热休克蛋白47与PⅠCP在慢性心力衰竭患者中的相关性

目的:慢性心力衰竭（CHF）是一种慢性的,逐渐进展的临床综合征。研究热休克蛋白47(HSP47)与血清Ⅰ型胶原羧基端肽(PⅠCP)在CHF不同心功能分级中的表达及其相关性。方法: 将60名患者分为心功能Ⅰ级、心功能Ⅱ级、心功能Ⅲ级,采用ELISA测定患者血清中的HSP47的含量与PⅠCP的含量,并研究两者与CHF的相关性。结果: 与心功能1级组比较,心功能Ⅱ级组PⅠCP含量显著增高（P<0.01）,且心功能Ⅲ级组较心功能Ⅱ级组PⅠCP含量显著增高（P<0.01）,且血清HSP47含量与PⅠCP含量呈正相关。结论: CHF患者存在心肌纤维化及左心室扩大,两者呈正相关关系,提示CHF患者存在心室结构重构,心肌纤维化在心室重构中起重要作用。CHF患者HSP47和PⅠCP显著升高,且呈显著正相关。     

慢性缺氧大鼠心肌HSP47 mRNA的表达及其与PⅠCP和PⅢNP含量的相关性研究

目的探讨慢性缺氧大鼠心肌HSP47 mRNA表达与血清Ⅰ型前胶原C端原肽(PⅠCP)、Ⅲ型前胶原N端原肽(PⅢNP)含量及心肌纤维化的相关性。方法模拟缺氧环境,建立慢性缺氧大鼠模型。将40只SD大鼠随机分为5组,每组8只。对照组不给于缺氧处理(A组),各慢性缺氧组大鼠分别缺氧7 d(B组)、14 d(C组)、21 d(D组)、28 d(E组)。采用实时荧光定量PCR(q-PCR)检测心肌中热休克蛋白(HSP47)mRNA的表达量;运用酶联免疫吸附测定(ELISA)方法检测血清及心肌中PⅠCP、PⅢNP的浓度;采用HE和MASSON染色法对对照组和慢性缺氧组大鼠进行组织切片染色。结果与对照组比较,模型组的HSP47 mRNA表达量增多(P0.01),血清和心肌的PⅠCP、PⅢNP浓度升高(P0.01);心肌HSP417 mRNA的表达与血清和心肌的PⅠCP、PⅢNP含量呈正相关(P0.05);HE和MASSON染色显示慢性缺氧组心肌组织广泛纤维化。结论在慢性缺氧条件下HSP47 mRNA的表达量与PⅠCP、PⅢNP浓度正相关,提示HSP47作为心肌胶原分子伴侣在慢性缺氧所致心肌纤维化中起一定作用。     

Klotho基因在慢性心力衰竭患者心肌中的表达

目的探讨慢性心力衰竭(CHF)患者心肌组织中Klotho基因的表达及其与心肌纤维化的关系。方法心肌组织样本取材于2013年8月至2014年8月在成都军区昆明总医院心脏外科建立体外循环的60例CHF患者,按照纽约心脏联合会(NYHA)心功能分级将其分为:NYHAⅠ级组、Ⅱ级组、Ⅲ级组,每组患者各20例。运用实时荧光定量反转录-聚合酶链反应(RT-PCR)检测Klotho基因表达量,同时采用酶联免疫吸附测定(ELISA)方法检测上述60例患者血清中Ⅰ型C端胶原前肽(PⅠCP)的浓度。并对正常心肌组织及CHF患者心肌组织进行HE染色。结果(1)HE染色显示CHF患者心肌胶原增生;(2)与NYHAⅠ级组比较,Klotho基因在NYHAⅡ级、NYHAⅢ级组的心肌组织中表达明显减少(均P0.05),且在NYHAⅢ级组中的表达较NYHAⅡ级组明显减少(P0.05);(3)NYHAⅢ级组患者血清中PⅠCP的含量高于Ⅱ级、Ⅰ级组(均P0.05),NYHAⅡ级组高于Ⅰ级组(P0.05)。结论 CHF患者心肌组织Klotho基因的表达减少可能与随着心功能恶化,其抗衰老作用及抗心肌纤维化作用逐渐减弱有关。     

