早期肠内谷氨酰胺补给对烫伤大鼠肠黏膜细胞紧密连接的影响

目的:了解早期肠内谷氨酰胺补给对烫伤后肠黏膜屏障功能的保护作用, 并探讨其可能的作用机制.方法:选取健康SD大鼠随机分为标准肠内营养组(EN组)和谷氨酰胺补给组(EN+Gln组), 每组32只, 制成烫伤动物模型(30% TBSA Ⅲ度烫伤), 伤后早期分别给予标准肠内营养制剂(能全力)和标准肠内营养制剂+谷氨酰胺, 于第1、4、7、10天观察血清D-乳酸, Western blot半定量分析紧密连接结构蛋白Occludin和RTPCR分析ZO-1 mRNA表达的变化.结果:烫伤后血清D-乳酸水平升高, EN组在观察时间内血清D-乳酸水平没有恢复至伤前水平, EN+Gln组在伤后4 d恢复(4.5±0.8 mg/Lvs 3.8±0.6 mg/L); Western blot半定量分析显示EN+Gln组伤后Occludin表达先下降后上升,在4、7 d时明显高于EN组(1.18±0.14 vs 0.79±0.09, 1.59±0.16 vs 1.12±0.13, 均P<0.05);烧伤后1 d时, 2组ZO-1 mRNA表达与伤前比较均明显下降(0.71±0.19, 0.76±0.17 vs 1.00, 均P<0.05), 4 d时EN+Gln组与EN组比较差异有显著的统计学意义(1.17±0.16 vs 0.76±0.15,P<0.05), 其余时间点各组间差异均无统计学意义.结论:早期肠内谷氨酰胺补给支持能快速逆转烧伤后TJ结构蛋白Occludin、ZO-1表达的下降, 从而改善肠黏膜的屏障功能.     

早期肠内谷氨酰胺补给对烫伤大鼠Peyer's结淋巴细胞亚群的影响

目的:观察烫伤大鼠伤后不同时间Peyer's结细胞总数及淋巴细胞亚群在营养支持影响下的变化形式,了解不同肠内营养支持对Peyer's结内细胞亚群的影响.方法:选取健康SD大鼠,随机分为标准肠内营养组(EN组,n=32)和谷氨酰胺补给组(EN+Gln组,n=32),制成烫伤动物模型(30%TBSAⅢ度烫伤),伤后早期分别给予标准肠内营养制剂(能全力)和标准肠内营养制剂+谷氨酰胺,于伤后第1、4、7、10天观察Peyer's结细胞总数及进行流式细胞仪细胞亚群(CD3+、CD45Ra+、CD3+/CD4+、CD3+/CD8+)分析.结果:烫伤后Peyer's结淋巴细胞总数在伤后1 d明显减少,主要体现为B细胞总数的减少.EN+Gln组在伤后7 d时淋巴细胞总数恢复至伤前水平[(5.29±1.03)×106vs(6.13±1.14)×106,P>0.05],而EN组没有恢复:EN+Gln组B细胞比例及总数在7、10 d时与伤前比较无明显差异[(28.7±0.69)×106,(3.05±0.72)×106vs(3.29±0.62)×106,P>0.05],而EN组B细胞总数在10 d时与伤前比较明显减少[(2.07±0.63)×106vs(3.29±0.62)×106,P<0.05]:CD4+和CD8+细胞在伤后两组变化不明显.结论:肠内谷氨酰胺补给支持能快速有效地促进Peyer's结淋巴细胞增殖,尤其是B细胞.增加Peyer's结内淋巴细胞总数;有利于肠道免疫屏障的恢复和强化.     

