Table of Content

15 October 2023, Volume 26 Issue 29

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Guidelines·Consensus

Expert Consensus on Betahistine Mesylate in the Treatment of Vertigo

The Vertigo Committee of the Chinese Medical Education Association

2023, 26(29):  3591-3598.  DOI: 10.12114/j.issn.1007-9572.2023.0312

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In order to standardize scientific drug use in vertigo, the Vertigo Committee of the Chinese Medical Education Association established an expert group to form Expert Consensus on Betahistine Mesylate in the Treatment of Vertigo after repeated discussion based on the existing medical evidence, and combined with the rich clinical experience of experts. The consensus includes the pharmacological basis of histamines, the strength of recommendation, dosage, course, review methods, medication for special populations, adverse drug reactions and other aspects of betahistine mesylate in common vertigo diseases (such as benign paroxysmal position vertigo, Menieres disease, and vestibular neuritis, etc.) to guide doctors in clinical work.

Monographic Research of Multimorbidity

Prevalence Trends of Multimorbidity among Residents in Mainland China: a Meta-analysis

HE Li, ZHANG Yifan, SHEN Xuechun, SUN Yan, ZHAO Yang

2023, 26(29):  3599-3607.  DOI: 10.12114/j.issn.1007-9572.2023.0217

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Background

The estimation of the prevalence of multimorbidity and identification of high-risk populations can directly affect the corresponding rational allocation of public health resources.

Objective

To comprehensively describe the prevalence trends and population characteristics of multimorbidity among residents in mainland China from 1998-2019 through Meta-analysis.

Methods

The databases including Web of Science, PubMed, CNKI, Wanfang Data Knowledge Service Platform and VIP were searched for journal literature relevant to the prevalence of multimorbidity in mainland China from inception to 2022-04-30. Data extraction and quality evaluation were performed on the literature and meta-analysis was performed using Stata 14.0 software. The pooled prevalence of multimorbidity was calculated by using random effects model, and subgroup analysis of the prevalence of multimorbidity was conducted based on survey time (before 2004, 2004-2013, since 2014), gender, region (urban, rural), geographical area (east, central, west, northeast), education level (uneducated, primary school, secondary school and above), marital status (married, others), and research quality (low, medium, high) .

Results

A total of 123 papers were included into analysis with a total sample size of 7 714 313 cases. There was significant heterogeneity among studies (I²=100.0%, P<0.001), and the prevalence of multimorbidity was 36.3%〔95%CI (32.8%, 39.9%) 〕. Meta-linear regression model showed a non-linear increasing trend in the prevalence of multimorbidity from 1998 to 2019〔β=0.013, 95%CI (0.006, 0.019) 〕. The results of the subgroup analysis showed that the prevalence of multimorbidity was higher since 2014〔40.4%, 95%CI (33.0%, 47.8%) 〕 than before 2004〔14.5%, 95%CI (12.5%, 16.5%) 〕 and 2004-2013〔35.2%, 95%CI (32.2%, 38.2%) 〕 (P<0.001) ; the prevalence of multimorbidity was higher among those aged 60-79 years〔38.1%, 95%CI (34.6%, 41.5%) 〕 than those aged ≥80 years〔36.6%, 95%CI (32.5%, 40.8%) 〕, 40-59 years〔27.7%, 95%CI (24.4%, 31.1%) 〕, and <40 years〔10.6%, 95%CI (9.0%, 12.3%) 〕 (P<0.001). There was no significant difference in the subgroup analysis of gender, education level, marital status, region, geographical area, type of chronic disease, quality of research, and the comparison of the prevalence of multimorbidity (P>0.05) .

Conclusion

The prevalence of multimorbidity among residents in mainland China was 36.3% from 1998 to 2019 with a rising trend and significant differences in age, therefore, attention should be paid to the early screening of high-risk population, active and effective strategies for prevention and control should be adopted.

Patterns of Coexistence of Multiple Chronic Conditions among Chinese Elderly

PAN Ye, LIU Zhihui, HU Qianqian, WANG Liuyi

2023, 26(29):  3608-3615.  DOI: 10.12114/j.issn.1007-9572.2023.0186

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Background

With the aging and longer survival of the population, comorbid chronic diseases is increasingly common. The variety and complexity of diseases pose challenges to the health management of the elderly. There is a relative lack of multimorbidity pattern researches in China, which are necessary issues for research.

Objective

To investigate the patterns of coexistence of common multiple chronic conditions among the elderly in China, in order to help policymakers, researchers, and clinicians better understand the current status of multimorbidity among Chinese elderly.

Methods

Data on the demographic characteristics and health status of 14 chronic diseases were extracted from the respondents aged 60 years and above in the China Health and Retirement Longitudinal Study (CHARLS) 2018, association rules, cluster analysis, principal component analysis, latent class analysis were used to explore the multimorbidity patterns of Chinese elderly, and the results of different methods were compared.

Results

The data from a total of 10 800 respondents were eventually included, there were differences among the patterns obtained by four methods. However, the consistent multimorbidity patterns were identified: hypertension, diabetes or elevated blood glucose, dyslipidemia; chronic lung disease and asthma; arthritis or rheumatism, stomach diseases or digestive diseases; stroke, memory-related diseases.

Conclusion

The consistent patterns obtained by different methods contain chronic diseases with significant relationships of etiologies. The reasons of differences in results are complex etiologic relationships and different method principles.

Epidemiological Characteristics of Dementia and Its Correlation with Multimorbidity among Residents Aged 65 and Above

ZHOU Sijing, LUO Bangan, CAO Hui, ZHANG Xi, WANG Dongxin

2023, 26(29):  3616-3621.  DOI: 10.12114/j.issn.1007-9572.2023.0234

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Background

In the context of aging society in China, the prevalence of Alzheimer's disease increases and multimorbidity becomes more common with years. However, the extensive investigations of Alzheimer's disease in Hunan province have not been reported adequately and the multimorbidity relationship between relevant diseases remains unclear.

Objective

To completely understand the prevalence of Alzheimer's disease in residents aged 65 or above in Hunan and analyze its multimorbidity relationships with 11 common chronic diseases.

