Physiology and health assessment,risk balance,and model for endstage liver disease scores:Postoperative outcome of liver transplantation

BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To provide fair organ distribution,predictive mortality scores have been developed.AIM To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of mortality.METHODS Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.RESULTS The transplant recipients were mainly male,with a mean age of 58.1 years.Donors were mostly male,with a mean age of 41.6 years.The median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 days.For APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD 24.2.The 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<0.008.At 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and survivors.As for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.

负压封闭引流联合保留臀上动脉浅支的臀大肌肌皮瓣修复骶尾部IV期压疮的临床效果

目的:探讨负压封闭引流联合保留臀上动脉浅支的臀大肌旋转肌皮瓣修复骶尾部压疮的临床效果。方法:选取2019年6月—2023年10月温州医科大学附属第一医院收治的12例骶尾部压疮患者,其中男7例,女5例,年龄31~86岁。入院后I期予行负压封闭引流术,4~7 d后行保留臀上动脉浅支的臀大肌肌皮瓣修复创面。观察术后皮瓣成活情况、并发症发生情况,随访观察皮瓣外形、压疮复发情况。结果:本组12例患者,均因长期卧床致骶尾部受压出现IV期压疮,压疮病因:截瘫患者5例,各种原因所致的长期卧床患者7例,其中脑梗死后遗症患者2例,帕金森病患者3例,老年痴呆症患者1例,股骨颈骨折患者1例。病程2周至8年,清创后创面面积为5.0 cm×5.0 cm~10.0 cm×12.0 cm。12例患者术后皮瓣均完全成活,无皮瓣坏死、静脉淤血、创缘开裂等发生。术后随访2~6个月,皮瓣外形较佳、骶尾部软组织饱满、压疮无复发。结论:保留臀上动脉浅支的臀大肌旋转肌皮瓣血运可靠,设计、操作简单,皮瓣可修复面积大,切取不需要离断臀上动脉浅支,供瓣区一般能直接缝合,修复骶尾部压疮效果较佳。

基于MIMIC-IV构建及评估脓毒症患者近期和远期死亡风险预测模型

目的:鉴于脓毒症的高发病率和高病死率,早期识别高风险患者并及时干预至关重要,而现有死亡风险预测模型在操作、适用性和预测长期预后等方面均存在不足。本研究旨在探讨脓毒症患者死亡的危险因素,构建近期和远期死亡风险预测模型。方法:从美国重症监护医学信息数据库IV(Medical Information Mart for Intensive Care-IV,MIMIC-IV)中选取符合脓毒症3.0诊断标准的人群,按7?3的比例随机分为建模组和验证组,分析患者的基线资料。采用单因素Cox回归分析和全子集回归确定脓毒症患者死亡的危险因素并筛选出构建预测模型的变量。分别用时间依赖性曲线下面积(area under the curve,AUC)、校准曲线和决策曲线评估模型的区分度、校准度和临床实用性。结果:共纳入14240例脓毒症患者,28 d和1年病死率分别为21.45%(3054例)和36.50%(5198例)。高龄、女性、高感染相关器官衰竭评分(sepsis-related organ failure assessment,SOFA)、高简明急性生理学评分(simplified acute physiology score II,SAPS II)、心率快、呼吸频率快、脓毒症休克、充血性心力衰竭、慢性阻塞性肺疾病、肝脏疾病、肾脏疾病、糖尿病、恶性肿瘤、高白细胞计数(white blood cell count,WBC)、长凝血酶原时间(prothrombin time,PT)、高血肌酐(serum creatinine,SCr)水平均为脓毒症死亡的危险因素(均P<0.05)。由PT、呼吸频率、体温、合并恶性肿瘤、合并肝脏疾病、脓毒症休克、SAPS II及年龄8个变量构建的模型,其28 d和1年生存的AUC分别为0.717(95%CI 0.710~0.724)和0.716(95%CI 0.707~0.725)。校准曲线和决策曲线表明该模型具有良好的校准度及较好的临床应用价值。结论:基于MIMIC-IV建立的脓毒症患者近期和远期死亡风险预测模型有较好的识别能力,对患者预后风险评估及干预治疗具有一定的临床参考意义。

