卡维地洛对慢性心衰合并肾功能不全患者肾功能的影响

目的:评价卡维地洛对慢性心衰(CHF)合并慢性肾功能不全(CRF)患者肾功能的影响。方法:入选27例CHF合并CRF患者,在充分抗心力衰竭治疗的基础上,加用卡维地洛,观察不同阶段左室射血分数(LVEF)和肾功能的变化。结果:卡维地洛治疗后,LVEF在治疗3个月后开始升高,12个月后显著高于基线水平(p<0.01)。治疗后1个月,血肌酐(Scr)升高(p<0.05),3个月时回落到基线水平以下(p<0.05),12个月时仍低于基线水平(p<0.05);治疗后1个月,内生肌酐清除率(Ccr)先轻度下降(p<0.05),3个月时回升高于基线水平(p<0.01),12个月时仍显著高于基线水平(p<0.01)。卡维地洛对尿微量白蛋白和24h尿蛋白定量影响不大(p>0.05)。结论:第三代β-受体阻滞剂卡维地洛,可改善慢性心衰合并慢性肾功能不全患者的心功能,早期引起肾功能的轻度降低,随后肾功能显著改善。     

β受体阻滞剂在慢性心力衰竭合并慢性阻塞性肺疾病患者中的使用状况调查

目的：了解慢性心力衰竭（CHF）患者合并慢性阻塞性肺疾病（COPD）发生率,了解β受体阻滞剂使用情况,为未来针对这部分患者β受体阻滞剂的使用提供依据。方法根据2007年1月1日-2009年12月31日出院诊断CHF患者住院资料和用药资料,研究慢性阻塞性肺病共存检出率、分析β受体阻滞剂使用比例、类型、剂量和未应用的原因。结果共有598例CHF患者,其中合并慢性阻塞性肺病的患者74例（12.4%）,β受体阻滞剂药物使用11例（14.9%）,最常用的为美托洛尔（29.4±10.1） mg/d,所有使用剂量均未达到目标剂量。有β受体阻滞剂禁忌证患者26例（35.1%）,没有明确的原因未应用β受体阻滞剂患者37例（50.0%）。结论 CHF患者合并COPD并不少见,β受体阻滞剂在这组患者中使用比例及用量明显不足,在未来应对相关的诊断和治疗给予足够的关注。     

卡维地洛治疗充血性心力衰竭70例

目的第三代β受体阻滞剂卡维地洛治疗充血性心力衰竭(CHF)疗效观察。方法共观察70例,不能满意控制心力衰竭,加用口服卡维地洛3.125mg,2次/d,口服,根据个体差异,每7d加量至5mg,后每7d加量一次,直至患者不能耐受或达最大剂量30mg/d(仅限于住院期间)。结果心力衰竭临床表现消失和减轻者63例,无变化或加重者7例,有效率90%,治疗有效的63例均继续服卡维地洛每日10mg,其中42例于1～3个月内能先后停用扩张血管药、洋地黄制剂、利尿剂,最后停用卡维地洛。结论卡维地洛小剂量长期使用治疗心力衰竭是安全的,患者也都能耐受,疗效好、不良反应少。不失为充血性心力衰竭较好的治疗方法。     

卡维地洛治疗慢性心力衰竭的临床疗效观察

随着对慢性心力衰竭（CHF）病理生理机制认识的加深,目前认为,CHF时除了血流动力障碍,更重要的是神经、内分泌系统的激活。近十几年来受体阻滞剂在充血性心力衰竭的治疗中占有重要地位,卡维地洛作为一种新型的β受体阻滞剂已应用于临床。本院对90例CHF患者应用卡维地洛进行治疗,收到良好效果,现报告如下。     

卡维地洛治疗慢性心力衰竭的临床疗效观察

慢性心力衰竭（CHF）是大多数心血管疾病的最终归宿,也是主要的死亡原因。β受体阻滞剂已经成为CHF治疗中拮抗神经内分泌过度激活的干预药物之一。卡维地洛是一种无内在拟交感活性的非选择性第三代β受体阻滞剂,同时具有α受体的阻滞作用,并且是一种强效自由基清除剂。     

接受安体舒通治疗的慢性心力衰竭患者还需要给予β受体阻滞剂吗?

