Clinical Focus

Meta analysis of the influence of DRD3 Ser9Gly variant on correlation for essential tremor

Zhang Jiang, Tian Xianjie, Wang Dali

2020, 35(6): 485-491. doi:10.3969/j.issn.1004-583X.2020.06.001

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Objective To systematically review the correlation between DRD3 Ser9Gly variant and the risk of essential tremor.Methods PubMed, Web of Science, CNKI, WanFang Data, VIP database and Chinese Biomedical Literature Database were searched to collect case control studies on the DRD3 Ser9Gly polymorphism and primary open angle glaucoma from inception to September 30th, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta analysis was performed by Stata 14.0 software. Results A total of 8 studies were included, which involved 1 456 cases and 1 651 controls. The results of meta analysis showed that individuals that carried GG+GA genotype risked more with essential tremor than those carried AA genotype (OR=1.16, 95%CI［1.00, 1.35］, P=0.043);Subgroup analysis based on race showed that significant correlation between DRD3 Ser9Gly polymorphism and essential tremor risk in the Asians and Caucasians. Conclusion DRD3 Ser9Gly polymorphism is significantly associated with susceptibility to essential tremor among Caucasian population, and more risk may exist in individuals that carried GG+GA genotype.

Diagnostic value of absolute lymphocyte count for chronic primary immune thrombocytopenia in children：a meta analysis

Hu Yangfan, Chen Xianrui, Shi Huixuan, Huang Jianqi

2020, 35(6): 492-497. doi:10.3969/j.issn.1004-583X.2020.06.002

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Objective To evaluate the clinical value of absolute lymphocyte count(ALC) for chronic primary immune thrombocytopenia in children. Methods The PubMed, Embase, Cochrane Library, CNKI, China Biology Medicine disc(CBMdisc), VIP and Wanfang digital knowledge service platform were searched for relevant literatures published in both English and Chinese. The search time was from the establishment of the database to February 2020. Two researchers independently extracted data and evaluated the included literature. Risk assessment of literature bias was carried out. Meta Disc 1.4 software was used for meta analysis, and the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and the summary receiver operating characteristic（SROC） curve were calculated. Results A total of five studies with 1 301 children were included, in which the combined sensitivity, combined specificity, combined positive likelihood ratio, combined negative likelihood ratio and the area under the SROC curve (AUC) for the diagnosis of chronic primary immune thrombocytopenia in children were 0.70（95%CI［0.66，0.73］）, 0.65（95%CI［0.60，0.69］）, 3.36（95%CI［1.57，7.19］）, 0.45（95%CI［0.34，0.60］） and 0.771, Q=0.711, respectively. Conclusion Initial ALC has only moderate sensitivity and specificity for predicting the diagnosis of chronic ITP in children, and the clinical value of ALC for predicting the development of chronic ITP in children remains further study.

Impact of estimated glomerular filtration rate on nosocomial prognosis in patients with acute coronary syndrome

Qiu Siyue1, Yang Haiyu2, Yu Tao2, Huang Zhichao1, Zhang Zixin1

2020, 35(6): 498-502. doi:10.3969/j.issn.1004-583X.2020.06.003

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Objective To study the effects of different levels of renal function on the inhospital prognosis of patients with acute coronary syndrome(ACS).Methods According to CKDEPI formula, the estimated glomerular filtration rate (eGFR) value was obtained. A total of 266 patients with ACS were divided into normal renal function group and mild reduction group, moderate reduction group, and severe reduction group. Retrospective analysis of the incidence of percutaneous coronary intervention (PCI) treatment and other related clinical adverse events among different groups were performed. Results The proportion of male patients in different renal function levels was significantly higher than that of females, and the proportion of hypertension was significantly increased in the group of moderate to severe renal insufficiency(P<0.05). Compared with the other three groups, the normal renal function group had younger age(P<0.01). Multivariate logistics regression analysis showed that elderly patients (≥75 years) and moderate or severe renal function decline increased the risk of heart failure during hospitalization, and PCI surgery and severe renal function increased the risk of death during hospitalization. Conclusion In elderly patients (≥75 years), moderate to severe renal decline may increase the risk of heart failure in patients with ACS. PCI surgery and severe renal decline may increase the risk of death in ACS patients in hospital.

