氨基末端脑钠肽对风湿性瓣膜病患者围手术期风险性评估的意义

目的研究风湿性瓣膜病患者围手术期血清氨基末端脑钠肽(NT-proBNP)浓度值的变化及其意义.探讨监测围手术期间血清NT-proBNP浓度值对瓣膜置换术后早期风险性的评估作用.方法2007-06至2007-10选择符合条件的41例在常规体外循环下行换瓣手术的风湿性瓣膜病患者.分别于术前,术后3 h,24 h,48 h,120 h抽取外周动脉血测定血清NT-proBNP值,分析围手术期其浓度变化.测定术前和术后16小时的心脏输出量(CO)和心脏指数(CI)值,比较术前血清NT-proBNP浓度值与CO和CI的关系.按照术后有无死亡,新发生心律失常,重要脏器功能受损,多巴胺使用时间,术后呼吸机辅助时间等,比较术前NT-proBNP浓度值.结果①NT-proBNP浓度值术后3 h开始上升,术后24 h达到高峰,与术前比差异具有显著意义(P＜0.01),此后缓慢下降,但是术后第120 h仍然高于术前,与术前比差异有统计学意义(P＜0.01).②术前NT-proBNP浓度值与术前CO值呈负相关r=-0.8734,t=-11.2022,P＜0.01;和术后16 h的CO值呈负相关r=-0.8579,t=-10.4291,P＜0.01;术前NT-proBNP浓度值与术前CI值呈负相关r=-0.8481,t=-9.9969,P＜0.01;和术后16 h的CI值呈负相关r=-0.7691,t=-7.5148,P＜0.01.③心律失常,脑、肝、肾等重要脏器功能受损等并发症患者的术前血清NT-proBNP浓度值明显高于无并发症患者,差异有统计学意义(P均＜0.01).结论术前监测血清NT-proBNP浓度值对于评估风湿性瓣膜病围手术期风险性具有重要意义.围手术期血清NT-proBNP浓度值越小,术后CO,CI较高,其术后并发症较少,术后恢复较好.术后早期NT-proBNP浓度开始升高,24 h达到高峰,后期开始下降.     

经皮冠状动脉介入治疗对急性心肌梗死患者血浆N末端脑钠肽前体的影响及其临床意义

目的探讨经皮冠状动脉介入(PCI)治疗对急性心肌梗死(AMI)患者血浆N末端脑钠肽前体(NT-proBNP)水平的影响,尝试拟定最佳检测时间截点来指导临床预后评估。方法选择2011年3月—2012年3月我院心脏中心收治的行PCI治疗的急性心肌梗死患者89例,根据干预方式分为急诊PCI组(n=50)和择期PCI组(n=39),分别记录术前、术后24~36 h、术后37~48 h的NT-proBNP床旁检测值和随访6个月时左室射血分数(LVEF)值。因NT-proBNP不符合正态分布,经自然对数(ln)处理后,采用重复测量方差分析和相关性检验。结果急诊PCI组患者NT-proBNP在术后24~36 h达到最高值,之后逐渐下降(P0.001);择期PCI组3个时间段NT-proBNP水平比较,差异无统计学意义(F=1.19,P=0.31)。虽然PCI治疗过程中NT-proBNP的变化有所不同,但不同的干预方案对NT-proBNP的总体影响,差异无统计学意义(F=0.09,P=0.77)。术后24~36 h急诊PCI组的NT-proBNP水平高于择期PCI组(P0.001)。急诊PCI组6个月时LVEF值与术后37~48 h的NT-proBNP呈负相关(r=-0.8,P0.001),而择期PCI组LVEF与3个时间段的NT-proBNP值呈负相关(r=-0.9,P0.001)。结论急诊PCI患者术后37~48 h内的NT-proBNP水平可以较准确地评估患者的预后心功能,择期PCI患者入院时的NT-proBNP水平可很好地评估预后。     

