Objectives:This study aims to evaluate the Scientific, Transparent, and Applicable Rankings (STAR) of guidelines and consensus published in Chinese geriatric medicine journals in 2023. Methods:The working group conducted a systematic search in eight major Chinese and English databases for guidelines and consensuses published by Chinese scholars in the field of geriatric medicine in 2023. The selected guidelines and consensuses were rated using the STAR rating tool, and the rating results were analyzed. Results:A total of 10 guidelines and 20 expert consensus documents were included. The STAR scores ranged from 9.4 to 55.7 with a mean of 29.3 ± 11.2. The STAR scores of 10 guidelines ranged from 16.1 and 55.7 with an average of 35.5 ± 13.1. The STAR scores of 20 consensus ranged from 9.4 and 48.5 with an average of 26.2 ± 8.9. Conclusion:Guidelines and consensus in geriatric medicine have shown significant improvements in 2023 compared to 2022 across registration, consensus methodology, working groups, and accessibility. However, areas such as protocol development, funding, and clinical issues require further refinement by the authors.
Objective:To investigate alterations in brain function among elderly patients with interstitial cystitis/bladder pain syndrome(IC/BPS)during the resting state.Methods:We prospectively recruited seven elderly patients with IC/BPS admitted to the Urology Department of Beijing Hospital from December 2023 to May 2024 as the experimental group, and concurrently selected twelve elderly healthy individuals as the control group.After enrollment, all participants underwent resting-state functional magnetic resonance imaging(rs-fMRI)scans.General clinical data, including age and gender, as well as standardized assessment scores from the Interstitial Cystitis Symptom Index(ICSI), Interstitial Cystitis Problem Index(ICPI), Visual Analogue Scale(VAS), Self-Rating Anxiety Scale(SAS), and Self-Rating Depression Scale(SDS), were collected.The data were processed using Matlab.This study employed a paired sample t-test to analyze the differences in gray matter volume between the two groups.The functional activities of the subjects' brains were analyzed using regional homogeneity(ReHo)and low-frequency amplitude(ALFF)algorithms.Based on the identified abnormal brain regions, further functional connectivity(FC)analysis was conducted to explore the connectivity patterns among the functional brain regions.Results:No significant differences were observed in age( t=-0.68, P=0.536)or gender( χ2=0.019, P=0.891)between the experimental group and the control group.The scores of SAS and SDS in the experimental group were significantly higher than those in the control group( P<0.001).No significant difference was observed in cerebral gray matter volume between the two subject groups.In contrast to the control group, the ALFF value of the left superior parietal lobe(MNI: x, y, z=-21, -66, 60; t=12.530 5)was elevated in elderly patients with IC/BPS, and the ReHo value of the left precuneus(MNI: x, y, z=-9, -54, 63; t=9.410 3)was also increased.Through FC analysis, it was revealed that elderly IC/BPS patients exhibited significantly lower FC values between the left superior parietal lobule and the central sulcus(MNI: x, y, z=21, 15, 3; t=-27.835 6), as well as between the left anterior cingulate and the left posterior cingulate gyrus(MNI: x, y, z=-12, 0, 42; t=-8.738 9)in comparison with the control group. Conclusions:In contrast to normal individuals, elderly IC/BPS patients demonstrate functional aberrations in the left superior parietal lobule and the left precuneus.Moreover, a decrease in functional connectivity is observed between the left superior parietal lobule and the central sulcus, as well as between the left precuneus and the left posterior cingulate gyrus.These abnormal functional alterations in the brain may be implicated in the maintenance and development of symptoms in IC/BPS patients.This study conducted research from the perspective of central nervous system regulation, presenting possible directions for further exploration of the pathophysiological mechanisms of IC/BPS.
