累积高敏C反应蛋白暴露与全因死亡的关系

目的探讨累积高敏C反应蛋白(cumhsCRP)暴露与全因死亡的关系。方法选择参加2006-2007年度开滦集团健康体检的人群作为观察对象。并于2008-2009年和2010-2011年分别对该人群进行第二、三次健康体检。最终纳入统计分析的研究对象有55 169人,进行了平均4.92年的随访,且每年通过开滦社会保障信息系统获取死亡信息。将研究对象按cumhsCRP四分位分成4组,比较各组全因死亡事件发生率的差异,采用多因素Cox比例风险模型分析cumhsCRP暴露对全因死亡的影响。结果共有1772人(3.2%)在平均4.92年随访期间内发生全因死亡。cumhsCRP各组的累积全因死亡发生率分别为1.6%、2.4%、3.2%、5.6%。在多因素Cox回归分析中,校正了包括基线高敏C反应蛋白在内的多种混杂因素,结果显示,以cumhsCRP第一四分位组为参照,第二、三、四四分位组发生全因死亡的风险增加,HR值(95%CI)分别为1.19(1.00~1.42)、1.34(1.14~1.58)、1.75(1.49~2.06);另外,cumhsCRP每增加10mg/L×年,发生全因死亡的HR值(95%CI)为1.05(1.04~1.06)。结论高cumhsCRP暴露是全因死亡的独立危险因素。     

累积血压暴露值对脑卒中事件的预测价值

目的探讨累积血压暴露[累积收缩压(cumSBP)和累积舒张压(cumDBP)]对脑卒中的预测价值。方法采取前瞻性队列研究方法,以参加2006-2007、2008-2009、2010-2011年开滦集团健康体检的无脑卒中病史的职工53 582人为观察对象,以脑卒中发生为终点事件。依据cumSBP(mm Hg·年)和cumDBP(mm Hg·年)四分位分组:cumSBP第1四分位组(480)、cumSBP第2四分位组(480~520)、cumSBP第3四分位组(520~560)、cumSBP第4四分位组(≥560),cumDBP第1四分位组(320)、cumDBP第2四分位组(320~340)、cumDBP第3四分位组(340~360)、cumDBP第4四分位组(≥360)。用寿命表法计算总人群不同cumSBP、cumDBP的累积脑卒中发生率,并采用Cox比例风险模型分析cumSBP、cumDBP第4四分位组对脑卒中事件的影响。结果观察对象53 582人中,男性41 171人(76.8%),女性12 411人(23.2%),年龄(49.0±11.8)岁。随访(2.99±0.40)年,共发生脑卒中事件526例。总人群脑卒中事件累积发生率随着cumSBP、cumDBP的增高而呈上升趋势。多因素Cox比例风险回归模型分析显示,与cumSBP第1四分位组相比,cumSBP第3、4四分位组发生脑卒中事件的HR值(95%CI)分别为1.69(1.21~2.35)、2.03(1.47~2.80);与cumDBP第1四分位组相比,cumDBP第3、4四分位组发生脑卒中事件的HR值(95%CI)分别为1.46(1.07~1.98)、1.86(1.41~2.46)。结论高cumSBP和高cumDBP是发生脑卒中事件的危险因素。     

静息心率对老年人群心脑血管事件及全因死亡的影响

目的探讨老年人群(≥60岁)静息心率(RHR)水平对心脑血管事件及全因死亡的影响。方法本前瞻性队列研究于2006年和2007年进行,参加者为101 010名开滦集团的员工,选择其中年龄≥60岁、无心律失常、无心脑血管病史、未服用β受体阻滞剂的18 924例职工为研究对象。按RHR四分位数值分为以下4组:<67次/min、68~71次/min、72~79次/min、≥80次/min。随访期间收集心脑血管疾病及全因死亡事件,应用Cox比例风险模型评估RHR与全因死亡及CVD的风险。结果 (1)中位随访11.18年,4组发生心脑血管事件例数和累积发病率分别为[536(11.32%)、479(12.38%)、686(12.53%)、618(12.76%)],差异无统计学意义(P>0.05);4组发生全因死亡例数和累积全因死亡率分别为1 086(22.93%)、940(24.30%)、1 330(24.28%)、1 462(30.19%)例,差异有统计学意义(P<0.01)。(2)校正传统心血管疾病危险因素后多因素分析显示,与RHR最低四分位数组相比,最高四分位组发生心脑血管事件及全因死亡的HR值分别为1.06(95%CI 0.93~1.20)、1.07(95%CI 0.95~1.20)、1.07(95%CI 0.94~1.21);1.14(95%CI 1.04~1.25)、1.12(95%CI 1.03~1.22)、1.37(95%CI 1.26~1.49)。结论 RHR升高是开滦研究老年人群全因死亡的危险因素。     

