恩替卡韦治疗合并肺结核的慢性乙型肝炎效果观察

目的探索恩替卡韦抗病毒治疗在慢性乙型肝炎(CHB)合并肺结核患者抗结核治疗过程中的有效性。方法回顾性分析2007年6月-2013年12月华中科技大学同济医学院附属同济医院收治的95例CHB合并肺结核患者,按是否在抗结核治疗的同时行恩替卡韦抗病毒治疗分为治疗组(n=38)和对照组(n=57),对其治疗前后临床生化指标等的变化情况及转归等进行比较。计量资料组间比较采用t检验或Mann-Whitey U检验,计数资料组间比较采用χ2检验。结果治疗过程中,对照组患者ALT、AST显著高于治疗组[(382.7(260.7~635.9)U/L vs 143.3(97.9~260.4)U/L,Z=-4.225,P0.001;280.7(197.6~461.8)U/L vs93.8(67.3~156.9)U/L,Z=-4.637,P0.001],TBil显著升高[157.4(139.7~269.6)μmol/L vs(106.8(88.3~187.1)μmol/L,Z=-2.671,P=0.008],出现黄疸的比例明显增高(63.2%vs 34.2%,χ2=7.650,P=0.007)。对照组患者在治疗过程中,PT明显延长[(22.5±15.5)s vs(17.3±9.7)s,t=2.553,P=0.012],PLT水平偏低[(131.0±69.4)×109/L vs(181.7±105.6)×109/L,t=2.826,P=0.004]。对照组发生肝衰竭的比例显著增高(42.1%vs 15.8%,χ2=7.306,P0.001),且治疗过程中,对照组患者因为肝功能受损而被迫停用部分或全部抗结核药物的概率亦增高(17.5%vs 2.6%,χ2=4.952,P=0.026;68.4%vs 15.8%,χ2=25.330,P0.001)。结论 CHB合并肺结核患者在抗结核过程中,予以恩替卡韦抗病毒治疗可有效降低抗结核过程中肝损伤的发生,从而保障抗结核治疗的有效性和安全性,值得临床进一步探究。     

恩替卡韦、拉米夫定治疗乙型重型肝炎的疗效和安全性

目的评估恩替卡韦、拉米夫定治疗HBV相关重型肝炎的疗效和安全性。方法选择2010年1月1日至2015年12月31日在本科住院治疗HBV相关慢加亚急性肝衰竭患者157例,分3组,恩替卡韦组52例,拉米夫定组55例,对照组50例。3组患者均接受内科综合治疗,恩替卡韦、拉米夫定组分别口服恩替卡韦、拉米夫定抗病毒治疗。观察指标包括:24周生存率,12周HBV DNA转阴率、肝功能、凝血酶原活动度(PTA)变化,住院时间,腹水、肝性脑病、消化道出血、肝肾综合征、自发性腹膜炎等并发症的发生率。结果恩替卡韦、拉米夫定组患者的24周生存率分别为69.2%(36/52)、72.7%(40/55),高于对照组56%(28/50)(P均0.05)。治疗12周,恩替卡韦、拉米夫定组较对照组患者的TBil、ALT、AST均显著下降(P均0.05)、PTA显著升高(P0.05);HBV DNA的转阴率分别为88.5%(46/52)、85.5%(47/55),高于对照组10%(5/50)(P均0.05)。恩替卡韦、拉米夫定组肝性脑病、肝肾综合征、腹水发生率均低于对照组(P均0.05),平均住院时间分别为(85±48.6)d、(79±44.3)d,低于对照组(124.3±58.5)d(P均0.05)。结论恩替卡韦、拉米夫定可提高乙型重型肝炎患者的生存率、减少并发症、缩短住院时间,安全性良好。     

恩替卡韦在失代偿期乙型肝炎肝硬化患者长期治疗的安全性和有效性

目的探讨恩替卡韦在失代偿期乙型肝炎肝硬化患者长期治疗中的安全性和有效性。方法选取我院2014年5月至2016年5月收治的失代偿期乙型肝炎肝硬化患者80例,依据治疗方法将患者分为常规治疗组(n=40例)和恩替卡韦组(n=40例),对两组患者的肝功能指标、PTA、HBV DNA定量及Child-Pugh评分、并发症发生情况进行统计分析。结果恩替卡韦组患者的ALT、AST、TBil水平均显著低于常规治疗组(P0.05),并发症发生率2.5%(1/40)显著低于常规治疗组7.5%(3/40)(P0.05),但两组患者的PTA、HBV DNA定量及Child-Pugh评分之间差异无统计学意义(P0.05)。结论恩替卡韦在失代偿期乙型肝炎肝硬化患者长期治疗中能够有效降低患者的ALT、AST、TBil水平,改善患者肝功能,并降低患者的并发症发生率,安全有效。     

