Follow-up study of hepatitis C virus infection in uremic patients on maintenance hemodialysis for 30 months

INTRODUCTIONA high prevalence of antibodies to hepatitis C virus(HCV)(range from 3.3%-80%)has beenreported in hemodialysis(HD)patients,andworrisome as it often becomes chronic and induceschronic liver disease,therefore thenephrologists face a major challenge of how toprevent it.The main route of HCV transmission

A phase Ⅳ study of homoharringtonine, cytarabine, aclacinomycin and G-CSF(HCAG) regimen compared with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia patients

Objective · To compare the efficacy and prognostic factors of HCAG regimen with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia(AML) patients. Methods · Forty-one patients with AML(aged 55-71 years) were randomly divided into two groups(Group HCAG and Group IA) between 2014 and 2016 for induction and consolidation therapy. Multivariate analysis was applied to identify prognostic factors for relapse-free survival(RFS). Results · A total of 29 patients(70.7%) achieved complete remission(CR). The estimated 2-year overall survival(OS) was 66.8% in Group HCAG and 75.4% in Group IA(P=0.913). The estimated 2-year RFS was 61.8% in Group HCAG and 49.1% in Group IA(P=0.411). Age remained as the unfavorable prognostic factor, leading to significant differences in OS and RFS. In addition, RFS was influenced by cytogenetic/molecular risk stratification. Conclusion · Although HCAG seemed not to particularly benefit the group, the dose reduction of anthracyclines may be applied in elderly patients with comparable short-time outcome. Furthermore, the introduction of homoharringtonine resulted in an improvement of treatment response for more than 20% compared with CAG regimen.

Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy:Prognostic factors and survival

AIM: To identify the prognostic factors with regard to survival for patients with brain metastasis from primary tumors of the gastrointestinal tract. METHODS: Nine hundred and sixteen patients with brain metastases, treated with whole brain radiation therapy (WBRT) between January 1985 and December 2000 at the Department of Radiation Oncology, University Hospital Freiburg, were analyzed retrospectively. RESULTS: Fifty-seven patients presented with a primary tumor of the gastrointestinal tract (esophagus: n=0, stomach: n=10, colorectal: n=47). Twenty-six patients had a solitary brain metastasis, 31 patients presented with multiple brain metastases. Surgical resection was performed in 25 patients. WBRT was applied with daily fractions of 2 Gray (Gy) or 3Gy to a total dose of 50Gy or 30Gy, respectively. The interval between diagnoses of the primary tumors and brain metastases was 22.6mo vs 8.0mo for patients with primary tumors of the colon/rectum vs other primary tumors, respectively (P<0.01, log-rank). Median overall survival for all patients with brain metastases (n=916) was 3.4mo and 3.2mo for patients with gastrointestinal neoplasms. Patients with gastrointestinal primary tumors presented significantly more often with a solitary brain metastasis than patients with other primary tumors (P<0.05, log-rank). In patients with gastrointestinal neoplasms (n=57), the median overall survival was 5.8 mo for patients with solitary brain metastasis vs 2.7mo for patients with multiple brain metastases (P<0.01, log-rank). The median overall survival for patients with a Karnofsky performance status (KPS) ≥70 was 5.5mo vs 2.1mo for patients with KPS <70 (P<0.01, log-rank). At multivariate analysis (Cox Model) the performance status and the number of brain metastases were identified as independent prognostic factors for overall survival. CONCLUSION: Brain metastases occur late in the course of gastrointestinal tumors. Pretherapeutic variables like KPS and the number of brain metastases have a profound influence on treatment outcome.

