美托洛尔治疗慢性心力衰竭目标剂量探讨

目的　探讨美托洛尔在慢性充血性心力衰竭 (心衰 )治疗中的剂量及耐受性。方法　对10 3例心力衰竭伴窦性心律患者在常规心衰治疗基础上加用美托洛尔 ,逐渐加量至目标剂量 ,目标分别为 :①心率下降到 5 0～ 6 5次 /min(不低于 5 0次 /min) ;②稍加剂量心功能下降Ⅰ级 ;③收缩压不低于90mmHg(1mmHg =0 133kPa)。结果　美托洛尔平均维持量为 (72 7± 36 1)mg/d(12 5～ 175mg/d)。其中 6 8例 (6 6 0 % )达心率目标 ,35例 (34 0 % )达心衰目标 ,无一例达血压目标。随访患者多因认识不足或不适当治疗而减量或停用美托洛尔。结论　在治疗期间内 ,心力衰竭 (NYHAⅡ级～Ⅳ级 )患者对合适剂量的美托洛尔耐受性较好。     

美托洛尔与卡维地洛在慢性心力衰竭中耐受性的比较

目的 :探讨美托洛尔与卡维地洛在慢性心力衰竭中的耐受性。方法 :186例慢性心力衰竭患者随机分成美托洛尔组与卡维地洛组 ,在常规抗心力衰竭治疗基础上从小剂量开始逐渐加用美托洛尔与卡维地洛 ,直至目标剂量维持。结果 :美托洛尔组平均维持剂量为 (81.1± 33.5 )mg/d ,坚持维持量者 80例 (84 .2 % ) ,卡维地洛组平均维持剂量为 (34.9± 14 .6 )mg/d ,坚持维持量者 78例 (85 .7% ) ,卡维地洛组较美托洛尔组更易达最大靶剂量 (5 8.2 %∶2 .1% ,P <0 .0 1) ,且剂量调整时间短 [(31.6± 9.4 )d∶(4 6 .7± 17.2 )d ,P <0 .0 1]。美托洛尔组降低心率 (16 .2± 3.5 )次 /min ,卡维地洛组为 (13.8± 4 .1)次 /min(P <0 .0 1)。美托洛尔组降低收缩压 (12 .9± 3.7)mmHg(1mmHg =0 .133kPa) ,舒张压 (6 .7± 2 .6 )mmHg ,卡维地洛组分别为 (14 .4± 4 .1)mmHg和 (7.9± 2 .9)mmHg (P <0 .0 5 )。结论 :慢性心力衰竭患者对美托洛尔和卡维地洛都具有良好的耐受性 ,美托洛尔对心率的影响较大 ,而卡维地洛对血压的影响较大 ,卡维地洛比美托洛尔更易达到最大靶剂量 ,且剂量调整时间短     

心先安并美托洛尔治疗难治性心力衰竭的临床观察

目的观察心先安联合美托洛尔治疗难治性心力衰竭的疗效.方法36例充血性心力衰竭(CHF)患者均被给予心先安120mg/d,静滴,疗程14天.同时美托洛尔6.25mg/次,每日2次口服,每3日增量12.5mg至有效剂量或达50mg,每日2次.治疗前、后记录心率、心功能分级、超声心动图测量的左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)并计算左室射血分数(LVEF).结果治疗前后心率为106.7±9.8∶83.8±8.2,LVEDd为57.8±3.7∶55.2±3.8,LVEF为33.5±4.93∶8.7±3.9,差异显著(P<0.05).结论心先安联合美托洛尔为CHF的有效治疗方法之一.     

慢性心房颤动对扩张性心肌病患者长期预后的影响

探讨慢性心房颤动 (简称房颤 )对扩张性心肌病患者长期预后的影响。将扩张性心肌病并心力衰竭 (简称心衰 )患者分为窦性心律 (简称窦律 )组 (共 38例 ,其中男 2 5例、女 1 3例 )和房颤组 (共 37例 ,其中男 2 5例、女 1 2例 ) ,二组基础状态基本相似。房颤组只控制心室率。随访二组患者的临床预后情况 ,包括 :死亡人数 ,死亡原因 ,入选至死亡的生存时间。结果 :经过 4 8.3± 2 5 .0月随访 ,发现二组患者远期生存率相似 ,死亡患者生存时间相似 ,死亡方式相似 ;与窦律组相比 ,房颤组左房内径较大 (5 3.1± 5 .6mmvs4 7.1± 4 .8mm)、最快心室率较快 (1 6 2 .8± 1 9.3vs1 1 7.2± 1 6 .9) ,二组差异有显著性 (P <0 .0 5 )。结论 :慢性房颤对扩张性心肌病的远期预后可能无明显影响     

