Clinical Focus

Meta-analysis of the antihypertensive effects of rosuvastatin

Ke Mengting, Chen Wei

2023, 38(11): 965-971. doi:10.3969/j.issn.1004-583X.2023.11.001

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Objective To evaluate the antihypertensive efficacy and safety of rosuvastatin combined with antihypertensive drugs on hypertension patients combined with dyslipidemia. Methods Randomized controlled trials (RCT) reporting the treatment of rosuvastatin combined with antihypertensive drugs versus the monotherapy of antihypertensive drugs in hypertension patients combined with dyslipidemia published before November 2015 were systematically searched in the online databases of PubMed, The Cochrane Library and the Web of Science Core Collection (including the SCIE, SSCI, A&HCI, and CPCI databases). Two investigators were independently responsible for screening eligible literatures based on the inclusion and exclusion criteria, extracting data, cross-checking and evaluating the quality. Meta-analysis was performed using STATA12.0 software. Results A total of 11 RCTs involving 1275 hypertension patients combined with dyslipidemia were included. Among them, 696 patients were included in the experimental group (rosuvastatin combined with antihypertensive drugs) and 579 were in the control group (monotherapy of antihypertensive drugs). Meta-analysis showed that the blood pressure decrease in the experimental group was significantly greater than that of the control group (systolic blood pressure: $W M D$ =-1.97, 95% $C I$ : -3.55, -0.38, $P$ =0.02; diastolic blood pressure: $W M D$ =-1.24, 95% $C I$ : -2.20, -0.29, $P$ =0.01). Subgroup analysis showed the tripe therapy of rosuvastatin combined with two types of antihypertensive drugs (amlodipine + sartan) presented the most significant antihypertensive effect (systolic blood pressure: $W M D$ =-4.06, 95% $C I$ : -6.84, -1.29, $P$ =0.004; diastolic blood pressure: $W M D$ =-1.46, 95% $C I$ : -2.90, -0.02, $P$ =0.047). No significant difference in the incidence of adverse events was found between the experimental group and control group ( $O R$ =1.17, 95% $C I$ : 0.73-1.86, $P$ =0.52). Conclusion Rosuvastatin combined with antihypertensive drugs lowers blood pressure more effectively compared with the monotherapy of antihypertensive drugs, and the triple therapy of rosuvastatin, amlodipine and sartan has a more significant antihypertensive effect without increasing adverse drug effects.

Correlation between the expression level of SPARC and prognosis in patients with non-small cell lung cancer: A meta-analysis

Zhang Na, Sun Yue, Dong Han, Zhao Peng, Yang Xin, Qi Yuan, Wang Lingling

2023, 38(11): 972-978. doi:10.3969/j.issn.1004-583X.2023.11.002

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Objective Secreted protein acidic and rich in cysteine (SPARC), also known as osteonectin and basal membrane-40 (BM-40), is a small molecule glycoprotein related to cell secretion. It promotes the invasion and metastasis of a variety of malignant tumors, which is correlated with the poor prognosis of tumor patients. At present, the prognostic role of SPARC in non-small cell lung cancer (NSCLC) is still controversial. This meta-analysis aims to assess the expression level of SPARC in NSCLC patients and its correlation with the prognosis. Methods Articles reporting the expression level of SPARC in NSCLC patients with and its correlation with the prognosis were systematically searched in the PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang databases. Data analysis was performed using Review Manager 5.4 software. Hazard ratio ( $H R$ ) and 95% Confidence interval ( $C I$ ) were calculated to assess the expression level of SPARC and its correlation with the overall survival (OS) of NSCLC patients. Results A total of 5 studies involving 430 NSCLC patients were recruited. Heterogeneity was tested ( $I 2$ =31%, $P$ =0.21), and the $H R$ of the pooled data using a fixed effects model was 1.77(95% $C I$ : 1.41-2.21), indicating that the high level of SPARC was correlated with a poor OS in NSCLC patients. A subgroup analysis based on the methylation of SPARC was conducted. There was no heterogeneity ( $I 2$ =0%, $P$ =0.89) in the articles without reporting the methylation of SPARC, with the combined $H R$ of 1.97(95% $C I$ : 1.40-2.79). A significant heterogeneity was detected in the articles reporting the methylation of SPARC ( $I 2$ =80%, $P$ =0.03), with the combined $H R$ of 1.63(95% $C I$ : 1.21-2.19), indicating that the prognostic significance of SPARC was changed by the presence or absence of methylation. Conclusion High level of SPARC predicts a poor prognosis in NSCLC patients, which can be used as a potential biomarker to assess the prognosis of NSCLC.

