基于多索茶碱血药浓度监测的剂量调整对该药与特布他林雾化液联用安全性的影响

目的探讨基于多索茶碱血药浓度监测的剂量调整对该药与特布他林联合治疗呼吸系统疾病安全性的影响。方法研究对象选自2014年1月1日至2018年12月31日在郑州市第二人民医院呼吸内科住院并需要使用多索茶碱注射液和/或特布他林雾化液治疗的患者。将符合入选标准的患者分为3组:多索茶碱组、特布他林组和多索茶碱联合特布他林组(联合用药组)。3组患者均给予常规治疗及对症处理,多索茶碱用法用量为300mg静脉滴注、1次/d,特布他林为2ml(5mg)雾化吸入、3次/d,疗程为7~14 d。比较3组患者不良反应发生情况。发生1级不良反应者多索茶碱剂量调整为250mg静脉滴注、1次/d,2级者剂量调整为200mg静脉滴注、1次/d,≥3级者停用多索茶碱。比较多索茶碱组和联合用药组患者剂量调整前后多索茶碱血药浓度、不良反应减轻或消失者占比、住院时间和治疗有效率。结果纳入研究的患者共6-582例,多索茶碱组1438例,男性793例,女性645例,年龄(61±11)岁;特布他林组2217例,男性1-281例,女性936,年龄(60±15)岁;联合用药组2927例,男性1644例,女性1283例,年龄(63±12)岁。3组患者性别、年龄分布和基础疾病、合并疾病及合并用药情况差异均无统计学意义(均P>0.05)。3组患者不良反应总发生率分别为13.1%(189/1438)、8.9%(197/2217)和21.2%(620/2927),联合用药组高于多索茶碱组(χ^2=41.271,P<0.001)和特布他林组(χ^2=142.766,P<0.001),多索茶碱组高于特布他林组(χ^2=16.738,P<0.001)。联合用药组震颤、头痛发生率均高于单独用药的2组(P<0.001);高血糖发生率高于多索茶碱组(P=0.003);失眠发生率高于特布他林组(P<0.001);心动过速发生率高于特布他林组(P<0.001);恶心发生率低于多索茶碱组(P<0.001),高于特布他林组(P<0.001);情绪异常发生率高于特布他林组(P=0.017)。3组均未发生≥3级不良反应,发生不良反应的患者中1级和2级不良反应构成比差异无统计学意义(χ^2=1.097,P=0.578)。联合用药组和多索茶碱组发生不良反应的患者剂量调整前多索茶碱血药浓度差异无统计学意义(P>0.05),调整后血药浓度均降低(均P<0.001),且联合用药组低于多索茶碱组[(8.38±2.19)μg/ml)比(10.64±2.55)μg/ml,P<0.001];联合用药组不良反应消失或减轻者占比高于多索茶碱组[40.81%(253/620)比30.16%(57/189,P=0.008)],住院时间短于多索茶碱组[(10±2)d比(15±3)d,P<0.001],治疗有效率高于多索茶碱组[531(85.65%)比136(71.96%,P<0.001)。结论多索茶碱注射液与特布他林雾化液联用时,通过多索茶碱血药浓度监测控制该药血药浓度在(8.38±2.19)μg/ml,既可提高疗效,又可提高联合用药的安全性。     

多索茶碱治疗矽肺合并慢性阻塞性肺疾病的临床观察

目的观察和评价多索茶碱治疗矽肺合并慢性阻塞性肺疾病的临床疗效。方法将120例矽肺合并慢性阻塞性肺疾病患者随机分为多索茶碱治疗组和氨茶碱治疗对照组,观察对比两组患者治疗后的临床症状、肺功能、血气变化及不良反应发生率。结果多索茶碱治疗组临床总有效率高于氨茶碱治疗组,且不良反应率低（P〈0．05）。结论多索茶碱是一种安全有效的缓解矽肺合并慢性阻塞性肺疾病急性发作的药物。     

