老年急性心肌梗死患者PCI术后血清NT-proBNP水平的影响因素并分析其对近期预后的影响

目的：探讨老年急性心肌梗死（AMI）患者经皮冠状动脉介入术（PCI）术后血清NT-proBNP水平的影响因素，分析其对患者近期预后的预测价值。方法：选取2020年5月至2022年8月我院98例老年AMI患者，均行PCI治疗，检测PCI前后血清NT-proBNP水平，以PCI术后≥125 pg/mL为升高，反之为正常。单因素分析NT-proBNP升高组与正常组一般资料，采用Lasso回归模型筛选筛选变量，再以Logistic回归分析老年AMI患者PCI术后血清NT-proBNP水平的影响因素，对比分析NT-proBNP不同患者预后恢复情况及不同预后患者NT-proBNP水平，绘制ROC曲线分析PCI术后NT-proBNP水平对患者短期预后的预测价值。结果：Logistic回归分析显示，发病至PCI时间、年龄、左心室射血分数（LVEF）、脑卒中、置入支架数目、无复流、支架直径为老年AMI患者PCI术后血清NT-proBNP水平的影响因素。术后随访6个月98例患者不良心血管事件（MACE）发生率为21.43%(21/98)，且NT-proBNP升高组发生率为68.00%(17/25)，显著高...     

哮喘患者血清白细胞介素-13、25和单核细胞趋化蛋白-1的检测分析

目的 观察IL-13、IL-25和单核细胞趋化蛋白-1（MCP-1）在哮喘患者血清中的表达及其相关性,探讨其在哮喘发病中的作用.方法 采用ELISA法检测哮喘患者100例（哮喘急性发作54例、临床缓解46例）与健康体检者50例（对照组）血清IL-13、IL-25和MCP-1的含量,并进行分析.结果 哮喘急性发作组血清IL-13、IL-25和MCP-1浓度分别为（2 875.39±846.72）ng/L、（1 001.21±223.35） ng/L、（393.46±75.27） ng/L,明显高于临床缓解组的（1 610.54±681.18） ng/L、（710.54±181.18）ng/L、（265.38±51.70） ng/L,差异均有统计学意义（t=8.14、7.06、9.80,均P＜0.05）;临床缓解组血清IL-13、IL-25和MCP-1水平高于对照组的（946.58±453.49） ng/L、（440.89±120.17） ng/L、（150.27±30.31） ng/L（t=5.58、8.68、13.40,均P＜0.05）;相关性分析结果表明,哮喘患者IL-13、IL-25和MCP-1浓度在血清中表达均呈正相关（r=0.702、0.654、0.738,均P＜0.01）.结论 哮喘患者血清IL-13、IL-25和MCP-1表达升高可能与哮喘的发生、发展有关,检测血清IL-13、IL-25和MCP-1对于哮喘早期诊断和预防具有临床意义.     

替格瑞洛与氯吡格雷对急性心肌梗死患者血栓中炎症因子及术后冠脉血流的影响

目的 探析急性心肌梗死患者经皮冠状动脉介入治疗(PCI)围术期应用替格瑞洛及氯吡格雷治疗的临床价值。方法 86例行PCI术的急性心肌梗死患者,按照随机数字表法分为A组和B组,每组43例。A组于围术期应用阿司匹林联合氯吡格雷治疗, B组于围术期应用阿司匹林联合替格瑞洛治疗。比较两组手术前后炎症因子水平及术后冠状动脉血流情况。结果 术后1周, A组白细胞介素6(IL-6)水平为(33.65±8.87)ng/L、白细胞介素-8(IL-8)水平为(70.64±12.38)ng/L、肿瘤坏死因子-α(TNF-α)水平为(6.68±2.02)ng/L;B组IL-6水平为(28.93±8.69)ng/L、IL-8水平为(64.58±11.21)ng/L、TNF-α水平为(4.11±1.10)ng/L。术后1个月, A组IL-6水平为(21.43±8.01)ng/L、IL-8水平为(63.47±9.46)ng/L、TNF-α水平为(5.54±2.18)ng/L;B组IL-6水平为(15.42±7.05)ng/L、IL-8水平为(50.20±10.23)ng/L、TNF-α水平为(3.03±0.84)n...     

