稳心颗粒与美托洛尔联用治疗缺血性快速心房纤颤的临床观察

目的观察步长稳心颗粒与美托洛尔联用治疗缺血性心脏病合并快速心房纤颤(缺血性快速房颤)的临床疗效和不良反应。方法将61例缺血性快速房颤患者随机分成两组,治疗组30例,对照组31例。治疗组予步长稳心颗粒9g/次,3次/d,冲服;美托洛尔12.5mg/次,2次/d,口服。对照组予美托洛尔12.5mg/次,2次/d,口服。两组疗程均为4周。观察用药前后疗效与不良反应。结果症状疗效:治疗组总有效率96.67%,对照组总有效率77.42%,两组比较差异有统计学意义(P<0.05);快速房颤情况疗效比较:治疗组总有效率90.00%,对照组总有效率67.74%,两组比较差异有统计学意义(P<0.05);药物不良反应发生率:治疗组6.67%,对照组12.90%,两组比较差异无统计学意义(P>0.05),其中对照组发生2例致心律失常(1例房颤合并Ⅱ度Ⅱ型房室传导阻滞,1例房颤合并高度房室传导阻滞),治疗组未见此情况发生。两组治疗后实验室检查无明显变化。结论步长稳心颗粒与美托洛尔联用治疗缺血性快速房颤不但安全有效,而且步长稳心颗粒还能有效减少西药抗心律失常药物所引起的不良反应。     

步长稳心颗粒治疗心律失常的疗效观察

目的观察步长稳心颗粒治疗心律失常的疗效及安全性。方法将90例心律失常患者随机分为治疗组和对照组。治疗组患者给予步长稳心颗粒1包（9g），3次／d，口服，对照组常规服用心律平100mg／次，3次／d，口服，治疗4周后，观察临床疗效及24h Holter动态心电图的变化，以评估其安全性。结果两组患者心电图疗效、临床疗效差异有显著性意义（P〈0．05）。结论步长稳心颗粒治疗心律失常与对照组比较疗效显著，使用简单安全，效果显著。     

中西医结合治疗心律失常65例临床观察

目的观察步长稳心颗粒与美托洛尔联合治疗心律失常的疗效。方法将65例心律失常患者随机分为治疗组(步长稳心颗粒+美托洛尔)35例和对照组(美托洛尔)30例,治疗4周,对动态心电图和临床症状进行观察。结果步长稳心颗粒+美托洛尔组对心律失常的疗效明显高于单用美托洛尔的疗效。结论步长稳心颗粒+美托洛尔治疗心律失常有较高的临床应用价值。     

稳心颗粒对室性早搏病人心率及主要症状改善的观察

目的观察稳心颗粒对室性早搏病人心率及主要症状改善的情况。方法将病人按随机分组原则分为3组,稳心颗粒组9g开水冲服,每天3次,经4周治疗后,效果不显著者加美托洛尔（倍他乐克）12.5mg口服,每天2次;倍他乐克组予口服倍他乐克12.5mg,每天2次;经治疗4周后无明显效果者加稳心颗粒9g开水冲服,每天3次;倍他乐克加稳心颗粒组,稳心颗粒9g开水冲服,每天3次,并加倍他乐克12.5mg口服,每天2次,其他情况处理3组相同。疗程均为8周。结果采用稳心颗粒加倍他乐克组治疗后病人心律失常、临床症状、早搏次数等方面,疗效优于稳心颗粒组和倍他乐克组。结论稳心颗粒与倍他乐克合用治疗室性早搏疗效确切。     

美托洛尔联合稳心颗粒治疗不适当窦性心动过速的临床研究

目的观察美托洛尔联合稳心颗粒治疗不适当窦性心动过速的临床疗效。方法选择不适当窦性心动过速患者12例,随机分为治疗组7例和对照组5例。两组均口服美托洛尔,从12.5mg/次,2次/d开始,根据病情调整剂量。治疗组同时给予稳心颗粒口服,每次1袋(9g),3次/d。2组均以4周为l疗程。比较2组治疗前后临床症状、心动过速变化及美托洛尔总剂量情况。结果治疗组临床症状改善总有效率为100%,对照组临床症状改善总有效率为80%(P0.05)。治疗组平均心率低于对照组(P0.05)。治疗组美托洛尔总剂量低于对照组。结论稳心颗粒与美托洛尔联合治疗不适当窦性心动过速有效并且安全性高。     

