拉莫三嗪药代动力学及儿科临床应用的进展

在我国,儿童癫痫(不含热性惊厥)每年的发病率为151/10万,患病率为3.45‰.婴幼儿期是癫痫发病的第一个高峰期,目前约70% ～80%患者未接受正规诊断与治疗,活动性癫痫治疗缺口高达60%[1].     

复方苯巴比妥溴化钠与德巴金治疗癫痫372例疗效及成本评价

癫痫是一种常见的临床神经系统疾病,患病率和发病率都很高,WHO调查显示2年和5年内有发作的活动性癫痫患者其治疗缺口很大,分别为64.8%和67.9%[1],据李世绰等[2]流行病学显示我国癫痫患病率为4.4%,由此可见大量的癫痫病患者未得到正规有效的治疗,根本原因多由疗效及医疗经济成本所致。     

顽固性癫痫96例分析

2007年据流行病学调查,癫痫的终生患病率为7.0‰,活动性癫痫患病率为4.9‰,70%80%左右的患者经过正规的内科治疗其发作可以得到控制或缓解,但20%30%的患者属于难治性癫痫患者,虽然近几年外科手术治疗取得一定成效,但位于大脑重要功能区域的病灶一直是手术的禁区,     

托吡酯片联合常规药物治疗难治性癫痫的临床观察

癫痫是一种由大脑神经元反复异常同步化放电所引起的短暂中枢神经系统功能失常为特征的慢性脑部疾病,具有突然发生、反复发作的特点。流行病学调查显示,我国癫痫患病率高达7.0‰,活动性癫痫的患病率达4.6‰。癫痫患者经传统抗癫痫药(AED)正规治疗,约有70%～80%的患者发作可获控制,重享健康人生,但仍有20%～30%的患者药物治疗效果不佳,成为难治性癫痫(IE)。为探索难治性癫痫的治疗方法,笔者于2007年1月～2010年1月,在常规抗癫痫治疗基础上加用托吡酯片治疗难治性癫痫,以开放性自身对照观察疗效及不良反应,现报告如下。     

癫痫的过去、现在和未来——访北京大学第一医院神经内科癫痫中心主任吴逊

癫痫,也就是老百姓俗称的“羊癫疯”。由于调查方法、定义、类型、年龄等各种因素的影响,癫痫的患病率受地区影响差异很大,如日本较低为3‰～5‰。美国较高,为5‰～1‰,我国的报告为7‰,一般认为,在4‰～9‰,儿童为5‰～7‰。     

难治性癫痫患者外科手术治疗的麻醉管理

癫痫是神经科常见病,是多种病因引起的一种临床综合征。在我国患病率高达7.0‰,活动性癫痫的患病率达4.6‰,约20%~30%的患者为药物不能控制的顽固性癫痫[1]。近年来神经科在脑皮层电图（electrocorticogram,ECoG）监测下行顽固性癫痫致痫灶切除术取得了较大进展,使许多难治性癫痫患者的病情得到了完全控制或显著改善;癫痫     

癫痫的药物治疗进展

癫痫是以脑神经元异常放电引起反复痫性发作为特征的短暂脑功能失调综合征，是一种常见病、多发病。癫痫的患病率在发达国家、经济转轨团家、发展中国家和不发达网家分别为5．0‰、6．1‰、7．2‰、11．2‰．估计全球有约5000万癫痫患者。国内的癫痫流行病学凋查表明：我国癫痫的发病率约23／10万／年左右，而患病率为3．5‰-4．8‰，其中用药物不能控制的顽同性癫痫约占20％左右。癫痫给患者个人、家庭和礼会都造成了很大危害和影响。因此癫痫的治疗引起了社会广泛关注。癫痫的治疗包括药物治疗、手术治疗、物理治疗和心理治疗等多种方法，其中药物治疗是目前最常用，最重要的手段。其应用也是最为复杂的。近年来，癫痫的药物治疗取得了较快发展，现将其治疗进展综述如下。     

