Salivary theophylline estimation in the management of asthma in children.

Simultaneous sampling was performed to determine whether saliva could replace plasma in the monitoring of theophylline dosages. Forty-eight children with moderate to severe asthma received oral theophylline preparation (usually sustained release) on a daily basis. They provided simultaneous saliva and plasma samples at routine out-patient visits. Saliva and plasma theophylline concentrations showed a wide variation between individuals, and their ratios also differed. Saliva theophylline concentrations below 7 micrograms/ml reflect plasma concentrations below 10 micrograms/ml, i.e. sub-therapeutic, while saliva concentrations above 7 micrograms/ml are consistent with therapeutic dosage. Estimation of saliva theophylline concentration on routine visits avoids the discomfort of blood sampling. It reflects whether daily oral theophylline dosage in childhood asthma is below or within the therapeutic range. The need for changes in dosage and the degree of patient-compliance with therapy can be usefully indicated.     

不同采血方法对血透半永久导管华法林抗凝者出凝血指标的影响

目的 探讨维持性血液透析以颈内半永久中心静脉导管作为血管通路的患者,在使用华法林抗凝进行出凝血监测时,以来自颈内半永久中心静脉导管的血标本代替外周静脉血标本进行检验的可行性。 方法 选取血透半永久中心静脉导管华法林抗凝的患者30例次,对每一例次患者同一时间段抽取3个不同的血标本:①常规外周静脉抽血作为对照组,②经颈内半永久导管静脉端抽取20 ml血后留取血标本(以下称方法一),③经颈内半永久导管静脉端抽取40 ml血后留取标本(以下称方法二),比较3组血标本凝血功能各项指标值的差异。 结果 方法一与对照组比较,凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)3项指标的差异均具有统计学意义(P＜0.01),方法二与对照组比较,PT、INR两项指标差异无统计学意义(P＞0.05),而APTT差异有统计学意义(P＜0.05)。 结论 对维持性血液透析以颈内半永久中心静脉导管作为血管通路,使用华法林抗凝的患者进行出凝血检验时,应尽量由外周静脉抽取血标本,当由外周静脉抽血存在实际困难时,可以用方法二由颈内半永久导管留取血标本来代替外周静脉抽血,但必须在送检标本上注明抽血方式以便临床医生参考。      

茶碱对单个核细胞IL-12分泌的影响

目的 :了解茶碱在体外对人脐带血单个核细胞 (CBMC)分泌IL 12和IL 12p4 0的影响 ,以及健康人服用茶碱后全血中IL 12及IL 12p4 0水平的变化 ,了解茶碱是否可能在抗原呈递细胞水平上参与细胞免疫的调节。方法 :30份新生儿脐带血随机分为 3组 :对照组 ,IL 12抗体组 ,茶碱组 ,分离出单个核细胞体外培养。比较每组产生IL 12和IL 12p4 0量的差异。 12名健康人随机分为两组 ,一组不服药作对照 ,另一组口服舒弗美片 (2 0 0mg) ,取全血作体外培养 ,收集上清液测IL 12及IL 12p4 0的含量。结果 :加用无水茶碱组的脐带血单个核细胞产生IL 12及IL 12p4 0水平 [(2 8.36± 5 .86 )pg·ml- 1 ,(87.91± 33.84 )pg·ml- 1 ]比对照组 [(5 6 .86± 14 .2 2 )pg·ml- 1 ,(2 13.71± 81.78)pg·ml- 1 ]显著降低 (P <0 .0 1)。服用舒弗美片 (2 0 0mg)组IL 12及IL 12p4 0水平 [(19.34± 11.0 2 )pg·ml- 1 ,(92 .2 2± 12 .94 )pg·ml- 1 ]比对照组 [(32 .39± 15 .71)pg·ml- 1 ,(2 0 4 .5 3± 2 4 .70 )pg·ml- 1 ]显著降低 (P <0 .0 1)。结论 :茶碱对CBMC及健康人血液中IL 12的分泌有抑制作用 ,可能对原始CD4 + T细胞极化有潜在调控性作用     

Oral aminophylline therapy. Increased dosage requirements in children

While monitoring oral aminophylline (theophylline ethylenediamine) therapy, larger doses (milligrams per kilogram) were necessary for children than for adults to achieve similar therapeutic serum levels. The mean apparent theophylline clearance (ATC) determined in 59 children was significantly higher (P less than .001) than determined in 114 adults (84.8 versus 51.4 ml/hr/kg). Additionally, the younger children (1 to 9 years) eliminated theophylline more rapidly than the older children (0 to 18 years) (93.8 versus 77.3 ml/hr/kd). When initiating continuous oral aminophylline therapy, dosage guidelines, based on the mean ATC calculated for each group, were predicted, and trough theophylline serum levels of 10mug/ml were obtained. The guidelines for aminophylline were 28.0, 23.2, and 15.6 mg/kg/day administered in four divided doses for the younger children, older children, and adults, respectively. Monitoring of serum levels is suggested to further individualize the patient's aminophyline therapy.     

