Objective:To understand the polymorphisms of CYP2C19*2/ *3/ *17 alleles 9154G>A, 7948G>A, and 806C>T in Guangzhou population, and to provide reference for the clinical application of voriconazole in the treatment of invasive fungal infections. Methods:A total of 318 patients with suspected invasive fungal infection who were scheduled to be treated with voriconazole and were tested for CYP2C19*2/ *3/ *17 allele in Guangzhou Chest Hospital from January 2022 to February 2023 were selected for analysis, including 249 males and 69 females, aged 19-94 years (with a mean age of 58 years old). The polymorphism of CYP2C19*2 (9154G>A), CYP2C19* 3 (7948G>A), and CYP2C19* 17 (806C>T) in the patients was detected by digital fluorescence molecular hybridization sequencing. The distribution frequencies of genotypes and haplotypes in patients with fast, medium, and slow voriconazole metabolism types were analyzed. Results:GG, AG, and AA genotypes were detected on the CYP2C19* 2 (9154G>A) locus, with the distribution frequencies of 47.80% (152/318), 42.45% (135/318), and 9.75% (31/318), respectively. GG, GA, and AA genotypes were detected on the CYP2C19* 3 (7948G>A) locus, with the distribution frequencies of 90.88% (289/318), 8.81% (28/318), and 0.31% (1/318), respectively. CC and CT genotypes were detected on the CYP2C19* 17 (806C>T) locus, with the distribution frequencies of 99.37% (316/318) and 0.63% (2/318), respectively. In the 318 patients to be treated with voriconazole, there were 135 (42.45%), 140 (44.03%), and 43 (13.52%) patients with fast, medium, and slow voriconazole metabolism types, respectively. The haplotypes of the 3 gene loci were 2 fast metabolism haplotypes of GG-GG-GC and GG-GG-CT, with the distribution frequencies of 99.26% (134/135) and 0.74% (1/135), 3 medium metabolism haplotypes of AG-GG-CC, GG-GA-CC, and AG-GG-CT, with the distribution frequencies of 87.86% (123/140), 11.43% (16/140), and 0.71% (1/140), and 4 medium metabolism haplotypes of AA-GG-CC, AG-GA-CC, AA-GA-CC, and GG-AA-CC, with the distribution frequencies of 69.77% (30/43), 25.58% (11/43), 2.33% (1/43), and 2.33% (1/43). Conclusions:From the genetic background of CYP2C19 gene, although most people in Guangzhou are fast and medium voriconazole metabolism types, slow voriconazole metabolism type account for a certain proportion. Therefore, the attention should be paid to the detection of its gene polymorphism in clinical diagnosis and treatment, so as to guide the reasonable clinical application of voriconazole.

Objective To fully analyze irrational medical instructions in pharmacy intravenous admixture services(PIVAS) from various scope or aspect for promoting rational use of clinical drugs. Methods The data of medical instructions in the PIVAS of our hospital were collected and straightened out from January, 2017 to December, 2018. And the cases of irrational medical instructions were studied further by using the frequency and percentage composition by descriptive analysis methods. Results Six hundred and ninety-four irrational instructions, which were composed of 736 errors and involved a total of 132 kinds of drugs, were found. The irrational instructions were classified as amount of solvent, solvent, frequency of medication, dosage, operational error, unreasonable compatibility, and others. And their values of frequency, the percentage composition, and the type of drug involved were 213, 28.94％, and 53; 186, 25.27％, and 37; 94, 12.77％, and 16; 74, 10.05％, and 32; 133, 18.07％, and 66; 30, 4.08％, and 16; and 6, 0.82％, and 5, respectively, according to previous order. The frequencies and percentage compositions of irrational medical instructions in the top 10 drugs involved were as follow: 44 groups (6.34％) of fat-soluble vitamin(Ⅱ)/water-soluble vitamin, 39 groups (5.62％) of adenosine monophosphate (0.5g), 36 groups (5.19％) of Melon smut injection [4 ml], 34 groups (4.90％) of cefoperazone tazobactam [2.5 g], 32 groups (4.61％) of piperacillin sulbactam [0.75 g], 32 groups (4.60％) of Shuganning [2 ml], 24 groups (3.46％) of doxofylline injection [0.2 g: 20 ml] ,24 groups (3.46％) of cefoperazone tazobactam [2.0 g], 21 groups (3.03％) of Mannan peptide (water) [5 mg: 2 ml], and 19 groups (2.74％) of compound glycyrrhizin [20 mg]. These irrational medical instructions accounted for 42.95％ (340/694) of all. The types of irrational medical instructions and drugs involved were obvious different in various kinds of clinical departments. Conclusion It is essential to improve clinical rational medication that medical review ability of pharmacist must be strengthened and appropriate intervention measures implemented according to the characteristics of each clinical department.

