目的 分析肺结核合并Ⅱ型呼吸衰竭患者经鼻高流量湿化氧疗期间应用多维度强化护理的效果。方法 纳入2022年12月—2025年1月在河北省胸科医院进行经鼻高流量湿化氧疗的肺结核合并Ⅱ型呼吸衰竭患者294例，随机分为强化护理组（147例，多维度强化护理）、对照组（147例，常规护理），测量比较两组患者在护理前后气道重塑指标、肺功能指标、血气分析指标，进行疗效评估。结果 护理后强化护理组气道壁面积、气道壁厚度低于对照组，气道腔面积高于对照组（P＜0.05）；护理后强化护理组第1秒用力呼气容积、用力肺活量高于对照组（P＜0.05）；护理后强化护理组动脉血氧分压高于对照组，动脉血二氧化碳分压低于对照组（P＜0.05）；强化护理组总有效率高于对照组（P＜0.05）。结论 肺结核合并Ⅱ型呼吸衰竭患者经鼻高流量湿化氧疗期间接受多维度强化护理可改善其气道重塑及肺功能，有利于血气分析指标恢复，应用效果显著。

       Objective To analyze the efficacy of multidimensional enhanced nursing during nasal high-flow humidified oxygen therapy in patients with pulmonary tuberculosis and type Ⅱ respiratory failure．Methods A total of 294 patients with pulmonary tuberculosis and type Ⅱ respiratory failure who received nasal high-flow humidified oxygen therapy at Hebei Chest Hospital between December 2022 and January 2025 were enrolled and randomly divided into an enhanced nursing group（147 patients，receiving multidimensional enhanced nursing）and a control group（147 patients，receiving conventional nursing）．Airway remodeling，pulmonary function，and blood gas analysis were measured and compared between the two groups before and after nursing，and the efficacy was evaluated．Results After nursing，the enhanced nursing group had lower airway wall area and airway wall thickness，and higher airway lumen area than the control group（P＜0.05）．The forced expiratory volume in 1 second and forced vital capacity in the enhanced nursing group were higher than those in the control group（P＜0.05）．The blood oxygen partial pressure（PaO₂）in the enhanced nursing group was higher than that in the control group，and the carbon dioxide partial pressure（PaCO₂）was lower than that in the control group（P＜0.05）．The total effective rate in the enhanced nursing group was higher than that in the control group（P＜0.05）．Conclusions Multidimensional enhanced nursing during nasal high-flow humidified oxygen therapy can improve airway remodeling and lung function in patients with pulmonary tuberculosis and type Ⅱ respiratory failure，and is beneficial for the recovery of blood gas analysis indicators．The application effect is significant．

      目的 探讨预后营养指数（PNI）对脓毒症合并心力衰竭患者发生谵妄的预测价值，并评估其在指导护理风险分层中的作用。方法 采用回顾性队列研究，纳入2022年2月—2024年9月广东省第二中医院收治的162例脓毒症合并心力衰竭患者。通过ROC曲线确定PNI预测谵妄的最佳截断值，并以此将患者分为高低PNI组。比较两组基线特征，采用Kaplan-Meier曲线分析谵妄累积发生率和28天院内死亡率，通过Cox比例风险模型评估PNI与谵妄及预后的独立关联，并利用ROC曲线评价其预测性能。最后利用亚组分析技术进一步评估PNI预测价值的普适性。结果 低PNI（≤35.72）是谵妄发生的独立危险因素。竞争风险模型显示，低PNI组10 d谵妄累积发生率达37.8%，高于高PNI组的10.0%。多因素分析表明，PNI每降低一个单位，谵妄风险增加约17.2%。限制性立方样条分析提示PNI与谵妄风险呈线性负相关。ROC曲线分析显示PNI预测谵妄的AUC为0.721，其预测效能优于白蛋白和SOFA评分。亚组分析进一步证实PNI的保护效应在不同临床特征患者中具有一致性。结论 PNI是脓毒症合并心力衰竭患者谵妄风险的独立预测指标，其预测效能优于传统单一指标。基于PNI的风险分层有助于早期识别谵妄高危患者，为实现精准护理干预提供重要依据。

