国产rhGH的免疫原性及其对临床疗效的影响

目的　通过测定生长激素缺乏症 (GHD)患儿用国产重组人生长激素 (recom bined hum angrowth horm one,rh GH)治疗时血清生长激素抗体 (GH- Ab)水平及其结合特性 ,探讨 rh GH的免疫原性及其对疗效的影响。方法　对 6 1例 (男 49例 ,女 12例 ) GHD患儿用国产 rh GH治疗 ,每晚睡前皮下注射 rh GH 0 .1IU /kg共6个月 ;用放射免疫法测定治疗期间患儿血清 GH- Ab水平和滴度 ,并计算抗体结合容量、亲和常数 (Ka)。结果　48%患儿 (2 9/6 1)用药后 3个月血清 GH - Ab呈阳性至试验结束时仍未消失 ,其中 2 0例抗体为弱阳性 (结合率 <10 % ) ,9例呈强阳性 (结合率 >15 % ) ;5 2 %患儿 (32 /6 1)治疗期间抗体为阴性 ;血清 GH- Ab的结合容量、Ka及滴度均为低水平 ,分别为 (0 .1～ 4.8) pmol/L、(1.7× 10 7～ 6 .5× 10 8) L /mol和 1∶ 4～ 1∶ 8。GH- Ab阳性患儿治疗后的身高、身高增长速率及身高落后于正常 SD值的变化与同期阴性者比较无统计学差异 (P>0 .0 5 )。结论　本试验所用国产 rh GH对 GHD患儿身高增长具有确切的促进作用 ,其免疫原性所导致产生的 GH - Ab未对患儿体格线性增长产生负性影响     

乐脂平治疗Ⅱ型糖尿病高脂血症的临床研究

观察了３０例伴有高脂血症的Ⅱ型糖尿病患者用小剂量乐脂平（５００ｍｇ／ｄ）治疗４周后血清脂质、脂蛋白的变化。结果：血总胆固醇、甘油三酯及极低密度脂蛋白—胆固醇水平较治疗前下降，高密度脂蛋白—胆固醇明显升高，血糖、血肌酐及血尿酸无明显变化。服用该药未观察到不良反应，提示乐脂平能较好地改善糖尿病患者的脂代谢紊乱。     

通脉养心口服液与通脉养心丸药理作用比较

对通脉养心口服液及丸剂进行了药理作用的比较，结果表明，２种剂型基本具有相同的心血管药理作用，但在作用强度上不完全相同，在抑制心肌缺血猎ＳＴ段抬高及提高减压缺氧耐力上，口服液较丸剂作用稍强，在抑制大鼠实验性血栓形成上，丸剂比口服液作用稍强。     

洛伐他汀对ⅡB型高脂血症患者血脂、血糖及胰岛素代谢的影响

作者观察了３０例ⅡＢ型高脂血症患者在给予洛伐他汀口服８周前后血脂、血糖及胰岛素的变化。发现用药８周后ＴＣ及ＬＤＬ－Ｃ明显降低（Ｐ＜ ０．０５）,ＴＧ、ＨＤＬ－Ｃ、ＶＬＤＬ－Ｃ变化不大（Ｐ＞ ０．０５）。空腹血糖（ＦＰＧ）及服糖后２小时血糖（２ｈＰＧ）较用药前升高（前者Ｐ＜ ０．０５）。空腹胰岛素（ＦＰＩ）及服糖后２ 小时胰岛素（２ｈＰＩ）也较治前增高（后者Ｐ＜ ０．０５）。空腹血糖与空腹胰岛素乘积的倒数〔（１／（ＦＰＧ×ＦＰＩ）〕,差异无统计学意义。而餐后２小时血糖与餐后２ 小时胰岛素乘积的倒数〔１／（２ｈＰＧ×２ｈＰＩ）〕,差异有统计学意义。可认为长期使用该药,对２Ｂ型高脂血症患者有可能导致高胰岛素血症,值得进一步探讨。     

H1N1 influenza: the trigger of diabetic ketoacidosis in a young woman with ketosis-prone diabetes

In this study, the authors report a case of new-onset ketosis-prone diabetes in a 21-year-old Chinese woman with H1N1 influenza, who presented with fever, polyuria and loss of appetite for 3 days before admission. She was hospitalized and diagnosed with acute-onset diabetic ketoacidosis for the first time. Her diabetes-associated antibodies were negative. Interestingly, she had an unexplained fever and her white blood cell count was low at admission and remained low for several days. She was believed to have a viral infection, which was found to be H1N1 influenza infection. The literature regarding virus infection and diabetic ketoacidosis is reviewed. The precipitating factors, symptomatology, pathophysiology and management of ketosis-prone diabetes are discussed in the current case report.     

