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中国医师进修杂志
中国医师进修杂志

姒健敏

旬刊

1673-4904

yishi@zgysjxzz.com

0411-82482314

116013

辽宁省大连市西岗区南石道街丙寅巷3号

中国医师进修杂志/Journal Chinese Journal of Postgraduates of Medicine北大核心CSTPCD
查看更多>>1978年创刊，中华人民共和国卫生部主管，中华医学会主办。本刊是综合性临床医学期刊，其主要读者对象为临床中、高级内、外、妇、儿、五官科医务人员。从创刊至今始终坚持以继续医学教育、岗位进修培训为办刊宗旨。现开设的主要栏目：专题辅导、专家论坛、临床论著、进展概述、综述与讲座、教学查房、临床病例讨论、病例报告、探讨与评价、药物与临床、影像与临床、新技术介绍、教训纵横等。其中专题辅导、教学查房等栏目深受读者欢迎。
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    磁共振弥散张量成像对系统性红斑狼疮患者脑小血管病的评估价值

    吴恺迪任占云史一雯王文云...
    97-102页
    查看更多>>摘要：目的 探讨磁共振弥散张量成像（DTI）对系统性红斑狼疮（SLE）患者脑小血管病（CSVD）的评估价值。 方法 采用前瞻性研究的方法，选择宜兴市人民医院2022年1—12月治疗的SLE合并CSVD患者82例，根据常规MRI检查结果分为急性期梗死组（16例）、慢性期梗死组（26例）和慢性缺血灶组（40例），所有患者均行DTI检查，获取患侧及对侧正常脑白质区的平均弥散系数（DCavg）和各向异性分数（FA），分析DTI对SLE患者CSVD的评估价值。 结果 82例患者病灶患侧DCavg显著高于健侧[（11.10 ± 3.48）10-3 mm2/s比（8.18 ± 2.42）10-3 mm2/s]，患侧FA显著低于健侧（0.28 ± 0.05比0.45 ± 0.08），差异有统计学意义（P<0.05）。急性梗死期组、慢性期梗死组、慢性缺血灶组DCavg分别为（11.88 ± 3.50）、（9.69 ± 3.24）和（8.52 ± 2.34）10-3 mm2/s，差异有统计学意义（P<0.05）；急性梗死期组、慢性期梗死组、慢性缺血灶组FA分别为0.28 ± 0.04、0.33 ± 0.06和0.40 ± 0.07，差异有统计学意义（P<0.05）。绘制受试者工作特征曲线，结果显示，DCavg、FA单独及联合评估急性期梗死组和慢性期梗死组的曲线下面积（AUC）分别为0.757、0.756和0.820，评估慢性期梗死组和慢性缺血灶组的AUC分别为0.772、0.776和0.813，联合评估的AUC值相对较大。 结论 DTI对SLE患者CSVD具有良好的评估价值，可准确判断CSVD类型。 Objective To explore the value of magnetic resonance diffusion tensor imaging (DTI) in evaluating cerebrovascular small vessel disease (CSVD) in patients with systemic lupus erythematosus (SLE). Methods Eighty-two patients with SLE combined with CSVD treated at Yixing People's Hospital from January to December 2022 were selected. They were divided into acute phase infarction group (16 cases), chronic phase infarction group (26 cases), and chronic ischemic lesion group (40 cases) based on routine MRI examination results. All patients underwent DTI examination to obtain the average diffusion coefficient (DCavg) and anisotropy score (FA) of the affected and contralateral normal white matter areas, and the evaluation value of DTI for CSVD in SLE patients was analyzed. Results The DCavg value on the affected side of 82 patients was significantly higher than that on the healthy side: (11.10 ± 3.48) 10-3 mm2/s vs. (8.18 ± 2.42) 10-3 mm2/s, and the FA value on the affected side was significantly lower than that on the healthy side: 0.28 ± 0.05 vs. 0.45 ± 0.08, with a statistical significant differences (P<0.05). The DCavg values of the acute infarction group, chronic infarction group, and chronic ischemic focus group were (11.88 ± 3.50), (9.69 ± 3.24) and (8.52 ± 2.34) 10-3 mm2/s, respectively, with statistical significant differences (P<0.05). The FA values of the acute infarction group, chronic infarction group, and chronic ischemic focus group were 0.28 ± 0.04, 0.33 ± 0.06 and 0.40 ± 0.07, respectively, with statistical significant differences (P<0.05). The receiver operating characteristic curve was drawn, and the results showed that the area under the curve (AUC) of the acute phase infarction group and the chronic phase infarction group evaluated by DCavg and FA alone and in combination were 0.757, 0.756, and 0.820, respectively. The AUC of the chronic phase infarction group and the chronic ischemic focus group evaluated by DCavg and FA were 0.772, 0.776, and 0.813, respectively. The AUC value of the combined evaluation was relatively large. Conclusions DTI has good evaluation value for CSVD in SLE patients and can accurately determine the type of CSVD.

    红斑狼疮,系统性脑小血管病磁共振成像弥散张量成像

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    利妥昔单抗注射液联合CHOP方案治疗弥漫性大B细胞淋巴瘤的疗效评价

