抗抑郁治疗对老年高血压降压疗效的影响

目的:探讨抗抑郁治疗对老年高血压患者降压疗效的影响.方法:观察85例老年高血压合并抑郁症状的患者随机分为2组,所有患者均给予钙拮抗剂(氨氯地平5 mg/d)、血管紧张素转化酶抑制剂(贝那普利10 mg/d),抗抑郁治疗组在此基础上加用帕罗西丁20 mg/d.结果:抗抑郁治疗组其降压幅度,降压有效率,汉密尔顿抑郁量减分率均优于治疗前及对照组,差异显著有统计学意义(P<0.05).结论:抗抑郁治疗可增强老年高血压合并抑郁患者的降压效果.     

单纯抗抑郁治疗对抑郁伴轻度高血压影响的临床研究

目的探讨单纯抗抑郁治疗对合并抑郁的轻度高血压患者血压的影响。方法300例合并抑郁的轻度高血压患者被随机分为舍曲林组和氨氯地平组。舍曲林组患者单纯给予盐酸舍曲林抗抑郁治疗而不予降压治疗;氨氯地平组患者给予氨氯地平每日5mg,4周后观察患者血压变化及用药的不良反应。结果舍曲林组患者69例（46．O％）血压达标,氨氯地平组血压达标87例（58．0％）,两组间差异无统计学意义（P〉0．05）。舍曲林组有51例（34．0％）血压水平下降但未达标,28例（18．6％）血压无明显改善,而氨氯地平组患者中46例（30．7％）血压下降但未达标,17例（11．3％）血压无明显改善,两组相比差异均无统计学意义。结论对于伴有抑郁的轻度高血压患者,积极的抗抑郁治疗可以起到与氨氯地平相近的良好降压效果,且具有良好的药物安全性。     

氟西汀治疗高血压伴抑郁症状的疗效分析

目的 评价氟西汀治疗高血压伴抑郁症状的效果。方法 70例原发高血压病伴抑郁症状的患者，分成治疗组和对照组，两组均用降压药物治疗，治疗组加用氟西汀，两周后观察疗效。结果 治疗组和对照组的有效率分别为78．9％和56．3％。两组比较差异显著。结论 氟西汀治疗高血压伴抑郁症状有显著疗效。     

综合干预对老年高血压伴抑郁症患者血压的影响

目的：探讨综合干预对老年高血压伴抑郁患者血压的影响。方法：70例老年高血压件抑郁症患者随机分为二组，综合干预组35例，给予降压、抗抑郁治疗及心理疏导，健康教育；常规治疗对照组35例，仅给予降压及抗抑郁治疗。分别了入院时和治疗6周对两组患者的降压效果及抑郁自我评定量表（SDS）分值进行评价。结果：综合干预组血压控制效果及SDS分值改善均显著优于常规治疗对照组（P〈0．05，〈0．01）。结论：对老年高血压伴抑郁患者进行综合干预治疗，不仅能改变患者的治疗态度，提高患者对治疗的依从性，还能明显提高血压控制率，改善SDS分值。     

抗抑郁治疗对老年高血压降压疗效的影响

该文探讨抗抑郁治疗对老年高血压患者降压疗效的影响。方法：对138例老年高血压合并抑郁的患者随机分为A、B组，并设老年高血压患者对照组103例，3组均给予氢氯噻嗪12．5mg／d和硝苯地平控释片30mg／d口服，A组在此基础上加服氟西汀（百优解）20mg／d口服，共12周；B组给予阿米三嗪（都可喜）1片和谷维素20mg，3次／d，共12周。结果：A组与治疗前及B组相比，其坐位血压、24h动态血压监测昼夜收缩压和舒张压均明显下降，差异有非常显著意义（P〈0.01）。结论：抗抑郁治疗有利于老年高血压合并抑郁患者的血压控制。     

