Table of Content

20 October 2023, Volume 38 Issue 10

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Meta-analysis of the efficacy and safety of dupilumab on the treatment of bronchial asthma

Ruan Junwen, Zhou Jianrong, Liu Weiyou, Yuan Xiaoliang, Yan Hao

2023, 38(10):  869-877.  doi:10.3969/j.issn.1004-583X.2023.10.001

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Objective To systematically evaluate the efficacy and safety of dupilumab on the treatment of bronchial asthma. Methods Randomized controlled trials (RCTs) reporting the treatment of dupilumab for bronchial asthma published from database establishment to February 20 in 2023 were systematically searched in CNKI, Wanfang Database, VIP, Chinese Biomedical Literature Database (CBM), Cochrane Library, PubMed, Embase and Web of Science. Meta-analysis was performed by RevMan5.4 software. Results A total of 11 RCTs involving 3759 bronchial asthma patients were enrolled. Meta-analysis results showed that the number of patients with acute exacerbation of asthma (RR=0.48, 95%CI: 0.40, 0.57, P<0.01) and the Asthma Control Questionnaire (ACQ) score (MD=-0.32, 95%CI: -0.43, -0.21, P<0.01) were significantly lower in the experimental group than those of control group. The forced expiratory volume in 1s (FEV₁, MD=0.51, 95% CI: 0.31,0.71, P<0.01) and the Asthma Quality of Life Questionnaire (AQLQ) score (MD=0.32, 95%CI: 0.20, 0.44, P<0.01) were significantly higher than those of the control group. There were no significant differences in the number of bronchial asthma patients with blood eosinophil count <300/μl (RR=1.10, 95%CI: 0.93, 1.31, P=0.26), incidence of adverse events (RR=1.03, 95%CI: 0.98,1.08, P=0.22) and incidence of serious adverse events (RR=1.21, 95%CI: 0.86, 1.71, P=0.28) between groups (P>0.05). Conclusion Dupilumab can decrease the number of asthma exacerbations, improve pulmonary function and quality of life with a high safety.

Prevalence of restless legs syndrome in patients with amyotrophic lateral sclerosis and its correlation with disease severity: A meta-analysis

Sun Yanan, Hao Yifeng, Li Xiaohong

2023, 38(10):  878-882.  doi:10.3969/j.issn.1004-583X.2023.10.002

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Objective To evaluate the prevalence of restless legs syndrome (RLS) in patients with amyotrophic lateral sclerosis (ALS) and its correlation with disease severity. Methods Relevant articles reporting RLS in ALS patients published before December 12th 2020 were systematically searched in the Cochrane library, PubMed, Embase, Web of science, Chinese Biomedical Literature Database (CBM), CNKI, and Wanfang Data. According to the inclusion and exclusion criteria, eligible studies were selected independently by two researchers. Quality of case-control studies and cohort studies was assessed according to the Newcastle-Ottawa Scale (NOS). Data pooling and publication bias were analyzed using Revman5.3. Results A total of 6 eligible studies were included into the analysis, including 2 cohort studies and 4 case-control studies. The NOS scores of all studies were ≥6. Meta-analysis showed that the prevalence of RLS increased significantly in ALS patients(OR=8.24,95%CI =4.57-14.87). Subgroup analysis showed that the proportion of excessive daytime sleepiness (EDS) in the RLS-positive group was significantly higher than that of the RLS-negative group (OR=3.42, 95%CI =1.61-7.27, P=0.001).The ALS Functional Rating Scale-Revised (ALFRS-R) score of ALS patients in RLS-positive group was significantly lower than that of the RLS-negative group, indicating that the functional impairment was more significant in ALS patients with RLS (MD=-3.76, 95%CI =-7.16, -0.36, P=0.03). The meta-analysis showed a slight publication bias. Conclusion The prevalence of RLS in ALS patients is significantly elevated, which affects their sleep quality. The functional defect of ALS patients with RLS is more significant, which should be well concerned.

