Table of Content

15 May 2023, Volume 26 Issue 14

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Guide·Consensus

Guidelines for the Diagnosis and Treatment of Primary Osteoporosis (2022)

Chinese Society of Osteoporosis and Bone Mineral Research

2023, 26(14):  1671-1691.  DOI: 10.12114/j.issn.1007-9572.2023.0121

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Expert Consensus for Management of Myocardial Injury, Myocarditis, and Post-infection Condition with Coronavirus Disease 2019 (Second Edition)

National Center of Gerontology, Electrocardiology and Cardiac Function Branch of Chinese Geriatric Society, Imaging Group of Cardiovascular Department, Beijing Medical Association, Chinese Medical and Health Culture Association Cardiovascular Health and Science Sports Branch of China Health Culture Association

2023, 26(14):  1692-1702.  DOI: 10.12114/j.issn.1007-9572.2023.0083

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Evidence shows that coronavirus disease 2019 (COVID-19) can impact multiple bodily systems, with the cardiovascular system being commonly affected. In order to guide healthcare providers in diagnosing and managing cardiovascular issues related to COVID-19, the consensus group recommends: (1) Routine cardiac troponin testing is necessary for patients who are hospitalized or exhibit symptoms related to heart conditions after COVID-19 infection to evaluate potential myocardial injury and help detect any cardiac complications. Patients with myocardial injury not related to heart issues tend to have a poorer outcome. (2) Relatively few cases of acute myocarditis linked to COVID-19 have been reported, and individuals suspected of having myocarditis should be evaluated and managed based on risk stratification. (３) COVID-19 infection should be considered a risk factor for increasing the incidence of cardiovascular disease. All individuals who have been infected should adhere to a healthy lifestyle more strictly and implement appropriate primary or secondary preventive measures for cardiovascular disease. (4) For individuals who experience the persistence or emergence of new symptoms 3 months after the initial COVID-19 infection and have been experiencing these symptoms for at least 2 months, with no clear diagnosis of a cardiovascular disease through standard diagnostic tests, it is advisable to consider the possibility of "post COVID-19 condition". Rehabilitation should be given top priority for these patients.

Original Research

A Ten-year Cohort Study of the Association between Cardiometabolic Risk Factor Cluster and All-cause Mortality Risk among Community-dwelling Aged 55 and Over Adults

MA Wanrui, MA Qianfeng, WU Jingjie, WANG Liqun, WANG Zhizhong

2023, 26(14):  1703-1708.  DOI: 10.12114/j.issn.1007-9572.2022.0658

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Background

Cardiometabolic risk factor cluster (CRFC) is a common health issue among aged 55 and over adults. Available studies mainly focus on the distribution of its epidemiological characteristics, but rarely assess the association between CRFC and all-cause mortality risk.

Objective

To explore the association between CRFC and all-cause mortality risk among community-dwelling aged 55 and over adults, to provide evidence for developing healthcare interventional programs for this group.

Methods

By use of typical sampling, this study selected 1 046 community-dwelling aged 55 and over adults from five urban communities in Wuzhong and Yinchuan cities of Ningxia Hui Autonomous Region during September to November 2011. And sociodemographic questionnaire survey, health check-up, ultrasonic examination, laboratory test and CRFC assessment 〔nine cardiometabolic risk factors, including central obesity, hypercholesterolemia, hypertriglyceridemia, elevated LDL-cholesterol, decreased HDL-cholesterol, hypertension, diabetes, hyperuricemia, and nonalcoholic fatty liver disease (NAFLD) 〕, were included in the multivariate Cox regression model to calculate the regression coefficient β of them after adjusting for confounders, then the coefficient of each factor was used as the weight to calculate the total risk score by adding them together were finished at baseline. The participants were followed up in 2017, 2019, and 2021 by face-to-face interview coupled with searching the national death surveillance system. Log-rank test was used to compare the survival curves for all-cause mortality plotted using the Kaplan-Meier method for tertile groups of the total cardiometabolic risk score (<P₅₀, P₅₀-P₇₅, and >P₇₅) . The Cox regression model was employed to assess the association of all-cause mortality risk with sociodemographics, cardiometabolic risk factors, the total cardiometabolic risk score, the level of the total cardiometabolic risk score, and age.

Results

The participants had an average age of (66.4±6.6) years (range: 55-88) at baseline. One hundred and six death cases were identified with a ten-year accumulated mortality rate of 10.13%. The individuals in >P₇₅ group had much lower accumulated mortality rate than the other two groups, indicating that the median survival time decreased with the increase in the total cardiometabolic risk score. Multivariate Cox regression analysis showed that age, sex, living alone and education level may be associated with all-cause mortality risk (P<0.05) . After adjusting for sociodemographic variables, the multivariate Cox regression model revealed that the cardiometabolic risk factor cluster was associated with increased risk of all-cause mortality〔HR=3.04, 95%CI (1.55, 5.97) , P=0.001〕, and a dose-response effect was found that higher score was associated with an increased risk of death〔HR=2.02, 95%CI (1.16, 3.50) , P=0.013〕for > P₇₅ when compared with risk score lower than P₅₀) . When stratified by age group, the association only persisted among those aged 65 and over〔HR=2.79, 95%CI (1.36, 5.74) , P=0.005〕; >P₇₅ group had higher risk of death than P₅₀ group〔HR=1.83, 95%CI (1.02, 3.28) , P=0.042〕.

