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Hand,foot and mouth disease in Yangpu District of Shanghai:an analysis of epidemiologic characteristics in 2009-2013 上海市杨浦区2009-2013年手足口病流行病学特征分析
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00044
Peng Qiao, Jing-jing Hu, Min Liu, Fei Li, Lin Wang, Hongwei Zhang, Rong Zhang
Objective To analyze the etiological and epidemiological characteristics of hand,foot and mouth disease(HFMD)in Yangpu District of Shanghai from 2009 to 2013,providing evidence for its prevention and control.Methods HFMD surveillance and report were done using the National Disease Supervision Information Management System.Descriptive epidemiological method was used to analyze the 2009-2013 epidemiologic characters and etiological characters(partial patients)of HFMD in Yangpu District,Shanghai.Nucleic acid of enterovirus(EV)genome was detected by real-time PCR in some patients.Results A total of 4 974 cases of HFMD were reported during 2009-2013 in Yangpu District,Shanghai,with the average annual incidence rate of 755.3per million,with no death cases and 9(0.18%)severe cases.The peak incidence was observed in the period of April to July.The epidemic peak had an increasing tendency and could be delayed.The incidence rates of HFMD were increased at an annual basis(Ptrend0.05)in all communities and were significantly different between different communities(P0.05).Most of the cases were less than 5-year-old scattered and childcare children.The main epidemic strains were EV71 and Cox A16 in 2010,and other enterovirus and Cox A16 in 2011-2013.The proportions of other enterovirus strains were increased,with overlapping phenomenon found in the pathogenic spectrum curves before and after the epidemic peak.Conclusion The 2009-2013 epidemiology of HFMD in Yangpu District of Shanghai had prominent seasonal,regional and population characteristics.Epidemic superiority strains vary annually and influence the epidemic trend and severity.
目的分析2009 - 2013年上海市杨浦区手足口病(手足口病)的病原学和流行病学特征,为手足口病的防治提供依据。方法采用国家疾病监测信息管理系统进行手足口病监测和报告。采用描述流行病学方法对上海市杨浦区2009-2013年手足口病流行病学特征及部分患者的病因学特征进行分析。采用实时荧光定量PCR法检测部分患者肠道病毒(EV)基因组核酸。结果2009-2013年,上海市杨浦区共报告手足口病4 974例,年平均发病率为755.3 / 100万,无死亡病例,重症病例9例(0.18%)。发病高峰期为4 ~ 7月。疫情高峰有上升趋势,有延迟的可能。手足口病发病率各社区呈逐年上升趋势(p < 0.05),不同社区间差异有统计学意义(p < 0.05)。以5岁以下散养儿童和托儿儿童居多。2010年主要流行毒株为EV71和Cox A16, 2011-2013年主要流行毒株为其他肠道病毒和Cox A16。其他肠道病毒株的比例增加,在流行高峰前后的致病谱曲线上出现重叠现象。结论2009-2013年上海市杨浦区手足口病流行病学具有明显的季节性、地域性和人群特征。流行优势菌株每年都在变化,并影响流行趋势和严重程度。
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引用次数: 0
Small bronchoscopic biopsy specimens for detecting EGFRgene mutations in advanced lung adenocarcinoma 小支气管镜活检标本用于检测晚期肺腺癌中EGFRgene突变
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00049
Yunqiang Nie, Cui-yun Li, Na Li, Xiaoying Zhang, Hui Wang, Da-cai Guo, P. Han, Xin Lü, Shulan Liu, Changzheng Wang, Xinyi Xu
Objective To examine epidermal growth factor receptor(EGFR)gene mutations in small bronchoscopic biopsy specimens,so as to provide guidance for clinical targeted therapy.Methods Fifty-six female patients with advancedstage Ⅲ B-Ⅳ lung adenocarcinoma underwent endoscopic endobronchial biopsy of tumor tissues or transbronchial needle aspiration of mediastinal and hilar lymph nodes.Under the endoscope,20 patients underwent only bronchial biopsy,28 underwent only transbronchial needle aspiration(TBNA)lymph node biopsy,and 8underwent both endobronchial biopsy and TBNA biopsy of mediastinal and hilar lymph nodes.A total of 64 specimens were collected and were subjected to detection of EGFR gene mutations after confirmation of lung adenocarcinoma.The specimens were then divided into endobronchial metastasis group and lymph node metastasis group,and the mutations of exons 19 and 21were detected and the clinical efficacy of targeted therapy was analyzed.Results Exon 19 had higher positive rate in the endobronchial metastasis group(χ2=4.304,P=0.038),and exon 21 had higher positive rate in lymph node metastasis group(χ2=18.727,P=0.000).A total of 24 cases were included for the clinical efficacy assessments:10had endobronchial metastasis(exon 19 mutations in 8cases,21 exon in 2cases),with the disease control rate being 90%(9/10)and median progression-free survival period being 14.8 months;14patients had lymph node metastasis(19exon 3cases,21 exon 11cases),with the disease control rate being 78.57%(11/14)and the median progression-free survival period being 9.2 months;the disease control rates were not significantly different between the two groups(P0.05)and the median progression-free survival periods were significantly different between the two groups(χ2= 4.134,P=0.042).Conclusion Mutations of different EGFRexons might relate to the metastasis forms of female advanced lung adenocarcinoma,with exon 19 prone to endobronchial metastasis and exon 21 to lymph node metastasis.Targeted therapy for patients with endobronchial metastasis has a better outcome than that for patients with lymph node metastasis.
