银杏叶提取物对大鼠急性心肌缺血再灌注时心肌细胞凋亡及凋亡相关基因表达的影响

目的 探讨银杏叶提取物(EGB)对大鼠心肌缺血再灌注时心肌细胞凋亡及凋亡相关基因表达的影响.方法 采用结扎左冠状动脉前降支(LAD)30 min,再灌注2 h复制大鼠心肌缺血再灌注模型,分别以缺口末端标记法(TUNEL)及免疫组织化学法检测心肌凋亡细胞、心肌细胞Bcl-2、Bax基因的蛋白表达的变化.结果 缺血再灌注(IR)组心肌细胞凋亡数量显著高于假手术组(P<0.01),EGB组心肌细胞凋亡明显受到抑制(P<0.01).IR组和EGB组Bax、Bcl-2、P53基因蛋白表达均明显增加(P<0.01);EGB明显促进Bcl-2基因表达,同时抑制Bax、P53基因表达(P<0.01),Bcl-2和Bax的比值也随之升高.结论 EGB可明显下调Bax和P53基因的蛋白表达,上调Bcl-2基因的蛋白表达,从而显著抑制心肌缺血再灌注损伤(MIRI)后心肌细胞凋亡.     

持续被动运动对兔骨关节炎软骨细胞凋亡相关基因P53、caspase-3、Bcl-2和Bax的影响

目的观察持续被动运动(CPM)对兔骨关节炎(OA)软骨细胞凋亡及凋亡相关基因P53、caspase-3、Bcl-2、Bax表达的影响。方法36只新西兰大白兔随机分为对照组、模型组、治疗组,每组12只。C组兔子在术后第1天即开始进行CPM治疗,8 h/d,连续8 w。流式细胞术检测关节软骨细胞凋亡情况。RT-PCR和Western印迹方法检测关节软骨细胞凋亡相关基因P53、caspase-3、Bcl-2、Bax表达情况。结果与对照组软骨细胞凋亡率(8.08±1.23)%相比,模型组软骨细胞凋亡率(39.85±9.93)%显著升高(P0.01);凋亡相关基因P53、caspase-3、Bax表达出现显著上调,Bcl-2表达出现显著下调。给予CPM治疗后,与模型组相比,治疗组软骨细胞凋亡率显著降低(P0.01),凋亡相关基因P53、caspase-3、Bax表达出现显著下调,Bcl-2显著上调。结论 CPM可通过影响兔OA膝关节软骨细胞的凋亡情况,从而改善OA病情,其机制可能与调节凋亡相关基因P53、caspase-3、Bcl-2、Bax表达相关,为临床上利用CPM治疗OA提供了一定的科学依据。     

miR-92a对H9C2心肌细胞增殖、凋亡及Wnt信号通路的影响

目的探讨miR-92a对过氧化氢(H2O2)诱导的H9C2心肌细胞增殖、凋亡及Wnt信号通路的影响。方法通过Lipofectamine~(TM)2000将miR-92a抑制物(inhibitor)及阴性对照组转染大鼠心肌细胞H9C2,RT-PCR检测转染后细胞中miR-92a的表达;将后续实验分为空白对照组、H2O2组和miR-92a inhibitor+H2O2组,利用CCK8法、流式细胞仪及Western印迹分别检测3组细胞的增殖、凋亡、凋亡相关蛋白B细胞淋巴瘤/白血病(Bcl)-2和Bcl-2相关X蛋白(Bax)及Wnt信号通路β-连环蛋白(β-catenin)和c-Myc的蛋白表达。结果 miR-92a inhibitor组miR-92a mRNA表达显著低于空白对照组(P0.05),阴性对照组与空白对照组差异无统计学意义(P0.05);与空白对照组比较,H2O2组细胞增殖显著降低,凋亡率显著增加,Bax、β-catenin、c-Myc蛋白显著上调表达,Bcl-2蛋白显著下调表达(均P0.05),与H_2O_2组比较,miR-92a inhibitor+H_2O_2组细胞增殖显著升高,凋亡率显著降低,Bax、β-catenin、c-Myc蛋白显著下调表达,Bcl-2蛋白显著上调表达(均P0.05)。结论抑制miR-92a的表达可促进H2O2诱导的H9C2心肌细胞增殖,抑制细胞的凋亡,其机制与调节Bax、Bcl-2蛋白及Wnt信号通路表达有关。     