Age is an independent adverse prognostic factor for overall survival in acute myeloid leukemia in Japan

AIM: To elucidate risk factors for survival of elderly acute myeloid leukemia(AML) patients in a real-world practice by observational study. METHODS: We conducted a population-based study in 213 adult and elderly AML patients(127 males and 86 females) in Kagawa Prefecture, Japan. To construct this cohort, we gathered all data for patients diagnosed with AML at 7 hospitals in Kagawa between 2006 and 2010. The primary end point was overall survival(OS) after AML diagnosis. Unadjusted Kaplan-Meier survival plots were used to determine OS in the overall cohort. Multivariate analysis was used to determine the independent adverse prognostic factors for OS, with the covariates of interest including age, gender, race/ethnicity, CCI, education, median income, metropolitan statistical area size and history of myelodysplastic syndrome.RESULTS: The average population of Kagawa during the study period was 992489, and the incidence of AML was 4.26 per 100000 person-years. A total of 197 patients with non-acute promyelocytic leukemia(non-APL)(119 males and 78 females) were also included. The median age of non-APL patients was 70 years(average 67, range 24-95). The 5-year OS rate was 21.1%. Subsequent analysis by age group showed that the survival rate declined with age; the 5-year OS rates of non-APL patients younger than 64 years, 65-74 years, and older than 75 years were 41.5%, 14.1%, and 8.9%, respectively. Multivariate analysis revealed that unfavorable risk karyotype, older age, poor performance status(PS)(3-4), lack of induction chemotherapy, and antecedent haematological disease were independent prognostic predictors. In the subgroup analysis, we also found that older patients with non-APL had lower complete remission rates and higher early death rates than younger patients, irrespective of PS. However, intensive chemotherapy was a significant predictor for longer survival not only in the patients < 75 years of age, but also in those over 75 with PS 0-2. CONCLUSION: Age would contribute considerable life expectancy to indicate induction chemotherapy with eligible dose of cytotoxic drugs for a favorable case even in advanced elderly.

Incidence and risk factors of tuberculosis among the elderly population in China:a prospective cohort study

Background:China is facing challenges of the shifting presentation of tuberculosis(TB)from younger to elderly due to an ageing population,longer life expectancy and reactivation disease.However,the burden of elderly TB and influence factors are not yet clear.To fill the gap,we generated a cohort study to measure the magnitude of TB incidence and associated factors among the elderly population aged 65 years and above in China.Methods:In this cohort established in 2013 through a prevalence survey conducted in selected sites,a total of 34076 elderlies without TB were enrolled into two-year follow-up.We used both active and passive case findings to find out all TB patients among them.The person-year(PY)incidence rates for both bacteriologically positive TB and active TB were calculated.Cox proportional regression model was performed to test effect of risk factors,and the population attributable fraction(PAF)of each risk factor contributing to incident TB among elderlies was calculated.Results:Over the two-year follow-up period,a total of 215 incident active TB were identified,62 of which were bacteriologically positive.The incidence rates for active TB and bacteriologically positive TB were 481.8 per 100000 PY(95%CI:417.4–546.2 per 100000 PY)and 138.9 per 100000 PY(95%CI:104.4–173.5 per 100000 PY),respectively.Incident cases detected by active case finding were significantly higher(P<0.001).Male,non-Han nationality,previously treated TB,ex/current smoker and body mass index(BMI)<18.5 presented as independent predictors for developing TB disease.For developing bacteriologically positive TB,the biggest contribution was from self-reported ex or current smoker(18.06%).And,for developing active TB,the biggest contribution was from non-Han nationality(35.40%),followed by male(26.80%)and age at 75 years and above(10.85%).Conclusions:Ageing population in China had a high TB incidence rate and risk to develop TB disease,implying that National TB Program(NTP)needs to prioritize for elderly.Active case finding should be applied capture more active TB cases among this particular population,especially for male,non-Han nationality,and those with identified risk factors.

