Table of Content

20 October 2020, Volume 35 Issue 10

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Metaanalysis of the application of Xuebijing injection as an adjuvant in the western routine treatment of severe communityacquired pneumonia

Sun Zhonghua, Xu Chi, Wang Yue, Liu Lijie, Li Bangbang, Liu Xuejuan

2020, 35(10):  869-875.  doi:10.3969/j.issn.1004-583X.2020.10.001

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Objective  To systematically evaluate the efficacy and safety of Xuebijing injection as an adjuvant in the western routine treatment of severe communityacquired pneumonia(SCAP). Methods  PubMed,  EMBASE,  Cochrane Library,  CNKI,  Wanfang Data,  VIP and other databases were searched by computer. The retrieval time was from the establishment of the database to March 2020. According to the set inclusion and exclusion criteria,  relevant literature were screened. The methodological quality of the included RCTs was evaluated by the risk bias assessment tool,  and the Metadata analysis was performed on the extracted data using Review Manager 5.3 analysis software. Results   A total of 9 articles were included,  involving a total of 1 410 patients,  including 703 in  experimental group and 707 in control group. Meta analysis showed that compared with the western routine treatment of  SCAP,  the application of Xuebijing injection as an adjuvant treatment on the basis of  western routine medicine treatment improved  the total effective rate (RR=1.29,  95%CI［1.20,  1.38］,  P<0.01),  reduced  the leukocyte count (WMD=-3.30,  95%CI［-3.69, -2.91］, P<0.01),  decrease the level of Creactive protein(WMD=-4.45,  95%CI［-8.16,  -0.74］, P=0.002),  lowered the comprehensive score APACHE Ⅱ (WMD=-0.97,  95%CI［-1.32, - 0.61］, P<0.01),  lessened mechanical ventilation time (WMD=-87.36,  95%CI［-173.91, -0.80］,  P=0.05),  cut down ICU hospitalization time (WMD=-66.44,  95%CI［-122.38, -10.51］,  P=0.02). Only 3 articles reported the occurrence of adverse reactions. The results showed that the treatment of  SCAP with Xuebijing injection on the basis of the western routine treatment may occur including skin itching,  dizziness and headache,  diarrhea,  upper extremity pain and allergic reactions,  with the incidence of  1.6%. Conclusion  Treating  SCAP with Xuebijing injection can improve the clinical effect,  reduce the ICU hospitalization time and improve the quality of life. However,  due to the limitations of the included literature in this study,  the results of metaanalysis are only for clinical reference.

Analysis of clinical and epidemiological characteristics of a cluster case of COVID-19  patients

Ye Chanyuan, Zhang Xiaoli, Lian Jiangshan, Jia Hongyu, Yang Yida

2020, 35(10):  876-879.  doi:10.3969/j.issn.1004-583X.2020.10.002

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Objective  To analyze the clinical manifestations and epidemiological characteristics of a cluster case of COVID19 caused by a large religious gathering  in Zhejiang, and to strengthen the awareness  of  the clustering and outbreak epidemic of the COVID19 infection,  so as to effectively control its spread. Methods  21 cases of pneumonia  in the clustered incidence of COVID19 in Zhejiang from January to February 2020 were collected and the clinical and epidemiological characteristics were analyzed  retrospectively. Results  All 21 patients were middleaged and elderly women,  aged (58.94±7.45) years,  10(47.6%)  had basic diseases,  only one patient was diagnosed as a severe case,  and the rest were mild cases, and no patients died during this period. The most common symptoms at the time of onset were fever (19 ［90.5%］),  cough (15［71.4%］),  sputum (9［42.8%］),  rare symptoms included fatigue (1［4.7%］),  diarrhea (1［4.7%］)  and headache (1［4.7%］),  the median time from exposure to disease onset was 7(311.5)  days.  At admission,  albumin  decreased  in  57.14%(12/21),  sodium  decreased in 42.85%(9/21),  urea nitrogen  decreased in  38.09%(8/21),  and lymphopenia  decreased  in  28.57%(6/21). 14.28%(3/21) of patients had decreased potassium and leukocytes. In addition,  patients with elevated blood glucose, Creactive protein,  serum lactate dehydrogenase and transaminase accounted for 61.90%（13/21）, 61.90%（13/21）, 33.33%（7/21）  and  23.80%（5/21）, respectively. All patients had abnormal changes in lung CT examination at admission,  and the  imaging findings were mostly bilateral lung infections with ground glass/spotlike changes. Conclusion  The onset of this cluster case is mainly among  elderly women. Group aggregation can lead to the spread of COVID19,  and the elderly people are more susceptible. Largescale gatherings should be restricted during unusual periods to reduce personnel mobility and contact,  thus contributing to disease control.

