急性放射性肺炎的诊治

急性放射性肺炎(Acute radiation pneumonitis)是指肺部受到一次或数天内多次照射8Gy以上(含8Gy)后所致肺组织的间质改变为主要病变的急性炎症性疾病。是在对胸部恶性肿瘤进行放射治疗后比较常见的并发症。     

局部进展期食管癌放射性心脏病的发病机制及其防治策略

放疗是食管癌的主要治疗手段之一,但其不可避免地会带来心脏损伤,一些损伤在数年甚至数十年后才发病。虽然随着诊疗技术的进步,食管癌患者的生存年限逐步提高,但因局部进展期食管癌放疗导致的放射性心脏病(RIHD)已成为非肿瘤致死的首要因素。为了尽量减轻辐射对心脏造成的损伤,降低RIHD的发病率,改善局部进展期食管癌患者的生存率,本文综述了心脏与食管解剖学关系、RIHD的机制和表现、不同放疗技术对心脏组织的影响,并探讨了现有的RIHD筛查和治疗策略。     

放射性肺炎的发生机制及其应对

放射性肺炎(rad iation pneum on itis)是由于在放射治疗恶性肿瘤过程中,正常肺组织受到照射损伤而出现的炎症反应,因属非感染性肺炎的一种类型,所以近年建议改称为“放射性肺病(rad iation pneum on itis)[1]。1放射性肺炎高危因子M oson将放射性肺炎相关因子分为患者相关性(p     

抗肿瘤治疗与心血管疾病关系的研究进展

正心血管疾病和肿瘤是全世界人口死亡的主要原因,提高预防和治疗水平已成为世界卫生组织的主要工作重点。近年来,肿瘤早期筛查和治疗有了显著进步,伴随着人口老龄化进程,肿瘤的发病率正呈现出逐年增长的趋势。肿瘤患者接受抗肿瘤治疗后可能出现的健康问题更多地被关注,除了肿瘤复发或转移的风险外,心血管疾病、全身功能衰退和心理障碍也是肿瘤科医生、心血管医生和老年科医生更加关注     

放射性脊髓病临床与MRI分析

放射性脊髓病(radiation myelopathy,RM)又称放射性脊髓炎,是由放射线所致的脊髓损害,多见于头颈部及躯干部恶性肿瘤放射治疗后,随着肿瘤放射治疗的普及,放射性脊髓病的发病率明显增高,逐渐被神经科医生所认识,现将近期收治的5例病例资料分析如下.     

放射治疗致心血管疾病的研究进展

近年来,随着恶性肿瘤综合治疗技术的不断进步,恶性肿瘤患者的生存期不断延长,放射治疗导致的远期不良心血管事件正逐渐成为影响恶性肿瘤患者预后和生存质量的重要因素。现综述放射治疗致心血管疾病的最新研究进展。     

肺癌放射性肺炎的综合治疗

放射治疗是肺癌重要的治疗手段之一，若肺癌放射治疗不当，常引起放射性肺炎，近期报道发病率为16．7％～50．3％。肺癌放疗始于20世纪20年代，1922年有学者首次报道放疗对肺的毒性反应，同年又有学者报道了2例尸检肺纤维化。1925年Evans和Leucutia首先将放射反应分成两期：早期呈浸润改变(放射性肺炎)，晚期表现为纤维化“放射性纤维化”。此种分期方法沿用至今。本文就放射性肺炎的发病机理、相关因素、临床症状、体征、治疗、预防和展望等问题进行     

