目的 分析晚期三阴性乳腺癌(TNBC)的危险因素并建立有效的预后列线图。方法 通过检索美国SEER(surveillance, epidemiology, and end results)数据库筛选晚期TNBC患者,采用单因素和多因素分析来确定晚期TNBC的独立预后因素,并以此构建了列线图,通过校准曲线检验和C指数(C-index)评估已建立的列线图。结果 共纳入4 687例晚期TNBC患者,与同期其他分子分型的乳腺癌相比较,TNBC的预后最差。单因素分析发现,年龄、性别、分期、手术、化疗、放疗、转移与更好的预后相关(P<0.05)。多因素分析发现年龄、性别、种族、分期、手术、化疗、放疗、各器官转移是患者预后的独立影响因素(P<0.05),并以此构建了列线图,其C-index为0.75(95％CI,0.71～0.79),校准图显示了预测的总生存期(OS)与观察到的OS之间的最佳一致性。结论 我们分析了晚期TNBC的临床特征,为TNBC患者的OS提供了一些预后因素,并根据这些预后因素制定了列线图,帮助临床医生进行风险管理并选择TNBC患者的长期生存策略。

Objective To analyze the risk factors of advanced triple-negative breast cancer (TNBC) and establish an effective prognostic nomogram. Methods Screening patients with advanced TNBC by searching the SEER (surveillance, epidemiology, and end results) database, using univariate and multivariate analysis to determine the independent prognostic factors of advanced TNBC, and constructing a nomogram based on it. Results A total of 4 687 patients with advanced TNBC were included. Compared with other types of breast cancer over the same period, TNBC had the worst prognosis. Univariate analysis found that age, gender, stage, surgery, chemotherapy, radiotherapy, and metastasis were associated with a better prognosis (P<0.05). Multivariate analysis found that age, gender, race, stage, surgery, chemotherapy, radiotherapy, and metastasis of the organs were independent factors affecting the prognosis of patients (P<0.05), and constructed a nomogram with a C-index of 0.75 ( 95% CI, 0.71～0.79). The calibration chart showed the best agreement between the predicted overall survival (OS) and the observed OS. Conclusion We analyzed the clinical features of advanced TNBC, provided some prognostic factors for the OS of TNBC patients, and developed a nomogram based on these prognostic factors to help clinicians manage risk and choose long-term survival strategies for TNBC patients.

目的 本研究旨在探讨肺癌合并肺栓塞的相关危险因素及肺栓塞对肺癌患者预后的影响。方法 检索2000年1月—2020年3月万方、中国知网、维普期刊、Medline Pubmed及EMBASE数据库中所有相关文献,并使用RevMan 5.3软件进行统计分析。结果 9项临床病例对照研究共1 179例患者纳入本研究。分析结果显示肺癌合并肺栓塞患者的中位生存时间明显低于单纯肺癌患者(HR=2.82,95%CI[2.06,3.87],P＜0.000 1)。危险因素分析显示腺癌发生肺栓塞的风险高于非腺癌(比值比(OR)=3.07, P＜0.000 1),III-IV期患者发生肺栓塞的风险明显高于I-II期患者(OR=2.97,P＜0.000 1),D-二聚体水平高的患者发生肺栓塞的风险是正常患者的4.32倍(P<0.000 1),白细胞(WBC) >11×109/L的患者发生肺栓塞的风险是WBC≤11×109/L患者的6.62倍(P＜0.000 1)。化疗史和中心静脉置管显著增加肺栓塞风险,OR值分别为3.02 (P＜0.000 1)和2.30 (P＜0.000 1)。然而,吸烟史、饮酒史、性别、糖尿病、COPD、高血压病等临床因素与肺栓塞发生无统计学相关性。结论 肺栓塞的发生明显影响肺癌患者的预后,其相关的危险因素为病理类型、分期、化疗史、中心静脉导管置入史、D-二聚体升高、白细胞＞11×10⁹/L。

