适形放疗联合化疗治疗非小细胞肺癌的疗效观察

目的观察适形放疗联合化疗同步与序贯治疗中晚期非小细胞肺癌的临床疗效。方法选择不能手术的中晚期非小细胞肺癌（NSCLC）患者100例，随机分成同步组和序贯组各50例。适形放疗采用三维适形放疗（3D—CRT）和调强放疗（IM—RT）方法，化疗方案为盖诺＋顺铂（NP方案）。结果治疗总有效率比较（CR＋PR）：同步组78％，序贯组46％，两组比较差异有显著性（P〈0．05）；生存率（Kaplan—Meier法）比较：同步组1年生存率为71．2％，序贯组为50．3％，两组比较差异有显著性（P〈0.05）；两组病人均能耐受治疗中的不良反应。结论同步组的近期疗效明显优于序贯组，能提高患者的一年生存率。该方法是治疗中晚期非小细胞肺癌较好的方案。     

非小细胞肺癌脑转移放化疗联合的疗效观察

目的比较非小细胞肺癌脑转移同步放化疗及序贯放化疗的近期疗效和1年生存率。方法同步放化组:脑放疗36GY后给予顺铂为主的方案化疗。序贯放化组:脑放疗结束后序贯顺铂为主的方案化疗。结果两组的脑转移灶及胸部原发灶的有效率均无统计学差异(P0.05);1年生存率分别为83.3%及79.4%(P0.05);中位PFS分别为13.8个月及11.2个月;中位生存时间(OS)分别为19.5个月及16.5个月。骨髓抑制、恶心呕吐和头晕头痛发生率分别为90%、100%、100%及76.4%、91.2%、97.1%。结论非小细胞肺癌脑转移同步放化疗比较序贯放化疗,前者的近期疗效及1年生存率均有升高的趋势,且毒副反应可耐受。     

非小细胞肺癌放疗同期联合化疗临床疗效分析

目的比较同步及序贯放化疗模式治疗Ⅲ期非小细胞肺癌的临床疗效和不良反应。方法对本院收治的Ⅲ期非小细胞肺癌68例,随机分为同步和序贯放化疗两组。前者38例,采用三维适形放疗(3-DCRT)同时TP方案化疗。后者30例,先行TP化疗2周期,2周后再行放疗,放疗结束再行TP化疗2周期。两组均于治疗结束后4周评价疗效。结果近期有效率同步优于序贯组(P0.05)。两组1、2、3年远期生存率无统计学差异。不良反应同步组高于序贯组。结论同步放化疗治疗Ⅲ期非小细胞肺癌近期疗效优于序贯放化疗组,但反应较重。     

适形放疗联合化疗治疗局限期小细胞肺癌的临床疗效观察

目的 探讨适形放疗联合化疗治疗局限期小细胞肺癌的临床疗效.方法 选取在我院接受治疗的局限期小细胞肺癌患者共63例,随机分为观察组33例,对照组30例.观察组为放、化疗同步疗法.对照组为放、化疗序贯疗法.结果 治疗后,观察组与对照组的治疗总有效率分别为93.9%、83.3%,比较发现,观察组的总有效率明显高于对照组（P〈0.05）.随访两年中,观察组与对照组1、2年的生存率分别为81.8%（27/33）、70.0%（21/30）与72.7%（24/33）、36.7（11/30）,差异具有统计学意义（P〈0.05）.治疗过程中,观察组患者出现毒副反应的情况略高于对照组,但差异不具有统计学意义（P＞0.05）.结论 适形放疗联合化疗治疗局限期小细胞肺癌疗效显著,安全可靠.     

放疗联合化疗治疗不可手术局部晚期非小细胞肺癌

目的 比较长春瑞宾／顺铂（NP方案）联合同步放疗对局部晚期非小细胞肺癌（NSCLC）的疗效与安全性。方法　60例ⅢA或ⅢB期NSCLC患者接受NP＋同步放化疗（同步组）或MVP／VP方案＋序贯放疗（序贯组）。放疗剂量范围在40～66Gy。结果　序贯组有效率为33％，明显低于同步组的63％；两组中位生存期相似。同步组47％患者出现不同程度的放射性食管炎症状，明显高于序贯组的13％；Ⅲ／Ⅳ食管炎在同步组为20％。结论　低剂量NP方案化疗联合同步胸部放射一线治疗局部晚期NSCLC有效，患者可以耐受。     

