Polymorphisms of the NOS3 gene and risk of myocardial infarction in the Tunisian population

Controversial results regarding the association of eNOS gene (NOS3) polymorphisms with myocardial infarction (MI) have been reported. This study investigated the relationship of the −786T>C (rs2070744), 894G>T (rs1799983) and 4a4b polymorphisms of the NOS3 gene with the presence of MI in the Tunisian population. In addition, we also examined the association of NOS3 gene haplotypes with MI in Tunisian subjects.A total of 303 patients with MI and 225 controls were included in the study. The 894G>T and −786T>C single nucleotide polymorphisms were analyzed by PCR-RFLP, and 4a4b polymorphism just for PCR.There was significant linkage disequilibrium between the three NOS3 polymorphisms (p < 0.0001). The genotype distribution and allele frequency of NOS3 4a4b, but not −786T>C and 894G>T, polymorphism was significantly different between MI patients and controls. The univariate logistic regression analysis showed a significant association of the 4a4b polymorphism and MI according to co-dominant, dominant and recessive models (co-dominant model OR: 4.38, 95%CI: 1.24–15.41; p = 0.021, dominant model OR: 1.66, 95%CI: 1.14–2.42); p = 0.007, and recessive model OR: 3.85, 95%CI: 1.10–13.47; p = 0.035). The multivariate analysis, adjusted for traditional cardiovascular risk factors, revealed that the NOS3 4a4a genotype was an independent predisposing factor to MI, according to the models considered. In addition, a haplotype 7 (C-T-4a), (OR = 12.05, p = 0.010) was a risk factor of MI after controlling for classical risk factors.These finding suggest that the 4a4b polymorphism of the NOS3 gene was associated with MI in Tunisian patients.     

Environmental temperature and mortality from acute myocardial infarction

Mortality from acute myocardial infarction (MI) over the 5 year period 1982–1987 in Brown County, Wisconsin, was analyzed to assess the relationship with environmental temperature. Deaths occurrring on the day of and the day following a significant snowfall as well as deaths occuring in health care facilities were eliminated from consideration because the focus was upon temperature, not snowfall or events within a hospital. These criteria resulted in the inclusion of 1,802 days and 926 cases of acute MI. The mean temperature on the day of death was obtained from climatological data and were grouped into six categories covering a range of temperatures from<–17.8°C (0°F) to 16.1°C (61°F). The number of deaths in each category was tabulated. The effect of temperature, sex, and age were analyzed by regression analysis. The results indicated a linear increase in mortality as mean daily temperature decreased over the temperature range. The inverse temperature effect was most pronounced in males over the age of 60. These results indicate that cold temperatures appear to be associated with an increased mortality from myocardial infarction.     

Procalcitonin as a prognostic marker in patients with acute myocardial infarction

Background: Procalcitonin is involved in the inflammatory response and is associated with adverse prognosis in certain conditions.

Aims: To investigate the association between procalcitonin and major adverse cardiac events (MACE), left ventricular (LV) function and remodelling following acute myocardial infarction (AMI).

Methods: Plasma procalcitonin was measured in 977 patients with AMI. Subjects were followed for MACE (median 671 days). A subgroup underwent echocardiography at discharge and follow-up LV function and volume assessment.

Results: Procalcitonin was associated with MACE on uni- and multivariable analysis. Kaplan–Meier assessment revealed an adverse outcome in subjects with procalcitonin above the median. Procalcitonin was related to markers of LV dysfunction and remodelling.

Conclusion: Procalcitonin is associated with MACE, LV dysfunction and remodelling post-AMI.     

Secular trends of obesity and cardiovascular risk factors in a Mediterranean population

Objective: To evaluate time trends of obesity, abdominal obesity, and cardiovascular risk factors (CRFs) according to BMI and waist circumference (WC) categories in a Mediterranean population. Research Methods and Procedures: Subjects were Spanish men (n = 2383) and women (n = 2525) 25 to 74 years old, examined in 1994 to 1995 and 1999 to 2000 in two independent population‐based cross‐sectional surveys in the northeast of Spain. Lifestyle measures, CRFs, and anthropometric variables were analyzed. Results: Over the 5 years of the study, mean age‐standardized BMI increased by 1.0 units in men and by 0.8 units in women. At the same time the prevalence of obesity increased from 15.4% to 21.9% in men and from 15.4% to 21.4% in women. An upward trend was observed for WC and abdominal obesity (WC > 102 cm in men and WC > 88 cm in women) only in men. The proportion of men and women with hypercholesterolemia, diabetes, and low high‐density lipoprotein‐cholesterol plasma concentration remained stable within BMI and WC categories. The proportion of hypertension and smoking in obese men significantly increased from 1995 to 2000. Discussion: The 5‐year increase in BMI and WC is of considerable magnitude in the present population, although several CRFs remained stable within BMI and WC categories.     

