他汀类药物的使用与核性白内障

背景：他汀类药物因其降脂作用而被广泛使用,但是他汀类药物可能还具有抗氧化作用。研究认为,氧化张力对核性白内障的发生有一定作用,但是他汀类药物使用与核性白内障发生之间的相互关系目前知之甚少。     

他汀类药物与贝特类药物联合应用安全性探析

目的探讨他汀类与贝特类药物联合应用的安全性。方法①病例选择：42例病例均为混合性高脂血症,且年龄〈70岁,用药前肝肾功能正常。②用法：辛伐他汀（舒降之）20mg,每晚1次,口服;吉非罗齐600mg,每日2次,口服,疗程4周。结果 42例患者除1例出现左肩肌肉轻度酸痛,丙氨酸转氨酶轻度升高,余均无不良反应,用药前后肝肾功能正常。结论小剂量他汀类与贝特类药物联合应用是相对安全的。     

他汀类药物与充血性心力衰竭

充血性心力衰竭(CHF)是临床上多种心脏疾病的最终发展结果，严重危害健康。在多种疾病发展为CHF和CHF逐步加重的过程中一直伴随着神经内分泌的过度激活，多种炎性细胞因子的参与及心室重构。因此，阻止神经内分泌的过度激活和抗炎性细胞因子及逆转心室重构已成为当代治疗CHF的基石。他汀类药物通过竞争性地抑制胆固醇生物合成初级阶段的限速酶-羟甲基戊二酸单酰辅酶A，减少胆固醇的生物合成，被认为是当前最强效的降低胆固醇的药物。     

他汀类药物的药理与临床应用

他汀类药物目前广泛应用于调脂治疗及冠心病治疗,作用肯定,在其他领域亦有应用价值。临床不良反应以横纹肌溶解症最为严重。本文综合近年公开发表的文章和资料,介绍他汀类药物的应用进展、调脂以外的作用及临床不良反应。     

合理应用他汀类药物

1概述 1．1他汀类药物临床研究现状 1．1．1治疗性生活方式改变（TLC）是临床治疗中必不可少的重要措施。     

他汀类药物的作用及临床应用

他汀类药物是以英文“Statin”为词尾的一类调脂药物 ,其化学名为“3-羟— 3甲基—戊二酰辅酶 A( HMG- COA)还原酶抑制剂。近年有关他汀类药物的大量的临床研究 ,如 :4S[1] 、CARE[2 ] 及“LIPID”[3 ]等研究 ,充分显示了他汀类药物调脂治疗的突破性进展和应用前景 ,现就他汀类药物的作用及临床应用综述如下 :1　他汀类药物的药理作用1 .1　直接调脂作用　 HMG- COA还原酶是胆固醇合成代谢中的一个关键限速酶 ,而他汀类药物作为HMG- COA还原酶抑制剂 ,其药理作用在于竞争性抑制 HMG- COA还原酶的作用 ,使肝内胆固醇合成减少 …     

他汀类药物的临床应用进展

他汀类药物是目前临床上疗效确切的调脂药物,除降脂作用外,他汀类药物还具有抗炎、抗氧化、修复损伤内皮、稳定粥样硬化斑块、防止血栓形成、降低炎性反应等多重作用。其阻滞胆固醇合成,治疗高胆固醇血症的作用已被临床广泛应用,近年来随着一系列大规模随机临床试验的揭晓,他汀类药物的非降脂作用逐渐被认识,现将他汀类药物非降脂作用的临床应用进展加以综述。     

他汀类药物应用与核性白内障

背景:他汀类药物广泛应用于降低血脂,该药亦有抗氧化的作用。氧化应激对核性白内障的发生发展起一定作用,但他汀类药物应用与白内障发病率间的关系尚不明确。目的:评估美国中西部1个族群中他汀类药物应用与成人白内障的关系。设计、机构及受试者:BeaverDam眼科研究是在威斯康星     