Ⅲ期非小细胞肺癌同步放化疗加巩固化疗临床疗效

目的观察Ⅲ期非小细胞肺癌同步放化疗加巩固化疗的近期疗效及急性毒性反应。方法收治的Ⅲ期NSCLC患者59例,同步加巩固化疗组36例,对照组为序贯放化疗组23例。同步加巩固化疗组:放疗同步2周期化疗,放疗后行2~4周期巩固化疗;序贯组:先行适型放疗,放疗后再行4~6周期化疗。化疗均为TP方案,放疗采用常规分割剂量放射治疗。结果同步放化疗加巩固化疗及序贯组近期有效率分别为61.1%,47.8%(P0.05),一年生存期率分别为78.3%,54.6%(P0.05)。主要毒副反应:骨髓抑制,同步组及序贯组分别为100%,73.9%(P0.05),其他如放射性食管炎,放射性肺炎,胃肠道反应,两者差异无统计学意义。结论同步放化疗加巩固化疗治疗NSCLC较序贯化疗疗效确切,近期局控率高。对于急性毒性反应,如骨髓抑制、放射性肺炎、放射性食管炎及消化道反应,在重组人粒细胞集落刺激因子、适型放疗等支持下,患者多可完成治疗。     

国产培美曲塞联合顺铂并同步或序贯脑放疗治疗非小细胞肺癌脑转移的疗效

目的 探讨国产培美曲塞联合顺铂全身化疗并同步或序贯脑放疗治疗非小细胞肺癌(NSCLC)脑转移患者的疗效与毒副反应.方法 分析2005年1月至2010年1月NSCLC脑转移患者46例,其中23例接受培美曲塞联合顺铂全身化疗同步脑放疗(同步组),23例采用培美曲塞联合顺铂全身化疗序贯脑放疗(序贯组).结果 共45例患者完成治疗,全身病灶的总体客观缓解率(ORR)为24.4％;脑转移灶的ORR为33.3％,中位无进展生存期(PFS)为3.67个月,中位生存期(MST)为16.7个月,1年和2年总生存率分别为56％和25.4％.同步组和序贯组全身病灶的总体ORR分别为22.7％和26.1％,脑转移灶的ORR分别为40.9％和26.1％,中位PFS分别为4个月和5个月,MST分别为17个月和14个月,差异均无统计学意义(均P＞0.05).同步组和序贯组的1年生存率分别为56.7％和50.8％ (P ＞0.05),2年生存率分别为38.4％和20.1％,同步组明显优于序贯组(P=0.009).序贯组的白细胞减少的发生率低于同步组(P =0.026);其他毒副反应的发生率差异无统计学意义(P＞0.05).结论 国产培美曲塞联合顺铂全身化疗并同步脑放疗治疗NSCLC脑转移可以取得较好疗效,且患者耐受性良好.     

放疗联合长春瑞滨加顺铂同步治疗Ⅲ期非小细胞肺癌的临床研究

目的为了比较放射治疗联合长春瑞滨(NVB)加顺铂(DDP)同步与序贯放化疗治疗Ⅲ期非小细胞肺癌(non-small cell lung cancer,NSCLC)的疗效及毒副反应。方法将64例Ⅲ期NSCLC患者随机分成2组,同步放化疗组(32例):放疗第1天起即同时开始化疗。序贯放化疗组(32例):入组后先予化疗2个疗程,再单独予放疗。结果近期有效率(CR+PR)同步放化疗组为68.7%,序贯放化疗组为43.7%,P=0.03。1、2、3年生存率同步放化疗组为75%、40%、21%。序贯放化疗组为50%、25%、12%。3年生存率差异有统计学意义,P=0.041。两组患者的毒副反应主要为可逆性骨髓抑制、放射性食管炎,两组发生率相似(χ2=1.65,P0.05),患者大多能耐受。结论初步研究结果提示,放射治疗联合长春瑞滨(NVB)加顺铂(DDP)同步放化疗治疗Ⅲ期NSCLC的疗效优于序贯放化疗,不良反应可耐受,值得进一步研究。     

