代谢综合征患者血清抵抗素与血脂、肥胖和胰岛素抵抗关系的研究

目的:探讨代谢综合征患者血清抵抗素水平与血脂、肥胖和胰岛素抵抗的关系。方法: 60 例代谢综合征患者和28 例年龄相匹配的正常对照者,按体重指数将代谢综合征患者分为肥胖组和非肥胖组。采用ELISA方法测定受试者空腹血清抵抗素和瘦素水平,同时检测其身高、体重、腰围、臀围、血压、血糖、血脂及胰岛素水平,并计算体重指数(BMI)、腰臀比(WHR)和胰岛素抵抗指数(HOMA)。结果:代谢综合征患者肥胖组和正常对照组相比其血清抵抗素水平明显升高(28.28±11.7μg/L与19.44±5.79μg/L,P<0.01);非肥胖组和正常对照组相比其血清抵抗素水平明显升高(26.14±11.9μg/L与19.44±5.79μg/L,P<0.05)。肥胖组和正常对照组相比其血清瘦素水平明显升高(1.47±0.57μg/L与0.31±0.13μg/L,P<0.01);非肥胖组和正常对照组相比其血清瘦素水平明显升高(1.35±0.57μg/L与0.31±0.13μg/L,P<0.01)。肥胖组和非肥胖组相比其血清抵抗素、瘦素水平无显著差异。相关分析显示空腹抵抗素水平与腰臀比、空腹胰岛素、胰岛素抵抗指数呈显著正相关(分别为r=0.22,0.22,0.19;P<0.05);与体重指数、腰围、臀围、瘦素呈显著正相关(分别为r=0.31,0.32,0.36,0.28;P<0.01);而与收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL C)、血     

2型糖尿病患者血浆抵抗素和炎性细胞因子水平的变化及临床意义

目的研究2型糖尿病(DM)患者血浆抵抗素及肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平的变化,探讨其与DM及胰岛素抵抗的关系。方法采用酶联免疫吸附法(ELISA)测定57例2型DM患者[按体质量指数分为非肥胖组(DM1)25例和肥胖组(DM2)32例]及40例正常对照者(NC)血浆抵抗素、TNF-αI、L-6浓度,同时测定空腹血糖(FPG)、空腹胰岛素(FINS)水平,并计算胰岛素抵抗指数(HOMA-IR)。结果DM1组和DM2组比对照组血浆抵抗素水平(16.6±5.8)mg/L(、25.1±9.5)mg/L vs(12.2±3.4)mg/L,TNF-α水平(60.67±17.33)ng/L、(82.42±35.51)ng/L vs(43.25±12.91)ng/L,IL-6水平(81.25±15.62)ng/L、(108.63±31.02)ng/L vs(61.30±16.82)ng/L明显升高(P<0.05~0.01),且DM2组的抵抗素、TNF-αI、L-6水平高于DM1组(P<0.05)。相关分析发现血浆抵抗素水平与HOMA-IR、BMI、FINS、TNF-α、IL-6呈正相关(r值分别为0.415,0.564,0.665,0.315,0.454,P值均<0.01);TNF-α水平与HOMA-IR、BMI、FINS呈正相关(r值分别为0.459,0.326,0.308,P值均<0.01);IL-6与HOMA-IR、BMI、FINS呈显著正相关(r值分别为0.395,0.375,0.279,P值均<0.01)。结论2型DM患者血浆抵抗素、TNF-αI、L-6水平升高,与肥胖有关,三者相互作用,参与糖尿病及胰岛素抵抗的发生发展。     

2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征患者血清抵抗素水平变化及其意义

目的 探讨2型糖尿病(T2DM)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者血清抵抗素水平变化及其在发病中的作用.方法 T2DM患者65例(T2DM组),根据是否合并OSAHS分为T2DM未合并OSAHS组35例,T2DM合并OSAHS组30例,并设正常对照组30名.测定血清抵抗素浓度,同时检测空腹血糖、空腹胰岛素、糖化血红蛋白、血脂等相关指标,计算体质量指数、腰臀比及稳态模型评价的胰岛素抵抗指数.结果 (1)与正常对照组血清抵抗素浓度(9.06±0.85) μg/L比较,T2DM组(12.54±1.74) μg/L显著升高,差异有统计学意义(t=2.547,P＜0.01);体质量指数、腰臀比、胰岛素抵抗指数、空腹胰岛素、空腹血糖、糖化血红蛋白和甘油三酯显著升高(P＜0.01),收缩压、低密度脂蛋白胆固醇及总胆固醇升高,差异有统计学意义(P＜0.05),高密度脂蛋白胆固醇显著降低(P＜0.01).(2)与T2DM未合并OSAHS组比较,T2DM合并OSAHS组血清抵抗素浓度[(13.84±1.31)μg/L与(11.43±1.21)μg/L]显著升高,差异有统计学意义(t=2.613,P＜0.01).糖化血红蛋白和甘油三酯显著升高(P＜0.05),高密度脂蛋白胆固醇降低(P＜0.05).抵抗素与低密度脂蛋白胆固醇、总胆固醇及空腹胰岛素呈正相关(r =0.343、0.315、0.298,P均＜0.05);与体质量指数、腰臀比、胰岛素抵抗指数、甘油三酯及空腹血糖呈显著正相关(r=0.615、0.587、0.517、0.435、0.453,P均＜0.01;与高密度脂蛋白胆固醇呈负相关(r=-0.436,P＜0.01).结论 血清抵抗素可能与T2DM发生相关,而且血清抵抗素可能不是通过进一步引起肥胖来增加T2DM患者发生OSAHS的患病风险,有可能通过其他途径,如影响炎症因子的表达来增加OSAHS的患病风险.     

