2010 Volume 12 Issue 2 Published: 28 April 2010

  

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临床论著

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  临床论著

  Efficacy and safety of long-term therapy with telbivudine compared to lamivudine in patients with chronic hepatitis B: a randomized controlled study

  Li Weili;Ma Xiuyun;Wu Lu;Cai Haodong

  2010, 12(2): 77-6.

  Abstract ( ) PDF ( )

  Objective: To compare the efficacy and safety of longterm treatment with tebivudine versus lamivudine in patients with chronic hepatitis B. Methods: Thirty-nine patients with chronic hepatitis B in accordance with inclusion criteria were enrolled in the study from March 2004 to February 2005. Thirtynine patients were randomly divided into two groups and received doubleblind therapy: the tebivudine group (22 cases) and the lamivudine group (17cases). The tebivudine group comprised 18 men and 4 women with average age of (30.9±7.8) years and the patients were given tebivudine 600mg once daily for 104 weeks. The lamivudine group comprised 13 men and 4 women with average age of （30.4±8.5）years and the patients were given lamivudine 100mg once daily for 104 weeks. After 104 weeks, all patients in the two groups received openlabel tebivudine therapy and were given tebivudine 600mg once daily for another 104 weeks. The serum HBV DNA levels, complete response rates and ALT levels were measured every 8 weeks. The Seroconversion of HBeAg after 104 weeks of therapy and the viral breakthrough rates as well as the adverse reactions of tebivudine during the treatment were observed in the two groups. Results: In the tebivudine and lamivudine groups at weeks 52 and 104 of the doubleblind therapy, the complete response rates of HBV DNA were 72.2%（16/22）and 77.3%（17/22），47.1%（8/17）and 47.1%（8/17）, respectively; the ALT normalization rates were 100%（22/22）and 86.4%（19/22），82.3%（14/17）and 76.5%（13/17）, respectively. The HBV DNA breakthrough rates were respectively 4.5%（1/22）, 18.2%（4/22）, and 28.6%（6/21） in the tebivudine group at weeks 60, 104 and in year 3, but there was no increase in cases of breakthrough in year 4; the HBV DNA breakthrough rates were 23.5%（4/17）and 41.2%（7/17）respectively at weeks 52 and 104 in the lamivudine group. The levels of HBV DNA in 4 patients with lamivudine resistance in the two groups decreased to the lower limit of detectable value after treatment combined with adefovir for 8-24 weeks. Five patients experienced 9 episodes of elevated creatine kinase (CK) levels [(1 065~4 915)U/L] without muscle symptoms in the tebivudine group during the doubleblind therapy; and 6 patients experienced 9 episodes of elevated CK levels [(1 036～45 984)U/L] with muscle symptoms during the open-label tebivudine therapy. Conclusion: Telbivudine is more effective than lamivudine in the treatment of patients with chronic hepatitis B，and the drug is well tolerated.

实验论著

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  实验论著

  Effects of a single intravenous injection of Lianbizhi on endogenous metabolite in rat urine

  Hu Zhonghui;Wu Chunqi;Wang Quanjun;Wang Qingxiu;Yang Baohua;Shi Chang;Liao Mingyang

  2010, 12(2): 83-8.

  Abstract ( ) PDF ( )

