Table of Content

20 December 2024, Volume 27 Issue 36

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Editorial Review

Establishment and Promotion of a Dyslipidemia Management and Control System Grounded on Hierarchical Medical Treatment

ZHANG Long, LI Jianping

2024, 27(36):  4493-4497.  DOI: 10.12114/j.issn.1007-9572.2024.0231

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Dyslipidemia constitutes an essential risk factor for atherosclerotic disorders. From employing diverse types of blood lipid indicators as markers for risk prediction to subsequently applying low-density lipoprotein cholesterol as the primary lipid-lowering target in both primary and secondary prevention of cardiovascular diseases, relevant research and clinical practices indicate that the dyslipidemia management system grounded on hierarchical medical care is a significant measure for effective blood lipid control and efficient reduction of cardiovascular diseases. Continuously optimizing the prediction model for cardiovascular diseases, enhancing the construction of the medical consortium specializing in dyslipidemia disorders, and promoting the dyslipidemia management and control system based on hierarchical medical treatment will facilitate elevating the overall prevention and treatment level of dyslipidemia in China, and mitigate the health menace of cardiovascular diseases for Chinese residents.

Monographic Rescarch·Lipid Management

Advances in Molecular Biotechnology for Diagnosing and Treating Familial Hypercholesterolemia

ZHANG Shuo, ZHANG Long, ZHANG Yan, LI Jianping

2024, 27(36):  4498-4504.  DOI: 10.12114/j.issn.1007-9572.2024.0126

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Familial hypercholesterolemia (FH) is an inherited disorder of lipid metabolism characterized by significant elevation of low-density lipoprotein cholesterol, increasing the risk of atherosclerotic cardiovascular disease and causing serious consequences for FH patients and the whole society. The development of molecular biotechnology is crucial for screening, diagnosing, and treating patients with FH. This paper systematically summarizes how the development of genetic testing technologies, particularly next-generation sequencing, has improved the accuracy of diagnosis and efficiency of genetic screening for FH, while also introducing many variations of unknown significance. In contrast to pharmacotherapy, transgenic technology and gene editing technology offer the potential to rectify the molecular aberration within the patient's physiological system, holding promise for eradicating FH at the molecular level. However, preliminary results have shown that patients could suffer from side-effects, such as liver damage, and long-term follow-up is needed to clarify the efficacy of these technologies. Therefore, this article reviews the latest advances in molecular biotechnology, including genetic testing technology and gene therapy technology, in the diagnosis and treatment of FH, aiming to provide new perspectives for FH related research.

Latest Progress of Lipoprotein (a) in Cardiovascular Diseases

LI Jie, DING Hu

2024, 27(36):  4505-4514.  DOI: 10.12114/j.issn.1007-9572.2024.0171

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Lipoprotein (a) [Lp (a) ] is significantly related to atherosclerotic cardiovascular disease (ASCVD), but it is unclear whether clinical agents that lower Lp (a) can reduce the risk of ASCVD. Here, we systematically reviewed the structure, function, genetic characteristics and detection status of Lp (a), discussed the relationship of Lp (a) with ASCVD, aortic valve stenosis and other cardiovascular diseases, and summarized new advance of Lp (a) -lowering therapies. The structural composition of Lp (a) indicates that Lp (a) may promote atherosclerosis, inhibit fibrinolytic reaction and promote inflammation. Multiple evidence from genetic studies and epidemiological studies supports that Lp (a) is significantly associated with an increased risk of ASCVD and major adverse cardiovascular events. In addition, Lp (a) is also associated with other cardiovascular diseases such as aortic valve stenosis. At present, several emerging drugs that lower Lp (a) are in clinical trials and may further reduce residual cardiovascular risk. This paper hopes to offer new thought for the study of Lp (a), and provide a basis for the monitoring and management of blood lipids.

Clinical Significance of Screening for Familial Hypercholesterolemia in Patients with Hypercholesterolemia

LI Yuan, MA Hongyang, LI Biao, YUE Anna, SHAO Yaqing, SUN Kangyun

2024, 27(36):  4515-4521.  DOI: 10.12114/j.issn.1007-9572.2024.0184

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Background

Familial hypercholesterolemia (FH) is an autosomal dominant inherited disorder characterized by severe hypercholesterolemia and significantly elevated levels of serum low-density lipoprotein cholesterol (LDL-C). Patients with FH are at an increased risk of premature atherosclerotic cardiovascular disease, and early detection and treatment can improve their survival rates.

Objective

This study aims to explore the clinical value and significance of screening for FH among patients with hypercholesterolemia in community populations.

Methods

During the period from July to December 2023, a total of 164 patients diagnosed with hyperlipidemia and exhibiting LDL-C levels ≥4.90 mmol/L underwent gene sequencing at Department of Cardiology, the Affiliated Suzhou Hospital of Nanjing Medical University and its 5 community health centers within the medical alliance. Based on quartile intervals of LDL-C levels, the patients were stratified into four groups: Q1 group (LDL-C ≤5.10 mmol/L, n=43), Q2 group (5.10 mmol/L≤LDL-C≤5.32 mmol/L, n=40), Q3 group (5.32 mmol/L≤LDL-C≤5.67 mmol/L, n=41), and Q4 group (LDL-C≥5.67 mmol/L, n=40). Baseline data and laboratory test results of the patients were collected.