血清apelin水平与2型糖尿病并颈动脉粥样硬化的关系

目的 探讨血清apelin水平与2型糖尿病(T2DM)惠者并颈动脉粥样硬化的关系.方法 分别测定正常时照组(30例)、T2DM无颈动脉粥样硬化组(简称:T2DM组,35例)、T2DM伴颈动脉粥样硬化组(35例)的体质量指数(BMI),空腹血糖(FPG),糖化血红蛋白(HbA1c),血脂,空腹胰岛素(FINS),胰岛素抵抗指数(HOMA-IR)等,采用酶联免疫吸附法(ELISA)测定血清apelin水平.结果 与正常对照组比较,血清apelin水平在T2DM组明显升高,(53.79±9.17)μg/L vs(44,44±9,20)μg/L(P<0.01);与T2DM组比较,血清apelin水平在T2DM伴颈动脉粥样硬化组也升高,(61.52±5.18)μg/L vs(53.79±9.17)μg/L(P<0.01).偏相关分析显示,血清apelin与HOMA-IR、FPG、总胆固醇(TC)呈正相关(r=0.486,0.400,0.491,P<0.05,P<0.01).logistic回归示:apelin、HOMA-IR是T2DM患者颈动脉粥样硬化的危险因素.结论 T2DM颈动脉粥样硬化患者的血清apelin水平升高,且与In、(HOMA-IR),FPG、TC呈正相关,推测apelin可能参与构成胰岛素抵抗综合征和动脉粥样硬化的病理生理基础.     

非酒精性脂肪肝患者血清抵抗素与胰岛素抵抗关系的探讨

目的 探讨非酒精性脂肪肝患者血清抵抗素水平及其与肥胖、胰岛素敏感性、血糖、血脂的关系.方法 选择非酒精性脂肪肝患者64例,正常对照30例,观察一般情况,并测定血清抵抗素、空腹血糖、空腹血胰岛素和血脂等指标,计算胰岛素敏感指数.结果 非酒精性脂肪肝患者血清抵抗素水平高于正常对照(非酒精性脂肪肝组(24.1±7.2) μg/L,正常对照(14.3±5.6) μg/L,P＜0.05).相关分析显示抵抗素与体重指数、甘油三酯呈正相关关系,与胰岛素敏感指数呈负相关关系,而与血脂、血糖等指标无明显相关性.结论 在非酒精性脂肪肝的发病过程中,抵抗素可能参与了胰岛素抵抗.     

维持性血液透析患者血清vaspin水平与胰岛素抵抗的相关性研究

目的 探讨维持性血液透析患者血清vaspin的水平及其与胰岛素抵抗的关系.方法 选取我院透析中心终末期肾病维持性血液透析患者48例,测定血脂、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)等指标,并抽血测定血清vaspin、血清胰岛素(FIns)、血糖(FBG),计算胰岛素敏感指数(ISI),胰岛素抵抗指数(HOMA-IR)及腰臀比(WHR)、体质量指数(BMI),根据是否有糖尿病分为糖尿病组18例和非糖尿病组30例,同时选取30例健康体检者作为对照组,并对相关数据进行统计分析.结果 ①维持性血液透析患者血清vaspin水平较正常对照组降低,(0.91±0.36)μg/L vs (1.15±0.31) μg/L(P＜0.01).②糖尿病组和非糖尿病组两组患者的血清vaspin水平差异无统计学意义,(0.87±0.38) μg/L vs (0.97±0.34) μg/L(P＞0.05).③相关分析显示:vaspin除与BUN、Cr、UA、WHR相关外,尚与性别有关(r=-0.294、-0.284、一0.278、-0.375、0.244,P＜0.05),其中,女性vaspin水平高于男性(1.11±0.38) μg/L vs (0.93±0.33) μg/L(P＜0.05).vaspin与HOMA-IR、FIns、FBG、年龄、BMI则没有相关性(r=-0.098,-0.146,0.049,-0.095、-0.182,P＞0.05).结论 在维持性血液透析中存在有糖脂代谢紊乱和胰岛素抵抗,血清vaspin水平下降,与肾功能相关,但与胰岛素抵抗不相关.     

