冠心病患者树突状细胞的功能及依那普利干预效应

目的研究冠心病(CHD)患者树突状细胞(DC)的功能状态及血管紧张素转化酶抑制剂(ACEI)的影响.方法分离CHD患者及体检健康者外周血单个核细胞(PBMC),在含重组人粒细胞巨噬细胞集落刺激因子(rhGM-CSF)、重组人白介素4(rhIL-4)培养条件下制备DC.CHD患者的DC并加以依那普利干预.用流式细胞仪检测DC表面共刺激分子CD86(B7-2)的表达,混合淋巴细胞反应(MLR)检测DC对同种异体T淋巴细胞的刺激能力.结果与正常人比较,CHD患者DC表面CD86的表达明显增高(84.1±2.6 vs 59.2±10.0,P＜0.001),对T淋巴细胞刺激的能力增强(1.3±0.2 vs 0.7±0.2,P＜0.001),CD86的表达与C反应蛋白水平呈正相关(r=0.72,P＜0.01);培养基中依那普利终浓度分别为1,10,100 ng/mL时,CHD患者DC表面CD86的表达明显降低(分别为75.3±5.1,66.9±4.1,58.8±5.3比84.1±2.6,P＜0.001),对T淋巴细胞刺激的能力下降(A值分别为1.0±0.2,0.8±0.2,0.7±0.1比1.3±0.2,P＜0.001).结论CHD患者DC处于激活状态,DC可能参与了CHD的发病.ACEI对CHD患者DC功能有明显的抑制作用,可能是其抗动脉粥样硬化的机制之一.     

依那普利对急性冠脉综合征患者树突状细胞功能的影响

目的 探讨急性冠脉综合征（ACS）患者树突状细胞（DC）功能状态以及依那普利（Enapril）对DC功能的影响.方法 将42例ACS随机分为常规治疗组（21例）和常规治疗加依那普利治疗组（21例）,分别于治疗前及治疗后1个月取血分离外周血T淋巴细胞,用流式细胞仪检测各组DC细胞表面共刺激分子CD86表达（以CD86^＋CD11c^＋细胞比例表示）;混合淋巴细胞反应（MLR）检测DC细胞对正常献血者T淋巴细胞刺激作用;分析依那普利治疗后CD86^＋CD11c^＋细胞比例,MLR的变化及其与血清C-反应蛋白（CRP）的相关性.结果 与正常人比较,ACS患者DC细胞中CD86^＋CD11c^＋细胞比例明显增加（P＜0.001）;对T淋巴细胞增殖刺激作用明显增强（P＜0.001）;与治疗前比较依那普利治疗后CD86^＋CD11c^＋细胞比例和MLR明显下降（P＜0.01）;CD86^＋CD11c^＋细胞比例、MLR均与CRP呈正相关.结论 ACS患者DC细胞功能明显增强;依那普利可能通过抑制DC细胞功能,负向调节患者的特异性免疫而抑制斑块的炎症反应.     

恩替卡韦对慢性乙型肝炎患者树突状细胞功能的体外影响

目的:研究恩替卡韦(ETV)对慢性乙型肝炎(CHB)患者外周血树突状细胞(dendritic cell,DC)功能的影响.方法:体外常规分离CHB患者及健康人外周血单个核细胞,诱导扩增后常规培养.第4天将其与一定浓度的恩替卡韦共培养,第8天收获DC进行细胞表型、同种异体混合淋巴细胞反应等相关检测.结果:细胞培养8 d时DC形态分化健康对照组优于CHB ETV处理组,CHB ETV处理组优于CHB组;CHB组CD1a(35.73±3.12 vs 62.31±5.22,P<0.01),CD80(28.19±1.64 vs 45.38±3.10,P<0.01),CD83(22.24±2.14 vs 40.63±7.21,P<0.01)及HLA-DR(36.74±0.98 vs 56.05±3.89,P<0.01)表达明显低于健康对照组,而ETV处理组与CHB组相比CD83 (27.41±9.23 vs 22.24±2.14,P<0.05),CD80(32.67±7.82 vs 28.19±1.64,P<0.05)及HLA-DR(40.84±5.57 vs 36.74±0.98,P<0.01)显著高表达;淋巴细胞增殖能力测定ETV处理组DC刺激同种异体T淋巴细胞增殖能力较CHB组增强(1.53±0.09 vs 1.45±0.12,P<0.05).结论:恩替卡韦作为治疗CHB的新一代核苷类药物,除了直接抑制乙肝病毒DNA合成外,也能够增强CHB患者外周血DC的功能,通过调节机体的免疫系统发挥间接抗病毒作用.     