Analysis of CT imaging characteristics of 64 patients with novel coronavirus pneumonia

Zou Yuyan1, Feng Pingyong2, Liang Kangning3, Wang Lidong4, Tian Ronghua1, Deng Lanting1

2020, 35(10):  880-884.  doi:10.3969/j.issn.1004-583X.2020.10.003

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Objective  To analyze the CT manifestation of the chest thinlayer CT of patients with Coronavirus Disease 2019(COVID19),  analyze its evolution process,  familiarize with the CT manifestations of the lungs,  and to understand the characteristics of the course of the disease. Methods  The data of 64 patients diagnosed with COVID19 by nucleic acid detection in our hospital from January 2020 to March 2020 were collected,  and the chest thinlayer CT manifestation was analyzed. All 64 patients underwent 5 chest CT scans,  4 cases of which showed no abnormalities in lung CT,  and the CT evolution characteristics of the other 60 patients were studied. Results  The CT findings of Covid19 were variable,  and the main manifestations were asymmetric distribution of both lungs,  consolidation under pleura or ground glass density shadow. At first,  the paving stone sign was more common,  and then it changed to the blur shadow and the strip shadow. In this group of patients,  lung lesions increased significantly in the first and second weeks after the onset of symptoms. Subsequently,  the CT scores of the lungs gradually decreased,  and the CT scores of the lower lobes of both lungs were higher,  followed by the upper lobe of the right lung,  and the upper lobe of the left lung had the lowest CT score. Conclusion  In most cases of COVID19,  the lung lesions disappeared completely in about 28 days,  but we needed  to follow up with large samples for a long time to observe whether the lungs would have irreversible damage.

Change of serum vaspin level in patients with unstable angina and correlation with vascular endothelial cell adhesion molecules

Liu Haining, Pu Dongyu, Bi Fangjie, Yin Bo

2020, 35(10):  885-889.  doi:10.3969/j.issn.1004-583X.2020.10.004

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Objective  To observe the serum levels of visceral adipose tissuederived serine protease inhibitor (Vaspin) in patients with unstable angina (UA) and to explore the correlation between serum Vaspin and soluble vascular cell adhesion molecule1 (sVCAM1),  soluble intercellular cell adhesion molecule1 (sICAM1). Methods  Quantitative sandwich enzymelinked immunoassay technology was used to detect the changes of serum Vaspin,  sVCAM1 and sICAM1 levels in 90 patients with UA(UA group),  90 patients with stable angina (SA group) and 80 healthy subjects (control group). Other clinical biochemical indicators were routinely detected at the same time. In UA group,  the relationships between serum Vaspin and sVCAM1,  sICAM1,  highsensitivity Creactive protein (hsCRP) and other biochemical indicators were analyzed by Pearson correlation analysis. Results  The levels of serum sVCAM1 and sICAM1 in  UA group were significantly higher than those in SA group（respectively P＜0.01）  and  control group（respectively P＜0.01）. Serum Vaspin levels in  UA group were significantly negatively correlated with sVCAM1 (r＝0.354，P=0.001),  sICAM1 (r＝0.287，P=0.006), and hsCRP (r＝0.3111，P=0.003) levels. Conclusion  The levels of serum Vaspin in patients with UA are significantly decreased,  and are negatively correlated with sVCAM1,  sICAM1 and hsCRP,  suggesting that serum Vaspin is closely related to vascular endothelial damage and the severity of coronary artery disease,  and may be important biomarkers of  UA  in patients.

