目的分析程序性细胞死亡因子5(programmed cell death 5,PDCD5)、半胱天冬酶1(cysteinyl aspartate specific proteinase-1,Caspase-1)及分化簇64(cluster of differentiation 64,CD64)联合与甲型H1N1流行性感冒病毒性肺炎患者短期预后...目的分析程序性细胞死亡因子5(programmed cell death 5,PDCD5)、半胱天冬酶1(cysteinyl aspartate specific proteinase-1,Caspase-1)及分化簇64(cluster of differentiation 64,CD64)联合与甲型H1N1流行性感冒病毒性肺炎患者短期预后的相关性及预测价值,构建甲型H1N1流行性感冒病毒性肺炎患者短期不良预后的预测模型。方法选取2023年3月—2024年8月在上海市同仁医院确诊的甲型H1N1流行性感冒病毒性肺炎患者362例,并依据28 d内生存结局分为生存组259例与死亡组103例。收集比较2组入院时的临床特征资料,通过多因素Logistic回归分析确定甲型H1N1流行性感冒病毒性肺炎28 d死亡的独立危险因素,通过R 4.3.1绘制列线图模型。绘制受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线、临床决策曲线分析(decision curve analysis,DCA)评估列线图模型的预测效能及临床获益。结果死亡组年龄、体温、心率、呼吸频率、白细胞计数、中性粒细胞、C反应蛋白、乳酸脱氢酶、降钙素原、乳酸、血二氧化碳分压、血氧分压、吸入氧浓度、丙氨酸转氨酶、天冬氨酸转氨酶、尿素氮、血肌酐、PDCD5、Caspase-1、CD64、中性粒细胞与淋巴细胞比值(neutrophil-tolymphocyte ratio,NLR)、急性生理与慢性健康评分II(acute physiology and chronic health evaluationII,APACHEII)评分、序贯器官衰竭估计评分、临床肺部感染(clinical pulmonary infection score,CPIS)评分、机械通气高于生存组,收缩压、舒张压、淋巴细胞低于生存组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,PDCD5(OR=1.02,95%CI:1.01~1.03)、Caspase-1(OR=1.03,95%CI:1.01~1.05)、CD64(OR=1.03,95%CI:1.01~1.05)、NLR(OR=1.23,95%CI:1.08~1.40)、APACHEII评分(OR=1.58,95%CI:1.24~2.02)、CPIS评分(OR=1.69,95%CI:1.29~2.22)、机械通气(OR=5.73,95%CI:2.97~11.08)均为甲型H1N1流行性感冒病毒性肺炎患者28 d死亡的独立相关因素(均P<0.05)。PDCD5、Caspase-1、CD64单项预测28 d死亡的曲线下面积(area under the curve,AUC)分别为0.723、0.704和0.639,三者联合预测模型的AUC为0.923。模型经Bootstrap法重抽样1000次内部验证后,C-index为0.903(95%CI:0.874~0.927)。校准曲线显示,预测概率与实际发生率拟合良好;DCA结果提示,当预测28 d死亡风险阈值概率在5%~62%范围内时,列线图模型可获得较高的净临床获益。结论基于PDCD5、Caspase-1、CD64构建甲型H1N1流行性感冒病毒性肺炎患者短期预后预测模型可对高危甲型H1N1流行性感冒病毒性肺炎患者进行早期预警。展开更多
目的探究CD5阳性弥漫大B细胞淋巴瘤(CD5-positive diffuse large B-cell lymphoma,CD5^(+)DLBCL)患者中的Ki67最佳截断值及其临床预后价值。方法选取2012年11月—2022年10月淮海淋巴瘤协作组中7家医疗中心具有完整Ki67免疫组织化学染色...目的探究CD5阳性弥漫大B细胞淋巴瘤(CD5-positive diffuse large B-cell lymphoma,CD5^(+)DLBCL)患者中的Ki67最佳截断值及其临床预后价值。方法选取2012年11月—2022年10月淮海淋巴瘤协作组中7家医疗中心具有完整Ki67免疫组织化学染色结果的CD5^(+)DLBCL且接受利妥昔单抗为基础的免疫治疗患者。选用最大选择秩统计量的方法计算Ki67的最佳截断值,并据此将患者分为高表达组和低表达组。比较2组基线信息及总生存期,并用Cox比例风险模型进行生存分析。结果共纳入231例初诊患者,平均年龄为(60.19±13.07)岁,其中男性111例(48.1%),Ann Arbor早期106例(45.9%)。Ki67的平均表达水平为70%,其最佳截断值为65%。高表达Ki67与中枢受累的比例显著升高相关(χ^(2)=6.229,P=0.013)。在校正其他混杂因素后,Cox结果表明Ki67高表达是CD5^(+)DLBCL患者预后的不良因素(HR=1.728,95%CI:1.127~2.649,P=0.012)。亚组分析结果提示,在BCL-2阳性患者中,Ki67高表达与更差的预后相关。将Ki67与IPI/NCCN-IPI联合应用后,可进一步提高对CD5^(+)DLBCL患者预后的预测准确性。结论Ki67在CD5^(+)DLBCL中的最佳截断值为65%。Ki67高表达为不良预后因素,结合IPI/NCCN-IPI可提高预后预测能力。展开更多
目的:探讨急性胰腺炎(AP)患者血清中ORM2、CD5L和PCT的表达水平及其对重症胰腺炎早期预测病情的价值。方法:收集2021年6月~2022年12月间安徽医科大学第二附属医院急诊外科收治的182例AP患者临床资料及入院24小时内血清标本,根据亚特兰...目的:探讨急性胰腺炎(AP)患者血清中ORM2、CD5L和PCT的表达水平及其对重症胰腺炎早期预测病情的价值。方法:收集2021年6月~2022年12月间安徽医科大学第二附属医院急诊外科收治的182例AP患者临床资料及入院24小时内血清标本,根据亚特兰大标准(2012),分为重症胰腺炎组(SAP)和非重症胰腺炎组(Non-SAP)。采用ELISA法检测两组患者血清中ORM2、CD5L、PCT的表达水平,并通过Spearman相关性分析和Logistic回归分析其与病情严重度的相关性及预测概率。构建ROC曲线评估预测效能,并与Ranson、CTSI、SOFA评分比较其区分度和校准度。结果:相比非重症急性胰腺炎(Non-SAP)组,重症急性胰腺炎组(SAP)其性别、年龄、收缩压、体重指数等指标无明显差异(P > 0.05)。