缺血性脑卒中合并2型糖尿病患者伴发尿路感染危险因素的回顾性分析

目的 探讨缺血性脑卒中合并2型糖尿病患者发生尿路感染的危险因素,为临床早期防治尿路感染提供参考依据。 方法 采用回顾性分析方法,选取首次缺血性脑卒中合并既往2型糖尿病患者459例。根据是否发生尿路感染,分为感染组（149例）和非感染组（310例）。采用单因素分析两组患者的一般资料及实验室指标,包括年龄、性别、缺血性脑卒中类型、身体质量指数（BMI）、冠心病史、糖化血红蛋白（HbAlc）、血清白蛋白（ALB）、血清葡萄糖（GLU）等;采用二元Logistic回归法分析缺血性脑卒中合并2型糖尿病患者伴发尿路感染的危险因素。 结果 共有149例患者（32.5%）发生尿路感染。单因素分析显示,性别、年龄、吸烟、饮酒、缺血性脑卒中类型、合并冠心病、BMI、HbA1c含量、ALB含量可能与发生尿路感染有关（P<0.05）;二元Logistic回归分析显示,女性［OR=13.917,95%CI（7.061,27.431）,P<0.001］、HbA1c≥6.5%［OR=2.425,95%CI（1.397,4.209）,P=0.002］、ALB＜40g/L［OR=2.071,95%CI（1.207,30552）,P=0.008］、肥胖（BMI≥28.0 kg/m2）［OR=2.240,95%CI（1.183,4.241）,P=0.013］、非腔隙性脑梗死［OR=2.649,95%CI（1.639,4.280）,P<0.001］是缺血性脑卒中合并2型糖尿病后尿路感染的危险因素。 结论 缺血性脑卒中合并2型糖尿病患者尿路感染的发生率较高,女性、肥胖、高HbA1c水平、低ALB水平、非腔隙性脑梗死是其并发尿路感染的危险因素。未来可针对以上危险因素进一步采取综合性治疗措施,降低尿路感染的发生率,提高患者的生活质量。     

HBeAg阴性慢性乙型肝炎病毒感染者发生肝硬化风险模型的建立

目的探讨乙型肝炎 e 抗原(HBeAg)阴性慢性乙型肝炎病毒(HBV)感染者发生肝硬化的独立影响因素, 建立列线图模型并检验其诊断效能。方法回顾性分析2011—2021年就诊于中国医科大学附属第一医院596例HBeAg阴性慢性HBV感染者和677例乙型肝炎相关肝硬化患者的临床常用实验室数据, 按7∶3比例随机分为建模组(892例)和验证组(381例), 采用多重共线性检验和多因素Logistic回归分析肝硬化的独立影响因素, 建立列线图模型并通过受试者工作特征(ROC)曲线、校准曲线、临床决策曲线及临床影响曲线对模型进行验证。结果多因素Logistic回归分析显示乙型肝炎核心抗体(OR=1.492, 95%CI 1.316～1.706)、γ-谷氨酰转移酶(OR=1.015, 95%CI 1.010～1.022)、血小板计数(OR=0.986, 95%CI 0.982～0.988)和白蛋白(OR=0.853, 95%CI 0.824～0.882)是乙型肝炎相关肝硬化发生的独立影响因素(P<0.05), 基于此4项指标构建列线图风险模型。ROC曲线显示模型的AUC为0.933(95%...     

急性Stanford A型主动脉夹层患者术后短期病死率的影响因素

目的探讨急性Stanford A型主动脉夹层患者术后短期病死率的影响因素。 方法回顾性收集新疆医科大学第一附属医院ICU于2017年1月至2021年1月收治的成功完成手术治疗的253例急性Stanford A型主动脉夹层患者的临床资料,其中男性213例（84.19%）;年龄（47.07±9.27）岁。根据患者术后30 d是否死亡分为存活组（216例,85.38%）和死亡组（37例,14.62%）,对患者一般基线特征及围术期临床资料进行分析。通过单因素和多因素logistic回归分析探讨急性Stanford A型主动脉夹层患者术后短期病死率的相关影响因素。 结果单因素分析结果显示,2组患者在年龄,术前伴器官灌注不良综合征,体外循环时间,术后48 h引流量＞1 L、需肾替代治疗的急性肾损伤（RRT-AKI）、低心排之间差异均有统计学意义（P＜0.05）。多因素logistic回归分析结果显示,年龄（OR=1.174,95%CI：1.083~1.272,P＜0.001）、术前伴器官灌注不良综合征（OR=7.339,95%CI：2.221~24.247,P=0.001）、体外循环时间（OR=1.031,95%CI：1.015~1.048,P＜0.001）、术后RRT-AKI（OR=12.490,95%CI：3.477~44.866,P＜0.001）、术后低心排（OR=14.325,95%CI：2.740~74.897,P=0.002）是急性Stanford A型主动脉夹层患者术后短期病死率的独立影响因素。 结论急性Stanford A型主动脉夹层患者术后病死率较高,年龄、术前伴器官灌注不良综合征、体外循环时间、术后发生RRT-AKI和低心排为急性Stanford A型主动脉夹层患者术后短期病死率的独立影响因素。     

