盐酸司他斯汀片治疗常年性变应性鼻炎的疗效分析

目的观察盐酸司他斯汀片对常年性变应性鼻炎的临床疗效。方法随机双盲双模拟平行对照临床试验,实际纳入试验组19例,对照组20例。试验组（盐酸司他斯汀,1.0 mg）及对照组（富马酸氯马斯汀片,1.0 mg）,两组均每天服药2次、模拟片1片,均连服14 d。在服药第7天、第14天观察治疗前后两组的疗效。结果两组均能有效控制和改善病情,试验组与对照组的总有效率均为65%,两组间差异无显著性。结论盐酸司他斯汀片治疗常年性变应性鼻炎临床疗效确切,与富马酸氯马斯汀疗效相当。     

412例药物致皮肤过敏反应及处置分析

目的分析近3年文献报道的药物致皮肤过敏反应及其药物治疗方案。方法通过检索维普信息数据库、清华同方中国期刊网数据库、中国生物医学文献光盘数据库,统计近3年关于药物致皮肤过敏反应的文献资料,分析其药物治疗方案。结果 412例报告中,涉及中药7类,化学药品21类。中药注射剂和抗菌药物是引起皮肤过敏反应的主要药物。药物致皮肤过敏的临床表现以荨麻疹和斑丘疹最为常见,其治疗以抗组胺药、糖皮质激素、葡萄糖酸钙等联用为主。结论药物致皮肤过敏反应在临床上具有较高的发生率,其治疗方法较局限。应合理使用药物,减少药物致过敏反应的发生,同时,应开发使用方便、副作用小的新型抗过敏药物。     

术前含漱口腔护理液对食管手术患者预防肺部感染的效果

目的 探讨术前不同口腔护理液对食管手术患者预防肺部感染的效果.方法 食管癌患者90例,随机分为3组,每组30例.A组用0.05%碘伏液口腔护理,B组用0.02%呋喃两林液口腔护理,C组用生理盐水口腔护理.术前1周.每天含漱5次.口腔干预后留取手术日晨咽拭子培养、术中气管插管2 h痰标本、拔管后气管套囊黏附分泌物进行培养,分析比对细菌培养结果及对肺部感染的预防作用.结果 咽拭子、痰标本、气管套囊黏附分泌物细菌培养阳性率:A组为30.0%、26.7%、20.0%,B组为63.3%、50.0%、56.7%,C组为80.0%、66.7%、76.7%;A、B、C组肺部感染发生率为20.0%、40.0%、56.7%,组间差异明显(P<0.01).结论 手术前使用0.05%碘伏液进行手术前口腔干预,可起到局部抑菌杀菌的作用,对预防食管手术患者肺部感染起到良好效果.     

盐酸奥洛他定在中国变应性鼻炎人群的非劣效临床研究设计及其定量分析*

目的:通过非劣性设计,评价盐酸奥洛他定片剂治疗变应性鼻炎的安全性和有效性。方法:以盐酸氯雷他定片为对照,采用随机、双盲双模拟、多中心、平行对照、非劣效临床研究。两组各120例。试验组早晚各1次口服盐酸奥洛他定,每次5 mg;对照组早晨服用氯雷他定片10 mg。按双模拟方法编盲,以症状体征总积分下降值为主要疗效指标,非劣效标准(δ)设为1分,疗程2周。结果:用药后2周,两组各项症状明显改善,症状体征总积分和生活质量评估等级较用药前显著下降(P<0.01);作为主要疗效指标的症状总积分差值(FAS集),组间差值95%可信区间为[-0.260,0.880],即试验组不劣于对照组(P<0.05)。对照组有效率为61.5%,不良反应发生率为9.2%;试验组有效率62.4%,不良反应发生率为5.8%,组间差异无统计学意义(P>0.05)。结论:盐酸奥洛他定治疗变应性鼻炎疗效确切,不劣于对照药氯雷他定,患者耐受性好,未发现严重不良反应。     

A disease management protocol for outpatient perioperative bridge therapy with enoxaparin in patients requiring temporary interruption of long-term oral anticoagulation

