原发性肝癌患者及其家族成员血清免疫抑制酸性蛋白的分析

目的　评估血清免疫抑制酸性蛋白 (IAP)与原发性肝癌 (PHC)发生的相关性。方法　应用单向免疫琼脂扩散法检测3 0例PHC患者、3 0例家族成员 (FM)和 3 0例正常健康人 (NS)血清IAP水平。结果　PHC患者血清IAP水平 (85 1± 2 12 ) μg/ml与正常健康人 (2 78± 10 4) μg/ml比较有显著差异 (P <0 0 1) ;FM组 (5 73± 2 2 8) μg/ml与NS组比较有统计学差异 (P <0 0 1)。结论　IAP水平的改变可能与PHC发生相关 ,且IAP检测可被用于PHC易患个体的筛选。     

牛磺酸对大鼠染铅所致贫血的疗效

[目的 ]探讨牛磺酸 (Tau)对大鼠染铅所致贫血的治疗作用。 [方法 ] 40只Wistar大鼠随机均分为 5组 :①空白对照组 ;②染铅组 :醋酸铅 40mg/(kg·d)连续灌胃 4周 ;③Tau治疗 1、2、3组 :与染铅组相同处理 4周后分别以 10 0、40 0、80 0mg/(kg·d)Tau灌胃 4周。实验第 8周末测定各组大鼠血红蛋白 (Hb)含量及红细胞 (RBC)数 ,并处死动物 ,颈动脉取血 ,测定血铅和血清丙二醛 (MDA)含量、超氧化物歧化酶 (SOD)水平。 [结果 ]①Tau 10 0mg/kg组和Tau 40 0mg/kg组大鼠Hb分别为 ( 13 1.98± 6.83 )g/L和 ( 13 6.2 5± 5 .97)g/L ,与染铅组大鼠Hb( 118.74± 5 .3 5 )g/L相比明显升高 ,差异有显著性(P <0 .0 1)。②Tau 10 0mg/kg、Tau 40 0mg/kg组大鼠RBC分别为 ( 4 .71± 0 .40 )× 10 12 /L和 ( 4 .89± 0 .44 )× 10 12 /L ,与染铅组大鼠RBC( 3 .5 3± 0 .19)× 10 12 /L相比明显升高 ,差异有显著性 (P <0 .0 1)。③Tau 10 0mg/kg、Tau 40 0mg/kg组大鼠血铅水平分别为 ( 2 .47± 0 .2 8) μmol/L、( 2 .3 4± 0 .48) μmol/L ,与染铅组大鼠血铅 ( 3 .5 4± 0 .75 ) μmol/L相比明显降低 ,差异有显著性 (P <0 .0 5 )。④Tau 10 0mg/kg和 40 0mg/kg组大鼠血清MDA含量分别为 ( 4 .96± 0 .5 5 )nmol/ml和 ( 4 .45     

糖尿病合并高血压对血糖和血脂及肾功能的影响

目的　探讨糖尿病合并高血压对糖代谢 ,脂代谢和肾功能的影响。方法　对住院的糖尿病患者 3 10例进行高血压组(n =15 0 )和非高血压组 (n =160 )划分 ,采集血标本并测定血糖 ,胰岛素 ,C肽 ,血脂 ,血肌酐 ,尿微量白蛋白等项目 ,进行统计分析处理。结果　高血压组较非高血压组的空腹和餐后血糖明显升高 (P <0 0 5 ,P <0 0 1) ,餐后胰岛素和空腹C肽明显低下 (均为P<0 0 1) ;除HDL外 ,脂代谢各项数据均显著升高 ;尿微量白蛋白排量分别是 ( 3 1 6± 3 3 3 ) μg/min和 ( 2 2 5± 18 5 ) μg/min ,有显著性差异 (P <0 0 1)。结论　在糖尿病和高血压的双重损害作用下 ,糖、脂代谢异常和肾功能损害明显加重     

