Table of Content

20 March 2020, Volume 35 Issue 3

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Relationship between ARID5B gene rs10821936 polymorphism and risk of  childhood acute lymphoblastic leukemia: a systematic and metaanalysis

Chen Xianrui, Wen Hong, Huang Jianqi, Guo Biyun, Bai Haitao, Wu Jinzhun

2020, 35(3):  197-205.  doi:10.3969/j.issn.1004-583X.2020.03.001

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Objective  To explore the association between ARID5B gene rs10821936 polymorphism and the risk of childhood acute lymphoblastic leukemia (ALL).Methods  The cochrane  library, PubMed, EMCC, OVID，CNKI, VIP and Wanfang digital knowledge service platform were searched for relevant articles published in English and Chinese up to March 2019.Two researchers independently extracted data and assessed the literature.Literature bias risk assessment was also conducted.RevMan5.3 and Stata 12.0 software were used to analyze the association between gene polymorphism and  the risk of childhood ALL with risk allele frequency,  recessive,  dominant,  codominant and allele models,  respectively.Results  A total of 19 studies in 15 references were included in the metaanalysis,  including 11 542 cases in  case group and 30 205 cases in  control group. Metaanalysis results of all models showed that risk allele frequency (OR=1.77,  95%CI:1.701.85),  recessive (OR=1.94,  95%CI:1.612.23),  dominant (OR=1.92,  95%CI: 1.752.12),  codominant (OR=2.65,  95%CI:2.313.03),  and allele model (OR=1.67,  95%CI:1.491.87) were associated withthe risk of childhood ALL. According to the group analysis by race,  the dominance model (CC+TC vs TT) of Chinese population (OR=2.16,  95%CI:0.935.00) was not correlated with the susceptibility of childhood ALL,  while the subgroup analysis of other gene models was still correlated with the increased risk of ALL in children.Conclusion  ARID5B gene SNPs rsl0821936  may be associated with an increased risk of childhood ALL, but the susceptibility correlation with ALL in Chinese children remains further study.

Correlation between serum chemerin levels and degree of  atrial fibrosis in patients with atrial fibrillation

Yang Hua, Meng Limin, Xin Shuanli, Chang Chao, Zhao Xiufeng, Wang Min

2020, 35(3):  206-210.  doi:10.3969/j.issn.1004-583X.2020.03.002

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Objective  To explore the correlation between serum chemerin levels and degree of atrial fibrosis in patients with atrial fibrillation (AF). Methods  Eighty patients with  AF  undergoing CARTOguided first catheter radiofrequency ablation for paroxysmal or persistent AF were enrolled. According to the presence or absence of low voltage areas,the patients were divided into nonlowvoltage group（n=32） and lowvoltage group（n=48）. According to the range of low voltage area, the lowvoltage group was divided into three subgroups:＞5%≤20%（n=30）,＞20%≤35%（n=12）,＞35%（n=6）. Low voltage area of left atrium reflects the degree of atrial fibrosis. Enzymelinked immunosorbent assay （ELISA）  was used to determine the serum chemerin levels of patients. Results  Compared with nonlowvoltage group, serum chemerin level was significantly increased in lowvoltage group.The difference in chemerin levels between ＞5%≤20%,＞20%≤35%, and ＞35% was statistically significant (P＜0.05 for all ).  The larger the range of the low voltage area, the higher the chemerin level. Besides, correlation analysis showed that the serum chemerin level was positively correlated with the lowvoltage range（r=0.721，P＜0.01）. Conclusion  The level of serum chemerin can be used as a noninvasive index to evaluate the degree of  AF, which is helpful for clinical selection of appropriate patients and ablation.