Gender difference in clinicopathologic features and survival of patients with hepatocellular carcinoma

AIM: To determine the influence of gender on the clinicopathologic characteristics and survival of patients with hepatocellular carcinoma (HCC). METHODS: A retrospective analysis of medical records was performed in 299 patients with HCC and their clinicopathologic features and survival were compared in relation to gender. RESULTS: There were 260 male (87%) and 39 female patients (13%), with a male-to-female ratio of 6.7:1. Female patients had lower mean serum bilirubin levels (P=O.03), lower proportion of alcohol abuse (P=O.O02), smaller mean tumor size (P=O.02), more frequent nodular type but less frequent massive and diffuse types of HCC (P=O.01), wereless advanced in Okuda's staging (P=O.04), and less frequently associated with venous invasion (P=O.03). The median survivals in females (14 mo) were significantly longer than that of male patients (4 mo) (P=O.O04, log-rank test). Multivariate analysis demonstrated that high serum alphafetoprotein levels, venous invasion, extrahepatic metastasis and lack of therapy were independent factors related to unfavorable prognosis. However, gender did not constitute a predictive variable associated with patient survival. CONCLUSION: Female patients tend to have higher survival rates than males. These differences were probably due to more favorable pathologic features of HCC at initial diagnosis and greater likelihood to undergo curative therapy in female patients.

肺小结节的健康管理问题研究

目的探讨良恶性肺小结节的危险因素,提高肺小结节健康管理水平。方法收集宁波市第一医院2020年1月至2021年2月手术切除的肺小结节临床、影像及病理资料。回顾性分析良、恶性2组间的特征及危险因素;查找小结节管理中的不足。结果1062例手术切除肺小结节中,良性336例,恶性726例;随访时间≥3个月者共685例,其中404例在本院有2次或以上胸部CT对照。单因素危险因素分析,性别、结节类型、结节最大径、结节增大或实变等在良恶性组间差异有统计学意义(P<0.05)。多因素logistic回归分析,女性(OR=1.759,95%CI:1.076~2.877)、非实性结节(OR=18.914,95%CI:7.768~46.054)、结节较大者(OR=1.333,95%CI:1.156~1.536)、结节增大(OR=3.815,95%CI:1.688~8.622)是恶性肿瘤的危险因素。3例出现转移或直接侵犯。结论女性、非实性肺小结节、直径较大者、结节增大是恶性肿瘤的危险因素,应规范全程管理。

基于十年随访的心血管代谢性危险因素聚集与社区≥55岁人群全因死亡风险关系的队列研究

背景心血管代谢性危险因素聚集(CRFC)是老年人常见的健康问题,目前相关研究主要集中在流行病学分布特征的描述,有关CRFC与人群全因死亡风险的研究鲜有报道。目的探讨CRFC与社区≥55岁人群全因死亡风险的关系,为开展≥55岁人群社区保健提供参考。方法于2011年9—11月采用典型抽样法选取宁夏回族自治区吴忠市和银川市5个社区的1046名≥55岁人群作为研究对象,对其开展一般情况问卷调查、体格检查、超声检查、实验室检查和CRFC评价〔纳入中心性肥胖、高胆固醇血症、高三酰甘油血症、高低密度脂蛋白血症、低高密度脂蛋白血症、高血压、糖尿病、高尿酸血症、非酒精性脂肪性肝病(NAFLD)共计9项心血管代谢性危险因素后,控制一般情况变量,通过构建多因素Cox比例风险回归模型,估计各个心血管代谢性危险因素的回归系数β,以回归系数β为权重将所有心血管代谢性危险因素的评分相加得出心血管代谢危险因素危险总评分〕,将心血管代谢危险因素危险总评分按照四分位数分为三组:<P_(50)组,P_(50)~P_(75)组,>P_(75)组;分别于2017年,2019年和2021年通过面访和死因监测系统搜索的方式完成随访。采用Kaplan-Meier法绘制<P_(50)组,P_(50)~P_(75)组,>P_(75)组社区老年人全因死亡的生存曲线,生存曲线比较采用Log-rank检验;采用多因素Cox比例风险回归分析一般情况、各心血管代谢性危险因素、心血管代谢危险因素危险总评分、心血管代谢危险因素危险总评分分组、年龄组分层与社区≥55岁人群全因死亡风险的关系。结果研究对象年龄55~88岁,平均年龄(66.4±6.6)岁。共观察到106例死亡案例,10年累计死亡率为10.13%。随着危险评分的增加,个体预期中位生存时间显著缩短,>P_(75)组累积生存率低于P_(50)~P_(75)组和<P_(50)组;多因素Cox比例风险回归分析结果显示,年龄、性别、独居、文化程度可能是社区老年人全因死亡风险的影响因素(P<0.05);控制一般情况后,多因素Cox比例风险回归分析结果显示,心血管代谢危险因素危险总评分是社区≥55岁人群全因死亡风险的影响因素〔HR=3.04,95%CI(1.55,5.97),P=0.001〕,且心血管代谢危险因素总评分越高死亡风险亦越高,>P_(75)组全因死亡风险高于<P_(50)组〔HR=2.02,95%CI(1.16,3.50),P=0.013〕;以年龄组分层多因素Cox比例风险回归分析结果显示,≥65岁年龄组心血管代谢危险因素总评分与社区≥55岁人群全因死亡风险显著关联〔HR=2.79,95%CI(1.36,5.74),P=0.005〕;>P_(75)组全因死亡风险高于<P_(50)组〔HR=1.83,95%CI(1.02,3.28),P=0.042〕。结论CRFC与社区≥55岁人群全因死亡风险显著关联,其聚集程度越高全因死亡风险越高,提示早期评价CRFC并给予干预可能对提高社区≥55岁人群保健效果、降低死亡风险具有一定意义。

