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1.
目的探讨不同剂量他汀类药物短期治疗后降脂疗效的差异,他汀类血药浓度与降脂疗效以及药物不良反应的关系。方法连续入选2010年8月至2011年4月于北京大学人民医院心内科住院治疗且近期未服用他汀类药物的高胆固醇血症患者153例,按随机数字表法分为4组,分别给予辛伐他汀20 mg、40 mg、阿托伐他汀10 mg、20 mg降脂治疗。测量治疗前及治疗1周后晨起空腹血脂水平及治疗1周后血药浓度血脂水平,同时观察治疗期间药物不良反应。结果不同剂量的辛伐他汀与阿托伐他汀用药1周均能有效降低TC及LDL-C水平(均为P<0.01)。与辛伐他汀10 mg组相比,辛伐他汀20 mg组的LDL-C及TC的下降幅度增加了7.1%和3.3%(P=0.156,P=0.104);与阿托伐他汀10 mg组相比,阿托伐他汀20 mg组的LDL-C及TC的下降幅度增加了1.5%和0.5%(P=0.352,P=0.259)。所有高危患者组较极高危患者组的LDL-C达标率更高(71.0%比32.8%,P<0.001)。不同剂量的辛伐他汀与阿托伐他汀用药1周后血药浓度比较,差异均无统计学意义,阿托伐他汀10 mg组的血药浓度与LDL-C下降幅度相关(均为P<0.05)。辛伐他汀与阿托伐他汀的血药浓度与药物不良反应无相关性。结论临床常规剂量范围内,不同剂量的辛伐他汀及阿托伐他汀短期治疗均能有效降低血脂水平。辛伐他汀及阿托伐他汀的血药浓度与药物不良反应无相关性。  相似文献   

2.
阿托伐他汀治疗高脂血症的疗效和安全性   总被引:46,自引:0,他引:46  
目的 评价阿托伐他汀(北京红惠生物制药股份有限公司生产,商品名阿乐)治疗高脂血症,特别是高胆固醇血症和混合型高脂血症的疗效和安全性。方法 211例高脂血症患者随机分为两组A组阿托伐他汀组110例(高胆固醇血症和混合型高脂血症分别为58例和52例),给予阿托伐他汀10mg/d;B组辛伐他汀组101例(高胆固醇血症和混合型高脂血症分别为48例和53例),给予辛伐他汀10mg/d。4周后如未达有效标准,均可加量至20mg/d,治疗8周,观察降脂疗效和不良反应。结果 高胆固醇血症用阿托伐他汀治疗,总胆固醇(TC)从(6.59±0.66)mmol/L降至(4.62±1.45)mmol/L(下降29.9%);低密度脂蛋白胆固醇(LDL-C)从(4.02±0.77)mmol/L降至(2.44±0.64)mmol/L(下降39.3%);(TC-HDL-C)/HDL-C从3.93±1.22降至2.37±1.54(下降39.7%)(P均<0.01)。阿托伐他汀降低LDL-C;(TC-HDL-C)/HDL-C作用优于同剂量的辛伐他汀(P均<0.05)。对于混合型高脂血症患者,阿托伐他汀可使甘油三酯(TG)从(3.17±0.97)mmol/L降低至(2.21±1.03)mmol/L(P<0.05),作用亦明显优于辛伐他汀(P<0.05)。结论 (1)阿托伐他汀有明显的降低TC、LDL-C、TG和(TC-HDL-C)/HDL-C作用,降低LDL-C、TG和(TC-HDL-C)/HDL-C作用明显优于同剂量的辛伐他汀,升高HDL-C作用则两组相似;(2)阿托伐他汀不良反应较轻微;(3)阿托伐他汀可用于高胆固醇血症和混合型高脂血症的治疗;(4)推荐常规剂量10mg/d,少数TC、LDL-C较高者可用20mg/d治疗。  相似文献   

