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OBJECTIVE To conduct the pharmacoeconomic evaluation of empagliflozin in the treatment of heart failure with reduced ejection fraction （HFrEF），and to provide evidence-based reference for rational drug use and medical and healthy decision-making. METHODS A Markov model was used to perform a cost-effectiveness analysis of the regimen of empagliflozin in the treatment of HFrEF ，and to evaluate the cost and effectiveness of standard treatment plan plus empagliflozin （empagliflozin group）vs. standard treatment plan （standard treatment group ）. Clinical parameters were obtained from the EMPEROR-Reduced study；cost and utility data came from the published literatures. The cycle of the model was 1 month and the simulation time was 20 years. Single-factor sensitivity analysis and probability sensitivity analysis were performed to validate the results of cost-effectiveness analysis. RESULTS Compared with the standard treatment group ，each additional quality-adjusted life year in the empagliflozin group cost 37 995.94 yuan more ，which was less than China ’s 1 time GDP per capita in 2020（72 447 yuan）. The results of single factor sensitivity analysis showed that steady-state hospitalization rate of 2 groups was the most important factor affecting the incremental cost-effectiveness ratio . The results of probability sensitivity analysis showed that when the willingness-to-pay threshold （WTP）was 1 time GDP per capita in 2020（72 447 yuan），the probability of empagliflozin group with cost-effectiveness advantage was 58.8％；when the WTP was 3 times GDP per capita in 2020（217 341 yuan），the probability of empagliflozin group with cost-effectiveness advantage was 63.8％. CONCLUSIONS Compared with standard treatment plan alone，standard treatment plan plus empagliflozin is more cost-effective in the treatment of HFrEF. However ，the economic probability is not high.
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Objective:To investigate effect of reperfusion injury following different ischemic duration on skeletal muscle in rats.Methods:A model of ischemia/reperfusion injury (IRI) was established by unilateral clamping femoral artery and additional application of tourniquet in skeletal muscle of hind limbs in 35 male Wsitar rats. According to different ischemia time, the animals were assigned to 2-hour ischemia and 24-hour reperfusion (I2R24 group), 2.5-hour ischemia and 24-hour reperfusion (I2.5R24 group), 3-hour ischemia and 24-hour reperfusion (I3R24 group), 4-hour ischemia and 24-hour reperfusion (I4R24 group) and sham group, with 7 rats per group. At the end of reperfusion, gastrocnemious tissues and plasma samples were collected and analyzed. The ratio of wet ∶ dry weight (W/D) was used to measure muscle edema. The assay of 3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) was conducted to evaluate muscle viability. HE staining was executed to observe histopathological changes. Immunofluorescence staining was performed to assess the levels of C1q, C3b/c, tissue factor (TF), fibrinogen (FN), bradykinin receptor 1 (BR1), BR2, vascular cell adhesion molecule-1 (VCAM-1), E-selectin, fibrinogen-like protein-2 (FGL-2) and myeloperoxidase (MPO) in muscle tissues. ELISA method was used to determine the concentrations of interferonγ (IFN-γ), interleukin7 (IL-7), IL-18, macrophage inflammatory1α (MIP-1α) and monocyte chemotactic protein 1 (MCP-1) in plasma.Results:With prolongation of ischemia time and subsequent reperfusion, tissue edema became severe gradually. The ratio of W/D was 5.3±0.2, 6.1±0.3, 6.9±0.2, 7.6±0.3 in I2R24, I2.5R24, I3R24 and I4R24 groups, higher than that in sham group (4.5±0.1) (all P<0.01). Muscle viability got decreased gradually. Muscle viability was (62.4±3.5)%, (45.3±3.3)%, (35.4±3.4)%, (27.1±5.9)% in I2R24, I2.5R24, I3R24 and I4R24 groups, lower than that in sham group［(93.8±7.2)%］(all P<0.01). Histopathological changes became aggravated gradually. The most severe group was I4R24 group, with the most severe myocyte injury, interstitial edema and extensive inflammatory infiltration, followed by I3R24, I2.5R24 and I2R24 groups in order. There was normal structure integrity and neatly arranged myocyte in sham group. Meanwhile, levels of C1q, C3b, FN, BR1, VCAM-1, E-selectin and FGL-2 got increased gradually. The highest levels for these factors were seen in I4R24 group, followed by I3R24 group, I2.5R24 group, I2R24 group and sham group in order. The rough ratio of the number of positive MPO cells/total cell number under high lens (×200) were increased gradually, with the highest level in I4R24 group, followed by I3R24 group, I2.5R24 group, I2R24 group and sham group in order. However, expression of TF and BR2 were not altered significantly among the groups. Plasma levels of INF-γ, IL-7, IL-18, MIP-1α and MCP-1 elevated gradually with prolongation of ischemia time (all P<0.01). The sequence was the sham group, I2R24 group, I2.5R24 group, I3R24 group and I4R24 groups for levels of these factors from low to high (all P<0.01). Conclusion:Reperfusion after prolongation of ischemia duration can increase the activation of complement, coagulation, kinin and endothelial cells as well as the release of inflammatory factors, and thus aggravate the degree of skeletal muscle tissue injury.
