显微镜下多血管炎肺受累患者的临床特征及预后分析

目的 探究显微镜下多血管炎（microscopic polyangiitis,MPA）肺受累的临床特征与预后因素分析。方法 回顾性分析2014年1月1日至2021年3月1日于重庆医科大学附属第一医院确诊及随访至2022年3月1日的237例MPA肺受累患者临床资料。采用Kaplan-Meier方法和Cox比例风险回归模型分析生存数据,得出累积生存率及预后因素。结果 MPA肺受累患者的平均年龄是65.18岁,中位随访时间为26.13个月。在纳入研究的237例患者中,MPA伴弥漫性肺泡出血（diffuse alveolar haemorrhage,DAH）患者98例（41.35%）。MPA肺受累患者1年、3年、5年累积生存率分别为67.50%、54.10%、43.00%。中位生存时间为45.03（0.10,97.73）个月。MPA伴DAH患者1年、3年、5年累积生存率分别为63.30%、49.40%、40.20%。Cox多因素回归分析显示年龄>65岁（HR=1.981,95%CI=1.244~3.154,P=0.004）、白细胞总数（white blood cell,WBC）>10×10⁹个/L（HR=1.860,95%CI=1.170~2.956,P=0.009）、血清肌酐（serum creatinine,sCr）>250 μmol/L（HR=1.987,95%CI=1.217~3.243,P=0.006）、氧合指数<300 mmHg（HR=2.780,95%CI=1.696~4.557,P<0.001）、诊断时第三版伯明翰血管炎活动性评分（Birmingham vasculitis activity score version 3,BVASv.3）（HR=1.040,95%CI=1.006~1.075,P=0.020）是影响患者生存时间的独立预测因素（P<0.05）。结论 MPA肺受累患者生存率低下,年龄>65岁、WBC>10×10⁹个/L、sCr>250 μmol/L、氧合指数<300 mmHg、诊断时BVASv.3是MPA肺受累预后不良的独立危险因素。     

肺间质纤维化患者血清和支气管肺泡灌洗液一氧化氮水平及临床意义

目的探讨肺间质纤维化时血清及支气管肺泡灌洗液一氧化氮水平与病变活动性的关系。方法应用生化方法检测11例特发性肺间质纤维化（idiopathic pulmonary fibrosis,IPF）、18例结节病患者及7例健康非吸烟者血清及支气管肺泡灌洗液一氧化氮（nitricoxide,NO）浓度。结果IPF组和结节病组患者支气管肺泡灌洗液(brocho-alveolar lavage fluid,BALF)NO水平分别为（12.67±2.43）μmol/L和（14.84±2.97）μmol/L,明显高于对照组的（9.69±3.52）μmol/L（P<0.05）,分别与BALF中中性粒细胞百分比和淋巴细胞百分比呈正相关（r= 0.6806,P<0.05和r=0.8976,P<0.01）。两组患者血清NO水平低于对照组,但无显著差异,与动脉血氧分压（PaO2）分别呈正相关（r=0.7013,P<0.05和r=0.7596,P<0.01）。结节病组BALF中NO水平14例与T4/T8呈正相关（r=0.6931,P<0.01）,10例与血清血管紧张素转换酶呈正相关（r=0.7347,P<0.05）。结论NO在肺间质纤维化的病理发生中起重要作用,BALF中NO的水平可反映疾病的活动性。     

