多发性硬化患者治疗方法与住院费用相关分析

目的回顾性分析缓解-复发型多发性硬化患者治疗方法与住院费用、住院天数的关系,为临床治疗方案的选择提供参考。方法184例缓解-复发型多发性硬化患者依据治疗方法的不同,对其总住院费用、日均住院费用及药品比例等进行统计学分析。结果分别应用丙种球蛋白、地塞米松及甲泼尼龙治疗的患者,其扩展残疾状态量表(EDSS)平均改善值分别为(2.14±0.34)分、(2.08±0.33)分和(3.20±0.54)分;平均总住院费用分别为(18407.45±4237.52)元、(11479.31±2458.36)元和(17630.07±3681.77)元;日均住院费用分别为(981.33±118.49)元、(530.35±97.12)元和(656.36±102.23)元;平均住院天数分别为(18.8±3.6)d、(22.2±4.2)d和(27.5±3.3)d。结论应用甲泼尼龙的患者,神经系统功能改善优于应用丙种球蛋白和地塞米松的患者,但其总住院费用及日均费用较高。应用丙种球蛋白患者神经系统功能改善不及应用甲泼尼龙的患者,且总住院费用及日均住院费用最高,但平均住院天数最短。临床医师应对疗效、费用和住院天数等因素进行综合考虑,为缓解-复发型多发性硬化患者制订个体化的治疗方案。     

多发性硬化患者的临床特点分析

[目的]通过分析总结我院267例多发性硬化（MS）的临床资料，探寻MS的临床表现特点。[方法]从临床表现和影像学等方面对病例进行描述性分析。[结果]267例MS病例中，男110例，女157例；发病年龄5到70岁，平均40岁。小于15岁的早发型病例占4．5％；23．9％病例病前有诱发因素；77．5％病例呈急性或亚急性起病；首发症状以肢体无力、感觉障碍和视力减退最常见。本组头颅MR／以侧脑室周围、半卵圆中心、脑干等处多见。[结论]MS起病年龄与欧美相当，。以急性或亚急性起病；病变多累及视神经；临床类型和病程与神经功能缺失程度相关：     

多发性硬化12例误诊分析

目的通过12例多发硬化误诊的病例资料分析探讨造成多发性硬化误诊的因素。方法对12例多发性硬化误诊患者进行回顾性分析,经诱导电位检查、腰部穿刺脑脊液检查及CT、MRI等辅助检查确诊。结果 12例误诊病例中有5例误诊为脑梗死,3例误诊为急性脊髓炎,2例误诊为病毒性脑炎,误诊为脑血管缺血和重症肌无力各1例。结论多发性硬化需要采用多种辅助手段进行确诊以降低临床的误诊率。     

儿童多发性硬化10例临床分析

目的 探讨多发性硬化（multiple sclerosis,MS）患儿的临床特点及辅助检查的诊断价值.方法 回顾性分析本院10例多发性硬化患儿的临床特点和辅助检查结果 资料.结果 儿童MS以急性起病为主,10例中8例急性起病;首发症状以视力障碍最常见,肢体无力、麻木、视力障碍是MS患者最常见的症状;核磁共振（MRI）的阳性检出率高（10/10）;糖皮质激素联合丙种球蛋白治疗本病效果肯定.结论 MS是一种临床表现复杂、病程多时相的自身免疫性疾病.结合本病临床特点、影像学、脑脊液及神经电生理检查,可提高临床确诊率.     

糖皮质激素治疗急性多发性硬化临床疗效分析

目的 通过糖皮质激素治疗多发性硬化(multiple sclerosis,MS)临床疗效分析,探究糖皮质激素治疗多发性硬化(multiple sclerosis,MS)临床效果,进而在多发性硬化(multiple sclerosis,MS)临床治疗中推广和应用效果更为优良的糖皮质激素治疗法。方法 选取2012年2月-2019年2月到我院就诊的40例急性多发性硬化(multiple sclerosis,MS)患者,随机分为实验组(20例)与对照组(20例)。实验组应用糖皮质激素治疗,通过使用静脉滴注甲基强的松龙;对照组应用米托蒽醌药物与氯化钠融合进行注射。对比两组治疗有效率、患者治疗前后EDSS评分变化,患者治疗满意度以及治疗后两组多发性硬化(multiple sclerosis,MS)患者出现的不良反应。结果 治疗效果、满意度、神经功能能量表(EDSS)评分变化结果,实验组优于对照组(P<0.05);治疗干预后,两组患者均出现不良反应,实验组出现不良反应少于对照组(P<0.05)。结论 使用糖皮质激素中甲基强的松龙有效治疗急性多发性硬化(multiple scler...     

