目的研究胃肠道恶性肿瘤患者术前营养状况以及营养不良发生的相关因素。方法选取2016年8月至2017年11月在武汉同济医院胃肠外科住院拟行手术治疗的胃肠道恶性肿瘤患者202例,入院后采用主观综合营养评估(subjective global assessment,S...目的研究胃肠道恶性肿瘤患者术前营养状况以及营养不良发生的相关因素。方法选取2016年8月至2017年11月在武汉同济医院胃肠外科住院拟行手术治疗的胃肠道恶性肿瘤患者202例,入院后采用主观综合营养评估(subjective global assessment,SGA)法评估营养状况,记录入院时体重指数(body mass index,BMI)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NRL)、营养指标(血红蛋白、白蛋白、前白蛋白)、血清肿瘤标志物(CA199、CA724、CEA)和肿瘤部位、TNM分期、分化程度。采用多元回归分析营养不良的相关因素。结果 202例患者中,SGA法评定营养不良发生率为46%。多因素回归分析显示,在矫正年龄、性别、NRL、CA199、CA724、TNM分期和肿瘤分化程度等因素后,肿瘤部位和CEA是营养不良的独立相关因素。与远端胃、左半结肠、乙状结肠和直肠的恶性肿瘤患者相比,近端胃和右半结肠恶性肿瘤患者的营养不良发生风险增高(OR=2.51,95%CI 1.25~5.03,P=0.009);与CEA<10ng/ml的患者相比,CEA≥10ng/ml的患者营养不良发生风险增高(OR=12.50,95%CI 2.66~58.63,P=0.001)。结论肿瘤部位和CEA水平是胃肠道恶性肿瘤患者营养状态的独立相关因素,对于肿瘤位于近端胃和右半结肠以及CEA≥10ng/ml的消化道肿瘤患者,其营养状况应引起临床医护人员更多的关注。展开更多
目的探讨患者主观整体评估量表(patient-generated subjective global assessment,PG-SGA)和术前人体体成分测量在胃肠道肿瘤患者中的应用及其与术后低白蛋白血症的关系。方法回顾性收集华中科技大学同济医学院附属同济医院2017年1—6...目的探讨患者主观整体评估量表(patient-generated subjective global assessment,PG-SGA)和术前人体体成分测量在胃肠道肿瘤患者中的应用及其与术后低白蛋白血症的关系。方法回顾性收集华中科技大学同济医学院附属同济医院2017年1—6月术前进行过人体体成分测量和PG-SGA评价的67例胃肠道新发肿瘤患者的病例资料。检测指标包括机体蛋白质含量、去脂体重、体脂含量、骨骼肌质量、上臂围、上臂肌围、体细胞量、相位角等,并计算体重指数、脂肪质量指数、去脂体重指数、骨骼肌指数。结果根据PG-SGA评价,51例(76.12%)患者被评为营养不良,其中31例(46.27%)为可疑和中度营养不良,20例(29.85%)为重度营养不良。男性重度营养不良组患者体脂百分比和脂肪质量指数均较营养良好组显著下降(P<0.05),女性患者两组差异无显著性(P>0.05)。而女性可疑和中度营养不良组、重度营养不良组患者上臂肌围、去脂体重指数、骨骼肌指数、机体蛋白质含量和体细胞量均较营养良好组显著下降(P<0.05),男性患者差异无显著性(P>0.05)。此外,女性重度营养不良组患者的相位角值较营养良好组显著下降(P<0.05),男性患者差异无显著性(P>0.05)。营养不良组患者术后低白蛋白血症的发生率高于营养良好组(P<0.05)。Logistic回归分析显示,营养不良可显著增加低白蛋白血症发生率(OR=4.82,95%CI 1.34～17.30),而相位角可显著降低低白蛋白血症发生率(OR=0.109,95%CI 0.02～0.65)。结论消化道肿瘤患者营养不良发生率高。从体成分构成来看,营养不良的男性体脂肪相关指标下降显著,而营养不良的女性瘦体组织相关指标下降显著。营养不良和低相位角可增加患者术后低白蛋白血症的风险。展开更多
Interactions of vascular endothelial growth factor （VEGF） with receptors VEGFR1/Fltl and VEGFR2/Flk1, and those of angiopoietins （Ang-1, Ang-2） with receptor Tie2 play important roles in placental angiogenesis. Th...Interactions of vascular endothelial growth factor （VEGF） with receptors VEGFR1/Fltl and VEGFR2/Flk1, and those of angiopoietins （Ang-1, Ang-2） with receptor Tie2 play important roles in placental angiogenesis. This study investigated vascular morphology and expression of these angiogenic factors in rat placenta on the day 15, 18, 21 of gestation （D 15, D 18 and D21）. The rats were randomly assigned into 3 groups： normal group, model group [fetal growth restriction （FGR） model], and Bushen Tqi Huoxue （BYHR） recipe treatment group （BYHR group, the pregnant rats with FGR were treated with BYHR recipe）. Morphological analysis indicated that during initial villous formation, fetal nucle- ated erythrocytes （FNEs） appeared in maternal blood sinus （MBS）. Subsequently, FNEs were sur- rounded by endothelial cells to form fetal capillary （FC） and then by trophoblast cells to form villi. As pregnancy proceeded, FC density increased progressively with increasing endothelial identification staining （EIS） in normal and BYHR groups. Whereas, villous formation was suppressed, normal in- crease in FC density was impaired and EIS was weakened in model group. Quantitative PCR analysis showed that VEGF and Flkl mRNA increased over gestation in all groups, indicating that VEGF might play a pivotal role in FC growth during late gestation. VEGF mRNA was increased on D15, while de- creased on D21 in model group as compared with normal group and BYHR group. Immunohistochemi- cally, Ang-2 protein was highly expressed in FNEs, gradually disappeared as villi matured, and decreased over gestation in all groups, indicating that Ang-2 might play a pivotal role in villous formation, which was further supported by decreased Ang-2 mRNA and protein expression in model group on D 15. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio increased from D15 to D18 in all groups as placenta matured. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio were decreased on D18 in model group as compared with normal and BYHR groups, indicating delayed maturity of FGR placenta. Alterations in angiogenic factors may result in altered placental vasculature and cause placental insufficiency. BYHR recipe could balance the angiogenic factors to promote the formation and maturation of FGR placental vasculature.展开更多
文摘目的研究胃肠道恶性肿瘤患者术前营养状况以及营养不良发生的相关因素。方法选取2016年8月至2017年11月在武汉同济医院胃肠外科住院拟行手术治疗的胃肠道恶性肿瘤患者202例,入院后采用主观综合营养评估(subjective global assessment,SGA)法评估营养状况,记录入院时体重指数(body mass index,BMI)、中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NRL)、营养指标(血红蛋白、白蛋白、前白蛋白)、血清肿瘤标志物(CA199、CA724、CEA)和肿瘤部位、TNM分期、分化程度。采用多元回归分析营养不良的相关因素。结果 202例患者中,SGA法评定营养不良发生率为46%。多因素回归分析显示,在矫正年龄、性别、NRL、CA199、CA724、TNM分期和肿瘤分化程度等因素后,肿瘤部位和CEA是营养不良的独立相关因素。与远端胃、左半结肠、乙状结肠和直肠的恶性肿瘤患者相比,近端胃和右半结肠恶性肿瘤患者的营养不良发生风险增高(OR=2.51,95%CI 1.25~5.03,P=0.009);与CEA<10ng/ml的患者相比,CEA≥10ng/ml的患者营养不良发生风险增高(OR=12.50,95%CI 2.66~58.63,P=0.001)。结论肿瘤部位和CEA水平是胃肠道恶性肿瘤患者营养状态的独立相关因素,对于肿瘤位于近端胃和右半结肠以及CEA≥10ng/ml的消化道肿瘤患者,其营养状况应引起临床医护人员更多的关注。
基金supported by the National Natural Science Foundation of China(No.30973833)
文摘Interactions of vascular endothelial growth factor （VEGF） with receptors VEGFR1/Fltl and VEGFR2/Flk1, and those of angiopoietins （Ang-1, Ang-2） with receptor Tie2 play important roles in placental angiogenesis. This study investigated vascular morphology and expression of these angiogenic factors in rat placenta on the day 15, 18, 21 of gestation （D 15, D 18 and D21）. The rats were randomly assigned into 3 groups： normal group, model group [fetal growth restriction （FGR） model], and Bushen Tqi Huoxue （BYHR） recipe treatment group （BYHR group, the pregnant rats with FGR were treated with BYHR recipe）. Morphological analysis indicated that during initial villous formation, fetal nucle- ated erythrocytes （FNEs） appeared in maternal blood sinus （MBS）. Subsequently, FNEs were sur- rounded by endothelial cells to form fetal capillary （FC） and then by trophoblast cells to form villi. As pregnancy proceeded, FC density increased progressively with increasing endothelial identification staining （EIS） in normal and BYHR groups. Whereas, villous formation was suppressed, normal in- crease in FC density was impaired and EIS was weakened in model group. Quantitative PCR analysis showed that VEGF and Flkl mRNA increased over gestation in all groups, indicating that VEGF might play a pivotal role in FC growth during late gestation. VEGF mRNA was increased on D15, while de- creased on D21 in model group as compared with normal group and BYHR group. Immunohistochemi- cally, Ang-2 protein was highly expressed in FNEs, gradually disappeared as villi matured, and decreased over gestation in all groups, indicating that Ang-2 might play a pivotal role in villous formation, which was further supported by decreased Ang-2 mRNA and protein expression in model group on D 15. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio increased from D15 to D18 in all groups as placenta matured. Ang-1 mRNA, Tie2 mRNA and Ang-1/Ang-2 ratio were decreased on D18 in model group as compared with normal and BYHR groups, indicating delayed maturity of FGR placenta. Alterations in angiogenic factors may result in altered placental vasculature and cause placental insufficiency. BYHR recipe could balance the angiogenic factors to promote the formation and maturation of FGR placental vasculature.
