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不断发现新的推广点,赖文雄,目录,Contents,IgA肾病,IgA nephropathy是肾小球系膜区以IgA或IgA沉积为主的原发性肾小球疾病，是肾小球源性血尿最常见的原因.是全世界范围内最常见的慢性肾小球肾炎疾病 IgA肾病治疗的重点在于保护修复肾功能、减少蛋白尿、控制高血压、延缓IgA肾病的进展。IgA肾病治疗的常用药物包括：血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、激素、免疫抑制剂、抗凝、抗血小板聚集及促纤溶药等.,文献（1） IgAN,Lipid peroxidation in IgA nephropathy andthe effect of lipo-prostaglandin E1J NEPHROL 2005; 18: 243-248 （肾脏病杂志，SCI文章，影响因子IF=1.5，）IgA肾病中的脂质过氧化作用及凯时的治疗效果,结论：LPO in IgAN was evident and was at least attributed to the decline in antioxidant ability. LPO could play a role in IgAN pathogenesis, and PGE1 is able to ameliorate the LPO in IgAN patients结论：IgA肾病中脂质过氧化反应时明显的，至少是抗氧化能力下降。LPO在IgA肾病的发病机制中可能发挥了作用，而前列腺素E1能改善IgA肾病患者的LPD水平。,浙大一附院肾脏病中心,文献（2）IgAN,Oxidative stress and damage induced by abnormal free radical reactions and IgA nephropathy Journal of Zhejiang University SCIENCE,结论： IgAN时产生了一系列自由基反应链造成了严重的病理恶化，从而导致组织氧化损伤。因此，在治疗有必要适当剂量的抗氧化剂，以减轻氧化损害。,文献(3),Long-Term Renoprotective Effect of Combination Therapy with Prostaglandin E1 and Angiotensin-Converting Enzyme Inhibitor in Patients with Chronic Renal FailureHypertens Res Vol. 28, No. 9 (2005) （ IF=2.426）前列腺素E1联合血管紧张素转换酶抑制剂对慢性肾功能衰竭患者的长期肾脏保护作用,N=60，G1：32，口服ACEI 30ug天，G2=28,+lipo-PGE1 30-60ug天测量：血压，血生化，尿蛋白排泄，1/Cr）的变化 。G1患者肾功能不全无明显改善。G2组肾功能有改善，而且这种改善不是通过降低血压和减少尿蛋白实现的。结论：前列地尔可以加强ACEI的肾脏保护作用，防治慢性肾功能不全,日本熊本大学 肾脏医学科学院,文献（4）造影剂肾病,Prediction and Prevention of Contrast Nephropathy造影剂肾病的预测和预防Journal of Interventional Cardiology Vol. 14, No. 5, 2001（介入心病学杂志 ）,N=117，45例应用不同剂量的PGEl（10微克，20微克和40ug）与安慰剂对比。极大降低了血清Cr和的CrCl postcontrast。研究表明PGEl 20微克剂量在血清Cr上清除上取得了很好的效果，证明PGEl防治RCN具有潜力，但是，需要更多的研究支持这一结论。最近乙酰半胱氨酸和PGEl在预防造影剂肾病中表明他们对造影剂肾病有较好的作用，同时也需要更加深入的研究。,密苏里大学，堪萨斯城,文献（5）腹膜透析,Effect of Prostaglandin E1 on Peritoneal Membrane Transport in CAPD-Treated Diabetic Patients前列地尔在糖尿病患者腹膜透析中的应用Peritoneal Dialysis International, Vol. 28, pp. 538557（国际腹膜透析）IF=1.636,9名腹膜透析患者，腹膜透析治疗（4 2000毫升），适应症：严重肢体缺血，无外科干预条件的患者。给药：前列腺素E1（前列地尔，60ug）的输液泵连续3天每天20小时。4.95 0.92 ng/kg/minute结果：前列地尔治疗20天，能明显的增加较大的蛋白质的转运，如35%白蛋白，57%IgG抗体和a2-巨球蛋白的转运水平。结论：前列腺素E1增加了大分子腹膜转运。,波兰，卢布林医科大学肾脏病研究中心,文献6（脑梗塞）,Effect of Prostaglandin E1 on Cerebral Blood Flow in Patients with Chronic Cerebral Infarction前列地尔对慢性脑梗塞患者脑血流量影响的前瞻性试验Yuichi Komaba, Shin Kitamura and Akiro Terashi,Internal Medicine Vol. 37, No. 10 (October 1998) 841,From the Second Department of Internal Medicine, Nippon Medical School, Tokyo,研究方法,Methods,研究入选10例慢性脑梗塞患者，除外脑出血或有出血史、颅内肿瘤等，最终入选 5例右脑梗塞，2例左侧大脑梗死，3例多发性脑梗死。表一列举了10例病人的详细信息，包括梗塞部位，病史及合并症。