Pembrolizumab-induced psoriatic arthritis treated with disease-modifying anti-rheumatic drugs in a patient with gastric cancer:A case report

BACKGROUND Immune checkpoint inhibitor(ICI)-induced rheumatic immune-related adverse events(ir AEs)have been infrequently reported,and the treatment of severe or refractory arthritis as ir AEs has not been established yet.CASE SUMMARY The patient was a 67-year-old man with a history of well-controlled foot psoriasis who presented with polyarthralgia.He had received pembrolizumab for metastatic gastric adenocarcinoma 2 mo previously.Physical examination revealed erythematous swelling in the distal interphalangeal joints,left shoulder,and both knees.He had plaque psoriasis with psoriatic nail dystrophy and dactylitis in the distal joints of the fingers and toes.Inflammatory markers including C-reactive protein and erythrocyte sedimentation rate were elevated but rheumatoid factor and anticyclic citrullinated peptide antibody were negative.The patient was diagnosed with psoriatic arthritis(PsA)and started on methylprednisolone 1 mg/kg/day after pembrolizumab discontinuation.However,despite 1 wk of methylprednisolone treatment,PsA worsened;hence,leflunomide and methotrexate were started.After 4 wk of steroid treatment,PsA worsened and improved repeatedly with steroid tapering.Therefore,the therapy was intensified to include etanercept,a tumor necrosis factor inhibitor,which ultimately resulted in adequate PsA control.CONCLUSION This is the first report of ICI-induced PsA in a gastric cancer patient.Some rheumatic ir AEs with refractory severe arthritis may require disease-modifying anti-rheumatic drugs and long-term management.

Blood glucose changes surrounding initiation of tumor-necrosis factor inhibitors and conventional disease-modifying anti-rheumatic drugs in veterans with rheumatoid arthritis

AIM To determine the scope of acute hypoglycemic effects for certain anti-rheumatic medications in a large retrospective observational study. METHODS Patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were selected who, during follow-up, initiated treatment with tumor necrosis factor inhibitors (TNFi's, including etanercept, adalimumab, infliximab, golimumab, or certolizumab), prednisone, or conventional disease-modifying anti-rheumatic drugs(DMARDs), and for whom proximate random blood glucose (RBG) measurements were available within a window 2-wk prior to, and 6 mo following, medication initiation. Similar data were obtained for patients with proximate values available for glycosylated hemoglobin A1C values within a window 2 mo preceding, and 12 mo following, medication initiation. RBG and A1C measurements were compared before and after initiation events using paired t-tests, and multivariate regression analysis was performed including established comorbidities and demographics.RESULTS Two thousands one hundred and eleven patients contributed at least one proximate measurement surrounding the initiation of any examined medication. A significant decrease in RBG was noted surrounding 653 individual hydroxychloroquine-initiation events(-3.68 mg/dL, P = 0.04), while an increase was noted for RBG surrounding 665 prednisone-initiation events(+5.85 mg/d L, P < 0.01). A statistically significant decrease in A1C was noted for sulfasalazine initiation, as measured by 49 individual initiation events(-0.70%, P < 0.01). Multivariate regression analyses, using methotrexate as the referent, suggest sulfasalazine (β =-0.58, P = 0.01) and hydroxychloroquine(β =-5.78, P = 0.01) use as predictors of lower post-medicationinitiation RBG and A1C values, respectively. Analysis by drug class suggested prednisone (or glucocorticoids) as predictive of higher medication-initiation event RBG among all start events as compared to DMARDs, while this analysis did not show any drug class-level effect for TNFi. A diagnosis of congestive heart failure(β = 4.69, P = 0.03) was predictive for higher post-initiation RBG values among all medication-initiation events.CONCLUSION No statistically significant hypoglycemic effects surrounding TNFi initiation were observed in this large cohort. Sulfasalazine and hydroxychloroquine may have epidemiologically significant acute hypoglycemic effects.