沥水调脂胶囊对氧化型低密度脂蛋白诱导内皮细胞凋亡及Bcl-2、BaX、P53和Caspase-3蛋白表达的影响

目的：研究沥水调脂胶囊抑制内皮细胞凋亡的机制。以氧化型低密度脂蛋白诱导人脐静脉内皮细胞凋亡，观察Bcl-2,Bax,P53和Caspase-3蛋白表达。方法：用流式细胞术检测细胞凋亡并进行周期分析；用细胞免疫荧光标记结合流式细胞术检测Bcl-2,Bax,P53和Caspase-3蛋白表达水平。结果：沥水调脂胶囊对氧化型低密度脂蛋白诱导的内皮细胞凋亡有抑制作用。在此过程中沥水调脂胶囊上调了Bcl-2蛋白表达水平，对Bax蛋白表达未见明显影响，同时下调了P53和Caspase-3蛋白表达水平。结论：推测沥水调脂胶囊可能是通过上调Bcl-2蛋白表达，下调P53和Caspase-3蛋白表达抑制内皮细胞凋亡的。     

PEP-1超氧化物歧化酶融合蛋白对大鼠心肌缺血再灌注细胞凋亡的影响

目的探讨PEP-1超氧化物歧化酶(SOD1)融合蛋白对大鼠心肌缺血再灌注细胞凋亡指数、Bax和Bcl-2蛋白表达的影响。方法 SD大鼠40只,制作心肌缺血再灌注模型,分为假手术组、缺血再灌注组、PEP-1-SOD1 100、300和500 μg组,每组8只。TUNEL法及免疫组织化学法检测心肌细胞凋亡指数(AI)及Bax、Bcl-2蛋白的表达。结果假手术组AI、Bax及Bcl-2蛋白表达水平均较低。PEP-1-SOD1各组AI和Bax蛋白的表达较缺血再灌注组明显降低,Bcl-2蛋白的表达明显增加,Bax/Rcl-2比值明显下降(P<0.05,P<0.01)。结论 PEP-1-SOD1可抑制缺血再灌注心肌细胞凋亡,原因可能为其减轻氧化应激、下调Bax和上调Bcl-2蛋白表达水平。     

吗啡依赖对大鼠支持细胞凋亡及Bcl-2和Bax蛋白表达的影响

目的探讨吗啡依赖对大鼠睾丸支持细胞凋亡及Bcl-2和Bax蛋白表达的影响。方法建立吗啡依赖大鼠模型,采用电镜观察支持细胞结构变化、流式细胞术检测支持细胞凋亡率及免疫组织化学法测定Bcl-2和Bax蛋白的表达。结果吗啡依赖大鼠睾丸支持细胞结构变化明显;与健康对照比较,吗啡依赖大鼠支持细胞凋亡率升高,Bcl-2降低,Bax蛋白表达升高（P均〈0.01）。结论吗啡依赖诱导大鼠睾丸支持细胞凋亡,其机制可能与下调抑凋亡因子Bcl-2、上调促凋亡因子Bax有关。     

特发性肺纤维化患者上皮细胞促凋亡及抗凋亡信号表达

目的 探讨促凋亡信号和抗凋亡信号在特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)发生中的意义.方法 应用末端原位杂交和免疫组织化学技术,检测12例IPF患者的肺活检组织和10例正常对照肺组织肺泡和支气管上皮细胞凋亡情况及P53、P21、Bax和Bcl-2蛋白表达的变化.结果 IPF患者肺组织的肺泡和支气管上皮细胞凋亡率明显上调(U=0.0,P＜0.01),肺泡和支气管上皮细胞中P53、P21、Bax蛋白表达上调(U=5.0～35.5,P值均＜0.05),肺泡和支气管上皮细胞中Bcl-2蛋白表达下调(U值分别为12.0、18.0,P＜0.01).相关分析结果表明,肺泡和支气管上皮细胞P53、P21、Bax蛋白表达与其凋亡率之间均呈显著正相关(r值为0.436～0.806,P值均＜0.05),肺泡和支气管上皮细胞Bcl-2蛋白表达与其凋亡率之间均呈显著负相关(r值为-0.715～-0.699,P值均＜0.01).结论 肺纤维化时肺泡和支气管上皮细胞凋亡率增高,P53、P21、Bax蛋白表达增强,Bcl-2蛋白表达减弱,这些因素在肺纤维化的发生和发展中起重要作用.     

