中华外科杂志
2026年 · 第139卷第13期
出版日期 2026-07-05电子版 ￥0.00元￥100.00元
中华外科杂志
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- Review Article
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Editorial
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缺血性卒中葡萄糖-6-磷酸脱氢酶缺乏症：潜在机制和临床挑战Linhan Zhang, Jianle Li, Yuangui Cai, Yicong Chen, Jiating Wei, Jinsheng Zeng
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000004135
摘要
葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症是最常见的X连锁酶病，影响全球超过5亿人，在非洲、亚洲、拉丁美洲和地中海地区观察到的频率最高。[
Review Article
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巨噬细胞相关代谢紊乱中的高盐饮食：机制和治疗意义Ke Xiao, Lin Gu, Jiayi Ma, Shanjie Rong, Xiongtao Yue, Yuechen Liu, Shiwei Liu, Fei Sun, Shu Zhang, Congyi Wang
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000004098
摘要
High-salt diet (HSD) has emerged as a prevalent environmental factor that exacerbates chronic inflammation and insulin resistance in obesity-associated type 2 diabetes (T2D) by modulating macrophage polarization, metabolic reprogramming, and epigenetic imprinting. Current evidence demonstrates that HSD activates p38/mitogen-activated protein kinase (MAPK), nuclear factor kappa-B (NF-κB), and NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome signaling pathways, by which it drives macrophage polarization toward a proinflammatory M1 phenotype while inducing a glycolysis-dominant metabolic shift, thereby establishing a persistent "metabolic memory". Moreover, HSD orchestrates metabolic memory in macrophages through coordinated epigenetic machinery, including histone modifications (Trimethylation of histone H3 at lysine 4 [H3K4me3] and Acetylation of histone H3 at lysine 27 [H3K27ac]), DNA methylation, and noncoding RNAs (e.g., long non-coding RNA MALAT1 and miR-155), leading to sustained inflammatory phenotypes. In multiple metabolic organs (e.g., adipose tissue, liver, pancreas, and gut), the HSD–macrophage axis aggravates systemic insulin resistance through shared proinflammatory signaling and other tissue-specific mechanisms. Most importantly, therapeutic strategies targeting the NLRP3 inflammasome, metabolic pathways, and epigenetic alterations offer novel approaches for managing metabolic inflammation. Future investigations are encouraged to leverage lineage tracing, single-cell sequencing, and spatial multi-omics technologies to advance the development of precision medicine for macrophage-associated metabolic disorders.
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细胞衰老的表观遗传动力学：从机制见解到精确的senotherapyXiangjun Hu, Weijing Lai, Mengyuan Liu, Bo Wang
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000004042
摘要
Cellular senescence functions as a pivotal stress response with dual roles; it serves as a barrier against early tumorigenesis while paradoxically driving late-stage tumor progression and the pathogenesis of many other age-related diseases, including cardiovascular, neurodegenerative, metabolic, and fibrotic disorders. This review comprehensively elucidates how the senescent phenotype is orchestrated by a dynamic epigenetic landscape. We detail how dysregulation in chromatin remodeling (e.g., heterochromatin loss), histone modifications, DNA methylation, and the epitranscriptome rewrites genome architecture to govern the initiation and maintenance of the senescent phenotype within these specific disease contexts. Crucially, we highlight the profound heterogeneity of senescence across different pathologies, contrasting its detrimental role in driving tissue degeneration in organs like the lung and kidney against its context-dependent beneficial effects, such as limiting fibrosis in the liver. Furthermore, we evaluate the translational potential of epigenetic drugs—categorized by targets such as DNA methyltransferases (DNMTs), histone methyltransferases (HMTs), and histone deacetylases (HDACs)—as dual-purpose therapeutics. Unlike genetic mutations, epigenetic alterations are reversible. We discuss strategies to either enforce senescence barriers for cancer suppression (pro-senescence) or reverse epigenetic aging signatures for tissue rejuvenation (anti-senescence). This review proposes a roadmap for leveraging epigenetic plasticity, offering a precision medicine approach to target specific senescent cell populations and extend health span.