儿童多发性硬化10例临床分析

目的 探讨多发性硬化(multiple sclerosis,MS)患儿的临床特点及辅助检查的诊断价值.方法 回顾性分析本院10例多发性硬化患儿的临床特点和辅助检查结果 资料.结果 儿童MS以急性起病为主,10例中8例急性起病;首发症状以视力障碍最常见,肢体无力、麻木、视力障碍是MS患者最常见的症状;核磁共振(MRI)的阳性检出率高(10/10);糖皮质激素联合丙种球蛋白治疗本病效果肯定.结论 MS是一种临床表现复杂、病程多时相的自身免疫性疾病.结合本病临床特点、影像学、脑脊液及神经电生理检查,可提高临床确诊率.     

儿童多发性硬化10例临床分析

目的 探讨多发性硬化(multiple sclerosis,MS)患儿的临床特点及辅助检查的诊断价值.方法 回顾性分析本院10例多发性硬化患儿的临床特点和辅助检查结果 资料.结果 儿童MS以急性起病为主,10例中8例急性起病;首发症状以视力障碍最常见,肢体无力、麻木、视力障碍是MS患者最常见的症状;核磁共振(MRI)的阳性检出率高(10/10);糖皮质激素联合丙种球蛋白治疗本病效果肯定.结论 MS是一种临床表现复杂、病程多时相的自身免疫性疾病.结合本病临床特点、影像学、脑脊液及神经电生理检查,可提高临床确诊率.     

多发性硬化患者1例临床护理体会

报道1例多发性硬化的护理．认为有效地预防复发，阻止病情进展是目前临床治疗的关键。     

多发性硬化36例临床分析

[目的]探讨多发性硬化(MS)临床特点及诊断治疗.[方法]对36例MS患者的临床表现、辅助检查及预后等资料,结合文献进行回顾分析.[结果]MS患者青壮年女性多见,病前常有诱因,病灶分布散在多发,病程中多有复发缓解,激素治疗可缓解症状.MRI及诱发电位联合有助干早期明确诊断.[结论]MS临床无特异性诊断指标,MRI及诱发电位联合可提高诊断率.     

多发性硬化患者脑白质微观病变的纹理特征分析

多发性硬化（MS）是中枢神经系统最常见的脱髓鞘疾病,MRI是诊断MS的主要手段.本文分别从MS患者MRI的T2WI上提取病灶区、表观正常脑白质区,和健康对照组的MRI图像提取正常脑白质区三组感兴趣区,利用灰度共生矩阵对图像进行了纹理分析,提取了能量、对比度、方差、逆差矩、熵等纹理特征参量,发现上述三组感兴趣区之间均存在显著性差异,提示MS患者表观正常脑白质中存在常规MRI无法显示的微观结构的改变,为进一步研究可能表征MS脑白质微观结构改变的特征提供了依据,如果此结论成立有助于揭示MS发病机理,从而有助于实现MS疾病的早期诊断.     

Clinico-electrophysiological correlates in patients with relapsing-remitting multiple sclerosis

INTRODUCTION: The degree of neurological deficit was evaluated in patients with multiple sclerosis (MS) relapse by the Expanded Disability Status Scale (EDSS), transcranial magnetic stimulation (TMS) and visual evoked potentials (VEPs). Clinical and electrophysiological changes before and after treatment were compared in an attempt to find significant associations between the indicators of disease activity. MATERIAL AND METHODS: In all the patients (n = 35, mean age 32.05 +/- 2.67 years) EDSS rating was assessed prior to and 2 months after the beginning of treatment with methylprednisolone (MP)--13 patients, and with MP in combination with cyclophosphamide (CPH)--22 patients. Transcranial magnetic stimulation with measuring central latency time (CLT) was performed in 20 patients (mean age 30.85 +/- 8.01 years) before and at the end of the 2nd month after treatment with MP independently (9 patients) and MP combined with CPH (11 patients). In another 15 patients with a mean age of 33.67 +/- 7.45 years VEPs are examined (P100 latency) before and on the 2nd month after treatment with MP (4 patients) and MP combined with CPH (11 patients). RESULTS: CLT (P < 0.001) and P100 (P < 0.001) were significantly shortened after treatment in comparison with the baseline values. A significant correlation (P < 0.05) between CLT and the pyramid subscale was found. CONCLUSION: The results suggests that CTL and P100 reflect the effect of treatment on the intensity of the pathological process, the CLT correlating with the severity of the pyramid deficit according to EDSS rating in the course of the treatment.     

The relationship between risk attitude and treatment choice in patients with relapsing-remitting multiple sclerosis.