北京市城乡老年人的健康状况及对生存的影响

目的 研究老年人躯体和心理健康状况对生存的影响。方法 1 992年在北京市城市和郊区 (平原和远郊山区 )随机抽取 1个区县 ,在所抽取的区县采取分层、分段及整群抽样方法抽取 55岁以上老年人 3 2 57名进行了调查。内容包括一般状况、慢性疾病史、健康自评及吸烟、饮酒等生活习惯情况。并对其中 2 1 0 1名老人做了体格检查和认知功能检查 (MMSE)。到 1 997年 8月共随访 3次 ,累计死亡 792人 ,占基线调查人数的2 4 .3%。结果 COX回归分析表明威胁老年人生存的危险因素从高到低的排序分别是 :高龄、认知功能异常、男性、居住在农村、健康自评差及慢性病史。研究表明认知功能异常、健康自评差和慢性病史是影响低龄老人生存的主要危险因素 (P<0 .0 5) ;对于高龄老人而言 ,健康自评和认知功能是影响其生存的主要危险因素 (P<0 .0 5)。结论 认知功能异常、健康自评差及慢性病史与北京市城乡老年人的生存相关 ,且心理精神健康状态的作用大于躯体健康作用。

西安地区急性脑梗死患者1年预后不良的相关危险因素分析

目的探讨西安地区急性脑梗死患者1年预后不良的相关危险因素。方法通过西安脑卒中数据库平台,收集2015年1月1日~12月31日4所三级甲等医院连续入院的急性脑梗死患者2016例,并分别在患者发病1、3、6个月以及1年时进行随访,以1年随访时改良Rankin评分(mRS评分)分为预后良好组(mRS评分≤2分)1660例,预后不良组(mRS评分≥3分)356例。通过单因素和多因素logistic回归分析急性脑梗死患者1年预后不良的危险因素。结果 2组年龄、入院48h不能行走、入院美国国立卫生研究院卒中量表(NIHSS)评分和白细胞计数比较,差异有统计学意义(P<0.01)。多因素logistic回归分析显示:年龄>60岁(OR=2.37,95%CI:1.49~3.77,P=0.001)、心房颤动(OR=2.61,95%CI:1.42~4.80,P=0.002)、入院NIHSS评分(OR=1.15,95%CI:1.10~1.21,P=0.001)、入院48h不能行走(OR=2.37,95%CI:1.54~3.65,P=0.001)、白细胞计数>10×109/L(OR=1.49,95%CI:1.09~2.72,P=0.010)是急性脑梗死患者1年预后不良的独立危险因素。结论早期识别预后不良危险因素,关注高危人群、进行有针对性的预防,有助于降低急性脑梗死患者1年不良预后的风险。