复方鳖甲软肝片结合恩替卡韦治疗慢性乙型肝炎肝纤维化的疗效及对患者肝功能的影响

目的对慢性乙型肝炎肝纤维化治疗中复方鳖甲软肝片结合恩替卡韦的疗效进行探讨。方法选择2016年7月至2017年6月我院收治的慢性乙型肝炎肝纤维化患者80例,依据随机数字表法分为实验组和常规组,每组各40例。常规组接受恩替卡韦治疗,实验组在此基础上结合应用复方鳖甲软肝片治疗,检测并对比两组肝功能指标、肝纤维化指标。结果治疗前两组ALT、AST、TBil对比差异无统计学意义(P0.05)。治疗后实验组ALT(32.6±9.6)U/L、AST(31.8±12.4)U/L、TBil(23.4±8.5)μmol/L均显著低于常规组,两组比较差异有统计学意义(P0.05)。治疗前两组透明质酸(HA)、层黏蛋白(LN)、Ⅳ型胶原(C-Ⅳ)对比差异无统计学意义(P0.05)。治疗后实验组HA(98.4±20.6)ng/mL、LN(118.6±36.3)ng/mL、C-Ⅳ(62.6±18.3)μg/L均显著低于常规组,两组比较差异有统计学意义(P0.05)。结论在慢性乙型肝炎肝纤维化治疗中应用复方鳖甲软肝片结合恩替卡韦效果显著,能够使患者肝功能有效改善,具有较高推广价值。     

恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水的效果观察

目的观察恩替卡韦与前列地尔联合治疗乙型肝炎肝硬化腹水的临床疗效。方法选取2012年5月-2014年2月德州市中医院收治的乙型肝炎肝硬化腹水患者100例,随机分为治疗组与对照组,每组各50例,两组均常规给予保肝、利尿、间断补充白蛋白(Alb)治疗,其中治疗组加用恩替卡韦0.5 mg口服,1次/d,联合前列地尔20μg+5%葡萄糖注射液100 ml静滴,1次/d,观察组只加用恩替卡韦0.5 mg口服,1次/d。住院治疗4周,观察两组治疗前后腹水消退情况、ALT、TBil、Alb、血液尿素氮(BUN)、肌酐(Cr)、凝血酶原活动度(PTA)、HBV DNA水平变化。出院后两组患者继续口服恩替卡韦0.5 mg,1次/d,随访3个月观察远期疗效。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果两组患者治疗后腹水量较治疗前均有不同程度降低,治疗组总有效率(84%)高于对照组(64%),差异有统计学意义(χ2=6.018,P0.05);两组患者肝肾功能各项指标(ALT、TBil、Alb、BUN、Cr)及PTA治疗后较治疗前均有不同程度改善,且治疗组疗效优于对照组,两组治疗后各项指标相比差异均有统计学意义(t值分别为7.567、6.875、-4.782、6.786、8.542、8.976,P值均0.01);两组患者治疗后HBV DNA水平均较治疗前有不同程度下降,差异均有统计学意义(t值分别为8.976、5.758,P值均0.01)),但两组间治疗后比较差异无统计学意义(P0.05);患者出院后随访3个月,治疗组在肝肾功能稳定、腹水反复方面优于对照组。结论恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水疗效确切,远期疗效较好,值得临床应用与推广;恩替卡韦单用对肾功能改善不明显,但肝功能可获得明显改善。     

