Clinical Focus

Key points to reduce diabetic amputation: early diagnosis and scientific treatment of diabetic foot ulcer

Xu Zhangrong， Shi Hongyan， Wang Yuzhen

2016, 31(9): 929-931,935. doi:10.3969/j.issn.1004-583X.2016.09.001

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Diabetic foot ulcer is the leading cause of hospitalization for the patients with foot diseases and diabetic amputation. Early diagnosis and scientific treatment are the key factors of improving the prognosis and saving the medical cost for these patients. This paper introduces two cases of diabetic foot ulcers caused by paronychia and emphasizes the importance of early diagnosing and scientific treating diabetic foot ulcer with infection， which promoted the ulcer healing， avoided amputation， but also decreased the hospital days and medical cost. By discussing another case with complicated diabetic foot problems， it is believed that trust between medical staff and patients is also very important in the diabetic foot prognosis. The conditions for the patients， who need urgent transferring from community medical centers to the tertiary hospitals with the professional and multidisciplinary diabetic foot care team， are also introduced.

Diabetic cardiomyopathy and potential intervention

Wang Yuehui1， Wang Zhe1，Liu Jia1，Cai Lu2

2016, 31(9): 932-935. doi:10.3969/j.issn.1004-583X.2016.09.002

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Diabetic cardiomyopathy， as one of the major diabetic cardiac complications， is known to be closely related with oxidative stress. Therefore， antioxidant therapy may be a hot approach to prevent diabetic cardiomyopathy. Metallothionein (MT)， an endogenous， effective and nonspecific antioxidant， Nrf2， a key regulating factor for antioxidant genes， play important role in antioxidant process. It would be a promising strategy in protecting diabetic cardiac complications if we explore safe and effective MT and/or Nrf2 inducers to prevent diabetic cardiomyopathy with clearance of various active free radicals.

Basing on national conditions in China：interpretation of Chinese Expert Consensus Statement on Postprandial Hyperglycemia in Type 2 Diabetes Mellitus

Qin Yingfen

2016, 31(9): 936-938. doi:10.3969/j.issn.1004-583X.2016.09.003

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Chinese Expert Consensus Statement on Postprandial Hyperglycemia in Type 2 Diabetes Mellitus is based on the characteristics of diabetes and the continuous enrichment of evidencebased medicine in Chinese population, and the consensus provides a new guidance for the management of diabetes in China. It answers the following four key questions: ①Why should we focus on the importance of postprandial glucose? ② Can we benefit from keeping in control of postprandial glucose? ③ Who are the monitoring people and objectives in control of postprandial glucose? ④ How should we do to intervene in postprandial glucose?

Oral hypoglycemic agents in treatment of type 2 diabetes mellitus

Wang Xiaojing， Xiao Xinhua

2016, 31(9): 939-943. doi:10.3969/j.issn.1004-583X.2016.09.004

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Type 2 diabetes mellitus (T2DM) is a chronic， progressive disease characterized by insulin resistance and impaired β cell function. The prevalence of T2DM is growing steadily. In recent years， advanced knowledge of the pathologic mechanisms of T2DM， such as decreased incretin effect， neurotransmitter dysfunction and abnormal renal handing of hyperglycemia lead to the development and use of novel treatments that target the mechanisms for T2DM. The review will describe the effectiveness and safety of some novel oral hypoglycemic agents.

Insulin therapy in diabetes mellitus

Wang Jing， Zhang Lihui

2016, 31(9): 944-948. doi:10.3969/j.issn.1004-583X.2016.09.005

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In recent years， the incidence of diabetes mellitus is increasing. In addition to oral antidiabetic agents（OADs）， insulin and its analogs have been widely applied to clinical treatment，and they have become the preferred option especially when the OADs failed. The advantages of insulin and its analogs have the distinct curative effect， safety， wide application range， etc. The aim of this article is to review current situation of diabetes insulin therapy and to provide reference for reasonable application of insulin and its analogs.

Prevention and treatment of type 2 diabetes macrovascular complications

Ren Luping， Song Guangyao

2016, 31(9): 949-952. doi:10.3969/j.issn.1004-583X.2016.09.006

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Macrovascular complications of diabetes are important causes for disablity and death of type 2 diabetes patients， thus the prevention and treatment of macrovascular complications are very meaningful in type 2 diabetes. Because of the complicated pathogenic mechanisms， a comprehensive intervention strategy should be emphasized in the prevention and treatment of macrovascular diseases. The present review focuses on the advances in management of the main risk factors of macrovascular complications in type 2 diabetes mellitus， including blood glucose， lipid， blood pressure and antiplatelet therapy.

