Table of Content

20 February 2021, Volume 36 Issue 2

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Relationship between homocysteine and hypertensive disorder complicating pregnancy: a meta-analysis

Zhou Yixuan, Lin Weizhao, Li Ruiman

2021, 36(2):  101-106.  doi:10.3969/j.issn.1004-583X.2021.02.001

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Objective To evaluate the correlation between plasma homocysteine (Hcy) levels and the risk of hypertensive disorder complicating pregnancy (HDCP). Methods PubMed, EMbase, Cochrane Library, Medline, Web of Science, CNKI, VIP and Wanfang data were searched for the literature which met inclusion and exclusion criteria. The quality evaluation of literature was carried out by Newcastle-Ottawa Scale. Rev Man 5.3 software was used to conduct meta-analysis. The included studies were analyzed to explore the correlation between plasma Hcy levels and risk of HDCP by the combination of the heterogeneity inspection and corresponding effect model. Results A total of 12 literature were included, all of which were of high quality (average score >5), with a total sample size of 10 079 cases. (1) The increase of plasma Hcy level was associated with the risk of HDCP(MD=4.44,95%CI: 3.01-5.87, P<0.01). (2)The plasma Hcy concentration in women with severe preeclampsia was higher than that in women with mild preeclampsia(MD=-2.84,95%CI:-3.78 - -1.90, P<0.01). (3) The correlation between serum folic acid and HDCP was statistically significant (MD=-3.21,95%CI:-4.50 - -1.91,P<0.01). (4) The correlation between serum Vit B12 level and HDCP was statistically significant (MD=-65.92,95%CI:-98.57 - -33.28, P<0.01). Conclusion Plasma Hcy level is closely related to the incidence of HDCP, its concentration is negatively correlated with serum levels of folic acid and Vit B12, and its expression level is significantly correlated with the severity of preeclampsia (PE). It is suggested that Hcy level may be a monitoring indicator for the efficacy and prognosis of PE.P

Relations between serum immunoglobulin, level of complement C3 or complement C4 and prognosis of hypertensive intracerebral hemorrhage patients

Wu Liang, Liu Ming

2021, 36(2):  107-111.  doi:10.3969/j.issn.1004-583X.2021.02.002

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Objective To explore the relations between serum immunoglobulin, changes in complement C3 and complement C4 and prognosis of hypertensive intracerebral hemorrhage(HICH) patients. Methods One hundred and fifty HICH patients admitted by the hospital were selected as study subjects, and the patients were divided into good prognosis group and poor prognosis group according to Modified Rankin Scale(mRS) scores of patients in one month after the onset of diseases, and healthy people with normal physical results during the same period were selected into normal control group. Glasgow Coma Scale (GCS) scores, NIH Stroke Scale (NIHSS) scores and hematoma volume were collected. IgG, IgA, IgM and C3 and C4 of serum samples were determined by immunoturbidimetry. Results GCS scores of poor prognosis group on the the 1st day were significantly lower than those of good prognosis group (P<0.05), and NIHSS score, hematoma volume and WBC of poor prognosis group were significantly higher than those of good prognosis group (P<0.05).The comparative difference in the level of IgG, IgM, complement C3 or complement C4 of humoral immunity of patients in poor prognosis group, good prognosis group and control group on the 1st day was statistically significant (P<0.05), and the level of IgG, IgM, complement C3 or complement C4 of poor prognosis group and good prognosis group was significantly lower than those of the control group (P<0.05), the level of IgG, IgA, IgM or complement C3 or complement C4 of poor prognosis group was significantly lower than those of good prognosis group (P<0.05). The serum level of IgG or IgM of both groups was minimized on the 3rd day. IgG, IgM, complement C3 or complement C4 of poor prognosis group for inter-group and identical time-point comparison on the 1st 3rd days were lower than those of good prognosis group (P<0.05), and the level of complement C3 or complement C4 of poor prognosis group on the 11th day were higher than those of good prognosis group (P<0.05). The inter-group interactions of IgG, complement C3 and complement C4 of patients at identical or different time points were statistically significant (P<0.05), and the comparison in IgM of patients in groups at different time points was statistically significant (P<0.05). The level of IgG, IgM, complement C3 or complement C4 were positively correlated with GCS scores (P<0.05). The level of IgG, IgM, C3 or C4 was negatively correlated with NIHSS scores, hematoma volume and WBC (P<0.05). Conclusion HICH patients are found to have suppressed humoral immune, serum immunoglobulin and level of complement C3 or complement C4 below than that of normal patients, and HICH patients with poor prognosis show suppressed humoral immunity or activation level higher than that of patients with good prognosis.