      Objective To explore the predictive value of the prognostic nutritional index（PNI）for delirium in patients with sepsis complicated by heart failure，and to evaluate its role in guiding nursing risk stratification．Methods A retrospective cohort study was conducted，including 162 patients with sepsis and heart failure admitted to Guangdong Provincial Second Hospital of Traditional Chinese Medicine between February 2022 and September 2024．The optimal PNI cut-off value for predicting delirium was determined using ROC curve analysis，and patients were divided into high and low PNI groups accordingly．Baseline characteristics of the two groups were compared．Kaplan-Meier curves were used to analyze the cumulative incidence of delirium and 28-day in-hospital mortality．Cox proportional hazards models were employed to assess the independent association between PNI and delirium as well as prognosis，and ROC curves were used to evaluate its predictive performance．Subgroup analysis was further utilized to assess the generalizability of PNI’s predictive value．Results A low PNI（≤35.72）is an independent risk factor for delirium．The competing risk model showed that the cumulative incidence of delirium in the low PNI group was 37.8% at 10 days，significantly higher than the 10.0% in the high PNI group．Multivariate analysis indicated that for each unit decrease in PNI，the risk of delirium increased by 17.2% approximately．Restricted cubic spline analysis suggested a linear negative correlation between PNI and delirium risk．ROC curve analysis demonstrated that the AUC of PNI for predicting delirium was 0.721，with its predictive performance surpassing that of albumin and SOFA score．Subgroup analysis further confirmed that the protective effect of PNI was consistent across patients with different clinical characteristics．Conclusions PNI is an independent predictor of delirium risk in patients with sepsis and heart failure，with superior predictive performance compared to traditional single indicators．Risk stratification based on PNI aids in the early identification of patients at high risk for delirium，providing an important basis for precise nursing interventions．

       目的 研究数字化口内扫描印模技术（DIOS）对重度牙周炎（SP）患者口腔种植修复效果及龈沟液炎症因子水平的影响并进行分析。方法 选取医院2022年1月—2025年1月收治的100例SP患者进行研究。以密封信封抽签法分为数字化组（n=50）及常规组（n=50）。两组均开展口腔种植修复，常规组采用常规硅橡胶印模技术，数字化组则采用DIOS。对比两组印模制取时间、印模过程中疼痛程度及种植成功率、修复体满意度、龈沟液炎症因子水平、并发症发生情况。结果 数字化组印模制取时间短于常规组，VAS评分低于常规组，而种植成功率高于常规组（均P＜0.05）。数字化组边缘密合度、咬合关系、邻接关系满意度均高于常规组（均P＜0.05）。修复3个月后两组龈沟液各项炎症因子水平均低于修复前，且数字化组低于常规组（均P＜0.05）。数字化组并发症总发生率低于常规组（P＜0.05）。结论 DIOS可显著提高SP患者口腔种植修复效果，降低龈沟液炎症因子水平，减少并发症的发生。

      Objective To investigate the effects of digital intraoral scanner（DIOS）on the oral implant restoration effect and the levels of inflammatory factors in gingival crevicular fluid in patients with severe periodontitis（SP）．Methods A total of 100 SP patients admitted to the hospital from January 2022 to January 2025 were selected for the study．They were divided into the digital group（n=50）and the conventional group（n=50）by the sealed envelope lottery method．Both groups underwent oral implant restoration．The conventional group used the conventional silicone rubber impression technology，while the digital group underwent DIOS．The time of impression preparation，the degree of pain during the impression process，the success rate of implantation，the satisfaction of restorations，the levels of inflammatory factors in gingival crevicular fluid，and the occurrence of complications were compared between the two groups．Results The impression acquisition time of the digital group was shorter than that of the conventional group，the VAS score was lower than that of the conventional group，while the implantation success rate was higher than that of the conventional group（all P＜0.05）．The marginal fit，occlusal relationship and adjacent relationship in the digital group were all higher than those of the conventional group（all P＜0.05）．Three months after repair，the levels of various inflammatory factors in gingival crevicular fluid in both groups were lower than those at admission，and the digital group was lower than the conventional group（all P＜0.05）．The total incidence of complications in the digital group was lower than that in the conventional group（P＜0.05）．Conclusions DIOS can significantly improve the oral implant restoration effect of SP patients，reduce the levels of inflammatory factors in gingival crevicular fluid，and reduce the occurrence of complications．

