江苏地区汉族儿童多药耐药基因3个单核苷酸多态性位点的单倍型研究

目的分析江苏汉族人群多药耐药基因-1（MDR1）的单核甘酸多态（12外显子1236C→T突变、21外显子2677G→T/A突变、26外显子3435C→T突变）及其构成的单倍型分布。方法通过多重单碱基延伸反应（SNaPshotSNP分型技术）对江苏地区170名健康儿童的MDR1C1236T、G2677T/A、C3435T的SNP位点进行基因分型,统计各基因型频率。UNPHASED软件对MDR1的SNPs（C1236T-G2677T/A-C3435T）进行单倍型分析。结果在170例儿童中,等位基因1236T、2677T、2677A、3435T频率分别为63.5%、37.4%、17.0%和35.0%。基因型频率分布符合Hardy-Weinberg平衡（HWE）,差异无统计学意义（P〉0.05）。MDR1的1236、2677、3435三个位点间（C1236T-G2677T/A-C3435T）存在连锁不平衡性,以TTT（31.8%）、TGC（25.3%）、CGC（17.7%）和CAC（16.2%）四种单倍型为主。结论江苏地区汉族人群MDR1的单核甘酸多态及单倍型分布具有自己的特点。在临床应用相关药物时,进行基因型及单倍型检测,将有助于指导临床个体化用药。     

ABCB1基因多态性对卡马西平血药浓度的影响

目的:探讨ABCB1基因多态性对卡马西平血药浓度的影响。方法:采用荧光偏振免疫法(FPIA)测定275例口服卡马西平癫痫患者的血药浓度,聚合酶链式反应-限制性片段长度多态性方法(PCR-RFLP)或直接测序法检测ABCB1多态性位点C1236T、G2677T/A和C3435T的基因型。单因素方差分析计算各SNP位点不同基因型对应的卡马西平血药浓度是否有差异。结果:G2677T/A不同基因型对应的调整后血药浓度均值之间差别有显著性,TT基因型对应的调整后血药浓度显著高于GG型(P=0.001)。C1236T、C3435T各基因型对应的调整后血药浓度均值差别无统计学意义(P>0.05)。结论:ABCB1基因SNP位点G2677T/A的基因多态性对口服卡马西平癫痫患者的血药浓度有影响,提示TT基因型的患者可适当减少药物使用剂量。     

CYP3A5和MDR1基因多态性对中国肝移植患者他克莫司药动学的影响

目的探讨细胞色素P450酶3A5（CYP3A5）基因和多药耐药基因（MDR1）C1236T、G2677T／A、C3435T多态性对肝移植患者口服他克莫司（TAC）后体内药动学参数的影响。方法采集28例肝移植患者手术后第1周和第3周血标本,采用LC—MS／MS法检测TAC血药浓度,计算主要药动学参数。采用聚合酶链反应结合基因测序分析28例肝移植患者CYP3A5＊3和MDR1主要基因型。结果携带MDR1 3435T基因型的肝移植患者口服TAC后,药动学参数AUC0→1和ρmax明显高于3435CC型患者,而CYP3A5＊3、MDR1 C1236T和G2677T／A基因多态性对TAC的药动学参数无明显影响。结论携带MDR1 3435T基因型肝移植患者比3435CC型患者需要较高剂量才能达到目标浓度。     

多药耐药基因多态性和单倍体对肾移植患者他克莫司血药浓度的影响

目的 研究多药耐药基因(MDR1)单核苷酸多态性及单倍体对中国汉族肾脏移植人群术后稳定期与他克莫司(免疫抑制剂)血药浓度的关系.方法 用基质辅助激光吸收电离子化-飞行时间质谱技术,分析63例肾移植患者的MDR1 exon12 C1236T、exon 21 G2677T/A、exon 26 C3435T的基因型,结合其口服他克莫司12 h后血药浓度,判断两者是否存在关联.结果 MDR1 C3435T基因多态性与他克莫司血药浓度/(剂量×体表面积)具有相关性,比值由小到大顺序:野生型纯合子＜杂合子＜突变型纯合子,差异具有统计学意义(P＜0.05).MDR1 C1236T、G2677T/A及单倍体型各组之间比较均无明显差异.结论 中国汉族肾移植患者稳定期,MDR1 C3435T与他克莫司血药浓度的个体差异具有相关性.     