  Objective: To observe the effects of a single injection of Lianbizhi on the endogenous metabolite in SD rat urine using metabonomics technique in order to explore the mechanisms of Lianbizhi-induced renal damage. Methods:Two kinds of Lianbizhi injections were used in this experiment as follow: Lianbizhi A containing andrographolide sodium bisulfis 98.7% and other related substance 1.3%, Lianbizhi B containing andrographolide sodium bisulfis 49.1% and other related substance 50.9%. Twenty five SPF male SD rats were randomly divided into five groups: the high-dose（1 600 mg/kg）and low-dose (400 mg/kg) Lianbizhi A groups, the high-dose（400 mg/kg）and low-dose (100 mg/kg) Lianbizhi B groups, and the control group (normal saline). Each group comprised 5 rats. All rats received respectively a single intravenous injection of Lianbizhi 10 mL/kg via caudal vein. The rat urine samples were collected over a 12 hours period before dosing, as well as within 0~6, 7~12, 13~24 and 25~48 hours after dosing respectively, and 1H nuclear magnetic resonance (¹H NMR) spectra of urine samples were measured. The blood biochemical indices were measured 48 hours after dosing. Results: The results of blood biochemical indices testing showed that the ALP level in the high-dose Lianbizhi A group and highdose Lianbizhi B group were respectively (306±13) and (294±45) U/L ,which were higher than that [(207±47) U/L] in the control group. The ALB levels in the high-dose Lianbizhi A and Lianbizhi B groups were respectively (28.26±1.07) and (27.34±1.01) U/L, which were higher than that [(25.70±0.37) U/L] in the control group. The TP levels in the highdose Lianbizhi A and Lianbizhi B groups were respectively (51.32±3.36) and (50.10±2.36) g/L, which were higher than that [(45.76±1.73 )g/L] in the control group, all differences were statistically significant (all P＜0.05）. In addition, the BUN levels in the high and low-dose Lianbizhi A groups as well as high-dose Lianbizhi B group were respectively (6.94±0.49), (6.69±0.31), and (6.81±0.38) mmol/L, which were higher than that [(5.90±0.45 ) mmol/L] in the control group, the differences were statistically significant ( P＜0.05）. The TG levels in the high- and low-dose Lianbizhi B groups were respectively (1.13±0.36) and (0.84±0.18)mmol/L, which were higher than that [(0.57±0.10) mmol/L] in the control group, the differences were statistically significant ( P＜0.05). No marked changes were found in other blood biochemical indices. The time-course trajectories diagram of the urinary ¹H NMR revealed the urinary metabolic profiles in all rats after dosing initially deviated from and subsequently returned to the levels of the control group. The principle components analysis (PCA) of ¹H NMR at different time periods showed there was no significant difference in the rat urinary metabolic profiles among the 5 groups before dosing. The metabolic profiles in the drug-exposed groups could be distinguished from those in the control group, and the metabolic profile in the high-dose Lianbizhi B group deviated farthest from those in the control group 0-6 hours after dosing. Meanwhile, the trimethylamine（δ2.90）and dimethylglycine（δ2.94）levels increased and the citric acid （δ2.54，δ2.66）and α-ketoglutarate（δ2.46，δ3.02）levels decreased in the drugexposed groups compared with the control group. The metabolic profiles in the drug-exposed groups could be distinguished from those in the control group 7-12 hours after dosing . Compared with the control group, citric acid and α-ketoglutarate in the drug-exposed groups decreased and the TMA and DMG levels in the high- and low-dose Lianbizhi A groups and high-dose Lianbizhi B group increased. The metabolic profiles in the drugexposed groups could not distinguished from those in the control group within 13-48 hours after dosing and the metabolic profiles in the drug-exposed groups gradually returned to the levels of the control group. Conclusion:There is a correlation between the contents of other related substance in the Lianbizhi injection and the changes in the levels of rat urine endogenous metabolites. And the decrease in the levels of citric acid and α-ketoglutarate as well as the increase in the levels of trimethylamine and dimethylglycine suggest that the mechanism of renal damage caused by Lianbizhi injection may be related to its effects affecting the energy metabolism of mitochondria and osmotic pressure in renal medulla.
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  Acute renal damage related to Lianbizhi injection in three patients

  Wang Yonga;Liu Haiyanb;Xie Jianzhongb

  2010, 12(2): 90-2.

  Abstract ( ) PDF ( )

  Three patients( 1man and 2 women aged 1845 years ) received an IV infusion of Lianbizhi injection 0.5 g in 5% glucose injection 250ml once daily. On days 2 or 3 of therapy, lumbago appeared. Renal function tests revealed the following values: BUN 9.6~15.3 mmol/L, SCr 233.0~550.0 μmol/L, blood uric acid 553.0~722.0 μmol/L. Lianbizhi injection was withdrawn immediately and symptomatic and supportive treatments were given. Their symptoms subsided and renal functions returned to within normal range.

实验论著

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  实验论著

  Effects of Dioscorea bulbifera rhizome and Dioscorea bulbifera rhizome plus Angelica sinensis root on expression of grp78 and bad genes in rat livers

  Tang Qing;Liu Shumin**;Wang Jiazhi;Zhou Qi;Liu Tianyu

  2010, 12(2): 91-5.

  Abstract ( ) PDF ( )

  Objective: To study the expression of grp78 and bad genes in rat livers after giving Dioscorea bulbifera rhizome alone and Dioscorea bulbifera rhizome plus Angelica sinensis root in order to explore the mechanism of Dioscorea bulbifera rhizome induced liver damage and actions of Angelica sinensis root on alleviation of liver damage induced by Dioscorea bulbifera rhizome. Methods:A total of 30 clean grade SD male rats were divided randomly into three groups: the Dioscorea bulbifera rhizome group, the Dioscorea bulbifera rhizome plus Angelica sinensis root group and the control group. Each group comprised 10 rats. The rats in the 3 groups mentioned above were respectively gavaged with 2 mL of the suspension of Dioscorea bulbifera rhizome extracts (1 mL of the suspension was equivalent to Dioscorea bulbifera rhizome 0.067g), 2 mL of the suspension of Dioscorea bulbifera rhizome extracts plus Angelica sinensis root extracts (1 mL of the suspension was equivalent to Dioscorea bulbifera rhizome 0.067 g and Angelica sinensis root 0.133 g), and 2 mL of 0.5% sodium carboxymethyl cellulose (CMC) solution twice daily for 14 days. The expression of grp78 and bad genes in rat livers were measured by quantitative realtime PCR (real time Q-PCR) 24 hours after the last administration. Results:After it was corrected by housekeeping gene gapdh, the expression of grp78 and bad genes in rat livers in the three groups were as follows: 2-△△Ct of grp78 and bad genes in the Dioscorea bulbifera rhizome group were 339.9 and 256.2, respectively; 17.0 and 9.9 in the Dioscorea bulbifera rhizome plus Angelica sinensis root group, respectively; 1.0 and 1.0 in the control group, respectively. The expression of grp78 and bad genes were upregulated in the Dioscorea bulbifera rhizome group compared with the control group. The difference was significant（P<0.01）. The expression of grp78 and bad genes were downregulated in the Dioscorea bulbifera rhizome plus Angelica sinensis
  root group compared with the Dioscorea bulbifera rhizome group. The difference was significant（P<0.01）. Conclusion:Dioscorea bulbifera rhizome can increase the expression of grp78 and bad genes in rat livers，which may be the mechanism of liver damage induced by Dioscorea bulbifera rhizome. Antagonistic actions of Angelica sinensis root on the expression of Dioscorea bulbifera rhizome-induced up-regulated grp78 and bad genes in rat livers is one of the possible mechanisms of alleviation of Dioscorea bulbifera rhizomeinduced liver damage.

