鼻咽癌放疗后颈部残留灶消退时间影响因素的Logistic回归分析

目的：追踪观察鼻咽癌放疗后颈部残留灶的消退时间，并分析其影响因素。方法：选取1998年5月-2002年6月鼻咽癌放疗后有颈部残留的患者60例，追踪观察其消退时间，并应用Logistic回归分析研究年龄、性别、临床分期等7个因素对其消退时间的影响。结果：80％的患者颈部残留灶可以在放疗结束后3个月内消退。单因素Logistic回归分析显示性别、N分期、化疗3个因素与颈部残留灶的消退有关；多因素Logistic回归分析表明仅有N分期、化疗2个因素影响颈部残留灶的消退。化疗与颈部残留灶的消退时间呈正相关，而N分期则与消退时间呈负相关。结论：鼻咽癌放疗后颈部残留灶大部分可在放疗结束后3个月内消退，影响消退的因素主要有N分期及化疗。     

胃癌患者术后NDV-ATV治疗对机体免疫功能的影响

目的 探讨新城鸡瘟病毒修饰的自体肿瘤疫苗(NDV—ATV)治疗胃病术后患者机体免疫功能的影响。方法 采用流式细胞术分析36例胃病术后(术后2、3、4、5周)NDV—ATV治疗患者外周静脉血T淋巴细胞亚群及NK细胞的变化情况，并以15例术后未接受NDV—ATV治疗的胃癌患者作对照。结果 对照组术后CD3^ 、CD4^ 、NK细胞所占百分比和CD4^ /CD8^ 逐渐升高，以术后3周内升高最为明显。NDV—ATV治疗组，术后CD3^ 、CD4^ 、NK细胞所占百分比和CD4^ /CD8^ 上升速度更快，持续时间更长。治疗结束后与治疗前比较，有非常显著性差异(P＜0．01)；且明显高于未接受NDV—ATV治疗的对照组患者(P＜0．05)。第1次治疗后和治疗结束后相比较有显著性差异(P＜0．05)。结论 NDV—ATV可同时视为1种免疫调节剂，能明显改善胃癌患者术后机体的免疫功能，提高机体抗肿瘤能力。     

洪涝灾害对灾民腹泻影响因素的Logistic回归分析

１９９６年８月３日至４日，河北省８个市９１个县１５１７万人口遭受洪涝灾害，对其中２０个县４０个乡８０个自然村２０８０户，７９０８名灾民进行腹泻调查，发现腹泻９３９例，人群罹患率为１１．８７％。对全部调查对象进行腹泻影响因素调查，并对共用Ｌｏｇｉｓｔｉｃ回归分析，结果发现灾区为平原、村进水或被水围、水源不以自来水为主、洪水时未组织有效地井水消毒和户内饮水消毒以及消毒不及时，当时降雨量、家庭有腹泻病人     

急性白血病早期死亡高危因素的Logistic回归分析

为了解急性白血病（ＡＬ）早期死亡的高危因素，对近１０ａ上海地区２７家医院共３４７例ＡＬ住院患者早期死亡的高危因素进行了Ｌｏｇｉｓｔｉｃ回归分析。结果表明：出血、感染和多脏器衰竭是ＡＬ死亡的主要原因。全反式维甲酸的应用降低了急性早幼粒细胞白血病早期病死率，早期死亡的高危因素为：年龄≥６０岁或≤１岁，发病时伴有出血，弥散性毛细血管内凝血，肝脏明显肿大，ＦＡＢ分类属于急性骨髓细胞白血病，外周血细胞＞１００×１０９／Ｌ，ＢＰＣ＜５０×１０９／Ｌ，伴发病发热和感染。提示：为了降低ＡＬ的早期病死率，必须针对上述高危因素采取相应防治措施     

经IFN-γ诱导的人IL-2基因修饰的人原代成纤维细胞体外细胞因子表达及某些免疫学特性的研究

成纤维细胞作为基因治疗载体细胞是肿瘤基因治疗的一项重要途径,但以往的研究仅仅将成纤维细胞作为载体而忽略了其自身的免疫学功能的发挥。本文采用本室构建的逆转录病毒载体将IL-2基因转入人原代成纤维细胞,再用IFN-7诱导。结果表明,IFN-7诱导后,IL-2基因修饰的成纤维细胞MHC-Ⅰ、MHC-Ⅱ、CD40等分子表达具有一定程度的增高,并且表达IL-2、IL-1、IL-6等,由于这些免疫分子及细胞因子的表达与肿瘤抗原的递呈、效应细胞的激活密切相关,提示这种经IFN-7诱导后的IL-2基因修饰的成纤维细胞可能作为抗原递呈细胞而参与肿瘤抗原的递呈及效应细胞的激活。     