氨基末端脑钠肽前体对围产期心肌病患者预后评估价值

目的：评价氨基末端脑钠肽前体水平对围产期心肌病患者预后的评估价值。方法对58例围产期心肌病患者入院时行氨基末端脑钠肽前体NT-proBNP、彩色多普勒检查测量左心室舒张末经（ LVEDD）和左心室射血分数（ LVEF）,随访观察,观察终点为心衰恶化再住院和死亡。结果58例中发生心脏不良事件者30例,其中心力衰竭恶化再入院者25例,心源性死亡者5例,未发生心脏不良事件者28例。再入院组的NT-proBNP明显高于无事件组（ P ＜0创．01）;死亡组的NT-proBNP;年龄、LVEDD、LVEF、NT-proBNP双变量相关分析显示,仅NT-proBNP与心源性死亡时间及心衰再入院时间独立相关;NT-proBNP≥2960 ng/L 组的死亡5例（21．21％）、再发心力衰竭23例（30．30％）,NNT-proBNP ＜2960 ng/L组死亡0例（0）、再发心衰5例（23．21％）;ChiSquare检验显示,≥2960 ng/L组心脏事件发生率高于＜2960 ng/L组,差异有统计学意义（ P ＜0．05）。结论血浆NT-proBNP 对围产期心肌病慢性心衰患者再发和死亡具有预测价值,尤其是当NT-proBNP≥2960 ng/L时敏感性高。     

N-末端脑钠尿肽原对急性心肌梗死患者PCI术后左心室舒张功能的评估

目的探讨N-末端脑钠尿肽原（NT-proBNP）对急性心肌梗死（AMI）患者经皮冠状动脉介入术（PCI）后左心室舒张功能的评价。方法入选左心室收缩功能正常行急诊PCI治疗的AMI患者102例,测定血浆NT-proBNP水平。根据脉冲多普勒超声技术评价左心室舒张功能,将患者分为2组：左心室舒张功能减低（LVDD）组（n=61）和左心室舒张功能正常组（非LVDD组）。结果 LVDD组的NT-proB-NP水平明显高于非LVDD组（P〈0.01）。结论 AMI患者PCI治疗后NT-proBNP水平能够独立评价其LVDD。     

人血清生长分化因子15与冠心病患者慢性心力衰竭的相关性研究

目的 探讨生长分化因子15（GDF-15）与冠心病患者慢性心力衰竭的关系及诊断价值.方法 选择复旦大学附属华山医院心内科269例行冠状动脉造影（CAG）检查的患者,根据CAG、心电图及心肌酶学检查结果分为3组：其中冠心病心肌梗死患者98例（MI组）,本组再根据纽约心脏病协会（NYHA）心功能分级Ⅰ～Ⅳ级分为4个亚组;未经历心肌梗死的冠心病患者84例（CAD组）;CAG正常患者87例（对照组）.采用酶联免疫吸附法测定患者GDF-15浓度.分析GDF-15与NYHA分级和血清N末端脑钠肽原（NT-proBNP）的关系.结果 MI组平均及其各不同心功能分级亚组[纽约心脏病协会（NYHA）Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级]、CAD组血清GDF-15浓度明显高于对照组,差异有统计学意义[1 622（888,1 995）,983 （808,1 501）、1 614（810,1 825）、1 940（1 837,2 063）、3 905（3 690,4 019）,945（856,1 000） ng/L比798 （728,873） ng/L] （P ＜0.05）.MI组平均及其各不同心功能分级亚组（NYHA Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级）血清NT-proBNP浓度明显高于对照组,差异有统计学意义[564（158,857）,233（105,552）、278（133,716）、790（636,1 490）、4 665（3 712,5 442） ng/L比121（108,134）ng/L] （P ＜0.05）.相关性分析显示GDF-15水平与血清NT-proBNP水平呈显著正相关（r=0.861,P＜0.01）,与血清LVEF呈显著负相关（r=-0.936,P＜0.01）.GDF-15与NT-proBNP对慢性心力衰竭的受试者工作特征曲线结果显示其下面积分别为0.804、0.795（P ＜0.01）.GDF-15的最佳临界值为1 086.38 ng/L时,对慢性心力衰竭诊断的敏感性为72.4％,特异性为93.6％.结论 GDF-15是一个新的冠心病患者慢性心力衰竭预后诊断标志物,能够对心力衰竭的严重程度进行客观评价.     