慢性阻塞性肺疾病患者血清抵抗素和肿瘤坏死因子水平与营养不良的关系

目的 探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者血清抵抗素、肿瘤坏死因子α(TNF-α)水平及其与营养状况的关系.方法 采用酶联免疫吸附测定(ELISA)方法检测AECOPD患者40例和健康对照者30例血清抵抗素、TNF-α水平,分析相关因素.结果 AECOPD组患者血清抵抗素水平低于健康对照组,(3.2±1.9)μg/Lvs(4.2±2.4)μg/L,TNF-α水平高于对照组.(1 505±252)ng/L vs(397±66)ng/L,差异均有统计学意义(P<0.01);AECOPD组营养不良患者抵抗素水平低于非营养不良患者,(2.6±1.8)μg/L vs(3.5±2.1)μg/L(P<0.01).AECOPD患者抵抗素水平与第1秒用力呼气客积(FEV1)及FEV1/用力肺活量(FVC)、体质量指数(BMT)及胸围、腹围呈显著正相关(r=0.356～0.493,均P<0.01),而TNF-α与FEV1、FEV1/FVC、BMI及胸围、腹围呈显著负相关(r=-0.521～-0.395,均P<0.01).结论 AECOPD患者血清抵抗素水平下降,合并营养不良时下降更加明显,而TNF-α水平则升高,合并营养不良时升高更加明显.     

肥胖人群脂联素、抵抗素和胰岛素抵抗水平的研究

目的探讨肥胖患者血清脂联素、抵抗素和胰岛素抵抗水平的变化及意义。方法分别测定106例肥胖者和107名健康对照者的体重指数(BMI)、腰围、臀围、空腹胰岛素、空腹血糖、血脂、脂联素和抵抗素水平,计算胰岛素抵抗指数(HOMA-IRI)。结果肥胖者的体重指数(BMI)、体脂分布百分比(BF)、HOMA-IRI、抵抗素、脂联素、总胆固醇(TC)、载脂蛋白B(apo B)与健康对照组比较,差异均有统计学意义(P<0.01、P<0.05)。脂联素和抵抗素均与BMI、BF和HOMA-IRI呈正相关([脂联素:相关系数(r)分别为0.439、0.236、0.398,P均<0.01;抵抗素:r分别为0.296(P<0.01)、0.175(P<0.05)、0.827(P<0.01)],抵抗素与腰臀比(WHR)呈正相关(r=0.169,P<0.05)。结论脂联素能较好地预测BMI和HOMA-IRI,抵抗素能较好地预测BMI。脂联素与抵抗素水平的变化可能导致肥胖和胰岛素抵抗,在向糖尿病的发生发展过程中起了一定作用。     

慢性心力衰竭患者血清瘦素水平改变及其与胰岛素抵抗、胰岛素水平之间的关系

目的探讨慢性心力衰竭(CHF)患者血清瘦素水平改变及其与胰岛素抵抗、胰岛素水平之间的关系.方法观察40例CHF患者(男性)及20例正常对照组(男性)血清瘦素水平变化,分析血清瘦素与胰岛素抵[(以胰岛素敏感指数(IAI)表示]、胰岛素水平之间的关系. 结果 CHF组血清瘦素水平较正常对照组明显升高[(6.1±2.1) μg/L vs (3.8±1.1) μg/L, P<0.01].与对照组相比,CHF组胰岛素浓度升高[(18±3)mU/L vs (10±2)mU/L, P=0.02],具有更高的IAI(4.4±0.6 vs 3.8±0.7, P<0.01).血清瘦素与胰岛素水平及胰岛素抵抗程度(IAI)显著正相关(r=0.803, 0.716, P<0.01). 结论 CHF患者血清瘦素水平较正常对照组升高.CHF患者存在高胰岛素血症和胰岛素抵抗.血清瘦素与血胰岛素浓度和IAI呈正相关,提示胰岛素-瘦素内分泌轴可能与慢性心衰的高能量消耗状态有关.     

肥胖人群脂联素、抵抗素和胰岛素抵抗水平的研究

目的 探讨肥胖患者血清脂联素、抵抗素和胰岛素抵抗水平的变化及意义.方法 分别测定106例肥胖者和107名健康对照者的体重指数(BMI)、腰围、臀围、空腹胰岛素、空腹血糖、血脂、脂联素和抵抗素水平,计算胰岛素抵抗指数(HOMA-IRI). 结果 肥胖者的体重指数(BMI)、体脂分布百分比(BF)、HOMA-IRI、抵抗素...     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.