氨氯地平与贝那普利对高血压脑卒中二级预防的效果

目的:比较贝那普利与氨氯地平对高血压病并发脑卒中的二级预防效果。方法: 入选常住居民中2个月前因高血压病并发脑卒中的患者325例,在常规治疗、生活干预的基础上,随机、单盲分配到以贝那普利为降压基础治疗的（贝那普利组）178例,以氨氯地平为降压基础治疗的（氨氯地平组）178例,主要观察所有脑卒中的复发率、脑卒中死亡、心肌梗死发生率及总死亡等,观察时间8~72个月,平均46个月。结果: 氨氯地平组的脑卒中复发率显著低于贝那普利组(27.8% vs. 34.0%,P<0.05),其它心脑血管事件两组相比,差异无统计学意义。结论: 氨氯地平对高血压病并发脑卒中二级预防的效果优于贝那普利。     

拉西地平与贝那普利治疗高龄老年高血压的临床研究

目的:评价拉西地平和贝那普利治疗高龄老年高血压的疗效.方法:选择2006-01-01至2009-12-31在我院门诊治疗的高龄老年高血压患者188例,随机分为拉西地平组和贝那普利组,观察2组的降压效果、并发症和停药率.结果:2组平均观察2.5年,拉西地平组患者血压平均下降25.75/13.54 mmHg(1 mmHg=0.133 kPa),贝那普利组患者血压平均下降24.11/13.48 mmHg,与治疗前相比,差异有统计学意义(P<0.05).2组降压的总有效率分别为82.98%和85.11%,2组的降压效果相当(P>0.05).拉西地平组主要事件发生率为10.64%,贝那普利组主要事件发生率为8.51%,2组差异无统计学意义(P>0.05).拉西地平组的次要事件发生率、总体事件发生率和停药率分别为22.34%、32.98%和5.32%,而贝那普利组的次要事件发生率、总体事件发生率和停药率发生率分别为40.43%、48.94%和14.89%,2组差异有统计学意义(P<0.01,P<0.05).结论:拉西地平和贝那普利均能有效治疗高龄老年高血压,但前者的次要事件明显少于后者,拉西地平的依从性明显好于贝那普利.     

咪达普利对高血压病病人血压的影响

目的观察咪达普利治疗高血压病的临床疗效。方法采用自身对照设计方案,对符合入选标准的高血压病病人进行2周的药物洗脱,然后口服咪达普利,每日1片,连续2周。第2周末观测血压、肝肾功能及不良反应。结果治疗后收缩压为(140.1±14.2)mmHg,舒张压(88.9±7.2)mmHg,均较治疗前降低。结论咪达普利对高血压病病人有降压作用。     

咪达普利与雷米普利治疗轻中度高血压的疗效比较

ACEI类药降压物作用明显,但咳嗽副作用发生率很高,报道在2%～30%之间[1,2,6,8].在我们的临床实践中,发现咪达普利降压作用明显,而咳嗽发生率极低;服用其它ACEI类咳嗽的患者,改用咪达普利后,咳嗽往往消失或者减轻.为此,我们选择一批病人进行随机开放交叉研究,观察咪达普利和雷米普利降压效果和咳嗽副作用发生情况及安全性.     

伊贝沙坦治疗原发性高血压的疗效和安全性评价

目的评价伊贝沙坦(irbesartan)治疗轻、中度原发性高血压的疗效和安全性.方法选取137例坐位舒张压(SeDBP)95～115mmHg(1mmHg＝0.133kPa)[根据1993年<新药(西药)临床研究指导原则>治疗前舒张压水平分成轻(95～104mmHg)、中(105～114mmHg)和重(＞115mmHg)三类]的轻、中度原发性高血压患者,随机分为伊贝沙坦组(150mg每日1次)和贝那普利(benazepril)组(10mg每日1次).于4周末SeDBP≥90mmHg者剂量分别加倍,继续服用4周.于安慰剂期末及治疗2、4、6、8周测诊室血压、心率并记录症状、体征;试验前后行实验室检查.结果有效率伊贝沙坦组81.2%,贝那普利组70.5%,两组比较无显著性差异(P＞0.05).8周伊贝沙坦组及贝那普利组SeSBP/SeDBP均下降,其中2、4、6、8周伊贝沙坦组SeDBP的下降幅度大于贝那普利组,两组有显著性差异(4周P＜0.05,2、6、8周P均＜0.01).贝那普利组咳嗽5例,发生率8%.结论伊贝沙坦150～300mg/d治疗轻、中度原发性高血压的有效率近似于贝那普利10～20mg/d,但耐受性好于贝那普利.     