C1236T、 G2677T/A 和C3435T 基因多态性与乳腺癌分子分型的关系及意义

摘要： 目的 观察多药耐药基因 1 （MDR1） 第 12、 21 及 26 外显子 C1236T、 G2677T/A 和 C3435T 基因多态性在乳腺癌患者外周血中的分布, 分析其与分子分型的关系。方法 应用高分辨熔解曲线 （HRM） 技术检测 400 例乳腺癌患者 C1236T、 G2677T/A 及 C3435T 基因多态性。采用 Hardy-Weinberg 遗传平衡检验进行基因型分布遗传平衡吻合度检验。参照 2013 年 St.Gallen 国际专家乳腺癌分子分型共识。分析乳腺癌患者中 C1236T、 G2677T/A 和 C3435T 基因型分布特点, 并探讨其与分子分型的关系。结果 （1）400 例乳腺癌患者中 C1236T、 G2677T/A 和 C3435T 中分别有 2 例、 3 例和 2 例标本未得出基因分型结果, C1236T 位点 CC、 CT 和 TT 基因型分别占 16.08% （64/398）、 44.22% （176/398） 和 39.70% （158/398）; G2677T/A 位点 GG、 GT、 GA、 TT 和 AT 基因型分别占 16.62% （66/397）、 44.33% （176/ 397）、 7.05% （28/397）、 27.46% （109/397） 和 4.54% （18/397）; C3435T 位点 CC、 CT 和 TT 基因型分别占 21.11% （84/ 398）、 56.03% （223/398） 和 22.86% （91/398）。经 Hardy-Weinberg 遗传平衡检验, 认为 C1236T、 G2677T/A 和 C3435T 基因多态性具有群体代表性 （P > 0.05）。（2） 分子分型显示, 11例人类表皮生长因子受体2 （HER-2, 2+） 患者未行荧光原位杂交 （FISH） 检测予以剔除, 其中Luminal A型占41.90% （163/389）, Luminal B型占32.65% （127/389）, HER-2过表达型占13.62% （53/389）, 三阴型占11.83% （46/389）。（3） C3435T位点CT/TT基因型在Luminal A型患者中的频率高于其在HER-2过表达型和三阴型患者中的频率 （χ2 =12.011, P=0.001; χ2 =13.976, P < 0.001）, C1236T和G2677T/A基因多态性在不同分子分型中的分布差异无统计学意义 （P > 0.05）。结论 MDR1基因C3435T位点多态性可以为乳腺癌异质性提供更合理的补充, 不同乳腺癌分子分型患者中CT/TT基因表型可能对药物治疗更敏感。     

肾移植中环孢素的血药浓度与多药耐药基因多态性的关系

目的 探讨肾移植术后患者的MDR1C3435T、G2677T/A和C1236T位点的基因多态性对环孢素(CsA)血药浓度的影响.方法 使用荧光偏振免疫分析法(AxsYM)测定65例肾移植患者在术后1 wk和1 mo时的CsA血药浓度(包括峰浓度ρ2和谷浓度ρ0),使用等位基因特异扩增法(ASA-PCR)对患者进行MDR1基因分型,比较不同基因型之间CsA浓度剂量比的差异.结果 在65例患者中,C3435T,CC型25例(38.5%),CT型35例(53.8%),TT型5例(7.7%);G2677T/A,GG型15例(23.1%),GT型21例(32.3%),TT型10例(15.4%),GA型12例(18.5%),AT型6例(9.2%),AA型1例(1.5%);C1236T,CC型10例(15.4%),CT型32例(49.2%),TT型23例(35.4%).C3435T的CT型患者的CsA浓度剂量比略大于CC型和TT型;G2677T/A的从型患者的CsA浓度剂量比略大于其他基因型;C1236T的TT型患者的谷浓度剂量比略大于CC型和CT型,CC型患者的峰浓度剂量比略大于CT型和TT型,但差异均无统计学意义(P＞0.05).结论 在肾移植患者中,MDR1多态性与CsA血药浓度无明显相关性,有待进一步确认.     

