Table of Content

20 September 2020, Volume 35 Issue 9

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Risk factors for composite end point events in patients with coronavirus disease 2019: a metaanalysis

Liu Ziqiang, Miao Jinfeng, Zou Qiong, Zhu Zhou

2020, 35(9):  773-782.  doi:10.3969/j.issn.1004-583X.2020.09.001

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Objective  To explore the risk factors forcomposite end point events in patients with coronavirus disease 2019 (COVID19). Methods  PubMed, EMbase, Web of Science, MedRxiv, CNKI, WanFang and VIP databases were searched to collect cohort,casecontrol and crosssectional studies on the risk factors for composite end point in patients with COVID19 from November 2019 to March 27, 2020. Composite end point events included the  admission to an intensive care unit (ICU)with the use of mechanical ventilation, or death. Metaanalysis was performed by using RevMan 5.3 and STATA 14 software. Results  A total of 8 studies involving 46 665 objects and 20 risk factors were included. The results of metaanalysis showed that: The older  males with history of hypertension, diabetes mellitus, chronic heart disease, cerebrovascular disease, tumor and smoking history, and whose CT showed bilateral lung involvement, as well as higher levels of alanine aminotransferase, glutamic oxalacetic aminotransferase,white blood cell count, neutrophils, creatinine, D dimer, prothrombin time and hypersensitive troponin I, may have higher risk of composite endpoint events. Patients with lower levels of albumin, platelet count, and lymphocyte count may have a higher risk of a composite endpoint events. Conclusion  The older patients  with preexisting medical history, the presence of heart, liver, kidney and other organ involvement, and whose  CT results suggest that bilateral lung involvement have a higher risk of composite endpoint events. Clinical attention should be paid to these patients and early intervention should be carried out.

A systematic review of hypoparathyroid cardiomyopathy

Zhang Yiran

2020, 35(9):  783-787.  doi:10.3969/j.issn.1004-583X.2020.09.002

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Objective  Hypoparathyroid cardiomyopathy,  a rare heart disease  belonging to one of the few reversible forms of dilated cardiomyopathy,  is often misdiagnosed as unexplained or refractory heart failure.  The characteristics of hypoparathyroid cardiomyopathy were explored. Methods  PubMed,  SinoMed,  and Wanfang database were searched for the cases of hypoparathyroid cardiomyopathy who met the criterion. Statistical grouping method was used to analyze the literature. And the results were reported according to the systematic review and the PRISMA statement. Results  A total of 41 patients were screened,  women were the majority (68.29%). The average age of patients was  45.5  years. And the disease could be seen in all age groups. The most common cause of parathyroid cardiomyopathy was idiopathic parathyroid hypothyroidism (78.05%),  followed by parathyroid cardiomyopathy (17.07%) due to neck surgery. All patients were diagnosed as heart failure with different degrees of hypocalcemia. 51% of patients had a history of increased neuromuscular excitability,  and 90% had decreased left ventricular ejection fraction. The rates of misdiagnosis and missed diagnosis were relatively high. Only 36% of patients were accurately diagnosed with parathyroid cardiomyopathy after admission to hospital. The correction of hypocalcemia was the key to treatment,  and 90% of patients had their heart function returned to normal after the normalization of serum calcium concentration. Conclusion  All patients with unexplained or refractory heart failure should be alert to the possibility of parathyroid cardiomyopathy.

Validity and reliability analysis of Chinese version of AntiClot Treatment Scale

Geng Yanping, Wang Lili, Gu Jian, Qi Peng, Chen Shuxia

2020, 35(9):  788-791.  doi:10.3969/j.issn.1004-583X.2020.09.003

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Objective  AntiClot Treatment Scale (ACTS) is an effective tool to evaluate patients' satisfaction with anticoagulant treatment. The scale is divided into two dimensions: burden and benefit.  The reliability and validity of the Chinese version of ACTS were evaluated. Methods  ACTS were tested for atrial fibrillation patients that had been on oral anticoagulants (OACs) therapy for more than 4 weeks by multistage sampling method. The reliability and validity of the scale were evaluated by structure validity,  internal consistency and testretest reliability. Results  ACTS data were collected in 1 379  patients. Four common factors were extracted by principal component analysis,  and the total　cumulative variance contribution rate of common factors was 67.164%. Internal consistency analysis showed that Cronbach's coefficient  α  of  ACTS  Burdens scale (13 items) and Benefits scale (4 items) were 0.823 and 0.968,  respectively. The testretest reliability analysis suggested that the intergroup correlation coefficients for ACTS Burdens and Benefits were 0.783 and 0.674,  respectively (P<0.01). Conclusion  Chinese version of ACTS has good validity and reliability,  providing a scientific assessment tool for patientreported treatment satisfaction with OACs in selftest.