Objective To investigate the risk factors of developing pulmonary embolism and its influence on the prognosis of lung cancer patients. Methods The following databases such as Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Weipu Database, Medline Pubmed and EMBASE were searched to identify relevant articles which were published during January 2000 to March 2020. Statistical analysis was performed using RevMan 5.3 software. Results 9 controlled trials incorporating 1 179 patients were included in this study. The results showed that the overall survival of lung cancer patients complicated with pulmonary embolism was significantly lower than that of lung cancer patients without pulmonary embolism (HR=2.82, 95%CI[2.06,3.87], P<0.000 1). The analysis on risk factors of developing pulmonary embolism showed that adenocarcinoma had a higher risk of pulmonary embolism than non-adenocarcinoma with Odds Ratio (OR)=3.07 (P<0.000 1). Patients in stage III-IV encountered significantly higher risk of pulmonary embolism than those in stage I-II (OR=3.07,P<0.000 1). Furthermore, the risk of pulmonary embolism in patients with high level of D-dimer was 4.32 times higher than in normal patients (P<0.000 1), and 6.62 times higher than those with WBC ≤11×10⁹/L (P<0.000 1). Additionally, the history of chemotherapy and central venous catheterization significantly increased the risk of pulmonary embolism, with OR of 3.02 (P<0.000 1) and 2.30 (P<0.000 1), respectively. However, smoking, alcohol consumption, gender, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease, hypertension were not statistical correlated with the occurrence of pulmonary embolism in lung cancer patients. Conclusion The occurrence of pulmonary embolism significantly affects the prognosis of patients with lung cancer, and the related risk factors were pathological type, stage, chemotherapy, central venous catheterization, increased D-dimer level, and WBC>11×10⁹/L.

目的 分析经胸超声心动图在Stanford A 型主动脉夹层的直接征象、间接征象和优缺点,探讨超声心动图在其诊断及预后评估中的应用价值。方法 回顾性收集2018年9月—2020年6月在我院诊治的A型主动脉夹层患者的临床资料,分析超声心动图的应用价值,以及住院期间发生不良预后的高风险因素。结果 经胸超声心动图直接征象诊断 A 型主动脉夹层的敏感性低于CTA,但对受累主动脉瓣结构及其功能评价优于CTA。 院内不良预后的发生率为42%, A型夹层的病因多与高血压相关,主动脉瓣返流、心包积液、手术时间长等是其高风险因素。结论 经胸超声心动图对A型主动脉夹层的早期诊断有较高的初筛价值,在局限于主动脉窦部夹层及观察主动脉瓣是否受累及有独特的优势,对于手术方式的选择和预后的判断有指导意义。

Objective To analyze the direct signs, indirect signs, advantages and disadvantages of transthoracic echocardiography in Stanford A-type aortic dissection, and explore the application value of echocardiography in its diagnosis and prognostic evaluation. Methods Retrospectively collect the clinical data of patients with type A aortic dissection diagnosed and treated in our hospital from Sept 2018 to Jun 2020, and analyze the application value of echocardiography and the high-risk factors for poor prognosis during hospitalization. Results The direct signs of transthoracic echocardiography were less sensitive than CTA in the diagnosis of type A aortic dissection, but it was better than CTA in evaluating the structure and function of the affected aortic valve. The incidence of poor prognosis in the hospital was 42%. The cause of type A dissection was mostly related to hypertension. Aortic regurgitation, pericardial effusion, and long operation time were high-risk factors. Conclusion Transthoracic echocardiography has a higher initial screening value for the early diagnosis of type A aortic dissection. It has unique advantages in confining to the aortic sinus dissection and observing whether the aortic valve is involved, the choice of surgical methods and the judgment of prognosis has guiding significance.

