雄激素对扩张型心肌病慢性心力衰竭大鼠心肌细胞凋亡及肿瘤坏死因子-α的影响

目的探讨雄激素对扩张型心肌病(DCM)慢性心力衰竭大鼠心肌细胞凋亡及肿瘤坏死因子(TNF)-α的影响。方法将48只雄性SD大鼠分为正常对照组、心力衰竭组(实验组A)、心力衰竭+睾丸切除组(实验组B)、心力衰竭+睾丸切出+睾酮替代治疗组(实验组C);采用放射免疫法检测大鼠血浆神经内分泌激素(睾酮)和TNF-α、内皮素(ET)-1的水平差异,免疫组化法检测各组大鼠心肌Bcl-2、Bax蛋白的表达情况,采用凋亡原位检测方法(TUNEL)法检测心肌组织细胞凋亡,并计算凋亡指数(AI),采用超声心动图观察大鼠左室心功能变化。结果实验组A、实验组B睾酮、左室质量、FS均显著低于对照组和实验组C,TNF-α、ET-1、AI、心脏质量指数均显著高于对照组和实验组C(P0.05),实验组B睾酮、左室质量、FS均显著低于实验组A,TNF-α、ET-1、AI、心脏质量指数均显著高于实验组A(P0.05)。实验组A、实验组B Bcl-2、Bcl-2/Bax值显著低于对照组和实验组C,Bax显著高于对照组和实验组C(P0.05)。结论雄激素可有效缓解DCM大鼠心肌细胞的凋亡,其作用机制可能与降低TNF-α、Bax蛋白表达,提高ET-1、Bcl-2的表达有关。     

丹参多酚酸盐对阿霉素诱导的扩张型心肌病大鼠心功能的影响及机制研究

目的:研究丹参多酚酸盐对阿霉素诱导的扩张型心肌病(DCM)大鼠心功能的作用及机制。方法:30只SD雄性大鼠分为对照组(10例)、阿霉素组(10例)和丹参多酚酸盐组(丹参多酚酸盐+阿霉素)(10例)。实验8周后行高频超声心动图检查,测定各项心功能指标后取心脏,行苏木精染色、masson染色及电镜观察。用TUNEL法检测各组大鼠心肌细胞凋亡,Western blot检测各组大鼠心肌细胞网腔钙结合蛋白(Calumenin)、内质网伴侣蛋白GRP78及凋亡因子chop、Bax、Bcl-2表达水平。结果:与阿霉素组比较,丹参多酚酸盐组大鼠心脏的收缩与舒张功能明显改善(P0.01);心肌细胞凋亡明显减少(P0.01);心肌细胞Calumenin表达增多,而GRP78及促凋亡因子chop、Bax表达减少(P0.01),抑制凋亡因子Bcl-2表达增多(P0.01)。结论:丹参多酚酸盐可改善DCM大鼠病理改变及心功能,减少DCM大鼠心肌细胞凋亡,上述作用可能通过增加心肌细胞Calumenin表达,缓解内质网应激,减少心肌细胞凋亡来实现。     

辛伐他汀治疗扩张型心肌病

目的:探讨他汀类药物对非缺血性心力衰竭的治疗作用.方法:将36例特发性扩张型心肌病患者随机分为辛伐他汀组(n=17)和安慰剂组(n=19).在常规治疗的基础上,辛伐他汀组加用辛伐他汀,起始剂量为5 mg/d,4周后增至10 mg/d.结果:治疗12后周,辛伐他汀组较安慰剂组血浆总胆固醇和低密度脂蛋白水平降低,心功能改善,左室射血分数提高,为(38.59±3.47)%对(34.11±3.16)%,P<0.01.血浆肿瘤坏死因子-α(TNF-α)和白介素(IL)-6水平在辛伐他汀组显著降低(P<0.01).结论:辛伐他汀可以显著改善扩张型心肌病心衰患者的心功能和血管内皮功能,提示他汀类药物可用于治疗非缺血性心力衰竭.     

辛伐他汀治疗扩张型心肌病

目的探讨他汀类药物对非缺血性心力衰竭的治疗作用.方法将36例特发性扩张型心肌病患者随机分为辛伐他汀组(n=17)和安慰剂组(n=19).在常规治疗的基础上,辛伐他汀组加用辛伐他汀,起始剂量为5mg/d,4周后增至10mg/d.结果治疗12后周,辛伐他汀组较安慰剂组血浆总胆固醇和低密度脂蛋白水平降低,心功能改善,左室射血分数提高,为(38.59±3.47)%对(34.11±3.16)%,P＜0.01.血浆肿瘤坏死因子-α(TNF-α)和白介素(IL)-6水平在辛伐他汀组显著降低(P＜0.01).结论辛伐他汀可以显著改善扩张型心肌病心衰患者的心功能和血管内皮功能,提示他汀类药物可用于治疗非缺血性心力衰竭.     

