盘点:2018年1月第1期BMJ研究精选

2018-01-08 zhangfan MedSci原创

BMJ

2018年1月第1期BMJ研究精选



【1】中国I型糖尿病发病率分析


近日,顶级杂志BMJ上发表了一篇研究文章,研究人员旨在估计2010年至2013年期间中国所有年龄组的I型糖尿病发病率。

研究以包含全国505家提供糖尿病诊治医院和13个中国糖尿病患者社区数据,总计随访超过1亿3300万患者年,约占总人口的10%。考察年龄、性别和研究区域的每100000患者的年I型糖尿病发生率。

研究期间总计新确诊I型糖尿病5018例,其中15岁以下儿童1239名,15-29岁青年1799名,≥30岁1980名。≥20岁人群的I型糖尿病发病率为65.3%。研究估计中国所有年龄段人群的I型糖尿病发病率为每100000人每年为1.01;0-14岁人群,每100000人每年发病率为1.93;15-29岁人群为1.28;≥30岁人群为0.69,峰值位于10-14岁年龄段。15岁以下I型糖尿病的发生率与纬度呈正相关(r=0.88,P<0.001),但15-29岁或≥30岁年龄段人群中未发现这一相关性。

【2】新辅助化疗可提高晚期上皮性卵巢癌患者3年生存率


近日研究人员评估了新辅助化疗(NACT)对晚期上皮性卵巢癌全死因死亡率的影响

2011-12年间,6034名3c-4期上皮性卵巢癌患者参与研究。研究的主要终点是3年的全因死亡率,采用Kaplan-Meier曲线以及比例风险模型考察组间死亡率的差异。

1156名患者接受新辅助化疗,4878人进行对照。研究发现,接受治疗的患者2012年间的死亡率较2011年降低(HR 0.81 95%CI 0.71-0.94),对照组无显著差异(1.02, 0.93-1.12)。与对照组相比,患者术后90天的死亡风险 (7.0%-4.0% vs 5.0% -4.3%, P=0.01)以及未进行放化疗治疗的患者比例(20.0%-17.4% vs 19.0-19.5%, P=0.04)降低。横断面分析显示接受NACT治疗地区患者死亡率较低(p=0.001)。

研究认为对于晚期上皮性卵巢癌患者,接受新辅助化疗可使诊断后三年内死亡率大幅下降。

【3】高死亡率随机对照试验中统计方法对功能性结果的影响


在许多危重患者参与的临床对照研究中,死亡率是最常用的主要终点指标。近年来许多衡量功能性指标,如生活质量评分,作为主要终点的临床研究比例增加。在许多研究中,患者在功能性评估之间就已经死亡,导致功能性评估结果的不准确。近日来自约翰霍普金斯大学的研究人员考察了统计方法分析对危重患者参与研究结果的影响。

研究比较了3种数据统计方法:仅考虑幸存者、幸存者平均因果效应以及复合终点。比较3种方法的优劣,包括所需的假设,其中一些假设在所观察到的试验数据中是不可测试的。

研究发现,如果参与者未死亡,3种统计方法的功能性结论的影响无显著差异;但因治疗导致患者死亡后,不同的统计方法会产生不同的结论,这再次强调了合理的试验终点设计对结果的影响。

【4】晚期黑色素瘤的治疗新途径


病例如下:一名60岁的白人妇女在一年前进行了黑色素瘤切除手术,但现在她左小腿出现了多个皮下结节。活检证实病灶为转移性黑色素瘤,为BRAF野生型。影像显示患者肺部存在多个小结节。患者正接受系统的免疫治疗。

据统计,全球每年新发黑色素瘤患者132000例。手术切除是原发肿瘤的一线治疗方法,少数患者出现肿瘤进展、溃疡增加或转移。患者预后与初始诊断分级相关。来自美国的数据表明,原始部位的局部肿瘤患者5年的生存率为98%,周围淋巴结或组织区域转移患者的5年生存率为63%,而远端转移患者的生存率仅为16%。氮烯唑胺等化疗药物对转移性黑色素瘤的治疗效果有限,其平均生存期仅为6-10个月。过去10年间,随着黑色素瘤生物机制以及信号调节通路的研究,不可切除的转移性黑色素瘤的治疗取得了长足的进步。

1、目前免疫治疗以及靶向BRAF基因突变疗法是晚期(不可切除以及转移性)黑色素瘤的主要治疗手段;

2、靶向治疗响应以及患者生存期均得到显著提高,但长期治疗受益却难以实现;

3、对于黑色素瘤复发患者,病变的大小或外观改变是提示疾病扩散的症状,对专科医师进行疾病分期至关重要,进行基因分析并开展靶向治疗是延长生存期的关键。

【5】急性肩袖撕裂的诊断及治疗


病例如下:45岁妇女因冰面跌倒肩部受伤入院,诊断显示仅有瘀伤,平片上无骨损伤。接受三个月的物理治疗后,患者仍存在疼痛、虚弱和手臂抬起无力等症状。肩部专门诊所检查后,超声证实其出现严重的椎管上肌腱撕裂。

急性完全肩袖撕裂的误诊率极高。肩袖由四个重要的肌肉(冈上肌、冈下肌、小圆肌和肩胛下肌,)组成,接近肱头,通过筋腱参与肩关节的稳定和功能。肩袖撕裂是指其中一个或多个肌腱撕裂或与肱骨分离,撕裂大小可以变化,可急性或慢性。

关于肩袖撕裂的诊断需要注意以下几点:

1、创伤后,肩部疼痛且活动不能超过90°是一种危险信号,应及时进行X线平片检查;

2、结合超声或磁共振成像,下列症状患者应及时转诊:肩伤2周后,无法拐臂90°以上的患者以及40岁以上肩关节脱位患者;

3、急性肩袖撕裂患者手术修复是一线的治疗手段。

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    2018-01-21 虈亣靌

    是很好的学习材料.不错.以后会多学习.

    0

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    2018-09-05 gaoxiaoe
  3. [GetPortalCommentsPageByObjectIdResponse(id=280688, encodeId=e43328068860, content=是很好的学习材料.不错.以后会多学习., beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sun Jan 21 13:48:32 CST 2018, time=2018-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1848434, encodeId=e6ca184843490, content=<a href='/topic/show?id=2977356edc' target=_blank style='color:#2F92EE;'>#BMJ#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3567, encryptionId=2977356edc, topicName=BMJ)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Wed Sep 05 08:12:00 CST 2018, time=2018-09-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278320, encodeId=a0652e8320f9, content=认真学习医学知识., beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun Jan 14 07:46:06 CST 2018, time=2018-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=278318, encodeId=817c2e8318d7, content=科学杂志., beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Sun Jan 14 07:45:40 CST 2018, time=2018-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=276740, encodeId=fc1c2e67409f, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzR8ylhYfiaoAUx2BsaYHVia1IKhG3Cg8CT84rBrn6iaVRkyAibJxBcLEXabOQ5p19vWgDe34ib5ErxNgx/0, createdBy=8a701629084, createdName=jihuaijun1112, createdTime=Tue Jan 09 00:12:36 CST 2018, time=2018-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=276657, encodeId=7ce52e66574b, content=henhao, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=b0041939716, createdName=hhh678, createdTime=Mon Jan 08 17:31:29 CST 2018, time=2018-01-08, status=1, ipAttribution=)]
    2018-01-14 jyzxjiangqin

    认真学习医学知识.

    0

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    2018-01-14 jyzxjiangqin

    科学杂志.

    0

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    2018-01-09 jihuaijun1112

    学习学习学习

    0

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    2018-01-08 hhh678

    henhao

    0

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