Clinical value of serum YKL40, CCL18 and hscTnT in predicting adverse cardiovascular events in patients with acute myocardial infarction

Li Yi, Ji Gaorong

2020, 35(3):  211-215.  doi:10.3969/j.issn.1004-583X.2020.03.003

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Objective  To observe the clinical value of serum chitinase protein (YKL)40, CCchemokine ligand 18 (CCL18) and highsensitivity cardiac troponin (hscTnT) in predicting adverse  cardiovascular events in patients with acute myocardial infarction(AMI). Methods  Totally 118 patients with AMI from January 2016 to June 2018 were selected in our hospital. The serum YKL40, CCL18 and hscTnT were detected by enzymelinked immunosorbent assay. The relationship among the serum YKL40, CCL18 and hscTnT levels in patients with AMI, the degree of coronary artery stenosis and adverse events were also observed. Results  The serum YKL40, CCL18 and hscTnT levels in AMI patients rose with the increase of Gensini score.  And the serum YKL40, CCL18 and hscTnT levels in event group were significantly higher than those in nonevent  group (P<0.01). The levels of serum YKL40, CCL18 and hscTnT in patients with AMI were independent risk factors for major adverse events, and had higher sensitivity and specificity in predicting major adverse events. The combined detection in predicting major adverse events in patients with AMI had a higher diagnostic efficacy, with a sensitivity of 89.2% and a specificity of 86.4%, and the area under the curve (ACU) was significantly higher than that measured by the detection of  YKL40 (Z=3.397, P<0.01), CCL18 (Z=2.796, P<0.01), and hscTnT (Z=2.613, P<0.01),  respectively. Conclusion  The serum YKL40, CCL18 and hscTnT are indicators reflecting the severity of AMI, and have predictive effects on the occurrence of adverse events in AMI.

Treating hypertrophic obstructive cardiomyopathy with percutaneous transluminal  septal myocardiam ablation via a transradial approach

Cao Wancai1, Cao Honglei2, Zhou Guo1，Dong Zhaoqiang3

2020, 35(3):  216-220.  doi:10.3969/j.issn.1004-583X.2020.03.004

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Objective  To investigate the efficacy and safety of percutaneous transluminal septal myocardiam ablation (PTSMA) via a transradial approach in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods  The clinical data of 32 patients with HOCM who underwent PTSMA treatment via a transradial approach were retrospectively analyzed. Left ventricular outflow tract (LVOT) thickness,  left ventricular outflow tract gradient (LVOTG) and interventricular septal (IVS) thickness and other indicators were observed and compared by cardiac color Doppler ultrasonography before and six months after the surgery. The efficacy of PTSMA was evaluated,  and the occurrence of complications were observed simultaneously. Results  PTSMA were successfully performed for 32 patients. The postoperative LVOTG decreased  from (75.17±12.70)  mmHg to (32.42±7.62)  mmHg,  and the postoperative IVS thickness decreased from (26.87±4.35) mm to (17.83±3.27)  mm. The preoperative LVOT thickness increased from (6.45±2.34) mm to (11.23±3.28) mm.  Postoperative LVOTG,  LVOT width and IVS thickness were better than before surgery,  all with statistically significant differences(P<0.01). The clinical symptoms were remarkably improved. In 11 patients,   transient thirddegree atrioventricular block (AVB) occurred during operation. In two patients with postoperative delayed thirddegree AVB,  one patient received a dualchamber pacemaker. There were no complications such as radial artery occlusion,  pericardial tamponade,  hemorrhage or acute pulmonary embolism. No dead case was found.Conclusion  PTSMA is a feasible method for treating HOCM,  which can significantly decrease LVOTG and IVS thickness,  improve clinical symptoms,  and the transradial approach is relatively safe.

Effect of continuous improvement of chest pain center on PPCI in patients  with acute myocardial infarction

Xu Yanqiu, Hu Xuemin, Zhang Wei

2020, 35(3):  221-223.  doi:10.3969/j.issn.1004-583X.2020.03.005

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Objective  To investigate the effects of continuous improvement of chest pain center on key indicators of direct percutaneous coronary intervention (PPCI)  in patients with acute ST segment elevation myocardial infarction (STEMI).Methods  A total of 90 patients with acute STEMI who underwent PPCI in our hospital from December 2017 to November 2018 were enrolled. Of which, 46 patients treated in the period of December 2017May 2018 were selected as control group, and 44 patients treated in the period of JuneNovember 2018 were selected as observation group. The first ECG acquisition time, WeChat transmission ratio, bypass emergency and coronary heart disease intensive care unit (CCU) ratio, and gateball expansion (DtoB) time were compared between two groups. Results  The first ECG acquisition time and DtoB time in observation group were lower than those in  control group (P<0.05); WeChat transmission ratio, bypass emergency departmentand CCU ratio in observation group were higher than those in control group (P<0.05). Conclusion  Continuous improvement of the chest pain center can increase the WeChat transmission ratio, bypass emergency department and CCU ratio of STEMI patients, and shorten the first ECG acquisition time and DtoB time, which can win time for further treatment of STEMI patients.

