湖北省A县农村儿童先性病医疗保障研究

目的 分析农村儿童先天性心脏病医疗保障试点工作运行效果。方法 运用SPSS17.0软件对湖北省A县先天性心脏病住院患儿就医费用及补偿数据进行分析。结果 先天性心脏病患儿实际补偿比低于新农合全体患者,患者负担沉重;支付方式改革有效控制了费用增长,定额支付标准能够引导供方诊疗行为;支付方式改革可能出现了人为加重诊断的负面效应。结论 逐步扩大重大疾病保障的病种覆盖范围,采用混合式的补偿模式,科学疾病分类、制定和调整单病种定额支付标准,针对支付方式改革可能产生的负面效应针对性地加强医疗机构监管。     

端粒长度及端粒酶活性与儿童先天性心脏病发病机制的相关性研究

目的:探讨不同年龄儿童外周血白细胞端粒长度及端粒酶活性与儿童先心病发病机制的相关性.方法:采用实时荧光定量PCR检测先天性心脏病2个年龄组及健康受试者外周血白细胞的端粒长度及hTERT mRNA(端粒酶催化亚基).比较相同年龄的先天性心脏病与健康受试者外周血白细胞的端粒长度及hTERT mRNA差异,并比较不同年龄组间外周血白细胞的端粒长度及hTERT mRNA差异.结果:先天性心脏组3-6岁组的受检者及健康受试者3-6岁组平均外周血白细胞端粒(1.63± 0.61)长于先天性心脏组7-10岁组的受检者及健康受试者7-10岁组(1.36± 0.46)(t=1 1.37,P＜0.05);各组均无端粒酶表达.结论:外周血白细胞的端粒长度随着年龄的增长而缩短.端粒酶活性与先天性心脏病发病并无直接相关性.     

先天性心脏病相关综合征的遗传学研究

先天性心脏病(congenitalheartdisease,CHD)是儿科常见的疾病,现已发现约有300多种临床综合征伴有CHD.对Alagille综合征、CHARGE联合征、Holt-Oram综合征、Noonan综合征、Turner综合征、VACTERL联合征、Williams综合征、22q11缺失综合征和13、18、21三体综合征与CHD相关流行病学、临床表型、遗传病因和诊断及其再发风险进行了综述,为产前和产后临床诊断,了解疾病预后和再发概率提供资料.     

Angiopoietin-2 in Adults with Congenital Heart Disease and Heart Failure

Background

Chronic heart failure is an important cause for morbidity and mortality in adults with congenital heart disease (ACHD). While NT-proBNP is an established biomarker for heart failure of non-congenital origin, its application in ACHD has limitations. The angiogenic factors Angiopoietin-1 and -2 (Ang-1, Ang-2), vascular endothelial growth factor (VEGF), and soluble receptor tyrosine kinase of the Tie family (sTie2) correlate with disease severity in heart failure of non-congenital origin. Their role in ACHD has not been studied.

Methods

In 91 patients Ang-2 and NT-proBNP were measured and related to New York Heart Association class, systemic ventricular function and parameters of cardiopulmonary exercise testing. Ang-1, VEGF, and sTie2 were also measured.

Results

Ang-2 correlates with NYHA class and ventricular dysfunction comparable to NT-proBNP. Further, Ang-2 showed a good correlation with parameters of cardiopulmonary exercise testing. Both, Ang-2 and NT-proBNP identified patients with severely limited cardiopulmonary exercise capacity. Additionally, Ang-2 is elevated in patients with a single ventricle physiology in contrast to NT-proBNP. VEGF, Ang-1, and sTie2 were not correlated with any clinical parameter.

Conclusion

The performance of Ang-2 as a biomarker for heart failure in ACHD is comparable to NT-proBNP. Its significant elevation in patients with single ventricle physiology indicates potential in this patient group and warrants further studies.