神经元特异性烯醇化酶在颅脑损伤中的意义

目的　探讨血清神经元特异性烯醇化酶 (NSE)与颅脑损伤及其预后之间的关系。方法　用RIA法测定了 70例急性颅脑损伤患者的血清NSE含量 ,结合Glasgow昏迷和预后分级进行比较分析。结果　⑴重型 (a)、轻型 (b)颅脑损伤患者与对照组(c)的血清NSE水平分别为 ( 2 5 8± 10 8)ng/ml、( 19 6± 8 9)ng/ml和 ( 9 5± 2 8)ng/ml ,存在显著性差异 (Pa -b<0 0 5 ,Pa -c<0 0 1,Pb -c<0 0 1) ;⑵死亡植物生存组 (e)、残废组 (f)和恢复良好组 (g)的血清NSE水平分别为 3 1 3± 11 0ng/ml、2 3 0± 8 7ng/ml和 16 3±7 5ng/ml ,两两对比差异明显 (Pe-f<0 0 5 ,Pe -g<0 0 1,Pf-g<0 0 5 ) ;⑶血清NSE≥ 2 2ng/ml组和NSE <2 2ng/ml之间 ,死亡植物生存率、残废率和恢复良好率有显著性差异 ( P <0 0 5 )。结论　伤后早期血清NSE水平在一定意义上反映了脑损害的程度 ;同时在颅脑损伤的预后评估上 ,是较重要的指标之一     

不同剂量和种类基因工程乙型肝炎疫苗免疫效果研究

为探讨不同剂量和种类基因工程乙型肝炎 (乙肝 )疫苗的免疫效果 ,在北京市大兴县、顺义区抽取健康新生儿 193名 ,随机分为 3组 :Ⅰ组接种重组酵母乙肝疫苗 10 μg -5 μg -5 μg ,Ⅱ组接种重组酵母乙肝疫苗 5 μg -5 μg -5 μg ,Ⅲ组接种中国仓鼠卵巢(CHO)细胞乙肝基因工程疫苗 10 μg -10 μg -10 μg ,3组均按 0、1、6月程序接种。结果 :全程免疫后 1年 ,抗 -HBs阳转率分别为85 5 1%、86 44%、10 0 .0 0 % ,几何平均滴度 (GMT)分别为 5 0 5 0mIU/ml、5 2 34mIU/ml、14 3 19mIU/ml;全程免疫后 2年 ,抗 -HBs阳性率分别为 79 6 6 %、70 2 1%、95 5 6 % ,GMT分别为 2 5 98mIU/ml、30 48mIU/ml、6 9 5 8mIU/ml。表明 :对HBsAg阴性母亲所生的新生儿采用重组酵母乙肝疫苗 10 μg -5 μg -5 μg与 5 μg -5 μg -5 μg接种 ,其抗 -HBs阳转率及GMT差异无显著的统计学意义 ,但免疫后第 2年 ,采用 5 μg -5 μg -5 μg免疫组的抗体下降速度较 10 μg -5 μg -5 μg组为快 ;两个重组酵母乙肝疫苗接种组与CHO乙肝基因工程疫苗接种组比较抗 -HBs阳性率和GMT的差异均有显著的统计学意义 ,CHO乙肝基因工程疫苗接种组免疫效果最好     

充血性心力衰竭患者血清Ⅲ型前胶原氨基端肽检测的临床价值

目的　测定充血性心力衰竭患者血清中的Ⅲ型前胶原氨基端肽 (PⅢP)及层粘连蛋白 (LN)水平 ,探讨其对心肌纤维化的诊断价值。方法　选择 4 4例充血性心力衰竭患者 (心功能Ⅲ级以上 )和正常健康对照者 30例 ,用放射免疫法测定其血清中的PⅢP及LN水平。结果　心力衰竭患者血清中的PⅢP水平明显高于健康对照组 (5 5± 1 1) μg/Lvs (3 8± 1 5 ) μg/L(P <0 0 1) ,心力衰竭患者血清的LN水平明显高于健康对照组 (14 8 0±32 6 ) μg/Lvs (10 2 6± 2 3 2 ) μg/L(P <0 0 1) ,心功能Ⅳ级组血清的PⅢP水平明显高于心功能Ⅲ级组 (5 7± 0 8)μg/Lvs (5 2± 0 6 ) μg/L(P <0 0 5 ) ,心功能Ⅳ级组血清的LN水平明显高于心功能Ⅲ级组 (16 8 3± 2 2 6 ) μg/Lvs(14 6 2± 18 4 ) μg/L(P <0 0 5 )。结论　PⅢP及LN水平的升高可能部分与心肌纤维化有关 ,可在充血性心力衰竭患者的血清中检测出来 ,并能反映心衰的严重程度     

