喹硫平增效治疗老年抑郁症的疗效及安全性

目的:探讨米氮平合并喹硫平治疗老年抑郁症的疗效及安全性。方法:将40例老年抑郁症患者根据随机分为研究组(米氮平并喹硫平)20例和对照组(单用米氮平)20例,疗程8周。于治疗前及治疗后第2、4、6、8wk末应用汉密尔顿抑郁量表(HAMD),副反应量表(TESS)分别评定疗效和治疗中出现的副反应。结果:治疗后第4、6、8周末,研究组HAMD评分较治疗前均显著降低(P<0.05);治疗后第6、8周末,对照组HAMD评分较治疗前均显著降低(P<0.05);治疗后第4、6、8周末,研究组的HAMD评分均低于对照组(P<0.05)。研究组、对照组的有效率分别为80%、45%,两组之间疗效有显著性差异(P<0.05);两组不良反应比较差异无显著性(P>0.05)。结论:米氮平合并喹硫平治疗老年抑郁症安全有效。     

文拉法辛联合喹硫平治疗难治性抑郁症的疗效分析

目的:探讨文拉法辛联合喹硫平治疗难治性抑郁症(treatment-resistantdepression,TRD)的疗效及安全性.方法:将76例TRD患者随机分为研究组和对照组,每组各38例,研究组给予文拉法新联合喹硫平治疗,对照组单用文拉治法辛治疗,疗程8周.分别于入组前及入组后2、4、8周末用汉密尔顿抑郁量表(Hamilton depression rating scaie,HAMD)及不良反应量表(TESS)评定治疗效果和不良反应.结果:两组在治疗2、4、8周末时HAMD总分及减分率的差异均有统计学意义(P＜0.05),两组间总有效率的差异无统计学意义(P＞0.05),药物不良反应两组间比较差异无统计学意义(P＞0.05).结论:文拉法辛联合喹硫平治疗TRD与单用文拉法辛相比,联合用药起效快,疗效显著,不增加不良反应,依从性好,复发率低,值得在临床推广应用.     

喹硫平联合伏硫西汀治疗难治性抑郁症的临床研究

目的探讨喹硫平联合伏硫西汀治疗难治性抑郁症的临床疗效。方法选取2018年11月—2019年10月在天津市安定医院治疗的难治性抑郁症患者159例,随机分为对照组(81例)和治疗组(78例)。对照组口服氢溴酸伏硫西汀片,初始剂量为10 mg/d,1～2周后加至20 mg/d。治疗组在对照组的基础上口服富马酸喹硫平片,初始剂量为0.1 g/d,1～2周后增加到0.2 g/d。两组患者均连续治疗8周。观察两组患者临床疗效,同时比较治疗前后两组患者汉密尔顿抑郁量表(HAMD)评分、重复成套神经心理状态测验(RBANS)评分,及血清白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)和干扰素-γ(IFN-γ)水平。结果治疗后,对照组临床有效率为72.84%,显著低于治疗组的85.90%,两组比较差异有统计学意义(P0.05)。治疗后,两组HAMD在第2、4、8周末均明显下降(P0.05),且治疗组在第4、8周末评分降低更明显(P0.05)。治疗后,两组RBANS评分在第4、8周末均显著升高(P0.05),且治疗组在第4、8周末均显著高于对照组(P0.05)。治疗后,两组患者IL-6、IL-8、TNF-α、IFN-γ水平显著降低(P0.05),且治疗组水平显著低于对照组(P0.05)。结论伏硫西汀联合喹硫平治疗难治性抑郁症起效快,可提高患者认知功能,安全性高。     

文拉法辛合并喹硫平治疗难治性抑郁症临床观察

目的:观察文拉法辛联合喹硫平对难治性抑郁症治疗的疗效和不良反应,探讨难治性抑郁症的治疗方案。方法:对符合难治性抑郁症患者95例,随机分组为研究组(文拉法辛合并喹硫平)和对照组(单用文拉法辛),治疗8周,使用HAMD和HAMA量表评定疗效,第2、4、6、8周末进行评分,比较观察疗效,使用TESS量表评定不良反应。结果:研究组疗效显著优于对照组,其HAMD、HAMA量表评分减分率,疗效评定均优于对照组,不良反应无显著性差异。结论:文拉法辛联用喹硫平对难治性抑郁症有较好的疗效,可提高近期临床疗效。     

米氨平与帕罗西汀治疗抑郁症的对照研究

目的:对米氮平和帕罗西汀治疗抑郁症的疗效和不良反应进行对比.方法:将74例抑郁症患者随机分为两组,分别给予米氮平和帕罗西汀口服,疗程8周.采用汉密顿抑郁量表(HAMD)和副反应量表(TESS)评定疗效及不良反应.结果:治疗8 周末,两组的疗效减分率比较差异无显著性(P>0.05).结论:米氮平与帕罗西汀治疗抑郁症的疗效相似,但米氮平起效快,不良反应少,依从性好,是一种安全、有效的新一代抗抑郁药物.     

黄精结合米氮平治疗老年脑梗死后抑郁症的临床研究

目的 观察中药黄精结合米氮平治疗脑梗死后抑郁症(PCID)患者的临床疗效及安全性评价.方法 将64例老年PCID患者按照硬币法随机分为研究组(A)组和对照组(B)组,每组各32例患者;A组用中药黄精联合米氮平治疗;B组用米氮平单纯治疗.该研究对患者在治疗前和治疗的第1、2、4、6周末时分别进行汉密尔顿抑郁量表(HAMD)的评估,并记录治疗过程中出现的所有不良反应.结果 治疗前,两组患者的HAMD评分差异无统计学意义(P>0.05),具有可比性.治疗过程中每周末A组HAMD评分下降值较B组更为明显,差异有统计学意义(P<0.05);同期治疗点两组之间相比:A组HAMD评分与B组相比差异有统计学意义(P<0.05).A组总有效率93.33%,B组总有效率86.67%,两组相比差异有统计学意义(P<0.05).A组的不良反应发生率26.67%与B组73.33%相比明显降低,差异有统计学意义(P<0.05).结论 中药黄精结合米氮平治疗老年PCID患者的临床疗效明显优于单纯应用米氮平,并能够减轻并消除治疗过程中的不良反应,值得临床推广.     