Methods

The residents aged 65 years and above in 30 districts (counties), 60 streets (townships), and 180 neighborhood (village) committees in Hunan Province were randomly selected between April and May 2021 by using stratified multistage sampling method. Alzheimer's disease was diagnosed by a neurologist or psychiatrist using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), after using the Community Screening Interview for Dementia (CSI-D) or the 8-item ascertain dementia (AD8) as the screening tools. In addition, all respondents were investigated for the prevalence of hypertension, cerebrovascular disease, ischemic heart disease, rheumatoid arthritis, intervertebral disc disease, diabetes, gastroenteritis, chronic obstructive pulmonary disease, calculous cholecystitis, peptic ulcer and cancer.

Results

A total of 5 979 residents were sampled, 5 616 of them completed the examinations and 785 (13.98%) were diagnosed with Alzheimer's disease. There were significant differences in the prevalence of Alzheimer's disease among respondents with different regions, gender, age, smoking history and presence of other chronic diseases (P<0.05). The total number of patients with other chronic diseases among all respondents was 5 606, with the top five diseases of hypertension〔2 205 (39.33%) 〕, intervertebral disc disease〔553 (9.86%) 〕, diabetes 〔526 (9.38%) 〕, cerebrovascular disease〔492 (8.78%) 〕, and ischemic heart disease〔467 (8.33%) 〕. The top five diseases in the dementia patients were hypertension〔325 (41.40%) 〕, cerebrovascular disease〔111 (14.14%) 〕, ischemic heart disease〔91 (11.59%) 〕, rheumatoid arthritis 〔89 (11.33%) 〕, and intervertebral disc disease〔81 (10.31%) 〕. The prevalence of dementia in patients with no chronic disease, with 1, 2, 3 or more types of other chronic diseases was 11.46% (214/1 867), 13.66% (309/2 262), 17.50% (176/1 006), and 18.26% (86/471), respectively. There were statistically significant differences in the prevalence of Alzheimer's disease between the subjects with and without gastroenteritis, rheumatoid arthritis, cerebrovascular disease, chronic obstructive pulmonary disease, and ischemic heart disease, respectively (P<0.05). Binary Logistic regression analysis showed that living in rural areas〔OR=2.048, 95%CI (1.655, 2.536) 〕, female〔OR=1.388, 95%CI (1.163, 1.655) 〕, aging〔OR=1.348, 95%CI (1.270, 1.431) 〕, and suffering from other chronic diseases〔OR=1.195, 95%CI (1.101, 1.297) 〕 were risk factors for the development of Alzheimer's disease in residents aged 65 years and above (P<0.05). The investigation results of timely medication taking in the patients with Alzheimer's disease showed that 12.79% (99/774) reported difficulties, 6.59% (51/774) needed help, and 2.97% (23/774) were unable to complete independently.

Conclusion

The prevalence of Alzheimer's disease in residents aged 65 years and above in Hunan Province increases with the number of other chronic diseases and correlates with multiple diseases. Great attention should be paid on the self-care ability and family care burden of Alzheimer's disease by society. The prevalence and multimorbidity of Alzheimer's disease were basically grasped by the investigation, in order to provide an objective basis for the formulation of policies on its prevention and treatment.

Influence of Multimorbidity on Anxiety Symptoms among Chinese Elderly People: a Propensity Score-matched Study

WANG Xiaoran, ZHANG Dan

2023, 26(29):  3622-3627.  DOI: 10.12114/j.issn.1007-9572.2023.0140

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Background

In China, as population aging quickens, multimorbidity has become a major public health problem threatening the health of elderly people. Multimorbidity has a negative impact on mental health, but there is a lack of research on its association with anxiety symptoms in elderly people.

Objective

To investigate the influence of multimorbidity on anxiety symptoms among Chinese elderly people, so as to provide references for improving mental health for older people with multimorbidity.

Methods

We selected 6 854 older adults (≥65 years old) from the participants of the Chinese Longitudinal Healthy Longevity Survey 2018 from December 2022 to February 2023. The 7-item Generalized Anxiety Disorder Scale was used to assess symptoms of anxiety. Multimorbidity was defined as having two or more coexisting chronic conditions, while non-multimorbidity was defined as having only one or no chronic condition. Propensity score matching (PSM) was used tomatch individuals with and without multimorbidity. The association of multimorbidity with anxiety symptoms was analyzed by univariate and multivariate Logistic regression analyses.

Results

Among the 6 854 cases, the prevalence of multimorbidity and anxiety symptoms was 38.04% (2 607/6 854), and 10.53% (722/6 854), respectively. There were 4 247 cases (61.96%) without multimorbidity, of whom 2 102 (30.67%) had no chronic disease, and 2 145 (31.29%) had one chronic disease. A total of 2 282 pairs of multimorbidity and non-multimorbidity (4 564 cases altogether) were obtained after matching. Multivariate Logistic regression analysis showed that multimorbidity was the risk factor of anxiety symptoms〔OR=1.399, 95%CI (1.166, 1.679), P<0.001〕. Besides that, gender, ability to perform activities of daily living and receiving a pension were also related to anxiety symptoms (P<0.05). Five hundred and twenty-two pairs (1 044 cases altogether) were obtained after matching the subjects with multimorbidity and those with one chronic disease using PSM, and the analysis found that those with one chronic disease had higher prevalence of anxiety symptoms〔64.76% (215/332) vs 43.12% (307/712) 〕 (P<0.001) .

Conclusion

Compared with their counterparts without multimorbidity, elderly people with multimorbidity had higher risk of anxiety symptoms, so more attentions should be paid to the mental health of these people.

Original Research

Relationship between Triglyceride-glucose Index and Risk of Cardiovascular Diseases in Middle-aged Obese Residents of Different Genders

PAN Yaojia, WANG Weiqiang, YI Weizhuo, GAO Bing, FU Fanglin, HAN Zheng, SUN Meng, DONG Yaqin, GU Huaicong

2023, 26(29):  3628-3635.  DOI: 10.12114/j.issn.1007-9572.2022.0891

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Background

Triglyceride-glucose (TyG) index is an index to evaluate insulin resistance (IR) and obesity-related metabolic diseases, which is closely related to the high risk of cardiovascular disease (CVD). However, TyG index may be different from the high risk of CVD in middle-aged obese people of different genders.

