培美曲塞联合顺铂不同途径治疗晚期非小细胞肺癌疗效观察

摘 要 目的： 研究培美曲塞联合顺铂不同给药途径治疗晚期非小细胞肺癌并发恶性胸腔积液的临床疗效与不良反应,为晚期非小细胞肺癌的临床治疗提供参考。方法: 老年晚期非小细胞肺癌并发恶性胸腔积液患者48例随机分为培美曲塞联合顺铂静脉滴注组(Ⅳ组) 和培美曲塞联合顺铂胸腔灌注组(IP组)。采用不同途径给药,评价比较两组疗效与药品不良反应。结果: 两组患者疗效比较,差异无统计学意义(P>0.05);IP组生活质量改善率明显高于IV组（P<0.05）,Ⅳ组的不良反应发生率明显高于IP 组( P<0.05)。结论:培美曲塞联合顺铂胸腔灌注治疗与全身化疗治疗晚期非小细胞肺癌并发恶性胸腔积液疗效相当,但胸腔灌注治疗较全身化疗治疗具有更好的安全性和耐受性。     

培美曲塞联合奥沙利铂或顺铂一线治疗晚期肺腺癌的临床研究

目的比较培美曲塞联合顺铂和培美曲塞联合奥沙利铂一线治疗晚期肺腺癌的疗效和不良反应。方法选择经病理确诊的57例肺腺癌初治患者,随机分入PO组(培美曲塞500 mg/m2,第1天,奥沙利铂135 mg/m2,第1天,予以静脉滴注,每3周为1个疗程;n=29)和PC组(培美曲塞500 mg/m2,第1天,顺铂25 mg/m2,第1、2、3天,予以静脉滴注,每3周为1个疗程;n=28)。经两周期治疗后,评价两组疗效和不良反应。结果培美曲塞联合奥沙利铂组总反应率为37.9%,培美曲塞联合顺铂组为35.7%;培美曲塞联合奥沙利铂组临床获益率为72.4%,培美曲塞联合顺铂组为78.6%;培美曲塞联合奥沙利铂组无进展生存期为19周,培美曲塞联合顺铂组为22周;培美曲塞联合奥沙利铂组总生存期为41周,培美曲塞联合顺铂组为39周。两组比较,差异无统计学意义(P>0.05)。但培美曲塞联合奥沙利铂组患者3～4级呕吐发生率为3.4%,培美曲塞联合顺铂组为10.7%;培美曲塞联合奥沙利铂组患者3～4级中性粒细胞减少发生率为10.3%,培美曲塞联合顺铂组为21.4%,两组比较,差异有统计学意义(P<0.05)。结论使用培美曲塞联合奥沙利铂或者顺铂作为一线方案治疗晚期肺腺癌具有相同的疗效,但联合奥沙利铂具有更好的耐受性。     

培美曲塞联合顺铂与多西他赛联合顺铂一线方案治疗晚期老年肺腺癌的比较

目的 探讨培美曲塞联合顺铂与多西他赛联合顺铂一线治疗晚期老年肺腺癌的临床疗效.方法 符合入组标准的72例晚期肺腺癌患者随机分为两组,每组36例.PEM组以培美曲塞联合顺铂化疗,DXT组以多西他赛联合顺铂化疗.结果 所有患者均完成2个以上诊疗周期化疗,两组有效率、疾病控制率、中位生存期、中位无进展生存期差异无统计学意义(P＞0.05).PEM组Ⅲ-Ⅳ级毒性反应WBC、PLT减少及乏力、恶心呕吐的发生率低于DXT组(P＜0.05).结论 培美曲塞联合顺铂与多西他赛联合顺铂一线治疗老年肺腺癌临床疗效相当,但培美曲塞联合顺铂毒副反应发生率低.     

顺铂或奈达铂联合紫杉醇治疗宫颈癌的疗效比较

目的 对比分析顺铂或奈达铂与紫醇联合治疗宫颈癌的疗效。方法 选择2012年2月-2015年12月在宁强县天津医院进行诊治的宫颈癌患者160例,按照使用化疗药物的不同分为顺铂组和奈达铂组。顺铂组采取TP化疗方案,奈达铂组采取TN化疗方案,对比两组的疗效、化疗不良反应、住院时间和治疗费用。结果 顺铂组的有效率为79.26%,与奈达铂组的82.05%相比无明显差异;奈达铂组Ⅰ~Ⅳ级血红蛋白降低、白细胞减少的发生率均明显高于顺铂组（P<0.05）,但两组间Ⅲ~Ⅳ级血红蛋白降低、血小板和白细胞减少发生率无明显差异,奈达铂组Ⅰ~Ⅳ级和Ⅲ~Ⅳ级恶心、呕吐发生率均明显低于顺铂组（P<0.05）;奈达铂组患者的住院时间明显短于顺铂组（P<0.05）;奈达铂组的治疗费用与顺铂组相比无明显差异。结论 顺铂或奈达铂与紫杉醇联合应用于宫颈癌辅助化疗的疗效相似,奈达铂的胃肠道不良反应比顺铂更低,骨髓抑制尽管增加但仍可控,采用奈达铂化疗较顺铂缩短了住院时间,且住院费用并无明显增加,患者更易接受。     