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  实验论著

  Analysis of drug resistance of Acinetobacter baumannii and Pseudomonas aeruginosa during the period 2006-2009

  Bai Shuyuan;Wang Peichang*;Li Yan;Zhang Lili;Min Rong;Zhang Hongyan;Wang Yuying;Shang Jing

  2010, 12(2): 96-4.

  Abstract ( ) PDF ( )

  Objective: To investigate the trend in development of resistance of Acinetobacter baumannii and Pseudomonas aeruginosa to 15 different kinds of commonly used antibacterial agents in clinical practice in order to provide a basis for appropriate selection of antibacterial agents. Methods:The strains of Acinetobacter baumannii and Pseudomonas aeruginosa were isolated from blood, urine, sputum, pus and other specimens from inpatients in Xuanwu Hospital of Capital Medical University during the period 20062009. The identification of bacteria and antimicrobial susceptibility testing were performed by a routine method and VITEK 32 automatic measurement system. The results were evaluated according to CLSI 2008. Results:Isolation rates of Acinetobacter baumannii during the period 20062009 were 8.7%（251/2 885）, 7.6%（218/2 868）, 7.6%（172/2 263）and 13.1%（396/3 023）, respectively. The isolation rate in 2009 increased markedly. Isolation rates of Pseudomonas aeruginosa during the period 20062009 were 14.5%（417/2 885）,13.3%（382/2 868）,14.1%（319/2 263）and 10.7%（322/3 023）, respectively. The isolation rate decreased year by year. Resistance rates of Acinetobacter baumannii to 12 different types of antibacterial agents during the period 20062009 increased: resistance rate of Acinetobacter baumannii to imipenem and meropenem were 10.4% and 11.2% in 2006 and increased to 56.3% and 57.1% in 2009, respectively. Resistance rate of Acinetobacter baumannii to cefepime and piperacillintazobactam were 22.7% and 20.3% in 2006 and increased to 64.1% and 52.5% in 2009, respectively . The resistance rate of Acinetobacter baumannii to cefoperazone-sulbactam was the lowest (26.8%) in the 15 antibacterial agents and that to other 14 antibacterial agents was higher than 50%. Resistance rates of Pseudomonas aeruginosa to piperacillintazobactam and cefepime were 22.8% and 18.6 % in 2006 and increased to 29.2% and 38.8% in 2009, respectively. Resistance rates of Pseudomonas aeruginosa to imipenem and levofloxacin were 42.4% and 45.8% in 2006, and decreased to 35.4% and 37.9% in 2009, respectively, and those to other 11 antibacterial agents were stable. The resistance rate of Pseudomonas aeruginosa to cefoperazonesulbactam in 2009 was the lowest (15.0%). Conclusion: Analysis of the resistance rate of Acinetobacter baumannii and Pseudomonas aeruginosa is beneficial to the appropriate choice of antibacterial agents and preventing transmission of drug-resistant strains.Ceroperazone-sulbactam may be considered the drug of choice in the treatment of the infections caused by the two bacteria.

调查研究

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  调查研究

  Analysis of rationality of antibacterial use in oral and maxillofacial surgery in perioperation period

  Han Rui;Duan Jingli;

  2010, 12(2): 100-5.

  Abstract ( ) PDF ( )

