目的 评估调脂药物靶点所介导的脂质表型（HMGCR、PCSK9和NPC1L1）与高血压肾病风险之间潜在的因果相关性。方法 使用来自欧洲人群公开可获得的全基因组关联研究（GWAS）汇总数据进行孟德尔随机化（MR）分析。采用与低密度脂蛋白胆固醇（LDL-C）相关的遗传变异,根据选定的调脂药物靶基因筛选工具变量,使用逆方差加权法作为主要MR分析方法,并进行敏感性分析确保结果的稳健性。结果 基因预测的LDL-C水平与较高的高血压肾病风险相关（OR=1.19,95% CI：1.03~1.38,P=0.021）。较高的HMGCR介导的LDL-C水平与高血压肾病风险存在正向因果相关性（OR=4.08,95% CI：2.86~5.81;P<0.001）。然而,PCSK9和NPC1L1介导的LDL-C水平与高血压肾病风险无相关性。Cochran Q检验、MR-PRESSO检测和MR-Egger截距测试显示工具变量之间不存在异质性或水平多效性。结论 HMGCR介导的LDL-C与高血压肾病的发病风险存在因果相关性,针对HMGCR基因的他汀类药物在高血压肾病的防治中可能具有潜在益处。

Objective To assess the potential causal relationship between lipid phenotypes mediated by lipid-lowering drug targets（HMGCR,PCSK9 and NPC1L1）and the risk of hypertensive nephropathy．Methods Mendelian randomization（MR）analysis was conducted using summary data from publicly available European ancestry genome-wide association studies（GWAS）．Genetic variants associated with low-density lipoprotein cholesterol（LDL-C）were used as instrumental variables based on selected lipid-lowering drug target genes screening tools．Inverse variance weighting was selected as the main MR analysis method,with sensitivity analyses conducted to ensure the robustness of the results．Results Genetically predicted LDL-C levels were associated with a higher risk of hypertensive nephropathy（OR=1.19,95% CI：1.03~1.38,P=0.021）．Higher LDL-C levels mediated by HMGCR were positively causally related to increased risk of hypertensive nephropathy（OR=4.08,95% CI：2.86~5.81;P<0.001）．However,LDL-C levels mediated by PCSK9 and NPC1L1 showed no significant association with the risk of hypertensive nephropathy．Cochran’s Q test,MR-PRESSO,and MR-Egger intercept tests showed no heterogeneity or horizontal pleiotropy among instrumental variables．Conclusions The findings of this study support the causal relationship between LDL-C mediated by HMGCR and increased risk of hypertensive nephropathy,suggesting potential benefits of statin therapy for hypertensive nephropathy．

随着中西医结合的不断深入,医学工作者在临床工作中发现,西药因囿于西医体系,很难在中医药理论体系指导下的临床诊疗上发挥作用,极有必要走西药中药化之路,以弥补这一方面的不足。本文以阿司匹林为主要范例,从推测西药的中药性质入手,总结归纳几种研究方法及注意事项,并大致总结目前研究西药中药化上的诸多不足,同时收集汇总目前相关文献中提到的西药的中药性质,以抛砖引玉,供后续研究者参考。

With the continuous deepening of Chinese medicalization of western medicine,it is not difficult to find that western medicine is limited to the western medicine system,which is hard to play a role in clinical diagnosis and treatment under the guidance of traditional Chinese medicine（TCM）system．It is extremely necessary to take the road of TCM of western medicines to make up for the deficiencies．In this paper,we take aspirin as the main example,start from the speculation of the nature of western medicines,summarize several research methods and notes,and generally summarize the many shortcomings of the current research on the Chinese medicalization of western medicines,and at the same time,collect and summarize the TLM nature of western medicines mentioned in the relevant literature,to provide a reference for the subsequent researchers．

目的 对腹腔镜子宫肌瘤切除术围手术期应用抗菌药物的情况进行回顾性分析,并分析腹腔镜子宫肌瘤切除术围手术期感染的影响因素。方法 选择2018年5月—2021年5月在我院行腹腔镜子宫肌瘤切除术的患者72例进行回顾性分析。收集患者一般资料及抗生素使用情况,根据有无术后感染将患者分为2组,比较2组患者上述各资料,并采用多因素分析法判断各因素对腹腔镜子宫肌瘤切除术后感染的综合作用。结果 本次纳入的72例腹腔镜子宫肌瘤切除术患者共有16例出现术后感染,术后感染率为22.22%。多因素Logistic回归分析结果显示:年龄≥50岁、手术时间≥60 min、合并糖尿病为腹腔镜子宫肌瘤切除术围手术期感染的危险因素,预防性使用抗生素、术前≤2 h抗生素使用、术后抗生素使用≤48 h为保护性因素(P<0.05)。结论 腔镜子宫肌瘤切除术患者术后感染率为22.22%,抗菌药物使用时机及使用时间对腹腔镜子宫肌瘤切除术患者术后感染有重要的影响,此外患者年龄、手术时间、合并糖尿病情况也与患者术后感染有关。

