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| 1 | 新媒体联盟地平线报告:2017高等教育版显示文摘《新媒体联盟地平线报告:2017高等教育版》由美国新媒体联盟与美国高校教育信息化协会学习促进会协作完成。来自5大洲22个国家的78位不同角色的专家选择了最有可能影响今后五年(2017—2021)技术规划和决策制定的六项主要趋势、六个关键挑战和六种重要技术,详细阐释了共18个主题的内容。本年度报告将18个主题内容分为六个元分类,并对每个内容进行元分类标注。从2017年的报告当中,我们既能够见到'混合式学习'、'自适应性学习'、'移动学习'等熟悉的主题,又能够看到'人工智能'、'自然用户界面'等新兴技术的最新进展。本报告对于指导各国政府和高等院校推进教育信息化工作具有宏观指导价值。 | S·亚当斯贝克尔 M·卡明斯 A·戴维斯 A·弗里曼 C·霍尔给辛格 V·安娜塔娜额亚婻 殷丙山(译) 高茜(译) 任直(译) 刘鑫驰(译) 曹红岩(译) 王济军(译) 赵广元(译) 邵恒(译) | 2017 | 开放学习研究2017，22，2： | 81 |
| 2 | BCLC策略:预后预测和治疗推荐2022版更新显示文摘2018版BCLC预后和治疗推荐策略发布后,肝细胞癌(简称HCC)的研究又取得了重大进展。本次更新基于肝癌各领域的研究进展结果。重点关注影响策略的重要研究进展。虽然近年的研究结果成绩斐然,但将其引入为临床医生和研究者提供行动依据的循证模型指南来说证据效力依然不够确切。本文对该问题进行分析,阐述了为HCC患者制定个体化治疗临床决策所需的批判性思维和专业知识。 | Reig M Forner A Rimola J Ferrer-Fabrega J Burrel M Garcia-Criado A Kelley RK Galle PR Mazzaferro V Salem R Sangro B Singal AG Vogel A Fuster J Ayuso C Bruix J 刘永凡(摘译) 崔笑(摘译) 耿小平(审校) | 2022 | 肝胆外科杂志2022，30，5： | 80 |
| 3 | 乳腺囊内型乳头状癌显示文摘 | Collins L C Carlo V P Hwang H 魏兵(摘译) 步宏(审校) | 2006 | 临床与实验病理学杂志2006，22，5： | 38 |
| 4 | 新媒体联盟地平线报告:2017图书馆版显示文摘地平线报告系列展示了5年内创新实践和技术对全球学术与研究型图书馆的影响。报告涉及6大关键趋势,6种重要挑战和6项技术发展,它们影响着图书馆战略、运营和服务,包括学习、创意调查、研究和信息管理。其中专家们认为大数据、数字学术技术、图书馆服务平台、网络身份、人工智能、物联网等技术具有促进学术和研究型图书馆发生真正改变的潜力。本报告为图书馆领导者、图书馆工作人员、政策制定者和技术人员提供参考和技术规划指南。 | S·亚当斯·贝克尔 M·卡明斯 A·戴维斯 A·弗里曼 C·霍尔·盖辛格 V·安娜塔娜额亚娟 K·兰利 N·沃尔夫森 高茜(译) 曹红岩(译) 徐路(译) 周晖(译) 谢艳秋(译) 洪长勇(译) 王丽媛(译) 鄂丽君(译) | 2017 | 开放学习研究2017，22，5： | 33 |
| 5 | Use of probiotics for prevention of radiation-induced diarrhea显示文摘AIM: To investigate the efficacy of a high-potency probiotic preparation on prevention of radiation-induced diarrhea in cancer patients. METHODS: This was a double-blind, placebo-controlled trial. Four hundred and ninety patients who underwent adjuvant postoperative radiation therapy after surgery for sigmoid, rectal, or cervical cancer were assigned to either the high-potency probiotic preparation VSL#3 (one sachet t.i.d.,) or placebo starting from the first day of radiation therapy. Efficacy endpoints were incidence and severity of radiation-induced diarrhea, daily number of bowel movements, and the time from the start of the study to the use of loperamide as rescue medication. RESULTS: More placebo patients had radiation-induced diarrhea than VSL#3 patients (124 of 239 patients, 51.8%, and 77 of 243 patients, 31.6%; P < 0.001) and more patients given placebo suffered grade 3 or 4 diarrhea compared with VSL#3 recipients (55.4% and 1.4%, P < 0.001). Daily bowel movements were 14.7 ± 6 and 5.1 ± 3 among placebo and VSL#3 recipients (P < 0.05), and the mean time to the use of loperamide was 86 ± 6 h for placebo patients and 122 ± 8 h for VSL#3 patients (P < 0.001). CONCLUSION: Probiotic lactic acid-producing bacteria are an easy, safe, and feasible approach to protect cancer patients against the risk of radiation-induced diarrhea. | P Delia G Sansotta V Donato P Frosina G Messina C De Renzis G Famularo | 2007 | World Journal of Gastroenterology2007，13，6： | 29 |
