乌司他丁联合奥曲肽治疗重症急性胰腺炎的临床效果观察

目的观察乌司他丁联合奥曲肽治疗重症急性胰腺炎的临床效果。方法参选由本院接受治疗急性胰腺炎患者54例,按入院先后均分成对照组患者27例和治疗组患者27例。对照组单一给药奥曲肽治,治疗组采用乌司他丁联合奥曲肽给药治疗,观察并比较临床疗效。结果治疗组的治疗效果达到96.01%,显著高于对照组的76.03%,治疗组不良反应率4.81%,显著低于对照组的5.91%,停药后不良反应可自行恢复,治疗组检验指标尿淀粉酶和血淀粉酶恢复率也显著高于对照组,比较差异显著,P <0.05。结论单用奥曲肽治疗急性胰腺炎效果没有乌司他丁联合奥曲肽用药诊治急性胰腺炎疗效显著,值得临床推广。     

奥曲肽与奥美拉唑联合应用对肉瘤S180生长的抑制作用

目的探讨奥曲肽联合奥美拉唑对肉瘤S180生长的影响。方法建立小鼠S180肉瘤模型,随机分为阴性对照组、顺铂组、单用药组和联合用药组,给药后测量肿瘤抑制率和微血管密度的变化。结果与阴性对照组比较,奥曲肽与奥美拉唑对S180生长的抑制率分别为31.3%、28.4%,联合作用时抑瘤率为36.6%。两者单独用药时可以抑制肉瘤S180的血管形成,其微血管密度分别为39.80±9.08、48.92±12.09,联合用药时为30.33±6.80,联合用药可以显著降低肉瘤S180的微血管密度。结论奥曲肽联合奥美拉唑能够显著抑制肉瘤S180的生长,联合用药具有一定的协同效应。     

奥曲肽联合立止血治疗难治性消化道出血18例临床分析

1994年1月至1996年10月，作者联合应用奥曲肽、立止血控制难治性消化道出血18例，取得明显疗效，现报道如下。资料和方法一、一般资料肝硬变食管和／或胃底静脉曲张破裂出血经三腔管气囊填塞无效者8例，男6例，女2例，年龄43～63岁，平均54.5岁。其中肝炎后肝硬变7例，血吸虫病性肝硬变1例，合并肝癌2例。肝功能Child分级：B级3例，C级5例。入院时大量呕血便血，估计出血量在800～1500ml以上，有不同程度的血压下降。三胶管气囊压迫后仍持续呕血便血，虽经输血补液、垂体后叶素及普通止血药物静脉滴注，仍出血不止，胃管内均能抽到大量新…     

奥曲肽对肝癌细胞SMMC-7721增殖的抑制作用

目的 :探讨奥曲肽抑制肝癌细胞生长的作用。方法 :人肝癌细胞SMMC 772 1培养于含 10 %胎牛血清、10 0U·ml-1青霉素、链霉素的RPMI16 40培养液中。以 4个稀释度 10 -5、10 -4、10 -3 、10 -2 g·L-1将奥曲肽加入培养液 ,于加药后第 4 8h行MTT比色实验检测生长抑制率。奥曲肽浓度为 10 -3 g·L-1时于0、6、12、2 4、36h行DNA染色分析细胞周期。结果 :MTT比色法测定显示奥曲肽抑制肝癌细胞的生长 ,在浓度为 10 -5、10 -4、10 -3 、10 -2 g·L-1作用 4 8h生长抑制率分别为 9.33%、 12 .70 %、 19.70 %、2 0 .93%。药物作用 12、2 4h ,G0 -G1期细胞比例增加 ,G2 -M期细胞比例减少。结论 :奥曲肽抑制体外培养的人肝癌细胞的增殖 ,机制可能是将肝癌细胞阻滞于G0 -G1期 ,阻止细胞进入G2 -M期。     

醋酸奥曲肽与奥曲肽治疗食管静脉曲张破裂出血的疗效比较

目的: 观察醋酸奥曲肽治疗食管静脉曲张破裂出血的疗效.方法: 90例食管静脉曲张破裂出血患者分为两组,治疗组60例用醋酸奥曲肽治疗,对照组30例用奥曲肽治疗,观察并比较两组的疗效、止血时间、输血量.结果: 治疗组总有效率为95%,对照组总有效率为90.0%.两组间无统计学差异(P>0.05).两组止血成功患者在24,48 h的输血量分别为:治疗组(314.3±129.5) ml,(445.2±312.9)ml;对照组(460.0±250.3)ml,(661.5±386.3)ml,两组比较在统计学上有明显差异(P<0.05).结论: 醋酸奥曲肽的临床疗效优于奥曲肽,醋酸奥曲肽能有效、安全地治疗食管静脉曲张破裂出血.     

