% the difference was not significant χ 2 = P = The sensitivity of TBI < 0. 7 diagnosing LEAD was 81. 8% 63 /77 specificity 71.

Size: px

Start display at page:

Download "1951 18. 3% the difference was not significant χ 2 = 0. 44 P = 0. 51. The sensitivity of TBI < 0. 7 diagnosing LEAD was 81. 8% 63 /77 specificity 71."

骥赫萧
7 years ago
Views:

1 1950 王莉, 杨彩哲, 王良宸, 关小宏, 张妲, 陈莹, 王敏 TBI LEAD TBI TBI TBI TBI < 0. 7 L - TBI TBI TBI 0. 7 N - TBI BMI TC LDL - C HDL - C TG FIB HbA 1c 0. 9 LEAD TBI < 0. 7 LEAD Kappa TBI N - TBI 138 L - TBI 127 FIB P < L - TBI 121 N - TBI 137 L - TBI TC LDL - C N - TBI P < L - TBI 120 HbA 1c % N - TBI 131 HbA 1c % HbA 1c χ 2 = P = TBI < 0. 7 LEAD 81. 8% 63 / % 313 / % 63 / % 313 /327 TBI Kappa TBI LEAD TBI TBI LEAD R A doi /j. issn J www. chinagp. net Toe - branchial Index Values in Diagnosis of Lower Extremity Arterial Diseases of Early DM zhe WANG Liang - chen et al. Hebei North Unviersity Zhangjiakou China WANG Li YANG Cai - Abstract Objective To investigate the values of toe - brachial index TBI in diagnosis of lower extremity arterial disease LEAD in patients with early diabetes mellitus DM. Methods A total of 265 T2DM patients hospitalized in department of endocrinology Air Force General Hospital from June 2012 to August 2013 had ankle branchial index and TBI measurement and were divided according to TBI scores into groups low TBI L - TBI group TBI < normal TBI N - TBI group TBI The general information and clinical indicators including gender age BMI duration diabetes smoking history complications and comorbidities hypertension coronary heart disease CHD cerebrovascular diseases CVD diabetic foot DF total cholesterol TC low density lipoprotein cholesterol LDL - C high density lipoprotein cholesterol HDL - C triglycerides TG fibrinogen FIB glycated hemoglobin HbA 1c were collected and diabetes control rate was analyzed was taken as the gold standard for LEAD to evaluate the related indicators of TBI < diagnosing LEAD sensitivity specificity positive predictive value negative predictive value positive likelihood ratio negative likelihood ratio. Kappa test was used to assess the consistency between TBI. Results There were 138 patients in N - TBI group 127 in L - TBI group. There was significant difference in age duration of diabetes incidences of hypertension CHD DF and CVD FIB between 2 groups P < Serum lipid parameters were measured in 121 of L - TBI group in 137 of N - TBI group. The control rates of TC LDL - C were higher in L - TBI group than in N - TBI group P < HbA 1c was detected in 120 of L - TBI group 26 reached the goal 21. 7% and in 131 of N - TBI group 24 reached the goal E - mail yangcaizhe2008@ 163. com

51 TBI < 0. 7 LEAD 81. 8% 63 /77 71. 5% 313 /438 33. 5% 63 /188 95. 7% 313 /327 TBI Kappa 0. 337TBI LEAD TBI TBI LEAD R 587. 1 A doi 10. 3969 /j. issn. 1007-9572. 2014. 17. 007. J.

