不同药物剂量对脑梗死康复期评价缺血性卒中再发对比分析的预防

目的 探讨蚓激酶Lum，抵可力得（TIC）及三种剂量的阿斯匹林（ASA）对康复期脑梗死病人缺血性卒中再发的预防作用。方法 对已患过脑梗死的病人165例，随机分为5组应用ASA25mg/d、50mg/d、100mg/d、TIC、Lum进行缺血性卒中再发的预防性治疗。结果 与ASA25mg/d组的每100例月累积复发率（7.75%)相比，ASA50mg/d（6.25%)，相对危险性减少20％（RR1.25;95%,CI,0.73-1.25)；ASA100mg12组（4.75%)，（RR1.70;95%CL,0.69-2.26);Lum600mg/d组（3.78%)，相对危险减少51.2%(RR2.05;95%ci,1.1-3.80);TIC250mg/d组相对危险性减少41％；（3.52％），相对危险性减少54.6%（RR2.20;95%CI,1.1-21.3)。结论 TIC250mg/d作为二级预防最为有效，除了传统的抗血小板剂处，Lum600mg/d也可作缺血性卒中的二级预防。     

中西医结合对缺血性卒中二级预防的效果观察

目的:探讨中西医结合对缺血性卒中二级预防的效果。方法:选取缺血性卒中240例,随机分成治疗组与对照组各120例。对照组予阿托伐他汀钙20 mg,1次/d,拜阿司匹林100 mg,1次/d;治疗组在对照组基础上加用脑安胶囊0.8 g,2次/d。每半年检测1次生活自理能力、神经功能、运动功能,随访3年。并统计复发率及死亡率。结果:治疗组复发率、死亡率较对照组下降,神经功能改善有效率较对照组升高,生活自理能力改善较对照组明显,P0.05。结论:中西医结合对缺血性卒中二级预防效果肯定,能减少复发率、死亡率,提高生活能力,改善神经功能。     

西洛他唑对缺血性卒中进行二级预防探讨

目的：探讨西洛他唑对缺血性卒中进行二级预防的安全性和有效性。方法：选取缺血性卒中患者80例,随机分为肠溶阿司匹林组和西洛他唑组,在常规治疗的基础上,肠溶阿司匹林组给予肠溶阿司匹林100mg,1次/d,西洛他唑组给予西洛他唑50 m g,2次/d,用药1 a后进行随访。结果：西洛他唑组卒中复发2例,有效率为95%;肠溶阿司匹林组卒中复发8例,有效率为80%。两组差异有统计学意义。结论：与肠溶阿司匹林相比,西洛他唑可能更为有效。     

脑梗死后痴呆对患者生存率的影响

背景：随着预期寿命的延长和人口的老龄化，痴呆患者的数量也不断地增加，因此发生痴呆后患者的生存率便成为一个重要的公共健康问题。尽管人们普遍认为痴呆能缩短人的预期寿命，但有关在发展中国家缺血性脑卒中后痴呆对患者生存率的影响报道较少。目的：研究缺血性痴呆对患者生存率的影响，探讨脑梗死后影响患者存活的危险因素。设计：以患者为研究对象，前瞻性随机对照实验。单位：一所军医大学医院野战外科研究所的脑二科。对象：1998一05-01／1999—12—28解放军第三军医大学大坪医院神经内科的急性脑梗死患者619例，其中男313例，女306例，年龄55～85(70．3&;#177;9．5)岁。干预：对619例缺血性脑卒中患者进行人文因素、血管因素、脑梗死特征资料收集和神经心理检查。在人院及脑梗死后3个月按DSM-Ⅳ标准对脑梗死患者进行痴呆诊断，并随访2年，分析痴呆患者的存活率及生存相关预测因素。主要观察指标：①脑梗死患者人文因素和血管危险因素与生存率的关系。②脑梗死患者脑梗死特征与生存率的关系。结果：脑梗死后3个月共有146例患者(23．6％)被诊断为脑梗死后痴呆，其中39例为脑梗死前痴呆，107例为脑梗死相关性痴呆。随访(19、4&;#177;8．3)个月，脑梗死后痴呆患者存活率为49.3％，随访(21．3&;#177;9.1)个月，脑梗死相关性痴呆存活率为53、7％，非痴呆患者存活率为92．0％。多因素分析显示脑梗死后痴呆与生存呈明显相关(RR=4．91，95％CI=3.85-13.49)，其余预测因素包括年龄(RR=1．12，95％CI=1.06～1.18)、Banhel指数(RR=1.63．95％CI=1．15—2.31)、心房纤颤(RR=1.47，95％CI=1.17～1.85)及脑梗死史(RR=2.81，95％CI=1.53～5.16)。结论：痴呆能降低脑梗死患者存活率，并可作为脑梗死后影响生存率的一个预测因素。     

