背景与目的对以利妥昔单抗为基础的免疫化疗耐药的弥漫性大B细胞淋巴瘤(diffuse large B-celllymphoma,DLBCL)的患者预后较差。目前难治性DLBCL的定义仍存在争议,并缺少亚洲国家大样本队列研究的数据。为确定中国难治性DLBCL的定义及疾...背景与目的对以利妥昔单抗为基础的免疫化疗耐药的弥漫性大B细胞淋巴瘤(diffuse large B-celllymphoma,DLBCL)的患者预后较差。目前难治性DLBCL的定义仍存在争议,并缺少亚洲国家大样本队列研究的数据。为确定中国难治性DLBCL的定义及疾病结局,我们开展了这项多中心回顾性队列研究。方法利用来自中国8个中心的真实世界数据,进行了难治性DLBCL治疗反应的回顾性分析(REtrospective AnaLysis of Treatment REspoNse of refractory DLBCL,REAL-TREND)。接受根治性化疗的DLBCL患者被纳入REAL-TREND数据集。用Kaplan-Meier法估计患者总生存(overallsurvival,OS),并用log-rank检验进行组间比较。由于不同研究中心之间的治疗缓解率存在差异,用随机效应模型对难治性患者的缓解率进行了汇总分析。用Cox回归模型进行多因素生存分析。结果2010年1月至2015年12月间确诊的、共2778例DLBCL患者被纳入本研究。对之前文献报道的定义进行验证后,SCHOLAR-1研究的定义适合界定难治性DLBCL。难治性患者的估计5年累积发生率为20%[95%置信区间(confidence interval,CI):18%–22%]。确定为难治性疾病后,总缓解率及完全缓解率分别为30%(95%CI:22%–38%)和9%(95%CI:4%–15%)。对免疫化疗无反应或干细胞移植后12个月以内复发的患者生存较差,中位OS为5.9个月(95%CI:5.5–7.1),2年OS率为16%(95%CI:12%–20%)。独立的不良预后因素包括国际预后评分4–5[风险比(hazard ratio,HR)=2.22;95%CI:1.47–3.35]、中枢神经系统复发(HR=1.43;95%CI:1.04–1.97)及最佳缓解状态(部分缓解,HR=2.68,95%CI:1.42–5.03;疾病稳定/疾病进展,HR=5.97,95%CI:3.21–11.11)。结论本研究是针对难治性DLBCL的第一个大样本亚洲队列研究。证实SCHOLAR-1研究中的难治性DLBCL定义筛选出的患者,预后最差,因此适用于作为难治性DLBCL的筛选标准。由于在利妥昔单抗时代的临床治疗结局较差,难治性DLBCL患者仍需新的治疗策略。展开更多
Background Elevated resting heart rate and hypertension independently increase the risk of mortality. However, their combined ef- fect on mortality in stages of hypertension according to updated clinical guidelines am...Background Elevated resting heart rate and hypertension independently increase the risk of mortality. However, their combined ef- fect on mortality in stages of hypertension according to updated clinical guidelines among dderly population is unclear. Methods We fol- lowed a cohort of 6100 residents （2600 males and 3500 females） of Kangwha County, Korea, ranging from 55 to 99 year-olds as of March 1985, for all-cause and cardiovascular mortality for 20.8 years until December 31, 2005. Mortality data were collected through telephone calls and visits （to 1991）, and were confirmed by death record matching with the National Statistical Office （1992-2005）. Hazard ratios were calculated for all-cause and cardiovascular mortality by resting heart rate and hypertension defined by Eighth Joint National Committee crite- ria using the Cox proportional hazard model after controlling for confounding factors. Results The hazard ratios associated with resting heart rate 〉 80 beats/min were higher in hypertensive men compared with normotensives with heart rate of 61-79 beats/rain, with hazard ratios values of 1.43 （95% CI： 1.00-1.92） on all-cause mortality for prehypertension, 3.01 （95% CI： 1.07-8.28） on cardiovascular mortality for prehypertension, and 8.34 （95% CI： 2.52-28.19） for stage 2 hypertension. Increased risk （HR： 3.54, 95% CI： 1.16-9.21） was observed among those with both a resting heart rate 〉 80 beats/rain and prehypertension on cardiovascular mortality in women. Conclusions Indi- viduals with coexisting elevated resting heart rate and hypertension, even in prehypertension, have a greater risk for all-cause and cardiovas- cular mortality compared to those with elevated resting heart rate or hypertension alone. These findings suggest that elevated resting heart rate should not be regarded as a less serious risk factor in elderly hypertensive patients.展开更多