Conclusion

The CRFC was positively associated with all-cause mortality risk among community-dwelling aged 55 and over adults, and higher level of clustering was associated with higher all-cause mortality risk. The findings indicate that early assessment and intervention of CRFC may play a role in improving the healthcare and reducing the risk of death in this population .

Effects of Cardiovascular Risk Factors on the Progression of Carotid Intima-media Thickening

CHEN Runlin, HE Tufeng, TAO Lijun, QIN Lingqiao, ZHANG Dacheng, ZHANG Yifan, ZHAO Min, ZHONG Qiuan

2023, 26(14):  1709-1715.  DOI: 10.12114/j.issn.1007-9572.2022.0750

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Background

As an alternative indicator of atherosclerosis, the prevention of carotid intima-media thickening is conductive to the primary prevention of atherosclerosis, but contributions of cardiovascular risk factors to carotid intima-media thickening are not clear.

Objective

To identity the controllable risk factors of carotid intima-media thickening, and to perform a dominance analysis of these factors in terms of percentage of contribution in people without major diseases, so as to provide a reference for the determination of key issues related to early prevention and control of cardiovascular diseases.

Methods

A total of 738 residents were recruited from Liuzhou, Guangxi Zhuang Autonomous Region from 2019 to 2021. By use of a questionnaire survey and a physical examination, participant information was collected, including demographics, biomarkers in fasting whole blood and urine samples, carotid intima-media thickness (CIMT) and internal diameter of the common carotid artery measured by color Doppler ultrasonography. The aforementioned information was compared between residents with normal CIMT (CIMT <1 mm, n=693) and those with thickened CIMT (CIMT≥1 mm, n=45) . Logistic regression model with adaptive Lasso was established with thickened CIMT as dependent variable to screen its potentially associated factors, then the identified ones were further analyzed using multivariate logistic regression, and the percentage of contribution of each identified associated factor to thickened CIMT was estimated using dominance analysis. Moreover, potential factors associated with naturally logarithmized CIMT were screened using Adaptive Lasso linear regression, then the identified ones were further analyzed using multiple linear regression, and the percentage of contribution of identified associated factors to CIMT was estimated and ranked in descending order.

Results

There was statistically significant difference in gender, age, ethnicity, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , smoking status, common carotid artery diameter, total cholesterol (TC) , urinary microalbumin creatinine ratio (ACR) , lipoprotein A (LPA) , vascular cell adhesion factor 1, apolipoprotein A/ Apolipoprotein B (ApoA/ApoB) , C-reactive protein (CRP) , urinary microalbumin (ALB) and physical activity level (PHYMET) (P<0.05) . Eleven factors potentially associated with thickened CIMT were identified by adaptive Lasso-logit regression analysis, including internal diameter of the common carotid artery, SBP, TC, overweight/obesity, ACR, physical activity level, CRP, LPA, renal function, VCAM-1, and ApoA/ApoB ratio. And 12 factors potentially associated with CIMT were identified by adaptive Lasso linear regression analysis, i.e., internal diameter of the common carotid artery, SBP, TC, physical activity level, ACR, smoking, alcohol consumption, CRP, LPA, ApoA/ApoB ratio, fasting plasma glucose, and family history of diabetes mellitus. Multivariate Logistic regression analysis revealed that risk factors for thickened CIMT were elevated SBP〔OR=1.032, 95%CI (1.013, 1.050) 〕, TC〔OR=1.558, 95%CI (1.049, 2.315) 〕, decreased physical activity level〔OR=2.226, 95%CI (1.289, 3.844) 〕, and elevated CRP〔OR=1.462, 95%CI (1.043, 2.050) 〕, and the percentage of contribution to thickened CIMT of them ranked from high to low was elevated SBP (63.7%) , elevated CRP (16.1%) , elevated TC (12.4%) and decreased physical activity level (7.8%) . Multiple linear regression analysis showed that SBP (β=0.017, P<0.001) , current smoking (β=0.076, P=0.021) , TC (β=0.020, P=0.021) , and physical activity level (β=0.022, P=0.034) were influential factors for CIMT (P<0.05) , and the percentage of contribution to thickened CIMT of them ranked descendingly was SBP (68.7%) , current smoking (19.9%) , TC (8.8%) , and physical activity level (2.6%) .

Conclusion

In our study, elevated SBP, TC, and CRP as well as reduced physical activity level were risk factors of CIMT thickening, and the percentage of contribution of them ranked from high to low was elevated SBP, elevated CRP, elevated TC, reduced physical activity level. The CIMT was significantly correlated with SBP, current smoking, TC and physical activity level, and the percentage of contribution of them ranked descendingly was SBP, current smoking, TC, physical activity level. Therefore, targeted measures for early control and prevention of cardiovascular diseases should keep in line with the controllable influencing factors and their contribution levels.

Predictive Value of Cardiometabolic Index for Metabolically Obese Phenotype in Normal Weight Population

CHEN Yijia, QI Shengxiang, DU Jinling, WANG Chenchen, ZHOU Hairong, YE Qing, QIN Zhenzhen, SU Jian, WU Ming, HONG Xin

2023, 26(14):  1716-1725.  DOI: 10.12114/j.issn.1007-9572.2022.0755

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Background

Cardiometabolic index (CMI) is a simple index to measure blood lipid, which is closely related to diabetes and stroke. Metabolically obese normal weight (MONW) individuals have higher risks of morbidity and mortality of diabetes and cardiovascular and cerebrovascular diseases. Correctly identifying individuals with MONW phenotype is essential for the prevention and control of metabolism-related diseases. However, there are few studies on the predictive value of CMI for MONW phenotype.

