ｄ组２１例,３００ｍｇ／ｄ组２０例,４５０ｍｇ／ｄ组２１例）。用阳性和阴性症状量表（ＰＡＮＳＳ）和副反应量表（ＴＥＳＳ）评定疗效及副反应。在治疗第２、４、６周末晨服药前测血药浓度。结果：３种剂量组间有效率、ＰＡＮＳＳ减分值、ＴＥＳＳ增分值均无显著差异（Ｐ〉０．０５）,不同时段ＰＡＮＳＳ分值改变也无明显差异,提示３组间不仅疗效相当且起效快慢也无明显差异。完成血药浓度测定者４２例,有效血浓度低于以往研究推荐的３５０～４５０μｇ／Ｌ。提示氯氮平血浓度治疗窗尚有较大探讨余地。结论：在一定范围内低剂量氯氮平能取得与高剂量同样的疗效,对临床工作中避免盲目大剂量用药有指导意义,同时也有助于人们对氯氮平血浓度治疗窗有新     

小剂量阿斯匹林预防缺血性脑血管病的长期随访研究

８１５例轻型缺血性卒中（ＭＩＳ）或ＴＩＡ病人随机分为阿斯匹林（ＡＳＡ）组（４１３例）与对照组（４０２例），随访１２～６０（平均２９．４）个月，结果发现：ＡＳＡ组卒中与死亡发生率（１５．３％）明显低于对照组（２４．４％）（Ｐ＜０．０１），ＡＳＡ组卒中与死亡危险性较对照组降低３７％［相对危险性（ＲＲ）为０．６３，９５％可信区间为０．４６～０．８６］；ＡＳＡ组卒中、血管性死亡及心肌梗塞发生率（２２．３％）显著低于对照组（３５．４％）（Ｐ＜０．００１），ＡＳＡ组卒中、血管性死亡及心肌梗塞危险性较对照组降低３６％（ＲＲ为０．６６，９５％可信区间为０．５０～０．８４）；ＡＳＡ组副作用发生率为１８．４％，严重副作用为２．７％。     

女性精神病患者口服利培酮引起停经8例

１资料８例女性患者,年龄１８～３４岁,因患精神分裂症分别于１９９７年５月～１９９７年１１月期间来我院精神科就诊,用药前月经周期均正常,予利培酮片口服。开始服用１～２ｍｇ／ｄ,根据病情逐渐增加剂量,到第４周分别增至３ｍｇ／ｄ（１例）、４ｍｇ／ｄ（６例）...     

利培酮治疗初发精神分裂症的固定剂量与疗效对照研究

目的 探讨利培酮治疗初发精神分裂症固定剂量与临床疗效关系。方法 将初发精神分裂症患者５２你随机分为固定剂量组（Ａ组）和常规剂量组（Ｂ组）,采用利培酮治疗１２周,并以简明精神病评定量表（ＢＰＲＳ）评定其疗效,用副反应量表（ＴＥＳＳ）观察不良反应。结果 Ａ、Ｂ两组治疗前后自身对照有显著性差异（Ｐ〈０．０１）。两组之间比较差异无显著性（Ｐ〉０．０５）。结论 利培酮治疗初发精神分裂症疗效肯定,常用最佳治疗剂量〈４ｍｇ／ｄ（可采用首次即达到治疗剂量）,老年患者治疗剂量〈２ｍｇ／ｄ（可采用首次即达到治疗剂量）,老年患者治疗剂量〈２ｍｇ／ｄ。为正常成人剂量的５０％较适宜。     

双相情感性精神障碍预防性治疗的对照研究

目的：评价丙戊酸镁预防性治疗双相情感障碍的儿及副作用。：９６例频发双相情感精神障碍的病人随机分为两组,分别使用丙戊酸镁（４７例）和碳酸锂（４９例）进行预防性随访时间为３９个月,使用躁狂量表（ＢＲＭＳ）、汉密尔顿抑郁量表（ＨＡＭＩ）,和副反应（ＴＥＳＳ）评定疗效和副作用。结果：丙戊酸镁缄及碳酸锂组预防性治疗有效率分别为８５．０％和８２．１％,副作用发生率分别为８１。．０％和５７．１％,经Ｒｉｄｉｔ分     