Objective

To investigate the relationship between TyG index and the high risk of CVD in middle-aged obese people of different genders, and to evaluate its role in the prevention and treatment of CVD.

Methods

A total of 30 425 middle-aged obese residents were selected from 10 early screening and comprehensive intervention projects of high-risk CVD population in Anhui Province and investigated by investigators who were trained and qualified, using the preliminary screening questionnaire and basic information registration form designed by the National Cardiovascular Center. The main survey contents included gender, age, hypertension, dyslipidemia, diabetes, smoking and alcohol consumption, etc, and perform a CVD high-risk assessment. The included residents were divided into the male group (n=11 566) and female group (n=18 859). The male group was divided into T₁ (7.417-8.870) (n=2 892), T₂ (8.871-9.204) (n=2 891), T₃ (9.205-9.578) (n=2 892) and T₄ (9.579-11.435) (n=2 891) subgroups, the female group was divided into F₁ (7.579-8.876) (n=4 715), F₂ (8.877-9.183) (n=4 720), F₃ (9.184-9.526) (n=4 710) and F₄ (9.527-11.647) (n=4 714) subgroups according to the quartiles of TyG index. Binary Logistic regression analysis was used to explore the relationship between TyG index and the high risk of CVD, and Z-test was used to compare the differences in effect values among subgroups.

Results

The high risk rate of CVD was 28.4% (3 280/11 566) in the male group and 26.0% (4 909/18 859) in the female group. Binary Logistic regression analysis showed that TyG index T₂ (F₂), T₃ (F₃), T₄ (F₄) in male group (female group) were correlated with the high risk of CVD (P<0.05), and the correlation with the high risk of CVD increased with the gradual increase of TyG index. In the male group, the risk of developing high risk of CVD in the T₄ subgroup compared to T₁ was OR (95%CI) =1.827 (1.622, 2.058) ; In the female group, the risk of developing high risk of CVD in the F₄ subgroup compared to F₁ was OR (95%CI) =1.552 (1.410, 1.708). There were significant differences in the TyG index and risk of developing high risk of CVD between the T₄ and F₄ subgroups in both male and female groups (P<0.05). After further adjustment for total cholesterol and other indicators (model 2), the correlation between T₂ (F₂), T₃ (F₃), T₄ (F₄) and the risk of developing high risk of CVD was attenuated. However, in both male and female groups, T₂ (F₂), T₃ (F₃) and T₄ (F₄) were all correlated with the high risk of CVD (P<0.05), and the correlation increased with the gradual increase of TyG index level. In the male group, the risk of developing high risk of CVD in the T₄ subgroup compared to T₁ subgroup was OR (95%CI) =1.804 (1.584, 2.055), in the female group, the risk of developing high risk of CVD in the F₄ subgroup compared to F₁ subgroup was OR (95%CI) =1.496 (1.345, 1.665) ; There were significant differences in the risk of developing high risk of CVD between the T₄ and F₄ subgroup in both male and female groups (P<0.05) .

Conclusion

Middle-aged obese men with high TyG index are more prone to develop high risk for CVD, and more attention should be paid to the TyG index level of the population.

Effect of Serum Uric Acid Longitudinal Trajectory on New-onset Hypertriglyceridemia: a Prospective Cohort Study

HE Yingmei, JIA Xue, ZHU Guojun, LIU Bing

2023, 26(29):  3636-3639.  DOI: 10.12114/j.issn.1007-9572.2023.0253

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Background

High serum uric acid (SUA) levels may be associated with hypertriglyceridemia. However, prospective cohort studies on the effect of longitudinal trajectory changes in SUA on new-onset hypertriglyceridemia are still lacking.

Objective

To investigate the correlation between the longitudinal trajectory of SUA and the new-onset hypertriglyceridemia.

Methods

A total of 3 871 architecture employees who underwent physical examinations in Shiyan Railway Hospital from 2015 to 2020 were selected as study subjects. The general data, physical examination data and laboratory test results of the study subjects were collected. Group-based trajectory model (GBTM) was used to group the uric acid trajectories of the study subjects, linear trend χ² test was used to detect linear trends in the density of hypertriglyceridemia development with SUA stratification. Generalized estimation equation (GEE) was used to analyze the relationship between each index and hypertriglyceridemia.

Results

The trajectories of GBTM group 1 showed low SUA fluctuation levels (250-350 μmol/L), group 2 showed medium SUA fluctuation levels (>350-450 μmol/L), and group 3 showed high SUA fluctuation levels (>450 μmol/L), the three groups were named as low fluctuation group (n=1 103), medium fluctuation group (n=2 141), and high fluctuation group (n=627) sequentially according to the trajectory characteristics. The results of linear trend χ² test revealed that the density of hypertriglyceridemia development increased with the rise of uric acid fluctuating levels (χ²_trend=146.728, P<0.001). There were significant differences in age, total cholesterol (TC), triacylglycerol (TG), SUA, creatinine (Cr), systolic blood pressure (SBP), diastolic blood pressure (DBP), and BMI among the three groups (P<0.05). GEE analysis showed that TC, Cr, SBP, DBP, fasting blood glucose and BMI were influencing factors in the development of hypertriglyceridemia (P<0.05), and the risk of hypertriglyceridemia was increased in the medium fluctuation group〔RR=2.294, 95%CI (1.834, 2.868) 〕and high fluctuation group〔RR=3.012, 95%CI (2.295, 3.953) 〕using the low fluctuation group as a reference (P<0.05) .

Conclusion

The incidence density of hyperhyperacylglyceremia increases with the increase of uric acid locus, which is a risk factor for hyperacylglyceremia. Controlling SUA fluctuation in the normal range may help to reduce the risk of hyperacylglyceremia.

Efficacy and Safety of Intermittent Hypoxic Training in the Prevention of Acute Hypoxic Injury

HUANG Dan, ZHANG Qihan, SONG Ge, WANG Qing, LI Yu, JI Xunming, WANG Yuan

2023, 26(29):  3640-3644.  DOI: 10.12114/j.issn.1007-9572.2023.0164

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Background

Acute hypoxic injury caused by acute altitude exposure is manifested by different degrees of clinical symptoms, some of which may develop into acute mountain sickness (AMS). However, the current prevention and treatment methods are limited and there is a lack of safe and effective methods to prevent and reduce the severity.

