补阳还五汤治疗气虚血瘀型脑梗死疗效及对患者血浆金属蛋白酶-2、8水平影响

目的：探讨补阳还五汤治疗气虚血瘀型脑梗死患者的疗效及对血浆金属蛋白酶（MMP）-2、8水平的影响.方法：70例气虚血瘀型脑梗死患者,随机分为观察组和对照组.两组患者入院后予以控制血压、颅内压和血糖、抗血小板聚集、改善脑循环和维持水电解质酸碱平衡等西医常规治疗.观察组患者在对照组治疗基础上加用补阳还五汤加减口服,连用2周.观察并比较两组患者治疗前后血浆MMP-2、8水平的变化及疗效.结果：治疗2周后,两组患者血浆MMP-2、8水平均较前明显下降（P＜0.01或0.05）,且观察组患者下降的幅度较对照组更大（P＜0.05）;两组患者临床疗效比较,差异无统计学意义（P＞0.05）,但治疗组显效率明显优于对照组（P＜0.05）.两组治疗期间均未发生严重药物不良反应,不良反应发生率差异无统计学意义（P＞0.05）.结论：补阳还五汤联合西医常规治疗治疗气虚血瘀型脑梗死的疗效优于单纯西医常规治疗,安全性较好,其作用可能与降低血浆MMP-2、8水平,减少细胞外基质的降解有关.     

脑脉欣颗粒治疗动脉硬化性脑梗死恢复期的临床试验

摘 要 目的： 评价中药新药脑脉欣颗粒治疗动脉硬化性脑梗死恢复期的有效性和安全性。方法: 采用随机、双盲、平行对照临床研究,以NIHSS量表评分、患者生活能力评定为主要效应指标,同时观察对中风病(中经络)气虚血瘀证的证候疗效;并进行了安全性评价。结果: 共完成观察病例177例,其中脑脉欣颗粒组60例、阳性对照脉络通颗粒组59例、安慰剂组58例。动脉硬化性脑梗死恢复期（气虚血瘀证）患者经4周治疗后,在NIHSS量表评分改善、生活能力评定、中医证候疗效等方面,脑脉欣颗粒试验组与脉络通颗粒对照组疗效均优于安慰剂组,差异有统计学意义（P<0.01或P<0.05）,且脑脉欣颗粒试验组疗效也明显优于脉络通颗粒对照组（P<0.05）。脑脉欣颗粒试验组,脉络通颗粒对照组和安慰剂组不良事件发生率分别为1.67%,1.69%和1.72%,组间比较差异无统计学意义(P＞0.05)。三组均无严重不良事件发生。结论: 脑脉欣颗粒治疗动脉硬化性脑梗死恢复期患者,安全有效。     

替米沙坦联合胺碘酮治疗高血压伴阵发性心房颤动患者疗效及对血清BNP、MMP-2及CTGF水平的影响

摘 要 目的：探讨替米沙坦联合胺碘酮对高血压伴阵发性心房颤动患者血清脑钠肽（BNP）、基质金属蛋白酶-2（MMP-2）及结缔组织生长因子（CTGF）水平的影响。方法: 90例高血压伴阵发性心房颤动患者随机分为胺碘酮+替米沙坦组和胺碘酮组,每组45例。胺碘酮组给予胺碘酮片维持治疗,胺碘酮+替米沙坦组给予替米沙坦联合胺碘酮治疗。治疗12个月后比较两组临床疗效及患者血压、心率、左心房容积、房颤次数及持续时间的变化,分析两组患者治疗前后血清BNP、MMP-2及CTGF水平变化。结果: 胺碘酮+替米沙坦组治疗总有效率为95.6%,显著高于胺碘酮组的75.6%（P<0.05）。治疗后胺碘酮+替米沙坦组患者血压水平、左心房舒张末和收缩末容积心房颤动次数及维持时间均较前明显改善（P<0.05）,且均明显优于胺碘酮组（P<0.05）。治疗后两组患者血清MMP-2、CTGF水平均较前明显降低（P<0.05）,胺碘酮+替米沙坦组BNP、MMP 2及CTGF水平均明显低于胺碘酮组（P<0.05）。结论:替米沙坦联合胺碘酮治疗高血压伴阵发性心房颤动的疗效确切,能够抑制患者左心房扩大,减少心房颤动次数及持续时间,降低患者血清BNP、MMP-2及CTGF水平。     