    尹珍珍韩春霞袁海龙贾安...
    102-106页
    查看更多>>摘要：目的 评价利妥昔单抗注射液联合CHOP方案（环磷酰胺+多柔比星+长春新碱+泼尼松龙）治疗弥漫性大B细胞淋巴瘤（DLBCL）患者的临床疗效。 方法 前瞻性选择新疆医科大学第一附属医院2019年6月至2022年6月收治的120例DLBCL患者为研究对象，按随机数字表法分为研究组和对照组，每组60例，对照组予以CHOP方案治疗，研究组在CHOP方案基础上联合利妥昔单抗注射液治疗。6个疗程后评估两组临床疗效，比较两组治疗前后炎性因子及免疫功能指标变化，比较两组治疗后不良反应发生情况。 结果 研究组治疗后临床总有效率高于对照组[88.33%（53/60）比70.00%（42/60）]，差异有统计学意义（χ2 = 6.11，P<0.05）。两组治疗前血清白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）比较差异无统计学意义（P>0.05）；两组治疗后血清IL-6、TNF-α水平均降低，并且研究组治疗后血清IL-6、TNF-α水平低于对照组[（223.56 ± 21.28）ng/L比（267.35 ± 25.36）ng/L、（9.34 ± 2.75）μg/L比（11.96 ± 3.83）μg/L]，差异有统计学意义（P<0.05）。两组治疗前血清免疫球蛋白（Ig）A、IgM、IgG比较差异无统计学意义（P>0.05）。两组治疗后IgA、IgM及IgG均不同程度降低，研究组治疗后血清IgA、IgM、IgG高于对照组[（1.83 ± 0.46）g/L比（1.34 ± 0.34）g/L、（1.15 ± 0.22）g/L比（0.83 ± 0.24）g/L、（10.67 ± 1.65）g/L比（8.02 ± 1.62）g/L]，差异有统计学意义（P<0.05）。研究组治疗后血小板减少、白细胞降低、胃肠道反应、骨髓抑制、肝功能损伤发生率均低于对照组[6.67%（4/60）比20.00%（12/60）、15.00%（9/60）比31.67%（19/60）、30.00%（18/60）比58.33%（35/60）、5.00%（3/60）比16.67%（10/60）、10.00%（6/60）比25.00%（15/60）]，差异有统计学意义（χ2 = 4.62、4.66、9.77、4.33、4.88，P<0.05）。 结论 针对DLBCL以利妥昔单抗注射液联合CHOP方案治疗效果显著，可减轻患者机体炎性反应，减少对机体免疫功能的损害，降低化疗引起的不良反应。 Objective To evaluate the clinical efficacy of rituximab injection combined with CHOP regimen (cyclophosphamide+doxorubicin+vincristine+prednisolone) in the treatment of diffuse large B-cell lymphoma (DLBCL). Methods One hundred and twenty patients with DLBCL who treatment in the First Affiliated Hospital of Xinjiang Medical University from June 2019 to June 2022 were selected as the study object. They were randomly divided into the study group (60 cases) and the control group (60 cases). The control group was treated with CHOP regimen, and the study group was treated with rituximab injection on the basis of CHOP regimen. The clinical efficacy, inflammatory reaction, immune function and adverse reaction were evaluated after 6 courses of treatment. Results After treatment, the total clinical effective rate in the study group was higher than that in the control group: 88.33%(53/60) vs. 70.00%(42/60), there was statistical difference (χ2 = 6.11, P<0.05). Before treatment, the levels of serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the two groups had no significant differences (P>0.05) after treatment, the levels of serum IL-6 and TNF-α were decreased, and the levels of serum IL-6 and TNF-α in the study group were lower than those in the control group: (223.56 ± 21.28) ng/L vs. (267.35 ± 25.36) ng/L, (9.34 ± 2.75) μg/L vs. (11.96 ± 3.83) μg/L, there were statistical differences (P<0.05). Before treatment, the levels of serum immunoglobulin (Ig) A, IgM and IgG in the two groups had no significant differences (P>0.05) after treatment, the levels of serum IgA, IgM and IgG were decreased, but the levels of serum IgA, IgM and IgG in the study group were higher than those in the control group: (1.83 ± 0.46) g/L vs. (1.34 ± 0.34) g/L, (1.15 ± 0.22) g/L vs. (0.83 ± 0.24) g/L, (10.67 ± 1.65) g/L vs. (8.02 ± 1.62) g/L, there were statistical differences (P<0.05). After treatment, the incidence of thrombocytopenia, leucopenia, gastrointestinal reaction, bone marrow suppression and liver function injury in the study group were lower than those in the control group: 6.67%(4/60) vs. 20.00%(12/60), 15.00%(9/60) vs. 31.67%(19/60), 30.00%(18/60) vs. 58.33%(35/60), 5.00%(3/60) vs. 16.67%(10/60), 10.00%(6/60) vs. 25.00%(15/60), there were statistical differences (χ2 = 4.62, 4.66, 9.77, 4.33, 4.88, P<0.05). Conclusions The treatment effect of rituximab injection combined with CHOP regimen in DLBCL is significant, which can reduce the inflammatory reaction of the body, reduce the damage of immune function, and reduce the adverse reactions of chemotherapy.

    淋巴瘤,大B细胞,弥漫性利妥昔单抗白细胞介素-6肿瘤坏死因子-α免疫球蛋白类药物相关的副作用和不良反应

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    血清降钙素原、淀粉酶、白蛋白和乳酸脱氢酶水平在急性重症胰腺炎临床诊断及病情评估中的作用

    许彬彬于蓉李兴吕彤...
    107-112页
    查看更多>>摘要：目的 探究血清降钙素原（PCT）、淀粉酶（AMY）、白蛋白（ALB）和乳酸脱氢酶（LDH）水平在急性重症胰腺炎临床诊断及病情评估中的作用。 方法 采用回顾性研究的方法，选择2020年1月1日至2022年12月31日就诊于盐城市第一人民医院的70例急性胰腺炎患者作为胰腺炎组，根据其病情严重程度分为轻症组（22例）和重症组（48例），并选取同期进行健康体检的70例患者作为对照组。收集所有研究对象入组时一般资料；检测受试者血清PCT、AMY、ALB和LDH水平；采用受试者工作特征（ROC）曲线分析各指标对急性重症胰腺炎的诊断价值及病情评估价值。 结果 胰腺炎组血清PCT、AMY、LDH水平显著高于对照组[（3.14 ± 0.67）μg/L比（0.82 ± 0.21）μg/L、（602.53 ± 199.47）U/L比（99.97 ± 30.85）U/L、（767.24 ± 198.73）U/L比（423.61 ± 59.19）U/L]（P<0.05），胰腺炎组ALB水平显著低于对照组[（33.47 ± 6.98）g/L比（45.79 ± 6.12）g/L]，差异有统计学意义（P<0.05）；ROC曲线分析显示，PCT、AMY、LDH、ALB和联合检测诊断急性胰腺炎的曲线下面积（AUC）分别为0.783、0.792、0.697、0.732和0.915；轻症组急性胰腺炎患者血清PCT、LDH水平显著低于重症组[（2.76 ± 0.44）μg/L比（3.59 ± 0.61）μg/L、（507.06 ± 131.67）U/L比（848.95 ± 207.79）U/L]（P<0.05），轻症组ALB水平显著高于重症组[（35.39 ± 4.73）g/L比（32.64 ± 5.09）g/L]，差异有统计学意义（P<0.05）；ROC曲线分析显示，PCT、LDH、ALB和联合检测评估患者病情严重程度的AUC分别为0.668、0.749、0.741和0.959。 结论 急性胰腺炎患者血清PCT、AMY、LDH水平异常升高，ALB水平异常降低，均可用来临床诊断，PCT、LDH、ALB可用来进行病情评估。 Objective To explore the value of serum procalcitonin (PCT), amylase (AMY), albumin (ALB) and lactate dehydrogenase (LDH) in the clinical diagnosis and evaluation of severe acute pancreatitis (SAP). Methods A total of 70 patients with acute pancreatitis treated in Yancheng First People′s Hospital from January 1, 2020 to December 31, 2022 were enrolled as pancreatitis group. According to disease severity, they were divided into mild group (22 cases) and severe group (48 cases). A total of 70 controls during the same period were enrolled as control group. The general data of all the objects were collected at enrollment. The levels of plasma PCT, AMY, ALB and LDH were detected. The diagnostic value of the above indexes for SAP and their evaluation value for disease severity were analyzed by receiver operating characteristic (ROC) curves. Results The levels of serum PCT, AMY and LDH in the pancreatitis group were significantly higher than those in the control group: (3.14 ± 0.67) μg/L vs. (0.82 ± 0.21) μg/L, (602.53 ± 199.47) U/L vs. (99.97 ± 30.85) U/L, (767.24 ± 198.73) U/L vs. (423.61 ± 59.19) U/L, P<0.05 while ALB was significantly lower than that in the control group: (33.47 ± 6.98) g/L vs. (45.79 ± 6.12) g/L,P<0.05. ROC curves analysis showed that area under the curve (AUC) values of PCT, AMY, LDH, ALB and combined detection in the diagnosis of acute pancreatitis were 0.783, 0.792, 0.697, 0.732 and 0.915, respectively. The levels of serum PCT and LDH in the mild group were significantly lower than those in the severe group: (2.76 ± 0.44) μg/L vs. (3.59 ± 0.61) μg/L, (507.06 ± 131.67) U/L vs. (848.95 ± 207.79) U/L,P<0.05 while ALB was significantly higher than that in the severe group: (35.39 ± 4.73) g/L vs. (32.64 ± 5.09) g/L,P<0.05. ROC curves analysis showed that the AUC values of PCT, LDH, ALB and combined detection for evaluating disease severity were 0.668, 0.749, 0.741 and 0.959, respectively. The evaluation value of combined detection was significantly higher than that of single index (P<0.05). Conclusions The levels of serum PCT, AMY and LDH are abnormally increased, while ALB level is abnormally decreased in patients with acute pancreatitis, and which all can be applied for clinical diagnosis. PCT, LDH and ALB can be applied for disease evaluation.

