Clinical Focus

Efficacy and safety of ticagrelor in coronary artery disease and chronic obstructive pulmonary disease: a metaanalysis

Zhang Qinxia, a, Zhang Haifu, b, Lyu Quna

2020, 35(11): 965-970. doi:10.3969/j.issn.1004-583X.2020.11.001

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Objective To analyze the safety and efficacy of ticagrelor in patients with coronary artery disease and chronic obstructive pulmonary disease (COPD). Methods The clinical trials of ticagrelor versus clopidogrel in patients with coronary artery disease and COPD were searched in domestic and foreign databases which included CNKI, VIP, PubMed, OVID, web of science. The primary endpoints of this study were the incidence of dyspnea, bleeding and cardiovascular adverse events in patients with coronary artery disease and COPD. Results In this study, 7 articles were included. Metaanalysis showed that the incidence of dyspnea was significantly increased in ticagrelor group compared with clopidogrel group(24.5% vs 13.8%, OR：2.04，95%CI：1.562.66, P<0.05). However, ticagrelor group had significant advantages over clopidogrel group in myocardial infarction rate (6.8% vs 10.6%, OR：0.61，95%CI：0.430.87, P<0.05), stroke incidence rate (1.1% vs 2.9%, OR：0.41，95%CI：0.200.84, P<0.05) and cardiogenic mortality (4.9% vs 8.8%, OR：0.53，95%CI：0.350.79, P<0.05). Conclusion Patients with coronary artery disease and COPD in ticagrelor group had a higher incidence of dyspnea, but the incidence of cardiovascular adverse events was significantly lower than that of clopidogrel group.

He Zhengfei, Wang Diqing, He Xiaolan, Sun Linggang

2020, 35(11): 971-975. doi:10.3969/j.issn.1004-583X.2020.11.002

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Objective To analyze the related factors of slow coronary flowno reflow (SCF/NR) after percutaneous coronary intervention (PCI) for acute coronary syndrome. Methods Totally 152 patients with acute STsegment elevation myocardial infarction (STEMI) undergoing PCI were selected. According to TIMI flow grades after PCI, they were divided into SCF/NR group and normal flow group. The related influencing factors of SCF/NF in two groups patients were analyzed after PCI. Results There were no statistically significant differences between two groups in sex, BMI, hypertension history, family history, smoking, drinking, preoperative TIMl flow grades, killip grades, occult blood in urine, left ventricular end systolic diameter, infarctrelated artery, lesion location, diffuse degree, interventional therapy method, ejection fraction, WBC, AST, TC, TG, HDLC, LPa, Cysc, K+, PT, INR, APTT, DD, number of lesion vessels, length of lesion vessels, diameter of lesion vessels and stent number(P>0.05). Compared with patients in nonSCF/NF group, Gender in SCF/NF group were older and had higher incidence of diabetes mellitus, higher LDLC, and longer time from onset to vascular patency (P<0.05). Multivariate Logistic regression analysis showed that age, LDLC, time from onset to vascular patency were independent risk factors for SCF/NR after surgery. Conclusion Age, LDLC, time from onset to vascular patency are independent risk factors for SCF/NR in acute coronary syndrome after PCI.

Role of serum MMP-1, MMP-3, TIMP-1 and Hcy levels in patients with hypertension complicated with atrial fibrillation

Lu Yuqin, Li Yingdong, Liu Kai

2020, 35(11): 976-979. doi:10.3969/j.issn.1004-583X.2020.11.003

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Objective To explore the role of serum matrix metalloproteinase (MMP) 1, MMP 3, matrix metalloproteinase inhibitor 1 (TIMP1) and homocysteine (Hcy) levels in patients with hypertension complicated with atrial fibrillation (AF).Methods A total of 161 patients with hypertension who had not been treated or discontinued from medication for more than one week were divided into sinus rhythm group and atrial fibrillation group according to ECG, dynamic ECG and medical history. Serum MMP1, MMP3, TIMP1, Hcy, uric acid (UA) and lipid levels were detected in all patients, and left atrial diameter (LAD) was determined by echocardiography. Results Compared with sinus rhythm group, the age, UA, Hcy, MMP1/TIMP1, MMP3/TIMP1 and LAD of atrial fibrillation group were all increased(P<0.05), while the total cholesterol (TC) and lowdensity lipoprotein cholesterol (LDLC) were significantly reduced(P<0.05). Age, Hcy, LAD and MMP1/TIMP1 were independent risk factors for atrial fibrillation in patients with hypertension. Conclusion Old age, high Hcy, enlarged LAD and increased MMP1/TIMP1 are independent risk factors for atrial fibrillation in patients with hypertension.

