特拉唑嗪联合坦索罗辛治疗前列腺增生患者的临床效果及对血清PSA、TNF-α水平的影响

【目的】探讨特拉唑嗪联合坦索罗辛对前列腺增生患者的临床效果及对血清PSA、TNF-α水平的影响。【方法】回顾性分析2017年12月至2019年4月本院收治的102例前列腺增生患者的临床资料,根据治疗方案的不同将其分为观察组(n=50)和对照组(n=52),对照组患者采用特拉唑嗪进行治疗,观察组在对照组的基础上联合坦索罗辛进行治疗。比较两组患者治疗后临床效果,比较两组患者血清前列腺特异抗原(PSA)、肿瘤坏死因子-α(TNF-α)水平,记录患者治疗后最大尿流量、残余尿量以及国际前列腺症状评分(IPSS)。【结果】观察组患者治疗后的总有效率为92.0%(46/50),明显高于对照组的86.5%(45/52),差异有统计学意义(χ^(2)=2.8319,P=0.004<0.05)。治疗后,观察组患者血清TNF-α、PSA水平明显低于对照组,两组比较差异有统计学意义(P<0.05);观察组患者治疗后最大尿流量、IPSS评分显著高于对照组,残余尿量显著低于对照组,两组比较差异有统计学意义(P<0.05)。【结论】特拉唑嗪联合坦索罗辛治疗能够有效改善前列腺增生患者最大尿流量以及残留尿量,降低患者PSA水平,提高抗炎免疫作用,值得在临床治疗中推广应用。

Beta receptor blocker therapy for the elderly in the COVID-19 era

When the coronavirus disease 2019(COVID-19)pandemic spread globally from the Hubei region of China in December 2019,the impact on elderly people was particularly unfavorable.The mortality associated with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection was highest in older individuals,in whom frailty and comorbidities increased susceptibility to severe forms of COVID-19.Unfortunately,in older patients,the course of COVID-19 was often characterized by significant cardiovascular complications,such as heart failure decompensation,arrhythmias,pericarditis,and myopericarditis.Ensuring that the elderly have adequate therapeutic coverage against known cardiovascular diseases and risk factors is particularly important in the COVID-19 era.Beta blockers are widely used for the treatment and prevention of cardiovascular disease.The clinical benefits of beta blockers have been confirmed in elderly patients,and in addition to their negative chronotropic effect,sympathetic inhibition and anti-inflammatory activity are theoretically of great benefit for the treatment of COVID-19 infection.Beta blockers have not been clearly shown to prevent SARS-CoV-2 infection,but there is evidence from published studies including elderly patients that beta blockers are associated with a more favorable clinical course of COVID-19 and reduced mortality.In this minireview,we summarize the most important evidence available in the literature on the usefulness of beta blocker therapy for older patients in the context of the COVID-19 pandemic.

卡维地洛联合胰激肽原酶注射液治疗2型糖尿病肾病合并高血压患者临床疗效和安全性

【目的】探讨卡维地洛联合胰激肽原酶注射液治疗2型糖尿病肾病合并高血压患者的疗效和安全性。【方法】94例2型糖尿病肾病合并高血压的患者随机分为两组,各47例。所有患者均接受常规治疗,在此基础上,对照组予以卡维地洛治疗,观察组予以卡维地洛联合胰激肽原酶注射液治疗,连续治疗3个月。观察两组治疗前后的血糖、血压、贤功能、肾动脉血流动力学指标以及临床疗效和不良反应发生率。【结果】(1)观察组治疗总有效率明显高于于对照组(78.72%vs 59.57%,P<0.05)。(2)治疗后两组患者的血糖、血压较治疗前均有所降低(P<0.05),治疗后两组患者空腹血糖(FPG)、餐后2 h血糖(2hPG)、收缩压(SBP)、舒张压(DBP)比较差异均无显著性(P>0.05)。(3)治疗后两组血清尿素氮(BUN)、肌酐(SCr)、肾小球滤过率(GFR)、24 h尿微量白蛋白排泄率(UAER)、尿微量白蛋白(UAlb)均有所降低,且观察组降低幅度大于对照组(P<0.05)。(4)治疗后两组阻力指数(R I)明显下降,肾段动脉收缩期血流峰值速度(Vmax)、舒张末期血流速度(Vmin)明显上升,且观察组各指标变化幅度均大于对照组(P<0.05)。(5)两组患者治疗期间不良反应发生率相比较差异无显著性(P>0.05)。【结论】卡维地洛联合胰激肽原酶注射液治疗2型糖尿病贤病合并高血压患者疗效确切,可显著降低血糖、血压水平,改善双肾血流动力学及肾功能,且安全有效。

