糖尿病患者维生素D受体基因多态性与骨质疏松的相关性

目的:观察糖尿病患者与正常人之间以及不同骨量的糖尿病患者之间维生素D受体基因型的分布差异。方法:选自青岛市内分泌糖尿病研究所内分泌科1998-09/2001-01住院糖尿病患者122例为糖尿病组,诊断参照WHO1999年新标准,并且除外重度吸烟、嗜酒者、肾功能损害者及服用影响骨代谢药物者。2型糖尿病组68例,1型糖尿病组54例。以中国骨质疏松症建议诊断标准为依据诊断骨质疏松和骨量减少。糖尿病组骨量正常58例(男/女=33/25),骨量减少30例(男/女=15/15),骨质疏松34例(男/女=17/17)。并以青岛市内分泌糖尿病研究所62名体检健康成年人为对照组,采用聚合酶链反应限制性片段长度多态性技术对其进行维生素D受体,基因(A-paI,TaqI位点)型检测,并计算其基因分布频率。结果:①1型糖尿病组、2型糖尿病组与健康人维生素D受体基因型分布频率的比较1型糖尿病组Tt基因型的分布频率有增高趋势(1型糖尿病组14.8%,2型糖尿病组7.4%,对照组4.8%,P=0.068)。②维生素D受体基因多态性与糖尿病性骨质疏松的相关性:在糖尿病患者群中,aa基因型在骨量减少和骨质疏松患者中分布频率显著高于糖尿病骨量正常者(骨量减少组63.3%,骨质疏松组73.5%,骨量正常组41.3%,P<0.05),Aa基因型分布频率显著低于骨量正常者(骨量减少组26.7%,骨质疏松组26.5%,骨量正常组44.8%,P<0.05),糖尿病骨质疏松患者中未检出AA基因型。结论:在糖尿患者群中,维生素D受体基因分布与健康人差异不显著。糖尿病患者对应于ApaI酶切位点的维生素D受体基因多态与骨质疏松存在相关性,对应于TaqI酶切位点的维生素D受体基因多态与1型糖尿病的发生有相关趋势,对糖尿病骨质疏松的发生有一定的预测价值。     

糖尿病患者维生素D受体基因多态性与骨质疏松的相关性

目的：观察糖尿病患者与正常人之间以及不同骨量的糖尿病患者之间维生素D受体基因型的分布差异。方法：选自青岛市内分泌糖尿病研究所内分泌科1998-09／2001-01住院糖尿病患者122例为糖尿病组，诊断参照WHO 1999年新标准，并且除外重度吸烟、嗜酒者、肾功能损害者及服用影响骨代谢药物者。2型糖尿病组68例，1型糖尿病组54例。以中国骨质疏松症建议诊断标准为依据诊断骨质疏松和骨量减少。糖尿病组骨量正常58例(男／女=33／25)，骨量减少30例(男／女：15／15)，骨质疏松34例(男／女=17／17)。并以青岛市内分泌糖尿病研究所62名体检健康成年人为对照组，采用聚合酶链反应限制性片段长度多态性技术对其进行维生素D受体，基因(ApaI，TaqI位点)型检测，并计算其基因分布频率。结果：①1型糖尿病组、2型糖尿病组与健康人维生素D受体基因型分布频率的比较1型糖尿病组Tt基因型的分布频率有增高趋势(1型糖尿病组14．8％，2型糖尿病组7．4％，对照组4．8％，P=0．068)。②维生素D受体基因多态性与糖尿病性骨质疏松的相关性：在糖尿病患者群中，aa基因型在骨量减少和骨质疏松患者中分布频率显著高于糖尿病骨量正常者(骨量减少组63．3％，骨质疏松组73．5%，骨量正常组41．3％．P&;lt;0．05)，Aa基因型分布频率显著低于骨量正常者(骨量减少组26．7％，骨质疏松组26．5％，骨量正常组44．8％，P&;lt;0．05)，糖尿病骨质疏松患者中未检出AA基因型。结论：在糖尿患者群中，维生素D受体基因分布与健康人差异不显著。糖尿病患者对应于ApaI酶切位点的维生素D受体基因多态与骨质疏松存在相关性，对应于TaqI酶切位点的维生素D受体基因多态与1型糖尿病的发生有相关趋势，对糖尿病骨质疏松的发生有一定的预测价值。     

老年男性维生素D受体基因多态性与骨转换指标及1，25（OH）2D3的关系

目的：维生素D受体(vitamin D receptor，VDR)基因多态性已成为骨质疏松遗传学研究的热点，了解VDR基因多态性在中国老年男性中的分布，并进一步认识其与骨钙素及双羟维生素D3[1，25(OH)2D3]等的关系。方法：采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法，分析145例老年男性的VDR基因型，同时采用放免法测定血清骨钙紊(bone gla-containin gprotein，BGP)、Ⅰ型胶原前胶原氨基端前肽(N-terminal propeptide of type procollagen，PINP)及1，25(OH)2D3。结果：VDR基因型分布频率为BB，0．014；Bb，0．117；bb，0．869。B，b等位基因分别占7．2％，92．8％。骨质疏松症的发生率为38．6％。骨质疏松组与非骨质疏松组之间VDR基因型分布频率的差异无显著性意义(P&;gt;0．05)。未发现VDR基因型与BGP，PINP及1。25(OH)2D3相关。结论：老年男性VDR基因型与骨钙素等骨转换升华指标及1，25(OH)2D3无明显联系。     

