帕罗西汀治疗咽异感症患者抑郁、焦虑症状的临床观察

目的 探讨帕罗西汀对咽异感症的疗效及安全性.方法 选自门诊咽异感症病人共66例,随机分为帕罗西汀组(33例)和丁螺环酮组(33例),疗程6周.采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评定临床疗效,副反应量表(TESS)评定副反应.结果 帕罗西汀组治疗前后的HAMD及HAMA评分比较有显著性差异(P＜0.01),两组问从治疗第2周末起,各时点HAMD评分有显著性差异(P＜0.05);两组问HAMA评分在治疗第2周末有显著性差异(P＜0.05);在第4、6周末无显著性差异(P＞0.05);两组间备时点TESS评分显著性差异(P＞0.05).结论 帕罗西汀在显著改善咽异感症患者抑郁症状的同时,其改善焦虑症状的疗效与抗焦虑药物丁螺环酮相当,疗效较好,副作用小.     

帕罗西汀合并加巴喷丁治疗躯体形式障碍对照研究

目的探讨帕罗西汀合并加巴喷丁治疗躯体形式障碍的疗效及安全性。方法 86例躯体形式障碍患者随机分为两组,研究组帕罗西汀合并加巴喷丁进行治疗,对照组单用帕罗西汀,疗程8周。治疗前及治疗后2、4、6、8周末分别应用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、症状自评量表(SCL-90)躯体化因子评定临床疗效,用副反应量表(TESS)评定不良反应。结果治疗后2、4、6、8周末研究组HAMD、HAMA、SCL-90躯体化因子评分与对照组有显著性差异(P0.01)。8周末研究组显效率76.74%,对照组显效率55.81%,研究组显效率高于对照组(χ2=4.214,P0.05)。不良反应均较轻,两组间比较无显著性差异。结论帕罗西汀合并加巴喷丁治疗躯体形式障碍的疗效优于单独应用帕罗西汀,且疗效出现较早,副作用无明显增加。     

帕罗西汀、阿普唑仑单一及早期联合使用治疗惊恐障碍的对照研究

目的比较帕罗西汀、阿普唑仑单一使用及早期联合使用治疗惊恐障碍急性期的临床疗效和安全性。方法将符合入组标准的90例惊恐障碍患者随机至为阿普唑仑组、帕罗西汀组和两药合用组各30例,为期12周。以临床判断和惊恐症状评定量表(PASS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评定临床疗效,以副反应量表(TESS)评定药物不良反应。结果在治疗第1周末,阿普唑仑组及合用组PASS、HAMA、HAMD评分即出现明显改善,帕罗西汀组在第4周评分才开始有改善(HAMD为第3周),至治疗结束,3组间PASS总分差异无统计学意义;阿普唑仑组、帕罗西汀组及合用组有效率(%)及治愈率(%)分别为88.9,89.3,92.9,和59.3,60.7,60.7,差异无统计学意义;阿普唑仑组、帕罗西汀组不良反应发生率为51.9%和25%,而合用组仅为14.3%,明显低于前两组。结论阿普唑仑、帕罗西汀早期联合使用治疗惊恐障碍急性期快速、安全、高效,优于单一使用。     

Risperidone Combined with Paroxetine in the Treatment of Treatment Resistant Depression.

目的 探讨利培酮合并帕罗西汀治疗难治性抑郁症的效果.方法 将56例难治性抑郁症患者随机分成两组,分别给予利培酮合并帕罗西汀(合用组)和单用帕罗西汀(单用组)治疗12周,以汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评定临床疗效,以副反应量表(TESS)和相关检查评定不良反应.结果 治疗结束时两组HAMD和HAMA的评分均明显降低,以舍用组疗效显著且快(t=3.6688,3.8299;P＜0.01).结论 利培酮合并帕罗西汀治疗难治性抑郁症的疗效优于单用帕罗西汀,且耐受性好.     

