盘点:2018年8月第2期BMJ研究精选

2018-08-22 zhangfan MedSci原创

BMJ

2018年8月第2期BMJ研究精选



【1】封面文章--NICE成人类风湿性关节炎诊断及治疗指南


类风湿关节炎是一种慢性、致残性自身免疫性疾病,其特征是大小关节滑膜炎,常伴有肿胀、僵硬、疼痛和渐进性关节损伤。在英国类风湿关节炎的发病率约1%,其中5%的类风湿关节炎患者为重症患者。女性的发病率是男性3倍,40-60岁为高风险人群。基础诊疗中,常常可以发现类风湿性关节炎的早期症状,包括关节疼痛和肿胀。早期患者接受专业治疗对实现早期缓解、预防或减少残疾是十分重要的。

近日NICE更新了成人类风湿性关节炎诊断及治疗指南,这是时隔9年后NICE再次公布成人类风湿性关节炎诊断及治疗指南。本次更新强调了类风湿性关节炎的治疗目标策略而不是特定的药物治疗方案,强调缓解或降低疾病活动作为治疗目标。初次治疗方案中,建议使用1种风湿性关节炎疾病治疗药物(DMARD),若效果不显著可首先考虑增加药物剂量,再考虑联合治疗,并且在开始一种新的常规合成DMARD治疗前,先考虑使用糖皮质激素短期桥接疗法,不建议初次治疗人群接受联合治疗。对于不受控制的疼痛或僵硬患者考虑口服非甾体类抗炎药(NSAIDs),NSAID使用原则为短期最低剂量,若患者同时服用质子泵抑制剂则需定期接受不良事件监测。指南中同时强调了超声技术在诊断和监测滑膜炎中的作用。

【2】美国不同种族中年人群死亡率变化趋势


近日研究人员就美国1999-2016年间不同种族和族裔群体中年人群(25-64岁)死亡率及其因素进行了考察。

研究发现,除非西班牙裔白人人群之外,中年群体全因死亡率持续上升,药物过量是最主要的死亡因素,酒精、自杀以及多系统器官疾病死亡率也不断上升。1999-2016年间,美洲印第安人和阿拉斯加土著人群12种致死因素发生率大幅增加,药物过量死亡率增加411.4%,高血压死亡率增加269.3%,肝癌死亡率增加115.1%,病毒性肝炎死亡率增加112.1%、神经系统死亡率增加99.8%。非西班牙裔黑人17种致死因素发生率大幅增加,药物过量(149.6%)、意外事件死亡(21.4%)、高血压病(15.5%)、肥胖(120.7%)和肝癌(49.5%)均是重要的死亡因素,同时非西班牙裔黑人酒精性肝病、慢性下呼吸道疾病、自杀、糖尿病胰腺癌的死亡率上升。西班牙裔人群12种致死因素发生率大幅增加,药物过量(80.0%)、高血压病(40.6%)、肝癌(41.8%)、自杀(21.9%)、肥胖(106.6%)、代谢紊乱(60.0%)是主要因素。亚洲和太平洋裔人群药物过量(300.6%)、酒精性肝病(62.9%)、高血压病(28.3%)以及脑癌(56.6%)是最主要的死亡因素。美国中年人群的自杀死亡率在2001年后增加了29.7%,女性药物过量死亡率高于男性。

【3】近年来发达国家平均寿命呈现下降趋势


近日研究人员就2014-16年间,18个发达国家平均寿命的变化情况及影响因素进行了考察。

研究发现,大部分高收入国家在2014-15年间平均寿命下降,18个成员国中,12个国家女性平均寿命下降,11个国家男性平均寿命下降,平均女性平均寿命下降0.21年,男性下降0.18年。平均寿命下降的国家中,65岁以上老年人群死亡率增加是主导因素,其中呼吸系统疾病、血管疾病、神经系统以及精神疾病是造成高龄人群死亡率上升的主要原因。在美国,0-65岁人群死亡率增加是平均寿命降低的主要因素,药物过量以及其他外部原因是主要驱动因素。

