脑心通胶囊辅助治疗不稳定型心绞痛的临床疗效和安全性的Meta 分析

摘要目的：系统评价脑心通胶囊辅助治疗不稳定型心绞痛的临床疗效及其安全性。方法：计算机检索PubMed(1966～2012.3)、 EMbase(1974～2012.3)、Cochrane Library(2012 年第3 期)、CBM(1978～2012.3)、CNKI(1994～2012.3)、VIP(1989～2012.3)。纳入脑 心通胶囊联合常规药物治疗不稳定型心绞痛的随机对照试验(RCT),并补充检索纳入研究的参考文献;按Cochrane 系统评价方法 对纳入研究进行资料提取及质量评估后,采用RevMan 5.1 软件进行统计学分析。结果：共纳入11 个RCT,包括共1384 例患者, Meta 分析结果显示：与常规药物治疗相比,脑心通胶囊联合常规药物明显缓解不稳定型心绞痛患者的临床症状,差异有统计学意 义[RR=1.24,95%CI(1.18-1.31),P<0.01],提高了心电图的改善率[RR=1.35,95%CI(1.24-1.47),P<0.01]。结论：目前研究表明脑心通 胶囊辅助治疗不稳定型心绞痛的短期疗效明显优于常规治疗,但其不良反应和远期疗效尚不确定,需要更多高质量随机对照试 验进一步证实。     

不稳定型心绞痛患者血小板计数对低分子肝素抗凝有效性的影响

目的:通过检测抗Xa因子活性,探讨不稳定型心绞痛患者血小板计数(PLT)对低分子肝素抗凝有效性的影响。方法:入选不稳定型心绞痛患者63例,分为两组,A组(n=24):PLT≥240×109/L,B组(n=39):PLT240×109/L。首先比较两组患者之间一般情况有无差异,而后在两组患者皮下注射那曲肝素前及注射后8 h两个时间点分别进行抗Xa因子活性检测并记录结果,分析两组患者抗Xa因子活性水平并比较活性低于0.5 IU·mL-1患者所占比例。结果:两组患者之间一般情况无显著性差异,抗Xa因子活性治疗前后差异在两组中均有统计学意义,A组治疗后抗Xa因子活性均值低于B组,抗Xa因子0.5 IU·mL-1的患者比率高于B组,组间比较差异显著。结论:在低分子肝素抗凝治疗中,血小板计数≥240×109/L的患者抗Xa因子活性较低,提示不稳定型心绞痛患者在应用低分子肝素后的抗凝力度不足与血小板计数偏高相关。     

前列地尔与益气复脉治疗老年心功能不全伴不稳定心绞痛的临床研究

目的:分析前列地尔与益气复脉治疗老年心功能不全伴不稳定心绞痛的临床效果。方法:选取2012年2月至2016年2月于我院诊治的心功能不全伴不稳定心绞痛老年患者300例,随机平均分为研究组和对照组各150例。对照组在常规治疗的基础上予以注射用益气复脉(冻干)治疗,研究组则在对照组基础上再予以前列地尔注射液治疗。分析比较两组患者的临床疗效、心电图疗效、心肌缺血发作情况以及心率、血流动力学指标的变化情况和不良反应的发生情况。结果:治疗后,研究组治疗后临床总有效率为96%,显著高于对照组(78%)(P0.05);研究组治疗后心电图总有效率为88%,显著高于对照组(64%)(P0.05);研究组心肌缺血的发作次数相比对照组降低程度更大,在各个时段以及总体的心肌缺血的平均发作次数均低于治疗前,且均低于对照组(P0.05);治疗后,两组患者的LVEF、CO、CI及MPI均明显升高(P0.05),而心率没有显著变化,研究组的LVEF、CO、CI及MPI显著高于对照组(P0.05);治疗期间,研究组的血管炎、血管疼痛的发生率显著高于对照组(P0.05),而其余不良反应发生率比较差异无统计学意义(P0.05)。结论:前列地尔与益气复脉治疗老年心功能不全伴不稳定心绞痛的疗效明显,可以减少心肌缺血的发作,改善血流动力学,且安全性高。     