2型糖尿病合并正常高值血压的危险因素分析及随访研究

目的分析血压正常的2型糖尿病(T2DM)患者合并正常高值血压的患病率及其危险因素,评价正常高值血压对T2DM患者肾功能的影响。方法应用回顾性分析与前瞻性研究相结合的方法,选取3 481例血压正常的T2DM患者作为研究对象,根据血压水平分为正常血压组和正常高值血压组。随访5年,比较正常血压组和正常高值血压组新发高血压的累计发病率,并分析T2DM合并正常高值血压发生高血压的影响因素。应用Excel数据库建库,采用SPSS 13.0软件进行统计学分析。结果正常血压组943例(27.1%),正常高值血压组2 538例(72.9%)。正常高值血压组男性多于正常血压组,打鼾率、吸烟率高于正常血压组,三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、体质指数(BMI)高于正常血压组(P<0.05);两组其余指标间差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示:男性、打鼾、吸烟及高水平的TG、LDL-C、BMI与正常高值血压有关(OR=1.622、1.304、1.428、1.085、1.341、1.092,P<0.05)。正常高值血压组肾功能不全发生率为38.3%,高于正常血压组的33.8%(χ2=6.761,P=0.009)。随访5年后,剔除死亡患者,正常高值血压组实际随访2 471例,正常血压组实际随访899例;正常高值血压组高血压累计发病率为35.8%(885/2 471),低于正常血压组的22.0%(198/899)(χ2=57.486,P<0.05)。男性、女性正常高值血压患者高血压累计发病率分别为36.7%和31.5%,超重和非超重患者高血压累计发病率分别为39.4%和31.3%,差异均有统计学意义(χ2=4.070、17.255,P<0.05)。结论男性、打鼾、吸烟及高水平的TG、LDL-C、BMI是T2DM合并正常高值血压的危险因素。正常高值血压是促进T2DM患者肾功能不全的危险因素。T2DM合并正常高值血压患者5年高血压累计发病率明显高于正常血压者。男性和超重为T2DM合并正常高值血压患者发生高血压的危险因素。应进一步强化对T2DM合并正常高值血压患者多种危险因素的综合防治,以改善患者预后。

山东某地农村人群自杀未遂危险因素的病例-对照分析和随访研究

为预防自杀行为 ,并为制定必要的可行的干预措施提供科学的依据 ,利用在山东某地区调查的病例 -对照研究资料和随访研究资料 ,应用多因素Logistic回归模型进行分析 ,寻找影响自杀未遂的危险因素。结果显示 :自杀未遂行为的发生与急性应激强度大、患精神病和冲动性人格特征呈正相关 ;与生命质量和家庭亲密度呈负相关。研究提示 :①负性生活事件是农村人群自杀未遂最重要的危险因素 ,其次是患精神疾病 ;②冲动性人格特征也是自杀未遂重要的独立危险因素之一 ;③我国农村人群不同于西方国家的“精神病自杀模式” 。

经鼻蝶显微手术治疗功能性垂体腺瘤的复发危险因素分析

目的分析经鼻蝶显微手术治疗功能性垂体腺瘤(FPAs)术后复发的危险因素,并构建判断FPAs术后复发的风险模型。方法回顾性分析2010年10月-2017年10月西安交通大学第一附属医院及西安交通大学第二附属医院共112例经鼻蝶显微手术切除FPAs患者的临床资料,应用医院门诊病历系统联合电话回访收集患者术后复诊情况,按患者随访结局分为复发组18例和未复发组94例。采用单因素分析和Cox回归分析判定FPAs患者术后复发的相关危险因素。结果两组患者性别、年龄、肿瘤病理分型及是否首次手术比较,差异无统计学意义(P>0.05);两组患者术后Knosp分级、肿瘤直径、术后肿瘤残留、Ki-67表达情况及辅助治疗比较,差异有统计学意义(P<0.05)。经Cox多元回归分析发现,肿瘤直径[=3.120(95%CI:1.248,7.798),P=0.015]、术后肿瘤残余[RR=3.246(95%CI:1.289,8.178),P=0.012]及Ki-67表达[RR=1.151(95%CI:0.826,4.871),P=0.034]是影响FPAs患者术后复发的独立危险因素。结论肿瘤直径较大、术后肿瘤残余及Ki-67≥3%是FPAs患者术后复发的高危因素。早期识别复发高风险患者,及早实施应对措施可改善患者预后。

