单克隆抗体体外大容量骨髓净化白血病的研究

应用补体介导细胞毒法体外消除２例白血病骨髓中残存瘤细胞，并作自身骨髓移植。用国产ＣＤ７单抗（ＬＮ６７－８及ＬＳ９３－２，ＩｇＧ２ｂ）首次净化１例Ｔ－ＡＬＬ骨髓及ＣＤ１０单抗（５５，ＩｇＧ２ａ）净化１例ＣＡＬＬＡ＋－ＡＬＬ。靶细胞清除率均达３个对数级，骨髓ＣＦＵ－ＧＭ回收率分别为５７．６％～７５．８％及５１．７％～７２．３％。Ｔ－ＡＬＬ病人移植后２６天获造血重建。现已完全缓解３年，首次证实国产单抗ＬＮ６７－８及ＬＳ９３－２净化骨髓有效、安全。     

血吸虫病人吡喹酮治疗后血清虫卵抗体十年追踪…

本文应用酶联免疫吸附试验（ＥＬＩＳＡ），对１２２例吡喹酮治疗后血吸虫病患者的血清虫卵抗体水平进行了１０年追踪观察。结果表明，血清虫卵抗体的效价逐年递减，治疗前ＥＬＩＳＡ反应滴度≥１：８００，占８７．７％，治疗后１年占２１．２％，２年占１％，２年后均〈１：８００。ＥＬＩＳＡ转阴率在治后１－５年及第１０年分别为５３．２％，７９．８％，８２．３％，９５．７％，９５．９％及９７％，治后４年ＥＬＩＳＡ阳性率     

14962 例急性心肌梗塞患者临床特征──中国心脏研究-Ⅰ 专题报告之五

目的分析１４９６２例急性心肌梗死（ＡＭＩ）患者的临床特征。方法用ＳＡＳ６０４软件统计分析１４９６２例ＡＭＩ患者的４周总病死率和并发症。结果１４９６２例ＡＭＩ患者临床特征为：男性病人７３．９％；平均年龄６１．２±１０．７岁；有心肌梗死、高血压、糖尿病病史者分别占１２．２％，４０．４％，９．４％；基础血压１２６．６±２４．３／８１．３±１４．６ｍｍＨｇ；基础心率７９．３±１８．８ｍｉｎ－１。试验４周期间主要并发症心力衰竭为１７．９％，休克４．６％，心室颤动３．２％，其他类型的心跳骤停２．３％，Ⅱ～Ⅲ度房室传导阻滞５．２％，室性心动过速３．６％，梗塞扩展４．８％，脑卒中１．２％，心脏破裂０．５％。总病死率（２８ｄ）为９．４３％，死于泵衰竭为３．２５％，死于心律失常为４．５６％。     

初治菌阳病例短程化疗对武汉市疫情控制的作用

本文总结武汉城区１９８７～１９９０年新登１１５４例初治菌阳肺结核采用２ＨＲＳＺ／４ＨＲ、２ＨＲＳＺ／４Ｈ＿２Ｒ＿２Ｚ＿２短程化疗方案效果。疗程完成率、规则用药率分别为９９．１％及９８．４％，失访率仅１．４％；痰菌阴转率、治愈率为９６．３％、９５．８％。随着实施短化比例的增高，使菌阳治愈速度加快，Ｐ／Ｉ值由１．１缩小至０．９７，１９８４、１９８９年流行病学断面调查，涂阳患病率以每年８％的速度递降。     

我国包虫病流行现况

至１９９２年，据不完全统计近４０年我国１４０家医院的囊型包虫病手术患者，总计在２７７１６例，地理分布较广泛，主要见于西部和北部的新疆，甘肃，青海，宁夏，陕西，四川，西藏和内蒙古等８省区，另有１２省为散在分布或仅见个案报告，根据６省流行区２６个组人群囊型包虫病的普查，ＩＨＡ和ＥＬＩＳＡ阳性率分别为０．４６％～１１．７％，和１．２％～３２．４％，感染程度随地区的不同而异，Ｂ型超声检出囊虫百分率为０．６     