Risk factors for left heart failure in patients with acute myocardial infarction  and right coronary artery as culprit blood vessel

Wang Ke1, Xuan Jingjing2

2020, 35(10):  890-894.  doi:10.3969/j.issn.1004-583X.2020.10.005

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Objective  To explore the risk factors for left heart failure in patients with acute myocardial infarction and right coronary artery as culprit blood vessel. Methods  From January 2017 to January 2020,  550 patients with acute myocardial infarction and right coronary artery as culprit blood vessel  confirmed by coronary angiography were selected from the First Affiliated Hospital of Henan University of Chinese Medicine. According to whether there was heart failure,  they were divided into heart failure group (n=120) and non heart failure group (n=430). The basic information,  laboratory tests,  medical history,  coronary angiography,  treatment options,  complications and other situations of  two groups were analyzed and compared  to explore the relevant risk factors of left heart failure. Results  The risks factors for the left heart failure in patients with acute myocardial infarction included many factors,  such as age,  the highest value of cTnI and CKMB,  percentage of STsegment resolution of ECG after emergency revascularization,  LAD lesion,  rightdominant type,  number of coronary artery lesions,  selective revascularization,  and the occurrence of arrhythmia and cardiogenic shock (P＜0.05). Conclusion  After the hospital admission of patients with acute myocardial infarction and right coronary artery as culprit blood vessel,  the general data of patients should be mastered in order to timely assess the highest values of cTnI and CKMB,  the percentage of STsegment resolution in ECG after emergency revascularization,  LAD lesions,  whether the artery is rightdominant,  the number of coronary artery lesions,  selective revascularization,  and whether arrhythmia and cardiogenic shock occur. When necessary,  timely response measures should be taken to reduce the risk of left heart failure and improve the prognosis of patients,  which is of great significance in clinical treatment.

Risk factors for oneyear poor prognosis in acute cerebral infarction patients

Xu Lihua, Wang Yongjun, Gao Suying, Yu Kai, Yang Hongna, He Yan, Geng Song

2020, 35(10):  895-899.  doi:10.3969/j.issn.1004-583X.2020.10.006

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Objective  To study the risk factors for oneyear poor prognosis in patients with acute cerebral infarction (ACI). Methods  From January 20,  2014 to December 30,  2017,   3 252 ACI patients who were admitted to hospital continuously and met the inclusion criteria were selected. They were divided into good prognosis group (mRs score≤2),  poor prognosis group (mRs score > 2) according to the modified Rankin scale (mRs) of oneyear followup. The former involved  2 912  patients,  and the latter included 340 patients.  The risk factors related to oneyear poor prognosis of ACI patients were analyzed. Results  There were statistically significant differences between poor prognosis group and good prognosis group in terms of  age,  history of diabetes,  hyperlipidemia,  stroke,  atrial fibrillation,  coronary heart disease,  smoking,  drinking,  carotid artery plaque formation and antiplatelet drug use,  education degree,  systolic blood pressure,  fasting glucose,  triglycerides,  highdensity lipoprotein cholesterol,  lipoprotein a,   creatinine,  cystatin C,  prothrombin time,  international standardization rate,  fibrinogen,  homocysteine and NIHSS score within 24hours of admission (P<0.05). Multivariate Logistic regression analysis showed that the independent risk factors for oneyear poor prognosis in ACI patients were age,  previous stroke,  systolic blood pressure,  creatinine,  fibrinogen,  and NIHSS score within 24 hours of admission. Conclusion  The independent risk factors for oneyear poor prognosis in ACI patients included age of onset,  previous stroke,  systolic blood pressure,  creatinine,  fibrinogen,  and NIHSS score within 24 hours of  admission. Early identification and attention to the population with poor prognosis and active prevention can reduce the risk of poor prognosis.

Effect of somatosensory games on  cognition and gait of patients with Parkinson's disease

Xia Min1,2, Jiang Yijing1, Zheng Dezhong1,2, Wang Huixing1,2, Zhan Zengtu1, Lin Zhicheng1

