丁苯酞联合阿替普酶溶栓治疗急性脑梗死的临床效果及血清炎症因子的变化

目的观察丁苯酞联合阿替普酶溶栓治疗急性脑梗死的疗效及血清炎症因子的变化。方法采集我院2014年5月至2018年10月神经科治疗的63例急性脑梗死(ACI)患者,分为2组,对照组30例施予阿替普酶溶栓治疗,观察组33例在其基础注入丁苯酞注射液治疗,比较2组疗效及血清炎症因子。结果观察组2周治疗总有效率比对照组更高(P<0.05);观察组治疗后脑梗死面积(11.1±2.0)cm~2相较于对照组(13.1±1.2)cm~2减少,且美国国立卫生研究院卒中量表(NIHSS)评分(4.1±1.1)分,相较于对照组(8.5±1.5)低(P<0.05);观察组治疗后C反应蛋白(CRP)(7.4±1.1)mg/L、IL-8(24.9±1.1)ng/L、IL-10(9.3±1.0)ng/L、降钙素原(PCT)(4.0±1.8)μg/L水平相较于对照组[CRP(13.8±1.4)mg/L、IL-8(30.8±1.5)ng/L、IL-10(11.0±0.9)ng/L、PCT(5.6±2.3)μg/L]均降低(P<0.05)。结论 ACI通过阿替普酶与丁苯酞联合治疗,不仅能提高临床疗效缩小梗死面积,改善脑神经功能,还能缓解炎症反应,无明显不良反应。     

急性脑梗死患者血清同型半胱氨酸水平及临床意义

目的探讨高同型半胱氨酸血症与急性脑梗死之间的关系及临床意义。方法采用循环酶法测定40例急性脑梗死患者和40例健康对照者的血清同型半胱氨酸水平。结果急性脑梗死组血清同型半胱氨酸水平为(16.79±4.16)μmol/L,明显高于对照组的(8.29±3.76)μmol/L,差异有统计学意义(P<0.05)。结论高同型半胱氨酸是急性脑梗死的一个独立危险因素,开展同型半胱氨酸的常规检测,利于早期发现脑梗死及进行预防。     

丁苯酞氯化钠注射液治疗内囊预警综合征的效果

目的观察丁苯酞氯化钠注射液治疗内囊预警综合征的效果。方法纳入2017年9月至2021年8月秦皇岛市第二医院收治的内囊预警综合征患者70例,通过随机数字表法分为观察组(n=35)和对照组(n=35)。对照组接受溶栓、抗血小板和调脂等常规治疗,合并高血压、糖尿病、冠心病者予以相应治疗,观察组在对照组基础上给予丁苯酞氯化钠注射液治疗,两组均治疗14 d,并随访90 d。比较治疗前、治疗14 d后两组患者神经功能、日常生活能力、血清细胞因子水平,随访90 d预后情况及随访期间不良反应发生情况。结果治疗14 d后,观察组总有效率高于对照组(91.43%比71.43%,P<0.05);两组患者美国国立卫生研究院卒中量表(NIHSS)评分[观察组:治疗前为(5.90±1.07)分,治疗后为(2.45±1.43)分;对照组:治疗前为(5.95±1.00)分,治疗后为(3.45±1.15)分]、血清S100B蛋白(S100B)[观察组:治疗前为(0.31±0.08)μg/L,治疗后为(0.15±0.05)μg/L;对照组治疗前为(0.32±0.08)μg/L,治疗后为(0.23±0.09)μg/L]、基质金属蛋白酶9(MMP-9)[观察组:治疗前为(318.66±38.24)ng/L,治疗后为(165.25±24.64)ng/L;对照组:治疗前为(311.62±41.35)ng/L,治疗后为(257.81±29.74)ng/L]、缺血修饰白蛋白(IMA)[观察组:治疗前为(77.12±8.64)μmol/L,治疗后为(52.65±6.53)μmol/L;对照组:治疗前为(78.88±8.38)μmol/L,治疗后为(65.32±6.81)μmol/L]水平均较治疗前降低,且观察组低于对照组;Barthel指数(BI)均升高,且观察组高于对照组(P<0.05)。随访90 d两组患者进展为脑卒中情况比较,差异无统计学意义(P>0.05),但观察组预后良好比例高于以对照组(94.29%比82.86%,P<0.05)。随访期间两组患者均未发生体位性低血压、发热、横纹肌溶解征、头痛、颅内出血、胸痛、胃肠道症状等明显不良反应。结论丁苯酞氯化钠注射液治疗内囊预警综合征疗效确切,安全性高。     