显微镜下多血管炎肺部病变临床回顾性研究（附94例报告）

目的：分析显微镜下多血管炎（microscopic polyangiitis,MPA）肺部病变特点及治疗方式,提高对MPA肺部受累的认识及诊疗水平。方法：回顾性分析2011年5月至2016年10月收治于重庆医科大学附属第一医院的94例MPA肺部受累患者的临床资料,包括临床表现、实验室检查、胸部影像学、病理学、治疗及预后等,并将上述患者分为以呼吸道症状为首发表现患者组（A组,34例）和以非呼吸道症状为首发表现患者组（B组,60例）,比较2组患者的主要临床症状、实验室检查和胸部CT表现。结果：男49例,女45例,平均年龄（65.2±10.9）岁。呼吸系统以咳嗽、咳痰、咯血及呼吸困难为主要表现,呼吸衰竭者21例。胸部CT或高分辨CT表现主要分为以下3类：①以斑片或磨玻璃影为主要表现者61例（64.89%）;②以网格影或蜂窝样改变为主要表现者13例（13.83%）;③上述2种表现均存在者20例（21.28%）。12例（12.77%）影像学特点符合普通型间质性肺炎（usual interstitial pnermonia,UIP）,30例（31.91%）符合弥漫性肺泡出血（diffuse alveolar hemorrhage,DAH）特点。A组呼吸系统表现发生率较B组高,差异有统计学意义（P＜0.05）,如咳嗽/咳痰（32/34 vs. 46/60）、咯血（15/34 vs. 13/60）、呼吸困难（27/34 vs. 20/60）,而全身症状及其他肺外表现2组无明显差异（P＞0.05）,如发热（24/34 vs. 37/60）、皮疹（3/34 vs. 8/60）、血尿（22/34 vs. 41/60）、蛋白尿（21/34 vs. 40/60）等。A组胸部CT中DAH发生率较B组高（18/34 vs. 12/60）,差异有统计学意义（P＜0.05）。82例接受治疗的患者均采用糖皮质激素和免疫抑制剂治疗,其中重症/危及生命患者中有11例采用甲泼尼龙+环磷酰胺静脉冲击治疗。结论：显微镜下多血管炎肺部受累发生率高,胸部影像学上以肺间质纤维化和DAH多见,DAH更易发生于以呼吸系统症状为首发表现的MPA患者。MPA治疗以激素联合免疫抑制剂为主,治疗短期预后较好。     

系统性红斑狼疮肺部受累的临床表现

目的 研究系统性红斑狼疮（SEE）肺部受累的发生率、临床表现和预后。方法回顾性分析320例SLE住院患者肺部病变的临床资料。结果320例SLE患者中肺部受累142例（发病率为44．4％）。有肺部受累者死亡10例（7．0％）,无肺部受累者死亡2例（1．1％）,两组比较差异有统计学意义（P〈0．05）。急性狼疮性肺炎4例,发病率为1．3％,主要表现为低氧血症、呼吸困难、发热、咳嗽,影像学表现为单侧或双侧弥漫、以肺底为主的斑片状实变影,存活率100％。弥漫肺泡出血6例,发病率为1．9％,咯血、呼吸困难、低氧血症、咳嗽、贫血、血性肺泡灌洗液是其主要表现。影像学表现为新出现的双侧弥漫斑片影或实变影。其他肺部表现包括：胸膜病变80例（25％）,慢性间质性肺病22例（6．9％）,肺动脉高压49例（15．3％）,肺栓塞6例（1．9％）,肺部感染61例（19．1％）。结论（1）SLE可以累及呼吸系统的任何部位,可以在疾病的任何阶段出现。（2）SLE肺部受累中危重症并不少见,肺部受累提示预后不良。（3）SLE肺部受累的临床及影像学表现可以相互重叠。     

COPD合并肺间质纤维化患者血清TGF-β_1及AngⅡ的变化

目的探讨慢性阻塞性肺疾病（COPD）合并肺间质纤维化患者血清中转化生长因子β1（TGF-β1）、血管紧张素Ⅱ（AngⅡ）的变化。方法纳入COPD合并肺间质纤维化患者60例（观察组）和单纯COPD患者28例（对照组）,检测采用双抗体夹心ELISA法测定TGF-β1水平;采用竞争放射免疫分析法测定AngⅡ水平。结果 COPD观察组患者TGF-β1为（580±150）ng/L,对照组为（496±122）ng/L,2组相比差异有统计学意义（P〈0.05）;观察组AngⅡ为（58±21）ng/L,对照组为（46±17）ng/L,2组相比差异有统计学意义（P〈0.05）。结论 TGF-β1可以介导肺间质纤维化的发生、发展,AngⅡ可以促进肺间质纤维化的发展。     