胺碘酮与起搏器联合治疗病窦综合征并阵发性心房颤动的观察

观察胺碘酮与起搏器联合治疗病窦综合征并阵发性心房颤动 (简称房颤 )有效性及安全性。 52例慢 快综合征患者 ,起搏器治疗后仍有阵发性房颤 (经心电图和动态心电图证实 ) ,在停用其他抗心律失常药物至少 5个半衰期后 ,按标准方案给予胺碘酮治疗 :负荷量 0 .2g,3次 /天 ,7天 ;继以 0 .2g,2次 /天 ,7天 ;维持量为 0 .2g ,1次 /天 ,连续服用 3个月。根据临床症状和动态心电图评价疗效及安全性。结果 :观察 9.6± 1 3 .5(2 .7～ 2 8)个月 ,总有效率为 69.2 % ,动态心电图自身心律所占时间 ,治疗前为 7.6± 3 .2 (5 .5～ 1 2 .5)h/d ,治疗后为 3 .4± 2 .6(0～ 7.2 )h/d(P <0 .0 1 ) ;在随访期间有 2例促甲状腺素轻度升高 ,经调整剂量后恢复正常 ;1例皮肤搔痒 ,经减量后症状消失。结论 :胺碘酮与起搏器联合治疗病窦综合征并阵发性房颤是安全有效的     

永久性心脏起搏器植入术中发生心房纤颤时心房电极导线定位经验

目的:研究永久性心脏起搏器植入术中心房纤颤(房颤)发作时以右心房波振幅最大处为右心房电极导线固定位置的可行性。方法:22例房颤发作时植入右心房电极导线的患者术中,测试右心房波振幅,术后随访恢复窦性心律(窦律)时测试右心房波振幅、起搏阈值,2者进行对比分析。结果:房颤心律时,所测得的右心房振幅与转为窦律后所测得的右心房波振幅有较好相关性,2者差异无统计学意义[(2.4±1.0)mv比(2.7±1.2)mv,P>0.05]。房颤时术中右心房波振幅平均(2.4±1.0)mv(1.6～3.7mv)者,在房颤转为窦律后所测定的心房感知和起搏功能良好。结论:在房颤发作时,右心房波振幅作为永久心脏起搏器合适的感知及起搏参数,有一定的临床实用价值。     

双腔频率应答起搏对病窦综合征合并的阵发性心房颤动的干预

探讨双腔频率应答起搏对病窦综合征(SSS)合并的阵发性心房颤动(简称房颤)的窦性心律维持及电生理干预。48例SSS并阵发性房颤患者安装了双腔频率应答起搏器,通过起搏器正确的心房感知监测房颤的发作情况,在窦性心律时测量P波时限和P波离散度,心脏B超测量左房内径、左室射血分数。比较术后1,12个月以及房颤控制组与复发组上述指标的差异。结果:置入起搏器术后1年,房颤控制和房颤负荷减少37例,占77%。术后1个月与1年左房内径,P波时限,房颤平均每天发作时间、发作次数均有显著性差异(3.6±0.6cmvs3.2±0.5cm,129.2±11.0msvs111.2±9.3ms,93.6±10.4min/dvs42.8±9.6min/d,8.1±3.2次/天vs5.3±1.4次/天,P<0.001)。与术后房颤复发组比较,房颤控制组术前左房内径较小,P波时限较短、离散度小(P<0.001)。结论:双腔频率应答起搏对SSS合并的阵发性房颤有预防和治疗作用。     