脑梗死患者同型半胱氨酸与血脂关系探讨

目的探讨脑梗死患者同型半胱氨酸(Hcy)与血脂的关系。方法用微量荧光检测仪对受试者晨起空腹静脉血,1h内分离血清。结果正常对照组Hcy水平为(10.2±3.8)μmol/L,脑梗死组为(24.3±7.8)μmol/L,两组比较差异有统计学意义(P<0.05)。结论同型半胱氨酸代谢异常导致的高同型半胱氨酸血症是动脉粥样硬化和心脑血管疾病发病的独立危险因素。     

多奈哌齐片联合丁苯酞软胶囊治疗血管性痴呆 49例

目的 观察多奈哌齐片联合丁苯酞软胶囊治疗血管性痴呆(VD)的疗效.方法 纳入中国人民解放军海军第九〇五医院2015年1月至2018年12月收治的VD病人98例,依照随机数字表法分为观察组(n=49)、对照组(n=49),在对症治疗基础上,对照组给予多奈哌齐片治疗,观察组给予多奈哌齐片、丁苯酞软胶囊治疗.观察两组治疗前后日常生活能力量表(ADL)、简易精神状态量表(MMSE)、临床痴呆评定量表(CDR)评分,事件相关电位(ERP)P300,血清丙二醛(MDA)、超氧化物歧化酶(SOD)水平,血浆胰岛素样生长因子-1(IGF-1)、细胞间黏附分子-1(IGAM-1)、转化生长因子-β(TGF-β)水平,不良反应.结果 治疗后,观察组ADL[(85.19±8.73)分比(74.28±7.62)分]、MMSE评分[(21.74±2.23)分比(19.26±2.04)分]均大于对照组,CDR评分小于对照组[(0.82±0.09)分比(1.17±0.11)分,P<0.05].观察组P300波幅[(8.85±0.89)μV比(8.02±0.82)μV]大于对照组,P300潜伏期[(322.77±34.57)ms比(362.96±37.82)ms]小于对照组(P<0.05).观察组SOD[(118.76±12.38)nU/mL比(97.96±11.82)nU/mL]、IGF-1[(15.38±1.64)ng/mL比(14.87±1.59)ng/mL]、ITGF-β[(30.22±3.21)ng/mL比(27.95±3.03)ng/mL]水平均高于对照组,MDA[(3.23±0.34)nmol/mL比(3.61±0.39)nmol/mL]、GAM-1[(221.65±24.39)ng/mL比(243.87±25.16)ng/mL]水平低于对照组(P<0.05).观察组总有效率(73.47％)高于对照组(51.02％)(P<0.05).两组均未见明显不良反应.结论 多奈哌齐片联合丁苯酞可有效抑制脑区自由基及炎性因子等有害物质生成,保护脑区神经细胞,促进脑区受损神经细胞修复,改善VD病人认知功能,疗效显著,且较为安全,有助于VD病人康复.     