惊厥型癫痫患者的诊断和治疗

根据近期流行病学调查数据,我国目前约有900万癫痫患者,其中500万～600万是活动性癫痫患者,而且每年还会出现40万新患者。癫痫患者及其家属对癫痫的性质、如何治疗以及日常生活中应注意的问题等知之甚少。农村三级医疗保健网的医务工作者对癫痫也缺乏科学的认识,诊断、治疗方法很不规范。病人有病乱投医,花费大量时间和金钱,癫痫仍然得不到有效的控制。最新调查发现,我国农村地区三分之二以上的癫痫病人没有得到合理的治疗。国内外临床研究表明,癫痫患者经过正规的抗癫痫药物治疗,约70%的患者其发作是可以得到控制的,其中50%～60%的患者经2～5年的治疗可以痊愈,患者可以和正常人一样地工作和生活。为加强我国农村地区癫痫防治工作,中央财政安排专项经费,在重点省(自治区)的部分县开展农村地区癫痫防治管理项目。为保障项目实施,卫生部也制定了《农村癫痫防治管理项目管理办法(试行)》《农村癫痫防治管理项目技术指导方案》《农村癫痫防治管理项目国家指导组成员名单》《2005年农村癫痫防治管理项目实施方案》,本刊特选其中的“惊厥型癫痫患者的诊断和治疗”部分进行刊登。     

江苏省0～14岁儿童智力低下的流行病学调查

本文对江苏省12259名0～14岁儿童智力低下患病率、病因及影响因素作抽样调查;以及调查了先天畸形、高热惊厥、癫痫患病率。结果表明,智力低下患病率为1.11%,其中城市0.65%,农村1.27%,男女间无差异。先天畸形患病率为32.55‰,该组儿童智力低下者达55.1‰,高于无先天畸形组(8.2‰)。高热惊厥患病率为67.1‰,该组智力低下者38.6‰,高于非高热惊厥组(7.7‰).癫痫患病率为5.1‰,该组智力低下者293.1‰,明显高于非癫痫组(8.3‰)。     

影响癫痫患者治疗依从性的因素分析及干预策略

WHO与我国合作的流行病学调查（2001）显示,我国癫痫终身患病率为7％。其中近5年内仍有发作的活动性癫痫患病率为5．4％,推算我国约有900万人罹患癫痫。很多癫痫患者症状都没有得到有效控制的主要原因是未遵医嘱服药,即治疗依从性差。本文对导致患者服药依从性差的原因进行分析及探讨提高癫痫患者服药依从性的方法,以达到控制发作、提高患者生活质量,减轻患者家庭及社会负担的目的。     

北京市居民人口中酒依赖及相关因素的流行学研究

1991年8月1日至9月30日在北京市16个区县进行了建国以来的第一次大样本的精神障碍流行学调查。对有关酒依赖及相关因素做了较仔细的研究。调查框架人口数为2 959 023人,在全市城乡采用分层、整群、随机抽样15 000户。其中城镇8050户,农村6950户。采用逐户调查法,对15 a及以上人口计35 385人进行了调查,逐人调查见面率为83.37％。调查结果显示,北京市城乡酒依赖的总患病率为14.3‰,男性患病率为29.11‰;女性为0.60‰,男女之比为45:1;民族患病率以蒙、朝、回为最高;小学及文盲教育程度患病率最高,分别为20.35‰及15.43‰,酒依赖随年龄增长呈明显上升趋势,与婚姻状况、经济、职业分布及家庭成员等关系密切。酒依赖的涉及范围呈零星分布状,没有聚集倾向,也不是流行性。 在人格倾向上P与N分值较对照组高,具有粗暴、残忍、孤独、敌意的特点。几乎1/2酒依赖者有负性生活事件。经SDSS测查,其中10.28％产生了不同程度的社会功能缺陷。 通过对单一因素和多因素的分析及统计验证发现,其危险因素为:最早饮酒年龄、饮酒频度、饮酒原因及速度。这些特点也充分反映酒成瘾的特征。     

Evaluation of epileptic dogs as an animal model of human epilepsy

In 126 epileptic dogs with spontaneously recurring generalized tonic-clonic (grand mal) seizures, epidemiological aspects and the efficacy of chronic oral treatment with common antiepileptic drugs were studied. Furthermore, the pharmacokinetics of antiepileptic drugs in dogs was compared with the values known for man. As in man, idiopathic epilepsy appeared to be more common than symptomatic epilepsy in dogs. There was a preponderance of male vs. female animals. When the breeds of the epileptic dogs were compared to the distribution of breeds in the hospital population, breed-related differences in the prevalence of epilepsy were found. The highest prevalence was seen in Cocker spaniels, Miniature schnauzers, Collies and Bassets. The total prevalence of dogs with epilepsy was 0.55%. Comparison of pharmacokinetics of antiepileptic drugs showed that some drugs were suited for maintenance therapy in dogs (primidone, phenobarbital, ethosuximide, trimethadione) whereas others appeared not to be ideally suited because of their short half-lives (phenytoin, carbamazepine, valproic acid, diazepam, clonazepam, nitrazepam). This was confirmed by the evaluation of antiepileptic drug efficacy in epileptic dogs. 46 dogs were treated with primidone at daily doses of 14-104 mg/kg for 6-60 months. During medication with primidone, effective plasma levels of its metabolite phenobarbital could be maintained. Complete control of seizures or a reduction of seizure frequency by at least 75% was achieved in 39% of the dogs at phenobarbital concentrations of 5-49 micrograms/ml. Similar figures were obtained during chronic treatment with phenobarbital at daily doses of 2.5-13 mg/kg.(ABSTRACT TRUNCATED AT 250 WORDS)     

