Table of Content

20 July 2020, Volume 35 Issue 7

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Meta analysis of efficacy and safety of LCZ696 in treatment of heart failure

He Yuqin1, Liu Yongming2, Yan Fangfang1

2020, 35(7):  581-588.  doi:10.3969/j.issn.1004-583X.2020.07.001

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Objective  To evaluate the efficacy and safety of LCZ696 in the treatment of heart failure by searching  its RCTs at home and abroad.Methods  The Cochrane library,  Pubmed,  Web of science,  CNKI,  VIP,  Wanfang database  were searched for literatures on  LCZ696 for heart failure. And the literature were screened according to the  inclusion and exclusion criteria.The bias risk assessment tool in Cochrane intervention system evaluation manual version 5.1.0 was used to evaluate the quality of included studies,  and RevMan 5.3 software was used to conduct the metaanalysis of all  outcome indexes.Results  A total of 14  967 patients were enrolled in 6 RCTs studies. Combined outcome indicators showed that  LCZ696,  LAVI ( WMD=-2.18,  95%CI［-3.63, -0.74］,  P=0.003),  E/e'  (WMD=-1.01,  95%CI［-1.89, -0.12］,  P=0.03),  mortality (RR=0.89,  95%CI［0.83, 0.96］, P=0.003),  the rate of rehospitalization for heart failure  (RR=0.83,  95%CI［0.78,  0.88］, P<0.01)  decreased more significantly after the treatment,  while the quality of life score  (WMD=1.32,  95%CI［0.69, 1.95］,  P<0.01)  and the incidence of symptomatic hypotension　(RR=1.46,  95%CI［1.34, 1.60］,  P<0.01)   increased more significantly.ConclusionLCZ696 can significantly reduce the mortality and rehospitalization rate of patients with heart failure,  and it does not increase the  risk of adverse events such as renal injury,  angioedema and hyperkalemia.

Increased expression of Zip13 in myocardium of rats with  hypersaltinduced left ventricular diastolic dysfunction

Teng Tianming, Huang Jinyong, Xue Yuchen, Huang Longfei, Yang Qing, Sun Yuemin

2020, 35(7):  589-594.  doi:10.3969/j.issn.1004-583X.2020.07.002

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Objective  To investigate the expressions and mechanisms of  zinc and zinc transporter (Zip13) in the myocardium of rats with hypersaltinduced left ventricular diastolic dysfunction（LVDD）.  Methods   A total of 36 Dahl saltsensitive (DSS) rats were randomly divided into model group  (a highsalt diet containing 8% NaCl,  n=22) and  control group (a highsalt diet containing 0.3% NaCl,  n=14）.  The Vevo 2100 ultrasound equipment for small animals was used to evaluate the cardiac function of rats in each group.  The concentrations of zinc ions in serum and myocardial tissues were determined by inductively coupled plasma optical emission spectroscopy(ICPDES).  The protein and mRNA expressions of Zip13 in the myocardium were detected by Western blot and RT qPCR methods. Results  Compared with the control group,  the model group showed significant increase in left ventricular posterior wall at enddiastole (LVPWd),  left ventricular enddiastolic dimension (LVDd),  left ventricular end systolic dimension (LVSd),  left ventricular posterior wall at endsystole (LVPWs),   left ventricular mass (LVM) and  ratio of LVM to weight (LVM/weight)(P<0.05).  The concentration of zinc ions in myocardial tissues significantly increased,  while that in serum decreased obviously(P<0.05).  The expressions of Zip13 protein and mRNA in myocardial tissues of the model group significantly increased (P<0.05).Conclusion  LVDD rats had a zinc homeostasis with elevated myocardial zinc ion concentration.  And the expressions of Zip13 protein and mRNA were upregulated,  which indicated that Zip 13 may help  regulate and correct the zinc homeostasis and inhibited myocardial remodeling of LVDD.  The specific mechanism needs to be further studied.

