舍曲林联合奥氮平治疗老年抑郁症的临床对照研究及随访

目的:为探讨舍曲林联合奥氮平治疗老年抑郁症的疗效及安全性。方法:被试随机分为研究组与对照组,研究组用舍曲林联合奥氮平治疗,对照组单用舍曲林治疗,治疗前及治疗1、2、4、6周、1年后分别用汉密尔顿抑郁量表(HAMD)评定治疗效果,用副反应量表(TESS)评定不良反应,评定1年后复发率。结果:研究组在第1周时有效率显著高于对照组(χ2=6.53,P0.05),两组HAMD评分比较在1、2、4周末及1年后有显著性差异(t=4.02,3.67,3.16,2.84;P0.05),两组TESS评分比较无明显差异,1年后随访研究组的复发率低于对照组(χ2=4.68,P0.05)。结论:舍曲林联合奥氮平治疗老年抑郁症起效快,安全性高,疗效好,复发率低,优于单一用药。     

盐酸舍曲林合并养心安神汤治疗老年期抑郁的对照研究

目的了解盐酸舍曲林合并中药养心安神汤治疗首发老年抑郁症的疗效及安全性。方法将符合入组标准的80例首发老年抑郁症患者随机分为研究组及对照组。研究组以舍曲林合并养心安神汤治疗,对照组单用舍曲林治疗。治疗6周后统计两组的有效率;分别于治疗后1、2、4、6周进行汉密顿抑郁量表(HAMD)评分。第6周末采用副反应量表(TESS)评定不良反应。结果治疗6周后,研究组痊愈的比例高于对照组,差异有统计学意义(P0.05);两组HAMD评分较治疗前均显著下降(P0.05),以研究组在各周降分更为明显(49.3%,P0.01)。两组不良反应差异无统计学意义。结论盐酸舍曲林合并养心安神汤治疗老年抑郁症比单用盐酸舍曲林起效快,治愈率高,安全可靠。     

心理干预联合舍曲林对强迫症患者生活质量的影响

目的探讨心理干预联合舍曲林对强迫症患者生活质量的影响。方法 60例强迫症患者随机分为研究组30例和对照组30例。研究组给予心理干预联合舍曲林治疗,对照组单用舍曲林治疗,观察8周。采用Yale-Brown强迫量表和生活质量综合评定问卷(GQOLI-74)分别于治疗前和治疗后8周来进行疗效和生活质量评定。结果心理干预联合舍曲林对患者强迫症状的改善好于单用舍曲林治疗(t=2.08,P0.05),对躯体功能、心理功能和社会功能的改善明显优于单用舍曲林组(t=2.18,2.14,2.09;P均0.05)。结论心理干预联合舍曲林可以更好的改善患者的生活质量。     

舍曲林治疗中学生强迫症临床分析

目的观察舍曲林治疗中学生强迫症的疗效及副作用,为临床工作提供客观依据。方法采用耶鲁-布朗强迫量表YBOCS和副反应量表TESS分别评定疗效和副作用。结果观察治疗4周、8周时YBOCS总均分较治疗前(42.17±11.26)明显减少(21.03±5.28、11.21±3.05),有明显统计学差异(P<0.05,P<0.01);观察治疗8周时临床治愈率86.46%,副反应发生率28.57%。结论舍曲林治疗中学生强迫症疗效显著,副反应少,值得临床推广。     

帕利哌酮对强迫症治疗的增效作用研究

目的探讨帕利哌酮对西酞普兰治疗强迫症的增效作用及安全性。方法将年龄在23~56岁之间符合CCMD-3强迫症诊断标准的患者58例随机分为对照组(西酞普兰组)及研究组(西酞普兰合并帕利哌酮组),治疗8周。于治疗前、治疗2、4、8周末分别应用耶鲁-布朗强迫量表(Y-BOCS)评价疗效,应用副反应量表(TESS)评定不良反应,将两组结果加以分析、比较。结果治疗结束后两组Y-BOCS评分均显著降低,而研究组更为明显,与对照组比较差异具有统计学意义(t=-4.07,P0.05)。两组各时期TESS评分无显著差异。治疗8周末研究组有效率为86.2%,对照组有效率为62.1%,两组间差异有统计学意义(χ2=4.41,P0.05)。结论帕利哌酮对强迫症治疗的增效作用明显且安全。     