奥曲肽与其他药物的联合应用

目的：分析奥曲肽与其他药物联合应用的临床研究，为临床合理用药提供依据。方法：查阅近期文献，进行分析。结果：奥曲肽与其他药物联合应用可以产生协同作用，效果显著。结论：临床在治疗消化道大出血和急性胰腺炎时．可考虑奥曲肽与其他药物的联合应用。     

奥曲肽治疗上消化道大出血临床观察

目的观察醋酸奥曲肽治疗各种原因引起的上消化道大出血的疗效。方法对56例上消化道大出血患者回顾性分析和总结,采用奥曲肽0.1mg配生理盐水20ml静脉缓慢推注,再以0.025mg/h静脉滴注24～72h。结果24h及72h止血率分别为53.6%和42.8%,3d总有效率为96.4%。未发现明显不良反应。结论奥曲肽治疗上消化道大出血止血效果显著,使用安全,在基层医院临床急救中应及早使用。     

奥曲肽对胃癌细胞株中存活素表达的抑制作用

目的探讨奥曲肽诱导胃癌细胞凋亡的机制。方法将胃癌细胞分为6组:不加药组(阳性对照A组)、0.1 mg/L组(B组)、0.2 mg/L组(C组)、0.5 mg/L组(D组)、1.0 mg/L组(E组)、2.0 mg/L组(F组),每组设6个复孔,爬片后进行免疫组织化学染色,观察存活素(Survivin)表达情况,吖啶橙(AO)染色、荧光显微镜下观察细胞凋亡情况。结果随着奥曲肽浓度的增大,Survivin表达阳性率逐渐下降,凋亡细胞数逐渐增多。结论奥曲肽可诱导癌细胞发生凋亡,可抑制胃癌细胞中Survivin的表达,其诱导凋亡的机制可能与抑制胃癌细胞中Survivin的表达有关。     

奥曲肽治疗肠梗阻的临床评价

目的 奥曲肽用于治疗肠梗阻的临床评价.方法 对我院2007年1月至2010年12月收治的128例肠梗阻的临床资料进行回顾性分析.结果 79例粘连性肠梗阻、12例肿瘤性肠梗阻、16例术后炎性肠梗阻临床症状均得到明显改善.19例绞窄性肠梗阻、1例粪石性肠梗阻行手术治疗后症状改善,1例肠系膜血管栓塞至肠坏死手术后放弃治疗.19例绞窄性肠梗阻患者中,12例出现肠坏死行坏死肠切除.结论 奥曲肽辅助治疗粘连性肠梗阻、肿瘤性和术后炎性肠梗阻能抑制肠管内体液丧失,缓解扩张,促进蠕动,解除梗阻,对粘连性、肿瘤性和术后炎性肠梗阻有明显作用;鉴于绞窄性肠梗阻及肠系膜血管栓塞在肠梗阻早期应用奥曲肽易掩盖症状,干扰并延误诊断,因此奥曲肽不能作为治疗肠梗阻的常规治疗,应视情况慎用于肠梗阻.     

某院奥曲肽临床应用合理性分析

目的 探讨奥曲肽临床应用的合理性.方法 选取医院2019年9月至12月使用奥曲肽的住院患者的病历70份,统计奥曲肽的用药适应证、用法用量、用药疗程、联合用药、药品不良反应(ADR)等情况,并分析用药合理性.结果 所选病历中奥曲肽的用药适应证以消化道出血、急性胰腺炎、肠梗阻为主,剂量为0.1～0.8 mg/d,疗程为1～...     