Synthesis and optophysical properties of blue-emitting iridium (Ⅲ) complex bearing oxadiazole-based picolinic acid derivative

An iridium （Ⅲ） bis[（4,6-difluorophenyl）pyridinato-N, C^2][6-（6＇-（4＂-（ 5＂-phenyl- 1＂, 3＂, 4＂-oxadiazole-2＂-yl） phenoxy） hexyloxy picolinate） was synthesized and characterized by IH NMR and elementary analysis in order to study the effect of ancillary ligand of the oxadiazole-based picolinic acid derivative on optophysical properties of its iridium complex, and further to obtain an iridium complex with highly-efficient blue emission. The thermal stability, UV absorption and photoluminescent properties of this iridium complex were investigated. Compared with iridium （Ⅲ） bis[（4,6-difluorophenyl）pyridinato-N, C^2]（picolinate） reported as a highly-efficient blue electroluminescent material, this iridium complex bearing an oxadiazole-based picolinic acid derivative presents higher thermal stability, more intense UV absorption at 291 nm and similar photoluminescent spectrum peaked at 469 nm. This indicates that tuning ancillary ligand of picolinic acid with an oxadiazole unit can improve the optophysical properties of its iridium complex.

IV型车载储氢瓶聚合物内衬材料的氢气渗透性分析

详细总结论述了气体在高分子聚合物材料中的渗透机理,并简要介绍了有关IV型储氢瓶聚合物内衬氢气渗透性的测试方法以及国内外测试标准。基于此,进一步探讨了测试温度、测试压力以及聚合物材料性能对IV型储氢瓶内衬材料氢气渗透性的影响,并展望了未来的发展方向。

Structure,stability,catalytic activity,and polarizabilities of small iridium clusters

At the second order Douglas–Kroll–Hess（DKH2） level, the B3 PW91 functional in conjunction with the relativistic all-electron basis set of valence triple zeta quality plus polarization functions are employed to compute bond lengths, dissociation energies, vertical ionization potentials, and the highest occupied molecular orbital-lowest unoccupied molecular orbital energy gaps of the small iridium clusters（Irn, n≤8）. These results are compared with the experimental and theoretical data available in the literature. Our results confirm the theoretical predictions made by Feng et al. about the catalytic activities of the Ir4 and Ir6 clusters. From the optimized geometries, DKH2 calculations of static electric mean dipole polarizabilities and polarizability anisotropies are also carried out. It is the first time that the polarizabilities of small iridium clusters have been studied. For n≤4, the mean dipole polarizabilities per atom present an odd–even oscillatory behavior,whereas from Ir5 to Ir8, they decrease with the cluster size increasing. The dependence of the polarizability anisotropy on the structure symmetry of the iridium cluster is verified.

基于IVE模型重型柴油车尾气排放时空特征分析

该研究基于国际机动车排放(IVE)模型结合GPS轨迹点密度和道路长度的方法,建立了昆明市主城区重型柴油车大气污染物和温室气体的高分辨率网格化排放清单,量化了重型柴油车的行驶特征,确定了车辆的VSP bin分布特征、环境变量和车辆技术特征,改进了污染物空间分配方法。结果表明,昆明市主城区的CO_(2)、NOx和PM日排放总量分别为373.481、2.43和0.193 t。驾驶模式工况主要向VSP bin12趋近,其后逐渐降低;污染物的排放因子随车速变化而有规律的变化。从时间分布来看,污染物的小时排放模式均呈现出双峰趋势,表明交通拥堵和通勤高峰时段是污染物排放的主要时段;将轨迹点密度和网格道路长度作为污染物空间分配的权重因子,能够更真实地反映污染物排放强度的分布模式。

Catalytic Activity of Iridium Dioxide With Different Morphologies for Oxygen Reduction Reaction

Iridium dioxide with different morphologies(nanorod and nanogranular) is successfully prepared by a modified sol-gel and Adams methods. The catalytic activity of both samples for oxygen reduction reaction is investigated in an alkaline solution. The electrochemical results show that the catalytic activity of the nanogranular Ir O2 sample is superior to that of the nanorod sample due to its higher onset potential for oxygen reduction reaction and higher electrode current density in low potential region. The results of Koutecky-Levich analysis indicate that the oxygen reduction reaction catalyzed by both samples is a mixture transfer pathway. It is dominated by four electron transfer pathway for both samples in high overpotential area, while it is controlled by two electron transfer process for both samples in low overpotential area.

