内分泌科涉及到的疾病广泛、知识点繁多,发病机制及病理生理过程复杂,一个良好的教学方法在教学中至关重要.本文对思维导图、CBL教学法进行了介绍,同时以内分泌科疾病低钠血症、原发性醛固酮增多症临床病例为中心,以学生为主体,结合思维导图多层次发散思维,指导学生们根据自己的喜好及现有条件选择适合的制作方式,利用主体关键词,建立从病因、辅助检查到诊断、治疗和预后的清晰诊疗过程,通过层级图标将各级主体表现出来,确立各个诊断要点间的逻辑关系和知识架构,将抽象的知识点在具体案例中具象化,以直观、生动的图形方式表达具体内容,把形象思维和逻辑思维结合起来,激发学生的主观能动性,以便更好地培养学生的创新性思维及解决临床实际问题的能力,提高教学效果和质量.

目的 探讨三碘甲腺原氨酸(T3)对甲状腺乳头状癌细胞TPC-1增殖的影响及其机制.方法 将TPC-1细胞分为对照组(0 ng/ml T3处理组)、12.5 ng/ml T3处理组和50 ng/ml T3处理组,分别用对应T3浓度处理细胞,实时无标记细胞功能分析技术(RTCA)和克隆形成实验检测细胞的增殖能力,Western blot检测细胞中PDZK1表达水平.利用慢病毒转染的方法将TPC-1细胞分为敲减PDZK1(shPDZK1)组、敲减对照(shNC)组、过表达PDZK1(PDZK1)组、过表达对照(Vector)组,采用Western blot检测TPC-1细胞中PDZK1表达水平,同时用不同浓度的T3(0、12.5、50 ng/ml)处理各组细胞,利用克隆形成实验检测细胞的克隆形成能力.结果 12.5及50 ng/ml T3处理组TPC-1的细胞指数及克隆形成数明显高于对照组,差异均有高度统计学意义(P<0.01).12.5及50 ng/ml T3处理组细胞中PDZK1表达量明显高于对照组,差异均有统计学意义(P<0.05或P<0.01).与shNC组比较,sh-PDZK1组细胞中PDZK1的表达量明显较低,差异有统计学意义(P<0.05).与Vector组比较,PDZK1组细胞PDZK1的表达量明显升高,差异有高度统计学意义(P<0.01).在0、12.5、50 ng/ml T3处理下,与shNC组比较,shPDZK1组细胞的克隆形成数均明显减少,差异均有统计学意义(P<0.05或P<0.01).在0、12.5、50 ng/ml T3处理下,与Vector组比较,PDZK1组细胞的克隆形成数均明显增加,差异均有统计学意义(P<0.05或P<0.01).结论 T3可能通过上调TPC-1细胞PDZK1的表达调控细胞增殖.

目的 探讨GLP?1受体激动剂艾塞那肽调控棕色脂肪组织(BAT)的作用机制.方法 20只8周龄雄性db/db小鼠随机分为正常对照(Con)组和艾塞那肽组(Exe组),每组各10只,Con组予0.9％氯化钠注射液,Exe组予艾塞那肽20 nmol/(kg·d),皮下埋泵干预6周,检测腹腔注射葡萄糖耐量试验(IPGTT)和体重,留取空腹血浆和BAT分别检测TC、TG.Western blot法检测过氧化物酶体增殖物激活受体γ共激活剂1 a(PGC?1a)、解偶联蛋白1(UCP?1)和血管生成素样蛋白4(ANGPTL4)等表达.10只C57小鼠分为正常对照组(NC)和敲除组(ANGPTL4?/?组),每组各5只,进行正电子发射计算机断层显像(pet?CT)实验,留取血浆和BAT进行TC、TG和Western blot实验.结果 与Con组比较,Exe组血糖水平在0、30、60、90和120 min时降低(P<0.05或P<0.01).与Con组比较,Exe组体重、TG、TC水平降低(P<0.05),UCP?1、PGC1?a和ANGPTL4蛋白表达升高(P<0.01).与NC组比较,ANGPTL4?/?组SUV、TG、TC水平降低(P<0.05),UCP?1、PGC?1α、UQCRC2、NDUFB8蛋白表达降低(P<0.05或P<0.01).结论 艾塞那肽提高ANGPTL4蛋白表达水平,增加BAT活性,ANGPTL4敲降后降低BAT活性和产热功能,ANGPTL4可能成为艾塞那肽调控BAT活性和功能的靶点.