Correlation analysis of serum levels of MMP-2, TIMP-2, Hcy, UA and carotid atherosclerosis in patients with hypertension

Lu Yuqin, Zhao Xinke, Feng Mingxia, Ji Zhaojuan

2020, 35(7):  595-598.  doi:10.3969/j.issn.1004-583X.2020.07.003

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Objective   To investigate the correlation between serum levels of matrix metalloproteinase 2 (MMP2),  matrix metalloproteinase inhibitor 2 (TIMP2),  homocysteine (Hcy),  uric acid (UA) and carotid intimamedia thickness (cIMT) in patients with hypertension.Methods  Doppler ultrasound was used to detect cIMT in 364 patients with hypertension. According to whether cIMT ≥1 mm, the patients were divided into cIMT thickening group and cIMT nonthickening group. The serum MMP2 and TIMP2 were measured by enzymelinked immunoassay,  and the serum Hcy,  UA and lipid levels were determined by laboratory at the same time. The independent risk factors for carotid intima thickening were analyzed. Results  Compared with cIMT nonthickening group,  the age, Hcy, UA and MMP2 increased in cIMT thickening group(P<0.05). Age was an independent risk factor for carotid intima thickening. Conclusion  Age is an independent risk factor for atherosclerosis. MMP2,  Hcy,  TC,  LDLC and UA are associated with atherosclerosis,  but they can  not be identified as independent damage factors for atherosclerosis at present.

Predictive value of atherogenic index of plasma in postmenopausal women  with coronary heart disease

Yang Xinyu1，Bao Baili2

2020, 35(7):  599-603.  doi:10.3969/j.issn.1004-583X.2020.07.004

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Objective  To investigate the predictive value of atherogenic index of plasma（AIP）  in postmenopausal women with coronary heart disease(CHD). Methods  A retrospective analysis method was used to select 233 postmenopausal women who were with suspected CHD and underwent coronary angiography in our hospital. The patients were divided into CHD group (n=171) and control group (n=62) according to the results of coronary angiography. The differences of AIP between two groups were compared. Binary logistic regression was used to analyze the independent risk factors for postmenopausal women with CHD. And the predictive value of AIP for postmenopausal women with CHD was analyzed. Results  The AIP levels in CHD group were significantly higher than those in control group(P<0.01). Binary Logistic regression analysis showed that high AIP,  low estradiol (E2),  and hypertension were independent risk factors for postmenopausal women with CHD（OR=8.784，P=0.002，95%CI：2.17035.558；OR=0.813，P=0.000，95%CI：0.7640.865；OR=2.151，P=0.037，95%CI：1.0464.422）. The ROC curve analysis showed that the optimal threshold for adjusted AIP to predict CHD was 2.02,  with sensitivity  66.7%  and specificity   64.5%. Conclusion  The high AIP levels and low estradiol level can be independent risk factors for postmenopausal women with CHD. AIP can be used to predict CHD in postmenopausal women. When adjusted AIP is more than 2.02,  there is a risk of  CHD.

Correlation between primary hypertension and β2 adrenergic  receptor gene polymorphism in Baise, Guangxi

Yuan Min1, Huang Guizhong2, Wei Bixiao2, Wu Xingqi2, Liu Huayong2, Liao Chilin2, Liang Dong2, Chen Xiulin2, Liang Linhui2

2020, 35(7):  604-609.  doi:10.3969/j.issn.1004-583X.2020.07.005

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Objective   To investigate the relationship between β2adrenergic receptor (β2AR) gene polymorphism and hypertension and genetic characteristics of primary hypertension  in Zhuang population in Baise  district.Methods  This study consisted of 98 patients,  who had hypertension with a history of at  least two years,  and 109 healthy individuals came from the same ethnical  group. For all the participants,  their  general physical health was examined and the biochemical biomarkers of their  blood  before  breakfast were  tested  by the analytical instruments. Then,  DNA was analyzed using polymerase chain reaction（PCR） in order to identify the genotypes and  allele frequencies of  β2AR genes rs6879202 and rs2053044. Meanwhile, Logistic regression of SPSS 19.0 software  was implemented to explore the risk of hypertension  induced by the gene frequency  of sites with significant statistical  differences.Results  There were significant differences in sex ratio,  creatinine,  smoking rate,  triglyceride and uric acid between case group and control group. For  β2ARrs6879202  gene locus: CC, CG, GG between  two groups,  the frequencies were 3.10%, 72.40%, 24.50%; 13.80%, 57.80%, 28.40%, respectively; the genotype  frequency distributions between two groups were statistically different (χ2=8.809,  P=0.012). The results of  Logistic  analysis showed that for  rs6879202, CG  was  associated with a higher risk of hypertension than the frequency of the other two genes.Conclusion   There was correlation between  β2AR gene rs6879202 locus polymorphism and primary hypertension in Zhuang ethical population in Baise region, while there was no correlation between  β2AR  gene rs2053044 locus polymorphism and primary hypertension in this region and nationality.

