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心脏移植后新生抗供者特异性抗体对移植心脏功能和受者存活的影响

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中华器官移植杂志 2017年第5期38卷 257-261页

作者：涂斌黄洁廖中凯郑哲宋云虎王巍胡盛寿中国医学科学院国家心脏病中心阜外医院心脏移植中心北京100037

目的研究心脏移植术后新生抗供者特异性抗体（DSA）对移植心脏功能和受者存活的影响.方法选择2013年3月至2016年1月连续195例接受心脏移植的受者,排除13例术前群体反应性抗体（PRA）阳性者及10例术后死亡者,共172例受者纳入研究.检测... 详细信息

目的研究心脏移植术后新生抗供者特异性抗体（DSA）对移植心脏功能和受者存活的影响.方法选择2013年3月至2016年1月连续195例接受心脏移植的受者,排除13例术前群体反应性抗体（PRA）阳性者及10例术后死亡者,共172例受者纳入研究.检测受者HLA分型及DSA,根据检测结果,将受者分为DSA阳性组、抗HLA抗体阳性DSA阴性组（DSA阴性组）及抗HLA抗体阴性组（HLA阴性组）3组进行观察.记录受者的心脏事件及其转归,分析新生DSA与心脏事件发生的相关性.心脏事件包括心脏原因心功能不全、移植心脏血管病（CAV）和心脏原因受者死亡.结果 172例受者术后随访（1.3±0.8）年,出现DSA阳性者6例,占3.4％,其中HLA Ⅰ类抗体阳性1例,占16.7％.DSA出现时间为术后（256±125）d,分布趋势集中在术后半年内.DSA阳性组的心脏事件发生率为83.3％,1例在发现DSA阳性后的145 d发生需要支架治疗的移植冠状动脉病变：4例在发现DSA阳性后（54±13）d出现心功能不全,经皮质激素冲击和免疫球蛋白治疗及调整免疫抑制方案后心功能恢复正常.而DSA阴性组心脏事件发生率为15.8％,1例为心脏原因死亡,2例出现心功能不全.HLA阴性组心脏事件发生率为4.1％,6例发生心功能不全.多变量分析结果表明,DSA阳性是导致移植心功能不全和影响受者中长期存活的独立危险因素（P=0.02）;Kaplan-Meier生存分析显示,3组间存活率的比较,差异均有统计学意义（P＜0.001）.结论心脏移植术后DSA阳性的出现与受者术后心脏事件密切相关.建议术后常规监测HLA抗体,尽早筛查出DSA阳性的受者并给予治疗.

关键词：心脏移植抗供者特异性抗体

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ECPKA在肝细胞癌中的诊断价值

肝脏 2015年第5期20卷 347-351页

作者：王姣锋李玉华林文尧江峰付朝伟孟炜复旦大学附属华东医院上海200040 长宁区疾病预防控制中心江苏省海门市疾病预防控制中心复旦大学公共卫生学院流行病学教研室教育部公共卫生安全重点实验室

目的探讨血清细胞外蛋白激酶A(ECPKA)在肝细胞癌(HCC)诊断中的价值。方法采用病例对照研究方法,收集研究对象的环境因素、疾病史及健康状况信息;检测血清中ECPKA和AFP活性。利用Logistic回归模型分析血清ECPKA与HCC的关系,对ECPKA进行Bo... 详细信息