肺动脉高压三尖瓣反流压差与血脑钠肽前体及并发心力衰竭的关系

目的 探讨肺动脉高压三尖瓣反流压差与血清脑钠肽前体(PRO-BNP)及并发心力衰竭的关系.方法 选取2016年2月至2018年11月无锡市精神卫生中心收治的肺动脉高压病人87例(疾病组),另选取同期体检健康者79例(健康组),均采用多普勒超声心动图检测三尖瓣反流压差及采用电化学发光法测定血清PRO-BNP水平,分析三尖瓣反流压差与血清PRO-BNP水平的关系;另根据病人是否并发心力衰竭情况将疾病组分为心衰组与无心衰组,对比两组三尖瓣反流压差、血清PRO-BNP水平,并采用logistic回归分析法分析其与心衰的关系.结果 疾病组三尖瓣反流压差及血清PRO-BNP水平分别为(52.17±6.58)mmHg、(619.72±113.47)ng/L,健康组分别为(21.09±4.51)mmHg、(194.37±41.26)ng/L,疾病组均高于健康组,差异有统计学意义(P<0.05);经Pearson相关性分析,疾病组三尖瓣反流压差与血清PRO-BNP水平呈显著正相关(r=0.643,P<0.05);87例肺动脉高压病人中共有26例伴发心力衰竭,心力衰竭并发率为29.89％(26/57);心衰组三尖瓣反流压差及血清PRO-BNP水平分别为(60.15±6.23)mmHg、(698.79±115.08)ng/L,无心衰组分别为(48.77±5.87)mmHg、(586.02±109.21)ng/L,心衰组均高于无心衰组,差异有统计学意义(P<0.05);经logistic回归分析法分析,三尖瓣反流压差>50 mmHg及血清PRO-BNP>600 ng/L均是肺动脉高压病人伴发心力衰竭的危险因素(OR=3.146、2.737,P<0.05).结论 肺动脉高压病人三尖瓣反流压差明显增大,血清PRO-BNP水平明显升高,此二者呈显著正相关,且三尖瓣反流压差可作为预测心衰的一项重要指标.     

血管生成素样蛋白2与血管生成素样蛋白1比值与急性心肌梗死介入术后支架内再狭窄的关系

目的 探讨血管生成素样蛋白2与血管生成素样蛋白1比值（Angptl2/Angptl1）与急性ST段抬高型心肌梗死（STEMI）病人经皮冠状动脉介入（PCI）术后支架内再狭窄（ISR）的关系。方法 选取2017年1月至2020年9月在濮阳市油田总医院行急诊PCI的STEMI病人221例为研究对象,均术后随访12个月,按冠状动脉造影检查的结果将其分为狭窄组（发生ISR的35例）和未狭窄组（未发生ISR的186例）。比较两组一般资料;血清Angptl1、Angptl2水平,计算Angptl2/Angptl1;logistic回归分析STEMI病人PCI术后ISR的影响因素;受试者操作特征（ROC）曲线评价Angptl2/Angptl1诊断STEMI病人PCI术后ISR的价值。结果 狭窄组STEMI病人支架直径、血清Angptl1水平低于未狭窄组[（2.92±0.47）mm比（3.39±0.51）mm,(1.45±0.48)mg/L比（2.01±0.67）mg/L,t=5.06、4.72,P<0.05],血清Angptl2水平及Angptl2/Angptl1高于未狭窄组[（2.54±0....     

等渗与半等渗盐水对急性冠脉综合征患者造影剂肾病的预防及左心功能影响的研究

目的 研究不同渗透压盐水对急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗术（PCI）后造影剂肾病的预防及左心功能的影响.方法 将128例拟行急诊PCI术的ACS患者随机分为两组,半等渗盐水组（65例）给予静脉滴注0.45%氯化钠溶液1 ml/（kg·h）,从注射造影剂前1 h用到造影后12 h 等渗盐水组（63例）给予静脉滴注0.9%氯化钠溶液1 ml/（kg·h）,从注射造影剂前1 h用到造影后12 h.观察：（1）两组患者PCI术前及术后24、48、72 h、7天的血清肌酐（SCr）、血浆氨基端脑钠肽原（NT-proBNP）水平 （2）两组患者PCI术前及术后7天超声心动图左室射血分数（LVEF） （3）两组患者术后造影剂肾病的发生率 （4）两组患者术后急性左心衰的发生率.结果 （1）两组患者术后24、48、72 h及7天SCr水平相比均无明显统计学差异（P＞0.05） （2）等渗盐水组患者血浆NT-proBNP水平术后48h（623.11±248.85）pg/ml、术后72 h（617.73±209.37）pg/ml、术后7天（455.43±185.07）pg/ml均明显高于半等渗盐水组（P均＜0.05） （3）等渗盐水组患者LVEF值术后7天时（0.51±0.03）明显低于半等渗盐水组（0.59±0.04）（P＞0.05） （4）两组患者术后造影剂肾病的发生率无明显统计学差异（14.04%：12.50%,P＞0.05） （5）等渗盐水组患者急性左心衰的发生率明显高于半等渗盐水组（16.67%：8.33%,P＜0.05）.结论 采用半等渗盐水组患者造影剂肾病的发生率与等渗盐水组相比差异无显著性,但对患者左心功能的影响明显优于等渗盐水组,提示ACS患者行急诊PCI时,采用静脉滴注0.45%氯化钠溶液,可有效预防造影剂肾病,减少左心功能不全的发生率.     