替吉奥联合奥沙利铂治疗进展期胃癌的疗效及对癌组织中MMP-9表达的影响

摘 要 目的：观察替吉奥联合奥沙利铂治疗进展期胃癌的疗效,探讨其对癌组织中基质金属蛋白酶 9(MMP 9)表达的影响。方法: 120例进展期胃癌患者随机分为观察组和对照组,每组60例,均接受新辅助化疗方案治疗3个周期：观察组给予替吉奥胶囊联合奥沙利铂;对照组给予氟尿嘧啶联合奥沙利铂化疗。观察两组近期疗效、不良反应及化疗前后癌组织中MMP 9表达的变化。结果: 治疗后,观察组和对照组客观缓解率差异无统计学意义(P>0.05),观察组临床受益率显著高于对照组(P<0.01);观察组重度骨髓抑制和肝肾功能损害发生率明显低于对照组(P<0.05);观察组MMP 9的阳性表达率明显低于对照组 (P<0.05)。结论: 替吉奥胶囊联合奥沙利铂可提高进展期胃癌患者的临床受益率,且能有效降低癌组织中MMP 9的表达。     

双歧杆菌四联活菌片对肠易激综合征患者血清白介素-8和肿瘤坏死因子-α水平的影响及疗效观察

摘 要 目的: 探讨双歧杆菌四联活菌片对肠易激综合征(IBS)患者血清白介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)水平的影响及疗效。方法：84例IBS患者随机分为观察组和对照组各42例。两组患者均予以调整饮食、胃肠解痉药和止泻药等常规治疗。在此基础上观察组患者加用双歧杆菌四联活菌片1.5 g,po tid。8周后观察两组患者治疗前后血清IL-8和TNF-α水平变化,比较两组临床疗效和药品不良反应。结果：治疗8周后,两组患者血清IL-8和TNF-α水平均较前下降(P<0.05或0.01),且观察组下降幅度明显大于对照组(P<0.05);观察组患者临床总有效率为92.86%,明显高于对照组的76.19%(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论：双歧杆菌四联活菌片治疗IBS具有较好的临床疗效,安全性好,作用机制与其能抑制IL-8和TNF-α的表达,降低血清IL-8和TNF-α水平,减轻局部炎症反应密切相关。     

小剂量泼尼松联合他克莫司治疗小儿过敏性紫癜性肾炎临床观察

摘 要 目的：观察小剂量泼尼松联合他克莫司治疗小儿过敏性紫癜性肾炎的疗效及对血清基质金属蛋白酶2（MMP2）、基质金属蛋白酶9（MMP9）、基质金属蛋白酶组织抑制因子1（TIMP1）水平的影响。 方法: 102例过敏性紫癜性肾炎患儿随机分为两组各51例,在基础治疗同时,对照组予小剂量醋酸泼尼松片联合环磷酰胺治疗,观察组予小剂量醋酸泼尼松片联合他克莫司治疗。持续治疗3个月后,比较两组治疗后临床疗效与药品不良反应、治疗前后肾功能和血清MMP2、MMP9、TIMP1水平变化。 结果: 治疗后,观察组和对照组治疗总有效率分别为94.12%和70.59%,差异有统计学意义（P＜0.05）。两组24 h尿蛋白定量（24hUpro）、尿β2 微球蛋白（β2 MG）、尿微量白蛋白（mALB）、血肌酐（SCr）、血尿素氮（BUN）以及血清MMP2、MMP9、TIMP1水平均较治疗前降低（P＜0.05）,且观察组上述指标明显低于对照组（P＜0.05）。两组药品不良反应发生率比较,差异无统计学意义（P＞0.05）。 结论: 小剂量泼尼松联合他克莫司治疗小儿过敏性紫癜性肾炎,疗效显著,同时能明显降低血清MMP2、MMP9、TIMP1水平。     

神经节苷酯辅助治疗急性脑梗死患者的疗效及对其血清hs-CRP、TNF-α的影响

摘 要 目的： 探讨神经节苷脂钠治疗急性脑梗死患者的疗效及对其血清高敏C反应蛋白（hs-CRP）、肿瘤坏死因子α（TNF-α）的影响。方法: 急性脑梗死患者216例随机分为观察组与对照组,每组108例。对照组患者予常规治疗,观察组患者在对照组基础上加用神经节苷脂注射液100 mg加入0.9%氯化钠注射液250 ml,ivd,qd。两组疗程均为14 d。评价两组临床疗效,比较两组患者治疗前后神经功能缺损程度评分（NDS）、日常生活活动量评分,以及血清hs-CRP和TNF-α水平变化。观察两组药品不良反应发生情况。结果: 观察组治疗总有效率为90.7%,明显高于对照组的71.3%（P＜0.05）。治疗后,观察组NDS评分较前明显降低,而ADL评分较前明显提高（P＜0.05）,且与对照组比较,差异均有统计学意义（P＜0.05）;而对照组患者治疗前后NDS及ADL评分无明显变化（P＞0.05）。两组患者治疗后血清hs-CRP和TNF-α水平均较治疗前明显降低（P＜0.05）,且观察组血清hs-CRP和TNF-α水平明显低于对照组（P＜0.05）。治疗期间两组患者均未见药品不良反应发生。结论: 神经节苷脂钠辅助治疗急性脑梗死疗效良好,能显著降低患者血清hs-CRP和TNF-α水平,改善患者NDS及ADL评分,且安全性好,值得在临床上进一步推广应用。     