Effect of sacubitril/valsartan in treatment of heart failure with preserved ejection fraction

Hao Zhen1, Li Wei2a, Yu Hong Wei2b, Jiang Shan2b

2020, 35(6): 503-507. doi:10.3969/j.issn.1004-583X.2020.06.004

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目的观察沙库巴曲缬沙坦钠对左心室射血分数保留心力衰竭患者的临床疗效及短期预后的影响。方法 2018年3月至2019年3月在辽宁省锦州市中心医院心内科就诊的左心室射血分数保留心力衰竭患者96例，随机分为观察组和对照组各48例。对照组给予基础抗心力衰竭治疗，包括休息、低盐低脂饮食及应用利尿剂、扩张血管药物、β受体阻滞剂、螺内酯及血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体拮抗剂（ARB）类药物。观察组将基础抗心力衰竭治疗中使用的ACEI/ARB类药物替换为沙库巴曲缬沙坦钠片，两组均连续治疗6个月。比较两组临床疗效。结果治疗6个月后观察组临床总有效率明显高于对照组，93.33% (42/45) vs 76.08% (35/46)(P<0.05)；两组治疗后NTproBNP水平、6MWT距离均较治疗前改善，观察组比对照组改善更显著(P<0.05)；观察组不良心血管事件发生率较对照组明显降低（P<0.05）。结论沙库巴曲缬沙坦钠可以明显改善左心室射血分数保留心力衰竭患者的心功能、提高活动耐力、减少不良心血管事件，提高临床疗效，且具有安全性。

Analysis of incidence, risk factors of death and clinical characteristics of gastrointestinal bleeding in patients admitted to the department of cardiology

Zhang Ming, Liu Demin, Wang Qian, Geng Xue, Hou Qian, Gu Guoqiang, Xie Ruiqin, Cui Wei

2020, 35(6): 508-512. doi:10.3969/j.issn.1004-583X.2020.06.005

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Objective To investigate the incidence of gastrointestinal bleeding(GIB), risk factors for death, and clinical characteristics of GIB in patients admitted to the department of cardiology. Methods The clinical data of 633 GIB patients admitted to the department of cardiology from January 2014 to December 2018 in the hospital were retrospectively analyzed. Results The incidence of GIB in patients was 0.5%. Age, heart rate, albumin, aspartate aminotransferase, platelet levels at admission and the use of aspirin+ticagrelor, warfarin Lin+statins and other drugs were independent risk factors for death. The cause of most GIB was unknown (57.0%, 361/633). The main clinical manifestations were melena (53.2%, 337/633), hematemesis(39.8%, 252/633) and bloody stools (12.3%, 78/633). Conclusion The incidence of GIB in patients was relatively low. Age, heart rate, albumin, aspartate aminotransferase, platelet levels at admission, and the use of aspirin+ticagrelor, warfarin+statins and other drugs were independent risk factors for death. The cause of most GIB was unknown.Hematemesis, melena and bloody stools werecommon clinical manifestations.

Clinical analysis of interventional therapy in patients with acute ST segment elevation myocardial infarction in hyperacute stage

Su Yongcai, Zhang Xiaole, Huang Zhifeng, Feng Xinwu, Su Liangxian

2020, 35(6): 513-516. doi:10.3969/j.issn.1004-583X.2020.06.006

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Objective To study the efficacy and safety of interventional therapy in patients with acute ST segment elevation myocardial infarction(STEMI) in hyperacute stage. Methods Acute STEMI patients who underwent emergency coronary intervention were divided into hyperacute group (49 cases) and control group (56 cases) according to the onset time of acute myocardial infarction and the level of troponin before the intervention. The success rate of stent implantation,the incidence of complications during the intraoperative and perioperative period, and the followup results of major adverse cardiac eventsone year after the operation in two groups were observed and compared.The risk factors were analyzed by logistic regression analysis. Results The success rate of stent implantation in hyperacute group was higher than that incontrol group, whilethe incidences of complications during the intraoperative and perioperative period, and the major clinical adverse cardiac events one year after the operation were lower in hyperacute group. There were statistically significant differences (P<0.05). Logistic regression analysis showed that preoperative troponin (OR=4.377, 95%CI: 1.29214.826, P=0.018) was an independent predictor for major clinical adverse cardiac events in STEMI patients one year after the emergency stenting. Conclusion Emergency coronary intervention is effective and safe for STEMI patients in hyperacute stage, and early emergent PCI can further reduce the incidence of major clinical adverse cardiac events.