Managing pasireotide-associated hyperglycemia: a randomized,open-label,Phase IV study

Purpose

Pasireotide is an effective treatment for acromegaly and Cushing’s disease, although treatment-emergent hyperglycemia can occur. The objective of this study was to assess incretin-based therapy versus insulin for managing pasireotide-associated hyperglycemia uncontrolled by metformin/other permitted oral antidiabetic drugs.

Methods

Multicenter, randomized, open-label, Phase IV study comprising a core phase (≤?16-week pre-randomization period followed by 16-week randomized treatment period) and optional extension (ClinicalTrials.gov ID: NCT02060383). Adults with acromegaly (n?=?190) or Cushing’s disease (n?=?59) received long-acting (starting 40 mg IM/28 days) or subcutaneous pasireotide (starting 600 µg bid), respectively. Patients with increased fasting plasma glucose (≥?126 mg/dL on three consecutive days) during the 16-week pre-randomization period despite metformin/other oral antidiabetic drugs were randomized 1:1 to open-label incretin-based therapy (sitagliptin followed by liraglutide) or insulin for another 16 weeks. The primary objective was to evaluate the difference in mean change in HbA_1c from randomization to end of core phase between incretin-based therapy and insulin treatment arms.

Results

Eighty-one (32.5%) patients were randomized to incretin-based therapy (n?=?38 received sitagliptin, n?=?28 subsequently switched to liraglutide; n?=?12 received insulin as rescue therapy) or insulin (n?=?43). Adjusted mean change in HbA_1c between treatment arms was – 0.28% (95% CI – 0.63, 0.08) in favor of incretin-based therapy. The most common AE other than hyperglycemia was diarrhea (incretin-based therapy, 28.9%; insulin, 30.2%). Forty-six (18.5%) patients were managed on metformin (n?=?43)/other OAD (n?=?3), 103 (41.4%) patients did not require any oral antidiabetic drugs and 19 patients (7.6%) were receiving insulin at baseline and were not randomized.

Conclusion

Many patients receiving pasireotide do not develop hyperglycemia requiring oral antidiabetic drugs. Metformin is an effective initial treatment, followed by incretin-based therapy if needed.

ClinicalTrials.gov ID: NCT02060383.

     

妊娠合并自发性肝破裂的临床研究(附1例报道)

目的探讨妊娠合并自发性肝脏破裂临床表现的特点,指导临床诊断与治疗。方法报道1例并复习23例文献报告病例,总结其发病时间、临床表现、治疗方法及预后,发现其中的规律。结果总计24例患者,14例合并有子痫或先兆子痫,死亡12例。发病与产次及是否初产妇无明显相关性,临床表现均有上腹疼痛或剑突下疼痛。B超是最好的诊断方法。破裂多见于右肝膈面,止血方法多样,术后有可能出现DIC及多器官功能衰竭。结论妊娠合并自发性肝脏破裂死亡率高,应重视其早期诊断与治疗,并注重术后康复治疗,以提高孕产妇及围产儿存活率。     

NIDDM患者血清生长激素,C肽水平与微血管病变的关系

本文测定了20例NIDDM患者血清GH、C肽水平并观察其与视网膜病变及肾脏病变的关系。结果表明有视网膜病变组血GH水平明显高于无视网膜病变组,C肽水平在两组中无明显变化。提示糖尿病患者血GH水平增高与微血管病变有一定关系。     

清胃黄连片的质量标准

目的:建立清胃黄连片的质量控制标准。方法:采用薄层色谱法对清胃黄连片中黄芩、黄连、黄柏、甘草、知母、桅子、赤芍进行定性鉴别,采用高效液相色谱法对清胃黄连片中的黄芩苷进行含量测定。结果:黄芩、黄连、黄柏、甘草、知母、桅子、赤芍可在不同的薄层条件下分别检出;利用高效液相色谱法测定制剂中黄芩的有效成分黄芩苷,黄芩苷在0.20～1.60μg范围内线性关系良好(r=0.999 8),平均回收率为98.46%,RSD为2.89%(n=6)。结论:该法专属性强,重复性好,可用于清胃黄连片的质量控制。     

Novel WEE2 compound heterozygous mutations identified in patients with fertilization failure or poor fertilization

Journal of Assisted Reproduction and Genetics - To study associations between novel WEE2 mutations and patients with fertilization failure or poor fertilization. Thirty-one Chinese patients who...