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色氨酸代谢：生育能力之外女性生殖健康的隐性调节器Qingyang Wu, Fengwu Zeng, Jie Qiao, Xinyu Qi
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000004145
摘要
Female reproductive health encompasses fertility, safe pregnancy and childbirth, and is vital throughout the entire life of women. Tryptophan, an essential amino acid in humans, is involved in protein synthesis and the generation of bioactive substances related to the health and disorders of multiple systems. An increasing number of studies have shown that tryptophan metabolism is closely related to female reproductive health. Tryptophan metabolism occurs mainly through the kynurenine, serotonin, and indole pathways and yields various bioactive substances. The homeostasis of this metabolism modulates the ovarian function by influencing follicle development and hormone secretion. The regulation of the female reproductive system by tryptophan metabolism may be related to its role in the maternal internal environment and its influence on the reproductive axis systemically. In pregnant women, tryptophan metabolism affects the entire process from embryo implantation to childbirth. Factors involved in tryptophan metabolism may represent new targets for the treatment of female reproductive system-related diseases. Here, we summarize the possible mechanisms by which tryptophan metabolites affect female reproductive health and discuss potential related treatments.
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lgG4相关疾病的发病机制探讨：传统中心教条及其重塑视角Shuning Guo, Jing Li, Wen Zhang
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003990
摘要
Immunoglobulin G4-related disease (IgG4-RD) is a chronic disease characterized by inflammation and fibrosis within multiple organs. The fundamental immunopathogenic mechanisms of IgG4-RD remain largely unidentified. Advancements in multiple omics technologies have enabled researchers to characterize the cellular heterogeneity of IgG4-RD. The pursuit of understanding the immune dysfunction in IgG4-RD is principally guided by genomic, transcriptomic, and proteomic investigations, encompassing three crucial aspects of the traditional central dogma. Besides, genetic and epigenetic mechanisms, along with alterations in posttranslational modifications (PTMs) and small molecules identified through metabolomics and microbiomics studies, interact to uncover the functional basis of abnormal cellular activities. Here, we systematically review the application of multiple omics technologies to uncover the fundamental mechanisms driving IgG4-RD, organized around the traditional central dogma of molecular biology and its remodeling. We also propose an integrated pathophysiological model of multi-layered immune dysregulation, illustrating a self-sustaining loop of immune activation and tissue remodeling in IgG4-RD. It is believed that adopting a combination of diverse technological advancements to examine a series of cellular processes holds promise for the development of personalized approaches to managing IgG4-RD patients.
Viewpoint
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围手术期应激、疼痛和多模式镇痛Xinrui Li, Le Shen
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003671
摘要
应激反应是一个生理过程，涉及对应激源的激素和代谢变化；其主要目的是在平衡时维持止血。在围手术期，压力源，如疼痛，积累并导致过度的应激反应。最近的研究将围手术期应激反应视为对术后恢复有负面影响的危险因素；因此，许多研究人员专注于提出更多的策略来抑制手术引起的应激反应。疼痛功能启动应激反应；同时，围手术期应激反应加剧了疼痛的强度。它们之间的相互作用值得研究。
Original Article
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60万儿童和青少年中与体育活动相关的社会、学校和个人层面因素的长期趋势及其与高血压的关系Jieyu Liu, Xinli Song, Qi Ma, Jianuo Jiang, Yi Zhang, Ruolin Wang, Ziqi Dong, Li Chen, Yang Qin, Wen Yuan 等
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003868
摘要
Background:
Physical activity (PA) is a key modifiable factor for elevated blood pressure (EBP). We aimed to clarify the evolving relationships between PA and EBP in childhood or adolescence by examining multilevel factors within an ecological model.
