Table of Content

05 November 2018, Volume 33 Issue 11

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Diagnosis and therapy of ascites in liver cirrhosis

Cheng Ran, Xu Xiaoyuan

2018, 33(11):  921-924.  doi:10.3969/j.issn.1004-583X.2018.11.001

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Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. Patients with ascites are at high risk of developing complications such as spontaneous bacterial peritonitis and progressive renal impairment.  Adequate management of cirrhotic ascites and its complications improves quality of life and increases survival. This article summarizes the advances in diagnosis and therapy of ascites in combination with guidelines.

Progress in diagnosis and treatment of liver cirrhosis complicated with infection

Ma Luyuan, Li Xingyu, Zhao Caiyan

2018, 33(11):  925-928.  doi:10.3969/j.issn.1004-583X.2018.11.002

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Liver cirrhosis is the late stage of many chronic liver diseases. Infection is one of the most important complications in patients with liver cirrhosis.  Tthis article aims to analyze the pathophysiological changes of cirrhosis, especially that during decompensated period, to understand the pathogenesis of cirrhosis complicated with infection, and to summarize the experiences of diagnosis and treatment, so as to promote correct clinical understanding, reasonable prevention and standardized diagnosis and treatment.

Endoscopic treatment of esophagogastric varices in cirrhosis

Yin Kaige, Jin Xiaoxu, Feng Zhijie

2018, 33(11):  929-932.  doi:10.3969/j.issn.1004-583X.2018.11.003

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Variceal bleeding in cirrhosis is a lifethreatening complication of portal hypertension. The primary prophylaxis strategy of esophageal varices is nonselective betablockers (NSBBs) or endoscopic variceal ligation (EVL). EVL is the first choice for acute esophageal varices bleeding. The combination of NSBBs and EVL is the recommended management in the secondary prophylaxis. For gastric varices bleeding, gastroesophageal varices type 1 (GOV1) is recommended for EVL, gastroesophageal varices type 2 (GOV2) and isolated gastric varices (IGV) are recommended for endoscopic tissue glue injection. In the prevention of gastric varices rebleeding, transjugular intrahepatic portosystemic shunt (TIPS) can be applied to GOV2 and IGV, and EVL, NSBBs or endoscopic tissue glue injection can be applied to GOV1. NSBBs or endoscopic tissue glue injection can be used for primary prophylaxis of gastric varices.

Early prognostic evaluation of biomarkers for acuteonchronic liver failure

Liu Huimin, Feng Zhijie

2018, 33(11):  933-937.  doi:10.3969/j.issn.1004-583X.2018.11.004

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Acuteonchronic liver failure is characterized by critical condition  and rapid development with poor prognosis. Early diagnosis and positive treatment is the key to survival of patients. Numerous prognostic biomarkers arising in recent years can be summarized and divided into four categories,  including proteins (biomarkers correlate with inflammation response,  apoptosis or necrocytosis,  and immunoreaction),  cytology,  nucleic acids,  and metabolomics. Part of them may have better prognostic evaluation value.

Role of transjugular intrahepatic portosystemic shunt in management of portal  hypertension

Chen Lei, Zhang Xueqiang

2018, 33(11):  938-941.  doi:10.3969/j.issn.1004-583X.2018.11.005

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As one of the main features of cirrhosis, portal hypertension (PH)  is associated with several clinical consequences. Transjugular intrahepatic portosystemic shunts (TIPS) has been regarded as a major technical advance in the management of  PHrelated complications. Recent years have seen the application expansion of  TIPS along with the advancement of technology. Therefore, this article discusses  the current knowledge of TIPS in PH.

