Association between Chinese Medicine Therapy and Survival Outcomes in Postoperative Patients with NSCLC: A Multicenter, Prospective, Cohort Study

Objective: To evaluate the association between Chinese medicine(CM) therapy and disease-free survival(DFS) outcomes in postoperative patients with non-small cell lung cancer(NSCLC). Methods: This multiple-center prospective cohort study was conducted in 13 medical centers in China. Patients with stage Ⅰ,Ⅱ, or ⅢA NSCLC who had undergone radical resection and received conventional postoperative treatment according to the National Comprehensive Cancer Network(NCCN) guidelines were recruited. The recruited patients were divided into a CM treatment group and a control group according to their wishes. Patients in the CM treatment group received continuous CM therapy for more than 6 months or until disease progression. Patients in the control group received CM therapy for less than 1 month. Fol ow-up was conducted over 3 years. The primary outcome was DFS, with recurrence/metastasis rates as a secondary outcome. Results: Between May 2013 and August 2016, 503 patients were enrol ed into the cohort; 266 were classified in the CM treatment group and 237 in the control group. Adjusting for covariates, high exposure to CM was associated with better DFS [hazard ratio(HR) = 0.417, 95% confidential interval(CI): 0.307–0.567)]. A longer duration of CM therapy(6–12 months, 12–18 months, 24 months) was associated with lower recurrence and metastasis rates(HR = 0.225, 0.119 and 0.083, respectively). In a subgroup exploratory analysis, CM therapy was also a protective factor of cancer recurrence and metastasis in both stage Ⅱ–ⅢA(HR=0.50, 95% CI: 0.37–0.67) and stage ⅢA NSCLC postoperative patients(HR = 0.48, 95% CI: 0.33–0.71), DFS was even longer among CM treatment group patients.Conclusions: Longer duration of CM therapy could be considered a protective factor of cancer recurrence and metastasis. CM treatment is associated with improving survival outcomes of postoperative NSCLC patients in China.(Registration No. ChiC TR-OOC-14005398)     

Supplementary inferior phrenic artery embolization in the interventional treatment of hemoptysis

Background Transcatheter bronchial artery embolization （BAE） is widely used for the treatment of hemoptysis and the immediate success rate is high, but there are still some hemorrhage recurrences. One of the common reasons for failure of BAE is collateral branches as blood supply. The inferior phrenic artery （IPA） is one of the most common collateral branches that is scarcely reported. Our purpose was to observe manifestations of IPA supplying to hemoptysis and evaluate the efficacy and safety of IPA embolization. Methods Angiography during interventional treatment of 178 hemoptysis patients in the past 7 years confirmed that IPA hemorrhage resulted in hemoptysis in 25 patients （26-67 years old） who had： lung cancer （11 patients）, bronchiectasis （11 patients）, chronic lung inflammation （2 patients）, and pulmonary tuberculosis （1 patient）. Among the 25 patients, 7 patients had twice interventional operations within one week and 6 patients still experienced intraoperative hemoptysis after conventional embolization of the bronchial artery, the internal thoracic artery, and the intercostal artery, then had the second interventional operation immediately. The total number of cases were 191. Selective embolization of the IPA was performed using polyvinyl alcohol microspheres, gelatin sponge particles, and microcoil. The safety and clinical significance of IPA embolization were evaluated. The Pearson X2 test and Fisher＇s exact probability test were used in this study. Results Selective IPA angiography showed increased diameter of the IPA, disorganization of the branches, and varying degrees of angiogenesis. In 11 cases, contrast material was seen in vessels supplying the tumor and in the tumor. In 9 cases, contrast material had leaked into the area supplied by the IPA; in 8 cases, non-specific flake-like deposits of contrast material were seen; and in 14 cases, abnormal communication or shunt was visualized. Lesions were closely related to the pleura in 25 patients. Fifteen lesions were close to the diaphragmatic pleura, seven close to the mediastinal pleura, and three close to the lateral pleura of the lower lung. Eleven cases had inferior thoracic pleural thickening and adhesions. The IPA was embolized in 25 cases, and the success rate of hemostasis was 100%. The IPA was not embolized in the other 166 cases, and the success rate of hemostasis was 92.17 %. In the 25 cases with IPA embolization, the involvement of the IPA in the blood supply of the hemoptysis was correlated with the duration of the disease （P=0.0344）. The involvement of IPA in the blood supply of the hemoptysis was not correlated with the characteristic of the lung lesions （benign or malignant） （P=1.0000）. Duration of follow-up was 8 months to 5 years. Hemoptysis recurred in four patients 1,2, 3, and 6 months after interventional operation, respectively, and was controlled by conservative treatment. Twenty-one patients had no recurrence of hemoptysis. Conclusions Bleeding from the IPA can result in hemoptysis and failure of BAE in the treatment of hemoptysis. If IPA hemorrhage contributes to hemoptysis, supplementary IPA embolization may be a safe and effective treatment.     