       目的 探讨不同附着体类型对上颌种植覆盖义齿修复患者种植体周围软硬组织健康状况的影响。方法 选取2020年1月—2023年12月于南京医科大学附属口腔医院就诊并接受上颌种植覆盖义齿修复的90例患者，根据所用附着体类型分为杆卡组（n=30）、球帽组（n=30）和Locator组（n=30）。戴用后随访12个月，比较三组种植体周围探诊深度（PD）、探诊出血（BOP）、菌斑指数（PLI）、牙龈指数（GI）、边缘骨吸收（MBL）等指标，并记录机械并发症发生情况。结果 佩戴12个月后，杆卡组在PD［（3.25±0.41） mm vs （3.58±0.50） mm，校正后P＜0.016 7］、PLI（1.25±0.38 vs 1.55±0.44，校正后P＜0.016 7）、GI（1.15±0.35 vs 1.37±0.42，校正后P＜0.016 7）及MBL［（0.38±0.11） mm vs （0.63±0.14） mm，校正后P＜0.016 7］方面的表现均优于Locator组；球帽组PLI（1.42±0.41 vs 1.55±0.44，校正后P＜0.016 7）、GI（1.28±0.39 vs 1.37±0.42，校正后P＜0.016 7）低于Locator组；三组间BOP阳性率两两比较差异均无统计学意义（校正后P＞0.016 7）。三组机械并发症总发生率的总体差异具有统计学意义（P＜0.05），进一步两两比较显示，杆卡组并发症发生率最低（16.67%），Locator组最高（50.00%）（校正后P＜0.016 7）。结论 对于上颌种植覆盖义齿修复，杆卡式附着体在维持种植体周围软硬组织健康、减少边缘骨吸收及降低机械并发症方面表现出相对优势，临床适用性较高。

       Objective To investigate the effects of different attachment types on the health of peri-implant soft and hard tissues in patients rehabilitated with maxillary implant-supported overdentures．Methods A total of 90 patients who received maxillary implant-supported overdentures at the Affiliated Stomatological Hospital of Nanjing Medical University between January 2020 and December 2023 were selected and divided into three groups based on the attachment type：bar-clip group（n=30），ball attachment group（n=30），and Locator group（n=30）．After prosthesis delivery，patients were followed up for 12 months．Parameters including probing depth（PD），bleeding on probing（BOP），plaque index（PLI），gingival index（GI），and marginal bone loss（MBL）were compared among the groups，and mechanical complications were recorded．Results At 12 months after delivery，the bar-clip group demonstrated significantly better performance in PD（［3.25±0.41］mm vs ［3.58±0.50］mm，adjusted P＜0.016 7），PLI（［1.25±0.38］ vs ［1.55±0.44］，adjusted P＜0.016 7），GI（［1.15±0.35］ vs ［1.37±0.42］，adjusted P＜0.016 7），and MBL（［0.38±0.11］mm vs ［0.63±0.14］mm，adjusted P＜0.016 7）compared to the Locator group．The ball attachment group showed significantly lower PLI（［1.42±0.41］ vs ［1.55±0.44］，adjusted P＜0.016 7）and GI（［1.28±0.39］ vs ［1.37±0.42］，adjusted P＜0.016 7）values than the Locator group．No statistically significant difference was observed in BOP positive rates among the three groups in pairwise comparisons（adjusted P＞0.016 7）．The overall difference in the total incidence of mechanical complications among the three groups was statistically significant（P＜0.05），and further pairwise comparisons showed that the bar-clip group had the lowest incidence（16.67%），while the Locator group had the highest（50.00%）（adjusted P＜0.016 7）．Conclusions For maxillary implant-supported overdentures，bar-clip attachments demonstrate relative advantages in maintaining peri-implant soft and hard tissue health，reducing marginal bone loss，and minimizing mechanical complications，suggesting good clinical applicability．

