慢性乙型肝炎抗病毒治疗

目前对于慢性乙型肝炎所采用的治疗方法主要有抗病毒、免疫调节、保肝降酶等,其中抗病毒治疗是关键。可以使用单药、联合或序贯疗法,应答率约30%~40%,由于其难治性,出现了一些误区,如盲目用药等,需要科学引导。     

慢性乙型肝炎抗病毒治疗的策略

抗病毒治疗是慢性乙型肝炎治疗的关键,有效的抗乙型肝炎病毒药物主要有干扰素和核苷（酸）类似物。单药抗病毒治疗可获得较好的疗效,便于监测、管理;联合抗病毒治疗增加抗病毒疗效尚难肯定,更无法避免耐药发生,并可导致多药耐药、增加药物副作用和治疗费用。因此,优选单药进行抗病毒治疗才是目前理想的方案。     

慢性乙型肝炎抗病毒治疗

目前对于慢性乙型肝炎所采用的治疗方法主要有抗病毒、免疫调节、保肝降酶等,其中抗病毒治疗是关键.可以使用单药、联合或序贯疗法,应答率约30%～40%,由于其难治性,出现了一些误区,如盲目用药等,需要科学引导.     

我院门诊应用抗菌药物处方分析

为了解我院门诊抗茵药使用状况,随机抽取全院2006年10月门诊处方1000份,统计并综合分析了使用抗茵药物的比率、抗茵药物种类及联合用药情况等项目.结果显示,门诊抗茵药的使用比率为20.90%,联合用抗茵药的比率为7.26%;合理用药处方占84.7%,但在某些方面还存在不合理现象.宜制定相应措施,提高用药合理性.     

关于血管紧张素转换酶抑制药＋β受体阻断药组合的重新审视

采取联合用药方案治疗高血压已成为近年来临床用药的总体趋势。临床用药情况调查结果表明,血管紧张素转换酶抑制药＋β受体阻断药的联合用药组合占有一定的使用率,分析两类药的降压作用以及对高血压常见并发症和对代谢、心率等的影响,可见这个组合是合理的。     

药物性肝损伤的临床处置策略

本文讨论了药物性肝损伤治疗的相关临床问题,概括出以下几点：（1）可预知性与不可预知性肝毒性药物的临床处置方法,强调治疗的关键是停止肝毒性药物的使用以及停药的具体指征;（2）支持治疗不应被忽视,以及如何实施;（3）解毒药物的概念和种类;（4）保肝药物应用中存在的问题,主要是不按药理机理选择和多重用药,介绍了保肝药的不同机理和代表药物,阐述不要多种保肝药联合的基本原则;（5）根据肝损伤临床类型选择不同的治疗方案,肝细胞损伤以保肝药物治疗为主,胆汁淤积以利胆治疗为主,对重症肝损伤者应人工肝支持治疗,必要时进行肝移植.     

安全有效用药的伦理思考

药物除了治疗疾病作用外 ,还有毒副作用。在预防、诊断、治疗疾病或调节生理机能过程中使用药物后出现的任何有害的与用药目的无关的反应称药品不良反应 (ａｄｖｅｒｓｅｄｒｕｇｒｅａｃｔｉｏｎｓ ,ＡＤＲ) ,程度严重导致机体组织或器官发生功能性或器质性损害 ,甚至死亡的称药源性疾病 (ｄｒｕｇ -ｉｎｄｕｃｅｄｄｉｓｅａｓｅｓ ,ＤＩＤ)。我们的祖先早就认识到 ,服用药物后会使人产生难受的症状。《神农本草经》收载了 365种药物 ,并把药品分为上、中、下三品 ,初步提出了合理用药、安全用药的概念。今天医药科技事业的高速发展 ,市场…     

药物治疗的矛盾现象、产生原因及其处理

药物治疗的矛盾表现在药物的选择和联合、剂型和给药途径、剂量、给药方法和疗程上.而引起药物治疗矛盾的因素主要有病情因素（如病因、诱因、临床表现、并发症和伴发症等）、患者因素（如生理因素、特殊体质、社会人文因素及依从性等）、药物因素（如禁忌证和适应证、药效学、药代动力学、药物不良反应和药物相互作用等）和其他治疗措施（如手术、透析等）4个方面.我们可以通过调整治疗的重点、治疗的措施、治疗的目标或预期结果,以及调整治疗的方案入手解决矛盾,特别需要避免人为的制造、扩大或激化矛盾.     