Objective To retrospectively analyze the perioperative application of antibacterial drugs during laparoscopic myomectomy, and to analyze the influencing factors of infection during the perioperative period of laparoscopic myomectomy. Methods Seventy-two patients who underwent laparoscopic myomectomy in our hospital from May 2018 to May 2021 were selected for retrospective analysis. The patients were divided into two groups according to postoperative infection status. The above data were compared between the two groups, and the comprehensive effects of various factors on postoperative infection after laparoscopic myomectomy were determined by multivariate analysis. Results There were 16 cases of 72 patients underwent laparoscopic myomectomy had postoperative infection, and the postoperative infection rate was 22.22%. Multivariate Logistic regression analysis showed that age over 50, operation time over 60 minutes, and with diabetes mellitus were the risk factors of perioperative infection in laparoscopic myomectomy. Prophylactic use of antibiotics, preoperative use of antibiotics in less than 2 hours and postoperative use of antibiotics in less than 48 hours were protective factors (P<0.05). Conclusions The infection rate of patients underwent laparoscopic myomectomy was 22.22%. The time and length of antibiotics use had important influence on postoperative infection of patients underwent laparoscopic myomectomy. In addition, age, operation time and complicated with diabetes mellitus were also related to postoperative infection.

目的 分析广州市某精神病院住院病人精神药物用药的情况变化,为该类药物药费控制、合理应用和科学管理提供参考。方法 统计2015年7月15日—2019年7月14日精神药物的销售金额、用药频度、日用药金额并进行分析。结果 该院4类精神药物共40种,抗精神病药销售金额先升后降,DDDs小幅度增加,非典型抗精神病药销售金额占97%以上,DDDs占87%以上;抗抑郁药销售金额和DDDs逐年增长,新型抗抑郁药占99%以上;抗焦虑药销售金额先升后降;心境稳定药销售金额先升后降,DDDs小幅度减少;65%精神药品排序比趋近1;62%精神药品DDDc下降;取消加成后,销售总金额减少,DDDs总和却增加。结论 取消药品加成对抗精神病药影响较大,对抗抑郁药、抗焦虑药以及心境稳定药影响较小;药品零加成可明显减轻患者经济负担,促进用药合理化。

Objective To analyze the changes in the use of psychotropic drugs by inpatients in a psychiatric hospital in Guangzhou, and to provide reference for the control, rational application and scientific management of the drugs. Methods The sales amount, frequency of use, and daily use of psychotropic drugs from July 15, 2015 to July 14, 2019 were counted and analyzed. Results There were a total of 40 kinds of psychotropic drugs of 4 types in this hospital. In the past 4 years, the sales of antipsychotic drugs increased first and then decreased, and DDDs increased slightly. The sales amount of atypical antipsychotic drugs accounted for more than 97% of the total drug cost, and DDDs accounted for more than 87%. The sales amount of antidepressants DDDs were increasing year by year, and new generation antidepressants account for more than 99% of the antidepressants. The sales of anti-anxiety drugs increased first and then decreased. The sales of mood stabilizer increased first and then decreased, and DDDs decreased slightly. 65% of psychotropic drug's rank closes to 1. DDDc in 62% of the psychotropic drugs decreased; after abolishing additional cost of drugs, the total sales amount decreased, but the total DDDs increased. Conclusion Abolishing additional cost of drugs had a greater impact on antipsychotic drugs, but little effect for antidepressants, anxiolytics, and mood stabilizers, which may greatly reduces patient's drug cost and promote rational use of drugs.