MDR1 C1236T、G2677T/A、C3435T的基因多态性对中国汉族肾移植患者环孢素药动学的影响(英文)

目的探讨中国汉族人中肾移植患者的多药耐药基因(MDR1)外显子exon12 C1236T、exon21 G2677T/A、exon26 C3435T的单核苷酸多态性对免疫抑制剂环孢素(CsA)药动学的影响。方法采用聚合酶联反应和限制性内切片段长度多态性(PCR-RFLP)的方法对89例肾移植术后的患者进行MDR1基因分型。单克隆抗体荧光免疫偏振法测定患者术后CsA的谷浓度(c0)及服药后2 h浓度(c2)。比较不同基因型之间CsA浓度剂量比值的差异。结果在89例肾移植患者中,等位基因1236T、2677T、2677A、3435T突变频率分别为66%、43%、18%和37%。肾移植术后1 mo内,G2677T/A基因多态性与CsA的药动学有相关性,2个等位基因都发生突变的患者,其剂量校正c0,在术后1~7 d、8~15 d和16~30 d比野生型分别提高51%(P=0.005)、32%(P=0.002)和63%(P<0.001)。在术后16~30 d,无论携带有1个或2个突变等位基因的患者,剂量校正c2都要比野生型患者高26%(P=0.007)和19%(P=0.041)。C1236T的剂量校正c0在术后8~15...     

MDR1基因多态性和单倍体对肾移植术后稳定期患者他克莫司浓度/剂量比值的影响

目的 探讨MDR1 C1236T、G2677T/A和C3435T 基因多态性和单倍体对中国汉族肾移植术后稳定期患者他克莫司浓度/剂量比值的影响,为他克莫司个体化用药提供依据。方法 采用PCR-基因测序法检测104例肾移植术后稳定期患者MDR1 C1236T、G2677T/A和C3435T 的基因多态性,采用均相酶免疫测定方法(EMIT法)测定他克莫司的谷浓度,比较不同基因型患者之间他克莫司血药浓度/(剂量×体质量)(C/D)比值。结果 104例患者中,MDR1 C1236T、G2677T/A和C3435T突变频率分别为56.73%、55.77%和33.17%。MDR1 C3435T、MDR1 TTT单倍体与他克莫司C/D比值具有相关性(P<0.05)。CYP3A5*3*3患者中,MDR1 TTT单倍体与他克莫司C/D比值仍存在显著相关(P<0.05)。MDR1 C1236T、G2677T/A、CGC单倍体与他克莫司C/D比值无显著性差异(P>0.05)。结论 MDR1 C3435T、MDR1 TTT单倍体与中国汉族肾移植术后稳定期患者他克莫司C/D比值具有显著相关性,是影响肾移植患者他克莫司浓度个体化差异的重要因素。     