社区精神疾病调查分析与管理

目的 根据精神卫生工作需求对社区精神疾病发病现状调查,通过随访管理,落实防治和康复相结合的政策.方法 随机选取仙霞社区团队所管辖区6429户家庭,采用健康档案和入户调查相结合的方法调查.结果 16083例共查出143例精神疾病患者,总发病率为8.89‰,发病率最高的为精神分裂症、精神发育迟缓和老年痴呆症,发病率分别为4.97‰、1.49‰和1.06‰.男性和女性发病率分别为8.81‰和8.98‰,差异无统计学意义(P＞0.05).本地和外地人群发病率分别为8.25‰和1.43％,差异具有统计学意义(P＜0.05).＞60岁和46 ～ 60人群发病率最高,分别为15.25‰和9.96‰.人均年收入＜ 2000元的发病率最高,为10.88‰.文盲的发病率最高,为10.60‰.结论 该社区精神疾病状况不容乐观,应加强对收入水平低下、文化程度低人群的筛查工作,加强对老年人群及对重点疾病的管理,切实履行防治结合,加强康复治疗.     

威海市城乡普通人群酒依赖流行病学调查

目的：了解目前威海市城乡普通人群的酒依赖情况。方法：采用整群抽样调查，使用定式问卷向50174名城乡普通人群调查酒依赖情况。结果：普通人群男、女及整体酒依赖终生患病率分别为22.38‰、0．16‰和11.38‰；农村（12.94‰），高于城市（9．19‰）。结论：威海市酒依赖（含慢性酒精中毒所致精神障碍）患病率较高，与酒相关的社会问题突出，酒依赖应列为物质滥用的防治和研究重点。     

High prevalence of low HDL-cholesterol in a pan-European survey of 8545 dyslipidaemic patients

OBJECTIVE: Low HDL-cholesterol is a strong independent cardiovascular risk factor recognized as a therapeutic target in recent guidelines. The Pan-European Survey on HDL-cholesterol collected data on plasma lipid profiles from 8545 dyslipidaemic patients in the care of 1339 specialist physicians in 11 European countries. The main objective was to obtain a reliable estimation of the prevalence of low HDL (< 1.03 mmol/L [< 40 mg/dL] in men; < 1.29 mmol/L [< 50 mg/dL] in women). RESEARCH DESIGN AND METHODS: Eligible patients were aged >or= 18 years and had received diet and exercise plus pharmacologic lipid-modifying treatment for >or= 3 months, or had serum cholesterol >or= 5.18 mmol/L (>or= 200 mg/dL) and/or serum triglycerides >or= 2.03 mmol/L (>or= 180 mg/dL) despite >or= 3 months of diet and exercise. RESULTS: The survey population was overweight (mean body mass index 29.0 kg/m2), with a high prevalence of sedentary lifestyle (68%), type 2 diabetes (45%), hypertension (72%) and coronary heart disease (45%). Lipid-modifying treatment, received by 85% of patients, included lifestyle modification (85%) and/or lipid-lowering drugs (85% received a statin). The prevalence of low HDL-cholesterol despite lipid-modifying treatment was 40% (women) and 33% (men). Very low HDL-cholesterol (< 0.90 mmol/L [< 35 mg/dL]) occurred in 14% of treated patients, with similar prevalence in the subgroup of patients not receiving such treatment. Hypertriglyceridaemia (> 1.69 mmol/L [> 150 mg/dL]) occurred in 57% of men not under lipid-modifying treatment and in 47% of men receiving such treatment; corresponding values in women were 48% and 43%. Both low HDL-cholesterol and hypertriglyceridaemia occurred in 26% of men and 27% of women who were not receiving lipid-modifying treatment and in 21% of men and 25% of women receiving lipid-modifying treatment. CONCLUSIONS: Low HDL-cholesterol and hypertriglyceridaemia are, therefore, common among European patients treated for dyslipidaemia. Clearly, physicians need to focus more of their attention on this major risk factor and to consider adequate treatment when indicated.     