Methods:
National data were extracted from 2010, 2014, and 2019 cycles of the Chinese National Survey on Students’ Constitution and Health, using a multistage stratified cluster sampling design. We defined EBP by the updated Chinese reference standards and obesity by sex- and age-specific body mass index (BMI) cutoffs. Inadequate PA was defined as <1 h/day; ecological factors at society-, school-, and individual-level were collected through a questionnaire. Multilevel logistic regression, interaction analyses, and population-attributable fractions were used to evaluate associations between multilevel ecological factors related to PA and EBP.
Results:
We included 642,386 participants (7–18 years). The EBP prevalence increased from 13.6% to 17.9% alongside increasing obesity, while inadequate PA decreased in prevalence. Inadequate PA was associated with EBP in 2010, with the odds ratio (OR) of 1.17 (95% confidence interval [CI]: 1.04, 1.21) but attenuated during 2010–2019. The multilevel factors related to PA displayed interactions to reduce EBP risk (P for interaction <0.05). At the societal-level, urban residence was protective against EBP, whereas a lack of exercise facilities increases the odds. At the school-level, inadequate physical education and sports competitions, coupled with unhealthy dietary lifestyles at the individual-level, contributed to EBP (P <0.05). The contributions of individual-level ecological factors related to PA decreased but of societal- and school-level increased on EBP, independent of obesity.
Conclusions:
A rise in EBP burdens during 2010–2019 contrasted with an increase in PA. PA-related ecological factors across society-, school-, and individual-level exhibited complex interactions on EBP. Although the impact of individual-level lifestyles on EBP was waning and obesity remained a primary concern, there was increased recognition of societal- and school-level’s ecological factors related to PA during 2010–2019. Promoting PA requires a comprehensive approach that addresses both facilitating and inhibiting factors, which is crucial for healthy blood pressure (BP).
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食管癌发病年龄的时空变化及预后价值Kan Zhong, Xin Song, Xueke Zhao, Xianlu Meng, Ran Wang, Mengxia Wei, Lei Ma, Quanxiao Xu, Jianwei Ku, Dongyun Zhang 等
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003856
摘要
Background:
Age plays a crucial role in the incidence and prognosis of esophageal cancer. In China, the age distribution of patients with esophageal cancer remains unclear, and comprehensive large-scale studies on its prognostic impact are lacking.
Methods:
Using a cohort of 294,523 patients with esophageal cancer, we compared onset age distributions across clinicopathological characteristics (χ2 test). Trends in the proportion of patients diagnosed under 60 years were analyzed using linear regression. Survival differences by age were assessed via Kaplan–Meier analysis and Cox regression (univariate and multivariate). Directed acyclic graphs defined causal relationships. Robustness was evaluated using multiple imputation and sensitivity analyses. Subgroup and propensity score matching analyses addressed confounding. Restricted cubic spline models explored nonlinear relationships between age and surgery rates, overall mortality risk, and perioperative mortality.
Results:
The proportion diagnosed under age 60 years significantly declined over time (P <0.05, R2 = 0.96), with this younger demographic being more prevalent among males, high-incidence area, smokers, alcohol consumers, and those with family history (all P <0.001). Surgical rates decreased sharply beyond age 62 years. Advanced age was an independent predictor of poorer survival, with surgery offering the best prognosis compared with radiochemotherapy and untreated, supported by subgroup and post-propensity score matching survival analyses. Mortality risk increased most rapidly with age in untreated patients (inflection at 65 years), followed by radiochemotherapy (63 years) and surgery (60 years), while perioperative mortality rose steeply beyond age 60 years.
Conclusions:
Male, residence in high-incidence area, smoking, alcohol intake, and positive family history were associated with earlier onset age of esophageal cancer; the proportion of patients under 60 years old declined significantly over time. While advanced age independently predicted poorer survival, it should not absolutely contraindicate surgery. A precise perioperative risk assessment system is crucial to balance surgical benefits and risks in the elderly.