3.
阿托伐他汀治疗原发性高脂血症的疗效评价   总被引:1,自引:0,他引:1  
目的评价阿托伐他汀治疗原发性高脂血症的疗效。方法 60例原发性高脂血症患者随机分为两组,在常规低脂饮食的基础上,治疗组服用阿托伐他汀10 mg,对照组服用辛伐他汀10 mg,均每晚1次,疗程8周。评价两组治疗前后血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平的变化。结果服药8周末与治疗前相比,两组TC、TG、LDL-C均显著下降(P〈0.05),HDL-C均明显上升(P〈0.05),但以治疗组更为显著。结论阿托伐他汀治疗原发性高脂血症疗效好。  相似文献   

4.
目的:研究阿托伐他汀联用烟酸缓释片治疗冠心病合并高脂血症的临床疗效及安全性。方法:入选60例冠心病合并高脂血症患者,随机分为2组即阿托伐他汀组和联合用药组,前者服用阿托伐他汀片,后者服用阿托伐他汀片联合烟酸缓释片,疗程均8周。服药前、服药4周及8周分别测定TC、TG、HDL-C、LDL-C值。结果:联合用药组降低LDL-C的能力优于阿托伐他汀组(P<0.05),升高HDL-C的能力明显优于阿托伐他汀组(P<0.01),降低TC的能力治疗8周后优于阿托伐他汀组(P<0.05)。其总有效率达96.7%,高于阿托伐他汀组86.7%(P<0.05)。无明显不良反应发生。结论:阿托伐他汀联合烟酸缓释片治疗冠心病合并高脂血症血脂达标率高,具有良好的临床疗效,安全性好。  相似文献   

5.
目的初步了解2007年血脂异常防治指南颁布后老年患者的调脂治疗达标情况。方法选择2009年2~7月在我院老年病房住院并服用他汀类药物治疗4周以上的男性患者144例,按照2007年中国成人血脂异常防治指南危险分层方案,分为高危组(65例)和极高危组(79例),并按指南规定的不同危险分层血脂控制目标值,判断调脂治疗是否达标,分析可能影响达标率的因素。结果高危组与极高危组患者多数服用阿托伐他汀治疗,平均治疗剂量差异无统计学意义。服药4周后,2组间TC、LDL-C、TG及HDL-C水平差异无统计学意义。TC总达标率为41.7%,LDL-C总达标率为54.9%,TC+LDL-C总达标率为41.7%。高危组TC、LDL-C及TC+LDL-C达标率分别为67.7%、70.8%和66.2%;极高危组达标率分别为20.3%、41.8%和21.5%(P0.05)。多因素logistic回归分析显示,极高危组达标率与年龄、冠心病、高血压、糖尿病、周围血管疾病及糖尿病控制情况无明显相关性。结论目前,老年患者的调脂治疗达标率仍较低,与指南要求存在较大差距,其中的影响因素值得进一步探讨。  相似文献   

6.
目的探讨高龄冠心病患者应用他汀类药物(阿托伐他汀、普伐他汀和瑞舒伐他汀)的疗效及安全性。方法回顾性分析于中南大学湘雅医院门诊或住院服用他汀类药物年龄≥80岁冠心病患者174例,根据服用他汀类药物种类分为3组:阿托伐他汀组58例,剂量为20mg/d;普伐他汀组55例,剂量为40mg/d;瑞舒伐他汀组61例,剂量为10mg/d。观察治疗前和治疗6个月后的血脂达标率、丙氨酸转氨酶(ALT)、肌酸激酶(CK)、血肌酐水平变化及1年内的心脑血管事件发生等情况。结果与治疗前比较,治疗后阿托伐他汀组、普伐他汀组、瑞舒伐他汀组LDL-C(31.03%vs 15.52%、21.82%vs 7.27%、27.87%vs 9.84%)和非HDL-C(58.62%vs 37.93%、43.64%vs25.45%、65.57%vs 31.15%)达标率均有显著提高,差异有统计学意义(P0.05,P0.01)。3组治疗前后ALT、CK和血肌酐无显著差异(P0.05)。治疗后1年内,阿托伐他汀组、普伐他汀组、瑞舒伐他汀组主要心脑血管事件发生率分别为18.97%、23.64%、16.39%,死亡事件(冠心病死亡和全因死亡)的发生率分别为5.17%、5.45%、4.92%,3组比较差异无统计学意义(P0.05)。结论高龄冠心病患者应用中等剂量的阿托伐他汀、普伐他汀、瑞舒伐他汀调脂治疗,其临床获益肯定,并且总体上是安全的。  相似文献   

