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1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 郭鹤鸣(译) 2021英国医学杂志中文版2021,24,9:7
2Muscle force and movement variability before and after total knee arthroplasty: A review显示文摘Variability in muscle force output and movement variability are important aspects of identifying individuals with mobility deficits, central nervous system impairments, and future risk of falling. This has been investigated in elderly healthy and impaired adults, as well as in adults with osteoarthritis(OA), but the question of whether the same correlations also apply to those who have undergone a surgical intervention such as total knee arthroplasty(TKA) is still being investigated. While there is a growing body of literature identifying potential rehabilitation targets for individuals who have undergone TKA, it is important to first understand the underlying post-operative impairments to more efficiently target functional deficits that may lead to improvedlong-term outcomes. The purpose of this article is to review the potential role of muscle force output and movement variability in TKA recipients. The narrative review relies on existing literature in elderly healthy and impaired individuals, as well as in those with OA before and following TKA. The variables that may predict longterm functional abilities and deficits are discussed in the context of existing literature in healthy older adults and older adults with OA and following TKA, as well as the role future research in this field may play in providing evidence-based data for improved rehabilitation targets.Jessica W Smith Jesse C Christensen Robin L Marcus Paul C LaStayo 2014World Journal of Orthopedics2014,5,2:3
3Listeria monocytogenes following orthotopic liver transplantation:Central nervous system involvement and review of the literature显示文摘Listeria monocytogene is a well-recognized cause of bacteremia in immunocompromised individuals,including solid organ transplant recipients,but has been rarely reported following orthotopic liver transplantation. We describe a case of listeria meningitis that occurred within a week after liver transplantation. The patient developed a severe headache that mimicked tacrolimus encephalopathy,and was subsequently diagnosed with listeria meningitis by cerebrospinal fluid culture. The infection was successfully treated with three-week course of intravenous ampicillin. Recurrent hepatitis C followed and was successfully treated with interferon alfa and ribavirin. Fourteen cases of listeriosis after orthotopic liver transplantation have been reported in the English literature. Most reported cases were successfully treated with intravenous ampicillin. There were four cases of listeria meningitis,and the mortality of them was 50%. Early detection and treatment of listeria meningitis are the key to obtaining a better prognosis.Shugo Mizuno Ivan R Zendejas Alan I Reed Robin D Kim Richard J Howard Alan W Hemming Denise C Schain Consuelo Soldevila-Pico Roberto J Firpi Shiro Fujita 2007World Journal of Gastroenterology2007,13,32:2
4Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience显示文摘Phil A Hart Mark D Topazian Thomas E Witzig Jonathan E Clain Ferga C Gleeson Robin R Klebig Michael J Levy Randall K Pearson Bret T Petersen Thomas C Smyrk Aravind Sugumar Naoki Takahashi Santhi S Vege Suresh T Chari 2013Gut2013,,11:2
5Treatment of relapsing autoimmune pancreatitis with immunomodulators and rituximab: the Mayo Clinic experience显示文摘Phil A Hart Mark D Topazian Thomas E Witzig Jonathan E Clain Ferga C Gleeson Robin R Klebig Michael J Levy Randall K Pearson Bret T Petersen Thomas C Smyrk Aravind Sugumar Naoki Takahashi Santhi S Vege Suresh T Chari 2013Gut2013,,11:2
6Healing of duodenal ulcer after eradication of Helicobacter heilmannii显示文摘Andrew F Goddard Robert PH Logan John C Atherton David Jenkins Robin C Spiller 1997The Lancet1997,,9068:2
7Autophagy promotes tumor cell survival and restricts necrosis, inflammation, and tumorigenesis显示文摘Kurt Degenhardt Robin Mathew Brian Beaudoin Kevin Bray Diana Anderson Guanghua Chen Chandreyee Mukherjee Yufang Shi Céline Gélinas Yongjun Fan Deirdre A. Nelson Shengkan Jin Eileen White 2006Cancer Cell2006,,1:2
8Novel p19 Protein Engages IL-12p40 to Form a Cytokine, IL-23, with Biological Activities Similar as Well as Distinct from IL-12显示文摘Birgit Oppmann Robin Lesley Bianca Blom Jackie C Timans Yuming Xu Brisdell Hunte Felix Vega Nancy Yu Jing Wang Komal Singh Francesca Zonin Elena Vaisberg Tatyana Churakova Man-ru Liu Daniel Gorman Janet Wagner Sandra Zurawski Yong-Jun Liu John S Abrams Ke 2000Immunity2000,,5:2
9Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS显示文摘Simon P Dunlop David Jenkins Keith R Neal Robin C Spiller 2003Gastroenterology2003,,6:2
10Network structure and the diffusion of knowledge 显示文摘ROBIN C NICOLAS J 2004Journal of Economic Dynamics & Control2004,,28:1
11Evidence for a K/ T impact event in the Pacific Ocean显示文摘Robin E Froget L Jehanno C 1993Nature1993,363,6430:1
12Cultural shift towards sustainability'in the construction industry of Hong Kong显示文摘Yip Robin C P Poon C S 2009Journal of Environmental Management2009,90,11:1
13Oculocutaneous albinism with TYRP1 gene mutations in a Caucasian patient显示文摘Rooryck C Roudaut C Robine E 2006Pigment Cell Res2006,19,3:1
14The Role of Environmental Factors in Growth Accounting显示文摘Jeon Byung M Robin C Sickles 2004Joumal of Applied Econometrics2004,19,5:1
15Effect of sub-lethal heating and growth temperature on expression of the ribosomal RNA rrnB P2 promoter during the lag phase of Pseudomonas fluorescens 显示文摘Robin C McKellar 2007International Journal of Food microbiology2007,116,2:1
16Genetic diversity of the Chestnut blight fungus Cryphonectria parasitica in four French populations assessed by microsatellite markers显示文摘Breuillin F Dutech C Robin C 2006Mycological Research2006,110,3:1
17Most mammalian mRNAs are conserved targets of microRNAs显示文摘Robin C F Kyle K F Christopher B B 2009Genome Research2009,19,:1
18Synthesis and properties of polyolefin graft copolymers by a grafting “onto” reactive process显示文摘Robin J J Boyer C Boutevin B 2008Polymer2008,49,21:1
19Light quality(red: far-red ratio): does it affect photosynthetic activity, net CO2 assimilation, and morphology of young white clover leaves?显示文摘Heraut-Bron V Robin C Varlet-Grancher C 1999Canadian Journal of Botany1999,77,:1
20Human placenta is a potent hematopoietic niche containing hematopoietic stem and progenitor cells throughout development显示文摘Robin C Bollerot K Mendes S 2009Cell Stem Cell2009,5,4:1
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