A pilot study on the relation between irisin single-nucleotide polymorphism and risk of myocardial infarction

BackgroundMyocardial infarction (MI) is the major cause of death and disability worldwide. Many recent studies revealed the relationship between circulating irisin levels, endothelial dysfunctions and subclinical atherosclerosis in adult patients.ObjectivesThe aim of this study was to investigate the distribution of Irisin gene single nucleotide polymorphism in patients with MI and its association with other clinical and laboratory variables in these patients.Patients and methodsThis study was carried out in 100 patients with MI, and 100 healthy subjects served as controls. All studied subjects underwent laboratory investigations, including measurement of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c) high-density lipoprotein cholesterol (HDL-c), creatinine kinase-MB (CK-MB), troponin I (TnI) and genotyping of rs 3480 and rs726344 of Irisin genes using the TaqMan Allelic Discrimination assay technique.ResultsThere was a significant difference of Irisin genotypes in patients when compared to controls. By estimating odd ratio (OR) an association was found between G allele of rs 3480 and A allele of rs726344with increase the risk of developing myocardial infarction by 4.03 and 3.47 fold respectively. GG of rs 3480 carriers had significantly increased Troponin I and triglyceride levels, while GA carriers of rs726344 had significantly increased CKMB, Total cholesterol, LDLc, HDLc, troponin I and triglyceride levels compared with other genotypes.ConclusionG allele of rs 3480 and A allele of rs726344can considered as genetic risk factors for MI; these findings could have an impact on preventive strategy for myocardial infarction.     

Meteorological factors and the time of onset of chest pain in acute myocardial infarction

Analysis of the time of onset of chest pain in 2254 patients with a myocardial infarction admitted to a coronary care unit in Leicester during a 10-year period shows an association with temperature and humidity. During both the most cold and humid times of the year, the relationship is a strong one. A generalized linear model with a log link was used to fit the data and the backward elimination selection procedure suggested a humid, cold day might help to trigger the occurrence of myocardial infarction. In addition, cold weather was found to have a stronger effect on the male population while those men aged between 50 and 70 years were more sensitive to the effect of high humidity.     

Oxidized LDL receptor gene (OLR1) is associated with the risk of myocardial infarction

Lectin-like oxidized low-density lipoprotein receptor (LOX-1/OLR1) has been suggested to play a role in the progression of atherogenesis. We analyzed the OLR1 gene and found a single nucleotide polymorphism (SNP), G501C, in patients with ischemic heart disease from a single family, which resulted in the missense mutation of K167N in LOX-1 protein. We compared the group of patients with myocardial infarction (MI) (n=102) with a group of clinically healthy subjects (n=102), and found that the MI group had a significantly high frequency of 501G/C+501C/C (38.2%) compared with the healthy group (17.6%; p<0.002). The odds ratio for the risk of MI associated with the 501G/C+501C/C genotype was 2.89 (95% CI, 1.51-5.53). These findings suggest that OLR1 or a neighboring gene linked with G501C SNP is important for the incidence of MI. Manipulating LOX-1 activity might be a useful therapeutic and preventative approach for coronary artery disease, especially for individuals with the G501C genotype of OLR1.     

