2型糖尿病合并高血压患者血清脂联素水平与胰岛素抵抗的关系

目的：观察2型糖尿病患者加之高血压、肥胖因素血清脂联素水平与单纯2型糖尿病患者及正常人群的差异，分析血清脂联素水平与胰岛素抵抗的关系。方法：选择2004-11／2005-12桂林医学院附属医院内分泌科、糖尿病防治中心住院及门诊2型糖尿病患者240例，以是否合并有高血压为标准分为两组，即高血压组120例，肥胖者（体质量指数≥25kg／m^2）68例，非肥胖者（体质量指数〈25kg／m^2）52例；非高血压组120例，肥胖者62例，非肥胖者58例；另纳入健康者50例为对照组。分别检测以上3组患者的空腹脂联素、瘦素、肿瘤坏死因子、胰岛素、空腹和馒头餐后2h血糖、糖化血红蛋白、体质量指数、血压、总胆固醇、三酰甘油，计算胰岛素敏感指数，比较脂联素水平变化，并与其他因素进行相关分析及逐步回归分析，观察其与胰岛素抵抗的关系。结果：参与观察的2型糖尿病患者240例及健康者50例全部进入结果分析。①2型糖尿病合并高血压组空腹血糖、胰岛素、C肽及餐后2h血糖与其他两组比较，差异有非常显著性意义（P〈0．01）；体质量指数、瘦素、肿瘤坏死因子、收缩压、舒张压、总胆固醇、三酰甘油、糖化血红蛋白、胰岛素敏感指数与其他两组比较，差异有显著性意义（P〈0．05）。②2型糖尿病合并高血压组和单纯2型糖尿病组血清脂联素水平低于正常对照组（P〈0．01）；2型糖尿病合并高血压组血清脂联素水平低于单纯2型糖尿病组（P〈0．01）；肥胖者均低于非肥胖者（P〈0．05～0．01）。③多元线性相关分析显示，2型糖尿病合并高血压组中，脂联素与体质量指数、收缩压、空愎血糖、胰岛素、三酰甘油、瘦素、肿瘤坏死因子α之间存在显著负相关，与胰岛素敏感指数呈独立正相关，进入回归方程的因素为脂联素、瘦素、肿瘤坏死因子α、体质量指数，三酰甘油、收缩压；2型糖尿病非高血压组中，脂联素与空愎血糖、胰岛素、三酰甘油，瘦素、肿瘤坏死因子α之间存在显著负相关，与胰岛素敏感指数呈独立正相关，进入回归方程的因素为脂联素、瘦素、肿瘤坏死因子α，三酰甘油。结论：在2型糖尿病患者中，血清脂联素水平明显降低，合并高血压者血清脂联素水平更低，与胰岛素敏感指数呈独立正相关，脂联素水平与高血压之间存在一定的相关性。     

不同人群血清脂联素、瘦素水平与胰岛素抵抗的关系

【目的】研究不同人群（健康人群、肥胖和2型糖尿病患者）血清脂联素（APN）、瘦素（LEP）水平及其与肥胖、胰岛素抵抗的关系。【方法】采用病例对照研究,2型糖尿病（T2DM）伴有肥胖组（DO）42例,T2DM不伴肥胖组（NDO）42例,单纯性肥胖组（OB）37例,正常对照组（NC）28名。检测了4组研究对象血脂、血糖、空腹胰岛素（Fins）、APN、LEP水平,用HOMA模型公式计算胰岛素抵抗指数（HOMAIR）。[结果]NC组的APN水平明显高于其他3组（均P〈0．05）。DO组、OB组的LEP水平明显高于NDO组及NC组（P〈0．05）。相关分析显示：APN与HOMAIR、体质指数（BMI）、腰围（WC）、腰臀比（WHR）、空腹血糖（FBG）、甘油三脂（TG）和Fins呈显著负相关（P〈0．01）;LEP与BMI和体脂百分含量（BFC）呈显著正相关（P〈0．01）,与WC和Fins呈正相关（P〈0．05）;APN与LEP无相关性。多元逐步回归分析显示：APN与Fins呈显著负相关（P〈0．01）,与WHR、FBG呈负相关（P〈0．05）;LEP与BFC呈显著正相关（P〈0．01）。【结论】血清APN水平与2型糖尿病及肥胖相关。血清瘦素水平与2型糖尿病无关,但与肥胖有关。APN与瘦素之间无相关性,APN对于胰岛素抵抗的影响程度明显大于瘦素。     

肥胖、2型糖尿病血清瘦素水平与胰岛素抵抗及代谢紊乱的相关分析

目的：研究2型糖尿病患血清瘦素水平与胰岛素抵抗及代谢紊乱综合征的关系。方法：随机选取2型糖尿病患77例。（1）将患分为高血压组和正常血压组，比较两组间瘦素水平。（2）将血清瘦素水平作为因变量，其他参数作为自变量，进行多因素逐步回归分析。结果：（1）高血压组与正常血压组间除高血压组年龄较大外，其余指标，差异均无显性。（2）血清瘦素水平与体重指数呈显正相关（P＜0．001），与胰岛素敏感指数呈负相关（P＜0．01）。结论：在2型糖尿病患中，高瘦素水平与胰岛素抵抗有密切关系。     

