82例老年人肺部念珠菌感染的临床分析

目的对我院１９８０年１月至１９９５年５月收治的８２例老年人肺部念珠菌感染病例进行分析，探讨其临床特点。方法３％过氧化氢溶液漱口后采取痰标本，连续３次以上痰真菌培养为同一种菌，并结合临床确诊。６３例应用氟康唑治疗的患者中，４２例口服，第１天３００ｍｇ，第２天改为１５０ｍｇ，每天１次；另２１例患者第１天４００ｍｇ静滴，第２天改为２００ｍｇ静滴，每天１次。连续１～２周后改口服１５０ｍｇ，每天１次。疗程３～４周。应用其它抗真菌药物治疗者包括酮康唑１４例，两性霉素Ｂ１例，５－ＦＣ１例。结果６３例应用氟康唑治疗患者，病死率９．５２％。应用其它抗真菌药物者，治愈９例，死亡７例。氟康唑治疗组１２例出现轻度胃肠道反应，其它抗真菌药物组中８例出现轻、中度胃肠道反应。结论老年人肺部念珠菌感染的治疗，除停用抗生素、改善营养状况外，应早期适当应用抗真菌药物     

国产氟康唑胶囊剂治疗深部真菌感染的多中心临床观察

为观察国产氟康唑胶囊剂治疗深部真菌病的临床疗效与安全性，用国产氟康唑胶囊治疗深部真菌感染９１３例。氟康唑每日剂量１００～２００ｍｇ，疗程３６～８个月。结果：痊愈率和总有效率分别为６９．２６％与９４．２９％，真菌清除率为９３．８３％。主要不良反应为恶心、呕吐、腹泻、腹痛等消化道症状，多可耐受，不良反应发生率为９．２０％。本临床试验表明，国产氟康唑胶囊剂为一有效、安全的治疗深部真菌感染的药物。     

幽门螺杆菌相关性十二指肠溃疡的治疗

为了研究幽门螺杆菌相关性十二指肠怕治疗方法，将本病４９６例随机分为六组。Ａ组奥美拉唑４０ｍｇ，每天１次，治疗２周。Ｂ组：泰胃美８００ｍｇ，每晚１次，治疗４周。Ｃ组：胶体饿剂（德诺）１２０ｍｇ，每天４次，治疗４周、弗莱莫星５００ｍｇ，每天４次治疗２周，Ｄ组：奥美拉唑４０ｍｇ，第天１次，弗莱莫星２５０ｍｇ和甲硝唑２００ｍｇ各每日４次，治疗２周，Ｆ组：胶体铋剂１２０ｍｇ，每天４次治疗４周。弗莱莫星２５０     

氯沙坦治疗轻、中度高血压病的疗效和安全性评价

目的 评价氯沙坦（ｌｏｓａｒｔａｎ,ＬＯＳ）治疗轻、中度高血压病（ＥＨ）的临床疗效和安全性。方法 选取轻中度ＥＨ患［坐位舒张压（ＳｉＤＢＰ）９０￣１１４ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ］,一组采用随机、双盲８周的平行对照,另一组服ＬＯＳ采用开放的８周２４小时动态血压监测（ＡＢＰＭ）和２４周的诊室血压研究。经１周药物冲洗期及２周安慰剂期后,服双盲药ＬＯＳ（６１例）５０ｍｇ／ｄ或对照药赖诺普利     

动态血压监测方法评价日服一次硝苯地平控制片的谷峰作用

评价硝苯地平的一种缓释剂型硝苯地一产控释片的抗高血压疗效。选择１２６例原发性高血压患者，进行随机、双盲、安慰剂对照研究，用动态血压监测方法进行评价。经过两周的安慰剂准备阶段后，服用硝苯地平控释片３０ｍｇ或６０ｍｇ或剂，日服１次，共４周。在每阶段的终末行２４－３６ｈ动态血压监测，每１５ｍｉｎ测一次血压。     

氟罗沙星治疗急性细菌性感染临床研究

本临床试验目的是对氟罗沙星进行安全性及有效性评价。采用随机对照开放试验方法，选用洛美沙星作对照药，两组治疗泌尿道感染和呼吸道感染各３０例，同时完成氟罗沙星开放试验５０例，共１１０例。氟罗沙星与洛美沙星给药方法均为２００ｍｇ／次，每日２次，或４００ｍｇ，每日１次，疗程７～１４天。随机对照氟罗沙星组细菌培养阳性率８３．３％；有效率９３．３％；细菌清除率９２．３％，不良反应发生率９．４％；洛美沙星对照组分别为８０．０％，９０．０％，８７．５％，６．７％；以上结果经统计学处理差异无显著性（Ｐ＞０．０５）。氟罗沙星随机加开放试验共治疗各种细菌性感染患者８０例，总有效率９０．０％，细菌阳性率８３．８％，细菌清除率８８．２％，不良反应发生率９．６％。表明氟罗沙星为广谱、高效、安全的抗菌药物。     