Breast

<正>209169 Analysis of the treatment and prognosis of recurrent breast phyllodes tumor/Fang Yi(Dept Abdomin Surg,Oncol Cancer Hosp(Institute),Chin Acad Med Sci,Beijing 100021)…∥Chin J Oncol.-2009,31(1).-72~74Objective To explore the methods of diagnosis,treatment and prognosis for patients with recurrent breast phyllodes tumor.Methods Clinicopathological data of 26 patients with pathologically proven recurrent phyllodes tumors treated from March 1972 to June 2006 were retrospectively analyzed.Results The mean age of the 26 cases was 45 years,and the median follow-up duration was 83 months.The mean overall survival time of this series was 96 months.The primary breast phyllodes tumor was ≥5 cm in 10 cases with a recurrence rate of 60.0%(6/10 cases);<5 cm in 16 cases with a recurrence rate of 31.3% 5/16(cases).After surgical removal of the breast primary tumor,the recurrent tumor was ≥5 cm in 14 cases with a re-recurrence rate of 35.7%(5/14 cases);<5 cm was in 12 cases with a re-recurrence rate of 50.0% (6/12 cases).There was no statistically significant relationship between the(primary and reccurent)tumor size and recurrence rate(P=0.094,P=0.383)or prognosis,(P=0.142,P=0.486).The benign or malignant nature of the breast phyllodes tumor was singificantly correlated with the rate of local re-recurrence(P=0.046)and prognosis(P=0.028).     

Follow-up Study of Retreatment TB Patients with Sputum Smear and/or Culture Positive Two Years after They were Declared Cured with First-line Anti-TB Drugs in Shandong Province

This study aimed to learn the recurrence rate in the retreatment TB patients with sputum smear and/or culture positive(ss+and/or c+)two years after they were declared cured,and to explore causes of recurrence in order to improve long-time treatment outcome.5 cities were selected as research locations.Recurrence of TB was judged by chest X-ray examination together with sputum smear and culture examination.Questionnaire was     

Surgical strategies for petroclival meningioma in 57 patients

Background Resection of petroclival meningioma （PCM） is difficult for neurosurgeons and usually brings poor performance status. In this study, we evaluated the possible risk factors for unfavorable clinical outcomes of surgical treatment of PCM, and tried to explore the optimal surgical strategies for better postoperative quality of life.Methods We recruited 57 patients （14 male, 43 female, mean age, 50.5 years） who underwent surgical resection of PCM in Huashan Hospital during 2002-2006. The primary outcomes including postoperative neurological deficits,modified Rankin scale （mRS） score and recurrence rate were evaluated, and all potential risk factors were assessed by the X2 test. Odds ratio and 95% confidence interval were calculated by univariate Logistic regression. The mean follow-up time was 34 months.Results Gross total resection was achieved in 58% of patients. One patient died during the perioperative period because of intracranial hemorrhage. Sixty-seven percent of patients experienced new postoperative neurological deficits and 26% had a higher mRS score at follow-up assessment. Postoperative complications were observed in 24 patients.Within the follow-up period, radiographic recurrence occurred in 12.3% of patients at a mean follow-up of 42 months.Postoperative radiosurgery was administered to 19 patients who had residual tumors or recurrence and no furtherprogression was found. Tumor adhesion, hypervascularity and engulfment of neurovascular structures were three risk factors for increased mRS score （P=0.0002; P=0.0051; P=0.0009）. Tumor adherence to adjacent structures clearly affected the extent of resection （P=0.0029）. The risk of postoperative cranial nerve deficits increased with tumor engulfment of neurovascular structures （P=0.0004）.Conclusions Intraoperatively defined tumor characteristics played a critical role in identifying postoperative functional status. An individual treatment strategy after careful preoperative evaluation could help improve quality of life.     