通腑颗粒改善犬缺血再灌注状态下实施肠内营养时的小肠功能

目的:研究通腑颗粒(TF)对肠缺血-再灌注(I/ R)状态下实施早期肠内营养(EN)时小肠功能的影响.方法:(?)杂种犬32只随机平均分为EN组、I/R组、I/R EN组和I/R EN TF组,夹闭肠系膜上动脉(SMA)1h后恢复灌流造成肠I/R损伤,复流后4h实施EN.检测小肠腔内压(ICP)、血浆D-木糖含量和二胺氧化酶(DAO)活性评价小肠动力、吸收和屏障功能.结果:肠I/R各组与单纯EN组比较ICP和DAO显著升高(ICP:17.5±1.1kPa,17.6±1.3kPa,17.3±1.5kPa vs 12.3±0.9kPa,均P<0.01;DAO:1.19±0.15U,1.14±0.13U,1.18±0.15U vs 0.68±0.23U,均P<0.01),血浆D-木糖明显降低(2.28±0.23mmol/L,2.31±0.14 mmol/L,2.33±0.10mmol/L vs 3.68±1.05 mmol/L,均P<0.01).肠I/R EN组上述变化最重,肠道不能耐受发生率显著高于I/R组和EN组(87.5% vs 12.5%,0%,P<0.01).EN后1h,通腑颗粒治疗组与I/R EN组相比,血浆ICP和DAO显著降低(ICP:17.1±1.3kPa vs 27.5±1.1kPa,P<0.01;DAO:1.19±0.24 U vs 1.94±0.27U,P<0.01).D-木糖明显升高(2.97±0.21 mmol/L vs 1.07±0.15 mmol/L,P<0.01);肠道不能耐受发生率也显著降低.结论:通腑颗粒能显著改善肠道吸收、动力和屏障功能指标,提高犬I/R时小肠对早期肠内营养的耐受能力.     

卡巴胆碱减轻大鼠烫伤休克期肠内补液时肠组织氧自由基的损伤

目的:研究拟胆碱药卡巴胆碱(carbachol,CAR)对大鼠烫伤休克期肠内补液时肠组织氧自由基损伤的影响.方法:38只♂ Wistar大鼠,采用沸水法(100℃,10 s)造成35%TBSAⅢ度烫伤.随机分为不复苏组(单烫组,n=8)、葡萄糖-电解质溶液(glucose electrolyte solution)复苏组(GES组,n=10)、单纯卡巴胆碱治疗组(CAR组,n=10)和GES CAR复苏组(GES/CAR组,n=10).两液体复苏组在伤后30 min将GES经十二指肠造口匀速泵入,按Parkland公式设定补液速率,CAR组和GES/CAR组在伤后30 min将CAR以60 μg/kg溶于0.5 mL生理盐水中一次注入十二指肠.所有大鼠在伤后4 h处死,取空肠组织测定脂质过氧化物丙二醛(malondialdehyde.MDA)含量、黄嘌呤氧化酶(xanthine oxidase,XOD)和髓过氧化物酶(myeloperoxidase,MPO)活性,并观察肠组织病理学变化.结果:烫伤后GES组肠组织XOD、MP0活性和MDA含量分别高于单烫组13.2%、21.3%和21.1%,并有统计学意义(P＜0.05);GES/CAR组XOD,MPO和MDA均较GES组明显下降(1.36±0.37 vs 2.5l±0.56;0.47±0.14 vs 0.83±0.21;3.97±1.57 vs 6.59±1.50,P＜0.01);CAR组各指标数值最低.肠组织病理损伤也表现为CAR组和GES/CAR组最轻,单烫组次之,GES组损伤最重.结论:卡巴胆碱能有效减轻烫伤休克大鼠肠内复苏时的肠道氧自由基损伤,机制可能与其抗炎作用和抑制黄嘌呤氧化酶活性、减少氧自由基生成有关.     

强化谷氨酰胺及合生元的肠内营养对老年住院患者营养状况与胃肠道耐受性的影响

目的研究强化谷氨酰胺和合生元的肠内营养对老年住院患者营养状态与胃肠道耐受性的影响。方法选取2013年1月至2016年12月于广西医科大学第一附属医院住院并接受肠内营养支持治疗的老年住院患者182例,采用随机数字表法分为两组:治疗组(n=90)和对照组(n=92)。对照组接受常规肠内营养治疗;治疗组在常规肠内营养治疗基础上每天加用谷氨酰胺与合生元。治疗10 d后对比治疗前后两组患者血清白蛋白(ALB)、前白蛋白(PA)和血红蛋白(Hb)水平,同时比较两组患者的胃肠道耐受性。采用SPSS 17.0软件进行数据处理,依据数据类型,组间比较分别采用t检验或x~2检验。结果治疗后治疗组患者的ALB[(37.16±4.94)vs(33.10±4.97)g/L]、PA[(218.26±89.57)vs(175.12±88.42)mg/L]和Hb[(104.99±16.47)vs(97.04±16.86)g/L]值均显著高于治疗前,差异有统计学意义(P0.05)。治疗后治疗组的ALB[(37.16±4.94)vs(34.67±4.51)g/L]、PA[(218.26±89.57)vs(211.83±98.39)mg/L]和Hb[(104.99±16.47)vs(102.20±20.35)g/L]值均显著高于对照组,差异有统计学意义(P0.05)。治疗组腹泻(6.67%vs 16.30%)、腹胀(7.78%vs 20.65%)以及恶心和呕吐(3.33%vs 10.87%)的发生率均显著低于对照组(P0.05)。结论强化谷氨酰胺及合生元的肠内营养能够改善老年住院患者的营养状态,提高肠道耐受性。     

