硫普罗宁联合替比夫定治疗慢性乙型肝炎的疗效观察

目的观察硫普罗宁联合替比夫定治疗慢性乙型肝炎的临床疗效。方法收集2014年1月—2015年5月在中国石油天然气集团公司中心医院感染科门诊及北京佑安医院重症肝病科门诊接受治疗的慢性乙型肝炎患者80例,随机分为对照组和治疗组,每组各40例。对照组患者口服替比夫定片,600 mg/次,1次/d。治疗组在对照组治疗基础上口服硫普罗宁肠溶片,0.2 g/次,3次/d。两组均连续治疗18周。观察两组的临床疗效,同时比较两组治疗前后天门冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GGT)、丙氨酸氨基转氨酶(ALT)、总胆红素(TBil)、层黏蛋白(LN)、透明质酸酶(HA)、Ⅲ型胶原(PCⅢ)、Ⅳ型胶原(Ⅳ-C)的变化情况。结果治疗后,对照组和治疗组的总有效率分别为72.5%、90.0%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者ALT、AST、GGT、TBil、HA、LN、C-Ⅳ、PCⅢ均显著降低,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P0.05)。结论硫普罗宁联合替比夫定治疗慢性乙型肝炎取得了良好的效果,可显著改善患者肝功能,降低患者的肝纤维化指标,具有一定的临床推广应用价值。     

肝苏颗粒联合替比夫定治疗慢性乙型肝炎的疗效观察

目的研究肝苏颗粒联合替比夫定片治疗慢性乙型肝炎的临床疗效。方法选取2014年1月—2017年2月四川大学华西医院收治的慢性乙型肝炎患者120例为研究对象,随机将所有患者分为对照组和治疗组,每组各60例。对照组口服替比夫定片,1片/次,1次/d;治疗组在对照组治疗的基础上口服肝苏颗粒,1袋/次,3次/d。两组患者均持续治疗48周。观察两组的临床疗效,比较两组的血清乙肝标志物和肝功能指标。结果治疗后,对照组和治疗组的总有效率分别为81.67%、95.00%,两组比较差异有统计学意义(P0.05)。治疗后,对照组和治疗组乙肝表面抗原(HBs Ag)转阴率分别为25.00%、61.67%,乙肝病毒的脱氧核糖核酸(HBV-DNA)转阴率分别为31.67%、55.00%,两组比较差异均具有统计学意义(P0.05)。治疗后,两组血清天门冬氨酸氨基转氨酶(AST)、丙氨酸氨基转移酶(ALT)、谷氨酰转肽酶(GGT)和总胆红素(TBIL)水平均显著下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组肝功能指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论肝苏颗粒联合替比夫定片治疗慢性乙型肝炎具有较好的临床疗效,能提高HBs Ag转阴率和HBV-DNA转阴率,改善患者肝功能,安全性较高,具有一定临床推广应用价值。     

心肝宝胶囊联合替比夫定治疗活动性代偿期乙型肝炎肝硬化的疗效观察

目的探讨心肝宝胶囊联合替比夫定片治疗活动性代偿期乙型肝炎肝硬化的临床疗效。方法选择2014年5月—2017年5月于洛阳市第一人民医院就诊的活动性代偿期乙型肝炎肝硬化患者94例为研究对象,采用随机数字表法将所有患者分为对照组和治疗组,每组各47例。对照组口服替比夫定片,1片/次,1次/d。治疗组在对照组治疗的基础上口服心肝宝胶囊,5粒/次,3次/d。两组患者均连续治疗6个月。观察两组的临床疗效,比较两组的肝功能指标、抗病毒相关指标、肝纤维化指标、肝脾影像学指标。结果治疗后,对照组和治疗组的总有效率分别为76.6%、89.4%,两组比较差异有统计学意义(P0.05)。治疗后,两组天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)水平均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组肝功能指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组乙肝病毒的脱氧核糖核酸(HBV-DNA)转阴率、e抗原阳性(Hbe Ag)血清学转换率、ALT复常率、HBeAg转换率均显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组Ⅲ型前胶原(PC-Ⅲ)、透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)和层黏连蛋白(LN)水平均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组肝纤维化指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组脾静脉内径(D_(sv))、门静脉内径(D_(pv))和脾厚度均显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组肝脾影像学指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。结论心肝宝胶囊联合替比夫定片治疗活动性代偿期乙型肝炎肝硬化具有较好的临床疗效,可改善肝功能和肝纤维化,提高抗病毒疗效,具有一定的临床推广应用价值。     

