Table of Content

20 December 2022, Volume 37 Issue 12

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A network meta-analysis of SGLT2 inhibitors on cardiovascular outcomes in patients with type 2 diabetes

Wang Runqing, Wang Qian, Liao Jianxiong

2022, 37(12):  1061-1073.  doi:10.3969/j.issn.1004-583X.2022.12.001

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Objective Type 2 diabetes is a chronic disease and heart failure is a common complication of type 2 diabetes, and large studies have demonstrated the role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in improving cardiovascular outcomes of patients with type 2 diabetes. In this paper, the efficacy effects of five different SGLT2i were indirectly compared by systematic evaluation. Methods PubMed, Web of science, Cochrane Library, CNKI, WanFang, and VIP databases were searched to collect relevant literature with a search time frame of build to July 2022. Two researchers independently screened the literature and extracted the corresponding data, using the composite outcome of heart failure hospitalization and cardiovascular death as the primary outcome indicator, with heart failure hospitalization, cardiovascular death and all-cause death as secondary outcome indicators, and a network meta-analysis was performed using Stata 16.0 as well as the network program package. Results A total of 340 publications were retrieved, eligible 11 publications representing 62 904 patients were included. The five intervention methods were involved, namely: empagliflozin, sotagliflozin, dapagliflozin, ertugliflozin and canagliflozin. There were no statistically significant differences (P>0.05) between the five different SGLT2i in altering the composite outcomes of heart failure hospitalization and cardiovascular death, cardiovascular death, heart failure hospitalization and all-cause death in patients with type 2 diabetes. All five different SGLT2i significantly improved heart failure hospitalization outcomes in patients with type 2 diabetes compared to placebo. There was a statistically significant difference between empagliflozin and sotagliflozin in improving the composite outcome of heart failure hospitalization and cardiovascular death. No significant difference between placebo and the five different SGLT2i in improving the outcome of cardiovascular death or all-cause death. Conclusion There was a trend towards a more significant benefit of empagliflozin and sotagliflozin improving the composite outcome of heart failure hospitalization and cardiovascular death and heart failure hospitalization outcome in type 2 diabetic patients, while for cardiovascular death or all-cause death outcome, there was no statistically significant difference between the five different SGLT2i and placebo, and the exact mechanisms and causes still need to be explored and validated in large studies.

Efficacy and safety of PCSK9 inhibitors on atherosclerotic cardiovascular disease: A meta-analysis

Zhang Lei, Lou Haidong, Zhi Yu, Qi Shuying

2022, 37(12):  1074-1080.  doi:10.3969/j.issn.1004-583X.2022.12.002

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Objective To systematically evaluate the efficacy and safety of proprotein convertase subtilisin/kexin type 9(PCSK9) inhibitors on atherosclerotic cardiovascular disease (ASCVD). Methods PubMed, Embase, Cochrane Library and Clinical Trails.gov were subject to the computer retrieval from the data of database construction to May 2022. The randomized controlled trials (RCTs) of PCSK9 inhibitors for ASCVD patients were screened and incorporated, and the meta analysis on conforming RCTs was performed with Review Manager 5.4 software. Results A total of 10 RCTs comprising 54 472 patients were enrolled. Efficacy analysis results showed that PCSK9 inhibitors could reduce the level of low-density lipoprotein cholesterol (LDL-C) by 49.26%(95%CI: -54.00 to -44.52, P<0.01) and significantly reduced the other five lipid levels compared with the control group. Percent atheroma volume (PAV) reduced by 1.1% (95%CI: -1.48 to 0.73, P<0.01) and the minimum fibrous cap thickness (FCT) increased by 31.32%(95%CI: 15.82 to -46.82, P<0.01) in the PCSK9 inhibitors group. PCSK9 inhibitors did not reduce the risk of cardiovascular death (RR=0.97, 95%CI: 0.86 to 1.10, P>0.05), and reduced the risk of myocardial infarction (RR=0.73, 95%CI 0.65 to 0.81, P<0.01) and stroke (RR=0.78, 95%CI 0.68 to 0.90, P<0.01). The incidence of serious adverse events (SAEs) between the PCSK9 inhibitors group and control group was similar (RR=0.97, 95%CI 0.95 to 1.00, P>0.05). The incidence of injection site reaction in the PCSK9 inhibitor group was higher (RR=1.57, 95%CI: 1.40 to 1.76, P<0.01). Differences in myalgia, neurocognitive reaction and incidence new-onset diabetes weren't statistically significant when compared to such indexes in the control group (P>0.05). Conclusion PCSK9 inhibitors is capable of significantly reducing the level of LDL-C, incidence of myocardial infarction and stroke without serious adverse reactions.