而Ranson、CTSI及SOFA评分及生物标志物ORM2、CD5L和PCT差异显著(P Objective: To investigate the expression levels of ORM2, CD5L and PCT in serum of patients with acute pancreatitis (AP) and their value in early prognosis of severe pancreatitis. Methods: Clinical data and serum samples within 24 hours after admission were collected from 182 AP patients admitted to the emergency surgery Department of the Second Affiliated Hospital of Anhui Medical University from June 2021 to December 2022. The patients were divided into severe pancreatitis group (SAP) and Non-SAP group (Non-SAP) according to the Atlanta standard (2012). Serum biomarkers were detected by ELISA, to compare the differences of ORM2, CD5L, PCT and integrated scores. Spearman correlation analysis and Logistic regression analysis were used to analyze the correlation with the severity of the disease and the prediction probability. ROC curve was constructed to evaluate the prediction efficiency, and its differentiation and calibration were compared with Ranson, CTSI and SOFA scores. Results: Compared with the non-severe acute pancreatitis (Non-SAP) group, there were no significant differences in gender, age, systolic blood pressure and body mass index in the severe acute pancreatitis (SAP) group (P > 0.05), but Ranson, CTSI and SOFA scores and biomarkers ORM2, CD5L and PCT were significantly different (P < 0.01). Spearman analysis revealed that ORM2, CD5L and PCT were positively correlated with the severity of the disease. Logistic regression confirmed these markers as independent predictors, ROC curve showed that ORM2, CD5L, PCT and other scoring systems were important predictors of disease progression in AP patients. When the three serum indexes were combined, the area under AUC was 0.920. It is better than traditional integrated scores and single index. Conclusion: Serum ORM2, CD5L, and PCT within 24 h of admission to AP patients are of great significance for the early prediction of the severity of AP patients, and the combined prediction effect is the best.展开更多
文摘目的分析程序性细胞死亡因子5(programmed cell death 5,PDCD5)、半胱天冬酶1(cysteinyl aspartate specific proteinase-1,Caspase-1)及分化簇64(cluster of differentiation 64,CD64)联合与甲型H1N1流行性感冒病毒性肺炎患者短期预后的相关性及预测价值,构建甲型H1N1流行性感冒病毒性肺炎患者短期不良预后的预测模型。方法选取2023年3月—2024年8月在上海市同仁医院确诊的甲型H1N1流行性感冒病毒性肺炎患者362例,并依据28 d内生存结局分为生存组259例与死亡组103例。收集比较2组入院时的临床特征资料,通过多因素Logistic回归分析确定甲型H1N1流行性感冒病毒性肺炎28 d死亡的独立危险因素,通过R 4.3.1绘制列线图模型。绘制受试者工作特征(receiver operating characteristic,ROC)曲线、校准曲线、临床决策曲线分析(decision curve analysis,DCA)评估列线图模型的预测效能及临床获益。结果死亡组年龄、体温、心率、呼吸频率、白细胞计数、中性粒细胞、C反应蛋白、乳酸脱氢酶、降钙素原、乳酸、血二氧化碳分压、血氧分压、吸入氧浓度、丙氨酸转氨酶、天冬氨酸转氨酶、尿素氮、血肌酐、PDCD5、Caspase-1、CD64、中性粒细胞与淋巴细胞比值(neutrophil-tolymphocyte ratio,NLR)、急性生理与慢性健康评分II(acute physiology and chronic health evaluationII,APACHEII)评分、序贯器官衰竭估计评分、临床肺部感染(clinical pulmonary infection score,CPIS)评分、机械通气高于生存组,收缩压、舒张压、淋巴细胞低于生存组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,PDCD5(OR=1.02,95%CI:1.01~1.03)、Caspase-1(OR=1.03,95%CI:1.01~1.05)、CD64(OR=1.03,95%CI:1.01~1.05)、NLR(OR=1.23,95%CI:1.08~1.40)、APACHEII评分(OR=1.58,95%CI:1.24~2.02)、CPIS评分(OR=1.69,95%CI:1.29~2.22)、机械通气(OR=5.73,95%CI:2.97~11.08)均为甲型H1N1流行性感冒病毒性肺炎患者28 d死亡的独立相关因素(均P<0.05)。