银杏达莫联合ACEI治疗糖尿病肾病的Meta分析

目的:对银杏达莫联合血管紧张素转化酶抑制剂(ACEI)治疗糖尿病肾病疗效进行Meta分析。方法:检索国内公开发表的有银杏达莫与ACEI联合治疗糖尿病肾病的随机对照试验(RCT),采用Cochrane系统评价手册进行质量评价,用RevMan 5.1.4软件进行Meta分析。结果:共纳入12项研究分析,银杏达莫与ACEI联合用药治疗组在降低尿白蛋白排泄率(UAER)、血尿素氮(BUN)、血肌酐(SCr)、血浆黏度以及血纤维蛋白原等方面优于单用ACEI组(P<0.05),但在降低血甘油三酯(TG)、胆固醇(TC)方面无统计学意义(P>0.05)。结论:银杏达莫与ACEI联合用药对早期糖尿病肾病有一定疗效,但由于现有研究质量存在一定方法学问题,尚需要严格设计的大样本RCT加以证实。     

ACEI联合ARB治疗糖尿病肾病临床疗效观察

目的探讨血管紧张素转换酶抑制剂（ACEI）联合血管紧张素Ⅱ受体阻断药（ARB）治疗糖尿病肾病临床疗效。方法选择本院2007年5月至2009年5月糖尿病。肾病患者83例,随机将上述患者分为观察组和对照组。两组均在常规治疗基础上,对照组给予苯那普利10mg／d,根据患者血压情况调整剂量。观察组给予苯那普利10mg／d,同时给予缬沙坦80mg／d,根据患者血压情况调整剂量。两组疗程均为3个月。两组患者分别在治疗前和治疗后测定24h尿蛋白总量、糖化血红蛋白、血肌酐水平。结果观察组治疗后糖化血红蛋白量和对照组洽疗后比较差异无统计学意义,P〉0．05;两组患者治疗后24h尿蛋白总量、血肌酐分别与本组治疗前比较,P〈0．05;治疗组治疗后24h尿蛋白总量、血肌酐与对照组治疗后比较,差异有统计学意义,P〈0．05。结论ACEI联合ARB治疗糖尿病肾病能够有效地控制尿蛋白,对肾脏起到保护作用,临床效果显著,值得借鉴。     

Autonomic nervous system mediates the cardiovascular effects of Rhodiola sacra radix in rats

ETHNOPHARMACOLOGICAL RELEVANCE: Rhodiola sacra (Crassulaceae) exhibits cardiovascular bioactivities and is used in Tibetan medicine for promoting circulation and preventing hypertension. However, the underlying mechanisms of its cardiovascular effects are poorly understood. AIM OF THE STUDY: The aim of this study was therefore to evaluate the cardiovascular activity of water-soluble fraction (WtF) and n-butanol-soluble fraction (BtF) of Rhodiola sacra radix and to explore its mechanism of action in propofol anesthetized Sprague-Dawley rats. MATERIALS AND METHODS: The changes of blood pressure, heart rate and cardiac contractility after systemic administration of the extracts (10-75mg/kg) were examined for at least 40min. Different antagonists were used to evaluate the mechanisms of cardiovascular effects of the extracts. RESULTS: Intravenous injection of the WtF (10, 25, 35, 50 or 75mg/kg) exhibited dose-dependent hypotension and increases in heart rate and cardiac contractility. In contrast, mild alterations in the same cardiovascular parameters were detected only at high dose (75mg/kg) BtF. The WtF-induced hypotensive, positive inotropic and chronotropic effects were significantly abolished by pretreatment with hexamethonium (30mg/kg, i.v.) or reserpine (5mg/kg, i.v.), whereas the hypotensive, but not the positive inotropic or chronotropic effect was potentiated by captopril (2.5mg/kg, i.v.). Pretreatment with methylatropine (1mg/kg, i.v.), on the other hand, reversed the positive inotropic and chronotropic but not the hypotensive effects of WtF. The WtF-induced cardiovascular responses were not affected in rats pretreated with N(G)-nitro-l-arginine methyl ester (20mg/kg, i.v.). CONCLUSIONS: We conclude that systemic administration of the WtF of Rhodiola sacra radix elicited a potent hypotensive effect that was mediated by the withdrawal of sympathetic vasomotor tone and interaction with the circulatory angiotensin system. The positive inotropic and chronotropic effects of WtF may result from a direct vagal inhibition on the heart.     

