维持性血液透析患者血磷波动与心脏瓣膜钙化关系

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者心脏瓣膜钙化影响因素,及血磷波动与心脏瓣膜钙化的关系。方法回顾性分析2015年6月至2018年6月于武汉大学中南医院血液净化中心规律接受血液透析的110例终末期肾病患者。使用心脏超声检测患者心脏瓣膜钙化情况,分为钙化组及无钙化组,收集患者每三个月复查的血磷,计算其1～3年(4～12次)的波动,使用多因素回归分析探讨其与钙化的关系。结果 110例血液透析患者中,存在心脏瓣膜钙化者51例(46.4%),多因素回归分析显示:年龄(OR=1.100,95%CI:1.051～1.150,P0.001)、透析龄(OR=1.023,95%CI:1.004～1.042,P=0.019)、原发病为糖尿病肾病(OR=3.120,95%CI:1.070～9.101,P=0.037)、血磷(OR=4.923,95%CI:1.664～14.571,P=0.004)为心瓣膜发生钙化的独立危险因素;高磷血症患者钙化率较血磷达标者明显增多(P=0.042),高全段甲状旁腺激素(intact parathyroid hormone,iPTH)患者钙化率较iPTH达标者及低iPTH者明显增多(P=0.015、0.015);进一步分析发现MHD患者3年的血磷波动为心脏瓣膜钙化的独立危险因素(P=0.006)。结论年龄、透析龄、原发病为糖尿病肾病、血磷及血磷波动为瓣膜钙化的独立危险因素,因此控制血磷的同时,应平稳的降血磷,避免血磷波动太大。     

老年住院患者急性肾损伤的临床特点

目的 探讨院内老年急性肾损伤(acute kidney injury,AKI)患者的临床特点.方法 本研究收集2015年1月至2015年12月首都医科大学附属北京潞河医院住院期间发生AKI患者的临床资料,分析老年患者发生AKI的临床特点.结果 共纳入202例院内AKI患者,老年AKI患者103例,死亡率44.66％,非老年AKI患者99例,死亡率33.33％.肾脏缺血及感染是老年AKI患者最常见的病因.多因素Logistic回归分析显示,BNP(OR=4.531,95％ CI1.112 ～10.312,P＜0.001)、C反应蛋白(OR=1.071,95％CI1.047～ 1.096,P＜0.05)、平均动脉压(OR=2.28,95％ CI 1.761～2.983,P＜0.001)、合并脓毒血症(OR=2.28,95％ CI 1.761 ～ 2.983,P＜0.001)、合并MODS(OR=27.316,95％ CI 13.936 ～ 48.344,P＜0.001)是老年AKI患者死亡的独立危险因素.结论 老年住院患者AKI病死率高,其中BNP、低平均动脉压、高C反应蛋白、合并脓毒血症及合并MODS为住院老年AKI患者死亡的独立危险因素.     

深低温停循环主动脉弓手术术后急性肾损伤的危险因素

目的 目的分析深低温停循环主动脉弓手术术后急性肾损伤(acute kidney injury,AKI)的危险因素.方法 回顾2005年1月至2011年6月549例行深低温停循环主动脉弓部手术患者的资料,按照术后是否发生AKI分为两组进行单因素分析,单因素分析差异有统计学意义的logistic回归多因素分析.结果 术后102例(18.6％)患者发生AKI,27例(4.9％)行透析治疗.Logistic回归多因素分析显示,体质量指数(BMI)(OR=1.072,95％ CI:1.006 ～1.141,P=0.031)、术前血清肌酐(OR=1.011,95％ CI:1.006 ～1.017,P=0.000)、体外循环(CPB)时间(OR=1.006,95％ CI:1.002 ～1.009,P=0.005)和术中血糖峰值(OR=1.007,95％CI:1.002 ～ 1.011,P=0.003)是AKI发生的独立危险因素.结论 患者术前BMI、血清肌酐高预示术后较高的AKI发生率,术中减少CPB时间和积极控制血糖水平可降低AKI的发生.     

