Sensory changes, C-and A-fiber function, and shoulder-hand syndrome in hemiplegic patients after stroke

BACKGROUND： Clinical diagnosis of various neurological disorders involving the sensory nerves depends primarily on subjective description, which cannot be quantitatively evaluated, and is also less reproducible and specific. Quantitative sensory testing methods can overcome these shortcomings and is currently used to identify the function of the C- and A-fibers. OBJECTIVE： To apply the quantitative sensory testing method for analyzing changes in temperature sensation, cryalgesia, thermalgesia, and vibration sense on the skin surface of hemiplegic patients with post-stroke shoulder-hand syndrome, and to analyze the relationship between these changes and shoulder-hand syndrome. DESIGN, TIME AND SETTING： A non-randomized, concurrent, control study was performed at the Clinic and Inpatient Department of the Third Xiangya Hospital, Central South University, between June 2000 and April 2001. PARTICIPANTS： Thirty post-stroke, hemiplegic patients were divided into shoulder-hand syndrome and control groups, according to whether patients exhibited shoulder-hand syndrome, with 15 patients in each group. METHODS： A TSA2001 quantitative sensory testing device （Medoc, Israel） was used for quantitative sensory testing. All sensory testing employed limits, testing temperature sense on the palm thenar eminence and vibration sense on the thumb metacarpal. Cold threshold was ≤ 28 ℃, warmth threshold was ≥ 36 ℃, cold-evoked pain threshold was ≤ 5 ℃, heat-evoked pain threshold was ≥ 51 ℃, vibration threshold was ≥ 5 μm/s; if a patient met one of these items, he/she was considered to be hypoanesthesia. MAIN OUTCOME MEASURES： Cold, warm, cold-evoked pain, heat-evoked pain and vibration threshold changes on skin from the paralyzed upper extremity was measured in the shoulder-hand syndrome and control groups. RESULTS： Incidence of sensory disability in the shoulder-hand syndrome group increased more significantly than in the control group （P 〈 0.05）, with the primary manifestations being decreased cold threshold （P 〈 0.05） and increased warmth threshold （P 〈 0.05）. The value differences between cold and cold-evoked pain thresholds, as well as between warmth and heat-evoked pain thresholds, decreased significantly in the shoulder-hand syndrome group （P 〈 0.05）. There were no significant differences between the two groups in cold-evoked pain, heat-evoked pain, or vibration thresholds. CONCLUSION： The primary manifestations of sensory impairment in hemiplegic patients with post-stroke shoulder-hand syndrome were displayed as thermohypesthesia and hyperalgesia. Functional impairments of nerve fibers that control pain and temperature sense may play an important role in the pathogenesis of post-stroke shoulder-hand syndrome.

Research progress on the effect of the combination of Jing acupoints bloodletting therapy and Sangzhi (Mori Ramulus) on shoulder-hand syndrome after stroke

Shoulder-hand syndrome(SHS)is one of the common complications of ischemic stroke.The pathogenesis is not completely clear and the therapeutic effects are not very satisfactory.As one of the Five-Shu acupoints(the general terms of acupoints that the twelve meridians are located below the elbow and knee of the body),Jing acupoints is distributed at the end of fingers and toes where the twelve meridians of the human body pass by,and has the functions of stimulating the meridians and dredging the channels and collaterals.For the effects of discharging neurons,promoting cerebral blood flow and improving the brain micro-circulation,Jing acupoints bloodletting therapy can effectively relieve the clinical symptoms of the patients with SHS after stroke.Sangzhi(Mori Ramulus),with the ability of dredging the meridian and relieving the pain,is also has certain treatment functions to the SHS.In clinical practice,the combination of Jing acupoints bloodletting and Sangzhi(Mori Ramulus)have been widely used in the treatment of various diseases,and in terms of their mechanism of action,the combined treatment has a positive effect on post-stroke SHS,but there are few reports on this.Therefore,it is worth affirming the efficacy of combined treatment of SHS after stroke.This article elaborates the theoretical basis of Jing acupoints bloodletting on SHS after stroke,and the research progress of Sangzhi(Mori Ramulus)in treating SHS after stroke,which provide the theoretical guidance for the combination.

