子宫内膜异位症的药物治疗评价

目的：本文探讨了药物治疗子宫内膜异位症的进展。方法：回顾近期国内外文献资料并进行归纳分析。结果：药物治疗子宫内膜异位症后患者的总主观症状评分均明显下降,临床症状均明显改善。结论：药物疗法仍是治疗轻中型子宫内膜异位症及预防重型子宫内膜异位症术后复发的重要方法,但现有的药物仍存在着各种程度的不良反应。     

孕期心律失常该用什么药

孕期心律失常在临床较为常见，其药物治疗均可能对胎儿产生一定影响，因此，这个阶段患者对药物的选择要更加谨慎。     

吸烟、饮酒与银屑病发病及治疗结局影响的研究进展

银屑病(psoriasis)是一种皮肤科常见的慢性、复发性、炎症性疾病,其确切病因尚未完全明确,遗传及环境因素是诱发或加重银屑病的重要因素,其中吸烟和饮酒是常见可控危险因素。研究显示,银屑病患者吸烟率高于一般人群,吸烟可能通过增强银屑病相关基因表达、激活银屑病发病相关信号通路等途径影响银屑病的发病和进展,从而增加银屑病的发生风险,导致银屑病患者病情加重。但吸烟是否会影响银屑病患者的治疗效果仍存争议,尚需更多研究来确认吸烟和戒烟对银屑病患者治疗效果的影响。流行病学调查显示,银屑病患者饮酒率高于一般人群。现有研究证据表明,饮酒可能通过影响银屑病相关易感基因、角质形成细胞增殖分化以及诱导免疫细胞异常活化对银屑病的发生、发展产生不利影响,同时饮酒会减弱银屑病的治疗反应,使治疗效果欠佳。但饮酒与银屑病发病和严重程度之间的关系尚无统一结论,仍需开展更多研究来探讨饮酒与银屑病之间的关联。     

药物对症状和体征的影响

症状和体征是临床用于诊断、鉴别诊断、制定和调整药物治疗方案、判断药物治疗效果和不良反应的重要依据,但应注意的是药物可能会对症状和体征产生影响。符合原发病治疗目的的药效作用常可使原发疾病相关的症状和体征得到改善,但非药物治疗目的的药物不良反应、药物相互作用则可使患者出现新的症状和体征,也可能引起、加重或掩盖原发病相关的症状和体征,而药物或其代谢物的颜色等理化性质也会影响症状和体征。这些影响会增加疾病的诊断和治疗的难度,干扰疗效判断和药物不良反应的鉴别,甚至延误治疗和处理。故在临床工作中应注意合理用药并加强药学监护,尽可能避免或减少药物对症状和体征的不利影响,保持高度警惕,及时发现这些影响并作相应处理。     

循证药学和药物经济学理论在我国基本药物 目录中的应用探讨

目的：为了以更合理的方式对我国基本药物目录所纳入的药物进行遴选,本研究尝试应用循证药学和药物经济学理论建立科学的定量遴选体系。方法：通过参考泰国ISafE评价法和其他国家和地区基本药物目录的遴选方法,以循证药学及药物经济学为理论基础,提出更为完善的我国基本药物目录遴选体系并对其进行说明。结果和结论：通过循证药学方法以及药物经济学方法科学合理地解决了我国目前基本药物目录遴选所存在的问题,该遴选机制也可用于以后基本药物的增补、医保目录药物遴选、增补以及确定同类药物间临床首选药等方面。由于国内文献数量以及质量问题,目前该机制的开展尚存在一定的问题,但也可以为我国基本药物遴选体系的发展起到一定的参考作用。     

基本医疗保障制度下完善我国罕见病高价值治疗药物医保准入的思路探讨

罕见病高价值治疗药物能填补临床空白,较标准治疗方案显著改善患者症状和生活质量,但因在患者数量规模、真实世界疗效、安全性表现及基金预算影响等方面存在不确定性,使医保部门决策风险的不确定性极大,叠加高价因素导致其医保准入难度不断增加。由于罕见病的特殊性,按照常规药物的遴选评价原则及采取“严准入、宽续约”思路进行目录管理存在一定局限性。从国际经验来看,罕见病治疗药物的医保准入需要差异化的评估体系。文章在分析罕见病高价值治疗药物医保准入的困境及成因基础上,借鉴国际经验并结合国内医保准入实践,提出完善我国罕见病高价值治疗药物医保准入政策的若干思路,以期为有关部门调整罕见病医疗保障思路和创新遴选评价机制提供参考,进一步提升罕见病高价值治疗药物的患者可及性。     

抗帕金森病药物药理研究进展

据报道,美国现有帕金森病(PD)患者约150万,每年用于治疗PD的费用高达100亿美元.研究报告显示,我国65岁以上PD患病率男性为1.7%,女性为1.6%,位居老年神经系统退行性疾病第2位[1].PD是一种终身性疾病,一旦患病则需终身治疗,药物治疗仍是目前最主要的方法.常用的临床治疗药物包括多巴胺类和抗胆碱能药物.本文就抗PD药物药理研究进展综述如下.     

