论著

基于中国PIM标准分析老年精神疾病住院患者潜在不适当用药现状

Analysis of potentially inappropriate medication in elderly psychiatric inpatients based on criteria of potentially inappropriate medication for the elderly in China

:57-61
 
目的 调查分析老年精神疾病住院患者潜在不适当用药(PIM)现状。方法 回顾分析2021年3月老年住院患者临床诊断、用药情况等资料,依据2017年版《中国老年人潜在不适当用药判断标准》分析处方PIM情况。结果 125例研究对象中,平均年龄(73.31±7.87)岁,平均用药(6.62±2.68)种。101例(80.80%)患者存在140项PIM,81例(64.80%)患者使用了A级警示药物共103项,33例(40.74%)患者使用了B级警示药物共37项;高风险药物39项(27.86%),低风险药物101项(72.14%);PIM发生率排名前3位的药物是奥氮平、利培酮、劳拉西泮;12例患者存在4项与疾病状态相关的PIM。结论 该院PIM发生率偏高,医生和药师应加大力度降低PIM比例,减少不良反应,提高用药安全,促进合理用药。
Objective To investigate the current status of potentially inappropriate medications (PIM) for elderly inpatients with mental illness in a psychiatric hospital. Methods Based on the 2017 edition of “Judgment Standards for Potentially Inappropriate Medications for the Elderly in China”, we retrospectively analyzed the PIM by investigating the clinical diagnosis and medication status of 125 elderly psychiatric inpatients in March 2021. Results Among 125 subjects, the average age was (73.31±7.87) years, and the average medication was (6.62±2.68). There were 101 patients (80.80%) had 140 items of PIM, 81 patients (64.80%) used a total of 103 items of A-level warning drugs, 33 patients (40.74%) used a total of 37 items of B-level warning drugs; there were 39 high-risk drugs(27.86%), 101 low-risk drugs (72.14%); the drugs with top three PIM incidence were olanzapine, risperidone and lorazepam; 12 patients had 4 PIMs related to the disease state. Conclusions The incidence of PIM in this hospital is relatively high. Doctors and pharmacists should be advised to increase their efforts to reduce the proportion of PIM, reduce the incidence of adverse reactions, improve medication safety, and promote rational drug usage.
论著

儿童重症肺炎支气管肺泡灌洗液病原学及疾病预后分析

Etiological analysis of bronchoalveolar lavage fluid and prognosis study in children with severe pneumonia

:53-56
 
目的 对儿童重症肺炎支气管肺泡灌洗液(BALF)进行病原学分析及疾病预后的分析。方法 本研究选取2019年3月—2020年12月在我院儿科住院并进行肺泡灌洗治疗的40例重症肺炎患儿作为研究对象。通过对这些患儿在感染急性期肺泡灌洗液中的细菌、真菌、肺炎支原体等进行病原学检查以及T 淋巴细胞亚群的检测,了解台山地区儿童重症肺炎病原体情况及耐药性、T淋巴细胞亚群与疾病严重程度、预后评估的关系。结果 BALF病原学检测结果分析中,肺炎支原体27例,肺炎支原体+肺炎链球菌5例,肺炎支原体+中间葡萄球菌2例,肺炎支原体+铅黄肠球菌1例,肺炎支原体+嗜麦芽假单胞菌2例,病原菌阴性3例;本组病例血清T细胞亚群检测结果显示:大部分病例CD3+、CD4+、CD8+及CD4+/CD8+水平有不同程度的下降。其中CD3+水平下降的有6例,CD4+水平下降的有16例,CD8+水平下降的有17例,CD4+、CD8+水平同时下降的有14例,CD3+、CD4+、CD8+水平同时下降的有4例;BALF细胞总数(3673.1±377.9)×106 /L,巨噬细胞比例(23.6±17.6)%,淋巴细胞(22.1±16.2)%,中性粒细胞(46.5±24.8)%。结论 病原学分析儿童重症肺炎BALF的主要病原菌为肺炎支原体,血清T细胞亚群检测大多表现为CD4+、CD8+水平下降。
Objective To analyze the etiology of bronchoalveolar lavage fluid and prognosis of children with severe pneumonia. Methods In this study, 40 children with severe pneumonia who were hospitalized in the pediatrics department of our hospital and underwent alveolar lavage treatment from March 2019 to December 2020 were selected as the research objects. Through the detection of pathogens such as bacteria, fungi, Mycoplasma pneumoniae and T lymphocyte subsets of these children in the acute phase of infection, we can understand the pathogens and drug resistance of children with severe pneumonia in Taishan area and the relationship among drug resistance, T lymphocyte subsets and disease severity and prognosis assessment. Results In the analysis of the BALF pathogenic test results, there were 27 cases with Mycoplasma pneumoniae, 5 cases with Mycoplasma pneumoniae+Streptococcus pneumoniae, 2 cases with Mycoplasma pneumoniae+Staphylococcus intermedius, 1 case with Mycoplasma pneumoniae+Enterococcus casseliflavus, 2 cases with Mycoplasma pneumoniae+Pseudomonas maltophilia and 3 cases were pathogenic bacteria negative. The test results of serum T cell subsets of these cases showed that most of the cases had different degrees of decline in the levels of CD3+, CD4+, CD8+ and CD4+/CD8+. Among them, CD3+ levels decreased in 6 cases, CD4+ levels decreased in 16 cases, CD8+ levels decreased in 17 cases, CD4+ and CD8+ levels decreased in 14 cases, and CD3+, CD4+, and CD8+ levels decreased in 4 cases; total cell number of BALF was (3 673.1±377.9)×106/L, the proportion of macrophages was (23.6±17.6)%, lymphocytes had (22.1±16.2)%, and neutrophils had (46.5±24.8)%. Conclusions Pathogenic analysis showed that the main pathogen of BALF in children with severe pneumonia is Mycoplasma pneumoniae, and the detection of serum T cell subsets mostly showed a decrease in CD4+ and CD8+ levels.
论著

