糖尿病患者应用他汀药物致肌病8例报告

目的：分析糖尿病患者应用他汀药物出现肌病的临床特点及发生原因。方法回顾性分析8例糖尿病患者应用他汀类药物致肌病的临床资料,并进行相关文献复习。结果8例患者均有肌肉酸痛,其中5例肌酸激酶( CK)升高。2例诊断为横纹肌溶解症,3例为肌炎,3例为较轻肌痛。引起肌病的药物主要为辛伐他汀、阿托伐他汀,1例为阿托伐他汀联用非诺贝特引起横纹肌溶解症,1例为氟伐他汀引起肌痛。2例横纹肌溶解病人合并多种疾病及多种合并用药。结论糖尿病患者尤其合并多种基础疾病及合并用药多的患者在应用他汀类药物时要严密观察临床症状及生化指标检测。     

辛伐他汀服用者并发急性横纹肌溶解症1例分析

本文在系统复习近5年辛伐他汀与肌不良反应文献的基础上,报道1例辛伐他汀服用者并发急性横纹肌溶解症,并探讨其发病相关因素及预防措施.指出他汀服用者,多种肌病危险因素的叠加是肌病发生的重要因素.西药的联合应用以及西药与植物药或中成药的合用,都存在肝脏细胞色素P450水平的药物相互作用,是导致他汀类血药浓度增高的重要因素,必须引起临床医生的足够重视.减少不必要的合并用药,采用合理的他汀类药物治疗剂量,以提高用药安全性.服用中成药应遵循中医辨证施治的原则.     

肝选择性他汀类药物研究进展

他汀类药物是临床广泛应用的降脂药,在多种心血管疾病的治疗中发挥重要作用.但2001年西立伐他汀的撤市加重了人们对药物引发的肌病和横纹肌溶解症的关注.降脂药物作用的靶器官是肝脏,如何利用药物的亲脂/亲水性来提高肝选择性,从而降低不良反应发生率是新型他汀类药物的研究重点.本文从药物的结构特征和脂水分配系数出发,综述近年来肝...     

调脂药物的分类与应用

目前,我国应用的调脂物可分为7类:他汀类:羟甲基戊二酰辅酶A(H M G-C o A)还原酶抑制剂,它抑制胆固醇在肝脏的合成,是降低T C、L D L-C最有效的药物,是当今应用最多的调脂药。我国现用的他汀类药物有5种:洛伐他汀、辛伐他汀、普伐他汀、氯伐他汀、阿托伐他汀。不良反应:全球l亿例以上患者应用他汀类药物,结果证明它是疗效好、比较安全的调脂药。有2%～3%患者有胃肠道功能紊乱及皮疹,2%的病人出现肝源性S GPT与CK酶升高,肌痛很少见,横纹肌溶解症罕见。贝特类:贝特类药物能增强脂蛋白酶活性,减少极低密度脂蛋白(VLDL)合成,降低T G,…     

降脂药物治疗病人需住院肌溶解症的发生率

背景：在美国降脂药物已获广泛应用。但是对各种降脂药物发生肌溶解症的危险性目前尚缺乏可靠的估计。 目的：对门诊情况下，不同他汀及贝特类药物（单用或联用）治疗病人肌溶解症的发生率进行估计。 设计、地点及病人：根据全美11个卫生保健计划申报数据建立不同他汀和贝特类用药起始队列。人选本队列的病例为1998年1月1H至2001年6月30日人组保健计划前至少用药180天的病人。人-时间按照单药治疗或他汀-贝特类联合治疗分类。 主要结局指标：每治疗10000人一年肌溶解症的发生率、所需治疗例数以及发生肌溶解症的相对危险性。 结果：在252460例采用降脂药物治疗的病人中，24例于治疗期间发生住院的肌溶解症。采用阿托伐他汀、普伐他汀或辛伐他汀单药治疗平均每10000人一年肌溶解症的发生率为0．44（95％可信区间[confidence interval，CI]，0．20～0．84）；西立伐汀为5．34（95％CI，1．46～13．68）；贝特类为2．82（95％CI，0．58—8．24；P=0．056）。未用药者（unexposed person—time）肌溶解症的发生率为0（95％CI，0—0．48，P=0．56）。阿托伐他汀、普伐他汀与一种贝特联川肌溶解症的发生率增至5．98（95％CI，0．72～216．0），西立伐他汀与叭特类联用增至1035（95％CI，389—2117）。每治疗1年，发现1例肌溶解症的所需治疗例数他汀单药治疗为2272例，采用他汀和贝特类联合治疗的年龄较大的糖尿病人为484例，采用西立伐他汀加贝特类治疗的病人为9．7到12．7例。 结论：采用阿托伐他汀、普伐他汀及辛伐他汀单药治疗发生肌溶解症的危险相似而且很低；联合使用他汀及贝特类者危险增加，特别是在老年糖尿病病人。西立伐他汀联合贝特类每年治疗10例即可能有1例发生肌溶解症。     

