Clinical Focus

Development of healing diabetic foot ulcers

Chen Lianming， Chen Axin， Shi Yuhua， Jiang Yufeng

2018, 33(2): 93-96. doi:10.3969/j.issn.1004-583X.2018.02.001

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This paper systematically expounds the mechanism and significance of diabetic foot wound repair， timing， treatment principles， method selection principles and techniques. Special emphasis should be based on diabetic foot debridement and infection treatment， elaborated wound repair modes and methods. For different stages of the wound， an explanation follows the appropriate treatment principles. Some new techniques and new methods applied to promote healing at different treatment stages of wounds in recent years are listed. At the same time， the paper illustrated the fundamental goal of diabetic foot wound repair as the concept of functional rehabilitation. It provides an effective treatment plan for the prevention and repair of clinical diabetic foot wounds and summarizes the experience.

Current status and future development of plantar decompression in patients with diabetic foot in China

Liu Yan1，3， Sun Mingliang2，3， Li Ping3， Ding Zejian3， Li Qiu3

2018, 33(2): 97-99. doi:10.3969/j.issn.1004-583X.2018.02.002

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This article briefly introduces the distribution of plantar pressure， enumerates the current status of plantar decompression in patients with diabetic foot in China， and points out the short comings to improve the medical staff，patients and their families’ attention to the plantar pressure.Prevention of diabetic foot will begin from decompression， early detection of abnormal plantar pressure， timely intervention will reduce the incidence of ulcer recurrence rate， improve the healing rate and reduce the cutoff rate and mortality.

Research progress in local antiinfection of diabetic foot

Wu Yuxiang1， Jiang Yufeng2a， Wang Aihong2b， Xu Zhangrong2b

2018, 33(2): 100-102,110. doi:10.3969/j.issn.1004-583X.2018.02.003

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Antiinfective treatment of diabetic foot is one of the challenges in the field. Infection of diabetic foot will not only prolong wound healing time，but also may lead to amputation， even can threaten life. Only systemic antibiotic treatment does not solve all the problems of foot infection. Some local antiinfection adjuvant therapies such as the local debridement， antibacterial dressing， topical antibiotics， have certain antibacterial effect. This article will review the current researches on the local antiinfective treatment of diabetic foot.

Modes of classification of diabetic foot in China

Li Kexin， Du Yuming， Duan Wenyan， Zhai Yinghui， Xiao Yan， Feng Yan

2018, 33(2): 103-110. doi:10.3969/j.issn.1004-583X.2018.02.004

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Diabetic foot (DF) is a serious chronic complication of diabetes. Its high incidence， high disability rate， high mortality rate and low control rate bring huge burden to the family， the whole medical and health system. The medical resources of our country match the difference， the difficulty， complexity and difference of the diagnosis and treatment of diabetic foot increase the difficulty of prevention and cure. The modes of diagnosis and treatment in foreign countries can be used for reference.In the consideration of our country is to carry out a chronic noncommunicable diseases diagnosis classification and grading diagnosis and treatment on DF patients reasonably， which can provide orderly， continuous and homogeneous health services for DF patients. This paper gives the following summary of Chinese classification of DF diagnosis and treatment mode.

Relationship between thyroid hormone level and insulin resistance among nondiabetic population with normal thyroid functions