Current status of diagnosis and treatment of hepatorenal syndrome

Cai Junjun, Jiang Huiqing

2018, 33(11):  942-946.  doi:10.3969/j.issn.1004-583X.2018.11.006

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Hepatorenal syndrome (HRS) is a critical complication of patients with advanced cirrhosis,  which is characterized by renal dysfunction,  hemodynamic changes and endogenous vascular substance abnormalities with the patients presenting  no substantial renal damage. It can significantly increase mortality in cirrhotic patients, which makes early diagnosis and timely treatment of HRS essential. Currently,  diagnosis of HRS is mainly based on serum creatinine criteria. Liver transplantation remains the only means of HRS. Further researches centered on its foundation and clinical manifestation should be conducted in the future so as to make some breakthrough.

Research advances of portal vein thrombosis in liver cirrhosis

Yang Xincheng, Jin Xiaoxu, Yao Jinfeng

2018, 33(11):  947-949，955.  doi:10.3969/j.issn.1004-583X.2018.11.007

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Portal vein thrombosis is the formation of thrombosis in the portal vein and its main branches, which is caused by multiple pathogenic factors, and liver cirrhosis is one of the main causes. With the gradual improvement in the understanding of the disease, more and more researches have been focused on this in recent years. This paper reviews the recent advances in the study of portal vein thrombosis in liver cirrhosis.

Factors associated with adherence to antiviral therapy in patients with HBV-related cirrhosis

Xu Manman1, Cheng Kailiang2, Qiu Qian3, Zhao Xinyu2, Duan Zhongping1, Wang Li2, Chen Yu1

2018, 33(11):  950-955.  doi:10.3969/j.issn.1004-583X.2018.11.008

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Objective  Based on real clinical data,  we firstly evaluated the adherence to antiviral therapy of patients with HBVrelated cirrhosis and explored the factors influencing the adherence of these patients. Methods  Demographic characteristics,  routine biochemical and virological detection data and antiviral prescription information of patients with HBVrelated cirrhosis who were referred to Beijing You'an Hospital during Feb 14,  2008 and Dec 31,  2012 were collected from the hospital's electronic database. According to the patients' antiviral dispensary records,  we used the medication possession rate(MPR)  to evaluate the level of adherence to antiviral treatment of patients with HBVrelated cirrhosis. Multivariate logistic regression was used to analyze the factors affecting the good adherence.Results  A total of 299 patients treated with ADV or ETV in Beijing area, with 117  patients being HBeAg positive and 182 being HBeAg negative. The male patients accounted for 65.9%. MPR was greater than or equal to 80% in most patients,  accounting for 68%; the patients whose MPR  greater than or equal to 95% accounted for 45%; the patients whose MPR was equal to 100% accounted for 26.1% and the patients whose MPR < 50% only accounted for 12%.Multivariate logistic regression was used to explore the factors associated with good adherence. Univariate analysis revealed that the medication adherence showed positive correlation with baseline ALB ≥ 35 g/L（OR=2.27，95%CI=1.4253.618）,  baseline CHE≥4 000  U/L(OR=2.601,  95%CI=1.6174.183);  and negative correlation with the longer treatment time (OR=0.549,  95%CI=0.3890.757). It was showed that only treatment time had significant association with medication adherence (OR=0.021,  95%CI=0.0050.088) through multivariate analysis. Conclusion  Compared to other chronic diseases,  the level of adherence to antiviral therapy of patients with HBVrelated cirrhosis is not lower. Patients with longer time of treatment tend to show  poorer adherence.

Efficacy and safety of catheter radiofrequency ablation for idiopathic ventricular arrhythmia guided by Carto3 system without fluoroscopy

Wang An1, Wen Weiming1, Li Jinyi1, He Yan1, Jiang Jingbo2, Lv Xiangwei1, Zhong Guoqiang1