特发性间质性肺炎的诊断及鉴别诊断

肺弥漫性疾病与肺间质性疾病(ILD)是一个同义词。自194 4年HammanRich两人报告了4例“特发性弥漫性肺间质纤维化”后,普遍认为肺纤维化的病理变化局限在肺间质。随着时间的推移慢慢认识到没有单纯的ILD ,而ILD大多起源于肺实质(肺泡壁) ,因此很多学者提出了不少名词,如“弥漫性     

弥漫性间质性肺病合并糖尿病3例

间质性肺疾病是一组主要累及肺间质、肺泡和细支气管的肺部弥漫性疾病[1].糖尿病是一种全身代谢紊乱为主的疾病.研究表明,肺组织也是糖尿病损害的靶器官[2].目前临床上对弥漫性间质性肺病合并糖尿病的报道较少,现就我科近两年收治的3例间质性肺炎合并糖尿病作一报道.     

血浆置换治疗肝功能障碍合并MODS的临床观察

目的探讨血浆置换（plasmaexchange,PE）在多器官功能障碍综合征（multipleorgandisfunctionsyndrome,MODS）治疗中的意义。方法将20例急性肝功能障碍患者随机分为两组：肝功能障碍合并MODS组10例,急性单纯肝功能障碍组（非病毒性肝炎）10例。在统一标准的内科综合治疗基础上,分别对两组患者进行了以PE为主的非生物性人工肝治疗。检测治疗前后总胆红素、直接胆红素、谷丙转氨酶的变化。结果肝功能障碍合并MODS组肝功能指标明显好转,总胆红素由（240．00±75．53）μmol／L降到（125．00±42．47）μmol／L,直接胆红素由（139．70±54．35）μmol／L降到（75．30±22．18）μmol／L,ALT由（111．10±29．76）U／L降到（72．90±17．80）U／L;病死率为80％。急性单纯肝功能障碍组肝功能指标明显好转。总胆红素由（207．90±72．68）μmol／L降到（87．60±45．26）μmol／L,直接胆红素由（102．30±55．37）μmol／L降到（45．20±25．85）μmol／L,ALT由（120．20±62．54）U／L降到（58．30±26．70）U／L;病死率为0。两组肝功能各指标治疗前后差值和病死率比较差异均有显著性（P〈0．01）。结论对于肝功能障碍合并MODS患者,PE可以显著改善肝功能指标及病情严重程度,延长患者生存时间,但不能改善患者预后。     

血清同型半胱氨酸、纤维蛋白原与急性缺血性脑卒中预后的相关性研究

目的：探讨血清同型半胱氨酸(Hcy)、纤维蛋白原(Fib)与急性缺血性脑卒中(AIS)预后的关系。方法选择2014年1月至2015年6月期间我院收治的150例急性缺血性脑卒中患者作为研究对象,选择同期50例健康体检者作为对照组。根据临床神经功能缺损程度评分(CNDS)将AIS患者分为轻度缺损组(n=36)、中度缺损组(n=84)及重度缺损组(n=30),并根据患者不同预后将其分为预后良好组(n=61)与预后不佳组(n=89);比较不同研究对象间血清Hcy、Fib水平。结果观察组患者血清Hcy、Fib水平分别为(19.64±5.49)μmol/L、(4.35±1.42) g/L,均明显高于对照组的(8.63±3.61)μmol/L、(2.79±0.62) g/L,差异均有统计学意义(P<0.05);血清Hcy、Fib水平在轻度缺损组为(15.14±2.19)μmol/L和(4.06±0.22) g/L、中度缺损组为(18.79±2.46)μmol/L和（4.25±0.33）g/L,重度缺损组为（24.13±2.71)μmol/L和(5.46±0.29) g/L,三组患者的Hcy、Fib水平均依次升高,差异均有统计学意义(P<0.05);预后不佳组患者血清Hcy、Fib水平分别为(21.68±7.63)μmol/L和（4.98±1.24）g/L,明显高于预后良好组的(17.24±6.19)μmol/L和(4.21±1.38) g/L,差异均有统计学意义(P<0.05)。结论血清Hcy、Fib水平与急性缺血性脑卒中患者病情严重程度及预后密切相关,临床可通过检测血清Hcy、Fib水平对患者疾病严重程度及预后进行评估。     

