J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？

2022-06-10 吴星环球医学

2018年5月，美国学者在《J Am Heart Assoc》发表一项研究，考察血管紧张素转换酶抑制剂和血管紧张素受体阻断剂治疗老年缺血性卒中，使用率是否正确。

2018年5月，美国学者在《J Am Heart Assoc》发表一项研究，考察血管紧张素转换酶抑制剂和血管紧张素受体阻断剂治疗老年缺血性卒中，使用率是否正确。

背景：在新发缺血性卒中的老年（＞65岁）患者中，评估与肾素-血管紧张素系统拮抗剂、血管紧张素转换酶抑制剂和血管紧张素受体阻断剂（ACEI/ARBs）用于二级预防的较高使用率相关的影响，并根据慢性肾病（CKD）进行分层。

方法和结果：使用工具变量（IV）估计量，通过CKD状态评估ACEI/ARBs对生存率和肾脏风险的影响。工具基于ACEI/ARB使用的地区变异性。病历中摘取的数据用于评估工具估计量背后潜在的假设。CKD和非CKD患者中，卒中后ACEI/ARBs的使用率分别为45.9%和45.2%。不同实践模式下各地区ACEI/ARB使用率差异在CKD和非CKD患者中几乎相同。非CKD患者较高的ACEI/ARB使用率与较高的2年生存率相关，而CKD患者较高的ACEI/ARB使用率与较低的2年生存率相关。虽然CKD患者生存率的阴性估计值与零相比不具有统计学差异，但是显着低于非CKD患者的估计值。病历摘取数据的混杂因素与使用的工具变量不相关。

结论：对于合并和不合并CKD的老年缺血性卒中患者，较高的ACEI/ARB使用率具有不同的生存意义。由于较高的使用率与较高的2年生存率相关，因此ACEI/ARB在不合并CKD的缺血性卒中患者中使用不足。研究结论不能推广到合并CKD的缺血性卒中患者，这是由于较高的ACEI/ARB使用率与较低的2年生存率相关，而CKD患者的2年生存率比非CKD患者统计学显着性低。

原始出处：

Brooks JM， et al. Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers for Geriatric Ischemic Stroke Patients： Are the Rates Right？ J Am Heart Assoc. 2018 May 30；7(11). pii： e009137. doi： 10.1161/JAHA.118.009137.

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[GetPortalCommentsPageByObjectIdResponse(id=2290190, encodeId=b43422901908e, content=针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>在<a href='/topic/show?id=9c8c13291117' target=_blank style='color:#2F92EE;'>#老年缺血性卒中#</a>患者中的应用，尤其是针对合并和不合并<a href='/topic/show?id=4c861123089e' target=_blank style='color:#2F92EE;'>#慢性肾病（CKD）#</a>的二级<a href='/topic/show?id=6abc1002e726' target=_blank style='color:#2F92EE;'>#预防#</a>价值，临床意义突出。对于无<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的老年缺血性卒中患者，提高<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的患者，研究发现较高的<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对<a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a>（如蛋白尿、肾小球滤过率分级）与<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及<a href='/topic/show?id=b0e9132913cb' target=_blank style='color:#2F92EE;'>#卒中类型#</a>和<a href='/topic/show?id=200b1329148f' target=_blank style='color:#2F92EE;'>#病情严重度#</a>对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如<a href='/topic/show?id=9f0f853e927' target=_blank style='color:#2F92EE;'>#腔隙性卒中#</a>、<a href='/topic/show?id=b438132915d1' target=_blank style='color:#2F92EE;'>#大动脉粥样硬化卒中#</a>等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的<a href='/topic/show?id=58f1132916b7' target=_blank style='color:#2F92EE;'>#ACEI/ARB使用率#</a>和预后相关性进行补充分析，以增强本土临床指导价值。建议补充<a href='/topic/show?id=9401204912f' target=_blank style='color:#2F92EE;'>#不良反应#</a>和<a href='/topic/show?id=61888e8231b' target=_blank style='color:#2F92EE;'>#药物相互作用#</a>信息，尤其在合并多种慢性病的老年人群中，关注<a href='/topic/show?id=098b102e854e' target=_blank style='color:#2F92EE;'>#高钾血症#</a>、<a href='/topic/show?id=a9fc824e728' target=_blank style='color:#2F92EE;'>#肾功能变化#</a>、<a href='/topic/show?id=e0bb13291e44' target=_blank style='color:#2F92EE;'>#低血压风险#</a>等安全问题。关键词示例：<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a> <a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a> <a href='/topic/show?id=f6f5536422e' target=_blank style='color:#2F92EE;'>#慢性肾病#</a> <a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a> <a href='/topic/show?id=720d2401409' target=_blank style='color:#2F92EE;'>#二级预防#</a> <a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a> #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank 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针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注 #ACEI/ARB#在#老年缺血性卒中#患者中的应用，尤其是针对合并和不合并#慢性肾病（CKD）#的二级#预防#价值，临床意义突出。对于无 #CKD#的老年缺血性卒中患者，提高 #ACEI/ARB#应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并 #CKD#的患者，研究发现较高的 #ACEI/ARB#使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对#CKD分型#（如蛋白尿、肾小球滤过率分级）与 #ACEI/ARB#获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及#卒中类型#和#病情严重度#对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如#腔隙性卒中#、#大动脉粥样硬化卒中#等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的#ACEI/ARB使用率#和预后相关性进行补充分析，以增强本土临床指导价值。建议补充#不良反应#和#药物相互作用#信息，尤其在合并多种慢性病的老年人群中，关注#高钾血症#、#肾功能变化#、#低血压风险#等安全问题。关键词示例：#ACEI/ARB# #卒中# #慢性肾病# #生存率# #二级预防# #CKD分型# #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后 #ACEI/ARB#疗效的新证据，有助于促进精准用药，但后续研究需加强CKD亚型分层、卒中类型与多中心大样本验证。临床实践应结合个体特点、药物安全性综合评估后决策。