胆汁CEA的检测对大肠癌肝转移的诊断价值

目的　探讨胆汁癌胚抗原 (CEA)的检测对大肠癌肝转移的诊断价值。方法　A组 35例 ,为非肿瘤患者 ;B组35例 ,为大肠癌患者 ;C组 2 0例 ,为大肠癌合并肝转移患者。所有患者均空腹抽取前臂静脉血 ,同时经鼻十二指肠引流管取胆汁 ,测定CEA值。结果　A、B和C组血清CEA值分别为 (3.1± 0 .6 )ng/ml、(10 .2± 2 .1)ng/ml、(13.8± 3.1)ng/ml;十二指肠胆汁CEA值分别为 (2 1.7± 6 .5 )ng/ml、(118.2± 31.0 )ng/ml、(76 0± 192 )ng/ml。后两者胆汁CEA值比较差异有显著性 (P <0 .0 1)。结论　检测胆汁CEA对诊断大肠癌肝转移有重要临床价值     

血清孕酮、肌酸激酶、甲胎蛋白在异位妊娠诊断中的意义

目的探讨血清孕酮、肌酸激酶及甲胎蛋白对异位妊娠早期诊断的意义。方法随机选择住院的异位妊娠患者56例,同期门诊的正常宫内妊娠者50例。检测比较两组血清孕酮、肌酸激酶及甲胎蛋白值。结果异位妊娠组的血清孕酮值(3·82±2·98ng/ml)显著低于正常早孕组(18·74±6·74ng/ml)(P(0·05);两组血清肌酸激酶值存在着明显的交叉;血清AFP值异位妊娠组(1·92±1·31ng/ml)与正常妊娠组(2·35±2·90ng/ml)无统计学显著性差异(P>0·05)。结论血清孕酮的测定可以协助异位妊娠与正常宫内妊娠的鉴别诊断。     

广州市孕妇硒碘营养状况调查

目的　了解广州市孕妇孕中、晚期硒碘营养状况。方法　用砷铈接触法测定尿碘 ,用放射免疫分析法(RIA)测定血清甲状腺素 (T4)、促甲状腺激素 (TSH) ,荧光光度法测定静脉全血硒。结果　孕中期血硒含量 (0 1375± 0 0 96 9) μg/ml及孕晚期血硒含量 (0 15 2 8± 0 0 85 9) μg/ml,远低于我国中硒区成人血硒值 (0 35± 0 0 2 ) μg/ml。孕中、晚期血硒含量无明显变化 (P >0 0 5 )。孕中期尿碘中位数为 2 4 9 3μg/L ,<10 0 μg/L者占 4 5 % ;孕晚期尿碘中位数为 2 4 1 2 μg/L ,<10 0 μg/L者占 12 5 % ,两期尿碘值自身比较差异无统计学意义 (P >0 0 5 )。孕中期血清T 4(15 7 0± 6 6 4 )nmol/L ,在正常范围者占 5 8 2 % ;孕晚期血清T4(12 4 4± 5 9 4 )nmol/L ,在正常范围者占 78 3%。孕中期血清TSH(中位数 3 9mU/L) >5mU/L者占 34 3% ,孕晚期血清TSH (中位数 6 9mU/L) >5mU/L者占81 8%。中晚期自身比较TSH >5mU/L与 >5mU/L的人数构成差异有统计学意义 (P <0 0 1)。结论　广州市孕妇硒碘营养状况良好 ,孕晚期血清TSH >5mU/L者 (81 8% )较多 ,与尿碘、T4水平不一致 ,有待进一步研究。     