心衰患者心肌中NHE1 mRNA的表达与血浆内皮素及心肌胶原的相关性研究

目的:观察心力衰竭(HF)患者心肌组织中钠氢交换体1（natrium-hydrogen exchanger 1,NHE1）的表达及其与血浆内皮素-1(ET-1)及心肌胶原的相关性,探讨NHE1、ET-1在HF、心肌纤维化发生发展中的作用。方法: 采用实时荧光定量PCR（FQ-PCR）检测35例HF患者心肌组织中NHE1 mRNA的表达水平。采用放射免疫分析法分别测定受试者血浆ET-1及Ⅰ型前胶原羧基端肽Ⅰ（PⅠCP）和Ⅲ型前胶原氨基端肽（PⅢNP）的含量。同时用心脏多普勒超声检查心脏左房内径、左室射血分数（LVEF％）。结果: FQ-PCR检测心功能Ⅰ、Ⅱ、Ⅲ级组HF患者心肌组织中NHE1 mRNA的△Ct值,分别为6.29±0.66、5.01±0.60和4.40±0.74。心功能Ⅱ级、Ⅲ级组患者心肌组织中NHE1 mRNA的表达明显高于心功能Ⅰ级组（P<0.01）,心功能Ⅲ级组患者心肌组织中NHE1 mRNA的表达明显高于心功能Ⅱ级组（P<0.05）。HF组ET-1及PⅠCP、PⅢNP的含量较对照组明显升高（P<0.01）,并随着HF程度的加重而增加,心功能Ⅱ级和Ⅲ级组显著高于心功能Ⅰ级组（P<0.05,P<0.01）,心功能Ⅲ级组显著高于心功能Ⅱ级组（P<0.05）;且ET-1及PⅠCP、PⅢNP的含量与NHE1 mRNA的△Ct值（r=-0.587,P<0.01）呈显著的负相关。ET-1与PⅠCP、PⅢNP含量（r=-0.418,P<0.05）呈显著的正相关。结论: HF患者NHE1 mRNA的表达与ET-1及PⅠCP、PⅢNP的含量均密切相关。NHE1在HF、心肌纤维化的发生和发展过程中可能起着重要作用。     

半乳糖凝聚素3对心肌纤维化和心室重构的作用

目的通过半乳糖凝聚素3(Gal-3)特异性竞争拮抗剂——改良柑橘果胶(MCP)抑制Gal-3途径,探讨Gal-3在心功能不全心室重构中的作用。方法将30只家兔随机分为假手术组、心功能不全组、MCP组。结扎冠状动脉前降支,制作心肌梗死后心功能不全模型。模型制作成功后,MCP组用生理盐水配置75 g/L MCP,以2 m L/(kg·d)灌胃4周;假手术组及心功能不全组给予生理盐水2 m L/(kg·d)灌胃4周。术前及术后2、4、6周,用心脏超声仪测定各组家兔心功能,ELISA检测血清Gal-3、脑钠肽(BNP)水平。实时荧光定量PCR检测心肌组织Gal-3、胶原蛋白Ⅰ、ⅢmRNA的表达,计算Ⅰ/Ⅲ比值。术后6周,Masson染色观察心肌梗死区域组织病理学情况,Western blot检测Gal-3、胶原蛋白Ⅰ、Ⅲ的蛋白表达。结果给药4周后MCP组心功能较心功能不全组明显好转(P0.01)。心功能不全组血清Gal-3高于假手术组(P0.05),MCP组血清Gal-3较心功能不全组明显下降(P0.05)。相关性分析显示,心功能不全组家兔心功能左心室射血分数与血清Gal-3呈负相关性(r=-0.841,P=0.009),左心室舒张末期内径与血清Gal-3呈正相关(r=0.905,P=0.002)。与心功能不全组相比,MCP组Gal-3、胶原蛋白Ⅰ、ⅢmRNA表达明显减低(P0.05)。光学显微镜下心功能不全组可见心肌细胞排列紊乱,部分心肌细胞坏死、水肿,胶原大量沉积并伴有炎性细胞浸润;MCP组可见心肌纤维增粗,排列稍整齐。心功能不全组梗死区域心肌组织Gal-3、胶原蛋白Ⅰ、Ⅲ蛋白表达明显高于MCP组和假手术组;相关性分析显示,心功能不全组梗死区域Gal-3与胶原蛋白Ⅲ呈正相关(r=0.793,P=0.019)。结论 Gal-3在心力衰竭心室重构和心肌纤维化进展中起到关键的作用。     

心肌热休克蛋白70在慢性心力衰竭患者中的表达

目的:观察慢性心力衰竭患者心肌热休克蛋白(HSP70)的表达。方法: 60例手术患者分为3组，其中心功能1级组20例，心功能2级组20例，心功能3级组20例。采用实时荧光定量（RT-PCR）方法检测HSP70的mRNA表达量。结果:①与心功能1级患者比较，HSP70 mRNA 水平在心功能2级、心功能3级组的心肌组织中表达明显减少（均P<0.05），且在心功能3级组较心功能2级组明显减少（P<0.05）。②HSP70 mRNA水平与慢性心力衰竭患者年龄、病程呈负相关。结论:慢性心力衰竭患者心肌HSP70的表达减少，可能与HSP70随着心功能恶化其保护作用减弱有关。     

