低热量肠外营养在老年胃癌患者术后的应用

目的 探讨低热量肠外营养在老年胃癌患者术后的应用. 方法 59例老年胃癌患者术后随机分为29例低热量肠外营养组(低热量组)和30例常规肠外营养组(常规组),术后第2天起低热量组给予84 kJ·kg-1·d -1的肠外营养支持,常规组给予126 kJ·kg- 1·d-1的肠外营养支持,共6 d.观察两组患者营养支持期间的并发症、血清蛋白、免疫功能、炎症反应、血糖、肝功能及胃肠道功能恢复时间. 结果 低热量组和常规组患者术后并发症发生率分别为37.9％ [11/29)和43.3％(13/30),以肺部感染为主(P＞0.05);术后3d及6d血清白蛋白、总蛋白及前白蛋白水平常规组与低热量组比较差异无统计学意义(P＞0.05);术后两组外周血淋巴细胞总数及T淋巴细胞亚群CD3+、CD4+、CD4+/CD8-比值均降低,CD8-值升高,两组差异无统计学意义(P＞0.0 5);两组C反应蛋白术后3d比术前明显升高,术后6d比术后3d降低(P＞0.05);两组血糖术后3d、6d逐渐降低(P＞0.05);术后肝功能指标均升高,术后3d时两组比较差异无统计学意义(P＞0.05),术后6d时常规组仍持续升高,两组比较差异有统计学意义(P＜0.05);低热量组患者术后排气、排便时间与常规组比较,差异无统计学意义(P＞0.05). 结论 老年胃癌患者术后低热量肠外营养支持是一种安全有效的营养支持方法.     

苯那普利对胰岛素抵抗影响的实验研究

目的 :研究苯那普利对实验性大鼠的胰岛素抵抗 ( ISR)的影响。方法 :选择雄性 SD大鼠饲以高蔗糖高盐饲料 4周后 ,用苯那普利 ( 3mg· kg-1· d-1,n =9;10 mg· kg-1· d-1,n =9)或安慰剂 ( n =10 )治疗 4周。另一组饲以高蔗糖高盐大鼠 ( SSFR) ( n =9)开始即用苯那普利 ( 10 mg· kg-1· d-1)治疗 4周。采用持续输注葡萄糖 ( 8mg· kg-1· min-1)和胰岛素 ( 2 .5 mu· kg-1·min-1)的血糖平均值 ( SSPG)方法测定胰岛素敏感性。观察空腹血胰岛素、血糖、甘油三酯、SSPG的变化。结果 :SSFR大鼠 4周时收缩压明显升高〔( 14 8.4± 18.8) mm Hg:( 12 5 .5± 13.2 ) mm Hg,P<0 .0 5 ( 1mm Hg=0 .133k Pa)〕;SSPG明显升高〔( 10 .80± 2 .39) mmol/ L:( 6.80± 1.38) mmol/ L,P <0 .0 5〕。表明大鼠产生高血压和 ISR。而同时用苯那普利治疗组 ,血压及 SSPG无明显升高。饲以高糖高盐 4周后用苯那普利 3mg· kg-1· d-1治疗组和 10 mg· kg-1· d-1治疗组 ,SSPG由( 11.2 0± 2 .32 ) mmol/ L分别下降至 ( 8.49± 2 .85 ) mmol/ L ( P <0 .0 5 )和 ( 7.45± 1.5 0 ) mmol/ L (P <0 .0 1)。结论 :苯那普利预防治疗 4周 ,大鼠未产生 ISR,苯那普利治疗能改善高糖高盐饲养大鼠的 ISR。     

肠内营养对老年术后患者营养代谢和肠粘膜屏障的影响

目的　评价肠内营养对老年腹部手术后患者营养代谢和肠粘膜通透性的影响。　方法　采用前瞻、随机、对照的方法 ,将 2 5例老年腹部手术患者分为肠内营养组 (肠内组 ,12例 )和肠外营养组 (肠外组 ,13例 ) ,2组患者具有可比性 ;分别给予整蛋白型肠内营养 (力苏 )和等氮、等热卡的肠外营养 ,对其血浆谷氨酰胺浓度、血浆蛋白和累积氮平衡、肠粘膜通透性、免疫球蛋白以及感染有关并发症、营养治疗费用等方面进行观察。　结果　进行 6d的不同营养支持后 ,于术后 10d ,肠内组血浆谷氨酰胺浓度 (5 93± 5 7) μmol·L-1、累积 6d氮平衡 (30± 2 4)mg·kg-1、IgG和IgM分别为 (12 4± 1 9)g·L-1和 (15 0 0± 80 0 )mg·L-1,均高于肠外组 (P <0 0 5 ) ;用药前后甘露醇 /乳果糖 (L/M)比值的变化为 0 0 12± 0 0 11,低于肠外组的 0 0 38± 0 0 2 2 (P <0 0 1) ;血浆蛋白结果相似 ;感染并发症 ,肠内组仅有 1例 ,肠外组 2例 ;肠内组的营养治疗费用为肠外组的 36 6 %。　结论　肠内营养能进一步改善患者营养代谢 ,维护其肠粘膜屏障 ,更为经济和减少感染并发症。     

