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Cancer Innovation 2024年第3期3卷 22-32页

作者： Wenhua Song Nan Zhang tonglian Lv Yang Zhao guangping li Gary Tse tong liu tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina department of Radiology Second Hospital of Tianjin Medical UniversityTianjinChina School of Nursing and Health Studies Hong Kong Metropolitan UniversityHong KongChina Cardiac Electrophysiology Unit Cardiovascular Analytics GroupPowerHealth LimitedHong KongChina

Background:The role of surgery in metastatic breast cancer(MBC)is currently *** novel statistical and deep learning(DL)methods promise to infer the suitability of surgery at the individual ***:The objective of this study was to identify the most applicable DL model for determining patients with MBC who could benefit from surgery and the type of surgery ***:We introduced the deep survival regression with mixture effects(DSME),a semi-parametric DL model integrating three causal inference *** models were trained to make individualized treatment *** who received treatments in line with the DL models'recommendations were compared with those who underwent treatments divergent from the *** probability weighting(IPW)was used to minimize *** effects of various features on surgery selection were visualized and quantified using multivariate linear regression and causal ***:In total,5269 female patients with MBC were *** was an independent protective factor,outperforming other models in recommend-ing surgery(IPW-adjusted hazard ratio[HR]=0.39,95%confidence interval[CI]:0.19–0.78)and type of surgery(IPW-adjusted HR=0.66,95%CI:0.48–0.93).DSME was superior to other models and traditional guidelines,suggesting a higher proportion of patients benefiting from surgery,especially breast-conserving *** debiased effect of patient characteristics,including age,tumor size,metastatic sites,lymph node status,and breast cancer subtypes,on surgery decision was also ***:Our findings suggested that DSME could effectively identify patients with MBC likely to benefit from surgery and the specific type of surgery *** method can facilitate the development of efficient,reliable treatment recommendation systems and provide quantifiable evidence for decision-making.

关键词： breast surgery causal inference deep learning metastatic breast cancer

Real-world data on ALK rearrangement test in Chinese advanced non-small cell lung cancer(RATICAL):a nationwide multicenter retrospective study

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Cancer Communications 2024年第9期44卷 992-1004页

作者： lin li Wencai li ChunyanWu Yanfeng Xi Lei Guo yuan Ji lili Jiang Ji li Jingping Yun gang Chen yuan li Yueping liu DianbinMu Yuchen Han Leina Sun Qingxin Xia Xiaodong Teng Nanying Che WeiWu xueshan Qiu Chao liu Xiaochu Yan Daiqiang li Zhihong Zhang ZheWang Yujun li ZhengWang lingchuan Guo Xiu Nie Jingshu Geng Jianhua Zhou Jianming Ying department of Pathology National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking UnionMedical CollegeBeijingP.R.China department of Pathology the First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanP.R.China department of Pathology Shanghai Pulmonary HospitalSchool of MedicineTongji UniversityShanghaiP.R.China department of Pathology Cancer Hospital Affiliated to Shanxi Medical UniversityShanxi Province Cancer HospitalShanxi Hospital Affiliated to Cancer HospitalChinese Academy of Medical SciencesTaiyuanShanxiP.R.China department of Pathology Zhongshan HospitalFudan UniversityShanghaiP.R.China department of Pathology West China Hospital of Sichuan UniversityChengduSichuanP.R.China department of Pathology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingP.R.China department of Pathology Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP.R.China department of Pathology Fujian Cancer HospitalFujian Medical University Cancer HospitalFuzhouFujianP.R.China department of Pathology Department of OncologyFudan University Cancer CenterShanghaiMedical College of Fudan UniversityShanghaiP.R.China department of Pathology The Fourth Hospital of Hebei Medical UniversityShijiazhuangHebeiP.R.China department of Pathology Shandong Cancer HospitalJinanShandongP.R.China department of Pathology Shanghai Chest HospitalShanghai Jiao Tong UniversityShanghaiP.R.China department of Pathology Tianjin Medical University Cancer Institute and HospitalTianjinP.R.China department of Pathology the Affiliated Cancer Hospital of Zhengzhou UniversityHenan Provincial Cancer HospitalZhengzhouHenanP.R.China department of Pathology the First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangP.R.China department of Pathology Bei