目的 探究m6A甲基化基因与卵巢癌生存预后的关系,为卵巢癌的靶向治疗、预后评估提供科学依据。方法 从TCGA及GTEx数据库中下载卵巢癌组织与正常组织mRNA表达数据进行组间差异分析,通过LASSO回归筛选与卵巢癌生存相关基因,进一步使用逐步Cox回归分析构建风险评分预测模型,根据风险评分中位数将患者分为高风险组和低风险组并使用ROC曲线下面积评价模型的预测能力。相关性分析构建与m6A基因的共表达调控网络,GO功能富集和KEGG通路分析初步探讨潜在的生物作用机制。结果 在癌组织与正常组织中发现20个m6A甲基化基因差异表达,逐步Cox回归分析筛选出3个基因(HNRNPA2B1,ZC3H13,WTAP)用于构建风险评分模型,高风险组患者的生存期较低风险组患者明显缩短(P=0.001 9),死亡风险显著增加(HR=2.643, P＜0.01),风险评分模型结合患者年龄、临床分级和分期后,1、3、5年的AUC为0.74、0.64、0.64。生物信息学分析结果提示m6A相关基因参与RNA的剪接、定位、转运、代谢调控、蛋白水解、细胞周期、核糖体合成等生物学过程。结论 成功构建卵巢癌m6A甲基化基因预后风险评估模型且该模型具备一定的预测效能。

Objective To explore the relationship between m6A methylated genes and prognosis of ovarian cancer, so as to provide scientific basis for targeted therapy and prognosis assessment of ovarian cancer. Methods The mRNA expression data of ovarian cancer tissues and normal tissues were downloaded from TCGA and GTEx databases for difference analysis between two groups. The genes related to ovarian cancer survival were screened by LASSO regression, and the risk score prediction model was further constructed by step Cox regression analysis. The patients were divided into high-risk group and low-risk group according to the median risk score, and the ROC was used for analysis. Correlation analysis was performed to construct an expression regulatory network with m6A genes, and GO function enrichment and KEGG pathway analysis were performed to preliminarily explore the potential biological mechanism. Results 20 m6A methylation genes were found in differential expression between cancer tissue and normal tissue, three genes (HNRNPA2B1, ZC3H13, WTAP) were used to construct the model through step Cox regression analysis. Patients' survivals of high-risk group were shortened than that of the low-risk group obviously (P=0.001 9), the risk of death significantly was increased (HR=2.643, P<0.01). After risk score model combined with patient age, clinical classification and stage, the AUC of 1, 3, 5 years was 0.74, 0.64 and 0.64. Bioinformatics analysis indicated that those m6A genes were involved in RNA splicing, localization, transport, metabolic regulation, proteolysis, cell cycle, ribosome synthesis and other biological processes. Conclusion The prognostic risk assessment model of m6A methylated genes for ovarian cancer was successfully constructed and the model had certain predictive efficacy.

目的 探究序贯器官衰竭评分(sequential organ failure assessment,SOFA)联合可溶性程序性死亡因子-1(soluble programmed death-1,sPD-1)水平对脓毒症患者的预后影响。方法 选我院2019年3月—2021年3月期间86例脓毒症患者为研究对象,依据其预后情况(28 d转归)分为生存组(59例)、死亡组(27例),记录两组患者sPD-1、炎症细胞因子水平、SOFA评分及急性生理学与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分情况,分析28 d死亡危险因素,并以ROC曲线分析SOFA+sPD-1对脓毒症患者预后评估价值。结果 死亡组年龄、C反应蛋白、降钙素原、sPD-1水平及SOFA、APACHEⅡ评分均较生存组高(P＜0.05);经Logistic回归分析,sPD-1、SOFA、APACHEⅡ为28 d死亡脓毒症患者独立预测因素(P＜0.05);联合预测后,SOFA+sPD-1的ROC曲线下面积最大,为0.862,敏感度、特异度分别为88.89%、88.14%。结论 在对脓毒症患者预后评估中,sPD-1、SOFA评分均为28 d病死独立预测因素,且SOFA+sPD-1对脓毒症患者转归预测能力更为理想。