卡巴胆碱对烫伤大鼠口服补液时小肠TNF-α及水通道蛋白-1的影响

目的:研究拟胆碱药卡巴胆碱对烫伤大鼠口服补液时小肠TNF-α及水通道蛋白-1(AQP-1)表达的影响.方法:♂Wistar大鼠50只,随机分为假烫(N)、单纯烫伤(S)、肠内葡萄糖-电解质液(GES)、肠内卡巴胆碱组(CAR)和肠内葡萄糖-电解质液 卡巴胆碱组(GES/CAR)5组(n=10).大鼠背部用沸水造成35%TBSA烫伤.N,GES和GES/CAR组于伤后30 min开始补液.免疫组化法测定肠组织AOP-1的表达,ELISA法检测肠组织TNF-α含量,酚红法测定大鼠小肠对水的吸收率.结果:S组大鼠小肠AQP-1与N组比明显降低(90.3±1 8.4 vs 4851.6±654.5,P<0.01);CAR,GES和GES/CAR组AQP-1与S组相比均显著增加(1806.1±110.1,2272.3±113.8,3322.0±595.9 vs 90.3±18.4.均P<0.01).给予卡巴胆碱组(CAR,GES/CAR)与未给予卡巴胆碱组(S,GES)相比肠组织TNF-α含量明显下降(0.9±0.3,1.0±0.47 vs 1.8±0.3,1.9±0.2,P<0.05).GES/CAR,CAR及S组AOP-1表达量与TNF-α含量成负相关(r=-0.9030,-0.9602,-0.9866,均P<0.05).GES/CAR组水吸收率较GES组明显升高(21.0%±0.1%vs 12.7%±0.1%,P<0.05).结论:卡巴胆碱可抑制促炎因子TNF-α的释放,上调小肠AQP-1表达,改善大鼠烫伤早期肠道对水的吸收.     

早期空肠内营养联合中药肠内滴注对重症急性胰腺炎患者肠麻痹的改善作用

目的:评价早期空肠内营养联合中药加味大承气颗粒肠内滴注治疗对改善重症急性胰腺炎患者肠麻痹的作用,探索重症急性胰腺炎的中西医结合治疗的新途径.方法:39例重症急性胰腺炎患者在常规治疗基础上,随机分成3组分别进行全胃肠外营养(PN组)、早期肠内营养(EN组)、肠内营养+中药大承气颗粒(EN+中药组)肠内滴注,观察患者腹痛腹胀缓解时间、胃肠道功能恢复(肠鸣音出现、肛门排气及排便)时间,并动态监测血淀粉酶、高敏C反应蛋白(CRP)、血浆肿瘤坏死因子-α(TNF-α).结果:EN组、EN+中药组患者经治疗后腹痛腹胀症状均缓解或消失,胃肠道功能恢复正常.PN组12例中,有2例腹胀、肠麻痹持续加重,其中1例出现腹腔隔室综合征并发多脏器功能衰竭.EN组、EN+中药组在腹胀(d)、腹痛缓解时间(d)以及胃肠道功能恢复时间(d)均优于PN组(4.22±0.94,3.02±0.75vs5.72±1.55;4.66±1.14,3.14±0.62vs6.81±1.81;3.42±0.82,3.21±0.88vs6.04±1.67,均P<0.05),其中EN+中药组腹胀(d)、腹痛缓解时间(d)优于EN组(3.02±0.75vs4.22...     