    胰腺炎淀粉酶类白蛋白乳酸脱氢酶类降钙素原

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    颅脑损伤患者并发创伤性脑梗死临床特点及危险因素分析

    赵晗朱奕雄李钢贾安...
    112-116页
    查看更多>>摘要：目的 探讨颅脑损伤合并创伤性脑梗死（PTCI）的相关危险因素、临床特点及预后情况。 方法 回顾性选择2021年1月至2023年1月三亚中心医院收治的颅脑损伤患者，其中48例合并PTCI（观察组），132例不合并PTCI（对照组），收集两组临床资料及随访资料，分析颅脑损伤合并PTCI的相关危险因素、临床特点及预后情况。 结果 单因素分析结果显示，两组患者年龄、性别构成、颅骨骨折、创伤性蛛网膜下隙出血、合并多发伤比较差异无统计学意义（P>0.05）；两组中线移位、脑疝、弥漫性脑肿胀、去骨瓣减压、失血性休克、入院Rotterdam CT评分>3分比较差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，脑疝、弥漫性脑肿胀、失血性休克是PTCI发生的危险因素（P<0.05）。Rotterdam CT评分分值越高，患者PTCI的发生率越高。观察组预后良好11例，预后不良37例，格拉斯哥预后量表（GOS）评分（2.45 ± 1.22）分；对照组预后良好74例，预后不良48例，GOS评分（3.69 ± 1.10）分；两组预后情况比较差异有统计学意义（P<0.05）。 结论 脑疝、弥漫性脑肿胀、失血性休克是颅脑损伤患者合并PTCI的危险因素，并发PTCI的患者预后更差。 Objective To explore the risk factors, clinical features and prognosis of traumatic cerebral infarction in patients with craniocerebral trauma. Methods The clinical data and follow-up data of 48 patients with craniocerebral trauma and traumatic cerebral infarction (observation group) and 132 patients with craniocerebral trauma without traumatic cerebral infarction (control group) admitted to the Sanya Central Hospital from January 2021 to January 2023 were retrospectively reviewed. Statistically significant risk factors were screened out by univariate analysis and Logistic regression analysis. Results The results of univariate analysis showed that there were no significant differences in age, sex, skull fracture, traumatic subarachnoid hemorrhage and multiple injuries between the two groups (P>0.05). There were statistical differences in midline displacement, herniation, diffuse brain swelling, decompression of the deboned flap, hemorrhagic shock, and admission Rotterdam CT score >3(P<0.05). The results of multivariate Logistic regression analysis showed that cerebral herniation, diffuse brain swelling and hemorrhagic shock were risk factors for traumatic cerebral infarction (P<0.05). The higher the Rotterdam CT score, the higher the incidence of traumatic cerebral infarction. In the observation group, 11 cases had good prognosis and 37 cases had poor prognosis, with an average Glasgow Prognostic Scale (GOS) of (2.45 ± 1.22) points. In the control group, 74 cases had good prognosis and 48 cases had poor prognosis, with an average GOS of (3.69 ± 1.10) points. The difference in prognosis between the two groups was statistically significant (P<0.05). Conclusions Cerebral herniation, diffuse cerebral swelling and hemorrhagic shock are risk factors for traumatic cerebral infarction in patients with craniocerebral trauma, and the prognosis of patients complicated by traumatic cerebral infarction is worse.

    颅脑损伤创伤性脑梗死危险因素预后

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    急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗中使用重组人尿激酶原对预后的影响