小切口劈核法白内障摘除术与超声乳化白内障摘除术治疗老年性硬核性白内障的疗效比较

目的:比较小切口劈核法白内障摘除术与超声乳化白内障摘除术治疗老年性硬核性白内障的疗效。方法:选取127例老年性硬核性白内障患者作为观察对象,依据随机数字表法将其分为对照组63例和观察组64例,对照组采取超声乳化白内障摘除术治疗,观察组采取小切口劈核法白内障摘除术治疗,比较两组角膜水肿分级、术后角膜散光值、术前及术后1个月视力。结果:由Ridit检验可知,观察组角膜水肿分级明显优于对照组,差异有统计学意义(P<0.05);两组术后角膜散光值比较,差异无统计学意义(P>0.05);术后1个月观察组视力明显高于对照组,差异有统计学意义(P<0.05)。结论:与超声乳化白内障摘除术相比,小切口劈核法白内障摘除术治疗老年性硬核性白内障,术后角膜水肿分级明显更优,视力更高。     

Statin use and incident nuclear cataract

Context  Statins are widely prescribed for their lipid-lowering effects but also have putative antioxidant properties. Oxidative stress is believed to play a role in the development of nuclear cataract, but little is known regarding the relationship of statin use and cataract incidence. Objective  To evaluate the relationship of use of statins and incident cataract in adults in a midwestern community in the United States. Design, Setting, and Participants  The Beaver Dam Eye Study, an observational, longitudinal, population-based study of age-related eye disease in Beaver Dam, Wis. There were 1299 persons who were seen at the third examination in 1998-2000, had gradable photographs in both eyes, and were deemed to be at risk of developing nuclear cataract within 5 years. Main Outcome Measure  Five-year incidence of cataract with respect to statin use. Cataracts were graded from photographs taken through the participant’s dilated pupil. Results  A total of 210 persons developed incident nuclear cataract in the interval from 1998-2000 to 2003-2005. Five-year incidence of nuclear cataract was 12.2% in statin users compared with 17.2% in nonusers (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.36-0.84), controlling for age. When only never smokers without diabetes were assessed, the age-, lipid level–, and sex-adjusted OR was 0.40 (95% CI, 0.18-0.90). Five-year incidence of cortical cataract was 9.9% in statin users and 7.5% in nonusers (OR, 1.28; 95% CI, 0.79-2.08); posterior subcapsular cataract occurred in 3.0% of statin users and 3.4% of nonusers (OR, 0.82; 95% CI, 0.39-1.71). Conclusion  Statin use in a general population appears to be associated with lower risk of nuclear cataract, the most common type of age-related cataract.      

小切口白内障囊外摘除术与白内障超声乳化术在硬核白内障中的治疗效果比较

目的 研究分析小切口白内障囊外摘除术与白内障超声乳化术在硬核白内障中的治疗效果.方法 对硬核白内障患者80例进行研究,采用随机数字表法将80例患者分为观察组与对照组,各40例.观察组患者应用小切口白内障囊外摘除术进行治疗,对照组患者应用白内障超声乳化术进行治疗,比较分析观察组与对照组的临床治疗效果.结果 观察组术后并发症发生率低于对照组,差异有统计学意义(P<0.05);观察组患者术后1天、1周、3个月视力水平与术后散光度与对照组比较,差异无统计学意义.结论 小切口白内障囊外摘除术与白内障超声乳化术在硬核白内障中的临床效果相当,但是小切口白内障囊外摘除术的安全性更高,值得推广应用.     

硬核白内障现代囊外摘除术与超声乳化术临床效果比较

目的：评价超声乳化术与现代囊外摘除术对硬核白内障的治疗效果。方法：128例（132眼）硬核白内障患者,随机分为两组,每组66眼,分别施行白内障现代囊外摘除术（ECCE）与超声乳化术（Phaco）,比较两组术后视力、角膜水肿及角膜内皮情况、术中并发症及术源性角膜散光。结果：两组术后1 d、1周、1个月、3个月、9个月裸眼视力差异无统计学意义（P〉0.05）。角膜水肿程度、角膜内皮细胞密度和平均内皮细胞面积及并发症两组比较差异有统计学意义（P〈0.05）。Phaco组术中后囊破裂3眼、悬韧带断裂3眼,ECCE组无后囊破裂、悬韧带断裂发生。术后9个月术源性角膜散光Phaco组与ECCE组差异无统计学意义（P〉0.05）。结论：高龄硬核白内障患者行ECCE比Phaco更安全,术后近期远期视力及角膜情况与Phaco无差异。     