瑞舒伐他汀强化治疗对心肌梗死患者经皮冠状动脉介入术后脂联素和脑钠肽及左心室重构的影响

目的探讨瑞舒伐他汀强化治疗对心肌梗死患者经皮冠状动脉介入（PCI）术后脂联素和脑钠肽及左心室重构的影响及机制。方法将2011年1月至2012年12月于滨州市人民医院就诊的96例急性心肌梗死早期行PCI术后合并心力衰竭患者完全随机分为对照组、治疗组和强化组,各32例。3组均给予常规治疗;治疗组术前1周加用瑞舒伐他汀10mg／d;强化组术前1周加用瑞舒伐他汀20mg／d。术后第1天及第4、8周空腹采取静脉血检测脂联素和脑钠肽浓度。术前及术后第8周采用彩色多普勒超声仪分别在左心室长轴切面、心尖四腔心、心尖五腔心测定左心室重构指标,包括左心室舒张末期内经（LVEDD）、左心室后壁厚度（LVPWT）、左心室射血分数（LVEF）、左心室质量指数（LVMI）、舒张期室间隔厚度（IVST）、E峰／A峰比值及室壁运动积分指数（WMSI）。记录住院期间及院外不良事件的发生情况。结果@PCI术后第1天、第4周及第8周3组患者血浆中脂联素水平均较术前明显升高[对照组：（5．9±1．5）、（7．1±1．4）、（8．2±1．3）g/L比（3．9±1．2）g/L;治疗组：（5．7±1．4）、（8．3±1．5）、（9．6±1．2）g／L比（4．1±1．0）g/L;强化组：（5．8±1．0）、（9．9±1．7）、（11．5±1．1）g/L比（4．3±0．9）g／L]（均P〈0．05）。术后第4、8周强化组血浆中脂联素水平均明显高于同期治疗组和对照组（均P〈0．05）。②PCI术后第1天、第4周及第8周,3组患者血浆中脑钠肽水平均较术前明显降低[对照组：（636±99）、（547±124）、（467±112）ug/L比（746±102）ug／L;治疗组：（676±107）、（436±89）、（401±91）ug/L比（730±142）ug／L;强化组：（607±131）、（346±67）、（286±72）ug/L比（738±127）ug/L]（均P〈0．05）。术后第4、8周强化组血浆中脑钠肽水平均明显低于同期治疗组和对照组（均P〈0．05）。③PCI术后第8周LVEDD、LVPWT、LVMI、WMSI均较术前明显降低（均P〈0．05）,LVEF、IVST、E峰／A峰比值均较术前明显升高（均P〈0．05）。术后第8周强化组LVEDD、LVPWT、LVMI、WMSI均低于同期治疗组和对照组（均P〈0．05）,LVEF、IVST、E峰／A峰比值均高于同期治疗组和对照组（均P〈0．05）。观察周期内强化组死亡1例,治疗组死亡2例,对照组死亡2例,3组病死率差异无统计学意义（P〉0．05）。结论瑞舒伐他汀强化治疗可明显升高PCI术后患者血浆中脂联素水平,从而保护冠状动脉血管内皮细胞,效果优于瑞舒伐他汀普通剂量治疗。瑞舒伐他汀强化治疗在左心室重构方面明显于瑞舒伐他汀普通剂量治疗。急性心肌梗死患者早期PCI基础上尽早应用瑞舒伐他汀强化治疗可明显降低冠心病患者PCI术后心血管事件发生率,同时瑞舒伐他汀安全,未见明显不良反应。     

