茶碱缓释剂的药动学及其对肺功能作用

尽管治疗支气管哮喘的药物进展迅速，各种新药层出不穷，但在国内，茶碱仍被作为治疗支气管哮喘的临床第一线用药，也常作为缓解期的治疗药物。本文对20例轻一中度哮喘患者应用葆乐浑短期治疗（8周），观察其药动力及其对哮喘患者肺功能影响。1对象和方法1．1对象轻中度哮喘20例，其中男9例，女11例。平均年龄43．2岁，全部病例符合WHot哮喘防治全球战略》的诊断标准［1］，进人试验前3天停用茶碱及β2受体激动剂。1．2方法20例均每天口服葆乐辉400mg。4周后随机分为A、B二组。A组继续服药，B组停用葆乐辉，症状发作时应用β2受体激动剂…     

茶碱对支气管哮喘疾病免疫调节作用

茶碱因对支气管平滑肌有直接的舒张作用而用于治疗支气管哮喘已有70多年了。因其治疗浓度(10～20μg/ml)与中毒浓度很相近,所以临床一直对其治疗价值颇有争议。近年来由于认识到口服低剂量茶碱类药具有可以抑制哮喘病情发展的非支气管扩张作用(抗炎和免疫调节作用),特别是最近以葆乐辉为代表的茶碱缓释药物在治疗慢性哮喘中的可靠疗效和独特药理作用,使茶碱类药物重新成为当前哮喘治疗研究的热点。     

葆乐辉和博利康尼分别加用安得新联合治疗慢性中度哮喘的临床观察

目的 比较安得新加用葆乐辉和加用博利康尼治疗中度哮喘的临床疗效。方法 随机把中度哮喘病人４０例分为两组，一组用安得新十葆乐辉，另一组用安得新＋博利康尼，动态观察两组的临床症状评分，肺功能和不良反应。结果 治疗８周后两组病人临床症状评分，肺功能均显著改善，但两组间疗效比较无差异性。结论 安得新加用葆乐辉与安得新加用博利康尼治疗中度哮喘疗效一致。     

葆乐辉对慢性阻塞性肺疾病患者(COPD)肺功能疗效观察的研究

目的了解无水茶碱控释片(葆乐辉)对慢性阻塞性肺疾病(COPD)的肺功能疗效。方法采用随机公开分组对照法,前瞻性比较口服葆乐辉与不服用葆乐辉对慢性阻塞性肺疾病患者肺功能的疗效。将患者分为治疗组(31例)及对照组(31例)。服药组采用葆乐辉400mg/d进行2个月的连续口服治疗;对照组31例不服药。服药前及服药后第2个月末,分别测定肺功能。结果服葆乐辉组肺功能的主要指标FVC、FEV_1及FEV_1/FVC％较服药前及对照组明显改善,有显著性差异。结论使用无水茶碱控释片(葆乐辉)治疗慢性阻塞性肺疾病,对其肺功能改善有肯定疗效。说明即使对可逆性不大的气流阻塞的COPD患者,葆乐辉也有肯定疗效,且葆乐辉为控释制剂。患者的依从性明显优于普通氨茶碱。     

布地奈德加用茶碱与单纯布地奈德对慢性症状性哮喘的治疗比较

为比较皮质激素吸入加用小剂量的茶碱联合应用治疗哮喘与单纯激素吸入,能否减低激素的用量并维持疗效,减少两药副作用。采用随机分组方法,将40例哮喘患者分为:A组为激素(布地奈德200μg,一日两次)加缓释放茶碱(葆乐辉,0.2g,一日一次);B组为单纯激素吸入(布地奈德200μg,一日3～4次),观察18周,(定期检测肺功能、呼气峰流速率、临床症状体征平分、β2激动剂的使用情况及内源性的皮质醇的水平等)。结果两组肺功能持续性的改善,FEV1及PEF随治疗后比治疗前有显著的提高(P<0.05),PEF的改善率>25%的占75%～80%,两组之间无差异;临床综合疗效两组均有明显的好转,两组之间无差异。单纯激素吸入组的内源性的皮质醇经18周的治疗后与治疗前比有所下降(P<0.05),而激素加茶碱组则无变化。表明小剂量茶碱加小剂量激素吸入,在治疗轻、中度的慢性症状性哮喘的临床疗效与单纯吸入较高剂量的激素相当,观察期间未见两药的明显副作用。认为小剂量的茶碱可作为轻、中度持续性哮喘常规抗炎药物来应用。     