大动脉僵硬度与高血压人群新发糖尿病的关系

目的研究大动脉僵硬度与高血压人群新发糖尿病的关系。方法本研究对象均来自开滦研究人群,用肱踝动脉脉搏波传导速度(baPWV)评价动脉僵硬度。以参加2010-2011、2012-2013、2014-2015年度开滦集团体检的高血压非糖尿病员工为观察对象,以baPWV检测时间为观察起点,以新发糖尿病为终点事件,以2016-2017年度体检时间为观察终点,最终有8 061例纳入研究队列。按baPWV四分位分组,采用Cox比例风险模型分析baPWV对终点事件的影响,按体质量指数(BMI)分层做敏感性分析。结果观察对象平均随访(4.22±2.10)年,随访期间新发糖尿病874例(10.8%),平均发病密度25.71/千人年。按baPWV四分位分组,第1~4四分位组新发糖尿病的发病密度分别为14.60/千人年、23.77/千人年、27.15/千人年、37.70/千人年(P<0.001)。以是否新发糖尿病为因变量进行多因素Cox比例风险模型分析,以baPWV第1四分位组作对照,校正年龄、性别、平均动脉压、基线空腹血糖、高敏C反应蛋白等混杂因素后,第2、3、4四分位组发生糖尿病的HR及95%CI分别为1.57(1.24~1.98)、1.74(1.37~2.20)、2.38(1.87~3.03)。baPWV每增加1个标准差,发生糖尿病的HR及95%CI为1.32(1.24~1.42)。结论大动脉僵硬度与高血压人群新发糖尿病的发病风险增高相关。     

老年高血压人群尿微量白蛋白与尿肌酐比值对新发心脑血管事件的预测

目的探讨尿微量白蛋白/尿肌酐比值(UACR)水平对老年高血压人群新发心脑血管事件的预测价值。方法选择在我院健康体检的老年高血压人群4026例,行UACR水平检测,根据UACR水平分为4组,第1分位组1002例(UACR 0.04³.10mg/g)、第2分位组1003例(UACR 3.113.10mg/g)、第2分位组1003例(UACR 3.11⁹.62mg/g)、第3分位组1023例(UACR9.639.62mg/g)、第3分位组1023例(UACR9.63¹8.24mg/g)、第4分位组998例(UACR 18.2518.24mg/g)、第4分位组998例(UACR 18.25³0.00mg/g)。4组人群平均随访(3.5±0.5)年。分析UACR水平对老年高血压人群新发心脑血管事件的预测价值。结果与第1分位组比较,第4分位组新发心脑血管事件、脑梗死和心肌梗死事件发生率均增高,差异有统计学意义(P<0.05);多变量Cox比例风险回归分析,校正年龄、性别、吸烟、空腹血糖、TC、TG、LDL-C、HDL-C、体质量指数后,第4分位组发生心脑血管事件、脑梗死和急性心肌梗死的相对危险分别为第1分位组的1.68倍(95%CI:1.2330.00mg/g)。4组人群平均随访(3.5±0.5)年。分析UACR水平对老年高血压人群新发心脑血管事件的预测价值。结果与第1分位组比较,第4分位组新发心脑血管事件、脑梗死和心肌梗死事件发生率均增高,差异有统计学意义(P<0.05);多变量Cox比例风险回归分析,校正年龄、性别、吸烟、空腹血糖、TC、TG、LDL-C、HDL-C、体质量指数后,第4分位组发生心脑血管事件、脑梗死和急性心肌梗死的相对危险分别为第1分位组的1.68倍(95%CI:1.23².45,P=0.002)、1.52倍(95%CI:1.142.45,P=0.002)、1.52倍(95%CI:1.14².36,P=0.036)和2.49倍(95%CI:1.272.36,P=0.036)和2.49倍(95%CI:1.27³.44,P=0.004)。结论基线UACR水平可预测老年高血压人群发生心脑血管事件,UACR水平较高者发生临床心脑血管事件的危险增加,尤其是脑梗死和心肌梗死的危险。     