BACKGROUND: Many patients with multiple sclerosis (MS) eligible for beta-interferons or glatiramer acetate have chosen to forgo or discontinue treatment The objective of this study was to evaluate risk attitude as a patient characteristic related to treatment choice for patients with MS. METHODS: Sixty-two MS patients completed a survey on treatment history, risk preference, and socioeconomic and clinical variables. Multinomial logistic regression was used to assess the relationship between treatment choice and risk attitude. Risk attitude was measured using a standard gamble question on short-term health outcomes. RESULTS: More risk-seeking patients were less likely to choose treatment compared with more risk-averse patients (P < 0.01). Forpatients who discontinued treatment, the explanatory variable of significance was severity of side effects (P < 0.05). CONCLUSIONS: Risk attitude is a patient characteristic related to treatment initiation in patients with MS. This could be an important factor to consider when identifying optimal treatment decisions for individual patients.     

麻疹合并症患者住院天数和住院费用分析

目的:分析具有合并症麻疹住院病例的住院天数和住院费用,为麻疹的DRGs研究提供数据参考。方法:回顾性调查2012-2018年南通市某三级甲等传染病医院的麻疹住院病例,非参数秩和检验方法分析其住院天数、住院总费用和各项医疗费用的差异,线性相关方法分析住院天数和住院费用的关系。结果:不同年龄组和不同合并症类型的麻疹合并症患者住院天数、住院总费用和各项医疗费用差异均有统计学意义;住院天数、住院总费用及各项医疗费用间存在线性相关。结论:加强对不合理用药和过度化验检查的监管与控制,尽早控制麻疹的合并症,减少住院天数,可有效减低麻疹患者医疗服务费、检查费、药费和耗材费,进而降低麻疹的住院总费用,为单病种管理、DRGs和医疗付费制改革提供参考依据。     

肺部感染患者住院费用及病死率的影响因素分析

目的调查广州市某三甲医院肺部感染患者住院费用、住院日数及病死情况,并探讨其影响因素,为医院进一步采取针对性的感染控制措施提供科学依据。方法收集该院2011年1月—2012年12月住院诊断为肺部感染患者的病案首页资料,采用单因素分析、多元线性回归和logistic回归法比较不同类型肺部感染患者住院费用、平均住院日和预后的差异及其影响因素。结果10 431例肺部感染患者住院费用平均为(29 081.95±38 682.92)元,中位数为16 085.25元;住院日平均为(15.93±20.54)d,中位数为13.00d;共有828例患者经治疗无效后死亡,病死率7.94%。不同性别、年龄、付款方式、入院病情、肺部感染类型以及手术与否的肺部感染患者住院费用和住院日数差异均有统计学意义(均P0.05),不同年龄、付款方式、入院病情、肺部感染类型以及手术与否的肺部感染患者死亡率差异也有统计学意义(P0.05);影响肺部感染患者住院费用从大到小的因素依次为住院日数、是否手术、付款方式(公费医疗)、肺部感染类型(HAP)、年龄、性别等,影响其住院日数的因素从大到小依次为是否手术、肺部感染类型(HAP)等,造成其死亡的危险因素有入院情况、肺部感染类型以及是否手术等。结论控制医院肺部感染,对有效控制住院费用,缩短平均住院日,提高患者生存率具有重要作用。     

Cost-utility of interferon β<Subscript>1b</Subscript> in the treatment of patients with active relapsing-remitting or secondary progressive multiple sclerosis

Economic evaluations of treatments for multiple sclerosis have focused either on relapsing-remitting or secondary progressive disease.None has addressed specifically the question of how treatments affect disease progression from diagnoses to severe disability;however, in both clinical and economic terms this is one of the key questions. This study therefore created a disease model that includes both relapsing and progressive multiple sclerosis and covers the full range of disease severity. In addition, the issue of covariates influencing the cost per QALY and the uncertainty in the estimates is addressed.The model is based on our earlier approach using a Markov model,where disease progression is measured as functional disability (EDSS), costs and utilities associated with different disability levels, and outcome expressed as QALY.Treatment is based on a subgroup of patients with active disease in two placebo-controlled clinical trials and open-label extensions with interferon-β_1b in relapsing-remitting or secondary progressive multiple sclerosis, and natural history data are used for the extrapolation beyond the trials.Disease progression (transition probabilities) was estimated using a probit model controlling for differences in patient and disease characteristics, and costs and utilities for different disability levels are taken from large population-based observational studies.Results are presented for Sweden and compared to the United Kingdom. When treatment is given for 36 months (adjusted for compliance) and no further effect is included, the cost per QALY is EURO 7800 (direct, indirect, and informal care costs included, discounted at 3%) over 10 years.The total number of QALYs increases from 3.45 in the no-treatment group to 3.64 in the treatment group.When treatment is prolonged to 54 months, the cost per QALY is EURO 38,700. Using the full range of costs and utilities, the probability that the cost per QALY over a 20-year time-frame is below EURO 50,000 for patients starting treatment at EDSS 3.0 is 80%.In view of the progression of MS over many years models are required to estimate the cost-effectiveness of new treatments. The model proposed here allows estimating disease progression, costs, and QALYs for patients with different characteristics and types of MS, and it can be adapted to different countries. It can hence be used to assess the cost-effectiveness of a defined intervention, such as interferon-β_1b. Gisela Kobelt HDI, France, 492 chemin des Laurens, 06530 Spéracèdes, France, e-mail: kobelt.gisele@wanadoo.fr     

