科素亚对慢性肾小球肾炎患者尿蛋白作用的短期观察

目的：了解新型AngⅡ受体拮抗剂科素亚对慢性肾小球肾炎患者尿蛋白排泄的影响。方法：观察了28例病人治疗前后24小时尿蛋白（24hrUpro）、平均动脉压(mBp）及血清尿素氮（Bun)、肌酐（Cr）的变化。结果：治疗后患者24hrUpro较治疗前明显减少（P＜0．01）,mBp明显下降（P＜0．05）,而血清尿素氮、肌酐治疗前后相比差异无显著意义（P＞0．05）。结论：科素亚能使慢性肾炎患者尿蛋白排泄明显减少,具有延缓肾小球硬化进程,保护肾脏功能的作用。     

Effects of very low versus standard dose acetyl salicylic acid, dipyridamole and sulfinpyrazone on platelet function and thromboxane formation in man

The effects of three conventional antiplatelet regimes, dipyridamole 3 × 75 mg/day (D), sulfinpyrazone 4 × 200 mg/day (S), acetylsalicylic acid 3 × 330 mg/day combined with dipyridamole 3 × 75 mg/day (ASA + D), and very low dose acetysalicylic acid 100 mg/day (ASA) on platelet function were studied in man following 4 days of treatment. D and S slightly increased mean minimal ADP concentration for irreversible aggregation (n.s.), S reduced aggregation and thromboxane (TXB₂) formation on low dose collagen (2P 0.05), ASA and ASA + D increased platelet count (2P 0.05), increased bleeding time (n.s. for ASA, 2P 0.05 for ASA + D), abolished irreversible aggregation on ADP, suppressed TXB₂ formation on all (2P 0.001) and aggregation on lower concentrations of collagen (2P 0.01) and abolished aggregation and TXB₂ formation on arachidonic acid (2P 0.001). Very low dose ASA suppresses platelet aggregation and TXB₂ formation on several stimuli of possible physiologic significance. In the light of a recently proposed critical belance of vascular antiaggregatory prostacyclin and platelet proaggregatory TXA₂ very low dose ASA might offer advantages over conventional dosage of ASA and should be evaluated in thromboembolic disorders.     

山莨菪碱对血栓性血小板减少性紫癜患者24小时尿蛋白定量的影响

目的观察山莨菪碱（Ani）联合血浆置换（PE）对血栓性血小板减少性紫癜（TTP）患者24h尿蛋白定量的影响。方法选择64例，TTP患者随机分为两组，每组32例。观察组予Ani联合PE治疗，对照组单用PE治疗，疗程均为21d。观察两组临床疗效，并于治疗后2、5、12、21d检查24h尿蛋白定量。结果两组治疗21d后24h尿蛋白均下降，其中观察组在治疗后2、5、12d与对照组差异均有统计学意义（均P〈0．05）；两组第21天尿蛋白定量差异无统计学意义（P〉0．05）。治疗21d后，观察组有效率97％，对照组有效率81％，两组差异有统计学意义（P〈0．05）。结论山莨菪碱联合血浆置换能更有效治疗TTP。     

2型糖尿病患者尿白蛋白排泄率与血浆纤溶活性的相关性分析

目的 探讨2型糖尿病患者24 h尿微量白蛋白排泄率(UAE)与血浆纤溶活性改变的关系.方法 129例2型糖尿病患者根据UAE分为尿白蛋白正常组、微量白蛋白尿组和大量白蛋白尿组,并以40例健康人为对照组,采用发光底物法测定血浆组织型纤溶酶原激活物(t-PA)和纤溶酶原激活抑制物-1(PAI-1)活性,计算PAI-1/t-PA,并进行UAE、血糖、血脂、血尿素氮、肌酐测定.结果 与健康对照组比较,2型糖尿病患者血浆PAI-1活性显著增高,t-PA活性显著降低(P＜0.01);三组2型糖尿病患者PAI-1/t-PA比值差异有统计学意义(P＜0.05),以大量蛋白尿组患者PAI-1/t-PA比值最高;单因素相关分析发现,AER与PAI-1/t-PA比值呈正相关,其中以微量白蛋白尿组最为明显(r=0.5422,P＜0.001).结论 2型糖尿病患者尿白蛋白排泄率与血浆纤溶活性密切相关.     