HPLC法监测人血清中茶碱类药物浓度

目的建立同时测定茶碱类药物血药浓度的高效液相色谱法。方法筛选得到的最佳色谱条件为:采用色谱柱Ultimate XB-C18柱(4.6×200mm,5μm),以咖啡因为内标,甲醇-乙腈-水(20∶3∶77)为流动相,流速1.0m L·min-1,检测波长273nm,柱温30℃。采用先沉淀后提取的方法进样测定。结果多索茶碱和茶碱分别在1.5~24mg·L-1(r=1.0000)和2.5~40mg·L-1(r=0.9996)范围内线性关系良好。多索茶碱的低、中、高浓度平均回收率为100.07±5.30%,日间精密度和日内精密度RSD均小于6.5%。茶碱的低、中、高浓度回收率为101.72±4.92%,日间精密度和日内精密度RSD均小于5.5%。结论该方法灵敏度高、准确、重复性好,适用于多索茶碱和茶碱血药浓度的测定。     

多索茶碱治疗慢性阻塞性肺疾病40例临床观察

目的观察慢性阻塞性肺疾病的临床疗效。方法将78例慢性阻塞性肺疾病患者随机分为两组:多索茶碱治疗组和氨茶碱对照组,观察两组治疗的结果:临床疗效、不良反应等。结果多索茶碱临床总有效率高于对照组。且不良反应发生率低。两组之间有显著差异(P<0.05)。结论多索茶碱是一种安全有效的治疗慢性阻塞性肺疾病的药物。     

HPLC同时测定慢性阻塞性肺病患者血浆中的茶碱和1,3-二甲基尿酸

目的 采用HPLC法同时测定慢性阻塞性肺病(COPD)患者血浆中的茶碱及其代谢物1,3-二甲基尿酸(1,3-DMU).方法 色谱柱为Hypersil BDS C18柱(250 mm×4.6 mm,5μm),流动相为乙腈-水(7∶93),流速1 mL·min-1,检测波长280 nm.43名COPD患者连续服用茶碱(100 mg,bid)两周后,测定茶碱及1,3-DMU的血药浓度.结果 茶碱、1,3-DMU的线性范围分别为0.20 ～ 10.00 μg∶ mL-1(r=0.9998)、0.05 ～ 2.00 μg∶ mL-(r=0.9996);日内、日间RSD均≤12.91％,提取回收率分别为77.52％ ～79.22％、71.69％ ～ 74.02％;患者的平均茶碱血药浓度为3.57±1.59 μg∶ mL-1,茶碱和1,3-DMU的浓度呈强相关(r=0.672),1,3-DMU/茶碱为0.064±0.024.结论 所用方法简便、快速、准确,可用于COPD患者茶碱血药浓度的监测,1,3-DMU与茶碱浓度的比值可评估不同个体对茶碱清除率的差异.     

RP-HPLC法同时测定人血浆中茶碱和多索茶碱的浓度

目的:建立以反相高效液相色谱法同时测定人血浆中茶碱和多索茶碱浓度的方法。方法:色谱柱为XterraRP18,流动相为甲醇-水(35:65),流速为1.0mL·min-1,检测波长为269.9nm,柱温为35℃,内标为非那西丁。结果:茶碱和多索茶碱浓度分别在1.563～50μg·mL-1(r=0.9995)、0.3125～10μg·mL-1(r=0.9999)范围内线性关系良好;茶碱、多索茶碱提取回收率分别为32.53%～35.08%、31.88%～34.55%,方法回收率分别为92.82%～109.41%、90.68%～102.72%,日内、日间RSD均<15%。结论:本方法快速、灵敏、准确,可用于同时测定人血浆中茶碱和多索茶碱的浓度。关键词茶碱;多索茶碱;反相高效液相色谱法;血药浓度监测     

多索茶碱联合噻托溴铵治疗慢性阻塞性肺疾病临床效果meta分析

目的:系统评价多索茶碱联合噻托溴铵治疗慢性阻塞性肺疾病的有效性与安全性。方法:检索Punmed、The Cochrane Library、EMBASE、CNKI、VIP、CBM、万方数据库,纳入多索茶碱联合噻托溴铵治疗慢性阻塞性肺疾病的随机对照试验(RCT),检索时限为建库至2017年7月。由两名研究者依据纳入与排除标准筛选文献并进行质量评价,采用RevMan5.3软件进行meta分析。结果:共纳入28项研究,2 401例患者。Meta分析结果显示:与对照组相比,多索茶碱联合噻托溴铵能显著提高临床总体有效率(OR=8.17,95%CI:5.64~11.83,P<0.00001),改善患者肺功能,主要体现在FEV1(SMD=1.10,95%CI:0.88~1.32),P<0.000 01)、FEV1/FVC(SMD=0.85,95%CI:0.76~0.94),P<0.000 01),降低不良反应发生率(RR=-0.44,95%CI:0.28~0.69,P=0.003)。结论:多索茶碱联合噻托溴铵治疗慢性阻塞性肺疾病可增加临床有效率,改善患者肺功能(FEV 1、FEV1/FVC),减少不良反应的发生。     