急性心肌梗死并发肺部感染患者的临床特点和病原菌特征及危险因素分析

分析急性心肌梗死（AMI）并发肺部感染患者的临床特点、病原菌特征及危险因素,为该类患者的治疗提供参考。

选择2019年1月至2021年1月海安市人民医院收治的96例AMI患者作为研究对象,并根据患者在治疗过程中是否并发肺部感染将其分为感染组（40例）和非感染组（56例）。采集患者痰液标本并对感染病原菌进行鉴定,同时观察肺部感染患者的临床特点。采用多因素Logistic回归分析探讨AMI患者并发肺部感染的危险因素。

96例AMI患者中存在40例肺部感染,共检出病原菌22株,其中革兰阴性菌14株（占63.64%）,革兰阳性6株（占27.27%）,真菌2株（占9.09%）。与非感染组比较,感染组患者血红蛋白、白蛋白、总蛋白水平较低,降钙素原、超敏C反应蛋白、肿瘤坏死因子-α水平较高（均P＜0.05）。单因素分析显示,AMI患者并发肺部感染与年龄、卧床时间、有无慢性阻塞性肺疾病、有无侵入性操作存在显著关联（均P＜0.05）。多因素Logistic回归分析显示,年龄≥60岁（OR = 3.71,95%CI：1.62～8.49）、卧床时间≥2周（OR = 3.42,95%CI：2.12～5.54）、慢性阻塞性肺疾病（OR = 2.68,95%CI：2.19～3.29）、侵入性操作（OR = 3.40,95%CI：2.69～4.30）及低蛋白血症（OR = 1.37,95%CI：1.09～1.74）均为AMI患者并发肺部感染的相关因素（均P＜0.05）。

AMI患者并发肺部感染的病原菌以革兰阴性菌为主,其次为革兰阳性菌;年龄、卧床时间、慢性阻塞性肺疾病、侵入性操作及低蛋白血症均为AMI患者并发肺部感染的独立危险因素。

     

冠心病患者胰岛素抵抗程度的影响因素分析

目的:分析冠心病患者胰岛素抵抗程度的影响因素。方法:选择我院收治的冠心病住院患者166例,根据胰岛素抵抗指数(HOMA-IR)水平将其分成四组。A组:HOMA-IR≤1.53(n=36);B组:1.53HOMA-IR≤3.46(n=30);C组:3.46HOMA-IR≤5.13(n=36);D组:HOMA-IR≥5.14(n=64)。检测和比较各组一般临床资料和相关生化指标的差异,并进一步分析影响冠心病患者胰岛素抵抗程度的危险因素。结果:C、D组腰围、空腹血糖(FBG)、餐后2 h血糖(2 h PBG)、低密度脂蛋白胆固醇(LDL-C)均高于A、B组;D组空腹胰岛素(INS)均高于A、B组,B、C组INS、LDL-C均高于A组;D组体质量、TC高于A组。上述差异均有统计学意义(P0.05)。多因素分析结果显示BMI、腰臀比(WHR)、FBG、INS、TC、HDL-C均是HOMA-IR的影响因素(P0.05)。结论:体重、腰围、FBG、2h PBG、INS、TC、HDL-C的上升均为加重冠心病患者胰岛素抵抗程度的危险因素。     

纤维蛋白原与冠心病PCI介入治疗围术期心肌梗死的相关性

目的:探讨纤维蛋白原与冠心病介入治疗围术期心肌梗死的相关性。方法:2013年1月到2015年1月,选择在我院进行诊治的冠心病患者92例,都给予PCI介入手术治疗,在手术前后进行纤维蛋白原与心功能的测定,对围术期心肌梗死发生情况与临床资料进行调查与分析。结果:所有患者都介入手术治疗成功,术后LVESVI与LVEDVI值都明显低于术前(P0.05),而术后LVEF值明显高于术前(P0.05);术后患者的血浆纤维蛋白原值为3.66±0.42 g/L,明显低于术前的7.45±0.56 g/L(P0.05)。围手术期发生心肌梗死8例,发生率为8.7%。Spearman秩相关分析法结果显示心肌梗死发病与血浆纤维蛋白原、LVESVI、LVEDVI、LVEF值都存在明显相关性(P0.05),多元Logistic回归分析结果显示纤维蛋白原、LVESVI、LVEDVI、LVEF、年龄为导致冠心病围术期心肌梗死的主要危险因素(P0.05)。结论:介入手术治疗冠心病具有很好的效果,但是围术期心肌梗死的发生率比较高,纤维蛋白原能有效反应病变状况,在心肌梗死的发生发展中起着关键性作用。     