  Objective: To analyze and evaluate the rationality of antibacterial use in patients undergoing oral and maxillofacial surgery in the perioperation period in order to raise the level of rational antibacterial use. Methods: Case records were randomly collected from the 4 037 patients discharged from Peking University Hospital of Stomatology following undergoing oral and maxillofacial surgery during the period from January to December 2009. The patients’sex, age, operation type, and the situation of antibacterial use in the perioperation period were retrospectively investigated and analyzed, and the rationality of antibacterial use was evaluated. Results: A total of 997 case records was colleted. These patients comprised 506 males (50.75%) and 491 females (49.25%) with average age of 31 years. Of them, 167 patients were ≥60 years, 217 patients≤10 years. The patients undergoing clean, cleancontaminated, and contaminated surgeries were 183 cases (18.36%), 806 cases (80.84%), and 8 cases (0.80%), respectively. All patients received antibacterials. Of them, 486 patients (48.75%) received a single antibacterial agent and 511 patients (51.25%) received a combination of two antibacterial agents. The three classes of most commonly used antibacterials were successively penicillins (581 cases, 38.53%), nitroimidazoles (447 cases, 29.64%), and cephalosporins (321 cases, 21.29%). The patients receiving metronidazole combined with penicillin as well as metronidazole combined with cefuroxime were 233 cases (45.6%) and 210 cases (41.1%), respectively. Before surgery, the antibacterials used for prophylaxis were given mainly by intravenous route, but 2 cases by oral route. The timing of antibacterials used for surgical prophylaxis (0.5-2.0 h before surgery) was rational to 979 patients; of them, the patients undergoing clean，cleancontaminated and contaminated surgeries were 181 cases (98.91%), 790 cases (98.01%), and 8 cases (100%), respectively. The timing of antibacterials used for surgical prophylaxis was irrational to 18 patients; of them, fourteen patients received antibacterials <0.5 hours before surgery and four 2.5 hours before surgery. The duration of antibacterial use after surgery was rational or basically rational to 804 patients; of them, the patients undergoing clean, cleancontaminated, and contaminated surgeries were 125 cases (68.31%), 671 cases (83.25%), and 8 cases (100%), respectively. Antibacterial use was irrational in 193 patients; the main problem was prolonged drug use, and the longest was 10 days. In the perioperation period, rational and basically rational antibacterial use were respectively 47 cases (4.71%) and 686 (68.81%), the total was 733 (73.52%). Of them, clean, cleancontaminated, and contaminated surgeries were 121, 605, and 7 cases, respectively. Antibacterial use were irrational in 264 patients (26.48%). Conclusion: The inappropriate antibacterial use in oral and maxillofacial surgery in the perioperation period includes drug use without indication, improper drug selection, improper timing of antibacterials used for surgical prophylaxis, and prolonged use of antibacterials after surgery. Therefore, further implementing the guidelines related to clinical antibacterial use and strengthening the education of appropriate drug use are essential.

安全用药

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  安全用药

  Statin-induced erectile dysfunction

  Lei Zhaobao

  2010, 12(2): 105-4.

  Abstract ( ) PDF ( )

  Statins are inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA） reductase .They have actions on reduction of endogenous cholesterol synthesis and are mainly used for the treatment of hypercholesterolemia, mixed hypercholesterolemia, and for the prevention of coronary heart disease and stroke. The most common adverse reactions of statins are diarrhea, nausea, headache and rash. Erectile dysfunction (ED) in association with statins was first reported by Bruckert in 1996. A total of 4 471 case reports of statininduced adverse reactions were collected by French Pharmacovigilance System from 1 January 1985 to 31 December 2006.Of them, 51 reports(1.14%) were statin-induced ED, including simvastatin (19 cases), atorvastatin (18 cases), pravastatin (8 cases), rosuvastatin (4 cases), and fluvastatin (2 cases). The mean time to ED onset after starting statins was 62 days (median 29 days, range 1-100 days): 25% of patients within 9 days and 75% of patients within 75 days after starting statins. Approximately 57% of cases recovered after withdrawal of statins. The mechanism of statin-induced ED may be attributed to the influence of cholesterol reduction on steroid hormone (including testosterone) synthesis, as well as individual differences and psychological state. The preventive and therapeutic measures are as follows: concomitant use of drugs that may caused ED should be avoided, such as antipsychotics, tricyclic antidepressants, fibrate lipid-lowering drugs, and β-blockers; if ED induced by statins is confirmed,the statins should be discontinued or changed to other lipid-lowering drugs.
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  安全用药

  Clinical features and mechanism of acute intravascular hemolysis induced by puerarin injection and its safe use

  Wang Hongbao;Guo Lin;Guan Yongbiao*

  2010, 12(2): 109-5.

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  Puerarin is a kind of isoflavones extracted from dried roots of Pueraria lobata (Willd.) Ohwi or Pueraria thomsonii benth.. Puerarin injection is used in the treatment of cardiovascular and cerebrovascular diseases. In recent years, reports about acute intravascular hemolysis induced by puerarin injection have increased. By searching domestic related literature between 1993 and 2005, 32 patients with puerarin injectioninduced acute intravascular hemolysis were collected. They comprised 21 men and 11 women with average age of (69±9) years. Of them, 10 patients died with average age of (72 ± 5) years. Of 25 patients with complete data, 21 patients received puerarin injection alone and 3 received combination therapy; and intravenous infusion of puerarin 100700 mg dissolved in 0.9% sodium chloride or 5% glucose was given; the duration of drug use was 5-10 days in 22 cases and >10 days in 3 cases. The clinical manifestations of intravascular hemolysis were mainly lumbago, backache, hematuria, oliguria, hemoglobinuria, increased reticulocyte count(0.05-0.30), and hyperbilirubinemia(29.1-123.2μmol/L).Twentytwo patients’symptoms disappeared or stabilized after stopping drug therapy and giving glucocorticoid, antihistamines or hemodialysis treatment. The possible factors for puerarin injectioninduced intravascular hemolysis were the quality of puerarin injection, allergic diathesis and age of patients, duration of drug use, and combination therapy. The mechanism may be related to immune and nonimmune response induced by puerarin injection or its promoting oxidative reaction. The preventive measures are as follows: puerarin injection should not be given to patients with allergic history; the dosage should be adjusted to patients with advanced age, renal and hepatic insufficiency; concomitant use with drugs that may cause hemolysis should be exercise with caution.