Objective

To investigate the efficacy and safety of intermittent hypoxic (IH) training in preventing acute hypoxic injury by simulating hypoxic environment at an altitude of 4 400 meters.

Methods

A total of 40 subjects were recruited by public recruitment in Beijing Xiaotangshan Hospital from 2022-08-01 to 10-31 and randomly divided into the IH group (experimental group, n=20) and sham training group (control group, n=20). The experimental group received the IH exposure intervention with the total duration of 55 min twice a day for 5 d, including 10 min of low oxygen (oxygen concentration of 13%, simulated altitude of 3 800 m), 5 min of normoxia (oxygen concentration of 21%). The control group received the simultaneous long normoxia intervention. On the first day after the IH intervention training, the subjects entered into the simulated high-altitude hypoxia environment for 6 h, and the oxygen concentration was set at 12% (equivalent to the altitude of 4 400 m). The Lake Louise Scale (LLS) was used to assess the severity of AMS. Peripheral oxygen saturation (SpO₂), cerebral oxygen saturation (ScO₂) and intracranial pressure (ICP) were collected at baseline, before and 6 h after the simulated high-altitude hypoxia environment.

Results

After 6 h of acute high-altitude hypoxia environment simulation, the incidence of AMS and LLS in the experimental group were significantly lower than those in the control group (P<0.05), SpO₂ in the experimental group was significantly higher than that in the control group (P<0.05). The results of intra-group comparison showed that SpO₂ and ScO₂ of subjects in both groups decreased significantly after 6 h of acute high-altitude hypoxia environment simulation compared with baseline and before acute high-altitude hypoxia environment simulation (P<0.05), the decrease level of SpO₂ after 6 h of acute high-altitude hypoxia environment simulation compared to before acute high-altitude hypoxia environment simulation in the experimental group was lower than the control group〔 (9.30±4.31 ) % vs. (13.10±6.66) %, P=0.039〕. The ICP was significantly increased after 6 h of acute high-altitude hypoxia environment simulation compared with before acute high-altitude hypoxia environment simulation in the control group (P<0.05) .

Conclusion

IH training can improve the to hypoxia tolerance of body, effectively reduce the incidence and severity of AMS.

Association of Alanine Transaminase and Aspartate Aminotransferase/Alanine Transaminase Ratio with Type 2 Diabetes and Metabolic Syndrome in the Elderly

ZHOU Xiaoqi, LIU Xinhui, ZHANG Wei, LI Changfeng, YAN Yaqiong

2023, 26(29):  3645-3649.  DOI: 10.12114/j.issn.1007-9572.2023.0028

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Background

Serum alanine transaminase (ALT) and aspartate aminotransferase (AST) are common liver enzymes, but there are few studies on the correlation of these enzymes with the prevalence of type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS) .

Objective

To explore the association of serum ALT and AST/ALT ratio with T2DM and MS in older physical examinees in the community.

Methods

From January to December, 2018, 30 060 elderly people (≥65 years) who underwent free physical examination in 19 community health centers of 6 districts in Wuhan were chosen as the subjects. Their demographic data, life style, previous medical history, and results of physical examination and biochemical test were collected. Subjects were divided into quartile groups of ALT〔Q1 (ALT≤11 U/L, n=8 116), Q2 (11 U/L<ALT≤14 U/L, n=7 008), Q3 (14 U/L<ALT≤19 U/L, n=7 438), Q4 (ALT>19 U/L, n=7 498) 〕, or quartile groups of AST/ALT ratio〔q1 (AST/ALT≤1.06, n=7 386), q2 (1.06<AST/ALT≤1.31, n=7 698), q3 (1.31<AST/ALT≤1.62, n=7 529), q4 (AST/ALT>1.62, n=7 447) 〕. Cochran χ² test was used to compare the prevalence trend of T2DM, MS, abdominal obesity, hypertension, elevated triglycerides (TG) and lowered high-density lipoprotein cholesterol (HDL-C) with the change of ALT level and AST/ALT ratio. Multivariate Logistic regression analysis was used to explore the correlation of prevalence of T2DM and MS with ALT level and AST/ALT ratio.

Results

The age of 30 060 subjects (13 381 men and 16 679 women) was 65-99 years old, and the average age was (71.7±5.6) years old. The prevalence of T2DM and MS was 18.76% (5 488/30 060) and 29.73% (8 938/30 060), respectively. The regular exercise rate, BMI, waist circumference, systolic pressure, diastolic pressure, ALT, TG and fasting plasma glucose (FPG) were significantly higher and smoking rate, drinking rate, AST, AST/ALT ratio, total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol (LDL-C) were significantly lower in T2DM subjects compared to non-T2DM subjects (P<0.01). MS subjects had significantly higher regular exercise rate, BMI, waist circumference, systolic pressure, diastolic pressure, ALT, TC, TG and FPG, and significantly lower male ratio, smoking rate, drinking rate, AST/ALT ratio, HDL-C and LDL-C than non-MS subjects (P<0.01). The prevalence of T2DM, MS, abdominal obesity, hypertension, elevated TG and lowered HDL-C increased with the increase of ALT level, and decreased with the increase of AST/ALT ratio (P<0.01). Multivariate Logistic regression analysis showed that compared with group Q1, the risk of T2DM and MS in group Q2-Q4 was increased (P<0.01), and the risk of T2DM and MS in group Q2-Q4 was decreased compared with group q1 (P<0.01). The prevalence risk of T2DM and MS was increased in Q2-Q4 groups compared to Q1 group, and in contrast, the risk was decreased in q2-q4 groups when comparing to q1 group (P<0.01) .

Conclusion

Serum ALT have an association with the prevalence of T2DM and MS, as well as AST/ALT ratio. Either elevated ALT or lowered AST/ALT ratio may increase the risk of prevalence of T2DM and MS.

