拉西地平合用阿托伐他汀治疗原发性高血压90例疗效观察

目的观察拉西地平合用阿托伐他汀治疗原发性高血压病的疗效和不良反应。方法原发性高血压病90例,随机分为A组（应用拉西地平）和B组（应用拉西地平＋阿托伐他汀）,疗程为6个月。分别在用药前后动态监测血压和不良反应。结果治疗6个月后两组患者血压均显著下降,B组降压更明显,两组降压幅度比较差异有统计学意义（P〈0．05）。降压疗效总有效率A组为77．7％,B组为88．9％,两组比较差异有统计学意义（P〈0．05）。结论拉西地平合用阿托伐他汀有协同降压作用,降压幅度较单用拉西地平高。     

贝伐单抗治疗肺癌患者恶性胸腔积液疗效观察

目的：观察贝伐单抗治疗肺癌患者恶性胸腔积液的疗效及其对癌胚抗原（ CEA ）和血管内皮生长因子（ VEGF）表达水平的影响。方法将92例肺腺癌患者随机分为观察组和对照组各46例,分别给予贝伐单抗局部灌注、顺铂局部灌注。比较两组疗效,采用酶联免疫分析法检测治疗前后胸腔积液中CEA和VEGF水平,采用Kap－lan－Meier生存分析方法分析生存情况。结果治疗组总有效率为84．78％,对照组为56．52％,两组比较有统计学差异（P＜0．05）;观察组不良反应发生率和治疗后胸腔积液中CEA、VEGF水平明显低于对照组（P＜0．05）;对照组中位无进展生存期为2．30个月,中位总生存期为7．28个月,观察组分别为3．38、9．25个月,两组比较均有统计学差异（ P均＜0．05）。结论贝伐单抗治疗恶性胸腔积液疗效显著,不良反应少,且能降低胸腔积液中CEA 和VEGF的表达,值得临床推广应用。     

吉西他滨单药治疗老年晚期非小细胞肺癌的疗效分析

目的观察吉西他滨单药治疗老年晚期非小细胞肺癌的疗效、临床受益反应（CBR）及毒副反应。方法34例经病理学或细胞学确诊的老年非小细胞肺癌患者（≥60岁）,应用吉西他滨1000mg／m^2,静脉滴注,第1,8天给药,每21天为1周期;对照组给予最佳支持治疗（BSC）。结果吉西他滨治疗组有效率（RR）为26．5％,中位缓解时间为6．2个月,中位肿瘤进展时间（TTP）为5．4个月,中位生存期（OS）为11．2个月,1年生存率为38．2％;对照组有效率（RR）为0％,中位TTP为2．4个月,中位OS为4．8个月,1年生存率为9．7％。治疗组临床受益反应较对照组均有明显提高（P〈0．01）。治疗组药物毒副反应较轻,无不良反应需停药者。结论吉西他滨单药治疗老年晚期非小细胞肺癌疗效明确,毒副反应较轻,耐受性较好。     

贝伐单抗治疗转移性结直肠癌20例近期疗效观察

将病理学证实的60例转移性结直肠癌患者随机分为两组,观察组20例予贝伐单抗（Avastin）联合伊立替康（CPT-11）、醛氢叶酸（LV）和5-氟尿嘧啶（5-Fu）,对照组40例予CPT-11联合LV和5-Fu治疗,至少化疗2个周期。观察近期疗效、不良反应和血清肿瘤标志物变化。结果观察组和对照组有效率分别为45％和35％（P〉0．05）;疾病控制率分别为80％和50％（P〈0．05）;肿瘤标志物治疗后均明显降低（P〈0．01）;两组不良反应多为Ⅰ～Ⅱ度,发生率无统计学差异（P〉0．05）。认为贝伐单抗联合伊立替康治疗转移性结直肠癌效果好,不良反应轻,值得临床借鉴。     