恩替卡韦治疗乙型肝炎肝功能衰竭的疗效分析

目的观察恩替卡韦对乙型肝炎肝功能衰竭患者的疗效与安全性。方法选择2012年1月至2014年12月于本院住院的乙型肝炎肝功能衰竭患者56例,采用随机数字表法分为治疗组和对照组,各28例。治疗组在常规治疗基础上予以恩替卡韦0.5 mg/d,口服。对照组仅给予综合对症支持治疗。观察两组患者48周后的生存率、肝功能变化、PTA和HBV DNA低于检测下限的比率,比较治疗组与对照组的疗效。结果治疗组与对照组治疗48周生存率分别为71.4%和42.9%,治疗组生存率高于对照组(χ~2=4.67,P=0.031)。治疗48周后,治疗组的PTA和TBil分别为(73±10)%和(55±13)μmol/L,对照组的PTA和TBil分别为(61±10)%和(89±22)μmol/L,差异均有统计学意义(t=0.003、-11.44,P=0.031、0.000)。治疗组HBV DNA低于检测下限的比率为80.0%,对照组为41.7%,差异有统计学意义(χ~2=4.89,P=0.027)。结论恩替卡韦可提高乙型肝炎肝功能衰竭患者的生存率,能够改善肝功能且安全性较好。     

人工肝血浆置换治疗肝衰竭的临床观察

目的观察血浆置换术(PE)治疗肝衰竭的疗效。方法回顾性分析2012年1月至2013年6月收治的肝衰竭患者的临床资料,PE组33例肝衰竭患者在内科综合治疗基础上加用血浆置换治疗,对照组30例肝衰竭患者予内科综合治疗,观察两组患者治疗2周后临床症状、并发症发生情况、肝功能生化指标的变化等,随访治疗后3个月内病情转归情况并分析影响疗效的因素。实验检测数据用均数±标准差(x±s)表示,计量资料用t检验进行比较,计数资料采用χ2检验或Fisher确切概率法。结果予血浆置换治疗后,患者乏力、纳差、腹胀等临床症状明显改善,血清中ALT、TBil水平较治疗前降低[(390.48±536.52)U/L vs(81.03±47.58)U/L;(479.27±130.01)μmol/L vs(244.64±151.05)μmol/L,P值均0.01],Alb、胆固醇(CHO)、凝血酶原活动度(PTA)水平较治疗前升高[(33.06±5.42)g/L vs(35.24±3.68)g/L;(2.50±1.24)mmol/L vs(3.59±0.86)mmol/L;(34.16±5.33)%vs(73.98±27.23)%,P值均0.01],对照组治疗后ALT、TBil、Alb、CHO、PTA水平较治疗前差异无统计学意义(P0.05);PE组患者好转率明显高于对照组(χ2=8.276,P0.01),而病死率低于对照组(χ2=13.258,P0.01);PE治疗效果与治疗前TBil水平、并发症、胆酶分离、年龄≥40岁有关(P0.05),TBil、胆酶分离是影响PE疗效的独立危险因素(P0.05,OR值分别为1.01、8.75);术中共发生不良反应8例次,予对症处理后均可好转并完成治疗。结论 PE治疗肝衰竭安全有效,有临床推广价值。TBil、胆酶分离是影响PE疗效的独立危险因素。     

恩替卡韦治疗合并肺结核的慢性HBV携带者效果观察

目的探讨肺结核合并慢性HBV携带患者抗结核治疗的同时应用恩替卡韦治疗的临床效果。方法收集2013年1月-2015年12月南安市医院收治的108例肺结核合并慢性HBV携带者,分为恩替卡韦组(n=58)和对照组(n=50)。恩替卡韦组在给予抗结核药物治疗前1个月至抗结核治疗全程均采用恩替卡韦进行干预,对照组单纯使用抗结核药物治疗,比较2组肝损伤及临床症状的发生率、肝功能异常出现时间及肝功能恢复的时间。计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ2检验。结果恩替卡韦组与对照组肝功能异常发生率(29.31%vs 64.00%)、肝损伤临床症状发生率(17.24%vs 28.00%)比较,差异均有统计学意义(χ2值分别为8.475、5.534,P值均0.05);恩替卡韦组与对照组肝功能异常出现及恢复正常的时间分别为(25.1±10.2)d vs(20.1±8.9)d、(26.5±9.8)d vs(32.6±11.2)d,2组比较差异均有统计学意义(t值分别为2.675、3.778,P值均0.05)。结论恩替卡韦能明显降低肺结核合并慢性HBV携带者抗结核治疗所引起的肝损伤,延缓肝损伤出现时间,并能加快肝功能的恢复。     