步长稳心颗粒治疗心律失常疗效观察

目的 观察心律失常患者应用步长稳心颗粒后心律失常控制情况.方法 将160例心律失常患者随机分为治疗组80例,对照组80例,治疗组应用稳心颗粒口服,1袋∕次,3次/d,治疗4周;对照组口服心律平150mg,3次/d,治疗4周.结果 两组临床症状改善比较,治疗组总有效率为92.5%,高于对照组的81.0%(P＜0.05);动态心电图疗效比较,治疗组总有效率为90.0%,对照组为72.5%,差异有统计学意义(P＜0.05).结论 步长稳心颗粒对各种心律失常均有较好的疗效,且无明显的不良反应,可作为治疗心律失常的首选中成药物.     

稳心颗粒治疗阵发性心房纤颤疗效及安全性研究

目的探讨阵发性心房纤颤应用步长稳心颗粒治疗的疗效及安全性。方法选择阵发性心房纤颤住院患者90例,随机分为两组,治疗组45例,对照组45例。两组患者均给予常规治疗。治疗组加用步长稳心颗粒,1包（5g）/次,开水冲服,3次/d;对照组给予胺碘酮片口服,200mg/次,3次/d,1周后改为200mg/次,2次/d,1周后改为200mg/次,1次/d,疗程为8周。结果治疗组与对照组比较,在临床症状改善与心律失常疗效方面,差异无统计学意义（P〉0.05）。结论步长稳心颗粒治疗阵发性心房纤颤耐受性好,安全有效。     

稳心颗粒联合美托洛尔治疗室性心律失常的疗效观察

目的观察稳心颗粒联合美托洛尔治疗室性心律失常的临床疗效。方法选择2010年5月—2013年11月在我院接受治疗的室性心律失常患者150例,随机分为对照组和观察组,每组75例。两组患者均接受针对基础疾病的常规治疗,对照组患者在此基础上口服美托洛尔25~50 mg/次,2~3次/d;观察组患者在对照组基础上口服稳心颗粒1袋/次,3次/d。两组患者均连续治疗4周。观察两组患者临床疗效及治疗期间不良反应情况。结果观察组总有效率为84.0%,高于对照组的64.0%(P0.05)。两组患者治疗期间均未出现明显不良反应。结论稳心颗粒联合美托洛尔治疗室性心律失常疗效较好,可有效改善患者临床症状,且安全可靠,具有较高的临床应用价值。     

稳心颗粒对原发性高血压患者心律失常及心率变异性的影响

目的观察稳心颗粒对原发性高血压患者心律失常及心率变异性的影响。方法将167例原发性高血压患者随机分为两组,稳心颗粒组（84例）及对照组（83例）。两组患者均口服卡托普利,起始量6.25~12.5 mg/次,3次/d。稳心颗粒组还给予步长稳心颗粒9g口服,3次/d。疗程均为4周。观察心律失常临床疗效及心率变异性时域指标。结果稳心颗粒组心律失常治愈率70%,总有效率93%。对照组心律失常治愈率38%,总有效率85%。两组治疗效果比较有显著性差异（P〈0.05）;稳心颗粒组与对照组治疗前两组间心率变异性各时域指标比较,差异无统计学意义（P〉0.05）;治疗4周后,稳心颗粒组SDNN、SDANN、SDNN-Index较对照组升高更显著,ST段下移减小更明显,与对照组比较,差异有统计学意义（P〈0.05）。结论原发性高血压患者合并心律失常合并应用稳心颗粒可明显改善心律失常及心率变异性,对预防心源性猝死及恶性心律失常的发生有积极的作用。     

稳心颗粒联合美托洛尔治疗冠心病室性心律失常疗效观察

目的观察稳心颗粒联合关托洛尔治疗冠心病室性心律失常的疗效。方法将115例冠心病合并室性心律失常患者随机分为治疗组（A组）40例,口服稳心颗粒和美托洛尔治疗;对照组75例[其中关托洛尔组（B组）37例。口服美托洛尔治疗,胺碘酮组（C组）38例,口服胺碘酮治疗]。结果治疗组在动态心电图疗效上优于单用美托洛尔组（P〈0．05）,与胺碘酮组疗效比较差异无统计学意义（P〉0．05）。在临床症状改善上效果优于单用美托洛尔组和胺碘酮组（P〈0．05）。结论稳心颗粒联合美托洛尔能有效治疗冠心病室性心律失常,不良反应小,患者耐受性良好,具有临床应用价值。     