净化及非净化自体骨髓移植治疗白血病39例临床研究

报告自体骨髓移植治疗白血病３９例，其中非净化自体骨髓移植（ＡＢＭＴ）１４例，净化自体骨髓移植（ＰＡＢＭＴ）２５例。中位年龄２８岁（１０～４３岁）。ＡＭＬ２７例，ＡＬＬ１０例，ＣＭＬ２例。ＣＲ１３１例，ＣＲ２７例，ＮＲ１例。ＣＲ至移植时间中位数６．７个月（２～１９个月）。预处理方案：ＴＢＩ加Ａｒａ－ｃ、ＤＮＲ或ＶＰ１６。ＡＢＭＴ组及ＰＡＢＭＴ组３年无病生存（ＤＦＳ）率分别为６８．３２％及６７．５７％，复发率为３０．７６％及２６．８０％。但ＰＡＢＭＴ组ＡＭＬ患者３年ＤＦＳ率为８２．３５％及ＣＲ２期移７５％３年ＤＦＳ率为７５％，明显高于ＣＲ。期移植未净化者５０％。化疗组３年ＤＦＳ率为７．３８％及复发率７６．４％，两移植组疗效优于化疗组。     

杭州市新生儿脐带血TSH水平分析

用免疫放射法（ＩＲＭＡ）测定杭州市区１４２析新生儿滤纸血ＴＳＨ及４５６例８－１０岁儿意志水碘测定分析。杭州市区新生儿ＴＳＨ值≥５ｍＩＵ／Ｌ者占５２．３％，８－１０岁儿童尿碘值大于１００μｇ／Ｌ占３２．２％，小于１００μｇ／Ｌ者占６８．８％，８－１０岁在校学生甲状腺肿大率１０．０１％－１９．４７％（触诊法）１６．４５％（Ｂ超法）；居民户食用盐碘含量为０．１２ｍｇ／ｋｇ。调查表明杭州市区人群缺碘存在。     

获得性免疫缺陷综合征患者肺部感染分析

获得性免疫缺陷综合征（ＡＩＤＳ）常不可避免发生肺部感染,为了解其特点,特将近些年来确诊的１０例ＡＩＤＳ的肺部感染作回顾性临床分析。１．一般资料：１９９１年２月～２０００年５月经作血清学抗艾滋病抗体阳性而确诊的ＡＩＤＳ１０例,其中男８例,女２例,年龄３１－７０岁（平均４３．８岁）,详见表１。２．肺部发病情况：（１）症状表现：全部病例均有发热、咳嗽、气促等呼吸道症状,其中３例发生呼吸衰竭（２例死亡）,以肺部感染为首发表现者９例（９／１０）,（２）胸部Ｘ线（或ＣＴ）表现：全部病例均有渗出、浸润、空洞、…     

G—CSF配合大剂量CTX和VCR动员自体外周血干细胞的研究

本研究对１２例拟行ＡＰＢＳＣＴ的患者予ＶＣＲ１－２ｍｇ／ｍ２，体表面静注及ＣＴＸ７ｇ／＾２体表面积静滴，５－７天后予Ｇ－ＣＳＦ１００μｇ／ｍ＾２体表面积静注５－７天，白细胞升至３．０×１０＾９／Ｌ以上时，用ＣＳ３０００血细胞分离机单次收集单个核细胞ＭＮＣ〉２．８×１０＾８／ｋｇ，ＣＤ＾＋３４〉．６×１０＾６／ｋｇ，ＣＦＵ－ＧＭ〉３．９×１－０＾４／ｋｇ，ＡＰＢＳＣＴ后，全部患者于＋５天－＋１０天白     

全国肺结核病例登记情况（1982—1993）

本文报告１９８２年以来我国活动性与菌阳病例新登记率，平均每年分别以６．６％和１１．６％的递升速度由１３．３／１０万和２．７／１０万上升至１９９３年的２６．７／１０万和８．９／１０万；登记率由４８．８／１０万经１９８８年５１．４％／１０万的峰值后降至３０．８／１０万，菌阳登记率由５．８／１０万上升至９．３／１０万；新发菌阳比例由２０．１％上升至３３．５％。１９９３年与１９８７年相比，新发初治菌阳病例     

A multicenter cross-sectional study on the health related quality of life of patients with rheumatoid arthritis using a revised Japanese version of the arthritis impact measurement scales version 2 (AIMS 2), focusing on the medical care costs and their associative factors]