Development and Validation of a Risk Prediction Model for Contrast-induced Acute Kidney Injury after Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

WANG Zhen, SHEN Guoqi, LI Yanan, ZHU Yinghua, QIU Hang, ZHENG Di, XU Tongda, LI Wenhua

2023, 26(29):  3650-3656.  DOI: 10.12114/j.issn.1007-9572.2023.0139

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Background

Early reperfusion therapy for acute myocardial infarction (AMI) is an effective approach to reduce mortality in AMI patients. Percutaneous coronary intervention (PCI) is one of the reperfusion therapy modalities, and contrast-induced acute kidney injury (CI-AKI) after PCI has become one of the common causes of AKI.

Objective

To investigate the risk factors for the development of CI-AKI in AMI patients after PCI, establish a risk prediction model for CI-AKI based on risk factors and evaluate its validity.

Methods

The clinical data of 1 274 patients who attended the Affiliated Hospital of Xuzhou Medical University diagnosed of AMI and treated with PCI were collected consecutively from 2019 to 2021. According to the chronological order of admission, the included patients were divided into the training group (January 2019 to March 2021, 900 cases) and validation group (April 2021 to December 2021, 374 cases) in a ratio of approximately 7∶3; and divided into the CI-AKI and non-CI-AKI groups according to the diagnostic criteria of CI-AKI. Independent risk factors were screened using univariable Logistic regression analysis, Lasso regression, cross-validation, multivariable Logistic regression analysis, and a nomogram for predicting the risk of CI-AKI was plotted. Their discriminatory power, calibration ability, and clinical application value were evaluated by calculating concordance statistic (C-statistic), plotting calibration curve and decision curve.

Results

Among the 900 patients in the training group, 109 patients (12.1%) developed CI-AKI after PCI; among the 374 patients in the validation group, 27 patients (7.2%) developed CI-AKI. Multivariable Logistic regression analysis showed that LVEF〔OR=0.903, 95%CI (0.873, 0.934) 〕, platelet distribution width〔OR=1.158, 95%CI (1.053, 1.274) 〕, MPVLR〔OR=1.047, 95%CI (1.016, 1.079) 〕, NHR〔OR=1.072, 95%CI (1.021, 1.124) 〕, Scr〔OR=1.006, 95%CI (1.002, 1.011) 〕, and diuretics〔OR=2.321, 95%CI (1.452, 3.709) 〕 were independent influencing factors for CI-AKI after PCI in AMI patients (P<0.05). A prediction model containing 6 risk factors of LVEF, platelet distribution width, MPVLR, NHR, Scr and diuretics was constructed and a nomogram for predicting the risk of CI-AKI was plotted. The C-statistic was 0.794〔95%CI (0.766, 0.820) 〕 for the training group and 0.799〔95%CI (0.774, 0.855) 〕 for the validation group, and the calibration plots showed good consistency between the predicted and actual results; the decision curve and clinical impact curve showed clinical application value of nomogram.

Conclusion

The CI-AKI risk prediction model including LVEF, platelet distribution width, MPVLR, NHR, Scr, and diuretics has good discrimination and accuracy, which can intuitively and independently screen high-risk population and has high predictive value for the development of CI-AKI after PCI in AMI patients.

Correlation of Platelet-albumin Ratio with Clinicopathological Features of IgA Nephropathy

ZHOU Wenjing, SHANG Shili, YANG Qian, FENG Yuerong, LI Jun

2023, 26(29):  3657-3664.  DOI: 10.12114/j.issn.1007-9572.2023.0013

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Background

Immunoglobulin A (IgA) nephropathy (IgAN) is a chronic inflammatory illness involving multiple factors and genes, platelet-albumin ratio (PAR) is regarded as a novel marker of inflammation, but the connection between PAR and IgA nephropathy remains unclear.

Objective

To examine the correlation of PAR with the clinicopathological indicators of IgAN and to evaluate the clinical significance of PAR in IgAN.

Methods

From October 2019 to August 2020, 210 patients with IgAN diagnosed by percutaneous renal biopsy at the Department of Nephrology of the First Affiliated Hospital of Kunming Medical University were selected as study subjects, general inforamtion of the included patients (gender, age, systolic blood pressure, diastolic blood pressure and disease duration), laboratory indicators〔white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), platelet count (PLT), serum albumin (ALB), serum uric acid (SUA), blood urea nitrogen (BUN), serum creatinine (Scr), IgA, immunoglobulin M (IgM), immunoglobulin G (IgG), serum complement C3, serum complement C4, urine red blood cell count (URBC), 24 h urinary microalbumin (24 h mALB), 24 h micrototal protein (24 h MTP) 〕, percutaneous renal biopsy pathology results, calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), PAR, immunoglobulin A-to-complement C3 ratio (IgA/C3), immunoglobulin G-to-complement C3 ratio (IgG/C3), complement C3-to-complement C4 ratio (C3/C4), and estimated glomerular filtration rate (eGFR) were collected. The study subjects were divided into three groups: group Q1 (PAR≤5.626 5), group Q2 (5.6265<PAR≤6.984 3) and group Q3 (PAR>6.984 3), each group of 70 cases. The differences in the baseline inforamtion among the three groups were compared, Spearman correlation analysis and Logistic regression analysis were used to explore the correlation between PAR and IgAN clinicopathological indicators of IgAN, receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of PAR on pathological indicators.

Results

There were significant differences in gender, WBC, ANC, PLT, PLR, PAR, URBC, ALB, IgG/C3, 24 h-mALB, 24 h-MTP, M lesions, Lee classification among the three groups (P<0.05). Spearman correlation analysis showed that PAR was positively correlated with PLT, WBC, ANC, PLR, URBC, 24 h-mALB, 24 h-MTP, M lesions, E lesionsand Lee classification, and negatively correlated with ALB and IgG/C3 (P<0.05). Multivariate Logistic regression analysis showed that PAR〔OR=2.688, 95%CI (1.178, 6.135) 〕 and ALB〔OR=0.736, 95%CI (0.587, 0.923) 〕 were independent influencing factors for M1 lesions in IgAN patients (P<0.05), ALB〔OR=0.896, 95%CI (0.824, 0.973) 〕 was an independent influencing factor for E1 lesions (P<0.05). The ROC curve showed that area-under-curve (AUC) of PAR predicting M1 and E1 lesions in IgAN patients was 0.727 and 0.599, respectively.