中重度颅脑外伤患者合并阵发性交感神经过度兴奋综合征的危险因素及对预后的影响

目的 分析在中重度颅脑外伤患者中与阵发性交感神经过度兴奋综合征（paroxysmal sympathetic hyperactivity,PSH）相关的危险因素,并分析PSH对此类患者预后的影响。方法 选择在我院收治的中重度颅脑外伤患者为研究对象。收集所有患者的人口学信息和临床诊治信息。按照是否合并PSH将患者分为PSH组（n=27）和对照组（n=99）,对相关变量进行回归分析,并分析PSH对中重度颅脑损伤预后［住院时间,住ICU时间,格拉斯哥预后评分(Glasgow Outcome Scale,GOS)］的相关性。结果 共纳入患者126 例（男性 82 例,女性 44例）,共有27例发生了PSH（21.4%）。与PSH发生相关的危险因素包括入院时收缩压>140 mmHg(1 mmHg=0.133 kPa)（OR=3.21,95%CI=1.31~7.87,P=0.011）,GCS<8分(OR=4.34,95%CI=1.73~10.93,P=0.002),创伤后急诊CT提示存在脑挫裂伤（OR=4.29,95%CI=2.55~8.26,P<0.001）,颅内出血量≥50 ml（OR=2.33,95%CI=1.42~5.13,P=0.003）以及后期出现脑积水(OR=3.57,95%CI=1.36~9.37,P=0.010)。而PSH又与住院时间>1个月（OR=5.21,95%CI=2.88~7.42,P=0.002）和GOS 1~3分有关（OR=1.75,95%CI=1.24~3.78,P=0.009）。结论 PSH是中重度颅脑外伤患者的一种常见并发症。PSH的发生与入院时收缩压较高、GCS较低、合并脑挫伤以及后期合并脑积水等因素密切相关,而合并PSH的患者住院时间更长,预后更差。     

影响维持性血液透析患者依从性相关因素的研究

目的了解维持性血液透析(maintenance hemodialysis,MHD)患者对治疗(包括透析、液体管理、药物及饮食等方面)的依从性、依从性的影响因素以及依从性与临床指标的关系。方法采用终末期肾脏病患者依从性问卷(end-stage renal disease-adherence questionnaire,ESRD-AQ)调查表,对北京市2家三甲医院的MHD患者进行问卷调查。用单因素方差分析患者依从性与临床指标的关系,用Logistic回归模型分析不依从性的独立影响因素。结果共发放问卷189份,收回186份,收回率98.4%,其中有效问卷182份。182名患者中,男性87人(47.8%),平均年龄57.8±14.4岁,51.1%的患者透析龄超过5年。透析、药物、液体管理和饮食的依从性分别为70.9%、93.4%、79.1%和76.9%。性别(OR=2.298,95%CI 1.127~4.683,P=0.022)、经济条件(OR=2.539,95%CI 1.123~5.740,P=0.025)、教育水平(OR=3.453,95%CI 1.080~11.039,P=0.037)、工作状态(OR=3.286,95%CI 1.272~8.489,P=0.014)、民族(OR=7.611,95%CI 1.815~31.922,P=0.006)是依从性的独立影响因素。结论经济条件差、学历低、女性、上班者和少数民族的MHD患者对治疗依从性较差,需要加强宣教,以提高治疗和生活质量。     