瑞舒伐他汀与阿托伐他汀对ACI并高脂血症、CAS患者血脂及CAS斑块的疗效比较

目的比较瑞舒伐他汀与阿托伐他汀对急性脑梗死（ACU并高脂血症、颈动脉粥样硬化（CAS）患者血脂及CAS斑块的疗效。方法选择ACI并高脂血症及CAS患者90例,随机分为A组、B组各45例,A组口服瑞舒伐他汀、B组口服阿托伐他汀治疗,疗程均为6个月。治疗前及治疗6个月后检测两组血脂、C反应蛋白（CRP）,以及颈动脉内膜一中膜厚度（IMT）及斑块面积、数量。结果疗程结束后,两组血清TC、LDL-C、TG、CRP降低,HDL—C升高,但A组LDL-C及CRP降低较B组明显（P均〈0．05）;两组颈部IMT较治疗前明显降低,但A组斑块面积缩小较B组明显（P均〈0．05）;A组药物不良反应发生率低于B组（P〈0．O5）。结论瑞舒伐他汀与阿托伐他汀均有明显的调脂、抗动脉粥样硬化作用,但瑞舒伐他汀控制ACI并高脂血症及CAS斑块的疗效优于阿托伐他汀。     

奈达铂联合多西他赛二线治疗晚期非小细胞肺癌的临床观察

目的探讨奈达铂联合多西他赛二线治疗晚期非小细胞肺癌（NSCLC）的有效性及安全性。方法选择100例一线治疗失败的晚期NSCLC患者,随机分为试验和对照两组,试验组接受奈达铂＋多西他赛化疗,对照组接受多西他赛单药化疗,评价两组患者的疗效、无进展生存时间（PFS）、中位总生存时间（OS）和不良反应。结果试验组与对照组患者的疾病控制率（DCR）分别为80％和62％,两组差异有统计学意义（P〈0．05）。试验组与对照组患者的中位PFS分别为4．2个月和4．0个月,中位OS分别8．8个月和8．1个月,1年生存率分别为24％和22％,两组差异无统计学意义（P〉0．05）。试验组的不良反应包括白细胞减少、血小板减少及恶心、呕吐,发生率均明显高于对照组。结论与多西他赛单药相比,奈达铂联合多西他赛二线治疗晚期NSCLC,可提高DCR,但未延长PFS,未显著增加OS,血液学及消化道不良反应更明显,但可耐受。     

老年弥漫性大B细胞淋巴瘤预后因素及治疗分析

目的探讨老年弥漫性大B细胞淋巴瘤（DLBCL）预后因素,不同治疗方案对其生存的影响。方法回顾性分析72例初发老年DLBCL的性别、年龄、临床分期、B症状、ECOG-PS评分、结外病灶、血清LDH水平、血红蛋白水平、IPI评分与预后的相关性,其中可评价的为64例。比较接受3周CHOP方案34例和接受3周R-CHOP方案30例的生存情况。结果老年DLBCL患者中位生存期40．3个月,2年OS率67．43％,3年OS率49．89％。多因素分析显示年龄、ECOG-PS、临床分期、IPI评分是影响老年DLBCL患者预后的独立危险因素（P〈0．05）。CHOP组和R-CHOP组2年及3年OS率差异均有统计学意义,2年OS率（53．3％VS72．1％,P〈0．05）,3年OS率（39．2％VS60．8％,P〈0．05）。结论年龄、ECOG-PS、临床分期、IPI评分是老年DLBCL患者的预后相关因素,R-CHOP方案疗效优于CHOP方案。     

