盘点:2017年10月28日Lancet研究精选

2017-10-27 zhangfan MedSci原创

2017年10月28日Lancet研究精选



【1】健康中国--中国医药卫生事业的新蓝图


刚刚结束的十九大为中国医药卫生事业的发生描绘新的蓝图,未来医药卫生事业将迎来更深层次的改革,包括初级卫生保健服务、医疗保险、健康中国倡议和现代化医院管理

中国社会主要矛盾的变化突出反映在教育、收入、医疗、住房和环境等方面。三十年两位数的GDP增长使得8亿人脱贫,同时也加剧了发展的不平衡。十八大以来中国贫困人口减少了6000万,贫困人口比例由10.2%下降至不足4%

卫生保健费用和大病医疗支出是造成贫困和返贫的主要原因。国家卫生和计划生育委员会估计44%的贫困家庭因素是健康因素。约 700万以上的慢性病患者受益于国家医疗卫生改革--加强基层全科医生建设,完善药品供应保障体系以及医疗体系药品价格改革。

避免医疗费用造成的贫困是实现中华民族复兴的中国梦的一部分,也是实现可持续发展的一个重要基本要素。习总书记强调"人民健康是民族昌盛和国家富强的重要标志"。 健康中国的美好愿景将成为14亿中国人民的新福祉。

【2】Rucaparib可用于经铂类化疗后缓解的复发性卵巢癌患者的维持治疗


Rucaparib,PARP抑制剂,对携带BRCA突变或者大片段基因杂合缺失的复发性卵巢癌具有抗癌作用。在本试验中,研究人员评估Rucaparib用于经二线治疗或后以顺铂为基础的化疗获得完全或部分缓解的高级别、复发性、铂类药物敏感性卵巢癌患者维持治疗的效果。

本试验为随机、双盲、安慰剂为对照的临床3期试验,从11个国家的87家医院招募年满18岁患有对铂类敏感、高级别浆液性或子宫内膜样卵巢、原发性腹膜癌或输卵管癌患者,至少已接受过两次以铂类为基础的化疗,且可获得完全或部分缓解,CA125浓度低于正常值上限。排除标准:有症状的或未经治疗的中枢神经转移、本研究开始前才接受14天或更短的抗癌治疗、已接受过PARP抑制剂治疗。患者随机分组(2:1),每天口服2次600mg Rucaparib或安慰剂,28天一疗程。主要评估指标无进展存活期。分为3个队列:携带BRCA突变、同源重组缺失和意向治疗人群。治疗后12周进行筛查

2014年4月7日-2016年7月19日,将招募的564位患者随机分组:375位(66%)在Rucaparib组、189位(34%)在安慰剂组。Rucaparib组携带BRCA突变的患者的无进展生存期的中位时间是16.6个月(95% CI 13.4-22.9;130位[35%]患者),而安慰剂组是5.4个月(3.4-6.7;66位[35%]患者)。在同源重组缺失的患者中(236[63%] vs 118[62%]),无进展生存期中位时间是13.6个月(10.9-16.2)vs 5.4个月(5.1-5.6;0.32[0.24-0.42];p<0.0001)。在意向治疗人群中,则是10.8个月(8.3-11.4)vs 5.4个月(5.3-5.5,0.36[0.30-0.45]'p<0.0001)。3级及以上副作用事件:Rucaparib组有209例[56%]、安慰剂组28例[15%]。最常见的副反应是贫血或血红蛋白浓度降低(70[19%]vs 1[1%])和丙氨酸转氨酶浓度升高(39[10%])。

【3】接受PCSK9抑制剂Evolocumab治疗后极低LDL浓度的安全性研究


低密度脂蛋白胆固醇是动脉粥样硬化心血管疾病公认的危险因素,但LDL降低到什么程度最为适当目前还没有定论。近日研究人员考察了PCSK9抑制剂Evolocumab的安全性与临床疗效。

本次研究是对FOURIER试验的二次分析,共25982名患者参与临床试验。考察治疗4周内达到的LDL胆固醇限度与后续的心血管事件(主要终点为心血管死亡、心肌梗死,中风,冠状动脉血运重建术,或不稳定型心绞痛的复合终点;次要终点为心血管死亡、心肌梗死卒中的复合终点)和10项安全性指标的关系,研究随访2.2年。

研究中,4%的患者4周内未达到LDL治疗指标,2%的患者在治疗后4周出现终点事件,其余的25982名患者,13013名接受Evolocumab治疗,12969名服用安慰剂,其中2669名(10%)患者的LDL浓度低于0.5 mmol/L,8003名患者LDL浓度处于0.5-1.3 mmol/L,3444名患者LDL水平在1.3-1.8 mmol/L,7471人LDL浓度在1.8-2.6 mmol/L之间,4395人的LDL浓度在2.6 mmol/L以上。LDL浓度低与主要和次要终点发生率降低相关,LDL低于0.2 mmol/L,主要终点的发生率为0.0012,次要终点的发生率为0.0001。