甘露糖结合凝集素对CD11c~+髓样树突状细胞表型和功能的影响

目的探讨甘露糖结合凝集素(MBL)对人外周血CD11c+髓样树突状细胞(CD11c+m DC)表型和功能的影响。方法磁珠分选技术获得健康志愿者CD11c+m DC和CD4+T淋巴细胞。在CD11c+髓样树突状细胞中加入不同浓度的MBL(5、10、20μg/ml)刺激,以不加MBL的细胞作为对照,应用ELISA法检测细胞培养上清液中的白细胞介素(IL)12水平,流式细胞仪检测细胞表面分子CD40、CD80、CD86及HLA-DR的表达。用MTT法测定CD11c+m DC刺激CD4+T淋巴细胞的增殖能力。ELISA法检测细胞培养液中IL-4和干扰素(IFN)γ水平。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验。结果与未加MBL刺激组相比,3种浓度MBL均显著增强CD11c+m DC表面分子CD40、CD80、CD86、HLA-DR表达及IL-12分泌(F值分别为44.34、27.35、15.57、48.38、38.27,P值均0.001),其中IL-12分泌呈MBL浓度依赖性;MBL刺激组细胞增殖能力显著高于正常对照组和未刺激组(F=23.43,P0.001);MBL刺激组细胞的IFNγ水平显著高于正常对照组和未刺激组(F=28.25,P0.001);而MBL刺激组细胞的IL-4水平明显低于正常对照组和未刺激组(F=40.03,P0.001)。结论 MBL能够有效刺激CD11c+m DC的活化,诱导CD4+T淋巴细胞向辅助性T淋巴细胞1分化,提示其可能通过调节CD11c+m DC的表型和功能参与HBV的控制和清除。     

树突状细胞和调节性T细胞在自身抗原所致小鼠免疫耐受模型中的作用

目的:探讨树突状细胞(DC)及CD4 CD25 调节性T细胞在胰岛素自身抗原sc所诱导的小鼠胰岛素依赖性糖尿病(IDDM)的免疫耐受中的重要作用．方法:低剂量链脲佐菌素(STZ)(40 mg／kg)ip 连续5次在Balb／c小鼠体内建立IDDM模型,胰岛素(100 μg)与不完全弗氏佐剂(IFA,1:1)混合液sc 1次／wk,连续4 wk．模型建立后每周测定血糖,5 wk时处死动物,取胰腺进行病理组织学检查．分离骨髓DC前体及脾脏T淋巴细胞并进行体外培养．采用流式细胞术测定DC表型和CD4 CD25 调节性T细胞,以同种淋巴细胞刺激实验检测DC刺激淋巴细胞增殖功能．结果:胰岛素sc 4 wk后可明显降低小鼠的血糖,与模型对照组有极显著差异(13．79± 2．71 mmol/L vs 20．98±1．43 mmol／L,P<0．05), 胰岛内炎症细胞浸润减少,组织结构完整． IDDM模型建立后,小鼠骨髓来源树突状细胞CD11c表达为26．4％,DC分化异常,而正常小鼠CD11c表达为47．5％;混合淋巴细胞反应中DC刺激能力减弱,刺激指数分别为1．47± 0．01和1．32±0．01(刺激细胞和反应细胞比例分别为1:10和1:20),与正常小鼠相比,差别具有极显著性意义(P值均小于0．01)．脾脏 CD4 CD25 调节性T细胞减少到1．43％,而正常小鼠为5．09％．与此相反,胰岛素自身抗原连续应用后,不仅使血糖得到控制,表达 CD11c的树突状细胞数量增加,CD86和MHC- Ⅱ表面分子表达降低到26．6％和28．8％,刺激淋巴细胞反应的能力弱于正常DC,但强于模型小鼠的DC,刺激指数分别为2．30±0．06(1: 10)和2．17±0．02(1:20),CD4 CD25 调节性T 细胞数量上升到7．15％．结论:胰岛素sc可预防STZ所致小鼠IDDM的发生,自身抗原可以通过改善功能异常的树突状细胞．诱导CD4 CD25 调节性T细胞分化在模型小鼠体内建立免疫耐受．     

冠状动脉支架术后C反应蛋白升高与树突状细胞的关系

目的 :研究冠状动脉支架术后高敏C反应蛋白 (hsCRP)的升高与树突状细胞 (DC)的关系。方法 :术前及术后 2d分离 11例冠状动脉支架术患者外周血单个核细胞 (PBMC) ,在含粒细胞巨噬细胞集落刺激因子(GM CSF)和白细胞介素 4 (IL 4 )的培养条件下制备DC。用流式细胞仪检测DC表面共刺激分子CD86 (B7 2 )的表达 ;混合淋巴细胞反应 (MLR)检测DC对同种异体T淋巴细胞的刺激能力 ;ELISA法测定MLR上清液中的细胞因子 ;比浊法测定hsCRP浓度 ,并探讨CD86表达与hsCRP的相关性。结果 :与术前比较 ,术后 2dDC表面CD86的表达明显增高 ;对T淋巴细胞刺激的能力增强 ;经DC刺激的淋巴细胞分泌促炎细胞因子 (IL 1β、IL 6、TNF α)增多 ,抑炎细胞因子 (IL 10 )减少 ;同时血hsCRP升高 ,且CD86的表达与血hsCRP水平正相关。结论 :支架术后DC的功能被激活 ,由此启动的T淋巴细胞的增殖和炎性反应可能是术后hsCRP升高的原因     

