Table of Content

20 March 2022, Volume 37 Issue 3

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The efficacy and safety of different blood pressure target on secondary stroke prevention: A systematic review and meta-analysis

Wang Xiaoqing, Guo Yijia, Tang Yifang, Tang Qin, Yang Jie

2022, 37(3):  197-203.  doi:10.3969/j.issn.1004-583X.2022.03.001

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Objective To assess the efficacy and safety of different blood pressure target on secondary stroke prevention. Methods We searched English and Chinese databases, including PubMed, Embase, Cochrane, Wanfang database, China National Knowledge Internet (CNKI), Chongqing VIP, and China Biology Medicine disc (CBM). The search time of database was up to June 1, 2020. Inclusion criteria: in randomized controlled trials (RCT) of stroke recurrence prevention, we included trials comparing BPLDs group (blood pressure-lowering drugs) versus control group (placebo or no treatment); we also included trials comparing intensive blood pressure lowering group with standard blood pressure lowering group (intensive blood pressure lowering defined as blood pressure <130/85 mmHg, standard blood pressure lowering defined as blood pressure <140/90 mmHg). Outcomes index: major vascular event, stroke, and myocardial infarction were used as efficacy outcomes. Vascular death and all-cause death were used as safety outcomes. Results Ten trials were included, with 39, 931 patients were included; of which, six studies were included in BPLDs group and the control group (35, 040 participants), and four studies were included intensive blood pressure lowering group and standard blood pressure lowering group (4, 891 participants). Compared with the control group, the pooled risk ratio (Risk Ratios, RR) of BPLDs was 0.80(95% confidence interval [CI] 0.69 to 0.93; P=0.003) for recurrent stroke, 0.85(95%CI 0.77 to 0.94; P=0.002) for vascular death in BPLDs group; there was no significant difference in the incidence of major vascular event, myocardial infarction and all-cause death between the two groups. Compared with standard blood pressure lowering group, the pooled RRs were 0.78 (95%CI 0.64 to 0.95; P=0.01) for recurrent stroke and 0.82 (95%CI 0.69 to 0.97; P=0.02) for major vascular event in intensive blood pressure lowering group. There was no significant difference in the incidence of myocardial infarction, vascular death and all-cause death between the two groups. Conclusion BPLDs reduce the risk of stroke recurrence and vascular death for stroke patients compared with no antihypertensive treatment. Intensive antihypertensive therapy for stroke patients can further reduce stroke recurrence and major vascular event compared with standard antihypertensive therapy.

Vascular endothelial function of juvenile idiopathic arthritis in pediatric patients: A systematic review and meta-analysis

Hu Fangfang, Zhong Shiling, Di Yazhen, Wu Ling

2022, 37(3):  204-210.  doi:10.3969/j.issn.1004-583X.2022.03.002

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Objective To assess the correlation between brachial artery flow mediated dilatation (FMD) and juvenile idiopathic arthritis (JIA) by systematic review, and to explore vascular endothelial function in JIA children fatherly. Methods A case-control and cross-sectional studies regarding FMD and JIA children were conducted to collect via Computer retrieval of PubMed, Embase, Web of Science, The Cochrane Library, CNKI, WangFang Date, VIP databases and CBM, the retrieval time is from the establishment of database to August 2020. The literature screening, data extraction and bias risk assessment were independently conducted by two participants, meta-analysis was performed using Reviewer Manager 5.3 and Stata 16 software. Results There were 10 literature, 6 case-control studies, and 4 cross-sectional studies including 439 JIA children and 382 healthy controls (control group). The results of meta analysis verified that FMD value of JIA children was significantly lower than that of healthy children in the control group (weight mean difference [WMD]=-3.51, 95%CI=-4.16, -2.85, P<0.01, respectively); the subgroup analysis showed that FMD values of JIA children with polyarticular, oligoarticular, and systemic were significantly lower than those in the control group (WMD polyarticular JIA=-3.30, 95%CI=-4.51, -2.09, P<0.01; WMD oligoarticular JIA=-2.39, 95%CI=-3.63, -1.15, P=0.0002; WMD systemic JIA=-2.02, 95%CI=-2.57, -1.48, P<0.01, respectively). Conclusion Children with JIA retain vascular endothelial dysfunction.