Predictive value of the platelet function PFA-200 P2Y on the secondary prevention of acute ischemic stroke with clopidogrel

Luo Weigang, Xu Yuzhu, Zhang Lingyan, Wu Xiangyun, Bu Wei, Ren Huiling

2023, 38(11): 979-983. doi:10.3969/j.issn.1004-583X.2023.11.003

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Objective To explore the predictive value of the platelet function analyzer (PFA)-200 P2Y testing in evaluating the clinical outcome of patients with acute ischemic stroke. Methods From January 2021 to December 2021, clinical data of patients with acute ischemic stroke and long-term use of clopidogrel for secondary prevention were collected. The patients were followed up for a median of 1 year. They were divided into ischemic vascular event group and non-ischemic vascular event group according to their prognosis. The closure time (CT) was measured using the PFA-200 P2Y analyzer to detect platelet function. The recurrence of ischemic vascular events during the follow-up period was observed. Logistic regression was used to analyze the risk factors for the recurrence of ischemic vascular events, and the receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of the PFA-200 P2Y testing for the recurrence of ischemic vascular events. Results A total of 142 patients with acute ischemic stroke were included, of whom 24 (16.9%) had recurrent ischemic vascular events during the follow-up period. The level of P2Y in the ischemic vascular event group was significantly lower than that of the non-ischemic vascular event group, and the modified Rankin Scale (mRS) score was significantly higher ( $P$ <0.05). Logistic regression analysis showed that the PFA-200 P2Y testing was the independent risk factor for ischemic vascular events in the prognosis of acute ischemic stroke ( $P$ <0.05). ROC results showed that the PFA-200 P2Y testing had a good predictive value for ischemic vascular events in patients receiving clopidogrel for secondary prevention of ischemic stroke, with an area under the curve (AUC) of 0.766 (95% $C I$ : 0.644, 0.887). Conclusion Low P2Y level is an independent risk factor for recurrence of ischemic vascular events in patients with acute ischemic stroke and the use of clopidogrel for secondary prevention, and PFA-200 P2Y results have a certain predictive value for ischemic vascular events within 1 year.

Effect of total magnetic resonance imaging burden on the cognitive function in patients with cerebral small vessel diseases

Zhu Fangfang, Wei Xuezhi, Feng Min

2023, 38(11): 984-990. doi:10.3969/j.issn.1004-583X.2023.11.004

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Objective To explore the correlation between total cerebral magnetic resonance imaging (MRI) burden and cognitive function in patients with cerebral small vessel diseases (CSVDs). Methods A total of 227 CSVD patients diagnosed by the brain MRI and hospitalized in the Department of Neurology from September 2021 to October 2022 were recruited. Their clinical data, brain imaging data, and hematological indicators were collected. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) scale. The correlation between MRI markers and cognitive dysfunction was explored. Results The multivariate analysis showed that age, hypertension, homocysteine (HCY), uric acid (UA), lacunar stroke score (Lac) and total burden of CSVDs were all significantly correlated with the MoCA score ( $P$ <0.05). When other variables remained unchanged, the MoCA score decreased by 2.27 points for each point increase in the total burden of CSVD. The MoCA score decreased by 0.74 points for each point increase in the Lac score. The MoCA score decreased by 0.94 points for patients with a history of hypertension compared with those lacking the history of hypertension. The MoCA score decreased by 0.01 points and 0.07 points for each unit increase in UA and HCY levels, respectively. The MoCA score decreased by 0.07 points for one year older. Overall, all predictors explained the 55.1% decrease in MoCA scores. Conclusion The cognitive function of CSVD patients is affected by many factors, and the brain MRI visualizes the intracranial pathological state. It is suggested that the total burden of brain MRI has an early warning significance for cognitive decline.