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Objective To evaluate the relationship between the change of the aortomitral angle (AMA) with left ventricular systolic function in patients with ischemic cardiomyopathy (ICM) by echocardiography.Methods Thirty-one patients were enrolled in the ICM group,and 59 healthy subjects were selected as the control group.On the parasternal left ventricular long axis plane,AMA were measured at the R wave apex (R-AMA),J-point(J-AMA),ST-segment midpoint(ST-AMA),T-final wave (T-AMA)and P-final wave (P-AMA).The angle difference(⊿ θ) =AMAmax-AMAmin,the angle changing rate =⊿ θ/AMAmax.The global left ventricular longitudinal strain (GLS) and global circumferential strain (GCS) were obtained by 2D-speckle tracking echocardiography.Left ventricular ejection fraction(LVEF),left ventricular end-diastolic volume(LVEDV) and left ventricular end-systolic volume(LVESV) were measured using Simpson biplane method.Results The J-AMA was the largest in the control group,while the ST-AMA was the largest in the ICM group.The levels of LVEDV,LVESV and AMA in ICM group were significantly higher than those in control group,while LVEF,GLS,GCS,⊿ θ/AMAmax and ⊿ θ were decreased (P ＜0.05).In the control group,there was a correlation between T-AMA and LVEF (r =-0.349,P =0.007),and ⊿ θ was negatively correlated with GLS (r =-0.372,P =0.004).In the ICM group,⊿1 θ/AMAmax and ⊿ θ were correlated with LVEF (r =0.424,P =0.018;r =0.490,P =0.005).Conclusions AMA in ICM patients is significantly increased.The angle difference and the rate of its change are closely related to the LVEF,which is a manifestation of three-dimensional structure change of the myocardial.
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Objective To compare the clinical effectiveness,safety,cost-effectiveness of Targeting Gene Therapy with conventional therapy on patients with Essential Hypertension by metoprolol.Methods 300 cases of patients with Essential Hypertension were included.165 cases were chosen and assigned to conventional therapy group(Group A)at random.The subjects of Group A were administrated with metoprolol for 100 mg,twice per day.Polymorphism of CYP2D6 and ?1 adenoreceptor gene of the remain 135 subjects were detected,133 cases with of ?1-AR gene carrying Arg 389 allele were devided into three groups according to CYP2D6 genetype:the poor metabolism group(PM,43 cases),intermediate metabolism group(IM,54 cases)and extensive metabolism group(EM,36 cases).The subjects of PM,IM and EM were administrated with metoprolol for 25,100,200 mg/d respectively,twice per day.Blood pressures and side effects were observed during 8-week following-up.The health economic evaluation on Gene Targeting Therapy was determined by using the cost-effectiveness analysis.Results Total effective rate in Group PM,IM or EM were obviously higher than that in Group A(P