目的:探讨低剂量(0.6mg/kg)与标准剂量(0.9mg/kg)阿替普酶静脉溶栓治疗高龄(年龄>80岁)急性脑梗死患者的疗效与安全性。方法:将40例发病3h内的高龄脑卒中患者分为阿替普酶低剂量组(n=21)和标准剂量组(n=19),比较两组患者的一般情况...目的:探讨低剂量(0.6mg/kg)与标准剂量(0.9mg/kg)阿替普酶静脉溶栓治疗高龄(年龄>80岁)急性脑梗死患者的疗效与安全性。方法:将40例发病3h内的高龄脑卒中患者分为阿替普酶低剂量组(n=21)和标准剂量组(n=19),比较两组患者的一般情况、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、出血事件、发病90d改良Rankin量表(mRS)评分和90d死亡率。结果:低剂量组与标准剂量组患者一般临床资料、基线NIHSS评分、溶栓24h及溶栓7dNIHSS差异无统计学意义。低剂量组与标准剂量组患者出血性脑梗死发生率、发病90d死亡率以及90d的mRS评分0～2分患者比例差异均无统计学意义。结论:高龄急性缺血性脑卒中患者早期低剂量与标准剂量阿替普酶静脉溶栓的疗效及安全类似。展开更多
Several studies have investigated the association between CYP2C19 polymorphism and clinical outcomes of patients treated with clopidogrel, but few have noticed the difference in association between Westerners and Asia...Several studies have investigated the association between CYP2C19 polymorphism and clinical outcomes of patients treated with clopidogrel, but few have noticed the difference in association between Westerners and Asians. We searched MEDLINE, EMBASE and Cochrane Library database and conducted a systematic review and meta-analysis. Thirty-six studies involving 44 655 patients with coronary artery disease（CAD） treated with clopidogrel were included, of which more than 68% had undergone percutaneous coronary intervention（PCI）. The primary outcome of our interest was the recurrence of major adverse cardiovascular events（MACE） in those CAD patients. Firstly, we found that the distribution of reduced-function CYP2C19 allele varied between Westerners and Asians. Among Asians, 1 and 2 reduced-function CYP2C19 mutant allele carriers accounted for 42.5% and 10%, respectively. While among Westerners, 1 and 2 reduced-function CYP2C19 mutant allele carriers accounted for 25.5% and 2.4%, respectively. Secondly, the impact of CYP2C19 polymorphism on clinical outcomes of patients treated with clopidogrel varied with races. Among Asians, only 2 reduced-function CYP2C19 mutant allele carriers had the reduced effect of clopidogrel. And the reduced effect was significant only after the 30 th day of treatment. While among Westerners, both 1 and 2 reduced-function CYP2C19 allele carriers had the reduced effect, and it mainly occurred within the first 30 days. Thirdly, the safety of clopidogrel was almost the same among races. Reduced-function allele non-carriers had higher risk for total bleeding but did not have higher risk for major bleeding. It is suggested that CYP2C19 polymorphism affects the efficacy of clopidogrel differently among Westerners and Asians.展开更多
文摘目的:探讨低剂量(0.6mg/kg)与标准剂量(0.9mg/kg)阿替普酶静脉溶栓治疗高龄(年龄>80岁)急性脑梗死患者的疗效与安全性。方法:将40例发病3h内的高龄脑卒中患者分为阿替普酶低剂量组(n=21)和标准剂量组(n=19),比较两组患者的一般情况、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、出血事件、发病90d改良Rankin量表(mRS)评分和90d死亡率。结果:低剂量组与标准剂量组患者一般临床资料、基线NIHSS评分、溶栓24h及溶栓7dNIHSS差异无统计学意义。低剂量组与标准剂量组患者出血性脑梗死发生率、发病90d死亡率以及90d的mRS评分0～2分患者比例差异均无统计学意义。结论:高龄急性缺血性脑卒中患者早期低剂量与标准剂量阿替普酶静脉溶栓的疗效及安全类似。
基金supported by grants from National Natural Science Foundation of China(Nos.81371311 and 81101905)New Century Excellent Talents in University of China(No.NCET-10-0406)
文摘Several studies have investigated the association between CYP2C19 polymorphism and clinical outcomes of patients treated with clopidogrel, but few have noticed the difference in association between Westerners and Asians. We searched MEDLINE, EMBASE and Cochrane Library database and conducted a systematic review and meta-analysis. Thirty-six studies involving 44 655 patients with coronary artery disease（CAD） treated with clopidogrel were included, of which more than 68% had undergone percutaneous coronary intervention（PCI）. The primary outcome of our interest was the recurrence of major adverse cardiovascular events（MACE） in those CAD patients. Firstly, we found that the distribution of reduced-function CYP2C19 allele varied between Westerners and Asians. Among Asians, 1 and 2 reduced-function CYP2C19 mutant allele carriers accounted for 42.5% and 10%, respectively. While among Westerners, 1 and 2 reduced-function CYP2C19 mutant allele carriers accounted for 25.5% and 2.4%, respectively. Secondly, the impact of CYP2C19 polymorphism on clinical outcomes of patients treated with clopidogrel varied with races. Among Asians, only 2 reduced-function CYP2C19 mutant allele carriers had the reduced effect of clopidogrel. And the reduced effect was significant only after the 30 th day of treatment. While among Westerners, both 1 and 2 reduced-function CYP2C19 allele carriers had the reduced effect, and it mainly occurred within the first 30 days. Thirdly, the safety of clopidogrel was almost the same among races. Reduced-function allele non-carriers had higher risk for total bleeding but did not have higher risk for major bleeding. It is suggested that CYP2C19 polymorphism affects the efficacy of clopidogrel differently among Westerners and Asians.
