Table of Content

20 May 2022, Volume 37 Issue 5

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Analysis on impacts of diabetes on the severity and mortality of patients with COVID-19: A Meta-analysis

Lin Xinxin, Zhang Chuhan, Kong Haolin, He Muchen, Xu Lin, Yang Zhonghan

2022, 37(5):  389-399.  doi:10.3969/j.issn.1004-583X.2022.05.001

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Objective Diabetes mellitus (DM) is chronic conditions with devastating multi-systemic complications and may be associated with sensitivity and severe form of Coronavirus Disease 2019 (COVID-19). Abundant studies prove that patients with DM are more vulnerable to be infected with COVID-19 and develop severe cases during the prevalence and spread of novel coronavirus pneumonia. The present study intends to conduct meta-analysis to acertain the correlation between DM and severity as well as mortality in patients with COVID-19.Methods The key words(1)“COVID-19” OR “SARS-CoV-2” OR “Coronavirus” OR “novel coronavirus” AND “clinical characteristics” (2)“COVID-19” OR “SARS-CoV-2” AND “Diabetes” were used to search the data available on PubMed, Embase and CNKI, periodicals and articles in English and Chinese published before Feb, 2021 were screened. RevMan 5.4 software was applied after data extraction to perform Meta-analysis, and the Stata 12.0 software was used to assess the publication bias. Results A total of 82 studies which included 35 715 patients were included. Meta-analysis showed that DM was associated with composite poor outcome(OR 2.29 [2.14, 2.46], P< 0.01; I²: 52%, P<0.01). The risk of severity (OR 2.40 [2.20, 2.62], P< 0.01; I²: 49%, P<0.01) and mortality(OR 2.08[1.70, 2.56], P< 0.01; I²: 60%, P<0.01) of DM patients with COVID-19 were elevated than those of patients without DM. Conclusion DM serves as a critical factor to impact the rate of severe cases of COVID-19 and mortality in patients with COVID-19. The mechanism of how DM impacting the prognosis of COVID-19 is required to be further clarified.

Meta-analysis of PD-1/PD-L1 inhibitors in the treatment of patients with non-small cell lung cancer having brain metastases

Li Qing, Zhong Wen, Liu Siqiang, Chen Yusheng, Li Hongru

2022, 37(5):  400-405.  doi:10.3969/j.issn.1004-583X.2022.05.002

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Objective To perfrom a meta-analyze of the efficacy of PD-1/PD-L1 inhibitors versus chemotherapy in the treatment of patients with NSCLC brain metastases. Methods Search of the literature included in Pubmed, Embase, Sciencedirect, Cochrane, X-mol, CNKI, Wanfang and other databases on the Internet. Two researchers screened the literature, extracted data and evaluated the risk of bias and adopted RevMan 5.3 performs meta-analysis on the overall survival (OS) and progress free survival (PFS) of NSCLC brain metastasis.Results A total of 7 RCTs were included, including 440 patients with NSCLC brain metastases. Compared with simple chemotherapy group, PD-1/PD-L1 inhibitors could markedly increase the patient's OS [HR=0.71, 95%CI(0.56, 0.92), P=0.008] and PFS[HR=0.53, 95%CI(0.41, 0.69), P<0.01]; OS [HR=0.41, 95%CI(0.24, 0.70), P=0.001] and PFS [HR=0.44, 95%CI(0.30, 0.63), P<0.01] in PD-1/PD-L1 inhibitors combined with chemotherapy group compared with OS [HR=0.83, 95%CI (0.63, 1.11), P=0.21] and PFS[HR=0.64, 95%CI(0.45, 0.91),P=0.01] in the monotherapy group could more significantly reduce the patient's risk of death and disease progression.Conclusion PD-1/PD-L1 inhibitors alone or in combination with chemotherapy for patients with NSCLC brain metastases have better effect than chemotherapy, and the combined chemotherapy group is better than monotherapy, which is a preferred treatment for patients with NSCLC brain metastases.

