2019年 · 第132卷第24期

出版日期 2019-12-20电子版￥0.00元

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Original Article

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抗环瓜氨酸肽抗体预测未分化关节炎患者类风湿性关节炎的发展

Chun Li, Yan Zhang, Hui Song, Jie Gao, Dong-Bao Zhao, Qi Zhu, Dong-Yi He, Li Wang, Xiang-Pei Li, Xu-Dong Liu 等

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000570

摘要

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老年心力衰竭住院患者非心脏合并症的年龄特异性差异：特别关注年轻人-老年人、老年人和老年人

Meng-Xi Yang, Hui An, Xue-Qiang Fan, Li-Yuan Tao, Qiang Tu, Li Qin, Li-Fang Zhang, Dong-Ping Feng, Yu Wang, Li Sun 等

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000560

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符合TAILORx试验纳入标准的722例乳腺癌患者的临床病理学分析

Hong-Yu Xiang, Yin-Hua Liu, Hong Zhang, Shuang Zhang, Ling Xin, Ling Xu, Jing-Ming Ye, Ting Li, Xue-Ning Duan, Qian Liu

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000548

摘要

Background: The results of the Trial Assigning IndividuaLized Options for Treatment (TAILORx) suggested that approximately 70% of T1-2N0M0, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients can avoid chemotherapy and receive only adjuvant endocrine therapy. We conducted a retrospective analysis of the clinicopathologic features and prognostic factors of patients with breast cancer who met the inclusion criteria of the TAILORx trial. Methods: According to the enrollment criteria of the TAILORx trial, a retrospective analysis was performed on patients with breast cancer who were treated from January 2008 to December 2015 at Peking University First Hospital. The clinicopathologic characteristics of all patients were analyzed, and prognoses were calculated using the Kaplan-Meier method and a Cox proportionate hazards model. Results: A total of 2430 patients with early stage breast cancer who were admitted at our hospital had complete clinicopathologic data and follow-up information. Of these patients, 722 met the inclusion criteria and were enrolled in the present study, accounting for 29.7% of all patients. Among them, 417 (57.8%) patients received only adjuvant endocrine therapy (the non-chemo group), and 305 (42.2%) patients received adjuvant chemotherapy followed by adjuvant endocrine therapy (the chemo group). No statistically significant difference was observed in overall survival (OS) between the two groups (non-chemo vs. chemo: 5-year OS: 97.9% vs. 97.9%, χ2 = 1.00, P = 0.995; hazard ratio [HR] = 1.00, 95% confidence interval [CI]: 0.46–2.21). A significant difference was observed in disease-free survival (DFS) between the two groups (non-chemo vs. chemo: 5-year DFS: 97.9% vs. 94.7%, χ2 = 8.65, P = 0.003; HR = 3.05, 95% CI: 1.40–6.67). The choice of adjuvant therapy was associated with clinicopathologic factors, such as the age at diagnosis, T stage, histologic grade, the Ki67 index, the presence of intravascular tumor thrombus (P < 0.001), pathologic type, and menstrual status (P = 0.014). Conclusions: In the absence of internationally recognized multigene testing methods, for patients with early hormone receptorpositive, HER2-negative breast cancer, clinicians can develop a treatment plan based on clinicopathologic features only, which can effectively screen some patients who do not need adjuvant chemotherapy. However, nearly half of patients still receive adjuvant chemotherapy, and whether these patients can be exempted from chemotherapy warrants further exploration.