二仙丸加减方含药血清抑制巨噬细胞焦亡的物质基础和作用机制

背景:课题组前期研究发现二仙丸加减方可以缓解胶原诱导性关节炎大鼠炎症反应,但其作用机制尚需进一步验证。目的:分析二仙丸加减方入血成分,观察二仙丸加减方含药血清对J774A.1巨噬细胞焦亡的影响。方法:①二仙丸加减方入血成分分析:采用超高效液相色谱-高分辨质谱(UHPLC-HRMS)对二仙丸加减方及入血成分进行检测和鉴定。②二仙丸加减方含药血清对J774A.1巨噬细胞焦亡的影响:采用分子对接技术对二仙丸加减方入血成分倍半萜类化合物与NLRP3进行初步验证。将J774A.1巨噬细胞随机分为空白对照组、脂多糖+三磷酸腺苷组及脂多糖+三磷酸腺苷+二仙丸加减方含药血清低(2.5%)、中(5%)、高(10%)剂量组。根据试剂盒说明书检测各组细胞上清液中乳酸脱氢酶释放情况;ELISA检测各组细胞上清液中白细胞介素1β、白细胞介素18水平;Hoechst/PI染色法检测各组细胞膜受损情况;Western blot检测各组细胞中NLRP3、Caspase-1、GSDMD及GSDMD-N蛋白表达水平。结果与结论:①共鉴定出二仙丸加减方药效成分32个,入血成分21个,其中入血成分主要包括多种倍半萜类化合物;②分子对接结果显示3-O-Acetyl-13-deoxyphomenone、Incensol oxide、Atractylenolide Ⅲ、Rupestonic acid、3,7-Dihydroxy-9,11-eremophiladien-8-one与NLRP3之间结合活性较好;③与空白对照组相比,脂多糖+三磷酸腺苷组细胞上清中乳酸脱氢酶活性及白细胞介素1β、白细胞介素18水平均显著升高(P<0.001),Hoechst/PI染色可见PI阳性细胞数量显著增加。脂多糖+三磷酸腺苷+二仙丸加减方含药血清各组上述指标均显示不同程度降低;④与空白对照组相比,脂多糖+三磷酸腺苷组NLRP3、Caspase-1、GSDMD及GSDMD-N蛋白表达显著升高(P<0.05);与脂多糖+三磷酸腺苷组相比,脂多糖+三磷酸腺苷+二仙丸加减方含药血清各组细胞中NLRP3、Caspase-1、GSDMD及GSDMD-N蛋白表达均有不同程度降低(P<0.05),且具有一定的剂量依赖性。结果表明:二仙丸加减方含药血清可能通过调控NLRP3/Caspase-1/GSDMD通路抑制J774A.1巨噬细胞焦亡。

Treatment of 60 Cases of Gouty Arthritis with Modified Simiao Tang

Objective:To observe the clinical effect of a modified Simiao Tang (加味四妙汤 Modified Decoction of Four Wonderful Drugs) for gouty arthritis and its influence on uric acid in blood. Methods: 120 cases of gouty arthritis were randomly divided into the treatment group and control group with 60 cases in each group. Modified Simiao Tang (MST) was orally administered to the patients in the treatment group and allopurinol tablet was orally administered to the patients in the control group. The clinical effects of two groups were evaluated after one-week treatment and uric acid (UA) and C-reactive protein (CRP) levels in blood were determined after 1-month treatment. Results: The total effective rate in the treatment group was significantly higher than in the control group, 86.7% vs. 68.3% (P< 0.01). And the treatment group was also significantly better than the control group in decreasing UA and CRP (P<0.05 or P<0.01). Conclusions: MST can significantly improve the symptoms and signs of gouty arthritis and decrease the levels of UA and CRP. It is good for gouty arthritis.