Correlation between nonspecific ST-T abnormalities in electrocardiogram and recurrence of acute ischemic stroke

Xu Wendeng, Shen Yi, Zhang Xiaofeng

2023, 38(10):  883-886.  doi:10.3969/j.issn.1004-583X.2023.10.003

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Objective Non-specific ST-T abnormalities (NSSTTAs) in electrocardiogram are common in asymptomatic people, which are risk factors for ischemic stroke. This study aims to investigate the correlation between NSSTTAs in electrocardiogram and recurrence of acute ischemic stroke. Methods Patients with acute ischemic stroke admitted to Department of Emergency, Beijing Tsinghua Changgung Hospital from December 2016 to August 2017 and hospitalized from August 2019 to April 2020 were included in this study, and the telephone / outpatient follow-up was performed. Recurrence of ischemic stroke within one year was the endpoint. According to the recurrence, patients were divided into recurrent group and non-recurrent group. Univariate and multivariate analyses were performed on the two groups to determine the correlation between NSSTTAs and recurrence of acute ischemic stroke. Results A total of 197 patients were included in this study, with the mean age of (66.4±11.4) years. Among them, 27.4% (54/197) were female. They were divided into recurrent group and non-recurrent group according to the 1-year recurrence, involving 11.2%(22/197) relapsed patients and 39.5% (78/197) with NSSTTAs. The proportion of patients with a history of smoking in the recurrent group was significantly higher than that of the non-recurrent group (72.7% vs 50.3%, P=0.047) and that with NSSTTAs in the recurrent group was significantly higher than the non-recurrent group (63.6% vs 36.6%, P=0.014). NSSTTAs (OR=2.847, 95%CI: 1.110-7.305, P=0.030) were the independent risk factor for recurrent ischemic stroke patients after adjustmnet for smoking, hyperhomocysteinemia and hyperlipemia. Conclusion NSSTTAs are common in patients with acute ischemic stroke. Patients with acute ischemic stroke and NSSTTAs may have a higher risk of recurrence.

Influencing factors for mild cognitive impairment in type H hypertension patients combined with type 2 diabetes mellitus

Xu Yang, Xue Ling

2023, 38(10):  887-892.  doi:10.3969/j.issn.1004-583X.2023.10.004

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Objective To study the influencing factors for cognitive dysfunction in type H hypertension patients combined with type 2 diabetes mellitus (T2DM). Methods A total of 163 type H hypertension patients combined with T2DM who were treated in the Anshan Central Hospital from September 2021 to September 2022 were recruited. All patients were surveyed with the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE). According to the scoring results, patients with MoCA < 26 points were included in the mild cognitive impairment group (MCI group), and those with MoCA ≥ 26 points were included in the normal cognitive function group (NMCI group). General data of the two groups of patients were collected, including age, gender, smoking history, drinking history, years of education, body mass index (BMI), duration of hypertension and diabetes, history of other diseases like coronary heart disease and dyslipidemia, systolic blood pressure (SBP) and diastolic blood pressure (DBP). In a fasting state, white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), platelet count (PLT), serum homocysteine (Hcy), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA-1), apolipoprotein B (ApoB), lipoprotein a (LPa), glycated hemoglobin (HbA₁c), fasting plasma glucose (FPG), serum creatinine (Scr), serum uric acid (SUA), and urinary microalbumin (ALB) were measured. Carotid artery color ultrasound were performed to measure the carotid intima-media thickness (CIMT) and plaque formation. The influencing factors for MCI in type H hypertension patients combined with T2DM were analyzed by binary logistic regression, and their prediction values were assessed by the receiver operating characteristic (ROC) curves. Results The age, smoking, hypertension and diabetes course, SBP, FPG, HbA₁c, HDL-C, LDL-C, APOA-1, SUA, Hcy, CIMT and plaque detection rate in MCI group were significantly higher than those of NMCI group (P<0.05), and the education level was significantly lower (P<0.05). The results of binary logistic regression analysis showed that age, HDL-C, Hcy, and CIMT were independent risk factors for MCI in type H hypertension patients combined with T2DM. ROC curves showed that the area under the curve (AUC) of age, HDL-C, Hcy, and CIMT in predicting MCI in type H hypertension patients combined with T2DM was 0.975, 0.637, 0.647, and 0.842, respectively. Conclusion Elderly, low HDL-C, high Hcy and CIMT thickening are independent risk factors for MCI in type H hypertension patients combined with T2DM. Monitoring blood lipid and Hcy is beneficial to prevent MCI in this population.

