国产奥美沙坦酯片治疗轻、中度高血压的疗效和安全性

目的 通过与氯沙坦比较,评价国产奥美沙坦单药治疗轻、中度原发性高血压的疗效和安全性.方法 采用随机、双盲、双模拟、阳性对照、多中心和平行方法进行研究.237例轻、中度原发性高血压患者分为奥美沙坦组(口服奥美沙坦20 mg+氯沙坦50 mg安慰剂)和氯沙坦组(氯沙坦50 mg+奥美沙坦20 mg安慰剂),治疗期为8周.治疗4周末,若坐位舒张压≥90 mmHg(1 mmHg=0.133 kPa),则药物剂量加倍;每2周随访1次,观察降压效果和不良反应.另选32例轻、中度原发性高血压患者单纯服用奥美沙坦,观察治疗前和治疗后8周的动态血压变化.结果 与治疗前比较,治疗8周后奥美沙坦组和氯沙坦组收缩压分别下降(15.2±13.3)mmHg和(19.5±11.8)mmHg(均P<0.001),舒张压分别下降(15.9±7.48)mmHg和(16.2±5.95)mmHg(均P<0.01),两组间比较差异无统计学意义(P>0.05).奥美沙坦组与氯沙坦组降压总有效率和不良反应发生率比较(86.9% vs 93.7%和7.63% vs 5.88%),差异均无统计学意义(P> 0.05).动态血压监测显示,收缩压和舒张压的谷峰比值分别为86%和71%.结论 国产奥美沙坦治疗轻、中度高血压与氯沙坦等效,降压平稳,安全性好.     

国产奥美沙坦酯片治疗轻、中度高血压的疗效和安全性

目的 通过与氯沙坦比较,评价国产奥美沙坦单药治疗轻、中度原发性高血压的疗效和安全性。方法 采用随机、双盲、双模拟、阳性对照、多中心和平行方法进行研究。237例轻、中度原发性高血压患者分为奥美沙坦组（口服奥美沙坦20 mg+氯沙坦50 mg安慰剂）和氯沙坦组（氯沙坦50 mg+奥美沙坦20 mg安慰剂）,治疗期为8周。治疗4周末,若坐位舒张压≥90 mmHg（1 mmHg=0.133 kPa）,则药物剂量加倍;每2周随访1次,观察降压效果和不良反应。另选32例轻、中度原发性高血压患者单纯服用奥美沙坦,观察治疗前和治疗后8周的动态血压变化。结果 与治疗前比较,治疗8周后奥美沙坦组和氯沙坦组收缩压分别下降（15.2±13.3）mmHg和（19.5±11.8）mmHg(均P<0.001),舒张压分别下降（15.9±7.48）mmHg和（16.2±5.95）mmHg（均P<0.01）,两组间比较差异无统计学意义（P>0.05)。奥美沙坦组与氯沙坦组降压总有效率和不良反应发生率比较（86.9% vs 93.7%和7.63% vs 5.88%）,差异均无统计学意义（P> 0.05)。动态血压监测显示,收缩压和舒张压的谷峰比值分别为86%和71%。结论 国产奥美沙坦治疗轻、中度高血压与氯沙坦等效,降压平稳,安全性好。     

奥美沙坦酯对轻中度原发性高血压患者24小时动态血压和动态动脉僵硬度的影响

目的:采用24小时(24h)动态血压监测(ABPM)评价国产奥美沙坦酯片对轻、中度原发性高血压患者的24h血压和动态动脉僵硬度(AASI)影响。方法 :随机双盲双模拟多中心活性药对照临床试验,对48例患者口服奥美沙坦酯20mg+傲坦安慰剂1片,或傲坦20mg+奥美沙坦酯安慰剂1片。4周后诊室坐位血压<140/90mm Hg,维持原剂量;血压未达标者剂量加倍,服药至8周末。在第0周和8周时分别进行ABPM监测,观察治疗前后动态血压和AASI的变化。结果:(1)治疗8周后,奥美沙坦酯组和傲坦组对24h血压的平均降幅分别为(8.8±3.0/10.8±2.8)mm Hg和(8.9±4.0/9.2±4.2)mm Hg,均较治疗前显著下降(P<0.01),2组降压幅度无显著差异(P>0.05)。奥美沙坦酯组收缩压和舒张压谷峰比(T/P)分别为73.7%和56.5%,傲坦组分别为83.4%和71.0%。(2)奥美沙坦酯组治疗8周后的AASI较治疗前显著降低(0.42±0.15vs0.58±0.19,P<0.01);傲坦组疗前后分别为0.54±0.17和0.39±0.19,也有降低,但2组间降幅无显著性差异(P>0.05)。(3)2组不良反应发生率分别为10.42%和8.33%,无显著性差异(P>0.05),主要是头晕、皮肤瘙痒、胸闷、皮疹和低血压。结论 :国产奥美沙坦酯治疗轻、中度原发性高血压患者能有效降低24h血压和AASI,其降压幅度与傲坦无显著性差异。     