糖尿病肾病致终末期肾病行维持性腹膜透析患者心脏瓣膜钙化及预后的临床研究

目的:探讨糖尿病肾病致终末期肾病行维持性腹膜透析患者的心脏瓣膜钙化及预后的影响。方法:166例行维持性腹膜透析(腹透)患者入组,其中DN患者60例,收集所有腹透患者的一般资料、评估残余肾功能和透析充分性、记录心脏超声结果和用药情况。采用二元Logistics回归分析腹透患者的心脏瓣膜钙化独立危险因素;Kaplan-Meier生存分析不同原发病对腹透患者生存预后的影响。结果:166例腹透患者中心脏瓣膜钙化病例48例(28.92%),其中DN腹透患者22例(36.67%),DN患者发生心脏瓣膜钙化的风险是慢性肾炎患者的2.688倍(95%CI 0.170~0.812,P=0.012);DN是影响腹透患者心脏瓣膜钙化发生的独立危险因素,其风险比达3.895倍;DN组患者生存率与高血压肾病组相比差异无统计学意义(χ2=0.951,P=0.329),但低于慢性肾炎组患者(χ2=4.065,P=0.044),且死亡风险为3.365倍。结论:DN是维持性腹膜透析患者心脏瓣膜钙化的独立危险因素,其生存率低于慢性肾炎组患者。     

维持性血液透析患者胎球蛋白A和炎症水平与心脏瓣膜钙化的相关性

目的 探讨继发性甲状旁腺功能亢进患者行甲状旁腺全切除或次全切除术的预后.方法 入选2009年1月至2014年3月前在青岛大学附属医院血液透析中心的维持性血液透析(maintenance hemodialysis,MHD)患者99例,所有患者均行超声心动检查,根据超声心动结果将患者分为合并心脏瓣膜钙化组和无心脏瓣膜钙化组,另根据心脏瓣膜钙化数量将患者分为无瓣膜钙化(A组)、单个瓣膜钙化(B组)和双瓣膜钙化(C组).采用酶联免疫吸附法(ELISA)检测血胎球蛋白A(Fetuin-A)、白细胞介素6(interleukin-6,IL-6)、超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)水平并评价上述指标与心脏瓣膜钙化的相关性.结果 99例患者中合并瓣膜钙化40例(占40.4％),其中二尖瓣瓣膜钙化(mitral valve calcification,MVC)27例(占27.3％),主动脉瓣瓣膜钙化(aortic valve calcification,AVC)30例(占30.3％),二尖瓣瓣膜合并主动脉瓣瓣膜钙化(MVC合并AVC)17例(占17.2％).比较合并瓣膜钙化组和无瓣膜钙化组患者的临床资料发现,合并瓣膜钙化组的年龄、透析时间、血磷、全段甲状旁腺素(intact parathyroid hormone,iPTH)、hs-CRP、IL-6更高,白蛋白、Fetuin-A水平更低.比较A组、B组和C组发现,随着年龄、透析时间的增高,血磷、钙磷乘积、IL-6、hs-CRP水平的增高,瓣膜钙化的数量逐渐增多,而随着血白蛋白、Fetuin-A水平的增高,瓣膜钙化的数量逐渐减少.以Fetuin-A为自变量行相关性分析发现,与年龄(r=-0.246,P=0.014)、透析时间(r=-0.297,P=0.003)、iPTH(r=-0.256,P=0.011)、hs-CRP(r=-0.272,P=0.006)、IL-6(r=-0.492,P=0.000)、心脏瓣膜钙化(r=-0.6,P=0.001)呈负相关,而与血白蛋白(r=0.298,P=0.003)呈正相关.结论 MHD患者心脏瓣膜钙化的发生率较高,以主动脉瓣瓣膜钙化多见.Fetuin-A、炎症水平与心脏瓣膜钙化有着重要的相关性,评估Fetuin-A、炎症水平可能对识别心血管事件特别是心脏瓣膜钙化的发展和恶化有重要价值.     

