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The Effectiveness of Albumin Combined with Diuretics in Treating Ascites in Cirrhosis
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作者 Yajun An 《Journal of Clinical and Nursing Research》 2024年第7期79-84,共6页
Cirrhosis often leads to various complications during its progression,with ascites being one of the most common.Among these cases,5%to 10%are classified as refractory ascites.In recent years,clinical research on the t... Cirrhosis often leads to various complications during its progression,with ascites being one of the most common.Among these cases,5%to 10%are classified as refractory ascites.In recent years,clinical research on the treatment of cirrhotic ascites has yielded increasingly enriched results.In this paper,a large number of clinical data on the treatment of ascites using albumin combined with diuretics were collected,and it was found that there were more results in group control studies.It was believed that albumin combined with diuretic therapy could effectively improve symptoms,reduce the occurrence of adverse reactions,ensure the safety of patients,and have a good clinical application prospect.This paper reviews the efficacy of albumin combined with diuretics in the treatment of ascites in cirrhosis. 展开更多
关键词 ALBUMIN diuretics Cirrhotic ascites Curative effect
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Effects of Different Diuretics on Water Drinking Amount, Urination Volume and Related Blood Indices of Sheep Fed with Cottonseed 被引量:1
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作者 郭璇 邵伟 +1 位作者 李艳丽 余雄 《Agricultural Science & Technology》 CAS 2013年第2期345-347,353,共4页
[Objective] This study aimed to investigate the effects of three kinds of diuretics on the water drinking amount and urination volume of sheep fed with cottonseed hulls. [Method] The method of self-control was adopted... [Objective] This study aimed to investigate the effects of three kinds of diuretics on the water drinking amount and urination volume of sheep fed with cottonseed hulls. [Method] The method of self-control was adopted. Five two-year-old male Kazak sheep about 40 kg which never had intake of the feeds containing gossypol were selected. The experiment was divided into five periods, namely the control period, a period with the supplement of 300 mg/d of hydrochlorothiazide, a period with the supplement of 200 mg/d of hydrochlorothiazide, a period with the supplement of 350 mg of GY-01 and a period with the supplement of 200 mg of GY-01. The sheep were fed with the concentrate and the cottonseed hulls in the control period, and corresponding diuretics were supplemented in the rest four periods. The water drinking amount, urination volume and the contents of the hormone and ion in the blood were determined in each period. [Result] After 350 mg GY-01 was supplemented, the water drinking amount of each sheep had an increase of 60.14% compared with that of the sheep in the control period and the urination volume was 2.67 times of that of the latter, and the differences were both significant (P0.01). The antidiuretic hormone declined by 32.59% compared with that of the sheep in the control period, with the significant difference (P 0.05). The adrenocorticotropic hormone content increased by 81.93% compared with that of the sheep in the control period and the difference was significant (P0.01). An increase of 28.04% (P 0.05) and 39.39% (P 0.01) was found in the contents of serum potassium and phosphorus respectively compared with that of sheep in the control period. [Conclusion] The diet with supplement of GY-01 can increase the urination volume of livestock fed with the cottonseed hulls, and the most appropriate supplement amount is 200 mg GY-01. 展开更多