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基于奥沙利铂的化疗或卡培他滨单药治疗对老年III期和高危II期结肠癌患者的益处：来自中国国家结直肠癌队列研究的数据Fei Huang, Tixian Xiao, Kexuan Li, Ran Wei, Shiwen Mei, Wei Zhao, Fangze Wei, Maiyue He, Zhaoxu Zheng, Qian Liu
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003813
摘要
Background:
Adjuvant chemotherapy is the standard management approach for patients with stage II/III colon cancer; however, the effectiveness in older patients is still unclear. This study aimed to explore the efficacy of adjuvant chemotherapy and whether oxaliplatin-based chemotherapy has better oncological outcomes than capecitabine monotherapy in older patients with stage III or high-risk stage II colon cancer.
Methods:
We analyzed and compared oxaliplatin-based adjuvant chemotherapy with capecitabine monotherapy and non-adjuvant chemotherapy in 468 patients aged ≥70 years with stage III and high-risk stage II colon cancer, and a propensity score-matched analysis was conducted. The endpoints were overall survival (OS), cancer-specific survival (CSS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS).
Results:
Multivariate analysis shows that adjuvant-treated stage III or high-risk stage II patients experienced a highly significant increase in OS (hazard ratio [HR]: 0.34, 95% confidence interval [CI]: 0.20–0.59, P <0.001) and CSS (HR: 0.39, 95% CI: 0.20–0.75, P = 0.005) compared with the control group without adjuvant chemotherapy. By contrast, no statistically significant difference was observed in either LRFS or DMFS (all P >0.05). The subgroup analysis suggested that no statistically significant benefits were observed between oxaliplatin-based adjuvant chemotherapy and capecitabine monotherapy, and no significant differences in oncological outcomes were detected with ≥6 months of therapy compared with 3–6 months (excluding 6 months) of therapy.
Conclusion:
Older patients with stage III or high-risk stage II colon cancer can benefit from adjuvant chemotherapy, and capecitabine monotherapy has non-inferior oncological outcomes compared with oxaliplatin-based regimens.
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小儿先天性心脏病术前铁状态及其与不良结局的关系Huayan Shen, Qiyu He, Sirui Zhou, Wenke Li, Yuze Liu, Zhou Zhou, Shoujun Li
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000004070
摘要
Background:
Iron imbalance, including iron deficiency and overload, is associated with increased cardiovascular morbidity and mortality. However, the iron status and its association with postoperative adverse outcomes in pediatric patients with congenital heart disease (CHD) is unclear. This study aimed to investigate the preoperative iron status and its correlation with adverse outcomes in pediatric patients with CHD.
Methods:
This is a single-center retrospective study. A total of 8065 pediatric patients (aged 1 month to 5 years) who underwent surgical treatment at Fuwai Hospital’s Pediatric Cardiac Surgery Center between 2017 and 2022 were consecutively included. All patients had undergone comprehensive preoperative laboratory tests, including iron-related hematology and biochemistry examinations. The association between ferritin and adverse outcomes was examined using restricted cubic splines. A multivariable logistic regression model was used to determine the associations between preoperative iron status and postoperative adverse outcomes.
Results:
Iron deficiency, anemia, and iron deficiency anemia were observed in 23.0% (1856/8065), 12.0% (969/8065), and 7.0% (564/8065) of patients, respectively. Patients with cyanotic CHD had a higher prevalence of iron deficiency but a lower incidence of anemia compared with patients with acyanotic CHD. A right-skewed U-shaped relationship was observed between ferritin and death and composite adverse events. Multivariable logistic regression analysis demonstrated that patients with high ferritin levels (ferritin ≥100 µg/L) had a significantly higher risk of in-hospital death (odds ratio [OR]: 8.20, 95% confidence interval [CI]: 1.61–41.86]) and composite adverse events (OR: 4.21 [95%CI: 2.65–6.68]) compared with patients with iron repletion (ferritin levels of ≥15 and <33 µg/L). In addition, patients with iron deficiency (OR: 1.80 [95%CI: 1.18–2.73]) and intermediate ferritin levels (ferritin levels of ≥33 and <100 µg/L; OR: 1.64 [95%CI: 1.11–2.44]) had a higher incidence of composite adverse events compared with those with iron repletion.