    孙亮佟飞廷段瑞雪吕彤...
    117-122页
    查看更多>>摘要：目的 探讨急性ST段抬高型心肌梗死患者（STEMI）急诊经皮冠状动脉介入（PCI）治疗中重组人尿激酶原（rhPro-UK）不同给药方式对心肌灌注及预后的影响。 方法 回顾性选取2017年8月至2022年8月中国人民解放军陆军第七十一集团军医院收治的行急诊PCI治疗的132例STEMI患者，根据其临床资料进行分析，A组66例为将导丝通过冠状动脉病变、球囊扩张及支架植入后分别注射rhPro-UK，B组66例为导丝通过冠状动脉病变后一次性注射rhPro-UK。对比两组患者PCI手术情况、靶血管灌注情况[校正心肌梗死溶栓试验（TIMI）血流帧数（CTFC）、TIMI血流分级]、心肌灌注情况[TIMI心肌灌注分级（TMPG）、术后90 min ST段回落率（STR）、无复流/慢血流（NR/SF）的发生率]、心脏功能指标[左室舒张末期容量（LVEDV）、左室收缩末期容量（LVESV）及左室射血分数（LVEF）]、主要不良心血管事件（MACE）发生率及出血事件发生情况。 结果 两组患者的罪犯血管分布、插管方式及支架植入数量比较差异无统计学意义（P>0.05）；治疗后A组TIMI血流分级3级比例高于B组[99.97%（64/66）比87.88%（58/66）]；治疗后两组CTFC均降低，且A组低于B组[（23.49 ± 4.27）帧比（27.14 ± 4.83）帧]（P<0.05）；治疗后A组TMPG 3级比例显著高于B组[95.45%（63/66）比83.33%（55/66）]，差异有统计学意义（P<0.05）；治疗后A组STR显著高于B组[95.45%（63/66）比83.33%（55/66）]（P<0.05）；治疗后A组NR/SF的发生率低于B组[3.03%（2/66）比14.29%（10/66）]，差异有统计学意义（P<0.05）；治疗前后两组患者LVEDV、LVESV比较差异无统计学意义（P>0.05）。治疗1个月后两组患者LVEF均提高，且A组高于B组[（71.08 ± 6.38）%比（66.24 ± 6.49）%]，差异有统计学意义（P<0.05）；治疗后A组MACE发生率低于B组[6.06%（4/66）比13.64%（9/66）]（χ2 = 2.13，P = 0.144），A组发生微出血2例，小出血1例，B组发生微出血4例，小出血3例，两组出血事件发生率比较差异无统计学意义（P>0.05）。 结论 对于行PCI的STEMI患者，分次注射rhPro-UK较一次性注射rhPro-UK能更好地改善心肌灌注，降低MACE发生率并有效改善预后。 Objective To investigate the effect of different administration methods of recombinant human prourokinase (rhPro-UK) during emergency percutaneous coronary intervention (PCI) on myocardial perfusion and prognosis of patients with acute ST segment elevation myocardial infarction (STEMI). Methods The clinical data of 132 patients with STEMI who underwent emergency PCI in the Military Hospital of the 71st Army Group of the Chinese People′s Liberation Army from August 2017 to August 2022 were analyzed retrospectively. Among them, 66 patients treated with rhPro-UK injection after the guide wire passed through the coronary artery lesion, balloon dilation and stent placement were included in group A. The other 66 patients treated with rhPro-UK injection once after the guide wire passed through the coronary artery lesion were included in group B. The two groups were compared in terms of PCI conditions, target vessel perfusion status [corrected TIMI frame count (CTFC) and blood flow (thrombolysis in myocardial infarction, TIMI) grade], myocardial perfusion status [TIMI myocardial perfusion grade (TMPG), ST segment regression rate (STR) at 90 min after operation and the incidence of no reflow/slow flow (NR/SF)], cardiac function indicators [left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) and left ventricular ejection fraction (LVEF)], the incidence of major adverse cardiovascular events (MACE), and the incidence of bleeding events. Results There were no statistically significant differences between the two groups in terms of the distribution of culprit blood vessels, intubation methods, and number of stents implanted (P>0.05). After treatment, the proportion of TIMI blood flow grade 3 in the group A was higher than that in the group B:99.97% (64/66) vs. 87.88% (58/66). CTFC of the two tgroups decreased, and CTFC of group A was lower than that of group B: (23.49 ± 4.27) frames vs. (27.14 ± 4.83) frames (P<0.05). The proportion of TMPG grade 3 in group A was significantly higher than that in group B: 95.45% (63/66) vs. 83.33% (55/66)(P<0.05). STR in group A was significantly higher than that in group B: 95.45% (63/66) vs. 83.33% (55/66)(P<0.05). The incidence of NR/SF in group A was lower than that in group B: 3.03% (2/66) vs. 14.29% (10/66)(P<0.05). There were no statistically significant differences in LVEDV or LVESV between the two groups before and after treatment (P>0.05). After 1 month of treatment, LVEF of the two groups increased, and LVEF of group A was higher than that of group B: (71.08 ± 6.38) % vs. (66.24 ± 6.49) % (P<0.05). After treatment, the incidence of MACE in group A was lower than that in group B: 6.06%(4/66) vs. 13.64%(9/66) (χ2 = 2.13, P = 0.144). There was no statistically significant difference in the incidence of bleeding events between the two groups (P>0.05). Conclusions For patients with STEMI undergoing PCI, fractional injection of rhPro-UK can better improve myocardial perfusion, reduce the incidence of MACE, and effectively improve the prognosis, compared with one-time injection of rhPro-UK.

    心肌梗塞,心肌梗死经皮冠状动脉介入治疗重组人尿激酶原心肌灌注预后

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    C反应蛋白与前白蛋白比值在脓毒症诊断和预后评估中的应用价值