临床医学中机体因素对药物效应的影响

据统计,临床医学医治各类疾病的疗效,70%来自药物的治疗效应。但临床也常注意到应用相同药物治疗不同患者时,其治疗效应可能出现差异,甚至可能产生与预期效应不同的临床反应。这是因为临床药物治疗效应受多种因素的影响,     

抗肿瘤药物的基础与转化研究助推临床治疗

恶性肿瘤已成为严重威胁人类健康的主要公共卫生问题之一。随着医药科技的发展,肿瘤患者的生存率有了明显提升。但是,现有治疗策略进进无法满足临床需求,目前仍存在可用药物少、不良反应严重等问题。为进一步推进肿瘤患者的临床治疗,本期推出了“抗肿瘤药物研究与转化”专栏,分别从“抗肿瘤药物靶点及先导化合物发现”及“抗肿瘤药物的智能递送转化研究”两大主题开展深入探讨,以期为肿瘤患者的临床治疗提供药物新靶点和治疗新策略,助推抗肿瘤创新药物的研发。     

限定日剂量在医院抗菌药物合理使用中的应用与探讨

<正>抗生素是目前临床应用中使用最广泛的药物之一,是治疗各种感染必不可少的药物,其使用情况对医院药品管理和医疗水平产生重要影响。随着现代医药科技不断发展,不断有新的抗感染药物涌现,为临床治疗提供了广阔的选择余地,但抗生素在有效治疗感染性疾病、治愈并挽救了许多患者生命的同时,也出可能由于使用不合理而导致发生不良后果,如患者出现不良反应增加,细菌耐药性增多及部分由于选药不当而造成最终治疗失败等,给患者健康乃至生命造成不利威胁。因此如何更加安全、有效和合理使用抗菌药物已经越来越引起人     

顺铂联合用药治疗乳腺癌的研究进展

乳腺癌发病率持续上升，严重影响女性健康。其治疗手段从手术治疗到化、放疗，再到内分泌治疗与免疫治疗，不断更新，但化疗仍是晚期乳腺癌或发生乳腺外转移的主要临床治疗手段。顺铂是治疗乳腺癌的一线化疗药物，但其不良反应和耐药性限制了其临床应用。目前众多研究报道顺铂联合其他药物可减轻顺铂不良反应、克服其耐药性，从而提高抗乳腺癌效果。本文拟对顺铂与天然活性成分、化疗药、抗体以及核酸类药联合治疗乳腺癌的最新研究进展进行综述，以期为乳腺癌联合治疗方案的选择提供参考。     

Pharmacogenetics of drugs withdrawn from the market

The safety and efficacy of candidate compounds are critical factors during the development of drugs, and most drugs have been withdrawn from the market owing to severe adverse reactions. Individuals/populations with different genetic backgrounds may show significant differences in drug metabolism and efficacy, which can sometimes manifest as severe adverse drug reactions. With an emphasis on the mechanisms underlying abnormal drug effects caused by genetic mutations, pharmacogenetic studies may enhance the safety and effectiveness of drug use, provide more comprehensive delineations of the scope of usage, and change the fates of drugs withdrawn from the market.     

Clinical relevance of cimetidine drug interactions.

The excellent efficacy and tolerability profiles of H2-antagonists have established these agents as the leading class of antiulcer drugs. Attention has been focused on drug interactions with H2-antagonists as a means of product differentiation and because many patients are receiving multiple drug therapy. The main mechanism of most drug interactions involving cimetidine appears to be inhibition of the hepatic microsomal enzyme cytochrome P450, an effect which may be related to the different structures of H2-antagonists. Ranitidine appears to have less affinity than cimetidine for this system. There have been many published case reports and studies of drug interactions with cimetidine, but many of these have provided pharmacokinetic data only, with little information concerning the clinical significance of these findings. Nevertheless, the coadministration of cimetidine with drugs that have a narrow therapeutic margin (such as theophylline) may potentially result in clinically significant adverse effects. The monitoring of serum concentrations of drugs coadministered with cimetidine may reduce the risk of adverse events but does not abolish the problem. However, for most patients, concomitant administration of cimetidine with drugs possessing a wide therapeutic margin is unlikely to pose a significant problem.     