Amphiphilic sodium alginate-vinyl acetate microparticles for drug delivery

To overcome the fast or burst release of hydrophilic drugs from hydrophilic alginate-based carriers,hydrophobic molecule(vinyl acetate,VAc)was grafted on alginate(Alg),which was further used to prepare drug carriers.Amphiphilic Alg-g-PVAc hydrogel beads were firstly prepared by emulsification/internal gelation technique for the loading of bovine serum albumin(BSA).Then,chitosan was coated on the surface of beads to form novel amphiphilic Alg-g-PVAc/chitosan(Alg-g-PVAc/CS)microcapsules.The BSA-loading amphiphilic Alg-g-PVAc/chitosan(Alg-g-PVAc/CS)microcapsules display similar morphology and size to the hydrophilic alginate/chitosan(AC)microcapsules.However,the drug loading and loading efficiency of BSA in Alg-g-PVAc/CS microcapsules are higher,and the release rate of BSA from Alg-g-PVAc/CS microcapsules is slower.The results demonstrate that the introduction of hydrophobic PVAc on alginate can effectively help retard the release of BSA,and the higher degree of substitution is,the slower the release rate is.In addition,the complex membrane can also be adjusted to delay the release of BSA.As a whole,amphiphilic sodium alginate-vinyl acetate/CS microparticles could be developed for macromolecular drug delivery.

Bi_(2)O_(3)/ZnO nanocomposite:Synthesis,characterizations and its application in electrochemical detection of balofloxacin as an antibiotic drug

In the present work,a chemically modified electrode has been fabricated utilizing Bi_(2)O_(3)/ZnO nanocomposite.The nanocomposite was synthesized by simple sonochemical method and characterized for its structural and morphological properties by using XRD,FESEM,EDAX,HRTEM and XPS techniques.The results clearly indicated co-existence of Bi_(2)O_(3) and ZnO in the nanocomposite with chemical interaction between them.Bi_(2)O_(3)/ZnO nanocomposite based glassy carbon electrode(GCE)was utilized for sensitive voltammetric detection of an anti-biotic drug(balofloxacin).The modification amplified the electroactive surface area of the sensor,thus providing more sites for oxidation of analyte.Cyclic and square wave voltammograms revealed that Bi_(2)O_(3)/ZnO modified electrode provides excellent electrocatalytic action towards balofloxacin oxidation.The current exhibited a wide linear response in concentration range of 150e1000 nM and detection limit of 40.5 nM was attained.The modified electrode offered advantages in terms of simplicity of preparation,fair stability(RSD 1.45%),appreciable reproducibility(RSD 2.03%)and selectivity.The proposed sensor was applied for determining balofloxacin in commercial pharmaceutical formulations and blood serum samples with the mean recoveries of 99.09% and 99.5%,respectively.

A novel modified paclitaxel-loaded discoidal recombinant high-density lipoproteins:Preparation,characterizations and in vivo evaluation

This study is one of the first to focus on the unexpected drug leakage from discoidal recombinant high-density lipoproteins(d-rHDLs)as a consequence of remodeling process,mainly associated with lecithin-cholesterol acyltransferase(LCAT)during their metabolic process.Here,a newly monocholesterylsuccinate(CHS)modified paclitaxel-loaded drHDLs(cP-d-rHDLs)were constructed successfully through structural modification,thus aiming to improve the performance of d-rHDLs.And next their in vitro physiochemical properties and pharmacokinetics in SpragueeDawley rats were elaborately investigated.Collectively our studies demonstrated that cP-d-rHDLs,whose remodeling behaviors were restrained effectively after structural modification,exhibited more excellent and promising properties as novel delivery vehicles for anti-cancer agents.