背景:目前已确定β受体阻滞剂和醛固酮受体拮抗剂对于重度收缩性慢性心力衰竭(CHF)患者的益处。但是,尚不清楚β受体阻滞剂对于已经接受醛固酮受体拮抗剂治疗的CHF患者是否还有额外的益处。因此,我们设计了一项COPERNICUS研究以回答这一问题。该研究共纳入2289例患者,给予β1、β2/α1受体阻滞剂卡维地洛(carvedilol)治疗,并与安慰剂相对照。方法:根据患者正在接受安体舒通治疗(n=445)或未接受安体舒通治疗(n=1844)分为两个组。根据预先确定的观察终点,即全因死亡率、与CHF相关的死亡或住院率、与心血管事件相关的死亡或住院率以及…     

卡维地洛治疗慢性心力衰竭31例疗效观察

目的观察卡维地洛治疗慢性心力衰竭的临床效果。方法观察组：卡维地洛6．25～50mg,2次／d口服;对照组：倍他乐克6．25—50mg,1次／d口服。二组均同时服用雅施达4mg,1次／d口服,卡维地洛与倍他乐克均从小剂量用起,根据患者耐受情况每2周调整剂量,至最大耐受量。结果观察组有效率93．54％;对照组有效率83．87％,观察组较对照组疗效有显著性差异（P〈0．05）。结论β受体阻滞剂（卡维地洛）优于选择性β1受体阻滞剂,能更有效改善心功能,提高患者的生存质量。     

卡维地洛治疗慢性心力衰竭疗效观察

目的 评价卡维地洛治疗慢性心力衰竭 （心衰）的疗效和安全性.方法 以65例慢性轻、中度心衰患者作为研究对象,在心衰标准用药基础上给予卡维地洛治疗,卡维地洛由小剂量开始,逐渐递增至目标剂量.在 7个月的疗程中,检查超声心动图 2次,以评价左心室功能和容积,治疗前后分别进行美国纽约心脏病协会（NYHA）心功能分级、心衰评分、血压、心率等体征及实验室（血常规,肝、肾功能及心电图等）检查,以评判疗效、耐受性及安全性.结果 65例患者中显效23例,有效35例,显效率为35.38%,有效率为53.85%,无效率为10.77%（7/65）,总有效率为89.23%（58/65）.不良反应发生率较小,多见的不良反应为头晕,未发现肝、肾功能损害或血常规、电解质和糖代谢变化.结论 慢性心衰患者在常规治疗基础上加用β受体阻滞剂--卡维地洛可明显改善患者心功能,增加射血分数,改善活动耐量,降低再住院率.     

β受体阻滞剂治疗充血性心衰药物利用分析

目的了解β受体阻滞剂在慢性心力衰竭(CHF)中的使用现状,提高用药水平.方法对一年来广东省人民医院心内科、心外科的986例CHF病例β受体阻滞剂使用情况作横断面分析,依据CHF治疗指南并结合最新循证医学的证据对用药情况作客观评估.结果美托洛尔、卡维地洛、比索洛尔分占1～3位,其它药物很少使用.结论反映了近几年来国内外在使用β受体阻滞剂治疗CHF方面的新认识和新进展,与发达国家的CHF治疗指南比较符合,但在心功能失代偿的住院病人中可能存在β受体阻滞剂滥用的倾向.     

卡维地洛与贝那普利联合治疗慢性充血性心力衰竭68例疗效观察

目的探讨贝那普利与卡维地洛联合应用治疗慢性充血性心力衰竭（chronic congestive heart failureCHF）的临床疗效。方法选择68例符合NYHA标准的心功能分级Ⅱ级Ⅲ级和Ⅳ级的CHF患者,随机分成两组：贝那普利和卡维地洛联合治疗组34例（治疗组）和贝那普利组34例（对照组）。对照组患者给予常规应用利尿剂、醛固酮受体拮抗剂及硝酸酯类抗心力衰竭治疗基础上,加用贝那普利治疗（2.5～10mg 1次/d）。治疗组在对照组基础上加服卡维地洛起始剂量为3.125 mg 2次/d、每2～4周剂量加倍,目标剂量12.5～25 mg2次/d）两组病例均治疗12个月。观察血压（SBP,DBP）、心率（HR）、左室舒张末内径（LVEDd）、每博输出量（SV）、左心室射血分数（LVEF）的变化情况。结果治疗组显效26例、有效5例、无效3例,总有效率91%;对照组显效11例、有效16例、无效7例,总有效率79%,两组治疗后临床疗效比较差异有统计学意义（P〈0.01）。结论贝那普利与卡维地洛联合治疗CHF安全有效,可显著提高对CHF患者的临床疗效。     

