JAM-C单抗对小鼠急性坏死性胰腺炎的抑制作用

目的:观察JAM-C单克隆抗体对小鼠急性坏死性胰腺炎(ANP)模型胰腺和全身炎症的抑制作用.方法:采用雨蛙素和脂多糖联合腹腔注射的方法建立小鼠重症急性胰腺炎模型.生理盐水对照组(NS组):小鼠给予腹腔注射无菌生理盐水(10 mL/kg),共注射6次,间隔1 h;ANP模型组(ANP组):小鼠给予腹腔注射雨蛙素(50μg...     

髓样细胞表达的激发受体-1在急性坏死性胰腺炎小鼠中的表达

目的 检测急性坏死性胰腺炎(ANP)小鼠外周血及胰腺组织中髓样细胞表达的激发受体-1(TREM-1)的表达,探讨其在ANP发生、发展中的作用.方法 50只雄性昆明小鼠按随机表法分为对照组,ANP 24、48、72、96 h组.以腹腔注射20%L-精氨酸4 mg/g体重、间隔1 h重复一次的方法制备ANP模型.对照组腹腔注射等容积生理盐水.取血检测淀粉酶、肌酐和谷丙转氨酶含量;取胰腺组织行病理学检查并评分;采用实时定量PCR法检测外周血白细胞TREM-1 mRNA的表达;免疫组化法检测胰腺组织TREM-1蛋白表达.结果 ANP 24 h组小鼠血清淀粉酶、肌酐、谷丙转氨酶水平为(9439±1273)U/L、(84.8±75.9)μmol/L、(158.1±122.1)U/L,均较对照组的(2412±297)U/L、(29.2±19.1)μmol/L、(41.4±7.9)U/L显著升高.ANP组胰腺组织的病理评分随着时间推移而增加.ANP 24、48、72、96 h组的TREM-1 mRNA相对表达量分别为15.55、30.36、15.77、28.32,ANP 48 h组的表达量显著高于其他时间点组(P值均<0.01),而胰腺组织TREM-1蛋白表达随胰腺炎的病程进展无显著变化.结论 TREM-1可能还通过促发其他炎症因子参与ANP的进展过程.     

抗氧化剂对急性胰腺炎大鼠核因子-κB和一氧化氮合酶的影响

目的:探讨抗氧化剂N-乙酰半胱氨酸(N-acetylcysteine,NAC)对急性胰腺炎大鼠胰腺核因子-κB(nuclear factorkappa B,NF-κB)和诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)表达的影响.方法:♂SD大鼠95只,随机分成正常对照组(C组,25只)、急性胰腺炎组(A组,35只)和NAC干预组(N组,35只).A组分2次腹腔内注射8 g/L的L-精氨酸(L-arginine,L-Arg)1.2 mg/g诱导急性坏死性胰腺炎(acute necrotizing pancreatitis,ANP)模型;C组同法腹腔内注射等量生理盐水;N组先提前1h腹腔内注射0.5 mol/L的NAC0.05 mg/g,然后同A组方法诱导ANP.在首次注射L-Arg后于6,12,24,36,48 h 5个时点分批处死大鼠,检测胰腺NF-κB及iNOS活性.结果:N组NF-κB浓度在ANP早期比A组的明显降低(10.4±2.3 vs 89.7±6.4,6.8±3.2 vs 21.5±3.5,7.9±3.4 vs32.5±4.5,5.4±2.7vs 14.7±5.2,5.0±3.7vs 11.1±2.3,P＜0.05及P＜0.01).A组各时点iNOS明显升高,N组各时点iNOS活性均较A组的明显下降(15.2±4.0 vs24.2±3.8,28.3±8.0 vs 36.8±6.0,25.2±3.8 vs30.5±3.5,21.2±3.7 vs 28.7±7.2,18.8±5.5 vs28.2±4.2,P＜0.05及P＜0.01).结论:抗氧化剂可通过抑制NF-κB的激活而抑制iNOS的表达.     