目的探讨小支气管镜活检标本中表皮生长因子受体(EGFR)基因突变情况,为临床靶向治疗提供指导。方法对56例晚期ⅢB-Ⅳ女性肺腺癌患者行内镜下支气管内活检或纵隔、肺门淋巴结穿刺活检。内镜下,20例患者仅行支气管活检,28例患者仅行经支气管穿刺活检(TBNA)淋巴结活检,8例患者同时行纵隔和肺门淋巴结支气管活检和TBNA活检。共采集标本64例,确诊肺腺癌后进行EGFR基因突变检测。将标本分为支气管内转移组和淋巴结转移组,检测19、21外显子的突变情况,分析靶向治疗的临床疗效。结果外显子19在支气管内转移组阳性率较高(χ2=4.304,P=0.038),外显子21在淋巴结转移组阳性率较高(χ2=18.727,P=0.000)。临床疗效评估共纳入24例:支气管内转移10例(外显子19突变8例,外显子21例),疾病控制率为90%(9/10),中位无进展生存期为14.8个月;淋巴结转移14例(外显子3 19例,外显子11 21例),疾病控制率为78.57%(11/14),中位无进展生存期为9.2个月,两组疾病控制率无显著差异两组间无进展生存期中位数差异有统计学意义(χ2= 4.134,P=0.042)。结论不同EGFRexons的突变可能与女性晚期肺腺癌的转移形式有关,其中外显子19易发生支气管内转移,外显子21易发生淋巴结转移。支气管内转移患者的靶向治疗效果优于淋巴结转移患者。
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引用次数: 0
Dual roles of Nemo-like kinase in tumor development and progression nemo样激酶在肿瘤发生和发展中的双重作用
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00069
Jian He, Wei Zhang
Nemo-like kinase(NLK)is an evolutionarily conserved mitogen activated protein kinase-like kinase,belonging to serine/threonine protein kinase superfamily.By participating in Wnt,Notch,FoxO and other pathways,NLK can regulate cell proliferation,differentiation,morphological changes,early embryonic development of vertebrate nervous system,and other biological processes.NLK is also a key molecule in tumor regulation and its roles vary in different tumors.In prostate cancer,non-small cell lung cancer,ovarian cancer,and breast cancer,NLK plays an inhibitory role,while it plays opposite roles in oral squamous cell carcinoma,hepatocellular carcinoma,and the bile duct tumors.