Comparison of different regimens of glucocorticoid replacement therapy in patients with hypoadrenalism

Since the optimal glucocorticoid replacement needs to avoid over and under treatment, the adequacy of different daily cortisone acetate (CA) doses was assessed in 34 patients with primary and central hypoadrenalism. The conventional twice CA 37.5 mg/day dose was administered to all patients (A regimen: 25 mg at 07:00 h, 12.5 mg at 15:00 h), while in 2 subgroups of 12 patients the dose was shifted on 2 thrice daily regimens (B: 25 mg at 07:00, 6.25 mg at 12: 00, 6.25 mg at 17:00; C: 12.5 mg, 12.5 mg, 12.5 mg). In other 12 patients the conventional dose was reduced to a thrice 25 mg/day administration (D regimen: 12.5 mg, 6.25 mg, 6.25 mg). In all patients, urinary free cortisol (UFC) excretion and cortisol day curves were evaluated. During the CA 37.5 mg administration, nadir cortisol levels were significantly higher with the thrice daily regimens (143 +/- 31 on B and 151 +/- 34 nmol/l on C) than with the conventional twice (85 +/- 16 nmol/l). Moreover, UFC, morning cortisol levels and mean cortisol day curves were similar in each group. Finally, during D regimen nadir cortisol levels were higher than in A and similar to B and C regimens. No difference in UFC and in cortisol day curves by reducing the CA dose was found. In conclusion, the thrice daily cortisone regimens, in which more physiological cortisol levels are achieved, perform better as replacement therapy. The administration of 25 mg/day CA confirms that replacement therapy is more adequate with a lower dose, particularly in patients with central hypoadrenalism.     

Interferon versus ribavirin plus interferon in chronic hepatitis C previously resistant to interferon: a randomized trial.

BACKGROUND: More than 70% of patients with chronic hepatitis C are resistant to interferon therapy. Ribavirin, in association with interferon, has been demonstrated as effective, at a dose of 800-1200 mg/day, but the efficacy of a lower dose has not been established. METHODS: We assessed the effectiveness of the combination of 600 mg/day of ribavirin plus 3 MU of interferon over a period of 6 months, in a group of patients previously resistant to interferon. Sixty-two patients with chronic hepatitis C with serum and hepatic HCV RNA relapsers or non-responders to interferon, were randomly divided into two groups: group A received 3 MU of interferon alpha-2b, three times a week for 6 months; group B was given the same dose plus 600 mg per day of ribavirin for 6 months. Two patients from each group dropped from therapy. One patient from group A and two from group B withdrew from treatment because of adverse effects. RESULTS: Mean alanine aminotransferase levels were similar in both groups throughout the study. A sustained response was observed in 7% and 7.4% of groups A and B with short-term response in 39% and 59%, and no response in 54% and 34% from both groups respectively (non-significant). At 12 months, 4 and 7 patients from groups A and B respectively, cleared serum HCV RNA however, only one sustained responder from each group cleared HCV RNA from peripheral blood mononuclear cells. At 18 months, 3 patients remained serum HCV RNA negative. Adverse effects were similar. Only haemoglobin values were lower in group B in the first month of therapy (p<0.05). CONCLUSION: In conclusion, the combination of 3 MU of interferon plus 600 mg of ribavirin is not effective in chronic hepatitis C resistant to interferon.     

