人TIMP-1转基因小鼠随增龄肾组织炎症反应变化的意义

目的利用人基质金属蛋白酶组织抑制物-1(tissue inhibitor of metalloproteinase-1,TIMP-1)转基因小鼠,研究了IMP-1在肾脏器官衰老过程中的作用。方法对3、12、24月龄人TIMP-1转基因小鼠和野生型小鼠肾组织石蜡切片行PAS染色；免疫荧光法检测肾组织内F4/80阳性细胞数；Western印迹方法检测肾组织内TIMP-1、TIMP-2、基质金属蛋白酶(matrix metalloproteinase,MMP)-9、MMP-2、细胞间黏附分子-1(intercellular adhesion molecule-1,ICAM-1)、转化生长因子β1(transforming growth factorβ1,TGF-β1)、Ⅲ型和Ⅳ型胶原蛋白质表达；明胶酶谱法检测明胶酶活性。反向酶谱法检测TIMP-1的活性。结果两种基因型小鼠随增龄肾组织内出现局灶性纤维化改变。24月龄,与野生型小鼠比较,转基因小鼠肾组织内TIMP-1表达及活性上调[(1．10±0．18)对(0．62±0．09)；(50．75±7．25)对(20．64±3．50),P＜0．05]；明胶酶的表达及活性降低[(MMP-2：(2．08±0．20)对(3．39±0．43)；MMP-9：(4．02±0．82)对(6．72±1．40),P＜0．05]；Ⅲ型和Ⅳ型胶原[(0．72±0．11)对(0．57±0．09)；(0．84±0．13)对(0．6±0．11),P＜0．05]、ICAM-1和TGF-β1的表达上调[(0．72±0．12)对(0．53±0．07)；(0．69±0．12)对(0．45±0．09),P＜0．05],F4/ 80阳性细胞增多[(18．8±4．4)对(12．7±3．6),P＜0．05]。结论TIMP-1通过上调ICAM-1、增强炎症,促进衰老相关肾脏纤维化。     

组织金属蛋白酶抑制物转基因对小鼠肝脏组织结构与抗氧化能力的影响

目的探讨金属蛋白酶抑制物-1（TIMP-1）及其金属蛋白酶（MMP）-2、MMP-9在TIMP1转基因小鼠和正常小鼠肝脏自然衰老过程中的表达和作用。方法选择3、12和24月龄正常和TIMP_1转基因小鼠，采用HE和Masson染色，观察小鼠肝脏的组织病理学改变，用RTPCR和Westernblot法分别检测TIMP-1和MMP-2、MMP-9在不同月龄小鼠肝脏组织中的表达。测定3月龄小鼠肝脏中超氧化物歧化酶（SOD）、单胺氧化酶（MAO）活性及丙二醛含量。结果24月龄小鼠肝脏中有较多的脂肪变性和胶原沉积，TIMP1的表达随小鼠月龄增加而增高，转基因小鼠的病变更明显。两组小鼠MMP-2和MMP-9的表达均无明显变化。3月龄转基因小鼠肝脏组织学结构和形态无明显改变，但SOD活性降低，MAO活性增高，丙二醛含量增高（P〈0．05）。结论TIMP-1表达增高在肝脏衰老过程中可能起重要作用。     