MHD患者心脏瓣膜钙化与营养状况的相关性分析

目的:分析维持性血液透析(maintenance hemodialysis,MHD)患者心脏瓣膜钙化(cardiac valve calcification,CVC)与营养状况的相关性。方法:选取2019年10月—2020年10月在我院行血液透析且资料完整的MHD患者110例,收集患者的一般临床资料、生化结果,并测量人体学指标,使用MQSGA评分量表评估患者的营养状况,通过多普勒超声心动图评估心脏瓣膜钙化的情况,根据有无瓣膜钙化分为两组,钙化组45例,非钙化组65例,比较两组间临床资料的差异,分析营养状况评分及其他营养相关指标与心脏瓣膜钙化的关系。结果:与非钙化组相比,钙化组MQSGA评分、年龄、透析龄、碱性磷酸酶、血清钙、超敏C反应蛋白水平均显著增高,上臂围、肱三头肌皮褶厚度、血清白蛋白、前白蛋白均显著降低,差异均具有统计学意义(P0.05);Spearman相关性分析显示MQSGA评分(r=0.413,P0.001)与心脏瓣膜钙化呈正相关;肱三头肌皮褶厚度(r=-0.389,P0.001)、血清白蛋白(r=-0.190,P=0.047)与心脏瓣膜钙化呈负相关。logistic回归分析显示影响MHD患者心脏瓣膜钙化的危险因素包括MQSGA评分、年龄、透析龄、肱三头肌皮褶厚度、超敏C反应蛋白。结论:MHD患者心脏瓣膜钙化发生率高;营养不良是维持性血液透析患者心脏瓣膜钙化发生的危险因素。     

心肺转流下心脏瓣膜术后急性肾损伤的危险因素分析

目的探讨成人心肺转流(cardiopulmonary bypass,CPB)下心脏瓣膜手术后急性肾损伤(acute kidney injury,AKI)的危险因素。方法回顾性分析1 349例心脏瓣膜手术患者的临床资料,采用多因素Logistic回归分析心脏瓣膜术后AKI的危险因素。结果 1 349例心脏瓣膜手术患者AKI发生率为28.4%,多因素Logistic回归分析显示,每增加1岁(OR=1.05,95%CI 1.03~1.06,P0.001)、糖尿病史(OR=2.11,95%CI 1.22~3.68,P=0.008)、贫血(OR=1.50,95%CI1.05~2.21,P=0.026)、术前血清肌酐(Scr)值每增加1mg/dl(OR=1.01,95%CI 1.01~1.02,P=0.001)、手术时间每增加1h(OR=1.28,95%CI 1.15~1.41,P0.001)、术中输注血浆(OR=1.50,95%CI 1.14~1.97,P=0.004)是心脏瓣膜术后发生AKI的独立危险因素。结论心肺转流下心脏瓣膜术后急性肾损伤的独立危险因素是高龄、糖尿病史、贫血、术前肌酐高、手术时间长以及术中输注血浆。     

维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及危险因素分析

目的 探讨维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及相关危险因素.方法 以中山大学附属东华医院腹膜透析中心192例患者为研究对象.根据腹膜透析液培养结果分成腹膜炎组与正常组.采用多因素logistic回归分析腹膜透析相关性葡萄球菌腹膜炎的危险因素.结果 共16例（8.3％）患者发生腹膜透析相关性葡萄球菌腹膜炎.致病菌以表皮葡萄球菌为主,占50.0％（8/16）.治愈12例（75.0％）,死亡1例.高龄（OR=1.35,95％ CI 1.16～7.68,P=0.026）、糖尿病（OR =3.34,95％ CI 1.90～6.54,P＜0.001）、低血红蛋白（OR=1.68,95％ CI 1.21～6.48,P=0.022）及低白蛋白血症（OR=1.04,95％ CI1.02～1.07,P=0.036）是腹膜透析相关性葡萄球菌腹膜炎的相关危险因素.结论 腹膜透析相关性葡萄球菌腹膜炎发生率较高;高龄、低血红蛋白、糖尿病及低白蛋白血症是其相关危险因素.     