氟西汀与氯丙咪嗪治疗强迫症的对照研究

本文对符合ＣＣＭＤ－２－Ｒ强迫症诊断标准的２８例强迫症病人随机分为两组，分别用氟西汀２０～４０ｍｇ／ｄ，氯丙咪嗪１５０～２５０ｍｇ／ｄ系统治疗８周。采用了强迫量表（Ｙ－ＢＯＣＳ）和副反应量表（ＴＥＳＳ）评分，以比较两药治疗强迫症的疗效及主要副反应。结果显示：两药的疗效相当，但氯丙咪嗪见效快，副作用重，而氟西汀见效慢，但事作用少而轻微，尤其适合于老年人或伴有心血管病的强迫病人。     

不同剂量氯氮平治疗精神分裂症的血药浓度与临床效应的关系

目的研究氯氮平不同剂量时稳态血药浓度与临床效应的关系。方法以氯氮平治疗１７６例精神分裂症患者，其中采用高剂量（５００ｍｇ／ｄ）治疗８２例和低剂量（２００ｍｇ／ｄ）治疗９４例。疗效和不良反应分别用简明精神病评定量表（ＢＰＲＳ）和副反应量表（ＴＥＳＳ）进行评定，并测定治疗第１，２，４，６周的稳态血药浓度。结果高、低剂量组间的ＢＰＲＳ减分率和有效率差异无显著性（Ｐ＞０．０５）。高剂量组ＴＥＳＳ增分值虽高于低剂量组，但差异无显著性。ＢＰＲＳ减分率和ＴＥＳＳ总分与血药浓度未发现显著性相关，但血浓度＞３００μｇ／Ｌ时疗效提高，＞６００μｇ／Ｌ时不良反应加重。结论提示稳态血药浓度３００μｇ／Ｌ为起效的阈浓度。氯氮平的血浓度监测对指导个体化合理用药具有临床意义。     

口服利培酮治疗精神分裂症

为验证利培酮治疗精神分裂症的疗效和安全性，对２０例精神分裂症住院患者给予利培酮４～８ｍｇ／ｄ治疗，疗程８周，以阳性和阴性症状量表（ＰＡＮＳＳ）、大体评定量表（ＧＡＳ）和临床总体印象量表（ＣＧＩ）评定疗效，以锥体外系副反应量表（ＥＳＲＳ）和不良反应量表（ＴＥＳＳ）评定药物不良反应。结果显示，治疗结束时显效率为９０％。利培酮的起效时间在１０天左右，仅有轻度的锥体外系副反应和失眠。提示利培酮对精神分裂症的阳性和阴性症状都有良好的疗效，且安全性较高     

Management of atherothrombosis with clopidogrel in high-risk patients with recent transient ischaemic attack or ischaemic stroke (MATCH): study design and baseline data

BACKGROUND: The CAPRIE study showed the superiority of clopidogrel over acetylsalicylic acid (ASA) for reducing the combined risk of major atherothrombotic events in patients with recent myocardial infarction (MI), recent ischaemic stroke (IS) or established peripheral arterial disease. The benefit of clopidogrel over ASA is amplified in high-risk patients. Proof of concept for the benefit of clopidogrel in addition to ASA in patients with coronary manifestations of atherothrombosis was provided by the CURE trial. METHODS: MATCH is a randomized, double-blind, placebo-controlled trial that compares clopidogrel and ASA versus clopidogrel alone in high-risk patients with recently symptomatic cerebrovascular disease. Eligible patients have experienced a transient ischaemic attack (TIA) or IS within the last 3 months and have evidence of at least 1 additional risk factor within the last 3 years (prior IS, MI, stable or unstable angina pectoris, diabetes or symptomatic peripheral arterial disease). Patients were randomized to receive ASA 75 mg once daily or placebo, with both groups receiving clopidogrel 75 mg once daily as part of standard therapy. The primary end point is the composite of IS, MI, vascular death and rehospitalization for an acute ischaemic event. The duration of treatment and follow-up is 18 months for each patient. RESULTS: Enrollment was completed in April 2002, with 7,599 patients randomized to receive the study medication. The mean age at randomization was 66 years, and the qualifying event was IS in 78.9% of patients and TIA in 21.1%. The baseline features of the study cohort indicate a population that is at a high risk for atherothrombotic recurrence. CONCLUSION: MATCH is a major ongoing trial that will provide important data on the benefit of clopidogrel and ASA compared with clopidogrel alone for reduction of vascular ischaemic events in patients with recent TIA or IS who are at high risk of atherothrombotic event recurrence.     

