肾移植患者伏立康唑与他克莫司药物相互作用的病例分析

目的探讨他克莫司(TAC)和伏立康唑(VRC)相互作用的机制,为临床合理用药提供依据。方法观察分析1例服用TAC的肾移植术后随访患者,在应用VRC治疗肺部真菌感染前后,TAC体内药物浓度的变化。结果联合用药前,TAC平均谷浓度C0为4.95ng·m L-1(4.3~6.0 ng·m L-1),平均C0/D为2.475 ng/(mg·m L)(2.15~3.0 ng/(mg·m L)),合用VRC后,C0为27.0ng·m L-1,C0/D为13.5 ng/(mg·m L),比未用VRC之前C0/D升高了445.5%。结论长期服用TAC的肾移植术后患者在应用VRC治疗肺部真菌感染时,应综合考虑患者遗传因素(CYP2C19和CYP3A5基因多态等)和非遗传因素,个体化给药。二者相互作用的机制是:VRC抑制肝脏CYP3A4/CYP3A5酶,使TAC的药物浓度显著升高;CYP2C19和CYP3A5基因多态在TAC与VRC相互作用中起了重要作用

注射用法罗培南钠治疗泌尿系统感染的临床研究

目的评价注射用法罗培南钠治疗泌尿系统感染的有效性和安全性。方法采用随机、盲法、平行对照临床研究,以注射用亚胺培南/西司他丁钠为对照。结果纳入全分析集(fAS)的病例39例,比较两组临床治愈率、细菌清除率和不良反应发生率,差异均无统计学意义。结论注射用法罗培南钠治疗泌尿系统感染安全有效,与注射用亚胺培南/西司他丁钠相近

Determination of Serum Voriconazole Concentration by HPLC

目的建立测定人血清中伏立康唑浓度的高效液相色谱法,用于临床该药的治疗药物浓度监测。方法采用乙腈沉淀处理血清样品,采用高效液相色谱紫外检测法测定。以硝西泮为内标,色谱柱为HyPErSIl OdS柱(200 MMx4.6 MM,5μM),流动相为25 MMOl/l磷酸二氢钾缓冲液-乙腈(32∶68),流速为1.0 M l/MIn,柱温为35℃,波长为256 nM。结果伏立康唑质量浓度在0.3~12μg/M l范围内与峰面积比线性关系良好(r=0.999 3),低、中、高质量浓度回收率分别为(105.0±3.6)%,(101.9±3.3)%,(101.1±3.4)%;日内、日间精密度的rSd均小于5%,定量限为0.3μg/M l。结论该方法简便快速、准确,适用于伏立康唑血药浓度的临床监测。Objective To establish a HPLC method to determine the concentration of voriconazole in human plasma for its clinical application in the curative drug concentration monitoring.Methods The serum sample was performed the precipitation treatment by actetonitrile, then HPLC- UV was adopted for detection.With nitrazepan as the internal standard, the chromatographic column was the Hypersil ODS columm( 200.0 mm × 4.6 mm, 5 μm), the mobile phase was 25 mmol / L potassium dihydrogen phosphate buffer solution-acetonitrile( 32 ∶ 68).The detection wavelength was at 256 nm with a flow rate of 1 m L / min and the column temperature of 35 ℃.Results The concentration of voriconazole in the range of 0.3-12 μg / mL( r = 0.999 3) showed the good linearity.The recovery rates of low, middle and high concentrations were( 105.0 ± 3.6) %,( 101.9 ± 3.3) % and( 101.1 ± 3.4) %, respectively.The intra- day and inter- day RSD were both less than 5%.The limit of quantitation was 0.3 μg / m L.Conclusion The established method is fast,accurate and suitable for the determination of blood voriconazole concentration

Study of the effect of Strong-bone granules on the differentiation of ROS1728 osteoblasts with silenced ER expression