Objective To compare the performance of 11 glomerular filtration rate(GFR)equations in Chinese elderly hospitalized patients using dynamic renal imaging as the reference standard.Methods The retrospective study involved patients aged 60 years and older who were admitted to Beijing Hospital between January,2017,and January 2020.Glomerular filtration rate(GFR)was assessed through dynamic renal imaging for all participants.Estimated GFR(eGFR)was calculated using various equations based on serum creatinine and/or cystatin C levels,including All Age Spectrum(FAS),Berlin Initiative Study(BIS),Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI),Modification of Diet in Renal Disease Study(MDRD),MDRD in China(MDRDc),and Xiangya..Results A total of 691 patients,of which 383 were males,with an age range of 60 to 90 years(mean age 71.9±7.7 years),were included in the study.Among the different equations used to estimate glomerular filtration rate(GFR)in ml·min-1·1.73m-2,the smallest deviations were observed with FAScys(2.48),FAScr-cys(3.07),CKD-EPIcys(4.20),and BIScr-cys(7.42).Conversely,the most accurate estimations were found with BIScr-cys(10.38),FAScr-cys(11.94),FAScys(12.08),CKD-EPIcr-cys(13.21),and CKD-EPIcys(13.51).The highest P30 values,indicating the proportion of estimates within 30％of the true GFR,were achieved by FAScr-cys(68.97％),FAScys(68.96％),CKD-EPIcys(63.22％),and BIScr-cys(61.67％).The equations with the lowest root mean square errors were BIScr-cys(9.73),CKD-EPIcr-cys(10.98),FAScr-cys(11.27),CKD-EPIcys(11.52),and FAScys(11.53).Specifically,the FAS equation showed higher accuracy in men,while BIScr-cys and CKD-EPIcys were more accurate in women.Among patients with chronic kidney disease(CKD),the P30 values for BIScr-cys,FAScys,and FAScr-cys were 86.96％,83.33％,and 80.95％respectively.Notably,for patients with mGFR ≥ 30 ml/min,MDRDc overestimated GFR the most,whereas for patients with mGFR＜30 ml/min,Xiangya exhibited the most significant overestimation of GFR.Conclusions Among the equations tested,BIScr-cys,FAScys,and FAScr-cys demonstrated the highest accuracy and are therefore recommended for use in Chinese elderly hospitalized patients.
Sarcopenia is an age-related disorder that influences the daily living ability of older adults and interacts with various chronic diseases. Older adults with sarcopenia typically experience a deterioration in their quality of life and healthy lifespan. The number of Chinese persons with sarcopenia is considerable, and the burden of sarcopenia is substantial; however, the specific sarcopenia clinics available for outpatients are insufficient. The promotion of sarcopenia clinics is beneficial for the early identification, standardized diagnosis, and treatment of older adults with sarcopenia, thereby helping to enhance their physical function and quality of life. This consensus incorporates the professional recommendations of Chinese geriatrics experts, synthesizes existing Chinese experiences in establishing sarcopenia clinics, offers guidance for managing sarcopenia clinics, and advocates for early identification, diagnosis, and intervention of sarcopenia in older adults.
With the deepening of aging in China,the prevalence of diabetes in older people has in-creased noticeably,and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people.In 2021,the National Center of Gerontology,Chinese Society of Geriatrics,and Diabetes Pro-fessional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China,the Guideline for the Management of Diabetes Mellitus in the Elderly in China(2021 edition).The guideline emphasizes that older patients with diabetes are a highly hetero-geneous group requiring comprehensive assessment and stratified and individualized management strategies.The guideline proposes simple treatments and de-intensified treatment strategies for older patients with diabetes.This edition of the guideline provides clinicians with practical and operable clinical guidance,thus greatly contribu-ting to the comprehensive and full-cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields.In the past 3 years,evidence-based medicine for older patients with diabetes and related fields has fur-ther advanced,and new treatment concepts,drugs,and technologies have been developed.The guideline edito-rial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China(2024 edition).More precise management paths for older patients with diabetes are proposed,for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.