2018, 33(11):  956-961.  doi:10.3969/j.issn.1004-583X.2018.11.009

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Objective  To compare the catheter radiofrequency ablation for idiopathic ventricular arrhythmia guided  by Carto3 system with or without fluoroscopy,  so as to evaluate the efficacy and safety of zero fluoroscopy approach.Methods  A prospective study was performed among 106 consecutive patients of idiopathic ventricular arrhythmia (IVA,  including idiopathic premature ventricular contraction and idiopathic ventricular tachycardia) who were hospitalized from January 2017 to March 2018 in the First Affiliated Hospital of Guangxi Medical University. The catheter radiofrequency ablation was performed under Carto3 system guidance.According to the date of operation,  patients were randomly divided into two groups. Of them,  39 cases operated on odd numbers were included zero fluoroscopy group (ZF group),  and 67 cases on double numbers were included in fluoroscopy group (F group). All the procedures were performed with contact force catheter of Biosense Webster  by 2 operators. The difference between the two groups in terms of their procedure time,  first mapping time,  number of ablation,  ablation time, fluoroscopy time, target position, immediate success rate, complications and recurrence rate were compared.Results  There was no statistical difference in baseline data such as age, sex,  disease course  and echocardiographic index between the two groups. ZF group was performed completely without fluoroscopy, and the fluoroscopy time of F group was 168.0(44.8,541.3) s. In terms of general procedure data such as the procedure time, first mapping time, number of ablation, ablation time, target position, no statistical difference was found between the two groups. As to the effectiveness and safety of the operation between the two groups, the immediate success rate, complications  and recurrence rate had no statistical difference（P＞0.05）.Conclusion  Catheter radiofrequency ablation for idiopathic ventricular arrhythmias guided by Carto3 system without fluoroscopy showed efficacy and safety, without increasing  the procedure time, the first mapping time,  and the number of ablation.

Comparative study on the risk factors of OSAHS patients with different severity betweent Bai and Han ethnic groups

Dai Rufen, Li Xianli, Li Liyun, Li Li, Li Xiuping, Duan Zhizhen

2018, 33(11):  962-965.  doi:10.3969/j.issn.1004-583X.2018.11.010

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Objective  To build the theoretical basis for the prevention and treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) by comparing difference in clinical features of OSAHS patients between Bai and Han ethnic groups. Methods  A total of 224 patients with OSAHS from Dali area were enrolled, among which 115 were from Han ethnic group and 109 were from Bai ethnic group. The patients were divided into mild, moderate and severe groups according to 2015 Diagnostic and Classification Criteria of OSAHS, and the clinical data of  the patients were collected and analyzed. Results  ①The number of patients with severe OSAHS was significantly greater than that of the mild and moderate OSAHS in both Han and　Bai ethnic groups (P<0.05). ②The severity of OSAHS in Han group was aggravated with the increase of smoking rate. The proportion, drinking rate, BMI and circumference of abdomen of male patients in the severe group were significantly higher than those of mild of OSAHS; The average age of severity of OSAHS was significantly elder than that of moderate of OSAHS (P<0.05). ③The lowest oxygen saturation of Han group in mild OSAHS patients was significantly lower than that in Bai group, the average age of Bai group in moderate OSAHS patients was significantly lower than that in Han group, and the smoking rate of Han group in severe OSAHS patients was significantly higher than that in Bai group (P<0.05).Conclusion  The majority of OSAHS patients in Dali are more severe, while Han people suffer from more severe hypoxia,  Bai group had earlier onset age of moderate OSAHS, and the smoking rate in severe Han OSAHS patients was higher.

Factors for the failure of noninvasive positive pressure ventilation for patients with mild or moderate acute respiratory distress syndrome induced by sepsis

