探索性新药临床试验的回顾与展望

基于创新药物研发成本-效益风险的控制诉求,除了一种以早期获得人体PK/ADME信息以及高效筛选先导化合物为目的药物研发的新方法(也被称为0期临床试验/探索性临床试验),国内外亦开展了一些利用0期临床试验方法的研究,为探讨0期临床试验作为一种新的药物研发技术在实际应用的可行性提供了参考.     

药物利用研究在中药注射剂临床应用合理性和安全性评价中的应用

随着中药注射剂上市后再评价的深入,围绕着中药注射剂安全性、有效性、经济性的评价,开展了大量的探讨。作为中药注射剂安全和有效使用的基础,合理用药也是中药注射剂上市后再评价研究不可忽视的重要研究内容。采用药物利用研究的相关方法对中药注射剂在医疗机构中的使用进行评价,不仅能够进一步的指导临床用药,提供合理用药信息,还可以促进医院的药事管理,同时药物利用研究具有的经济学评价属性使得其可以为医政部门制定药品政策提供决策依据。通过对中药注射剂的药物利用研究,提示基于PDD计量指标的药物利用研究可作为中药注射剂药物利用评价的借鉴方法,基于DUR的药物流行病学和药物经济学能够为中药注射剂临床使用合理性与安全性再评价提供可借鉴的思路和方法。     

临床前药物代谢动力学关键技术与研究体系

临床前药物代谢动力学研究在创新药物研发中占有十分重要的作用，贯穿于创新药物研发的每一环节。我国临床前药物代谢动力学研究水平在“九五”以前相当落后，本课题组在国家自然科学基金、国家高技术研究发展计划（“八六三”计划）、国家重点基础研究发展计划（“九七三”计划）及江苏省药物代谢动力学重点实验室建设等多项课题的资助下，围绕我国药物代谢动力学研究的薄弱环节和亟待解决的关键问题，通过近十年的创新攻关研究，解决了生物样品中微量／痕量药物高灵敏度、快速定量分析，体内外吸收、分布、代谢与排泄特性快速筛选与评价等11项关键技术，建立了较为完善的先导／候选化合物快速筛选体系、创新药物体内外临床前药物代谢动力学评价体系以及中药整体药物代谢动力学研究体系，项目研究成果对促进我国药物代谢动力学水平的整体提高、推动创新药物研发与中药现代化研究进程具有重要意义。     

中药注射剂应用现状及安全性问题与对策

中药注射剂的研发是中医药现代化的积极探索和重要创新,在我国医疗健康事业中具有重要的临床价值和不可替代性。然而近年来,随着中药注射剂应用范围的扩大,不良事件的报道逐渐增多,安全性问题备受关注。其原因主要有药物因素和临床应用不合理等。前者包括历史原因和质量标准不统一,后者包括中西药合用、剂量使用不规范以及方证药证不对应。我们应当积极面对问题,从药厂、医生以及政府三方面入手,制定切实可行的有效的防范措施：一是严格把好药物制剂关;二是倡导方证对应的用药理念,最大程度减少不良反应发生;三是加强药品上市后再评价,强化市场监督管理。     

药学干预在保证中药注射剂使用合理性中的应用分析

目的：探讨药学干预在保证中药注射剂使用合理性中的应用效果,提高中药注射剂的临床合理应用水平。方法：分别对药学干预前后3个月的152例住院患者使用中药注射剂的资料进行分析,从药品适应症、用法、用量、疗程、联合用药以及配伍禁忌等方面对其使用合理性进行评价,观察药学干预的临床应用效果。结果：实施药学干预后中药注射剂的使用合理性较干预前有显著提高,差异有统计学意义（P〈0．05）,不良反应发生率为3．8％,显著低于干预前的16．7％,干预前后药物不良反应发生率之间的差异有统计学意义（P〈0．05）。结论：加强对中药注射剂使用的药学干预时于保证用药合理性,提高临床疗效,降低不良反应发生率,保证用药安全性具有重要的意义,值得临床进一步推广应用。     

中药创新药物研究开发的回顾、策略与实践

以“十一五”、“十五”重大科技专项为主线,回顾中药创新药物研究的历程,通过剖析美国FDA第一个植物药Veregen TM对中药研发的启示,以及对创新药物研究中的重大成果学习、感悟,试图提出创新中药研发策略并指出实践的路径。以中药复方创制新药为中药创新的主要途径,创新可以从新物质,包括新化合物和新有效部位/群或组分配伍,一个已知化合物或已知提取物等的新药用及名优中成药的二次开发3方面实现;并借鉴国际经验以近代临床应用为基础的靶点依赖性先导物的筛选、评价与优化和在分子及基因水平对中药复方的作用机制和分子靶点进行诠释,来支撑具有中国特色的原创治疗药的研究与开发。     

抗肿瘤药物的腹膜内给药

腹膜内直接给予抗肿瘤药物治疗癌症,其药代动力学优于目前抗肿瘤药物的全身给药.临床前和临床试验资料表明,腹膜内给药可增加肿瘤部位的抗肿瘤药物浓度,并延长药物作用时间.Ⅰ/Ⅱ期的临床试验进一步证实了这一方法可提高癌症患者的生存率.该方法对于卵巢癌具有较好的疗效.尚需充分的Ⅲ期临床试验研究,以评价该法作为临床治疗标准方法的可行性.     

基于处方评价系统对我院2008年中药注射剂使用监测

目的:了解我院中药注射剂临床用药状况,提高中药注射剂合理用药水平.方法:我院2008年1月1日-2008年12月31日处方共395928份,采用自主研发的处方评价系统对所有含中药注射剂处方进行分析.结果:我院全年中药注射剂处方8980份,占全年处方的2.27%,月中药注射剂使用百分率1.88%～3.93%,个别科室使用率偏高.结论:在中药注射剂使用过程中仍需加强监测,规范中药注射剂的使用管理.     

中药注射剂致药源性疾病及临床对策

中药注射剂以其独特的疗效在临床上广泛使用,尤其是近年来,中药注射剂品种及数量增多,药源性疾病(DID)的发生率随着中药注射剂在临床上广泛使用呈上升趋势,其危害性不亚于心血管疾病、恶性肿瘤和感染性疾病。因此加强对药源性疾病危害性认识,充分了解药物与环境相互作用的关系,减少影响病人生存质量的各种因素,对防止药源性疾病的发生有重要的意义。     

中药注射剂过敏反应非临床评价方法

中药注射剂不良反应问题日益严峻,以发生率最高的过敏反应最为突出,已经成为临床医生担忧的重点和药监部门重点监管的对象。然而,由于目前中药注射剂过敏反应评价方法尚不完善和存在诸多缺陷,尚不能有效地预测中药注射剂临床过敏反应的发生。对现有的非临床过敏反应实验方法、评价指标及其意义进行综述,为建立适合中药注射剂的过敏反应非临床评价方法提供参考。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.