Objective The predictive value of the metabolic syndrome （MetS） for mortality from all-cause and cardiovascular disease （CVD） in the Chinese population is unclear. The aim of this present study was to compare MetS...Objective The predictive value of the metabolic syndrome （MetS） for mortality from all-cause and cardiovascular disease （CVD） in the Chinese population is unclear. The aim of this present study was to compare MetS with its individual components as predictors of mortality in Chinese elderly adults. Methods A cohort of 1,535 subjects （994 men and 541 women） aged 50 years or older was selected from employees of a machinery factory in 1994 and followed until 2009. Cox models were used to estimate the hazard ratios （HRs） predicted by MetS according to the harmonized defmition and by its individual components. Results The baseline prevalence of MetS was 28.0% in men and 48.4% in women. During a median follow-up of 15 years, 414 deaths occurred, of these, 153 participants died from CVD. Adjusted for age and gender, the HRs of mortality from all-cause and CVD in participants with MetS were 1.47 （95% confidence interval （CI）： 1.20-1.80） and 1.96 （95%CI： 1.42-2.72）, respectively, compared with those without MetS. Non-significant higher risk of CVD mortality was seen in those with one or two individual components （HR = 1.22, 95%CI： 0.59-2.50; fir = 1.82, 95%CI： 0.91-3.64, respectively）, while a substantially higher risk of CVD mortality only appeared in those with 3, 4, or 5 components （H_R = 2.81-3.72）, compared with those with no components. On evaluating the MetS components individually, we found that, independent of MetS, only hypertension and impaired glucose predicted higher mortality. Conclusions The number of positive MetS components seems no more informative than classifying （dichotomous） MetS for CVD risks assessment in this Chinese cohort.展开更多
文摘背景与目的对以利妥昔单抗为基础的免疫化疗耐药的弥漫性大B细胞淋巴瘤(diffuse large B-celllymphoma,DLBCL)的患者预后较差。目前难治性DLBCL的定义仍存在争议,并缺少亚洲国家大样本队列研究的数据。为确定中国难治性DLBCL的定义及疾病结局,我们开展了这项多中心回顾性队列研究。方法利用来自中国8个中心的真实世界数据,进行了难治性DLBCL治疗反应的回顾性分析(REtrospective AnaLysis of Treatment REspoNse of refractory DLBCL,REAL-TREND)。接受根治性化疗的DLBCL患者被纳入REAL-TREND数据集。用Kaplan-Meier法估计患者总生存(overallsurvival,OS),并用log-rank检验进行组间比较。由于不同研究中心之间的治疗缓解率存在差异,用随机效应模型对难治性患者的缓解率进行了汇总分析。用Cox回归模型进行多因素生存分析。结果2010年1月至2015年12月间确诊的、共2778例DLBCL患者被纳入本研究。对之前文献报道的定义进行验证后,SCHOLAR-1研究的定义适合界定难治性DLBCL。难治性患者的估计5年累积发生率为20%[95%置信区间(confidence interval,CI):18%–22%]。确定为难治性疾病后,总缓解率及完全缓解率分别为30%(95%CI:22%–38%)和9%(95%CI:4%–15%)。对免疫化疗无反应或干细胞移植后12个月以内复发的患者生存较差,中位OS为5.9个月(95%CI:5.5–7.1),2年OS率为16%(95%CI:12%–20%)。独立的不良预后因素包括国际预后评分4–5[风险比(hazard ratio,HR)=2.22;95%CI:1.47–3.35]、中枢神经系统复发(HR=1.43;95%CI:1.04–1.97)及最佳缓解状态(部分缓解,HR=2.68,95%CI:1.42–5.03;疾病稳定/疾病进展,HR=5.97,95%CI:3.21–11.11)。结论本研究是针对难治性DLBCL的第一个大样本亚洲队列研究。证实SCHOLAR-1研究中的难治性DLBCL定义筛选出的患者,预后最差,因此适用于作为难治性DLBCL的筛选标准。由于在利妥昔单抗时代的临床治疗结局较差,难治性DLBCL患者仍需新的治疗策略。
基金国家自然科学基金(the National Natural Science Foundation of China under Grant No.60362001)云南省教育厅资助科研课题(the research Project of Department of Education of Yunnan rovinceChina under Grant No.5Y0542D)