Conclusion

PAR was significantly correlated with the clinical manifestations and the degree of M and E lesions of IgAN, which has clinical significance in evaluating IgAN activity. Patients with high PAR levels should be treated more aggressively to inhibit active lesions and improve renal outcomes.

Study on the Changes of Intestinal Flora and Its Metabolite Phenylacetylglutamine in Patients with Chronic Heart Failure

ZHANG Zhendong, CAI Bin, WANG Hongwei, QIAO Zengyong

2023, 26(29):  3665-3673.  DOI: 10.12114/j.issn.1007-9572.2023.0166

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Background

The intestinal flora and its metabolites play an important role in the pathology of chronic heart failure (CHF), which is a severe manifestation or terminal stage of various cardiovascular diseases. Increasing evidence has shown that dysbiosis of the intestinal flora and its metabolites can lead to bacterial translocation, release of mediators, inflammatory response and consequently aggravation of CHF.

Objective

To analyze the changes of intestinal flora and its metabolite phenylacetylglutamine (PAGln) in patients with CHF and explore the role played by gut microbiota in heart failure.

Methods

A total of 58 patients with heart failure admitted to the Department of Cardiology of the South Branch of the Sixth People's Hospital of Shanghai Jiaotong University were selected as the CHF group, and 46 patients with the same CHF risk factors but without clinical symptoms and past medical history of CHF were selected as the control group from June 2021 to June 2022. Plotting ROC curves of brain natriuretic peptide (BNP) and PAGln for the diagnosis of CHF. The abundance and diversity of intestinal flora in the two groups were analyzed using 16S rRNA sequencing. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) was used to detect PAGln concentrations in the plasma of samples from both two groups.

Results

The left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), BNP, and PAGln in the CHF group were higher than the control group, and the left ventricular ejection fraction (LVEF) was lower than the control group (P<0.05). The area under curve (AUC) of BNP and PAGln levels for the diagnosisof CHF patients was 0.995 and 0.913, respectively. Venn diagram showed that the number of OTUs specific to the CHF group was less than the control group. Alpha diversity analysis showed that the Chao1 index was lower in the CHF group than the control group (P<0.05). β diversity analysis showed that the overall structure of the intestinal flora differed between the two groups. At the genus level, the relative abundances of Escherichia-Shigella, Megamonas, Klebsiella, Bifidobacterium, Parabacteroides, and Romboutsia were higher in the CHF group than the control group (P<0.05), and the relative abundances of Solimonas and Dorea were lower than the control group (P<0.05). The results of LEfSe analysis showed that Lachnospiraceae, Solimonadaceae, Solimonas, Dorea, and Burkholderiaceae were elevated in the control group (P<0.05), and Enterobacteriaceae, Escherichia, Bifidobacterium, Bifidobacteriaceae, Klebsiella, Lactobacillaceae, Lactobacillus, Megamonas, Rikenellaceae, Alistipes, Parabacteroides, and Tannerellaceae were elevated in the CHF group (P<0.05). Typical correlation analysis (CCA) showed that BNP, PAGln, LVEDD, and LVESD were significantly correlated with the CHF group, with BNP having the greatest effect on community changes. Correlation analysis showed that Escherichia-Shigella was positively correlated with BNP and PAGln (P<0.05) ; Bacteroides was negatively correlated with BNP; Romboutsia, Fusobacterium, and Phascolarctobacterium were negatively correlated with BNP and PAGln (P<0.05) .

Conclusion

The structural composition of the intestinal flora in patients with CHF was significantly different from the patients with the same co-morbidities but without clinical manifestations and previous medical history of CHF, with a decrease in flora diversity and a significant increase in the abundance of pathogenic intestinal bacteria, which may lead to an increase in the level of PAGln in CHF patients and participate in the development of CHF.

Effect of Huoxue Tongluo Capsule on Intestinal Flora of Rats with Steroid-induced Osteonecrosis of the Femoral Head

WEI Yurou, TIAN Jiaqing, XIAO Fangjun, HE Xianshun, ZHAN Zhiwei, WEI Tengfei, LIN Tianye, HE Mincong, WEI Qiushi

2023, 26(29):  3674-3682.  DOI: 10.12114/j.issn.1007-9572.2023.0144

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Background

Steroid-induced osteonecrosis of the femoral head (SONFH) is common and disabling. The efficacy of Huoxue Tongluo Capsule has been consistently demonstrated in the prevention and treatment of osteonecrosis of the femoral head, but there is no research on whether the treatment can be carried out by regulating the intestinal flora.

Objective

To establish SONFH rat model intervened by Huoxue Tongluo Capsule, analyze and compare the diversity of intestinal flora in each group of rats, screen out SONFH-specific altered bacterial genera and observe the effect of Huoxue Tongluo Capsule on intestinal flora.

Methods

24 male SD rats were selected from April to October 2022 and divided into the blank group (n=8), model group (n=8) and Huoxue Tongluo group (n=8) by random number table method. The SONFH model was prepared. The Huoxue Tongluo group was given 0.63 g·kg^-1·d^-1 Huoxue Tongluo Capsule by gavage on the 3rd to 28th day of modeling. The blank group and model group were given an equal volume of 0.9% sodium chloride solution by gavage. After drug intervention, rat femurs were collected for HE staining and Micro-CT analysis. Rat feces were collected for 16S rDNA sequencing. α diversity analysis was used to evaluate species diversity, β diversity analysis was used to explore the similarity or dissimilarity of sample community composition, and linear discriminant analysis (LEfSe) was used to compare the differences of intestinal flora among the three groups. COG function was used to predict the intestinal flora function of the rats in the three groups.

