Clinical Focus

Relationship between serum uric acid level and prognosis of acute ischemic stroke: a metaanalysis

Peng Cheng1, Zhang Yuanxin1, Lin Guiying1, Lu Xiaoliang2

2020, 35(8): 677-683. doi:10.3969/j.issn.1004-583X.2020.08.001

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Objective To evaluate the relationship between serum uric acid (SUA) level and the prognosis of acute ischemic stroke. Methods Pubmed, Embase, Cochrane library databases were searched for the literatures about the relationship between SUA level and the prognosis of acute ischemic stroke from inception to November 20,2019. The reference literatures were also consulted.The odds ratio(OR) of the prognosis of acute ischemic stroke per unit of SUA level in 95% confidence interval (95%CI) was collected.After evaluating the bias analysis of included studies,a metaanalysis was performed by Stata 16.0 software. Results Fourteen studies involving 15 283 patients with acute ischemic stroke were included.Compared with the low SUA level, the high SUA level was related to the good prognosis of acute ischemic stroke（OR=1.18，95%CI，1.101.26，P=0.006）. Sensitivity analysis further identified the effects of SUA levels on the prognosis of acute ischemic stroke. Patients with good prognosis had a higher SUA level than those with poor prognosis. There was no obvious publication bias found in the metaanalysis. Conclusion This metaanalysis supports that SUA level has a protective effect on neurological prognosis after acute ischemic stroke.

Correlation of red cell distribution width with blood pressure levels, central arterial pressure

He Lianman, Liu Min, Wang Hao, Men Fansen, Wang Menglin

2020, 35(8): 684-688. doi:10.3969/j.issn.1004-583X.2020.08.002

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Objective To investigate the correlation of red cell distribution width (RDW) with blood pressure levels, central arterial pressure and blood pressure variability in patients with essential hypertension (EH). Methods A total of 531 EH patients in Henan Provincial People's Hospital were selected. With RDW quartile as the cutoff point, the patients were divided into four groups (group A1 n=138, group A2 n=137, group A3 n=132, and group A4 n=124). The blood pressure levels, central arterial pressure and blood pressure variability were compared among four groups. Results 24hour mean systolic blood pressure (SBP), daytime SBP, night SBP, and central arterial pressure of four groups showed significant difference among four groups(P<0.01). The allday coefficient of variation (CV), daytime CV, nighttime CV had significant difference among four groups (P<0.01), and group A4 was significantly higher than that of other groups. RDW was positively correlated with 24hour SBP, daytime SBP, nighttime SBP, allday CV, daytime CV, nighttime CV and central arterial pressure.Conclusion RDW was positively correlated with blood pressure, blood pressure variability and central artery pressure in patients with EH.

Difference of cardiovascular biochemical indicators among Dai, Hani and Yi in Yuanjiang county of Yunnan Province

Nian Shiyana, Feng Leib

2020, 35(8): 689-692. doi:10.3969/j.issn.1004-583X.2020.08.003

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Objective To realize the difference of cardiovascular biochemical indicators among Dai, Hani and Yi. Methods A total of 507 samples were selected randomly in Yuanjiang of Yuxi, among while 217 cases were Dai nationality, 123 cases were Hani nationality and 167 cases were Yi nationality. Statistical analysis was performed in gender, age, height, weight, smoking or drinking habits and eating habits of the targeted people. The fasting serum cholesterol(TC), highdensity lipoprotein cholesterol(HDLC), low density lipoprotein cholesterol(LDLC), uric acid（UA) and homocysteine(HCY) were tested at the same time.Results There were significant differences between physiological and biochemical indicators among three minorities and in males and females. There were also significant differences between serum homocysteine among males in various minorities and the same to females. Conclusion Differences of minorities exist in the biochemical indicators, and then reference range should be established in accordance with the national characteristics respectively.