Effects of indoor and outdoor working environment on inflammatory markers of cardiovascular system

Zhang Lingxia, Nie Qian, Hao Zhihua, Liu Chenghao, Wang Zhongli, Chen Feifei, Liu Huanxin

2020, 35(3):  224-227.  doi:10.3969/j.issn.1004-583X.2020.03.006

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Objective  To investigate the effects of atmospheric particulates in indoor and outdoor working environment on inflammatory markers of the cardiovascular system in healthy people. Methods  A questionnaire survey was conducted amongthe residents aged 3060 in Shijiazhuang urban area according to their work situation (indoor group and outdoor group)from October to December 2018. Physical examination (including blood pressure,height, weight and etc), carotid ultrasound, and blood tests (including oxidized low density lipoprotein ［OxLDL］, serum lipoproteinassociated phospholipase A2 ［LpLPA2］, blood lipids and etc)  were carried out on the residents who met the eligibility criteria, then the statistical results were analyzed. Results  The educational level and risk factors related to cardiovascular system diseases including abdominal circumference, hip circumference,  systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol,  and highdensity lipoprotein cholesterol in the outdoor group were significantly different from those in the indoor group（P＜0.05). Conclusion  Atmospheric particulate matter in outdoor working environment may have no significant effects on markers associated with cardiovascular diseases including OxLDL and LpLPA2. However, it can increase blood pressure, fasting blood glucose, abdominal circumference, hip circumference, BMI and decrease HDLC, which may increase the incidence of cardiovascular diseases.

Predictive value of plasma NLR, PLR and their combinedindex in prognosis of  thrombolysis in patients with  cerebral infarction

Jin Jiamin1, Ma Cuihong2, Fan Kunpeng1, Zhang Junlian1, Zhu Haibao2

2020, 35(3):  228-232.  doi:0.3969/j.issn.1004-583X.2020.03.007

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Objective  To investigate the predictivevalue of plasma neutrophilto lymphocyte ratio (NLR), plateletto lymphocyte ratio (PLR) in the prognosis of intravenous thrombolysis in patients with cerebral infarction within 24 hours. Methods  Totally 128 patients who received intravenous thrombolysis for cerebral infarction were continuously included.According to the modified Rankin scale (mRS) score after 90 days of thrombolytic therapy,  all patients were separated into good prognosis group (mRS 02 points,  75 cases) and poor prognosis group (mRS 36 points,  53 cases). General information of patients were collectedin order to measure the blood routine,  blood uric acid,  homocysteine,  blood lipidand calculate NLR and PLR after thrombolysis. Following the binary logistic regression analysis, the receiver operating characteristic curve (ROC) was used to further evaluate the predictive value for the prognosis of thrombolysis in patients with cerebral infarction. Results  There were statistically significant difference in NLR and PLR between two groups (P<0.01). Further analysis of NLR, PLR,  and their combined indicators by using ROC found that the area under the curve (AUC) for judging the prognosis of thrombolytic therapy in cerebral infarction was 0.772. When the optimal threshold was 3.755,  the sensitivity was 69.8% and the specificity was 74.7%. And the AUC measured by the detection of PLR was 0.746. When the optimal threshold  was 145.055,  the sensitivity was 64.2% and the specificity was 78.7%. The AUC measured by the combined detection of NLR and PLR was 0.781. When the critical value was 1.337,  the sensitivity was 69.8%  and the specificity was 76.5%.Conclusion  The NLR,  PLR and their combined indicators are new indicators of inflammation,  and their elevation has good predictive value for the poor prognosis of thrombolysis in patients with cerebral infarction.

