Objective To explore the association between dietary chili intake and cognitive function in the elderly population and the modifying effect of body mass index. Methods On the basis of the baseline survey data of the West China Elderly Health Cohort,a cross-sectional design was adopted,and 1 961 older adults aged 60 and above who had completed a dietary survey were included in this study.Multivariate linear regression and multivariate Logistic regression models were used to explore the associations of chili intake with cognitive function score and cognitive decline,respectively.Stratified analysis was performed to explore whether the associations varied among different body mass index groups. Results Among the surveyed older adults,1 119(57.06%) were diagnosed as with cognitive decline by minimum mental state examination.The results of multivariate linear regression analysis showed that after adjusting for possible confounding factors in turn,the score of chili intake had a stable positive correlation with cognitive function score(β=0.086,95%CI=0.010-0.163,P=0.027).Compared with those who did not have chili intake,the following groups had increased cognitive function scores:those with low chili intake(β=0.559,95%CI=0.023-1.096,P=0.041) or moderate chili intake(β=0.641,95%CI=0.075-1.207,P=0.026),those who had chili intake 1-5 days per week(β=0.994,95%CI=0.430-1.558,P=0.001),those who began chili intake over the age of 18(β=0.797,95%CI=0.172-1.422,P=0.013),those who began chili intake at the age of 18 and under(β=0.476,95%CI=0.045-0.907,P=0.031),those had mild chili intake(β=0.471,95%CI=0.047-0.896,P=0.030),and those who had high chili intake(β=0.982,95%CI=0.275-1.689,P=0.007).Logistic regression analysis showed that chili intake 1-5 days per week(OR=0.634,95%CI=0.474-0.849,P=0.002) was associated with a lower risk of cognitive decline than those without chili intake.Stratified analysis showed that the positive association between chili intake and cognitive function was more significant in the group with body mass index ≥24 kg/m2,and the higher score of chili intake corresponded to the lower risk of cognitive decline(OR=0.924,95%CI=0.875-0.975,P=0.004). Conclusions Appropriate chili intake may have a protective effect on cognitive function in the elderly population,especially in the overweight and obese elderly.Prospective studies are needed to further verify the causal relationship. 目的 探索老年人群膳食辣椒摄入与认知功能的关联及体重指数的效应修饰作用。方法 基于华西老年人群健康队列基线调查资料,采用横断面研究设计,纳入1 961名进行膳食调查的60岁及以上研究对象,使用多元线性回归模型及Logistic回归模型分别探索辣椒摄入与认知评分及认知功能下降的关联;分层分析探索不同体重指数分组人群中该关联是否有差异。结果 1 119名(57.06%)研究对象经简易精神状态量表初筛为认知功能下降。多元线性回归分析结果显示,依次调整可能的混杂因素后,辣椒摄入评分(β=0.086,95%CI=0.010~0.163,P=0.027)与认知评分呈现稳定的正关联,相较于不吃辣者,低水平辣椒摄入(β=0.559,95%CI=0.023~1.096,P=0.041)、中等水平辣椒摄入(β=0.641,95%CI=0.075~1.207,P=0.026)、每周1~5 d吃辣(β=0.994,95%CI=0.430~1.558,P=0.001)、18岁以上开始吃辣(β=0.797,95%CI=0.172~1.422,P=0.013)、18岁及以下开始吃辣(β=0.476,95%CI=0.045~0.907,P=0.031)、吃微辣(β=0.471,95%CI=0.047~0.896,P=0.030)及吃中辣以上者(β=0.982,95%CI=0.275~1.689,P=0.007)认知评分均更高;Logistic回归分析显示每周1~5 d吃辣者(OR=0.634,95%CI=0.474~0.849,P=0.002)相较于不吃辣者认知功能下降风险显著降低。分层分析显示,体重指数≥24 kg/m2组人群中辣椒摄入与认知功能的正向关联更为显著,辣椒摄入评分越高,认知功能下降风险越低(OR=0.924,95%CI=0.875~0.975,P=0.004)。结论 对于老年人群,尤其是超重及肥胖的老年人群,适当的辣椒摄入对其认知功能可能存在一定的保护效应,需前瞻性研究进一步验证因果关系。.
Objective To develop a novel carrier-free spherical nanomedicine with daunorubicin(DNR)for combined chemotherapy of leukemia and systematically study its physicochemical properties,drug release behavior,and in vitro and in vivo therapeutic efficacy. Methods DNR was chemically conjugated with 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine(DOPE)for the self-assembly of nanoparticles,which were further loaded with cytarabine(Ara-C)to form DOPE-DNR Ara-C nanomedicine(DDA NPs)for combined chemotherapy of acute myeloid leukemia.The particle size and surface potential of DDA NPs were characterized by dynamic light scattering and zeta potential analysis.The drug release behavior in high-concentration glutathione(GSH)was studied through reduction-responsive drug release experiments.In vitro cytotoxicity assays were conducted to evaluate the inhibitory effect on leukemia cells,while a rat model of leukemia was used to assess the antitumor efficacy in vivo. Results DDA NPs exhibited a spherical nanostructure with a particle size of(123.67±0.11)nm and the zeta potential of(-25.60±0.67)mV,showing good stability under physiological conditions.High-concentration GSH effectively triggered disulfide bond cleavage,facilitating targeted drug release.In vitro,DDA NPs significantly enhanced drug accumulation in the nuclei of LT-12 leukemia cells and improved the cytotoxicity of DNR.The animal experiment showed that compared with free drugs,DDA NPs significantly reduced the number of leukemia cells in rat bone marrow,prolonged the survival,and effectively inhibited leukemia cell infiltration while alleviating organ damage. Conclusions DDA NPs as a novel carrier-free nanomedicine significantly enhanced drug delivery efficiency and synergistic therapeutic effects.It demonstrates good clinical translation potential and may provide a new therapeutic strategy for the treatment of acute myeloid leukemia. 目的 采用柔红霉素构建一种新型自载体球形纳米药物,用于白血病的联合化疗,并对其物理化学性质、药物释放行为以及体内外疗效进行系统研究。 方法 通过化学连接1,2-二油酰-sn-甘油-3-磷酸乙醇胺(DOPE)与柔红霉素(DNR),自组装形成纳米颗粒,并进一步负载阿糖胞苷(Ara-C)形成DOPE-DNR Ara-C 纳米药物(DDA NPs),以对急性髓系白血病进行联合化疗。通过动态光散射和Zeta电位分析对纳米药物的粒径和表面电位进行表征;采用还原响应的药物释放实验研究其在高浓度谷胱甘肽(GSH)下的药物释放行为;通过体外细胞实验评估其对白血病细胞的药物抑制效果;同时开展大鼠体内白血病模型实验,评估其抗肿瘤效果。 结果 DDA NPs粒径为(123.67±0.11)nm,Zeta电位为(-25.60±0.67)mV,在生理条件下表现出良好的稳定性。高浓度GSH能有效触发二硫键断裂,促进药物靶向释放。体外实验表明,DDA NPs显著促进了药物在LT-12白血病细胞核内的富集,并提高了柔红霉素对细胞杀伤作用。体内研究中,与游离药物组相比,DDA NPs处理组能够显著减少大鼠骨髓中白血病细胞的数量,延长生存期,并有效抑制白血病细胞浸润,减轻器官损伤。 结论 构建的DDA NPs作为一种新型无载体纳米药物,能够有效提高药物的递送效率及协同治疗效果,具有良好的临床转化潜力,有望为急性髓系白血病治疗提供一种新的治疗策略。.