β受体阻滞剂可减慢心率、降低心肌耗氧量、抑制肾素-血管紧张素-醛固酮系统(RAAS)、延缓心肌重构、提高左心室的射血分数(LVEF)、改善患者长期预后,是治疗心衰的基石药物.但对于心脏射血分数(EF)保留的心衰和右心衰,β受体阻滞剂的获益则尚不明确.且对植入起搏器患者的用药更应结合其自身情况分析利弊.临床药师关注医生容易忽略的药物相互作用问题,提供药学服务等,减少或避免了中毒不良事件的发生,保障安全有效的药物治疗.临床药师在临床药物治疗实践中积累药物使用和药学监护经验,并体现临床药师的价值.

目的 通过分析2010-2016年广州市抗结核固定剂量复合剂使用核查差异度,评价本市结核病防治规划中政府提供的免费抗结核药品使用的覆盖面,为药品的使用测算、采购、分发及管理监测提供参考依据.方法 用全市2010-2016年登记的结核病例数求得药品理论消耗量,通过与实际消耗量的使用核查比较,用差异度的大小,评价本地区结核病防治规划中政府提供的免费抗结核药品使用情况.结果 2010-2016年广州市抗结核固定剂量复合剂使用核查差异度较大,异福酰胺使用差异度在35.92％～48.81％之间,异福胶囊使用差异度在43.07％～63.27％之间,均超过《抗结核药品管理手册》30％的规定;其中荔湾、越秀、海珠、天河等区抗结核固定剂量复合剂使用核查差异度超过50％,原因可能与距城市中心较近,患者有更多的治疗模式选择,愿意选择住院治疗,使用自费散装抗结核药品有关.结论 本市抗结核固定剂量复合剂使用核查差异度较大,并存在较大的地区差异,应根据实际情况做好药品的需求测算,积极开展FDC药品不良反应监测工作,进一步扩大政府治疗肺结核减免政策的覆盖面.

2010年WHO提供的数据显示[1]:1400万例结核病患者中约50万例是MDR-TB;中国每年新发结核病患者约100万例,其中MDR-TB患者约10万例[2].MDR-TB具有三高一低(即死亡率高、复发率高、治疗费用高和治愈率低)的现状,是结核病逐年上升的重要因素之一[3],故此MDR-TB是目前我国结核病控制的一道难题.因而治疗MDR-TB逼在眉睫,同时也是抑制结核病上升的重要保障.为了解对氨基水杨酸异烟肼(pasiniazide,力克肺疾)对MDR-TB和广泛耐药结核病(extensive drug resistant-TB,XDR TB)菌株的抑制作用H-5],本研究对在实验室中证实为MDR-TB或XDR-TB菌株进行了力克肺疾及其他6种二线抗结核药物[包括克拉霉素(Clr)、左氧氟沙星(Lfx)、莫西沙星(Mfx)、阿米卡星(Am)、利福布汀(Rfb)和丙硫异烟胺(Pto)]药物敏感性试验(简称"药敏试验"),以观察各种药物对MDR-TB和XDR-TB菌株的抑制状况,为临床治疗MDR-TB和ⅪR-TB患者提供科学依据.

Objective To analyze drug sensitivity of non-tuberculosis mycobacteria(NTM) in Guangzhou,to provide reliable scientific basis for the clinical treatment.Methods 14095 mycobacterial isolates were identified by traditional mycobacterial species identification method.1819 NTM isolates were determined their sensitivity to 13 first-line and second-line anti-tuberculosis drugs(including INH,RFP,S,EMB,Am,Clr,Lfx,Mfx,CIP,Depasic,Rfb,Pto,Cm).Results Of 1819 NTM isolates,the INH-and depasic-resistant rates reached 96.15%(1749/1819)and 95.41%(1248/1308),other drug-resistant rates were 76.25%(1387/1819)(S),73.94%(817/1105)(Pto),72.94%(954/1308)(Lfx),72.51%(1319/1819)(RFP),70.42%(1281/1819)(EMB),65.29%(854/1308)(Mfx),60.13%(543/903)(CIP),56.87%(236/415)(Rfb)and 50.50%(102/202)(Cm),respectively.While Clr-and Am-sensitive rates were 88.17%(1163/1319)and 67.73%(892/1317),respectively.Conclusion NTM showed natural resistance to the first-line anti-tuberculosis drugs.The macrolide Clr and Amino sugar glycoside have stronger bacteriostatic effect on NTM.NTM isolates need perform the drug sensitivity testing.

