Table of Content

20 January 2022, Volume 37 Issue 1

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Effect of extracorporeal hemopurification for clinical prognosis and cytokine levels of septic: A meta-analysis

Xiao Liuniu, Zhong Yanxia, Li Shusheng

2022, 37(1):  5-13.  doi:10.3969/j.issn.1004-583X.2022.01.001

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Objective The purpose of this study is to systematically analyze the effect of extracorporeal hemopurification (EH) for clinical prognosis, and the association between EH-related cytokines levels and clinical prognosis for septic patients. Methods Available studies accessing the effect of extracorporeal hemopurification for septic patients were collected from Pubmed, Web of Science, Cochrane Library and China National Knowledge Internet between January 2010 and January 2020. Relationships between EH and in-hospital mortality (IHM) and length of intensive care unit in sepsis patients were calculated and systematically analyzed by Forest Plot in Review Manager 5.3. We further analyzed the correlation between changing of cytokine levels and clinical prognosis. Results Twenty-eight researches which covered a total of 2587 patients were included in this meta-analysis. The results indicated that EH (hemoperfusion, hemofiltration, hemoadsorption, cytosorb, et. al) could significantly decrease IHM (OR=0.83, P=0.04) without affecting the length of intensive care unit (OR=-0.50, P=0.69). Subgroup analysis suggested that High-volume Hemofltration or Hemoperfusion with Polymyxin B-immobilized cartridge failed to improve IHM (P=0.22; P=0.87); meanwhile, EH showed little therapy efficiency in severe burn septic patients or septic patients with acute kidney injury (P=0.08; P=0.77). During the whole EH period, septic patients with lower cytokine levels at last presented no benefit for a lower risk of IHM (P=0.48), but the length of intensive care unit was significantly decreased (OR=-17.58, P=0.04). Conclusion Routine EH is recommended for septic patients with no contraindication. Controlling relative levels of cytokines during the whole treatment is a useful way to shorten the length of intensive care unit.

Cardiovascular protective effects of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes mellitus patients with severe renal insufficiency: A meta-analysis

Xu Cangdan, Zhao Xin, Gu Wenyuan

2022, 37(1):  14-19.  doi:10.3969/j.issn.1004-583X.2022.01.002

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Objective To evaluate the cardiovascular protective effects and adverse reaction of sodium-glucose cotransporter 2 (SGLT2) inhibitors in type 2 diabetes mellitus (T2DM) patients with severe renal insufficiency. Methods We searched three public databases, including Medline, Embase and Cochrane Library, to collect randomized controlled trials on SGLT2 inhibitors in patients with diabetic nephropathy from the inception to August 2021. Results A total of six RCTs were included, including 3679 diabetic patients with severe renal insufficiency. The meta-analysis showed that SGLT2 inhibitor had significantly reduced the risk of hospitalization (HR=0.74, 95% CI=0.55-0.99, P=0.04) and stroke (HR=0.75, 95% CI=0.60-0.93, P=0.008) due to heart failure in comparison with placebo group. The incidence of cardiovascular death (HR=0.89, 95% CI=0.60-1.30, P=0.54) and all-cause death (HR=0.84, 95% CI=0.56-1.28, P=0.43) in the SGLT2 inhibitor group was similar to that in placebo group. As for side effects, there was no significant difference in total adverse events (RR=1.00, 95% CI=0.94-1.07, P=0.96), fracture (RR=2.34, 95% CI=0.52-10.51, P=0.27), urinary tract infection (RR=1.22, 95% CI=0.64-2.35, P=0.54), hypotension (RR=1.32, 95% CI=0.59-2.95, P=0.49), reproductive tract infection (RR=0.67, 95% CI=0.15-2.93, P=0.6) and acute kidney injury (RR=0.96, 95% CI=0.41-2.26, P=0.93) between groups. Conclusion For T2DM patients with severe renal insufficiency, the administration of SGLT2 inhibitors is capable of reducing the risks of hospitalization and stroke due to heart failure, without increasing the risk of adverse events. SGLT2 inhibitors may have a protective and relatively safe effect on their cardiovascular outcomes. Future clinical trials are needed to support the impact of SGLT2 inhibitors on cardiovascular benefits in T2DM patients.

