他汀类药物在糖尿病患者心血管事件一级预防中的新证据和新指南

大量的循证医学证据证实了他汀类药物的心血管事件二级预防作用。但是，他汀类药物在心血管事件一级预防中患者是否获益目前仍有争论。糖尿病本身是冠心病的等危症，无心血管疾病的糖尿病患者使用他汀类药物进行心血管事件一级预防应视为非糖尿病患者的二级预防。如此推论，糖尿病患者使用他汀类药物进行心血管事件一级预防应该获得肯定。临床真实情况是否如此？近期陆续发表的一些研究，用部分临床研究证据对其进行了初步的分析和探索。

Serological variation and risk factors of HCV in maintenance hemodialysis patients with 3-year of follow-up

Objective To investigate the serological variation and its risk factors of HCV infection in maintenance hemodialysis（MHD）patients. Methods A total of 184 MHD patients on Feb. 2009 were enrolled in this study. The total follow-up time was 3 years. The following data were collected ： age, gender, dialysis duration, blood transfusion and kidney transplantation, t test, X2 test and binary logistic regression analysis were performed for statistics. Results Among the 184 MHD patients,20 patients were HCV antibody positive. The prevalence of HCV infection in MHD patients were 10. 8%. Among of the 20 HCV-positive MHD patients,11 patients（55% ）were HCV antibody and HCV-RNA positive. There were no significant differences in age and gender between HCV-positive and HCV-negative MHD patients. There were significant differences in dialysis duration, blood transfusion and kidney transplantation between HCV-positive and HCV-negative MHD patients. Binary logistic regressive analysis revealed that blood transfusion and kidney transplantation were the independent risk factors of HCV infection in MHD patients. No new HCV infection in 3 years. 4（20% ） of the HCV-positive MHD were seronegative in 3-year follow-up. Conclusions The prevalence of HCV infection in MHD patients decreased was due to HCV being seronegative. Blood transfusion and kidney transplantation were the independent risk factors of HCV infection in MHD patients.