植物乳杆菌WCFS1对急性坏死性胰腺炎小鼠胰腺及回肠损伤的影响

目的探讨益生菌植物乳杆菌WCFS1(LP)灌胃对急性坏死性胰腺炎(ANP)小鼠胰腺及回肠损伤的影响。方法 24只健康雄性小鼠应用广谱抗生素持续灌胃3周以建立肠道无菌鼠, 然后随机分为正常对照组(CON组)、ANP模型组(ANP组)、LP灌胃组(LP组)和LP灌胃后再诱导ANP组(LP+ANP组), 每组6只。LP组与LP+ANP组给予1×109 CFU/ml、0.2 ml/d的LP灌胃1周, CON组与ANP组以0.2 ml/d无菌磷酸盐缓冲液灌胃1周。采用雨蛙肽(100 μg/kg)腹腔注射10次, 每次间隔1 h, 第10次注射时腹腔加注脂多糖5 mg/kg的方法构建ANP小鼠模型, 2 h后处死小鼠。采用荧光定量PCR法检测小鼠粪便及回肠黏膜中LP数量;取胰腺和回肠组织行病理学检查, 观察组织的炎症程度, 并行病理学评分;采用酶动力化学法检测血清淀粉酶水平, ELISA法检测血清炎症因子水平及肠通透性指标;荧光定量PCR法检测胰腺与回肠组织炎症因子的表达;免疫荧光组织化学法检测回肠紧密连接蛋白occludin、claudin-1、ZO-1表达量。结果 LP灌胃后小鼠粪便及回肠黏膜...     

硫氧还蛋白-1在急性坏死性胰腺炎大鼠肺组织中的表达及褪黑素干预的影响

目的:探讨内源性硫氧还蛋白-1(Trx-1)在急性坏死性胰腺炎(ANP)大鼠模型肺组织中的表达:观察褪黑素对ANP胰和肺脏的保护作用和对肺组织Trx-1表达的影响.方法:将72只SD大鼠随机分成对照组(C组,n=24)、急性胰腺炎组(A组,n=24)、褪黑素前干预组(M组,n=24).A组用6%的左旋精氨酸(L-Arginine,L-Arg)腹腔内注射,每次25 mL/kg体质量,共3次,注射间隔1 h,诱导ANP模型,在首次注射L-Arg前30 min腹腔注射生理盐水20mL/kg体质量1次;C组同法注射相当于A组各次注射用量的等容积生理盐水:M组在诱导胰腺炎前30 min腹腔内注射0.25%褪黑素(20mL/kg体质量)干预.在注射完L-Arg后的6、12、24 h三个时点分批处死大鼠.应用免疫组织化学技术检测各组ANP肺组织Trx-1的表达.并观察各组对应各时点胰腺、肺组织病理学和肺免疫组织化学的改变;抽取动脉血测定Trx-1和淀粉酶.结果:A组大鼠胰腺和肺组织病理损伤在6、12、24 h时点比C组明显加重(均P＜0.01);M组胰腺和肺组织病理损伤在6、12、24 h时点较A组明显减轻(P＜0.01或0.05).A组、M组肺组织表达Trx.1量在6、12、24 h时点较C组显著升高(均P<0.01).在24 h,A组血清淀粉酶较C组显著升高(4 598 U/L±2 274 U/L vs2 033U/L±863 U/L,P＜0.01);M组较A组低(3 990U/L±1 146 U/L vs 4 598 U/L±2 274 U/L,P＜0.05).A组大鼠血清Trx-1含量在6、12 h时点显著降低,24 h时点显著升高,呈前低后高趋势;与A组比较,M组血清Trx-1在6、12 h时点显著升高,24 h时点显著降低,量的峰值前移.结论:Trx-1在ANP肺损伤组织中的过度表达与急性胰腺炎相关性肺损伤关系密切.褪黑素影响Trx-1表达,并可能在一定程度上减轻ANP的胰、肺组织损伤.     

