Table of Content

05 June 2018, Volume 33 Issue 6

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The blood lipids and its clinical significance

Liang Yi1, Hu Rui2，3

2018, 33(6):  461-464.  doi:10.3969/j.issn.1004-583X.2018.06.001

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Being an important clinical indicator, blood lipids can reflect the metabolism of lipids in the bodyand are widely used in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD). Clinically, the excessive total cholesterol (TC) and/ortriglyceride (TG) , or inadequate highdensity lipoprotein cholesterol (HDLC) in  plasma are defined as lipid abnormality. TG, HDLC, low density lipoprotein cholesterol (LDLC), lipoprotein (a) ［Lp (a)］, ApoA1, ApoB are all of great significance for the assessment of the occurrence and development of ASCVD. This article reviews the classification of blood lipids and lipid abnormality.The clinical significance of lipid abnormality is also explored.

Indications for statins in primary prevention of cardiovascular disease

Zhao Jia1, Li Gang2

2018, 33(6):  465-468.  doi:10.3969/j.issn.1004-583X.2018.06.002

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At present,  cardiovascular disease (CVD) is the main cause of human disability and death. How to effectively prevent and control CVD has become the most important thing in the medical field of disease prevention and control. A large number of evidencebased medicine evidences have proved that statins play an important role in the prevention and control of CVD. Statins can not only effectively reduce the mortality and morbidity of patients with coronary heart disease,  but also have a significant effect on the primary prevention of high risk people who have not yet had cardiovascular disease. High risk groups for primary prevention include patients with hypertension,  diabetes and most elderly patients. This review will discuss the necessity and indications of statins as primary prevention in different populations.

Further understanding of hypertriglyceridemia in the statin era

Wang Miana, Hao Yumingb

2018, 33(6):  469-473.  doi:10.3969/j.issn.1004-583X.2018.06.003

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In recent years, more and more evidences show that lowering lowdensity lipoprotein cholesterol may reduce the incidence of cardiovascular events and mortality, but a problem that could not be ignored is that even after treatment with standard low density lipoprotein cholesterol, there is still a risk of large blood vessels and capillaries events (Cardiovascular residual risk). The prevalence of hypertriglyceridemia in Chinese adults is high, which is closely related to the risk of cardiovascular diseases, and should be given enough attention to.

Progress in the study of dyslipidemia in diabetes

Xue Peng, Li Yukun

2018, 33(6):  474-477,481.  doi:10.3969/j.issn.1004-583X.2018.06.004

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Diabetes and dyslipidemia are closely related, and the two affect each other. This article summarizes the research on diabetes and dyslipidemia in recent years and describes type 1 diabetes, the clinical manifestations of dyslipidemia associated with type 2 diabetes and the influence of dyslipidemia on the development of diabetes, and the effect of lipotoxicity on pancreatic beta cells, and puts forward rational suggestions on the management of blood lipids in diabetic patients, aiming to emphasize the strengthening of blood lipid management in the comprehensive management of diabetes.

Clinical features and treatment of statinsinduced liver injury

Niu Guochao, Yin Fengrong, Zhang Xiaolan

2018, 33(6):  478-481.  doi:10.3969/j.issn.1004-583X.2018.06.005

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Thanks to its antiinflammatoryand lipidmodulating effect,  statins are now  widely used in the treatment of atherosclerotic diseases, especially in the prevention of primary and secondary cardiocerebrovascular disease. However, its related side effects such as myopathy, rhabdomyolysis, and liver injury have been reported repeatedly.This article reviews the characteristics,  pathogenesis,  monitoring and the treatment of statinsinduced liver injury.