Objective

To investigate the association between CMI and MONW phenotype, and to evaluate the predictive value of CMI for MONW phenotype.

Methods

The multistage stratified cluster sampling method was used to select permanent residents aged ≥18 years as subjects from Nanjing. The investigation time was from January 1, 2017 to June 30, 2018. The basic data of subjects were collected and multivariate robust Poisson regression model was used to evaluate the RR value with 95%CI of CMI for MONW phenotype. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of CMI, waist-to-height ratio (WHtR) , triglyceride/ high-density lipoprotein cholesterol (TG/HDL-C) ratio, waist circumference (WC) and body mass index (BMI) for MONW phenotype. DeLong test was used to compare the area under the ROC curve (AUC) of the above-mentioned five indicators, and to further explore the value of CMI in predicting MONW phenotype in different gender and age groups.

Results

A total of 30 408 people were included, including 13 213 males and 17 195 females, 23 691 cases of MHNW and 6 717 cases of MONW. There was statistically significant difference in age, education, occupation, current smoking, alcohol consumption, physical activity, duration of static behavior, high red meat intake, disease history, medication history, height, waist circumference (WC) , body mass index (BMI) , total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) , systolic blood pressure (SBP) , diastolic blood pressure (DBP) , fasting blood glucose (FPG) , TG/HDL-C, waist-height ratio (WHtR) and CMI (P<0.05) . There was statistically significant difference in age, education, occupation, current smoking, alcohol consumption, duration of static behavior, high red meat intake, history of disease, medication, height, WC, BMI, TC, TG, HDL-C, LDL-C, SBP, DBP, FPG, TG/HDL-C, WHtR, and CMI of male MHNW and NONW phenotypes (P<0.05) . There was statistically significant difference in age, education, occupation, current smoking, alcohol consumption, physical activity, duration of static behavior, history of disease, medication, height, WC, BMI, TC, TG, HDL-C, LDL-C, SBP, DBP, FPG, TG/HDL-C, WHtR, and CMI of the female MHNW and NOWN phenotype subjects (P<0.05) . The number of Q1 to Q4 groups was 7 739, 7 940, 7 904, 6 825, and the CMI range was ≤0.253, 0.254 to 0.382, 0.383 to 0.539, and ≥0.540, respectively. Male subjects in Q1 to Q4 were 2 697, 3 410, 3 661, 3 445, and the CMI range was ≤0.281, 0.282 to 0.407, 0.408 to 0.569, and ≥0.570, respectively. 5 042, 4 530, 4 243 and 3 380 female subjects in Q1 to Q4 group were studied, and the CMI ranges were ≤0.235, 0.236-0.361, 0.362-0.516 and ≥0.517, respectively. After adjusting for confounding factors, the CMI quartile grouping was the factor affecting metabolic phenotype in all subjects, male subjects, and female subjects (P<0.05) . Multivariate robust Poisson regression model analysis showed that the risk of MONW phenotype in the general population, male and female increased by 68%, 55% and 81% with each additional SD of CMI. In male subjects, CMI predicted MONW phenotype better than WHtR (Z=18.97, P<0.001) , TG/HDL-C (Z=12.53, P<0.001) , WC (Z=23.85, P<0.001) and BMI (Z=24.13, P<0.001) . The predictive power of CMI for MONW phenotype in female subjects was higher than that of WHtR (Z=27.38, P<0.001) , TG/HDL-C (Z=15.27, P<0.001) , WC (Z=30.83, P<0.001) and BMI (Z=30.84, P<0.001) . The AUC value of CMI predicted MONW phenotype in female subjects was higher than that in male subjects (Z=-6.10, P<0.001) , and the difference was statistically significant. In male subjects, the AUC predicted by CMI from 18 to 34 years old was 0.835〔95%CI (0.818, 0.852) 〕, higher than that of 35 to 44 years old (Z=1.55, P=0.04) , 45 to 54 years old (Z=6.92, P<0.001) , 55 to 64 years old (Z=4.95, P<0.001) , ≥65 years old (Z=7.92, P<0.001) ; In female subjects, the AUC predicted by CMI from 18 to 34 years old was 0.832〔95%CI (0.817, 0.847) 〕, which was higher than that of 35 to 44 years old (Z=1.95, P=0.03) , 45 to 54 years old (Z=2.56, P=0.02) , 55 to 64 years old (Z=3.79, P<0.001) , ≥65 years old (Z=5.71, P<0.001) .

Conclusion

CMI was positively associated with the risk of the MONW phenotype, which has strong predictive power and can be used as an effective tool to identify MONW phenotype in the general population, especially in 18-34 years-old people.

The Predictive Value of Ankle Brachial Index, Brachial-ankle Pulse Wave Velocity, Flow-mediated Dilation Combined with Apolipoprotein B to Apolipoprotein A-1 Ration on Coronary Heart Disease with Blood Stasis Syndrome in Middle-aged and Young Adults

CHEN Ying, WANG Zihan, XUE Chongxiang, TAO Shiyi, SUN Ziyi, HUANG Li

2023, 26(14):  1726-1732.  DOI: 10.12114/j.issn.1007-9572.2022.0830

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Background

Coronary heart disease (CHD) belongs to the category of "pectoral stuffiness and pains" in traditional Chinese medicine (TCM) . Blood stasis syndrome is the most common syndrome distribution and the incidence of that in middle-aged and young adults is higher than old adults. Expending on the previous team study, the artery stiffness, vascular endothelial function and apolipoprotein ration were combined for the diagnosis of CHD with blood stasis syndrome in middle-aged and young adults for the first time in the study, in order to provide new approaches for the early detection and reference for optimising diagnostic criteria of CHD with blood stasis syndrome in middle-aged and young adults.