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[GetPortalCommentsPageByObjectIdResponse(id=2290190, encodeId=b43422901908e, content=针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>在<a href='/topic/show?id=9c8c13291117' target=_blank style='color:#2F92EE;'>#老年缺血性卒中#</a>患者中的应用，尤其是针对合并和不合并<a href='/topic/show?id=4c861123089e' target=_blank style='color:#2F92EE;'>#慢性肾病（CKD）#</a>的二级<a href='/topic/show?id=6abc1002e726' target=_blank style='color:#2F92EE;'>#预防#</a>价值，临床意义突出。对于无<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的老年缺血性卒中患者，提高<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的患者，研究发现较高的<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对<a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a>（如蛋白尿、肾小球滤过率分级）与<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及<a href='/topic/show?id=b0e9132913cb' target=_blank style='color:#2F92EE;'>#卒中类型#</a>和<a href='/topic/show?id=200b1329148f' target=_blank style='color:#2F92EE;'>#病情严重度#</a>对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如<a href='/topic/show?id=9f0f853e927' target=_blank style='color:#2F92EE;'>#腔隙性卒中#</a>、<a href='/topic/show?id=b438132915d1' target=_blank style='color:#2F92EE;'>#大动脉粥样硬化卒中#</a>等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的<a href='/topic/show?id=58f1132916b7' target=_blank style='color:#2F92EE;'>#ACEI/ARB使用率#</a>和预后相关性进行补充分析，以增强本土临床指导价值。建议补充<a href='/topic/show?id=9401204912f' target=_blank style='color:#2F92EE;'>#不良反应#</a>和<a href='/topic/show?id=61888e8231b' target=_blank style='color:#2F92EE;'>#药物相互作用#</a>信息，尤其在合并多种慢性病的老年人群中，关注<a href='/topic/show?id=098b102e854e' target=_blank style='color:#2F92EE;'>#高钾血症#</a>、<a href='/topic/show?id=a9fc824e728' target=_blank style='color:#2F92EE;'>#肾功能变化#</a>、<a href='/topic/show?id=e0bb13291e44' target=_blank style='color:#2F92EE;'>#低血压风险#</a>等安全问题。关键词示例：<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a> <a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a> <a href='/topic/show?id=f6f5536422e' target=_blank style='color:#2F92EE;'>#慢性肾病#</a> <a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a> <a href='/topic/show?id=720d2401409' target=_blank style='color:#2F92EE;'>#二级预防#</a> <a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a> #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>疗效的新证据，有助于促进精准用药，但后续研究需加强CKD亚型分层、卒中类型与多中心大样本验证。临床实践应结合个体特点、药物安全性综合评估后决策。, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1834, encryptionId=c3831834bc, topicName=ACEI/ARB), TopicDto(id=4790, encryptionId=8a934e90c5, topicName=CKD), TopicDto(id=20491, encryptionId=9401204912f, topicName=不良反应), TopicDto(id=24014, encryptionId=720d2401409, topicName=二级预防), TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中), TopicDto(id=53642, encryptionId=f6f5536422e, topicName=慢性肾病), TopicDto(id=69009, encryptionId=43706900963, topicName=生存率), TopicDto(id=82477, encryptionId=a9fc824e728, topicName=肾功能变化), TopicDto(id=85379, encryptionId=9f0f853e927, topicName=腔隙性卒中), TopicDto(id=87823, encryptionId=61888e8231b, topicName=药物相互作用), TopicDto(id=100277, encryptionId=6abc1002e726, topicName=预防), TopicDto(id=102785, encryptionId=098b102e854e, 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GetPortalCommentsPageByObjectIdResponse(id=1357928, encodeId=5a70135e928a1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=190, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563618, encodeId=fccf1563618d4, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=229, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615921, encodeId=f0131615921e8, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026124, encodeId=cca61026124c9, content=卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 10 01:34:00 CST 2018, time=2018-08-10, status=1, ipAttribution=)]
2018-09-29 guihongzh