应用ECT扫描患者局部脑血流，前后对比，进行评估。,Results（1）,结果：应用前列地尔后，各脑缺血部位，包括额叶、颞叶、顶叶、枕叶、丘脑、纹状体、脑干、小脑等的脑血流量明显增加，具有显著的统计学意义，且部分患者的主观症状明显改善。,Figure 1. Changes in regional cerebral blood flow in each patient,Results（2）,Results（2）,Figure 1. Changes in regional cerebral blood flow in each patient,Results（3）,Figure 2. Changes in rCBF in case2.Top,before administration of PGE1;Bottom, after PGE1 administration. Intravenous administration of PGE1 increased rCBF of all regions without producing the intracerebral steal phenomenon.,Conclusions,PGE1 increases the CBF of patientswith chronic cerebral infarction without causing the intracerebral steal phenomenon.,Effect of Prostaglandin E1 on Cerebral Blood Flow in Patients with Chronic Cerebral Infarction Internal Medicine Vol. 37, No. 10 (October 1998) 841 Yuichi Komaba, Shin Kitamura and Akiro Terashi，From the Second Department of Internal Medicine, Nippon Medical School, Tokyo.,前列地尔可以增加脑梗塞部位的血流，改善脑血循环，且不会引起盗血。,文献7,Synergistic effects of prostaglandin E1 and lithium in a rat model ofcerebral ischemia1Acta Pharmacol Sin 2008 Oct; 29 (10): 11411149(IF=1.783),This work was supported by grants from the Natural Science Foundation of China (No30470587), the Natural Science Foundation of Jiangsu province (No BK2007548), and the Social Progress and Medicine Foundation ofSuzhou (No SS0729); Department of Pharmacology and Laboratory of Aging and Nervous Diseases, Soochow University School of Medicine, Suzhou 215123, China,Brain ischemia was induced by a permanent middle cerebral artery occlusion (pMCAO) in rats. Rats were pretreated with subcutaneous injection of lithium for 2 d and a single intravenous administration of PGE1 immediately after ischemic insult. .,Results（1）,Treatment with lithium starting 2 days before the onset of pMCAO, or a single intravenous injection of PGE1 immediately after the onset of pMCAO resulted in a significant reduction in infarct volume . Furthermore, coadministration of lithium and PGE1 produced a greater reduction in infarct volume (P0.05 vs PGE1 16 g/kg) (Figure 1A and 1B).,Results（2）,Results（3）,Discussion,Treated with PGE1 or lithium alone, reduction ininfarct volume was observed，lithium can enhance the neuroprotective effects of PGE1. The effects of PGE1 on cytoprotection, inhibiting platelet aggregation, membrane stabilization and anti-inflammation, etc，may participate in neuroprotection. As PGE1 and lithium are drugs used in clinics, these results strongly support a potential use in clinical therapy for ischemic cerebrovascular diseases.,Synergistic effects of prostaglandin E1 and lithium in a rat model of cerebral ischemial Acta Pharmacol Sin 2008 Oct; 29 (10): 11411149,Conclusions,锂和前列地尔治疗缺血性脑血管疾病具有协同效应，因此在临床治疗脑卒中，具有潜在的价值 。