<正>患者男,26岁。因"全身红斑伴发热7 d"于2010年12月9日来我院就诊。8年前患者因反复阵发性咳嗽伴胸闷,在当地医院诊断为肺结核,间断口服抗结核药物治疗,具体药物及剂量不详,效果较差,并多次出现咯血症状,遂来我院就诊。依药敏结果于8月份开始给予利福布丁、力克肺疾、克拉霉素、乙胺丁醇等药物规律治疗,2个月后仍有咯血症

<正>分枝杆菌菌型鉴定在结核病流行病学调研和临床用药指导方面起到了至关重要的作用,因由Mtb或非结核分枝杆菌(non-tuberculosis Mycobacteria,NTM)引致的肺部疾病,其临床症状和X线影像表现没有任何的区别,但临床治疗有很大的差异甚至完全不同,因此结核分枝杆菌复合群(MTC)与NTM正确的区分尤为重要。故中国防痨协会基础专业委员会在1995年制定并于2006年再版修订了《结核

Objective To determine the heavy metal elements concentration in traditional Chinese medicine in the market,so as to provide reference for the quality control of traditional Chinese medicine.Methods Determine 12 elements' concentration in Jiehe pill which need take a long time by ICP-MS.Results Cd,As,Cr,Cu,Pb,Sb,Ni,Mu,Ba,and Zn had been determined in Jiehe pill.The concentrations of toxicity elements such as Cd,As,Cr,Cu,Pb were very low,and were within the safety range.Conclusion The concentration of Cd,As,Cr,Cu,Pb in Jiehe pill are lower than the limit standards for traditional Chinese medicine in Chinese Pharmacopeia(2010)(Cd≤0.3,Cu≤20.0,Pb≤5.0 μg/g,the dose limit of As is in the range of 2.0~10.0 μg/g,and the safety dose of cr is inthe range of 50~200 mg/d).There are no limit standards of Sn,Ag,Sb,Ni in Chinese Pharmacopeia(2010),and those elements in Jiehe pill are also very low.

目的了解我院住院病人抗感染药物的用药情况及发展趋势,为临床用药提供参考。方法采用2003-2005年我院中心药房抗感药物的领药记录数据进行DUI、DDD的统计和分析。结果大多数抗感染药物的DUI≤1,DDD s呈现增长趋势,其中抗结核药物的使用情况基本保持稳定,喹诺酮类药物用量增加较快。结论我院住院病人使用抗感染药物基本合理,但也存在一定滥用的趋势,目前,各类抗感染药物种类繁多,临床应用广泛,应注意合理使用。

目的:探讨胸腺肽治疗肺结核并糖尿病的疗效和机制.方法:将80例肺结核并糖尿病患者随机分为治疗组和对照组各40例,两组均给予9个月的抗结核治疗及降血糖治疗,治疗组加用胸腺肽治疗.依据症状、体征、胸片、痰抗酸杆菌、血糖评价治疗效果,并通过检测淋巴细胞转化率、T淋巴细胞亚群和血清白细胞介素-2(IL-2),探讨其治疗机制.结果:两组症状、体征均明显改善或消失,治疗组痰抗酸杆菌阴转率、结核治愈率及血糖复常率明显高于对照组(P<0 01).治疗组淋巴细胞转化率、CD3、CD4、CD4/CD8、IL-2显著高于对照组(P <0 01).结论:胸腺肽能够增强机体细胞免疫功能,从而提高肺结核并糖尿病的治疗效果.

目的: 考察利巴韦林注射液在木糖醇输液中的稳定性.方法: 模拟临床用法用量,对配伍溶液在6 h之内的外观、pH值及含量的变化进行研究.结果: 配伍溶液的各项指标均无显著性变化.结论: 利巴韦林注射液可与木糖醇输液配伍使用.