关键词 Cottonseed hulls SHEEP diuretics Urination volume Hormone Inorganic ions
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Ototoxic effects and mechanisms of loop diuretics 被引量:6
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作者 Dalian Ding Hong Liu +6 位作者 Weidong Qi Haiyan Jiang Yongqi Li Xuewen Wu Hong Sun Kenneth Gross Richard Salvi 《Journal of Otology》 CSCD 2016年第4期-,共12页
Over the past two decades considerable progress has been made in understanding the ototoxic effects and mechanisms underlying loop diuretics. As typical representative of loop diuretics ethacrynic acid or furosemide o... Over the past two decades considerable progress has been made in understanding the ototoxic effects and mechanisms underlying loop diuretics. As typical representative of loop diuretics ethacrynic acid or furosemide only induces temporary hearing loss, but rarely permanent deafness unless applied in severe acute or chronic renal failure or with other ototoxic drugs. Loop diuretic induce unique pathological changes in the cochlea such as formation of edematous spaces in the epithelium of the stria vascularis, which leads to rapid decrease of the endolymphatic potential and eventual loss of the cochlear microphonic potential, summating potential, and compound action potential. Loop diuretics interfere with strial adenylate cyclase and Nat/Kt-ATPase and inhibit the Na-K-2Cl cotransporter in the stria vascularis, however recent reports indicate that one of the earliest effects in vivo is to abolish blood flow in the vessels supplying the lateral wall. Since ethacrynic acid does not damage the stria vascularis in vitro, the changes in Nat/Kt-ATPase and Na-K-2Cl seen in vivo may be secondary effects results from strial ischemia and anoxia. Recent observations showing that renin is present in pericytes surrounding stria arterioles suggest that diuretics may induce local vasoconstriction by renin secretion and angiotensin formation. The tight junctions in the blood-cochlea barrier prevent toxic molecules and pathogens from entering cochlea, but when diuretics induce a transient ischemia, the barrier is temporarily disrupted allowing the entry of toxic chemicals or pathogens. 展开更多
关键词 diuretics Stria vascularis ISCHEMIA PERICYTES RENIN
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The use of diuretics in acute heart failure: Evidence based therapy? 被引量:3
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作者 Ali Vazir Martin R. Cowie 《World Journal of Cardiovascular Diseases》 2013年第2期25-34,共10页
The evidence base for the use of diuretics in acute heart failure is limited, with no large double-blind placebo-controlled randomized trials. However, their use as a first line treatment of acute heart failure is fir... The evidence base for the use of diuretics in acute heart failure is limited, with no large double-blind placebo-controlled randomized trials. However, their use as a first line treatment of acute heart failure is firmly established in clinical practice, and endorsed in clinical guidelines. Loop diuretics are typically the first line diuretic strategy for the treatment of acute heart failure. For patients with considerable