2 % the difference was not significant χ 2 = P = The sensitivity of TBI < 0. 7 diagnosing LEAD was 81. 8% 63 /77 specificity 71. 5% 313 /438 the positive predictive value was 33. 5% 63 /188 and the negative was 95. 7% 313 /327. In consistence test between TBI the Kappa value was Conclusion TBI is a sensitive index for LEAD in early stage in DM patients. TBI and do not have good consistency and can not fully substitute for each other so TBI should be routinelymeasured in diabetic patients for early diagnosis of LEAD but not as a supplement to check the abnormal increase of. Key words Diabetes mellitus Lower extremity arterial disease Toe - brachial index Ankle - brachial index lower extremity arterial disease LEAD diabetes mellitus DM TC LDL - HDL - C TG DM FIB HbA 1c 12% TBI perpetual arterial disease PAD 1 DM BP - 203RPEⅢ TBI DM ~ 15 min LEAD diabetic foot DF DF ankle - brachial index LEAD TBI / TBI / DM LEAD > LEAD LEAD 4 TBI < TBI TBI 0. 7 > / TBI N - TBI TBI < 0. 7 ACCF /AHA > 1. 4 TBI L - TBI toe - brachial index 5 - TBI Brooks 9 LDL - C TC TG HDL - C 2 HbA 1c < DM TBI 7. 0% LDL - C < 2. 6 mmol /L TBI TBI LDL - C < 1. 8 mmol /L TC < TBI 4. 5 mmol /L TG < 1. 5 mmol /L HDL - C DM TBI > 1. 0 mmol /L HDL - C > 1. 3 mmol /L 0. 9 LEAD 2 = DM TBI TBI LEAD / LEAD x ± s t TBI 2 DM ~ ± DM ± WHO DM 1 DM P < DM 3 DM N - TBI 138 L - TBI DF FIB BMI DM P < DF 2 ~ 3 cm DM 1 HbA 1c 1. 3 SPSS M QR χ LEAD TBI < 0. 7 LEAD DM

TBI and do not have good consistency and can not fully substitute for each other so TBI should be routinelymeasured in diabetic patients for early diagnosis of LEAD but not as a supplement to check

3 1952 / Table 1 1 Comparison of general information between the two groups BMI DM kg /m 2 M QR n % n % n % DF n % FIB n % g /L N - TBI / ± ± ± 0. 8 L - TBI / ± ± ± * * * * * * P < < < * χ 2 t Z BMI = DM = DF = FIB = 2. 2 DM L - TBI / % 63 /188 N - TBI 137 L % 313 / TBI TC TG LDL - C N - TBI P < L - TBI 120 HbA 1c % N - TBI 131 HbA 1c % HbA 1c χ 2 = P = Table 2 2 n % Comparison of standard reaching rate between the two groups TC TG LDL - C HDL - C N - TBI L - TBI χ P < < FIB TC = TG = LDL - C = HDL - C = 2. 3 TBI 265 TBI TBI / DM TBI TBI DM TBI 3 Table 3 3 TBI The distribution of TBI in different levels of 0. 9 > 0. 9 ~ 1. 3 > 1. 3 TBI < = TBI = 2. 4 TBI LEAD TG LDL LEAD > 1. 3 TBI < 0. 7 LEAD 81. 8% 63 / % TBI Kappa Table 4 4 TBI LEAD The diagnostic value of TBI for LEAD TBI N - TBI L - TBI DM DF DM TBI DM TBI LEAD 2 Aso LEAD % 13 DF DM LEAD TBI N - TBI L - TBI FIB FIB FIB Chou 19 TG TC LDL L - TBI TC TG LDL - C

68 * 4. 64 * 24. 68 * 3. 21 * - 3. 65 P 0. 47 < 0. 01 0. 08 0. 00 0. 21 0. 00 0. 03 < 0. 01 0. 07 < 0. 01 * χ 2 t Z BMI = DM = DF = FIB = 2. 2 DM L - TBI 121 313 /438 33.

