Research progress of clinical application of Zhibitai capsule / 中国基层医药

Dyslipidemia is the pathological basis of the occurrence and development of atherosclerosis. It is a major independent risk factor for hypertension, coronary heart disease and cerebrovascular disease. Regulating blood lipid level plays an important role in decreasing the incidence of cardio-cerebrovascular disease. Zhibitai capsule, a lipid-regulating Chinese medicine, has the similar effect to statins. We searched animal experiment studies, clinical trials and reviews in China National Knowledge Infrastructure to analyze the application value and advantages of Zhibitai capsule.

Effects of SLCO1B1 521 T>C and APOE gene polymorphisms on lipid-lowering efficacy and adverse reactions of atorvastatin / 药学实践杂志

Objective To study the effect of SLCO1B1 521 T>C and APOE gene polymorphisms on the clinical efficacy and safety of atorvastatin in ischemic stroke patients with dyslipidemia. Methods 210 cases of ischemic stroke with dyslipidemia were enrolled from April 2018 to December 2018 to determine SLCO1B1 521 T>C and APOE gene polymorphisms. Patients received atorvastatin 20 mg/d orally. TC, TG, HDL-C, LDL-C levels were measured to evaluate the efficacy 3 months pre-and post- treatment. TBil, ALT, AST, CK levels were assayed with following up adverse reactions to evaluate safety. Results SLCO1B1 521 T>C genotype distribution was TT79.05%, TC19.05%, CC1.90%. E2, E3, E4 allele frequencies of APOE genes were 14.28%, 67.62%, 18.10%. Each genotype conforms to the law of Hardy-Weinberg balance. After three months of medication, there were significant differences in TC, TG, LDL-C, HDL-C changes in patients with different APOE genotypes. No obvious abnormality was found in safety index. The incidence of myalgia in SLCO1B1521 T>C mutant group was significantly higher than that in the wild group (P<0.01). Conclusion Lipid regulation of atorvastatin was affected by APOE gene polymorphism. SLCO1B1521 T>C may be associated with myalgia, the adverse reaction of atorvastatin. The detection of SLCO1B1 and APOE genotyping is helpful for individualized treatment of blood lipids and provides basis for rational use of statins in patients for drug therapy management.

O uso da pílula anticoncepcional e as alterações das principais vias metabólicas / The use of contraceptive pill and alterations of main metabolic pathways

As pílulas anticoncepcionais são esteroides que visam impedir a gravidez indesejada e regular distúrbios menstruais. Acessíveis em grande variedade no mercado e no SUS, são o método contraceptivo mais aceito pelas mulheres, entretanto trazem diversos efeitos colaterais. O objetivo deste trabalho foi analisar como a pílula anticoncepcional pode alterar as principais vias metabólicas femininas. Trata-se de uma revisão bibliográfica nas bases de dados SciELO, BVS e PubMed, com foco nas correlações entre o uso da pílula anticoncepcional e as alterações metabólicas. Os anticoncepcionais orais atuam na inibição da biossíntese de androgênios e estimulação da SHBG, o que reduz o efeito anabólico proteico. Também promovem o acréscimo dos níveis de LDL-colesterol, colesterol total, PCR-us e dímero D, e alterações na sensibilidade da insulina, no metabolismo do zinco e na hemostasia. Apesar de existirem recomendações que preconizam o uso de outros métodos contraceptivos e estudos que demonstram a satisfação feminina ao trocar os anticoncepcionais orais pelos LARCs, a pílula ainda é a mais utilizada pelas mulheres.(AU)

Contraceptive pills are steroids that prevent unwanted pregnancy and regular menstrual disorders. Accessible in a great variety in market and SUS, they are the contraceptive method most accepted by women, however, they bring several side effects. The objective of this study was analyze how the contraceptive pill can alter the main female metabolic pathways. This is a literature review in the SciELO, BVS and PubMed databases, focusing on the correlations between the use of contraceptive pill and metabolic alterations. Oral contraceptives act to inhibit androgen biosynthesis and stimulate SHBG, which reduces the protein anabolic effect. They also bring about high levels of LDL cholesterol, total cholesterol, CRP, D-dimer, changes in insulin, absence of zinc metabolism and hemostasis. Although there are recommendations that recommend the use of other contraceptive methods and studies that demonstrate the satisfaction of women in exchanging oral contraceptives with LARCs, the pill is still the most used by women.(AU)

