目的 探究腹主动脉瘤EVAR术后联合应用地塞米松对患者术后应激反应、术后并发症的影响.方法 收集2018年5月至2021年5月湖南省人民医院收治腹主动脉瘤且行腹主动脉瘤腔内修复术(EVAR)患者92例进行回顾性研究分析,并根据期间患者所采取的治疗方案对其进行分组整理,分别为对照组、研究组,每组各46例,其中对照组采用EVAR治疗,研究组则在接受EVAR治疗后联用地塞米松.比较两组的手术效果、术后患者应激反应指标[皮质醇、前列腺素E2(PGE2)、促肾上腺皮质激素(ACTH)、促肾上腺皮质激素释放激素(CRH)]、并发症和生存质量.结果 研究组术后24 h视觉模拟评分法(VAS)评分、术后72 h血小板下降数量分别为(3.31±0.64)分、(21.18±2.40)×109L,均低于对照组[(4.82±0.76)分、(30.84±3.41)×109L],术后首次下床活动时间、住院时间分别为(25.28±2.11)h、(7.75±1.42)d,均短于对照组[(29.85±2.47)h、(10.04±1.63)d],差异均有统计学意义(P<0.05).术后24 h,研究组皮质醇、PGE2、ACTH、CRH水平为(138.46±12.75)ng/L、(270.38±20.75)pg/mL、(24.79±4.83)ng/mL、(44.11±8.69)pg/mL,均低于对照组[(153.47±15.92)ng/L、(309.75±24.80)pg/mL、(31.94±6.13)ng/mL、(53.64±10.55)pg/mL],差异均有统计学意义(P<0.05).研究组术后近期并发症发生率为8.70％,远期并发症发生率为6.52％,均较低于照组(39.13％、28.26％),差异有统计学意义(P<0.05).术后6个月研究组世界卫生组织生命质量测定量表(WHOQOL-100)各维度评分均高于对照组,差异均有统计学意义(P<0.05).结论 腹主动脉瘤EVAR术后联合应用地塞米松效果满意,不仅能缓解术后应激反应,还能减少并发症发生率,提高患者生存质量,值得推广.

Objective:Compare the efficiency and safety of sequential transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) versus PVE alone before major hepatectomy for patients with hepatocellular carcinoma (HCC).Methods:PubMed, the Cochrane Library were screened. The primary endpoints were overall survival rate (OSR), recurrence-free survival rate (RFSR), the increase in the percentage of FLR volume; secondary endpoints were hepatectomy rate, postoperative complications, hepatic failure rate after surgery, and mortality after surgery.Results:A total of five retrospective studies were included. The results showed the TACE + PVE group had a higher 1-year OSR, 3-year OSR, 5-year OSR, and 10-year OSR than PVE group. The results also indicated the TACE + PVE group had a higher 1-year RFSR, 3-year RFSR, 5-year RFSR, and 10-year RFSR than PVE group. The results demonstrated the TACE + PVE group had a higher FLR volume, as well as higher hepatectomy rate, and lower postoperative complications than PVE group.Conclusions:Sequential TACE and PVE seem to be a more effective therapy than PVE alone before major hepatectomy for HCC patients, with better survival and safety.

近年来主动脉夹层(AD)发病率和检出率日益增高,临床上越来越引起重视.随着介入技术日益发展,血管腔内治疗已成为AD主要治疗方法之一.研究发现,存在AD远端破口是影响胸主动脉腔内修复术中远期疗效的重要因素之一.该文从AD流行病学表现、分期分型、基础治疗和介入治疗方式进行综述分析,并就Stanford B型AD远端破口治疗研究进展作一总结,为临床术式决策提供可行参考.

目的:研究中性粒细胞/淋巴细胞比值(NLR)联合心型脂肪酸结合蛋白(H-FABP)对Stanford B型主动脉夹层胸主动脉腔内修复术(TEVAR)患者预后的预测价值.方法:选取2017年6月至2020年9月在我院接受TEVAR治疗的172例Stanford B型主动脉夹层患者为研究对象.收集所有患者基线资料、相关实验室指标水平,随访追踪患者预后,按照预后差异分作预后不良组和预后良好组,比较两组患者基线资料和实验室指标差异,采用多因素Logistic回归分析患者预后的影响因素,以受试者工作特征(ROC)曲线分析NLR联合H-FABP对患者预后的预测价值.结果:预后不良组收缩压、舒张压高于预后良好组(P＜0.05).预后不良组NLR、H-FABP、白细胞计数(WBC)水平均高于预后良好组,而血小板计数(PLT)水平低于预后良好组(P＜0.05).多因素Logistic回归分析显示:收缩压、舒张压、NLR、H-FABP、WBC均是Stanford B型主动脉夹层TEVAR患者预后的影响因素(P＜0.05).ROC曲线分析显示:NLR联合H-FABP预测Stanford B型主动脉夹层TEVAR患者预后的曲线下面积为0.876均高于上述两项指标单独预测的0.626及0.712.结论:NLR联合H-FABP对Stanford B型主动脉夹层TEVAR患者预后具有一定预测价值.