Background:Anaplastic lymphoma kinase(ALK)test in advanced non-small cell lung cancer(NSCLC)can help physicians provide target therapies for patients harboring ALK gene *** study aimed to investigate the real-world test patterns and positive rates of ALK gene rearrangements in advanced ***:In this real-world study(ChiCTR2000030266),patientswith advanced NSCLC who underwent an ALK rearrangement test in 30 medical centers in China between October 1,2018 and December 31,2019 were retrospectively *** training was conducted before the study was *** controls were performed at participating centers using immunohistochemistry(IHC)-*** positive ALK gene rearrangement rate and consistency rate were *** associated clinicopathological characteristics of ALK gene rearrangement were investigated as ***:The overall ALK gene rearrangement rate was 6.7%in 23,689 patients with advanced NSCLC and 8.2%in 17,436 patients with advanced lung *** quality control analysis of IHC-VENTANA-D5F3 revealed an intrahospital consistency rate of 98.2%(879/895)and an inter-hospital consistency rate of 99.2%(646/651).IHC-VENTANA-D5F3 was used in 53.6%,real-time polymerase chain reaction(RT-PCR)in 25.4%,next-generation sequencing(NGS)in 18.3%,and fluorescence in-situ hybridization(FISH)in 15.9%in the adenocarcinoma *** specimens tested with multiple methods,the consistency rates confirmed by IHC-VENTANA-D5F3 were 98.0%(822/839)for FISH,98.7%(1,222/1,238)forNGS,and 91.3%(146/160)for *** overall ALK gene rearrangement rateswere higher in females,patients of≤35 years old,never smokers,tumor cellularity of>50,and metastatic specimens used for testing in the total NSCLC population and adenocarcinoma subgroup(all Plights the real-world variability and challenges of ALK test in advanced NSCLC,demonstrating a predominant use of IHCVENTANA-D5F3 with high co

关键词： anaplastic lymphoma kinase diagnosis gene fusion non-small cell lung cancer

Hyperuricacidemia as an independent predictor of paroxysmal atrial fibrillation

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Rosiglitazone attenuates atrial structural remodeling and atrial fibrillation promotion in alloxan-induced diabetic rabbits

中华医学会心电生理和起搏分会第十次全国学术年会

作者： tong liu,Yingle Wu,gang xu,ruyu yuan,guangping li department of cardiology,second hospital of tianjin medical university 300211

Objective Uric acid(UA) is a cardiovascular risk marker associated with oxidative stress and ***,atrial fibrillation(AF) has been associated with inflammation and oxidative stress. The objective of this observational study was to investigate the association between UA levels and paroxysmal AF. Methods Consecutive patients with paroxysmal AF who were hospitalized in the second hospital of tianjin medical university from September 2011 to May 2012,were screened in this study.,We excluded subjects with acute coronary syndrome,congestive heart failure,valvular heart disease, congenital heart disease,cardiomyopathy,acute inflammatory conditions,thyroid *** final study population consisted of 106 patients,65 patients with paroxysmal atrial fibrillation were finally enrolled,and 41 age,sex matched-subjects without AF were served as the control *** baseline clinical data and laboratory examinations results were detected,left atrium diameter(LAD),left ventricular end-diastolic dimension(LVEDD) and left ventricular ejection fraction(LVEF) were determined by 2D-echocardiography. Results In univariate analysis,serum UA,LAD,LVEF,urea nitrogen and estimated glomerular filtration(eGFR) level were significantly increased in patients with paroxysmal AF compared with *** multivariate logistic regression analysis,the serum uric acid level(OR:5.935,P<0.05) and LAD(OR:1.144,P<0.05) were independent risk factors for the occurrence of paroxysmal AF. Conclusion We demonstrated that hyperuricacidemia is an independent risk factor for the development of paroxysmal *** larger studies are needed to evaluate this potential association as well as the underlying mechanisms.

