多烯磷脂酰胆碱胶囊联合还原型谷胱甘肽治疗药物性肝病患者的临床疗效

目的 探讨多烯磷脂酰胆碱胶囊联合还原型谷胱甘肽治疗药物性肝病患者的临床疗效.方法 选取2018年1月至2020年5月于建昌县人民医院住院治疗的56例药物性肝病患者作为研究对象,将其随机分为对照组和观察组,各28例.对照组患者予以还原型谷胱甘肽治疗,观察组患者在对照组治疗基础上采用多烯磷脂酰胆碱胶囊.比较两组患者临床疗效...     

多烯磷脂酰胆碱治疗非酒精性脂肪肝120例

目的观察多烯磷脂酰胆碱治疗非酒精性脂肪肝的临床疗效。方法选择2009年3月至2012年2月来我院门诊就诊及住院治疗,确诊为非酒精性脂肪肝的患者120例。在低脂饮食和适量运动的基础上,采用口服多烯磷脂酰胆碱治疗3个月。结果治疗前后血生化指标差异具有统计学意义（P〈0.05）。CT影像学检查均得到了改善,其总有效率为88.3%。结论采用多烯磷脂酰胆碱治疗非酒精性脂肪肝,可减轻肝脏脂肪沉积,从多方面保护肝细胞免受损害。同时,本品的不良反应较少,易于患者接受。     

腺苷蛋氨酸与多烯磷脂酰胆碱在酒精性肝硬化治疗中的疗效比较

目的评价腺苷蛋氨酸与多烯磷脂酰胆碱治疗酒精性肝硬化的临床疗效。方法选取酒精性肝硬化患者64例,随机分为对照组32例,治疗组32例,分别采用多烯磷脂酰胆碱和多烯磷脂酰胆碱联合腺苷蛋氨酸治疗,对两组患者疗效进行对比。结果治疗后,治疗组总有效率(90.6%)明显优于对照组(71.9%),差异有统计学意义(P<0.05)。两组患者各项指标差异均有统计学意义(P<0.05),且治疗组变化幅度各项指标明显优于对照组,差异有统计学意义(P<0.05)。结论采用多烯磷脂酰胆碱与S-腺苷蛋氨酸联合治疗酒精性肝硬化,能明显改善肝功能,提高临床治疗效果。     

还原型谷胱甘肽对抗结核药所致药物性肝损害的治疗效果

目的 探讨还原型谷胱甘肽对抗结核药所致药物性肝损害的治疗效果.方法 选取2017年1月至2020年3月东莞市松山湖中心医院收治的72例抗结核药所致药物性肝损害患者作为研究对象,依据随机数字表法分为试验组35例、对照组37例.对照组予以异甘草酸镁治疗,试验组在对照组治疗基础上采用还原型谷胱甘肽,比较两组的治疗效果.结果 ...     

还原型谷胱甘肽片治疗慢性结肠炎的临床疗效观察

目的探讨还原型谷胱甘肽片治疗慢性结肠炎的临床疗效与安全性。方法选取2016年5月至2018年5月广东省梅州市第二中医医院门诊收治的120例慢性肠炎患者作为研究对象,采用随机数字表法法将其分为试验组(还原型谷胱甘肽片结合对症治疗)和对照组(对症治疗),各60例。比较两组患者的治疗效果。结果试验组慢性结肠炎患者的腹痛、腹泻、里急后重、黏液脓血便症状缓解时间均明显短于对照组(均P<0.05);试验组慢性结肠炎治疗的总有效率明显高于对照组(P<0.05)。两组患者治疗期间均未发生严重药物不良反应。结论在常规治疗方案基础上应用还原型谷胱甘肽治疗慢性结肠炎可显著提升其药物治疗有效率,促进患者临床症状快速缓解,且安全性、可靠性较高。     