       目的 利用心脏代谢指数（CMI）和轻量级梯度提升机（LightGBM）模型评估代谢综合征（MetS）患者靶器官损害风险，探究其性别特异性关联，为精准干预提供依据。方法 纳入2022年8月至2025年2月在惠州市第一人民医院住院的132例MetS患者以及健康体检者400例（即对照组，仅作为基线对比参数），以心肾损害、大血管病变为复合靶器官损害终点，选取CMI、年龄等为核心特征；构建LightGBM分类模型（70%训练集、30%测试集分层抽样），并采用100次随机拆分验证得出曲线下的面积（AUC）和95%置信区间（CI）并绘制校准曲线；以AUC评估性能，结合沙普利加性解释算法（SHAP）和偏依赖图（PDP）进行可解释性及性别分层分析。结果 基线对比显示，MetS患者CMI（6.8±2.3）高于对照组（3.2±1.1），靶器官损害（TOD）阳性率（57.6%）高于对照组（12.0%）（P均＜0.001）；LightGBM模型预测AUC达0.812，CMI为最重要预测特征（相对贡献度31.5%），且CMI与性别交互作用检验差异有统计学意义（P＜0.01）；CMI与靶器官损害呈非线性S形关联，风险拐点为5.7，高危平台期为7.5；女性风险加速阈值（CMI 5.0）早于男性（CMI 6.5）。结论 以健康人群为对照明确了MetS患者的高CMI水平与高TOD风险特征，LightGBM-SHAP框架明确了CMI的核心预测价值，性别特异性阈值为制定男女个性化早期干预策略提供量化指导，具有良好的临床应用潜力。

    Objective This study aims to use the cardiometabolic index（CMI）and the LightGBM model to assess the risk of target organ damage（TOD）in metabolic syndrome（MetS）patients，explore its gender-specific associations，and provide a basis for precise intervention．Methods MetS patients meeting diagnostic criteria and healthy individuals（the control group，used only as a baseline reference parameter）were enrolled．The composite endpoint of TOD was defined as cardiorenal damage and macro/microvascular lesions．Core features selected included CMI and age．A LightGBM classification model was constructed（70% training set，30% test set with stratified sampling），and 100 random splits were used for validation to generate the area under the curve（AUC） with 95% confidence interval（CI）and draw the calibration curve．Performance was assessed using AUC，combined with the SHAP algorithm and Partial Dependence Plot（PDP）for interpretability and gender-stratified analysis．Results Baseline comparison showed that the CMI level of MetS patients（6.8±2.3）was significantly higher than that of the control group（3.2±1.1），and the positive rate of TOD（57.6%）was significantly higher than that of the control group（12.0%）（both P＜0.001）．The LightGBM model achieved an AUC of 0.875 in prediction，with CMI as the most important predictive feature（relative contribution of 31.5%），and the interaction test between CMI and gender showed a significant difference（P＜0.01）．CMI showed a non-linear S-shaped association with TOD，with a risk inflection point at 5.7 and a high-risk plateau at 7.5．Significant gender differences were observed：the threshold for accelerated risk in females（CMI 5.0）was earlier than that in males（CMI 6.5）．Conclusions Using healthy individuals as controls clarifies the characteristics of high CMI levels and high TOD risk in MetS patients．The LightGBM-SHAP framework clarifies the core predictive value of CMI．The gender-specific thresholds provide quantitative guidance for formulating personalized early intervention strategies for males and females，demonstrating good potential for clinical application．

       肺癌作为全球恶性肿瘤中发病率和死亡率较高的一种，手术是其主要治疗手段。然而，肺切除手术常引起肺功能下降，影响患者术后功能恢复及生活质量。准确预测术后肺功能对制定个体化手术方案、降低并发症风险及改善患者预后具有重要意义。目前，研究者已开发出多种结合临床指标、影像学参数及生物标志物的预测模型，用于评估肺癌患者术后肺功能变化。然而，现有模型在准确性、特异性、标准化及临床推广方面仍存在诸多挑战。本文系统综述肺癌术后肺功能的影响因素，并对现有预测模型进行总结与评价，以期为患者术前评估、手术方案选择及术后管理提供参考，进而为改善治疗效果与患者生活质量提供理论依据。