Evaluation of three risk scores to predict postoperative nausea and vomiting

BACKGROUND: So far there are three different scores to predict postoperative vomiting (PV: Apfel et al., 1998) or postoperative nausea and vomiting (PONV: Koivuranta et al., 1997; Palazzo and Evans, 1993). All three scores used logistic regression analysis to identify and create weights for the risk factors for PV or PONV. In short, these were sex, age, history of previous PONV, motion sickness, duration of anaesthesia, and use of postoperative opioids. However, an external evaluation and a comparison of these scores has not been performed so far. METHODS: Patients undergoing a variety of surgical procedures under general anaesthesia were studied prospectively. Preoperatively, they completed a questionnaire concerning potential risk factors for the occurrence of PV or PONV implemented in the three risk scores. Balanced anaesthesia (induction agent, nondepolarising neuromuscular blocker, opioid, and inhalation agent in nitrous oxide/oxygen) was performed. No intravenous anaesthesia or any antiemetic prophylaxis was applied. Postoperatively, the patients were observed in the recovery room for the occurrence of PV and PONV and were visited twice on the ward within the 24-h observation period. Both the patients and the nursing staff were asked whether PV or PONV was present. The severity of PONV was categorised using a standardised scoring algorithm. A total of 1,444 patients was finally included into the analysis. Using information of the predicted risk for the individual patients and the actual occurrence of PV or PONV, Receiver Operator Characteristics (ROC-curves) were drawn. The area under each ROC-curve was calculated as a means of the predictive properties of each score and was compared for statistical differences. RESULTS: For prediction of PONV (any severity) the AUC-values (AUC=area under the curve) and the corresponding 95%-confidence intervals were: Apfel: 0.70 (0.67-0.72); Koivuranta: 0.71 (0.69-0.73); Palazzo: 0.68 (0.65-0.70). For prediction of PV: Apfel: 0.73 (0.71-0.75); Koivuranta: 0.73 (0.70-0.75); Palazzo: 0.68 (0.65-0.70). Thus, all three scores appeared to have a moderate accuracy as measured by the AUC. The score of Koivuranta predicts PONV (P=0.007) and also PV (P=0.002) significantly better than Palazzo's score. Furthermore, for predicting of PV the score of Apfel was also superior to Palazzo's score (P=0.005). All three scores predict PV with the same accuracy as PONV. CONCLUSION: The occurrence of PV and PONV in patients undergoing surgery under balanced anaesthesia can be predicted with moderate but acceptable accuracy using one of the available risk scores, regardless of local surgical or anaesthesiological circumstances. For clinical practice, we recommend the score published by Koivuranta, since its calculation is very simple.     

Age and Outcome After Severe Head Injury

The authors analyzed the relationship between patient age and the final outcome in a series of 810 patients aged 14 years or older who were consecutively admitted between 1987 and 1996 after suffering a severe closed head injury. The most relevant clinico-radiological variables were prospectively collected in a Data Bank. Stratified and logistic regression analyses were performed in order to assess the influence of age on adverse outcome and the interaction between patient age and other prognostic indicators. Our results reaffirm that the adverse outcome rate increases steadily with age in severe head injured patients and that age effect on outcome is independent of other prognostic variables. The odds of having an adverse outcome increases significantly over 35 years of age being 10 times higher in patients older than 65 years as compared to those aged 15-25 years (reference age group). The adverse influence of an advanced age on the final outcome has not yet been satisfactorily explained but an older brain may have an impaired ability to recover after a pathological insult as compared to a younger one.     

Haemoconcentration by gelatin-induced acceleration of erythrocyte sedimentation rate

Erythrocyte sedimentation rates from 40 suspensions of packed red blood cells in modified fluid gelatin, 4% albumin solution, 6% hydroxyethyl starch and normal saline were measured at room temperature using Westergren's method. The erythrocyte sedimentation rate was extremely high in gelatin and this increase was significant after 10-60 min when compared with the other fluids. Erythrocyte sedimentation rates in albumin, hydroxyethyl starch and normal saline were low and there were no differences between these fluids [erythrocyte sedimentation after 60 min, median (interquartile range): gelatin 128 (111.2-130.0) mm, albumin 2 (1.5-2.0) mm, hydroxyethyl starch 1.5 (1.0-1.6) mm, normal saline 2 (1.9-2.5) mm, p < 0.0001]. The addition of twice the volume of modified fluid gelatin to a volume of red blood cells leads to rapid acceleration of the erythrocyte sedimentation rate. This is caused by increased erythrocyte aggregation, and in clinical practice this effect may be useful for the haemoconcentration of diluted blood from cardiopulmonary bypass circuits or cell-saver autotransfusion in paediatric surgery.     

原发性中枢神经系统淋巴瘤患者预后因素的 Weibull回归模型分析

目的:研究原发性中枢神经系统淋巴瘤患者术后的生存期,寻找影响患者生存期的主要因素.方法:通过回顾性调查收集我院1995～2002年期间接受手术治疗的22例中枢神经系统淋巴瘤患者的病例资料,用Kaplan-Meier方法估计患者的生存率曲线和平均生存期,采用Weibull回归对患者生存的影响因素进行模型拟合.结果:原发性中枢神经系统淋巴瘤患者的中位生存时间为18个月(95%CI:14～22月).Weibull回归模型分析显示:患者的年龄、肿瘤发生的部位、病程、手术后治疗方法是影响患者生存期的主要因素;患者的性别以及肿瘤的病理特点与患者的生存期没有关系.结论:Weibull回归模型对患者的生存期及其影响因素具有较好的拟合优度.     

宁波市鄞县农村2型糖尿病危险因素病例对照研究

目的探索农村2型糖尿病的危险因素,为预防控制提供依据.方法采用成组病例对照研究方法,选择2型糖尿病病例238例,对照3866例,运用多因素Logistic回归分析.结果年龄、性别、超重(肥胖)、既往高血压病史、直系亲属糖尿病史、水果摄入多等进入主效应模型,OR值分别为1.22、1.36、2.18、1.56、2.51和0.64.结论超重(肥胖)、既往高血压史、直系亲属糖尿病史是主要的危险因素,水果摄入多是保护因素.