丙戊酸钠血药浓度影响因素及不良反应分析

目的 分析癫痫患者丙戊酸钠血药浓度的影响因素及血药浓度与不良反应的相关性,为临床合理用药提供参考。方法 回顾性分析2019年1月—2022年2月神经内科与神经外科使用丙戊酸钠的住院癫痫患者98例临床资料,收集患者相关信息与生化指标。应用SPSS 26.0软件,以多元线性回归分析法评价丙戊酸钠血药浓度与相关因素的关联性;以独立样本t检验分析肝功能、肾功能及碳青霉烯类抗生素对丙戊酸钠血药浓度的影响,并评价丙戊酸钠血药浓度对生化指标的影响。结果 癫痫患者血小板计数与丙戊酸钠血药浓度呈线性负相关(P<0.001);联用碳青霉烯类抗生素组丙戊酸钠血药浓度低于未联用碳青霉烯类抗生素组(t=-4.982,P<0.001);肝功能指标异常患者丙戊酸钠血药浓度低于肝功能指标正常患者(t=2.474,P=0.015);血药浓度≥100μg/ml患者血小板计数低于血药浓度<100μg/ml的患者(t=2.747,P=0.007)。结论 推荐使用丙戊酸钠患者常规监测血小板计数;癫痫患者丙戊酸钠血药浓度与肝功能异常有关,需关注该类患者肝功能指标及丙戊酸钠血药浓度的变化;碳青霉烯类抗生素能降低丙...     

多索茶碱辅助治疗慢性阻塞性肺疾病对肺功能的影响

目的探讨多索茶碱辅助治疗对慢性阻塞性肺疾病对肺功能的影响。方法 2016年1月至2016年12月选择在我院诊治的慢性阻塞性肺疾病患者135例作为研究对象,根据随机数字表法分为观察组68例与对照组67例,对照组给予氨茶碱治疗,观察给予多索茶碱治疗,两组都治疗观察2周,记录临床疗效与肺功能的变化情况。结果治疗后观察组的总有效率明显高于对照组(χ2=8.137,P=0.018)。治疗后,观察组与对照组的FEV1值都明显高于治疗前(P<0.05),且观察组的FEV1值(0.55±0.26%)也明显高于对照组的(0.48±0.32%)(t=5.298,P=0.024)。结论多索茶碱辅助治疗对慢性阻塞性肺疾病能有效改善肺功能,从而提高治疗疗效。     

茶碱类药物的血药浓度监测方法与应用

目的测定茶碱和多索茶碱的血清浓度,为临床血药浓度监测提供方法学依据。方法采用高效液相色谱法测定,以内标法定量。色谱柱为ShimpackCLCC18(150×6mm,5μm),流动相为0.02mol·L-1KH2PO4乙腈(85∶15),流速为1ml·min-1,检测波长为270nm。结果茶碱和多索茶碱在0.4～40μg·ml-1范围内呈良好的线性关系。茶碱的低、中、高浓度回收率分别为105.64%、104.23%和99.09%,日内RSD(相对标准偏差)分别为3.4%、1.1%和2.5%,日间RSD分别为5.6%、3.5%和3.8%,平均回收率为102.95%(n=36,RSD=5.0%)。多索茶碱的低、中、高浓度回收率分别为101.53%、103.78%和99.89%,日内RSD分别为4.1%、1.2%和1.6%,日间RSD分别为6.1%、4.4%和2.5%,平均回收率为101.76%(n=36,RSD=4.7%)。结论方法快速、简便、准确,适合于临床对茶碱和多索茶碱的血药浓度监测。     

Acute effects of a new vasodilator,Ro 12-4713, on blood pressure,plasma renin activity,aldosterone and catecholamine levels,and renal function in hypertensive and normal subjects