中国哮喘患者吸入给药依从性影响因素的meta分析

目的 探讨中国哮喘患者吸入给药依从性的影响因素,为提高患者吸入治疗的依从性提供依据。方法 检索PubMed、中国知网、万方、维普、中国生物医学文献数据库中建库至2021年12月发表的中国哮喘患者吸入给药依从性影响因素分析的相关文献。采用RevMan 5.2软件进行meta分析。结果 共纳入16项研究,研究样本量为2 600例,吸入给药依从性好1 084例,吸入给药依从性差1 516例,吸入给药依从性好的占41.69%。文献质量评价得分均≥4分,均为中等质量及以上。Meta分析显示,影响哮喘患者吸入给药依从性的因素包括患者年龄[比值比（odds ratio,OR）=0.54,95%CI置信区间（confidence interval,CI）(0.32,0.91),P=0.02]、文化程度[OR=0.57,95%CI(0.36,0.90),P=0.02]、医患关系[OR=0.42,95%CI(0.19,0.93),P=0.03]、病情严重程度[OR=0.25,95%CI(0.11,0.58),P=0.001]、哮喘知识掌握程度[OR=2.51,95%(1.11,5.65),P=0.03]、...     

纤维蛋白原与白蛋白比值对慢阻肺患者急性加重风险的预测价值分析

目的 分析纤维蛋白原与白蛋白比值（FAR）对慢性阻塞性肺疾病（COPD）患者急性加重风险的预测价值。方法 选取2019年11月至2021年11月在我院接受治疗的86例COPD患者作为COPD组,同时选取同期来我院健康体检的40例健康人群作为对照组。根据患者入院前1年急性加重次数将COPD患者分为急性加重风险组（n=36）和无急性加重风险组（n=50）。所有纳入对象入院后均检测血清纤维蛋白原（FIB）、白蛋白（ALB）水平,并计算FAR比值。分析比较各组基本资料、生化指标,采用受试者工作特性曲线（ROC）评估血清FAR比值对COPD患者急性加重风险的预测价值,同时采用多因素Logistic回归分析影响COPD患者急性加重风险的相关因素。结果 COPD组血清FIB、FAR水平均明显高于对照组（P<0.05）,ALB水平明显低于对照组（P<0.05）。急性加重风险组患者血清FIB、FAR水平明显高于无急性加重风险组（P<0.05）,ALB水平明显低于无急性加重风险组（P<0.05）。ROC曲线结果显示,FAR预测COPD患者急性加重风险的曲线下面积为0.806,截断值0.29,敏感度、特异度分别为89.7%、85.3%,FIB曲线下面积为0.658,截断值8.50g/L,敏感度、特异度分别为75.6%、69.9%,ALB曲线下面积为0.689,截断值30.62g/L,敏感度、特异度分别为78.4%、70.2%。多因素logistic回归模型分析结果显示,血清FIB[OR（95%CI）：3.39（1.73~6.42）]、ALB[OR（95%CI）：3.56（1.79~7.06）]、FAR[OR（95%CI）：4.04（1.70~9.59）]均为影响COPD患者出现急性加重风险的相关因素（P<0.05）。结论 FAR比值在COPD患者急性加重风险中升高,是增加COPD患者急性加重风险的相关因素之一,有望作为预测患者出现急性加重风险的有效指标。     

肺结核合并艾滋病患者抗结核治疗的转归及危险因素分析

目的分析肺结核合并艾滋病患者抗结核治疗的转归,探讨导致不良转归的危险因素。方法对117例接受抗结核治疗的肺结核合并艾滋病患者的转归情况进行调查,分析体质量、年龄、CD4+T淋巴细胞计数、抗病毒治疗接受情况、HIV感染时间、HIV感染途径、肺结核类型、其他机会感染等对患者不良转归的影响。结果 117例患者死亡21例为不良转归组,96例为未死亡组,病死率17.9%;不良转归组患者开始抗结核治疗时CD4+T淋巴细胞计数[(89.7±55.2)个/μL]、实施抗病毒治疗率(52.4%)均低于未死亡组[(173.5±82.4)个/μL、91.7%],经静脉吸毒感染HIV(66.7%)、涂阳肺结核比率(57.1%)高于未死亡组(39.6%、32.3%)(P0.05);未接受抗病毒治疗(OR=12.391,95%CI:2.552~35.871,P=0.000)、静脉吸毒感染HIV(OR=0.259,95%CI:0.105~0.551,P=0.001)、涂阳肺结核(OR=0.412,95%CI:0.182~0.805,P=0.000是不良预后的独立危险因素。结论肺结核合并艾滋病患者抗结核治疗期间病死率高,未接受抗病毒治疗、静脉吸毒感染HIV及涂阳肺结核是其不良预后的危险因素。     