老年局部晚期非小细胞肺癌三种治疗模式的临床对比分析

目的 评价三种治疗模式对老年局部晚期非小细胞肺癌(NSCLC)的临床疗效和安全性.方法 对近年我院采用三种治疗模式治疗老年局部晚期NSCLC的疗效进行回顾性分析.结果 (1)近期疗效:同步放化疗组(70.0%)＞序贯放化疗组(61.8%)＞单纯化疗组(35.7%),同步放化疗组和序贯放化疗组有效率均明显高于单纯化疗组(P＜0.05);而同步放化疗组和序贯放化疗组之间无显著性差异(P＞0.05).(2)远期疗效:序贯放化疗组(67.6%)＞同步放化疗组(65.0%)＞单纯化疗组(39.3%),序贯放化疗组明显高于单纯化疗组(P＜0.05),而单纯化疗组与同步放化疗组、序贯放化疗组和同步放化疗组间无显著性差异(均P＞0.05).(3)毒副反应:同步放化疗组的骨髓抑制、食管炎、放射性肺炎和恶心呕吐发生率均明显高于单纯化疗组(均P＜0.05),而单纯化疗组和序贯放化疗组间无显著性差异(均P＞0.05).结论 同步放化疗会加重毒副反应,尤其是老年患者,对提高近期疗效和生存率并无益处.在临床实践中可优先考虑序贯化放疗作为老年局部晚期NSCLC的治疗方案.     

放化疗联合治疗局部晚期非小细胞肺癌临床疗效观察

目的探讨放疗同期紫杉醇联合卡铂方案与序贯放化疗治疗局部晚期非小细胞肺癌(NSCLC)疗效及毒副反应。方法将60例局部晚期NSCLC患者随机分为放化同步组(同步组)和放化疗组(序贯组)各30例;两组均行适形放疗,化疗均为PC方案,同步组每周一次;序贯组每3周一次,化疗2周期后再行放疗。观察两组治疗近期有效率、生存率及急性毒副反应。结果两组均完成放化疗,同步组总有效率86.67%,序贯组63.33%(P0.05);3~4级骨髓抑制发生率同步组为30.0%,序贯组为23.3%;同步组和序贯组3~4级放射性肺炎发生率分别为13.4%和6.7%(P0.05);均可耐受。结论同步放化疗能够显著提高局部晚期NSCLC生存率,急性毒副反应均可耐受。     

Simultaneous Compared With Sequential Blood Pressure Measurement Results in Smaller Inter‐Arm Blood Pressure Differences

There are currently few recommendations on how to assess inter‐arm blood pressure (BP) differences. The authors compared simultaneous with sequential measurement on mean BP, inter‐arm BP differences, and within‐visit reproducibility in 240 patients stratified according to age (<50 or ≥60 years) and BP (<140/90 mm Hg or ≥140/90 mm Hg). Three simultaneous and three sequential BP measurements were taken in each patient. Starting measurement type and starting arm for sequential measurements were randomized. Mean BP and inter‐arm BP differences of the first pair and reproducibility of inter‐arm BP differences of the first and second pair were compared between both methods. Mean systolic BP was 1.3±7.5 mm Hg lower during sequential compared with simultaneous measurement (P<.01). However, the first sequential measurement was on average higher than the second, suggesting an order effect. Absolute systolic inter‐arm BP differences were smaller on simultaneous (6.2±6.7/3.3±3.5 mm Hg) compared with sequential BP measurement (7.8±7.3/4.6±5.6 mm Hg, P<.01 for both). Within‐visit reproducibility was identical (both r=0.60). Simultaneous measurement of BP at both arms reduces order effects and results in smaller inter‐arm BP differences, thereby potentially reducing unnecessary referral and diagnostic procedures.     

Analysis of pathological complete response rates with paclitaxel‐based regimens in trimodality therapy for esophageal cancer