Delphi and Analytic hierarchy process for the construction of a risk assessment index system for post-stroke shoulder-hand syndrome

Background:Shoulder-hand syndrome(SHS)is one of the common complications after stroke,which is difficult to cure once it occurs.Early risk identification is an effective measure to prevent and treat SHS,but there is no effective tool to assess the risk assessment of SHS.Objective:To develop a validated tool to assess the risk of SHS occurrence after stroke.Methods:This was an observational study with a 3-step process:(1)Literature review to establish initial indicators;(2)Application of a modified Delphi method for two rounds of correspondence,with final indicators obtained by modifying each round based on expert opinion;(3)Application of hierarchical analysis to determine the weights of each indicator.Results:The initial literature review constructed4 primary indicators and 24 secondary indicators;after the first round of Delphi,a total of 10 secondary indicators were deleted and 6 secondary indicators were added,and the final indicators included 3 primary indicators and 15 secondary indicators,and in the second round,consensus was reached;by AHP analysis,the highest weight was given to existing risk factors(0.5584),followed by relevant medical history(0.3196);lastly,demographic factors(0.1220),and the scores of other secondary indicators met the requirements.Conclusion:This study establishes and constructs a post-stroke SHS risk assessment tool,which provides a basis for early identification of SHS and early intervention.Meanwhile,this study provides a methodological reference for the development of other indicatorssets.

Clinical Research of Traditional Chinese Medicine Fumigation and Washing Combined with Rehabilitation Training in the Treatment of Post-Apoplexy Shoulder-Hand Syndrome

Objective:To observe the clinical effect of traditional Chinese medicine fumigation and washing combined with routine rehabilitation training on post-stroke shoulder and hand syndrome(SHS).Comparing and analysing the effects of this treatment on the living ability of patients with post-stroke shoulder and hand syndrome.Methods:Fifty patients with post-stroke SHS who met the inclusion criteria were divided into observation group and control group by random number table method with 25 cases in each group.Both groups were given post-stroke secondary prophylactic drugs,while the control group was given routine rehabilitation training,20-30 minutes at a time,once a day,5 days a week,4 weeks as a course of treatment.On the basis of treatment in the control group,the observation group was combined with traditional Chinese medicine fumigation and washing,decocted with water to extract 3,000-4,000 ml juice,and added into the medicine bath bucket to soak the affected limb for 30-40 minutes,once a day,5 days a week,4 weeks as a course of treatment.The changes of upper limb edema degree,Numeric Rating Scale(NRS)score,Barthel index(MBI)and Fugl-Meyer Rating(FMA)scores before and after treatment were observed between the two groups,and the differences of clinical efficacy between the two groups were compared.Results:After treatment,the total effective rate in observation group was significantly better than that in control group(P<0.05).After treatment,the degree in upper limb edema in the two groups was significantly reduced(P<0.05),NRS score was decreased(P<0.05).Barthel index and FMA score were significantly increased(P<0.05),and the degree of upper limb edema and NRS score in the observation group were significantly lower than those in the control group(P<0.05).Barthel index and FMA score were significantly higher than those in the control group(P<0.05).Conclusion:The combination of traditional Chinese medicine fuming and washing with rehabilitation training has a better therapeutic effect on SHS,and the clinical efficacy of the former is more significant than that of single rehabilitation training.In clinical application,the former shows low cost,simple and easy operation,high acceptance by patients,and is conducive to promotion and use.