#缺血性#

209 0 举报
[GetPortalCommentsPageByObjectIdResponse(id=2290190, encodeId=b43422901908e, content=针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>在<a href='/topic/show?id=9c8c13291117' target=_blank style='color:#2F92EE;'>#老年缺血性卒中#</a>患者中的应用，尤其是针对合并和不合并<a href='/topic/show?id=4c861123089e' target=_blank style='color:#2F92EE;'>#慢性肾病（CKD）#</a>的二级<a href='/topic/show?id=6abc1002e726' target=_blank style='color:#2F92EE;'>#预防#</a>价值，临床意义突出。对于无<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的老年缺血性卒中患者，提高<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的患者，研究发现较高的<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对<a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a>（如蛋白尿、肾小球滤过率分级）与<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及<a href='/topic/show?id=b0e9132913cb' target=_blank style='color:#2F92EE;'>#卒中类型#</a>和<a href='/topic/show?id=200b1329148f' target=_blank style='color:#2F92EE;'>#病情严重度#</a>对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如<a href='/topic/show?id=9f0f853e927' target=_blank style='color:#2F92EE;'>#腔隙性卒中#</a>、<a href='/topic/show?id=b438132915d1' target=_blank style='color:#2F92EE;'>#大动脉粥样硬化卒中#</a>等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的<a href='/topic/show?id=58f1132916b7' target=_blank style='color:#2F92EE;'>#ACEI/ARB使用率#</a>和预后相关性进行补充分析，以增强本土临床指导价值。建议补充<a href='/topic/show?id=9401204912f' target=_blank style='color:#2F92EE;'>#不良反应#</a>和<a href='/topic/show?id=61888e8231b' target=_blank style='color:#2F92EE;'>#药物相互作用#</a>信息，尤其在合并多种慢性病的老年人群中，关注<a href='/topic/show?id=098b102e854e' target=_blank style='color:#2F92EE;'>#高钾血症#</a>、<a href='/topic/show?id=a9fc824e728' target=_blank style='color:#2F92EE;'>#肾功能变化#</a>、<a href='/topic/show?id=e0bb13291e44' target=_blank style='color:#2F92EE;'>#低血压风险#</a>等安全问题。关键词示例：<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a> <a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a> <a href='/topic/show?id=f6f5536422e' target=_blank style='color:#2F92EE;'>#慢性肾病#</a> <a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a> <a href='/topic/show?id=720d2401409' target=_blank style='color:#2F92EE;'>#二级预防#</a> <a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a> #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>疗效的新证据，有助于促进精准用药，但后续研究需加强CKD亚型分层、卒中类型与多中心大样本验证。临床实践应结合个体特点、药物安全性综合评估后决策。, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1834, encryptionId=c3831834bc, topicName=ACEI/ARB), TopicDto(id=4790, encryptionId=8a934e90c5, topicName=CKD), TopicDto(id=20491, encryptionId=9401204912f, topicName=不良反应), TopicDto(id=24014, encryptionId=720d2401409, topicName=二级预防), TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中), TopicDto(id=53642, encryptionId=f6f5536422e, topicName=慢性肾病), TopicDto(id=69009, encryptionId=43706900963, topicName=生存率), TopicDto(id=82477, encryptionId=a9fc824e728, topicName=肾功能变化), TopicDto(id=85379, encryptionId=9f0f853e927, topicName=腔隙性卒中), TopicDto(id=87823, encryptionId=61888e8231b, topicName=药物相互作用), TopicDto(id=100277, encryptionId=6abc1002e726, topicName=预防), TopicDto(id=102785, encryptionId=098b102e854e, 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style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Sat Sep 29 23:34:00 CST 2018, time=2018-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1656109, encodeId=8e7d1656109ee, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=275, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Fri Nov 30 16:34:00 CST 2018, time=2018-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806262, encodeId=2798180626257, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Feb 14 15:34:00 CST 2019, time=2019-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339346, encodeId=ac11339346e5, content=不错耶，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sat Aug 18 13:04:54 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357928, encodeId=5a70135e928a1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=190, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563618, encodeId=fccf1563618d4, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=229, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615921, encodeId=f0131615921e8, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026124, encodeId=cca61026124c9, content=卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 10 01:34:00 CST 2018, time=2018-08-10, status=1, ipAttribution=)]
2018-11-30 shanyongle

