盘点:Chest 9月重要原始研究汇总

2018-09-14 MedSci MedSci原创

【1】可以精确预测非小细胞肺癌完全切除后复发风险的列线图 DOI: https://doi.org/10.1016/j.chest.2018.04.040 目前关于非小细胞肺癌(NSCLC)完全切除术后的最佳随访策略尚未达成共识。这项研究的目的是开发基于网络的列线图,以精确地预测NSCLC患者术后特定部位的复发,并指导包括何时随访和进行什么检查的个体化监测策略。研究人员调查了201

【1】可以精确预测非小细胞肺癌完全切除后复发风险的列线图

DOI: https://doi.org/10.1016/j.chest.2018.04.040

目前关于非小细胞肺癌NSCLC)完全切除术后的最佳随访策略尚未达成共识。这项研究的目的是开发基于网络的列线图,以精确地预测NSCLC患者术后特定部位的复发,并指导包括何时随访和进行什么检查的个体化监测策略。研究人员调查了2017年在复旦大学上海癌症中心(发展队列)接受完全手术切除的NSCLC患者(鳞状细胞癌和非鳞状浸润性腺癌)的复发类型,并开发了基于Cox回归的特定部位复发风险的网络临床病理预测模型。列线图开发队列和外部验证队列用于预测总体复发、胸部复发、腹部复发、颈部复发、脑复发和骨复发的Harrell's C统计值分别为0.743和0.748,0.728和0.703,0.760和0.749,0.779和0.757,0.787和0.784,0.777和0.739。校准图显示列线图预测的3年无复发生存率(RFS)与实际3年RFS之间的一致性最佳。这些用户友好的列线图可以根据临床病理特征精确地预测NSCLC患者完全切除后部位特异性复发。这可以帮助临床医师制定个性化的术后随访计划。

【2】PPI与H2B在预防重症监护患者消化道大出血的疗效比较

DOI: https://doi.org/10.1016/j.chest.2018.05.015

质子泵抑制剂(PPI)和组胺-2受体阻滞剂(H2Bs)可用于应激性溃疡(SU)的预防。虽然PPIs具有更强的抑酸效力,但它们对于预防临床上肠道大出血(CIGIB)的相对有效性尚未明确。近日,新的一项研究旨在明确危重症患者预防性地运用PPIs降低CIGIB的风险比H2Bs更强。研究人员招募的受试者是从2018年1月1日至2012年6月30日期间进入回顾性队列研究的参与者,这些受试者至少有一个SU危险因素,并且接受PPI或H2B治疗超过三天。在70093例高危患者中,49576例(70.7%)患者接受至少三天的预防性治疗,424例患者(0.6%)符合CIGIB的定义。与服用H2B的受试者相比,服用PPI所致的CIGIB风险增加两倍。敏感性分析未能发现PPIs在预防CIGIB方面优于H2B。由此可见,在重症患者中,与PPIs相比,H2Bs可以稳定并且显著降低CIGIB的风险。

【3】简单的血液检查是否可排除肺癌

https://doi.org/10.2337/dc18-0918

近日,来自南卡莱罗纳医药大学(MUSC)的一项新的研究评估了“液体活检(或生物标志物)”准确性为目的的多中心临床试验。这项研究是肺结节患者血浆蛋白质组分类(Pulmonary Nodule Plasma Proteomic Classifier,PANOPTIC)项目的一部分,纳入了685例40岁及以上的新发(少于60天)肺结节(8-30毫米直径)患者。通过测量患者血浆蛋白LG3BP和C163A水平,结合癌症临床预测指标(如年龄、结节大小等特性)。结果表明,生物标志物对区分良性结节和恶性结节的有效性高达98%。

【4】可视化估计的冠状动脉钙化可预测COPD患者血管疾病

DOI: https://doi.org/10.1016/j.chest.2018.05.037

COPD与血管疾病(CVD)相关,并且为冠状动脉钙化(CAC)提供了更多的预后信息。随着非门控CT扫描在临床实践中的应用越来越多,近日,研究人员假设视觉韦斯顿CAC评分将如AGAST评分一样可以预测COPD患者冠状动脉事件和冠状动脉病变(CAD)的患病情况和发生率。研究人员对1875名纳入COPD基因研究的当前和既往吸烟者基于CT扫描测定Agatston评分和Weston评分。纳入了133例(7.1%)CAD患者,分别有413例(22%)和241例(12.9%)显著的Weston(>7)和Agatston(>400)评分确定的CAC,两种方法具有显著相关性。超过5年的随访期间,127例(6.8%)患者发生CVD事件。对于预测CAD的患病情况,Weston和Agatston的c指数分别为0.78和0.74,预测CVD的发生率分别为0.62和0.61。校正混杂因素后,Weston>7与首次急性冠状动脉事件的发生时间相关,而Agtston>400则不是。由此可见,CAC的简单视觉评分在预测患有COPD和不患有COPD的吸烟者CAD事件具有很好的效果。

【5】社区获得性肺炎住院死亡病例分析

DOI: https://doi.org/10.1016/j.chest.2018.05.021

社区获得性肺炎(CAP)住院的成人短期死亡率高。然而,目前尚不清楚医院内肺炎护理的改善能否能大大降低这种风险。近日,一项大型前瞻性CAP研究中,研究人员广泛地回顾了所有住院死亡病例,以评估每个死亡患者的原因并评估潜在可预防死亡率的程度。研究人员在美国五所三级医院招募了住院治疗的CAP患者。五名医生调查员回顾了每一位死亡患者的病历和研究数据库,以确定死亡原因、CAP对死亡的贡献以及任何可能导致死亡的可预防因素。结果显示,在低死亡率的三级护理医院的CAP成年患者,大多数院内死亡似乎没有因住院肺炎护理改善而变得可预防。在护理中存在临终前的限制、高龄和高合并症负担在死亡患者中很是常见。

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    2019-03-25 Smile2680
  2. [GetPortalCommentsPageByObjectIdResponse(id=1929514, encodeId=ed23192951498, content=<a href='/topic/show?id=9e604625ab' target=_blank style='color:#2F92EE;'>#Chest#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4625, encryptionId=9e604625ab, topicName=Chest)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c48a270, createdName=Smile2680, createdTime=Mon Mar 25 05:13:00 CST 2019, time=2019-03-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2051240, encodeId=6191205124085, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Sun Apr 07 11:13:00 CST 2019, time=2019-04-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345174, encodeId=57383451e432, content=谢谢分享,学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/07/16/3b24606172648eea459125cb74754afe.jpg, createdBy=6c022216608, createdName=liumin1987, createdTime=Sun Sep 16 05:49:15 CST 2018, time=2018-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345009, encodeId=2fb934500950, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Fri Sep 14 22:30:41 CST 2018, time=2018-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=345005, encodeId=a6f13450052f, content=^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Fri Sep 14 22:20:29 CST 2018, time=2018-09-14, status=1, ipAttribution=)]
    2019-04-07 xiangyuzhou971
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    2018-09-16 liumin1987

    谢谢分享,学习了。

    0

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    2018-09-14 医者仁心5538

    学习了

    0

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    2018-09-14 wqkm

    ^_^^_^^_^

    0