中国幽门螺杆菌耐药状况以及耐药对治疗的影响—— 全国多中心临床研究

随着幽门螺杆菌（H．pylori）根除治疗的广泛开展，H．pylori对抗生素的耐药率逐年上升，并成为含质子泵抑制剂（PPI）三联疗法根除率下降的主要原因。了解我国H．pylori对抗生素的总体耐药情况，对指导我国临床医师开展H．pylori根除治疗有重要参考价值。目前这方面的资料尚少。目的：了解我国H．pylori对抗生素（甲硝唑、克拉霉素和阿莫西林）的耐药情况以及耐药对三联7d疗法根除H．pylori治疗的影响。方法：采用全国多中心随机对照临床研究。共纳入910例因上消化道症状而接受胃镜检查的H．pylori感染者．所有患者随机分为两个治疗组：LCA组，兰索拉唑30mg bid，克拉霉素500mg bid，阿莫西林1000mg bid；LCM组，兰索拉唑30mg bid，克拉霉素500mg bid，甲硝唑400mg bid。疗程均为7d，均行H．pylori培养。H．pylori分离菌株采用E-test法行甲硝唑、克拉霉素和阿莫西林药敏实验，甲硝唑最低抑菌浓度（MIC）≥8mg／L、克拉霉素MIC≥2mg／L、阿莫西林MIC≥1mg／L判断为耐药。结果：910例患者中，LCA组和LCM组的H．pylori按方案（PP）分析根除率分别为82．7％和68．6％（P〈0．001）。340例H．pylori菌株培养阳性。H．pylori对甲硝唑、克拉霉素和阿莫西林的耐药率分别为75．6％、27．6％和2．7％。LCM组对甲硝唑和克拉霉素均敏感和均耐药菌株的PP根除率分别为84．4％和42．1％（P〈0．001）。LCA组对克拉霉素敏感和耐药菌株的PP根除率分别为91．6％和58．1％（P〈0．001）。结论：中国H．pylori菌株对甲硝唑和克拉霉素的耐药率均较高．对阿莫西林的耐药率较低。H．pylori对抗生素耐药是导致根除治疗失败的主要原因。     

上海市青浦区幽门螺杆菌抗生素耐药情况的研究

背景：幽门螺杆菌（H．pylori）对抗生素的耐药率在世界范围内呈上升趋势,但存在地域差异。目的：调查上海市青浦区H．pylori对5种根除治疗方案中常用抗生素的耐药情况。方法：选取青浦区两所医院因上消化道症状行胃镜检查、快速尿素酶试验阳性并符合纳入和排除标准的患者,取胃窦黏膜分离培养H．pylori．采用Kirby-Bauer纸片扩散法行药敏试验。结果：成功分离培养出120株H．pylori临床菌株,对甲硝唑、阿莫西林、克拉霉素、左氧氟沙星和呋喃唑酮的耐药率分别为82．5％、22．5％、36．7％、41．7％和0．8％。耐药率与患者性别无关;慢性胃炎菌株对左氧氟沙星的耐药率显著高于十二指肠溃疡菌株（P〈0．05）。60．8％的菌株对两种以及两种以上抗生素联合耐药。结论：青浦区H．pylori对甲硝唑、阿莫西林、克拉霉素、左氧氟沙星的耐药情况相当严重且多重耐药率高。初次根除治疗失败后．再次治疗时可在药敏试验指导下选择有效抗生素。呋喃唑酮可作为当地根除治疗方案的一线用药．     

贵阳地区儿童感染幽门螺杆菌的分离培养及耐药性检测

目的:了解贵阳地区儿童感染幽门螺杆菌(Helicobacter pylori,H.pylori)临床分离株对常用抗H.pylori抗生素甲硝唑、克拉霉素、阿莫西林等的体外敏感性,以指导临床用药根除H.pylori感染.方法:收集2011-10/2014-06贵阳市儿童医院行胃镜检查的患儿胃黏膜标本进行H.pylori分离培养,对分离鉴定后的菌株采用界值法进行甲硝唑、克拉霉素、阿莫西林、左氧氟沙星的敏感性试验.结果:从434例患儿胃黏膜中培养出H.pylori63株(14.5%),63例H.pylori菌株中3株为敏感菌株,60株为耐药菌株,其对甲硝唑、克拉霉素、阿莫西林、左氧氟沙星的耐药率分别为57.1%、85.7%、38.1%、90.5%.二重、三重、四重耐药率分别为90.5%(57/63)、57.1%(36/63)、38.1%(24/63).结论:贵阳地区儿童感染H.pylori对阿莫西林敏感性高于对其他常用药物的敏感性;对左氧氟沙星和克拉霉素的耐药率较高,并且多重耐药率较高.     