分层应变技术评价结直肠癌患者化疗前后左心室功能的变化

Evaluation of changes in left ventricular function before and after chemotherapy by layer-specific strain analysis

:7-12
 
目的 使用分层应变技术评价以mFOLFOX6化疗的结直肠癌患者左心室功能的变化。方法 收集30例病理确诊为结直肠癌患者,各位患者均采用mFOLFOX6(5-氟尿嘧啶+奥沙利铂+亚叶酸钙)化疗方案,以自身对照做研究,分别于化疗前、化疗中期、化疗后期行心脏超声检查,获取常规参数,并采集左心室心尖四腔、三腔、两腔切面、短轴二尖瓣、乳头肌、心尖切面的三维动态图像,获取左心室的心肌心内膜下、中层、心外膜下心肌的纵向应变(GLSendo、GLSmid、GLSepi)及左心室心肌心内膜下、中层、心外膜下圆周应变(GCSendo、GCSmid、GCSepi)的数值,计算△GLS(△GLS=GLSendo-GLSepi),△GCS(△GCS=GCSendo-GCSepi),并比较这些数值的绝对值在化疗前后的变化。结果 无论化疗前还是化疗后,各层心肌均有跨壁梯度的存在。与化疗前相比:化疗后各层心肌应变参数的绝对值均降低,GLSendo和GCSendo、ΔGLS下降更为显著(P<0.05),其中,GLSendo的ROC曲线下面积为0.766,P<0.001,选25.3%为诊断界点,灵敏度为83.3%,特异度为70%;ΔGLS的ROC曲线下面积为0.749,P<0.001,选4.1%为诊断界点,灵敏度为76.7%,特异度为73.3%。结论 心肌分层应变技术有助于早期发现mFOLFOX6致结直肠癌患者左心室各层心肌功能的变化,GLSendo、ΔGLS是该技术中较为敏感的指标。
Objective To evaluate the changes of left ventricular function in patients with colorectal cancer treated with mFOLFOX6 using layer-specific strain analysis. Methods The data of 30 patients with pathologically diagnosed with colorectal cancer were collected. All patients were treated with mFOLFOX6 (5-fluorouracil+oxaliplatin+calcium leucovorin) chemotherapy. The self-control study was carried out before, during, and after chemotherapy, and cardiac ultrasound was performed to obtain conventional parameters, and three-dimensional dynamic images of the left ventricular apex four-chamber, three-chamber, two-chamber section, short-axis mitral valve, papillary muscle, and apical sectionare were acquired. The longitudinal strain of the three layer of myocardium (GLSendo、GLSmid、GLSepi) and the circumferential strain of myocardium (GCSendo、GCSmid、GCSepi) were collected, and △GLS (△GLS=GLSendo-GLSepi), △GCS (△GCS=GCSendo-GCSepi) were calculated, and the absolute values of these indexes before and after chemotherapy were compared. Results No matter before or after chemotherapy, there was a transmural gradient in each layer of myocardium. Compared with those before chemotherapy, the absolute values of myocardial strain parameters of each layer were reduced after chemotherapy, and GLSendo and GCSendo and ΔGLS decreased more significantly (P<0.05),while the area under the ROC curve of GLSendo was 0.766, P<0.001.Selecting 25.3% as the diagnostic boundary, the sensitivity was 83.3%, and the specificity was 70%.The area under the ROC curve of ΔGLS was 0.749, P<0.001. Selecting 4.1% as the diagnostic boundary, the sensitivity was 76.7%, and the specificity was 73.3%. Conclusions The myocardial layer-specific strain analysis is helpful for early detection of changes in the myocardial function of the left ventricle, which caused by mFOLFOX6 in patients with colorectal cancer. GLSendo and ΔGLS are sensitive indicators in this technique.
临床诊疗