Prediction of no reflow phenomenon in patients with acute myocardial infarction  undergoing coronary intervention by CHA2DS2VASc score

Sun Wei

2020, 35(9):  792-795.  doi:10.3969/j.issn.1004-583X.2020.09.004

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Objective   To verify the clinical predictive value of CHA2DS2VASc score in the absence of reflow in STsegment elevation myocardial infarction (STEMI) patients after direct  percutaneous coronary intervention (PCI). Methods   300 STEMI patients admitted to our hospital for primary PCI were divided into two groups: 27 patients without reflow as the first group, and the remaining 273 patients as the control group. CHA2DS2VASc risk score was calculated for each patient.Results  There was statistically  significant difference in multivariate analysis between CHA2DS2VASc score and nonreflow correlation (P<0.05).The components of CHA2DS2VASc score showed  significant differences in the prediction ability of nonreflow(P<0.05). ConclusionIn  STEMI patients treated with primary PCI, higher CHA2DS2VASc score was associated with the risk of no reflow and inhospital mortality.

Application value of caprini 2005 risk assessment model in patients with acute stroke

Xie Changqing, Wang Haifang, Xu Lan, Cai Jianzheng, Zhang Yingying, Yu Weixia

2020, 35(9):  796-800.  doi:10.3969/j.issn.1004-583X.2020.09.005

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Objective  To evaluate the diagnostic value and clinical operability of  Caprini 2005  Risk Assessment Model for deep venous thrombosis (DVT) in patients with acute stroke. Methods  A prospective study was conducted on 489 patients with acute stroke who were selected from First Hospital Affiliated to Soochow University from Nov. 2018 to Nov. 2019. Color Doppler ultrasound was used as the gold standard for DVT diagnosis, and Caprini 2005 Risk Assessment Model was used to assess the risk of the patients. Results  The area under curve (AUC) of receiver operating characteristic curve(ROC) of  Caprini 2005 Risk Assessment Model was 0.761（95%CI: 0.7200.798, P<0.0001).  When the  cutoff point was  11, the sensitivity and specificity were 78.87% and 66.51%, respectively. The item utilization rate of  Caprini Risk Assessment Model was 60.0%, and there were  16 evaluation items with the utilization rate of 0. Conclusion  Caprini 2005 Risk Assessment Model has moderate diagnostic  value, but its clinical operability is not good.The critical value and evaluation items of the model need to be adjusted appropriately.

Clinical characteristics and prognostic factors of extrapulmonary complications  in children with mycoplasma pneumonia

Li Bing, Zhang Guangchao, Li Xia

2020, 35(9):  801-804.  doi:10.3969/j.issn.1004-583X.2020.09.006

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Objective  To explore the clinical characteristics and prognostic factors of extrapulmonary complications in children with mycoplasma pneumonia (MPP). Methods  The clinical data of 276 cases of MPP complicated with extrapulmonary complications were retrospectively analyzed. The patients were divided into good prognosis group (169 cases) and poor prognosis group (107 cases). The clinical manifestations of extrapulmonary complications were recorded to  analyze different system damage. The singlefactor and multiplefactor analysis were conducted to analyze the risk factors that may affect the prognosis of MPP children with extrapulmonary complications. Results  Extrapulmonary complications in children occurred in digestive system and other systems,  and digestive complications accounted for the highest proportion. The singlefactor and multiplefactor analysis showed that the independent risk factors which affected the prognosis of children with MPP complicated with extrapulmonary complications were the course before admission,  CRP,  ESR,  anemia,  albumin <30 g/L,  initial usage time of azithromycin,  pulmonary consolidation,  complications involving multiple systems. Conclusion  MPP may cause multiple system complications,  and digestive system complications were the most common. The independent risk factors that affected the prognosis of MPP children with extrapulmonary complications included preadmission course,  CRP,  ESR,  anemia,  albumin < 30 g/L,  initial usage time of azithromycin,   pulmonary consolidation and complications involving multiple systems.