老年男性冠心病患者血清总胆固醇水平与冠心病死亡的11年随访研究

目的探讨老年男性冠心病患者血清TC水平与冠心病死亡的关系。方法采用回顾性队列研究方法,将878例年龄≥65岁的老年男性冠心病患者按TC水平分为4组:1组(158例):TC<4.16mmol/L、2组(182例):4.16mmol/L≤TC<4.68mmol/L、3组(205例):4.68mmol/L≤TC<5.2mmol/L、4组(333例):TC≥5.2mmol/L,应用COX比例风险模型进行11年生存分析。结果与2组患者比较,校正前,1组和4组冠心病死亡的发病风险分别增加了131%(P=0.034)、28%(P=0.039),TC与冠心病死亡呈U型关系;校正传统危险因素后,1组患者的冠心病死亡风险增加了271%(P=0.028),TC浓度与冠心病死亡风险呈"L"型关系。结论在老年男性冠心病患者中,TC过低能明显增加冠心病病死率。

胎儿生长发育与成年期冠心病生物学危险因素的关系

目的 探讨中国人群中冠心病生物学危险因素的水平与低出生测量指标间的关系。方法 对628名1948～1954年在北京协和医院出生的活产单生子进行追访调查。结果 成年期发生冠心病(CHD)心肌缺血症状的风险概率随出生体重的降低而增加(β=-0.0018,P<0.01);随着出生体重和出生体重指数(PI)降低,患高血压风险加大,出生消瘦组(PI≤24kg/m3)的OR(oddsratio)值是PI>28kg/m3组的5.9倍;成年期发生糖耐量低减(IGT)的风险随出生体重和PI降低而逐渐增大。空腹血浆胰岛素水平(反映胰岛素抵抗)随出生体重和头围的降低而显著升高(趋势检验,P<0.01)。血清甘油三脂(TG)水平随出生体重、PI和头围升高而下降(趋势检验P<0.01,P<0.01,P<0.05),而高密度脂蛋白胆固醇(HDL-C)水平随出生体重和头围升高而上升(趋势检验P<0.05,P<0.01)。上述出生指标与CHD生物学危险因素间的关系与胎龄和成年期生活方式无关。血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平与出生指标无关。结论 我国人群中,以低出生测量指标反映的宫内发育迟缓可能使成人期发生高血压、糖尿病、胰岛素抵抗、高血清TG和低HDL-C等冠心病生物学危险因素的风险增加。

胸腺瘤合并重症肌无力患者术后预后影响因素分析

目的探索影响胸腺瘤合并重症肌无力患者预后的危险因素。方法纳入163例胸腺瘤合并重症肌无力患者,所有患者均行胸腺切除术,收集患者住院期间的临床资料,采用单因素与多因素Logistic回归分析,分析影响影响术后预后的危险因素。结果单因素分析显示年龄(t=2.784,P=0.020)、Osserman分型(χ~2=7.369,P=0.018)、术前病程(Z=4.550,P=0.001)和Masaoka分期(χ~2=12.413,P<0.01)为影响患者的预后因素;多因素Logistic回归分析显示,Osserman分型(RR=2.675,95%CI:1.243~5.678,P=0.021)、术前病程(RR=1.173,95%CI:1.067~1.487,P=0.001)和年龄(RR=1.719,95%CI:1.164~3.082,P=0.023)为影响胸腺瘤合并重症肌无力患者术后预后的独立危险因素。结论 Osserman分型、术前病程和年龄为影响术后预后的独立危险因素。