高敏肌钙蛋白T与急性前循环大血管闭塞性卒中 血管内治疗患者预后的相关性分析

目的：探讨早期高敏肌钙蛋白T（hs-cTnT）水平与急性前循环大血管闭塞性卒中（ALVOS）血管内治疗 患者预后的关系。方法：回顾性分析行血管内治疗的ALVOS患者的临床资料。根据患者3月后mRS评分,分 为良好预后组（mRS＜3分）和不良预后组（mRS≥3分）,比较2组基线资料。通过单因素分析及多因素Logistic 回归分析得出预后的独立危险因素,使用ROC曲线下面积评估hs-cTnT对预后不良的预测价值。结果：最终 纳入 127 例患者,其中预后良好 55 例（43.3%）,预后不良 72 例（56.7%）。多因素 Logistic 回归分析表明 hs-cTnT升高（OR1.037,95%CI 1.000～1.075,P=0.047）、年龄增加（OR1.070,95%CI 1.020～1.123,P=0.005）、 取栓次数增加（OR1.912,95%CI1.149～3.182,P=0.017）、ASPECT评分降低（OR1.479,95%CI 1.005～2.174, P=0.041）及颈内动脉闭塞（OR4.695,95%CI 1.524～14.492,P=0.007）是预后不良的独立危险因素。hs-cTnT预 测预后不良的ROC曲线下面积为0.730（95%CI 0.643～0.816,P＜0.001）,最佳截断值为15.45 ng/L,敏感度 63.9%,特异度69.1%。结论：早期hs-cTnT升高是ALVOS血管内治疗患者3月预后不良的独立危险因素。     

上海市宝山区居民散发诺如病毒感染性腹泻影响因素的病例对照研究

目的 探索居民散发诺如病毒感染的潜在危险因素。方法 采用1:2配比病例对照研究方法,选取2015年3月1日至2016年4月30日在上海市宝山区各级医疗机构肠道门诊就诊、实验室确诊为诺如病毒感染的80例患者为病例组,选择2周内无腹泻、呕吐症状的人群作为对照组。利用自行设计的调查表进行问卷调查,应用条件logistic回归进行单因素与多因素分析。结果 80例诺如病毒感染病例,实验室分型G Ⅱ型66例,占82.50%,G Ⅰ型14例,占17.50%。单因素分析显示从事低体力劳动的人群感染诺如病毒的风险是从事高强体力劳动的人群的2.446倍（OR=2.446,95%CI:1.228~4.872）;发病前3 d接触呕吐、腹泻患者（OR=8.267,95%CI:2.359~28.975）、发病前3 d有外出就餐史（OR=2.822,95%CI:1.467~5.429）和发病前3 d食用海鲜（OR=3.000,95%CI:1.841~4.888）是诺如病毒感染的危险因素。多因素分析显示:发病前3 d接触呕吐、腹泻患者（OR=6.959,95%CI:1.896~25.537）和发病前3 d食用海鲜（OR=2.283,95%CI:1.336~3.899）为诺如病毒感染的危险因素,饭前洗手（OR=0.609,95%CI:0.408~0.909）为保护性因素。结论 上海市宝山区诺如病毒感染以G Ⅱ型为主。接触患者和食用海鲜是诺如病毒感染的可能危险因素。应加强健康宣传,做好海水产品卫生监测工作。     