OBJECTIVE: To survey the actual conditions of medical care costs incurred by Japanese patients with rheumatoid arthritis, and to investigate impacts of health status, demographic and socioeconomic factors, clinical and laboratory measures, and medications on disease costs. METHODS: Self-reported health status questionnaires of the revised Japanese version of AIMS 2, and reports on out-of-pocket medical care costs were collected from 1471 patients with classical and definite rheumatoid arthritis recruited through the arthritis study group of Ministry of Public Health and Welfare consisting of eleven arthritis centers across the country during three months from September, 1994. Impacts of health status and other demographic and clinical factors on medical care costs were statistically analyzed by using chi-square tests for categorical variables and Spearman's rank correlation analysis for numerical variables. RESULTS: 1. Averaged out-of-pocket medical care costs for RA patients was estimated at yen 25,225 ($253.5) per person-month in 1994, in which direct medical care costs accounted for 53.9% and indirect medical care costs accounted for 46.1% of the total. Averaged substantial direct medical care costs including the costs covered by the public health insurance in addition to out-of-pocket costs was estimated at yen 512,000 ($5,140) per person-year based on the averaged 11.8% self-pay rate of the public health insurance in 1994. 2. The distribution curve of the total out-of-pocket medical care costs was highly skewed. Averaged total medical care costs in the 90th, 95th, and 100th percentiles were 4.5, 8.1, and 48 times as large as those in the median percentile, respectively. 3. Out-of-pocket direct medical care costs totaled in the top 1 and 5 percentiles reached 26.6%, and 57.6% of those in whole patients, respectively. 4. Variables most strongly related to the total out-of-pocket medical care costs were work disability in AIMS health status scales, followed by physical disability, rate of functional decline, pain, affect, daily dose of oral prednisolone, global assessment by physician, joint counts, blood levels of CRP, ESR, grip strength, blood concentrations of hemoglobin, age, Steinbrocker's class, sex, and medications, in this order. 5. There was a trend of increase in number of cases of male, middle aged, with lower levels of formal education and annual income, longer disease duration of 20 years or more, and single (male) or separated (female) in marital status, as the total out-of-pocket medical care costs increased. 6. The average rate of missed days due to illness to whole working days of RA patients was estimated at 21.9%. With increase in the rate of missed days, the annual income of RA patients decreased, indicating that the lower annual income of RA patents possibly resulted from their work disabilities. Based on the rate of missed days, the average earning loss due to the illness in RA patients was estimated approximately at yen 650,000 ($6,540) perperson-year, which was equivalent to 1.3 times the average direct medical care costs for RA per person-year. CONCLUSION: The costs of RA were strongly related to work disability and other health status as represented by AIMS-HRQOL scores. A small number of patents severely disabled shared a disproportionately large part of medical care costs. To reduce the costs, the measures to prevent the development of disability are most important.     

Direct medical costs for patients with type 2 diabetes in Sweden

OBJECTIVES: To estimate the total direct medical costs to society for patients with type 2 diabetes in Sweden and to investigate how different factors, for example diabetic late complications, affect costs. DESIGN: Cross-sectional data regarding health care utilization, clinical characteristics and quality of life, were collected at a single time-point. Data on resource use cover the 6-month period prior to this time point. SETTING: Patient recruitment and data collection were performed in nine primary care centres in three main regions in Sweden. SUBJECTS: Only patients with an age at diabetes diagnosis >/= 30 years (type 2 diabetes) were included (n = 777). RESULTS: The total annual direct medical costs for the Swedish diabetes type 2 population were estimated at about 7 billion SEK (Swedish Kronor) in 1998 prices, which is about 6% of the total health care expenditures and more than four times higher than the former Swedish estimate obtained when using diabetes as main diagnosis for calculating costs. The annual per patient cost was about 25 000 SEK. The largest share of this cost was hospital inpatient care. Costs increased with diabetes duration and were higher for patients treated with insulin compared to those treated with oral hypoglycaemic drugs or with life style modification only. Patients with both macro- and microvascular complications had more than three times higher costs compared with patients without such complications. CONCLUSIONS: Type 2 diabetes is a serious and expensive disease and the key to reducing costs seems to be intensive management and control in order to prevent and delay the associated late complications.     

