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    20 November 2021, Volume 36 Issue 11
    Efficacy and safety of half-dose versus standard-dose of tirofiban for percutaneous coronary intervention in elderly Chinese patients with acute coronary syndrome: a meta-analysis
    Liu Yuanliang, Li Biao, Jiang Zuofeng, Zhu Youfeng, Zhang Shaoheng, Wang Yarong, Li Rongseng, Li Li
    2021, 36(11):  965-971.  doi:10.3969/j.issn.1004-583X.2021.11.001
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    Objective To systematically review the effectiveness and safety of half-dose versus standard-dose of tirofiban for percutaneous coronary intervention (PCI) in elderly Chinese patients with acute coronary syndrome (ACS).Methods Randomized controlled trials(RCTs), which were about standard or half dose of tirofiban for elderly Chinese patients with ACS undergoing PCI, and published by Cochrane, PubMed, Embase, Wanfang, and CNKI databases until January 2021 at home and abroad, were retrieved. Secondly, meta-analysis was performed based on the literature review results, and publication bias was evaluated. Results Five articles were included out of 768 retrieved literatures, a total of 596 patients were enrolled, including 300 cases in the half-dose group and 296 cases in the standard-dose group. Meta-analysis showed that, the first, in terms of curative outcomes, there was no statistically significant difference in the incidences of grade III forward-flow of postoperative thrombolysis myocardial infarction (TIMI) and major adverse cardiovascular events(MACE) in clinical between groups (P>0.05). The second, in terms of safety, the incidence of clinical bleeding downregulated notably in half-dose group when compared with standard-dose group, and with statistically significant difference [RR=3.70, 95%CI=(1.89, 5.00), P<0.01]. The difference was not statistically significant in the incidence of thrombocytopenia between groups (P=0.61).Conclusion For elderly Chinese patients with ACS undergoing PCI, on the basis of conventional double antibodies, the safety of half-dose of tirofiban might be better than that of standard-dose, and the efficacy of two doses was equivalent.

    Efficacy of magnesium isoglycyrrhizinate in anti-tuberculosis drug-induced liver injury
    Yang Zhibin, Shao Yanfang, Pan Li, Yang Yanxia, Yang Yuxi, Zhao Lihui, Zeng Rongkun, Li Yang, Wang Qiaofeng, Wang Cong, Ma Shiwu
    2021, 36(11):  972-975.  doi:10.3969/j.issn.1004-583X.2021.11.002
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    Objective To explore the efficacy of magnesium isoglycyrrhizinate(MgIG) in the treatment of anti-tuberculosis drug-induced liver injury (AT-DILI) and influence on cytokines (IFN-γ, IL-10, TNF-α).Methods The study enrolled 50 patients with mild hepatocellular injury who admitted to Infection Department, the Sixth Affiliated Hospital of Kunming Medical University from February 2016 to December 2019, and the patients met the criteria of AT-DILI. Patients were randomly grouped, 25 patients in observation group treated with MgIG, 25 patients in control group with polyene phosphatidylcholine(PPC). The key observation was liver function (ALT, AST, TBIL) and cytokine levels (IFN-γ, IL-10, TNF-α).Results The total effective rates were significantly higher in observation group than in control group (100% vs 76.0%, P<0.01). Compared with before treatment, IFN-γ, IL-10, and TNF-α in both groups were lower after treatment (all P<0.05), and the indexes were significantly decreased in observation group (all P<0.05). Pearson correlation analysis showed the cytokine levels were positively correlated with ALT in both groups at different time points.Conclusion MgIG can quickly improve liver function in mild AT-DILI, which may relate to the reduction of inflammatory cytokines.

