Objective To investigate the relationship between stress hyperglycemia ratio and severity of coronary artery disease in patients with coronary artery disease aged 80 years and above.Methods Coronary artery disease(CAD)patients aged 80 years and above who hospitalized in Beijing Hospital and underwent percutaneous coronary intervention(PCI)from January 1,2015,to December 31,2021 were consecutively enrolled enrolled.The patients'clinical data,including coronary angiography results,laboratory test results and echocardiography data were collected.According to the coronary angiography(CAG)results,patients were divided into single-vessel and multi-vessel lesions groups;according to the tertile of stress hyperglycemia ratio,they were divided into 3 groups(T1 group,stress hyperglycemia ratio(SHR)<0.867;T2 group,0.867≤SHR<1.115;and T3 group,SHR≥1.115),and the correlation between SHR and the severity of coronary disease was analyzed by logistic regression analysis.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to determine the sensitivity and specificity of SHR in predicting CAD severity.Controlling confounding factors,the restricted cubic spline plot was drawn to analyze the dose-response relationship between SHR and multi-vessel disease.Results A total of 486 patients were finally enrolled,including 286(58.8%)males and 200(41.2%)females with a median age of 82(81,84)years.Patients in the multi-vessel lesion group had higher SHR values than those in the single-vessel lesion group.According to the tertiles of SHR,the proportion of patients with multi-vessel lesions in the T3 group(91.9%)was higher than that in the other two groups(P<0.05).Logistic regression analysis showed that the SHR was an independent risk factor for multi-vessel lesions when used as a continuous variable after adjusting for risk factors(OR=3.718,95%CI:1.319-10.479,P=0.013).When SHR was used as a categorical variable,the risk of multi-vessel lesions in the T3 group was 2.106 times(95%CI:1.020-4.334,P<0.05)higher than that in the T1 group after adjusting for risk factors.SHR was associated with an increased risk of multi-vessel lesions in the diabetic group,whereas there was no significant association in the nondiabetic group(P for interaction=0.003).In addition,the area under the curve of SHR for predicting CAD severity was 0.606(95%CI:0.536-0.676).The restricted cubic spline analysis showed that there is a linear dose-response relationship between SHR and multi-vessel disease(Poverall=0.042,Pnonlinear=0.865).Conclusions SHR was significantly correlated with the risk of multi-vessel lesions and a predictor of coronary lesion severity in patients with CAD aged 80 years and above,especially in diabetic metillus patients.Monitoring SHR in elderly CAD patients is important for the evaluation of their condition and prognosis.
人类的衰老是在成熟期后随增龄而发生的机体正常形态和功能的退行性改变.从进化和自然选择的角度来看,衰老并非进化的必然产物,而是一个随机事件,是在完成进化使命的繁殖期后自然选择的作用惯性,提示衰老并非生命终结的前提,因此抗衰老是可行的.抗衰老并不是抗增龄、抗死亡,而是推动健康老龄化.未来抗衰老研究和老年医学的目标应聚焦于如何减缓身体功能的衰退、减少增龄相关疾病的发生、延长健康寿命.
手术切缘是肝癌外科治疗的基本问题,但是迄今为止这个具有重要临床意义的问题仍然存在诸多争议.多数研究提出理论上残肝体积足够时,宽切缘能让患者获得更好的生存获益.然而,也有部分研究发现切缘宽度对单发肝细胞癌患者预后无显著影响.因此,针对肝细胞癌最佳手术切缘宽度的争议,本文重点关注切缘宽度在个体因素方面对单发肝细胞癌患者根治性肝切除术后生存获益的影响.
肝细胞癌的主要根治方法 是手术切除,而术后高复发率是影响患者预后改善的主要瓶颈.新辅助治疗在减少术前肿瘤负荷、控制微小转移、提高根治切除率、降低术后复发和延长生存等方面有巨大潜在优势,肝细胞癌新辅助治疗正在成为目前肝癌临床研究领域的前沿.本文对肝细胞癌新辅助治疗现状进行了梳理,重点讨论了肝细胞癌新辅助治疗的热点问题,以期为深入掌握肝细胞癌新辅助治疗的进展和发展趋势提供帮助.
肝移植是治疗终末期肝病最有效的方法,术后免疫抑制方案与受者的长期存活和生存质量密切相关.哺乳动物雷帕霉素靶蛋白抑制剂(mammalian target of rapamycin inhibitor,mTORi)是一种三烯大环内酯类免疫抑制剂,具有抑制T细胞增殖、诱导受者免疫耐受、减轻钙调磷酸酶抑制药(calcineurin inhibitor,CNI)的肾脏毒性和有效抑制肿瘤细胞生长等作用.近年肝移植受者使用以mTORi为基础的免疫抑制方案逐渐增多.为了更好地为国内肝移植临床医师提供参考,中国器官移植发展基金会组织国内多中心移植专家,针对mTORi在肝移植中的作用机制和临床应用、推荐剂量和血药浓度监测、不良反应及应对措施等4个方面,经广泛征求意见,共同制订本专家共识.