Summary Selected cardiovascular and endocrine effects of the new oral vasodilator Ro 12-4713 have been evaluated in an acute single dose study. In five patients with essential hypertension, Ro 12-4713 caused a dose-dependent decrease in supine and upright blood pressure and an increase in heart rate. Initial effects occurred one to 2 h after drug ingestion and maximal effects were noted after five hours and persisted for at least 8 h. Blood pressure was normalized, and the antihypertensive and chronotropic effects persisted for 24 h after a dose of about 300 mg/1.73 m². Plasma and urinary norepinephrine and plasma renin levels tended to be raised, whereas plasma and urinary epinephrine and plasma aldosterone did not change. Changes in supine heart rate were inversely correlated with changes in mean blood pressure (r=–0.60; P<0.02), and positively with those in plasma norepinephrine (r=0.55; P<0.05) and renin (r=0.62, P<0.01); changes in supine plasma renin level were also inversely correlated with those in mean blood pressure (r=–0.65; P<0.01), and positively with those in plasma norepinephrine (r=0.58; P<0.05). 24 h-urinary sodium excretion was significantly (P<0.001) decreased; it was positively correlated with mean blood pressure (r=0.51; P<0.05) and inversely with supine plasma renin activity (r=–0.63; P<0.01). In six normal subjects and six patients with essential hypertension, effective renal plasma flow and the renal clearance of sodium, potassium, calcium and uric acid were not significantly altered five hours after a dose of Ro 12-4713 of about 250 mg/1.73 m²; glomerular filtration rate tended to be slightly decreased, and filtration fraction was significantly (P<0.05) reduced in the hypertensive patients. At the same time blood pressure was decreased and plasma norepinephrine (P<0.01) and renin (ns) were slightly increased in both groups. Ro 12-4713 in a single oral dose of about 300 mg appeared to be a potent, long acting, hypotensive vasodilator.     

桉柠蒎肠溶软胶囊联合多索茶碱治疗慢性阻塞性肺疾病急性发作的临床研究

目的探讨桉柠蒎肠溶软胶囊联合多索茶碱治疗慢性阻塞性肺疾病急性发作的临床效果。方法选取2017年1月—2018年6月濮阳市安阳地区医院收治的慢性阻塞性肺疾病急性发作患者108例,随机分成对照组(54例)和治疗组(54例)。对照组静脉滴注多索茶碱注射液,0.2 g加入100 mL葡萄糖液,1次/d。治疗组在对照组基础上餐前0.5 h口服桉柠蒎肠溶软胶囊,1粒/次,3次/d。两组患者连续治疗10 d。观察两组患者临床疗效,同时比较治疗前后两组患者主要症状体征缓解时间、肺功能、血气分析指标及呼出气冷凝液中白三烯B4(LTB4)、白介素-6(IL-6)浓度和血清C反应蛋白(CRP)水平。结果治疗后,对照组和治疗组临床总有效率分别为85.2%和96.3%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患者咳嗽、咳痰、气短、肺部哮鸣音的缓解时间较对照组患者均显著缩短(P0.05)。治疗后,两组患者第1秒用力呼气容积占预计值百分比(FEV1%pred)、FEV1/用力肺活量(FVC)、每分钟最大通气量占预计值百分比(MVV%pred)和动脉血氧分压(pO_2)值显著升高(P0.05),动脉二氧化碳分压(pCO_2)值显著降低(P0.05),且治疗组患者这些肺功能和血气分析指标明显好于对照组(P0.05)。治疗后,两组呼出气冷凝液中LTB4、IL-6水平及血清CRP浓度显著下降(P0.05),且治疗组患者这些肺功能和血气分析指标明显低于对照组(P0.05)。结论桉柠蒎肠溶软胶囊联合多索茶碱治疗慢性阻塞性肺疾病急性发作可明显缓解患者症状,改善肺功能和动脉血气状态,且患者耐受性良好。     