美托洛尔静脉注射治疗快速心房颤动疗效评价

目的:观察美托洛尔(商品名:倍他乐克)注射液治疗快速心房颤动(房颤)的疗效及安全性。方法:42例快速房颤患者随机分为美托洛尔组与西地兰组,美托洛尔组21例予美托洛尔注射液5～15mg静脉注射,西地兰组21例予西地兰注射液0.4～0.8mg静脉注射,分别观察治疗前及治疗后40min、60min及120min患者心率及血压的变化。结果:1.2组患者分别有12例和8例在120min内心室率降至<100次/min,2组比较差异无显著性(57.14%vs38.09%,P>0.05)。2.美托洛尔组患者心室率降至<100次/min所需的时间为(18.33±12.31)min,西地兰组心室率降至<100次/min所需的时间为(65.00±35.05)min,2组比较差异有显著性(P<0.01)。3.美托洛尔静注起效平均时间(14.00±9.95)min,西地兰静注起效平均时间为(62.50±41.66)min,二者比较差异有显著性(P<0.01)。4.美托洛尔组总有效率85.71%(18/21),西地兰组总有效率47.62%(10/21),2组比较差异有显著性(P<0.01)。5.美托洛尔组治疗主要不良反应为低血压,无心力衰竭及严重心律失常。结论:美托洛尔静脉注射治疗快速房颤安全有效,为急诊科治疗快速房颤的可靠方法。     

风湿性心脏病心房颤动患者心房细胞外信号调节蛋白与纤维化的关系

探讨风湿性心脏病 (简称风心病 )心房颤动 (简称房颤 )患者心房组织细胞外信号调节激酶 (ERK)与心房纤维化的关系。 33例风心病二尖瓣病变患者行心脏外科手术时取右心耳组织。通过逆转录 聚合酶链反应和免疫组织化学技术 ,测量ERK2 mRNA和激活的ERK2 蛋白相对表达量 ,测定心房组织血管紧张素Ⅱ (AngⅡ )含量和胶原纤维容积分数 (CVF)。结果 :阵发性和慢性房颤患者的心房组织CVF、AngⅡ均明显高于窦性心律患者 (10 .4 4 %±1.83% ,15 .0 1%± 2 .30 %vs 7.4 8%± 1.2 6 % ;10 .17± 1.73,12 .13± 1.95vs 6 .6 9± 1.18ng/mg,P均 <0 .0 1) ,而慢性房颤患者的CVF、AngⅡ又明显高于阵发性房颤患者 (P <0 .0 1,P <0 .0 5 ) ;阵发性和慢性房颤患者的心房组织ERK2mRNA表达量显著高于窦性心律患者 (1.2 0 9± 0 .2 85 ,1.30 5± 0 .2 6 3vs 0 .92 3± 0 .2 71;P <0 .0 5 ,P <0 .0 1) ,而阵发性和慢性房颤患者之间无明显差别 (P >0 .0 5 ) ;阵发性和慢性房颤患者的心房间质细胞激活的ERK2 蛋白表达量显著高于窦性心律患者 (0 .2 5 2± 0 .0 75 ,0 .2 88± 0 .0 6 3vs 0 .175± 0 .0 74 ;P均 <0 .0 1) ,而阵发性和慢性房颤患者之间无明显差别 (P >0 .0 5 )。结论 :心房间质ERK途径的激活是风心病房颤患者心房纤维     

苯那普利联合美托洛尔治疗心力衰竭的疗效观察

目的 :观察苯那普利 (商品名 :洛汀新 )联合美托洛尔治疗充血性心力衰竭 (CHF)的临床疗效。方法 :2 0 0例 CHF均经临床表现、超声心动图及心脏二位片确诊 ,按就诊顺序随机分为 A、B两组 ,A组 10 0例给予洛汀新 5～ 10 mg/ d,美托洛尔 6 .2 5～ 10 0 mg/ d,B组 10 0例服同等剂量安慰剂 ,两组基础治疗类同。定期来院随访 ,坚持服药 0 .5～ 2 .0年 ,平均服药时间为 32 7d,随访满半年后复查心脏 B超 ,判定疗效的终点事件为临床心功能状况。结果 :洛汀新联合美托洛尔使 CHF患者心率减慢 ,心功能改善 ,超声心动图复查显示左室舒张末期内径及左房内径缩小 ,左室射血分数增高 ,半年随访心功能改善者明显多于对照组。结论 :CHF患者长期服用洛汀新加美托洛尔可使心功能改善 ,提高生活质量     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。