小剂量阿司匹林和噻氯匹定合用在缺血性脑血管病中抗聚效果的观察

目的 :观察阿司匹林 (ASA)和噻氯匹定 (TIC)合用对ICVD患者血小板聚集功能的影响。方法 :用花生四烯酸 (AA)、二磷酸腺苷 (ADP)、肾上腺素 (EPN)和胶原 (COL)做诱导剂检测ICVD患者合用ASA +TIC组与单用TIC或ASA组的血小板聚集率。结果 :合用组对EPN、COL、AA诱导聚集的抑制与TIC组比较差异有显著性 ,对ADP诱导聚集的抑制与ASA组比较差异有显著性 ,P均 <0 0 1。结论 :两者合用后的抗聚效果有相加及协同作用。对需加强抗聚的患者 ,在监测下小剂量的ASA和TIC合用有较好的价 /效比 ,可做为高危ICVD二级预防的一种选择。     

拉萨地区城镇职工脑卒中患病率的流行病学调查

目的 调查拉萨地区城镇职工脑卒中的患病率、亚型及危险因素,为其防治提供依据.方法 采用基于人群的描述性研究方法 ,以2006年10月1日至2008年9月30日拉萨地区81298例城镇参保职工为调查对象,以ICD-10疾病分类为依据,纳入符合诊断脑卒中和心肌梗死的患者,比较其总患病率、分析脑卒中的亚型及患病的影响因素.结果 81298人群中脑卒中患者165例,患病率为202.96/10万,与心肌梗死相比(14例、患病率为17/10万)较高,差异有统计学意义(P＜0.05);脑卒中亚型以脑梗死最多,其次为脑出血、蛛网膜下腔出血;不同年龄段(30～89岁)的脑卒中患病率不同,随着年龄的增加,脑卒中的患病率增高,差异有统计学意义(P＜0.05);男性患病率高于女性,汉族患病率高于藏族和其他,差异有统计学意义(P＜0.05).结论 脑卒中是危害拉萨地区老年人群引起死亡的主要疾病,亚型以缺血型为主,影响患病率的因素包括年龄、性别和民族.合并有高血压病为主要危险因素.     

Acetylsalicylic acid in the prevention of stroke in patients with reversible cerebral ischemic attacks. A Danish cooperative study

Two hundred and three patients, 148 males and 55 females, who during the last month before admission had experienced at least one reversible cerebral ischemic attack of less than 72 hours duration, were randomly assigned to treatment with either acetylsalicylic acid (ASA) 1000 mg daily (101 patients) or placebo (102 patients). The average follow-up period was 25 months. The two treatment groups were comparable with respect to age, sex, associated diseases, risk factors, number and duration of cerebral ischemic attacks. No statistically significant differences were found between the treatment groups as to the primary end point: stroke or death (ASA group 20.8%, placebo group 16.7%). Occurrence of transient ischemic attacks during the treatment period was not reduced by ASA treatment, whereas there was a trend suggesting fewer myocardial infarctions in the ASA group (5.9%) than in the placebo group (13.7%). The difference, however, was not statistically significant (p = 0.10). We were thus unable to demonstrate any favorable influence of ASA 1000 mg daily in patients with reversible ischemic attacks. This study does not, of course, prove that ASA treatment is ineffective in stroke prevention.     

阿司匹林联合氯吡格雷治疗进展性脑梗死的疗效观察

目的观察阿司匹林联合氯吡格雷治疗进展性脑梗死的临床疗效。方法将116例进展性脑梗死患者随机分为治疗组58例和对照组58例。2组均采用脑梗死常规治疗,治疗组给予氯吡格雷75mg和阿司匹林300mg,1次/d,连续7d,7d后改为阿司匹林300mg,1次/d,连续7d。对照组单用阿司匹林300mg,1次/d,连续14d。治疗前和治疗14d、30d后进行神经功能缺损程度评分(NIHSS评分),同时评估出血风险。结果治疗组治疗14d和30d后神经缺损评分明显优于对照组,差异有统计学意义。治疗30d后,冶疗组总有效率(89.7%)明显高于对照组(72.4%),差异有统计学意义(P0.05)。2组血小板计数、凝血指标治疗前后对比差异均无统计学意义(P0.05),2组的不良反应发生率无明显差异(P0.05)。结论短期阿司匹林联合氯吡格雷治疗进展性脑梗死可阻止病情进展,降低患者的致残率,且不会增加出血的风险。     

