To compare the long-term prognostic value of troponins (Tn) vs. conventional cardiac biomarker creatine kinase (CK) and CK-MB across the spectrum of acute coronary syndromes(ACS). In the prospective, observational Can...To compare the long-term prognostic value of troponins (Tn) vs. conventional cardiac biomarker creatine kinase (CK) and CK-MB across the spectrum of acute coronary syndromes(ACS). In the prospective, observational Canadian ACS Registry, 4627 patients with ACS were enrolled from 51 centres. The CK, CK-MB, Tn samples were analysed in each hospital clinical laboratory and the results related to the reference levels of the individual laboratories. The study cohort comprised 3138 (67.8%) patients who had both CK (or CK-MB) and Tn measurements during the first 24 h of hospitalisation. Vital status at one-year was determined by standardized telephone interview. 61.2%and 59.0%of patients had abnormal Tn and CK(or CK-MB) levels, respectively. Vital status at one-year was ascertained for 2950 patients(6%lost to follow-up). Among patients with normal CK (or CK-MB) levels, elevated Tn was associated with increased one-year mortality (odds ratio[OR]-2.06; 95%CI 1.37-3.11; P=0.001). Similarly, among patients with abnormal CK (or CK-MB) levels, abnormal Tn predicted higher one-year mortality(OR 1.83; 95%CI 1.14-2.93; P=0.01). In contrast, abnormal CK(or CK-MB) was not predictive of mortality after stratification by Tn status. In multivariable analysis controlling for other known prognosticators including creatinine, abnormal Tn (adjusted OR 1.78; 95%CI 1.30-2.44; P< 0.001) but not CK/CK-MB was independently associated with increased one-year mortality. Elevated Tn was independently associated with worse outcome at one-year, while CK or CK-MB status did not provide incremental prognostic information. Our findings support the use of Tn in the risk stratification of unselected ACS patients.展开更多
目的:了解2021年重庆市宫颈癌发病率、死亡率与五年生存率,为开展恶性肿瘤防治提供依据。方法:收集整理2021年重庆市新发宫颈癌发病死亡数据,分析2021年重庆市宫颈癌发病率、标化发病率、死亡率、标化死亡率、年龄别发病率与死亡率。中...目的:了解2021年重庆市宫颈癌发病率、死亡率与五年生存率,为开展恶性肿瘤防治提供依据。方法:收集整理2021年重庆市新发宫颈癌发病死亡数据,分析2021年重庆市宫颈癌发病率、标化发病率、死亡率、标化死亡率、年龄别发病率与死亡率。中国人口标化率采用2000年第五次人口普查标准人口构成进行标化,世界人口标化率采用2000年世界人口构成进行标化。不同性别和地区率的比较采用χ^(2)检验。对2016年新报告的宫颈癌病例进行主动和被动生存随访,采用生存分析寿命表法计算观察生存率,采用乘积极限法(Kaplan-Meier)计算平均生存时间,生存率的比较采用Log Rank of Mantel-Cox进行统计检验。结果:2021年重庆市宫颈癌发病率、中国标化发病率、世界标化发病率分别为21.60/10万、14.64/10万与14.71/10万,宫颈癌发病率农村(23.32/10万)高于城市(17.67/10万)(χ^(2)=6.96,P<0.01)。宫颈癌死亡率、中国标化死亡率、世界标化死亡率分别为5.00/10万、2.79/10万与3.02/10万,宫颈癌死亡率农村(5.65/10万)高于城市(3.53/10万)(χ^(2)=5.42,P=0.02)。2021年重庆市宫颈癌五年生存率为64.32%,城市地区宫颈癌五年生存率(76.35%)高于农村地区(59.79%),差异有统计学意义(χ^(2)=46.65,P<0.01)。结论:重庆市宫颈癌发病率与死亡率高,五年生存率较低,应重视宫颈癌的防治。展开更多