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Rosiglitazone attenuates atrial structural remodeling and at...

Characterization of acute-on-chronic liver diseases: A multicenter prospective cohort study

中华医学会心电生理和起搏分会第十次全国学术年会

作者： tong liu,Hui Zhao,Jian li,guangping li department of cardiology,tianjin Institute of cardiology,second hospital of tianjin medical university

Objectives The pleiotropic effects of glitazones may favorably affect atrial *** sought to investigate the effects of peroxisome proliferator-activated receptor-γ(PPAR-γ) activator rosiglitazone on atrial structural remodeling and atrial fibrillation(AF) promotion in alloxan-induced diabetic rabbits. Methods Twenty alloxan-induced diabetic rabbits were *** of these were treated with rosiglitazone for 4 weeks and the remaining were left untreated while 10 additional healthy rabbits served as *** Langendorff perfused rabbit hearts were used to evaluate atrial electrophysiological parameters and vulnerability to AF which examined by burst *** also performed histology examination to measure atrial fibrosis and measured plasma oxidative stress and inflammatory biomarkers. Results The duration of induced AF was significantly prolonged in the alloxan-induced diabetic rabbits than controls(1.6±0.4 s vs 0 s).Rosiglitazone treatment significantly reduced the duration of induced AF in the treated rabbits(1.6±0.4 s vs 1.2±0.05 s).Moreover,rosiglitazone attenuated atrial structural remodeling reducing the interatrial activation time(35.4±12.1 ms vs 24.2±10.8 ms, P23.3±10.4ms) and the atrial interstitial fibrosis as well(collagen volume fraction:5.6±3.9%vs 2.4±2.1%, P1.6±0.8%).Rosiglitazone increased plasma superoxide dismutase(SOD) activity and on the other hand decreased malondialdehyde(MDA),hs-C reactive protein,and tumor necrosis factor-αlevels. Conclusions Rosiglitazone attenuates arrhythmogenic atrial structural remodeling and AF promotion in alloxan-induced diabetic ***,it seems to modulate oxidative stress and inflammation in this experimental model.

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World Journal of Hepatology 2024年第5期16卷 809-821页

作者： yuan-Yao Zhang Sen Luo Hai li Shu-Ning Sun Xian-Bo Wang Xin Zheng Yan Huang Bei-ling li Yan-Hang Gao Zhi-Ping Qian Feng liu Xiao-Bo Lu Jun-Ping liu Hao-Tang Ren Yu-Bao Zheng Hua-Dong Yan Guo-Hong Deng liang Qiao Yan Zhang Wen-Yi Gu Xiao-Mei Xiang Yi Zhou Yi-Xin Hou Qun Zhang Yan Xiong Cong-Cong Zou Jun Chen Ze-Bing Huang Xiu-Hua Jiang Ting-Ting Qi yuan-yuan Chen Na Gao Chun-Yan liu Wei yuan xue Mei Jing li Tao li Rong-Jiong Zheng Xin-Yi Zhou Jun Zhao Zhong-Ji Meng department of Infectious Disease Institute of Biomedical ResearchRegulatory Mechanism and Targeted Therapy for Liver Cancer Shiyan Key LaboratoryHubei provincial Clinical Research Center for Precise Diagnosis and Treatment of Liver CancerTaihe HospitalHubei University of MedicineShiyan 442000Hubei ProvinceChina department of Gastroenterology Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200120China department of Infectious Diseases Southwest HospitalThe Third Military Medical University(Army Medical University)Chongqing 400000China Center of Integrative Medicine Beijing Ditan HospitalCapital Medical UniversityBeijing 100020China department of Infectious Diseases Institute of Infection and ImmunologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430020Hubei ProvinceChina department of Infectious Diseases Hunan Key Laboratory of Viral HepatitisXiangya HospitalCentral South UniversityChangsha 110051Hunan ProvinceChina Hepatology Unit Department of Infectious DiseasesNanfang HospitalSouthern Medical UniversityGuangzhou 510515Guangdong ProvinceChina department of Hepatology The First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina department of liver Intensive Care Unit Shanghai Public Health Clinical CentreFudan UniversityShanghai 200093China tianjin Institute of Hepatology Nankai University Second People's HospitalTianjin 300192China Infectious Disease Center The First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054Xinjiang Uygur Autonomous RegionChina department of Infectious Diseases and Hepatology The Second Hospital of Shandong UniversityJinan 250000Shandong ProvinceChina State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Collaborative Innovation Center for Diagnosis and Treatment of Infectious DiseaseThe First Affiliated HospitalZhejiang University School of MedicineHangzhou 310000Zhejiang ProvinceChina department of Infectious Diseases The Thir