参附注射液对实验性心力衰竭大鼠血浆凋亡相关因子的影响

目的 观察参附注射液对实验性心力衰竭大鼠血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及可溶性Fas(sFas)含量的影响,探讨参附注射液在心力衰竭治疗中抗凋亡作用机制.方法 采用结扎冠状动脉左前降支近端的方法建立心肌梗死后心力衰竭大鼠模型.将大鼠随机分为假手术组(14只,除不结扎冠状动脉左前降支外,余同手术组)CAF组(13只)和参附组(11只).参附组腹腔注射参附注射液[6.2 mL/(kg·d)],CHF组和假手术组给予同等量生理盐水,每日1次腹腔注射,连续4周.给药4周后颈动脉取血,采用双抗体夹心ELISA法测定血浆中TNF-α、IL-6及sFas含量.结果 与假手术组相比,CHF组大鼠血浆TNF-α、IL-6及sFas浓度明显增高(P<0.01),参附注射液能降低CHF大鼠血浆TNF-α、IL-6及sFas的水平(P<0.05).结论 参附注射液改善梗死后心衰大鼠的心功能,可能与抑制凋亡相关因子减少心肌细胞的凋亡,发挥心肌细胞的保护作用有关.     

心力衰竭大鼠心肌细胞凋亡与心肌纤维化的相关性

目的探讨心力衰竭大鼠心肌细胞凋亡与心肌纤维化的相关性。方法雄性SD大鼠18只,随机分为两组,每组9只。模型组腹腔注射阿霉素建立心力衰竭模型,空白对照组腹腔注射等体积生理盐水。模型建立后检测两组大鼠血清炎性因子表达水平及心肌细胞凋亡、心肌纤维化情况,并进行相关性分析。结果所有大鼠在实验中都存活,模型组大鼠建模均成功。与空白对照组比较,模型组血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)含量明显增加(P0.05)。模型组左心室重量指数(LVMI)、心肌胶原体积比例(CVF)、心肌血管周围胶原与管腔面积比例(PVCA)均高于空白对照组(P0.05)。模型组心肌组织Caspase-8、Bcl-2蛋白相对表达量高于空白对照组(P0.05)。相关分析显示,心肌组织Caspase-8、Bcl-2蛋白相对表达量与LVMI、CVF、PVCA呈正相关(P0.05)。结论心力衰竭大鼠伴有心肌细胞凋亡增加与心肌纤维化,并表现为炎性因子的过量表达,两者可相互影响。     

鱼油对阿霉素诱导慢性心力衰竭大鼠心肌结构和细胞因子的影响

目的 腹腔注射阿霉素建立慢性心力衰竭大鼠模型,应用超声心动图评价该模型,使用鱼油对成模后的大鼠进行干预,观察大鼠心肌结构和血清肿瘤坏死因子(TNF)-α、白介素(IL)-10水平的变化.方法 雄性SD大鼠46只随机分成对照组和阿霉素组,经腹腔注射阿霉素建立慢性心力衰竭大鼠模型,超声心动图检测评价心功能变化.造模后的26只阿霉素组大鼠随机分为2组:心衰组和鱼油组,分别使用生理盐水和鱼油进行干预,干预结束后给两组大鼠行超声心动图,处死所有大鼠,取心肌组织行HE染色光镜下观察心肌形态变化；留取血清,ELISA法检测TNF-α和IL-10水平.结果 与对照组相比,阿霉素组大鼠超声心动图各项指标改变具有统计学意义,符合慢性心力衰竭的特征,鱼油组大鼠较心衰组大鼠心功能改善(P＜0.05).HE染色示对照组大鼠心肌细胞排列整齐,细胞间隙正常,胞核清晰,高倍镜下可见清晰横纹,未见胞体水肿,组织间隙无炎性渗出；心衰组大鼠心肌细胞失去正常结构形态、排列明显不规则、部分呈水肿和空泡变性,部分出现灶性坏死,部分心肌纤维出现溶解断裂,心肌细胞间隙明显增宽；鱼油组大鼠可见心肌细胞变性和坏死,心肌细胞间隙增宽,但程度和范围均较心衰组减轻.与对照组相比,心衰组TNF-α和IL-10浓度升高,且上调IL-10/TNF-α比值；与心衰组相比,鱼油组TNF-α和IL-10降低,且下调IL-10/TNF-α比值.结论 鱼油可能通过调控细胞因子平衡对阿霉素诱导的心衰大鼠起保护作用.     