阿司匹林在卒中二级预防中的获益与风险

脑卒中是老年人重要的致死、致残原因,调查资料显示,中国卒中的复发率占国际之首。阿司匹林是用于缺血性卒中二级预防的常用药物,在中国,阿司匹林100mg／d的剂量应用最为广泛,但此剂量能否有效减少缺血性卒中复发,是否会增加上消化道出血、颅内出血的风险性,针对这些问题,     

西洛他唑与阿司匹林对缺血性脑卒中二级预防的系统评价

目的系统评价西洛他唑对比阿司匹林在缺血性脑卒中二级预防中的有效性与安全性。方法计算机检索Cochrane图书馆(2009年4期)、PubMed(1980.1～2009.11),EMBASE(1980.1～2009.11)、中国生物医学文献数据库(1978.1～2009.11)、CNKI(1979.1～2009.11)等数据库,收集所有西洛他唑对比阿司匹林治疗缺血性脑卒中的随机对照试验(RCT)和交叉试验,提取数据,依据Cochrane Handbook 5.0.2推荐的方法评价纳入研究质量,采用RevMan5.0软件进行统计学分析。结果研究纳入2个随机对照试验和1个交叉对照试验,共838位受试者。其中1篇随机对照试验质量较高,1篇随机对照试验和交叉对照试验质量较低。Meta分析结果显示,西洛他唑组在治疗缺血性脑卒中患者的初期结果(30d[RR=3.00,95%CI(0.31,28.70)]、90d[RR=1.67,95%CI(0.40,6.92)]、180d[RR=1.25,95%CI(0.50,3.13)]、360d[RR=0.65,95%CI(0.33,1.29)]、540d[RR=0.80,95%CI(0.54,1.18)]);二期结果(30d[RR=4.00,95%CI(0.45,35.61)]、90d[RR=1.75,95%CI(0.52,5.93)]、180d[RR=1.00,95%CI(0.48,2.07)]、360d[RR=0.77,95%CI(0.45,1.29)]、540d[RR=0.66,95%CI(0.40,1.09)]);卒中复发率:西洛他唑组:RR=0.64,95%CI(0.31,1.30),阿司匹林组:RR=0.21,95%CI(0.04,1.06);血液中血小板衍生物水平(PDMP)[RR=1.00,95%CI(0.39,2.58)]方面与阿司匹林组差异无统计学意义。但西洛他唑组在颅内出血率[RR=7.14,95%CI(0.7,58.33)]等安全性指标的发生率低于阿司匹林组。结论西洛他唑与阿司匹林在缺血性脑卒中的二级预防方面疗效相似,且服用西洛他唑发生头晕、头痛、心动过速和心悸的概率高于服用阿司匹林,但服用西洛他唑颅内出血率和其他脏器出血率方面低于服用阿司匹林。由于部分纳入研究质量级别较低,所以两种药物对缺血性脑卒中的二级预防的治疗有待实施高质量大样本临床试验进一步验证。     

吸烟与2型糖尿病发生风险关系前瞻性研究的meta分析

目的 探讨吸烟与2型糖尿病的关系及风险效应.方法 采用meta分析方法,对国内外21篇关于吸烟与2型糖尿病关系 的前瞻性研究进行定量分析.结果 现吸烟、戒烟合并RR值(95％CI)分别为1.42(1.14,1.77),1.37(1.16,1.61),吸烟(＜20支/d)、吸烟(≥20支/d)合并RR值(95％CI)分别为1.12(0.87,1.43),1.45(1.03,2.04),男、女性吸烟合并RR值(95％CI)分别为1.35(1.15,1.60),0.77(0.63,0.96).结论 不同吸烟状态不仅是2型糖尿病发生的风险因素,且不同性别随着吸烟量的增加,2型糖尿病的发生风险不同.     

