Medicina clinica (English ed.)最新文献

英文中文

Usefulness of therapeutic drug monitoring of vedolizumab in the control of response in Crohn’s disease vedolizumab治疗药物监测在克罗恩病反应控制中的作用

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-02-21 DOI: 10.1016/j.medcle.2026.107254

Laura Moñino-Dominguez, Alicia Aguado-Paredes, Jaime Cordero-Ramos, Maria José Tirado-Pérez, Alejandro Martínez-Escudero, Federico Argüelles-Arias, Vicente Merino-Bohórquez

Introduction

The predictive value of therapeutic drug monitoring (TDM) of vedolizumab in Crohn’s disease (CD) during the maintenance phase remains uncertain. This study assessed its association with clinical and biochemical remission in routine clinical practice and explored variables influencing trough concentration variability.

Methods

A retrospective observational study was conducted at a tertiary hospital between July 2022 and December 2024. Adult CD patients receiving vedolizumab during maintenance and undergoing routine TDM were included. Clinical variables (age, treatment duration, administration route, perianal disease), laboratory markers (albumin, C-reactive protein [CRP], fecal calprotectin [FCP]), and pharmacokinetic data were collected. Trough concentrations were measured using ELISA. Clinical remission was defined as a Harvey–Bradshaw Index <5 and biochemical remission as FCP < 250 µg/g, both evaluated six months after the trough level. Non-parametric tests, multiple linear regression, ROC analysis, and multiple imputation were used for statistical analysis.

Results

Seventy patients were included. Clinical remission was observed in 76.8%. Median trough levels were higher in patients in clinical remission (17.5 µg/mL [IQR: 12.5–26.2]) than in those without remission (13.4 µg/mL [IQR: 8.8–23.5]; p = 0.07). A total of 65.2% reached ≥14 µg/mL; however, remission rates did not differ significantly between groups with high or low exposure, for either clinical (84.4% vs. 62.5%; p = 0.07) or biochemical remission (73.1% vs. 69.2%; p = 1). ROC analysis identified an optimal threshold of 11.3 µg/mL (AUC = 0.647). Subcutaneous administration was associated with higher concentrations (p = 0.0057), as were higher albumin levels (p = 0.012). Significant correlations were found between vedolizumab levels and CRP (positive, p = 0.0025) and FCP (inverse, p = 0.0186). No anti-drug antibodies were detected.

Conclusions

Vedolizumab trough levels were not significantly associated with clinical or biochemical remission during maintenance. These findings suggest that the isolated use of TDM may have limited predictive value. However, factors such as administration route, albumin, and inflammation levels influence exposure and should be integrated into the interpretation of drug concentrations in clinical practice.

vedolizumab治疗性药物监测（TDM）在克罗恩病（CD）维持期的预测价值仍不确定。本研究在常规临床实践中评估其与临床和生化缓解的关系，并探讨影响谷浓度变异性的变量。方法于2022年7月至2024年12月在某三级医院进行回顾性观察研究。在维持期间接受维多单抗治疗并接受常规TDM的成年CD患者被纳入研究。收集临床变量（年龄、治疗时间、给药途径、肛周疾病）、实验室标志物（白蛋白、c反应蛋白（CRP）、粪钙保护蛋白（FCP））和药代动力学数据。采用ELISA法测定谷浓度。临床缓解定义为哈维-布拉德肖指数（Harvey-Bradshaw Index <5），生化缓解定义为FCP <； 250µg/g，均在低谷水平后6个月评估。统计分析采用非参数检验、多元线性回归、ROC分析和多元插值。结果共纳入70例患者。76.8%的患者临床缓解。临床缓解患者的中位波谷水平（17.5µg/mL [IQR: 12.5-26.2]）高于无缓解患者（13.4µg/mL [IQR: 8.8-23.5]; p = 0.07）。65.2%达到≥14µg/mL；然而，无论是临床缓解（84.4% vs. 62.5%, p = 0.07）还是生化缓解（73.1% vs. 69.2%, p = 1），高暴露组和低暴露组之间的缓解率均无显著差异。ROC分析确定最佳阈值为11.3µg/mL （AUC = 0.647）。皮下给药与较高的白蛋白浓度相关（p = 0.0057），白蛋白水平也较高（p = 0.012）。vedolizumab水平与CRP（阳性，p = 0.0025）和FCP（阴性，p = 0.0186）之间存在显著相关性。未检出抗药物抗体。结论vedolizumab谷水平与维持期间的临床或生化缓解无显著相关性。这些发现表明单独使用TDM可能具有有限的预测价值。然而，诸如给药途径、白蛋白和炎症水平等因素影响暴露，应纳入临床实践中对药物浓度的解释。