肥胖症是指体内脂肪总含量的增多或分布异常而造成的慢性代谢性疾病,可以引起糖、脂、尿酸等代谢异常,增加心脑血管疾病的发生率;肥胖患者睡眠呼吸暂停、骨性关节炎等生物力学相关并发症的发生率也比普通人高 [1].

甲状腺结节是临床上常见的疾病,发病率逐年增高.诊断和治疗甲状腺结节的首要问题是要识别其良恶性.超声已成为甲状腺疾病诊断的首选方法,但分析需要专家知识,且比较费时.近年来,多个基于深度学习的甲状腺分类系统被提出并用于计算机辅助诊断,但是训练过程一般都需要大量的超声图像数据.本研究中数据集共674个甲状腺结节,包含恶性结节240个,良性结节434个.为了在较小数据集上也可获得满意的性能,我们采用预训练的经典AlexNet、VGG16与ResNet50,基于迁移学习来调整参数,采用多模型、多切片集成学习方法.结节分类的准确率、精度和召回率分别为86.7％、79.2％和84.7％.实验结果表明,该算法在数据量较小的情况下也可以取得较好性能.

Objective: To investigate the association between smoking and the severity of coronary lesions among young and middle-aged female patients with acute coronary syndrome (ACS). Methods: Data of this study were derived from the Improving Care for Cardiovascular Disease in China (CCC)-ACS project, a collaborative study of the Chinese Society of Cardiology and the American Heart Association. Since 2014, the CCC-ACS project consecutively enrolled inpatients with ACS, systematically collected their clinical data and evaluated medical quality of these patients from 158 tertiary hospitals and 82 secondary hospitals across China. This study enrolled female patients less than 60 years old with initial ACS, who received coronary angiography in CCC-ACS project. Patients were divided into two groups according to smoking status. A multivariate logistic regression analysis was used to analyze the association between smoking and the severity of coronary lesions among young and middle-aged female patients with ACS. Results: A total of 2 863 female patients younger than 60 years old with initial ACS, who received coronary angiography, were enrolled. Among them, 12% (340 cases) was smokers. Proportion of patients younger than 45 years old was higher (13.2% (45/340) vs. 8.5% (215/2 523), P<0.01) and prevalence of hypertension (59.4% (202/340) vs. 66.7% (1 683/2 523), P<0.01) and diabetes (39.4% (134/340) vs. 44.2% (1 116/2 523), P=0.09) was lower in smoker group than in non-smoker group. However, prevalence of ST-elevation myocardial infarction (66.8% (227/340) vs. 53.7% (1 354/2 523), P<0.01), coronary multi-vessel lesions (39.1% (133/340) vs. 32.6% (822/2 523), P<0.01) and severe stenosis in either single-vessel (56.2% (109/194) vs. 46.1% (706/1 530), P<0.01) or multi-vessel (63.2% (84/133) vs. 58.2% (478/822), P=0.29) was significantly higher in smoker group than in non-smoker group. Multivariate logistic regression analyses showed that after adjusting for age, hypertension, diabetes, elevated low-density lipoprotein cholesterol, lower high-density lipoprotein cholesterol, elevated triglyceride, renal insufficiency, family history of coronary heart disease and types of ACS, smokers faced a higher risk of coronary multi-vessel lesions, coronary multi-vessel severe lesions and coronary severe lesions with the odds ratios and 95% confidence interval of 1.41 (1.11-1.79), 1.40 (1.10-1.78) and 1.78 (1.11-2.87), compared with non-smokers. Conclusions: Smoking is significantly associated with an increased risk of extensive and severe coronary lesions among young and middle-aged female patients with ACS. This study provides crucial evidence for further understanding the harms of smoking and the need to strengthen the tobacco control education and smoking cessation guidance for young and middle-aged women.