单纯性肥胖患者血清瘦素与胰岛素、性激素的相关分析

[目的]观察单纯性肥胖患者血清瘦素水平与胰岛素、性激素浓度的父系。[方法]川放射免疫法测定64例肥胖者和65例非肥胖者的血清瘦素水平,并分析血清瘦素水平与年龄,体重指数（BMI）、腰臀比值（WHR）、胰岛素（INS）、睾酮（T、）雌二醇（E2）的相关性。[结果]1．无论肥胖组还是非肥胖组,女性血清瘦素水平显著高于男性（P〈0．01）;同性别比较,肥胖组显著高于非肥胖组（P〈0．01）。2．相关性分析,无论是男性还是女性,血清瘦素与BMI、WHR旱显著正相关,而与年龄无关。3．血清瘦素水平与胰岛素浓度呈正相关,与血糖浓度无关。4．血清瘦素水平与T,男性呈负相关（r=一0．310,P〈0．01）,而女性呈正相关（r=0．360,P〈0．01）;与E2在男性无相关性,女性呈正相关（r=0．323,P〈0．01）。[结论]肥胖者窄腹血清瘦素水平升高,血清高瘦素与高胰岛索血症的相关性提示瘦素可能在2型糖尿病的发病中起一定作用。BMI足影响血清瘦素水平的主要原因之一,而性别间的差异则与性激素有关。     

女性高血压患者血清瘦素与胰岛素抵抗及左室肥厚的关系

目的：探讨女性患者血清瘦素水平与胰岛素抵抗和原发性高血压左室肥厚的关系。方法：女性原发性高血压患者44例，对照组43例，测定其空腹血清瘦素、血糖、胰岛素、血脂、体重指数，稳态模型评估法计算胰岛素抵抗指数，心脏彩色多谱勒测定室间隔厚度并计算左心室重量指数，分析血清瘦素水平与胰岛素抵抗和原发性高血压患者左室肥厚的关系。结果：女性高血压组的血清瘦素水平、胰岛素抵抗指数高于对照组，差异有统计学意义（P〈0．05），瘦素与胰岛素抵抗指数、左心室重量指数呈正相关。结论：女性高血压患者血清瘦素水平与胰岛素抵抗和左室肥厚有关。     

脑梗死患者血清瘦素、胰岛素敏感指数与梗死体积及神经功能缺损的关系

目的：观察瘦素、胰岛素敏感指数在脑梗死患者急性期血清水平变化，探讨其与患者梗死体积及神经功能缺损的关系。 方法：选择华北煤炭医学院附属医院2004-02／2005-02收治的86例急性脑梗死患者为观察对象。测定其急性期血清中的瘦素、胰岛素、血糖、胰岛素敏感指数的水平，与同期健康体检者31例对照。将脑梗死患者按梗死体积分为小梗死组（〈5cm^3），中梗死组（5-15cm^3），大梗死组（〉15cm^3）；根据神经功能缺损程度评分分为轻度损伤组（0～15分），中度损伤组（16～30分），重度损伤组（31-45分），比较不同梗死体积和损伤程度时瘦素水平、胰岛素抵抗程度的变化，并进行血清瘦素与胰岛素抵抗之间的直线相关和回归分析。 结果：按实际处理分析，117例观察对象全部进入结果分析。①脑梗死组的血糖、瘦素水平显著高于对照组[（7．05&;#177;2．22），（5．39&;#177;0．88）mmol／L；（17．85&;#177;15．09），（9．21&;#177;4．76）μg／L，（P〈0．05）]，胰岛素、胰岛素敏感指数显著低于对照组[（11．22&;#177;3．35），（19．75&;#177;8．06）mIU／L；-0．94&;#177;0．52，-1．89&;#177;0．79，（P〈0．05）]。②脑梗死体积越大，脑梗死患者血清中瘦素、胰岛素、血糖越高（F=15．79～12．00，P〈0．05），胰岛素敏感指数越低（F=24．27，P〈0．05）。③神经功能缺损程度越重，脑梗死患者血清中瘦素、胰岛素、血糖越高（F=14．28～11．00，P〈0．05），胰岛素敏感指数越低（F=23．24，P〈0．05）。④直线与相关回归分析表明瘦素与胰岛素、血糖呈显著正相关（r=0．53，0．26，P〈0．001），与胰岛素敏感指数呈显著负相关（r=-0．66，P〈0．001）。 结论：①脑梗死体积越大，神经功能缺损评分越高，瘦素水平越高，胰岛素抵抗程度越重，提示瘦素抵抗，胰岛素抵抗可加重缺血性脑损害。②瘦素水平越高，胰岛素抵抗程度越重，脑梗死体积越大，神经功能缺损评分越高，提示观测脑梗死患者血清瘦素水平及胰岛素抵抗程度对脑组织损伤程度及预后判断有一定的价值。③瘦素抵抗与胰岛素抵抗可能相巨促进．相互影响促进脑梗死的发生，加重病情。     