Objective To explore the effect of sequential organ failure assessment (SOFA) combined with soluble programmed death factor-1 (sPD-1) level on the prognosis of patients with sepsis. Methods A total of 86 patients with sepsis in our hospital from March 2019 to March 2021 were selected and divided into survival group (59 cases) and death group (27 cases) according to their prognosis (28-day outcome). The levels of sPD-1, inflammatory cytokines, SOFA and APACHEⅡ scores of two groups were recorded. The risk factors of 28-day mortality were analyzed. The prognostic values of SOFA+sPD-1 in patients with sepsis were analyzed by ROC curve. Results Age, C-reactive protein (CRP), procalcitonin (PCT) and sPD-1 levels and SOFA, APACHEⅡ scores of death group were higher than those of survival group (P＜0.05). By Logistic regression analysis, sPD-1 level, SOFA and APACHEⅡ scores were identified as independent predictors of 28-day death in patients with sepsis (P＜0.05). After combining prediction, the area under the ROC curve of SOFA+sPD-1 was the largest (0.862), and the sensitivity and specificity were 88.89% and 88.14% respectively. Conclusion In the prognosis evaluation of patients with sepsis, both sPD-1 level and SOFA score were independent predictors of 28-day mortality, and SOFA+sPD-1 was more effective in predicting the prognosis of patients with sepsis.

目的 评估中性粒细胞与淋巴细胞比值(NLR)在晚期结直肠癌(CRC)患者化疗疗效及预后的意义。方法 回顾性收集2016年1月—2019年4月期间接受以奥沙利铂为基础的标准一线化疗的晚期不可切除结直肠癌患者50例临床病历资料,并在2个化疗周期后评估化疗疗效;根据入组患者化疗前血液学数据计算中性粒细胞与淋巴细胞比值(NLR),运用受试者工作特征曲线确定的NLR最佳截断值,将患者分为高NLR(≥3.785) 组和低NLR(＜3.785) 组,比较高、低NLR与临床病理特征、化疗疗效及无进展生存期(PFS)、总生存期(OS)差异;采用COX回归分析模型分析影响晚期结直肠癌患者PFS、OS的因素。结果 高、低NLR两组肿瘤分化程度(P=0.030)、ECOG评分(P=0.003)、CEA(P=0.011)、CA19-9(P=0.047)比较,差异有统计学意义;高低NLR两组间化疗疗效比较,差异有统计学意义(P＜0.001),高NLR组化疗疗效较差;两组中位PFS分别为3.44个月和12.84个月,差异有统计学意义(χ²=39.730,P＜0.001),两组中位OS分别为7.59个月和22.32个月,差异有统计学意义(χ²=40.505,P＜0.001);Cox回归分析提示NLR高低、CEA水平是PFS、OS的独立预后因素(P＜0.05)。结论 高水平NLR与晚期结直肠癌患者化疗疗效不佳和预后不良相关,可作为其化疗疗效及预后监测的指标。

Objective To evaluate the value of neutrophil-lymphocyte ratio (NLR) in the chemotherapy curative effect and prognosis of patients with advanced colorectal cancer (CRC). Methods Retrospective collection of clinical data from 50 patients with advanced unresectable colorectal cancer who received oxaliplatin-based standard first-line chemotherapy between January 2016 and April 2019. Chemotherapy curative effect was evaluated following 2 chemotherapy cycles. Calculation of neutrophil to lymphocyte ratio (NLR) based on pre-chemotherapy hematology data. The receiver operating characteristic curve was used to determine the optimal cutoff value of NLR,according to patients who were divided into groups of high NLR(NLR≥3.785)and low NLR(NLR≥3.785).The differences between high and low NLR and clinicopathological features, efficacy of chemotherapy, progression-free survival (PFS), and total survival (OS) were compared. COX regression analysis mode was used to analysis of factors affecting PFS and OS in patients with advanced colorectal cancer. Results The differences in tumor differentiation (P=0.030), ECOG score (P=0.003), CEA (P=0.011), CA19-9 (P=0.047) in the high and low NLR groups were statistically significant. The differences in chemotherapy between the two groups was statistically significant (P<0.001), and the high NLR group was less effective. The median PFS of the high and low NLR groups were 3.44 months and 12.84 months, respectively, and the difference was statistically significant (χ²=39.730, P<0.001). The median OS of the high and low NLR groups was 7.59 months and 22.32 months, respectively, and the difference was statistically significant (χ²=40.505, P<0.001). Cox regression analysis suggested that NLR levels and CEA levels were independent prognostic factors for PFS and OS(P＜0.05). Conclusion High-level NLR is associated with poor chemotherapy response and poor prognosis in patients with advanced colorectal cancer, and was used as an indicator of chemotherapy efficacy and prognosis.

