厄贝沙坦治疗2型糖尿病伴尿白蛋白患者有效性和安全性：多中心随机双盲对照研究

该文评估厄贝沙坦治疗2型糖尿病伴白蛋白尿患者的疗效与安全性。方法：采用随机、双盲、安慰剂对照、多中心临床研究方法，8个医院326例受试者随机分配到厄贝沙坦（300mg／d）组（160例）或安慰剂组（166例），治疗24周。检测尿白蛋白排泄率（UAER）、收缩压、舒张压、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇（LDL-C）和糖化血红蛋白（HbA1c）水平。     

厄贝沙坦对糖尿病高血压的降压疗效及肾脏保护作用

对30例血糖控制在理想水平合并高血压的患者进行为期6周的厄贝沙坦治疗,分析比较治疗前后收缩压(SBP)、舒张压(DBP)、24h尿UMA、24h尿TP的变化.结果厄贝沙坦150mg治疗2周后SBP、DBP较治疗前明显下降(P＜0.01),血压达标率46.7%.未达标者继续予厄贝沙坦300mg治疗2周,SBP、DBP较2周时明显下降(P＜0.001),血压达标率86.7%,6周时复查24h尿UMA、24h尿TP较治疗前明显下降(P＜0.01).结论厄贝沙坦可明显降低2型糖尿病的SBP、DBP,呈剂量依赖,并且具有降低蛋白尿、保护肾脏的作用.本药耐受性好,没有不良事件发生.     

厄贝沙坦对高血压伴多重危险因素患者血压平滑指数及炎症因子的影响

目的研究厄贝沙坦对高血压伴多重危险因素和高血压不伴多重危险因素患者的血压平滑指数(SI)及治疗前后炎症因子的影响。方法选择伴危险组和不伴危险组高血压患者817例,均予厄贝沙坦片150mg每日一次,晨服,服药8周。服药前后进行动态血压监测,计算两组患者平均收缩压、舒张压以及对应的血压平滑指数和血压变异性,同时测定比较治疗前后血清高敏C反应蛋白(hs-CRP)、可溶性CD4O配体(SCD4OL)。结果两组治疗后与治疗前比较各指标均显著改善(P0.01);治疗前伴危险组收缩压、收缩压SI、收缩压变异性、舒张压SI、舒张压变异性显著高于不伴危险组(P0.01);治疗后与治疗前比较除舒张压差值外,其他指标差值伴危险组均较不伴危险组显著改善(P0.01)。治疗前伴危险组hs-CRP、SCD4OL显著高于不伴危险组,治疗后两组hs-CRP、SCD4OL均显著下降;治疗前后差值伴危险组hs-CRP、SCD4OL显著高于不伴危险组,差异均有统计学意义(P0.01)。结论厄贝沙坦治疗高血压伴危险组患者的血压平滑指数升高且炎症因子更容易控制。     

厄贝沙坦治疗2型糖尿病伴尿白蛋白患者有效性和安全性:多中心随机双盲对照研究

该文评估厄贝沙坦治疗2型糖尿病伴白蛋白尿患者的疗效与安全性。方法:采用随机、双盲、安慰剂对照、多中心临床研究方法,8个医院326例受试者随机分配到厄贝沙坦(300 mg/d)组(160例)或安慰剂组     

厄贝沙坦与非洛地平联用对高血压病左室肥厚的逆转作用

目的探讨厄贝沙坦、非洛地平联合用药对原发性高血压(EH)病人左室肥厚(LVH)的逆转作用.方法 EH伴LVH病人180例随机分为对照组(非洛地平每天10 mg,90例)和治疗组(厄贝沙坦每天75 mg加非洛地平每天5 mg,90例),治疗两周时若血压≥160/90 mmHg,则厄贝沙坦和非洛地平分别增加1倍,总疗程共6个月.治疗前后观察心率变化、24 h动态血压监测和彩色超声多普勒检测左室相关指标,计算左室重量指数(LVMI).结果两组治疗后均能显著降低LVMI(P＜0.01),且治疗组较对照组更为显著(P＜0.01);两组治疗前心率、24 h平均收缩压、平均舒张压比较无统计学意义(P＞0.05),治疗后24 h平均收缩压、平均舒张压较治疗前显著降低(P＜0.01),但治疗后两组间无统计学意义(P＞0.05).结论厄贝沙坦与非洛地平联用逆转EH病人LVH效果较单用非洛地平疗效更为显著.     