显微镜下多血管炎69例临床分析

目的：分析显微镜下多血管炎（MPA）临床表现、病理特点、治疗及预后。方法回顾性分析北京协和医院2007年9月至2012年9月住院的69例MPA患者资料。结果①男30例,女39例,平均65岁。②临床表现：78.2%发热,46.3%体重下降;肾脏主要表现为中小量蛋白尿（76.8%）、血尿,部分呈急进性肾小球肾炎（23.2%）,肾脏病理特点为新月体形成、坏死性血管炎;肺部表现以肺间质纤维化（55.1%）和肺泡出血（8.7%）为主;其他包括周围神经病变（23.2%）、皮疹（17.4%）、消化道出血（13.0%）等。③65例（94.2%）抗中性粒细胞胞浆抗体（ANCA）阳性,63例为髓过氧化物酶（MPO）阳性。④全部接受糖皮质激素治疗（1/4冲击）,超过90%接受环磷酰胺治疗,9例血液透析,3例血浆置换。⑤经治疗,63例好转出院,6例因肺部感染、感染性休克死亡。结论 MPA多发于老年患者,肾脏受累突出,病理特点多见于新月体形成和坏死性血管炎,肺部、周围神经、皮肤病变等,以MPO-ANCA阳性为主,激素、免疫抑制剂治疗可改善预后。     

术后经导管动脉化疗栓塞对肝内胆管细胞癌患者远期预后的影响

目的 评估术后经导管动脉化疗栓塞(pTACE)对肝内胆管细胞癌(ICC)患者远期预后的影响,并鉴别适合进行术后pTACE辅助治疗的ICC患者.方法 纳入2010年1月至2011年1 2月在第二军医大学东方肝胆外科医院接受根治性切除术治疗的114例ICC患者,通过单因素和多因素分析确定总生存期(()S)和无复发生存期(RFS)的独立危险因素.有l项及以上复发危险因素的患者被定义为高风险组(n=73),没有复发危险因素的被定义为低风险组(n=41),比较pTACE对这两组患者预后的影响.结果 多因素分析结果显示多发肿瘤(HR=3.515,95％CI:2.083～5.932,P＜0.00l)、肿瘤最大径＞5 cm(HR=2.050,95％CI:1.309～3.210,P=0.002)、微血管侵犯(HR=2.287,95％CI:1.104～4.736,P=0.026)、手术切缘阳性(HR=5.089,95％ CI.2.055～12.600,P＜0.001)和淋巴结转移(HR=2.880,95％CI:1.579～5.251,P=0.00l)是()S的独立危险因素;多发肿瘤(HR=2.752,95％CI:1.619～4.678,P＜0.001)、肿瘤最大径＞5 cm(HR=2.010,95％CI:1.298～3.113,P=0.002)和微血管侵犯(HR=3.857,95％CI:1.856～8.013,P＜0.001)是RFS的独立危险因素.虽然pTACE不是OS或RFS的独立预后因素,但pTACE可以改善高风险组患者的OS和RFS(P＜0.05).结论 具有术后复发危险因素的ICC患者可从pTACE中获益,应该建议接受pTACE治疗.     