Clinicopathological characteristics of type Ⅳ G-NENs and analysis of risk factors affecting postoperative recurrence

Wang Yanxu, Liu Miao, Zhang Ruixing

2020, 35(9):  805-810.  doi:10.3969/j.issn.1004-583X.2020.09.007

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Objective  To explore the clinicopathological characteristics and the risk factors in postoperative recurrence of type Ⅳ GNENs. Methods  According to  GNENs pathological grading standard proposed by  World Health Organization in 2010, 69 patients with type Ⅳ GNENs were divided into GNEC group and GMANEC group. The clinicopathological characteristics and risk factors affecting postoperative recurrence of these two groups were analyzed. Results  Type Ⅳ GNENs were more common in middleaged and old men, and the symptoms at the first diagnosis were not typical. There was no statistically significant difference in the clinicopathological characteristics between GNEC and GMANEC group (P>0.05). GMANEC group was less prone to recurrence after operation than GNEC group, and the patients with adjuvant chemotherapy had better prognosis than those without chemotherapy. In patients with type Ⅳ GNENs and GMANEC, the use of EP regimen or SOX regimen for adjuvant chemotherapy had no statistically significant effect on postoperative recurrence (P>0.05). Conclusion  The clinical manifestations of patients with type Ⅳ GNENs are not typical. The clinicopathological characteristics of GNEC and GMANEC are similar. GMANEC patients have better prognosis than GNEC patients. Adjuvant chemotherapy can improve the prognosis of patients with type Ⅳ GNENs. The effects of adjuvant chemotherapy using EP or SOX regimen have no significant difference in the prognosis of patients with type Ⅳ GNENs and GMANEC.

Cut-off value of baseline unconjugated bilirubin for early lifestyle weight loss in obese people

Zhou Ye1, Jin Yong1, Wang Xuepeng1, Chen Yanshu2a, Xu Miao2a, Liu Jianing2b, Yang Xi2b, Li Li2a

2020, 35(9):  811-815.  doi:10.3969/j.issn.1004-583X.2020.09.008

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Objective  To explore the identification of baseline unconjugated bilirubin(UBiL)  cutoffs for whether the early lifestyle weight loss is up to standard in obese people. Methods  314 simple obese people who underwent weight management  were included for weight loss by recording the weight of baseline and after 3 months. The percentage of weight loss greater than 10% was defined as successful weight loss, which was divided into standard group and  nonstandard group. Binary logistic regression analysis were used to study the influencing factors for whether the weight  loss was up to standard. The sensitivity and specificity of baseline unconjugated bilirubin were evaluated for predicting weight loss by using receiver operating characteristic curve. Results  UBiL was the influencing factor of weight loss among women. ROC curve analysis showed that the area under the ROC curve of UBiL in women was 0.747(95%CI 0.622, 0.871), cutoff value was 9.50  μmol/L, and  Yoden index was 0.416. Sensitivity and specificity were  52.4% and  89.2%,  respectively. Conclusion  Baseline unconjugated bilirubin has a high specificity for predicting whether women's lifestyle weight loss is up to standard. We recommend adding drugs, weight loss surgery and other weight loss methods as soon as possible based on lifestyle weight loss，when the baseline unconjugated bilirubin is less than 9.50  μmol/L.

Correlation study between serum level of bilirubin and type 2 diabetic retinopathy

Tong Jingjing1, Shi Kexin2, Leng Fei2, Li Fengping2

2020, 35(9):  816-822.  doi:10.3969/j.issn.1004-583X.2020.09.009

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Objective  To explore  the relationship between serum levels of bilirubin  and diabetic retinopathy (DR).Methods  293 patients with type 2 diabetes admitted to  the hospital and diagnosed were selected. According to the fundus examination,  the patients were divided into nondiabetic retinopathy group (NDR) (n=146)  and diabetic retinopathy group (DR) (n=147). DR group was divided into nonproliferative diabetic retinopathy group (NPDR) (n=103) and  proliferative diabetic retinopathy group(PDR)  (n=44).The clinical data of  NDR, NPDR and PDR  groups  were analyzed and compared. According to the quartile of  total bilirubin, the groups were divided into Q1, Q2, Q3 and Q4, and the relationship between total bilirubin(TBIL) and DR prevalence was analyzed.Results  Compared with  NDR group, both  disease duration and systolic blood pressure in  NPDR group and PDR group were increased (P<0.05), and the disease duration and systolic blood pressure in PDR group were higher than those in  NPDR group (P<0.05).  Compared with  NDR group, TBIL, direct bilirubin(DBIL) and  Cpeptide 2 hours meal(2 hCP) in NPDR group and PDR group were  all decreased, and TBIL, DBIL, indirect bilirubin(IBIL) and 2 hCP  in  PDR group were lower than those in NPDR group (P<0.05). Compared with NDR group, IBIL of PDR group was lower than that of NDR group(P<0.05).Compared with NDR group, FPG, 2 hPG, HbA1c and  TC in NPDR group and PDR group were all  increased, and  FPG, 2 hPG, HbA1c and  γGGT in PDR group were higher than those in NPDR group (P<0.05).  Compared with NDR group, γGGT  in  PDR group was higher than that in  NDR group (P<0.05). Multiple  ordered  Logistic regression analysis  showed that  TBIL and 2 hCP were protective factors for DR. Duration of disease, systolic blood pressure, FPG, 2 hPG, HbA1c and γGGT were the risk factors for DR.The prevalence of DR varied with different TBIL levels. With the increase of TBIL levels, the prevalence  of   DR showed a decreasing trend(P<0.05).Conclusion  The decrease of  TBIL level is  correlated with the increased risk of DR, and can be used as a potential biomarker to predict the risk  of DR  in DM patients.For patients with low serum bilirubin, close monitoring of  2 hCP level and strengthening monitoring and management of blood glucose, HbA1c, SBP and  γGGT  are of great significance for the prevention of DR.