Status and influencing factors of antiplatelet drug compliance in patients with ischemic stroke

Yue Zan, Wang Huijuan, Wang Binglei, Bian Xin, Li Yan, Shen Jianhua

2020, 35(3):  233-237.  doi:10.3969/j.issn.1004-583X.2020.03.008

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Objective  To investigate the status and influencing factors of antiplatelet drug compliancein patients with ischemic stroke.Methods  A total of 739 patients with ischemic stroke were consecutively selected. The general clinical data and related risk factors of those patients were recorded, then they were followed up at three, six and twelve months after discharge in order to see the conditions of drug usageand the reasons of withdrawal (or dose reduction) of antiplatelet drug. Results  The number and proportion of patients taking antiplatelet drugs at thee, six and twelve months were 677(91.61%), 635(85.93%) and 608(82.28%),  respectively.  Hypertension was the independent factor associated with antiplatelet drug compliance (OR=1.787, 95%CI=1.133, 2.817, P<0.05). And the withdrawal after the improvement of disease on one's own (20.61%) was the main reason for poor compliance.Conclusion  Antiplatelet medication compliance in patients with ischemic stroke decreases gradually as discharge timegoes on. Patients with hypertension have better compliance with antiplatelet drugs. The main reason for poor complianceis that patients stopped taking drugs by themselves after getting better.

Changes of NGAL and inflammatory cytokines in patients with type 2 diabetic nephropathy

Jiang Wenwen1, Song Yawei2, Qi Meijiao1, Li Xiaojuan3, Liu Yumei1

2020, 35(3):  238-241.  doi:10.3969/j.issn.1004-583X.2020.03.009

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Objective  To investigate the changes of neutrophil gelatinase associated lipocalin(NGAL) and inflammatory cytokines in patients with type 2 diabetes mellituskidney disease (T2DMDKD). Methods  A total of 180 patients with T2DM were selected. According to the excretion rate of urinary microalbumin, they were divided into simple diabetes group, early nephropathy group and clinical nephropathy group. And 60 healthy volunteers were selected as control group.Then the expression levels of NGAL, interleukin 6（IL6）  and tumor necrosis factor α (TNFα)  in each group were detected. Results  Before the treatment, the levels of IL6 and  TNFα in  T2DM patients were significantly higher than those in patients of control group, and the more serious the DKD was, the higher the levels of IL6 and  TNFα  were (P<0.05). The levels of fasting blood glucose (FBG), serum creatinine (SCr) and blood urea nitrogen (BUN) in T2DM patients were significantly higher than those in patients of the control group. The more severe the DKD was, the higher the levels of FPC, SCr and BUN in serum were (P<0.05). Conclusion  The expression levels of NGAL and inflammatory cytokines increaseas T2DM DKD worsens.

Analysis of risk factors for thyroid nodules in patients with type 2 diabetes mellitus

Xu Haifeng, Zhao Meng

2020, 35(3):  242-244.  doi:10.3969/j.issn.1004-583X.2020.03.010

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Objective   To investigate the prevalence of thyroid nodules in patients with type 2 diabetes mellitus (T2DM) and the related risk factors. Methods  A total of 202 patients newly diagnosed as T2DM were enrolled, including 98 patients with thyroid nodules (nodule group) and 104 patients without thyroid nodules (nonnodule group). The general dataof patients were collected, involving gender, age, height, weight, fasting blood glucose (FBG), fasting insulin (FINS), hemoglobin A1c(HbA1c), triglyceride (TG), total cholesterol (TC), highdensity lipoprotein cholesterol (HDLC), lowdensity lipoprotein cholesterol (LDLC), uric acid (UA) and thyroid nodule size. Results  The age, FINS, insulin resistant index(HOMAIR), TC, and HbA1c in nodule group were significantly higher than those in nonnodule group, the difference was statistically significant(P<0.05). The proportion of women in nodule group was higher than that in nonnodule group. And the thyroid nodule size was positively correlated with HOMAIR and age. The gender, age, TC, HOMAIR and HbA1c  were risk factors for thyroid nodules. Conclusion  Insulin resistance may be a risk factor for thyroid nodules. It is of great clinical significance to perform thyroid doppler ultrasonography on patients with newly T2DM.

