- ISSN 1008-5734
- CN 11-4015/R
- 1999年创刊
- 主管: 中国科学技术协会
- 主办: 中华医学会
ObjectiveTo evaluate the efficacy and safety of concomitant use of mometasone furoate nasal spray and montelukast sodium chewable tablets in children with moderate to severe allergic rhinitis. Methods The subjects were selected from the children who were aged from 6 to 12 with moderate to severe allergic rhinitis and presented to outpatient department of Tongji Hospital, Tongji Medical College, Huazhong University of science and Technology from September 2011 to March 2012. According to the time order of treatment, the children were divided into the following 2 groups using randomized digital table: the combination therapy group and the mono-drug therapy group. The children were treated with mometasone furoate nasal spray 100 μg once daily plus one chewable tablet of montelukast sodium 5 mg once daily in the combination therapy group and mometasone furoate nasal spray alone 100 μg once daily in the mono-drug therapy group. The treatment course was 2 weeks in the 2 groups. On days 7 and 14 of treatment, the symptoms of allergic rhinitis were scored using 0-10 cm visual analogue scale, the adverse reactions were recorded, and the statistical analysis were performed in the 2 groups. ResultsA total of 252 children were entered in this study. The combination therapy group comprised 127 children, including 54 boys and 73 girls with average age of (8.1±2.6) years. The mono-drug therapy group comprised 125 children, including 58 boys and 67 girls with average age of (8.7±3.0) years. The differences in gender, age distribution，treatment course, general symptoms of allergic rhinitis, and single symptom of allergic rhinitis between the 2 groups were not statistically significant (P>0.05). Two children were withdrawn from the study due to joint pain, abdominal pain, and sleep disorders after the drug use. Compared with the scores before treatment, the scores of general symptoms of allergic rhinitis on days 7 and 14 of treatment decreased by (4.7±1.9) and (5.5±2.2) scores ［(2.6±1.7) and (1.8±1.7) vs (7.3±1.3) scores］ in the combination therapy group, (3.9±2.2) and (4.9±1.7) scores ［(3.2±2.0) and (2.3±2.1) scores vs (7.2±1.5) scores］ in the mono-drug therapy group. The differences before and after treatment in the 2 groups were statistically significant (P<0.05 for all comparison). The efficacy in the combination therapy group was better than that in the mono-drug therapy group(P<0.05). On days 7 and 14 of treatment, the efficacy for single symptom of runny nose or stuffy nose in children in the combination therapy group were better than that in the mono-drug therapy group (P<0.05 for all comparison). The differences in runny nose and stuffy nose scores between the 2 groups were statistically significant (P<0.05). The differences in sneezing and itchy nose scores between the 2 groups were not statistically significant (P>0.05). Five children presented with adverse reactions in the combination therapy group (3.9%); of them, mometasone furoate nasal spray-related adverse reactions were nasal bleeding (2 cases) and dry nose (1 case), and montelukast sodium chewable tablets-related adverse reactions were joint pain, abdominal pain (1 case), and sleep disorders (1 case). Four children (3.2%) in the mono-drug therapy group presented with adverse reactions, including 2 cases of nasal bleeding and 2 cases of dry nose. The difference in adverse reaction incidence between the 2 groups was not statistically significant (P>0.05). All adverse reactions in the 2 groups were mild, and resolved soon after drug withdrawal. No severe adverse reactions occurred in the 2 groups. ConclusionThe efficacy of the concomitant use of mometasone furoate nasal spray and montelukast sodium chewable tablets is better than that of mometasone furoate nasal spray alone. The combination therapy has a good safety.