辽河油田居民全血硒含量水平的评价

采用新极谱法对辽河油田居民的全血样品进行硒含量的测定。其中健康人 2 0 7例 ,血硒含量为 12 9 0± 4 8 1μg/L ,男性 10 5例 ,血硒含量为 12 5 3± 4 8 3μg/L ,女性 10 2例 ,血硒含量为 132 7± 4 7 6 μg/L ,处于营养状态。不同血型血硒含量没有明显差异 (P >0 10 )。患者 2 18例 ,血硒含量为 89 9± 2 6 5 μg/L ,男性12 4例 ,血硒含量为 90 9± 2 5 9μg/L ,女性 94例 ,血硒含量为 87 9± 2 7 0 μg/L。各种疾病患者血硒含量没有显著性差异 (P >0 10 ) ,但均显著低于健康人血硒含量 (P <0 0 0 1)。     

加硒食盐对疾病的干预效果观察

报告添加１５×ｌ０￣（－６）亚硒酸钠的富硒食盐对扬中居民主要疾病的５年干预效果（１９８９～１９９３年）。吃硒盐的５个乡镇１２．６万人，吃普通盐的５个乡镇１０．４万人，试验开始前成人血硒值０．０７２±０．０２μｇ／ｍｌ，观察结束时普盐区血硒０．０８５６±０．０１７μｇ／ｍｌ，硒盐区为０．０９２±０．０１３５μｇ／ｍｌ。普盐区１９８７～１９８８年总死亡率为８２５．３９×１０￣（－５），１９９０～１９９３年为８２０．５０×１０￣（－５），硒盐区则从７４９．８５×１０￣（－５）降为７０６．１５×１０￣（－５）下降了４３．７×１０￣（－５）或５．８３％。其中恶性肿瘤后４年比前２年下降３×１０￣（－５）或１２％，有统计意义，而对照区前后变化不大。主要呼吸系病（肺炎、支气管炎、肺气肿、哮喘）和３种心脏病（高血压性心脏病、急性心肌梗塞、冠心病）死亡率，硒盐区皆有下降而对照区均呈上升但未达显著性水平，未观察到硒盐对脑血管病及肝炎有何作用     

血清胱抑素C在糖尿病、高血压早期肾损害诊断中的价值

目的 通过对2型糖尿病和原发性高血压患者进行血清胱抑素C（CysC）、肌酐及尿微量白蛋白排泄量（UAE）的检测,评估CysC在糖尿病和高血压早期肾损害诊断中的价值.方法 选择2型糖尿病患者66例,其中38例UAE在30 ～ 300 mg/24 h的患者归入早期糖尿病肾病（DN）组,28例UAE＜ 30 mg/24 h的患者归入无肾病的糖尿病（NDN）组;原发性高血压患者52例,其中25例UAE≥30 mg/24 h的患者归人高血压肾损害组,27例UAE＜ 30 mg/24 h的患者归入高血压无肾损害组;60例健康成年人为对照组.所有入选者检测UAE、CysC、肌酐含量.结果 早期DN组CysC显著高于对照组和NDN组[（1.84±0.83） mg/L比（0.41 ±0.62）,（0.66 ±0.59） mg/L],差异有统计学意义（P＜ 0.05）;而NDN组CysC与对照组比较差异无统计学意义（P＞0.05）;三组肌酐和UAE比较差异均无统计学意义（P＞0.05）.高血压肾损害组CysC显著高于对照组和高血压无肾损害组[（0.93±1.04） mg/L比（0.41±0.62）,（0.69±0.57） mg/L],差异有统计学意义（P＜0.05）;而高血压无肾损害组CysC与对照组比较差异无统计学意义（P＞0.05）;三组肌酐和UAE比较差异均无统计学意义（P＞0.05）.结论 CysC可作为判断早期肾损害的指标,对患者病情进展有很好的了解,及时采取治疗措施,可降低和避免慢性肾衰竭的发生.     