BACKGROUND Acute-on-chronic liver disease(AoCLD)accounts for the majority of patients hospitalized in the department of Hepatology or Infectious *** To explore the characterization of AoCLD to provide theoretical guidance for the accurate diagnosis and prognosis of *** Patients with AoCLD from the Chinese Acute-on-Chronic liver Failure(ACLF)study cohort were included in this *** clinical characteristics and outcomes,and the 90-d survival rate associated with each clinical type of AoCLD were analyzed,using the Kaplan-Meier method and the log-rank *** A total of 3375 patients with AoCLD were enrolled,including 1679(49.7%)patients with liver cirrhosis acute decompensation(LC-AD),850(25.2%)patients with ACLF,577(17.1%)patients with chronic hepatitis acute exacer-bation(CHAE),and 269(8.0%)patients with liver cirrhosis active phase(LC-A).The most common cause of chronic liver disease(CLD)was HBV infection(71.4%).The most common precipitants of AoCLD was bacterial infection(22.8%).The 90-d mortality rates of each clinical subtype of AoCLD were 43.4%(232/535)for type-C ACLF,36.0%(36/100)for type-B ACLF,27.0%(58/215)for type-A ACLF,9.0%(151/1679)for LC-AD,3.0%(8/269)for LC-A,and 1.2%(7/577)for *** HBV infection is the main cause of CLD,and bacterial infection is the main precipitant of *** most common clinical type of AoCLD is *** diagnosis and timely intervention are needed to reduce the mortality of patients with LC-AD or ACLF.

关键词： Acute-on-chronic liver disease Acute-on-chronic liver failure liver cirrhosis Clinical features Prognosis

A multicenter prospective study on the management of hepatoblastoma in children:a report from the Chinese Children's Cancer Group

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World Journal of Pediatrics 2024年第6期20卷 590-601页

作者： Meng-Jie Tang Xiao-li Ma Xiang-ling He Wei-Hua Pan Xiao-Hong Zhang Sha-Yi Jiang Ju Gao Fu li Wei Yao Song Gu Wei-ling Zhang Qiang Zhao Shi-Hao Huang Yong-Jun Fang Wei liu Hui-Zhong Niu Chun-Mei Wang li-Rong Sun Hui Gao Yun-Peng Dai Shun-Gen Huang Zhi-Yong Zhong Xi-Ge Wang Zhong-Rong li liang-Chun Yang Ye-Ming Wu Huan-Min Wang Xin Sun Xiao-Jun yuan department of Pediatric Hematology/Oncology Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineNo.1665Kongjiang RoadYangpu DistrictShanghai 200092China medical Oncology department Pediatric Oncology CenterBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijing 100045China department of Hematology/Oncology Children's Medical CenterHunan Provincial People's HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangsha 41005China department of Pediatric Surgery Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092China department of Hematology/Oncology Guangzhou Women and Children's Medical CenterNational Children's Medical Center for South Central RegionGuangzhou 510623China department of Hematology Shanghai Children's HospitalShanghai Jiao Tong UniversityShanghai 200062China department of Pediatrics West China Second University HospitalSichuan UniversityChengdu 610041China department of Hematology/Oncology Qilu Children's Hospital of Shandong UniversityJinan 250022China department of Pediatric Surgery Children's Hospital of Fudan UniversityShanghai 201102China department of General Surgery Shanghai Children's Medical Center(National Children's Medical Center-Shanghai)Shanghai Jiao Tong University School of MedicineShanghai 200127China department of Pediatrics Beijing Tongren HospitalCapital Medical UniversityBeijing 100730China department of Pediatric Oncology Tianjin Medical University Cancer Institute and HospitalTianjin 300060China department of Hematology/Oncology Children's Hospital of Nanjing Medical UniversityNanjing 210008China department of Hematology/Oncology Henan Children's HospitalZhengzhou 450018China department of Pediatric General Surgery Hebei Children's Hospital of Hebei Medical UniversityShijiazhuang City 050031China Children's hospital the First Affliated Hospital of Zhengzhou UniversityZhengzhou 450052China department of Paediatric