Objective

To investigate the correlation between ankle brachial index (ABI) , brachial-ankle pulse wave velocity (baPWV) , flow-mediated dilation (FMD) , apolipoprotein B to apolipoprotein A-1 ratio (apoB/apoA-1) and CHD with blood stasis syndrome in middle-aged and young adults (<50 years old) and their diagnostic predictive value, respectively.

Methods

Middle-aged and young patients with CHD hospitalized in the Department of Integrative Cardiology of China-Japan Friendship Hospital from December 2016 to December 2021 were selected as the objects and divided into blood stasis syndrome group and non-blood stasis syndrome group according to Diagnostic Criteria of Blood Stasis Syndrome of Coronary Heart Disease. Clinical data such as ABI, baPWV, FMD and apoB/apoA-1 were collected before the first coronary angiography (CAG) was collected. Multivariate Logistic regression analysis was used to construct a predictive model for CHD with blood stasis syndrome in middle-aged and young adults. Receiver operator characteristic (ROC) curve was used to evaluate the accuracy of the prediction model.

Results

A total of 206 middle-aged and young patients of CHD with blood stasis syndrome were included in this study, including 127 cases in the blood stasis syndrome group and 79 cases in the non-blood stasis syndrome group. The results of multivariate Logistic regression analysis showed that ABI, baPWV, FMD, apoB/apoA-1 are the influencing factors of CHD with blood stasis syndrome in middle-aged and young adults (P<0.05) . The predictive model equation was P=1/ [1+e^{- (5.519-0.599×ABI+0.297×baPWV-0.515×FMD+0.172×apoB/apoA-1)} ] . The area under the curve (AUC) for ABI, baPWV, FMD, apoB/apoA-1 and predictive model were 0.647, 0.676, 0.680, 0.606 and 0.807, the sensitivity and specificity of the predictive model were 0.740 and 0.734, respectively.

Conclusion

ABI, baPWV, FMD and apoB/apoA-1 are independent influencing factors of the CHD with blood stasis syndrome in middle-aged and young adults. The combination of the four factors is of high value in predicting CHD with blood stasis syndrome, providing reference for the early detection of these patients.

Effects of Dapagliflozin on the Expression of MicroRNA-423-5p and Cardiac Function in Patients with Type 2 Diabetes Mellitus and Chronic Heart Failure

CHEN Ruimin, LIU Fang, TAN Hong, HAN Shufang, CHEN Yingjian, SU Congcong

2023, 26(14):  1733-1738.  DOI: 10.12114/j.issn.1007-9572.2022.0840

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Background

There are numerous patients with diabetes complicated with heart failure. Dapagliflozin is a new hypoglycemic drug that has been used for heart failure according to guideline recommendation, however, its mechanism of improving heart function has not been fully defined.

Objective

To study the effects of dapagliflozin on the expression of plasma miRNA-423-5p and cardiac function in patients with type 2 diabetes mellitus (T2DM) and chronic heart failure (CHF) .

Methods

Fifty patients with T2DM complicated with CHF admitted to the 960th Hospital of PLA from April 1 to November 30, 2021 were enrolled and randomly divided into dapagliflozin group (n=25) and control group (n=25) . Both groups received the same treatment for six months except that dapagliflozin group received dapagliflozin 10 mg/d per day, and the control group received other hypoglycemic drugs. They were compared to healthy physical examinees with normal cardiac function (healthy group, n=25) . Basic data of the patients were collected through the electronic medical record system, including age, sex, smoking history, hypertension, blood pressure level, body mass index (BMI) , blood lipid, blood glucose, creatinine (Cr) , amino-terminal pro-B-type natriuretic peptide precursor (NT-proBNP) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , NYHA class, results of cardiac color ultrasound and drug combination. Blood samples were collected for the detection of miRNA-423-5p. A six-month follow-up was given to the patients with the time of first administration of dapagliflozin after inclusion as the starting point, during which patients' cardiac function indices and miRNA-423-5p were measured and collected at the end of four weeks of treatment, and their cardiac function indices, blood pressure level, ALT, AST, and Cr were measured at six months of treatment. Pearson correlation analysis or Spearman rank correlation analysis was used to analyze the correlation between miRNA-423-5p expression level and cardiac function indices of the patients.

Results

After 6 months of intervention, left ventricular ejection fraction (LVEF) , stroke output (SV) and left ventricular short-axis shortening rate (LVFS) in daglizin group were higher than those in control group, while left ventricular end-diastolic diameter (LVEDD) was lower than those in control group (P<0.05) . After 4 weeks and 6 months of intervention, LVEDD in 2 groups was lower than before intervention, while LVEF, SV and LVFS in 2 groups were higher than before intervention (P<0.05) . After 4 weeks of intervention, the level of NT-proBNP and miRNA-423-5p in Dagliegine group was lower than that in control group (P<0.05) , the level of NT-proBNP and miRNA-423-5p in two groups after intervention was lower than that before intervention in the same group (P<0.05) . The results of correlation analysis showed that the expression level of miRNA-423-5p was positively correlated with the level of NT-proBNP (r_s=0.609, P<0.05) , and negatively correlated with the level of LVEF (r=-0.406, P<0.05) .