Microvesicles containing mirorna21 from tubular epithelial cells promote cardiomyocyte hypertrophy

Di Jia1a, Zhou Hua1a, Li Min1a, Xu Ting1b, Zhao Jiabi2

2020, 35(3):  245-250.  doi:10.3969/j.issn.1004-583X.2020.03.011

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Objective  To investigate the effect and mechanism of microvesicles (MVs) containing miroRNA21(miR21) from tubular epithelial cells in cardiomyocyte hypertrophy.Methods  Renal tubular epithelial cells were stimulated by transforming growth factor β1 (TGFβ1),  and the conditioned medium was extracted by differential centrifugation. Renal tubular epithelial cells were labeled with DilC18 dye and the recipient cardiomyocytes were observed by fluorescence microscope. MiR21 level in MVs was detected by qPCR,  and the length and diameter of cardiomyocytes were measured by eyepiece. Bicinchoninic acid(BCA) protein kit and atrial natriuretic peptide(ANP) kit were used to detect the content of cell protein and the level of ANP. MiR21 inhibitor was transfected into recipient cardiomyocytes in advance to observe the effects on the length and diameter,  protein content and ANP level of the cells.Results  TGFβ1 could induce donor renal tubular epithelial cells to produce MVs which were then delivered into cardiomyocytes,  and the diameter,  protein content and ANP level of cardiomyocytes were significantly increased. Meanwhile,  miR21 in MVs could cause recipient cardiomyocyte hypertrophy. And pretransfection of miR21 inhibitors could inhibit MVsinduced cardiomyocyte hypertrophy.Conclusion  The damaged renal tubular epithelial cells can secrete MVs containing miR21 which can induce cardiomyocyte hypertrophy. And this may be involved in the progress of chronic kidney disease complicated with heart failure.

Effect of early enteral nutrition support on critically ill patients treated with mechanical ventilation

Zhang Junkaia, Xing Yunfeia, Mai Pujieb, Liu Ningninga, Yang Nannana

2020, 35(3):  251-254.  doi:10.3969/j.issn.1004-583X.2020.03.012

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 Objective  To investigate the effect of early enteral nutrition (EN) support on critically ill patients treated with mechanical ventilation. Methods  Seventy cases of critically ill patients were randomly divided into group A and group B,  35 cases in each group. Both groups received routine treatment. Group A received early enteral nutrition support,  and group B was given enteral nutrition support 48 h after admission. The nutritional indicators,  immunological indicators,  incidence of malnutrition,  incidence of ventilatorassociated pneumonia (VAP),  mechanical ventilation time,  and length of hospital stay were compared after treatment. Results  After treatment,  hemoglobin and serum albumin were higher in both groups than before treatment,  and higher in group A than in group B (P<0.05). After treatment,  the total serum protein was lower in both groups than before treatment,  and lower in group A than in group B (P<0.05). After treatment,  the immune function indicators were significantly improved in both groups (P<0.05). The levels of CD3+,  CD4+, and CD4+/CD8+ in the immune function indicators of group A were higher than those of group B,  and the levels of CD8+ were lower than those of group B(P<0.05). The incidence of malnutrition (8.57%) and VAP (2.86%) in group A were lower than those in group B (42.86%) and VAP (28.57%) after treatment (P<0.05). The mechanical ventilation time and length of hospital stay in group A were shorter than those in group B after treatment (P<0.05). Conclusion  In order to prevent malnutrition in critically ill patients during mechanical ventilation treatment,  it is effective to give early enteral nutrition support on the basis of conventional drug treatment.