The study aimed to examine whether omission of 5‐fluorouracil (5‐FU)‐containing chemotherapy alters pathological complete response rates in patients receiving trimodality therapy for locally advanced esophageal cancer. A total of 159 patients were identified. One hundred twenty‐nine patients received platinum/5‐FU concurrently with radiotherapy, and 30 received taxane/platinum‐containing chemoradiotherapy prior to esophagectomy. Patients were staged using the 2002 American Joint Committee on Cancer staging system. Patients were matched between chemotherapeutic groups, with no significant demographic or clinical differences other than T stage (14% T2 in the 5‐FU group; no T2 in the platinum/taxane group) and radiotherapy technique (8.5% received intensity‐modulated radiotherapy in the 5‐FU group; 60% in the platinum/taxane group). Pathological complete response rates for 5‐FU and platinum/taxane‐based groups were not significantly different (45% and 30%, respectively; P = 0.1548). Five‐year overall survival and progression‐free survival were not statistically different between the two groups. Significant predictors of pathological complete response included N stage (56% N0 and 33% N1; P = 0.0083), histology (37% adenocarcinoma and 59% squamous cell; P = 0.0123), tumor location (39% distal and 59% proximal/mid; P = 0.048), gastroesophageal junction involvement (33% involved and 55% uninvolved; P = 0.005), and radiotherapy end‐to‐surgery interval (50% < 55 days and 34% ≥ 55 days; P = 0.04). Grades 3–4 hematological toxicity was higher in the 5‐FU group (36%) than in the paclitaxel‐containing therapy group (17%; P = 0.0484). Use of paclitaxel‐containing chemoradiotherapy did not result in inferior pathological complete response, overall survival, or progression‐free survival rates, and resulted in less hematological toxicity than 5‐FU treatment.     

Effects of simultaneous and optimized sequential cardiac resynchronization therapy on myocardial oxidative metabolism and efficiency

Introduction: Cardiac resynchronization therapy (CRT) can improve left ventricular (LV) hemodynamics and function. Recent data suggest the energy cost of such improvement is favorable. The effects of sequential CRT on myocardial oxidative metabolism (MVO₂) and efficiency have not been previously assessed. Methods and Results: Eight patients with NYHA class III heart failure were studied 196 ± 180 days after CRT implant. Dynamic [¹¹C]acetate positron emission tomography (PET) and echocardiography were performed after 1 hour of: 1) AAI pacing, 2) simultaneous CRT, and 3) sequential CRT. MVO₂ was calculated using the monoexponential clearance rate of [¹¹C]acetate (k_mono). Myocardial efficiency was expressed in terms of the work metabolic index (WMI). P values represent overall significance from repeated measures analysis. Global LV and right ventricular (RV) MVO₂ were not significantly different between pacing modes, but the septal/lateral MVO₂ ratio differed significantly with the change in pacing mode (AAI pacing = 0.696 ± 0.094 min^?1, simultaneous CRT = 0.975 ± 0.143 min^?1, and sequential CRT = 0.938 ± 0.189 min^?1; overall P = 0.001). Stroke volume index (SVI) (AAI pacing = 26.7 ± 10.4 mL/m², simultaneous CRT = 30.6 ± 11.2 mL/m², sequential CRT = 33.5 ± 12.2 mL/m²; overall P < 0.001) and WMI (AAI pacing = 3.29 ± 1.34 mmHg*mL/m²*10⁶, simultaneous CRT = 4.29 ± 1.72 mmHg*mL/m²*10⁶, sequential CRT = 4.79 ± 1.92 mmHg*mL/m²*10⁶; overall P = 0.002) also differed between pacing modes. Compared with simultaneous CRT, additional changes in septal/lateral MVO₂, SVI, and WMI with sequential CRT were not statistically significant on post hoc analysis. Conclusion: In this small selected population, CRT increases LV SVI without increasing MVO₂, resulting in improved myocardial efficiency. Additional improvements in LV work, oxidative metabolism, and efficiency from simultaneous to sequential CRT were not significant.     

Impact of an integrated approach to diabetes care at the Rumbalara Aboriginal Health Service