不稳定型心绞痛患者冠脉介入术前后N末端脑钠肽前体水平的变化

目的 观察冠脉介入前、后不稳定型心绞痛（UAP）患者N末端脑钠肽前体（NT-proBNP）水平变化,探讨心肌缺血与NT-proBNP的关系.方法 选择心功能正常的UAP患者75例,胸痛症状无发作3 d以上时行冠状动脉造影检查,病变适宜者接受经皮冠状动脉介入治疗.术前及术后16～24 h进行超声心动图检查和血浆NT-proBNP浓度测定,术后72 h复查血浆NT-proBNP水平.结果 单纯冠脉造影（CAG组）37例,经皮冠状动脉介入治疗（PCI组）38例,其中单支病变28例,包括左冠状动脉前降支置入支架（LAD组）18例、右冠状动脉或回旋支置入支架（非LAD组）10例.CAG组术前和术后16～24 h的NT-proBNP水平及左室射血分数（LVEF）无明显变化（P＞0.05）;PCI组术后16～24 h的血浆NT-proBNP浓度高于术前（P＜0.05）,LVEF较术前降低,但差异无统计学意义（P＞0.05）;LAD组的NT-proBNP升高幅度大于非LAD组（P＜0.05）,两组术后72 h的NT-proBNP水平均低于术前（P＜0.05）.结论 在心功能正常且无明显改变的情况下,UAP患者介入治疗后血浆NT-proBNP浓度暂时升高,可能与术中球囊扩张所致的一过性心肌缺血有关.心肌缺血是刺激NT-proBNP分泌增多的重要因素.     

冠状动脉造影术造影剂与肾功能关系的研究

目的探讨冠状动脉造影术中造影剂对肾功能的影响。方法①按患者所用造影剂的量分成50~100ml组、100~200ml组和>200ml组。②分别测定术前、术后24h、术后48h、术后10d的血尿素氮(BUN)、血肌苷(Cr)、尿微量白蛋白(MAU)、尿β2-微球蛋白(β2MG)的值并进行比较。结果造影后24h、48h尿β2MG与造影前及造影后10d比较有显著性差异(P<0.05),其余指标各时段之间比较无显著性差异(P>0.05)。造影后24h、48h造影剂>200ml组与50~100ml组及100~200ml组之间Cr、MAU及β2MG的变化有显著性差异(P<0.05)。其余各组之间比较无显著性差异(P>0.05)。结论造影剂对肾功能有一定的损害,并且随造影剂剂量的增加其损害加重。     

心内直视手术对先天性心脏病与风湿性心脏病患者脑组织损伤的对比研究

目的 :观察和比较接受心内直视手术的先天性心脏病 (CHD)与风湿性心脏病 (RHD)患者围手术期血浆中神经元特异性烯醇化酶 (neuron specificenolase ,NSE)与星状细胞胶质蛋白S 10 0b (pro teinS 10 0b)的含量及脑电图 (EEG)的变化 ,探讨心内直视手术对不同疾病患者脑损伤的差异。方法 :选择心内直视手术患者 4 0例 ,分为CHD组 (A组 ,n =2 0 ) ,RHD组 (B组 ,n =2 0 )。 2组均在浅低温体外循环 (CPB)心脏不停跳下施行手术。所有患者均在术前、CPB开始后 2 0min、CPB结束后 1h和CPB后 2 4h采取血样本 ,用酶联免疫吸附法 (ELISA)测定血浆中NSE和S 10 0b蛋白含量。结合患者术前与术后 7d的脑电图检查 ,比较患者术后脑组织损伤的程度。结果 :CPB开始 2 0min 2组患者血浆中S 10 0b均明显升高 ,而且一直持续到CPB后 2 4h仍高于术前水平 (P <0 .0 1) ;CHD患者S 10 0b升高程度较RHD患者明显。血浆NSE水平在CPB开始后 2 0minCHD组明显升高 (P <0 .0 1) ,一直持续至CPB结束后 1h达到最高点 ,以后NSE浓度逐渐下降 ,至CPB后 2 4h已接近术前水平 (P >0 .0 5 ) ;RHD患者在CPB开始后 2 0minNSE升高 (P <0 .0 5 ) ,在CPB结束后 1h明显高于术前 ,一直持续到CPB后 2 4h仍较术前高(P <0 0 1)。术后 2组患者EEG的异常率无明显差     

