云南省纳西族居民糖尿病患病、知晓、治疗和控制率的变化趋势研究

  目的  分析云南省纳西族糖尿病患病、知晓、治疗和控制率的变化趋势。  方法  采用重复横断面设计,于2013年和2018年采用多阶段分层随机抽样方法在云南玉龙县分别抽取1402名和1426名35岁及以上常住纳西族居民进行问卷调查和体格检查。  结果  2018年调查人群糖尿病前期和糖尿病患病率分别为19.5%和8.6%,知晓、治疗和控制率分别为52.8%、89.2%和29.2%。2013年1～2月至2018年1～2月期间,调查人群糖尿病前期患病率无明显变化,但65岁及以上老年人、初中及以上学历者和人均收入高者糖尿病前期患病率分别从21.5%、17.7%和17.9%上升至28.9%、22.3%和23.6%（P < 0.05）;糖尿病患病率由4.1%增长至8.6%（P < 0.001）,且分性别、年龄段、文化程度和家庭人均收入的糖尿病患病率也呈上升趋势（均P < 0.05）;糖尿病知晓率由69.0%下降至52.8%;糖尿病治疗率和控制率无明显变化（均P > 0.05）,但女性、55-64岁、小学及以下学历和人均收入低的糖尿病患者治疗率分别从71.4%、62.5%、57.9%和71.4%上升至93.9%、95.0%、88.9%和90.5%（均P < 0.05）。  结论  纳西族居民糖尿病的患病率呈上升趋势,而知晓率呈下降趋势,治疗率和控制率无明显变化。应根据不同特征人群采取有效措施降低糖尿病前期和糖尿病的患病率,提高知晓率和控制率,延缓糖尿病的发生和发展。     

白藜芦醇在绝经后骨质疏松症中抗氧化机制的研究进展

绝经后骨质疏松症(PO)是一种全身性骨骼疾病,由雌激素缺乏和衰老引起,其特征是低骨密度(BMD)和骨组织的微结构恶化,并导致骨质疏松性骨折的风险增高。在PO的发生发展过程中,潜在的致病机制是复杂和多方面的,雌激素缺乏是骨吸收增加和骨质流失加速的重要原因。同时,由于雌激素的缺乏和机体的衰老导致氧化应激(OS)水平的升高,是PO发生的主要机制之一。针对老年绝经后骨质疏松患者的治疗目前较为有效的是采用雌激素替代疗法,但也增加了患乳腺癌、子宫癌和心血管事件发生的风险。因此,寻找有效的抗氧化应激药物以治疗PO受到了越来越多研究者的关注。其中以白藜芦醇(RES)为代表的天然植物化合物,是一种具有抗氧化和抗衰老作用的天然抗氧化剂。它能通过多种通路抑制体内氧化应激,促进成骨分化和减少骨量丢失,并调节骨转换的能力,从而有效治疗PO。本文就白藜芦醇在PO中的抗氧化机制及其研究进展做一综述。     

Treatment response,survival, and safety profile of camrelizumab plus apatinib regimen as third-line treatment in metastatic gastric cancer patients

BackgroundCamrelizumab, as a PD-1 inhibitor on the market recently, presents favorable therapeutic efficacy in several advanced cancers, while its application in metastatic gastric cancer (mGC) lacks data. This study aimed to assess treatment response, survival profile, and adverse events of camrelizumab plus apatinib regimen as third-line treatment in mGC patients.MethodsNineteen mGC patients who received camrelizumab plus apatinib as third-line treatment were analyzed in this observational study. Subsequently, treatment response and adverse events were documented, then progression-free survival (PFS) and overall survival (OS) were calculated.ResultsNo (0.0%) patient achieved complete response; 5 (26.3%) patients achieved partial response; 8 (42.1%) patients had stable disease; 6 (31.6%) patients had progressive disease, resulting in objective response rate and disease control rate of 26.3% and 68.4%, respectively. Meanwhile, the median PFS and OS were 7.0 (95%CI: 2.9–11.0) months and 10.0 (95%CI: 7.4–12.6) months, accordingly. Besides, multiple metastases linked with worse PFS (P = 0.029) and OS (P = 0.021); Eastern Cooperative Oncology Group performance status (ECOG PS) score 1 (vs. 0) related to shorter OS (P = 0.030). Worth noting, the common adverse events were fatigue (42.1%), anemia (42.1%), neutropenia (42.1%), leukopenia (36.8%), pruritus (31.6%), proteinuria (31.6%), nausea and vomiting (31.6%), reactive capillary hemangioma (31.6%) and thrombocytopenia (31.6%). Meanwhile, grade 3–4 adverse events only included: thrombocytopenia (5.3%), hypertension (5.3%), and proteinuria (5.3%).ConclusionCamrelizumab plus apatinib as third-line treatment achieves satisfactory therapeutic efficacy and survival profile with generally manageable adverse events in mGC patients.     

