类风湿关节炎(rheumatoid arthritis,RA)是一种慢性炎症性疾病,以关节受累为主,引起关节软骨和骨的破坏,最终导致关节畸形[1].IgA肾病是临床上常见的肾小球疾病,肾脏免疫病理表明以免疫球蛋白A为主的免疫复合物在肾小球系膜区沉积,其临床表现多样,或单纯蛋白尿、血尿,或急性乃至急进性肾炎综合征[2].目前IgA肾病确切病因及发病机制尚不明确,由于没有特异性治疗方案,约40％的IgA肾病患者在发病10～20年后进入终末期肾病[3].

目的 :分析和评价发生药物不良反应的老年患者不适当用药情况,为临床合理用药提供参考.方法 :统计该院2016—2017年60岁及以上住院患者药物不良反应的情况,以2015版Beers标准及《中国老年人潜在不适当用药目录》为依据,评价该类患者潜在不适当用药情况.结果:218例老年患者,按照2015年版Beers标准,181(83.0％)例存在潜在不适当用药共计599项;按照《中国老年人潜在不适当用药目录》标准,147(67.4％)例存在潜在不适当用药共计263项.结论 :不适当用药现象在发生药物不良反应的老年患者中较普遍,临床应引起重视.

Objective:To evaluate the clinical efficacy and safety of hospital preparation Wenjing Mixture combined with western medicine in the treatment of rheumatoid arthritis of dampness-heat obstruction pattern.Methods:132 cases were randomized into two groups:observation group in which 66 cases were treated by Wenjing Mixture,methotrexate (MTX) and leflunomide,and control group in which 66 cases were treated by MTX and leflunomide with the course of 12 weeks.The clinical efficacy,syndrome of TCM and adverse drug reaction(ADR) were observed.Results:The duration of morning stiffness,visual analogue scale(VAS),SJC,TJC,ESR,CRP and DAS28 index were significantly improved after treatment of 4 weeks in the experimental group and control group (P ＜0.01).There were significant differences of visual analogue scale (VAS) after 4 weeks of treatment (P ＜ 0.05),duration of morning stiffness (P ＜ 0.05) and VAS after 8 weeks of treatment (P ＜ 0.01),while the others showed there was no significant difference between groups (P ＞ 0.05).The remission rate of disease activity score (DAS28) in observation group after treating 12 weeks was 13.11％,which was better than that of control group's 5.08％ (P ＞ 0.05).The total effective rate and the total effective rate of TCM syndromes between the two groups were statistically significant(P ＜0.05 or P ＜ 0.001).The incidence of ADR in observation group was less than that in control group,but there was no significant difference between two group (P ＞ 0.05).Conclusion:Wenjing Mixture combined western medicine could improve the clinical efficacy and reduce risk of ADR,it was the effective therapeutic regimen of rheumatoid arthritis of dampness-heat obstruction pattern.

目的:了解某关节病专科医院药品不良反应(ADR)发生特点,为临床合理用药提供参考.方法:采用回顾性分析方法,对2010 ～ 2012年本院上报的ADR,按患者性别、年龄、给药途径、涉及药品种类、ADR累及器官或系统、临床表现进行统计分析.结果:301例ADR中,女性217例(71.1％),男性87例(18.9％);50～59岁81例(构成比26.9％);不同给药途径中口服最多;导致ADR的可疑药品前3类分别是疾病缓解抗风湿药、解热镇痛抗炎药、抗菌药;ADR累及器官或系统以胃肠系统损害为主,其次为皮肤及附件损害和肝胆系统损害;ADRs主要临床表现是恶心、呕吐、腹泻、皮疹、瘙痒、肝功能异常,有1例死亡.结论:应重视疾病缓解抗风湿药和解热镇痛抗炎药导致的ADR,服药期间注意患者有无胃肠系统或皮肤及附件不适,可定期监测肝功能和血常规,以减少或避免肝功能损害和白细胞减少等严重ADR的发生.

目的:了解我院药品不良反应发生的特点及引发药品不良反应的相关因素,促进临床合理用药。方法:对我院2006年1月至2009年6月收集上报的295例药品不良反应报告进行分类统计和分析。结果:由解热镇痛抗炎及抗风湿类药引起的药品不良反应所占比例最高,为51.30%,其次为抗微生物类药、中药制剂。临床表现主要为胃肠道反应;其次为药物性皮疹、瘙痒和红肿。结论:应重视药物不良反应问题,进一步加强药品不良反应的监测、通报和宣传工作。