Table of Content

05 July 2017, Volume 32 Issue 7

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Atrial fibrillation and atrial cardiomyopathy

Chen Qi1，2， Cheng Jie2

2017, 32(7):  553-555.  doi:10.3969/j.issn.1004-583X.2017.07.001

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Atrial fibrillation (AF) is one of the most common reasons for tachycardiainduced cardiomyopathy， and left ventricle dysfunction can induce and facilitate the long lasting of AF. Any complex of structural， architectural， contractile or electrophysiological changes affecting the atria with the potential to produce clinicallyrelevant manifestations was defined as atrial cardiomyopathies. Atrial cardiomyopathies can be led by the long lasting AF， while it may also cause the onset of AF. However， further studies are necessary to explore the type and cause of atrial cardiomyopathies， and its association with AF.

Cardiomyopathys lead to arrhythmias

Liu Yangong1，2， Ono Katsushige1

2017, 32(7):  556-560.  doi:10.3969/j.issn.1004-583X.2017.07.002

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Cardiomyopathies are a heterogeneous group of diseases of the myocardium associated with mechanical and/or electrical dysfunction. Arrhythmia， one of major clinic manifestations of  cardiomyopathies， plays a significant role in the progression and prognosis of cardiomyopathies， for it will aggravate myocardial remodeling and lead to cardiac sudden death. Given that cardiomyopathies have complicated pathological changes and various manifestations of arrhythmia， it has great clinical value to understand， prevent and cure arrhythmias for cardiomyopathy patients.

Recent advances in arrhythmogenic cardiomyopathy

Zhang Bin，Zhang Erjian，Tian Fuli

2017, 32(7):  561-564.  doi:10.3969/j.issn.1004-583X.2017.07.003

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Arrhythmogenic cardiomyopathy is a special type of cardiac diseases， its etiopathogenesis is mainly due to the emergence of fast or slow arrhythmiainduced hemodynamic changes， it first appears in electrical remodeling of myocardium followed by myocardial mechanical remodeling. Arrhythmogenic cardiomyopathy performed diversely with mainly manifested as atrial heart failure， and others mainly manifested as ventricular heart failure， at present， the study of arrhythmia cardiomyopathy is gradually deepened， treatment methods increased gradually， but mainly include drug therapy and interventional therapy. In this review， we discussed the molecular mechanisms of atrial and ventricular cardiomyopathy in order to improve the cure rate of this disease.

Advances of clinical manifestations and diagnosis in arrhythmogenic right ventricular cardiomyopathy

Wei Mengyan， Zheng Mingqi

2017, 32(7):  565-570.  doi:10.3969/j.issn.1004-583X.2017.07.004

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This review aims to give an update on the pathogenesis， clinical manifestations， and diagnosis of arrhythmogenic right ventricular cardiomyopathy(ARVC). Arrhythmogenic right ventricular cardiomyopathy is mainly an autosomal dominant inherited disease. Classic symptoms include palpitations， cardiac syncope， and aborted cardiac arrest due to ventricular arrhythmias. Diagnosis is based on the presence of major and minor criteria from the Task Force Criteria revised in 2010(TFC 2010)， which includes evaluation of findings from six different diagnostic categories. Imaging is important in ARVC diagnosis， including both echocardiography and cardiac magnetic resonance imaging. Electrocardiograms(ECGs) and signalaveraged ECGs are analyzed for depolarization and repolarization abnormalities. Ventricular arrhythmias are considered a major diagnostic criterion. Family history of ARVC and detection of an ARVCrelated mutation are included in TFC 2010.

