目的 明确冠心病患者新发恶性肿瘤情况及其与冠心病患者全因死亡的相关性,为优化冠心病患者临床综合管理策略提供依据.方法 根据纳入排除标准,通过SPSS 25.0 随机抽取 2011 年 1 月 1 日至 2015 年 12 月 31 日在中国人民解放军总医院第一医学中心心血管内科住院,首次行冠状动脉造影并明确诊断为冠心病的患者 4625 例,收集患者基线资料,并对患者出院后的肿瘤情况和死亡情况进行随访.根据随访结局有无发生死亡,分为生存组(n=3385)和死亡组(n=335).采用Cox回归分析明确新发恶性肿瘤与冠心病患者全因死亡的相关性.采用SPSS 25.0 软件进行数据分析.根据数据类型,组间比较分别采用t检验、非参数检验及χ2 检验.结果 随访成功患者 3720 例(80.4％),中位随访时间为 9(8,10)年;其中发生恶性肿瘤 150 例(4.0％),全因死亡 335 例(9.0％);死亡的冠心病患者中新发恶性肿瘤 40 例(11.9％),生存的冠心病患者中新发恶性肿瘤 110 例(3.3％),2 组新发肿瘤发生率差异有统计学意义(P＜0.05).死亡组和生存组患者的年龄≤65 岁,身体质量指数≥24kg/m2,左主干、左前降支、左回旋支及右冠状动脉狭窄程度、Gensini评分(＞20 分)比较,差异均有统计学意义(均P＜0.05);患者合并高血压、高血脂、肾功能不全、气管炎/肺气肿比例,差异均有统计学意义(均P＜0.05);2 组患者的血红蛋白水平、中性粒细胞/淋巴细胞、甘油三酯、凝血酶原活动度、血浆纤维蛋白原、国际标准化比值、尿素氮、肌酐、丙氨酸氨基转移酶、左心室射血分数、肌钙蛋白T、血清脑利钠肽比较,差异均有统计学意义(均P＜0.05).Log-rank检验显示,在随访时间内,发生肿瘤的冠心病患者的累积生存率显著低于未发生肿瘤的冠心病患者(P＜0.001).多因素校正后,Cox回归分析显示新发恶性肿瘤使冠心病患者全因死亡风险增加 3.815 倍(95％CI 2.362～6.164;P＜0.001).结论 死亡的冠心病患者新发恶性肿瘤发生率显著高于生存的冠心病患者,冠心病患者新发恶性肿瘤显著影响冠心病患者长期生存预后.

BACKGROUND:Coronary artery disease (CAD) is associated with cancer. The role of inflammation in the association of CAD with cancer remains unclear. The study investigated whether inflammation could impact the relationship between CAD and lung cancer.METHODS:The study involved 96 newly diagnosed lung cancer patients without receiving anti-cancer therapy and 288 matched non-cancer patients. All the patients underwent coronary angiography and were free from previous percutaneous coronary intervention or coronary artery bypass grafting. SYNTAX score (SXscore) were used to assess severity of CAD. High SXscore (SXhigh) grade was defined as SXscore > 16 (highest quartile). Neutrophil-to-lymphocyte ratio (NLR) served as an inflammatory biomarker. NLR-high grade referred to NLR > 2.221 (median).RESULTS:Among 384 study patients, 380 patients (98.96%) had NLR value (median: 2.221, interquartile range: 1.637-3.040). Compared to non-cancer patients, lung cancer patients had higher rate of SXhigh among total study patients (P = 0.014) and among patients with NLR-high (P = 0.006), but had not significantly higher rate of SXhigh among patients with NLR-low (P = 0.839). Multivariate logistic regression analysis showed that SXhigh was associated with lung cancer [odds ratio (OR) = 1.834, 95% CI: 1.063-3.162, P = 0.029]. Subgroup analysis showed that SXhigh was associated with lung cancer among patients with NLR-high (OR = 2.801, 95% CI: 1.355-5.794, P = 0.005), however, the association between SXhigh and lung cancer was not significant among patients with NLR-low (OR = 0.897, 95% CI: 0.346-2.232, P = 0.823).CONCLUSIONS:Inflammation could lead different association between anatomical severity of CAD and lung cancer. Severity of CAD was significantly associated with increased risk of lung cancer among patients with high inflammation rather than among patients with low inflammation.