    赵云张磊马晓晨王晓田...
    123-128页
    查看更多>>摘要：目的 探讨C反应蛋白（CRP）与前白蛋白（PA）比值在脓毒症诊断和预后评估中的应用价值。 方法 采用回顾性研究的方法，选取2021年9月至2022年9月东营市人民医院收治的95例脓毒症患者（脓毒症组）和100例局部感染患者（非脓毒症组）为研究对象。脓毒症患者按照28 d转归分为存活组（57例）和死亡组（38例）。收集患者临床资料，计算CRP/PA比值；应用多因素Logistic回归和Cox回归分析各指标与脓毒症发生及预后的关系，绘制受试者工作特征（ROC）曲线评价CRP/PA比值对脓毒症发生和预后的预测价值，应用Kaplan-Meier生存曲线评价不同CRP/PA比值患者的生存率。 结果 脓毒症组收缩压、舒张压、PA低于非脓毒症组[（117.27 ± 11.65）mmHg（1 mmHg = 0.133 kPa）比（123.26 ± 10.71）mmHg、（69.42 ± 8.58）mmHg比（75.44 ± 6.53）mmHg、（174.09 ± 24.77）g/L比（207.13 ± 34.31）g/L]，心率、呼吸频率、CRP、CRP/PA比值、降钙素原高于非脓毒症组[（97.87 ± 12.73）次/min比（86.90 ± 10.19）次/min、22.00（20.00，25.00）次/min比21.00（19.00，23.00）次/min、（93.96 ± 19.64）mg/L比（77.56 ± 22.54）mg/L、0.54（0.44，0.65）比0.37（0.28，0.46）、3.35（2.16，4.17）μg/L比1.52（0.81，2.16）μg/L]，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，CRP/PA比值、降钙素原是脓毒症的危险因素（P<0.05）。ROC曲线分析结果显示，CRP/PA比值诊断脓毒症的曲线下面积（AUC）为0.821，特异度为76.0%，灵敏度为93.7%。存活组舒张压、PA、中性粒细胞计数高于死亡组[（71.76 ± 8.86）mmHg比（67.86 ± 8.10）mmHg、（181.46 ± 24.35）g/L比（163.05 ± 21.28）g/L、（63.46 ± 9.88）× 109/L比（57.13 ± 8.64）× 109/L]，心率、呼吸频率、CRP、CRP/PA比值、淋巴细胞计数、降钙素原低于死亡组[（95.68 ± 13.48）次/min比（101.16 ± 10.88）次/min、22.00（19.50，24.00）次/min比24.00（20.00，28.00）次/min、（88.09 ± 19.35）mg/L比（102.76 ± 16.75）mg/L、0.46（0.41，0.58）比0.63（0.55，0.72）、21.00（16.00，30.00）×109/L比29.50（18.00，37.30）×109/L、2.94（2.10，3.97）μg/L比3.82（2.21，4.77）μg/L]，差异有统计学意义（P<0.05）。多因素Cox回归分析结果显示，CRP/PA比值、降钙素原是脓毒症预后的独立危险因素（P<0.05）。CRP/PA比值预测脓毒症预后的AUC为0.827，特异度为92.1%，灵敏度为63.8%。以CRP/PA比值最佳临界值（0.48）分组，CRP/PA>0.48组患者28 d病死率高于CRP/PA≤0.48组，差异有统计学意义（P<0.01）。 结论 CRP/PA比值可作为脓毒症诊断和评估预后的指标。 Objective To explore the application of C-reactive protein(CRP) to prealbumin (PA) ratio(CRP/PA) for diagnosis and prognosis evaluation of sepsis. Methods By a retrospective study, a total of 95 sepsis patients (sepsis group) and 100 local infection patients(non-sepsis group) treated in Dongying People′s Hospital from September 2021 to September 2022 were enrolled. Sepsis patients were divided into survival group(57 cases) and death group (38 cases) according to the 28-day outcome. The clinical data were collected and CRP/PA was calculated. Multivariate Logistic regression and Cox regression were used to analyze the relationship between various indicators and the occurrence and prognosis of sepsis, and receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic and prognostic value of CRP/PA for sepsis. Kaplan-Meier survival analysis was used to evaluate the prognostic value of different CRP/PA ratios for patients with sepsis. Results The systolic blood pressure, diastolic blood pressure, prealbumin were lower and heart rate, respiratory rate, CRP, CRP/PA, procalcitonin were higher in the sepsis group compared to the non-sepsis group: (117.27 ± 11.65) mmHg (1 mmHg = 0.133 kPa) vs. (123.26 ± 10.71) mmHg, (69.42 ± 8.58) mmHg vs. (75.44 ± 6.53) mmHg, (174.09 ± 24.77) g/L vs. (207.13 ± 34.31) g/L, (97.87 ± 12.73) bpm vs. (86.90 ± 10.19) bpm, 22.0(20.00, 25.00) times/min vs. 21.00(19.00, 23.00) times/min, (93.96 ± 19.64) mg/L vs. (77.56 ± 22.54) mg/L, 0.54(0.44, 0.65) vs. 0.37(0.28, 0.46), 3.35(2.16, 4.17) μg/L vs. 1.52(0.81, 2.16) μg/L, there were statistical differences ( P<0.05). Multivariate Logistic regression analysis showed that CRP/PA and procalcitonin were risk factors for sepsis (P<0.05). The results of ROC curve showed that the area under the curve (AUC) of CRP/PA in diagnosis of sepsis was 0.821, the specificity and sensitivity was 76.0% and 93.7%, respectively. The diastolic blood pressure, prealbumin, neutrophil were higher and the heart rate, respiratory rate, CRP, CRP/PA, lymphocytes, procalcitonin were lower in the survival group compared to the death group: (71.76 ± 8.86) mmHg vs. (67.86 ± 8.10) mmHg, (181.46 ± 24.35) g/L vs. (163.05 ± 21.28) g/L, (63.46 ± 9.88) × 109/L vs.(57.13 ± 8.64) × 109/L, (95.68 ± 13.48) times/min vs. (101.16 ± 10.88) times/min, 22.00(19.50, 24.00) times/min vs. 24.00(20.00, 28.00) times/min, (88.09 ± 19.35) mg/L vs. (102.76 ± 16.75) mg/L, 0.46(0.41, 0.58) vs. 0.63(0.55, 0.72), 21.00(16.00, 30.00) ×109/L vs. 29.50(18.00, 37.30) ×109/L, 2.94(2.10, 3.97) μg/L vs. 3.82(2.21, 4.77) μg/L, there were statistical differences ( P<0.05). Multivariate Cox regression analysis showed that CRP/PA and procalcitonin were independent risk factors for the prognosis of sepsis (P<0.05). The AUC of CRP/PA in predicting the prognosis of sepsis was 0.827, the specificity and sensitivity was 92.1% and 63.8%, respectively. Grouped by the cut-off of CRP/PA (0.48), the 28-day mortality rate of patients in the CRP/PA>0.48 was significantly higher than that of patients in the CRP/PA≤0.48, there was statistical difference (P<0.01). Conclusions CRP/PA ratio can be used as an index for diagnosis and prognosis evaluation of sepsis.

    C反应蛋白质前白蛋白脓毒症诊断预后

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    热性惊厥患儿继发癫痫发作的危险因素及构建列线图预测模型