培垛普利和厄贝沙坦在胺碘酮治疗慢性心房颤动中的作用

目的观察培垛普利和厄贝沙坦分别与胺碘酮联合运用在持续性心房颤动复律中的作用。方法持续性心房颤动患者216例,按入院顺序随机分成A（胺碘酮组72例）、B（胺碘酮＋培垛普利组72例）、c（胺碘酮＋厄贝沙坦组72例）三组。A组抗凝3周后给予胺碘酮静脉450mg负荷,同时口服胺碘酮0．2gTid×7d,0．2gBid×7d,随后0．2gqd。B组开始抗凝3周时给予培垛普利4mgqd,C组开始抗凝3周时给予厄贝沙坦150mgqd,3周后加用胺碘酮复律（剂量和服法同A组）。4周后观察各组转复为窦性心律的例数和已复律者6个月时窦性心律维持情况。结果厄贝沙坦和培垛普利＋胺碘酮组较仅用胺碘酮组转复成功率（72．86％、70．42％比54．29％,P〈0．01）及中期（6个月）维持窦性的情况均优于单用胺碘酮组（90．00％、84．31％比68．42％,P〈0．05）。结论复律前短期服用厄贝沙坦或培垛普利均能提高胺碘酮对持续性房颤复律效果,中期使用厄贝沙坦和培垛普利能防止房颤的复发。     

缬沙坦对老年高血压患者同型半胱氨酸的影响

目的 观察缬沙坦治疗前后老年高血压患者同型半胱氨酸(Hcy)的变化;探讨缬沙坦对老年高血压患者Hcy的影响. 方法 150例老年高血压2级患者和80例健康老年人进行Hcy的测定.再将高血压组随机分为A组和B组:A组给予缬沙坦(80 mg,1次/d)治疗;B组给予氢氯噻嗪(12.5 mg,2次/d)治疗,监测2组患者血压均能控制在＜ 140/90 mmHg,在给药前及给药1、3月后分别进行Hcy测定. 结果 老年高血压患者血清Hcy的含量高于对照组(P＜0.05).A组治疗后Hcy含量下降,并且下降幅度大于B组(P＜0.05). 结论 老年高血压病人Hcy增高,缬沙坦可降低Hcy的含量.     

Interferon versus ribavirin plus interferon in chronic hepatitis C previously resistant to interferon: a randomized trial

Abstract: Background: More than 70% of patients with chronic hepatitis C are resistant to interferon therapy. Ribavirin, in association with interferon, has been demonstrated as effective, at a dose of 800–1200 mg/day, but the efficacy of a lower dose has not been established. Methods: We assessed the effectiveness of the combination of 600mg/day of ribavirin plus 3 MU of interferon over a period of 6 months, in a group of patients previously resistant to interferon. Sixty-two patients with chronic hepatitis C with serum and hepatic HCV RNA relapsers or non-responders to interferon, were randomly divided into two groups: group A received 3 MU of interferon alpha-2b, three times a week for 6 months; group B was given the same dose plus 600 mg per day of ribavirin for 6 months. Two patients from each group dropped from therapy. One patient from group A and two from group B withdrew from treatment because of adverse effects. Results: Mean alanine aminotransferase levels were similar in both groups throughout the study. A sustained response was observed in 7% and 7.4% of groups A and B with short-term response in 39% and 59%, and no response in 54% and 34% from both groups respectively (nonsignificant). At 12 months, 4 and 7 patients from groups A and B respectively, cleared serum HCV RNA however, only one sustained responder from each group cleared HCV RNA from peripheral blood mononuclear cells. At 18 months, 3 patients remained serum HCV RNA negative. Adverse effects were similar. Only haemoglobin values were lower in group B in the first month of therapy (p<0.05). Conclusion: In conclusion, the combination of 3 MU of interferon plus 600 mg of ribavirin is not effective in chronic hepatitis C resistant to interferon.     

美托洛尔对急性心肌梗死心率变异性及 恶性心律失常的影响

目的探讨美托洛尔对急性心肌梗死(AMI)后心率变异性(HRV)及恶性心律失常(MVA)事件的影响。方法将77例分为美托洛尔组(40例)及对照组(37例),美托洛尔组在常规治疗基础上给予美托洛尔6.25～12.5mg,bid,以后根据病情渐加量到25～50mg,bid;对照组仅常规治疗,并分别测定入院后第1天、第7天、0.5年、1年时48h动态心电图,常规进行HRV分析,并同时观察各阶段MVA发生率。结果1周内两组HRV及MVA变化差异无显著性意义,但美托洛尔组MVA事件有减少趋势,0.5年后美托洛尔组HRV显著改善(P＜0.01）,MVA事件发生率显著低于对照组(P＜0.01）。结论美托洛尔能有效改善AMI后患者HRV,降低MVA发生率,但此种改变在长时间治疗后明显。     