Novel Iridium Complex with Carbazol-2-yl-β-diketone Derivative:Low-energy Excitation and Red Electrophosphorescent Devices

A novel iridium-complex,（BPPBI） 2 Ir（2-TFDBC）[BPPBI=2-（biphenyl-4-yl）-1-phenyl-1H-benzo[d]imidazole,2-TFDBC=1-（9-ethyl-9H-carbazol-2-yl）-4,4,4-trifluorobutane-1,3-dione],was synthesized,and its structure and component were confirmed by 1 H NMR and element analysis,respectively.UV-Vis absorption and photoluminescent（PL） spectra of（BPPBI） 2 Ir（2-TFDBC） in dichloromethane were investigated.The Ir-complex exhibited a long wavelength excitation of 470 nm,i.e.,low-energy excitation.So,it is a promising candidate for phosphorescent probe and PL material.（BPPBI） 2 Ir（2-TFDBC）-based electroluminescent devices,ITO/MoO 3（10 nm）/NPB（80 nm）/CBP：x（BPPBI） 2 Ir（2-TFDBC）（20 nm）/TPBi（45 nm）/LiF/Al,were fabricated,where x（%） was of 4% or 8% doping concentration（mass fraction）;ITO=indium tin oxides;NBP=N,N＇-bis-（1-naphthalenyl）-N,N＇-bis-phenyl-（1,1＇-biphenyl）4,4＇-diamine,CBP=4,4＇-bis（N-carbazolyl）-1,1＇-biphenyl,TPBi=1,3,5-tris（1-phenyl-1H-benzimidazol-2-yl）benzene.The devices showed a red emission of 620 nm.The maximum current efficiency and brightness were 1.7 cd/A and 4063 cd/m 2 for a device of 8%（mass fraction） doping level,respectively.The moderate luminous efficiency was due to the inadequate energy transfer from the host material to the guest material.

Morphology and Electrochemical Properties of Activated and Sputtered Iridium Oxide Films for Functional Electrostimulation

Iridium oxide (IrOx) has attracted much attention for neural interface applications due to its ability to transfer between ionic and electronic current and to resist corrosion. The physical, mechanical, chemical, electrical and optical properties of thin films depend on the method and parameters used to deposit the films. In this report, the surface morphology, impedance and charge capacity of activated iridium oxide film (AIROF) and sputtered iridium oxide film (SIROF) were investigated in vitro and compared. The Utah Electrode Array (UEA) having similar electrode area and shape were employed in this study. The electrode coated with AIROF and SIROF were characterized by scanning electron microcopy, cyclic voltammetry, electrochemical impedance spectroscopy and potential transient measurements to measure charge injection capacity (CIC). SIROF and AIROF selectively deposited on electrode tip had dendrite and granular microstructure, respectively. The CIC of unbiased SIROF and AIROF was found to be 2 and 1 mC/cm2, respectively, which is comparable to other published values. The average impedance, at a frequency of 1 kHz was ~65 and ~7 kΩ for the AIROF and SIROF, respectively. Low impedance and high CIC makes SIROF highly recommended stimulation and recording material.

Microfluidic-oriented synthesis of enriched iridium nanodots/carbon architecture for robust electrocatalytic nitrogen fixation

Electrocatalytic nitrogen reduction reaction(NRR)is considered as a promising candidate to achieve ammonia synthesis because of clean electric energy,moderate reaction condition,safe operating process and harmless by-products.However,the chemical inertness of nitrogen and poor activated capacity on catalyst surface usually produce low ammonia yield and faradic efficiency.Herein,the microfluidic technology is proposed to efficiently fabricate enriched iridium nanodots/carbon architecture.Owing to in-situ co-precipitation reaction and microfluidic manipulation,the iridium nanodots/carbon nanomaterials possess small average size,uniform dispersion,high conductivity and abundant active sites,producing good proton activation and rapid electrons transmission and moderate adsorption/desorption capacity.As a result,the as-prepared iridium nanodots/carbon nanomaterials realize large ammonia yield of 28.73 μg h^(-1) cm^(-2) and faradic efficiency of 9.14%in KOH solution.Moreover,the high ammonia yield of 11.21 μg h^(-1) cm^(-2) and faradic efficiency of 24.30%are also achieved in H_(2)SO_(4) solution.The microfluidic method provides a reference for large-scale fabrication of nano-sized catalyst materials,which may accelerate the progress of electrocatalytic NRR in industrialization field.