    唐敏朱健吕彤
    129-134页
    查看更多>>摘要：目的 分析热性惊厥患儿继发癫痫发作的危险因素及构建列线图预测模型。 方法 采用回顾性研究的方法，选取恩施州民族医院2018年8月至2021年9月收治的热性惊厥患儿235例，根据随访6个月患儿是否继发癫痫发作分为发作组（62例）和未发作组（173例）。所有患者受试者工作特征曲线分析获取各因素的最佳截断值，多因素Cox回归分析热性惊厥患儿继发癫痫发作的独立风险因素，R软件"rms"包构建预测热性惊厥患儿继发癫痫发作高风险的列线图模型，校正曲线对列线图模型进行内部验证，决策曲线评估列线图模型的预测效能。 结果 发作组患者年龄低于未发作组[（14.45 ± 1.54）个月比（21.47 ± 2.18）个月]，有癫痫家族史比例高于未发作组[56.45%（35/62）比35.84%（62/173）]，围生期（异常）比例高于未发作组[59.68%（37/62）比15.61%（27/173）]，惊厥发作类型（全面性）比例高于未发作组[70.97%（44/62）比36.99%（64/173）]，脑电图情况（异常）比例高于未发作组[74.19%（46/62）比20.81%（36/173）]，惊厥次数高于未发作组[（5.45 ± 2.32）次比（2.04 ± 1.02）次]，惊厥持续时间高于未发作组[（18.89 ± 4.29）min比（12.62 ± 2.34）min]及肿瘤坏死因子-α（TNF-α）高于未发作组[（25.65 ± 5.32）ng/L比（18.21 ± 2.29）ng/L]，差异有统计学意义（P均<0.05）；年龄、惊厥次数、惊厥持续时间、TNF-α的曲线下面积分别为0.906、0.913、0.899、0.890；最佳截断值分别是3岁、4次、15 min、21 ng/L；年龄（≤3岁）、癫痫家族史（有）、惊厥发作类型（全面性）、围生期（异常）、惊厥次数（≥4次）、惊厥持续时间（≥15 min）是热性惊厥患儿继发癫痫发作的独立危险因素（P<0.05）；此列线图预测模型的C-index为0.744（0.567~0.932）；决策曲线显示当风险阈值>0.11时，此预测模型所提供的临床净收益均高于单个独立危险因素并且在预测热性惊厥患儿继发癫痫发作的高风险方面可以提供显著额外的临床净收益。 结论 基于年龄、癫痫家族史、惊厥发作类型、围生期、惊厥次数、惊厥持续时间构建热性惊厥患儿继发癫痫发作风险的列线图模型，为癫痫发作的防治提供重要策略指导。 Objective To analyze the risk factors of secondary epileptic seizures in children with febrile seizures and to construct a nomogram prediction model. Methods A total of 235 children with febrile seizures who were admitted to Enshi State Hospital for Nationalities from August 2018 to September 2021 were selected. According to whether the children had secondary epileptic seizures during the 6-month follow-up, the children were divided into the seizure group (62 cases) and no-seizure group (173 cases). The best cut-off value of each factor were obtained by the receiver operating characteristic (ROC). Multivariate Cox regression analysis was used to analyze the independent risk factors of secondary seizures in children with febrile seizures. The R software "rms" package was constructed to predict secondary seizures in children with febrile seizures. High-risk nomogram models, calibration curves was used for internal validation of nomogram models, and decision curves to assess the predictive power of nomogram models. Results The age of the patients in the seizure group was lower than that in the no-seizure group: (14.45 ± 1.54) months vs. (21.47 ± 2.18) months and the proportion of family history of epilepsy, the proportion of perinatal (abnormal), the proportion of seizure type (comprehensive), the proportion of electroencephalogram (EEG) (abnormal), the number of seizures, the duration of seizure, the tumor necrosis factor-alpha (TNF-α) level in the seizure group were higher than those in the no-seizure group: 56.45%(35/62) vs. 35.84%(62/173), 59.68% (37/62) vs. 15.61%(27/173), 70.97%(44/62) vs. 36.99% (64/173), 74.19% (46/62) vs. 20.81% (36/173), (5.45 ± 2.32) times vs. (2.04 ± 1.02) times, (18.89 ± 4.29) min vs. (12.62 ± 2.34) min, (25.65 ± 5.32) ng/L vs.(18.21 ± 2.29) ng/L, there were statistical differences (P<0.05). The area under the curve (ACU) of age, number of convulsions, duration of convulsion, and TNF-α were 0.906, 0.913, 0.899, and 0.890, respectively the best cut-off values were 3 years, 4 times, 15 min, 21 ng/L age (≤3 years), family history of epilepsy (yes), type of seizures (generalized), perinatal period (abnormal), number of seizures (≥4 times), duration of seizures (≥15 min) were febrile seizures independent risk factors for secondary epileptic seizures in children (P<0.05), the C-index of this nomogram prediction model was 0.744 (0.567-0.932) the decision curve showed that when the risk threshold was greater than 0.11, the clinical net benefit provided by this prediction model. The benefits were all higher than individual independent risk factors and provided a significant additional net clinical benefit in predicting a high risk of seizures secondary to febrile seizures in children with febrile seizures. Conclusions This study constructed a nomogram model of the risk of secondary seizures in children with febrile seizures based on age, family history of epilepsy, type of seizures, perinatal period, number of seizures, and duration of seizures. Important strategic guidance.

    惊厥,发热性癫痫发作危险因素列线图预测模型

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    超声测量视神经鞘直径与眼球横径比值对颅脑外伤患者颅内高压诊断和预后评估的价值

    张坤马凤杰李会燕房亚云...
    134-138页
    查看更多>>摘要：目的 评价超声测量视神经鞘直径（ONSD）与眼球横径（ETD）比值对颅脑外伤患者颅内高压的诊断和预后评估价值。 方法 前瞻性选取2021年12月至2023年1月华北医疗健康集团邢台总医院收治的120例颅脑外伤患者，根据颅内压测量结果分为颅内压正常组（73例）和颅内高压组（47例），颅内高压组再根据随访预后情况分为预后良好组（20例）和预后不良组（27例）。比较各组ONSD、ETD及ONSD/ETD，采用受试者工作特征（ROC）曲线分析ONSD、ONSD/ETD对颅内高压诊断及预后评估的效能，采用Kaplan-Meier法评估患者6个月不良预后风险，并通过Log-rank检验进行比较。 结果 颅内压正常组颅内压、ONSD、ONSD/ETD低于颅内高压组[（130.73 ± 23.63）mmH2O（1 mmH2O = 0.009 8 kPa）比（270.11 ± 35.78）mmH2O、（5.47 ± 0.29）mm比（5.78 ± 0.44）mm、0.246 ± 0.018比0.263 ± 0.018]，差异有统计学意义（P<0.05）。预后良好组入院时格拉斯哥昏迷量表（GCS）评分、颅内压、ONSD、ONSD/ETD低于预后不良组[（5.50 ± 1.24）分比（6.41 ± 1.34）分、（256.15 ± 30.23）mmH2O比（280.44 ± 36.56）mmH2O、（5.62 ± 0.40）mm比（5.90 ± 0.44）mm、0.254 ± 0.014比0.270 ± 0.017]，差异有统计学意义（P<0.05）。ROC曲线分析结果显示，ONSD、ONSD/ETD诊断颅脑外伤患者颅内高压的曲线下面积（AUC）分别为0.718和0.765，临界值分别为5.87 mm和0.263；ONSD、ONSD/ETD预测颅内高压患者预后的AUC分别为0.677和0.763，临界值分别为5.90 mm和0.267。以ONSD/ETD预测颅内高压预后的临界值（0.267）分组，ONSD/ETD>0.267组不良预后发生率高于ONSD/ETD≤0.267组，差异有统计学意义（P<0.05）。 结论 ONSD/ETD可作为颅脑外伤患者颅内高压诊断和预后评估的指标。 Objective To investigate the value of ultrasonic measurement of the ratio of optic nerve sheath diameter (ONSD) to eyeball transverse diameter(ETD) in the diagnosis and prognosis of intracranial hypertension in patients with craniocerebral trauma. Methods A total of 120 patients with craniocerebral trauma treated in the Xingtai General Hospital of North China Medical and Health Group from December 2021 to January 2023 were perspectively selected, and they were divided into normal intracranial pressure group (73 cases) and intracranial hypertension group (47 cases) according to the results of intracranial pressure measurements, and the intracranial hypertension group was divided into good prognosis group (20 cases) and poor prognosis group (27 cases) according to the follow-up prognosis. The efficacy of ONSD, ETD and ONSD/ETD in intracranial hypertension diagnosis and prognosis assessment were analyzed by receiver operating characteristic (ROC) curve. Kaplan-Meier method was used to evaluate the 6-month risk of adverse prognosis of patients, and the comparison was made by Log-rank test. Results The levels of intracranial pressure, ONSD, ONSD/ETD in the normal intracranial pressure group were lower than those in the intracranial hypertension group: (130.73 ± 23.63) mmH2O (1 mmH2O = 0.009 8 kPa) vs. (270.11 ± 35.78) mmH2O, (5.47 ± 0.29) mm vs. (5.78 ± 0.44) mm, 0.246 ± 0.018 vs. 0.263 ± 0.018, there were statistical differences (P<0.05). The scores of Glasgow Coma Scale (GCS), intracranial pressure, ONSD, ONSD/ETD in the good prognosis group were lower than those in the poor prognosis group: (5.50 ± 1.24) scores vs. (6.41 ± 1.34) scores, (256.15 ± 30.23) mmH2O vs. (280.44 ± 36.56) mmH2O, (5.62 ± 0.40) mm vs. (5.90 ± 0.44) mm, 0.254 ± 0.014 vs. 0.270 ± 0.017, there were statistical differences (P<0.05). ROC curve analysis results showed that the area under the curve (AUC) of ONSD and ONSD/ETD for diagnosing intracranial hypertension in patients with craniocerebral trauma were 0.718 and 0.765, respectively, and the critical values were 5.87 mm and 0.263, respectively. The AUC of ONSD and ONSD/ETD predicting prognosis of intracranial hypertension patients was 0.677 and 0.763, respectively, and the critical values were 5.90 mm and 0.267, respectively. Grouped by the threshold of ONSD/ETD for the prognosis of intracranial hypertension (0.267), the incidence of adverse prognosis in ONSD/ETD > 0.267 group was higher than that in the ONSD/ETD≤0.267 group, there was statistical difference (P<0.05). Conclusions ONSD/ETD can be used as an index for diagnosis and prognosis of intracranial hypertension.