Risk factors of cerebral hemorrhage in uremic patients on regular hemodialysis

Li Wenzhe, Shang Jinchun, Li Chunmei, Tian Fen, Li Jun, Cui Li, Xing Guangqun

2022, 37(1):  20-25.  doi:10.3969/j.issn.1004-583X.2022.01.003

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Objective To explore the risk factors of cerebral hemorrhage in uremic patients on regular hemodialysis. Methods Totally 44 uremic patients with cerebral hemorrhage on regular hemodialysis (cerebral hemorrhage group) admitted to the Affiliated Hospital of Qingdao University and other surrounding hospitals from January 2012 to June 2020 were analyzed retrospectively, 224 uremic patients on regular hemodialysis without cerebral hemorrhage in the same period were randomly enrolled (control group). The general data and laboratory indicators between groups were analyzed. Data was addressed with independent sample t-test, chi-square test (χ² test), Mann-Whitney U-test and Logistic regression analysis, the nomogram for predicting factor was drawn to establish clinical prediction model. Results The results of multivariate logistics regression analysis showed that the independent risk factors for uremic patients with cerebral hemorrhage on regular hemodialysis were high serum serum calcium, low serum sodium, high white blood cell count, high systolic blood pressure on daily regular hemodialysis, systolic blood pressure before cerebral hemorrhage events, previous history of hypertension and cerebrovascular events, primary polycystic kidney disease, daily intervention by warfarin. Based on the above risk factors a nomogram for prediction model factor of risk of cerebral hemorrhage in patients with uremia on regular hemodialysis was established, and the correction curve showed good accuracy of the model. Conclusion The independent risk factors for uremic patients with cerebral hemorrhage on regular hemodialysis were high serum calcium, low serum sodium, high white blood cell count, high systolic blood pressure on daily regular hemodialysis, systolic blood pressure before cerebral hemorrhage events, previous history of hypertension and cerebrovascular events, primary polycystic kidney disease, daily intervention by warfarin, and the nomogram has certain clinical value for the risk assessment of uremic patients with cerebral hemorrhage on regular hemodialysis.

Correlation analysis between neutrophil percentage-to-albumin ratio and degree of coronary artery stenosis

Chen Xi, Jiang Shan

2022, 37(1):  26-29.  doi:10.3969/j.issn.1004-583X.2022.01.004

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Objective To explore the relationship between neutrophil percentage-to-albumin ratio (NPAR) and the degree of coronary artery stenosis. Methods A total of 406 patients who underwent coronary angiography (CAG) in Jinzhou Central Hospital from November 2020 to July 2021 were selected. They were divided into the non-CHD group (84 cases) and the CHD group (322 cases) as the CAG result. Gensini score was used to evaluate the degree of coronary artery stenosis. The independent risk factors for coronary heart disease and the correlation between Gensini score and NPAR were evaluate by Multivariate Logistic regression analysis and Spearman correlation analysis, respectively. Receiver operating characteristic (ROC) curve was drawed to assess the predictive value of NPAR for coronary heart disease. Results The independent risk factors for coronary heart disease are age, gender, high-sensitivity C-reactive protein, NPAR. Gensini score was positively correlated with NPAR (r=0.364, P<0.01); the areas under curve of the ROC curve was 0.687(95%CI 0.632-0.741, P<0.05), and the cutoff value, sensitivity, specificity of NPAR were 1.6128,50.3%, and 85.7%, respectively. Conclusion NPAR is positively correlated with the coronary artery stenosis degree, which has certain predictive value for coronary heart disease.