Risk factors of intraoperative acquired pressure injury: A systematic review and meta-analysis

Song Siping, Jiang Qixia, Liu Xiaoqing

2022, 37(3):  211-219.  doi:10.3969/j.issn.1004-583X.2022.03.003

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Objective To systematically identify the risk factors of intraoperative acquired pressure injury(IAPI) to provide a basis for the prevention IAPI. Methods A systematic search regarding to IAPI risk factors in PubMed, Web of Science, Cochrane library, OVID, EMBASE, Chinese Biomedical Database(CBM), China National Knowledge Infrastructure(CNKI), Wanfang Data from January 2000 to July 2019 was performed to collect from January 2000 to July 2019. According to the criterias for inclusion and exclusion, screening eligible literature and data, evaluating the quality of included studies were all conducted by independent two reviewers, and using RevMan5.3 and Stata15 for a Meta-analysis. Results Totally 22 studies were recruited, including 267, 152 cases. In the Mate-analysis, 13 risk factors were involved, among which age, gender, body mass index(BMI)<23 kg/m², operation duration, low preoperative Braden score, lateral position, supine position were the main risk factors for IAPI. Conclusion The older age, BMI <23 kg/m², lower preoperative Braden score, longer operative duration are related to higher risk for IAPI female patients. Presently, because of insufficient evidence on risk factors of IAPI among patients and sample size of each study varied greatly, the effects of gender, comorbidities, operation position, intraoperative special medication, cardiopulmonary bypass, intraoperative hypotensive episodes are still inconclusive, and more high-quality studies are needed to supplement and improve for future research.

Application of endobronchial ultrasound transbronchial lung biopsy with guide sheath and rapid on-site evaluation in the diagnosis of bacteriologically-negative pulmonary tuberculosis

Xu Jingran, Li Feifei, Xie Chengxin, Gong Hui, Luan Qiyun, Li Li

2022, 37(3):  220-224.  doi:10.3969/j.issn.1004-583X.2022.03.004

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Objective To evaluate the combination of endobronchial ultrasonography with guide sheath (EBUS-GS), transbronchial lung biopsy (TBLB), and rapid on-site evaluation (ROSE) for the diagnosis of bacteriologically-negative pulmonary tuberculosis (PTB).Methods A total of 70 patients with suspected PTB were enrolled from January 2020 to December 2020 based on clinical symptoms, abnormal radiographic findings, sputum bacteriological examination (smear and culture), and initial sputum molecular detection negative results. The patients randomly divided into two groups: group A underwent EBUS-GS-TBLB (n=34), and group B underwent EBUS-GS-TBLB+ROSE (n=36). The diagnostic rates and biopsy numbers were evaluated between the two groups.Results 16 patients with PTB were detected in group A, and 22 in group B. After the joint ROSE, The PTB diagnostic rate improved from 47.06% to 61.11%(P=0.238), and the mean numbers of biopsy decreased from 4.53±0.50 to 3.08±0.60(P<0.01). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ROSE for the diagnosis of PTB were 86.36%, 86.67%, 85.71%, 92.86%, and 75.00%, respectively, with no serious complications.Conclusion The combination of EBUS-GS-TBLB and ROSE can improve the diagnostic rate, and reduce the biopsy numbers, which is thought of an effective and safe novel diagnostic modality.