    Correlation of serum sST2 and liver function, platelet level and Ishak score in chronic hepatitis B patients
    Wang Yuanyuan, Cheng Ning, Lin Haiyan
    2021, 36(11):  976-980.  doi:10.3969/j.issn.1004-583X.2021.11.003
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    Objective To observe the expression of serum soluble suppression of tumorigenicity-2 (sST2) in patients with chronic hepatitis B (CHB), and to analyze the correlation of sST2 and liver function, platelet(PLT) and Ishak score. Methods Totally 190 inpatients with CHB who met the inclusion criteria were prospectively enrolled from December 2018 to December 2020 in Dalian Sixth People's Hospital. The patients were divided into no fibrosis (29 cases), fibrosis (124 cases), and cirrhosis (37 cases) according to Ishak inflammation score. Thirty healthy controls in the physical examination center during the same period were recruited. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), total bilirubin (TBIL), sST2 and PLT were detected, and APRI was counted. Results There were significant differences in serum sST2, AST, ALT, ALB, TBIL, APRI and PLT among four groups (P<0.05). Compared with controls, sST2, AST, ALT and TBIL in CHD patients were significantly higher (P<0.05), while serum ALB was significantly lower (P<0.05). Compared with patients with and without fibrosis, serum sST2, AST, ALT and TBIL of cirrhosis patients were significantly higher (P<0.05), while ALB and PLT were significantly lower (P<0.05). Compared with controls, PLT of cirrhosis patients was significantly lower (P<0.05). Pearson results showed that sST2 of CHB patients was closely related to AST, ALT, ALB, TBIL, PLT and APRI (r=0.939, 0.918, -0.816, 0.795, -0.469, 0.933, P<0.05). Spearman results showed that there was positive correlation between serum sST2 and Ishak score (r=0.885, P<0.05). Multivariate analysis showed that AST, ALT, ALB, TBIL, PLT, and Ishak score were influencing factors for sST2. The AUC values of the area under ROC curve of SST2, APRI and the combined diagnosis of cirrhosis were 0.715, 0.789 and 0.806. The sensitivity were 0.700, 0.780 and 0.810. The specificity 0.903, 0.847, 0.855, respectively. Conclusion For CHB patients, when serum sST2 abnormally elevates, liver fibrosis increases. At the same time, influencing factors for serum sST2 are liver function indexes. PLT and Ishak score, and serum sST2 combined with APRI can improve the predictive value of cirrhosis.

    Correlation between 25-(OH)D3 and degree of coronary artery stenosis in patients with coronary heart disease
    Zhao Weifeng, Ma Chunyu
    2021, 36(11):  981-985.  doi:10.3969/j.issn.1004-583X.2021.11.004
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    Objective To study the correlation between 25-(OH)D3 and the degree of coronary artery stenosis in patients with coronary heart disease(CHD).Methods Totally 216 patients who underwent coronary angiography(CAG) were divided into control group (43 cases), mild stenosis group (73 cases), moderate stenosis group (53 cases), and severe stenosis group (47 cases) on the basis of the diagnostic criteria for CHD and the Gensini score. The key observations were 25-(OH)D3, total cholesterol(TC), high density lipoprotein-cholesterol (HDL-C), low-density lipoprotein cholesterol(LDL-C), triglyceride(TG), creatinine(Cr) and other indicators. Results Among the four groups, the differences were statistical significance in 25-(OH)D3, male, HDL-C, LDL-C, TC and TG (P<0.05). 25-(OH)D3 was negatively correlated with Gensini score (r=-0.355, P<0.001). Multiple logistic regression showed that high 25-(OH)D3 was protective against coronary stenosis (B=-0.084, P<0.001). Receiver operating characteristic(ROC) curve showed that 25-(OH)D3 had strong predictive value for the occurrence of CHD and severe coronary stenosis. Area under curve(AUC) of the former and the latter was respectively 0.74(95%CI: 0.663-0.817) and 0.72 (95%CI: 0.636-0.804),respectively; the optimal cut-off value was 17.57 ng/ml and 11.42 ng/ml, the sensitivity was 74.4% and 63.8%, and the specificity was 72.3% and 74.6%.Conclusion 25-(OH)D3 had negative correlation with the degree of coronary stenosis. Higher 25-(OH)D3 had a certain protective effect on coronary stenosis. The diagnosis for severe stenosis is significantly higher than for mild and moderate.

