奥氮平治疗儿童精神分裂症的有效性和耐受性

目的:探讨奥氮平治疗儿童精神分裂症的有效性和耐受性。方法:对30名9-17岁精神分裂症患儿进行为期至少8周的奥氮平治疗,并定期进行BPRS、CGI、TESS评定及血常规、心电图、肝肾功能、血糖、血脂、心肌酶检查。结果:对于总体组和各亚组,治疗前后BPRS、CGI-I及CGI-S评分均存在统计学显著性差异(F=4.82-53.39,P<0.001)(难治组治疗前后BPRS评分除外),治疗8周及观察终点时,总体组有效率分别为43.3%和56.7%。对于三个亚组,治疗8周和观察终点时,首选组和难治组间BPRS减分和减分率、CGI-S和CGI-I评分均存在显著性差异(P<0.05或0.01),首选组和次选组的有效率均明显高于难治组(x2=4.54-7.78,P<0.05或0.01)。最常见不良反应为体重增加,其他出现比例超过10%的不良反应为:肝功能异常、心电图改变、过度镇静、心悸、乏力、锥体外系反应、头昏和头晕、血脂增高、血常规异常、心肌酶异常等,但多为一过性,程度较轻且与剂量有关。结论:奥氮平可有效治疗儿童精神分裂症,对首选组和次选组的疗效明显优于难治组,无严重不良反应,患儿对该药耐受良好。     

阿戈美拉汀与度洛西汀治疗抑郁症的效果对照研究

目的:观察评价阿戈美拉汀和度洛西汀在抑郁症治疗方面的效果和不良反应,为抑郁症患者的临床治疗提供实践经验。方法:将2013年7月至2015年3月间于我院精神科就诊的100例经确诊为抑郁症患者作为研究对象,随机分为2组,对照组采用度洛西汀治疗,观察组采用阿戈美拉汀治疗。经过16周治疗,通过汉密尔顿抑郁量表(HAMD)和副反应量表(TESS)对治疗效果和不良反应进行评定。结果:经过治疗后,观察组的有效率明显好于对照组(χ~2=4.88,P0.05);HAMD评分观察组明显低于对照组(8周末:t=7.35,P0.05;16周末:t=6.12,P0.05);头痛头晕、直立性低血压、嗜睡发生率观察组明显低于对照组(χ~2=5.32,4.33,P0.05;χ~2=7.11,P0.01)。结论:阿戈美拉汀在治疗抑郁症方面,具有较好的改善抑郁症状,且不良反应少,值得在临床推广应用。     

不同剂量文拉法辛与阿戈美拉汀治疗难治性抑郁症的疗效分析

目的 研究不同剂量文拉法辛与阿戈美拉汀治疗难治性抑郁症的疗效。方法 选取2017年6月~2018年8月我院收治的难治性抑郁症患者236例,随机分为观察组和对照组,每组118例。观察组采用大剂量文拉法辛与阿戈美拉汀治疗,对照组采用小剂量文拉法辛与阿戈美拉汀治疗,6周为1疗程,共治疗1个疗程。分析两组不同时间段（治疗2周、4周、6周末）HAMD-17评分和不良反应。结果 观察组治疗后2、4、6周HAMD-17评分分别为（17.21±1.02）分、（14.22±1.34）分、（10.03±1.21）分,均低于对照组的（21.64±1.57）分、（16.98±1.76）分、（13.88±1.97）分,差异具有统计学意义（P＜0.05）。观察组不良反应发生率为1.69%,与对照组的2.54%比较,差异无统计学意义（P＞0.05）。结论 使用大剂量文拉法辛与阿戈美拉汀治疗难治性抑郁症,疗效显著,不仅能够改善患者抑郁症状,且具有极高安全性。     

阿戈美拉汀的药理机制及临床疗效

抑郁症是一种高患病率和高致残性疾病,现有的治疗药物主要是以单胺递质系统作为靶点。阿戈美拉汀是一种新型抗抑郁药,同时具有褪黑激素能激动和5-HT2C受体拮抗作用,动物实验和临床研究均显示出明确的抗抑郁效果,并且表现出起效时间早、药物耐受性好等特点,成为抗抑郁治疗的新选择。本综述总结了阿戈美拉汀的药理作用和临床疗效,希望有助于临床实践者更清楚认知该药,合理使用。     