累积血压暴露对新发心房颤动的预测价值

目的探讨累积血压暴露(cumBP)对新发心房颤动(AF)的预测价值。方法本研究采用前瞻性队列研究的方法,观察对象为唐山开滦集团员工,自2006年开始每隔2年进行1次体检,截止至2015年底,共进行了5次体检。前3次体检均参加且血压等基线资料完整的研究对象为57927例。排除既往AF病史者、随访时心电图资料缺失者,最终纳入统计学分析的观察对象为40727例。根据累积收缩压暴露(cumSBP)进行四分位数分组:第一分位组:cumSBP464 mmHg·year;第二分位组:464 mmHg·year≤cumSBP512 mmHg·year;第三分位组:512 mmHg·year≤cumSBP569 mmHg·year;第四分位组:cumSBP≥569 mmHg·year。比较不同cumSBP组新发AF的情况。COX比例风险模型分析cumBP对新发AF的预测价值。结果 (1)40727例观察对象,平均年龄51.81±11.54岁,其中男性30693例(75.4%),女性10034例(24.6%)。(2)结果表明,男性比例和年龄、体质指数、空腹血糖、总胆固醇和尿酸水平均随cumSBP的增加而增加,各组间差异有统计学意义(P0.05)。(3)平均随访4.97±0.37年,影响新发AF事件的多因素COX比例风险模型分析显示:校正其他混杂因素后,cumSBP每增加10 mmHg·year,发生新发AF的HR值为1.034(95%CI 1.012～1.057);累积舒张压暴露每增加5 mmHg·year,发生新发AF的HR值为1.026(95%CI 1.008～1.044)。结论 cumBP对新发AF具有预测价值。     

总胆固醇及甘油三酯与卒中亚型关系的前瞻性研究

目的 研究人群总胆固醇(TC)、甘油三酯(TG)水平与缺血性和出血性卒中发病的关系.方法 1987年5至7月,对在北京等5个城市社区所选取的35岁以上无卒中队列人群进行卒中危险因素调查和体格检查,1998至2000年对入选的队列人群进行全面复查,共10093例完成基线血脂调查及队列随访.采用Cox回归模型估计基线TC和TG中、高三分位组缺血性与出血性卒中发病的相对危险度(风险比,HR)和95%可信区间(95%CI).结果 平均随访8年,新发卒中491例.舒张压模型调整舒张压、年龄和性别等多因素后,与低TC组相比,中、高TC组缺血性卒中发病风险分别增加61%(HR:1.61,95% CI:1.14～2.27)和58%(HR:1.58,95%CI:1.12～2.22).与低TG组相比,高TG组缺血性卒中发病风险增加43%(HR:1.43,95%CI:1.02～2.00).TC与出血性卒中呈负相关,与低TC组相比,中、高TC组人群出血性卒中发病的危险分别减少了12%(HR:0.88,95%CI:0.64～1.22)和33%(HR:0.67,95%CI:0.48～0.95).结论 血清TC和TG升高均为缺血性卒中发病独立危险因素.但TC过低却增加出血性卒中的发病风险.     

