1型心肾综合征对急性心肌梗死患者院内死亡的影响

目的 观察不同严重程度1型心肾综合征(CRS1)对急性心肌梗死(AMI)患者院内死亡的影响。方法 采用回顾性方法分析北京友谊医院心血管中心数据库中2094例AMI患者。收集人口学、生化检查、既往病史及入院治疗情况等临床资料。根据心肾功能将CRS1患者分为轻度、中度及重度3级。分层考察CRS1及其不同严重程度与AMI患者院内死亡率之间的关系。Kaplan-Meier生存分析及Cox比例风险回归评估CRS1及其不同严重程度对AMI患者院内死亡的影响。采用SPSS 22.0统计学软件对数据进行分析。结果 随着CRS1严重程度的加重,AMI患者的院内全因死亡率逐渐升高(P<0.001)。Kaplan-Meier生存分析显示:CRS1组患者的院内累积生存率低于非CRS1组(P<0.001),并且随着CRS1严重程度的加重,AMI患者的院内累积生存率有下降趋势(P<0.001)。院内发生CRS1是AMI患者院内死亡的独立危险因素(RR=4.233, 95%CI 2.013~8.901; P<0.001)。结论 院内发生CRS1将对AMI患者的预后产生不良影响。随着CRS1严重程度的加重,AMI患者的院内死亡风险逐渐增加。     

肾功能不全对急性心肌梗死患者治疗方案及预后的影响

目的观察肾功能不全对急性心肌梗死(AMI)患者治疗方案及预后的影响。方法入选2011年6月~2012年5月因AMI住院治疗患者523例,根据改良的MDRD方程计算估测的肾小球滤过率(eGFR),根据eGFR水平将患者分为肾功能正常及轻度肾功能不全组(A组,eGFR≥60ml/min.1.73m2),中重度肾功能不全组(B组,eGFR60ml/min.1.73m2)。比较两组患者临床特点、治疗方案和预后的差异。结果 A组患者占71.7%(375/523),B组患者占28.3%(148/523)。与A组患者相比,B组患者年龄偏大、女性较多(P0.01),合并高血压、糖尿病、脑卒中及贫血比例较高(P0.05)。B组患者接受抗凝、β受体阻滞剂、他汀类、ACEI/ARB类药物以及PCI治疗的比例显著低于A组患者(P0.01)。B组患者院内死亡率显著高于A组(P0.01)。影响院内死亡的多因素回归分析显示:除年龄、女性、合并高血压、糖尿病、PCI治疗外,eGFR下降与院内死亡率增加独立相关(OR=6.362,95%CI:2.154~16.892,P0.01)。结论急性心肌梗死合并中重度肾功能不全患者住院期间接受急性心肌梗死指南推荐治疗的比例低于肾功能正常及轻度异常组;急性心肌梗死合并中重度肾功能不全患者院内死亡率增高;中重度肾功能不全是急性心肌梗死患者院内死亡的独立危险因素。     