丹参多酚酸盐联合常规治疗急性脑梗死疗效及对血清白细胞介素-6影响观察

摘 要 目的：观察丹参多酚酸盐联合常规治疗对急性脑梗死患者的疗效及对血清炎性因子白细胞介素 6（IL 6）的影响。方法: 70例急性脑梗死患者随机分为观察组和对照组各35例,均给予脑梗死常规治疗,观察组在此基础上加用丹参多酚酸盐注射液200 mg+0.9%氯化钠注射液250 ml,ivd,qd。两组疗程均为2周。另选取30例健康体检者为健康对照组。分别于治疗第3天、第7天、第10天及第14天评定两组患者神经功能缺损评分（NIHSS评分）;于发病24 h内,治疗第3天、第7天、第10天及第14天检测两组患者血清IL 6水平,并与健康对照组的血清IL 6水平相比较。结果: 治疗第7天开始观察组NIHSS评分较入院时显著下降（P<0.05）,此后NIHSS评分持续下降;对照组NIHSS评分则在治疗第10天开始显著下降（P<0.05）。治疗第7天后,观察组NIHSS评分均显著低于对照组同期（P<0.05）。两组入院24 h内血清IL 6水平均显著高于健康对照组（P<0.05）。观察组血清IL 6水平从治疗第7天开始逐渐下降,治疗第14天时与健康对照组差异无统计学意义(P>0.05)。对照组血清IL 6水平在治疗第10天后逐渐下降,但对照组各时段血清IL 6水平均高于健康对照组（P<0.05）。治疗第7天开始观察组血清IL 6水平明显低于对照组（P<0.05）;且观察组血清IL 6水平最高值明显低于对照组最高值（P<0.05）。结论: 丹参多酚酸盐联合常规治疗能有效降低脑梗死患者NIHSS评分,降低其血清IL 6水平,效果优于单纯常规治疗。     

依达拉奉联合常规治疗对急性脑梗死患者神经功能的影响

摘 要 目的:观察依达拉奉联合常规治疗对急性脑梗死患者神经功能的影响。方法：144例急性脑梗死患者随机分为观察组(n=72)和对照组(n=72),对照组给予常规治疗,观察组在常规治疗基础上加用依达拉奉,疗程2周。比较两组患者治疗前后的血清超氧化物歧化酶(SOD)、血清丙二醛(MDA)和神经元特异性烯醇化酶(NSE)水平变化,根据美国国立卫生研究院卒中量表(NIHSS)评定两组神经功能缺损。结果：治疗后两组的NIHSS评分均较治疗前明显降低(P<0.05),观察组治疗后评分明显低于对照组(P<0.05)。治疗后两组患者血清SOD水平均较治疗前明显升高,MDA和NSE水平则明显降低(P<0.05);且治疗后两组患者SOD、MDA和NSE水平比较,差异有统计学意义(P<0.05)。两组药品不良反应发生率比较,差异无统计学意义(P>0.05)。结论：依达拉奉能明显改善急性脑梗死患者的神经功能,其作用机制与清除自由基、降低神经元特异性烯醇化酶有关。     