Drug-induced erythroderma in patients with acquired immunodeficiency syndrome

BACKGROUND: To explore the clinical manifestations, diagnosis, and treatment of patients with acquired immunodeficiency syndrome(AIDS) complicated with drug-induced erythroderma.METHODS: The clinical data of 12 AIDS patients with drug-induced erythroderma in our hospital were retrospectively analyzed. The general information, offending medications, complications, modified severity-of-illness score for toxic epidermal necrolysis(SCORTEN) scores, and disease outcome spectrums were analyzed.RESULTS: Drug-induced erythroderma was mostly caused by antiviral drugs, antituberculosis drugs, antibiotics, traditional Chinese medicine, and immune checkpoint inhibitors. The spectrum of sensitizing drugs was broad, the clinical situation was complex, and infections were common. The affected areas were greater than 40% body surface area in all patients. The modified SCOTERN score averaged 3.01±0.99. All patients were treated with glucocorticoids, and nine patients were treated with intravenous immunoglobulin(IVIG) pulse therapy at the same time. The average time to effectiveness was 7.08±2.23 days, and the average hospital stay was 17.92±8.46 days. Eleven patients were cured, and one patient died of secondary multiple infections, who had a modified SCORTEN score of 5 points. The mortality rate in this study was 8.3%.CONCLUSIONS: The clinical situation of AIDS patients with drug-induced erythroderma in hospitalized patients is complex and the co-infection rate is high. The use of modified SCORTEN score may objectively and accurately assess the conditions, and the use of glucocorticoid combined with IVIG therapy may improve the prognosis.

Electrochemical Evaluation of Aminoguanidine Hydrazone Derivative with Potential Anticancer Activity:Studies of Glassy Carbon/CNT and Gold Electrodes Both Modified with PAMAM

Aminoguanidine hydrazones (AGHs) are a class of compounds that have interesting pharmacological activities. They are derived from the same chemical group as aminoguanidine, so it has mixed properties (receptor and donor) in the formation of hydrogen bonds. Its anticancer agent properties were recently highlighted, but the molecules of this class have solubility in aqueous solutions that can be considered low. The identification of this class, by a simple, sensitive and low-cost technique, such as electrochemistry, which also allows the evaluation of its solubilization process through agents such as PAMAM dendrimer is the main objective of the work described here. The electrochemical response of the LQM10 (AGH derivative) was evaluated, as well as its behavior in different electrochemical sensors. Electrochemical experiments were performed in buffered (phosphate at pH 7.02 and acetate at 4.5). LQM10 has a reversible oxidation peak with a potential of +0.22 V. It was efficiently detected in different electrodes tested (glass carbon/CNT, glass carbon/CNT/PAMAM), which proves the viability of the electrodes for various analyses and has the determination of the apparent constant association, indicating its interaction with the analysis that is higher in the presence of the PAMAM encapsulating agent. This was corroborated by the results for the modified gold electrode with MUA and PAMAM. The sum of the results shows the possibility of electrochemically evaluating the Aminoguanidine hydrazone derivative, the viability of electrodes employed and the greater solubilization of LQM10 in the presence of the PAMAM dendrimer.

改良型左甲状腺素钠相关药疹2例

优甲乐是一种人工合成外源性左甲状腺素,成分类似于甲状腺自然分泌的四碘甲状腺原氨酸,且可在外周器官中转化为游离三碘甲状腺原氨酸,并进一步结合受体,调节甲状腺功能。我院2例患者均为年轻女性,既往无药物及食物过敏史,也无家族遗传史。入院后行甲状腺切除术,术后常规给予优甲乐预防甲状腺肿复发,且服用同一批次、同一厂家优甲乐。2例患者前后出现不同程度的药物性皮疹,经抗过敏治疗后好转。2例患者的不良反应均与优甲乐的服用具有时间相关性,考虑为优甲乐的新辅料甘露醇引起。甘露醇静滴时,常见的不良反应包括过敏性皮疹和荨麻疹。本研究基于我院2例优甲乐疑似引起药物性皮疹病例,综合分析患者相关指标变化,并结合国内外相近案例回顾分析,探讨药物性皮疹特点及可能机制,以期提高临床医师对这一现象的关注,并为该疾病的深入研究、促进优甲乐安全合理用药提供一定参考。

