芬太尼与5-氟尿嘧啶联合诱导MCF-7乳腺癌细胞凋亡及其机制

目的研究芬太尼与5-氟尿嘧啶(FU)联合应用对MCF-7乳腺癌细胞凋亡的影响及内、外源性途径的调控机制。方法作用48 h后通过流式细胞技术(FCM)检测Annexin V-EGFP/PI染色的细胞凋亡情况,通过免疫细胞化学检测Bcl-2、Bax、Fas表达情况。结果单独应用芬太尼时1μmol/L与10μmol/L浓度组凋亡率均增加(P0.05,P0.01),Bcl-2表达减弱(P0.05,P0.01)、Bax表达增强(P0.01)、Fas表达增强(P0.01);单独应用500μmol/L 5-FU后凋亡率亦明显增加(P0.01),Bcl-2表达减弱(P0.01)、Bax、Fas表达增强(P0.01);联合应用芬太尼与5-FU,协同作用在3组均显现(P0.05,P0.01)。结论芬太尼、5-FU在一定浓度范围内单独或联合应用可促进MCF-7乳腺癌细胞凋亡,并使Bcl-2表达下调,Bax、Fas表达上调。联合应用两类药物可能在内源性、外源性途径调控细胞凋亡上显示协同效应。     

罗格列酮对高糖诱导RIN-m细胞凋亡的作用及其机制探讨

目的探讨罗格列酮对高糖诱导的RIN-m细胞凋亡作用及其机制。方法采用分别含5.5 mmol/L葡萄糖、33.3 mmol/L葡萄糖、5.5 mmol/L葡萄糖＋10μmol/L罗格列酮及33.3 mmol/L葡萄糖＋50μmol/L罗格列酮的培养液培养RIN-m细胞。以放射免疫法检测胰岛素分泌水平。以流式细胞仪及TUNEL法检测RIN-m细胞凋亡情况。同时行免疫细胞化学染色,半定量分析Bcl-2和Bax的表达。RT-PCR检测胰腺十二指肠同源盒-1（PDX-1）mRNA表达。结果长期高糖可导致RIN-m细胞胰岛素分泌功能下降、凋亡率增加2.7倍（P〈0.05）。罗格列酮可以增加高糖环境下RIN-m细胞胰岛素的分泌、降低RIN-m细胞凋亡率（P〈0.05）。长期高糖可以降低RIN-m细胞Bcl-2/Bax的比例,并下调PDX-1 mRNA表达（P〈0.05）。10μmol/L罗格列酮即可增加高糖环境下RIN-m细胞Bcl-2/Bax表达的比例及上调PDX-1 mRNA表达（P均〈0.05）。结论罗格列酮对RIN-m细胞有直接的保护作用,这种保护作用可能与罗格列酮增加了Bcl-2/Bax表达比例和上调PDX-1 mRNA表达,进而抑制RIN-m细胞凋亡有关。     

大蒜素对高糖环境人心脏成纤维细胞的影响

目的 观察大蒜素对高糖环境人心脏成纤维细胞（HCFs）增殖和凋亡的影响及其作用机制。方法 贴壁法培养HCFs，体外建立高糖诱导的HCFs增殖模型，分为对照组（5.5 mmol/L）、高糖组（25 mmol/L）以及高糖联合不同浓度的大蒜素组（分别为2.5μg/mL、5μg/mL、10μg/mL、20μg/mL）。应用MTT比色、瑞氏-吉姆萨染色倒置生物显微镜、Hochest 33258染色荧光显微镜、流式细胞分析技术、半胱氨酸蛋白酶-3(Caspase-3)活性测定、Western blot检测等方法观察大蒜素对HCFs增殖和凋亡的作用。结果 与对照组比较，高糖组细胞增殖增加，B细胞淋巴瘤-2(Bcl-2)增加，Bcl-2相关X蛋白（Bax）降低。与高糖组比较，大蒜素各组细胞增殖降低，细胞凋亡率及Casepas-3水平提高，高糖联合10μg/mL大蒜素组及高糖联合20μg/mL大蒜素组Bcl-2减低，Bax增加，差异均有统计学意义（P <0.05）。不同浓度大蒜素处理高糖环境HCFs 72 h，可见到细胞增殖受到抑制，细胞数较高糖组有所减少，染色质浓缩、边集、碎裂，凋亡细胞增多。...     

