替米沙坦对缺血再灌注兔心肌细胞凋亡的影响

目的 探讨替米沙坦对缺血再灌注兔心肌细胞凋亡的影响.方法 48只雄性新西兰大白兔随机分为6组:假手术组、缺血再灌注模型组、GW9662组、替米沙坦组、替米沙坦+GW9662组、坎地沙坦组,每组8只.灌胃给药2周,假手术组左前降支近端穿线但不结扎,其余5组予60 min缺血,360 min再灌注.采用放射免疫法检测心肌血管紧张素Ⅱ含量,双波长荧光分光光度法测定心肌细胞内游离钙浓度,免疫印迹法测定过氧化体增殖物激活型受体γ蛋白的表达,透射电镜和末端标记法检测心肌细胞凋亡.结果 缺血再灌注模型组、GW9662组、替米沙坦组、替米沙坦+GW9662组及坎地沙坦组心肌血管紧张素Ⅱ含量均较假手术组明显增高(P<0.01).替米沙坦组过氧化体增殖物激活型受体γ蛋白的表达明显高于其余各组(P<0.01).电镜显示,替米沙坦、替米沙坦+GW9662及坎地沙坦抑制心肌缺血再灌注诱导的心肌细胞凋亡的特征性形态学改变如核染色质浓缩边集,出现凋亡小体等.与缺血再灌注模型组比较,替米沙坦组、替米沙坦+GW9662组和坎地沙坦组心肌细胞游离钙浓度、凋亡指数均明显降低(P<0.01);替米沙坦组凋亡指数显著低于替米沙坦+GW9662组和坎地沙坦组(P<0.01).结论 替米沙坦通过阻断血管紧张素Ⅱ1型受体降低细胞内钙浓度,并通过上调过氧化体增殖物激活型受体γ的表达,抑制兔缺血再灌注心肌细胞凋亡而发挥心肌保护效应.     

烟酸对高脂血症兔瘦素、过氧化体增殖物激活型受体γ和CD36表达的影响

目的探讨烟酸对高脂血症兔血清瘦素及皮下脂肪组织瘦素、过氧化体增殖物激活型受体γ及CD36 mRNA表达的影响。方法12只健康雄性新西兰兔给予高胆固醇饮食饲养8周后,随机分为高脂组和烟酸组:高脂组继续饲以高胆固醇饲料6周;烟酸组在饲以高胆固醇饲料的基础上给予烟酸0.2g/(kg.d),共6周。另选择普通饮食14周兔(n=6)作为对照组。实验结束后,取腹股沟处皮下脂肪组织称重并冻存,用酶联免疫吸附法测定血清及脂肪细胞培养基瘦素水平;半定量逆转录聚合酶链反应测定脂肪组织瘦素、过氧化体增殖物激活型受体γ及CD36mRNA的表达。此外,在体外观察不同浓度的烟酸对高脂兔脂肪细胞瘦素、过氧化体增殖物激活型受体γ及CD36 mRNA的表达。结果高脂组兔血清及脂肪组织瘦素水平明显高于正常对照组,烟酸治疗6周后可降低血清及脂肪组织瘦素水平。逆转录聚合酶链反应表明烟酸组较高脂组瘦素mRNA表达降低,瘦素mRNA与过氧化体增殖物激活型受体γmRNA和CD36 mRNA的表达呈负相关。体外实验亦表明,烟酸呈剂量依赖性地降低脂肪细胞瘦素mRNA表达,并剂量依赖性地上调过氧化体增殖物激活型受体γ及CD36 mRNA的表达。结论烟酸治疗能降低高脂血症兔血清及脂肪分泌瘦素水平,上调过氧化体增殖物激活型受体γ及CD36 mRNA的表达。     