Accurate monitoring of blood glucose in diabetic patients

Guo Shuqin

2016, 31(9): 953-955,959. doi:10.3969/j.issn.1004-583X.2016.09.007

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Precision medicine is the medical model proposed in the era of big data， diabetes blood glucose monitoring is also affected by the impact of precision thinking. Based on adequate assessment of various means of monitoring blood glucose， blood glucose monitoring is recommended from the self monitoring of the "point" blood sugar， to dynamically monitor the blood glucose change curve， and then to reflect the total blood glucose level of three months of glycosylated hemoglobin under the present stage. Future artificial pancreas technology will achieve accurate blood glucose management.

More attention to diabetic residual cardiovascular risk

Pan Runzhou， Li Yukun

2016, 31(9): 956-959. doi:10.3969/j.issn.1004-583X.2016.09.008

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Dyslipidemia is an important risk factor for residual cardiovascular risk in patients with diabetes mellitus. Diabetic patients should pay more attention to the normal TG， low LDLC and high HDLC levels of this specific dyslipidemia. The article reviews the research on the residual cardiovascular risk in diabetic patients in recent years to increase awareness of the residual cardiovascular risk in diabetic patients.

Concept and clinical significance of metabolic inflammatory syndrome

Hu Renming

2016, 31(9): 960-963. doi:10.3969/j.issn.1004-583X.2016.09.009

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Metabolic products， such as free fatty acid（FFA）， lipopolysaccharide（LPS） etc often induce chronic lowgrade inflammation， which calls metabolic inflammation and participates in and leads to atherosclerosis， type 2 diabetes mellitus（T2DM）， nonalcoholic fatty liver disease and obesity as well. Our study group first proposed the concept and diagnostic idea of “Metabolic inflammatory syndrome (MIS)” in national and international field. We recommended that patients who meet two or more metabolic disorders above could be diagnozed as MIS. In the patients with T2DM， the detection rate of MIS and prediction on the relative risk of coronary heart disease were significantly higher over metabolic syndrome （MS）. These suggested that the concept of MIS was more suitable than MS for early screening， prevention and research in metabolic diseases. If the patients have one of four metabolic diseases of MIS，they should be screened other disease， especially atherosclerosis. Therefore， the concept of MIS will promote the prevention and treatment for patients with different diseases.

Association of diabetic kidney disease with hypertriglyceridaemic-wasit phenotype in patients of type 2 diabetes mellitus

Hao Huiyao， Zhang Fang， Zhou Jing， Chen Yanxia， Wang Jing， Hao Yongmei

2016, 31(9): 964-967. doi:10.3969/j.issn.1004-583X.2016.09.010

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ObjectiveTo investigate the association between hypertriglyceridemicwaist phenotype and diabetic kidney disease in patients with type 2 diabetes mellitus(T2DM). MethodsAccording to the cut point of plasma triglycerides concentration ≥1.7 mmol/L， waist circumference ≥85 cm in men or ≥80 cm in women， 753 patients with T2DM were divided into four groups: normal waist circumference and triglycerides， normal waist circumference and hypertriglyceridemia， abdominal obesity and normal triglycerides， and hypertriglyceridemic waist (HTWC) group， DKD incidence and correlation indices were compared， and Logistic regression analysis was adopted for study. ResultsThe body mass index， waist circumference， hip circumference， systolic blood pressure， fasting bloodglucose， uric acid， triglycerides and urinary albumin to creatinine ratio in HTWC group were significantly higher than those in nonHTWC groups (all P<0.01)， as well as DKD incidence (P<0.05). Multiple logistic regression analysis revealed that HTWC was an independent risk factor of DKD (OR=2.014，95%CI=1.1833.625). ConclusionHTWC pyhenotype is significantly related to DKD incidence in T2DM patients.