丁苯酞联合奥拉西坦治疗急性脑梗死后认知障碍的疗效观察

摘 要 目的：探讨丁苯酞联合奥拉西坦治疗急性脑梗死后认知障碍患者的疗效及对事件相关电位P300和侧支循环的影响。方法: 急性脑梗死后认知功能障碍患者108例随机分为两组,每组54例。在常规治疗基础上,对照组加用奥拉西坦胶囊治疗,观察组加用奥拉西坦胶囊和丁苯酞软胶囊治疗。两组患者均连续治疗14 d。比较两组治疗后总有效率和侧支循环开放率,以及两组治疗前后中国脑卒中临床神经功能缺损程度评分量表（CSS）评分、血清神经元特异性烯醇化酶水平、蒙特利尔认知评估量表（MoCA）评分、事件相关电位P300潜伏期和波幅变化。结果: 观察组治疗后总有效率为88.9%,显著高于对照组的70.4%(P＜0.05)。与治疗前比较,两组治疗后CSS评分均降低（P＜0.05）,而观察组降低幅度明显大于对照组（P＜0.05）;观察组治疗后MoCA总分和记忆力得分均明显高于本组治疗前和对照组治疗后(P＜0.05),而对照组治疗前后MoCA总分和各单项得分无明显变化(P＞0.05)。观察组治疗后事件相关电位P300潜伏期明显缩短,波幅明显升高,与本组治疗前及对照组治疗后比较,差异有统计学意义(P＜0.05),而对照组治疗前后无明显变化(P＞0.05)。观察组治疗后侧支循环开放率明显高于对照组(P＜0.05)。结论: 丁苯酞联合奥拉西坦对于急性脑梗死后认知功能障碍的疗效确切,可有效改善患者神经功能缺损和纠正事件相关电位P300异常,有利于侧支循环的建立。     

Effects of cannabidiol and of diphenylhydantoin on the hippocampus and on learning

Cannabidiol (3.5 mg/kg, i.p.) depressed hippocampal facilitation and posttetanic potentiation of evoked responses in rats, such, as had been reported before for diphenylhydantoin. Both diphenylhydantoin (80 mg/kg, i.p.) and cannabidiol blocked the increase of hippocampal RNA concentration caused by afferent stimulation, and depressed the acquisition of a conditioned avoidance response in rats. Neither drug affected the retention of such response when given by posttrial injection, nor the spontaneous locomotor activity of mice. The effects of both agents may be explained by the interference they have been previously shown to produce with the release of K⁺ from the hippocampus during stimulation. In fact, hippocampal facilitation and posttetanic potentiation and the RNA response to stimulation have been shown to be phenomena which depend on this K⁺ release, and have been attributed a role in learning.     

β3-肾上腺素受体激动剂的研究进展

摘要β     

妊娠合并子宫肌瘤对母儿影响的分析

目的 探讨妊娠合并子宫肌瘤对母儿的影响。方法 对1999年1月～2004年12月73例在剖宫产术中发现的子宫肌瘤进行分析。结果 妊娠合并肌瘤的胎位异常（臂位）率、产后出血率分别为17．8％、20．54％,而对照组分别为3．18％和8．97％;低体重儿发生率12、33％,而对照组为6．07％,有显著差异。结论 子宫肌瘤增加了母儿并发症的可能性;合并黏膜下肌瘤也有望使妊娠过程成功。     

朱砂及含朱砂制剂的肝肾毒性研究

目的 探讨朱砂、含朱砂制剂（柏子养心片）及甲基汞对大鼠的体内外毒性,为其临床安全用药提供科学依据。方法 ①对比甲基汞、朱砂及柏子养心片体外对人肝HL-7702细胞和人肾近曲小管上皮HK2细胞的毒性,计算半数抑制浓度（IC₅₀）。②SD大鼠随机分为对照组,朱砂组0.1 g/kg,柏子养心片0.2、0.4、0.8 g/kg组,甲基汞组0.001 g/kg,每天ig 1次,连续给药90 d后,取血及肝、肾组织;试剂盒法检测血清中丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、肌酐（CREA）、尿素氮（BUN）水平,测汞仪固体直接进样法检测肝、肾组织中汞蓄积量,并对大鼠肝脏和肾脏做组织病理学检查。结果 体外试验表明,朱砂、柏子养心片及甲基汞对HL-7702细胞的IC₅₀分别为7.852、6.035、0.009 5 g/L;对HK2细胞的IC₅₀分别为6.297、4.484、0.008 9 g/L。亚慢性毒性试验表明,甲基汞组大鼠肝、肾组织中汞蓄积量及血清中ALT、AST、CREA、BUN值均显著高于对照组,而朱砂及柏子养心片（高、中、低剂量）组与对照组比较均没有显著性差异;甲基汞组大鼠肝脏呈现肝细胞变性,肾脏可见明显肾小管损伤,而朱砂及柏子养心片（高、中、低剂量）组与对照比较没有明显差异。结论 朱砂及柏子养心片的体内外毒性均显著低于甲基汞,在目前药典规定的临床用量下使用安全性较好。     

Effects of raunescine and isoraunescine on behaviour and on the 5-hydroxytryptamine and noradrenaline contents of brain

Some behavioural effects of raunescine and isoraunescine on pigeons have been studied; no qualitative difference was detected between their effects and those of reserpine. Isoraunescine is between five and ten times less potent than raunescine, which, in turn, is much less potent than reserpine in producing these effects.