A randomized trial of induction doses of interferon alone or in combination with ribavirin or ribavirin plus amantadine for treatment of nonresponder patients with chronic hepatitis C

Background Efficacy and safety of interferon induction therapy alone or in combination with ribavirin or ribavirin plus amantadine were evaluated in chronic hepatitis C patients who were nonresponders to primary antiviral treatment. Methods The study was designed to have 225 HCV nonresponder patients, but at an interim analysis the response rate difference between groups was lower than expected and the enrollment was stopped when 75 patients had been randomized to receive interferon-α2a (group A, n = 26), interferon-α2a plus 15 mg/kg per day of ribavirin (group B, n = 24), or interferon-α2a plus ribavirin plus 200 mg/day of amantadine hydrochloride (group C, n = 25). Treatment duration was 48 weeks. The dose of interferon was 6 MU/day for 4 weeks followed by 3 MU/day for the remaining 44 weeks. Results On intention-to-treat, the sustained virological response at 24 weeks of follow-up was 11.5% in group A, 12.5% in group B, and 12% in group C. Therapy was discontinued because of adverse effects in three patients in group A (11.5%), three in group B (12.5%), and two in group C (8%). Conclusions Nonresponders with chronic hepatitis C may achieve a sustained virological response rate of approximately 12% if retreated with interferon induction treatment followed by administration of a daily dose. The addition of ribavirin or amantadine did not seem to improve the response rates.     

The bone mineral density effects of calcitonin and alendronate combined therapy in patients with rheumatoid arthritis

Aim The bone mineral density (BMD) effects of calcitonin (CT) and alendronate (ALEN) therapy either alone or in combination were evaluated in patients with rheumatoid arthritis (RA). Method Eighty out of 100 patients with RA using methotrexate 5–12.5 mg/week and prednisone 5–10 mg/day were included in the study. These were randomly divided into four groups: the first group was given ALEN 70 mg/week; the second was given 200 IU/day CT nasal spray; and the third group was given combined therapy of 70 mg/week ALEN and 200 IU/day CT nasal spray. The fourth group (control) as well as the other three groups were given 600 mg calcium and 400 IU vitamin D. Dual‐energy X‐ray absorptiometry BMD of lumbar, hip and forearm regions and laboratory investigations were performed before and at the 12th month of the therapy. Reuslts Only the combined therapy group displayed significant decreases of alkaline phosphatase levels, pointing out that the high bone turnover seen in RA patients can only be normalized by combination therapy. Also the combined therapy group showed significant increases at the lumbar and hip regions, whereas at the forearm regions BMD values stabilized. Conclusion We recommend the use of CT and ALEN combined therapy, especially in severe active cases of RA, but further prospective studies consisting of larger patient populations are needed to confirm the additive effects of this combined therapy on fracture risk in these patients.     

复方阿嗪米特肠溶片联合多潘立酮治疗功能性消化不良的随机、双盲、安慰剂对照临床研究

目的 评估复方阿嗪米特肠溶片与促动力剂联合使用对功能性消化不良(FD)患者症状和生活质量的影响.方法 随机、双盲、安慰剂对照临床试验.卫生部北京医院门诊就诊的208例符合罗马Ⅲ诊断标准的FD患者,随机分为复方阿嗪米特肠溶片+多潘立酮组(A组,102例)和安慰剂+多潘立酮组(B组,106例)进行治疗.复方阿嗪米特肠溶片2片/次,3次/d;多潘立酮10 mg/次,3次/d,疗程均为4周.测定治疗前后改良消化不良严重程度评估(mSODA)分数的改变值,并计算有效率.结果 mSODA各项评分:(1)腹胀痛严重度评分,A组治疗前后改变值为-12.35±5.48,B组为-10.52±4.65(P=0.009);(2)非腹胀痛症状评分改变值,A组为-5.75±3.31,B组为-4.86±2.65(P=0.033);(3)生活满意度评分改变值,A组为7.09±3.78,B组为5.62±3.54(P=0.004).A组的治疗总有效率为89.2%,B组为76.4%,A组显著高于B组(P=0.015).两组均无严重不良事件发生.结论 复方阿嗪米特肠溶片与促动力剂联合使用较单用促动力剂可更有效缓解FD患者各种消化不良症状,并显著改善生活质量.