左卡尼汀在全肠外营养大鼠短肠综合征模型中的作用

目的探讨左卡尼汀在全肠外营养大鼠短肠综合征模型中的作用。方法健康雄性Wistar大鼠50只,随机分为5组,每组10只大鼠,第1组为假手术组,其余4组分别为生理盐水对照组、左卡尼汀低剂量组(50 mg·kg-1·d-1)、中剂量组(100 mg·kg-1·d-1)、高剂量组(200 mg·kg-1·d-1);5组均予全肠外营养液支持治疗。采用黄嘌呤氧化法和硫代巴比妥酸显色法分别测定大鼠血清丙二醛(MDA)浓度和超氧化物歧化酶(SOD)活力,并按试剂盒说明书操作测钠钾ATP酶活力,并检测肝功能及脂质代谢水平。结果左卡尼汀组大鼠MDA含量明显低于对照组;左卡尼汀给药浓度与MDA下降水平现剂量依赖性。左卡尼汀组大鼠SOD活性显著高于对照组,大鼠SOD活性与左卡尼汀亦呈浓度依赖性,随左卡尼汀给药浓度增加SOD活性逐渐增加。左卡尼汀组大鼠ATP酶活力较对照组显著提高,并呈现左卡尼汀剂量依赖性。与生理盐水对照组相比,不同浓度左卡尼汀组大鼠肝组织甘油三酯(TG)和总胆固醇(TC)含量显著下降,而血清谷丙转氨酶(ALT)和谷草转氨酶(AST)活性显著升高。结论左卡尼汀可能有助于减少短肠综合征模型大鼠全肠外营养治疗后心力衰竭、肝功能损伤等情况的发生。     

谷氨酰胺强化的肠外营养对老年重症急性胰腺炎大鼠C-反应蛋白和体液免疫功能的影响

目的考察谷氨酰胺(Gln)强化的肠外营养对重症急性胰腺炎(SAP)老年大鼠C-反应蛋白(CRP)和体液免疫功能的影响。方法所有大鼠分5组:1对照组、2假手术组、3SAP组、4常规肠外营养组和5 Gln强化营养组,每组5只。1~3组颈内静脉给予400 ml·kg-1·d-1注射用生理盐水;4组建模24 h内,经颈内静脉以400 ml·kg-1·d-1匀速输入平衡液,建模24 h后,给予常规肠外营养液;5组在4组基础上按1.5 ml/kg加入L-丙氨酰-L-谷氨酰胺(LALG)注射液后立即输入,连续给药7 d。结果对照组、假手术组与Gln强化营养组无死亡,SAP组死亡2只,常规肠外营养组死亡1只。对照组和假手术组免疫功能无显著差异(P0.05);与假手术组比,SAP组Ig G、Ig A和Ig M均有不同程度的降低(P0.05);与SAP组比,常规肠外营养组和Gln强化营养组的Ig G、Ig A和Ig M均有不同程度的升高(P0.05);与常规肠外营养组比,Gln强化营养组的Ig G、Ig A和Ig M均有不同程度的升高(P0.05)。与对照组比,其余组别的血浆内毒素显著增高(P0.05);与SAP大鼠组比,常规肠外营养组和Gln强化营养组内毒素显著降低(P0.05);与常规肠外营养组比,Gln强化营养组内毒素显著降低(P0.05)。对照组与假手术组的胰腺组织间质水肿、炎细胞浸润和坏死评分较低,其余组别评分较高。与SAP组比,常规肠外营养组和Gln强化营养组胰腺组织间质水肿、炎细胞浸润和坏死评分均有不同程度的降低(P0.05);与常规肠外营养组比,Gln强化营养组胰腺组织间质水肿、炎细胞浸润和坏死评分较低(P0.05)。结论 Gln增强的肠外营养能显著改善SAP大鼠机体免疫、降低血浆内毒素,有利于细胞与器官功能的恢复,减轻病情的危重程度。     