中文版8条目Morisky服药依从性量表在2型糖尿病患者中的信效度评价及应用研究

目的评价中文版8条目Morisky服药依从性量表（MMAS-8）在2型糖尿病患者中应用的信度、效度,探讨不同因素对患者服药依从性的影响。 方法选取2014年7月至2015年1月就诊于昆明医科大学第一附属医院的148例2型糖尿病患者,进行中文版MMAS-8及4条目Morisky服药依从性量表（MMAS-4）的调查。对中文版MMAS-8,选用Cronbach′s α系数评价其内部一致性信度,选用组内相关系数（ICC）评价重测信度;采用主成分因子分析法评价结构效度,采用Spearman相关系数评价聚合效度。对血糖达标组与血糖未达标组中文版MMAS-8得分采用两独立样本t检验进行比较,对血糖达标组与血糖未达标组服药依从性分布采用χ²检验进行比较,评价中文版MMAS-8区分效度。对2型糖尿病患者服药依从性影响因素采用多因素有序多分类logistic回归方法进行分析。 结果中文版MMAS-8的Cronbach′s α系数为0.776,ICC为0.854（P<0.05）;主成分因子分析法共提取3个公因子;MMAS-8与MMAS-4评分的相关系数为0.878（P<0.001）;血糖达标组（糖化血红蛋白<7%）MMAS-8得分高于血糖未达标组（糖化血红蛋白≥7%）,差异具有统计学意义［（7.20±1.04）vs（5.94±2.03）,t=3.910,P<0.001］,两组间低、中等、高依从性分布比较,差异有统计学意义（χ²=14.554,P=0.010）。影响2型糖尿病患者服药依从性的多因素有序多分类logistic回归分析提示：男性患者较女性患者服药依从性低（OR=0.405,95%CI=0.197~0.829,P=0.013）;职工医保患者较自费患者服药依从性低（OR=0.130,95%CI=0.021~0.800,P=0.028）;单药治疗较联合治疗患者依从性高（OR=2.970,95%CI=1.499~5.882,P=0.002）。年龄、病程、学历、职业、BMI、并发症、合并症、胰岛素治疗与否对服药依从性无显著影响,差异无统计学意义（P均>0.05）。 结论中文版MMAS-8具有良好的信度、效度;2型糖尿病患者的服药依从性与性别、医保类型及降糖方案有关。     

Is positivity for hepatitis C virus antibody predictive of lower risk of death in COVID-19 patients with cirrhosis?

Liver injury has been reported in coronavirus disease 2019 (COVID-19) cases but the impact of pre-existing liver damage and related etiology have not been completely elucidated. Our research interests include the potential reciprocal influence of COVID-19 and pre-existing liver damage related to hepatitis C virus (HCV) infection, in particular. To this end, we have evaluated three cohorts of patients admitted at three Italian hospitals during the coronavirus pandemic; these included 332 patients with COVID-19 and 1527 patients with HCV who were from established real-world antiviral treatment study cohorts (sofosbuvir/velpatasvir), with either liver disease (various severities; n = 1319) or cirrhosis (n = 208). Among the COVID-19 patients, 10 had cirrhosis (3%), including 7 of metabolic origin and 3 of viral origin. Mortality among the COVID-19 patients was 27.1%, with 70% of those with cirrhosis of metabolic etiology having died. Cirrhosis, older age, low white blood cell count and lymphocyte count being identified as risk predictors of death [odds ratio (OR) = 13.7, 95% confidence interval (CI): 2.59-83.01, P = 0.006; OR = 1.05, 95%CI: 1.03-1.08, P = 0.0001; OR = 1.09, 95%CI: 1.36-1.16, P = 0.001; OR = 0.61, 95%CI: 0.39-0.93, P = 0.023, respectively]. In the two cohorts of HCV patients, COVID-19 diagnosis was made in 0.07% of those with liver disease and 1% of those with cirrhosis. Thus, the prevalence of HCV antibodies among COVID-19-infected patients was comparable to that currently reported for the general population in Italy. Amongst the COVID-19 patients, pre-existing metabolic cirrhosis appears to be associated with higher mortality, while HCV antibodies may be suggestive of “protection” against COVID-19.     