Results

A total of 164 patients with hypercholesterolemia were included, with a prevalence of awareness of dyslipidemia at 39.02% (64/164), and 21.95% (36/164) of the patients had previously taken lipid-lowering medications. The comparison of total cholesterol (TC) and LDL-C among Q1 to Q4 groups showed statistically significant differences (P<0.05). Physical examinations of the patients in all groups revealed no tendon xanthomas or corneal arcus, but one case in Q4 had a family history of premature coronary heart disease. The comparison of Dutch Clinical Lipid Network criteria scores and the proportion of suspected FH among Q1 to Q4 groups showed statistically significant differences (P<0.05). The main results of genetic sequencing in all groups were the diagnosis of FH, with a detection rate of FH gene mutations at 14.6% (24/164), including LDL receptor (LDLR) mutations accounting for 11.0% (18/164), apolipoprotein B (ApoB) mutations accounting for 3.1% (5/164), and proprotein convertase subtilisin/kexin type 9 (PCSK9) mutations accounting for 0.6% (1/164). The comparison of FH gene mutation detection rates, pathogenic, likely pathogenic, heterozygous genotypes, and LDLR proportions among Q1 to Q4 groups showed statistically significant differences (P<0.05). The secondary results of genetic sequencing, defined as suspected FH and other primary lipid metabolism abnormalities, showed a mutation rate of 70.12% (115/164). The comparison of secondary results of genetic sequencing among Q1 to Q4 groups showed no statistically significant differences (P>0.05) .

Conclusion

In community populations with hypercholesterolemia and LDL-C ≥ 4.9 mmol/L, the rate of FH gene mutations is relatively high, and the rate of other primary (genetic) lipid metabolism gene mutations is also high. Screening for FH among patients with hypercholesterolemia in community populations has significant clinical importance and value.

Study on the Efficacy Differences of Moderate-dose Statin Therapy in Patients with Atherosclerotic Cardiovascular Disease among Different Ethnic Groups

LUO Sifu, JIN Menglong, SUBINUER· Jureti, LIU Ziyang, FU Zhenyan

2024, 27(36):  4522-4526.  DOI: 10.12114/j.issn.1007-9572.2024.0235

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Background

Statins are the cornerstone of lipid-lowering therapy and moderate-dose statin therapy is the preferred treatment strategy for lipid management in the Chinese population. Despite the widely recognized efficacy of statins in reducing cholesterol levels and preventing cardiovascular diseases, there are significant differences in treatment responses among patients from different ethnic groups.

Objective

To explore the differences in therapeutic efficacy between Han and Uyghur patients under moderate-dose statin therapy to guide the formulation of individualized treatment plans.

Methods

A total of 780 patients diagnosed with atherosclerotic cardiovascular disease (ASCVD) by coronary angiography at the First Affiliated Hospital of Xinjiang Medical University's Cardiac Center from 2012 to 2022 were included in the study. Baseline data and laboratory examination results of the patients were collected.

Results

A total of 780 ASCVD patients were included, with 408 Han and 372 Uyghur patients. The mean age and gender composition of the two groups were statistically significant (P<0.05). Prior to statin therapy, Han patients had higher levels of total bilirubin (Tbil), albumin (ALB), glycated hemoglobin (HbA_1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), and proportions of hypertriglyceridemia and hypercholesterolemia compared to Uyghur patients. Conversely, Han patients had lower levels of alanine aminotransferase (ALT), hypoalphalipoproteinemia, hypoapolipoproteinemia A1, and hyperlipoproteinemia a compared to Uyghur patients (P<0.05). After statin therapy, Han patients had higher levels of Tbil, aspartate aminotransferase, ALB, HbA_1c, HDL-C, ApoA1, and lower levels of ALT, TC, low-density lipoprotein cholesterol (LDL-C), ApoB, hypoalphalipoproteinemia, hypoapolipoproteinemia A1, and hyperapolipoproteinemia B compared to Uyghur patients (P<0.05). After medium-dose statin therapy, the reduction levels of TC, HDL-C, LDL-C, and ApoB in Han patients were higher than those in Uyghurs (P<0.05) ; the reduction levels of TC, LDL-C, and ApoB were higher in Han patients than those in Uyghurs, and the increase level of HDL-C was lower in Han patients than those in Uyghurs (P<0.05). Patients were categorized into sensitive group (n=124), resistant group (n=104), and Intermediate group (n=552) based on the reduction in LDL-C. The resistant group consisted of 42 Han and 62 Uyghur patients, the sensitive group of 78 Han and 46 Uyghur patients, and the intermediate group of 288 Han and 264 Uyghur patients. The distribution of ethnicities among the three groups was statistically significant (χ²=11.511, P=0.030) .

Conclusion

Han patients showed a significantly better lipid-lowering effect following moderate-dose statin therapy compared to Uyghur patients. Uyghur patients may require more frequent monitoring of lipid levels and consideration of increased statin dosage or early combination with other lipid-lowering drugs to improve therapeutic efficacy.

Exploration and Practice of the Construction of Outpatient Model for Blood Lipid Management in Comprehensive Hospitals

ZHANG Jun, LUO Wen, WANG Luya, YANG Ya, CHEN Yan

2024, 27(36):  4527-4533.  DOI: 10.12114/j.issn.1007-9572.2024.0185

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Background

Cardiovascular disease, mainly atherosclerotic cardiovascular disease, is the first cause of death for urban and rural residents in China. Low density lipoprotein cholesterol is the pathogenic risk factor of ASCVD.

Objective

By establishing a new outpatient model for blood lipid management, to analyze the awareness rate of abnormal blood lipids in patients before and after the establishment of the new model, the proportion of rational drug use, patient compliance, and medication compliance rate.