Clinical observation of local resection or enucleation for uveal melanoma

Backround Local resection is an effective method for treating the uveal melanoma. The aim of this study is to evaluate the survival and clinical outcomes of patients with uveal melanoma treated by local resection or enucleation. Methods Totally, 167 consecutive patients with uveal melanoma were recruited for the study, of whom 57 patients were treated with local resection and 110 patients were treated with enucleation. The main outcome was measured by the visual acuity, local recurrence, eye retention, metastases, and melanoma-related mortality. Results There were statistically significant differences in the largest basal diameter of the tumor （t=-3.441）, the tumor thickness （t=-4.140）, the ciliary body infiltration （X2=8.391）, and the duration of follow-up （Z=3.995） between the two groups （P 〈0.05）. The univariate survival analysis showed that the method of treatment was not significantly associated with metastases. The Cox proportion hazard analysis showed that the risk factors for metastasis involved the age at the time of diagnosis （RR=1.752, 95% CI 1.066- 2.880, P=0.027）, the largest basal diameter of the tumor （RR=3.508, 95% CI 1.934-6.336, P=0.000）, and the histological type （RR=2.444, 95% CI 1.106-5.877, P=0.046）. The 5-year metastases rate was 18.60% for the group with local resection and 27.81% for enucleation （X2=1.214, P 〉0.05）; the 5-year melanoma-related mortality was 16.27% for the group with local resection and 25.33% for enucleation （X2=1.304, P 〉0.05）. The 5-year local tumor recurrence rate was 29.50% and the 5-year accumulated eye retention rate was 69.00% after local resection. The visual acuity which light perception or better of 60 months after local resection was observed in 25 （92.60%） among persons retaining eye. Conclusions The survival outcomes of the patients with local resection were not worse than that of the patients with enucleation, and local resection could make the patient retain eye and partial visual functions. Hence, local res     

An extensive subfrontal approach to the lesions involving the skull base.

A modification of the transbasal approach of Dorome called extensive subfrontal approach and the surgical results with this approach in 22 cases are presented. Bilateral frontal craniotomies incorporated with the removal of orbital ridges and part of the orbital roofs were fashioned en bloc. It may give rise to good exposure of the midline lesions of the anterior, middle and posterior skull base, minimizing the need for the retraction of frontal lobes. There was no surgical mortality in this series of cases. Of the 20 cases with tumors, total resections were achieved in 11 cases, subtotal or large resections in 4 cases and partial resection in one case. Two patients with spontaneous rhinorrhea were successively treated surgically, 21 patients had a follow-up with a time ranging from 1-11 years (a mean of 3 years). 15 patients resumed their jobs with no evidence of recurrence of the original disease, and 5 patients able to live self-care. One patient with an olfactory neuroblastoma died 3 years after the     