妊娠妇女肛肠疾病的患病现状及危险因素分析

Analysis of status and risk factors of anorectal diseasesin pregnant women

:125-128
 
目的 本项目主要探究关于妊娠期妇女肛肠疾病的患病现状和危险因素分析,为减少妇女在妊娠阶段肛肠疾病的发病几率,有效预防疾病发生提供参考建议。方法 本研究主要采用现况研究,以2020年5月1日—2021年5月在本院就诊的妊娠妇女患者633例作为研究对象。采用现况调查,对研究对象进行临床检查和问卷调查。临床检查为肛肠科检查,包括肛门视诊、肛门直肠指诊检查、肛门镜检查等。问卷调查主要包括五个部分,第一部分为基础资料,包括年龄,居住地(农村/城市),学历、怀孕次数,怀孕时间,流产次数;第二部分为饮食习惯;第三部分为生活习惯和方式;第四部分为肛肠疾病患病信息;第五部分为孕产妇心理焦虑调查量表。使用SPSS、SAS统计学软件对患者数据进行分析,使用t检验和单因素方差分析检测数据之间的差异性,使用多元Logistic回归对危险因素进行分析。结果 通过对妊娠妇女进行肛肠检查,根据临床肛肠疾病诊断标准得知,633名妊娠妇女中,共有437名,患病率为69.03%;根据疾病种类进行分类得知,单纯性疾病:便秘患者156例、痔疮患者105例、肛裂患者35例、肛周脓肿患者29例、直肠脱垂24例、直肠息肉15例、直肠阴道瘘10例;合并疾病:肛裂合并痔疮43例;肛肠类癌症疾病:无;根据数据分析结果得知:633名妊娠妇女中,共有437名,患病率为69.03%;根据差异性分析,肛肠疾病患病率在不同年龄、居住地、生产次数、流产次数、饮食习惯、运动量、饮酒史、焦虑状况等因素之间有统计学差异(P<0.05),在不同学历、吸烟史、睡眠时间之间无统计学差异(P>0.05);经过采用多元Logistic回归分析,结果显示,年龄、生产次数、流产次数、食物喜好、使用水果蔬菜的频率、每日运动量、饮酒史、焦虑状况等是造成妊娠期妇女肛肠疾病发病的独立危险因素。结论 造成妊娠期妇女肛肠疾病的发病的主要影响因素为年龄、居住地、怀孕次数、孕期、流产次数、饮食习惯、运动量、焦虑状况,应该针对以上因素进行防范,有效减少发病率。
论著

失效模式与效应分析在医务人员血源性职业暴露监测分析及防护的应用

Application of failure mode and effect analysis in monitoring and protection of blood-borne occupational exposure in medical personnel