Association of lowlevel triiodothyronine with shortterm prognosis in patients with large artery atherosclerosis cerebral infarction

Wang Hongmei, Zhang Ting, Chen Jingjiong, Deng Jiangshan, Xu Zhouwei, Fu Jianliang, Zhao Yuwu

2020, 35(6): 517-520. doi:10.3969/j.issn.1004-583X.2020.06.007

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Objective To investigate the association of triiodothyronine(T3) level with shortterm prognosis in patients with large artery atherosclerosis(LAA) cerebral infarction.Methods A total of 191 patients with LAA cerebral infarction were divided into low T3 group (n=76) and normal T3 group (n=115). The laboratory indicators of thyroid function, demographic and clinical data of these two groups were compared.Neurological impairment was evaluated by using National Institutes of Health Stroke Scale(NIHSS) scores and modified Rankin Scale (mRS) scores after 90 days followup. The mRS scores≤2 was defined as favorable prognosis, while mRS scores >2 was defined as unfavorable prognosis.Results The levels of total triiodothyronine(TT3), free triiodothyronine(FT3) and total thyroxine(TT4) in low T3 group were significantly lower than those in normal T3 group.However, patients in low T3 group were significantly older than those in normal T3 group. And low T3 group had significant higher NIHSS scores compared to normal T3 group (P<0.01). NIHSS scores on admission were negatively correlated with TT3 and FT3 levels (r=-0.267, P<0.01 and r=-0.306, P<0.01). NIHSS and mRS scores after 90 days followup in low T3 group were significantly higher than those in normal T3 group (P<0.01)．The mRS scores after 90 days followup were negatively correlated with TT3 and FT3 levels (r=-0.400, P<0.01 and r=-0.379, P<0.01), while mRS scores after 90 days followup were positively correlated with age and NIHSS scoreson admission(r=0.217, P<0.01 and r=0.765, P<0.01).Conclusion Low T3 level may be relevant to shortterm poor prognosis in patients with LAA cerebral infarction.

Deng Weisheng, Lin Weihan, Wang Hong

2020, 35(6): 521-524. doi:10.3969/j.issn.1004-583X.2020.06.008

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Objective To investigate the related factors of instent restenosis (ISRS) after stent implantation for vertebral artery stenosis.Methods Totally 110 patients with vertebral artery stenosis who underwent stent implantation in our hospital from June 2015 to September 2018 were selected as the study group. The mean followup period was 15months. When the inner diameter stenosis of implanted segment was more than or equal to 50%, it should be regarded as restenosis.According to this, patients were divided into restenosis group (33 cases) and control group (77 cases).The clinical data, biochemical indexes and angiographic results were analyzed retrospectively in order to explore the relationship between them and ISRS of vertebral artery.Results Multivariate logistic regression analysis showed that the risk factors of ISRS included type 2 diabetes mellitus (OR=6.392, 95%CI 1.36130.032), stent length (> 13 mm )(OR=1.799, 95%CI 1.2092.678), primary vascular diameter (<3.5 mm)(OR=0.069, 95%CI 0.0130.383), variation of initial part of vertebral artery (OR=7.369, 95%CI 1.55834.860) and multiple stenosis(OR=8.985, 95%CI 1.33960.290).Conclusion Type 2 diabetes, stent length >13 mm,vascular diameter <3.5 mm, the abnormality of initial part of the vertebral artery and its complication with multiple stenosisare major risk factorsfor predicting ISRS.It is necessary to pay more attention to the preoperative evaluation, followup and reexamination of patients with such risk factors.

The relationship between the levels of serum cystatin C, fibrinogen and Creactive protein and the occurrence and rupture of intracranial aneurysms

Yang Jing, Zhu Jinfen, Ma Lan, Meng Ling

2020, 35(6): 525-527. doi:10.3969/j.issn.1004-583X.2020.06.009

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Objective To investigate the relationship between the levels of serum cystatin C (CysC), fibrinogen (FBG) and Creactive protein (CRP) and the occurrence and rupture of intracranial aneurysms.Methods A total of 100 patients with intracranial aneurysms were divided into the ruptured group (n=54) and the unruptured group (n=46), and 50 healthy people were selected as the control group. Blood and cerebrospinal fluid samples were collected and the levels of serum CysC, FBG and CRP were measured. Results Among patients with intracranial aneurysms, the proportion of drinking, smoking, hypertension and atherosclerosis was significantly higher than that of the control group, and the proportion of age ≥60 years old, male, drinking, smoking, diabetes, hypertension and atherosclerosis in the ruptured group were higher(P<0.05). Compared with the control group, the levels of CysC, FBG and CRP in the blood and cerebrospinal fluid of patients with intracranial aneurysms were significantly increased(P<0.05). Conclusion The levels of CysC, FBG and CRP in the blood and cerebrospinal fluid of patients with intracranial aneurysms are increased abnormally, and the levels of CysC, FBG and CRP are related to the rupture of intracranial aneurysms.