The comparative study of NEWS score,  qSOFA score and SIRS score in evaluating prognosis of patiens of infectious diseases in emergency department

Wang Ziqi1, Liu Zhiqiang2，Zhu Tingting1，Liang Lu2

2018, 33(6):  482-485.  doi:10.3969/j.issn.1004-583X.2018.06.006

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Objective  To evaluatethe value of national early warning score (NEWS),  quick sepsisrelated organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) score in predicting the prognosis in patients with infectious diseases of emergency department. Methods  A total of  412  patients diagnosed with infectious diseases and treated in the emergency department of our hospital from June 2016 to June 2017 were enrolled in this study.The general clinical data and vital signs of patients were collected; NEWS,  qSOFA and SIRS score were counted;  the patients were divided into death and survival groups according to the outcomes. The correlation between the 3 scores and the prognosis of the patients were analyzed.The area under the ROC curve was used to evaluate the value of these three scores in predicting prognosis of patients. Results  The higher score of NEWS score, qSOFA score and SIRS score, the higher mortality of patients；Area under the ROC curve of NEWS score,  qSOFA score and SIRS score were 0.750, 0.792 and 0.723, respectively.Conclusion  NEWS score,  qSOFA score and SIRS score are useful in evaluating prognosis of patients of infectious diseases in emergency department.Moreover, among the three methods, the qSOFA score is the best one to evaluate the prognosis of infectious diseases.

Expression of microRNA451 and prognosis in lung adenocarcinoma patients with positive expression of EGFR

Wang Tongfu, Zhang Zhen, Yao Chuanshan, Li Fangfang

2018, 33(6):  486-489.  doi:10.3969/j.issn.1004-583X.2018.06.007

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Objective  To analyze the relationship between the expression of RNA (microRNAs) 451 and prognosis in patients with positive expression of epidermal growth factor receptor (EGFR). Methods  A total of 67 lung adenocarcinoma patients with systemic chemotherapy and targeted therapy with positive EGFR expression confirmed by pathological biopsy were enrolled. After RTqPCR (realtime quantitative polymerase chain reaction), the pathological specimens of cancer tissues were examined for microRNA451 expression, and were divided into high expression group and low expression group based on the median expression of microRNA451. The incidence of adverse reactions to chemotherapy was compared between the two groups, as well as their differences in survival.Results  The 3 and 4 degree myelosuppression in the high expression group was lower than that in the low expression group (χ2=5.382, P=0.020; χ2=4.947, P=0.026), and the low expression group was low (χ2=7.208, P=0.007; χ2=6.211, P=0.013)  in the high expression group in the course of chemotherapy with 3 and 4 degrees of digestive tract reaction. In the two groups, the median PFS in the high expression group was 12.3  months, and the middle PFS in the low expression group was 9 months. The two groups had a statistically significant difference (χ2=9.582, P=0.002). The median overall survival (OS) in the high expression group was 12.3 months, while the median OS in the low expression group was 11.5 months, and the difference between the two groups was statistically significant (χ2=5.749, P=0.016).Conclusion  Targeted therapy with positive expression of EGFR combined with systemic chemotherapy in patients with high expression of microRNA451 in lung adenocarcinoma has mild adverse reactions and a long survival time.

Clinical features and prognosis in patients with multiple myeloma who had extramedullary disease at diagnosis