目的探讨血清细胞外蛋白激酶A(ECPKA)在肝细胞癌(HCC)诊断中的价值。方法采用病例对照研究方法,收集研究对象的环境因素、疾病史及健康状况信息;检测血清中ECPKA和AFP活性。利用Logistic回归模型分析血清ECPKA与HCC的关系,对ECPKA进行Box-cox正态转换后,计算ROC曲线下面积及其95%可信区间。将ECPKA和AFP转化为有序数据后,拟合Logistic回归模型,计算ECPKA、AFP及二者同时存在时的ROC曲线下面积及其95%可信区间,并进行两两比较。根据Youden指数最大原则,并结合Logistic回归分析结果及ROC曲线,确定最佳临界值。结果 HCC患者血清ECPKA表达水平为(15.579±7.441)U/mL,健康对照为(5.277±3.190)U/mL,两组间差异有统计学意义(P<0.05)。单因素和多因素Logistic回归结果显示,ECPKA粗OR值及调整年龄和性别后OR值分别为1.48(1.37,1.59)和1.49(1.38,1.61)。ROC曲线下面积为0.908(0.870,0.946)。将ECPKA和AFP转换为有序数据后,ECPKA+AFP、ECPKA和AFP ROC曲线下面积分别为0.931(0.897,0.967)、0.895(0.858,0.932)和0.789(0.721,0.838)。ECPKA和ECPKA+AFP的ROC曲线下面积均高于AFP,u值分别为3.38和4.70(均P<0.01);ECPKA与ECPKA+AFP之间的差异无统计学意义(u=1.41,P=0.079)。根据约登指数最大原则,结合Logistic回归结果及ROC曲线,选择10 U/mL为ECPKA的最佳临界值,此时,灵敏度为75.25%,特异度为91.87%,阳性预测值为69.72%,阴性预测值为93.72%。结论 HCC患者血清中ECPKA表达显著上调,ECPKA可能是一个新的、有价值的HCC诊断的替代指标。

关键词：原发性肝细胞癌细胞外蛋白激酶A 肿瘤标记物

急性心肌梗死后住院期间血压测值的预后价值:来自存活试验的见解

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世界核心医学期刊文摘(心脏病学分册) 2007年第6期 45-45页

作者： Yap Y.G Duong T Bland j.M 刘相飞 jalan Pahang No.72 G.S.Ave. Kuala Lumpur 53000 Department of Medicine Faculty of Medicine andHealth Sciences University Putra Malaysia

背景:急性心肌梗死后住院期间血压测值的预后价值一直以来未被研究,尤其是其对于心律失常性死亡的价值。方法:研究对象为EMIAT、CAMIAT、SWORD、

关键词：心肌梗死后血压住院期间预后价值测值

Offspring from Heterotopic Transplantation of Newborn Mice Ovaries

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Offspring from Heterotopic Transplantation of Newborn Mice O...

他汀类药物应用和痴呆发病风险的心血管健康研究

第九届中国实验动物科学年会（2010新疆）

作者： S Li1~*,B-L Qin2~*.F Li1,W-L Li2,Z-D Shi2,Y-B Tian3 and X-j Chen1 1 Center for Developmental Biology,Xinhua Hospital,Shanghai jiao Tong University,School of Medicine, Shanghai,China 2College of Animal Sciences,South China Agricultural University,Guangzhou,China 3Zhongkai College of Agriculture and Technology,Guangzhou,China

Objective Ovarian tissue transplantation was initially described as a means of rescuing endocrine and reproductive functions in women(Oktay and Karlikaya 2000;Oktay et al.2001).For example,fertility loss due to iatrogenic disruption of ovarian function in female oncological patients is expected as a consequence of receiving chemotherapy and/or radiation *** et al.(2004) reported that live births could be achieved using oocytes derived from cryopreserved human ovarian cortical tissues after orthotopic *** technology has offered an important strategy for potentially preserving ***,a similar approach would also be very useful for the conservation of endangered wild animals orrare *** on ovarian tissue transplantation has been ongoing for decades(Parrott 1957,1959a;b),and live mouse offspring have been derived from cryopreserved primordial follicles(Carroll et al.1990;Eppig and O’Brien 1996).Ovarian tissue transplantation has been developed as a simple and highly efficient alternative for obtaining matured *** transplantation of mouse ovaries to the kidney capsule has also been described(Telfer et al.1990).When fertilized in vitro and transferred into surrogate mothers,oocytes derived from transplanted ovarian tissues resulted in a few live offspring(cox et al.1996;Liu et al.2000;Lee et al.2004).Recently,Liu et *** that live offspring can be obtained from oocytes derived from the ovarian tissues of newborn *** study reports that after the ovarian tissue is transplanted,the retrieved oocytes require a longer time for in vitro maturation(Dinnyes et al.2001).In order to further investigate this technology,in this study,we demonstrate that frozenthawed newborn mouse ovarian tissues can produce mature oocytes after xenograft transplantation into the kidney capsules of adult female mice administered pregnant mare serum gonadotropin(PMSG).In addition,we developed a system that facilitates in vitro

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世界核心医学期刊文摘（神经病学分册） 2005年第12期1卷 6-6页

作者： Rea T.D. Breitner j.C. Psaty B.M. 郭俊 Dr.Department of Medicine University of Washington Metropolitan Park 1730 Minor Ave Seattle WA 98101 United States