辽宁锦州市居民健康状况与血硒含量相关性的研究

采用新极谱法测定辽宁省锦州市居民的全血硒含量。其中健康人 2 0 0例 ,血硒含量为1 36.5± 47.9μg/ L,男、女各 1 0 0例 ,血硒含量分别为 1 38.5± 46.4μg/ L和 1 34.5± 49.3μg/L。不同血型血硒含量没有明显差异 ( P<0 .1 0 ) ,处于营养状态。患者 338例 ,血硒含量为1 0 2 .2± 38.7μg/ L,男 1 82例、女 1 56例 ,血硒含量分别为 1 0 0 .3± 38.7μg/ L和 1 0 4 .5± 38.6μg/ L,并显著低于健康人血硒含量 ( P<0 .0 0 1 ) ,处于次缺硒状态。不同疾病患者血硒含量大小顺序为呼吸道疾病 >>脑血管疾病≈癌症 >消化道疾病≈心血管疾病 >糖尿病 >眼科疾病     

新型冠状病毒肺炎治疗结局相关危险因素

目的 了解新型冠状病毒肺炎（COVID-19）的流行病学及临床特征,揭示与治疗结局相关的危险因素。方法 回顾性分析武汉市某三甲医院2019年12月27日-2020年1月30日收治的确诊COVID-19患者临床资料并追踪治疗结局,按治疗结局分为生存组（好转出院）和死亡组,通过单因素及多因素分析寻找与治疗结局有关的危险因素。结果 随访至2020年3月3日,100例COVID-19患者经治疗后好转出院85例（生存组）,死亡15例（死亡组）。患者中位年龄44.0岁,女性占60.0%,1例新型冠状病毒核酸检测阳性患者除胸部CT示"右肺斑片状阴影"外无其他临床表现。单因素分析发现,患者年龄≥ 60岁,既往合并慢性心脏疾病、慢性肺部疾病、脑血管疾病、糖尿病、高血压等,入院时临床分型为重型或危重型,入院时实验室检查血小板计数<100×10⁹/L、淋巴细胞计数<0.5×10⁹/L、乳酸脱氢酶≥ 250 U/L、谷丙氨酸氨基转移酶和/或天冬氨酸氨基转移酶≥ 40 U/L、血肌酐≥ 97 μmol/L、纤维蛋白原≥ 4 g/L、D-二聚体≥ 1 mg/L,治疗上未联合中药及使用机械通气（P<0.05）,以上因素所占比例死亡组高于生存组,差异均有统计学意义（均P<0.05）。多因素分析结果显示,入院时临床分型为重型或危重型、合并慢性心脏病是死亡相关的独立危险因素（P<0.01）。结论 COVID-19治疗结局与多种因素相关,其中入院时COVID-19临床分型为重型或危重型、合并慢性心脏病是患者死亡的独立危险因素。     

黔南州农村30岁及以上高血压、糖尿病人群慢性肾脏疾病的流行病学特征分析

目的 调查黔南州农村30岁及以上高血压、糖尿病人群慢性肾脏疾病（CKD）的患病情况。方法 于2019年10月—2020年9月,在黔南州12县（市）采用多阶段整群随机抽样方法,选取农村30岁及以上高血压、糖尿病人群进行问卷调查、体格检查、肾损害相关指标检测。结果 19 687名农村30岁及以上高血压、糖尿病人群中,CKD总患病率为39.61%（男性34.71%,女性44.82%）。女性CKD患病率高于男性（χ2 = 251.974,P＜0.001)。单纯高血压、单纯糖尿病、同时患高血压及糖尿病人群CKD患病率分别为37.28%、34.67%、48.76%,且3种人群CKD患病率随年龄增加而增加（χ2值分别为16.754、15.876、21.335,P = 0.005）。汉族、布依族、苗族、水族、瑶族、毛南族、其他民族单纯高血压、单纯糖尿病及同时患高血压及糖尿病者CKD患病率分别为17.54%、27.57%、20.46%、17.23%、16.56%、18.81%、17.45%,7.33%、9.02%、7.72%、7.02%、6.75%、6.39%、6.46%和12.76%、13.59%、13.16%、11.69%、11.48%、10.69%、10.84%。不同民族间3种人群CKD患病率差异有统计学意义（χ2值分别为25.673、24.837、33.462,P = 0.001）。黔南州12县（市）中单纯高血压、单纯糖尿病、同时患高血压及糖尿病者CKD患病率最高是惠水县（23.28%、9.79%、13.52%）,其次是平塘县（20.81%、9.03%、12.65%）。单纯高血压、单纯糖尿病、同时患高血压及糖尿病者CKD1期、CDK2期患病率比较差异有统计学意义(χ2值分别为573.150、84.825,P＜0.001)。结论 黔南地区农村30岁及以上高血压、糖尿病人群中慢性肾脏病患病较高,具有性别、民族和县市分布特点。     