Clinical characteristic of Primary biliary cholangitis complicating Sjögren syndrome

Wang Dandan, Zhang Xiaolan, Deng Zhihua

2022, 37(1):  30-34.  doi:10.3969/j.issn.1004-583X.2022.01.005

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Objective To investigate the clinical characteristics of primary biliary cholangitis (PBC) complicating Sjögren syndrome (SS). Methods The medical records of patients diagnosed with PBC and primary Sjögren syndrome (pSS) from November 2010 to June 2016 at Second Hospital of Shanxi Medical University were collected to analyze the clinical characteristics of the patients. Results A higher proportion of females and a longer course of disease were found in PBC complicating SS group versus PBC-only group; liver injury-related symptoms and biochemical indicators in the baseline data were milder in PBC complicating SS group in comparison with PBC-only group during diagnosis confirmed; patients diagnosed with PBC at the initial diagnosis and combined with SS at a later stage had more dry mouth symptoms than those of PBC-only patients at the initial diagnosis; anti-SSB antibody positivity rate and fever symptoms were more common in patients with pSS than those with PBC combined. There was no difference in the progression of cirrhosis and hepatic decompensation between PBC complicating SS patients and PBC-only patients at year 1 and 5. Conclusion Although PBC complicating SS in patients have characteristics of both PBC and pSS, those are not identical, and the combination of the two diseases does not accelerate disease progression.

Correlation analysis between atherogenic index of plasma and nonalcoholic fatty liver disease

Wen Jie

2022, 37(1):  35-38.  doi:10.3969/j.issn.1004-583X.2022.01.006

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Objective To investigate the correlation between atherogenic index of plasma (AIP) and nonalcoholic fatty liver disease (NAFLD). Methods Totally 160 patients who admitted to Health Checkup Center, Wangjiang Hospital, Sichuan University from May 2020 to May 2021 were enrolled, those patients underwent color doppler ultrasound and were initially diagnosed as NAFLD without drug therapy (NAFLD group), meanwhile, selected concurrent 160 age- and sex- matched controls (control group). The recorded data included age, height, weight, blood pressure, body mass index (BMI); blood lipid tests were performed in groups to calculate the AIP. The difference indicators of two groups were compared, NAFLD-related factors were performed in Logistic regression analysis, receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of AIP for NAFLD. Results Except for stature, differences in the other indicators of two groups were statistically significant. The risk factors for NAFLD were AIP (OR=2.070, 95%CI: 1.785-2.732, P<0.01) and BMI (OR=1.46, 95%CI: 1.172-1.819, P<0.01). The ROC curve of diagnostic index of AIP for NAFLD showed that the areas under curve (AUC), cut-off value, sensitivity and specificity were 0.899(Z=13.233, P<0.01), 1.896(95%CI: 0.836-1.943), 82.93% and 88.10%, respectively. Conclusion Strong correlation were found between AIP and NAFLD, AIP can take on the role of screening indicator for the risk of NAFLD.

Relationship between tuberculin test with serum apolipoprotein A-1 and anti-tuberculosis drug-induced liver injury

Qu Ying, Liu Zhongyang

2022, 37(1):  39-42.  doi:10.3969/j.issn.1004-583X.2022.01.007

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Objective To explore the relationship between tuberculin test (PPD) with serum apolipoprotein A-1 (ApoA-1) and anti-tuberculosis drug-induced liver injury (ATB-DILI). Methods Totally 541 tuberculosis patients diagnosed at 967 Hospital of the Joint Logistics Support Force of PLA from January 2017 to June 2021 were divided into case group (56 cases) and control group (485 cases) as whether or not ATB-DILI, and the general clinical data of included subjects were recorded. Influencing factors of ATB-DILI were analyzed by binary Logistic regression, and receiver operating characteristic (ROC) curve was used to determine the predictive value of PPD test and serum ApoA-1 for ATB-DILI.Results The patients in case group were more positive PPD test, decreased ApoA-1 level as compared to the patients in control group, and with statistically significant difference between groups (all P<0.05). The ROC curve showed that strong positive PPD test and ApoA-1 level <1.175 g/L could play a part of independent factors for judging ATB-DILI. Conclusion Response intensity of PPD test and ApoA-1 level has certain predictive value for ATB-DILI, and the combination of the two displays a more higher predictive value for ATB-DILI.