4 1953 N - TBI FIB DM TBI LEAD DF TBI 28. 5% 125 / < 1. 3 TBI LEAD 1 Azam SM Carman TL. Diagnostic approach to peripheral arterial dis- 20 ease J. Cardiol Clin TBI DM 6% Bundó 21 TBI 11. 7% 2013 TBI DF TBI 2011 ACCF /AHA J TBI < Bundó 21 4 Potier L Halbron M Bouilloud F et al. Ankle - to - brachial ratio TBI < 0. 6 index underestimates the prevalence of peripheral occlusive disease in diabetic patients at high risk for arterial disease J. Diabetes Care TBI e44. LEAD LEAD 5 Norgren L Hiatt WR Dormandy JA et al. Inter - Society Consensus for the Management of Peripheral Arterial Disease TASC J. Eur J DF DF Vasc Endovasc Surg Suppl 1 S1 - S75. LEAD 6 Rooke TW Hirsch AT Misra S et al ACCF /AHA Focused LEAD Update of the Guideline for the Management of Patients With Peripheral 22 Artery Disease Updating the 2005 Guideline a report of the American College of Cardiology Foundation / AmericanHeart Association Task DM LEAD DF Force on Practice Guidelines J. J Am Coll Cardiol Hirsch AT Haskal ZJ Hertzer NR et al. ACC /AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease LEAD DM lower extremity renal mesenteric and abdom - inal aortic a collaborative report from the American Association for Vascular Surgery / So- LEAD 4 ciety for Vascular Surgery Society for Cardiovascular Angiography and LEAD Interventions Society for Vascular Medicine and Biology Society of Interventional Radiology and the ACC /AHA Task Force on Practice TBI LEAD TBI DM LEAD Guidelines Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease endorsed by the A LEAD TBI < 0. 7 LEAD 81. 8% merican Assoc - iation of Cardiovascular and Pulmonary Rehabilitation 71. 5% National Heart Lung and Blood Institute Society for Vascular Nursing TransAtlantic Inter - Society Consensus and Vascular Disease Foundation J. Circulation e463 - e654. DM 8. 2 TBI < 0. 7 LEAD J % 71. 5% TBI < 0. 7 LEAD 9 Brooks B Dean R Patel S et al. TBI or not TBI that is the question. Is it better to measure toe pressure than ankle pressure in diabetic TBI Kappa TBI patients J. Diabet Med DM TBI M M LEAD DF 11 Aso Y Okumura K Inoue T et al. Results of blood inflammatory LEAD markers are associated more strongly with toe - brachial index than with LEAD TBI LEAD ankle - brachial index in patients with type 2 diabetes J. Diabetes TBI Care

6 index underestimates the prevalence of peripheral occlusive disease in diabetic patients at high risk for arterial disease J. Diabetes Care TBI 2009 32 4 e44.