老年急性心肌梗死患者直接冠状动脉介入治疗术后随访分析

目的分析老年急性心肌梗死患者直接PCI术后的危险因素。方法将619例直接行PCI的急性心肌梗死患者,按年龄分为老年组(≥65岁)236例和对照组(<65岁)383例,全部入选患者行PCI术后记录主要不良心脏事件,进行回顾性分析,采用Log-Rank检验进行两组的生存分析,Cox回归分析用于预后多因素分析。结果老年组患者女性比例、左心功能不全、肾功能不全比例高于对照组,差异有统计学意义(P<0.01)。高血压、糖尿病、血肌酐水平、LVEF值、无复流、支架的数目是老年组预后的独立危险因素。结论老年AMI患者直接PCI是有效可行的治疗手段。

冠状动脉痉挛患者的长期临床随访分析

目的对冠状动脉痉挛患者住院期间及院外资料进行回顾分析,了解冠状动脉痉挛患者的长期预后,探讨影响冠状动脉痉挛的原因。方法选择确诊冠状动脉痉挛患者88例,常规内科治疗,行门诊和(或)电话随访,了解患者一般情况,包括有无胸痛再发、服药状况、吸烟现状、门诊检查结果等。以有无胸痛再发为因变量对患者临床因素行logistic回归分析,探讨影响冠状动脉痉挛再发的因素。结果患者出院后进行门诊和(或)电话随访,平均随访(61±1 7)个月,其中19例(21.6%)患者出院后仍有静息或晨起胸部不适、胸痛或类似入院主诉,其中11例表现为咽部紧缩感,6例表现为胸痛、胸部压榨感,舌下喷服硝酸甘油均有效,2例因反复胸痛治疗,1例患者发生猝死。logistic回归分析显示,入院时高敏C反应蛋白(OR=0.55,95%CI:0.32～0.95,P=0.033)、吸烟(OR=0.26,95%CI:0.56～0.98,P=0.028)是冠状动脉痉挛复发的危险因素。Kaplan-Meier曲线显示,患者在1年时胸痛发生率较高,为8.0%,1年后总体发生趋向平稳。结论入院高敏C反应蛋白水平、吸烟是冠状动脉痉挛发作的危险因素,严格戒烟和规律用药后患者总体预后较好。

脱毒治疗后复吸危险因素的Cox回归分析

目的··:探讨毒品复吸的危险因素 ,为制定其防治对策和措施提供科学依据。方法··:以110例脱毒治疗成功者为研究对象 ,随访观察6个月。应用SPSS10.0软件包做Cox回归分析 ,分析影响复吸的主要危险因素 ,并计算其生存及复吸危险函数。结果··:6个月累计复吸率为82.7%。就业状况、毒品心理依赖、家庭冷落、结交新朋友、毒品易获得是影响复吸的主要因素 ,相对危险度分别为0.566、2.045、2.017、0.380和3.168。复吸危险函数随时间延长而增加 ,而生存函数则与此相反。结论 :·· 毒品心理依赖、家庭冷落、毒品易获得是复吸的主要危险因素 ,而有正当职业、交结新朋友可降低复吸的危险。要巩固脱毒效果 ,使之真正回归社会 ,必须家庭、社会共同参与 ,综合治理 ,最大限度降低复吸的危险因素。

205例先天性心脏病胎儿妊娠结局分析

目的探讨先天性心脏病(CHD)胎儿的妊娠结局,为产前诊断、咨询提供依据。方法收集2011年1月-2012年12月产前诊断为CHD并随访至妊娠结局的胎儿205例,分析胎儿引产率、继续妊娠者围产儿死亡率、存活患儿无症状存活率。结果 CHD胎儿异常核型检出率为36.7%,合并心外异常者占44.4%;复杂型CHD和合并心外异常均可增加胎儿引产率(P<0.001)及继续妊娠者围产儿死亡率(P<0.05);合并心外异常可降低患儿无症状存活率(P=0.0058)。结论 CHD胎儿异常核型检出率高;CHD病变类型及合并心外异常均是影响胎儿妊娠结局的危险因素,CHD病变类型较是否合并心外异常对胎儿引产及继续妊娠胎儿围产儿死亡率的影响更大。