国人小剂量重组织织型纤溶酶原激活剂与尿激酶治疗急性心肌梗塞随机对照研

目的 评价重组组织型纤溶酶原激活剂（ｒｔ－ＰＡ）５０ｍｇ对国人急性心肌梗塞（ＡＭＩ）溶栓治疗的疗效及安全性，并与国产尿激酶（ＵＫ）常用剂量的疗效进行对比。方法 该研究系在１７所医院进行的开放、多中心随机理平行对照试验。在５５例患作为ｒｔ－ＰＡ５０ｍｇ预试验完成后，研究继续进行，其人选合格患３２４例。符合条件的患随机分为ｒｔ－ＰＡ与ＵＫ两组：前后ｒｔ－ＰＡ给予８ｍｇ静脉注射，继之４２ｍｇ在９０     

西沙必利治疗反流性食管炎多中心双盲对照临床观察

应用双盲多中心研究观察了西沙必利和雷尼替丁治疗１００例反流性食管炎的疗效，西沙必利１０ｍｇ，４次／ｄ，雷尼替丁为１５０ｍｇ，２次／ｄ。每２周复诊１次，４周后复查内镜，如未愈合，８周后再次检查内镜，结果表明，二组患者治疗后症状的总分均明显下降。?     

国产伊普拉封防治绝经后骨质疏松的评价

目的 观察国产伊普拉封（Ｉｐｒｉｆｌａｖｏｎｅ）口服剂对防治绝经后骨质疏松症（ＰＭＯ）的疗效和；安全性。方法 将确诊为绝经后骨量减少或骨质疏松的４８例患者采用双盲和随机法分为两组。治疗组（２５例），口服伊普拉封６００ｍｇ／ｄ；对照组（２３例）服用安慰剂，进行对比观察。结果 治疗组症状好转较对照组明显。疗程结束时，治疗组ＢＭＤ增加；对照组ＢＭＤ略有降低。     

卡托普利对急性心肌梗死患者早期血压、心率的影响——中国心脏研究－Ⅰ暨血管紧张素转换酶抑制剂治疗急性心肌梗死大型随机临床试验专题报告之二

探讨血管紧张素转换酶抑制剂卡托普利对急性心肌梗死病人早期血压、心率、死亡率及临床事件的影响。方法多中心随机双盲安慰剂对照临床试验，给发病３６ｈ内的急性心肌梗死病人随机口服卡托普利（ｎ＝７４６８，１２．５ｍｇ３／ｄ）或安慰剂（ｎ＝７４９４）治疗４周。结果基础血压＜１００ｍｍＨｇ或舒张压＜７０ｍｍＨｇ、心率＜７０ｍｉｎ－１者，卡托普利组４周总死亡率略高于安慰剂对照组；基础收缩压≥１００ｍｍＨｇ或舒张压≥７０ｍｍＨｇ、心率≥７０ｍｉｎ－１（尤其心率偏快）者，卡托普利组死亡率均低于对照组。用首剂（６．２５ｍｇ）药后２ｈ收缩压或舒张压较前下降１０％～１９％者卡托普利组死亡率（８．５％，７．１％）均明显低于对照组（１０．７％，Ｐ＝０．０４；１０．０％，Ｐ＝０．００３），而血压下降幅度＜１０％者两组死亡率相似。基础收缩压＜１００ｍｍＨｇ者卡托普利组休克发生率（１０．０％）高于对照组（７．８％），低血压发生率（３６．５％ｖｓ２４．０％）更高。基础心率＜６０ｍｉｎ－１者卡托普利组心力衰竭（１３．４％）、休克（５．８％）、室颤（２．８％）发生率均略高于对照组（１１．９％，３．６％，１．３％）；心率≥６０ｍｉｎ－１者卡托普利     

Amphotericin B combined with itraconazole or fluconazole for treatment of histoplasmosis

To investigate the efficacy of combined treatment with fluconazole (Flu) and amphotericin B (AmB) for Histoplasma capsulatum meningitis, MICs were determined for 10 clinical isolates, following National Committee for Clinical Laboratory Standards guidelines. Weak synergy was observed for 6 of the 10 isolates. For the in vivo models, mice either were sham treated or were given Flu (75 mg/kg/day), AmB (2 mg/kg every other day), itraconazole (Itra; 75 mg/kg/day), AmB+Flu, or AmB+Itra. Following infection with 5x105 yeasts, Flu antagonized AmB's reduction of fungal burden without reducing its effect on survival. When in vivo antagonism was reproduced following infection with 1x104 yeasts, a higher fungal burden was observed in the lungs. Itra had no effect on AmB's activity and was more effective than Flu for clearance of fungal burden. These findings caution against use of AmB+Flu for treatment of histoplasmosis, but studies of the effect of treatment on the fungal burden in the brain are needed to assess combination therapy for meningitis.     

