佐使配伍对含关木通的龙胆泻肝汤全方肾毒性作用的影响

目的观察单味关木通、龙胆泻肝汤和去当归、生地、甘草的龙胆泻肝汤给药后大鼠肾功能和组织形态学变化。方法大鼠随机分为正常对照组、单味关木通组、龙胆泻肝汤组和龙胆泻肝汤去归地草方组,正常对照组给予等量蒸馏水,后3组分别按6、17.5、14.5 g/kg给以相应方药的水煎液灌胃,各组关木通含量均为6 g/kg,连续8周。给药结束后,测定大鼠血、尿生化指标,观察肾脏组织形态学改变。结果各水煎液灌胃组,均有明显肾损伤表现,其中以单味关木通组损伤最为严重,龙胆泻肝汤组较轻,去归地草的龙胆泻肝汤组较龙胆泻肝汤组损伤重,个别指标甚至高于单味关木通组。结论实验剂量的关木通与配伍关木通的两个复方均可引起肾损伤,龙胆泻肝汤去当归、生地、甘草方的肾毒性较龙胆泻肝汤强。提示含关木通配伍的复方的毒性作用不等于关木通,龙胆泻肝汤方中当归、生地、甘草的配伍对关木通的肾损伤有一定的减毒作用。     

HPLC法测定关木通及4种中成药中马兜铃酸A含量

目的 了解几种主要马兜铃属植物药中马兜铃酸A的含量以指导用药。方法 采用HPLC方法，测定了关木通粉剂和水煎剂以及川芎茶调丸、青宁丸、龙胆泻肝丸和纯阳正气丸4种中成药中马兜铃酸A的含量。结果 关木通粗粉中马兜铃酸A含量平均为0．23％；川芎茶调丸、青宁丸和龙胆泻肝丸中的马兜铃酸A含量很低；关木通水煎剂中马兜铃酸A含量约相当于甲醇提取液的1／3。结论 马兜铃酸A含量应被列为马兜铃属药品的质量监控标准之一。     

单味关木通和龙胆泻肝汤肾毒性的比较探讨

目的:探讨比较单味关木通和龙胆泻肝汤肾毒性。方法:收集72只大鼠,随机分为正常组、关木通组、龙胆泻肝汤组,关木通组和龙胆泻肝汤组给予相同剂量的单味关木通水提液7g·kg-1与17.7g·kg-1龙胆泻肝汤水提液,给予正常组等量的饮用水。连续使用8周。结果:使用两种水提液的大鼠肾脏匀浆中IL-1β和IL-6的水平高于正常组,肾功能发生明显的改变,龙胆泻肝汤组肾损伤程度明显轻于单味关木通组。结论:关木通和配伍关木通的龙胆泻肝汤均能够导致肾功能损伤,而龙胆泻肝汤的肾毒性较低,这可能药物中单味关木通减轻引起的免疫诱导的炎性反应有关。     

关木通配伍减毒研究进展

关木通,为马兜铃科北马兜铃AristolochinacontortaBge.或马兜风铃A.debilisSieb.etZucc.的果实,种子中含马兜铃酸。马兜铃酸的毒副作用临床表现为急性肾小管坏死或慢性肾小管间质性肾炎,易发展成慢性肾功能衰竭。合理配伍是降低含马兜铃酸中药肾毒性的主要途径。本文就此综述如下。1导赤散中关木通的配伍李春香等[1]进行了导赤散与单味药关木通水煎液对动物肾毒性的观察。发现导赤散6g/(kg.d)组大鼠,无论是肾功能检测指标,还是肾组织形态学均未发现任何明显的肾损伤痕迹。用RP-HPLC法测定导赤散药液中马兜铃酸含量为0.1605mg/mL,低于关…     

应注意木通类中药的鉴别与使用

众所周知 ,近来国内外关于马兜铃酸具有肾毒性的研讨及采取的措施极其激烈。特别是关木通 ,其含有的马兜铃酸虽具有抗感染和增加吞噬细胞活性作用 ,但其对肾脏有较强的毒性 ,可以损害肾小管功能 ,导致肾功能衰竭。龙胆泻肝丸(组方中有关木通 )引起的不良反应已引起药监部门、医院医师及患者的广泛重视。 2 0 0 3年 2月 2 8日 ,国家药品监督管理局在《关于加强对龙胆泻肝丸监督管理的通知》指出 :在对此药依法进行不良反应监测工作的基础上 ,决定自 2 0 0 3年3月 1日起对含关木通的龙胆泻肝丸严格按处方药管理 ,在零售药店购买必须凭医师处方…     

