Table of Content

20 January 2021, Volume 36 Issue 1

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Systematic review on the efficacy of dual-energy CT and ultrasound in the diagnosis of gout

Lyu Yixuan, Lu Zhanfei, Sun Nianzhe, Li Fuhan, Liu Rong

2021, 36(1):  5-7.  doi:10.3969/j.issn.1004-583X.2021.01.001

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Objective To assess the efficacy of ultrasound and dual-energy CT (DECT) in the diagnosis of gout. Methods PubMed, Embase, Cochrane Library, CNKI, Wanfang Data and CBM database were searched for the studies about diagnostic accuracy of DECT and ultrasound in gout. The deadline for the search was June 30, 2018. Four researchers screened and extracted data based on the inclusion and exclusion criteria, with two people in one group. The QUADAS-2 entry was used to evaluate the methodological quality of the included studies. The heterogeneity test Meta-analysis were conducted on sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR) and negative likelihood ratio (-LR) with the use of Meta-Disc 1.4. The summary receiver operating characteristics (SROC) curve was plotted, and the area under the curve (AUC) was calculated. Results DECT was included in 22 studies involving 1 999 subjects, and ultrasound was included in 10 studies involving 941 subjects. The SEN, SPE and AUC of in the combined studies including DECT were 0.91(CI 95%[0.90, 0.93]), 0.92(CI 95%[0.90, 0.94]) and 0.9725, respectively, and those in the combined studies including ultrasound were 0.77 (CI 0.95%[0.73, 0.80]), 0.88(CI 0.95%[0.85, 0.91]) and 0.8993. Conclusion DECT has a higher diagnostic efficacy than ultrasound.

Clinical characteristics and prognosis of patients with isolated left main stenosis in coronary intervention

Zhou Jing, Dai Yunlang

2021, 36(1):  12-15.  doi:10.3969/j.issn.1004-583X.2021.01.002

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Objective The clinical features and prognosis of patients with isolated left main coronary artery (LMCA) were analyzed retrospectively. Methods Thirty consecutive patients with isolated LMCA stenosis were selected and divided into two groups: open lesion group (n=21) and non-open lesion group (n=9).The follow-up endpoint was major adverse cardiac or cerebrovascular event(MACCE), which was defined as all-cause death and cardiovascular and cerebrovascular events requiring hospitalization.Results Most of the 30 patients with isolated LMCA were treated with percutaneous coronary intervention (PCI)(25/30, 83.3%), only 2 patients received coronary artery bypass grafting, and the remaining 3 patients only received medication. During the median follow-up period of 37.0 months, the incidence of MACCE was 23.3%(7/30), including 4 deaths.Compared with non-open lesion group, open lesion group had more female patients (47.6% vs 0%, P=0.013), younger age (57.8±10.9 vs 66.0±7.8, P=0.050), and significantly lower MACCE incidence (9.5% vs 55.6%, P=0.014).Conclusion PCI is an effective and safe treatment for isolated LMCA stenosis, and the long-term MACCE incidence in open lesion group was lower than that in non-open lesion group.

Relationship between serum amyloid A, high sensitive C-reactive protein, nitric oxide and adverse cardiovascular events in patients with stable coronary heart disease

Ren Ling, Jiang Shan

2021, 36(1):  16-20.  doi:10.3969/j.issn.1004-583X.2021.01.003

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Objective To investigate the relationship between serum amyloid A(SAA), high-sensitivity C-reactive protein(hs-CRP), nitric oxide(NO) and adverse cardiovascular events(ACE) in patients with stable coronary heart disease(CHD).Methods 161 patients with stable CHD were selected retrospectively, and were divided into group A (78 cases with ACE) and group B (83 cases without adverse cardiovascular events) based on one-year follow-up results.The clinical data of the patients were collected, the risk factors of ACE in stable CHD were analyzed, and the predictive value of SAA, hs-CRP and NO for ACE in stable CHD was observed.Results The incidence of diabetes and hypertension in group A was significantly higher than that in group B (P<0.05). SAA and hs-CRP in group A were significantly higher than those in group B, and NO was lower than that in group B (P<0.05). Logistic regression analysis showed that diabetes mellitus, hypertension, SAA, hs-CRP, NO were the risk factors of ACE in stable CHD. ROC curve showing the AUC of SAA, hs-CRP and NO in the diagnosis of ACE in patients with stable CHD was 0.603, 0.633 and 0.706 respectively, the specificity was 0.634, 0.651 and 0.680 respectively, the sensitivity was 0.673, 0.665 and 0.673 respectively, the AUC of the three combined diagnosis of cardiovascular adverse events in patients with stable CHD was 0.744, the specificity was 0.716 and the sensitivity was 0.773. Conclusion High expression of SAA, high expression of hs-CRP and low expression of NO are the risk factors of ACE in patients with stable CHD, and the combination of the three factors has a high clinical value in predicting ACE in patients with stable CHD.

