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紫杉醇和西罗莫司洗脱支架在日常临床工作中的对比：SORT OUT II随机试验
Comparison of Paclitaxel- and Sirolimus- Eluting Stents in Everyday Clinical Practice: The SORT OUT II Randomized Trial
Galloe AM, for the SORT OUT II Investigators  2009/5/27 10:48:50 
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JAMA, 2008,
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Abstract
Context:
Approval of drug-eluting coronary stents was based on results of relatively small trials of selected patients; however, in routine practice, stents are used in a broader spectrum of patients.

Objective:
To compare the first 2 commercially available drug-eluting stents—sirolimus-eluting and paclitaxel-eluting—for prevention of symptom-driven clinical end points, using a study design reflecting everyday clinical practice.

Design, Setting, and Patients:
Randomized, blinded trial conducted August 2004 to January 2006 at 5 university hospitals in Denmark. Patients were 2098 men and women (mean [SD] age, 63.6 [10.8] years) treated with percutaneous coronary intervention (PCI) and randomized to receive either sirolimus-eluting (n=1065) or paclitaxel-eluting (n=1033) stents. Indications for PCI included ST-segment elevation myocardial infarction (STEMI), non-STEMI or unstable angina pectoris, and stable angina.

Main Outcome Measures:
The primary end point was a composite clinical end point of major adverse cardiac events, defined as either cardiac death, acute myocardial infarction, target lesion revascularization, or target vessel revascularization. Secondary end points included individual components of the composite end point, all-cause mortality, and stent thrombosis.

Results:
The sirolimus- and the paclitaxel-eluting stent groups did not differ significantly in major adverse cardiac events (98 [9.3%] vs 114 [11.2%]; hazard ratio, 0.83 [95% confidence interval, 0.63-1.08]; P=.16) or in any of the secondary end points. The stent thrombosis rates were 27 (2.5%) and 30 (2.9%) (hazard ratio, 0.87 [95% confidence interval, 0.52-1.46]; P=.60), respectively.

Conclusion:
In this practical randomized trial, there were no significant differences in clinical outcomes between patients receiving sirolimus- and paclitaxel-eluting stents.

Trial Registration:
Clinicaltrials.gov Identifier: NCT00388934.
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甲状腺功能亢进合并黄疸

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上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
 

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