目的 观察大气细颗粒物PM2.5对老年雄性大鼠骨密度、骨小梁结构的影响,及对核因子κ受体激活剂B配体(RANKL)/骨保护素(OPG)表达的作用,探讨PM2.5对老年大鼠骨代谢的影响.方法 采用雾霾仓暴露系统,按照随机数字表法将20只19月龄老年SD雄性大鼠分为清洁组和PM2.5组,每组10只.将其分别饲养于清洁仓和雾霾仓,每周监测体重,12周后,取材留取股骨组织,检测大鼠骨密度.苏木精-伊红(HE)染色观察骨组织形态;提取骨髓中的mRNA,应用Real-time PCR检测RANKL/OPG的表达情况.结果 两组体重随着时间的延长呈现稳定的增高,但两组体重比较,差异无统计学意义(P＞0.05).HE结果显示,与清洁组比较,PM2.5组松质骨部位的骨小梁减少,排列稀疏、部分断裂.与清洁组比较,PM2.5组骨密度、骨小梁数量、骨小梁面积和骨小梁面积百分比均明显下降,差异均有统计学意义(P＜ 0.05或P＜ 0.01).Real-time PCR结果显示,与清洁组比较,PM2.5组骨髓中的OPG mRNA含量降低,而RANKL mRNA含量增高,差异均有统计学意义(均P＜0.05).结论 长期暴露于PM2.5中有可能通过增加成骨细胞RANKL表达并降低OPG表达,增加破骨细胞活性,进而降低骨密度和骨小梁,加重老年大鼠骨质疏松.

目的 初步评估葡萄糖激酶(glucokinase,GCK)基因突变引起的青少年发病的成年型糖尿病2型(maturity onset diabetes of the young 2,MODY2)在妊娠期血糖异常人群中的比例,建立一种识别GCK基因突变的筛查方法.方法 回顾性分析2016年1月1日至2018年12月31日在首都医科大学附属北京潞河医院进行孕期检查的妊娠妇女,以孕早期、孕中期及孕后期空腹静脉血糖均≥5.5 mmol/L,血清三酰甘油至少1次≤1.43 mmol/L,妊娠24～28周75 g葡萄糖耐量试验2 h增量小于4.6 mmol/L为筛查条件,对受试者进行葡萄糖激酶基因序列测定.结果 共纳入2454例受试者,符合GCK基因筛查条件者12例,获得外周血DNA标本5例,发现1例GCK基因突变者.结论 妊娠期间3次空腹静脉血糖均≥5.5 mmol/L且血清三酰甘油至少1次≤1.43 mmol/L且口服葡萄糖耐量试验2 h血糖增量<4.6 mmol/L的方法,可以发现GCK基因突变,该类型糖尿病在妊娠期血糖异常人群中比较罕见.

Objective: To examine the characteristics and trends regarding the 30-day coronary heart disease (CHD) readmission rates in patients discharged for acute myocardial infarction (AMI) in Beijing, during 2007-2012. Methods: Patients hospitalized for AMI in Beijing from 1 January 2007 to 31 December 2012 were identified from "The Cardiovascular Disease Surveillance System in Beijing". In total, 64 355 patients aged 25 years and over with permanent Beijing residency survived and discharged for AMI in Beijing during the above-said six years. After excluding duplicate and validation for the completeness and accuracy of the records, clinical features and 30-day CHD readmission rates for those AMI discharged patients were analyzed. Trends regarding the 30-day CHD readmission rates in patients discharged for AMI were analyzed by Poisson regression models. Results: The overall age-standardized average 30-day CHD readmission rate for AMI discharged patients was 7.7% in patients aged 25 years and over in Beijing. During the six years under study, an increasing trend was observed on the 30-day CHD readmission rates for AMI discharged patients after adjusting the age and gender (P<0.001). The age-standardized 30-day CHD readmission rates for AMI discharged patients increased by 21.3% in the past six years, from 7.0% in 2007 to 8.5% in 2012. The increase of 30-day CHD readmission rates was noted in both men and women during the six years, whereas it appeared higher in women (8.4%) than in men (7.4%), after adjusting for age. Among the AMI discharged patients, the 30-day CHD readmission rates were higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than those with ST-segment elevation myocardial infarction patients (P<0.01), and higher in discharged patients with multiple comorbidities than those without multiple comorbidities (P<0.01). Conclusions: An increasing trend in the 30-day CHD readmission rates for AMI discharged patients was observed during 2007-2012 among Beijing residents aged 25 years and over. It called for an urgent need in improving the secondary prevention of AMI discharged patients, particularly in women, with NSTEMI and those with multiple comorbidities. Findings from these unselected "real-world" data in Beijing may help to guide the management of AMI in the country as well as in other developing countries.