病例报告

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  病例报告

  Severe erythema multiformetype drug eruption induced by paracetamol, pseudoephedrine hydrochloride and dextromethorphan hydrobromide tabletsⅡ /paracetamol, pseudoephedrine hydrochloride, diphenhydramine hydrochloride and dextromethorphan hydrobromide tablets

  Zhang Xiuhong;Lu Yi

  2010, 12(2): 113-2.

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  A 55year old woman received initially one tablet of paracetamol, pseudoephedrine hydrocholoride and dextromethorphan hydrobromide Tablets Ⅱ (day use tablets), and subsequently one tablet of paracetamol, pseudoephedrine hydrochloride, diphenhydramine hydrochloride and dextromethorphan hydrobromide tablets (night use tablets). Two weeks later, the patient developed facial erythema which gradually increased and progressed to involve her trunk and extremities. Meanwhile she experienced oral mucosa erosion, conjunctiva hyperemia, erosion in palpebral margin, numerous vesicles on toes, as well as erythema in labium majus. Her temperature was 39.2℃. Routine urine tests revealed the following values: WBC 182.2 cells/μL, RBC 89.6 cells/μL, ketone(+), leukocyte esterase(++), glucose(++++), occult blood(+++). She was given antiallergic, preventing infective, symptomatic, and supportive treatments. Four days later, her condition improved and the erythema disappeared after 13 days.

中毒救治

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  中毒救治

  Clinical manifestations and management of botulinum toxin poisoning due to cosmetic procedures in 6 patients

  Qiu Zewu;Wang Zhe;Peng Xiaobo;Shen wei;Sun Chengwen;Jiang Yanping

  2010, 12(2): 114-3.

  Abstract ( ) PDF ( )

  Botulinum toxin(BTX) is a neurotoxin produced by Clostridium botulinum. BTX poisoning could cause multiple organ dysfunctions. All 6 patients were women aged 25-55 years. They developed poisoning symptoms 2-9 days after starting injection of BTX. Clinical manifestations included blepharoptosis, dysphagia, blurred vision, barylalia, weakness in the extremities, dyspnea, insomnia accompanied by agitation, and so on. One of them experienced respiratory failure Ⅱ. All the patients received anti-infection, nutritional support, anxiolytic and symptomatic therapy. Meanwhile the patients with severe poisoning received ventilator support and hemoperfusion. All patients recovered and were discharged.
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  中毒救治

  Clinical manifestations of acute methamphetamine poisoning and management

  Wu Liyonga;Che Linhaia;Liu Fangyanb;Li Yalinb;Tang Huib;Xing Xiurongb;Sun Changyib;Qin Jianb;Jia Jianpinga

  2010, 12(2): 117-3.

  Abstract ( )

  Methamphetamine, commonly called as ice (MA), is illegal drugs. MA abuse could cause severe psychiatric and physical disorders even lifethreatening reactions. A 28-year-old man had a history of MA abuse for one year and more and he took MA four to five times every month on average. The patient experienced 5~6 episodes of agitation, confusion, convulsion of extremities, and trismus within 4 hours, and each episode lasted for 3~5 minutes. He subsequently was admitted to hospital. Physical examination showed temperature of 38.5℃, a BP of 140/90 mm Hg, a respiratory rate of 30 breaths/min, and a heart rate of 120 beats/min, delirium, confusion, sluggish light reflex, agitation, and generalized polyhydrosis. Toxicological analysis revealed the following results: serum MA 0.2 μg/ml, serum amphetamine 0.1 μg/ml, urine MA 12.3 μg/ml, urine amphetamine 1.3 μg/ml. MA serum concentration reached a fatal dose of the drug. He underwent endotracheal intubation and ventilator support. Meanwhile he was given symptomatic and supportive treatments. Two days later, he returned to consciousness and spontaneous respiration. The patient was discharged after six days of hospitalization in the intensive care unit.
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  中毒救治

  Acute mercury poisoning attributed to Chinese herbal medicine pills containing calomel

  Li An;Sun Limei;Wang Dixin

  2010, 12(2): 120-2.