丁苯酞注射液对急性脑梗死患者血清炎性因子和血管内皮功能的影响分析

目的探究丁苯酞(NBP)注射液对急性脑梗死患者血清炎性因子和血管内皮功能的影响分析。方法172例急性脑梗死患者,根据治疗方法不同分为研究组和常规组,各86例。常规组应用丹参注射液治疗,研究组应用丁苯酞注射液治疗。比较两组血清炎性因子指标、血流动力学指标、血管内皮功能、Barthel指数(BI)评分和美国国立卫生院卒中量表(NIHSS)评分。结果治疗后,两组白细胞介素(IL-6)、粒细胞集落因子(G-CSF)、肿瘤坏死因子(TNF-α)、C反应蛋白(hs-CRP)水平均低于治疗前,差异均有统计学意义(P<0.05)。治疗后,研究组IL-6、G-CSF、TNF-α、hs-CRP水平分别为(51.92±10.81)ng/L、(48.95±12.71)ng/L、(1.37±0.19)ng/L、(3.41±1.24)mg/L,均低于常规组的(80.67±11.24)ng/L、(89.45±14.42)ng/L、(1.84±0.21)ng/L、(5.27±1.36)mg/L,差异均有统计学意义(P<0.05)。治疗前,两组血流量、血流速、外周阻力比较差异无统计学意义(P>0.05)。治疗后,两组血流量、血流速、外周阻力均优于治疗前,差异均有统计学意义(P<0.05)。治疗后,研究组血流量、血流速、外周阻力分别为(10.24±2.19)ml/min、(16.95±3.82)cm/s、(1685.27±195.47)Pa,均优于常规组的(7.64±2.52)ml/min、(12.54±3.71)cm/s、(1945.87±197.35)Pa,差异均有统计学意义(P<0.05)。治疗后,两组血管内皮生长因子(VEGF)、人内皮素-1(ET-1)、血栓素A2(TXA2)、血管内皮依赖性舒张(FMD)、血浆一氧化氮(NO)均优于治疗前,差异均有统计学意义(P<0.05)。治疗后,研究组VEGF、ET-1、TXA2、FMD、NO分别为(202.48±21.48)ng/L、(62.49±11.47)μmol/L、(150.59±25.14)μmol/L、(7.12±2.11)%、(64.16±6.72)μmol/L,均优于常规组的(304.94±31.28)ng/L、(73.59±12.85)μmol/L、(184.65±24.16)μmol/L、(5.96±2.59)%、(53.59±4.87)μmol/L,差异均有统计学意义(P<0.05)。治疗后,两组BI评分及NIHSS评分均优于治疗前,差异均有统计学意义(P<0.05)。治疗后,研究组BI评分、NIHSS评分分别为(81.59±16.22)、(11.49±3.48)分,均优于常规组的(60.79±24.26)、(16.45±4.67)分,差异均有统计学意义(P<0.05)。结论丁苯酞注射液治疗急性脑梗死可促进血管内皮功能与血清炎性因子的恢复,有益于提升患者生活质量,是急性脑梗死的理想用药。     

冠心病介入治疗后采用降同型半胱氨酸疗法的疗效及对炎性因子水平的影响

目的研究冠心病介入治疗后采用降同型半胱氨酸疗法的疗效及对炎性因子水平的影响。方法100例冠心病患者,均行介入治疗。根据患者术后治疗方法的不同分为对照组和观察组,各50例。对照组患者术后采用常规治疗,观察组患者术后在对照组的基础上加以降同型半胱氨酸疗法治疗。比较两组患者的炎性因子(血清同型半胱氨酸、C反应蛋白、白介素-6、可溶性细胞间粘附因子-1、降钙素原)水平,临床治疗效果,不良反应发生情况。结果观察组患者的血清同型半胱氨酸、C反应蛋白、白介素-6、可溶性细胞间粘附因子-1、降钙素原水平分别为(12.29±0.42)μmol/L、(42.67±2.62)mg/L、(67.78±3.12)μg/L、(139.76±45.75)ng/ml、(15.77±1.68)ng/ml,均低于对照组的(15.45±1.64)μmol/L、(65.45±3.34)mg/L、(83.75±3.45)μg/L、(234.76±56.34)ng/ml、(23.64±2.57)ng/ml,差异均具有统计学意义(P<0.05)。观察组患者的治疗总有效率为96.00%,高于对照组的70.00%,差异具有统计学意义(P<0.05)。观察组患者的不良反应发生率为8.00%,低于对照组的22.00%,差异具有统计学意义(P<0.05)。结论冠心病患者进行降同型半胱氨酸疗法治疗可以明显降低患者的炎性因子水平及不良反应发生率,提高临床治疗效果,保护患者的心肌功能,值得临床上推荐使用。     