瑞舒伐他汀联合厄贝沙坦治疗对老年高血压伴糖尿病患者血压及血脂水平的影响

目的观察并分析瑞舒伐他汀联合厄贝沙坦治疗对老年高血压伴糖尿病患者血压及血脂水平的影响。方法采用随机简单随机化法于该院2016年1月—2017年12月心内科进行治疗的110例老年高血压伴糖尿病患者为分为观察组和对照组,各55例。对照组给予口服厄贝沙坦片剂;观察组给予口服瑞舒伐他汀+厄贝沙坦治疗。治疗2个周后,观察两组患者治疗前后血脂[甘油三酯(TC)、总胆固醇(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)]、血压[舒张压(DBP)、收缩压(SBP)]水平的变化情况及血糖控制情况。结果经治疗2周后,观察组患者SBP及DBP情况显著优于对照组,TC、TG及LDL-C水平均分别较对照组低,HDL-C水平较对照组高,且观察组患者空腹血糖、空腹胰岛素水平低于对照组,胰岛素敏感指数高于对照组,差异有统计学意义(P0.05)。结论瑞舒伐他汀联合厄贝沙坦治疗老年高血压伴糖尿病,可有效改善患者血压的变化情况及血脂水平,值得临床推广。     

厄贝沙坦对老年肥胖高血压患者的影响

目的探讨厄贝沙坦对老年肥胖高血压患者的影响。方法选取2015—2016年同济大学附属同济医院收治的老年肥胖高血压86例,采用随机数字表法分为对照组与观察组,每组43例。对照组患者予以氨氯地平治疗,观察组患者予以厄贝沙坦治疗;两组患者均连续治疗6个月。比较两组患者治疗前后血压、血脂指标、炎性因子、胰岛素抵抗指数(HOMA-IR),并分析观察组患者血压、血脂指标与炎性因子、HOMA-IR的相关性。结果治疗前两组患者收缩压、舒张压及总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P0.05);治疗后观察组患者收缩压、舒张压及TC、TG水平低于对照组(P0.05),而两组患者LDL-C、HDL-C水平比较,差异无统计学意义(P0.05)。治疗前两组患者超敏C反应蛋白(hs-CRP)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平及HOMA-IR比较,差异无统计学意义(P0.05);治疗后观察组患者hs-CRP、IL-6、TNF-α水平及HOMA-IR低于对照组(P0.05)。Pearson相关性分析结果显示,观察组患者收缩压、舒张压、LDL-C、HDL-C与hs-CRP、IL-6、TNF-α、HOMA-IR无直线相关性(P0.05);TC、TG与hs-CRP、IL-6、TNF-α呈正相关(P0.05),与HOMA-IR无直线相关性(P0.05)。结论厄贝沙坦治疗可有效改善老年肥胖高血压患者血压及血脂代谢,减轻胰岛素抵抗。     

厄贝沙坦和依那普利治疗原发性高血压的对比研究

目的对比观察厄贝沙坦与依那普利治疗轻中度原发性高血压的疗效和安全性。方法随机观察厄贝沙坦(41例,150mg～300mg)与依那普利(42例,10～20mg)治疗高血压患者4周和8周的有效率,并分两组进行比较。结果两组治疗第2周后开始平均收缩压、舒张压较治疗前明显降低(P<0.01),在整个治疗期间血压持续平稳下降;厄贝沙坦与依那普利治疗4周降低舒张压总有效率分别为90.2%(37/41)和83.3%(35/42),8周降低舒张压总有效率分别为95.1%(39/41)和90.5%(38/42),两组比较P>0.05。结论厄贝沙坦是一安全、有效、长效,耐受性好,不良反应轻的降压药物。     

