阿伐斯汀治疗荨麻疹40例

目的 :观察阿伐斯汀治疗各类麻疹的疗效。方法 :83例荨麻疹患者随机分为两组 ,治疗组 40例 ,给予阿伐斯汀片 8mg ,tid ,po。对照组 43例 ,特非那定片 60mg ,bid ,po ,急性荨麻疹 5d为 1个疗程 ;慢性荨麻疹 10d为 1个疗程 ,服药后 3 ,7或 14d观察结果。结果 :治疗组总有效率 71.79% ,对照组 62 .79%。结论 :阿伐斯汀是一种中枢作用轻微的新型抗组胺药物 ,尤其适用于急性荨麻疹。     

玉屏风散联合抗组胺药用于慢性荨麻疹疗效的系统评价

目的:定量分析并系统评价常规剂量玉屏风散联合抗组胺药用于慢性荨麻疹疗效的影响。方法:计算机联网检索从建库至2019年10月中国知网、中国生物医学文献数据库、维普数据库、万方数据库、PubMed及EMBase等数据库发表的玉屏风散联合抗组胺药治疗慢性荨麻疹的随机对照试验文献(联合组干预措施为常规剂量玉屏风散与抗组胺药联合应用;对照组干预措施为单纯使用常规剂量抗组胺药;抗组胺药包括咪唑斯汀、依巴斯汀、西替利嗪、左西替利嗪、氯雷他定、枸地氯雷他定、非索非那定、奥洛他定、阿伐斯汀、氮卓斯汀、苯磺贝他斯汀及地氯雷他定等)。采用RevMan 5.3和Stata 14.2软件进行荟萃分析(Meta分析)。结果:共纳入28篇文献,涉及1422例患者。Meta分析结果显示,联合组患者的总有效率明显高于对照组(OR=3.85,95%CI=2.91~5.11,P<0.00001),复发率明显低于对照组(OR=0.36,95%CI=0.27~0.49,P<0.00001),差异均有统计学意义;两组患者不良反应发生率比较,差异无统计学意义(OR=0.79,95%CI=0.52~1.20,P=0.27)。结论:相较于单纯使用抗组胺药,玉屏风散联合抗组胺药治疗慢性荨麻疹的疗效更优,复发率更低,且安全性大致相当。     

枸地氯雷他定与阿伐斯汀递减疗法治疗慢性荨麻疹的临床效果对比分析

目的探讨枸地氯雷他定与阿伐斯汀递减疗法治疗慢性荨麻疹的临床效果对比。方法选择我院60例2017年1月至2018年2月慢性荨麻疹患者。随机分组,阿伐斯汀组采取阿伐斯汀递减疗法治疗,枸地氯雷他定组则采取枸地氯雷他定递减疗法治疗。比较两组治疗效率;风团消失时间、瘙痒消失时间、持续发作时间;治疗前后患者症状体征积分、血浆组胺水平;不良反应概率。结果枸地氯雷他定组治疗效率、风团消失时间、瘙痒消失时间、持续发作时间、症状体征积分、血浆组胺水平相比较阿伐斯汀组更好,P <0.05。两组无严重不良反应。结论枸地氯雷他定递减疗法治疗慢性荨麻疹可获得较好预后。     

变应原皮肤点刺试验的护理研究

目的:通过变应原皮肤点刺试验(skin prick test,SPT)的操作与结果判断,了解支气管哮喘患者常见的过敏原并进行健康教育.方法:应用Spotter畅点点刺液进行皮肤点刺试验,同时应用生理盐水和组胺液进行阴性和阳性对照.结果:280例哮喘患者行变应原皮肤点刺试验,185例皮试阳性,阳性率66.07%.吸入性变应原阳性率明显高于食人性变应原(P<0.01);尘螨过敏原(粉尘螨和户尘螨)皮试阳性率明显高于其他过敏原(P<0.001).本组点刺试验过程中未发生严重的过敏反应.结论:规范的操作与结果分析是顺利完成Spotter畅点变应原皮肤点刺试验的关键.     