    Diagnostic efficacy of cystatin C for vascular Parkinsonism
    Shen Huinan, Guo Chang, Sun Yimeng, Wang Dongyu
    2021, 36(11):  986-990.  doi:10.3969/j.issn.1004-583X.2021.11.005
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    Objective To analyze the diagnostic efficacy of cystatin C(Cys C) for vascular Parkinsonism(VP). Methods Fifty-six inpatients with VP in Central Hospital of Jinzhou from December 2019 to May 2021 were included in VP group. In the same period, 51 inpatients with Parkinson's disease(PD) in PD group, and 50 healthy physical examiners at outpatient in healthy control group. The general clinical data and serum biochemical indexes were collected for analysis. The correlation between serum Cys C and other serum indexes in VP were compared and judged in auxiliary diagnostics. Results Compared with PD group, triglyceride(TG), low-density lipoprotein cholesterol(LDL-C) and homocysteine(Hcy) in VP group showed significantly increase, and the prevalence rates of cerebral infarction(CI), hypertension and hyperlipidemia were higher (P<0.05, P<0.01). Compared with control group, age, male, serum Cys C, TG, LDL-C and Hcy in VP group were significantly increased, and the prevalence rates of CI, hypertension, diabetes, hyperlipidemia and coronary heart disease(CHD) were higher,too(P<0.05, P<0.01). Logistic regression analysis showed that risks for VP were age, the history of CI, Cys C, TG, LDL-C and Hcy (P<0.05, P<0.01). ROC curve analysis showed that AUC of Cys C, TG, LDL-C, Hcy and Cys C+TG+LDL-C+Hcy in auxiliary diagnosis for VP were 0.764(95%CI:0.671-0.857, P=0.000), 0.801(95%CI: 0.718-0.884, P=0.000), 0.751(95%CI: 0.657-0.844, P=0.000), 0.723(95%CI: 0.627-0.818, P=0.000) and 0.920(95%CI: 0.870-0.969, P=0.000).Conclusion Serum Cys C combined with TG, LDL-C and Hcy may have potential auxiliary diagnosis and differential diagnostic value in VP.

    Clinical analysis of serum homocysteine in patients with acute ischemic stroke
    Zhou Haitao, Huang Chao, Wang Hao, Liu Ruihua, Du Yanjiao, Ren Xiangyang
    2021, 36(11):  991-995.  doi:10.3969/j.issn.1004-583X.2021.11.006
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    Objective To retrospectively analyze the clinical characteristics of serum homocysteine(HCY) in patients with acute ischemic stroke(AIS) for the risk factors associated with increased HCY in AIS secondary prevention. Methods A restrespective study was performed in 1 055 patients diagnozed AIS by diffusion weighted imaging(DWI) and apparent diffusion coefficient(ADC) sequence of cranial MRI in our hospital from January 2019 to December 2019. General informations and HCY levels were based on gender and age. The T test or one-way analysis of variance(ANOVA) method was used to compare the difference between groups and binary Logistic regression method was used to analyze the risk factors for HCY. Results The age range for 1 055 AIS patients was 28 to 98 years, (66.4±11.7) years, HCY 3.7-115.5 μmol/L, (20.1±13.0) μmol/L. The stratified analysis based on gender showed that the age of female was significantly increased when comparing with males, while HCY of female was significantly decreased (all P<0.05). The stratified analysis based on the combination of gender and age showed the difference was not statistically significant in HCY level in males in different age groups (P>0.05). HCY level in females were different and HCY of patients aged over 80 years was significantly increased than aged under 50 years and aged 71-80 years (all P<0.05). Binary logistic regression analysis showed that the independent risk factors for HCY were male, age, and type 2 diabetes mellitus. Conclusion Higher HCY are noted in male, elderly, T2DM of AIS patients, the reduction of HCY may allow the patients to obtain greater benefits in the secondary prevention.

    Effects of cerebroprotein hydrolysate on Nrf2 oxidative stress signaling pathway in acute stroke patients
    Liu Ting, Ji Weidong, Yang Qingsong
    2021, 36(11):  996-1000.  doi:10.3969/j.issn.1004-583X.2021.11.007
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    Objective To explore the effect of cerebroprotein hydrolysate on nuclear factor-E2 correlation factor 2-cored Keap1-Nrf2/ARE (Nrf2) oxidative stress signaling pathway in patients with acute stroke (AS). Methods Totally 195 AS patients treated in the hospital from October 2017 to October 2020 were divided into study group (n=98) and control group (n=97) according to therapeutic methods. The patients in control group were administered with conventional therapies involving the enhancement of cerebral circulation, improvement of brain function and antiplatelet aggregation, and patients in study group additionally with cerebroprotein hydrolysate on the basis of control group. All patients were treated for 14 days, the efficacy was observed, The key observation was National Institutes of Health Stroke Scale (NIHSS) score, Activity Ability-daily Life (Barthel) Index, inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-8(IL-8) and interleukin-19(IL-19) oxidative stress indexes including serum superoxide dismutase (SOD), malondialdehyde (MDA), vascular endothelial function such as serum adiponectin (APN), and plasma von Willebrand factor (vWF), protein expressions of Nrf2 oxidative stress signaling pathways Keap1, NQO1, ARE and Nrf2.Results Total effective rate in study group (91.84%) and control group (60.82%) was statistically significant difference (P<0.01). After treatment, NIHSS score were significantly lower in study group than in control group. Barthel index was significantly higher in study group than in control group (P<0.01). TNF-α, IL-8, IL-19, MDA, vWF and Keap1 were significantly lower in study group than in control group. Serum SOD, APN, NQO1, ARE and Nrf2 were significantly higher in study group than in control group(P<0.01). Conclusion For AS patients, cerebroprotein hydrolysate can effectively regulate Nrf2 oxidative stress signaling pathway related proteins, and deliver significant effects in improving the vascular endothelial function, controlling inflammation and oxidative stress, and enhancing the neurological function and quality of life.