Correlation of MCT1 and ABCC2 gene polymorphisms with valproic acid resistance in patients with epilepsy on valproic acid monotherapy

Valproic acid (VPA) is used as one of the first-line antiepileptic drugs to control seizure in epilepsy patients. However, one third of patients do not respond to VPA. This study is to investigate the influence of single nucleotide polymorphisms (SNPs) in multidrug transporters on VPA responses in Han Chinese epilepsy patients on VPA monotherapy. Twelve SNPs involved in VPA transport pathways, including ABCC2, ABCC4, ABCG2, MCT1, MCT2 and OATP2B1 were genotyped in 153 Han Chinese epilepsy patients. We found that among all the patients, MCT1 rs60844753 CC carriers have higher incidence of VPA-resistance than CG carriers (P = 0.05), and in subgroup of generalized seizure, ABCC2 rs3740066 CC carriers had higher frequency of VPA resistance than TC + TT carriers (P = 0.03). Although other SNPs were not correlated with VPA resistance, significant ethnic difference was found in minor allele frequency of these SNPs, indicating that the influence of these SNPs on VPA efficacy should be broadly investigated in other ethnic populations. This study provides nominal evidence that SNPs of genes involved in the transport of VPA contribute to interpatient variation in VPA response. Although the associations were abolished after Bonferroni correction, the results provide an incentive for further research in sufficiently large samples.     

Effects of glucagon-like peptide 1 receptor agonists and sodium glucose cotransporter 2 inhibitors on major adverse cardiovascular events in type 2 diabetes by race,ethnicity, and region: A meta-analysis

Background:The effects of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists on major adverse cardiovascular events (MACE) in type 2 diabetic subgroups defined by race, ethnicity, and region are unestablished.Methods:We searched PubMed and Embase for related randomized controlled trials. We conducted random-effects meta-analysis, stratified by drug class, on MACE in various subgroups defined by 3 factors of interest (ie, race, ethnicity, and region) to estimate pooled hazard ratio (HR) and 95% confidence interval. Random-effects meta-regression was conducted to evaluate the differences between 2 drug classes.Results:We included 11 randomized controlled trials for pooled analysis. Compared with placebo, SGLT2is and GLP-1 RAs significantly reduced the risk of MACE (HR ranged from 0.76 to 0.93) in most diabetic subgroups defined by 3 factors of interest. The 2 drug classes did not significantly reduced this risk in the Black race group (HR 0.92, 95% confidence interval 0.70–1.20). The effect of the 2 drug classes on MACE was not significantly different in all diabetic subgroups of interest (P-value for subgroup differences ranged from .101 to .971).Conclusions:SGLT2is and glucagon-like peptide 1 receptor agonists can significantly reduce the risk of MACE in most type 2 diabetic subgroups defined by race, ethnicity, and region, whereas they fail to do it in Black individuals.     

主动脉内球囊反搏泵的临床应用进展

主动脉内球囊反搏泵（IABP）是一项临床上常用的治疗手段,现已广泛应用于急性心肌梗死合并心源性休克、血流动力学不稳定的高危经皮冠状动脉介入治疗、冠状动脉旁路移植术等临床情况。最近一些研究对IABP的应用提出质疑,但我们综合分析认为IABP的应用是有价值的。     

Impact of unknown diabetes and prediabetes on clinical outcomes in “nondiabetic” Chinese patients after a primary coronary intervention

Background and aimTo explore the prevalence of unknown diabetes (DM) or prediabetes (pre-DM) in “nondiabetic” patients and its association with 2-year clinical outcomes after primary percutaneous coronary intervention (PCI).Methods and results5202 consecutive “nondiabetic” patients who underwent primary PCI at Fuwai Hospital from January to December 2013 were prospectively enrolled. The patients were grouped according to their glycemia status: unknown DM (HbA1c ≥ 47 mmol/L; FPG≥ 7.0 mmol/L), pre-DM (HbA1c 39–47 mmol/L; FPG: 5.6–6.9 mmol/L) and normoglycemia (NG, HbA1c < 39 mmol/L; FPG < 5.6 mmol/L). The main endpoint was 2-year major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, and target vessel revascularization. A total of 905 patients had unknown DM, and 3407 patients had pre-DM. Unknown DM and pre-DM were associated with aging (p < 0.001); a greater proportion of hypertension (p < 0.001), previous myocardial infarction (p < 0.001), and chronic kidney disease (p = 0.004). During the 2-year follow-up, the rate of MACE was significantly higher in the unknown DM and pre-DM groups than in the NG group (8.1% vs. 5.8% vs. 4.1%, respectively, p = 0.001). Multivariate analyses demonstrated that unknown DM was associated with a 1.9-fold higher event risk compared to NG (95% CI: 1.2–2.8).ConclusionsThe prevalence of abnormal glucose metabolism was high in “nondiabetic” Chinese PCI patients. Patients with unknown DM and pre-DM had higher event risks than those with NG. In “nondiabetes” patients requiring PCI, routine assessment of HbA1c and FPG appears to be of value to identify patients with an increased event risk.