非甾体类抗炎药与心血管事件风险的研究进展

非甾体类抗炎药是一类广泛用于消炎、镇痛的药物,根据对环氧化酶的选择性不同分为三类,研究发现其对心血管事件有一定的影响。环氧化酶-1选择性抑制剂对心血管疾病有二级预防作用,但一级预防作用尚存争议。大多环氧化酶-2选择性抑制剂增加心血管事件风险,部分尚存争议。非选择性抑制剂大多增加心血管事件风险,少部分则几乎无影响。现拟对非甾体类消炎药与心血管事件风险的研究进展做一综述。     

Peripheral targets in obesity treatment: a comprehensive update

Obesity is a major epidemic of our time and is associated with diseases such as metabolic syndrome, type 2 diabetes mellitus and atherosclerotic cardiovascular disease. Although weight loss drugs, when accompanied by diet and exercise, could be a very helpful medical tool in treating obese or overweight patients, their usefulness has been questioned due to the complexity of this type of medication, which regards a plethora of issues such as efficacy and safety of the drug and also risks and benefits among different patients. In general, obesity drugs that target peripheral pathophysiological mechanisms can be divided into two main categories. The first category includes anti‐obesity agents able to reduce or limit energy absorption, such as pancreatic lipase and microsomal triglyceride transfer protein inhibitors. The second category consists of a heterogeneous group of compounds aiming to decrease fat mass by increasing energy expenditure or by redistributing adipose tissue. Angiogenesis inhibitors, beta‐3 receptor agonists, sirtuin‐I activators, diazoxide and other molecules belong to this group. The glucagon‐like peptide‐1 receptor agonists consist the third category of peripheral anti‐obesity agents discussed therein. This review aims to provide a general overview of the molecules and substances that are already or could potentially be used as peripheral anti‐obesity drugs, the molecular mechanisms by which they act, as well as their current stage of development, production and/or availability.     

Management of hepatitis B reactivation in immunosuppressed patients: An update on current recommendations

The proportion of hepatitis B virus(HBV) previously exposed patients who receive immunosuppressive treatment is usually very small. However, if these individuals are exposed to potent immunosuppressive compounds, the risk of HBV reactivation(HBVr) increases with the presence of hepatitis B surface antigen(HBsAg) in the serum. Chronic HBsAg carriers have a higher risk than those who have a total IgG anticore as the only marker of resolved/occult HBV disease. The loss of immune control in these patients may results in the reactivation of HBV replication within hepatocytes. Upon reconstitution of the immune system, infected hepatocytes are once again targeted and damaged by immune surveillance in an effort to clear the virus. There are different virological scenarios, and a wide spectrum of associated drugs with specific and stratified risk for the development of HBVr. Some of this agents can trigger a severe degree of hepatocellular damage, including hepatitis, acute liver failure, and even death despite employment of effective antiviral therapies. Currently, HBVr incidence seems to be increasing around the world; a fact mainly related to the incessant appearance of more powerful immunosuppressive drugs launched to the market. Moreover, there is no consensus on the length of prophylactic treatment before the patients are treated with immunosuppressive therapy, and for how long this therapy should be extended once treatment is completed. Therefore, this review article will focus on when to treat, when to monitor, what patients should receive HBV therapy, and what drugs should be selected for each scenario. Lastly, we will update the definition, risk factors, screening, and treatment recommendations based on both current and different HBV management guidelines.     

Triggers of histologically suspected drug-induced colitis

BACKGROUND Drug toxicity is a common and even serious problem in the gastrointestinal tract that is thought to be caused by a broad spectrum of agents.Although withdrawal of the causative agent would cure the disease knowledge is scarce and mostly derives from case reports and series.AIM To investigate potential triggers of drug-induced colitis(DiC).METHODS We conducted a retrospective,observational case control study.Patients were assigned to DiC or one of two age-and gender-matched control groups(noninflammatory controls and inflammatory colitis of another cause)based on histopathological findings.Histopathology was reassessed in a subset of patients(28 DiC with atherosclerosis,DiC without atherosclerosis and ischaemic colitis each)for validation purposes.Medical history was collected from the electronic database and patient records.Statistical analysis included chi-squared test,t-test,logistic and multivariate regression models.RESULTS Drug-induced colitis was detected in 211 endoscopically sampled biopsy specimens of the colon mucosa(7%of all screened colonoscopic biopsy samples);a total of 633 patients were included equally matched throughout the three groups(291 males,mean age:62.1±16.1 years).In the univariate analysis,DiC was associated with diuretics,dihydropyridines,glycosides,ASS,platelet aggregation inhibitors,nonsteroidal anti-inflammatory drugs(NSAIDs),statins and fibrates,and with atherosclerosis,particularly coronary heart disease,and hyperlipoproteinaemia.Echocardiographic parameters did not show substantial differences.In the multivariate analysis only fibrates[odds ratio(OR)=9.1],NSAIDs(OR=6.7)and atherosclerosis(OR=2.1)proved to be associated with DiC.Both DiC reassessment groups presented milder inflammation than ischaemic colitis.The DiC patients with atherosclerosis exhibited histological features from both DiC without atherosclerosis and ischaemic colitis.CONCLUSION Several drugs indicated for the treatment of cardiovascular and related diseases are associated with DiC.Atherosclerosis and microcirculatory disturbances seem to play an important pathogenetic role.     

中药炮制增效原理探讨

目的:改进中药炮制方法,提高炮制品质量。方法:探讨能使中药炮制后增效的原理。结果:发现能使药物增效的方法和原理很多。结论:选择适当的炮制方法,能更好地发挥药物的药理作用。     

肾性高血压大鼠血浆ET、CGRP、AngⅡ水平变化及缬沙坦、贝那普利干预的影响

目的:研究肾性高血压大鼠血浆内皮素(ET)、降钙素基因相关肽(CGRP)、血管紧张素Ⅱ(AngⅡ)等血管活性物质的变化及降压药物缬沙坦、贝那普利干预对收缩压和ET、CGRP、AngⅡ的影响。方法:采用两肾一夹方法复制肾性高血压大鼠模型,成模大鼠随机分为缬沙坦组(30mg/kg/天,n=8)、贝那普利组(10mg/kg/天,n=8)、肾性高血压模型组(n=8);假造模大鼠作为假手术组(n=10),前两组以缬沙坦和贝那普利溶液、后两组以等量生理盐水每日灌胃。分别于术前及术后每周末测定各组大鼠收缩压变化,并在灌药治疗8周后用放免法测定各组血浆ET、CGRP、AngⅡ含量变化。结果:两肾一夹术后4周可形成稳定肾性高血压大鼠模型。缬沙坦组、贝那普利组大鼠经灌胃治疗8周后血压明显下降(P<0.01)。肾性高血压模型组ET、CGRP、AngⅡ血浆浓度均高于假手术组(P<0.05或P<0.01);缬沙坦组、贝那普利组CGRP浓度高于肾性高血压模型组(P<0.05),贝那普利组AngⅡ浓度低于肾性高血压模型组和缬沙坦组(P<0.05);肾性高血压模型组血浆ET与AngⅡ浓度呈正相关(r=0.62,P<0.05)。结论:肾性高血压大鼠血浆ET、CGRP、AngⅡ浓度增高,缬沙坦、贝那普利可能通过调节血管活性物质水平而降低收缩压。