Results

There were significant differences in the rate of empty bone lacunae among the three groups, and the rate of empty bone lacunae in the model group was higher than that in the blank group, while the rate of empty bone lacunae in the Huoxue Tongluo group was lower than that in the model group (P<0.05). There were significant differences in the bone volume (BV/TV), bone trabeculae number (Tb.N), bone trabeculae thickness (Tb.Th) and bone trabeculae separation (Tb.Sp) among the three groups, and the BV/TV, Tb.N and Tb.Th of the model group were lower than those of the blank group, while the Tb.Sp of the model group was higher than that of the blank group (P<0.05). The BV/TV, Tb.N, Tb.Th of the Huoxue Tongluo group were lower than those of the blank group, while the Tb.Sp was higher than that of the blank group (P<0.05). There were significant differences in the intestinal flora structure of rats among the three groups, the number of intestinal flora ASVs in the model group was higher than the blank group, the number of intestinal flora ASVs in the Huoxue Tongluo group was lower than the model group (P<0.05). There were significant differences in the Shannon index among the three groups, and the Shannon index in the model group was higher than the blank group (P<0.05). The PCoA plot of β-diversity analysis showed that there was partial overlap among the three groups, but the community structure of the three groups could be distinguished. The results of similarity analysis showed that the differences among the groups were greater than that within groups, and the differences were statistically significant (R=2 062, P=0.01). The results of LEfSe analysis showed that the abundances of Desulfovibrio, Hafnia-Obesumbacterium, Leuconostoc and Staphylococcus were increased, the abundances of Bacteroides and Prevotella _UCG-001 were decreased (P<0.05). The abundances of Oxalobacteraceae and Ruminococcus_torques_group were increased and the abundances of Rekenella and Kineothrix were decreased in the Huoxue Tongluo group compared with the model group (P<0.05). The prediction results of COG function in the three groups of rats showed that compared with the blank group, COG function of the model group mainly focused on carbohydrate transport and metabolism, inorganic ion transport and metabolism, amino acid transport and metabolism, lipid transport and metabolism, cell wall/membrane/envelope biogenesis. The function of the Huoxue Tongluo group focused on inorganic ion transport and metabolism, carbohydrate transport and metabolism, and the levels of replication, recombination and repair, transcription, cell cycle control, cell division, chromosome division, and cell motor function were increased compared with the model group.

Conclusion

The bacterial diversity of SONFH rats was higher than that of normal rats, and the increased bacteria genera was mainly pathogenic bacteria, with the decrease of corresponding beneficial bacteria genera. Huoxue Tongluo Capsule may achieve the therapeutic purpose of SONFH by changing the abundance and diversity of intestinal flora and regulating the abundance of Oxalobacteraceae, Ruminococcus_torques_group and other genera.

Evaluation of the Efficacy and Safety of "Crowbar Effect" Technique to Facilitate Balloon Crossing Resistant Chronic Total Occlusions Lesions

LIU Ruifang, XU Fangxing, LIU Tongku, ZHOU Yujie, WU Xiaofan

2023, 26(29):  3683-3688.  DOI: 10.12114/j.issn.1007-9572.2023.0147

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Background

The inability of the balloon to cross coronary chronic total occlusion (CTO) lessions is one of the reasons for the failure of percutaneous coronary intervention (PCI) in the revascularization of CTO.

Objective

To evaluate the efficacy and safety of the "Crowbar Effect" technique to facilitate balloon crossing resistant CTO lesions, so as to provide an alternative novel technique for CTO recanalization and improving the success rate of CTO recanalization.

Methods

A total of 648 patients with coronary artery CTO lesions treated by antegrade approach at Beijing Anzhen Hospital, Capital Medical University and the Affiliated Hospital of Beihua University from January 2010 to January 2019 were collected, 84 (12.96%) cases of whom suffered from resistant CTO lesions which could be not crossed with balloon after the first guide wire successfully crossed the lesions. The "Crowbar Effect" technique was applied to those patients to facilitate the small-sized balloon crossing CTO lesions to complete PCI. The success rate of PCI and incidence of major adverse cardiac events (MACE) were observed.

Results

The average J-score of CTO lesions in 84 patients was (1.63±0.90). After successful crossing of the first guide wire through the CTO lesions, the success rate of small-sized balloon crossing CTO lesions was 91.67% (77/84) due to the use of "Crowbar Effect" technique. There were still failures in 7 cases (8.33%), including 2 cases caused by 360-degree severe calcified lesions and 5 cases caused by coronary artery perforation. No perioperative cardiac death or nonfatal myocardial infarction occurred in 84 patients.

Conclusion

The "Crowbar Effect" technique is effective and safe in facilitating small-sized balloons to cross balloon uncrossable CTO lesions. The application of this simple technique has a high success rate and application value for CTO recanalization.

Evaluation of Cardiac Structure and Function in Patients with Wilson Disease Based on RT-3DE: a Clinical Study

ZHANG Yu, WANG Meixia, ZHANG Jing, WANG Fei, LI Zhonglei, ZHANG Yanyun, JIANG Zhenzhen

2023, 26(29):  3689-3697.  DOI: 10.12114/j.issn.1007-9572.2023.0128

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Background

Wilson disease (WD) is a rare autosomal recessive disease that causes impaired copper excretion, mainly manifestedashepatic and/or neuropsychiatric symptoms, but diversifies with the varying affected organs and severity of the disease. The accumulation of copper in various organs and systems throughout the bodyleads to other (usually milder) clinical symptoms such as Kayser-fleischer ring (K-F), hemolytic disease, impaired renal function, abnormal bone metabolism, myocarditis, arrhythmias, other organ and systemic damage. It has been recently found that WD may result in varying degrees of cardiac damage and even fatal cardiac disorder inextensive studies. Clinical examination of the cardiovascular system has not been included in the routine testing of WD patients. Therefore, early attention and intervention of subclinical cardiac disease in WD patients are of great significance for the treatment and prognosis.

Objective

To observe the dynamic changes in cardiac structure and function in WD patients based on real-time three-dimensional transesophageal echocardiography (RT-3DE), electrocardiogram (ECG) and serological indicators such as myocardial injury markers, so as to provide objective imaging and serological basis for the assessment of early cardiac involvement in WD and facilitating timely intervention in WD patients with early subclinical cardiac damage.

Methods

From October 2021 to October 2022, 60 patients with WD admitted to the neurological department of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine were selected as the WD group, and 60 healthy physical examiners were selected as the control group during the same time. The included WD patients were divided into the neurologic-type (mainly manifested as neuropsychiatric symptoms) and hepatic-type (mainly manifested ashepatic symptoms) groups according the mainsymptoms. ECG, RT-3DE-related parameters and serum myocardial injury markerssuch ashomocysteine (Hcy), cystatin C (CysC), cardiac troponin I (cTnI), amino-terminal B-type natriuretic peptide precursor (NT-proBNP), and total serum bilirubin (TBIL) of the both groups were recorded.