对氧磷酶1在老年2型心肾综合征患者中表达

目的探讨对氧磷酶(PON)1在老年2型心肾综合征(CRS)患者中的表达。方法老年2型CRS患者98例根据肾小球滤过率(eGFR)分为2个亚组:T1[eGFR:60 ml/(min·1.73 m~2)]49例,T2[eGFR:≤60 ml/(min·1.73 m~2)]49例。两组均根据相关指南给予抗心力衰竭、保肾治疗。另选取同期体检健康的老年人20例作为健康对照组。观察组分别于治疗前及治疗14 d抽取空腹静脉血测定血清胱抑素(Cys)C、尿素氮(BUN)、eGFR、N末端脑钠肽(NT-proBNP)、对氧磷酶(PON)1、超声测定左室射血分数(LVEF);健康对照组于体检当日完成上述指标采集;采用Pearson相关分析,分析PON1与NT-proBNP、EF、CysC、eGFR的关系。结果 2型CRS各亚组CysC、BUN、NT-proBNP水平显著高于健康对照组(P0.05),eGFR、LVEF显著低于健康对照组(P0.05);治疗14 d后2型CRS各亚组eGFR、EF较治疗前显著升高(P0.05),CysC、BUN、NT-proBNP较治疗前均显著降低(P0.05);2型CRS各亚组PON1水平均显著高于健康对照组(P0.05),治疗14 d后,2型CRS各亚组PON1水平较治疗前均显著升高(P0.05);PON1与eGFR、LVEF呈正相关(均P0.05)与CysC、BUN、NT-proBNP呈负相关(均P0.05)。结论老年2型CRS患者的血清PON1水平较健康人群降低,且与心肾功能相关。PON1可用于老年2型CRS患者病情及心肾功能评估的新的参考指标,可在一定程度上评价2型CRS的治疗效果。     

老年慢性心力衰竭合并心肾综合征的高危因素分析

目的:分析老年慢性心力衰竭(HF)合并心肾综合征(CRS)的发病特点及其临床高危因素。方法:收集年龄 60岁慢性HF患者167例的临床资料,按照血肌酐(Cr)水平分为CRS组(42例)与非CRS组(125例),分析其临床表现及生化指标,通过单因素及多因素回归方法评价慢性HF患者合并CRS的临床高危因素。结果:与非CRS组比较,CRS组患者中既往高血压、糖尿病、急性心肌梗死等基础病以及心功能NYHA分级Ⅲ～Ⅳ级者较多,急性感染患病率和脑血管意外患病率升高(P 0. 05)。多因素Logistic回归分析显示急性感染、血尿酸(UA)、血Cr、既往糖尿病史、高敏C反应蛋白(hs-CRP)是老年慢性HF合并CRS的独立影响因素。结论:老年慢性HF合并CRS存在自身特征性,急性感染、血Cr升高、UA升高、既往糖尿病史及hs-CRP升高是老年慢性HF合并CRS的临床高危因素。     

NT-proBNP对急性心肌梗死患者新发房颤的预测价值研究

目的探讨N末端B型脑利钠肽前体(NT-proBNP)对急性心肌梗死患者新发房颤的预测价值。方法从2008年1月至2010年12月收住我院心脏监护室的患者中入选急性心肌梗死(AMI)患者293例,按照患者住院期间是否出现房颤(AF)分为房颤组(n=43)和非房颤组(n=250)。比较两组间差异,分析血浆NT-proBNP水平对新发房颤的预测价值。结果 (1)AMI患者住院期间出现新发房颤的比例为14.7%;(2)房颤组患者NT-proBNP水平明显高于非房颤患者,且平均年龄较大,左心室射血分数、血红蛋白含量和肾小球滤过率(eGFR)均低于非房颤组;(3)多因素Logistic回归分析显示NT-proBNP可独立预测急性心肌梗死患者新发房颤(OR4.918,95%CI1.662-14.549,P=0.004)。结论血浆NT-proBNP水平可独立预测急性心肌梗死患者新发房颤的发生,可用于患者危险分层及指导早期预防治疗。     