Soft tissue sarcomas represent a rare and highly heterogeneous category of malignant tumors,with the diagnosis and treatment contingent upon the precise identification of histopathological subtypes.Due to their complex molecular mechanisms and diverse clinical behaviors,histological classification methods sometimes struggle to accurately distinguish different subtypes,highlighting the need for effective biomarkers for early diagnosis.As an emerging technology,liquid biopsy provides real-time tumor dynamic information for the diagnosis,recurrence monitoring,and treatment effect evaluation of soft tissue sarcomas by analyzing biomarkers in body fluids.This article comprehensively reviews the advancements in the research and clinical application of tumor biomarkers in the liquid biopsy of soft tissue sarcomas.It emphasizes biomarkers such as circulating tumor cells,cell-free DNA,non-coding RNA,and extracellular vesicles.Although liquid biopsy has shown great potential in the study of soft tissue sarcoma biomarkers,its clinical application still faces the challenges of low sensitivity and specificity,difficulty in tracing tissue origin,and the need for integration of multi-omics techniques.In the future,it is necessary to further develop conventional,non-invasive,and highly specific liquid biopsy markers and incorporate multi-omics technology and other clinical detection methods to promote the precise diagnosis and treatment of soft tissue sarcomas. 软组织肉瘤是一类罕见且高度异质性的恶性肿瘤,其诊疗依赖于准确识别组织病理学亚型。由于其复杂的分子机制和多样的临床行为,传统组织学分类方法有时难以准确区分不同亚型,凸显了早期诊断对有效生物标志物的需求。液体活检作为一种新兴技术,通过分析体液中的生物标志物,为软组织肉瘤的诊断、复发监测和治疗效果评估提供实时动态信息。本文主要综述软组织肉瘤液体活检肿瘤标志物的研究进展及临床应用,重点探讨循环肿瘤细胞、循环游离DNA、非编码RNA和细胞外囊泡等生物标志物。尽管液体活检在软组织肉瘤生物标志物研究中显示出巨大潜力,但其在临床应用中仍面临敏感性和特异性低、组织来源追溯困难及对多组学技术整合需求方面的挑战。未来需进一步开发常规、无创、高特异性的液体活检标志物,结合多组学技术和其他临床检测方法,推动软组织肉瘤的精准诊疗。.
PICALM∶∶MLLT10 fusion gene-positive precursor B-cell acute lymphoblastic leukemia(pro-B-ALL)is clinically rare.This article reports the case of a 29-year-old female patient who presented a mediastinal mass.Diagnostic investigations confirmed PICALM∶∶MLLT10 fusion gene-positive pro-B-ALL.The patient sequentially received radiotherapy and multiple lines of chemotherapy but developed short-term drug resistance and lineage change,progressing to mixed-phenotype acute leukemia.A review of relevant literature was conducted to analyze its pathogenesis and molecular characteristics,aiming to provide references for clinical diagnosis and treatment. PICALM∶∶MLLT10融合基因阳性急性前体B淋巴细胞白血病(pro-B-ALL)临床罕见。本文报道1例29岁女性患者,以纵隔肿物起病,经检查确诊为PICALM∶∶MLLT10融合基因阳性pro-B-ALL,先后接受放射治疗及多线化学治疗,但短期内出现耐药及谱系变化,进展为混合表型急性白血病。进行相关文献复习,分析其发病机制、分子特征,以期为临床诊断和治疗提供参考。.
With the rapid development of biomedical research in China,biobanks have been widely established as crucial infrastructure supporting precision medicine and big data research.However,at the practical level,informed consent-central to safeguarding the rights and interests of research participants-often shows a disconnection between ethical principles and technological realities.This study first examines the Chinese translation of the term "biobank", arguing that "biological sample data bank" better reflects both the data-centric nature and governance complexity of such entities.It then systematically reviews the ethical debates surrounding various models of informed consent,including blanket consent,broad consent,dynamic consent,and meta-consent.Building on this analysis,this paper identifies key ethical elements that an effective informed consent form should include.Special attention is paid to the legitimacy and practical challenges of components such as research purpose,data collection,data use,storage duration,risk disclosure,and return of results.This study aims to provide an ethical foundation and practical guidance for improving the informed consent framework in China's biobank governance,thereby promoting a shift from mere regulatory compliance to robust ethical engagement and fostering a virtuous cycle between public trust and sustainable research development. 随着中国生物医学研究的快速发展,生物样本数据库(Biobank)广泛建立,成为支持精准医学与大数据研究的重要基础设施。然而,在实践层面,知情同意作为保障研究参与者权益的核心机制,其内容设计在伦理理念与技术现实之间存在一些脱节。本文首先对“Biobank”概念的中文译名进行辨析,提出“生物样本数据库”更能体现其数据性与治理复杂性。继而系统梳理不同知情同意模式,包括一揽子知情、广泛知情、动态知情、元知情之间的伦理分歧,并在此基础上归纳出一份有效知情同意书应当包含的关键伦理要素,重点分析研究目的、数据采集、数据使用、储存时间、风险告知与结果反馈等维度的正当性与实践困境。本文旨在为中国生物样本数据库知情同意制度的完善提供伦理依据和实践参考,促进科研治理从合规导向走向伦理充分,实现公众信任与科研可持续性的良性互动。.