还原型谷胱甘肽钠、磷酸肌酸钠治疗新生儿窒息后心肌损伤疗效观察

目的观察还原型谷胱甘肽钠、磷酸肌酸钠治疗新生儿窒息后心肌损伤的疗效。方法将78例新生儿窒息致心肌损伤患儿随机分为还原型谷胱甘肽钠组、磷酸肌酸钠组和对照组。三组均给予常规治疗,还原型谷胱甘肽钠组静脉泵入还原型谷胱甘肽钠,磷酸肌酸钠组静脉泵入磷酸肌酸钠,对照组加用大剂量维生素C 250mg/kg。观察三组患儿治疗前、后症状、体征以及血清肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)的变化。结果还原型谷胱甘肽钠组、磷酸肌酸钠组和对照组治疗前cTnI、CK-MB比较,差异均无统计学意义,治疗后比较,还原型谷胱甘肽钠组和对照组、磷酸肌酸钠组和对照组差异均有统计学意义,还原型谷胱甘肽钠组和磷酸肌酸钠组差异无统计学意义;同组治疗前、后比较,差异均有统计学意义(P<0.05);还原型谷胱甘肽钠组、磷酸肌酸钠组的有效率分别为89.7%、84.6%,对照组有效率为60.9%,差异有统计学意义(P<0.05)。结论还原型谷胱甘肽钠、磷酸肌酸钠治疗新生儿窒息后心肌损伤疗效显著,可明显降低cTnI、CK-MB水平,从而改善心肌损伤。     

葵花护肝片治疗药物性肝损伤的疗效观察

目的探讨葵花护肝片治疗药物性肝损伤患者的临床疗效。方法选取2016年1—12月阜阳市人民医院收治的97例药物性肝损伤患者作为研究对象,按照随机数字表法将其分为观察组48例和对照组49例。对照组患者予以双环醇片口服治疗,观察组患者则采用葵花护肝片口服治疗,比较两组患者肝功能改善情况、不良反应发生情况以及治疗费用。结果观察组患者肝功能改善总有效率为91.67%(44/48),与对照组的85.71%(42/49)相比较,差异无统计学意义(P>0.05)。观察组患者不良反应发生率为0.00%(0/48),明显低于对照组的12.24%(6/49),差异有统计学意义(P<0.05)。观察组患者治疗费用为(162.77±20.50)元,明显低于对照组的(1032.58±192.55)元,差异有统计学意义(P<0.05)。结论葵花护肝片与双环醇片治疗药物性肝损伤的疗效相当,但葵花护肝片可显著降低不良反应发生率,经济性较佳。     

苦黄针剂序贯苦黄颗粒用于治疗急性药物性肝损伤的疗效

病毒感染所致肝损伤的发病率呈下降趋势,药物所致肝损伤的发病率有增加趋势。药物性肝损伤常见于老年患者,处方和药品数量增加可能是老年患者药物性肝损伤发生率较高的一个重要原因。本文报告了1例75岁男性患者,因多种慢性疾病长期服用多达10余种西药和中药,近期又加用中成药癃闭舒胶囊、虎力散和瘀血痹片及中药汤剂等,其中至少含有被报告有肝脏毒性的补骨脂、草乌、白鲜皮等。该患者采用苦黄针剂-颗粒序贯治疗96 d,获得了满意的疗效。     

麝香保心丸联合还原型谷胱甘肽在心肌梗死经皮冠状动脉介入治疗围手术期的应用及对TIMI血流分级、心肌损伤、脂蛋白α、脂蛋白相关磷脂酶A2的影响

目的探讨麝香保心丸联合还原型谷胱甘肽在心肌梗死经皮冠状动脉介入治疗(PCI)围手术期的应用及对TIMI血流分级、心肌损伤、脂蛋白α(Lp-α)、脂蛋白相关磷脂酶A_(2)(Lp-PLA_(2))的影响。方法选取河池市中医医院2018年1月至2020年12月收治的心肌梗死患者60例作为研究对象,根据治疗方案不同将其分为观察组(麝香保心丸联合还原型谷胱甘肽,30例)和常规组(常规治疗,30例)。比较两组患者TIMI血流分级情况及血清肌钙蛋白Ⅰ(cTn I)、肌酸激酶同工酶(CK-MB)、Lp-α、Lp-PLA_(2)水平。结果两组患者手术前后TIMI血流分级比较,差异无统计学意义(P>0.05);两组患者治疗前血清CTn I、CK-MB、Lp-α、Lp-PLA_(2)水平比较,差异无统计学意义(P>0.05),观察组患者治疗后血清CTn I、CK-MB、Lp-α、Lp-PLA_(2)水平明显低于常规组(P<0.05)。结论麝香保心丸联合还原型谷胱甘肽应用于心肌梗死PCI围手术期可改善冠状动脉血流情况,同时降低心肌损伤标志物和Lp-α、Lp-PLA_(2)表达水平,有助于改善患者预后。     