Background This study aimed to identify survival risk factors in Chinese children with hepatoblastoma(HB)and assess the effectiveness of the new treatment protocol proposed by the Chinese Children's Cancer Group(CCCG)in *** A multicenter,prospective study that included 399 patients with HB from January 2015 to June 2020 was *** demographics,treatment protocols,and other related information were *** regression models and Kaplan-Meier curve methods were *** The 4-year event-free survival(EFS)and overall survival(OS)were 76.9 and 93.5%,*** 4-year EFS rates for the very-low-risk,low-risk,intermediate-risk,and high-risk groups were 100%,91.6%,81.7%,and 51.0%,*** 4-year 0S was 100%,97.3%,94.4%,and 86.8%,*** regression analysis found that age,tumor rupture(R+),and extrahepatic tumor extension(E+)were independent prognostic factors.A total of 299 patients had complete remission,and 19 *** with declining alpha-fetoprotein(AFP)>75%after the first two cycles of neoadjuvant chemotherapy had a better EFS and OS than those≤75%.Conclusions The survival outcome of HB children has dramatically improved since the implementation of CCCG-HB-2016 ***≥8 years,R+,and E+were independent risk factors for *** with a declining AFP>75%after the first two cycles of neoadjuvant chemotherapy had better EFS and OS.

关键词： Alpha-fetoprotein Hepatoblastoma Multicenter Prospective study Survival

Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography:A single-blind,multicenter,randomized controlled trial

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Chinese medical Journal 2024年第12期137卷 1437-1446页

作者： Wenbo Meng Joseph W.Leung Zhenyu Wang Qiyong li Leida Zhang Kai Zhang xuefeng Wang Meng Wang Qi Wang Yingmei Shao Jijun Zhang Ping Yue Lei Zhang Kexiang Zhu Xiaoliang Zhu Hui Zhang Senlin Hou Kailin Cai Hao Sun Ping xue Wei liu Haiping Wang li Zhang Songming Ding Zhiqing Yang Ming Zhang Hao Weng QingyuanWu Bendong Chen Tiemin Jiang Yingkai Wang lichao Zhang Ke Wu xue Yang Zilong Wen Chun liu LongMiao Zhengfeng Wang Jiajia li Xiaowen Yan Fangzhao Wang lingen Zhang Mingzhen Bai Ningning Mi XianzhuoZhang Wence Zhou Jinqiu yuan Azumi Suzuki Kiyohito Tanaka Jiankang liu Ula Nur Elisabete Weiderpass xun li department of General Surgery The First Hospital of Lanzhou UniversityLanzhouGansu 730000China Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province LanzhouGansu 730000China Division of Gastroenterology and Hepatology UC Davis Medical CenterSacramentoCA 95816USA department of Minimally Invasive Surgery Tianjin Nankai HospitalTianjin 300100China Division of Hepatobiliary and Pancreatic Surgery Department of SurgeryShulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren UniversityHangzhouZhejiang 310000China department of Hepatobiliary Surgery Southwest HospitalArmy Medical UniversityChongqing 400000China Hepatobiliary Surgery department Shandong Provincial Third HospitalJinanShandong 250000China department of General Surgery Xinhua HospitalAffiliated to Shanghai Jiao Tong University School of MedicineShanghai Key Laboratory of Biliary Tract Disease ResearchShanghai 200000China department of Hepatobiliary and Pancreatic Surgery The First Hospital of Jilin UniversityChangchunJilin 130000China department of Hepatobiliary Surgery The General Hospital of Ningxia Medical UniversityYinchuanNingxia 750000China department of Hepatobiliary&Hydatid Digestive and Vascular Surgery CenterXinjiang Key Laboratory of Echinococcosis and Liver Surgery ResearchThe First Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiang 830000China department of Hepatobiliary and Pancreatic Surgery The First Hospital of Shanxi Medical UniversityTaiyuanShanxi 030000China department of General Surgery The Second Hospital of Lanzhou UniversityLanzhouGansu 730000China department of Biliopancreatic Endoscopic Surgery The Second Hospital of Hebei Medical UniversityShijiazhuangHebei 050000China Gastrointestinal Surgery department Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430000China department of Hepatobiliary Surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710000China Depart