Efficacy and safety of anticoagulant therapy for patients with heart failure in sinus rhythm

Li Heng, Li Yonghui, Sun Xiaoqiang, Wang Lin, He Feng

2022, 37(5):  406-411.  doi:10.3969/j.issn.1004-583X.2022.05.003

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Objective To investigate the safety and efficacy of prophylactic anticoagulant therapy in patients with heart failure in sinus rhythm. Methods The related research of anticoagulant therapy for patients with heart failure in sinus rhythm were collected from Pubmed, Embass, Cochrane databases for a Meta-analysis, the deadline was until June 1, 2021. The safety and efficacy of anticoagulant drugs preventing heart failure in sinus rhythm were assessed. Results Eligible 9 studies were included. Meta-analysis confirmed the difference was not statistically significant in the all-cause mortality rate (OR=0.87, 95%CI: 0.75-1.01, P=0.08), myocardial infarction rate (OR=0.86, 95%CI: 0.71-1.04, P=0.12), related readmission rate (OR=0.90, 95%CI: 0.75-1.07, P=0.23) between anticoagulant therapy and non-anticoagulant therapy. Compared with non-anticoagulant therapy, anticoagulant therapy could significantly reduce the risk of ischemic stroke (OR=0.38, 95%CI: 0.16-0.93, P=0.03), but meantime, increase the bleeding risk (OR=1.69, 95%CI: 1.43-2.00, P<0.05). Conclusion Anticoagulant therapy can effectively reduce stroke risk for patients with heart failure in sinus rhythm. Although the all-cause mortality rate and myocardial infarction rate of these patients tend to decrease, bleeding risk should be attention.

Predicting value of neutrophil to lymphocyte ratio combined with GRACE score on in-hospital major adverse cardiovascular events of postoperative PCI in acute STEMI patients

Wang Jiaqi, Gao Man, Zhang Feifei, Li Yingxiao, Dang Yi, Qi Xiaoyong

2022, 37(5):  412-417.  doi:10.3969/j.issn.1004-583X.2022.05.004

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Objective To explore the predicting value of neutrophil to lymphocyte ratio (NLR) combined with global registry of acute coronary events (GRACE) score on in-hospital major adverse cardiovascular events (MACE) of postoperative primary percutaneous coronary intervention (PCI) of patients with acute ST-segment elevation myocardial infarction (STEMI). Methods From September 1, 2018 to December 31, 2019, a total of 275 patients with acute STEMI underwent primary PCI who visited the Department of Cardiology, Hebei General Hospital were enrolled and divided into the MACE group (n=35) and the non-MACE group (n=240), postoperative PCI in-hospital MACE included all-cause mortality, cardiogenic shock, in-hospital repeat revascularization, fatal arrhythmia, cardiac arrest. The clinical data was recored, the independent risk factors of in-hospital MACE were analyzed. The receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of NLR, GRACE score and the two combined for in-hospital MACE of postoperative PCI in acute STEMI patients. Results Compared with the non-MACE group, increased age, GRACE score, CRUSADE score and NLR and decreased estimated glomerular filtration rate were detected in the MACE group (all P<0.05). Multivariate Logistic regression analysis showed that GRACE score and NLR were independent risk factors of in-hospital MACE of postoperative PCI in patients with acute STEMI (all P<0.05). ROC curve indicated that GRACE score, NLR had certain predictive value for in-hospital MACE, while the two combined had a greater areas under curve for better predicting in-hospital MACE. Conclusion GRACE score and NLR are independent risk factors for in-hospital MACE of postoperative PCI in acute STEMI patients, the two combined has a greater predictive value for in-hospital MACE.

Cohort study on effects of type D personality on mortality of adults with congenital heart disease

Li Li, Bai Lu, Sun Mingyu, Zhang Shiyang

2022, 37(5):  418-421.  doi:10.3969/j.issn.1004-583X.2022.05.005

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Objective To study the effects of type D personality on mortality of adults with congenital heart disease (CHD).Methods Two hundred and eighty seven adult patients with CHD admitted to the Department of Cardiovascular Medicine, the First Affiliated Hospital of University of Science and Technology of China from April 2016 to April 2020 were included in the study. Type D personality scale was applied to evaluate if the patients had Type D personality, the follow-up was ended in April 2021. The differences in general data and mortality of patients with type D personality and those without type D personality were further compared. Results A total of 263 patients were enrolled, 124 were male with average age of (49.4±7.1) years, 62 patients were found to have type D personality. Patients with type D personality were more likely to have NYHA II or higher cardiac function, and were more likely to have higher percentage for chronic kidney disease (12.9% vs 4.5%, P=0.039), unemployed status (32.3% vs 20.0%, P=0.043), and single (35.5% vs 20.1%, P=0.019). The patients with type D personality were found to have significantly worse survival than those without type D personality (82% vs 87%, P=0.014) at the end of the follow-up. Type D personality was noted to be significant predictor of death (hazard ratio of 1.85, 95% confidence interval 1.12-3.04, P=0.015) in Cox proportional hazard regression model analysis. Conclusion Type D personality is eligible to predict the mortality rate in adults with CHD, and need to pay attention to assessment in nursing work.

