Beers标准是老年人用药安全的有力保障

多重用药在老年人中非常普遍,特别需要重视.优化药物治疗是老年人医疗的重要部分,也是对临床医师的挑战.美国老年医学会(AGS)制定的Beers标准是老年人用药安全的有力保障.     

Development of new drug-regimens against multidrug-resistant tuberculosis

Tuberculosis (TB) being the leading infectious killer in the domain wherein globally, almost 20% of all TB strains are resistant to at least 1 major TB drug and there's a growing incidence of multi-drug resistance tuberculosis (MDR-TB). Looking at the current scenario and challenges the existing strategies fall back in terms of treatment of TB. So, to overcome this new, stronger, improved TB drug pipeline and a new standard for the development of novel anti-TB drugs are required in order to make more drug-resistant and efficient drug which also lower the duration period of the treatment of the TB. This review article aims to highlight the recent developments in the anti-tuberculosis agents, those are currently in the clinical development stage.     

Does delayed urticaria induced by drug allergy exist?

With the help of a routine clinical case about delayed urticaria induced by drug, we have analyzed the scientific societies reports published during the last 5 years on this topic.We highlighted the differences between the EAACI consensus and documents on drug allergy, commenting their positions and some of their definitions on delayed urticaria.However, the question of disagreement between definitions of delayed urticaria can generate confusion. It would be beneficial to have more and “official” clearness about this topic because of its important clinical application to our patients.     

甘肃武威地区2006～2007年常见葡萄球菌感染及耐药状况分析

目的了解甘肃武威地区常见葡萄球菌感染及耐药状况,以更好地指导临床用药。方法将2006～2007年甘肃省武威市医院采集的320株葡萄球菌采用常规方法分离,用Vitek-32全自动微生物分析仪进行菌种鉴定及药敏试验。结果分离到金黄色葡萄球菌192株,表皮葡萄球菌86株,溶血性葡萄球菌42株。其中耐甲氧西林葡萄球菌213株,包括耐甲氧西林金黄色葡萄球菌118株（36．9％）,耐甲氧西林表皮葡萄球菌60株（18．8％）,耐甲氧西林溶血性葡萄球菌35株（10．9％）。耐甲氧西林金黄色葡萄球菌、表皮葡萄球菌和溶血性葡萄球菌均成多重耐药特征,未发现耐万古霉素、替考拉丁的葡萄球菌。结论耐甲氧西林葡萄球菌检出率呈明显上升趋势,合理使用抗生素,尤其万古霉素的使用,已成为当务之急。     

非小细胞肺癌肿瘤药敏与耐药基因MDR1、MRP、GST-π表达的相关性研究

目的研究非小细胞肺癌(NSCLC)多药耐药(MDR1)、谷胱甘肽转移酶(GST-π)、多药耐药相关蛋白(MRP)基因表达和肿瘤药物敏感试验之间的相关性及临床指导意义.方法 48例NSCLC(可手术)进入研究,药敏方法采用磷脂结合蛋白V(Annexin V)联合碘化丙啶(PI)双参数法,耐药基因MDR1、GST-π、MRP采用逆转录聚合酶链反应(RT-PCR)检测.结果抗癌药物检测显示紫杉醇(商品名泰素)、顺铂、去甲长春花碱、丝裂霉素、鬼臼乙叉甙、双氟胞苷、长春碱酰胺、长春新碱的平均抑瘤率分别为(15.7±21.8)%, (20.7±22.2)%,(7.9±16.2)%,(10.3±17.1)%,(9.7±20.1)%,(11.2±13.8)%,(5.6±14.9)%,(4.7 ±8.7)%.耐药基因MDR1、MRP、GST-π阳性率分别为67%(32/48),42%(20/48),48%(23/48).耐药基因MRP、GST-π阳性及阴性表达与病理类型之间未见明显相关;而在MDR1组中鳞癌及腺癌的MDR1阳性表达明显高于阴性表达组(P<0.05).NSCLC各期别中MDR1、MRP、GST-π阳性表达统计学上未见明显差异.在所检测的所有抗癌药物与MDR1耐药基因阳性与阴性表达未见相关性.MRP表达阳性者对去甲长春花碱、长春碱酰胺、长春新碱和丝裂霉素的肿瘤抑制率显著低于阴性表达组(P<0.05).而MRP表达与顺铂、鬼臼乙叉甙、紫杉醇肿瘤药敏未见明显相关.耐药基因GST-π阳性表达者对顺铂、去甲长春花碱、丝裂霉素的抑瘤率显著低于阴性表达组(P<0.05).结论肺癌耐药基因GST-π、MRP表达与部分化疗药物肿瘤药敏存在相关性,耐药基因检测对指导临床化疗药物的选择具有一定的帮助.     