老年急性冠状动脉综合征患者树突状细胞的功能状态

目的　研究老年急性冠状动脉综合征 (ACS)患者树突状细胞 (DC)的功能。方法　将 4 5例ACS患者分为老年组 (2 5例 )和非老年组 (2 0例 ) ,另选健康体检者 2 2例分为老年对照组 (12例 )和非老年对照组 (10例 ) ,入院时取外周血分离单个核细胞 ,制备DC。检测DC表面共刺激分子CD86的表达和DC对同种异体T淋巴细胞的刺激能力 ;酶联免疫吸附法测定培养液中细胞因子浓度 ;分析CD86表达相关因素。结果　与非老年组比较 ,老年组DC功能下降。与老年和非老年对照组比较 ,ACS患者DC表面CD86的表达明显增高 ;对T淋巴细胞刺激的能力增强 ;经DC刺激的淋巴细胞分泌致炎细胞因子增多 ,抑炎细胞因子减少 ;CD86的表达与血清低密度脂蛋白及C反应蛋白水平呈正相关。ACS时DC的激活与年龄无关。结论　正常人DC功能随年龄增加而下降 ;老年ACS患者DC的功能亢进可能是ACS发病及预后不良的原因 ;低密度脂蛋白与DC的激活有关。     

氧化苦参碱对小鼠树突状细胞成熟和功能的影响

目的:研究氧化苦参碱(OXY)对小鼠树突状细胞(DC)成熟、表型及功能的影响。方法:流式细胞术检测DC表面分子CD40的表达;混合淋巴细胞反应(MLR)检测DC对T淋巴细胞的刺激能力;ELISA法检测MLR上清中细胞因子IFN-γ的分泌。结果:第0天OXY处理组较对照组DC表面分子CD40的表达明显升高(P<0.01),刺激T细胞能力增强,分泌细胞因子IFN-γ明显升高(P<0.05),对LPS诱导的DC成熟,与DC LPS组对照显著升高(P<0.05)。结果:OXY对DC的成熟和功能有一定的促进作用。     

阿托伐他汀对不稳定型心绞痛患者树突状细胞功能的影响

目的 研究不稳定型心绞痛患者(UAP)树突状细胞(DC)的功能及阿托伐他汀对其的影响。方法 将27例UAP分为常规治疗组(12例)和常规加阿托伐他汀治疗组(15例),分别于治疗前及治疗后2周取血分离外周血单个核细胞,在含粒细胞巨噬细胞集落刺激因子和白细胞介素(IL)4的培养条件下制备DC。用流式细胞仪检测DC表面共刺激分子CD86(B7-2)的表达;混合淋巴细胞反应(MLR)检测DC对同种异体T淋巴细胞的刺激能力;ELISA法测定MLR上清液中的细胞因子;探讨CD86表达与冠心病危险因素及C反应蛋白(CRP)的相关性。结果 与正常对照组比较,UAP者DC表面CD86的表达明显增高;对T淋巴细胞刺激的能力增强;经DC刺激的淋巴细胞分泌致炎细胞因子(IL-1β,IL-6,肿瘤坏死因子α)增多,抑炎细胞因子(IL-10)减少;用药前CD86的表达与血LDL-C水平正相关;阿托伐他汀抑制DC功能的同时显著降低血CRP水平;且CD86与CRP水平正相关。结论 (1)UAP者DC的功能亢进,由此启动的T淋巴细胞的增殖和炎性细胞因子分泌可能是UAP者动脉斑块不稳定的原因,(2)LDL-C可能是其刺激因素;(3)阿托伐他汀抑制斑块炎症的机制之一是其对DC的抑制。     

炎症性肠病患者外周血单个核细胞细胞毒性 T淋巴细胞相关抗原4的表达

背景:细胞毒性T淋巴细胞相关抗原(CTLA)4是一种重要的免疫细胞共刺激分子,主要表达于活化的T淋巴细胞,对T细胞的激活起抑制作用。目的:通过检测炎症性肠病(IBD)患者外周血单个核细胞表面CTLA4的表达,探讨CTLA4在IBD发病中的作用和功能。方法:将18例活动性溃疡性结肠炎(UC)、4例活动性克罗恩病(CD)患者以及21名健康对照者外周血单个核细胞分离后,以流式细胞仪检测细胞表面CTLA4、CD4 和CD8 的表达。结果:自然状态下,UC和CD患者CD4 CTLA4 表达显著高于对照组(8.2%±4.7%对1.4%±1.3%,P<0.001;4.3%±2.9%对1.4%±1.3%,P=0.011);CD8 CTLA4 表达亦显著高于对照组(9.1%±7.2%对0.9%±0.3%;8.7%±3.5%对0.9%±0.3%,P均<0.001)。经植物血凝素(PHA)刺激后,IBD患者和对照组外周血单个核细胞CTLA4的表达均增加;CD组CD8 CTLA4 表达显著高于对照组(35.0%±10.9%对18.1%±10.1%,P=0.005)。结论:活动性UC和CD患者外周血单个核细胞CTLA4表达增强,提示T细胞激活第二信号通路B7/CD28/CTLA4在IBD的发病过程中起重要作用。     

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。