Diagnosis and surgical treatment of atrial myxoma combined with coronary heart disease

Zhang Hang, An Jinghui, Shi Fengwu

2020, 35(11): 980-983. doi:10.3969/j.issn.1004-583X.2020.11.004

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Objective To summarize the clinical experience of simultaneous coronary artery bypass grafting (CABG) and atrial myxoma removal. Methods Clinical data, surgical methods and prognosis of 18 patients undergoing atrial myxoma removal and CABG in our department from January 2013 to March 2019 were retrospectively analyzed. Results All patients underwent simultaneous CABG and atrial myxoma removal under extracorporeal circulation. According to the tumors seen during the operation, the tumor locations were consistent with those observed by cardiac ultrasound. And the tumors were different in sizes and shapes, such as lobulated, irregular and close round appearance. The tumors were brittle, most of them were gelatinous and few possessed envelope with mucus effusion, bleeding or calcification on the surface. A few parts of tumors can fall mitral or tricuspid valve mouth. There were no postoperative deaths. One case with postoperative low cardiac output syndrome was cured after corresponding treatment. There were 5 patients with newly atrial fibrillation after operation, and all of them returned to normal after treatment with amiodarone. Two patients underwent rethoracotomy for hemostasis. After the postoperative followup of one year, no tumor recurrence was found in 18 patients, and their cardiac function returned to NYHA ⅠⅡ. Conclusion The simultaneous removal of atrial myxoma and CABG are effective methods for treating atrial myxoma complicated with coronary heart disease, which can achieve a good prognosis.

Correlation of platelet distribution width and red blood cell distribution width in peripheral blood with atrial fibrillation in patients with coronary artery disease

Gao Xiuxina, Si Yueqiaoa, Ding Zhenjianga, Zhang Yinga, Liu Huilinga, Liu Jingyia, Han Chaoa, Sunwang Lexianaa

2020, 35(11): 984-987. doi:10.3969/j.issn.1004-583X.2020.11.005

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Objective To explore the correlation of platelet distribution width (PDW) and red blood cell distribution width (RDW) with atrial fibrillation (AF) in patients with coronary artery disease (CAD).Methods A total of 149 patients with CAD and AF in the Affiliated Hospital of Chengde Medical University from January 2012 to December 2013 were selected as case group. During the same period of admission, 149 patients with CAD but without AF were selected as the control group. The auxiliary diagnosis and prediction value of PDW and RDW for AF in CAD patients were respectively analyzed through diagnostic tests and binary logistic multiple factors regression model. Results The area under the curve(AUC) of the PDW and RDW for AF in CAD patients was 0.612(95%CI 0.5840.616) and 0.684(95%CI 0.6240.744), respectively (both P＜0.01). The optimal diagnostic threshold of PDW was 13.5%, and the sensitivity, specificity, positive predictive value and negative predictive value were 0.426, 0.770, 0.653 and 0.575, respectively. The optimal diagnostic threshold of RDW was also 13.5%, and the sensitivity, specificity, positive predictive value and negative predictive value were 0.631, 0.651, 0.646 and 0.642, respectively. Logistic regression analysis showed that PDW>13.5% and RDW≥13.5% were new independent risk factors for CAD combined with AF (both P<0.05). Conclusion The elevation of PDW and RDW in peripheral blood is an independent risk factor for AF in CAD patients, and it is expected to be a novel and reliable clinical laboratory biomarker for AF prediction in CAD patients.

