Risk of cardiovascular death in patients with hepatocellular carcinoma based on the Fine-Gray model

BACKGROUND Hepatocellular carcinoma(HCC)is one of the most common types of cancers worldwide,ranking fifth among men and seventh among women,resulting in more than 7 million deaths annually.With the development of medical tech-nology,the 5-year survival rate of HCC patients can be increased to 70%.How-ever,HCC patients are often at increased risk of cardiovascular disease(CVD)death due to exposure to potentially cardiotoxic treatments compared with non-HCC patients.Moreover,CVD and cancer have become major disease burdens worldwide.Thus,further research is needed to lessen the risk of CVD death in HCC patient survivors.METHODS This study was conducted on the basis of the Surveillance,Epidemiology,and End Results database and included HCC patients with a diagnosis period from 2010 to 2015.The independent risk factors were identified using the Fine-Gray model.A nomograph was constructed to predict the CVM in HCC patients.The nomograph performance was measured using Harrell’s concordance index(C-index),calibration curve,receiver operating characteristic(ROC)curve,and area under the ROC curve(AUC)value.Moreover,the net benefit was estimated via decision curve analysis(DCA).RESULTS The study included 21545 HCC patients,of whom 619 died of CVD.Age(<60)[1.981(1.573-2.496),P<0.001],marital status(married)[unmarried:1.370(1.076-1.745),P=0.011],alpha fetoprotein(normal)[0.778(0.640-0.946),P=0.012],tumor size(≤2 cm)[(2,5]cm:1.420(1.060-1.903),P=0.019;>5 cm:2.090(1.543-2.830),P<0.001],surgery(no)[0.376(0.297-0.476),P<0.001],and chemotherapy(none/unknown)[0.578(0.472-0.709),P<0.001]were independent risk factors for CVD death in HCC patients.The discrimination and calibration of the nomograph were better.The C-index values for the training and validation sets were 0.736 and 0.665,respectively.The AUC values of the ROC curves at 2,4,and 6 years were 0.702,0.725,0.740 in the training set and 0.697,0.710,0.744 in the validation set,respectively.The calibration curves showed that the predicted probab-ilities of the CVM prediction model in the training set vs the validation set were largely consistent with the actual probabilities.DCA demonstrated that the prediction model has a high net benefit.CONCLUSION Risk factors for CVD death in HCC patients were investigated for the first time.The nomograph served as an important reference tool for relevant clinical management decisions.

Effect of programmed cell death factor 4 on the severity of coronary heart disease and coronary artery disease with blood stasis and toxin

Objective:To explore the diagnostic value of PDCD4 on the degree of arterial stenosis in"blood stasis"coronary heart disease.Methods:Select 80 patients with coronary heart disease in the Second Cardiovascular Zone of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine in April 2020,and divide them into the"phlegm toxin"group(n=40)and the"phlegm stasis"group(n=40)based on the dialectics of traditional Chinese medicine.).Record the gender,age,smoking,and alcohol consumption of the subjects between the two groups,and detect their white blood cell count,neutrophil count,platelet count,platelet volume,platelet distribution width,blood creatinine,uric acid,cystatin,and fibrin The expression levels of original,high-sensitivity C-reactive protein,D-dimer,total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,apolipoprotein a,apolipoprotein b,and PDCD4.Multivariate logistic regression analysis was used to screen out the risk factors that affect coronary plaque formation,and the receiver operating characteristic(ROC)curve of each index was established to evaluate the severity of coronary stenosis in patients with stasis coronary heart disease by each index and combined index Diagnostic efficiency.Results:The two groups of patients were tested in terms of gender,age,smoking,drinking,triglycerides,cholesterol,high-density lipoprotein,low-density lipoprotein,apolipoprotein-a,apolipoprotein-b,white blood cell count,neutrophil The cell count,platelet count,platelet volume width and platelet distribution width were not statistically significant(P>0.05);the expression levels of hypersensitivity-C-reactive protein,serum creatinine,cystatin,uric acid and PDCD4 were statistically significant between the two groups Difference(P<0.05),and the corresponding hypersensitivity-C-reactive protein,creatinine,cystatin,uric acid and PDCD4 expression levels in the blood stasis group were higher than those in the phlegm blood stasis group.After multivariate logistic regression analysis,the level of PDCD4 in peripheral blood[OR=31.088,95%CI(2.498,3.869)]was an independent influencing factor of the"stagnation"type of coronary heart disease,and PDCD4 was diagnosed as the"stagnation"type of coronary heart disease The area under the ROC curve(AUC)is 88.6%,95%CI(1.894,2.532)(P=0.29);the level of PDCD4 in peripheral blood is positively correlated with the number and severity of coronary artery disease,the number of coronary artery disease and stenosis The greater the degree,the higher the detection value of PDCD4,(P<0.05).Conclusion:The expression level of PDCD4 in peripheral blood is closely related to the subtype of"stasis toxin"and the severity of coronary vascular stenosis.It can be used as a quantitative diagnostic index for the diagnosis of"stasis toxin"coronary heart disease and the severity of coronary vascular stenosis.