谷氨酰转肽酶轨迹与新发代谢综合征相关性的队列研究

目的探索谷氨酰转肽酶(GGT)轨迹与新发代谢综合征的相关性, 为代谢综合征的防治提供科学依据。方法以郑州市健康体检人群中符合入选标准的3 209例观察对象组成研究队列, 采用R LCTMtools程序将随访前GGT水平确定3个不同的GGT轨迹组, 分别为低稳定组、中稳定组、高稳定组, 用Cox比例风险回归模型分析不同GGT轨迹与新发代谢综合征的相关性。结果 2020年随访结束时代谢综合征累积发病率为7.0%, 低稳定组、中稳定组、高稳定组代谢综合征的发病率分别为3.9%、11.4%、15.0%, 呈增长趋势(P<0.001);Cox比例风险回归模型调整多种混杂因素后, 总人群中稳定组、高稳定组代谢综合征发病风险均升高;男性人群高稳定组代谢综合征发病风险为低稳定组的1.67倍(95%CI 1.07～2.60), 女性人群中稳定组代谢综合征发病风险为低稳定组的3.29倍(95%CI 1.14～9.53)。结论 GGT纵向轨迹水平升高是新发代谢综合征的危险因素, 总人群代谢综合征的发生风险随着长期GGT水平的升高而增加。建议男性和女性分别将长期GGT水平维持在28 U/L和14 U/L...     

急性心肌梗死后的新发心房颤动及相关因素分析

目的探讨影响急性心肌梗死(AMI)后新发心房颤动(简称房颤)的危险因素。方法收集2013年2月至2014年10月间心内科住院首次诊断为AMI患者共376例,根据心律情况分为窦性心律(简称窦律)组和房颤组。对其临床特征进行对比,并进行Logistic多因素回归分析。结果 376例AMI患者中,新发房颤46例,与窦律组比较,房颤组年龄更大,脑利钠肽前体、高敏C反应蛋白(hs-CRP)、肌钙蛋白峰值、TIMI评分、Killip分级更高,Logistic多因素回归分析显示:hs-CRP(OR值:3.429、95%CI:1.384~8.496、P=0.008)、肌钙蛋白峰值(OR值:1.014、95%CI:1.003~1.024、P=0.010)和TIMI评分(OR值:1.251、95%CI:1.020~1.534、P=0.031)与新发房颤相关。结论 hs-CRP、肌钙蛋白峰值、TIMI评分为影响AMI后新发房颤的独立危险因素。     

累积心率暴露对臂踝脉搏波传导速度的影响

目的探讨累积心率暴露(cum HR)与臂踝脉搏波传导速度(ba PWV)的关系。方法选择开滦研究人群中卒中队列和老年人群队列7904例组成观察人群,最终纳入研究队列的为5153例。根据cum HR将研究对象进行四分位分组。采用偏相关分析cum HR与ba PWV的相关性,多因素线性回归和多因素Logistic回归分析cum HR对ba PWV的影响。结果随着cum HR的增加,平均ba PWV水平和ba PWV≥1400 cm/s的检出率均呈上升趋势。偏相关分析结果表明,cum HR与ba PWV呈正相关(r=0.35,P0.05);校正了年龄、性别后cum HR与ba PWV仍呈正相关(r=0.24,P0.05)。多因素线性回归分析显示,cum HR每增加1次/分,ba PWV增加1.071 cm/s。Logistic回归分析表明,校正了其他混杂因素后,与cum HR第一分位组相比,cum HR第二分位组、第三分位组、第四分位组均是ba PWV≥1400 cm/s的危险因素,OR值(95%CI)分别为1.432(1.121~1.829)、1.738(1.371~2.204)、2.475(1.949~3.143)。结论 cum HR与ba PWV呈正相关关系。cum HR是脉搏波传导速度增加的危险因素。     

Serial measurements of C-reactive protein after acute myocardial infarction in predicting one-year outcome

Systemic markers of inflammation are considered reliable predictors of future coronary events in patients with acute myocardial infarction (AMI). The aim of this study was to evaluate the prognostic relevance of serial C-reactive protein (CRP) measurements in patients with ST-elevation AMI (STEMI) on one-year outcome. In 31 patients with STEMI, serial measurements of CRP were obtained, and for each patient, the following values were determined: (i) values at admission, up to 12 hours after symptom onset, (ii) maximal values obtained 24-72 hours after symptom onset (early acute values), and (iii) late acute values (96-120 hours after symptom onset). The combined endpoint was any new cardiovascular event, including death. Early and late acute CRP levels were the only parameters found to be significantly higher in patients with an adverse outcome than in patients with a good outcome. A significantly higher rate of endpoint events was found in patients with elevated early (Hazard ratio [HR] 5.54, 95%CI 2.05-25.40; P = 0.007) and late acute CRP (HR 9.01, 95% CI 1.66-19.56; P = 0.005). Multiple logistic regression analysis identified only early acute CRP as an independent predictor of an unfavorable outcome (Odds ratio 8.00, 95%CI 1.15-55.60; P = 0.04), after adjustment for established risk factors. CRP level measured 24-72 hours after symptom onset is an independent predictor of one-year outcome in patients with STEMI. Values obtained later in the setting of STEMI do not add further prognostic information. CRP at admission is not related to long-term prognosis.     