Relations between lipoprotein-associated phospholipase A2 and unstable carotid atherosclerotic plaque in middle-aged or elderly patients with hypertension

Deng Yujie, Fan Linqing, Zhang Tao

2021, 36(2):  112-116.  doi:10.3969/j.issn.1004-583X.2021.02.003

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Objective To explore and analyze the relations between the activity level of plasma lipoprotein-associated phospholipase A2(Lp-PLA2) and unstable carotid atherosclerotic plaque in middle-aged or elderly patients with hypertension and corresponding clinical significance. Methods One hundred and two patients with hypertension were selected to undergo bilateral carotid ultrasound examinations and were divided into two groups including 50 cases in stable carotid atherosclerotic plaque and 52 cases in unstable carotid atherosclerotic plaque based on the comprehensive evaluation involving ultrasound images, plaque morphology and echo characteristics. The enzyme activity method was used to determine the activity level of plasma Lp-PLA2 in patients, and the influencing factors of unstable carotid atherosclerotic plaque and predictive value of activity level of plasma Lp-PLA2 on unstable carotid atherosclerotic plaque were analyzed. Results The activity level of plasma Lp-PLA2 activity in the patients in unstable carotid atherosclerotic plaque group was higher than that in in patients in the stable carotid atherosclerotic plaque group (P<0.05). The activity level of plasma Lp-PLA2 activity isserved as an independent risk factor affecting unstable carotid atherosclerotic plaque in middle-aged and or elderly hypertensive patients (P<0.05). The area under the ROC curve (AUC) of Lp-PLA2 predicting unstable carotid atherosclerotic plaque was 0.921, and when the best cut-off value was 551.15 U/L, its prediction sensitivity was 75% and specificity was 94%. Conclusion The activity level of plasma Lp-PLA2 is significantly elevated in middle-aged or elderly patients with hypertension complicated with unstable carotid atherosclerotic plaque, and it is considered to be an independent risk factor. The activity level of Plasma Lp-PLA2 delivers high predictive value for unstable carotid atherosclerotic plaque. When its value is 551.15 U/L, it can help predict whether the plaque is stable, and it is expected to be an inflammatory marker for early warning on early clinical evaluation of cerebrovascular embolic events.

Clinical study on reteplase in treating acute ischemic stroke

Zhang Qiang, Zhang Gaolan, Liu Qingdong

2021, 36(2):  117-120.  doi:10.3969/j.issn.1004-583X.2021.02.004

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Objective To evaluate the efficacy and safety of reteplase in thrombolytic therapy for acute ischemic stroke. Methods Sixty-three patients with acute ischemic stroke admitted to Tai’an Hospital of Traditional Chinese Medicine were enrolled and randomly divided into the reteplase group and urokinase group. NIHSS scores, Barthel index and bleeding complications of patients in two groups before and after thrombolysis were compared. Results NIHSS scores of patients in two groups after treatment were improved significantly, the efficacy of thrombolytic drugs on patients in two groups was definite, and the difference was statistically significant at different time points (P<0.05). No significant differences in interactions of patients in two groups were found between groups and at different time points (P>0.05). The response rate of reteplase group on day 1, day 7 and day 14 after treatment was 64.5%, 77.4% and 80.6% respectively, and those of urokinase group were 31.3%, 46.9% and 53.1%, respectively. The response rate of reteplase group was higher than that of urokinase group, the response rate of patients on day 1, day 7 and day 14 was statistically significant. The comparison in Bathel index of patients in two groups showed that patients in the reteplase group had better recovery and lower disability rate (P<0.05). The cerebral hemorrhage remained to be the most serious complication, and comparative differences in haemorrhagic conditions of patients in two groups were not statistically significant. Conclusion Reteplase thrombolytic therapy delivers definite efficacy in treating acute ischemic stroke, can better improve neurological deficit function and improve the quality of life without increasing the bleeding risk.