Study on clinicopathological and treatment  of  IgM  nephropathy

Wang Yuhui1， Guan Xin2， Zheng Hongguang2， Wang Shaxi2， Chen Jianhua1

2017, 32(7):  571-574.  doi:10.3969/j.issn.1004-583X.2017.07.005

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Objective  To analyze the pathogenesis regularity and treatment of IgM nephropathy in adults with kidney disease.Methods  The clinicopathological and treatment  data were collected from 52 patients of IgM nephropathy confirmed by renal biopsy.Results  A  prevalence  of  IgM nephropathy of  4.9%(52/1 045)  accounted for all primary glomerular diseases on renal biopsies. The majority of the patients presented with nephrotic syndrome. The mean age was (20.1±10.3) years old. The malefemale ratio was 1.6∶1. 16 cases with hypertension at onset accounted for 30.7%.There were 5 patients with acute renal failure. The mean 24hour urine protein level was (4.44±1.48) g. The mean albumin  level was (16.68±4.65)  g/L. The mean cholesterol level was (12.75±3.64) mmol/L. The mean triglycerides level was (12.75±3.64) mmol/L. The most common morphologic change consisted of mild and moderate mesangial cell proliferaion of the glomeruli，found in 40 biopsies （76.9%），severe hyperplasia  in  3 biopsies（5.7%）. The morphological pattern of FSGS was found in 9 cases（17.3%）. IgM was the sole localizing immunoglobulin，and it was the predominant globulin in  34 cases（65.3%），IgM+C3 accounted for  23.0%(12/52). 14 cases( 26.9%)  were sensitive to glucocorticoid. There were 26 cases(50%) of glucocorticoid dependence. There were 12 cases(23%) of glucocorticoid resistance. Combined with cyclophosphamide treatment， clinical remission in 30 cases， the total clinical remission rate was 57.6%; invalid cases were 19 cases( 36.5%); 3 worsening cases(5.7%). Conclusion  A high incidence with IgM  nephropathy in young men. The majority of the patients presented with idiopathic nephrotic syndrome. The most common morphologic change consisted of mild and moderate mesangial cell proliferaion of the glomeruli.Predominant IgM deposition in mesangium was the sole localizing immunoglobulin. Glucocorticoid dependent was the most    common response. Clinical complete remission rate was increased in glucocorticoid with cyclophosphamide.

Different hemopurification modes on beta 2microglobulin and calciumphosphorous metabolism in maintenance hemodialysis patients

Huang Junyue，Ma Zhigang，Xue Rong，Li Yingping，Jing Xiaojiang，Huang Wenhui

2017, 32(7):  575-578.  doi:10.3969/j.issn.1004-583X.2017.07.006

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Objective  To compare the effects of different hemopurification modes on beta 2microglobulin (β2MG) and calciumphosphorous metabolism with maintenance hemodialysis(HD) patients. Methods  Totally 84 maintenance hemodialysis patients were enrolled and randomed into three groups. Group HD was treated by lowflux HD three times a week. Group HD+ hemodialysis filtration (HD+HDF) was treated by lowflux hemodialysis two times a week + hemodiafiltration one time a week. Group highflux HD (HFHD) was treated by HFHD three times a week. All patients were followed up for six months. Calcium， phosphorous， Ca×P product， intact parathyroid hormone (iPTH) and β2MG were measured before and after six months’  treatment. Results  The levels of serum phosphorus， Ca×P product， iPTH and β2MG in group HD showed no  significant decrease before and after treatment (P>0.05). Serum phosphorus， Ca×P product， iPTH and β2MG in group HD+HDF and HFHD decreased significantly before and after treatment as compared with those in group HD， respectively (P<0.05). Serum phosphorus in group HFHD reduced more than that in group HD+HDF (P<0.05). The levels of Ca×P product， iPTH， β2MG had no significant difference between HFHD and HD+HDF group (P>0.05). Conclusion  Both HFHD and HD+HDF could significantly reduce serum phosphorus， Ca×P product， iPTH and β2MG， and also effectively improve the calcium and phosphorus metabolism in MHD patients. HFHD might be a better hemopurification mode due to the advantages of convenient operation and low cost.

Relationship between apolipoprotein E gene polymorphism and shortterm prognosis in patients with acute coronary syndrome

Xia Jinggang， Xu Ji， Hao Hengjian， Yin Chunlin， Xu Dong

2017, 32(7):  579-582.  doi:10.3969/j.issn.1004-583X.2017.07.007

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Objective  To investigate the relationship between apolipoprotein E (ApoE) gene polymorphism and shortterm prognosis in patients with acute coronary syndrome (ACS).Methods  88 patients with ACS were enrolled from October 2016 to January 2017. The patients were divided into three groups according to the polymerase chain reaction restriction fragment length polymorphism (PCRRFLP) and PCR amplification results. The baseline data， number of coronary artery vessels， GRACE score at admission， and major adverse cardiovascular events (MACE) during hospitalization and one month followup after discharge were observed and compared. Results  ①There were 25 cases of ApoE4 phenotype， 45 cases of E3 phenotype and 18 cases of E2 phenotype. ②Compared with E2 group， serum total cholesterol， low density lipoprotein cholesterol levels， coronary artery multivessels， GRACE score increased significantly in E4 group (P<0.05). ③Compared with E2 group， MACE was significantly increased in E4 group during hospitalization and at one month followup (P<0.05).Conclusion  The recent prognosis of  patients with ACS may have an important relationship with ApoE gene polymorphism. Apo E4 may play an important role in the prognosis of ACS.