TFP5抑制高糖诱发的细胞周期依赖性激酶5过度激活、减少胰岛β细胞凋亡

目的：探讨TFP5对高糖诱发的细胞周期素依赖性激酶5（Cdk5）活性的抑制作用及其对胰岛β细胞的保护作用。方法体外培养小鼠胰岛细胞株Min6。将TFP5转染Min6细胞,分别用免疫印迹和免疫荧光观察其表达。实验分3组：低糖（5mmol/L）组,高糖（25mmol/L）＋空病毒载体（EV）组和高糖（25mmol/L）＋TFP5组,分别用同位素标记法测定3组细胞内Cdk5激酶活性;用酶联免疫吸附法测定3组细胞胰岛素分泌水平;用免疫印迹法测定胰岛β细胞凋亡。结果（1）表明TFP5来源和它的分子序列;（2）TFP5在Min6细胞内表达良好;（3）在高糖＋TFP5组Cdk5的活性明显低于高糖＋EV组（ P＜0.01）,而且在高糖＋TFP5组胰岛素分泌明显高于高糖＋EV组（P＜0.01）;（4）在高糖组Min6细胞的Bax表达增加,Bcl-2表达减少,Bax/Bcl-2比值升高,细胞凋亡增加（P＜0.01,vs 低糖组）,而加入TFP5后,Bax表达减少,Bcl-2表达增加,Bax/Bcl-2的比值减低（P＜0.01,vs 高糖组）,细胞的凋亡减少。结论 TFP5可抑制高糖诱发的Cdk5激酶的过度活性、减少高糖刺激下胰岛细胞凋亡,从而恢复胰岛素分泌,具有潜在的以Cdk5为靶点治疗2型糖尿病的前景。     

Syk对高糖诱导的H9c2心肌细胞凋亡的影响及其机制研究

目的 探讨脾酪氨酸激酶(Syk)对高糖诱导的H9c2心肌细胞凋亡的影响及其机制.方法 将体外培养的H9c2心肌细胞分为5组:对照组(5.5 mmol/L葡萄糖,NG组)、高糖组(33 mmol/L葡萄糖,HG组)、Syk抑制剂对照组(5.5 mmol/L葡萄糖+1μmol/L BAY,NG+ BAY组)、Syk抑制剂高糖组(33 mmol/L葡萄糖+1μmol/L BAY,HG+ BAY组)、甘露醇高渗透压对照组(5.5 mmol/L葡萄糖+27.5 mmol/L甘露醇,OC组).采用Western印迹方法检测磷酸化Syk(p-Syk)、cleaved-caspase-1及Bax、Bcl-2的蛋白水平;逆转录PCR检测caspase-1、Bax、Bcl-2 mRNA的表达;流式细胞仪检测H9c2心肌细胞凋亡率;MTT比色法检测细胞活力.结果 与NG组相比,HG组H9c2心肌细胞活力下降(F=37.3,P<0.05)、凋亡率增加(F=46.5,P<0.05),OC组、NG+ BAY组细胞凋亡率与细胞活力差异均无统计学意义(P均>0.05);且HG组p-Syk、cleaved-caspase-1及Bax表达增加,Bcl-2表达降低(F=8.4、80.5、7.6、37.4,P均<0.05),caspase-1及Bax mRNA表达升高,Bcl-2 mRNA表达降低(F=130.7、17.8、7.18,P均<0.05);与HG组相比,HG+ BAY组细胞活力升高(F=37.3,P <0.05)、细胞凋亡率降低(F=46.5,P<0.05),且cleaved-caspase-1及Bax表达降低,Bcl-2表达水平升高(F =80.5、7.6、37.4,P均<0.05),caspase-1及Bax mRNA表达降低,Bcl-2 mRNA表达升高(F=130.7、17.8、7.18,P均<0.05).结论 在高糖条件下,Syk可诱导心肌细胞凋亡,其作用是通过调控Bax、Bcl-2的表达.     