Facile fabrication of ultrafine nickel-iridium alloy nanoparticles/graphene hybrid with enhanced mass activity and stability for overall water splitting

Developing active and durable electrocatalysts for overall water splitting is desirable but challenging to realize sustainable hydrogen production.Here,we report a facile and general method to prepare ultrafine nickel(Ni)-iridium(Ir)alloy nanoparticles/graphene hybrids for overall water splitting.The optimized hybrid with 4.9 wt%Ir exhibits much higher catalytic activity and durability than commercial 20 wt%Ir/C for both oxygen evolution reaction(OER)and hydrogen evolution reaction(HER).Theoretical simulations reveal that the incorporation of Ir in metallic Ni lattice regulates hydrogen adsorption free energy to the optimum level,thus improving HER activity,while in situ generated amorphous Ir-Ni hydr(oxy)oxides around metallic Ni-Ir core have been demonstrated to be the active species under OER conditions,which switches OER rate-determining step to energy-favorable pathway.The overall water splitting electrolyzer assembled by the optimized electrocatalyst shows a low cell voltage of only 1.52 V and excellent stability to deliver a current density of 10 m A cm-2.This work provides a powerful strategy toward general synthesis of ultrafine alloy nanoparticles for high-performance overall water splitting.

Effective ethanol-to-CO_(2) electrocatalysis at iridium-bismuth oxide featuring the impressive negative shifting of the working potential

Since low overpotential for the anodic ethanol oxidation reaction(EOR)can favor the higher output voltage and power of direct ethanol fuel cells(DEFCs),it is critical to design new EOR catalysts with efficient ethanol-to-CO_(2)activity at low applied potentials.Thereby,carbon-supported Ir-Bi_(2)O_(3)(Ir-Bi_(2)O_(3)/C)catalysts with highly dispersive bismuth oxide on the iridium surface are designed and prepared,which can merit splitting the ethanol C–C bond and promoting the oxidation of C1 intermediates at the bifunctional interfaces.The as-obtained Ir-Bi2O3/C catalysts show superior EOR mass activity of up to ca.2250 m A mgIr-1.Moreover,they exhibit the record lowest onset oxidation potentials(0.17–0.22 V vs.RHE)and the peak potential(ca.0.58 V vs.RHE),being 130–300 m V lower than the previous landmark noble metallic catalysts.Furthermore,an apparent C1 pathway faraday efficiency(FEC1)of 28%±5.9%at 0.5 V vs.RHE can be obtained at Ir-Bi_(2)O_(3)/C.This work might provide new insights into the new anodic EOR catalysts for increasing the power of DEFCs.

Selective hydrogenation of 1,3-butadiene on iridium nanostructures:Structure sensitivity, host effect, and deactivation mechanism

A systematic study on the structure sensitivity,host effect,and the deactivation mechanism of Ircatalyzed selective hydrogenation of 1,3-butadiene,a key process in the purification of alkadiene for the upgrading of C4 cut,is presented by coupling steady-state catalytic testing,in-depth characterization,kinetic evaluation,and density functional theory calculations.We reveal that:(i) 1,3-Butadiene hydrogenation on iridium is structure-sensitive with the optimal particle size of about 2 nm,and the H_(2) dissociation energy is a reliable activity descriptor;(ii) The nature of the NC hosts exerts a critical impact on the catalytic performance,and balanced nitrogen content and speciation seem key for the optimized performance;and (iii) Different deactivation mechanisms occur:fouling by coke deposition on the catalysts with a high N:C ratio (>1),and site blockage due to the competitive adsorption between 1-butene/cis-2-butene and 1,3-butadiene.These molecular insights provide valuable guidelines for the catalyst design in selective hydrogenations.