| 6 | 急性缺血性卒中的血管内治疗:神经介入外科学学会实践标准委员会的报告显示文摘目的总结采用血管内技术治疗急性缺血性卒中的有关证据并等级分类。方法对美国心脏协会(American Heart Association,AHA)以前发表的推荐意见进行审查并作为当前流程的基础。在此这基础上,进行系统的文献回顾以评估支持急性缺血性卒中血管内治疗的证据。根据AHA卒中委员会和牛津大学循证医学中心提出的循证医学证据分级指南进行评估。对操作安全性、技术效果以及对临床转归的影响进行特别审核。 | K A Blackham P M Meyers T A Abruzzo F C Alberquerque D Fiorella J Fraser D Frei C D Gandhi D V Heck J A Hirsch D P Hsu M Jayaraman S Narayanan C Prestigiacomo J L Sunshine 包元飞(译) 李永坤(译) 刘新峰(译) | 2012 | 国际脑血管病杂志2012，20，12： | 28 |
| 7 | Pediatric functional constipation treatment with Bifi dobacterium-containing yogurt:A crossover,double-blind,controlled trial显示文摘AIM: To evaluate the treatment of pediatric functional chronic intestinal constipation (FCIC) with a probiotic goat yogurt. METHODS: A crossover double-blind formula-controlled trial was carried out on 59 students (age range: 5-15 years) of a public school in Belo Horizonte, MG, Brazil, presenting a FCIC diagnostic, according to Roma Ⅲ criteria. The students were randomized in two groups to receive a goat yogurt supplemented with 109 colony forming unit/mL Bifidobacterium longum (B.longum) (probiotic) daily or only the yogurt for a period of 5 wk (formula). Afterwards, the groups were intercrossed for another 5 wk. Defecation frequency, stool consistency and abdominal and defecation pain were assessed.RESULTS: Both treatment groups demonstrated improvement in defecation frequency compared to baseline. However, the group treated with probiotic showed most signif icant improvement in the f irst phase of the study. An inversion was observed after crossing over, resulting in a reduction in stool frequency when this group was treated by formula. Probiotic and formula improved stool consistency in the f irst phase of treatment, but the improvement obtained with probiotic was significantly higher (P = 0.03). In the second phase of treatment, the group initially treated with probiotic showed worseningstool consistency when using formula. However, the difference was not signif icant. A signif icant improvement in abdominal pain and defecation pain was observed with both probiotic and formula in the first phase of treatment, but again the improvement was more signif icant for the group treated with B. longum during phase I (P < 0.05). When all data of the crossover study were analyzed, significant differences were observed between probiotic yogurt and yogurt only for defecation frequency (P = 0.012), defecation pain (P = 0.046) and abdominal pain (P = 0.015). | Paula VP Guerra Luiza N Lima Tassia C Souza Vanessa Mazochi Francisco J Penna Andreia M Silva Jacques R Nicoli Elizabet V Guimares | 2011 | World Journal of Gastroenterology2011，17，34： | 25 |