mTOR抑制剂PP242对高糖诱导足细胞损伤保护机制的实验研究

目的探讨高糖诱导的小鼠肾足细胞增殖、凋亡和Podocin蛋白表达的变化以及哺乳动物雷帕霉素靶蛋白(mTOR)抑制剂PP242的干预效应。方法以体外培养的条件永生性的小鼠肾足细胞为研究对象,将足细胞分为4组。正常组给予葡萄糖5.5 mmol/L;高糖组给予葡萄糖30 mmol/L;PP242干预1组给予葡萄糖30 mmol/L、1μmol/L PP242; PP242干预2组给予葡萄糖30 mmol/L、10μmol/L PP242。用四甲基偶氮唑蓝(MTT)法检测PP242对高糖诱导的足细胞增殖的影响,用流式细胞仪检测PP242对高糖诱导的足细胞凋亡的影响,用Western Blot方法检测PP242对高糖诱导的足细胞Podocin蛋白表达。结果高糖诱导足细胞48 h后,与正常组比较,高糖组细胞增殖减少,细胞凋亡增加,Podocin蛋白表达降低,差异均有统计学意义(P0.05)。高糖诱导经PP242干预后,与高糖组比较,PP242干预1组、PP242干预2组足细胞增殖增加,足细胞凋亡减少,Podocin蛋白表达明显升高,差异均有统计学意义(P0.05)。结论 PP242可以部分减少高糖诱导的足细胞损伤,具有潜在的足细胞保护作用。     

微小RNA-34a调控高糖诱导H9c2心肌细胞凋亡的初步研究

目的探讨微小RNA-34a(miR-34a)对高糖诱导的H9c2心肌细胞凋亡的影响。方法将培养的H9c2心肌细胞随机分为3组:正常组(葡萄糖浓度5.5mmol/L)、高糖组(葡萄糖浓度33mmol/L),抑制剂组(miR-34a抑制剂浓度50nmol/L+葡萄糖33mmol/L)。采用定量PCR检测miR-34a和凋亡相关基因Bcl-2基因表达的变化,Western blot检测凋亡相关蛋白Bcl-2表达的变化;采用流式细胞术检测细胞凋亡。结果与正常组比较,高糖组心肌H9c2细胞凋亡率明显升高(P<0.05),H9c2细胞miR-34a表达显著上调(P<0.05),H9c2细胞Bcl-2mRNA和蛋白表达减少(P<0.05)。与高糖组比较,抑制剂组H9c2细胞凋亡明显下降(P<0.05),H9c2细胞Bcl-2mRNA和蛋白表达明显升高(P<0.05)。结论 miR-34a能调控高糖所致的H9c2心肌细胞凋亡,可能是通过直接抑制抗凋亡基因Bcl-2的表达而实现的。     

内源性途径调控芬太尼与5-氟尿嘧啶联合诱导的MCF-7乳腺癌细胞凋亡

目的探讨芬太尼与5-氟尿嘧啶(FU)联合应用对MCF-7乳腺癌细胞凋亡的影响及内源性途径的调控机制。方法作用48 h后通过流式细胞技术检测亚二倍体峰细胞凋亡情况,通过Western印迹检测Bcl-2、Bax表达情况。结果 1μmol/L及10μmol/L浓度的芬太尼单独应用均引起凋亡率增加(P0.01),Bcl-2表达减弱(P0.01),Bax表达增强(P0.05,P0.01);5-FU单独应用后凋亡率亦明显增加(P0.01),Bcl-2表达减弱(P0.01),Bax表达增强(P0.01);三种浓度芬太尼与5-FU联合应用均具有协同作用(P0.05,P0.01)。结论一定浓度的芬太尼、5-FU及联合应用48h对MCF-7乳腺癌细胞有促进凋亡作用,并显著下调Bcl-2表达、上调Bax表达,两药联合应用启动内源性凋亡途径具有协同作用。     