【4】2007-16年间美国阿片类药物使用情况研究


近日研究人员就2007-16年间美国阿片类药物处方率和每日剂量的变化趋势进行了考察。

总计4800万医保或商业保险受益人参与研究,包括所有商业保险受益人,65岁以上的医疗保险受益人以及65岁以下残疾医疗保险受益人,研究的主要终点为参保者阿片处方比例、每日平均剂量(以毫克吗啡当量计MME)以及长期阿片类药物使用事件比例。

研究发现,商业保险受益人、65岁以上的医疗保险受益人以及65岁以下残疾医疗保险受益人平均阿片处方率分别为14%、26%以及52%。商业保险受益人中阿片处方率自2011年后保持稳定,约6%,平均日剂量为17 MME。65岁以上的医疗保险受益人中,阿片处方率由11%上升至14%。65岁以下残疾医疗保险受益人阿片处方率以及剂量均最大,处方率为39%,日均剂量高达56NME。

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    2019-06-09 gaoxiaoe
  2. [GetPortalCommentsPageByObjectIdResponse(id=1848580, encodeId=44a21848580e8, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Jun 09 14:29:00 CST 2019, time=2019-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341147, encodeId=b08234114ecd, content=哈哈哈,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e1ee1608797, createdName=huangshang9812, createdTime=Mon Aug 27 14:21:11 CST 2018, time=2018-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340622, encodeId=f6c934062270, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://login.medsci.cn/upload/avatar/f3d88083d8829740786bed95c22464d1/e325f3af93bb747a620d16c209094d69.jpg, createdBy=9efb2014947, createdName=小小小麦兜, createdTime=Fri Aug 24 23:49:48 CST 2018, time=2018-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340287, encodeId=c08434028e8a, content=学习了谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Thu Aug 23 07:17:21 CST 2018, time=2018-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340234, encodeId=ef63340234c9, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Wed Aug 22 23:17:08 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-27 huangshang9812

    哈哈哈,学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1848580, encodeId=44a21848580e8, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Jun 09 14:29:00 CST 2019, time=2019-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341147, encodeId=b08234114ecd, content=哈哈哈,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e1ee1608797, createdName=huangshang9812, createdTime=Mon Aug 27 14:21:11 CST 2018, time=2018-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340622, encodeId=f6c934062270, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://login.medsci.cn/upload/avatar/f3d88083d8829740786bed95c22464d1/e325f3af93bb747a620d16c209094d69.jpg, createdBy=9efb2014947, createdName=小小小麦兜, createdTime=Fri Aug 24 23:49:48 CST 2018, time=2018-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340287, encodeId=c08434028e8a, content=学习了谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Thu Aug 23 07:17:21 CST 2018, time=2018-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340234, encodeId=ef63340234c9, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Wed Aug 22 23:17:08 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-24 小小小麦兜

    学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1848580, encodeId=44a21848580e8, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Sun Jun 09 14:29:00 CST 2019, time=2019-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=341147, encodeId=b08234114ecd, content=哈哈哈,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e1ee1608797, createdName=huangshang9812, createdTime=Mon Aug 27 14:21:11 CST 2018, time=2018-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340622, encodeId=f6c934062270, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://login.medsci.cn/upload/avatar/f3d88083d8829740786bed95c22464d1/e325f3af93bb747a620d16c209094d69.jpg, createdBy=9efb2014947, createdName=小小小麦兜, createdTime=Fri Aug 24 23:49:48 CST 2018, time=2018-08-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340287, encodeId=c08434028e8a, content=学习了谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Thu Aug 23 07:17:21 CST 2018, time=2018-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=340234, encodeId=ef63340234c9, content=学习了,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Wed Aug 22 23:17:08 CST 2018, time=2018-08-22, status=1, ipAttribution=)]
    2018-08-23 kafei

    学习了谢谢

    0

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    2018-08-22 惠映实验室

    学习了,谢谢分享。

    0

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