fluid retention, there is some evidence that initial treatment with continuous infusion or boluses of high dose loop diuretic is superior to an initial lower dose strategy. In patients who are diuretic resistant, the addition of an oral thiazide or thiazide-like diuretic to induce sequential nephron blockade can be beneficial. Intravenous low-dose dopamine has also been used to assist diuresis and preserve renal function in such circumstances, but trials are underway to confirm the clinical value of this agent. Mechanical ultrafiltration has been used to treat patients with heart failure and fluid retention, but the evidence base is not secure, and its place in clinical practice is yet to be established. 展开更多
关键词 ACUTE HEART Failure diuretics diuretIC Resistance ULTRAFILTRATION
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Determination of 8 Diuretics and Probenecid in Human Urine by Gas Chromatography-Mass Spectrometry: Confirmation Procedure 被引量:2
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作者 Olga Zaporozhets Iuna Tsyrulneva Mykola Ischenko 《American Journal of Analytical Chemistry》 2012年第4期320-327,共8页
A fast and sensitive method for determination of 8 diuretics (acetazolamide, bendroflumethiazide, bumetanide, chlorthalidone, furosemide, hydrochlorothiazide, metolazone, triamterene) and masking agent (probenecid) in... A fast and sensitive method for determination of 8 diuretics (acetazolamide, bendroflumethiazide, bumetanide, chlorthalidone, furosemide, hydrochlorothiazide, metolazone, triamterene) and masking agent (probenecid) in human urine using gas-chromatography with mass spectrometric detection is described. The extraction of the substances as function of the nature of organic solvent, mixing time and pH of aqueous phase was studied. The tandem mass spectrometry was used to increase selectivity of diuretics determination due to elimination of background interferences. Fragmentation reactions were studied for each compound and their collision energies were optimized to obtain the best selectivity. The results of method’s validation demonstrate its suitability in routine analysis for confirmation purposes. 展开更多
关键词 diuretics URINE Gas CHROMATOGRAPHY Tandem Mass SPECTROMETRY CONFIRMATION
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The Effect of Loop Diuretics on Sarcopenia and Long-Term Prognosis in Patients with Refractory Hepatic Ascites Treated with Tolvaptan
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作者 Masaaki Shimada Hiroaki Iwase +7 位作者 Noboru Hirashima Masashi Saito Hisashi Kondo Noboru Urata Satoshi Unita Takashi Kondo Daiki Tanaka Takuya Tsunekawa 《Open Journal of Gastroenterology》 2018年第6期201-208,共8页
We investigated sarcopenia, focusing on the dose of loop diuretics used in 70 patients with refractory hepatic ascites treated with tolvaptan. Bloating improved in 68.5% of patients, as determined using the Japanese v... We investigated sarcopenia, focusing on the dose of loop diuretics used in 70 patients with refractory hepatic ascites treated with tolvaptan. Bloating improved in 68.5% of patients, as determined using the Japanese version of the Support Team Assessment Schedule. The psoas muscle index (PMI) was used to define sarcopenia. A statistically significant difference was observed in the PMI between patients receiving low-dose (3.6 ± 1.2 cm2/m2) and high-dose furosemide (3.1 ± 1.2 cm2/m2) before tolvaptan treatment (P = 0.048). The PMI increased from 3.2 ± 1.1 cm2/m2 to 3.5 ± 1.3 cm2/m2 (P = 0.002) in responders, but decreased from 3.4 ± 1.2 cm2/m2 to 3.0 ± 1.0 cm2/m2 (P = 0.106) in non-responders before and after tolvaptan treatment, respectively. The long-term prognosis improved in responders compared with non-responders (mean survival time: 646 days vs. 228 days, P < 0.001). Early introduction of tolvaptan treatment is necessary to prevent the progression of sarcopenia. 展开更多
