Table of Content

05 March 2017, Volume 32 Issue 3

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Therapy keys and advances in acute heart failure

Du Jibing，Cong Hongliang

2017, 32(3):  185-188,196.  doi:10.3969/j.issn.1004-583X.2017.03.001

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Acute heart failure is one of the most serious clinical disease， with high mortality and poor prognosis. But in recent years， there have been few reports on the progress of diagnosis and treatment of acute heart failure. With China Heart Failure Guidelines in 2014 and European Heart Failure Guidelines in 2016， some new ideas on the diagnosis and treatment of acute heart failure were put forward. In this paper， we reviewed the latest guidelines and recent literatures on the diagnosis and treatment of acute heart failure and clinical treatment progress.

Reassessment of cardiotonic drugs in heart failure

Zhao Guoyan，Sun Yuemin

2017, 32(3):  189-192,207.  doi:10.3969/j.issn.1004-583X.2017.03.002

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Cardiotonic drugs are divided into two categories of digitalis and nondigitalis drugs. Cardiotonic drugs have been used as the first choice drugs in the treatment of heart failure for more than 200 years. However， their evidence for longterm prognosis is not sufficient. Many clinical trials and post hoc analysis of the longterm efficacy of cardiotonic drugs to evaluate， the results are controversial. Due to the lack of evidencebased support， cardiotonic drugs have been used as the final choice in the treatment of heart failure.

Body fluid management in patients with chronic heart failure

Jia Xinwei

2017, 32(3):  193-196.  doi:10.3969/j.issn.1004-583X.2017.03.003

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Good body fluid management improves the long term prognosis in rehospitalization and mortality in patients with chronic heart failure. This review summarized the current recommendation in respect of body fluid management， from the monitoring to the management， in patients with congestive heart failure. For the monitoring， signs such as body weight， urine output， extent of dyspnea and edema， distention of jugular vein， and auxiliary use of echocardiography， biomarkers were discussed. For the body fluid management， problems such as the dietary， refractory edema， the use of diuretics and glucocorticoid， ultra filtration and cardiac rehabilitation were discussed.

Chronic congestive heart failure and electrolyte disturbances

Zu Xiuguang， Zheng Wuqiang， Hao Yuming

2017, 32(3):  197-200.  doi:10.3969/j.issn.1004-583X.2017.03.004

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Electrolytes are widely distributed inside and outside of cells， involved in many important functions and metabolic activities and play an important role in biological activities. Because of the neurohumoral abnormalities， less food intake，application of diuretics and ACEI/ARB，the patients with chronic congestive heart failure have always electrolyte disturbances. Studies have shown that electrolyte disturbances could result in disease aggravation， death and re-admissions. Therefore， it is very important to investigate the mechanism， complication and treatment of heart failure complicated with electrolyte disorder.

Drug treatment in heart failure with arrhythmia

Chen Fei， Liu Fan

2017, 32(3):  201-204.  doi:10.3969/j.issn.1004-583X.2017.03.005

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Heart failure usually occurs with arrhythmia in clinic. Most of antiarrhythmic drugs can inhibit conduction and contraction of the heart， so it is difficult to treat patients with heart failure and arrhythmia. This article reviews the recent literatures of the drug treatment in heart failure and arrhythmia.

Concerns in treatment of elderly hear failure

Lu Yongxin

2017, 32(3):  205-207.  doi:10.3969/j.issn.1004-583X.2017.03.006

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Heart failure management is complicated by aging， comorbidities， frailty and cognitive impairment， cachexia and so on. The paper focuses on specific recommmdations regarding monitoring and followup of the elderly with heart failure by 2016 ESC guidelines for diagnosis and treatment of acute and chronic heart failure. Discussion of treatment heart failure in elderly patients， evaluation of globalcondition and individual therapy are important. Introduction of thromboemolism  prophylaxia  in elderly patients with heart  failure. The current guidelines from evidence base for HF treatment is more limited as comorbidities were mostly an exclusion criterion in trials， management should change the way.