目的 应用生物信息学的方法筛选参与星型胶质细胞瘤的预后生物标志物。方法 首先,下载GEO(gene expression omnibus,GEO)数据库中星型胶质细胞瘤的基因芯片数据,通过R语言将来自4个数据集的基因芯片数据进行合并,将合并后的194人来源的脑组织样本分为:星型胶质细胞瘤组和正常组。然后对原始基因芯片数据进行批次效应去除和标准化处理,并使用密度图和主成分分析监测处理前后的效果。利用R语言中的limma包对处理后的基因芯片数据进行差异表达分析,从而筛选得到星型胶质细胞瘤组和正常组中之间的差异表达基因(differentially expressed genes,DEGs)。接着对差异表达基因进行GO(gene ontology,GO)分析和KEGG(kyoto encyclopedia of genes and genomes,KEGG)分析,并对所有基因的表达矩阵进行GSEA(gene set enrichment analysis,GSEA)分析。通过STRING数据库构建差异表达基因的蛋白—蛋白相互作用网络(protein-protein interaction,PPI),通过Cytoscape中的cytoHubba插件筛选Hub基因。为了探索Hub基因在星型胶质细胞中的诊断价值和预后价值,我们下载TCGA(the cancer genome atlas,TCGA)数据库中的基因表达数据和临床预后资料,使用ROC曲线评价Hub基因的诊断价值,并对诊断价值较高的Hub基因进行COX回归,筛选HR值最有意义的基因进行总生存分析(overall survival,OS)。结果 通过limma包总共分析得到1 043个差异表达基因。GO分析结果表明差异表达基因主通过影响神经突触的功能而发挥作用。KEGG分析结果显示钙信号通路、cAMP信号通路、MAPK信号通路、PI3K-Akt信号通路、Rap1信号通路和Ras信号通路等通路等在星型胶质细胞瘤中发挥着重要的作用。GSEA富集分析结果主要富集于细胞因子-细胞因子受体相互作用、JAK-STAT信号通路、逆行内源性大麻素信号、神经活性配体-受体相互作用、GABA能突触和钙信号通路等通路。通过PPI网络总共分析得到ADCY1、ANXA1和PENK等20个Hub基因。通过对Hub基因的诊断价值和预后价值进行评价,发现SST在星型胶质细胞瘤既可作为诊断标志物,也可作为预后生物标志物。结论 我们通过生物信息学分析发现SST可作为星型胶质细胞的预后生物标志物,又预测了Rap1信号通路有可能成为星型胶质细胞分子机制中的新通路。

Objective To screen biomarkers involved in the prognosis of astrocytoma by bioinformatics. Methods Firstly,the gene chip data of astrocytoma in GEO database were downloaded. The gene chip data from four data sets were combined by R language. The combined 194 human brain samples were divided into astrocytoma group and normal group. Then,the original microarray data were processed by batch effect removal and standardization,and the effects before and after processing were monitored by density map and principal component analysis. The differentially expression genes (DEGs) between astrocytoma group and normal group were screened by using limma package of R language to analyze the differentially expression of the processed gene chip data. Then gene ontology(GO) analysis and Kyoto encyclopedia of genes and genes (KEGG) analysis were carried out for the differentially expressed genes,and gene set enrichment analysis (GSEA) was carried out for the expression matrix of all genes. The protein-protein interaction (PPI) network of differentially expressed genes was constructed by using string database,and the Hub gene was screened by using the cytohubba plug-in of Cytoscape. In order to explore the diagnostic value and prognostic value of Hub gene in astrocytes,we downloaded the gene expression data and clinical prognostic data in the Cancer Genome Atlas(TCGA) database,used ROC curve to evaluate the diagnostic value of hub gene,and Cox regression for Hub gene with high diagnostic value,and screen the most significant gene of HR value for overall survival(OS) analysis. Results A total of 1 043 differentially expressed genes were obtained by limma analysis. Go analysis showed that the differentially expressed genes played an important role by affecting the function of synapses. KEGG analysis showed that calcium signaling pathway,cAMP signaling pathway,MAPK signaling pathway,PI3K Akt signaling pathway,Rap1 signaling pathway and Ras signaling pathway played an important role in astrocytoma. The results of GSEA enrichment analysis were mainly enriched in cytokine cytokine receptor interaction,JAK-STAT signaling pathway,retrograde endogenous cannabinoid signaling,neuroactive ligand receptor interaction,GABAergic synapse and calcium signaling pathway. A total of 20 Hub genes such as ADCY1,ANXA1 and PINK were obtained by PPI network analysis. By evaluating the diagnostic and prognostic value of hub gene,we found that SST could be used as both a diagnostic marker and a prognostic biomarker in astrocytoma. Conclusion We found that SST could be used as a biomarker for the prognosis of astrocytes by bioinformatics analysis,and predicted that Rap1 signaling pathway may be a new pathway in the molecular mechanism of astrocytes.