PDCD5、Caspase-1、CD64单项预测28 d死亡的曲线下面积(area under the curve,AUC)分别为0.723、0.704和0.639,三者联合预测模型的AUC为0.923。模型经Bootstrap法重抽样1000次内部验证后,C-index为0.903(95%CI:0.874~0.927)。校准曲线显示,预测概率与实际发生率拟合良好;DCA结果提示,当预测28 d死亡风险阈值概率在5%~62%范围内时,列线图模型可获得较高的净临床获益。结论基于PDCD5、Caspase-1、CD64构建甲型H1N1流行性感冒病毒性肺炎患者短期预后预测模型可对高危甲型H1N1流行性感冒病毒性肺炎患者进行早期预警。
文摘目的:探讨急性胰腺炎(AP)患者血清中ORM2、CD5L和PCT的表达水平及其对重症胰腺炎早期预测病情的价值。方法:收集2021年6月~2022年12月间安徽医科大学第二附属医院急诊外科收治的182例AP患者临床资料及入院24小时内血清标本,根据亚特兰大标准(2012),分为重症胰腺炎组(SAP)和非重症胰腺炎组(Non-SAP)。采用ELISA法检测两组患者血清中ORM2、CD5L、PCT的表达水平,并通过Spearman相关性分析和Logistic回归分析其与病情严重度的相关性及预测概率。构建ROC曲线评估预测效能,并与Ranson、CTSI、SOFA评分比较其区分度和校准度。结果:相比非重症急性胰腺炎(Non-SAP)组,重症急性胰腺炎组(SAP)其性别、年龄、收缩压、体重指数等指标无明显差异(P > 0.05)。而Ranson、CTSI及SOFA评分及生物标志物ORM2、CD5L和PCT差异显著(P Objective: To investigate the expression levels of ORM2, CD5L and PCT in serum of patients with acute pancreatitis (AP) and their value in early prognosis of severe pancreatitis. Methods: Clinical data and serum samples within 24 hours after admission were collected from 182 AP patients admitted to the emergency surgery Department of the Second Affiliated Hospital of Anhui Medical University from June 2021 to December 2022. The patients were divided into severe pancreatitis group (SAP) and Non-SAP group (Non-SAP) according to the Atlanta standard (2012). Serum biomarkers were detected by ELISA, to compare the differences of ORM2, CD5L, PCT and integrated scores. Spearman correlation analysis and Logistic regression analysis were used to analyze the correlation with the severity of the disease and the prediction probability. ROC curve was constructed to evaluate the prediction efficiency, and its differentiation and calibration were compared with Ranson, CTSI and SOFA scores. Results: Compared with the non-severe acute pancreatitis (Non-SAP) group, there were no significant differences in gender, age, systolic blood pressure and body mass index in the severe acute pancreatitis (SAP) group (P > 0.05), but Ranson, CTSI and SOFA scores and biomarkers ORM2, CD5L and PCT were significantly different (P < 0.01). Spearman analysis revealed that ORM2, CD5L and PCT were positively correlated with the severity of the disease. Logistic regression confirmed these markers as independent predictors, ROC curve showed that ORM2, CD5L, PCT and other scoring systems were important predictors of disease progression in AP patients. When the three serum indexes were combined, the area under AUC was 0.920. It is better than traditional integrated scores and single index. Conclusion: Serum ORM2, CD5L, and PCT within 24 h of admission to AP patients are of great significance for the early prediction of the severity of AP patients, and the combined prediction effect is the best.