瑞舒伐他汀联合非诺贝特治疗混合性高脂血症疗效与安全性观察

为了探讨瑞舒伐他汀与非诺贝特联合治疗混合性高脂血症疗效与安全性,选取152例混合性高脂血症患者,随机分为瑞舒伐他汀组(n=50),非诺贝特组(n=49),两药联合组(n=53)。比较三组调脂水平、不良反应情况。结果显示联合组调脂能力明显高于单药组(P值小于0.01或0.05)。联合组调脂达标率明显高于单药组(P0.05)。联合组安全性良好,不良反应发生率同另外两组相比差异无统计学意义(P值均0.05)。因此,联合组具有安全、高效的调脂能力。     

神经病学临床教学中治疗矛盾的运用

1　提出矛盾,强调正确处理治疗矛盾的重要性癫痫为神经科常见疾病,是由多种病因引起的大脑神经元反复发作性异常放电所致的临床症候群。由于放电部位不同,临床表现也多种多样。癫痫的主要治疗原则是寻找病因、对因治疗及早期应用抗癫痫药物控制发作。但所有抗癫痫药物都有...     

Reproductive dysfunction in women with epilepsy: antiepileptic drug effects on sex-steroid hormones

Women with epilepsy are at risk for reproductive health dysfunction. Sex-steroid hormone abnormalities have been reported in women with epilepsy, but it has been difficult to determine whether these abnormalities are due to epilepsy-related hypothalamic-pituitary axis dysfunction, or to pharmacokinetic actions of antiepileptic drugs (AEDs). Sex-steroid hormones were evaluated in 84 reproductive-aged women with epilepsy receiving an AED in monotherapy, and in 20 nonepileptic controls. Estrone, free testosterone, and androstenedione were significantly lower in subjects receiving enzyme-inducing AEDs than in nonepileptic controls. Free testosterone was significantly elevated in subjects receiving valproate compared to nonepileptic controls. Subjects with epilepsy receiving gabapentin or lamotrigine were no different from the nonepileptic controls in any of the endocrine variables. Subjects with epilepsy who are receiving AEDs that alter cytochrome P450 enzymes are at risk for significant abnormalities in sex-steroid hormones. In contrast, subjects receiving AEDs that do not alter cytochrome P450 enzymes show no differences in sex-steroid hormones compared with nonepileptic controls. With new AEDs available that do not alter cytochrome P450 enzymes, physician selection of therapy should consider not only seizure control, but also potential effects on reproductive physiology.     

Drug treatment of epilepsy: when does it fail and how to optimize its use?

Although modern community-based studies have shown that a majority of people with newly diagnosed epilepsy will enter long-term remission, seizures remain refractory to treatment in a substantial proportion of this population--perhaps as much as 40%. A consensus is being reached that, for operational purposes, pharmacoresistance can be suspected when two appropriately chosen, well-tolerated, first-line antiepileptic drugs (AEDs) or one monotherapy and one combination regimen have failed due to lack of efficacy. Poor prognostic factors include lack of response to the first AED, specific syndromes, symptomatic etiology, family history of epilepsy, psychiatric comorbidity, and high frequency of seizures. These observations suggest that prognosis can often be determined early in the course of the disorder. We propose a management paradigm that aims to maximize the chance of successful AED therapy, including the early use of "rational polytherapy" for patients not responding to monotherapy, and to identify efficiently patients suitable for "curative" resective surgery, in particular those with mesial temporal lobe epilepsy. An orderly approach to each epilepsy syndrome will optimize the chance of perfect seizure control and help more patients achieve a fulfilling life.     

Treatment of epilepsy in the multiply handicapped

The medical management of epilepsy in the multi-handicapped patient requires careful evaluation, classification, and pharmacologic treatment. It is estimated that 20-40% of patients with mental retardation and cerebral palsy have epilepsy. This review reports the clinical trial data and personal experience related to the use of newer AEDs in the chronic management of epilepsy syndromes in children and adults, as well as information available on the treatment of seizures in individuals with mental retardation and associated handicaps. Furthermore, clusters of seizures, prolonged seizures and status epilepticus are more commonly seen in the multiply handicapped and mentally retarded population and require special attention. The new antiepileptic drugs felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide show specific advantage in some multiply handicapped patients, be it for seizure control or medication tolerance. Furthermore, new modalities of treatment for prolonged seizures allow better efficacy both outside of hospital and within hospital facilities. The treatment of epilepsy in multi-handicapped and retarded adults and children has significantly advanced in the past few years, and much of this improvement can be attributed to improved knowledge and monitoring of new antiepileptic drugs. Conventional anticonvulsants remain first line therapy for most clinicians, but newer AEDs must broaden the therapeutic option and do allow improved therapy for some multiply handicapped patients.     

The use of antiepileptic drugs in bipolar disorders: a review based on evidence from controlled trials

Antiepileptic drugs (AEDs) have diverse psychotropic profiles. Some AEDs have proven to be efficacious in the treatment of mood disorders, especially bipolar disorder. Others are ineffective as primary treatments but may be useful adjuncts for mood disorders or comorbid conditions. Valproate (acute mania and mixed episodes), carbamazepine (acute mania and mixed episodes), and lamotrigine (maintenance to delay recurrence) have United States Food and Drug Administration indications for the treatment of bipolar disorder. This article provides an overview of data on the use of AEDs in bipolar disorder, including acute mania and depression, prophylaxis, and rapid cycling.     