Correlative analysis between homocysteine and Nterminal probrain natriuretic peptide in chronic heart failure

Yin Xia1，Zhang Jingtao2

2017, 32(3):  208-211.  doi:10.3969/j.issn.1004-583X.2017.03.007

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ObjectiveTo investigate the change of homocysteine (Hcy) and Nterminal probrain natriuretic peptide (NT proBNP) in patients with chronic heart failure(CHF).MethodsThe study enrolled 122 patients with CHF who were divided  into  three  groups  according to NYHA function， NYHA Ⅱ，NYHA Ⅲ，NYHA Ⅳ. At the same time，30 healthy outpatients were selected as control group. The serum Hcy， NT proBNP and other biochemical indexes such as including blood glucose，lipids，renal function were detected. The left ventricular end diastolic diameter(LVEDD) and left ventricular ejection fraction (LVEF) were examined using ultrasound cardiogram during hospitalization. The relationship between Hcy and heart function classification was observed. Furthermore， the correlation between Hcy and NT proBNP was also observed.ResultsIn 122 patients with CHF，hyperhomocysteinemia accounting for 59.84%(73 cases)，was significantly higher than thatof control group (P<0.05) . With higher cardiac function NYHA classification，Hcy，NT proBNP and LVEDD significantly increased  (P<0.05). In CHF group，Hcy positively correlated with NT proBNP(r=0.445，P<0.05). Logistic regression analysis indcated that  hyperhomocysteinemia  is an independent risk for CHF.ConclusionHcy  and NT proBNP were positively correlated to cardiac function classification. Meanwhile， there is correlation between Hcy and NT proBNP. Hyperhomocysteinemia is an independent risk for CHF.The combined application of Hcy and NT proBNP could be effective indexes for evaluating cardiac function.

MTHFR C677T gene polymorphism and ventricular remodeling in elderly patients with heart failure

Wang Xinli1，Chen Liang2，Jiang Zifan1，Zhang Shufeng3

2017, 32(3):  212-215,219.  doi:10.3969/j.issn.1004-583X.2017.03.008

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ObjectiveTo investigate the distribution of MTHFR C677T genotypes on the subjects， and analyze its relationship to the ventricular remodeling in elderly patients with heart failure(HF). MethodsThe study involved 98 patients with HF as HF group， 40 health people from body check as normal control group. MTHFR C677T gene polymorphism was detected by PCRdirect sequencing method. Meanwhile， plasma total homocysteine（Hcy）  and brain natriuretic peptide(BNP) were measured. Left ventricular remodeling was evaluated by calculating the left ventricular enddiastolic diameter (LVDd)， left ventricular posterior wall thickness (LVPWT)， interventricular septal thickness (IVST) and left ventricular ejection fraction (LVEF)，left ventricular mass index(LVMI) of the subjects in two groups.ResultsCompared with those of control group， the genotype TT and allele T frequencies of C677T in MTHFR gene in HF group were significantly higher (P＜0.05). Hcy， LVMI and NTpro BNP in HF group were higher than those in control group (P＜0.05).In  HF group， LVMI was the highest， while LVEF was the lowest in TT genotype among three genotypes (P＜0.05).The frequencies of genotype TT and allele T in HF group with left ventricular hypertrophy (LVH) group were higher than those in HF without LVH group(P＜0.05).ConclusionThe MTHFR genotypes have correlation with the ventricular remodeling in elderly HF patients， and the patients with TT genotype or T allele are easier to develop into LVH.

Association between serum triiodothyronine level and coronary artery disease  in elderly patients with low triiodothvronine syndrome