普罗布考对急性脑梗死患者血浆高敏C反应蛋白和血小板聚集率的影响

目的观察普罗布考对急性脑梗死患者高敏C反应蛋白和血小板功能的影响。方法56例急性脑梗死患者按入院顺序随机分为治疗组和对照组各28例。治疗组在常规治疗的基础上加普罗布考0.5g,2次/d,连续30d,并于治疗前后进行神经功能评估（NIHSS评分）与高敏C反应蛋白和血小板功能测定。结果普罗布考治疗后在神经功能改善的同时,能够降低高敏C反应蛋白并且血小板功能亦得以改善。结论普罗布考具有降低C反应蛋白和改善血小板功能的作用。     

当归注射液对冠心病患者血浆前列环素、血栓素 A_2 及血小板聚集的影响

２４例冠心病患者静脉滴注当归注射液治疗后，血浆６－酮－前列腺素Ｆ１α（６－Ｋ）、６－Ｋ／血栓素Ｂ２（ＴＸＢ２）和ＴＸＢ２、血小板最大聚集率均分别显著高于和低于治疗前水平。结果表明，当归注射液有调节前列环素－血栓素Ａ２平衡和抑制血小板聚集的作用。     

氯沙坦钾联合益肾化湿颗粒对慢性肾炎患者血浆蛋白浓度和IL-1、IL-6、IL-13水平的影响

目的：研究氯沙坦钾联合益肾化湿颗粒对慢性肾炎患者尿蛋白浓度和IL-1、IL-6、IL-13水平的影响。方法：回顾性分析我院收治的59例慢性肾炎患者，按照给药方法分为对照组29例和观察组30例，对照组给予50 mg/d的氯沙坦钾，1次/d，观察组在此基础上再给予益肾化湿颗粒，3次/d，10 g/次。两组患者的疗程均为12周。观察治疗前后患者的血浆蛋白浓度、尿蛋白浓度和IL-1、IL-6、IL-13的水平变化，并分别记录其不良反应发生率。结果：经过治疗，观察组的尿蛋白浓度比对照组低（P<0.01），而血浆蛋白浓度则比对照组高(P<0.05)，差异均具有统计学意义。对照组IL-6、 IL-13水平比观察组低，差异均具有统计学意义(P<0.05)。两组的IL-1水平均有下降，但差异不具有统计学意义（P>0.05）。结论：氯沙坦钾联合益肾化湿颗粒治疗慢性肾炎的疗效更好，能有效增加血浆蛋白含量，减少尿蛋白，降低血清IL-1、IL-6、IL-13的水平，不良反应较少。     

氯沙坦钾对慢性肾小球肾炎患者血清尿酸的影响

目的评价氯沙坦钾、缬沙坦、替米沙坦治疗慢性肾小球肾炎的疗效及对尿酸的影响。方法选择2013年5月至2014年5月于我院住院的148例原发性慢性肾小球肾炎患者。按照治疗方法不同,分为氯沙坦钾组(54例)、缬沙坦组(48例)、替米沙坦组(46例)。观察对比治疗3个月后患者血清尿酸、血压、24 h尿蛋白定量、血清白蛋白及肾功能变化。结果治疗3个月后,氯沙坦钾组患者血清尿酸由(378.18±108.58)降至(325.91±99.04),治疗前后比较差异有统计学意义(P<0.01);治疗前,缬沙坦组、替米沙坦组的血清尿酸分别为(370.75±72.70)、(356.59±91.21),治疗后为(379.08±82.128)、(354.85±59.16),治疗前后比较差异无统计学意义(P>0.05)。氯沙坦钾组治疗后24 h尿蛋白定量、血压、血清白蛋白及肾功能和缬沙坦组及替米沙坦组相似,差异无统计学意义(P>0.05)。结论氯沙坦钾亚除具有降低尿蛋白及降压作用外,还具有良好的降尿酸作用。     

Platelet aggregation and plasma levels of acetylsalicylic acid in stroke patients on long-term treatment with an enteric-coated aspirin formulation

Summary Enteric-coated formulations of acetylsalicylic acid (ASA) should be advantageous in prophylaxis after stroke because they cause fewer gastrointestinal side effects. However, the absorption of unchanged ASA and the effectiveness of these formulations have been questioned, which prompted the present investigation. Fourteen elderly stroke patients on long-term medication with enteric-coated ASA 1.5 g daily and four patients on placebo were studied. When tested with arachidonic acid platelet aggregation was completely inhibited in all ASA subjects whereas it was normal in the controls. Plasma samples, drawn every 1/2 h for 6 h after tablet intake, were analyzed by HPLC. The presence of ASA was short lasting with a mean peak concentration of 55 µmol/l reached after 2–3.5 h. Salicylic acid (SA) appeared later, having a mean peak value of 591 µmol/l after 2.5–6 h. Thus, absorption of ASA as well as inhibition of platelet aggregation were confirmed during long-term medication with enteric-coated ASA.     