| 8 | 皮质下小血管病诊断的共识声明显示文摘血管性认知损害是用于描述一组涉及大血管和小血管的散发性和遗传性异质性疾病的诊断术语。皮质下小血管病可导致腔隙性梗死和进行性白质损害。被称为宾斯旺格病(Binswanger's disease, BD)的进行性白质损害患者构成了从单纯血管性疾病到合并神经变性病变的疾病谱。BD患者是一个相对同质性的亚组,存在缺氧缺血、腔隙性梗死和炎症,它们协同作用破坏血脑屏障和髓鞘。通过临床、脑脊液、神经心理学和影像学检查获得的多模式疾病标记物能促进该亚组患者的鉴别。本共识声明确定了一系列基于基础病理学改变的潜在生物学标记物,这将有助于诊断以及将来协作性治疗试验的患者选择。 | Gary A Rosenberg Anders Wallin Joanna M Wardlaw Hugh S Markus Joan Montaner Leslie Wolfson Costantino Iadecola Berislav V Zlokovic Anne Joutel Martin Dichgans Marco Duering Reinhold Schmidt Amos D Korczyn Lea T Grinberg Helena C Chui Vladimir Hachinski 王训师 张劼 陈涵丰 俞娅美 徐子奇 罗本燕 | 2016 | 国际脑血管病杂志2016，24，6： | 18 |
| 9 | Evaluation of clinical relevance of examining K-ras, p16 and p53 mutations along with allelic losses at 9p and 18q in EUS-guided fine needle aspiration samples of patients with chronic pancreatitis and pancreatic cancer显示文摘AIM: To establish an optimum combination of molecular markers resulting in best overall diagnostic sensitivity and specificity for evaluation of suspicious pancreatic mass. METHODS: Endoscopic ultrasound (EUS)-guided fine needle aspiration cytology (FNA) was performed on 101 consecutive patients (63 males, 38 females, 60 ± 12 years; 81 with subsequently diagnosed pancreatic cancer, 20 with chronic pancreatitis) with focal pancreatic mass. Samples were evaluated on-site by an experienced cytopathologist. DNA was extracted from Giemsa stained cells selected by laser microdissection and the presence of K-ras, p53 and p16 somatic mutations was tested by cycling-gradient capillary electrophoresis (CGCE) and single-strand conformation polymorphism (SSCP) techniques. In addition, allelic losses of tumor suppressor genes p16 (INK4, CDKN2A) and DPC4 (MADH4, SMAD4) were detected by monitoring the loss of heterozygosity (LOH) at 9p and 18q, respectively. RESULTS: Sensitivity and specificity of EUS-guided FNA were 75% and 85%, positive and negative predictivevalue reached 100%. The remaining 26% samples were assigned as inconclusive. Testing of molecular markers revealed sensitivity and specificity of 70% and 100% for K-ras mutations (P < 0.001), 24% and 90% for p53 mutations (NS), 13% and 100% for p16 mutations (NS), 85% and 64% for allelic losses at 9p (P < 0.001) and 78% and 57% for allelic losses at 18q (P < 0.05). When tests for different molecular markers were combined, the best results were obtained with K-ras + LOH at 9p (92% and 64%, P < 0.001), K-ras + LOH at 18q (92% and 57%, P < 0.001), and K-ras + LOH 9q + LOH 18q (96% and 43%, P < 0.001). When the molecular markers were used as complements to FNA cytology to evaluate inconclusive samples only, the overall sensitivity of cancer detection was 100% in all patients enrolled in the study. CONCLUSION: EUS-guided FNA cytology combined with screening of K-ras mutations and allelic losses of tumor suppressors p16 and DPC4 represents a very sensitive approach in screening for pancreatic malignancy. Molecular markers may find its use particularly in cases where FNA cytology has been inconclusive. | C Salek L Benesova M Zavoral V Nosek L Kasperova M Ryska R Strnad E Traboulsi M Minarik | 2007 | World Journal of Gastroenterology2007，13，27： | 18 |