季节性偏头痛患者过敏原试验与IgE检测结果分析

目的探讨季节性偏头痛与Ⅰ型超敏反应的关系,并寻找相关致敏原。方法用北京协和医院提供的15种吸入性过敏原和美国DPC液相酶联免疫试验对已确诊的100例季节性、80例非季节性偏头痛患者进行过敏原皮试及IgE检测,并对比分析两组结果。结果季节性偏头痛组主要致敏原为夏秋花粉、早春花粉、豚草花粉、蒿属花粉,过敏原皮试阳性率94%,与非季节性偏头痛组(15%)比较,差异有统计学意义(P<0.01);血清总IgE比较,前者高于后者,差异亦有统计学意义(P<0.01)。结论季节性偏头痛的发病机制为IgE介导的Ⅰ型超敏反应,临床上对患者行过敏原皮试及IgE检测可作为本病诊断的重要指标,并为脱敏治疗的选择提供依据。     

支气管哮喘患者过敏原调查分析

目的探讨九江地区支气管哮喘患者的过敏原种类和阳性率。方法选用德国阿罗格过敏原17种进行皮肤点刺试验,组胺作阳性对照,生理盐水作阴性对照。分别对80例支气管哮喘患者、80例过敏性鼻炎患者进行过敏原皮肤点刺试验,对过敏原检查的临床资料进行分析。结果皮肤过敏原检查阳性,80例支气管哮喘患者中有77例对吸入性过敏原出现阳性反应,阳性率为96.3%(77/80)。其中有67例患者又对食入性过敏原出现阳性反应,阳性率为83.8%(67/80)。2支气管哮喘患者的过敏原以吸入性为主,常对4种,10种吸入性过敏原同时过敏。结论皮肤过敏原检查(皮肤点刺试验)可为支气管哮喘患者寻找病因,减少过敏原检查的种类,九江地区过敏原检查时可以选择常见过敏原(吸入性过敏原如粉尘螨、屋尘螨、多主枝孢、特异青霉、梧桐花粉、早春花粉过敏原,食入性过敏原花生、大螯虾等)。     

右美沙芬降低组胺肺功能激发试验假阳性率

目的:探讨组胺激发试验过程中咳嗽不良反应与阳性率的关系。方法:选取我院呼吸内科行组胺支气管激发试验患者120例,随机分为两组,试验前10 min分别予氢溴酸右美沙芬口服溶液30 mg与安慰剂口服,以咳嗽量表评价激发试验过程中咳嗽剧烈程度,并记录激发试验测试结果。3 d后试验组激发试验阴性患者于试验前10 min口服安慰剂重新行激发试验。结果:试验组重度咳嗽发生率较对照组低;试验组重度咳嗽患者支气管激发试验阳性率亦较对照组下降;试验组激发试验阴性患者予安慰剂重复激发试验,结果仍全部为阴性。结论:氢溴酸右美沙芬可通过减轻咳嗽不良反应减少重度咳嗽的发生率,从而降低组胺肺功能试验假阳性率,且未出现明显假阴性。     

季节性偏头痛患者过敏原试验与IgE检测结果分析

目的探讨季节性偏头痛与Ⅰ型超敏反应的关系,并寻找相关致敏原。方法用北京协和医院提供的15种吸入性过敏原和美国DPC液相酶联免疫试验对已确诊的100例季节性、80例非季节性偏头痛患者进行过敏原皮试及IgE检测,并对比分析两组结果。结果季节性偏头痛组主要致敏原为夏秋花粉、早春花粉、豚草花粉、蒿属花粉,过敏原皮试阳性率94％,与非季节性偏头痛组（15％）比较,差异有统计学意义（P〈0．01）;血清总IgE比较,前者高于后者,差异亦有统计学意义（P〈0．01）。结论季节性偏头痛的发病机制为IgE介导的Ⅰ型超敏反应,临床上对患者行过敏原皮试及IgE检测可作为本病诊断的重要指标,并为脱敏治疗的选择提供依据。     