Abstract Aims: To describe the effectiveness of an integrated ­primary?secondary care diabetes clinic on metabolic control among indigenous patients in a rural community Methods: A retrospective audit of attendance to the clinic over 2 years (2 August 1999 to 31 August 2001). The service included a weekly specialist diabetes clinic integrated with the primary care team at the Rumbalara Aboriginal Health Service, Mooroopna, Victoria, Australia. Between clinics, follow up was provided by the Aboriginal health worker and other members of the integrated care team. Of the 47 patients seen, 20 had an HbA1c persistently ≥9.0% (of 21 patients identified in the community) and seven had gestational diabetes. Results: Among 40 patients without gestational diabetes, microalbuminuria or proteinuria were present in 62%, retinopathy was present in 50%, neuropathy was present in 50% and at least one past cardiac or vascular event/surgical procedure had occurred in 25%. Of these, the 30 patients seen more than once increased their self glucose monitoring (baseline (53.3%) vs. last visit (90%); P = 0.003) and reduced their HbA1c (10.4 ± 2.2%vs. 7.9 ± 1.9%; P < 0.001), systolic blood pressure (138 ± 20 vs. 127 ± 18 mmHg; P = 0.003) and diastolic blood pressure (78 ± 11 vs. 73 ± 12 mmHg; P = 0.037) and total cholesterol (6.1 ± 1.7 vs. 5.1 ± 1.6 mmol/L; P = 0.002), but not their weight, smoking or triglycerides. Conclusion: The introduction of an integrated diabetes care service in an Aboriginal health service can overcome many of the pre‐existing barriers to achieving metabolic targets. Poor metabolic control in Aboriginal patients is often due to lack of resources and inappropriateness of approach, rather than ‘compliance’. (Intern Med J 2003; 33: 581?585)     

Primary radiotherapy with or without chemotherapy in non-metastatic esophageal squamous cell carcinoma: a retrospective study

The purpose of this study was to report the outcome of radio(chemo)therapy in the curative management of esophageal squamous cell carcinoma (ESCC). We retrospectively analyzed 163 patients with T1‐T4, N0‐1, M0 ESCC who were treated between January 1988 and December 2006 at the Technische Universität München. One hundred sixty patients were inoperable due to a poor performance status, comorbidities or locally advanced unresectable disease. External beam radiation therapy (EBRT) was performed with (n= 146) or without (n= 17) systemic chemotherapy. Fifty‐four patients received an additional boost with intraluminal brachytherapy (IBT). Surviving patients were followed for a median of 72 months (range 10–173 months). The estimated overall survival (OS) at 2 and 5 years was 27 ± 4% and 11 ± 3%, respectively. Loco‐regional recurrence at the primary site was observed in 29% of patients (n= 47). The recurrence‐free survival (RFS) at 2 and 5 years was 24 ± 3% and 9 ± 2%, respectively. In multivariate analyses, the ECOG performance status (P= 0.004), 3D conformal (vs conventional) radiotherapy (P= 0.031) and continuous standard fractionation (vs split‐course radiotherapy, P= 0.048) were associated with a better OS. Simultaneous chemotherapy (P= 0.49) or IBT (P= 0.31) had no significant impact on survival. Outcome for patients with ESCC is poor. Despite the very unfavorable patient selection (poor performance status, high rate of comorbidities, and advanced disease), long‐term survival with radio(chemo)therapy was achieved in about 10% of patients. The introduction of modern treatment techniques/modalities (3D conformal planning/ continuous standard fractionation) might be associated with better outcomes.     

Effect analysis of chemoradiotherapy after operation in patients with stage III A non-small cell lung cancer

ObjectiveTo investigate the effect of chemoradiotherapy after surgery on III A stage non-small cell lung cancer (NSCLC).MethodsA total of 156 NSCLC patients undergoing total pneumonectomy or pulmonary lobectomy were included in this study. The chemotherapy group (n=75) received the protocol of cisplatin (DDP) + gemcitabine (GEM) / docetaxel (DOC) / vinorelbine (NVB); the radiotherapy + chemotherapy group (n=81) received sequential chemoradiotherapy. The response rate, local control rate in 1 to 2 years, overall survival (OS), progression-free survival (PFS) and adverse reactions were evaluated.ResultsThe overall response rate was obviously higher in radiotherapy + chemotherapy group (79.4%) than in chemotherapy group (56.8%) (P<0.01). The 1 year local control rates for chemotherapy group and radiotherapy + chemotherapy group were (69.1±7.9)% and (77.8±8.2)% respectively and the difference reached statistical significance (P<0.001). The 2 year local control rates were (42.1±6.1)% and (61.5±6.9)% respectively (P<0.001). The difference in median follow-up time between the two groups did not reach statistical meaning (P>0.05), while the median PFS of two groups were 10.8 months and 16.9 months respectively (P<0.001). 1-year and 3-year survival rates were obviously higher in radiotherapy + chemotherapy group than in chemotherapy group, and the difference reached statistical significance (P<0.05 or P<0.01). The adverse reactions manifested as hematological toxicity and digestive tract reaction in the two groups. In the radiotherapy + chemotherapy group, incidences of radiation-induced esophagus injury and lung injury were 24.7% and 34.6% respectively, all occurring within 2 to 6 weeks after the start of radiation and both below grade 2.ConclusionsChemoradiotherapy after surgery can improve local control rate and reduce or prevent distant metastasis, but there are still many controversies. In clinical work, we should carefully evaluate each patient's age, lung function, basic physical condition scoring and complications to choose a therapeutic schedule that is suitable for the patient.     