河北省抑郁症患者药物治疗的现况调查

目的了解河北省抑郁障碍患者精神药物的治疗现状。方法使用自制调查问卷,按一定的抽样比例,选择河北省37家专科医院或综合医院精神科进行调查。结果1共调查住院和门诊抑郁障碍病人223例;单一药物治疗97例(43.5%),联合2种及其以上药物治疗124例(55.6%),未用药2例(0.9%);2门诊患者帕罗西汀的使用频度明显高于住院患者(P0.01),其它药物在门诊与住院患者的使用中没有明显差异;三环类抗抑郁剂多虑平、阿米替林住院患者用药剂量明显高于门诊患者(P0.05,P0.01);3合并使用苯二氮类药113例(50.7%),使用频率依次为阿普唑仑、氯硝西泮、劳拉西泮、艾司唑仑;使用剂量在正常范围,持续时间超过60天者占30.8%(43/140);4伴精神病性症状的抑郁症37例(16.6%),伴精神病性症状者治疗多合并精神药物73.0%(27/37)。结论河北省抑郁障碍治疗基本合理,但应注意减少合并用药及缩短苯二氮卓类药物使用时间。     

阿戈美拉汀在Aβ_(25-35)诱导的PC12细胞损伤的保护作用研究

目的:研究阿戈美拉汀(Agomelatine)在阿尔茨海默病病理损伤中的保护作用。方法:利用Aβ_(25-35)诱导PC12细胞损伤作为细胞模型,给予Agomelatine预保护,通过Western Blot方法检测Tau蛋白磷酸化的表达情况,流式细胞术检测细胞凋亡率,并检测氧化应激指标MDA水平以及SOD活性。结果:Aβ_(25-35)显著地提高Tau蛋白磷酸化表达以及MDA水平,增加细胞总凋亡率并降低SOD活性(P0.05),而加入阿戈美拉汀预保护后,与Aβ_(25-35)单独处理组相比,阿戈美拉汀预保护组Tau蛋白磷酸化表达、MDA水平以及细胞总凋亡率明显降低(P0.05),而SOD活性明显上升(P0.05)。结论:阿戈美拉汀在Aβ_(25-35)诱导的PC12细胞损伤中具有保护效应。     

ERCP用于老年患者诊断和治疗的安全性和耐受性分析

目的对内镜逆行胰胆管造影(ERCP)用于老年患者诊断及治疗的安全性和耐受性进行回顾性分析。方法回顾性分析2010年1月至2013年12月在我院接受诊断和治疗的1 560例患者资料,年龄(71.6±11.4)岁,其中60~69岁1 116例,70岁及以上444例,数据包括患者的临床和生化特征,ERCP诊断和并发症。结果对潜在的复合因素进行多变量Logistic回归分析,60~69岁和70岁2组中相关因素的差异未见统计学差异(P=0.039)。老年ERCP检查和治疗中,60~69岁和70岁及以上2组间在成功插管、插管困难和插管失败方面均有一定差异(P0.05);2组间胆总管结石发生胆道梗阻和临床诊断无明显差异(P0.05),但2组间ERCP诊断、术后并发症和急性胰腺炎并发症均有一定差异(P0.05),70岁及以上的患者耐受性较好,但胆管结石大约是60~69岁患者的2倍(P=0.004)。结论老年患者进行ERCP诊断和治疗是安全的,且耐受性良好,对70岁及以上的老年患者ERCP并发症风险相对更少。     

首发的精神分裂症和抑郁症及双相障碍的治疗延迟(综述)

本文旨在综述首发的精神分裂症、抑郁症、双相障碍治疗延迟的相关研究,对3类首发精神障碍治疗延迟的影响因素进行比较,发现患者责任感提高、家庭凝聚力降低、病耻感、疾病相关知识匮乏、就医资源匮乏、医疗支持不足会导致治疗延迟,使患者病程更长,症状更重,影响其社会功能。     

