急性冠脉综合征患者检测血清E-选择素的意义

目的:探讨急性冠脉综合征者E-选择素水平与冠状动脉病变程度的关系.方法:将125例急性冠脉综合征患者分为急性心肌梗死组(n=71)和不稳定型心绞痛组(n=54),并设对照组(n=47),比较各组血清E-选择素的水平.对患者的冠状动脉损害进行Gensini评分,并与其血清E-选择素水平进行直线相关分析.结果:急性冠脉综合征组的血清E-选择素显著高于对照组(P＜0.001);急性心肌梗死组与不稳定型心绞痛组血清E-选择素水平有显著性差异(P＜0.05);血清E-选择素水平与冠状动脉Gensini评分呈正相关.结论:急性冠脉综合征患者的血清E-选择素水平与冠状动脉病变程度密切相关,浓度越高,病情越重.     

血清骨保护素和脑利钠肽水平与非ST段抬高型急性冠状动脉综合征患者冠状动脉病变程度的相关性

目的 探讨血清骨保护素和脑利钠肽水平与非ST段抬高急性冠状动脉综合征患者冠状动脉病变程度之间的关系.方法 192例受试者分为三组:稳定型心绞痛患者58例,不稳定型心绞痛/非ST段抬高心肌梗死患者99例,对照者35例,入院时检测血清骨保护素和脑利钠肽水平,并进行冠状动脉造影.根据造影结果对冠状动脉病变进行Gensini评分,分析两种标志物与冠状动脉狭窄数及冠状动脉病变Gensini评分的相关性.结果所有冠心病患者骨保护素水平高于对照组(P<0.01),稳定型心绞痛组骨保护素水平低于不稳定型心绞痛/非ST段抬高心肌梗死组(P<0.01);稳定型心绞痛组脑利钠肽水平略高于对照组(P>0.05),不稳定型心绞痛/非ST段抬高心肌梗死组脑利钠肽水平明显高于稳定型心绞痛组(P<0.01);多支血管病变患者脑利钠肽水平显著高于单支血管病变患者(P<0.01),脑利钠肽与冠状动脉病变Gensini评分轻微相关(r=0.45,P<0.01),骨保护素与冠状动脉病变Gensini评分显著相关 (r=0.64,P<0.001),多元回归分析发现骨保护素和脑利钠肽与冠心病独立相关(P<0.01).结论血清骨保护素与不稳定型心绞痛/非ST段抬高心肌梗死患者冠状动脉狭窄程度及病变进展有关,提示骨保护素可能参与了冠状动脉疾病的进程.不稳定型心绞痛/非ST段抬高心肌梗死患者脑利钠肽水平也增高,表明脑利钠肽水平与缺血范围以及严重程度有较大的关联.     

冠心病患者血清可溶性E-选择素检测的意义

目的　探讨血清可溶性E 选择素在监测冠心病病情及与冠状动脉病变程度的关系。方法　 81例冠心病患者 ,按临床诊断分为 4组 :急性心肌梗死 (AMI) 17例、不稳定性心绞痛 (UAP) 2 4例、稳定性心绞痛 (SAP) 2 0例和对照组患者 2 0例。检测各组患者血清可溶性E 选择素的水平 ,并比较各组间的差异。对冠心病患者的冠状动脉损害行Gensini评分 ,并与其血清可溶性E 选择素水平进行直线相关分析。结果　 (1)AMI组、UAP组及SAP组的血清可溶性E 选择素水平比对照组高 ;(2 )AMI组、UAP组可溶性E 选择素水平和SAP组相比 ,其值增加明显 ;AMI组和UAP组结果相似 ;(3)急性冠脉综合征 (AMI组 +UAP组 )血清可溶性E 选择素水平与冠状动脉Gensini评分呈正相关。结论　血清可溶性 E选择素可能是冠状动脉粥样硬化的标志 ,参与了冠心病的发病过程 ,在急性冠脉综合征中 ,其值与冠状动脉病变程度密切相关。     

脑钠肽、和肽素和高敏C反应蛋白与急性冠状动脉综合征的相关性

目的 探讨急性冠状动脉综合征患者冠状动脉粥样硬化程度与脑钠肽、和肽素和高敏C反应蛋白水平之间的相关性.方法 检测30例急性心肌梗死(急性心肌梗死组)患者,38例不稳定型心绞痛(不稳定型心绞痛组)患者和20例健康对照组血浆脑钠肽、和肽素和血清高敏C反应蛋白水平;比较冠状动脉病变支数、左主干病变、冠状动脉Gensini评分与脑钠肽、和肽素和高敏C反应蛋白水平的相关性.结果 急性心肌梗死组、不稳定型心绞痛组脑钠肽、和肽素和高敏C反应蛋白水平显著高于正常对照组(P<0.01),急性心肌梗死组脑钠肽、和肽素和高敏C反应蛋白水平显著高于不稳定型心绞痛组(P<0.01);脑钠肽、和肽素水平与冠状动脉病变支数、左主干病变、冠状动脉Gensini评分呈正相关(P<0.01),而高敏C反应水平与冠状动脉病变支数、左主干病变、冠状动脉Gensini评分差异无显著性(P>0.05).结论 急性冠状动脉综合症患者脑钠肽、和肽素和高敏C反应蛋白的水平明显升高,和冠状动脉病变程度之间存在相关性.     