喹硫平联合曲唑酮治疗重度抑郁症的疗效观察

目的研究喹硫平联合曲唑酮治疗重度抑郁症的临床效果.方法收集2012年6月—2014年6月在北京市门头沟龙泉医院住院及门诊重度抑郁症患者104人,采用随机数字法将患者随机分为治疗组和对照组,每组各52人.对照组口服盐酸曲唑酮片,100 mg/d起始,2周内加至充分治疗剂量300~400 mg/d.治疗组在对照组的基础上同时口服富马酸喹硫平片,从100 mg/d起,1周内增加剂量至300 mg/d,并根据病情调整剂量,最高剂量400 mg/d.两组患者疗程均为8周.分别在患者入组时及治疗 4、8 周末进行汉密尔顿抑郁量表(HAMD)(24 项版)、药物副作用量表(TESS)评估.结果 对照组和治疗组的总有效率分别为78.84%、90.38%,两组比较差异有统计学意义(P<0.05).与治疗前比较,治疗组4、8周末HAMD总分显著降低(P<0.01),对照组8周末HAMD总分明显降低(P<0.05).与对照组治疗后比较,治疗组治疗前及治疗4周末HAMD总分无明显变化,8周末HAMD总分显著降低(P<0.01).与治疗前比较,治疗组4周末焦虑躯体化、睡眠障碍评分差异均有统计学意义(P<0.05),治疗8周末焦虑躯体化、认识障碍、睡眠障碍、绝望感评分差异显著(P<0.01),而对照组只有焦虑躯体化评分在治疗 8 周末的变化有统计学意义(P<0.05).与对照组比较,治疗组治疗 8 周末焦虑躯体化、认识障碍、睡眠障碍、绝望感评分明显降低,差异显著(P<0.01).结论 富马酸喹硫平片联合盐酸曲唑酮片是治疗重度抑郁症有效且相对较安全的方法,值得临床推广应用.     

米氮平与帕罗西汀治疗抑郁症的临床对照研究

目的比较米氮平与帕罗西汀治疗抑郁症的临床疗效和安全性。方法将86例抑郁症患者随机分为米氮平组与帕罗西汀组,每组各43例,疗程8周,以汉密尔顿抑郁量表(HAMD)和不良反应量表(TESS)评定在治疗前和治疗后1周、2周、4周及8周末的疗效与不良反应。结果经过8周治疗,显效率和治愈率米氮平组分别为82.2%和65.8%,帕罗西汀组分别为79.1%和63.3%,差异无统计学意义(P>0.05);治疗后两组HAMD评分均显著低于治疗前,差异有统计学意义(P<0.01);治疗后1周末米氮平组HAMD评分显著低于帕罗西汀组(P<0.05);而治疗2周后两组间HAMD评分差异无统计学意义(P>0.05)。两组不良反应无统计学意义(P>0.05)。结论米氮平治疗抑郁症安全有效,且起效快,不良反应轻,值得应用。     

喹硫平辅助治疗难治性抑郁症的临床观察

目的探讨喹硫平辅助治疗难治性抑郁症临床效果及安全性。方法选取我院2010年2月至2012年2月收治难治性抑郁症患者90例,采用随机数字表法分为两组,其中对照组90例,采用文拉法辛口服,首次剂量为75mg/d,1周后增至150mg/d,喹硫平辅助组90例,在对照组基础上加用喹硫平口服,首次剂量为50mg/d,1周后增至250mg/d;疗程均为2个月;比较两组患者临床治疗总有效率,治疗前后汉密尔顿抑郁量表(HAMD)评分及不良反应发生情况等。结果喹硫平辅助组患者临床治疗总有效率明显优于对照组(P<0.05);对照组与喹硫平辅助组患者治疗后HAMD评分较治疗前均明显改善,且喹硫平辅助组患者治疗后HAMD评分改善程度明显高于对照组(P<0.05);同时对照组与喹硫平辅助组患者恶心呕吐、口干、头晕、视物模糊及静坐不能等不良反应发生率组间比较无显著差异(P>0.05)。结论喹硫平辅助治疗难治性抑郁症能够有效缓解临床症状,改善生活质量,且无严重不良反应。     

氟西汀合用奎硫平或利培酮治疗难治性抑郁的临床研究

目的:探讨氟西汀合用奎硫平或利培酮治疗难治性抑郁症的疗效和不良反应.方法:对58例难治性抑郁症患者.随机分为奎硫平组(氟西汀合用奎硫平)和利培酮组(氟西汀合用利培酮).疗程6周.采用汉密尔顿抑郁量表(HAMD)评定疗效和用副反应量表(TESS)评定不良反应,并在治疗前及治疗第6周检查血常规、肝功能、肾功能.结果:奎硫平组显效率为72%,利培酮组为41%,两组之间比较,治疗第2周末起,奎硫平组HAMD评分显著低于利培酮组.奎硫平组不良反应相对较少.结论:氟西汀合用奎硫平治疗不伴精神病性症状的难治性抑郁疗效好,安全,起效快.不良反应少.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Disease control in asthmatic children seen in private practice in Switzerland

ABSTRACT

Background: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice.

Methods: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2.

Results: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2.

Conclusions: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.