恩替卡韦抗病毒治疗对乙型肝炎相关肝细胞癌肝动脉化疗栓塞术预后的影响

目的探讨恩替卡韦抗病毒治疗对乙型肝炎相关肝细胞癌肝动脉化疗栓塞术(TACE)预后的影响。方法选取2011年1月—2018年3月在南方医院肝肿瘤中心首次接受TACE治疗的HCC患者170例,包括恩替卡韦治疗组114例,对照组(未抗病毒治疗)56例。记录治疗前基线的人口学资料,ALT、AST、TBil、Alb、PLT和Child-Pugh分级,HBeAg和HBV DNA水平,AFP、BCLC分期,以及治疗后4~8周的HBV DNA水平,ALT、AST、TBil、Alb和Child-Pugh分级变化和治疗后长期的生存状况。观察患者的短期和长期临床获益(总生存期)。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。对治疗前临床相关指标进行多因素logistic分析,以发现与乙型肝炎再活动的相关危险因素。Kaplan-Meier法分析总生存期的生存曲线,log-rank检验生存曲线间差异性。结果恩替卡韦治疗组患者乙型肝炎再活动的发生率与对照组比较无差异(15.79%vs 16.07%,χ2=0.002,P=0.962)。PLT水平在乙型肝炎再活动组与无乙型肝炎再活动组间差异有统计学意义(Z=-2.183,P=0.029)。多因素分析结果显示,HBV DNA水平是乙型肝炎再活动的独立危险因素(HR=1.000,P=0.015)。恩替卡韦组的1、3和5年生存率分别是56.20%、30.30%和13.20%,对照组的1、3和5年生存率分别是60.60%、27.20%和16.30%,两组在总体生存率上差异无统计学意义(χ2=0.049,P=0.755)。结论抗病毒治疗可以抑制乙型肝炎相关HCC患者TACE术后HBV复制,从而减少TACE治疗的肝毒性。     

谷氨酸脱羧酶抗体在乙肝肝硬化并肝源性糖尿病患者中的临床应用价值

[目的]探讨谷氨酸脱羧酶抗体(GADA)在乙肝肝硬化并肝源性糖尿病中的临床应用价值。[方法]选取住院治疗的乙肝肝硬化患者225例,根据是否合并肝源性糖尿病分为肝源性糖尿病组(126例)和乙肝肝硬化组(99例),45例健康体检人员作为健康对照组(健康组)。比较上述各组血清GADA的阳性率。选择乙肝肝硬化患者中资料完整可用于Child-pugh分级197例,其中A级有71例,B级65例,C级61例。比较不同Child-pugh分级的GADA阳性率。肝源性糖尿病组患者根据其是否应用恩替卡韦抗病毒治疗分为恩替卡韦组(68例)和对照组(58例)。比较恩替卡韦组与对照组治疗前及治疗48周后血清GADA的阳性率及TBil、ALT、AST、LN、CⅣ、HA、PCⅢ、LSM、空腹血糖、糖化血红蛋白等变化;观察2组患者治疗前后病毒学应答情况。[结果]肝源性糖尿病组GADA阳性率35.7%(45/126)明显高于乙肝肝硬化组22.2%(22/99)和健康组8.9%(4/45),差异有统计学意义(t=4.60,P=0.031;t=11.7,P=0.001)。治疗前,恩替卡韦组血清GADA阳性率与对照组相比差异无统计学意义(χ~2=0.221,P=0.638)。治疗48周后,恩替卡韦组血清GADA阳性率明显低于对照组,差异有统计学意义(χ~2=4.83,P=0.028)。治疗前,2组患者的血清生化指标、肝纤维化指标及空腹血糖等相比无明显统计学意义(P0.05);治疗48周后,恩替卡韦组TBil、ALT、AST、LN、CⅣ、HA、PCⅢ、LSM、空腹血糖、糖化血红蛋白数值低于对照组,差异有统计学意义(P0.05)。恩替卡韦组患者在治疗48周后有50例(73.5%)出现病毒学应答,对照组患者有10例(17.2%)出现病毒学应答,差异有统计学意义(χ~2=39.76,P0.001)。[结论]乙肝肝硬化伴肝源性糖尿病患者应用恩替卡韦抗病毒治疗效果显著,GADA阳性率可作为乙肝肝硬化伴肝源性糖尿病患者的鉴别诊断及病情严重程度的判断指标,同时也可作为抗病毒疗效的评价指标,具有较高的临床应用价值。     

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。