STUDY OBJECTIVE: Traditional perioperative bridge therapy for patients receiving long-term oral anticoagulation involves weight-adjusted intravenous unfractionated heparin (UFH) in the perioperative period during temporary discontinuation of the oral anticoagulant. We sought to determine whether an alternate strategy of outpatient-based perioperative disease management with low-molecular-weight heparin (LMWH) as bridge therapy provides the potential for cost savings. DESIGN: Retrospective review of all clinic notes from an anticoagulation clinic. SETTING: An integrated, staff-model health maintenance organization. PATIENTS: Patients receiving long-term warfarin therapy from January 1998-March 2002 who received perioperative bridge therapy with the LMWH enoxaparin 1 mg/kg twice/day subcutaneously MEASUREMENTS AND MAIN RESULTS: A total of 126 bridge therapy encounters in 84 patients receiving LMWH as perioperative bridge therapy were identified, with 48 of those encounters involving patients with at least one mechanical heart valve. A total of 1108 hospital bed days were saved. Based on 1996 cost estimates, the total approximate cost savings for the 4.25 years of the outpatient bridge therapy program was dollars 903,020. No thrombotic events were reported. Three major hemorrhagic events that required discontinuation of LMWH were reported. CONCLUSION: Outpatient-based disease management protocols and the LMWH enoxaparin as bridge therapy during temporary discontinuation of warfarin for an elective surgical procedure resulted in cost savings of approximately dollars 212,475/year in an integrated health maintenance organization. In addition, this strategy appears both safe and effective.     

Bronchial epithelial cells in allergic reactions

Bronchial epithelial cells (BEC) are known to play an integral role in the airway defense mechanism via mucociliary system as well as mechanical barriers. Recent studies further indicate that BEC produce and release biologically active compounds including lipid mediators, growth factors, endothelin and a variety of cytokines/chemokines important in the pathogenesis of airway disorders. Cytokines and chemokines produced by BEC include IL-6, IL-8, G-CSF, GM-CSF, RANTES, eotaxin and TARC. Pro-inflammatory cytokines IL-1 and TNF-alpha, generally upregulate expression and release these cytokines/chemokines. BEC from patients with bronchial asthma showed increased levels of mRNA for these potent inflammatory peptides. BEC also interact with immune and inflammatory cells by direct adhesion as well as by humoral factors including cytokines. For example, eosinophil adhesion to BEC may be an important signal for the activation and degranulation of eosinophils. BEC is also believed to take part in the airway mucosal immunity via Toll-like receptors. Finally, BEC may play a crucial role in the processes of airway remodeling by cross-talk with mesenchymal cells. These findings strongly suggest that BEC are actively involved as regulators of allergic inflammatory responses, and become a target for therapeutic intervention.     

阿瑞匹坦用于乳腺癌患者化疗的止吐效果观察

目的观察分析阿瑞匹坦用于乳腺癌患者化疗的止吐效果及安全性。方法选取我院经病理确诊的68例初诊化疗的乳腺癌患者,随机分为试验组及对照组。试验组34例,给予阿瑞匹坦联合托烷司琼、地塞米松;对照组给予安慰剂、格拉司琼、地塞米松,用药剂量及用法与试验组相同。观察两种治疗方案对化疗所致恶心、呕吐的疗效。结果 68例患者均纳入分析,阿瑞匹坦组患者完全缓解率明显优于对照组(61.8%vs.31.3%,P=0.029);阿瑞匹坦组与对照组的急性呕吐完全缓解率分别为85.3%和67.6%(P=0.086),呈降低趋势,但差异无统计学意义;阿瑞匹坦组迟发性呕吐的完全缓解率明显高于对照组(70.6%vs.44.1%,P=0.027),迟发性呕吐的发生率明显低于对照组(5.9%vs.29.4%,P=0.011)。本研究中未观察到阿瑞匹坦相关中重度不良反应,药物安全性良好。结论阿瑞匹坦对于乳腺癌化疗患者止吐效果良好,在迟发性呕吐的缓解方面尤其突出,且不良反应较轻,患者可耐受。     

Role of zinc transporter in allergic reactions

Zinc (Zn) is an essential nutrient and its deficiency causes growth retardation, immunodeficiency, and neuronal degeneration. Zn homeostasis is tightly controlled by transporting through Zn transporters and by buffering via metallothioneins, all of which are involved in the intricate regulation of Zn concentration and distribution in individual cells. Research in understanding of these molecules has progressed with application of genetic techniques, which allow us to clarify the diverse role of Zn in vivo and in vitro. However, the precise roles and molecular mechanism(s) of Zn's function in allergic response have not been clarified. Mast cells are granulated cells that play a pivotal role in allergic reactions. The granules of mast cells contain various chemical mediators and inflammatory cytokines that are released upon FcεRI crosslinking. In this article, I will describe a role of Zn/Zn transporter in FcεRI-mediated mast cell degranulation and cytokine production. Furthermore, Zn acts as an intracellular signaling molecule, that is, a molecule whose intracellular status is altered in response to an extracellular stimulus in mast cell, and that is capable of transducing the extracellular stimulus into an intracellular signaling event, like Ca(2+). I have proposed that there are two classes of Zn signaling: "Early" and "Late" Zn signaling. In this review, I discussed how Zn and its homeostasis affect biological events especially for mast cell-mediated allergy response.     