Pharmacokinetics of carteolol in patients with impaired renal function

Summary In order to determine the appropriate dosage of carteolol in renal dysfunction, the pharmacokinetics of carteolol has been examined in appropriate patients. The plasma concentrations and urinary excretion of carteolol were investigated in 15 patients with varying degrees of renal impairment during the administration of 5–20 mg carteolol hydrochloride (5 mg/tablet) for 2–45 months.Plasma carteolol levels were linearly correlated with the serum creatinine concentration (r = 0.87) and reciprocally with the creatinine clearance (r = 0.82). The urinary carteolol concentration was correlated with the urinary creatinine concentration (r = 0.69) and the urinary carteolol excretion was also correlated with the creatinine clearance (r = 0.79). These relationships become even closer when the plasma carteolol concentrations and urinary excretion rate of carteolol were factored by the administered tablets. The fractional renal excretion of carteolol was virtually constant at various degress of renal function, and it always exceeded 100%, which indicates that carteolol was actively secreted, even in patients with renal failure. The estimated tubular secretion rate of carteolol was logarithmically correlated with the fractional renal excretion of carteolol (r = 0.93).The results indicate that the dose of carteolol should be determined according to the degree of renal impairment.     

Disposition kinetics of buspirone in patients with renal or hepatic impairment after administration of single and multiple doses

The single dose and steady-state pharmacokinetics of buspirone and its metabolite 1-pyrimidinyl piperazine (1-PP) have been evaluated in normal volunteers and patients with renal or hepatic impairment, using a parallel group design, with assignment of patients to study group on the basis of the degree of renal (mild, moderate, severe) or hepatic (compensated or decompensated) impairment. Each healthy volunteer or patient received a single dose of 10 mg buspirone on Day 1 of the study, and starting 36 h after the first dose, healthy volunteers and patients received 10 mg doses of buspirone every 12 hours for 9 days. On the morning of Day 10 they received the last dose. Serial blood samples were collected on Days 1, 5 and 10 and plasma was analysed for buspirone and 1-PP. The plasma concentrations of buspirone and 1-PP were highly variable regardless of the renal or hepatic function. The peak concentrations (C_max) and area under the curves (AUC) of buspirone and 1-PP on Days D 5 and 10 were higher than on Day D 1. The trough levels (C_min) and AUCs (D 5 and 10) of buspirone and 1-PP indicated, that, regardless of renal or hepatic function, steady state was reached after 3 to 5 days of dosing. At steady-state, patients with renal or hepatic impairment had significantly higher C_max and AUC values of buspirone than in normal volunteers. However, the intensity and frequency of adverse experiences in patients with renal or hepatic impairment were not significantly different from those observed in normal volunteers. There was no correlation between the average plasma concentrations of buspirone ( ) and the degree of renal impairment judged by creatinine clearance. An excellent correlation was observed between of buspirone and serum albumin (r=0.862, and P<0.0001) as well as between and bromsulphalein clearance (r=0.678, P<0.0003).In view of high intra-and inter-subject variability in buspirone concentrations, definitive dosing recommendations for patients with compromised renal or hepatic function could not be made, but such patients should initially be dosed cautiously with buspirone.     

儿童结核患者抗结核药物血药浓度影响因素及其安全性分析

目的 监测儿童结核患者抗结核药物的血药浓度,探讨血药浓度影响因素,并评价其安全性,指导临床合理用药。方法 回顾性分析浙江省中西医结合医院40例儿童结核患者接受异烟肼、利福平、吡嗪酰胺、乙胺丁醇治疗后的血药浓度监测结果、不良反应以及药物使用前后各生化指标变化情况。结果 儿童结核患者中异烟肼、利福平、吡嗪酰胺、乙胺丁醇的血药浓度达标率分别为48.15%、34.88%、73.81%、18.52%。其中,日剂量与异烟肼(P=0.0250)和利福平(P=0.0212)浓度呈正相关;年龄也是影响异烟肼(P=0.0430)和利福平(P=0.0057)浓度的因素之一,血清白蛋白(P=0.0475)和性别(P=0.0087)分别与利福平和吡嗪酰胺血药浓度相关。药物不良反应主要表现为肝功能异常(5/40,12.50%)和皮疹(4/40,10%),抗结核药物治疗前后谷草转氨酶(aspartate aminotransferase,AST)、谷丙转氨酶(alanine aminotransferase,ALT)、尿酸水平有所升高。结论 异烟肼、利福平、乙胺丁醇在儿童结核患者中的血药浓度达标率较低,患儿抗结核治疗可能与AST、ALT、尿酸升高相关。在抗结核治疗期间进行血药浓度和肝肾功能监测有助于提高药物治疗安全性和实施个体化治疗。     