Effect and mechanism of Guanxin-Shutongcapsule in the treatment of arterial elasticity on the patients with hypertension / 国际中医中药杂志

Objective To observe the effect ofGuanxin-Shutongcapsule in the treatment of arterial elasticity on patients with hypertension.Methods The hypertension patients who met the inclusion criteria were divided into treatment group (50 cases) and control group (52 cases). The control group was treated with antihypertensive drugs to control blood pressure within the normal range. The treatment group was treated withGuanxin-Shutongcapsule on the basis of the control group. All were given 8 weeks treatment. The main artery elastic parameters were meansured by the carotid-femoral pulse wave velocity (C-FPWV) and cervical-dorsal arterial pulse wave velocity (C-DPWV). The immune turbidimetric method was employed to enhance for the determination of high sensitive C reactive protein (hs-CRP); and radioimmunoassay was used to assess the serum IL-6, TNF-a, triglyceride (TG) and total cholesterol (TC). The blood pressure was monitored during the treatment.Results After the treatment, the level of hs-CRP (2.83 ± 1.35 mg/Lvs. 3.65 ± 1.38 mg/L,t=6.357), TNF-α (0.16 ± 0.08 mg/Lvs. 0.28 ± 0.07 mg/L,t=18.213), C-FPWV (13.85 ± 1.86 m/svs. 15.34 ± 1.78 m/s,t=6.524), C-DPWV (11.98 ± 1.45 m/svs. 12.87 ± 1.48 m/s,t=7.152) in treatment group was significantly lower than those in the control group (P<0.01).ConclusionGuanxin-Shutong capsule by inhibiting systemic inflammation, reducing and reversing atherosclerosis, and improving the arterial elasticity and blood pressure.

Analysis of the Utilization of Lipid-regulating Agents from 74 Hospitals in 6 Areas of China in 2013 / 中国药房

OBJECTIVE:To provide reference for drug procurement and supply and rational use of lipid-regulating agents. METHODS:The epidemiological investigation was carried out among 159 506 cases from 74 hospitals in Beijing,Chengdu, Guangzhou,Hangzhou,Shanghai and Tianjin in 2013. The utilization of lipid-regulating agents was analyzed statistically in re-spects of purchase value,DDDs,DDC,actual average daily dose and sort ratio. RESULTS:The prevalence rate of hyperlipidemia was relatively high,accounting for 29.56% and showing a tendency of regional distribution and young age in all regions. The pa-tients with hypertension,diabetes and coronary heart disease had a higher incidence to suffer from hyperlipidemia. The use of atorv-astatin was in the first place,but it also had a higher DDC;while rosuvastatin hasd the advantage over aorvastatin in drug market. Simvastatin had a lower DDC and was more suitable for the patients with low income. The doses of lipid-regulating agents in other regions were lower than DDD except for those in Beijing and Tianjin. CONCLUSIONS:Statins dominate the lipid-regulating agents market. But new lipid-regulating agents and drug combination provide a new choice for clinical treatment.

Efeito do composto natural Yo Jyo Hen Shi Ko (YHK) no ciclo de replicação do vírus da hepatite C (VHC) / Effects of the natural compound Yo Jyo Hen Shi Ko (YHK) on the replication cycle of the hepatitis C virus

Estima-se que 170 milhões de pessoas no mundo estejam infectadas com o vírus da hepatite C (VHC), o que está altamente relacionado à ocorrência de hepatite crônica e carcinoma hepatocelular. A prevalência de esteatose hepática em doentes com hepatite C crônica é muito maior do que na população geral variando entre 40 a 75%. A associação entre a infecção pelo VHC e esteatose hepática é multifatorial. Duas formas de esteatose hepática são encontradas em pacientes com hepatite C crônica: esteatose metabólica (fatores de risco) e citopática relacionada ao genótipo 3a. Os lipídios são essenciais para o ciclo de replicação do VHC, eles podem exercer seu efeito em diferentes níveis como: grupos prostéticos em proteínas virais e/ou cofatores celulares na replicação de VHC, componentes especializados na estrutura do VHC onde ocorre a replicação ou como constituinte das partículas lipovirais. Trabalhos experimentais realizados anteriormente por nosso grupo relataram que a administração do composto natural Yo Jyo Hen Shi Ko (YHK) promove a inibição do desenvolvimento da esteatose, redução dos marcadores de estresse oxidativo, menor escore de inflamação, melhora nas concentrações de aminotransferases e diminuição da gordura visceral em um modelo animal de esteato-hepatite não alcoólica. A terapia padrão da hepatite C consiste em uma combinação de interferon peguilado alfa (PEG-IFN-alfa) que estimula o sistema imunológico do hospedeiro para combater a infecção e o composto antiviral ribavirina. Atualmente foram aprovados pelas agências de saúde os inibidores de protease Boceprevir, Telaprevir, Daclatasvir e Simeprevir. No entanto, sua eficiência varia entre os genótipos e as constantes mutações do vírus podem levar a resistência. A falta de uma vacina ou uma terapia definitiva faz com que diversos compostos com diferentes mecanismos de ação sejam testados como possíveis alternativas de tratamento. Tendo em vista a capacidade do YHK de reduzir a esteatose e a importância...