低分子肝素联合阿司匹林治疗进展性脑梗死疗效的Meta分析

目的 评价低分子肝素(low molecular weight heparin,LMWH)联合阿司匹林治疗进展性脑梗死的疗效及安全性.方法 计算机检索PubMed、EMBASE、Science Direct、OVID、Cochrane Library、CBMdisc、CNKI和万方数据库,同时手动检索纳入文献的参考文献,收集符合纳入标准的随机对照试验.运用RevMan 5.0.0软件进行Meta分析.结果 纳入16项随机对照试验共计1 554例受试者,其中试验组779例,对照组775例.两组基线资料均差异无统计学意义.其方法学质量有13篇为B级,3篇为C级.Meta分析结果显示:LMWH联合阿司匹林治疗进展性脑梗死可使患者的神经功能评分下降3.33(95％ CI=-4.15～-2.52,P＜0.01);临床总有效率优于单用阿司匹林或LMWH组,其相对危险度及95％ CI为(RR =1.18,95％ CI =1.13～1.23,P＜0.01);两组间不良反应的发生情况差异无统计学意义(RR =1.30,95％ CI =0.60～2.82,P＞0.05).结论 LMWH联合阿司匹林治疗进展性脑梗死疗效优于单用LMWH或阿司匹林.     

轻型缺血性卒中静脉溶栓后双重抗血小板治疗研究

目的 探讨轻型缺血性卒中重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rtPA)静脉溶栓治疗后3个月是否能够改善患者的预后,探索轻型缺血性卒中静脉溶栓后24小时,给予双重抗血小板药物治疗是否安全,能否降低患者的卒中复发率并改善预后.方法 传统静脉溶栓组22例,给予rt-PA静脉溶栓,24小时后复查头颅CT,排除脑出血转换后,给予阿司匹林100 mg,每日1次,口服治疗;联合静脉溶栓组23例,接受rt-PA静脉溶栓后24小时复查头颅CT,排除脑出血转换后,给予阿司匹林100 mg,每日1次,口服治疗,同时联合氯吡格雷75 mg,每日1次,口服治疗2周,然后继续单用阿司匹林药物治疗;未溶栓组25例,发病时间小于24小时,未接受rt-PA静脉溶栓的轻型卒中患者,常规予阿司匹林100mg,每日1次,口服治疗.3个月时评测美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)、改良Rankin量表评分(mRS),其中NIHSS评分0～1分、BI 95～100分、mRS为0～1分者定义为良好结局.评估3个月内脑出血率、病死率和脑梗死复发率.结果 3个月时,传统及联合静脉溶栓组良好结局的比例明显高于未溶栓组(P＜0.05,P＜0.01),传统静脉溶栓组和联合静脉溶栓组之间差异无统计学意义.未溶栓组脑梗死复发率明显高于溶栓组(P＜0.05).3组之间的脑出血率和病死率差异无统计学意义.结论 轻型缺血性卒中rt-PA静脉溶栓治疗可提高3个月内良好结局的比例、减少卒中的复发.轻型缺血性卒中rt-PA静脉溶栓后24小时,短期给予双重抗血小板治疗,不增加脑出血风险.     