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低级别胶质瘤异柠檬酸脱氢酶2基因突变的临床神经病理学特征

Lei-Ming Wang, Zhuo Li, Yue-Shan Piao, Yan-Ning Cai, Li-Yan Zhang, Hai-Jing Ge, Wei-Wei Xu, De-Hong Lu

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000565

摘要

Background: Mutations in the isocitrate dehydrogenase 1 (IDH1) and IDH2 genes are important for both the integrated diagnosis and the prognosis of diffuse gliomas. The p.R132H mutation of IDH1 is the most frequently observed IDH mutation, while IDH2 mutations were relatively rarely studied. The aim of the study was to determine the pathological and genetic characteristics of lowergrade gliomas that carry IDH2 mutations. Methods: Data from 238 adult patients with lower-grade gliomas were retrospectively analyzed. The status of IDH1/2 gene mutations, telomerase reverse transcriptase (TERT) promoter mutations, O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation, 1p/19q co-deletion and the expressions of IDH1 R132H, alpha-thalassemia X-linked mental retardation, and p53 were evaluated. Progression-free survival (PFS) and overall survival (OS) were calculated via Kaplan-Meier estimation using the log-rank test. Results: Totally, 71% (169/238) of patients were positive for IDH mutations, including 12 patients harboring mutations in IDH2. Among the 12 patients with IDH2 mutations, ten patients harbored the R172K mutation, one patient harbored the R172S mutation and one harbored the R172W mutation. Of these, 11 tumors occurred in the frontal lobe and showed morphology typical of oligodendroglioma. The proportion of grade II tumors was higher than that of grade III tumors in IDH2 mutant-gliomas. IDH2 mutations were frequently associated with TERT promoter mutations, 1p/19q co-deletion and MGMT promoter methylation. IDH2 mutations were associated with better outcomes compared with IDH wild-type gliomas (P < 0.05). However, the PFS and OS did not differ from that of IDH1 mutant patients (P = 0.95 and P = 0.60, respectively). Conclusions: IDH2 mutations are more frequent in oligodendrogliomas and associated with a better prognosis. IDH2 mutations may segregate in distinct clinico-pathological and genetic subtypes of gliomas, and therefore may merit routine investigation.

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2型糖尿病患者白细胞端粒长度与非酒精性脂肪性肝病的关系

Min Zhang, Man-Li Hu, Jiao-Jiao Huang, San-Shan Xia, Yan Yang, Kun Dong

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000559

摘要

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髓鞘少突胶质细胞糖蛋白(MOG)的表征_35–55-特异性CD8⁺实验性自身免疫性脑脊髓炎中的T细胞

Yong Peng, Fei-Zhou Zhu, Zhi-Xing Chen, Jian-Xiong Zhou, Lu Gan, Shan-Shan Yang, Shuai Gao, Qian-Qian Liu

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000551

摘要

Background: The pathogenesis of multiple sclerosis (MS) is mediated primarily by T cells, but most studies of MS and its animal model, experimental autoimmune encephalomyelitis (EAE), have focused on CD4+ T cells. The aims of the current study were to determine the pathological interrelationship between CD4 and CD8 autoreactive T cells in MS/EAE. Methods: Female C57BL/6 mice (n =20) were induced by myelin oligodendrocyte glycoprotein (MOG) 35-55 peptide. At 14 days after immunization, T cells were isolated from the spleen and purified as CD4+ and CD8 + T cells by using CD4 and CD8 isolation kits, and then the purity was determined by flow cytometric analysis. These cells were stimulated by MOG35–55 peptide and applied to proliferation assays. The interferon-gamma (IFN-γ) and interleukin (IL)-4 secretion of supernatant of cultured CD4 + and CD8 + T cells were measured by enzyme-linked immunosorbent assays (ELISA). For adoptive transfer, recipient mice were injected with MOG35–55-specific CD8+ or CD4+ T cells. EAE clinical course was measured by EAE score at 0–5 scale and spinal cord was examined by staining with hematoxylin and eosin and Luxol fast blue staining. Results: CD8+CD3+ and CD4+CD3 + cells were 86% and 94% pure of total CD3+ cells after CD8/CD4 bead enrichment, respectively. These cells were stimulated by MOG35–55 peptide and applied to proliferation assays. Although the CD8+ T cells had a generally lower response to MOG35–55 than CD4+ T cells, the response of CD8+ T cells was not always dependent on CD4. CD8+ T cell secreted less IFN-γ and IL-4 compared with CD4+ T cells. EAE was induced in wildtype B6 naïve mice by adoptive transfer of MOG35–55-specific T cells from B6 active-induced EAE (aEAE) mice. A similar EAE score and slight inflammation and demyelination were found in naive B6 mice after transferring of CD8 + T cells from immunized B6 mice compared with transfer of CD4 + T cells. Conclusion: Our data suggest that CD8+ autoreactive T cells in EAE have a lower encephalitogenic function but are unique and independent on pathogenic of EAE rather than their CD4+ counterparts.