肝胆消炎片联合复方甘草酸苷注射液治疗铂类抗癌药致肝损伤的疗效

目的 探讨肝胆消炎片联合复方甘草酸苷注射液治疗铂类抗癌药致肝损伤的疗效。方法 选取2021年1月至2023年1月江门市新会区中医院收治的60例因铂类抗癌药致肝损伤患者作为研究对象,按照随机分组法分为观察组（n=30,肝胆消炎片联合复方甘草酸苷注射液治疗）和对照组（n=30,仅用复方甘草酸苷注射液治疗）。比较两组临床疗效,治疗前后肝功能指标[血清总胆红素（TBIL）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）]、炎症因子[白细胞介素6(IL6)、单核细胞趋化蛋白-1(MCP-1)、转化生长因子-β(TGF-β)、肿瘤坏死因子-α(TNF-α)]水平,治疗后生命质量以及治疗期间不良反应发生情况。结果 治疗后,两组TBIL、ALT、AST、IL6、MCP-1、TNF-α降低（P<0.05）,且观察组TBIL、ALT、AST、IL6、MCP-1、TNF-α低于对照组（P<0.05）;治疗后,两组TGF-β升高（P<0.05）,且观察组TGF-β高于对照组（P<0.05）;治疗后,观察组躯体功能（PF）、情绪功能（EF）、总健康状况（QL）评分高于对照组,疲倦（FA...     

生大黄联合乌司他汀治疗重症急性胰腺炎临床疗效观察

目的观察生大黄联合乌司他汀治疗重症急性胰腺炎的临床疗效。方法入选济宁市附属医院住院确诊的重症急性胰腺炎患者88例,随机分成治疗组、对照组两组。对照组给予禁饮食、胃肠减压、抑酸、抗生素、补充血容等对症支持治疗,治疗组在上述治疗基础上加用生大黄粉及乌司他汀。结果生大黄联合乌司他汀治疗后,治疗组CRP浓度、血尿淀粉酶、白细胞数均较对照组显著降低,肝功能损害较入院时明显好转。结论生大黄联合乌司他汀治疗重症急性胰腺炎疗效好。     

Economic impact of contrast-induced acute kidney injury associated with invasive cardiology: role of iso-osmolar contrast media in Germany,Italy, Poland,and Spain

Objective:

Iso-osmolar Iodixanol is associated with a lower rate of contrast-induced acute kidney injury (CI-AKI) in patients at increased risk compared to low-osmolar contrast media (LOCM). The aim of this study was to assess the financial consequences of CI-AKI risk reduction in patients undergoing coronary angiography (CA) with or without percutaneous coronary intervention (PCI) in German, Italian, Polish and Spanish hospitals.

Methods:

This budget impact analysis (BIA) compared a scenario with iodixanol to a scenario without, where only LOCM were used, in patients at increased risk of CI-AKI over a 3-year horizon. A meta-analysis based on a systematic review observed a lower rate of CI-AKI with iodixanol compared to LOCM (Risk Reduction?=?0.46) in patients with underlying impaired renal function (serum creatinine ≥1.6?mg/dl and estimated glomerular filtration rate ≤50?ml/min/1.73 m²). Contrast media and CI-AKI hospitalization costs were included in the analysis and unit costs were obtained from published literature, official sources or, when available, from hospital data. In the absence of country-specific data, resource utilization for a CI-AKI hospitalization was obtained by interviews with local clinicians in each country. The percentage of patients who received iodixanol was assumed to increase over time.

Results:

Based on a percentage of patients at increased risk of CI-AKI equal to 20% in Germany, 24% in Italy, 23% in Poland and 10% in Spain, results showed that the introduction of iodixanol would bring a 3-years cumulative net percentage saving on the total hospital budget of 29%, 34%, 25%, and 33% in the four countries respectively.

Conclusion:

The results of the analysis for the four countries showed that iodixanol use in patients at increased risk of CI-AKI undergoing CA with or without PCI may bring considerable savings on the hospital’s budget, due to the associated reduction in CI-AKI incidence.     

Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures

Aims: This study aimed to estimate the cost of platelet transfusion in patients with chronic liver disease (CLD)-associated thrombocytopenia undergoing an elective procedure in the United States.