| 10 | 气象卫星云图的多分辨小波分解及人工神经网络降水估计研究显示文摘采用多分辨小波分析对卫星图象进行预处理 ,在保留其特征信息的同时 ,减小了数据量 ,改善了神经网络训练过程的收敛性能 ,提高了处理速度。采用这一方法根据 GOES- 8的红外亮温图象和气象雷达资料对巴西圣保罗州中部的降水量估计进行了试验 ,取得了良好的效果。 | 李伟钢 Maria C V Ramirez Nelson J Ferreira 石立华 Leonardo D de A Sá | 2000 | 南京气象学院学报2000，23，2： | 13 |
| 11 | MicroRNA-185通过靶向调节DN-MT1/PTEN/Akt通路抑制肝细胞癌的生长显示文摘近来研究表明miRNAs与肝癌的发生密切相关,然而单个miRNAs的具体作用机制仍未完全阐明。作者对microR-NA-185(miR-185)在肝细胞癌生物学功能和分子机制方面做了一些研究。实验发现,与非肿瘤性的肝脏实质相比, miR-185在人肝细胞癌组织中的表达减少;qRT-PCR检测显示,与原代肝细胞相比, miR-185在人肝细胞癌细胞中的表达下降;在体外人肝细胞癌细胞中miR-185的过表达会抑制细胞的增殖和侵袭,并且阻止SCID小鼠体内肿瘤的生长。miR-185的过表达能够抑制肝细胞癌细胞中DNMT13′端非翻译区域荧光素酶的活性,当 miR-185结合位点发生突变时,就不存在该效应;miR-185的复制或过表达会减少肝细胞癌细胞中DNMT1蛋白的表达。这些结果表明DNMT1是miR-185在肝细胞癌细胞中的靶向作用蛋白。 DNMT1在miR-185诱导抑制肝细胞癌的增殖中所起的作用,可进一步通过DNMT1的过表达阻止miR-185诱导抑制肝细胞癌细胞的增殖和侵袭这一事实所证实。 miR-185的复制或过表达能够减少PTEN启动子DNA甲基化并且提高PTEN的表达,从而抑制Akt磷酸化;如果DNMT1过表达,这些效应刚好相反。以上结果表明:miR-185靶向作用于DNMT1,通过诱导PTEN和抑制Akt,从而抑制肝细胞癌细胞的增殖,活化或激活miR-185可能成为肝细胞癌新的治疗策略之一。 | Qadir X V Han C Lu D 魏建国 许春伟 | 2014 | 临床与实验病理学杂志2014，30，12： | 12 |
| 12 | Cytotoxicity evaluation and hepatoprotective potential of bioassay guided fractions from Feronia limmonia Linn leaf显示文摘Objective:To evaluate the cytotoxicity and hepatoprotective potentials of extracts,fractions or isolated compound from the leaves of Feronia limonia(F.limonia).Methods:Qualitative phytochemical analysis of extracts,fractions or compound was performed by means of thin layer chromatography and spectroscopic assays.The%purity of compound was measured by analytical HPLC.Extracts,fractions or compound have been individually evaluated for their cytotoxicity effects(10,20,100,250,500,750 and 1 000 μg/mL).Based on the inhibitory concentration(IC_(50)) obtained from the cell viability assay,graded concentrations of extracts,fractions or isolated compound were assessed(10,20,50,100,200 μg/mL) for its hepatoprotective potential against CCl_4-induced hepatotoxicity by monitoring activity levels of serum glutamatic pyruvatic transaminase(SGPT) and serum glutamic oxaloacetic transaminase(SGOT).Results:Results indicated that the methanol extract of F.limonia was non-toxic and hepatoprotective in nature as compared with the petroleum ether extract.The acetone fraction of methanolic extract also showed similar properties but the subsequent two fractions were cytotoxic.However,the pure compound isolated from the penultimate fraction of methanolic extract was non-toxic and hepatoprotective in nature.Biochemical investigations(SCOT,SCPT) further corroborated these cytological observations.Conclusions:It can be concluded from this study that F.limonia methanol extract,some fractions and pure isolated compound herein exhibit hepatoprotective activity.However,cytotoxicity recorded in the penultimate fraction and investigation of structural details of pure compound warrants further study. | Mahendra Jain Rakhee Kapadia Ravirajsinh N Jadeja Menaka C Thounaojam Ranjitsinh V Devkar SH Mishra | 2011 | Asian Pacific Journal of Tropical Biomedicine2011，1，6： | 11 |