Comparative study of urokinaseselective intracoronary thrombolysis combined with interventional therapy and direct percutaneous coronary intervention in acute ST segment elevation myocardial infarction

Li Lei, Li Huixiao

2020, 35(8): 693-696. doi:10.3969/j.issn.1004-583X.2020.08.004

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Objective To investigate the efficacy of selective intracoronary thrombolysis combined with interventional therapy and direct intracoronary intervention on acute ST segment elevation myocardial infarction(STEMI). Methods From October 2018 to October 2019, a total of 61 STEMI patients admitted to Gongyi People's Hospital were divided into control group (direct PCI, n=31) and treatment group (thrombolysis + PCI, n=30) by a randomized and singleblind method. TIMI blood flow grading, Nterminal proBtype natriuretic peptide (NTProBNP) level, left ventricular ejection fraction (LVEF) value, mortality during hospitalization, reinfarction rate and incidence of bleeding events were observed in two groups. Results After treatment, the TIMI blood flow grading　in treatment group was better than that of control group (P<0.05). Conclusion Compared with direct intracoronary thrombolysis, interventional therapy after intracoronary thrombolysis can better improve the myocardial perfusion level in patients, reduce the incidence of noreflow, improve cardiac function and not increase the incidence of bleeding during hospitalization.

Effects of smoking status on longterm cardiovascular adverse events in male patients with heart failure

Song Chunli, Liu Hongbin, Dong Wei, Ma Like, Mo Ruixing

2020, 35(8): 697-701. doi:10.3969/j.issn.1004-583X.2020.08.005

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Objective To explore the effect of smoking status on longterm cardiovascular adverse events in male patients with heart failure. Methods A total of ninetyeight male patients with heart failure diagnosed between January 2013 and June 2018 were enrolled in the study. The patients' age, body mass index, course of disease, cardiac function grading, blood pressure, heart rate, left ventricular ejection fraction (LVEF), history of underlying diseases and medication were recorded. Patients were divided into those who had never smoked, those who had quit smoking and those who were current smokers according to their smoking status. The patients were followed up for one year until June 30, 2019, and their clinical outcomes were recorded. Major cardiovascular adverse events included heart failure, death and cardiogenic death requiring hospitalization. Multivariate COX regression was used to analyze the effects of smoking status on longterm cardiovascular adverse events. Results In this study, 40 patients(40.82%) had never smoked, 39 (39.80%) had quit smoking, and 19 (19.39%) were current smokers.The difference of systolic blood pressure, diastolic blood pressure, heart rate, hypertension, type 2 diabetes mellitus, beta receptor blockers in patients with different smoking status was statistically significant(P<0.05). A oneyear followup showed there were statistically significant differences in the incidence of heart failure, allcause death and cardiac death among patients with different smoking status who required hospitalization (P<0.05C). The results of multivariate COX regression analysis showed that after excluding other factors, smoking was currently a risk factor for heart failure, allcause death and cardiogenic death requiring hospitalization(P<0.05). Conclusion At present, smoking is a risk factor for longterm hospitalization, allcause death and cardiogenic death in male patients with heart failure. Clinicians should conduct health education for patients with heart failure and urge them to quit smoking to promote their longterm prognosis.

Therapeutic effect of intravenous thrombolysis with rtPA on acute mild ischemic stroke

Yao Meifen, Xu Jianhua

2020, 35(8): 702-706. doi:10.3969/j.issn.1004-583X.2020.08.006

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目的探讨重组组织型纤溶酶原激活剂(rtPA)治疗NIHSS≤5分的轻型急性缺血性脑卒中的疗效及安全性。方法回顾性分析2018年1月-2019年4月在上海市嘉定区中心医院神经内科病房住院的发病≤4.5 h的急性缺血性脑卒中患者115例，其中基线NIHSS≤5分58例，NIHSS>5分57例。比较两组基线资料，并比较两组治疗后24 h、7 d、90 d NIHSS评分下降率及下降分值判断疗效，7 d、90 d改良Rankin's量表（mRS）评分判断预后，同时比两组间死亡比例及出血并发症发生率判断安全性。结果轻型卒中组在静脉溶栓后24 h、7 d及90 d NIHSS评分较基线NIHSS评分下降的比例均要高于非轻型卒中组，但仅在90 d NIHSS下降率上两者差异有统计学意义(P＜0.05)；轻型卒中组7 d和90 d mRS评分均要低于非轻型卒中组(P＜0.01)，轻型卒中组90 d mRS预后良好（mRS评分0~2分）的比例要显著高于非轻型卒中组(P=0.000)；轻型卒中组的出血转化率和死亡比例均要明显低于非轻型卒中组(P＜0.01)。结论对NIHSS≤5分轻型脑卒中患者进行rtPA静脉溶栓安全有效。

Characteristics of etiology and predisposing factors of acute ischemic stroke in Yi and Han nationalities of Liangshan Prefecture