夜间血液透析患者退出原因及危险因素分析

目的 分析夜间血液透析(nocturnal hemodialysis,NHD)患者退出的原因并探讨其危险因素.方法 收集第二军医大学长征医院2009年2月至2016年11月行NHD满3个月后退出NHD的47例患者和维持NHD的64例患者的临床资料,收集患者一般资料,比较两组患者首次行NHD及末次行NHD时的血红蛋白、血小板、白蛋白、铁蛋白、血钙、血磷、甲状旁腺激素等指标的差异,采用Cox回归模型分析患者退出NHD和死亡的危险因素.结果 47例患者退出NHD,行NHD的平均时间为(31.55±20.30)个月,退出原因分别是死亡、转院、转传统血液透析(CHD)、肾移植及其他.单因素Cox回归分析显示,在原发疾病中,高血压肾病(P=0.007,HR=2.913,95％CI:1.348～6.293)和糖尿病肾病(P=0.047,HR=2.401,95％CI:1.014～5.685)是NHD患者退出的危险因素,慢性肾炎综合征(P＜0.001,HR=0.095,95％CI:0.046～0.195)则是保护因素;在血液检测指标中,低白蛋白水平(P=0.007,HR=0.904,95％CI:0.840～0.973)是NHD患者退出的危险因素;高龄(P=0.027,HR=1.052,95％CI:1.006～1.101)是NHD患者退出的危险因素.多因素Cox回归分析显示,低白蛋白水平(P=0.007,HR=0.911,95％CI:0.848～0.991)是NHD患者死亡的独立危险因素.结论 高血压肾病和糖尿病肾病是NHD患者退出的危险因素,慢性肾炎综合征是其保护因素.低白蛋白是NHD患者死亡的独立危险因素.     

Risk or Beneficial Factors Associated with Unplanned Revascularization Risk Following Percutaneous Coronary Intervention: A Large Single-Center Data

Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied.Results The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%,6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio(HR) = 2.320; 95% confidence interval(CI): 1.643–3.277; P 0.001], time of procedure(HR = 1.006; 95%CI: 1.001–1.010; P = 0.014), body mass index(HR = 1.104; 95% CI: 1.006–1.210; P = 0.036), incomplete revascularization(ICR)(HR = 2.476; 95% CI: 1.030–5.952; P = 0.043), and age(HR = 1.037; 95% CI:1.000–1.075; P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux(HR = 0.618; 95% CI: 0.531–0.719; P 0.001), secondgeneration durable polymer drug-eluting stent(HR = 0.713; 95% CI: 0.624–0.814; P 0.001), left anterior descending artery involvement(HR = 0.654; 95% CI: 0.530–0.807; P 0.001), and age(HR = 0.992; 95%CI: 0.985–0.998; P = 0.014), were independently associated with decreased two-year UR risk. While,Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score(HR =1.024; 95% CI: 1.014–1.033; P 0.001) and ICR(HR = 1.549; 95% CI: 1.290–1.860; P 0.001) were negatively associated with two-year UR risk.Conclusion Specific factors were positively or negatively associated with short-and medium-long-term UR following PCI.     

Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty

ObjectiveTotal knee arthroplasty is one of the most common orthopedic surgeries. Readmission due to severe complications after total knee arthroplasty is a grave concern to surgeons. In this study, we evaluated the risk factors for severe complications after primary total knee arthroplasty.MethodsWe retrospectively collected clinical data of 2,974 patients who underwent primary total knee arthroplasty from July 2013 to June 2019 in our hospital. Postoperative complication > grade IE was defined as severe complication according to Clavien-Dindo classification system. Binary logistic regression was used to identify the predictive risk factors for severe complications.ResultsThe complication rate after primary total knee arthroplasty was 6.8% and severe complication rate was 2.5%. Male (OR = 2.178, 95%CI: 1.324-3.585, P = 0.002), individuals above 75 years old (OR = 1.936, 95%CI: 1.155-3.244, P = 0.012), arrhythmia (OR = 2.913, 95%CI: 1.350-6.285, P = 0.006) and cerebrovascular disease (OR = 2.804, 95%CI: 1.432-5.489, P = 0.003) were predictive risk factors for severe complications after primary total knee arthroplasty.ConclusionAdvanced age, male, arrhythmia, and cerebrovascular disease might be patients-related risk factors for postoperative severe complications after primary total knee arthroplasty. Special attention should be paid to patients with risk factors.     