Wang Hong1, Dong Shimin2, Zhao Shuncheng1, Wang Lin1, Zhang Zhongxue1,

2018, 33(11):  966-969,973.  doi:10.3969/j.issn.1004-583X.2018.11.011

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Objective  To evaluate the clinical efficacy and safety of noninvasive positive pressure ventilation(NPPV) for patients with mild or moderate acute respiratory distress syndrome（ARDS） induced by sepsis,  and to analyze the independent risk factors of NPPV treatment failure. Methods  A retrospective observation was conducted. NPPV  was used for mild or moderate ARDS patients induced by sepsis who admitted to Intensive Care Unit of Baoding First Hospital from January 2013 to December 2018. Fiftysix patients with ARDS treated with NPPV，according to whether patients needed invasive ventilation finally, were divided into success group and failure group. The data included general state,  Acute Physiology and Chronic Health Evalution Ⅱ (APACHEⅡ) score，ARDS cause,  NPPV related parameters,  vital signs and blood gas analysis before and after NPPV. Results  Of all the patients, 36 fell into the success group,  while 20 (35.7%)  were included failure group.  The multivariate analysis showed that higher APACHEⅡ  score（P=0.039），PaO2/ FiO2<145 mmHg after two hours of NPPV（P=0.000）,  RR>30 times/min after two hours of NPPV（P=0.016）, and pulmonary infection derived ARDS（P=0.026）  were the independent risk factors of NPPV treatment failure．Conclusion  NPPV might be an effective and safe method for treatment of patients with mild or moderate ARDS  induced by sepsis.  The independent risk factors associated with failure of NPPV were higher APACHEⅡ  score,  PaO2/FiO2 <145 mmHg after two hours of NPPV,  RR>30 times/min after two hours of NPPV,  and pulmonary infection derived ARDS.

Clinical analysis of 53 children with mycoplasma pneumoniae infection complicated by heart failure

Lin Meichai1, Wang Chengyi1，2, Wu Ling1, Chen Qin1, Chen Lu1

2018, 33(11):  970-973.  doi:10.3969/j.issn.1004-583X.2018.11.012

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Objective  To investigate the clinical characteristics of children with mycoplasma pneumonia infection complicated by heart failure. Methods  Retrospective analysis was conducted on the clinical data of 53 children who were hospitalized at  Fujian Provincial Maternity and Children’s Hospital due to mycoplasma pneumonia infection complicated by heart failure between October 2012 and June 2018. A total of 111 concurrent children with mycoplasma pneumonia infection and no complications were selected as control group. General information and results of laboratory tests between two groups were compared. Results  Thirty cases(56.6%) of children with mycoplasma pneumonia infection complicated by heart failure were one year or younger. Fortyfour cases of children with mycoplasma pneumonia infection complicated by heart failure showed diminished heart sounds. Compared to the control group,  the group of children with mycoplasma pneumonia infection complicated by heart failure were exposed to higher proportions of dyspnea,  the underlying disease and coinfection of two or more noxaes,  higher white blood count,  Creactive protein and alactate dehydrogenase,  lower platelet count and hemoglobin with statistical significance. Conclusion  Mycoplasma pneumonia infection is more susceptible to being accompanied by heart failure if it presents in the infant period and is complicated with basic heart disease,  coinfection of two or more noxae,  high Creactive protein，alactate dehydrogenase and low hemoglobin levels.

Influencing factors of  left ventricular diastolic dysfunction in patients with chronic kidney disease

Yu Hongyana, Yang Haipingb, Geng Wenyana, Zhang Ruifenga, Li Ruiyinga, Ge Shijiea

2018, 33(11):  974-977,982.  doi:10.3969/j.issn.1004-583X.2018.11.013

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Objective  To investigate the risks factors of left ventricular(LV) diastolic dysfunction (DD) in patients with chronic kidney disease (CKD).Methods  A  total of 120 patients with CKD  stage 35 and LV ejection fraction (EF)>50%  were  enrolled in this study.According to the results of peak early diastolic velocity (EmLV), patients were divided into LV diastolic dysfunction (DD+) group (EmLV<8 cm/s) (n=59) and normal LV diastolic dysfunction (DD-) group (EmLV≥8 cm/s) (n=61). Standard echocardiography and tissue Doppler echocardiography were  performed to evaluate the parameters related to LV diastolic function. The following laboratory parameters were detected: serum creatinine concentration, estimated glomerular filtration rate, urea, Ca, P, parathormone, platelet count, hemoglobin and Nterminal proBtype natriuretic peptide (NTproBNP). Results  Compared with DD(-) patients, the level of serum Ca was significantly decreased in DD(+) patients（P<0.01）. ROC curve derived Ca≤ 1.98 mmol/L was characterized by a sensitivity of  92.8% and specificity of 39.2% for diagnosing LV diastolic dysfunction. Moreover, multivariate logistic regression showed that serum Ca≤1.98  mmol/L  was the only variable predicting LV diastolic dysfunction.Conclusion  Hypocalcemia is the  independent predictive factor for LV diastolic dysfunction in patients with CKD.