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引用次数: 0

Takotsubo syndrome: From pathophysiology to clinical practice Takotsubo综合征：从病理生理学到临床实践

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-02-20 DOI: 10.1016/j.medcle.2026.107291

Paula Mula , Marco Tomasino , Aitor Uribarri

Takotsubo syndrome (TTS) is an acute and transient cardiomyopathy characterised by left ventricular systolic dysfunction in the absence of obstructive coronary artery disease. Although its clinical presentation frequently resembles acute myocardial infarction, TTS is driven by distinct pathophysiological mechanisms involving sympathetic hyperactivation, catecholamine surge, coronary microvascular dysfunction, and imbalance within the brain–heart axis. Once considered a benign condition, it is now recognized to carry a significant burden of adverse events—including cardiogenic shock, malignant arrhythmias, and thromboembolic complications—with short- and long-term mortality rates comparable to those of acute coronary syndromes. Diagnosis requires the integration of clinical assessment, cardiac biomarkers, characteristic electrocardiographic changes, and advanced imaging techniques, particularly echocardiography and cardiac magnetic resonance. Management is primarily supportive and should be adapted to the predominant haemodynamic phenotype. This review provides an updated and comprehensive synthesis of the epidemiology, pathophysiology, diagnostic strategies, complications, treatment approaches, and prognosis of TTS, while highlighting current evidence gaps that warrant ongoing and future clinical trials.

Takotsubo综合征（TTS）是一种急性和短暂性心肌病，其特征是在没有阻塞性冠状动脉疾病的情况下，左心室收缩功能障碍。尽管其临床表现经常类似于急性心肌梗死，但TTS是由不同的病理生理机制驱动的，包括交感神经过度激活、儿茶酚胺激增、冠状动脉微血管功能障碍和脑-心轴失衡。曾经被认为是一种良性疾病，现在人们认识到它具有严重的不良事件负担，包括心源性休克、恶性心律失常和血栓栓塞并发症，其短期和长期死亡率与急性冠状动脉综合征相当。诊断需要综合临床评估、心脏生物标志物、特征性心电图变化和先进的成像技术，特别是超声心动图和心脏磁共振。管理主要是支持性的，应适应主要的血流动力学表型。本综述对TTS的流行病学、病理生理学、诊断策略、并发症、治疗方法和预后进行了更新和全面的综合，同时强调了目前的证据差距，值得正在进行和未来的临床试验。

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引用次数: 0

Rhino-orbito-cerebral mucormycosis Rhino-orbito-cerebral毛霉菌病

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-03-13 DOI: 10.1016/j.medcle.2026.107274

Juan Francisco García Granado , Yesica Miranda Bacallado , Jesús de la Nuez González , Marta González Vega , Ayoze Nauzet González Hernández

引用次数: 0

Thrombopoietin agonists in monotherapy or associated with fostamatinib in severe or refractory thrombocytopenias to immunosuppressants in patients with systemic lupus erythematosus 血小板生成素激动剂单药治疗或与福司他替尼联合治疗严重或难治性血小板减少对系统性红斑狼疮患者免疫抑制剂的影响