Du Ronggui

2017, 32(3):  216-219.  doi:10.3969/j.issn.1004-583X.2017.03.009

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ObjectiveTo investigate coronary artery lesion in elderly patients with coronary artery disease(CAD) combined with low three triiodothyronine(T3）syndrome，and the correlation between T3 serum hormone levels and coronary artery lesion. MethodsA total of 275  elderly CAD patients with low T3 syndrome served as group A，275 elderly CAD patients with normal free triiodothyronine（FT3），free thyroxine（FT4），thyroid stimulating hormone （TSH）  were selected as group B（control group）. FT3，FT4 and TSH in two groups were determined. CAD was evaluated by lesion count and Gensini score was calculated according to the results of coronary arteriongraphy. ResultsTotal cholesterol and LDLC were higher in group A than in group B（P<0.05）.Serum FT3 in group A was lower than in group B（P<0.05）.Gensini score in group A was higher than in group B(P<0.05).As the characteristics of coronary artery lesion，three vessels disease incidence was higher in group A  than in  group  B（P<0.05）.In group A，severe coronary artery stenosis and complete occlusion were higher compared with those in group B（P<0.05）.Multivariate logistic regression analysis showed that low FT3 was related to number and degree of coronary artery lesions. ConclusionThe lesion of  CAD in the elderly patients with low T3 syndrome are mainly multivessel and twovessel lesion involving a wide range and higher severity.

Prediction of transforming growth factor β1 for instent restenosis in patients with coronary artery disease after percutaneous coronary intervention procedure

Qiao Xingke， Shi Yunqi， Wang Yongxin， Li Zhanquan， Hou Aijie

2017, 32(3):  220-223.  doi:10.3969/j.issn.1004-583X.2017.03.010

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ObjectiveTo discuss the significance of transforming growth factor β1 (TGFβ1) for instent restenosis(ISR) in patients with coronary disease after percutaneous coronary intervention (PCI). MethodsPCI procedure was carried out in 74 patients with coronary disease in the hospital. After the procedure， both coronary angiography and optical coherence tomography (OCT) were conducted. According to the results of coronary angiography， the patients were divided into ISR group and nonISR group. The maximal neointimal hyperplasia thickness of stent， minimal lumen area（LA）， stent crosssectional area， the neointimal hyperplasia area， the percentage of the area of the neointimal， diameter stenosis ratio were measured and calculated，respectively. The serum TGFβ1 level was detected 1 day before PCI， 24 hours， 7 days and 6 months after PCI. TGFβ1 levels after PCI in each group were compared. ResultsCompared with nonISR group， both neointimal hyperplasia thickness and area in ISR group were increased significantly. Compared with prePCI， the concentration of TGFβ1 in both ISR group and nonISR group were significantly increased 24 hours，7 days and 6 months after PCI (P＜0.01). The concentration of TGFβ1 at 24 hours 7 days and 6 months  after PCI in ISR group were obviously higher than those in nonISR group
(P＜0.01). The percentage of the area of the neointimal was positively correlated to TGFβ1. ConclusionThe concentration of TGFβ1 at 24 hours and 7 days after PCI bears close relationship to the restenosis degree.

Study of nocturnal hypertension in patients with chronic kidney disease by normal blood pressure

Li Songyanga， Chen Songb， Ma Juna， Wu Liqungb， Yi Yanga， Xuan Yia

2017, 32(3):  224-227,232.  doi:10.3969/j.issn.1004-583X.2017.03.011

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ObjectiveTo investigate the conditions of night blood pressure in patients with chronic kidney disease (CKD) by normal blood pressure and the incidence of nocturnal hypertension. MethodsA total of 236 CKD patients with normal blood pressure were selected， 69 cases male， 167 cases female， the average age (55.8±15.1)  years old. The patients were divided into CKD1 grade (1 194 cases)， GFR≥90 ml/(min·1.73 m2)，CKD2 grade (73 cases)， GFR 6089 ml/(min·1.73 m2)，CKD 35 grade (44 cases)， GFR 3059 ml/(min·1.73 m2)，1529  ml/(min·1.73 m2)，<15  ml/(min·1.73 m2)，respectively，according to the glomerular filtration rate. Fifty healthy subjects were enrolled as control group.  24 h ambulatory blood pressure was monitored in these patients by Spacelab noninvasive ambulatory blood pressure instrument made in the United States. ResultsNocturnal ambulatory blood pressure(mean)  increased in 79 cases， 33.5%(79/236 cases). But in control group，there was  no nocturnal hypertension. Mainly night time diastolic blood pressure increased，others were either systolic or diastolic blood pressure increased. Fortysix patients had hypertension only in the night. The night time systolic blood pressure of CKD patients were also corresponding increased by the increased CKD stage， but only the CKD35 phase group and CKD1 group showed significant differences(P<0.05). The night time diastolic blood pressure were no significant differences in three groups. The incidence of nocturnal hypertension in three groups were also corresponding increased by the increased CKD stage，31.1%，35.6%，36.4%，respectively. ConclusionThe incidence of nocturnal hypertension was higher in CKD patients with normal blood pressure， so ambulatory blood pressure monitoring should be performed in CKD patients， in order to find  the  nocturnal  hypertension  and other abnormal situations as well as  the evidence for clinical diagnosis and treatment.