Predictive value of procalcitonin clearance and SOFA score on the prognosis of patients with severe sepsis

Zhang Mengyuan, Zhu Yong

2022, 37(3):  225-229.  doi:10.3969/j.issn.1004-583X.2022.03.005

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Objective To investigate the predictive value of procalcitonin (PCT), and procalcitonin clearance (PCTc) and the dynamic changes of sequential organ failure assessment (SOFA) score on the prognosis of patients with severe sepsis. Methods The clinical data of 60 patients with severe sepsis were analyzed using a retrospective study. The PCTc were calculated based on the PCT at 0 h, 24 h, 48 h, 72 h and 120 h of enrollment, and the SOFA scores at 0 h and 48 h of enrollment were recorded, and the △SOFA at 48 h was figured out. The patients were divided into survival (n=44) and death group (n=16) according to whether they died at 28 d, and the interclass differences of PCT and PCTc at different time points were analyzed. Multivariate Cox regression analysis was used to explore the influencing factors of the prognosis of these patients, and the receiver operating characteristic (ROC) curve was used to verify the assessment ability of different indicators for the prognosis. Results There were statistically significant differences in PCT between groups, and the interaction between time and treatment factors was statistically significant (all P<0.05), but there was no significant difference between different time points (P>0.05). Compared with the death group, the PCT at 120 h in the survival group was significantly lower (P<0.05). The differences in PCTc between groups were statistically significant, the differences between different time points were statistically significant, and the interaction between time and treatment factors was statistically significant (all P<0.05). PCTc at 24 h, 48 h, 72 h, 120 h in the survival group were significantly higher (all P<0.05). Compared with the death group, the SOFA score of the survival group at enrollment was lower, and the△SOFA score at 48 h was significantly higher (all P<0.05). Multivariate Cox regression analysis showed that age>65 years old, PCTc at 24 h, PCTc at 120 h, SOFA score at enrollment and △SOFA at 48 h was an independent factor for the 28-day death of sepsis patients. The ROC curve results showed that the area under the curve (AUC) of PCTc at 120 h was 0.958, which could be used as a prognostic indicator. Conclusion Compared with the absolute value of PCT, PCTc is an indicator for judging the prognosis of sepsis. PCTc at 24 h, PCTc at 120 h, SOFA score at enrollment and △SOFA at 48 h are the independent influencing factors for the 28 d-death of sepsis patients. PCTc at 120 h can be used as an assessment tool for the prognosis of sepsis patients.

Searching for an optimal therapy for H.pylori eradication: High-dose proton-pump inhibitor dual therapy vs. bismuth-containing quadruple therapy

Huang Yehong, Liu Gaifang, Xin Chenxi, Zhao Yunhong, Wu Jing

2022, 37(3):  230-233.  doi:10.3969/j.issn.1004-583X.2022.03.006

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Objective To compare the eradication rate and adverse incidence of proton pump inhibitor high dose dual therapy with bismuth-containing quadruple therapy for Helicobacter pylori (H.pylori). Methods From January 2021 to August 2021, a total of 208 patients with positive H.pylori admitted to the Department of Gastroenterology, Hebei General Hospital were enrolled and randomly grouped into experimental group (n=105, proton pump inhibitor high dose dual therapy) and control group (n=103, bismuth-containing quadruple therapy). The patients in experimental group were given oral administration of esomeprazole 40 mg two times a day and amoxicillin 750 mg a day, and patients in control group were given esomeprazole 20 mg two times a day, colloidal bismuth subcitrate 220 mg two times a day, amoxicillin 1 000 mg two times a day, Furazolidone 100 mg two times a day. The treatment period for both groups was 14 days; after 4 week, ¹³C/¹⁴C urease breath test (¹³C/¹⁴C-UBT) for detecting H.pylori infection was performed and the eradication rate and adverse incidence were compared.Results The eradication rate of H.pylori for the experimental group and the control group were 77.1% and 82.5% (P=0.334) in intention-to-treat (ITT) analysis; the eradication rate of H.pylori for the experimental group and the control group were 82.7% and 87.6%(P=0.329) in per-protocol (PP) analysis. The incidence of adverse reactions in the experimental group was 9.0%, which was significantly lower than 19.0% in the control group (P=0.042). Adverse reactions in the experimental group were mainly bloating, diarrhea and rash; adverse reactions were mainly oral odor, constipation and abdominal pain in the control group. Conclusion The eradication rate was similar both proton pump inhibitor high dose dual therapy and bismuth-containing quadruple therapy; but proton pump inhibitor high dose dual therapy has significantly lower incidence for adverse reactions, expecting to be optimal eradication program.