Methods

From September 1, 2023 to February 28, 2024, has established a comprehensive outpatient model for managing blood lipid abnormalities based on scientific research projects by integrating medical resources. The model takes the outpatient service of "patients with dyslipidemia" as the carrier, and collaborates with specialized doctors and general practitioners to standardize the management of dyslipidemia patients, optimize the consultation and follow-up process, effectively screen the population with dyslipidemia, diagnose hyperlipidemia patients, and provide correct treatment methods.

Results

The model of patients with dyslipidemia included in the management of chronic diseases has shifted from a dispersed model to a comprehensive, standardized, and centralized management of lipid management outpatient services, and the number of patients managed has significantly increased compared to before. The proportion of standardized medication for first-time patients in our blood lipid management outpatient department has increased from 25.3% (147/580) to 30.3% (242/798), the proportion of adherence to medication has increased from 32.7% (190/580) to 41.6% (332/798), and the compliance rate of medication has increased from 15.8% (92/580) to 22.5% (180/798) (P<0.05) .

Conclusion

Through the implementation of the "comprehensive and specialized" prevention and treatment model, the number of patients with dyslipidemia included in chronic disease management has significantly increased, and the proportion of standardized medication, medication compliance, and medication compliance rate have been improved. The model not only cultivates talents while implementing scientific research projects, but also enhances the research capabilities and professional service levels of general practitioners, graduate students, and regulatory trainees.

Original Research

Prevalence and Risk Factors of Atrioventricular Block in the Population: a Study Based on the Kailuan Cohort

TAO Jintao, WU Shouling, ZHAO Xiaohong

2024, 27(36):  4534-4539.  DOI: 10.12114/j.issn.1007-9572.2024.0061

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Background

Atrioventricular block (AVB) is associated with adverse outcomes in patients with cardiovascular diseases, and there is a relative scarcity of epidemiological data in China. Identifying and eliminating risk factors for AVB to prevent its occurrence is of great importance.

Objective

To explore the prevalence and risk factors of AVB in the Kailuan study population.

Methods

Participants who underwent health examinations from 2018 to 2020, consisting of employees and retirees of the Kailuan Group, were included as subjects of observation. General information, medical history, and medication history of the participants were collected. On the day of the physical examination, 5 mL of blood was drawn from the elbow vein after fasting for 8 hours for biochemical tests, and an electrocardiogram was conducted simultaneously. Multivariate Logistic regression analysis was used to explore the risk factors affecting AVB and to perform sensitivity analysis.

Results

A total of 80 859 subjects were included in the final observation, with an average age of (53.8±14.9) years. The prevalence of AVB was 0.97% (786/80 859), with a first-degree AVB prevalence of 0.91% (732/80 859) and a second-degree or higher AVB prevalence of 0.07% (54/80 859). The proportion of male, age, systolic pressure, fasting blood glucose, low-density lipoprotein cholesterol, BMI, hypertension, diabetes, alcohol consumption, blood uric acid, medication use, and atherosclerotic cardiovascular diseases (ASCVD) was higher in AVB patients than in those without AVB, while diastolic pressure and heart rate was lower (P<0.05). Further, the study subjects were divided into three groups according to the presence and degree of AVB: no AVB group (n=80 073), first-degree AVB group (n=732), and second-degree or higher AVB group (n=54). The comparison of gender, age, heart rate, hypertension, BMI, diabetes, hyperuricemia, hyper-low-density lipoprotein, alcohol consumption, and ASCVD among the three groups showed statistically significant differences (P<0.05). Multivariate Logistic regression results showed that male gender, older age, hypertension, diabetes, hyper-low-density lipoprotein, hyperuricemia, Elevated BMI, and alcohol consumption were risk factors for AVB, while an increased heart rate was a protective factor for AVB (P<0.05) .

Conclusion

The prevalence of AVB in the Kailuan population is 0.97%, with older age, male gender, high BMI, hypertension, diabetes, hyper-low-density lipoprotein, hyperuricemia, and alcohol consumption being risk factors for AVB, and a high heart rate being a protective factor for AVB.

Value of Lysophospholipid Metabolites in Prognosis of Major Adverse Cardiac Events in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: a Prospective Cohort Study

SUN Xuechun, DU Zhiyong, YU Huahui, LYU Qianwen, JIAO Xiaolu, WANG Yu, QIN Yanwen

2024, 27(36):  4540-4545.  DOI: 10.12114/j.issn.1007-9572.2024.0066

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Background

Percutaneous coronary intervention (PCI) is the main treatment for acute coronary syndrome (ACS), but some patients may experience recurrent major cardiovascular events (MACE) after the treatment. Recent studies have shown that lysophospholipid metabolites such as lysophosphatidylcholine (LPC) and lysophosphatidic acid (LPA), which are important components of oxidized low-density lipoprotein and low-density lipoprotein, can promote the formation and rupture of atherosclerotic plaques. However, it remains unclear whether lysophospholipid metabolites can be used to predict the occurrence of MACE following PCI in patients with ACS.

Objective

To investigate the predictive value of lysophospholipids for MACE following PCI in patients with ACS.

Methods

The study included patients with ACS who underwent PCI at Beijing Anzhen Hospital, Capital Medical University from June 2017 to September 2019. Baseline data of the patients were collected, and targeted metabolomics was performed to detect phospholipids and lysophospholipids. Patients were followed up at 1, 3, 6, 9, and 12 months post-enrollment, and then every 6 months thereafter, through outpatient visits and telephone consultations to record the occurrence of MACE. Principal component analysis (PCA) score plots were used to analyze the metabolic profiles and inter-group distributions of lysophospholipids between the non-MACE and MACE groups. A partial least squares-discriminant analysis (PLS-DA) with variable importance in projection (VIP) plots was utilized to assess the differential metabolites of lysophospholipids between the groups. The importance of each phospholipid and lysophospholipid metabolite was ranked using the random forest accuracy decrease diagram. Monte Carlo cross-validation was applied to construct the receiver operating characteristic (ROC) curve for the multivariable random forest models composed of different numbers of metabolites, and the area under the curve (AUC) was calculated to select key lysophospholipid metabolites associated with MACE. The accuracy of the predictive models was assessed using permutation tests.