老年患者茶碱血药浓度监测分析

目的：了解老年患者体内茶碱血药浓度,以便调整用药方案。方法：采用双波长紫外分光光度法测定茶碱谷浓度。结果：进行了40例次监测,达到有效血药浓度12例次,占总数30％;低于有效血药浓度26例次,占总数65％;达中毒血药浓度2例次,占总数5％。结论：老年患者在使用茶碱时应经常监测茶碱的血药浓度,以保证用药安全、有效。     

2012年儿童药物浓度监测分析

目的对本院2012年儿童血药浓度监测结果进行回顾性分析,为临床合理用药提供依据。方法采用酶增强免疫分析法(EMIT)测定,对服用丙戊酸钠、苯妥英、卡马西平、地高辛、茶碱、甲氨蝶呤、环孢素、他克莫司的病人进行血药浓度监测,并对4055例监测结果进行统计和分析。结果丙戊酸钠的受检例数最多,2679例(75.89%),平均浓度(58.70±25.97)μg/ml,地高辛的受检例数最少,只有2例。三个免疫抑制剂项目中,甲氨蝶呤的受检例数最多,463例(31.1%)。结论血药浓度监测对指导儿童临床合理用药具有重要作用。     

Gentamicin: use of a programmable calculator to determine dosages from pharmacokinetic data for individual patients.

Gentamicin, an antibiotic frequently used in the treatment of gram-negative infections, has a narrow therapeutic index, so the correct prediction of its serum concentrations is important. Recent studies have emphasized the dubious accuracy of commonly used formulas, and computer programs that provide pharmacokinetic data for individual patients from multiple blood samples have helped to adjust dosages but are expensive. This study tested the applicability of a method using only two blood samples and a programmable calculator to estimate pharmacokinetic parameters for individual patients and adjust dosages to aim at peak and trough serum levels of 6 and 1 micrograms/ml respectively. In the 48 patients with normal renal function this method produced peak serum concentrations of gentamicin within 1 microgram/ml of the desired level in 22 (46%) and therapeutic peak concentrations (between 4 and 10 micrograms/ml) in all the patients. In 10 patients with renal failure it produced peak serum concentrations within 1 microgram/ml of the desired value in 4 and therapeutic serum concentrations in 7. Two patients had peak concentrations below 4 micrograms/ml and one had a peak concentration above 10 micrograms/ml. Two of the three patients whose serum levels were outside the therapeutic range had unstable renal insufficiency. Thus, patients with renal insufficiency need continued monitoring of the serum level of gentamicin, particularly when their renal function is changing.     

吸入性变应原和口服糖皮质激素对过敏性哮喘患者血清可溶性CD86的影响

目的:探讨吸入变应原与口服糖皮质激素对过敏性哮喘患者血清可溶性CD86浓度的影响。方法:采用随机、双盲、安慰剂对照,平行分组,给予单相哮喘反应组和双相哮喘反应组患者吸入变应原,口服强的松或安慰剂,每天1次,共2周。吸入性变应原或强的松前后抽静脉血检验血清。用酶链免疫吸附分析法测定血清中sCD86浓度。结果:在吸入变应原后24 h,双相哮喘反应组血清sCD86浓度从(491.8±15.4)IU/ml上升到(603.8±19.3)IU/ml,而单相哮喘反应组sCD86浓度与基础值相比无显著提高。强的松治疗2周后血清sCD86与基础值相比显著下降,从(532.7±12.3)IU/ml下降至(448.3±15.1)IU/ml。而安慰剂组则没有显著下降。结论:该研究证实过敏性哮喘患者血清sCD86浓度在吸入变应原后升高,而用强的松治疗后其浓度则下降。     

胰岛素早期释放试验在评价2型糖尿病患者胰岛素分泌缺陷上的应用

目的:探讨初发糖尿病患者胰岛素早期分泌缺陷与血糖的关系,评价糖尿病患者的胰岛功能。方法:对初发未予降糖药治疗糖尿病病人53例,正常对照组9例,在进行常规口服葡萄糖耐量(OGTT)及胰岛素动态释放试验基础上加测口服葡萄糖后10min静脉血糖及血清胰岛素测定。按空腹血糖10mmol/L为标准将糖尿病患者分为低于10mmol/L(A)组(32例)及高于10mmol/L(B)组(21例)。结果:糖尿病患者空腹及120min血清胰岛素较对照组明显增高(P<0.01),而10min血清胰岛素明显低于对照组(P<0.05)。A组与B组比较,血清胰岛素A组除空腹低于B组外(P<0.05),其余10min、30min、60min、120min。均明显高于B组(P<0.01)。结论:用口服葡萄糖法测定早期(10min)胰岛素分泌的情况来了解2型糖尿病患者胰岛素早期分泌缺陷有一定意义,方法简便而且患者较容易接受。     

