Genotype MTBDR plus快速检测耐多药结核病的临床应用

目的评价Genotype MTBDR plus快速检测耐多药结核病的临床应用价值。方法对涂阳肺结核患者痰标本和临床分离菌株分别用传统比例法药敏试验和Genotype MTBDR plus进行异烟肼和利福平耐药性检测,以比例法药敏试验为金标准对Genotype MTBDR plus检测结果进行比较分析。结果在368例涂阳痰标本中,比例法药敏试验与Genotype MTBDR plus检测异烟肼、利福平耐药率比较,差异均无统计学意义(P均0.05);两种方法检测异烟肼和利福平的一致率分别为95.38%(351/368)和97.55%(359/368)。在85例临床分离菌株中,比例法药敏试验与Genotype MTB-DR plus检测异烟肼、利福平耐药率比较,差异均无统计学意义(P均0.05)。两种方法检测异烟肼和利福平一致率分别为92.94%(79/85)和96.47%(82/85)。与比例法药敏试验比较,Genotype MTBDR plus检测涂阳痰标本和菌株中异烟肼的灵敏度分别为76.32%(29/38)、78.57%(11/14),特异性分别为97.58%(322/330)、95.77%(68/71));检测利福平的灵敏度分别为93.55%(29/31)、91.67%(11/12),特异性分别为97.92%(330/337)、97.26%(71/73)。结论 Genotype MTBDRplus能快速检测结核分枝杆菌对异烟肼、利福平的耐药性,和传统药敏试验比较具有较高的一致性和特异性,是目前快速诊断耐多药结核病的一种较为理想的检测方法,适宜在有条件的实验室开展。     

利福平联合左氧氟沙星治疗骨科术后耐甲氧西林金黄色葡萄球菌感染的临床分析

目的 探讨利福平联合左氧氟沙星治疗骨科手术后耐甲氧耐西林金黄色葡萄球菌的临床疗效及安全性.方法 70例骨科手术后甲氧西林耐药葡萄球菌感染患者分别予以万古霉素(对照组)和利福平联合左氧氟沙星(观察组)治疗.治疗2周后,对比两组的总有效率、细菌清除率及不良反应,并测定患者治疗前后的相关炎性因子水平.结果 治疗后,观察组总有效率(94.29%)高于对照组(80.00%)、细菌清除率(88.57%)高于对照组(68.57%),差异均有统计学意义(P<0.05);两组均未见严重不良反应.观察组治疗后的炎性因子IL-1β、IL-6 及TNF-α水平显著低于对照组同期(P<0.05).结论 利福平联合左氧氟沙星治疗骨科术后耐甲氧西林金黄色葡萄球菌感染的效果显著、安全性高,可明显降低患者血清炎性因子水平.     

Rifampicin exacerbates isoniazid-induced toxicity in human but not in rat hepatocytes in tissue-like cultures

BACKGROUND AND PURPOSE: Rifampicin has been extensively reported to exacerbate the hepatotoxicity of isoniazid in patients with tuberculosis. However, this was controversially claimed by previous reports using rat models. This study evaluated the effect of rifampicin on isoniazid-induced hepatocyte toxicity by using human and rat hepatocytes in tissue-like culture.EXPERIMENTAL APPROACH: Hepatocytes in tissue-like gel entrapment were used to examine isoniazid toxicity, as shown by cell viability, intracellular glutathione content and albumin secretion. For demonstration of the differential effects of rifampicin on human and rat hepatocytes, induction by rifampicin of cytochrome P450 (CYP) 2E1, a major enzyme associated with isoniazid hepatotoxicity, was detected by 4-nitrocatechol formation and RT-PCR analysis.KEY RESULTS: Rifampicin (12 microM) enhanced isoniazid-induced toxicity in human hepatocytes but not in rat hepatocytes. Enhanced CYP 2E1 enzymic activity and mRNA expression were similarly detected in human hepatocytes but not in rat hepatocytes. Both rat and human hepatocytes in gel entrapment were more sensitive to isoniazid treatment compared with the corresponding hepatocytes in a monolayer culture.CONCLUSIONS AND IMPLICATIONS: The difference in induction of CYP 2E1 by rifampicin between rat and human hepatocytes accounted for the difference in exacerbation of isoniazid hepatocyte toxicity by rifampicin, with more significant toxicity in gel entrapment than in monolayer cultures. Thus, human hepatocytes in tissue-like cultures (gel entrapment) could be an effective model for hepatotoxicity research in vitro, closer to the in vivo situation.     