三七皂甙联合阿司匹林预防脑梗死复发疗效观察

目的:探讨三七皂甙联合阿司匹林预防脑梗死复发的临床疗效.方法:2006年10月至2007年10月江阴市人民医院神经内科住院患者,明确诊断为急性脑梗死患者221例,随机分两组:对照组:阿司匹林100mg,每日一次口服,101例患者(男65例,女56例),观察组:120例患者(男68例,女52例).三七皂甙片200mg,每日3次口服;阿司匹林100mg,每日1次口服.观察2组1年内缺血性脑卒中的发生率,并于治疗后分别检测组血小板聚集率.结果:观察组1年内脑梗死再发率(5.83%)与对照组相比(17.82%),差异有统计学意义(P<0.05).治疗后观察组与对照组血小板聚集率相比,差异不具有统计学意义(P>0.05).结论:三七皂甙与阿司匹林联用,对预防缺血性卒中复发效果优于单用阿司匹林,可能与三七皂甙降低血小板聚集率,减少阿司匹林抵抗有关.     

Evaluation of Antiplatelet Agents for Secondary Prevention of Stroke Using Mixed Treatment Comparison Meta-analysis

Background

The current guidelines recommend various antiplatelet agents used alone or in combination for secondary prevention of noncardioembolic stroke.

Objective

The purpose of this study was to conduct a mixed treatment comparison meta-analysis to determine which antiplatelet or combination of antiplatelet agents is most efficacious and tolerable in patients with prior stroke.

Methods

A comprehensive literature search was conducted in MEDLINE (1945 through March 2012), EMBASE (1974 through March 2012), and the Cochrane Controlled Trials Registry (1975 through April 2012) to identify randomized trials evaluating the role of various antiplatelet agents and combinations for the secondary prevention of stroke. Key articles were cross-referenced for additional studies. Data were screened and evaluated to generate direct and indirect comparisons for recurrent stroke and overall hemorrhagic events. Data were reported as rate ratios (RRs) and 95% CIs.

Results

A total of 24 articles were included in the analysis. Eleven antiplatelet regimens were compared in >88,000 patients. The combination of acetylsalicylic acid (ASA) plus dipyridamole (DP) was more protective against recurrent stroke than ASA alone (RR = 0.78; 95% CI, 0.64–0.93), and no differences were found in all other direct and indirect comparisons with active treatment. ASA plus DP was associated with more overall hemorrhagic events than DP (RR = 1.83; 95% CI, 1.17–2.81), cilostazol (RR = 2.12; 95% CI, 1.21–3.48), and triflusal (RR = 1.67; 95% CI, 1.05–2.78) but fewer events than the combination of ASA plus clopidogrel (RR = 0.38; 95% CI, 0.25–0.56). The combination of ASA plus clopidogrel was associated with an excess of overall hemorrhagic events compared with clopidogrel (RR = 2.81; 95% CI, 1.96–4.10), cilostazol (RR = 5.56; 95% CI, 3.03–9.66), DP (RR = 4.78; 95% CI, 2.80–8.21), sarpogrelate (RR = 3.59; 95% CI, 1.96–6.45), terutroban (RR = 2.13; 95% CI, 1.21–3.61), ticlopidine (RR = 2.80; 95% CI, 1.69–5.00), and triflusal (RR = 4.36; 95% CI, 2.62–7.81).

Conclusion

We found that ASA plus DP was more protective than ASA alone for preventing recurrent stroke; however, no difference was found between most direct and indirect comparisons of antiplatelet agents and combinations. More overall hemorrhagic events seemed to occur with the combination of ASA and clopidogrel than with other treatments. Selection of antiplatelet therapy for the secondary prevention of stroke must be individualized according to patient comorbidities, including risk of stroke recurrence and bleeding.     