CYP2C19基因多态性对埃索美拉唑三联疗法根除幽门螺杆菌疗效的影响

目的 研究CYP2C19(cytochrome P450 2C19)基因多态性对以埃索美拉唑为基础三联1周疗法的Hp根除率的影响.方法 选取101例Hp阳性的慢性胃炎或消化性溃疡患者,分成2组,分别进入埃索美拉唑联合阿莫西林与克拉霉素方案(EAC)或奥美拉唑联合阿莫西林与克拉霉素方案(OAC)进行1周根除治疗.治疗前采...     

伊曲康唑与氟康唑预防肝移植术后侵袭性真菌感染疗效比较

目的 比较伊曲康唑口服液和氟康唑胶囊预防肝移植术后侵袭性真菌感染的有效性和安全性。方法 本试验为随机、对照、开放的临床试验。入选的60例肝移植术后患者随机分为两组。试验组（30例）使用伊曲康唑口服液预防肝移植术后真菌感染,20ml,1次／d,空腹服用;对照组（30例）使用口服氟康唑胶囊预防肝移植术后真菌感染,0．15g,1次/d;两组均常规使用15d,在服药期间观察两组患者真菌感染的发生情况和药物敏感情况。结果 伊曲康唑口服液组服药期间有3例发生真菌感染,感染率为10．0％,其中确诊1例,临床诊断2例。氟康唑胶囊组10例发生真菌感染,感染率为33．3％,其中确诊2例,临床诊断6例,拟诊2例。两组患者真菌感染率差异有统计学意义（P〈0．05）,用药前及用药后两组患者肝肾功能指标差异均无统计学意义（P〉0．05）。结论 伊曲康唑口服液较氟康唑胶囊能更有效地预防肝移植术后侵袭性真菌感染,且两者的安全性相当。     

4404例阴道炎患者霉菌和滴虫感染状况分析

目的了解阴道炎患者霉菌和滴虫感染状况。方法对患者阴道分泌物进行镜检,查找霉菌和滴虫,对霉菌和滴虫的感染状况进行统计描述与分析。结果 4 404例阴道炎患者,检出霉菌性阴道炎有1 118例,感染率为25.39%;检出滴虫性阴道炎患者143例,感染率为3.25%;检出双重感染性阴道炎患者24例,感染率为0.54%。霉菌性阴道炎阳性率以≤20岁组为最高,≤50岁人群感染率显著高于≥51岁人群,感染率随年龄的增长明显降低;滴虫性阴道炎以≥51岁年龄组人群感染率最高,≥31岁人群感染率显著高于≤30岁人群,感染率随年龄的增长呈上升趋势。霉菌性阴道炎感染率以夏季最高,为29.17%,滴虫性阴道炎感染率夏季和秋季较高,分别为3.85%和4.17%。结论兰州地区妇女非细菌性阴道炎主要以霉菌性阴道炎为主,应加强防治。     

Effectiveness of 10 day-sequential therapy for Helicobacter pylori eradication in Korea

BACKGROUND/AIMS: Antibiotic resistance and poor compliance are the main causes of Helicobacter pylori (H. pylori) eradication failure. Proton pump inhibitor (PPI)-based triple therapy is the most preferred regimen in clinical practice. However, a critical fall in the H. pylori eradication rate has been observed in the recent years. A novel 10 day-sequential therapy consists of five days of dual therapy followed by five days of triple therapy regimen has recently been described. We aimed to evaluate whether 10 day-sequential therapy eradicated H. pylori infection better than the PPI-based triple therapy in Korea. METHODS: 158 patients with proven H. pylori infection were randomized to receive either 10 day-sequential therapy (20 mg of omeprazole, 1.0 g of amoxicillin, each administered twice daily for the first 5 days, followed by 20 mg of omeprazole, 500 mg of clarithromycin, 500 mg of metronidazole, each administered twice daily for the remaining 5 days) or PPI-based triple therapy (20 mg of omeprazole, 1.0 g of amoxicillin, 500 mg of clarithromycin, each administered twice daily for 1 week). Outcome of eradication therapy was assessed 8 weeks after the cessation of treatment. RESULTS: Eradication rates of 10 day-sequential therapy and PPI-based triple therapy were 77.9% (60/77) and 71.6% (58/81) by intention to treat analysis, respectively (p=0.361). By per protocol analysis, eradication rates of 10 day-sequential therapy and triple therapy were 85.7% (60/70) and 76.6% (58/76), respectively (p=0.150). There were no significant differences in adverse event rates and treatment compliance between two groups. CONCLUSIONS: The 10 day-sequential therapy regimen failed to achieve significantly higher eradication rates than PPI-based triple therapy.     