过氧化体增殖物激活型受体对心肌能量代谢调控的病理生理机制

过氧化体增殖物激活型受体是调节编码脂肪酸β－氧化相关酶类基因的重要转录调节因子，在调节心肌能量代谢中发挥重要作用。心肌肥厚和心力衰竭时心肌细胞过氧化体增殖物激活型受体α的表达和转录调控活性均降低，脂肪酸β－氧化的相关酶类基因（过氧化体增殖物激活型受体α的靶基因）的表达在转录水平降低，说明过氧化体增殖物激活型受体α可能通过信号转导途径影响心肌的能量代谢。过氧化体增殖物激活型受体γ激活剂可增加心肌细胞对葡萄糖的氧化和利用，减轻心肌缺血／再灌注损伤和心肌肥厚的程度，有潜在的心脏保护作用。但仍缺乏过氧化体增殖物激活型受体γ激活剂对心肌能量代谢的调控与心脏保护作用关系的研究报道。     

大蒜素对鼠缺血再灌注心肌过氧化物酶体增殖物激活受体α表达的影响

目的：探讨大蒜素对实验性大鼠缺血再灌注心肌梗死面积及过氧化物酶体增殖物激活受体α（PPARα）表达的影响。方法：Wistar大鼠70只被随机分为三组：假手术组（n=24），缺血再灌注组（n=24），大蒜素组（n=22）。采用鼠心冠状动脉左前降支结扎法制作在体缺血再灌注模型，观察心肌梗死范围，运用半定量RT-PCR方法对心肌PPARα mRNA的表达情况进行分析，运用Western—blotting方法对检测PPAR蛋白表达情况。结果：大蒜素组心肌梗死面积显著减少（P〈0．05），并且心肌PPARα mRNA及蛋白表达水平显著上调（P〈0．01）。结论：大蒜素可显著减少实验性大鼠缺血再灌注后梗死面积及并使心肌中过氧化物酶体增殖物激活受体α（PPARα）显著上调。     

阿托伐他汀对老年大鼠心肌凋亡和过氧化物体增殖物激活型受体α蛋白表达的影响

目的 通过在体动物实验的方法,观察老年大鼠心肌凋亡和过氧化体增殖物激活型受体α蛋白表达水平的变化及阿托伐他汀干预对上述因素的影响.方法 30只20月龄的wistar大鼠,随机分为老年对照组、大剂量阿托伐他汀处理组[10 mg/(kg·d)]和小剂量阿托伐他汀处理组[1 mg/(kg·d)].10只3月龄的wistar大鼠作为青年对照组.阿托伐他汀组每天给予相应剂量的药物灌胃处理,共4个月.对照组给予相同体积的生理盐水灌胃.采用TdT介导的dUTP缺口末端标记技术(TUNEL)检测心肌细胞凋亡;用western blot方法检测各组大鼠心肌的过氧化体增殖物激活型受体α蛋白表达水平.结果 ①与青年对照组相比,老年对照组大鼠的心肌过氧化体增殖物激活型受体α蛋白表达显著降低(P<0.01),阿托伐他汀可显著增加过氧化体增殖物激活型受体α的表达(P<0.01);②老年对照组大鼠的心肌细胞凋亡水平较青年对照组大鼠显著增高(P<0.01),阿托伐他汀干预组的心肌细胞凋亡水平较老年对照组明显降低(P<0.01).结论 阿托伐他汀干预可显著抑制老年大鼠心肌心肌细胞凋亡的发生,其作用可能与其上调过氧化体增殖物激活型受体α的表达有关.     