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等压标签用于依托泊苷诱导肾细胞癌凋亡中X连锁凋亡抑制剂和H2AX的相对和绝对定量定量蛋白质组学分析

Tian-Shu Liu, Chao Chen, Biao Zhou, Bo-Wen Xia, Zong-Ping Chen, Yong Yan

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000553

摘要

Meta Analysis

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补充维生素D对成人肺结核治疗结果的有效性：随机对照试验的荟萃分析

Jing Zhang, Chun Chen, Jin Yang

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000554

摘要

Background: Tuberculosis (TB) is one of the most debilitating diseases worldwide. Current studies have shown that vitamin D plays a significant role in host immune defense against Mycobacterium tuberculosis, but clinical trials reported inconsistent results. Therefore, we systematically reviewed the literature to investigate whether vitamin D supplementation could improve the effect of anti-TB therapy. Methods: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from their inception to February 8th, 2019 for randomized controlled trials on vitamin D supplementation in patients with pulmonary TB receiving anti-TB therapy. The primary outcomes were time to sputum culture and smear conversion and proportion of participants with negative sputum culture. The secondary outcomes were clinical response to treatment and adverse events. A random-effects model was used to pool studies. Data were analyzed using RevMan 5.3 software. Results: Five studies with a total of 1126 participants were included in our meta-analysis. Vitamin D supplementation did not shorten the time to sputum culture and smear conversion (hazard ratio [HR] 1.04, 95% confidence interval [CI] 0.89–1.23, P = 0.60; HR 1.15, 95% CI 0.93–1.41, P = 0.20, respectively) and did not lead to an increase in the proportion of participants with negative sputum culture (relative risk [RR] 1.04, 95% CI 0.97–1.11, P = 0.32). However, it reduced the time to sputum culture conversion in the sub-group of participants with TaqI tt genotype (HR 8.09, 95% CI 1.39–47.09, P = 0.02) and improved the multidrug-resistant(MDR) TB sputum culture conversion rate (RR 2.40, 95% CI 1.11–5.18, P = 0.03). There was no influence on secondary outcomes. Conclusions: Vitamin D supplementation had no beneficial effect on anti-TB treatment, but it reduced the time to sputum culture conversion in participants with tt genotype of the TaqI vitamin D receptor gene polymorphism and improved the MDR TB sputum culture conversion rate.

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股骨头缺血性坏死患者经转子旋转截骨术后髋关节生存率的系统评价和meta分析