透析患者肺动脉高压与血管钙化之间的关系分析

目的探讨透析患者肺动脉高压(pulmonary hypertension,PHT)与血管钙化之间的关系,为临床透析患者PHT的预防与治疗提供依据。方法回顾性分析自贡市第一人民医院透析中心病情稳定的患者172例,其中血液透析88例,腹膜透析患者84例。纳入标准:透析时间3个月,病情稳定的规律性透析患者;排除标准:怀孕、艾滋病毒感染者、严重的感染、肝胆疾病、活动性消耗性疾病(如恶性肿瘤或肺结核);急性心肌梗死、心力衰竭、急性脑血管疾病;原发性甲状旁腺疾病,行甲状旁腺切除、手术、创伤和严重营养不良的患者均排除。所有患者使用超声心动图检查提示肺动脉收缩压大于37 mmHg定义为PHT。采用双手及骨盆X片检查评估患者血管钙化情况。结果血液透析患者PHT、的发生率明显高于腹膜透析患者(51.2%比22.7%);透析患者中有PHT的患者的血管钙化严重程度高于无。PHT的透析患者。多因素分析显示血管钙化程度(OR=2.68)、二尖瓣病变(OR=7.79)、血液透析(OR=3.35)、左心房内径增大(OR=11.39)是透析患者发生PHT的独立危险因素。结论血液透析患者PHT的发生率高于腹膜透析患者;透析患者中血管钙化可能是预测患者PHT发生的独立危险因素,预防透析患者血管钙化的发生对减轻透析患者PHT可能有着重要的临床意义。     

应用腰椎侧位片评价血液透析患者腹主动脉钙化

目的 应用X线平片腹主动脉钙化评分探讨维持性血液透析( MHD)患者腹主动脉钙化患病率和相关危险因素分析.方法 选取我院资料完整的155例MHD患者为研究对象.通过X线腰椎侧位片检测腹主动脉钙化( AAC)并对其进行评分.结果 155例的腰椎侧位片中,腹主动脉钙化主要发生在第4腰椎节段,并随着节段的上升而逐渐减少.63.63％患者的侧位平片上可见腹主动脉钙化;28.39％患者可见严重腹主动脉钙化(钙化累及3个节段以上).MHD患者的年龄(OR=1.094,P＜0.01)、透析龄(OR=1.013,P=0.022)、血三酰甘油(OR=1.261,P=0.030)和血磷(OR=1.324,P=0.023)水平是发生腹主动脉钙化的独立危险因素,而白蛋白(OR=0.239,P=0.013)为保护性因素.结论 MHD患者腹主动脉钙化患病率高,且与多个血管钙化因素相关.半定量的X线腰椎侧位片方法价格便宜、操作简便,易于临床推广.其对MHD患者的预测价值有待日后更多的随访研究.     

Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients.

This study was designed to investigate the relationship among brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) and left ventricular mass (LVM), ejection fraction, and LV geometry in a large cohort of dialysis patients without heart failure (n = 246) and to test the prediction power of these peptides for total and cardiovascular mortality. In separate multivariate models of LVM, BNP and ANP were the strongest independent correlates of the LVM index. In these models, the predictive power of BNP was slightly stronger than that of ANP. Both natriuretic peptides also were the strongest independent predictors of ejection fraction, and again BNP was a slightly better predictor of ejection fraction than ANP. In separate multivariate Cox models, the relative risk of death was significantly higher in patients of the third tertile of the distribution of BNP and ANP than in those of the first tertile (BNP, 7.14 [95% confidence interval (CI), 2.83 to 18.01, P = 0.00001]; ANP, 4.22 [95% CI, 1.79 to 9.92, P = 0.001]), and a similar difference was found for cardiovascular death (BNP, 6.72 [95% CI, 2.44 to 18.54, P = 0.0002]; ANP, 3.80 [95% CI, 1.44 to 10.03, P = 0.007]). BNP but not ANP remained as an independent predictor of death in a Cox's model including LVM and ejection fraction. Cardiac natriuretic peptides are linked independently to LVM and function in dialysis patients and predict overall and cardiovascular mortality. The measurement of the plasma concentration of BNP and ANP may be useful for risk stratification in these patients.     