季节对急性心肌梗死发病的影响

目的探讨季节对急性心肌梗死(AMI)发病的影响。方法选取2016年7月至2019年12月入住东莞市人民医院与哈尔滨医科大学附属第二医院心内科的2610例冠心病患者,收集基础资料。依据国际通行的季节划分标准,按发病时间将患者分组:春季组(3~5月),夏季组(6~8月),秋季组(9~11月),冬季组(12~2月)。结果基础资料显示4组患者高血压、糖尿病、低密底脂蛋白胆固醇(LDL-C)、性别的分布差异无统计学意义。春季组与冬季组的患者年龄稍大,而秋季组和冬季组的患者吸烟比例较高。各组男性AMI患者的发病比例均高于女性(P=0.001)。Logistic回归分析显示,以春季组作为参照,秋季组和冬季组与AMI的发病独立相关(OR=2.274,95%CI 1.487~3.478,OR=1.512,95%CI 1.023~2.235),男性(OR=2.424,95%CI 1.733~3.391)、吸烟(OR=1.862,95%CI 1.332~2.603)和低密度脂蛋白胆固醇(LDL-C)(OR=2.797,95%CI 2.356~3.320)是AMI发病的独立危险因素。ROC分析提示,秋、冬季诊断AMI的AUC值为0.540,95%CI 0.503~0.578,P=0.033。结论秋、冬季是AMI发病的独立因素。     

Temporal trends in the frequency and longer-term outcome of heart failure complicating myocardial infarction

AIMS: To investigate trends in incidence and long-term outcome of heart failure (HF) developing within 28 days of first-ever acute myocardial infarction (AMI). METHODS AND RESULTS: We identified all residents of Perth, Western Australia aged 25-64 years, with no history of HF, who experienced a non-fatal, first-ever AMI between 1984 and 1993, and followed them for ten years. All patients (N=4006) met the criteria for 'definite AMI' in WHO MONItoring trends and determinants of CArdiovascular disease (MONICA) Project and 897 (22.4%) had early-onset HF complicating the index event. After adjustment for age, current smoking, history of diabetes and hypertension, Q-wave and anterior wall AMI, the odds of developing HF declined by 9% (odds ratio for period 1989-1993 relative to 1984-1988=0.91, 95% confidence interval (95%CI): 0.78 to 1.06). Over 10 years of follow-up, patients with early-onset HF had a cumulative average number of re-admissions of 28 per 100 as compared with 9 per 100 in patients without HF. After adjustment for age, history of diabetes and hypertension, the hazard of death in patients with early-onset HF declined by 26% (HR for the period 1989-1993 relative to 1984-1988=0.74, 95%CI: 0.57 to 0.96). CONCLUSION: Our data suggest a decline in the incidence of, and show encouraging evidence of improvement in survival after, early-onset HF complicating AMI.     

Trends and risk factors of elderly-onset Crohn's disease: A nationwide cohort study