降同型半胱氨酸疗法对冠心病介入治疗后患者炎性因子水平的影响分析

目的 分析降同型半胱氨酸疗法对冠心病介入治疗后患者炎性因子水平的影响。方法 96例冠心病介入治疗后患者,依据随机数字表法分为观察组与对照组,每组48例。对照组采用常规药物治疗,观察组在对照组基础上增加降同型半胱氨酸疗法治疗。比较两组治疗前后同型半胱氨酸及炎性因子水平、生存质量评分、心肌梗死发生率、不良反应发生情况。结果 治疗后,两组同型半胱氨酸、降钙素原、超敏C反应蛋白、血清淀粉样蛋白A水平均优于本组治疗前,且观察组同型半胱氨酸(10.56±1.21)μmol/L、降钙素原(0.56±0.21)ng/ml、超敏C反应蛋白(7.19±1.02)mg/L、血清淀粉样蛋白A(4.22±1.16)mg/L均优于对照组的(15.45±1.66)μmol/L、(1.45±0.28)ng/ml、(9.22±1.56)mg/L、(8.52±1.56)mg/L,差异均有统计学意义(P<0.05)。治疗后,两组物质生活、躯体功能、心理功能、社会功能评分均优于本组治疗前,且观察组物质生活、躯体功能、心理功能、社会功能评分分别为(92.12±6.94)、(93.21±5.23)、(93.12±4.94)...     

丁苯酞对急性脑梗死血清高敏C反应蛋白和同型半胱氨酸的影响

目的：通过采用丁苯酞治疗急性脑梗死患者,观察丁苯酞对血清高敏C反应蛋白和同型半胱氨酸的水平变化的影响。方法将76例急性脑梗死患者随机分为对照组和试验组。对照组即临床常规治疗组,试验组即在临床常规治疗的基础上加用丁苯酞,分别检测对照组和试验组在治疗前和治疗2周后急性脑梗死患者血清高敏C反应蛋白和血清同型半胱氨酸的水平。结果与治疗前相比,对照组和试验组患者在治疗后血清高敏C反应蛋白和血清同型半胱氨酸水平均显著降低,差异具有统计学意义（P＜0.05）;与治疗后的对照组相比,试验组患者血清高敏C反应蛋白和血清同型半胱氨酸水平均显著降低,差异具有统计学意义（P＜0.05）。结论丁苯酞能降低急性脑梗死患者血清高敏C反应蛋白和同型半胱氨酸水平。     

血清同型半胱氨酸与冠心病的相关性研究

目的探讨冠心病与血清同型半胱氨酸检测结果相关性。方法对研究组冠心病患者应于治疗前、后及对照组均实施血清同型半胱氨酸检测,记录其检测结果。结果研究组治疗前血清同型半胱氨酸检测结果为(18.27±3.34)μmol/L、对照组血清同型半胱氨酸检测结果为(11.79±1.55)μmol/L(P<0.05);研究组治疗后血清同型半胱氨酸检测结果(13.66±2.34)μmol/L较之前[(18.27±3.34)μmol/L]显著降低(P<0.05)。结论血清同型半胱氨酸检测结果可为临床医师提供准确的冠心病诊断依据,根据治疗前后Hcy水平变化情况有利于判断患者治疗效果并及时调整用药方案,对保障其疗效及预后均具有积极意义。     

近视影响因素的临床研究

目的 临床分析非病理性近视的病因及影响因素.方法 收集2009 -2011年我院眼科门诊1000例非病理性近视患者,记录屈光度数,采用自制调查表调查可能影响近视的相关因素,建立数据库,使用SPSS13.0统计软件对所获资料进行描述性统计分析.结果 近视与遗传因素和环境因素相关.结论 遗传因素、近距离工作、科学验光以及其他环境因素在近视眼的发病与发展中有重要的影响.     