氯吡格雷联合阿司匹林对冠心病心绞痛患者血清hs-CRP, TNF-alpha 及IL-6 水平的影响

目的：探讨氯吡格雷与阿司匹林对冠心病心绞痛患者血清炎症因子水平的影响及其临床疗效。方法：选择2014 年3月-2016 年3 月在我院确诊为冠心病心绞痛患者69 例作为研究对象,根据治疗方法不同,将患者随机分成研究组（39 例）和对照组（30 例）。对照组患者采用阿司匹林治疗,研究组患者在此基础上联合使用氯吡格雷治疗。观察并比较两组患者治疗前后血清高敏C- 反应蛋白(high-sensitivity C-reactive protein, hs-CRP)、肿瘤坏死因子-alpha（tumor necrosis factor-alpha, TNF-alpha）及白细胞介素-6 (interleukin-6, IL-6)水平的变化情况,以及临床疗效。结果：治疗前两组患者血清hs-CRP,IL-6 及TNF-alpha水平比较,差异无统计学 意义（P>0.05）;治疗后两组患者血清hs-CRP,IL-6 及TNF-alpha水平均低于治疗前,且研究组低于对照组,差异具有统计学意义（P<0. 05）。研究组患者临床总有效率（94.7%）高于对照组（88.9%）,差异具有统计学意义（P<0.05）。结论：氯吡格雷联合阿司匹林治疗冠 心病心绞痛的临床效果显著,能够降低患者血清hs-CRP,IL-6 及TNF-alpha炎症因子水平,值得临床推广应用。     

川芎嗪注射液对冠心病心绞痛患者临床症状及血液流变学的影响

目的:探讨川芎嗪注射液对冠心病(CHD)心绞痛患者临床症状及血液流变学的影响。方法:选择2014年3月至2016年3月在我院进行治疗的CHD心绞痛患者60例,按随机数字表法分为实验组和对照组各30例,对照组患者给予常规治疗,实验组患者在常规治疗基础上加用川芎嗪注射液治疗,两组患者均治疗20 d,比较两组患者临床疗效及治疗前后心绞痛症状、血液流变学指标和血脂指标。结果:实验组治疗后的总有效率高于对照组(P0.05)。两组治疗后心绞痛发作次数、发作时长均减少,且实验组少于对照组(P0.05)。治疗后,两组的全血黏度、血浆黏度、红细胞聚集指数、纤维蛋白原(Fib)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均低于治疗前,且实验组低于对照组,(P0.05)。结论:川芎嗪在治疗CHD心绞痛方面具有显著的疗效,不仅能够有效改善患者心绞痛症状,还能改善血液流变学异常情况,因此值得临床推广使用。     

Stabilizing HDAC11 with SAHA to assay slow-binding benzamide inhibitors

Among 18 human histone deacetylases (HDAC), HDAC11 is least studied. MS275, a benzamide HDAC inhibitor (HDACi), was stereotypically considered to selectively target Class I HDACs. We verified this slow-binding inhibitor also targeted HDAC11. In a traditional enzyme based assay, MS275 at low concentrations surprisingly behaved as an agonist. This was attributed to the poor stability of HDAC11 which lost 40% activity in 3 h at 37 °C. By adding 0.2 μM SAHA, HDAC11 activity was stabilized during the 3-h assay period. Since 0.2 μM SAHA inhibited 50% HDAC11 activity, the apparent IC₅₀′ of MS275 was adjusted to the true IC₅₀ = 0.65 μM. Finally, the new method demonstrated its superiority in one-dose-screening assays by decreasing false negative results. This work highlighted an optimized strategy to assay slow-binding inhibitors of unstable proteins with known fast-binding inhibitors. It should be especially useful in a hit-discovery stage to find moderate potent compounds.     

Analysis of progress curves of enzymatic reactions with unstable species

We present a general kinetic analysis of the Michaelis-Menten mechanism for the case in which the enzyme, the enzyme-substrate complex and the product are unstable. The kinetic data analysis which we suggest is based on the time progress curves of the product and/or on the time progress curve of the species into which the immediate product is transformed. This analysis, carried out under conditions of limiting enzyme concentration, allows the determination of the rate and equilibrium constants if adequate experimental results are available. We illustrate the method numerically by computer simulation of the reaction with added experimental errors.     