培美曲塞联合顺铂或卡铂方案治疗晚期非小细胞肺癌对比分析

目的：观察顺铂／培美曲塞二钠方案与卡铂／培美曲塞二钠方案一线治疗晚期非小细胞肺癌（ NSCLC）,对比其疗效和安全性。方法使用我院电子病历系统,筛选2012年1月至2013年12月应用培美曲塞联合铂类一线治疗非小细胞肺癌的案例共71例,将其分为顺铂组（34例）和卡铂组（37例）,对比分析两组的疗效和不良反应。结果顺铂组无进展生存时间（PFS）为160d,顺铂组为150d,（P>0.05）;一年生存率为分别为50%和48.7%（P>0.05）,客观缓解率（CR+PR）分别为为26.5%和29.7%（P>0.05）;两方案Ⅲ-Ⅳ度血液毒性和肠胃道反应发生率对比差异无显著性（P>0.05）。结论两组方案在一线治疗晚期NSCLC中具有相似的疗效与不良反应。     

培美曲塞联合卡铂与吉西他滨联合卡铂一线治疗晚期非鳞非小细胞肺癌的临床观察

目的：观察培美曲塞联合卡铂与吉西他滨联合卡铂治疗晚期非鳞非小细胞肺癌（NSCLC）的近期疗效及毒副反应。方法： 57例ⅢB Ⅳ期经病理组织学和（或）细胞学检查确诊的晚期非鳞NSCLC患者,其中培美曲塞组（PC组）26例,吉西他滨组（GC组）31例,分别给予培美曲塞联合卡铂和吉西他滨联合卡铂方案治疗至少2周期以上,评价其近期疗效及毒副反应。结果： PC组和GC组的客观缓解率（42.3% vs 41.9%）,疾病控制率（88.5% vs80.6%）,中位无进展生存期（5.9 个月vs4.7 个月）差异均无统计学意义（P＞0.05）。两组的主要毒副反应均为骨髓抑制和胃肠道反应,PC组Ⅲ-Ⅳ度血小板减少的发生率明显低于GC组（P=0.042）。结论：培美曲塞联合卡铂和吉西他滨联合卡铂一线治疗晚期非鳞NSCLC疗效相近,培美曲塞组不良反应轻,安全性更好。     

培美曲塞联合顺铂一线化疗对39例老年ⅢB/Ⅳ期非小细胞肺癌患者的治疗效果

目的观察培美曲塞联合顺铂一线化疗对78例老年ⅢB～Ⅳ期非小细胞肺癌患者的治疗效果。方法选取78例非小细胞肺癌患者为研究对象,按照随机数表法将其随机分为对照组和观察组各39例,对照组给予多西他赛联合顺铂方案进行治疗,研究组给予培美曲塞联合顺铂方案进行治疗。结果观察组治疗有效率和1年内生存率均明显高于对照组(P <0.05),无进展生存时间明显长于对照组(P<0.05)。结论对老年ⅢB～Ⅳ期非小细胞肺癌患者采取培美曲塞联合顺铂一线化疗方案,可显著提升临床治疗效果,有利于延长患者无进展生存时间,提高其1年内生存率。     