脑血管病继发癫痫临床分析

目的对脑血管病继发癫痫的特征等进行研究,探讨脑血管病与继发癫痫之间的关系。方法回顾性分析我科2008年3月至2011年3月收治的56例脑血管病继发癫痫患者的临床资料。结果脑血管病继发癫痫的发病率为6.79%(56/825),脑出血组高于脑梗死组(P<0.05),早发性多于迟发性,发作类型以全身强直阵挛发作最多(42.9%),皮质病变继发癫痫者明显高于皮质下病变(P<0.05),药物治疗效果良好。结论继发性癫痫多见于脑血管病初期,其发病率与脑血管病的类型、病灶部位等有关。     

Prevalence and risk of thrombocytopenia with valproic acid: experience at a psychiatric teaching hospital.

STUDY OBJECTIVE: To investigate the prevalence and potential risk factors of thrombocytopenia in hospitalized patients receiving valproic acid (VPA) for psychiatric indications (excluding epilepsy). DESIGN: Retrospective study SETTING: University-affiliated psychiatric facility. PATIENTS: Two hundred sixty-four patients treated with VPA. INTERVENTION: Data from patients hospitalized between January 1, 1994, and December 31, 1998, who were receiving VPA and had at least one platelet count recorded. MEASUREMENTS AND MAIN RESULTS: Of 264 VPA-treated patients, 31 (12%) met our criteria for thrombocytopenia. Mild thrombocytopenia (platelet count of 101-150 x 10(3)/mm3) occurred in 25 (9%) patients, and moderate thrombocytopenia (platelet count of 40-100 x 103/mm3) occurred in 6 (2%) patients. Age older than 65 years (p=0.02) and VPA dosage greater than 1,000 mg/day (p<0.001) were identified as significant risk factors for developing thrombocytopenia. CONCLUSION: The estimated prevalence of thrombocytopenia is 12% in the general psychiatric population receiving VPA, with the elderly at greatest risk.     

Treating hepatitis C in methadone maintenance patients: an interim analysis

OBJECTIVE: This study evaluates the safety, tolerability, and efficacy of interferon/ribavirin combination therapy in methadone maintenance (MM) patients with active hepatitis C (HCV). End-of-treatment results are presented as an interim analysis of efficacy. METHODS: Fifty eligible MM patients with active HCV and concomitant liver fibrosis were treated with interferon/ribavirin combination therapy using standard dosing regimens. Patients with active drug or alcohol use at the start of treatment, severe or untreated psychiatric illness, and/or decompensated liver disease were excluded. RESULTS: Treated MM patients were older, had a longer history of HCV infection, a high prevalence of psychiatric illness, and had substantially more liver fibrosis than in previous studies of HCV treatment in non-opioid-dependent populations. Seventy-eight percent completed the 6-12 month course of treatment. The end-of-treatment virologic response rate was 64% in patients completing treatment and 54% on an intent-to-treat basis. CONCLUSION: Methadone maintenance patients exhibit a number of factors that make HCV treatment more difficult: they are older, have a higher prevalence of psychiatric illness, and show evidence of more advanced liver disease. Despite this, their end-of-treatment response rate to interferon/ribavirin combination therapy is similar to that of patients without a history of IDU. Further analysis of the sustained virologic response (SVR) rate is planned at the study's completion. These preliminary results show that MM patients are in need of timely HCV diagnosis, and should be considered good candidates for referral and HCV treatment.     

佳木斯市向阳区学龄前儿童龋病患病情况调查与分析

目的:了解佳木斯市向阳区学龄前儿童龋病患病情况,为该区的学龄前儿童龋病预防和治疗提供参考资料。方法:随机抽样检查向阳区的幼儿园内儿童共计97例。其中,男童47(48.45%)例,女童50(51.55%)例。结果:调查对象总体患龋率为64.95%,龋均为3.95,修复率为7.47%。患病模式呈现患龋率和严重程度无性别差异(P>0.05),与年龄呈正相关,且组间差异显著(P<0.05)。乳磨牙中的下颌第二磨牙(46.91%)有较高患病率,乳切牙中的上颌中切牙(22.16%)有较高患病率。乳磨牙中下颌牙齿患病率较高,乳切牙中上颌牙齿患病率较高。大部分的患者(66.15%)同时发生磨牙和切牙龋损。结论:在研究的样本中学龄前儿童患龋率及病变严重程度均较高。应定期进行学龄前儿童口腔检查,对发现的龋损尽早治疗。