降脂益肝冲剂对NASH大鼠肝脏抵抗素mRNA表达的影响

目的:观察降脂益肝冲剂对非酒精性脂肪性肝炎(nonalcoholic steatohepatitis,NASH)大鼠肝脏抵抗素mRNA表达的影响,并探讨抵抗素在大鼠NASH发病机制中的作用.方法:24只♂Wistar大鼠随机分为3组:正常组普通饲料喂养,模型组和治疗组高脂饮食喂养.治疗组在高脂饮食12 wk后给予降脂益肝冲剂,同时模型组和正常组给予等量的生活饮用水灌胃,17 wk末处死各组大鼠.观察动物一般情况,肝组织脂肪变性及炎症活动程度,测定血清TNF-α、ALT、AST,空腹血糖(FBG)、空腹胰岛素(FINS),并计算胰岛素敏感指数(ISI);RT-PCR法检测肝组织抵抗素mRNA相对含量.结果:在正常肝脏组织探测到抵抗素mRNA的微量表达(0.42±0.08),模型组其表达量显著升高(2.14±0.11,P<0.01),与模型组相比治疗组则显著下降(0.90±0.06,P<0.01).模型组抵抗素水平与血清TNF-α、ALT、AST水平、肝脏炎症活动度计分成显著正相关(r=0.873,0.772,0.716,0.892,P<0.05),与ISI无相关.治疗组上述各项指标均得到显著改善.结论:抵抗素与反映肝脏炎症程度及肝功能的指标密切相关,可能在NASH的发病中起重要作用.降脂益肝冲剂对NASH有很好的疗效,抵抗素是其可能的作用靶点.     

抵抗素mRNA在非酒精性脂肪性肝炎大鼠肝组织中的表达与定位

目的观察高脂饮食诱导的非酒精性脂肪性肝炎（NASH）大鼠肝组织抵抗素mRNA的表达与定位，探讨其在NASH发病中的作用。方法16只雄性Wistar大鼠被随机分为普通饲料和高脂饲料喂养组，连续18周后处死各组大鼠，测定血清甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、游离脂肪酸（FFA）、肿瘤坏死因子（TNF-α）、空腹血糖（FBS）和空腹胰岛素（FINS），并计算胰岛素敏感指数（ISI），观察肝脏组织病理变化和炎症活动度计分；应用原位杂交和半定量RT—PCR技术检测各组大鼠肝脏组织抵抗素mRNA的表达及定位。结果模型组肝组织抵抗素mRNA表达较正常组显著性升高，其阳性颗粒主要分布于小叶内及汇管区炎细胞浸润区的巨噬细胞胞浆中。模型组肝组织抵抗素和血清TNF-α水平、肝脏炎症活动度计分成显著性正相关（r=0．873，0．892，P〈0．01），但与ISI无相关。结论NASH模型大鼠肝脏抵抗素定位于小叶内及汇管区炎细胞浸润区的巨噬细胞胞浆中，参与NASH的炎症发病机制。     

非酒精性脂肪性肝病大鼠肝脏肝细胞核因子-4α的表达

目的:探讨高脂饮食所致大鼠非酒精性脂肪性肝病(NAFLD)肝细胞核因子4α(HNF-4α)mRNA的表达及在NAFLD发病机制中的作用.方法:24只Wistar大鼠随机分为模型组和对照组(各12只),通过高脂饮食建立NAFLD大鼠模型,并在造模第8、12周末分批处死大鼠,同期设正常饮食组作为对照组.检测大鼠血清甘油三酯(TG)、肿瘤坏死因子-α(TNF-α)、丙氨酸转氨酶(ALT)及内毒素(ET)等指标,测空腹血糖(FBG)、空腹胰岛素(FINS),并计算胰岛素抵抗指数(IRI);采用逆转录-聚合酶链反应(RT-PCR)技术检测肝脏HNF-4α mRNA的表达;取肝标本做HE染色,观察其病理变化.结果:模型组大鼠肝脏HNF-4α mRNA表达量于第8周时开始降低,与同期对照组比较差异有统计学意义(P<0.05);同时血清TNF-α、IRI及ET与同期对照组相比明显升高(P<0.05),HNF-4α与TNF-α、IRI、ALT、TG及ET均呈负相关(P<0.05).结论:胰岛素抵抗(IR)可能是NAFLD发生、发展的基础,NAFLD大鼠肝脏HNF-4α可能通过一定机制参与了IR及炎症反应,进而影响了NAFLD的发生、发展.     