Analysis of the incidence and risk factors for venous thromboembolism in 145 patients with diffuse large B-cell lymphoma

Shen Rui, Lei Yanhua, Jia Haokun

2022, 37(1):  43-45.  doi:10.3969/j.issn.1004-583X.2022.01.008

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Objective To explore the incidence and risk factors for venous thromboembolism (VTE) in 145 patients with diffuse large B-cell lymphoma (DLBCL). Methods Totally 145 DLBCL patients admitted to our hospital from May 2016 to August 2019 were selected and divided into a VTE group (n=22) and a non-VTE group (n=123) as the results in ultrasonography for VTE. Multivariate Logistic regression was used to analyze the risk factors for VTE in DLBCL patients, as well as the difference of recurrence rate, recurrence-free survival rate, and overall survival rate between groups. Results The independent risk factors for VTE were intravenous catheterization, non-complete remission (non-CR) after 3-4 courses of chemotherapy, D-dimer level ≥1.44 μg/ml(OR=5.143, 9.000, 16.514, P<0.05). But performance status (PS) score ≥2 was considered a protective factor (OR=0.170, P<0.05); there was no significant difference in recurrence rate, recurrence-free survival rate, and overall survival rate between groups (P>0.05). Conclusion Independent risk factors for VTE in DLBCL patients were Intravenous catheterization, non-CR after 3-4 courses of chemotherapy, D-dimer ≥1.44 μg/ml, and protective factor for VTE is PS score ≥2.

Clinical data and genotype of cblC type methylmalonic acidemia: 19 cases report analysis

Wei Chenxi, Zhao Wanqing, Zhang Yanan

2022, 37(1):  46-51.  doi:10.3969/j.issn.1004-583X.2022.01.009

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Objective To provide thinking and measures for early diagnosis by exploring the relations between clinical characteristics, laboratory examination and genotypes of cblC type methylmalonic acidemia.Methods The data of clinical manifestation, gene results, tandem mass spectrometry, imageological examination of 19 children with methylmalonic acidemia admitted to the Department of Pediatric Endocrinology and Growth Development, the Second Hospital of Hebei Medical University from 2016 to 2020 were retrospectively analyzed. Results There were 10 male and 9 female patients in out of 19 cases, of which 8 cases were confirmed by neonatal screening. A total of 13 mutations were found by genetic testing, the most common mutations satisfied c.609G>A, followed by the mutations satisfying c.80A>G and c.656_ c.658delAGA. Initial neurological symptoms of 11 cases who were not confirmed by neonatal screening were feeding difficulties, developmental delay, poor response, visual impairment, convulsions, etc. C3 /C0, C3 /C2, urinary methylmalonic acid and homocysteine were significantly elevated in tandem mass spectrometry. Laboratory testing data showed that multiple organs were damaged involving the blood system, nervous and digestive systems, etc. Conclusion The clinical manifestations and laboratory examination of children with cblC type methylmalonic acidemia demonstrate diversely with poor specificity. The genotypes showing the termination or frame-shift mutation normally develop early and have relatively severe symptoms may be show severe neurological complications including the hydrocephalus. The late-onset conditions are mild and have better prognosis by early treatment. late-onset disease of children is easily ignored normally, causing delayed diagnosis on pathogenetic condition. It is necessary to take early diagnosis on cblC type methylmalonic acidemia Attributing to great improvements of the condition and prognosis. Neonatal tandem mass spectrometry screening makes for the early diagnosis, and genotype detection contribute to specific disease classification and targeted treatment, thereby reducing the disability rate and mortality of the disease.