Validation of serum ferritin values by magnetic susceptometry in predicting iron overload in dialysis patients

BACKGROUND: Guidelines for treating anemia in dialysis patients accept, as high-end range of serum ferritin useful to optimize erythropoietin therapy, values high as 500 to 900 microg/L, on the hypothesis that ferritin might be not representative of iron overload. METHODS: A superconducting quantum interference device (SQUID) was used to make direct noninvasive magnetic measurements of nonheme hepatic iron content in 40 dialysis patients treated with intravenous iron, and liver iron content was compared with biochemical markers of iron status. RESULTS: Only 12/40 (30%) patients showed normal hepatic iron content (SQUID <400 microg/g), while 32.5% had mild (400 to 1000 microg/g) and 37.5% severe (>1000 microg/g) iron overload, although 28/40 patients (70%) had serum ferritin below 500 microg/L. Among many parameters, hepatic iron content was only correlated with ferritin (r= 0.324, P= 0.04). The receiver operating characteristic (ROC) analysis showed the best specificity/sensitivity ratio to identify iron overload for ferritin >340 microg/L (W = 0.716). Multivariate logistic regression analysis demonstrated that an increase in serum ferritin of 100 microg/L and female gender were independent variables associated with moderate to severe hepatic iron overload: OR 1.71 (95% CI 1.10 to 2.67) and OR 10.68 (95% CI 1.81 to 63.15), respectively. CONCLUSION: Hepatic iron overload is frequent in dialysis patients with ferritin below currently proposed high-end ranges, and the diagnostic power of ferritin in indicating true iron stores is better than presumed. Safety concerns should prompt a reevaluation of acceptable iron parameters, focusing on potential gender-specific differences, to avoid potentially harmful iron overload in a majority of dialysis patients, mainly females.     

Luminal亚型浸润性乳腺癌

目的 研究Luminal亚型浸润性乳腺癌的临床特点和生存状况.方法 回顾性分析中国医学科学院肿瘤医院2002年1月1日至9月30日收治的162例接受手术治疗、资料完整的浸润性Luminal亚型乳腺癌的临床资料,对其临床特征、复发及生存情况进行分析.结果 162例患者随访4 ～98个月,中位随访时间92个月,41例患者(25.3％,41/162)出现局部复发或远处转移,包括远处转移32例(19.8％,32/162),局部复发2例(1.2％,2/162)及局部复发合并远处转移7例(4.3％,7/162).总的无病生存率为73.1％,5年无病生存率为79.6％;27例死亡(16.7％,27/162),总生存率为82.5％,5年生存率为85.3％.Kaplen-Meier单因素生存分析显示,肿瘤大小、淋巴结状况、临床分期影响患者的总生存时间(P＜0.05);肿瘤大小、淋巴结状况、肿瘤分级、临床分期、PR影响患者无病生存时间(P＜0.05).多因素分析显示,TNM分期、PR和PCNA是影响总生存时间的独立影响因素(OR =0.633,95％ CI:0.411～0.976,P ＜0.05; OR =0.823,95％ CI:1.012～ 3.283,P＜0.05);TNM分期和PR是影响无病生存时间的独立影响因素(OR =3.273,95％CI:1.719 ～6.232,P＜0.01; OR=0.599,95％CI:0.423 ～0.850,P＜0.01).结论 在浸润性Luminal亚型乳腺癌中,PR、PCNA状况均能明显影响患者预后.     