Serum Creaction protein， endothelin1 and brain natriuretic peptide  in patients with  chronic obstructive pulmonary disease in plateau region and pulmonary hypertension

Wang Qianga， Bai Qianb， Chen Qiuhongc

2017, 32(7):  583-586.  doi:10.3969/j.issn.1004-583X.2017.07.008

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Objective  To investigate the levels of plasma Creactive protein(CRP)，brain  natriuretic peptide (BNP)， endothelialin1(ET1) and pulmonary hypertension(PH) in the patients with chronic obstructive pulmonary disease(COPD) in the plateau region. Methods  A total of 118 patients with COPD were included. Pulmonary artery pressure was measured by Doppler echocardiogram. CRP， BNP and ET1  were tested by ELISA. All the patients were divided into three groups: COPD nonPH(COPDnPH group)，COPD with mild PH(COPDmPH group)， COPD with serious PH(COPDsPH) group serious.Results  As pulmonary artery pressure increased， PO2 decreased， there were significantly differences among three groups (P<0.05). Hb and HCT in COPDsPH group were significantly higher than those of COPDmPH (F=10.672，P<0.05)  and COPDNPH group (F=6.383，P<0.05). There were also significant differences  in the levels of CRP， BNP， and ET1  among three groups(P<0.01). Pulmonary artery systolic pressure was positively associated with CRP (r=0.354，P=0.000)， BNP (r=0.427，P=0.000)， and ET1 (r=0.453，P=0.000).Conclusion  The patients with COPD in the plateau region have worse hypoxemia， greater abnormal Hb and HCT， and higher condensation state of blood， which promotes pulmonary arterial  pressure. As the pulmonary artery pressure increases， the plasma CRP increases， suggesting systemic inflammation may be involved in the PH induced by COPD.


Features of clinical manifestation and imaging in 37 cases of  sporadic CreutzfeldtJakob disease

Jia Qian， Guo Dongmei

2017, 32(7):  587-590.  doi:10.3969/j.issn.1004-583X.2017.07.009

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Objective  To analyze the characteristics of  clinical manifestation and imaging in sporadic CreutzfeldtJakob disease.Methods  Clinical data of 37 patients with sporadic CreutzfeldtJakob  disease were retrospectively analyzed.Results  19 male and 18 female patients were included．The mean age at onset of male patients was 56.8 years old，while that at onset of female patients was 60.3 years old.17 patients firstly presented with impaired cognition. All of them presented with rapidly progressive dementia. 24 cases were with myoclonus．1 patient was in  akinetic mutism state. 17 cases showed  periodic sharpwave complexes on electroencephalogram， 22 patients showed 14-3-3 protein   in cerebrospinal fluid positive. 35 cases were hyperintensity of  frontal lobe， temporal lobe， parietal lobe and occipital lobe on diffusionweighted magnetic resonance imaging(DWI). Conclusion  Sporadic CreutzfeldtJakob disease mainly manifested with rapidly progressive dementia  and myoclonus. Diffusionweighted magnetic resonance imaging has high sensitivity and specificity for diagnosis of sporadic CreutzfeldtJakob disease.

Current situation and related factors of coronary intervention treatment  in patients with non STelevation acute coronary syndrome

Pan Guangjie，Chen Huili，Gu Yunfei，Liu Lei，Chen Yan，Li Songsen，Ma Huifang，Jin Jun，Zhang Shouyan

2017, 32(7):  591-594.  doi:10.3969/j.issn.1004-583X.2017.07.010

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Objective  To analyze current situation and related factors of percutaneous coronary intervention (PCI) in patients with nonST segment elevated acute coronary syndrome(NSTEACS). Methods  475 NSTEACS patients in our hospital were enrolled from 2008 to 2015. The clinical data  included gender， age， smoking， drinking， hypertension， diabetes mellitus， stroke， chronic kidney disease， chronic myocardial infarction， and level of blood sugar， blood fat， creatinine， myocardial biomarkers， and the status of coronary angiography and interventional therapy. Comparison was made in the clinical information between PCI group and non PCI group， the association factors of PCI in multiple logistic regression mode were analyzed. Results  Compared to nonPCI group (n=105)，PCI group (n=109) had higher percentage of male(67.0% vs 51.4%，P<0.01)， NSTEMI (32.1% vs 9.5%，P<0.01) and heart function class Ⅱ (50.9% vs 30.4%，P<0.01)，and higher fasting bloodglucose (6.5±2.6 vs 5.8±1.9  mmol/L，P=0.02). The percentage of cardiovascular risk factors， and serum creatinine， triglycerides level were not different significantly between two groups. The male， heart function grade Ⅱ，and NSTEMI were influence factors of PCI in the multiple logistic regression mode. Conclusion  The rate of coronary intervention in NSTEACS patients was 22.9% in our hospital，the male， function grade，and MI are influence factors of PCI.