拉米夫定治疗HBeAg阳性慢性乙型肝炎随机对照试验的Meta分析

目的评价拉米夫定治疗HBeAg阳性慢性乙型肝炎的疗效。方法检索MEDLINE,SCI,CurrentContent Connect,Cochrane图书馆和CBMdisc,并追查所有纳入研究的参考文献。检索年限均从建库检索到2005年9月。纳入拉米夫定与安慰剂、空白或支持治疗比较治疗HBeAg阳性慢性乙型肝炎的随机对照试验(RCT)。由两名评价员独立筛查文献,评价质量和提取资料。采用χ2检验鉴定研究间异质性,使用随机效应和固定效应模型合并研究,对疗程进行亚组分析。结果纳入11个RCT(n=1333),研究拉米夫定100mg/d的疗效,其中1个RCT同时研究拉米夫定25mg/d。8个RCT拉米夫定的疗程为常规疗程(52周);3个RCT为短疗程(≤26周),其中2个为12周、1个为26周。纳入文献的总体质量较高,6个研究采用了正确的随机分配方法,4个分配隐藏较充分,5个较好地实施了盲法;其余5个仅简单叙述为随机试验,未描述随机产生的方法;1个研究的盲法实施不充分。3个研究未报道失访人数及原因,其余均作了详细描述且采用意向性分析。纳入研究的随机方法、分配隐藏及盲法实施均无部分充分者。Meta分析结果显示,拉米夫定(100mg/d)常规疗程(52周)HBeAg转阴率高于对照组[41·2%vs12·9%,RR=3·20,95%CI(2·33,4·39)],HBV-DNA转阴率高于对照组[70·2%vs20·1%,RR=3·40,95%CI(2·77,4·16)],HBeAg血清转换率高于对照组[15·3%vs7·03%,RR=2·13,95%CI(1·22,3·49)],组织学反应率高于对照组[57·9%vs26·2%,RR=2·17,95%CI(1·67,2·81)],ALT复常率高于对照组[65%vs34·9%,RR=1·91,95%CI(1·64,2·21)]。短疗程者仅HBV-DNA转阴率拉米夫定组高于对照组[50·7%vs3·9%,RR=8·68,95%CI(1·72,43·74)],其差异有统计学意义。但HBeAg转阴、HBeAg血清转换及ALT复常,拉米夫定组均与对照组无统计学差异。拉米夫定25mg/d的HBV-DNA转阴率高于对照组[97·9%vs22·2%,RR=4·41,95%CI(2·86,6·79)];组织学反应率高于对照组[59·3%vs30%,RR=1·98,95%CI(1·31,2·99)],但HBeAg血清转换与对照组相比,差异无统计学意义。结论拉米夫定100mg/d,52周可使HBeAg阳性的慢性乙肝患者的HBV-DNA转阴、HBeAg转阴、ALT复常及HBeAg血清转换。     

Chinese herbal medicine reduces acute hepatitis exacerbation in patients with hepatitis B virus infection: A case-control study in Taiwan

ObjectivesLittle information is available about the impact of Chinese herbal medicine (CHM) treatment on acute exacerbation of hepatitis. This study aimed to assess the risk of acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma in HBV patients with and without CHM use.Design and settingThis population-based case-control study used data from the Taiwan Longitudinal Health Insurance Database from 2000 to 2013. Newly diagnosed HBV patients had acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma as the case group, while another patients had no acute exacerbation of hepatitis and cirrhosis and hepatoma as the control group. To correct the differences in sociodemographic factors and Western medication use between the two groups, propensity score matching was used at a 1:1 ratio, and resulted in a comparison of 1306 and 805 patients per group, respectively.Main outcome measuresOccurrence of acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma.ResultsOverall rate of acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma was 7.9% and 4.8%, respectively. Patients receiving CHM had a significantly lower risk of acute exacerbation of hepatitis (adjusted odds ratio [aOR] =0.20, 95% confidence interval [95%CI]: 0.13–0.31) and subsequent cirrhosis and hepatoma (aOR = 0.29, 95%CI: 0.18–0.49) than those not receiving CHM after adjusting for relevant covariates. However, no dose-dependent relationship was exhibited for either incidence of acute exacerbation of hepatitis and cirrhosis and hepatoma.ConclusionThese findings highlight that the use of CHM was associated with a significantly reduced risk of acute exacerbation of hepatitis and subsequent cirrhosis and hepatoma in patients with HBV. Future research could further explore the benefit of CHM therapies for treatment of acute hepatitis exacerbation.     

Medication adherence and the associated health-economic impact among patients with type 2 diabetes mellitus converting to insulin pen therapy: an analysis of third-party managed care claims data