咳嗽变异型哮喘的缓解期小剂量茶碱治疗

探讨小剂量茶碱在咳嗽变异型哮喘缓解期作后续巩固治疗的作用暨小剂量茶碱的免疫调节及抗炎效应。方法：临床实验病列分两组，各8例咳嗽变异型哮喘患者，小剂量茶破治疗组于临床症状控制后继续口服无水茶碱缓释片藻乐辉（0．4g／天）作后续巩固治疗，时间为半年。对照组则于临床症状控制后停药。结果：临床追踪3年，小剂量茶碱治疗组基本未见反复发作，而对照组则时有反复。结论：咳嗽变异型哮喘患者于临床症状控制的缓解期内用小剂量茶碱作后续巩固治疗半年，可获较长时间临床缓解。     

小剂量布地奈德联合茶碱缓释片对哮喘症状控制的临床观察

目的:探讨小剂量布地奈德联合茶碱缓释片控制支气管哮喘症状的效果。方法:将46例支气管哮喘患者随机分为对照组(23例)和观察组(23例),在常规治疗基础上对照组使用大剂量布地奈德(800～1 000μg/d),观察组使用小剂量布地奈德(200～400μg/d)加茶碱缓释片(200 mg/d),比较两组治疗2周、4周、8周、12周的哮喘控制评分。结果:两组均可有效控制哮喘症状,治疗2周、4周的评分差异无统计学意义(P>0.05),观察组治疗8周和12周的评分显著低于对照组(P<0.05)。结论:小剂量布地奈德吸入联合茶碱缓释片控制哮喘症状的效果优于单独应用大剂量布地奈德,且不良反应少,值得临床推广应用。     

博利康尼、无水茶碱对阻塞性肺疾病肺功能的影响

目的观察博利康尼、无水茶碱对慢性阻塞性肺疾病肺功能的影响.方法 39例阻塞性肺疾病住院患者,分成博利康尼组、葆乐辉组、对照组.博利康尼2.5mg1日3次,葆乐辉0.4每晚1次,对照组治疗前治疗后分别查肺功能.结果博利康尼、无水茶碱口服治疗FEV1、FVC、FEV1/FVC均增加,肺功能改善.结论博利康尼、无水茶碱对肺功能有明显改善作用.博利康尼、无水茶碱两种药物对肺功能影响无明显差异.     

吸入激素联合茶碱与吸入双倍剂量激素治疗哮喘的比较

目的　比较吸入激素 (ICS)联合缓释茶碱 (SRT)和双倍剂量ICS对中重度哮喘患者的疗效及抗炎作用。方法　 4 1例中重度哮喘患者随机分成 2组 :A组 2 1例 ,予必可酮 (BDP) 5 0 0 μg ,2次 /d ;B组 2 0例 ,予BDP 2 5 0 μg ,2次 /d ,SRT 0 2g ,2次 /d。疗程均为 6周。于治疗前、后诱导痰 ,行痰细胞分类计数 ,并测定白细胞介素 5 (IL 5 )。比较治疗前、后的症状评分。结果　治疗后两组患者痰嗜酸性粒细胞比例、IL 5水平和症状评分均较治疗前显著降低 (P <0 0 5 )。两组比较无显著性差异 (P >0 0 5 )。结论　ICS联合SRT和双倍剂量ICS对治疗中重度哮喘的疗效和抗气道炎症作用相当。     

联合噻托溴铵在哮喘控制不良患儿中的应用观察

目的:观察抗胆碱能药物-噻托溴铵在哮喘控制不良患儿中的疗效。方法:2013年1月至2014年1月我院哮喘门诊诊断中度持续性哮喘患儿,按2008年修订《儿童支气管哮喘诊断与防治指南》进行临床评估,予丙酸氟替卡松气雾剂(辅舒酮,125μg/次,2次/d)治疗3个月仍评估为哮喘未控制者60例。随机分为A组:辅舒酮125μg/次,早晚各2喷;B组:辅舒酮125μg/次,2次/d+福莫特罗粉吸入剂(奥克斯都保)4.5μg 1次/d;C组:辅舒酮125μg/次,2次/d+噻托溴铵粉吸入剂(思力华,18μg 1次/d),观察4周。结果:A组患儿治疗前后肺功能无显著改善,差异无统计学意义;B组及C组治疗后FEV1和PEF占预计值百分比均较治疗前有显著改善(P<0.001)。哮喘控制不良患儿夜间临床症状评分显著高于日间临床症状评分(P<0.001);无论是日间还是夜间临床症状评分3组患儿治疗后均较治疗前有显著改善(P<0.001);C组夜间临床症状评分较B组改善更显著(P<0.05)。结论:对于低剂量糖皮质激素吸入哮喘控制不良的中度持续性患儿,每日加用一次长效受体阻滞剂-噻托溴铵与联合长效β2受体激动剂疗效相当,不良反应罕见,可成为哮喘治疗效果不佳患儿的另一种可选择方案。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.