心衰大鼠微颗粒对内皮细胞迁移的抑制作用

目的 检测慢性心力衰竭（HF）大鼠循环微颗粒（MPs）数量及蛋白浓度的变化并观察其对人脐静脉内皮细胞迁移能力的影响。 方法 将SD大鼠随机分为手术组（n=15）和伪手术组（n=6）,采用腹主动脉缩窄法建立慢性HF大鼠模型,术后12周采用超声心动图检测心脏功能,HE染色检测心脏形态学改变。应用流式细胞术检测大鼠的总循环MPs及膜联蛋白（Annexin）Ⅴ阳性的MPs数量,BCA法检测总循环MPs的蛋白量。划痕实验观察各组大鼠MPs对内皮细胞的影响。 结果 ①术后12周,与伪手术组大鼠相比,手术组大鼠心功能下降,表现为左室收缩末期内径（LVIDs）与左室舒张末期内径（LVIDd）显著增大（均P<0.01）,左室射血分数（LVEF）与左室短轴缩短率（LVFS）明显减小（均P<0.01）。HE染色结果显示,手术组大鼠的心肌结构紊乱,表明慢性HF大鼠模型建立成功。②手术组大鼠总循环MPs及Annexin Ⅴ（+） MPs的数量和总循环MPs的蛋白量显著高于伪手术组（均P<0.01）。③手术组大鼠循环MPs作用内皮细胞24 h后,其迁移能力下降（P<0.05）;孵育36 h和48 h时,细胞迁移率显著下降（P<0.01）。 结论 在慢性HF大鼠模型中循环MPs的数量及蛋白量显著升高,HF大鼠的循环MPs可抑制内皮细胞的迁移功能。     

血清醛固酮和急性ST段抬高型心肌梗死经皮冠状动脉介入术后无复流的关系

目的 探讨急性ST段抬高型心肌梗死(STEMI)急诊PCI术前血清醛固酮(aldosterone,ALDO)水平和术后无复流的关系.方法 2007年1月至2007年10月连续收集117例STEMI患者,在发病12 h内行急诊PCI,在术前股动脉穿刺后留取血清,采用放射免疫法测定醛固酮含量.按ALDO水平分成三组,ALDO＜100 pg/mL组37例,100 pg/mL≤ALDO≤200 pg/mL组43例,ALDO＞200 pg/mL组37例.PCI术后通过评估冠状动脉血流TIMI分级,来判断无复流的发生.又将117例分为无复流(10例)和心肌充分复流(107例)两组,比较两组ALDO水平.结果 ALDO＞200 pg/mL组的无复流发生率(21.62%)明显高于ALDO＜100 pg/mL组(2.70%)和100 pg/mL≤ALDO≤200pg/mL组(2.33%),P=0.003 8.另外,无复流组ALDO水平为379.1±234.3 pg/mL,明显高于心肌充分复流组的164.5±100.6 pg/mL(P=0.001 0).STEMI发病早期PCI术前的ALDO水平与术后TIMI分级两者呈负相关(相关系数-0.392 41,P＜0.000 1).结论 随着血清醛固酮水平的升高,无复流的发生也相应增加.STEMI发病早期PCI术前的ALDO水平与术后TIMI分级两者呈负相关.     