Clinical value of serum Cla1, MK and Gal1 levels in diagnosis  of Hashimoto thyroiditis with papillary thyroid cancer

Tang Zhijin, Shen Hua, Yu Haiwen

2020, 35(3):  255-259.  doi:10.3969/j.issn.1004-583X.2020.03.013

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Objective  To observe the clinical value of serum claudin1 (Cla1), midkine (MK), and galectin1 (Gal1) levels in the diagnosis of Hashimoto thyroiditis (HT) with papillary thyroid cancer (PTC). Methods  Totally 107 HT patients with PTC in our hospital from January 2018 to December 2019 were selected as HT  with  PTC group, meanwhile, 65 HT patients and 30 healthy people examined in our hospital during the same period were selected as the HT group and the healthy control group, respectively. The serum Cla1, MK and Gal1  levels were observed in each group. And the correlation among serum Cla1, MK and Gal1 levels in HT patients with PTC, HT stage, and TNM stage were also observed, as well as its diagnostic value for  HT with PTC.Results  The serum Cla1, MK and Gal1 levels in HT with PTC group were significantly higher than those in HT group and healthy control group (P<0.01). The serum Gal1 level in HT group was obviously higher than that in health control group (P<0.01). The levels of serum  Cla1, MK and Gal1 in HT patients with PTC increased significantly with the increase of HT stage and TNM stage (P<0.01). The serum Cla1 level was positively correlated with MK and Gal1 levels in HT patients with PTC, and the serum MK was positively correlated with Gal1. The serum Cla1, MK and Gal1  levels had higher sensitivity and specificity in the diagnosis of HT with PTC. The sensitivity and specificity of the combined detection were  88.8% and 90.8%, respectively. And the AUC was 0.941, which was significantly higher than that measured by the detection of Cla1, MK and Gal1, respectively. Conclusion  The Cla1, MK and Gal1 are involved in the development of HT with PTC, which havehigher diagnostic efficacy in predicting the occurrence of  PTC  in HT patients.

Efficacy  of  Zhenqi  Fuzheng  Capsule  combined with ursodeoxycholic acid on primary biliary cholangitis and its impact  on thyroid function

Cheng Mingrong, Dai Dejian

2020, 35(3):  260-263.  doi:10.3969/j.issn.1004-583X.2020.03.014

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Objective  To observe the efficacy of  Zhenqi Fuzheng Capsule  combined with ursodeoxycholic acid on primary bile cholangitis (PBC) and its impact on the thyroid function. Methods  A total of 70 PBC patients treated in our hospital were randomly divided into observation group and control group,  with 35 cases in each group.The control group was treated with ursodeoxycholic acid,  and the observation group was treated with Zhenqi Fuzheng Capsule combined with ursodeoxycholic acid. The level changes in two groups were observed before and after the treatment in order to compare the efficacy between two groups, including the levels of the alanine aminotransferase (ALT), aspartate aminotransferase (AST),  total bilirubin (TBIL),  alkaline phosphatase (ALP),  hyaluronan acid (HA), laminin(LN),  type Ⅲ  procollagen peptide (PCⅢ),  tissue inhibitor of metalloproteinase 1 (TIMP1),  total triiodothyronine (TT3),  free triiodothyroxine (FT3),  total thyroxine (TT4) and free thyroxine (FT4).Results  The total effective rate was 97.14% in observation group,  and that was 77.14%  in control group (P<0.05). After treatment,  the levels of serum ALT,  AST,   TBIL,  ALP,  HA,  TIMP1,  LN and PCⅢ  in two groups were significantly lower than those before treatment (P<0.01),  and the levels of serumTT3,  FT3,  TT4 and FT4 were significantly higher than those before treatment (P<0.01).The decrease or increase of level in observation group was more obvious than that in control group (P<0.01). Conclusion  Zhenqi Fuzheng Capsule combined with ursodeoxycholic acid has significant effecton PBC,  which can also improvethe fibrosis of the body and relievethe hypothyroidism.

One case of NeuroBehet disease misdiagnosed as tuberculous meningitis in early stage  and literature review

Xin Zikai, Fan Jia, Hui Haixia, Bu Hui, He Junying

2020, 35(3):  264-267.  doi:10.3969/j.issn.1004-583X.2020.03.015

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NeuroBehet disease is a rare clinical disease and its clinical manifestation is  variable and complex.This disease may occur in many parts of the body. The laboratory results are lack of specificity.Cerebrospinal fluid(CSF)cytology can be characterized by neutrophil reaction and mixed cytology reaction,  which is easy to be misdiagnosed as central nervous system infectious. This paper reports a rare case of NeuroBehet  disease misdiagnosed as tuberculous meningitis in the early stageand reviews the literature in order to increase the clinicians’ understanding.