Physical development and health status of iron deficiency anemia children aged 6-12 years in Lanzhou and Dongxiang

Mu Jing1， Yang Wenkai1， Chen Hong2， Ye Xinhua2， Kang Xiguang2

2017, 32(7):  595-598.  doi:10.3969/j.issn.1004-583X.2017.07.011

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Objective  To evaluate the physical development and health status of children with iron deficiency anemia(IDA) aged 612 years old in Lanzhou and Dongxiang. Methods  396 children aged 612 years old were enrolled from four primary schools in Lanzhou and Dongxiang by stratified random sampling during October in 2015. Measurements of physical development， venous blood collection(including hemoglobin， mean corpuscular volume， mean corpuscular hemoglobin concentration， mean hemoglobin， serum iron， serum ferritin and other indicators)， and questionnaires were conducted.Results  The height and weight of IDA children were lower than that of the same age in normal children (P<0.05).The prevalence rate of dental caries was higher than that of normal children (P<0.05). Iron deficiency anemia in children with respiratory diseases， gastrointestinal diseases， the existence probability of sleep problems and phenomenon of concentration were greater than those of normal children (P<0.05).Conclusion  This study illustrated that iron deficiency anemia could lead to physical retardation in children， immune function and sleep quality. There is relationship between the prevalence of iron deficiency anemia and dental caries.

Ultrasound detection of patent foramen ovale in young and middleaged patients  with cryptogenic stroke and mechanism

Wang Xin， Ma Dongmei， Meng Xuan

2017, 32(7):  599-601,605.  doi:10.3969/j.issn.1004-583X.2017.07.012

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Objective  To investigate the transcranial Doppler(TCD) for detection of patent foramen ovale(PFO) in young and middleaged patients with cryptogenic ischemic stroke(CS) and the mechanism of stroke. Methods   The subjects were divided into two groups: CS patient group 70 young and middleaged patients with CS; normol control group 70 healthy persons with matched age and sex for CS group. PFO and the extent of righttoleft shunt(RLS) were  detected by TCD with bubble study and under Valsava maneuver(VM). The atrial septal aneurysm(ASA) was detected by transthoracic echocardiography(TTE) and the deep venous thrombosis(DVT) was detected by color Doppler flow imaging(CDFI). The fibrinogen and platelet aggregation were tested by cluse assay and turbidimetry assay.Results   The prevalence of PFO. PFO with ASA， PFO with DVT and the extent of RLS were significantly higher in CS group than those in normal control group (P<0.01). Compared with normal control group，  the fibrinogen and the frequencies of platelet aggregation in CS group significantly increased(P<0.01). Conclusion  TCD is an excellent method for PFO identification with high sensibility with contrastenhanced and under VM in young and middleaged patients with CS. The mechanism of  PFO induce ischemic stroke may relate to formed of paradoxical embolism.

Risk factors for convulsion with purulent meningitis in children

Yang Zhiguo， Zhang Ni， Yang Baowang， Li Xingchuan， Wang Jing， Wang Haidong

2017, 32(7):  602-605.  doi:10.3969/j.issn.1004-583X.2017.07.013

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Objective  To explore the risk factors of purulent meningitis complicated with convulsion. Methods  The data of 86 children with purulent meningitis admitted in our department were retrospectively analyzed. The patients were divided into observation group and control group according to the presence of convulsion. Clinical features， cerebrospinal fluid (CSF)  laboratory examination and etiology examination were collected， and the multivariable logistic regression analysis was used to evaluate statistical differences. Results  Serum sodium （<135 mmol/L）  and cerebrospinal fluid leukocyte count （<1 000×106/L）  were significantly higher in observation group than in control group (P<0.05); there were no significant difference in the contents of protein or sugar of cerebrospinal fluid between two groups; there were significant differences in Streptococcus pneumoniae positive rate between two groups  (P<0.05)， and there were no significant difference in the positive rate of Haemophilus influenza and other species between two groups. Multivriable logistic regression analysis was performed in children with purulent meningitis suffering from convulsions and showed that children under two years old， consciousness disorder，Streptococcus pneumoniae and serum sodium  (<135 mmol/L)  were the risk factors for children with purulent meningitis complicated with convulsion. Conclusion  Children with purulent meningitis complicated with convulsion are related with age under two years old， disorder of consciousness， Streptococcus pneumoniae  and blood sodium less than 135  mmol/L.