Abstract：

Objective To study the efficacy and safety of combined therapy of compound azintamide and domperidone in functional dyspepsia. Methods A randomised, double-blind, placebo-controlled trial.Two hundred and eight patients with functional dyspepsia were randomly grouped into group A (experimental group, 102 cases) and group B (control group, 106 cases). The patients in the group A were given 2 tablets of compound azintamide 3 times a day in addition to domperidone 10 mg 3 times per day for four weeks. The patients in the group B were only given domperidone 10 mg 3 times per day for 4 weeks. The therapeutic efficacy was evaluated by modified Severity of Dyspepsia Assessment (mSODA) and Global Patient Assessment (GPA). Results Subscore in mSODA:the change of bloating/pain intensity score in group A is -12.35±5.48 while group B is -10.52±4.65(P=0.009), the change of non-bloating/pain symptoms score in group A is -5.75±3.31 while group B is - 4. 86 ± 2.65 (P=0.033), and the change of satisfaction score in group A is 7. 09 ± 3. 78 while group B is 5.62 ± 3. 54 (P = 0. 004). The response rate in group A is 89. 2% which is significantly higher than 76.4% in group B (P=0. 015). Other symptoms for response assessment included loss of appetite, early satiety, fullness after meal, diarrhea. No severe side-effect was found in both groups. Conclusions Combined therapy of compound azintamide and domperidone may lead to bigger improvement in overall efficacy and health related quality of life in patients with functional dyspepsia than use of motility medicine alone. Potential mechanisms that may account for the efficacy of compound azintamide in functional dyspepsia include modulation of visceral sensitivity and/or gastrointestinal motility.     

幽门螺旋杆菌根除治疗对老年人Barrett食管复发的影响

目的 通过对经胃镜氩离子凝固消融技术(APC)治疗后老年Barrett食管(BE)患者进行胃镜随访,探讨根除幽门螺旋杆菌(Hp)治疗对食管黏膜恢复的影响及Hp感染与BE的关系.方法 将经胃镜及病理确诊的201例老年BE患者分为无Hp感染(对照组)组53例和Hp感染组148例,Hp感染组再随机分为感染1组和感染2组各74例.所有患者经APC治疗后,给予抑制胃酸治疗,奥美拉唑40 mg,2次/d,静脉滴注,连续7d;7d后改用奥美拉唑胶囊20mg,2次/d,早晚口服,总疗程2个月.感染2组同时给予根除Hp治疗,阿莫西林1000 mg,2次/d;克拉霉素500 mg,2次/d;替硝唑500 mg,2次/d,上述3种抗生素选用2种,共用2周.所有患者于治疗结束后第1、3、6、12、24个月进行胃镜及病理复查,并进行24 h食管pH监测.结果 3组患者APC治疗平均2.4次(1～3次),治疗后1个月所有患者BE黏膜消失,复层鳞状上皮完全修复;治疗后3个月,各组均有反流性食管炎(RE)和BE复发;治疗后6个月RE复发率明显上升,对照组为22.6%,感染1组和感染2组分别为12.2%和17.6%(χ2=61.28、59.00和43.96,P＜0.05);12个月BE复发率明显增加,对照组为22.6%,感染1组和感染2组分别为18.9%和23.0%(χ2=6.79、6.62和5.97,P＜0.05).治疗前3组患者均有病理性胃食管酸反流(DeMeester指数＞14.7),治疗后1个月DeMeester指数恢复正常,对照组为14.5±0.9,感染1组和感染2组分别为13.2±0.4和12.0±0.5(t=2.09、2.22和2.15,P＜0.05);治疗后6个月DeMeester指数明显升高(t=2.29、2.33和2.14,P＜0.05),但3组间差异无统计学意义(均P＞0.05).结论 胃窦部感染Hp的老年BE患者,在进行APC治疗同时可进行根除Hp治疗;APC联合根除Hp治疗对老年BE患者的远期预后与单独APC治疗无显著差别;APC治疗可完全清除BE上皮,长期应用抑制胃酸治疗可能延缓BE复发.