Role of TNFSF15 in the intestinal inflammatory response

Gastrointestinal diseases, specifically Crohn's disease, ulcerative colitis, diverticular disease, and primary biliary cirrhosis are all characterized by complicated inflammation of the digestive tract. Their pathology is multifactorial, and risk factors encompass both genetic and environmental factors. Recent advances in the genetic component of inflammatory bowel diseases(IBDs) have revealed that the tumor necrosis factor superfamily member 15(TNFSF15) contains a number of risk alleles associated not only with IBD but also with other diseases such as diverticular disease and primary biliary cirrhosis. These risk alleles in TNFSF15 and the altered expression of its gene product can serve as the common ground between these disorders by explaining at least some of the underlying processes that lead to a dysregulated immune response and subsequent chronic inflammation. Here, we aim to outline how the TNFSF15 gene is involved in the proliferation and cell fate of different populations of T cells and subsequently in the control of both pro-and anti-inflammatory cytokines. Furthermore, we summarize what is currently known of TNFSF15 control region variants, how they are associated with each mentioned disease, and how these variants can explain the autoimmune pathology of said diseases through altered TNFSF15 expression.

Novel nervous and multi-system regenerative therapeutic strategies for diabetes mellitus with mTOR

Throughout the globe,diabetes mellitus（DM） is increasing in incidence with limited therapies presently available to prevent or resolve the significant complications of this disorder.DM impacts multiple organs and affects all components of the central and peripheral nervous systems that can range from dementia to diabetic neuropathy.The mechanistic target of rapamycin（m TOR） is a promising agent for the development of novel regenerative strategies for the treatment of DM.m TOR and its related signaling pathways impact multiple metabolic parameters that include cellular metabolic homeostasis,insulin resistance,insulin secretion,stem cell proliferation and differentiation,pancreatic β-cell function,and programmed cell death with apoptosis and autophagy.m TOR is central element for the protein complexes m TOR Complex 1（m TORC1） and m TOR Complex 2（m TORC2） and is a critical component for a number of signaling pathways that involve phosphoinositide 3-kinase（PI 3-K）,protein kinase B（Akt）,AMP activated protein kinase（AMPK）,silent mating type information regulation 2 homolog 1（Saccharomyces cerevisiae）（SIRT1）,Wnt1 inducible signaling pathway protein 1（WISP1）,and growth factors.As a result,m TOR represents an exciting target to offer new clinical avenues for the treatment of DM and the complications of this disease.Future studies directed to elucidate the delicate balance m TOR holds over cellular metabolism and the impact of its broad signaling pathways should foster the translation of these targets into effective clinical regimens for DM.