心理社会因素在述情障碍病因中的研究

目的：探讨心理及社会因素在述情障碍病因中所产生的作用和影响。方法：42例述情障碍患者均列入研究组,另随机选取同期我院其他疾病治疗的,经诊断不存在述情障碍症状的患者40例列入对照组。结果：研究组患者心理评价总分（15.23±4.80）明显高于对照组（12.96±4.06）,数据经统计学比较具有显著差异（P〈0.01）;研究组患者社会支持总分（1.67±0.93）明显低于对照组（4.18±1.79）,数据经统计学比较具有显著差异（P〈0.01）。结论：心理社会因素对述情障碍的患病具有明显的影响作用。     

Influence of Risk and Protective Factors on Substance Use Outcomes Across Developmental Periods: A Comparison of Youth and Young Adults

Data were collected from samples of youth (ages 11–18; N = 38,268) and young 10 adults (ages 18–24; N = 602) across 30 Tennessee counties using surveys and telephone interviews conducted in 2006–2008. Data were analyzed using hierarchical nonlinear modeling to determine: (1) which risk and protective factors predicted alcohol and marijuana use, and (2) whether predictors differed as a function of developmental period. Findings provide preliminary evidence that prevention efforts need to take into consideration the changing environment and related influences as youth age, especially as they move from a more protected community environment to one where they live somewhat independently. Implications and limitations are discussed.     

功能性消化不良的精神心理因素研究进展

功能性消化不良是临床常见的疾病,常伴有焦虑、抑郁、躯体化障碍等心理障碍.而心理干预可改善功能性消化不良患者的症状,且抗焦虑或抗抑郁治疗对其也有明显的疗效.因此,就功能性消化不良与精神心理因素的关系及其目前的精神心理治疗现状作一综述.     

Acquired risk factors and susceptibility to environmental toxicants

Susceptibility to illness after exposure to environmental toxicants is determined by the interaction of numerous factors involving both constitutive and acquired traits. Constitutive susceptibility (risk) factors are the intrinsic traits determined by developmental stage, gender, and genetic makeup. Within a population, changes in constitutive risk factors tend to occur slowly, through aging, alterations in the birth or death rate, or by migration in or out of the population. Often overlooked is the effect of acquired susceptibility factors on susceptibility to environmental toxicants. Acquired susceptibility factors, which are related to the effects of living conditions, psychosocial factors, diet, behavior and access to medical care, may modify the effect of constitutive factors. Three examples demonstrate the interaction of acquired susceptibility factors with exposure and constitutive factors. The increased prevalence of asthma in children is suspected of having a strong environmental component but the underlying acquired susceptibility factors, if any, are difficult to identify because of the multifactorial nature of asthma and the use of surrogate risk factors such as parent's education. β-Carotene is a dietary component which may modify acquired susceptibility. While numerous observational studies find that dietary β-carotene reduces the risk of lung cancer in cigarette smokers, intervention studies do not support this role. Hepatitis B is an example of an infectious agent functioning as an acquired susceptibility factor. Hepatitis B synergistically increases the risk of hepatocellular carcinoma when accompanied by exposure to aflatoxin, a relationship that may be modified by constitutive risk factors, such as epoxide hydrolase capabilities. Acquired risk factors have the potential to greatly influence risk and their impact should be included in future studies of the health effects of environmental toxicants.     

Family Factors of Low-Income African-American Youth Associated with Substance Use

Abstract

Objectives: An extensive body of literature has identified several risk and protective factors for adolescent substance use. Several facets of family relationships have been identified in the general adolescent and African-American adolescent substance use literature. There are gaps in the knowledge base for African-American rural youth living in poverty and would benefit from further exploration. It is possible that this unique population may exhibit trends not seen in the general population or urban African-American adolescents.

Method: A sample of 826 African-American adolescents, living in rural low-income areas and ranging in age from 14 to 19 years old were given a survey of 294 questions. Topics of the survey ranged from school attendance and attitudinal questions to queries concerning risk behaviors such as gang activity and substance use. Only variables concerning the family of the adolescent were used in this analysis. An exploratory analysis was performed to determine the relationship of family relationship variables to African-American rural adolescent substance use.

Results: The results suggest that several factors, namely existence of family rules and parental monitoring, are significant factors in buffering adolescent substance use for alcohol, marijuana and cocaine. These factors proved to be significant across gender.