芝麻素与维生素E联用对代谢综合征

目的:观察芝麻素与维生素E联用对代谢综合征大鼠肾脏的保护作用并探讨两药联用的协同关系.方法:采用高脂高糖饮食24周诱导大鼠代谢综合征,第9周(57 d)口服含芝麻素(30 mg·kg~(-1)·d~(-1))、芝麻素+维生素E[(30+20)、(15+20)mg·kg~(-1)·d~(-1)]和维生素E(20mg·kg~(-1)·d~(-1))饲料16周.24周末称体重和左肾湿重;测血糖、血脂、血压、肾功能、肾皮质氧化和抗氧化指标;HE和Masson染色观察肾脏形态及胶原沉积;免疫组化法表达诱导型一氧化氮合酶和硝基酪氨酸.结果:(1)模型组肾功能明显损害,肾小球发生硬化和肾间质纤维化,并出现大量炎症细胞浸润,肾小球和肾间质胶原沉积,脂质过氧化物损伤因子MDA、NO_2~-/NO_3~-和OH~-含量升高,iNOS蛋白和硝基酪氨酸表达明显上调,抗氧化酶保护因子T-SOD、CAT、GSH-Px活性显著降低;(2)芝麻素+维生素E[(30+20mg/kg)]组能明显降低血糖、血脂和血压,提高肾皮质总超氧化物歧化酶、过氧化氢酶、谷胱甘肽过氧化酶活性,减少丙二醛、NO_2~-/NO_3~-和羟自由基含量,下调诱导型一氧化氮合酶和硝基酪氨酸,减轻肾小球与肾间质胶原沉积,逆转肾小球硬化和肾间质纤维化,改善肾功能,并且优于单用芝麻素组和维生素E组(P＜0.01或P＜0.05).结论:芝麻素(30 mg/kg)与维生素E(20 mg/kg)联用具有协同抗氧化和抗代谢综合征大鼠肾脏损伤作用.     

Improvement in endothelial dysfunction in patients with systemic lupus erythematosus with N-acetylcysteine and atorvastatin

Objective:

To study the effects of N-acetylcysteine (NAC) and atorvastatin on endothelial dysfunction in patients with systemic lupus erythematosus (SLE).

Materials and Methods:

Thirty-two SLE patients and age, sex-matched 10 healthy control subjects were studied. The patients were between 17 and 65 years of age and positive for diagnostic tests, such as antinuclear antibodies (ANA). Photoplethysmogram (PPG) detects the changes in the amount of light absorbed by hemoglobin, which reflects changes in the blood volume. Pulse wave analysis was performed at rest, 30 s, 90 s after shear stress, and 10 min after 300 μm of salbutamol inhalation.

Results:

Stiffness index (SI) of patients before the treatment was 8.46±2.78 cm/s and of controls was 6.07±1.4 cm/s (P = 0.002) and that of reflection index (RI) was 73±13 for patients and 65±7 for controls (P = 0.001). The percentage change in RI after salbutamol inhalation for controls and patients were -16±6 and -7±4 (P = 0.001), respectively, indicating the presence of endothelial dysfunction. The percentage decrease in RI after salbutamol inhalation was from -2.36±0.76 to ?7.92±1.46 in patients treated with N-acetylcysteine (NAC, P = 0.007). The percentage decrease in RI after salbutamol inhalation was from ?6.36΁1.21 to -9.92±1.21 in patients treated with atorvastatin (P = 0.05). This indicated the improvement in endothelial function. There was decrease in C-reactive protein (CRP) from 1.03±0.72 mg/dL to 0.52±0.22 mg/dL and that of malondialdehyde (MDA) from 11.20±4.07 nmol/mL to 8.81±2.79 nmol/mL with N-acetylcysteine treatment (P < 0.05). The CRP was decreased from 1.11±0.92 mg/dL to 0.440.16 mg/dL (P = 0.05) and that of MDA was decreased from 9.37±3.29 nmol/mL to 8.51±3.27 nmol/mL after treatment with atorvastatin. It showed improvement in oxidative stress with these treatments.

Conclusion:

The presence of arterial stiffness indicated endothelial dysfunction. There was reduction in RI and SI with treatment of N-acetylcysteine and atorvastatin suggesting improvement in endothelial dysfunction. There was decrease in CRP (a marker of inflammation) and MDA after treatment with N-acetylcysteine suggesting improvement in endothelial dysfunction. There was reduction in CRP after treatment with atorvastatin, suggesting improvement in endothelial function. Improvement in endothelial dysfunction is associated with decreased incidence of cardiovascular and cerebrovascular accidents.     