微生态肠内营养治疗重症急性胰腺炎肠黏膜损伤的临床研究

目的 观察微生态肠内营养对SAP肠黏膜损伤治疗和菌群紊乱的调节作用.方法 40例SAP患者随机分为对照组和治疗组.对照组给予常规肠内营养,治疗组加用微生态制剂,治疗7 d,检测患者血浆二胺氧化酶(DAO)、D-乳酸水平以及肠道菌群变化.结果 治疗7 d后,治疗组血浆DAO水平为(4.35±0.91)U/ml,较对照组的(5.45±2.19)U/ml明显下降(P＜0.05);D-乳酸为(10.41±5.36)mg/L,与治疗前无显著性差异,但明显高于对照组的(5.53±2.05)mg/L(P＜0.05);治疗组患者肠道双歧杆菌、乳杆菌的总数达(5.98±1.63)In/g和(7.23±1.94)In/g,较治疗前的(3.76±1.67)In/g和(3.91±1.82)In/g明显增加(P＜0.05),肠道菌群比例接近正常,而对照组仍存在一定程度的菌群紊乱.结论 微生态肠内营养具有减轻SAP肠黏膜损伤、调节肠道菌群微生态平衡、保护肠屏障功能的辅助治疗作用.     

复合乳酸菌对不同营养治疗途径的重症急性胰腺炎大鼠肠屏障功能的影响

目的:观察复合乳酸菌对早期肠内营养(EEN)和肠外营养(PN)治疗的重症急性胰腺炎(SAP)大鼠肠屏障功能的影响.方法:♂ SD大鼠胰腺被膜下均匀注射38 g/L牛磺胆酸钠制作SAP模型,96只大鼠随机分为假手术早期肠内营养治疗组(Sham-EEN)、早期肠内营养治疗组(EEN)、早期肠内营养联合复合乳酸菌治疗组(EEN Lac);假手术肠外营养治疗组(Sham-PN)、肠外营养治疗组(PN)、肠外营养联合复合乳酸菌组(PN Lac),每组16只,分别于第4和7天随机取8只大鼠,预处理后取材,检测肝和肠系膜淋巴结(MLN)肠道菌群易位(BT)、血浆内毒素(ET)、肠转运指数,TUNEL法检测肠上皮细胞凋亡、BCA法测定小肠黏膜蛋白含量、ELISA法测定小肠黏液SIgA含量.结果:PN组大鼠的BT率高于EEN组和PN Lac组(14/16 vs 9/16,10/16,均P＜0.05);4 d EEN组高于EEN Lac组(12/16 vs 9/16,P=0.026).PN组血浆ET高于EEN组(276.83±30.81 EU/Lvs 138.52±22.56 EU/L,P＜0.05);不加用Lac组高于加用Lac组(均P＜0.05).PN Lac组肠转运系数高于PN组(0.70±0.08 vs 0.59±0.05,P＜0.01).PN组小肠上皮细胞AI高于EEN组和PN Lac组(22.67%±4.97% vs 15.31%±4.18%,18.40%±2.01%,P＜0.01).加用Lac组空肠黏膜蛋白含量高于不加用Lac组(均P＜0.05);EEN Lac组高于PN Lac组(56.91±3.73 mg/gvs 44.69±2.99 mg/g,P＜0.01).EEN Lac组小肠黏液SIgA含量高于EEN组和PN Lac组(82.17±6.02 μg/g vs 69.26±5.66 μg/g,59.87±5.54μg/g,P＜0.05及P＜0.01).结论:加用复合乳酸菌可改善EEN和PN治疗的SAP大鼠肠屏障功能,其中EEN Lac的作用最为显著,EEN在维护SAP大鼠肠屏障方面的作用优于PN.     

益生菌及肠内外营养对重症急性胰腺炎大鼠肠道黏附分子及免疫屏障的影响

目的:观察益生菌及肠外、肠内营养对重症急性胰腺炎(SAP)大鼠肠道黏附分子MAdCAM-1及免疫屏障的影响.方法:经胆胰管逆行注射50g/L牛磺胆酸钠制作SAP模型24h后,分别给予肠外营养(PN组),肠外 肠内营养(PN EN组),肠外 肠内营养 益生菌(益生菌组),持续6d,7d时处死,检测腹腔脏器组织菌群易位率,免疫组化法测定末端回肠和Peyer结MAdCAM-1,CD4,CD8,IgA.结果:益生菌组、PN EN组CD4、CD8T细胞数量及IgA,MAdCAM-1表达高于PN组(P<0.05);益生菌组Peyer结MAdCAM-1,CD8表达高于PN EN组(P<0.05).PN组菌群易位率(70.2%)、7d死亡率(75.6%)高于益生菌组(27.5%,50.0%)、PN EN组(30.5%,52.4%)(P<0.01或P<0.05),但后两组间差异无显著性意义.结论:EN能增加MAdCAM-1表达,提高SAP时肠免疫屏障,减少菌群易位,提高生存率.加用益生菌后总体改善不明显.     

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     

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。     

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.