2型糖尿病下肢血管病变发生率及危险因素分析

目的了解2型糖尿病下肢血管病变(PVD)发生率,分析PVD的相关危险因素。方法收集住院的2型糖尿病患者145例进行回顾性分析。结果多普勒超声检查提示有下肢血管病变者占72.41%。2型糖尿病PVD组年龄(66.68±9.87)岁与无PVD组(50.83±12.29)岁相比,差别有统计学意义(P<0.01),PVD组病程(8.63±6.48)a、总胆固醇(4.82±1.18)mmol/L]、低密度脂蛋白胆固醇(2.79±1.01)mmol/L,患高血压比例(74/105)也明显高于无PVD组(P<0.05)。Logistic回归分析结果表明,年龄、性别、病程、总胆固醇是PVD的独立危险因素(OR=1.151,0.098,1.142,2.021)。结论2型糖尿病下肢血管病变发生率高,年龄、性别、病程、血脂是2型糖尿病患者下肢血管病变的危险因素。     

微机极谱法同步测定血中铜 锌 铁的方法学探讨

探讨Cu2 + 、Zn2 + 和Fe2 + 在乙二胺—三乙醇胺体系中的极谱联合测定方法 ,同时测定了 75 8例健康受试者中铜、锌和铁离子浓度。Cu2 + 、Zn2 + 和Fe2 + 在 0～ 4 g/L范围内线性较好 ,其检测极线分别是 7.8× 10 -5、5 .9× 10 -5和 8.2× 10 -6g/L ;样本分析的SD(CV)分别是 0 0 5 (4 5 6 % ) ,0 0 5 (4 5 9% )和 0 0 6 (4 5 1% ) ;回收率 (均值 )分别是 95 31%～ 10 2 4 8% (98 2 3% ) ,96 71%～ 10 1 34% (99 2 8% )和 98 16 %～ 10 3 95 %(10 1 92 % ) ;测定峰电位分别是 - 0 5 8V ,- 0 96和 - 1 35V。该方法与原子吸收分光光度法测定结果之间无统计学差异。     

SP-D、SP-A在煤工尘肺病患者肺泡灌洗液、血清中的表达意义及与肺部炎症相关性

目的 研究肺泡表面活性蛋白(surfactant-associated proteins,SP)D、肺泡表面活性蛋白A(SP-A)在煤工尘肺病(coal worker's pneumoconiosis,CWP)患者肺泡灌洗液、血清中的表达意义及与肺部炎症相关性。 方法 选取2016年8月—2019年6月收治的CWP患者88例作为病例组,同矿区具备相同粉尘接触条件的非CWP井下作业工人92例作为对照组。检测两组血清、肺泡灌洗液SP-D、SP-A水平,并分析其对CWP的诊断价值,同时比较不同分期患者血清、肺泡灌洗液SP-D、SP-A、炎性因子[γ干扰素(interferon gamma,IFN-γ)、白细胞介素-10(interleukin-10,IL-10)]水平及二者关联性。 结果 病例组血清、肺泡灌洗液SP-D分别为(46.24±10.44)μg/ml和(40.26±13.40)μg/ml、SP-A分别为(42.17±7.30)μg/ml和(11.28±3.74)μg/ml,均低于对照组水平[SP-D分别为(57.63±13.69)μg/ml和(94.18±31.35)μg/ml、SP-A分别为(49.55±9.12)μg/ml和(63.75±21.20)μg/ml(P＜0.05)];肺泡灌洗液SP-D、SP-A联合诊断AUC(0.901)＞肺泡灌洗液SP-D(0.873)＞肺泡灌洗液SP-A(0.863)＞血清SP-D(0.788)＞血清SP-A(0.764);血清、肺泡灌洗液SP-D、SP-A与IFN-γ、IL-10呈负相关(r₁=-0.528,r₂=-0.410,r₃=-0.549,r₄=-0.544,P均＜0.05)。 结论 SP-D、SP-A在CWP患者肺泡灌洗液、血清中呈低表达态势,与肺部炎症存在负相关关系,肺泡灌洗液SP-D、SP-A联合有望成为临床鉴别诊断、判断疾病分期、评估肺部炎症程度的重要有效生物标志物。     

Health Plan Retention and Pharmacy Costs of Newly Diagnosed Patients with Chronic Kidney Disease in a Managed Care Population

Background

Chronic kidney disease is prevalent in the United States, and diabetes and hypertension cause up to two thirds of all new cases. Many health plans believe that these patients do not retain their health plans for a long duration, therefore plans do not focus on prevention for this disease.