7.
阿托伐他汀治疗原发性高脂血症疗效观察   总被引:2,自引:0,他引:2  
目的评价阿托伐他汀的调脂作用和安全性.方法60例原发性高脂血症病人,随机分为两组:阿托伐他汀组30例,给予阿托伐他汀10 mg/d,展起顿服;辛伐他汀组30例,给予辛伐他汀20 mg/d,睡前顿服.均治疗8周,观察降脂疗效和不良反应.结果阿托伐他汀组:总胆固醇(TC)下降30.72%;低密度脂蛋白胆固醇(LDL-C)下降39.44%,(TC-HDL-C)/HDL-C下降44.7%.各项指标治疗前后比较有统计学意义(P均<0.001).与辛伐他汀组比较,治疗后各项指标下降幅度均无统计学意义(P>0.05).结论阿托伐他汀可降低TC、LDL-C、(TC-HDL-C)/HDC-C、TG指标,与辛伐他汀作用相似,且不良反应轻微,可用于高胆固醇血症的治疗.  相似文献   

8.
目的观察阿托伐他汀治疗高脂血症的疗效及安全性。方法将78例高脂血症患者随机分为两组:治疗组40例,每晚餐前口服阿托伐他汀20mg,对照组38例,每晚餐前口服辛伐他汀20mg,持续8周,观察服药前及服药第8周血脂指标(TG、TC、LDL-C、HDL-C)、肝、肾功能、肌酸激酶、心电图等变化及不良反应。结果治疗后TC、TG、LDL-C及HDL-C水平与治疗前比较差异均有统计学意义(P0.05);同时还观察到心电图较用药前均有不同程度的改善,且无明显不良反应。结论阿托伐他汀有明显的降低TC、LDL-C、TG和升高HDL-C的作用,并能使冠心病患者的心电图改善,且不良反应轻微,使用安全。  相似文献   

9.
氟伐他汀和辛伐他汀治疗原发性高胆固醇血症的比较   总被引:2,自引:0,他引:2  
目的比较氟伐他汀和辛伐他汀治疗原发性高胆固醇血症的疗效和安全性。方法72例原发性高胆固醇血症的患者随机分为氟伐他汀组,辛伐他汀组,两组剂量为20mg,每日一次,疗程8周,治疗前后分别测TC、TG、HDL-C、LDL-C、ALT、AST。结果治疗8周后TC、LDL-C、TG与治疗前比较均有显著下降(P<0.05),HDL-C无明显升高(P>0.05)。两组间比较无明显差异,未见明显不良反应。结论氟伐他汀、辛伐他汀治疗原发性高胆固醇血症疗效好且安全,耐受性良好。  相似文献   

10.
目的探讨阿托伐他汀对急性冠状动脉综合征(ACS)患者血清C-反应蛋白(CRP)水平的影响。方法66例ACS患者随机分为常规治疗组(30例)和阿托伐他汀治疗组(36例),30例健康人为对照组。阿托伐他汀治疗组于常规治疗基础上加用阿托伐他汀40mg/d,疗程为两周。两组均于治疗前和治疗结束时测定血清CRP、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)浓度。结果阿托伐他汀组治疗两周后,CRP、TC、TG、LDL-C较治疗前下降(P<0.05 ̄0.01)。常规组治疗前后无明显变化(P>0.05)。阿托伐他汀组治疗后CRP与TC、LDL-C水平变化无相关性。结论在ACS早期给予大剂量阿托伐他汀治疗,使CRP水平下降,可能有利于抑制炎症反应,稳定斑块。  相似文献   