关键词 TOLVAPTAN HEPATIC ASCITES SARCOPENIA Loop diuretics Long-Term Prognosis
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Urea transporter inhibitors identified as novel diuretics
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《中国药理学通报》 CAS CSCD 北大核心 2015年第B11期106-107,共2页
Urea transporters (UT), including isoforms of UT-A endothelia and erythrocytes, play an important role in the urine in kidney tubule epithelia and UT-B in vasa recta concentration mechanism by mediated an intrarenal... Urea transporters (UT), including isoforms of UT-A endothelia and erythrocytes, play an important role in the urine in kidney tubule epithelia and UT-B in vasa recta concentration mechanism by mediated an intrarenalurea recycling, suggesting that functional inhibition of these proteins could have therapeutic use as diuretic. By in- tegrated cell based high throughput screening and in silico methods, a class of small-molecule drug-like compounds with thienoquinolin core structure was found to have inhibition activity on both UT-A and UT-B. The structure and activity relationship analysis showed a compound PU-48, named chemically as methyl 3-amino-6-methoxythieno[ 2, 3-b] quinoline-2-carboxylate, had the best UT-A and UT-B inhibition activity. IC50s of PU-48 on UT-B facilitated as determined by erythrocyte lysis assay. In vivo urea transport were micromole level in human, rat, and mouse, activity of PU-48 on urinary concentrating function was evaluated in rats fed ad libitum in metabolic cages. Urine output significantly increased in a dose-dependent manner in rats subcutaneously administered PU-48. Urinary os- molality and urea concentration were significantly decreased. The peak changes of urine output, urinary osmolality and urinary urea concentration occurred between 2 and 4 h after PU/18 administration, with values returning to was subcutaneously injected every 6 h the 24 h urine output in baseline by 10 h. When PU-48 at 50 mg · kg^-1 PU-48 treated rats was significantly higher than that in vehicle control rats. Urinary osmolality and urea concentra- tion in PU-48 treated rats were significantly lower than in vehicle control rats. The excretion of Na + , K + , C1- was PU-48 treated rats had significantly higher urea excre- similar in PU-48 treated and vehicle control rats. However, tion than vehicle control rats. The data suggest that PU-48 caused a urea-selective diuresis without disturbing elec- TGs, and LDL-C in PU-48-treated rats were similar with those trolyte metabolism. Notably, blood urea, T-CHO, in vehicle control rats, which are normal levels. These data indicate that the diuretic effect of PU-14 does not cause electrolyte imbalance and abnormal metabolism. It is predicated that UT inhibitors have potential clinical applica- tions as sodium-sparing diuretics in edema from different etiologies, such as congestive heart failure and cirrhosis. 展开更多
关键词 UREA UREA TRANSPORTER diuretics KIDNEY DRUG discovery
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GC-MS STUDY ON DIURETICS IN URINE Ⅰ.BETECTION METHOD USING METHYLATION