替米沙坦对肥胖大鼠内脏脂肪组织中脂肪细胞大小及TNF-α表达的影响

目的观察替米沙坦对肥胖大鼠内脏脂肪组织中脂肪细胞大小及炎症因子TNF-α表达的影响。方法将30只雄性SD大鼠随机分为A、B、C组各10只,A组给予普通饮食,B、C组给予高脂饮食;8周后C组行替米沙坦5 mg/(kg.d)灌胃,A、B组等量蒸馏水灌胃;6周后,测定各组体质量(BW)、内脏脂肪重量及血清甘油三酯(TG)、游离脂肪酸(FFA)、空腹血糖(FBG)、胰岛素(FINS)等,计算胰岛素敏感指数(ISI),光镜观察内脏脂肪细胞形态,Western blot法检测大鼠内脏脂肪组织中的TNF-α。结果 B组BW、脂肪细胞大小及血清TG、FFA、FINS显著高于A组,内脏脂肪组织中TNF-α相对表达量(153.17±0.28)也明显高于A组(100),ISI显著下降,P均<0.01;与B组比较,C组内脏脂肪组织TNF-α相对表达量明显下降,脂肪细胞大小回复正常,ISI显著提高,血清TG、FFA、FINS显著下降,P均<0.01。结论替米沙坦能促进肥胖大鼠内脏脂肪组织中脂肪细胞分化,增加小脂肪细胞数量,降低脂肪组织中TNF-α表达。     

二甲双胍对高脂饲养大鼠肝脏脂肪变的干预作用

目的:探讨胰岛素抵抗在非酒精性脂肪性肝发病中的作用及机制,观察二甲双胍对高脂饲养大鼠肝脏脂肪变的干预效果.方法:21只(?) Wistar大鼠分为3组,每组7只,普通饮食组(SD),高脂饮食组(HF),二甲双胍组(HF- Met)在高脂饮食的同时给予二甲双胍,共8wk.8 wk末处死大鼠,称量附睾脂肪,计算肝指数,生化方法测定ALT、AST、TG、TC、FFA、SOD和MDA.放免法测定空腹胰岛素,逆转录聚合酶链反应(RT-PCR)和ELISA法检测肝脏TNF-αmRNA和蛋白的表达,用葡萄糖输注率(GIR)来评价胰岛素敏感性,并观察肝组织病理变化.结果:与HF相比,HF-Met肝细胞脂肪变和小叶炎症明显减轻,肝指数、胰岛素、AST、ALT、TG、FFA显著下降(3.25±0.26 vs 4.29±0.12,33.37±8.34 vs 46.73±5.24,17.29±5.34 vs 43.48±6.21,4.10±2.47 vs 12.05±4.05,P<0.01;106.0±31.04 vs 141.37±24.87,48.31±16.11 vs 88.34±21.94,P<0.05)TNF-α的表达也显著下降,GIR增加(7.58±1.05 vs 6.31±1.28,P<0.05).结论:二甲双胍干预能明显改善高脂饲养大鼠的胰岛素抵抗,降低肝脏TG、FFA和TNF-α的表达,减轻肝脏脂肪变的程度,提示胰岛素增敏治疗可能是NAFLD防治的一种积极策略.     

高脂饮食诱导非酒精性脂肪性肝病大鼠血清脂肪甘油三酯脂酶的活性变化

目的探讨在大鼠非酒精性脂肪性肝病(NAFLD)发生发展的过程中脂肪甘油三酯脂酶(ATGL)mRNA的表达及血清ATGL酶活性、TNF-α水平的变化。方法 28只雄性SD大鼠随机分为对照组13只和NAFLD模型组15只。模型组饲以高脂饲料,对照组给予普通维持饲料。于喂养16周末处死所有动物,提取肝组织,计算肝指数,RT-PCR法半定量测定肝脏ATGL mRNA表达,观察肝脏病理变化;检测大鼠血清TG、TC、空腹血糖(FBG)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、ATGL、TNF-α等指标。结果模型组大鼠血清TG、TC、FBG、ALT、AST、TNF-α等较对照组显著升高(P均<0.05),肝脏ATGL mRNA表达和血清ATGL酶水平显著降低(P均<0.01),且肝脏出现严重的脂肪变性伴大量炎性细胞浸润。血清ATGL与TNF-α呈高度负相关(r=-0.983,P<0.01)。结论 ATGL可能在NAFLD的发生发展中发挥重要作用,并与TNF-α密切相关。     

糖代谢异常大鼠心肌超微结构改变及TNF-α的表达

目的观察糖代谢异常(糖调节受损和糖尿病)大鼠心肌的超微结构改变及肿瘤坏死因子-α(TNF-α)的表达,揭示糖尿病心肌病(diabetic cardiomyopathy,DC)发生发展的炎性机制。方法30只雄性Wistar大鼠随机分为:正常对照组、胰岛素抵抗组(IR组)和T2DM组。用免疫组化法检测心肌组织中TNF-α的表达,透射电镜观察心肌的超微结构,并测定空腹血糖(FPG)、空腹血清胰岛素(FINS)等生化指标及计算胰岛素敏感指数(ISI)。结果TNF-α在IR组、T2DM组大鼠心肌组织中的阳性表达平均积分光密度值(IDP)显著高于正常对照组(P<0.01);且T2DM组大鼠IDP值显著高于IR组(P<0.01)。IR、T2DM组ISI负值均显著高于正常对照组(P<0.01)。电镜下IR、T2DM组大鼠心肌超微结构发生不同程度的损害。相关分析表明:TNF-α的IDP值与FPG水平、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)呈明显正相关(r=0.905,0.602,0.493,0.430,均P<0.01),与ISI明显呈负相关(r=-0.896,P<0.01),多元逐步回归分析显示FBG、ISI是影响TNF-α水平的重要因素。结论TNF-α的表达与高血糖、胰岛素抵抗(IR)密切相关,且TNF-α作为一种重要的炎症因子可能参与了DC的发病机制。     