11.
目的观察小剂量辛伐他汀在军队离退休老干部中的调脂疗效及减少心血管事件危险性的作用。方法选择北京军区驻京部分离退休老干部综合干预中TC控制未达标者,且从2002年6月~2006年12月服用辛伐他汀10~20 mg/d的冠心病及其高危患者245例作为辛伐他汀组。同期未进行综合干预、未服用他汀类药物的冠心病及高危患者221例作为对照组,并进行对比分析。结果与基线比较,研究结束时辛伐他汀组TC、LDL C、TG分别下降了21.24%、34.09%和18.44%(P<0.01),HDLC下降了3.10%(P>0.05);对照组TC、LDL-C分别下降了3.11%、4.34%(P<0.05),TG下降了10.50%(P>0.05),HDL-C下降了10.24%(P<0.01)。与对照组比较,辛伐他汀组TC、LDLC分别下降了18.13%、29.75%(P<0.01),TG下降了7.94%(P<0.05),HDL-C上升了7.14%(P<0.01);心血管事件危险性降低了43.21%(P<0.05),脑卒中危险性降低了35.58%(P>0.05)。结论小剂量辛伐他汀在老年血脂异常人群中的调脂效果显著,心血管事件危险性明显降低。  相似文献   

12.
We compared the effects of five different statins (atorvastatin, simvastatin, pravastatin, lovastatin, and fluvastatin) on the lipid, lipoprotein, and apolipoprotein (apo) A-I-containing high-density lipoprotein (HDL) subpopulation profiles of 86 coronary heart disease (CHD) patients. Patients with established CHD, and low density lipoprotein (LDL) cholesterol (C)>130 mg/dl, and triglyceride (TG)<400 mg/dl, were treated with atorvastatin 20, 40, and 80 mg/day and one of the other four statins at 20, 40, and when available 80 mg/day in increasing doses (4 weeks of each dose) in a randomized crossover fashion. There was an 8-week placebo controlled washout period between different drug treatments. All five statins on each dose resulted in significant reductions in total- and LDL-C compared to placebo treatment. There were also decreases in plasma TG and increases in HDL-C and apoA-I concentrations, but not all treatments changed these parameters significantly. Each statin except fluvastatin improved the HDL subpopulation profile by increasing the concentrations of the large, cholesterol-rich, LpA-I alpha-1 and prealpha-1 HDL subpopulations. CHD patients have significantly lower concentration of the large, LpA-I alpha-1 HDL particles compared to controls. Our data indicate that statins which are the most effective in lowering LDL-C and TG are also the most effective agents in modifying the HDL subpopulation profile in CHD patients towards the patterns found in healthy individuals. The order of efficacy of statins in increasing alpha-1 HDL subpopulation was: atorvastatin, simvastatin, pravastatin, lovastatin and fluvastatin.  相似文献   

13.
This study compared the effects of fluvastatin and pravastatin on the in vivo oxidation of LDL in a crossover design to evaluate whether or not it is justified to switch between the two statins with regard to serum levels of lipids, lipoproteins, and apolipoproteins (apo), and circulating autoantibodies to oxidized LDL (OxLDL-Ab). Patients with hypercholesterolemia (n = 46) were randomly assigned into groups who received fluvastatin (20 mg/d) or pravastatin (10 mg/d). After 3 months, they were crossed to receive the other statin for another 3 months. Circulating levels of OxLDL-Ab were measured by an OxLDL IgG ELISA test. Fluvastatin and pravastatin similarly decreased serum levels of total cholesterol (TC), LDL-C, and apo B, and increased HDL(2)-C levels. After crossover to the other statin, these lipid parameters were not further changed by either statin. Before crossover, circulating levels of OxLDL-Ab were decreased in patients with fluvastatin treatment, but not in those with pravastatin treatment. After switching from the other statin, both fluvastatin and pravastatin further decreased OxLDL-Ab levels. In conclusion, fluvastatin at 20 mg/d and pravastatin at 10 mg/d are similar with regard to their efficacy in decreasing TC, LDL-C, and apo B levels and increasing HDL(2)-C levels. Fluvastatin lowered circulating levels of OxLDL-Ab, and these effects continued after switching to pravastatin.  相似文献   