Background Idiopathic membranous nephropathy (IMN) is the leading cause of nephrotic syndrome in the elderly. The treatment of idiopathic membranous nephropathy is quite challenging due to the particularity of elderly patients. This study intends to investigate the clinicopathological characteristics and initial therapeutic effect of idiopathic membranous nephropathy among elderly patients. Methods A retrospective study of 67 elderly patients (58.2% male, median age 69.0 years, range, 65-83 years) with biopsy-proven membranous nephropathy was conducted at Guangdong Provincial People's Hospital from 2016 to 2020. Data on clinicopathological characteristics and initial therapeutic effects were analyzed. Results Of the 67 patients, the mean eGFR of overall patients was 66.49 mL/min/1.73m(2) while the median urine protein-to-creatinine ratio (uPCR) and urine albumin-to-creatinine ratio (uACR) was 5676.73 mg/g and 2951.56 mg/g, respectively. Pathological data revealed that the membranous Churg's stage II was the most frequent (71.64%). Moreover, glomerular PLA2R antigen fluorescence intensity of (+) and IgG4 antigen fluorescence intensity of (++) were detected in 63.6% and 86.4% of all patients, respectively. Overall, 44 patients, accounting for 65.7%, achieved remission including complete remission and partial remission within 1 year after renal biopsy. Compared with a non-remission group, the levels of uPCR (6274.6 vs. 3235.6 mg/g, p = 0.007) and uACR (3433.6 vs. 1773.2 mg/g, p = 0.017) were significantly higher in remission group. The proportion of immunosuppressive therapy in the remission group was also higher (86.4% vs. 30.4%, p < 0.01). Compared with conservative treatment, patients with combined treatment with glucocorticoid and cyclophosphamide (CTX) or glucocorticoid and calcineurin inhibitor (CNIs) achieved higher remission rate (glucocorticoid plus cyclophosphamide vs. conservative treatment, 84.6% vs. 27.3%, p = 0.001; glucocorticoid plus calcineurin inhibitor vs. conservative treatment, 88.0% vs. 27.3%, p < 0.001). Further analysis showed that compared with patients who underwent conservative treatment, the proportion of males, the levels of uPCR, uACR, BUN, Scr, CysC and PLA2R antigen-positive staining rate in kidney biopsy were higher in those who underwent combined treatment with glucocorticoid and CTX, while the levels of eGFR, TP and ALB were lower (p < 0.05). In addition, patients who received combined treatment with glucocorticoid and CNIs had higher levels of uPCR, uACR, TC and lower levels of TP, ALB than those who received conservative treatment (p < 0.05). Moreover, there were no statistically significant differences in the 1-year progression rate in eGFR between the immunosuppressive treatment group and conservative treatment group (3.3 vs. 0.2 ml/min/1.73m(2), p = 0.852). Conclusions Most elderly patients diagnosed with IMN had multiple comorbidities, and the membranous Churg's stage II was most common. The glomerular PLA2R and IgG4 antigen deposition were frequently detected accompanied by glomerulosclerosis and severe tubulointerstitial injury. For high-risk elderly patients with severe proteinuria, early initial immunosuppressive therapy could achieve a higher urinary protein remission rate. Therefore, it is crucial for clinicians to balance the risks and benefits of immunosuppressive therapy based on clinical and pathological characteristics and develop individualized treatment regimens for elderly patients with IMN.
Gastroesophageal reflux disease (GERD) in the elderly is characterized by atypical symptoms, relatively severe esophageal injury, and more complications, and when GERD is treated, it is also necessary to fully consider the general health condition of the elderly patients. This consensus summarized the epidemiology, pathogenesis, clinical manifestations, and diagnosis and treatment characteristics of GERD in the elderly, and provided relevant recommendations, providing guidance for medical personnel to correctly understand and standardize the diagnosis and treatment of GERD in the elderly.
Sarcopenia is the age-related loss of skeletal muscle mass and muscle strength or physical function. It is most common in elderly individuals. Due to its high incidence, insidious onset, and extensive impact on the body, it has a huge impact on the family medical burden and the social public health expenditure in China. The understanding of sarcopenia in China is still lacking, and the recommendations for prevention, control, and intervention are not clear and unified. The purpose of this consensus report is to standardize the prevention, control, and intervention methods for sarcopenia in elderly patients in China; improve the efficacy of intervention; reduce complications during the intervention process; and reduce the risk of falls, fractures, disability, hospitalization, and even death in elderly individuals.