利用动态血压监测指导临床用药68例疗效分析

目的评价利用动态血压监测(ABPM)指导降压治疗的临床疗效。方法 136例高血压患者随机分成治疗组和对照组,各68例。治疗组利用24 h ABPM仪对高血压患者口服降压药时进行临床监测,根据血压监测结果进行数据分析,及时调整临床用药;对照组未采用监测的治疗方案,患者出现不适时随机测量血压,调整临床用药。评价两组患者治疗前后的血压控制达标率。结果治疗组血压控制达标率优于对照组,差异有统计学意义(P<0.01)。结论利用ABPM指导临床降压治疗较常规治疗血压控制平稳、疗效好、并发症少。     

Relation of oral dose of oxtriphylline to serum theophylline level.

Serum theophylline levels were studied in relation to oral doses of oxtriphylline in 30 patients with reversible airway obstruction. A wide scattering of levels was observed and was attributed to widely differing rates of metabolism of the drug. From the data obtained it was concluded that the most commonly prescribed daily dose of oxtriphylline, 800 mg, will produce a therapeutic level of theophylline in only about one quarter of patients. A daily starting dose of 15 to 20 mg/kg, however, will produce therapeutic levels in approximately one third of patients without significant toxic effects. Once the patient's conditions is stable the serum theophylline concentration should be measured; if it is subtherapeutic the dose of oxtriphylline should be increased slowly and the serum theophylline concentration remeasured until a level of 10 to 20 microgram/ml is achieved.     

腺苷、白介素—1及茶碱对哮喘患者外周血单核细胞A2腺苷受体mRNA表达的影响

目的 通过研究腺苷、白介素（IL）－1、茶碱对哮喘患者外周血单个核细胞（PBMCs)表达A2a及A2b腺苷受体（A2aAR及A2bAR)mRNA的影响,探讨A2aAR及A2bAR在哮喘发病中的作用,为临床使用茶碱提供理论依据。方法 11例正常人及哮喘患者PBMCs经Ficoll液分离,分对照组,腺苷组、腺苷＋IL－1组及腺苷＋茶碱4组,体外培养18小时,收集细胞,采用逆转录－聚合酶链反应（RT－PCR）法和图象分析半定量法检测A2aAR及A2bAR mRNA表达。结果 正常人及哮喘患者各组PBMCs表达A2aARmRNA无明显差异（P＞0．05）。哮喘患者PBMCsA2bAR mRNA表达较正常人增加（P＜0．01）,腺苷、IL－1促进哮喘患者（P＜0．01）。腺苷及IL－1对哮喘患者PBMCsA2bAR mRNA表达的影响与血清TIgE水平呈正相关（P＜0．05）,与FEV1％呈负相关P＜0．05）。结论 PBMCs A2bARmRNA表达的影响与血清TIgE水平呈正相关（P＜0．05）,与FEV1％呈负相关P＜0．05）。结论 哮喘患者PBMCs表达A2bmRNA增加,腺苷及IL－1促进其表达,且与患者机体过敏状态及气道阻塞程度相关,茶碱能抑制A2bAR mRNA表达;腺苷、IL－1及茶碱对PBMCs表达A2aAR mRNA无明显影响。     

阿托伐他汀钙对高血压患者的治疗作用及血清中细胞因子TNF-a、CRP、IL-4和IL-10的影响

目的 观察阿托伐他汀钙对高血压患者治疗前后血清中细胞因子的影响及其降压效果.方法 82例高血压病(EH)患者,随机分为2组:治疗组41例,每日晨服硝苯地平控释片30mg,晚睡前服阿托伐他汀钙20mg;对照组41例,服用硝苯地平控释片30mg,疗程均12周.于治疗前后采用酶联免疫法测定细胞因子TNF-a、IL-4和IL-...     

支气管哮喘患者并发胃食道返流的相关因素探讨

为探讨影响支气管哮喘（简称哮喘）并发胃食道返流的主要因素,分析４５例哮喘患者生活习惯、临床及治疗的有关资料,对各项参数进行单因素和多因素相关分析。结果显示,哮喘类型、茶碱类药物、病程、饮酒及食富脂食物与患者并发ＧＥＲ密切相关（Ｐ均＜０．０５）。因而,内源性哮喘、长期服用茶碱、饮酒及食用富脂食物患者易并发ＧＥＲ。     