Fatty liver disease:Disparate predictive ability for cardiometabolic risk and all-cause mortality

AIM: To assess the association of a surrogate of fatty liver disease(FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality.METHODS: In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index(FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease(CHD), and all-cause mortality.RESULTS: At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormonebinding globulin. In adjusted Cox models, FLD was(with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio(HR) = 1.72, 95% confidence interval(CI): 1.17-2.53] and men(HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women.CONCLUSION: A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. Allcause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies.

Profile of men＇s health in Malaysia： problems and ：hallenges

Men＇s health concerns have evolved from the traditional andrology and male sexual health to a more holistic approach that encompasses male psychological, social and physical health. The poor state of health in men compared to their female counterparts is well documented. A review of the epidemiological data from Malaysia noted a similar trend in which men die at higher rates in under 1 and above 15 years old groups and most disease categories compared to women. In Malaysia, the main causes of death in men are non-communicable diseases and injuries. Risk factors, such as risk-taking behaviour, smoking and hypertension, are prevalent and amenable to early interventions. Erectile dysfunction, premature ejaculation and prostate disorders are also prevalent. However, many of these morbidities go unreported and are not diagnosed early; therefore, opportunities for early intervention are missed. This reflects poor health knowledge and inadequate health-care utilisation among Malaysian men. Their health-seeking behaviour has been shown to be strongly influenced by family members and friends. However, more research is needed to identify men＇s unmet health-care needs and to develop optimal strategies for addressing them. Because the Malaysian population is aging and there is an increase in sedentary lifestyles, optimizing men＇s health will remain a challenge unless effective measures are implemented. The existing male-unfriendly health-care system and the negative influence of masculinity on men＇s health behaviour must be addressed. A national men＇s health policy based on a male-friendly approach to health-care delivery is urgently needed to provide a framework for addressing these challenges.

基于CHARLS数据库肌酐水平与心脏病患者死亡的相关性分析

目的基于中国健康与养老追踪调查(CHARLS)大型社区研究数据库,探究中国中老年人群肌酐水平预期心脏病发生死亡的相关性。方法收集CHARLS数据库中心脏病患者的2011年血液学检查结果及2018年生存情况数据,将患者按2018年生存情况分为死亡组和存活组,共纳入死亡组133例,存活组982例。比较两组一般人口学、血液学检查结果、疾病史的差异,并通过线性回归方法分析与心脏病死亡有关的因素。结果与存活组相比,死亡组的平均年龄更高、男性比例更多,差异有统计学意义(P<0.05);与存活组相比,死亡组心脏病有关的风险指标(如慢性肺部疾病、胃部疾病或消化系统疾病)患者比例更高(P<0.05),死亡组有哮喘、吸烟史的比例更高(P<0.05)。两组在有无高血压、血脂异常、糖尿病或血糖升高、肝脏疾病、卒中、情感及精神方面问题、与记忆相关的疾病、关节炎或风湿病方面比较,差异无统计学意义(P>0.05)。血液学检查结果显示,两组肌酐、血小板计数、尿素氮、血糖、C反应蛋白、尿酸、血红蛋白水平比较,差异有统计学意义(P<0.05);而白细胞计数、平均红细胞体积、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白、红细胞比容比较,差异无统计学意义(P>0.05)。多因素Logistic线性回归分析结果显示,除胃部疾病或消化系统疾病、哮喘、吸烟史、血糖、C反应蛋白、年龄是心脏病患者死亡的高风险因素外,2011年心脏病患者的肌酐水平和长期死亡风险增加有关[比值比(OR)=3.068,95%CI:1.193~7.894,P=0.020]。结论高肌酐水平可能预示着心脏病患者死亡风险增加,胃部疾病或消化系统疾病、哮喘、吸烟史、血糖、肌酐、C反应蛋白、年龄可能是中老年心脏病患者长期死亡风险的危险因素。