硫氧还蛋白-1 在急性坏死性胰腺炎大鼠中的表达及褪黑素对其的影响

目的 观察硫氧还蛋白-1(TRX-1)在急性坏死性胰腺炎(ANP)大鼠胰腺组织的表达和褪黑素干预对其的影响.方法 72只雄性SD大鼠随机分成ANP组、褪黑素组和对照组,每组24只.以腹腔注射6%L-Arginine 25 mL/kg体重3次、每次间隔1 h的方法制备ANP模型.褪黑素组在制模前30min腹腔注射0.25%褪黑素20 ml/kg体重;ANP组和对照组大鼠腹腔注射等容积生理盐水.术后6、12、24 h分批处死大鼠.抽血测定血清淀粉酶含量;取胰腺组织行病理学检查,并评分;检测胰腺组织丙二醛(MDA)、髓过氧化酶(MPO)含量;免疫组化检测胰腺组织TRX-1蛋白表达;RT-PCR检测胰腺组织TRX-1 mRNA的表达.结果 ANP组12 h点血清淀粉酶、胰腺组织MDA和MPO以及TRX-1 mRNA和蛋白表达水平分别为(3 012±1 425)u/L、(4.13±1.85)nmol/mg prot、(7.45±1.26)nmol/mg prot、0.68±0.18、66.8±8.1;褪黑素组分别为(1 835±499)U/L、(3.03±2.12)nmol/mg prot、(5.32±1.06)nmml//mgprot、0.50±0.09、80.29±8.14,两组比较均有显著差异(P<0.05).褪黑素组胰腺TRX-1 mRNA和蛋白表达峰值从ANP组的制模后12 h提前到制模后6 h.结论 ANP大鼠胰腺组织TRX-1 mRNA和蛋白表达增高;褪黑素干预能促进胰腺组织早期表达TRX-1 mRNA和蛋白,减轻胰腺组织的损伤.     

姜黄素对大鼠慢性酒精性胰腺炎的作用和机制研究

目的 观察姜黄素对大鼠实验性慢性胰腺炎的干预作用.方法 18只1月龄雄性SD大鼠按数字表法随机分为对照组、ANP组和姜黄素组,每组6只.以25％乙醇代水饮12周后每周1次腹腔注射脂多糖(2 mg/kg体重)、共4次的方法建立慢性胰腺炎模型.姜黄素组制模同时饲以姜黄素.17周后处死动物.测血糖浓度,常规胰腺病理检查及胶原纤维染色,检测胰腺组织淀粉酶和脂肪酶水平.采用RT-PCR法检测胰腺组织转化生长因子β1(TGF-β1) mRNA表达.结果 对照组、ANP组和姜黄素组胰腺病理评分分别为1.17±0.41、7.33±2.58和3.50±1.05,姜黄素组较ANP组降低(P＜0.01),但仍高于对照组(P＜0.05).各组血糖值无统计学差异.姜黄素组胰腺组织匀浆淀粉酶和脂肪酶含量分别为(7348±102)、(14135±1272)U/g,均高于ANP组的(5428±547)和(9123±1250) U/g(P值均＜0.05).对照组、ANP组和姜黄素组胰腺TGF-β1 mRNA表达量分别为0.618±0.019、0.818±0.012、0.745±0.088,ANP组显著高于对照组和姜黄素组(P值均＜0.01).结论 在长期摄入乙醇的基础上反复腹腔注射脂多糖可诱导慢性胰腺炎;姜黄素可能通过抑制TGF-β1表达而产生抗胰腺纤维化的作用.     

