238例门诊支气管哮喘患者规范治疗后哮喘控制临床分析

目的 探讨门诊支气管哮喘(简称哮喘)患者哮喘控制情况并作临床分析.方法 238例门诊哮喘患者,采用德国Mediwiss敏筛检测系统检测血清特异性IgE抗体,根据全球哮喘防治创议(GINA)及我国哮喘防治指南推荐分级规范用药治疗(75±15)d.记录哮喘日记,复诊时填写哮喘控制测试(ACT)量表,将ACT分值≥20分定义为哮喘良好控制,ACT分值＜20分定义为哮喘未控制.结果 经过3个月的规范化治疗,据ACT量表,达到良好控制率为66.81％(159/238);未控制率33.19％(79/238).哮喘未控制组中82.28％(65/79)的患者有吸烟史,79.75％(63/79)患者有饲养宠物,79.75％(63/79)的患者合并变应性鼻炎,明显高于良好控制组的14.46％(23/159),14.46％(23/159),56.60％(90/159).此外,患者的职业因素、依从性差及合并其他皮肤过敏阳性率哮喘未控制组明显高于良好控制组.对于吸人性过敏原如:猫狗毛皮屑、常见的霉菌血清特异性IgE阳性率哮喘未控制组分别为44.30％(35/79)、27.85％(22/79),明显高于哮喘良好控制组24.53％(39/159)、7.55％(12/159),但对于尘螨,两组有类似的阳性率.对于季节性过敏原:春季树花粉、秋季矮豚草蒿及葎草,未控制组血清特异性IgE阳性率分别为34.18％(27/79)、43.04％(34/79)和16.45％(13/79),哮喘良好控制组分别为18.24％(29/159)、29.56％(47/159)和6.29％(10/159).二者相比,哮喘未控制组阳性率明显高于哮喘良好控制组.结论 ACT是一种评价哮喘控制简易有效的方法,吸烟、宠物饲养、合并变应性鼻炎和依从性是其是否达到良好控制的主要因素.宠物毛皮屑、常见的霉菌以及季节性过敏原是哮喘未控制的主要变应原.     

Systems medicine and metabolic modelling

Several complex diseases are caused by the malfunction of human metabolism, and deciphering the underlying molecular mechanisms can elucidate their aetiology. Systems biology is an integrative approach combining experimental and computational biology to identify and describe the molecular mechanisms of complex biological systems. Systems medicine has the potential to elucidate the onset and progression of complex metabolic diseases through the use of computational approaches. Advances in biotechnology have resulted in the provision of high-throughput data, which provide information about different metabolic processes. The systems medicine approach can utilize such data to reconstruct genome-scale metabolic models that can be used to study the function of specific enzymes and pathways in the context of the complete metabolic network. In this review, we outline the importance of genome-scale models in systems medicine and discuss how they may contribute towards the development of personalized medicine.     

Glycaemic control and hypoglycaemia with insulin glargine 300 U/mL versus insulin glargine 100 U/mL in insulin-naïve people with type 2 diabetes: 12-month results from the EDITION 3 trial

AimTo explore if efficacy and safety findings for insulin glargine 300 U/mL (Gla-300) versus insulin glargine 100 U/mL (Gla-100), observed over 6 months in insulin-naïve people with type 2 diabetes, are maintained after 12 months.MethodsEDITION 3 was a phase 3a, randomized, multicentre, open-label, parallel-group, treat-to-target study of once-daily Gla-300 versus Gla-100 (target fasting self-monitored plasma glucose, 4.4–5.6 mmol/L [80–100 mg/dL]). Participants completing the initial 6-month treatment phase continued their previously allocated basal insulin.ResultsOf 878 participants randomized, 337/439 (77%) and 314/439 (72%) assigned to Gla-300 and Gla-100, respectively, completed 12 months of treatment. Improved glycaemic control was sustained until 12 months in both treatment groups, with similar reductions in HbA_1c from baseline to month 12 (difference: −0.08 [95% confidence interval (CI): −0.23 to 0.07] % or −0.9 [−2.5 to 0.8] mmol/mol). Relative risk of experiencing ≥ 1 confirmed (≤ 3.9 mmol/L [≤ 70 mg/dL]) or severe hypoglycaemic event with Gla-300 versus Gla-100 was 0.86 (95% CI: 0.69 to 1.07) at night and 0.92 (0.82 to 1.03) at any time of day. For events with a glycaemic threshold of < 3.0 mmol/L (< 54 mg/dL) these numbers were 0.76 (0.49 to 1.19) and 0.66 (0.50 to 0.88). A similar pattern was seen for documented symptomatic events. No between-group differences in adverse events were identified.ConclusionOver 12 months, Gla-300 treatment was as effective as Gla-100 in reducing HbA_1c in insulin-naïve people with type 2 diabetes, with lower overall risk of hypoglycaemia at the < 3.0 mmol/L threshold.     