ABCB1基因多态性与肾移植患者围手术期服用他克莫司相关不良反应的相关性

目的:探讨腺苷三磷酸(ATP)结合盒转运体B1(ABCB1)基因多态性与肾移植患者围手术期服用他克莫司相关不良反应的相关性。方法:选取2014年11月-2018年3月于我院行肾移植术且术后服用他克莫司的患者170例,检测其ABCB1 C1236T(rs1128503)、ABCB1 G2677T/A(rs2032582)和ABCB1 C3435T(rs1045642)基因型。采用χ2检验比较不同基因型患者间他克莫司相关不良反应的发生率,相关不良反应包括消化道反应、肺部感染、肾功能异常、肝功能异常、血糖升高、血脂升高、白细胞降低。采用Logistic回归模型进行单位点危险度分析。应用PHASE软件分析患者上述基因的主要单倍型,并分析其主要单倍型与他克莫司相关不良反应的相关性。结果:170例患者中,ABCB1 C1236T(rs1128503)检测结果显示CC型21例(占12.3%)、CT型78例(占45.9%)、TT型71例(占41.8%);ABCB1 G2677T/A(rs2032582)检测结果显示GG型25例(占14.7%)、GA+GT型95例(占55.9%)、AA+AT+TT型50例(占29.4%);ABCB1 C3435T(rs1045642)检测结果显示CC型57例(占33.5%)、CT型82例(占48.2%)、TT型31例(占18.3%)。不同ABCB1基因型患者间消化道反应、肺部感染、肾功能异常、血糖升高、血脂升高、白细胞降低的发生率差异均无统计学意义(P>0.05),但ABCB1 C1236T(rs1128503)及ABCB1 C3435T(rs1045642)不同基因型患者间肝功能异常的发生率差异有统计学意义(P<0.05),ABCB1 G2677T/A(rs2032582)不同基因型患者间肝功能异常的发生率差异虽无统计学意义(P=0.069),但P<0.1。Logistic回归分析显示,ABCB1 C1236T(rs1128503)CC型[OR=4.959,95%CI(1.700,14.468),P=0.003]、ABCB1 G2677T/A(rs2032582)GG型[OR=3.500,95%CI(1.164,10.524),P=0.026]以及ABCB1 C3435T(rs1045642)CC型[OR=3.033,95%CI(1.012,9.095),P=0.048]均为他克莫司致相关肝功能异常的风险因子。ABCB1 CGC单倍型为主要单倍型,其携带与否与他克莫司相关肝功能异常的发生率差异存在统计学意义(P=0.002),且是他克莫司相关肝功能异常的风险因子[OR=3.173,95%CI(1.512,6.656),P=0.002]。结论:携带ABCB1 CGC单倍型的肾移植患者围手术期服用他克莫司出现肝功能异常的可能性较大。     

CYP3A4/5、ABCB1基因单倍型与中国肾移植患者他克莫司血药谷浓度相关性的研究

目的:探讨CYP3A4*18B、CYP3A5*3、ABCB1基因单倍型对中国肾移植患者术后一月内他克莫司谷浓度(C0/D)的影响。方法:采用限制性片段长度多态性技术分析46名肾移植患者CYP3A4*18B、CYP3A5*3、ABCB1(外显子C1236T、G2677A/T、C3435T)基因型,采用酶增强免疫测定技术测定患者C0值。结果:经分析患者CYP3A4*18B、CYP3A5*3、ABCB1(C1236T,G2677A/T,C3435T)等位基因频率分别为0.304、0.707、0.554、0.478和0.304,均符合HardyWeinberg平衡。CYP3A4-3A5、G2677A/T-C3435T及C1236T-C3435T间均表现为连锁不平衡。术后8~15、16~30天内CYP3A4*18B与患者FK506 C0/D值显著相关,野生型患者C0/D值分别为杂合及突变型患者的1.34和1.67倍。CYP3A5*3基因也与患者FK506 C0/D值显著相关。突变型患者C0/D值在术后1~7、8~15及16~30天时分别为野生及杂合型患者的1.56、1.98及1.99倍。单倍型分析发现CYP3A4/5单倍型GG型携带者C0/D值较非携带者在移植术后8~15、16~30天显著性增加1.43、1.77倍。未观察到ABCB1基因多态性及单倍型对FK506血药浓度的影响。结论:仅CYP3A4/5单倍型与他克莫司C0/D值显著相关,移植前对CYP3A4/5单倍型进行检测将有利于他克莫司给药剂量的调整。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.