14.
辛伐他汀对高脂血症患者载脂蛋白E的影响   总被引:7,自引:0,他引:7  
目的探讨辛伐他汀对高脂血症患者血清总载脂蛋白E(apoE)水平的影响。方法40例高脂血症患者每晚顿服辛伐他汀10mg4周,比较服药前后血清甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、apoA1、apoB、apoE及脂蛋白(a)〔Lp(a)〕水平的变化。结果用药后血清TC及TG分别下降21.3%及9.2%(P<0.001,<0.05),LDL-C下降24.7%(P<0.01),apoB及apoE分别下降13.8%及34.7%(P<0.05,<0.001),apoA1增加7.5%(P<0.05)。apoE下降幅值分别与其自身基础值和TG及LDL-C基础值呈正相关(P<0.01,<0.01,<0.05)。HDL-C呈增高趋势,Lp(a)改变无统计学差异。结论辛伐他汀能导致血清apoE水平显著下降其可能参与了抗动脉粥样硬化过程。  相似文献   

15.
INTRODUCTION: Major cardiac events are strongly associated with high levels of low-density lipoprotein cholesterol (LDL-C) and low levels of high-density lipoprotein cholesterol (HDL-C). The HDL-C target level (40 mg/dl) is often not achieved with statins. The aim of this study was to compare the proportions of patients achieving the HDL-C target levels after one year of treatment with statins or fibrates. Furthermore, a subgroup with low HDL-C levels during statin treatment was investigated and suggestions are made for a better management of these patients. METHODS: A survey of lipid levels, cardiovascular disease and risk factors in 120 outpatients treated with a statin or a fibrate for hyperlipidaemia (total cholesterol (TC) > 250 mg/dl or triglycerides (TG) > 200 mg/dl after diet). After one year of treatment the proportions of patients achieving the target levels for TC, LDL-C, HDL-C,TG,TC/HDL-C and LDL-C/HDL-C are compared for statins and fibrates. RESULTS: The proportions of patients achieving the target lipid levels with statins or fibrates are comparable except for HDL-C. Compared to the baseline, the proportion of patients achieving the HDL-C target level of 40 mg/dl increases only by 8.3% for statins and by 42.9% for fibrates. In total, 38.5% of the statin group had low HDL-C-levels after one year of treatment. Among these patients, eight were treated with a fibrate before the statin and six were treated with a fibrate afterwards. In those 14 patients, mean HDL-C increased during fibrate treatment by 48.5% and TC/HDL-C and LDL-C/HDL-C decreased by 25.7 and 26.5%, respectively as compared with statins. CONCLUSIONS: Patients with low levels of HDL-C during statin treatment had far better levels of HDL-C, TC/HDL-C and LDL-C/HDL-C with fibrates. A randomised double-blind crossover trial with simvastatin and fenofibrate has been initiated to corroborate these findings.  相似文献   

16.
目的评价依折麦布联合辛伐他汀对冠心病高脂血症患者的疗效及安全性。方法入选2011年6月至2013年8月在北京军区总医院干一科住院的冠心病高脂血症患者60例。随机分为对照组和治疗组,每组30例。检测患者治疗前后总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)水平,观察并记录不良反应。结果在对照组中,与治疗前比较,治疗后TC、TG和LDL-C均降低,差异具有统计学意义(P均0.05)。在治疗组中,与治疗前比较,治疗后TC、TG和LDL-C均降低,差异具有统计学意义(P均0.05)。与对照组治疗后比较,治疗组TC[(4.10±1.24)mmol/L]、TG[(1.64±0.75)mmol/L]和LDL-C[(2.33±0.75)mmol/L]均降低,差异具有统计学意义(P均0.05)。药物降脂治疗后,对照组LDL-C的达标率为46.7%,治疗组为76.7%,差异有统计学意义(P0.05)。结论依折麦布联合辛伐他汀可达到强化降脂的效果,疗效优于单独应用辛伐他汀,且不良反应较少。  相似文献   

17.
目的探索依折麦布联合普伐他汀治疗高胆固醇血症的临床疗效。方法选择符合高胆固醇血症的患者180例,男女各90例,在合理的饮食、生活习惯和体育运动下,分为三组,每组男女平衡:A组为单用依折麦布治疗组60例:B组为单用普伐他汀治疗组60例;C组为依折麦布联合普伐他汀治疗组60例。观察三组血清总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、高密度脂蛋白胆固醇(high—density lipoprotein cholesterol,HDL—C)、载脂蛋白B(apoprotein B,Apo—B)及三酰甘油(triacylglycerol,TG)等治疗前、后的变化,并记录不良反应。结果三组治疗后血清TC、LDL—C、Apo-B、TG浓度均能降低,血清HDL—C浓度均能升高,但以C组更明显(P〈0.05);C组总有效率达91.7%,优于A、B组。结论依折麦布联合普伐他汀具有良好的药物协同效应,可有效调节胆固醇代谢,效果明显优于单独使用,可避免大剂量他汀类药物的不良反应。  相似文献   

