盘点:2017年9月2日刊BMJ研究精选

2017-09-04 zhangfan MedSci原创

BMJ

2017年9月2日刊BMJ研究精选



【1】母乳喂养可降低子宫内膜异位风险


10%美国妇女患有子宫内膜异位症。近日研究人员考察了母乳喂养与子宫内膜异位症之间的关系。研究人员发现,母乳喂养的总体时间以及纯母乳喂养时间和子宫内膜异位症的风险降低显著相关。研究发现母乳喂养不足一个月的女性中,每10万人中有453例子宫内膜异位症患者,而母乳喂养超过36个月的女性中,每10万人中有184例子宫内膜异位症患者。母乳喂养时间每增加三个月,女性子宫内膜异位症风险就会降低8%。每次怀孕都纯母乳喂养的时间每增加三个月,女性子宫内膜异位症风险就会降低14%。与从未母乳喂养的女性相比,母乳喂养总体时间超过36个月的女性子宫内膜异位症的发生率降低40%。母乳喂养的保护性效果在分娩5年内最为显著(P = 0.04)。母乳喂养或纯母乳喂养和子宫内膜异位症之间的关联部分受产后闭经的影响。

【2】教育年限延长可降低冠心病风险


近日研究人员发现,教育事件延长可降低心脏疾病有关风险,即教育年限越长,冠心病风险越低。研究人员利用孟德尔随机化模型对与多年教育有关的162种遗传变异进行了研究,涉及543733名参与者。研究发现,教育年限延长3.6年,冠心病风险降低1/3。教育年限延长可降低吸烟率,体重指数(BMI)并改善血脂状况。

【3】疫苗接种与幼儿感染入院


近日研究人员对麻疹、腮腺炎和风疹疫苗(MMR)的积极非特异性效应进行了研究,并比较了接种活MMR疫苗或灭活白喉、破伤风、百日咳、脊髓灰质炎、b型流感嗜血杆菌疫苗(DTaP-IPV-Hib)后2岁以下幼儿感染住院率的差异。共1096594名幼儿参与了本次研究,研究发现,最近接种MMR或C性脑膜炎球菌疫苗的幼儿,其感染入院风险为0.62,损伤或副作用入院风险为0.84,其风险高于新近接种4联DTaP-IPV-Hib以及肺炎球菌(PCV)的幼儿;新近接种4联DTaP-IPV-Hib+PCV的幼儿其感染入院的风险为0.69,高于接种第3次4联疫苗的幼儿。

【4】阿片类药物便秘的治疗原则


阿片类药物通常用于癌症止痛。据报道52%的晚期癌症和87%末期疾病患者受到阿片类药物引发的便秘的影响。癌症患者便秘往往是多因素的,阿片类药物可能是一个原因,在服用药物后,阿片类药物引起肠道习惯改变导致便秘,其症状包括排便频率降低,排便张率改变,直肠排空感异常或大便一致性变化。研究发现阿片类药物通过阿片受体导致便秘,在某些情况下应限制阿片类药物的使用。

阿片类药物便秘的治疗原则:

1、阿片类药物治疗开始后应给予患者缓泻药以预防便秘的发生;

2、如便秘加重或和泻药不响应,应考虑使用外周μ-阿片受体拮抗剂;

3、便秘治疗药物的选择应缓解阿片类药物对肠道的影响而不影响阿片类药物的镇痛作用。

【5】难治性哮喘及其治疗建议


高剂量药物仍不能有效控制的严重成人哮喘对临床医生和病人均是严重的挑战。治疗指南建议对于难治哮喘患者应采取强化治疗,通常为口服皮质类固醇激素。长期全身糖皮质激素治疗对于患者而言是极具风险,近日研究人员总结了应对难治性哮喘的临床建议:

1、全英国每年约1000人死于哮喘;

2、医患双方应共同确立治疗目标,并对哮喘治疗方案达成一致;

3、难治性哮喘患者需多个科室联合行动;

4、密切关注哮喘误诊患者,排除其他潜在疾病;