Ying-Xing Xu, Yuan-Zhong Ren, Zhi-Ping Zhao, Ying-Zhen Wang, Teng Wang, Tao Li

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000562

摘要

Background: The clinical outcome of transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH) remains controversial, and the promising clinical results of several Japanese studies could not be reproduced in American and European studies. Trying to solve controversies on TRO for ONFH rising from apparently conflicting studies, a meta-analysis was conducted to assess the 5- and 10-year hip survival rates (with conversion to artificial joint replacement and radiographic failure as endpoints) after TRO. Methods: All eligible studies were searched in seven comprehensive databases including PubMed, Web of Science, Embase, Cochrane Library, VIP Database, China Knowledge Resource Integrated Database, and Wan Fang Database prior to June 2019. The outcomes evaluated were 5- and 10-year hip survival rates after TRO. The odds ratio and risk difference for the noncomparative binary data with the 95% confidence intervals (CIs) were calculated for each outcome. The included studies were assessed for methodologic bias and potential reasons for heterogeneity were explored. Results: Nineteen studies of TRO for ONFH were eligible for this meta-analysis according to inclusion criteria. Based on the previous report, two calculation methods (Methods 1 and 2) were adopted in this meta-analysis. Furthermore, we performed a subgroup analysis of the 5- and 10-year hip survival rates (Method 1) after TRO for ONFH: Asian sub-population and non-Asian subpopulation. Taking conversion to artificial joint replacement as the endpoint, 5- and 10-year hip survival rates (Method 1) after TRO for ONFH in the Asian population were 0.86 (95% CI = 0.82–0.89) and 0.72 (95% CI = 0.65–0.78), respectively, and 5- and 10- year hip survival rates after TRO for ONFH in the non-Asian population were 0.55 (95% CI= 0.43–0.67) and 0.42 (95% CI = 0.28–0.55), respectively. The 5- and 10-year hip survival rates (Method 2) after TRO for ONFH were 0.90 (95% CI = 0.79–0.95) and 0.89 (95% CI = 0.81–0.94), respectively. Taking radiographic failure as the endpoint, 5- and 10-year hip survival rates after TRO for ONFH were 0.70 (95% CI= 0.64–0.76) and 0.53 (95% CI= 0.46–0.61), respectively. Conclusions: The 5- and 10-year hip survival rates after TRO for ONFH were satisfactory in the Asian population, and were acceptable in the non-Asian population despite high early failure rates.

Review Article

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类风湿性关节炎相关冠状动脉疾病的免疫治疗：前景与未来

Lun Wang, Yang Zhang, Shu-Yang Zhang

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000530

摘要

Objective: To review the latest progress on the pathogenic mechanism and management of rheumatoid arthritis (RA)-associated coronary artery disease (CAD), and propose advice on future management optimization as well as prospects for research and development of new therapeutic regimen. Data sources: This study was based on data obtained from PubMed up to May 2019 using various search terms and their combinations, including coronary artery disease, myocardial ischemia, cardiovascular diseases, RA, rheumatic diseases, treatment, therapy, strategies, immunotherapy, inflammation, and anti-inflammation. Study selection: All retrieved literature was scrutinized, most relevant articles about the pathogenic mechanism and clinical management, especially anti-inflammatory therapy of RA-associated CAD were reviewed. Results: RA is an immune-mediated chronic inflammatory disease which has a great social disease burden. In addition to typical arthritic manifestations, RA also affects extra-articular tissues and organs, within which the involvement of the cardiovascular system, especially incorporating CAD, is the leading cause of death for patients with RA. Recently, numerous basic and clinical studies have been carried out on the mechanism of CAD development and progression under the inflammatory cascade of RA. The effect of traditional RA drugs on CAD risk management has been gradually clarified, and more emerging biologic agents are being explored and studied, which have also achieved satisfactory outcomes. Furthermore, with the success of the CANTOS clinical trial, novel anti-inflammatory therapy for the prevention of cardiovascular disease is believed to have a broad prospect. Conclusions: RA is an independent risk factor for CAD, which mainly results from the underlying inflammatory cascade; therefore, anti-inflammatory therapy, especially the emerging novel biologic drugs, is important for CAD management in patients with RA and may also be a promising approach among the general population.

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子宫内膜异位症除激素治疗外的新治疗途径

Fang-Ying Chen, Xi Wang, Rui-Yi Tang, Zai-Xin Guo, Yu-Zhou-Jia Deng, Qi Yu

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000569

摘要

Perspective

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我国骨盆恶性骨肿瘤保肢治疗20年

Wei Guo

中华医学杂志英文版2019年 132卷 24期

DOI: 10.1097/CM9.0000000000000509