高龄老年男性高血压患者腔隙性脑梗死与血清尿酸水平的相关性研究

目的：探讨男性高龄高血压患者腔隙性脑梗死（LI）与血清尿酸水平的相关性。方法：以98例男性高龄高血压患者为对象,均行颅脑磁共振成像（MRI）检查和血清尿酸水平测定,同时收集患者的临床和其他实验室数据。根据患者尿酸水平分为1、2、3三组（n=32、32、34）。结果：以尿酸水平分组的患者一般资料比较,单因素方差分析提示,随着尿酸水平的增高,三组的LI个数、血肌酐、尿素水平增高,而高密度脂蛋白（HDL）水平降低,差异有统计学意义（P〈0.05）。三组患者的24 h收缩压、舒张压、年龄、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）和空腹血糖比较,差异无统计学意义（P〉0.05）;LI个数与影响因素的Spearman相关分析提示尿酸及尿素水平与腔梗个数相关（P〈0.05）;LI个数与影响因素的多元线性回归分析提示血清尿酸水平是影响LI个数的独立危险因素（P〈0.01）。结论：在高龄高血压患者中,尿酸水平的增高可能是LI的危险因素之一。     

老年冠心病患者血尿酸水平与肠道菌群的关系

目的探讨老年冠心病患者血尿酸(SUA)水平与肠道菌群的关系,为该类患者的治疗提供参考。方法选择2018年5月至2019年5月我院收治的83例冠心病患者为研究组,选择同期我院83例健康体检者的作为对照组。比较两组对象SUA水平及粪便标本中肠道菌群分布情况(乳杆菌、双歧杆菌、幽门螺杆菌、大肠埃希菌、链球菌);比较不同菌群紊乱程度冠心病患者SUA水平;比较不同SUA水平冠心病患者肠道菌群分布情况。采用Pearson相关分析冠心病患者SUA水平与肠道菌群相关性。结果研究组患者肠道乳杆菌、双歧杆菌数量明显低于对照组(均P<0.05),而肠道幽门螺杆菌、大肠埃希菌、链球菌数量明显高于对照组(均P<0.05)。研究组患者SUA水平明显高于对照组(P<0.05),不同菌群紊乱程度冠心病患者SUA水平有差异有统计学意义(均P<0.05)。不同SUA水平冠心病患者肠道乳杆菌、双歧杆菌、幽门螺杆菌、大肠埃希菌、链球菌数量差异有统计学意义(均P<0.05)。冠心病患者SUA水平与肠道乳杆菌、双歧杆菌数量呈负相关(r=-0.872、-0.912,均P<0.001),与肠道幽门螺杆菌、大肠埃希菌、链球菌数量呈正相关(r=0.915、0.896、0.889,均P<0.001)。结论冠心病患者存在肠道细菌紊乱及高尿酸现象。冠心病患者SUA水平与肠道菌群显著相关,检测冠心病患者SUA水平对监测肠道菌群状态及治疗方案制定具有重要意义。     

女性冠心病患者的危险因素分析及与冠脉病变严重程度的关系

目的:了解女性冠心病患者的危险因素及与冠脉病变严重程度的关系。方法:随机选取本院2012年至2014年心血管科住院治疗的疑似冠心病女性患者150例,经冠脉造影确诊冠心病患者105例,非冠心病患者45例。对患者的临床资料和冠脉病变严重程度进行单因素和多因素分析。结果:冠心病患者高血压与糖尿病百分比、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)及纤维蛋白原水平均高于非冠心病患者,而高密度脂蛋白(HDL-C)和血红蛋白水平均低于非冠心病患者(P0.05);年龄、高血压与糖尿病百分比、血脂上升百分比(高TC、高TG、低HDL-C、高LDL-C)、高尿酸百分比和纤维蛋白原水平均随冠状动脉病变支数及Gensini积分的增加而增加(P0.05);多因素分析发现女性冠心病的影响因素分别为高LDL-C、糖尿病、低HDL-C、TG和高血压,其中高LDL-C的影响最为显著(P0.05)。结论:高血压、糖尿病史、血脂水平为女性冠心病的影响因素,其中高LDL-C的影响最显著,各影响因素均与冠脉病变程度紧密相关。     

Sudden death and its predictors in myocardial infarction survivors in an Indian population