Gu Xiaolan1， Zhang Delong2， Niu Min1， Gao Zhengnan1， Fu Hongjun1， Lu Linna1

2018, 33(2): 111-114. doi:10.3969/j.issn.1004-583X.2018.02.005

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Objective To investigate the relationship between thyroid hormone level and insulin resistance among nondiabetic population with normal thyroid functions. Methods Relying on the REACTION Research initiated by Chinese Medical Association in 2011， totally 5 428 individuals who met the research requirements were selected in Dalian. The following data were collected， including height， weight， blood pressure， OGTT， the levels of blood lipids， blood creatinine， blood uric acid， blood glucose， glycosylated hemoglobin， fasting insulin， thyroid function indicators， and HOMAIR. The whole group was divided into two teams， team A with TSH levels lower than 2.5 mIU/L and team B with TSH levels higher than 2.5 mIU/L. The same items above between two teams were compared. The relationship between thyroid hormone level and insulin resistance was studied. Results Compared with team A， team B had lower levels of blood creatinine， blood uric acid and FT4 and higher levels of LDL， cholesterol， glycosylated hemoglobin， fasting insulin and HOMAIR (P＜0.05). There was a positive correlation between TSH level and HOMAIR (r=0.145，P=0.000） and a positive correlation between FT3 level and HOMAIR as well (r=0.040，P=0.003)， while there was a negative correlation between FT4 level and HOMAIR (r=0.017，P=0.000). Logistic regression analysis showed that gender， diastolic blood pressure， BMI， HDL， LDL， cholesterol， glycosylated hemoglobin， blood uric acid， TSH and FT4 were independently the risk factors to affect HOMAIR (P＜0.05)， in which HDL and FT4 were protecting factors (P＜0.05). Conclusion There is a positive correlation between TSH level within normal ranges and insulin resistance of nondiabetic people， while there is a negative correlation between FT4 and insulin resistance. In addition， TSH and FT4 are the independent risk factors affecting insulin resistance.

He Ke，Zhu Lihua，Lu Xiwan，Hu Yuan， Zhou Weiqiang， Jiang Yan， Liu Ling， Bian Rongrong

2018, 33(2): 115-117,121. doi:10.3969/j.issn.1004-583X.2018.02.006

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Objective To investigate the related factors of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus(T2DM). Methods One hundred and fourteen patients with T2DM were included. Diabetic peripheral neuropathy was evaluated according to the motor and sensory nerve conduction velocity， and the patient were divided into diabetic peripheral neuropathy group (DPN group， 73 cases) and non diabetic peripheral neuropathy group (NDPN group， 41 cases). The gender， age， duration， body mass index， waist circumference， fasting blood glucose， postprandial blood glucose， glycosylated hemoglobin (HbA1c)， the blood lipid， motor and sensory nerve conduction velocity， carotid intimamedia thickness， foot and ankle brachial index， sensory threshold index were analyzed. Results The age， disease course， fasting and postprandial blood glucose and HbA1c in DPN group were significantly higher than those in NDPN group (P<0.05). The motor and sensory nerve conduction velocity was significantly lower than that in group NDPN (P<0.01)， the carotid intimamedia thickness and foot sensation threshold were significantly higher than those in group NDPN (P<0.05). The data showed that advanced age， long duration and high HbA1c levels in patients with T2DM were independent risk factors of DPN (P<0.05). Conclusion DPN is associated with age， duration and HbA1c level in patients with T2DM.

Correlation between eyeground atherosclerosis and coronary slow flow phenomenon

Li Shijing1， Chen Hao1， Zhang Liping2， Pan Liming1， Feng Jing1， Wang Jun1， Wang Dezhao3

2018, 33(2): 118-121. doi:10.3969/j.issn.1004-583X.2018.02.007

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Objective To explore the correlation between eyeground atherosclerosis（EA） and coronary slow flow （CSF）.Methods A retrospective analysis was performed in 146 patients with CSF and 101 patients with normal coronary flow (NCA) in the hospital from January 2013 to December 2016. All cases were examined by fundus photography， and underwent medical history collection，blood routine，biochemical，fibrinogen，urine microalbumin (UMA)，glycosylated hemoglobin，high sensitive Creactive protein (hsCRP) and carotid atherosclerosis test. The correlation between EA and CSF was evaluated. Results ①The positive rate of EA in CSF group was significantly higher than that in group NCA(P<0.05)； ②With the increase of EA， the incidence of CSF increased gradually (P<0.05)；③ Synthesis consideration of EA， gender， hsCRP and other risk factors， it revealed that EA≥Ⅱ grade，female，hypertension，age>65 years，hsCRP>5 mg/L were predictors of CSF（all P<0.05 or <0.01）. Conclusion With the increase of EA， the incidence of CSF increased gradually， there are certain correlation between EA and CSF， EA is an independent predictor of CSF.