培美曲塞联合顺铂对晚期非鳞非小细胞肺癌患者血清肿瘤标志物的影响

目的 探讨培美曲塞联合顺铂治疗晚期非鳞非小细胞肺癌对血清肿瘤标志物的影响。方法 采用随机抽样、随访、回顾性调查研究方法,2013年6月—2015年8月选择在重庆市开州区人民医院进行诊治的晚期非鳞非小细胞肺癌患者102例作为研究对象,根据治疗方法的不同分为观察组与对照组各51例。对照组给予紫杉醇联合顺铂的常规化疗;观察组给予培美曲塞联合顺铂治疗,21 d为1个治疗周期,两组都治疗观察4个周期。比较两组临床疗效和毒副反应情况,采用酶联免疫吸附（ELISA）法测定癌胚抗原（CEA）、载脂蛋白A1（ApoA1）表达情况,随访并比较两组的生存期。结果 治疗后观察组与对照组的总有效率分别为76.5%和41.2%,观察组高于对照组,差异有统计学意义（P<0.05）。治疗期间观察组的皮肤反应、骨髓抑制、消化道反应等毒副反应情况与对照组相比无统计学意义。观察组与对照组治疗后的CEA值都低于治疗前,同组治疗前后比较差异有统计学意义（P<0.05）;治疗后观察组的CEA低于对照组,差异有统计学意义（P<0.05）。观察组与对照组治疗后的ApoA1值都高于治疗前,同组治疗前后比较差异有统计学意义（P<0.05）;治疗后观察组的ApoA1高于对照组,差异有统计学意义（P<0.05）。观察组与对照组的中位生存期分别为（16.44±2.12）个月和（11.94±3.19）个月,KM法分析显示观察组高于对照组,差异有统计学意义（P<0.05）。结论 培美曲塞联合顺铂治疗晚期非鳞非小细胞肺癌应用能降低血清肿瘤标志物CEA表达水平,提高ApoA1表达水平,提高治疗疗效,且不会增加毒副反应的发生,从而延长患者的生存期。     

靶向联合化疗与常规化疗治疗表皮生长因子受体基因突变肺腺癌患者的临床效果

目的 探讨靶向联合化疗治疗表皮生长因子受体（EGFR）基因突变晚期肺腺癌患者的临床疗效及靶向联合化疗对EGFR基因不同突变位点患者的疗效差别。方法 选择安徽省胸科医院2016年1~12月收治确诊的64例EGFR基因检测阳性的Ⅲb/IV期肺腺癌患者,使用随机数字表方法分为靶向联合化疗组（33例）与常规化疗组（31例）,同时对靶向联合化疗组患者按照其基因突变位点不同分为3个亚组（19外显子突变组、21外显子突变组、20外显子突变组）。靶向联合化疗组患者采用EGFR受体酪氨酸抑制剂靶向治疗联合培美曲塞+卡铂/顺铂治疗,常规化疗组患者采用培美曲塞+卡铂/顺铂治疗。比较两治疗组患者的近期及远期疗效,并对靶向联合化疗组不同位点远期疗效进行数据分析。结果 靶向联合化疗组的中位无进展生存期高于常规化疗组,两组差异有统计学意义（P<0.05）,两组患者总体疗效和不良反应总发生率相似,差异无统计学意义（P>0.05）。靶向联合化疗组中,不同外显子突变的肺腺癌患者之间靶向联合化疗的生存期相似,差异无统计学意义（P>0.05）。结论 EGFR基因突变晚期肺腺癌患者接受靶向联合化疗能延长无进展生存时间,且不良反应未见增加。不同位点基因突变患者接受靶向联合化疗的临床效果无明显差别。     

培美曲塞联合铂类一线治疗晚期肺腺癌疗效

目的观察培美曲塞联合顺铂或卡铂一线治疗晚期肺腺癌的疗效及毒性反应。方法经病理确诊的晚期肺腺癌患者62例,给予培美曲塞联合顺铂或卡铂方案全身化疗。其中,培美曲塞联合顺铂治疗41例,联合卡铂21例。培美曲塞500mg/m2,顺铂75mg/m2或卡铂血药浓度-时间曲线下面积(AUC)=5。均为第1天静脉滴注,21d为1个周期,连用2-6个周期。按照实体瘤疗效标准(RECIST)进行疗效评定和按照美国癌症研究所(NCI)毒性评价标准(CTC-AE 3.0)评价毒性反应。结果 62例患者中,无完全缓解(CR)病例,部分缓解(PR)27例,稳定(SD)21例,进展(PD)14例,总有效率为43.5%,疾病控制率为77.4%。所有患者无进展生存期(PFS)为5.7个月;Cox回归多因素生存分析显示,年龄、性别、疾病分期及培美曲塞联合不同铂类对PFS无明显影响(P>0.05)。患者毒性反应较轻。结论培美曲塞联合顺铂或卡铂一线治疗晚期肺腺癌疗效较好,安全性高。     

Chlordiazepoxide antinociception: Cross-tolerance with opiates and with stress

Chlordiazepoxide (CDP) has been previously shown to possess antinociceptive properties that are resistant, except at high doses, to the opiate antagonist naloxone. The present study evaluated whether CDP's antinociceptive effects were subject to tolerance following repeated injections and whether cross-tolerance might develop between the antinociceptive action of CDP and that of either morphine or cold water swims. CDP increased flinch-jump thresholds following acute administration and exhibited tolerance following repeated injections. Neither morphine-tolerant nor cold water swim-adapted rats displayed an antinociceptive effect when tested with CDP. On the other hand, chronic pretreatment with CDP attenuated the antinociceptive effects of cold water swims, but did not produce any clear effect upon morphine analgesia.     

