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Table of Content

    Volume 29 Issue 2
    26 February 2024
    Di'ao Xinxuekang activates IRS-1/PI3K/Akt signal pathway to improve insulin resistance in nonalcoholic fatty hepatitis mice
    WANG Xin, WANG Yifan, SHANG Muhong, LIU Yuyan, CHEN Guangliang
    2024, 29(2):  121-129.  doi:10.12092/j.issn.1009-2501.2024.02.001
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    AIM: To study the effect and mechanism of Di'ao Xinxuekang (DXXK) on insulin resistance in nonalcoholic steatohepatitis (NASH) mice. METHODS: C57BL/6J mice were randomly divided into normal group and model group. After 16 weeks of high-fat diet, the model group was randomly divided into model group and Pioglitazone group (6.0 mg·kg-1·d-1), DXXK high, medium, and low (200, 60, 20 mg·kg-1·d-1) dose groups, with 8 animals in each group, and were administered by gavage for 8 consecutive weeks. The body weight, activity, fat mass, fasting blood sugar (FBG), serum insulin (FINS), total cholesterol (TC), triglyceride (TG), aspartic acid transaminase (AST), alanine amino transferase (ALT), and the contents of TC and TG in the liver were measured; oral glucose tolerance test (OGTT), intraperitoneal insulin tolerance test (IPITT), calculate insulin resistance index (HOMA-IR), insulin sensitivity index (ISI), area under curve (AUC) of OGTT and IPITT. HE staining was used to observe liver pathology, and Oil Red O staining was used to observe liver lipid accumulation. Western blot was used to detect the related proteins and downstream target SREBP-1c protein in the IRS-1/PI3K/Akt signaling pathway in liver tissue. RESULTS: Compared with the model group, the body weight, fat mass, FBG, FINS, HOMA-IR, ISI, TC, TG, AST, ALT levels, AUC of OGTT and IPITT in DXXK group and pioglitazone group were significantly reduced, significant increase in activity, liver lipid deposition and liver function abnormalities were significantly improved, hepatocyte steatosis and ballooning were significantly reduced, and liver p-IRS-1/IRS-1, PI3K, p-AKT/AKT protein expression was significantly increased, SREBP-1c protein expression was significant decrease. CONCLUTION: DXXK can improve insulin resistance in NASH mice, and its mechanism of action may be related to the activation of the IRS-1/PI3K/Akt signaling pathway.
    Study on the mechanism of astragalus glycyrrhiza decoction regulating SIRT1/FOXO1 pathway to prevent QT interval prolongation induced by arsenic trioxide based on metabolomics
    XU Lan, HAI Yang, REN Ke, ZHANG Yarong, CAO Haoshi, LIU Dongling
    2024, 29(2):  130-138.  doi:10.12092/j.issn.1009-2501.2024.02.002
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    AIM: To explore the protective effect of astragalus glycyrrhiza decoction (AGD) on arsenic trioxide (ATO)-induced QT interval prolongation and its mechanism based on metabonomics. METHODS: The model of ATO-induced QT interval prolongation in rats was established, and ECG, blood routine, and metabonomics were detected, and the key targets were collected combined with network pharmacology. The possible candidate genes and pathways for the protective effect of AGD were screened by GO and KEGG enrichment analysis and then verified by experiments in vitro. RESULTS: AGD could significantly alleviate the ATO-induced QT interval of SD rats. GO enrichment analysis was mainly related to inflammatory response, reactive oxygen species, oxidative stress, inner cell vesicles, folds, inner cell vesicles, SMAD binding, R-SMAD binding, and signal receptor activator activity. KEGG analysis showed that it was mainly concentrated in the PI3K-Akt signal pathway, lipid and arteriosclerosis, FOXO signal pathway, TNF signal pathway, HIF-1, and other signal pathways. Through the H9c2 cell model in vitro, it was verified that AGD could reverse the expression of SIRT1 and FOXO1 proteins. CONCLUSION: AGD may improve the ATO-induced QT interval prolongation and reduce the cardiotoxicity of ATO by regulating the SIRT1/FOXO1 signal pathway.