A meta-analysis of the renal protective effects of vitamin D and its analogues in non dialysis patients with chronic kidney disease

Wang Lingling, Wu Jinlan, Wu Wei, Shen Shipeng, Chi Yanqing, Liu Maodong

2022, 37(12):  1081-1088.  doi:10.3969/j.issn.1004-583X.2022.12.003

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Objective To investigate the renal protective effect of vitamin D and its analogs in non-dialysis patients with chronic kidney disease (CKD). Methods PubMed, Embase, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), etc. were searched according to the literature search strategy, and randomized controlled studies regarding the effects of vitamin D and its analogs on proteinuria and disease progression in CKD patients were included. Controlled studies were conducted, and the literature was screened according to the inclusion and exclusion criteria, the data of the included literature was meta-analyzed by Revman 5.4 software. Results A total of 7 articles with 616 patients were included.Compared with the control group, the vitamin D and its analogs reduced the ratio of urine protein/creatinine in CKD patients (SMD=-0.30, P=0.001; 95%CI:-0.48 to -0.12), decreased 24-hour urine protein (SMD=-0.67, P=0.01; 95%CI: -1.19 to -0.14), meantime, reduce serum parathyroid hormone (PTH) (SMD=-33.53, P=0.008; 95%CI: -58.48 to -8.58), increase serum calcium (SMD=0.11, P=0.04; 95%CI: 0.01 to 0.21), decreased blood phosphorus (SMD=-0.01, P=0.04; 95%CI: 0.01 to 0.21). However, the positive effect of vitamin D on serum creatinine (SMD=-9.41, P=0.38; 95%CI: -30.27 to 11.46) and estimated glomerular filtration rate ( eGFR ) (SMD=0.94, P=0.67; 95%CI: -3.35 to 5.22) was not observed. Conclusion Vitamin D and its analogs can reduce 24-hour proteinuria and urine protein/creatinine ratio in non-dialysis patients with CKD, also increase blood calcium level, reduce PTH, and inhibit the occurrence and development of secondary hyperparathyroidism. However, there is no evidence-based medical evidence to support the roles in reducing serum creatinine and improving renal function in CKD patients.

Correlation of Chinese visceral adipose index and visceral fat area with diabetic nephropathy and their warning values

He Feng, Nin Lu, Luo Gao, Yang Ruifei, Li Fanfan, Cheng Xiaoqiong, An Binbin, Li Jingjuan, Liu Yuanyuan, Guo Qian, Wang Jinyang