The diagnosis and treatment of phyllodes tumor of the breats: report of 14 cases

Objective To evaluate the potential prognostic factors, and to better define appropriate treatment strategies for patients with phyllodes tumor of the breast. Methods Fourteen patients treated primarily for phyllodes tumor of the breast were reviewed retrospectively. Results The median age was 35 years. According to the histologic criteria of WHO .there were 5 benign cases (36 %), 5 borderline cases (36 %), and 4 malignant cases (29 %). Seven patients underwent local excision, 4 cases did simple mastectomy, and 3 cases did modified radical mastectomy. Follow-up was obtained for 11 cases, with an average of 19 months. One patients died from metastasis 2 years after a modified radical mastectomy. Three patients treated by local excision presented local recurrence. Conclusion The outcome of phyllodes tumor appears to be determined by the biology of the tumor rather than by treatment modality. A wide local excision, with an adequate margin of normal breast tissue is the preferred initial therapy for phyllod     

Modification of closed tympanoplasty in middle ear cholesteatoma

Background Classic mastoidectomy and modified mastoidectomy are traditional surgical procedures for middle ear cholesteatoma with goals of eradicating diseases, creating dry ears and preventing severe complications. However, the drawback of these procedures is the lack of hearing improvement. Therefore, our study aimed to investigate the effects and safety of a modification of closed tympanoplasty for middle ear cholesteatoma. Methods Eighty-three patients were recruited in this study based on the following two criteria： each patient had middle ear cholesteatoma in one ear; the affected ears had a functional eustachian tube and had neither intracranial nor extracranial complications. All the patients received a modification of closed tympanoplasty which included ossicular reconstruction with total ossicular replacement prosthesis （TORP） or partial ossicular replacement prosthesis （PORP） and membrane repair with conchal cartilage-perichondral complex. Results All the 83 cases had dry ears with membranes healed within 4-6 postoperative weeks. After 6 postoperative months, there were 3 cases with re-perforation at the tympanic membrane center and after 1.5 postoperative years, there were 5 cases with cholesteatoma recurrence （6.02%）. Function tests after one postoperative year exhibited an improvement of pure tone audiometry （PTA） in 27 cases that was more than 30 dB, in 33 cases between 20-29 dB, 14 cases with improvement between 10-19 dB, and in 9 cases there was no improvement. Conclusions The modified closed tympanoplasty procedure for middle ear cholesteatoma in the present study has all the advantages of both close-cavity and open-cavity procedures. It has low recurrence rate and good hearing improvement.     

Flaps for the repair of bladder exstrophy.

From April 1986 to March 1992, flaps were used in the surgical treatment of 17 patients with congenital bladder exstrophy. Eleven of these patients had had surgery in other hospitals but all failed. Using the flap method for the repair all of them had procured a functional bladder except one who could not have a complete control of urination. The longest follow-up period was 3 years, and the renal and bladder functions were completely normal. The immediate result in 14 patients was good in the control of urination right after the removal of the catheter. The follow-up results were good in 16 cases. The flaps used included 8 types of skin flaps, fasciae and vascular pedicles. Provided with the central vascular supply, the new series of procedures were suitable for the treatment of a variety of exstrophy deformities.

     

四川省西昌市2008—2018年初始抗病毒治疗HIV感染者死亡和脱失情况

目的 了解四川省西昌市2008–2018年初始抗病毒治疗HIV感染者死亡和脱失的情况及其影响因素。方法 采用回顾性队列研究的方法,从艾滋病基本防治信息系统选取2008–2018年在西昌市首次开始抗病毒治疗（ART）的HIV感染者,分析抗病毒治疗者的死亡和脱失情况。采用Cox比例风险回归模型对影响抗病毒治疗HIV感染者病死率和脱失率的相关因素进行分析。结果 共计2 723例HIV感染者进入队列,总体病死率为1.92/100人年,总体脱失率为2.49/100人年。在开始抗病毒治疗的第1年内病死率和脱失率分别为10.83/100人年、13.89/100人年。Cox回归分析结果显示接受抗病毒治疗患者主要的死亡风险是年龄≥40岁（HR=2.30,95%CI：1.53~3.48）、男性（HR=1.94,95%CI：1.14~3.30）、ART前一年内结核感染（HR=1.92,95%CI：1.01~3.65）、ART前三个月出现艾滋病相关疾病/症状（HR=2.44,95%CI：1.50~3.99）、ART前乙肝感染（HR=2.50,95%CI：1.32~4.71）、CD4⁺T淋巴细胞计数< 200 cells/ul（HR=1.79,95%CI：1.12~2.86）。接受抗病毒治疗患者主要的脱失风险是年龄≥40岁（HR=1.53,95%CI：1.07~2.18）、男性（HR=5.60,95%CI：2.60~12.08）、静脉吸毒（HR=2.18,95%CI：1.46~3.27）、初始抗病毒治疗方案为EFV+3TC+TDF（HR=2.57,95%CI：1.32~5.01）。结论 西昌市HIV感染者的抗病毒治疗效果显著,但在开始治疗的第1年内病死率和脱失率较高。抗病毒治疗工作需采取针对性的措施,重点要减少静脉吸毒人群刑满释放后的脱失,从而提高抗病毒治疗效果。     