冠心病患者血清非对称二甲基精氨酸水平与冠状动脉狭窄程度的相关性

目的探讨血清非对称二甲基精氨酸与冠状动脉狭窄程度及冠心病病情的关系及其临床意义。方法选取75例行冠状动脉造影患者,并根据冠状动脉造影结果和临床表现分为稳定型心绞痛组(n=15)、不稳定型心绞痛组(n=23)、急性心肌梗死组(n=20)和对照组(n=17)。所有患者分别进行病史采集,并检测血脂、非对称二甲基精氨酸水平,应用Gensini积分系统评价患者的冠状动脉粥样硬化病变程度。分析血清非对称二甲基精氨酸水平与年龄、性别构成比、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇及冠状动脉病变程度的相关性。结果与对照组血清非对称二甲基精氨酸水平(3.81±0.48μmol/L)相比,稳定型心绞痛组(4.82±0.50μmol/L)、不稳定型心绞痛组(5.52±0.55μmol/L)和急性心肌梗死组(6.03±1.13μmol/L)均明显升高,且差异有统计学意义(P<0.01);不稳定型心绞痛组和急性心肌梗死组血清非对称二甲基精氨酸明显高于稳定型心绞痛组,差异具有统计学意义(P<0.01)。急性心肌梗死组血清非对称二甲基精氨酸与不稳定型心绞痛组相比,虽有升高的趋势,但差异不具有统计学意义(P=0.279)。冠心病各亚组Gensini评分均明显高于对照组(Gensini评分为0),差异有统计学意义(P<0.01);稳定型心绞痛组Gensini评分(17.79±1.86)分别与不稳定型心绞痛组(38.05±4.46)和急性心肌梗死组(40.62±3.80)比较,差异有统计学意义(P<0.01)。血清非对称二甲基精氨酸水平与总胆固醇和低密度脂蛋白胆固醇呈正相关(P<0.01),而与年龄、性别构成比、甘油三酯、高密度脂蛋白胆固醇无显著相关性(P>0.05)。血清非对称二甲基精氨酸水平与冠状动脉狭窄程度Gnesini评分有明显相关性(r=0.704,P=0.000)。结论冠心病患者的血清非对称二甲基精氨酸水平与冠状动脉狭窄程度和冠心病病情的严重程度相关,监测血清非对称二甲基精氨酸水平对于判断冠心病病情、指导诊断治疗具有一定的价值。     

急性冠状动脉综合征患者P-选择素水平与冠状动脉病变的关系

目的探讨急性冠状动脉综合征(ACS)患者可溶性P-选择素(sP-选择素)水平及其与冠状动脉病变的关系。方法应用酶联免疫吸附法检测54例ACS患者(ACS组)、15例稳定性心绞痛患者(SA组)和19例冠状动脉造影正常者(对照组)血浆sP-选择素水平,对冠状动脉粥样硬化病变程度按照病变支数、Gensini评分和美国心脏病学会和美国心脏病协会A、B、C型分型进行评估。结果ACS组sP-选择素水平高于SA组和对照组(P<0.01);sP-选择素水平与冠状动脉病变数量,Gensini评分,A、B、C型冠状动脉病变程度均为正相关。结论ACS患者P-选择素水平明显升高,提示P-选择素是ACS临床识别和预测的炎症指标;P-选择素水平受冠状动脉粥样硬化程度的影响。     

血清可溶性P-选择素和IL-18水平与冠状动脉病变程度相关研究

目的探讨冠心病不同类型患者中血清可溶性P-选择素、白细胞介素-18（IL-18）水平与疾病严重程度、冠状动脉粥样硬化狭窄程度是否相关。方法入选2006年5月至2006年11月冠心病患者包括急性冠脉综合征（ACS）和稳定型心绞痛（SAP）86例;用酶联免疫吸附法检测血清可溶性P-选择素和IL-18水平;对不稳定型心绞痛（UAP）患者进行Braunwald分级,对急性心肌梗死患者进行Killip分级,对冠状动脉粥样硬化病变程度按Gensini评分,用SPSS软件包进行统计学分析。结果ACS患者血清可溶性P-选择素、IL-18水平与疾病严重程度存在良好的相关性。ACS组P-选择素和IL-18水平高于SAP组,且与Gensini法评分呈线性正相关。结论ACS患者血清P-选择素、IL-18浓度与疾病的严重程度有一定的相关性,与冠状动脉粥样硬化狭窄病变程度呈正相关。     