Conclusion

Dapagliflozin could improve cardiac function, reduce the levels of NT-proBNP and LVEDD, and increase the levels of LVEF, SV and LVFS in patients with T2DM and CHF, and the mechanism of action may be related to its regulation of the expression of plasma miRNA-423-5p .

Effect of Atrial Fibrillation on the Risk of New-onset Myocardial Infarction in Hypertensive Population

YUE Bocheng, HOU Qiqi, HAN Quanle, YANG Bo, WU Zheng, WU Jianmei, CHEN Shuohua, WU Shouling, LI Kangbo

2023, 26(14):  1739-1744.  DOI: 10.12114/j.issn.1007-9572.2022.0734

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Background

Global population epidemiology research shows that by 2019, there were 1.28 billion hypertensive patients, and about 59.7 million patients with atrial fibrillation (AF) worldwide. Hypertension greatly increases the risk of AF. And in older hypertensive patients, the incidence of AF will be higher than 60%. Moreover, AF increases the risk of ischemic stroke, heart failure, myocardial infarction, chronic kidney disease and dementia. However, there are few studies on whether AF increases the risk of new-onset myocardial infarction, and whether the risk interacts with age is still unclear in large hypertensive populations.

Objective

To examine whether AF increases the risk of new-onset myocardial infarction in hypertensive patients.

Methods

Individuals with hypertension were selected as subjects from the employees of Kailuan Group who underwent the medical check-up in Tangshan Gongren Hospital and Kailuan General Hospital from June 2006 to October 2007. General data and laboratory test results of subjects were collected. And all of them were regularly followed up until 2020-12-31. The endpoint event was new-onset myocardial infarction. The finally enrolled cases (n=42 833) included 270 with AF diagnosed by baseline ECG (AF group) and 42 563 without (non-AF group) . The cumulative incidence of myocardial infarction was calculated by the life table method. The survival curve for the cumulative incidence of new-onset myocardial infarction was plotted by Kaplan-Meier method. The difference of the cumulative incidence of myocardial infarction between AF and non-AF groups was compared by Log-rank test. Multivariate Cox proportional hazards regression model was used to investigate the effect of AF on new-onset myocardial infarction in hypertension.

Results

AF group had greater mean age, and lower mean levels of diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol than non-AF group (P<0.05) . There were also statistically differences in the incidence of myocardial infarction and cumulative incidence of new-onset myocardial infarction between the two groups (P<0.05) . After age-stratification, it was found that the differences in the incidence of new-onset myocardial infarction and cumulative incidence of myocardial infarction were statistically significant between those aged ≤60 years with AF and without AF (P<0.05) , but were insignificant between those aged > 60 years with and without AF (P>0.05) . Adjusted multivariate Cox proportional hazards regression analysis showed that AF was a risk factor for new-onset myocardial infarction in hypertensive population〔HR=2.89, 95%CI (1.74, 4.82) , P<0.01〕, and also in hypertensive population aged ≤60 years old〔HR=4.72, 95%CI (2.11, 10.56) , P<0.01〕.

Conclusion

AF is a risk factor for new-onset myocardial infarction in hypertensive population, especially in those ≤60 years old. Active control of blood pressure and treatment of AF are important prevention and treatment measures for new-onset myocardial infarction.

Influence of Gastroesophageal Variceal Bleeding on One-year Mortality and Associated Factors in Patients with Liver Cirrhosis

YU Xueke, LI Mengling, PENG Siyuan, SHEN Yueming, LIANG Lunxi, ZENG Ya

2023, 26(14):  1745-1752.  DOI: 10.12114/j.issn.1007-9572.2022.0730

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Background

Esophageal and gastric varices bleeding (EGVB) is one of the most common and dangerous complications of liver cirrhosis. However, whether EGVB affects the one-year mortality of patients with liver cirrhosis remains unclear.

Objective

To explore the influence of EGVB on one-year mortality and influencing factors in patients with liver cirrhosis, providing guidance for follow-up for these patients.

Methods

This study selected liver cirrhosis patients who were admitted to the Affiliated Changsha Central Hospital, University of South China from January 2015 to May 2021. The patients were divided into EGVB group and non-bleeding (control group) by the prevalence of EGVB at the first consultation. One-year routine follow-up was conducted with them until the date of death from liver cirrhosis or the termination follow-up day. Logistic regression analysis was conducted for screening the factors affecting one-year mortality. Furthermore, the covariates between the two groups were matched in a 1∶2 ratio using propensity score matching (PSM) . Then, Logistic regression analyses were applied to identify and compare the influencing factors of one-year mortality in the groups.

Results

Among the 812 patients enrolled, 158 (19.5%) were diagnosed with EGVB, and the other 654 (80.5%) had no EGVB. The one-year mortality of the EGVB and control groups was 13.3% (21/158) and 13.9% (91/654) , respectively, showing no significant difference (P>0.05) . Before PSM, multivariate Logistic regression analysis showed that elevated serum sodium level〔OR=0.95, 95%CI (0.90, 0.99) 〕 and albumin level [OR=0.95, 95%CI (0.91, 0.99) 〕 were associated with a decreased risk of one-year mortality (P<0.05) , while older age〔OR=1.04, 95%CI (1.02, 1.06) 〕 and hepatic encephalopathy (grade Ⅲ or Ⅳ) 〔OR=3.72, 95%CI (1.21, 11.37) 〕were associated with an increased risk (P<0.05) . After PSM, the one-year mortality was the same in EGVB group (n=145) and control group (n=290) 〔12.4% (18/145) vs 12.4% (36/290) 〕, showing no significant difference (P>0.05) . Moreover, elevated blood urea nitrogen (BUN) 〔OR=1.15, 95%CI (1.02, 1.29) 〕 was an independent risk factor for one-year mortality in EGVB group (P<0.05) , while older age〔OR=1.09, 95%CI (1.04, 1.14) 〕 and elevated neutrophil-to-lymphocyte ratio (NLR) 〔OR=1.09, 95%CI (1.00, 1.18) 〕 acted as independent risk factors for one-year mortality in the control group (P<0.05) .