广西重症手足口病患儿接受重症监护及出现死亡的危险特征分析

目的:分析重症手足口病(HFMD)患儿在不同临床症状和体征下,进入重症监护室(ICU)及死亡的风险,为重症HFMD患儿接受重症监护与不同临床转归的危险体征识别提供参考。方法:在2014-2018年间,通过现场调查方法,对广西各县(市、区)重症住院的HFMD确诊患儿进行了连续的个案调查;采用Epidata软件对调查资料进行双录入;使用二分类logistic回归分析,比较重症HFMD患儿不同的临床症状和体征与其死亡或被收入ICU的风险(比值比,OR),明确哪些临床症状体征导致患儿更可能进入ICU及更容易死亡。结果:2014—2018年共调查广西各县(市、区)重症HFMD病例1 500例,男女性别比例为1.78∶1;发病年龄中位数为1.85岁(0~11岁)。与未出现这些症状的患儿相比,共济失调、谵妄、口唇紫绀、面色苍灰、嗜睡、无力麻痹、肢体抖动、易惊是患儿进入ICU的危险症状体征(OR分别为4.924、4.515、2.781、2.750、2.311、2.162、2.139、1.361)。血性泡沫痰、呼吸浅促、面色苍灰、口唇紫绀、呕吐是预示死亡风险增加的危险症状(OR分别为19.045、5.438、3.175、3.031、2.621)。结论:重症HFMD患儿如出现共济失调、谵妄、口唇紫绀等症状,其病情进一步发展为危重症的概率更高,并需接受重症监护治疗;如出现血性泡沫痰、呼吸浅促、面色苍灰、口唇紫绀、呕吐等症状时,应重点关注病情是否恶化而导致死亡。

基于无创血流动力学参数预测老年慢性心力衰竭患者院内死亡的列线图构建与验证

目的利用无创血流动力学监测结合年龄、舒张压、C反应蛋白(CRP)及肾功能不全(血肌酐≥442μmol/L)构建列线图模型,预测慢性心力衰竭(CHF)患者院内死亡结局风险。方法选取2022年9月至2023年3月解放军总医院第一、第二医学中心收治的老年CHF急性发作住院患者223例,根据死亡结局分为存活组196例和死亡组27例。根据随访院内死亡结局联合其他相关指标构建列线图模型预测CHF死亡危险因素。结果无创监测显示,死亡组LVEF、LCWI高于存活组,左心室舒张末期容积(LVEDV)低于存活组(P<0.05,P<0.01)。多因素logistic回归分析显示,年龄(OR=1.131,95%CI:1.052~1.213,P=0.001)、舒张压(OR=0.932,95%CI:0.882~0.982,P=0.011)、CRP(OR=1.171,95%CI:1.021~1.352,P=0.024)、LVEDV(OR=0.984,95%CI:0.962~0.992,P=0.011)及肾功能不全(OR=5.863,95%CI:1.351~1.731,P=0.004)为老年CHF急性发作死亡的独立危险因素,构建列线图模型,ROC曲线下面积为0.902(95%CI:0.819~0.948,P<0.05),校准曲线验证模型预测结果准确性的C指数为0.902。结论年龄、舒张压、LVEDV、CRP、肾功能不全是CHF短期预后独立危险因素。