Predictive value of ApoB/ApoA1 ratio on the extent of coronary artery disease in patients with unstable angina pectoris

Zhu Jun, Liu Yue, Chen Shuxia, Wang Xian, Zheng Luyan, Gu Jian

2022, 37(5):  422-426.  doi:10.3969/j.issn.1004-583X.2022.05.006

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Objective To explore the predictive value of ApoB/ApoA1 ratio on the degree of coronary artery lesions in patients with unstable angina (UA). Methods One hundred and seventy six patients with UA who were hospitalized and underwent coronary angiography in the Department of Cardiovascular Medicine, Hebei General Hospital from October 2019 to August 2021 were retrospectively analyzed. Clinical data of the enrolled patients were collected, ApoB/ApoA1 ratio was calculated, and Gensini score was calculated based on coronary angiography results. The median Gensini score of UA patients was used to divide the patients into the high Gensini score group (Gensini score ≥40) and low Gensini score group (Gensini score <40), and clinical data of patients in two groups were compared. Correlation analysis on Gensini scores and ApoB/ApoA1 ratio in UA patients was performed. Binary multivariate Logistic regression was applied to analyze the independent risk factors for high Gensini score. ROC curves were applied to analyze the diagnostic value of ApoB/ApoA1 ratio and other lipid indices for high Gensini score, and the best diagnostic threshold was determined by the Yordon index. Results The ApoB/ApoA1 ratio of patients in the high Gensini score group was significantly higher than that of patients in the low Gensini score group (P<0.01). The Gensini score of UA patients was positively correlated with the ApoB/ApoA1 ratio (r=0.321, P<0.01). Binary multivariate Logistic regression analysis showed that ApoB/ApoA1 ratio was an independent risk factor for severe coronary lesions (Gensini score ≥40) in UA patients (OR=4.593, 95%CI=2.434-8.664, P<0.01). ROC curve analysis showed that the diagnostic value of ApoB/ApoA1 ratio was higher than that of ApoB, TG, TC and LDL-C, with an AUC of 0.723(P<0.01), an optimal diagnostic threshold of 0.69, a sensitivity of 0.644 and a specificity of 0.742.Conclusion The ApoB/ApoA1 ratio is positively correlated with the degree of coronary artery lesion in UA patients, and it has a certain diagnostic and predictive value and serves an independent risk factor for severe coronary artery lesions in UA patients, delivering guiding significance in the clinical diagnosis and treatment of UA.

Effect of high frequency and low frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke spasticity: A comparative study

Xia Jing, Chen Miaocun, Lin Min, Hao Youguo

2022, 37(5):  427-430.  doi:10.3969/j.issn.1004-583X.2022.05.007

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Objective To compare the clinical effect between high frequency and low frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke spasticity. Methods Totally 54 post-stroke spasticity patients were randomely divided into the high frequency group (n=18), the low frequency group (n=18) and the control group (n=18). In addition of 4-week routine treatment (secondary prevention medications+rehabilitation training), the high frequency group were additionally treated with high-frequency rTMS on the affected side, the low frequency group additionally with low-frequency rTMS on the healthy side. The control group did not receive rTMS. The effect assessment was conducted before and after treatment. The therapeutic effect was determined by comparing the motor evoked potentials (MEP) latency of wrist flexor muscles on the affected side, central motor conduction time (CMCT), Fugl-Meyer assessment (FMA) of upper extremity (FMA-UE), Modified Ashworth Scale (MAS), clinical spasticity index (CSI), Modified Barthel Index (MBI).Results The difference was not statistically significant in the related indicators among the three groups before treatment (P>0.05). After treatment, FMA-UE, MBI score in groups were significantly increased, while wrist flexor MAS, CSI, MEP latency, CMCT were apparently decreased (P<0.05). Among the three groups, FMA, MBI were remarkably increased in the frequency groups than in the cortrol group, and wrist flexor MAS, CSI, MEP latency, CMCT were obviously decreased when compared with the cortrol group (P<0.05), the high frequency group was more prevalent (P<0.05). Conclusion For post-stroke spasticity patients, both the high frequency rTMS on the affected side and the low-frequency rTMS on the healthy side can relieve post-stroke spasticity and elevate the FMA-UE score, which is safe and effective. And the high frequency rTMS on the affected side is better than low frequency rTMS on the healthy side.