Conclusion

EGVB had no obvious association with one-year mortality in liver cirrhosis patients. But there were considerable discrepancies in the risk factors affecting one-year mortality between the two groups. Elevated BUN was the independent risk factor for one-year mortality in the EGVB group, while older age and elevated NLR were independent risk factors for one-year mortality in the control group. These results provide a new reference for clinical follow-up and treatment of patients with liver cirrhosis.

Risk Factors of Enlarged Perivascular Space and Its Association with Fundus Lesions in Patients with Mild Acute Cerebral Infarction

ZHUANG Fei, LI Ping, HE Xing, SHI Yushan, SUN Liping

2023, 26(14):  1753-1757.  DOI: 10.12114/j.issn.1007-9572.2022.0667

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Background

Enlarged perivascular spaces (EPVS) have been reported to be associated with cerebral infarction, cerebral hemorrhage or cognitive dysfunction. However, there is still a lack of relevant reports on the risk factors of EPVS, especially fundus arteriovenous crossing phenomenon and fundus exudation in patients with mild acute cerebral infarction.

Objective

To investigate the risk factors of EPVS and the association between EPVS and fundus lesions in patients with mild acute cerebral infarction.

Methods

Two hundred and sixty-six patients with mild acute cerebral infarction were retrospectively chosen from the Fifth People's Hospital of Pingdingshan and Pingdingshan the Second People's Hospital in the period from January 2015 to December 2020, including 114 with EPVS, and 152 without. General demographics, laboratory test and imaging data were collected. Multivariate Logistic regression was used to analyze the independent influencing factors of EPVS in mild acute cerebral infarction. Spearman's rank correlation and multivariate linear regression were used to analyze the correlation between the severity and number of EPVS with fundus lesions.

Results

Among the 266 patients, 178 were male and 88 were female, with a mean age of (67.8±12.9) years. Patients with and without EPVS had significant differences in mean age, prevalence of hypertension history, mean severity of fundus arteriosclerosis, diameter of the central retinal artery, retinal arteriovenous ratio, prevalence of hemangioma and retinal arteriovenous crossing phenomenon (P<0.05) . Multivariate Logistic regression analysis showed that the history of hypertension〔OR=3.127, 95%CI (1.514, 6.457) , P=0.002〕and the severity of fundus arteriosclerosis〔OR=3.077, 95%CI (2.289, 4.137) , P<0.001〕were independent influencing factors of EPVS in mild acute cerebral infarction. Spearman's rank correlation analysis showed that the severity of EPVS was positively correlated with the severity of fundus arteriosclerosis (r_s=0.751, P<0.001) , hemangioma (r_s=0.644, P<0.001) , retinal arteriovenous crossing phenomenon (r_s=0.589, P<0.001) , and negatively correlated with the diameter of the central retinal artery (r_s=-0.342, P<0.001) , and the retinal arteriovenous ratio (r_s=-0.463, P=0.012) . Multivariate linear regression analysis showed that the number of EPVS was positively correlated with the severity of fundus arteriosclerosis〔B=0.586, 95%CI (0.345, 0.827) , P=0.016〕and retinal arteriovenous crossing phenomenon〔B=0.472, 95%CI (0.291, 0.653) , P=0.010〕, and negatively correlated with the retinal arteriovenous ratio〔B=-3.974, 95%CI (-5.548, -2.400) , P=0.012〕.

Conclusion

EPVS may be more likely to occur in mild acute cerebral infarction patients with hypertension and fundus arteriosclerosis, and the severity of EPVS is positively correlated with the severity of fundus arteriosclerosis, hemangioma and retinal arteriovenous crossing phenomenon, and negatively correlated with the diameter of the central retinal artery and retinal arteriovenous ratio.

Clinical Study of Characteristics of Acute Poisoning Caused by Calcium Channel Blockers

LI Hui, REN Zhen, GUO Zhiguo

2023, 26(14):  1758-1765.  DOI: 10.12114/j.issn.1007-9572.2022.0798

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Background

Calcium channel blockers (CCBs) are the most commonly used class of antihypertensive drugs in China. Despite the high mortality rate of severe CCBs poisoning, few relevant reports on its clinical characteristics can be found currently.

Objective

To analyze the clinical characteristics of acute CCBs poisoning and the value of blood purification therapy by summarizing the clinical manifestations and treatment results of 11 patients with acute CCBs poisoning.

Methods

A retrospective analysis was conducted with regard to the clinical presentation, scores for condition assessment, treatment process and prognosis of 11 patients who presented to the Emergency Department, Peking University Third Hospital for acute CCBs poisoning from January 2019 to June 2022.