Effects of pharmaceutical intervention on medication adherence and prognosis of discharged patients with myocardial infarction

Su Jiangbo, Yang Lixia, Liu Junqi

2021, 36(1):  21-24.  doi:10.3969/j.issn.1004-583X.2021.01.004

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Objective To explore the effects of pharmaceutical services and interventions in discharged patients with acute myocardial infarction(AMI). Methods A total of 140 discharged patients with AMI treated in Cardiovascular Medicine Department of the Hospital were selected and randomly divided into two groups (70 cases in each group), routine medical advices were implemented for patients in the control group, professional pharmaceutical interventions were implemented for patients in the observation group on the basis of such advices implemented for patients in the control group. The patients in both groups were followed up for 12 months, score of Morisky Medication Adherence Scale 8-item version(MMAS-8), incidence rate of missed dosing and prognosis of patients in two groups were compared. Results The difference in the effect of pharmaceutical intervention on medication adherence was statistically significant (P<0.01);The difference in the effect of the time on medication adherence was statistically significant (P<0.01);The interaction was statistically significant between groups and time (P<0.01), the missed dosing of patients in the observation group in the 3 months, 6 months and 12 months after interventions were lower than those of patients in the control group(all P<0.01). AMI recurrence rate (7.14%) and rehospitalization rate (8.57%) of patients in the observation group after 12-month follow-up period were lower those of patients in the control group (18.57%, 21.43)(P<0.05). Conclusion The pharmaceutical interventions implemented on discharged patients with AMI can improve the medication adherence of patients, reduce the rate of disease recurrence, and improve the prognosis of patients.

Correlation between serum hypersensitive C-reactive protein, lipoprotein-related phospholipase A₂ and senile essential hypertension complicated with type 2 diabetes

Liu Xiaoteng, Shan Weichao, Hou Ruitian, Lin Jinping, Gao Yu, Jin Fengbiao, Liu Chang

2021, 36(1):  25-29.  doi:10.3969/j.issn.1004-583X.2021.01.005

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Objective To investigate the correlation between serum hypersensitive C-reactive protein(HS-CRP), lipoprotein-associated phospholipase A₂(LP-PLA₂) and senile essential hypertension(EH) complicated with type 2 diabetes mellitus (T2DM). Methods A total of 128 EH patients aged ≥60 years were selected as research subjects. According to whether T2DM was combined, the patients were divided into simple EH group (n=60) and EH+DM group (n=68). Patients with pure T2DM during the same period were selected as pure DM group (n=63) and healthy physical examinees as control group (n=61). The differences of FPG, HbA₁c, hs-CRP, Lp-PLA₂ in EH patients with T2DM in different hypertensive subgroups were analyzed. The differences of FPG, HbA₁c, systolic blood pressure(SBP), diastolic blood pressure(DBP) in hs-CRP and Lp-PLA₂ subgroups were analyzed. The correlation between hs-CRP, Lp-PLA₂ and HbA₁c, SBP and DBP was analyzed. Results In EH+DM group, EH group and DM group, LDL-C, hs-CRP and Lp-PLA₂ were all higher than those in control group, while HDL-C was lower than that in control group (all P<0.05). In EH+DM patients, FPG, HbA₁c, hs-CRP and Lp-PLA₂ were all increased with the increase of hypertension level(all P<0.05). With the increase of hs-CRP level, FPG, HbA₁c and SBP all increased (all P<0.05). With the increase of Lp-PLA₂ level, both SBP and DBP increased (all P<0.05). Hs-CRP was positively correlated with HbA₁c, SBP and DBP. Lp-PLA₂ was positively correlated with HbA₁c, SBP, and DBP.At the same time, HbA₁c was positively correlated with SBP and DBP. After adjusting for age, gender, smoking history, body mass index(BMI) and triglyceride(TG), the elevated levels of hs-CRP and Lp-PLA₂ were the risk factors for EH combined with T2DM (all P<0.05). Conclusion The levels of hs-CRP and Lp-PLA₂ can predict the severity of EH combined with T2DM to a certain extent, and hs-CRP and Lp-PLA₂ are risk factors of EH combined with T2DM, which can reflect the patients’ blood pressure, blood glucose control and hypertension classification.