【4】印度0-59个月幼儿死亡率变化趋势研究--2000-2015


近日研究人员考察了印度2000-15年间1个月以下新生儿以及1-59个月幼儿的特异性死亡率变化。

总计52252名新生儿以及42057幼儿研究期间死亡,其中新生儿感染死亡率下降了66%,出生窒息或外伤发生率下降了76%。1-59个月幼儿的肺炎死亡率下降了63%,腹泻死亡率下降了66%。新生儿破伤风死亡率下降至0.1‰,幼儿麻疹死亡率下降至0.3‰,但新生儿早产或低出生体重儿死亡率上升至14.3‰。总体而言,2000-15年间,新生儿死亡率年下降3.3%,幼儿下降5.4%,这一下降趋势总计减少了约100万婴幼儿死亡。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1829287, encodeId=ce1b182928ea8, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Apr 27 15:58:00 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256995, encodeId=63e9256995eb, content=优质资源.共同学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, 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 Oct 29 17:30:25 CST 2017, time=2017-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256951, encodeId=ec352569519f, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun Oct 29 12:50:42 CST 2017, time=2017-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256639, encodeId=d1492566396a, content=了解了解.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sat Oct 28 11:04:47 CST 2017, time=2017-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256451, encodeId=f2022564512e, content=不错的.学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdqKgfW3nMpOkC3jXxiaW2po0PtglY5ZuVjERqKADW4HyMI8bcZXWlKgH7tEP9ULBoBzuQMibia4pr1s9rQPqLvqQJ/0, createdBy=e8c02060444, createdName=中医痴, createdTime=Fri Oct 27 19:31:57 CST 2017, time=2017-10-27, status=1, ipAttribution=)]
    2018-04-27 howi
  2. [GetPortalCommentsPageByObjectIdResponse(id=1829287, encodeId=ce1b182928ea8, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Apr 27 15:58:00 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256995, encodeId=63e9256995eb, content=优质资源.共同学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, 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 Oct 29 17:30:25 CST 2017, time=2017-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256951, encodeId=ec352569519f, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun Oct 29 12:50:42 CST 2017, time=2017-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256639, encodeId=d1492566396a, content=了解了解.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sat Oct 28 11:04:47 CST 2017, time=2017-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256451, encodeId=f2022564512e, content=不错的.学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdqKgfW3nMpOkC3jXxiaW2po0PtglY5ZuVjERqKADW4HyMI8bcZXWlKgH7tEP9ULBoBzuQMibia4pr1s9rQPqLvqQJ/0, createdBy=e8c02060444, createdName=中医痴, createdTime=Fri Oct 27 19:31:57 CST 2017, time=2017-10-27, status=1, ipAttribution=)]
    2017-10-29 虈亣靌

    优质资源.共同学习

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1829287, encodeId=ce1b182928ea8, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Apr 27 15:58:00 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256995, encodeId=63e9256995eb, content=优质资源.共同学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, 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 Oct 29 17:30:25 CST 2017, time=2017-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256951, encodeId=ec352569519f, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun Oct 29 12:50:42 CST 2017, time=2017-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256639, encodeId=d1492566396a, content=了解了解.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sat Oct 28 11:04:47 CST 2017, time=2017-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256451, encodeId=f2022564512e, content=不错的.学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdqKgfW3nMpOkC3jXxiaW2po0PtglY5ZuVjERqKADW4HyMI8bcZXWlKgH7tEP9ULBoBzuQMibia4pr1s9rQPqLvqQJ/0, createdBy=e8c02060444, createdName=中医痴, createdTime=Fri Oct 27 19:31:57 CST 2017, time=2017-10-27, status=1, ipAttribution=)]
    2017-10-29 大爰

    学习了谢谢分享!!

    0

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    2017-10-28 1dd8c52fm63(暂无匿称)

    了解了解.继续关注

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1829287, encodeId=ce1b182928ea8, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Apr 27 15:58:00 CST 2018, time=2018-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256995, encodeId=63e9256995eb, content=优质资源.共同学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, 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 Oct 29 17:30:25 CST 2017, time=2017-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256951, encodeId=ec352569519f, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun Oct 29 12:50:42 CST 2017, time=2017-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256639, encodeId=d1492566396a, content=了解了解.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Sat Oct 28 11:04:47 CST 2017, time=2017-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=256451, encodeId=f2022564512e, content=不错的.学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NdqKgfW3nMpOkC3jXxiaW2po0PtglY5ZuVjERqKADW4HyMI8bcZXWlKgH7tEP9ULBoBzuQMibia4pr1s9rQPqLvqQJ/0, createdBy=e8c02060444, createdName=中医痴, createdTime=Fri Oct 27 19:31:57 CST 2017, time=2017-10-27, status=1, ipAttribution=)]
    2017-10-27 中医痴

    不错的.学习了.谢谢分享!

    0

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