Risk factors for epilepsy after delayed post-stroke epilepsy and its clinical correlation with blood Hcy, hs-CRP and D-D

Ding Siqi, Liu Shihua, Zhang Chao, Zhong Ping, Cao Li

2023, 38(10):  893-897.  doi:10.3969/j.issn.1004-583X.2023.10.005

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Objective To analyze the risk factors for delayed post-stroke epilepsy (dPSE) and its clinical correlation with blood homocysteine (Hcy), hypersensitive C-reactive protein (hs-CRP) and D-dimer (D-D) levels. Methods It was a retrospective analysis involving 34 dPSE patients (epilepsy group) diagnosed and treated in Suzhou Municipal Hospital from February 2021 to May 2023. During the same period, 41 patients with acute ischemic stroke were selected as the control group. The clinical data were compared between groups. Multivariate Logistic regression was performed to analyze risk factors for dPSE. The predictive value of blood Hcy, hs-CRP and D-D in dPSE was analyzed by plotting the receiver operating characteristic (ROC) curves and calculating the area under curve (AUC). Results There were significant differences in alcohol history, the National Institutes of Health Stroke Scale (NIHSS) score, range of stroke, location of the infarcted lesions, serum Hcy and plasma hs-CRP between groups (P<0.05). There were no significant differences in the sex, age, history of smoking, hypertension, diabetes mellitus and coronary atherosclerotic heart disease, family history of cerebrovascular diseases and D-D level between groups (P>0.05). Logistic regression analysis showed that alcohol history, NIHSS score on admission, infarcted lesion in the cortex and high expression levels of Hcy and hs-CRP were the risk factors for dPSE (OR=4.296, 1.277, 5.373, 1.094, 1.040, P<0.05). ROC curves showed that the optimal cut-off values of serum Hcy and plasma hs-CRP in predicting dPSE was 13.900 μmol/L(AUC=0.683) and 8.505 mg/L (AUC=0.693), respectively. Conclusion Alcohol history, NIHSS score on admission, infarcted lesion in the cortex and high expression levels of Hcy and hs-CRP are the risk factors for dPSE. There is no clear correlation between plasma D-D and dPSE. Serum Hcy and plasma hs-CRP have important predictive values for secondary epilepsy in patients with acute ischemic stroke, which can be used as predictors of dPSE.

Diagnosis and differential diagnosis of pancreatic tuberculosis

Liu Ye, Ruan Guiren, Liu Xiaoqing, Shi Xiaochun, Fei Guijun

2023, 38(10):  898-903.  doi:10.3969/j.issn.1004-583X.2023.10.006

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Objective Pancreatic tuberculosis (PTB) is a rare type of tuberculosis, which is easily misdiagnosed as pancreatic neoplasms. The aim of this study is to discuss the key points of diagnosis and differential diagnosis of PTB. Methods Medical records of 23 patients with PTB diagnosed by biopsy from puncture or surgery from January 2012 to December 2021 in Peking Union Medical College Hospital were retrospectively reviewed. The pancreatic malignant tumor (PMT) patients matched by the admission date were selected as controls. Clinical and laboratory features were analyzed and compared between PTB and PMT patients. Results Among 23 patients with PTB, 15 (65.2%) were males. There mean age was (49±13) years. The predominant symptoms of PTB were abdominal pain (12/23, 52.2%), followed by weight loss (8/23, 34.8%) and fever (5/23, 21.7%). The level of C-reactive protein (CRP) in PTB group was significantly higher than that of PMT group (Z=-2.151, P=0.03). There were no significant differences in clinical features and other laboratory test findings between the two groups. The positive rate of Tuberculin skin test (TST) and enzyme-linked immunospot assay test (T-SPOT.TB) in PTB patients was 26.1% and 86.7%, respectively. The head of the pancreas was the most common involved site (12/23, 52.2%), and peripancreatic lymph node enlargement was revealed in 15 cases (65.2%). Peripancreatic lymph node enlargement was more common in PTB group (65.2% vs 30.0%, P=0.021), while dilatation of the pancreatic duct was more common in PMT group (50% vs 0, P<0.01). Among the 23 PTB patients, only 5 patients (21.7%) were bacteriologically diagnosed. Malignant tumor was considered as the first diagnosis in 15 PTB patients, and the misdiagnosis rate was as high as 65.2%. In 23 PTB patients, 14 (60.9%) and 9 cases (39.1%) received endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and surgery, respectively. Among the 14 PTB patients diagnosed by EUS-FNA, 6 patients were misdiagnosed as PMT at first and avoided unnecessary surgical resection. Conclusion It is difficult to distinguish PTB from pancreatic tumors based on clinical manifestations and laboratory tests. Tissue biopsy and bacteriological tests are key points for the diagnosis and differential diagnosis. PTB should be well concerned, and a timely examination of EUS-FNA is able to prevent unnecessary surgery.