老年患者消化道手术后胃肠外营养相关肝损伤及危险因素分析

目的 探讨老年患者消化道手术后胃肠外营养(PN)相关肝功能损伤发生率及其危险因素. 方法 回顾性分析75例消化道手术后接受PN老年患者资料,包括年龄、身高、体质量、原发疾病、既往史、PN使用时间、总热能、非蛋白热能、脂肪乳剂种类和用量、氨基酸种类和用量、葡萄糖用量、非蛋白热能与氮比值、糖脂比、肝功能、肾功能、血常规. 结果 75例老年患者中,出现PN相关的肝功能损伤19例(25.3%).肝功能损伤组与正常组总热能分别为(24.0±6.5)和(20.7±5.4)kcal·kg-1·d-1,非蛋白热能(20.5±5.5)和(17.2±4.8)kcal·kg-1·d-1,蛋白质(1.0±0.3)和(0.9±0.2)g·kg-1·d-1,葡萄糖用量(2.9±0.9)和(2.3±0.9)g·kg-1·d-1,糖脂比(1.5±0.7)和(1.1±0.5),肝功能损伤组明显高于肝功能正常组,而血红蛋白分别为(97.4±15.1)和(110.1±19.1)g/L,则明显降低.营养液中氨基酸种类(χ2=0.114)和脂肪种类(χ2=0.843)、性别(χ2=0.116)、慢性疾病史(χ2=0.531)、原发疾病(χ2=0.344)、体质指数(χ2=1.588)、血白蛋白(χ2=0.006)和白细胞水平(χ2=0.063)、肾功能(χ2=0.549)均未对PN相关肝功能损伤产生明显影响(均为P>0.05). 结论 老年人消化道手术后PN相关肝功能损伤发生率为25.3%,老年患者应用PN时应适当减少热能,降低葡萄糖用量和糖脂比.     

老年男性高血压病人胰岛素抵抗与脂代谢变化

目的　 研究老年男性高血压病人的胰岛素抵抗及脂质代谢变化的特点。　 方法 　对 3 0例老年男性高血压病人及老年男性正常人的血脂、血糖及胰岛素水平进行测定 ,观察其变化特点。　 结果 　老年男性高血压病人与老年男性正常人相比有较高的血清甘油三酯水平 [( 1 9± 0 9)mmol·L-1vs ( 1 3± 0 4)mmol·L-1]及胰岛素水平 [( 13 5± 4 3 )mIU·L-1vs ( 9 4± 2 0 )mIU·L-1] ,差异有显著性 (P <0 0 5 ) ;而且胰岛素敏感性 [( 4 3±0 4)vs ( 3 9± 0 5 ) ]也是降低的 (P <0 0 5 )。　 结论　老年男性高血压病人不仅存在着脂质代谢紊乱 ,而且存在着胰岛素抵抗     

老年2型糖尿病患者基础-餐时胰岛素治疗剂量

目的探讨老年2型糖尿病(T2DM)患者的基础-餐时胰岛素剂量。方法对169例住院老年T2DM患者,随机分每日多次皮下注射(MDI)组89例和持续皮下胰岛素输注(CSII)组80例,比较两组胰岛素量、基础量-餐前量及比例。结果血糖稳定达标后,MDI组胰岛素另为(35.88±9.54)U/d、(0.57±0.17)U·kg-1·d-1,基础量和餐前量分别占(49.70±8.69)%和(50.30±8.69)%,低血糖发生率6.47%。CSII组胰岛素量为(32.23±9.71)U/d、(0.51±0.19)U·kg-1·d-1,基础量和餐前量分别占(68.30±7.75)%和(31.70±7.75)%,低血糖发生率1.25%。两组差异显著(P<0.05)。结论老年T2DM患者CSII组比MDI组基础量显著增加,胰岛素总量减少,达到控制血糖和减少低血糖的目的。     

氯沙坦对原发性高血压病人胰岛素抵抗性的影响

目的　探索氯沙坦对高血压病的疗效及对胰岛素抵抗的影响。　 方法　采用随机单盲对照法治疗原发性高血压 32例 ,用氯沙坦 5 0mg·d-1,疗程 6周。对照组为 31例 ,用福辛普利 10mg·d-1,疗程 6周。　 结果　氯沙坦组治疗后收缩压下降 (18± 6 )mmHg(P <0 0 1) ,舒张压下降 (12± 7)mmHg(P <0 0 1) ,福辛普利组治疗后收缩压下降 (15± 8)mmHg(P <0 0 1) ,舒张压下降 (14± 6 8)mmHg(P <0 0 1) ,氯沙坦组治疗后糖负荷后 12 0min胰岛素下降 (13± 11)mU·L-1(P <0 0 5 ) ,胰岛素敏感指数下降 (3 1± 2 ) (P <0 0 5 ) ,福辛普利组治疗后 12 0min时胰岛素下降(17± 15 )mU·L-1(P <0 0 1) ,胰岛素敏感指数下降 (3 8± 3) (P <0 0 1) ,氯沙坦组治疗后血清尿酸水平降低 (0 0 4±0 0 1)mmol·L-1(P <0 0 5 ) ,福辛普利组治疗后血清尿酸水平无明显变化。　 结论　氯沙坦治疗高血压病人有改善胰岛素抵抗和降低血尿酸水平的作用。     

合并感染与否的2型糖尿病患者CSⅡ应用的胰岛素剂量比较

对伴与不伴感染的2型糖尿病(T2DM)患者行连续皮下胰岛素输注(CSⅡ)治疗,发现感染组平均胰岛素用量(0.67±0.24U·kg-1·d-1),较非感染组(0.60±0.18U·kg-1·d-1)高(P<0.05);主要为基础率高,餐前量在两组间无统计学差异(P>0.05);影响血糖达标和胰岛素用量的主要因素是感染、血糖水平和体质指数.     

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.     

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。     

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。     

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。