Clinical analysis of endovascular recanalization for chronic intracranial segment of intracranial artery occlusion

Xu Yaoming, Du Yanqiu, Miu Zhongrong, Gao Feng

2021, 36(1):  30-34.  doi:10.3969/j.issn.1004-583X.2021.01.006

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Objective To evaluate the safety and efficacy of endovascular recanalization in the treatment of chronic occlusion of symptomatic internal carotid artery.Methods Chronic intracranial internal carotid artery occlusion endovascular recanalization treatment of 9 cases of patients, in the internal carotid artery occlusion parts C6-C7 segment, 8 cases of recanalization in patients with all used the balloon expansion, including 2 cases using ball expand stents, 6 cases since used of stents, collection was involved all of the patient's clinical information, imaging, and follow-up data were analyzed retrospectively. Results The time from first onset to interventional recanalization was 21-43 days, median 29 days. One of the 9 patients ended the operation because the guide wire failed. The technical success rate was 89.1%(8/9).After surgery, one patient had a reversible central retinal arterial embolization on the treatment side, and there was no high perfusion complication and no death.During 3-12 months of follow-up, one patient developed mild restenosis within the stent (stenosis 30%), and the restenosis rate was 11%, no stroke occurred.Conclusion Endovascular recanalization is safe and feasible in the treatment of chronic occlusion of the internal carotid artery in the intracranial segment, with a high surgical success rate, and can be promoted clinically under strict screening criteria.

Relationship between homocysteine and early neurological impairment severity and prognosis of acute cerebral infarction

Gong Tao, Gao Yun, Hu Yueyuan, Wang Dongyu

2021, 36(1):  35-38.  doi:10.3969/j.issn.1004-583X.2021.01.007

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Objective Homocysteine(Hcy) serves as main risk factor for cerebral infarction, especially for large artery atherosclerosis (LAA) cerebral infarction. The relations between Hcy, severity and prognosis of early neurological impairment in patients with LAA were clinically studied. Methods A total of 260 patients with LAA acute cerebral infarction(ACI) were selected, the degree of neurological impairments of patients at admission was evaluated (mild NIHSS≤5 points, moderate to severe NIHSS>5 points) according to the National Institutes of Health Stroke Scale (NIHSS); the fasting serum Hcy level within 24 hours was tested, and the patients were divided into high Hcy group (Hcy≥10 μmol/L) and normal Hcy group (Hcy<10 μmol/L); the follow-up for 90 days was implemented to record the prognosis, the correlation between the serum Hcy level and severity or prognosis of early neurological impairments in ACI was analyzed. Results The serum Hcy level in patients with moderate or severe ACI was higher than that of patients with mild cerebral infarction (P<0.01); The serum Hcy level in patients with poor prognosis was significantly elevated (P<0.01), and binary logistic regression analysis showed that elevated Hcy level was an independent risk factor for higher severity of neurological impairments in early stages of ACI (P<0.01; OR=1.387, 95%Cl: 1.245-1.545) and an independent risk factor for poor prognosis (P<0.01; OR=1.478, 95%Cl: 1.312-1.666). Conclusion Elevated serum Hcy level may be an independent risk factor for early deterioration of neurological function and poor prognosis of LAA in ACI.

Status investigation of chronic comorbidity status in elderly at tertiary hospitals and community hospitals

Zhang Xinhui, Gu Yumeng, Wang Zhongyan, Wang Donglai, Xia Xiaoshuang, Wang Lin, Liu Xia

2021, 36(1):  39-43.  doi:10.3969/j.issn.1004-583X.2021.01.008

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Objective To understand the status of comorbidity of chronic diseases in elderly people aged ≥60 years and their correlation, so as to provide reference for optimizing the management of comorbidities and formulating the prevention and control measures of comorbidities. Methods Taking a tertiary hospital and community hospital in Tianjin as a pilot, retrospective analysis was involved in the elderly ≥60 years who were hospitalized in the geriatric department of the tertiary hospital and the community hospital. The study collected and compared demographic characteristics including gender, age, and the detection of chronic diseases, etc.Results A total of 950 geriatric inpatients of a tertiary hospital and 14 377 elderly people in community hospitals were included in the study. The detection rates of chronic diseases in the elderly≥60 years in the two hospitals were 94.3% and 57.3%, respectively. The detection rates of hypertension in the two hospitals were 74.1% and 51.9%, respectively, ranking first in chronic diseases(P<0.05). Conclusion The number of elderly patients with comorbidities is huge,and most chronic diseases are related to hypertension. More attention should be paid to the popularization and application of hypertension prevention and treatment strategies, and the construction of networking and interaction between tertiary hospitals and community hospitals should be strengthened to improve the prevention and treatment level of chronic diseases.