Nemo-like kinase(NLK)是一种进化保守的丝裂原活化蛋白激酶样激酶,属于丝氨酸/苏氨酸蛋白激酶超家族。NLK通过参与Wnt、Notch、FoxO等通路,调节细胞增殖、分化、形态改变、脊椎动物神经系统早期胚胎发育等生物学过程。NLK也是肿瘤调控的关键分子,其在不同肿瘤中的作用各不相同。在前列腺癌、非小细胞肺癌、卵巢癌和乳腺癌中,NLK发挥抑制作用,而在口腔鳞状细胞癌、肝细胞癌和胆管肿瘤中,NLK发挥相反的作用。
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引用次数: 0
Death and potential years of life lost of residents living in Yubei District of Chongqing City in 2012: an analysis on the main causes 2012年重庆市渝北区居民死亡及潜在寿命损失年数:主要原因分析
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00095
W. Huang, Wen Wang, Wei Feng, Ling-li Hang, Yu Chen
Objective To understand the main causes of death and the potential years of life lost(PYLL)of residents living in Yubei District of Chongqing,so as to provide evidence for disease control and health promotion.Methods The data of the death cases were classified according to ICD-10 method and were subjected to analysis by DeathReg2005 software.The characteristics of death of our population were analyzed using the following parameters:the crude mortality,proportions of death due to different reasons,order of death causes and the PYLL,etc.Results The crude death rate of residents in our study was 605.02 per 100 000 in 2012,with the standardized death rate being 440.72 per 100 000;and the mortality was higher in males than in females(χ2=227.87,P0.001).The top five causes of deaths in order were:circular system diseases,malignant tumors,respiratory system diseases,injury and poisoning,and digestive system diseases;these 5causes contributed to 95.15%of all death causes.The top six causes of PYLL in order were:malignant tumors,injury and poisoning,circular system diseases,respiratory system diseases,perinatal system diseases,and digestive system diseases.The main causes of death among different ages have their own characteristics.Conclusion The predominant causes of death among residents in our study include chronic non-infectious diseases(circular system diseases and malignant tumors);injuries and poisoning,especially death due to traffic accident,are the major causes among young adults.Appropriate preventive and interventional measures should be taken based on the death causes of residents.
目的了解重庆市渝北区居民主要死亡原因及潜在生命损失年(PYLL),为疾病控制和健康促进提供依据。方法采用ICD-10方法对死亡病例资料进行分类,并采用DeathReg2005软件进行分析。采用粗死亡率、不同原因死亡比例、死因顺序、PYLL等参数分析人群死亡特征。结果2012年本区居民粗死亡率为605.02 / 10万,标准化死亡率为440.72 / 10万,男性死亡率高于女性(χ2=227.87,P0.001)。死亡原因前5位依次为:循环系统疾病、恶性肿瘤、呼吸系统疾病、损伤中毒、消化系统疾病,占死亡原因的95.15%。PYLL的前6位病因依次为:恶性肿瘤、损伤和中毒、循环系统疾病、呼吸系统疾病、围产期系统疾病、消化系统疾病。不同年龄段的主要死亡原因各有特点。结论慢性非传染性疾病(循环系统疾病和恶性肿瘤)是本区居民死亡的主要原因,伤、中毒,尤其是交通事故死亡是青壮年居民死亡的主要原因。应根据居民死亡原因采取相应的预防和干预措施。
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引用次数: 0
Doubled dose rosuvastatin or rosuvastatin combined with probucol for treatment of patients with coronary artery disease and hypercholesterolemia: a comparison of effectiveness 双倍剂量瑞舒伐他汀或瑞舒伐他汀联合普罗布考治疗冠状动脉疾病和高胆固醇血症的疗效比较
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00083
Yang Lu, Mingxing Lei, Miao Xu, Xianxian Zhao, Song-hua Li
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引用次数: 0
Expression of vascular adhesion protein-1 in severe hemorrhagic shock and resuscitation in rats 血管粘附蛋白-1在大鼠严重失血性休克及复苏中的表达
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00124
Jun-Yan Yao, Wei Yi, Z. Ya, C. Qian, Zhi Hu
Objective To observe the expression and activity changes of vascular adhesion protein-1(VAP-1)in the small intestine and serum of rats during severe hemorrhagic shock and resuscitation,and to study its influence on shock prognosis.Methods Fifty rats were evenly randomized into sham group,hemorrhagic shock group,shock resuscitation group,control recovery group and the experimental recovery group.Rat models of severe hemorrhagic shock and resuscitation were established.Before shock,1hour after shock and 1hour after resuscitation,the expressions of VAP-1protein and mRNA in the intestinal tissues of rats were examined by Western blotting analysis and real-time RT-PCR,respectively;and the serum levels of VAP-1and its activities were determined by ELISA kit.Rats in the experimental recovery group was resuscitated by injection of 20mg/kg2-bromoethylamine and those in the control recovery group were given 1 mL/kg normal saline,and then the blood pressure,intestinal mucosa injury(Chiu's score),small intestinal epithelial cell apoptosis(TUNEL detection)and 24-hour survival rates were compared between the two recovery groups.Results The intestinal VAP-1protein and mRNA expressions and the serum VAP-1and its activities in the severe hemorrhagic shock group were significantly higher than those in the sham shock group(P0.05).Compared with the shock group,the above parameters were decreased in the recovery group,but were still higher than those in the sham group.Compared with the saline control group,20mg/kg 2-bromoethylamine significantly increased the blood pressure of animals 1hand 24 hafter recovery(P=0.010,0.039),significantly improved the Chiu's score and apoptosis index of small intestinal epithelial cells(P=0.022,P=0.002),and improved the 24-hour survival rates of rats(90%to 60%).Conclusion The levels of VAP-1and its activities are increased in severe hemorrhagic shock rats,and fluid resuscitation can inhibit this increase.Inhibition of VAP-1activities can improve the low blood pressure,intestinal mucosa injury and apoptosis of small intestinal mucosa cells after the severe hemorrhagic shock and resuscitation,improving the 24-hour survival rates of rats.