Hu Jian, Dan Xia, Liu Dan, Xu Chunmei, Du Longting, Yang Bing

2020, 35(8): 707-710. doi:10.3969/j.issn.1004-583X.2020.08.007

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Objective To explore the characteristics of etiology and predisposing factors of acute ischemic stroke in Yi and Han nationalities of Liangshan Prefecture. Methods The data of all patients who met the diagnosis of acute ischemic stroke in the department of neurology of the Second People's Hospital of Liangshan Yi Autonomous Prefecture, from January 2017 to March 2019 were collected. The predisposing factors and TOAST classification of Yi and Han patients were analyzed. Results Compared with Yi group, Han group had a higher proportion of hypertension, coronary heart disease and stroke, lower proportion of rheumatic heart disease and cigarette addiction(P＜0.05).Simultaneously, Han group had higher levels of blood glucose, HDLC and lower levels of LDLC, BMI (P＜0.05). According to TOAST classification: the proportion of unexplained acute ischemic stroke in Yi group was higher than that in Han group(P＜0.05), however, aortic atherosclerotic stroke and arterial lateral occlusion stroke were dominant in both groups(P＜0.05). Conclusion The etiology and predisposing factors of acute ischemic stroke were different between Yi and Han nationalities in Liangshan Prefecture.

Therapeutic effect of vitamin D2 on type 2 diabetes complicated with cardiac autonomic neuropathy in different medication cycles

Cheng Xiangjuan, Wang Qiongkang, Li Jing

2020, 35(8): 711-713. doi:10.3969/j.issn.1004-583X.2020.08.008

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Objective To explore the effect of vitamin D2 (VD2) on type 2 diabetic cardiac autonomic neuropathy (DCAN) in different medication cycles. Methods 200 DCAN patients were randomly divided into the control group and the treatment group B1B3, both groups were given conventional treatment. The treatment group was given intramuscular injection of VD2 according to body weight, 5000 IU/kg each time, once every 2 weeks. According to different medication cycle plans, they were divided into three groups: B1, B2, and B3, and the medication time was 3 months, 6 months, and 1 year respectively. One year after treatment was the clinical end point. The efficiency was observed, and the concentration of 25hydroxyvitamin D(25［OH］D) and heart rate variability (HRV) index were observed before, at the end of treatment and one year after the end of treatment. Results At the end of treatment and one year later, the efficiency of the 1year group was higher than that of the 3month and 6month groups, the VD deficiency rate was lower than that of the 3month and 6month groups, and the heart rate variability index and 25 (OH) D level were better than those of the 3month and 6month groups (P<0.05). Conclusion VD deficiency is common in DCAN patients. VD2 is effective for DCAN, and can improve VD nutritional status and HRV indexes of patients. The curative effect of longterm treatment is better than that of shortterm treatment.

A multicenter study of antibiotic resistance characteristics of Helicobacter pylori in Shenzhen

Lu Tao1, Ni Li1, Seto Waikay1, 2, Liu Jun3, Guo Haijian3, Wu Jianwei4, Lu Zhiwu4, Li Yinpeng5, Yang Qiu5, Yu Xiqiu6

2020, 35(8): 714-718. doi:10.3969/j.issn.1004-583X.2020.08.009

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Objective To analyze the antibiotic resistance characteristics of Helicobacter pylori(H.pylori) in Shenzhen, and the eradication rate of it based on the results of antibiotic resistance. Methods Patients undergoing gastroscopy with initial treatment of 13C urea breath test (13CUBT) positive in Shenzhen from January 2017 to December 2018 were collected. H.pylori culture and antimicrobial susceptibility testing were carried out to analyze the antibiotic resistance characteristics. H.pyloriwas cured according to the drug susceptibility. The eradication rate of H.pyloribased on the antimicrobial susceptibility testing and resistance background was analyzed.Results A total of 688 H.pyloricultures were completed from January 2017 to December 2018, and the positive rate of culture was 76.9%. The antimicrobial susceptibility testing showed the antibiotic resistance rates: 1.3% for amoxicillin, 34.0% for clarithromycin, 40.5% for levofloxacin, and 90.4% for metronidazole. No resistance was observed for furazolidone and tetracycline hydrochloride. The resistance rate for multiple antibiotics was 56.1%. The eradication rate of patients with positive culture was 94.4% based on the results of antimicrobial susceptibility testing, and that of patients with negative culture was 85.4% according to the resistance background. Conclusion Shenzhen sees that the multiple antibiotics resistance rate for H.pyloriwas higher than 55%. The resistance rate of amoxicillin, furazolidone and tetracycline was low, and that of clarithromycin and levofloxacin was relatively higher. And levofloxacin had a higher resistance rate than clarithromycin. The eradication rate for H.pylori could be improved according to the results of antimicrobial susceptibility testing and the local antibiotic resistance background.