Objective

To determine health plan retention rates and direct healthcare costs of adults with newly diagnosed chronic kidney disease with diabetes or hypertension.

Methods

A total of 31,917 patients with chronic kidney disease were included in this study between January 1995 and December 2006, using a managed care database. Patients were divided into 3 subgroups for cost comparison—patients with chronic kidney disease only (n = 8836), those with chronic kidney disease with diabetes (n = 11,252), and patients with chronic kidney disease with hypertension (n = 20,836). Follow-up of patients from index period of initial kidney disease diagnosis was 5 years. Average enrollment duration was 38 months; 60% of all patients remained enrolled at 3 years postdiagnosis.

Results

On average, patients with chronic kidney disease and diabetes and those with chronic kidney disease and hypertension remained enrolled slightly longer than chronic kidney disease-only patients (39 months, 40 months, and 36 months, respectively). The largest number of claims was for inpatient medical, followed by pharmacy and laboratory. Mean annual direct healthcare costs were higher for patients with chronic kidney disease and diabetes ($20,165) and those with chronic kidney disease and hypertension ($17,612) compared with patients with chronic kidney disease only ($9390).

Conclusion

The study findings indicate that most patients who are newly diagnosed with chronic kidney disease retain their health plan affiliation for a considerable period, including those with diabetes or hypertension. Increased direct healthcare costs were associated with the presence of comorbidities in patients with chronic kidney disease.Chronic kidney disease (CKD) affects approximately 26 million people in the United States.1 Diabetes and hypertension cause up to two thirds of all new CKD cases.1,2 According to Medicare policy, health plans are financially responsible for the care of CKD patients for up to 33 months after they have reached the final stage of end-stage renal disease (ESRD).3 Data from the Institute for Health and Productivity Management 2001 database show that treatment costs nearly double from one stage of CKD to the next.4 The stages of CKD are defined based on the glomerular filtration rate (GFR) as determined by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines.5Insurance claims for patients with CKD average $5000 to $12,000 per patient per year (PPPY) as a patient proceeds from stage 1 (GFR ≥90 mL/min/1.73 m²) to stage 2 (GFR 60–89 mL/min/1.73 m²), $15,000 to $28,000 PPPY from stage 3 (GFR 30–59 mL/min/1.73 m²) to stage 4 (GFR 15–29 mL/min/1.73 m²), and exceed $70,000 PPPY once the patient reaches stage 5 (GFR <15 mL/min/1.73 m²).4 Progressive CKD presents a burden to employers as suggested by researchers who examined ESRD-related nonmedical costs for employers.6 It was estimated that employers may incur life insurance costs of $55,055 per ESRD-related death, disability insurance costs of $31,617 per ESRD disability, and worker replacement costs of $27,869 per ESRD-related lost worker.6From a managed care perspective, it has been suggested that controlling and stabilizing the main comorbidities of CKD—diabetes and hypertension—may slow the progression of CKD, which would result in a reduction of healthcare costs.7 Factors that may be associated with optimal quality of care for patients with CKD during the 12-month predialysis phase have been identified, including predialysis erythropoietin therapy, nephrology referrals, and phosphate binder/vitamin D administration. As many as 48.7% of patients did not have any interventions associated with optimal care, suggesting a need for proactive management of CKD in the managed care setting to reduce utilization, while improving patient outcomes.8 Similarly, a retrospective claims analysis of 27 health plans in 19 states evaluated resource utilization in 3 defined time periods9:

• Predialysis: months 2 to 6 before initial dialysis
• Peridialysis: 30 days before and 30 days after dialysis
• Postdialysis: months 2 and 3 after initial dialysis.