阿司匹林联合氯吡格雷治疗不稳定型心绞痛200例临床疗效分析

目的:探讨阿司匹林联合氯吡格雷治疗不稳定型心绞痛临床效果。方法:选取我院2012年7月-2013年6月不稳定型心绞痛患者200例,其中88例设置为对照组,在常规治疗基础上应用阿司匹林;观察组112例,在对照组基础上联合应用氯吡格雷治疗。结果:观察组效果评分为3.87±0.03,高于对照组3.24±0.05(P0.05);观察组心绞痛持续时间和心绞痛发作频率分别为3.18±0.03 min和1.39±0.02次/d,均低于对照组3.62±0.07 min和2.81±0.03次/d(P0.05);观察组血浆黏度、红细胞压积和红细胞聚积指数分别为0.78±0.02 P a o s,0.33±0.02 L/L和7.13±0.04(P0.05),均低于对照组(P0.05);两组结果比较差异均有统计学意义(P0.05);两组不良反应结果比较差异均无统计学意义(P0.05)。结论:阿司匹林联合氯吡格雷治疗不稳定型心绞痛疗效确切,可以进一步提高患者血流变学指标。     

Inverse effects of recent warming on trees growing at the low and high altitudes of the Dabie Mountains,subtropical China

Understanding how tree rings of different species at different elevations respond to climate, and whether their relationship is stable over time is crucial not only for credible palaeoclimatic reconstructions, but also for better awareness of forest growth dynamics and therefore making scientific management decisions against a background of global warming. In this work, six tree-ring chronologies of Pinus taiwanensis at three sites from 800 to 1550 m above sea level (asl), and Pinus massoniana at three sites from 500 to 650 m asl were developed in the Dabie Mountains (DBS), subtropical China. In recent decades, only P. taiwanensis at 1550 m asl showed a positive growth-trend. Both P. taiwanensis at 800 m asl and three low-altitude P. massoniana at 500–650 m asl showed negative growth trends. Climate-growth relationship analyses revealed that 1) temperature was the dominant climatic factor that controlled tree-ring growth in DBS. It exerted most influence on trees growing at the lower and upper limit, than for trees growing at altitudes from 650 to 1450 m asl. Only precipitation in October positively influenced tree growth of P. massoniana at all three sites and P. taiwanensis at 800 m asl; 2) There was a shift in temperature’s impact on trees, that was from significantly negative relationship at the four lower altitudes, mainly for the current growing-season, to significantly positive relationship in previous February–July period at the highest altitude. The higher the altitude, the more significant the lag effect of temperature on trees; 3) The influence of temperature on tree growth at most altitudes were variable over time. The positive influence of temperature on trees at 1550 and 1450 m asl was comparatively stable during the early period of instrumental records. It strengthened evidently since the early 1990s, which is coincidental with the timing of the evident temperature increase in DBS. On the contrary, the negative impacts of temperature on tree growth at 800, 650 and 500 m asl had weakened since the early 1990s. Besides the increase of water use efficiency of trees, we speculated that the increasing influence of precipitation in May and July weakened the relationship between temperature and tree rings at low altitudes. This work points out that the upper and lower limits of forest in DBS offer the preferred locations for future sampling in climate reconstruction, but the stability of tree growth and climate over time should be considered. Moreover, forest management should give priority to altitude factors, in addition to tree species representation.     

120 例不稳定型心绞痛的地尔硫卓治疗临床观察

目的:探讨地尔硫卓治疗不稳定型心绞痛的临床疗效,以供医生参考使用。方法:将我院2010年1月~2011年5月收治的120例不稳定型心绞痛的患者随机分为两组,对照组患者给予硝酸甘油,实验组患者给予地尔硫卓,比较两组患者的治疗效果。结果:实验组患者的总有效率为93.33%(56/60),对照组患者总有效率为78.33%(47/60),实验组明显优于对照组患者,P<0.05。结论:地尔硫卓治疗不稳定型心绞痛具有较好的疗效,值得在临床应用。