       Lung cancer is a kind of malignant tumor with high morbidity and mortality in the world，and surgery is the main treatment．However，pneumonectomy is often accompanied by the loss of lung function，which seriously affects the recovery of lung function and the  quality of life．Accurate prediction of postoperative pulmonary function is of great significance for formulating individualized surgical plans，reducing the risk of complications and improving the prognosis of patients．At present，researchers have developed a variety of predictive models that combine clinical indicators，imaging parameters，and biomarkers to evaluate postoperative lung function changes in patients with lung cancer．However，there are still many challenges in the accuracy，specificity，standardization and clinical promotion of existing models．This paper systematically reviews the influencing factors of lung function after lung cancer surgery，and summarizes and evaluates the existing prediction models，in order to provide a reference for preoperative evaluation，surgical plan selection and postoperative management of patients，and then provide theoretical basis for improving treatment effect and quality of life of patients．

      目的 探讨不同体质指数（BMI）分组成年1型糖尿病（T1DM）患者的临床特征以及超重/肥胖与心血管代谢危险因素之间的关系。方法 纳入2015年6月至2022年6月在广州市第一人民医院内分泌代谢科住院的268例成人T1DM患者。分为超重肥胖组（BMI≥24.0 kg/m²，41例）、体质量正常组（18.5≤BMI＜24.0 kg/m²，155例）和体质量过低组（BMI＜18.5 kg/m²，72例）。比较三组人口学、人体测量及代谢指标的差异，采用多元线性回归分析BMI与估算肾小球滤过率（eGFR）的关联。结果 超重肥胖组患者的特征表现为年龄更大、病程更长、体脂肪量更高、腹部皮下脂肪面积更大、腰围、臀围更大、合并高血压比例更高、收缩压更高、高密度脂蛋白胆固醇更低、eGFR更低、糖化血红蛋白（HbA1c）更低。多元线性回归分析显示，校正年龄、性别、病程后，BMI与eGFR呈负相关（β=-2.050，P=0.012）；进一步校正HbA1c、血压、血脂后，该关联不再显著。结论 超重/肥胖成人T1DM患者存在多重代谢异常聚集，BMI与eGFR的负向关联可能主要与血糖、血压、血脂等代谢因素有关。

Objective To investigate the clinical characteristics of adult patients with type 1 diabetes mellitus（T1DM）in different body mass index（BMI）categories and the associations of overweight and obesity with cardiometabolic risk factors．Methods A total of 268 adult T1DM inpatients from Guangzhou First People’s Hospital were enrolled．Patients were divided into three groups：overweight/obese（BMI≥24.0 kg/m²，n=41），normal-weight（18.5≤BMI＜24.0 kg/m²，n=155），and underweight（BMI＜18.5 kg/m²，n=72）．Demographic characteristics，anthropometric measurements，and metabolic parameters were compared among the three groups．Multivariable linear regression analyses were performed to evaluate the association between BMI and estimated glomerular filtration rate（eGFR）．Results Patients in the overweight/obesity group were characterized by older age，longer diabetes duration，higher body fat mass，larger abdominal subcutaneous fat area，greater waist and hip circumferences，a higher prevalence of hypertension，higher systolic blood pressure，lower high-density lipoprotein cholesterol levels，lower eGFR，and lower glycated hemoglobin（HbA1c）levels．Multivariable linear regression analysis demonstrated that BMI was inversely associated with eGFR after adjustment for age，sex，and diabetes duration（β=-2.050，P=0.012）．However，this association was no longer significant after further adjustment for HbA1c，blood pressure，and lipid parameters．Conclusions Overweight/obese adult T1DM patients exhibit clustering of metabolic abnormalities．The negative association between BMI and eGFR may be primarily mediated by metabolic factors such as hyperglycemia，hypertension，and dyslipidemia．