Impact of body mass index in the clinicopathology and prognosis of patients with IgA nephropathy

Gao Pengli, Chen Lili, Tian Fen, Zhang Jiaqian, Chen Yipeng, Qi Xiaojing, Xing Guangqun

2022, 37(3):  234-242.  doi:10.3969/j.issn.1004-583X.2022.03.007

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Objective To investigate the impact of body mass index (BMI) on the clinicopathology and prognosis of patients with IgA nephropathy (IgAN). Methods The clinicopathological data and prognosis of 533 primary IgAN patients who were diagnosed by renal biopsy in the Affiliated Hospital of Qingdao University from February 2013 to May 2021 were retrospectively analyzed.Serum creatinine levels doubling and/or entered end-stage renail disease(ERSD) and/or renal replacement therapy and/or death were endpoints.According to the BMI and World Health Organization (WHO) obesity classification, the patients were grouped as follows: low body weight group (BMI<18.5 kg/m²), normal weight group (18.5≤BMI<25.0 kg/m²) and overweight obese group (BMI≥25.0 kg/m²). The differences in clinicopathological and prognosis of of patients in each group were compared.The Kaplan-Meier survival curve was used to assess the cumulative renal survival rate of patients, and the multifactorial Cox regression analysis was used to analyze the risk factors affecting the renal prognosis of IgAN patients with overweight and obesity. Results In 533 IgAN patients, 19 patients (3.6%) were underweight, 267 patients (50.1%) were normal weight, and 247 patients (46.3%) were obese weight. Compared with low body weight group and normal weight group, the overweight obese group showed increased age, systolic blood pressure (SBP), diastolic blood pressure (DBP), angiotensin-converting-enzyme inhibitors(ACEI)/angiotensin II receptor type 1(ARB)use ratio, hemoglobin, 24-hour urinary protein excretion, triglycerides, fasting plasma glucose, blood complement C3 and C4 levels, and uric acid, and decreased HDL-C and eGFR levels (all P<0.05). In comparison of normal group and low group, normal group displayed increased age, SBP, DBP, ACEI/ARB use ratio, uric acid, and decreased eGFR (all P<0.05). LDL-C levels were higher in both the overweight obese group and the normal group than in the low group (all P<0.05). IgM levels were lower and male prevalence and CRP levels were higher in the overweight obese group compared with the normal group (all P<0.05). Neutrophil counts were higher in the low group than in the normal group (P<0.05). In light microscopic examination, low group showed decreased the degree of vascular damage and inflammatory cell infiltration among three groups (all P<0.05). Mesangial deposition of C3 was weakened in the overweight obese group compared with the normal group (P<0.05). Kaplan-Meier survival curve analysis showed that the cumulative renal survival rate was higher in the normal group than in the overweight obese group (Log-rank test, χ ²=8.702, P=0.003), whereas, which was higher in the overweight obese group than in the low group (Log-rank test, χ ²=4.624, P=0.032). 5-year renal survival rates were 69.8%, 75.6%, and 85.9%, for low group, overweight obese group and normal group respectively, with higher 5-year renal survival rates in the normal group than in the overweight obese group (Log-rank test, χ ²=4.996, P=0.025), and higher 5-year survival rates in the overweight obese group than in the low group (Log-rank test, χ ²=5.764, P=0.016). The multifactorial Cox regression analysis showed that 24-hour urinary protein excretion, triglycerides, and hemoglobin were risk factors for endpoint events in IgAN patients with overweight obese.Conclusion Among the IgAN patients, the clinical manifestations of overweight and obesity patients are worst characterized by severer vascular damage and inflammatory cell infiltration, poorer renal prognosis. Thus the therapeutic effect of those patients and follow-up lifestyle and weight management should be emphasized.