Diagnostic value of serum CA199, NLR and PLR levels in renal function impairment of acute cholangitis

Cheng Mingrong, Dai Dejian

2020, 35(6): 528-532. doi:10.3969/j.issn.1004-583X.2020.06.010

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Objective To observe the diagnostic value of serum carbohydrate antigen (CA) 199, neutrophillymphocyte ratio (NLR) and plateletlymphocyte ratio (PLR) in renal function impairment of acute cholangitis. Methods 140 patients with choledocholithiasis admitted in our hospital from January 2017 to December 2019 were divided into 45 noncholangitis (common choledocholithiasis group) and 95 acute cholangitis(acute cholangitis group) according to whether they had acute cholangitis. Totally 45 health people were selected as health control group. The serum CA199, NLR and PLR levels in the three groups were compared in each group, related with the severity of acute cholangitis and the renal function impairment, and their efficacy on the sensitivity and specificity in predicting renal function impairment. Results The serum levels of CA199, NLR and PLR in acute cholangitis group were significantly higher than those in common choledocholithiasis group and healthy control group (P<0.01), while those in common choledocholithiasis group were significantly higher than those in healthy control group (P<0.01). The levels of CA199, NLR and PLR in patients with acute cholangitis increased significantly with the severity of acute cholangitis
(P<0.01). The serum CA199, NLR and PLR levels in abnormal renal function group in patients with acute cholangitis were significantly higher than those in normal renal function group (P<0.01). The serum CA199, NLR and PLR in patients with acute cholangitis had higher sensitivity and specificity in the diagnosis of renal impairment. The combined detection of CA199, NLR and PLR had a sensitivity of 90.0%, a specificity of 93.8%, and the area under the curve (AUC) of 0.933 which was significantly better than CA199 (Z=3.322, P<0.01), NLR(Z=3.042, P<0.01), and PLR (Z=2.301, P<0.05), and there was no significant difference in renal function impairment among the each makers (P>0.05). Conclusion The serum CA199, NLR and PLR levels are related to the severity of acute cholangitis and renal damage, and have high sensitivity and specificity in predicting renal function impairment in acute cholangitis.

Bioinformatics analysis of differential genes and potential therapeutic drugs in primary Sjgren's syndrome

Xu Huaa, Chen Jiab

2020, 35(6): 533-540. doi:10.3969/j.issn.1004-583X.2020.06.011

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Objective To screen genes associated with primary Sjgren's syndrome (PSS) and potential small molecule therapeutic drugs by gene expression profiles. Methods The expression profiles of three PSS related genes were obtained and analyzed in GEO databaseto obtain differentially expressed genes.Furthermore,GO and KEGG enrichmentanalysiswere carried out on the differential genes, andthehub genes of PSS were screened and verified by PPI. Finally, CMAP database was used to predict the potential therapeutic drugs of PSS, and the role of potential drugs in PSS treatment was discussed in combination with drug targets and drug pathways. Results A total of 90 PSS related differential genes were identified, including 79 upregulated genes and 11 downregulated genes, which were mainly involved in NODlike receptor signaling pathway, Influenza A and cytokinecytokine receptor interaction pathway. In addition, through screening and verification, 19hub genes (STAT1, MX1, ISG15, IFIH1, GBP1, IFIT1, XAF1, RSAD2, IFIT2, SAMD9L, TRIM22, IFIT3, IFI44L, HERC5, IFIT5, IFI44, IFI6, RTP4 and ISG20) were identified, most of which were interferoninduced genes. Interferon may play an important role in the pathogenesis of PSS. Finally, 15 candidate drugs such as fluticasone and cloxacillin were selected through CMAP database, and their action pathways and targets were analyzed.Conclusion In this study,through the screening of PSS hub genes and candidate drugs,we can further getanin sight into the pathogenesis of PSS and the studyprovides clues for thefurther study of PSS.