Clinical study of Jieyu Anshen Particles combined with paroxetine in treating senile coronary stable angina pectoris with depression

Xie Bing, Zhao Fengfeng, Chen Liang

2021, 36(2):  121-124.  doi:10.3969/j.issn.1004-583X.2021.02.005

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Objective To observe clinical effects of Jieyu Anshen Particles combined with paroxetine in treating elderly patients with coronary stable angina pectoris and depression. Methods Eighty-six elderly patients with coronary stable angina pectoris complicated with depression were randomly divided into observation group and control group. The patients in control group was treated with drugs for coronary heart disease such as western medicine routine coronary artery expansion, antiplatelet aggregation, lipid regulation, and reduction of myocardial oxygen consumption, and then orally took paroxetine tablets with 20 mg/d. Based on the control group, the patients in observation group received Jieyu Anshen Particles and took each dose in 5 g in the morning and evening. The effiicacy, TCM syndrome scores, Hamilton Depression Scale(HAMD) scores and Self-rating Depression Scale(SDS) scores of patients in two groups before and after treatment were compared. Results The overall response rate of patients in observation group and control group was 88.10% and 68.29%, respectively(P<0.05). The scores of TCM symptoms, HAMD and SDS of patients in two groups were lower than before treatment (P<0.05), and the scores of observation group after treatment were lower than those of control group (P<0.05). Conclusion Jieyu Anshen Particles combined with paroxetine can not only improve the depression but also relieve the symptoms of coronary heart disease complicated with stable angina pectoris, and corresponding clinical effect is better than that of paroxetine alone, being worthy of promotion and application.

Clinical application of thromboelastogram in patients with primary acute myocardial infarction

Zhang Xiaole, Cai Zhaoxu, Zhang Heqiong, Wang Yangyang, Lu Shaoyun, Yang Chunwan

2021, 36(2):  125-128.  doi:10.3969/j.issn.1004-583X.2021.02.006

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Objective To analyze whether thromboelastogram (TEG) monitoring related to the severity of coronary artery pathological changes in patients with acute myocardial infarction ( AMI ) and whether it involved with cardiovascular adverse events in hospital. Methods Eighty patients with primary AMI were selected in our hospital as AMI group, 30 healthy persons served as normal control group. According to electrocardiogram, AMI group was further divided into 49 cases of acute ST-elevated myocardial infarction (STEMI) group and 31 cases of non-ST-elevated myocardial infarction (NSTEMI) group. Thromboelastogram was monitored by blood drawing within 2 hours before taking antiplatelet drugs and undergoing emergency coronary intervention. The relationship between the thromboelastogram and coronary artery pathological changes degree Gensini score and major adverse cardiac events (MACE) were evaluated in two subgroups. Results The R value and K value of AMI patients were lower than those of normal control group. The R value and K value of STEMI group were lower than those of NSTEMI (P<0.05). The Angle and MA value of patients with AMI were higher than those of normal control group, and the angle, MA value, Gensini score and MACE incidence in STEMI group were higher than those in NSTEMI group (P<0.05). Conclusion Hypercoagulability in patients with AMI predicts more severe coronary artery pathological changes and a higher incidence of MACE.

Effects of Tongxinluo Capsules on myocardial microperfusion in patients free of reflow after PCI and long-term efficacy and safety

