循证医学与临床试验透明化

1各种类型证据都有其特殊价值 循证医学主张一切临床决策都必须以当前最佳证据为依据，将临床医学实践过程归结为“五步法”模式，即①提出一个可解决的临床问题；②检索证据；③严格评价证据；④将证据应用于患者；⑤后效评价。     

初始腹膜透析患者铁代谢及其影响因素分析

探讨初次行腹膜透析(PD)的终末期肾病患者铁代谢和铁缺乏（ID）情况,分析其可能的影响因素。方法 纳入 2011年1月—2018年1月在四川大学华西医院初次行PD的患者633例,根据是否缺铁分为ID组（n=256）和Non-ID组（n=377）,采集开始透析后1～3月内初次行PD评估时的铁代谢指标、生化指标和透析指标等临床资料。对铁代谢指标血清铁蛋白（Fer）、转铁饱和度水平(TSAT)和不同ID情况进行分析,并通过相关分析和回归分析探索影响铁代谢指标的相关因素和独立影响因素。 结果 纳入患者平均Fer水平(277.9±278.1) μg/L,TSAT水平(29.9±12.9)%。41.0%患者存在相对性铁缺乏,15.5%绝对性铁缺乏(AID),7.9%功能性铁缺乏（FID）。Fer和TSAT达标率分别为50.7%和69.5%。Fer和TSAT均与性别相关,与血小板计数和炎症因子等负相关。血清铁蛋白还与糖尿病和使用EPO相关。多元线性回归分析显示女性、低血清白蛋白、低血小板计数和高敏C反应蛋白（hsCRP）是Fer水平降低的独立影响因素;低血小板计数、糖尿病和高白介素6（IL-6）是TSAT降低的独立影响因素。结论 初始腹膜透析患者中铁缺乏者并不少见。女性、血小板增多、糖尿病和炎症是铁储备或铁利用降低的独立影响因素。在腹膜透析初期即应针对可能的危险因素,制定合理的补充铁剂的治疗方案     

肾素-血管紧张素-醛固酮系统抑制剂相关联合用药策略的降压疗效及肾脏保护作用

<正>临床实践及病理观察均发现控制不良的高血压会导致慢性肾脏疾病(CKD)或加重既有CKD及糖尿病肾病(DKD)的肾脏损害[1-2]。大型荟萃分析及临床随机对照试验(RCT)结果提示不同降压药对降低心血管事件风险无差异[3]。结合不同降压药适用人群不同,CKD合并高血压没有首选降压药。但蛋     

Urgent Need to Improve the Quality of Case Report in Traditional Chinese Medicine: Assessment on Reporting Quality of 3,417 Cases

Objective

To survey the reporting quality of traditional Chinese medicine (TCM) case reports published in recent years and understand the common problems. The assessment results would lay the foundation for the development of recommendations for case report in Chinese medicine.

Methods

This survey determined the reporting quality of cases with Chinese herbal decoction, Chinese proprietary medicine, acupuncture, moxibustion and other traditional therapies published in 20 core medical journals of China by searching the China Academic Journals Full-text Database from 2006 to 2010. Fifty survey items in 16 domains were used to determine the reporting quality. One point was assigned to each item (Yes=1 point; No=0 point), and total score was 50 points. The domain of treatment was assessed independently, ranging from 2 to 9 items for different TCM interventions.

Results

The total of 1,858 case reports, covering 3,417 cases were included to analyze from 13 out of 20 core medical journals of China. There were 74.8% of them did not identify the nature of study in title, while 73.9% did not comprise an abstract. Incomplete reporting was found in discussions/ comment, and only 38.9% had made recommendations or take-away messages. Figures and tables were infrequently used. Three cases cited the full names of patients, but without declaring that any consent was obtained. Over 90% reported the symptoms and signs of TCM, and characteristics on tongue and pulse, but less than 50% did mention other medical history and diagnostic rationale. More than 90% treatments of the included cases were herbal decoction, with clear reporting on the ingredients and dosages. However, the reporting rate of the dosages of each ingredient was just 48.4%. Almost none reported the quality control of crude herbs, manufacturers and lot numbers of herbal proprietary medicine. Besides, advices and precautions on diet, emotions and living were rare to be illustrated.

Conclusion

Systematic reporting recommendations are urged to develop for improving the contents and format of case reports in TCM.

     

ct静脉血管成像在中心静脉导管功能障碍中的应用

目的 探讨多层CT静脉血管成像(multi-detector computed tomography venography,MDCTV)在中心静脉导管功能障碍评估中的应用价值.方法 中心静脉导管动能障碍但胸片及颈内静脉超声无异常发现的患者31例,行MDCTV观察导管走形、中心静脉狭窄、血栓形成、纤维蛋白鞘形成等.结果 MDCTV示导管位置异常10例,中心静脉狭窄5例,中心静脉血栓形成4例(2例伴有颈内静脉血栓形成),管周纤维鞘形成7例,无明显异常者5例.结论 MDCTV可有效评估中心静脉导管功能障碍,有临床推广价值.     

基于超声稀释法的血管通路监测在维持性血液透析患者血管通路维护中的临床应用

正随着血液透析技术的应用和提高,维持性血液透析(maintenance hemodialysis,MHD)患者的生存时间和生活质量得到很大提高。良好的血管通路功能是决定血液透析治疗成败的最重要因素之一[1]。血管通路的失功不仅会造成透析剂量不达标,并且带来很大的卫生经济学和生物学损失[2,3]。因此,如何监测和维护血管通路成为了临床关注的重要课题[4]。目前用于通路内流量测定的方法有超声稀释法[5,6](ultrasounddilu-     

大型三甲医院建立数据驱动的科研项目服务模式实践与探索

数据驱动的科研合作项目顺利有效开展是健康医疗大数据领域能够深入挖掘数据价值和科研水平不断发展的重要保障.作者从数据驱动的科研项目开展面临的突出问题出发,以四川大学华西医院华西生物医学大数据中心在服务数据科研项目的探索实践为例,总结出大型三甲医院建立数据驱动的科研项目基本服务流程和特色化的服务模式,旨在为医疗机构科研项目...     

肾素-血管紧张素-醛固酮系统抑制剂单用或联合钙通道阻滞剂治疗门诊慢性肾脏病疗效比较:基于倾向性评分匹配的队列研究

目的探讨肾素-血管紧张素-醛固酮系统(RAAS)阻滞剂联用钙通道阻滞剂(CCB)与单用RAAS阻滞剂在四川大学华西医院门诊慢性肾脏病(CKD)患者中控制血压、保护肾脏的作用。方法纳入2012年12月至2015年11月四川大学华西医院门诊123例CKD患者。采用倾向性评分匹配(propensity score matchin,PSM),比较匹配后31对患者用药方案开始1年后收缩压、舒张压、血肌酐、估算肾小球滤过率(e GFR)、尿蛋白定性及定量结果、随访期间入院及高钾血症发生情况。结果两种用药在控制血压、控制血肌酐和e GFR、控制尿蛋白的疗效、患者入院、发生高钾血症情况差异均无统计学意义。结论 RAAS受体阻滞剂联用CCB与RAAS受体阻滞剂单药超单倍剂量在血压控制、肾脏保护效果、患者入院、高钾血症发生情况上差异均无统计学意义。