5 1954 J Steg PG Bhatt DL Wilson PW et al. One - year cardiovascular e- vent rates in outpatients with atherosclerosis J. JAMA nontraditional risk factors for peripheral arterial disease in elderly type diabetic patients in Taiwan J. Diabetes Research and Clinical Practice J Green D Foiles N Chan C et al. Elevated fibrinogen levels and TBI subsequent subclinical atherosclerosis the CARDIA Study J. Atherosclerosis Sabeti S Exner M Mlekusch W et al. Prognostic impact of fibrinogen in carotid atherosclerosis nonspecific indicator of inflammation or independent predictor of disease progression J. Stroke Rosero EB Kane K Clagett GP et al. A systematic review of the limitation and approaches to improve detection and management of peripheral arterial disease in hispanics J. J Vasc Surg Suppl 27S - 35S J Chou CK Weng SW Chang HW et al. Analysis of traditional and J Bundó M Urrea M Mu oz L et al. Correlation between toe - brachial index and ankle - brachial index in patients with diabetes mellitus type 2 J. Medicina Clinica Hirsch AT Criqui MH Treat - Jacobson D et al. Peripheral arterial disease detection awareness and treatment in primary care J. JAMA WONCA 癌症晚期患者在家中临终前的症状及其难以忍受的程度与性质 : 基层医疗研究展望基层医生可以在家中为癌症患者提供以缓解症状为目的的医疗服务以荷兰为例, 在家去世的癌症患者 ( 占全部癌症患者的 45% ) 大约每 7 人中就有 1 人在离世过程中表现出难以忍受的痛苦本试验将从接受基层医疗服务的临终癌症患者的常见症状分布, 症状及其难以忍受程度的强弱随病程进展的变化情况及其性质之间的关系两个方面展开研究 44 名全科医生 3 年中不断选取预期寿命 < 6 个月的癌症患者根据痛苦状况 - V ( SOS - V), 每隔 2 个月对 69 种症状在选取患者中表现出的强弱及难以忍受程度进行量化同样按照 5 分评价的方法从 1 分 ( 一点不痛苦 ) 到 5 分 ( 不能更痛苦 ), 对总体症状难以忍受的程度也进行量化对于评估为难以忍受程度的症状, 应采用开放式提问的方法, 进一步调查因该症状使患者所遭受痛苦的性质对最终的访谈材料进行分析, 且为把握病情纵向演进过程, 也要对之前的访谈材料进行分析症状强弱程度评分达到 4 分和 5 分, 则判断为高强度 ; 症状难以忍受程度评分达到 4 分和 5 分, 则判断为痛苦难以忍受通过上述两项评价指标, 对症状难以忍受的情况进行分类定性描述 148 例受邀患者中有 51% 接受并参加了试验, 其中死亡前一直接受随访的有 64 例截止到死亡前 30 d 时,60 例患者至少接受过 1 次 SOS - V 调查,33 例患者至少接受过 2 次 SOS - V 调查脆弱感是出现频率最高的难以忍受的症状 ( 占 57% ) 在 25% 的患者中, 疼痛成为难以忍受的症状症状强度较高时, 疼痛失去对生活的控制, 以及对未来病痛折磨的恐惧常常成为难以忍受的症状 ( 占 89% ~ 92% ) 症状强度较低时, 失去对生活的控制呕吐, 以及重要事务不能自理常常成为难以忍受的症状 ( 占 52% ~ 80% ) 截至死亡前的连续访谈材料显示 : 感到脆弱的症状, 难以忍受程度随时间的推移显著升高整体上觉得症状难以忍受的患者, 往往更易表现出躯体症状, 感觉生活缺乏意义不能自主, 觉得自己成了负担, 对将来的病痛折磨感到恐惧, 并显得焦虑不安在接受基层医疗服务的临终癌症患者中, 脆弱感是最常见的难以忍受的症状整体上觉得症状难以忍受的患者, 往往更易表现出躯体症状, 感觉生活缺乏意义不能自主原文见 : Ruijs CD,Kerkhof AJ,van der Wal G,et al. Symptoms,unbearability and the nature of suffering in terminal cancer patients dying at home: a prospective primary care study [J]. BMC Family Practice,2013,14: 201. doi: / Published at: http: / / www. biomedcentral. com / /14 /201 ( 中国石油天然气集团公司中心医院周淑新译 )

15 Green D Foiles N Chan C et al. Elevated fibrinogen levels and 20. 2 TBI subsequent subclinical atherosclerosis the CARDIA Study J. Atherosclerosis 2009 202 2 623-631.

405 急性心肌梗死是临床较为常见的心血管疾病, 病情危急, 病死率高 [1] 随着经皮冠状动脉介入治疗 (percutaneous coronary intervention,pci) 技术在急性心肌梗死急诊

405 急性心肌梗死是临床较为常见的心血管疾病, 病情危急, 病死率高 [1] 随着经皮冠状动脉介入治疗 (percutaneous coronary intervention,pci) 技术在急性心肌梗死急诊 404 冠心舒通胶囊预防急性心肌梗死 PCI 术后再狭窄的临床研究李静, 王建榜, 王西辉西安医学院第二附属医院心内科, 陕西西安 710038 摘要 : 目的研究冠心舒通胶囊预防急性心肌梗死经皮冠状动脉介入治疗 (PCI) 术后再狭窄的临床