Yang Jianzhua, Zhang Jinqiaob, Wang Xiaomenga, Lv Hongyanb, Sun Lixiab

2018, 33(6):  490-493,497.  doi:10.3969/j.issn.1004-583X.2018.06.008

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Objective  To investigate the clinical features and prognosis of patients with multiple myeloma (MM) who had extramedullary disease (EMD) at diagnosis. Methods  A total of 51 newly diagnozed MM patients who had EMD at diagnosis (including skeletalEMD and extraskeletalEMD) were retrospectively analyzed. The clinical features, EMD location, efficacy, survival and prognosis were explored. Results  The median followup was 44 months (ranged from 7 to 98 months). Patients in skeletalEMD group had  significantly higher percentage of osteolytic lesions ≥3(P=0.033), higher lymphocyte cells (P=0.016), and lower monocytetolymphocyte ratio (P=0.036) than that extraskeletalEMD group. The estimated overall survival(OS) of patients in extraskeletalEMD group was shorter than those  in skeletalEMD group (38 months vs not reached, P=0.056). Multivariate analysis showed that hemoglobin (HGB)＜118.8  g/L (OR=0.139, 95%CI=0.0400.488, P=0.002) was independently associated with inferior OS for the MM patients who had EMD at diagnosis. Conclusion  The prognosis in patients with MM who had EMD at diagnosis is poor. The patients in skeletalEMD group have better prognosis than those  in extraskeletalEMD group. Lower HGB is an independent factor for predicting inferior OS.

PCI preoperative single load dose and conventional dose risuvastatin on prognosis of patients with coronary heart disease

Wei Zhenheng, Zhang Juntang

2018, 33(6):  494-497.  doi:10.3969/j.issn.1004-583X.2018.06.009

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Objective  To investigate the effect of single loading dose and conventional dose of rosuvastatin on the prognosis of patients with coronary heart disease before and after percutaneous coronary intervention (PCI). Methods  Totally 108 patients who underwent PCI intervention in our hospital were randomly divided into conventional group (n=54,  rosuvastatin 5 mg at 12 h preoperatively) and loading group (n=54,  rosuvastatin 20 mg at 12 h preoperatively). After operation,  all patients in two groups took contineously the conventional dose of rosuvastatin 5 mg. Basic clinical indexes,  myocardial basic indicators and followup for the whole patients were detected before and after PCI. Meanwhile,  changes in each index,  major adverse cardiovascular events (MACE),  hepatotoxicity and myotoxicity of rosuvastatin were observed and compared. Incidence of MACE,  hepatotoxicity and myotoxicity of rosuvastatin were compared respectively. Results  The levels of myocardial markers,  cardiac troponin T(cTnT),  monocyte chemotactic protein1(MCP1), C reactive protein (CRP) and creatine kinase (CKMB) at 24 h and 7 d postoperatively rose as compared with those before PCI,  indicating statistically significant differences bewteen conventional group and loading group (P<0.05); Followup of MACE,  hepatotoxicity and myotoxicity of rosuvastatin within 30 d and 1 year postoperatively were recorded and revealed statistically significant differences (P<0.05). Conclusion  The single loading dose of rosuvastatin before PCI is of positive significance for the prognosis of patients with coronary heart disease. Moreover,  application of loading dose of statins before operation can reduce postoperative adverse cardiac events.

Clinical study of AIMS65 score for risk assessment of esophagealgastric variceal bleeding in liver cirrhosis

Jin Yan, Ge Zhihua, Sun Yuanyuan, Xu Shuyan, Shao Jianguo

2018, 33(6):  498-501.  doi:10.3969/j.issn.1004-583X.2018.06.010

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Objective  To evaluate the clinical value of AIMS65 score system in the prediction of shortterm prognosis and rebleeding of esophagealgastric variceal bleeding(EGVB) in liver cirrhosis. Methods  A total of 110 patients with EGVB were graded with Model of Endstage Liver Disease(MELD) and AIMS65 score. Sixweeks' mortality and rebleeding of the patients were observed. The accuracy of the two scores on predicting shortterm prognosis and rebleeding were analyzed using the area under the receiver operating characteristic  (ROC) curve  (AUC). Results  The sixweeks' mortality and rebleeding rate were 14.6%  and  17.3% in the patients, respectively. MELD and AIMS65 score for deaths were higher than those for survivors significantly(P＜0.05).The AUC of MELD and AIMS65 score for predicting 3month mortality were 0.813 and 0.825, respectively, but no significant difference was found between the two scores(P＞0.05). MELD and AIMS65 score in patients with rebleeding were higher than those with nonrebleeding significantly(P＜0.05). The AUC of MELD and AIMS65 score for predicting rebleeding were 0.599 and 0.767 with stastistical significance(P＜0.05).Conclusion  AIMS65 score is useful for prediction of shortterm prognosis and rebleeding of EGVB in liver cirrhosis. It is a simple, rapid and convenient method.