    颅脑损伤颅内压超声检查视神经鞘直径眼球横径

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    替莫唑胺联合γ-分次立体定向放疗治疗非小细胞肺癌脑转移瘤对S100B、外泌体微小RNA-330表达的影响

    张敦利贾安
    139-143页
    查看更多>>摘要：目的 探讨替莫唑胺联合γ-分次立体定向放疗治疗非小细胞肺癌（NSCLC）脑转移瘤对S100B、外泌体微小RNA-330（miR-330）表达的影响。 方法 前瞻性选取2018年2月至2020年10月82例NSCLC脑转移瘤患者为研究对象，按随机数字表法分为对照组和观察组，每组41例。对照组给予γ-分次立体定向放疗，观察组在对照组治疗基础上联合替莫唑胺治疗。比较两组的疗效及预后情况；比较两组治疗前后血清髓鞘碱性蛋白（MBP）、神经元特异性烯醇化酶（NSE）、神经胶质纤维酸性蛋白（GFAP）水平及肝肾功能指标、血清S100B、癌胚抗原（CEA）、外泌体miR-330水平；采用简易智能精神状态检查量表（MMSE）、美国国立卫生院神经功能缺损评分（NIHSS）评价两组患者脑神经功能并进行比较。 结果 观察组总缓解率高于对照组[65.85%（27/41）比34.15%（14/41）]，差异有统计学意义（χ2 = 8.24，P<0.05）。两组疾病控制率比较差异无统计学意义（P>0.05）。观察组治疗后血清MBP、GFAP及NSE水平均低于对照组[（10.13 ± 2.07）μg/L比（14.39 ± 2.58）μg/L、（0.57 ± 0.12）μg/L比（0.75 ± 0.16）μg/L、（5.09 ± 1.16）μg/L比（7.17 ± 1.35）μg/L]，差异有统计学意义（P<0.05）。两组治疗后丙氨酸氨基转移酶、尿素氮、血肌酐水平比较差异无统计学意义（P>0.05）。观察组治疗后NIHSS评分低于对照组[（4.16 ± 0.52）分比（4.73 ± 0.44）分]，MMSE评分高于对照组[（22.07 ± 2.51）分比（20.68 ± 2.19）分]，差异有统计学意义（P<0.05）。观察组治疗后血清S100B、CEA水平均低于对照组[（62.37 ± 10.54）mg/L比（68.05 ± 9.39）mg/L、（12.61 ± 2.05）μg/L比（14.08 ± 1.97）μg/L]，外泌体miR-330表达高于对照组（0.49 ± 0.12比0.42 ± 0.05），差异有统计学意义（P<0.05）。观察组中位生存时间为14.6个月，对照组为11.50个月；两组各项不良反应发生率比较差异均无统计学意义（P>0.05）。 结论 对NSCLC脑转移瘤患者给予替莫唑胺联合γ-分次立体定向放疗，可提高疗效，改善神经功能，抑制血清S100B、CEA及外泌体miR-330表达，延长生存时间。 Objective To investigate the effects of temozolomide combined with γ-fractional stereotactic radiotherapy on the expression of S100B and exosomal microRNA-330(miR-330) in the treatment of non-small cell lung cancer (NSCLC) patients with brain metastases. Methods A total of 82 patients with NSCLC brain metastases from February 2018 to October 2020 were selected prospectively, and they were divided into the control group and the observation group by the random number table method, each with 41 patients. The control group received γ-fractional stereotactic radiotherapy, and the observation group received temozolomide on the basis of the control group. The therapeutic efficacy and prognosis of the two groups were compared, and the levels of serum myelin basic protein (MBP), neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP) levels, liver and kidney function indexes, serum S100B, carcinoembryonic antigen (CEA), exosomal miR-330 were compared between the two groups before and after the treatment. The neurologic function of the patients were evaluated by Mini Mental State Examination (MMSE) and National Institutes Health Stroke Scale (NIHSS). Results The total remission rate in the observation group was higher than that in the control group: 65.85%(27/41) vs. 34.15%(14/41), there was statistical differences (χ2 = 8.24, P<0.05), but the disease control rate between the two groups had no significant difference (P>0.05). After the treatment, the levels of serum MBP, GFAP and NSE in the observation group were lower than those in the control group: (10.13 ± 2.07) μg/L vs. (14.39 ± 2.58) μg/L, (0.57 ± 0.12) μg/L vs. (0.75 ± 0.16) μg/L, (5.09 ± 1.16) μg/L vs. (7.17 ± 1.35) μg/L, there were statistical differences (P<0.05). The levels alanine aminotransferase, blood urea nitrogen and serum creatinine after treatment between the two groups had no significant differences (P>0.05). After the treatment, the NIHSS scores in the observation group was lower than that in the control group, MMSE scores was higher than that in the control group: (4.16 ± 0.52) scores vs. (4.73 ± 0.44) scores, (22.07 ± 2.51) scores vs. (20.68 ± 2.19) scores, there were statistical differences (P<0.05). After treatment, the serum levels of S100B and CEA in the observation group were lower than those in the control group, and the expression of exosomal miR-330 was higher than that in the control group: (62.37 ± 10.54) mg/L vs. (68.05 ± 9.39) mg/L, (12.61 ± 2.05) μg/L vs.(14.08 ± 1.97) μg/L, 0.49 ± 0.12 vs. 0.42 ± 0.05, there were statistical differences (P<0.05). The median survival time in the observation group was 14.6 months, while that in the control group was 11.50 months. There were no significant differences in the incidence of adverse reactions between the two groups (P>0.05). Conclusions Treatment with temozolomide combined with γ-fractional stereotactic radiotherapy for NSCLC patients with brain metastases can improve the therapeutic efficacy, neurological function, inhibit the expression of serum S100B, CEA and exosomal miR-330, and prolong the survival time of patients.