活体肾移植术中靶控输注丙泊酚效应室浓度与实测血浆药物浓度的对比分析

目的 探讨终末期肾功能衰竭（ESRD）患者行亲属供肾肾移植术,丙泊酚靶控输注（TCI）效应室浓度与实测血浆药物浓度相关性。方法 选取2016年3~10月安徽省立医院择期活体供肾肾移植受体27例,选择血浆靶控,采用丙泊酚和瑞芬太尼诱导麻醉,维持脑电双频指数（BIS）为45~55。依次记录麻醉诱导后10、20、30及40 min及肾移植术中开放髂血管后10、20、30及40 min各时间点丙泊酚TCI效应室浓度,并采集动脉血3 mL,经高效液相色谱串联质谱法（HPLC/MS/MS）测定人血浆实测丙泊酚浓度。监测计算肾移植手术中丙泊酚TCI的偏象度及精密度。结果 与麻醉前（基础值）比较,麻醉后术中HR减慢、平均动脉压（MAP）及BIS值下降,差异有统计学意义（P<0.05）,SpO₂差异无统计学意义（P>0.05）。与麻醉前（基础值）比较,术中髂血管开放前中心静脉压（CVP）差异均无统计学意义（P>0.05）,术中髂血管开放后CVP较开放前均增高,差异有统计学意义（P<0.05）。髂血管开放前丙泊酚TCI偏离度及精密度分别为9.58%、10.42%,髂血管开放后丙泊酚TCI偏离度及精密度分别为14.17%、14.19%,二者均在临床使用范围（-15%<偏离度<15%,精密度<30%）。髂血管开放前丙泊酚效应室浓度、髂血管开放后丙泊酚效应室浓度与实测血浆药物浓度间均存在显著的相关性（F=2.35,R²=0.58,F=2.95,R²=0.71,P<0.05）。髂血管开放前后丙泊酚效应室浓度与实测血浆药物浓度间浓度差值比较,差异无统计学意义（P>0.05）。结论 TCI丙泊酚用于ESRD患者术中维持,效应室浓度与实测血药浓度存在显著相关关系。肾移植患者术中丙泊酚TCI,其偏离度及精密度均在临床使用范围。髂血管开放后大量补液对麻醉深度影响较小,无需增加丙泊酚效应室浓度。     

多索茶碱和茶碱缓释片对支气管哮喘的疗效和安全性比较

目的 比较多索茶碱和茶碱缓释片对稳定期哮喘患者的疗效和安全性,为临床用药提供依据。方法 前瞻性入组汉中市中心医院收治的稳定期哮喘患者100例,随机分为观察组（n=50）和对照组（n=50）。观察组给予多索茶碱400 mg,2次/d;对照组给予300 mg茶碱缓释片,2次/d。两组疗程均为6周。观察记录两组患者治疗前后的肺功能指标-1秒用力呼气量（FEV1）,用力肺活量（FVC）,FEV1/FVC（%）,最大呼气流量（PEFR）及不良反应。结果 治疗前,两组患者肺功能指标（FEV1、FVC、FEV1/FVC、PEFR）均无统计学差异;治疗6周后,与治疗前比较,两组患者肺功能FEV1、FEV1/FVC、PEFR均显著提高,但观察组和对照组患者肺功能比较没有统计学差异。对照组患者总不良反应事件发生率显著高于观察组（P<0.05）。结论 茶碱缓释片和多索茶碱均能改善轻度支气管哮喘患者肺功能,但多索茶碱安全性好于茶碱缓释片。     