珠子肝泰胶囊联合替比夫定治疗慢性乙型肝炎的临床研究

目的探讨珠子肝泰联合替比夫定治疗慢性乙型肝炎的临床疗效。方法选取2018年10月—2020年10月在平煤神马医疗集团总医院治疗的116例慢性乙型肝炎患者,随机分为对照组(58例)和治疗组(58例)。对照组口服替比夫定片,600mg/次,1次/d。治疗组患者在对照组的基础上饭后口服珠子肝泰胶囊,4粒/次,3次/d。两组患者连续服用8周。观察两组患者临床疗效,比较治疗前后两组患者临床症状缓解时间,肝功能指标总胆红素(TBIL)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和白蛋白(ALB)水平,血清白细胞介素4(IL-4)、白细胞介素10(IL-10)、肿瘤坏死因子α(TNF-α)和转化生长因子β1(TGF-β1)水平及不良反应情况。结果治疗后,治疗组患者临床疗效明显优于对照组(96.55%vs 82.76%,P0.05)。治疗后,治疗组患者临床症状缓解时间均早于对照组(P0.05)。治疗后,两组患者肝功能指标TBIL、AST、ALT水平均明显降低,而ALB水平明显升高(P0.05),且治疗组肝功能明显好于对照组(P0.05)。治疗后,两组患者血清IL-4、IL-10、TNF-α、TGF-β1水平均低于治疗前(P0.05),且治疗组明显低于对照组(P0.05)。治疗组患者药物不良反应发生率明显低于对照组(P0.05)。结论珠子肝泰与替比夫定联合治疗效果显著,能够有效改善慢性乙型肝炎患者临床症状,恢复肝功能,降低炎性因子水平,安全有效。     

复方鳖甲软肝片联合替比夫定治疗慢性乙型肝炎肝硬化疗效分析

目的 探讨复方鳖甲软肝片联合替比夫定治疗慢性乙型肝炎肝硬化的疗效.方法 选择病情、病程相近且满足入选标准的40例患者,采用分层随机(随机分配表)、单盲法分为治疗和对照组,治疗组给予口服替比夫定0.6g/次,1次/d,复方鳖甲软肝片4片/次,3次/d;对照组仅口服替比夫定0.6g/次,1次/d.治疗48周后统计疗效.观测指标为治疗前后临床症状和肝功能、血清纤维化指标、腹部肝脾超声检查.使用SPSS 13.0统计软件进行分析,计量资料用t检验,计数资料用,检验.结果 治疗2两组临床症状均有明显改善,但比较差异无统计学意义(P＞0.05);2组治疗后肝功能ALT、白蛋白、白/球比值、血清TBil均明显好转,但治疗组优于对照组,2组比较差异有统计学意义(P＜0.05);2组治疗后肝纤维化指标比较,对照组透明质酸酶、层粘连蛋白、Ⅲ型前胶原分别为(142±26)、(131±31)、(103±50) μg/L,治疗组分别为(93±21)、(85±28)、(90±52) μg/L,治疗组优于对照组,2组比较差异有统计学意义(P＜0.05);治疗后治疗组肝脾超声检查结果优于对照组,2组比较差异有统计学意义(P＜0.05).结论 复方鳖甲软肝片联合替比夫定治疗慢性乙型肝炎肝硬化优于单用替比夫定,两者联合有协同作用.肝硬化治疗是长期过程,寻找多途径、多靶点药物联合,可能比单一用药效果更好.     

复方鳖甲软肝片联合恩替卡韦对慢性乙型肝炎纤维化的治疗作用

目的探讨复方鳖甲软肝片联合恩替卡韦对慢性乙型肝炎纤维化的治疗作用。方法选取我院收治的100例慢性乙型肝炎纤维化患者,根据治疗方案分为两组各50例。对照组采取恩替卡韦治疗,观察组采取复方鳖甲软肝片联合恩替韦卡治疗,比较两组的效果。结果治疗后观察组总胆红素(TBiL)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)等肝功能指标显著优于对照组;治疗后观察组透明质酸(HA)、Ⅲ型胶原(cⅢ)、Ⅳ型胶原(cⅣ)、层黏蛋白(LN)等血清肝纤维化等指标显著优于对照组(P <0.05)。结论对于慢性乙型肝炎纤维化的患者,采取复方鳖甲软肝片联合恩替卡韦,疗效显著,值得在临床进一步探讨。     