甲状旁腺素、维生素D受体、雌激素受体基因多态对糖尿病患者骨密度的影响

目的探讨甲状旁腺素(PTH)基因多态与中国北方汉族人糖尿病患者骨密度的关系。分析维生素D受体(VDR)、雌激素受体(ER)基因多态性对PTH基因多态性与骨密度、骨量减少及骨质疏松关系的影响。方法运用PCR-RFLP技术检测1型糖尿病(T1DM)组54例、2型糖尿病(T2DM)组104例、健康对照(CON)组102例的中国北方汉族人PTH基因多态性。结果甲状旁腺素基因型和等位基因分布频率在T1DM组、T2DM组与CON组间差异无统计学意义(P0.05);DM患者Bb/bb基因型者发生骨量减少/骨质疏松的相对危险度增加(OR=2.8684)。联合VDR基因多态分析,Bbaa基因型组糖尿病患者并发骨量减少/骨质疏松的相对危险度增高(OR=4.3125);联合ER基因多态分析,bPxx基因型骨量减少/骨质疏松的相对危险度也增高(OR=4.0);联合分析PTH、VDR、ER基因型,同时存在3个或4个易感基因型者伴有骨量减少或骨质疏松,相对危险度增加(OR=5.5385)。结论糖尿病患者PTH基因多态性(BST B1位点)可能是预测骨量减少、骨质疏松易感性的遗传标志。联合VDR、ER基因多态有助于识别DM患者发生骨质疏松的高危人群。     

老年男性维生素D受体基因多态性与骨转换指标及1,25(OH)2D3的关系

目的维生素D受体(vitamin D receptor,VDR)基因多态性已成为骨质疏松遗传学研究的热点,了解VDR基因多态性在中国老年男性中的分布,并进一步认识其与骨钙素及双羟维生素D3[1,25(OH)2D3]等的关系.方法采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法,分析145例老年男性的VDR基因型,同时采用放免法测定血清骨钙素(bone gla-containing protein,BGP)、Ⅰ型胶原前胶原氨基端前肽(N-terminal propeptide of type procollagen,PINP)及1,25(OH)2D3.结果VDR基因型分布频率为BB,0.014;Bb,0.117;bb,0.869.B,b等位基因分别占7.2%,92.8%.骨质疏松症的发生率为38.6%.骨质疏松组与非骨质疏松组之间VDR基因型分布频率的差异无显著性意义(P＞0.05).未发现VDR基因型与BGP,PINP及1,25(OH)2D3相关.结论老年男性VDR基因型与骨钙素等骨转换升华指标及1,25(OH)2D3无明显联系.     

维生素D受体基因多态性与维生素D缺乏性佝偻病的关系

目的观察维生素D受体（VDR）基因多态性与维生素D缺乏性佝偻病的关系，探讨维生素D缺乏性佝偻病的遗传因素。方法选择确诊的佝偻病患儿40例和健康体检的婴幼儿50例，采用聚合酶链反应．限制性内切酶多态性分析技术检测VDR基因多态性。结果佝偻病组Bb和bb基因型分布频率分别为62．5％和35．0％。健康对照组分别为18．0％和82．0％；佝偻病组等住基因B和b分布频率为33．8％和66．2％，健康对照组分别为9．0％和91．0％；佝偻病组和健康对照组Bb和bb基因型分布频率和等位基因分布频率间差异均有显著性（均P〈0．05）。结论VDR基因多态性与维生素D缺乏性佝偻病有相关性，提示VDR基因多态性可能是佝偻病患儿难于治疗的原因之一。     

维生素D及其受体基因多态性与1型糖尿病

1型糖尿病的发病机制十分复杂，是以T细胞免疫介导为主的自身免疫性疾病，是遗传因素和环境因素交互作用共同促进了1型糖尿病的发生。近年来，各国各地区对与1型糖尿病相关的多种基因进行了广泛研究。大量研究显示，维生素D通过维生素D受体（VDR）在1型糖尿病的发病机制中可能起着重要作用。现就维生素D及其受体基因多态性与1型糖尿病的关系作一综述。     