2020, 35(10):  900-903.  doi:10.3969/j.issn.1004-583X.2020.10.007

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Objective  To investigate the effect of somatosensory games on the cognition and gait of patients with Parkinson's disease (PD). Methods   From June 2018 to January 2020, 35 PD patients were randomly divided into  control group (n=17) and  experimental group (n=18), among which 5 cases fell out, leaving 15 patients in each of two groups. Control group received four weeks of traditional gait training, while  experimental group received four weeks of additional game training on the basis of traditional gait training. Before and after treatment, Unified Parkinson's Disease Rating ScaleⅢ (UPDRSⅢ), Berg Balance Scale (BBS), Montreal Cognitive Assessment MoCA, doubletest the time up and go TUGTDT, and 10meter walking test were used to score PD patients. The intervention was completed in 30 patients, including 15 in  control group and 15 in  experimental group. Results  The UPDRSⅢ, BBS and TUGTDT scores of  experimental group and  control group were improved after treatment compared with before treatment(P<0.05), and  experimental group was better than  control group (P<0.05); In  experimental group, 10meter walking test and MoCA score improved after treatment compared with before treatment (P<0.05). Conclusion  Traditional gait training combined with games can improve the gait, balance and cognition of PD patients more than traditional gait training alone.

Effects of female healthy donor characteristics on CD34+ cells and immune cells in the mixed collection

Shang Bofei, Sun Yuqian, Wang Xinyu, Chang Yingjun, Liu Yanrong, Wang Yu, Huang Xiaojun, Zhao Xiaosu

2020, 35(10):  904-908.  doi:10.3969/j.issn.1004-583X.2020.10.008

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Objective  To investigate the effects of female healthy donor characteristics on the components of hematopoietic cells and immune cells from a mixture of bone marrow and peripheral blood collection preactivated by granulocyte colonystimulating factor (GCSF). Methods  A total of 111 healthy female donors were mobilized with GCSF to determine the number of CD34+ cells and Tcell subsets in a mixture of bone marrow and peripheral blood by flow cytometry. The effects of pregnancy,  age,  height and other donor characteristics on the cell components in bone marrow and peripheral blood collection were analyzed.Results  The median values of CD34+cells,  CD3+T cells,  CD3+CD4+T cells,  CD3+CD8+T cells and CD3+CD4-CD8- regulatory T cells in the mixture of bone marrow and peripheral blood samples from 111 healthy female donors were 2.39×106,  226.57×106,  120.80×106,  89.99×106 and 15.05×106 per kg of donor body weight,  respectively.① Age had an effect on the number of CD3+CD4-CD8-T cells in the mixed allografts.② Body mass index (BMI) had an effect on the number of CD3+T cells and CD3+CD4-CD8-T cells in the mixed collection.③The number of CD3+T cells,  CD3+CD4+T cells and CD3+CD8+T cells in the mixture was affected by lymphocyte (LYM) counts on the day of peripheral blood stem cell collection.④The number of CD3+T cells and CD3+CD4-CD8-T cells in the mixture was affected by lymphocyte counts on the day of bone marrow stem cell collection.⑤Compared with pregnant donors, the mixed collection of non pregnant donors contained a higher number of CD3+CD8+T cells. Conclusion  Donor age,  BMI, pregnancy status and LYM on the day of bone marrow stem cells and peripheral blood stem cells were the main influencing factors of bone marrow immunohistochemical components.

Influence of TKIs on proliferation of CD19 CAR-T cells in  refractory/relapsed Ph+ acute lymphoblastic leukemia

Lyu Cuicui, Li Xin, Li Qing, Mu Juan, Wang Jia, Yuan Ting, Jiang Yanyu, Deng Qi

2020, 35(10):  909-913.  doi:10.3969/j.issn.1004-583X.2020.10.009

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Objective  To observe the influence of tyrosine kinase inhibitors (TKIs) on the proliferation,  efficacy and adverse reactions (AEs) of CD19 CART cells in refractory/relapsed Ph+ acute lymphoblastic leukemia (Ph+ ALL).Methods  Ten patients with refractory/relapsed Ph+ ALL (TKIs group) and 16 patients with refractory/relapsed Phnegative BALL (nonTKIs group) were collected,  and TKIs group was given TKIs orally. CD19 CART cells were detected  in peripheral blood at 0,  4,  7,  14,  21 and 28  days after infusion, and the clinical efficacy and AEs of  two groups  were analyzed. Results  The peak value of CD19 CART cells in peripheral blood in TKIs group was higher than that in nonTKIs group,  with statistically  significant differences between the two groups (P=0.0037). There were no statistically  significant differences in cytokine  peak, cytokine release syndrome (CRS) grading,  the complete response (CR) rate at day 14,  overall survival (OS) rate  and diseasefree survival (DFS)  rate  between the two groups (P>0.05). Conclusion  TKIs promoted the proliferation of CD19 CART cells in refractory/relapsed Ph+ ALL,  without inhibiting the clinical efficacy of CD19 CART cells and aggravating AEs,  which showed positively shortterm and longterm effects.