目的 探讨60Coγ射线照射对血管内皮细胞线粒体结构和功能的影响.方法 分别采用60Coγ射线0(细胞对照组),5,10和20 Gy单次照射人脐静脉内皮细胞(HUVEC),照射后24和48 h,采用流式细胞术检测细胞凋亡;荧光探针H2DCF-DA标记,用激光共聚焦显微镜检测细胞产生活性氧(ROS)水平;JC-1探针标记,分别用流式细胞术和激光共聚焦显微镜检测细胞线粒体膜电位;通过钙黄绿素-AM探针标记,激光共聚焦显微镜定性检测线粒体膜通道孔(mPTP)开放状态;电镜观察线粒体结构变化;Western印迹法检测线粒体分裂相关标志物磷酸化动力相关蛋白1(p-Drp1)和磷酸化线粒体分裂因子(p-Mff)蛋白表达水平.结果 与细胞对照组相比,照射后24和48 h,5,10和20 Gy组细胞凋亡率增加(P<0.01),细胞ROS水平增加(P<0.05,P<0.01),细胞mPTP开放增加(P<0.05,P<0.01).流式细胞术和荧光显微镜检测结果显示,与细胞对照组相比,照射后24和48 h,5,10和20 Gy组线粒体膜电位下降(P<0.01).电镜观察显示,与细胞对照组相比,照射组照射后48 h,单个线粒体面积增加(P<0.05,P<0.01),单个线粒体周长增加(P<0.05),线粒体密度下降(P<0.05,P<0.01),异常线粒体数量大幅增加(P<0.01).与细胞对照组相比,各照射组照射后48 h,p-Drp1和p-Mff蛋白表达水平均显著增加(P<0.05,P<0.01).结论 60Coγ射线照射加重血管内皮细胞线粒体损伤,促进线粒体分裂,诱发线粒体功能障碍.

1临床资料 患者,男性,68岁,因"阵发性胸闷胸痛1个月,加重1周"入院.2020年8月初,患者每行走约100m即出现胸痛、胸闷症状,休息10min后缓解.同年8月20日休息时胸痛剧烈,伴灼热、大汗,持续约30min后缓解.8月28日就诊于我院门诊,查心电图示:窦性心律,V1～V2导联呈QS型,V1～V3导联ST段抬高,V1～V5导联T波倒置.超声心动图示:节段性室壁运动障碍,左室心尖部血栓形成,左室射血分数为52％.肌钙蛋白T0.274ng/ml,肌红蛋白及肌酸激酶同工酶水平正常,2020年9月1日以"急性冠状动脉综合征"收入院.

Objective To study the relationship between the different factors and the pathogenicity of chronic cholecystitis,and reveal the distribution pattern of TCM syndromes of chronic cholecystitis.Method Two hundred cases of chronic cholecystitis was selected by epidemiological method,the form of clinical observation was filled and TCM causes of chronic cholecystitis,characteristics and symptoms distribution,TCM syndrome type distribution pattern,the relationship between different factors and the type distribution were analyzed by statistical methods.Result There were no statistical significance in age and sex of incidence of chronic cholecystitis(P >0.05).TCM syndromes distribution of chronic cholecystitis was syndrome of stagnated heat in liver and stomach 33%,syndrome of qi stagnation in liver and stomach 26%,syndrome of dampness and heat in liver and gallbladder 19%,syndrome of liver qi stagnation 14%,deficiency syndrome of liver yin 8%.There were no difference in sex,age,occupation,educational level,whether or not associated with gallstones in syndromes distribution of patients with chronic cholecystitis(P >0.05).The cluster analysis of 20 most frequent symptoms was consistent with the frequency analysis in TCM syndrome distribution.Conclusion Age,sex has no relation with the incidence of chronic cholecystitis.TCM syndromes of stagnated heat in liver and stomach and qi stagnation in liver and stomach of chronic cholecystitis are more common.Sex,age,occupation,educational level and whether or with gallbladder stone has no relation with the distribution of TCM syndromes.

<正>胃下垂主要临床表现为胃脘胀满、嗳气、恶心、呕吐、食欲减退、便秘或腹泻等。以往中医临床多以补中益气汤治疗,但疗效不甚理想。2007年1月-2007年12月,笔者应用枳术丸治疗胃下垂30例,并与补中益气汤进行对照观察。现将结果

慢性萎缩性胃炎(CAG)是以胃黏膜腺体萎缩为特征的一种常见的消化系统疾病,在其基础上伴发的不完全型肠上皮化生和(或)中、重度异型增生则被视为痛前病变,CAG伴肠上皮化生和异型增生的诊治一直是医学界的研究热点[1].目前,现代医学对于本病的治疗主要是改善、缓解症状,如应用促动力药、胃黏膜保护剂、抗酸及抑酸剂等[2],尚无理想治疗方法.而应用中医药治疗CAG已成为医学界关注之焦点.笔者现就近5年来中医药治疗CAG进展综述如下.