Conclusions:
Iron deficiency and anemia are common concern in children with CHD. Preoperative iron imbalance, including both iron deficiency and high iron load, was significantly associated with postoperative adverse outcomes in pediatric patients with CHD. Assessment of preoperative iron status might facilitate early identification of high-risk patients, and correcting iron imbalance could potentially mitigate adverse outcomes.
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单细胞和空间转录组分析揭示了心肌梗死后心肌淋巴管生成的动态转录谱Jiaqi He, Dali Zhang, Haixu Song, Ziqi Liu, Dan Liu, Xiaolin Zhang, Xiaojie Zhao, Yan Zhang, Jing Liu, Jiaxin Xu 等
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003647
摘要
Background:
Cardiac lymphatics play an important role in myocardial edema and inflammation, however, the heterogeneity of cardiac lymphatic endothelial cells (LECs) and their biological functions have rarely been investigated.
Methods:
This study integrated single-cell sequencing data and spatial transcriptome data from mouse heart tissue at different time points post-myocardial infarction (MI), and then revealed LECs heterogeneity and biological functions by clustering, spatial localization, cell trajectory, and Cell-Chat analyses.
Results:
Four transcriptionally distinct subtypes of LECs were identified and localized in space. Cardiac LEC subgroups were found to be localized in different zones of infarcted heart related to different functions. LEC capillary III (LEC CaIII) may be involved in the direct regulation of myocardial injuries in an infarcted zone (IZ) from the perspective of metabolic stress, while LEC CaII may be related to the rapid immune inflammatory responses of the border zone (BZ) in the early stage of MI. LEC CaI, as well as LEC collection mainly participate in the regulation of myocardial tissue edema resolution in the middle and late stages post-MI. Cell trajectory and Cell-Chat analyses further identified that LECs may regulate myocardial edema through Aquaporin 1, and might affect the infiltration of macrophages through the galectin-9 (Gal-9)-CD44 pathway.
Conclusion:
This study revealed the dynamic transcriptional heterogeneity distribution of LECs in different regions of the infarcted heart, and these LECs formed different functional subgroups that might exhibit different bioeffects in myocardial tissue post-MI.
Correspondence
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双弹簧圈经动脉化疗栓塞联合索拉非尼治疗肝细胞癌门静脉癌栓患者：一项回顾性队列研究Shangkun Ning, Sen Yan, Xiangyu Ma, Lin Zhang, Tong Sun, Liang Xu, Shanshan Li, Renjie Yang, Huabao Xiong, Jibing Liu
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000004119
摘要
致编辑肝细胞癌（HCC）是全球最常见的恶性肿瘤之一，也是癌症相关死亡的重要原因。[
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泛发性脓疱型银屑病中的中性粒细胞：疾病进展的关键因素Xin Zhang, Yuting Xia, Haoyu Li, Juan Tao, Jing Yang