Fibrinogen gene variation and ischemic stroke

Summary.  Background : Plasma fibrinogen level and fibrin clot structure are heritable traits that may be of importance in the pathogenesis of ischemic stroke. Objectives : To investigate associations between variation in the fibrinogen gamma (FGG), alpha (FGA) and beta (FGB) genes, fibrinogen level, and ischemic stroke. Methods : The Sahlgrenska Academy Study on Ischemic Stroke comprises 600 cases and 600 matched population controls. Stroke subtypes were defined according to TOAST criteria. Plasma fibrinogen level was measured by an automated clot-rate assay. Eight tagging single nucleotide polymorphisms (SNPs) were selected to capture genetic variation in the FGA, FGG, and FGB genes. Results:  Plasma fibrinogen was independently associated with overall ischemic stroke and all subtypes, both in the acute stage ( P  < 0.001) and at three-month follow-up ( P  < 0.05). SNPs belonged to two haplotype blocks, one containing the FGB gene and the other the FGG and FGA genes. FGB haplotypes were associated with fibrinogen level ( P  < 0.01), but not with ischemic stroke. In contrast, FGG/FGA haplotypes showed independent association to ischemic stroke but not to fibrinogen level. In an additive model with the most common FGG/FGA haplotype (A1) as reference, the adjusted odds ratios of ischemic stroke were 1.4 [95% confidence interval (95% CI) 1.1–1.8], P  < 0.01, 1.4 (95% CI 1.0–1.8), P  < 0.05, and 1.5 (95% CI 1.0–2.1), P  < 0.05 for the A2, A3, and A4 FGG/FGA haplotypes, respectively. Conclusion:  FGG/FGA haplotypes show association to ischemic stroke. This association is independent of fibrinogen level, thus suggesting that the association between ischemic stroke and variation at the FGG/FGA genes is mediated by qualitative rather than quantitative effects on fibrin(ogen).     

Cardiovascular safety of lumiracoxib: a meta-analysis of all randomized controlled trials > or =1 week and up to 1 year in duration of patients with osteoarthritis and rheumatoid arthritis

BACKGROUND: The cardiovascular (CV) safety of non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 inhibitors has been the subject of considerable debate. OBJECTIVE: The objective of this study was to determine the risk of CV events with lumiracoxib by meta-analysis of all completed, randomized controlled trials (RCTs) of > or =1 week and up to 1 year in duration of patients with osteoarthritis and rheumatoid arthritis. METHODS: The Novartis Lumiracoxib Clinical Trial Database, which includes all clinical studies conducted to date with lumiracoxib, was reviewed. Data were extracted from RCTs of > or =1 week and up to 1 year in duration, the maximum study duration; 34,668 patients were included in standard and cumulative meta-analyses. Twenty-two RCTs of lumiracoxib 100 to 1200 mg daily were identified; 22,781 patients were included in 1-year trials. Mean age of the patients was 61.5 years and 74% were female. More than 50% of the patients in these studies had hypertension at baseline and 6% had diabetes. Parameters analyzed were the Antiplatelet Trialists' Collaboration (APTC) composite CV end point of myocardial infarction (MI), stroke (ischemic and hemorrhagic), and CV death; MI alone; and stroke alone. Twenty-one of the 22 RCTs have been published. RESULTS: For all 3 parameters, relative risk (RR) was calculated versus non-naproxen NSAIDs, naproxen, and placebo. The results were as follows: for the APTC end point versus non-naproxen NSAIDs: RR 0.83, 95% CI, 0.46-1.51; versus naproxen: RR 1.49, 95% CI, 0.94-2.36; versus placebo: RR 1.08, 95% CI, 0.41-2.86; for MI alone versus non-naproxen NSAIDs: RR 0.80, 95% CI, 0.28-2.25; versus naproxen: RR 1.69, 95% CI, 0.82-3.48; versus placebo: RR 1.27, 95% CI, 0.25-6.56; and for stroke alone versus non-naproxen NSAIDs: RR 0.91, 95% CI, 0.35-2.35; versus naproxen: RR 1.42, 95% CI, 0.70-2.91; versus placebo: RR 0.59, 95% CI, 0.13-2.74. Cumulative meta-analyses of lumiracoxib versus all comparators (placebo, diclofenac, ibuprofen, celecoxib, rofecoxib, and naproxen) did not find any significant differences in APTC, MI alone, or stroke alone. CONCLUSION: This meta-analysis of 34,668 patients receiving > or =1 week and up to 1 year of treatment found no evidence that lumiracoxib was associated with a significant increase in CV risk compared with naproxen, placebo, or all comparators (placebo, diclofenac, ibuprofen, celecoxib, rofecoxib, and naproxen).     