伊马替尼治疗慢性髓细胞白血病慢性期临床疗效观察

目的：分析甲磺酸伊马替尼（IM）治疗慢性髓系白血病（CML）慢性期的临床疗效及影响疗效的因素。方法随访观察74例 CML 慢性期患者,IM中位治疗剂量为400（200～600）mg·d －1,评估其临床疗效,总生存时间和疾病无进展生存时间,并对相关疗效影响因素进行分析。结果中位随访时间为20（6～72）个月,累积达到血液学缓解（CHR）为98．6％,血液学中位缓解时间1（1～3）月;63例（85．1％）达到主要细胞遗传学缓解（MCyR）,中位达 MCyR 时间为9（5～24）个月;53例（71．6％）达完全细胞遗传学缓解（CCyR）,41例（55．4％）达到主要分子生物学缓解（MMR）;6例（8．1％）达到完全分子生物学缓解（CMR）;初治组及复治组应用 IM治疗后 CHR 及 MCyR 差异无统计学意义,但 CCyR 及 MMR 差异均有统计学意义（P ＜0．016）;由 EUTOS 评分区分的低危组与高危组应用 IM治疗后 CHR 差异无统计学意义,但 MCyR、CCyR 及 MMR 差异均有统计学意义（P ＜0．020）;其中初治组与复治组及 EUTOS 评分低危组与高危组 OS 差异无统计学意义,但其 PFS 差异均有统计学意义（P 分别为0．021和0．004）。结论IM用于 CML 慢性期患者治疗可获得极高的血液学缓解率和较高细胞遗传学缓解率,不良反应少,提高了患者生存质量,延长患者的生存时间;在 CML 确诊早期应用可提高疗效,IM治疗前时间大于6个月或EUTOS 评分高危组可影响 IM疗效。     

AraC-based pharmacotherapy of chronic myeloid leukaemia

In interferon-α (IFN) treated chronic phase chronic myeloid leukaemia (CML) patients, survival depends on individual risk profile and achievement of a complete haematological response (CHR) and a major cytogenetic response (MCR) (< 35% Philadelphia-chromosome-positive metaphases). The highest cytogenetic response rates have been achieved with the combination of IFN and low-dose sc. AraC (10 mg daily to 10 - 20 mg/m² for 10 - 14 days/month). Whether the higher cytogenetic response rates are also associated with a significant improvement of survival still remains controversial. The different results obtained from large randomised and observational trials may be due to the numbers of patients enrolled, distribution of risk profiles and the treatment schedule, which is influenced greatly by the haematological and gastrointestinal toxicity of AraC. An oral formulation (YNK01), which is lipophilic and resistant to deamination, is currently under investigation. Clinically, it has similar activity, but toxicity leads to discontinuation of treatment in a considerable proportion of patients. The clinical benefits may therefore be outweighed by the dose-limiting toxicity for both application forms. Combinations with other drugs, e.g., STI571 or homoharringtonine, have shown promising early results in vitro and in vivo.     

Pharmacotherapy strategies in chronic prostatitis/chronic pelvic pain syndrome management

Importance of the field: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the most common diagnoses arising out of urologic office visits. It is a costly problem and sufferers compare the effect of this syndrome on quality of life as being similar to the effects of diabetes mellitus and myocardial infarction. The syndrome is variable in presentation and symptom management and efficacy will vary between inflicted men.

Areas covered in this review: CP/CPPS is not highly responsive to therapy. As such, it is often a waxing and waning illness with symptoms in multiple domains, including urinary symptoms, pain and ejaculatory dysfunction. The pharmacotherapeutic options and management strategies for CP/CPPS presented in this review are based on the published literature from September 1989 to January 2010. When available, randomized, placebo-controlled studies were reviewed to aid in making definitive recommendations for treatment strategies.

What the reader will gain: The reader will be familiarized with the commonly used classes of pharmaceutical and non-pharmaceutical therapies. Readers will then use the efficacy data to inform treatment decisions for patients with disparate symptomatology. This will be crystallized in the author's treatment algorithm and summary statement.

Take home message: Many practitioners use antimicrobials as a first-line agent, particularly a fluoroquinolone, such as levofloxacin. Trimethoprim/sulfamethoxazole is another medication alternative, with comparable response rates. Many afflicted men will have significant improvement on a 4- to 6-week regimen of a fluoroquinolone antibiotic. Second-line pharmacotherapy includes alpha-blockers, 5-alpha reductase inhibitors and anti-inflammatories for men with urinary symptoms or pain as a predominant symptom domain. Other pharmacotherapy includes steroids, glycosaminoglycans and phytotherapy. Surgical options are generally not recommended for CP/CPPS. Despite the lack of curative therapies, effective symptom management can be achieved with knowledge of the classes of pharmacotherapy. Therapeutic decisions can be based on the symptoms of the patient. Pelvic floor physical therapy is a useful second-line therapy in the author's opinion, but randomized controlled trials and standardization of technique for CP/CPPS are needed before recommendations can be substantiated.     