Portopulmonary hypertension and hepatopulmonary syndrome

Portopulmonary hypertension(POPH) and hepatopulmonary syndrome(HPS) are two frequent complications of liver disease, with prevalence among liver transplant candidates of 6% and 10%, respectively. Both conditions result from a lack of hepatic clearance of vasoactive substances produced in the splanchnic territory. Subsequently, these substances cause mainly pulmonary vascular remodeling and some degree of vasoconstriction in POPH with resulting elevated pulmonary pressure and right ventricular dysfunction. In HPS the vasoactive mediators cause intrapulmonary shunts with hypoxemia. Medical treatment is disappointing overall. Whereas liver transplantation(LT) results in the disappearance of HPS within six to twelve months, its effect on POPH is highly unpredictable. Modern strategies in managing HPS and POPH rely on a thorough screening and grading of the disease's severity, in order to tailor the appropriate therapy and select only the patients who will benefit from LT. The anesthesiologist plays a central role in managing these high-risk patients. Indeed, the important hemodynamic and respiratory modifications of the perioperative period mustbe avoided through continuation of the preoperatively initiated drugs, appropriate intraoperative monitoring and proper hemodynamic and respiratory therapies.

Alternative technique to save ischemic bowel segment in management of neonatal short bowel syndrome: A case report

BACKGROUND Congenital short bowel syndrome(SBS)associated with malrotation,gut volvulus and jejuno-ileal atresia is a very rare condition.It is a severe challenge for surgeons to preserve residual ischemic bowel segment in the management of short bowel syndrome,especially in neonates.CASE SUMMARY We report a newborn baby with gut malrotation associated with jejuno-ileal atresia,congenital SBS and jejunal volvulus.Hematemesis and abdominal distention were noted.At laparotomy,malrotation associated with jejuno-ileal atresia,congenital SBS and jenunal volvulus was confirmed.The total length of the small bowel was 63 cm with proximal jejunal bowel segment measuring 38 cm,including 18 cm necrotic segment below the Treitz’s ligament and 20 cm severe ischemic segment.The distal part of the small bowel was 25 cm in length and only about 0.8 cm in diameter.Ladd’s procedure,necrotic segment resection and end-to-back duodeno-ileal anastomosis were performed.The residual severe ischemic jejunum was preserved with single proximal stoma and distal end closure.Three months later,to restore the continuity of the isolated gut segment,end-to-end duodeno-jejunal and jejuno-ileal anastomosis was performed.The entire functional small bowel length increased to 80 cm.Intravenous fluid therapy and parenteral nutrition were discontinued on the 10th day postoperatively.Twelve months later,her body weight was 9.5 kg.CONCLUSION Isolation of severe ischemic bowel segment and staged anastomosis to restore the gut continuity for infants with SBS are safe and feasible.

Hepatorenal syndrome

Hepatorenal syndrome (HRS) is a "functional" and reversible form of renal failure that occurs in patients with advanced chronic liver disease. The distinctive hallmark feature of HRS is the intense renal vasoconstriction caused by interactions between systemic and portal hemodynamics. This results in activation of vasoconstrictors and suppression of vasodilators in the renal circulation. Epidemiology, pathophysiology, as well as current and emerging therapies of HRS are discussed in this review.

Relationship between the Clinical Features and the Viral Antigen in the Extremity Blood of the Patients with Hemorrhagic Fever with Renal Syndrome

Summary: The direct immunogold silver staining (D IGSS) method was used to detect the viral antigen in the extremity blood of 67 cases of hemorrhagic fever with renal syndrome. The positive rate of viral antigen was the highest during the fever, hypotension and oligouria phrase; and the rate dropped gradually during the polyuria and convalescent phase. It is suggested that clinical staging was positively related with the percentage of the viral antigen positive cells (P<0.001). It is concluded that the positive rate was related to the extent of the injuries by direct viral attack and immune reaction. The D IGSS was proved to be fast, simple, economical, with high sensitivity and specificity.

