天津地区汉族人群IL-10-592C/A基因多态性与冠状动脉支架术后再狭窄的关系

目的 探讨中国天津地区汉族人群白细胞介素-10(interleukin-10,IL-10)-592C/A基因多态性的功能性以及其对经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后再狭窄的发病,PCI术后血清IL-10水平的影响.方法 对437例接受PCI并进行冠状动脉造影随访的患者,按冠状动脉造影结果分为再狭窄组(166例)和非再狭窄组(271例),应用聚合酶链反应-限制性片段长度多态性方法检测IL-10-592位点基因型和等位基因频率的分布;用酶联免疫吸附试验法测定2组PCI术前及PCI术后24 h血清IL-10浓度,并比较两组间和各基因型间IL-10水平.结果 (1)IL-10-592C/A基因型和等位基因频率在再狭窄组和非再狭窄组之间差异无统计学意义(P均＞0.05);(2)PCI术后24 h血清IL-10水平再狭窄组显著低于非再狭窄组[(82.67±35.02)ng/Lvs.(95.08±32.26)ng/L,P＜0.05];(3)IL-10-592位点A等位基因携带者(AA+AC基因型)术后24 h血清IL-10水平明显低于非携带者(CC型)[(86.13±34.77)ng/L vs.(102.50±27.52)ng/L,P＜0.05];(4)再狭窄组A等位基因携带者术后24 h血清IL-10水平明显低于非携带者[(78.51±34.09)ng/L vs.(102.19±33.66)ng/L,P＜0.05];(5)再狭窄危险的多因素Logistie回归分析显示:急性冠状动脉综合征、术前狭窄程度、靶病变长度与冠状动脉内支架再狭窄呈正相关(()R值分别为5.90、1.86、2.83),术后24 h血清IL-10水平、参照血管直径、支架直径与冠状动脉内支架再狭窄呈负相关(OR值分别为0.99、0.70、0.46).结论 (1)IL-10基因-592 C/A多态性与中国天津地区汉族人群再狭窄发病无关;(2)IL-10是PCI术后早期的炎症细胞因子,术后24 h血清IL-10水平为再狭窄的独立预测因素,携带A等位基因的个体可能通过降低其表型血清IL-10水平而增加了冠状动脉内支架术后再狭窄的发病.

Abstract：

Objective To investigate the relationship of interleukin-10 gene (IL-10)polymorphism and the serum IL-10 level with restenosis after percutaneous coronary intervention (PCI) in Tianjin Chinese Han population and study the effect of IL-10 gene polymorphism on serum IL-10 level. Methods Four hundred and thirty-seven patients who successfully underwent PCI with a follow-up angiography were divided into a restenosis group (n= 166) and non-restenosis group (n= 271). The IL-10 gene promoter polymorphism at position -592 was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Meanwhile their serum IL-10 level before and 24 h after PCI was determined by enzyme-linked immunosorbent assay (ELISA). Results (1) There was no significant difference in frequencies of -592 genotypes and alleles between the two groups (P＞0. 05); (2) The 24 hpost-PCI IL-10 serum level of restenosis group was significantly lower than that of the non-restenosis group [(82. 67±35. 02) ng/L vs. (95.08±32.26) ng/L, P＜0.05]; (3) The serum level of the A allele carriers (AA+AC) was significant lower than that of the CC carriers [(86.13±34.77) ng/L vs. (102. 50±27.52)ng/L,P＜0.05]; (4) In the restenosis group, the 24 h post-PCI serum level of IL-10 in the A allele carriers was also significantly lower than that in those without the A allele [(78.51 ± 34.09) ng/L vs. (102.19 ±33.66) ng/L, P＜ 0. 05]; (5) Logistic regression analysis revealed positive correlations between acute coronary syndrome patients, pre-PCI degree of stenosis, length of target stenosis lesion and restenosis (OR=5.90, 1.86, 2.83 respectively); and there were negative correlations between 24 h post-PCI serum level of IL-10, the stent diameter, the diameter of reference vessel before stent implantation and restenosis (OR=0. 99, 0. 70, 0. 46 respectively). Conclusion (1) TheIL-10 gene -592 C/A polymorphism was not associated with restenosis in the Tianjin Chinese Han population; (2) IL-10 is an early post-PCI inflammatory cytokine, 24 h post-PCI serum IL-10 level was an independent predictive factor for restenosis,the IL-10 A allele carriers may have increased incidence of in-stent restenosis (ISR) by reducing the serum IL-10 levels.     

医共体总额预付对基层医疗服务供给的影响分析——基于湖北省黄冈市黄州区的实证研究

目的：分析总额预付制改革对黄州区医共体基层医疗服务供给的影响。方法：收集黄州区医共体月度数据,描述性分析基层医疗服务供给能力、效率及数量的变化,利用间断时间序列检验总额预付两次政策改革前后服务供给数量的变化情况。结果：黄州区分别于2018年、2019年开展并完善总额预付制改革。改革后,基层卫生技术人员占比、医师日均诊疗人次及床位使用率总体呈增长趋势。两阶段政策改革后基层门急诊人次及其占比均呈增长趋势(P<0.05),第一阶段政策改革后出院人数及其占比显著增长(P<0.05)。结论：总额预付制促进了基层医疗服务供给增加,但仍存在门急诊服务量增长趋势平缓、住院服务量不合理增长的问题,第二阶段政策改革应进一步扩大总额预付改革成果。     

三明市医共体内外经济激励对医疗服务供给的影响研究

目的：了解三明市内部年薪工分制改革与外部医共体打包支付及其他一系列配套政策改革下医疗服务供给的变化情况,以及内外部经济激励政策的协同影响机制。方法：以三明市2015年8月年薪工分制改革、2018年1月医共体打包支付改革为政策干预时点,采用间断时间序列(ITSA)分段回归模型对3个政策时段月度数据的变化情况进行分析。结果：年薪工分制实施后,全市及基层门急诊人次均较改革前有大幅提升,医院门急诊人次仍保持既往上涨趋势。医共体打包支付实施后,全市、基层、医院门急诊及入院人次的上升趋势均明显减缓,基层门急诊人次占比增长速度明显下降。结论：发挥外部经济激励的宏观调控作用,能够规范由不合理内部经济激励引起的过度医疗服务供给行为;内部与外部经济激励联动改革,才能顺利推进分级诊疗制度的实施。