硫普罗宁联合糖皮质激素治疗放射性肠炎的临床观察

[目的]探讨硫普罗宁联合糖皮质激素治疗放射性肠炎的作用。[方法]选择接受盆腔精确放疗的64例患者,随机分为实验组与对照组,实验组33例,对照组31例。实验组使用糖皮质激素联合硫普罗宁、对照组单纯使用糖皮质激素控制急性放射性肠炎症状,记录所有患者放疗前后一般状况、体质量、血象等指标;并跟踪随访1年左右时间,对比2组慢性放射性肠炎发生情况。[结果]实验组急性放射性肠炎控制率为90.90%,高于对照组的78.26%,但2组比较差异无统计学意义(P0.05);实验组食欲下降、乏力不适发生率及重度中性粒细胞减少率为24.24%及30.30%,对照组为54.84%及58.06%,2组比较均差异有统计学意义(χ~(2 )=5.07、P0.05及χ~(2 )=5.01,P0.05)。实验组、对照组慢性放射性肠炎发生率分别为3.03%、25.81%,2组比较差异有统计学意义(χ~(2 )=5.11,P0.05);放疗完成后,实验组、对照组KPS评分下降10分以上的发生率分别为15.15%、38.71%,2组比较差异有统计学意义(χ~(2 )=4.55,P0.05);实验组总体体质量均数下降(5.38±2.76)%,对照组下降(7.71±2.64)%,2组比较差异有统计学意义(t=3.45,P0.01)。[结论]硫普罗宁联合糖皮质激素治疗放射性肠炎,能有效控制腹痛、腹泻、便血等局部症状,缓解患者放疗过程中食欲下降、乏力全身不适,改善患者营养状况和机体功能状态,防治骨髓抑制及减少慢性放射性肠炎的发生,提高患者对放疗耐受性,有助于改善预后,为临床治疗放射性肠炎提供新思路。     

ROCK抑制剂治疗心血管疾病的研究进展

ROCK为Rho相关的卷曲蛋白激酶,其表达上调常引起平滑肌细胞收缩异常,导致冠状动脉痉挛、动脉粥样硬化、心肌肥厚和肺动脉高压等,因此ROCK抑制剂对这些心血管疾病的发生发展有一定抑制作用,但临床应用尚需更多的研究来证实,本文就ROCK抑制剂在心血管疾病的应用作一综述。     

Metabolic Dysfunction-Associated Fatty Liver Disease Better Predicts Incident Cardiovascular Disease

Background/AimsMetabolic dysfunction (MD)-associated fatty liver disease is a new positive diagnostic criterion based on hepatic steatosis and MD. However, a comprehensive evaluation on the association of MD and hepatic steatosis with incident cardiovascular disease (CVD) has yet to be performed.MethodsThis retrospective cohort study included 333,389 participants from the Korean National Health Insurance Service database who received a health examination between 2009 and 2010. Hepatic steatosis was defined using the Korean National Health and Nutrition Examination Survey-derived nonalcoholic fatty liver disease scoring system. Cox proportional hazards regression was adopted to determine the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for CVD according to the presence of hepatic steatosis and MD, as well as the composite term.ResultsThis study included 179,437 men and 153,952 women with a median age of 57 years. Hepatic steatosis with MD (aHR, 2.00; 95% CI, 1.89 to 2.13) and without MD (aHR, 1.30; 95% CI, 1.10 to 1.54) significantly increased the risk of CVD compared to no steatosis without MD (reference). However, steatosis revealed no significant difference in the risk of CVD compared to no steatosis among participants with one MD (aHR, 1.09; 95% CI, 0.91 to 1.30). In participants with steatosis, the presence of one and ≥2 MDs had aHR values of 1.25 (95% CI, 0.87 to 1.79) and 1.71 (95% CI, 1.22 to 2.41), respectively, compared to no MD.ConclusionsCombined consideration of hepatic steatosis and MD was significantly associated with increased CVD risk and showed better predictive performance for CVD than hepatic steatosis or MD alone.     

干细胞在心血管疾病中的应用

干细胞在心血管疾病可分化成心肌细胞,减少缺血心肌,改善心功能。现概述目前临床可用的细胞移植种类、方法和应用范围。     

Urinary Stones and Risk of Coronary Heart Disease and Stroke: the Japan Public Health Center-Based Prospective Study

Aim: Evidence is lacking about whether urinary stones are associated with the subsequent risk of cardiovascular diseases. Herein, we investigated the association between history of urinary stones and the risk of coronary heart disease (CHD) and stroke among middle-aged Japanese.Methods: This cohort study included 89,037 Japanese men and women (45–74 years) registered in the Japan Public Health Center-based prospective study. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for incident CHD and stroke among Japanese adults with a self-reported history of urinary stones compared with those without it. The following covariates were included in the regression models: age, sex, area, body mass index, and histories of hypertension, diabetes, hyperlipidemia, smoking habit, alcohol intake, and physical activity.Results: In total, 1.31% of Japanese adults reported a positive history of urinary stones. Throughout a median follow-up period of 12 years, 1.16% of Japanese adults developed CHD, and 4.96% developed stroke. No associations were detected between history of urinary stones and the risk of CHD (HR 1.04; 95% CI: 0.64–1.67), stroke (HR 0.92; 95% CI: 0.71–1.20), or total CVD (HR 0.95; 95% CI: 0.75–1.19). Younger urinary stone formers (45–59 years) tended to have a higher, though statistically insignificant, risk of CHD than older urinary stone formers (60–74 years): [(HR 1.15; 95% CI: 0.61–2.15) versus (HR 0.83; 95% CI: 0.40–1.76)], respectively.Conclusion: The history of urinary stones was shown to be not associated with the risk of CVD among Japanese adults.     