ObjectiveThis study was conducted to assess the incidence of sudden cardiac death (SCD) in post myocardial infarction patients and to determine the predictive value of various risk markers in identifying cardiac mortality and SCD.MethodsLeft ventricular function, arrhythmias on Holter and microvolt T wave alternans (MTWA) were assessed in patients with prior myocardial infarction and ejection fraction ≤ 40%. The primary outcome was a composite of cardiac death and resuscitated cardiac arrest during follow up. Secondary outcomes included total mortality and SCD.ResultsFifty-eight patients were included in the study. Eight patients (15.5%) died during a mean follow-up of 22.3 ± 6.6 months. Seven of them (12.1%) had SCD. Among the various risk markers studied, left ventricular ejection fraction (LVEF) ≤ 30% (Hazard ratio 5.6, 95% CI 1.39 to 23) and non-sustained ventricular tachycardia (NSVT) in holter (5.7, 95% CI 1.14 to 29) were significantly associated with the primary outcome in multivariate analysis. Other measures, including QRS width, heart rate variability, heart rate turbulence and MTWA showed no association.ConclusionsAmong patients with prior myocardial infarction and reduced left ventricular function, the rate of cardiac death was substantial, with most of these being sudden cardiac death. Both LVEF ≤30% and NSVT were associated with cardiac death whereas only LVEF predicted SCD. Other parameters did not appear useful for prediction of events in these patients. These findings have implications for decision making for the use of implantable cardioverter defibrillators for primary prevention in these patients.     

慢性阻塞性肺疾病并念珠菌性口炎患者病原学及危险因素分析

目的 探讨入院慢性阻塞性肺疾病(COPD)并念珠菌性口炎患者的病原学特征以及相关危险因素.方法 采用病例研究,对2007年4月1日至2011年1月31日入院的82例COPD并念珠菌性口炎患者和82例无念珠菌性口炎COPD患者进行匹配,应用SPSS 17.0统计软件行条件logistic回归模型分析COPD患者念珠菌性口炎发生的危险因素.结果 (1)从念珠菌性口炎患者假膜培养共分离出念珠菌83株,以白念珠菌(90.4％)为最多,其次为光滑念珠菌(3.6％)、克柔念珠菌(2.4％)、热带念珠菌(2.4％)、近平滑念珠菌(1.2％);(2)统计学分析结果显示全身应用、吸入糖皮质激素是入院患者口腔念珠菌感染的独立危险因素.结论 白色念珠菌是COPD患者口腔部念珠菌感染的主要病原菌,规范使用全身糖皮质激素、正确吸入糖皮质激素是预防COPD患者口腔念珠菌感染的关键.     

Plasma metallomics reveals potential biomarkers and insights into the ambivalent associations of elements with acute myocardial infarction

Acute myocardial infarction (AMI) is a leading cause of mortality and morbidity worldwide. Using a validated and efficient ICP-MS/MS-based workflow, a total of 30 metallomic features were profiled in a study comprising 101 AMI patients and 66 age-matched healthy controls. The metallomic features include 12 essential elements (Ca, Co, Cu, Fe, K, Mg, Mn, Na, P, S, Se, Zn), 8 non-essential/toxic elements (Al, As, Ba, Cd, Cr, Ni, Rb, Sr, U, V), and 10 clinically relevant element-pair product/ratios (Ca/Mg, Ca×P, Cu/Se, Cu/Zn, Fe/Cu, P/Mg, Na/K, Zn/Se). Preliminary linear regression with feature selection confirmed smoking status as a predominant determinant for the non-essential/toxic elements, and revealed potential routes of action. Univariate assessments with adjustments for covariates revealed insights into the ambivalent relationships of Cu, Fe, and P with AMI, while also confirming cardioprotective associations of Se. Also, beyond their roles as risk factors, Cu and Se may be involved in the response mechanism in AMI onset/intervention, as demonstrated via longitudinal data analysis with 2 additional time-points (1-/6-month follow-up). Finally, based on both univariate tests and multivariate classification modelling, potentially more sensitive markers measured as element-pair ratios were identified (e.g., Cu/Se, Fe/Cu). Overall, metallomics-based biomarkers may have utility for AMI prediction.     

Everolimus- and sirolimus-eluting stents in patients with and without ST-segment elevation myocardial infarction

Aims

Everolimus-eluting stents (EES) were superior to sirolimus-eluting stents (SES) in a dedicated myocardial infarction trial, a finding that was not observed in trials with low percentages of ST-elevation myocardial infarction (STEMI). Therefore, this study sought to investigate the influence of clinical presentation on outcome after EES and SES implantation.