Background: Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) reduce cardiovascular risk through mechanisms that might affect the development of dementia. Abstract:Objective: To evaluate whether statin use is associated with a lower risk of dementia compared with never use of lipid-lowering agents (LLAs). Design: Cohort study of community-dwelling adults 65 years and older. The analysis included 2798 participants free of dementia at baseline. Main Outcome Measures: Using cox proportional hazards regression analysis, we estimated the risk of incident all-cause and type-specific dementia associated with time-dependent statin therapy compared with never use of LLAs. The primary analyses incorporated a 1-year lag between exposure and outcome. Secondary analyses included the final year of exposure and modeled statin use as current use vs nonuse to simulate a case-control approach. Results: Compared with never use of LLAs, ever use of statins was not associated with the risk of all-cause dementia (multivariable-adjusted hazard ratio [HR], 1.08; 95%confidence interval [CI], 0.77-1.52), Alzheimer disease alone (HR, 1.21; 95%CI, 0.76-1.91), mixed Alzheimer disease and vascular dementia (HR, 0.87; 95%CI, 0.44-1.72), or vascular dementia alone (HR, 1.36; 95%CI, 0.61-3.06). In contrast, in secondary analyses, current use of statins compared with nonuse of LLAs was associated with HRs of 0.69 (95%CI, 0.46-1.02) for all-cause dementia and 0.56 (95%CI, 0.35-0.92) for any Alzheimer disease. Conclusions: In this cohort study, statin therapy was not associated with a decreased risk of dementia. Methodological differences may explain why results of this cohort investigation differ from those of prior case-control studies. Additional investigation is needed to determine whether and for whom statin use may affect dementia risk.

关键词：心血管健康他汀类药物发病风险阿尔茨海默病心血管病降脂药物病例对照方法队列研究血管性痴呆无痴

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女性运动能力列线图的预测价值

世界核心医学期刊文摘(心脏病学分册) 2006年第3期 25-25页

作者： Gulati M. Black H.R. Shaw L.j. 姜朝晖 Northwestern University Bluhm Cardiovascular Institute 201 E. Huron St. Chicago IL 60611 United States Dr.

BACKGROUND: Recent studies have demonstrated that exercise capacity is an independent predictor of mortality in women. Normative values of exercise capacity for age in women have not been well established. Our objectives were to construct a nomogram to permit determination of predicted exercise capacity for age in women and to assess the predictive value of the nomogram with respect to survival. METHODS: A total of 5721 asymptomatic women underwent a symptom-limited, maximal stress test. Exercise capacity was measured in metabolic equivalents(MET). Linear regression was used to estimate the mean MET achieved for age. A nomogram was established to allow the percentage of predicted exercise capacity to be estimated on the basis of age and the exercise capacity achieved. The nomogram was then used to determine the percentage of predicted exercise capacity for both the original cohort and a referral population of 4471 women with cardiovascular symptoms who underwent a symptom-limited stress test. Survival data were obtained for both cohorts, and cox survival analysis was used to estimate the rates of death from any cause and from cardiac causes in each group. RESULTS: The linear regression equation for predicted exercise capacity(in MET) on the basis of age in the cohort of asymptomatic women was as follows: predicted MET=14.7-(0.13× age). The risk of death among asymptomatic women whose exercise capacity was less than 85 percent of the predicted value for age was twice that among women whose exercise capacity was at least 85 percent of the age-predicted value(P< 0.001). Results were similar in the cohort of symptomatic women. CONCLUSIONS: We have established a nomogram for predicted exercise capacity on the basis of age that is predictive of survival among both asymptomatic and symptomatic women. These findings could be incorporated into the interpretation of exercise stress tests, providing additional prognostic information for risk stratification.