Association Between Lipid Profiles and Left Ventricular Hypertrophy: New Evidence from a Retrospective Study

ObjectiveTo explore the association between lipid profiles and left ventricular hypertrophy in a Chinese general population.MethodsWe conducted a retrospective observational study to investigate the relationship between lipid markers [including triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL-cholesterol, apolipoprotein A-I, apolipoprotein B, lipoprotein[a], and composite lipid profiles] and left ventricular hypertrophy. A total of 309,400 participants of two populations (one from Beijing and another from nationwide) who underwent physical examinations at different health management centers between 2009 and 2018 in China were included in the cross-sectional study. 7,475 participants who had multiple physical examinations and initially did not have left ventricular hypertrophy constituted a longitudinal cohort to analyze the association between lipid markers and the new-onset of left ventricular hypertrophy. Left ventricular hypertrophy was measured by echocardiography and defined as an end-diastolic thickness of the interventricular septum or left ventricle posterior wall > 11 mm. The Logistic regression model was used in the cross-sectional study. Cox model and Cox model with restricted cubic splines were used in the longitudinal cohort.ResultsIn the cross-sectional study, for participants in the highest tertile of each lipid marker compared to the respective lowest, triglycerides [odds ratio (OR): 1.250, 95%CI: 1.060 to 1.474], HDL-cholesterol (OR: 0.780, 95%CI: 0.662 to 0.918), and lipoprotein(a) (OR: 1.311, 95%CI: 1.115 to 1.541) had an association with left ventricular hypertrophy. In the longitudinal cohort, for participants in the highest tertile of each lipid marker at the baseline compared to the respective lowest, triglycerides [hazard ratio (HR): 3.277, 95%CI: 1.720 to 6.244], HDL-cholesterol (HR: 0.516, 95%CI: 0.283 to 0.940), non-HDL-cholesterol (HR: 2.309, 95%CI: 1.296 to 4.112), apolipoprotein B (HR: 2.244, 95%CI: 1.251 to 4.032) showed an association with new-onset left ventricular hypertrophy. In the Cox model with forward stepwise selection, triglycerides were the only lipid markers entered into the final model.ConclusionLipids levels, especially triglycerides, are associated with left ventricular hypertrophy. Controlling triglycerides level potentiate to be a strategy in harnessing cardiac remodeling but deserve to be further investigated.     

肺动脉高压对左心室射血分数正常的系统性轻链型淀粉样变性患者预后的影响

目的　评估初诊时肺动脉高压（PH）在左心室射血分数正常的系统性轻链型淀粉样变性（AL）患者预后中的价值。方法　回顾性分析2014年6月至2021年12月海军军医大学（第二军医大学）第二附属医院收治的初发AL患者134例。纳入标准为患者均经病理活检证实且左心室射血分数正常,并排除有先天性心脏病、中重度慢性阻塞性肺疾病等PH病因的患者。根据经胸超声心动图估测肺动脉压力值,将患者分为PH组和无PH组。使用Kaplan-Meier法计算总生存率和无进展生存率,并绘制生存曲线。采用单因素和多因素Cox比例风险回归模型分析PH对生存预后的影响。结果　最终纳入AL患者93例,其中PH组17例、无PH组76例。中位随访时间为19.4（1.0～87.0）个月,随访期间33例患者死亡。PH组和无PH组患者的中位总生存期分别为20.9（9.93,NA）个月、未达到,中位无进展生存期分别为10.5（6.93,NA）、47.0（35.87,NA）个月,差异均有统计学意义（P＜0.05）。校正基线资料后进行多因素Cox比例风险回归模型分析,结果显示PH是影响AL患者生存预后的独立危险因素,伴PH患者死亡的风险是无PH患者的4.93倍（95% CI 1.41～17.23,P=0.012 4）,疾病进展的风险是无PH患者的3.53倍（95% CI 1.22～10.20,P=0.019 6）;在伴有心脏浸润的AL患者中,伴PH患者死亡和疾病进展的风险更高（HR=13.23,95% CI 2.35～74.93,P=0.003 4;HR=3.58,95% CI 1.09～11.71,P=0.035 3）。结论　超声心动图评估PH对于左心室射血分数正常的AL患者有重要的预后价值,在临床实践中需予以重视。     