Results

Of the 11 patients, 3 were female and 8 were male. The average age was (39.8±18.0) years and the median interval between drug administration and consultation was 2.25 (6.58) hours. The main clinical manifestations at presentation were shock (9 cases, 9/11) , nausea and vomiting (5 cases, 5/11) , dizziness (4 cases, 4/11) , fatigue (3 cases, 3/11) , tachycardia (3 cases, 3/11) , bradycardia (2 cases, 2/11) , syncope (1 case, 1/11) and lethargy (1 case, 1/11) . Ten patients arrived at the ED with a clear consciousness (with a Glasgow Coma Score of 15 points) . In addition to conventional treatment, 6 of the patients received blood purification treatment, including hemoperfusion, plasma exchange and continuous veno-venous hemofiltration (CVVH) in 2 cases, hemoperfusion combined with CVVH in 2 cases, and hemoperfusion alone in 2 cases. Four of these 6 patients also received extracorporeal membrane pulmonary oxygenation therapy. The blood concentration of CCBs decreased after the first blood purification treatment, and the percentage of decrease was higher for nifedipine (40.00%-63.64%) than for amlodipine and verapamil (9.09%-26.67%) . Nine of the 11 patients survived at discharge. The median Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score at admission was 10 (25) points. The median Poisoning Severity Score (PSS) at admission was 3 (1) points. Two of the 8 patients with a PSS score of 3 points at admission died, and two of the 5 patients with an APACHEⅡ score ≥15 points at admission died.

Conclusion

Clarity of consciousness at the early stage of shock is a more common manifestation of acute CCBs poisoning. Hemoperfusion may play a more effective role in acute nifedipine poisoning than in acute amlodipine and verapamil poisoning. The APACHEⅡ score may be superior to the PSS score in predicting the prognosis of death in acute poisoning of CCBs.

Evidence-based Medicine

Factors Affecting Pain in Patients with Parkinson's Disease: a Systematic Review

ZHANG Yutong, WANG Qiuqin, XU Yuchen, WENG Heng, LIANG Yongqi, WANG Lulu, WANG Qing, XU Guihua

2023, 26(14):  1766-1774.  DOI: 10.12114/j.issn.1007-9572.2022.0788

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Background

Pain is a common non-motor symptom in patients with Parkinson's disease (PD) , which has a serious impact on patients' quality of life. Current scholars have explored the factors influencing the occurrence of pain in patients with PD, but there is some variability in the findings.

Objective

To evaluate the influencing factors of pain in PD patients.

Methods

We searched the CNKI, Wanfang Data, VIP, SinoMed, Web of Science, PubMed, Medline, Embase and Cochrane Library databases for studies on factors influencing pain in patients with PD from database establishment to April 12, 2022. Two researchers independently conducted literature screening and relevant information extraction. We used the Agency for Healthcare Research and Quality (AHRQ) Scale and the Newcastle-Ottawa Scale (NOS) to evaluate the risk of bias in cross-sectional studies and case-control studies, respectively. We performed a descriptive analysis of all influencing factors of pain, and implemented a meta-analysis of these influencing factors using RevMan 5.3.

Results

Sixteen studies were finally included, with a total sample size of 2 855 cases, and 24 influencing factors of pain identified. There were two protective factors and 22 risk factors in descriptive analysis. The meta-analysis showed that, female〔OR=3.73, 95%CI (1.75, 7.96) , P=0.000 7〕, long duration of PD〔OR=1.35, 95%CI (1.15, 1.60) , P=0.000 3〕, depressed mood 〔OR=1.14, 95%CI (1.07, 1.22) , P<0.000 01〕, high UPDRS Ⅲ score〔OR=1.07, 95%CI (1.03, 1.11) , P=0.000 2〕, advanced Hoehn-Yahr stages〔OR=2.28, 95%CI (1.28, 4.04) , P=0.005〕, and high NMSS score〔OR=1.68, 95%CI (1.46, 1.93) , P<0.000 01〕 were risk factors for pain in PD patients. The GRADE analysis showed that the quality of evidence for the effects of gender and NMSS score on pain was moderate, and that for the effects of duration of PD, depressed mood and UPDRSⅢ score on pain was low, and that for the effect of Hoehn-Yahr stage on pain was very low.

Conclusion

Female, long duration of PD, depressed mood, motor impairment, advanced Hoehn-Yahr stages and other severe non-motor symptoms (sleep disturbance, fatigue) are risk factors for pain in PD patients, which need to be further validated by high-quality, large-sample studies in the future.

Relationship between Different Personality Traits and Postpartum Depression: a Meta-analysis

YUAN Dehui, LI Yuhong, DONG Yuanyuan, WANG Minghuan

2023, 26(14):  1775-1782.  DOI: 10.12114/j.issn.1007-9572.2022.0726

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Background

Postpartum depression and personality problems have adverse effects on maternal and infant health. At present, the research results on the relationship between different personality traits and postpartum depression are still controversial, and there is a lack of the systematic reviews on it in China.

Objective

To systematically review the relationship between different personality traits and postpartum depression.

Methods

The research was performed Web of Science, PubMed, EBSCOhost, Embase, PsycInfo (Proquest) , CNKI, Wanfang Data Knowledge Service Platform, and VIP for studies on the relationship between different personality traits and postpartum depression from inception until June 4, 2021. The relevant data extraction was conducted after the quality evaluation of literature. Stata 16.0 was used for meta-analysis. Subgroup analysis and publication bias tests were performed for the relationship between neuroticism and postpartum depression. Sensitivity analysis of the relationship between different personality traits and postpartum depression was performed using rollover effect models.

