泛血管疾病（PVD）是一类以动脉粥样硬化为共同病理基础、累及心、脑、肾及外周血管系统的临床综合征, 具有多血管床共病特征, 发病率高、致残致死率大。非编码RNA（ncRNA）作为基因表达的重要调控因子, 在PVD的发生发展中发挥关键作用。微小RNA（miRNA）、长链非编码RNA（lncRNA）、环状RNA（circRNA）等ncRNA通过调节炎症反应、内皮功能、血管重塑、代谢稳态等多路径参与PVD的病理过程, 并展现出时空特异性和双向调控特征。最新研究揭示ncRNA在临床中的诊断预测及靶向干预潜力, 包括外泌体载体及circRNA递送系统等新策略。此外, 中医药通过调控ncRNA网络, 干预血瘀、痰浊等证型相关通路, 体现中西医结合治疗的系统优势。本文系统综述了ncRNA在PVD中的作用机制与研究进展, 强调其在精准诊疗与转化研究中的应用前景, 并指出未来需加强基础与临床协同、推进个体化干预策略的落地实施。
Panvascular diseases（PVD）are a group of clinical syndromes characterized by atherosclerosis as a common pathological foundation, involving heart,brain,kidneys,and peripheral vascular systems．These diseases often exhibit multi-vascular bed comorbidities and are associated with high incidence,disability, and mortality rates．Non-coding RNAs（ncRNAs）, as key regulators of gene expression, play a crucial role in the onset and progression of PVD．Various types of ncRNAs—including microRNAs（miRNAs）, long non-coding RNAs（lncRNAs）, and circular RNAs（circRNAs）—are involved in the pathological processes of PVD through multiple pathways, such as modulation of inflammatory responses, endothelial function, vascular remodeling, and metabolic homeostasis, exhibiting spatiotemporal specificity and bidirectional regulatory effects．Recent studies have highlighted the potential of ncRNAs in clinical diagnosis, prognosis, and targeted therapy,with novel strategies including exosome-based delivery and circRNA-targeting systems．In addition, traditional Chinese medicine（TCM）exerts regulatory effects on ncRNA networks to intervene in syndrome-specific pathways, such as those related to blood stasis and phlegm-dampness, reflecting the systemic advantages of integrating TCM with Western medicine．This review systematically summarizes the regulatory mechanisms and research progress of ncRNAs in PVD,emphasizes their potential in precision medicine and translational research, and proposes the need to strengthen collaboration between basic and clinical studies to facilitate the implementation of personalized therapeutic strategies．
在过去的几十年中,随着RNA生物学的深入研究,越来越多的证据表明,非编码RNA（ncRNA）对包括癌症在内的多种疾病进展起着关键作用,同时在作为生物标志物和治疗靶点方面表现出了巨大的潜力。在全球范围内,消化道（GI）肿瘤是肿瘤相关死亡的主要原因,目前消化道肿瘤晚期患者的生存率依然很低。既往大量研究报道了ncRNA中,特别是长链非编码RNA（lncRNA）在消化道肿瘤发生发展中发挥重要作用。本文将着重阐述lncRNA在消化道肿瘤分子生物学中的作用,旨在为深入理解lncRNA在消化道肿瘤发生发展机制以及临床转化应用提供新的思路和线索。
In recent decades,an increasing body of evidence has pointed to the pivotal roles of non-coding RNAs（ncRNAs）,particularly long non-coding RNAs（lncRNAs）,in the development of various diseases,including cancer．Meanwhile,ncRNAs have been shown great potential as biomarker and therapeutic target．Gastrointestinal（GI）cancers are a leading cause of cancer-related mortality globally and the survival rate of advanced GI cancer patients is still very low．Extensive research has underscored the significant involvement of lncRNAs in the initiation and progression of GI cancers．This review aims to offer a comprehensive overview of lncRNAs,shedding light on their roles in the molecular biology of GI cancers．By synthesizing previous studies,this review seeks to provide new insights into the mechanisms underlying lncRNAs' contribution to GI cancer development and their potential clinical applications．
目的 利用品管圈工具提高某三甲医院住院病案首页主要诊断编码正确率。方法 成立品管圈小组,选取2022年11月出院日期前200份住院病案首页作为开展品管圈前的对照组,按照出院科室分层抽取2021年8月1日—2022年3月31日的2 007份首页作为开展品管圈后的研究对象,对上述首页的主要诊断填写及疾病分类编码进行核对、检查、汇总统计。针对主要诊断编码错误率高的现象,从人、法、测3个维度进行分析,根据找出的原因制定对策并执行。根据具体情况使用χ2检验或者四格表资料的Fisher确切概率法检验比较品管圈前后主要诊断编码正确、错误份数的差异。结果 开展一系列改进措施后医生主要诊断填写正确率从95.00%上升到98.01%,编码员主要诊断编码正确率从97.50%上升至99.55%,住院病案首页主要诊断编码正确率从93.50%提高到97.56%,临床医师的书写质量、编码员的编码质量均有改善。品管圈开展前后主要诊断编码正确、错误份数差异有统计学意义。通过开展品管圈,标准化了一个院级规范、多个院级编码共识、两个科级工作工具和机制以及一个科级绩效分配方案。结论 品管圈质量改进工具能有效提高病案首页主要诊断编码正确率,后期应持续开展。
Objective To improve the accuracy of main diagnostic codes on the home page of inpatient medical records in a Class III Grade A Hospital by using the quality control circle．Methods The Medical Record Department set up a quality control circle group．A total of 200 inpatient medical records' home pages were selected as the control group before the quality control circle carried out,which patients were discharged in November 2022．Home pages of 2 007 inpatient medical records from August 1,2021 to March 31,2022 were selected according the discharge department as the research objects after the quality control circle carried out．The main diagnosis filling and disease classification codes on those home pages of the above medical records were checked and summarized．We analyzed the reason of the high error rate of the main diagnostic codes from three dimensions of people,law and test．