目的 探索既不影响患肢活动又能有效控制老年患者全膝关节置换术(TKA)后疼痛的改良髂筋膜间隙阻滞(FICB)中罗哌卡因有效浓度,观察FICB后24 h的不良反应.方法 本研究是一项前瞻性、单臂序贯试验.选择2021年9月至2022年3月苏州大学附属第一医院行TKA的老年患者45例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级.所有患者在全身麻醉后、手术开始前10 min给予超声引导下术侧FICB,注射容量均为30 ml.根据预实验及参考文献,罗哌卡因的初始浓度为0.1％,依据改良Dixon序贯法确定下1例患者的浓度,若前1例患者术后24 h患肢股四头肌肌力评分≥4分,静息痛为阴性[视觉模拟疼痛评分(VAS)≤1分],且活动时VAS评分≤3分,则下1例患者降低浓度;反之,则增加浓度;罗哌卡因浓度的增减梯度为0.01％,直到出现12次折返后停止试验.采用Probit概率法计算罗哌卡因的半数有效浓度(ED50)、95％有效浓度(ED95)及95％可信区间(CI).同时观察FICB后24 h不良反应发生情况.结果 43例老年患者完成试验,其中有效23例,无效20例.在保证不影响老年患者术后患肢活动的前提下,单次FICB 30 ml的罗哌卡因,能有效抑制患者术后疼痛的罗哌卡因浓度ED50为0.072％(95％CI:0.065％～0.078％),ED95为0.093％(95％CI:0.084％～0.124％).FICB后24 h,共发生下肢无力,无法下床行走2例,疼痛剧烈,需要额外给予镇痛药物的5例,未见其他不良反应.结论 罗哌卡因在老年患者TKA后抑制术后疼痛的有效浓度ED50为0.072％,ED95为0.093％;不良反应发生率低.
目的 探讨更为精准的老年初诊多发性骨髓瘤(NDMM)患者预后分层,尤其是预测早期死亡(EM).方法 回顾性分析3个中心223例老年(年龄≥65岁)NDMM患者,单因素及多因素Cox回归分析影响总生存时间(OS)的不良预后因素;x2检验及Logistic多因素分析影响EM的预后因素.结果 氨基末端脑钠肽前体(NT-pro-BNP)升高(≥300 pg/ml)、美国东部肿瘤协作组体力状态(ECOG-PS)≥2和修订国际分期系统(R-ISS)Ⅲ期是影响OS的三个独立不良预后因素.3个月内死亡(EM3)、6个月内死亡(EM6)、12个月内死亡(EM12)及24个月内死亡(EM24)的发生率分别为12.1％、20.1％、32.2％和60％,其中EM6(特别是EM3)主要由于体能状态和脏器功能差失去治疗机会或由于无法耐受造成治疗中断而死于疾病相关并发症,而EM12(特别是EM24)则主要由于疾病进展(治疗不足为主要原因).R-ISS分期不能预测EM预后;eGFR下降、ECOG-PS≥2和NT-pro-BNP 升高可预测 EM 预后;其中,NT-pro-BNP 升高是 EM12(P=0.03)和 EM24(P=0.015)共同的独立影响因素.结论 反映多发性骨髓瘤(MM)生物学特点的R-ISS分期并不能预测EM患者预后,而体现衰弱和脏器功能的ECOG-PS、eGFR和NT-pro-BNP则可预测EM风险,其中NT-pro-BNP可能是EM最重要的独立影响因素.因此,在R-ISS分期基础上,纳入这些衰弱生物标志物有望更为精准地对老年MM患者进行预后分层和EM预测.
住院相关性失能是指发病后至出院期间新出现的一项或多项日常生活能力的丧失,在老年住院人群中十分常见,其与发病前的基础状况、疾病因素、医院相关因素及出院后因素相关,可导致住院时间延长,增加出院后的照护负担,增加长期失能风险、死亡风险和医疗花费.在临床工作中应早期识别住院相关性失能的高危人群,积极予以干预.本文就住院相关性失能的定义、流行病学、危险因素、识别工具、治疗及干预措施进行综述,以提高老年科医务工作者对此问题的重视程度和管理水平,从而改善老年住院患者的预后.