Clinical characteristics and regularities of patients with somatic symptom disorder in the cardiology clinic

Gu Weizhonga, Li Xiujuan, Qu Junminb

2020, 35(11): 988-991. doi:10.3969/j.issn.1004-583X.2020.11.006

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Objective To conduct a crosssectional study on the clinical characteristics and regularities of patients with somatic symptom disorder in the cardiology clinic. Methods A total of 181 patients who met the standards and were waiting in the cardiology clinic of a general hospital in Yantai from January to December 2019 were selected to participate in the study by using a convenient sampling method. The selfcompiled demographic questionnaire and medical attendance questionnaire, SCL90 and structured diagnostic interview were conducted, and the results of SSD group and nonSSD group were statistically analyzed. Results 51(28.2%) of 181 respondents were diagnosed with SSD.There were statistically significant differences between two groups in gender,age,marital status and feelings of family care(P<0.05, P<0.01).There were statistically significant differences between two groups in the duration of symptoms,the number of visits in the past one year,whether they had received treatment in the past one year, and the degree of satisfaction with treatment in the past one year(P<0.01).The results of SCL90 test showed that the score of SSD group, somatization, interpersonal sensitivity, depression, anxiety, paranoia, psychosis, and other factors (diet and sleep) were higher than those of nonSSD group(P＜0.05, P＜0.01). Conclusion The rate of SSD diagnosis in the cardiology department of general hospitals is similar to that in the department of gastroenterology and Traditional Chinese Medicine, with more females than males, low utilization of social support, long duration of symptoms, and poor mental health status.

Effect of Ningbo Branch Center of the National Metabolic Management Center on blood glucose management in patients with type 2 diabetes mellitus

Wang Xuepeng, Zhou Ye, Xu Bin, Jin Yong, Zhou Renke, Li Li

2020, 35(11): 992-996. doi:10.3969/j.issn.1004-583X.2020.11.007

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Objective To compare the effects of glycemic management between the National Metabolic Management Center (MMC) and routine hospitalization on patients with type 2 diabetes mellitus(T2DM). Methods Totally 367 patients with T2DM who were involved in the management of MMC and treated in Ningbo First Hospital's clinic from March, 2018 to January, 2020, were selected as MMC group. The hospitalized patients with T2DM) in Ningbo First Hospital were selected as hospitalization group from March, 2018 to January, 2020 according to 1∶1 matching principle based on age, gender, course, fasting blood grulose's basal level and hemoglobin A1c's basal level. Patients in MMC group were treated according to MMC standards, while those in hospitalization group had routine treatment of threeA hospitals. After the followup of half a year, the effects of two kinds of management on patients glycemic level were analyzed retrospectively.Results After the followup of half a year, compared with the baseline, fasting blood glucose, hemoglobin A1c, total cholesterol, triglyceride, low density lipoprotein cholesterol, alanine aminotransferase in both groups were significantly improved (P<0.05). Conclusion MMC has good effects on the improvement of hemoglobin A1c level which decreased from 8.32% to 6.91% in the patients. Compared with the hospitalization group, MMC group can reach the same level of glucose control.

Preventive effect of buckwheat chemical composition on related complications of type 2 diabetes mellitus

Wang Baoping, Zhang Yuan, Tong Hongmei, Song Qiao

2020, 35(11): 997-1000. doi:10.3969/j.issn.1004-583X.2020.11.008

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Objective To get an insight into the preventive effect of buckwheat chemical composition on related complications in patients with type 2 diabetes mellitus. Methods A total of 102 patients with confirmed type 2 diabetes were selected. The patients were divided into observation group and control group. According to the standard dietary intake of diabetes, patients in observation group used buckwheat flour as the staple food, and patients in control group used wheat flour as the staple food. Blood glucose, blood pressure, blood lipids and antioxidant capacity were compared before and after intervention in two groups. Results After intervention, systolic blood pressure and total cholesterol (TC) in observation group were significantly lower than those in control group (P<0.05). After intervention, highdensity lipoprotein (HDLC) in observation group was higher than that in control group (P<0.05). Fasting blood glucose (FPG), 2 h postprandial blood glucose (2 hPG), glycosylated hemoglobin (HbA1c) and propylene glycol (MDA) in observation group were all lower than those before intervention and control group (P<0.05). The activity of superoxide dismutase (SOD) in observation group after intervention was significantly higher than that in control group and before intervention (P<0.05).Conclusion Buckwheat may prevent the complications of type 2 diabetes mellitus by improving the blood glucose level, blood lipid and blood pressure, reducing MDA content and increasing SOD activity.