Monitoring significance of CD4⁺ T lymphocyte count on evaluating frailty status of chronic renal failure in patients

Li Yingying, Li Ting, Zhang Ming, Fan Minghua, Xing Guangqun

2022, 37(3):  243-247.  doi:10.3969/j.issn.1004-583X.2022.03.008

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Objective To evaluate the significance of CD4⁺ T lymphocyte count in the evaluation of nutrition and prognosis of chronic renal failure in patients. Methods Totally 381 chronic renal failure patients were selected from YIDUCLOUD database of the Affiliated Hospital of Qingdao University during 2013 to 2020 for systematic analysis. CD4⁺ T lymphocyte counts and indicators related to immunity and nutrition of those patients were detected on admission, and acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA) score, and frailty score combined with Edmonton Frailty Scale were performed. As CD4⁺ T lymphocytes count of admission, patients were divided into three groups: A group of 67 cases (CD4⁺ T lymphocyte count< 200 cells/μl), B group of 175 cases (200 cells/μl≤CD4⁺ T lymphocyte count <544 cells/μl), and C group of 139 cases (CD4 ⁺ T lymphocyte count≥544 cells/μl). The correlation between CD4⁺ T lymphocyte counts, immune, nutrition-related indicators, SOFA score, APACHE Ⅱ score, and frailty score were analyzed. Kaplan-Meier survival curve was drawn. Results In this study, the overall proportion of frail patients was 36.5%(139/381), the proportion of frail patients was as high as 53.7%(130/242) at the count of CD4 ⁺ T lymphocytes <544 cells/μl, and the frail patients accounted for only 6.5% (9/139) at the count in the normal range. There was no significant difference in general data of admission among groups (all P>0.05), but the differences in serum total protein, prealbumin, albumin, APACHE Ⅱ score, SOFA score, and frailty score were statistically significant (all P<0.01). The difference in survival rate among the three groups was statistically significant (P<0.01). Conclusion Due to interactions of nutritional and immune status in chronic renal failure patients, the frail status cannot be ignored. The immune status of the patient can be improved by monitoring CD4 ⁺ T lymphocyte count and timely improving nutritional status, thereby improving the prognosis.

Diagnosis value of serum lipoprotein α, cystatin-C and uric acid on early diabetic nephropathy

Gao Shixin, Song Bing, Shi Kexin

2022, 37(3):  248-252.  doi:10.3969/j.issn.1004-583X.2022.03.009

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Objective To analyze the diagnostic value of serum lipoprotein (α)[LP(α)], cystatin-C (Cys-C) and uric acid (UA) on early diabetic nephropathy (DN). Methods In this retrospective analysis, 150 diagnosed type 2 diabetes mellitus (T2DM) patients admitted to Huludao Central Hospital from January 2020 to August 2021 were enrolled, according to urinary albumin/creatinine ratio (UACR), those patients were assigned into normal albuminuria (NA) group (n=50, UACR: 0~3 mg/mmol), microalbuminuria (MA) group (n=51, UACR: 3~29 mg/mmol), clinical albuminuria (CA) group (n=49, UACR>30 mg/mmol). The general clinical data, correlated clinical indexes, Serum LP(α), Cys-C, UA level were detected and compared among three groups. Pearson's correlation and Logistic regression analysis were used to analyze the correlation between each index and DN; receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of each index for DN.Results Among three groups, difference was statistically significant in the systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P<0.05); there were significant differences in the serum creatine (SCr), estimated glomerular filtration rate (eGFR), fasting plasma glucose (FPG), glycosylated hemoglobin A₁c (HbA₁c), Cys-C, UA, LP(α) (P<0.05). LP(α) in MA group significantly increased when compared with NA group, with statistically significant difference (P<0.05). Pearson's correlation showed that serum Cys-C, UA, LP(α) were positively correlated with UACR and SCr, while negatively correlated with eGFR. Logistic regression analysis showed that the independent risk factors for early DN included Cys-C and LP(α). The results of ROC curve analysis showed that serum Cys-C and LP(α) had high diagnostic value for early DN. Conclusion Different degrees of renal damage in T2DM patients were reflected by Serum LP(α), Cys-C and UA, of which LP(α) and Cys-C being independent risk factors for early DN. The highest accuracy emerges in the combined of the three, with high diagnostic efficacy of prediction for early DN.