| 13 | Effect of human skin-derived stem cells on vessel architecture, tumor growth, and tumor invasion in brain tumor animal models显示文摘 | Pisati F Belicchi M Acerbi F Marchesi C Giussani C Gavina M Javerzat S Hagedorn M Carrabba G Lucini V Gaini SM Bresolin N Bello L Bikfalvi A Torrente Y | 2007 | 中国神经肿瘤杂志2007，5，2： | 10 |
| 14 | 酒精摄入、心脏生物标志物和心房颤动风险与不良结局显示文摘酒精摄入和新发心房颤动相关性证据不一,尤其是在低剂量下。该研究评估欧洲队列在整个饮酒范围内酒精摄入、生物标志物和新发心房颤动的关系。方法和结果:在一个以社区为基础的汇集队列中,研究者随访107845人,以评估酒精摄入(酒精种类和饮酒方式)与新发心房颤动的关系。研究者收集经典心血管病危险因素和新发心力衰竭的信息,并检测生物标记物氨基末端脑钠肽前体和高敏肌钙蛋白I。 | 陈嘉睿(译) 练桂丽((审校) Csengeri D Sprünker NA Di Castelnuovo A Niiranen T Vishram-Nielsen JK Costanzo S S derberg S Jensen SM Vartiainen E Donati MB Magnussen C Camen S Gianfagna F L chen ML Kee F Kontto J Mathiesen EB Koenig W Stefan B de Gaetano G J rgensen T Kuulasmaa K Zeller T Salomaa V Iacoviello L Schnabel RB | 2021 | 中华高血压杂志2021，29，2： | 9 |
| 15 | Near-infrared fluorescence sentinel lymph node detection in gastric cancer: A pilot study显示文摘AIM: To investigate feasibility and accuracy of nearinfrared fluorescence imaging using indocyanine green: nanocolloid for sentinel lymph node(SLN) detection in gastric cancer.METHODS: A prospective, single-institution, phaseI feasibility trial was conducted. Patients suffering from gastric cancer and planned for gastrectomy were included. During surgery, a subserosal injection of 1.6 m L ICG:Nanocoll was administered around the tumor. NIR fluorescence imaging of the abdominal cavity was performed using the Mini-FLARE? NIR fluorescence imaging system. Lymphatic pathways and SLNs were visualized. Of every detected SLN, the corresponding lymph node station, signal-to-background ratio and histopathological diagnosis was determined. Patients underwent standard-of-care gastrectomy. Detected SLNs outside the standard dissection planes were also resected and evaluated.RESULTS: Twenty-six patients were enrolled. Four patients were excluded because distant metastases were found during surgery or due to technical failure of the injection. In 21 of the remaining 22 patients, at least 1 SLN was detected by NIR Fluorescence imaging(mean 3.1 SLNs; range 1-6). In 8 of the 21 patients, tumor-positive LNs were found. Overall accuracy of the technique was 90%(70%-99%; 95%CI), which decreased by higher p T-stage(100%, 100%, 100%, 90%, 0% for respectively Tx, T1, T2, T3, T4 tumors). All NIR-negative SLNs were completely effaced by tumor. Mean fluorescence signal-to-background ratio of SLNs was 4.4(range 1.4-19.8). In 8 of the 21 patients, SLNs outside the standard resection plane were identified, that contained malignant cells in 2 patients.CONCLUSION: This study shows successful use of ICG:Nanocoll as lymphatic tracer for SLN detection in gastric cancer. Moreover, tumor-containing LNs outside the standard dissection planes were identified. | Quirijn RJG Tummers Leonora SF Boogerd Wobbe O de Steur Floris PR Verbeek Martin C Boonstra Henricus JM Handgraaf John V Frangioni Cornelis JH van de Velde Henk H Hartgrink Alexander L Vahrmeijer | 2016 | World Journal of Gastroenterology2016，22，13： | 9 |