不同中药配伍对关木通毒性成分马兜铃酸A含量的影响

【目的】观察比较关木通及龙胆泻肝汤各拆方组中马兜铃酸A的变化趋势,探讨中药配伍对马兜铃酸A含量的影响。【方法】按龙胆泻肝汤原方比例将供试样品分7组:关木通组、全方组、关木通 清热组、关木通 滋阴组、关木通 利水组、关木通 甘草组、阴性对照组(全方去关木通);采用反相高效液相色谱(RP-HPLC)法,以DiamonsilTM(钻石)C18(250 mm×4.6 mm,5μm)为色谱柱,以甲醇—水—冰乙酸(体积比74:24:1)为流动相,检测波长315 nm,测定各组中马兜铃酸A的含量。【结果】与关木通组相比,龙胆泻肝汤全方中马兜铃酸A含量最低;关木通 滋阴组马兜铃酸A含量也有明显降低。【结论】在方剂配伍理论指导下,通过合理配伍降低关木通的毒性是可行的。     

关木通在"龙胆泻肝丸"中的毒性见解

龙胆泻肝丸是中医常用的传统药物 ,在临床上主要用于肝胆湿热、头晕耳鸣等症。近期国内不断有报道患者因服用龙胆泻肝丸而造成马兜铃酸肾病 ,造成肾功能衰竭 ,引起了我院高度重视 ,并在中医科开展了龙胆泻肝丸临床合理应用的讨论。目前研究认为 ,龙胆泻肝丸的一味佐药“关木通”是导致严重肾损害的元凶。1　关木通的科属、类别、药理作用关木通是马兜铃科植物木通马兜铃的木质茎 ,主要分布于黑龙江、吉林、辽宁等地。它的主要成分是马兜铃酸 (木通甲素 )、齐墩果酸、常春藤皂甙元等。药物饮片表面灰黄色或褐色 ,节部略粗 ,质坚实、木部黄色…     

关木通及其复方制剂的肾损害

中草药一向被人们误为无不良反应的药物,许多药物广告也这样误导宣传。但据有关资料表明仅2000—2002年北京药物不良反应监察中心就收到龙胆泻肝丸含关木通在内的药物不良反应80多例,有关医学刊物的文献检索,其中因龙胆泻肝丸导致肾损害者累计数为157例。1病因分析据关木通及其复方制剂的肾毒性病例的临床观察,认为关木通的肾毒性可能与超量、长期、不辨证服用有关。国内现有3种不同科属的木通,即木通科木通、毛茛科的川木通和马兜铃科的关木通,而引起肾损害的主要是含马兜铃酸成分的关木通。由于品种混用,误将关木通当木通使用。木通从临床…     

关于"龙胆泻肝丸"的最新报道

新华社记者就广大读者所关心的“龙胆泻肝丸可能导致肾损害”一事采访了医生、患者和国家药监局有关人士。国家药监局有关人士在接受记者电话采访时说，含马兜铃酸的关木通将不再出现在中成药中，含关木通的药物将被禁止生产。国家药监局目前正在研究以替代品代替“关木通”，使龙胆泻肝丸能更好地服务群众。这位人士说，龙胆泻肝丸是一个有悠久历史的配方，其中的配伍药“关木通”引起肾损害，甚至导致尿毒症，这是近年发现的事。他说，国家药品不良反应监测中心原来共收到１５例龙胆泻肝丸不良反应报告，之后发现包括北京中日友好医院等上…     

关木通不再入药

为保证患者用药安全,解决历史上木通品种的混用问题,国家药监局日前决定,取消关木通(马兜铃科)的药用标准。国家药监局在《取消关木通药用标准的通知》中要求,凡生产龙胆泻肝丸(含浓缩丸、水丸)、龙胆泻肝胶囊(含软胶囊)、龙胆泻肝颗粒、龙胆泻肝片的企业,务必于2003年4月30日前将处方中的关木通替换为《中国药典》2000年版2002年增补本中收载的木通(木通科)。其他国家标准处方中含有关木通的中成药品种,务必于2003年6月30日前替换完毕。替换后的品种涉及原标准需要修改的,须将修订后的标准报国家药监局药品注册司。《通知》同时要求,各省、…     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.