宣肺降浊清肠汤治疗稳定期支气管扩张症疗效及对肠道微生态的影响

目的观察宣肺降浊清肠汤治疗稳定期支气管扩张患者的效果及对肠道微生态的影响。方法选取2022年1月—2023年1月广州医科大学附属第一医院收治的稳定期支气管扩张症痰湿蕴肺型患者90例为观察对象,随机分为西药组、中药组、中西医结合组,每组各30例;同时于广州医科大学附属第一医院体检中心随机选取30例健康者作为空白组,用于肠道菌群检测的对照。西药组给予氨溴索口服,中药组给予宣肺降浊清肠汤颗粒剂口服,中西医结合组给予宣肺降浊清肠汤联合氨溴索口服。连续治疗6个月后评估3组临床疗效,比较3组治疗前后肺功能指标[第一秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、呼气峰值流速(PEF)]、支气管扩张严重程度指数(BSI)评分、24 h痰量、急性加重次数、咳嗽-咳痰评估问卷(CASA-Q)评分、圣乔治呼吸问卷(SGRQ)评分及粪便标本中直肠真杆菌、多形拟杆菌表达量(采用PCR扩增法测定)。结果治疗结束后,中西医结合组临床总有效率明显高于中药组、西药组[93.3%(28/30)比63.3%(18/30)、76.7%(23/30),P均<0.05]。与治疗前比较,治疗后3组FEV_(1)、FVC、PEF均明显提高,BSI评分、SGRQ评分均明显降低,24 h痰量、急性加重次数均明显减少,CASA-Q评分均明显升高,且中西医结合组各指标改善情况均明显优于中药组及西药组,西药组各指标改善情况均明显优于中药组,差异均有统计学意义(P均<0.05)。治疗后中西医结合组和中药组粪便中直肠真杆菌、多形拟杆菌表达量均较治疗前明显改善(P均<0.05),西药组粪便直肠真杆菌、多形拟杆菌表达量均无明显变化(P均>0.05);治疗后中药组和中西医结合组直肠真杆菌表达量均明显低于西药组(P均<0.05),多形拟杆菌表达量均明显高于西药组(P均<0.05),中药组和中西医结合组直肠真杆菌、多形拟杆菌表达量比较差异均无统计学意义(P均>0.05)。结论宣肺降浊清肠汤联合氨溴索治疗稳定期支气管扩张症痰湿蕴肺型患者效果优于二者单独应用,可有效缓解患者病情,改善肺功能和生活质量,机制可能与宣肺降浊清肠汤可调节肠道菌群微生态相关。

“筋揉骨正”中医特色疗法在股骨粗隆间骨折术后康复中的应用

目的:基于“筋揉骨正”理论观察中医特色康复疗法在股骨粗隆间骨折患者术后康复中的应用效果。方法:回顾性分析天津中医药大学第二附属医院2021年6月至2022年6月收治的股骨粗隆间骨折住院患者84例,按照治疗方法不同分为对照组和观察组,每组42例。对照组采用Intertan或PFNA髓内钉固定手术治疗,观察组在其基础上结合中医特色三期辨证治疗。比较2组疗效、中医证候积分、髋关节功能、骨强度及并发症。结果:观察组治疗总有效率高于对照组,观察组治疗后的各项中医证候积分均低于对照组,差异有统计学意义(P<0.05)。观察组治疗后的Harris髋关节评分和骨密度值高于对照组,差异有统计学意义(P<0.05)。2组感染、下肢深静脉血栓、关节僵硬、压疮等并发症发生率差异无统计学意义(P>0.05)。结论:基于“筋揉骨正”理论采用中医特色康复疗法治疗股骨粗隆间骨折术后康复效果显著,可以提高患者髋关节功能和骨密度,安全性良好。