Results

Participants included 212 cases of patients, with an average follow-up of 3 years. Patients were divided into the MACE group (n=29) and the non-MACE group (n=183) based on whether MACE occurred during the follow-up period. There was no statistically significant difference in baseline data between the two groups (P>0.05). The PCA score plot revealed a distinct distribution of MACE and non-MACE group samples, indicating significant differences in the lysophospholipid metabolite profiles. Integrated analysis identified significant changes in LPA, oxidized lysophosphatidylcholine (LPC-O), LPE, LPI, and LPS. Monte Carlo cross-validation was used to construct a predictive model for MACE using the top 13 ranked lipid metabolites [mainly including 10 lysophospholipid metabolites (LPA 16: 0, LPA 18: 1, LPC-O 16: 0, LPC 16: 0, LPG 18: 2, LPC 18: 0, LPE 20: 3, LPE 22: 6, LPG 18: 1, LPS 20: 4) and 3 phospholipid metabolites (PA 16: 0-18: 0, PA 16: 0-20: 4, PA 16: 0-18: 1) ]. The ROC curve indicated that the model had an AUC of 0.934 (95%CI=0.793-0.998) for predicting MACE.

Conclusion

Abnormal expression of lysophospholipids metabolites in preoperative serum is closely correlated with the risk of recurrent MACE following PCI in patients with ACS. This exhibits significant predictive efficacy and clinical value for MACE following PCI in patients with ACS.

Factors Influencing Biochemical Progression in Distant Metastatic Papillary Thyroid Carcinoma

ZHANG Jin, SUN Di, WANG Hao, SHI Cong, ZHAO Yihan, PAN Yijin, MU Zhuanzhuan, DING Zhiguo, LIN Yansong

2024, 27(36):  4546-4553.  DOI: 10.12114/j.issn.1007-9572.2023.0930

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Background

In advanced papillary thyroid carcinoma (PTC), particularly distant metastatic PTC (DM-PTC), disease progression is primarily monitored through serum markers like thyroglobulin (Tg) and imaging modalities such as computed tomography (CT). Due to limitations inherent in imaging techniques, such as radiation exposure, high cost, and complexity of metastatic lesion distribution, Response Evaluation Criteria In Solid Tumors version 1.1 (RECIST 1.1) often fail to timely capture disease changes in DM-PTC patients. The integration of Tg doubling time (TgDT) has demonstrated its efficacy in sensitively monitoring PTC disease progression.

Objective

To explore the biochemical progression and its influencing factors in DM-PTC using TgDT as the outcome variable.

Methods

This retrospective study included 61 DM-PTC patients treated at the Department of Nuclear Medicine, Peking Union Medical College Hospital from January 2018 to June 2023. Baseline data and genetic mutation analyses (including BRAF mutation, TERT mutation, RET fusion, and RAS mutation) were collected. Peripheral blood T cell subsets, natural killer (NK) cells, and lymphocyte counts were measured 4 months to 1 year post-last ¹³¹I treatment. Patients were categorized into two groups based on TgDT<3 years (n=16) and ≥3 years (n=45). The initial and final values of T cell subsets, NK cell percentages, and lymphocyte counts were defined at the first and last Tg measurement points, respectively. The lymphocyte subset change rate was calculated as [ (final value - initial value) /initial value] ×100%. Differences in initial values and change rates of lymphocyte subsets between the two groups were compared. Multivariate Logistic regression analysis was performed to identify factors influencing biochemical progression in DM-PTC.

Results

The ≥3 years group had a lower age at diagnosis, fewer local surgeries before the last ¹³¹I treatment, lower RAIR, TERT mutation, and co-occurrence of BRAF and TERT mutations, but a higher RET fusion rate compared to the <3 years group (P<0.05). The ≥3 years group exhibited higher percentages of CD₃⁺ and CD₈⁺ T cells and lower percentages of NK cells and CD₄/CD₈ ratio compared to the <3 years group (P<0.05). Multivariate Logistic regression analysis indicated that a decrease in CD₈⁺ T cell percentage (OR=0.879, 95%CI=0.792-0.975) and co-occurrence of BRAF and TERT mutations (OR=7.044, 95%CI=1.368-36.265) were factors influencing biochemical progression in DM-PTC (P<0.05) .

Conclusion

An immune status characterized by a low proportion of CD₈⁺ T cells and the co-occurrence of BRAF and TERT mutations are influential factors in the biochemical progression of DM-PTC. Lymphocyte subset analysis and combined genetic testing are crucial for disease monitoring and prognosis evaluation in DM-PTC.

Influencing Factors for Subendocardial Viability Ratio in the Community Population

GAO Lan, ZHANG Xiangning, XIE Haotai, FAN Fangfang, JIA Jia, LI Jianping, MA Wei, ZHANG Yan

2024, 27(36):  4554-4560.  DOI: 10.12114/j.issn.1007-9572.2024.0187

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Background

At present, cardiovascular diseases still have a high incidence and mortality worldwide. Subendocardial viability ratio (SEVR) is calculated from the analysis of left ventricular and aortic pressure curves in invasive hemodynamic studies, serving as a valuable indicator of myocardial perfusion, and predictive factor for cardiovascular adverse events and mortality in different populations. Although having certain limitations, non-invasive measurements of SEVR are valuable tools for evaluating myocardial perfusion and assessing cardiovascular risk. However, large-scale epidemiological studies to explore the practical value of SEVR in primary and secondary prevention of cardiovascular diseases are scant.