A study on the psychological status of patients with obstructive sleep apnea hypopnea syndrome

Han Bing1, Zhu Jianyong2

2020, 35(6): 541-545. doi:10.3969/j.issn.1004-583X.2020.06.012

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Objective To analyze the psychological status of patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Methods SCL90 psychological scale was used to evaluate 200 patients with OSAHS diagnosed by polysomnography(PSG) and met the inclusion and exclusion criteria. The correlation between the scores of anxiety and depression and PSG indicators was analyzed, and the relationship was discussed. Results The overall psychological status of OSAHS patients was worse than that of normal people, and the scores of somatization, obsessivecompulsive symptoms, interpersonal sensitivity, depression, anxiety, fear, paranoia and psychotic factors were higher than those of the domestic norm, with statistically significant differences(P<0.05).There were statistically significant differences in the psychological status of OSAHS patients with different illness degrees(P<0.05).OSAHS patients' anxiety and depression scores were positively correlated with apnea hypopnea index(AHI),microawakening index(MAI), and the time when blood oxygen saturation was less than 90% of total sleep time(TS90%)(P<0.05), and negatively correlated with LSaO2, proportion of rapid eye movement(REM) sleep and deep sleep(P<0.05).Conclusion The overall psychological status of OSAHS patients is worse than that of normal people, and the psychological status of patients with different degrees of illness is also different. The scores of anxiety and depression were related to chronic nocturnal hypoxia, sleep fragmentation and sleep structure disorder.

Association amongmeprin A, IL-1β and IVIG-ineffective Kawasaki disease

Chen Zhengjie1, Wu Ling2, Hu Fangfang1, Ying Qianqian3, Di Yazhen2, Zhong Shiling2

2020, 35(6): 546-551. doi:10.3969/j.issn.1004-583X.2020.06.013

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Objective To explore the predictive value of meprin A and interleukin1β for gamma globulinin ineffective Kawasaki disease(KD).Methods A total of 410 KD patients were selected as test group, and 210 patients with upper respiratory tract infection were selected as control group. KD patients were further divided into IVIGeffective group and IVIGineffective group according to the initial treatment outcome of IVIG. All KD patients were tested for laboratory indicators, such as meprin A and IL1β in acute and recovery phase.Results ①The levels of IL1β and meprin A in KD patients in the acute phase were higher than those in the control group and in KD patients in the remissionphase (P<0.01). ②There was strong positive correlation between meprin A and IL1β levels in KD children（r=0.635，P<0.01）.③ The levels of meprin A and IL1β in IVIGineffective group were higher than those in IVIGeffective group. There were statistically significant differences in the feverprocess，the first application of intravenous gamma globulin，blood WBC，CRP，ESR and NTproBNP between the two groups (P<0.01). ④ When the blood meprin A was higher than or equal to 12.95 ng/ml，its sensitivity and specificity for predicting IVIGineffective KD was 81.8％ and 89.6％，respectively；When IL1β was higher than or equal to 4.05 pg/ml，its sensitivity and specificity was 61.8％ and 87.3％，respectively；When both of the above conditions were met，the specificity was 94.9%.Conclusion Meprin A and IL1β may participate in the pathogenesis of KD, so they can be seen as an indicator to evaluate the disease activity of KD and better predict IVIGineffective KD.

Three cases of nummular headache with chiair type Ⅰ malformation and literature analysis

Zhu Taiqinga, Zhang Lifenga, Yuan Xueqiana, Wang Guowenb

2020, 35(6): 552-554. doi:10.3969/j.issn.1004-583X.2020.06.014

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To analyze the clinical features and therapeutic effects of three patients (two females and one male) with nummular headache（Video EEG excluded headache epilepsy） combined with chiair type I malformation. Among the patients, two cases had increased headache when coughing or Valsalva maneuver occurred, while another patient had no changes in it. None of the three cases were treated with operation. And the headache was relieved completely by oral medication or combined with nerve block for pain region. At present, there was no recurrence in the followup.

Kawasaki disease with G6PD deficiencya case report and literature review

Shi Huixuan, Chen Guobing, Chen Xianrui

2020, 35(6): 555-557. doi:10.3969/j.issn.1004-583X.2020.06.015

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Kawasaki disease is a systemic vasculitis. The most serious complications are coronary artery dilatation and coronary artery aneurysm. The main treatments include highdose gamma globulin intravenous drip and oral aspirin. G6PD deficiency is usually considered a relative contraindication of aspirin intake. In this paper, we reported that the color Doppler ultrasound of children with Kawasaki disease complicated with G6PD deficiency showed coronary aneurysm formation. After highdose gamma globulin intravenous drip, plus lowdose aspirin for preventing platelet aggregation, a successful diagnosis and treatment process was obtained. And the relevant literature was reviewed to arouse the attention of clinicians and to provide reference for clinical work.

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