护肩载药用于脑卒中肩手综合征Ⅰ期的疗效观察

目的评估护肩载药对脑卒中患者肩手综合征Ⅰ期的疗效。方法脑卒中肩手综合征Ⅰ期患者96例,随机分为对照组、中药外敷组与护肩载药组,每组各32例。所有患者均接受脑卒中基础治疗和常规护理,对照组予传统康复治疗,中药外敷组予传统康复治疗和中药外敷治疗,护肩载药组予护肩载药、传统康复治疗和中药外敷治疗。比较三组治疗前、治疗后2、4周疼痛评分(VAS)、上肢功能评分(FMA)、日常生活能力(Barthel指数)、手部肿胀情况,以及治疗后满意度和舒适度。结果4周后,护肩载药组总有效率高于中药外敷组和对照组,差异有统计学意义(P<0.05)。治疗2周后,护肩载药组和中药外敷组VAS评分和手部肿胀程度较治疗前下降,Barthel指数和FMA评分提高(P<0.05),护肩载药组效果优于中药外敷组和对照组(P<0.05)。治疗4周后,三组患者VAS评分和手部肿胀程度较治疗前明显降低;FMA评分和Barthel指数提高(P<0.05)。护肩载药组在改善VAS评分和FMA评分方面优于中药外敷组和对照组(P<0.05)。护肩载药组患者满意度和舒适度高于中药外敷组和对照组(P<0.05)。结论护肩载药对脑卒中后肩手综合征Ⅰ期治疗效果满意,能够有效缓解疼痛、减轻肿胀、提高患者肢体功能和日常生活能力,同时增强患者的舒适感和满意度。

周婷基于经筋理论分期论治亨特氏综合征临床经验

拉姆齐-亨特综合征(Ramsay Hunt syndrome,RHS)是一种由水痘-带状疱疹病毒重新激活侵犯面神经膝状神经节导致剧烈耳痛,耳聋,眩晕及面瘫的综合征,病情重、预后差,是临床难治性面瘫类型。目前的西医治疗对面瘫改善情况并不理想。周婷主任医师善于将传统针灸理论与现代医学相结合,认为RHS病因病机为正邪相争、经筋失养,病位在头面三阳经筋。根据疾病不同阶段采取不同治疗手段,急性期浅刺配合艾灸主驱邪兼扶正;恢复期透刺结合电针强调疏通经筋,驱邪与扶正并举;后遗症期以透刺结合滞针提拉手法调和气血,柔筋解痉。针对不同阶段灵活调整不同针刺方法及治疗方案,分期治疗,可提高临床治疗RHS的疗效。

培本清利通络方治疗慢性肾脏病3~5期伴CKD-MBD脾肾两虚兼湿瘀证的临床研究

目的:观察基于吴门医派“络病理论”创立的培本清利通络方联合骨化三醇胶丸治疗慢性肾脏病(CKD)3~5期伴CKD-矿物质及骨代谢紊乱(CKD-MBD)脾肾两虚兼湿瘀证患者的效果。方法:选择2022年7月—2023年6月于南京中医药大学附属苏州市中医医院就诊的脾肾两虚兼湿瘀证CKD 3~5期合并有CKD-MBD的患者60例,随机分为治疗组和对照组,每组30例。对照组予控制血压、控制血糖、改善贫血等基础治疗,同时口服骨化三醇胶丸;治疗组在对照组治疗基础上加服培本清利通络方,两组疗程均为12周。比较两组患者治疗前后肾功能[血肌酐(Scr)、血尿素氮(BUN)、尿酸(UA)]、矿物质及骨代谢[钙(Ca)、磷(P)、全段甲状旁腺激素(iPTH)、碱性磷酸酶(ALP)]、中医症候积分、生活质量评分,并评估临床疗效;治疗前后检测两组血常规、肝功能、血钾,以评估用药安全性。结果:两组治疗后中医症候积分均较治疗前降低,且治疗组低于对照组(P<0.05);治疗组总有效率为93.33%,明显高于对照组的73.33%(P<0.05);治疗后,治疗组BUN、UA均明显低于治疗前,且Scr、BUN均明显低于对照组,差异均有统计学意义(P<0.05);治疗后,治疗组P、iPTH均明显低于治疗前,Ca明显高于治疗前,且治疗组Ca高于对照组,iPTH低于对照组,差异均有统计学意义(P<0.05);治疗后,治疗组生活质量评分较治疗前明显下降,且治疗组低于对照组(P<0.05);两组治疗后安全性指标比较,差异均无统计学意义(P>0.05)。结论:培本清利通络方可改善CKD 3~5期合并CKD-MBD脾肾两虚兼湿瘀证患者Ca、P、iPTH指标,延缓肾功能减退,减轻患者腰脊酸痛、皮肤瘙痒、倦怠乏力等症状,并可提高患者生活质量。