2022, 37(12):  1089-1093.  doi:10.3969/j.issn.1004-583X.2022.12.004

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Objective To explore the correlation between Chinese visceral adipose index (CVAI) and visceral fat area (VFA) with diabetes nephropathy (DN) in Chinese population, and their values of early warning. Methods Clinical data of 240 patients with type 2 diabetes (T2DM) hospitalized in the Department of Endocrinology of Gansu Provincial People's Hospital from October 2020 to October 2021 were retrospectively analyzed, including the baseline characteristics, physical examination findings, and biochemical indicators. They were divided into DN group (n=114) and non-DN group (n=126) according to the presence or absence of DN. The correlation between CVAI and VFA with urinary albumin excretion rate (UAER), urinary albumin-to-creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR) was assessed by the Spearman’s correlation test. Independent risk factors of DN in T2DM patients were screened by multivariatestepwise logistic regression analysis, and a multivariate logistic regression model was created. The predictive value of the model and each risk factor was evaluated by plotting the receiver operating characteristic (ROC) curve. Results Compared with those of the non-DN group, patients in DN group presented significantly longer duration of diabetes, larger weight, body mass index, waist circumference, hip circumference, waist height ratio, waist hip ratio, and neck circumference, and higher fasting plasma glucose (FPG), urinary albumin excretion rate (UAER), urine albumin-creatinine ratio (UACR), glycosylated hemoglobin(HbA₁c), lipid accumulation production, CVAI, VFA and subcutaneous fat area, and lower estimated glomerular filtration rate (eGFR) (all P<0.05). Spearman’s correlation test showed that UAER and UACR were positively correlated with CVAI and VFA (all P<0.05). Logistic regression analysis showed that CVAI, VFA, FPG and the course of diabetes were independent risk factors for DN in T2DM patients (all P<0.05). ROC curve analysis showed that the area under the curve (AUC), sensitivity and specificity of CVAI were 0.6730, 0.3947, and 0.881, respectively, which of VFA were 0.6453, 0.7456, and 0.4921, respectively. Besides, AUC, sensitivity and specificity of the created logistic regression model were 0.7493, 0.7368, and 0.6825, respectively. The predictive potential of the logistic regression model was better than that of a single independent risk factor. Conclusion CVAI, VFA, FPG and the course of diabetes are independent risk factors for DN in T2DM patients. CVAI and VFA can be used as early warning indicators for DN in T2DM patients, providing an important basis for the management of visceral obesity patients.

The effect of serum intact parathyroid hormone level on the maturation of autogeneous arteriovenous fistula

Wang Pengrui, Chen Huaqian, Yang Tao, Zhao Li, Li Peng

2022, 37(12):  1094-1098.  doi:10.3969/j.issn.1004-583X.2022.12.005

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Objective To investigate the effect of serum intact parathyroid hormone (iPTH) level on the maturation of autogeneous arteriovenous fistula (AVF) in patients with chronic renal failure (CRF). Methods A total of 108 patients treated with AVF angioplasty in the Nephrology Department of Sinopharm Dongfeng General Hospital from January 2019 to May 2022 were recruited. Their baseline characteristics, biochemical data, color ultrasound reports of arteries and veins of both upper limbs and those of radial artery cephalic vein fistula at 2 months postoperatively were collected. Patients were assigned into AVF maturation group and AVF malmaturation group. The influence of clinical data on the maturation of AVF was analyzed. Results Compared with patients in the AVF malmaturation group, patients in the AVF maturation group were significantly younger, and the incidence of diabetes was significantly lower (P<0.05). Moreover, the use of calcium antagonists was significantly less frequent (P<0.05). Serum iPTH and high-sensitivity C-reactive protein were significantly lower in the AVF maturation group (P<0.05). The diameter of cephalic vein was significantly larger than that of AVF malmaturation group (P<0.05). Multivariate Logistic regression analysis showed that age, high-sensitivity C-reactive protein and head vein diameter were independent risk factors for AVF maturation (all P<0.05). Conclusion Age, high sensitivity C-reactive protein and head vein diameter are independent risk factors for AVF maturation. Elevated iPTH levels are associated with poor AVF maturation.

Renal anemia in patients with maintenance peritoneal dialysis and Related Factors: A single-center study