TLR2信号通路对急性冠状动脉综合征患者冠脉病变的影响

目的：探讨TLR2信号通路激活对急性冠状动脉综合征患者冠脉病变的影响。 方法：选择2015年1月至12月在我院行冠状动脉造影确诊的180例急性冠状动脉综合征患者为研究组;对照组是因胸痛入院但经冠状动脉造影排除冠状动脉粥样硬化,并除外其他疾病的患者50例。用流式细胞仪检测单核细胞表面TLR2蛋白表达,ELISA 法检测血清TNF-α、IL-6水平,免疫浊度法测定 hsCRP,冠状动脉造影评价：冠状动脉造影评分采用 Gensini 评分标准,并根据Gensini 评分将患者分为低Gensini组(n=44)、中Gensini组(n=95)及高Gensini组(n=41)组,比较各组之间TLR2表达比例、TNF-α、IL-6及hsCRP水平。术后电话随访1月、3个月、6个月不良心血管事件的发生情况。 结果：急性冠状动脉综合征患者单核细胞TLR2表达比例、TNF-α、IL-6及hsCRP均较对照组升高,差异有统计学意义(P＜0.05)。多支病变组和两支病变组外周血单核细胞表面TLR2表达水平及TNF-α、IL-6及hsCRP高于单支病变组,差异有统计学意义(P＜0.05)。Gensini评分高者,单核细胞TLR2表达比例高（90.33±12.46）%,TLR2水平与Gensini评分呈正相关(r=0.297,P=0.009) ,TNF-α、IL-6、 hsCRP 与 Gensini 评分呈正相关(r=0.396,P=0.019;r=0.113,P=0.024;r=0.201,P=0.005),高Gensini组比低Gensini组不良心血管事件比例高（10.52% vs 4.76%）,差异有统计学意义(P＜0.05)。 结论:急性冠状动脉综合征患者单核细胞TLR2蛋白表达水平能预测冠脉病变严重性,TLR2信号通路激活对冠心病风险的预测价值。 关键词 急性冠状动脉综合征;Toll样受体2;冠状动脉狭窄;危险因素     

胰岛素抵抗及氧化应激对急性冠脉综合征患者冠脉病变评估的研究

目的 探讨胰岛素抵抗及氧化应激对急性冠状动脉综合征（ACS）患者病情评估的价值及与冠脉病变程度的相关性.方法 入选急性心肌梗死患者30例为A组,不稳定型心绞痛患者30例为B组,冠脉造影正常者30例为C组.对各组受试者于入院24h内空腹抽取静脉血,测定入选患者血清脂质过氧化物（MDA）、一氧化氮（NO）、一氧化氮合酶总活力（tNOS）、诱导型一氧化氮合酶（iNOS）、空腹血糖（FPG）、空腹胰岛素（FINs）水平,均采用分光比色法.计算胰岛素抵抗指数（HOMA-IR）,对入选患者行冠脉造影检查,根据冠脉造影结果所显示的血管狭窄程度及部位计算Gensini积分值.对胰岛素抵抗及氧化应激指标与冠脉Gensini积分进行相关性分析.结果 FPG、FINs、HOMA-IR、MDA、Gensini积分急性心肌梗死组高于不稳定型心绞痛组及冠脉造影正常组,差异具有统计学意义（P＜0.05）;而tNOS、iNOS、NO急性心肌梗死组低于不稳定型心绞痛组及冠脉造影正常组,差异具有统计学意义（P＜0.05）;急性心肌梗死组及不稳定型心绞痛组FPG、FINs、HOMA-IR、MDA、Gensini积分均高于冠脉造影正常组,而NO、tNOS、iNOS均低于冠脉造影正常组,差异具有统计学意义（P＜0.05）;急性心肌梗死组及不稳定型心绞痛组HOMA-IR与MDA、Gensini积分呈正相关,与NO、tNOS、iNOS呈负相关.结论 胰岛素抵抗与氧化应激反应与急性冠状动脉综合征（ACS）患者病情密切相关,且与冠脉病变程度呈正相关.     

髓过氧化物酶在急性冠脉综合征危险分层中的临床意义

目的测定冠心病患者血清髓过氧化物酶(MPO)的变化,探讨MPO在冠心病危险分层中的临床意义。方法入院时测定150例冠心病患者及50名健康对照组MPO水平。冠心病患者分为稳定型心绞痛(SA)组50例、不稳定型心绞痛(UA)组50例及急性心肌梗死(AMI)组50例,根据冠状动脉造影结果采用Gensini评分系统进行Gensini评分,同时分单支病变组、双支病变组及多支病变组。结果 AMI组、UA组及SA组的MPO浓度明显高健康对照组(P0.01),冠心病各组之间比较,差异有统计学意义(P0.01);血清MPO浓度与冠心病Gensini评分积分正相关(r=0.70,P0.05);冠心病患者中单支、双支、多支病变组中MPO比较,各组间比较差异有统计学意义(P0.05)。结论 MPO水平与冠心病严重程度相关,MPO可作为判断急性冠脉综合征严重程度的危险因素之一。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。