#ACE#

275 0 举报
[GetPortalCommentsPageByObjectIdResponse(id=2290190, encodeId=b43422901908e, content=针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>在<a href='/topic/show?id=9c8c13291117' target=_blank style='color:#2F92EE;'>#老年缺血性卒中#</a>患者中的应用，尤其是针对合并和不合并<a href='/topic/show?id=4c861123089e' target=_blank style='color:#2F92EE;'>#慢性肾病（CKD）#</a>的二级<a href='/topic/show?id=6abc1002e726' target=_blank style='color:#2F92EE;'>#预防#</a>价值，临床意义突出。对于无<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的老年缺血性卒中患者，提高<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的患者，研究发现较高的<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对<a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a>（如蛋白尿、肾小球滤过率分级）与<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及<a href='/topic/show?id=b0e9132913cb' target=_blank style='color:#2F92EE;'>#卒中类型#</a>和<a href='/topic/show?id=200b1329148f' target=_blank style='color:#2F92EE;'>#病情严重度#</a>对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如<a href='/topic/show?id=9f0f853e927' target=_blank style='color:#2F92EE;'>#腔隙性卒中#</a>、<a href='/topic/show?id=b438132915d1' target=_blank style='color:#2F92EE;'>#大动脉粥样硬化卒中#</a>等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的<a href='/topic/show?id=58f1132916b7' target=_blank style='color:#2F92EE;'>#ACEI/ARB使用率#</a>和预后相关性进行补充分析，以增强本土临床指导价值。建议补充<a href='/topic/show?id=9401204912f' target=_blank style='color:#2F92EE;'>#不良反应#</a>和<a href='/topic/show?id=61888e8231b' target=_blank style='color:#2F92EE;'>#药物相互作用#</a>信息，尤其在合并多种慢性病的老年人群中，关注<a href='/topic/show?id=098b102e854e' target=_blank style='color:#2F92EE;'>#高钾血症#</a>、<a href='/topic/show?id=a9fc824e728' target=_blank style='color:#2F92EE;'>#肾功能变化#</a>、<a href='/topic/show?id=e0bb13291e44' target=_blank style='color:#2F92EE;'>#低血压风险#</a>等安全问题。关键词示例：<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a> <a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a> <a href='/topic/show?id=f6f5536422e' target=_blank style='color:#2F92EE;'>#慢性肾病#</a> <a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a> <a href='/topic/show?id=720d2401409' target=_blank style='color:#2F92EE;'>#二级预防#</a> <a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a> #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>疗效的新证据，有助于促进精准用药，但后续研究需加强CKD亚型分层、卒中类型与多中心大样本验证。临床实践应结合个体特点、药物安全性综合评估后决策。, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1834, encryptionId=c3831834bc, topicName=ACEI/ARB), TopicDto(id=4790, encryptionId=8a934e90c5, topicName=CKD), TopicDto(id=20491, encryptionId=9401204912f, topicName=不良反应), TopicDto(id=24014, encryptionId=720d2401409, topicName=二级预防), TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中), TopicDto(id=53642, encryptionId=f6f5536422e, topicName=慢性肾病), TopicDto(id=69009, encryptionId=43706900963, topicName=生存率), TopicDto(id=82477, encryptionId=a9fc824e728, topicName=肾功能变化), TopicDto(id=85379, encryptionId=9f0f853e927, topicName=腔隙性卒中), TopicDto(id=87823, encryptionId=61888e8231b, topicName=药物相互作用), TopicDto(id=100277, encryptionId=6abc1002e726, topicName=预防), TopicDto(id=102785, encryptionId=098b102e854e, 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style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Sat Sep 29 23:34:00 CST 2018, time=2018-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1656109, encodeId=8e7d1656109ee, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=275, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Fri Nov 30 16:34:00 CST 2018, time=2018-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806262, encodeId=2798180626257, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Feb 14 15:34:00 CST 2019, time=2019-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339346, encodeId=ac11339346e5, content=不错耶，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sat Aug 18 13:04:54 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357928, encodeId=5a70135e928a1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=190, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563618, encodeId=fccf1563618d4, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=229, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615921, encodeId=f0131615921e8, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026124, encodeId=cca61026124c9, content=卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 10 01:34:00 CST 2018, time=2018-08-10, status=1, ipAttribution=)]
2019-02-14 12498da4m32(暂无昵称)

#缺血性卒#

0 0 举报
[GetPortalCommentsPageByObjectIdResponse(id=2290190, encodeId=b43422901908e, content=针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>在<a href='/topic/show?id=9c8c13291117' target=_blank style='color:#2F92EE;'>#老年缺血性卒中#</a>患者中的应用，尤其是针对合并和不合并<a href='/topic/show?id=4c861123089e' target=_blank style='color:#2F92EE;'>#慢性肾病（CKD）#</a>的二级<a href='/topic/show?id=6abc1002e726' target=_blank style='color:#2F92EE;'>#预防#</a>价值，临床意义突出。对于无<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的老年缺血性卒中患者，提高<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的患者，研究发现较高的<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对<a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a>（如蛋白尿、肾小球滤过率分级）与<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及<a href='/topic/show?id=b0e9132913cb' target=_blank style='color:#2F92EE;'>#卒中类型#</a>和<a href='/topic/show?id=200b1329148f' target=_blank style='color:#2F92EE;'>#病情严重度#</a>对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如<a href='/topic/show?id=9f0f853e927' target=_blank style='color:#2F92EE;'>#腔隙性卒中#</a>、<a href='/topic/show?id=b438132915d1' target=_blank style='color:#2F92EE;'>#大动脉粥样硬化卒中#</a>等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的<a href='/topic/show?id=58f1132916b7' target=_blank style='color:#2F92EE;'>#ACEI/ARB使用率#</a>和预后相关性进行补充分析，以增强本土临床指导价值。建议补充<a href='/topic/show?id=9401204912f' target=_blank style='color:#2F92EE;'>#不良反应#</a>和<a href='/topic/show?id=61888e8231b' target=_blank style='color:#2F92EE;'>#药物相互作用#</a>信息，尤其在合并多种慢性病的老年人群中，关注<a href='/topic/show?id=098b102e854e' target=_blank style='color:#2F92EE;'>#高钾血症#</a>、<a href='/topic/show?id=a9fc824e728' target=_blank style='color:#2F92EE;'>#肾功能变化#</a>、<a href='/topic/show?id=e0bb13291e44' target=_blank style='color:#2F92EE;'>#低血压风险#</a>等安全问题。关键词示例：<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a> <a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a> <a href='/topic/show?id=f6f5536422e' target=_blank style='color:#2F92EE;'>#慢性肾病#</a> <a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a> <a href='/topic/show?id=720d2401409' target=_blank style='color:#2F92EE;'>#二级预防#</a> <a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a> #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>疗效的新证据，有助于促进精准用药，但后续研究需加强CKD亚型分层、卒中类型与多中心大样本验证。临床实践应结合个体特点、药物安全性综合评估后决策。, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1834, encryptionId=c3831834bc, topicName=ACEI/ARB), TopicDto(id=4790, encryptionId=8a934e90c5, topicName=CKD), TopicDto(id=20491, encryptionId=9401204912f, topicName=不良反应), TopicDto(id=24014, encryptionId=720d2401409, topicName=二级预防), TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中), TopicDto(id=53642, encryptionId=f6f5536422e, topicName=慢性肾病), TopicDto(id=69009, encryptionId=43706900963, topicName=生存率), TopicDto(id=82477, encryptionId=a9fc824e728, topicName=肾功能变化), TopicDto(id=85379, encryptionId=9f0f853e927, topicName=腔隙性卒中), TopicDto(id=87823, encryptionId=61888e8231b, topicName=药物相互作用), TopicDto(id=100277, encryptionId=6abc1002e726, topicName=预防), TopicDto(id=102785, encryptionId=098b102e854e, 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createdName=slcumt, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615921, encodeId=f0131615921e8, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026124, encodeId=cca61026124c9, content=卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 10 01:34:00 CST 2018, time=2018-08-10, status=1, ipAttribution=)]
2018-08-18 owlhealth