Zhang Hongtao, Wang Zhikui

2022, 37(12):  1099-1103.  doi:10.3969/j.issn.1004-583X.2022.12.006

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Objective To evaluate renal anemia in patients with maintenance peritoneal dialysis, analyze factors affecting hemoglobin in patients with maintenance peritoneal dialysis, and guide clinical intervention and treatment. Methods The demographic characteristics and clinical data of 238 patients with peritoneal dialysis who were regularly followed up in the Peritoneal Dialysis Center of Linyi People's Hospital of Shandong Province from January 2011 to December 2020 were retrospectively analyzed. Hematocrystalin (Hb)≥110 g/L was used as the cutoff value. They were divided into the qualified Hb group (Hb≥110 g/L) and the unqualified Hb group (Hb<110 g/L). Both groups were compared in terms of gender, age, basic disease, biochemical examination, urea clearance index (KT/V), peritoneal balance test results, and other factors. In this center, the qualified rate of hemoglobin treatment and its influencing factors in patients undergoing peritoneal dialysis were analyzed. Results ①The mean Hb of recruited patients was (103.85±19.13) g/L. There were 108 cases (45.38%) in the qualified Hb group and 130 cases (54.62%) in the unqualified Hb group. ② Univariate analysis showed that the Hb level was positively related to total KT/V (r=0.282, P<0.05), peritoneal KT/V (r=0.230, P<0.05) and ultra-filtration amount (r=0.146, P<0.05), which was negatively correlated with body mass index (r=0.154, P<0.05). ③ Multivariate logistic regression analysis showed that body mass index (BMI), low albumin, creatinine, and ultrafiltration volume were risk factors for Hb in patients with continuous ambulatory peritoneal dialysis (CAPD). Conclusion A patient's BMI, albumin, creatinine, and ultrafiltration volume may be used to predict eligibility for Hb therapy during peritoneal dialysis. It is more likely that Hb would qualify for peritoneal dialysis patients with a lower BMI, a higher ultra-filtration volume, and a higher peritoneal KT/V and total KT/V.

Correlation between heart type fatty acid binding protein and mild & severe COVID-19

Guo Wenxiu, Wang Hailong, Wang Doudou

2022, 37(12):  1104-1107.  doi:10.3969/j.issn.1004-583X.2022.12.007

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Objective To analyze the clinical characteristics of patients with mild & severe corona virus disease 2019 (COVID-19) and explore the correlation between herart fatty acid binding protein(H-FABP)and mild & severe COVID-19. Methods Totally 40 patients with negative expression of high-sensitivity troponin T (hs-cTnT) admitted to the Chongqing University Three Gorges Hospital before June 2022 were retrospectively analyzed. According to the diagnostic criteria of “Diagnosis and Treatment Protocol for COVID-19 (Trial Version 8)”, the patients were enrolled into the mild and severe groups. The expression levels of H-FABP in peripheral blood were compared between the two groups. Results Eligible 40 COVID-19 patients representing 20 cases in the mild group and 20 cases in the severe group were included. Compared with the mild group, the patients in the severe group were older ([41.9±10.5] vs [58.2±16.3]) years, and the proportion of patients with diabetes was higher (all P<0.05). H-FABP level in the severe group was significantly higher than that in the mild group ([3.97±1.80] vs [6.88±3.90] μg/L; [P<0.05], respectively). Conclusion In COVID-19 patients with negative hs-cTnT expression, serum H-FABP expression level is associated with the severity of COVID-19 disease. H-FABP may serve as a more sensitive and independent myocardial injury factor to contribute to the disease typing of COVID-19.

Clinical analysis of 16 cases of venous thromboembolism combined with psychiatric disorders treated with olanzapine

Wang Jiaoyan, Zhang Yingchun, Ren Keming, Ma Guofeng, Ying Kejing

2022, 37(12):  1108-1113.  doi:10.3969/j.issn.1004-583X.2022.12.008

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Objective To improve the early recognition and early diagnosis of venous thromboembolism (VTE) in patients with psychiatric disorders. Methods Clinical symptoms, laboratory and imaging tests, anti-psychotic medication and treatment prognosis of 16 patients with psychiatric disorders combined with VTE who were first diagnosed in the Department of Mental Health, Sir Run Run Shaw Hospital affiliated to Zhejiang University from May 2019 to March 2022 were retrospectively analyzed. Results Among the 16 patients, there were 6 males and 10 females with an average age of 67 years. 13/16 were diagnosed with pulmonary embolism, 4/16 were diagnosed as deep venous thrombosis, and 1 suffered pulmonary embolism complicated with deep venous thrombosis. The diagnosis of pulmonary embolism and deep venous thrombosis was confirmed following the Chinese guidelines for the prevention and treatment of thrombotic diseases 2018 edition. 12 cases of pulmonary embolism were low-risk and one case was high-risk. Two patients had transient chest tightness and shortness of breath before onset, while the remaining 14 patients had no obvious symptoms of chest tightness and shortness of breath. 16 patients had abnormal D-dimer, 9 had hyperlipidemia, 8 had hyperhomocysteinemia, 5 had hyperprolactinemia and 2 had elevated coagulation factor VIII. 10 patients had VTE within the first 6 months of antipsychotic use. 3 cases occurred within 1 year and 3 cases occurred within 5 years. Olanzapine was given to all 16 patients. The risk of thrombosis was low in all 16 patients, as assessed by the Caprini and Padua Thrombosis Risk Assessment Scale. Conclusion The clinical presentation of VTE in patients with psychiatric disorders is atypical that lacks obvious clinical signs and symptoms, easily leading to misdiagnosed and untimely treatment. Conventional VTE prevention assessment scales are not suitable for them. VTE in patients with psychiatric disorders most often occurs within the first 6 months of olanzapine use, which is often associated with abnormal elevations in D-dimer and other metabolic laboratory markers. Concurrent olanzapine use in patients with psychiatric disorders may precipitate VTE and requires significant clinical attention.