因1型慢性丙型肝炎慢应答患者复发与疗程相关性的探讨

目的：探讨基因1型慢性丙型肝炎（CHC）慢应答患者复发与疗程的相关性。方法收集2010年4月－2013年3月焦作市第三人民医院、焦作市人民医院住院或门诊的基因1型CHC患者157例,采用干扰素α－1b联合利巴韦林治疗,其中51例获得慢应答患者在治疗6个月时随机分为A（24例）、B（27例）两组,分别继续原方案治疗6、12个月,停药后随访1年。观察不良反应对抗病毒治疗方案的影响,比较两组治疗结束时HCV RNA阴转率、ALT复常率,停药后6个月、1年的复发率及ALT复常率。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果治疗中两组患者不良反应的发生率比较,差异均无统计学意义（P值均＞0．05）。治疗结束时两组患者HCV RNA阴转率（95．65％ vs 92．59％）、ALT复常率（95．65％ vs 88．89％）比较差异均无统计学意义（χ2值分别为0．02、0．13,P值均＞0．05）。停药6个月、1年后,B组患者复发率均显著低于A组（20．00％ vs 50．00％;36．00％ vs 68．18％）,差异具有统计学意义（χ2值分别为4．69、4．85,P值均＜0．05）;停药6个月、1年后,B组患者ALT复常率均高于A组（84．00％ vs 59．09％;72．00％ vs 50．00％）,但差异均无统计学意义（χ2值分别为3．63、2．40,P值均＞0．05）。结论 基因1 型CHC 慢应答患者延长疗程6 个月可明显减少复发。     

贝伐单抗联合化疗一线治疗转移性结直肠癌疗效的Meta分析

目的系统评价贝伐单抗联合化疗一线治疗转移性结直肠癌患者对生存期的影响。方法利用万方、维普、CNKI、PUMED、EMBASE数据库,收集贝伐单抗联合化疗一线治疗转移性结直肠癌的随机对照试验,对纳入研究的方法学质量进行评价,以文献为基础采用固定效应模型或随机效应模型对中位总生存期（OS）、无进展生存期（PFS）进行Meta分析。结果共纳入5篇文献,包括1778例。Meta分析显示,与未联合贝伐单抗对照组比较,贝伐单抗联合化疗组的0s（Z=2．55,P=0．01）和PFS（Z=11．96,P〈0．01）明显延长。结论贝伐单抗联合化疗一线治疗转移性结直肠癌可延长患者OS、PFS。     

重组人血管内皮抑制素联合FOLFOX4方案治疗晚期结直肠癌的临床对照研究

背景：临床前和临床研究结果显示重组人血管内皮抑制素能抑制血管内皮细胞增殖、血管生成和肿瘤生长．且耐受性良好。目的：评价重组人血管内皮抑制素联合FOLFOX4方案治疗晚期结直肠癌（ACRC）的反应率（RR）、临床获益率（CBR）、中位疾病进展时间（TTP）和肿瘤进展率,观察患者生活质量（QOL）改善情况和药物不良反应。方法：收集50例病理学诊断为Ⅳ期、初治或复治、Karnofsky评分（KPS）≥60分的ACRC患者,随机分为试验组和对照组。试验组25例,联合应用FOLFOX4方案和重组人血管内皮抑制素（7．5mg／m^2,d1-14）。对照组25例,应用FOLFOX4方案＋安慰剂（0．9％NaCl溶液,用法同重组人血管内皮抑制素）。结果：50例患者均可评价疗效。试验组总RR（44．0％对16．0％,P-0．062）、总CBR（76．0％对48．0％,P=0．041）、总中位TTP（7．8个月对5．0个月,P=0．040）和QOL改善率（64．0％对36．0％,P=0．048）均高于对照组,肿瘤进展率低于对照组（P〈0．05）。初治患者中,试验组RR、CBR和中位TTP均显著高于对照组（P〈0．05）;复治患者中,试验组和对照组上述指标无明显差异。两组间不良反应发生率差异无统计学意义。结论：重组人血管内皮抑制素联合FOLFOX4方案能明显提高ACRC患者,尤其是初治患者的RR．延长中位TTP,在一定程度上改善患者的QOL,且安全性较好。     

Welche Rolle spielen die neuen Therapieoptionen in der palliativen Therapie des Kolonkarzinoms?