Clinical analysis of subacute cough in patients with allergic rhinitis

Li Yuanpeng, Chen Liang, Liu Junan, Li Tianlin

2023, 38(10):  904-906.  doi:10.3969/j.issn.1004-583X.2023.10.007

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Objective To analyze the characteristics and severity of cough, as well as the increase in fractional exhaled nitric oxide (FeNO) and the treatment of subacute cough in patients with allergic rhinitis. Methods A total of 526 patients with subacute cough were divided into experimental group and control group according to the presence of allergic rhinitis or not. The severity of cough, FeNO, nocturnal cough and throat itching between the experimental group and control group were statistically analyzed. According to the FeNO test results and with the combination of allergic rhinitis, patients were further divided into subgroup A, B, C and D. They were treated with antitussive, antiallergic, inhaled corticosteroids alone or in the combination, followed by the analysis of the 1-week remission rate of cough. Results A total of 526 patients were included in the study, including 216 males with the mean age of (39.68±11.95) years and 310 females with the mean age of (38.18±12.17) years. There were 94 cases (17.9%) in the experimental group, including 46 males and 48 females, and 432 cases (82.1%) in the control group, including 171 males and 261 females. The median and quartile interval of cough severity score in the experimental group was significantly greater than those of control group (4 [2, 5] vs 3 [2, 5], Z=3.648, P=0.000). The ratio of increased FeNO (≥25 ppb) in the experimental group was significantly higher than that of control group (35.5% vs 23.6%, χ²=5.647, P=0.017). The positive rate of nocturnal cough and throat itching in the experimental group was significantly higher than that of control group (48.4% vs 36.1%, χ²=4.887, P=0.027). After one week of treatment, the cough relief rate of subgroup C was significantly lower than that of other groups, which was relatively high in subgroup A, B and D. Conclusion Allergic rhinitis patients combined with subacute cough have severer cough, eosinophilic airway inflammation or mixed airway inflammation, which is better responsive to the combination of antiallergic or inhaled corticosteroids.

Effects of intermittent feeding versus continuous feeding on tolerance, nutritional indexes, and prognosis in critically ill patients undergoing mechanical ventilation

Wei Peixuan, Lan Xiaojing, Wu Tingting, Shi Junfeng, Xue Yanying, Wang Jingmei

2023, 38(10):  907-911.  doi:10.3969/j.issn.1004-583X.2023.10.008

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Objective To compare the effects of intermittent feeding versus continuous feeding on the tolerance, nutritional indexes and prognosis of critically ill patients undergoing mechanical ventilation. Methods A total of 100 critically ill patients receiving mechanical ventilation in the Handan Central Hospital from June 2021 to June 2022 were recruited. They were randomly divided into continuous feeding group (50 cases) and intermittent feeding group (50 cases). The compliance rate of nutrition calories, feeding tolerance, mechanical ventilation time and nutritional indexes were compared between the two groups. Nutritional indexes included prealbumin (PA), albumin (ALB), total protein (TP), and hemoglobin (Hb). Results There was no significant difference in the compliance rate of nutrition calories from the 1st to 6th day of feeding (P>0.05). On the 7th day of feeding, the compliance rate of nutrition calories was significantly higher in patients of intermittent feeding group than that of continuous feeding group (P<0.05). There were no significant differences in feeding tolerance and mechanical ventilation time between the two groups (P>0.05). There were no significant difference in ALB, PA and Hb levels on the 1st and 7th day of feeding between the two groups (P>0.05). After enteral nutrition support, ALB and Hb on the 7th day of feeding were significantly enhanced in both groups (P<0.05). Conclusion Early intermittent feeding provides a comparable effect with continuous feeding on critically ill patients with mechanical ventilation. Improving feeding tolerance is the key to improve the feeding effect.

Aortic dissection with weakness and numbness of both lower limbs as the first manifestation: A case report and literature review

Zhang Yongzhi, Li Yanmin, Ma Xiaowen, Gu Ping

2023, 38(10):  912-916.  doi:10.3969/j.issn.1004-583X.2023.10.009

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Objective To investigate the occurrence and prognosis of aortic dissection (AD) with neurological symptoms as the first symptom. Methods Clinical data of a case of AD with weakness and numbness of both lower limbs as the initial manifestation were retrospectively analyzed. Relevant literatures were reviewed as well. Results A 32-year-old male patient presented with numbness and weakness of both lower limbs for 1 hour. He had previous history of hypertension. One hour before admission, he suddenly appeared numbness and weakness of both lower limbs when riding a bicycle, and the symptoms progressed rapidly. Within 10 minutes, the strength of both lower limbs completely disappeared. Neurological examination showed grade 0 of limb muscle strength on both lower limbs, and decreased muscle tension. Bilateral knee and ankle reflexes were not elicited. Depth and superficial sensation below the plane of the 12th thoracic vertebra (T12) were lost. Babinski sign of both lower limbs was negative. Combined with coagulation routine test, cardiac ultrasound and aortic CT angiography, the patient was diagnosed as AD (Starnfor type A). However, the patient and his family refused surgical treatment, and later died after the failure of conservative treatment. Conclusion AD neurological symptoms as the first symptom is rare. This paper reporteda case of AD with isolated spinal cord injury and absence of painful symptoms as the first presentation. Through literature review, our case report provided references for clinical improvement of diagnosis and treatment and reduction of mortality rate.