The predictive and prognostic potential of serum parathyroid hormone combined with the nutritional status score on peritoneal dialysis catheter-related peritonitis

Gong Zhiqing, Lu Dongmei, Xing Guangqun

2023, 38(11): 991-995. doi:10.3969/j.issn.1004-583X.2023.11.005

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Objective To investigate the effects of malnutrition and serum intact parathyroid hormone (iPTH) level on the incidence and prognosis of peritoneal dialysis catheter-related peritonitis. Methods A retrospective analysis was performed on hospitalized patients with uremia who underwent peritoneal dialysis catheterization in the Affiliated Hospital of Qingdao University from January 1, 2018 to April 30, 2022 and they were followed up until July 30, 2022. Kaplan-Meier survival curve and Cox regression were used to analyze the effects of iPTH and the Controlling Nutritional Status (CONUT) score on the occurrence and prognosis of peritoneal dialysis catheter-related peritonitis. Results A total of 193 patients with peritoneal dialysis were included in this study, with the mean age of (51.50±16.85) years old and 117 (60.6%) males. According to blood iPTH level and CONUT score, patients were divided into four groups. Forty-two cases (21.76%) presented low parathyroid hormone (iPTH<150 pg/ml, Hypo-PTH) combined with moderate-to-severe malnutrition (CONUT>4). There were significant differences in the distribution of chronic glomerulonephritis, lupus nephritis, diabetic nephropathy and the incidence of heart failure between groups ( $P$ <0.05). The largest number of patients treated with hormone or immunosuppressants was found in those with low parathyroid hormone and moderate-to-severe malnutrition. There were significant differences in age, hemoglobin, blood uric acid, C-reactive protein (CRP), B-type natriuretic peptide (BNP), blood sodium, blood calcium, blood phosphorus, albumin and globulin between groups ( $P$ <0.05). The highest incidence of peritonitis within 30 days after operation was 26.19% in patients with Hypo-PTH group and moderate-to-severe malnutrition. Cox regression analysis showed that this group had the highest risk of peritonitis, with a hazard ratio ( $H R$ ) of 5.206 (95% $C I$ 1.594, 17.002; $P$ =0.006). After adjusting for age, sex, BMI, hemoglobin, CRP, blood uric acid, BNP and other indicators, HR was still 5.187 (95% $C I$ 1.465, 18.360; $P$ =0.011). The incidence of poor prognosis was also significantly higher than that of the other three groups, with a $H R$ of 2.998 (95% $C I$ 1.328, 6.766; $P$ =0.008) and adjusted $H R$ of 2.665 (95% $C I$ 1.089, 6.522; $P$ =0.032). Conclusion The coexistence of hypoparathyroidism and moderate-to-severe malnutrition in patients with peritoneal dialysis is the risk factor for peritonitis after peritoneal dialysis catheterization, which can directly lead to the poor prognosis.

Study on the correlation of NLR, PLR and MLR with type 2 diabetes mellitus complicated with coronary heart disease