Comparative characterization of iridium loading on catalyst assessment under different conditions

To discuss the potential role of iridium(Ir)nanoparticles loaded under atmospheric and high pressures,we prepared a series of cata-lysts with the same active phase but different contents of 10wt%,20wt%,and 30wt%on gamma-alumina for decomposition of hydrazine.Un-der atmospheric pressure,the performance of the catalyst was better when 30wt%of the Ir nanoparticles was used with chelating agent that had greater selectivity of approximately 27%.The increase in the reaction rate from 175 to 220 h^(−1)at higher Ir loading(30wt%)was due to a good dispersion of high-number active phases rather than an agglomeration surface.As a satisfactory result of this investigation at high pressure,Ir catalysts with different weight percentages showed the same stability against crushing and activity with a characteristic velocity of approxim-ately 1300 m/s.

基于STM32F373的光伏组件IV特性测试系统

为准确方便测量光伏组件的IV特性曲线,设计一款基于STM32F373的光伏组件IV特性测试系统,可测量开路电压、短路电流、IV曲线、PV曲线等。该系统由电流控制单元、信号采集单元、软件处理单元、通信单元、上位机显示单元等组成,采用电子负载电路,以STM32F373单片机DAC输出来调节恒流的电流,同时采集光伏电池的输出电压,对采集到的数据进行卡尔曼滤波和曲线拟合,将电压、电流、功率生成IV、PV曲线显示在TFT彩屏上。该系统还可将数据远程传输到PC端进行数据分析与曲线观察。结果表明,该系统采集曲线准确且速度快,性能良好,采集一次IV曲线的时间仅需1 s,测量的电压电流误差小于1%。该系统体积小便于携带且内部带有锂电池,可充电,可在室外使用。

珍珠蚌肉二肽基肽酶-IV抑制肽的制备与分离

目的:以珍珠蚌肉为原料制备对二肽基肽酶(dipeptidyl peptidase,DPP)-IV具有抑制作用的生物活性肽。方法:利用两步酶解法并优化珍珠蚌肉酶解条件,筛选体外DPP-IV抑制活性较高组分进行超滤膜浓缩,Superdex^(TM) peptide 10/300 GL凝胶柱层析与反相高效液相色谱(reverse phase-high performance liquid chromatography,RP-HPLC)技术分离纯化出酶解液中的DPP-IV抑制肽,最终通过液相色谱-串联质谱鉴定其氨基酸序列。结果:中性蛋白酶与碱性蛋白酶对珍珠蚌肉均有良好降解效果,经3 kDa超滤膜浓缩后,酶解产物的DPP-IV抑制率可达67.4%。通过凝胶过滤柱和RP-HPLC进一步分离纯化出6个活性较高的肽段,序列分别为FNAPAM、FIPNY、IYNPPTPF、LAMPYP、FFVVMP和LAGMP。进一步,以分子对接的方式分析6个肽段与DPP-IV的相互作用关系。结论:本研究利用珍珠蚌肉制备DPP-IV抑制肽,可为以水产加工副产物为原料制备功能性食品提供理论参考。

参苓白术散联合桂枝茯苓丸、达格列净治疗2型糖尿病肾病IV期的蛋白尿的随机对照研究

目的:观察参苓白术散联合桂枝茯苓丸、达格列净治疗2型糖尿病肾病IV期患者蛋白尿的临床疗效。方法:收集于2021年9月~2022年9月潍坊市益都中心医院就诊的诊断为2型糖尿病肾病IV期患者60例。采用随机、对照的临床研究设计分为治疗组和对照组,观察患者症状评分、实验室指标、疾病疗效等指标变化。结果:本研究最终纳入统计分析的治疗组29例、对照组28例。治疗后,治疗组的中医证候、蛋白尿、肾小球滤过率(eGFR)、糖化血红蛋白(HbA1c)、D-二聚体、尿NGAL、低密度脂蛋白疗效优于对照组(P 0.05)。对照组经治后,尿NGAL较治疗前明显下降(P < 0.05),其余指标与治疗前均无差异(P < 0.05)。两组均未见不良反应。结论:参苓白术散联合桂枝茯苓丸、达格列净治疗可减轻DKD IV期患者临床症状,降低蛋白尿、NGAL、糖化血红蛋白、D-二聚体、低密度脂蛋白,保护肾小管及肾小球、改善机体高凝状态及血糖,延缓肾功能下降,提高临床疗效。