内脏脂肪素对糖尿病非酒精性脂肪性肝病大鼠肝组织的作用

目的通过观察糖尿病大鼠肝脏中内脏脂肪素(visfatin)的表达,探讨其在非酒精性脂肪性肝病(NAFLD)中的作用。方法雄性SD大鼠40只,随机分为正常对照组(NC组)、饮食诱导肥胖组(DIO组)、糖尿病组(DM组),成模后测定空腹血糖(FPG)、空腹胰岛素(Fins)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL)、游离脂肪酸(FFA)、丙氨酸氨基转移酶(ALT)、肝脏脂质含量、肝脏visfatin mRNA及蛋白表达;HE染色后光镜观察肝脏病理变化。结果 DIO组大鼠Fins、HOMA-IR、TG、TC、肝脏TG较NC组显著增高,ISI显著降低(P<0.05,P<0.01);DM组FPG、Fins、HOMA-IR、ALT、FFA、TG、TC、LDL、肝脏TG较NC、DIO组显著增高,ISI显著降低(P<0.01);DM组大鼠肝脏visfatin mRNA和蛋白较NC组显著增高(P<0.05)。肝脏HE染色显示DIO大鼠肝组织出现明显脂肪变性,糖尿病大鼠肝细胞明显脂肪变性、碎片状坏死伴炎细胞浸润及肝纤维组织增生。结论由于胰岛素抵抗而致的visfatin表达上调可能参与了NAFLD的发生。     

高脂饲料诱导的胰岛素抵抗大鼠骨骼肌已糖胺通路流量的变化

目的 探讨已糖胺通路(HBP)在高脂饲料诱导胰岛素抵抗形成中的作用.方法 雄性SD大鼠随机分为3组:对照组、高脂组和罗格列酮组.13周后,检测大鼠血清甘油三酯(TG)、总胆固醇(TC)、游离脂肪酸(FFA)、骨骼肌中TG和FFA的含量,胰岛素敏感性采用胰岛素敏感指数(ISI)和高胰岛素正糖钳夹试验稳态时的葡萄糖输注率(GIR)来评估,骨骼肌HBP的流量用谷氨酰胺:6-磷酸果糖转氨酶(GFAT)mRNA的表达水平、二磷酸尿嘧啶-N-乙酰葡萄糖胺(UDP-GlcNAc)的含量及蛋白O-GIcNAc糖基化水平来衡量.结果 高脂组大鼠与对照组相比,血清TG、TC、FFA以及骨骼肌TG、FFA均升高(均P<0.01);ISI、GIR均降低(均P<0.01),骨骼肌GFAT mRNA的表达(0.51±0.05对0.18±0.02)、UDP-GlcNAc 含量[(6.18±0.86对2.42±0.36)nmol/g]以及蛋白O-GlcNAc糖基化水平均明显升高(均P<0.01).罗格列酮组大鼠与高脂组相比,血清和骨骼肌TG、FFA明显降低(均P<0.01),胰岛素敏感性提高(P<0.05),GFAT mRNA的表达(0.27±0.03)、UDP-GlcNAc含量[(2.62±0.32)nmol/g]以及蛋白O-GIeNAc糖基化水平均明显降低(均P<0.05).结论 高脂饲料诱导大鼠胰岛素抵抗与其增加骨骼肌HBP的流量相关,可被罗格列酮降低.     

降脂护肝胶囊治疗非酒精性脂肪性肝病的实验研究

目的:探讨降脂护肝胶囊对非酒精性脂肪性肝病(NAFLD)的疗效.方法:采用高胆固醇高脂饮食喂养,复制NAFLD大鼠模型,设降脂护肝胶囊治疗组(Z组)、模型组(M组)及空白对照组(K组),检测各组大鼠血清ALT、AST、TG、TC、TNF-α、IFN-γ水平及肝组织SOD活性、MDA浓度,观察肝脏组织病理学变化.结果:M组大鼠ALT、AST、TG、TC、MDA、TNF-α、IFN-γ水平明显升高,而SOD表达下降,与K组比较,差异有显著性意义(P<0.01或P<0.05);Z组大鼠的8次指标检测结果均得到明显改善,与M组比较,差异有显著性意义(P<0.01或P<0.05).M组大鼠肝脏脂肪变明显,且有散在坏死灶及炎性细胞浸润;Z组大鼠肝脏脂肪变比M组明显减轻,肝窦基本正常,无炎性细胞浸润.结论:降脂护肝胶囊能显著改善非酒精性脂肪肝大鼠的肝功能,降低血脂,提高肝细胞SOD活性,降低MDA含量,抑制炎症反应中细胞因子TNF-α、IFN-γ,改善肝组织学病理情况,对非酒精性脂肪性肝病有较好的治疗效果.     

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。