BACKGROUND The incidence of inflammatory bowel disease(IBD)is increasing in Asia.Numerous risk factors associated with IBD development have been investigated.AIM To investigate trends and environmental risk factors of Crohn’s disease(CD)diagnosed in persons aged≥40 years in South Korea.METHODS Using the National Health Insurance Service database,a total of 14060821 persons aged>40 years who underwent national health screening in 2009 were followed up until December 2017.Patients with newly diagnosed CD were enrolled and compared with non-CD cohort.CD was identified according to the International Classification of Diseases 10th revision and the rare/intractable disease registration program codes from the National Health Insurance Service database.The mean follow-up periods was 7.39 years.Age,sex,diabetes,hypertension,smoking,alcohol consumption,regular exercise,body mass index,anemia,chronic kidney disease(CKD)and dyslipidemia were adjusted for in the multivariate analysis model.RESULTS During the follow-up,1337(1.33/100000)patients developed CD.Men in the middle-aged group(40-64 years)had a higher risk than women[adjusted hazard ratio(aHR)1.46,95%confidence interval(CI):1.29-1.66];however,this difference tended to disappear as the age of onset increases.In the middle-aged group,patients with a history of smoking[(aHR 1.46,95%CI:1.19-1.79)and anemia(aHR 1.85,95%CI:1.55-2.20)]had a significantly higher CD risk.In the elderly group(age,≥65 years),ex-smoking and anemia also increased the CD risk(aHR 1.68,95%CI:1.22-2.30)and 1.84(95%CI:1.47-2.30,respectively).Especially in the middle-aged group,those with CKD had a statistically elevated CD risk(aHR 1.37,95%CI:1.05-1.79).Alcohol consumption and higher body mass index showed negative association trend with CD incidence in both of the age groups.[Middle-aged:aHR 0.77(95%CI:0.66-0.89)and aHR 0.73(95% CI:0.63-0.84),respectively][Elderly-group:aHR 0.57(95% CI:0.42-0.78)and aHR 0.84(95%CI 0.67-1.04),respectively].For regular physical activity and dyslipidemia,negative correlation between CD incidences was proved only in the middle-aged group[aHR 0.88(95%CI:0.77-0.89)and aHR 0.81(95%CI:0.68-0.96),respectively].CONCLUSION History of cigarette smoking,anemia,underweight and CKD are possible risk factors for CD in Asians aged>40 years.     

The dietary and lifestyle indices of insulin resistance are associated with increased risk of cardiovascular diseases: A prospective study among an Iranian adult population

Background and aimsPrevious studies have introduced insulin resistance (IR) as a major risk factor for poor cardiovascular diseases (CVDs) outcomes. Diet, body weight, and physical activity are three key pillars of lifestyle that can significantly impact the IR status. We aimed to assess the possible link between the empirical dietary index for IR (EDIR) and the empirical lifestyle index for IR (ELIR) with the risk of chronic heart disease (CHD) and CVDs.Methods and resultsThis study was conducted on 4980 participants aged ≥30 years (follow-up rate: 99.85%). Dietary intake data was collected using a validated food frequency questionnaire. Cox proportional hazard regression was used to estimate the hazard ratio and 95% confidence intervals (HRs and 95% CIs) of CVDs and CHD across tertiles of EDIR and ELIR scores. In the final model, after adjusting for all potential confounding variables, participants in the highest tertile of EDIR had a higher risk of CVD (HR:1.36, 95%CI:1.03–1.80, P-trend = 0.016) and CHD (HR:1.36, 95% CI:1.01–1.83, P-trend = 0.023) compared to the lowest tertile. Also, participants with a higher score of ELIR had a higher risk of CVD (HR: 1.64, 95%CI:1.24–2.16, P-trend=<0.001) and CHD (HR: 1.72, 95%CI:1.28–2.32, P-trend=<0.001).ConclusionA greater adherence to the lifestyle and diet with a higher EDIR and ELIR may be associated with an increased risk of CVD and CHD outcomes in the adult population.     