替比夫定联合强肝胶囊治疗YMDD变异失代偿期HBV肝硬化的研究

目的探讨替比夫定联合强肝胶囊治疗核苷(酸)类似物抗病毒治疗过程中出现YMDD变异失代偿期乙型肝炎肝硬化患者的疗效和安全性。方法将60例患者随机分为治疗组、对照组(各30例),两组给予替比夫定,治疗组联合强肝胶囊治疗,48周时观察Child-Pugh评分,肝功能主要指标、病毒学指标的变化。结果治疗24、48周时治疗组HBV-DNA转阴率、ALT复常率高于对照组(P<0.05);两组未出现耐药及与药物相关的不良反应。结论替比夫定联合强肝胶囊治疗YMDD变异的失代偿期HBV肝硬化有良好的疗效和安全性,抗纤维化持续改善效果优于替比夫定单药治疗。     

肝苏颗粒联合替比夫定对慢性乙型肝炎患者血清乙肝标志物水平及肝功能的影响

目的 探讨肝苏颗粒联合替比夫定治疗慢性乙型肝炎(CHB)对患者肝功能和肝纤维化指标的影响.方法 选取2017年6月至2019年6月于广东医科大学附属第二医院就诊的84例CHB患者,按随机数字表法分为两组,每组各42例.对照组予以替比夫定治疗,观察组加用肝苏颗粒治疗.比较两组血清乙肝标志物、肝功能指标和肝纤维化指标,并记...     

参芪肝康胶囊联合拉米夫定治疗慢性乙型肝炎的临床研究

目的探讨参芪肝康胶囊联合拉米夫定治疗慢性乙型肝炎的临床疗效。方法选取2016年4月—2017年4月在中山医院青浦分院治疗的慢性乙型肝炎患者82例,根据用药的差别分为对照组(41例)和治疗组(41例)。对照组口服拉米夫定片,0.1 g/次,1次/d;治疗组在对照组的基础上口服参芪肝康胶囊,2 g/次,3次/d。两组患者均经48周。观察两组患者临床疗效,同时比较治疗前后两组患者HBV-DNA和HBeAg转阴率及肝功能指标、肝纤维化指标和血清学指标。结果治疗后,对照组和治疗组临床总有效率分别为80.49%和97.56%,两组比较差异具有统计学意义(P0.05)。治疗24、48周后,治疗组HBV-DNA和HBeAg转阴率均明显高于同期对照组(P0.05)。治疗24、48周后,两组丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、总胆汁酸(TBA)、透明质酸(HA)、三型前胶原N端肽(PC-Ⅲ)、四型胶原(Ⅳ-C)、层黏连蛋白(LN)、白细胞介素-17(IL-17)、白细胞介素-18(IL-18)、基质金属蛋白酶-13(MMP-13)、肿瘤坏死因子-α(TNF-α)水平均明显降低(P0.05),且治疗组上述指标水平明显低于同期对照组(P0.05)。结论参芪肝康胶囊联合拉米夫定治疗慢性乙型肝炎不仅有利于肝功能改善,还可有效抑制肝纤维化、降低机体炎性因子水平。     

替比夫定联合异甘草酸镁治疗慢性乙型肝炎疗效观察

目的观察替比夫定联合异甘草酸镁治疗慢性乙型肝炎疗效。方法吉林省榆树市医院2009年1月至2010年10月的共诊断收治的200例慢性乙型肝炎患者,随机分成对照组和治疗组,即对照组和治疗组各100例,治疗组口服替比夫定,同时异甘草酸镁150mg+5%葡萄糖(糖尿病患者应用0.9%氯化钠)注射液250mL稀释后静脉滴注治疗,1次/d,治疗48周。对照组仅用替比夫定治疗。治疗期间每1周随访1次,检测血清HBV-DNA、HBV标志物、生化指标。HBV-DNA检测下限为<300copies/mL。治疗结束后,观察对照组和治疗组治疗不同时间点的生化指标、HDV-DNA水平及病毒耐药的变化。结果替比夫定联合异甘草酸镁治疗治疗组随着治疗时间延长,病毒载量继续下降。血清丙氨酸转氨酶(ALT)水平随HBV-DNA下降逐渐复常。结论替比夫定联合异甘草酸镁治疗慢性乙型肝炎疗效显著,值得临床推广。     

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.     

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.     

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.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.