不错耶，学习了

197 0 举报
[GetPortalCommentsPageByObjectIdResponse(id=2290190, encodeId=b43422901908e, content=针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>在<a href='/topic/show?id=9c8c13291117' target=_blank style='color:#2F92EE;'>#老年缺血性卒中#</a>患者中的应用，尤其是针对合并和不合并<a href='/topic/show?id=4c861123089e' target=_blank style='color:#2F92EE;'>#慢性肾病（CKD）#</a>的二级<a href='/topic/show?id=6abc1002e726' target=_blank style='color:#2F92EE;'>#预防#</a>价值，临床意义突出。对于无<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的老年缺血性卒中患者，提高<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的患者，研究发现较高的<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对<a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a>（如蛋白尿、肾小球滤过率分级）与<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及<a href='/topic/show?id=b0e9132913cb' target=_blank style='color:#2F92EE;'>#卒中类型#</a>和<a href='/topic/show?id=200b1329148f' target=_blank style='color:#2F92EE;'>#病情严重度#</a>对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如<a href='/topic/show?id=9f0f853e927' target=_blank style='color:#2F92EE;'>#腔隙性卒中#</a>、<a href='/topic/show?id=b438132915d1' target=_blank style='color:#2F92EE;'>#大动脉粥样硬化卒中#</a>等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的<a href='/topic/show?id=58f1132916b7' target=_blank style='color:#2F92EE;'>#ACEI/ARB使用率#</a>和预后相关性进行补充分析，以增强本土临床指导价值。建议补充<a href='/topic/show?id=9401204912f' target=_blank style='color:#2F92EE;'>#不良反应#</a>和<a href='/topic/show?id=61888e8231b' target=_blank style='color:#2F92EE;'>#药物相互作用#</a>信息，尤其在合并多种慢性病的老年人群中，关注<a href='/topic/show?id=098b102e854e' target=_blank style='color:#2F92EE;'>#高钾血症#</a>、<a href='/topic/show?id=a9fc824e728' target=_blank style='color:#2F92EE;'>#肾功能变化#</a>、<a href='/topic/show?id=e0bb13291e44' target=_blank style='color:#2F92EE;'>#低血压风险#</a>等安全问题。关键词示例：<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a> <a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a> <a href='/topic/show?id=f6f5536422e' target=_blank style='color:#2F92EE;'>#慢性肾病#</a> <a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a> <a href='/topic/show?id=720d2401409' target=_blank style='color:#2F92EE;'>#二级预防#</a> <a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a> #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>疗效的新证据，有助于促进精准用药，但后续研究需加强CKD亚型分层、卒中类型与多中心大样本验证。临床实践应结合个体特点、药物安全性综合评估后决策。, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1834, encryptionId=c3831834bc, topicName=ACEI/ARB), TopicDto(id=4790, encryptionId=8a934e90c5, topicName=CKD), TopicDto(id=20491, encryptionId=9401204912f, topicName=不良反应), TopicDto(id=24014, encryptionId=720d2401409, topicName=二级预防), TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中), TopicDto(id=53642, encryptionId=f6f5536422e, topicName=慢性肾病), TopicDto(id=69009, encryptionId=43706900963, topicName=生存率), TopicDto(id=82477, encryptionId=a9fc824e728, topicName=肾功能变化), TopicDto(id=85379, encryptionId=9f0f853e927, topicName=腔隙性卒中), TopicDto(id=87823, encryptionId=61888e8231b, topicName=药物相互作用), TopicDto(id=100277, encryptionId=6abc1002e726, topicName=预防), TopicDto(id=102785, encryptionId=098b102e854e, 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style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Sat Sep 29 23:34:00 CST 2018, time=2018-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1656109, encodeId=8e7d1656109ee, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=275, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Fri Nov 30 16:34:00 CST 2018, time=2018-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806262, encodeId=2798180626257, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Feb 14 15:34:00 CST 2019, time=2019-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339346, encodeId=ac11339346e5, content=不错耶，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sat Aug 18 13:04:54 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357928, encodeId=5a70135e928a1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=190, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563618, encodeId=fccf1563618d4, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=229, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615921, encodeId=f0131615921e8, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026124, encodeId=cca61026124c9, content=卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 10 01:34:00 CST 2018, time=2018-08-10, status=1, ipAttribution=)]
2018-08-11 zhaojie88