米氮平与西酞普兰治疗女性更年期抑郁症的对照研究

目的观察米氮平和西酞普兰对更年期抑郁障碍患者的疗效和不良反应。方法将符合入组标准的60例患者随机分成米氮平组和西酞普兰组各30例。于治疗前和治疗后第1、4、8周末采用汉密尔顿抑郁量表(HAMD)17项评定疾病严重程度和疗效;采用不良反应量表(TESS)评定药物不良反应。结果米氮平组痊愈14例,显著进步12例,进步4例,无效1例,痊愈显著进步率86.67%;西酞普兰组痊愈12例,显著进步13例,进步5例,无效0例,痊愈显著进步率83.33%,两组疗效差异不显著(χ2=0.81,P=0.368)。米氮平组治疗第1周末的HAMD-17总分明显低于西酞普兰组22.2±6.7/25.4±7.1,t=-2.367,P=0.042。米氮平组药物不良反应主要是食欲增加,体重增加和嗜睡;西酞普兰组不良反应主要是口干,睡眠障碍,两组的不良反应均较轻微,差别无显著性意义(χ2=3.86,P0.05)。结论西酞普兰和米氮平均为治疗女性更年期抑郁的安全有效药物。     

Efficacy and Tolerability of Anticholinergics in Korean Children with Overactive Bladder: A Multicenter Retrospective Study

We investigated the efficacy and tolerability of various anticholinergics in Korean children with non-neurogenic overactive bladder (OAB). A total of 326 children (males:females= 157:169) aged under 18 yr (mean age 7.3±2.6 yr) who were diagnosed with OAB from 2008 to 2011 were retrospectively reviewed. The mean duration of OAB symptoms before anticholinergic treatment was 16.9±19.0 months. The mean duration of medication was 5.6±7.3 months. Urgency urinary incontinence episodes per week decreased from 1.9±3.1 to 0.4±1.5 times (P<0.001). The median voiding frequency during daytime was decreased from 9.2±5.4 to 6.3±4.2 times (P<0.001). According to 3-day voiding diaries, the maximum and average bladder capacity were increased from 145.5±66.9 to 196.8±80.3 mL and from 80.8±39.6 to 121.8±56.5 mL, respectively (P<0.001). On uroflowmetry, maximum flow rate was increased from 17.6±8.4 to 20.5±8.2 mL/sec (P<0.001). Adverse effects were reported in 14 (4.3%) children and six children (1.8%) discontinued medication due to adverse effects. Our results indicate that anticholinergics are effective to improve OAB symptoms and tolerability was acceptable without severe complications in children.     

抗抑郁治疗早期临床变化与疗效的相关分析

目的探讨盐酸氟西汀抗抑郁治疗的临床症状早期变化与疗效的关系,为临床制定个体化治疗方案提供理论依据。方法采用盐酸氟西汀20mg/d对103例抑郁症患者治疗并完成随访6周,按照治疗6周末抑郁症状是否缓解分为缓解组和未缓解组。采用自行设计的一般情况问卷、汉密尔顿抑郁量表、临床疗效总评定量表进行评定。统计方法采用t检验和Pear-son相关分析。结果两组基础因子分比较,仅缓解组的阻滞因子基础分低于未缓解组,差异有显著性(t=-3.300,P<0.01)。治疗2周末,缓解组阻滞因子及睡眠障碍因子的减分率均显著高于未缓解组,差异具有显著性(t=2.880,2.602,P<0.05);两组总分、认识障碍因子、焦虑/躯体化因子及体重因子的减分率比较,差异无显著性(t=0.210,0.547,0.578,-0.309,P>0.05)。阻滞因子和睡眠障碍因子的2周末减分率与6周末总分减分率显著正相关(r=0.380,0.254,P<0.05)。结论治疗前患者的阻滞症状越轻,后期疗效越好。治疗2周末临床总严重程度评分愈小、阻滞症状及睡眠障碍的好转愈明显,后期疗效愈好。     