Application value of high frequency ultrasound in hemophiliac arthropathy

Sun Chaoa, Peng Chenxinga, Qi Xuana, Guo Huifanga, Lei Lingyana, Zhang Jingyub

2018, 33(6):  502-505.  doi:10.3969/j.issn.1004-583X.2018.06.011

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Objective  To detect the joints of hemophilia patients with high frequency ultrasound, and to explore the correlation between ultrasound results and clinical factors. Methods  Nineteen cases of patients who were clearly diagnosed with  hemophilia were collected. Common data were investigated,  including the age of the first joint bleeding,  the number of hemorrhagic joints,  the frequency of joints bleeding and therapy method. Ultrasound was applied to detect the patients' shoulders,  elbows,  hips,  knees and ankles and the joints were scored by the Hemophilia Early Arthropathy Detection with Ultrasound（HEADUS）   system.  The correlation analysis was conducted for  the clinical factors. Results  Nineteen male patients were diagnosed with hemophilia A,   with their ages ranging  from 5 to 50 and average age being  (24.53±14.82)  years. A total of  116 joints were examined,  72（62.07%）  of which were found to have lesions. Cartilage lesion,  bone erosion or osteophyte,  synovial hypertrophy,  synovial vascular hyperplasia and joint effusion were 88.89% (64/72),  66.67%(48/72),  58.33%(42/72),  47.22%(34/72) and 26.39%(19/72),  respectively. The results of kappa test were consistent among the operators. The age of the patients was positively correlated with the number of hemorrhagic joints and the HEADUS score（r=0.700, P=0.001；r=0.631, P=0.004）;  the frequency of joint bleeding was positively correlated with HEADUS score(r=0.335, P=0.000).There was no correlation between the age of joint hemorrhage at the first time and the number of hemorrhage joint and HEADUS score(r=0.115, P=0.640；r=0.108, P=0.660). Conclusion  Ultrasonography can be used to evaluate the joint of hemophiliacs. The ultrasonic score related to the clinical factors can be used as an objective index to evaluate hemophilia osteoarthropathy and  worths  generalizing.

Assessment of right ventricular systolic function in pulmonary hypertension patients by realtime threedimensional echocardiography and tissue velocity vector

Ma Hui, Zhang Yongfeng, Li Huili, Fen Guoyan

2018, 33(6):  506-509,514.  doi:10.3969/j.issn.1004-583X.2018.06.012

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Objective   To evaluate the global and regional systolic function of the right ventricle using realtime threedimensional ultrasound (RT3DE) and tissue velocity vector image(VVI) techniques, and to predict its value to patients with pulmonary hypertension (PH) associated with right heart failure. Methods  A total of 86 PH patients was selected and divided into two groups according to pulmonary arterial systolic pressure (PASP) :  the lightto moderate PH group mild group and the severe  PH  group.  Totally 43 patients in each group were selected for physical examination. Realtime threedimensional ultrasound quantitative analysis of right ventricular threedimensional ejection fraction (3DRVEF), right ventricular threedimensional stroke volume (3DRVSV), right ventricular threedimensional enddiastolic volume (3DRVEDV), right ventricular threedimensional endsystolic volume (3DRVESV) were analyzed using the VVI technique to analyze the longitudinal myocardial strain (LS) , strain rate (LSR) global strain (Globle S) and strain rate (Globle SR) in six segments of the right ventricle. The relationship between the parameters was analysed. Results  Compared with the control group, 3DRVEF was gradually decreased in the mildtomoderate group and the severe group, and 3DRVEDV, 3DRVESV, and 3DRVSV witnessed increase (P<0.01). There was no statistical difference in LSR between the three groups of interventricular septum A. Compared with the control group, the LS and LSR in the left ventricular segments of the right ventricle in both PH groups decreased  (P<0.05). Compared with the lighttomoderate group, the LS and LSR in the severe group decreased. Compared with the control group, the LS and LSR in the left ventricular segments of the right ventricle in both PH groups decreased (P<0.05). Compared with the light tomoderate group, the LS and LSR in the severe group decreased. 3DRVEF was positively correlated with Globe S and Globle SR. PASP was negatively correlated with Globle S and Globle SR, but the correlation was not strong. Conclusion  The systolic function of the right ventricle in the pulmonary arterial hypertension group was reduced. With the increase of the pulmonary artery pressure, the longitudinal strain and strain rate of the right ventricle segments gradually decreased. However, in the groups with different levels of PH, the change of right ventricular local systolic function was earlier  that of the overall function.