目的观察严重失血性休克及复苏大鼠小肠及血清中血管粘附蛋白-1(VAP-1)的表达及活性变化,并探讨其对休克预后的影响。方法50只大鼠随机分为假手术组、失血性休克组、休克复苏组、对照恢复组和实验恢复组。建立大鼠严重失血性休克及复苏模型。休克前、休克后1小时、复苏后1小时,分别采用Western blotting和real-time RT-PCR检测大鼠肠道组织中vap -1蛋白和mRNA的表达,ELISA试剂盒检测血清vap -1水平及其活性。实验恢复组大鼠给予20mg/kg2-溴乙胺复苏,对照组恢复组大鼠给予生理盐水1 mL/kg复苏,比较两组大鼠血压、肠黏膜损伤(Chiu’s评分)、小肠上皮细胞凋亡(TUNEL检测)及24小时存活率。结果重型失血性休克组大鼠肠道vap -1蛋白、mRNA表达及血清vap -1及其活性显著高于假性休克组(P0.05)。与休克组比较,恢复组上述各项指标均有所下降,但仍高于假手术组。与生理盐水对照组相比,20mg/kg 2-溴乙胺可显著提高动物恢复后1 ~ 24小时血压(P=0.010、0.039),显著提高小肠上皮细胞的Chiu’s评分和凋亡指数(P=0.022、P=0.002),提高大鼠24小时存活率(90% ~ 60%)。结论重型失血性休克大鼠vap -1水平及活性升高,液体复苏可抑制其升高。抑制vap -1活性可改善严重失血性休克复苏后的低血压、肠黏膜损伤和小肠黏膜细胞凋亡,提高大鼠24小时存活率。
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引用次数: 0
Establishment and validation of mathematics model for differentiating benign and malignant solitary pulmonary nodules 良恶性孤立性肺结节鉴别数学模型的建立与验证
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00407
Juanjuan Yang, Xuewei Sun, Guobin Lai, Hui-zhen Yu, Qiang Li, Yi-ping Han
{"title":"Establishment and validation of mathematics model for differentiating benign and malignant solitary pulmonary nodules","authors":"Juanjuan Yang, Xuewei Sun, Guobin Lai, Hui-zhen Yu, Qiang Li, Yi-ping Han","doi":"10.3724/SP.J.1008.2015.00407","DOIUrl":"https://doi.org/10.3724/SP.J.1008.2015.00407","url":null,"abstract":"","PeriodicalId":6893,"journal":{"name":"Academic Journal of Second Military Medical University","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69846578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Endovascular treatment for basilar tip aneurysms associated with moyamoya disease 烟雾病相关基底尖动脉瘤的血管内治疗
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00330
Yan Chen, Dai Dongwei, Yibin Fang, Qinghai Huang, Wen-yuan Zhao, Jianmin Liu
Objective To assess the safety and efficacy of endovascular treatment for basilar tip aneurysms associated with moyamoya disease.Methods Seven patients with basilar tip aneurysms associated with moyamoya disease were treated by endovascular embolization in our department between Oct.2006 and Jul.2013.Two patients were treated by pure coiling and the others were treated by stent-assisted coiling.The immediate angiographic result was evaluated by Raymond scale.Postoperative angiographic and clinical follow-ups were obtained in all the 7cases,and the clinical outcomes were evaluated by the modified Rankin score(mRS).Results All the 7 patients successfully received endovascular embolization without procedure-related complications.Immediate angiographic results showed complete occlusion in 3cases,neck residual in 2,and partial occlusion in 2.Postoperative angiographic follow-ups were obtained for a mean of(10.4±3.5)months,with complete occlusion found in 6patients and stable in 1patient.No progressive thrombosis or in-stent occlusion were detected by follow-up angiograms in the stent group.Clinical follow-ups were obtained for a mean of(21.1±15.8)months and all the patients reported good outcomes(mRS 0-2).Conclusion Our data suggest that endovascular embolization is a safe and efficient treatment for basilar tip aneurysms associated with moyamoya disease.Stent-assistance might be a safe and effective option for the large or wide-necked aneurysms,though the long-term safety still remains to be confirmed.
