SGLT-2抑制剂和GLP-1受体激动剂的心血管安全性研究进展

2型糖尿病是动脉粥样硬化性心血管疾病发病的高危因素。研究发现,钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂、胰高血糖素样多肽-1(GLP-1)受体激动剂对2型糖尿病合并心血管疾病的患者具有心血管保护作用。故从心血管安全性试验及其Meta分析、网状Meta分析方面,对SGLT-2抑制剂、GLP-1受体激动剂的心血管安全性研究进展进行归纳和总结。     

Incredible pharmaceutical residues in human milk in a cohort study from Şanlıurfa in Turkey

Maternal milk is essential for optimum growth and development of an infant. The aim was to examine the presence of pharmaceutical residuals in breastmilk. This cohort study enrolled 90 healthy mother-infant pairs at 5−14 days after delivery and a control examination was performed 4–8 weeks later. Milk samples were taken at both visits. RANDOX Infiniplex kit performed residual analysis. More than half of mothers (54.4 %) had anti-inflammatory drug residues in at least one milk sample: those were 52.2 % for tolfenamic acid and 2.2 % for meloxicam and 1.1 % for metamizole. The most frequent residue group included the beta-lactam antibiotic group, which was detected in 93.3 % of mothers’ milk. The second one was the quinolone group (81.1 %). One-third of mothers expressed nitroxynil and one-fifth polymyxin in at least one sample. Almost all mothers had some unexpected drug residues in their milk. Additional studies from other countries can display maternal environmental exposures.     

重庆地区HIV感染者长期选择免费二线药物抗病毒治疗的原因及合理性分析

目的：了解重庆地区艾滋病免费二线抗病毒药物的使用是否合理。方法：回顾性收集某中心2013-2017年间使用免费二线药物抗HIV治疗患者的临床资料,统计该类患者的比例,分析选择二线药物的原因。结果：筛选出使用二线药物治疗的HIV感染者262例,占同期HIV感染治疗者7.0%,至2018年12月病毒抑制率96.9%,CD4⁺T细胞均值（334.5±225.6）个/μL。按初始抗病毒治疗即选用二线药物和由一线药物转换为二线药物分两类,分别有63例（24.0%）、199例（76.0%）。初始选择二线药物因素有合并中枢神经系统疾病（50.8%）、生育需求（20.6%）、肝功能异常（12.7%）、过敏体质（9.5%）、药物间相互作用（DDI）（6.3%）;一线药物转换的因素有药物毒副反应（47.8%）、耐药（28.1%）、免疫重建不良（13.6%）、生育需求（8.0%）,DDI（2.5%）。因耐药导致转换二线药物者病毒学抑制率达100%;因免疫重建不良更换二线药物者CD4⁺T细胞值（209.1±167.5）个/μL较更换方案前[（123.2±62.7）个/μL]明显升高（P<0.05）。结论：重庆地区艾滋病二线药物使用合理,但总体使用者偏少,需提高医务人员认识,对免疫重建不良患者及存在DDI的患者应及时更换抗病毒治疗方案。     

PCSK9抑制剂依洛尤单抗在降低心血管事件风险中的研究进展

2015年,前蛋白转化酶枯草杆菌蛋白酶/kexin 9（proprotein convertase subtilisin kexin 9,PCSK9）抑制剂依洛尤单抗被美国食品药品监督管理局（the Food and Drug Administration,FDA）批准上市,为高脂血症及心血管高危患者的治疗带来了新的希望。本文综述了依洛尤单抗的药学性质及相关临床试验结果,并介绍其在真实世界中的应用效果,以期为临床药物治疗提供参考。     

抗结核药物研究进展

结核病病例一般集中在发展中国家。抗结核领域一直以来未受到学术界和制药企业的关注,随着多药耐药结核病和广泛耐药结核病不断出现,以及艾滋病患者感染结核杆菌的病例逐渐增加,抗结核药物的研究已成为药物研发领域中的一个热点。本文系统地总结了已上市抗结核药物及正处在研发阶段的新型化学实体,根据其作用机制划分为4个大类,同时结合近期文献报道对其作用机制进行了简要阐述。在过去40年中,只有两种全新作用机制的新药：贝达喹啉与德拉马尼上市,以ATP合成酶抑制剂为代表的具有新型作用机制的药物将有望成为抗结核药物研发的重点。     

我国医院进口(合资)药品依赖情况研究——基于2013-2019上半年全国药品采购面板数据

目的：掌握我国目前进口（合资）药品在临床使用情况和用药特征,了解当下临床对进口药品的依赖情况,为有针对性地降低对进口药品的依赖提供数据支持。方法：从通用名、剂型和规格三个层次对进口药品的国产替代性进行划分,然后分别从替代程度、批准文号数量、临床用量等角度对比分析2013－2019年上半年814家样本医院的进口药品与相应国产药品的使用情况。结果：进口药品在临床用量、占比上均呈上涨趋势,且在临床选择中处于优势地位;国产仿制药的批准文号仍存在着总量大、分配不均的情况;国产仿制药对进口药品的替代仍有待提高。结论：应重点推进通用名层面无国产替代品种的进口药的仿制药上市;同步提高国产仿制药对进口药品的临床替代;提高自主创新能力,鼓励国内企业研发满足我国临床需求的民族创新药。     

含海洋药物的经方及其在妇科疾病治疗中的现代应用概况

通过分析《伤寒杂病论》中涉及的海洋药物及含海洋药物经方在现代妇科疾病辨治中的运用,并参照历代文献的相关阐述,探讨海洋药物药理作用的物质基础及临床应用的理论依据,分析海洋药物研究与发展的趋势,以帮助开拓用药思路,推动相关海洋药物治疗妇科疾病的现代化研究进程。     

Clinical outcomes in patients on preinjury ibuprofen with traumatic brain injury

Background

The aim of our study was to evaluate the clinical outcomes in patients on preinjury Ibuprofen with traumatic brain injury.

Methods

We performed a 2-year analysis of all patients on prehospital Ibuprofen with traumatic brain injury and intracranial hemorrhage. Patients on preinjury Ibuprofen were matched using propensity score matching to patients not on Ibuprofen in a 1:2 ratio for age, Glasgow Coma Scale, head-abbreviated injury scale, injury severity score, International Normalized Ratio, and neurologic examination. Outcome measures were progression on repeat head computed tomography (RHCT) and neurosurgical intervention.

Results

A total of 195 matched (Ibuprofen 65, no-Ibuprofen 130) patients were included. There was no difference in the progression on RHCT (Ibuprofen 18% vs no-Ibuprofen 24%; P = .50). The neurosurgical intervention rate was 18.9% (n = 37). There was no difference for need for neurosurgical intervention (26% vs 16%; P = .10) between the 2 groups.

Conclusions

In a matched cohort of trauma patients, preinjury Ibuprofen use was not associated with progression of initial intracranial hemorrhage and the need for neurosurgical intervention. Preinjury use of Ibuprofen as an independent variable should not warrant the need for a routine RHCT scan.