解郁丸合用氟西汀治疗重性抑郁障碍的对照研究

目的评价解郁丸合用氟西汀治疗重性抑郁障碍的疗效和安全性。方法将符合重性抑郁障碍诊断标准的74例住院患者随机分为两组,分别给予解郁丸合用氟西汀(38例)及单用氟西汀(36例)治疗6周,于治疗前和治疗后2、4、6周使用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、临床疗效总评量表的病情严重程度(CGI-SI)、副反应量表(TESS)评定疗效和不良反应。结果治疗6周后两组HAMD、HAMA评分较治疗前差异有非常显著性(t=10.62～13.70,P0.01);两组间2、4、6周HAMD评分及4、6周HAMA评分差异有显著性(t=2.27～4.61,P0.05～P0.01);研究组有效率87%,对照组有效率67%,差异有显著性(t=4.25,P0.05);两组间TESS评分差异有显著性(t=2.31,P0.05)。结论解郁丸合用氟西汀治疗重性抑郁障碍疗效较好,安全性高。     

帕罗西汀与氟西汀对脑卒中后抑郁总体康复影响的对照研究

目的：比较帕罗西汀与氟西汀（百忧解）对脑卒中后抑郁总体康复的影响。方法：将符合入组标准的脑卒中后抑郁患者随机分为帕罗西汀组,氟西汀组,用汉密顿抑郁量表（HAMD）,汉密顿焦虑量表（HAMD）,副反应量表（TESS）和改良爱丁堡与斯堪的维亚评分（SSS）进行评估。结果：帕罗西汀组与氟西汀组治疗前与治疗后第4,8周SSS评分均有显著差异,帕罗西汀组与氟西汀组之间无差异。治疗后第2周帕罗西汀组与氟西汀组HAMA评分有显著差异。结论：帕罗西汀与氟西汀均能有效地治疗脑卒中后抑郁,加快病人总体康复,帕罗西汀具有较好的治疗依从性。     

认知行为疗法合并帕罗西汀治疗重度抑郁的对照研究

目的:评价认知行为疗法合并帕罗西汀治疗重度抑郁的疗效和安全性。方法:将符合国际疾病分类(ICD-10)重度抑郁发作诊断标准的66例患者随机分为两组,研究组(n=34)给予认知行为疗法合并帕罗西汀治疗,对照组(n=32)给予帕罗西汀治疗,疗程12周。于治疗前和治疗后2、4、6、8、12周采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、临床总体印象疗效总评量表病情严重程度(CGI-SI)、不良反应量表(TESS)评定疗效和不良反应。结果:治疗前研究组和对照组的HAMD、HAMA评分差异无统计学意义(t=-0.88,0.93;P0.05)。治疗12周后,两组HAMD、HAMA评分均低于治疗前(研究组t=40.26,-27.29;P均0.01;对照组t=19.11,70.85;P均0.01);研究组6、8、12周HAMD、HAMA评分均低于对照组(t=-2.82,-2.84,-3.41;P均0.05;t=-2.14,-3.01,-3.34;P均0.05);研究组有效率高于对照组(χ2=4.799,P0.05);研究组不良反应发生率低于对照组(χ2=4.855,P0.05)。结论:认知行为疗法合并帕罗西汀治疗重度抑郁疗效较好,安全性高。     

度洛西汀与帕罗西汀治疗首诊广泛性焦虑症的对照研究

目的探讨度洛西汀与帕罗西汀治疗首诊广泛性焦虑症的临床疗效、安全性。方法将首诊的广泛性焦虑症患者随机分为两组,研究组口服度洛西汀治疗,对照组口服帕罗西汀治疗,观察8周疗效。于治疗前及治疗1周、2周、4周、8周末采用汉密尔顿焦虑量表(HAMA)和焦虑自评量表(SAS)评定临床疗效,副反应量表(TESS)评定不良反应。结果两组治疗8周末总有效率分别为度洛西汀组89.8%、帕罗西汀组87.2%。治疗1周末两组汉密尔顿焦虑量表总分均较治疗前有显著下降(P0.05或0.01),但研究组较对照组下降更显著(P0.05),随治疗时间的延续评分均呈持续性下降;两组治疗后汉密尔顿焦虑量表、焦虑自评量表总分均较治疗前有显著下降(P0.01);服药初期帕罗西汀不良反应较度洛西汀明显严重,影响治疗的依从性。结论度洛西汀治疗广泛性焦虑疗效与帕罗西汀相当,起效更快,安全性、依从性方面优于帕罗西汀。     