#ART#

190 0 举报
[GetPortalCommentsPageByObjectIdResponse(id=2290190, encodeId=b43422901908e, content=针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>在<a href='/topic/show?id=9c8c13291117' target=_blank style='color:#2F92EE;'>#老年缺血性卒中#</a>患者中的应用，尤其是针对合并和不合并<a href='/topic/show?id=4c861123089e' target=_blank style='color:#2F92EE;'>#慢性肾病（CKD）#</a>的二级<a href='/topic/show?id=6abc1002e726' target=_blank style='color:#2F92EE;'>#预防#</a>价值，临床意义突出。对于无<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的老年缺血性卒中患者，提高<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的患者，研究发现较高的<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对<a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a>（如蛋白尿、肾小球滤过率分级）与<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及<a href='/topic/show?id=b0e9132913cb' target=_blank style='color:#2F92EE;'>#卒中类型#</a>和<a href='/topic/show?id=200b1329148f' target=_blank style='color:#2F92EE;'>#病情严重度#</a>对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如<a href='/topic/show?id=9f0f853e927' target=_blank style='color:#2F92EE;'>#腔隙性卒中#</a>、<a href='/topic/show?id=b438132915d1' target=_blank style='color:#2F92EE;'>#大动脉粥样硬化卒中#</a>等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的<a href='/topic/show?id=58f1132916b7' target=_blank style='color:#2F92EE;'>#ACEI/ARB使用率#</a>和预后相关性进行补充分析，以增强本土临床指导价值。建议补充<a href='/topic/show?id=9401204912f' target=_blank style='color:#2F92EE;'>#不良反应#</a>和<a href='/topic/show?id=61888e8231b' target=_blank style='color:#2F92EE;'>#药物相互作用#</a>信息，尤其在合并多种慢性病的老年人群中，关注<a href='/topic/show?id=098b102e854e' target=_blank style='color:#2F92EE;'>#高钾血症#</a>、<a href='/topic/show?id=a9fc824e728' target=_blank style='color:#2F92EE;'>#肾功能变化#</a>、<a href='/topic/show?id=e0bb13291e44' target=_blank style='color:#2F92EE;'>#低血压风险#</a>等安全问题。关键词示例：<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a> <a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a> <a href='/topic/show?id=f6f5536422e' target=_blank style='color:#2F92EE;'>#慢性肾病#</a> <a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a> <a href='/topic/show?id=720d2401409' target=_blank style='color:#2F92EE;'>#二级预防#</a> <a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a> #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>疗效的新证据，有助于促进精准用药，但后续研究需加强CKD亚型分层、卒中类型与多中心大样本验证。临床实践应结合个体特点、药物安全性综合评估后决策。, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1834, encryptionId=c3831834bc, topicName=ACEI/ARB), TopicDto(id=4790, encryptionId=8a934e90c5, topicName=CKD), TopicDto(id=20491, encryptionId=9401204912f, topicName=不良反应), TopicDto(id=24014, encryptionId=720d2401409, topicName=二级预防), TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中), TopicDto(id=53642, encryptionId=f6f5536422e, topicName=慢性肾病), TopicDto(id=69009, encryptionId=43706900963, topicName=生存率), TopicDto(id=82477, encryptionId=a9fc824e728, topicName=肾功能变化), TopicDto(id=85379, encryptionId=9f0f853e927, topicName=腔隙性卒中), TopicDto(id=87823, encryptionId=61888e8231b, topicName=药物相互作用), TopicDto(id=100277, encryptionId=6abc1002e726, topicName=预防), TopicDto(id=102785, encryptionId=098b102e854e, 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GetPortalCommentsPageByObjectIdResponse(id=1357928, encodeId=5a70135e928a1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=190, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563618, encodeId=fccf1563618d4, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=229, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615921, encodeId=f0131615921e8, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026124, encodeId=cca61026124c9, content=卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 10 01:34:00 CST 2018, time=2018-08-10, status=1, ipAttribution=)]
2018-08-11 slcumt