IgA肾病的治疗进展

IgA肾病(IgAN)是世界范围内最常见的肾小球疾病,我国IgAN占原发性肾小球肾炎的45.2％ ～58.2％.IgAN目前发病机制尚不清楚,临床工作中血管紧张素转化酶抑制剂( ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)、糖皮质激素、免疫抑制剂等药物应用广泛,进行了很多有益探索,但治疗方案仍缺乏统一标准.2010年美国肾脏病学会年会(ASN)上,改善全球肾脏疾病预后组织( KDIGO)提出了有关IgAN循证治疗意见的初稿,本文就此循证治疗意见作一综述.     

几种ACEI对实验性糖尿病大鼠心肌细胞凋亡和Caspase-3及Fas、FasL基因表达影响的类效应

目的:探讨几种血管紧张素转换酶抑制剂(ACEI)卡托普利、培哚普利、咪达普利、贝那普利、福辛普利对糖尿病大鼠左室心功能及心肌细胞凋亡和凋亡相关蛋白影响的类效应。方法:将48只SD大鼠腹腔注射链脲佐菌素(STZ)诱发糖尿病模型,随机分为5个给药组和1个糖尿病组(每组8只),另选8只做正常对照组。给药组每日分别灌胃给予卡托普利(50 mg/kg),培哚普利(雅施达4 mg/kg),咪达普利(达爽10 mg/kg),贝那普利(洛汀新10 mg/kg),福辛普利(蒙诺10 mg/kg),糖尿病组给予生理盐水灌胃,共8周。对照观察心肌细胞凋亡、心肌组织Fas、FasL蛋白、Caspase-3及其Fas mRNA表达的变化。结果:与正常对照组相比,糖尿病给药组及未给药组的心肌细胞凋亡指数明显增高(均为P<0.05);Caspase-3阳性蛋白表达率明显增高(均为P<0.05);Fas蛋白阳性染色指数增高(均为P<0.05);Fas的mRNA表达明显增高(均为P<0.05)。但糖尿病给药组的较未给药组低(均为P<0.05)。所有各组的FasL蛋白阳性染色指数差异不明显(均为P>0.05)。各种ACEI治疗组之间差异无显著性(均为P>0.05)。结论:糖尿病心肌病的发生、发展过程中有心肌细胞凋亡的变化和Caspase家族及Fas、FasL系统的参与;糖尿病大鼠心肌细胞凋亡指数、心肌组织Fas蛋白以及Fas的mRNA表达水平、Caspase-3蛋白表达水平增高。ACEI干预糖尿病心肌病,能够降低细胞凋亡及Fas基因的表达及Caspase-3蛋白表达水平,且几种ACEI具有类效应。     

ACEI与ARB联合治疗临床糖尿病肾病的疗效与安全性的Meta分析

目的:系统评价血管紧张素转化酶抑制剂(ACEI)与血管紧张素II受体拮抗剂(ARB)联合治疗临床糖尿病肾病的疗效与安全性。方法:计算机检索CoChrane图书馆、PubMed、Embase、中国期刊全文数据库、维普资讯网。采用Revman 5.1软件对11篇随机对照试验(RCTs)的602例患者进行Meta分析。结果:与单用ACEI相比,ACEI与ARB联合用药组的24 h尿白蛋白、收缩压、24 h平均收缩压、舒张压、24 h平均舒张压均明显下降;血钾明显升高。与单用ARB类药物相比,ACEI与ARB联合用药组的收缩压、舒张压明显下降。与单用ACEI或ARB相比,ACEI与ARB联合用药对降低临床糖尿病肾病患者的24 h尿白蛋白的疗效尚存在分歧,不能得出明确结论。结论:ACEI与ARB联合治疗临床糖尿病肾病有一定的疗效且相对安全。但由于本系统评价纳入的试验样本量较小且方法学质量偏低,现有证据不足以推荐临床常规应用ACEI与ARB联合治疗临床糖尿病肾病。     