Therapeutic options in the treatment of metastatic colorectal cancer have recently been expanded by the introduction of two new monoclonal antibodies: bevacizumab and cetuximab. These antibodies were the proof of principle of two exciting new antitumor strategies: antiangiogenesis and inhibition of epidermal growth factor (EGF) receptor. Bevacizumab binds to vascular endothelial growth factor and thus blocks its angiogenic effects. In a randomized phase III trial bevacizumab in combination with irinotecan + 5-fluorouracil/leucovorin (IFL) was compared to chemotherapy alone as first-line treatment. The combination showed a superior response rate, a prolonged progression-free and overall survival. Cetuximab binds to the EGF receptor and thus inhibits its activation by its natural ligand. In a randomized phase II trial irinotecan refractory patients were treated with cetuximab alone or cetuximab plus irinotecan. The combination showed a response rate of 22,5% and a prolonged progression-free survival identifying cetuximab as an important new option for this patient group.     

Modified irinotecan plus bolus 5-fluorouracil/L-leucovorin for metastatic colorectal cancer at a single institution in Japan

Background  The modified irinotecan plus bolus 5-fluorouracil/L-leucovorin (IFL) regimen (irinotecan plus bolus 5-fluorouracil/L-leucovorin) used to be one of the standard treatments for metastatic colorectal cancer until approval of oxaliplatin in Japan. We evaluated the efficacy of modified IFL therapy for Japanese patients. Methods  Forty-seven patients with metastatic colorectal cancer received irinotecan (100 mg/m²) and bolus 5-fluorouracil (500 mg/m²) plus L-leucovorin (10 mg/m²) on days 1 and 8 every 3 weeks until progression or unmanageable toxicity occurred. The data on toxicity and tumor response were analyzed retrospectively. Results  All patients discontinued modified IFL therapy due to cancer progression, except for one patient who developed severe liver dysfunction. The overall response rate was 25%. The median progression-free survival time (PFS) was 6.1 months. The median overall survival time (OS) was 17.4 months for all patients, 28.8 months for patients receiving subsequent oxaliplatin therapy, and 8.9 months for patients without oxaliplatin (P = 0.0031). According to multivariate analysis results, good performance status, a normal white cell count, and absence of local recurrence were associated with a better PFS. Tumor response was a good prognostic factor for both PFS and OS. Gastrointestinal symptoms were the most common toxicities, including grade 3 diarrhea (8%) and grade 3 anorexia (10%). Grade 4 neutropenia occurred in 6% of patients. No other drug-related severe adverse events or deaths were observed. Conclusions  Modified IFL therapy is an effective and well-tolerated regimen for Japanese patients with metastatic colorectal cancer. Modified IFL therapy combined with biological agents might remain an option for some patients who refuse a central venous catheter. An erratum to this article can be found at     

联合应用埃索美拉唑、铝碳酸镁和莫沙比利治疗难治性胃食管反流病

目的:探讨联合应用埃索美拉唑、铝碳酸镁和莫沙比利治疗难治性胃食管反流病(r-GERD)的临床疗效.方法:101例rGERD患者随机为A(n=36),B(n=34)和C组(n=31),分别采用埃索美拉唑 铝碳酸镁 莫沙比利、埃索美拉唑 莫沙比利及铝碳酸镁 莫沙比利治疗.4及8 wk后评价临床症状,8 wk后评价内镜下有效率.结果:治疗4 wk后,A,B和C组临床症状总改善率分别为88.9%,79.4%和61.3%,A组与B,C两组相比差异显著(χ2=7.3531,P＜0.05).治疗8 wk后,A,B和C组临床症状总改善率分别为97.2%,88.2%和71.0%,内镜下有效率分别为94.4%,85.3%和67.7%,A组临床症状总改善率和内镜下有效率与B,C组相比存在显著性差异(χ2=9.6079,P＜0.01;χ2=8.6496,P＜0.05).结论:埃索美拉唑联合铝碳酸镁和莫沙比利治疗rGERD有很高的临床疗效.     

Does pentoxifylline prolong the walking distance in exercised claudicants? A placebo-controlled double-blind trial.