Clinical value of dynamic monitoring of CD4+T lymphocyte count  in  treatment of lupus nephritis

Zhang Ming1, Li Wenzhe1, Li Yingying1, Fan Minghua2, Xing Guangqun1

2020, 35(9):  823-828.  doi:10.3969/j.issn.1004-583X.2020.09.010

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Objective  To detect and evaluate the clinical value of dynamic monitoring of  CD4+T lymphocyte count in the treatment of  patients with lupus nephritis (LN). Methods  38 patients with newly diagnosed LN who had measured CD4+ T lymphocyte count at initial diagnosis and after induction therapy were selected  as our study subjects.The CD4+ T lymphocyte count at the time of initial diagnosis, after induction therapy and during maintenance therapy  were monitored.Among them, 20 cases improved the third CD4+ T lymphocyte count during maintenance therapy. The relationship between CD4+T lymphocyte count and clinical, immune indicators and  clinical infection  events in each treatment stage  was analyzed. Results The decrease of CD4+T lymphocyte count at initial diagnosis  was negatively correlated with the activity of systemic lupus erythematosus (SLE) (P=0.023). However, the relapse of CD4+T lymphocyte count reductions  during maintenance of therapy was associated with immunosuppression and high infection rate (70%). Further statistical analysis CD4+T lymphocyte count indicates shows that the area under the ROC curve (AUC) was 0.833, which reflect the prediction of infection.The sensitivity and specificity of the prediction of infection were 83.3%  and  85.7% respectively. In LN patients during maintenance treatment, 56.2% of the infections occurred within 6 months after their induction therapy. Pulmonary infection was the most common. Conclusion  The decrease of CD4+T lymphocyte count in LN patients at initial diagnosis is associated with SLE activity. For the LN patients at the maintenance therapy stage, especially in 6 months after their induction therapy, the renewed decrease of CD4+T lymphocyte count should be highly valued as a signal of infection occurrence.

Study of IL7R mutations in Tcell acute lymphoblastic leukemia

Zhang Hui, Zhu Hongsheng, Liu Wenya

2020, 35(9):  829-832.  doi:10.3969/j.issn.1004-583X.2020.09.011

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Objective  To evaluate the prevalence and impact of IL7R gene mutations in Tcell acute lymphoblastic leukemia. Methods  Bone marrow samples were collected from 125 patients with TALL,  and 125 cases of specimens were amplified,  cloned and sequenced to analysis the frequencies,  position and the type of gene mutations in IL7R. Some laboratory indexes were used to make a difference between wild type and patients who were detected with IL7R gene mutations. Results  The rate of IL7R mutation was 5.60% (7/125). All seven cases had an inframe insertion or substitution at residues P240S246 of the transmembrane domain of IL7R. Seven mutation sites were identified，including：c.727730 InsAGCCACTGCCAGG DelCTAA, c.724736 InsCCTACGGGAT DelTTACTAACCATCA,  c.732 InsGGGCCCAATATTGTGACGT DelC, c.724736InsCCTACGGGAT DelTTACTAACCATCA, c.732 InsCTAAGGTGC, c.731732 InsGGTTGTCAGAG DelAC,  c.720736 InsAAAACGGT DelTATCTTACTAACCATCA. Conclusion  Seven mutation sites were identified in this study. IL7R mutation might play an important role in the occurrence of TALL.