He Na, Li Minxian, Zhang Qi, Xu Fang, Zhang Chenfeng, Song Da

2021, 36(2):  129-133.  doi:10.3969/j.issn.1004-583X.2021.02.007

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Objective To explore the effects of Tongxinluo Capsules on myocardial microperfusion in patients with percutaneous coronary intervention (PCI) free of reflow and corresponding long-term safety. Methods One hundred and twenty eight patients free of reflow after PCI were randomly divided into two groups by random grouping method, the patients in control group(n=63) received standardized medications, and those in treatment group(n=65) received oral Tongxinluo Capsules based on standardized medications. Baseline clinical conditions, intraoperative surgical operations as well as changes in inflammatory and oxidative stress indicators(hs-CRP, SOD, MDA), cardiac function indicators and myocardial contrast echocardiography images on the 7th day, 30th day and 90th day after surgery, 24 months follow-up of MACE events as well as adverse reactions caused by the use of Tongxinluo Capsules of patients in two groups were compared. Results Highly sensitive C-reactive protein(hs-CRP) and malondialdehyde(MDA) of treatment group at post-operative time node were significantly lower than those of control group, and the differences in two groups till post-operative 30 days were statistically significant, the superoxide dismutase(SOD) of treatment group was higher than those of control group(P<0.05); Myocardial contrast echocardiography was performed on the 30th day, the patients in treatment group were found to have low myocardial perfusion imaging time, high contrast score indexes, and high A·β value when compared to those in the control group, and the difference was even greater on the 90th day(P<0.05); LVEF level of patients in two groups escalated over time, and the level of LVESVI and WMSI decreased over time. The heart function indexes of treatment group were better than those of control group at each time points(P<0.05). The 24-month MACE event rate of treatment group was significantly lower compared to those of control group(P<0.05). No serious adverse drug reactions caused by Tongxinluo capsules were found after 24 months follow-up. Conclusion Early use of Tongxinluo Capsule in patients free of reflow after PCI can reduce inflammation, inhibit oxidative stress, improve myocardial microperfusion and cardiac function, and further enhance patient prognosis, and long-term follow-up shows Tongxinluo Capsule delivers good safety.

Clinical efficacy of comprehensive pulmonary rehabilitation therapy with full oxygenation in senile patients with COPD at stable stage

Xia Xiaoli, Ma Yanping, Wang Yafeng

2021, 36(2):  134-138.  doi:10.3969/j.issn.1004-583X.2021.02.008

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Objective To evaluate the clinical efficacy of comprehensive pulmonary rehabilitation therapy with sufficient oxygenation in senile patients with chronic obstructive pulmonary disease(COPD) at stable stage. Methods A total of 52 patients with COPD aged 65 years or over who were admitted to the department of geriatrics of our hospital from January 2019 to August 2019 were randomly divided into observation group and control group with 26 cases in each group. The control group was given conventional therapy, and the observation group received comprehensive pulmonary rehabilitation therapy with sufficient oxygenation on the basis of conventional treatment in the control group. British Medical Research Council Dyspnea scale (mMRC) score, 6 min walking distance(6MWD), lung function, arterial blood gas analysis, heart rate (HR), and blood oxygen saturation (SaO₂) were compared before treatment and 3 months after treatment in two groups. Results 6MWD, mMRC score, and SaO₂ in observation group were significantly better after 3 months of treatment than before treatment and control group (P<0.01). Partial arterial blood carbon dioxide pressure (PaCO₂), partial oxygen pressure (PaO₂), the percentage of forced breathing volume in the first second (FEV1%), and middle expiratory flow rate (FEF25%-75%) were all improved after 3 months of treatment as compared with before treatment and control group (P<0.05). Conclusion Comprehensive pulmonary rehabilitation therapy with sufficient oxygenation can effectively improve the lung function of senile patients with COPD at stable stage, correct carbon dioxide retention, relieve dyspnea symptoms, and improve the quality of life of senile patients.

Prognostic value of NLR, PLR and CEA in advanced non-small cell lung cancer

Bao Xinran, Ha Minwen

2021, 36(2):  139-143.  doi:10.3969/j.issn.1004-583X.2021.02.009

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Objective To investigate the prognostic value of neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), and carcinoembryonic antigen(CEA) in patients with advanced non-small cell lung cancer(NSCLC). Methods One hundred and thirty-five cases of advanced NSCLC were divided into high and low NLR group, high and low PLR group and high and low CEA group, and the general clinical data among the groups were compared. The evaluation value of NLR, PLR and CEA on the prognosis of advanced NSCLC was compared. Results The median OS of low PLR group was significantly higher than that of high PLR group (χ²=6.128, P=0.013). The median OS of low CEA group was significantly higher than that of high CEA group (χ²=12.18, P<0.01). Among NLR, PLR and CEA, the index NLR 0.761 was the largest in the area under the ROC curve (AUC). Conclusion NLR, PLR and CEA can evaluate the prognosis of patients with advanced NSCLC to different degrees, among which NLR has the best predictive efficacy.