Incidence of adverse reactions to COVID-19 vaccination:A meta-analysis of randomized controlled trials

Objective:To systematically evaluate the incidence of adverse reactions to coronavirus disease 2019(COVID-19)vaccination.Methods:We systematically searched PubMed,Embase,The Cochrane Library,Web of Science,CNKI,WanFang Data,and VIP Database from the inception of each database to August 31,2021.Randomized controlled clinical trials(RCTs)on the safety of different types of COVID-19 vaccines were retrieved and analyzed.A random or fixed-effects model was used with an odds ratio as the effect size.The quality of each reference was evaluated.The incidence of the adverse reactions of the placebo group and the vaccination group was compared.Heterogeneity and publication bias were taken care of by meta-regression and sub-group analyses.Results:A total of 13 articles were included,with 81287 subjects.Compared with the placebo group,the vaccination group showed a higher combined risk ratio(RR)of total adverse reactions(RR=1.67,95%CI:1.46-1.91,P<0.01),local adverse reactions(RR=2.86,95%CI:2.11-3.87,P<0.01),systemic adverse reactions(RR=1.25,95%CI:0.92-1.72,P=0.16),pain(RR=2.55,95%CI:1.75-3.70,P<0.01),swelling(RR=4.16,95%CI:1.71-10.17,P=0.002),fever(RR=2.34,95%CI:1.84-2.97,P<0.01),fatigue(RR=1.36,95%CI:1.32-1.41,P<0.01)and headache(RR=1.22,95%CI:1.18-1.26,P<0.01).The subgroup analysis showed the incidence of adverse reactions of the vaccination group after injection of the three COVID-19 vaccines(inactivated viral vaccines,mRNA vaccines and adenovirus vector vaccines)was higher than that of the placebo group,and the difference between the placebo group and the vaccination group in the mRNA vaccine subgroup and the adenovirus vector vaccine subgroup was statistically significant(P<0.01).The incidence of adverse reactions after injection of COVID-19 vaccine in subgroups of different ages was significantly higher than that in the placebo group(P<0.01).Conclusions:COVID-19 vaccines have a good safety,among which adenovirus vector vaccine has the highest incidence of adverse reactions.Both adolescents and adults vaccinated with novel coronavirus vaccine have a certain proportion of adverse reactions,but the symptoms are mild and can be relieved by themselves.Our meta-analysis can help boost global awareness of vaccine safety,promote mass vaccination,help build regional and global immune barriers and effectively curb the recurrency of COVID-19.     

Severe vascular events in migraine patients

OBJECTIVE: To estimate rates of vascular events in relation to dispensing of triptans and ergot alkaloids among migraineurs, and to compare these rates with those of nonmigraineurs. CONTEXT: It has been speculated that the use of triptans or ergot alkaloid drugs might increase risk of ischemic events through vasoconstriction. Design: A retrospective cohort study of 130,411 migraineurs and 130,411 age-, sex-, and health plan-matched nonmigraineurs who were members of UnitedHealthcare during 1995 through 1999. The data source for this study was Ingenix's research database containing pharmacy and medical claims for UnitedHealthcare members, and the National Death Index. MAIN OUTCOME MEASURES: Incidence of cardiovascular and cerebrovascular events and mortality. RESULTS: Migraineurs and nonmigraineurs had identical rates of myocardial infarction: 1.4 per 1000 person-years. Migraineurs were 67% more likely to suffer a stroke than nonmigraineurs (adjusted relative risk [RR] 1.67, 95% confidence interval [CI] 1.31-2.13), and had higher rates of unstable angina and transient ischemic attacks. There was no increase in risk of myocardial infarction with current (adjusted RR 0.80, 95% CI 0.58-1.11) or recent (adjusted RR 1.15, 95% CI 0.71-1.87) triptan use. Neither current (adjusted RR 0.90, 95% CI 0.64-1.26) nor recent (adjusted RR 0.84, 95% CI 0.46-1.55) triptan use was associated with risk of stroke. Current users of ergot alkaloids were somewhat more likely to have a stroke than other migraineurs (adjusted RR 1.49, 95% CI 0.93-2.41), but there was no dose-response relationship. CONCLUSIONS: Use of triptans is not associated with increased risk of any ischemic events, including myocardial infarction and stroke, or mortality. Consistent with previous studies, migraineurs in general have an elevated risk of stroke, but not myocardial infarction, compared with nonmigraineurs.     