    Levels and clinical significance of RDW, NT-proBNP, BigET-1, HMGB1 in patients with idiopathic pulmonary arterial hypertension
    An Qinyan, Jiang Rong, Kang Bin, Du Ming, Zhou Renming, Zhao Hongjuan, Duan Yi, Lu Fei, Liu Jinming
    2021, 36(11):  1001-1004.  doi:10.3969/j.issn.1004-583X.2021.11.008
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    Objective To explore the changes and clinical significance of red blood cell distribution width(RDW), N-terminal pro-brain natriuretic peptide(NT-proBNP), big endothelin-1(BigET-1), high mobility group protein-B1(HMGB1) in patients with idiopathic pulmonary arterial hypertension(IPAH).Methods Totally 80 IPAH patients admitted to our hospital from Nov 2019 to Oct 2020 were enrolled as the observation group,the control group comprised 80 healthy volunteers undergoing physical examination in our hospital during the same period; the aim was to compare RDW, NT-proBNP, BigET-1, HMGB1 as well as echocardiogram indexes between groups; and the correlation of the above indicators was analyzed. Results Compared with control group, RDW, NT-proBNP, BigET-1, HMGB1 in observation group were significantly higher (all P<0.01), left ventricular end diastolic dimension(LVEDD) was notably smaller (P<0.01), right ventricular end diastolic diameter(RVEDD) was significantly larger (P<0.01). Correlation analysis showed that RDW, NT-proBNP, BigET-1, HMGB1 were negatively correlated with LVEDD, left ventricle ejection fraction(LVEF), cardiac index(CI), while positively correlated with RVEDD. Positive correlation existed between NT-proBNP, HMGB1 and pulmonary artery mean pressure(PAMP), pulmonary vascular resistance(PVR)(P<0.05).Conclusion RDW, Nt-proBNP, BigET-1, HMGB1 in IPAH patients are increased, and the indexes are related to LVEDD, PAMP, PVR, and those can be used as references for diagnosis and evaluation of IPAH.

    Effects of angiotensin Ⅱ type 1 receptor blockers on urinary nephrin and Beclin-1 mRNA excretion in urine of patients with early diabetic nephropathy
    Liu Lunzhi, Deng Lu, Zhang Mingxia
    2021, 36(11):  1005-1008.  doi:10.3969/j.issn.1004-583X.2021.11.009
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    Objective To observe the urinary excretion of podocytes, podocyte-related protein nephrin and autophay gene Beclin-1 mRNA of patients with early diabetic nephropathy(DN) and the effects of Losartan on the above indicators.Methods Forty-eight cases of early DN patients in our hospital from January 2018 to January 2021 were selected and given Losartan 50 mg or 100 mg orally for 6 months. The urine of early DN patients was sampled to determine the excretion of microalbumin, podocytes, podocyte-related protein nephrin mRNA, and autophagy gene Beclin-1 mRNA before and after treatment.Results The urinary excretion of microalbumin, podocyte, podocyte-related protein nephrin, autophagy gene Beclin-1 mRNA of early DN patients were significantly increased compared with healthy people (P<0.01). After six months of treatment with Losartan, urinary excretion of microalbumin and podocytes in patients with early DN decreased (P<0.05).The urinary excretion of nephrin mRNA showed a downward trend (P<0.05). The autophagy gene Beclin-1 mRNA excretion increased to a certain extent after treatment, but the difference was not statistically significant (P=0.067).Conclusion Podocyte damage can be confirmed by urine examination in patients with early DN.Angiotensin Ⅱ type 1 receptor blockers can reduce the excretion of microalbumin to protect podocytes and enhance podocyte autophagy in early ND patients.