坦索罗辛治疗输尿管下段结石的临床疗效观察

【目的】探讨坦索罗辛治疗输尿管下段结石的临床疗效。【方法】对门诊180例输尿管下段结石患者进行分组治疗，1组为对照组86例，U组为治疗组94例。两组均每日饮水2000ml以上，服用左氧氟沙星0．2，2次1日，治疗组加用盐酸坦索罗辛0．2，2次／日，疗程4周。【结果】治疗组结石排出率为72．3％（68/94），对照组结石排出率为31．3％（27／86）；两组比较排石率有统计学差异（P〈0．05）。平均排石时间治疗组为（6±2）d，对照组为（15±3）d，2纽比较有统计学差异（P〈0．05）。【结论】坦索罗辛治疗输尿管下段结石安全、有效，能明显提高排石率。

CRT联合β受体阻断剂治疗慢性心力衰竭的临床疗效及对患者心功能的影响

【目的】探讨心脏再同步化治疗(CRT)联合β受体阻断剂治疗慢性心力衰竭(CHF)的临床疗效及对患者心功能的影响。【方法】回顾性分析2017年7月至2020年2月长安医院收治的76例CHF患者的临床资料,根据治疗方法的不同将其分为观察组(CRT联合β受体阻断剂治疗,n=36)和对照组(β受体阻断剂治疗,n=40)。比较两组治疗前及治疗1个月、3个月、6个月后左室射血分数(LVEF)、左室舒张末径(LVEDD)和收缩末径(LVESD),比较血清脑钠肽(BNP)、肌钙蛋白I(cTnI)、C反应蛋白(CRP)、炎性因子肿瘤坏死因子(TNF-α)和白细胞介素-6(IL-6)水平,记录两组治疗期间不良反应发生情况。【结果】治疗1个月、3个月、6个月后,观察组LVEF高于治疗前,LVEDD、LVESD低于治疗前(P<0.05);对照组治疗后LVEF呈升高趋势,LVEDD、LVESD呈降低趋势,但差异无统计学意义(P>0.05)。治疗1个月、3个月、6个月后,观察组患者血清BNP、cTnI、CRP、TNF-α、IL-6水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);对照组治疗6个月后血清TNF-α、IL-6低于治疗前,差异有统计学意义(P<0.05)。两组治疗期间均出现疲乏、肢端发凉、心动过缓和肠胃不适的症状,但组间比较差异无统计学意义(P>0.05)。【结论】CRT联合β受体阻断剂治疗慢性心力衰竭可明显改善患者心功能,降低炎性因子水平,且不增加不良反应,值得临床推广。

Role of Soluble ST2 Levels and Beta-Blockers Dosage on Cardiovascular Events of Patients with Unselected ST-Segment Elevation Myocardial Infarction

Background： Serum soluble ST2 （sST2） levels are elevated early after acute myocardial infarction and are related to adverse left ventricular （LV） remodeling and cardiovascular outcomes in ST-segment elevation myocardial infarction （STEMI）. Beta-blockers （BB） have been shown to improve LV remodeling and survival. However, the relationship between sST2, final therapeutic BB dose, and cardiovascular outcomes in STEMI patients remains unknown. Methods： A total of 186 STEMI patients were enrolled at the Wuhan Asia Heart Hospital between January 2015 and June 2015. All patients received standard treatment and were followed up for 1 year. Serum sST2 was measured at baseline. Patients were divided into four groups according to their baseline sST2 values （high 〉56 ng/ml vs. low ≤56 ng/ml） and final therapeutic BB dose （high ≥47.5 mg/d vs. low 〈47.5 mg/d）. Cox regression analyses were performed to determine whether sST2 and BB were independent risk factors for cardiovascular events in STEMI. Results： Baseline sST2 levels were positively correlated with heart rate （r = 0.327, P = 0.002）, Killip class （r = 0.408, P = 0.000）, lg N-terminal prohormone B-type natriuretic peptide （r = 0.467, P = 0.000）, lg troponin I （r = 0.331, P = 0.000）, and lg C-reactive protein （r = 0.307, P = 0.000） and negatively correlated to systolic blood pressure （r = ？0.243, P = 0.009） and LV ejection fraction （r = ？0.402, P = 0.000）. Patients with higher baseline sST2 concentrations who were not titrated to high-dose BB therapy （P 〈 0.0001） had worse outcomes. Baseline high sST2 （hazard ratio [HR]： 2.653; 95% confidence interval [CI]： 1.201–8.929; P = 0.041） and final low BB dosage （HR： 1.904; 95% CI, 1.084–3.053; P = 0.035） were independent predictors of cardiovascular events in STEMI. Conclusions： High baseline sST2 levels and final low BB dosage predicted cardiovascular events in STEMI. Hence, sST2 may be a useful biomarker in cardiac pathophysiology.