,Synergistic effects of prostaglandin E1 and lithium in a rat model of cerebral ischemial Acta Pharmacol Sin 2008 Oct; 29 (10): 11411149,Lithium and PGE1 may exert synergistic effects in treatment ofcerebral ischemia and thus may have potential clinical value for the treatment of stroke.,文献（8） 肺高,Prostaglandin E1 Testing in Heart Failureassociated PulmonaryHypertension Enables Transplantation: The PROPHET StudyJ Heart Lung Transplant 2006;25:10706.（心肺移植杂志 IF=3.541 ）Methods: This study included 208 consecutive patients being evaluated for heart transplantationin 7 transplant centers in Germany and Switzerland. Testing was performed with increasingintravenous doses of prostaglandin E1 in 92 patients通过对德国和瑞士七个移植中心208例患者的对比研究，92例使用凯时，观察凯时疗效。结论认为：心肺移植后肺血管阻力升高是是可逆的，前列地尔发挥了重要的作用。,文献9 肺高,Successful weaning from cardiopulmonary bypass with central venous prostaglandin E1 and left atrialCritical Care MedicineVolume 27(10), October 1999, pp 2180-2183（危重病急救医学 IF=6.37）危重病医学类别按影响因子最高In patients with refractory postoperative pulmonary hypertension, the combinedadministration of low-dose PGE1 in the right atrium and NE in the left atrium is an effective means to wean patients from cardiopulmonary bypass右心房低剂量PGEI联合NE左心房治疗，对体外循环术后难治性肺动脉高压具有积极的疗效,意大利 罗马大学心脏和外科部,文献10 再植、皮瓣移植,PGE-1 IN REPLANTATION AND FREE TISSUE TRANSFER:EARLY PRELIMINARY EXPERIENCEPGE-1应用于游离皮瓣移植和再植的早期研究Microsurgery DOI 10.1002/micr（显微外科IF=1.244）方法：60例患者，其中16例上肢再植，46例游离皮瓣移植用药方案：术中100UmL肝素灌注，静脉滴注PGE1 40ug Bid，静脉肝素40Ukg.术后：阿司匹林100-375mgd，30天；PGE1 40ug bid,5-7天；低分子肝素和肝素结果：所有手术都很成功，且没有发生皮瓣坏死。联合应用肝素、阿司匹林、PGE-1，并没有加大患者的出血倾向。应用PGE-1有一定的副反应，但可以耐受。讨论：再植术后或皮瓣移植后由于缺血可能发生严重的微血管痉挛。PGE1非常有效的预防和解决了微血管痉挛，保障了手术的成功。结论：PGE1将有可能成为断指再植和皮瓣移植后抗血栓形成的一线用药。总体疗效和安全性仍待进一步的研究证明。,西班牙 马德里,前列腺素E1注射液治疗指（ 趾）不全离断伤血循环障碍100 例中华创伤杂志2005 年12月第21卷第12期游离皮移植术后应用前列腺素E1 40例疗效观察中国血液流变学杂志 2003年13卷4期结论：PGE1用于游离皮移植术的治疗,可改善局部循环,促进组织再生,减少创面渗液,为皮片成活,创面愈合提供了良好的条件在皮瓣移植术后应用Lipo PGE1的临床效果应用色差计和温度记录器的讨论结论： Lipo PGE1能同时改善皮瓣的动静脉血流，促进皮瓣的生长前列腺素E1在断指再植术后的临床应用 中国实用医药 2009年1月第4卷第2期结论：前列腺素E1能有效地防止断指再植术后血管危象的发生，提高再植指的成活率,文献11 脊柱肿瘤,Surgical Site Infection in Spinal MetastasisRisk Factors and Countermeasures脊转移时外科手术部位感染的危险因素及对策SPINE Volume 34, Number 6, pp 635639（脊柱IF=2.624）（整形外科类别SCI期刊热门程度排行榜 第一名）方法：一、110例脊柱转移肿瘤患者的回顾性分析SSI危险因素。 二、94例脊柱肿瘤患者，病变是在胸椎68例，腰椎20个，颈椎6。 术前60ug bid,术后持续给药7天，观察PGE1干预SSI的前瞻性研究。原发灶来源丰富。