目的评价血管内治疗基底尖动脉瘤合并烟雾病的安全性和有效性。方法对我科2006年10月至2013年7月收治的7例基底尖动脉瘤合并烟雾病患者行血管内栓塞治疗。2例患者采用单纯盘绕治疗,其余患者采用支架辅助盘绕治疗。即刻血管造影结果采用雷蒙德评分法评价。7例患者均行术后血管造影及临床随访,采用改良Rankin评分(mRS)评价临床疗效。结果7例患者均成功行血管内栓塞,无手术并发症。即时血管造影结果显示完全闭塞3例,颈部残留2例,部分闭塞2例。术后血管造影随访平均为(10.4±3.5)个月,6例患者发现完全闭塞,1例患者病情稳定。支架组随访血管造影未发现进展性血栓形成或支架内闭塞。临床随访时间平均为(21.1±15.8)个月,全部患者预后良好(mRS 0-2)。结论血管内栓塞是治疗基底尖动脉瘤合并烟雾病的一种安全有效的方法。对于大的或宽颈的动脉瘤,支架辅助可能是一种安全有效的选择,尽管长期的安全性仍有待证实。
{"title":"Endovascular treatment for basilar tip aneurysms associated with moyamoya disease","authors":"Yan Chen, Dai Dongwei, Yibin Fang, Qinghai Huang, Wen-yuan Zhao, Jianmin Liu","doi":"10.3724/SP.J.1008.2015.00330","DOIUrl":"https://doi.org/10.3724/SP.J.1008.2015.00330","url":null,"abstract":"Objective To assess the safety and efficacy of endovascular treatment for basilar tip aneurysms associated with moyamoya disease.Methods Seven patients with basilar tip aneurysms associated with moyamoya disease were treated by endovascular embolization in our department between Oct.2006 and Jul.2013.Two patients were treated by pure coiling and the others were treated by stent-assisted coiling.The immediate angiographic result was evaluated by Raymond scale.Postoperative angiographic and clinical follow-ups were obtained in all the 7cases,and the clinical outcomes were evaluated by the modified Rankin score(mRS).Results All the 7 patients successfully received endovascular embolization without procedure-related complications.Immediate angiographic results showed complete occlusion in 3cases,neck residual in 2,and partial occlusion in 2.Postoperative angiographic follow-ups were obtained for a mean of(10.4±3.5)months,with complete occlusion found in 6patients and stable in 1patient.No progressive thrombosis or in-stent occlusion were detected by follow-up angiograms in the stent group.Clinical follow-ups were obtained for a mean of(21.1±15.8)months and all the patients reported good outcomes(mRS 0-2).Conclusion Our data suggest that endovascular embolization is a safe and efficient treatment for basilar tip aneurysms associated with moyamoya disease.Stent-assistance might be a safe and effective option for the large or wide-necked aneurysms,though the long-term safety still remains to be confirmed.","PeriodicalId":6893,"journal":{"name":"Academic Journal of Second Military Medical University","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69845298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of hepatitis B virus mutation, somatic mutations of hosts and related immune genetics in liver cirrhosis and hepatocellular carcinoma 乙型肝炎病毒突变、宿主体细胞突变及相关免疫遗传学在肝硬化和肝细胞癌中的作用
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00367
Zi-xiong Li, R. Pu, Yan Du, G. Cao
{"title":"Role of hepatitis B virus mutation, somatic mutations of hosts and related immune genetics in liver cirrhosis and hepatocellular carcinoma","authors":"Zi-xiong Li, R. Pu, Yan Du, G. Cao","doi":"10.3724/SP.J.1008.2015.00367","DOIUrl":"https://doi.org/10.3724/SP.J.1008.2015.00367","url":null,"abstract":"","PeriodicalId":6893,"journal":{"name":"Academic Journal of Second Military Medical University","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69845616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of anatomic liver resection on prognosis of patients with hepatocellular carcinoma 解剖性肝切除术对肝癌患者预后的影响