肌钙蛋白Ⅰ与慢性充血性力衰竭病人心室重构、心功能的关系探讨

目的 探讨慢性充血性心力衰竭(CHF)病人血清心肌肌钙蛋白Ⅰ(cTn Ⅰ)与心室重构、心功能的关系.方法 对59例CHF(NYHA分级Ⅲ级～Ⅳ级)病人分别于入院后第2天抽血测量cTn Ⅰ水平,同时观察分析病人左心房内径(LAd)、左心室内径(LVd)、室间隔厚度(IVS)、左心室后壁厚度(LVPW)作为心室重构的指标.结果 随着心功能的恶化血清cTn Ⅰ浓度在升高,与健康对照组比较有统计学意义(P＜0.05).与cTn Ⅰ正常组比较,cTn Ⅰ升高组LAd,LVd,IVS,LVPW均有统计学意义(P＜0.05).结论 血清cTn Ⅰ的监测对判断心力衰竭病人心肌损伤是一个高度敏感和特异指标,对判断心功能障碍的严重程度也有一定价值.     

左西孟旦对急性心肌梗死合并心力衰竭患者心室重构、心功能及心肌损伤指标的影响

目的探讨左西孟旦对急性心肌梗死(AMI)合并心力衰竭患者心室重构、心功能及心肌损伤指标的影响。方法回顾性分析2015年6月至2017年5月收治的96例AMI合并心力衰竭患者。其中49例患者接受标准化抗心力衰竭加左西孟旦治疗(研究组),47例患者接受标准化抗心力衰竭治疗(对照组)。比较两组患者治疗前后心室重构、心功能、心肌损伤指标,Killip心功能分级,以及不良反应发生率。结果治疗后研究组患者各心室重构指标水平均显著低于治疗前以及治疗后对照组患者(P均0.05),而对照组患者治疗前后各心室重构指标水平差异均无统计学意义(P均 0.05)。两组患者治疗后心功能指标、心肌损伤指标均明显改善(P均0.05)。治疗后研究组患者心功能指标显著优于对照组患者(P 0.05),心肌损伤指标显著低于对照组患者(P均0.05)。治疗后研究组患者Killip心功能分级显著优于治疗前以及治疗后对照组患者(P 0.05),而对照组患者治疗前后Killip心功能分级差异无统计学意义(P 0.05)。研究组和对照组患者治疗后不良反应发生率分别为6.1%(3/49)和4.3%(2/47),差异无统计学意义(P 0.05)。结论左西孟旦可改善AMI合并心力衰竭患者的心功能,减轻心室重构与心肌损伤,疗效显著。     

肌钙蛋白Ⅰ与慢性充血性心力衰竭病人心室重构、心功能的关系探讨

目的探讨慢性充血性心力衰竭(CHF)病人血清心肌肌钙蛋白Ⅰ(cTnⅠ)与心室重构、心功能的关系。方法对59例CHF(NYHA分级Ⅲ级~Ⅳ级)病人分别于入院后第2天抽血测量cTnⅠ水平,同时观察分析病人左心房内径(LAd)、左心室内径(LVd)、室间隔厚度(IVS)、左心室后壁厚度(LVPW)作为心室重构的指标。结果随着心功能的恶化血清cTnⅠ浓度在升高,与健康对照组比较有统计学意义(P<0.05)。与cTnⅠ正常组比较,cTnⅠ升高组LAd,LVd,IVS,LVPW均有统计学意义(P<0.05)。结论血清cTnⅠ的监测对判断心力衰竭病人心肌损伤是一个高度敏感和特异指标,对判断心功能障碍的严重程度也有一定价值。     

丹参酮ⅡA对自发性高血压大鼠血清前胶原末端肽的影响

目的 研究丹参酮ⅡA(TSN)对于自发性高血压大鼠(SHR)血清I型前胶原羧基端肽(PⅠCP)和Ⅲ型前胶原氨基端肽(PⅢNP)水平的影响.方法 24只8周龄SHR大鼠随机分为三组:SHR对照组,丹参酮组,缬沙坦组.另有8只相同周龄Wistar大鼠为正常对照组.给予相应的药物治疗4 w后,测量鼠尾血压和心室质量,用VG染色检测心肌胶原容积分数(CVF),并用放射免疫分析法测定血清PⅠCP和PⅢ NP浓度.结果 SHR对照组血压、心室质量、心室质量指数、CVF均显著高于其他组(P＜0.01);血清PⅠCP和PⅢNP水平亦明显升高(P＜0.05).经丹参酮和缬沙坦治疗4 w后,其血压(P＜0.01)、心室质量、心室质量指数(P＜0.05)、CVF(P＜0.01)较SHR对照组有不同程度的降低;血清PⅠCP和PⅢ NP水平较SHR对照组亦有不同程度的降低(P＜0.05).结论 TSN能够抑制心肌纤维化,其机制可能与其抑制心肌胶原合成有关.     

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。