Effects of ureklin combined with atorvastatin on clinical efficacy, ox-LDL and hs-CRP in patients with acute cerebral infarction

Liu Manzhuo, Wang Hui, Zhao Suxia, Wang Jing

2020, 35(11): 1001-1004. doi:10.3969/j.issn.1004-583X.2020.11.009

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Objective To observe the effects of ureklin combined with atorvastatin on clinical efficacy, oxidized lowdensity lipoprotein (oxLDL) and hypersensitive creactive protein (hsCRP) in patients with acute cerebral infarction (ACI).Methods A total of 120 ACI patients with aortic atherosclerosis but without thrombolysis and thrombectomy according to TOAST classification were randomly divided into control group and observation group, 60 cases in each group. Routine treatment was given to two groups, including antiplatelet, neuroprotective agents and drugs that improved blood circulation. The control group was treated with atorvastatin (20 mg/time) and qn. The observation group was treated with atorvastatin(20 mg), qn and ureklin, 0.15 PNA, 0.9% normal saline(100 ml) and qd. Both groups were continuously treated for 2 weeks. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the clinical efficacy before and 14 days after the treatment. The oxLDL, hsCPR content were determined before and 14 days after the treatment. Results After 14 days of treatment, oxLDL and hsCRP levels in observation group were significantly lower than those in control group (P<0.01). The NIHSS scores in both groups before the treatment were lower than before (P<0.05), and the score of observation group was significantly lower than that of control group (P<0.05). The clinical efficacy of observation group was better than that of control group (P<0.05). Conclusion Ureklin combined with atorvastatin in the treatment of ACI patients without thrombolysis and thrombectomy can effectively improve the nerve function defect, promote the recovery of nerve function, and its effect is obviously superior to routine treatment.

Analysis of clinical characteristics of 12 patients with COVID-19

Li Guanhonga, Li Wena, Zeng Jianb, Zhang Yua, Qiu Qingpinga, Zheng Yuqionga

2020, 35(11): 1005-1009. doi:10.3969/j.issn.1004-583X.2020.11.010

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Objective To analyze the clinical and epidemiological characteristics of corona virus disease2019 (COVID19), and to provide reference for epidemic prevention and control. Methods From January 26 to April 5, 2020, the clinical data of 12 patients with COVID19 in the Second Clinical Observation Department of Chengdu Integrated TCM & Western Medicine Hospital were collected for their basic information, epidemiological history, laboratory examinations, chest CT and so on. Results There were more males patients than females patients, with a male to female ratio of 1.4∶1. The disease was mainly concentrated on the middleaged and elderly people older than 40 years old, and the number of common patients was bigger than that of severe patients, with a ratio of 1∶5. In the early stage, the cases were mainly indigenous, while after midFebruary, they were mainly imported from foreign countries. 75% of the local cases had a history of Wuhan/Hubei travel or close contact with patients with COVID19, and the shortest incubation period was 4 days and the longest was 11 days. The main clinical symptoms were fever, cough, and cold. There was no significant increase in white blood cells and high sensitivity Creactive protein. The main changes of chest CT were ground glass in both lungs. Compared with severe patients, the common patients had higher percentages of white blood cells, neutrophils and lymphocytes, while they had lower percentages of lymphocytes and hypersensitive Creactive protein, and lower chest CT scores. Conclusion COVID19 is mainly concentrated on males, and people older than 40 years old are at a high risk. Fever is the main clinical symptom. In severe patients, the hypersensitive Creactive protein significantly increases, and the chest CT lesions are obvious.

Pathogenic bacteria and etiological analysis of peritoneal dialysisassociated peritonitis in a single peritoneal dialysis center