  Abstract ( ) PDF ( )

  A 46-year-old man received one Chinese herbal medicine pill prepared by a clinic ( each pill contained approximately 21 mg of calomel ) twice daily and he took 13 pills in total. On day 7, the patient developed dizziness, chest distress, and mouth ulcer accompanied by fever and generalized pain. His symptoms exacerbated and he was hospitalized. His temperature was 37.2℃. Physical examination showed congested erythema, which faded when pressed, in both face and trunk skin and oralmucosal congestion, as well as gingival swelling. Laboratory tests revealed the following levels: blood mercury 0.029 mg/L, urine mercury 39.565 μmol/molCr, ALT 61 U/L, AST 28 U/L, BUN 7.42 mmol/L, SCr 67.0 μmol/L, blood β2-microglobulin 1 549.20 ng/mL, urine β2-microglobulin 167.0 ng/mL. Unithiol therapy was given. His condition improved, and urine mercury tended to normal. On reexamination, his liver functions, blood and urine β2-microglobulin levels returned to within normal range.

病例报告

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  病例报告

  Acute pancreatitis and lactic acidosis due to combination therapy with interferonand telbivudine

  Sun Fangli;Wu Jun;Jiang Lili;Xiao Shuxin;Teng Chunyuan

  2010, 12(2): 127-2.

  Abstract ( ) PDF ( )

  A 29-year-old man with chronic hepatitis B received IM interferon α-2b 3,000,000 IU every other day. Four months later, telbivudine 600 mg once daily was added to his regimen due to poor efficacy. At the ninth month of combination therapy, the patient experienced muscle aching pain and, at month 11, the two drugs were discontinued. At month 15, he developed nausea, vomiting, diarrhea, abdominal pain. Subsequently, constipation and upper abdominal pain after meal appeared and he was hospitalized. On admission, laboratory tests revealed the following levels: pH 7.25, lactic acid 11 mmol/L, and serum amylase 305 U/L. The treatments including fluid supplementation, anti-infection, and correction of acidosis were given. After 6 days of admission, his symptoms relieved.
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  病例报告

  Rhabdomyolysis occurring in a patient with hypokalemic periodic paralysis taking telbivudine

  Lv Feijuan;Yang Yanling;Yang Daichun

  2010, 12(2): 129-2.

  Abstract ( ) PDF ( )

  A 25-year-old man with hypokalemic periodic paralysis received telbivudine 600 mg/d once daily for chronic viral hepatitis B. After 10 months of treatment, the patient developed nausea, vomiting, generalised aching pain, decreased urinary output, and dark urine. Telbivudine was discontinued and switched to lamivudine. Symptomactic and supportive treatments were given. His aching pain in lower limbs was still marked and he was hospitalized. Rhabdomyolysis, metabolic acidosis, and chronic viral hepatitis B were diagnosed. Lamivudine was stopped. Meanwhile he received symptomatic and supportive therapies. His symptoms aggravated and, on day 9 of admission, he died from respiratory and circulatory failure.
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  病例报告

  Myositis and peripheral neuropathy associated with telbivudine and interferon

  Liu Min;Yi Wei;Cai Haodong

  2010, 12(2): 130-2.

  Abstract ( ) PDF ( )

  A 31yearold woman received telbivudine 600 mg once daily for chronic viral hepatitis B. After 10 months of therapy, SC interferon 3 million units every other day was added to her regimen. After 9 months of treatments, interferon was stopped and telbivudine was continued. The patient developed numbness in both lower limbs and her symptoms aggravated. Subsequently, she experienced obvious myalgia, weakness in lower extremities, and paresthesia. Physical examinations showed slight hypoalgesia in peripheral extremities, weak tendon reflex in both lower limbs, slightly pale skin in her distal lower extremities, and grey nail in left hallux. Laboratory test showed a CK level of 1 694.3 U/L. Motor nerve conduction velocity tests revealed increased latency and decreased amplitude in her distal left nerus peroneus communis; sensory nerve conduction velocity tests revealed slow velocity in her left tibial nerve. Telbivudine was withdrawn and switched to lamivudine. Meanwhile she was treated with vitamin B1 and coenzyme Q₁₀. Two months later, her symptoms improved.

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  Acute renal failure induced by compound rifampicin capsules

  Jiang Chunling;Yang Siyun

  2010, 12(2): 132-2.

  Abstract ( ) PDF ( )

  A 29yearold man with tuberculosis received one capsule of compound rifampicin (each capsule contains rifampicin 600 mg and isoniazid 600 mg ) every other day. After 3 months of therapy, his symptoms improved and drug was stopped by himself. One year later, the patient developed cough, night sweats and other symptoms again. So he took compound rifampicin capsules at the abovementioned therapeutic dosage by himself. After 8 days of treatment, nausea, vomiting, lumbago, edema of face and both lower extremities, decreased urine output, and dark urine appeared. Laboratory examinations revealed the following values: BUN 21.2 mmol/L, SCr 877.8 μmol/L, protein (+), and occult blood (+ + +). On ECT test, his left and right kidneys showed GFR levels of 21.11 ml/min and 20.98 ml/min, respectively. Rifampicin was withdrawn and hemodialysis was given. Meanwhile he was treated with symptomatic and supportive therapies. Twentyfive days later, his symptoms improved.
  