氯吡格雷和沙格雷酯联用致血小板减少

1例74岁女性患者行人工血管旁路移植术,术后给予肝素,约8．33U·Kg^-1·min^-1静脉泵入;氯吡格雷50mg,1次／d口服;沙格雷酯100mg,3次／d口服;华法林3mg／d口服。手术次日停用肝素,改为达肝素钠0．4ml,1次／12h皮下注射。术后第7天血小板301×10^9／L,停用达肝素钠,同时加用辛伐他汀20mg／d,氯吡格雷、沙格雷酯及华法林按原剂量口服。术后6个月停用华法林,继续口服其他3种药物,此时复查血小板计数为240×10^9／L。术后9个月复查,血小板计数降至1×10^9／L,白细胞及血红蛋白水平正常。立即停用氯吡格雷和沙格雷酯,继续口服辛伐他汀。停药4周,血小板计数恢复至156×10^9／L。     

他巴唑(MMI)与丙基硫氧嘧啶(PTU)治疗甲亢的比较和选择

目的 他巴唑(MMI)与丙基硫氧嘧啶(PTU)治疗甲亢的比较和选择.方法 选择我院2008年至2010年收治的甲亢患者52例,随机分为MMⅠ组和PTU组,治疗6月观察症状缓解,甲亢恢复情况、副作用等.结果 任何一个选择抗甲状腺药物(ATD)治疗甲亢的患者,均可使用MMI,但妊娠早期,甲亢危象,对.MMI治疗不敏感者都除外.     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

Interaction of streptonigrin with metals and with DNA.

The antitumor antibiotic, streptonigrin, interacted with zinc, copper, and manganese but not with calcium or magnesium, as indicated by spectral shifts and difference spectra. The titration data showed the formation of 1:1 complexes, and further titration continued to show spectral shifts until a molar ratio for zinc to streptonigrin of 5-10 to 1 was reached. Streptonigrin interacted with DNA only in the presence of a metal ion such as zinc. Streptonigrin titration with DNA at varying zinc molar equivalents revealed that one antibiotic molecule required 5-7 moles of zinc and 20-25 moles of DNA-phosphorus for complexation. Similar values were obtained from gel permeation chromatography.     

Comparative efficacy and tolerance of ibuprofen syrup and acetaminophen syrup in children with pyrexia associated with infectious diseases and treated with antibiotics

A double-blind, randomised, parallel group study has been done comparing the efficacy and tolerability of 7.5 mg/kg ibuprofen syrup (n=77) and 10 mg·kg^–1 acetaminophen syrup (n=77) in 154 children (6 months to 5 years) with fever (38°C) associated with infectious diseases and treated with antibiotic therapy.The area under the percentage reduction in temperature curve captured the net effect of each drug and provided the best estimate for comparison of efficacy during a defined period. Temperature evolution over time was not significantly different between the two groups. Nevertheless, the temperature reduction over the first 4 h of treatment (H0–H4) was significantly higher after ibuprofen (60%) than acetaminophen (45%). Both ibuprofen and acetaminophen were well tolerated.In conclusion, significant antipyretic activity, good tolerability and its availability as a syrup make ibuprofen an effective means of fever control in children.     

Thinking with pleasure: Experimenting with drugs and drug research

Within the field of drug and alcohol studies, researchers think about pleasure or against it; we analyse, consider, investigate, invoke or ignore it. The philosophically inclined may think of pleasure or write on it, but in each of these scenarios pleasure is kept at an arm’s length while the researcher appears to remain unmoved – detached observers, objective scientists, conceptual experts, program directors, sharp critics, policy advocates – sober judges whose sovereignty is secured by the formal conventions of positivist research, established theory, institutional authority and/or disciplinary knowledge. This paper asks what happens when pleasure is allowed to emerge as a constitutive element in the relations of drug and alcohol research. What happens when we conceive our work as thinking with pleasure, rather than simply researching pleasure or thinking about it? I return to the later work of Foucault, reading it alongside conceptions of the experiment drawn from Science and Technology Studies, arguing that both the pleasures of drug consumption and drug research might be conceived more generatively as mutually implicated in events.