甘草酸对胰腺星状细胞细胞外基质代谢调节作用的研究

目的观察甘草酸对胰腺星状细胞（PSC）合成分泌Ⅰ型胶原、基质金属蛋白酶（MMP）及其抑制物（TIMP）的影响，探讨其抗胰腺纤维化的作用机制。方法采用组织块培养法分离培养活化的PSC，培养基中添加0、1、2．5、5和10mg／ml不同剂量的甘草酸，培养24h后分别留取上清和细胞。采用放射免疫法测定上清中Ⅰ型胶原含量；明胶酶谱和反式明胶酶谱测定浓缩上清中MMP-2、MMP-9和TIMP1、TIMP-2的表达；RT-PCR测定MMP-2、MMP-9、TIMP-1、TIMP-2和I型胶原mRNA的表达。结果甘草酸可明显抑制PSC中Ⅰ型胶原含量，以5mg／ml时抑制最明显[从（52±10）ng／ml降至（35±8）ng／m1]。明胶酶谱和RT-PCR显示，PSC有MMP-2、MMP-9和TIMP-2基因和蛋白表达，而TIMP-1仅有基因表达。甘草酸可抑制MMP-2和MMP-9蛋白表达，而MMP-9基因表达未受明显抑制；甘草酸对TIMP-1和TIMP-2基因表达无明显作用，对TIMP-2蛋白的表达仅在10mg／ml浓度时有部分抑制。结论甘草酸可能通过抑制Ⅰ型胶原合成、减少MMP-2和MMP-9表达等途径抑制PSC中细胞外基质的代谢。     

MMP-9、TIMP-1和VEGF在视网膜母细胞瘤中的表达及意义

目的探讨基质金属蛋白酶-9（MMP-9）、基质金属蛋白酶抑制剂-1（TIMP-1）和血管内皮生长因子（VEGF）在视网膜母细胞瘤（RB）中的表达及其与RB分化程度和视神经浸润的关系。方法应用MMP-9、TIMP-1单克隆抗体、VEGF多克隆抗体,采用PV6000免疫组化方法,对32例RB常规石蜡包埋标本进行MMP-9、TIMP-1和VEGF表达的测定。结果MMP-9和VEGF在RB中表达阳性率分别为56.25%（18/32）和68.75%（22/32）,均与RB的分化程度及视神经浸润有关（P均〈0.05）。TIMP-1的阳性表达率（18.75%,6/32）与RB的分化程度及视神经浸润无关（P〉0.05）。MMP-9和VEGF在RB中的表达明显正相关（P〈0.05）。结论MMP-9可以通过激活VEGF并上调VEGF的表达,促进RB组织中新生血管的生成。     

明胶酶及其抑制物在衰老大鼠肾组织中的表达及意义

目的　探讨明胶酶 A、B(MMP- 2、9)及组织金属蛋白酶抑制剂 - 1、2 (TIMP- 1、2 )在衰老大鼠肾组织中的表达及它们在大鼠肾脏衰老过程中的作用。方法　选用 3月、2 4月龄 Wistar大鼠 ,采用 RT- PCR及 Western blot方法分别检测 TIMP- 1、TIMP- 2、MMP- 2及 MMP- 9等在大鼠肾脏中的表达 ;用明胶酶谱法检测不同鼠龄大鼠肾组织中 MMP- 2及 MMP- 9的活性。结果　与青年鼠相比 ,衰老大鼠肾组织内 TIMP- 1、TIMP- 2的m RNA的表达明显增加 (0 .2 58± 0 .0 2 9对 0 .667± 0 .0 59;0 .42 6± 0 .0 36对 0 .80 2± 0 .0 51 ,P<0 .0 1 ) ,蛋白质的表达明显增加 (0 .348± 0 .0 57对 0 .74± 0 .0 2 9;0 .488± 0 .0 80对 0 .92 8± 0 .0 31 ,P<0 .0 1 )。 MMP- 9和 MMP- 2的活性则显著下降 (1 64.35± 2 .95对 1 4 4 .2 4± 2 .77;1 50 .74± 2 .1 0对1 31 .57± 2 .2 6,P<0 .0 1 )。结论　由于 TIMP- 1、TIMP- 2的高表达及 MMP- 9和 MMP- 2的活性下降而引起的明胶酶及其抑制物表达异常可能与肾脏衰老密切相关。     