Investigation of different vascular injuries  in newly diagnosed diabetic patients with Htype hypertension

Huang Guolan1， Yang Weihong1， Pu Liumei2

2017, 32(3):  228-232.  doi:10.3969/j.issn.1004-583X.2017.03.012

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ObjectiveTo observe different vascular injuries  in diabetic patients with Htype hypertension.  MethodsA total of 379 patients with newly diagnosed T2DM were divided into three group according to whether with Htype hypertension: T2DM+Htype hypertension group (n=110)， T2DM+nonHtype hypertension group (n=110) and T2DM group (n=159). The left ventricular structure， CIMT or with carotid atherosclerotic plaque formation were tested by ultrasonic cardiogram and color flow Doppler sonography. The LVMI， UAlb/UCr and CCr were counted. Results①The levels of SBP， DBP and Hcy in T2DM+Htype hypertension group and T2DM+nonHtype hypertension group were higher than those in T2DM group， HDLC was lower than that in T2DM group. Hcy level was higher in T2DM+Htype hypertension group than in T2DM+nonHtype hypertension group， and HDLC was significantly lower (P＜0.05 or P＜0.01); ②Compared with T2DM group， the rates of LVEF＜50%， brian damage and IMT in T2DM+Htype hypertension group and T2DM+nonHtype hypertension group were significantly increased (P＜0.05 or P＜0.01)， incidence of LVH and impaired renal function in T2DM+Htype hypertension were significantly increased (P＜0.05 or P＜0.01). The levels of LVMI， UAlb/UCr and CIMT in T2DM+Htype hypertension group and T2DM+nonHtype hypertension group were significantly higher than those in T2DM group， but the LVEF was significantly lower （P＜0.05 or P＜0.01）， the levels of LVMI， CCr， UAlb/UCr and CIMT were significantly higher in T2DM+Htype hypertension group than those in T2DM+nonHtype hypertension group， and LVEF level was significantly lower (P＜0.05).  ConclusionWhen patients are newly diagnosed with diabetes， vascular injury in different parts has formed， and Htype hypertension will aggravate the damage degree.

Relationship study between serum secreted frizzledrelated protein 5 level and diabetic nephropathy

Xu Naa， Guo Shuqina， Zhang Yunlianga， Ma Jingxuana，Wang Hea，

2017, 32(3):  233-236.  doi:10.3969/j.issn.1004-583X.2017.03.013

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ObjectiveTo investigate relationship between serum secreted frizzledrelated protein 5 (SFRP5)  and diabetic nephropathy. MethodsA total of 137 patients with type 2 diabetes mellitus were enrolled. According to urinary albumin excretion rate， all patients with type 2 diabetes mellitus  were divided into three groups: normal albuminuria group (group A， n=47)， microalbuminuria group (group B， n=45) and macroalbuminuria group (group C，n=45). The control group included 50 healthy individuals. Serum SFRP5 was determinated with ELISA method. Fasting venous blood samples were collected for glucose and lipid.Twentyfour  hour urine was also collected for UAER. Differences of indexes were compared between groups. ResultsThe level of serum SFRP5 between groups was statistically significant (P<0.05); The level of serum SFRP5 in T2DM group was significantly lower than that of the normal control group (P<0.05); The levels of serum SFRP5 in the microalbuminuria group and macroalbuminruia group were significantly higher than that of normal albuminuria group (P<0.05)， and the level of serum SFRP5 in the macroalbuminuria group was significantly higher than that of the microalbuminuria group (P<0.05). Correlation analysis showed that the levels of SFRP5 were positively correlated with DBP， CHO， TG， FBG， Fins， HOMAIR， BUN， CR and UAER， and negatively correlated with HDL， eGFR and total bilirubin. Multiple linear regression analysis showed that the levels of UAER， HOMAIR， FBG， UA， SBP and TG were independent influencing factors for SFRP5. ConclusionSerum SFRP5 gradually increases as the urinary albumin excretion rate becomes higher in patients with type 2 diabetes mellitus，both may be involved in the occurrence and development of diabetic nephropathy (DN)， and may Serum SFRP5 become a new marker of diabetic nephropathy.