缺血性卒中二级预防的药物依从性调查

目的评估缺血性卒中患者抗血栓药物和危险因素用药的依从性、停药和药物变更原因及影响因素。方法通过电话随访获得卒中患者出院后1年时用药等方面的情况。结果2002年10月至2003年4月北京天坛医院神经内科缺血性卒中患者412例,其中374例患者进入调查,其中完成电话随访者296例(79.1%)。患者抗血栓药物的依从性为35.1%;伴有高血压、糖尿病和高血脂患者1年后仍接受治疗者的比例分别为77.9%、80.2%和48.4%。医保或公费(OR2.117,95%CI1.174～3.821)可促进患者对药物的依从,非阿司匹林抗血栓药物(OR0.352,95%CI0.153～0.812)和较低的日常生活能力指数(62.5±13.3)(MannWhitneyU检验,P=0.000)可明显降低卒中患者的药物依从性。结论卒中二级预防中药物依从性差主要表现为停药和剂量减小。支付方式、收入水平、抗血栓药物的种类以及患者的个人生活能力等可影响卒中患者的药物依从性。     

The cost burden of diabetes mellitus: the evidence from Germany—the CoDiM Study

Aims/hypothesis The aim of this study was to identify the health care costs of diabetic patients in Germany in 2001, focusing on the influence of age, sex, and type of treatment.Subjects and methods Annual direct costs of medical care and indirect costs of inability to work and early retirement in diabetic subjects were compared with costs of age- and sex-matched non-diabetic control subjects. The analysis was based on routine health care data from a random sample (18.75%) taken from a database of 1.9 million insured persons. Incremental differences in medical and national expenditure between subjects with and without diabetes were calculated.Results Annual direct mean costs per diabetic patient were €5,262, and indirect costs were €5,019. In the control group, mean direct and indirect costs were €2,755 and €3,691, respectively. Analysis of cost components revealed that the high costs associated with the care of diabetic patients could be largely attributed to inpatient care and overall medication costs. Hypoglycaemic drugs amounted to only one-quarter of the medication costs. The total health care costs were correlated with the type of treatment. Direct excess costs increased with increasing age in insulin-treated patients, but were unaffected by age in patients receiving other types of treatment.Conclusions/interpretation The Costs of Diabetes Mellitus (CoDiM) study is the first comprehensive study to provide estimates of costs associated with diabetes care in Germany. Direct costs of diabetic patients account for 14.2% of total health care costs, which includes the proportion that specifically accounts for diabetes-related costs (6.8%).Electronic Supplementary Material Supplementary material is available for this article at     

Direct costs of emergency medical care: a diagnosis-based case-mix classification system

STUDY OBJECTIVE: To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. DESIGN: Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. SETTING: Three community hospital EDs in Los Angeles County during selected times in 1984. MEASUREMENTS AND MAIN RESULTS: Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients versus 80% of ancillary service costs and 51% of total direct costs for admitted patients. CONCLUSION: We have developed a diagnosis-based case mix classification system for ED patient visits based on direct costs of care designed for an outpatient setting which, unlike diagnosis-related groups, includes the measurement of time-based cost for physician and nonphysician services. This classification system helps to define direct costs of hospital and physician emergency services by type of patient.     

Assessing use of primary health care services by very low-income adults in a managed care program

OBJECTIVE: To assess the effect of providing free health care services to low-income adults. METHODS: We measured access to primary care services by enrollees with 4 chronic medical conditions in the General Relief Health Care Program (GRHCP), a program designed for adults receiving General Relief (GR). Implemented by the Los Angeles County Health Department in October 1995, the GRHCP is composed of private and public health care facilities. As adults registered for GR, they were asked to complete a baseline health survey, were enrolled in the GRHCP, and assigned a health care provider. A total of 8520 surveys were completed between September and November 1996 (98% response rate). The analyses of this article are limited to individuals (N = 2164) who reported a history of hypertension, diabetes mellitus, a nonresolving cough, or substance dependence. We reviewed medical records to determine whether new GR recipients had visited their designated GRHCP provider within 4 months of enrollment and used multivariate logistic regression to assess the effect of individual patient factors on the use of free health care. RESULTS: A total of 17% of individuals visited their assigned GRHCP provider within 4 months of enrollment. In multivariate analysis, patients were more likely to have made a visit if they were younger than 50 years, were female, were Asian/Pacific Islander, reported needing to see a physician, or had seen a physician within 12 months. CONCLUSIONS: It is not sufficient to merely supply the name and address of a health care provider to this population. More aggressive efforts should be attempted to increase utilization of services for patients with medical conditions responsive to ambulatory care.     