N末端B型钠尿肽前体与超敏C反应蛋白联合检测在急性心肌梗死危险度评估中的应用研究

摘要目的：通过联合检测急性心肌梗死(AMI)患者N末端B型钠尿肽前体(NT-proBNP)及超敏C反应蛋白(hs-CRP)水平,分析其与心脏事件发生率及冠脉血管病变程度的相关性,对急性心肌梗死危险度进行早期评估。方法：选取2015年2月至2017年10月医院收治的AMI患者185例,95例急性ST段抬高型心肌梗死患者及90例急性非ST段抬高型心肌梗死患者,选取同期22例冠脉造影正常者为对照,联合检测NT-proBNP、hs-CRP水平,记录24小时、1周、1月、6月内心脏事件（猝死、心衰、血运重建）MACE发生情况,对比分析不同水平NT-proBNP、hs-CRP心脏事件发生率及与冠脉病变程度相关性。结果：血浆NT-proBNP、hs-CRP水平STEMI组、NSTEMI组均高于对照组（P＜0.05）,STEMI组与NSTEMI组之间比较差异无统计学差异（P＞0.05）;NT-proBNP、hs-CRP水平多支病变组＞双支病变组＞单支病变组＞对照组（P＜0.05）,NT-proBNP、hs-CRP水平与Gensini积分呈正相关（r=0.678、0.814,P＜0.05）;NT-proBNP、hs-CRP对终点事件预测cut-off值分别为960pg/ml、6mg/L（AUC：0.952、0.891,P＜0.05）,MACE发生率高NT-proBNP、高hs-CRP组＞高NT-proBNP、低hs-CRP组＞低NT-proBNP、高hs-CRP组＞低NT-proBNP、低hs-CRP组（P＜0.05）。结论：AMI患者冠脉病变程度、不良心脏事件发生率与NT-proBNP、hs-CRP水平有一定相关性,可作为急性心肌梗死危险度早期评估指标。     

N末端脑钠肽前体、超敏C反应蛋白和肌钙蛋白I检测对急性冠脉综合征临床治疗、危险分层的意义

目的探讨N末端脑钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)和心肌肌钙蛋白(cT n)I血清水平在急性冠脉综合征(ACS)中的临床价值。方法 177例ACS患者中急性心肌梗死(AMI)组90例,不稳定型心绞痛(UAP)组87例,同时选取健康体检者67例为健康组,分别测定hs-CRP、cT nI、NT-proBNP和Killip分级,行冠脉造影判断血管病变程度。结果 ACS组患者患病程度与NT-proBNP呈正相关(r=0. 63,P0. 01),cT nI与hs-CRP水平呈正相关(r=0. 72,P0. 01);随着脑钠肽(BNP)水平的升高,左室射血分数(LVEF)下降,BNP水平分级与LVEF值呈显著负相关(P0. 05);与保守组比较,介入治疗的患者发病7 d血清hs-CRP和BNP水平显著下降,LVEF明显升高(均P0. 05);血清hs-CRP浓度与BNP浓度与病变支数呈正相关(r=0. 99、0. 99,均P0. 05)。结论在ACS早期NT-proBNP和hs-CRP已有明显升高,是cT nI升高之前早期心肌缺血诊断不足的补充,可作为ACS患者在出现心肌缺血程度、AMI后心肌损伤面积及心功能情况判定的重要指标,是临床分层、ACS患者发生心血管事件及早期心衰发生率的预测因子。     

N末端脑钠肽前体、超敏C-反应蛋白和血清CD137对急性心肌梗死患者左心室重构的预测价值

目的探讨急性心肌梗死(AMI)患者N末端脑钠肽前体(NT-proBNP)、超敏C-反应蛋白(hs-CRP)和血清白细胞分化抗原137(CD137)的表达及其与左心室重构(LVR)的关系。方法选择2017年1月至2018年5月于宜兴市人民医院心血管内科确诊为急性心肌梗死的住院患者124例,入院常规检测血常规、生化、心肌酶、血清肌钙蛋白T(cTNT)、NT-proBNP、hs-CRP、血清CD137等指标,入院期间及出院12个月行超声心动图检查。随访12个月后根据是否存在LVR分为LVR组(n=38)和非LVR组(n=86)。采用SPSS 16.0统计软件进行数据分析。相关性分析采用Pearson相关分析法。采用多因素二分类logistic回归法分析LVR的独立危险因素。采用受试者工作特征(ROC)曲线评估NT-proBNP、hs-CRP、血清CD137对LVR的预测价值。结果 LVR组患者入院时NT-proBNP、hs-CRP、血清CD137均明显高于非LVR组,差异具有统计学意义(P0.05)。Pearson相关分析表明,NT-proBNP(r=0.419)、hs-CRP(r=0.209)和血清CD137(r=0.604)水平与左心室舒张期末内径增加值呈正相关(均P0.05)。二分类logistic回归分析显示,NT-proBNP、hs-CRP和血清CD137水平是AMI后发生LVR的独立危险因素(P0.05)。NT-proBNP、hs-CRP和血清CD137水平预测LVR发生的ROC曲线下面积(AUC)分别为0.753,0.722,0.690,三者联合预测的AUC为0.805(均P0.05)。结论 NT-proBNP、hs-CRP和血清CD137水平与急性心肌梗死后LVR密切相关,三者联合检测对急性心肌梗死后LVR有一定的预测价值。     