Objective

This study aims to non-invasively measure SEVR in a large-scale Beijing community-based population and to identify the influencing factors.

Methods

It was a cross-sectional follow-up study involving a cohort of residents (≥40 years of age) with atherosclerosis in the Shougang Community, Shijingshan District, Beijing, who were treated in the Department of Cardiology, Peking University First Hospital from December 2011 to April 2012. Non-invasive SEVR measurements were conducted using Pulsepen (DiaTecne srl, San Donato Milanese, Italy) during the follow-up period in 2018. Generalized linear regression models were applied to analyze influencing factors for SEVR.

Results

A total of 6 568 participants followed up in 2018 were initially enrolled. After excluding those without SEVR data for arrhythmia (2.8%), 6 382 eligible ones were finally included in our study. SEVR measurements were obtained from 97.2% of patients. In the cohort, there were 2 130 males and 4 252 females, with a mean SEVR of (144±22) %. The Multivariate linear regression analysis showed that sex (β=-11.00), age (β=-0.53), smoking (β=2.36), hypertension (β=-4.12), dyslipidemia (β=-1.45), diabetes (β=-4.36), antihypertensive drugs (β=3.72), and hypoglycemic treatment (β=-3.71) were independently associated with SEVR (P<0.05). In males, age (β=-0.67), hypertension (β=-3.20), dyslipidemia (β=-2.73), diabetes (β=-3.42), and hypoglycemic treatment (β=-5.07) were independent influencing factors for SEVR (P<0.05). In females, age (β=-0.48), smoking (β=9.44), hypertension (β=-4.98), diabetes (β=-4.95), antihypertensive drugs (β=5.26), and hypoglycemic treatment (β=-2.82) were independent influencing factors for SEVR (P<0.05) .

Conclusion

Non-invasive measurement of SEVR is feasible in large-scale community-based populations. SEVR is associated with traditional risk factors, such as sex, age, smoking, hypertension, dyslipidemia, and diabetes. The relationship between SEVR and medication needs to be explored through further research.

Correlation of Nucleolin with the Stability and Severity of Coronary Plaque in Acute Coronary Syndrome

ZHANG Qiongdan, MAO Zhuoni, HUANG Dan, FANG Li

2024, 27(36):  4561-4567.  DOI: 10.12114/j.issn.1007-9572.2023.0870

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Background

Acute coronary syndrome (ACS) is a group of pathological clinical syndromes characterized with coronary atherosclerotic plaque rupture or erosion, and secondary complete or incomplete occlusion of thrombosis. The selection of specific and sensitive serological markers and detection methods has an important clinical value for rapid, accurate early diagnosis, assessment, and treatment of ACS.

Objective

To explore the correlation of plasma nucleolin (NCL) with the stability and severity of coronary artery plaques in ACS patients, and to analyze the value of NCL in predicting ACS.

Methods

A total of 117 ACS patients admitted to the Cardiovascular Department of the First Hospital of Changsha in 2022 and examined by coronary angiography were selected as the study subjects, including 36 cases of unstable angina (UA group), 36 cases of non-ST segment elevation myocardial infarction (NSTEMI group), and 45 cases of ST segment elevation myocardial infarction (STEMI group). During the same period, 39 cases of non-ACS patients were selected as the control group. Blood samples and general clinical data were collected. Plasma levels of NCL, C-reactive protein (CRP), and low-density lipoprotein cholesterol (LDL-C) were measured. According to the results of coronary angiography, ACS patients were divided into non-lesion group, single vessel lesion group, double vessel lesion group, and multi-vessel lesion group. ACS patients were further assigned into the vulnerable plaque group and stable plaque group based on the characteristics of ultrasonic echo. Those without atherosclerotic plaque were classified as plaque-free group. The correlation of NCL levels with CRP and LDL-C levels in different groups of ACS patients was evaluated. The correlation of NCL levels with the number of coronary artery lesions, severity of coronary artery lesions, and the Gensini score in ACS patients was identified. Multivariate Logistic regression analysis was used to identify whether plasma NCL was an independent risk factor for ACS. The optimal cut-off value of plasma NCL in predicting ACS was determined by the receiver operating characteristic (ROC) curves.

Results

Plasma NCL levels were positively correlated with LDL-C and CRP (r=0.572, and 0.639, respectively; both P<0.05). Plasma NCL levels were compared in ACS patients with varied degrees of carotid plaque, and they were higher in the vulnerable plaque group (n=73), followed by the stable plaque group (n=49) and plaque-free group (n=33). Plasma NCL was positively correlated with the degree of carotid plaque (r=0.543, P<0.05). Plasma NCL levels in ACS patients were significantly higher in the multi-vessel lesion group (n=39) than the double vessel lesion group (n=49) (P<0.05), while plasma NCL levels were significantly higher in the double vessel lesion group (n=49) than the single vessel lesion group (n=29) (P<0.05). Plasma NCL was positively correlated with the number of diseased coronary vessels in ACS patients (r=0.445, P<0.05). Plasma NCL levels were significantly higher in the high Gensini score group than those of the low Gensini score and medium Gensini score groups (P<0.05), which were positively correlated with the number of diseased coronary vessels (r=0.799, P<0.05). Multivariate Logistic regression analysis showed that increased NCL was an independent risk factor for ACS, with the optimal cut-off value of 0.765 ng/mL in ROC curves.

Conclusion

Plasma NCL levels have a certain clinical significances in evaluating plaque stability, recognizing ACS and risk stratification of ACS patients. Plasma NCL level is positively correlated with the number of coronary artery lesions and Gensini score, serving as a reference indicator for predicting and evaluating the severity of coronary artery lesions to a certain extent. Elevated plasma NCL levels may be an independent risk factor for the occurrence of ACS and have predictive diagnostic value for ACS.

Analysis of Influencing Factors of Plasma Proprotein Convertase Subtilisin/Kexin Type 9 in Patients with Acute Myocardial Infarction

JIA Jia, LIU Jiahui, JI Wenjun, ZHENG Bo, WANG Xingang, FAN Fangfang, LI Yin, ZHANG Long, ZHANG Yan

2024, 27(36):  4568-4574.  DOI: 10.12114/j.issn.1007-9572.2024.0074

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Background

Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays a crucial role in lipid metabolism. The factors influencing PCSK9 in acute myocardial infarction (AMI) patients have not been fully understood.

Objective

To investigate the influence factors of PCSK9 among AMI patients.

Methods

Patients with an admission diagnosis of AMI between 2010 and 2018 were consecutively enrolled in the Department of Cardiology, Peking University First Hospital. Baseline information was collected from patients' current history, past history, and physical examination in the electronic medical record system at admission, and baseline plasma PCSK9 levels were measured. The related factors of PCSK9 were analyzed using univariate and multivariate linear regressions. The LASSO method was employed, the selected variables were subsequently included in the analysis of a multivariate linear regression model.

Results

996 AMI patients were consecutively enrolled from 2010 to 2018, and 37 patients with no PCSK9 measurement results due to insufficient volume of retained blood samples were excluded. A total of 959 patients were included in the analysis. The median PCSK9 levels were 543.1 (425.4, 692.1) ng/mL. The multivariate linear regression analysis of non-genetic factors of PCSK9 showed that gender had the greatest effect (standardized regression coefficient was 0.13). Other significant factors related to PCSK9 levels were history of atrial fibrillation (standardized regression coefficient was 0.09), white blood cell count (standardized regression coefficient was 0.07) and uric acid levels (standardized regression coefficient was 0.07) .

Conclusion

In patients with AMI, gender, history of atrial fibrillation, blood white blood cell count, and uric acid levels were significant independent factors related to plasma PCSK9 levels.

Application of Internet-based Self-management Intervention in the Clinical Treatment of Middle-aged and Elderly Female Patients with Stress Urinary Incontinence: a Randomized Controlled Trial

LIANG Jing, ZHANG Kui, NIU Lichun, ZHANG Ying

2024, 27(36):  4575-4581.  DOI: 10.12114/j.issn.1007-9572.2023.0720

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Background

Stress urinary incontinence (SUI) is one of the common diseases in middle-aged and elderly women, which seriously affects their quality of life and physical and mental health. Internet medicine has the advantages of flexibility, privacy and accessibility, which can be used as an effective approach of self-management intervention for urinary incontinence patients. However, its effectiveness on the clinical treatment of middle-aged and elderly female SUI patients is unclear.

Objective

To explore the effects of Internet-based self-management intervention on improving clinical symptoms, self-efficacy, and psychological status in middle-aged and elderly female SUI patients.

Methods

A total of 120 middle-aged and elderly female SUI patients treated in the Air Force 986 Hospital of PLA from January to December 2022 were recruited. They were randomly assigned into control group (n=60) and experimental group (n=60) by double-blind random number table method. Patients in both groups were given conventional pelvic floor muscle training (PFMT), with 20 minutes per day, once every other day for a course of 10 times of PFMT, and those in the experimental group were additionally given Internet-based self-management intervention for 6 months. Outpatient re-examination and follow-up visits were conducted before treatment and 3 and 6 months after treatment. Clinical symptoms of SUI in middle-aged and elderly female patients were evaluated by surveying the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF) and 1-hour pad test, thus determining the clinical efficacy. The Broome Pelvic Muscle Self-efficacy Scale (BPMSES) was used to evaluate the self-management efficacy. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to evaluate the anxiety and depression status, respectively.

Results

The ICI-Q-SF scores of experimental group at 3 months [ (6.58±3.91) points vs. (9.27±3.11) points, P<0.05] and 6 months [ (3.37±2.74) points vs. (7.41±3.55) points, P<0.001] after treatment were significantly lower than those of control group. Urinary loss in 1-hour pad test at 3 months [ (4.83±1.64) g vs. (5.29±2.34) g, P<0.05] and 6 months [ (2.16±0.88) g vs. (3.87±1.66) g, P<0.01] after treatment was significantly less in the experimental group than that of control group. The total clinical effective rate of the control group was significantly lower than that of the experimental group (78.33%, 47/60, vs. 91.67%, 55/60, χ²=6.227, P=0.044). The total scores of BPMSES in the experimental group at 3 months [ (105.70±15.68) points vs. (77.90±17.52) points, P<0.05] and 6 months [ (126.61±16.64) points vs. (108.12±15.74) points, P<0.05] after treatment were significantly higher than those of control group. The expected self-efficacy scores of the experimental group at 3 months [ (69.27±5.91) points vs. (59.08±6.84) points, P<0.05] and 6 months [ (79.71±10.41) points vs. (61.17±6.92) points, P<0.001) ] after treatment were significantly higher than those of control group. The expected efficacy scores at 3 months [ (58.17±8.69) points vs. (50.26±9.04) points, P<0.05] and 6 months [ (64.93±7.84) points vs. (50.17±8.76) points, P<0.001) after treatment were significantly higher in the experimental group than those of the control group. The SAS scores [3 months (43.29±7.71) points vs. (45.25±7.50) points, P<0.05; 6 months (39.18±8.32) points vs. (42.58±8.39) points, P<0.001] and SDS scores [3 months (46.86±10.62) points vs. (47.17±10.22) points, P<0.05; 6 months (38.68±11.24) points vs. (42.54±10.31) points, P<0.001] at 3 months and 6 months were significantly lower in the experimental group than those of the control group.