The use of alternative medical therapies in patients with systemic lupus erythematosus. Trination Study Group

OBJECTIVE: As part of an ongoing study of health resource utilization and diminished productivity in patients with systemic lupus erythematosus (SLE), the use of alternative medical therapies was assessed. METHODS: A cohort of 707 patients with SLE from 3 countries completed questionnaires on demographics, social support, health status (using the Short Form 36 health survey), satisfaction with health care, health resource utilization (conventional resources and alternative therapies), and time losses in labor market and non-labor market activities. Annual direct and indirect costs (1997 Canadian dollars) were calculated and compared for users and nonusers of alternative medical therapies. RESULTS: Among the 707 patients, 352 (49.8%) were found to use alternative therapies and at similar rates across Canada, the United States, and the United Kingdom. Users were younger and better educated than nonusers, exhibited poorer levels of self-rated health status and satisfaction with medical care, and had minimal to no objective evidence of worse disease (according to the revised Systemic Lupus Activity Measure instrument). The mean of log direct medical costs for conventional resources was higher for users of select alternative therapies compared with nonusers. In a logistic regression, neither the number of alternative therapies used nor the individual therapy increased the probability of incurring indirect costs. CONCLUSION: The use of alternative medical therapies is common in patients with SLE. Users of many alternative medical therapies accrue greater conventional medical costs compared with nonusers. The use of alternative medical therapy may be a marker for care-seeking behavior associated with higher consumption of conventional medical resources in the absence of demonstrable additional morbidity and should be considered in future cost analyses of patients with SLE.     

Costs of Acid-Related Disorders to a Health Maintenance Organization

BACKGROUND: Little is known about the economic impact of the acid-related disorders (ARDs), which include dyspepsia, gastritis, gastroesophageal reflux disease (GERD), and peptic ulcer disease (PUD), in managed care patient populations.OBJECTIVES: To describe the prevalence of medically attended ARDs, and their direct medical costs from the perspective of a large health maintenance organization (HMO).METHODS: A total of 1,550 ARDs subjects (age ≥18 years), were randomly sampled from outpatient diagnosis and pharmacy databases of the Kaiser Permanente Medical Care Program of Northern California and verified by chart review. Five age- and gender-matched controls were identified per subject. One-year prevalence, excess annual costs, and initial 6-month costs for incident cases were estimated using the HMO cost accounting system.RESULTS: Total ARDs prevalence (5.8%) increases with advancing age. GERD is the most common ARD (2.9% overall prevalence). Annual per person attributable costs were $1,183, $471, and $431 respectively for PUD, GERD, and gastritis/dyspepsia. Excess inpatient costs for PUD explain its higher costs. Outpatient costs were somewhat higher for GERD ($279) than for PUD or gastritis/dyspepsia. Pharmacy costs were relatively low for each condition, in part because many patients were treated with generic cimetidine. Total annual HMO expenditures for ARDs were $59.4 million, with 40.6%, 36.8%, and 22.6% respectively for GERD, PUD, and gastritis/dyspepsia.CONCLUSIONS: Acid-related disorders, particularly GERD and PUD, contribute substantially to the direct costs of medical care in this managed care population.     

Cost-effectiveness of losartan-based therapy in patients with hypertension and left ventricular hypertrophy: a UK-based economic evaluation of the Losartan Intervention for Endpoint reduction in hypertension (LIFE) study

The Losartan Intervention for Endpoint reduction in hypertension (LIFE) study demonstrated the clinical benefit of losartan-based therapy in hypertensive patients with left ventricular hypertrophy (LVH), mainly due to a highly significant 25% reduction in the relative risk of stroke compared with an atenolol-based regimen, for a similar reduction in blood pressure. The aim of this economic evaluation was to estimate the cost-effectiveness of losartan compared with atenolol from a UK national health system perspective. Quality-adjusted survival and direct medical costs were modelled beyond the trial using the within-trial incidence of stroke. Survival with stroke, study medication use and quality of life by stroke status were taken directly from the LIFE trial. The LIFE data were supplemented with UK data on lifetime direct medical costs of stroke and life expectancy in individuals without stroke. No additional stroke events or use of study treatment were assumed beyond the trial. Costs and benefits were discounted using current UK Treasury rates. In the base-case analysis, the reduction in stroke-related costs (by 968 sterling pound) offset 86% of the increase in study medication costs (1128 sterling pound) among losartan-treated patients. The incremental cost-effectiveness ratio (ICER) for losartan versus atenolol in hypertensive patients with LVH was 2130 sterling pound per quality-adjusted life year (QALY) gained (3195 Euro/QALY), and this increased to 11,352 sterling pound per QALY gained (16,450 Euro/QALY) when the costs of stroke beyond the first 5 years were excluded. Thus, the clinical benefit of losartan was achieved at a cost well within reported thresholds for cost-effectiveness.