Gastroscopy in 131 cases of patients with type 2 diabetes mellitus

Zhu Chunyinga， Zhang Yingfub， Ma Jingjinga， Yang Qiana， Li Zhihonga， Guo Shuqina

2016, 31(9): 968-970. doi:10.3969/j.issn.1004-583X.2016.09.011

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ObjectiveTo investigate gastroscope clinical characteristics， pathological characteristics and helicobacter pylori(Hp) infection status of patients with type 2 diabetes mellitus(T2DM). Besides，to explore the effect of diabetes course and HbA1c on gastric disease. MethodsWe selected 131 patients with T2DM who received gastroscopy and pathological examination，compared with non diabetic patients into the same period， to study gastroscopic clinical and pathological characteristics.Through HbA1c test，we observed the effects of glucose on the stomach disease. ResultsIn diabetes group， the rate of gastritis with duodenal lesions and erosive gastritis was higher than that of control group (P＜0.05). Hp infection rate in diabetes group was 47.3%(62/131)， helicobacter pylori infection rate in control group was 30.0%(37/112)(P＜0.05).In Hp negative diabetes group， the rate of gastritis with reflux esophagitis was higher than that of control group(P＜0.05). Diabetes course and HbA1c had no obvious effect on gastric disease. ConclusionIn patients with T2DM， Hp infection rate was higher， the rate of gastritis with duodenal lesions and erosive gastritis was higher， patients with histological features of precancerous lesions should maintain a high clinical vigilance. It is necessary to do endoscopic followup check and histopathological examination in a regular stage.

Influence of clinic intervention on medication compliance and antihypertensive effect in patients with hypertension

Liu Yingxuea， Li Hub， Cheng Zhihuaa， He Danzhua，Wang Qib

2016, 31(9): 971-974. doi:10.3969/j.issn.1004-583X.2016.09.012

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ObjectiveTo investigate the influence of clinic intervention on antihypertensive effects and medication compliance in patients with hypertension. MethodsA total of 148 patients with hypertension were randomly divided into control group and intervention group. The control group was treated with clinic procedure. The intervention group was given intervention on the basis of general clinic procedure. The pharmacists helped explain the importance of drug use. Outpatient doctors visited to the medical records of the selected medical records and the health education of hypertension was carried out. Patients were required to return once every two weeks. The situation of blood pressure and blood pressure were measured and recorded by the outpatient nurses. Three months later， the medication compliance and blood pressure of two groups were statistically analyzed. ResultsThe medication compliance and blood pressure control rate in intervention group were superior to those in control group (P<0.05). ConclusionClinic intervention by outpatient doctors can enhance the medication compliance of patients and effectively improve the hypertension control.

Antiatherosclerosis effect of sitagliptin in patients with type 2 diabetes mellitus

Guo Yunfei1， Lu Qingyu1， Han Ping1， Zhang Ling1， Xu Dongmei1， Yang Jingwen1， Zhang Fuchun2

2016, 31(9): 975-977,982. doi:10.3969/j.issn.1004-583X.2016.09.013

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ObjectiveTo explore the effect of sitagliptin， a dipeptidyl peptidase 4 inhibitor， on carotid intimamedia thickness (IMT)in insulintreated patients with type 2 diabetes mellitus (T2DM). MethodsThis prospective， randomized， parallel group and comparative study included 172 insulintreated patients with T2DM who were randomly allocated to either the sitagliptin group (n=84) or the control group (n=88). The primary outcomes were changes in mean IMT of the carotid artery measured by echography at the end of a 12months′ treatment. ResultsChanges in the mean IMT of the carotid arteries were significantly greater after sitagliptin treatment compared with conventional treatment (P＜0.05). After followup of 12 months， sitagliptin， but not conventional treatment， significantly reduced the mean IMT of carotid arteries relative to the baseline. Sitagliptin had a more potent glucoselowering effect compared with the conventional treatment (P＜0.05)， without increasing hypoglycemic episodes or body mass. ConclusionSitagliptin attenuated the progression of carotid IMT in insulintreated T2DM patients with glucoselowering effect.

Impact of hypokalemia on longterm prognosis in patients with acute myocardial infarction