Materials and methods: The study was conducted in two parts: development of a conceptual framework identifying direct, indirect and intangible costs of platelet transfusion, followed by the estimation of the total cost of platelet transfusion in patients with CLD-associated thrombocytopenia before an elective procedure in the United States using the conceptual framework and cost data obtained from a literature search. The cost of the entire care required to raise a patient’s platelet count before the procedure was considered.

Results: The final conceptual framework included the costs of generating the supply of platelets, the platelet transfusion itself, adverse events associated with platelet transfusion and refractoriness to platelet transfusion. When costs were accounted for in all the framework cost categories, the total direct cost of a platelet transfusion in a patient with CLD and associated thrombocytopenia was estimated to be in the range of $5258 to $13,117 (2017?US dollars) in the United States. The largest portion of costs was incurred by the transfusion event itself ($3723 to $4436) and the cost of refractoriness ($874 to $7578), which included the opportunity cost of a delayed procedure and subsequent platelet transfusions with human leukocyte antigen-matched platelets.

Limitations and conclusions: Although we were unable to include all cost components identified in the conceptual framework in our total cost estimate, thus likely underestimating the true total cost, and despite the data gaps and challenges limiting our estimate of the full cost of a platelet transfusion in patients with CLD-associated thrombocytopenia undergoing an elective procedure in the United States, this study outlines a comprehensive conceptual framework for estimating the cost elements of a platelet transfusion in these patients.     

Cost-effectiveness analysis of mechanical thrombectomy with stent retriever in the treatment of acute ischemic stroke in Italy

Background: Stroke has a significant disease burden in terms of acute and long-term disability in Italy and throughout the world. Endovascular treatments for the management of a stroke event have been coupled in the past years with the possibility to mechanically remove the occlusion by means of specially designed thrombectomy devices, and their exclusive use showed levels of effectiveness in line with those of the existing pharmacological treatments.

Objective: To assess the cost-effectiveness of mechanical thrombectomy (MT) with the Solitaire Revascularization Device (stent retriever) for the treatment of acute ischemic stroke (AIS) in patients with large vessel occlusions (LVOs), comparing MT plus intravenous tissue plasminogen activation (MT plus IV t-PA) vs IV t-PA alone, in Italy.

Methods: A Markov model was used to simulate costs and benefits of MT plus IV t-PA and IV t-PA alone over a 5-year time horizon and considering the perspective of the Italian National Health Service (NHS). Results are reported in terms of Incremental Cost Effectiveness Ratio (ICER). Deterministic and probabilistic sensitivity analyses are carried out in order to test the robustness of the results.

Results: Total costs of MT plus IV t-PA and IV t-PA alone are equal to €31,798 and €34,855, respectively. The MT allows incremental QALYs for 0.77, determining a dominant ICER. The utilities associated to the mRS health states are the parameters with the highest impact on the results. Multiway sensitivity analyses determined a 90% probability of dominance.

Conclusions: MT plus IV t-PA for AIS patients with LVO is cost-effective from year 1 through year 3, and cost-saving from year 4 onward in the Italian context, achieving better results, both in terms of efficacy and in terms of resource consumption.     

A simple approximation to the average effect of the treatment on the treated in panel settings with selective enrolment

This article shows that, in panel settings when the probability of receiving a treatment is low, simple comparisons of outcomes between those who are treated in a given period and those who are untreated in that period, but receive the treatment in some other period, approximately identify the average effect of the treatment on the treated. Monte Carlo simulations reveal that this approximate selection-correction substantially reduces selection bias relative to naive comparisons of outcomes between treated and untreated units.     

The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy

Objective:

To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients.

Methods:

An observational study compared a prospective cohort of patients ≥65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of ≥3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources.

Results:

There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8% in the tested group vs 16.1% in the untested group (RR?=?0.61, 95% CI?=?0.39–0.95, p?=?0.027), ED visit rate was 4.4% in the tested group vs 15.4% in the untested group (RR?=?0.29, 95% CI?=?0.15–0.55, p?=?0.0002) and outpatient visit rate was 71.7% in the tested group vs 36.5% in the untested group (RR?=?1.97, 95% CI?=?1.74–2.23, p?<?0.0001). The rate of overall HRU was 72.2% in the tested group vs 49.0% in the untested group (RR?=?1.47, 95% CI?=?1.32–1.64, p?<?0.0001). Potential cost savings were estimated at $218 (mean) in the tested group. The provider majority (95%) considered the test helpful and 46% followed CDST provided recommendations.

Conclusion:

Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate.