Table of Content

20 July 2024, Volume 39 Issue 7

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Efficacy and safety of sotagliflozin in the treatment of type 2 diabetes mellitus: A meta-analysis

Yue Jianghong, Wang Heng, Cai Gang, Zhang Xuanming, Peng Xi

2024, 39(7):  581-592.  doi:10.3969/j.issn.1004-583X.2024.07.001

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Objective To evaluate the efficacy and safety of sotagliflozin in the treatment of type 2 diabetes mellitus (T2DM). Methods Randomized controlled trials (RCTs) involving sotagliflozin versus placebo (or other oral hypoglycemic agents) in the treatment of T2DM pulished before October 31, 2023 were retrieved in PubMed, Embase, Web of science, Medline, Cochrane Library, the North American Clinical Trial Register, CNKI, Wanfang, VIP, SinoMed and other databases. The extracted Valid data were performed for quality evaluation, and a meta-analysis was conducted using RevMan 5.3 software. Results Fourteen RCTs representing 16, 959 patients were included. The results of meta-analysis showed: In terms of efficacy, compared with the control group, sotagliflozin group presented significantly decreased glycated hemoglobin (HbA₁c, MD=-0.45, 95%CI[-0.58, -0.33]; P<0.01) and fasting blood glucose (FBG, MD=-0.66, 95%CI[-1.01, -0.31]; P=0.0002) and 2-h postprandial glucose (2hPG, MD=-1.01, 95%CI[-1.58, -0.44]; P=0.0005), and improved compliance rate of HbA₁c <7% (RR=1.88, 95%CI[1.64, 2.15], P<0.01). Compared with control group, sotagliflozin group had decreased systolic blood pressure (SBP, MD=-2.13, 95%CI[-2.81, -1.45], P<0.01) and body mass (BM, MD=-1.40, 95%CI[-1.63, -1.17], P<0.01), but there was no statistical significance in reducing diastolic blood pressure (DBP). In terms of safety, the incidence of hypoglycemic events was similar between the sotagliflozin group and the control group (RR=1.00, 95%CI[0.92, 1.09], P=0.97). However, the incidence of adverse reactions was significantly lower in sotagliflozin group (RR=0.92, 95%CI [0.88, 0.96], P<0.01). Subgroup analysis according to different doses of sotagliflozin showed that compared with the control group, sotagliflozin 200 mg and 400 mg groups could significantly reduce the HbA₁c and FBG, improve the compliance rate of HbA₁c<7%, and reduce SBP, BM and other indexes (P<0.05), and without increasing the risk of hypoglycemia events (P>0.05). Conclusion Sotagliflozin can significantly reduce HbA₁c, FBG, 2hPG, SBP, and BM in T2DM patients without increasing the risk of hypoglycemia or the incidence of adverse reactions.

Effectiveness of high-frequency vagus nerve stimulation in the treatment of drug-resistant epilepsy: A meta-analysis

Wang Caizhen, Miao Lina, Chen Yuan, Li Shuangcheng

2024, 39(7):  593-597.  doi:10.3969/j.issn.1004-583X.2024.07.002

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Objective To analyze the efficacy of high-frequency vagus nerve stimulation (VNS) in the treatment of drug-resistant epilepsy (DRE). Methods Randomized controlled trials (RCTs) related to VNS in treating DRE published before September 2023 were independently screened in PubMed, Chinese Biomedical Literature Database (CBM), EMbase, The Cochrane Library, Web of science, Chinese National Knowledge Infrastructure (CNKI) and WanFang Data by two researchers. The extracted data were conducted for a Meta analysis using the RevMan5.3 software. Results Nine RCTS representing 918 patients with DRE were included. High-frequency VNS had a higher effective rate for DRE versus drug treatment or low-frequency VNS ( O R=2.30, 95% C I[1.41,3.75], P=0.0009). The results for subgroup analysis showed that the efficacy of high-frequency VNS in Asian and American subgroups grouped by different intercontinental, non-20-week subgroups grouped by different observation cycles, neck VNS subgroups grouped different stimulation sites, and drug treatment subgroups grouped by different treatment regimens were better than those in control subgroups, with statistically significant differences (P<0.05). Conclusion The high-frequency VNS has a good efficacy for DRE.

Efficacy and safety of intracoronary injection of teneplase versus tirofiban on the treatment of acute ST-segment elevation myocardial infarction

Zhang Lei, Li Xin, Guo Zhenfeng

2024, 39(7):  598-602.  doi:10.3969/j.issn.1004-583X.2024.07.003

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Objective To observe and compare the efficacy and safety of intracoronary injection of teneplase and tirofiban in the treatment of acute ST-segment elevation myocardial infarction (STEMI). Methods A retrospective analysis was performed on 46 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) in the Affiliated BenQ Hospital of Nanjing Medical University from August 2021 to August 2023. According to different treatment plans, patients were divided into observation group (n=21, intracoronary injection of teneplase) and control group (n=25, intracoronary injection of tirofiban). The number of stents, thrombolysis in myocardial infarction (TIMI) blood flow grading, TIMI thrombus grading, corrected TIMI blood flow frame count (CTFC), percentage of postoperative 2-hour ST segment regression (STR)≥50%, postoperative N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction at 72 hours after PCI, bleeding events and cardiovascular adverse events during hospitalization were compared between the two groups. Results In terms of effectiveness, TIMI thrombus classification and CTFC after intracoronary administration were superior in the observation group than control group (P<0.05), and postoperative left ventricular ejection fraction (LVEF) and postoperative NT-proBNP of observation group were superior to control group (P<0.05). There were no significant differences in the number of stents, TIMI blood flow grade and percentage of postoperative 2-hour STR≥50% between the two groups (P>0.05). In terms of safety, there were no significant differences in the incidence of bleeding events and cardiovascular adverse events during hospitalization between the two groups (P>0.05). Conclusion PCI combined with intracoronary injection of teneplase and tirofiban is safe and effective on treating STEMI, and teneplase is superior to tirofiban.

Predictive value of serum total bilirubin, neutrophil-to-total bilirubin ratio in evaluating the condition of ulcerative colitis

Chen Xiaotian, Huo Lijuan

2024, 39(7):  603-611.  doi:10.3969/j.issn.1004-583X.2024.07.004

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Objective To analyze the correlation of serum total bilirubin (TBIL), indirect bilirubin (IBIL), direct bilirubin (DBIL), neutrophil-to- total bilirubin ratio (NBR) with ulcerative colitis (UC) with the severity and lesion range. Methods This was a retrospective case-control study involved 250 active UC patients and 250 healthy participants hospitalized in the First Hospital of Shanxi Medical University from June 2018-June 2023. The clinical data of the patients were collected and NBR was calculated. SPSS 26.0 software was performed to analyze the differences in TBIL, IBIL, DBIL, and NBR between healthy individuals and UC with different severity, lesion scope, and clinical types. Spearson correlation analysis was used to analyze the correlation between the above indicators with hemoglobin (Hb), albumin (ALB), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and clinical Mayo scores. The binary logistic regression analysis were performed to assess the odds ratio (OR) values of TBIL, IBIL, DBIL, and NBR with UC, severe UC, and E3 type UC. Finally, the predictive value of the above indicators for UC, severe UC, and E3 type UC was determined by plotting receiver operating characteristic (ROC) curves. Results The serum levels of TBIL, IBIL, and DBIL in UC patients were significantly lower than those in healthy individuals, while the levels of NBR were significantly increased. TBIL and IBIL were significantly reduced in patients with severe UC and E3 type UC, while NBR was significantly increased. There was no significant difference in DBIL among different subgroups. There was no statistically significant difference in various indicators between initial type and chronic recurrent type in UC patients. Correlation analysis showed that TBIL, IBIL were significantly positively correlated with Hb and ALB levels, significantly negatively correlated with ESR, CRP, and modified Mayo scores, but NBR was the opposite. Low levels of TBIL, IBIL and high levels of NBR were risk factors for severe UC and E3 type UC. When TBIL≤8.28 μmol/L, IBIL≤6.48 μmol/L and NBR>7.89, the OR values for severe UC were 4.119, 6.550 and 4.947, respectively, and the OR values for E3 type UC were 2.215, 3.087 and 2.244, respectively. ROC curve showed that TBIL, IBIL and NBR had mild predictive value for severe UC and E3 type UC. Conclusion TBIL, IBIL and NBR are correlated with the severity and lesion range of UC, and there is certain predictive value for severe UC and E3 type UC.

Correlation of triglyceride-glucose index combined with obesity indicators with diabetic retinopathy

Yan Tianmei, Wu Yanan, Liu Yueying, Wei Limin

2024, 39(7):  612-619.  doi:10.3969/j.issn.1004-583X.2024.07.005

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Objective To investigate the correlation of triglyceride-glucose index (TyG) and TyG combined with obesity indicators with diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM), and to analyze the predictive value of TyG and its combination with obesity indicators in DR. Methods This was a retrospective study. According to the inclusion and exclusion criteria, a total of 373 T2DM patients hospitalized in the Department of Endocrinology of Hebei General Hospital from September 2018 to May 2021 were recruited. They were assigned into T2DM group and DR group according to the presence of DR or not. The clinical data were collected. TyG, TyG-waist circumference index (TyG-WC), TyG-body mass index (TyG-BMI), TyG-waist-to-hip ratio (TyG-WHR), and TyG-waist-to-height ratio (TyG-WHtR) were calculated. Risk factors for DR were identified by binary logistic regression. The receiver operating characteristic (ROC) curves were plotted to determine the role of TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR in predicting DR. Results Patients in DR group had significantly higher age, course of T2DM, WC, WHR, WHtR, triglyceride (TG), serum creatinine (SCr), blood urea nitrogen (BUN), fasting blood glucose (FBG), glycosylated hemoglobin (HbA₁c), TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR, but lower glomerular filtration (GFR) than those of T2DM group (P<0.05). DR was positively correlated with age, course of T2DM, WC, WHR, WHtR, TG, SCr, BUN, FBG, HbA₁c, TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR, but negatively correlated with GFR. TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR were independent risk factors for DR. ROC curves showed the potential of TyG, TyG-WC, TyG-BMI, TyG-WHR and TyG-WHtR for predicting DR, with the largest area under the curve (AUC) of 0.623 in TyG-WHR. Conclusion TyG-WHR is closely related to DR in T2DM patients, and it may be a new clinical effective marker for early identification of the risk of DR in T2DM patients.

Application of insulin dose spectrum after an intensive insulin pump therapy in type 2 diabetes mellitus

Du Sina, Li Wei, Lin Yajing, Sun Jianguo, Mao Mao, Chen Jianwei, Sun Danbo, Mao Yushan

2024, 39(7):  620-624.  doi:10.3969/j.issn.1004-583X.2024.07.006

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Objective To explore the treatment time, timing and type of premixed insulin analogs in patients with type 2 diabetes mellitus (T2DM). Methods A total of 655 T2DM patients treated with continuous subcutaneous insulin infusion(CSII) short-term intensive treatment in 5 hospitals in Ningbo City, China were recruited to determine the optimal treatment plan of premixed insulin analogs. Results After CSII titration, the ratio of insulin dosage before meals to total basal insulin was 1.12, with the total insulin dosage of 51.35±29.7 U. 58% of T2DM patients were recommended to the use of premixed insulin analogs before dinner. 74% of them were recommended to the use of low premixed insulin analogs before breakfast. An individualized preparation of premixed insulin analogs with varied dosage formulations was expected to yield the optimal goal to control blood sugar. An inferred ratio of premixed insulin analogs twice a day (b.i.d.) in the morning and evening was 3∶2. A higher dosage in the morning than evening favored a simple informed consent of insulin dosage, thus preventing the misuse of premixed insulin analog dosages in the morning and evening and the incidence of hypoglycemia. An intensive insulin pump therapy showed that the insulin dose spectrum of T2DM was extremely heterogeneous, and a quantitative selection was of more significance. Conclusion A premixed insulin analog regimen b.i.d. is recommended, with a medium premixing before dinner, and low premixing before breakfast. A single type of insulin is dominant in clinical treatment of T2DM. An optimal regimen of the two types of premixed insulin analogs, either combined with oral hypoglycemic drugs or not, can be selected based on the individualized conditions of blood sugar.

Changes in pulmonary function, inflammatory factors, and clinical symptoms after smoking cessation in COPD patients with varied HRCT phenotypes

Liu Cuicui, Zhu Yafang, Lyu Wenjuan

2024, 39(7):  625-629.  doi:10.3969/j.issn.1004-583X.2024.07.007

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Objective This study aims to evaluate the advantages of smoking cessation in patients with chronic obstructive pulmonary disease (COPD) across various high-resolution CT (HRCT) phenotypes. Methods We included 272 COPD patients who were smokers and underwent HRCT examination at our hospital's Department of Respiratory and Critical Care Medicine between June 2021 and June 2022. Patients were categorized based on their willingness to quit smoking and their success in doing so, while continuing their basic COPD treatment. A total of 104 successful quitters were selected for this study. These 104 COPD patients were further classified into three types according to the classification of low attenuation areas (LAA) under HRCT and the thickness of the airway wall: Type A (33 cases), Type E (35 cases), and Type M (34 cases). We recorded their lung function indicators (forced expiratory volume in the first second [FEV1], FEV1/forced vital capacity [FVC]), expression levels of inflammatory factors (T helper 17 cells/regulatory T cells [Th17/Treg], tumor necrosis factor alpha [TNF-α]), arterial carbon dioxide pressure (PaCO₂), erythrocyte sedimentation rate (ESR), cough score, and number of acute exacerbations. Results ①Lung Function Indicators: Prior to smoking cessation, there was no statistically significant difference in FEV1 and FEV1/FVC among the three groups (P>0.05). Post-cessation, both the A and E groups exhibited higher FEV1 and FEV1/FVC compared to the M group, with a statistically significant difference (P<0.05). ②Cytokine Expression Levels: Prior to smoking cessation, there was no statistically significant difference in Th17/Treg and TNF-α among the three groups (P>0.05). Post-cessation, both the A and E groups demonstrated lower Th17/Treg and TNF-α levels compared to the M group, with a statistically significant difference (P<0.05). ③PaCO₂ and ESR: Prior to smoking cessation, there was no statistically significant difference in PaCO₂ and ESR among the three groups (P>0.05). Post-cessation, both the A and M groups had lower PaCO₂ levels compared to the E group; both the A and E groups had lower ESR levels compared to the M group, with a statistically significant difference (P<0.05). ④Number of Acute Exacerbations and Cough Score: Prior to smoking cessation, there was no statistically significant difference in the number of acute exacerbations and cough score among the three groups (P>0.05). Post-cessation, both the A and M groups experienced fewer acute exacerbations compared to the E group; both the A and E groups had higher cough scores compared to the M group, with a statistically significant difference (P<0.05). Conclusion There are variations in the number of acute exacerbations and therapeutic effects post-smoking cessation among COPD patients with different HRCT phenotypes. Specifically, patients with Type E and Type M exhibit a weaker improvement effect after quitting smoking. However, quitting smoking has a more pronounced improvement effect on the number of acute exacerbations, lung function, and inflammatory factors in patients with Type A.

Effect of treatment regimen containing Bedaquiline for drug-resistant tuberculosis on the QT interval of electrocardiogram

Wan Rong, Li Guangmei, Ji Yongjing, Liu Lei, Cui Cancan, Li Mingwu

2024, 39(7):  630-634.  doi:10.3969/j.issn.1004-583X.2024.07.008

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Objective To explore the effect of treatment regimen containing Bedaquiline for drug-resistant tuberculosis on the QT interval of electrocardiogram. Methods A total of 204 patients with drug-resistant tuberculosis admitted in the Department of Tuberculosis, Kunming Third People's Hospital from August 2018 to December 2022 were selected. Eighty-four patients treated with Bedaquiline-containing regimen were included in the observation group. After excluding 4 dropouts and 2 deaths, 78 cases were finally included in the observation group. A total of 120 patients treated with the regimen without Bedaquiline were enrolled in the control group, and finally 115 were eligible (4 dropouts and 1 death).The QT interval and clinical data of two groups at different stages of treatment were compared. Results Compared with the baseline, the QT interval of electrocardiogram in the observation group was significantly higher at the 2 nd, 4 th, 8 th, 12 th, 16 th, 20 th and 24 th weeks of treatment significantly (P<0.05). The QT period of the observation group was significantly longer than that of the control group at the 16 th, 20 th and 24 th week of treatment(P<0.05). In the observation group, there were 15 cases (19.2%, 15/78 ) with QT interval greater than 500 ms, including 7 cases of background regimen containing clofazimine and moxifloxacin. Conclusion Treatment regimen containing Bedaquiline for drug-resistant tuberculosis prolongs QT interval, but the background regimen containing Clofazimine and Quinolones aggravates the prolonged QT interval. Therefore, electrocardiogram monitoring and cardiac examination should be strengthened when using betamethasone in combination with Clofazimine and Quinolones.

Value of transrectal ultrasound combined with contrast-enhanced ultrasound in the diagnosis of benign and malignant prostate hypoechoic lesions

Hao Yuanyuan, Wang Jun, Huang Qian

2024, 39(7):  635-639.  doi:10.3969/j.issn.1004-583X.2024.07.009

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Objective To explore the value of transrectal ultrasound (TRUS) combined with contrast-enhanced ultrasound (CEUS) in the diagnosis of benign and malignant prostate hypoechoic lesions. Methods A total of 54 suspected prostate cancer patients (75 hypoechoic lesions of the prostate) from September 2022 to August 2023 who were admitted in our hospital were selected. All patients underwent TRUS and CEUS. With the pathological examination results as the gold standard, the capacity of TRUS combined with CEUS in distinguishing benign from malignant prostate lesions was evaluated. Univariate and multivariate logistic regression analyses were performed to clarify the value of TRUS combined with CEUS in diagnosing benign and malignant prostate hypoechoic lesions. Results Among 75 prostate hypoechoic lesions, 39 malignant lesions and 36 benign lesions were detected through pathological examination. The proportion of lesions with incomplete capsule, calcification within the lesion, irregular lesion morphology, and enhanced contrast peak value was significantly higher in malignant lesions than those of benign lesions. There were significant differences in sonographic characteristics and contrast patterns between the benign and malignant lesions (P<0.05). Multivariate logistic regression analysis showed that the lesion with an incomplete capsule (OR=10.592), stain-like hypoechoic lesions (OR=13.325), fast-in and fast-out (OR=12.960), and high peak contrast enhancement (OR=16.025) were independent risk factors for malignant prostate hypoechoic lesions (P<0.05). The receiver operating characteristic (ROC) curve showed that the area under curve (AUC) of TRUS, CEUS, and their combination for diagnosing benign and malignant prostate hypoechoic lesions was 0.889, 0.837, and 0.953, respectively. The AUC of TRUS combined with CEUS was higher than that of a single examination. Conclusion TRUS combined with CEUS for the diagnosis of benign and malignant prostate hypoechoic lesions has a high diagnostic value. Ultrasound features, such as lesion capsule, ultrasound features, contrast mode, and contrast peak intensity should be concerned.

Analysis of hepatitis associated aplastic anemia in children

Wu Qiupin, Yan Shiwei, He Xiaoyin, Li Yun, LU Liju, Wu Yi

2024, 39(7):  640-643.  doi:10.3969/j.issn.1004-583X.2024.07.010

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Objective To analyze the clinical manifestation, etiology and treatment of hepatitis associated aplastic anemia (HAAA) in children. Methods Clinical data of two children with HAAA were retrospectively analyzed. Results The two children were all male, with an average age of 5 years and 11 months. Hepatitis A, B and C virus, treponema pallidum, acquired immunodeficiency syndrome (AIDS) virus, Epstein-Barr virus (EBV), TORCH (Toxoplasma gondii, Rubella virus, Cytomegalovirus, Herpes simplex virus I and II) and parvovirus B19 were all negative. Case 1 treated with cyclosporine prednisone immunosuppression was partially relieved. Case 2 underwent allogeneic hematopoietic stem cell transplantation (brother donor brother) was completely relieved. Conclusion HAAA in children often occurs in the recovery period of acute hepatitis, with undetermined etiology. The treatment is mainly immunosuppressive.

HELLP syndrome with liver damage: A case report and literature review

Liu Yun

2024, 39(7):  644-649.  doi:10.3969/j.issn.1004-583X.2024.07.011

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Objective To study the changes and management of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome with liver damage. Methods A retrospective analysis of one case of HELLP syndrome with liver damage and a review of relevant literature were conducted. Results A 35-year-old woman with a history of gestational hypertension and eclampsia developed HELLP syndrome with liver damage at 30⁺⁴ weeks of gestation. After treatment with spasm-relieving, blood pressure lowering, liver protection, hormones, plasma exchange and termination of pregnancy, the patient was discharged from hospital after her condition gradually improved. Conclusion Early identification and timely multidisciplinary management are crucial for preventing catastrophic bleeding, liver failure, and death in HELLP syndrome. Considering the severity of the evolution that may occur in young women, it is necessary to correctly diagnose and treat liver complications caused by HELLP syndrome.