Wang Minghui， Bu Haiwei， Li Chunhua， Zhang Ying， Zhao Jie，Sun Wanglexian

2016, 31(9): 978-982. doi:10.3969/j.issn.1004-583X.2016.09.014

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ObjectiveTo explore the impact of hypokalemia on longterm prognosis of patients with acute myocardial infarction and establish COX multiple prognostic risk factors model for these patients. MethodsA total of 446 AMI inpatients undergoing percutaneous coronary intervention were consecutively enrolled in this study and divided into two groups: hypokalemia(K)＜3.5 mmol/L (n=123) and normal control，3.5≤K＜5.5 mmol/L (n=233). All the demographic and clinical data were collected by the physicians and master degree students in the departemnt， and then the prognosis of these patients were assessed after regular followup. ResultsThe rates of MACE of the patients with hypokalemia were significantly higher than those in normal control group (17.1% vs 9.9%，P＜0.05). Hypokalemia group had higher mortality than normal control group，but the difference was not significant (3.4% vs 1.3%，P＞0.05). The Cox proportional regression model of multiple prognostic risk factors showed that hypokalemia， ST elevation myocardial infarction， and hidden chest pain were all independent risk factors poor longterm prognosis of AMI patients(all P＜0.05). ConclusionHypokalemia is an independent risk factor of the poor longterm prognosis of AMI patients.

Correlation of tumor necrosis factor α， high sense Creactive protein，lower density lipoprotein cholesterol with acute cerebral infarction in elderly patients

He Shuqina，Zhang Xueyinb

2016, 31(9): 983-985,989. doi:10.3969/j.issn.1004-583X.2016.09.015

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ObjectiveTo investigate the correlation of tumor necrosis factor α(TNFα)， high sense Creactive protein(hsCRP)， lower density lipoprotein cholesterol C(LDLC) with acute cerebral infarction(ACI) in elderly patients. MethodsSeventyfive cases of elderly patients with ACI were collected in our hospital， 40 elderly healthy people in our hospital served as the controls from health check at the same time， the differences of biochemical indicators were compared between two groups. Analysis was made in the relationship between clinical features and TNFα， hsCRP， LDLC levels， and the correlation analysis of TNFα， hsCRP and LDLC levels in acute cerebral infarction patients. ResultsThe TC， TG， LDLC， hsCRP and TNFα in ACI group were higher than those in control group (P<0.05). LDLC， hsCRP， TNFα in patients with ACI increased with BMI and the disease degree and IMT(P<0.05); LDLC and hsCRP positively correlated (0.424，P<0.01)， LDLC and TNFα showed positive correlation (r=0.352，P=0.002)，hsCRP and TNFα positively related (r=0.480，P<0.01). ConclusionTNFα，hsCRP and LDLC in elderly patients with ACI were abnormally higher， and correlated with the degree of disease， and they could be used as important indexes in evaluation of the occurrence and development of the patients' condition.

Application study of homocysteine in ischemic cerebrovascular disease

Wang Yanzhu， Ren Zhijun， Wan Tingyu， Li Mengxiu， Wang Dan

2016, 31(9): 986-989. doi:10.3969/j.issn.1004-583X.2016.09.016

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ObjectiveTo explore the relationship between homocysteine (Hcy) and ischemic cerebrovascular disease， and the effect of B vitamins intervention. MethodsPatients with ischemic cerebrovascular disease， including cerebral infarction， transient ischemic attack， were selected as observation group and normal healthy people were selected as control group. Observation group was then divided into two subgroups based on the level of Hcy: observation group 1 and observation group 2. Both subgroups had antiplatelet therapy and other conventional therapy， meanwhile， observation group 1 took additionally vitamin B6， vitamin B12 and folic acid. The level of Hcy， PWV， CIMT before and after treatment were determined and the recurrence rate of ischemic cerebrovascular disease was compared between groups within 1 year. ResultsThe level of Hcy in patients with cerebral infarction plasma was significantly higher than that of the control group (P<0.05). Folic acid and vitamin B6， B12 can effectivly reduce the levels of Hcy， PWV and CIMT (P<0.05). The recurrence rate of ischemic cerebrovascular disease had no significant difference between subgroups within one year (P>0.05). ConclusionThere is a close correlation between the occurrence of cerebral infarction and Hcy concentration. Extensive screening of Hcy concentration in highrisk population of cerebrovascular disease and active intervention with B vitamins in people with high level of Hcy will effectively reduce the incidence of atherosclerosis and its complications.