目的 对比中成药镇痛活络酊和非甾体抗炎药(Nonsteroidal Anti-inflammatory Drugs,NSAIDs)治疗肱骨外上髁炎(lateral epicondylitis,LE)的短期临床疗效差异。方法 筛选后符合纳入标准的LE患者60例,随机分为镇痛活络酊组(n=30)和NSAIDs组(n=30)。镇痛活络酊组外用镇痛活络酊,NSAIDs组外用法斯通凝胶(酮洛芬),两组均连续用药3周,3次/d。用药后3 周、6 周和12 周连续随访,主要观测指标包括视觉模拟评分(visual analog scale,VAS);肩、肘和手的功能评分(Disabilities of the arm, Shoulder And Hand,DASH);无痛握力(Pain-free grip strength,PFGS)。VAS评分分别测量患者1周前用力活动时的VAS评分和正常休息时的VAS评分,记为VAS(活动时)和VAS(休息时)。运用统计学方法对比分析两组患者在VAS评分(活动时)、VAS评分(休息时)、DASH评分和PFGS上的差异。结果 两组患者在VAS评分(活动时)、VAS评分(休息时)和DASH评分上均未见组间差异(P>0.05)。两组患者在用药前、用药后3周、用药后6周的PGFS对比同样无组间差异(P=0.91,P=0.42,P=0.13)。但是,在用药后12周,镇痛活络酊组的PFGS高于NSAIDs组(P=0.02)。结论 镇痛活络酊缓解LE疼痛的效果与外用NSAIDs相当,对提升伸肌力效果则更优。

Objective To compare the short-term clinical effects difference between analgesic tincture and topical nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of lateral epicondylitis (LE). Methods 60 cases of LE patients were randomly divided into an analgesic tincture group (n=30) and a NSAIDs group (n=30). Analgesic tincture was chosen for the analgesic tincture group and topical ketoprofen gel for the NSAIDs group to treat LE. Two groups were treated continuously for 3w, 3 times/day. Clinical results of each drug were followed-up at the time point of 3w, 6w and 12w after usage. Observational indexes included the visual analogue scale (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and pain-free grip strength (PFGS). The inter-group difference of VAS (at activity), VAS (at rest), DASH score and PFGS were compared subsequently. Results No difference of the VAS (at activity), VAS (at rest), DASH score were ascertained (P> 0.05) between groups. Inter-group difference of PGFS was also not discerned at the time points of pre-treatment and 3 weeks and 6 weeks (P=0.91, P=0.42, P=0.13) post-treatment. However, PFGS of the analgesic tincture group was found to be higher than that of the NSAIDs group (P=0.02) after 12 weeks post-treatment. Conclusion Effect of analgesic tincture in releasing pain is almost the same to that of tropical NSAIDs, but a better effect in improving muscle strength.

目的 调查分析中山市某三甲医院抗菌药物不良反应的发生和分布情况,为临床合理应用抗菌药物提供相关信息。方法 以中山市某三甲医院2013—2015年上报国家药品不良反应监测系统的528例抗菌药物的不良反应为考察对象,按照给药途径、不良反应严重程度、年龄、性别、药物种类、不良反应累及的系统-器官、不良反应发生时间进行分类、整理、归纳和总结。结果 累及系统-器官涉及皮肤及其附件、血液系统、神经系统、消化系统、泌尿系统等。其中皮肤及其附件损害、神经系统、胃肠道反应容易发现,消化系统、血液系统、泌尿系统、肝胆系统的反应具有隐匿性。结论 临床在使用抗菌药物时,既要关注其抗菌效应,也要高度警惕其不良反应的危害性。避免无指征用药,合理选用抗菌药物,科学地开展ADR 监测工作,确保临床安全、有效、合理用药。

Objective To investigate occurrence and distribution of adverse drug reaction ADR of antibiotic drugs in a hospital of Zhongshan, in order to provide relevant information for clinical rational use of antibacterial drugs. Methods We classified and analyzed 528 cases of adverse drug reaction of antibiotic drugs which was reported to National center for ADR Monitoring during 2013～2015, according to the administration route、the severity of ADRs、age、sex、types of drugs、the organs systems involved by ADRs, the time of ADRs occurrence. Results Adverse drug reaction of antibiotic drugs involved in skin and its appendix、hematological system、nervous system、digestion system、urinary system and so on. Among them skin and its appendix、nervous system and gastrointestinal reactions were easy to acquire, others were obscure and difficult to find. Conclusion When the clinical use of antibacterial drugs, should not only focus on its antibacterial effect, also need to keep high vigilance against the dangers of its adverse reactions. To ensure the clinical safety, effective and rational drug use, we need to avoid no indication of medicine, take rational use of antibiotic drugs,scientifically to carry out the ADR monitoring.