奥曲肽对胰十二指肠切除术后胰瘘及胃排空的影响

目的观察奥曲肽对胰十二指肠切除术后胰瘘(POPF)的预防作用和对胃排空的影响。方法按随机数字表法将67例胰十二指肠切除术患者分为奥曲肽组(n:35)和对照组(,l=32)。奥曲肽组给予术后当日皮下注射奥曲肽1 mL(100μg),q8h,共7 d;对照组给予皮下注射相同体积的氯化钠注射液。研究终点为患者出现胃排空延迟或者出现POPF等并发症。进行胃闪烁显像和氢呼气试验(HBT),并对其他影响胃排空的因素进行相关分析。结果两组胃排空延迟的发生率无显著差异(P>0.05)。术后7d,奥曲肽组中胃闪烁显像的半衰期为(76.3±15.2)min,对照组为(86.7±18.0)min;奥曲肽组HBT(65.0±6.5)min后达到最大,对照组(67.0±5.7)min后达到最大。两组胰瘘发生率无显著差异(P>0.05)。多因素分析显示,术后腹腔感染(OR=0.206,95%CI:0.051⁰.836,P=0.027)和出血(OR=1.341,95%CI:1.0490.836,P=0.027)和出血(OR=1.341,95%CI:1.049¹.715,P=0.019)是术后胃排空延迟危险因素,术前胆道引流为保护因素(OR=3.828,95%CI:0.9791.715,P=0.019)是术后胃排空延迟危险因素,术前胆道引流为保护因素(OR=3.828,95%CI:0.979¹4.967,P=0.054),而与应用奥曲肽无相关性(OR=1.047,95%CI:0.32514.967,P=0.054),而与应用奥曲肽无相关性(OR=1.047,95%CI:0.325¹0.591,P=0.154)。结论预防性使用奥曲肽并不影响胰十二指肠切除术后的胃排空。也不会降低POPF的发生率。     

Chronic octreotide therapy can induce pancreatic insufficiency: a common but under-recognized adverse effect

Octreotide analogs are used in the treatment of neuroendocrine tumors and are investigated as treatment options in many diseases. These agents mimic somatostatin effect which is inhibitory to pancreatic hormones. The most common side effects are biliary dysfunction and gastroenterologic disorders. Pancreatic insufficiency is a common adverse effect of this medication which is explained by the direct inhibition of pancreatic hormones responsible for stimulating the production and excretion of pancreatic enzymes. This side effect is misdiagnosed leading to increasing octreotide analog dosage, and eventually more pancreatic insufficiency and cost of treatment. We report our experience with pancreatic insufficiency developing in neuroendocrine tumor patients treated with octreotide analogs, reviewing the pathogenesis of this side effect. This common but underpublished condition is easy to diagnose and treat.     

GP方案动静脉联合化疗治疗晚期胰腺癌的临床研究

目的观察吉西他滨+顺铂区域动脉灌注化疗结合静脉化疗治疗晚期胰腺癌的疗效。方法 43例晚期胰腺癌采用区域动脉灌注吉西他滨1 000 mg.m-2加顺铂30 mg.m-2,结合顺铂30 mg.m-2静脉滴注2～3 d,吉西他滨1 000 mg.m-2静脉滴注8 d,每3周为一周期。结果 43例患者,有效率(CR+PR)为30.2%,临床受益率(CBR)为76.7%,中位生存期为14.6月,中位疾病进展时间(TTP)为6.7月。结论 GP方案动静脉联合化疗治疗晚期胰腺癌疗效较高而且毒副反应可以接受。     

Enhanced skin permeation of rofecoxib using topical microemulsion gel

Microemulsion gels containing rofecoxib and rofecoxib solid dispersion with polyethylene glycol (PEG) 4000 were prepared for the study of rapid percutaneous absorption. The solubility of rofecoxib in oil phase of microemulsion, e.g., isopropyl myristate, was increased by the addition of dimethyl formamide and ethanol. Topical microemulsion gels (MEGs) were prepared by using neat rofecoxib as well as its solid dispersion to compare the efficacy of individual MEG with conventional gel (CG). MEGs showed better spreadability than CG and also showed increased globular size with increasing concentration of the oil phase. The release of rofecoxib through dialysis membrane and excised rat abdominal skin was affected by the size of the oil globule in MEGs. Rofecoxib release was higher for MEGs when compared to CG. MEGs containing rofecoxib‐PEG 4000 solid dispersion exhibited higher cumulative drug permeation when compared to MEG containing neat rofecoxib. MEGs containing rofecoxib‐PEG 4000 solid dispersion exhibited faster antiinflammatory activity than CG. Drug Dev. Res. 63:33–40, 2004. © 2004 Wiley‐Liss, Inc.     

Novel treatments and therapies in development for pancreatic cancer

Until recently, 5-fluorouracil was the most widely used treatment for non-resectable pancreatic cancer. This treatment, however, only resulted in a median survival time of ~ 4 months. In the last few years, gemcitabine has rapidly become the new treatment benchmark, due more to its superior clinical benefit rather than to it conferring an increased median survival (～ 5 – 6 months). Thus, the outlook for patients with pancreatic cancer is still relatively bleak. A number of new treatment options are presently being investigated. Some of these are combination therapies involving gemcitabine and other chemotherapeutic agents or radiation. Other novel treatment strategies are also already being evaluated in clinical studies. Some of the more promising treatments in development are discussed and evaluated in this article.     