终末期肾脏病患者血清FGF23与心衰及死亡发生风险的前瞻性队列研究

目的探讨终末期肾脏病(ESRD)患者成纤维细胞生长因子-23(FGF23)血清浓度与心力衰竭及全因死亡的相关性。方法采用前瞻性队列研究,纳入医院肾脏内科收治的无心衰症状的ESRD患者,采用基线问卷和体格检查、超声心动图检查、实验室检查收集患者数据,采用酶联免疫吸附法(ELISA)检测患者血清FGF23浓度。随访时间2年,以随访发生新发的心力衰竭(ACC/AHA stage C-D)和全因死亡为复合终点结局事件,采用Cox比例风险模型分析患者发生结局事件的危险因素,通过亚组分析和交互作用分析,进一步探讨FGF23与结局事件的关联在不同亚组中是否存在异质性。结果该研究最终纳入ESRD患者107例,平均年龄(52.00±12.51)岁,男性39(36.45%)例,中位随访时间为23个月(21,25个月),出现结局事件32(29.9%)例,其中新发心衰22(20.6%)例,全因死亡10(9.3%)例。该研究结果显示结局事件组患者血清FGF23浓度显著高于非事件组[(4.40±1.16)pmol/ml vs(3.85±0.82)pmol/ml,P<0.05]。Cox比例风险模型结果显示升高的FGF23可以增加ESRD患者发生结局事件的风险(HR=1.730,95%CI:1.164~2.570,P=0.007)。亚组分析显示FGF23水平与性别对于结局事件发生风险存在交互作用,尤其在男性ESRD患者中升高的FGF23风险更高(P_(-交互作用)<0.05)。结论升高的血清FGF23是ESRD患者发生心衰和全因死亡的独立危险因素,尤其在男性患者中风险更高。

Transcription Factors:Potential Cell Death Markers in Parkinson's Disease

Parkinson＇s disease （PD） is a neurodegenerative disease with a long preclinical phase. The continuous loss of dopaminergic （DA） neurons is one of the pathogenic hallmarks of PD. Diagnosis largely depends on clinical observation, but motor dysfunctions do not emerge until 70%-80% of the nigrostriatal nerve terminals have been destroyed. Therefore, a biomarker that indicates the degeneration of DA neurons is urgently needed. Transcrip- tion factors are sequence-specific DNA-binding proteins that regulate RNA synthesis from a DNA template. The precise control of gene expression plays a critical role in the development, maintenance, and survival of cells, including DA neurons. Deficiency of certain transcription factors has been associated with DA neuron loss and PD. In this review, we focus on some transcription factors and discuss their structure, function, mechanisms of neuropro- tection, and their potential for use as biomarkers indicating the degeneration of DA neurons.

心内科5年住院患者死亡因素分析

目的分析心内科5年住院患者死亡的相关因素,为制订干预措施提供一定的依据。方法回顾性分析2017年1月至2021年12月阜阳市人民医院心血管内科一病区19457例出院患者中的105例死亡患者的临床资料,分析患者性别、年龄、死亡率、住院时间、死亡疾病、死亡月份、死亡时间段及合并症情况。结果2018年死亡率最高,为28.57%,2021年最低,为9.53%。105例患者中,3 d内死亡57例(54.29%),其中24h死亡41例(占3d死亡例数的71.93%),>3d死亡48例(45.71%);心源性猝死为患者死亡的最主要原因,占比65.71%;急性心肌梗死为患者死亡的最主要基础疾病,占比52.38%;55例心肌梗死患者中,ST段抬高型心肌梗死29例,非ST段抬高型心肌梗死26例,其中仅13例行急诊冠状动脉造影(ST段抬高型10例,非ST段抬高型3例)。90岁之前,随着年龄增长,患者死亡率逐渐上升,死亡率最高的年龄组为70~79岁,占比35.24%。105例患者中,12月至次年2月(冬季)死亡人数最多,占比38.10%;1天中不同时间段死亡人数相差不大;最常见的4种合并症为:高血压43例(占40.95%),感染36例(占34.29%),2型糖尿病33例(占31.43%),脑梗死24例(占22.86%)。结论积极控制心血管危险因素,加强有合并症老年患者的慢性病管理,重视住院患者3d以内猝死的前驱症状及相关诱因,可能会降低心血管疾病住院患者的死亡率。