A sample research on prevalence and risk factors of amnestic mild  cognitive impairment in elderly in Shijiazhuang

Zhang Yuanyuana, Duan Junyingb, Zhang Yaxina, Liang Dongmeia, Liu Guoqinga, Li Yana

2020, 35(7):  610-615.  doi:10.3969/j.issn.1004-583X.2020.07.006

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Objective  To investigate the prevalence and risk factors of amnestic mild cognitive impairment(aMCI) among the elderly in Shijiazhuang. Methods   A convenient sampling method was used to investigate 1 614 cases of people over 60 years in 3 community health service centers and 1 nursing home for the elderly in Shijiazhuang. The minimental state examination(MMSE),  montreal cognitive assessment(MoCA),  auditory verbal learning test(AVLT),  digital spantest(DST),  boston naming test(BNT), trail making test(TMT),  Clock Drawing Test,  Animal Fluency Test and ADL were used to assess the examinees' overall cognitive functions, the cognitive domain such as memory,  language,  attention,  visual space, executive function and daily activity ability.The prevalence of aMCI was calculated,  and Logistic regression analysis was used to identify the related risk factors for aMCI. Results  The prevalence of aMCI among the sampled elderly in Shijiazhuang was 16.11%,  and there were significant differences in the prevalence of aMCI among the elderly of different age,  gender,  occupations,  educational levels and marital status  (P<0.01). Age,  gender,  marital status and education level were the factors influencing the aMCI(P<0.05). Conclusion  Old age,  female,  nonspouse and the elderly with low education level are the highrisk groups of aMCI,  so early intervention should be focused on the above groups.

Correlation analysis of serum uric acid, creatinine and cystatin C levels with  neurological deficits in young stroke patients

Yu Honga, Li Jiayana, Fu Yananb

2020, 35(7):  616-619.  doi:10.3969/j.issn.1004-583X.2020.07.007

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Objective   To analyze the correlation between serum uric acid (SUA), creatinine (Cr) and cystatin C (CysC) levels and the degree of neurological deficits in young stroke patients. Methods   Forty  young patients with stroke who were hospitalized in Department of Neurology of  Beijing Pinggu Hospital  from May 2019 to December 2019 were selected as study group, and 40 healthy people who received physical examinations in the hospital were selected as  control group  during the same period. The levels of SUA, Cr, and CysC in two groups were compared by retrospective analysis of the clinical data.And at the same time, patients were divided into mild  group, moderate  group, and severe group according to National Institute of Health Stroke Scale(NIHSS). SUA, Cr, and CysC in patients with different NIHSS scores were compared.The correlation between SUA, Cr, CysC and NIHSS scores  were analyzed by linear regression. Results   The levels of SUA, Cr and CysC in study group were significantly higher than those in control group (P<0.05); SUA, Cr and CysC  of patients with different degrees of neurological deficits were different(P<0.05). With the aggravation  of neurological deficits, the  levels of SUA, Cr and CysC in patients  also gradually increased.  The results of correlation analysis showed that SUA, Cr and CysC of  young stroke patients  were significantly positively correlated with NIHSS scores (r=0.954, 0.954, 0.953, P<0.01). Multiple linear regression results showed that SUA, Cr, and CysC were all independent influencing factors of NIHSS score in young stroke patients (P<0.05). Conclusion  The  levels of SUA, Cr, and CysC in young stroke patients are significantly positively correlated with NIHSS scores, and SUA, Cr, and CysC are independent influencing factors of NIHSS score in young stroke patients. By detecting  the levels of SUA, Cr and CysC in young stroke patients, the early prediction of the degree of neurological deficits in patients  can be realized.

Occurrence and clinical analysis  of gallbladder disease in patients infected with hepatitis C virus

Yuan Huifang

2020, 35(7):  620-623.  doi:10.3969/j.issn.1004-583X.2020.07.008

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Objective  To investigate the occurrence of gallbladder disease and its related risk factors in patients with hepatitis C virus(HCV). Methods  According to the results of color  ultrasound  report, 290 cases of HCV infection were divided into the group with  gallbladder disease (169 cases) and the group without gallbladder disease(121 cases). The clinical data disease of course,  body mass index(BMI),  negative emotion,  alcoholism history, total bilirubin(TBIL),  alanine aminotransferase(ALT), aspartate aminotransferase(AST),  γglutamyl  transpeptidase (GGT), serum albumin(ALB),  triglyceride(TG),  cholesterol (TC),  HCV viral load (HCVRNA) ,  portal vein width(PVW),  thickness of spleen and ascites were analyzed.The risk factors of gallbladder disease in  HCV  infected patients were explored. Results  The total incidence of gallbladder disease in 290 cases of HCV infection was 58.28% (169/290) .The disease course,  alcoholism  history,  TG,  GGT,  PVW and thickness of spleen of the group with gallbladder disease were higher than those without gallbladder disease(P<0.05).  Logistic regression analysis showed that alcoholism,  GGT and spleen thickness were independent risk factors for gallbladder disease in HCV infected patients. Conclusion  The incidence of gallbladder disease in patients with HCV infection was 58.28%. Alcoholism,  spleen thickness and GGT were independent risk factors for gallbladder disease in patients with HCV infection.

Risk factors for expiratory flow limitation in patients with mechanical ventilation and prognosis

Hou Liyan, Jia Rujiang, Wang Jingmei

2020, 35(7):  624-627.  doi:10.3969/j.issn.1004-583X.2020.07.009

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 Objective    To evaluate the incidence of expiratory flow limitation in patients with mechanical ventilation in Intensive Care Unit,  and to identify the main clinical characteristics,  risk factors and prognostic implications associated with expiratory flow limitation. Methods    A total of 202 patients requiring mechanical ventilation in the department of intensive medicine were selected and divided into two groups by positive endexpiratory pressure (PEEP) test: the expiratory flow limitation group and the nonexpiratory flow limitation group. The respiratory mechanics indexes were measured within 12 hours after mechanical ventilation and daily for 3 days. All patients were assessed with SAPS score and Sequential Organ Failure Assessment(SOFA) score. The modified British Medical Council dyspnea score scale (mMRC) was used to assess the severity of dyspnea. Results    22.77%  of the patients were found to have expiratory flow limitation,  including 39 cases of septic shock,  25 cases of ARDS,  27 cases of hemorrhagic shock,  32 cases of acute exacerbation of chronic obstructive pulmonary disease,  45 cases of acute respiratory failure,  12 cases of heart failure and 22 cases of cerebrovascular disease with pneumonia. Patients with expiratory flow limitation had a higher body mass index (BMI). Limited expiratory velocity was associated with history of heart disease and history of chronic lung disease (all P<0.05). In terms of respiratory mechanics data,  patients with expiratory flow limitation had poor scores of dyspnea,  high maximum airway resistance and increased elastic resistance,  higher positive endexpiratory resistance pressure and endogenous endexpiratory pressure,  higher peak pressure and lower oxygenation index (all P<0.05). The SOFA scores and SAPSⅡ were higher in the expiratory flow limitation group,  and the mechanical ventilation was longer,  with higher mortality (all P<0.05). Conclusion    High BMI and a history of lung disease or heart disease are high risk factors for expiratory flow limitation in patients with mechanical ventilation in Intensive Care Unit. The respiratory parameters of patients with expiratory flow limitation were worse. Patients with expiratory flow limitation have longer mechanical ventilation time,  longer hospitalization time,  higher mortality and poor prognosis.

Relationship between local factors of esophageal cancer and prognosis of patients based on CT scan

