促红细胞生成素及铁剂治疗肾性贫血的合理性评价

目的评价肾性贫血药物治疗方案的合理性,建立肾性贫血药物使用的临床路径,规范肾性贫血药物治疗。方法依据国内外相关指南、共识、参考文献及药品说明书建立肾性贫血药物治疗评价标准,回顾性分析肾性贫血患者的药物治疗方案(促红细胞生成素、蔗糖铁复合物和多糖铁复合物),对其合理性进行评价。结果 511例肾性贫血患者中,促红细胞生成素使用合理率为80.63%,铁剂使用合理率为48.14%,血红蛋白值与促红细胞生成素用药合理性相关(P<0.05),年龄、铁蛋白值、疾病数、是否联用促红细胞生成素与铁剂用药合理性相关(P<0.05)。结论建立的肾性贫血药物治疗方案合理、标准明确、简单易行,为肾性贫血规范化治疗提供参考。     

两种补铁方法对血透患者肾性贫血40例疗效观察

贫血是慢性肾衰的重要并发症,应用促红细胞生成素(EPO)治疗慢性肾衰肾性贫血可明显提高患者的生活质量及成活率,但许多患者对促红细胞素治疗无反应或疗效差,而补充铁剂对提高促红细胞生成素疗效至关重要,以往绝大多数临床上使用的是口服铁剂右旋糖酐铁,但副作用较大,疗效也不是     

中西医结合治疗肾性贫血50例临床观察

贫血是慢性肾脏病患者的常见并发症,基因重组人类促红细胞生成素（rHuEPO）的应用使肾性贫血的治疗有了很大的改观,但疗效尚不能完全令人满意。我们从2007年7月至2008年12月在使用rHuEPO和口服铁剂、叶酸及维生素B12的基础上加用自拟补肾健脾化浊养血汤治疗肾性贫血,取得了较满意的疗效。     

关注肾性贫血

何谓肾性贫血肾脏是体内合成促红细胞生成素的重要器官,肾脏功能受损可导致促红细胞生成素生成减少,进而发生肾性贫血。所以肾性贫血是慢性’肾脏病患者常见的临床表现。慢性肾脏病的不同阶段均可以合并不同程度的贫血,且贫血现象随着肾功能的减退而加重。据统计,约50％未接受透析的慢性肾脏病患者存在贫血,透析患者的贫血发生率更高。     

促红细胞生成素联合静脉铁剂治疗肾性贫血的临床观察

目的探讨使用促红细胞生成素联合静脉铁剂治疗慢性肾功能衰竭患者肾性贫血的疗效及不良反应。方法收集本院肾病科69例慢性肾功能衰竭患者入组。静脉滴注蔗糖铁100mg/次,每周两次,总量600～1000mg。同时皮下注射促红细胞生成素150U/(kg w)。观察6周。治疗期间间隔两周抽静脉血测血红蛋白(Hb)、红细胞比容(Hct)、铁蛋白(SF)、转铁蛋白饱和度(TSAT)等指标。结果治疗第四周后患者的Hb、Hct、SF、TSAT均明显升高,与治疗前相比,有显著差异。未发生不良反应。结论促红细胞生成素联合静脉铁剂治疗慢性肾功能衰竭患者肾性贫血代替口服补铁及传统的输血治疗,疗效更稳定、持久,避免输血相关的并发症及传染病,解决了临床用血紧张的困难。     

肾性贫血患者静脉铁剂使用中值得关注的问题

慢性肾脏疾病(CKD)患者贫血治疗使用促红细胞生成素(EPO)同时需常规补充铁剂.静脉铁剂在提高CKD患者对EPO的反应、减少EPO用量、达到并维持血红蛋白靶目标方面的疗效优于口服铁剂,其生物利用度高,起效快,无胃肠道刺激,已成为肾性贫血患者的重要治疗方案.本义简要阐述肾性贫血患者临床静脉铁剂使用情况,探讨需引起注意的若干问题.     

归脾汤加减治疗肾性贫血的效果及对促红细胞生成素水平的影响

目的:总结分析归脾汤加减治疗肾性贫血的效果及对促红细胞生成素水平的影响。方法:选择我院2020年5月—2021年5月期间收治的120例肾性贫血者为研究对象,均合并存在慢性肾衰竭症状,随机性分组后,观察组和对照组各60例,两组都积极补充铁剂、护肾、排毒、降压,对照组应用促红细胞生成素治疗,观察组联合运用促红细胞生成素与归脾汤。治疗2个疗程后观察两组EPO(促红细胞生成素)水平、Hb(血红蛋白)、HCT(红细胞压积)等指标。结果:(1)治疗后观察组EPO、Hb、HCT、SF明显高于对照组,BUN、Scr明显低于对照组,差异明显(P<0.05);(2)观察组治疗总有效率为85.00%,高于对照组（P<0.05）。结论：归脾汤加减治疗肾性贫血的效果显著,且安全可靠,同时可以提升机体促红细胞生成素水平,减少治疗中促红细胞生成素的用量,值得推广使用。     

新型静脉用铁补充剂Ferumoxytol

慢性肾脏病（CKD）4、5期患者往往合并。肾性贫血,需要应用促红细胞生成素（EPO）治疗,而EPO起效的一个重要基础是患者体内要有充足的铁。在诊断患者缺铁后需要给予补铁治疗。补铁可以选择口服铁剂,服用简便且患者依从性较好,但口服铁剂生物利用度较低,胃肠道不良反应发生率高,难以达到理想的疗效。美国肾脏病基金会透析指南（K／DOQI）提出,采用静脉补铁才符合治疗的要求。     

持续性促红细胞生成素受体激活剂联合铁剂治疗慢性肾脏病透析患者肾性贫血的疗效观察

目的：观察联合促红细胞生成素受体激活剂和铁剂治疗维持性血液透析患者肾性贫血的疗效与安全性。方法将82例血液透析患者随机分为观察组和对照组,每组各41例。观察组联合使用促红细胞生成素受体激活剂和琥珀酸亚铁。对照组仅口服用琥珀酸亚铁200 mg,每日3次。所有患者治疗持续时间的长度为24周。观察并比较两组患者治疗贫血的效果、铁代谢指标的变化及不良反应发生的情况。结果治疗后两组患者血红蛋白、血细胞比容和血清铁蛋白均较治疗前升高,但对照组升高不明显,升高幅度两组相比差异有统计学意义（P ＜0．05）。不良反应发生情况观察组发生率明显低于对照组。结论持续性促红细胞生成素受体激活剂治疗慢性肾脏病透析患者肾性贫血疗效满意,不良反应轻微,值得推广。     

肾康注射液辅助治疗慢性肾功能衰竭并肾性贫血30例

目的 观察肾康注射液治疗慢性肾功能衰竭(CRF)并肾性贫血的临床疗效。方法 将60例慢性肾功能衰竭并肾性贫血患者随机分为治疗组和对照组,各30例,均给予重组人促红细胞生成素(r Hu EPO)注射液及口服铁剂等治疗,治疗组加用肾康注射液。观察两组治疗前后血红蛋白(Hb)、血细胞比容(Hct)、血清肌酐(SCr)、血尿素氮(BUN)等指标的变化情况。结果 治疗组的肾性贫血和肾功能指标改善均明显优于对照组(P<0.05)。结论 肾康注射液治疗慢性肾功能衰竭并肾性贫血,疗效显著,值得临床推广。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.