普罗布考对动脉粥样硬化兔肝脏PPARα表达的影响

目的 探讨普罗布考对动脉粥样硬化模型兔肝脏的保护作用及其对过氧化体增殖物激活型受体α表达的影响.方法 16只新西兰大白兔给予高脂饲养8周后,随机平分为2组:高脂组饲以高脂饲料及1%淀粉;普罗布考组在饲以高脂饮食基础上每天给予0.25g普罗布考;另选8只兔为正常对照组给予普通饮食.14周末,处死所有动物,检测血脂、主动脉斑块面积、肝组织病理学等指标,并用RT-PCR和western blot检测各组肝脏过氧化体增殖物激活型受体α mRNA和蛋白的表达量.结果 与高脂组相比,普罗布考组动脉粥样斑块减少,肝脏脂肪病变明显减轻,血清总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇显著降低.高脂组肝脏过氧化体增殖物激活型受体αmRNA和蛋白的表达量明显低于对照组,而普罗布考可上调过氧化体增殖物激活型受体α mRNA和蛋白的表达量.结论 普罗布考降低动脉粥样硬化模型兔血浆胆固醇水平,上调其肝细胞过氧化体增殖物激活型受体α表达水平,对动脉粥样硬化模型兔脂肪肝具有治疗作用.     

高密度脂蛋白2和高密度脂蛋白3对THP-1巨噬细胞脂质蓄积及过氧化体增殖物激活型受体γ和CD36表达的影响

为探讨高密度脂蛋白2和高密度脂蛋白3对THP-1巨噬细胞过氧化体增殖物激活型受体γ和CD36表达及脂质蓄积的影响。取新鲜抗凝血浆，用超速离心术进行密度梯度离心，收集低密度脂蛋白、高密度脂蛋白2和3。将氧化型低密度脂蛋白分别与高密度脂蛋白2和3共孵育THP-1巨噬细胞，用油红O染色及高效液相分析法观测细胞内脂质蓄积程度；用逆转录聚合酶链反应检测CD36和过氧化体增殖物激活型受体γ mRNA的表达：用Westem blotting检测CD36和过氧化体增殖物激活型受体γ蛋白的表达。结果发现，与单独用氧化型低密度脂蛋白和THP-1孵育相比，用高密度脂蛋白2、高密度脂蛋白3分别与氧化型低密度脂蛋白共孵育THP-1可使细胞内脂质蓄积明显减少，过氧化体增殖物激活型受体γ mRNA及蛋白表达上调，CD36 mRNA及蛋白表达下调。而高密度脂蛋白3比高密度脂蛋白2作用更明显。结果提示，高密度脂蛋白2和3对氧化型低密度脂蛋白诱导THP-1细胞脂质蓄积有显著抑制作用，而高密度脂蛋白3的作用更强。其机制与高密度脂蛋白可以增强过氧化体增殖物激活型受体γ mRNA和蛋白表达上调及过氧化体增殖物激活型受体γ磷酸化，进而抑制过氧化体增殖物激活型受体γ的应答基因CD36 mRNA及蛋白表达有关。     

中药虎杖和山楂提取物对载脂蛋白E基因敲除小鼠巨噬细胞PPARγ、ABCA1及CD36 mRNA表达的影响

目的 观察中药虎杖、山楂配伍对栽脂蛋白E基因敲除小鼠巨噬细胞源性泡沫细胞内过氧化体增殖物激活型受体γ、三磷酸腺苷结合盒转运子A1及cD36 mRNA表达的影响,从基因水平探讨虎杖和山楂配伍对动脉粥样硬化泡沫细胞形成的干预机制.方法 培养载脂蛋白E基因敲除小鼠腹腔巨噬细胞,分为空白组、虎杖苷组、山楂提取物组、虎杖苷+山楂提取物组、洛伐他汀组、罗格列酮组及模型组.除空白组外,其他各组均同时加入氧化型低密度脂蛋白及脂多糖.各组细胞在培养箱内共孵育(泡沫化)2天,以逆转录聚合酶链反应法检测0 h、24 h和48 h各组细胞内过氧化体增殖物激活型受体γ、三磷酸腺苷结合盒转运子A1及CD36的mRNA表达.结果与空白组比较,干预24 h和48 h后,模型组及各用药组三个指标的表达均显著增高(P<0.01);与模型组比较,干预24 h后,虎杖苷+山楂提取物组和罗格列酮组过氧化体增殖物激活型受体γ mRNA表达显著增高,虎杖苷组、虎杖苷+山楂提取物组和罗格列酮组三磷酸腺苷结合盒转运子A1 mRNA表达显著增高(P<0.05或P<0.01),各用药组CD36 mRNA表达无显著差异(P>0.05);干预48 h后,各用药组过氧化体增殖物激活型受体γ和三磷酸腺苷结合盒转运子A1 mRNA表达均显著增高,CD36 mRNA表达显著降低,且虎杖苷+山楂提取物组优于虎杖苷组、山楂提取物组及洛伐他汀组(P<0.05或P<0.01).结论 虎杖和山楂配伍可能具有与罗格列酮相似的过氧化体增殖物激活型受体γ激动作用,通过上调栽脂蛋白E基因敲除小鼠巨噬细胞过氧化体增殖物激活型受体γ和三磷酸腺苷结合盒转运子A1 mRNA表迭、下调CD36 mRNA表达的调控途径显著抑制巨噬细胞泡沫化过程,阻止动脉粥样硬化进程.     