Clinical value of the two combination of single-day growth hormone provocation test in short stature children

Li Lei, Li Minglei, Wang Qianqian, Mu Suping, Li Tianhua, Han Chunfang

2022, 37(12):  1114-1116.  doi:10.3969/j.issn.1004-583X.2022.12.009

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Objective To explore the clinical value of single-day combined Pyridostigmine Bromide and clonidine test on short stature (SS) children. Methods The children (n=125) presenting with SS visiting the Department of Pediatric Internal Medicine, Weifang People's Hospital from June 2019 to June 2021 were selected, and they were randomized into two groups. Pyridostigmine Bromide and clonidine provocation test was implemented for children in the experimental group, the single-day combined arginine and clonidine test was implemented for children in the control group. Growth hormone (GH) was tested by the chemiluminescence method. The positive rate and incidence of adverse reactions of GH deficiency between two methods were compared to evaluate the efficacy and safety of GH provocation test. Results The average GH peak level for provocation test in two groups was (17.44±5.56)μg/L and (17.88±5.60)μg/L, respectively, no difference was statistically significant (P>0.05). Differences in GH peak positive rate and adverse reaction rate between two groups weren't statistically significant (all P>0.05). Conclusion The outcome of combined Pyridostigmine Bromide and clonidine provocation test is highly consistent with that of the combined arginine and Alonidine provocation test, it is eligible to be used to evaluate GH level in SS children, and it is identified as a simple and effective test method.

Correlation between serum bilirubin level and the imbalance of the normal gut microbiota in neonates with cholestatic jaundice

Qi Yumin, Wang Youjun

2022, 37(12):  1117-1121.  doi:10.3969/j.issn.1004-583X.2022.12.010

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Objective To investigate the correlation between serum bilirubin level and the imbalance of normal gut microbiota in neonates with cholestatic jaundice. Methods A total of 109 neonates with cholestatic jaundice treated in Nanyang Central Hospital from August 2019 to August 2021were selected as the cholestatic jaundice group, 68 neonates with breast milk jaundice were selected as the breast milk jaundice group, and 80 healthy neonates during the same period were selected as the healthy group. Serum bilirubin level andgut microbiotain stools were detected. Differences in the dominant flora at the level of phylum and genus in three groups were compared. The correlation between serum bilirubin level and the imbalance of normal gut microbiota was analyzed by Pearson’s correlation coefficient. Results Serum level of alanine aminotransferase (ALT) and direct bilirubin and total bilirubin ratio (DBIL/TBIL) in cholestatic jaundice group were significantly higher than those in healthy group and breast milk jaundice group (all P<0.05). The proportion of grade Ⅱ and Ⅲ imbalance of gut microbiota was significantly higher in cholestatic jaundice group than that in the healthy group and breast milk jaundice group (P<0.05).The abundances of Bacteroides and Firmicutes in cholestatic jaundice group were significantly higher than those in breast milk jaundice group and healthy group (P<0.05).The abundances of Bifidobacteria and Lactobacillus in cholestatic jaundice group were significantly lower than that in healthy group and breast milk jaundice group (P<0.05), and the abundances of Escherichia coli and Enterococcus in cholestatic jaundice group weresignificantly higher than that in healthy group and breast milk jaundice group (P<0.05). The ratio of Bifidobacteria/Escherichia coli (B/E) in cholestatic jaundice group was significantly lower than that in healthy group and breast milk jaundice group (P<0.05).ALT, TBIL, DBIL, DBIL/TBIL were positively correlated with the abundances of Bacteroides and Firmicutes (all P<0.05), and negatively correlated with that of Actinomyces (all P<0.05).TBIL was negatively correlated with the abundance of Bifidobacterium and B/E (P<0.05), and positively correlated with abundances of Escherichia coli and Enterococcus (P<0.05).DBIL was negatively correlated with the abundance of Bifidobacterium and B/E (P<0.05) DBIL/TBIL were negatively correlated with the abundances of Bifidobacterium, Escherichia coli, and Enterococcus, and B/E (all P<0.05). Conclusion The gut microbiota of neonates with cholestatic jaundice is imbalance, with significantly reduced abundance of Bifidobacteria, and the serum bilirubin level has a certain correlation with the gut microbiota. An active supplement of probiotics may be an effective way to treat cholestatic jaundice.