    Effects of sodium pyruvate on the morphology, structure and function of erythrocytes stored in vitro in type 2 diabetes rats
    BAI Yu, YAO Na, XIE Xiaoyi, WU Mandi, CUI Yinghui, CHI Yongbin, GUO Jianrong
    2024, 29(2):  139-145.  doi:10.12092/j.issn.1009-2501.2024.02.003
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    AIM: To observe the effect of RBC preservation solution with sodium pyruvate on the morphology, structure and function of RBC stored in vitro in type 2 diabetes rats.?METHODS: Thirty SPF male SD rats,were randomly divided into 3 groups (n=10): non-T2DM conventional RBC preservation solution (group A), T2DM conventional RBC preservation solution (group B) and T2DM sodium pyruvate RBC preservation solution (group C).?The leukoreduced RBC from the tail vein and stored for 0 d (T0), 7 d (T1), 14 d (T2), 21 d (T3) and 28 d (T4) to detect the morphology, structure and the contents of 2,3-DPG, reactive oxygen species (ROS), malondialdehyde (MDA) and lactic acid (LA) of RBC in group A, B and C. The RBC stored for 14 days in vitro were labeled with PKH26, and its survival rate were tested in vivo at 1, 4, 10 and 16 hours after intravenous infusion. RESULTS: At T0, the RBC morphology of group A was intact, which was better than that of group B and group C. With the extension of storage time, the morphology of RBC in each group gradually transformed into a spindle-spherical shape. Compared with group A, the incidence of acanthocytes in group B and group C was higher, and the incidence of acanthocytes in group C was lower than that in group B. Compared with group A, the content of 2,3-DPG in group B and group C decreased, while ROS and MDA increased at different time points (P<0.05). The content of 
    2,3-DPG in group C was higher than that in group B (P<0.05), and the contents of ROS and MDA were lower than those in group B (P<0.05). LA content in group B was higher than that in group A and group C (P<0.05). At T2-T4, the LA content in group C was lower than that in group A (P<0.05). The survival rate of RBC in group A was higher than that in group B and C, and the survival rate of RBC in group B was lower than that in group C (P<0.05). CONCLUSION: Sodium pyruvate added RBC preservation solution has a certain protective effect on RBC stored in vitro in type 2 diabetic rats, and its mechanism may be related to its antioxidant effect.
    Effects of remimazolam on early postoperative cognitive function in elderly patients with hip fracture
    DUAN Gongchen, WU Jimin, XU Qiaomin, JIANG Jianxin, LAN Haiyan, ZHANG Xutong, YUAN Kaiming, LI Jun
    2024, 29(2):  146-153.  doi:10.12092/j.issn.1009-2501.2024.02.004
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    AIM: To evaluate the effect of remimazolam on early postoperative cognitive function in elderly patients with hip fracture based on a randomized controlled trial. METHODS: A total of 106 elderly patients, aged 65-90 years, ASA grade Ⅱ or Ⅲ, who underwent hip fracture surgery under combined spinal-epidural anesthesia in the Sixth Affiliated Hospital of Wenzhou Medical University from December 2022 to June 2023 and met the inclusion criteria, were selected and randomized into remimazolam group (group R) and propofol group (group P) according to the random number table, with 53 cases in each group. Patients in group P received a slow intravenous injection of propofol at a dose of 0.3-0.5 mg/kg (injection time of 1min), followed by a pump infusion at 0.5-3 mg·kg-1·h-1 for maintenance. In group R, intraoperative sedation was maintained by remimazolam at 0.1-0.3 mg·kg-1·h-1 after a loading dose of 0.05 mg/kg (injection time of 1min). The pump infusion rate were adjusted by maintaining MOAA/S score at 3-4 and BIS value at 75-85, and stopped administering sedatives while suturing the incision. MOAA/S score, MAP, HR, RR, SpO2 and BIS values were recorded before sedation (T0), 5 (T1), 10 (T2), 15 (T3), 30 (T4) and 60 (T5) min after sedation and at the end of surgery. The emergence time, intraoperative amnesia, the incidence of postoperative delirium (POD) and delayed neurocognitive recovery (DNR) within 7 days after operation, and the occurrence of adverse events during perioperative observation were recorded. RESULTS: Compared with T0, the BIS and MOAA/S scores of the two groups at T1-T5 were significantly decreased, and the MAP and HR of the two groups at T1-T6 were significantly lower (P<0.05). Compared with group P, group R showed higher MAP at all time points from T1 to T6 (all P<0.05), shorter emergence time (6.6±1.8 vs. 7.7±2.2 min, P<0.05), less decline in Hopkins Verbal Learning Test scores on postoperative day 7 (3.9±3.9 vs. 6.2±4.6, P<0.05), lower incidence of postoperative delirium and DNR (7.5% vs. 28.3%,5.7% vs. 20.8%, P<0.05), higher incidence of intraoperative amnesia (52.8% vs. 28.3%, P<0.05) lower incidence of hypotension and bradycardia (15.1% vs. 37.7%, 5.6% vs. 22.6%, P<0.05), and fewer frequent use of vasoactive drugs (P<0.05). CONCLUSION: Application of remimazolam for perioperative sedation in elderly patients with hip fracture can provide effective sedation and stable hemodynamic, with little effect on early neurocognitive function, and overall safety higher than propofol.