AEDs and psychotropic drugs in children with autism and epilepsy

The efficacy of antiepileptic drugs (AEDs) and psychotropic medications in children with autism is limited to the treatment of seizures or to specific behaviors such as irritability, impulsivity, hyperactivity, repetitive behaviors, or aggression. The reliability and value of the available data--to determine the efficacy of these medications in autism--are limited by lack of controlled clinical trials, the small number of subjects, the heterogeneity of the population studied, and the brief duration of most drug trials. Indeed, few controlled clinical trials using AEDs in autism, with or without seizures, have been conducted. Because some AEDs also have a positive effect on mood, the benefits that children with autism sometimes obtain from these medications may not be due to the treatment of the abnormal electrical activity or the seizures per se but to an effect on common neuronal systems responsible for both behavior and epilepsy. The relationship between epilepsy and autism, and specifically the effects that abnormal electrical activity may have on the developing brain, may provide some valuable insights into the type of studies that are needed to help us understand the pathophysiology of autism.     

The effect of alterations in consciousness on quality of life (QoL) in epilepsy: searching for evidence

The impact of epilepsy on quality of life (QoL) is well-documented. The ability of epileptic seizures to alter the conscious states of patients is also well established. Although there is much research on the QoL of people with epilepsy, few researchers have looked specifically at the effect of sudden, unanticipated alterations of consciousness on QoL. This lack of systematic studies of consciousness alterations and QoL in epilepsy limits our ability to shed light on this interrelation. In this article, with these limitations in mind, we focus on studies of newer AEDs. We review the evidence as to whether a significant reduction (typically more than 50%) in seizures that induce alterations of consciousness, as a result of switching to one of the newer AEDs, leads to improvements in QoL. We draw on this literature to speculate on the relationship between ictal consciousness alterations and poor QoL in epilepsy, to identify contributory and confounding factors and to highlight implications for future research. We suggest that an understanding of how factors associated with consciousness impairment affect QoL could help the treatment and management of these patients.     

Winter Depression Recurrence One Year After Cognitive-Behavioral Therapy, Light Therapy, or Combination Treatment

The central public health challenge in the management of seasonal affective disorder (SAD) is prevention of depression recurrence each fall/winter season. The need for time-limited treatments with enduring effects is underscored by questionable long-term compliance with clinical practice guidelines recommending daily light therapy during the symptomatic months each year. We previously developed a SAD-tailored group cognitive-behavioral therapy (CBT) and tested its acute efficacy in 2 pilot studies. Here, we report an intent-to-treat (ITT) analysis of outcomes during the subsequent winter season (i.e., approximately 1 year after acute treatment) using participants randomized to CBT, light therapy, and combination treatment across our pilot studies (N = 69). We used multiple imputation to estimate next winter outcomes for the 17 individuals who dropped out during treatment, were withdrawn from protocol, or were lost to follow-up. The CBT (7.0%) and combination treatment (5.5%) groups had significantly smaller proportions of winter depression recurrences than the light therapy group (36.7%). CBT alone, but not combination treatment, was also associated with significantly lower interviewer- and patient-rated depression severity at 1 year as compared to light therapy alone. Among completers who provided 1-year data, all statistically significant differences between the CBT and light therapy groups persisted after adjustment for ongoing treatment with light therapy, antidepressants, and psychotherapy. If these findings are replicated, CBT could represent a more effective, practical, and palatable approach to long-term SAD management than light therapy.     

Therapy of treatment resistant depression: focus on the management of TRD with atypical antipsychotics

Treatment-resistant depression (TRD) represents a significant challenge for physicians. About one third of patients with major depressive disorder fail to experience sufficient symptom improvement despite adequate treatment. Despite this high occurrence of TRD there was no general consensus on diagnosis criteria for TRD until 1997 when researchers proposed a model of defining and staging TRD. In 1999, others defined operational criteria for the definition of TRD. Treatment of TRD is commonly separated into pharmacologic and nonpharmacologic methods. This review gives a short overview of these two methods. The nonpharmacologic methods include psychotherapy, electroconvulsive therapy, and vagus nerve stimulation. Pharmacologic methods include switching to another antidepressant monotherapy, and augmentation or combination with two or more antidepressants or other agents. This review especially focuses on the augmentation of the antidepressant therapy with atypical antipsychotics.     

Parental Marital Discord and Treatment Response in Depressed Adolescents

Evidence suggests that parental marital discord contributes to the development of internalizing and externalizing symptoms in children and adolescents. Few studies, however, have examined the association between parental marital discord and youth’s response to treatment. The present study examined the impact of interparental discord on treatment response in a randomized control trial of adolescents with major depression enrolled in the Treatment for Adolescents with Depression Study (TADS). Participants were 260 adolescents from two-parent households randomly assigned to one of four treatment groups: fluoxetine (FLX), cognitive behavior therapy (CBT), their combination (COMB), or placebo (PBO). Logistic regressions revealed that parental marital discord interacted with youth gender and co-morbid oppositionality symptoms to predict group differences in treatment response.