Li Xinhai, Wang Longqing, Li Hongwei

2020, 35(7):  628-632.  doi:10.3969/j.issn.1004-583X.2020.07.010

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Objective  To explore the relationship between the local tumor factors and prognosis of esophageal cancer patients who received radical radiotherapy (chemoradiotherapy) based on CT scan. Methods  Analysis was performed in 271 patients with esophageal squamous cell carcinoma who received radical radiotherapy (chemotherapy) and were at clinical stage N0. The local tumor related factors and patients' recurrence was analyzed,  and the factors affecting longterm prognosis of patients were analyzed.Results  GTVD, GTVL, GTVV, GTVV/L and Xray angiography length were the best indicators to predict the recurrence of patients. The optimal boundary values for predicting patients' recurrence were 3.5 cm,  5.5 cm,  28.7 cm3,  4.8 cm2 and 3.5  cm,  respectively. GTVD,  GTVL, clinical T stage, presence or absence of chemotherapy and shortterm efficacy were all independent factors affecting the survival rate of patients. Age,  lesion,  GTVV/L, clinical T stage and shortterm efficacy were all independent factors affecting the  patients'  local control rate.Conclusion  Local tumor related factors of esophageal cancer have impact on the recurrence of patients with clinical N0 esophageal squamous cell carcinoma after radical radiotherapy,  among which GTVD, GTVL and GTVV/L were the independent factors affecting the prognosis.

Characteristics and correlation of sleep disorder and attention  deficit hyperactivity disorder in children with asthma

Xie Qinglinga, Liu Shujuna, Qin Lingb, Qin Haijiaob, Tan Yinga, Zhang Diwena, Li Zhongqinga, Chen Honglinga, Pang Xiaoronga

2020, 35(7):  633-638.  doi:10.3969/j.issn.1004-583X.2020.07.011

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Objective   To explore the characteristics and correlation of sleep disorders and attention deficit hyperactivity disorder in children with asthma. Methods   Thirtyfive children aged 6 to 14 with chronic duration of asthma were selected and divided into asthma basic control group and asthma noncontrol group according to the lung function and asthma control test (ACT) scores. The children's sleep disorder scale was scored and their nighttime sleep monitoring was performed. The integrated visual and auditory continuous performance test(IVACPT) and DasNaglieri cognitive assessment system (DN:CAS) were completed. Results  There were significant differences in the indicators of  Sleep Disturbances Scale for Children(SDSC) total score, disorders of initiating or maintaining sleep, sleepwake transition disorders and excessive sleep sweating between two groups (P<0.01). There were significant differences in the night sleep monitoring parameters between  two groups (P<0.05). Full scale response control quotient(FSCQ) and full scale attention quotient(FSAQ) in asthma noncontrol group detected by IVACPT were significantly lower than those in basic control group (P<0.01). Among the DN: CAS parameters, there were significant differences in planning ability(PLAN), simultaneous processing ability(SIM), attention ability(ATT), successive processing ability(SUC) and full cognition score(FS) of children between two groups(P<0.05). FSCQ and FSAQ in IVACPT parameters and PLAN, SIM, ATT, SUC and FS in DN: CAS parameters were negatively correlated with SDSC total score, disorders of initiating or maintaining sleep, sleepwake transition disorders and AHI  in the sleep parameters(all P<0.05), and positively correlated with sleep efficiency and lowest blood oxygen value (all P<0.05). Conclusion  Children with asthma are prone to sleep structure disorder and attention deficit hyperactivity disorder,  which are related to each other.

One case of antiAMPAR encephalitis combined with  myasthenia gravis and literature review

Tang Yingchao1, Li Xiaojia2, Zeng Quantao2, Ran Ningjing1, Xiao Wen1, Yang Dongdong1, Yang Xuhong1

2020, 35(7):  639-642.  doi:10.3969/j.issn.1004-583X.2020.07.012

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 This paper presented a case of antiAMPAR  encephalitis combined with myasthenia gravis who had a cognitive impairment for one week. It is not clear whether the pathogenesis of autoimmune encephalitis and myasthenia gravis with thymoma are related or similar  in consideration  by clinicians. Through the discussion, we hope to raise clinicians' attention and awareness to the disease, to avoid missed diagnosis.

One case of neonatal chylothorax and literature review

Zhang Yan, Liu Yang

2020, 35(7):  643-646.  doi:10.3969/j.issn.1004-583X.2020.07.013

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Neonatal chylothorax is a rare disease in the neonatal period,  which can lead to respiratory failure at early birth and lifethreatening complications caused by the loss of massive lymphatic fluid,  such as infection,  malnutrition and immunodeficiency. A case report and literature review were conducted on the clinical manifestations,  laboratory examination,  nonenhanced MRI application and conservative treatment of neonatal chylothorax,  so as to enhance the understanding of pediatric clinicians in the diagnosis and treatment of the disease.