    癌,非小细胞肺脑转移瘤替莫唑胺放射治疗计划,计算机辅助S100B蛋白微小RNA-330

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    治疗前血小板与白蛋白比值对肝硬化伴食管和胃静脉曲张出血内镜治疗短期预后的预测价值

    胡建姚运河顾宇余杰杰...
    144-149页
    查看更多>>摘要：目的 探讨治疗前血小板与白蛋白比值（PAR）对肝硬化伴食管和胃静脉曲张出血（EGVB）患者内镜治疗短期预后的预测价值。 方法 回顾性分析2019年1月至2022年4月蚌埠市第一人民医院行内镜治疗的195例肝硬化伴EGVB患者的临床资料，根据治疗前血小板计数和白蛋白计算PAR。采用单因素和多因素Cox回归分析影响患者6周再出血和死亡的独立危险因素，绘制受试者工作特征（ROC）曲线评价PAR对再出血和死亡的预测价值，采用Kaplan-Meier生存曲线评价不同PAR患者再出血率和生存率。 结果 195例患者中6周内再出血36例，非再出血159例；6周内死亡15例，存活180例。再出血组血小板计数、PAR低于非再出血组[74.0（66.5，88.8）× 109/L比98.0（85.0，111.0）× 109/L、2.48（2.18，2.78）比3.35（2.81，4.04）]，直接胆红素、三酰甘油、丙氨酸氨基转移酶、凝血酶原时间、病死率高于非再出血组[18.5（14.0，23.8）μmol/L比16.0（11.0，20.0）μmol/L、（4.73 ± 2.52）mmol/L比（3.94 ± 1.65）mmol/L、36.0（27.0，46.0）U/L比21.0（13.3，33.0）U/L、（14.78 ± 1.63）s比（13.47 ± 0.87）s、36.11%（13/36）比1.26%（2/159）]，差异有统计学意义（P<0.05）。多因素Cox回归结果显示，PAR、丙氨酸氨基转移酶是影响肝硬化伴EGVB患者6周再出血的主要危险因素，PAR是影响患者6周死亡的主要危险因素（均P<0.05）。PAR预测6周再出血和死亡的曲线下面积分别为0.876、0.776，最佳临界值分别为2.94和2.71，特异度分别为69.8%和72.2%，灵敏度分别为94.4%和73.3%。以PAR预测再出血最佳临界值分组，PAR≤2.94组6周再出血率高于PAR>2.94组，差异有统计学意义（χ2 = 36.88，P<0.01）；以PAR预测死亡最佳临界值分组，PAR≤2.71组6周病死率高于PAR>2.71组，差异有统计学意义（χ2 = 16.44，P<0.01）。 结论 治疗前PAR可作为接受内镜治疗的肝硬化伴EGVB患者6周内再出血和死亡的预测指标。 Objective To explore the predictive value of pre-treatment platelet-to-albumin ratio (PAR) in short-term prognosis of endoscopic treatment for cirrhosis with esophageal and gastric variceal bleeding(EGVB). Methods By retrospective analysis method, the clinical data of 195 cirrhotic patients with EVGB from January 2019 to April 2022 treatment at Bengbu First People′s Hospital were collected and analyzed. The PAR was calculated according to platelet count and albumin. The independent risk factors that affecting 6-week rebleeding and death were analyzed by univariate and multivariate Cox regression, the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of PAR for rebleeding and death, and Kaplan-Meier survival analysis was used to evaluate the rebleeding rate and survival rate of patients with different PAR ratios. Results Among 195 patients, 36 patients were rebleeding and 159 patients were non-rebleeding within 6 weeks while 15 cases died and 180 cases survived. The platelet count, PAR in the rebleeding group were lower than those in the non-rebleeding group, the direct bilirubin, triglyceride, alanine transaminase, prothrombin time and mortality in the rebleeding group were higher than those in the non-rebleeding group: 74.0(66.5, 88.8) × 109/L vs. 98.0(85.0, 111.0)×109/L, 2.48(2.18, 2.78) vs. 3.35(2.81, 4.04), 18.5(14.0, 23.8) μmol/L vs. 16.0(11.0, 20.0) μmol/L, (4.73 ± 2.52) mmol/L vs. (3.94 ± 1.65) mmol/L, 36.0(27.0, 46.0)U/L vs. 21.0(13.3, 33.0)U/L, (14.78 ± 1.63) s vs. (13.47 ± 0.87) s, 36.11%(13/36) vs. 1.26%(2/159), there were statistical differences ( P<0.05). Cox multivariate regression showed that PAR, alanine transaminase were the independent risk factors for the rebleeding (P<0.05), PAR was the independent risk factor for the death within 6 weeks (P<0.05). The area under the curve (AUC) of PAR for predicting 6-week rebleeding and death was 0.876, 0.776, the cut-off was 2.94, 2.71, the specificity was 69.8%, 72.2%, the sensitivity was 94.4%, 73.3%, respectively. According to the cut-off of PAR to predict rebleeding, the 6-week rebleeding rate in the PAR≤2.94 group was higher than that in the PAR>2.94 group (χ2 = 36.88, P<0.01). According to the cut-off of PAR to predict death, the 6-week mortality rate in the PAR≤2.71 group was higher than in the PAR>2.71 group (χ2 = 16.44, P<0.01). Conclusions PAR can be used as a predictor for rebleeding and death within 6 weeks of EGVB in cirrhotic patients.

    肝硬化食管和胃静脉曲张血小板与白蛋白比值再出血死亡

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