广西钦州市2008—2018年初始抗病毒治疗HIV感染者死亡和脱失分析

目的 了解初始抗病毒治疗HIV感染者死亡和脱失情况及其影响因素,为HIV感染者有效管理和治疗提供依据。方法 采用回顾性队列研究方法,从艾滋病综合防治信息系统下载广西钦州市2008—2018年初始抗病毒治疗（ART）HIV感染者数据,采用Cox比例风险回归模型分析其死亡和脱失情况。结果 共7 812例HIV感染者进入队列,总体病死率和脱失率分别为3.25/100人年和2.41/100人年。抗病毒治疗第1年内病死率和脱失率分别为5.70/100人年和 4.88/100人年。Cox回归分析显示,死亡影响因素是年龄≥50岁（HR=2.60,95%CI：2.27~2.98）、男性（HR=1.90,95%CI：1.62~2.23）、静脉吸毒（HR=1.84,95%CI：1.56~2.17）、治疗前WHO临床分期为Ⅲ/Ⅳ期（HR=1.33,95%CI：1.15~1.53）、治疗前CD4⁺T淋巴细胞计数<200 cells/μL（HR=1.58,95%CI：1.25~1.99）、治疗机构为县级（HR=2.74,95%CI：2.36~3.19）、HIV诊断到抗病毒治疗间隔天数30~< 90 d（HR=1.17,95%CI：1.01~1.36）、间隔天数90 ~<365 d（HR=1.21,95%CI：1.02~1.44）;脱失影响因素是年龄≥50岁（HR=1.60,95%CI：1.37~1.87）、男性（HR=1.56,95%CI：1.32~1.85）、静脉吸毒（HR=1.96,95%CI：1.62~2.36）、开始ART前CD4⁺T淋巴细胞计数≥ 350/μL（HR=1.43,95%CI：1.16~1.77）、抗病毒治疗初始方案含LPV/r（HR=1.80,95%CI：1.36~2.38）、抗病毒治疗开始时间在2013—2016年（HR=1.36,95%CI：1.12~1.65）、抗病毒治疗开始时间在2017—2018年（HR=1.66,95%CI：1.30~2.14）、HIV诊断到抗病毒治疗时间间隔天数>365 d（HR=1.21,95%CI：1.01~1.45）。结论 钦州市HIV感染者抗病毒治疗效果较好,但治疗第1年内病死率和脱失率较高。需针对死亡和脱失的影响因素,加强抗病毒治疗医疗卫生人员培训和治疗者宣传教育以提高抗病毒治疗效果。     