HPLC法同时测定青天葵药材中7种黄酮的含量

建立同时测定青天葵中鼠李秦素(1)、鼠李柠檬素(2)、鼠李素(3)、鼠李秦素-3-O-β-D-葡萄糖苷(4)、鼠李秦素-3-O-β-D-木糖-(1→4)-β-D-葡萄糖苷(5)、鼠李秦素-3-O-β-D-葡萄糖-(1→4)-β-D-葡萄糖苷(6)和鼠李柠檬素-3-O-β-D-葡萄糖-(1→4)-β-D-葡萄糖苷(7)含量的高效液相色谱法。采用Kromasil C18色谱柱(250 mm×4.6mm,5μm),以0.4%磷酸乙腈为流动相进行梯度洗脱,流速为1.0 mL.min 1,检测波长为256 nm,柱温为40℃。7种黄酮类化合物(1～7)的线性范围分别为0.55～70.00μg.mL 1(r=0.999 7)、0.86～110.00μg.mL 1(r=0.999 7)、0.39～50.00μg.mL 1(r=0.999 7)、0.55～70.00μg.mL 1(r=0.999 5)、1.33～170.00μg.mL 1(r=0.999 8)、1.33～170.00μg.mL 1(r=0.999 8)、0.16～20.00μg.mL 1(r=0.999 5),平均回收率在97.19%～99.45%之间,RS...     

Ciprofibrate increases paraoxonase activity in patients with metabolic syndrome

AIMS: Diabetic dyslipidaemia with decreased high-density lipoprotein-cholesterol (HDL-C) concentration plays a key role in enhanced atherosclerosis. The antioxidant effect of HDL is due to the influence of human paraoxonase 1 (PON1) and several authors have described decreased activity of this enzyme in Type 2 diabetics and subjects with metabolic syndrome. The goal of this study was to examine the effect of daily ciprofibrate on serum PON1 and lipoprotein concentrations in patients with metabolic syndrome. METHODS: Fifty-one patients with metabolic syndrome were enrolled into the study. We examined the effect of 100 mg day(-1) ciprofibrate treatment on lipid concentrations, oxidized low-density lipoprotein (LDL), PON1 concentrations and activity. We also investigated the calculated size of LDL-cholesterol (LDL-C). RESULTS: During the 3-month study, it was observed that following treatment with ciprofibrate, the serum triglyceride concentration decreased significantly (from 2.76 +/- 0.9 mmol l(-1) to 2.27 +/- 1.6 mmol l(-1); -18%; P < 0.001), while HDL-C increased significantly (from 0.95 +/- 0.2 mmol l(-1) to 1.2 +/- 0.3 mmol l(-1); 26%; P < 0.001). The oxidatively modified LDL-C concentration decreased significantly (from 137 +/- 19 U l(-1) to 117 +/- 20 U l(-1); P < 0.001), while HDL-associated apolipoprotein A1 significantly increased (from 1.35 +/- 0.2 g l(-1) to 1.75 +/- 0.3 g l(-1); P < 0.001). The LDL-C/LDL-apoB ratio, which reflects the size of LDL, increased significantly (from 0.96 +/- 0.05 to 1.05 +/- 0.06; P < 0.05). Serum PON1 activity was significantly elevated (from 108 +/- 34 U l(-1) to 129 +/- 31 U l(-1); P < 0.05), while standardized values for HDL-C remained significantly unchanged (PON1/HDL-C) (from 114 +/- 21 to 107 +/- 20; NS). CONCLUSION: Three months of treatment with ciprofibrate favourably affected the lipid profile, increased LDL resistance to oxidation and improved antioxidant status by increasing serum paraoxonase activity in these patients.     