Conclusions: The parent-adolescent relationship is an important factor influencing adolescent substance use. Also, the quality and type of parental/adolescent relationship is important. This relationship should also be targeted when considering any intervention for treating these adolescents. Further research should be conducted in this domain.     

1例华法林过度抗凝治疗的原因分析

目的 分析导致患者发生过度抗凝的可能原因,并指导临床用药.方法 回顾病例资料,从遗传因素、环境因素等角度出发,查阅相关文献报道,探讨各因素与过度抗凝之间的相关性.结果 患者VKORC1基因型为突变纯合型,华法林抗凝期间合并使用苯溴马隆、注射用头孢尼西钠、阿托伐他汀钙片,维生素K摄入量减少,合并肝功能异常、心力衰竭两种疾病状态,且存在华法林给药方案调整欠妥当的问题,以上因素均可能在一定程度上导致患者的过度抗凝治疗.结论 临床药师应从遗传因素、环境因素各个角度出发,筛查发生过度抗凝的高危人群,及时给医生提出建议,减少过度抗凝的发生,促进临床用药安全.     

高尿酸血症与冠脉造影确诊的冠心病的相关性

目的:探讨高尿酸血症(HUA)与冠脉造影确诊的冠心病(CAD)的发生及严重程度的相关性。方法:对647例接受冠脉造影的患者测定各项临床指标,根据冠脉造影结果分为CAD组和对照组,以发生病变的血管支数及Gen?sini积分反映冠心病严重程度,分性别进行对照研究。结果:(1)女性CAD组的HUA比例高于对照组(P=0.012)。(2)HUA仅在女性是冠心病发生的影响因素(OR=2.022,95%CI:1.098~3.723,P=0.023),但在对年龄进行调整后,HUA亦未入选冠心病影响因素(OR=1.513,95%CI:0.778~2.931,P=0.221)。两性患有HUA都不是冠心病发生的独立危险因素。(3)女性病变血管支数的分布在HUA组与非HUA组之间差异有统计学意义(Z=2.51,P=0.01)。女性HUA患者的Gensini积分高于非HUA患者(P=0.04),且在女性的全组、HUA组及非HUA组Gensini积分与血尿酸水平均呈正相关(rs分别为0.181、0.291和0.138,P<0.05或P<0.01)。结论:女性HUA与冠心病的发生有一定关联,但不是独立危险因素。临床诊断中似应重视高龄女性HUA患者发生冠心病的危险。     

Religiosity as a Protective Factor Against the Use of Drugs

Although many studies have suggested that risk and protective factors are related to the use of drugs, their role has not been given due importance. More attention to protective factors could make them a fundamental tool in prevention programs. Since low socioeconomic level and adolescence are known as risk factors, the aim of this study was to identify which factors would prevent Brazilian adolescents from low-income families from using drugs. A qualitative method and an intentional sample selected by criteria were adopted for this investigation. During 2003, sixty-two youngsters, ages 16 to 24 years old, 30 drug users, and 32 nonusers were administered a semistructured interview. The subjects perceived family and religiosity as important protective factors in their lives. With regard to religiosity, 81% of nonusers believed in and practiced a religion, whereas only 13% of users considered themselves as being religious. The belief in and practice of a religion were also more evident among family members of nonusers (74%) than those of users (33%). These results indicated that religion may be a relevant protective factor for the sample studied, helping the family unit in keeping youth away from drugs. The study's limitations were noted.     

Investigation for the quality factors on the tablets containing medicated pellets

Sustained and controlled pellets are considered as one of the ideal dosage forms. Due to the large coverage area of pellets, loaded drugs can be absorbed completely in the body and bioavailability is improved correspondingly. Coated pellets-containing tablet is a special oral formulation consisting of various pellets with different release rate. Desired rate of drug release rate can be achieved by adjusting the proportion of pellets. However, this formulation faces strict requirements in the process of preparation. Several factors will influence release behavior of tablets, including pellet cores, coating, and tabletting. Therefore, these factors will be investigated sufficiently in this review to provide valuable information for manufacturing process.