厄贝沙坦对老年H型高血压合并糖尿病患者靶器官损害的相关研究

目的探讨厄贝沙坦对老年H型高血压合并2型糖尿病患者血压变异性和靶器官损害的影响。方法选择老年H型高血压合并2型糖尿病患者341例,随机分为2组,厄贝沙坦组170例,对照组171例。随访1年后超声心电图检测左心室结构,计算左心室质量指数(LVMI);彩色多普勒超声仪检测颈动脉,测量颈动脉内膜中层厚度(IMT)或有颈动脉粥样硬化斑块形成;检测晨尿微量白蛋白/肌酐比值(ACR),并进行统计分析。结果治疗前,厄贝沙坦组与对照组在收缩压、舒张压、收缩压变异性、舒张压变异性、同型半胱氨酸、LDL-C、HDL-C、TG、TC、空腹血糖、餐后2h血糖以及糖化血红蛋白比较,差异无统计学意义(P>0.05)。治疗1年后,厄贝沙坦组收缩压变异性、舒张压变异性、同型半胱氨酸、LVMI和ACR较对照组明显降低,HDL-C、内生肌酐清除率较对照组明显增高(P<0.05,P<0.01)。厄贝沙坦组治疗1年后左心室肥厚(25.3%vs 40.9%)、脑损害(21.8%vs 32.2%)、肾功能损害(40.6%vs 51.5%)和存在至少一项靶器官损害发生率(55.9%vs 74.9%)较对照组明显减少,差异有统计学意义(P<0.05,P<0.01)。结论厄贝沙坦可以改善老年H型高血压合并2型糖尿病患者的血压变异性,改善患者心室重构,减少蛋白尿。厄贝沙坦能减轻患者心脑肾功能损伤,具有保护靶器官功能的作用。     

氨氯地平对2型糖尿病伴高血压患者维生素D水平的影响

目的探讨氨氯地平对2型糖尿病伴高血压患者维生素D水平的影响。方法 120例2型糖尿病伴高血压患者随机分为氨氯地平组、厄贝沙坦组及联合用药组,治疗3个月后比较三组患者血维生素D〔25羟维生素D(25-(OH)D3)〕浓度、血糖、血脂等指标。结果治疗后三组患者维生素D浓度均高于治疗前,且治疗后氨氯地平组患者维生素D浓度高于厄贝沙坦组,联合用药组患者维生素D浓度高于其他两组(P0.05);治疗后三组患者收缩压、舒张压均低于治疗前,联合用药组收缩压、舒张压低于其他两组(P0.05)。结论氨氯地平和厄贝沙坦联合治疗2型糖尿病伴高血压患者,均可提高其维生素D浓度,降低收缩压及舒张压,且氨氯地平升高维生素D浓度作用更强,其疗效确切、安全性高。     

Biliary microlithiasis,sludge,crystals,microcrystallization,and usefulness of assessment of nucleation time

BACKGROUND:The process of microcrystallization,its sequel and the assessment of nucleation time is ignored.This systematic review aimed to highlight the importance of biliary microlithiasis,sludge,and crystals,and their association with gallstones,unexplained biliary pain,idiopathic pancreatitis, and sphincter of Oddi dysfunction.DATA SOURCES:Three reviewers performed a literature search of the PubMed database.Key words used were"biliary microlithiasis","biliary sludge","bile crystals","cholesterol crystallisation","bile microscopy","microcrystal formation of bile","cholesterol monohydrate crystals","nucleation time of cholesterol","gallstone formation","sphincter of Oddi dysfunction"and"idiopathic pancreatitis".Additional articles were sourced from references within the studies from the PubMed search.RESULTS:We found that biliary microcrystals account for almost all patients with gallstone disease,7%to 79%with idiopathic pancreatitis,83%with unexplained biliary pain, and 25%to 60%with altered biliary and pancreatic sphincter function.Overall,the detection of biliary microcrystals in gallstone disease has a sensitivity ranging from 55%to 87%and a specificity of 100%.In idiopathic pancreatitis,the presence of microcrystals ranges from 47%to 90%.A nucleation time less than 10 days in hepatic bile or ultra-filtered gallbladder bile has a specificity of 100%for cholesterol gallstone disease.CONCLUSIONS:Biliary crystals are associated with gallstone disease,idiopathic pancreatitis,sphincter of Oddi dysfunction, unexplained biliary pain,and post-cholecystectomy biliary pain.Pathways of cholesterol super-saturation,crystallisation, and gallstone formation have been described with scientificsupport.Bile microscopy is a useful method to detect microcrystals and the assessment of nucleation time is a good method of predicting the risk of cholesterol crystallisation.     