5、口服皮质类固醇是治疗重度哮喘的主要方法,对大部分患者有效,但皮质类固醇应采取最低维持剂量。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1848374, encodeId=0e8118483e436, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, 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 Jan 28 01:29:00 CST 2018, time=2018-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244921, encodeId=9a5724492176, content=学习了先进的技术水平, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Sun Sep 17 08:21:13 CST 2017, time=2017-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240980, encodeId=faf1240980ab, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK1ZqsYk10AC3I1qCTSOOLGsb7hc2dljeUTjrMkicga7YWNj4MnLgU5QyIsglfeD4h3fHO9dCh3uw/0, createdBy=1c1f1694537, createdName=waixiangren, createdTime=Wed Sep 06 08:50:41 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240419, encodeId=f6c62404194a, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Sep 04 17:10:59 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240412, encodeId=ff8024041268, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=550d2008262, createdName=luominglian113, createdTime=Mon Sep 04 16:30:17 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240411, encodeId=6f8d24041198, content=很多研究结果很实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151005/IMG5612955936CFA7964.jpg, createdBy=18621654109, createdName=Guoxj3234, createdTime=Mon Sep 04 16:28:34 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240410, encodeId=6d032404109f, content=学习咯, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/y6Sk2KiaDibWSs0icexcRzKWXKao9dILdyaB6olvWApA1uiaapa4T9XMiaU7hTZA04uj2iavabfdCT5iaO6AYue5qSJ7MzXaAVSqh6j/0, createdBy=08e01983553, createdName=执迷不悔, createdTime=Mon Sep 04 16:25:04 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2018-01-28 gaoxiaoe
  2. [GetPortalCommentsPageByObjectIdResponse(id=1848374, encodeId=0e8118483e436, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, 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 Jan 28 01:29:00 CST 2018, time=2018-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244921, encodeId=9a5724492176, content=学习了先进的技术水平, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Sun Sep 17 08:21:13 CST 2017, time=2017-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240980, encodeId=faf1240980ab, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK1ZqsYk10AC3I1qCTSOOLGsb7hc2dljeUTjrMkicga7YWNj4MnLgU5QyIsglfeD4h3fHO9dCh3uw/0, createdBy=1c1f1694537, createdName=waixiangren, createdTime=Wed Sep 06 08:50:41 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240419, encodeId=f6c62404194a, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Sep 04 17:10:59 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240412, encodeId=ff8024041268, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=550d2008262, createdName=luominglian113, createdTime=Mon Sep 04 16:30:17 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240411, encodeId=6f8d24041198, content=很多研究结果很实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151005/IMG5612955936CFA7964.jpg, createdBy=18621654109, createdName=Guoxj3234, createdTime=Mon Sep 04 16:28:34 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240410, encodeId=6d032404109f, content=学习咯, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/y6Sk2KiaDibWSs0icexcRzKWXKao9dILdyaB6olvWApA1uiaapa4T9XMiaU7hTZA04uj2iavabfdCT5iaO6AYue5qSJ7MzXaAVSqh6j/0, createdBy=08e01983553, createdName=执迷不悔, createdTime=Mon Sep 04 16:25:04 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-17 雅文博武

    学习了先进的技术水平

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1848374, encodeId=0e8118483e436, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, 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 Jan 28 01:29:00 CST 2018, time=2018-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244921, encodeId=9a5724492176, content=学习了先进的技术水平, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Sun Sep 17 08:21:13 CST 2017, time=2017-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240980, encodeId=faf1240980ab, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK1ZqsYk10AC3I1qCTSOOLGsb7hc2dljeUTjrMkicga7YWNj4MnLgU5QyIsglfeD4h3fHO9dCh3uw/0, createdBy=1c1f1694537, createdName=waixiangren, createdTime=Wed Sep 06 08:50:41 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240419, encodeId=f6c62404194a, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Sep 04 17:10:59 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240412, encodeId=ff8024041268, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=550d2008262, createdName=luominglian113, createdTime=Mon Sep 04 16:30:17 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240411, encodeId=6f8d24041198, content=很多研究结果很实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151005/IMG5612955936CFA7964.jpg, createdBy=18621654109, createdName=Guoxj3234, createdTime=Mon Sep 04 16:28:34 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240410, encodeId=6d032404109f, content=学习咯, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/y6Sk2KiaDibWSs0icexcRzKWXKao9dILdyaB6olvWApA1uiaapa4T9XMiaU7hTZA04uj2iavabfdCT5iaO6AYue5qSJ7MzXaAVSqh6j/0, createdBy=08e01983553, createdName=执迷不悔, createdTime=Mon Sep 04 16:25:04 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-06 waixiangren

    学习了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1848374, encodeId=0e8118483e436, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, 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 Jan 28 01:29:00 CST 2018, time=2018-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244921, encodeId=9a5724492176, content=学习了先进的技术水平, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161027/IMG58114E1818EA51495.jpg, createdBy=4b2c1959822, createdName=雅文博武, createdTime=Sun Sep 17 08:21:13 CST 2017, time=2017-09-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240980, encodeId=faf1240980ab, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK1ZqsYk10AC3I1qCTSOOLGsb7hc2dljeUTjrMkicga7YWNj4MnLgU5QyIsglfeD4h3fHO9dCh3uw/0, createdBy=1c1f1694537, createdName=waixiangren, createdTime=Wed Sep 06 08:50:41 CST 2017, time=2017-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240419, encodeId=f6c62404194a, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Sep 04 17:10:59 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240412, encodeId=ff8024041268, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=550d2008262, createdName=luominglian113, createdTime=Mon Sep 04 16:30:17 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240411, encodeId=6f8d24041198, content=很多研究结果很实用, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151005/IMG5612955936CFA7964.jpg, createdBy=18621654109, createdName=Guoxj3234, createdTime=Mon Sep 04 16:28:34 CST 2017, time=2017-09-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=240410, encodeId=6d032404109f, content=学习咯, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/y6Sk2KiaDibWSs0icexcRzKWXKao9dILdyaB6olvWApA1uiaapa4T9XMiaU7hTZA04uj2iavabfdCT5iaO6AYue5qSJ7MzXaAVSqh6j/0, createdBy=08e01983553, createdName=执迷不悔, createdTime=Mon Sep 04 16:25:04 CST 2017, time=2017-09-04, status=1, ipAttribution=)]
    2017-09-04 天涯183

    非常好的文章.学习了

    0

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    2017-09-04 luominglian113

    学习了.谢谢分享

    0

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    2017-09-04 Guoxj3234

    很多研究结果很实用

    0

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    2017-09-04 执迷不悔

    学习咯

    0

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