Shi Peihua, Lin Yanlin, Bi Lifang

2023, 38(11): 996-1001. doi:10.3969/j.issn.1004-583X.2023.11.006

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Objective To investigate the correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) with the severity of coronary artery disease in patients with type 2 diabetes mellitus (T2DM) complicated with coronary heart disease (CHD). Methods A total of 517 T2DM patients who underwent coronary angiography (CAG) in Weihai Central Hospital from January 2019 to December 2021 were divided into T2DM group ( $n$ =161) and T2DM + CHD group ( $n$ =356) according to the CAG findings of CHD or not. The general data and laboratory examination indexes of the two groups were compared. According to the results of CAG, Gensini scores were calculated. Patients in T2DM+CHD group were further divided into low-risk subgroup (Gensini score<16, $n$ =151), medium-risk subgroup (16≤Gensini score <40, $n$ =97) and high-risk subgroup (Gensini score≥40, $n$ =108). The general data and laboratory examination indexes of patients in each subgroup were compared. Spearman correlation analysis was used to evaluate the correlation of NLR, PLR and MLR with the Gensini scores. Logistic regression analysis was used to explore the risk factors for the severity of coronary artery disease in T2DM patients complicated with CHD. Results There were significant differences in sex constituent ratio, age, low density lipoprotein (LDL), LDL/high density lipoprotein (HDL), glycosylated hemoglobin (HbA₁c), urea nitrogen, creatinine, cystatin, NLR, PLR and MLR between T2DM group and T2DM+CHD group. The levels of age, cystatin, NLR, PLR and MLR in the high-risk subgroup were significantly higher in those of the low-risk and medium-risk subgroups ( $P$ <0.05). Spearman correlation analysis showed that NLR, PLR and MLR were positively correlated with the Gensini scores ( $r s$ =0.393, $P$ <0.01; $r s$ =0.322, $P$ <0.01; $r s$ =0.360, $P$ <0.01). Ordered multivariate logistic regression analysis showed that age, sex, diastolic blood pressure, body mass index, creatinine, NLR and PLR were independent factors for the severity of coronary artery disease in T2DM patients complicated with CHD ( $P$ <0.05). Conclusion NLR, PLR and MLR are positively correlated with the Gensini score of T2DM patients complicated with CHD. NLR and PLR can be used as independent predictors of the severity of coronary artery disease in them. Monitoring NLR and PLR is helpful to early identify the severity of coronary artery disease in T2DM patients complicated with CHD and prevent the occurrence of acute coronary syndrome.

Research on the effects of diaphragm relaxation technique combined with resistance breathing training on motor ability of stroke survivors

Yu Yifu, Yuan Chunhua

2023, 38(11): 1002-1007. doi:10.3969/j.issn.1004-583X.2023.11.007

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Objective To explore the effects of diaphragm relaxation technique combined with resistance breathing training on motor ability of stroke survivors. Methods A total of 60 patients with cerebral apoplexy in the Rehabilitation Department of Zhengzhou Central Hospital were randomly divided into group A, group B and group C. Patients in Group A received routine rehabilitation training, diaphragm relaxation and resistance breathing training; those in group B received routine rehabilitation training and diaphragm relaxation; and those in group C received routine rehabilitation training and resistance breathing training. Maximal inspiratory pressure, peak inspiratory velocity, Fugl-Meyer motor function assessment (FMA), 10-meter walking test (10MWT), Berg balance function (BBS), and limits of stability (LOS) of all subjects were evaluated before intervention and 4, 8, and 12 weeks after rehabilitation training. Statistical data were analyzed. Results Before experiment intervention, there were no significant differences in MIP, PIF, FMA, 10MWT, BBS and LOS among group A, B and C ( $P$ >0.05). After experiment intervention, MIP, PIF, FMA, BBS and LOS in groups A, B and C significantly increased ( $P$ <0.05), but 10MWT significantly decreased at 4, 8 and 12 weeks compared with those before the experimental intervention ( $P$ <0.05). After experiment intervention, there were significant differences in the MIP, PIF, FMA, 10MWT, BBS and LOS at 4, 8 and 12 weeks among group A, B and C ( $P$ <0.05). MIP, PIF, FMA, BBS and LOS of group A were significantly higher than those of group B and C, while 10MWT was significantly lower ( $P$ <0.05). MIP, PIF, FMA, BBS and LOS of group C were significantly higher than those of group B, but 10MWT of group C was significantly lower than that of group B ( $P$ <0.05). Conclusion Diaphragm relaxation technique combined with resistance breathing training has better healing effects than the single training. Diaphragm relaxation technique can be extended as a choice of home rehabilitation exercise for stroke patients.