目的探讨健骨颗粒对成骨细胞中ERalpha介导的TERT信号通路的调控作用。方法采用雌激素受体拮抗剂ICI182780(Faslodex)阻断成; 骨细胞中雌激素受体alpha(ERalpha)的表达,建立ER抑制的大鼠成骨细胞株ROS1728细胞模型,采用酶联免疫吸附法(ELISA)检测成; 骨细胞液中碱性磷酸酶(alkaline phosphatase,ALP) 、骨钙素(osteocalcin,BGP); 、Ⅰ型胶原(collagen I,Col Ⅰ)的含量。采用实时荧光定量SYBR; GREEN法检测ERE、ERalpha、c-MYCmRNA的表达。采用Western Blot检测TERT、ERalpha、c-; MYC蛋白的表达。结果ELISA法检测结果显示:随着干预时间的延长,培养液中的ALP、BGP、ColⅠ的含量逐渐上升。其中对照组3种信号因子的含; 量最高血,雌激素组次之,健骨颗粒组再次之,模型组最低,各组比较差异有统计学意义(P < 0.05),; 4组TERT、ERalpha、c-MYCmRNA及蛋白表达量情况以对照组的蛋白表达含量最高,雌激素组次之,健骨颗粒组再次之,模型组最低。各组比较; 均有统计学意义(P < 0.05); 。结论雌激素介导TERT信号通路及其相关因子与成骨细胞分化的关系密切,而补肾健脾中药健骨颗粒可通过雌激素介导TERT信号通路促进成骨细胞分化。Objective To investigate the effect of Strong-bone granules on the; regulation of TERT signaling pathway mediated by ER alpha in; osteoblasts. Methods The estrogen receptor antagonist ICI182780; (Faslodex) was used to inhibit the expression of ER in osteoblasts and; to establish the ER-silenced model of rat osteoblast cell line ROS1728.; Serum ALP,BGP,and Col I were determined using enzyme-linked; immunosorbent assay. The mRNA expression of ERE,ERalpha,and c-MYC was; determined using real time quantitative SYBR GREEN assay. The protein; expression of ERE,ERalpha,and c-MYC was detected using Western blotting.; Results The results of ELISA showed that the content of ALP,BGP,and Col; in the culture medium increased gradually with the prolonging of; intervention time. The levels were the highest in the control group,then; followed in estrogen group,Strong-bone granules group,and the model; group,and the difference among the groups was significant (P < 0.05).; The mRNA and protein expression of TERT,ER alpha,and c-MYC was the; highest in the control group,then followed in estrogen group,Strong-bone; granules group,and the model group,and the difference among the groups; was significant (P < 0.05). Conclusion The estrogen mediated TERT; signaling pathway and its related factors are closely related to the; differentiation of osteoblasts. Strong-bone granules promote osteoblast; differentiation through estrogen mediated TERT signaling pathway.国家自然科学基金; 福建省卫生厅中医课题; 福州市卫生系统科技项

Evaluation of convective PCR for the detection of influenza A virus

目的评价热对流PCR应用于口岸现场甲型流感病毒快速检测的效果。方法设计热对流PCR的引物和探针,用于甲型流感病毒的检测。用甲型和乙型流感病毒毒株和入境发热人员的鼻咽拭子样本验证热对流PCR的检测灵敏度、特异性及稳定性,并与市售商品化实时荧光定量PCR试剂比较检测甲型流感病毒的效果。结果通过对8株甲型流感病毒和1株乙型流感病毒毒株进行检测,热对流PCR对H1、H3及H5亚型的甲型流感病毒毒株的检测下限为0.001~0.005HAU,具有较好的检测广谱性,且不与乙型流感病毒发生交叉反应。对155份鼻咽拭子样本进行检测,和实时荧光定量PCR相比,检测灵敏度为94.74%,特异性为97.44%,且具有很好的检测稳定性。结论热对流PCR具有很高的检测灵敏度和特异性,可用于口岸现场的甲型流感病毒快速筛查。Objective To evaluate the efficiency of convective PCR on rapid detection of influenza A virus at frontier ports. Methods The convective PCR primers and probe were designed for the detection of influenza A virus.Influenza A virus strains,influenza B virus strain and nasopharyngeal swabs of entry travelers with fever were used to analyze the sensitivity,specificity and stability of convective PCR. The detection efficiency of convective PCR was compared with commercial Real-time PCR kit. Results A broad detection spectrum of convective PCR was observed in testing 8 influenza A virus strains with different genotypes（H1、H3 and H5）and 1 influenza B virus strain,the detection limit of convective PCR for influenza A virus strain was 0.001 ~0.005 HAU. There was no cross reaction with influenza B virus. When convective PCR was applied to the detection of 155 nasopharyngeal swabs,comparison with Real-time PCR,the detection sensitivity was 94.74%,the detection specificity was 97.44%,and the detection stability was good. Conclusion Convective PCR had a high sensitivity and specificity,was fit for the rapid detection for influenza A virus at frontier ports.厦门市科技惠民计划项目（3502Z20174044）; 国家质检总局科技计划项目（2014IK045）; 福建省自然科学基金项目（2010J01152