人参炔醇对人胰腺癌细胞PANC-1增殖的抑制作用

目的探讨人参炔醇(PNN)对人胰腺癌细胞PANC-1增殖的抑制作用。方法将人胰腺癌细胞PANC-1分为3个PNN浓度(1、9、27μmol/L)组和对照(C)组,MTT检测各组细胞增殖情况,流式细胞术检测各组细胞周期变化,Western blot检测各组细胞Ki67蛋白表达。结果 PNN组细胞抑制率和G1期细胞比例均呈浓度依赖性增加,而Ki67蛋白表达量呈浓度依赖性递减(P<0.01)。结论 PNN可能通过抑制细胞分裂和Ki67表达对人胰腺癌细胞PANC-1增殖发挥抑制作用。     

The role of adjuvant therapy for pancreatic cancer

Patients with pancreatic cancer have a very poor outlook. There have been major advances in the standard surgical treatment of this disease, resulting in decreased post-operative mortality and morbidity. The use of chemotherapy and radiotherapy has been developed to increase long-term patient survival following potentially curative resection. The standard chemotherapeutic agent is 5-fluorouracil (5-FU), although newer cytotoxic agents are in clinical trials for advanced cancer. Initial studies of adjuvant therapy have been based on small numbers of patients, but recently two large European randomised controlled trials of adjuvant therapy (EORTC and ESPAC-1) have been completed. These suggest that adjuvant chemotherapy has a significant survival advantage over resection alone but chemoradiotherapy does not. Promising new agents are being developed and tested mainly in clinical trials of advanced pancreatic cancer. The results of large-scale randomised controlled trials to assess adjuvant therapies for pancreatic cancer demonstrate the great surgical and oncological progress that has been made over the past decade.     

Impact of taurolidin and octreotide on liver metastasis and lipid peroxidation after laparoscopy in chemical induced ductal pancreatic cancer

Summary Background: There is controversial discussion whether metastasis initiated by laparoscopy with carbon dioxide might be prevented by instillation of taurolidin or radical scavengers like the somatostatin analogue Octreotide. Therefore we evaluated the effects of laparoscopic lavage with taurolidin and Octreotide on liver metastasis after staging laparoscopy in ductal pancreatic cancer. Methods: In 60 Syrian hamsters pancreatic adenocarcinoma was induced by weekly subcutanous injection of 10 mg N-nitrosobis-2-oxopropylamin/kg body weight for 10 weeks. In the 16th week laparoscopic staging biopsy by use of carbon dioxide was performed. Finally animals underwent abdominal irrigation with saline (gr.1, n = 20), taurolidin (0.5%) (gr.2, n = 20) or Octreotide (gr.3, n = 20). In week 25 animals were sacrificed, pancreas and liver were analysed. Results: Size of pancreatic carcinomas was decreased in the taurolidin gr. compared to the other two groups. Furthermore the number of liver metastasis per animal was reduced after lavage with taurolidin (2 ± 2) and Octreotide (2.5 ± 2) compared to saline irrigation (4 ± 4) (p < 0.05). Additionally the incidence of port site metastases was significantly reduced in the taurolidin group. Activity of antioxidative enzyme superoxide dismutase (SOD) was increased while concentration of products of lipidperoxidation was decreased in non-metastatic liver after taurolidin irrigation compared to saline or Octreotide irrigation. Conclusions: Taurolidin irrigation during laparoscopy might be a new concept to reduce the number of liver metastasis and port site metastases in pancreatic cancer.     

Emerging pathways and future targets for the molecular therapy of pancreatic cancer

Introduction: Pancreatic cancer treatment remains a challenge for clinicians and researchers. Despite undisputable advances in the comprehension of the molecular mechanisms underlying cancer development and progression, early disease detection and clinical management of patients has made little, if any, progress in the past 20 years. Clinical development of targeted agents directed against validated pathways, such as the EGF/EGF receptor axis, the mutant KRAS protein, MMPs, and VEGF-mediated angiogenesis, alone or in combination with gemcitabine-based standard chemotherapy, has been disappointing.

Areas covered: This review explores the preclinical rationale for clinical approaches aimed at targeting the TGF-β, IGF, Hedgehog, Notch and NF-κB signaling pathways, to develop innovative therapeutic strategies for pancreatic cancer.

Expert opinion: Although some of the already clinically explored approaches (particularly EGFR and KRAS targeting) deserve further clinical consideration, by employing more innovative and creative clinical trial designs than the gemcitabine–targeted agent paradigm that has thus far invariably failed, the targeting of emerging and relatively unexplored signaling pathways holds great promise to increase our understanding of the complex molecular biology and to advance the clinical management of pancreatic cancer.