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作者 Ya wei LI Jun LI Shao Tang ZHU Tong Hui ZHOU Institute of Materia Medica,Chinese Academy of Medical Sciences Beijing 100050,China 《Chinese Chemical Letters》 SCIE CAS CSCD 1990年第3期225-228,共4页
A reliable and sensitive method is developed for the detection of common diuretics in human urine. diuretics along with probenecid are methylated and subjected to GC-MS analysis.Both chromatographic and mass spectrom... A reliable and sensitive method is developed for the detection of common diuretics in human urine. diuretics along with probenecid are methylated and subjected to GC-MS analysis.Both chromatographic and mass spectrometric data are obtained in selected ion monitoring and full scanning modes.The average detection limit is 0.1-1.0 ag/mi urine.This method is suitable to large-scale and routine screening or confirmation of diuretics in doping control. 展开更多
关键词 OC GC-MS STUDY ON diuretics IN URINE BETECTION METHOD USING METHYLATION MS
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GC-MS STUDY ON DIURETICS IN URINE Ⅱ.DETECTION METHOD USING TRIMETHYLSILYLATION
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作者 Ya Wei LI Jun LI Tong Hui ZHOU Institute of Materia Medica,Chinese Academy of Medical Sciences Beijing 100050,China 《Chinese Chemical Letters》 SCIE CAS CSCD 1991年第1期19-22,共4页
A reliable method is described for the detection of amitoride,triamterene. canrenone and spironolactone in human urine using GC-MS analysis after trimethytsitytation.The mass spectrometric and metabotic features of th... A reliable method is described for the detection of amitoride,triamterene. canrenone and spironolactone in human urine using GC-MS analysis after trimethytsitytation.The mass spectrometric and metabotic features of the compounds are discussed 展开更多
关键词 mode GC-MS STUDY ON diuretics IN URINE DETECTION METHOD USING TRIMETHYLSILYLATION OC MS
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Application of Large Dose of Diuretics in ESRD Patients on Maintenance Hemodialysis
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作者 Guimian Zou Weiguo Sui +1 位作者 Yihong Jian Hequn Zou 《器官移植内科学杂志》 2013年第3期86-91,共6页
关键词 终末期肾病 血液透析 利尿剂 大剂量 患者 平均动脉压 抗高血压 应用
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参芪益心汤治疗心力衰竭合并利尿剂抵抗患者的临床疗效及对其心功能、NT-proBNP水平的影响
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作者 王琪 吴限 +3 位作者 刘丰 苗永悦 孙少谦 刘莉 《世界中西医结合杂志》 2024年第5期971-974,981,共5页
目的 探讨参芪益心汤加减治疗心力衰竭合并利尿剂抵抗患者的疗效。方法 选取2021年12月—2022年12月期间黑龙江中医药大学附属第一医院收治的心力衰竭合并利尿剂抵抗患者100例作为研究对象,按照随机数字表法分为对照组和试验组,每组各5... 目的 探讨参芪益心汤加减治疗心力衰竭合并利尿剂抵抗患者的疗效。方法 选取2021年12月—2022年12月期间黑龙江中医药大学附属第一医院收治的心力衰竭合并利尿剂抵抗患者100例作为研究对象,按照随机数字表法分为对照组和试验组,每组各50例。对照组予常规治疗,试验组在对照组基础上加用参芪益心汤,两周为1个疗程,两组患者均治疗4周。观察比较两组患者治疗前后心功能指标[左心室舒张末期内径(Left ventricular end-diastolic diameter,LVDD)、左房内径(Left atrial diameter,LAD),计算左室射血分数(Left ventricular ejection fraction,LVEF)]、血清指标[N端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、肌钙蛋白T(Cardiac troponin T,CTnT)、肌酸磷化脢同功脢(Creatine kinase isoenzyme,Ck-MB)]、中医证候积分,比较两组患者临床疗效及不良反应。结果 治疗后两组患者心功能LVDD、LAD水平均较治疗前降低,LVEF水平均较治疗前升高,差异有统计学意义(P<0.05);且试验组LVDD、LAD水平均明显低于对照组,LVEF水平明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者NT-proBNP、CTnT、Ck-MB水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组NT-proBNP、CTnT、Ck-MB水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者心悸、气短、气喘、胸闷评分均较治疗前降低,差异有统计学意义(P>0.05);且试验组心悸、气短、气喘、胸闷评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后试验组总有效率96.00%(48/50)高于对照组72.00%(36/50),差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论 应用参芪益心汤能够显著改善心功能,缓解临床症状,疗效显著,值得临床应用。 展开更多