Jailed balloon technique for coronary bifurcation lesions: a metaanalysis

Cao Bin, Pan Lanping, Jiang Baifeng, Zou Guihe, Guan Zheng

2018, 33(11):  978-982.  doi:10.3969/j.issn.1004-583X.2018.11.014

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ObjectiveTo explore the jailed balloon(JBT) technique for coronary bifurcation lesions. MethodsThe database PubMed, EMBASE, the Cochrane Library database, CNKI and WanFang database were used to collect the relevant research literature on the application  of JBT to the treatment of coronary bifurcation lesions. The  metaanalysis was applied to the comprehensive quantitative evaluation of the literature collected. The patients treated with JBT was set as a group, while those who hadn't belong to the control group.REVMAN 5.3 was used for statistical analysis. ResultsA total of 8 studies were included, which involved 360 cases as JBT group and 585 as the control group. Compared with the control group,  JBT group saw their time of percutaneous coronary intervention(WMD=-20.41, 95%CI=-24.00-16.82,P<0.05) significantly shortened,  and lower incidence of complications such as side support occlusion, dissection or slow blood flow (RR=0.40,95%CI=0.240.66，P<0.05), and there were no significant differences in main adverse coronary event (MACE)(RR=0.58,95%CI=0.311.07，P=0.08).ConclusionCompared with the traditional sidebranch (SB) protection technique, JBT can shorten the operation time, reduce the incidence of complications of SB occlusion, dissection or slow blood flow,  and the incidence of MACE events.

A meta analysis of the correlation between  rheumatoid arthritis and obstructive lung disease

Zou Rongxin1,2, Li Xiaoke1,2, Chu Zanpo1,2, Ying Ying1, Peng Yong1, Chen Yong1

2018, 33(11):  983-986.  doi:10.3969/j.issn.1004-583X.2018.11.015

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目的 系统评价类风湿关节炎（rheumatoid arthritis,  RA）与肺部阻塞性疾病的相关性。方法 计算机检索Pubmed、embase数据库，对RA并发慢性阻塞性肺病（ chronic obstructive pulmonary disease，COPD）和哮喘的临床随机对照研究进行检索，采用Revman 5.3 软件进行数据分析。结果 最终纳入文献7篇，包括RA患者91 191例，对照组246 923例。采用随机效应模型，RA组发生肺部阻塞性疾病的危险性大于对照组（OR=1.81，95%CI=1.64～2.01，P<0.01）。结论  RA与肺部阻塞性疾病发病密切相关，RA患者COPD和哮喘的发生风险显著增加。

Interpretation of the consensus on diagnosis and management of inflammatory bowel disease (Beijing, 2018) from the perspective of diagnosis of ulcerative colitis

Liang Xiaonan, Yin Fengrong, Zhang Xiaolan

2018, 33(11):  987-990.  doi:10.3969/j.issn.1004-583X.2018.11.016

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In May 2018, the Consensus on Diagnosis and Management of Inflammatory Bowel Disease (Beijing, 2018) was published on Chinese Journal of Digestion, which was formulated by the Inflammatory Bowel Disease Group of the Chinese Medical Association Digestive Diseases Branch. The progress of the diagnosis and management of inflammatory bowel disease was updated on the basis of the 2012 consensus, providing canonical diagnosis and normative treatment for the medical personnel. This paper focuses on the diagnosis and management of ulcerative colitis, aiming to help the clinicians improve their understanding of the new consensus and the diagnosis and treatment of UC.