Anterior internal lenticonus accompanied by congenital nuclear cataract

Internal lenticonus is a very rare morphologic abnormality of crystalline lens which has been reported in only several cases in the literature. We herein reported the clinical characteristics and surgical findings of the anterior internal lenticonus accompanied by congenital nuclear cataract. Cataract extraction accompanied with intraocular lens implantation was uneventfully performed, and a good visual outcome was achieved in this case. Viral infection during embryonal and fetal period might account for the formation of the anterior internal lenticonus and congenital nuclear cataract in our case.

     

硬核白内障超声乳化术的疗效分析

目的 分析硬核白内障超声乳化术的临床效果.方法 表面麻醉下采用拦截劈裂技术对120例(136眼)硬核性白内障患者实施超声乳化白内障摘除术.结果 术后1 d视力≥0.5者占55.9%,术后1周视力≥0.5者占83.1%,术后1个月视力≥0.5者占88.2%.结论 表面麻醉下采用拦截劈裂技术行硬核白内障超声乳化术,是一种安...     

TGF—β和FN在皮质型核型老年性白内障中的表达

研究表明 ,晶状体上皮细胞的异常增殖分化凋亡是白内障发生的机制之一〔1、2〕。细胞的增殖、分化、凋亡主要靠基因、细胞外基质、细胞密度来调控。而晶状体为一无血供器官 ,主要靠细胞外基质、细胞因子、细胞密度调控。细胞外基质 (ＥＣＭ )影响各种细胞的粘连、迁移、分化〔3～ 5〕 。其中纤维连接蛋白 (ＦＮ)诱导的增殖细胞分化能力下降 ,且迁移能力下降 ,这些细胞对Ⅰ型胶原和ＦＮ有较强的亲和力。在白内障患者中 ,特别是老年性白内障中 ,晶状体核越堆越厚 ,各种还原酶能力下降 ,抗氧化能力下降。机体为弥补这些改变自动调节一些细胞因…     

Statin use and sepsis events [corrected] in patients with chronic kidney disease

Context  Patients with chronic kidney disease are at high risk for sepsis and sepsis-related mortality. Objective  To assess whether statin use is associated with a reduction in hospitalizations for sepsis in dialysis patients. Design, Setting, and Patients  National prospective cohort study that enrolled 1041 incident dialysis patients at 81 US not-for-profit outpatient dialysis clinics from October 1995 to June 1998, with follow-up to January 2005. Statin use was determined by medical record review. Rates of hospitalization for sepsis between statin users and control patients were compared using multivariate regression models, with adjustment for potential confounders in the overall cohort and in a subcohort in which control patients were matched to statin users according to their likelihood (propensity) to have been prescribed a statin. Main Outcome Measure  Hospitalizations for sepsis were determined through hospital records from the United States Renal Data System (mean follow-up, 3.4 years). Results  There were 303 hospitalizations for sepsis. Rates of sepsis-related hospitalizations were significantly lower in patients receiving statins (crude incidence rate, 41/1000 patient-years) than in those not receiving statins (crude incidence rate, 110/1000 patient-years) (P<.001). With adjustment for demographics and dialysis modality, statin users were substantially less likely to be subsequently hospitalized for sepsis (incidence rate ratio, 0.41; 95% confidence interval [CI], 0.25-0.68). Further adjustment for comorbidities and laboratory values continued to show this protective association (incidence rate ratio, 0.38; 95% CI, 0.21-0.67). In the propensity-matched subcohort, statin use was even more protective (incidence rate ratio, 0.24; 95% CI, 0.11-0.49). Conclusions  Use of statins was strongly and independently associated with a reduction in the risk of hospitalization for sepsis in patients who had chronic kidney disease and were receiving dialysis. Randomized trials of statins in patients with chronic kidney disease should examine the prevention of sepsis as a potentially important benefit.