HPLC法测定人血浆中阿伐斯汀的浓度及其药动学研究

目的:建立以高效液相色谱法测定人血浆中阿伐斯汀浓度的方法,研究其在健康男性体内的药动学。方法:血浆样品经乙腈提取并浓缩后进样测定,外标法定量,色谱柱为Symmetry ShieldTM PR18,流动相为乙腈-2%三乙胺水溶液(用稀磷酸调节pH值至6.8±0.2)=25∶75,流速为1.0mL.min-1,柱温为35℃,紫外检测波长为250nm。结果:阿伐斯汀血药浓度在4.6875～600ng·mL-1范围内线性关系良好(r=0.9994);方法回收率为96.14%～98.89%,日内RSD=1.60%～3.00%,日间RSD=2.03%～6.98%;口服阿伐斯汀胶囊后的药-时数据符合一室药动学模型。结论:本方法简便、灵敏、准确、回收率高,适用于阿伐斯汀的血药浓度测定及临床药动学研究。     

上海局部区域变应性鼻炎变应原流行病学分析

目的了解上海西南片局部区域变应性鼻炎变应原分布情况。方法参照文献方法,应用“阿罗格”变应原皮试液,以组胺为阳性对照,生理盐水为阴性对照,对680例疑似变应性鼻炎患者进行皮肤点刺试验,明确其主要致敏变应原。结果变应原皮试结果显示,436例为阳性（64．12％）,吸入性粉尘螨和屋尘螨的皮试阳性率分别为49．56％和49．26％。结论本试验区域临床变应性鼻炎的主要致敏原为吸入性粉尘螨和屋尘螨。“阿罗格”变应原皮肤点刺试验可明确变应性鼻炎的致敏因素,对该疾病的预防与诊治具有指导意义。     

盐酸贝尼地平治疗稳定型心绞痛的疗效观察

目的:观察盐酸贝尼地平对稳定型心绞痛患者的临床疗效。方法:80例稳定型心绞痛患者随机分为治疗组和对照组。治疗组给予盐酸贝尼地平片(4mg,bidpo),对照组给予硝苯地平控释片(30mg,qdpo),4周后观察心绞痛改善情况、消心痛使用量、心肌缺血程度等,监测不良反应事件,同时进行安全评价。结果:治疗组心绞痛症状明显改善,总有效率达90%,与对照组(总有效率65%)比较有显著性差异(P<0.05);消心痛使用量明显下降,总有效率达85%,与对照组(总有效率50%)比有显著性差异(P<0.01)。在运动试验中,治疗组总运动时间、运动至ST段下降至1mm所需时间、运动至心绞痛出现时间均明显延长,与对照组比亦有显著性差异(P分别<0.05、0.01、0.01);与治疗前相比有显著性差异(P分别<0.01、0.05、0.01)。最大运动当量也有增加,与对照组相比亦有显著性差异(P<0.05),与疗前比有显著性差异(P<0.01)。最大ST段下降幅度与疗前比有显著性差异(P<0.05),与对照组比无显著性差异(P>0.05);对照组运动至心绞痛出现时间明显延长,与疗前比有显著性差异(P<0.05),其余四项指标均无明显改善,与疗前比均无显著性差异(P均>0.05)。治疗组用药后不良反应事件总发生率12.5%,与对照组相比无显著性差异(P>0.05)。结论:与硝苯地平比,盐酸贝尼地平治疗稳定型心绞痛有更好的疗效及安全性。     

Acrivastine. A review of its pharmacological properties and therapeutic efficacy in allergic rhinitis, urticaria and related disorders.

Acrivastine is a short acting histamine H1-receptor antagonist with a rapid onset of action. Double-blind clinical trials have shown acrivastine (usually 8mg three times daily) to be an effective and well tolerated antihistamine in the treatment of chronic urticaria and allergic rhinitis. Acrivastine was more effective than placebo and similar in efficacy to clemastine or terfenadine in the treatment of seasonal allergic rhinitis. In the treatment of dermatoses in which histamine has a pathogenetic role, the efficacy of acrivastine was superior to that of placebo and similar to that of usual dosages of clemastine, hydroxyzine, chlorpheniramine, cyproheptadine or terfenadine. Acrivastine caused less drowsiness than clemastine, the incidence of adverse effects being indistinguishable from that with placebo or terfenadine. Thus, acrivastine is an effective addition to drugs currently available for the treatment of patients with allergic diseases in whom a histamine H1-receptor antagonist is indicated. Because of its rapid onset of action acrivastine will be particularly useful for 'on demand' therapy in patients with intermittent symptoms.     