慢性肾脏病患者高血压的控制及其相关因素

目的 研究并发高血压的住院慢性肾脏病（CKD）患者的降压药使用和血压控制情况,以及其相关因素。 方法 对象为2009年3月至2010年4月期间于本院住院的并发高血压的CKD患者共726例,记录其基本资料、血压、降压药使用及其他相关资料,分析其用药方案及血压控制率。 结果 91.74%患者接受了降压治疗,分别有21.21%、22.59%、19.56%、28.37%患者使用1、2、3、≥4种降压药。CKD患者总体高血压控制率为42.4%,平均血压为（137.86±20.75）/（76.30±11.35） mm Hg。CKD1+2、3、4+5期（未透析）、透析组的高血压控制率分别为50.8%、46.7%、42.0%、33.5%,各组间差异有统计学意义（P < 0.05）。非透析组高血压控制率（<130/80 mm Hg）显著高于透析组（<140/90 mm Hg）（44.9%比33.5%,P < 0.05）。血透组与腹透组高血压控制率差异无统计学意义（32.3%比38.7%,P > 0.05）。多因素Logistic回归分析显示,女性（优势比OR=1.787,95%CI 1.045~3.056）和应用ACEI类降压药（OR=4.378,95%CI 1.830~10.472）是高血压控制的有利因素;而脉压差增大（OR=0.847,95%CI 0.811~0.885）和并发糖尿病（OR=0.415,95%CI 0.188~0.919）是高血压控制的不利因素。 结论 住院CKD患者的高血压治疗率很高,但控制率仍较低。女性、ACEI类降压药是CKD患者血压控制的有利因素,而脉压差大、糖尿病是血压控制不良的独立危险因素。     

Relationship between left atrial volume and atrial fibrillation following coronary artery bypass grafting

Abstract Background: Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). However, limited information is available about the role of preoperative echocardiographic left atrial evaluation to predict AF occurrence after CABG. Thus, we prospectively compared the ability of echocardiographic measurements of left atrial volume to predict AF in this setting. Methods: From January to December 2009, 220 patients (75% males, 66.8 ± 10.0 years) met the inclusion criteria of our study (isolated and elective CABG, no valve surgery, no permanent AF, or other chronic atrial arrhythmias). The day before CABG a complete echocardiographic evaluation was performed with left atrial volume measurements. The primary endpoint of the study was postoperative AF (POAF) lasting >30 seconds. Results: POAF was observed in 61 patients (27.7%). POAF patients showed increased left atrial M‐mode anteroposterior dimension (41.2 ± 6.4 mm vs. 43.6 ± 7.3 mm; p = 0.020) and increased left atrial volume (59.0 ± 18.3 mL vs. 70.6 ± 28.1 mL; p = 0.0004). Left atrial volume was an independent risk factor for POAF (OR 10.03; 95% CI 10.01 to 10.05; p = 0.01), along with postoperative bleeding with hemoglobin levels below 8 g/dL (OR 20.84; 95% CI 10.12 to 70.19; p = 0.03) and preoperative left ventricular ejection fraction below 40% (OR 10.08; 95% CI 10.01 to 10.15; p = 0.02). Conversely, preoperative statin therapy exerted a protective role (OR 0.30; 95% CI 0.12 to 0.74; p = 0.009). Conclusion: Preoperative echocardiographic evaluation of patients with isolated CABG demonstrated that left atrium volume measurements were independently correlated to the occurrence of POAF. Further investigations should focus on the opportunity to target prophylactic antiarrhythmic treatments to patients with large left atrial volumes. (J Card Surg 2012;27:128–135)     

股神经阻滞用于全膝关节置换术患者术后镇痛的Meta分析

目的 采用Meta分析的方法评价股神经阻滞(femoral nerve block,FNB)对全膝关节置换术(total knee arthroplasty,TKA)患者术后镇痛的效果. 方法 检索PubMed、OVID、EMBASE、Cochrane图书馆,检索时间从建库至2014年11月.收集在TKA术后使用FNB与患者自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)或患者自控硬膜外镇痛(patient-controlled epidural analgesia,PCEA)的临床随机对照实验(randomized controlled trial,RCT).采用Cochrane协作网系统评价法评价纳入文献的质量,采用RevMan5.2软件进行Meta分析评价. 结果 共纳入14项研究,包括1 157例患者,其中FNB组616例,PCIA组380例,PCEA组161例.与PCIA组比较,FNB有效减少了患者术后24 h[加权均数差(weighted mean difference,WMD)=-17.93,95％置信区间(confidence interval,CI)=-27.38～-8.49]及48 h(WMD=-25.70,95％CI:-41.67～-9.74)的吗啡累计消耗量,降低患者术后24 h活动时VAS(WMD=-1.99,95％CI:-3.14～-0.85)(P＜0.05);且FNB组患者术后恶心呕吐比值比(odds ratio,OR)(0.31,95％CI:0.22～0.44)、尿潴留(OR=0.24,95％CI:0.13～0.43,P＜0.05)及头晕的发生率(OR=0.27,95％CI:0.14～0.52)都较低(P＜0.05). 结论 比较PCIA及PCEA,FNB可能是TKA患者术后镇痛的一种更好的选择.     