云南省保山市1990—2020年HIV/AIDS病例生存分析

目的 通过对云南省保山市1990—2020年艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS）生存时间及其影响因素进行全面分析,为提高HIV/AIDS病人生存质量提供科学依据。方法 运用回顾性队列研究方法, 计算1990—2020年保山市6 838例HIV/AIDS病人的生存率;用Cox比例风险模型分析生存时间的影响因素。结果 6 838例HIV/AIDS病人,全死因死亡1 757例（25.69%）,平均生存时间为19.51年（95%CI:18.51~20.51）;随着防控措施的强化,相对于2005年以前的第一个时期,后三个时期5年生存率均有所升高而死亡风险均下降。多因素Cox比例风险模型分析发现,HIV/AIDS生存的相关影响因素包括性别（男比女：HR=1.223,95%CI=1.094~1.367）、确诊年龄（40~<50岁比15~<25岁：HR=1.743,95%CI=1.110~2.739;50~<60岁比15~<25岁：HR=2.092,95%CI=1.306~3.351;≥60岁比15~<25岁：HR=3.179,95%CI=1.984~5.094）、感染途径（经注射吸毒传播比经异性传播：HR=0.694,95%CI:0.58~0.83）、样本来源（医疗机构其他就诊者检测比羁押人员：HR=1.584,95%CI=1.283~1.955）、抗病毒治疗（未接受ART比接受ART：HR=17.159,95%CI=15.062~19.547）、首次CD4细胞值（CD4为200~<350个/μL比<200个/μL：HR=0.536, 95%CI=0.459~0.627;350~<500个/μL比<200个/μL：HR=0.390,95%CI=0.323~0.472;≥500个/μL<200个/μL：HR=0.350,95%CI=0.286~0.427）。结论 在云南防治艾滋病政策和措施不断完善的背景下,保山31年来HIV/AIDS病人生存率得到较大提升,但男性、确诊年龄大、异性性途径传播、样本来源为医疗机构其他就诊者检测、未接受抗病毒治疗和首次CD4结果低是HIV/AIDS生存的危险因素,需要进一步精准防控。     

海南省三亚市158例耐多药肺结核患者危险因素的Logistic回归分析

目的 探讨三亚市158例耐多药结核病（MDR-TB）患者的危险因素,为MDR-TB的防治提供科学依据。 方法 对三亚市158例MDR-TB患者（病例组）和316例敏感性结核患者（对照组）的相关情况进行调查,应用单因素及多因素Logistic回归模型分析MDR-TB发生的危险因素。 结果 单因素及多因素Logistic回归分析显示,居住地（OR=2.308,95%CI：1.597~5.104）、既往抗结核治疗史（OR=16.218,95%CI：14.815~25.106）、结核空洞（OR=2.904,95%CI：2.116~7.915）、治疗过程中断（OR=5.706,95%CI：4.508~12.319）、抗结核药物不良反应（OR=3.382,95%CI：2.672~10.137）、不规律用药（OR=2.508,95%CI：1.813~5.646）及首次抗结核治疗效果（OR=3.513,95%CI：2.914~10.870）是MDR-TB发生的危险因素。 结论 三亚市MDR-TB发生的危险因素较多,需要进一步加强早期发现和规范诊疗,以减少MDR-TB的发生。     

Past medical history and risk of death due to hepatocellular carcinoma, univariate analysis of JACC study data

The relationship between the past history of selected diseases and the risk of dying from hepatocellular carcinoma (HCC) was analyzed using 110,792 cohort members (46,465 males and 64,327 females) recruited between 1988 and 1990 by the JACC Study (the Japan Collaborative Cohort Study for Evaluation of Cancer Risk). Significantly elevated hazard ratios (HRs) were observed in both genders for the past history of kidney diseases, liver diseases, gallstones or cholecystitis, diabetes mellitus, and blood transfusion. Further, when analyzed by age group (those 40-59 years of age were "younger" and those 60-79 years of age were "older"), although the significant associations were generally maintained, the magnitude of the HRs for liver diseases and diabetes mellitus seemed to be considerably different between the younger and older age groups for male cohort members. When the analyses were limited to cohort members without the past history of liver diseases, the past histories which had significantly elevated HRs were hypertension (HR = 3.14, 95% confidence interval (CI): 1.25-7.89), diabetes mellitus (HR = 4.17, 95% CI: 1.22-14.25), and blood transfusion (HR = 7.69, 95% CI: 3.09-19.15) in the younger male age group and gallstone or cholecystitis (HR = 2.58, 95% CI: 1.11-5.98) in the older male age group. On the other hand, for females, the significantly elevated HRs were gastric or duodenal ulcer (HR = 4.33, 95% CI: 1.09-17.25) in the younger age group and diabetes mellitus (HR = 6.16, 95%CI: 2.25-16.90) and blood transfusion (HR = 3.86, 95%CI: 1.58-9.41) in the older age group. However, since the evidence from our univariate analyses might not be decisive, multivariate Cox proportional hazards models controlling for potential confounders and effect modifiers will be required to obtain more valid or unbiased hazard ratios.     