:96-99
 
目的 观察失效模式与效应分析(FMEA)在医务人员血源性职业暴露监测分析及防护的应用。方法 采用FMEA回顾性分析2018年1月—2019年6月我院医务人员血源性职业暴露高危因素,计算风险指数(RPN),优先处理最高风险因素,制定改进措施,且于2019年7月—2020年12月采用改进后方案,对照分析方案实施前后失效模式RPN值、血源性职业暴露情况、医院安全氛围量表中文版。结果 采用FMEA后,RPN、权重系数(Wi)均降低,且RPN实施前为2 633分,实施后为853分,降幅为67.60%,Wi实施前为0.729 9,实施后为0.268 0,降幅为63.28%,均达到预定目标。采用FMEA前,血源性职业暴露率为28.74%,采用FMEA后,血源性职业暴露率为4.65%。实施整改方案后的安全工作阻碍(11.99±2.16)分、清洁度和整洁度(11.48±1.89)分、管理与支持(28.58±3.24)分、冲突与沟通(22.54±2.83)分、反馈和培训(13.82±2.55)分均高于实施前(10.67±2.68)分、(10.06±2.36)分、(26.80±3.86)分、(20.85±2.62)分、(12.52±1.19)分,P<0.05。结论 在医务人员血源性职业暴露管理中采用FMEA,可以细化高风险环节,提高改进措施的针对性,减少职业暴露。
Objective To observe the application of failure mode and effect analysis (FMEA) in monitoring analysis and protection countermeasures of blood-borne occupational exposure of medical personnel. Methods FMEA was used to retrospectively analyze the high risk factors of blood-borne occupational exposure of medical staff in our hospital from January 2018 to June 2019, to calculate the risk priority number (RPN), to give priority to the highest risk factor, to formulate improvement measures. The improved scheme was adopted from July 2019 to December 2020. The RPN value of failure mode, blood-borne occupational exposure and Chinese Hospital Safety Atmosphere Scale (C-HSCS) before and after the implementating of the scheme were compared and analyzed. Results After implementating FMEA, RPN and weight coefficient (Wi) decreased, and the RPN scores were 2 633 and 853 before and after implementation, with a decrease of 67.60%, Wi was 0.729 9 before implementation and 0.268 0 after implementation, with a decrease of 63.28%. Before FMEA, the blood-borne occupational exposure rate was 28.74%, and after FMEA, the rate was 4.65%. After the implementation, the scores of safety work obstruction was (11.99±2.16), cleanliness and tidiness was (11.48±1.89), management and support was (28.58±3.24), conflict and communication was (22.54±2.83), feedback and training was (13.82±2.55), which were higher than those before the implementation: (10.67±2.68), (10.06±2.36), (26.80±3.86), (20.85±2.62), (12.52±1.19), P<0.05. Conclusions Using FMEA in the management of blood-borne occupational exposure of medical personnel could refine high-risk steps, improve the pertinence of improvement measures and reduce occupational exposure.
论著

羌活胜湿汤对风湿外感头痛患者的疗效分析

Therapeutic effect analysis of Qianghuo Shengshi decoction on patients with wind-damp headache

:65-68
 
目的 研究羌活胜湿汤对风湿外感头痛患者的疗效。方法 选择2018年1月—2020年12月我院收治的62例风湿外感头痛患者,随机分为2组。对照组服用5 mg的氟桂利嗪胶囊,每晚1次;观察组联用羌活胜湿汤。比较2组风湿外感头痛患者的有效率,治疗前后的睡眠质量评分和视觉模拟评分法(VAS)评分。结果 观察组风湿外感头痛患者的有效率(96.77%)高于对照组(80.64%) (P<0.05);治疗前,2组风湿外感头痛患者的VAS评分无差异(P>0.05),治疗后,2组风湿外感头痛患者的VAS评分降低(P<0.05),且观察组风湿外感头痛患者的VAS评分更低(P<0.05);治疗前,2组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分无差异(P>0.05),治疗后,2组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分降低(P<0.05),且观察组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分低于对照组(P<0.05)。结论 羌活胜湿汤对风湿外感头痛患者有显著的疗效,与其能明显减轻疼痛程度和改善睡眠质量有关。
Objective To investigate the effect of Qianghuo Shengshi decoction on patients with wind-damp headache. Methods A total of 62 cases of patients with wind-damp headache who were treated in our hospital from January 2018 to December 2020 were selected and divided into two groups randomly. The control group took 5 mg of flunarizine capsules once a night; the observation group took Qianghuo Shengshi decoction additionally. The effective rate, sleep quality score and visual analogue scale(VAS) score before and after treatment were compared between the two groups of patients. Results The effective rate of the observation group (96.77%) was significantly higher than that of the control group (80.64%, P<0.05). Before treatment, the VAS scores of the two groups of patients with exogenous wind-damp headache were not significantly different (P>0.05). After treatment, the VAS scores of the two groups were significantly reduced (P<0.05), and the score drop of the observation group was significant (P<0.05). Before treatment, there were no significant differences in night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition score between the two groups (P>0.05), after treatment, the scores of night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition in patients with wind-damp headache in both groups were significantly decreased (P<0.05), and the scores of night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition in patients with wind-damp headache in the observation group were significantly lower than those in the control group (P<0.05). Conclusions Qianghuo Shengshi decoction had a significant effect on patients with wind-damp headache, and its was related to its ability of significant pain reduction and sleep quality improvement.
论著