Relationship between a body shape index and newly-diagnosed type 2 diabetes mellitus complicated with non-alcoholic fatty liver disease

Ye Jingjing, Qin Yu, Zhao Li, Yang Ling

2021, 36(2):  144-148.  doi:10.3969/j.issn.1004-583X.2021.02.010

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Objective To analyze the relationship between a body shape index (ABSI) and newly-diagnosed type 2 diabetes mellitus(T2DM) complicated with non-alcoholic fatty liver disease(NAFLD). Methods A retrospective study included 107 newly-diagnosed T2DM patients complicated with NAFLD treated in Affiliated Hospital of Jiangsu University. According to the results of abdominal color ultrasonography, those patients were divided into the experimental group (n=57) with T2DM complicated with NAFLD patients and T2DM group (n=50) with signal newly-diagnosed T2DM patients. Additionally, 48 healthy controls were selected into the control group (n=48). The clinical baseline data including height, weight, waist circumference(WC), and hip circumference(HC) were recorded for all participants to calculate ABSI, waist hip rate(WHR), body mass index(BMI), waist height rate(WHtR). And, the relevant biochemical indicators were measured. All the clinical parameters were compared among three groups. The relationship between ABSI and metabolic indexes was analyzed. Results Compared with T2DM group and control group, the levels of ABSI, fasting insulin, HOMA-IR, low-density lipoprotein cholesterin(LDL-C), triacylglycerol(TG), total cholesterol(TC), uric acid(UA), white blood cell(WBC), neutrophils/lymphocytes ratio(NLR), WC, WHR, BMI, and WHtR in experimental group were higher, while the level of high-density lipoprotein cholesterin (HDL-C) was lower. Furthermore, with the increase of ABSI level, the levels of fasting blood-glucose(FBG), 2-hour post-meal blood glucose(2 hPG), LDL-C, TG, TC, HOMA-IR, and NLR were remarkably elevated, which had a positive correlation. However, the level of HDL-C was decreased, which meant a negative correlation. The logistic regression analysis showed that ABSI was a risk factor for the newly-diagnosed T2DM complicated with NAFLD. The ROC curve indicated that ABSI had a certain value in predicting the NAFLD development in newly-diagnosed T2DM patients. The area under the ROC curve was 0.78. Conclusion The ABSI which has a close relation to insulin resistance and NLR level can be significantly increased and serve as a risk factor in patients with newly-diagnosed T2DM complicated with NAFLD. And it can provide a new clinical idea for the prevention and early screening of NAFLD.

Risk factors for poor prognosis of children with Mycoplasma pneumonia pneumonia complicated with atelectasis

Li Ximei, Tang Yu, Gong Chenfang

2021, 36(2):  149-152.  doi:10.3969/j.issn.1004-583X.2021.02.011

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Objective To explore the risk factors for poor prognosis of children with Mycoplasma pneumoniae pneumonia(MPP) complicated with atelectasis. Methods The study involved 126 children with MPP complicated with atelectasis who were hospitalized in the hospital from January 2018 to January 2020. According to prognosis, 61 children with unhealed atelectasis were divided into observation group, and 65 children with healed atelectasis were put into control group. Enzyme-linked immunosorbent assay (ELISA) was used to measure interleukin-2(IL-2), IL-4, IL-6, IL-10, tumor necrosis factor α(TNF-α), C reactive protein(CRP) and interferon-γ(IFN-γ). Results The right middle lobe atelectasis accounted for 31.96% in children with MMP complicated with atelectasis, ranking the top place; and followed by right upper lobe atelectasis 23.71%; the age, treatment duration, lesion site, as well as serum IL-4, IL-6 and IL-10, CRP, and IFN-γ in observation group were higher than those in control group (P<0.05). Conclusion The serum IL-4, IL-6, IL-10 and IFN-γ are related to the poor prognosis of MPP complicated with atelectasis.