肾细胞癌MMP-2、血管内皮生长因子表达与血管生成的关系

采用免疫组化法检测75例肾细胞癌（RCC）、12例正常肾组织中的基质金属蛋白酶．2（MMP-2）与血管内皮生长因子（VEGF）表达情况,计数微血管密度（MVD）。结果与正常肾组织比较,RCC组MMP-2、VEGF表达明显升高（P〈O、05）,不同病理类型组织中二者表达无统计学差异,不同临床分期组织中二者表达有统计学差异（P〈0.05）。MVD与VEGF、MMP-2蛋白表达呈显著相关性（P〈0．05）,VEGF与MMP-2蛋白表达呈显著相关性（P〈0．05）。提示MMP-2、VEGF与RCC的血管生成有关,二者表达可作为反映RCC侵袭和转移的生物学指标。     

广谱基质金属蛋白酶抑制剂对高血压肾纤维化的影响

目的 研究多西环素(DOX)对卒中易感型自发性高血压大鼠(SHR-SP)肾脏基质金属蛋白酶(MMPs)及金属蛋白酶组织型抑制剂(TIMPs)活性的影响,探讨DOX对高血压肾纤维化病理转归的作用机制.方法 选用7周龄雄性SHR-SP随机分为药物干预组和对照组,定期观察大鼠体重、测量无创鼠尾压、尿量、尿肌酐、尿蛋白变化.观察终止时进行血流动力学分析;测定血清肌酐、尿素氮浓度;采用组织病理、明胶酶谱和逆明胶酶谱等方法观察各组大鼠肾脏组织学改变和MMP-2、MMP-9、TIMP-1、TIMP-2等活性变化.结果 收缩压、脉压、血清肌酐浓度在DOX组与对照组之间无统计学差异,但DOX组有升高趋势;从19周龄起,DOX组大鼠尿蛋白浓度与尿肌酐浓度比值即高于对照组[(8.3±6.4 vs 3.3±2.0)mg/μmol,P＜0.05];病理染色显示肾小管损伤平均指数和胶原容积分数均高于对照组(损伤平均指数:3.14±0.47 vs 2.69±0.38,P＜0.05;胶原容积分数:10.5%±2.7% vs 6.6%±1.9%,P＜0.01);与血压正常大鼠相比,高血压大鼠肾脏MMP-2、MMP-9、TIMP-1和TIMP-2的活性升高;药物干预后MMP-2、MMP-9活性降低(MMP-2:2.62±0.75 vs 3.39±0.92;MMP-9:2.89±1.13 vs 4.01±0.91,P＜0.05),而TIMP-1、TIMP-2活性则显著升高(TIMP-1:2.89±1.76 vs 1.54±0.86,P＜0.05;TIMP-2:1.69±0.47 vs 1.06±0.47,P＜0.01).结论 广谱基质金属蛋白酶抑制剂DOX可以抑制SHR-SP肾脏中MMP-2、MMP-9活性,加重高血压造成的肾脏损害.在肾脏损害发生后,抑制MMPs活性可能会加重高血压肾脏纤维化的进展.     

肾透明细胞癌中MMP-2、TIMP-2的表达及意义

采用免疫组化S-P法检测52例肾透明细胞癌明胶酶A（MMP-2）、金属蛋白酶2组织抑制剂（TIMP-2）表达情况，结果浸润被膜和淋巴结转移组肾透明细胞癌MMP-2的表达明显高于无被膜浸润和无淋巴结转移组（P〈0．05）IMMP-2与肿瘤浸润和淋巴结转移呈正相关，而TIMP-2与其呈负相关（P〈0．05）。表明MMP-2、TIMP-2可作为肿瘤进展及估计预后的参考指标。     