疏血通注射液预防胫骨骨折术后下肢深静脉血栓形成的疗效

目的观察疏血通注射液预防胫骨骨折髓内钉内固定术后下肢深静脉血栓（DVT）形成的疗效。方法将89例患者按就诊顺序随机分为研究组（43例）和对照组（46例）,研究组于术后第1天给6ml加入5％葡萄糖或9％氯化钠注射液250ml中静脉滴注,10次／d。对照组术后12h起使用低分子肝素钙4000U皮下注射,1次／d,2组疗程均为7d。对照组予低分子肝素钙常规抗凝;研究组采用疏血通注射液行中药抗凝。术后第14天行下肢血栓B超检查,观察DVT的发生率。结果术后第14天,研究组DVT发生率低于对照组[11．6％（5例）比13．0％（6例）],但差异无统计学意义（P〉0．05）。研究组日平均抗凝费用低于对照组[（73．3±9．1）元比（149．3±14．5）元],差异有统计学意义（P〈0．05）。研究组治疗前、术后第3天、术后第14天内皮素分别为（30±9）、（80±9）、（454-9）ng／L,对照组分别为（32±9）、（83±9）、（52±9）ng／L,2组术后第14天内皮素水平明显低于术后第3天,研究组明显低于对照组,差异均有统计学意义（均P〈0．05）。结论疏血通注射液能有效预防胫骨髓内钉术后DVT的发生,且治疗费用更低廉。     

Reduction in warfarin adverse events requiring patient hospitalization after implementation of a pharmacist-managed anticoagulation service

STUDY OBJECTIVE: To compare adverse events related to anticoagulation in patients assigned to a pharmacist-managed anticoagulation service versus those receiving usual care. DESIGN: Retrospective cohort analysis. SETTING: Three hundred-bed community hospital. PATIENTS: Four hundred twenty patients referred for anticoagulation management. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were the number of adverse events requiring patient hospitalization and the number of patients experiencing such events. Secondary outcomes were the median length of hospital stay/admission and the total number of hospital days. The total numbers of adverse events requiring hospitalization were three for the pharmacist-managed group and 14 for the usual care group (p=0.0153). The number of patients experiencing an adverse event requiring hospitalization was also lower for the pharmacist-managed group than for the usual care group (3 vs 10, p = 0.0962). The median length of hospital stay associated with each adverse event was not significantly different between the two groups; however, the total number of hospital days accrued was higher in the usual care group. CONCLUSION: At 6 months after discontinuation of the pharmacist-managed anticoagulation service, the frequency of adverse events increased significantly, resulting in both an increased number of hospitalizations and an increased number of hospital days accrued. This coordinated anticoagulation program using a pharmacist reduced warfarin-related complications.     

左旋卡尼汀防治心肌缺血老年患者围术期心肌梗死的效果观察

目的：研究在围术期应用左旋卡尼汀对心肌缺血老年患者心肌梗死的预防和治疗作用。方法：40例有心肌缺血基础的老年患者随机分为治疗组和对照组，每组各20例。治疗组在麻醉诱导前30min以左旋卡尼汀3．0g加入0．9％氯化钠注射液250mL持续静滴；对照组静脉滴注0．9％氯化钠注射液。术中纪录心电图各导联（Ⅱ、Ⅲ、Ⅴ、avF）ST段水平、MAP、HR，并计算HR和SBP的乘积（RPP），同时抽取外周静脉血检测术前、术毕、术后24h血清心肌肌钙蛋白Ⅰ（cTnⅠ）水平。结果：术中对照组出现明显的ST段下降和RPP升高，与治疗组比较差异有显著性（P〈0．05）；治疗组术后cTnⅠ水平的升高程度较对照组为低，两组间差异有显著性（P〈0．05）。术后对照组有2例出现灶性心肌梗死。结论：左旋卡尼汀预防和治疗老年患者围术期心肌缺血、心肌梗死具有较好的作用。     

Tolerogenic role of Kupffer cells in allergic reactions

Drug-induced allergic reactions (DIARs), including allergic hepatitis, cutaneous reactions, and blood dyscrasias, are unpredictable and can be life threatening. Although current studies suggest that DIARs are caused by immunogenic drug-protein adducts, it remains unclear what factors determine the susceptibility to DIARs. We hypothesized that most individuals may be resistant to DIARs in part because they become immunologically tolerant to drug-protein adducts in the liver, an organ with tolerogenic properties. Because animal models of DIARs are elusive, we tested this hypothesis using a murine model of 2,4-dinitrochlorobenzene (DNCB)-induced delayed type hypersensitivity reaction that is mediated by immunogenic 2,4-dinitrophenylated (DNP)-protein adducts. Intravenous pretreatment of mice with DNP-BSA led to its accumulation in hepatic Kupffer cells (KC) and induced immunological tolerance to subsequent DNCB sensitization. Tolerance could be abrogated by prior depletion of KC or induced in na?ve mice by transferring a T cell-depleted, KC-enriched fraction of liver nonparenchymal cells from mice tolerized 1 month earlier by DNP-BSA pretreatment. These findings implicate KC as a primary and sustained inducer of tolerance against DNP-protein adducts and suggest a similar role in modulating allergic reactions against drug-protein adducts. Perhaps genetic and/or environmental factors affecting the activities of these cells may play a role in determining individual susceptibility to DIARs.     