Serum Ferritin,Vitamin B<Subscript>12</Subscript>, Folate,and Zinc Levels in Children Infected with <Emphasis Type="Italic">Helicobacter pylori</Emphasis>

We sought to explore the relationship between Helicobacter pylori infection and serum ferritin, vitamin B₁₂, folate, and zinc status among children. Fifty patients aged 5–18 years who underwent upper gastrointestinal endoscopy because of dyspeptic symptoms, were studied, prospectively. Patients were grouped as H. pylori positive (group 1, n=32) or H. pylori negative (group 2, n=18) by histopathologic examination and rapid urease test. Fasting serum ferritin, vitamin B₁₂, folate, and zinc levels of patients were measured. Both groups were indifferent according to age, gender, height standard deviation score (H_SDS), and weight standard deviation score (W_SDS). Serum ferritin levels were 33±26 and 50±46 ng/mL (P=.098), vitamin B₁₂ levels were 303±135 and 393±166 pg/mL (P=.042), folate levels were 9.64±3.2 and 9.61±2.8 ng/mL (P=.979), and zinc levels were 95±48 and 87±31 μg/dL (P=.538), in groups 1 and 2, respectively. Ferritin levels of 14 (43.8%) patients in group 1 and 6 (33.3%) patients in group 2 were below the normal range (P=.470). Serum vitamin B₁₂ levels of 9 children (28%) in group 1 and 2 children (11%) in group 2 were below the normal range (P=.287). The findings of the present study suggest that H. pylori infection has a negative effect on serum ferritin and vitamin B₁₂ levels in children. This negative effect on vitamin B₁₂ levels is rather marked in contrast to that on ferritin levels. H. pylori infection has no significant effect on serum folate or zinc levels among children.     

Hepatitis B surface antigen reduction by switching from long‐term nucleoside/nucleotide analogue administration to pegylated interferon

Hepatitis B surface antigen (HBsAg) reduction during nucleoside/nucleotide analogue (NA) therapy is slow and an alternative strategy for patients receiving ongoing NA to facilitate HBsAg reduction is required. We investigated whether switching to pegylated interferon (PEG‐IFN) after long‐term NA administration enhances HBsAg reduction. Forty‐nine patients who switched from long‐term NA to 48 weeks of PEG‐IFN alfa‐2a were studied. The mean duration of previous NA was 48 months (sequential group). A total of 147 patients who continued NA and matched for baseline characteristics were analysed for comparison (NA continuation group). The treatment response was defined as HBsAg reduction ≥1.0 logIU/mL at the end of PEG‐IFN. HBsAg reduction at week 48 was 0.81±1.1 logIU/mL in the sequential group, which was significantly higher than that in the NA continuation group (0.11±0.3 logIU/mL, P < .001). The treatment response was achieved in 29% and 2% of the sequential group and NA continuation group (P < .001), and the odds ratio of sequential therapy for the treatment response was 19 compared with the NA continuation (P < .001). In patients tested positive for hepatitis B e antigen (HBeAg), HBeAg seroconversion was higher in the sequential group (44% vs 8%, P < .001). In HBeAg‐negative patients, only patients in the sequential group achieved HBsAg loss. No patient needed to resume NA administration because of HBV DNA increase accompanied by alanine aminotransferase flares. In summary, sequential therapy with PEG‐IFN after long‐term NA enhances the reduction of HBsAg and may represent a treatment option to promote HBsAg loss.     