Conclusion

Internet-based self-management intervention can significantly improve the self-management efficacy of middle-aged and elderly female SUI patients and alleviate psychological states of depression and anxiety, thus enhancing the clinical efficacy of PFMT on middle-aged and elderly female SUI patients. It provides unique advantages in improving treatment compliance and relieving negative psychological factors in middle-aged and elderly female SUI patients. Serving as a safe, effective and economic friendly intervention, Internet-based self-management intervention is worthy of clinical promotion to middle-aged and elderly female SUI patients.

Construction of an Artificial Intelligence-assisted System for Automatic Detection of Pressure Injury Based on the YOLO Neural Network

WANG Zhenni, XU Yueping, XIA Kaijian, XU Xiaodan, GU Lihua

2024, 27(36):  4582-4590.  DOI: 10.12114/j.issn.1007-9572.2024.0168

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Background

With the aging population, the incidence of pressure injury (PI) is gradually increasing. This not only severely impacts the quality of life for patients but also increases healthcare expenditures. However, the early detection and accurate staging of PI heavily depend on specialized training.

Objective

To construct and validate an artificial intelligence model for the automatic detection and staging of PI aimed at enhancing the real-time nature, accuracy, and objectivity of PI diagnostics.

Methods

A total of 693 PI images from the electronic management system of pressure ulcers at Changshu No.1 People's Hospital were selected from January 2021 to February 2024, the images were randomly divided into a training set (551 images) and a test set (142 images), and categorized into six stages according to National Pressure Ulcer Advisory Panel (NPUAP) guidelines: StageⅠ (154 images), StageⅡ (188 images), StageⅢ (160 images), StageⅣ (82 images), deep tissue injury (57 images), and unstageable (52 images). A deep learning object detection model for PI was established using five different versions of the YOLOv8 [nano (n), small (s), medium (m), large (l) and extra large (x) ] neural network and transfer learning. The model evaluation metrics included accuracy, sensitivity, specificity, false positive rate, and detection speed. Finally, the model was deployed to a mobile application via the Ultralytics Hub platform, facilitating the application of the AI model in clinical practice.

Results

During the evaluation of a test set containing 142 PI images, the YOLOv8l version demonstrated high accuracy (0.827) and fast inference speed (68.49 fps), achieving the best balance between precision and speed among the YOLO versions. Specifically, it achieved an overall accuracy of 93.18% across all categories, a sensitivity of 76.52%, a specificity of 96.29%, and a false positive rate of 3.72%. Among the six stages of PI, the model achieved the highest accuracy for StageⅠat 95.97%. The accuracies for StageⅡ, StageⅢ, StageⅣ, deep tissue injury, and unstageable were 91.28%, 91.28%, 91.95%, 95.30%, and 93.29%, respectively. In terms of processing speed, YOLOv8l took a total of 2.07 seconds to process 142 images, averaging 68.49 PI images per second.

Conclusion

The AI model based on the YOLOv8l network can quickly and accurately detect and stage PI. Deploying this model to a mobile app allows for portable use in clinical practice, demonstrating significant potential for clinical application.

Importance Measurement and Moderating Effect of Influencing Factors for Proactive Health in Undergraduates

ZHAO Meng, XU Mengyuan, ZHAO Zhongtao, LOU Pengyu

2024, 27(36):  4591-4597.  DOI: 10.12114/j.issn.1007-9572.2023.0286

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Background

Undergraduates, as the backbone of the youth group and highly educated members of the family and society, had a strong radiating function on the health of the whole population. Undergraduates have good health awareness but poor health behaviors, and the realization of proactive health among undergraduates faces a series of challenges that require conceptual change and action support.

Objective

To study the influencing factors of proactive health of undergraduates and provide suggestions for health education in colleges and universities.

Methods

A total of 4 036 undergraduates from 6 universities in Shandong Province were selected by stratified cluster sampling method to conduct a questionnaire survey on proactive health by using self-designed questionnaires (including general information questionnaires and proactive health scales). Pearson correlation analysis and multiple linear regression analysis were used for the analysis of factors affecting proactive health, and the importance of influencing factors was analyzed using random forest metrics.

Results

The proactive health score of undergraduates was 24.61±4.65 score. Females had higher active health scores than males, while lower grade undergraduates had higher proactive health scores than higher grade (P<0.05). IncNodePurity of health responsibility, health publicity, parent-child relationship and health investment were 32 491.77, 13 331.00, 10 051.22 and 9 902.84, respectively. Health publicity (β=0.024, 95%CI=0.039-0.171, P<0.001), health communication needs (β=0.026, 95%CI=0.043-0.145, P<0.001), curriculum practice activities (β=0.033, 95%CI=0.069-0.167, P<0.001), desired state (β=0.033, 95%CI=0.008-0.019, P<0.001), and diet (β=0.019, 95%CI=0.027-0.161, P<0.001) positively regulated the relationship between health responsibility and proactive health.

