常用降糖药物对心血管系统的影响郭立新课件_1.ppt

Bottom line on prescribing new drugs Go slowly: See what six to 12 months of post-marketing experience reveals in terms of both efficacy and side effects. Weigh carefully the risks associated with a new drug against the value for a specific patient. When discussing new drugs with pharmaceutical reps, ask for head-to-head studies with older, standard drugs in comparable doses, and ask for the absolute risk reduction (not relative risk reduction), the number needed to treat and the size of clinical trials. (If you arent familiar with these terms, see Understanding the Risks of Medical Interventions, FPM, May 2000.) Use unbiased resources for your decision making. The Prescribers Letter, The Medical Letter, Epocrates, knowledgeable colleagues and your local pharmacists and pharmacologists are excellent resources. Scrutinize new drugs that end with XL, CR, ER, SR or XR. Does the drug offer clinically relevant new efficacy, safety or adherence benefits, or is it simply a me too product? Finally, get smart about the costs of the prescriptions you write every day. Engage your patients to find out if they are able to buy the drugs you prescribe. I use the line, Lots of my patients are having a hard time paying for their prescriptions. Will this $20 drug be a problem for you? While many new drugs do represent advances in patient care, many others are not far superior to their older, cheaper counterparts. It is our job as physicians to sort out these issues and prescribe drugs that are truly in our patients best interests. 磺脲类对KATP 通道的影响 一些磺脲类比其它磺脲类对胰腺KATp 通道有更高的选择性。 KATP 通道, 是磺脲类受体(SUR2A and SUR1) 和钾通道(Kir6.2)的复合体，在葡萄糖介导的胰腺?细胞分泌胰岛素中起到关键的作用。格列美脲没有阻断心脏组织线粒体KATP 通道的开放，格列本脲没有如此选择性，会阻断心脏组织KATP 通道的反应。这一发现对于2型糖尿病、有心肌梗塞危险的患者的治疗有一定意义。 从事件累积发生率曲线看，2组曲线在研究过程中基本重合。主要终点的结果显示，平均治疗5.5年后，两组的心血管住院或心血管死亡（包括心脏病发作、充血性心力衰竭和脑卒中）没有统计学差异（达到了排除风险升高20%的非劣效性界值）。具体来说，接受文迪雅治疗的患者发生了321次事件（14.5%），接受对照药物治疗的患者发生了323次事件（也是14.5%）（风险比=0.99，95%可信区间=0.85－1.16）。 在次要终点方面，罗格列酮组的全因死亡、心血管死亡、主要心血管不良事件（MACE）的复合终