白细胞介素17A对小鼠柯萨奇B3病毒性心肌炎心肌纤维化的影响

目的探讨白细胞介素17A（interleukin-17A,IL-17A）对小鼠病毒性心肌炎（viral myocarditis,VMC）心肌纤维化的影响。方法将100μL柯萨奇病毒B3（coxsackie-virus B3,CVB3）分别感染BALb/c小鼠野生型（wild-type,WT）和IL-17A基因敲除型（IL-17A-deficient,IL-17A-/-）建立小鼠心肌炎模型,造模后0 d、14 d、28 d、42 d分别取心肌组织作石蜡切片,行苏木素伊红及Masson染色观察病理改变,免疫组化（SP法）检测心肌基质金属蛋白酶（matrix metalloproteinases,MMP）-2、MMP-9及组织金属蛋白酶抑制剂-1（tissue inhibitors of metalloproteinase-1,TIMP-1）的表达。结果与WT小鼠比较,IL-17A-/-小鼠在感染CVB3后心肌炎症及纤维化程度明显减轻,生存率提高。并且MMP-2和MMP-9在IL-17A-/-小鼠心肌中的表达在14 d和28 d明显低于其在WT小鼠心肌中的表达,差异有统计学意义[14 d亚组：0.21±0.02 vs.0.32±0.04,0.22±0.02 vs.0.38±0.05,P均〈0.05;28 d亚组：0.14±0.02 vs.0.22±0.02,0.15±0.01 vs.0.26±0.03,P均〈0.05];而TIMP-1在IL-17A-/-小鼠心肌中的表达则在14 d显著高于其在WT小鼠心肌中的表达,差异有统计学意义（P〈0.05）。WT组小鼠心肌MMP-2/TIMP-1、MMP-9/TIMP-1的值先升高后降低,峰值出现在14 d左右。而IL-17A-/-组小鼠感染CVB3后14 d、28 d和42 d三个亚组心肌MMP-2/TIMP-1、MMP-9/TIMP-1的值较0 d亚组有所降低,差异有统计学意义（P〈0.05）,但以上各亚组之间比较则差异无统计学意义（P〉0.05）。结论 IL-17A基因敲除有助于维持MMP-2/TIMP-1和MMP-9/TIMP-1的动态平衡。IL-17A可能通过介导胶原合成/降解系统的失衡参与小鼠VMC心肌纤维化过程,提示阻断IL-17A的作用有助于减轻VMC心肌损伤后心肌纤维化的程度。     

先天性心脏病并肺动脉高压患者肺组织eNOS、MMP-1、TIMP-1的表达变化及意义

目的观察先天性心脏病（CHD）并发肺动脉高压（PH）患者肺组织中内皮型一氧化氮合酶（eNOS）与基质金属蛋白酶-1（MMP-1）、基质金属蛋白酶组织抑制因子-1（TIMP-1）的表达变化,并探讨其意义。方法光镜下观察60例CHD患者肺小动脉形态,按照Heath-Edwards PH分级法分组,CHD无PH患者14例为对照组,CHD合并PHⅠ、Ⅱ、Ⅲ级46例为观察组。采用RT-PCR技术检测患者肺组织中eNOS mRNA、MMP-1 mRNA、TIMP-1 mRNA。结果 MMP-1 mRNA、TIMP-1 mRNA、TIMP-1 mRNA/MMP-1 mRNA在观察组的表达高于对照组（P均〈0.01）,eNOS mRNA则低于观察组（P〈0.01）。MMP-1 mRNA与TIMP-1 mRNA的表达呈正相关（r=0.879,P〈0.01）;MMP-1 mRNA、TIMP-1 mRNA、TIMP-1 mRNA/MMP-1 mRNA与PH分级呈正相关（r分别为0.858、0.802、0.315,P均〈0.05）,eNOS mRNA与PH分级呈负相关（r=-0.714,P〈0.01）;TIMP-1 mRNA、MMP-1 mRNA、TIMP-1mRNA/MMP-1 mRNA与eNOS mRNA呈负相关（r分别为-0.607、-0.642、-0.777,P均〈0.01）。结论 CHD合并PH患者肺组织中eNOS、MMP-1、TIMP-1表达失调,参与肺血管重构及PH形成过程。     

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.     

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。     

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。     

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。