超敏C 反应蛋白小于2 mg/L 的心绞痛患者抗血小板聚集治疗方案探讨

摘要： 目的 比较双重抗血小板聚集和单用药物治疗超敏 C 反应蛋白 （hs-CRP） ＜2 mg/L 的心绞痛患者的效果差异。方法 选取因心绞痛 6～48 h 内就诊于我院且 hs-CRP＜2 mg/L 的患者 96 例, 采用随机数字表法分为阿司匹林组和联合治疗组, 每组 48 例。阿司匹林组患者口服拜阿司匹林 100 mg/d, 联合治疗组患者口服拜阿司匹林 10 mg/d 并加硫酸氢氯吡格雷片 75 mg/d, 治疗后 30 d 时对患者进行疗效评定, 并通过随访对患者 6 个月内出现复合终点事件的情况进行统计。结果 阿司匹林组总效率 ［81.25% （39/48）］ 与联合治疗组 ［85.42% （41/48）］ 差异无统计学意义 （χ2 =0.300, P＞0.05）。2 组患者治疗后的复合终点事件差异均无统计学意义 （P > 0.05）。结论 对于 hs-CRP＜ mg/L 的心绞痛患者, 即心血管事件风险相对较小的患者, 单一与双重抗血小板聚集治疗方案的效果无明显差异。     

复方阿司匹林抑制心血管病患者血小板聚集的24周疗效

目的:观察24周疗程中复方阿司匹林(铝镁匹林)抑制心血管病患者血小板聚集功能的效果变化。方法:选择临床需要服用阿司匹林抗血小板治疗且ADP诱导的血小板聚集率增高的心血管病患者103例,给予铝镁匹林2片(含阿司匹林162 mg)口服24周。于用药前及用药6,12,24周后分别测定血小板聚集率。结果:服用铝镁匹林后患者的血小板聚集率显著降低,6,12,24周测定血小板聚集率与基线比较有极显著差异,血小板聚集抑制率分别为-(20.49±22.35)%,-(28.10±22.88)%,-(23.23±22.68)%。12周的血小板聚集率较6周进一步下降,但24周较12周则明显升高,两个差值均有统计学差异(P<0.05)。结论:铝镁匹林可明显降低患者的血小板聚集功能,但抗血小板聚集作用在24周后较12周有明显下降。     

The influence of fenflumizole on platelet aggregation in patients with unstable angina pectoris

Summary We have studied the antiaggregatory effect of fenflumizole, a new non-steroidal antiinflammatory imidazole derivative, in ten patients with unstable angina pectoris.We have measured the aggregation induced by arachidonic acid (AA), ADP, and collagen, and serum or plasma concentrations of -thromboglobulin (-TG), platelet factor 4 (PF-4), thromboxane B₂ (TXB₂), and fenflumizole before, during, and after treatment with fenflumizole in two different regimens either as 10 mg b.i.d. for four days followed by 10 mg daily for six days (Group I,n=5), or as 20 mg b.i.d. for four days followed by 20 mg daily for six days (Group II,n=5).The threshold concentration of AA-induced platelet aggregation increased in both groups by the first day of treatment, the mean increase being significantly higher in Group II than in Group I. There was close correlation between serum fenflumizole and the threshold concentration of AA-induced platelet aggregation (r=0.95).A significant fall in TXB₂ occurred in both groups. In group I TXB₂ concentrations subsequently increased to initial values during treatment, whereas it remained significantly reduced in Group II. There were no significant changes in collagen and ADP aggregation, and -TG and PF-4 concentrations remained unchanged during and after the administration of fenflumizole.     

Effect of nifedipine monotherapy on platelet aggregation in patients with untreated essential hypertension

Summary The effect of 6 weeks of nifedipine 30–60 mg/d on platelet aggregation and lipid parameters has been studied.A diminution in ADP-, adrenaline- and collagen-induced aggregation was observed. In the case of adrenaline-and collagen-stimulated aggregation the decrease was statistically significant. It was found that platelets which aggregated markedly during the placebo treatment were most strongly inhibited by nifedipine. The changes in lipid parameters were not significantly correlated with changes in aggregation.This report is a part of a project realized within the frames of the government programme of studies of the side-effects of hypotensive drugs given for 1 year.     