Impact of multivessel coronary disease on inhospital outcome in acute coronary syndrome patients undergoing primary percutaneous coronary intervention

Huang Ping， Wang Xiaodong， Wang Wei

2018, 33(2): 122-124,128. doi:10.3969/j.issn.1004-583X.2018.02.008

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Objective To investigate the clinical characteristics of multivessel coronary disease in acute coronary syndrome patients undergoing primary percutaneous coronary intervention and the impact on inhospital outcome. Methods This retrospective analysis was performed on 72 patients with ACS undergoing primary PCI. Patients were divided into two groups according to the coronary angiogram: singlevessel group(n=35) and multivessel group(n=37). Results In multivessel group， age， hypertension， diabetes mellitus， smoking， glucose at admission， triacylglyceride were higher than those in singlevessel group(P<0.05). And the left ventricular ejection fraction in multivessel group was lower than that in singlevessel group(P=0.001). Compared with singlevessel group， the incidence of MACE happened more frequently in multivessel group(P<0.05). Conclusion The patients with multivessel coronary disease undergoing primary percutaneous coronary intervention had more risk factors and major adverse cardiac events.

Blood glucose variability and prognosis in patients with acute ischemic stroke

Zhang Hao， Wei Jing， Ni Min， Jin Hai

2018, 33(2): 125-128. doi:10.3969/j.issn.1004-583X.2018.02.009

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Objective To study the relationship between blood glucose variability and prognosis in patients with acute ischemic stroke for the clinical basis in relieving the prognosis in the patients. Methods Acute ischemic stroke patients in our hospital were enrolled. All patients were classified by TOAST subtypes. According to the standard deviation of the blood glucose level， the patients were divided into the blood glucose variability group (standard deviation of blood glucose level≥1.4 mmol/L) and control group(standard deviation of blood glucose level ＜1.4 mmol/L). In addition， neurological function deicits scale was evaluated by the National Institutes of Health Stroke Scale(NIHSS) and the conditions of prognosis after the 90 days was evaluated by the modified Rankin Scale. The difference in blood glucose variability group and control group was compared. Then， the relationship between blood glucose variability and prognosis was analyzed with logistic regressive model. Results Eightythree patients (47.4%) had blood glucose variability. The average age (74.7±12.7 vs 70.0±13.3 years，P=0.019)， diabetes history(28 cases vs 14 cases，P=0.007)， and stroke history (16 cases vs 6 cases，P<0.01) were significantly different between blood glucose variability group and control group. Logistic regressive model showed that the blood glucose variability (OR=3.235，95%CI=1.1858.130，P=0.022)， advanced age(OR=1.114，95%CI=1.0611.169，P<0.001) and higher admission NIHSS scores(OR=2.214， 95%CI=1.7132.863，P<0.001) were independent risk factors of acute ischemic stroke. Conclusion Blood glucose variability， advanced age and higher admission NIHSS scores were related to 90 days’ prognosis of acute ischemic stroke.

Clinical effect of cognitive function training on intelligent development of children with brain injury syndrome

Gao Lijuan， Xu Shuling， Fu Jiena， Zhu Xiwei

2018, 33(2): 129-131. doi:10.3969/j.issn.1004-583X.2018.02.010

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Objective To observe the clinical effect of cognitive perceptual function training on the intelligent development of children with brain injury.Methods Ninetysix cases of children with brain injury syndrome were divided into control group and observation group， 48 cases in control group with routine comprehensive rehabilitation training， observation group of children on the basis of routine comprehensive rehabilitation treatment combined with early cognitive perception function training，and 3 months after treatment， separately Gesell psychological behavior were evaluated in two groups of children. Results Two groups improved social adaptation， big action， language and individual social development quotient (P<0.05)， and there was no difference in fine motor development quotient (P>0.05). The improvement of intelligence in observation group after training was better than that of control group (P<0.05).There was significant difference in the social development quotient between edge intelligence group and mental retardation group(P<0.05). Observation group showed significant difference in the intelligence level social adaptation development as compared with control group(P<0.05).Conclusion Early cognitive perception function training can improve the mental development in children with brain injury syndrome， and to promote the development of other functional areas， children with different intelligence have different levels of improvement.