Correlation analysis of clinical efficacy and prognostic factors in different timing of endovascular embolization of intracranial aneurysms

Zhang Qi，Hu Zhiyuan

2016, 31(9): 990-993. doi:10.3969/j.issn.1004-583X.2016.09.017

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ObjectiveTo study the clinical efficacy in different timing of endovascular embolization of intracranial aneurysms and to analyze the correlative factors of prognosis. MethodsA total of 121 patients with intracranial aneurysms were selected into this study between January 2012 to January 2016. All patients were divided into four groups based on the surgical time， including ultraearly group (23 cases)， early group ( 25 cases)，interval group (47 cases) and delayed group (26 cases). Embolization effect and complication rate were compared. The influence of hypertension， HuntHess grade and Fisher grade on prognosis were analyzed by unconditional logistic regression analysis. ResultsThe embolization rates in ultraearly and early groups were significantly higher than those of interval and delayed groups (P<0.01). The incidences of the postoperative limb dysfunction and cerebral vasospasm in ultraearly and early groups were significantly lower than those of interval group and delayed groups (P<0.05). Univariate analysis showed that history of hypertension， HuntHes grade， Fisher grade， multiple aneurysms and operation time were significantly correlated with the prognosis quality (P<0.05). Multivariate logistic analysis showed Fisher grade， HuntHes grade， history of hypertension and other factors were independent prognostic factors of prognosis quality (P<0.05). ConclusionEarly and ultraearly embolization of intracranial aneurysm can achieve better results， but also significantly reduce the incidences of postoperative limb dysfunction and cerebral vasospasm，meanwhile hypertension， HuntHes grade and Fisher grade were independent prognostic factors.

Shortterm curative effect of intervention on senile patients with rupture and bleeding of primary liver carcinoma

Xu Guobin1， Da Jun2， Yi Guangxin2

2016, 31(9): 994-997. doi:10.3969/j.issn.1004-583X.2016.09.018

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目的探讨介入性肝动脉栓塞/化疗栓塞治疗老年原发性肝癌合并破裂出血患者近期疗效。方法回顾性分析16例老年原发性肝癌合并破裂出血患者介入治疗资料，评价介入治疗的安全性及近期疗效。结果15例患者治疗后出血停止，止血成功率93.8%，1例因持续出血及肝功能严重损害于1周内死亡，未发生介入相关严重并发症。转氨酶治疗后2～3天升高（P＜0.01），7～10天恢复至术前水平（P＞0.05），总胆红素变化不明显（P＞0.05）。12例接受后续介入治疗，随访期内肝动脉化疗栓塞1～4（平均2.5）次。3个月时14例存活，患者肿瘤客观有效率85.7%。3、6、12个月生存率为87.5%、75%、56.3%。结论介入治疗老年原发性肝癌合并破裂出血安全性较高，可以有效止血、短期内延缓肿瘤进展并改善近期预后。

A case report of familially hemophagocytic lymphohistiocytosis and literature review

Zhang Yanan1，Liu Chunxia2，Yao Xiaojian2，Zhao Li2

2016, 31(9): 998-1001. doi:10.3969/j.issn.1004-583X.2016.09.019

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ObjectiveTo improve the diagnosis and treatment of familially hemophagocytic lymphohistiocytosis (FHL). MethodsOne patient with FHL confirmed by diagnosis was presented and relevant FHL cases reported in China and abroad were combined to gather and analyze the clinical characteristics. ResultsFHL2 was often associated with PRF1 gene mutations， about 20%40% of the patients was in perforin gene mutations. ConclusionFor patients with positive family history and clear genetic diagnosis， chemotherapy or hematopoietic stem cell transplantation is needed as soon as possible. Without a family history， the primary cause of associated with secondary HLH was unknown， genetic screening can be considered in order to make clear the possibility of FHL.

Clinical study of cytomegalovirus infection and preemptive therapy after haploidentical peripheral blood hematopoietic stem cell transplantation

Cao Weijie， Wan Dingming， Liu Changfeng，Wang Chong， Zhang Suping

2016, 31(9): 1002-1005. doi:10.3969/j.issn.1004-583X.2016.09.020

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ObjectiveTo analyze the clinical characteristics of cytomegalovirus(CMV) infection after human leukocyte antigen（HLA） haploidentical peripheral blood hematopoietic stem cell transplantation（HDIPBSCT） and the effect of the preemptive treatment. MethodsThe study enrolled 69 patients who underwent HDIPBSCT in the Department of Hematology of our hospital from Mar 2010 to Mar 2015. The CMV infection rate， the median time when CMVDNA was positive at the first time， the response rate of the preemptive treatment and the median time of CMVDNA turning negative were analyzed. Fiveyear survival rate was compared between the patients with or without CMV infection. ResultsThe results indicated that CMV viremia was 73.9％(51/69).The median time of CMV when CMVDNA was positive at the first time was 36 d（14120 d）after HIDPBSCT．After the preemptive treatment， 80.4%（41/51） of the patients with CMV viremia turned negative. The median time of CMVDNA turning negative were 21 d（782 d）， only two patients died of CMV pneumonia. Fiveyear survival rate of the patients with or wihout CMV viremia was respectively 52.9% and 50% (P>0.05). ConclusionThe incidence of CMV infection is high after HIDPBSCT. The preemptive treatment can effectively prevent the progression of CMV viremia to CMV disease.