病例报告

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  病例报告

  Abnormal liver and renal function due to moxifloxacin

  Yuan Xiangpinga;Cheng Zhentianb;Pan Yuxingb;Liu Zhijun

  2010, 12(2): 133-2.

  Abstract ( ) PDF ( )

  A 83yearold man with pneumonia received an IV infusion of moxifloxacin 0.4 g in 0.9% sodium chloride once daily and aerosol inhalation of ipratropium bromide and salbutamol. On day 2, biochemical tests showed an ALT level of 201 U/L, an AST level of 455 U/L, and a TBil level of 60 μmol/L. Meanwhile he experienced yellowish skin and sclera. Subsequently, his jaundice progressively worsened and laboratory examinations revealed the following values: TBil 126 μmol/L, DBil 98.6 μmol/L, CCr 187.5 μmol/L, BUN 40.16 mmol/L, 24hour urine protein 0.8 g. Moxifloxacin was withdrawn and changed to concomitant use of cefatriaxone and azithromycin. Twentythree days later, the patient’s biochemical tests basically returned to normal.
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  Liver damage associated with sodium fusidate

  Yu Xiongjie;Wang Linxia;Liu Shengyou

  2010, 12(2): 134-2.

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  A 41yearold man received an IV infusion of sodium fusidate 0.5 g every eight hours for pulmonary infection after undergoing an operation of delayed sternal closure. On day 3 after drug administration, the patient developed yellowish skin and sclera. Bultrasound showed an increase in liver volume. Laboratory tests revealed the following levels: ALT 68 U/L, AST 43 U/L, ALP 58 U/L, γ-GT 42 U/L, TBil 121.8 μmol/L, and DBil 73.3 μmol/L. Sodium fusidate was stopped and switched to vancomycin. Meanwhile he was given symptomatic therapy. Three weeks later, his liver function returned to within normal range.
  
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  Abnormal liver function due to nadroparin calcium in two patients

  Wang Yuzhu;Chang Yan;Wang Qing;Lu Congzhe;Yu Xiaohong

  2010, 12(2): 136-2.

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  Two male patients, aged 52 and 79 years, received SC nadroparin calcium 6 000 IU every 12 hours for cerebral infarction and unstable angina pectoris, respectively. Liver function tests in patient 1 showed an ALT level of 169 U/L on day 6; and laboratory examinations in patient 2 revealed the following values on day 3: ALT 246 U/L, γ-GT 521 U/L, TBil 28.5 μmol/L, DBil 8.9 μmol/L. Nadroparin calcium was stopped and an IV infusion of polyene phosphatidylcholine was given. Subsequently, their liver function improved gradually.
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  Bradycardia, hypotension, and severe liver damage due to amiodarone

  Lan Anjie;;Chu Yanqi;Liu Lihong;Yuan Fang

  2010, 12(2): 137-2.

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  A 69yearold women received an IV push of amiodarone 150 mg for arrhythmia, paroxysmal supraventricular tachycardia, and a heart rate of 166 beats/min. Thirty minutes later, the patient developed sinus bradycardia and hypotension. Her heart rate was 35 beats/min and blood pressure was 81/50 mm Hg. She was undergone temporary pacemaker. Meanwhile fluid supplementation and an IV dopamine were given. One hour later，her symptoms relieved. She was treated with an IV infusion of amiodarone 300 mg diluted in 5% glucose 50 ml via pump at a rate of 0.6 mg/min for intermittent episodes of tachycardia. The next day，her laboratory tests revealed the following values：ALT 1 770 U/L，AST 1 360 U/L，TBil 130.20 μmol/L, DBil 98.40 μmol/L; PT 17.3 s, INR 1.45. Amiodarone was stopped and she received symptomatic and supportive treatment. One week later，her symptoms improved.
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  Atrial fibrillation following an IV infusion of milrinone via pump in a patient with coronary heart disease

  Sun Mu

  2010, 12(2): 139-2.

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  A 70yearold woman was hospitalized for coronary heart disease, heart failure, and pulmonary infections. On admission, the patient received an IV infusion of milrinone 5 mg dissolved in 0.9% sodium chloride 30 ml via pump at a rate of 8 ml/h. About 30 minutes later, she experienced palpitation and chest distress. Physical examination showed a pulse of 128 beats/min, a heart rate of 135 beats/min, arrhythmia, and pulse deficit. ECG electrocardiogram revealed atrial fibrillation. Milrinone was stopped immediately and an IV push of amiodarone was given. One hour later, her symptoms subsided. Electrocardiogram monitoring revealed that the cardiac rhythm had turned to sinus rhythm, and her heart rates were 80 beats/min.
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  A case report of reexposure to paclitaxel in a patient with paclitaxelinducedanaphylactic shock

  Dang Yanli;Zhang Wenying;Du Jianxin;Lu Yeyan;Liu Yinlan

  2010, 12(2): 140-2.

