目的分析CD4^+CD29^+T细胞含量及细胞毒性T淋巴细胞相关抗原4(CTLA-4)、程序坏死因子1(PD-1)及程序坏死因子配体1(PD-L1)免疫检查点表达水平与非小细胞肺癌患者的化疗效果及远期存活率的关系。方法选取2015年1月至2017年1月沧州市中心医院收治的100例非小细胞肺癌患者;采用流式细胞术检测患者血中CD4^+CD29^+T、CTLA-4^+T、PD-1^+T及PD-L1^+T细胞水平;随访2年,记录患者生存情况,分为存活组79例,死亡组21例;依照RECIST Version 1.1标准对患者化疗效果进行评估,并按此分为缓解组54例,进展组46例。比较各组的CD4+CD29+T、CTLA-4^+T、PD-1^+T及PD-L1^+T细胞水平,分析以上各细胞水平与患者疗效及远期存活率之间的相关关系。结果化疗缓解组CD4^+CD29^+T、CTLA-4^+T及PD-1^+T细胞水平均高于进展组[(22.74±1.92)%vs.(18.04±2.15)%、(28.91±1.24)%vs.(20.13±1.77)%、(26.29±1.19)%vs.(18.94±1.64)%],PD-L1+T细胞水平低于进展组[(17.22±1.07)%vs.(22.73±1.25)%],差异均有统计学意义(P<0.05);存活组CD4+CD29+T、CTLA-4+T及PD-1+T细胞水平均高于死亡组[(22.11±1.17)%vs.(14.81±1.64)%、(28.32±1.24)%vs.(11.90±1.93)%、(25.88±2.01)%vs.(11.73±2.06)%],PD-L1+T细胞水平低于死亡组[(16.41±2.72)%vs.(24.81±2.11)%],差异均有统计学意义(P<0.05)。CD4^+CD29^+T、CTLA-4^+T、PD-1^+T细胞水平与患者疗效及远期存活率呈正相关(P<0.05),PD-L1^+T细胞水平与患者疗效及远期存活率呈负相关(P<0.05)。结论非小细胞肺癌患者血中CD4^+CD29^+、CTLA-4^+、PD-1^+T细胞水平与化疗效果及远期生存呈正相关,PD-L1+T细胞水平与其呈负相关关系。
Stephen D. Surgenor, MDRobert S. Kramer, MDElaine M. Olmstead, BACathy S. Ross, MSFrank W. Sellke, MDDonald S. Likosky, PhDCharles A. S. Martin, MBBSRobert E. Helm, Jr., mDBruce J. Leavitt, MDJeremy R. Morton, MDDavid C. Charlesworth, MDRobert A. Clough, MDFelix Hernandez, MDCarmine Frumiento, MDArnold Benak, CCPChristian DioData, CCPGerald T. O'Connor, PhD, DSc周全红(译)江伟(校)
Context: Cardiogenic shock remains the major cause of death for patients hospitalized with acute myocardial infarction(MI). Although survival in patients with cardiogenic shock complicating acute MI has been shown to be significantly higher at 1 year in those receiving early revascularization vs initial medical stabilization, data demonstrating long-term survival are lacking. Objective: To determine if early revascularization affects long-term survival of patients with cardiogenic shock complicating acute MI. Design, Setting, and Patients: The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock(SHOCK) trial, an international randomized clinical trial enrolling 302 patients from April 1993 through November 1998 with acute myocardial infarction complicated by cardiogenic shock(mean[SD] age at randomization, 66[11] years); long-term follow-up of vital status, conducted annually until 2005, ranged from 1 to 11 years(median for survivors, 6 years). Main Outcome Measures: All-cause mortality during long-term follow-up. Results: The group difference in survival of 13 absolute percentage points at 1 year favoring those assigned to early revascularization remained stable at 3 and 6 years(13.1%and 13.2%, respectively; hazard ratio[HR], 0.74; 95%confidence interval[CI], 0.57-0.97; log-rank P=.03). At 6 years, overall survival rates were 32.8%and 19.6%in the early revascularization and initial medical stabilization groups, respectively. Among the 143 hospital survivors, a group difference in survival also was observed(HR, 0.59; 95%CI, 0.36-0.95; P=.03). The 6-year survival rates for the hospital survivors were 62.4%vs 44.4%for the early revascularization and initial medical stabilization groups, respectively, with annualized death rates of 8.3%vs 14.3%and, for the 1-year survivors, 8.0%vs 10.7%. There was no significant interaction between any subgroup and treatment effect. Conclusions: In this randomized trial, almost two thirds of hospital survivors with cardiogenic shock who were treated with earl
Background: Determinants of survival and of risk of vascular events after tra nsient ischaemic attack (TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patien ts after TIA or minor ischaemic stroke (Rankin grade≤ 3), after 10 years or mor e. Methods: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial (recruitment in 1986- 89; arterial ca use of cerebral ischaemia). We included 24 hospitals in the Netherlands that rec ruited at least 50 patients. Primary outcomes were all- cause mortality and the composite event of death from all vascular causes, non- fatal stroke, and non - fatal myocardial infarction. We assessed cumulative risks by Kaplan- Meier a nalysis and prognostic factors with Cox univariate and multivariate analysis. Fi ndings: Follow- up was complete in 2447 (99% ) patients. After a mean follow- up of 10.1 years, 1489 (60% ) patients had died and 1336 (54% ) had had at le ast one vascular event. 10- year risk of death was 42.7% (95% CI 40.8- 44. 7). Age and sex- adjusted hazard ratios were 3.33 (2.97- 3.73) for age over 65 years, 2.10 (1.79- 2.48) for diabetes, 1.77 (1.45- 2.15) for claudication, 1. 94 (1.42- 2.65) for previous peripheral vascular surgery, and 1.50 (1.31- 1.71 ) for pathological Q waves on baseline electrocardiogram. 10- year risk of a vascular event was 44.1% (42.0- 46.1). After falling in the first 3 years, yearly risk of a vascular ev ent increased over time. Predictive factors for risk of vascular events were sim ilar to those for risk of death. Interpretation: Long- term secondary preventio n in patients with cerebral ischaemia still has room for further improvement.