One-week low-dose triple therapy without anti-acid treatment has sufficient efficacy on Helicobacter pylori eradication and ulcer healing

BACKGROUND/AIMS: The aim of this study was to determine the efficacy of a 1-week low-dose proton pump inhibitor-based triple therapy without further acid suppression for cure of Helicobacter pylori infection and the ulcer healing in peptic ulcer disease. METHODOLOGY: Patients with endoscopically proven peptic ulcers who were H. pylori positive participated in this study. All patients were treated for 1 week with omeprazole 20 mg b.d., clarithromycin 250 mg b.d. and tinidazole 500 mg b.d., then patients were treated randomly for another 4 weeks with either omeprazole 20 mg once daily (OCM-O group; n = 40) or without acid suppressing agents (OCM group; n = 39). Patients were investigated endoscopically for H. pylori and ulcer status before treatment, four weeks (week 5) and 8 weeks later (week 9) after anti-H. pylori treatment. H. pylori infection was assessed by rapid urease test and histology. RESULTS: The eradication rates of H. pylori were 72.5% (95% CI: 59-86%) and 76.3% (95% CI: 63-90%) by intention-to-treat analysis and by per protocol analysis respectively in the OCM-O group and were 87.2% (95% CI: 77-98%) and 97.1% (95% CI: 92-100%) by intention-to-treat analysis and by per protocol analysis respectively in the OCM group (p < 0.05 in per protocol analysis). In respect to ulcer healing status at week 5, 89.5% (34/38) of patients in the OCM-O group and 80% (28/35) of patients in the OCM group had healed ulcers; at week 9, 86.8% (33/38) of patients in the OCM-O group and 88.6% (31/35) of patients in the OCM group had healed ulcers (p = NS). When the ulcer status was analyzed in relation to the H. pylori status, at week 5 ulcer had healed in 84.4% (54/64) of patients with clearance of H. pylori infection and in 88.9% (8/9) of those with persistent infection. At week 9, ulcer healing increased up to 93.8% (60/64) of patients with clearance of H. pylori infection and decreased to 44.4% (4/9) of patients with persistent infection. The adverse events (20%) were mild in these two treatment groups and no patients required discontinuation of the study medications. CONCLUSIONS: Continuation of antisecretory drug therapy beyond a one-week low-dose triple therapy consisting of omeprazole, clarithromycin and tinidazole is actually excessive regarding eradication efficacy and peptic ulcer healing.     

Does Helicobacter pylori eradication depend on the period of amoxicillin treatment? A retrospective study

In this study, the effect of different periods of amoxicillin (AMPC) treatment on the eradication rate of Helicobacter pylori in 173 patients with peptic ulcers (gastric ulcer, 109; duodenal ulcer, 64) was investigated. AMPC (1.5 g/day) was administered for 2, 4, or 6 weeks with omeprazole (20 mg/day) and plaunotol (240 mg/day), a mucoprotective drug, for 8 weeks. The H. pylori eradication rate was 46.7% for 2 weeks' treatment, 83.4% for 4 weeks' treatment, and 100% for 6 weeks' treatment. The eradication rate had a good correlation with the period of AMPC treatment. The healing rates of peptic ulcer at 4 and 8 weeks were 93.3% and 100%, respectively, in the 2-week group, 98.0% and 99.3% in the 4-week group, and 85.7% and 100% in the 6-week group. The recurrence rate of gastric and duodenal ulcers was 3.5% and 0% respectively, in the patients in whom H. pylori was eradicated and 30.0% and 40%, respectively, in the patients in whom H. pylori was not eradicated for 12 months after the H. pylori eradication treatment. Adverse effects of this regimen were observed in 5 (2.9%) of the 173 patients. Diarrhea was observed in 3 patients and eruption in 2. These adverse effects disappeared within a few days after only AMPC was withdrawn. Therefore, these may be caused by AMPC. The eradication rate of H. pylori depends on the period of AMPC treatment. This regiment, AMPC (1.5 g/day) + omeprazole (20 mg/day) + plaunotol (240 mg/day), is safe and well tolerated for eradication of H. pylori. Received Oct. 17, 1996; accepted June 27, 1997     