Analysis of hospital infection with gram positive bacteria from patients with hematological diseases during 2005-2014

Zhu Haibo， Deng Qi， Liu Pengjiang， Lin Xuemei， Li Yuming

2016, 31(9): 1006-1010,1014. doi:10.3969/j.issn.1004-583X.2016.09.021

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ObjectiveTo analyze the epidemiology， antibiotic resistance， and antiinfection treatment of hospital infection with gram positive bacteria from patients who had hematological diseases during 20052014. MethodsA total of 827 gram positive bacterial strains were isolated from patients with hematological diseases from January 2005 to December 2014. Antimicrobial susceptibility testing was done by microdilution method. Results①The percentage of isolated gram positive bacterial strains from secretion and urine was higher than that of gram negative bacillus， while the percentage of isolated gram positive bacterial strains from sputum was lower than that of gram negative bacillus; The percentage of isolated gram positive bacterial strains showed upward during 20052007， and then downward， but upward again after 2012; The staphylococcus presented an upward trend， while the enterococcus presented an upward trend; In Staphylococcus aureus， the positive rate of MASA was lower than that of our hospital. ②All the isolated gram positive bacterial strains were sensitive to vancomycin， teicoplanin and linezolid， while the resistance rate to moxifloxacin with an upward trend in staphylococcus aureus and staphylococcus epidermidis， and there was no obvious change in Enterococcus faecalis and Enterococcus faecium. ③The rate of catheterrelated gram positive strains in all gram positive bacterial strains was significantly higher than the rate of catheterrelated gram negative bacillus in all gram negative bacillus (P<0.05). ④No significant difference in efficacy occurred between antibiotics to gram negative bacillus combined with or without antibiotics to gram positive bacteria when used in patients with fever and lack of granulocyte (P＞0.05). ConclusionOur research summarized the epidemiology， antibiotic resistance of hospital infection with gram positive bacteria， and it is valuable for the choice of rational antimicrobial therapy.

Clinical significance of Ddimer and fibrinogen in relapsing polychondritis

Gao Guanmina，Jiang Dongbina，Li Yanmina，Zheng Xiaolonga，Zhang Leileia， Liu Shengyuna，Zheng Zhaohuia， Kan Quanchengb

2016, 31(9): 1011-1014. doi:10.3969/j.issn.1004-583X.2016.09.022

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ObjectiveTo analyze the clinical significance of Ddimer (DD) and fibrinogen (FDP) in relapsing polychondritis（RPC）and respiratory tract involvement. MethodsA retrospective analysis of DD and FDP was performed in 52 cases of confirmed RPC patients hospitalized in the First Affiliated Hospital of Zhengzhou University in January 2010  December 2015. And the difference of DD and FDP levels of respiratory tract involvement and noninvolvement patients were compared. Results29 cases (55.8%) in 52 RPC patients were with laryngeal and tracheal， bronchial cartilage inflammation of respiratory tract.37 cases (71.2%) with higher level DD，FDP or both. Serum DD and blood sedimentation were positively correlated (r=0.635，P=0.000). And the CRP positive correlation (r=0.421，P=0.002).Serum FDP positively related to the blood sedimentation (r=0.725，P=0.000); And CRP (r=0.689，P=0.000).The DD differences between patients with respiratory tract involvement and non involvement appeared statistically significant (P<0.001)， the difference of FDP had no statistical significance (P=0.146).ConclusionRespiratory tract involvement is not uncommon in RPC， and it is the most important factor influencing the prognosis of RPC.DD and FDP detection are of great significance for determining RPC disease activity， DD and elevated FDP and respiratory tract involvement have important relation， with ESR and CRP，these inflammation markers can be the indexes of disease activity or severity.