幽门螺杆菌对左氧氟沙星耐药的研究

背景：耐药菌株的出现是近年来药物根除幽门螺杆菌（H．pflori）成功率下降的主要原因，尤其是对常用抗生素克拉霉素和甲硝唑耐药。左氧氟沙星是一个新近用于根除H．pylori的抗生素，含左氧氟沙星的方案是有效的补救方案，但关于左氧氟沙星的耐药率以及耐药机制目前知之甚少。目的：监测H．pylori对左氧氟沙星的耐药率，观察耐药倾向．探讨可能的耐药机制。方法：对2003年在仁济医院内镜中心行胃镜检查的连续26株临床菌株行左氧氟沙星、克拉霉素和甲硝唑敏感性试验；选取8株敏感株（2株标准菌株）行左氧氟沙星体外选择耐药试验；以修饰内切酶位点的指定引物人工将Hinf Ⅰ酶切位点引入左氧氟沙星耐药菌株（体外人工选择分离株和临床株）的聚合酶链反应（PCR）产物．然后以Hinf Ⅰ行酶切以鉴别gyrA基因91位密码子是否存在突变。结果：左氧氟沙星的耐药率为3．8％（1/26），2株对克拉霉素耐药的菌株均对左氧氟沙星敏感。体外选择耐药试验的8株菌株中有5株选择分离出耐药菌株，但均为低度耐药菌株。4株体外人工选择分离耐药菌株均为gyrA基因喹诺酮耐药决定区域（QRDR）中编码Asp91的密码子突变，5株临床耐药株中有4株为91位密码子突变。结论：目前Mpylori对左氧氟沙星的耐药率低．左氧氟沙星是较好的根除H．pylori方案的可选药物之一。由于体外试验较易选择出耐药，因此需监测左氧氟沙星的耐药率。gvrA基因0RDR中编码91位Asp的密码子突变在左氧氟沙星的耐药机制中占主导地位。     

兰索拉唑三联疗法根除幽门螺杆菌的疗效及耐药研究

目的 研究以兰索拉唑为基础的不同治疗方案对幽门螺杆菌(H.pylori)根除率的影响并了解湖南地区H.pylori 耐药情况.方法 将76例H.pylori感染患者分成兰索拉唑加克拉霉素、阿莫西林组(LCA组)38例和兰索拉唑加克拉霉素与甲硝唑组(LCM组)38例,治疗1周,治疗前采用快速尿素酶试验(RUT)、14C-尿素呼气试验(14C-UBT)、组织学检查筛选,入选患者进行H.pylori培养及药物敏感性检测.治疗后停用抗生素至少4周行14C-UBT复查.结果 LCA组共有31例完成治疗,26例H.pylori 被根除, 根除率为83.87%;LCM组共有35例完成治疗,21例H.pylori 被根除, 根除率为60.00%.LCA组根除率明显高于LCM组(P＜0.05).阿莫西林、克拉霉素及甲硝唑耐药率分别为0.00%、28.00%和92.00%,对克拉霉素及甲硝唑均耐药率为24.00%;两组药物副作用发生率比较无明显差别(P＞0.05).结论 (1) 兰索拉唑联合克拉霉素、阿莫西林组较联合克拉霉素与甲硝唑组H.pylori根除率高;(2)湖南地区H.pylori对甲硝唑耐药率最高(92.00%),克拉霉素次之(28.00%).尚未发现对阿莫西林耐药的菌株.     

山西省243株幽门螺杆菌药物敏感性及克拉霉素耐药基因突变特征分析

目的 了解山西幽门螺杆菌（Helicobacter pylori,H.pylori）对5种抗生素药物敏感性及其克拉霉素耐药相关基因突变特征.方法 收集临床分离的H.pylori243株,采用纸片扩散法检测H.pylori对5种抗菌药物的敏感性.选取所有耐克拉霉素及相当数量的敏感菌株,提取基因组DNA,PCR法扩增23SrRNA基因功能区并测序,测序结果采用DNAStar软件包分析.统计结果分析采用x2检验和Fisher精确概率法.结果 临床分离的243株H.pylori,药敏结果显示对甲硝唑,克拉霉素,阿莫西林,左氧氟沙星和呋喃唑酮5种药物的耐药率分别为：75.3％（183/243）,7.4％（18/243）,7.4％（18/243）,12.4％（30/243）,8.6％（21/243）,5种药物的耐药率有统计学意义（P＜0.05）.结论 H.pylori临床菌株对甲硝唑,左氧氟沙星,克拉霉素、阿莫西林及呋喃唑酮存在不同程度的耐药,以对甲硝唑耐药率最高.克拉霉素耐药菌株23SrRNA基因突变以A2143C为主,此突变可能与该地区H.pylori耐药性有关,此外,还发现了A2214G位点的突变.     