ObjectiveTo observe the safety of low-dose dexmedetomidine used in children undergoing combined inhaled and intravenous general anesthesia with tracheal intubation in order to provide the basis for safe drug use in clinical practice. Methods The children, who were scheduled to undergo radical surgery for snoring and surgical correction of entropion at Wuhan Medical Health Center for Women and Children from January to July in 2011, were enrolled in the study. The children were randomly divided into three groups: group A (receiving an IV infusion of dexmedetomidine 0.5 μg/kg at the beginning of anesthesia induction), group B (receiving an IV infusion of dexmedetomidine 1.0 μg/kg at the beginning of anesthesia induction) and group C (receiving no dexmedeto-midine). Combined inhaled and intravenous general anesthesia with tracheal intubation was used in children in the three groups. The children’s heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), partial pressure of carbon dioxide in end-expiratory gas (PetCO2), tidal volume and respiratory rate were observed and recorded. The degree of sedation was scored. The incidences of respiratory depression and dysphoria in the three groups were recorded. ResultsA total of 120 children aged 4-11 years were enrolled in the study, and comprised 80 boys and 40 girls. Each group consisted of 40 children. There were no statistically significant in baseline characteristics and the operation time among the children in the three groups (all P＞0.05) . There was no statistically significant difference in SpO2, PetCO2, tidal volume and respiratory rate at different time points among the three groups (all P＞0.05). The cases of respiratory depression after operation in groups A, B and C were one case (2.5%) , 2 cases (5.0%) and 5 cases (12.5%), respectively. The degree of respiratory depression remitted after administration of hyperbaric oxygen via a face mask. HR decreased and MAP increased in the children in groups A and B after receiving dexmedetomidine, but the changes were in normal range and returned to the baseline spontaneously after receiving atropine. The incidence of dysphoria in groups A and B after operation was 5.0% (2/40) and 2.5% (1/40), respectively, and was significantly lower than that in group C (22.5%, 9/40) (P＜0.05 for all comparison). The incidence of excessive sedation in the children in the group B (12.5%, 5/40) was higher than that in the group A (2.5%, 1/40) (P＜0.05). ConclusionAn IV infusion of low-dose dexmedetomidine(0.5 μg/kg) used in children undergoing combined inhaled and intravenous general anesthesia with intracheal intubation could prevent respiratory depression and dysphoria after surgery, and it might be a safe and effective regimen.
ObjectiveTo explore the relationship between the cytotoxic T lymphocyte-associated antigen 4 gene (CTLA-4) polymorphisms and the liver injury caused by methimazole (MMI) in the Chinese Han patients with Graves disease (GD) in Shandong district. Methods The subjects were selected from out- and in-patients with GD at the Department of Endocrinology (the GD group), and the healthy people receiving physical examination at the medical center (the healthy control group) in the Affiliated Hospital of Qingdao University from March 2011 to April 2012. The GD group comprised 3 subgroups: the simple GD group, the MMI-induced liver injury group, and the hyperthyroidism-related liver injury group. Clot of non-anticoagulated blood from a peripheral vein in each subject was collected, genomic DNA was extracted, and genotypes at position 49 in exon 1 and position -318 in promoter region of CTLA-4 gene were detected using polymerase chain reaction-restriction fragment length polymorphism. The genotype and allele frequencies in all groups were calculated. ResultsA total of 160 GD patients were collected. Of them, 65 patients were in the simple GD group, including 10 males and 55 females with an average age of (40.4±14.4) years; 40 patients in the MMI-induced liver injury group, including 11 males and 29 females with an average age of (40.5±13.7) years; 55 patients in the hyperthyroidism-related liver injury group, including 9 males and 46 females with an average age of (38.0±12.9) years. Sixty-four healthy people were in the healthy control group, including 20 males and 44 females with an average age of (40.7±10.7) years. The differences in gender and age among all groups were not statistically significant (P>0.05). The genotype frequencies of AG+GG at position 49 in exon 1 of CTLA-4 gene in the GD and the health control groups were 91.9%(147/160)and 78.1% (50/64), respectively; the allele frequencies of G were 74.4% (238/320) and 59.4% (76/128), respectively; the differences in the 2 groups were statistically significant (χ2=8.153，P=0.004； χ2=6.259，P=0.012). The genotype frequencies of CT+TT and the allele frequencies of T at position -318 in promoter region of CTLA-4 gene between the GD and the health control groups were not statistically significant (P>0.05 for all comparisons). The differences in the genotype frequencies of AG+GG and the allele frequencies of G at position 49 in exon 1 of CTLA-4 gene, the genotype frequencies of CT+TT and the allele frequencies of T at position -318 in promoter region of CTLA-4 gene among the 3 subgroups in the GD group were not statistically significant (P>0.05 for all comparisons). ConclusionIn Chinese Han patients with GD in Shandong district, the polymorphisms of CTLA-4 gene at position 49 in exon 1 and -318 promoter region are not significantly related to MMI-caused liver injury, and the polymorphism of A/G at position 49 in exon 1 might be related to the pathogenesis of GD.