西酞普兰与帕罗西汀治疗老年期抑郁症的对照研究

目的 比较西酞普兰与帕罗西汀治疗老年期抑郁症的临床治疗及安全性.方法 将52例老年期押郁症患者随机分为西酞普兰组与帕罗西汀组(各26例),疗程6周.用汉密尔顿抑郁量表(HAMD)评定疗效,用副反应量表(TESS)评定不良反应.结果 西酞普兰组与帕罗西汀组的有效率分别为84.6%和80.7%,两组相仿.但治疗1、2用后,西酞普兰组的有效率高于帕罗西汀组.两组问不良反应比较差异无显著性.结论 西酞普兰是一种起效快,且安全、有效的杭抑郁药物,能用于老年期押郁症患者.     

帕罗西汀对海洛因依赖者的抑郁焦虑症状的治疗研究

目的:评价帕罗西汀对海洛因依赖者的抑郁及焦虑症状的治疗效果.方法:对103例符合诊断标准的海洛因依赖并伴焦虑抑郁者,分别应用帕罗西汀和丁螺环酮进行治疗,疗程为4周.采用HAMA及HAMD两种量表进行评定疗效 ,用TESS量表对不良反应进行评定.结果:帕罗西汀组治疗后与治疗前的HAMA及HAMD评分比较,有显著性差异(P＜0.01);两组间从治疗第1周末起,各时点HAMD评分有显著性差异(P＜0.05);两组间HAMA评分在治疗第1、2周末有显著性差异(P＜0.05),在第3、4周末无显著性差异(P＞0.05);两组间各时点TESS评分无显著性差异(P＞0.05).结论:帕罗西汀在显著改善海洛因依赖者抑郁症状的同时,其改善焦虑症状的疗效与抗焦虑药物丁螺环酮相当,疗效显著,副作用小.     

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.)     

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。     

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.     

Establishing Safety with Patients with Dissociative Identity Disorder

Abstract

The incidence of self-mutilation and suicidality among patients with dissociative disorders is quite high. It is necessary for clinicians working with this population to be adept at dealing with safety problems. This article presents a sequence of basic steps that can be used when helping dissociative patients establish safety, a discussion of the functions of self-destructiveness, and an overview of specific experiences and thinking patterns that contribute to self-destructiveness among dissociative patients.     

VACTERL with hydrocephalus: Family with X-linked VACTERL-H

We describe in a five generation family four affected males with hydrocephalus (4 offspring/4 examined) due to aqueductal stenosis (3/3), symmetrical radial ray abnormalities (4/4), renal anomalies (2/3), anal atresia (3/4), hypoplastic penis/abnormal testes (2/3), and cardiac abnormalities (1/3). X-linked inheritance seems certain in this family. These abnormalities are characteristic of the rare X-linked VACTERL-H syndrome. In addition, one maternal female cousin had a severe tracheo-esophageal fistula. This may represent partial manifestation in a female carrier. Chromosomes were apparently normal (46XY) with no spontaneous or excess induced breakages in one of the affected offspring and his mother. In the absence of a genetic marker, diagnostic ultrasonography is the investigation of choice for early in utero detection of this syndrome. A confident ultrasonographic diagnosis was possible by 20 weeks in the 2 cases examined. Am. J. Med. Genet. 76:74–78, 1998. © 1998 Wiley-Liss, Inc.     

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.