Analysis of  blood pressure morphology and clinical effect in patients with chronic renal disease

Wu Peng, Zhang Jiachen, Shen Lei

2020, 35(10):  914-921.  doi:10.3969/j.issn.1004-583X.2020.10.010

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Objective  To study the morphological characteristics of blood pressure in patients with chronic kidney disease (CKD) and the clinical effect of  antihypertensive drugs before bedtime on patients. Methods  The dynamic blood pressure data and clinical indicators of 182 CKD patients with hypertension who were hospitalized  from January 2018 to September 2019 were collected to describe the characteristics of patients  blood pressure  circadian rhythm and the distribution of special blood pressure types. The clinical  effect of taking antihypertensive drugs before bedtime on patients  were analyzed. Results  There were significant differences in age, 24hour systolic blood pressure, daytime systolic blood pressure and night systolic blood pressure among patients with different CKD stages. The pattern of blood pressure in CKD patients with hypertension was mainly  nondipper. Compared with the patients in  dippertype  blood pressure  group, the patients with nondipper or antidipper had higher age, higher hypersensitive Creactive protein (HSCRP) and lower hemoglobin. Multivariate regression analysis showed that age and HSCRP were independent risk factors for abnormal blood pressure rhythm. The blood pressure control rate of the patients in the  clinic  was  25.3%, the dynamic blood pressure control rate was 14.3%, the average control rate was 5.5%, and the uncontrolled blood pressure rate at  night  was 83.5%. 19.8% of the patients had masked hypertension, and whitecoat hypertension  was found in  8.8% of the patients. The 24hour urine protein and serum uric acid were significantly improved in patients who took antihypertensive drugs before going to bed for three months (P<0.05). Conclusion  The main pattern of blood pressure in patients with CKD complicated with hypertension is nondipper. Age and HSCRP are independent risk factors for abnormal blood pressure rhythm. Patients with lower hemoglobin are more likely to develop nondipper blood pressure. Taking antihypertensive drugs before bedtime may reduce urine protein and serum uric acid by restoring the circadian rhythm of blood pressure.

Correlation between level of serum klotho protein,  FGF23 and nutritional status of peritoneal dialysis patients

Yao Can, Wang Rongzhen, Liu Tianxi

2020, 35(10):  922-926.  doi:10.3969/j.issn.1004-583X.2020.10.011

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Objective  To investigate the relationship between the level of serum klotho protein,  FGF23 and nutritional status of patients with maintenance peritoneal dialysis. Methods  A total of 54 patients with continuous ambulate peritoneal dialysis（CAPD）  treated in our hospital from January 2018 to January 2019 were selected as the study subjects. CAPD patients were divided into three groups according to the Modified Quantitative Subjective Global Assessment (MQsGA).Group A: wellnourished group; Group B: the mild to moderate malnutrition group; Group C: the severe malnutrition group. Serum levels of klotho protein and FGF23 were detected by ELISA. Results  The incidence of CAPD combined with malnutrition in the center was 59.2%,  and the incidence of severe malnutrition was 16.7%. Compared with the wellnourished group,  there were statistically significant differences in the levels of albumin,  creatinine,  hemoglobin,  CRP,  PTH,  BMI,  MAMC,  klotho and FGF23 in the mild to moderate malnutrition group and the severe malnutrition group. There were statistically significant differences in albumin,  creatinine,  hemoglobin,  PTH,  klotho and FGF23 between the severe malnutrition group and the mild to moderate malnutrition group. Correlation analysis showed that  MQsGA score was negatively correlated with the levels of creatinine,  hemoglobin,  albumin and  klotho,  while positively correlated with the levels of CRP,  FGF23  and PTH. Multiple linear regression analysis showed that the levels of klotho and FGF23 were correlated with the nutritional status of peritoneal dialysis. Conclusion  Patients with peritoneal dialysis have a higher incidence of malnutrition. Serum klotho and FGF23 levels are closely related to the nutritional status of patients,  and serum klotho and FGF23 levels are independent risk factors for the nutritional status of peritoneal dialysis patients.