    Efficacy and safety analysis of tigecycline and polymyxin B in the treatment of carbapenem-resistant enterobacteriaceae pneumonia in critically ill patients
    ZHA Xian, CHEN Dayu, SHAO Hua
    2024, 29(2):  154-163.  doi:10.12092/j.issn.1009-2501.2024.02.005
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    AIM: To compare the efficacy and safety of tigecycline with polymyxin B in the treatment of carbapenem resistant enterobacteriaceae (CRE) pneumonia in critically ill patients. METHODS: A retrospective analysis was performed on the clinical data of patients with CRE pneumonia who received tigecycline or polymyxin B therapy from January 1,2018 to Jun 30,2023 in the Intensive Care Unit (ICU). Primary outcomes included the 28-day all-cause mortality and clinical cure rate within 28days. Secondary outcomes included the ICU mortality, in-hospital mortality, the length of hospital stay and ICU stay, microbial eradication, duration of mechanical ventilation. Independent predictors affecting 28-day clinical cure rate were tested using Cox regression analyses. RESULTS: A total of 83 eligible patients were included in the final analysis after propensity score matching, 54 in the tigecycline group and 29 in the polymyxin B group. The 28-day all-cause mortality was 31.5% (17/54) in the tigecycline group and 37.9% (11/29) in the polymyxin B group, the difference was not statistically significant (P=0.554); the clinical cure rate was 63% (34/54) in the tigecycline group, which was significantly higher than that of the polymyxin B group of 34.5% (10/29) (P = 0.013). There were no statistical differences between the two groups in terms of secondary outcomes. Multivariate logistic regression analysis found that the use of tigecycline was an independent predictor of the 28-day clinical cure rate (HR 2.083, 95%CI 1.018-4.263, P = 0.045). However, activated partial thromboplastin time (APTT) and prothrombin time (PT) were significantly prolonged in the tigecycline group compared with the polymyxin B group (P=0.047; P=0.027), and fibrinogen (FIB) was significantly decreased (P < 0.001) after drug administration. CONCLUSION: There was no significant difference in 28-day all-cause mortality between the tigecycline and polymyxin groups; tigecycline might be associated with a higher 28-day clinical cure rate compared with polymyxin B. It should be noted that tigecycline may increase the risk of coagulation abnormalities.
    Efficacy and safety of paclitaxel albumin assisted platinum chemotherapy in the treatment of recurrent and metastatic cervical cancer based on tumor factors and inflammatory status
    ZHOU Ying, WANG Liqun
    2024, 29(2):  164-170.  doi:10.12092/j.issn.1009-2501.2024.02.006
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    AIM: To investigate the efficacy and safety of paclitaxel albumin assisted platinum chemotherapy in the treatment of recurrent and metastatic cervical cancer based on tumor factors and inflammatory status. METHODS: A total of 100 patients with recurrent and metastatic cervical cancer in our hospital from January 2020 to January 2023 were randomly divided into two groups: 50 patients in the control group were treated with paclitaxel-assisted nedaplatin regimen, and 50 patients in the study group were treated with paclitaxel-assisted nedaplatin regimen. The short-term efficacy, tumor factors, inflammatory factors, relapse-metastasis related indexes, quality of life, functional status and adverse reactions were compared between the two groups. RESULTS: The total remission rate of the study group (72.00%) was higher than that of the control group (48.00%) (P<0.05). In the study group, after one and three cycles of treatment, serum cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), carbohydrate antigen 724 (CA724), squamous cell carcinoma antigen (SCC Ag), interleukin-4 (IL-4), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) The levels of serum microrna-367 (mir-367), microrna-383 (mir-383), quality of life (QOL) and Karnofsky functional status score (KPS) in the tumor patients were significantly higher than those in the control group (P<0.05); There was no significant difference in the incidence of nausea/vomiting, diarrhea, fatigue, leukopenia and allergic reactions between the study group and the control group during treatment (P>0.05), but the total incidence of adverse reactions (12.00%) was lower than that of the control group (32.00%) (P<0.05). CONCLUSION: Paclitaxel albumin-assisted nedaplatin has a reliable effect in the treatment of recurrent and metastatic cervical cancer, which can further reduce the level of tumor factors, relieve inflammation, and has high safety.