他汀类药联合其他药物用药致不良反应的临床特点分析

目的对他汀类药与其他药物联用导致药物不良反应的临床特点进行分析。方法选择的研究对象均为本院收治的他汀类药物与其他药物联用致药物不良反应发生的患者,时间段为2018年全年,共计选择患者100例,应用回顾性分析法归类分析全部患者的一般资料、用药情况、药物不良反应等情况。结果发生的主要不良反应:发生肌肉毒性的患者有32例,患者的主要临床症状为横纹肌溶解症。其次为肝毒性患者22例,消化系统不适20例,患者的主要临床症状为肝脏不适与消化不良。再次为神经系统症状8例,皮肤不适患者6例,呼吸系统症状4例与泌尿系统症状4例。最后为其他不良反应,有4例患者,患者的主要临床症状为高热。导致药物不良反应的他汀类药物主要包括:辛伐他汀的有46例患者;其次为阿托伐他汀28例;再次为普伐他汀14例,洛伐他汀8例;最后为氟伐他汀4例。导致药物不良反应的联合用药主要为抗心肌药物或降压药物,主要有32例患者,其中主要为卡托普利;其次为贝特类调脂药物、抗凝药物或抗血小板药物分别有20例、18例,主要分别为氯贝特、氯吡格雷;再次为抗菌药物、抗病毒药物、中成药或注射剂,分别有8例,主要分别为克拉霉素、利托那韦、丹参;最后为抗糖尿病药物为6例,其中主要为格列本脲。结论他汀类药与其他药物联用致药物不良反应发生率相对较高,临床用药时要格外注意。     

临床药师参与1例阿托伐他汀致肌病的药学实践

目的分析他汀致肌病的影响因素,使临床更加合理的使用他汀类药物,减少不良反应的发生。方法对1例口服阿托伐他汀钙片治疗5天后出现双大腿肌肉酸痛伴CK升高患者的病理生理因素、联合用药等情况进行分析,探讨他汀致肌病的相关因素及药学监护要点。结果临床药师判断他汀导致肌病可能性大,提出治疗建议和监护计划,促进了患者病情好转。结论他汀类药物导致肌病的影响因素较多,临床药师参与患者的临床治疗过程并加强药学监护,可促进药物治疗的安全性和有效性。     

他汀类药物相关性肌病研究进展

他汀类药物为3-羟基3-甲基戊二酰辅酶A（3-hydroxymethyl-3-methy lglutaryl coezymeA,HMG-CoA）还原酶抑制剂。自1987年上市以来,几项大型随机试验证实了他汀类药物在减少心血管死亡、非致死心肌梗死、中风等事件上起着重要作用。但是，他汀类药物最为严重的常见副作用是肝脏损害和肌病，其他表现包括胃肠不适、头痛、睡眠障碍、周围神经病变等。在他汀类药物广泛使用及2001年西伐他汀因横纹肌溶解副作用停止销售后，他汀类药物的安全性越来越受到人们的关注，而他汀类相关性肌病中的横纹肌溶解症，对生命影响最为严重。本文主要对他汀类药物相关性肌病的发病率、发病机制、防治措施等方面进行总结，以供临床参考。     

他汀类药物的不良反应分析及防治对策

目的 分析他汀类药物的不良反应情况,为临床合理用药提供依据.方法 回顾性分析服用他汀类药物出现不良反应的89例患者的临床资料.结果 本组＜60岁患者47例（52.8％）,≥60岁患者42例（472％）.81例患者于服用他汀类药物3个月内发生不良反应,占91.0％.其中单一用药的有32例,占36.0％,合并用药的57例,占64.0％.以辛伐他汀的不良反应的发生率最高,为55.1％ （49/89）,其次分别为阿托伐他汀、洛伐他汀、氟伐他汀、西立伐他汀及普伐他汀4.5％（4/89）;药物所致的不良反应类型包括神经肌肉系统、消化系统、泌尿系统及皮肤、附件等.结论 临床应严格掌握他汀类药物用药指征,密切观察患者的临床表现,确保用药安全,减少不良反应发生.     

合用他汀类药物不良反应的处方分析

目的了解两种他汀类药物（辛伐他汀、阿托伐他汀）的合并用药情况,为临床合理用药提供参考依据。方法收集2009年1～3月间本院门诊患者所有的含阿托伐他汀和辛伐他汀的处方共1811张。记录了这些处方的正文,统计阿托伐他汀和辛伐他汀各自的单用和合并用药处方数;这二种药物的合并用药处方中含有CYP3A4底物或抑制剂的处方数。结果在辛伐他汀合并用药处方中,与CYP3A4底物和抑制剂合用的处方分别占45．5％、5．4％;在阿托伐他汀合并用药处方中,与CYP3A4底物和抑制剂合用的处方分别占46．3％、5．8％。涉及的CYP3A4底物和抑制剂分别有17种、9种。结论他汀类药物与其他药物之间存在的代谢性相互作用应引起重视,以确保用药安全。     

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.