清热解毒法在恶性肿瘤治疗中的临床应用

现代中医肿瘤学的癌毒病机理论提出,清热解毒法为治疗恶性肿瘤的抗癌解毒八法之一,可在恶性肿瘤治疗中广泛应用。清热解毒法治疗恶性肿瘤的临床应用需基于辨证、辨病、分期、辨体相结合的综合辨治模式。若肿瘤患者热毒证候明显,辨证应用清热解毒法无疑;若热毒不明显或无证可辨,结合现代肿瘤的病理本质特征,在不违背整体遣方用药原则下,可辨病应用清热解毒法以发挥抗癌祛毒之效。清热解毒法本质属于攻法,其辨证或辨病应用均应以患者正气强弱为考量因素,同时还需结合患者的肿瘤分期、体质因素等。辨证应用强调了清热解毒法运用于肿瘤热毒证的普遍性,辨病应用突破了清热解毒法仅用于宏观热毒证的局限性,分期应用体现了清热解毒法阶段性使用的精准性,辨体应用则体现了清热解毒法应用过程中的个体性。辨证、辨病、分期、辨体4种辨治模式当相互参照、综合运用,方可取得显效。治疗肿瘤常用的清热解毒药物有白花蛇舌草、半枝莲、重楼、天葵子、漏芦、山豆根等。

糖尿病肾病中医辨证分型研究概述

近年来临床上关于糖尿病肾病(DKD)中医辨证分型和治法方药的研究涌现了多种学术观点。辨证方式主要包括根据病因病机辨证及根据临床分期辨证两种。病因病机辨证主要包括病因辨证与脏腑辨证,脏腑辨证中主要涉及脾不散精理论和心肾一体论;分期辨证则多以DKD的各种西医分期为基础。随着检验检查技术的提高,检验指标和检查结果逐渐成为辨证分型的物质基础和量化指标,DKD辨证分型涉及的检查指标主要有糖脂代谢指标、炎症因子、尿蛋白及肾功能相关指标、肾脏血流动力学指标等。参考文献82篇。

支气管哮喘“辨病、辨期、辨证、辨体”防治体系探讨

本文梳理辨证论治及辨病论证的源流脉络,结合现代医学的研究成果,提出基于病证结合的支气管哮喘“辨病、辨期、辨证、辨体”防治体系,以哮喘核心病机为着眼点,以不同临床分期的阶段病机为落脚点,以达到缓解急性发作、改善疾病控制、调节禀赋体质、延缓疾病进展的目的,为相关现代中西医结合疾病防治体系的构建提供思路与启示。