关键词：列线图运动能力预测值数值分析预测价值女性运动

原发胆汁性肝硬化存活率依赖于腹水和(或)外周水肿的进展:一项阶段性预后模型

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世界核心医学期刊文摘（胃肠病学分册） 2006年第2期2卷 62-62页

作者： Carpenter j.R. Rigamonti C. A.K. Burroughs 李宏宇 Liver Transplantation and Hepatobiliary Medicine Royal FreeHospital Pond StreetHampsteadLondonNW3 2QG United Kingdom

Objective. Current prognostic models in primary biliary cirrhosis (PBC) have low precision, partly due to the restricted inclusion criteria of some cohorts used for modelling but also because of the prolonged natural course of the disease. It is hypothesized that better precision could be achieved with a staged model, using ascites or peripheral oedema as a new startingpoint for prediction. Material and methods. The study was based on an established database of 289 consecutive patients, followed between 1977 and 1998. Stepwise cox regression was used to construct a staged model based on 143 patients who first developed ascites (n = 111) or peripheral oedema (n = 32) at entry or during subsequent follow-up. The model was compared with published models using graphical methods and receiver operating characteristics (ROCs). Results. Mean time from clinical diagnosis of ascites or peripheral oedema to death was 3.1 years. The following variables had independent prognostic significance: log10(bilirubin) (p < 0.001), albumin (p < 0.001), age (p < 0.001) and history of encephalopathy (p < 0.001). Goodness of fit showed that the survival probabilities predicted by the Ascites Stage Model fitted well with the observed data. The Ascites Stage Model (ROC 0.8324 (SE 0.0348)) was a better predictor of survival than the Mayo long-term model (ROC 0.7833 (SE 0.0397)), the Mayo Repeated Patient Visits Model (ROC 0.7779 (SE 0.0399)) and the Royal Free PBC Prognostic Model (ROC 0.7785 (SE 0.0396)). Conclusions. The Ascites Stage Model gives a better survival estimate for PBC patients once they have developed ascites or peripheral oedema compared with the current models, and demonstrates an advantage of staged models in diseases with a prolonged natural history.

关键词：胆汁性肝硬化外周水肿存活时间临床诊断预后意义作图法吻合度选择标准

剥脱性青光眼和原发性开角型青光眼生存率的比较:乙酰唑胺应用的影响

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世界核心医学期刊文摘（眼科学分册） 2005年第2期1卷 5-5页

作者： Ritland j.S. Egge K. Lydersen S. 杨建刚 Eye Department úlesun d Hospital N-6026 úlesund Norway

Purpose: To compare the survival rates of patients with exfoliative glaucoma ( XFG) and those with primary open-angle glaucoma (POAG), and to establish whethe r the use of acetazolamide has any influence on survival. Methods: The survival data, including date and cause of death, for 1147 patients with XFG or POAG who were ultimately hospitalized at the Eye Department, National Hospital, Oslo, bet ween 1961 and 1970, were analysed retrospectively. The cox proportional hazard m odel was used in the survival analyses. Results: No statistically significant di fferences in survival were found between patients with XFG and those with POAG ( P=0.85). As expected, female gender and younger age at diagnosis were associated with longer survival periods. Surprisingly, we found that patients with more re cent birth dates had relatively lower survival rates than patients with earlier birth dates; when this was included in the analyses, the use of acetazolamide wa s found to be associated with reduced survival (n=492, P=0.02).

关键词：剥脱性青光眼乙酰唑胺生存分析存活期统计学显著性死亡原因医院眼科住院治疗

1940～1991年期间Ⅰ型糖尿病(胰岛素依赖型)死亡率情况分析

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Oncology and Translational Medicine 1994年第2期11卷 74-74页

作者： N.T.Raymont P.G.McNally P.R.Burton j.L.Botha P.G.F.Swift A.C.Burden j.R.Hearnshaw 胡春平 Departments of Epidemiology and Public Health Diabetes Leicester Royal Infirmary UK 同济医科大学附属同济医院

一项以人口为基础的,1940～1989年期间,年龄小于17岁就作出诊断的Ⅰ型糖尿病(胰岛素依赖型)845例患者死亡率研究,于1991年12月31日得到确认,这项研究代表了14 039个危险人年时。该研究用 cox 配比适合模型对随时间死亡的相对危险度进行... 详细信息

一项以人口为基础的,1940～1989年期间,年龄小于17岁就作出诊断的Ⅰ型糖尿病(胰岛素依赖型)845例患者死亡率研究,于1991年12月31日得到确认,这项研究代表了14 039个危险人年时。该研究用 cox 配比适合模型对随时间死亡的相对危险度进行了研究。年龄、性别和时间的调整标化死亡率(SMR)使用一般线型模型进行了预测,诊断时

关键词：胰岛素糖尿病多肽代谢病可信限死亡率