白脂素(Asprosin)是2016年由Romere,C.发现的一种新的脂肪因子,由白色脂肪分泌,到达肝脏,促进肝糖释放,具有昼夜节律,其分泌水平受饮食和运动影响,在胰岛素抵抗的人和鼠体内升高.Asprosin以嗅觉受体OLFR734为受体调节肝脏葡萄糖生成,促进肝糖释放,维持葡萄糖稳态;穿过血脑屏障作用于神经元促进摄食;作用于胰腺介导 β细胞炎症和 β细胞功能障碍;作用于骨骼肌引起胰岛素敏感性降低.近几年,很多研究提示asprosin与糖尿病、肥胖、多囊卵巢综合征及冠心病等多种疾病相关,有望成为这些疾病的潜在治疗靶点.

Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has occurred in China. Higher risk of COVID-19 infection and worse prognosis were observed among patients with diabetes. There are rigorous challenges existing in terms of diabetes prevention and glycemic control in primary medical care during period of COVID-19. Here, expert recommendations were presented by Chinese diabetologists, healthcare providers, and public health administrators to improve the ability of primary health facilities and provide standardized basic public health and medical services throughout the country. The main contents include basic requirements for management, workflow of health management, referral, treatment, as well as the long-term follow-up.

目的 探讨ERBB3在甲状腺癌发生发展过程中的功能和作用.方法 收集2017年12月～2018年12月北京潞河医院内分泌科甲状腺癌患者4例与甲状腺结节患者6例的细针穿刺组织进行RNA-seq检测,并分析ERBB3水平;利用TCGA甲状腺癌数据库与GEO甲状腺癌数据库,分析比较癌与癌旁,T、N分期,复发患者中ERBB3的水平;采用基因富集分析GSEA分析ERBB3水平与EGFR、PI3K、ERK1/2信号通路的关系,以及肿瘤增殖、转移的关系.结果 与良性甲状腺结节比较,ERBB3 mRNA在甲状腺癌中表达量升高(P＜ 0.001).与癌旁比较,ERBB3 mRNA在甲状腺癌组织中升高(TCGA来源:P＜ 0.0001;GEO来源:P＜ 0.0001).在甲状腺癌患者中,EGFR、PI3K、ERK1/2基因集显著富集于ERBB3高表达患者中.随着T分期的增长,ERBB3水平逐渐增加(P＜0.0001);与增殖相关的基因集显著富集于ERBB3高表达患者中.与N0组比较,N1期患者ERBB3水平显著增加(P＜ 0.0001).与转移相关的基因集显著富集于ERBB3高表达患者中.甲状腺癌复发患者ERBB3的水平升高(P=0.0124).结论 ERBB3可能参与了甲状腺癌的增殖、转移及复发,有望成为甲状腺癌治疗的新靶点.

The standardized training of general practitioners is the key to cultivate qualified general practitioners. Endocrine metabolic disease is an emerging discipline. Improving the clinical teaching quality of standardized training of general practitioners in the field of endocrine metabolic diseases is worthy of attention. In this paper, though analyzing teaching requirements and objectives,and based on our experience in clinical teaching practice, it summarized the problema in training of general practitioners in the field of endocrine metabolic diseases, such as the teaching content method, the teachers level, and student's own questions. Then, it puts forward countermeasures to improve and advance the training quality.

1 病例简介 患者男,63 岁,主因"发现血糖升高3 年,反复低血糖10 天"入院.患者3 年前体检时发现血糖升高,空腹静脉血糖7. 1mmol/ L,无多尿、多饮、多食,无体重下降,故未重视,之后未控制饮食及规律监测血糖.4个月前因腰痛就诊于北京协和医院泌尿外科,做腹部CT 发现腹膜后占位性病变,大小12. 3cm×8. 4cm×3. 5cm,并于北京协和医院穿刺活检病理为"节细胞神经瘤".近1 个月体重下降4 ～5kg,同时发现尿糖(+++),无多食易饥、怕热、心慌、易怒症状,自测空腹指尖血糖15. 9mmol/ L,餐后2 小时血糖19mmol/ L,自行口服阿卡波糖50 ～100mg, 3 次/ 日.服药1 周后就诊于本院门诊,查糖化血红蛋白(HbA1c) 13. 6％,诊断为2型糖尿病.降糖方案:二甲双胍0. 5g,3 次/ 日;格列美脲3mg,1 次/ 日.10 天前患者出现早餐后心慌、头晕,测血糖3. 2mmol/ L,故自行将格列美脲减量至2mg,1次/ 日;监测空腹血糖4 ～ 6mmol/ L, 餐后血糖8 ～10mmol/ L,期间饮食、运动规律.4 天前患者无诱因自测空腹血糖2. 8mmol/ L,进食糖果并停用降糖药,为进一步诊治收入院.