Countermeasures were formulated and implemented according to the identified causes．Fisher exact probability method of four grid data or χ2 test were used to compare the correct copies of main diagnostic codes before and after the quality control circle according to the specific situation．Results The writing quality of clinicians and the coding quality of coders were improved after a series of improvement measures were carried out．The correct rate of doctors' main diagnostic codes increased from 95.00% to 98.01%,the correct rate of coders' main diagnostic codes increased from 97.50% to 99.55%,and the correct rate of main diagnostic codes on the home page of inpatient medical records increased from 93.50% to 97.56%．The number of correct copies of main diagnostic codes before and after the development of the quality control circle was statistically significant．Through the development of the quality control circle,one institute level specification,multiple institute level coding consensus,two department level work tools and mechanisms,and one department level performance allocation scheme have been standardized．Conclusions The application of the quality control circle tool can effectively improve the accuracy of the main diagnostic codes on the home page of the inpatient medical record,which should be continued in the later period．
目的 探寻病案首页国际疾病分类(ICD)编码的准确率对按疾病诊断相关分组(DRGs)分值付费影响。方法 整体抽取2019年心血管内科和脊柱关节外科医保病例,分析DRGs分值付费存在的问题,对全院病案首页ICD编码采取相应的干预措施。结果 2019年病案首页ICD编码准确率为81.55%,DRGs分值付费亏损2 812 804.7元,经干预后,2020年病案首页ICD编码准确率为97.13%,DRGs分值付费结余14 089 039.36元。结论 准确、规范的填写病案首页ICD编码,提高病案首页ICD编码的准确率,避免医院在DRGs分值付费模式下出现亏损有重要意义。
Objective To investigate the influence of the front page International Classification of Diseases(ICD) coding accuracy of medical records on diagnosis related groups(DRGs) score payment system.Methods Medical insurance cases of cardiovascular medicine and spine and joint surgery in 2019 were totally selected,the problems of DRGs score payment system were investigated and analyzed,and managements improving the ICD coding on the medical records of discharged patients were carried out.Results In 2019,the accuracy of ICD coding of medical records was 81.55%,and the DRGs score payment system had lost 2 812 804.7 yuan.After improving,in 2020,the ICD coding accuracy achieved 97.13%,and DRGs score payment system had a positive balance of 14 089 039.36 yuan.Conclusions The accuracy and standardization of ICD coding on the medical records is of great significance in avoiding losses on DRGs score payment system.
目的 利用椎间孔镜微创治疗腰椎管狭窄症的手术编码容易出现错编、漏编情况,找到相应的解决办法。方法 通过查阅某院脊柱关节外科2016年引进椎间孔镜微创治疗腰椎管狭窄症的88份出院病案,以2011版 ICD-9-CM-3分类中查找出现的问题。结果 发现存在编码缺陷率达34.8%。结论 对于上述病案进行手术编码时,需要查阅腰椎微创融合手术的相关知识,需要判断手术方式、路径等情况,编码员应积极与临床手术医师进行沟通,加强工作责任心,才能做出准确编码,为临床医、教、研提供最具价值的病案信息。
目的 探索长链非编码RNA LINC00672在肺癌组织中的表达及其与患者预后的关系。方法 采用实时荧光定量PCR技术检测LINC00672在75对肺癌组织和癌旁正常组织中的表达,分析其在癌组织中的表达水平与肺癌患者临床分期和预后的关联。结果 LINC00672在肺癌组织中的表达显著低于癌旁正常组织(P=0.026),LINC00672高表达与低表达相比能显著降低肺癌患者的死亡率(死亡风险比=0.46;95%置信区间=0.23~0.95;P=0.036),延长患者中位生存期(34个月 vs 18个月,P=0.027)。并且,LINC00672与肺癌预后的关联在低年龄组(<60 a)、吸烟者和非饮酒者中更为显著。进一步相乘交互作用分析显示LINCOO672与饮酒在肺癌死亡风险上具有显著的交互效应(P=0.049)。然而,LINC00672的表达水平在不同分期、T、N、M患者来源的肺癌组织中的表达无显著性差异。结论 LINC00672与肺癌发生发展存在关联,可用于预测肺癌患者的预后。
Objective To explore the expression status of long non-coding RNA LINC00672 in lung cancer tissues and its correlation with survival of lung cancer. Methods We applied the real-time PCR method to measure the expression level of LINC00672 in 53 pairs of lung cancer tissues and adjacent lung normal tissues, and analyzed the correlation between its expression and survival of lung cancer. Results LINC00672 was significantly down-regulated in lung cancer tissues than their adjacent lung normal tissues (P=0.026). Compared to those with low expression level of LINC00672, patients with high expression level of LINC00672 exerted a significant long median survival time than those with low expression level (34 vs 18 months, P=0.027). High LINC00672 expression also contributed to low mortality rate than low LINC00672 expression (hazard ratio=0.46, 95% confidence interval =0.23-0.95, P=0.036). Meanwhile, the correlation was more evident in those low age groups (< 60 years), smokers and non-drinkers. There was also a significant interaction between LINC00672 and drinking on affecting death risk of lung cancer. However, no significant association was observed between LINC00672 expression and clinical stages as well as T, N, M status. Conclusion LINC00672 is correlated with development of lung cancer, which may be a valuable biomarker to predict lung cancer prognosis.