Clinical observation on Shengxuening treating anemia in peritoneal dialysis patients

Zhao Xia， Guo Xin， Wang Rong， Zhang Dongcheng

2016, 31(9): 1015-1018. doi:10.3969/j.issn.1004-583X.2016.09.023

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ObjectiveTo compare the effect of Shengxuening tablet and capsule polysaccharideiron complex on anemia in peritoneal dialysis patients. MethodsA total of 60 peritoneal dialysis patients with anemia were randomly divided into Lifeineng group and Shengxuening tablet group. Hemoglobin， hematocrit， C reactive protein and other indicators were detected before treatment and each month after the treatment. ResultsBefore treatment， there was no significant difference between two groups. The levels of Hb and Hct were significantly increased after 3 month's treatment in both groups， however， there was no significant difference between two groups. After 9 month's treatment， the use of erythropoientin was significantly reduced in both groups， however， there was no significant difference between two groups. Shengxuening had significantly less adverse reaction of digestive tract and excessively rise of Hb than Lifeineng. ConclusionBoth oral iron and Shengxuening tablet can effectively improve the iron deficiency，anemia and reduce the use of erythropoientin in patients with peritoneal dialysis. Shengxuening has significantly less adverse reaction of digestive tract and excessively rise of Hb than Lifeineng.

Relationship between human angiopoietin1 and pulmonary fibrosis

Wu Shucai1a， Yang Yonghui1b， Guo Sumin1c， Du Jiejie2， Song Lichao2， Gao Li2

2016, 31(9): 1019-1022. doi:10.3969/j.issn.1004-583X.2016.09.024

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ObjectiveTo analyze the optimal time course and relevant molecular mechanism of recombinant human angiopoietin1 (rHuANG1) in the treatment of pulmonary fibrosis in mice. MethodsThe model of pulmonary fibrosis was established on C57/BL6 mice. And 40 mice were subdivided into NS group and rHuANG1 group (20 mice per group). NS group experienced treatment of intraperitoneal injection NS 0.2 ml/d， while rHuANG1 group was treated rHuANG1 for 5 mg·kg-1·d-1. The samples of 5 mice were obtained at d2，d4，d6 and d9 after treatment in NS group and rHuANG1 group， respectively. Regulator of Gprotein signaling 5(RGS5) was estimated by ELISA in lung. Results①The pulmonary fibrosis model on C57/BL6 mice was established successfully. ②Hydroxyprolinc in the lung of NS group and rHuANG1 group at d6 and d9 reduced significantly(P<0.01). ③ ELISA results indicated the expression of RGS5 in the lung of rHuANG1 group at d4 and d6 increased as compared with that of NS group(P<0.05). ④HE staining results showed that different degrees of pulmonary fibrosis were observed at different periods. The degree of necrosis in NS group was higher than that of rHuANG1 group. Among them， tissue repair in rHuANG1 group was more obvious at d4 and d6， while NS group did not present the same result at the corresponding time. ⑤The results of immunohistochemistry assay showed that the expression of VEGF in rHuANG1 group had significalnt decrease at d4 and d6 as compared with that of in NS group(P<0.05).ConclusionrHuANG1 could have positive effect on pulmonary fibrosis model of C57/BL6 mice. The time d4d6 was considered as a brief normalized time window due to the normalization of VEGF.

Pentoxifylline and corticosteroid for treatment of severe alcoholic hepatitis: a metaanalysis

Kuang Xiaoqing， Zhang Xiaoyan，Fu Nian

2016, 31(9): 1023-1026,1029. doi:10.3969/j.issn.1004-583X.2016.09.025

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ObjectiveTo evaluate the efficacy of pentoxifylline and corticosteroid in treatment of patients with severe alcoholic hepatitis(SAH). MethodsPubMed， Embase， Ovid， Cochrane Library， CNKI， WANFANG and VIP were searched to collect randomized controlled trials （RCTs） of pentoxifylline and corticosteroid in treatment of patients with severe alcoholic hepatitis， the published time was up to before April， 2016. The retrieved studies were selected according to the predefined inclusion and exclusion criteria， the quality of included studies were evaluated and metaanalysis was performed using the Cochrane Collaboration's RevMan 5.3 software. ResultsSeven RCTs out of 726 papers involving 998 patients with severe alcoholic hepatitis were included. Two drugs showed no significant difference in decreasing SAH early (P=0.58) and midterm mortality (P=0.19) and the incidence of hepatorenal syndrome (P=0.33) and gastrointestinal bleeding (P=0.75)，while the pentoxifylline significantly reduced the incidence of infection (P=0.001). ConclusionPentoxifylline and corticosteroids have no significant difference in treatment of SAH，but facing the case of coinfection is recommended to use pentoxifylline.

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