#HEART#

229 0 举报
[GetPortalCommentsPageByObjectIdResponse(id=2290190, encodeId=b43422901908e, content=针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>在<a href='/topic/show?id=9c8c13291117' target=_blank style='color:#2F92EE;'>#老年缺血性卒中#</a>患者中的应用，尤其是针对合并和不合并<a href='/topic/show?id=4c861123089e' target=_blank style='color:#2F92EE;'>#慢性肾病（CKD）#</a>的二级<a href='/topic/show?id=6abc1002e726' target=_blank style='color:#2F92EE;'>#预防#</a>价值，临床意义突出。对于无<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的老年缺血性卒中患者，提高<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的患者，研究发现较高的<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对<a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a>（如蛋白尿、肾小球滤过率分级）与<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及<a href='/topic/show?id=b0e9132913cb' target=_blank style='color:#2F92EE;'>#卒中类型#</a>和<a href='/topic/show?id=200b1329148f' target=_blank style='color:#2F92EE;'>#病情严重度#</a>对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如<a href='/topic/show?id=9f0f853e927' target=_blank style='color:#2F92EE;'>#腔隙性卒中#</a>、<a href='/topic/show?id=b438132915d1' target=_blank style='color:#2F92EE;'>#大动脉粥样硬化卒中#</a>等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的<a href='/topic/show?id=58f1132916b7' target=_blank style='color:#2F92EE;'>#ACEI/ARB使用率#</a>和预后相关性进行补充分析，以增强本土临床指导价值。建议补充<a href='/topic/show?id=9401204912f' target=_blank style='color:#2F92EE;'>#不良反应#</a>和<a href='/topic/show?id=61888e8231b' target=_blank style='color:#2F92EE;'>#药物相互作用#</a>信息，尤其在合并多种慢性病的老年人群中，关注<a href='/topic/show?id=098b102e854e' target=_blank style='color:#2F92EE;'>#高钾血症#</a>、<a href='/topic/show?id=a9fc824e728' target=_blank style='color:#2F92EE;'>#肾功能变化#</a>、<a href='/topic/show?id=e0bb13291e44' target=_blank style='color:#2F92EE;'>#低血压风险#</a>等安全问题。关键词示例：<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a> <a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a> <a href='/topic/show?id=f6f5536422e' target=_blank style='color:#2F92EE;'>#慢性肾病#</a> <a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a> <a href='/topic/show?id=720d2401409' target=_blank style='color:#2F92EE;'>#二级预防#</a> <a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a> #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>疗效的新证据，有助于促进精准用药，但后续研究需加强CKD亚型分层、卒中类型与多中心大样本验证。临床实践应结合个体特点、药物安全性综合评估后决策。, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1834, encryptionId=c3831834bc, topicName=ACEI/ARB), TopicDto(id=4790, encryptionId=8a934e90c5, topicName=CKD), TopicDto(id=20491, encryptionId=9401204912f, topicName=不良反应), TopicDto(id=24014, encryptionId=720d2401409, topicName=二级预防), TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中), TopicDto(id=53642, encryptionId=f6f5536422e, topicName=慢性肾病), TopicDto(id=69009, encryptionId=43706900963, topicName=生存率), TopicDto(id=82477, encryptionId=a9fc824e728, topicName=肾功能变化), TopicDto(id=85379, encryptionId=9f0f853e927, topicName=腔隙性卒中), TopicDto(id=87823, encryptionId=61888e8231b, topicName=药物相互作用), TopicDto(id=100277, encryptionId=6abc1002e726, topicName=预防), TopicDto(id=102785, encryptionId=098b102e854e, topicName=高钾血症), TopicDto(id=112308, encryptionId=4c861123089e, topicName=慢性肾病（CKD）), TopicDto(id=132911, encryptionId=9c8c13291117, topicName=老年缺血性卒中), TopicDto(id=132912, encryptionId=9a8c13291258, topicName=CKD分型), TopicDto(id=132913, encryptionId=b0e9132913cb, topicName=卒中类型), TopicDto(id=132914, encryptionId=200b1329148f, topicName=病情严重度), TopicDto(id=132915, encryptionId=b438132915d1, topicName=大动脉粥样硬化卒中), TopicDto(id=132916, encryptionId=58f1132916b7, topicName=ACEI/ARB使用率), TopicDto(id=132917, encryptionId=e0bb13291e44, topicName=低血压风险)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Sun Nov 23 10:46:41 CST 2025, time=2025-11-23, status=1, ipAttribution=威斯康星), GetPortalCommentsPageByObjectIdResponse(id=1893513, encodeId=0d41189351315, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Sat Sep 29 23:34:00 CST 2018, time=2018-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1656109, encodeId=8e7d1656109ee, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=275, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Fri Nov 30 16:34:00 CST 2018, time=2018-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806262, encodeId=2798180626257, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Feb 14 15:34:00 CST 2019, time=2019-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339346, encodeId=ac11339346e5, content=不错耶，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sat Aug 18 13:04:54 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357928, encodeId=5a70135e928a1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=190, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563618, encodeId=fccf1563618d4, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=229, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615921, encodeId=f0131615921e8, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026124, encodeId=cca61026124c9, content=卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 10 01:34:00 CST 2018, time=2018-08-10, status=1, ipAttribution=)]
2018-08-11 ms3830150583600765