Correlation of serum high-sensitivity C-reactive protein and urine microalbumin/creatinine and retinal lesions in diabetic

Wang Desheng, Sun Zhigang, Ma Zhoupeng

2022, 37(3):  253-256.  doi:10.3969/j.issn.1004-583X.2022.03.010

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Objective To explore the correlation of serum high-sensitivity C-reactive protein (hs-CRP), urine microalbumin (U-mAlb)/ creatinine (Cr) and diabetic retinopathy (DR), and the risk factors of proliferative diabetic retinopathy (PDR). Methods Totally 150 patients with type 2 diabetes mellitus (T2DM) were divided into three groups: non DR group (NDR group, n=67), non PDR group (NPDR group, n=55) and PDR group (n=28). The subjects were detected the level of fasting venous blood glucose (FPG), glycosylated hemoglobin (HbA₁c), hs-CRP and U-mAlb/Cr; the variation of hs-CRP and U-mAlb/Cr in different stages of DR as well as the risk factors associated with PDR were analyzed. Results The levels of hs-CRP and U-mAlb/C rised gradually among the three groups, which in PDR group were most prevalent, following by NPDR group (P<0.05). Spearman correlation analysis showed that the levels of hs-CRP and U-mAlb/Cr were significantly positively correlated with the severity of DR (P<0.05). Logistic regression analysis indicated that the risk factors for PDR were hs-CRP, U-mAlb/Cr and DR disease duration (P<0.05). Conclusion The detection of hs-CRP and U-mAlb/Cr should be emphasize in the diagnosis and treatment of DR, because the high expression of which are significantly positively correlated with the severity of DR.

Changes of serum Gremlin1 level in pregnant women in the second and third trimester of pregnancy and its relation with gestational diabetes mellitus

Qi Qi, Jiang Lichen, Sun Rong, Hu Honglin, Zhang Qiu

2022, 37(3):  257-261.  doi:10.3969/j.issn.1004-583X.2022.03.011

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Objective To explore the changes of serum Gremlin1 level in pregnant women in the second and third trimester of pregnancy and its relation with gestational diabetes mellitus (GDM). Methods From September to November 2020, a total of 175 pregnant women received pregnancy test in the First Affiliated Hospital of Anhui Medical University were enrolled, the patients had finished the oral glucose tolerance test (OGTT) during 24 to 28 weeks of pregnancy. They were divided into GDM group and normal glucose metabolism group (NGT group) by the OGTT results. The interclass clinical data including general data, Gremlin1 level and other biochemical indicators were collected, the differences of clinical data between the two groups were analyzed. Results The pre- and post-pregnancy body weight, pre-pregnancy body mass index (BMI), post-pregnancy BMI, fasting blood glucose (FBG), 1 h blood glucose (1 hBG), 2 h blood glucose (2 hBG), fasting insulin (FINS), 1 h insulin (1 hINS), 2 h insulin (2 hINS), fasting C protein (FCP), 1 h C peptide (1 hCP), 2 h C peptide (2 hCP), homeostasis model assessment of insulin resistance (HOMA-IR), area under curve of glucose (AUC-G), area under the curve for insulin (AUC-I) were higher in GDM group than in NGT group; homeostasis model assessment for beta-cell function index (HOMA-β) and insulin sensitivity index (ISI) in GDM group were lower than those in NGT group (all P<0.05). Serum Gremlin1 level in GDM group was higher than that in NGT group (P<0.05). Pearson correlation analysis showed that serum Gremlin1 level was positively correlated with post-pregnancy BMI, FBG, 1 hBG, 1 hINS, 2 hBG, 2 hINS, 2 hCP, HOMA-IR, AUG-G, AUC-I, and negatively correlated with HOMA-β, ISI (all P<0.05). Multivariate Logistic regression analysis showed that the independent risk factor for GDM was serum Gremlin1 (OR=8.922, 95%CI 1.863-42.736, P<0.05). Conclusion There is a positively correlated between increased serum Gremlin1 with insulin resistance in GDM patients, participating in the glucose metabolism of GDM.