Correlation between calciumbinding protein S100A12 level and severity of patients with chronic obstructive pulmonary disease in acute exacerbation

Yu Hongxin1， Liu Hua2， Du Weishan1， Wang Hongyan3， Wu qinxun1， Ma Jianke1

2018, 33(2): 132-135. doi:10.3969/j.issn.1004-583X.2018.02.011

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Objective To investigate the relationship between serum calcium binding protein S100A12 level and the severity of chronic obstructive pulmonary disease in acute exacerbation(AECOPD) and its diagnostic value. Methods From November 2016 to February 2017， 40 patients with AECOPD hospitalized were enrolled and 20 healthy subjects were enrolled as controls. The hsCRP and procalcitonin (PCT) values of AECOPD patients on the day of treatment and on the day before discharge hsCRP were collected. The level of serum calcium binding protein S100A12 was detected by enzymelinked immunosorbent assay (ELISA). Results Before treatment， the serum level of S100A12 in AECOPD group was significantly higher than that in healthy controls (P<0.05)， and after treatment， the serum level of S100A12 in AECOPD group was significantly lower than that in healthy controls (P<0.05) . Before treatment， the level of S100A12 in AECOPD group showed a positive correlation with hsCRP and PCT（r=0.414，P<0.01; r=0.326，P<0.05）. There was no correlation between S100A12， hsCRP and PCT after treatment. Conclusion The level of calcium binding protein S100A12 can be used as an indicator in AECOPD severity assessment and diagnosis.

Influence of obstructive sleep apnea hypopnea syndrome on thyroid function

Du Jianping1，An Zhenmei2a，Tang Xiangdong2b

2018, 33(2): 136-139. doi:10.3969/j.issn.1004-583X.2018.02.012

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Objective To investigate the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on thyroid hormone function. Methods 400 hospitalized patients of West China Hospital of Sichuan University with sleep breathing monitoring and thyroid function examination were enrolled from January 2015 to February 2016. The differences in gender， age， body mass index (BMI)， hypothyroidism， diabetes or hypertension， thyroid hormone levels (TSH， FT3， FT4) and thyroid associated antibodies (TgAb， TPOAb) were compared. The clinical data as well as the thyroid hormones and related antibodies were compared between the nonOSAHS and mild to severe OSAHS groups. The relationship between OSAHS and thyroid hormone levels was analyzed using binary Logistic regression analysis.Results The proportion of male， age， BMI， combined diabetes or hypertension in the OSAHS group were higher than those in the non OSAHS group (P<0.01). The level of FT3 in the severe OSAHS group was slightly higher than that of the non OSAHS group and the mild OSAHS group (P<0.05). The positive rate of TPOAb in non OSAHS group was higher than that in group OSAHS (P=0.049). The binary Logistic regression analysis showed that OSAHS was not related to the thyroid function. Conclusion OSAHS may have no effect on thyroid function.