浙江省温州地区围生儿先天性心脏病相关因素病例对照研究

目的 探讨温州地区先天性心脏病（CHD）发病的相关影响因素,为CHD的病因学研究和制定预防措施提供科学依据。方法 本研究采用1:1病例对照研究,通过自行设计的调查问卷进行调查,采集温州地区2015-2016年围生儿中500名CHD患儿和500名正常儿童母亲的相关信息,采用单因素和多因素条件logistic回归分析进行CHD的相关因素分析。结果 单因素和多因素条件logistic回归分析结果显示,大专及以上文化程度、单胎妊娠、服用叶酸等为保护因素,OR值分别为0.741（95%CI:0.551~0.996）、0.191（95%CI:0.083~0.441）和0.528（95%CI:0.368~0.757）;接触化学物质、孕早期感冒、服促排卵药、接触宠物、居屋装修、染发、饮酒、异常生育史、丈夫吸烟9项为危险因素,OR值分别为9.033（95%CI:1.116~73.129）、1.616（95%CI:1.193~2.189）、17.333（95%CI:7.197~136.751）、2.679（95%CI:1.089~6.593）、15.240（95%CI:5.945~39.068）、3.030（95%CI:1.656~5.546）、8.448（95%CI:1.043~68.432）、3.028（95%CI:1.655~5.538）和1.336（95%CI:1.008~1.772）。结论 积极做好预防工作,针对危险因素进行有效干预,降低CHD的发生率,提高人口素质。     

Migraine and the risk of stroke, TIA, or death in the UK (CME)

BACKGROUND: Previous observational studies have reported a higher risk of stroke in migraine patients. Objective.- We aimed to estimate the risk of stroke, transient ischemic attack (TIA), or death in migraineurs in the UK. METHOD: We conducted a population-based follow-up study within the General Practice Research Database from 1994 to 2001. RESULTS: The relative risk (RR) of stroke in migraineurs compared with non-migraineurs was 2.2 (95% confidence interval [CI] 1.7-2.9). It was highest for patients with a migraine diagnosis recorded within 30 days prior to a stroke (odds ratio 11.1, 95% CI 5.69-21.5). The RR of TIA in migraineurs compared with non-migraineurs was 2.4 (95% CI 1.8-3.3), the mortality of migraineurs was slightly decreased. CONCLUSION: In our study, the RR of developing a stroke or a TIA was doubled in migraineurs as compared with non-migraineurs, while that for death was close to unity.     

BNP与hs-CRP联合检测对ST段抬高心肌梗死患者静脉溶栓效果的观察

目的通过持续12-导联ECGST段监测,评估血液中B型尿钠肽（BNP）、高敏C反应蛋白（hs—CRP）的检测对心肌梗死患者静脉溶栓效果预测的重要性。方法2003年8月到2007年12月间指标性疼痛发生6h内接受静脉内溶栓治疗的ST段拾高心肌梗死（sTEMI）连续患者共372例,溶栓失败是以静脉溶栓开始后90min内ST段恢复≤50％来认定。结果心肌梗死患者静脉溶栓失败率为57．4％,多变量Logistic回归分析BNP组（RR1．5;95％CI1．1～1．8,P=0．004高／中组;RR2．2,95％CI1．9～3．5,P=0．001高／低组;RR1．5,95％CI1．2～1．8,P=0．001中／低组）和hs—CRP组（RR2．0,95％CI1．6～2．2;P=0．001高／中组;RR2．6,95％CI 2．1～3．5,P=0．001高／低组;RR1.3,95％CI1．2～1．7,P=0．02中／低组）。均与溶栓失败的发生率显著相关。结论研究结果表明循环中BNP和hs—CRP的升高与溶栓失败的发生率显著相关。     

Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of-1.6 to -2.5 at the femoral neck: the Fracture Intervention Trial