Results

There were significant differences in the proportion of abnormal ECG results between the two groups, with 37 abnormal cases in the WD group and 14 abnormal cases in the control group (P<0.001) ; compared with the control group, HR, QRS duration, QT interval were increased and P-R interval were decreased in the WD group (P<0.01). There were significant differences in the proportion of abnormal RT-3DE results between the two groups, with 23 abnormal cases in the WD group and 10 abnormal cases in the control group (P<0.001) ; compared with the control group, LAD, E/E', EDV, ESV, PAP were increased and E', EF, SV were decreased in the WD group (P<0.01). Compared with the control group, Hcy, TBIL, CysC, cTnI were increased in the WD group. Compared with the hepatic-type group, QRS duration, QT interval and QTc interval were increased (P<0.05), LAD, IVST, LVD, ESV, EDV were increased, SV was decreased (P<0.05), Hcy, CysC, cTnI were increased (P<0.01) in the neurologic-type group.

Conclusion

No features of structural heart disease were found in WD patients, however, WD patients had a higher risk of developing subclinical cardiac damage than healthy controls. In particular, neurologic-type WD patients had a higher risk of subclinical cardiac dysfunction, ventricular remodeling, and myocardial fibrosis than hepatic-type WD patients. RT-3DE technique has high value in assessing cardiac function in WD patients.

Review & Perspectives

Advances in Ferroptosis and Inflammatory Bowel Disease

PU Yu, ZHANG Jixiang, DONG Weiguo

2023, 26(29):  3698-3703.  DOI: 10.12114/j.issn.1007-9572.2022.0698

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Inflammatory bowel disease (IBD) is a group of chronic non-specific gastrointestinal inflammatory conditions, whose pathogenic factors and pathogenesis may be related to environmental factors, genetic susceptibility, gut microbiota and immune responses. Ferroptosis is a newly found cell death caused by the accumulation of iron-dependent lipid hydroperoxides, which is tightly regulated by a lipid repair system including glutathione (GSH) and glutathione peroxidase 4 (GPx4). Increasing studies have reported the fundamental features of ferroptosis in the injured gastrointestinal tract in IBD patients, including iron deposition, GSH exhaustion, GPx4 inactivation, and lipid peroxidation. Furthermore, regulating the key ferroptosis-related genes may alter the progression, severity, or even morbidity of IBD. We reviewed the basic mechanism of ferroptosis, and the prospect of ferroptosis pathways as therapeutic targets in IBD. In addition, the initiation of ferroptosis for improving IBD by extrinsic (transporter-dependent) or intrinsic (enzyme-regulated) pathway, may be a new direction for clinical treatment of IBD.

Advances in the Association of High Salt-induced Gut Microbiota Disturbances with Salt-sensitive Blood Pressure

XIAO Liqi, YANG Li, CUI Saixian, ZHANG Yayuan, WANG Yulu, HE Yan

2023, 26(29):  3704-3709.  DOI: 10.12114/j.issn.1007-9572.2022.0448

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Excessive salt intake is a major risk for hypertension, an illness posing a serious threat to human health. Salt-sensitive blood pressure (SSBP) refers to a rising blood pressure response to relatively high salt intake, which is a susceptibility of blood pressure to salt in some individuals. Recent studies have found that gut microbiota is significantly associated with blood pressure and salt intake, and it plays an important role in the development of SSBP. We reviewed the advances in the association of dietary salt intake, gut microbiota and SSBP, and summarized that gut microbiota plays an important role in high-salt diet-induced intestinal inflammation and hypertension, indicating that gut microbiota and its disturbance as well as inflammation/immune responses may be possibly involved in the development of SSBP. This review will provide new ideas for clinical prevention and treatment of SSBP by adjusting the homeostasis of gut microbiota and related inflammatory and immune pathways.

Research Progress on Mechanism of Autophagy in the Pathogenesis of Rheumatoid Arthritis

LIU Yu, YUE Ting, YANG Dongyu, ZHAO Zhongting, YANG Jibo, ZHU Tiantian

2023, 26(29):  3710-3714.  DOI: 10.12114/j.issn.1007-9572.2023.0149

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Rheumatoid arthritis (RA) is a refractory autoimmune disease with chronic and systemic characteristics, however, the pathogenesis of this disease has not been fully defined. Autophagy is a metabolic process that exists in eukaryotic cells and maintains normal physiological activities and cell homeostasis. Dysregulation of autophagy is related to the occurrence and development of various diseases such as RA. The databases of CNKI, Wanfang Data, VIP, PubMed, Web of Science, Elsevier, etc. were searched for the literature related to autophagy in RA pathogenesis. The role of autophagy in the pathogenesis of RA was summarized in terms of maintaining synovial inflammation (improving anti-apoptosis rate of synovial cells and regulating the phenotype transformation of synovial cells), promoting bone destruction (participating in osteoclastogenesis and regulating chondrocyte apoptosis) and disrupting immune system homeostasis (regulating the activation and maturation of immune cells, participating in the presentation of citrullinated proteins, and inducing carbamoylation of proteins), in order to provide basis and reference for the pathogenesis research and treatment of RA.

Research of Typical Cases

Multiple Deep Muscle Abscesses in Type 2 Diabetes in the Elderly: Report of One Case and Literature Review

ZHAO Xiaohua, DU Lin, GAO Shengnan, JIANG Ziyun

2023, 26(29):  3715-3718.  DOI: 10.12114/j.issn.1007-9572.2022.0508

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Older adults with diabetes often have comorbidities, and are prone to acute infection. Abscess is a serious infectious disease, and untimely treatment of which may lead to sepsis and septic shock, endangering the life. Most studies on abscesses in diabetes focus on visceral abscess, among which the commonly seen are liver abscess and lung abscess, while multiple muscle abscesses have been rarely reported. We reported the diagnosis and treatment process of an older case of type 2 diabetes complicated with multiple deep muscle abscesses, and investigated the pathogenesis characteristics by referring to relevant literature, providing insights into clinical practice.