Background:Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography(ERCP),the benefits and safety of high-carbohydrate fluid diet(CFD)intake 2 h before ERCP remain *** study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’***:This prospective,multicenter,randomized controlled trial involved 15 tertiary ERCP centers.A total of 1330 patients were randomized into CFD group(n=665)and fasting group(n=665).The CFD group received 400 mL of maltodextrin orally 2 h before ERCP,while the control group abstained from food/water overnight(>6 h)before *** ERCP procedures were performed using deep sedation with intravenous *** investigators were blinded but not the *** primary outcomes included postoperative fatigue and abdominal pain score,and the secondary outcomes included complications and changes in metabolic *** outcomes were analyzed according to a modified intention-to-treat ***:The post-ERCP fatigue scores were significantly lower at 4 h(4.1±2.6 vs.4.8±2.8,t=4.23,Plications in patients with native papilla(odds ratio[OR]:0.61,95%CI:0.39-0.95,P=0.028)in the multivariable ***:Ingesting 400 mL of CFD 2 h before ERCP is safe,with a reduction in post-ERCP fatigue,

关键词： Endoscopic retrograde cholangiopancreatography ERCP Carbohydrate Fasting Safety Complications Enhanced recovery after surgery Randomized controlled trial

达比加群酯治疗老年非瓣膜性房颤患者的效果观察

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国际医药卫生导报 2024年第10期30卷 1604-1608页

作者：王学文李广平毕晓雪张子钊徐延敏刘彤天津市心血管病离子与分子机能重点实验室、天津医科大学第二医院心脏科天津心脏病学研究所天津300211

目的探讨达比加群酯治疗老年非瓣膜性房颤患者对凝血功能、心功能的影响及不良反应和预后。方法本研究为随机对照试验,共纳入2020年1月至2023年9月期间天津医科大学第二医院130例老年非瓣膜性房颤患者。通过随机数字表法将患者分为A组(... 详细信息