Second European Stroke Prevention Study: antiplatelet therapy is effective regardless of age

Background - The Second European Stroke Prevention Study (ESPS2) was a randomized, placebo-controlled trial that investigated the efficacy of low-dose acetylsalicylic acid (ASA) and modified-release dipyridamole (DP), alone or in combination, in the secondary prevention of ischemic stroke. The trial demonstrated that the combination was significantly more effective than either agent used alone. The aim of the present study was to evaluate the influence of age on the efficacy of ASA and DP, alone or in combination, in the secondary prevention of stroke in the ESPS2 population. Methods and results - A total of 6602 patients were recruited to the ESPS2 and there were 4 treatment groups: ASA (25 mg twice daily), DP (200 mg twice daily), ASA and DP in a combined formulation, or placebo. Primary endpoints were stroke, death, and stroke or death together. The endpoints evaluated in the present study were stroke, stroke and/or death, and vascular events. Stroke was the qualifying event in 76% of the patients, while 24% had a transient ischaemic attack. Patients were reviewed at 3-month intervals for 2 years. The study population consisted of 2565 (39%) patients aged less than 65 years, 2240 (34%) patients aged between 65 and 74 years, and 1797 (27%) patients aged 75 years and over. Advancing age was associated with an increased incidence of endpoints in all 4 treatment groups. The combination of ASA and DP significantly reduced the incidence of all endpoints, compared with placebo, in each age group. There was no influence of age on the efficacy of antiplatelet therapy for any of the evaluated endpoints. Relative risk reductions of treatment compared with placebo were 11.1–27.6% in the ASA group, 8.0–18.7% in the DP group, and 20.3–45.2% in patients receiving combination therapy. Conclusion - This study clearly demonstrates that combination therapy with DP and ASA is superior to either agent used alone in the secondary prevention of ischemic stroke, irrespective of the age of the patient.     

Intravenous acetylsalicylic acid--dose-related effects on platelet function and fibrinolysis in healthy males.

Low-dose acetylsalicylic acid (ASA) has been shown to be beneficial in patients with acute myocardial infarction and unstable angina pectoris. Oral administration of ASA is difficult in the acute phase of these syndromes. In this study we evaluated the effect of 25 mg, 50 mg or 100 mg of ASA given as an intravenous bolus injection on platelet function and fibrinolysis in healthy males and related this to plasma concentrations of ASA. No adverse effects were found. A complete inhibition of serum thromboxane B2 synthesis was demonstrated 5 min after injection of 100 mg ASA intravenously. ASA disappeared from the circulation within 60 min after bolus injection and at this time thromboxane B2 synthesis was inhibited dose-dependently by 71%, 90% and 100% for doses of 25 mg, 50 mg and 100 mg, respectively. Inhibition of thromboxane B2 synthesis after 100 mg of intravenous ASA was still 96.5% at 24 h and 93.4% at 48 h after the injection. The bleeding time measured at 30 min after ASA administration was significantly prolonged on the average by 70 s, 144 s and 211 s after 25 mg, 50 mg and 100 mg of ASA, respectively. Minor, but significant changes were found in tissue plasminogen activator antigen and in plasminogen activator inhibitor within the first hour after injection of low dose ASA, but similar changes were found after injection of saline. No change in tissue plasminogen activator activity was found.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of factor V Leiden in patients with myocardial infarction and normal coronary angiography

Factor V Leiden is associated with an increased risk of venous thrombosis and myocardial infarction in young women, but not in men in this latter case. The aim of this study was to evaluate the prevalence of this mutation in patients with myocardial infarction but normal coronary angiography. We compared 3 groups of patients: one group consisted of 107 patients with premature myocardial infarction but no significant coronary artery stenosis; another group of 244 patients with myocardial infarction and significant coronary artery stenosis; a third group of 400 healthy controls. Factor V Leiden was found in 13 patients (12.1%) who had a myocardial infarction without significant coronary artery stenosis, 11 patients (4.5%) who had a myocardial infarction with significant coronary artery stenosis (p = 0.01) and in 20 controls (5%) (p = 0.01). Odds ratio associated with factor V Leiden were respectively 2.93 (CI95: 1.18-7.31 ) and 2.63 (CI95: 1.19-5.78) when we compared myocardial infarction patients without significant coronary artery stenosis to controls or to patients with significant coronary artery stenosis. In myocardial infarction patients without significant coronary artery stenosis, prevalence of factor V Leiden is significantly higher than in controls. This new finding supports the hypothesis that thrombosis plays a key role in this selected situation.     