Treatment of variant angina pectoris guided by the optical coherence tomography: A case report and literature review

Wang Jiaqi, Xie Yuetao, Gao Man, Song Xuelian, Zhang Feifei, Dang Yi, Qi Xiaoyong

2023, 38(10):  917-921.  doi:10.3969/j.issn.1004-583X.2023.10.010

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Objective To explore the clinical characteristics of variant angina pectoris, thus improving its diagnosis and treatment. Methods The clinical data of a patient with variant angina pectoris who was treated under the guidance of optical coherence tomography (OCT) were retrospectively analyzed. The clinical features of variant angina pectoris were analyzed by searching relevant articles in the CNKI, PubMed and Wanfang database with key words of “variant angina pectoris” and “OCT”. Results The male older patient presented with intermittent chest for more than 2 years and aggravated for more than 10 days was admitted. Electrocardiography on attack showed ST elevations in leads of II, III and arteriovenous fistula (AVF), and downwards of the remaining leads. The ST segment fell back after symptoms were relieved. The results of coronary angiography under the guidance of OCT showed a stenosis of 20%-30% in the proximal and middle segments of the right coronary artery, a stenosis of 70% in the second turn of the middle segment, and a stent shadow in the distal segment. Ergonovine stimulation test in the right coronary artery showed diffuse spasm, which was relieved after the treatment of nitroglycerin and sodium nitroprusside. Considering the repeated attacks of chest tightness, poor response to medication andintraoperative coronary spasm, the patient was managed by stent implantationin the right coronary artery.After stent implantation, symptoms of chest tightness disappeared with a good efficacy. Conclusion Disease characteristics and treatment of variant angina differ from those of coronary atherosclerosis, presenting a high rate of misdiagnosis. It is necessary to improve the vigilance and understanding of the disease. Timelyintracavitary imaging examination and provocation test contribute to a precise diagnosis and favor the selection of the optimal treatment and improvement of the prognosis.

Type I Kounis syndrome caused by drug allergy: A case report

Yang Changlin, Cao Shufeng, Qiao Lian, Zhao Huimin

2023, 38(10):  922-925.  doi:10.3969/j.issn.1004-583X.2023.10.011

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Objective To explore the clinical features, diagnosis and treatment points, and causes of misdiagnosis and missed diagnosis of Kounis syndrome. Methods Medical records of one case of type I Kounis syndrome were retrospectively analyzed. Results The elderly patient was hospitalized due to community-acquired pneumonia, and presented delayed anaphylaxis during the anti-infection treatment of Piperacillin Sodium and Tazobactam Sodium. The anti-allergy treatment alleviated the delayed anaphylaxis, but the patient developed symptoms of chest tightness and suffocation. Electrocardiography (ECG) showed a typical pattern of ST elevation in lead Ⅱ, Ⅲ and AVF, with dynamic changes. Myocardial enzyme levels were within the normal ranges. Coronary angiography showed the right coronary artery spasm, which was disappeared after a local injection of nitroglycerin. Conclusion Kounis syndrome is a syndrome of coronary artery spasm secondary to anaphylaxis, which may even cause acute myocardial infarction. It is a rare disorder that causes missed diagnosis and misdiagnosis. Early identification and proper treatment are the key points to improve the clinical prognosis.

Guidelines for Diagnosis and Treatment of Chronic Gastritis in China (2022, Shanghai): An interpretation

Wu Haotian, Fan Yuwen, Zhang Xiaolan

2023, 38(10):  926-930.  doi:10.3969/j.issn.1004-583X.2023.10.012

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In 2022, the Chinese Society of Gastroenterology has referred the research and guidelines associated with chronic gastritis at home and abroad in recent years, formulated a total of 53 recommendations on the epidemiology, clinical manifestations, endoscopic and laboratory diagnosis, treatment principles, outcomes and prognosis, and unsolved problems at home and abroad, and published the Guidelines for Diagnosis and Treatment of Chronic Gastritis in China (2022, Shanghai). This article interprets the updates and highlights of this guideline.