Analysis of clinical characteristics of 61 cases of neuromyelitis optica spectrum disorders and the influence of NLR and ELR on disease severity

Li Yangfan, Li Jian

2022, 37(5):  431-436.  doi:10.3969/j.issn.1004-583X.2022.05.008

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Objective To investigate the clinical characteristics, neutrophil to lymphocyte ratio and eosinophil to lymphocyte ratio of 61 patients with neuromyelitis optica spectrum disorders (NMOSD). Methods A total of 61 patients admitted to the Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University from June 2017 to June 2021 and diagnosed as acute stage of NMOSD were collected.NMOSD patients’ general clinical information(gender, age), concomitant antibodies were gathered.61 healthy volunteers with matched gender and age were randomly selected from physical examination department as healthy controls(HCs). Routine blood indexes of both groups (neutrophil, eosinophil, monocyte, lymphocyte, platelet, uric acid, cystatin C, C-reactive protein) were collected, and neutrophil to lymphocyte ratio(NLR), eosinophil to lymphocyte ratio(ELR), monocyte to lymphocyte ratio(MLR), platelet to lymphocyte ratio(PLR) were calculated separately according to the above laboratory indicators.The extended disability scale(EDSS) on admission and groups were divided according to the scale results. Cys C, UA, CRP, NLR, ELR, MLR, PLR of NMOSD group and control group, mild- and moderate- severe NMOSD groups were compared.Binary Logistic regression analysis and ROC curve were used analyze the correlation between the above indicators with statistically significant differences and the severity. Results Compared with 61 healthy controls, gender, CRP, NLR, ELR, MLR and PLR of 61 NMOSD patients were statistically significant(P<0.05). In univariate analysis, there were statistically significant differences in the combination of other autoantibodies, NLR and ELR between the mild NMOSD group and moderate severe group(P<0.05). Binary Logistic regression analysis showed, NLR(OR=4.082,95%CI=0.970-7.177,P=0.035), ELR(OR=5.541,95%CI=0.001-8.225,P=0.045), combined with other autoimmune antibodies(OR=0.105,95%CI=0.002-4.997,P=0.038) were independent risk factors affecting the severity in NMOSD patients(P<0.05). NLR combined ELR was the most effective index for evaluating the severity of disease, and the optimal critical value of NLR combined ELR was 0.299, the area under the curve was 0.885, the specificity was 0.765, and the sensitivity was 0.926. Conclusion Patients with other autoimmune antibodies has a significantly high impact on the severity of the disease, and the prognosis is worse.NLR, ELR were effective indicator to evaluate changes in disease severity.

Early diagnostic value of serum cystatin C and β2-microglobulin in renal function impairment after neonatal asphyxia

Chen Xiaoting, Yan Zheng, Liu Fan, Wei Yi

2022, 37(5):  437-440.  doi:10.3969/j.issn.1004-583X.2022.05.009

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Objective To explore the value of serum cystatin C (CysC) and β2- microglobulin (β2-MG) in early diagnosis of renal function impairment after neonatal asphyxia. Methods Fifty four newborns clinically clearly diagnosed as asphyxia were enrolled, early asphyxia neonates with renal function impairment (immediately admitted to the hospital) and asphyxia neonates combined with Renal function impairment (5 days after treatment) were included in the case group (n=24), and uncombined asphyxiated newborns with impaired renal function were combined in the control group(n=30). Latex particle enhanced immunoturbidimetry, scattering rate turbidimetry, urease-glutamate dehydrogenase method and sarcosine oxidase method were applied to detect the level of CysC, β2-MG, urea nitrogen(BUN) and creatinine(Cr) respectively; the t test was applied to compare the difference in above detection indicators between the case group and the control group. The sensitivity, specificity and the area under the receiver operating characteristic curve (ROC) of indexes in the renal function impairment after neonatal asphyxia were observed, Z test was applied to determine the difference of the area under the different ROC curve.Results The CysC and β2-MG level of newborns in the case group were the highest at admission, and the CysC and β2-MG level of newborns in the control group were the lowest. The index levels in the case group after 5 days of treatment were in intermediate, and the difference was statistically significant (P<0.05). The sensitivity, specificity, and area under the ROC curve of CysC and β2-MG under separate and combined diagnosis were 62.9%, 70.3%, 74.1%, 70.0%, 75.0%, 76.0%, 0.668, 0.692, 0.704, respectively. The Z test indicated that the combined diagnosis on CysC and β2-MG delivered higher diagnostic capacity compared with a single index, and the differences were statistically significant (P<0.05). Conclusion The level of CysC and β2-MG in children with renal function impairment after neonatal asphyxia is higher in the early stage of the disease, and it delivers great significance for the early diagnosis on such disease. The combined detection on CysC and β2-MG honor great diagnostic capaity for renal function impairment after neonatal asphyxia.