Study on the identification of a case with blood type B(A)  and the concerned clinical safety transfusion strategies

Liu Likun, Liang Juyou, Chen Jing, Yao Yao, Guo Meng, Li Xiaona, Zhao Junli, Zhao Yiran, Xing Qiaoling, Pan Hongjuan, Li Xutong

2018, 33(6):  510-514.  doi:10.3969/j.issn.1004-583X.2018.06.013

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Objective  To identify the blood type B(A) which is rare to see, and to investigate the concerned clinical blood transfusion safety strategies.  Methods  Automatic blood analyzer was used to detect ABO blood group, and  the group typing   and reverse typing of a patient  were  found to be inconsistent. Then the blood type and gene sequencing of this patient and nine of the family members were identified by blood group serology and molecular biology to analyze the genetic characteristic of the blood group of this family and clinical transfusion research was conducted on them to ensure the safety of clinical blood transfusion. Results  Which wascontrasted with B101 gene sequence were all nt640A>G and B(A) 04/O01 by gene identification.There was no agglutination between serum B(A) and O, B, B(A) red blood cells. B(A) red blood cells do not agglutinate with type B(A) and AB serum.Conclusion  The group typing and reverse typing were identified as B(A) with blood group serology that could be further confirmed by molecular biological techniques; clinical blood transfusion should adopt autologous blood transfusion, sametype infusion and compatible blood transfusion.

Evaluation  of  endoscopic  ultrasonography in minimally invasive treatment of lowgrade gastrointestinal neuroendocrine neoplasm

Er Limian, Wu Mingli, Zheng Xiuli, Wang Shunping, Xu Zhibin, Yuan Li, Wen Zhuan, Jin Lingyao

2018, 33(6):  515-518.  doi:10.3969/j.issn.1004-583X.2018.06.014

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Objective  To evaluate the value of endoscopic ultrasonography in minimally invasive treatment of lowgrade gastrointestinal neuroendocrine neoplasm. Methods  The endoscopic and pathological data of 130 cases of neuroendocrine tumors of the stomach in our hospital were analyzed retrospectively. All cases were examined and found the tumor body by gastroscopy and the diagnosis was confirmed by immunohistochemistry,  minimally invasive endoscopic treatment,  in which 59 cases were treated by endoscopic ultrasonography,  and 71 cases were removed by direct microscopy. Results  All 130 cases diagnozed by pathology G grade,  incoluded  G1  114 cases, G2  16 cases. The patients were divided into two groups according to the preoperative evaluation of endoscopic ulrasonography(EUS).The positive rate of vertical cutting edge in the group without EUS evaluation was higher than that in EUS group (P=0.03),  but there was no significant difference in horizental edge positive between two groups. Followup results showed that 23 cases of retreatment were all multiple cases. Conclusion  Endoscopic resection of lowgrade gastrointestinal neuroendocrine neoplasm is a safe and effective method to improve endoscopic resection rate,  and the prognosis is good.