OBJECTIVES: To determine the efficacy of alendronate treatment on risk of vertebral fracture in a subgroup of women from the Fracture Intervention Trial who had bone mineral density T scores between -1.6 and -2.5 at the femoral neck and to describe how soon after initiation of therapy alendronate becomes effective and whether it is consistent in women with and without existing radiographic vertebral fracture. PATIENTS AND METHODS: From May 1992 to March 1997, postmenopausal women aged 55 to 80 years were randomized to receive alendronate at 5 mg/d for 2 years and 10 mg/d thereafter or placebo for up to 4.5 years (mean, 3.8 years) in a controlled, double-blind, multicenter study. RESULTS: A total of 3737 postmenopausal women were included in the study, 1878 in the alendronate group and 1859 in the placebo group. Risk of vertebral fracture was significantly reduced by alendronate compared with placebo for clinical (relative risk [RR], 0.40; 95% confidence interval [CI], 0.19-0.76; P=.005) and radiographic (RR, 0.57; 95% CI, 0.41-0.81; P=-.002) fracture. The reductions in vertebral fracture risk were consistent in women with and without an existing radiographic vertebral fracture for clinical (RR, 0.34; 95% CI, 0.12-0.84; and RR, 0.46; 95% CI, 0.16-1.17; respectively) and radiographic (RR, 0.53; 95% CI, 0.34-0.82; and RR, 0.64; 95% CI, 0.38-1.10; respectively) fractures. In both groups, the effect of alendronate on clinical vertebral fracture was noted soon after therapy was initiated. The absolute risk of vertebral fracture was low in women without a baseline radiographic fracture. CONCLUSIONS: In women with low bone mass who do not meet the bone mineral density criterion for osteoporosis, alendronate is effective in reducing the risk of vertebral fractures. The absolute benefit of this therapy in women with a T score between -1.6 and -2.5 is greater in women with an existing vertebral fracture and/or with other risk factors. The effect of alendronate occurs early.     

Strict glycaemic control in patients hospitalised in a mixed medical and surgical intensive care unit: a randomised clinical trial

Introduction

Critically ill patients can develop hyperglycaemia even if they do not have diabetes. Intensive insulin therapy decreases morbidity and mortality rates in patients in a surgical intensive care unit (ICU) and decreases morbidity in patients in a medical ICU. The effect of this therapy on patients in a mixed medical/surgical ICU is unknown. Our goal was to assess whether the effect of intensive insulin therapy, compared with standard therapy, decreases morbidity and mortality in patients hospitalised in a mixed ICU.

Methods

This is a prospective, randomised, non-blinded, single-centre clinical trial in a medical/surgical ICU. Patients were randomly assigned to receive either intensive insulin therapy to maintain glucose levels between 80 and 110 mg/dl (4.4 to 6.1 mmol/l) or standard insulin therapy to maintain glucose levels between 180 and 200 mg/dl (10 and 11.1 mmol/l). The primary end point was mortality at 28 days.

Results

Over a period of 30 months, 504 patients were enrolled. The 28-day mortality rate was 32.4% (81 of 250) in the standard insulin therapy group and 36.6% (93 of 254) in the intensive insulin therapy group (Relative Risk [RR]: 1.1; 95% confidence interval [CI]: 0.85 to 1.42). The ICU mortality in the standard insulin therapy group was 31.2% (78 of 250) and 33.1% (84 of 254) in the intensive insulin therapy group (RR: 1.06; 95%CI: 0.82 to 1.36). There was no statistically significant reduction in the rate of ICU-acquired infections: 33.2% in the standard insulin therapy group compared with 27.17% in the intensive insulin therapy group (RR: 0.82; 95%CI: 0.63 to 1.07). The rate of hypoglycaemia (≤ 40 mg/dl) was 1.7% in the standard insulin therapy group and 8.5% in the intensive insulin therapy group (RR: 5.04; 95% CI: 1.20 to 21.12).

Conclusions

IIT used to maintain glucose levels within normal limits did not reduce morbidity or mortality of patients admitted to a mixed medical/surgical ICU. Furthermore, this therapy increased the risk of hypoglycaemia.

Trial Registration

clinicaltrials.gov Identifiers: 4374-04-13031; 094-2 in 000966421