目的分析急性大血管闭塞性脑卒中(Acute large vascular occlusive stroke,ALVOS)成功再通后发生恶性脑水肿(Malignant brain edema,MBE)的早期影像学预测因素及临床结局。方法纳入急性大血管闭塞性脑卒中成功再通患者149例,术后即刻非...目的分析急性大血管闭塞性脑卒中(Acute large vascular occlusive stroke,ALVOS)成功再通后发生恶性脑水肿(Malignant brain edema,MBE)的早期影像学预测因素及临床结局。方法纳入急性大血管闭塞性脑卒中成功再通患者149例,术后即刻非增强计算机断层扫描(Non-contrast computed tomography,NCCT)评估介入后高密度影(Postinterventional cerebral hyperdensities,PCHDs),根据PCHDs的分布特点及范围提出一种征象即绸带征,定义为术后即刻NCCT上最大面积的高密度改变呈沿脑回的带状高密度影;根据术后72 h内是否发生恶性脑水肿分组;采用单因素和多因素Logistic回归分析MBE的预测因素,并绘制受试者工作特征(Receiver operating characteristic,ROC)曲线来检验绸带征的性能。结果共纳入149例患者(男性60.40%),其中27例(18.12%)发生MBE,108例(72.50%)发生PCHDs,50例(33.60%)发生绸带征;在调整混杂因素后术后美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分(OR=1.228,95%CI=1.064~1.417,P=0.005)、绸带征(OR=19.007,95%CI=4.123~87.615,P<0.001)、术后白细胞数(OR=1.444,95%CI=1.06~1.966,P=0.020)是ALVOS成功再通后发生MBE的独立危险因素;绸带征([曲线下面积(Area under the curve,AUC)]=0.815,95%CI=0.726~0.904,P<0.001)对ALVOS成功再通后发生MBE的预测价值高于术后NIHSS评分(AUC=0.812,95%CI=0.722~0.902,P<0.001)和术后白细胞数(AUC=0.719,95%CI=0.620~0.818,P<0.001)。结论急性大血管闭塞性脑卒中成功再通后仍有较高的MBE发生率,并与不良的功能预后相关,绸带征作为术后影像学的标志物是血管内治疗术成功再通后发生MBE的独立危险因素,有助于临床医师的诊疗决策。展开更多
Objective： The purpose of the study was to study the mechanism of vasculogenic mimicry （VM） and its relationship with tumor stage in non-small cell lung cancer （NSCLC）. Methods： Forty-two patients with NSCLC wer...Objective： The purpose of the study was to study the mechanism of vasculogenic mimicry （VM） and its relationship with tumor stage in non-small cell lung cancer （NSCLC）. Methods： Forty-two patients with NSCLC were collected, 19 belonged to the early stage （stages Ⅰ ＋Ⅱ） while 23 were late stage （stages Ⅲ ＋ Ⅳ）. Moreover, 20 patients got surgical treat ment and 22 got chemotherapy. We studied the relationship of VM with stage, chemotherapeutic effect, HIF-la, microves sel density （MVD） and clinicopathologic features. Results： VM in patients of early stages were significantly more than late stages （68.4% vs 26.1%, P = 0.006）, and the positive rate of VM was proportional to HIF-la （P = 0.034）. But no correlation was found between VM and chemotherapeutic effect （14.3% vs 26.7%, P = 1.00） or MVD （P 〉 0.05）. Furthermore, we found VM also showed a negative correlation with distant metastases and lymph nodes metastases （P 〈 0.05） while no correlation was found with other clinicopathologic. Conclusion： VM was generated during the early stage in NSCLC and correlated with lymph nodes metastases. As the disease progressed, VM may be replaced by vascular endothelial cells, so the late-stage patients especially people with distant metastases had fewer VM. As the main factor produced by hypoxia, HIF-la may make a difference in VM formation. Thus we inferred VM might be a new target for targeted therapy, and could provide help for clinical staging and treatment.展开更多
文摘目的分析急性大血管闭塞性脑卒中(Acute large vascular occlusive stroke,ALVOS)成功再通后发生恶性脑水肿(Malignant brain edema,MBE)的早期影像学预测因素及临床结局。方法纳入急性大血管闭塞性脑卒中成功再通患者149例,术后即刻非增强计算机断层扫描(Non-contrast computed tomography,NCCT)评估介入后高密度影(Postinterventional cerebral hyperdensities,PCHDs),根据PCHDs的分布特点及范围提出一种征象即绸带征,定义为术后即刻NCCT上最大面积的高密度改变呈沿脑回的带状高密度影;根据术后72 h内是否发生恶性脑水肿分组;采用单因素和多因素Logistic回归分析MBE的预测因素,并绘制受试者工作特征(Receiver operating characteristic,ROC)曲线来检验绸带征的性能。结果共纳入149例患者(男性60.40%),其中27例(18.12%)发生MBE,108例(72.50%)发生PCHDs,50例(33.60%)发生绸带征;在调整混杂因素后术后美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分(OR=1.228,95%CI=1.064~1.417,P=0.005)、绸带征(OR=19.007,95%CI=4.123~87.615,P<0.001)、术后白细胞数(OR=1.444,95%CI=1.06~1.966,P=0.020)是ALVOS成功再通后发生MBE的独立危险因素;绸带征([曲线下面积(Area under the curve,AUC)]=0.815,95%CI=0.726~0.904,P<0.001)对ALVOS成功再通后发生MBE的预测价值高于术后NIHSS评分(AUC=0.812,95%CI=0.722~0.902,P<0.001)和术后白细胞数(AUC=0.719,95%CI=0.620~0.818,P<0.001)。结论急性大血管闭塞性脑卒中成功再通后仍有较高的MBE发生率,并与不良的功能预后相关,绸带征作为术后影像学的标志物是血管内治疗术成功再通后发生MBE的独立危险因素,有助于临床医师的诊疗决策。
文摘Objective： The purpose of the study was to study the mechanism of vasculogenic mimicry （VM） and its relationship with tumor stage in non-small cell lung cancer （NSCLC）. Methods： Forty-two patients with NSCLC were collected, 19 belonged to the early stage （stages Ⅰ ＋Ⅱ） while 23 were late stage （stages Ⅲ ＋ Ⅳ）. Moreover, 20 patients got surgical treat ment and 22 got chemotherapy. We studied the relationship of VM with stage, chemotherapeutic effect, HIF-la, microves sel density （MVD） and clinicopathologic features. Results： VM in patients of early stages were significantly more than late stages （68.4% vs 26.1%, P = 0.006）, and the positive rate of VM was proportional to HIF-la （P = 0.034）. But no correlation was found between VM and chemotherapeutic effect （14.3% vs 26.7%, P = 1.00） or MVD （P 〉 0.05）. Furthermore, we found VM also showed a negative correlation with distant metastases and lymph nodes metastases （P 〈 0.05） while no correlation was found with other clinicopathologic. Conclusion： VM was generated during the early stage in NSCLC and correlated with lymph nodes metastases. As the disease progressed, VM may be replaced by vascular endothelial cells, so the late-stage patients especially people with distant metastases had fewer VM. As the main factor produced by hypoxia, HIF-la may make a difference in VM formation. Thus we inferred VM might be a new target for targeted therapy, and could provide help for clinical staging and treatment.