Aortic dissection during pregnancy: A retrospective analysis of 6 patients

Wang Jing, Xu Fangfang, Liu Xiaozhuan

2022, 37(1):  52-56.  doi:10.3969/j.issn.1004-583X.2022.01.010

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Objective To explore the clinical manifestations, diagnosis and treatment of aortic dissection during pregnancy. Methods A retrospective analysis of clinical data, auxiliary examination, therapeutic regimen, maternal-fetal outcomes of 6 pregnancy patients complicated with aortic dissection, who admitted to the Henan Provincial people's Hospital from January 2015 to December 2020 was performed, in order to explore the influence for the outcome on different operation time. Results Those patients ranged 30 to 38 years, with mean age 32.16 years; age at the the time of onset ranged from 5-week pregnancy to 1-month postpartum; there were 2 cases in first trimester, 3 cases in third trmester, and 1 case in the puerperium. The cardinal symptom included 4 cases of pain in chest and back, 1 case of hest pain and panting, and 1 case of low back pain. All patients perpormed aortic angiography, in term of classification of aortic dissection, 4 cases were Stanford type A, and 2 cases were Stanford type B. All patients underwent aortic surgery, simultaneous aortic surgery and pregnancy termination were performed in 3 case (1 case of hysterectomy and 2 cases of retained uterus); the pregnancy was terminated after aortic surgery in 2 cases (Bentall surgery first, pregnancy termination on week 1 postoperative); aortic surgery was performed in 1 case during the puerperium. No postoperative mortality was reported. There were 2 fetuses of induced abortion, and 4 fetuses of surviver with good follow-up maternal-fetal outcome. Conclusion For aortic dissection during pregnancy, the treatment regimen should be fully evaluated the scope and type of aortic dissection, the gestational age of the fetus, and the pregnant woman's willingness. The appropriate timing of surgery should be selected to ensure the safety of mother and fetus, and futher reduce the mortality rate.

Coffin-siris syndrome: A case literature review

Luo Shunchang, Li Sitao, Cai Yao, Shi Congcong, Xiao Xin, Hao Hu

2022, 37(1):  57-61.  doi:10.3969/j.issn.1004-583X.2022.01.011

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Objective To investigate the clinical and genetic characteristics of child sufferer with Coffin-siris syndrome(CSS). Methods The clinical features, laboratory tests and genetic tests of a case of CSS diagnosed in the Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University from February 2018 to February 2019 were collected. The “CSS”, “ARID1B” and “CSS” were selected as key words, the papers collected by China National Knowledge Infrastructure, Knowledge Service Platform of Wanfang Data and PubMed from January 2010 to November 2019 were retrieved. Clinical features and genetic characteristics of children with CSS were summarized. Results The child sufferer with CSS demonstrated unique facial features, specific skeleton & limb deformities, developmental retardation and cognitive delay, mental retardation, hearing and speech disorder, etc. The mutations of ARID1B genes were almost new mutations, and pathogenic variants were almost cut off. The heterozygous mutation of ARID1B gene c.2248C>T (p.R750*) was detected in the child sufferer, and it was an nonsense mutation. The parents did not carry such mutation, indicating that the mutation was a new mutation. Conclusion CSS is mainly caused by the mutation of ARID1B gene, it is almost new mutation, and no significant genotype-phenotype correlation is found. The heterozygous mutation of ARID1B gene c.2248C>T (p.R750*) in this case is classified to be autologous new mutation, no related gene is reported in China, and the gene mutation spectrum of CSS in China is supported to be enriched.

Implications of hermeneutic theory on improving doctor-patient communication

Liu Yunzhang

2022, 37(1):  62-65.  doi:10.3969/j.issn.1004-583X.2022.01.012

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Doctor-patient communication, in its essence, is a process in which doctors and patients communicate with each other in terms of medical cognition, medical ability and medical values, bridge the differences, form consensus, and adopt corresponding medical treatments. Effective interpretation and acceptance of relevant information are necessary in doctor-patient communication. Based on hermeneutic theories and principles, doctor and patient's mutual respect and “pre-understanding” cognition of disease and medicine is the prerequisite for doctor-patient communication in this process. Reasonable viewing and rational treating of the actual differences in the medical process is the basis for doctor-patient communication. Striving to achieve “fusion of horizons” is the key to doctor-patient communication.