我院开展治疗药物监测的实践与思考

目的讨论开展治疗药物监测(TdM)的临床意义,查找存在不足,并思考解决问题的对策。方法全面总结回顾该院TdM工作开展的基础、主要内容、药学服务举措及教学与科研创新成果,并结合临床实际,探讨今后开展工作的新思路。结果TdM工作中遇到的问题主要是医务人员利用TdM手段实施个体化给药的意识还不够强,医药团队协作能力有待提高。结论应通过加大TdM宣传力度,以TdM为切入口,加强与临床的密切配合与协作,配备更多高素质的临床药师,并通过与药物基因组学的结合,进一步提高治疗药物监测的工作质量

HCG 日不同优势卵泡比例对 IVF/ICSI 妊娠结局的影响

【目的】为摸索适合不同方案最佳人绒毛膜促性腺激素注射日（HCG日）优势卵泡比例，探讨HCG日直径18mm以上卵泡不同比例在不同方案中对体外受精/单精子卵泡浆内显微注射-胚胎移植（IVF/ICSI-ET）结局的影响，为个体化确定HCG日提供依据。【方法】本研究回顾性分析2014年至2016年长方案IVF/ICSI共3064周期，拮抗剂方案IVF/ICSI共918周期临床资料。按照HCG日优势卵泡（直径≥18mm）的不同比例将患者在不同方案中均分成3组：低比例组：优势卵泡比例40%。分别分析不同方案中不同年龄段，3组患者间基本资料及助孕结局。【结果】≤30岁年龄群患者中，促性腺激素释放激素激动剂（GnRHa）长方案中，成熟卵子率在HCG日优势卵泡比0.05）。≥40岁年龄群患者中，长方案中，获卵数在HCG日优势卵泡比40%组高，但临床妊娠率低于另外2组，但差异无统计学意义。拮抗剂方案中，临床妊娠率在HCG日优势卵泡比40%，临床妊娠率明显降低，在拮抗剂方案中将优势卵泡比例控制在20%以内更重要

智能化门诊药房存在的问题及其改进措施

门诊药房是医院与病人交流的窗口,处方调剂是病人在医院就诊的最后环节,发药速度快慢对病人及其家属的就医满意度产生直接影响[1]。为创造良好的工作环境、提高药房管理水平[2]、确保病人用药安全[3],解放军第一七五医院于2015年8月底启用了智能化门诊药房。该药房的引进给药师带来很多便利,同时也对药房工作模式的改进提出了要求。作者从自身工作出发,结合医院现状及智能化门诊药

甲酸甲酯氢解制甲醇铜基催化剂上吸附物种的现场红外光谱表征

应用原位红外光谱的方法，在反应现场条件下，研究了促进型甲酸甲酯（ＭＦ）氢解制甲醇铜铬催化剂上的化学吸附物种．结果表明，在ＭＦ氢解反应条件下，工作态催化剂上主要的化学吸附物种和反应中间物种是ＣＨ３Ｏ－ＣＨＯ…Ｈ－Ｏ（ａ）（１７５１，２７３０，１４５５ｃｍ－１）、ＣＨ３Ｏ－ＣＨＯ…Ｃｕ＋（ａ）（１６５４，２７３０，１４５５ｃｍ－１）、ＣＨ３Ｏ－ＣＨＯ…Ｃｒ３＋（ａ）（１５５２，２７３０，１４４５ｃｍ－１）和ＯＣＨ３（３０１２，２９４６，１４５５ｃｍ－１）．结合对该催化剂活性位本质的探讨，推断了甲酸甲酯氢解制甲醇的主要反应途径