FibroTouch combined with FIB-4， APRI and GPRI in diagnosis of liver fibrosis

Zhao Wen， Zhang Siyu， Lu Yu， Zhao Suxian， Wang Rongqi， Nan Yuemin

2018, 33(2): 140-144. doi:10.3969/j.issn.1004-583X.2018.02.013

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Objective To explore the value of the combination of FibroTouch， fibrosis index based on the 4 factors (FIB4)， ASTtoPLT ratio index (APRI) and GGTtoPLT vatio index (GPRI) in diagnosis of liver fibrosis in patients with chronic liver disease. Methods A total of 337 patients with chronic liver disease were selected and performed liver biopsy in Department of Traditional and Western Medical Hepatology， the Third Hospital of Hebei Medical University from January 2014 to April 2017. The GPRI， APRI， FIB4 were calculated and liver stiffness was measured by FibroTouch. The diagnostic values of FibroTouch， GPRI， APRI and FIB4 for liver fibrosis degree were compared by receiver operating characteristic (ROC) curves， and area under ROC curves (AUROCs) were used to analyze the results of the models. Spearman analysis was used to evaluate the correlation between LSM， APRI， GPRI， FIB4 and clinical characteristics. Posterior probability was calculated to explore the accuracy of combining four methods in diagnosis of liver fibrosis. Results The patients were divided into significant liver fibrosis group (a liver fibrosis stage of ≥S2， n=169)， advanced liver fibrosis group (a liver fibrosis stage of ≥S3， n=86)， liver cirrhosis group (a liver fibrosis stage of =S4， n=42). The AUROCs of the LSM for predicting significant liver fibrosis， advanced liver fibrosis and liver cirrhosis were 0.826， 0.882，0.920， which were significantly higher than FIB4 (0.734， 0.711， 0.739)， APRI (0.662， 0.669， 0.719) and GPRI (0.621， 0.674， 0.720); LSM was correlated with histopathological fibrosis (r=0.564， P=0.000) and inflammation grade (r=0.651， P=0.000). The probability of LSM in diagnosing liver fibrosis of S≥2， S≥3 and S=4 was 72.44%， 80.52%， 84.21%. When FIB4， APRI and GPRI were combined with LSM in diagnosing liver fibrosis of S≥2， S≥3 and S=4， the posterior probability was 95.71%， 98.6%， 99.08%. Conclusion A combination of FibroTouch and FIB4 can improve the accuracy of diagnosing liver fibrosis， and the demand of liver biopsy will dicrease significantly when combined with APRI and GPRI further， which is beneficial to confirming timely， monitoring dynamically and treating effectively.

Xuefuzhuyu Decoction on contrast induced nephropathy after percutaneous coronary intervention

Liu Huahua， Tang Weiliang， Yang Fangfang， Zhao Jingjing， Peng Fang

2018, 33(2): 145-149. doi:10.3969/j.issn.1004-583X.2018.02.014

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Objective To investigate the protective effect of Xuefuzhuyu Decoction in patients with contrast agent nephropathy after percutaneous coronary intervention (PCI).Methods A total of 240 patients was enrolled and randomly divided into two groups: Control group (n=120) and Observation group (n=120). Before and after PCI， all the patients were routinely given antiplatelets， lipid regulation， hydration therapy， and were not fasting. Based on the routine therapy， observation group was given Xuefuzhuyu Decoction once a day before 3 days PCI and after 3 days of PCI. Serum creatinine (SCr)， estimated glomerular filtration rate (eGFR)， superoxide dismutase (SOD) and malondialdehyde (MDA) were measured respectively before and after PCI.Results Compared with Control group， observation group presented a lower fluctuation of SCr and eGFR(P<0.01) Moreover， MDA content was significantly lower than that in the conventional group (P<0.05) and SOD was significantly higher than that in the conventional group (P<0.05).Conclusion The medication of Xuefuzhuyu Decoction before and after PCI may effectively reduce the incidence of contrast agent nephropathy. The mechanism may be related to the removal of oxygen radicals and the decrease of contrast agent viscosity.