改良德尔菲法构建《雷公藤多苷片治疗慢性肾脏病合理用药指南》的临床问题

目的:确定纳入《雷公藤多苷片治疗慢性肾脏病合理用药指南》临床问题与结局指标。方法:通过文献检索和专家头脑风暴会议形成临床问题与结局指标清单,经3轮改良德尔菲法调查问卷进行重要性评分和排序,最后召开专家共识投票会确认。由专家积极系数、权威系数以及变异系数进行问卷质量控制。结果:13个临床问题达成共识,主要涉及雷公藤多苷片单独使用或与治疗慢性肾脏病的常规西药联合使用时,与单独使用常规西药比较,是否有额外的获益;使用雷公藤多苷片期间出现肝功能异常时,是否需要停药;有生育需求的人群,使用雷公藤多苷片后需要停药多长时间。纳入结局指标51个,疗效性指标26个,包括蛋白尿改善、肾功能评价、远期预后、生命质量、免疫功能5方面。安全性指标25个,主要为系统性毒性,还包括血浆白蛋白降低、血尿酸升高、血糖以及血脂异常等。结论:通过改良德尔菲法确定了临床问题与结局指标,初步形成指南的结构体系,为指南的后续制定奠定了工作基础。

地舒单抗对比唑来膦酸治疗乳腺癌骨转移的疗效和安全性:一项倾向评分匹配队列研究

目的比较地舒单抗与唑来膦酸治疗乳腺癌骨转移患者的有效性与安全性。方法回顾性收集2020年9月至2022年7月南京医科大学第一附属医院肿瘤科收治的经骨改良药物治疗(地舒单抗90例,唑来膦酸86例)的晚期乳腺癌骨转移患者的临床资料。通过倾向评分后进行1∶1匹配,分为地舒单抗组66例和唑来膦酸组66例。比较两组患者无骨相关事件(skeletal-related event,SRE)生存率和不良事件的发生情况。结果截至2023年7月20日,中位随访时间为18.3个月,两组患者中位至首次SRE发生时间均未达到。地舒单抗组和唑来膦酸组治疗后1年无SRE生存率分别为80.3%(95%CI:68.7%~89.1%)和63.6%(95%CI:50.9%~75.1%)。与唑来膦酸组比较,地舒单抗组降低SRE发生风险(HR=0.48,95%CI:0.26~0.90,P=0.022)。两组发生的不良事件主要为低钙血症,唑来膦酸组关节痛发生率更高(P=0.028)。结论与唑来膦酸比较,地舒单抗治疗晚期乳腺癌骨转移患者可延迟SRE的发生,且关节痛不良事件的发生率更低。

靶向合成改善病情抗风湿药在类风湿关节炎中的应用评价

近年来,新型抗类风湿关节炎药不断涌现,包括生物类改善病情抗风湿药(bDMARDs)和靶向合成改善病情抗风湿药(tsDMARDs)。其中,tsDMARDs因其良好的临床疗效、口服制剂的便利性及可控的不良反应而在临床广泛应用。本文就tsDMARDs的作用机制、临床研究、不良反应、上市情况等进行综述,以期为临床应用提供参考。

黄芪桂枝五物加味汤联合甲钴胺治疗紫杉醇化疗后周围神经病变疗效观察

目的观察黄芪桂枝五物加味汤联合甲钴胺治疗紫杉醇化疗后周围神经病变的临床疗效。方法选取2021年9月—2022年9月于陕西中医药大学第二附属医院肿瘤乳腺外科住院治疗的恶性肿瘤患者96例,根据随机数字表法将患者分为3组,加味汤组35例给予黄芪桂枝五物加味汤联合甲钴胺治疗,原汤组32例给予黄芪桂枝五物汤联合甲钴胺治疗,对照组29例给予甲钴胺治疗,3组均连续治疗14 d。观察3组治疗前后周围神经病变分级、体力状况(ECOG)评分、卡氏功能状态(KPS)评分及治疗14 d后的临床疗效和治疗安全性。结果与治疗前比较,3组治疗后周围神经病变分级、ECOG评分、KPS评分均明显改善(P均<0.05);治疗后组间比较,加味汤组、原汤组周围神经病变分级、ECOG评分与对照组比较差异均无统计学意义(P均>0.05),KPS评分均明显高于对照组(P均<0.05),加味汤组和原汤组周围神经病变分级、ECOG评分、KPS评分比较差异均无统计学意义(P均>0.05)。3组治疗总有效率比较差异无统计学意义(P均>0.05),且均未出现不良反应。结论黄芪桂枝五物加味汤联合甲钴胺可减轻紫杉醇化疗后周围神经病变,改善患者体力状况和身体功能状态。