Q4 Medicine Pub Date : 2015-01-01 DOI: 10.3724/SP.J.1008.2015.00492
Jin-long Huang, Qing Wang, Yong Yu, Xiaoqing Jiang, Xiang-ji Luo
Objective To explore the effect of anatomic liver resection(AR) and non-anatomic liver resection(NAR) on the prognosis of patients with hepatocellular carcinoma(HCC).Methods The clinical data of 721 HCC patients,who were treated between July 2008 to July 2009,were collected from Eastern Hepatobiliary Surgery Hospital; the patients included 317 undergoing AR and 404 undergoing NAR.The prognosis of the patients was compared between the two groups by using the Kaplan-Meier method and log-rank test.The influence factors of the prognosis were analyzed by using the Cox proportional hazards regression model.The propensity score matching method was used to eliminate the selection bias in clinical and pathological features.Results The 1-year,3-year and 5-year overall survival(OS) rates of the 721 patients were 85.9%,64.7% and 51.5%,respectively; and the 1-year,3-year and 5-year disease free survival(DFS) rates were 59.3%,34.0% and 25.5%,respectively.AR conferred better OS than NAR(93.1%,74.5% and 62.5% vs 80.2%,56.8% and 42.9%,P 0.001,respectively); the same was also true for DFS rates(69.3%,41.3% and 34.9% vs 51.4%,38.3% and 18.7%,P 0.001,respectively).After propensity matching,AR still achieved better prognosis than NAR(OS rates: 93.9%,73.3%,and 59.4% vs 86.0%,62.8%,52.8%,P = 0.010; DFS rates: 67.9%,37.5%and 31.3% vs 56.8%,33.1% and 22.6%,P = 0.024).The results of multivariate analysis showed that the tumor size,tumor number,capsule,liver cirrhosis,microvascular invasion,and method of liver resection were the independent risk factors of OS; and blood transfusion,tumor size,tumor number,capsule,liver cirrhosis,microvascular invasion,and method of liver resection were the independent risk factors of DFS.However,the OS and DFS rates were not significantly different between AR and NAR groups in patients with hepatocirrhosis(P = 0.767 and P = 0.638,respectively).AR group achieved better prognosis than NAR group in the HCC patients without cirrhosis(P 0.001).Conclusion AR can achieve better prognosis than NAR in HCC patients,but for patients with hepatocirrhosis NAR should be recommended in order to retain better liver function.
目的探讨解剖性肝切除术(AR)与非解剖性肝切除术(NAR)对肝细胞癌(HCC)患者预后的影响。方法收集东方肝胆外科医院2008年7月~ 2009年7月收治的肝癌患者721例的临床资料;其中AR 317例,NAR 404例。采用Kaplan-Meier法和log-rank检验比较两组患者的预后。采用Cox比例风险回归模型分析影响预后的因素。采用倾向评分匹配法消除临床和病理特征的选择偏倚。结果721例患者的1年、3年和5年总生存率(OS)分别为85.9%、64.7%和51.5%;1年、3年、5年无病生存率(DFS)分别为59.3%、34.0%、25.5%。AR比NAR获得更好的OS(93.1%、74.5%和62.5% vs 80.2%、56.8%和42.9%,P分别为0.001);DFS率也是如此(分别为69.3%、41.3%和34.9% vs 51.4%、38.3%和18.7%,P值分别为0.001)。倾向匹配后,AR的预后仍优于NAR(OS率:93.9%、73.3%、59.4% vs 86.0%、62.8%、52.8%,P = 0.010;DFS率分别为67.9%、37.5%和31.3% vs 56.8%、33.1%和22.6%,P = 0.024)。多因素分析结果显示,肿瘤大小、肿瘤数量、包膜、肝硬化、微血管侵犯、肝切除方式是发生OS的独立危险因素;输血、肿瘤大小、肿瘤数量、包膜、肝硬化、微血管侵犯、肝切除方式是发生DFS的独立危险因素。而肝硬化患者的OS和DFS在AR组和NAR组间差异无统计学意义(P = 0.767和P = 0.638)。无肝硬化HCC患者AR组预后优于NAR组(P < 0.001)。结论在HCC患者中,AR的预后优于NAR,但对于肝硬化患者,应推荐NAR,以保留较好的肝功能。
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引用次数: 1
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第二军医大学学报
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