抗抑郁治疗对老年高血压降压疗效的影响

该文探讨抗抑郁治疗对老年高血压患者降压疗效的影响。方法:对138例老年高血压合并抑郁的患者随机分为A、B组,并设老年高血压患者对照组103例,3组均给予氢氯噻嗪12.5mg/d和硝苯地平控释片30mg/d口服,A组在此基础上加服氟西汀(百优解)20mg/d口服,共12周;B组给予阿米三嗪(都可喜)1片和谷维素20mg,3次/d,共12周。结果:A组与治疗前及B组相比,其坐位血压、24h动态血压监测昼夜收缩压和舒张压均明显下降,差异有非常显著意义(P<0.01)。结论:抗抑郁治疗有利于老年高血压合并抑郁患者的血压控制。抗抑郁治疗对老年高血压降压疗效的影响…     

抗抑郁治疗对老年高血压合并抑郁障碍患者血压的影响

正该文研究抗抑郁治疗对老年高血压合并抑郁障碍患者血压的影响及其改善生活质量的临床疗效。方法:老年高血压合并抑郁障碍患者304例,随机分为治疗组156例和对照组148例,分别给予盐酸曲唑酮和盐酸曲唑酮模拟药,2组治疗4周,观察治疗前和治疗后第1、2、3、4周患者血压、17项汉密尔顿抑郁量表     

抗抑郁治疗对老年高血压降压疗效的影响

目的探讨抗抑郁治疗对老年高血压患者降压疗效的影响。方法对138例老年高血压合并抑郁的患者随机分为A、B组,并设103例老年高血压患者对照组,三组均给予氢氯噻嗪12．5mg／d和硝苯地平控释片30mg／d口服,A组在此基础上加服氟西汀20mg／d口服,共12周;B组给予阿米三嗪1片和谷维素20mg,3次／d,共12周。结果A组与治疗前及B组相比,其坐位血压、24h动态血压监测昼夜收缩压和舒张压均明显下降,差异有显著的统计学意义（P〈0．01）。结论抗抑郁治疗有利于老年高血压合并抑郁患者的血压控制。     

帕罗西汀对原发性高血压伴抑郁症患者的疗效观察

近年研究表明,高血压患者患抑郁症的比例明显增高[1,2].抑郁症既是高血压的促发因素,也是高血压预后不良的因素,抑郁症和高血压发生密切相关[3].高血压伴抑郁症患者易对治疗丧失信心,因此必须配合抗抑郁或/和抗焦虑药物治疗才能有效控制血压[4].但在降压治疗同时合并抗抑郁治疗,在国内外均不多见,本研究对自2003年1月～2007年12月1200例确诊的原发性高血压患者采用Hamilton抑郁量表进行评估,选择了130例原发性高血压伴抑郁症患者进行为期4w的基础降压+帕罗西汀抗抑郁治疗,对其疗效进行评价.     

轻中度高血压患者应用可乐定透皮控释贴片的临床研究

目的评价可乐定透皮控释贴片（C-TTS）治疗轻中度原发性高血压降压疗效和安全性。方法门诊轻中度原发性高血压患者40例,随机分为两组,第1组单用C-TTS（0.1mg／片）,第2组为C-TTs加用双氢克尿塞6.25mg。每周根据诊室血压下降情况调整贴片用量,治疗前后进行24小时动态血压监测。结果第1组在治疗后应用1～3贴C-TTS血压降至目标血压者9例（45％）,第2组应用1～3贴血压降至目标血压者12例（60％）,平均52％。两组未达标者治疗后血压与基线相比均有明显下降（P〈0.05）。两组治疗前后的各周末诊室血压无论收缩压还是舒张压均有明显下降（P〈0.01）。加用利尿剂组降压幅度较大,但两组间比较无显著性差异。两组24小时平均收缩压、舒张压,白天平均收缩压、舒张压,夜间平均收缩压、舒张压与基线比较,均有明显下降（P〈0.05）。结论C-TTS对轻中度原发性高血压患者具有很好的降压效果,治疗依从性好,与利尿剂联合应用,可以提高降压效果。     

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.     

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。     

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。     

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。