Changes and significance of CD86 expression on pDCs in patients with acute hepatitis B

Wang Xiaoling, Shen Lixian, Li Huiwen, Zhang Yaqin, Li Yao, Wu Shuna

2020, 35(8): 719-723. doi:10.3969/j.issn.1004-583X.2020.08.010

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Objective To explore the changes and functions of plasmacytoid dendritic cells (pDCs) in peripheral blood of patients with acute hepatitis B (AHB) in clinical outcome. Methods Totally 40 AHB patients (AHB group) were selected from June 2015 to May 2017. They were treated with drugs to relieve jaundice, reduce enzyme activity and protect liver. They were also given 0.5 mg oral entecavir on an empty stomach once a day. And 26 healthy people were selected as health control group (HC group). The whole blood samples were obtained from AHB group six weeks before and after the treatment, and from HC group at the time of medical examination, respectively. ELISA method was used to detect the levels of HBV DNA, HBsAg, HBeAg and liver function indexes, and flow cytometry was used to detect the frequency of pDCs and the expression level of CD86. Results After six weeks of treatment, the clinical symptoms of AHB group were significantly relieved, and the levels of serological indicators and hepatitis B markers significantly decreased(P<0.01). The negative conversion ratio of HBV DNA in AHB patients was 82.5%, the clearance rate of HBsAg was 72.5%, and the serological conversion rate of HBeAg was 75.0%. There were statistically significant differences before and after the treatment (P<0.01). The frequency of pDCs in HC group was higher than that in AHB group before the treatment. The expression level of CD86 on pDCs in AHB patients after the treatment was higher than before. CD86ABC in HC group was obviously lower than that in AHB group before the treatment. Conclusion The frequency of pDCs in peripheral blood decreased in AHB group. The CD86 on pDCs increased in AHB patients after the treatment. The expression of CD86 on pDCs in AHB patients was upregulated.

Evaluation value of RDW, NLR and hsCRP detection on the severity of acute pancreatitis

Gao Meiling1, Wang Xiaomei2

2020, 35(8): 724-726. doi:10.3969/j.issn.1004-583X.2020.08.011

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Objective To explore the evaluation value of red blood cell distribution width(RDW), neutrophiltolymphocyte ratio(NLR) and hypersensitive Creactive protein(hsCRP) levels on the severity of acute pancreatitis (AP).Methods According to the Guidelines for the Diagnosis and Treatment of Acute Pancreatitis in China (Shenyang, 2019), 175 patients with AP were divided into mild and severe groups. General information and related indicators were compared between the two groups. The evaluation value of RDW, NLR, hsCRP and combined detection for AP severity were compared. Results The RDW, NLR and hsCRP levels in the severe group were significantly higher than those in the mild group (P<0.05). RDW, NLR and hsCRP can all assess the severity of AP. The combined detection had a higher diagnostic efficiency for the assessment of AP severity, with the sensitivity and specificity of 90.9% and 90.8%, respectively, and the area under the curve (ACU) was significantly higher than that of RDW, NLR and hsCRP. ConclusionRDW, NLR and hsCRP can all assess the severity of AP to different degrees. Combined detection can improve the diagnostic efficiency of AP severity.

Expression of mirna141 in diffuse large B cell lymphoma and its relationship with prognosis