Objective To examine the expression patterns,prognostic relevance,and immune regulatory functions of thymine DNA glycosylase (TDG) across a spectrum of cancer types,with a particular emphasis on its role in lung adenocarcinoma. Methods A comprehensive analysis was conducted using multiple bioinformatics databases to assess TDG expression levels in pan-cancer contexts,as well as its associations with prognosis and immune regulation.The expression and clinical relevance of TDG in lung adenocarcinoma were examined through online platforms such as UALCAN and BEST.Additionally,small interfering RNA targeting TDG was developed,and cell biological function assays were performed to determine the impact of TDG on cell functionality in lung adenocarcinoma.The LinkedOmics database was used to analyze the genes related to TDG and target kinases in lung adenocarcinoma,and their correlations with tumor status.The PRISM database was utilized to examine the correlation between TDG expression and clinical treatment response in lung adenocarcinoma. Results TDG was markedly overexpressed in a variety of cancers,including lung adenocarcinoma,papillary renal cell carcinoma,and gastric cancer (all P<0.001).It held potential as a prognostic biomarker for hepatocellular carcinoma,lung adenocarcinoma,and papillary renal cell carcinoma.The expression of TDG was intricately linked to immune cell infiltration and tumor heterogeneity.In the context of lung adenocarcinoma,the analysis using the TIMER algorithm revealed negative correlations between TDG expression and the infiltration levels of CD4+ T cells,dendritic cells,and B cells (all P<0.001).Furthermore,CIBERSORT analysis demonstrated that TDG expression was positively correlated with activated CD4+ memory T cells (P<0.001),neutrophils (P<0.001),resting NK cells (P<0.001),resting mast cells (P<0.001),M1 macrophages (P<0.001),M0 macrophages (P=0.014),and naive B cells (P<0.001),while it was negatively correlated with regulatory T cells (P<0.001),monocytes (P<0.001),activated mast cells (P<0.001),and memory B cells (P<0.001). Additionally,TDG expression was positively associated with tumor mutational burden (P<0.001),microsatellite instability (P=0.045),mutant-allele tumor heterogeneity (P=0.001),and tumor neoantigens (P<0.001) in lung adenocarcinoma.In lung adenocarcinoma,the expression of TDG was notably elevated in the tumor tissue compared with that in adjacent normal tissue (P<0.001).Male patients exhibited higher levels of TDG expression than female patients (P=0.002),and smokers demonstrated higher TDG expression than non-smokers (P<0.001).Furthermore,TDG expression was correlated with smoking cessation duration (P=0.014).Positive correlations were observed for TDG expression with both clinical T stage (P=0.003) and distant metastasis (P=0.012),while a negative correlation was found with patient prognosis (P=0.030).Furthermore,TDG emerged as an independent prognostic factor for lung adenocarcinoma.In vitro experiments revealed that silencing TDG inhibited the proliferation and migration of lung adenocarcinoma cells (both P<0.05).A correlation analysis between TDG-related genes and target kinases revealed that in lung adenocarcinoma,genes encoding aurora kinase A,cyclin-dependent kinase 2 and other enzymes exhibited positive correlations with TDG expression (all P<0.001).Furthermore,TDG expression demonstrated positive correlations with functional states including the cell cycle,DNA damage,and DNA repair processes (all P<0.001).In addition,the expression of TDG was correlated with the efficacy of treatment in the first course in clinical patients (P=0.007).Specifically,TDG expression levels were higher in the progressive disease group than in the stable disease group (P=0.016),and lower in the complete remission group than in the progressive disease group (P<0.001).Additionally,elevated TDG expression was associated with enhanced resistance to oxaliplatin (P<0.001),carmustine (P<0.001),and olaparib (P=0.004). Conclusion TDG serves as a potential prognostic biomarker,an immunotherapeutic target,and a oncogene in pan-cancer,with particular significance in lung adenocarcinoma. 目的 探究胸腺嘧啶DNA糖基化酶(TDG)在多种癌症中的表达、预后相关性、免疫调节作用及其在肺腺癌中的功能。方法 采用多种生物信息学数据库分析TDG在泛癌中的表达水平及其与预后、免疫调节的相关性。通过UALCAN、BEST等在线分析TDG在肺腺癌中的表达及其临床相关性。设计靶向TDG的小干扰RNA,利用细胞生物学功能实验评估其对肺腺癌细胞功能的影响。利用LinkedOmics数据库分析肺腺癌中TDG的相关基因、靶标激酶及其与肿瘤状态的相关性。利用PRISM数据库分析肺腺癌中TDG表达与临床治疗反应的相关性。结果 TDG在大多数癌症[如肺腺癌、肾乳头状细胞癌、胃癌(P均<0.001)等]中高表达,可作为肝细胞癌、肺腺癌和肾乳头状细胞癌的预后标志物。TDG表达与免疫细胞浸润、肿瘤的异质性密切相关[在肺腺癌中,TIMER 算法显示TDG表达与CD4+ T 细胞、树突状细胞和B 细胞的浸润水平均呈显著负相关(P均<0.001);CIBERSORT分析显示TDG表达与活化CD4+记忆性T细胞(P<0.001)、中性粒细胞(P<0.001)、静息NK细胞(P<0.001)、静息肥大细胞(P<0.001)、M1型巨噬细胞(P<0.001)、M0型巨噬细胞(P=0.014)和初始B细胞(P<0.001)均呈显著正相关,与调节性T细胞、单核细胞、活化肥大细胞和记忆B细胞均呈显著负相关(P均<0.001);TDG表达与肺腺癌中的肿瘤突变负荷(P<0.001)、微卫星不稳定性(P=0.045)、突变等位基因肿瘤异质性(P=0.001)和肿瘤新抗原(P<0.001)均呈显著正相关]。在肺腺癌中,与癌旁正常组织相比,TDG表达显著升高(P<0.001);男性患者TDG的表达水平显著高于女性(P=0.002),吸烟者TDG表达显著高于非吸烟者(P<0.001),并且TDG表达与戒烟年限显著相关(P=0.014)。此外,TDG表达与临床T分期(P=0.003)、远端转移(P=0.012)均呈显著正相关,与患者的预后呈显著负相关(P=0.030);且TDG是肺腺癌的独立预后因子。体外实验显示,沉默TDG抑制肺腺癌细胞的增殖与迁移(P均<0.05)。TDG相关基因和靶标激酶相关性分析显示,在肺腺癌中,极光激酶A、细胞周期蛋白依赖性激酶2等基因与TDG均呈显著正相关(P均<0.001);TDG的表达与细胞周期、DNA损伤、DNA修复等功能状态均呈显著正相关(P均<0.001)。TDG的表达与临床患者首程治疗效果显著相关(P=0.007);与稳定疾病组相比,进展性疾病组中TDG的表达水平更高(P=0.016);与进展性疾病组相比,完全缓解组中TDG的表达水平较低(P<0.001);TDG表达越高,患者对奥沙利铂(P<0.001)、卡莫司汀(P<0.001)、奥拉帕利(P=0.004)越抵抗。结论 在泛癌中,尤其是肺腺癌中,TDG是一种潜在的肿瘤预后生物标志物、潜在免疫治疗靶点和癌基因。.