Clinical analysis and therapy on urinary tract infection in children

Yu Xiaoxia, Wang Qiaohong

2021, 36(2):  153-156.  doi:10.3969/j.issn.1004-583X.2021.02.012

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Objective To analyze clinical characteristics of 147 children with urinary tract infection in the hospital and to provide reference basis for clinical diagnosis and treatment by combining the progress of new researches at home and abroad. Methods The descriptive clinical epidemiological method was applied to conduct retrospective analysis on 147 hospitalized cases with urinary tract infection in the hospital from May 2016 to May 2020. Results The 88 out of 147 cases were male patients, accounting for 59.86%; the number of patients in the infancy stage ranked top, hitting 63 cases(42.86%). Enterococcus faecalis and Escherichia coli were common in urine cultures; Cephalosporin antibiotics was used to treat 136 cases(92.52%), in which 132 cases(89.80%) were treated with third-generation cephalosporin; 22 cases of 45 children(48.89%) undergoing excretory cystoureterography suffered from vesicoureteral reflux. Conclusion Urinary tract infection is a common disease in children, and it is easy to cause recurrent infection due to its close relation with urinary tract malformations especially vesicoureteral reflux. Early diagnosis and treatment and search for its potential malformation can prevent recurrence and improve prognosis of urinary tract infection.

Investigation on current situation of clinical blood management in tertiary general hospitals of Hebei province

Song Junzhen, Shi Cuiying, Wang Fenghong, Ma Yuanyuan, Zhao Qian

2021, 36(2):  157-161.  doi:10.3969/j.issn.1004-583X.2021.02.013

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Objective To investigate current situation of clinical blood management in tertiary general hospitals, and to raise rationalization proposal for clinical blood management. Methods Forty-two tertiary general hospitals of Hebei province were investigated on clinical blood management. Clinical blood management, construction of blood transfusion department, blood transfusion medical records were inspected and evaluated via the report hearing, data check, on-site inspection, questionnaires and testing. Results The hospitals were divided into four grades based on total points scored, the number of such hospitals thorough from Grade 1 to Grade 4 were 9, 14, 10 and 9 respectively, and total points scored were (192.6±2.08) points, (183.5±2.09) points, (175.6±3.22) points and (161.7±5.36) points, the scores of clinical blood management of hospital were (73.3±1.09) points, (69.7±2.66) points, (66.2±3.58) points and (59.0±7.29) points respectively, the scores (45.7 points) of blood transfusion department were (44.6±0.91) points, (42.8±1.74) points, (42.1±1.89) points and (39.1±4.62) points respectively, the scores (79.0 point) of blood transfusion medical records were (74.7±1.95) points, (71.1±2.60) points, (67.3±2.78) points and (63.6±7.57) points respectively. Conclusion Substantial insufficiencies for construction and implementation of clinical blood management service, software and hardware construction of blood transfusion department were found with tertiary general hospitals in Hebei. It is an effective measure to properly implement top level design of clinical blood management, strengthen infrastructure and technology construction, improve training and assessment system, emphasize the sense of responsibility, and strictly tighten on supervision and management.

Cerebral venous sinus thrombosis as the first manifestation of Neuro-Behcet's disease: one case report and literature review

Yin Yuanyuan, Ren Huiling

2021, 36(2):  162-167.  doi:10.3969/j.issn.1004-583X.2021.02.014

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Neuro-Behcet's disease (NBD) represents the involvement of the nervous system in patients with Behcet's disease (BD). The central nervous system manifestations of NBD are divided into parenchyma type and non-parenchyma type. Cerebral venous sinus thrombosis(CVST) serves as main manifestation of NBD non-parenchymal type. CVST, a rare manifestation in BD patients, is usually complicated with cranial hypertension involving the headache, vomitin, and papilledema. BD mainly relies on clinical diagnosis due to the lack of specific diagnostic test. It is necessary to consider the occurrence of BD with CVST for young male patients suffering from persistent headache and increased intracranial pressure. A young male patient with CVST as the first manifestation is introduced, and the literature related to BD combined with CVST are reviewed.