驻京某部队干部常见慢性病患病率的变化研究及慢病管理探讨

目的：调查驻京某部队干部近5年常见慢性病的患病率情况及变化。方法解放军305医院干部病房常规查体的207例男性部队干部，跟踪随访5年，采用SPSS 17．0统计分析软件进行分析。结果近5年部队干部外周血管动脉硬化、高血压、血脂异常患病率呈现快速增长趋势。慢病患病率随年龄变化也不断增加，年龄≥55岁组的部队干部5种常见慢性病的患病率均高于＜55岁组，但＜55岁组5年内慢病增长趋势高于≥55岁组，主要表现为血脂异常、外周血管动脉硬化呈明显上升趋势。结论近5年部队干部慢性病增长迅速，需采取早期干预措施和针对性健康管理来逐步降低慢病患病率。     

Pharmacoeconomics of the management of acute exacerbations of chronic obstructive pulmonary disease

Acute exacerbations of chronic obstructive pulmonary disease (COPD) impose a significant burden on society in terms of morbidity, mortality, reduced quality of life and healthcare expenditure. New generations of antibiotics are used to treat exacerbations, and other modes of delivery involving home support are being implemented. The optimal strategy to manage exacerbations on pharmacoeconomic grounds depends on issues such as diagnosis of an exacerbation and safety, effectiveness and costs of available alternatives. This review outlines the state of the art of pharmacoeconomic knowledge of the management of acute COPD exacerbations. It presents estimates of the level and distribution of costs associated with exacerbations and reports on the cost-effectiveness or cost-utility of antimicrobial therapy and other approaches to the management of exacerbations.     

The economic impact of chronic obstructive pulmonary disease

The cost burden associated with chronic bronchitis and emphysema, collectively known as chronic obstructive pulmonary disease (COPD), is large. The disease impacts not only on patients but caregivers and society as well. An estimated 16 million people in the US are currently diagnosed with COPD, the majority having chronic bronchitis. Mortality associated with this disease is on the upswing, as is its prevalence in the female population and the elderly. It is currently the fourth most common cause of death both in the US and worldwide. To date, the only proven cost-effective therapies for the disease are the cessation or prevention of smoking, which is the single most common cause of COPD, and vaccination to prevent influenza and pneumococcal infection. Hospitalisation and associated costs represent the greatest healthcare expenditures for people with the disease. Long-term oxygen therapy is also among the most costly interventions in terms of total money spent on direct medical costs for COPD treatment, although it is probably cost-effective because of its positive impact on rates of mortality. In fact, oxygen therapy is the only intervention to date that has been shown to decrease death rates due to COPD. Appropriate treatment with medication has the potential to decrease resource utilisation but does not appear to affect death rates. Similarly, pulmonary rehabilitation programs appear to benefit patients in terms of quality of life; however, long-term cost-effectiveness and effects on mortality have yet to be elucidated. Indirect costs also contribute a substantial part of the economic burden of the disease but are significantly harder to quantify.     

Emerging drugs for chronic urticaria

Chronic urticaria (CU), with or without angioedema, is a frequent disorder defined as the occurrence of pruritic wheals for > 6 weeks. Studies carried out in the last two decades showed that the origin of the disease is autoimmune in up to 50% of cases. Currently available treatments include antihistamines, corticosteroids and ciclosporin; recently, leukotriene receptor antagonists proved effective in a subset of patients as well. For patients with an unremitting and extremely severe disease unresponsive to standard treatments, plasmapheresis and immunosuppressive drugs have been successfully attempted. Recent findings that the autologous plasma skin test scores positive in nearly all patients and that plasmas from patients with both autoimmune and ‘idiopathic’ chronic urticaria are frequently characterised by signs of thrombin activation (plasma levels of prothrombin fragment F_1.2 are significantly increased) suggest that clotting cascade might be somehow involved in the pathogenesis of CU. These findings put under a new light some rather sparse studies of the effect of drugs active on the coagulation system (heparin and oral anticoagulants) in patients with CU.     

慢性前列腺炎/慢性盆腔疼痛综合征中药新药临床试验设计的思考

慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)是中医治疗的优势特色之一.随着对疾病认识的深入,在中药新药的临床研究方面,国内2002年《中药新药临床研究指导原则(试行)》中CP/CPPS部分尚不能完全覆盖对本病的最新认识,目前国内外监管机构亦缺少CP/CPPS较新的指导原则,笔者通过梳理CP/CPPS中西医认识、治...