Extracellular matrix is a 3D reticular molecular structure that maintains the structures and functions of cells and provides biomechanical support for cell proliferation and differentiation.The increase in extracellular matrix hardness can destroy the ecological structures and biological functions of normal organs and affect the signal transduction of normal tissue and cells,being a key driver of organ fibrosis.Therefore,reducing the extracellular matrix hardness by inhibiting key signaling pathways and activating fibroblasts can reverse organ fibrosis and promote the steady development of extracellular matrix.This paper expounds the key role of extracellular matrix hardness in fibrosis diseases,providing key therapeutic targets and clinical research directions for ameliorating and reversing organ fibrosis. 细胞外基质是维持细胞结构和功能的一种3D网状分子结构,为细胞的增殖、分化提供了生物力学支撑。细胞外基质的硬度增加可以破坏正常脏器的生态结构和生物功能,影响正常组织细胞的信号传导,是脏器纤维化的关键驱动要素。因此,通过抑制关键信号通路、成纤维细胞活化等手段可以降低细胞外基质的硬度,逆转脏器纤维化,促进细胞外基质的稳态发展。本文主要对细胞外基质硬度在纤维化疾病中的关键作用进行阐述,为改善和逆转脏器纤维化提供关键治疗靶点和临床研究方向。.
Basolateral amygdala(BLA),an important component of the amygdala,has become a key region in the study of the regulation of anesthesia and the sleep-wake cycle in recent years.In addition to the role in the regulation of emotions and behaviors,BLA regulates the depth of anesthesia and affects the recovery from anesthesia through the interactions of a variety of neurotransmitters and neural circuits.Moreover,BLA mediates the transition of the sleep-wake state to affect the sleep duration.It has been demonstrated that BLA plays an extremely important role in the neurobiological mechanisms of anesthesia and sleep.This paper reviews the recent research progress in the roles of BLA in anesthesia and sleep-wake regulation,aiming to provide a new perspective for deeply understanding the function of BLA and offer a potential theoretical basis for improving clinical anesthetic outcome and sleep quality. 基底外侧杏仁核(BLA)是杏仁核的重要组成部分,近年来成为研究调节麻醉和睡眠-觉醒周期的关键区域。除了在情绪和行为调控中发挥作用,BLA还通过多种神经递质与神经回路的相互作用调节麻醉深度以及影响麻醉复苏的过程,并介导睡眠-觉醒状态的转换和影响整个睡眠时长。已有研究证明,BLA在麻醉和睡眠的神经生物学机制中起着极为重要的作用。本文旨在综述BLA在麻醉与睡眠-觉醒调节中的最新研究进展,为深入理解BLA的功能提供新的视角,并为改善临床麻醉效果与睡眠质量提供潜在的理论依据。.
Objective This study aims to systematically analyze the current status of downward referral among rehabilitation physicians in secondary and tertiary hospitals and investigate its influencing factors.By identifying key bottlenecks in the rehabilitation referral process,this study seeks to provide recommendations for optimizing the hierarchical medical system. Methods A multi-stage stratified cluster sampling method was employed to recruit 203 rehabilitation physicians from 33 secondary and tertiary medical institutions across 18 cities in eastern,central,and western China.Data were collected via self-administered online questionnaires,covering demographic characteristics,professional background,and hierarchical medical system-related factors.An ordered multinomial logistic regression model was used to analyze the factors influencing rehabilitation physicians' downward referral behavior. Results After controlling for confounding factors,the nature of the institution in which the doctor worked (OR=0.475, 95%CI=0.245-0.923, P=0.028),downward referral based on the doctor's own clinical experience (OR=0.423, 95%CI=0.217-0.824, P=0.011),the number of outpatient (emergency) visits received in the last week (OR=1.006, 95%CI=1.001-1.011, P=0.018),knowledge of two-way referrals (OR=1.646, 95%CI=1.042-2.601, P=0.033),confidence in correctly judging the timing of patient referrals (OR=1.556, 95%CI=1.013-2.391, P=0.043),and willingness to refer patients downward (OR=1.901, 95%CI=1.366-2.646, P<0.001) were all independent factors influencing rehabilitation physicians' downward referral behavior. Conclusions Rehabilitation physicians' downward referral behavior is influenced by institutional nature,clinical experience,patient volume,referral system awareness,confidence in referral decisions,and referral intention.To enhance referral efficiency and promote the balanced development of rehabilitation services within the hierarchical medical system,this paper proposes the following recommendations:improving bidirectional referral policies,optimizing medical insurance payment structures,strengthening rehabilitation physician training,and encouraging public-private collaboration. 目的 系统分析二、三级医院康复医生向下转诊行为的现状,并探究其影响因素,以揭示当前康复转诊环节的关键瓶颈,为完善分级诊疗体系中的康复转诊流程提供策略建议。方法 采用多阶段分层整群抽样方法,从我国东、中、西部18个城市的33家二、三级医疗机构中抽取203名康复医生作为研究对象。通过网络自填问卷的方式收集数据,问卷内容包括医生的社会人口学特征、职业概况及分级诊疗相关情况。采用有序多分类Logistic回归模型分析康复医生向下转诊行为的影响因素。结果 在控制其他混杂因素后,公立机构的医生(OR=0.475,95%CI=0.245~0.923,P=0.028)、根据本人临床经验办理下转(OR=0.423,95%CI=0.217~0.824,P=0.011)、上周门(急)诊接诊人次越多(OR=1.006,95%CI=1.001~1.011,P=0.018)、对双向转诊的了解程度越高(OR=1.646,95%CI=1.042~2.601,P=0.033)、正确判断患者转诊时机的信心越强(OR=1.556,95%CI=1.013~2.391,P=0.043)、向下转诊患者的意愿越强(OR=1.901,95%CI=1.366~2.646,P<0.001),康复医生向下转诊患者的可能性越高。结论 康复医生的下转行为受医院性质、临床经验、接诊量、转诊认知、判断信心及转诊意愿的影响。建议通过完善双向转诊政策、优化医保支付、加强康复医生培训、鼓励公私协作,提升转诊便利性,促进康复服务的均衡化和分级诊疗体系落地。.