慢性完全闭塞病变对接受急诊介入治疗的急性心肌梗死患者远期预后的影响

目的:分析慢性完全闭塞(CTO)病变对接受急诊介入治疗的急性心肌梗死(AMI)患者远期预后的影响。方法:分析自2013年1月至2014年9月间纳入中国急性心肌梗死(CAMI)注册登记研究的接受急诊介入治疗的14176例AMI患者,根据冠状动脉造影的结果,将患者分为AMI合并CTO病变组(n=1235)和AMI不合并CTO病变组(n=12941)。随访2年,比较两组的临床预后,主要研究终点为死亡率,次要研究终点为包括心原性死亡、脑卒中、心力衰竭再入院、再次血运重建等的主要不良心血管事件。结果:合并CTO病变的AMI患者占8.7%(1235/14176)。随访2年,AMI合并CTO病变组的患者全因死亡率(9.9%vs.5.4%)和心原性死亡率(5.0%vs.2.6%)明显高于AMI不合并CTO病变组患者(P均<0.01)。单因素分析显示,CTO病变增加AMI患者死亡(HR=1.44,95%CI:1.02~2.03,P=0.04)和再次血运重建(HR=2.14,95%CI:1.55~2.96,P<0.01)风险。多因素回归分析显示,高龄(HR=1.07,95%CI:1.05~1.09)和就诊时存在心力衰竭(HR=2.05,95%CI:1.36~3.09)与患者2年死亡的不良预后明显相关(P均<0.01),而CTO病变不是2年死亡的独立危险因素(HR=1.33,95%CI:0.93~1.90,P=0.11)。结论:合并CTO病变的AMI患者的远期死亡率和心原性死亡率明显高于不合并CTO病变的患者。高龄和就诊时存在心力衰竭是远期死亡的独立危险因素,而CTO病变并不是远期死亡的独立危险因素。     

结核病危重患者的死亡预后因素初步分析

目的 探讨结核病危重患者死亡预后的影响因素.方法 对2008年6月至2010年2月浙江省中西医结合医院结核科ICU的62例成年结核病危重患者的临床资料进行回顾性分析,其中男48例,女14例,年龄20～91岁,平均(63±4)岁.以入住结核科ICU时间为研究起点,以转出结核科ICU或死亡时间为研究终点,将患者分为存活组(33例)和死亡组(29例),对年龄、性别、呼吸衰竭类型、有无机械通气、合并其他感染、耐多药结核病、抗结核治疗、急性病生理学和长期健康评价Ⅱ(APACHEⅡ)评分及肝损害等变量进行单因素分析.采用Cox回归分析患者死亡预后的独立危险因素,采用Kaplan-Meier生存分析法计算患者的累积生存率.结果 与结核病危重患者死亡预后有关的因素为:真菌感染,风险比(HR值)为3.44,95%CI为1.23～9.62;Ⅱ型呼吸衰竭,HR值为4.03,95%CI为1.56～10.38;肝损害,HR值为3.96,95%CI为1.30～12.10;APACHEⅡ评分＞25分,HR为4.91,95%CI为1.99～12.11.上述4项因素均可使结核病危重患者住院死亡的风险显著增高(x2值为5.53～11.88,均P＜0.05),住院累积生存率显著降低(x2值为4.43～22.68,均P＜0.05).结论 结核病危重患者的病死率高,合并真菌感染、Ⅱ型呼吸衰竭、肝损害和APACHEⅡ评分＞25分是患者死亡预后的危险因素.

Abstract：

Objective The purpose of this study was to investigate the prognostic factors associated with mortality in critically ill tuberculosis patients, and therefore to provide information for the early diagnosis and treatment of the disease. Methods The clinical daza of 62 patients with tuberculosis, who were admitted to the intensive care unit (ICU) of Integrated Chinese and Western Medicine Hospital of Zhejiang Province between June 2008 and Feb 2010, were analyzed retrospectively, with the admission date as a start point and the transferring out of ICU date or death date in the ICU as an end point. Forty-eight patients were males and 14 were females, and the patient' s age ranging from 20 to years (63 ± 4) years. In addition,these patients were divided into the survival (33 cases) and the death groups (29 cases). A total of 19 factors including age, sex, respiratory failure types, mechanical ventilation, infection, anti-tuberculous drug resistance, chemotherapy, clinical complications, critical illness score, liver damage, were analyzed for a single risk factor by the univariate model, and calculated for the independent death risk factors using the Cox logistic regression multivariate model. The cumulative survival rate based on the Kaplan-Meier survival model was calculated. Results The mortality was associated with 4 independent factors: fungal infection ( HR =3.44, 95% CI = 1.23 - 9. 62), type Ⅱ respiratory failure ( HR = 4. 03, 95% CI = 1.56 - 10. 38), liver damage (HR=3.96, 95% CI=1.30 -12. 10) and elevated APACHEⅡ score (＞25) (HR =4.91,95%CI = 1.99 - 12. 11 ). These factors significantly ( x2 =5. 53 - 11.88, all P ＜0. 05) increased the in-hospital mortality and decreased the hospital cumulative survival rate( x2 = 4. 43 -22. 68, all P ＜ 0. 05 ). Conclusion The high mortality of tuberculosis patients admitted to ICU was associated with fungal infection, type Ⅱ respiratory failure, liver damage, and elevated APACHE Ⅱ score ( ＞ 25).     