艾塞那肽对高糖诱导的小鼠足细胞损伤的保护作用及机制研究

目的探讨艾塞那肽对高糖诱导的小鼠足细胞损伤的作用及相关机制。方法将足细胞系MPC5细胞按照不同葡萄糖培养浓度和干预因素分为以下5组:正糖对照组(5.5 mmol/L葡萄糖,n=3)、甘露醇高渗对照组(5.5 mmol/L葡萄糖+19.5 mmol/L甘露醇,n=3)、高糖组(25.0 mmol/L葡萄糖,n=3)、高糖+艾塞那肽组(25.0 mmol/L葡萄糖+100 nmol/L艾塞那肽,n=3)和高糖+艾塞那肽+LY294002组(25.0 mmol/L葡萄糖+100 nmol/L艾塞那肽+50μmol/L磷脂酰肌醇-3-激酶抑制剂LY294002,n=3)。采用原位缺口末端标记法荧光染色观察细胞凋亡,膜联蛋白Ⅴ-异硫氰酸荧光素/碘化丙啶双染法检测细胞凋亡率,Western blot检测细胞内裂孔膜肾病蛋白(nephrin)、磷酸化蛋白激酶B(p-AKT)以及磷酸化Bcl-xL/Bcl-2相关死亡启动子(p-BAD)水平。多组间比较采用单因素方差分析,组间多重比较采用最小显著性差异t检验。结果与正糖对照组和甘露醇高渗对照组比较,高糖组足细胞凋亡率显著增加[分别为(28.60±2.65)%、(4.50±0.75)%和(4.55±0.65)%,t=-19.19、-19.15,均P<0.01],细胞内nephrin蛋白表达降低(分别为0.22±0.03、0.72±0.06和0.73±0.08,t=11.43、11.52,均P<0.01),p-AKT和p-BAD蛋白表达下调(分别为0.14±0.03、0.83±0.06和0.86±0.04,0.16±0.03、0.66±0.06和0.68±0.04,均P<0.01)。与高糖组比较,高糖+艾塞那肽组足细胞凋亡率显著下降,细胞内nephrin表达升高,p-AKT和p-BAD蛋白表达上调(均P<0.01)。而高糖+艾塞那肽+LY294002组较高糖+艾塞那肽组足细胞凋亡率增加,细胞内nephrin蛋白表达降低,p-AKT和p-BAD蛋白表达下调(均P<0.05)。结论艾塞那肽通过上调足细胞中nephrin蛋白表达和减少足细胞凋亡从而保护高糖诱导的足细胞,其机制可能与激活AKT/BAD信号途径有关。     

阿托伐他汀通过调节Bcl-2/Bax蛋白表达抑制高糖诱导的人脐静脉内皮细胞凋亡

目的研究阿托伐他汀对高浓度葡萄糖诱导的人脐静脉内皮细胞凋亡的影响以及其分子机制。方法将培养的人脐静脉内皮细胞与不同浓度的葡萄糖(5.6 mmol/L、17.6 mmol/L、33.3 mmol/L)及阿托伐他汀(0.1μmol/L、1μmol/L、10μmol/L)作用24 h后用吖啶橙/溴化已啶荧光染色观察凋亡细胞形态,四甲基偶氮唑蓝比色法测定人脐静脉内皮细胞增殖率,流式细胞仪和W estern Blotting分别检测细胞早期凋亡率及Bcl-2/Bax蛋白表达。结果随着葡萄糖浓度的增加,人脐静脉内皮细胞增殖率逐渐降低(P0.05),细胞早期凋亡率逐渐升高(P0.05)。人脐静脉内皮细胞Bcl-2蛋白表达逐渐减弱,Bax蛋白表达逐渐增强。用不同浓度的阿托伐他汀干预后,人脐静脉内皮细胞的增殖率逐渐升高(P0.05),而凋亡率逐渐降低(P0.05);人脐静脉内皮细胞Bcl-2蛋白表达逐渐增强,Bax蛋白表达逐渐减弱。其中,与高糖组比较,10μmol/L阿托伐他汀干预组能提高Bcl-2蛋白表达(P0.05),抑制Bax蛋白表达(P0.05)。结论阿托伐他汀可能通过调节Bcl-2/Bax蛋白表达抑制高浓度葡萄糖诱导的人脐静脉内皮细胞凋亡。     

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     

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。     

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.