| 16 | Superoxide Dismutase and Stress Tolerance显示文摘 | C Bowler M V Montagu D Inze | 1992 | Annual Review of Plant Physiology and Plant Molecular Biology1992，，： | 8 |
| 17 | 高产奶量的母猪有更高的采食量和体动员显示文摘选择能哺育更大窝产仔数的超高产母猪以提高产仔数,但是综合考虑这些现代母猪产奶量、采食量和体动员相互之间联系的研究还很有限。试验旨在研究什么样的母猪产奶量高、窝产仔数多,不同胎次有何影响,以及哺乳期生产性能对下一胎繁殖性能有何影响。选择565头1~4胎母猪,试验期从产前7 d至断奶。产后第2天每窝仔猪统一调整为14头。产前7 d、产后第2天和断奶时测定母猪体重和背膘厚度。产后第2天和断奶时称取仔猪窝重。计算变量之间的皮尔森相关系数,建立回归模型。母猪的平均日采食量(6.1±1.1)kg,仔猪每天窝增重(2.92±0.53)kg,每头母猪的平均断奶仔猪数(13.0±1.1)头。总的来讲,与2~4胎母猪相比,1胎母猪平均日采食量和产奶量更低,下一胎总产仔数也下降,这可能是因为初产母猪相比经产母猪会动用更多体储。仔猪每窝平均日增重与母猪的采食量、窝产仔数和体重损失呈正相关。1~4胎母猪整个哺乳期日采食量每提高1 kg,仔猪窝日增重提高220~440 g,母猪哺乳期体重下降6.6~13.9 kg。但是每天平均产奶量提高1 kg,第4胎母猪哺乳期体重损失减少4.3~21.0 kg。下一胎总产仔数与上一胎产仔数呈正相关。总之,高采食量和高体动员是高产奶量的先决条件。母猪可能已经非常接近他们身体饲料摄取的生理极限,因此,未来的研究应着眼于优化哺乳期超高产母猪的饲粮能量和营养浓度以及初产母猪和经产母猪之间的区别。 | Strathe A V Bruun T S Hansen C F 李元凤 | 2017 | 养猪2017，，4： | 8 |
| 18 | Gastroenteropancreatic neuroendocrine tumours显示文摘 | Irvin M Modlin Kjell Oberg Daniel C Chung Robert T Jensen Wouter W de Herder Rajesh V Thakker Martyn Caplin Gianfranco Delle Fave Greg A Kaltsas Eric P Krenning Steven F Moss Ola Nilsson Guido Rindi Ramon Salazar Philippe Ruszniewski Anders Sundin | 2008 | Lancet Oncology2008，，1： | 8 |
| 19 | Direct-fed microbes: A tool for improving the utilization of low quality roughages in ruminants显示文摘For many years, ruminant nutritionists and microbiologists have been interested in manipulating the microbial ecosystem of the rumen to improve production efficiency of different ruminant species. Removal and restriction of antibiotics subtherapeutic uses from ruminant diets has amplified interest in improving nutrient utilization and animal performance and search for more safe alternatives. Some bacterial and fungal microorganisms as a direct-fed microbial(DFM) can be the most suitable solutions. Microorganisms that are commonly used in DFM for ruminants may be classified mainly as lactic acid producing bacteria(LAB), lactic acid utilizing bacteria(LUB), or other microorganism's species like Lactobacillus, Bifidobacterium, Enterococcus, Streptococcus, Bacillus, Propionibacterium, Megasphaera elsdenii and Prevotellabryantii, in addition to some fungal species of yeast such as Saccharomyces and Aspergillus. A definitive mode of action for bacterial or fungal DFM has not been established; although a variety of mechanisms have been suggested. Bacterial DFM potentially moderate rumen conditions, and improve weight gain and feed efficiency. Fungal DFM may reduce harmful oxygen from the rumen, prevent excess lactate production, increase feed digestibility, and alter rumen fermentation patterns. DFM may also compete with and inhibit the growth of