心力衰竭患者血浆凋亡相关因子水平的变化及其临床意义

目的 :探讨作为凋亡抑制因子Fas (sFas)和凋亡诱导因子Fas配体 (sFasL)在心力衰竭患者血浆中的水平及其临床意义。方法 :采用酶联免疫吸附法测定 6 7例心力衰竭患者 (心力衰竭组 )和 2 0例健康人 (正常对照组 )血浆中的sFas、sFasL、肿瘤坏死因子α、白细胞介素 6水平。结果 :心力衰竭不同心功能状态患者血浆sFas、肿瘤坏死因子α水平均高于正常对照组 ,心功能Ⅲ级、Ⅳ级患者中sFas水平 ,心功能Ⅲ级患者白细胞介素 6水平亦高于正常对照组 (P <0 0 5～ 0 0 1) ,并随心功能下降而上升 ,与心功能状态呈负相关 ,其水平与原发病无关。sFas和肿瘤坏死因子α水平在心功能Ⅱ级和Ⅳ级患者间比较有显著差异 (P <0 0 5 )。结论 :心力衰竭患者血浆中的sFas和sFasL的水平显著升高 ,提示sFas和sFasL水平升高乃至整个Fas/FasL系统可能在心力衰竭的发病中起着重要作用     

芪苈强心胶囊联合替米沙坦治疗扩张型心肌病的临床研究

目的观察芪苈强心胶囊联合替米沙坦对扩张型心肌病病人心功能、活动耐量及心力衰竭加重住院次数的影响。方法选取2016年1月—2018年12月在复旦大学附属中山医院心内科诊治的扩张型心肌病病人96例,随机分为联合组与对照组,每组48例。对照组采用常规治疗加替米沙坦治疗,联合组在对照组治疗基础上加用芪苈强心胶囊。观察两组治疗前与治疗3个月后超声心动图指标、利尿药与地高辛停减率及N末端脑钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平,随访6个月心力衰竭加重住院人数、心力衰竭加重住院次数以及心功能情况。结果联合组心功能疗效总有效率为91.67%,明显高于对照组的77.08%(P0.05)。治疗3个月后,两组超声心动图指标较治疗前明显改善(P0.05),但联合组改善效果优于对照组(P0.05);两组NT-proBNP、hs-CRP、TNF-α水平较治疗前明显降低(P0.05),但联合组明显低于对照组(P0.05)。第6个月随访时联合组心力衰竭加重住院人数为11例(22.91%),心力衰竭加重住院次数为16例次(33.33%),均明显低于对照组的21例(43.75%)、26例次(54.17%),差异均有统计学意义(P0.05)。结论芪苈强心胶囊联合替米沙坦可进一步改善扩张型心肌病病人的心功能,增强活动耐量,减轻炎症反应,减少心力衰竭加重住院次数。     

实验性心力衰竭大鼠模型的建立及评价

目的建立实验性心力衰竭大鼠模型,并对其进行评价。方法35只雄性Wistar大鼠随机分两组:正常对照组(CON组,n=10)和心力衰竭模型组(CHF组,n=25),CHF组采用阿霉素2.5 mg/kg尾静脉注射,每周一次,连续10 w,建立CHF大鼠模型。12 w时采用超声和血流动力学检测评价其心功能,放免法检测血浆肿瘤坏死因子-α、血管紧张素Ⅱ及醛固酮水平,氯胺T法检测羟脯氨酸及胶原含量,苦味酸天狼星红染色进行左室胶原特异染色及定量分析,计算胶原容积分数(CVF),并进行HE染色,观察其组织学变化。结果CHF组大鼠死亡率为40%(10/25),CON组无死亡。与CON组相比,CHF组大鼠左室舒张末期内径(LVEDD)及收缩末期内径(LVESD)增加,心功能明显下降,表现为左室短轴缩短率(FS)、二尖瓣环收缩期长轴方向峰值运动速度(Vs)、左室内压最大上升速率( dp/dtmax)、左室内压最大下降速率(-dp/dtmax)明显降低,左室舒张末期压(LVEDP)升高(P<0.01);CHF组血浆肿瘤坏死因子-α、血管紧张素Ⅱ及醛固酮水平升高(P<0.01),心肌羟脯氨酸及胶原含量较CON组增加(P<0.01);苦味酸天狼星红染色显示CHF组左室胶原明显增加,胶原容积分数(CVF)明显增高(P<0.01);病理学结果证实符合心肌病样改变。结论阿霉素多次小剂量静脉注射能导致大鼠发生心脏间质纤维化及心脏舒缩功能降低,可成功建立实验性心力衰竭大鼠模型。     

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.     

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.     

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.     

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。     

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     

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。     

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。