Incidence of hepatocarcinoma in patients with chronic hepatitis combined with diabetes--a  metaanalysis

Sun Tingting1, Guo Jian2a, Sun Wenwen2b, Zhao Yanzhen1, Liu Limin1, Zhu Bin1

2018, 33(6):  519-524,531.  doi:10.3969/j.issn.1004-583X.2018.06.015

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Objective  Hepatitis C virus infection can lead to liver fibrosis, liver cirrhosis, and even liver cancer. The influence of diabetes mellitus(DM)  in patients with chronic hepatitis C on the incidence of hepatocarcinoma (HCC) is not clear. The effect of chronic  hepatitis C(CHC) patients with DM on the incidence of HCC was studied. Methods  This study searched CNKI, Wanfang database, CQVIP, Pubmed, Embase and other literature retrieval platform for related studies of the effect of CHC patients with DM on the incidence of HCC.This study included the literature that was in line with  the standards of the cohort study by literature selection, quality assessment; Then, data extraction and statistical analysis were carried out. This study selected the random effects model,with the combined effect amount being relative risk(RR); the sensitivity analysis, heterogeneity and publication bias detection were also conducted. Results  A total of nine cohort studies were selected, including 11 855 CHC patients,  with 1 058 in DM group and  10 797  in nonDM group. The incidences of HCC in group DM and nonDM were of  statistical significance (RR=2.674, 95%CI=1.8003.974, P=0.000), and the heterogeneity was big (P=0.000, I2=86.2%). Subgroup analysis was conducted according to whether the subjects were complicated with cirrhosis. When the subjects were all patients with cirrhosis, the amount of combined effect was of no statistical significance (95%CI=0.6891.580, P=0.842), while the heterogeneity decreased significantly (I2=40.8%, P=0.194); When all the subjects were free from liver cirrhosis, the amount of combined effect was statistically significant (95%CI=2.3416.101, P=0.000),  and  heterogeneity also decreased significantly (I2=42.2%, P=0.188).The results of sensitivity analysis showed that the results were relatively stable, the results of publication bias were within allowed band (Harbord: 95%CI=-1.58282310.18881, P=0.130; 95%CI=-409.0079382.1317, P=0.9391). Conclusion  Among CHC patients with cirrhosis, there is no significant difference in the incidence of HCC in cirrhosis patients with DM; while in  patients with CHC, merging DM can increase the incidence of HCC. DM may affect the incidence of HCC by affecting the process of liver cirrhosis in patients with CHC.

Percutaneous transhepatic biliary drainage versus endoscopic biliary drainage for perihilar cholangiocarcinoma: a metaanalysis

Mu Chunhong, Feng Jinlong, Liu Shaofei, Ma Pingan, Zhang Zhifeng

2018, 33(6):  525-531.  doi:10.3969/j.issn.1004-583X.2018.06.016

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Objective  To determine the best initial procedure for performing preoperative biliary drainage in patients with perihilar cholangiocarcinoma (PHCC).Methods  PubMed, the Cochrane Library, Embase database, CNKI, CBM, Wanfang database were searched for all studies published until April 2017 comparing endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) for preoperative biliary drainage. A Metaanalysis was performed by using STATA 12.0 software.Results  A total of  799 patients with PHCC were involved in the 8 studies .The rates of initial technical failure(OR=2.50, 95%CI=1.314.79, P=0.006) and conversion(OR=9.71, 95%CI=4.6420.30, P=0.001) were higher in EBD group than those in PTBD group. However, there are no significant differences in overall complication(OR=1.27, 95%CI=0.891.82, P=0.185), procedurerelated morbidity rate(OR=0.45, 95%CI=0.131.58, P=0.212), and bilirubin levels(SMD=-0.47, 95%CI=-1.110.17, P=0.149).Conclusion  Compared to EBC, PTBD, with a lower rate of initial technical failure and conversion,  is a better initial procedure for performing preoperative biliary drainage in PHCC.