Methods

A pooled population of 1602 randomised patients was formed from XAMI (acute MI trial) and APPENDIX-AMI (all-comer trial). Primary outcome was cardiac mortality, MI and target vessel revascularisation at 2 years. Secondary endpoints included definite/probable stent thrombosis (ST). Adjustment was done using Cox regression.

Results

In total, 902 EES and 700 SES patients were included, of which 44 % STEMI patients (EES 455; SES 257) and 56 % without STEMI (EES 447; SES 443). In the pooled population, EES and SES showed similar outcomes during follow-up. Moreover, no differences in the endpoints were observed after stratification according to presentation. Although a trend toward reduced early definite/probable ST was observed in EES compared with SES in STEMI patients, long-term ST rates were low and comparable.

Conclusions

EES and SES showed a similar outcome during 2-year follow-up, regardless of clinical presentation. Long-term safety was excellent for both devices, despite wide inclusion criteria and a large sub-population of STEMI patients.     

Organoids in recapitulating tumorigenesis driven by risk factors: Current trends and future perspectives

Environmental and exogenous/ endogenous factors, in a setting of individual genetic predisposition, contribute to the cancer development. Over the years, epidemical evidence increasingly highlights the correlations of multiple cancer incentives and genetic alterations with cancer incidence. Unraveling the pivotal carcinogenesis events prompted by particular risk factors remarkably advances early surveillance and oncogenesis intervening. Traditional cell-based models and animal-based models are unrealistic and unreliable for translational study, respectively ascribing to the limited tumor heterogeneity and species-related variation. Organoid emerged as a fidelity model that well preserves the properties of its origin. With inherent quality of holistic perspective, organoid is therefore ideally suited for delineating the carcinogenesis under risk exposure, in favor of understanding pathogen-host interactions and alleviating cancer initiation. In this review, we have summarized the organoid model-based evidence that identified or validated carcinogenic risks, mainly including diet, aging, microbial infection, and chemical exposure. In addition, we envisioned the exciting prospect of organoid model in screening promising treatment and/or prevention during tumorigenesis. As a robust 3D in vitro system, organoid has been widespread applied in basial and clinical cancer research, which may elucidate crucial mechanisms of oncogenesis and develop novel targeting strategies.     

脂肪来源干细胞治疗心肌梗死的现状及策略

急性心肌梗死是最常见的心血管疾病之一,由于冠状动脉供血不全导致心肌细胞大量坏死、生存微环境恶化,近期可发生心肌细胞机械-电生理功能紊乱,远期可导致心力衰竭。目前的临床治疗方法虽能在一定程度上改善心功能,减轻心室重塑,但由于心肌细胞再生能力有限,心脏功能难以完全恢复正常。近年来,脂肪来源干细胞移植治疗急性心肌梗死受到广泛关注,但由于移植后细胞的存留和存活率普遍较低,总体治疗效果并不理想。本文对目前脂肪来源干细胞治疗急性心肌梗死的现况及提高其疗效的途径和方法作一综述。     

糖尿病合并肺结核患者诱导耐药性危险因素的回归分析

目的:研究2型糖尿病(Type 2 Diabetes,T2DM)合并肺结核(Tuberculosis,TB)患者诱导耐药性危险因素的回归分析。方法:从2012年3月到2013年3月,于我院共计有124例患者被确诊为肺结核,将其作为研究对象。根据患者是否合并有2型糖尿病,将其分成观察组(49例)及对照组(75例)。对全部患者进行耐药性实验,分别经单因素分析及Logistic回归性分析寻找诱导耐药性的危险因素。结果:观察组在治疗过程中断、有吸烟习惯、依从性差、病程≥1年、HbAlc值≥6.5%等方面所占比例显著高于对照组,差异均有统计学意义(均P0.05)。由多因素分析可知,治疗过程中断、有吸烟习惯、依从性差、病程≥1年、HbAlc值≥6.5%等均为糖尿病合并肺结核患者的危险因素。结论:T2DM合并TB患者诱导耐药性的危险因素较多,临床应重点关注,并采取相应措施,从而为临床治疗提供更为有利的条件。