Relationship between eosinophil levels and carotid atherosclerosis in maintenance hemodialysis patients

Shang Qihang, Chen Huaqian

2021, 36(1):  44-48.  doi:10.3969/j.issn.1004-583X.2021.01.009

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Objective To investigate the relationship between eosinophil (EOS) level and carotid atherosclerosis in maintenance hemodialysis (MHD) patients. Methods 151 MHD patients with complete clinical data in our hospital were selected and divided into control group and hardening group 96 cases according to carotid ultrasound. Comparison of two groups included high sensitivity C-reactive protein (hs-CRP), eosinophil (EOS), white blood cell (WBC), hemoglobin (HB), platelet (PLT), albumin (ALB), serum ferritin (SF), intact parathyroid hormone (iPTH), total cholesterol (TC), low density lipoprotein (LDL-C), triglyceride (TG), high-density lipoprotein (HDL-C), small and low-density lipoprotein (sdLDL), lipoprotein a (Lpa). The patients were divided into the lower quartile group, the middle quartile group, and the upper quartile group according to the quartiles of EOS. The detection rates of carotid atherosclerosis and micro-inflammation were compared among the three groups, and the relationship between eosinophil level and carotid atherosclerosis was analyzed.The correlation between carotid intima-media thickness (IMT) and EOS count was analyzed. Observation was further performed for the role of EOS in carotid atherosclerosis in MHD patients.Results Among 151 patients, 96 patients (64%) had carotid atherosclerosis. The number of patients with microinflammation in sclerotic group was more than that in control group, and TC, LDL-C, sdLDL levels were higher in sclerotic group(P<0.05); There were significant differences in the detection rate of carotid atherosclerosis and microinflammation among different EOS groups (P<0.05); IMT was positively correlated with EOS, TC, LDL-C.TC and LDL-C are independent factors of cervical arteriosclerosis in MHD patients. Conclusion Eosinophilia is a related factor of carotid atherosclerosis in MHD(maintenance hemodialysis) patients, and MHD patients with higher eosinophilia level are more likely to develop carotid atherosclerosis.

Relationship between urinary albumin and glucose increase 2 hours after glucose load in patients with type 2 diabetes

Wang Yali, Wang Ruiying, Cui Yue

2021, 36(1):  49-53.  doi:10.3969/j.issn.1004-583X.2021.01.010

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Objective To explore the relationship between urinary albumin in patients with type 2 diabetes and the increase in blood glucose (2hPG-FBG) 2 hours after oral 75 g glucose tolerance test (OGTT) glucose load. Methods The electronic medical record system, 120 patients with type 2 diabetes who were hospitalized in the Endocrinology Department of the Second Hospital of Hebei Medical University were retrospectively collected. According to the urine albumin/creatinine ratio (UACR), the patients were divided into normal urine albumin group (group N: UACR<30 mg/g), microalbuminuria group (group A: 30 mg/g≤UACR<300 mg/g) and massive albuminuria group (group B: UACR≥300 mg/g). The differences in the indicators among three groups were compared. Results 2 hPG-FBG in microalbuminuria group was higher than that of normal urine albumin group, and massive albuminuria group was higher than that of the microalbuminuria group (P<0.05). The HbA₁c in microalbuminuria group and massive albuminuria group were higher than that of normal urine albumin group (P<0.05). Spearman correlation analysis showed that UACR was positively correlated with HbA₁c (r=0.294) and 2 hPG-FBG (r=0.516) (all P<0.05). Multiple linear stepwise regression analysis showed that 2 hPG-FBG was an independent risk factor for UACR (β=3.239). Conclusion Postprandial blood glucose fluctuation, represented by 2 h blood glucose increase after glucose loading, is an important factor causing the increase of urinary albumin in patients with type 2 diabetes, and its effect is more obvious than that of sustained blood glucose level.