Conclusion

Health responsibility was the key factor affecting proactive health. Health publicity, health communication needs, curriculum practice activities, desired state and diet have positive interaction with health responsibility, which enhance individual proactive health. It is suggested to form diversified health promotion relationships by creating an active ecological environment of proactive health, building classroom, performing extracurricular and self-practice education mode, and improving initiatives to promote proactive health such as synergy path of health policy.

Research on Tools/Methods in General Practice

Study of Techniques and Methods for Building a Database of Lung Auscultation Sounds

ZHANG Dongying, YE Peitao, LI Qiasheng, JIAN Wenhua, LIANG Zhenyu, ZHENG Jinping

2024, 27(36):  4598-4608.  DOI: 10.12114/j.issn.1007-9572.2023.0863

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Currently, the results of lung sound auscultation with either physical or electronic stethoscopes still rely mainly on the doctor's professional auscultation identification ability, which has not yet been able to realise intelligent diagnosis and interpretation. When patients are affected by lung diseases at home, they are unable to detect lung abnormalities on their own and delay treatment; when they are in the process of rescue and treatment of respiratory infectious diseases, in-ear stethoscopes are easily contaminated and cause nosocomial infections. Although stethoscopic sounds contain a wealth of information about health status, the lack of standardised collection methods, classification criteria and analysis tools has limited the objective analysis and application of stethoscopic sounds in practice. In this study, the data collection, arrangement and database design of the lung auscultation sound were carried out by using the unified auscultation sound collection equipment and process. The study used the software MetlabR2017a for data management and analysis to create a database of lung auscultation sounds in a healthy group and a group of patients with lung disease. A database of lung auscultation sounds was established for healthy groups and groups of patients with lung diseases. A standard set of classification of auscultatory tones, labelling specifications, audio characteristic signal parameters were developed. Building a system for storing, managing and analysing lung auscultation sound data to provide important data support for research related to the screening and monitoring of lung diseases and the translation of medical artificial intelligence applications. The study accumulated the experience of building an audio database of lung auscultation sounds, provided a useful reference for the management and analysis of the audio database, and laied the foundation for supporting the subsequent application of medical artificial intelligence-assisted auscultation in the screening and monitoring of lung diseases, which was of great medical value and practical application.

Research of Typical Cases

Clinical Manifestations of 30 Patients with Hereditary Hemorrhagic Telangiectasia

WANG Shihong, LI Jing

2024, 27(36):  4609-4614.  DOI: 10.12114/j.issn.1007-9572.2024.0076

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Background

Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disorder that primarily affects the vasculature and exhibits a broad spectrum of clinical manifestations. There is a paucity of detailed literature on its clinical characteristics.

Objective

This study aims to deepen the understanding of HHT's clinical aspects by documenting the presentations, management, and outcomes of 30 patients diagnosed with the condition, thereby improving recognition and treatment approaches among healthcare professionals.

Methods

A retrospective review was conducted on 30 HHT cases treated at Peking Union Medical College Hospital from December 2012 to September 2023, focusing on analyzing their clinical features, therapeutic interventions, and follow-up outcomes.

Results

The study included 8 males and 22 females, with a mean onset age of 20.0 years (range 10.5-34.0 years) and an average disease duration of 19.5 years (range 7.8-26.0 years). Epistaxis was universally present (100.0%), skin and mucosal telangiectasia were noted in 27 patients (90.0%), and 28 (93.3%) exhibited involvement of internal organs, including liver in 24 (80.0%), lungs in 15 (50.0%), gastrointestinal tract in 5 (16.7%), and brain in 3 (10.0%). Additionally, pulmonary hypertension was observed in 17 (56.7%) and iron deficiency anemia in 15 (50.0%). Genetic analysis in 15 patients identified ACVRL1 mutations in 12, ENG mutations in 2, and one patient with both. Beyond routine symptomatic care, some patients underwent targeted medical or interventional treatments, with the majority showing clinical improvement.

Conclusion

HHT is a systemic disorder affecting multiple organs, with frequent liver and occasional brain involvement. It commonly leads to serious complications such as pulmonary hypertension and iron deficiency anemia. Detailed patient history, thorough examinations, targeted screening of visceral vessels, and genetic testing are essential for early diagnosis and effective management in suspected cases.

A Case Report of Neonatal Beckwith-Wiedemann Syndrome and Literature Review

ZENG Liuyu, YANG Xiufang

2024, 27(36):  4615-4620.  DOI: 10.12114/j.issn.1007-9572.2024.0144

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Beckwith-Wiedemann syndrome (BWS) is a growth disorder in which BWS is associated with aberrant expression of genes imprinted in the critical region of BWS and is considered a clinical spectrum in which affected individuals may have many or only one or two typical clinical features. Postnatal neonatal screening is particularly important to facilitate early diagnosis and treatment of this disorder. In this paper, we report a case of a neonate with a large tongue as the first symptom, hypoglycemia during hospitalization, and umbilical hernia in the late follow-up, and genetic testing results suggesting that he carried a c.235T>C (p.Trp79Arg) variant as a missense variant in the coding region of the cyclin dependent kinase inhibitor 1C (CDKN1C) gene, and that a T→C transition in nucleotides at position 235 of the CDKN1C gene, i.e., a missense mutation in the amino acid located in amino acid 79. This resulted in the mutation of tryptophan to arginine. Combining the clinical features of the child with the genetic test results, the diagnosis of BWS was confirmed. The purpose of this case report and the related genetic research progress is to improve the understanding of the clinical diagnosis and treatment of BWS, and to avoid misdiagnosis and under-diagnosis.