湖北省黄石市2003—2018年艾滋病抗病毒治疗患者生存分析

目的 研究黄石市艾滋病抗病毒治疗患者生存情况及影响因素。方法 提取艾滋病综合防治信息系统中黄石市2003—2018年进行艾滋病抗病毒治疗的患者信息,通过寿命表法计算患者的累积生存率; Log-Rank检验进行生存时间影响的单因素分析,Cox比例风险模型进行生存时间影响的多因素分析。结果 截至2018年12月,研究对象存活1 159例,平均生存时间为142.50个月,95%CI (139.09~147.94个月)。1~5年累积生存率分别为90.54%、85.76%、82.82%、80.50%、78.87%。全死因死亡253人,平均死亡年龄(62.77±11.46)岁,死于艾滋病相关疾病患者157人,治疗后1年之内死亡162人,全死因患者中位数生存时间为10.00个月(P ₂₅~P ₇₅为3~24个月)。经Cox比例风险模型分析,基线CD4⁺T淋巴细胞计数为351~500个/μL,治疗效果较好(HR =0.20,95%CI 0.09~0.47);年龄越大,生存率越低(HR = 22.57,95%CI 5.89~86.49)。结论 黄石市艾滋病抗病毒治疗患者累积生存率较高,开始治疗年龄、CD4⁺T淋巴细胞计数、WHO临床分期等是艾滋病抗病毒治疗患者生存时间的影响因素。     

重庆市流动人口肺结核患者服药依从性影响因素调查

目的 探讨重庆市流动人口肺结核患者服药依从性的影响因素,为制定完善相关管理模式和防控策略提供科学依据。方法 搜集2018年1月1日—12月31日重庆市9个区县初治结案的流动人口肺结核患者156例病案信息。通过问卷调查患者相关情况,单因素和多因素Logistic回归分析,以了解患者服药依从性的影响因素。结果 单因素分析显示不同性别、职业对服药依从性差异无统计学意义（P>0.05）;不同文化程度、结核病灾难性支出、结核病防治知识的知晓情况以及定点医院可及性对服药依从性差异有统计学意义（P<0.05）。多因素分析显示年龄在35~59岁、结核病灾难性支出、结核病防治知识知晓情况是影响患者服药依从性的重要因素,OR(95%CI):分别为0.17（0.450~0.646）、19.13（6.902~53.028）、3.38（1.166~9.818）。结论 根据年龄采取有针对性的结防知识宣教,提高患者对疾病的认识;重点关注经济状况差的患者,并加强督导随访;通过完善流动人口结核病保障体系,提高患者服药依从性。     