文摘Background Elevated resting heart rate and hypertension independently increase the risk of mortality. However, their combined ef- fect on mortality in stages of hypertension according to updated clinical guidelines among dderly population is unclear. Methods We fol- lowed a cohort of 6100 residents （2600 males and 3500 females） of Kangwha County, Korea, ranging from 55 to 99 year-olds as of March 1985, for all-cause and cardiovascular mortality for 20.8 years until December 31, 2005. Mortality data were collected through telephone calls and visits （to 1991）, and were confirmed by death record matching with the National Statistical Office （1992-2005）. Hazard ratios were calculated for all-cause and cardiovascular mortality by resting heart rate and hypertension defined by Eighth Joint National Committee crite- ria using the Cox proportional hazard model after controlling for confounding factors. Results The hazard ratios associated with resting heart rate 〉 80 beats/min were higher in hypertensive men compared with normotensives with heart rate of 61-79 beats/rain, with hazard ratios values of 1.43 （95% CI： 1.00-1.92） on all-cause mortality for prehypertension, 3.01 （95% CI： 1.07-8.28） on cardiovascular mortality for prehypertension, and 8.34 （95% CI： 2.52-28.19） for stage 2 hypertension. Increased risk （HR： 3.54, 95% CI： 1.16-9.21） was observed among those with both a resting heart rate 〉 80 beats/rain and prehypertension on cardiovascular mortality in women. Conclusions Indi- viduals with coexisting elevated resting heart rate and hypertension, even in prehypertension, have a greater risk for all-cause and cardiovas- cular mortality compared to those with elevated resting heart rate or hypertension alone. These findings suggest that elevated resting heart rate should not be regarded as a less serious risk factor in elderly hypertensive patients.
基金This study was supported by the National Natural Science Foundation of China，Ministry of Science and Technology of China，National Department Public Benefit Research Foundation by Ministry of Health of China
文摘Objective The predictive value of the metabolic syndrome （MetS） for mortality from all-cause and cardiovascular disease （CVD） in the Chinese population is unclear. The aim of this present study was to compare MetS with its individual components as predictors of mortality in Chinese elderly adults. Methods A cohort of 1,535 subjects （994 men and 541 women） aged 50 years or older was selected from employees of a machinery factory in 1994 and followed until 2009. Cox models were used to estimate the hazard ratios （HRs） predicted by MetS according to the harmonized defmition and by its individual components. Results The baseline prevalence of MetS was 28.0% in men and 48.4% in women. During a median follow-up of 15 years, 414 deaths occurred, of these, 153 participants died from CVD. Adjusted for age and gender, the HRs of mortality from all-cause and CVD in participants with MetS were 1.47 （95% confidence interval （CI）： 1.20-1.80） and 1.96 （95%CI： 1.42-2.72）, respectively, compared with those without MetS. Non-significant higher risk of CVD mortality was seen in those with one or two individual components （HR = 1.22, 95%CI： 0.59-2.50; fir = 1.82, 95%CI： 0.91-3.64, respectively）, while a substantially higher risk of CVD mortality only appeared in those with 3, 4, or 5 components （H_R = 2.81-3.72）, compared with those with no components. On evaluating the MetS components individually, we found that, independent of MetS, only hypertension and impaired glucose predicted higher mortality. Conclusions The number of positive MetS components seems no more informative than classifying （dichotomous） MetS for CVD risks assessment in this Chinese cohort.