腹腔镜子宫肌瘤切除术围手术期应用抗菌药物的情况回顾性分析

Retrospective analysis of the perioperative application of antibacterial drugs during laparoscopic myomectomy

:51-55
 
目的 对腹腔镜子宫肌瘤切除术围手术期应用抗菌药物的情况进行回顾性分析,并分析腹腔镜子宫肌瘤切除术围手术期感染的影响因素。方法 选择2018年5月—2021年5月在我院行腹腔镜子宫肌瘤切除术的患者72例进行回顾性分析。收集患者一般资料及抗生素使用情况,根据有无术后感染将患者分为2组,比较2组患者上述各资料,并采用多因素分析法判断各因素对腹腔镜子宫肌瘤切除术后感染的综合作用。结果 本次纳入的72例腹腔镜子宫肌瘤切除术患者共有16例出现术后感染,术后感染率为22.22%。多因素Logistic回归分析结果显示:年龄≥50岁、手术时间≥60 min、合并糖尿病为腹腔镜子宫肌瘤切除术围手术期感染的危险因素,预防性使用抗生素、术前≤2 h抗生素使用、术后抗生素使用≤48 h为保护性因素(P<0.05)。结论 腔镜子宫肌瘤切除术患者术后感染率为22.22%,抗菌药物使用时机及使用时间对腹腔镜子宫肌瘤切除术患者术后感染有重要的影响,此外患者年龄、手术时间、合并糖尿病情况也与患者术后感染有关。
Objective To retrospectively analyze the perioperative application of antibacterial drugs during laparoscopic myomectomy, and to analyze the influencing factors of infection during the perioperative period of laparoscopic myomectomy. Methods Seventy-two patients who underwent laparoscopic myomectomy in our hospital from May 2018 to May 2021 were selected for retrospective analysis. The patients were divided into two groups according to postoperative infection status. The above data were compared between the two groups, and the comprehensive effects of various factors on postoperative infection after laparoscopic myomectomy were determined by multivariate analysis. Results There were 16 cases of 72 patients underwent laparoscopic myomectomy had postoperative infection, and the postoperative infection rate was 22.22%. Multivariate Logistic regression analysis showed that age over 50, operation time over 60 minutes, and with diabetes mellitus were the risk factors of perioperative infection in laparoscopic myomectomy. Prophylactic use of antibiotics, preoperative use of antibiotics in less than 2 hours and postoperative use of antibiotics in less than 48 hours were protective factors (P<0.05). Conclusions The infection rate of patients underwent laparoscopic myomectomy was 22.22%. The time and length of antibiotics use had important influence on postoperative infection of patients underwent laparoscopic myomectomy. In addition, age, operation time and complicated with diabetes mellitus were also related to postoperative infection.
论著