       目的 探讨肥胖与肺功能参数的相关性。方法 将90例接受肺功能检查的患者依据体质指数（BMI）分为肥胖组（BMI≥25 kg/m²，n=50）和正常体质量组（18.5 kg/m²＜BMI≤24.9 kg/m²，n=40），比较两组各项肺功能参数的差异，包括肺通气功能的参数如［用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、1秒率（FEV₁/FVC）、最大呼气流量（PEF）］以及反映小气道功能的参数［50%最大呼气流量（MEF₅₀），25%最大呼气流量（MEF₂₅）］；比较肥胖组不同性别间上述肺功能参数的差异及其与腰围（WC）与BMI的相关性。结果 肥胖组FVC、FEV₁、FEV₁/FVC、MEF₅₀、MEF₂₅低于正常体质量组（P＜0.01）；肥胖组中男性FVC及FEV₁低于女性（P＜0.01）。相关分析结果显示，肥胖组中WC与BMI均与肺功能多个参数呈负相关趋势，其中WC的负相关趋势更突出，且与FVC呈负相关关系（P＜0.05）。结论 肥胖影响反映肺功能的多个参数，表现为肺通气功能和小气道功能多个指标水平降低，且肥胖男性更甚；在肥胖人群中，相较于BMI，WC与FVC的关系更密切。

      Objective To investigate the correlation between obesity and pulmonary function parameters．Methods Ninety patients undergoing pulmonary function testing were categorized into an obese group（BMI≥25 kg/m²，n=50）and a normal-weight group（18.5 kg/m²＜ BMI≤24.9 kg/m²，n=40）．Differences in pulmonary function parameters were compared between groups，including ventilatory parameters（forced vital capacity［FVC］，forced expiratory volume in 1 second［FEV₁］，FEV₁/FVC ratio，peak expiratory flow［PEF］） and parameters reflecting small airway function（maximum expiratory flow at 50% of forced expiratory volume［MEF₅₀］，and 25% maximum expiratory flow［MEF₂₅］）．Differences in these pulmonary function parameters between genders within the obese group and their correlations with waist circumference（WC）and BMI were also assessed．Results FVC，FEV₁，FEV₁/FVC，MEF₅₀，and MEF₂₅ were significantly lower in the obese group compared to the normal-weight group（P＜0.01）．Among obese subjects，male FVC and FEV₁ were significantly lower than female values（P＜0.01）．Correlation analysis revealed negative correlations of WC and BMI with multiple pulmonary function parameters in the obese group，with WC exhibiting a more pronounced negative correlation and a significant negative relationship with FVC（P＜0.05）．Conclusions Obesity impacts multiple parameters reflecting lung function，manifesting as reduced levels of several indicators of pulmonary ventilation and small airway function，with male obese individuals exhibiting greater impairment．Within the obese population，WC correlates more closely with FVC than BMI．

       目的 探究体成分变化对肥胖患者肾小球高滤过的影响。方法 根据纳入排除标准，连续收集在中南大学湘雅二医院营养科及代谢内分泌科就诊的肥胖患者（体质指数≥28 kg/m²），对其随访3个月以上，纳入体质量减轻≥5%的患者，记录一般人口学、人体测量学、体脂率（BFP）、体脂肪量（BFM）、内脏脂肪面积（VFA）和骨骼肌量（SMM）等体成分和实验室检验数据，计算估计肾小球滤过率（eGFR）。肾小球高滤过被定义为eGFR大于普通人群第95个百分位数，根据此标准分为肾小球高滤过组和正常滤过组，比较组间一般人口学资料、生化指标及体成分的差异，绘制限制性立方样条图分析体成分的变化与eGFR变化之间的非线性关联。结果 （1）共收集85例肥胖患者初复诊资料，其中肾小球正常滤过患者43例，肾小球高滤过患者42例，男性35例，女性50例；（2）单因素分析提示肾小球高滤过患者减重前后eGFR差异有统计学意义［143.34 mL/（min·1.73 m²） vs 125.68 mL/（min·1.73 m²）；（3）非线性相关分析结果显示肥胖肾小球高滤过患者eGFR的变化与VFA的变化相关（P=0.015 1），与BFP的变化相关（P=0.022 6）。结论 肥胖患者减重后，随着VFA和BFP的下降可能改善肾小球高滤过。