丹参多酚酸盐对大鼠心肌缺血再灌注后心肌细胞凋亡的抑制作用及机制研究

目的研究丹参多酚酸盐对大鼠心肌缺血再灌注损伤后心肌细胞凋亡的抑制作用及其机制。方法通过夹闭左冠状动脉前降支复制心肌缺血再灌注大鼠模型,设假手术组、模型组和丹参多酚酸盐各剂量组(分别予10mg/kg、20mg/kg、40mg/kg),每组20只。观察心电图波动情况,2,3,5-氯化三苯基四氮唑(TTC)染色法检测心肌梗死面积;苏木素-伊红(HE)染色法进行心肌组织病理学检查;缺口末端标记法(TUNEL)观察心肌细胞凋亡,蛋白质免疫印迹(western blotting)法检测其凋亡相关蛋白表达。结果与模型组比较,丹参多酚酸盐各剂量组心电图明显改善。与假手术组比较,模型组大鼠心肌组织梗死面积明显升高(P <0.01);丹参多酚酸盐20mg/kg组、40mg/kg组大鼠心肌组织梗死面积较模型组显著降低(P <0.05或P <0.01)。丹参多酚酸盐各剂量组大鼠心肌组织病变较模型组明显改善。模型组大鼠心肌细胞凋亡指数(AI)较假手术组显著升高(P <0.01);丹参多酚酸盐20mg/kg组、40mg/kg组AI较模型组显著降低(P <0.05或P <0.01)。模型组大鼠心肌组织Bcl-2、Bax蛋白、激活型Caspase-3蛋白较假手术组显著上调表达(P <0.05或P <0.01),Bcl-2/Bax比值较假手术组显著降低(P <0.01)。与模型组比较,丹参多酚酸盐20mg/kg组、40mg/kg组抑凋亡蛋白Bcl-2表达显著上调,促凋亡蛋白Bax表达显著下调(P <0.05或P <0.01),Bcl-2/Bax比值提高(P <0.01),促凋亡蛋白激活型Caspase-3蛋白表达显著下调(P <0.05或P <0.01)。结论丹参多酚酸盐对缺血再灌注后心肌细胞凋亡具有抑制作用,而调节凋亡相关蛋白(Bcl-2、Bax、激活型Caspase-3)表达可能是其重要的分子机制。     

螺内酯和缬沙坦对高血压大鼠心肌细胞凋亡相关蛋白的影响

目的探讨螺内酯和缬沙坦对肾血管性高血压大鼠左心室细胞凋亡调控相关蛋白P53、Bax及Bcl-2表达的影响。方法选取SD大鼠46只制成肾血管性高血压大鼠模型后,随机分为高血压组(N组,12只)、缬沙坦组(V组,11只)、螺内酯组(S组,12只)、螺内酯加缬沙坦组(S+V组,11只),另选10只未造模大鼠为假手术组(C组),各组治疗10周后行超声心动图检查,测定大鼠颈动脉压,应用免疫组织化学法检测P53、Bax及Bcl-2蛋白的表达。结果治疗10周后,与C组比较,N组大鼠收缩压明显升高(P0.01);与N组比较,V组、S+V组大鼠收缩压明显降低(P0.05);与C组比较,N组大鼠Bax、Bcl-2和Bax/Bcl-2明显升高,S组大鼠Bax和Bax/Bcl-2明显升高(P0.05,P0.01);与N组比较,S组大鼠Bax、Bax/Bcl-2和V组、S+V组大鼠Bax、Bcl-2、Bax/Bcl-2均明显下降(P0.05,P0.01);与S组比较,V组、S+V组大鼠Bax、Bax/Bcl-2明显下降(P0.05,P0.01)。结论两肾一夹肾血管性高血压大鼠左心室肥厚形成过程中,Bax过表达不完全依赖P53调节。缬沙坦可以通过与血管紧张素Ⅱ1型受体结合,抑制心肌细胞凋亡相关蛋白P53、Bax及Bcl-2的表达及左心室肥厚的发生。螺内酯可以通过与醛固酮受体结合明显降低P53及Bax的表达,降低Bax/Bcl-2比值,部分地逆转左心室肥厚。     

体外心脏震波对大鼠心肌梗死后心肌凋亡的影响

目的研究体外心脏震波治疗(CSWT)对大鼠心肌梗死后(MI)心肌细胞凋亡及凋亡蛋白的影响。方法结扎大鼠左冠状动脉前降支建立大鼠急性心肌梗死模型,随机分为假手术(Sham)组(n=10)、MI组(n=10)及CSWT组(n=10)。CSWT治疗4 w后,取各组心肌样本进行TUNEL检测观察心肌细胞凋亡,Masson染色观察心肌纤维化,Western印迹检测Bax、Bcl-2和Caspase-3蛋白表达。结果与Sham组相比,MI和CSWT组心肌细胞凋亡指数及纤维化程度均增高,Bax和Caspase-3表达显著上调,Bcl-2表达明显下调(P0.05);而CSWT组较MI组,心肌细胞凋亡指数及纤维化程度均降低,Bax和Caspase-3表达下调,Bcl-2则表达上调(P0.05)。结论大鼠心肌梗死后心肌凋亡明显增加,体外心脏震波可抑制大鼠心肌梗死后细胞凋亡,减轻左心室纤维化。     

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。