结论：1、2、静脉给予PGE1能显著降低接受放疗的脊柱肿瘤转移患者的外科手术部位感染。,日本 金泽大学,MedSci指数，是根据杂志的国际影响力，以及投稿难易程度评价而成，基本是越高越难投稿。,缺血性肠病,缺血性肠病（ischemicboweldisease）是因肠壁缺血、乏氧，最终发生梗死的疾病。本病多见于患动脉硬化，心功能不全的老年患者。它是一组因 小肠、结肠血液供应不足导致的不同程度局部组织坏死和一系列症状的疾病. 自1963年Boley17、1966年Marston18报告该病以来，随着人口的老龄化，报告 病例正在增加. 凡全身循环动力异常，肠系膜血管病变及其他某些全身性或局部疾病引起进入肠管的血流量减少，不能满足肠管的需要致肠壁缺血时，均可发生本病. 本病常在一些疾病基础上发生，最多见于心脑血管疾病，如高血压、冠心病、动脉粥样硬化、糖尿病等. 也有不少作者认为该病可无任何先驱疾病，而表现为特发性19.,根据发病机制可分为血管阻塞性缺血和非血管阻塞性缺血两种1急性肠系膜缺血;2慢性肠系膜缺血;3结肠缺血 一、积极治疗原发病二、应用血管扩张剂,改善微循环,如静注丹参,654-2等。抗生素应用,对于栓塞或血栓形成的患者,先用溶血栓药物链激酶或尿激酶,然后肝素治疗。坏疽型应立即手术,引起肠梗阻者亦应手术治疗,Survival in Nonocclusive Mesenteric Ischemia EarlyDiagnosis by Multidetector Row Computed Tomography andEarly Treatment With Continuous Intravenous High-dose Prostaglandin E1Ann Surg 2007;246: 229235)（外科纪事外科年鉴IF=7.6）目的：早期诊断非血管阻塞性肠系膜缺血并研究前列地尔的疗效。方法：PGE1 was administered intravenously at a dose of 0.01to 0.03 g/kg per min结论：MDCT能早期诊断NOMI，早期应用前列地尔能提高NOMI的存活率NOMI患者年事已高，疾病的病人更可能发生在ICU和CCU的心血管手术后和透析。可诱发症状，腹痛，恶心，呕吐，肠梗阻，但其特征的早期症状和实验室检测结果目前还不清楚。,日本 东京三菱医院外科部,文献12 NOMI,Lipo-PGE1对肠道缺血再灌注微循环障碍的干预作用南京医科大学学报结论：凯时干预能明显改善肠道淤血再灌注后微循环血流状况，减轻肠道组织损伤。脂微球前列腺素E1治疗缺血性结肠炎的研究中华老年多器官疾病杂志2008年2月第7卷第1期结论：LipoPGEl对IC（缺血性结肠炎）有较好的治疗效果，可以减轻结肠损伤。治疗机制可能主要与抑制血栓形成、改善组织微循环、减轻炎症反应及氧自由基的产生有关。,文献 13,PGE1 Administration Following Orthotopic Liver Transplantation A Randomized Prospective Multicenter Trial前列地尔应用于原位肝移植患者的意义GASTROENTEROLOGY 1996;111:710715（胃肠肝病学类别按影响因子第一 IF=12.8）,Departments of Surgery and Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Departments of Surgery and Pharmacy, Medical University of South Carolina, Charleston, South Carolina; Departments of Surgery and Pharmacy, University of Virginia Health Sciences Center, Charlottesville, Virginia,118 (58 PGE1) patients were randomized to receive either PGE1 or crystalloid placebo intravenously after allograft revascularization.PGE1: 0.25ug-1kg-1h-1 for patients receiving PGE1, for a total of 7 days.,Results,(A) Mean serum creatinine（mg/dl),(B) Mean BUN levels（mg/dl),(C)Mean serum ALT(UL/L),C,Post-operative days 17 in patients receiving PGE1 or crystalloid placebo infusion (*P0.05, *P0.01). Control; PGE1 .,Conclusions,PGE1 infusion was associated with improved early renal function（Mean peak creatinine level of 1.4+2.0 with PGE1 and 2.0+1.0 with placebo; P 0.001）,Severe renal dysfunction occurred more frequently in the placebo group(26.7%) than in the PGE1 group (13.8%;P0.65),ICU stay was shorter in patients treated with PGE1 (4.0+3.6days) compared with controls (10.5+17.1 days) (P0.01).,PGE1 administration