肾移植患者应用咪唑立宾与麦考酚酸酯2种三联免疫抑制方案的疗效比较

目的:观察咪唑立宾(MZR)的免疫抑制效果及安全性,采用MZR替代麦考酚酸酯(MMF),比较环孢素A(CsA)+MZR/MMF+泼尼松龙(Pre)两种三联免疫抑制治疗的疗效。方法:尸体肾移植患者70例,按手术顺序交替登记MZR组和MMF组。移植后采用CsA+MZR/MMF+Pre三联免疫抑制疗法,MZR组剂量为200mg.d-1(体重>60kg)或150mg.d-1(体重<60kg);MMF组剂量为1500mg.d-1(体重>60kg)或1000mg.d-1(体重<60kg)。观察肾移植术后1年的人/肾存活率、急性排斥反应发生率及治疗逆转率、感染发生情况及药物毒副作用。结果:全部病例术后随访至少1年,MZR组和MMF组的急性排斥反应发生率分别为17.1%和11.4%,两组之间无显著性差异。MZR组和MMF组肺部感染的发生率分别为8.6%和48.6%,MMF组的发生率显著升高。血尿酸升高的发生率两组之间比较未见显著性差异,MZR组在术后24,36,48周时血尿酸的水平要高于MMF组。MZR组的持续用药率显著高于MMF组。结论:MZR可以与钙调神经素阻滞剂、激素联合应用于肾移植患者,具有一定的安全性和有效性,不良...     

Clinical efficacy and pharmacokinetics of artemisinin monotherapy and in combination with mefloquine in patients with falciparum malaria

1The aim of this study was to assess the pharmacokinetics, clinical efficacy and safety of artemisinin alone and in combination with mefloquine. 2Thirty-eight adults with symptomatic Plasmodium falciparum malaria were randomly assigned to receive either artemisinin (500 mg single dose followed by another 500 mg on day 1 and then 250 mg twice daily for 4 days) or artemisinin (500 mg single dose followed by 750 mg on day 1 and then 250 mg three times daily for one more day) in co-administration with mefloquine (250 mg three times daily for the first day). All drug administration was by the oral route. Patients were hospitalized at the Kibaha Designated District Hospital, Kibaha, Tanzania, for 6 days and a follow up for 3 weeks was performed. 3Treatment with the artemisinin/mefloquine combination resulted in a shorter parasite clearance time (PCT) of 24 (22, 27; 95% confidence interval) h vs 31 (27, 36) h and fever subsidence time (FST) of 14 (12, 16) h vs 20 (18, 23) h compared with artemisinin monotherapy. The 95% CI for the difference of the PCT and FST were 1.7, 12 and 3, 10, respectively. Parasites were detected in 7 out of 17 patients (41%) receiving artemisinin monotherapy at the 3rd and 4th week follow up visits. No parasites were detected after the combination therapy. 4The maximum plasma concentrations ( C_max) were similar after artemisinin monotherapy (615.4±387.0 ng ml⁻¹) and in combination with mefloquine (851.8±523.6 ng ml⁻¹). Elimination half-lives (t_1/2) were also identical at 2.2±0.6 h and 2.5±0.7 h, respectively. However, the AUC values were higher ( P<0.05) after combination therapy (3252±1873 ng  ml⁻¹ h) than after monotherapy (2234±1502 ng ml⁻¹ h). The oral clearance values were lower ( P<0.05) after combination therapy (195.4±86.9 l h⁻¹) than after monotherapy (314.3±189.4 l h⁻¹). PCT and FST normalized to initial parasitaemia correlated with AUC(0,  t) (r_s=0.56, P=0.02, r_s=0.58, P=0.01, respectively) and with C_max (r_s=0.62, P=0.01, r_s=0.68, P=0.005, respectively) in the artemisinin monotherapy only. 5One patient on the combination therapy developed a psychiatric condition and two patients on the monotherapy developed skin itch.     

Cyclin D1 and epidermal growth factor polymorphisms associated with survival in patients with advanced colorectal cancer treated with Cetuximab

The study aimed to investigate whether polymorphisms in genes of the EGFR signaling pathway are associated with clinical outcome in advanced colorectal cancer (CRC) patients treated with single-agent Cetuximab. Polymorphisms of interest in the EGFR pathway include: cyclin D1 (CCND1) A870G, cyclooxygenase 2 (Cox-2) G-765C, epidermal growth factor (EGF) A61G, epidermal growth factor receptor (EGFR) codon R497 K, EGFR CA dinucleotide repeat in intron 1, interleukin (IL)-8 T-251A and vascular endothelial growth factor (VEGF) C936 T gene polymorphisms. Thirty-nine metastatic CRC patients were enrolled in the IMCL-0144 trial and treated with single-agent Cetuximab. Using the polymerase chain reaction-restriction fragment length polymorphism method, gene polymorphisms of CCND1, COX-2, EGF, EGFR, IL-8 and VEGF were assessed from genomic DNA extracted from blood samples. A significant association was found between the CCND1 A870G polymorphism and overall survival in our 39 CRC subjects. Patients with the AA homozygous genotype survived for a median of 2.3 months [95% confidence interval (CI)=2.1-5.7], whereas those with any G allele (AG, GG genotype) survived for a median of 8.7 months (95% CI=4.4-13.5) (P=0.019, log-rank test). When we analysed the cyclin D1 and EGF polymorphisms together, patients with favourable genotypes (EGF any A allele and CCND1 any G allele) showed a median survival time of 12 months (95% CI=4.8-15.2), whereas patients with any two unfavourable genotypes (EGF GG or CCND1 AA) showed a median survived time of 4.4 months (95% CI=2.1-5.7) (P=0.004, log-rank test). The findings of this pilot study suggest that the cyclin D1 A870G and the EGF A61G polymorphisms may be useful molecular markers for predicting clinical outcome in CRC patients treated with single-agent Cetuximab.     