Worldwide is estimated that nearly 170 million people are infected with hepatitis C virus (HCV), highly correlated with the occurrence of chronic hepatitis and hepatocellular carcinoma. Hepatitis C patients present higher prevalence of steatosis when compared with the general population, ranging between 40% and 75%. There are two forms of steatosis in HCV infected patients: metabolic steatosis (risk factors) and cytopathic associated with genotype 3. Lipids are essential for the HCV replication cycle. It acts on different functions: as prosthetic groups into viral proteins and / or cellular cofactors in the HCV replication, as specific HCV components or as a constituent of lipovirals particles. Our group previously reported that the administration of the natural compound Yo Jyo Hen Shi Ko (YHK) inhibits steatosis development, decreases markers of oxidative stress and inflammation, improves aminotransferases concentration and decreases the visceral fat. Standard therapy for hepatitis C is a combination of pegylated interferon alpha (PEG-IFN-alfa), stimulating the host immune system to fight infection and the antiviral compound named ribavirin. Nowadays, Telaprevir, Boceprevir, Sofosbovir and Simeprevir are approved as new anti-HCV drugs; they act as protease inhibitors. Its efficiency, however, varies between genotypes, and the constant mutations of the virus can lead to resistance. The lack of vaccines, or a definitive therapy, stimulates the research of new compounds and alternative treatments. In this study, we evaluated the effect of YHK in HCV replication cycle due to the effect of YHK and the importance of lipid metabolism for HCV. For this purpose we used cell culture techniques allowing the study of different stages of HCV replication cycle: entry (HCVpp), replication - replicons JFH1 NS3-5B and Con1, also replication and infection-JC1-Fluc. We also used active compounds of its ingredients: Panax pseudo ginseng - Notoginsenoside R1...

Efeitos da atorvastatina e do polimorfismo T-786C do gene eNOS sobre parâmetros do metabolismo lipídico plasmático / Effects of atorvastatin and T-786C polymorphism of eNOS gene on plasma metabolic lipid parameters

FUNDAMENTO: A atividade do óxido nítrico sintase endotelial (eNOS) pode ser modulada pelo colesterol da lipoproteína de alta densidade (HDL-C), estatinas ou polimorfismos, como o T-786C de eNOS. OBJETIVO: Este estudo teve como objetivo avaliar se o polimorfismo T-786C está associado a alterações nos efeitos da atorvastatina no perfil lipídico, nas concentrações de metabólitos de óxido nítrico (NO) e da proteína C reativa de alta sensibilidade (PCR-as). MÉTODOS: Trinta voluntários do sexo masculino, assintomáticos, com idade entre 18-56 anos foram genotipados e classificados de acordo com a ausência (TT, n = 15) ou presença (CC, n = 15) do polimorfismo. Eles foram selecionados aleatoriamente para a utilização de placebo e atorvastatina (10 mg/dia por 14 dias). Após cada tratamento foram medidos lípides, lipoproteínas, frações HDL2 e HDL3, atividade da proteína de transferência de colesteril éster (CETP), metabólitos de NO e PCR-as. RESULTADOS: As comparações entre genótipos após a administração de placebo mostraram aumento da atividade da CETP polimorfismo-dependente (TT, 12 ± 7; CC, 22 ± 12, p < 0,05). As análises da interação entre os tratamentos indicaram que a atorvastatina tem efeito sobre colesterol, LDL, nitrito e razões lípides/proteínas (HDL2 e HDL3) (p < 0,001) em ambos os genótipos. É interessante notar as interações genótipo/droga sobre a CETP (p < 0,07) e a lipoproteína (a) [Lp(a)] (p < 0,056), levando a uma diminuição limítrofe da CETP, embora sem afetar a Lp(a). A PRC-as não mostrou alterações. CONCLUSÃO: Os resultados sugerem que o tratamento com estatinas pode ser relevante para a prevenção primária da aterosclerose em pacientes com o polimorfismo T-786C do eNOS, considerando os efeitos no metabolismo lipídico.