pathogens, immune system modulation, and modulate microbial balance in the gastrointestinal tract. Improved dry matter intake, milk yield, fat corrected milk yield and milk fat content were obtained with DFM administration. However, the response to DFM is not constant; depending on dosages, feeding times and frequencies, and strains of DFM. Nonetheless, recent studies have supported the positive effects of DFM on ruminant performance. | Mona M Y Elghandour Abdelfattah Z M Salem Jose S Martínez Castaeda Luis M Camacho Ahmed E Kholif Juan C Vázquez Chagoyán | 2015 | Journal of Integrative Agriculture2015，14，3： | 7 |
| 20 | 钠-葡萄糖共转运蛋白-2抑制剂或胰高血糖素样肽-1受体激动剂治疗成人2型糖尿病:临床实践指南显示文摘临床问题对于存在不同心血管风险及肾脏结局的2型糖尿病患者,在原有生活方式干预和/或其他降糖药物的基础上加用钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂的获益及风险是什么?现行做法几十年来,2型糖尿病的治疗决策都以控制血糖为主导。SGLT-2抑制剂和GLP-1受体激动剂在传统观念中常被用于二甲双胍治疗后血糖仍控制不佳的患者。目前这一现状已经发生了改变,这得益于多项临床研究结果。研究显示SGLT-2抑制剂和GLP-1受体激动剂拥有独立于药物降糖作用之外的对于动脉粥样硬化性心血管病(CVD)和慢性肾脏病(CKD)的获益。建议本指南阐述了针对不同风险分层的成人2型糖尿病患者使用SGLT-2抑制剂或GLP-1受体激动剂的建议。•伴有3种或更少的心血管风险因素且不存在CVD或CKD:不建议启动SGLT-2抑制剂或GLP-1受体激动剂治疗。(推荐等级:弱)•伴有3种以上心血管风险因素且不存在CVD或CKD:建议启动SGLT-2抑制剂治疗,不建议启动GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD或CKD:建议启动SGLT-2抑制剂治疗和GLP-1受体激动剂治疗。(推荐等级:弱)•已经存在CVD和CKD:建议启动SGLT-2抑制剂治疗(推荐等级:强)和GLP-1受体激动剂治疗。(推荐等级:弱)•对于那些想要进一步降低CVD和CKD结局风险的患者:推荐优先启用SGLT-2抑制剂治疗而非GLP-1受体激动剂治疗。(推荐等级:弱)这项指南是如何制订的一个由患者、临床医生和方法学家共同组成的国际小组提出了这些推荐意见。这些推荐意见基于可信度较高的指南的标准,并使用GRADE分级方法进行评估。该小组采用了息者个体化的观点。证据一项关于获益与风险的系统综述和网络meta分析(764项随机对照研究,包括421346例参与者)发现SGLT-2抑制剂和GLP-1受体激动剂可以降低总体死亡率、心肌梗死发生率、终末期肾病或肾衰竭的发生率(中等至高等质量的证据)。在不同的亚组中这些药物对卒中、因心力衰竭所致住院和其他主要不良事件有不同的影响。药物绝对获益的程度因患者个体风险的不同有很大的差异。(例如,对于接受了超过5年药物治疗的1000例患者,在最低风险人群中死亡人数减少了5人,在最高风险人群中死亡人数减少了48人)。一项关于预后的综述确认了14种风险预测模型,其中一种(RECODe)在证据总结中报告了大部分基线风险评估数据,小组利用该模型以支持风险分层的建议。考虑到患者的价值观及个体差异,指南推荐的支撑证据包括一项对已发表论文的系统综述、一项患者焦点小组研究、一项临床问题总结,以及一项指南调查。指南解读我们依据不同的CVD和CKD风险水平,综合考虑获益、风险和其他因素的平衡,以及每一个风险组别的实际问题,来对推荐意见进行分层。本指南强烈建议CVD和CKD患者使用SGLT-2抑制剂治疗,这说明专家组认为其具有显著的获益。而对于其他成人2型糖尿病患者,推荐等级较弱,这说明专家组想要在获益、风险及治疗花费上取得一个更好的平衡。临床医生通过该指南可以使用可靠的风险计算模型,如RECODe,来明确其患者的个体心血管和肾脏疾病风险。医患交互式总结临床证据和制订决策有助于患者知晓治疗选择,包括进行共同决策。2型糖尿病人群(全球患病率不断增长1-2)正面临着不断增加的心血管疾病、肾脏病和其他并发症的风险3。数十年来,2型糖尿病的管理始终以控制血糖及糖化血红蛋白(HbA1c)为治疗目标4-5,但是,最近的高质量随机对照研究已经对这种以血糖为中心的治疗模式发起了挑战。研究结果显示,强化血糖控制未必会降低大血管不良事件,它还可能带来不利影响监管机构现在要求新型糖尿病药物必须证明其具有心血管和肾脏获益才能获得批准。对两类新药--钠-葡萄糖共转运蛋白2(SGLT-2)抑制剂和胰高血糖素样肽1(GLP-1)受体激动剂(见框图1)的临床试验结果显示,在现有治疗方案(常规治疗)之上加用这些药物,对死亡、心肌梗死、卒中、心力衰竭和肾脏的结局(如进展为终末期肾病)都有获益8-12。 | Sheyu Li Per Olav Vandvik Lyubov Lytvyn Gordon H Guyatt Suetonia C Palmer Rene Rodriguez-Gutierrez Farid Foroutan Thomas Agoritsas Reed A C Siemieniuk Michael Walsh Lawrie Frere David J Tunnicliffe Evi V Nagler Veena Manja Bjφrn Olav Asvold Vivekanand Jha Mieke Vermandere Karim Gariani Qian Zhao Yan Ren Emma Jane Cartwright Patrick Gee Alan Wickes Linda Fems Robin Wright Ling Li Qiukui Hao Reem A Mustafa 无 郭鹤鸣(译) | 2021 | 英国医学杂志中文版2021，24，9： | 7 |
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