左旋氨氯地平联合贝那普利治疗2型糖尿病肾病合并高血压22例效果观察

目的探讨左旋氨氯地平与贝那普利联用治疗2型糖尿病肾病合并高血压患者的效果。方法将确诊的62例2型糖尿病肾病合并高血压患者随机分为氨氯地平组、贝那普利组各20例及联合组22例。三组均口服降糖药或皮下注射诺和灵30R等,洗脱期2周后口服降压药物治疗。氨氯地平组、贝那普利组分别予左旋氨氯地平2.5 mg、贝那普利10 mg;联合组予左旋氨氯地平2.5 mg＋贝那普利10 mg;用药1次/d,疗程为4个月。观察治疗前后血压、24 h尿蛋白排泄量和肾功能变化。结果治疗后联合组血压、24 h尿蛋白量及血肌酐均明显低于氨氯地平组及贝那普利组（P均〈0.05）,治疗过程中均未见明显不良反应。结论左旋氨氯地平联合贝那普利治疗糖尿病肾病合并高血压效果优于单独用药,且较为安全。     

贝那普利联用螺内酯对慢性心力衰竭患者左室重构和心功能的影响

目的观察贝那普利联合螺内酯治疗慢性充血性心力衰竭（CHF）的有效性和安全性。方法将143例CHF患者随机分为贝那普利联合螺内酯组（73例）和贝那普利组（70例）。观察时间为24周,对比治疗前后左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）及血生化各项指标的变化,记录高钾血症等不良反应的发生率。结果联合治疗组显效率和总有效率（65.3%和92.1%）高于贝那普利组（58.1%和80.9%）;联合治疗组无效率（7.9%）显著低于贝那普利组（19.1%）。治疗前后两组LVEDD、LVESD均明显缩小,两组LVEF均有明显改善,但联合治疗组LVEDD、LVESD缩小较贝那普利组更为显著。不良反应发生率两组无显著差异。结论贝那普利联合螺内酯不仅能改善CHF患者的左心室重构及临床症状,而且安全性良好。     

贝那普利联合氯沙坦对慢性心力衰竭患者核因子-KB和C-反应蛋白的影响

目的研究贝那普利联合氯沙坦对慢性心力衰竭患者核因子-KB（NF-KB）和高敏c-反应蛋白（hs—CRP）的影响。方法将40例慢性心力衰竭患者，随机分为贝那普利组和贝那普利联合氯沙坦组。超声心动图测左室射血分数（LVEF）；免疫细胞化学法测定外周血淋巴细胞NF—KB活化的阳性率；ELISA法测定血浆hs—CRP水平，比较两组治疗前后的差异。结果治疗3个月后：贝那普利组LVEF低于联合治疗组（P〈0．05）；贝那普利组NF—KB活化的阳性率及hs—CRP水平高于联合治疗组（P〈0．05）。结论贝那普利联合氯沙坦治疗慢性心力衰竭患者，在改善心功能，降低外周血淋巴细胞NF—KB活化的阳性率和血浆hs—CRP水平方面优于单用贝那普利。     

硝苯地平和贝那普利对高血压患者肾脏功能的影响

目的探讨硝苯地平和贝那普利对高血压患者肾脏功能的影响。方法将90例高血压患者随机分成硝苯地平组、贝那普利组和联合治疗组各30例,硝苯地平组给予30 mg/d硝苯地平控释片口服,贝那普利组给予10 mg/d贝那普利片口服,联合治疗组给予30 mg/d硝苯地平控释片+10 mg/d贝那普利片口服,连续治疗12周。测定患者治疗前和治疗6周、12周末时的血压,24 h尿白蛋白、β2-微球蛋白(β2-MG)含量以及外周血中尿素氮(BUN)、肌酐(SCr)水平。结果三组治疗后血压、SCr和BUN水平均显著降低(P均<0.05),但组间降压幅度无统计学差异(P>0.05)。24 h尿白蛋白和β2-MG均较治疗前显著降低,且联合治疗组较单药组下降幅度更明显(P均<0.05)。结论硝苯地平和贝那普利单独用于治疗高血压可减少尿白蛋白水平,保护肾脏功能,两药联合效果更佳。     

贝那普利联合安体舒通对高血压致左心房重塑的研究

目的 探讨贝那普利联合安体舒通对高血压致左心房重塑的影响.方法 治疗组应用贝那普利联合安体舒通治疗,对照组应用非贝那普利联合安体舒通治疗,比较1年后患者的血压、左房内径、脑钠肽、血管紧张素Ⅱ(AT-Ⅱ)及醛固酮(ALD)的变化.结果 治疗后两组患者的左房内径、脑钠肽、AT-Ⅱ、ALD间差异有统计学意义(P＜0.05).结论 贝那普利与安体舒通对高血压致左心房重塑有明显改善作用.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.