舒张性心力衰竭治疗的现状和展望

舒张性心力衰竭（心衰）的治疗主要是针对高血压、糖尿病、高脂血症等原发疾病,积极纠正不良的生活习惯、进行饮食及运动疗法,必要时给予相应的药物治疗。临床及基础研究均证实,高血压可应用ACEI或ARB、长效钙离子拮抗剂、β受体阻断剂;高胆固醇血症可应用他汀类药物;2型糖尿病可以应用胰岛素增敏剂（注意体液潴留所致的淤血）来改善舒张功能障碍。其中,人们期望他汀类药物不仅可以使收缩性心衰患者获益,也可以让舒张性心衰患者获得良好的治疗效果（尚待论证）。目前认为舒张功能的控制与血管内皮细胞来源的NO密切相关（除了前述药物外还有开放KATP通道的药物、利钠肽等）。然而,在舒张功能不全的临床治疗方面仍存在许多问题,需要今后进一步的探讨和研究。     

Attenuation of diabetic nephropathy by Chaihuang-Yishen granule through anti-inflammatory mechanism in streptozotocin-induced rat model of diabetics

Ethnopharmacological relevance

Traditional Chinese medical herbs have been used in China for a long time to treat different diseases. Based on traditional Chinese medicine (TCM) principle, Chaihuang-Yishen granule (CHYS) was developed and has been employed clinically to treat chronic kidney disease including diabetic nephropathy (DN). The present study was designed to investigate its mechanism of action in treatment of DN.

Materials and methods

Diabetic rats were established by having a right uninephrectomy plus a single intraperitoneal injection of STZ. Rats were divided into four groups of sham, diabetes, diabetes with CHYS and diabetes with fosinopril. CHYS and fosinopril were given to rats by gavage for 20 weeks. Samples from blood, urine and kidney were collected for biochemical, histological, immunohistochemical and molecular analyses.

Results

Rats treated with CHYS showed reduced 24 h urinary protein excretion, decreased serum TC and TG levels, but CHYS treatment did not affect blood glucose level. Glomerular mesangial expansion and tubulointerstitial fibrosis in diabetic rats were significantly alleviated by CHYS treatment. Moreover, CHYS administration markedly reduced mRNA levels of NF-κB p65 and TGF-β1, as well as decreased protein levels of NF-κB p65, MCP-1, TNF-α and TGF-β1 in the kidney of diabetic rats.

Conclusions

CHYS ameliorates renal injury in diabetic rats through reduction of inflammatory cytokines and their intracellular signaling.     

杭州地区18家医院ACE抑制剂用药情况分析

目的: 分析杭州地区血管紧张素转换酶(ACE)抑制剂的用药现状和趋势.方法: 调查杭州地区18家医院 2000～2002年ACE抑制剂的用药数据,采用金额排序法进行分析.结果: 2000～2002年杭州地区ACE抑制剂的用药金额 2000,2001,2002年分别为 1156.24,1057.90,1074.56万元,其中2001年较2000年下降 9.30%,2002年较2001年增长1.55%.结论: ACE抑制剂是一类很有发展潜力的药物.     

卡托普利治疗急性冠脉综合征合并心房颤动的临床疗效

目的:探讨转换酶抑制剂(ACEI)卡托普利在急性冠脉综合征(ACS)合并心房颤动(房颤)治疗中的作用。方法:选择我院1998年1月至2004年1月期间收住的急性冠脉综合征合并心房颤动患者126例,分为ACEI治疗组(82例)和对照组(44例),随访2年,评价两组的治疗效果。结果:ACEI治疗组房颤再发率、转为永久性房颤的发生率及缺血相关事件均明显低于对照组,P(0.05。结论:ACEI类药物早期、长期应用于ACS,对治疗ACS合并房颤是有效的。