茶碱不同给药方案与其血药浓度关系的研究

目的探讨茶碱不同给药方案与其血药浓度的关系,为临床合理应用茶碱提供理论依据.方法利用荧光偏振免疫法测定茶碱血药浓度,246例患者茶碱给药方案为：口服组（两个剂量组）,静滴组,口服＋静滴组.结果采用口服＂茶碱缓释片0.2gBid＂组以及口服＂茶碱缓释片0.1gBid＂＋静滴＂氨茶碱针0.25gQd＂组给药方案的患者,超过70%的患者血药浓度值在有效范围5.00～15.00μg/mL,并且平均茶碱血药浓度大于口服＂茶碱缓释片0.1gBid＂与静滴＂氨茶碱针0.25gQd＂组.茶碱血药浓度与不良反应的发生有显著关系,采用口服＂茶碱缓释片0.2gBid＂组的患者,不良反应发生率最高.结论口服＂茶碱缓释片0.1gBid＂＋静滴＂氨茶碱针0.25gQd＂为较好的给药方案.     

B型钠尿肽与心功能不全严重程度及近期愈后的关系探讨

目的:探讨B型钠尿肽与心功能不全严重程度的关系以及对近期愈后的评估价值。方法:免疫荧光法测定的52例心功能不全患者住院次日的血B型钠尿肽浓度,并对20例NYHAⅢ~Ⅳ级的患者于住院治疗5~12天重复测定,超声心动图测定不同心功能患者的心脏结构和功能,分析血液B型尿钠肽浓度与超声指标及心功能分级的关系,探讨B型脑钠肽在评价心力衰竭患者治疗效果和近期愈后中的价值。结果:血BNP浓度在心功能不全患者各组间两两比较均有显著性差异,随着心力衰竭严重程度加重,血液BNP浓度增加。血BNP浓度与左室舒张末期内径、呈显著正相关(r=0.706,P<0.001),与左室射血分数和左室短轴缩短率均呈负相关(r=-0.712和r=-0.685,均P=0.001)。其中好转出院的17例NYHA心功能Ⅲ~Ⅳ级的患者治疗后BNP平均浓度显著低于治疗前水平(539.19±219.57 pg/ml和1 072.35±352.17 pg/ml,P<0.001),而另外3例死亡患者血BNP较入院前显著升高(4 694.11±1 642.45和2 014.19±566.12,P<0.001)。结论:B型脑钠肽浓度与心功能不全严重程度密切相关,并且是评价治疗效果和近期愈后的重要指标。     

RAPID ASSAY OF INSUU[N IN PORTOSPLENIC BLOOD FOR INSULINOMA

Intraoperative rapid insulin assay has been successfully used for a year in our hospital for monitoring completeness of insulinoma excision during operations on 5 patients* According to our experience, portal blood insulin levels fell sharply shortly after removal of insulinoma. Wicth rapid immunoreactive insulin assay9 the time between sample taking and final reading was about 45 minutes. As blood sugar monitoring is influenced by many factors and correct result can only be obtained in an average of 70 minutes or even longer after complete remoival of tumor, rapid immunoreactive insulin assay has evident advantages over blood sugar monitoring.     

老年高血压患者轻度认知功能障碍与血压参数的相关性研究

目的:探讨老年高血压患者认知功能障碍与血压参数的相关性研究.方法: 选取120例老年高血压患者为观察组,选取老年健康人群145名为对照组,对两组进行动态血压监测,并采用简易中文版智能量表(MMSE)评定其认知功能.结果: 观察组轻度认知障碍患者比例显著高于对照组(P＜0. 05);高血压分级越高,MMSE得分越低,轻度认知功能障碍患病率越高;轻度认知功能障碍与低密度脂蛋白(LDL-C)、口服葡萄糖耐量试验2 h血糖(OGTT 2 h)等危险因素密切相关.结论:老年人认知障碍与高血压分级、LDL-C、OGTT 2 h血糖等危险因素相关.     

茶碱对慢性哮喘和肺功能改善的作用

目的 了解茶碱在慢性哮喘轻症患者临床症状缓解和气道炎症抑制作用的机制。方法选择41例慢性哮喘的第1级及第2级中的轻症患者,口服缓释茶碱每天4～6mg／kg.b．w．,每12h 1次,连用16周。对照组15例,未服药治疗。对比评估临床症状,检测晨间最大呼气流黄（PEFa）、用力肺活量（FVC）、1秒钟用力呼气容积（FEV1）、1秒钟用力呼气容积降低20％所需药物累积量（PD20）,静脉血T细胞亚群（CD3^＋、CD4^＋,CD8^＋）的变化。结果 经茶碱口服治疗后,临床症状评分、PD20、PEFnm、FEV1,CD3^＋、CD4^＋与对照组比较差异有显著意义。结论 慢性哮喘轻症患者小剂量茶碱口服治疗16周后,哮喘患者临床症状有明显改善,气道高反应性与对照组比较得到改善（P〈0．01）。