Adjuvant probiotics improve the eradication effect of triple therapy for Helicobacter pylori infection

AIM:To investigate whether the addition of probiotics can improve the eradication effect of triple therapy for Helicobacter pylori (H. pylori ) infection. METHODS:This open randomized trial recruited 234 H. pylori positive gastritis patients from seven local centers. The patients were randomized to one-week standard triple therapy (omeprazole 20 mg bid , clarithromycin 500 mg bid , and amoxicillin 1000 mg bid ; OCA group, n = 79); two weeks of pre-treatment with probiotics, containing 3 × 107 Lactobacillus acidophilus per day, prior to one week of triple therapy (POCA group, n = 78); or one week of triple therapy followed by two weeks of the same probiotics (OCAP group, n = 77). Successful eradication was defined as a negative C13 or C14 urease breath test four weeks after triple therapy. Patients were asked to report associated symptoms at baseline and during follow-up, and side effects related to therapy were recorded. Data were analyzed by both intention-to-treat (ITT) and per-protocol (PP) methods. RESULTS:PP analysis involved 228 patients, 78 in the OCA, 76 in the POCA and 74 in the OCAP group. Successful eradication was observed in 171 patients; by PP analysis, the eradication rates were significantly higher (P = 0.007 each) in the POCA (62/76; 81.6%, 95% CI 72.8%-90.4%) and OCAP (61/74; 82.4%, 95% CI 73.6%-91.2%) groups than in the OCA group (48/78; 61.5%, 95% CI 50.6%-72.4%). ITT analysis also showed that eradication rates were significantly higher in the POCA (62/78; 79.5%, 95% CI 70.4%-88.6%) and OCAP (61/77; 79.2%, 95% CI 70%-88.4%) groups than in the OCA group (48/79; 60.8%, 95% CI 49.9%-71.7%), (P = 0.014 and P = 0.015). The symptom relieving rates in the POCA, OCAP and OCA groups were 85.5%, 89.2% and 87.2%, respectively. Only one of the 228 patients experienced an adverse reaction. CONCLUSION:Administration of probiotics before or after standard triple therapy may improve H. pylori eradication rates.     

Triple therapy with clarithromycin, amoxicillin and omeprazole for Helicobacter pylori eradication in children and adolescents

BACKGROUND: Helicobacter pylori infection presents high prevalence in developing countries, but there are few pediatric assays evaluating antimicrobial treatment. OBJECTIVE: The aim of this study was to investigate Helicobacter pylori eradication rate using a short regimen (7 and 10 days) of triple therapy with clarithromycin, amoxicillin and omeprazole. PATIENTS AND METHODS: Twenty-five Hp positive patients who presented severe epigastralgia, were submitted to antimicrobial treatment with amoxicillin (50 mg/kg/day--maximum dose 1 g bid), clarithromycin (30 mg/kg/day--maximum dose 500 mg bid) and omeprazole (0.6 mg/kg/day--maximum dose 20 mg bid) during 7 or 10 days. After 2 months, clinical symptoms were evaluated and gastric biopsies were taken to test Hp eradication. RESULTS: Overall eradication rate was achieved in 16/25 patients (64%--IC(95% = 45-83%), in 11/15 (73%--IC(95%) = 51-95%) patients who used 10 days therapy course and in 5/10 (50%--IC(95%) = 19-81%) who used 7 days therapy course. Eradication drugs were well accepted and adverse effects were reported in two patients (8%). CONCLUSIONS: This triple therapy regimen had moderate efficacy (64%). The data suggests that 10 days therapy course achieves better eradication rate (73%) than 7 days course (50%) to treat Hp infection in our population.     

Effect of Helicobacter pylori eradication on malignant transformation of gastric adenoma

BACKGROUND: A nonrandomized trial of Helicobacter pylori eradication was conducted in patients with endoscopically diagnosed gastric adenoma to determine the long-term effect of antimicrobial treatment on progression of the adenoma. METHODS: Of 64 patients with an endoscopically diagnosed gastric adenoma and H pylori infection, 32 were treated with omeprazole and antibiotics to eradicate the infection, and 32 were not. RESULTS: During 2 years of follow-up, 4 (12.5%) of the 32 patients in the untreated group developed an early stage, intestinal-type gastric cancer, whereas no gastric cancer was found in the 32 patients in the treated group. CONCLUSION: H Pylori eradication may inhibit progression of gastric adenoma to carcinoma.