目的 观察老年射血分数保留心力衰竭(HFpEF)合并心房颤动(房颤,AF)患者的临床表现和心脏结构功能改变.方法 横断面研究,连续纳入2009年4月至2020年12月兰州大学第一医院老年心血管科收治的年龄≥60岁的HFpEF患者835例,根据是否合并AF,分为HFpEF+AF组(267例)和HFpEF组(568例),评价其心脏结构功能.根据ROC分析二尖瓣血流频谱舒张早期峰值速度(E)与二尖瓣环舒张早期最大速度(e')比值(E/e')的最佳切点,将HFpEF+AF分为E/e'＞11和E/e'≤11两个亚组,比较其临床表现、心脏结构功能差异以及左心与右心的关系.结果 HFpEF+AF 组左心房容积指数(LAVi)大于 HFpEF 组[(60.0±23.3)ml/m2比(43.9±19.0)ml/m2,t=10.130,P＜0.01],而左心室射血分数、二尖瓣环间隔部收缩速度(s's)、E/e'小于HFpEF组(均P＜0.01),右心室内径、右心房内径和面积、三尖瓣反流速度以及肺动脉压均大于HFpEF组(均P＜0.05).相对于E/e'≤11亚组,E/e'＞11亚组高血压、冠心病、糖尿病患病率更高、病程更长,s'下降更严重(均P＜0.05),E/e'与LAVi,LAVi与肺动脉收缩压(PASP)均独立相关(t=2.114和1.963,P=0.034和0.042),上述表现与HFpEF组相似.而E/e'≤11亚组较E/e'＞11亚组女性比例较高,房颤病程更长(中位:5年比1年,P=0.003);右心室、右心房扩大更明显,三尖瓣反流速度及PASP升高更严重(均P＜0.05).结论 老年HFpEF合并AF的左心房容积进一步增大,左心室收缩功能及右心结构损害更加严重,并且可能存在两种病理生理机制不同的表型.
目的 评价不同形式的抗阻力运动对老年人肌少症治疗和预防效果.方法 计算机检索Pubmed、Embase、Web of Science、Cochrane Library、中国知网、维普和万方7个数据库,收录从建库至2023年3月发表的关于探讨阻力运动对老年人肌少症治疗和预防效果的随机对照研究.由两名研究人员进行文献检索和筛选,并独立对纳入文献进行质量评价.采用RevMan 5.3软件进行Meta分析.结果 最终纳入12篇文献,1018例老年人.与对照组比较,抗阻力运动可改善骨骼肌质量指数(MD=0.34,95％CI:0.24～0.44,P＜0.001)和握力(MD=1.63,95％CI:0.73～2.53,P＜0.01)及 5 次坐立试验时间(MD=-1.99,95％CI:-2.48～-1.51,P＜0.01);但对肌肉质量(MD=1.28,95％CI:-0.38～2.94,P＞0.05)和膝关节伸展肌力(SMD=1.71,95％CI:-0.51～3.93,P＞0.05)及步速(MD=0.03,95％CI:-0.03～0.08,P＞0.05)改善效果不显著.结论 抗阻力运动能改善老年人的骨骼肌质量指数和握力及5次坐立试验时间,延缓肌少症老年人骨骼肌退行性变化,对健康老年人的肌少症有预防效果.
老年衰弱&肌少症(PF& S)病理机制多样且复杂,从局部肌肉特异性过程(骨骼肌细胞的线粒体质量控制紊乱)到全身系统性变化(慢性炎症)均有涉及,但是目前连接这些机制的重要分子因素研究尚不够充分.近年来的研究表明细胞外囊泡(EVs)在衰老微环境和衰老相关疾病中发挥重要作用.本文综述了在PF&S背景下线粒体质量控制(MQC)紊乱和慢性炎症的特点及其潜在联系,重点关注了 EVs在二者相互作用过程的潜在作用,以期为未来研究提供思路.