TFEB translocation renal cell carcinoma: A case and literature review

He Chendong, Ge Fenglin, Yang Wei

2022, 37(12):  1122-1126.  doi:10.3969/j.issn.1004-583X.2022.12.011

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Objective To report a case of TFEB translocation renal cell carcinoma and review the literature, to explore its clinical and imaging features, in order to improve the understanding of the disease. Methods The clinical and imaging data of a case of TFEB translocation renal cell carcinoma were retrospectively analyzed, the “TFEB translocation renal cell carcinoma”, “MiT-family translocation renal cell carcinoma”, “6p21 translocation renal cell carcinoma”, and “t (6;11)(p21; q12)” were selected as keywords. The papers collected by China National Knowledge Internet (CNKI), Wanfang database and PubMed from January 2010 to present were retrieved. Clinical features and imaging characteristics of TFEB translocation renal cell carcinoma were summarized. Results A 54-year-old male patient was admitted to the hospital because of backache and gross hematuria. The computed tomography (CT) scan showed a cystic and solid mass with clear borders, accompanied by hemorrhage and calcification. The enhanced scan showed uneven enhancement and no distant metastasis. The 13 confirmed cases reported in the literature had a male to female ratio of 8∶5; the average age was 37.8 years; the average maximum diameter of the tumor was about 7.7 cm. The surgical resection of the tumor was performed in all cases, one case had bilateral lung metastasis before surgery, and the other 12 cases had no metastasis. The masses had clear boundaries, mainly cystic and solid mixed density, and the enhancement mode was mainly continuous mild to moderate enhancement. Conclusion TFEB translocation renal cell carcinoma is a rare non-invasive low-grade malignant tumor, which occurs in young patients with well-defined, mild to moderately enhanced cystic-solid masses, the possibility of TFEB translocation renal cell carcinoma needs to be considered.

Respiratory Whipple's disease: A case report and literature review

Li Lifang, Wang Hongyan

2022, 37(12):  1127-1131.  doi:10.3969/j.issn.1004-583X.2022.12.012

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Objective To further improve the understanding of Whipple's disease(WD) as rare diseases, aiming to enhance clinicians' ability for the diagnosis of this intractable cases. Methods The clinical features and treatment process of one case respiratory WD were reported, and the literature was reviewed for discussion. Results WD can involve multiple systems, rarely involve the lungs, and the symptoms are atypical, which can be manifested as fever, dry cough, fatigue, chest pain, dyspnea, etc. Chest CT findings were mainly multiple nodules and interstitial lung disease, accompanied by mediastinal lymphadenopathy or pleural effusion. Tropheryma whippleii (TW) was detected by second-generation gene sequencing (NGS). Conclusion The course of WD is obscure, the clinical manifestation of respiratory system is atypical, and the general laboratory and imaging examinations are non-specific. The diagnosis of WD is helpful to NGS. After treatment with ceftriaxone sodium and doxycycline, the symptoms will be relieved with a good prognosis.