目的 分析2009—2011年惠州市区医院三七总皂苷制剂的用药情况,并评价其安全性。方法 根据惠州市区医院2009—2011年三七总皂苷制剂的用药金额和用药量以及药品DDD值,计算其DDDs,分析药品的用药金额排序、DDDs排序以及用药金额排序与DDDs排序的比值;从药物不良反应报告评价其安全性。结果 三七总皂苷制剂用药金额和DDDs逐年增加,口服制剂安全性优于注射剂。结论 三七总皂苷制剂用药金额和用药频度逐年增加,其安全性较好。

Objective To analyse the usage and safety of Panax Notoginseng Saponins Drugs of hospitals in Huizhou from 2009 to 2011. Methods Calculate the DDDs and analyse the sequence of consumption sum, the sequence of DDDs, the ratio of the sequence of consumption sum to the sequence of DDDs according to the consumption sum, the consumption amount and DDD of Panax Notoginseng Saponins Drugs of hospitals in Huizhou from 2009 to 2011. We evaluated its safety according to adverse event reports. Results The consumption sum and DDDs increased year by year, oral medication was safer than injection. Conclusion The consumption sum and DDDs of Panax Notoginseng Saponins drugs of hospitals in Huizhou increase year by year, and they are safe.

目的 探讨社区老年高血压病人直立性低血压的药物影响。方法 通过对辖区内897例社区老年高血压病人开展体检,将年轻老年和老老年高血压两组分为直立性低血压组和非直立性低血压组两组。分析降压药物对社区老年高血压病人直立性低血压的影响。结果 OH组的降压药物使用率稍高于非OH组的降压药物使用率,经统计分析P>0.05。OH组联合两种以上及联合三种以上降压药物使用率略高于非OH的药物使用率, P>0.05。利尿剂OH发生率稍高于其他组的OH发生率,P>0.05。结论 社区老年高血压OH的发病可能与目前常用的5大类降压药物无关。

       目的   通过分析广州某三甲医院临床试验用药品规范管理体系构建前后试验用药品超温次数及质控发现缺陷项数量变化情况，为药物临床试验规范开展提供参考。方法   结合某医院临床试验用药品管理实践，以试验用药品超温次数、质控发现缺陷项数量占项目比为评价指标，使用卡方检验进行比较。结果   某医院实施临床试验用药品规范管理体系后，发生试验用药品超温次数由实施前的9次下降至3次，呈明显下降趋势，2018—2020年试验用药品管理方面质控发现缺陷项数量占项目比为70.25%，2021—2023年占项目比为18.90%，实施前后组间比较差异有统计学意义（P＜0.001）。结论   构建临床试验用药品规范管理体系，可以减少试验用药品超温次数和试验用药品管理方面质控发现缺陷项数量，从而保证药物临床试验的质量。

       Objective   To analyze the changes in the number of excessive temperature incidents and the proportion of quality control issues in drug management before and after the establishment of construction and practice of standardized management system in a tertiary hospital in Guangzhou，to provide a reference for drug clinical trials standard development．Methods  Based on the management practice of investigational medicinal products from a hospital，the number of excessive temperature incidents and the proportion of quality control issues in drug management were taken as evaluation index and compared using chi-square tests．Results  After implementing the standardized management system for investigational drugs，the number of temperature exceeding incidents decreased from 9 times to 3 times，showing an obvious decreasing trend，and from 2018 to 2020，the  proportion of quality control issues in drug management accounted for 70.25%，while from 2021 to 2023，it accounted for 18.90%．There was a statistically significant difference between the groups before and after the implementation（P＜0.001）．Conclusions  The establishment of  standardized management  system for investigational medicinal  products can  reduce the  number of excessive temperature incidents and the proportion of quality control issues in drug management，and ensure the quality of drug clinical trials．

