目的 研究影响冠状动脉粥样硬化性心脏病（冠心病）患者参与心脏康复意愿的因素及干预措施。方法 选取高州市人民医院 2021年1月—2022年3月收治的624例冠心病患者为研究对象,使用自行设计的调查问卷心脏康复参与意愿调查表及西雅图心绞痛量表对患者进行调查评估,分析冠心病患者心脏康复参与意愿现状及其影响因素。结果 624例冠心病患者中,162例愿意参加（25.96%）,126例希望参加（20.19%）,66例计划参加（10.58%）;单因素分析显示影响冠心病患者心脏康复参与意愿的因素主要包括社会支持、文化水平、娱乐活动、呼吸困难及心绞痛,社会支持方面,主观支持、客观支持、支持利用度得分分别为（2.32±0.41）（2.99±0.74）（2.58±0.95）分,组间比较差异有统计学意义（F=53.428,P<0.001）;文化水平方面,初中及以下、高中及中专、大专及以上得分分别为（2.35±0.18）（2.61±0.90）（3.09±0.63）分,组间比较差异有统计学意义（F=29.947,P<0.001）;娱乐活动方面,无、偏少、正常得分分别为（2.60±0.12）（2.88±0.29）（3.13±0.72）分,组间比较差异有统计学意义（F=44.903,P<0.001）;呼吸困难方面,≥1次/天、≥1次/周、<1次/月或无得分分别为（2.09±0.84）（2.31±0.70）（3.06±0.53）分,组间比较差异有统计学意义（F=116.082,P<0.001）;心绞痛方面,≥1次/天、≥1次/周、<1次/月或无得分分别为（2.51±0.33）（2.82±0.76）（3.15±0.87）分,组间比较差异有统计学意义（F=16.442,P<0.001）;多因素分析显示影响冠心病患者心脏康复参与意愿的独立影响因素主要包括文化程度、娱乐活动、呼吸困难及社会支持,结果有统计学意义（P<0.05）。结论 文化程度、娱乐活动、呼吸困难及社会支持等因素是导致冠心病患者心脏康复参与意愿较低的主要原因,临床上应对此予以重视,并采取康复教育、实施延续性护理、建立支持环境等措施,促使冠心病患者积极参与到心脏康复中,从而有效改善其预后。

Objective To study the factors and intervention measures that affect the willingness of coronary heart disease patients to participate in cardiac rehabilitation．Methods A total of 624 patients with coronary heart disease admitted to Gaozhou People's Hospital from January 2021 to March 2022 were selected as the research subjects．A self-designed survey questionnaire on willingness to participate in cardiac rehabilitation and the Seattle Angina Pectoris Scale were used to investigate and evaluate the patients．The current status and influencing factors of willingness to participate in cardiac rehabilitation in coronary heart disease patients were analyzed．Results Among 624 patients with coronary heart disease,162 were willing to participate（25.96%）,126 hoped to participate（20.19%）,and 66 planned to participate（10.58%）．Uunivariate analysis showed that the main factors affecting the willingness of coronary heart disease patients to participate in cardiac rehabilitation included social support,education level,entertainment activities,breathing difficulties,and angina．In terms of social support,subjective support,objective support,and support utilization scores were（2.32±0.41）points,（2.99±0.74）points,and（2.58±0.95）points,respectively,with statistically significant differences（F=53.428,P<0.001）．In terms of education level,the scores for middle school and below,high school and vocational school,college and above were（2.35±0.18）points,（2.61±0.90）points,and（3.09±0.63）points,respectively,with statistically significant differences（F=29.947,P<0.001）．In terms of entertainment activities,the scores for none,less and normal were（2.60±0.12）points,（2.88±0.29）points,and（3.13±0.72）points,respectively,with statistically significant differences（F=44.903,P<0.001）．In terms of breathing difficulties,the scores for ≥1 time/day,≥1 time/week,<1 time/month,or no were（2.09±0.84）points,（2.31±0.70）points,and（3.06±0.53）points,respectively,with statistical significance（F=116.082,P<0.001）．In terms of angina,the scores for ≥1 time/day,≥1 time/week,<1 time/month,or no were（2.51±0.33）points,（2.82±0.76）points,and（3.15±0.87）points,respectively,with statistical significance（F=16.442,P<0.001）．Multivariate analysis showed that the independent influencing factors on the willingness of coronary heart disease patients to participate in cardiac rehabilitation mainly include education level,entertainment activities,breathing difficulties,and social support,and the results were statistically significant（P<0.05）．Conclusions Education level,entertainment activities,breathing difficulties,and social support are the main reasons for the low willingness of coronary heart disease patients to participate in cardiac rehabilitation．Clinical attention should be paid to this and measures such as rehabilitation education,implementation of continuity of care,and establishment of a supportive environment should be taken to encourage coronary heart disease patients to actively participate in cardiac rehabilitation and effectively improve their prognosis．

N⁶-甲基腺苷(N⁶-methyladenosine, m⁶A)修饰是真核生物信使 RNA中最丰富的表观遗传修饰,其失调会导致mRNA异常生物学行为如翻译和降解紊乱,从而调控肿瘤发生发展。近期研究表明m⁶A在免疫调控过程中可发挥重要作用,其不仅可调节免疫细胞的活化,还在肿瘤微环境中免疫应答发挥重要调控作用,从而影响免疫治疗效果。越来越多的证据表明m⁶A修饰可能是肿瘤免疫治疗的重要潜在干预靶点。本文阐述了免疫细胞中m⁶A修饰调控及其在肿瘤免疫微环境中相关调节作用,并进一步探讨了靶向m⁶A调控蛋白在肿瘤免疫治疗中的干预策略及潜在治疗价值。

N⁶-methyladenosine (m⁶A) modification is the most abundant epigenetic modification in eukaryotic messenger RNA (messenger RNA). Its dysregulation drives abnormal transcription and translation processes, which promotes the occurrence and development of tumors. Studies have shown that m⁶A modification can regulate the activation of immune cells and their infiltration into the tumor microenvironment (TME), which may affect the efficiency of immunotherapy. Therefore, m⁶A modification may be a potential target for tumor immunotherapy. This paper describes the modification of m⁶A in immune cells and the antitumor immune response associated with TME, and explores the potential therapeutic value of targeting m⁶A regulators in tumor immunotherapy.