美沙拉嗪联合马来酸曲美布汀治疗肠易激综合征患者的临床疗效观察

目的评估美沙拉嗪联合马来酸曲美布汀治疗肠易激综合征(IBS)患者的临床疗效。方法根据罗马Ⅲ诊断标准纳入2014年10月至2016年6月在上海市嘉定区中心医院就诊的腹泻型IBS(IBS-D)和便秘型IBS(IBS-C)患者各40例。40例IBS-D患者随机分为美沙拉嗪+马来酸曲美布汀组和马来酸曲美布汀组,每组各20例;40例IBS-C患者随机分为美沙拉嗪+马来酸曲美布汀组和马来酸曲美布汀组,每组各20例。同期选择20名健康体检者作为正常对照。治疗前后均使用肠易激严重程度评分系统(IBSSS)和医院焦虑抑郁量表(HADS)评估患者的临床疗效和情绪障碍的严重程度。结果研究过程中未观察到严重的药物相关不良反应。在IBS-D患者中,美沙拉嗪+马来酸曲美布汀组经过4周治疗后,IBSSS总分由基线时的(194.5±62.6)分下降至(136.3±47.2)分(P0.000 1),而马来酸曲美布汀单药组则由治疗前的(207.3±49.2)分下降至治疗后的(197.5±47.8)分(P=0.01);在IBS-C患者中,美沙拉嗪+马来酸曲美布汀组经过4周治疗后,IBSSS总分由基线时的(245.8±70.4)分下降至(231.3±65.0)分(P=0.005)。基线状态时,IBS患者组的焦虑和(或)抑郁评分均高于健康对照组(P0.000 1)。在IBS-D患者中,美沙拉嗪+马来酸曲美布汀组经过4周治疗后,焦虑和抑郁评分分别由基线时的(11.9±4.1)分下降至(11.3±4.1)分(P=0.019)、(13.6±4.7)分下降至(12.5±4.5)分(P=0.002 6)。结论美沙拉嗪联合马来酸曲美布汀治疗可改善IBS患者,尤其是IBS-D患者的临床症状和精神心理障碍。     

Association Between Patient-Reported Medication Adherence and Anticoagulation Control

Background

The prevention of thromboembolism events remains challenging in cases of poor medication adherence. Unfortunately, clinical prediction of future adherence has been suboptimal. The objective of this study was to examine the correlation between 2 measures of real-time, self-reported adherence and anticoagulation control.

Comparison of the psychosocial quality of life in hemodialysis patients between the elderly and non‐elderly using a visual analogue scale: The importance of appetite and depressive mood

Aim: The number of hemodialysis (HD) patients is increasing along with their mean age in Japan. The assessment of their psychosocial status and quality of life (QOL) is therefore becoming more and more important along with laboratory data or comorbidities. Methods: We examined the psychosocial status of 211 HD patients (72 elderly and 139 non‐elderly) and compared the difference between elderly and non‐elderly patients using a visual analogue scale (VAS). We then examined how QOL affected mortality rate in 3‐year prospective follow up. We assessed 10 items of QOL: health condition, appetite, sleep, mood, memory, family relationships, friendship, economical status, life satisfaction in daily life, and happiness with qualified self‐evaluating questionnaires along with laboratory data and comorbidities. Furthermore, we investigated the correlation between the scores of mood and geriatric depression scale (GDS)‐15. Results: There was no difference in VAS scores between elderly and non‐elderly patients. Lower VAS scores for appetite and mood correlated with higher mortality in HD patients, especially in the non‐elderly. VAS scores for mood correlated with GDS‐15 in HD patients. Conclusions: More attention should be paid to appetite and the diagnosis and therapy of depressive mood to improve the prognosis of HD patients, especially for the non‐elderly. Geriatr Gerontol Int 2012; 12: 65–71.     