    Effects of short-term intensive insulin pump treatment on type 2 diabetes and its influencing factors
    SHEN Jizhong, TANG Jifa
    2024, 29(2):  171-176.  doi:10.12092/j.issn.1009-2501.2024.02.007
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    AIM: To observe the real world efficacy of continuous subcutaneous insulin infusion (CSII) with insulin pump in short-term intensive treatment of patients with type 2 diabetes (T2DM) and explore the influencing factors associated with efficacy. METHODS: A total of 369 hospitalized T2DM patients were treated with CSII short-term intensive therapy. Based on the blood glucose levels on the 5th day of treatment, they were divided into two groups, namely the qualified blood glucose control group and the non-qualified blood glucose control group. The differences of glucose metabolism, physiology, biochemistry and other indicators between the two groups were compared, and the influencing factors of insulin pump efficacy were analyzed by regression statistics. RESULTS: After 4 days of CSII short-term treatment, 225 patients (61%) achieved blood glucose control standards, while 144 patients (39%) did not achieve blood glucose control standards. Compared with the qualified blood glucose control group, the non-qualified blood glucose control group was older and with higher levels of total daily insulin dose per kilogram of body weight (TDD), fasting blood glucose (FBG), fasting insulin, fasting C-peptide, and insulin resistance index (HOMA-IR), while lower levels of blood phosphorus, insulin growth factor 1 (IGF1). In terms of biochemical indicators, there was no significant difference between the two groups as a whole, including blood lipid levels, liver function, and kidney function. The results of univariate regression and multivariate stepwise regression analysis showed that 2-hour postprandial insulin, TDD and blood phosphorus were the key factors influencing the efficacy of Insulin pump. Among them, qualified blood glucose control was positively correlated with blood phosphorus, and negatively correlated with 2-hour postprandial insulin and TDD. CONCLUSION: CSII with insulin pump is an ideal method for short-term intensive treatment of type 2 diabetes. In order to achieve a more satisfactory rate of qualified blood glucose control, more attention should be paid to the patient's blood phosphorus, 2-hour postprandial insulin and TDD in clinical use. 
    Role of heterotrimer G protein in podocyte injury
    LIU Can, DAI Enlai, DING Zhaoran, DUAN Shuwen, WANG Xiaohui
    2024, 29(2):  177-187.  doi:10.12092/j.issn.1009-2501.2024.02.008
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    GPCRs are the largest membrane protein receptor superfamily in the human body, with more than 800 isoforms, and approximately 35% of Food and Drug Administration-approved and marketed drugs currently target GPCRs for the treatment of a wide range of diseases, for heart failure (beta-adrenergic receptors), peptic ulcer (histamine receptors), prostate cancer (gonadotropin receptors), hypertension (adrenergic and angiotensin receptors), pain (opioid receptors), and bronchial asthma (beta2-adrenergic receptors) examples. Although the number of GPCRs is enormous, the signaling proteins downstream of them are limited, heterotrimeric G proteins (GPs) are key proteins that signal GPCRs, translate extracellular stimuli into intracellular responses by coupling to GPCRs and initiate multiple signaling events via downstream cascades. Podocytes are an important component of the glomerular filtration barrier, and their damage is a central event in proteinuria formation and progressive glomerulosclerosis. This article reviews the regulation of GPs, their signaling and their role in podocyte injury to provide a theoretical basis for scientific research and clinical treatment of this disease.
    Recent progress of targeting Nrf2-ferroptosis to treat brain injury after ischemic stroke
    LI Mei, LI Qiang
    2024, 29(2):  188-197.  doi:10.12092/j.issn.1009-2501.2024.02.009
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    Emerging evidences suggest that ferroptosis plays a vital role in the pathophysiological process of brain injury after Ischemic stroke. Accumulating evidence supports  pharmacological inhibition of ferroptosis as a therapeutic target for brain injury after Ischemic stroke through activating nuclear factor erythroid 2-related factor 2 (Nrf2), which transcriptionally controls many key components of the ferroptosis pathway. In this review, briefly describe ferroptosis processes and the roles they play in contributing to brain injury after ischemic stroke in the brain. We then provide a critical overview of the relationship between Nrf2 signalling and ferroptosis. With a focus on discuss how therapeutic modulation of the Nrf2 pathway is a viable strategy to explore in the treatment of ferroptosis-driven brain injury after Ischemic stroke.