KEY POINTS

• ▸ Approximately 26 million Americans have chronic kidney disease.
• ▸ About two thirds of all new cases are caused by diabetes and hypertension, suggesting that early intervention can reduce or delay the progression to this devastating and costly disease.
• ▸ This study''s findings indicate that most patients who are newly diagnosed with chronic kidney disease retain their health plan for a considerable period.
• ▸ In this study of 31,917 patients with chronic kidney disease, the mean annual total medical costs were $22,444 for patients with kidney disease plus diabetes, $19,667 for those with kidney disease plus hypertension, and $10,170 for patients with kidney disease only.

Per patient per month charges were highest in the peridialysis period ($35,292 vs $4265 for predialysis and $15,399 for postdialysis), and treatments with nutritional supplements and medications such as angiotensin-converting enzyme inhibitors and erythropoietin were suboptimal.9 A directive has been issued for managed care plans to manage CKD through early intervention to improve outcomes and reduce costs.10–12Although data are available that establish the cost impact of CKD, as well as identify gaps in the treatment of CKD patients at all stages, data to characterize retention among newly diagnosed CKD patients in managed care plans are limited.Information regarding retention of CKD patients will enable managed care plans to understand the potential impact of treating predialysis CKD as a chronic illness on the plan and the impact on its members. Such data may encourage plans to implement early-intervention strategies and potentially minimize costly expenditures in later stages.The purpose of this study was to examine the health plan retention rates and pharmacy costs among newly diagnosed CKD patients, including those with diabetes or hypertension, from a managed care perspective. The main focus was to look at the length of time patients with CKD, CKD and diabetes, and CKD and hypertension remain within a health plan after the initial CKD diagnosis, and compare the direct costs of CKD alone and the costs of CKD plus these closely related comorbidities.     

The Consumption of Synbiotic Bread Containing Lactobacillus sporogenes and Inulin Affects Nitric Oxide and Malondialdehyde in Patients with Type 2 Diabetes Mellitus: Randomized,Double-Blind,Placebo-Controlled Trial

Objectives: To our knowledge, no reports are available indicating the effects of synbiotic bread consumption on nitric oxide (NO), biomarkers of oxidative stress, and liver enzymes among patients with type 2 diabetes mellitus (T2DM). This study was performed to determine the effects of the daily consumption of synbiotic bread on NO, biomarkers of oxidative stress, and liver enzymes in patients with T2DM.

Methods: This randomized, double-blind, placebo-controlled trial was performed among 81 patients with diabetes, aged 35–70 years old. After a 2-week run-in period, patients were randomly divided into 3 groups: group A (n = 27) received synbiotic bread containing viable and the heat-resistant probiotic Lactobacillus sporogenes (1 × 10⁸ CFU) and 0.07 g inulin per 1 g, group B (n = 27) received probiotic bread containing Lactobacillus sporogenes (1 × 10⁸ CFU), and group C (n = 27) received control bread for 8 weeks. Patients were asked to consume the synbiotic, probiotic, or control breads 3 times a day in 40 g packages for a total of 120 g/day. Fasting blood samples were taken at baseline and after an 8-week intervention for quantificationof related markers.

Results: After 8 weeks, the consumption of synbiotic bread compared to the probiotic and control breads resulted in a significant rise in plasma NO (40.6 ± 34.4 vs 18.5 ± 36.2 and ?0.8 ± 24.5 µmol/L, respectively, p < 0.001) and a significant reduction in malondialdehyde (MDA) levels (?0.7 ± 0.7 vs 0.6 ± 1.7 and 0.5 ± 1.5 µmol/L, respectively, p = 0.001). We did not find any significant effect of the synbiotic bread consumption on plasma total antioxidant capacity (TAC), plasma glutathione (GSH), catalase, serum liver enzymes, calcium, iron, magnesium levels, and blood pressure compared to the probiotic and control breads.

Conclusion: In conclusion, consumption of the synbiotic bread for 8 weeks among patients with T2DM had beneficial effects on plasma NO and MDA levels; however, it did not affect plasma TAC, GSH, catalase levels, serum liver enzymes, calcium, iron, magnesium levels, and blood pressure.