Both raunescine (5 mg./kg.) and isoraunescine (50 mg./kg.) were found to cause a reduction in the concentration of noradrenaline in the brains of rats. Raunescine (5 mg./kg.) also caused a reduction in the concentration of 5-hydroxytryptamine in brain; isoraunescine did not do so in the same dose; higher dose levels were not studied.

     

丹参多酚酸盐治疗不稳定型心绞痛的疗效及其对一氧化氮和内皮素的影响

目的观察丹参多酚酸盐治疗不稳定型心绞痛（UA）的疗效及其对血清一氧化氮（NO）和内皮素（ET）水平的影响。方法 60例患者随机分为治疗组和对照组各30例。对照组给予常规抗心绞痛治疗,治疗组在对照组治疗的基础上加用丹参多酚酸盐注射液。观察比较2组临床疗效、血清NO和ET水平及心电图改善和药物不良反应情况。结果 治疗组临床疗效、血清NO和ET水平及心电图改善情况均优于对照组,差异有统计学意义（P〈0.05）。2组均未发生药物不良反应。结论丹参多酚酸盐可明显改善UA患者的临床症状和心电图ST-T改变,要提高血清NO水平的同时降低ET水平。     

Influence of streptozotocin-induced diabetes on blood pressure and on renin formation and release

Summary I.v. injection of 40 mg/kg or 65 mg/kg streptozotocin reliably induced diabetes in female Sprague-Dawley rats, but failed to induce hypertension within the following 42 days. In most animals injected with the higher dose and in some animals injected with the lower dose, the tail blood flow was permanently impaired so that no blood pressure signals could be obtained by tail plethysmography. This phenomenon occurred also when the drug was injected into the jugular vein and thus was not due to a local effect of streptozotocin. 15 days after 65 mg/kg streptozotocin, the mean arterial pressure of the rats was similar to that of controls, when measured in the awake state (carotid cannula) or under ether anaesthesia. 42 days after streptozotocin, under pentobarbital anaesthesia, the blood pressure was again normal in the animals given 40 mg/kg of the drug and depressed in the animals given 65 mg/kg of the drug 42 days previously. The increase of blood pressure induced by 1 g/kg (–)-noradrenaline i.v. was similar in the latter group of animals and in controls.The renal cortical renin concentration was much lower than in controls 42 days after either dose of streptozotocin, while the plasma renin activity was normal (40 mg/kg) or increased (65 mg/kg). The low renal renin content may have been due to the diabetic state, rather than to the drug itself. Adrenal medullary dopamine-beta-hydroxylase activity was increased 42 days after the higher dose of streptozotocin.Supported by the Swiss National Science Foundation, grant Nr. 3.410.078     

Effect of endothelin on total and regional coronary resistance and on myocardial contractility

Endothelin is a 21-amino acid peptide produced by the endothelium and has a potent vasoconstrictor effect. Because of the importance of the endothelium on vasomotor regulation, we studied the effect of endothelin on total and regional coronary vascular resistance and on myocardial contractility in the intact heart of anesthetized dogs. Intracoronary administration of 2 to 80 pmol/kg of endothelin produced a dose-dependent increase in coronary resistance, ischaemic decrease in myocardial contractility and atrium-ventricular blockade. The increase in resistance was greater towards the outer layer of the left ventricular wall. When the coronaries were perfused at a constant rate and vasoconstriction was prevented with adenosine or nitroglycerine, endothelin did not produce inotropic changes. These results show that endothelin is a potent vasoconstrictor of the resistance coronary vessels, producing a redistribution of transmural blood flow and a decrease in myocardial contractility secondary to ischaemia.     

Effect of ranitidine on ileal myenteric plexus preparation and on acetyl- and butyrylcholinesterase

Ranitidine at concentrations from 1 microM to 0.1 mM brought about a dose-dependent potentiation of the twitch responses elicited by electrical stimulation of the ileal myenteric preparation. At higher concentrations (0.3-3 mM) ranitidine also caused irregular slow contractions of the unstimulated ileal preparation which were potentiated by eserine and blocked by atropine and tetrodotoxin. In order to identify the mechanism of these apparently cholinomimetic actions, the effects of ranitidine on AChE and BuChE were studied. Ranitidine showed an instantaneous and promptly reversible inhibitory action at concentrations between 0.5 and 30 microM. Double reciprocal plots were prepared and equilibrium dissociation constants calculated. It appears that ranitidine exerts an inhibition of the "mixed" type on both AChE and BuChE, but the dissociation constants for BuChE were markedly higher than those for AChE. Since AChE inhibition occurs in the same concentration range potentiating the twitch responses on the ileal myenteric preparation, it may explain the cholinomimetic effect of ranitidine.