Effect of TPOAb, HbA₁c, PLGF and lipid level on pregnancy outcome in pregnant women with gestational diabetes mellitus

You Mu, Cai Manhong

2021, 36(1):  54-57.  doi:10.3969/j.issn.1004-583X.2021.01.011

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Objective To investigate the levels and significance of antithyroid peroxidase antibody(TPOAb), hemoglobin A1c(HbA₁c), placental growth factor(PLGF) and blood lipid in pregnant women with gestational diabetes mellitus(GDM). Methods A total of 180 GDM patients in Nanjing Maternity and Child Health Care Hospital were selected as observation group. A total of 180 healthy pregnant women who were examined in the above hospital during the same period were selected as control group. Fasting venous blood was collected at 24-27 weeks of gestation, and TPOAb, HbA₁c PLGF and lipid indexes were detected and compared between two groups. The pregnancy outcomes of GDM patients were recorded, and TPOAb, HbA₁c, PLGF and blood lipid indexes between patients with poor pregnancy outcomes and those with normal pregnancy outcomes were analyzed. Results TPOAb, HbA₁c, TG in observation group were higher than those in control group, while PLGF was lower than that in control group (P<0.05); TPOAb positive rate in observation group was higher than that in control group (χ²=12.394, P<0.01); there were 56 patients(31.11%) with poor pregnancy outcomes and 124 patients(68.89%) with normal pregnancy outcomes in observation group. TPOAb, HbA₁c, TG in patients with poor pregnancy outcome were higher than those in patients with normal pregnancy outcome, while PLGF was lower than that in patients with normal pregnancy outcome (P<0.05); TPOAb positive rate of patients with poor pregnancy outcome was higher than that of normal pregnancy outcome (χ²=5.762, P=0.016).Conclusion There were significant differences in TPOAb, HbA₁c, PLGF and TG between GDM pregnant women and healthy pregnant women, which may have some adverse influence on pregnancy outcomes.

Effects of Jiangzhi Ligan Granules combined with simvastatin on hepatic biochemical indexes, leptin and adiponectin in treatment of NAFLD

Zhang Ying, Wang Chunsheng

2021, 36(1):  58-61.  doi:10.3969/j.issn.1004-583X.2021.01.012

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Objective To investigate the effect of Jiangzhi Ligan Granules combined with simvastatin on hepatic biochemical indexes, leptin and adiponectin in the treatment of non-alcoholic fatty liver disease (NAFLD). Methods A total of 94 NAFLD patients admitted to our hospital were randomly divided into control group and observation group, with 47 cases in each group. Patients in control group were treated with simvastatin, and those in observation group were treated with Jiangzhi Ligan Granules more. The postoperative efficacy of two groups was analyzed, and the levels of blood lipids, liver biochemistry, leptin (LP), adiponectin (ADPN) and other indicators of two groups were recorded before and after treatment. Results After three months of treatment, the total efficacy rate of patients in observation group was 91.49% (43/47), which was significantly higher than 72.34% (34/47) in control group(P<0.05). TG, TC, LDL-C, ALT, AST, GGT and LP levels in both groups were significantly decreased, while HDL-C and ADPN levels were significantly increased, and the change degree in observation group was significantly higher than that in control group(P<0.05). Conclusion Jiangzhi Ligan Granule combined with simvastatin can significantly improve the balance of blood lipid metabolism and liver function metabolism in NAFLD patients,and effectively regulate the secretion, immunity and insulin functions of the body.

Case report of a neonate with cleidocranial dysplasia caused by novel RUNX2 mutation

Li Na, Zhang Fang, Hao Lihong, Liu Yang

2021, 36(1):  62-65.  doi:10.3969/j.issn.1004-583X.2021.01.013

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Cleidocranial dysplasia (CCD) is a rare autosomal dominant hereditary disease with multiple skeletal dysplasia. Its pathogenic gene is RUNX2 located at chromosome 6p21. The clinical manifestations of CCD are diverse, and the management of its treatment requires multidisciplinary cooperation. Early diagnosis and treatment are essential to correct malformations and improve the life quality of patients. The clinical manifestations of CCD in the neonatal period are incomplete, and the abnormal clavicle is easily misdiagnosed as fracture. This paper summarizes the clinical characteristics of a newborn CCD caused by novel RUNX2 mutation, and reports the new mutation sites so as to improve clinicians' understanding of the disease and provide a reference for exploring the molecular genetic mechanism of CCD pathogenesis.

A case of acute hemorrhagic cerebral infarction caused by infective endocarditis

Lin Na, Liu Chuan, Wu Tianyu, Cao Lei

2021, 36(1):  66-69.  doi:10.3969/j.issn.1004-583X.2021.01.014

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Infective endocarditis related stroke is clinically rare and has high mortality rate, atypical course and imaging. Due to the lack of clinical understanding, it is easy to cause misdiagnosis and mistreatment, followed by poor prognosis. This paper reports a case of infective endocarditis with hemorrhagic cerebral infarction. The purpose is to improve the clinicians' cognition of this disease, in order to give patients early targeted treatment and improve their prognosis.