BACKGROUND: Endothelial nitric oxide synthase (eNOS) activity may be modulated by high-density lipoprotein cholesterol (HDL-C), statins or polymorphisms, such as the T-786C of eNOS. OBJECTIVE: This study aimed at evaluating if the T-786C polymorphism is associated with changes of atorvastatin effects on the lipid profile, on the concentrations of metabolites of nitric oxide (NO) and of high sensitivity C-reactive protein (hsCRP). METHODS: Thirty male volunteers, asymptomatic, aged between 18 and 56 years were genotyped and classified according to absence (TT, n = 15) or presence (CC, n = 15) of the polymorphism. They were randomly selected for the use of placebo or atorvastatin (10 mg/day/14 days). After each treatment lipids, lipoproteins, HDL2 and HDL3 composition, cholesteryl ester transfer protein (CETP) activity, metabolites of NO and hsCRP were evaluated. RESULTS: The comparisons between genotypes after placebo showed an increase in CETP activity in a polymorphism-dependent way (TT, 12±7; CC, 22±12; p < 0.05). The interaction analyses between treatments indicated that atorvastatin has an effect on cholesterol, LDL, nitrite and lipid-protein ratios (HDL2 and HDL3) (p < 0.001) in both genotypes. Interestingly, we observed genotype/drug interactions on CETP (p < 0.07) and lipoprotein (a) (Lp(a)) (p < 0.056), leading to a borderline decrease in CETP, but with no effect on Lp(a). HsCRP showed no alteration. CONCLUSION: These results suggest that statin treatment may be relevant for primary prevention of atherosclerosis in patients with the T-786C polymorphism of eNOS, considering the effects on lipid metabolism.

Efficacy and safety of simvastatin and Xuezhikang in newly diagnosed elderly type 2 diabetic patients with dyslipidemia / 中华老年医学杂志

Objective To observe the incidence and awareness of dyslipidemia in newly diagnosed elderly type 2 diabetic patients,and to determine the efficacy and safety of simvastatin and Xuezhikang in the treatment of dyslipidemia.Methods Totally 255 newly diagnosed type 2 diabetic patients aged 60 to 75 years in CDCPS research were included and the incidence of dyslipidemia were retrospectively analyzed.Patients were divided into 3 groups:the group 1 was given simvastatin (20 mg/d); the group 2 was given Xuezhikang (0.6～ 1.2 g/d); the group 3 was given no lipid-lowering drugs.All the three groups were given lifestyle intervention and blood pressure and blood sugar control.All patients were followed up monthly and TG,TC,LDL-C,BUN,ALT and creatinine were examined at 7th,14th,and 20th months.Results The incidence of dyslipidemia and the rate of awareness in the study cohort was 62％ and 55.7％.Hypertriglyceridemia was the most common type of dyslipidemia (29％).Among 88 patients with dyslipidemia,25 (28.4％) patients had been treated with lipid-lowering drugs before our study,in whom,8(32％) patients had normal serum lipid levels and only 3 (12％)patients reached to the control standards.20 months after the treatment,the decrement scales of TG,TC and LDL-C were 1.8％,10.5 ％ and 20 ％ respectively in group 1;5.5 ％,15.0％ and 15.7％ respectively in group 2;2.7％,8.7％ and 4.5％ respectively in group 3.The long-term lifestyle intervention and blood pressure and blood sugar control reduced serum lipid to some degree.In the patients with dyslipidemia,lipid-lowering drugs had a better effect on serum lipid reduction than did the lifestyle intervention (P=0.0047,0.0433).There was no significant difference between simvastatin and Xuezhikang.The function changes of liver and kidney had no difference before and after drug intervention (P＞0.05).Conclusions Serum lipid should be monitored and early medicine intervention should be taken in newly diagnosed elderly type 2 diabetic patients.Medicine intervention has a better effect on serum lipid reduction than lifestyle intervention,and there are no significant differences in efficacy and safety between simvastatin and Xuezhikang.