肿瘤并发病原菌感染患者NLR的临床意义

目的 探讨肿瘤患者外周血象中性粒细胞与淋巴细胞数比值（NLR）对肿瘤并发病原菌感染的诊断价值。方法 回顾分析中科院合肥物质研究院肿瘤医院2014年4月至2016年1月收治的43例伴病原菌感染肿瘤患者（感染组）和43例无病原菌感染患者（非感染组）资料,统计学分析两组与健康对照组患者白细胞数（WBC）、中性粒细胞数（NEUT）、淋巴细胞数（LYMPH）、NLR、血红蛋白（Hb）及血清白蛋白（ALB）指标差异及其相关性;采用logistic二分类回归分析肿瘤并发病原菌感染危险因素;ROC曲线分析NLR对肿瘤并发病原菌感染诊断价值。结果 感染组患者的NLR高于非感染组及对照组且非感染组高于对照组,差异均有统计学意义（P=0.000）;感染组WBC及NEUT数均高于非感染组及对照组（P=0.000、P=0.001）但非感染组与对照组比较,差异无统计学意义（P=0.240、P=0.666）;感染组LYMPH、ALB及Hb均低于非感染组及对照组（P=0.000、P=0.000、P=0.003）且非感染组低于对照组（P=0.000、P=0.000、P=0.000）;肿瘤组NLR与其ALB、Hb、淋巴细胞呈负相关（r=-0.530、r=-0.216、r=-0.740,P=0.000、P=0.046、P=0.000）,与中性粒细胞正相关（r=0.604,P=0.000）;logistic回归显示,NLR升高及ALB降低是肿瘤患者合并病原菌感染独立危险因素（P=0.001、P=0.023）。ROC曲线显示,NLR的曲线下面积（AUC）为0.864（P=0.000）,当NLR取值为4.19、4.62时,NLR诊断感染敏感性为88.39%,83.7%,特异性为69.77%、74.4%,诊断价值最大;NEUT的AUC为0.647（P=0.018）;WBC对感染无诊断价值（P=0.237）。结论 NLR对肿瘤患者发生病原菌感染具有较好诊断效能;NLR与ALB、Hb有相关性。     

Relationship between endogenous concentrations of vasoactive substances and measures of peripheral vasodilator function in patients with coronary artery disease

• 1 The aim of the present study was to determine the relationship between plasma concentrations of nitrite/nitrate (NO_x) and endothelin (ET)‐1 and non‐invasive measures of peripheral vasodilator function in patients with coronary artery disease (CAD).
• 2 Twenty‐two patients with angiographic CAD underwent non‐invasive measurement of peripheral vasodilator function in the brachial conduit artery (flow‐mediated dilation (FMD) testing via ultrasound) and in the forearm resistance arteries (via venous occlusion plethysmography) during reactive hyperaemia after 5 min ischaemia. In addition, plasma NO_x and ET‐1 concentrations were determined.
• 3 The plasma concentration of NO_x was related to the peak brachial FMD response when expressed as either the relative (%) or absolute (mm) change in diameter (r = 0.73, P < 0.001; and r = 0.64, P < 0.01, respectively). Moreover, plasma concentrations of NO_x demonstrated a relationship with forearm vasodilation estimated by total forearm blood flow following 5 min ischaemia (r = 0.63, P < 0.01) and the flow debt repayment of the forearm (r = 0.54, P < 0.01). Finally, ET‐1 concentrations were inversely related to FMD% (r = –0.45, P < 0.05).
• 4 The findings of the present study demonstrate a relationship between the plasma concentrations of NO_x and measures of vascular reactivity in conduit and resistance arteries in patients with CAD. Therefore, measurement of plasma NO_x may serve as a reliable marker for peripheral vasodilator dysfunction in patients with CAD.

     

Fluphenazine plasma levels in patients receiving low and conventional doses of fluphenazine decanoate

Plasma fluphenazine concentrations (FLU) were measured in 45 patients with schizophrenic disorders who participated in a double-blind comparison of 5 and 25 mg fluphenazine decanoate (FD). The rise in plasma level of FLU 24 h after a test dose was significantly correlated with steady state FLU concentration at 12 weeks (for 5 mg patients, r=0.45, P=0.04; for 25 mg, r=0.78, P=0.005). Patients who had low FLU at baseline required nearly 6 months to reach a steady state when they received 25 mg. Patients who received 5 mg and had low FLU at baseline continued to demonstrate relatively low plasma levels for the entire 1st year. Although the mean FLU at 6 months was lower for patients who relapsed during the subsequent 18 months (0.57 ng/ml for relapsers vs 1.01 ng/ml for nonrelapsers), this difference was not statistically significant. When plasma levels from both dosage groups were combined, FLU at 12 weeks correlated significantly with factor scores for akinesia (r=0.52, P=0.002) and BPRS cluster scores for retardation (r=0.52, P=0.002). These results indicate that the measurement of fluphenazine plasma levels may be useful in determining when patients treated with FD are receiving drug doses which are likely to cause discomforting side effects.