Analysis of early risk factors for infectious mononucleosis in children from Chengdu city

Nie Fang, Luo Jun

2023, 38(11): 1008-1011. doi:10.3969/j.issn.1004-583X.2023.11.008

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Objective To analyze the different clinical manifestations and early laboratory risk for infectious mononucleosis (IM) in children caused by Epstein-Barr (EB) virus infection, EB virus infection combined with Mycoplasma pneumoniae (MP), EB virus infection combined with human cytomegalovirus (CMV) infection and EB virus infection combined with MP and CMV infection. Methods From October 2015 to April 2023, totally 163 children with IM patients and positive for EB virus who were admitted or first diagnosed in Chengdu Second People's Hospital were recruited. Among them, IM patients with EB virus infection were included in the experimental group, and those with EB virus infection combined with MP infection were included in the control group 1; those with EB virus infection combined with CMV infection were included in the control group 2; and those with EB virus infection combined with MP and CMV infection were included in the control group 3. Gender, age and clinical symptoms of children were collected, and the early laboratory indicators of infection were detected for statistical analyses. Results There were no significant differences in gender, age and incidence of clinical symptoms like fever, tonsil enlargement and lymph node enlargement among the four groups ( $P$ >0.05). Alanine aminotransferase (ALT), aspartate aminotransferase (AST) and glutamyl transpeptidase (GGT) of the experimental group were significantly higher than those of the control group 1 ( $P$ <0.05). GGT of the experimental group was significantly higher than that of the control group 2( $P$ <0.05). ALT and GGT of the experimental group were significantly higher than those of the control group 3 ( $P$ <0.05). Conclusion The clinical symptoms of EB virus infection in children with IM are similar to those with the co-infection, but presenting severer liver function impairment. An early routine detection of risk factors for liver function favors early clinical diagnosis and treatment and thus improves the prognosis.

Aortic root anatomy and atrial septal mobility analyzed by transesophageal echocardiography

Li Lisha, Shen Xianghui, Liu Yanhui, Ren Yanbin

2023, 38(11): 1012-1015. doi:10.3969/j.issn.1004-583X.2023.11.009

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Objective To investigate the correlation between aortic sinus diameter and atrial septal mobility (ASM). Methods A total of 103 patients who underwent transesophageal echocardiography (TEE) were retrospectively collected. ASM, anterior and posterior diameter of interatrial septum, aortic root diameter, and incidence of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) were reviewed and evaluated. Age, sex, weight, height, previous stroke, medical history of atrial fibrillation, TEE indication, left ventricular ejection fraction, left atrial diameter, and left ventricular diastolic function were obtained from the electronic medical records and TEE reports. Linear regression model was used to analyze the correlation between ASM and aortic root diameter. Results In 103 patients, the mean ASM was 4.3 mm. The prevalence of ASA and PFO was 9.7%(10/103) and 44.7%(46/103), respectively. After adjustment for age, sex, weight, height and left atrial size, ASM increased by 6.3 mm for every 10 mm increase in aortic root diameter (B=0.63; $P$ <0.01). There was no correlation between aortic root diameter and anteroposterior diameter of atrial septum ( $P$ =0.083). Conclusion The increased ASM may be related to aortic dilatation. Aortic root diameter should be considered in studies of the association between atrial septal characteristics and the risk of embolic stroke.