The aim of this study was to test whether in claudicants oral pentoxifylline, given for twelve weeks in addition to physical exercise, prolongs the walking distance more than placebo plus exercise. Forty outpatients were randomized into group A (2 x 600 mg oral pentoxifylline per day) or group B (placebo). Both groups received the same exercise program in addition. The maximal and painfree walking distances and blood viscosity were measured. Intergroup differences in terms of blood viscosity reached the level of significance only after twelve weeks (p = 0.006 at shear rate of 94.5 s-1), but values of group A continuously decreased and those of group B continuously increased. After one and eight weeks, but not after twelve weeks, the maximal walking distances were significantly longer in group A than in group B. At no point were there significant intergroup differences in terms of painfree walking distance. The data suggest that pentoxifylline is clinically effective in claudicants even when given in addition to exercise. The benefit of drug plus physical therapy compared with exercise alone could be observed mainly in the first weeks of treatment and may wear off during long-term therapy.     

两种含铂化疗方案对晚期非小细胞肺癌近期疗效观察

目的观察诺维本(NVB)与顺铂(DDP)组成的NP方案与丝裂霉素(MMC)、长春地辛(VDS)、DDP组成的MVP方案对晚期非小细胞肺癌(NSCLC)的近期疗效和毒副反应。方法将2003年2月至2005年2月在解放军总医院第二附属医院肿瘤科治疗的经病理组织学或细胞学证实的晚期NSCLC患者63例,随机分为A组(32例)和B组(31例)分别实施NP方案及MVP方案治疗,21d为1个治疗周期。观察2种治疗方案的有效率及毒副反应情况。结果A组有效率为40.63%,B组32.26%,两组比较P>0.05。主要毒副反应为骨髓抑制、胃肠道反应、周围神经毒性及静脉炎。结论NP与MVP方案的近期疗效大致相同,毒副反应差异无统计学意义,2种方案均可作为NSCLC的一线治疗方案。     

Antimitochondrial antibodies in patients with chronic graft-versus-host disease.

Chronic graft-versus-host disease (cGVHD) and primary biliary cirrhosis (PBC) have many clinical and laboratory features in common. These include scleroderma or lupus erythematosus-like skin lesions, a Sj?gren-like sicca syndrome, cholestatic liver disease and a variety of serological autoimmune phenomena. Furthermore, liver histology in both diseases is characterized by lymphocytic infiltration of the portal fields and destruction of small bile ducts. We investigated whether there were also parallels between both diseases in incidence and characteristics of antimitochondrial (AMA) and other autoantibodies. Sera from patients with cGVHD (n = 11, group 1) were examined by immunofluorescence (IFL) and immunoblot (IBL), and the results were compared with sera from patients without cGVHD (n = 21, group 2) and after autologous BMT (n = 16, group 3). In group 1 AMA was detected by IFL in one and by IBL in nine of 11 (81%) patients. Group 2 and 3 patients were AMA-negative by IFL and AMA positive by IBL in statistically lower incidence of 19% and 6% (p less than 0.001), respectively. cGVHD-associated AMA recognized a spectrum of mitochondrial proteins, the most frequent being molecules of 63/60 kD and 22 kD. Follow-up studies showed a temporal correlation between the emergence of AMA and the clinical occurrence of cGVHD. We conclude that patients with cGVHD have a high incidence of AMA similar to patients with PBC, but the reaction pattern of AMA differs between the diseases. The presence of AMA in cGVHD further emphasizes the concept that both diseases may have a related pathogenetic background.     

An observational study of outcomes after initial infused therapy in Medicare patients diagnosed with chronic lymphocytic leukemia

The study goal was to characterize older chronic lymphocytic leukemia (CLL) patients and to evaluate outcomes in those patients who initiated infused therapy. Patients 66 years of age and older in the Surveillance, Epidemiology, and End Results (SEER) program with a CLL diagnosis were matched to their Medicare Part A and Part B claims for long-term follow-up. Treatment patterns, survival after initiation of infused therapy, and both hematologic and hospitalization outcomes were assessed. There were 6433 CLL patients identified, and 2040 received infused therapy. Treated patients were categorized as receiving rituximab monotherapy (16%), rituximab plus chemotherapy (14%), and chemotherapy alone (70%) based on the initial 60 days after infusion. Rituximab plus chemotherapy compared with chemotherapy alone was associated with a 25% lower risk of overall mortality (95% confidence interval, 9%-38%). Restricting to patients age 70 years and older did not change the risk reduction for rituximab plus chemotherapy. Hematologic interventions were more common with rituximab plus chemotherapy compared with chemotherapy alone, but there was no difference in all-cause hospitalizations. These analyses, based on observational data, suggest that the benefits of initial therapy with rituximab in a heterogeneous group of older CLL patients are comparable with those demonstrated in younger patients.     