Objective To analyze the research bases,research hotspots,and future research trends in the relationship between the circadian rhythm and obesity,thus providing a reference for research in this field. Methods Literature on obesity and circadian rhythm published from 2001 to June 2024 was retrieved from the Web of Science.CiteSpace and VOSviewer were used for scientometric analysis. Results This study included 1 185 publications from 4 083 organizations in 354 countries/regions.Annual number of publications in this field showed an overall upward trend,with particularly rapid growth after 2019.Countries such as the United States and Ireland exerted significant influence in this field.Keyword co-occurrence and cluster analysis identified adipose tissue and meal timing as closely related keywords.The burst analysis indicated gut microbiota and DNA methylation as current research hotspots. Conclusions The research on the association between circadian rhythm and obesity primarily centers on the interaction between circadian rhythm and gut microbiota,which influences lipid metabolism processes,and on the regulation of circadian rhythm through meal timing to reduce obesity risk.Incorporating epigenetics in the research on circadian rhythm and obesity may represent an important future research direction. 目的 分析生物钟与肥胖关系的研究基础、研究热点以及未来的研究发展趋势,为该领域研究提供参考。 方法 从Web of Science数据库检索2001年至2024年6月发表的关于肥胖与生物钟的文献,采用CiteSpace和VOSviewer进行科学计量分析。 结果 共纳入来自354个国家/地区4 083个机构的1 185 篇文献。该领域年发文量总体呈增长趋势,特别是在2019年之后经历了快速的发展。其中美国、爱尔兰等国在该领域影响力较大。通过关键词共现和聚类分析,密切相关的关键词为脂肪组织、进食时间,关键词突现分析表明肠道菌群、DNA甲基化为当前研究热点。 结论 生物钟与肥胖间密切的关联主要集中在昼夜节律与肠道菌群的相互作用影响脂质代谢的进程,以及进食时间调节生物钟可减少肥胖风险,表观遗传学与生物钟、肥胖的交叉研究可能是未来研究的重要方向。.
Objective To investigate the association between Epstein-Barr virus(EBV)and nasopharyngeal carcinoma(NPC)and to evaluate the roles of EBV antibodies Rta-IgG,VCA-IgA,and EA-IgA in the screening of NPC. Methods The related literature was retrieved from the Web of Science Core Collection.The publication output,keyword co-occurrence,and country/region collaboration were analyzed with VOSviewer,CiteSpace,and Excel.A total of 402 NPC patients,915 individuals with nasal symptoms,and 27 395 healthy participants undergoing physical examination in Xiangya Hospital,The Second Xiangya Hospital,and The Third Xiangya Hospital were enrolled.Serum Rta-IgG,VCA-IgA,and EA-IgA levels were measured by ELISA,and their diagnostic performance for NPC was assessed by receiver operating characteristic curves.Inter-group differences were compared through the χ2 test. Results The research on EBV-NPC was highly productive.The top three keywords by frequency were nasopharyngeal carcinoma,Epstein-Barr virus,and cancer.China was the leading contributor.In the NPC cohort,the diagnostic sensitivities of Rta-IgG,VCA-IgA,and EA-IgA were 76.12%,83.58%,and 62.19%,respectively,which were higher than those in the other two groups(all P<0.001).VCA-IgA showed the highest sensitivity(83.58%),whereas EA-IgA exhibited the best specificity(97.41%).The three antibodies showed high negative prediction values,which were 99.65%,99.76%,and 99.45%.Combined testing of Rta-IgG,VCA-IgA,and EA-IgA increased the sensitivity to 99.50%. Conclusions The EBV-NPC link remains a major research focus.Serum Rta-IgG,VCA-IgA,and EA-IgA levels are clinically valuable for NPC diagnosis,and their combined detection significantly improves the screening efficiency. 目的 研究EB病毒(EBV)与鼻咽癌(NPC)的相关性及EBV Rta蛋白IgG抗体(Rta-IgG)、衣壳抗原IgA抗体(VCA-IgA)和早期抗原IgA抗体(EA-IgA)在NPC筛查中的作用。 方法 通过Web of Science Core Collection数据库检索文献,采用VOSviewer、CiteSpace和Excel分析发文量、关键词共现及国家/地区共现。选取湘雅医院、湘雅二医院和湘雅三医院的402例NPC患者、915例有鼻部症状患者和27 395例健康体检者,采用ELISA法检测3组受试者血清中的Rta-IgG、VCA-IgA和EA-IgA,分析其在NPC筛查中的效能,并用卡方检验比较组间差异,受试者工作特征曲线评价诊断效能。 结果 EBV与NPC研究发文量高,出现频次前三的关键词是nasopharyngeal carcinoma、estein-barr virus和cancer,中国是核心研究国家。NPC组Rta-IgG、VCA-IgA和EA-IgA的诊断灵敏度分别为76.12%、83.58%和62.19%,显著高于其他两组(P均<0.001)。VCA-IgA灵敏度最高(83.58%),EA-IgA特异度最好(97.41%);3种抗体的阴性预测值均较高,分别为99.65%、99.76%和99.45%;联合检测Rta-IgG、VCA-IgA和EA-IgA可提高NPC诊断灵敏度至99.50%。 结论 EBV和NPC的联系是研究热点之一。NPC患者血清Rta-IgG、VCA-IgA、EA-IgA抗体具临床诊断价值,联合检测可提高NPC筛查效率。.
Objective To quantitatively evaluate China's core research integrity policies by constructing an evaluation index system specific to the medical field and reveal the applicability and structural shortcomings of these policies,thereby providing empirical evidence and optimization pathways for enhancing the scientific rigor and practical effectiveness of research integrity governance in China. Methods Eighteen research integrity policy documents issued at the national level by the central government and ministries from January 2010 to January 2025 were collected.An evaluation framework based on the policy modeling consistency index model was constructed via text mining and keyword analysis to quantitatively assess the consistency and effectiveness of these policies.According to their scores,the policies were rated as excellent,good,medium,or bad grade. Results The 18 policies showed the average policy modeling consistency index of 6.27 and the sag index of 2.73,which indicated good overall performance but with clear disparities.Among them,3 policies were rated as excellent,6 as good,and 9 as medium.Analysis of the dimensional averages revealed that while the policies performed robustly in terms of policy function and policy timeliness,they exhibited significant shortcomings in the dimensions of policy target and policy scope,with average scores of 0.59 and 0.44,respectively. Conclusions While China's medical research integrity policy framework is generally effective,it exhibits clear structural shortcomings,including a lack of international perspective,monolithic policy targets,insufficient enforcement rigidity,and low operability.Accordingly,it is recommended that measures such as aligning with global standards,establishing a multi-stakeholder collaborative governance network,strengthening policy enforcement,and improving policy operability should be adopted.These measures will help to systematically optimize China's medical research integrity policy system,thereby enhancing the overall governance level in this domain. 目的 通过构建医学领域科研诚信政策评价指标体系,对我国主要科研诚信政策进行量化评估,旨在揭示科研诚信政策在医学领域的适用性水平与结构性短板,从而为提升我国医学领域科研诚信治理的科学性与实践效能提供实证依据与优化路径。方法 收集2010年1月至2025年1月国家及部委层面发布的18项科研诚信政策文件,通过文本挖掘和关键词分析构建基于政策一致性指数模型的评价指标体系,量化评估政策的一致性与有效性,并依据得分范围将政策分为优秀、良好、中等、不良4个等级。结果 18项政策一致性指数均值为6.27,整体呈现良好水平,凹陷指数均值为2.73,但存在明显参差,其中优秀级3项、良好级6项、中等级9项。从各维度均值看,政策功能与政策时效维度表现稳固,但在政策客体与政策作用范围维度上存在显著不足,其均值分别为0.59和0.44。结论 我国医学领域科研诚信政策整体表现良好,但存在缺乏国际化视野、政策客体单一、政策执行刚性和实操性不足等短板,建议采取与全球标准对接、构建多元主体协同治理网络、增强政策执行刚性、提升内容可操作性等措施,系统性地优化我国医学领域科研诚信政策体系,以整体提升我国医学领域科研诚信治理水平。.