利福平脂质体温敏型原位凝胶的制备及其体外释药特征研究

目的 制备利福平脂质体温敏型原位凝胶,并对其体外性质进行研究。方法 采用薄膜分散法制备利福平脂质体,并对利福平脂质体进行表征研究;以泊洛沙姆188、泊洛沙姆407为凝胶基质,制备利福平脂质体温敏型原位凝胶;以无膜溶出模型研究温敏型原位凝胶体外累积溶蚀率;采用透析袋法分析药物体外释放情况。结果 制备的利福平脂质体平均粒径、聚分散指数、Zeta电位、包封率和载药量分别为(149.0±5.67)nm、0.275±0.056、-(29.8±1.59)mv、(79.6±2.67)%,(18.6±0.25)%;利福平脂质体温敏型原位凝胶的胶凝温度为(34.3±0.6)℃。体外溶蚀曲线和体外释药曲线均符合零级动力学特征。结论 利福平脂质体温敏型原位凝胶的制备工艺简单易行,体外释放显示其有很好的缓释作用。     

HPLC法测定异福胶囊中异烟肼和利福平的含量

目的：建立异福胶囊中同时测定异烟肼和利福平的含量的方法。方法采用HPLC梯度洗脱法,色谱柱为十八烷基硅烷键合硅胶为填充柱（Agilent ZORBAX Eclipse XDB－C18,4．6mm ×250mm,5μm）,流动相分别为流动相A：甲醇－0．015mol? L －1磷酸二氢钠溶液（用磷酸调节pH值为6．5）（5∶95）,流动相B：甲醇－0．015mol? L－1磷酸二氢钠溶液（用磷酸调节pH值为6．5）（62∶38）;流速：1．3mL? min －1,检测波长：262nm。结果以峰面积（y）对进样浓度（x）线性回归,异烟肼回归方程：y＝29773x－7020．2,r＝0．9998,线性范围为11．48～183．6μg? mL －1;利福平回归方程：y＝35061x－67601,r＝0．9997,线性范围为13．78～275．6μg? mL －1,峰面积与浓度呈良好的线性关系。异烟肼和利福平加样回收率分别为：分别为100．1％和99．9％（n＝9）,RSD分别为O．23％和0．26％。结论本方法操作简便、准确、重现性好,可用于同时测定异福胶囊中异烟肼和利福平的含量。     

银杏叶醇提取物对异烟肼和利福平肝毒性保护作用的实验研究

目的 :观察银杏叶醇提取物对异烟肼和利福平肝毒性的保护作用及其机制探讨。方法 :分别测定肝损害组和银杏叶醇提取物大、小剂量组小鼠的血清谷丙转胺酶 (SGPT)、肝指数、肝匀浆丙二醛 (MDA)含量、肝微粒体P4 50和线粒体Ca2 ATP酶活性 ,以及肝病理检查 ,并与对照组比较。结果 :银杏叶醇提取物大、小剂量均可对抗异烟肼和利福平引起的MDA、SGPT、肝微粒体P4 50 的增高 (P <0 .0 5) ,以及对抗其引起的形态学改变 ;银杏叶醇提取物大剂量对抗其线粒体Ca2 ATP酶活性的降低。结论 :银杏叶醇提取物可对抗异烟肼和利福平所致肝毒性。     

Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa

The rifampicin (RF)–clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy. The aim of the present study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS. In the period January 2017–May 2018, 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by Revuz, Hidradenitis Suppurativa Physician Global Assessment [HS‐PGA] and International Hidradenitis Suppurativa Severity Score System [IHS4]) before (W0) and after (W12) CL oral therapy. CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12‐week period (p ≤ .01). There was also a statistically significant change in the mean visual analogue scale for pain. The present study demonstrates the efficacy of oral CL monotherapy as RF‐sparing regimen alternative to RF–CL combination in a selected group of patients.     

Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that causes a significant decline in quality of life. There are numerous treatment options; however, real‐life data on the efficacy of these treatments is limited. This study was performed in two centers to describe clinical characteristics and assess treatment outcome in a cohort of 139 patients with HS. Data on demographic and clinical characteristics, Hurley stage and comorbidities were collected from patient charts and evaluated retrospectively. Treatment response was measured with HS clinical response index (HISCR). Mean body mass index was 27.8±4.88 . Inflammatory comorbidities were present in 23%. Among first‐line drugs systemic doxycycline resulted in 60% HISCR followed by rifampicin–clindamycin combination (46.4%). Isotretinoin had the lowest HISCR (30.7%) in this group. For second‐line therapies, all acitretin treated patients achieved response and patients treated with tumor necrosis factor alpha (TNF‐α) inhibitors had the highest HISCR. Currently recommended first‐line therapies have moderate efficacy in HS. Acitretin appears to be a reasonable alternative for the highly effective TNF‐α inhibitors in patients with severe and resistant HS. Overall, these results support that excessive inflammatory response play an important role in pathogenesis of HS.     

Development and validation of liquid chromatography-mass spectrometry method for the estimation of rifampicin in plasma

A selective, rapid and sensitive liquid chromatography-mass spectrometry method was developed for the quantitative estimation of rifampicin in plasma. With phenacetin as internal standard, sample pretreatment involved a one-step extraction with ethyl acetate from plasma. The sample was analyzed using methanol: 2mM ammonium acetate: 80:20 v/v as mobile phase. Chromatographic separation was achieved on a BDS Hypersil Gold C(18) column which was followed by detection with mass spectrometry. Linear calibration curves were obtained in the concentration range of 5.021-1008.315 ng/ml. The inter- and intra-day accuracy values were below 15% at all quality control levels. Percent recoveries for rifampicin at high, middle and low quality control samples was obtained 55.15, 48.65 and 49.62%, respectively and for internal standard was 60.22%. Rifampicin was found stable through all validation parameters. Developed method was found to be simple, precise, accurate and rapid for estimation of rifampicin in plasma. Thus, the method can be employed for routine pharmacokinetic and bioequivalence studies.