骨质疏松症与维生素D受体基因多态性的相关性

背景:骨质疏松是多基因调控疾病,峰值骨量变化和骨量丢失均受遗传因素影响.目的:通过观察维生素D受体基因 ApaⅠ多态性在山东半岛汉族人群中的分布规律及与骨质疏松的关系,探讨原发性骨质疏松症的遗传易感因素.方法:选取367名长期居住在山东半岛地区无亲缘关系的汉族人群.将受试者分为骨密度正常组227例,骨质疏松组63例,骨质疏松性骨折组77例.结果与结论:实验人群维生素D受体基因的基因型频率分布符合Hardy-Weinberg平衡定律(χ2 =1.583,P > 0.05).基因型频率分布依次为aa型占53.1%,Aa型占10.6%,AA型占36.3%.年龄与不同部位骨密度值之间呈负相关(P < 0.01),体质量指数与骨密度值之间呈正相关(P < 0.01),在将年龄和体质量指数进行校正后发现aa基因型在腰椎(P < 0.05)、wards三角(P < 0.05)骨密度较低.运用χ2检验分析骨密度正常组各基因型与骨质疏松性骨折组之间差异无显著性意义(χ2 =4.795,P > 0.05).结果证实,山东半岛地区汉族人群中,维生素D受体基因ApaⅠ酶切位点多态性与原发性骨质疏松症存在关联,提示维生素D受体基因ApaⅠ酶切位点多态性在决定个体骨质疏松症遗传易感性方面起重要作用.     

老年男性维生素D受体基因（Fok 1）多态性与骨质疏松的关系

背景：维生素D受体基因5’端启动子区外显子2上存在而Fok 1酶切位点多态性，这一位点的多态性影响维生素D受体氨基酸的结构，与骨密度变化相关。 目的：分析老年男性维生素D受体基因Fok 1多态性与骨密度的关系。 设计：病例一对照，对比观察。 单位：解放军总医院老年医学研究所和解放军第二炮兵总医院内分泌科。 对象：选择2002—01／06解放军总医院及解放军第二炮兵总医院门诊就诊的26例老年男性骨质疏松患者为骨质疏松组，平均年龄（70&;#177;5）岁。腰椎骨密度均低于峰值骨密度2．0～2．5个标准差。选择同期本院健康体检者老年男性66名为对照组，平均年龄（73&;#177;4）岁。纳入对象均对检测项目知情同意，且相互无血缘关系，汉族，北京地区居民。 方法：采用聚合酶链反应限制性片段长度多态性分析技术确定维生素D受体基因Fok1基因型，分析老年男性维生素D受体基因Fok1基因型的分布情况。 主要观察指标：两组老年男性维生素D受体基因Fok1基因型分布情况。 结果：老年男性骨质疏松患者26例及健康老年人66名均进入结果分析。维生素D受体基因Fok1多态位点基因型分别为FF，Ff,ff基因型。对照组维生素D受体基因Fok1多态性FF，Ff，ff基因型频率与骨质疏松组（42％，42％，15％；15％，50％，35％）比较，差异明显（x^2=12．078，P〈0．01），等位基因F，f频率与骨质疏松组（64％，36％；40％，60％）比较，差异也明显（x^2=-8．232，P〈0．01）。 结论：正常老年男性与骨质疏松症老年男性患者的维生素D受体基因5’端启动子区Fok 1酶切位点多态性差异明显。     

中国老年人骨量丢失与维生素D受体基因启动子中Cdx-2结合位点的多态性

背景：骨质疏松症是一种与基因有关的骨脆性疾病，维生素D受体基因是主要候选基因之一。目的：前瞻性调查老年人维生素D受体基因启动于中Cdx-2结合位点多态性与骨密度、骨量丢失的关系。设计、时间及地点：前瞻性横断面调查，于200003／200503在沈阳医学院营养与食品卫生学教研室完成。对象：选取沈阳市某社区无血缘关系、60岁以上的100名汉族健康老年人作为调查对象，性别不限，未服用过维生素D和钙补充剂，均自愿参与调查。方法：用聚合酶链反应限制性片段长度多态性方法检测维生素D受体基因启动子中Cdx-2结合位点的多态性，应用DPX-L双能X射线吸收仪分别在调查初始和5年后两次测量调查对象的髋部骨密度。主要观察指标：检测维生素D受体基因启动予中Cdx-2结合位点基因型分布，以协方差分析法分析维生素D受体基因启动子中Cdx-2结合位点多态性与髋部骨密度的关系。结果：调查人群维生素D受体基因启动子中Cdx-2结合位点基因型频率分布为AA型17％，AG型57％，GG型26％；男女间等位基因型分布差异无显著性意义（P〉0．05）；该人群中等位基因频率分布符合Hardy—Weinberg定律。无论男女各基因型间年龄、身高和体质量差异均无显著性意义（P〉0．05）。经身高、体质量和年龄校正后，调查初始不同基因型调查对象问股骨颈和大转子的骨密度差异无显著性意义（P〉0．05）；不同基因型调查对象问各部位年骨量丢失率差异也无显著性意义（P〉0．05）。结论：调查人群维生素D受体基因启动子中Cdx-2结合位点基因型与髋部骨密度及骨量丢失无明显相关性。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.