Clinical analysis of 469 cases of HenochSchonlein purpura in children

Wu Hui， Zhang Chunwei， Wang Yongqing， Li Yanlin

2017, 32(7):  606-608,612.  doi:10.3969/j.issn.1004-583X.2017.07.014

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Objective  To investigate the epidemiological characteristics of HenochSchonlein purpura (HSP) and to study the characteristics of each phenotype and risk factors of HSPN.  Methods  The HSP  patients  from 2010  to  2016  were enrolled in  the Third Affiliated Hospital of Soochow University and the clinical data were analyzed retrospectively.Results  The onset age of HSP was 2 years13 years old， mainly in autumn and winter.The  precursor infection was one of the commonest causes; as the first symptom， skin purpura  accounted  for 94.0%(441/469)， joint discomfort as the first symptom accounted  for 2.6%(12/439)，3.4%(16/469) were abdominal symptoms; HSPN recurrence  accouted for 12.3%(58/469)， of which HSPN group of 2.6%(12/469);  ANCA was negative in all of children  and  the total IgE  positive rate was 50.7%(238/469). The increase  of WBC and  Ddimer were  the risk of gastrointestinal bleeding.  The  multivariate analysis showed that age， Ddimer， CysC，malb increased the risk of renal involvement.Conclusion  HSP children rash easy to relapse， especially  in  HenochSchonlein purpura nephritis patients.The increase  of WBC and Ddimer may indicate increased  the risk of gastrointestinal bleeding.The age， two Ddimer， serum CysC， microalbuminuria was correlated with the incidence of HSPN.Thus，we should be aware of the occurrence of HSPN when examining abnormalities.HenochSchonlein purpura is generally a benign disease， as a  selflimiting disease with  good prognosis.

Compound Danshen Dropping Pill  in  treatment of diabetic peripheral neuropathy

Cheng Xiaodong1， Fang Xinmei1， Wang He1， Li Liqin1， Gao Dayun2， Zhang Yunliang1

2017, 32(7):  609-612.  doi:10.3969/j.issn.1004-583X.2017.07.015

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Objective  To observe the effect and mechanism of Compound Danshen Dripping Pills in the treatment of diabetic peripheral neuropathy (DPN). Methods  A total of 160 of DPN patients were divided into treatment group (diabetes foundation treatment+mecobalamin+Danshen Dripping Pills) and control group (basic treatment+mecobalamin). After two months of treatment，the changes of the symptom score， curative effect， nerve conduction velocity and microcirculation index  were compared  between two groups. Results  Compared with control group， the sensory and motor nerve conduction velocity and nailfold microcirculation indexes in treatment group improved significantly (P<0.01). Conclusion  Danshen Dripping Pill can improve the blood stasis symptoms of DPN and nerve conduction velocity， and thus play a good therapeutic effect.

Effectiveness and safety on immunosuppressant combined with nucleoside analogues therapy  in hepatitis B virusassociated glomerulonephritis patients：a  metaanalysis

Xiong Liangwei， Zhang Xianggui， Zhang Wei， Tang Jieyin

2017, 32(7):  613-617.  doi:10.3969/j.issn.1004-583X.2017.07.016

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Objective  To evaluate the efficacy and safety of immunosuppressant combined with nucleoside analogues therapy in adult hepatitis B virusassociated glomerulonephritis (HBVGN) patients. Methods  We searched the Cochrane Library， PubMed， Embase， SCI， Chinese BioMedical database， CNKI， VIP and Wanfang of Database from Jan  1，2009 to  Dec 31，2016 to screen the clinical trials of immunosuppressant combined with nucleoside analogues therapy in adult HBVGN patients. Two researchers critically screened literatures by incorporating and exclusion criteria， extracted relevant data，then independently assessed by methodological quality. Rev Man 5.3 software was used for metaanalysis. Results  A total of 13 cohort studies involving 606 adult HBVGN patients were  finally included. The results of metaanalysis showed that the combining therapy group was better than the control group in reducing 24 hour urinary protein quantity;the combining therapy group was better than the control group in increasing serum albumin， the complete remission rate and the objective response rate; the two groups showed no significant difference in alanine aminotransferase and negative conversion ratio of HBVDNA. Conclusion  Compared with single nucleoside analogues therapy， immunosuppressant combined with nucleoside analogues therapy can increase the objective response rate and complete remission rate， more effectively reduce 24 hours urinary protein quantity and protect hepatorenal  function，keep  hepatic  function  intact and no replication of HBVDNA in adult HBVGN patients.