ABSTRACT
Objective:To analyze the costs and effectiveness of five common screening modes and genetic screening for thalassemia in China in order to find the optimal way and provide evidence for the implementation of thalassemia prevention and control projects in Hunan Province.Methods:From June 2020 to April 2021, 12 971 couples from 14 cities and autonomous prefectures in Hunan Province were selected as the study population. The diagnosis of thalassemia was based on the results of genetic testing. Results of routine blood test and hemoglobin electrophoresis were collected and analyzed. The efficacy of five screening modes, at the cut-off value of <80 fl or 82 fl for the mean corpuscular volume (MCV), was analyzed by positive predictive value, negative predictive value, Jorden index and cost-effectiveness ratio. Sensitivity analysis was used to assess the feasibility of genetic screening at different costs after fixing the costs of routine blood and hemoglobin electrophoresis. The five thalassemia screening models are as follows: Mode 1: The woman had a blood routine test first. If the result was positive, the spouse required a blood routine test. If both results were positive, a thalassemia gene test should be offered to the couple. Mode 2: Both husband and wife were screened by blood routine and hemoglobin electrophoresis. If one or both of them were positive, both would be tested for thalassemia gene. Mode 3: The couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing. Mode 4: The woman was screened by blood routine and hemoglobin electrophoresis. If any one of them was positive, the woman would be tested for thalassemia gene. If the gene test result was positive, the spouse should receive thalassemia gene. Mode 5: Both spouses conducted a blood routine test. If either was positive, both would conduct hemoglobin electrophoresis test. If both were positive, both spouses should receive thalassemia gene testing. Gene testing mode: The woman would be tested for thalassemia, and her spouse would have thalassemia test too if her result was positive.Results:When using MCV<80 fl as the cut-off for diagnosing thalassemia, the Youden indices of the five prenatal screening modes in Hunan Province were 0.551, 0.639, 0.898, 0.555 and 0.356, while when using MCV<82 fl as the cut-off, the Youden indices were 0.549, 0.629, 0.851, 0.548 and 0.356. When the MCV cut-off value was <80 fl, the missed diagnosis rates of the five screening modes were 44.44%, 0.00, 0.00, 18.52% and 62.96%, and the cost-effectiveness ratios were 21 709, 250 939, 76 870, 138 463 and 92 860 yuan (RMB)/couple, respectively. When the price of genetic testing was lower than 55 yuan (RMB), the cost-effectiveness ratio of genetic screening was lower than that of Mode 3.Conclusions:MCV<80 fl can be considered as the positive criteria in blood routine screening for thalassemia in Hunan Province, and the cost-effectiveness ratio of Mode 3 (the couple received blood routine tests initially. If either was positive, both should receive hemoglobin electrophoresis testing. If either was positive, both parties will conduct thalassemia gene testing) is the best. Genetic screening has certain advantages with the decreasing price.
ABSTRACT
Objective:To investigate the efficacy of compound carbidopa tablets combined with Bunao Xifeng Zhijing soup in the treatment of Parkinson’s disease(PD)and the influence on the levels of IL-6,IL-1β,MDA,SOD and serum cystatin C. Methods:Totally 68 patients with PD were divided into the observation group and the control group with 34 cases in each. The course of treatment was 3 months. The control group was treated with compound carbidopa tablets,and the observation group was treated with Bunao Xifeng Zhijing soup additionally. The Parkinson's disease quantitation table(UPDRS),quality of life,TCM symptoms,self-rating depression scale(SDS),self-rating anxiety scale(SAS)and changes of inflammatory factors before and after the treatment were compared between the two groups. Results:After the treatment,UPDRS-1,UPDRS-2,UPDRS-3, UPDRS-4,PDQ-39 SI,SDS,SAS and TCM symptom scores were all decreased in both groups(P < 0. 05),and the decrease was more notable in the observation group(P < 0. 05). Observation group UPDRS-4 score also significantly lower than the control group(P < 0. 05). After treatment,two groups of patients of interleukin(IL)6,IL-1 beta,malondialdehyde(MDA),serum(C level was a significant reduction in the inhibition(P < 0. 05),superoxide dismutase(SOD)levels,compared with the previous significantly increased(P < 0. 05). And the observation group of patients with IL-6,IL-1 beta,MDA,urinary inhibition C level significantly lower than the control group,serum SOD levels are significantly higher than control group(P < 0. 05). Observation group total effectiveness 91. 18% ,significantly higher than that of control group 64. 70%(P < 0. 05). Conclusion:compound carbidopa tablets combined with Bunao Xifeng Zhijing soup in the treatment of PD can significantly improve the movements and non-motor symptoms of the patients with high safety and good clinical efficacy.
ABSTRACT
Objective:To explore the levels of serum leptin,adiponectin and resistin in simple obesity and also to investigate their roles in this disease. Methods:The serum adiponectin,resistin,leptin,anthropometric and biochemical measurements of fasting blood glucose,fasting insulin were detected in 31 simple obesity subjects and 30 normal subjects. Results:① The adiponectin level in obesity group was significantly lower than that in normal group,but levels of leptin and resistin were higher(P