Analysis on de novo mutations in PAH genes of the family with phenylalanine hydroxylase deficiency

Ma Cuixia, Feng Lulu, Li Lixin, Ma Qianqian, Li Yang, Feng Jizhen

2022, 37(5):  441-446.  doi:10.3969/j.issn.1004-583X.2022.05.010

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Objective To investigate the pathogenesis of a family with phenylalanine hydroxylase deficiency (PAHD) by detecting and analyzing the mutation sites of phenylalanine hydroxylase (PAH) genes of the family. Methods PAH genome sequencing and exon deletion or duplication analysis were performed in the venous blood of probands and their parents by the next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA). Results The proband was found to have one missense mutation and one splice deletion, namely c.630t > G in Exon 6 and c.61-1G > A in Exon 2, respectively, which were not reported in Human Gene Mutation Database (HGMD), and were determined as clinically unknown and suspected pathogenic variants in America College of Medical Genetics and Genomics (ACMG) guidelines. The two mutations were predicted to be harmful and unknown in prediction results of information software REVEL, and no abnormal copy number of exon of PAH gene was found in the exon deletion and duplication analysis on the proband by using MLPA. Conclusion Exon 6 c.630T > G and exon 2 c.61-1G > A of PAH gene may be pathogenic mutations of PAHD in the family.

McCune-Albright syndrome in adolescence with regular menstrual cycle: A case report and literature review

Lian Yihua, Pi Yalei, Zhang Yanan, Zhang Huifeng

2022, 37(5):  447-450.  doi:10.3969/j.issn.1004-583X.2022.05.011

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Objective To analyze the differences of various drugs in treatment of peripheral precocious puberty, and improve the therapeutic level to McCune-Albright syndrome (MAS). Methods In this article, the data of a MAS child from pediatric vaginal bleeding in infancy to regular menstrual cycle in adolescence and the relevant literatures were retrospectively review, the pros and cons of various drugs in treatment of peripheral precocious puberty were analyzed, aiming to provide reference for pediatric endocrinologists. Results Letrozole was relatively safe by reducing endogenous estrogen during treatment. Conclusion Letrozole seems to be more suitable for the treatment of peripheral precocious puberty in MAS children, but follow-up assessments are essential.

Multiple system atrophy complicated with syndrome of inappropriate antidiuresis: A case report and literature review

Qiu Jianmei, Shen Hongxia, Wang Defeng

2022, 37(5):  451-454.  doi:10.3969/j.issn.1004-583X.2022.05.012

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Objective To provide evidences for clinical diagnosis and treatment of multiple system atrophy (MSA) complicated with the syndrome of inappropriate antidiuresis (SIAD) by exploring clinical features of the disease. Methods The clinical data, diagnosis & treatment process of a patient with MSA complicated with SIAD were retrospectively analyzed, and relevant literature was reviewed. Results The patient was a 58-year-old male with intermittent disturbance of consciousness accompanied by cough and sputum for more than 1 month, and then underwent the disease attack for 2 days. In combination with the patient's medical history, physical examination and auxiliary examination, the following findings of admission diagnosis were made: ①Severe hyponatremia; ②Pulmonary infection; ③ MSA. The patient was confirmed to have SIAD after supplementing relevant auxiliary examination and combining corresponding clinical manifestations. The patient's pulmonary infection was cured except for persistent hyponatremia after therapies including anti-infection, water fasting and sodium supplementation. Conclusion MSA may be the cause of SIAD, and pulmonary infection may be the susceptible factor of SIAD complicated with MSA. The control over water-sodium balance should be strengthened for patients with MSA, especially the cases complicated with pulmonary infection.