药师干预对老年高血压患者用药依从性的影响

目的：探讨接受药师药物咨询对老年高血压患者用药依从性的影响。方法：随机抽取确诊的高血压患者曾接受药师药物咨询者（药物咨询组）和仅接受常规药物治疗者（常规治疗组）,各80例,在治疗前及治疗后1个月及3个月后用Morisky调查问卷评价用药依从性。结果：干预前药物咨询组和常规治疗组患者用药依从性佳者比例分别为20％和21．2％,两组无明显差异（P〉0．05）,1个月及3个月后药物咨询组依从性佳者比例分别上升至42．5％及57．6％,较常规治疗组的22．5％和23．7％显著升高（P〈0．01）。3个月后药物咨询组血压达标率明显高于常规治疗组（60．0％比42．5％,P〈0．05）。结论：药师药物咨询可显著提高病人用药依从性和疗效,药师在提高用药疗效方面能发挥重要作用。     

肺癌药敏与耐药基因MRP1、P-gp、GST-π和TopoⅡ表达的相关性研究

目的 研究多药耐药相关蛋白1 （MRP1）、P-糖蛋白（P-gp）、谷胱甘肽S转移酶-π（GST-π）、拓扑异构酶Ⅱ（TopoⅡ）基因表达和肺癌药物敏感试验相关性.方法 药物敏感试验采用MTT比色法,MRP1、P-gp、GST-π及TopoⅡ采用免疫组化检测.结果 MRP1、P-gp、GST-c及TopoⅡ在肺癌中总的阳性率分别为72.5％、67.5％、57.5％、50.0％.在鳞癌和腺癌中,这四种因子其表达无显著性差异（P＞0.05）,但P-gp、GST-π在鳞癌或腺癌中与在小细胞肺癌中表达有明显差异（P＜0.05）.P-gp和GST-π表达与顺铂、吉西他滨、长春瑞滨、紫杉醇耐药性呈正相关（P＜0.05）,与异环磷酰胺的耐药性无相关性（P ＞0.05）;MRP1的表达与顺铂、吉西他滨、长春瑞滨的耐药性均呈正相关（P＜0.05）,其表达与紫杉醇、异环磷酰胺的耐药性无相关性（P＞0.05）;TopoⅡ的表达与顺铂、吉西他滨、紫杉醇、异环磷酰胺的耐药性均呈正相关（P＜0.05）,其表达与长春瑞滨的耐药性无相关性（P＞0.05）.结论 MRP1、P-gp和GST-π的高表达及TopoⅡ的低表达共同介导参与了肺癌耐药的机制,且与检测的化疗药物耐药性有不同程度的相关性.     

228例初治培阳肺结核病人短化疗效与耐药性分析

目的　分析228例初治培阳肺结核病人其耐药性与短化疗效的关系。方法 病人治疗采用全程隔日间歇短化方案,(2R₃H₃E₃Z₃/4R₃H₃)。采用绝对浓度法进行药敏测定。结果 33例初治耐药肺结核病例,经6个月正规短程化疗失败率高达12.1%。 (1)对耐R类药物者化疗失败率为40%(2/5),敏感组化疗失败率为2.6% (5/195),两组有显著性差异 (P＜0.05);(2)对其他类 (不含耐R类)化疗失败率为7.1%,与敏感组比较无显著性差异 (P＞0.05)。二年随访耐药组细菌复发率为3.5%,敏感组细菌复发率为1.1%。结论 药物敏感病例和耐1种或2种药的病例 (不含耐R类)采用6个月短程化疗方案是合理有效的。     

Drug allergy in tertiary care in Turkey: Results of a national survey. The ADAPT study: Adult drug allergy perception in Turkey

BackgroundNo data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients.MethodsThis multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded.ResultsAmong 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH.ConclusionOur results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH.     

Homelessness and Gender in Out-of-Treatment Drug Users

This study examines 5225 out-of-treatment crack users and drug injectors drawn from five different geographic areas to examine selected factors associated with homelessness. Of these crack users, 27% considered themselves undomiciled, and 60% had previously entered some type of drug treatment. Logistic regression found that substance abusers who were married, female, and persons of color were less likely to be without a home when other variables were controlled. Trading sex for money and perceived chance of getting acquired immunodeficiency syndrome (AIDS) were associated positively with homelessness, while participating in methadone detoxification and methadone maintenance programs seemed to offer some protection from homelessness.     