OBJECTIVE: This study evaluated the impact on adherence, hypoglycemic events, resource utilization, and the associated health care costs of converting from administration of insulin therapy by a vial/syringe to an insulin analogue pen device in patients with type 2 diabetes mellitus. METHODS: This pre-post analysis used an integrated medical and pharmacy claims database containing information for >40 million covered lives from 57 managed care health plans in the United States. Adults with a diagnosis of type 2 diabetes whose treatment was converted from conventional human or analogue insulin injection (vial/syringe) to a prefilled insulin analogue pen from July 2001 through December 2002, with no use of an insulin analogue pen device in the preceding 6 months, were identified and analyzed retrospectively. The primary end points were adherence (as measured by a medication possession ratio [MPR] > or =80%); the odds ratio (OR) for hypoglycemic events requiring health care resource utilization and resulting in a claim; the association between adherence and hypoglycemic events; and all-cause, hypoglycemia-attributable (HA), and diabetes-attributable (DA) health care costs. RESULTS: A total of 1156 subjects were identified and analyzed (mean [SD] age, 45.4 [13.7] years; 53.8% male; previous insulin vial use: 595 [51.5%] human, 561 [48.5%] analogue). Medication adherence was significantly improved after conversion to the insulin pen device (from 62% to 69%; P < 0.01). The proportion of subjects considered adherent was significantly higher in the period after the conversion compared with before the conversion (54.6% vs 36.1%, respectively; P < 0.01). The likelihood of experiencing a hypoglycemic event was significantly reduced after conversion (OR = 0.50; 95% CI, 0.37-0.68; P < 0.05), and the incidence of hypoglycemia in subjects with an MPR > or =80% decreased by nearly two thirds (incident rate ratio = 0.35; 95% CI, 0.11-0.81; P < 0.05). There were significant decreases in HA emergency department visits (OR = 0.44; 95% CI, 0.21-0.92; P < 0.05) and physician visits (OR = 0.39; 95% CI, 0.24-0.64; P < 0.05), whereas HA-related hospitalizations and outpatient visits remained similar after conversion. Total mean all-cause annual treatment costs were reduced by $1590 per patient (from $16,359 to $14,769; P < 0.01). Annual HA costs were reduced by $788 per patient (from $1415 to $627; P < 0.01), predominantly as a result of decreased hospitalization costs (from $857 to $288; P < 0.01). Annual DA costs were reduced by $600 per patient (from $8827 to $8227; P < 0.01). CONCLUSIONS: Among these patients with type 2 diabetes treated in a managed care setting, a switch from administration of insulin therapy by vial/syringe to a prefilled insulin analogue pen device was associated with improved medication adherence, fewer claims for hypoglycemic events, reduced emergency department and physician visits, and lower annual treatment costs.     

Prolonged Entecavir Therapy Is Not Effective for HBeAg Seroconversion in Treatment-Naive Chronic Hepatitis B Patients with a Partial Virological Response

The aims of this study were to investigate the efficacy of prolonged entecavir (ETV) therapy in treatment-naive chronic hepatitis B (CHB) patients and to determine whether continuous ETV therapy is feasible to achieve HBeAg seroconversion, particularly in patients with partial virological response (PVR). A total of 142 treatment-naive patients with CHB were enrolled. The mean duration of treatment was 65 (range, 26 to 90) months, and 86 patients (60.6%) were HBeAg positive. PVR was defined as detectable hepatitis B virus (HBV) DNA (>116 copies/ml) at year 1. The cumulative incidence of virological response (VR) increased from 54.9% at year 1 to 98.2% at year 7. HBeAg positivity (odds ratio [OR], 4.146; P = 0.001) and initial alanine aminotransferase (ALT) (OR, 0.997; P = 0.004) were independent risk factors for PVR. Among the 64 patients with PVR, 47 patients (73.4%) achieved VR within 4 years after prolonged ETV therapy without treatment adaptation. Three patients (2.1%) experienced virological breakthrough and HBV variants with genotypic resistance. The cumulative rate of HBeAg seroconversion was significantly higher in the patients with VR than in the patients with PVR (P = 0.018). None of the PVR patients with HBV DNA at ≥5,000 copies/ml at year 1 ever experienced HBeAg seroconversion. Multivariate analysis identified VR at year 1 as the only determinant of HBeAg seroconversion (hazard ratio [HR], 3.009; P = 0.010). In conclusion, although there were patients with PVR, prolonged ETV therapy showed excellent VR, with only 2.1% emergence of viral resistance during a 7-year follow-up. However, to achieve HBeAg seroconversion, drug modification is needed for HBeAg-positive patients with PVR (especially those with HBV DNA at ≥5,000 copies/ml at year 1).     