间质性肺疾病急性加重患者外周血淋巴细胞亚群特点分析

目的 分析间质性肺疾病急性加重(AE-ILD)患者外周血淋巴细胞亚群特点,并分析其与AE-ILD预后的相关性。方法 本研究收集了2020年1月至2022年12月我院呼吸重症监护室收治的AE-ILD患者的临床数据及实验室检查结果,通过统计学方法分析AE-ILD患者淋巴细胞亚群特点以及AE-ILD患者死亡的危险因素。结果 本研究共纳入29例AE-ILD患者,外周血总T淋巴细胞中位数为567个/μL,辅助T细胞中位数为284个/μL,抑制T细胞中位数175个/μL,B淋巴细胞中位数为135个/μL,NK细胞中位数为67个/μL。住院死亡12人(41.4%),与好转组相比,死亡组患者具有较高的呼吸频率、D-二聚体和IL-6水平,较低的辅助T细胞和NK细胞计数(P<0.05),Logistic回归分析结果显示辅助T细胞计数降低是AE-ILD患者死亡的独立危险因素(OR:1.007,95%CI:1.001~1.014,P=0.035),ROC曲线检测辅助T细胞对AE-ILD患者死亡的预测效果,曲线下面积为0.800(95%CI:0.585~1.000,P=0.020)。结论 AE-ILD患者外周血T淋巴细胞绝对计数减少,且辅助T淋巴细胞可作为AE-ILD患者的死亡预测因素。

北京市895名老年人慢性病现状及其影响因素分析

目的探讨老年人慢性病现状及其影响因素。方法对北京市朝阳区社区和中关村社区 90 0名 6 0岁及以上老年人进行社区卫生服务问卷调查。结果北京市 895名老年人各种慢性病的患病率达 91.7% ,患有一种慢性病者 15 .2 % ,患有两种慢性病者 2 1.6 % ,患有三种及以上慢性病的老年人占 5 4 .9% ;慢性病患病率位于前五位的依次为高血压病4 2 .3%、白内障 35 .1%、冠心病 35 .0 %、颈椎病 2 5 .0 %、脑血管病 2 2 .0 % ;前五位主要慢性病自报患病率的影响因素为年龄、性别、文化程度、工作类型、月收入、医疗保障形式。结论老年人慢性病患病率高 ,年龄、性别、文化程度、工作类型。

维持性血液透析患者死亡及其危险因素的单中心分析

【目的】探讨维持性血液透析(MHD)患者死亡的的主要原因及影响死亡的危险因素。【方法】采用回顾性研究,纳入210例中山大学附属第三医院维持性血液透析患者,死亡的68例为观察组,存活的142例患者为对照组,采用单因素及二分类Logistic回归方法分析各临床指标对患者预后的影响。对死亡患者还进行亚组分析,比较心血管死亡患者和非心血管死亡患者心脏彩超数据。【结果】患者年龄(56.6±16.6)岁,其中男性患者125人。与对照组相比,死亡组患者年龄更大,并发高血压、糖尿病、心脑血管疾病的比例更高,血红蛋白、白蛋白、血肌酐及血尿酸水平更低,而超敏C反应蛋白水平则明显升高(P值均<0.05)。68例死亡患者中,死亡前3位原因分别是心脑血管疾病(33例,48.5%)、感染(16例,23.5%)、营养不良性衰竭(8例,11.8%)。Logistic回归分析显示年龄、合并心脑血管疾病、糖尿病、超敏C反应蛋白及血肌酐水平是MHD患者死亡的独立危险因素。亚组分析显示,与非心脑血管疾病死亡组患者心脏彩超结果相比,心脑血管疾病死亡组患者左心室肥厚和瓣膜钙化的发生率更高。【结论】心脑血管疾病、感染、营养不良是维持性血液透析患者死亡的主要原因,心血管死亡患者伴发左心室肥厚及瓣膜钙化的比例显著高于非心血管死亡患者。