小剂量利培酮口服液对难治性抑郁症的辅助治疗

目的 探讨小剂量利培酮口服液对难治性抑郁症的辅助疗效及安全性.方法 将60例难治性抑郁症患者随机分成研究组和对照组各30例,研究组采用小剂量利培酮口服液联合盐酸舍曲林治疗并与单独采用盐酸舍曲林治疗的对照组进行对照,分别在治疗1、2、4、6、8周以汉密尔顿抑郁量表(HAMD)评定疗效,以副反应量表(TESS)评定不良反应.结果 两组HAMD评分治疗后与治疗前比较均有显著差异性(P＜0.01),两组间HAMD评分在治疗后第4、6、8周均有显著性差异(t分别为5.67,6.75,2.85;P＜0.01).两组间副反应量表评分比较差异不明显.结论 小剂量利培酮口服液联合盐酸舍曲林治疗难治性抑郁症效果好于单独采用盐酸舍曲林,起效快,且耐受性好.     

舍曲林与氯丙咪嗪治疗少年强迫症的对照研究

目的比较舍曲林与氯丙咪嗪治疗少年强迫症的临床疗效及不良反应。方法将54例少年强迫症患者随机分为舍曲林纽和氯丙咪嗪纽,疗程均为8周。分别于入组前、服药2、4、6、8周末应用Yale—Brown强迫量见（Y—BOCS）,汉密尔顿抑郁量表（HAMD）,汉密尔顿焦虑量表（HAMA）评定疗效,采用副反应量表（TESS）评定不良反应。结果舍曲林组和氯丙咪嗪组治疗后,Y—BOCS、HAMD、HAMA分值均显著下降,差异无显著性。舍曲林不良反应发生率明显少于氯丙咪嗪。结论舍曲林治疗少年强迫症与氯丙咪嗪疗效相当,不良反应较轻。     

箱庭治疗在儿童青少年抑郁症治疗中的疗效研究

目的:探讨箱庭治疗对儿童青少年抑郁症患者的疗效。方法:将20例儿童青少年抑郁症患者随机分为研究组与对照组各10例。对照组选择舍曲林治疗,研究组选择箱庭疗法,进行为期8周的治疗,分别用汉密尔顿抑郁量表(HAMD)、自信心测试量表、临床疗效总评量表(CGI)进行疗效评估。结果:研究组与对照组在治疗第2周末、4周末、8周末进行HAMD、自信心测试评分比较,与治疗前比较差异均有统计学意义。两组间2周末时比较,差异有统计学意义(t=2.42,df=18,P0.05),而4周末、8周末比较差异无统计学意义(t=0.98、0.48,df=18,P0.1)。结论:箱庭治疗在儿童青少年抑郁症治疗早期(2周内)起效速度不如对照组,长程治疗(4周、8周)上与对照组无显著性差异。箱庭治疗对儿童青少年抑郁症是有效的,且在提升自信心方面箱庭治疗组优于对照组。     

舍曲林与帕罗西汀治疗强迫症的对照研究

目的 比较舍曲林与帕罗西汀治疗强迫症的疗效及安全性。方法 分别用舍曲林和帕罗西汀治疗强迫症患者各36例,采用Yale—Brown强迫量表、汉密尔顿抑郁量表（HAMD）及副反应量表（TESS）评定疗效和不良反应。结果 舍曲林和帕罗西汀疗效相似,差异无显著性,舍曲林起效慢于帕罗西汀,其副反应也少于帕罗西汀。结论 舍曲林治疗强迫症安全有效,值得推广。     

舍曲林联合家庭疗法治疗青少年焦虑障碍的疗效

目的:观察舍曲林联合家庭疗法治疗青少年焦虑障碍的疗效。方法:40例青少年焦虑障碍的患者,根据自愿原则分别采用舍曲林治疗20例(对照组),舍曲林联合家庭治疗20例(家庭组)。治疗前后予以汉密尔顿焦虑(HAMA)及生活满意度评定量表(LSR)测定,治疗4周评价疗效。结果:对照组及家庭组治疗前后HAMA、LSR均有非常显著差异(t=12.46,9.70,-5.14,-9.18;P0.01)。治疗结束两组药物剂量有显著差异(t=2.200,P=0.03);治疗结束LSR评分家庭组优于对照组(t=-2.39,P0.05);药物不良反应思睡、口干两组比较有统计学差异(Fisher精确检验P=0.02、0.03)。结论:舍曲林联合家庭疗法以及单独采用舍曲林疗法对青少年焦虑治疗均有效。联合治疗临床效果更好。     

Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma

Background: Racemic albuterol is an equal mixture of (R)-albuterol (levalbuterol), which is responsible for the bronchodilator effect, and (S)-albuterol, which provides no benefit and may be detrimental. Objective: We sought to compare 2 doses of a single enantiomer, levalbuterol (0.63 mg and 1.25 mg), and equivalent amounts of levalbuterol administered as racemic albuterol with placebo in patients with moderate-to-severe asthma. Methods: This was a randomized, double-blind, parallel-group trial. Three hundred sixty-two patients 12 years of age or older were treated with study drug administered by means of nebulization 3 times daily for 28 days. The primary endpoint was peak change in FEV₁ after 4 weeks. Results: The change in peak FEV₁ response to the first dose in the combined levalbuterol group was significantly greater compared with the combined racemic albuterol group (0.92 and 0.82 L, respectively; P = .03), with similar but nonsignificant results after 4 weeks (0.84 and 0.74 L, respectively). Improvement in FEV₁ was similar for levalbuterol 0.63 mg and racemic albuterol 2.5 mg and greatest for levalbuterol 1.25 mg. Racemic albuterol 1.25 mg demonstrated the weakest bronchodilator effect, particularly after chronic dosing. The greatest increase in FEV₁ was seen after levalbuterol 1.25 mg, especially in subjects with severe asthma. All active treatments were well tolerated, and β-adrenergic side effects after administration of levalbuterol 0.63 mg were reduced relative to levalbuterol 1.25 mg or racemic albuterol 2.5 mg. At week 4, the predose FEV₁ value was greatest in patients who received levalbuterol or placebo when compared with those who received racemic albuterol. The difference was more evident and was statistically significant in patients who were not receiving inhaled corticosteroids. Conclusion: Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function. (J Allergy Clin Immunol 1998;102:943-52.)     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Satellite RNA associated with bamboo mosaic potexvirus shares similarity with satellites associated with sobemoviruses

Summary A putative nonstructural protein encoded by a satellite RNA associated with bamboo mosaic potexvirus shares 46% identity with the capsid protein of satellite virus of panicum mosaic sobemovirus. The sequence similarity among satellite plant viruses which have no apparent relationship implies a common origin.     

拉米夫定与泛昔洛韦联合治疗乙型肝炎病毒慢性感染的临床研究

目的 观察拉米夫定与泛昔洛韦联合治疗乙型肝炎病毒(HBV)慢性感染的临床疗效。方法 慢性乙型肝炎患者90例。设联合治疗组28例，单用拉米夫定组30例，单用泛昔洛韦组32例。联合治疗组给予口服拉米夫定0．1g／d(PO)，泛昔洛韦1．5g／d(PO)，24周。拉米夫定、泛昔洛韦单用组剂量及疗程分别同联合治疗组。结果 3组均无明显副反应，丙氨酸转氨酶(ALT)复常率无差异。3组HBV DNA阴转率分别为89．3％、66．7％、40．6％，差异有显著性。乙型肝炎表面抗原(HBeAg)阴转率分别为28．6％、23．3％、21．9％，差异无显著性。结论 拉米夫定与泛昔洛韦联合用药安全、耐受性好，临床显示联合治疗对HBV DNA的抑制作用显著优于单用药。     

Gynecomastia with marked cellular atypia associated with chemotherapy

Gynecomastia is a common benign male breast disease, which may exhibit mild cellular atypia in cytology specimens. However, marked cytologic atypia can be seen in gynecomastia superimposed by chemotherapy. The case described in this report demonstrated severe cytologic atypia of gynecomastia mimicking carcinoma in a patient treated with chemotherapy for acute leukemia. A distinct cytologic feature helpful in avoiding the diagnostic error is described, namely, atypical cells admixed with bland ductal cells and appearing at a different plane. The importance of applying strict diagnostic criteria in breast cytology and clinical correlation is also emphasized.     

Intervention with epinephrine in hypotension associated with mastocytosis

The occurrence of the episodes of vasodilatory hypotension can be a life-threatening manifestation of systemic mastocytosis. This article describes the reversal by epinephrine of episodes of severe hypotension in two hospitalized patients with mastocytosis. Recognition of the efficacy of epinephrine in hypotension associated with mastocytosis can be important when other methods fail to restore hemodynamic stability.