经脊柱椎间隙穿刺蛛网膜下腔脑桥前池置管药物输注技术应用指南

目的:鞘内镇痛药物的分布特点和目前置管技术的限制使传统的鞘内镇痛方法对头面部难治性疼痛无法发挥作用。本技术应用指南的制订旨在促进经脊柱椎间隙穿刺蛛网膜下腔脑桥前池置管药物输注技术的推广和规范、安全应用。方法:工作小组采用改良德尔菲法,邀请本技术领域的10名专家对脑桥前池药物输注技术的相关议题进行3轮电子邮件函询及3轮现场会议讨论。结果:针对脑桥前池药物输注技术的有效性和安全性,在技术原理、适应证和禁忌证、患者准备、脑桥前池置管手术规范、镇痛药物选择和剂量衔接、术后镇痛管理和并发症防治共7个议题形成一致意见(同意率≥80%)。结论:脑桥前池药物输注镇痛技术应用于头面部难治性疼痛患者具有微创、安全、有效的优点,既可减轻长期罹受疼痛患者的痛苦,也能帮助一些患者保持人生最后一程的生活质量和生命尊严,值得在国内外相关专业领域推广和规范应用。

我国化学药改良型新药临床试验最新进展研究

目的:总结已公开的化学药改良型新药临床试验开展情况,以期为后续化学药改良型新药临床试验的顺利开展提供参考。方法:通过国家药品监督管理局药品审评中心药物临床试验登记与信息公示平台并结合药智、丁香园等第三方数据库,检索2020年1月1日至2023年12月31日期间的化学药改良型新药临床试验信息,并采用Excel等方法进行统计分析,研究其临床试验开展情况。结果:自2020年1月1日至2023年12月31日,化学药改良型新药临床试验公示的数量逐年上升,3年时间总计公示了548次。其中,2.2类改良型新药占比最高,超过50%,2.1类改良型新药占比最少。开展的临床试验分期主要以Ⅰ期临床研究为主。结论:化学药改良型新药可借鉴已上市产品的临床开发数据,减免部分临床研究,缩短研发周期,这些是目前新药研发的热点。

生物制品治疗类风湿关节炎评价新视角

类风湿关节炎(rheumatoid arthritis,RA)是一种广泛存在的系统性自身免疫性疾病,以关节免疫功能紊乱伴随严重滑膜炎和关节侵蚀为特征,进一步发展会导致进行性残疾。目前,临床上针对RA的治疗药物以缓解病情的抗类风湿药物(disease-modifying anti-rheumatic drugs,DMARDs)为主,包括传统合成DMARDs(traditional synthetic DMARDs,cs DMARDs)、生物类DMARDs(biological DMARDs,b DMARDs)和靶向合成DMARDs(targeted synthetic DMARDs,tsDMARDs),此外还包括非甾体类抗炎药(nonsteroidal antiinflammatory drugs,NSAIDs)及糖皮质激素类药物(glucocorticoids,GCs)。其中,bDMARDs和tsDMARDs已成为RA市场的绝对主力,但因其使用周期长且存在一定的安全性问题,无法达到有效的持续缓解状态,停药后往往会有复发可能,进一步限制了临床应用。综述了临床上主要RA治疗药物及停药后复发情况的研究进展,以期为临床用药周期及方式提供有效的理论依据和新思路。