经济毒性在晚期肺癌病人症状负担与失志综合征中的中介效应

目的:探讨经济毒性在晚期肺癌病人症状负担与失志综合征中的中介作用。方法:采用便利抽样法选取2022年2月-2023年2月在郑州市某三级甲等医院住院的292例晚期肺癌病人作为研究对象,采用一般资料调查表、癌症病人报告结局的经济毒性量表、安德森症状量表、简化版失志量表进行问卷调查。应用SPSS 26.0软件及AMOS 28.0软件进行统计分析。结果:晚期肺癌病人经济毒性总分为(11.66±4.35)分,症状严重程度总分为(123.14±14.23)分,症状困扰程度总分为(37.96±6.31)分,失志综合征总分为(18.73±5.11)分;Pearson相关分析显示,经济毒性总分与症状严重程度、症状困扰程度及失志综合征得分均呈负相关(r值分别为-0.601,-0.537,-0.578,P<0.01),失志综合征得分与症状严重程度及症状困扰程度得分均呈正相关(r值分别为0.502,0.538,P<0.01)。Bootstrap法显示,经济毒性在症状负担与失志综合征间起部分中介作用,经济毒性在症状严重程度与失志综合征间的间接效应占总效应的33.15%。经济毒性在症状困扰程度与失志综合征间的间接效应占总效应的35.26%。结论:晚期肺癌病人经济毒性在症状负担与失志综合征间起部分中介作用,医护人员应为病人提供全面支持,降低其经济毒性,进而降低其失志水平。

代谢综合征与胰腺癌患者的临床病理特征和预后的相关性研究

目的:探讨代谢综合征(MS)及其组分与胰腺癌患者临床病理特征的相关性和预后影响,为胰腺癌的综合防治、个性化诊疗提供理论参考。方法:回顾性分析2017年1月至2021年12月广西医科大学第一附属医院收治的184例胰腺癌患者的临床资料。根据MS诊断标准,分为非MS组(144例)和MS组(40例)。比较两组临床病理特征。Cox回归模型分析未经抗癌治疗的49例患者预后的影响因素,Kaplan-Meier法分析MS及其组分与预后的关系。结果:与非MS组比较,MS组患者TNM分期晚,肿瘤远处转移发生率高(P<0.05)。低水平高密度脂蛋白胆固醇(HDL-C)和高血糖均为胰腺癌TNM分期的独立危险因素(P<0.05)。49例未经抗癌治疗的患者中位生存时间为2.5个月。生存分析显示,TNM分期晚、高血糖为生存时间的独立危险因素(P<0.05),其中Ⅳ期患者中位生存时间为2.2个月,高血糖是Ⅳ期患者预后的独立危险因素,超重是保护因素(均P<0.05)。MS患者与非MS患者生存时间比较,差异无统计学意义(P>0.05)。有无高血压、高甘油三酯(TG)、低HDL-C的患者之间的中位生存时间比较,差异均无统计学意义(均P>0.05)。结论:MS与胰腺癌患者的临床分期、肿瘤远处转移发生率相关,但尚不能证明是患者生存的影响因素,高血糖和超重分别是患者预后的独立危险因素和保护因素。

急性呼吸窘迫综合征患者死亡率预测的两阶段堆叠异构集成模型

目的建立一个机器学习模型能够准确预测急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者死亡风险,选取合适的填充方式解决现有电子健康记录(electronic health record,EHR)中存在的稀疏性、不规则性问题,辅助医生进行临床决策。方法从重症监护医学信息数据库(medical information mart for intensive care,MIMIC-Ⅲ)中筛选符合“柏林定义”的ARDS患者,并对患者入院24 h内的生命体征、实验室指标、诊断代码、影像学报告等数据进行回顾性分析,首先使用非负潜在因子分解填补缺失值,然后构建两阶段的堆叠异构集成学习方法,预测患者30 d内的死亡风险,采用受试者工作特征曲线下面积(area under the receiver operation characteristic curve,AUROC)、准确度、精确度、F1值等指标对模型进行评价,并进行特征重要性分析。结果本研究共纳入2576个患者,80%用于训练,20%用于模型测试。利用不同填充方式对数据进行处理,非负潜在因子分解相较于其他填充方式能够更好地保留原数据的分布结构,有着更高的填充精度。对填充好的数据进行建模,两阶段堆叠集成模型的准确度为0.841,AUROC为0.846,F1值为0.586,相较于其他机器学习模型展示出了更好的预测能力。结论两阶段的堆叠异构集成学习模型能够较好地实现对ARDS患者死亡风险预测。