Determination of the time of onset of action of ranitidine and famotidine on intra-gastric acidity

BACKGROUND: No standard methods exist for determining the onset of action of gastric antisecretory agents in human subjects. METHODS: Intragastric pH was measured when placebo, ranitidine 150 mg, ranitidine 75 mg or famotidine 10 mg were administered 30 min after the end of a meal. RESULTS: When the onset of action was defined as the earliest time that mean gastric pH with active treatment was statistically significantly higher (P < 0.05) than the corresponding placebo value, the onsets of action of ranitidine 75 mg and 150 mg were 55 min, and of famotidine 10 mg, 90 min. When onset was defined in terms of a particular decrease in gastric acid concentration for the group as a whole or for individual subjects, there was an important variation in the relative times of onset of ranitidine 75 mg and famotidine 10 mg. CONCLUSIONS: When administered after a meal, the onset of action of ranitidine and famotidine on gastric pH can be determined for individual subjects as well as for the group as a whole. When onset was determined for the group using statistical significance, which does not depend on arbitrary cut-off points, ranitidine 75 mg had an earlier onset of action than did famotidine 10 mg.     

Suppression of the histamine-induced wheal and flare response by fexofenadine HCl 60 mg twice daily, loratadine 10 mg once daily and placebo in healthy Japanese volunteers

BACKGROUND: The effects of the selective H1-receptor antagonist fexofenadine have been widely demonstrated in Western populations; however, to date, limited data comparing the effects of fexofenadine with other antihistamines have been reported in Japanese subjects. OBJECTIVE: To investigate the effect of fexofenadine and loratadine on the histamine-induced cutaneous wheal and flare response in healthy Japanese volunteers. METHODS: Eighteen healthy male and female Japanese volunteers aged 20-53 years were randomized to receive fexofenadine HCl 60 mg twice daily, loratadine 10 mg once daily or placebo in a 1-day, three-period, double-blind, crossover study. For each treatment, the wheal and flare response to 100 mg/mL histamine was assessed at baseline and at 1, 1.5, 2, 2.5, 3, 3.5, 4, 8, 12 and 24 hours post-dose. Blood samples were taken for pharmacokinetic analysis. RESULTS: Fexofenadine produced significantly greater percentage suppression of the overall wheal response compared with placebo and loratadine (43.1% versus 10.0% and 15.2%, respectively; p < 0.001). Similarly, fexofenadine significantly suppressed the overall flare response compared with placebo and loratadine (43.0% versus 3.5% and -8.9%, respectively; p < 0.01). Loratadine was statistically no different from placebo in terms of both overall wheal and flare suppression. Area under the curve analysis for wheal and flare reduction (0-12 hours post-dose) confirmed these findings. For wheal inhibition, fexofenadine had a significantly faster onset of action (defined as time to > or = 35% inhibition) compared with placebo (p < 0.001) and loratadine (p < 0.01); for flare, fexofenadine had a significantly faster onset of action than loratadine (p < 0.01). Mean maximum inhibition (the mean of the greatest inhibition achieved from baseline for each treatment) for wheal was achieved significantly faster with fexofenadine than loratadine (p < 0.01), and fexofenadine had a significantly longer duration of effect on suppressing wheal and flare compared with placebo and loratadine (p < 0.05 for all). The antihistamine effects of fexofenadine correlated significantly with its Cmax, while loratadine activity did not correlate significantly with its plasma levels. CONCLUSIONS: Fexofenadine is a potent suppressor of the histamine-induced wheal and flare response in healthy Japanese volunteers. These results support findings in Caucasian subjects, and confirm that fexofenadine has greater antihistaminergic activity than loratadine in this human model.     