Shi Youshan, Chen Tianhao

2020, 35(11): 1010-1014. doi:10.3969/j.issn.1004-583X.2020.11.011

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Objective To analyze the etiology, pathogen distribution and drug resistance of peritoneal dialysisassociated peritonitis (PDAP) in a single peritoneal dialysis center, and to provide reference for PDAP prevention and control.Methods The general data, bacterial culture, drug resistance analysis, curative effects and prognosis of 94 PDAP patients/times were retrospectively analyzed. Results Among 94 PDAP patients, The most common cause of infection was operational contamination (53.19%) which centered on grampositive bacterial infection, followed by intestinal infection（27.66%） which centered on gramnegative bacterial infection. Totally 65 cases of dialysate pathogen culture in 94 patients were positive, with a positive rate of 69.15%. A total of 67 bacterial strains were separated from 65 cases of dialysate pathogen culture, including 45 grampositive strains (67.16%) with Staphylococcus epidermidis as the most common, 20 gramnegative strains (29.85%) with Escherichia coli as most common, and 2 fungi(2.99%). Grampositive bacteria was highly resistant to penicillin (91.11%), erythromycin (91.11%) and oxacillin (88.89%), while it had no resistance to both linezolid and vancomycin. Gramnegative bacteria was not resistant to imipenem and meropenem, and its resistance to Ceftazidime (10.00%) and cefepime (5.00%) was relatively low. In addition, none of the fungi showed resistance to fluconazole, amphotericin B, 5fluorouracil and itraconazole. Totally 51 cases(78.46%） of the 65 cases were cured after the treatment, and 14 cases (21.54%) withdrew from peritoneal dialysis of the 14 cases above, there was one death, with a fatality rate of 1.54%, and 13 cases were converted to hemodialysis after catheter removal. There were no statistically significant differences in cure rate and withdrawal rate between patients with Grampositive bacterial infection and patients with Gramnegative bacterial infection (P>0.05). The two cases with fungal infection were converted to hemodialysis after catheter removal. Conclusion It is necessary to strengthen the health education for patients with PDAP of the peritoneal dialysis center, and to improve the positive rate of dialysate culture.The main pathogenic bacteria of PDAP centers on grampositive bacteria. The combination of the first and the third generation of cephalosporins can still be used as an initial empirical drug for PDAP in the hospital.

Preexcitation cardiomyopathy in children: four cases report and literature review

Dong Xuqing, Feng Lin, Wang Xiaoning, Wu Xinhua, He Juan

2020, 35(11): 1015-1018. doi:10.3969/j.issn.1004-583X.2020.11.012

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Objective To analyze the clinical features, treatment and followup of 4 children with preexcitation cardiomyopathy, to understand the prognosis of the disease and to explore the influencing factors of preexcitation cardiomyopathy. Methods The clinical data of 4 children with preexcitation cardiomyopathy in our hospital were analyzed retrospectively, and the literature were reviewed to understand the prognosis and influencing factors of the disease.Results All the 4 children met the diagnostic criteria of preexcitation cardiomyopathy. Totally 3 cases of them underwent intracardiac electrophysiological examination and were found with accessory pathways, then radiofrequency ablation was performed. The preexcitation syndrome of case 1 and case 2 disappeared, while case 3 still had such syndrome. Echocardiography showed that the left ventricle gradually retracted and its function was significantly improved. The prognosis of the disease was favorable. Case 4 had not yet undergone radiofrequency ablation and was currently at followup. Conclusion The radiofrequency ablation is the first choice for the treatment of preexcitation cardiomyopathy and the prognosis is favorable. Age at diagnosis, preexcitation load (persistent or intermittent) and type of preexcitation (location and number of accessory pathways) are the influencing factors of preexcitation cardiomyopathy.

A case of successful rescue of ultra-high concentration methotrexate poisoning and literature review

Yuan Yuting, Tian Chuan, Liu Lili, Ye Zhonglu

2020, 35(11): 1026-1029. doi:10.3969/j.issn.1004-583X.2020.11.014

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The patient was diagnosed with acute lymphoblastic leukemia (Bline highrisk) for more than 5 months, and was hospitalized again for consolidation chemotherapy. According to the treatment plan, the patient was treated with highdose methotrexate (HDMTX) 5 g/m2 for chemotherapy, and the rescue drugcalcium folinate, was used according to the first dose of MTX at 43 h (that is, full 42 h). The dosage of calcium folinate was 15 mg/m2, and plasma concentration of MTX at 48 h was 32 μmol/L. Considering the MTX poisoning, the chemotherapy was suspended and the patient was rescued with large dose of calcium folinate according to MTX poisoning regimen, and the treatment of fluid rehydration, alkalization and forced diuresis was strengthened. At 72 h, MTX plasma concentration was 16.9 μmol/L. The largedose calcium folinate was continuously given to the patient, then hydration and alkalization still went on. The child's abdominal pain showed no signs of remission, and continuous renal replacement therapy (CRRT) was conducted from the 82nd hour. The plasma concentration of MTX still reached 7.2 μmol / L at 96 h. Considering the poor efficacy of CRRT, plasma exchange was carried out at 124 h after MTX, followed by CRRT. At 120 h, the MTX plasma concentration dropped to 3.8 μmol/L. On the 7th day (148 h) of the poisoning, plasma exchange was carried out again to accelerate the detoxification. The plasma concentration of MTX dropped to 0.52 μmol/L at 192 h.

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