抗炎保肝药物的作用机制及地位

肝脏炎症坏死及其所致的肝纤维化是疾病进展的主要病理学基础.因此,如能找出病因,在对病因治疗的基础上有效控制肝组织炎症,有可能减少肝细胞破坏和延缓肝纤维化的发展.     

抗炎保肝药在药物性肝损伤中的应用

肝脏是机体主要的解毒器官,在药物代谢中起着重要的作用,大多数药物在肝内经过生物转化而清除.而药物本身或其代谢产物可造成对肝脏的损害及病变.药物性肝损伤可发生在任何人群,且发生率逐年上升.据统计,我国药物性肝损伤占急性肝损伤住院病例的10%.国外报告在暴发性肝功能衰竭中,20%～50%与药物有关.     

Factors associated with the appropriate use of asthma drugs

BACKGROUND:

When used properly, asthma drugs can reduce asthma-related morbidity and mortality.

OBJECTIVE:

To assess the use of asthma drugs, and to identify factors associated with appropriateness of use among patients 12 to 45 years of age.

METHODS:

Asthmatic patients were interviewed about their asthma drug(s) use and the factors potentially associated with appropriateness of use according to the 2003 Canadian Asthma Consensus Conference guidelines. To determine the factors associated with the appropriate use of asthma drugs, a multivariate logistic regression model was built using a stepwise procedure, and ORs and associated 95% CIs were calculated.

RESULTS:

Of the 349 study participants, 43 (12.3%) reported appropriate use of their asthma drugs. Respondents who were more likely to report appropriate use were patients with sound knowledge of their asthma drugs (OR 2.61 [95% CI 1.29 to 5.29]), those in good, very good or excellent self-perceived health (OR 3.37 [95% CI 1.31 to 8.71]), those who had consulted a specialist during the preceding year (OR 2.28 [95% CI 1.05 to 4.97]) and those who declared themselves short of drugs due to a lack of money (OR 2.78 [95% CI 1.26 to 6.17]).

CONCLUSIONS:

Results of the present study suggested that recommendations in the current guidelines regarding the appropriate use of asthma medications are being poorly implemented. Educational interventions with the aim of improving quality of care and knowledge about asthma drugs should be offered.     

河南省结核病耐药水平对全程督导短程化疗效果的影响

目的探讨河南省结核病耐药水平对全程督导短程化疗效果的影响。方法于2001年8月至2002年6月，河南省与WHO合作开展了第2轮结核病耐药监测，采用比例法进行药敏试验，采用现代结核病控制策略的全程督导短程化疗技术（DOTS）对入选的痰涂片阳性肺结核患者1571例进行化疗。结果痰涂片阳性肺结核患者的治疗成功率为85．5％（1343／1571），其中初治成功率为89．6％（1159／1293）；耐药患者治疗成功率为76．6％（433／565），其中初治成功率为86．8％（341／393），复治成功率为53．5％（92／172）；耐多药患者治疗成功率为58．6％（126／215），其中初治成功率为75．4％（83／110），复治成功率为41．0％（43／105）。耐2～4种药物的初治患者的治疗成功率均显著高于复治患者。多因素分析结果表明，与治疗失败有统计学意义的相关因素为复治和耐2种及以上药物，与因结核病死亡有统计学意义的相关因素为复治、年龄较大和耐多药。结论河南省采用DOTS技术对初治肺结核患者治疗效果较好，对复治患者，尤其是对耐多药复治患者的疗效非常差。复治、年龄较大、耐2种及以上药物或耐多药是导致患者化疗效果差的危险因素。     

104例不同程度耐多药肺结核的临床分析

目的临床分析耐多药肺结核产生的相关因素和不同程度耐多药（MDRXDRTDR）肺结核病个体化治疗效果。方法采取回顾性分析。选择具有24个月临床观察结果者104例。采用计算机X^2检验。结果①耐多药产生：主要集中在不规律用药、原发耐药和规律用药完成疗程后。三者共占耐多药产生总原因的近80％，分别是31．7％、27．9％和20．2％。②MDR，XDR和TDR24个月痰菌阴转率分别为52．2％，40．9％和O；MDR和XDR之间治疗效果接近，无统计学显著差异（P〉0．05），而MDR和XDR分别与其TDR之间的治疗后比较则分别有显著统计学显著差异（P〈0．01）和统计学差异（P〈0．05）。结论对初治肺结核彻底治愈，应制定细则；警惕和早期发现耐药病例，尽早采取干预，以提高MDR—TPB的治愈率，减少和控制MDR—PTB的广泛传播。