Background Previous studies have revealed obesity, nutrition, lifestyle, genetic and epigenetic factors may be risk factors for the occurrence and development of non-alcoholic fatty liver disease (NAFLD). However, the effect of total polyunsaturated fatty acid (PUFA) consumption on the risk of NAFLD is uncertain. Therefore, this study aimed to determine whether the total PUFA intake is independently associated with the risk of NAFLD and explore the threshold of PUFA intake better illustrate the correlation between them in Chinese Han adults. Methods The present study was a retrospective case–control study. A total of 534 NAFLD patients and 534 controls matched by gender and age in the same center were included in this study. Using a semi-quantitative food frequency questionnaire in a health examination center in China to collect information about dietary intake and calculate nutrient consumption. A multivariate logistic regression model was used to estimate the association between total PUFA daily intake and its quartile and the incidence of NAFLD. Results Multivariate analyses suggested a significant association between total PUFA intake and the occurrence of NAFLD. A non-linear relationship between total PUFA consumption and NAFLD risk was detected after adjusting for potential confounding factors. There was a significant connection between PUFA and the risk of NAFLD (OR: 1.32, 95% CI: 1.23–1.41, P < 0.0001) when PUFA intake is between 18.8 and 29.3 g/day. Conclusions The relationship between total PUFA intake and NAFLD is non-linear. Total PUFA was positively related to the risk of NAFLD when PUFA intake is between 18.8 and 29.3 g/day among Chinese Han adults.

患儿男性,5岁,8个月早产儿.因尿色深黄1周,皮肤巩膜重度黄疸1天于2019年4月外院就诊.腹部体检:腹部稍膨隆,上腹部可见腹壁静脉显露,余项无明显异常.白细胞计数10.23×109/L,谷丙转氨酶142?U/L,谷草转氨酶317?U/L,总胆红素151.4?μmol/L,糖基抗原19-9?162.97?U/mL.MRI示:胰头区占位性病变并肝内外胆管扩张.于2019年4月转入湖南师范大学附属第一医院后,复查血常规:白细胞计数13.46×109/L,总胆红素 142.1 ?μmol/L,谷草转氨酶372.16?U/L,谷丙转氨酶100?U/L.

Abstract Background: Hepatocellular carcinoma (HCC) ranks as the sixth most common cancer and the second leading cause of cancer-related death worldwide, local and systemic therapies are beneficial for those who have more advanced disease or are not suitable for radical treatment. We aim to investigate the clinical outcomes of transarterial chemoembolization (TACE) plus sorafenib compared with sorafenib monotherapy for intermediate–advanced HCC. Methods: A systematic search according to preferred reporting items for systematic reviews and meta-analyses guidelines in the PubMed database was conducted from inception to December 31, 2020 for published studies comparing survival outcomes and tumor response between TACE + sorafenib and sorafenib alone for intermediate–advanced HCC. Results: Five eligible cohort studies and a randomized controlled trial with a total of 3015 patients were identified. We found that the TACE + sorafenib group had a significantly better overall survival (OS) (hazard ratio, 0.77; 95% confidence interval [CI] 0.66–0.88, P < .001) than those treated with sorafenib. Median OS ranged from 7.0 to 22.0 months with TACE + sorafenib and from 5.9 to 18.0 months with sorafenib. The combination of TACE + sorafenib had a significantly better time to progression (hazard ratio, 0.74; 95% CI 0.65–0.82, P < .001) than those treated with sorafenib. Median time to progression ranged from 2.5 to 5.3 months with TACE + sorafenib and from 2.1 to 2.8 months with sorafenib. The results showed the TACE + sorafenib group had a higher disease control rate (log odds ratio, 0.52; 95% CI 0.25–0.80, P = .0002), objective response rate (log odds ratio, 0.85; 95% CI 0.37–1.33, P = .0006) than sorafenib group. Hand–foot skin reaction, diarrhea, fatigue, vomiting, and alanine aminotransferase (ALT) elevation were common adverse events. The adverse events were similar between the 2 groups excluding elevated ALT. Conclusion: Although the TACE + sorafenib group had a higher elevated ALT, the combination of TACE + sorafenib had an OS benefit compared with sorafenib in the treatment of intermediate–advanced HCC. Further research is necessary to affirm this finding and clarify whether certain subgroups benefit from different combinations between TACE and sorafenib.

目的 探讨肝脏血管肉瘤临床症状、病理特点及诊治要点.方法 回顾性分析本院2014年5月到2020年5月收治的11例肝脏血管肉瘤患者的临床资料,包括临床症状及特征、病理特点及诊治方法.结果 发现肝血管肉瘤存在腹胀、腹痛表现,存在轻度贫血、D-二聚体水平增高的实验室检查特点,而甲胎蛋白(alpha fetoprotein,AFP)值在正常范围,B超及CT影像学结果均显示为血供丰富的肿瘤.结论 肝脏血管肉瘤缺乏临床特异性症状与体征,病理检查可明确诊断,穿刺诊断较为安全,预后差而且目前没有成熟的治疗方案.