目的探讨达比加群酯治疗老年非瓣膜性房颤患者对凝血功能、心功能的影响及不良反应和预后。方法本研究为随机对照试验,共纳入2020年1月至2023年9月期间天津医科大学第二医院130例老年非瓣膜性房颤患者。通过随机数字表法将患者分为A组(华法林治疗,43例)、B组(利伐沙班治疗,43例)和C组(达比加群酯治疗,44例)。A组男性22例,女性21例,年龄为(74.56±6.43)岁;心功能分级Ⅰ级23例、Ⅱ级20例。B组男性24例,女性19例,年龄为(73.89±6.21)岁;心功能分级Ⅰ级22例、Ⅱ级21例。C组男性20例,女性24例,年龄为(74.12±6.38)岁;心功能分级Ⅰ级23例、Ⅱ级21例。A组接受华法林钠片治疗,每日一次,起始剂量为2.5 mg,后根据国际标准化比值(INR)调整剂量,每次调整0.5mg,保持INR在2.0~3.0之间;B组接受利伐沙班片治疗,每次15mg,每日一次;C组接受达比加群酯胶囊治疗,每次110 mg,每日两次。疗程为2个月。对比3组患者肝肾功能指标[肌酐(Cr)、尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)]的水平、凝血功能[凝血酶时间(TT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)]、心房颤动栓塞风险CHA2DS2-VASc评分、心房颤动抗凝出血风险HAS-BLED评分和不良反应(皮肤瘀斑、恶心呕吐、脑卒中、血尿)的发生情况,并随访3个月,统计3组的血栓栓塞形成率和出血情况。采用重复测量方差分析、χ^(2)检验、Fisher确切概率法。结果治疗2个月后,B组和C组Cr、BUN、ALT和AST水平低于A组,差异均有统计学意义(均P0.05)。A组、B组和C组的不良反应发生率为16.28%(7/43)、4.65%(2/43)、2.27%(1/44);C组的不良反应发生率低于A组,差异有统计学意义(P0.05)。结论相比华法林,达比加群酯和利伐沙班在治疗老年非瓣膜性房颤患者中能改善肝肾功能和凝血功能,降低不良反应发生率,减少血栓栓塞和出血事件,显示出更好的治疗效果和安全性。

关键词：达比加群酯利伐沙班华法林非瓣膜性房颤老年预后

CHA2DS2-VASc评分对慢性肾脏疾病患者冠状动脉支架内再狭窄的预测价值

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天津医科大学学报 2024年第1期30卷 65-69页

作者：宋艳梅车京津陈康寅徐延敏李广平刘彤张晓伟天津医科大学第二医院心脏科天津市心血管离子与分子机能重点实验室天津心脏病学研究所天津300211

目的:探讨CHA2DS2-VASc评分对慢性肾脏疾病(CKD)患者冠状动脉支架内再狭窄(ISR)的预测价值。方法:分析2019年1月—2022年1月行冠状动脉支架置入的CKD患者147例,平均年龄(66.6±10.9)岁,67.3%为男性。CKD的定义为根据MDRD公式得出的估算... 详细信息

目的:探讨CHA2DS2-VASc评分对慢性肾脏疾病(CKD)患者冠状动脉支架内再狭窄(ISR)的预测价值。方法:分析2019年1月—2022年1月行冠状动脉支架置入的CKD患者147例,平均年龄(66.6±10.9)岁,67.3%为男性。CKD的定义为根据MDRD公式得出的估算肾小球滤过率(eGFR)50%。收集患者基线临床资料、实验指标,计算术前CHA2DS2-VASc评分。采用多因素Logistic回归分析评估CHA2DS2-VASc评分对CKD患者发生冠状动脉ISR的影响。绘制受试者工作特征(ROC)曲线,评估CHA2DS2-VASc评分对CKD患者冠状动脉ISR的预测价值。结果:与非ISR组相比,ISR组糖尿病比例、单核细胞绝对值、CHA2DS2-VASc评分更高,eGFR、左室射血分数水平更低(χ^(2)=4.714,t=-3.605,Z=-2.997、-4.938,均P<0.05)。多因素Logistic回归分析结果显示,ISR组单核绝对值(OR=24.106,95%CI:2.500~232.395,P=0.006)、eGFR(OR=0.906,95%CI:0.858~0.956,P<0.001)和CHA2DS2-VASc评分(OR=1.377,95%CI:0.999~1.899,P=0.020)是CKD患者发生冠状动脉ISR的独立危险因素。ROC曲线显示,CHA2DS2-VASc评分预测CKD患者发生冠状动脉ISR的曲线下面积(AUC)为0.646,95%CI为0.557~0.735,敏感性为83.0%,特异性为55.3%。结论:CHA2DS2-VASc评分对CKD患者发生冠状动脉ISR的预测有临床应用价值。

关键词：冠状动脉支架内再狭窄 CHA2DS2-VASc评分慢性肾脏疾病