    Objective This study aimed to investigate the impact of alterations in body composition on glomerular hyperfiltration in obese patients．Methods According to predefined inclusion and exclusion criteria，obese patients（body mass index ≥28 kg/m2）from the department of clinical nutrition and the department of metabolism and endocrinology at Second Xiangya Hospital of Central South University were consecutively enrolled．Patients who achieved a weight loss of ≥5% after more than three months of follow-up were included．Data on general demographics，anthropometric measurements，body composition parameters-including body fat percent（BFP），body fat mass（BFM），visceral fat area（VFA），and skeletal muscle mass（SMM）-and laboratory test results were collected．The estimated glomerular filtration rate（eGFR）was calculated．Glomerular hyperfiltration was defined as an eGFR greater than the 95th percentile for the general population．Based on this criterion，patients were categorized into a hyperfiltration group and a normofiltration group．Differences in demographic characteristics，biochemical indices，and body composition parameters between the two groups were compared．Restricted cubic spline curves were plotted to analyze the non-linear relationship between changes in body composition and changes in eGFR．Results （1）A total of 85 obese patients（35 males and 50 females） with initial and follow-up data were included，comprising 43 patients with normofiltration and 42 with hyperfiltration；（2）Univariate analysis indicated a statistically significant difference in eGFR before and after weight loss in the hyperfiltration group（143.34 mL/min/1.73m² vs 125.68 mL/min/1.73m²，P＜0.001）；（3）Non-linear correlation analysis revealed that changes in eGFR among obese patients with hyperfiltration were significantly associated with changes in VFA（P=0.015 1）and changes in BFP（P=0.022 6）．Conclusions Weight loss in obese patients may ameliorate glomerular hyperfiltration，potentially mediated through reductions in VFA and BFP．

       目的  分析对肺癌化学治疗（化疗）患者采取个性化营养干预联合分级步行运动方案的应用价值。方法   将郑州大学附属郑州中心医院2023年7月—2024年7月符合标准的198例肺癌化疗患者作为研究对象，通过随机数字表法分为观察组和对照组各99例。对照组仅采用个性化营养干预方案，观察组则联合分级步行运动方案，两组患者均在同一时间内入组并接受持续干预3个月。对两组干预前后癌因性疲乏［Piper疲乏修订量表（PFS-R）］、营养状况、睡眠质量［匹茨堡睡眠质量指数（PSQI）］、生活质量［生活质量评估量表（SF-36）］水平予以比较。结果  相较于对照组，干预后观察组PFS-R、PSQI评分较低，白蛋白、前白蛋白、血红蛋白、铁转蛋白水平和SF-36评分较高（P＜0.05）。结论  对肺癌化疗患者采取个性化营养干预联合分级步行运动方案，有利于促进其癌因性疲乏的减轻和营养状态、睡眠质量及生活质量水平的提高。

       Objective  To analyze the effects of personalized nutritional intervention combined with graded walking exercise treatment on cancer-related fatigue and quality of life in lung cancer patients during chemotherapy．Methods  A total of 198 lung cancer patients undergoing chemotherapy who met the criteria in our hospital from July 2023 to July 2024 were selected as the research subjects．They were divided into an observation group and a control group，with 99 cases in each group，by the random number table method．The control group only received individualized nutritional intervention，while the observation group received graded walking exercise additionally．Both groups of patients were enrolled at the same time and received continuous intervention for three months．Cancer-related fatigue（Piper’s Fatigue Scale-Revised［PFS-R］），nutritional status，sleep quality（Pittsburgh Sleep Quality Index［PSQI］），and quality of life（Quality of Life Scale［SF-36］） before and after the intervention were compared between the two groups．Results  Compared with the control group，the observation group had lower PFS-R and PSQI scores and higher albumin，prealbumin，hemoglobin，transferrin levels and SF-36 scores after the intervention（P＜0.05）．Conclusions  Adopting personalized nutritional intervention combined with graded walking exercise for lung cancer patients during chemotherapy is beneficial to promote the reduction of cancer-caused fatigue and the improvement of their nutritional status，sleep quality and quality of life．