Clinical features and analysis of 86 patients with acute kidney injury

Hu Zhiwei

2018, 33(2): 150-152. doi:10.3969/j.issn.1004-583X.2018.02.015

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Objective To investigate the etiology， clinical features and prognosis of acute renal injury(AKI). Methods The clinical characteristics of 86 patients with AKI were analyzed retrospectively.They were divided into the recovery group (including renal function recovered completely and partially restored) and the nonrecovery group (including death， automatic discharge and longterm dialysis). The age， gender， hemoglobin， serum albumin， serum uric acid， basic diseases (hypertension， diabetes， coronary heart disease)， dialysis rate and rate of oliguria were statistically analyzed. Additionally，the risk factors of poor prognosis were analyzed. Results Of 86 patients， 4 patients died (4.65%)， 13 patients were discharged automatically (15.12%)， 2 patients received longterm dialysis(2.33%)， and 67 patients improved (77.90%)， the main causes of the disease included insufficient anterior renal perfusion， infection， postrenal obstruction， cardiac insufficiency， drugs and so on， among which renal insufficiency and infection were the main causes. There were no significant differences in age， gender， hemoglobin， serum albumin， basic disease， dialysis rate between two groups (P>0.05). The blood uric acid level and oliguria incidence in nonrecovery group were significantly higher than those in the recovery group (P<0.05). Multiple logistic regression analysis showed that oliguria was an independent risk factor for poor prognosis in patients with AKI. Conclusion AKI patients have high clinical morbidity and mortality， early diagnosis and active intervention can improve the clinical prognosis; prerenal hypoperfusion and infection; oliguria is an independent risk factor of poor prognosis of patients with AKI.

Early application of low molecular heparin in treatment of senile severe sepsis

Ge Chunli1， Song Rong2

2018, 33(2): 153-156. doi:10.3969/j.issn.1004-583X.2018.02.016

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Objective To observe the effect and mechanism of early application of low molecular heparin in treatment of senile severe sepsis. Methods Thirtytwo cases of elderly patients with severe sepsis were randomly divided into experimental group and control group， control group given conventional treatment， treatment group on the basis of conventional treatment to low molecular heparin. Before and after treatment， APACHE Ⅱ score， SOFA score and the incidence of MODS， 28 days in hospital mortality and plasma thromboplastin， Ddimer， blood fibrinogen (FIB)， platelets and coagulation function index and serum levels of interleukin6(IL6)， tumor necrosis factor alpha were observed in two groups. Results After treatment， the APACHE grade and SOFA and the serum level of IL6 in treatment group were significantly lower than those in control group. Conclusion Early application of low molecular heparin can improve the prognosis of elderly patients with severe sepsis by improving coagulation function and reducing inflammatory response.

Application value of bedside ultrasound on EICU patients with mechanical ventilation combined with pneumothorax

Fu Liminga， Wang Huab

2018, 33(2): 157-159. doi:10.3969/j.issn.1004-583X.2018.02.017

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Objective To discuss the diagnosis method in critical patients with mechanical ventilation and pneumothorax by ultrasound in emergency intensive care unit（EICU）.Methods For 57 patients with highly suspicious of mechanical ventilation combined with pneumothorax admitted to EICU， the diagnosis was performed by bedside pultrasound， bedside chest Xray and chest CT. Analysis of various inspection methods were performed in the time needed for diagnosis， diagnostic sensitivity， specificity and accuracy. Results The diagnostic time in bedside ultrasound， bedside chest Xray and chest CT was (5.05±1.91) min， (16.04±3.73) min and (22.55±3.52) min， respectively; the shortest diagnosis time was done by bedside ultrasound （P<0.01）. Kappa value by bedside pulmonary ultrasound and bedside chest CT was 0.930， Kappa value by bedside chest Xray and bedside chest CT was 0.444， bedside ultrasound was obviously better than bedside chest Xray. Conclusion The bedside ultrasound has a high value and efficiency in the diagnosis of mechanical ventilation combined with pneumothorax in EICU patients.