以冠心病和缺血性卒中为主的动脉粥样硬化性心血管疾病(ASCVD)严重威胁着我国人民生命健康.保持血脂健康水平是重要的预防策略,其重点目标为一级预防人群保持低密度脂蛋白胆固醇在理想水平、ASCVD高危人群和患者应在他汀为主的调脂药物治疗基础上,将低密度脂蛋白胆固醇降低并保持在指南推荐的目标水平以下.本文概述了我国人群血脂异常流行趋势和防治现状,以评价现阶段血脂异常的危害程度、存在问题和防治需求.

Objective To investigate the effect of PM2.5 exposure on the thyroid function in male SD rats.Methods Adult Sprague-Dawley rats were divided into "filtered air"（FA） and "PM2.5" groups.These rats exposed to the 2kinds of air for 12 weeks were killed and their plasma and thyroid tissues were taken for investigation.The morphological status and pathological changes of thyroid tissue were observed after H＆E staining.The levels of triiodothyronine （T 3 ）,free triiodothyronine （FT3）,thyroxine

Objective: To assess the use of statins and low-density lipoprotein cholesterol (LDL-C) levels at admission in hospitalized patients aged 75 years and older with acute coronary syndrome (ACS) in China. Methods: Data used in this study derived from the Improving Care for Cardiovascular Disease in China (CCC)-ACS project, a nationwide registry with 150 tertiary hospitals reporting details of clinical information of ACS patients. This study enrolled patients 75 years and older with ACS in CCC-ACS project from November 2014 to June 2017. Patients were divided into two groups according to the history of atherosclerotic cardiovascular disease (ASCVD). Pre-hospital statin use, LDL-C levels at admission and prescription of statins at discharge were reported. Results: A total of 10 899 patients 75 years and older with ACS were enrolled. The median age was 79 years and 58.7% (6 397 cases) were male. Among patients with history of ASCVD, 33.9% (1 028 cases) of them received statins before hospitalization. Among patients without history of ASCVD, 12.7% (996/7 871) received statins before hospitalization. The mean level of LDL-C was (2.4±0.9) mmol/L and LDL-C was <1.8 mmol/L in 24.7% (747 cases) of patients with history of ASCVD. The mean level of LDL-C was (2.6±0.9) mmol/L and LDL-C was <2.6 mmol/L in 51.7% (4 072 cases) of patients without history of ASCVD. At discharge, 91.2% (9 524/10 488) of patients were prescribed with statins in patients without contraindications for statin. Conclusion: In elderly patients with recurrent ASCVD, there was an inadequate statin use before hospitalization and most patients did not reach the LDL-C target level when they had the recurrent events. In the elderly ACS patients without history of ASCVD, more than half of the patients had an ideal LDL-C level. It seems that ideal LDL-C level for primary prevention of ACS in elderly people needs to be reevaluated with further studies.

一般来说,肥胖症有以下几个原因: 1.遗传因素:人类单纯性肥胖的发病有一定的遗传背景.有研究认为,双亲中一方为肥胖,其子女肥胖率约为50％;双亲中双方均为肥胖,其子女肥胖率上升至80％.人类肥胖一般认为属多基因遗传,遗传在其发病中起着一个易发的作用.肥胖的形成还与生活行为方式、摄食行为、嗜好、气候以及社会心理因素相互作用有关.

Objectives: Based on the concept of health quotient (HQ), we designed and facilitated personalized plans to improve patients' compliance and oral health. The study aims to increase HQ level of patients with chronic periodontitis from four aspects, namely self-care, health knowledge, lifestyle, and mental health, and evaluate the effects of HQ training in maintaining oral health. Method: In total, 105 patients with chronic periodontitis were recruited from Capital Medical University-Affiliated Beijing Chaoyang Hospital from January 2015 to January 2017. The patients were randomly split into two groups (control versus test). All the patients received standard periodontal treatments. In addition, patients in the control group received conventional oral health instructions, and patients in the test group received the HQ training. At the end of the training, oral health status of both groups was evaluated and recorded. Results: The oral health status and the HQ scores were significantly better in the test group than the control group (P < 0.01). The training in HQ provided a better guidance for patients in oral health maintenance and further improved patients' compliance. Conclusion: HQ training for patients with chronic periodontitis increased their scores in self-care and health knowledge and significantly slowed down the progression of chronic periodontitis.