卡立泊来德与维拉帕米对大鼠缺血再灌注心肌保护作用的比较研究

目的比较Na+/H+交换抑制剂卡立泊来德(cariporide)和钙离子拮抗剂维拉帕米(verapamil)这两类药物对于心肌保护作用的差别,从而给寻找更有效的心肌保护药物提供参考。方法建立大鼠在体心肌冠状动脉左前降支(LAD)缺血再灌注损伤模型,实验大鼠随机分为5组,每组6只,即伪手术组(LAD下只穿线不结扎)、对照组(缺血再灌注组,不给药)、卡立泊来德治疗组、维拉帕米治疗组、卡立泊来德与维拉帕米合用组。结扎LAD30min后松解结扎线,开始再灌注,再灌注60min后结束实验。于再灌注前分别应用卡立泊来德和维拉帕米,从心电图ST段变化、心肌损伤标志物肌钙蛋白I及肌红蛋白定量检测和心肌超微结构改变等方面探讨比较这两类药物对于心肌保护作用的差别。结果肌红蛋白值各组间差异无统计学意义(P>0.05),肌钙蛋白I值示组间差异有统计学意义(P<0.05)。卡立泊来德组、维拉帕米组及卡立泊来德与维拉帕米合用组肌钙蛋白I值与对照组比较差异有统计学意义(P<0.05);卡立泊来德组、维拉帕米组及卡立泊来德与维拉帕米合用组之间肌钙蛋白I值两两比较差异无统计学意义(P>0.05)。心电图ST值变化趋势结果示,卡立泊来德组与对照组ST值变化趋势比较差异有统计学意义(P<0.05),维拉帕米组与对照组ST值变化趋势比较差异无统计学意义(P>0.05),卡立泊来德组与维拉帕米组ST值变化趋势比较差异无统计学意义(P>0.05)。心肌细胞超微结构电镜观察结果示卡立泊来德组、维拉帕米组及卡立泊来德与维拉帕米合用组心肌细胞结构损伤较对照组轻,但三组间差异不明显。结论卡立泊来德与维拉帕米有一定的心肌保护作用,单一应用卡立泊来德的心肌保护效果较单一应用维拉帕米无明显优势,两者合用的效果并不优于单用其一者。     

Lack of antihistamine properties of single dose cinnarizine in man

A simple way to study a histamine antagonist in man is to observe the effect it has on the magnitude of the skin reaction to intradermal histamine. The aim of the present study was to evaluate the antihistamine activity of single oral doses of 75 mg cinnarizine using 75 mg diphenhydramine as control, both being compared to placebo. The study was performed with two groups of 5 healthy subjects, each group receiving one of the active treatments or placebo randomly under blind conditions. All subjects received intradermal injections on the forearm of a 0.05 ml saline solution containing 5 micrograms of histamine before and at different times after drug intake. The histamine-induced wheal area was measured and, after drug administration, the percent decrease of the wheal area was calculated. Results showed that diphenhydramine produced a significant inhibition of the histamine-induced wheal size at 1.5 h which lasted up to 4 h after drug administration, reaching maximum inhibition at 2.5 h. After cinnarizine treatment no significant decrease of the histamine-induced wheal area was observed at any time.     

Efficacy of nicardipine in angina pectoris

The dose-related efficacy and safety of nicardipine, a new calcium antagonist of the dihydropyridine class, was assessed by exercise tolerance testing in a randomized, double-blinded, placebo-controlled study in 19 patients with chronic, stable effort angina pectoris. Four patients were assigned to each of four treatment sequences receiving nicardipine three times daily in an extended Latin-Square study design. An increase in total exercise capacity, time to onset of angina and time to 1 mm ST segment depression was observed with nicardipine 90 mg/day compared to placebo (P less than .05). Gradual upward dose titration in 30 mg/day increments starting from 30 mg/day appeared to produce maximal increase in exercise capacity. Two patients developed adverse side effects attributable to the drug when administered nicardipine 90 mg/day directly from placebo.     

Inhibition of allergen-induced wheal and flare reactions by levocetirizine and desloratadine

Aims

To evaluate the inhibitory activity of the new-generation antihistamines levocetirizine and desloratadine at their therapeutic doses on the allergen-induced wheal and flare reaction at 1.5 h, 4 h, 7 h, 12 h and 24 h postdose, and to measure their plasma and skin concentrations.

Methods

A double-blind, randomized, cross-over, placebo-controlled study in 18 allergic subjects was carried out. The time–response of the wheal and flare reaction areas under the curve (AUC) were compared by anova.