Preliminary investigation of health management path of hypertension under the hospitalcommunity integrated management model in rural community

Zhang Yunhong， Long Long， Yang Yu， Zhao Yijuan， Sha Min， Zhang Bifang， Zhao Yanping， Ye Fengxian

2018, 33(2): 160-162. doi:10.3969/j.issn.1004-583X.2018.02.018

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Objective To explore an effective health management mode of hypertension in rural community. Methods A total of 486 cases with hypertension in Wanqiao rural community were enrolled and divided into three groups， including hospitalcommunity group (166 cases)， selfmanagement group (146 cases) and selfcommunity group (174 cases). All three groups were comparatively analyzed after a series of interventions. Results There were significant increase in three groups in awareness rates of knowledge of hypertension， treatment rates and control rates after intervention. The K scores， A scores， P scores and Mofisky scores were increased after intervention， and the hospitalcommunity group had the highest score (P<0.05)． Conclusion Hospitalcommunity integrated management model can improve medication compliance in patients with hypertention，it was worth popularizing in other communities.

Comparison of pegaspargase and Lsparaginase in treatment of Chinese children with acute lymphoblasfic leukemia: a meta analysis

Chen Hui， Lin Xiaoxia， Chen Yanhui

2018, 33(2): 163-166. doi:10.3969/j.issn.1004-583X.2018.02.019

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Objective To evaluate the efficacy， safety and pharmacoeconmics between pegaspargase(PEGasp) and Lsparaginase(Lasp) in treatment of Chinese children with acute lymphoblasfic leukemia. Methods CNKI， Wanfang， VIP， PubMed and OVID databases were searched to collect RCTs which compared PEGasp with Lasp in treatment of Chinese children with acute lymphoblasfic leukemia， and the retrieval time was until March， 2017. Metaanalysis was conducted by Revman 5.3 software. Results Finally， five RCTs were included in this study. A total of 544 children with ALL were enrolled， including 272 patients in PEGasp group and 272 patients in Lasp group. ①The metaanalysis showed that the complete remission CR) rate and the total response (RR) rate between the two therapy groups were similar. Compared to Lasp group， the OR of the CR rate of PEGasp group was 0.85 (95%CI=0.551.34，P＞0.05); and the RR of the CR rate was 1.35 (95%CI=0.632.90，P＞0.05). ② All five articles reported the occurrence of adverse reaction. In each study， the occurrence rate of adverse reaction between the two therapy groups was no statistically significant difference. ③In three articles， the hospitalized days and the number of drugs between the two therapy groups were compared. The metaanalysis of the hospitalized days between the two therapy groups showed that the hospitalized days of PEGasp group was significantly shorter than that in Lasp group (WMD: -6.60， 95%CI=-7.99 to -5.22). Conclusion The effectiveness of PEGasp and Lasp in treatment of pediatric ALL is similar and has no difference in adverse effect. However， PEGasp may be a better choice from the point of view of pharmacoeconmics.

Association between serum vitamin D level and adult bronchial asthma：a metaanalysis

Yun Xiaoxiao1， Wu Shiman2， Zhang Honghong1

2018, 33(2): 167-171. doi:10.3969/j.issn.1004-583X.2018.02.020

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Objective To investigate the relationship between serum vitamin D level and bronchial asthma in adults. Methods We searched the CoChrane Library， PubMed，EMbase，Web of science，OVID，Springerlink，Wiley online library，ScienceDirect，EBSCOhost，CNKI， VIP，Wanfang data databases from inception to May 1st 2017 to collect studies about the association between vitamin D and adult asthma. Two reviewers independently screened literature according to inclusion and exclusion standard， extracted data and assessed the quality of included studies.Then，metaanalysis was performed using RevMan5.3 software. Results Nine casecontrol studies involving 827 asthma patients and 287 controls were finally included.The metaanalysis showed that 25(OH)D in adult asthma group was lower than that in control group(MD=-15.90，95%CI=-18.55-13.25，P<0.01). Adult asthma presented more vitamin D deficiency than the controls(RR=2.03，95%CI=1.572.63， I2=0%，P=0.79). In asthma patients， FEV1 % in vitamin D deficiencies was lower than that of the normal(MD=-9.78，95%CI=-12.21-7.36，P<0.01).Conclusion Vitamin D level is associated with asthma in adults. Vitamin D deficiency is common in patients with asthma and associated with lung function.The lack of vitamin D may be one of the potential risk factors for asthma.

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