Mu Xiaohui, Ai Limei

2020, 35(8): 727-731. doi:10.3969/j.issn.1004-583X.2020.08.012

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Objective To investigate the expression of miRNA141 in diffuse large B cell lymphoma (DLBCL) and its relationship with prognosis. Methods Paraffin embedded tissue specimens of 40 patients with DLBCL admitted to the First Affiliated Hospital of Jinzhou Medical University from January 2017 to December 2019 before initial treatment were selected. The expression level of miRNA141 was detected by fluorescence realtime quantitative PCR. At the same time, the relationship between the relative expression level of miRNA141 and the clinical characteristics was investigated according to the groups of immune typing and international prognostic index (IPI score).In addition, we selected paraffin tissue samples from 20 patients with reactive hyperplasia of lymph node(RHL) matched by gender and age as the control group. Results The expression level of miRNA141 in DLBCL patients was lower than that in RHL group(P<0.05). The 2year overall survival rate (92.2%) of the group with high expression of miRNA141 in DLBCL was higher than 26.2% of the group with low expression(P=0.001). Multivariate COX model analysis showed that the low expression group of miRNA141 (P=0.009) and the international prognostic index IPI≥3 (P=0.012) were the independent prognostic factors among 40 cases of DLBCL. Conclusion The expression of miRNA141 is decreased in patients with DLBCL, and the overall survival rate of the group with high expression of miRNA141 was significantly higher than that of the group with low expression, suggesting that miRNA141 may be another marker for assisting diagnosis and evaluating prognosis.

Clinical effect of gamma globulin on children with severe mycoplasma pneumonia

Huang Guangju, Zhang Huiyu, Li Juan, Li Jia

2020, 35(8): 732-735. doi:10.3969/j.issn.1004-583X.2020.08.013

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目的探讨丙种球蛋白治疗儿童重症支原体肺炎的临床疗效。方法根据治疗方案的不同，将80例重症肺炎支原体肺炎患儿分为观察组和对照组，每组40例。对照组给予阿奇霉素等常规治疗，观察组给予丙种球蛋白+常规治疗，比较两组患儿热退时间、咳嗽消失时间、胸部CT炎症吸收时间、C反应蛋白(CRP)及D二聚体、乳酸脱氢酶（LDH）水平。结果治疗7天后，观察组总有效率高于对照组（P<0.05）。观察组患儿的退热时间短于对照组（P<0.05）。观察组咳嗽消失时间和胸部CT炎症吸收时间均短于对照组（P<0.05）。观察组CRP，D二聚体、LDH水平均低于对照组（P<0.05）。结论丙种球蛋白联合常规治疗方案对儿童重症支原体肺炎疗效更佳，可有效促进患儿临床症状恢复，缩短病程，改善预后。

Gender differences in clinical features of obsessivecompulsive disorder

Sun Zhenxiao, Yu Xiangfen

2020, 35(8): 736-739. doi:10.3969/j.issn.1004-583X.2020.08.014

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Objective To explore the gender differences in clinical features of obsessivecompulsive disorder. Methods A total of 135 patients with obsessivecompulsive disorder who were admitted to Linyi Mental Health Center from January 1, 2018 to December 31, 2019, including 85 males and 50 females, were selected.The differences in clinical features of patients with different genders were assessed by means of selfmade general survey questionnaire and obsessivecompulsive inventoryrevised(OCIR) scale. Results The age and onset age of male patients were lower than those of female patients（P＜0.01）. The rate of comorbidity generalized anxiety disorder in female patients(20.0%) was higher than 7.06% in male patients（P<0.05）.OCIR cleaning, examination, hoarding and subscale scores and total OCIR scores of female patients were higher than those of male patients（P<0.05）.The OCIR ranking and obsessive subscale scores of male patients were higher than those of femal epatients（P<0.01）.Conclusion There are gender differences in obsessivecompulsive disorder in terms of age, age of onset, comorbidity,dimensions and severity of obsessivecompulsive symptoms.

Intravascular large Bcell lymphoma with myelopathy as the first manifestation: a case report and literature review

Yu Yijiao, Du Juan, Li Wei, Cai Yiling, Zhu Lin, Lu Dongxu, Liu Li

2020, 35(8): 740-744. doi:10.3969/j.issn.1004-583X.2020.08.015

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A case of intravascular large Bcell lymphoma(IVLBCL) with myelopathy as the first manifestation and confirmed by stereotactic brain biopsy in the department of neurology of PLA Strategic Support Force Characteristic Medical Center was reported and analyzed. The diagnosis process was complicated. The myelopathy lesions were reduced after early treatment with methylprednisolone and rglobulin.The changes of intracranial lesions were multiterminal, with recurrent symptoms and progressive aggravation.The patient was finally diagnosed with a definitive brain biopsy and died in the 4th month of the course of the disease. For myelopathy lesions with unclear diagnosis and poor therapeutic effect, it is necessary to keep a high level of vigilance and conduct biopsy to the maximum extent to avoid entering the diagnostic trap.

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