目的 探讨急性脑出血并发高钠血症的原因及预后情况。方法 选择2017年1月—2018年8月就诊于我院的急性脑出血并发高钠血症60例为观察组[根据血清钠离子浓度分为重度组37例（血清钠离子浓度>170 mmol/L）,中度组12例（钠离子浓度161~170 mmol/L）,轻度组11例（钠离子浓度145~160 mmol/L）],选择同期就诊于我院不伴高钠血症的脑出血患者60例为对照组。比较两组意识障碍程度、出血部位、死亡率,并分析急性脑出血并发高钠血症患者中不同血清钠离子浓度患者预后情况。结果 观察组GCS评分≤8分比例、丘脑出血比例、死亡率高于对照组,差异有统计学意义（P<0.05）;观察组基底节区、脑干小脑、脑叶出血比例与对照组比较,差异无统计学意义（P>0.05）;血清钠离子浓度越高则患者的预后越差,差异有统计学意义（P<0.05）。结论 与急性脑出血患者相比,急性脑出血患者并发高钠血症患者的死亡率较高,且预后情况与血清钠离子浓度密切相关;丘脑部出血与急性脑出血患者并发高钠血症密切相关,临床应加以重视。

目的 探讨血清ApoA-1浓度与食管鳞状上皮细胞癌的相关性及其预后价值。方法 对我院2010年1月—2012年10月收治的食管鳞状上皮细胞癌患者的血清ApoA-1浓度进行回顾性调查分析,与我院体检中心2009年1月—2009年4月219例正常人群的血清ApoA-1浓度作为对照组进行统计学处理分析。结果 210例食管鳞状上皮细胞癌患者组和219例健康对照组在性别和年龄比较均无统计学差异(P>0.05)。血清ApoA-1 浓度在ESCC组的pTNM和临床分期均有统计学差异(P<0.05)。与ApoA-1水平高的患者相比,ApoA-1水平低的患者的总体生存率更低(P=0.002)。结论 血清ApoA-1 水平是食管鳞状上皮细胞癌食管癌的一个重要的预后因素。

目的 了解老年冠脉支架植入患者的临床特征及治疗疗效。方法 按照纳入、排除标准入选2015年10月—2017年10月于我院住院并接受冠状动脉支架治疗的患者372例,分为女性组和男性组,收集临床资料并随访预后。结果 女性组157例,男性组215例,2组冠脉病变支数、发生心血管不良事件比例无统计学意义(P>0.05),女性组不稳定性心绞痛、合并糖尿病、高血压比例及胆固醇、甘油三酯、低密度脂蛋白、脂蛋白a、TSH水平均高于男性组(P<0.05),急性心肌梗死、吸烟比例及年龄、血肌酐均低于男性组(P<0.05)。结论 老年患者合并可控制的危险因素较多,女性要强调血糖、血脂的控制,男性要强调戒烟。冠脉病变支数、术后1年发生不良心血管事件比例无性别差异。