Prediction of hepatocellular carcinoma development by aminotransferase to platelet ratio index in primary biliary cholangitis

AIM To investigate the usefulness of aspartate aminotransferase to platelet ratio index(APRI) in predicting hepatocellular carcinoma(HCC) risk in primary biliary cholangitis(PBC).METHODS We identified PBC patients between 2000 and 2015 by searching the electronic medical database of a tertiary center. The hazard ratio(HR) of HCC with different risk factors was determined by Cox proportional hazards model. RESULTS One hundred and forty-four PBC patients were recru-ited. Patients were diagnosed at a median age of 57.8 years [interquartile range(IQR): 48.7-71.5 years), and 41(28.5%) patients had cirrhosis at baseline. The median follow-up duration was 6.9 years(range: 1.0-26.3 years). Twelve patients developed HCC, with an incidence rate of 10.6 cases per 1000 patient-years. The overall 5-, 10-and 15-year cumulative incidences of HCC were 2.3% 95%CI: 0%-4.8%), 8.4%(95%CI: 1.8%-14.5%) and 21.6%(6.8%-34.1%), respectively. Older age(HR = 1.07), cirrhosis(HR = 4.38) and APRI at 1 year after treatment(APRI-r1) 0.54(HR = 3.94) were independent factors for HCC development. APRI-r1, when combined with treatment response, further stratified HCC risk(log rank P 0.05). The area under receiver operating curve of APRI-r1 in predicting HCC was 0.77(95%CI: 0.64-0.88).CONCLUSION APRI-r1 can be used to predict the development of HCC in PBC patients. Combination of APRI-r1 with treatment response can further stratify the HCC risk.     

Una puntuación de riesgo genético predice recurrencias en pacientes jóvenes con infarto agudo de miocardio

Introduction and objectivesTo evaluate whether a genetic risk score (GRS) improves prediction of recurrent events in young nondiabetic patients presenting with an acute myocardial infarction (AMI) and identifies a more aggressive form of atherosclerosis.MethodsWe conducted a prospective study with consecutive nondiabetic patients aged < 55 years presenting with AMI. We performed a genetic test, cardiac computed tomography, and analyzed several biomarkers. We studied the association of a GRS composed of 11 genetic variants and a primary composite endpoint (cardiovascular mortality, a recurrent event, and cardiac hospitalization).ResultsA total of 81 patients were studied and followed up for a median of 4.1 years. There were 24 recurrent cardiovascular events. Compared with the general population, study participants had a higher prevalence of 9 out of 11 risk alleles. The GRS was significantly associated with recurrent cardiovascular events, especially when baseline low-density lipoprotein cholesterol (LDL-C) levels were elevated. Compared with the low-risk GRS tertile, the multivariate-adjusted HR for recurrences was 10.2 (95%CI, 1.1-100.3; P = .04) for the intermediate-risk group and was 20.7 (2.4-181.0; P = .006) for the high-risk group when LDL-C was ≥ 2.8 mmol/L (≥ 110 mg/dL). Inclusion of the GRS improved the C-statistic (ΔC-statistic = 0.086), cNRI (continuous net reclassification improvement) (30%), and the IDI (integrated discrimination improvement) index (0.05). Cardiac computed tomography frequently detected coronary calcified atherosclerosis but had limited value for prediction of recurrences. No association was observed between metalloproteinases, GRS and recurrences.ConclusionsA multilocus GRS may identify individuals at increased risk of long-term recurrences among young nondiabetic patients with AMI and improve clinical risk stratification models, particularly among patients with high baseline LDL-C levels.