Results

A total of 19 articles and 9 personality traits were finally included in the meta-analysis, including neuroticism (14 studies) , extraversion (6 studies) , agreeableness (5 studies) , openness (4 studies) , conscientiousness (4 studies) , vulnerability (3 studies) , obsessive-compulsive personality disorder (2 studies) , avoidant personality disorder (2 studies) and dependent personality disorder (2 studies) . The result of Meta-analysis showed that neuroticism 〔OR=1.30, 95%CI (1.20, 1.40) 〕, vulnerability 〔OR=1.39, 95%CI (1.10, 1.76) 〕, avoidant personality 〔OR=6.27, 95%CI (2.55, 15.40) 〕and dependent personality 〔OR=7.11, 95%CI (1.62, 31.14) 〕 were risk factors of postpartum depression (P<0.05) . Extraversion 〔OR=0.86, 95%CI (0.77, 0.97) 〕 and openness 〔OR=0.94, 95%CI (0.90, 0.98) 〕 were protective factors of postpartum depression (P<0.05) . The results of the subgroup analysis showed that the different threshold value of Edinburgh Postnatal Depression Scale (EPDS≥12 scores: OR=1.71, EPDS≥9 scores: OR=1.14, P=0.028) and different investigation time of postpartum depression (OR=1.13 for <1 week postpartum, OR=1.33 for 2-12 weeks postpartum, OR=2.22 for ≥13 weeks postpartum; P=0.008) were the sources of heterogeneity in the pooled results. Sensitivity analysis showed that the pooled results about personality traits were reliable except for obsessive-compulsive personality disorder.

Conclusion

Personality traits have different effects on postpartum depression, among which neuroticism and vulnerable personality are risk factors of postpartum depression, extraversion and openness are protective factors of postpartum depression. Postpartum depression may be more severe and more likely to occur after 13 weeks postpartum in postpartum women with neuroticism. Due to the inconsistent results of domestic and foreign researches, the relationships between avoidant, dependent, and obsessive-compulsive personality disorders and postpartum depression need to be further explored in the future.

Review

Advances in Sedentary Behavior among Cancer Survivors

LU Jinling, XU Qin, HOU Hui, HU Jieman, LI Weiying, XU Xinyi, YANG Chunjing, CHEN Li

2023, 26(14):  1783-1789.  DOI: 10.12114/j.issn.1007-9572.2022.0672

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Among cancer survivors who are characterized by poorprognosis and quality of life, there is a high prevalence of sedentary behavior, which is closely associated with adverse outcomes, requiring urgent attention. Based on this, we reviewed the latest advances in sedentary behavior among cancer survivors, including relevant theories, assessment methods, influencing factors, association with prognosis and intervention, and concluded that sedentary behavior that sedentary behavior is a major risk factor for poor prognosis in cancer survivors, and single physical activity intervention or a combined intervention of physical activity and sedentary behavior is effective intervention. Additionally, given the situation where there is an urgent need to manage sedentary behavior in this group, indigenized studies ought to be carried out actively to make some improvements in their prognosis.

Clinical Research Progress on Carcinogenesis of Different Pathological Types of Colorectal Polyps

YU Rong, DONG Weiguo, TIAN Shan, WANG Ting

2023, 26(14):  1790-1794.  DOI: 10.12114/j.issn.1007-9572.2022.0722

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Colorectal cancer (CRC) is one of the most common tumors in the world. Colorectal polyps are local protuberant lesions that elevate the intestinal mucosa, and about 90% of CRC is evolved from polyp. According to the traditional concept, the occurrence and development of CRC is mostly through the "adenoma-cancer" sequence. However, studies have found that serrated polyps also form subclasses with different morphology and genes, and are closely related to microsatellite unstable CRC. About 15%-30% of CRC develops through the "serrated polyp-cancer" pathway. This article mainly reviewed the clinical characteristics of colorectal adenoma, serrated polyp and post-inflammatory polyps, through retrospective analysis of large samples, to summarize the incidence of different pathological types of colorectal polyps in the progression of carcinogenesis and the follow-up monitoring after polypectomy, so as to provide a better reference for follow-up monitoring of polyp patients and early screening and treatment of precancerous lesions.

Study of Typical Cases

RET Proto-oncogene C634Y Mutation-associated Multiple Endocrine Adenomatosis Type 2A: a Case Report and Literature Review

DENG Yuxuan, HE Li, SONG Zhiwang, JIANG Yanxia

2023, 26(14):  1794-1798.  DOI: 10.12114/j.issn.1007-9572.2022.0464

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Multiple endocrine adenomatosis type 2A (MEN2A) is a subtype of multiple endocrine adenomatosis type 2, which is clinically characterized by medulloid thyroid carcinoma (MTC) , pheochromocytoma (PHEO) , and hyperparathyroidism, and has been reported to be caused by mutations in the RET proto-oncogene on chromosome 10. We reported a case of MEN2A caused by RET proto-oncogene C634Y mutation, and conducted a pedigree analysis of the patient. Genetic test results showed C634Y mutation in the patient's siblings and their offspring. The diagnosis and treatment of this case in combination with a review of the relevant literature suggest that endocrine gland tests and RET proto-oncogene test should be performed for a patient diagnosed with endocrine adenomatosis to reduce the possibility of misdiagnosis and missed diagnosis, and to achieve early treatment, improve the effect of treatment and the prognosis of patients. In addition, the first- and second-degree relatives of the patient should also be tested for the mutation of the RET proto-oncogene.