奥美沙坦与氯沙坦治疗轻中度原发性高血压患者的 疗效与安全性比较

目的 比较奥美沙坦与氯沙坦治疗轻中度原发性高血压8周的疗效和安全性.方法 采用随机双盲双模拟活性药对照的试验设计,将符合入选要求的180例轻中度原发性高血压患者分为奥美沙坦组和氯沙坦组,各90例,奥美沙坦组患者给予奥美沙坦酯片20 mg和氯沙坦钾安慰剂50 mg治疗,氯沙坦组患者给予氯沙坦钾片50 mg和奥美沙坦酯安慰剂20 mg治疗.研究对象服药前测量坐位血压、进行动态血压监测、心电图及实验室检查;治疗期间每间隔2周测量坐位血压,根据患者血压水平调整药物剂量;8周治疗完成后,再次进行坐位血压测定、动态血压监测、心电图以及实验室检查;分析治疗前后24 h动态血压变化.定义8周治疗结束后患者收缩压<140 mmHg且舒张压<90 mmHg,或收缩压下降≥20 mmHg且舒张压下降≥10 mmHg为治疗有效.结果 从服药第2周起,奥美沙坦组和氯沙坦组患者坐位收缩压和舒张压较基线均有明显下降(P<0.05).与氯沙坦组相比,奥美沙坦组收缩压和舒张压降低更明显(P<0.01).治疗8周结束后,奥美沙坦组治疗有效率为91.1%(82/90),氯沙坦钾组治疗有效率为88.9%(80/90),两组没有明显差异(P=0.619).动态血压分析结果显示,每天口服1次奥美沙坦酯片20~40 mg,降压作用可持续24 h,药物降低收缩压和舒张压的谷峰比值均良好.奥美沙坦组和氯沙坦组患者药物不良反应发生率均较低,且无显著性差异.结论 与每天口服50~100 mg氯沙坦钾比较,每天口服奥美沙坦酯20~40 mg治疗轻中度高血压降压效果显著,耐受性良好,有较高的谷峰比值,能24小时平稳降压.     

奥美沙坦治疗老年轻中度原发性高血压患者的效果及安全性研 究简

目的 通过与氯沙坦钾比较评价奥美沙坦治疗老年人轻、中度原发性高血压患者的效果和安全性.方法 将106例研究对象随机分为研究组与对照组,分别接受口服奥美沙坦酯20 mg或氯沙坦钾50 mg治疗,qd.用药4周后对患者进行血压评价,如果患者平均舒张压（SeDBP）仍≥90 mm Hg（1 mm Hg=0.133 kPa）,则药物剂量加倍,直至8周试验结束;否则维持原剂量继续治疗至第8周.结果 治疗8周后研究组和对照组患者收缩压（SBP）分别为（133.29±14.05）mm Hg和（138.96±14.17）mm Hg,舒张压（DBP）分别为（84.59±7.64）mm Hg和（88.01±7.83）mm Hg,差异均有统计学意义（t=2.069,P=0.041;t=2.276,P=0.025）.研究组降压的总有效率为83.02％,优于对照组的77.36％,差异无统计学意义（x2=0.726,P=0.696）.24h动态血压监测显示,治疗8周后研究组患者DBP和SBP的谷/峰比值均高于对照组.研究组和对照组药物有关的不良事件的发生率分别为3.77％和7.55％,差异无统计学意义（x2=0.177,P=0.674）.不良反应症状均轻微,不需停药接受特殊治疗.结论 奥美沙坦酯每日口服20～40 mg能够有效、安全地治疗高血压.与氯沙坦钾50～100 mg降压作用相比,奥美沙坦24 h内持续降压时间更长,降压效果更好.     

奥美沙坦酯治疗原发性高血压的疗效及安全性

目的观察血管紧张素Ⅱ受体拮抗剂奥美沙坦酯治疗轻、中度原发性高血压(EH)的疗效和安全性。方法采用前瞻性、随机双盲、阳性药物对照研究方法,将40例轻、中度EH患者随机分为奥美沙坦酯组(n=20)与氯沙坦组(n=20),分别经安慰剂洗脱2周后,患者每天口服1次奥美沙坦酯20mg或氯沙坦50mg,若4周后患者坐位舒张压(DBP)≥90mmHg,则剂量加倍后治疗至8周。每2周观察血压、心率变化及不良反应的发生情况;比较治疗前后血尿常规、血生化指标及心电图改变。结果治疗8周后,与基线血压比较,奥美沙坦酯组与氯沙坦组血压均显著下降(P<0.01),但两组间降压幅度无统计学差异(P>0.05);两组降压总有效率分别为64.21%和60.0%,无统计学差异(P>0.05)。两组治疗前后心率及血生化指标均无显著改变(P>0.05),亦无不良反应发生。结论奥美沙坦酯能有效降低轻、中度EH患者的血压,疗效与氯沙坦相似,具有良好的安全性。     