Outcomes of Chinese Patients with End-stage Pulmonary Disease while Awaiting Lung Transplantation: A Single-center Study

Background:

The factors affecting the outcome of patients referred for lung transplantation (LTx) still have not been investigated extensively. The aim of this study was to characterize the patient outcomes and identify the prognostic factors for death while awaiting the LTx.

Methods:

From January 2003 to November 2013, the clinical data of 103 patients with end-stage lung disease that had been referred for LTx to Department of Thoracic Surgery, Shanghai Pulmonary Hospital were analyzed retrospectively. The relationship between predictors and survival was evaluated using the Kaplan–Meier method and the Cox proportional hazards model.

Results:

Twenty-five patients (24.3%) died while awaiting the LTx. Fifty patients (48.5%) underwent LTx, and 28 patients (27.2%) were still on the waitlist. Compared to the candidates with chronic obstructive pulmonary disease (COPD), patients with idiopathic pulmonary fibrosis (IPF) had a higher mortality while awaiting the LTx (40.0% vs. 12.3%, P = 0.003). Patients requiring mechanical ventilation (MV) had a higher mortality while waiting than others (50.0% vs. 20.2%, P = 0.038). Two variables, using MV and IPF but not COPD as primary disease, emerged as significant independent risk factors for death on the waitlist (hazard ratio [HR] = 56.048, 95% confidence interval [CI]: 3.935–798.263, P = 0.003 and HR = 14.859, 95% CI: 2.695–81.932, P = 0.002, respectively).

Conclusion:

The type of end-stage lung disease, pulmonary hypertension, and MV may be distinctive prognostic factors for death while awaiting the LTx.     

Survival Analysis of Hepatocellular Carcinoma: A Comparison Between Young Patients and Aged Patients

Background:

To compare the clinicopathological features and prognosis between younger and aged patients with hepatocellular carcinoma (HCC).

Methods:

We analyzed the outcome of 451 HCC patients underwent liver resection, transcatheter arterial chemoembolization and radiofrequency ablation, respectively. Then risk factors for aged and younger patients’ survival were evaluated by multivariate analysis, respectively.

Results:

The patients who were older than 55 years old were defined as the older group. The overall survival for aged patients was significantly worse than those younger patients. The younger patients had similar liver functional reserve but more aggressive tumor factors than aged patients. Cox regression analysis showed that the elevated levels of aspartate aminotransferase (AST) (Wald χ² = 3.963, P = 0.047, hazard ratio [HR] =1.453, 95% confidence interval [CI]: 1.006–2.098), lower albumin (Wald χ² = 12.213, P < 0.001, HR = 1.982, 95% CI: 1.351–2.910), tumor size (Wald χ² = 8.179, P = 0.004, HR = 1.841, 95% CI: 1.212–2.797), and higher alpha-fetoprotein level (Wald χ² = 4.044, P = 0.044, HR = 1.465, 95% CI: 1.010–2.126) were independent prognostic factors for aged patients, while only elevated levels of AST (Wald χ² = 14.491, P < 0.001, HR = 2.285, 95% CI: 1.493–3.496) and tumor size (Wald χ² = 21.662, P < 0.001, HR = 2.928, 95% CI: 1.863–4.604) were independent prognostic factors for younger patients.