    Evaluation of carotid Doppler ultrasonography in degree and hemodynamics of atherosclerosis of chronic kidney disease
    Wang Chao, Wan Duo, Li Sali, Wang Xi
    2021, 36(11):  1009-1012.  doi:10.3969/j.issn.1004-583X.2021.11.010
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    Objective To analyze the evaluation of carotid doppler ultrasonography(CDU) in degree of atherosclerosis and hemodynamics of atherosclerosis in patients with chronic kidney disease(CKD).Methods Totally 80 CKD patients admitted to Department of Nephrology, the Second Affiliated Hospital of Shenyang Medical College from June 2020 to January 2021 were prospectively enrolled. The patients were classified into hemodialysis group (n=40), peritoneal dialysis group (n=40), 40 healthy subjects who underwent regular physical examinations during the same period randomly in control group. The key observation was carotid intima-media thickness(CIMT), left common carotid artery(LCCA), left internal carotid artery(LICA), right common carotid artery(RCCA), blood flow velocity(BFV) in right internal carotid artery(RICA), end diastolic velocity(EVD) between groups. Results CIMT in peritoneal dialysis group and hemodialysis group obviously increased in comparing with control group (P<0.05). LCCA, LICA, RCCA, BFV in RICA and EVD decreased notably in control group when compared with peritoneal dialysis group and hemodialysis group (P<0.05), which were significantly lower in hemodialysis group than in peritoneal dialysis group (P<0.05). Conclusion The dialysis type of CKD patients is closely related to atherosclerosis degree. CDU can quantitatively detect the hemodynamic indices, which has positive significance in preventing and treating atherosclerosis in CKD patients.

    Predictive value of dual-energy CT for Ki-67 expression in gastric stromal tumors and relationship with pathological factors
    Yuan Shichao, Zhao Qing, Fan Hongyan
    2021, 36(11):  1013-1018.  doi:10.3969/j.issn.1004-583X.2021.11.011
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    Objective To explore the predictive value of dual-energy CT for Ki-67 expression in gastric stromal tumors(GST) and its relationship with pathological factors. Methods Totally 82 GST patients admitted from February 2019 and April 2020 were retrospectively selected. Dual-energy CT were performed to measure Ki-67, the patients were divided into two groups based on Ki-67 expression, namely 39 cases in high expression group (Ki-67>6%), 43 cases in low expression group (Ki-67≤6%). Pathological factors were analyzed in between groups, and CT parameters were compared between Ki-67 different expressions. Receiver operating characteristic(ROC) curve analysis were used to analyze the predictive value of CT parameters, the correlation between Ki-67 index expression and pathological factors by Pearson's correlation coefficient. Results The values of each phase (40 keV, 50 keV, 60 keV, 70 keV) and iodine concentration(IC), normalized iodine concentration(NIC) on arterial and venous phase were higher in high expression group than in concurrent low expression group (P<0.05). The area under curve(AUC) of the parameters to identify Ki-67 expression on venous phase were 0.867, 0.907, 0.939, 0.758, 0.952 and 0.854, respectively, and with 0.998, 0.944, 0.967, 0.888, 0.925 and 0.764 on arterial phase, respectively. Pearson's correlation analysis showed Ki-67 expression were negatively correlated with the parameters. Meanwhile the indexes negatively correlated with single/multiple, nuclear division, with or without bleeding, tumor location. A positively correlated was found between Ki-67 expression and the risk classification.Conclusion Dual-energy CT value of each phase (40 keV, 50 keV, 60 keV, 70 keV), and IC value, NIC value on arterial and venous phase are negatively correlated with Ki-67 expression, which may reflect GST cell proliferation, moreover Ki-67 expression can use to be an important reference index for prognosis and risk grading of GST.

    Hereditary spherocytosis caused by SPTB gene hybrid mutation: a case report
    Wen Xue, Zhang Zhihua, Zhang Rongjuan, Hao Changlai
    2021, 36(11):  1019-1023.  doi:10.3969/j.issn.1004-583X.2021.11.012
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    Retrospective analsis concerned with the clinical data of a patient with hereditary spherocytosis (HS), and SWISS-MODEL software used for protein structure prediction of SPTB gene mutation. The literatures were reviewed. Blood routine of the patient in clinic showed anemia, RBC, WBC and platelet decreased. Gene sequencing analysis proved that heterozygous mutation of SPTB gene c.5551C>T (exon26, NM_001355436) underwent spontaneous mutation. Protein structure prediction was c.5551C>T (p.Q1851X) mutation caused protein truncation mutation, and merged with heterozygous mutation of ANK1 gene c.1495G>T (p.A499S). The mutation site was agnate source, and non-pathogenic gene was confirmed.