A cohort study for the derivation and validation of a clinical prediction scale for hospital-onset Clostridium difficile infection

OBJECTIVE:

To develop and validate a clinical prediction scale for hospital-onset Clostridium difficile infection (CDI).

METHODS:

A community-based, 360-bed hospital located in the suburbs of a metropolitan area in the United States served as the setting for the present retrospective cohort study. The cohort consisted of patients admitted to the adult medical service over a six-year period from October 2005 to September 2011. The cohort was divided into derivation (October 2005 to September 2009) and validation (October 2009 to September 2011) groups. The primary outcome measure was hospital-onset CDIs identified as stool positive for C difficile after 48 h of hospital admission ordered for new-onset unformed stool by the treating physician.

RESULTS:

In the derivation phase, 35,588 patients were admitted to the medical service and 21,541 stayed in hospital beyond 48 h. A total of 266 cases of CDI were identified, 121 of which were hospital onset. The developed clinical prediction scale included the onset of unformed stool (5 points), length of hospital stay beyond seven days (4 points), age >65 years (3 points), long-term care facility residence (2 points), high-risk antibiotic use (1 point) and hypoalbuminemia (1 point). The scale had an area under the receiver operating curve (AUC) of 0.93 (95% CI 0.82 to 0.94) in predicting hospital-onset CDI, with a sensitivity of 0.94 (95% CI 0.88 to 0.97) and a specificity of 0.80 (95% CI 0.79 to 0.80) at a cut-off score of 9 on the scale. During the validation phase, 16,477 patients were admitted, of whom 10,793 stayed beyond 48 h and 58 acquired CDI during hospitalization. The predictive performance of the score was maintained in the validation cohort (AUC 0.95 [95% CI 0.93 to 0.96]) and the goodness-to-fit model demonstrated good calibration.

CONCLUSION:

The authors developed and validated a simple clinical prediction scale for hospital-onset CDI. This score can be used for periodical evaluation of hospitalized patients for early initiation of contact precautions and empirical treatment once it is validated externally in a prospective manner.     

594例轻度慢性乙型肝炎中医证候分布规律调查研究

目的:探讨轻度慢性乙型肝炎(CHB)患者的中医证候分布规律,为规范化治疗CHB提供参考依据.方法:运用中医证候量表对594例轻度CHB患者进行中医证候调查,采用聚类分析的方法对纳入的患者进行聚类,并结合变量频数分析对证型归属进行判定.结果:收集的轻度CHB病例均以肝郁脾虚为主要证型,在此基础上合并有6个兼证,分别为肝郁脾虚兼湿热阴虚血瘀证型(62.80％)、肝郁脾虚兼肝肾阴虚证型(24.24％)、肝郁脾虚兼肝郁化火证型(5.05％)、肝郁脾虚兼肝胃不和证型(3.70％)、肝郁脾虚兼中气亏虚证型(2.53％)和肝郁脾虚兼瘀血阻络证型(1.68％).肝郁脾虚兼湿热阴虚血瘀证型又进一步分为5个亚型,分别为脾虚为主型(45.30％)、普通型(22.52％)、气滞为主型(17.70％)、湿热为主型(10.46％)、肾虚为主型(4.02％).结论:肝都脾虚证型为轻度CHB的基本证型.     

天智颗粒联合丁苯酞治疗血管性认知障碍的对照研究

目的:观察天智颗粒联合丁苯酞对血管性认知障碍(VCI)患者的治疗作用。方法:VCI患者90例,随机分为联合治疗组、天智颗粒组及对照组各30例。联合治疗组给予天智颗粒与丁苯酞联合治疗,天智颗粒组仅给予天智颗粒,对照组不使用改善认知功能的药物,均治疗30d。3组患者分别在治疗前及治疗1、2月后进行蒙特利尔认知(MoCA)量表测评。结果:治疗1、2个月后,联合治疗组的MoCA评分及视空间与执行功能、注意力、延迟回忆、定向力等子项目的改善优于天智颗粒组(P<0.05)。结论:天智颗粒和丁苯酞联合治疗对VCI患者的认知功能有较好的改善作用,且对MoCA评分各主要子项目都有较好的改善作用。