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-02-25 DOI: 10.1016/j.medcle.2026.107285

Marina Salido Olivares

引用次数: 0

Clinical characteristics, disease course, and chronic organ damage in a real-world cohort of IgG4-related disease: Insights from an Interdisciplinary Unit igg4相关疾病的临床特征、病程和慢性器官损伤：来自跨学科单位的见解

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-03-13 DOI: 10.1016/j.medcle.2026.107317

Ernestina Angarola , Analia Pasqua , Horacio Matías Castro , Agustín Cáceres , Juan Carlos Spina , Paola Casciato , IgG4-RD Interdisciplinary Unit

Background and objective

IgG4-RD is a multisystemic disease, often underdiagnosed, with natural progression to chronic organ damage. We aim to describe clinical features, relapse and chronic organ damage.

Methods

Dynamic ambispective cohort including patients from the Institutional Registry of IgG4-RD at Hospital Italiano de Buenos Aires who met ACR/EULAR 2019 criteria. We analyzed clinical phenotypes, response to treatment, biomarkers and chronic organ damage.

Results

Sixty patients were included; 73% were male and median age at diagnosis was 61 years. Median time to diagnosis was 9 months (IQR 3–21), 10% had >10 years of delay. Multiorgan disease was present at diagnosis in 65% and the most common phenotype was pancreatohepatobiliary (40%). Corticosteroids were used at diagnosis in 77%; seven patients with totally resected disease required no further immunosuppression (median 59 months; IQR 31–144). Relapses occurred in 47%, predominantly in those with multiorgan involvement (89%). Kidneys and the biliary tract were most commonly affected in relapse. Relapsing predictive biomarkers were present in 63% at the onset; multiorgan involvement was associated with relapsing disease (p = 0.002). Chronic organ damage occurred in 71%, in 44% after surgical resection. The most frequent was exocrine pancreatic insufficiency (35%). Patients with baseline damage had a significantly longer diagnostic delay (p = 0.03). After a year of diagnosis, 85% of patients experienced damage.

Conclusion

Baseline organ damage was highly frequent, particularly with delayed diagnosis, while multiorgan involvement predicted relapse, underscoring the need for earlier and multidisciplinary management.

背景与目的igg4 - rd是一种多系统疾病，常被漏诊，可自然发展为慢性器官损伤。我们的目的是描述临床特征，复发和慢性器官损伤。方法：动态双视角队列研究，包括来自布宜诺斯艾利斯意大利医院IgG4-RD机构登记处符合ACR/EULAR 2019标准的患者。我们分析了临床表型、对治疗的反应、生物标志物和慢性器官损伤。结果共纳入60例患者；73%为男性，诊断时的中位年龄为61岁。中位诊断时间为9个月（IQR 3-21）， 10%延迟10年。65%的诊断时存在多器官疾病，最常见的表型是胰肝胆道（40%）。诊断时使用皮质类固醇的占77%；7例完全切除的患者无需进一步免疫抑制（中位59个月；IQR 31-144）。复发发生率为47%，主要是多器官受累（89%）。复发时最常受肾脏和胆道的影响。63%的患者在发病时存在复发性预测性生物标志物；多器官受累与疾病复发相关（p = 0.002）。慢性器官损害发生率为71%，手术切除后为44%。最常见的是外分泌性胰腺功能不全（35%）。基线损伤患者的诊断延迟明显延长（p = 0.03）。经过一年的诊断，85%的患者出现了损伤。结论基线脏器损害非常频繁，特别是延迟诊断，而多脏器累及预示复发，强调早期和多学科治疗的必要性。

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引用次数: 0

Relapsing polychondritis 复发polychondritis

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-03-04 DOI: 10.1016/j.medcle.2026.107349

Antonio Rosales-Castillo, Laura Gallo Padilla

引用次数: 0

Coexistence of McArdle disease and hypokalemic periodic paralysis: A case report 麦卡德尔病与低钾血症性周期性麻痹共存1例