18.
Recently, it has been reported that circulating oxidized low-density lipoprotein (Ox-LDL) might be a pivotal indicator for coronary artery disease and the severity of acute coronary syndromes. The purpose of this study was to investigate the effects of statins on Ox-LDL in patients with hypercholesterolemia. Sixteen patients with hypercholesterolemia were randomly assigned to 2 groups, one received 10 mg of pravastatin (n = 8) and the other received 20 mg of fluvastatin (n = 8). The plasma level of Ox-LDL was measured using a newly developed sandwich enzyme-linked immunosorbent assay (ELISA) method. There were no differences between the two groups in Ox-LDL, total cholesterol (TC), or LDL cholesterol (LDL-C) at the baseline. The reduction in Ox-LDL in the fluvastatin group was significantly higher than that in the pravastatin group (47.5% versus 25.2%, P = 0.033). The reductions in TC and LDL-C did not differ between the two groups. CONCLUSION: The present study has shown for the first time that the level of circulating Ox-LDL was significantly decreased by treatment with statins. In addition, the lowering effect of statins on the circulating Ox-LDL was independent of their lipid-lowering effect. Fluvastatin was more effective than pravastatin with regard to decreasing the circulating Ox-LDL.  相似文献   

19.
不同剂量辛伐他汀调脂治疗冠心病的疗效及安全性研究   总被引:6,自引:0,他引:6  
目的 观察冠心病 (CHD)患者中 ,辛伐他汀不同剂量调脂的有效性和安全性。方法 选择确诊为CHD的 114例患者 ,随机 (计算机数字表 )、开放分为辛伐他汀 2 0mg组 (n =5 8)和 10mg组 (n =5 6 ) ,年龄 40~ 86岁 ,平均年龄(6 0 .7± 9.7)岁。均为每晚服药 1次。分别于用药前、用药后第 6、12、2 4周空腹采静脉血清 ,以酶法测定总胆固醇(TC)、低密度脂蛋白胆固醇 (LDL C)、高密度脂蛋白胆固醇 (HDL C)、甘油三酯 (TG)以及肝、肾功能等。结果  (1)用药第 6周始 ,两组TC和LDL C均比用药前明显下降 ,且一直保持到用药 2 4周末 (P均 <0 .0 5 )。 (2 )第 6、12、2 4周的TC、LDL C水平 ,在 2 0mg组比 10mg组明显低 (P <0 .0 5 )。 (3) 2 4周TC达标率 ,2 0mg组明显高于 10mg组(78.2 %比 5 2 .9% ,P <0 .0 5 )。 (4 )两组间谷丙转氨酶 (ALT)升高等副作用未见明显差异。结论  2 0mg辛伐他汀能够安全而且更有效地降低TC和LDL C水平 ,使更多的CHD患者的血清胆固醇达到理想标准水平  相似文献   

20.
张云  孙一荣  陈立 《山东医药》2009,49(29):17-19
目的观察强化调脂对老年冠心病患者的治疗作用。方法将120例老年冠心病患者随机分为强化组和常规组各60例,分别给予辛伐他汀40 mg/d和20 mg/d。治疗1、3、6及12个月进行随访,观察两组的血脂水平、血脂达标率和心脏事件发生情况。结果两组用药后TC、TG、LDL-C、hs-CRP水平均明显低于用药前(P均〈0.01),而且强化组的下降程度大于常规组(P均〈0.05)。两组用药6个月后血脂达标率强化组明显高于常规组(31%vs 8%),心脏事件发生率强化组低于常规组(12%vs 28%)(P〈0.01或〈0.05)。结论强化调脂可通过降低TC、TG、LDL-C、hs-CRP水平改善老年冠心病患者血液流变学状态,从而改善心肌供血,抑制冠心病的发生发展过程。  相似文献   

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