乙型肝炎肝硬化患者血清GRP78、caspase-12表达与肝脏炎症的相关性分析

目的 观察乙型肝炎肝硬化患者血清葡萄糖调节蛋白78(glucose regulated protein 78,GRP78)、caspase-12水平,探讨其表达与患者肝脏炎症的关系.方法 83例乙型肝炎肝硬化患者均行常规综合治疗48周,根据治疗后患者肝脏炎症活动度分为进展组17例和未进展组66例;采用ELISA法检测血...     

云南省德宏州成人艾滋病病毒感染者中乙型病毒性肝炎病毒合并感染研究

目的 了解云南省德宏州艾滋病病毒(HIV)感染者中乙型病毒性肝炎(乙肝)病毒(HBV)合并感染率,并分析其影响因素。方法 对德宏州HIV感染者进行横断面调查,进行乙肝五项指标检测。结果 在进行乙肝五项指标检测的5732例HIV感染者中,共有486例(8.5%)乙肝表面抗原(HBsAg)阳性,2737例(47.7%)乙肝表面抗体(HBsAb)阳性,102例(1.8%)乙肝e抗原(HBeAg)阳性,522例(9.1%)乙肝e抗体(HBeAb)阳性,3727例(65.0%)乙肝核心抗体(HBcAb)阳性,90例(1.6%)感染者为乙肝大三阳(HBsAg、HBeAg和HBcAb三项阳性)。多因素logistic回归分析显示,18～29岁年龄组大三阳阳性率高于50岁以上年龄组(OR=3.04,95%CI:1.30～7.15);男性大三阳阳性率高于女性(OR=1.77,95%CI:1.06～2.95)。结论 德宏州HIV感染者中存在一定比例的HBV合并感染者;不同特征HIV感染者,HBV合并感染率不同。     

Hepatitis B virus replication and liver disease progression: the impact of antiviral therapy

Chronic hepatitis B virus (HBV) infection is a serious health issue worldwide. The presence of HBV replication markers--hepatitis B e antigen (HBeAg) or HBV DNA--is associated with continuing hepatitis activity or intermittent hepatitis flares and subsequent disease progression, including hepatic decompensation and development of liver cirrhosis or hepatocellular carcinoma (HCC). Long-term (>10 years) prospective studies in patients >30 years of age have shown that HBeAg seropositivity is associated with increased risk of disease progression, and the risk of cirrhosis and HCC begins to increase at an HBV DNA level of 10(4) copies/ml. Therefore, elimination of HBV, or at least sustained or maintained suppression of HBV, is the key to reducing hepatitis and thereby halting or preventing disease progression. Therapy with interferon-alpha or a direct antiviral agent has been shown to reduce the risk of cirrhosis and prevent further disease worsening. In both the woodchuck hepatitis model and in HBV patients, maintained suppression of HBV replication by a direct antiviral agent may reduce the progression to HCC. However, the efficacy of current antiviral therapy is still far from satisfactory. The ability to achieve a high rate of sustained or maintained HBV suppression with a low risk of drug resistance would be the ultimate goal in the treatment of chronic HBV infection.     

症状性椎动脉狭窄支架植入术后再狭窄的相关危险因素分析

目的 探讨椎动脉狭窄支架植入术后支架内再狭窄（ISRS）的相关危险因素。方法 选取2015年6月至2018年9月间在我院接受椎动脉狭窄支架植入术患者110例作为研究组,平均随访15个月,以支架植入段内径狭窄≥50%为再狭窄,分为再狭窄组（33例）和对照组（77例）,回顾性分析两组患者的临床资料、生化指标及动脉造影结果的差异,分析其与椎动脉支架内再狭窄的关系。结果 通过对可能与ISRS相关的危险因素进行多因素Logistic回归分析显示,ISRS的危险因素有：2型糖尿病（OR=6.392, 95%CI 1.361 30.032）、支架长度>13 mm(OR=1.799, 95%CI 1.209 2.678)、椎动脉原始内径<3.5 mm(OR=0.069, 95%CI 0.013 0.383)、椎动脉起始部变异（OR=7.369, 95%CI 1.558 34.860）以及合并多处狭窄病变（OR=8.985, 95%CI 1.339 60.290）。结论 2型糖尿病、支架长度>13 mm、椎动脉原始内径<3.5 mm、椎动脉起始部变异及合并多处狭窄为预测ISRS发生的主要危险因素,必须更加重视这类危险因素患者的术前评估、随访和复查。