还原型谷胱甘肽联合黄芪注射液对早期糖尿病肾病尿白蛋白排泄率及C反应蛋白的影响

目的 观察还原型谷胱甘肽(GSH)联合黄芪注射液治疗对糖尿病肾病患者尿白蛋白排泄率(UAER)及C反应蛋白(CRP)水平的影响.方法 将59例2型早期糖尿病肾病患者,完全随机分为对照组(29例)和研究组(30例),经3周治疗后,观察24 h尿蛋白、UAER和CRP水平的变化.结果 2组治疗后24 h尿蛋白、UAER、CRP均较治疗降低[研究组分别为(0.5±0.3) g/24 h比(0.9±0.2) g/24 h,(58±32) μg/min比(92±36) μg/min,(2.4±0.5)g/L比(4.7±1.6) g/L,对照组分别为(0.7±0.2) g/24 h比(0.9±0.2)g/24 h,(74±294) μg/min比(94±39) μg/min,(3.1±0.7)g/L比(4.6±1.6)g/L],差异均有统计学意义(P＜0.01),研究组较对照组降低更明显(P＜0.05).2组治疗后血清肌酐、BUN较治疗前均有下降,差异有统计学意义(P＜0.05),治疗后2组间比较,差异无统计学意义(P＞0.05).结论 GSH联合黄芪注射液治疗明显降低早期糖尿病肾病患者UAER及CRP的水平,减低肾脏损伤程度,改善肾脏功能,较单用黄芪注射液作用明显.     

辛伐他汀对冠心病合并高血压患者尿蛋白的影响

目的探讨辛伐他汀对冠心病合并高血压患者尿蛋白的影响。方法选取内蒙古自治区人民医院2008年4月至2011年1月收治冠心病合并高血压患者110例,采用随机数字表法分为对照组和辛伐他汀组,每组各55例;分别给予安慰剂和辛伐他汀40mg／d,疗程均为6个月;比较两组患者治疗前后TG（甘油三酯）、TC（总胆固醇）、HDL—C（高密度脂蛋白）、LDL—C（低密度脂蛋白）、血肌酐（Cr）、24h尿微量白蛋白（UMA）、血清超敏C反应蛋白（hsCRP）及血压水平等。结果两组患者治疗前TG、TC、HDL—C、LDL～C、Cr、UMA及hsCRP水平组间比较无显著差异（P〉0．05）;治疗后两组患者TG、TC、HDL—C、LDL—C、Cr、UMA及hsCRP水平较治疗前均明显改善,且辛伐他汀组患者治疗后TG、TC、HDL—C、LDL—C、Cr、UMA及hsCRP水平明显优于对照组（P〈0．05）;同时两组患者治疗前后收缩压、舒张压水平比较差异无统计学意义（P〉0．05）。结论辛伐他汀能够有效改善冠心病合并高血压患者尿蛋白水平,可用于早期肾病临床治疗。     

金芪降糖片对2型糖尿病尿微量白蛋白排泄率的影响

目的探讨金芪降糖片对2型糖尿病患者尿微量白蛋白排泄率（UAER）的影响。方法选择2型糖尿病经单纯饮食治疗血糖控制失败并伴早期糖尿病肾病29例随机给以金芪降糖片或二甲双胍治疗6个月，比较两组间UAER的差别。结果治疗前两组间UAER无明显差别（65．9±16．1） vs （63．6±18．6）μg／min，P=0．2693。治疗六个月时金芪降糖片组UAER（43．7±11．5）μg/min较二甲双胍组（56．6±12．0）μg/min明显降低（P=0．0065）。结论金芪降糖片除降血糖作用外还具有潜在的降尿微量白蛋白作用，有价值进一步探讨。     

不稳定性心绞痛患者调脂干预对C反应蛋白的影响

目的 探讨阿托伐他汀对不稳定性心绞痛(UA)患者血浆高敏C-反应蛋白(hs-CRP)的影响.方法 测定60例不稳定性心绞痛患者在常规治疗基础上口服阿托伐他汀(商品名立普妥)20mg,治疗12个月前后血浆hs-CRP.结果 60例不稳定性心绞痛患者经阿托伐他汀治疗12个月后血浆hs-CRP显著下降(P＜0.01).结论 阿托伐他汀对不稳定性心绞痛患者减少炎症反应起着重要的作用.     