目的 分析二维斑点追踪超声心动图(2D-STE)评估增强型体外反搏(EECP)对老年冠状动脉慢血流(CSF)患者左心室功能的影响.方法 前瞻性病例对照研究,纳入2017年12月至2018年12月在山东大学齐鲁医院老年医学科就诊的年龄≥60岁冠状动脉无狭窄性病变但存在≥1条主要冠状动脉慢血流现象30例患者,数字抽签法分为药物治疗组16例,药物联合EECP治疗组(联合治疗组)14例.联合治疗组患者在改善生活方式和药物治疗基础上接受为期6周36 h的EECP治疗.同时纳入冠状动脉血流正常患者14例为对照组.采用常规超声心动图和2D-STE评价CSF患者在药物及EECP治疗前、后左心室功能变化.结果 治疗前与对照组比较,药物治疗组和联合治疗组患者二尖瓣环舒张早期运动速度下降(P＜0.01),二尖瓣舒张早期峰值血流速度与二尖瓣环舒张早期峰值速度平均值比值增大(P＜0.05),左心室收缩期纵向应变(P＜0.01)、收缩期纵向应变率(P＜0.01)及舒张早期纵向应变率均减低(P＜0.01).CSF患者药物治疗组常规超声心动图参数治疗前、后比较差异无统计学意义(均P＞0.05).联合治疗组治疗前、后室间隔舒张早期运动速度(6.22±0.64)cm/s 比(6.69±0.44)cm/s、侧壁舒张早期运动速度(8.01±0.68)cm/s 比(8.41 ±0.29)cm/s、二尖瓣舒张早期峰值血流速度与二尖瓣环舒张早期峰值速度平均值(10.51±1.38)比(9.74±0.37)、左心室收缩期纵向应变(-16.21±0.46)％比(-16.80±0.48)％、收缩期纵向应变率(-1.29±0.03)s-1 比(-1.35±0.04)s-1、舒张早期纵向应变率(1.35±0.03)s-1 比(1.40±0.03)s-1,差异有统计学意义(t 值分别为-3.70、-2.74、2.23、10.25、12.30、-19.15,均 P＜0.05).结论 2D-STE可以早期、定量地评价老年CSF患者亚临床心肌功能障碍,客观反映EECP临床干预前后左心室功能改变.EECP治疗可改善CSF患者亚临床左心功能障碍.
目的 制订针对衰弱老年人的多元运动干预方案,评价其对改善衰弱状态的影响,并探讨不同干预方式的效果.方法 选取北京市某社区衰弱及衰弱前期老年人174例,随机分为3组,空白对照组不予特殊干预,健康教育组采用讲解、示范及宣传手册的方式开展衰弱基础知识及多元运动方案指导,微信小程序组将多元运动方案制作为视频课程,植入微信小程序并定时推送,干预3个月,比较3组研究对象的衰弱状态及运动依从性.结果 最终166例研究对象完成研究,健康教育组及微信小程序组的衰弱表型得分较基线时降低(均P＜0.05),干预后空白对照组、健康教育组、微信小程序组衰弱表型得分分别为1(1,2)分、1(0,1)分、1(0,1)分,差异具有统计学意义(H=15.539、P＜0.001).空白对照组、健康教育组、微信小程序组研究对象中各有10例(17.2％)、15例(25.9％)、28例(48.3％)的老年人由衰弱或衰弱前期逆转为无衰弱(x2=12.770、P=0.002),微信小程组逆转为无衰弱的例数多于空白对照组(x2=11.536、P=0.001)及健康宣教组(x2=5.659、P=0.014).空白对照组、健康教育组、微信小程序组研究对象的衰弱例数分别为9例(15.5％)、1例(1.7％)、1例(1.7％)(x2=13.040、P=0.001),健康宣教组及微信小程序组的衰弱例数少于空白对照组(x2=7.552、7.210,P=0.006、0.007).微信小程序组的运动方案完成情况优于空白对照组(x2=49.366、P＜0.001),且优于健康宣教组(x2=26.481、P＜0.001),健康宣教组优于空白对照组(x2=6.171、P=0.013).结论 多元运动方案可改善老年人衰弱状态,且基于微信小程序的多元运动干预方式在改善衰弱及提升运动依从性方面更具优势.