自体血循管预防血透病人首次使用综合征的疗效分析

目的 研究使用自体血循管预防血透病人首次使用综合征的可行性,提高透析质量、减轻患者痛苦及医疗费用.方法 将维持性血液透析的患者156人共1158例次,按照透析时间分为对照组和实验组.对照组按常规血透流程操作,实验组在对新的透析器和管路进行常规预冲后使用患者自体血密闭式循管10 ～ 15 min,对两组患者血透过程中首次使用综合征（First-useSyndrome,FUS）发生率及体外凝血发生率进行对比.结果 对照组在560例次透析治疗的病人中,共发生FUS 23例次（4.11％）,而实验组在598例次透析治疗的病人中,共发生FUS 5例次（0.84％）.FUS发生率实验组明显低于对照组,两组比较差异有统计学意义（P＜0.01）,而体外凝血发生率则两组无明显改变,差异无统计学意义（P＞0.05）.结论 使用患者自体血循管能有效预防血透病人血透过程中首次使用综合征的发生,且不增加出血及体外凝血现象风险.     

阿瑞吡坦在中国肺癌患者中预防高剂量顺铂引起恶心和呕吐的疗效(英文)

目的探讨在中国肺癌患者中应用阿瑞匹坦减轻高剂量顺铂为主的化疗方案引起的恶心和呕吐的效果。方法纳入预接受高剂量顺铂为主化疗方案的肺癌患者291例,随机分为两组。阿瑞吡坦组139例,化疗第1日予阿瑞吡坦125 mg;第2,3日,予阿瑞吡坦80 mg,口服。标准治疗组152例,予安慰剂口服。两组均接受静脉注射格拉司琼和口服地塞米松。评估两组总完全反应率及在化疗第1日(急性期)和第2~5日(延迟期)的完全反应率,比较两组接受高度或中度致吐化疗方案患者的完全反应率。结果阿瑞吡坦组总完全反应率为69.1%(96/139),高于标准治疗组[57.2%(87/152),P=0.035],延迟期亦高于标准治疗组[72.7%(101/139)vs.59.9%(91/152),P=0.019],急性期组间无显著差异[79.9%(111/139)vs.80.9%(123/152),P=0.914]。阿瑞吡坦组接受高度或中度致吐化疗方案患者中完全反应率为60%(3/5),高于标准治疗组[33%(1/3),P=0.034]。结论阿瑞吡坦治疗可以预防中国肺癌患者接受高剂量顺铂化疗引起的恶心和呕吐,特别是在延迟期效果优于标准治疗。     

Desensitization of patients with allergic reactions to immunosuppressives in the treatment of inflammatory bowel disease

Crohn's disease and ulcerative colitis are chronic, immune-mediated inflammatory bowel diseases (IBDs) of unknown etiology with high morbidity in patients who are not receiving adequate medical treatment. A variety of medical therapies are currently available, and much progress has been made to alleviate symptoms and restore quality of life. The mainstay of treatment in those with moderate to severe disease consists of medications that alter or suppress the body's immunologic attack on its own gastrointestinal tract. The medications currently in use are highly effective when given in the appropriate clinical context, but side effects are not uncommon and must be treated expeditiously when they occur. One class of immunosuppressive medication, 6-mercaptopurine and its prodrug azathioprine, is effective at inducing remission and improving the lives of patients with IBD. The most common side effects of these drugs are allergic reactions and rarely can they be severe and life threatening. These reactions can sometimes be overcome by desensitizing the immune system to the drug. This review emphasizes allergy to 6-mercaptopurine and azathioprine and the process of desensitization when these allergic reactions occur in order to continue use of this important class of medication in the total treatment of IBD.     

变应性鼻炎特异性免疫治疗的疗效

目的 评价变应原特异性免疫治疗(SIT)对螨虫引起的常年变应性鼻炎的疗效.方法 90例以尘螨为主要变应原的中-重度常年性变应性鼻炎患者分为两组:A组60例,采用SIT治疗及必要时药物对症治疗;B组30例,仅采用药物治疗.比较两组治疗前、治疗6个月和12个月症状的VAS评分和用药评分变化.结果 治疗6个月和12个月后,两组VAS评分均较治疗前下降(P＜0.05);A组低于B组(P＜0.05).治疗后A组用药评分下降,B组无明显变化.治疗12个月后,A组有效率93.33％,高于B组的76.67％ (P＜0.05).结论 SIT对于尘螨引起的常年性变应性鼻炎有较好的疗效.