In response to the challenges posed by the profound integration of generative artificial intelligence(AI)into medical education,this consensus proposes a logically coherent,medically distinctive,forward-looking,and operable AI proficiency framework for medical educators(competency items of medical educators' AI proficiency,CAIP-ME).Through systematic literature review,preliminary framework construction,multiple rounds of expert pre-study,and a structured Delphi method involving extensive consultations with 60 interdisciplinary experts,the core competency items and assessment standards for AI proficiency among medical educators were demonstrated and calibrated.The framework encompasses five core dimensions and 25 specific competency items.The five dimensions are value recognition and ethical foundation,technical understanding and tool application,teaching integration and innovative practice,learning assessment and precise empowerment,and professional development and ecosystem co-construction.Competency items are categorized into 11 foundational competency items essential for all educators and 14 developmental competency items for those pursuing excellence.Each competency item is described in terms of its conceptual definition and key behavioral manifestations,accompanied by observable assessment indicators.This consensus aims to provide a scientific basis for the professional development of medical educators and the faculty building in medical institutions,while establishing a key reference standard for educator competency development in the context of digital transformation in medical education. 为应对生成式人工智能(AI)技术深刻融入医学教育对教师角色与能力提出的挑战,本共识通过系统性文献综述、初步框架构建、多轮专家预研,采用结构化德尔菲法,广泛征集 60位跨学科专家的意见,对医学教师AI素养的核心能力项及其观测标准进行论证与校准,首次提出一套逻辑清晰、医学特色鲜明,兼具前瞻性与可操作性的医学教师AI素养框架。该框架涵盖五大核心维度、25项具体能力(CAIP-ME)。五大维度依次为价值认知与伦理根基、技术理解与工具应用、教学融合与创新实践、学习评价与精准赋能、专业发展与生态共建。框架将各项能力区分为11项所有教师应具备的基础能力与14项追求卓越的发展能力,每项能力均从内涵界定与关键行为表现进行描述,并配套可观测的测评指标。共识旨在为医学教师的专业化发展与院校师资队伍建设提供科学依据,也为医学教育数字化转型背景下的师资能力建设确定了关键参照标准。.
Objective To evaluate the value of dual-layer spectral CT-derived iodine concentration (IC) and extracellular volume (ECV) in the portal venous phase in assessing hepatic functional reserve. Methods A total of 24 patients who underwent triphasic abdominal spectral CT enhancement scanning between January 2020 and August 2022 were retrospectively enrolled.IC and ECV maps were generated from spectral base data of the portal venous phase,and IC and ECV values were measured in the left lobe,right lobe,and caudate lobe of the liver.Differences in parameters among hepatic lobes were compared by the Kruskal-Wallis test.Pearson or Spearman correlation analysis was performed to assess the relationships of IC and ECV with parameters of the indocyanine green (ICG) clearance test.The key parameters analyzed included the ICG retention rates at 5 min (ICGR5),at 10 min (ICGR10),at 15 min (ICGR15),and the ICG clearance rate (ICG-CR).On the basis of correlation results,multivariate linear regression models were constructed. Results ECV in the right hepatic lobe showed negative correlations with ICGR5 (r=-0.48,P=0.019),ICGR10 (r=-0.48,P=0.019),and ICGR15 (r=-0.47,P=0.021) and a positive correlation with ICG-CR (r=0.48,P=0.019).IC in the right hepatic lobe also showed negative correlations with ICGR5 (r=-0.52,P=0.009),ICGR10 (r=-0.52,P=0.009),and ICGR15 (r=-0.53,P=0.008) and a positive correlation with ICG-CR (r=0.52,P=0.009).IC in the right hepatic lobe demonstrated the best predictive performance for ICGR5 (y=0.62-0.16×IC,R2=0.26,P=0.011) and ICG-CR (y=0.09-0.07×IC,R2=0.32,P=0.004),whereas ECV was not selected in the multivariate regression model. Conclusion The dual-layer spectral CT-derived IC in the portal venous phase of the right hepatic lobe demonstrates significant clinical relevance with hepatic functional reserve,potentially serving as a non-invasive imaging biomarker for liver function assessment. 目的 探讨双层探测器光谱CT门脉期碘浓度(IC)和细胞外容积(ECV)定量参数对肝功能储备的评估价值。方法 回顾性纳入2020年1月至2022年8月行腹部光谱CT三期增强检查的24例患者,基于门脉期能谱基数据生成IC及ECV图,测量肝左叶、右叶及尾状叶的IC与ECV值。通过Kruskal-Wallis检验比较各肝叶参数差异,采用Pearson/Spearman法分析IC及ECV与吲哚菁绿(ICG)清除试验参数之间的相关性。分析的关键参数包括:ICG 5 min滞留率(ICGR5)、ICG 10 min滞留率(ICGR10)、ICG 15 min滞留率(ICGR15)及ICG血浆清除率(ICG-CR),并基于相关性分析结果进一步构建多元线性回归模型。结果 肝右叶ECV与ICGR5(r=-0.48,P=0.019)、ICGR10(r=-0.48,P=0.019)、ICGR15(r=-0.47,P=0.021)均呈显著负相关,与ICG-CR呈显著正相关(r=0.48,P=0.019)。肝右叶IC与ICGR5(r=-0.52,P=0.009)、ICGR10(r=-0.52,P=0.009)、ICGR15(r=-0.53,P=0.008)均呈显著负相关,与ICG-CR呈显著正相关(r=0.52,P=0.009)。肝右叶IC对ICGR5(y=0.62-0.16×IC,R2=0.26,P=0.011)及ICG-CR(y=0.09-0.07×IC,R2=0.32,P=0.004)的预测效能最佳,而ECV未通过多元回归筛选。结论 双层探测器光谱CT门脉期肝右叶IC值可作为评估肝功能储备的潜在影像标志物,其与ICG清除试验的强相关性为无创肝功能定量评估提供了新思路。.