参保脑卒中患者住院费用影响因素分析

目的 探讨参保脑卒中患者住院费用构成及其主要影响因素,为合理控制医保费用过快增长、完善医疗保障制度和减轻患者经济负担提供参考依据。方法 2015年5月,回顾性收集安徽省某三甲综合医院12 363例主要诊断为脑卒中的出院患者的病例资料,对患者的一般情况及住院费用构成进行描述性分析,采用单因素分析及多元线性逐步回归分析探讨住院费用的主要影响因素。结果 安徽省某三甲医院2005-2014年参保脑卒中患者例均住院费用为7 746.74元,例均住院费用呈逐年上升趋势（P<0.01）;参保脑卒中患者药品费、耗材费、检查费、治疗费、检验费、床位费、护理费等费用分别为4 736.82元（63.33%）、90.83元（12.20%）、590.00元（7.28%）、433.00元（5.82%）、453.80元（5.72%）、216.00元（2.94%）和132.00元（1.92%）;平均住院日为14.28 d,中位数为12 d;多元线性回归分析显示,住院日是参保脑卒中患者住院费用的首要影响因素,住院时间越久、药占比越高、疗效越差、入院Rankin评分越高、年龄越大、存在手术情况的参保脑卒中患者住院费用高于无上述情况的患者。结论 降低参保脑卒中患者住院费用的不合理增长应以合理缩短住院日、降低药占比为突破口,采取综合措施控制相关因素。     

基于结构方程模型的脑卒中患者住院费用影响因素分析

目的 分析脑卒中患者住院费用的影响因素,为合理控制和降低住院费用提供有针对性、可操作性的措施.方法 收集某院2019年住院病案数据库中疾病主要诊断为脑卒中(诊断编码为I60-I64)的患者2343例,采用单因素分析和路径分析脑卒中患者住院费用的影响因素.结果 脑卒中患者平均住院费用为21532元.其中,药品费用及检查费...     

The cost of multiple sclerosis in Norway

Health economic aspects have been increasingly important during introduction of new treatments for multiple sclerosis. As a partial response for Norway, a cost-of-illness study was carried out to estimate the yearly cost of the illness to society and relate costs and patients’ quality of life to illness severity. Estimated cost to society was Euro 439 million in 2002 exclusive of the cost of reduced quality of life. The cost per patient was close to Euro 65,000. Account taken of methodological differences, the results compare to results for Sweden, Norway’s closest neighboring country. The illness reduced patients’ quality of life with 0.26. More patients were early retired because of their MS in Norway than in any of nine other European countries comprised by a recent European study, illustrating a liberal practice in Norway. The Norwegian cost of unpaid assistance was almost identical to the Swedish cost that was the lowest found across the countries in the European study. When related to illness severity, the cost per patient increased, and the patients’ experienced quality of life decreased with increasing EDSS levels in line with what has been found for other countries. Cost-of-MS studies have been carried out for a number of countries. Together they contribute to our understanding of the economic consequences of multiple sclerosis and, if their results are related to illness severity, also provide valuable information for further economic analyses of treatment and medication. Our study adds to this.     

Exploiting relationships between outcomes in Bayesian multivariate network meta-analysis with an application to relapsing-remitting multiple sclerosis

In multivariate network meta-analysis (NMA), the piecemeal nature of the evidence base means that there may be treatment-outcome combinations for which no data is available. Most existing multivariate evidence synthesis models are either unable to estimate the missing treatment-outcome combinations, or can only do so under particularly strong assumptions, such as perfect between-study correlations between outcomes or constant effect size across outcomes. Many existing implementations are also limited to two treatments or two outcomes, or rely on model specification that is heavily tailored to the dimensions of the dataset. We present a Bayesian multivariate NMA model that estimates the missing treatment-outcome combinations via mappings between the population mean effects, while allowing the study-specific effects to be imperfectly correlated. The method is designed for aggregate-level data (rather than individual patient data) and is likely to be useful when modeling multiple sparsely reported outcomes, or when varying definitions of the same underlying outcome are adopted by different studies. We implement the model via a novel decomposition of the treatment effect variance, which can be specified efficiently for an arbitrary dataset given some basic assumptions regarding the correlation structure. The method is illustrated using data concerning the efficacy and liver-related safety of eight active treatments for relapsing-remitting multiple sclerosis. The results indicate that fingolimod and interferon beta-1b are the most efficacious treatments but also have some of the worst effects on liver safety. Dimethyl fumarate and glatiramer acetate perform reasonably on all of the efficacy and safety outcomes in the model.