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发表于 2009-10-23 20:56:27
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本帖最后由 大人物 于 2009-10-23 21:16 编辑
先说两句题外话:
1. 我翻译的不一定十分准确,大意应该没错。有发现错误的同志尽管指出哈。
2. 时间、兴趣的关系,也没有太认真地翻,有违专业精神:)(翻译过东西的同志知道,自己看个大致明白很容易也很快,但要白纸黑字地翻译成正经文章,还是要多费不少脑细胞的)
3. 对于多数看客来说,其实前面那兄弟发的每个英文文章前面的汉字说明,基本就能满足你了:)
4. 我个人理解,散木的想法以及这里所讨论的激素的话题是:长期低剂量用激素维持其副作用是否会比用其他药物维持大?就有限的这几篇文章来看,似乎这算是个有争议的话题。前面那兄弟新近发的几篇文章,证明的是长期低剂量用激素维持不太好,所以才有激素是桥不是路的说法(不过你可以抬杠说自己生活在威尼斯哈)。
5. 科学的前沿文章有些常具争议性,也许后面就又有文章来批驳这几篇文章了,所以,在仔细研究之前,大家不要因为看到某一篇文章就轻易下结论,自己多积累点之后,再自行评判吧。。。。。
(算术没学好,好像不是“两句”:))
Objective. To evaluate mortality and causes of death in patients with rheumatoid arthritis (RA) treated with low-dose oral glucocorticoids.
目的:评价使用低剂量口服糖皮质激素治疗的RA患者的死亡率和死因。
Methods. Mortality was analyzed in population-based data of 604 patients with RA. In the original study in 1988, state of general health, severity of RA, and treatment including the use of oral glucocorticoids were recorded. In 1999 vital status and causes of death were evaluated. Mortality in patients with RA who had not received glucocorticoids (Group A, n = 209) was compared to that in patients treated with glucocorticoids for less than 10 years (Group B, n = 276) or for more than 10 years (Group C, n = 119).# P
方法:基于604位RA患者的数据分析死亡率。在1988年开始研究时即记录一般健康状况、RA严重性和包括口服糖皮质激素的使用的记录。1999年评价了生命状态和死因。将未接受糖皮质激素的RA患者(A组,209人)的死亡率与使用糖皮质激素治疗少于10年的患者(B组,276人)或超过10年的患者(C组,119人)的死亡率相比较。
Results. From onset of RA to 1999, 395 (65%) patients had been treated with oral glucocorticoids. In 1999 a total of 160 (26%) patients had died, 23% of patients in Group A, 21% in Group B, and 45% in Group C. In multivariate Cox regression analysis, male sex (hazard ratio 2.50; 95% CI 1.74–3.59), impaired functional capacity by Health Assessment Questionnaire (HR 2.11; 95% CI 1.65–2.96), heart failure (HR 1.96; 95% CI 1.36–2.84), and diabetes (HR 1.87; 95% CI 1.17–3.01) predicted increased mortality. In the same analysis glucocorticoid treatment for 1 year increased the mortality risk by 14% (HR 1.14; 95% CI 0.98–1.27, p = 0.057) and treatment over 10 years by 69% (HR 1.69; 95% CI 1.12–2.56, p = 0.011) compared to RA patients without treatment. The major cause of death was cardiovascular disease in all groups, but infections and intestinal perforations due to amyloidosis were more frequent in patients with long-lasting glucocorticoid therapy. Lymphomas were more frequent in all patients treated with glucocorticoids (Groups B and C) than in those not receiving glucocorticoids.
结果:从RA发病至1999年间,有395位(65%)患者使用过口服糖皮质激素治疗。到1999年,总共有160位(26%)患者已死亡,其中有A组中的23%、B组中的21%和C组中的45%。在多元Cox回归分析(大人物注:一种分析模型,有兴趣自己去网上查吧,比较专业啦)中,男性(危险率2.50;95% CI 1.74–3.59)、HAQ((斯坦福)健康评估问卷)评价的破坏的功能(HR 2.11; 95% CI 1.65–2.96)、心力衰竭(HR 1.96; 95% CI 1.36–2.84)、糖尿病(HR 1.87; 95% CI 1.17–3.01)这些情况预示着死亡率较高。在相似的分析中,与未经糖皮质激素治疗的RA患者相比,经糖皮质激素治疗1年死亡风险上升14%(HR 1.14; 95% CI 0.98–1.27, p = 0.057),经糖皮质激素治疗10年以上死亡风险上升69% (HR 1.69; 95% CI 1.12–2.56, p = 0.011)。在这三组中死亡的主要原因都是心血管疾病,但是感染和因淀粉样变性而导致的肠穿孔更常见于长期持续使用糖皮质激治疗的患者。较之未接受糖皮质激素治疗的患者,使用糖皮质激素治疗的患者(B组和C组)更常发生淋巴腺瘤。
Conclusion. Patients with RA treated with low-dose oral glucocorticoids for more than 10 years had increased mortality compared to those who did not receive glucocorticoids or whose duration of treatment was less than 10 years. The increased mortality was related mainly to infections and complications caused by systemic amyloidosis. (First Release Aug 1 2006; J Rheumatol 2006;33:1740–6)
结论:与未接受糖皮质激素治疗的患者或使用低剂量口服糖皮质激素治疗持续时间少于10年的患者相比,使用低剂量口服糖皮质激素治疗10年以上的RA患者具有较高的死亡率。升高的死亡率主要与感染和因全身淀粉样变性而引起的并发症有关。 |
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