Analysis of etiology and related factors in 430 cases of neonatal hyperbilirubinemia in Lanzhou area

Chen Ting1，2， Yang Xuemei1， Wu Nan1，2， Lin Lixing1

2017, 32(3):  237-240.  doi:10.3969/j.issn.1004-583X.2017.03.014

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ObjectiveTo explore the etiology and related factors of neonatal hyperbilirubinemia. MethodsThe clinical data in neonates with hyperbilirubinemia were retrospectively analyzed from January 2011 to December 2015. ResultsIn infection factors， pneumonia was considered as the first cause accounting for 33.80%， followed by sepsis accounting for 23.47%; In the noninfection factors， hemolysis was considered as the first cause accounting for 24.65%， followed by perinatal factors accounting for 16.05%. Compared with the preterm infants， the term infants had treatment and jaundice peak at later time and shorter time of hospital stay (P<0.05). Compared with the noninfection infants， the infection infants had smaller gestational age， later time of jaundice appearance and peak， lower decline rate of jaundice and shorter time of hospital (P<0.05). ConclusionInfection is a major cause of high blood bilirubin. To do a good job in perinatal care and hemolytic disease of prenatal screening， prevention of infection and improving the system of the followup after discharge can reduce high blood bilirubin and bilirubin encephalopathy.

Effects of obesity  on  mental health of  college students

Yu Qian1，Qiao Hong2

2017, 32(3):  241-244,248.  doi:10.3969/j.issn.1004-583X.2017.03.015

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ObjectiveTo study the effects of obesity on mental health through psychological investigation and analysis for providing physical and mental protection for college students. MethodsA total of 12 900 college students underwent medical examination， personality questionnaires and SCL assessment， excluding those who did not complete the questionnaire due to subjective or objective factors and finally a total of 964 obese students and 11 936 nonobese students were enrolled. ResultsCompared with nonobese students， obese students scored higher in hostility and bigotry significantly. Stratified analysis showed that overweight girls showed the increased score in interpersonal sensitivity and overweight boys showed the increased score in psychotic factor. Stratified analysis also showed that overweight undergraduates had significant change in interpersonal sensitivity， hostility and bigotry; overweight masters had significant change in interpersonal sensitivity and obsession; doctoral students had significant change in interpersonal sensitivity， hostility and anxiety (P<0.05). The number of overweight students with the scores equal or greater than three in interpersonal sensitivity and hostility significantly increased. Stratified analysis showed that the number of overweight boys with the  scores equal or greater than three in obsession was more than that of normal boys，and the number of overweight girls with the scores equal or greater than three in terror was more than that of normal girls. Besides， the number of overweight students belonging to the first category of psychological type was more than that of normal students. ConclusionObesity has effects on mental health for college students as well as study and life， which needs common concern of family， school and society.