Clinical analysis of 4 cases of IgG4-related kidney disease

He Peihua, Zhou Xingfu, Hong Weihong, Wang Lichun, Liu Sujun, Jin Yuyan, Zeng Jiahao, Liu Lichang

2023, 38(11): 1016-1021. doi:10.3969/j.issn.1004-583X.2023.11.010

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Objective To explore the clinical manifestations, laboratory and imaging characteristics, pathological features of the kidney and treatment regimen for immunoglobulin G4 (IgG4)-related kidney disease (IgG4-RKD). Methods Four cases of IgG4-RKD diagnosed by renal biopsy in Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Zhuhai from March 2016 to March 2021 were retrospectively analyzed. Their clinical manifestations, laboratory and imaging characteristics, pathological features of the kidney and therapeutic outcome were compared. Results A total of 4 cases of IgG-RKD were included, involving three males and one female with the median age of 71 years. Two cases presented acute onset and two cases were chronic course. The injured organs of one case were kidney and pancreas and the other case was affected by the kidney and retroperitoneum. The main clinical manifestations were varied and unspecific. Four cases developed elevated serum creatinine with mild proteinuria. Three cases presented significantly increased serum IgG4. All patients were diagnosed with IgG4-related tubulointerstitial nephritis. Patients received glucocorticoid therapy with a significant therapeutic efficacy. Conclusion IgG4-RKD is rare and prone to missed diagnosis and misdiagnosis. Serum IgG4 screening can help to elevate the diagnosis rate. Renal biopsy is the gold standard for diagnosing IgG4-RKD. Glucocorticoid therapy is effective and obtains a favorable follow-up outcome.

Adult Bartter syndrome complicated with acute exacerbation of chronic renal insufficiency: A case report

Dong Hui, Huang Wenhui, Zhao Hui, Qian Rui

2023, 38(11): 1022-1026. doi:10.3969/j.issn.1004-583X.2023.11.011

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Objective To explore the pathogenesis, treatment, and prognosis of Bartter syndrome by analyzing a case of acute exacerbation of chronic renal insufficiency in an adult with Bartter syndrome. Methods Clinical data, treatment and outcomes of a hospitalized patient from the Department of Nephrology at Gansu Provincial Hospital were retrospectively analyzed and discussed. Results The patient presented with hypokalemia, metabolic alkalosis, hyperreninemia, and hyperaldosteronism, accompanied by acute exacerbation of chronic renal insufficiency. After excluding other causes of secondary aldosteronism, and renal biopsy and genetic testing were performed to confirm the diagnosis of Bartter syndrome type Ⅲ. After a clear diagnosis, the patient was managed by blood dialysis, spironolactone, and potassium supplementation, and the blood potassium returned to normal and renal function improved significantly. Conclusion The onset of Bartter syndrome is insidious, and long-term hypokalemia and hyperreninemia may cause tubulointerstitial nephritis and glomerular lesions. After diagnosis, a series of treatments like potassium supplementation and potassium preservation should be timely carried out.

Transient peripheral carotid inflammation syndrome diagnosed by ultrasonography: A case report and literature review

Li Zhiyong

2023, 38(11): 1027-1030. doi:10.3969/j.issn.1004-583X.2023.11.012

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Objective To investigate the clinical manifestations and imaging features of transient perivascular inflammation of the carotid artery (TIPIC) syndrome, and to estimate the clinical application value of ultrasonography in its diagnosis. Methods Clinical datas of 1 patient with TIPIC syndrome were retrospectively analyzed, and relevant literatures were reviewed. Results A 42-year-old woman presented with neck pain for three days. The ultrasound examination showed local thickening from the left carotid bifurcation to the anterior and medial walls of the internal carotid artery, with an unclear margin with surrounding tissues and visible blood flow signals in the left carotid artery, indicating TIPIC syndrome. The condition was improved by aspirin treatment. Two months later, the ultrasound scans showed that the carotid artery lesions basically disappeared. Conclusion TIPIC syndrome is a rare and newly named disease. The clinical manifestations of TIPIC syndrome are mostly unilateral neck pain with or without radiation to the head, which are non-specific leading to a high risk of misdiagnosis. Ultrasound examination is ofgreat significance in the diagnosis of TIPIC, visualizing the morphological and hemodynamic changes in the affectedcarotid artery, as well as the extent and blood supply of the lesion. It may be apreferred imaging examination in the diagnosis and prognosis of TIPIC.

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