    Progress in perioperative application of tranexamic acid
    WANG Wenli, YAO Yiting, YANG Chun
    2024, 29(2):  198-206.  doi:10.12092/j.issn.1009-2501.2024.02.010
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    Perioperative bleeding is closely related to the prognosis of patients, and massive blood loss can lead to serious adverse events. Tranexamic acid, a lysine derivative, exerts anti-fibrinolytic effects by competitively blocking lysine binding sites on plasminogen to achieve hemostasis. Perioperative use of tranexamic acid can effectively reduce the risk of bleeding and the need for blood transfusion, and reduce the risk of bleeding related complications and death. At present, the use of tranexamic acid for perioperative hemostasis is increasingly widespread, and it is gradually entering the consensus and guidelines in more surgical fields. In this paper, the mechanism of action, perioperative application and adverse reactions of tranexamic acid were reviewed, and the effectiveness and safety of tranexamic acid in different surgical types were discussed, so as to provide reference for the application and research of tranexamic acid in China.
    Research progress in the treatment of early Alzheimer's disease with lecanemab
    JIN Panpan, LIU Yang, QIU Bo, WU Huizhen
    2024, 29(2):  207-214.  doi:10.12092/j.issn.1009-2501.2024.02.011
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    Lecanemab is a new drug used to treat early Alzheimer's disease (AD) with mild cognitive impairment or mild dementia. It is a human anti-Aβ fibril monoclonal IgG1 antibody, which is injected intravenously into the patient, through the blood-brain barrier into the brain, clearing amyloid plaque, thereby slowing the rate of cognitive decline in patients and delaying disease progression. This article reviews the pharmacological studies, clinical studies, safety and limitations of lecanemab, in order to help clinical understand the current research status and existing achievements of this drug.
    Research progress of pharmacologic therapy in obstructive sleep apnea
    WU Xingdong, YUE Hongmei, ZHU Haobin, LIU Miaomiao, LI Yating, XU Jinhui
    2024, 29(2):  215-229.  doi:10.12092/j.issn.1009-2501.2024.02.012
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    Obstructive sleep apnea (OSA) is a common sleep disordered breathing disorder. As a major global public health problem, untreated OSA can lead to a variety of adverse health outcomes, including various cardiovascular and cerebrovascular diseases, metabolic disorders, and psychiatric disorders such as anxiety and depression. Traditional OSA therapies such as positive airway pressure (PAP), weight loss, oral?appliance, upper airway surgery, and postural therapy focus on the anatomical factors of OSA. However, the pathogenesis of OSA is heterogeneous, and non-anatomical factors also play an important role in most patients. Although there is no drug with exact efficacy for the treatment of OSA, with the deepening understanding of the pathophysiological mechanism of OSA, more and more clinical studies are devoted to the study of drug treatment of OSA and its complications, and a series of results have been achieved. The following is a review of the relevant studies on drug treatment of OSA in recent years, hoping to provide literature support and theoretical basis for future research on drug treatment of OSA.
    Research advance in progesterone therapy for endometrial cancer
    ZHANG Liyi, GUO Zifen
    2024, 29(2):  230-235.  doi:10.12092/j.issn.1009-2501.2024.02.013
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    Endometrial cancer originates from the endometrium and is one of the common gynecologic malignancies, with its incidence and mortality rate increasing year by year. Although endometrial cancer is more prevalent in the peri- and post-menopausal female population, it has been an evident trend in recent years towards younger patients. For young patients who have not yet given birth but intend to do so, the application of progestins in endometrial cancer treatment has made significant progress in clinical practice. Considering the existence of large individual differences and unclear mechanisms of action in the clinical application of progestins, this paper aims to provide an overview of the current clinical application status, efficacy, hormone resistance, and its mechanisms in the context of hormone therapy.
    Advances in the study of ω-3 PUFA in heart failure
    YU Jiling, ZHANG Jing, DENG Yifan, HE Shenghu
    2024, 29(2):  236-240.  doi:10.12092/j.issn.1009-2501.2024.02.014
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    Free fatty acids, as important energy metabolism substrates for the heart, play an important role in various cardiovascular diseases; ω-3 PUFA, as an important branch of free fatty acids, has been confirmed by more and more researches to be closely related to cardiovascular diseases. Heart failure, as a common cardiovascular problem, seriously affects people's quality of life. Studies have shown that ω-3 PUFA plays a significant role in the development of heart failure. In this paper, we try to review the metabolism, pathogenesis and therapeutic significance of ω-3 PUFA in heart failure.