过氧化体增殖物激活型受体γ对巨噬细胞脂质蓄积及CD36表达的影响

目的观察过氧化体增殖物激活型受体γ激动剂和拮抗剂对THP-1巨噬细胞胆固醇蓄积及CD36表达的影响。方法实验分对照组、氧化型低密度脂蛋白组、Ciglitazone处理组和GW9662处理组,后两组用50 mg/L氧化型低密度脂蛋白分别与过氧化体增殖物激活型受体γ激动剂Ciglitazone(10μmol/L)及拮抗剂GW9662(10μmol/L)共同孵育24 h,高效液相色谱分析法检测细胞总胆固醇蓄积情况,RT-PCR和Western blot分别检测THP-1巨噬细胞CD36 mRNA和蛋白的表达。结果与对照组(76.28±10.36 mg/g)相比,氧化型低密度脂蛋白(121.63±13.32 mg/g)能使细胞总胆固醇含量显著增加,而Ciglitazone能使氧化型低密度脂蛋白处理的细胞总胆固醇含量进一步增加(136.23±14.78 mg/g),GW9662能使氧化型低密度脂蛋白处理的细胞总胆固醇含量减少(98.52±11.45 mg/g)。过氧化体增殖物激活型受体γ拮抗剂GW9662使巨噬细胞CD36 mRNA和蛋白的表达下调及胆固醇蓄积减少,过氧化体增殖物激活型受体γ激动剂Ciglitazone使巨噬细胞CD36 mRNA和蛋白的表达上调及胆固醇蓄积增多。结论过氧化体增殖物激活型受体γ拮抗剂使THP-1巨噬细胞胆固醇蓄积减少及氧化型低密度脂蛋白诱导的CD36表达下调。     

过氧化体增殖物激活型受体β/δ激活剂抑制体外血管紧张素Ⅱ诱导的心肌细胞肥大

目的探讨过氧化体增殖物激活型受体β/δ激活剂GW0742在体外对血管紧张素Ⅱ诱导的肥大心肌细胞的作用,分析过氧化体增殖物激活型受体β/δ在其中的可能作用。方法体外培养新生大鼠的心室肌细胞,用血管紧张素Ⅱ诱导建立心肌肥厚模型,在模型中加入GW0742,用软件分析心肌细胞表面积观察心肌细胞面积,3H-亮氨酸的掺入检测心肌细胞蛋白合成速率及使用逆转录聚合酶链反应半定量测定心房钠尿肽、脑钠尿肽和过氧化体增殖物激活型受体β/δmRNA的表达变化,用免疫荧光方法测定过氧化体增殖物激活型受体β/δ的蛋白表达水平。结果血管紧张素Ⅱ可使体外培养的心肌细胞面积和3H-亮氨酸的掺入增加,升高心房钠尿肽和脑钠尿肽的表达,过氧化体增殖物激活型受体β/δ表达下降;GW0742可逆转上述变化。结论GW0742具有抑制血管紧张素Ⅱ诱导的体外心肌细胞肥大的作用,很可能通过活化过氧化体增殖物激活型受体β/δ途径。     

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。