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003661
摘要
致编辑:泛发性脓疱型银屑病(GPP)是一种罕见的、高度异质性的自身炎症性皮肤病，其特征是表皮中性粒细胞浸润。最近的进展强调中性粒细胞通过多方面的机制是GPP发病机制的中心驱动因素。
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来自中国全国注册队列的secukinumab治疗银屑病的转换模式Jinzhu Guo, Hua Zhang, Wenhui Wang
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003653
摘要
致编辑：银屑病是一种慢性、免疫介导的全身性炎症皮肤病。与传统的全身治疗相比，生物疗法已成为一种更好的选择。鉴于银屑病的高复发率，维持治疗至关重要。尽管长期管理可能涉及转换生物制剂，但关于中国银屑病患者转换模式的数据仍然有限。本研究调查了中国银屑病患者secukinumab的转换模式。该研究由北京大学第三医院医学科学研究伦理委员会（编号：IRB00006761-M2024895）和北京大学第一医院（编号：2020-255）批准。入组前，所有患者均签署了电子知情同意书。
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使用22号针头在EBUS-TBNA过程中基于核心组织长度和重量的宏观现场评估Yifei Zhang, Sen Tian, Xiangqi Wang, Xiang Li, Qin Wang, Ying Xia, Yanfang Liu, Sunmin Zhang, Yilin Chen, Wei Zhang 等
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000004122
摘要
致编辑：支气管内超声引导下经支气管针吸（EBUS-TBNA）是诊断纵隔和肺门淋巴结病和支气管周围/气管周围肿块以及侵袭性纵隔分期的一线方法。[
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炎症性肠病是一个难题Consolato M. Sergi
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003548
摘要
致编辑：炎症性肠病（IBD）在世界范围内呈上升趋势。自1956年中国报告第一例患者以来，发病率一直在上升，并一直是公共卫生面临的一个巨大挑战。营养和 IBD 令人困惑，因为每个患者的生活方式、环境和微生物群都不同。在这里，我们强调与IBD相关的微生物组、遗传景观和营养因素。饮食因素、微生物组和遗传易感性可能在决定这种疾病如何代表医学上的一个难题方面发挥作用。[
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结合表型和遗传特征识别冠心病分层中的遗传异质性Yujia Ma, Kexin Ding, Han Xiao, Zechen Zhou, Xiaoyi Li, Yiqun Wu, Tao Wu, Na Liu, Dafang Chen
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003822
摘要
致编辑：冠心病（CHD）仍然是一个严重的公共卫生问题，严重影响着世界各地的人口。冠心病的病因通常很复杂，涉及多种风险因素。尽管患有冠心病的个体具有共同的内表型，但他们通常表现出不同的分子或信号通路。[
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循环炎性蛋白与复发性自然流产的关系Xianyang Hu, Tingxuan Yin, Min Yu, Xixi Huang, Hailin Yu, Lu Liu, Meirong Du
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000004076
摘要
致编辑：复发性自然流产（RSA），定义为与同一伴侣在怀孕20周前连续流产两次或两次以上，影响全球2-5%的育龄妇女。它不仅会扰乱当前的妊娠，还会增加随后并发症的风险，包括宫腔粘连、子宫内膜异位症和宫颈功能不全。RSA的病因是多因素的，涉及染色体异常、子宫异常、自身免疫性疾病和子宫内膜功能障碍。越来越多的证据表明免疫耐受失衡是一个关键的促成因素。[
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白质高强度个体信息处理速度受损的关键：注意和执行网络效率下降Jing Jin, Jie Ma, Jiajia Wu, Lingling Li, Juanjuan Lu, Kunpeng Li, Yunting Xiang, Rongrong Huang, Mouxiong Zheng, Xuyun Hua 等
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000004049
摘要
致编辑信息处理速度（IPS），通常使用符号数字模态测试（SDMT）进行评估，是一个高度敏感但脆弱的认知领域，通常介导其他认知能力与年龄相关的下降。[
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早期系统性硬化症、器官并发症和治疗反应中的miRNA谱Jing Huang, Sijia Liu, Kun Wang, Yisha Li, Hui Luo, Xiaoxia Zuo, Honglin Zhu
中华医学杂志英文版2026年 139卷 13期
DOI: 10.1097/CM9.0000000000003566
摘要
致编辑系统性硬化症（SSc）是一种复杂的自身免疫性疾病，其特征是免疫功能障碍和胶原过度沉积，导致跨多个器官和组织的纤维化。[
Corrigendum
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更正：一种新型冠状动脉内低温装置减少猪心肌再灌注损伤中华医学杂志英文版2026年 139卷 13期
DOI: 10.3760/cma.j.issn.0366-6999.2026.13.101
摘要
在发表于《猪心肌再灌注损伤》第137卷第20期的文章“一种新型冠状动脉内低温装置减少猪心肌再灌注损伤”中中华医学杂志,[
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