奥美沙坦酯治疗原发性高血压的疗效及安全性

目的 观察血管紧张素Ⅱ受体拮抗剂奥美沙坦酯治疗轻、中度原发性高血压(EH)的疗效和安全性.方法 采用前瞻性、随机双盲、阳性药物对照研究方法,将40例轻、中度EH患者随机分为奥美沙坦酯组(n=20)与氯沙坦组(n=20),分别经安慰剂洗脱2周后,患者每天口服1次奥美沙坦酯20 mg或氯沙坦50 mg,若4周后患者坐位舒张压(DBP)≥90 mmHg,则剂量加倍后治疗至8周.每2周观察血压、心率变化及不良反应的发生情况;比较治疗前后血尿常规、血生化指标及心电图改变.结果 治疗8周后,与基线血压比较,奥美沙坦酯组与氯沙坦组血压均显著下降(P＜0.01),但两组间降压幅度无统计学差异(P＞0.05);两组降压总有效率分别为64.21%和60.0%,无统计学差异(P＞0.05).两组治疗前后心率及血生化指标均无显著改变(P＞0.05),亦无不良反应发生.结论 奥美沙坦酯能有效降低轻、中度EH患者的血压,疗效与氯沙坦相似,具有良好的安全性.     

24小时动态血压监测评价奥美沙坦酯对轻、中度原发性高血压患者清晨血压的影响

目的:采用24小时(24h)动态血压监测(ABPM)评价奥美沙坦酯对轻、中度原发性高血压患者的清晨血压、24h血压和服药末6h血压的影响。方法:随机双盲双模拟活性药对照临床试验,选取2008年10月~2009年6月在中日医院和河南省人民医院门诊就诊的患者48例。试验组24例患者口服奥美沙坦酯20mg+日本产奥美沙坦酯(傲坦)安慰剂1片,对照组24例口服傲坦20mg+奥美沙坦酯安慰剂1片。在第0周和8周时分别进行24h ABPM监测,观察治疗前后清晨血压、24h血压和服药末6h血压的变化。结果:试验组和对照组基线年龄、体质量指数、诊室血压、24h血压差异均无统计学意义。治疗8周后,试验组、对照组平均清晨血压均较治疗前显著降低(P<0.01),2组平均血压降幅分别为8±12/11±8和9±11/11±8mm Hg,降幅差异均无统计学意义(P>0.05);试验组和对照组清晨血压达标率分别为75.0%和83.3%。治疗8周后2组24h血压、日间血压、夜间血压、服药末6h血压均较治疗前显著下降(P<0.01),组间降幅差异均无显著性(P>0.05)。结论:每日清晨口服一次国产奥美沙坦酯能有效降低轻、中度原发性高血压患者的清晨血压、24h血压和服药末6h血压,其降压幅度与傲坦疗效相当。     

坎地沙坦酯与缬沙坦治疗原发性高血压的疗效和安全性比较

目的比较国产坎地沙坦酯与缬沙坦治疗轻、中度原发性高血压的疗效和安全性。方法采用随机、单盲、平行对照试验。对90例原发性高血压病人每日1次服用坎地沙坦酯片8mg（n=45）,或缬沙坦片80mg（n=45）,2周后如舒张压≥12kPa则剂量加倍,疗程8周。结果两组病人的血压均明显降低（P〈0．01）;坎地沙坦酯组总有效率为84．4％,缬沙坦组为82．2％,两组间比较差异无统计学意义。坎地沙坦酯组和缬沙坦组收缩压和舒张压的降压谷峰（T／P）比值分别为0．75、0.71和0．76、0．94。结论坎地沙坦酯片治疗轻、中度原发性高血压病人有效、安全且易耐受,每日1次能维持24h降压效应。     

老年高血压患者奥美沙坦降压疗效的分析

目的:探讨奥美沙坦对老年高血压的治疗效果。方法:选择高血压病患者60例,分为两组,奥美沙坦组给予奥美沙坦酯20 mg,氯沙坦组给予氯沙坦50 mg。结果:奥美沙坦组的nSBP、nDBP与氯沙坦组比较均显著降低(P<0.05),两组药物降压的谷峰比值差异有统计学意义(P<0.01)。结论:奥美沙坦能够对老年高血压的24小时血压进行理想地控制,减轻晨峰现象。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

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.