Atherosclerosis (AS) is characterized by lipid deposition and the formation of arterial intimal plaques,which can lead to serious cardiovascular events such as acute coronary syndrome,myocardial infarction,or stroke.It is one of the leading causes of mortality among Chinese residents.Recent studies have demonstrated that porphyromonas gingivalis lipopolysaccharide activates the inflammatory pathway through binding to Toll-like receptors,thereby stimulating the expression of inflammatory mediators.This process induces functional impairments in macrophages and endothelial cells,promotes foam cell formation,and consequently accelerates the progression of AS.This article reviews the latest research progress in the roles and mechanisms of porphyromonas gingivalis lipopolysaccharide in AS and explores its potential value as a clinical therapeutic target,aiming to provide new insights for the prevention and treatment of AS. 动脉粥样硬化(AS)以脂质沉积及动脉内膜斑块形成为特征,可引发急性冠脉综合征、心肌梗死或中风等严重心血管事件,是我国居民主要死因之一。近年研究发现,牙龈卟啉单胞菌脂多糖通过结合Toll样受体刺激炎症介质的表达从而激活炎症通路,诱导巨噬细胞与内皮细胞功能紊乱,促进泡沫细胞的形成,从而加速AS的发生与发展。本文主要总结牙龈卟啉单胞菌脂多糖在AS中作用及机制的最新研究进展,并探讨其作为临床治疗靶点的潜在价值,以期为AS的防治提供新思路。.
We examine the status and path of the discipline construction of palliative medicine from both knowledge and institutional dimensions.From the knowledge dimension,palliative medicine is driven by the demand of the times and has significant interdisciplinary characteristics.From the institutional dimension,the development direction of palliative medicine remains to be clarified,despite the established foundation.It is recommended that the boundaries of palliative medicine,hospice care and other secondary disciplines of clinical medicine be clearly defined from the knowledge dimension.From the institutional dimension,establishing a pilot master's degree program in palliative care is proposed as a key breakthrough,and the collaboration of multiple stakeholders should be promoted to advance the institutionalization and knowledge innovation of this discipline. 基于学科建设的知识属性与制度属性双重维度,探讨中国缓和医学学科建设的现状与发展路径。研究表明,缓和医学在知识层面具有鲜明的时代动力与显著的跨学科特性,而在制度层面虽已具备一定基础,但仍须进一步明确发展方向。建议从知识层面明确缓和医学与安宁疗护及其他临床医学二级学科的边界,在制度层面以硕士学位点建设为切入点,推动多元主体协同参与,实现学科制度化与知识创新的良性互动。.
This article reports on the diagnosis and treatment of a 75-year-old male patient who presented with abdominal distension,fatigue,and elevated inflammatory markers.After multiple examinations and tissue biopsies,he was diagnosed with severe idiopathic multicentric Castleman disease-TAFRO subtype.Due to concurrent peptic ulcer bleeding,the initial treatment did not follow the recommended combination of high-dose corticosteroids or chemotherapy containing corticosteroids as per international/Chinese guidelines.Instead,only siltuximab monotherapy with a weekly dosing regimen was adopted,which also yielded significant efficacy.This case aims to highlight the diversity of treatment options for idiopathic multicentric Castleman disease. 介绍1例75岁男性患者的诊疗经过,患者主诉腹胀、乏力,伴有炎症指标升高,经过重复血清学检查和组织病理学结果,诊断为特发性多中心型Castleman病-TAFRO亚型。本患者因合并消化性溃疡出血,在治疗初期未能遵循国际/国内指南的推荐:联合大剂量激素冲击或者含有糖皮质激素的联合化疗,仅单独给予司妥昔单抗,采用每周1次的给药方式,亦取得显著疗效。本病例旨在强调特发性多中心型Castleman病的治疗方案多样性。.
A review of the development course of palliative care reveals that its goal of alleviating suffering determines the indispensability of the social dimension in this field.As palliative care emerges in response to the general trends such as aging and disease spectrum changes of social development,it naturally becomes one of the key solutions to social issues including the difficulties in caregiving and hospitalization for end-of-life patients.Beyond its social value,the comprehensiveness and localization of care emphasized by palliative care also require the support and intervention of theoretical perspectives such as social support and sociocultural adaptation.Through the framework of suffering and care,medicine and social sciences have achieved significant interdisciplinary integration in palliative care. 回溯缓和医疗的发展历程可以发现,缓和医疗缓解苦痛的目标定位决定了社会维度在其中的不可或缺。缓和医疗既是应老龄化、疾病谱变化等社会发展之大势而生,也就自然成为解决终末期患者照护难、住院难等社会问题的密匙之一。而在社会价值之外,缓和医疗强调的照护的综合性以及本土化同样需要社会支持、社会文化调适等理论视角的支撑与介入。藉由苦痛和照护的框架,医学和社会科学在缓和医疗中实现了重要的交叉。.