Relationship between nutritional status and longterm mortality of  inpatients with chronic obstructive pulmonary disease

Peng Liming, Zhou Rong

2020, 35(9):  833-836.  doi:10.3969/j.issn.1004-583X.2020.09.012

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Objective  To explore the correlation between nutritional status and longterm mortality of inpatients with chronic obstructive pulmonary disease(COPD). Methods  From January 2015 to July 2016, 82 patients with COPD were admitted to our hospital.  The clinical data of patients were collected by retrospective analysis. The patients were divided into normal nutrition group (49 cases) and malnutrition group (33 cases) according to the level of BMI.The nutritional status, pulmonary function, hospital stay and longterm mortality of  two groups were compared. Spearman correlation analysis was used to explore the relationship between the nutritional status of patients and the longterm mortality. Results  The levels of serum albumin（ALB）, prealbumin（PAB）and blood lymphocyte count（TCL） in malnutrition group were significantly lower than those in normal nutrition group（P<0.05）. The levels of peak expiratory flow（PEF）, forced expiratory volume in 1st second（FEV1）and FEV1/FVC in malnutrition group were significantly lower than those in normal nutrition group（P<0.05）. The length of hospital stay and longterm mortality of patients in malnutrition group were significantly higher than those in normal nutrition group（P<0.05）. Spearman correlation analysis showed that BMI was positively correlated with PEF, FEV1 and FEV1 / FVC of lung function（P<0.05）, and BMI was negatively correlated with longterm mortality（P<0.05）. Conclusion  The nutritional status of COPD patients is closely related to the improvement of pulmonary function and the good recovery of prognosis. The longterm mortality of malnourished patients increases.

Shortterm and longterm curative effect of pemetrexed combined  with carboplatin on advanced NSCLC

Liu Xitinga, Wu Yuqianga, Chen Zeb

2020, 35(9):  837-840.  doi:10.3969/j.issn.1004-583X.2020.09.013

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Objective   To observe the shortterm and longterm curative effect of pemetrexed combined with carboplatin on advanced nonsmall cell lung cancer (NSCLC). Methods   A total of 92 NSCLC patients treated in the hospital from June 2015 to September 2017 were selected and divided into observation group and control group by random, 46 cases in each group. Control group was given gemcitabine combined with carboplatin, while observation group received carboplatin combined with pemetrexed.The total response rate (RR) of treatment, scores of Lung Cancer Symptom Scale (LCSS) before and after treatment, 1year survival rate, mortality and recurrence rate, and the occurrence of toxic and side effects during treatment were compared between two groups. Results  RR in observation group was higher than that in control group (P<0.05). After treatment, LCSS scores in observation group were higher than those in control group (P<0.05). The 1year survival rate in observation group was higher than that in control group, while the mortality and recurrence rates were lower than those in control group (P<0.05).  The incidences of bone marrow suppression and gastrointestinal reactions in observation group were lower than those in control group (P<0.05). Conclusion  The application of pemetrexed combined with carboplatin in the treatment of advanced NSCLC has a high efficiency, which can increase the 1year survival rate, improve the quality of life, and reduce the incidence of toxic and side effects.

One case of Waldenstrom macroglobulinemia with capillary leak syndrome  after treatment with Ibrutinib and literature review

Liu Xiaojuan1, 2, Sun Xuemei2

2020, 35(9):  841-844.  doi:10.3969/j.issn.1004-583X.2020.09.014

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One senior patient diagnosed as  Waldenstrom's  macroglobulinemia(WM) for  more than four years was discussed in detail. The patient had immune pancytopenia during the course of disease and was treated with hormone for a long time. After the treatment with ibrutinib for one month,  capillary leak syndrome (CLS) appeared. The manifestations were  high fever,  dyspnea,  edema of the whole body and hypotension. Laboratory and imaging examination showed pulmonary infection,  large amount of effusion in bilateral thorax,  hypoalbuminemia,  hyponatremia,  and atrial fibrillation. In critical condition,  the patient was treated with colloidal solution and hormone to inhibit inflammatory reaction and reduce capillary permeability. After the treatment with  vasoactive drugs and other aggressive measures,  the condition still had no improvement. The case was used to explore the causes of CLS and related clinical significance.

Clinical  analysis  of  2  cases  of  hemichorea  associated  with non-ketotic hyperglycemia and  literature  review

Xu Ping

2020, 35(9):  845-849.  doi:10.3969/j.issn.1004-583X.2020.09.015

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The clinical manifestations of hemichorea associated with nonketotic hyperglycemia tend  to be diverse.Two cases of  hemichorea  associated  with nonketotic hyperglycemia were admitted  to the hospital.  Case 1 was a recurrent case,  the first presentation was focal dystonia of  the left foot with nonchoreographic movements,  and the second clinical symptom was clearly inconsistent with the imaging changes. In case 2,  there was a unilateral dancelike movement,  and MRI showed bilateral  T1  hypersignaling  lesions.This rare clinical manifestation is helpful for clinicians to further understand the disease and reduce misdiagnosis.