       目的   探讨免疫及靶向药物联合肝动脉灌注化学治疗（化疗）治疗晚期肝癌的临床疗效。方法   选取甘肃省武威市人民医院2021年1月—2024年1月收治的78例晚期肝癌患者进行回顾性分析，其中20例患者采取单纯肝动脉灌注化疗（HAIC）治疗为单化疗组，30例患者采取HAIC联合程序性细胞死亡受体-1（PD-1）抗体治疗为免疫组，28例患者采取HAIC联合PD-1抗体免疫治疗与甲磺酸仑伐替尼胶囊靶向治疗为联合组。对比三组临床疗效、治疗前后胚抗原（CEA）、糖类抗原125（CA125）、甲胎蛋白（AFP）表达水平，不良反应发生率，并采用Piper疲乏修正量表（PFS-R）、世界卫生组织生存质量量表简表（WHOQOL-BREF）对两组癌因性疲乏程度及生存质量进行评价。结果   单纯化疗组、免疫组、联合组客观缓解率分别为15.00%、40.00%、64.29%，疾病控制率为30.00%、66.67%、82.14%，联合组高于单纯化疗组与免疫组（χ ² =11.720，P=0.003；χ ² =13.890，P＜0.001）；治疗后三组患者CEA、CA125、AFP水平均降低，且联合组［CEA：（13.62±4.24）ng/mL、CA125：（31.62±13.66）U/mL、AFP：（35.21±5.93）ng/mL］低于免疫组［（17.85±3.32）ng/mL、（59.26±9.35）U/mL、（42.12±4.12）ng/mL］及单纯化疗组［（23.73±4.79）ng/mL、（64.57±5.23）U/mL、（47.46±5.32）ng/mL］，对比差异有统计学意义（F=7.698，P＜0.001；F=11.480，P＜0.001；F=14.952，P＜0.001；P＜0.05）；所有患者均无5级不良反应及严重肝功能损害出现，且三组血小板减少、白细胞减少、腹痛、呕吐、消化道出血、厌食等不良反应发生率对比差异无统计学意义（P＞0.05）；治疗后三组患者PFS-R评分均降低，联合组（3.85±1.13）分低于免疫组（5.39±1.25）分及单纯化疗组（6.33±1.26）分，WHOQOL-BREF评分均升高，联合组（348.58±66.12）分高于免疫组（297.24±72.21）分及单纯化疗组（256.35±41.67）分，对比差异有统计学意义（F=2.526，P=0.014；F=2.167，P=0.033）。结论   免疫及靶向药物联合肝动脉灌注化疗治疗晚期肝癌疗效显著，可有效控制疾病进展的同时，降低机体肿瘤标志物水平，安全性可控，同时可改善患者生存质量，减轻癌因性疲乏程度。

       Objective  To explore the clinical efficacy of immune and targeted drugs combined with hepatic artery infusion chemotherapy（HAIC）in the treatment of advanced liver cancer．Methods  A retrospective analysis was conducted on 78 patients with advanced liver cancer admitted to our hospital from January 2021 to January 2024．Among them，20 patients were treated with simple HAIC and divided into a single chemotherapy group．Thirty patients were treated with HAIC combined with PD-1 antibody，and divided into an immune group．Twenty-eight patients were treated with HAIC combined with PD-1 antibody immunotherapy and lenvatinib mesylate capsule targeted therapy，and divided into a combination group．The clinical efficacy of three groups，the expressionlevels of CEA，CA125，AFP，and incidence of adverse reactions before and after treatment were compared．Piper Fatigue Correction Scale（PFS-R）and the WHO QOL-BREF were used to assess cancer-related fatigue in both groups．The degree of fatigue and quality of life were assessed．Results  The objective response rates of the simple chemotherapy group，the immune group，and the combination group were 15.00%，40.00% and 64.29%，respectively．The disease control  rates were 30.00%，66.67% and 82.14%，respectively．The indicators above of the combination group was significantly higher than those in the simple chemotherapy group and the immune group（χ ² =11.720，P=0.003；χ ² =13.890，P＜0.001；P＜0.05）．After treatment，the levels of CEA，CA125 and AFP were all decreased in the three groups，and those in the combined group （CEA［13.62±4.24］ng/mL，CA125［31.62±13.66］U/mL，AFP：Ng/mL［35.21±5.93］）were lower than those in the immune group（17.85±3.32 ng/mL，59.26±9.35 U/mL，/ 42.12±4.12 ng/mL）and single chemotherapy group（23.73±4.79 ng/mL，64.57±5.23 U/mL47.46±5.32］ng/mL），the differences were statistically significant（F=7.698，P＜0.001；F=11.480，P＜0.001；F=14.952，P＜0.001；P＜0.05）．All patients had no grade 5 adverse reactions or severe liver function damage，and there was no statistically significant difference in the incidence adverse reactions such as thrombocytopenia，leukopenia，abdominal pain，vomiting，gastrointestinal bleeding，and anorexia among the three groups（P＞0.05）．After treatment，the PFS-R score of the three groups was decreased，and the combined group（3.85±1.13）score was lower than that of the immune group（5.39±1.25）and the chemotherapy group（6.33±1.26）．While the WHOQOL-BREF score was increased，the score of combination group（348.58±66.12）was higher than that of immune group（297.24±72.21）and chemotherapy group（256.35±41.67），and the difference was statistically significant（F=2.526，P=0.014；F=2.167，P=0.033；P＜0.05）．Conclusions  The combination of immune and targeted drugs with hepatic artery infusion chemotherapy has a significant therapeutic effect on advanced liver cancer．It can effectively control disease progression，reduce tumor marker levels in the body，improve patient quality of life，and alleviate cancer-related fatigue，with controllable safety