曲美他嗪与美托洛尔联合治疗稳定型心绞痛

目的 :评价曲美他嗪和美托洛尔联合治疗稳定型心绞痛的疗效。方法 :选择稳定型心绞痛的病人 94例 ,随机分成 2组。治疗组 4 8例给曲美他嗪 2 0mg ,po ,tid和美托洛尔 12 .5mg ,po ,bid ,疗程 4wk。对照组 4 6例给美托洛尔 12 .5mg ,po ,bid及安慰剂 ,po ,tid ,疗程 4wk。结果 :治疗前后 2组心绞痛发作次数 ,硝酸甘油消耗量和静息、运动时血压心率的二项乘积差值分别为 (- 6± 4 )次·wk- 1和 (- 3.3± 2 .2 )次·wk- 1,(- 4± 3)mg·wk- 1和(- 2 .1± 1.4 )mg·wk- 1,- 1198± 4 5 8和 - 82 8±5 36,- 2 0 0 6± 1131和 - 616± 14 65 (P <0 .0 1)。结论 :曲美他嗪联合美托洛尔治疗稳定型心绞痛疗效确切。     

左卡尼汀对尿毒症血透病人营养不良的改善作用

目的 :调查尿毒症血透病人的营养状况 ,观察左卡尼汀的治疗作用。方法 :对 30例尿毒症血透病人进行营养分析 ,其中 16例于每次透析后静脉应用左卡尼汀 1g ,共治疗 3mo ,观察营养指标的变化。结果 :尿毒症血透病人饮食蛋白、热量摄入分别为 ( 0 .95±s0 .16)g·kg- 1·d- 1和 ( 113± 2 1)kJ·kg- 1·d- 1,血清前清蛋白为 ( 0 .2 5± 0 .0 5) g·L- 1,血浆游离卡尼汀浓度为 ( 35± 12 ) μmol·L- 1。治疗后 ,血浆游离卡尼汀浓度为 ( 155± 37) μmol·L- 1(P <0 .0 1) ,干体重增加 ,血清清蛋白、前清蛋白也增高。结论 :左卡尼汀可明显纠正血透病人的卡尼汀缺乏 ,改善营养不良     

Propranolol disposition in patients with hepatosplenic schistosomiasis

Eight Sudanese patients with hepatosplenic schistosomiasis and seven Sudanese controls were administered a single oral dose of long acting (LA), propranolol 160 mg; blood propranolol levels were measured at regular intervals for 12 h using g.l.c. In patients with hepatosplenic schistosomiasis, propranolol blood concentrations were greater (P less than 0.05) at all time intervals, Cmax 63.5 (29-143) ng ml-1 (median and range) than controls Cmax 23 (12-37) ng ml-1. Median AUC0-12 was also greater (P less than 0.05) (533 and 218 ng ml-1 h respectively), tmax were not significantly different. In patients and controls prior to treatment, standing heart rate (77.5 (60-110), 72 (68-74) beats min-1) systolic (120 (105-150), 110 (100-120) mm Hg) and diastolic blood pressure (75 (60-90), 70 (60-80) mm Hg) were not significantly different. However following propranolol administration a reduction (P less than 0.05) occurred in both systolic (median 20 mm Hg) and diastolic (median 12.5 mm Hg) blood pressure in the patients compared with controls. Heart rate was reduced by a median of 10 beats min-1 in both groups. These observations indicate that propranolol bioavailability in patients with hepatosplenic schistosomiasis is increased possibly due to reduced presystemic extraction.