枸橼酸铋钾对幽门螺杆菌耐药菌株体外抗菌活性研究

目的铋制剂被广泛应用于幽门螺杆菌（H．pylori）感染的根除治疗，目的在于了解枸橼酸铋钾在体外对H．pylori耐药菌株是否存在抗菌活性及枸橼酸铋钾在体外对甲硝唑和克拉霉素抗H．pylori耐药菌株活性的影响。方法选取H．pylori标准菌株NCTC11637（对照）和8株l临床分离H．pylori耐药菌株作为实验菌株：抑菌研究采用琼脂稀释法测定枸橼酸铋钾对H．pylori菌株的最小抑菌浓度（MIC），通过E试验法在含枸橼酸铋钾培养基和普通培养基上分别测定甲硝唑或克托霉素对H．pylori菌株的MIC值。杀菌研究采用时间一杀菌曲线法，分别在含有枸橼酸铋钾、甲硝唑、克拉霉素及枸橼酸铋钾与甲硝唑或克拉霉素混合物的液体培养基中对H．pylori标准菌株NCTC11637及l临床分离的H．pylori耐药菌株进行培养，分别计算空白对照组和各实验组0、4、8、24h的细菌数量，采用半对数法绘制时间-杀菌曲线：结果枸橼酸铋钾对H．pylori标准菌株及临床分离的H．pylori耐药菌株平均MIC值为2．6mg／L（铋）：枸橼酸铋钾降低甲硝哗和克拉霉素对H．pylori耐药菌株的MIC值。枸橼酸铋钾1mg／L（铋）对标准菌株H．pylori11637具有明显的体外杀菌作用，4mg／L（铋）对临床分离耐药菌株也具有明显的体外杀菌作用，其杀菌效果随剂量增加而增强：、枸橼酸铋钾与抗生素混合物对H．pylori标准菌株及临床耐药菌株的体外杀菌作用增强。结论枸橼酸铋钾对H．pylori标准菌株及临床分离的H．pylori耐药菌株均有体外抑菌和杀菌作用，并且与甲硝唑或克拉霉素联用对标准菌株及临床分离的H．pylori耐药菌株具有体外协同抑菌或杀菌作用。     

克拉霉素耐药幽门螺杆菌株的基因型分布

背景：根除幽门螺杆菌（H.pylori）治疗在临床上的应用日益普遍。耐药菌株的出现是近年H.pylori根除率下降的主要原因,尤其是目前根除治疗作用最强的抗生素之一——克拉霉素。目的：研究克拉霉素耐药H.pylori菌株的基因型分布,为快速检出抗生素耐药提供基础。方法：以琼脂稀释法筛选出2002年9月～2003年2月13株原发性、22株获得性克拉霉素耐药H.pylori菌株,提取基因组DNA。聚合酶链反应（PCR）-反向斑点杂交法检测克拉霉素耐药H.pylori菌株23SrRNA基因中7种不同的点突变（A2115G、G2141A、A2142G、A2142C、A2143G、A2143C和A2142T）。结果：34株（97.1%）克拉霉素耐药H.pylori菌株发生A2143G突变,其中13株为原发性,21株为获得性;1株（2.9%）获得性耐药菌株发生A2142G突变。结论：我国克拉霉素耐药H.pylori菌株基因型以23SrRNA基因A2143G突变占主导地位,与欧美国家报道的A2142G和A2143G突变率相近不同。     

江津地区幽门螺杆菌耐药情况分析

目的分析江津地区幽门螺杆菌(H.pylori)的耐药情况,探讨对H.pylori耐药菌株合理使用抗生素的方法。方法对首次做胃镜检查H.pylori尿素酶试验阳性的患者,检查前2周内未服用过抗菌、铋剂等药物,用琼脂稀释法和E-test法检测H.pylori对阿莫西林、克拉霉素和甲硝唑的耐药情况,同时行药敏试验检测H.pylori的药物敏感情况。结果江津地区H.pylori菌株对阿莫西林、克拉霉素、甲硝唑和克拉霉素双重耐药分别为1.8%(1/57)、15.8%(9/57)和54.4%(31/57);H.pylori菌株对呋喃唑酮高度敏感,对左氧氟沙星、青霉素敏感。不同性别和病种对甲硝唑和克拉霉素的耐药率无显著性差异(P>0.05)。结论重庆市江津地区H.pylori对甲硝唑和克拉霉素耐药现象已经相当普遍,对阿莫西林的耐药情况也不容忽视。医生应选择敏感药物使用,必要时适当延长抗H.pylori用药时间以增强疗效。     

广东珠海地区慢性胃炎患者幽门螺杆菌的体外多重耐药性研究

目的分析广东珠海地区幽门螺杆菌（Hp）临床分离株体外多重耐药特点,为临床根除Hp治疗提供依据。方法对珠海地区312例经胃镜确诊、活检快速尿素酶试验阳性的慢性胃炎患者行Hp分离及菌株培养,采用折点敏感试验方法测定Hp对甲硝唑、呋喃唑酮、阿莫西林、克拉霉素的单药及多药耐药情况。结果共获得95株Hp菌株,其对4种抗生素耐药率由高到低依次为甲硝唑、呋喃唑酮、阿莫西林、克拉霉素,双重耐药率为30．53％-58．95％,多重耐药率26．32％～37．89％。结论广东珠海地区Hp多重耐药情况严重,行根除Hp治疗时应尽量避免应用甲硝哗：府进行药敏试验,寻求个体化治疗方案。     

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。