Risk Factors in Ischemic Stroke Subtypes: A Community-Based Study in Brno,Czech Republic

BackgroundIt is not known if risk factors differ between ischemic stroke (IS) subtypes in Central and Eastern Europe.AimsWe performed a community-based analysis of risk factors in patients admitted with IS over a 1 year period in Brno, the second largest city in the Czech Republic (CR).MethodsBased on the National Register of Hospitalized Patients, all patients with IS admitted in Brno in 2011 were identified. Comprehensive discharge summaries from hospital admissions were collected and reviewed. IS subtype and relevant risk factors were ascertained for all patients. The age- and sex-adjusted association of risk factors with IS subtypes was determined.ResultsOverall, 682 patients with IS were admitted in 2011 to Brno hospitals. The distribution of IS subtypes was: 35% cardioembolism, 28% large-artery atherosclerosis, 23% small-artery occlusion, 7% stroke of undetermined etiology, 7% stroke of other determined etiology. Several of the risk factors showed high prevalence in the overall sample – e.g. hypertension (84%) and hyperlipidemia (61%). Cardioembolism as compared to other subtypes was positively associated with a history of myocardial infarction, cardiac failure, and atrial fibrillation. Small-artery occlusion was positively associated with history of dementia. No significant association was found between IS subtypes and history of IS, hypertension, diabetes, obesity, alcohol abuse or smoking.ConclusionsWe found high frequency of stroke risk factors in all IS subtypes. These findings have implications for stroke prevention strategies in the CR and across Central Europe.     

Medium intensity oral anticoagulants versus aspirin after cerebral ischaemia of arterial origin (ESPRIT): a randomised controlled trial

BACKGROUND: Oral anticoagulants are better than aspirin for secondary prevention after myocardial infarction and after cerebral ischaemia in combination with non-rheumatic atrial fibrillation. The European/Australasian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) aimed to determine whether oral anticoagulation with medium intensity is more effective than aspirin in preventing future vascular events in patients with transient ischaemic attack or minor stroke of presumed arterial origin. METHODS: In this international, multicentre trial, patients were randomly assigned within 6 months after a transient ischaemic attack or minor stroke of presumed arterial origin either anticoagulants (target INR range 2.0-3.0; n=536) or aspirin (30-325 mg daily; n=532). The primary outcome was the composite of death from all vascular causes, non-fatal stroke, non-fatal myocardial infarction, or major bleeding complication, whichever occurred first. In a post hoc analysis anticoagulants were compared with the combination of aspirin and dipyridamole (200 mg twice daily). Treatment was open, but auditing of outcome events was blinded. Primary analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial (number ISRCTN73824458) and with ClinicalTrials.gov (NCT00161070). FINDINGS: The anticoagulants versus aspirin comparison of ESPRIT was prematurely ended because ESPRIT reported previously that the combination of aspirin and dipyridamole was more effective than aspirin alone. Mean follow-up was 4.6 years (SD 2.2). The mean achieved INR was 2.57 (SD 0.86). A primary outcome event occurred in 99 (19%) patients on anticoagulants and in 98 (18%) patients on aspirin (hazard ratio [HR] 1.02, 95% CI 0.77-1.35). The HR for ischaemic events was 0.73 (0.52-1.01) and for major bleeding complications 2.56 (1.48-4.43). The HR for the primary outcome event comparing anticoagulants with the combination treatment of aspirin and dipyridamole was 1.31 (0.98-1.75). INTERPRETATION: Oral anticoagulants (target INR range 2.0-3.0) are not more effective than aspirin for secondary prevention after transient ischaemic attack or minor stroke of arterial origin. A possible protective effect against ischaemic events is offset by increased bleeding complications.