Association study between inflammation and prognosis of patients with HuntHess ⅣⅤ grade aneurismal subarachnoid hemorrhage

Min Jie， Wu Mingcan， Yao Yuan， Yang Lei， Wang Xian， Chen Shijie

2017, 32(3):  245-248.  doi:10.3969/j.issn.1004-583X.2017.03.016

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ObjectiveTo investigate the factors on the prognosis of patients with HuntHess ⅣⅤ grade aneurismal subarachnoid hemorrhage.MethodsClinic characteristics， inflammation markers in blood and cerebrospinal fluid were investigated in 49 patients with HuntHess ⅣⅤ grade aneurismal subarachnoid hemorrhage; logistic regression was used for screening the factors  influencing the prognosis. ResultsThe treatment schemes， surgery time， Fisher classifications and postoperative complications were possibly associated with clinical outcomes (P＜0.05）; patients with different clinical outcomes had significantly different leucocytes on 1 d， 3 d and 7 d after admission(P＜0.05）; patients with different clinical outcomes had significantly different levels of CRP， but not with time; patients with different clinical outcomes had significantly different total protein and IgG in the cerebrospinal fluid (P＜0.05）; logistic regression showed that the factors influencing the prognosis were leucocytes on the seventh day， IgG in the cerebrospinal fluid and CRP on the third day， treatment scheme， Fisher classification and postoperative complication (P＜0.05）.ConclusionInflammation was possibly associated with the prognosis of patients with HuntHess ⅣⅤ grade aneurismal subarachnoid hemorrhage， treatment scheme， Fisher classification， and postoperative complication.

Special hematological manifestations of P230 BCR/ABL  positive chronic myeloid leukemia in peripheral blood

Yang Hongle， Yang Limiao， Li Yanhui， Hu Rui，Liu Xueguang， Du Huanhuan， Zhu Yun

2017, 32(3):  249-251.  doi:10.3969/j.issn.1004-583X.2017.03.017

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ObjectiveTo analyze the clinical and special laboratory features of one case with BCR/ABL P230 positive chronic myeloid leukemia (CML) patient through reviewing comprehensive literature and to identify the disease with chronic neutrophilic leukemia (CNL) and improve the level of diagnosis and treatment. MethodsLaboratory tests included routine blood examination， bone marrow，histochemical staining， chromosome examination， detection of fusion gene and analysis comprehensively. ResultsRoutine blood test did not show anemia， but increased white blood cells， platelets， many times white blood cell classification: neutrophil all >0.86. The bone marrow showed very active and active proliferation of nuclear cells， and the proliferation of the cells in the middle and late stage， and eosinophils and basophils easily seen. Tissue chemical staining of alkali phosphatase was negative. Ph chromosome positive， t(9; 22) (q34; q11)，BCR breakpoint was in the μ BCR，with the corresponding BCR of e19a2，coding protein was P230. ConclusionThe Ph+BCR gene rearrangement should be diagnosed CML， and not  diagnosed as CNL， no Ph chromosome and BCR/ABL fusion gene is the real CNL.

Diagnotic value of interferongamma in pleural for tuberculous pleural effusion: a metaanalysis

Li Huimin，Ma Qingguang， Li Hongying

2017, 32(3):  252-258.  doi:10.3969/j.issn.1004-583X.2017.03.018

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ObjectiveTo  evaluate the value of interferon gamma(IFNγ) measurements in the diagnosis of tuberculous pleural effusion. MethodsA systematic review was conducted in  CNKI， WANFANG DATA， Pubmed， Cochrane library， CBM and EMbase to identify studies on the evaluation of the diagnosis accuracy of  IFNγ for tuberculous pleurisy effusion from inception to July 2016. Metaanalysis was performed using MetaDisc software provided by Cochrane Collaboration， and the heterogeneity was evaluated. Finally， 27 papers were included. ResultsThe summary estimates for IFNγ in the diagnosis of tuberculous pleurisy effusion were sensitivity (SEN) 0.91(95%CI  0.890.93)， specidicity 0.96(95%CI=0.950.97)， positive likelihood ratio (+LR) 20.26(95%CI  13.1631.19)， negative likelihood ratio (-LR) 0.1(95%CI  0.080.14)，diagnostic odds ratio 250.8(95%CI  138.7453.41) and the area under the SROC was 0.9816. ConclusionIFN γ  in pleural effusion plays a valuable role in the diagnosis of tuberculous pleurisy effusion.