Difference between remitting seronegative symmetrical synovitis with pitting edema syndrome and seronegative rheumatoid arthritis

Lin Changyi, Song Minghui, Wu Peicheng

2022, 37(3):  262-265.  doi:10.3969/j.issn.1004-583X.2022.03.012

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Objective To investigate the difference between remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome and seronegative rheumatoid arthritis (SNRA). Methods During January 2009 to December 2020, a total of 12 patients with RS3PE syndrome (RS3PE group) admitted in our hospital were enrolled, and 36 patients with SNRA (SNRA group) during the same period were collected. In-group general data, clinical features and laboratory indexes were included as comparison. Results Compared with the SNRA group, the patients in the RS3PE group had older aged, more males, higher serum C-reactive protein (CRP), more involved in ankle joints, less involved in small joints and hand joints, and easy to combine tumor (all P<0.05). Conclusion Older men and relatively higher CRP levels are higher risk for combined tumors in patients with RS3PE syndrome, they are more likely to involve the ankle joint. A actively screened for malignancy should be carried out in older, male, and RS3PE syndrome patients with limb edema.

Analysis of influencing factors on antidepressants compliance of patients with somatic symptoms disorder

Qu Junmin, Yang Limin, Yuan Fengying

2022, 37(3):  266-270.  doi:10.3969/j.issn.1004-583X.2022.03.013

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Objective To analyze the factors affecting the antidepressant compliance of patients with somatic symptoms disorder (SSD). Methods A total of 147 patients with SSD were prospectively enrolled, thay were divided into three groups according to Morisky Medication Adherence Scale (MMAS-8) score: good compliance group (41 cases), medium compliance group (64 cases) and poor compliance group (42 cases), the differences of sex, age, education, residence, life satisfaction, economic status, social support, insight, onset time, symptom severity, comorbidity, complication, treatment effect, adverse reaction and doctor-patient relationship among the three groups were compared. Results There were no significant differences in sex, education level and onset time among the three groups (P>0.05), there were significant differences in age, residence, life satisfaction, economic status, social support, insight, symptom severity, comorbidity, complication, treatment effect, adverse reaction and doctor-patient relationship (P<0.05, P<0.01). Logistic analysis showed that high life satisfaction, good social support, self-insight, severe symptoms and good treatment effect were the protective factors of treatment compliance, complications and severe adverse reactions were risk factors for treatment compliance. Conclusion High life satisfaction, good social support, insight, severe symptoms, good treatment results will improve the treatment compliance of SSD patients, however, complications, adverse reactions will reduce treatment compliance.

Literature review on one case of cerebral venous sinus thrombosis mainly featured with isolated headache

Chang Yajun, Guo Weina, Guo Qiaozhen, Wang Tianjun

2022, 37(3):  271-274.  doi:10.3969/j.issn.1004-583X.2022.03.014

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Objective To explore the etiology, clinical features, imaging characteristics and therapeutic regimen of cerebral venous sinus thrombosis (CVST). Methods One case of CVST mainly featured with isolated headache was retrospective analyzed, and related literature was reviewed. Results A 28-year-old male patient was admitted to the hospital with a 10-day headache and aggravated for 4 days. Magnetic resonance imaging (MRI) plain scan and enhancement of the head indicated filling defect of the left sigmoid and transverse sinuses, T1 and Flair showed high signal. The thrombosis of left transverse sinus and sigmoid sinus was confirmed by digital subtraction angiography (DSA). The patient recovered well after anti-infection and anticoagulant treatment. A total of 145 CVST patients with complete data in recent 5 years were collected, the most common features, pathogenic factor, disease location were headache accompanied by focal impairment symptom of neurologic system, hyperhomocysteinemia, superior sagittal sinus (SSS) and transverse sinus, respectively.Conclusion CVST patients normally exhibit the symptoms including the headache, hypopsia, limb weakness, epilepsy and disturbance of consciousness, only a few show simple headache. Anticoagulant therapy with vascular intervention is effectively capable of improving the prognosis of CVST patients. It is necessary to pay high attention to the patients with acute single recurrent progressive headache to avoid missed diagnosis and adverse consequences.