关键词 心力衰竭 利尿剂抵抗 参芪益心汤 中医证候积分
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连续性肾脏替代疗法对难治性心力衰竭伴利尿药抵抗患者预后的影响
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作者 尹伟 马强 李海涛 《岭南心血管病杂志》 CAS 2024年第3期311-315,342,共6页
目的探讨连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)对难治性心力衰竭(refractory heart failure,RHF)伴利尿药抵抗患者预后的影响,分析其影响因素。方法选取北京市普仁医院2019年1月至2022年1月收治的利尿药抵抗... 目的探讨连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)对难治性心力衰竭(refractory heart failure,RHF)伴利尿药抵抗患者预后的影响,分析其影响因素。方法选取北京市普仁医院2019年1月至2022年1月收治的利尿药抵抗性RHF患者102例开展回顾性研究。患者均采用CRRT治疗,比较患者治疗前、后的左心室射血分数(left ventricular ejection fraction,LVEF)、心脏指数(cardiac index,CI)、心排血量(cardiac output,CO),检测血清氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、血肌酐(serum creatinine,Scr)、尿酸(uric acid,UA)、血尿素氮(blood urea nitrogen,BUN)浓度,并记录24 h尿量变化。观察患者28 d的预后情况,根据预后分成生存组、死亡组,收集并比较两组患者的临床资料,利用多元Logistic回归模型分析CRRT治疗患者预后的影响因素。结果经治疗后,患者LVEF、CI、CO高于治疗前,血清NT-proBNP浓度低于治疗前,差异有统计学意义(P<0.05)。患者治疗后的血清Scr、UA、BUN浓度低于治疗前,而24 h尿量高于治疗前,差异有统计学意义(P<0.05)。102例患者中病死率为35.29%,生存率为64.71%。死亡组入院后6 h内治疗占比为13.89%,低于生存组的40.91%,且死亡组入院时平均动脉压(mean arterial pressure,MAP)、血红蛋白(hemoglobin,Hb)浓度及24 h尿量低于生存组,血清NT-proBNP浓度高于生存组,差异有统计学意义(P<0.05)。多元Logistic回归分析显示,患者入院后6 h内接受治疗及入院时相对较高的MAP、Hb浓度及24 h尿量是预后保护性因素,入院时血清NT-proBNP浓度过高是预后危险因素(P<0.05)。结论CRRT对利尿药抵抗性RHF患者有一定治疗作用,但早期病死率仍较高,且CRRT治疗的预后与多种因素相关,临床需引起重视。 展开更多
关键词 心力衰竭 连续性肾脏替代疗法 利尿药抵抗 预后 影响因素
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真武汤加减治疗慢性心力衰竭合并利尿剂抵抗的Meta分析
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作者 唐娥 王定寅 +1 位作者 林姗姗 毕颖斐 《世界中西医结合杂志》 2024年第6期1087-1093,共7页
目的系统评价真武汤加减联合西药常规治疗慢性心力衰竭(Chronic heart failure,CHF)合并利尿剂抵抗(Diuretic resistance,DR)的临床疗效。方法检索自建库起至2023年11月1日中国知网、万方数据库、维普数据库、中国生物医学文献数据库、P... 目的系统评价真武汤加减联合西药常规治疗慢性心力衰竭(Chronic heart failure,CHF)合并利尿剂抵抗(Diuretic resistance,DR)的临床疗效。方法检索自建库起至2023年11月1日中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase、Web of Science、Clinical Trials、中国临床试验注册中心等数据库中真武汤加减治疗CHF合并DR的随机对照试验,采用Review Manager 5.4软件对文献数据进行Meta分析。结果共纳入15篇文献,包括1187例患者。Meta分析结果显示,与单纯西药对照组相比,真武汤加减联合西药常规治疗组患者在24 h总尿量[n=1058,MD=397.30,95%CI(269.44,525.16),P<0.01]、临床总有效率[n=625,RR=1.24,95%CI(1.15,1.34),P<0.01]、左心室射血分数(Left ventricular ejection fractions,LVEF)[n=697,MD=4.32,95%CI(2.51,6.112),P<0.01]、氨基末端脑利钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)水平[n=282,MD=734.4,95%CI(828.93,639.87),P<0.01]、外周血IL-6水平[n=170,MD=-5.70,95%CI(-7.23,-4.16),P<0.01]、外周血TNF-α水平[n=170,MD=-12.79,95%CI(-15.53,-10.04),P<0.01]方面均有明显改善,而左室舒张末内径未见明显改善[n=266,MD=-4.50,95%CI(-9.36,0.35),P=0.07]。药物安全性良好,加载中药治疗可显著降低低钾血症发生率[n=177,RR=0.32,95%CI(0.18,0.57),P<0.01]。结论在单纯西药治疗基础上,予真武汤加减可改善CHF合并DR患者24 h尿量、提高临床总有效率、改善患者心功能、降低炎症因子水平,且安全性较好。 展开更多
关键词 真武汤 心力衰竭 利尿剂抵抗 随机对照试验 META分析
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芪苈强心胶囊降低慢性心力衰竭急性失代偿患者发生利尿剂抵抗风险的回顾性研究 被引量:2
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作者 冯超 蒋汉涛 +2 位作者 樊官伟 李澜 冯津萍 《中国全科医学》 CAS 北大核心 2024年第21期2578-2585,共8页