急性肝衰竭TNF-α、Caspase-3及TGF-β1 mRNA的表达及罗格列酮的干预

目的: 观察D-氨基半乳糖(D-Ga lN)联合脂多糖(LPS)诱导的小鼠急性肝衰竭TNF-α、Caspase-3、TGF-β1 mRNA的表达,并探讨罗格列酮的干预作用.方法: ♂昆明小鼠随机分为3组: 正常组、对照组、干预组.对照组和干预组以D-Ga lN/LPS腹腔注射构建小鼠急性肝衰竭模型,正常组则相应予以生理盐水腹腔注射;干预组于造模前2 h予以罗格列酮灌胃,正常组和对照组则相应予以生理盐水灌胃.比较各组小鼠血清丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)水平,肝组织病变程度及肝组织TNF-α、Caspase-3,TGF-β1 mRNA的表达水平.结果: D-GalN联合LPS腹腔注射成功构建了小鼠急性肝衰竭模型,对照组肝组织中TNF-α、Caspase-3、TGF-β1 mRNA的表达较正常组明显增高( P＜0.001);干预组小鼠血清ALT,AST水平明显低于对照组(403.6±76.1 U/L vs 3664.8±646.1 U/L,464.6±63.0 U/L vs 3514.0±468.9 U/L,均P＜0.001),肝组织中TNF-α、Caspase-3、TGF-β1 mRNA表达水平明显低于对照组(0.270±0.042 vs 0.459±0.072,0.388±0.033 vs 0.553±0.033,0.261±0.031 vs 0.403±0.042,均P＜0.001);与对照组比较,干预组肝组织炎性细胞浸润明显减少,肝细胞以变性为主,未见明显坏死.结论: 罗格列酮可能通过下调T N F - α、Caspase-3、TGF-β1的表达对D-GalN/LPS小鼠急性肝衰竭起保护作用.     

人重组血管生成素-1对小鼠急性胰腺炎的治疗作用及机制

目的观察血管生成素-1(Ang-1)对小鼠急性胰腺炎(AP)的治疗作用,并探讨其作用机制。方法BALB/c小鼠54只,随机分为对照组、AP组、Ang-1治疗组(各18只)。AP组:腹腔注射雨蛙素50μg/kg,1次/h,共7次,制成AP模型;Ang-1治疗组:同法制作AP模型,之后腹腔注射100μg/kg的Ang-1;对照组:腹腔注射等量生理盐水。上述各组小鼠在作相应处理后分别于9、18、24 h各取6只,摘眼球取血处死,取胰腺组织观察其病理变化并评分(Schmidt法),检测小鼠血清淀粉酶(AMY)、TNF-α、IL-6。结果 AP组胰腺组织病理学评分及血清AMY、TNF-α、IL-6水平较对照组明显升高(P均<0.01),Ang-1治疗组胰腺组织病理学评分及血清AMY、TNF-α、IL-6水平较AP组下降(P均<0.05)。结论 Ang-1可明显减轻雨蛙素诱导的小鼠AP的炎症反应及胰腺损伤,其作用机制与降低炎症因子TNF-α、IL-6的水平有关。     

自噬相关基因LC3和Beclin1在大鼠急性坏死性胰腺炎中的表达和意义

目的:研究大鼠急性坏死性胰腺炎(ANP)胰腺组织LC3、Beclin1的表达,并探讨其在ANP中的作用及意义.方法:36只SD大鼠随机分为假手术(SO)组和ANP组,ANP组采用胰胆管逆行注射5%牛磺胆酸钠诱导制作大鼠ANP模型,SO组开腹后翻动胰腺后关腹,各组再分3、6和12h3个不同时间点.观察各组大鼠血清炎症因子及胰腺的病理改变,运用免疫组织化学法检测各组大鼠在不同时间点胰腺组织LC3和Beclin1的变化.结果:ANP组血浆淀粉酶(U/L)、TNF-α(μg/L)较SO组明显增加(血浆淀粉酶:3h:4936±1207vs1447±355;6h:5464±768vs1513±333;12h:6139±710vs1539±231;TNF-α:3h:111.24±21.86vs56.14±7.69;6h:107.55±33.05vs57.13±11.30;12h:108.24±24.83vs58.60±9.54,均P<0.05),且ANP组大鼠胰腺病理改变随着时间延长加重.正常大鼠胰腺腺泡细胞LC3、Beclin1低表达,大鼠ANP3h后胰腺细胞LC3、Beclin1表达开始增多,在6和12h呈强表达.结论...     

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。