Objective To systematically evaluate the effects of acute and long-term exercise interventions on the physical health of children with Prader-Willi syndrome (PWS). Methods A systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses of non-randomized studies of interventions guidelines.Relevant studies from 1987 to 2023 were retrieved from PubMed,Web of Science,and EBSCO databases.Eligible studies were primarily non-randomized controlled trials focusing on acute or long-term exercise interventions in the children with PWS.Outcome measures included cardiorespiratory function,muscle strength,body composition,metabolism,and inflammation. Results A total of 19 studies were included.Studies of acute exercise showed that the children with PWS had lower cardiorespiratory function and muscle strength than normal or obese children,but similar metabolic responses.Long-term exercise interventions resulted in significant body mass index reduction,increased muscle mass,improved cardiorespiratory function,and regulation of inflammation markers such as interleukin-8.In addition,exercise improved the quality of life in the children with PWS. Conclusions Exercise interventions positively impact the health of children with PWS by reducing the body mass index,increasing the muscle strength,improving the cardiorespiratory function,and regulating inflammation.Exercise intervention combined with hormone therapy and nutritional intervention can serve as an effective rehabilitation regimen for the health management of children with PWS.Future research should explore optimal exercise prescriptions and long-term effects and mechanisms. 目的 系统评估急性及长期运动干预对普拉德-威利综合征(PWS)儿童体质健康的影响。方法 遵循非随机干预研究的系统综述和Meta分析报告规范,通过检索PubMed、Web of Science、EBSCO等数据库,收集1987至2023年发表的关于运动干预PWS儿童体质健康影响的文献。纳入的文献主要为非随机对照试验,研究对象为PWS儿童,干预措施为急性或长期运动训练,结局指标包括心肺功能、肌肉力量、体成分、代谢指标及炎症反应等。对纳入的研究进行偏倚风险评估,并汇总分析运动干预的效果。结果 共纳入19篇研究,急性运动干预研究显示PWS儿童的心肺功能和肌肉力量均显著低于正常儿童或肥胖对照组,但其代谢反应与对照组相似。长期运动干预结果显示,PWS儿童的体重指数显著下降,肌肉质量增加,心肺功能和身体协调性均显著改善,且长期运动调节部分炎症标志物如白细胞介素-8的水平。此外,部分研究表明运动干预提升了PWS儿童的生活质量。结论 运动干预对PWS儿童的体质健康具有多方面的积极影响,尤其在控制体重、提高肌肉力量、改善心肺功能及调节炎症反应方面具有重要作用。结合激素治疗和营养干预,运动干预可为PWS儿童的健康管理提供有效的康复方案,未来应进一步优化运动处方,探索长期干预的效果和机制。.
Objective To investigate the relationships of various types of renal vascular lesions with the clinical,pathological,and prognostic features of lupus nephritis (LN). Method A retrospective analysis was performed on the clinical and pathological data of LN patients treated in the Peking Union Medical College Hospital over the past 10 years to explore the relationships of different vascular lesions with clinical and pathological features and analyze the effects of renal vascular lesions on kidney prognosis from multiple perspectives. Results Among 644 enrolled LN patients,females accounted for 82.6%,and LN Ⅳ/Ⅳ+Ⅴ (60.4%) was the predominant pathological type.According to the types of renal vascular lesions,the patients were classified into four groups:atherosclerosis (AS)(n=171,26.6%),thrombotic microangiopathy (TMA)(n=78,12.1%),uncomplicated immune complex deposition (ICD)(n=29,4.5%),and lupus vasculopathy (LV)(n=19,3.0%). No renal vascular lesion (NRVL)(n=347,53.9%) was taken as the control group.The average age of patients in the AS group was higher than that in the other groups (all P<0.001).The TMA (P=0.009,P=0.025) and LV groups (P=0.007,P=0.005) had lower levels of complement C3,and higher disease activity index of systemic lupus erythematosus and incidence of acute kidney injury (both P<0.001) than the NRVL and AS groups.The TMA (P<0.001),LV (P<0.001),and AS (P=0.037) groups had lower estimated glomerular filtration rate (eGFR) than the NRVL group,and the eGFR of the TMA group was lower than that of the LV,AS,and ICD groups (all P<0.001).The renal pathological activity index (AI) of each renal vascular lesion group was higher than that of the NRVL group (all P<0.001),and the AI value of the TMA and LV groups was higher than that of the AS group (both P<0.001).There was no significant difference in AI value between TMA and LV groups (P=0.675),while the proportion of fibrinoid necrosis in the LV group was higher than that in the TMA group (P=0.012).The TMA group had the highest degree of chronicity and higher chronic index than the AS (P=0.021),LV (P<0.001),ICD (P<0.001),and NRVL (P<0.001) groups.The AS group had the secondary highest degree of chronicity and higher median chronic index than the NRVL group (P=0.004).The TMA group had the lowest 1-year clinical remission rate and the highest proportion of annual eGFR decline >5 mL/(min·1.73 m2).Both TMA and AS groups showed lower long-term renal survival rates than the NRVL group (P<0.001,P=0.023) respectively. Conclusions Intrarenal vascular lesions are strongly associated with clinical severity and prognosis in LN.LV correlates with acute kidney injury and severe active renal injury,while TMA is the most severe subtype and characterized by high pathological activity,chronicity,poor treatment response,and adverse outcomes.AS,the most common type,does not affect treatment response but predicts unfavorable long-term renal survival. 目的 探讨狼疮性肾炎(LN)不同类型血管病变与患者临床、病理及预后的关系。方法 回顾性分析我院10年间LN患者的临床病理数据,探究不同血管病变与临床病理间的关系及多个角度分析肾血管病变对肾脏预后的影响。结果 共纳入644例LN患者,女性占82.6%,LN Ⅳ/Ⅳ+Ⅴ型占60.4%。根据血管病变类型分为4组:肾小动脉硬化(AS)组171例(26.6%)、血栓性微血管病(TMA)组78例(12.1%)、单纯免疫复合物沉积(ICD)组29例(4.5%)及狼疮血管病(LV)组19例(3.0%),无血管病变(NRVL)组347例(53.9%)作为对照。AS组患者平均年龄显著高于其他各组(P均<0.001)。与NRVL及AS组相比,TMA(P=0.009,P=0.025)和LV组(P=0.007,P=0.005)补体C3水平均显著降低、系统性红斑狼疮疾病活动指数及急性肾损伤的发生率均显著增加(P均<0.001)。除ICD组外,TMA(P<0.001)、LV(P<0.001)和AS组(P=0.037)估算的肾小球滤过率(eGFR)均显著低于NRVL组,其中TMA组的eGFR均显著低于LV、AS和ICD组(P均<0.001)。各肾血管病变组肾脏病理活动指数(AI)均显著高于NRVL组(P均<0.001),TMA和LV组AI值均显著高于AS组(P均<0.001)。TMA与LV组比较,AI值差异无统计学意义(P=0.675),但LV组纤维素样坏死比例显著高于TMA组(P=0.012)。慢性化程度TMA组最高,慢性指数显著高于AS(P=0.021)、LV(P<0.001)、ICD(P<0.001)和NRVL组(P<0.001);其次为AS组,中位慢性指数显著高于NRVL组(P=0.004)。TMA组1年内临床缓解率最低,年eGFR下降>5 mL/(min·1.73 m2)的比例最高。经长期随访,TMA和AS组患者肾脏存活率均显著低于NRVL组(P<0.001,P=0.023)。结论 肾内血管病变与LN临床和预后密切相关。LV与急性肾损伤的发生及严重活动性肾损伤相关;TMA最严重,存在较高的肾脏病理活动性和慢性病变,治疗反应相对较差,预后不佳;AS最常见,其存在不影响治疗反应,但与长期肾脏不良预后相关。.