溶解素E1、可诱导共刺激分子、载脂蛋白A-IV在甲状腺功能减退症患者血清中的表达及相关性

目的探究甲状腺功能减退症(甲减)患者血清中溶解素E1(RvE1)、可诱导共刺激分子(ICOS)、载脂蛋白A-IV(Apo-AIV)表达水平,并分析其与疾病的相关性。方法选择2023年5月-2024年5月本院收治的234例甲减患者作为甲减组,另选同期240名甲状腺功能正常体检者作为对照组。依据垂体促甲状腺激素(TSH)及游离甲状腺素(FT4)水平将甲减组分为亚临床甲减组(103例)及临床甲减组(131例)。采用酶联免疫吸附法(ELISA)检测血清RvE1、ICOS、Apo-AIV水平,比较不同类型甲减患者甲状腺激素及血清RvE1、ICOS、Apo-AIV水平,采用Pearson法相关性分析血清RvE1、ICOS、Apo-AIV水平与甲状腺激素水平的相关性,采用多因素Logistic回归分析甲减发生的影响因素,采用受试者工作特征(ROC)曲线分析血清RvE1、ICOS、Apo-AIV水平对甲减的诊断价值。结果甲减组血清RvE1水平及游离三碘甲状腺原氨酸(FT3)、FT4水平低于对照组,血清ICOS、Apo-AIV水平及TSH水平高于对照组(P<0.05);亚临床甲减组患者血清RvE1水平及FT3、FT4水平高于临床甲减组,血清ICOS、Apo-AIV水平及TSH水平低于临床甲减组(P<0.05);血清RvE1水平与FT3、FT4水平正相关,与TSH水平负相关,血清ICOS、Apo-AIV水平与FT3、FT4水平负相关,与TSH水平正相关(P<0.05);血清RvE1(95%CI=0.464~0.692)、ICOS(95%CI=2.772~35.012)、Apo-AIV(95%CI=2.977~13.154)水平及FT3(95%CI=0.623~0.966)、FT4(95%CI=0.448~0.921)、TSH(95%CI=1.827~14.701)水平是甲减发生的影响因素(P<0.05);血清RvE1、ICOS、Apo-AIV水平联合诊断甲减发生的曲线下面积(AUC)高于血清RvE1水平单独诊断的AUC(Z=2.601,P=0.009),高于血清ICOS水平单独诊断的AUC(Z=7.638,P<0.05),高于血清Apo-AIV水平单独诊断的AUC(Z=5.391,P<0.05)。结论甲减患者血清RvE1水平降低,血清ICOS、Apo-AIV水平升高,与甲状腺激素水平相关,联合诊断甲减的价值较高。

18例不可切除IV期胸腺鳞癌的临床特征及预后分析

目的:探讨不可切除IV期胸腺鳞癌的临床特征、治疗方式和预后。方法:收集2018年1月1日至2022年12月31日期间就诊于青岛大学附属医院的18例不可切除IV期胸腺鳞癌患者的临床资料和治疗资料,并随访至2024年2月29日。结果:18例患者中男性12例,女性6例,中位发病年龄60岁;TNM分期IVA期9例,IVB期9例;单纯化疗8例,单纯放疗1例,序贯放化疗4例,同步放化疗2例,化疗联合免疫疗法3例。18例患者总进展率66.7%,中位PFS 27 (19~36)个月。IVA期和IVB期进展率分别为33.3%和100.0% (p = 0.009),中位PFS分别为50 (21~79)和21 (5~37)个月(p = 0.008)。单纯化疗,放化疗和化疗联合免疫疗法进展率分别为75.0%,66.7%,和33.3% (p = 0.793),中位PFS分别为24 (16~32),50 (27~73),和10 (4~16)个月(p = 0.057)。结论:不可切除IV期胸腺鳞癌主要采用以化疗为主的综合治疗,总体预后差,IVA期较IVB期好,化疗联合放疗或免疫疗法较单纯化疗好,建议对非广泛转移阶段的患者行精准治疗。