心脏专科医院急诊观察室疾病谱分析

目的了解心脏病专科医院急诊观察室疾病分布特点及规律。方法选择北京市安贞医院2008年1月1日～2011年12月31日收治的13 200例急诊观察室患者作为研究对象,分别按年龄、性别、疾病种类、发病时间、心力衰竭病因等因素进行回顾性调查研究。结果 13 200例患有不同疾病的患者的构成:心血管系统疾病是就诊的首位疾病,占患者总数的66.81%,第2位是神经系统疾病,占9.28%,第3位是呼吸系统疾病,占8.09%。心血管系统疾病中以各种原因导致心力衰竭为首位疾病,占68.73%,在心力衰竭患者中女性(53.65%)多于男性(46.35%)。导致心力衰竭的基础心脏病构成比由高到低的顺序依次为:冠心病(38.30%)、糖尿病(17.91%)、高血压病(11.97%)、风湿性心脏病(8.59%)、扩张型心肌病(6.64%)等。各系统疾病尤其是心血管系统疾病发病呈现明显的季节性,以冬春两季为高发季节,夏季相对减少。结论心脏病专科医院急诊观察室以心血管系统疾病为主,心力衰竭患者是主要的人群,成立心力衰竭病房加强患者管理有重要意义。可根据心脏急诊患者发病高峰季节特点,科学合理地安排工作和配置。     

绝经后妇女骨质疏松症与心血管病危险因素的相关性研究

目的探讨绝经后妇女骨密度与冠心病危险因素的相关性研究。方法选取2007年10月—2011年10月航空总医院心内科门诊及住院的绝经后妇女460例,分为骨质疏松组和非骨质疏松组,记录其存在的心血管病危险因素。结果骨质疏松组中,吸烟、高血脂、糖尿病、冠心病所占的比例高于非骨质疏松组,两组比较差异有统计学意义(P<0.05)。多因素logistic回归分析显示,糖尿病,高脂血症是绝经后妇女骨质疏松患者的主要危险因素。雌激素水平与绝经后妇女骨密度呈负相关,绝经后妇女体内雌激素水平明显下降。结论老年人骨质疏松是一个全身性疾病,与高脂血症等心血管疾病的危险因素密切相关,治疗时应采取系统全身性措施,绝经后妇女骨质疏松患者更应采取积极的预防和治疗措施。     

Association between plasma bilirubin and mortality

Introduction and aimIt has been proposed that plasma concentration of bilirubin, an endogenous antioxidant, is protective against diseases mediated by increased oxidative stress, including cardiovascular diseases (CVD) and cancer. To examine this hypothesis, we investigated the relationship between plasma bilirubin concentrations and bilirubin UDP-glucuronosyl transferase (UGT1A1) promoter gene variations (associated with increased bilirubin concentrations) with total/CVD and cancer mortality.Materials and methodsA nested case–control study was conducted within the Polish arm of the HAPIEE cohort. At baseline in 2002–2005, participants were examined in detail. Mortality follow-up (median (IQR) between blood draw and death was 3.7 (2.1–5.1) years) was performed by linkage with regional and national death registers. Plasma biomarkers were analysed in all subjects who died from any cause (cases, n = 447) and in a random subsample of survivors (controls, n = 1423).ResultsThere was a strong negative association between plasma bilirubin levels and total and cancer mortality, expressed more profoundly in men. The adjusted OR of deaths from all causes and cancer, comparing the highest vs. lowest plasma bilirubin categories were 0.61 (95% CI: 0.42–0.87) and 0.39 (0.24–0.65), respectively. There was no association of bilirubin with CVD mortality. The UGT1A1*28 allele, a genetic marker of raised bilirubin, was also negatively associated with total/cancer mortality, although the associations were not statistically significant.DiscussionBoth the observational and genetic associations support the negative relationship between bilirubin and total mortality; this association appears to be driven by cancer mortality, while that with CVD mortality is not evident.