Effect of long-term beta-blockade with alprenolol on platelet function and fibrinolytic activity in patients with coronary heart disease

Summary In 14 patients with coronary heart disease the effect of long-term treatment (mean 16 months, range 12–33) with alprenolol on platelet function and fibrinolytic activity was studied. While on the beta-blocker and two weeks after gradula withdrawal of it, the patients performed a bicycle-ergometer test and blood samples were obtained before and following exercise. Pre-exercise fibrinolytic activity, assessed by the euglobulin clot lysis time, was 183±27 min (mean ± SEM) while on alprenolol as compared to 111±18 min (p<0.01) after its withdrawal. Activation of fibrinolysis following exercise was not significantly influenced by alprenolol. In patients treated with alprenolol, the pre-exercise threshold level of ADP, producing platelet aggregation was 3.3 µM (geometric mean) and 5.1 µM after stopping treatment (p0.05). In patients receiving the beta-blocker, the ADP- threshold value dropped from 3.3 µM before exercise to 2.3 µM immediately after exercise (not significant). The corresponding values after withdrawal of alprenolol were 5.1 µM and 2.7 µM (p0.02). Adrenaline — stimulated aggregation was not significantly influenced by alprenolol. Serotonin release from platelets following maximal ADP- and adrenaline stimuli was not significantly changed by exercise in patients on beta-blockade. After stopping treatment, ADP-induced serotonin release was 22±4.1% before and 15±4.7% after exercise (p<0.02). The corresponding values using the adrenaline stimulus were 29±5.7% and 17±4.7% (p<0.05). It is suggested that during physical stress alprenolol may protect platelets against aggregatory stimuli.     

肾炎四味胶囊治疗慢性肾小球肾炎的疗效及对血清VEGF、TNFα的影响

目的探讨肾炎四味胶囊对慢性肾小球肾炎患者的临床疗效及对血浆清血管内皮生长因子（VEGF）和血清肿瘤坏死因子（TNFα）影响。方法以35例健康查体者作正常对照,77例患者随机分为治疗组和对照组,治疗组给予洛汀新片10mg,1次/d,加肾炎四味胶囊3g,3次/d。对照组给予洛汀新片10mg,1次/d,观察治疗前后VEGF和TNFα的改变。结果慢性肾炎患者治疗前血清TNFα和血浆VEGF水平明显增高（P〈0.01）。治疗组经过3个月的治疗其TNFα和VEGF水平明显降低,临床有效率为89.2%,对照组有效率71.1%。结论VEGF、TNFα参与了慢性肾炎的病理生理过程,肾炎四味胶囊可有效地治疗慢性肾炎,其机制可能与降低患者血液中两种因子的含量有关。     

奥美拉唑和法莫替丁对冠心病患者氯吡格雷和阿司匹林抗血小板治疗的影响

目的研究奥美拉唑和法莫替丁对冠心病患者氯吡格雷和阿司匹林抗血小板治疗的影响。方法选择2011年6月至2013年1月在商丘市第一人民医院接受双重抗血小板治疗的186例冠心病患者。根据治疗方法不同分为对照组（66例）、奥美拉唑组（88例）和法莫替丁组（32例）。其中对照组患者使用阿司匹林肠溶片（0．1g／d）＋氯吡格雷片（75mg／d）;奥美拉唑组患者使用阿司匹林肠溶片（0．1g／d）＋氯吡格雷片（75mg／d）＋奥美拉唑（40mg／d,静脉滴注）;法莫替丁组患者使用阿司匹林肠溶片（0．1g／d）＋氯吡格雷片（75mg／d）＋法莫替丁（20mg,2次／d,口服）。检测指标：血小板聚集阈值,二磷酸腺背（ADP）和胶原蛋白诱导的血小板聚集率。结果对照组ADP-血小板聚集阈值为（3．5±1．0）μmol／L,法莫替丁组为（3．8±0．5）μmol／L,奥美拉唑组为（3．4±0．9）μmol／L,各组比较差异无统计学意义（P〉0．05）。对照组胶原蛋白-血小板聚集阈值为（1．93±0．25）mg／L,法莫替丁组为（1．99±0．03）mg／L,奥美拉唑组为（1．95±0．16）mg／L,各组比较差异无统计学意义（P〉0．05）。法莫替丁组和对照组在胶原蛋白0．5mg／L诱导的聚集率差异有统计学意义[（7．1±2．3）％比（9．4±6．6％）,P〈0．05],但法莫替丁组和对照组在胶原蛋白诱导的最大聚集率差异无统计学意义（P〈0．05）。血小板聚集率在对照组和奥美拉唑组间差异无统计学意义（P〉0．05）。结论冠心病患者在双重抗血小板治疗期间,联用奥美拉唑或法莫替丁并不影响氯吡格雷和阿司匹林的抗血小板作用。