血液病致死性医院感染危险因素分析

目的 为了解血液病致死性医院感染及相关危险因素。方法 回顾分析了 5年来我院血液病住院患者 5 10例有关临床资料。结果 医院感染率为 17.0 5 % ,其中 2 8.7%死亡。在医院感染死亡患者中 ,中性粒细胞 ( PMN)、CD4及 CD8比例显著下降。感染的病原菌以革兰阴性杆菌及念珠菌为主 ,并以下呼吸道及血液感染多见。结论 人体免疫功能极度低下是导致感染死亡的主要内在因素 ,对该类患者应加强防护。

慢型克山病死亡病例中猝死病例分析

目的 了解慢型克山病猝死的有关因素 ,在防治工作中采取有针对性的措施 ,以减少或避免猝死的发生。方法 设计慢型克山病死亡 (病死、猝死、意外死亡 )病例有关资料的统一调查表 ,由专业人员查阅有关病例资料填写。工作结束后进行表格汇总、统计与分析。结果 慢型克山病无论病程长短都可能发生猝死 ,女性明显多于男性 ,发病在 5年内猝死的最多 ,猝死的发生主要由左心室大劳损合并多源多发、单源多发性室性早搏及各种传导阻滞 ,再在诱发因素的作用下所引起。结论 在慢型克山病病人中 ,一般情况下是心胸比率越大、心功能越差 ,猝死的机会越大 ,但心功能在 级、心胸比率在 0 .5 1～ 0 .5 5之间的病例猝死率也较高。

维持性血液透析患者死亡原因分析

目的总结维持性血液透析患者死亡原因,分析其相关影响因素。方法回顾性分析36例维持性血液透析患者死亡原因及其相关影响因素。结果36例死亡的血液透析患者中,主要死亡病因为心血管事件15例(41.7%),脑血管意外7例(19.4%),感染7例(19.4%),上消化道出血3例(8.3%),恶性肿瘤2例(5.6%),原因不明2例(5.6%)。与非心脑血管疾病死亡患者相比,死于心脑血管疾病的患者中合并糖尿病45.5%(10/22)vs 7.1%(1/14)(P<0.05)、充血性心力衰竭54.6%(12/22)vs 14.3%(2/14)(P<0.05)、左心室肥厚50.0%(11/22)vs14.3%(2/14)(P<0.05)的比例较高,而血白蛋白的水平较低(31.9g/L vs 36.3g/L,P<0.05)。进一步进行logistic回归分析提示糖尿病、透析前充血性心力衰竭史、左心室肥厚可能是维持性血液透析患者死亡的危险因素。结论持性血液透析患者的死亡原因主要为心血管疾病、脑血管疾病和感染。积极改善患者的营养状况,有效预防和干预糖尿病、充血性心力衰竭、左心室肥厚等并发症,可能有助于提高患者的早期和长期生存率。

维持性血液透析患者6年死亡情况及危险因素分析

目的分析维持性血液透析（MHD）患者的死亡情况,为提高MHD患者的长期生存率提供依据。方法收集2009年1月1日—2014年12月31日首次入院的MHD患者的临床资料,分析死亡原因及相关危险因素。结果共纳入176例患者,首次透析年龄为（58.2±16.1）岁,平均随访时间为（37.6±22.0）月;死亡33例（18.8%）,总体病死率为59.7/1 000病人年;主要死亡原因为心脑血管疾病,共15例（45.6%）。与存活组比较,死亡组患者的首次透析年龄较大（P=0.000）;吸烟和既往合并心血管事件者比例较高（P=0.045,P=0.002）;起始透析频率较高（P=0.004）;透析前血红蛋白浓度和血细胞比容较低（P=0.011,P=0.012）,血清高敏C反应蛋白水平较高（P=0.036）,内生肌酐清除率较低（P=0.049）。Cox回归分析结果提示首次透析年龄（HR=1.033,95%CI 1.007~1.061）和透析前血红蛋白浓度（HR=0.980,95%CI 0.962~0.998）是MHD患者死亡的独立危险因素。结论 MHD患者的主要死亡原因为心脑血管疾病。首次透析年龄越大、透析前血红蛋白浓度越低,则患者的死亡风险越大。