背景利尿剂抵抗与心力衰竭(HF)患者的病死率增加有关。芪苈强心胶囊是用于治疗HF的中药。目前缺乏其在改善利尿剂抵抗方面作用的临床证据。目的探讨芪苈强心胶囊能否降低慢性HF急性失代偿(ADCHF)患者发生利尿剂抵抗的风险并改善其预后... 背景利尿剂抵抗与心力衰竭(HF)患者的病死率增加有关。芪苈强心胶囊是用于治疗HF的中药。目前缺乏其在改善利尿剂抵抗方面作用的临床证据。目的探讨芪苈强心胶囊能否降低慢性HF急性失代偿(ADCHF)患者发生利尿剂抵抗的风险并改善其预后。方法纳入2018年1月—2022年6月在天津大学胸科医院CICU病区住院治疗的HF患者374例为研究对象,根据是否发生利尿剂抵抗将患者分为利尿剂抵抗组(118例)和非利尿剂抵抗组(256例)。收集患者的一般资料和实验室检查结果等。对患者随访12个月,观察因心血管事件再住院或全因死亡情况。绘制各组患者的Kaplan-Meyer生存曲线,生存曲线比较采用Log-rank检验。采用多因素Logistic回归分析探究患者发生利尿剂抵抗风险的影响因素。采用多因素Cox回归分析探究ADCHF患者发生终点事件的影响因素。结果利尿剂抵抗组年龄、体质量、N末端前体脑利钠肽(NT-proBNP)、血尿素氮、血肌酐、血尿酸、国际标准化比值(INR)高于非利尿剂抵抗组,24 h液体摄入量、估算肾小球滤过率(eGFR)、淋巴细胞绝对值、芪苈强心胶囊使用率低于非利尿剂抵抗组。多因素Logistic回归分析结果显示,使用芪苈强心胶囊(OR=0.363,95%CI=0.186~0.708,P=0.003)、24 h液体摄入量升高(OR=0.286,95%CI=0.177~0.461,P<0.001)是ADCHF患者发生利尿剂抵抗风险的保护因素。体质量增加(OR=1.064,95%CI=1.040~1.088,P<0.001)、血尿酸增高(OR=1.002,95%CI=1.000~1.004,P=0.027)是患者发生利尿剂抵抗风险的危险因素。Log-rank检验结果显示,利尿剂抵抗组无终点事件平均生存时间短于非利尿剂抵抗组(χ^(2)=11.866,P=0.001);未使用芪苈强心胶囊患者无终点事件平均生存时间短于使用芪苈强心胶囊患者(χ^(2)=6.502,P=0.011)。多因素Cox回归分析结果显示,使用芪苈强心胶囊(HR=0.536,95%CI=0.308~0.933,P=0.027)和使用血管紧张素受体脑啡肽酶抑制剂/血管紧张素转化酶抑制剂/血管紧张素受体阻滞剂(HR=0.435,95%CI=0.229~0.826,P=0.011)是患者发生终点事件的保护因素,总胆红素升高(HR=1.019,95%CI=1.008~1.030,P=0.001)、总胆汁酸升高(HR=1.029,95%CI=1.002~1.058,P=0.036)是患者发生终点事件的危险因素。结论在常规抗HF治疗的基础上使用芪苈强心胶囊可以降低ADCHF患者发生利尿剂抵抗的风险,同时降低这类患者1年内因心血管事件再住院或全因死亡的风险。 展开更多
关键词 心力衰竭 利尿剂抵抗 芪苈强心胶囊 回顾性研究
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从三焦理论探讨恶性胸腹腔积液的治疗
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作者 吴嫣然 李婧 +2 位作者 王定坤 苏浩 陈刚 《河南中医》 2024年第10期1502-1506,共5页
恶性胸腹腔积液病机为三焦阻滞,水饮内停,元气运行受阻,血液凝滞,痰瘀内结,治疗应在行气利水、淡渗利湿或峻下逐水、逐瘀利水通利三焦的基础上,兼顾肺、脾,肾三脏的功能失调。通利三焦多为宣上通下的行气利水药物,如柴胡、枳实、桔梗等... 恶性胸腹腔积液病机为三焦阻滞,水饮内停,元气运行受阻,血液凝滞,痰瘀内结,治疗应在行气利水、淡渗利湿或峻下逐水、逐瘀利水通利三焦的基础上,兼顾肺、脾,肾三脏的功能失调。通利三焦多为宣上通下的行气利水药物,如柴胡、枳实、桔梗等,同时配以淡渗利湿药物或者峻下逐水药物以通调水道,如茯苓、猪苓、泽泻等,尚需加用利水逐瘀药物,如水蛭、桃仁、泽兰等。兼顾肺、脾,肾三脏的功能失调,分别以开宣肺气、健脾益气、温补肾阳之法,开宣肺卫通利三焦用以麻黄为基础的方药如越婢汤、越婢加术汤、甘草麻黄汤及大小青龙汤;健脾渗湿疏利三焦用以黄芪为基础的方药如防己茯苓汤、桂枝加黄芪汤、桂枝苦酒汤;温补肾阳用附子,干姜。同时尚需要考虑恶性肿瘤癌毒这一主要病理因素,加用祛除癌毒之邪药物如山慈菇、蛇六谷、全蝎等。 展开更多
关键词 恶性胸腹腔积液 三焦 行气利水 淡渗利湿 峻下逐水 逐瘀利水
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利尿肾动态显像20分钟残留率对肾盂成形术时机选择的临床预测价值
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作者 纪学理 苟金玉 +3 位作者 陈素芸 傅宏亮 邹仁健 王辉 《上海交通大学学报(医学版)》 CAS CSCD 北大核心 2024年第7期899-906,共8页
目的·探究利尿肾动态显像中20分钟残留率(20-minute residual rate,R_(20))等参数对于先天性单侧肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)患儿肾盂成形术手术时机的预测价值。方法·回顾性分析2018年8... 目的·探究利尿肾动态显像中20分钟残留率(20-minute residual rate,R_(20))等参数对于先天性单侧肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)患儿肾盂成形术手术时机的预测价值。方法·回顾性分析2018年8月到2023年8月期间在上海交通大学医学院附属新华医院核医学科初次就诊的110例先天性单侧UPJO患儿的临床资料和利尿肾动态显像结果。随访患儿初次行利尿肾动态显像后的影像检查结果和肾积水进展情况。以患儿是否因肾积水进展行肾盂成形术为结局事件,将患儿分为手术组和非手术组。比较2组患儿年龄、性别、肾积水侧别,以及基线利尿肾动态显像参数包括肾血流灌注率(blood perfusion rate,BPR)、分肾功能(differential renal function,DRF)、达峰时间(time to peak,T_(max))、半排时间(time to half,T_(1/2))及R_(20)。采用Logistic回归分析各参数对肾积水进展的影响。采用受试者操作特征(receiver operating characteristic,ROC)曲线分析利尿肾动态显像参数对患儿是否需要手术干预的预测价值。采用Wilcoxon检验比较行2次利尿肾动态显像患儿的检查参数。结果·在随访过程中有60例患儿因肾积水进展行肾盂成形术,50例患儿肾积水未进展。手术组与非手术组患儿基线状态DRF、T_(max)、T_(1/2)和R_(20)的差异均有统计学意义(均P<0.05)。单因素和多因素Logistic回归分析显示,R_(20)是肾盂成形术的独立预测因素(OR=4.730,95%CI 1.009~1.178,P=0.030)。R_(20)预测肾盂成形术的灵敏度为88.3%,特异度为56%,ROC曲线下面积为0.758(95%CI 0.667~0.850,P=0.000),临界值为90.08%。38例患儿在随访过程中进行了第二次利尿肾动态显像,DRF较前下降,2次DRF的差异有统计学意义(Z=-2.589,P=0.010),尤其是R_(20)≥90.08%的患儿(Z=-2.166,P=0.030)。非手术组患儿R_(20)较基线明显下降(Z=-2.062,P=0.039),而手术组患者R_(20)较基线增加,但差异无统计学意义(P>0.05)。结论·R_(20)对于先天性单侧UPJO患儿肾盂成形术的预测具有重要意义。对于R_(20)≥90.08%的患儿,应尽早行肾盂成形术,以防止肾功能进一步恶化。 展开更多
关键词 利尿肾动态显像 肾盂输尿管连接部梗阻 先天性肾积水 肾盂成形术 残留率
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强心利尿基础上联合诺欣妥治疗心肌梗死后心力衰竭的效果和安全性 被引量:1
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作者 戴昭冰 周敏 +3 位作者 石鑫 房红梅 陈晓晴 王艳丽 《中国医药科学》 2024年第2期91-95,共5页