Effects of killing Helicobacter pyloriquadruple therapy on peptic ulcer： A randomized double-blind clinical trial

AIM: To study the therapeutic efficacy of a Chinese and Western integrated regimen, killing Helicobacter pylori quadruple therapy on H pylori-associated peptic ulcers (PU). METHODS: With prospective and double-blind controlled method, seventy-five active PU patients with H pylori infection were randomized to receive one of the following three regimens: (1) new triple therapy (group A: lansoprazole 30 mg qd, plus clarithromycin 250 mg bid, plus amoxycillin 500 mg tid, each for 10 d); (2) killing Hp quadruple therapy(group B: the three above drugs plus killing H pylori capsule 6 capsules bid for 4 wk) and (3) placebo(group C: gastropine 3 tablets bid for 4 wk). H pylori eradication and ulcer healing quality were evaluated under an endoscope 4 wk after treatment. The patients were followed up for 5 years. RESULTS: Both the healing rate of PU and H pylori eradication rate in group B were significantly higher than those in group C (100% and 96.4% vs20% and 0%, respectively,P<0.005), but there was no significant difference compared to those in group A (88% and 92%, P>0.05). The healing quality of ulcer in group B was superior to that in groups C and A (P<0.05). The recurrence rate of PU in group B (4%) was lower than that in group A (10%) and group C (100%,P<0.01). CONCLUSION: Killing Helicobacter pylori quadruple therapy can not only promote the eradication of H pylori and healing quality of ulcer but also reduce recurrence rate of ulcer.     

埃索美拉唑对十二指肠球溃疡合并幽门螺杆菌感染的治疗

目的:观察埃索美拉唑加利复星、克拉霉素治疗十二指肠溃疡合并幽门螺杆菌(H Pylori) 感染的临床疗效．方法:将64例幽门螺杆菌阳性的十二指肠球溃疡患者随机分为治疗组(n=32)和对照组(n= 32)．治疗组口服埃索美拉唑、利复星、克拉霉素．对照组口服法莫替丁、利复星、克拉霉素．各组疗程结束后复查胃镜,观察溃疡愈合率、H pylori清除率和临床症状的改善情况．结果:治疗组和对照组镜下溃疡愈合率分别为32例(100％)和26例(81．3％)(P<0．01);H pylori根除率分别为90．6％和71．9％(P<0．01); 治疗组显效32例,总有效率100％;对照组显效率20例(62．5％),有效8例(25％),总有效率 87．5％．治疗组显效率和总有效率显著高于对照组(P<0．01)．两组均无明显不良反应．结论:埃索美拉唑缓解临床症状快,有效促进溃疡愈合,与抗生素联合应用提高H pylroi清除率．     

不同疗程三联方案根除幽门螺杆菌后的复发情况

目的观察不同疗程奥美拉唑三联方案根除幽门螺杆菌(Hp)后的复发率。方法Hp阳性的干二指肠溃疡103例患者,随机分为二组:A组50例;B组53例。均给予奥美拉唑20 mg(每日2次)、阿莫西林1.0 g(每日2次)、呋喃唑酮0.1 g(每日3次),A组疗程2周,B组疗程1周。观察2组Hp根除率、溃疡复发率、3年Hp复发率及不良反应。结果A组Hp根除率、溃疡愈合率、Hp根除者3年累积复发率分别为92.0%、96.0%、8.7%;B组分别为88.7%、92.5%、12.8%,两组三项差异均无显著性(P>0.05)。结论1周和2周疗程方案近、远期疗效相同,但1周疗程方案疗程短,病人依从性好,费用减半,效-价比优于2 周疗程方案。