Antibacterial activity of cefpodoxime in comparison with cefixime,cefdinir, cefetamet,ceftibuten, loracarbef,cefprozil, BAY 3522, cefuroxime,cefaclor and cefadroxil

Summary The new oral cephalosporins cefpodoxime, cefixime, cefdinir, cefetamet and ceftibuten demonstrate enhanced activity against Enterobacteriaceae susceptible to the established compounds as well (e.g. cefuroxime, cefaclor, cefadroxil). In addition, cefpodoxime, cefixime, cefdinir, cefetamet and ceftibuten include in their spectrum species hitherto resistant to oral cephalosporins (Proteus vulgaris, Providencia spp.,Yersinia enterocolitica). Besides, the majority of these compounds demonstrate relevant activity (MIC₅₀ equal to or below 2 mg/l) againstEnterobacter spp.,Citrobacter freundii, Serratia spp. andMorganella morganii. Ceftibuten is the most potent oral cephalosporin against most of the Enterobacteriaceae. Non-fermentative bacilli (Acinetobacter spp.,Pseudomonas spp.) remain completely resistant to oral cephalosporins (except someAcinetobacter species against cefdinir andPseudomonas cepacia against ceftibuten). Antistaphylococcal activity for oral cephalosporins is highest for cefdinir followed by BAY 3522, cefprozil, cefuroxime and cefpodoxime. Loracarbef, cefaclor and cefadroxil are about equally active, while the other compounds are only weakly active (cefixime) or inactive (cefetamet, ceftibuten). Enterococci are insensitive to new generation oral cephalosporins as they have been to established compounds. The most active oral cephalosporins against hemolytic streptococci are cefdinir and cefprozil.Streptococcus pneumoniae, Streptococcus milleri andStreptococcus mitior are most susceptible to cefpodoxime, cefdinir, cefuroxime and BAY 3522. Penicillin resistant pneumococci have to be regarded as resistant to all oral cephalosporins. Fastidious pathogens likeHaemophilus spp.,Moraxella catarrhalis andNeisseria gonorrhoeae are more susceptible to cefpodoxime, cefixime, cefdinir, cefetamet and ceftibuten than to the other oral cephalosporins. The activity of oral cephalosporins is only weak againstListeria spp.,Helicobacter pylori and anaerobic pathogens (except BAY 3522).Bordetella pertussis remains resistant to all absorbable cephalosporins. Progress in antibacterial activity of oral cephalosporins was mainly achieved by cefpodoxime, cefixime, cefdinir, cefetamet and ceftibuten against Enterobacteriaceae and the fastidious pathogens and against staphylococci and the nonenterococcal streptococci by cefdinir, BAY 3522, cefprozil and cefpodoxime.

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Antibakterielle Aktivität von Cefpodoxim im Vergleich mit anderen oralen Cephalosporinen