Pharmacogenetics in geriatric medicine: challenges and opportunities for clinical practice

The genetics of drug metabolizing enzymes, drug transporters and drug receptors is a very active area of multidisciplinary research, overlapping the interest of medicine, biology, pharmacology and genetics. Indeed, these proteins are virtually responsible for the metabolism, disposition and efficacy of most of available drugs. Variations in the gene encoding these proteins may account for the interindividual differences observed in drug efficacy, including severe clinical consequences such as therapeutic failures and adverse drug reactions. It is well known that the prevalence of both therapeutic failures and adverse drug reactions strongly increased in older subjects, and this did not seem to be always related to the presence of multiple pharmacological treatments, a common status in subjects aged 65 years and over. The present article explored some basic concepts of human genetics that may have important implications in the pharmacogenetics of drug metabolizing enzymes, drug transporters and receptors. We also focus the current knowledge on the genetic basis of the efficacy and the adverse drug reactions of the most common drugs used in the geriatric patient. Thus we explore the status of what we know and what we need to know to forward the application of pharmacogenetics in clinical practice, in order to introduce a personalized treatment project for the older people.     

纳米脂质体药物在类风湿性关节炎治疗中的研究进展

类风湿性关节炎（RA）是一种病因未明的自身免疫性疾病,典型病理改变为慢性滑膜炎,严重影响患者生活质量。目前的治疗药物能够缓解症状,延缓病程,但均存在明显的不良反应。以脂质体为代表的纳米药物递送系统在临床上已显现出了明显的优势,其能够通过被动或主动靶向从而提高药物的治疗效应及减少不良反应。在本文中,我们回顾了脂质体药物递送系统在RA治疗中的作用,阐述了其在临床前研究和临床试验的进展,并讨论了可能阻碍其临床转化的因素。     

胆红素代谢酶UGT1A1介导的中药不良反应研究进展

尿苷二磷酸葡萄糖醛酸转移酶1A1（UGT1A1）是哺乳动物体内分布的一种重要的Ⅱ相代谢酶,其不仅介导了大量临床药物、毒物的代谢清除,还是机体参与内源性毒性物质胆红素代谢清除的唯一代谢酶。药物或食品中的化学成分对UGT1A1的强烈抑制会引发多种不良反应,如药物/草药-药物相互作用、高胆红素血症、肝功能异常及神经毒性等。近年来,研究发现许多草药提取物及其化学成分可通过强效抑制UGT1A1引发药物-草药相互作用等不良反应。结合药物代谢及药物毒理学相关领域的新近研究进展,系统总结了UGT1A1抑制剂筛选与评价常用方法,以及中草药化学成分对UGT1A1抑制作用的研究进展。上述信息对于临床安全合理的使用中草药,尤其是在中西药联用或中药方剂使用过程中尽可能避免因UGT1A1抑制引发的不良反应,具有重要指导意义。     

Ranitidine versus cimetidine. A comparison of their potential to cause clinically important drug interactions

The literature on H2-antagonist drug interactions is now extensive. The whole subject is so complicated as to make things difficult for the potential prescriber. However, it is possible to reduce most of the information contained in the literature to a few simple messages. Firstly, H2-antagonists bind to cytochrome P450 and may inhibit the metabolism of drugs eliminated by the mixed function oxygenase system. In this respect, cimetidine has a marked effect which, in most studies, has reached statistical significance. Ranitidine, on the other hand, has a much weaker effect which, even if demonstrable, is statistically non-significant. The potential benefit of ranitidine, however, has to be weighed against the relative costs of the 2 drugs. Secondly, H2-antagonists inhibit gastric acid production and may alter the rate of gastric emptying, and hence the rate of drug absorption. They may also have some effect on portal vein and hepatic artery flow. However, these effects are small and probably not clinically relevant. Thirdly, pharmacodynamic effects of H2-antagonist-drug interactions are difficult to demonstrate in planned studies, and although they are reported from time to time, adverse reactions of consequence are relatively uncommon. Fourthly, the prescriber needs to be aware that cimetidine may produce higher plasma concentrations of some drugs which have a fairly narrow therapeutic range, and this may be clinically important. Examples of drugs for which it may be undesirable to inadvertently increase plasma concentrations include warfarin, theophylline and phenytoin. Finally, for most drugs metabolised by the liver, the risk of an important interaction is small. However, if such an interaction is noted it may be helpful to refer to the other reported cases, and a number of references are included here.