ANN INTERN MED：2012年临床医学研究的重大研究成果

2012年陆续发表了一系列临床研究结果为临床医师提供了更好的临床实践参考。传统的临床检验，如前列腺特异性抗原(PSA)检测，常常存在是否用于所有患者临床筛查的的争议。这种争议往往不能得出明确的结论，但是去年的两项研究提供了这方面的证据，即PSA筛查对死亡率的影响较小，并且有造成重大伤害的风险。

一项新技术使结直肠癌患者的检测更为简便，而且有希望增加检出率。血栓栓塞性疾病的治疗有了重要的进展。新型抗凝剂，Xa因子抑制剂在未来几年或许会得到更广泛的使用。这些新型药物使得血栓性疾病的治疗更为简单有效。

去年两项新研究提示阿司匹林治疗可有效预防左心室功能障碍患者静脉血栓性(VTE)和卒中的复发。此外 一项新研究显示Bariatric减肥手术在治疗糖尿病方面有着深远影响，现在的问题是何时并如何推荐这种治疗方法。肥胖的新治疗包括美国FDA在2012年新批准的2种药物，但是临床医师在开此类药物之前应该仔细分析这些数据。

1、阿司匹林每天100 mg可以有效预防非肿瘤或心血管病患者特发性深静脉血栓的复发

Aspirin Reduces the Risk for Recurrent VTE After an Initial Unprovoked Deep Venous Thrombosis or Pulmonary Embolism

Becattini C, Agnelli G, Schenone A, et al. Aspirin for preventing the recurrence of venous thromboembolism.

2、口服Xa因子抑制剂利伐沙班与标准治疗方案（低分子量肝素加法华林）在治疗症状性肺栓塞上效果相当

Rivaroxaban, an Oral Factor Xa Inhibitor, Is Noninferior to Standard Treatment of Symptomatic Pulmonary Embolism

Bu¨ ller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism.

3、华法林与阿司匹林在预防正常窦性心律心衰患者发生缺血性卒中、出血性卒中和死亡方面没有明显不同

No Difference Between Aspirin and Warfarin Anticoagulation for Patients With Heart Failure in Normal Sinus Rhythm

Homma S, Thompson JL, Pullicino PM, et al. Warfarin and aspirin in patients with heart failure and sinus rhythm.

4、不用泻药的CT仿真虚拟内镜诊断结肠腺瘤敏感性与特异性较高

Laxative-Free Computed Tomographic Colonography Approaches Colonoscopy Accuracy for Colorectal Cancer Screening

Zalis ME, Blake MA, Cai W, et al. Diagnostic accuracy of laxativefree computed tomographic colonography for detection of adenomatous adenomatous polyps in asymptomatic adults: a prospective evaluation.

5、PSA检测前列腺癌可降低前列腺相关的死亡但不能降低全因死亡率

Prostate Cancer Screening Reduces Prostate-Specific but Not All-Cause Mortality

Schro¨ der FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up.

6、局限性前列腺癌积极的手术治疗并不明显优于临床观察

Surgery for Localized Prostate Cancer Is Not Clearly Superior to Observation

Wilt TJ, Brawer MK, Jones KM, et al. Radical prostatectomy versusobservation for localized prostate cancer.

7、美国FDA2012年批准替诺福韦加恩曲他滨用于HIV的暴露前预防

Preexposure Prophylaxis for HIV Prevention

Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women.

8、联合应用芬特明/托吡酯或可有效降低体重

Combination Phentermine–Topiramate May Be Effective for Weight Loss

Garvey WT, Ryan DH, Look M, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study.

9、减肥手术相比非手术治疗2型糖尿病更有效

Bariatric Surgery Is More Effective Than Nonsurgical Treatment for Controlling Type 2 Diabetes

Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes.

原文阅读：Update in general internal medicine: evidence published in 2012.

This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of general internal medicine. Topics include venous thromboembolism, colorectal cancer screening, prostate cancer, HIV infection, and obesity.