目的 分析和比较血清胱抑素C(ScysC)和血清肌酐(SCr)在老年人肾功能评估中的应用价值.方法 采用横断面回顾性分析,纳入研究对象2 450例,根据年龄分为非老年组(＜65岁)和老年组(≥65岁).应用锝-二乙三胺五乙酸(99mTc-DTPA)清除率检测肾小球滤过率(GFR),分别运用局部增强免疫比浊法和氧化酶法测定ScysC和SCr.采用x2检验比较相同GFR水平段Scys C与SCr异常增高的占比,以受试者工作特征曲线(ROC)的曲线下面积(AUC)评价Scys C和SCr对GFR＜60 ml·min-1·1.73m-2的筛查价值,以95％参考区间建立不同GFR水平Scys C和SCr的参考值范围.结果 总人群中GFR在30～59 ml·min-1·1.73m-2和＜30 ml·min-1· 1.73m-2时,ScysC增高的占比分别为82.74％(556/672)和94.74％(90/95),而SCr水平升高仅占38.24％(257/672)和 75.79％(72/95)(X2=278.328、13.571,均 P＜0.001).在上述 GFR 区间,老年人群Scys C增高的占比分别为84.81％(240/283)和100.00％(43/43),非老年人Scys C增高的占比分别为 81.23％(316/389)和 90.38％(47/52)(x2=1.463、4.364,P=0.226、0.037).总人群中 Scys C对GFR＜60 ml·min-1·1.73m-2的筛查价值、灵敏度、特异度及约登指数略优于SCr,但老年人中Scys C的筛查灵敏度和特异度分别为76.4％和75.7％,均低于非老年人的78.7％和84.0％.随增龄Scys C的变异度逐渐增大,且在相同GFR水平段中,老年人Scys C的参考值范围高于非老年人.结论 Scys C筛查GFR＜60 ml·min-1·1.73m-2的灵敏度和特异度略优于SCr,但在老年人群中低于非老年人群.老年人Scys C水平更高,变异度更大,应用Scys C评估GFR可能导致老年人慢性肾脏病的过度诊断.
目的 评估抗M型磷脂酶A2受体(PLA2R)抗体阳性在我国老年人群中替代肾活检诊断特发性膜性肾病(IMN)的可行性.方法 收集2021年6月至2022年3月在郑州大学第一附属医院肾内科就诊,抗PLA2R抗体阳性(酶联免疫吸附实验≥14 RU/ml)且有完整肾脏病理资料并排除继发因素及糖尿病的96例老年肾病患者(≥60岁)的临床病理资料,分为高估算肾小球滤过率(高 eGFR 组,≥60 ml·min-1·1.73m-2)和低 eGFR 组(＜60 ml·min-1·1.73 m-2).结果 96例患者中IMN 95例占99.0％(其中1期1例、Ⅱ期59例、Ⅲ期34例、Ⅳ期1例),不典型膜性肾病(AMN)l 例(1.0％).IMN 患者中高 eGFR 组 81 例(85.3％),以 Ⅱ 期 IMN 最多见(66.7％),其中 10例(12.3％)合并其他病理表现,以轻度系膜增生性IgA肾病(2例)、亚急性肾小管间质性肾病(2例)最多见;低eGFR组IMN患者14例(14.7％),Ⅲ期IMN最多见(57.1％),其中10例(71.4％)合并其他病理表现,高于高eGFR组(x2=21.642,P＜0.05),以急性肾小管损伤(4例)、缺血性肾损伤(2例)最多见.结论 对于我国老年患者,抗PLA2R抗体阳性高度预测IMN,但合并其他病理诊断较多,需对肾活检检出其他病理诊断的优势及其操作风险进行权衡.
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颈动脉狭窄支架植入术的常规入路分为桡动脉入路和股动脉入路.桡动脉入路具有穿刺口并发症少,患者舒适度增加和术后制动时间短等优点,越来越多的介入医师倾向选择经桡动脉入路行介入治疗.但目前这两种途径的优先选择仍有争议,因此我们旨在回顾经桡动脉对比经股动脉途径行颈动脉支架植入手术的文献,来阐明经桡动脉入路在安全性和可行性上的优势.