Omega-3多不饱和脂肪酸通过调节钙/钙调蛋白依赖性蛋白激酶-2/腺苷酸活化蛋白激酶蛋白信号通路对大鼠骨骼肌衰老的抑制作用

目的 探讨omega-3多不饱和脂肪酸(n-3PUFAs)对D-半乳糖(D-gal)诱导的大鼠骨骼肌衰老的延缓作用及其可能机制。方法 将30只老年雄性Wistar大鼠随机分为空白组(注射0.9%生理盐水)、模型组(骨骼肌衰老大鼠模型)和n-3PUFAs组(骨骼肌衰老大鼠模型加n-3PUFAs饲料喂养),每组各10只。比较3组大鼠生长状况、体质量、比目鱼肌质量变化及四肢肌肉力量,分析n-3PUFAs对衰老肌肉萎缩大鼠肌肉再生的作用。采用Western blot分别检测钙/钙调蛋白依赖性蛋白激酶-2(CaMKK2)、腺苷酸活化蛋白激酶蛋白(AMPK)表达水平。采用SPSS 21.0统计软件进行数据分析。多组间比较采用单因素方差分析,两两比较采用LSD-t检验。结果 与空白组大鼠[(466.04±33.83)g]比较,模型组[(403.33±25.37)g]和n-3PUFAs组[(435.72 ±27.32)g]大鼠体质量明显减轻;且n-3PUFAs组大鼠体质量较模型组大鼠增加,差异均有统计学意义(P＜0.05)。与空白组比较,模型组大鼠在饲养1个月[(2.40±0.50)和(1.07±0.15)s]和2个月[(7.33±0.76)和(1.33±0.32)s]后开始攀爬的时间明显延长;与模型组比较,n-3PUFAs组大鼠在1个月[(1.76±0.32)和(2.40±0.50)s]和2个月[(4.07±0.61)和(7.33±0.76)s]后开始攀爬的所需时间明显缩短,差异均有统计学意义(P＜0.05)。与空白组比较,模型组大鼠骨骼肌细胞间隙增大,大鼠骨骼肌萎缩严重,肌纤维直径明显缩小,p21、p16蛋白表达上调;与模型组比较,n-3PUFAs组大鼠骨骼肌细胞间隙缩小,肌纤维直径增粗,p21、p16蛋白表达下调,差异均有统计学意义(P<0.05)。与空白组比较,模型组大鼠中CaMKK2、磷酸化的p-AMPK的相对蛋白表达明显下降;与模型组比较,n-3PUFAs组大鼠中CaMKK2、磷酸化的p-AMPK相对蛋白表达明显增加,差异均有统计学意义(P<0.05);而AMPK在3组中的表达差异无统计学意义(P>0.05)。结论 n-3PUFAs 可延缓 D-半乳糖诱导的大鼠骨骼肌衰老,其机制可能与 CaMKK2/AMPK 信号通路关键蛋白水平上调有关。     

Serum glucose level at hospital admission correlates with left ventricular systolic dysfunction in nondiabetic, acute coronary patients: the Hellenic Heart Failure Study

The purpose of this work was to evaluate the relation between serum glucose levels at hospital admission and left ventricular systolic function in nondiabetic patients with an acute coronary syndrome (ACS). Of the 1000 ACS patients who were consecutively enrolled during 2007–2008, 583 (63 ± 13 years, 20% females) nondiabetic patients were studied in this work. Of these, 254 presented left ventricular systolic dysfunction (ejection fraction <40%). Biochemical measurements and detailed medical information were recorded in all participants. Patients having glucose levels at hospital admission in the highest tertile (>155 mg/dl) had lower left ventricular ejection fraction (40% vs 45%, P = 0.003), were older (66 ± 11 vs 61 ± 13, P = 0.004) and less physically active (49% vs 63%, P = 0.02), had higher troponin (14.7 ± 39.7 vs 5.6 ± 13.5, P = 0.03), higher brain natriuretic peptide (510.39 ± 932.33 vs 213.4 ± 301.14, P = 0.008), higher C-RP (42.26 ± 55.26 vs 26.46 ± 38.18, P = 0.04), lower creatinine clearance levels (68 ± 33 vs.81 ± 31, P = 0.009), higher white blood cell count (13 416 ± 16 420 vs 9310 ± 3020, P = 0.001), and lower body mass index (26.8 ± 4 vs 27.2 ± 4.4, P = 0.07), compared to those in the lowest tertile (<114 mg/dl). The multiadjusted logistic regression analysis revealed that a 10 mg/dl difference in glucose levels was independently associated with 8% (95% confidence interval 2%–14%) higher likelihood of left ventricular systolic dysfunction. Low glucose concentrations at hospital admission in nondiabetic post-ACS patients is a predictor for the appearance of left ventricular dysfunction, and could be a target marker for risk stratification.