遵义地区4 604例住院新生儿TORCH感染状况分析

Analysis of TORCH infection status of 4 604 hospitalized neonates in Zunyi area

:5-8
 
目的 了解遵义地区住院新生儿TORCH感染状况、发病率,为相关疾病的早期预防和治疗提供重要参考依据。方法 采用回顾性研究方法,对遵义市妇幼保健院2018—2019年住院新生儿弓形虫(TOX)、风疹(RV)、巨细胞(CMV)和单纯疱疹病毒(HSV)Ⅰ型感染结果进行分析。结果 遵义地区4 604例住院新生儿TORCH-IgM的总体阳性率为1.35%,其中CMV、TOX、RV、HSV Ⅰ的阳性率分别是1.00%、0.20%、0.13%和0.02%;对应TORCH-IgG的阳性率分别是67.38%、0.91%,54.54%、22.22%。对2018—2019年住院新生儿TORCH感染筛查结果显示:CMV-IgM阳性率分别从1.47%下降到0.43%(χ2=4.981,P=0.026),RV-IgM的阳性率从0.24%下降到0.00(χ2=12.446,P<0.001),差异均有统计学意义。在研究的2 607例男性患儿中,CMV、TOX、RV、HSV Ⅰ的IgM阳性率率分别是0.19%、0.11%、0.96%和0.04%,其IgG的阳性率为1.07%、55.20%、67.93%和22.48%。在研究的1 997例女性患儿中,CMV、TOX、RV、HSV Ⅰ的IgM阳性率分别是0.20%、0.15%、1.05%和0.00%,其IgG的阳性率为0.70%、53.68%、66.65%和21.88%。不同CMV-IgM感染对谷丙转氨酶(ALT)和谷草转氨酶(AST)的活性影响研究中,CMV-IgM抗体阳性对照组的ALT活性高于阴性组(t=-2.793,P<0.05),AST的活性无差异(t=0.067,P>0.05) 结论 遵义地区4 604例住院新生儿中以CMV感染率相对较高,不容忽视。2018—2019年CMV和RV的新近感染率呈下降趋势。CMV-IgM的感染能引起ALT活性的升高。
Objective To reveal the TORCH infection status and incidence of hospitalized newborns in Zunyi area, and provide important reference for early prevention and treatment of related diseases. Methods The retrospective research method was used to analyze the infection results of toxoplasma gondii (TOX), rubella virus (RV), cytomegalovirus (CMV) and herpes simplx virus (HSV) type I in hospitalized newborns in Zunyi Maternal and Child Health Hospital from 2018 to 2019. Results The overall positive rate of TORCH-IgM in 4 604 hospitalized newborns in Zunyi area was 1.35%, of which the positive rates of CMV, TOX, RV, and HSV Ⅰ were 1.00%, 0.20%, 0.13% and 0.02%, respectively; the corresponding TORCH-IgG positive rates were 67.38%, 0.91%, 54.54%, 22.22%. The TORCH infection screening results of neonates hospitalized in 2018—2019 showed that the CMV-IgM positive rate decreased from 1.47% to 0.43% (χ2=4.981, P=0.026), and the RV-IgM positive rate decreased from 0.24% to 0.00 (χ2=12.446, P< 0.001), the differences were statistically significant. In 2 607 male children, the IgM positive rates of CMV, TOX, RV and HSVⅠwere 0.19%, 0.11%, 0.96% and 0.04%, respectively; and the corresponding IgG positive rates were 1.07%, 55.20%, 67.93% and 22.48%. In 1 997 female children, the IgM positive rates of CMV, TOX, RV and HSVⅠwere 0.20%, 0.15%, 1.05% and 0.00,respectively; and the corresponding IgG positive rate was 0.70%, 53.68%, 66.65% and 21.88%. In the study of effects of different CMV-IgM infection on alanine aminotransferase(ALT) and aspartate aminotransferase(AST) activity, the ALT activity of CMV-IgM positive group was significantly higher than that of negative group (t=-2.793, P<0.05), and there was no difference in AST activity between the two groups (t=0.067, P>0.05). Conclusions The CMV infection rate among 4 604 hospitalized newborns in Zunyi area was relatively high, which should not be ignored. The recent infection rates of CMV and RV showed a downward trend from 2018 to 2019. CMV-IgM infection could cause an increase in ALT activity.
论著

基于铁死亡相关的lncRNA在肺鳞癌预后的分析

Prognostic analysis based on ferroptosis related lncRNAs in lung squamous cell carcinoma