目的进一步探讨透析前慢性肾脏病(chronic kidney disease,CKD)管理是否在血液透析后具有“长期效应”,为更好的推动C K D管理从经济学以及人口学角度贡献力量。方法纳入2015年3月一2018年3月在江苏大学附属医院CKD管理门诊随诊并进入...目的进一步探讨透析前慢性肾脏病(chronic kidney disease,CKD)管理是否在血液透析后具有“长期效应”,为更好的推动C K D管理从经济学以及人口学角度贡献力量。方法纳入2015年3月一2018年3月在江苏大学附属医院CKD管理门诊随诊并进入透析的70例患者(管理组),及同时期从肾脏内科专科门诊进入透析的142例患者(非管理组),随访5年,比较2组患者透析启动时以及透析后1年内的住院情况及费用,以及透析后1年、5年的死亡情况,并分析各种因素对患者全因死亡的影响。结果启动透析时管理组人均总住院费用少于非管理组(t=-3.100,P=0.002)。透析后1年内管理组的人均总住院费用少于非管理(t=-2.269,P=0.024),主要归因于药品、检验、治疗、手术及输血费用的减少。在透析启动时以及透析开始后1年内,多元线性回归发现不管是未调整、根据年龄和性别进行调整、根据合并症进行调整、根据进入血液透析时的基线实验室指标进行调整还是根据启动血液透析时的血管通路情况进行调整,C K D管理与住院人均总费用的降低独立相关(透析启动时β=0.386、0.392、0.392、0.359、0.248,P分别<0.001、<0.001、<0.001、<0.001、0.018;透析1年内β=0.151、0.154、0.148、0.168、0.343,P=0.028、0.025、0.038、0.021、0.002)。Kaplan-Meier分析显示管理组透析5年的累积生存率差异有统计学意义(χ^(2)=3.947,P=0.047)。多因素分析结果显示年龄(HR=1.042,95%CI:1.021~1.062,P<0.001)和合并糖尿病(HR=0.390,95%CI:0.226~0.671,P=0.001)是患者全因死亡的独立危险因素,而透析前CKD管理则是患者全因死亡的保护性因素(HR=0.503,95%CI:0.295~0.857,P=0.012)。结论透析前C K D管理对透析后经济结果有遗留影响,能改善维持性血液透析患者的长期预后,在管理工作中尤其要关注糖尿病及老年患者。展开更多
文摘To compare the long-term prognostic value of troponins (Tn) vs. conventional cardiac biomarker creatine kinase (CK) and CK-MB across the spectrum of acute coronary syndromes(ACS). In the prospective, observational Canadian ACS Registry, 4627 patients with ACS were enrolled from 51 centres. The CK, CK-MB, Tn samples were analysed in each hospital clinical laboratory and the results related to the reference levels of the individual laboratories. The study cohort comprised 3138 (67.8%) patients who had both CK (or CK-MB) and Tn measurements during the first 24 h of hospitalisation. Vital status at one-year was determined by standardized telephone interview. 61.2%and 59.0%of patients had abnormal Tn and CK(or CK-MB) levels, respectively. Vital status at one-year was ascertained for 2950 patients(6%lost to follow-up). Among patients with normal CK (or CK-MB) levels, elevated Tn was associated with increased one-year mortality (odds ratio[OR]-2.06; 95%CI 1.37-3.11; P=0.001). Similarly, among patients with abnormal CK (or CK-MB) levels, abnormal Tn predicted higher one-year mortality(OR 1.83; 95%CI 1.14-2.93; P=0.01). In contrast, abnormal CK(or CK-MB) was not predictive of mortality after stratification by Tn status. In multivariable analysis controlling for other known prognosticators including creatinine, abnormal Tn (adjusted OR 1.78; 95%CI 1.30-2.44; P< 0.001) but not CK/CK-MB was independently associated with increased one-year mortality. Elevated Tn was independently associated with worse outcome at one-year, while CK or CK-MB status did not provide incremental prognostic information. Our findings support the use of Tn in the risk stratification of unselected ACS patients.