江苏省丹阳市2005—2020年初始抗病毒治疗HIV感染者死亡和脱失情况

目的 了解江苏省丹阳市初始抗病毒治疗HIV感染者死亡和脱失情况及其影响因素。方法 本研究选取中国疾病预防控制信息系统艾滋病综合防治数据中江苏省丹阳市2005—2020年首次开始抗病毒治疗的HIV感染者,根据纳入和排除标准最终共纳入413例HIV感染者进行研究,采用Cox比例风险回归模型分析初始抗病毒治疗HIV感染者的死亡和脱失情况,探索影响抗病毒治疗HIV感染者病死率和脱失率的相关因素。结果 本研究最终结局为正在治疗314例,转出28例,死亡58例,失访1例和停药12例。413例HIV感染者,平均年龄为45岁（18~84岁）,男女比例为3.8∶1,共随访1 516.75人年,总体病死率为3.82/100人年,总体脱失率为0.86/100人年。主要流行病学特征为已婚或同居占64.6%,异性性传播占63.0%,治疗前CD4⁺ T淋巴细胞计数≥ 200 cells/μL占52.3%,抗病毒治疗初始方案为EFV+3TC+TDF占50.9%。Cox回归模型分析结果显示,使抗病毒治疗患者死亡风险增加的因素有：年龄≥40岁（AHR=4.21, 95%CI:1.58~11.17）、治疗前CD4⁺T淋巴细胞计数<200 cells/μL（AHR=2.63,95%CI:1.37~5.08）和未检测CD4⁺T淋巴细胞（AHR=3.66, 95%CI:1.13~11.84）;而女性的风险降低（AHR=0.37, 95%CI:0.15~0.92）。治疗前CD4⁺T淋巴细胞计数 <200 cells/μL（AHR=0.21, 95%CI:0.04~0.99）和已婚或同居（AHR=0.20, 95%CI:0.04~0.93）脱失率风险较低。结论 江苏省丹阳市艾滋病抗病毒治疗后死亡率较高和脱失率较低,仍需提高治疗前CD4⁺淋巴细胞检测和抗病毒治疗及时性以及治疗管理服务质量来进一步减少死亡。     

贵州省盘州市肺结核病患者就诊延迟影响因素

目的 分析贵州省盘州市肺结核病患者就诊延迟的影响因素,为该市肺结核病的有效防控提供参考依据。方法 从中国疾病预防控制信息系统的结核病管理信息系统中导出盘州市2014年1月1日—2018年12月31日肺结核病患者的病案信息,采用非条件多因素Logistic回归分析肺结核病患者就诊延迟的危险因素。结果 盘州市2014年1月1日—2018年12月31共报告活动性肺结核病患者5 342例,有2 776例患者就诊延迟,就诊延迟率为51.97%,就诊中位天数为13 d （2~42 d）。单因素分析结果显示,年龄、居住地、户籍、职业、文化程度、患者来源和病原学检查结果为盘州市肺结核病患者就诊延迟的影响因素。多因素分析结果显示,>60岁（OR=2.61,95%CI：1.30~7.01）、郊区或农村（OR=1.67,95%CI：1.10~6.27）、农业和运输业（OR=2.35,95%CI：1.86~4.19）、转诊（OR=1.71,95%CI：1.22~4.21）及因症推荐（OR=1.70,95%CI：1.15~4.61）的患者发生就诊延迟的比例更高。结论 居住在郊区或农村、农业和运输业是盘州市肺结核患者就诊延迟的危险因素。盘州市肺结核患者就诊延迟率较高,应根据就诊延迟患者的特征,制定有效的干预措施。     

慢性阻塞性肺疾病对非小细胞肺癌预后的影响

目的探讨慢性阻塞性肺疾病（COPD）对非小细胞肺癌（NSCLC）预后的影响。方法收集96例确诊NSCLC患者的临床资料,通过Kaplan—Meier分析伴发或不伴发COPD的NSCLC患者的生存时间。以TNM分期为分层因素,应用COX比例风险回归模型评价年龄、性别、ECOG体能评分及COPD分级对NSCLC预后的影响。结果伴发COPD共有38例患者,占所有病例39．6％。伴发COPD的NSCLC患者生存时间8．0个月（95％CI7．0—9．0个月）较未伴发COPD的NSCLC患者生存时间11．0个月（95％CI9．1～12．9个月）显著缩短（P=0．009）。多因素分析结果显示：ECOG体能评分（HR=2．35,95％CI1-214．56）、伴发中度（HR=2．65,95％CI1．44－4．85）或重度以上COPD（HR=4．659,95％凹2．04～10．65）可作为NSCLC独立的预后因素。结论COPD影响NSCLC患者的预后,是一个独立的不良预后因素,对指导NSCLC个体化治疗有着重要意义。