#使用率#

209 0 举报
[GetPortalCommentsPageByObjectIdResponse(id=2290190, encodeId=b43422901908e, content=针对该文章“J Am Heart Assoc：ACEI/ARB治疗老年缺血性卒中：使用率正确吗？”的专业化评论如下：临床实用性与价值该研究关注<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>在<a href='/topic/show?id=9c8c13291117' target=_blank style='color:#2F92EE;'>#老年缺血性卒中#</a>患者中的应用，尤其是针对合并和不合并<a href='/topic/show?id=4c861123089e' target=_blank style='color:#2F92EE;'>#慢性肾病（CKD）#</a>的二级<a href='/topic/show?id=6abc1002e726' target=_blank style='color:#2F92EE;'>#预防#</a>价值，临床意义突出。对于无<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的老年缺血性卒中患者，提高<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>应用率可以显著提升两年生存率，提示目前这部分患者存在用药不足，具有指导实际临床用药的价值。对于合并<a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=8a934e90c5' target=_blank style='color:#2F92EE;'>#CKD#</a></a>的患者，研究发现较高的<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>使用率反而与生存率降低相关，此现象虽未达统计学显著，但提示临床医生需谨慎权衡这类患者的获益与风险，具有重要的警示作用。方法学上，采用工具变量分析并基于区域用药差异来纠正混杂，数据严谨，提高了结论的可信度和实用性。文章不足与补充建议缺乏对<a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a>（如蛋白尿、肾小球滤过率分级）与<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>获益的进一步探讨，细化CKD分层有助于更精准指导临床决策。未涉及<a href='/topic/show?id=b0e9132913cb' target=_blank style='color:#2F92EE;'>#卒中类型#</a>和<a href='/topic/show?id=200b1329148f' target=_blank style='color:#2F92EE;'>#病情严重度#</a>对用药获益的差异，实际操作时应个体化评估患者临床情况和卒中分型（如<a href='/topic/show?id=9f0f853e927' target=_blank style='color:#2F92EE;'>#腔隙性卒中#</a>、<a href='/topic/show?id=b438132915d1' target=_blank style='color:#2F92EE;'>#大动脉粥样硬化卒中#</a>等）。缺少中国或亚洲人群数据可借鉴性，建议结合国内真实世界数据，对本地患者群体的<a href='/topic/show?id=58f1132916b7' target=_blank style='color:#2F92EE;'>#ACEI/ARB使用率#</a>和预后相关性进行补充分析，以增强本土临床指导价值。建议补充<a href='/topic/show?id=9401204912f' target=_blank style='color:#2F92EE;'>#不良反应#</a>和<a href='/topic/show?id=61888e8231b' target=_blank style='color:#2F92EE;'>#药物相互作用#</a>信息，尤其在合并多种慢性病的老年人群中，关注<a href='/topic/show?id=098b102e854e' target=_blank style='color:#2F92EE;'>#高钾血症#</a>、<a href='/topic/show?id=a9fc824e728' target=_blank style='color:#2F92EE;'>#肾功能变化#</a>、<a href='/topic/show?id=e0bb13291e44' target=_blank style='color:#2F92EE;'>#低血压风险#</a>等安全问题。关键词示例：<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a> <a href='/topic/show?id=b64035999ca' target=_blank style='color:#2F92EE;'>#卒中#</a> <a href='/topic/show?id=f6f5536422e' target=_blank style='color:#2F92EE;'>#慢性肾病#</a> <a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a> <a href='/topic/show?id=720d2401409' target=_blank style='color:#2F92EE;'>#二级预防#</a> <a href='/topic/show?id=9a8c13291258' target=_blank style='color:#2F92EE;'>#CKD分型#</a> #临床实用性# #药物安全性# #个体化治疗# 总结：文章为临床提供了年龄、肾功能分层后<a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'><a href='/topic/show?id=c3831834bc' target=_blank style='color:#2F92EE;'>#ACEI/ARB#</a></a></a></a></a>疗效的新证据，有助于促进精准用药，但后续研究需加强CKD亚型分层、卒中类型与多中心大样本验证。临床实践应结合个体特点、药物安全性综合评估后决策。, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1834, encryptionId=c3831834bc, topicName=ACEI/ARB), TopicDto(id=4790, encryptionId=8a934e90c5, topicName=CKD), TopicDto(id=20491, encryptionId=9401204912f, topicName=不良反应), TopicDto(id=24014, encryptionId=720d2401409, topicName=二级预防), TopicDto(id=35999, encryptionId=b64035999ca, topicName=卒中), TopicDto(id=53642, encryptionId=f6f5536422e, topicName=慢性肾病), TopicDto(id=69009, encryptionId=43706900963, topicName=生存率), TopicDto(id=82477, encryptionId=a9fc824e728, topicName=肾功能变化), TopicDto(id=85379, encryptionId=9f0f853e927, topicName=腔隙性卒中), TopicDto(id=87823, encryptionId=61888e8231b, topicName=药物相互作用), TopicDto(id=100277, encryptionId=6abc1002e726, topicName=预防), TopicDto(id=102785, encryptionId=098b102e854e, 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style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Sat Sep 29 23:34:00 CST 2018, time=2018-09-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1656109, encodeId=8e7d1656109ee, content=<a href='/topic/show?id=2a011829d7' target=_blank style='color:#2F92EE;'>#ACE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=275, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1829, encryptionId=2a011829d7, topicName=ACE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=635024767990, createdName=shanyongle, createdTime=Fri Nov 30 16:34:00 CST 2018, time=2018-11-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1806262, encodeId=2798180626257, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Thu Feb 14 15:34:00 CST 2019, time=2019-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339346, encodeId=ac11339346e5, content=不错耶，学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=197, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b2c1627329, createdName=owlhealth, createdTime=Sat Aug 18 13:04:54 CST 2018, time=2018-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357928, encodeId=5a70135e928a1, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=190, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563618, encodeId=fccf1563618d4, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=229, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615921, encodeId=f0131615921e8, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=209, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Sat Aug 11 13:34:00 CST 2018, time=2018-08-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026124, encodeId=cca61026124c9, content=卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！, beContent=null, objectType=article, channel=null, level=null, likeNumber=159, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Aug 10 01:34:00 CST 2018, time=2018-08-10, status=1, ipAttribution=)]
2018-08-10 健健

卒中虽然是临床上常见病，溶栓，取栓等血管内治疗也很成熟，但是仍然有很多未知问题有待认知！

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