Objective: To evaluate the impact of different intervention models on adherence to secondary prevention therapies in patients with acute coronary syndrome (ACS). Methods: This multi-center cross-sectional study collected data from 34 hospitals covering 22 provinces in China. Hospitals were randomly divided into four groups: control group(routine treatment and care), promotional calendar group (routine treatment and care plus giving propaganda desk calendar to patients), education group (routine treatment and care add patients education by nurses) and combined intervention group (promotional calendar and education).At least 90 patients with ACS were consecutively enrolled from each involved hospital from April 15, 2012 to June 30, 2013. To reduce the impact of uneven distribution of inter-group variables on the results, 1∶1∶1∶1 propensity score matching method was used. The drug usage for secondary prevention and prognosis wasobtainedat 6 months after hospital discharge. Results: (1) A total of 3 391 patients were selected and 2 244 patients were included for the final analysisafter propensity score analysis. (2) At 6 months after discharge, the adherence rates of antiplatelet, statins, angiotensin converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB), β-blocker and the combination of 4 medications were similar between control group and promotional calendar group (all P>0.016).The adherence rates of antiplatelet and statins were 97.0% (526/542) and 91.0% (493/542) in the education group, 3.7% and 5.5% higher than in the control group (both P<0.016). The adherence rates of statins,ACEI/ARB and combined medication were 91.0% (496/545), 68.3% (372/545) and 53.2% (290/545) in the combined intervention group,significantly higher than in the control group (5.5%,8.3% and 9.6%, all P<0.016). (3) Poisson regression analysis showed that the adherence of antiplatelet drugs in the education group was 3.4%(OR=1.034, 95%CI 1.007-1.060,P<0.05) and 3.5%(OR=1.035, 95%CI 1.007-1.063, P<0.05) higher than in the control group and the promotional calendar group, and the statins adherence rate was 5.5%(OR=1.055, 95%CI 1.012-1.101,P<0.05) higher than in the control group. The antiplatelet drug adherence rates in the combined intervention group were 3.0% (OR=1.030, 95%CI 1.002-1.058,P<0.05) and 3.1% (OR=1.031, 95%CI 1.003-1.060,P<0.05) higher than in the control group and the promotional calendar group, respectively, and statin adherence was 6.1% (OR=1.061, 95%CI 1.017-1.107,P<0.01) higher than in the control group. The adherence rates of ACEI/ARB in combined intervention group were respectively 15.4%(OR=1.154, 95%CI 1.057-1.259, P<0.01),20.0%(OR=1.200, 95%CI 1.096-1.314, P<0.01) and 25.5%(OR=1.255, 95%CI 1.142-1.380, P<0.01) higher than in the control group, promotional calendar group and education group. The adherence rates of combined medication in combined intervention group were respectively 21.6%(OR=1.216, 95%CI 1.079-1.371, P<0.01),21.5%(OR=1.215, 95%CI 1.077-1.371, P<0.01) and 27.8%(OR=1.278, 95%CI 1.126-1.450, P<0.01) higher than in the control group, promotional calendar group and education group. (4) At 6 months after discharge, the control rates of blood pressure (<140/90 mmHg,1 mmHg=0.133 kPa) in the education group were significantly higher than in the control group and promotional calendar group (78.7% (398/506) vs. 70.2%(373/531) and 71.1% (354/498) , all P<0.016),and the control rates of blood pressure in combined intervention group were higher than in the control group and promotional calendar group (78.2% (376/481) vs. 70.2%(373/531) and 71.1% (354/498) , all P<0.016).The rehospitalization rates were 7.0% (39/561) in the promotional calendar group, and 7.6% (42/561) in the education group, both significantly higher than in the control group (3.8% (21/561), all P<0.016).The rate of the low density lipoprotein cholesterol<2.07 mmol/L and the rate for all-cause mortality were similar among groups (all P>0.016) . Conclusion: Post-discharge medication adherence in ACS patients can be enhanced by either promotional calendaror nurses education strategy, and the efficacy is better by nurse education as compared with promotional calendar, the combination of both methods can further increase the post-discharge medication adherence rates in ACS patients.