臭氧/陶瓷膜/除臭处理核酸药物废水应用

针对核酸类药物生产废水中高浓水废水生物毒性强的特点,首先采用臭氧氧化大幅度消减毒性后和低浓度废水混合,采用水解+A/O+浸没式MBR组合处理工艺进行处理。水解过程中加入零价铁来提高水解效率;浸没式MBR采用多巴胺修饰的纳米平板陶瓷膜,具有亲水性强,膜通量大,化学清洗频率低等优点。整个污水站除臭系统采用碱喷淋+生物除臭+活性炭吸附的组合工艺。长期工程调试运行效果表明,出水水质优于《废水综合排放标准》(DB 12/356-2018)(天津市地方标准)表2中的间接排放标准,即COD≤500 mg/L,BOD5≤300 mg/L,氨氮≤45 mg/L,总氮≤70 mg/L,SS≤400 mg/L。经过核算,水处理运行费用为9.8元/m^(3)。

主支药物洗脱支架+分支药物涂层球囊术式治疗真性分叉病变患者的临床预后

目的 探究主支药物洗脱支架(DES)+分支药物涂层球囊(DCB)术式治疗真性分叉病变患者的有效性和安全性,以及DCB治疗分叉病变的临床预后。方法 单中心、回顾性研究。连续纳入2019年3月至2021年6月于内蒙古医科大学附属医院接受经皮冠状动脉介入治疗且诊断为真性分叉病变的患者131例。依据接受术式不同将其分组:被动球囊拘禁组43例、主动球囊拘禁组43例和主支DES+分支DCB组45例。比较术后6个月随访时各组的血管晚期管腔丢失,以及术后12个月内各组的主要不良心血管事件(MACE)发生率。结果 术后6个月随访时,三组主支血管的晚期管腔丢失比较,差异无统计学意义(P=0.107);而主支DES+分支DCB组分支血管的晚期管腔丢失均低于其他两组(均为P<0.05)。术后12个月随访时,MACE发生率分别为主动球囊拘禁组16.3%、被动球囊拘禁组18.6%和主支DES+分支DCB组4.4%,三组间比较差异无统计学意义(P=0.107)。与普通球囊组(主动球囊拘禁组+被动球囊拘禁组)相比,主支DES+分支DCB组的MACE发生率显著降低(4.4%比17.4%,P=0.036)。结论 主支DES+分支DCB术式治疗真性分叉病变时,可有效改善患者预后,使用DCB治疗分叉病变可取得良好的临床预后。

归脾汤加减联合免疫化学药物治疗气血亏虚型非小细胞肺癌疗效观察

目的:研究分析归脾汤加减联合免疫化学药物治疗气血亏虚型非小细胞肺癌(NSCLC)疗效。方法:选取2021年1月—2023年12月井冈山大学附属医院和峡江县人民医院收治的60例中医辨证为气血亏虚型的非小细胞肺癌患者作为本次研究对象,根据不同治疗方案进行分组,即对照组与观察组,各30例。2组患者均接受免疫化学药物、护胃、营养支持、镇痛等常规对症治疗。对照组实施免疫化学药物治疗,采用含替雷利珠单抗免疫化学药物治疗方案,治疗3个疗程,至疾病进展,或有不耐受毒性。观察组采用归脾汤加减联合免疫化学药物,治疗3个疗程。比较2组患者临床治疗效果、气血亏虚型中医证候积分、功能状态评分、生存质量评分及不良反应发生情况差异。结果:经不同用药方案治疗后,观察组临床治疗总有效率高于对照(P<0.05);观察组气血亏虚型中医证候积分低于对照组(P<0.05);观察组生活质量评分各条目得分均优于对照组(P<0.05);观察组肿瘤病人功能状态评分低于对照组(P<0.05);与对照组相比,观察组患者的周围神经损伤、免疫性肺炎、骨髓抑制、胃肠道反应及肝肾功能异常等不良反应发生率显著降低,差异具有统计学意义(P<0.05)。结论:采用归脾汤加减联合免疫化学药物治疗气血亏虚型非小细胞肺癌疗效显著,不仅能够有效缓解患者气血亏虚的症状,还能够降低西医治疗过程中的不良反应发生率,显著提升患者的生活质量。