文摘目的:了解2021年重庆市宫颈癌发病率、死亡率与五年生存率,为开展恶性肿瘤防治提供依据。方法:收集整理2021年重庆市新发宫颈癌发病死亡数据,分析2021年重庆市宫颈癌发病率、标化发病率、死亡率、标化死亡率、年龄别发病率与死亡率。中国人口标化率采用2000年第五次人口普查标准人口构成进行标化,世界人口标化率采用2000年世界人口构成进行标化。不同性别和地区率的比较采用χ^(2)检验。对2016年新报告的宫颈癌病例进行主动和被动生存随访,采用生存分析寿命表法计算观察生存率,采用乘积极限法(Kaplan-Meier)计算平均生存时间,生存率的比较采用Log Rank of Mantel-Cox进行统计检验。结果:2021年重庆市宫颈癌发病率、中国标化发病率、世界标化发病率分别为21.60/10万、14.64/10万与14.71/10万,宫颈癌发病率农村(23.32/10万)高于城市(17.67/10万)(χ^(2)=6.96,P<0.01)。宫颈癌死亡率、中国标化死亡率、世界标化死亡率分别为5.00/10万、2.79/10万与3.02/10万,宫颈癌死亡率农村(5.65/10万)高于城市(3.53/10万)(χ^(2)=5.42,P=0.02)。2021年重庆市宫颈癌五年生存率为64.32%,城市地区宫颈癌五年生存率(76.35%)高于农村地区(59.79%),差异有统计学意义(χ^(2)=46.65,P<0.01)。结论:重庆市宫颈癌发病率与死亡率高,五年生存率较低,应重视宫颈癌的防治。
文摘目的进一步探讨透析前慢性肾脏病(chronic kidney disease,CKD)管理是否在血液透析后具有“长期效应”,为更好的推动C K D管理从经济学以及人口学角度贡献力量。方法纳入2015年3月一2018年3月在江苏大学附属医院CKD管理门诊随诊并进入透析的70例患者(管理组),及同时期从肾脏内科专科门诊进入透析的142例患者(非管理组),随访5年,比较2组患者透析启动时以及透析后1年内的住院情况及费用,以及透析后1年、5年的死亡情况,并分析各种因素对患者全因死亡的影响。结果启动透析时管理组人均总住院费用少于非管理组(t=-3.100,P=0.002)。透析后1年内管理组的人均总住院费用少于非管理(t=-2.269,P=0.024),主要归因于药品、检验、治疗、手术及输血费用的减少。在透析启动时以及透析开始后1年内,多元线性回归发现不管是未调整、根据年龄和性别进行调整、根据合并症进行调整、根据进入血液透析时的基线实验室指标进行调整还是根据启动血液透析时的血管通路情况进行调整,C K D管理与住院人均总费用的降低独立相关(透析启动时β=0.386、0.392、0.392、0.359、0.248,P分别<0.001、<0.001、<0.001、<0.001、0.018;透析1年内β=0.151、0.154、0.148、0.168、0.343,P=0.028、0.025、0.038、0.021、0.002)。Kaplan-Meier分析显示管理组透析5年的累积生存率差异有统计学意义(χ^(2)=3.947,P=0.047)。多因素分析结果显示年龄(HR=1.042,95%CI:1.021~1.062,P<0.001)和合并糖尿病(HR=0.390,95%CI:0.226~0.671,P=0.001)是患者全因死亡的独立危险因素,而透析前CKD管理则是患者全因死亡的保护性因素(HR=0.503,95%CI:0.295~0.857,P=0.012)。结论透析前C K D管理对透析后经济结果有遗留影响,能改善维持性血液透析患者的长期预后,在管理工作中尤其要关注糖尿病及老年患者。