Results

Both antihistamines significantly (P < 0.001) inhibited the allergen-induced wheal and flare reactions compared with placebo. Levocetirizine was significantly more potent than desloratadine. Mean ± SEM wheal AUC(0–24 h) was 506.4 ± 81.0 with levocetirizine and 995.5 ± 81.0 mm² h with desloratadine as compared with placebo (1318.5 ± 361.0 mm² h). Flare AUC(0–24 h) was 5927.3 ± 1686.5 and 15838.2 ± 1686.5 mm² h, respectively [P < 0.001 for both compared with placebo (22508.2 ± 7437.1 mm² h)]. Levocetirizine showed significant inhibition of wheal and flare already at 1.5 h postdose compared with placebo (P ≤ 0.001); desloratadine achieved a significant effect only after 4 h. The mean total plasma concentration at 12 h and 24 h after intake was higher for levocetirizine (58.1 ± 13.4 and 20.0 ± 8.1 ng ml⁻¹, respectively) as compared with desloratadine (0.82 ± 0.24 and 0.45 ± 0.16 ng ml⁻¹). Similarly, higher mean unbound skin concentrations were observed for levocetirizine 24 h after intake (1.80 ng g⁻¹) than for desloratadine (0.07 ng g⁻¹). This was associated with greater receptor occupancy for levocetirizine (54%) than desloratadine (34%) at 24 h.

Conclusions

Levocetirizine suppressed the cutaneous allergic reactions with a higher potency than desloratadine, which correlated with its high receptor occupancy. Receptor occupancy rather than drug affinity or plasma half-life is more representative of antihistamine potency.

What is already known about this subject

• The reproducible and standardized histamine-induced wheal and flare model helps identify the objective effectiveness of antihistamines in humans, as well as their differences in onset and duration of action.
• Some of the newest antihistamines have already been compared in a head-to-head setting using this model. However, their objective action at inhibiting the allergen-induced wheal and flare response has not been reported yet.

What this study adds

• The time–response study presented here shows the objective activity of two of the newest generation of antihistamines, levocetirizine and desloratadine, at inhibiting the allergen-induced wheal and flare response in a randomized, cross over, placebo-controlled trial.
• This model is interesting to the clinical setting since allergic subjects are recruited, and the response to allergen involves mast cell degranulation and release of numerous vasoactive and pro-inflammatory mediators additionally to histamine.
• In addition, this study reports receptor occupancy for both antihistamines at therapeutic dosage, leading to analysis of potential differences in activity.
• This study clearly shows the potential anti-inflammatory properties of desloratadine and levocetirizine in their skin activity when allergen is the challenging agent as occurs in the clinical situation.

     

艾塞那肽联合小檗碱对初发2型糖尿病患者早期胰岛素分泌的影响

目的探讨艾塞那肽联合小檗碱对初发2型糖尿病患者早期胰岛素分泌的影响,以及对胰岛β细胞功能的保护机制。方法将48例初发2型糖尿病患者随机分为治疗组和对照组各24例。治疗组予以艾塞那肽联合小檗碱治疗,对照组仅予以格列苯脲治疗,疗程均为12周。于治疗前、后分别行75g口服葡萄糖耐量试验(OGTT),测定空腹、服糖后30min、服糖后120min血糖(FPG、P30PG、P120PG)和血胰岛素(FISN、P30ISN、P120ISN)以及三酰甘油(TG)、C反应蛋白(CRP)水平,并计算胰岛素敏感指数(ISI)。结果治疗组治疗后P30INS水平高于治疗前,其他观察指标低于治疗前;对照组治疗后P30INS水平高于治疗前,FPG、P30PG、P120PG水平低于治疗前,差异均有统计学意义(P<0.01)。治疗组治疗后P120PG、FINS、P120INS、TG、CRP、ISI水平低于对照组,P30INS水平高于对照组,差异均有统计学意义(P<0.05和P<0.01)。结论艾塞那肽联合小檗碱治疗初发2型糖尿病,在明显降低血糖的同时,能提高早期胰岛素分泌,保护和恢复胰岛β细胞功能,疗效更确切。     

特非那丁对皮肤试验风团反应的抑制作用

本试验的目的是客观评价特非那丁的疗效。共选择了42例典型的花粉症患者,用双盲法分为特非那丁组(20例)及安慰剂组(22例)。试验前进行皮肤试验终点滴定,在服特非那丁60mg,bid,或安慰剂3d后重复滴定。结果表明,特非那丁明显抑制了风团反应,平均终点稀释度从10~(-5.6)移至10~(-3.9)(P<0.01),而安慰剂组的风团大小及终点稀释度均无明显变化。