Study on Early Clinical Changes and Efficacy of Antidepressant Treatment

目的 探讨盐酸氟西汀抗抑郁治疗的临床症状早期变化与疗效的关系,为临床制定个体化治疗方案提供理论依据.方法 采用盐酸氟西汀20mg/d对103例抑郁症患者治疗并完成随访6周,按照治疗6周末抑郁症状是否缓解分为缓解组和未缓解组.采用自行设计的“一般情况问卷”、“汉密尔顿抑郁量表”、“临床疗效总评定量表”进行评定.统计方法采用t检验和Pearson相关分析.结果 两组基础因子分比较,仅缓解组的阻滞因子基础分低于未缓解组,差异有显著性(t=-3.300,P＜0.01).治疗2周末,缓解组阻滞因子及睡眠障碍因子的减分率均显著高于未缓解组,差异具有显著性(t=2.880,2.602,P＜0.05);两组总分、认识障碍因子、焦虑/躯体化因子及体重因子的减分率比较,差异无显著性(t=0.210,0.547,0.578,-0.309,P＞0.05).阻滞因子和睡眠障碍因子的2周末减分率与6周末总分减分率显著正相关(r=0.380,0.254,P＜0.05).结论 治疗前患者的阻滞症状越轻,后期疗效越好.治疗2周末临床总严重程度评分愈小、阻滞症状及睡眠障碍的好转愈明显,后期疗效愈好.     

Efficacy and Tolerability of Calcitonin in the Prevention and Treatment of Osteoporosis

Calcitonin in general, and, more specifically, salmon calcitonin (salcatonin), has been known for 30 years to be a specific inhibitor of bone resorption. Studies have confirmed its efficacy in metabolic bone diseases characterised by excessive bone resorption, such as osteoporosis. Most randomised studies in which salcatonin and oral calcium were administered for 1 to 5 years to recently postmenopausal women for the prevention of osteoporosis have shown that bone mineral density or bone content of the lumbar spine increased significantly, compared with a reduction among women receiving calcium only. Prospective studies have shown that salcatonin is effective in the treatment of established osteoporosis, reducing significantly the relative risk of new vertebral fractures. The benefits of salcatonin nasal spray therapy were observed in the majority of women studied, and it has been shown to be an effective alternative for osteoporotic women more than 5 years postmenopausal who refuse estrogens, or for whom estrogens are contraindicated. Finally, in established osteoporosis, nasal calcitonin possesses a potent analgesic effect. The well-demonstrated effects of nasal calcitonin permit it to be considered a well tolerated and efficient approach for prevention and treatment of postmenopausal osteoporosis.     

Efficacy and Tolerability of Conversion from Cyclosporin to Azathioprine After Kidney Transplantation

After the introduction of cyclosporin as an immunosuppressive drug for organ transplantation at the beginning of the 1980s, concern arose about adverse effects of this new drug. Nephrotoxicity, fear of progressive loss of renal function with long term use of cyclosporin, a higher incidence of lymphomas in the first studies with cyclosporin and the high costs of the new drug led to the modification of immunosuppressive regimens so that cyclosporin was replaced by azathioprine several months after renal transplantation. Short and long term follow-up of elective conversion studies demonstrated equal patient and graft survival in the azathioprine (conversion) and cyclosporin (control) groups. Shortly after conversion, renal function improved considerably and a decrease was found in the number of patients with hypertension and gout. Conversion also resulted in a substantial reduction in the costs of immunosuppressive drugs. In most studies a higher incidence of acute rejection was found after conversion. These rejection episodes were generally reversible and at long term follow-up did not result in a higher incidence of chronic rejection or graft loss. Elective conversion from cyclosporin to azathioprine after kidney transplantation can be done safely and has beneficial effects on renal function and cardiovascular risk factors. Conversion should also be considered for patients with prolonged non-function of the graft, in cyclosporin-treated patients with substantial renal or neurological toxicity persisting after cyclosporin dosage reduction, and in patients who cannot afford the high costs of cyclosporin therapy.