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-03-13 DOI: 10.1016/j.medcle.2026.107336

Juyi Liu , Guang Ji , Xueqin Song

引用次数: 0

Autoinflammatory syndrome associated with a variant of the NLRP1 gene (NAIAD): Description of a pediatric case treated with canakinumab 与NLRP1基因变异相关的自身炎症综合征（NAIAD）：用canakinumab治疗的儿科病例描述

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-03-04 DOI: 10.1016/j.medcle.2026.107325

Judith Hernández Sánchez, Doryan José García Olivas, Sergio Machín García

引用次数: 0

Prognostic value of the PROFUND index in patients with chronic obstructive pulmonary disease after exacerbation 慢性阻塞性肺疾病加重后患者PROFUND指数的预后价值

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-02-20 DOI: 10.1016/j.medcle.2026.107314

Irene Casado López, Francisco Javier Teigell Muñoz, José Manuel Casas Rojo, María Mateos González, Alba Hernández Piriz, Pilar Cubo Romano

Objective

To evaluate the prognostic value of the PROFUND index for predicting all-cause mortality during hospitalization or within three months after discharge in patients hospitalized due to COPD exacerbation, as well as predicting readmissions within three months.

Method

An observational, retrospective, single-center study that included all patients hospitalized between January and December 2022 due to COPD exacerbation.

Results

The analysis included 172 patients. Half of the patients (50.6%) were multimorbid. These patients were older, had greater baseline dyspnea, a higher degree of obstruction, greater dependency for basic daily living activities, a higher PROFUND index, and were at higher risk of readmission within three months and in-hospital mortality (p < 0.05). There was a 35.98% readmission rate within three months, mostly due to a new COPD exacerbation (86%), an in-hospital mortality rate of 3.4%, and a three-month mortality rate of 5.2%. A high PROFUND index (≥7) was significantly associated with increased mortality during hospitalization or within the first 3 months after discharge (OR 33, [95% CI 3.9–273.4], p = 0.001) and a higher risk of hospital readmission for any cause (OR 4.91, [CI 1.99−12.13], p = 0.0003). The variables most influencing mortality were severe dyspnea, anemia, confusional syndrome, and functional impairment (Barthel index <60).

Conclusion

The PROFUND index could be a good predictor of mortality and readmission risk in patients hospitalized due to a COPD exacerbation.

目的评价PROFUND指数对COPD加重住院患者住院期间及出院后3个月内全因死亡率的预测价值，以及对3个月内再入院的预测价值。方法一项观察性、回顾性、单中心研究，纳入2022年1月至12月因COPD恶化住院的所有患者。结果纳入172例患者。半数患者（50.6%）为多病。这些患者年龄较大，基线呼吸困难程度较高，梗阻程度较高，对基本日常生活活动的依赖程度较高，PROFUND指数较高，3个月内再入院和院内死亡风险较高（p < 0.05）。3个月内再入院率为35.98%，主要是由于新的COPD加重（86%），住院死亡率为3.4%，3个月死亡率为5.2%。高PROFUND指数（≥7）与住院期间或出院后前3个月内死亡率增加（or 33, [95% CI 3.9-273.4], p = 0.001）和因任何原因再入院的高风险（or 4.91, [CI 1.99 - 12.13], p = 0.0003）显著相关。对死亡率影响最大的变量是严重呼吸困难、贫血、精神混乱综合征和功能障碍（Barthel指数60）。结论PROFUND指数可以很好地预测慢性阻塞性肺病加重患者的死亡率和再入院风险。

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引用次数: 0

Towards comprehensive fall prevention in older adults 全面预防老年人跌倒

Medicina clinica (English ed.)

Pub Date : 2026-02-01 Epub Date: 2026-02-20 DOI: 10.1016/j.medcle.2026.107249

Alberto Lana

引用次数: 0

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全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

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Medicina clinica (English ed.)

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