Conclusions:

Age is a risk factor to determine the prognosis of patients with HCC. Aged patients who have good liver functional reserve are still encouraged to receive curative therapy.     

补益强心片联合西药常规治疗慢性心力衰竭随机对照试验的Meta分析

[目的] 系统评价补益强心片联合西药常规治疗慢性心力衰竭的临床疗效与安全性。[方法] 计算机检索中国期刊全文数据库（CNKI）、维普中文期刊数据库（VIP）、万方期刊数据库（WanFang Data）、中国生物医学文献服务系统（SinoMed）、PubMed、Embase、Web of Science和The Cochrane Library（2018年3期）,检索时间均从数据库建库至2018年3月,纳入补益强心片联合西药常规与西药常规对照治疗慢性心力衰竭的临床随机对照研究。采用Cochrane协作网的偏倚风险评估工具对纳入研究进行方法学质量评价。采用RevMan 5.3.5对疗效指标进行Meta分析。[结果] 共纳入7个随机对照试验,573例患者。Meta分析显示,补益强心片联合西药常规治疗慢性心力衰竭可以进一步增加患者左室射血分数（LVEF）[MD=4.31,95%CI（3.73,4.90）,P<0.000 01],降低N末端B型利钠肽原（NT-proBNP）水平[SMD=-2.02,95%CI（-3.02,-1.02）,P<0.0001],改善心功能（NYHA）[RR=1.25,95%CI（1.09,1.43）,P=0.001],降低Lee氏心衰积分[MD=-1.09,95%CI（-1.36,-0.83）,P<0.000 01]和明尼苏达心衰生活质量评分（MLHFQ）[MD=-10.90,95%CI（-13.12,-8.68）,P<0.000 01]。[结论] 纳入研究评价提示,补益强心片联合西药常规治疗慢性心力衰竭可进一步改善患者心功能、临床症状和生活质量且安全。由于纳入文献质量普遍较低,证据强度不足,上述结论仍需更多大样本、高质量试验研究证实。     

Clinical Features of Spontaneous Remission in the Classic Fever of Unknown Origin: A Retrospective Study

ObjectiveTo summarize the clinical features of spontaneous remission in classic fever of unknown origin (FUO).MethodsMedical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively. Patients who were discharged without etiological diagnoses were followed for 2 years. The clinical features and outcomes of these patients were summarized. Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.ResultsAfter excluding 2 patients who lost to follow-up, the etiology of 119 FUO patients were as follows: infectious diseases in 30 (25.2%) cases, connective tissue diseases in 28 (23.5%) cases, tumor diseases in 8 (6.7%) cases, other diseases in 6 (5.0%) cases, and unknown diagnoses in 47 (39.5%) cases. Totally, 41 patients experienced spontaneous remission of fever (the median time from onset to remission was 9 weeks, ranging from 4 to 39 weeks). In patients with spontaneous remission in FUO, lymphadenopathy was less common clinical manifestation, the levels of inflammatory markers including leukocyte count, neutrophil count, neutrophil ratio, C-reactive protein, and ferritin were lower, and the proportion of CD8 positive T lymphocytes expressing CD38 was lower. Multivariate logistic regression analysis of factors with a P-value < 0.05 in univariate analysis shown that white blood cell count (OR: 0.545, 95%CI: 0.306-0.971, P = 0.039), neutrophil count (OR: 2.074, 95%CI: 1.004-4.284, P = 0.049), and proportion of neutrophils (OR: 0.928, 95%CI: 0.871-0.990, P = 0.022) were independent significant factors associated with spontaneous remission in FUO.ConclusionsThis study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously. Thus, for patients with stable clinical conditions, follow-up and observation could be the best choice. Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.