Zusammenfassung Die neuen oralen Cephalosporine Cefpodoxim, Cefixim, Cefdinir, Cefetamet und Ceftibuten zeigen eine verstärkte Aktivität auch gegen solche Enterobacteriaceae, die gegen etablierte Substanzen empfindlich sind (z.B. Cefuroxim, Cefaclor, Cefadroxil). Zusätzlich schließt das Spektrum von Cefpodoxim, Cefixim, Cefdinir, Cefetamet und Ceftibuten Spezies ein, die gegen die bisherigen oralen Cephalosporine resistent waren (Proteus vulgaris, Providencia spp.,Yersinia enterocolitica). Daneben zeigt die Mehrheit der neuen Substanzen erhöhte Aktivität (MHK₅₀<2 mg/l) gegenEnterobacter spp.,Citrobacter freundii, Serratia spp. undMorganella morganii. Gegen die meisten Enterobacteriaceae ist Ceftibuten das wirksamste orale Cephalosporin. Non-Fermenter (Acinetobacter spp.,Pseudomonas spp.) bleiben gegenüber oralen Cephalosporinen vollständig resistent (mit Ausnahme einigerAcinetobacter-Spezies gegen Cefdinir undPseudomonas cepacia gegen Ceftibuten). Die Antistaphylokokken-Aktivität oraler Cephalosporine ist am höchsten bei Cefdinir, gefolgt von BAY 3522, Cefprozil, Cefuroxim und Cefpodoxim. Loracarbef, Cefaclor und Cefadroxil sind etwa gleich aktiv, während die anderen Substanzen nur schwach aktiv (Cefixim) oder inaktiv sind (Cefetamet, Ceftibuten). Enterokokken sind gegenüber der neuen Generation oraler Cephalosporine ebenso unempfindlich wie gegenüber den etablierten Substanzen. Die aktivsten oralen Cephalosporine gegen hämolysierende Streptokokken sind Cefdinir und Cefprozil.Streptococcus pneumoniae, Streptococcus milleri undStreptococcus mitior sind am empfindlichsten gegen Cefpodoxim, Cefdinir, Cefuroxim und BAY 3522. Penicillin-resistente Pneumokokken müssen als resistent gegenüber allen oralen Cephalosporinen betrachtet werden. Anspruchsvolle Erreger wieHaemophilus spp.,Moraxella catarrhalis undNeisseria gonorrhoeae sind gegen Cefpodoxim, Cefixim, Cefdinir, Cefetamet und Ceftibuten empfindlicher als gegen die anderen oralen Cephalosporine. Die Aktivität oraler Cephalosporine gegenListeria spp.,Helicobacter pylori und Anaerobier (Ausnahme BAY 3522) ist nur schwach.Bordetella pertussis bleibt gegen alle resorbierbaren Cephalosporine resistent. Der Fortschritt in der antibakteriellen Aktivität oraler Cephalosporine wurde gegen Enterobacteriaceae und anspruchsvolle Erreger hauptsächlich durch Cefpodoxim, Cefixim, Cefdinir, Cefetamet und Ceftibuten erlangt, gegen Staphylokokken und Streptokokken (außer Enterokokken) durch Cefdinir, BAY 3522, Cefprozil und Cefpodoxim.

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Supported by Luitpold-Werk, a company of the Sankyo group.     

Electrochemical Recovery and Behaviors of Rare Earth (La,Ce, Pr,Nd, Sm,Eu, Gd,Tb, Dy,Ho, Er,Tm, and Yb) Ions on Ni Sheets

The electrochemical behaviors of rare earth (RE) ions have extensively been studied because of their high potential applications to the reprocessing of used nuclear fuels and RE-containing materials. In the present study, we fully investigated the electrochemical behaviors of RE(III) (La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, and Yb) ions over a Ni sheet electrode in 0.1 M NaClO₄ electrolyte solution by cyclic voltammetry between +0.5 and −1.5 V (vs. Ag/AgCl). Amperometry electrodeposition experiments were performed between −1.2 and −0.9 V to recover RE elements over the Ni sheet. The successfully RE-recovered Ni sheets were fully characterized by scanning electron microscopy, energy dispersive X-ray spectroscopy, Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, and photoluminescence spectroscopy. The newly reported recovery data for RE(III) ions over a metal electrode provide valuable information on the development of the treatment methods of RE elements.     

Clinical trials update: highlights of the scientific sessions of The American College of Cardiology 2002: LIFE,DANAMI 2, MADIT-2, MIRACLE-ICD,OVERTURE, OCTAVE,ENABLE 1 & 2, CHRISTMAS,AFFIRM, RACE,WIZARD, AZACS,REMATCH, BNP trial and HARDBALL

This article continues a series of reports updating recent research developments of particular interest to personnel involved in the treatment and management of patients with heart failure. This is a summary of selected presentations made at the American College of Cardiology 51st Annual Scientific Session held in Atlanta on 17-20 March 2002. Reports of the following clinical studies are included: LIFE, DANAMI 2, MADIT-2, MIRACLE-ICD, OVERTURE, OCTAVE, ENABLE 1 & 2, CHRISTMAS, AFFIRM, RACE, WIZARD, AZACS, REMATCH, BNP trial and HARDBALL.