Risk factors of death in dermatomyositis/polymyositis

Huang Hua, Peng Chenxing, Chen Yubin

2020, 35(10):  927-930.  doi:10.3969/j.issn.1004-583X.2020.10.012

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Objective  To retrospectively summarize the clinical characteristics of patients with dermatomyositis (DM)/polymyositis (PM),  and analyze the independent risk factors of death in DM/PM. Methods  The clinical data of  212 patients who had their first consultation in the Second Hospital of Hebei Medical University from January 2016 to September 2019 and met the idiopathic inflammatory myositis(IIM) classification and diagnosis criteria recommended by the international myopathy cooperation group in 2004 were retrospectively analyzed. The patients were divided into research group (death group) and control group (nondeath group) according to whether they died within half a year or not. The differences in clinical characteristics of patients and laboratory examination between these two groups were analyzed to summarize the independent death risk factors of DM/PM. Results  Two groups showed significant difference in male,  albumin(ALB)<35 g/L,  ferritin increased,  positive antiMDA5 antibody,  pulmonary infection,  interstitial lung disease(P<0.05). Logistic regression analysis showed that  ALB<35  g/L,  ferritin increase,  positive antiMDA5 antibody,  pulmonary infection and interstitial lung disease  closely related to death in DM/PM( P<0.05). Conclusion  Male,  albumin (ALB) <35g/L,   ferritin  increase,  positive antiMDA5 antibody,  pulmonary infection,  and interstitial lung disease were independent risk factors of death in DM/PM,  and suggested poor prognosis.

Risk factors  for  HenochSchonlein Purpura in children with abdominal pain as initial symptom

Chen Fengxiu, Ye Hong, Wang Shibiao, Liu Guanghua

2020, 35(10):  931-934.  doi:10.3969/j.issn.1004-583X.2020.10.013

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Objective  To analyze the clinical characteristics of HenochSchonlein Purpura (HSP) in children with abdominal pain as initial symptom, to explore its associated risk factors. Methods  A total of 168 cases of abdominal type of HSP were included.According to whether abdominal pain  was the initial symptom,  they were divided into case group 55 cases and control group 113 cases. In  case group, abdominal pain was the  initial symptom, while in control group, skin rash appeared before abdominal pain. The independent risk factors of HSP  in children with abdominal pain as the initial symptom were explored. Results  In 168 cases of  children with abdominal  HSP,  abdominal pain as the initial symptom accounted for  32.7%(55/168). The rash lagged  behind the onset of abdominal pain for a time range of 1 to 20 days. Significant differences between two groups included fecal occult blood test, admission  body  weight, leukocyte count, platelet count, total protein, albumin and Ddimer. Logistic regression model analysis showed that Ddimer  was  an independent risk factor for HSP children with abdominal pain as initial symptom. Conclusion  For children  with abdominal pain and increased Ddimer, the possibility of  abdominal  HSP should be warned. Ddimer has certain reference value for the  early diagnosis of HSP with abdominal pain as initial symptom.

Rheumatoid arthritis with acute fibrinous and organizing pneumonia as initial manifestation  literature--a case report with review

Jiao Xiaodan, Zhao Jing, Yuan Yadong

2020, 35(10):  935-938.  doi:10.3969/j.issn.1004-583X.2020.10.014

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One case of rheumatoid arthritis (RA) with acute fibrinous and organizing pneumonia (AFOP) was admitted.  The clinical manifestations of this patient were mainly fever,  hypoxemia,  dyspnea,   some dry and wet rales in the lungs,  chest CT manifestation for lung consolidation and a little pleural effusion. The rheumatoid factors and antiCCP antibody greatly increased. “Fiber ball” was seen by CTguided pulmonary biopsy. The patient was diagnosed as RArelated AFOP. And lesions absorption improved after the hormone therapy. AFOP,  a rare clinical disease with high mortality,  is easy to be diagnosed as severe pneumonia. Lung pathology is the gold standard for the diagnosis of AFOP,  hormone is the main therapeutic schedule for the disease,  and  early confirmed diagnosis is the key to  prognosis.