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  A 70yearold woman received an IV infusion of paclitaxel 210 mg in 0.9% sodium chloride 500 ml for chemotherapy 21 days after ovarian cancer operation. Five minutes later, the patient developed chest distress and generalized acanthesthesia, and then unconsciousness, pallor, clamminess in her extremities, dyspnea occurred. Meanwhile her blood pressure was 80/62 mm Hg and heart rate was 100 beats/min. Paclitaxel was discontinued immediately and dexamethasone and promethazine hydrochloride were given. Ten minutes later, her symptoms relieved. Subsequently, anaphylactic reactions did not recur after reexposure to a low concentration paclitaxel infusion at a slow rate.
  

病例报告

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  Death from anaphylactic shock due to asarone injection

  Li Zhuojun;Liu Ji;Liu Jiaming

  2010, 12(2): 141-2.

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  A 39yearold women with an upper respiratory tract infection received an IV infusion of clindamycin, ribavirin, and Shuanghuanglian for two days. However, these had no obvious effect. And they were replaced by cefoperazone and asarone. She was administered an IV infusion of cefoperazone 2 g in 5% glucose 250 ml without adverse reactions, followed by an IV infusion of asarone 16 mg dissolved in 5% glucose 250 ml. About 5 minutes after asarone infusion start, the patient suddenly developed chest distress, dyspnea, convulsion. Subsequently, she experienced confusion, respiratory and cardiac arrest. Finally, the patient died desipite resuscitation attempts.
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  Anaphylactic shock due to cefoxitin sodium

  Huang Banghua;Hong Min;Pu Yanfang

  2010, 12(2): 142-2.

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  A 40yearold man with pericoronitis accompanied by spaces infections received an IV infusion of cefoxintin sodium 2 g in 5% glucose 100 ml. About 5 minutes after cefoxitin sodium infusion start, the patient experienced numb tongue and peripheral extremities, dizziness, abdominal colic with an urge to defecate. Physical examination revealed weak pulses, muffled heart sounds, mild lip cyanosis, and cold peripheral extremities. His heart rate was 110 beats/min and blood pressure was undetectable. Adrenaline, dexamethasone, and methylprednisolone were given. One hour later, his symptoms improved.
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  Hallucination caused by combined zolpidem tartrate and venlafaxine

  Zang Ruohong;Yu Ran

  2010, 12(2): 143-2.

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  A 54yearold women with anxious state received venlafaxine 75 mg and zolpidem tartrate 10 mg at bedtime. About 15 minutes later, the patient developed hallucination which disappeared after fell asleep. Subsequently, her symptoms aggravated. The adverse reactions were considered to be related to concomitant use of these two drugs, so zolpidem tartrate and venlafaxine were given separately and the interval time was over two hours. One week later, his symptoms subsided.

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  Oddi’s sphincter spasm caused by controlledrelease morphine sulphate tablets in one case and literature review

  Ning Xiaohong;Zhang Zaijun;Bai Chunmei

  2010, 12(2): 144-2.

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  A 76yearold man received controlledrelease morphine sulphate 30 mg tablets every 12 hours and potassium diclofenac 25 mg every 8 hours for pulmonary cancer pain. On day 10, the patient developed upper abdominal pain, accompanied by fever, nausea, and vomiting. His temperature was 38.5℃. Both abdominal CT scan and B-ultrasound revealed dilation of intrahepatic and extrahepatic bile duct and enlarged gallbladder. Controlledrelease morphine sulphate tablets were withdrawn and potassium diclofenac was continued. Meanwhile he was given symptomatic and supportive treatments. His symptoms relieved and abdominal Bultrasound reexamination showed no dilation of intrahepatic and extrahepatic bile duct.
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  Epileptiform seizure induced by oral chlorpheniramine

  Liu Haiyan

  2010, 12(2): 146-1.

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  A 40yearold woman received vitamin C 0.2 g and chlorpheniramine 4 mg for skin itching. Two hours later, the patient developed dizziness, asthenia, and nonprojectile vomiting, followed by stiffness in her extremities, foam from her mouth, and no response to voice stimuli lasting for about 1~2 minutes. Subsequently, she experienced another two seizure episodes. On day 3 after admission, her electroencephalogram revealed moderate abnormalities. She was given diazepam and carbamazepine. Her symptoms did not recur.

中药不良反应

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  中药不良反应

  Death from anaphylactic shock after taking Niuhuangjiedu tablets in a child

  Yang Yia;Sun Shuboa;Lei Lilia;Nie Leib

  2010, 12(2): 147-1.

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  A boy aged one and a half years with constipation was given one tablet of Niuhuangjiedu by his parents themselves. One hour later, the child developed facial edema. Subsequently, he experienced convulsion, facial and peripheral cyanosis, respiratory and cardiac arrest, and he was then hospitalized. Physical examination showed a coma state, a sluggish light reflex, a respiratory rate of 60~80 breaths/min, and a blood pressure of 35/0 mm Hg. Laboratory tests revealed the following values: ALT 368.00 U/L, AST 2 000.00 U/L, CK 2 000.00 U/L, LDH 9 040 U/L, Urea 15.20 mmol/L, SCr 114.30 μmol/L. Resuscitations were given immediately and he died from respiratory and cardiac arrest.