生物标志物与全球急性冠状动脉事件注册研究评分在不稳定性心绞痛患者预后中的价值

目的探讨高敏C反应蛋白(hs-CRP)、N末端B型钠尿肽前体(NT-proBNP)联合检测对老年不稳定性心绞痛患者的预后评估价值,并与全球急性冠状动脉事件注册(GRACE)研究危险分层相对比。方法回顾性连续收集老年不稳定性心绞痛患者76例,按随访1年心血管事件发生与否分为事件组36例,非事件组40例。测定hs-CRP、NT-proBNP,计算GRACE评分,比较2项指标联合检测与GRACE危险分层预后判断的准确性。结果事件组年龄、心率、hs-CRP、NT-proBNP及GRACE评分明显高于非事件组,差异有统计学意义(P0.05,P0.01)。hs-CRP、NT-proBNP的ROC曲线下面积分别为0.816、0.786,截断值分别为3.87 mg/L、150.10ng/L。hs-CRP≥3.87mg/L或NT-proBNP≥150.10ng/L预测事件阳性的敏感性、特异性、约登指数、阳性预测值、阴性预测值分别为83.3%、72.5%、55.8%、73.2%、82.9%,GRACE评分≥109分预测事件阳性的敏感性、特异性、约登指数、阳性预测值、阴性预测值分别为80.6%、50.0%、30.6%、59.2%、74.1%。结论 hs-CRP和NT-proBNP联合检测对老年不稳定性心绞痛患者预后判断的准确性高于GRACE危险分层。     

高敏C反应蛋白对老年女性急性心肌梗死患者肾功能不全的独立预测作用

目的探讨高敏C反应蛋白(hs-CRP)对于老年女性急性心肌梗死(AMI)患者肾功能不全的预测作用。方法选择天津医科大学第二医院就诊的老年女性AMI患者317例,根据估算的肾小球滤过率(eGFR)水平分为肾功能正常组209例[eGFR≥60 ml/(min·1.73 m^2)],肾功能不全组108例[eGFR<60ml/(min·1.73 m^2)]。采用Spearman相关性分析eGFR与临床生化指标的关系,二元logistic回归分析老年女性AMI患者肾功能不全的危险因素。结果与肾功能正常组比较,肾功能不全组年龄、饮酒、KillipsⅡ级、尿酸、尿素、肌酐、hs-CRP、N末端钠尿肽前体、肌酸激酶水平明显升高,TC、LDL-C和白蛋白/球蛋白比值明显降低(P<0.05,P<0.01)。Spearman相关性分析显示,hs-CRP与eGFR呈负相关(r=-0.317,P=0.000)。单因素logistic回归分析显示,hs-CRP是老年女性AMI患者肾功能不全的重要预测指标(OR=1.010,95%CI:1.005~1.015,P=0.000)。多因素logistic回归分析显示,年龄、hs-CRP和N末端钠尿肽前体是老年女性AMI患者肾功能不全的危险因素(P=0.011,P=0.024,P=0.000)。结论 hs-CRP与老年女性AMI患者肾功能密切相关。     

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.     

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。     

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     

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。