Association between nutrition and peripheral artery disease in continuous ambulatory peritoneal dialysis patients

Objective To investigate the association between nutrition and peripheral artery disease (PAD) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods One hundred and two stable CAPD patients from a single center were enrolled in this cross-sectional study. Automatic ankle-brachial index (ABI) measuring system was applied to examine ABI. Patients were divided into PAD group (ABI＜0.9) and non-PAD group (ABI≥0.9). Clinical data were collected. Biochemical parameters were detected. Nutritional status was evaluated by serum albumin, handgrip strength (HGS) and subjective global assessment (SGA). Logistic regression analysis was performed to estimate the association of PAD with each nutritional marker as well as other potential risk factors. Results The incidence of PAD was 23.53% (24/102). ABI was significantly lower in patients with malnutrition as compared to those without malnutrition [(0.72±0.21) vs (1.04±0.14), P＜0.01]. Compared with non-PAD patients, serum albumin (P＜0.01), HGS (P＜0.01), diastolic blood pressure (P＜0.05), serum creatine (P＜0.05)、blood urine nitrogen (P＜0.01) were significantly decreased, but age (P＜0.01), the incidence of malnutrition [SGA, P＜0.01], diabetic status (P＜0.01), cardiovascular disease history (P＜0.01) were significantly increased in PAD patients. Logistic regression analysis showed that serum albumin (OR=0.762, 95％CI：0.611-0.948, P=0.015), HGS (OR=0.988, 95％CI：0.979-0.997, P=0.013) were independent protective factors for PAD, malnutrition [(SGA), OR=21.101, 95％CI：5.008-88.901, P＜0.01] was independent risk factor for PAD in CAPD patients. Conclusions The PAD incidence of CAPD patients in our center is 23.53%. Nutrition is independent factor associated with PAD in CAPD patients.     

腹腔镜与开腹进展期胃癌D2根治术远期疗效的Meta分析

目的 系统评价腹腔镜与开腹进展期胃癌D2根治术的远期临床疗效.方法 以胃肿瘤、腹腔镜、胃切除术、远期疗效、Meta分析、Gastric neoplasms、Laparoscopy、Gastrectomy、Long-term outcomes、Meta-analysis为检索词,检索发表于PubMed、EMBASE、Medline、Cochrane Library、万方数据库、中国期刊全文数据库、中国生物医学期刊文献数据库及维普数据库中比较腹腔镜与开腹进展期胃癌D2根治术临床疗效的文献,检索时间为2002年1月-2016年10月.按预设标准进行筛选并进行质量评价,提取数据后用RevMan5.2软件对两组患者的远期生存及复发情况进行Meta分析.生存率及复发率采用OR及95％CI表示.采用I2检验对异质性进行分析.结果 有15项对照研究共计4 053例患者纳入分析,其中腹腔镜组2 091例,开腹组1 962例.Meta分析结果显示,腹腔镜组与开腹组的3年总体生存率(OR=1.00,95％ CI:0.83 ～ 1.20,P=0.98),5年总体生存率(OR=1.14,95％CI:0.95～ 1.36,P=0.15),5年无病生存率(OR=1.13,95％CI:0.93 ～ 1.39,P=0.22),复发率差异均无统计学意义(OR =0.96,95％CI:0.79 ～ 1.18,P=0.71).结论 腹腔镜进展期胃癌D2根治术可以达到与开腹手术相当的远期疗效.