ObjectiveTo investigate the risk factors for linezolid-associated thrombocytopenia. Methods The clinical data of 162 in-patients receiving linezolid for infections in Zhongshan Hospital, Fudan University from January 2011 to July 2012 were collected and retrospectively analyzed. The patients were divided into the thrombocytopenia group and the normal platelet group according to the platelet count after linezolid administration. The main analytic indicators included sex, age, body weight，platelet count, serum creatinine clearance rate (Ccr),levels of albumin, hemoglobin, alanine aminotransferase(ALT)and aspartate aminotransferase (AST) before linezolid administration, dosage, administration route and duration of linezolid therapy, and the situation of drug combination. The correlated variables which affected platelet count were analyzed by t test, Mann-Whitney U test and Kruskal-Wallis H test, respectively. The selected risk factors were analyzed by stepwise Logistic regression, and the odds ratio (OR) and 95% confidence intervals (CI) were calculated. ResultsOne hundred and sixty-two patients comprised 113 male and 49 female with average age of (57.2±16.1) years. All of them received IV infusion of linezolid 600 mg twice daily. The duration of linezolid therapy was 1-46 days and the median time was 6 days. The platelet normal group comprised 115 cases and the thrombocytopenia group comprised 47 cases. The median time of thrombocytopenia onset in 47 patients was 4.5 days, the average count of platelet was (53±29)×109/L, the cases who developed mild, moderate and severe thrombocytopenia were 25,10 and 12, respectively. Stepwise Logistic regression analysis revealed the following results: before drug administration, the OR and 95% CI for Ccr＜50 ml/min were 6.75 and 2.93～15.58, P=0.000; the OR and 95% CI for platelet count＜100×109/L were 4.54 and 1.53～13.50, P=0.006; the OR and 95% CI for AST＞75 U/L were 2.73 and 1.07～6.99, P=0.036; the OR and 95% CI for duration of linezolid therapy＞14 days were 4.00 and 1.40～11.39, P=0.009. ConclusionThe Ccr and platelet count below normal, the AST level above normal before linezolid administration and the duration of linezolid therapy over 14 days may be the risk factors for linezolid-associated thrombocytopenia.
Drug-induced interstitial lung disease is the most common type of drug-inducedrespiratory diseases. It is known that a lot of drugs can cause interstitial lung diseases. The underlying mechanism may be associated with allergy and the direct cellular toxicity. Its clinical symptoms, imaging, and histopathology were untypical. Clinical diagnosis of the disease was based on the medical history (medication history), clinical features, chest imaging, histopathological changes, and response to treatment. If interstitial lung diseases were suspected to be drug-induced, the drug should be discontinued immediately and glucocorticoid could be given. The prognosis is good if intervention is rapid.
Benzodiazepines are mainly used to treat anxiety and insomnia. Prolonged use of benzodiazepines can lead to physical and psychological dependence. The mechanism of benzodiazepine dependence is related to central neurotransmitters such as γ-aminobutyric acid and glutamate acid. The risk factors for benzodiazepine dependence include drug selection, drug administration, and individual difference. The clinical manifestations of benzodiazepine dependence are increased tolerance to the drug, withdrawal symptoms, and psychological dependence. The treatment strategies for benzodiazepine dependence include the drug withdrawal, adjuvant treatment with drug, substitutive treatment, combined therapy of Chinese and western medicine, and psychotherapy.
Atorvastatin, a 3-hydroxy-3methylglutaryl-coenzmye A (HMG-CoA) reductase inhibitor, is a lipid-lowering drug with good effects on plasma lipids. Atorvastatin can cause dose-dependent increase in serum aminotransferase accompanied by an enlarged liver, jaundice, an increased direct bilirubin level, and a prolonged prothrombin time. The types of atorvastatin-induced liver injury are cytotoxic, cholestatic, and mixed. The mechanism of atorvastatin-induced cytotoxic liver injury may be related to breakage of hepatocyte chromosome DNA and change in hepatocyte morphology by competitive inhibition of HMG-CoA and ultimately causes hepatocyte apoptosis. The mechanism of atorvastatin-induced cholestatic liver injury may be related to the decreased expression or dysfunction of transporter, which located in sinusoidal membrane of hepatocytes and bile duct membrane, or may be related to the inhibited activity of bile salt and bile acid excretion relative transporter protein. The measures of treatment and prevention for atorvastatin-induced liver injury include: before atorvastatin administration, patients’liver function should be tested and the physician should be aware of patients’medical history, other medications, and alcohol habit; it is suggested that atorvastatin should be started at a small dose; if atorvastatin-induced mild-to-moderate increase in aminotransferase occurs, the dosage should be reduced and the patient might receive liver-protective drug; once severe liver injury appears, the drug should be discontinued immediately and symptomatic treatment should be given.
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