检测血清同型半胱氨酸水平对评价胰岛素抵抗、胰岛β细胞分泌功能的意义

[目的]探讨2型糖尿病患者血清同型半胱氨酸水平与胰岛素抵抗、胰岛B细胞分泌功能的相关性。[方法]用循环酶法测定49例2型糖尿病患者的血清同型半胱氨酸水平，葡萄糖氧化酶法测定血糖水平，放射免疫法测定C肽、胰岛素水平并与36例正常对照组作比较。[结果]2型糖尿病患者血清同型半胱氨酸水平明显高于正常对照组（P〈0．01），与空腹胰岛素、胰岛素抵抗指数HOMA—IR呈明显负相关（r=-0．362，-0．532；P〈0．05），与空腹血糖、空腹C肽、胰岛β细胞分泌功能指数HO-MA-β无明显相关（r=-0．298，-0．131，0．056；P〉0．05）。[结论]胰岛素缺乏可能是2型糖尿病患者血清同型半胱氨酸水平升高的一个重要相关因素。检测2型糖尿病患者血清同型半胱氨酸水平对于了解患者病情，指导临床治疗具有一定的意义。     

慢性乙型肝炎合并酒精性肝病患者血清瘦素测定的临床价值

目的测定慢性乙型肝炎合并酒精性肝病患者血清瘦素水平，并探讨与胰岛素抵抗的关系。方法选择慢性乙型肝炎合并酒精性肝病患者17例，肝硬化15例，慢性乙型肝炎19例与12例男性健康受试者为对照组，各组间在性别、年龄和体质量指数（BMI）均相匹配。采用酶联免疫吸附法（ELISA）测定血清瘦素，同时测定血糖、血脂、胰岛素和肝肾功能等指标，并测量身高、体质量，计算BMI。并进行结果分析。结果慢性乙型肝炎合并酒精性肝病、肝硬化组血清瘦素水平高于对照组（P〈0．05），慢性乙型肝炎组与对照组比较差异无统计学意义（P〉0．05），慢性乙型肝炎合并酒精性肝病组瘦素水平与BMI、FINS呈显著正相关（r值分别为0．169，0．267，P〈0．05）；瘦素与三酰甘油里明显负相关（r值为-0．249，P〈0．05）。结论慢性乙型肝炎合并酒精性肝病患者血清瘦素水平明显增高，与高胰岛素血症和胰岛素抵抗存在相关性，瘦素表达不能评价肝病严重程度。     

瘦素与2型糖尿病的关系

目的　观察瘦素与体重指数、腰围、臀围及糖代谢指标间的相关性,探讨瘦素与2型糖尿病的关系。方法　将6 4例2型糖尿病患者按体重指数分为非肥胖组及肥胖组,并将6 7例正常对照组亦按体重指数分为健康对照组及单纯肥胖组,测定体重指数、腰围、臀围及糖代谢指标、瘦素等,以胰岛素抵抗指数(HOMA- IR)来评价胰岛素的敏感性。应用SPSS10 .0软件统计分析。结果　①2型糖尿病者的血清瘦素水平及HOMA -IR均高于对照组(P <0 .0 5 ) ;肥胖者的瘦素水平及HOMA -IR均高于非肥胖者(P <0 .0 5 ) ;②Logistic多元回归显示:HOMA- IR(OR =10 6 .6 96 )、瘦素(OR =6 .86 3)是2型糖尿病的危险因素。结论　瘦素抵抗与胰岛素抵抗及2型糖尿病的发生相关。     

基质金属蛋白酶-9及胰岛素抵抗与2型糖尿病颈动脉粥样硬化的相关性研究

目的研究2型糖尿病患者基质金属蛋白酶-9（MMP-9）及胰岛素抵抗与颈动脉粥样硬化的关系。方法采用ELISA法分别检测正常人25例（对照组）、按体重指数（BMI）分成糖尿病非肥胖组26例和糖尿病肥胖组34例患者的血清MMP-9水平和胰岛素抵抗指数（HOMA-IR）等生化指标，应用彩色多普勒超声测量颈动脉内膜中层厚度（IMT）进行相关分析。结果糖尿病2组的HbAlc、FPG、FINS、HOMAIR、MMP-9、IMT的指标较对照组明显增高（P〈0．05或0．01），糖尿病肥胖组的FINS、HOMAIR、MMP-9的水平均高于非肥胖组（P〈0．05或0．01），而HbAlc、FPG、IMT相比较没有显著性差异（P〉0．05）。相关分析表明糖尿病2组血清MMP-9和HOMA-IR指标与IMT呈正相关。结论2型糖尿病患者颈动脉粥样硬化病变严重程度与血清MMP-9和HOMA-IR增高有密切的关系。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.