1.The Direct Medical Costs And Prognosis Of Cerebral Ischemia 2.Predictive Value Of Plasma Matrix Metalloproteinase-9 For Atherosclerotic Cerebrovascular Events

Part One The direct medical costs and prognosis of cerebral ischemiaBackground:Economic evaluation has permeated through every corner of health service research since the 1970s.It would be beneficial to optimizing the allocation of health care resource reasonably and improving the payment system of medical service.Stroke is a heavy economic burden on the individuals,society and health service,accounting for 2～4%of the direct costs of healthcare.At present,there is no study concerned with the features of diagnosis and treatment of stroke in our country,such as long-term venous transfusion,widely application of traditional chinese medicine,lack of referral system.Based on foreign experience,we will analyse this features in our study.Objectives:(1) Set up the stroke data bank of the emergency,and prospective study the direct medical costs of stroke.(2) Discuss the factors that influence the direct medical costs.(3) Assess the outcome and cost-effectiveness ratio of mild or moderate patients based on inpatients versus no inpatients.Methods:Data were obtained from the stroke data bank of emergency in peking union hospital, we identified 151 patients with a first or recurrent stroke during may 1,2006,to March 31,2007. Univariate and multivariate analyses were performed to identify the main predictors of resource use and costs.Logistic regression analysis were applied to examine the main predictors of prognosis in the mild or moderate patients.Compare the cost-effectiveness ratio of mild inpatients versus no inpatients.Results:(1) By the 12th month after stoke,the median hospital cost per patient was 11282.9 yuan(equal to 28.3 percent per capita annual net income of urban residents),488.6 yuan per day. Of the first year stroke costs 54.06%accounts for the inpatient costs.(2) The largest contributors to the the inpatient costs were medication(32.80%),image studies(16.66%),medical material(13.83%),laboratory tests(12.42%).5.42%attribut to the costs for staff.(3) The significant variables associated with the inpatient costs on multiple linear regression analysis were:(ⅰ) length of venous transfusion,(ⅱ) intentive care,(ⅲ) length of stay,(ⅳ) stroke severity(NIHSS),(4) In mild or moderade patient,the direct medical costs wasn't associated with the outcomes of prognosis based on logistic regression analysis,(5) Inpatient is not a cost-effective choice for the mild and moderade patients.Conclusions:(1) Compare with developed country,our expenditure of stroke is still at a low level stage.The ratio of stroke costs accounting for per capita annual net income of urban residents is in rational range that can be burdened.But it is a heavy burden to the low-income groups.(2)The main components to the the inpatient costs were medication,image studies,medical materials,laboratory tests.(3) The hospital costs are significantly determined by length of venous transfusion,intentive care, length of stay and stroke severity(NIHSS).It may be the effective method to reduce the discharge of stroke by reasonably controlling the length of venous transfusion and intentive care.(4) Inpatient is not a cost-effective choice for the mild and moderade patients.Diagnosis Related Groups System may provide a good reference to cutting down the costs of stroke. Part Two Predictive value of plasma matrix metalloproteinase-9 for atherosclerotic cerebrovascular eventsBackground:Rupture of atherosclerotic plaque is the main trigger of acute cardiovascular and Cerebrovascular events.Inflammatory response play a crucial role in every session of atherosclerosis.Through the study of inflammation factors people expect to find the markers that related to vascular events.Matrix metalloproteinases 9(MMPs-9) is one of the most promising markers.But the plasma levels of MMPs-9 of atherosclerotic cerebrovascular patients in the stable period have not been reported.Objectives:To study the differences of the MMPs-9 levels of the atherosclerotic cerebrovascular patients in the stable period,and to approach the clinical application values of this detection.Methods:Recruit 122 cerebrovascular atherosclerotic patients and 43 normal subjects.All patients were divided into 3 groups according to symptomatology(group 1,asymptomatic;group 2,recurrent;group 3,without recurrence).Plasmas MMPs were measured quantificatly during the stable period were subjected by ELISA.Results:(1) The plasma MMPs-9 levels of patients were significantly higher than that of the normal subjects.(2) There were no statistical significance differences among subgroups of patients in the levels of MMPs.But the trend of the levels was asymptomatic＞recurrent＞stable patients.(3) There is no significant correlation between the MMPs-9 level and the extent of cerebrovascular lesions.(4) No significant increase was observed for MMPs-9 level according to the risk factors,and the using of medications(angiotensin-converting enzyme inhibitors and statin) as well.Conclusions:(1).The plasma MMPs-9 levels of patients were significantly higher than that of the normal subjects. (2).There was a gradually rising trend of the MMPs-9 levels in the asymptomatic,recurrent and stable patients.But this results needs further investigation.(3).There is no significant correlativity between the MMPs-9 levels and the extent of cerebrovascular lesions.(4).the risk factors of cerebrovascular disease do not affect the MMPs-9 level,so do ACEI and statin drugs.These conclusions were inconsistent with the reports of foreign authors'.