冠状动脉介入术前高负荷量氯吡格雷预治疗的近期疗效

目的:对比观察拟行冠状动脉(冠脉)介入术患者术前服用高负荷剂量氯吡格雷600 mg与常规负荷剂量300 mg预治疗的有效性及安全性.方法:选取100例拟行冠脉介入术的患者,术前随机分别给予600 mg(50例)或300 mg(50例)负荷剂量氯吡格雷预治疗.分别检测2组服药前、服药后16、36 h二磷酸腺苷(ADP)诱导的血小板最大凝集率(MPAR),随访术后30 d和6个月主要临床心血管事件(包括死亡、心肌梗死、紧急靶血管血运重建、脑卒中等)和出血事件的发生情况.结果:服药后16 h,氯吡格雷600 mg组较之300 mg组对ADP(5μmol/L和20μmol/L)诱导的MPAR产生更大的抑制作用[ADP 5μmol/L,(21.83±18.04)%:(14.79±9.18)%,P＜0.05];[ADP 20μmol/L,(22.12±14.81)%:(15.67±10.15)%,P＜0.05)].而服药后36 h,2组ADP(5μmol/L和20μmol/L)诱导的MPAR率分别降低[ADP5μmol/L.(16.70±15.42)%:(12.94±10.34)%,P＞0·05]和[20μmol/L :(14.14±13.16)%:(10.19±9.49)%,P＞0.05].氯吡格雷600 mg组30d和6个月主要临床心血管事件发生率较300 mg组显著减少(P＜0.05,P＜0.01).2组30 d和6个月出血事件差异均无统计学意义.结论:冠脉介入术患者术前服用高负荷剂量氯吡格雷600 mg较之常规负荷剂量300 mg预治疗能更大程度抑制血小板凝集.同时可显著改善临床预后.     

发绀患者体外循环中不同氧浓度管理对心肌的影响

目的 观察在发绀患者心内畸形矫治术中使用不同氧浓度管理对心肌的影响.方法 选择2009年1月至2011年9月期间74例发绀型先心病患者随机分为两组：常规组37例,采用氧浓度（FiO2）80%～100%、动脉氧分压（PaO2） 300～380 mm Hg启动体外循环（CPB）;逐级增氧组37例,FiO2 20%、PaO2 80～100 mm Hg启动CPB,在随后10～30 min逐渐增加FiO2 30%～50%,CPB中控制血流复温前PaO2≤130 mm Hg,血流复温后PaO2逐级增加至200～300 mm Hg,保持红细胞压积28%～30%,灌注流量100～180 ml/kg.监测心肌生化变化：气管插管后（T1）、CPB后10 min（T2）、升主动脉开放（CCR）后10 min（T3）、术后6 h（T4）及24 h（T5）抽外周血监测肌酸激酶同工酶（CK-MB）及肌钙蛋白I（cTnI）浓度.结果 CK-MB及cTnI浓度：气管插管后、CPB后10 min两组差异无统计学意义（P＞0.05）;CCR 10 min、术后6 h及24 h逐级增氧组水平显著低于常规组（P＜0.05）.结论 发绀患者CPB中采用逐级增氧管理模式,通过缩小CPB和患者自身的氧分压差,减少自由基等生成,可降低CK-MB及cTnI释放,从而减轻心肌损伤.     

下肢康复训练机器人对脑梗死偏瘫患者肌力肌张力与P300的影响

目的探讨下肢康复训练机器人对脑梗死偏瘫患者肌力肌张力与P300的影响。方法脑梗死下肢偏瘫患者60例随机分为对照组(30例)和机器人组(30例),对照组采用常规康复疗法,机器人组在常规康复疗法的基础上给予Lokomat康复训练为主的运动训练方法。均在干预前及干预8 w后分别采用Lokomat康复训练机器人系统评测(下肢髋膝关节的肌力肌张力)和事件相关电位(ERP)N100、N200、P200和P300电位变化检测。结果干预前,两组肌力肌张力参数差异不显著(P0.05),干预后,两组肌力肌张力参数差异明显(P0.05),与对照组比较,机器人组各项评定结果差异显著(P0.05);干预前,N100、N200、P200和P300波幅及潜伏期数值无差异(P0.05)。干预8 w后两组N200和P300波幅及潜伏期数值差异显著(P0.05)。结论早期进行机器人康复训练可增强脑梗死患者肌力,降低肌张力,对于脑卒中患者认知功能的提高具有明显促进作用。     

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。