目的探析强心利尿基础上联合诺欣妥治疗心肌梗死(MI)后心力衰竭(HF)的临床效果。方法纳入济南高新东区医院2022年6—12月经临床确诊的68例MI后HF患者,采用简单随机化方法将纳入患者分为两组,对照组34例给予强心利尿治疗,观察组34例在对... 目的探析强心利尿基础上联合诺欣妥治疗心肌梗死(MI)后心力衰竭(HF)的临床效果。方法纳入济南高新东区医院2022年6—12月经临床确诊的68例MI后HF患者,采用简单随机化方法将纳入患者分为两组,对照组34例给予强心利尿治疗,观察组34例在对照组基础上加施诺欣妥治疗,比较两组临床疗效、心功能指标、心肌损伤指标以及神经内分泌因子和不良反应发生率。结果观察组临床总有效率为94.12%,高于对照组的76.47%,差异有统计学意义(P<0.05)。治疗后,观察组左室射血分数(LVEF)、心搏出量(CO)高于对照组,左室收缩末期内径(LVDs)、左室舒张末期内径(LVDd)低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组心肌肌钙蛋白I(cTn-I)、肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)均低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组N末端脑钠肽前体(NT-pro BNP)、血清肾素(RA)、血管紧张素Ⅱ(AngⅡ)均低于对照组,差异有统计学意义(P<0.05)。观察组低血压、胃肠道反应、心律失常以及血管性水肿不良反应总发生率为5.88%,与对照组的8.82%比较,差异无统计学意义(P>0.05)。结论在强心利尿基础上采用诺欣妥治疗MI后HF,整体效果较好,改善心功能指标、心肌损伤指标以及神经内分泌因子水平作用显著,不良反应较少,值得临床推广、应用。 展开更多
关键词 心肌梗死 心力衰竭 强心利尿 诺欣妥 临床疗效 心功能
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心力衰竭患者利尿剂抵抗的发病机制与治疗进展
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作者 李忠衡 李睿宁 +2 位作者 叶桢 刘艺硕 孙丽杰 《心血管病学进展》 CAS 2024年第8期717-721,共5页
心力衰竭(HF)是各种原发或继发性心脏病的最终结局,是全世界的重大健康问题之一。控制钠摄入及使用利尿剂被普遍认为是HF的基本治疗方式,但有20%~50%的心力衰竭患者存在利尿剂抵抗(DR)。DR与HF患者心血管事件的风险增加、住院时间延长... 心力衰竭(HF)是各种原发或继发性心脏病的最终结局,是全世界的重大健康问题之一。控制钠摄入及使用利尿剂被普遍认为是HF的基本治疗方式,但有20%~50%的心力衰竭患者存在利尿剂抵抗(DR)。DR与HF患者心血管事件的风险增加、住院时间延长以及再入院有关。现概述HF患者中的DR现象,并全面总结其发病机制及治疗,旨在为临床医生及科研人员提供更全面、多维度的理解,促进对合并DR的HF患者的发病机制和治疗策略的深入探讨。 展开更多
关键词 心力衰竭 利尿剂 利尿剂抵抗
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急性心力衰竭患者利尿剂抵抗的危险因素及风险预测模型构建
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作者 薛忠文 吕松桧 王爽 《河北医药》 CAS 2024年第8期1156-1160,共5页
目的分析急性心力衰竭(AHF)患者利尿剂抵抗的危险因素并构建风险预测模型,为利尿剂抵抗的临床防治提供参考。方法回顾性分析2019年1月至2021年11月收治的102例AHF患者临床资料,根据住院期间利尿剂抵抗发生情况分为抵抗组与非抵抗组。查... 目的分析急性心力衰竭(AHF)患者利尿剂抵抗的危险因素并构建风险预测模型,为利尿剂抵抗的临床防治提供参考。方法回顾性分析2019年1月至2021年11月收治的102例AHF患者临床资料,根据住院期间利尿剂抵抗发生情况分为抵抗组与非抵抗组。查阅并记录患者一般资料及实验室指标,通过Logistic回归分析AHF患者利尿剂抵抗的危险因素,绘制列线图构建AHF患者利尿剂抵抗的风险预测模型,并评估风险预测模型对AHF患者利尿剂抵抗的预测价值。结果住院期间,102例患者中38例发生利尿剂抵抗,发生率为37.25%;抵抗组入院时NYHA心功能分级高于非抵抗组,低钠血症、入院前使用非甾体抗炎药占比高于非抵抗组,差异有统计学意义(P<0.05);抵抗组入院时血清白蛋白水平低于非抵抗组,血清B型钠尿肽(BNP)、氨基末端B型钠尿肽原(NT-proBNP)、醛固酮水平高于非抵抗组,差异有统计学意义(P<0.05)。Logistic回归分析发现,入院前使用非甾体抗炎药、入院时血清BNP、NT-proBNP、醛固酮水平高是AHF患者利尿剂抵抗发生的独立危险因素(OR>1,P<0.05);入院时血清白蛋白水平高是AHF患者利尿剂抵抗发生的保护因素(OR<1,P<0.05);通过上述影响因素构建风险预测模型并验证,结果显示,模型C-index值为0.967,模型区分度良好,校准曲线Y与X直线相近,模型准确度良好。结论入院前使用非甾体抗炎药、入院时血清BNP、NT-proBNP、醛固酮水平高、入院时血清白蛋白水平低均为AHF患者利尿剂抵抗发生的影响因素,根据上述因素构建的风险预测模型对AHF患者利尿剂抵抗的发生具有较好的预测价值。 展开更多
关键词 急性心力衰竭 利尿剂抵抗 预测模型 白蛋白 醛固酮
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基于大鼠尿液生物标志物探析冬葵果醇提物的利尿作用
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作者 陈德阿尤西 孟香花 +4 位作者 陈玉花 胡伊力格其 刘锦文 韩晓静 白梅荣 《中医药信息》 2024年第5期37-44,共8页
目的:采用尿液代谢产物分析方法评价冬葵果醇提物利尿作用机制。方法:选取50只雄性SD大鼠随机分为正常组(Z组),冬葵果醇提物高剂量组(DG组)、冬葵果醇提物中剂量组(DZ组)、冬葵果醇提物低剂量组(DD组),阳性对照组(Y组)。制备大鼠水负荷... 目的:采用尿液代谢产物分析方法评价冬葵果醇提物利尿作用机制。方法:选取50只雄性SD大鼠随机分为正常组(Z组),冬葵果醇提物高剂量组(DG组)、冬葵果醇提物中剂量组(DZ组)、冬葵果醇提物低剂量组(DD组),阳性对照组(Y组)。制备大鼠水负荷模型后置代谢笼收集0~1、1~2、2~4、4~6、6~24 h范围内尿液;按照试剂盒要求检测尿液K+、Cl−、Na+及血清ADH、ANP、ALD、cAMP、cGMP、AQP1和AQP2的含量;采用代谢组学方法检测尿液中内源性代谢产物,并进行代谢差异表征,查寻尿液中差异代谢产物。结果:与Z组比较,Y组0~1、1~2、2~4 h三个时间段的尿量明显增加,差异有统计学意义(P<0.05,P<0.01);DD组2~4 h和6~24 h两个时间段的尿量明显增加,差异有统计学意义(P<0.05,P<0.01);DZ组和DG组2~4、4~6 h两个时间段的尿量明显增加,差异有统计学意义(P<0.05)。与Y组比较,DD组、DZ组和DG组0~1、1~2 h两个时间段尿量明显降低,差异有统计学意义(P<0.05)。与Z组比较,冬葵果醇提物各剂量组能显著升高尿液Na+和Cl-含量,差异有统计学意义(P<0.01)。与Y组比较,DG组Cl-含量显著升高,DZ组和DD组Na+、Cl-含量显著升高,差异有统计学意义(P<0.05)。与Z组比较,DG组ANP和AQP2含量显著升高、ADH含量显著下降,差异有统计学意义(P<0.05);DD组cAMP和AQP1含量显著升高,差异有统计学意义(P<0.05)。与Y组比较,DG组ADH含量显著降低,ANP含量显著升高,差异有统计学意义(P<0.05)。代谢组学分析显示,与Z组比较,尿液样本中共筛选得出DD组6个、DZ组8个、DG组10个差异代谢物,这些代谢物水平存在明显的变化。结论:羟脯氨酸、葡萄糖酸和儿茶酚是参与冬葵果醇提物利尿作用机制的尿液生物标志物。 展开更多
关键词 大鼠 尿液 生物标志物 冬葵果醇提物 利尿作用
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