:113-120
 
目的 探究铁死亡相关的lncRNA在肺鳞状上皮细胞癌(简称肺鳞癌)患者中的预后意义。方法 从美国癌症和肿瘤基因图谱数据库(the Cancer Genome Atlas,TCGA)中下载肺鳞癌数据551例,包括49例正常对照样本和502例肺鳞癌患者样本。筛选出与铁死亡相关基因的共表达的lncRNA,使用单变量Cox回归进一步筛选lncRNA,然后,使用Lasso回归和多元Cox回归分构建铁死亡相关的lncRNA模型。建立基于模型的风险评分,并使用Cox回归测试其是否为独立的预后因素。铁死亡相关lncRNAs的功能富集使用基因本体(Gene Ontology)和京都基因和基因组百科全书(Kyoto Encyclopedia of Genes and Genomes)可视化。结果 4个预后铁死亡相关的lncRNA(AC253536.6,FLJ46906LUCAT,AC022150.2)显著不同,这构建了铁死亡相关的lncRNA模型。此模型将肺鳞癌患者分为低风险组和高风险组。基于模型的风险评分是肺鳞癌患者的显著独立因素(HR =2.116,95%CI=1.513~2.961;P<0.001)。此外,4个lncRNA在铁死亡过程,代谢和肿瘤经典途径中均显著富集。结论 4个铁死亡相关的lncRNAs可能是肺鳞癌患者的分子生物标志物和治疗靶标。
Objective To explore the prognostic significance of ferroptosis related lncRNAs in patients with lung squamous cell carcinoma. Methods Data of 551 lung squamous cell carcinoma cases was downloaded from the Cancer Genome Atlas (TCGA) of the United States, including 49 normal control samples and 502 lung squamous cell carcinoma samples. The lncRNAs co-expressed with genes related to ferroptosis was screened out. Univariate Cox regression was used to further screen out the lncRNAs. Then, Lasso regression and multiple Cox regression were used to construct lncRNA models related to ferroptosis. A model-based risk score system was established and Cox regression was used to test whether it was an independent prognostic factor. The functional enrichment of ferroptosis related lncRNAs were visualized using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes. Results The four prognostic ferroptosis related lncRNAs (AC253536.6, FLJ46906 LUCAT, AC022150.2) were significantly different, and the ferroptosis lncRNAs model was constrncted with them. This model divided lung squamous cell carcinoma patients into low-risk group and high-risk group. The model-based risk score was a significant independent factor for patients with lung squamous cell carcinoma (HR=2.116, 95% CI=1.513-2.961; P<0.001). In addition, the four lncRNAs were significantly enriched in metabolism and tumor classical pathways during the ferroptosis process. Conclusions The four ferroptosis lncRNAs could be molecular biomarkers and therapeutic targets for patients with lung squamous cell carcinoma.
论著

自适应调强放疗同步铂类化疗治疗局部晚期宫颈癌患者的可行性分析

Feasibility analysis of adaptive intensity modulated radiotherapy combined with platinum-based chemotherapy in the treatment of local advanced cervical cancer

:93-96
 
目的 研究自适应调强放疗(ART)同步铂类化疗治疗局部晚期宫颈癌患者的可行性。方法 选取我院诊治的92例局部晚期宫颈癌患者,随机分为研究组与对照组各46例,其中对照组行调强放疗(IMRT)同步铂类化疗,研究组行ART同步铂类化疗。治疗8周后,比较2组患者临床疗效;于治疗前后比较2组患者肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)]水平;以急性放射损伤分级标准(RTOG)和常见不良反应事件评价标准(CTCAE)比较2组患者不良反应发生情况。结果 治疗8周后,研究组客观缓解率高于对照组(P<0.05);2组患者CEA、SCC-Ag水平均较治疗前降低,且研究组低于对照组 (P<0.05);研究组基于RTOG的消化道反应等级与泌尿系统反应等级均低于对照组(P<0.05);2组患者基于CTCAE的肝功能损害与皮疹评级相比,差异无统计学意义(P>0.05)。结论 ART同步铂类化疗治疗局部晚期宫颈癌患者疗效较好,使患者病情好转,同时安全性突出,切实可行。
Objective To study the feasibility of adaptive radiotherapy (ART) combined with platinum chemotherapy in the treatment of locally advanced cervical cancer. Methods A total of 92 patients with locally advanced cervical cancer treated in our hospital were randomly divided into study group and control group, with 46 cases in each group. The control group received intensity-modulated radiation therapy (IMRT) combined with platinum chemotherapy and the study group received ART combined with platinum chemotherapy. After 8 weeks of treatment, the clinical effects of the two groups were compared. The levels of tumor markers [carcinoembryonic antigen (CEA) and squamous cell carcinoma associated antigen (SCC-Ag)] were compared between the two groups before and after treatment. The incidence of adverse reactions in the two groups was compared with the grading standard of Acute Radiation Injury Group (RTOG) and Common Terminology Criteria for Adverse Events (CTCAE). Results After 8 weeks of treatment, the Objective remission rate in the study group was higher than that in the control group (P<0.05). The levels of CEA and SCC-Ag in the study group were significantly lower than those in the control group (P<0.05). The reaction grades of digestive tract and urinary system based on RTOG in the study group were significantly lower than those in the control group (P<0.05). There was no significant difference in CTCAE based liver function impairment and rash rating between the two groups (P> 0.05). Conclusions ART combined with platinum chemotherapy is effective and safe in the treatment of locally advanced cervical cancer.
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