Table of Content

20 February 2025, Volume 28 Issue 06

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Guidelines Interpretation

Recommendations for the Management of Hypertensive Disorders of Pregnancy in China: Based on the A Summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand Hypertension in Pregnancy Guideline

FANG Xiang, SONG Haiqi, LIAO Xiaoyang, LIU Lidi, ZHANG Peng, JIA Yu, YANG Ziyu, YANG Rong, LIU Ruhui

2025, 28(06):  649-654.  DOI: 10.12114/j.issn.1007-9572.2024.0478

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Hypertensive disorders of pregnancy (HDP) is one of the most common complications of pregnancy and one of the leading causes of maternal mortality worldwide. In 2023, the Society of Obstetricians of Australia and New Zealand released the A Summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand Hypertension in Pregnancy Guideline. This article interprets its key contents and proposes suggestions on non-drug intervention measures and refined management processes for HDP in China, in order to provide a new basis for the management of HDP in China.

Frontiers of Medicine

Familial Hypercholesterolemia: Diagnostic Differences between Domestic and Foreign Guidelines

MA Hongyang, YUE Anna, SUN Kangyun

2025, 28(06):  655-665.  DOI: 10.12114/j.issn.1007-9572.2024.0104

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Family hypercholesterolemia (FH) is a common genetic metabolic disease, characterized by an abnormal increase in low-density lipoprotein cholesterol (LDL-C), which may manifest as corneal arcus and xanthomas. Long-term high levels of LDL-C can increase the risk of atherosclerotic cardiovascular disease (ASCVD). FH patients have a higher risk of early-onset ASCVD, with homozygous FH being more severe. Global prevalence of FH has gradually gained attention, but diagnosis and treatment still face challenges. Leveraging the release of the 2023 Chinese Lipid Management Guidelines, this article primarily compares domestic and foreign screening and diagnostic approaches to emphasize the importance of screening for lipid profiles and recommend early identification of FH patients. Additionally, genetic testing is also recommended, including not only a few key genes but also other related genes or whole-genome detection. Furthermore, this article compares different guidelines on LDL-C control management levels and ASCVD risk factors for different LDL-C subgroups. It highlights the differences in dietary recommendations, lifestyle advice, and medication control between domestic and foreign guidelines, pointing out that statins are the primary cholesterol-lowering agents universally recognized as important, with combination therapy being particularly crucial. However, for patients who failed to achieve LDL-C control after maximally tolerated therapy, international lipid management guidelines have made updates. Meanwhile, for Homozygous familial hypercholesterolemia (HoFH) patients, high-intensity statin combination therapy with other medications is the preferred approach, and early treatment is crucial; timely consideration of lipoprotein apheresis and Recombinant proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can help reduce the incidence and mortality rate of ASCVD.

Research Progress on the Mechanism of Ferroptosis in Neonatal Hypoxic-ischemic Brain Damage

ZHANG Tianyang, XU Wenxiu, QIN Xinyu, XING Xuexue, BI Meirong

2025, 28(06):  666-672.  DOI: 10.12114/j.issn.1007-9572.2024.0254

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Neonatal hypoxic-ischemic brain damage (HIBD) is one of the common causes of neurological injuries in the neonatal period, which is prone to lead to high disability and mortality in newborns, and its pathogenesis is complex and there is no specific treatment in the clinic. Ferroptosis, as a newly discovered type of non-apoptotic cell death in recent years, has received widespread attention and has gradually become a research hotspot. Research on ferroptosis and neonatal HIBD has been increasing year by year, and a large number of studies have shown that ferroptosis is closely related to the occurrence and development of neonatal HIBD. Moreover, it has been pointed out that vitamin K₂, especially MK-4, can exert its neuroprotective effect by inhibiting ferroptosis. In this paper, we briefly review the mechanism of ferroptosis in neonatal HIBD and microglia, and look forward to the possibility that vitamin K₂, especially MK-4, can improve the prognosis of neonatal HIBD by inhibiting ferroptosis, with the aim of providing a more economical, safer, and more targeted treatment.

General Practice Education

Application of Murtagh Safe Diagnostic Strategy Combined with Mind Mapping for Establishing Clinical Thinking in General Practice Teaching Clinic

YANG Ling, DU Xueping

2025, 28(06):  673-680.  DOI: 10.12114/j.issn.1007-9572.2023.0906

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General practice teaching clinic is an important training method to develop clinical thinking and improve general practice diagnosis and treatment ability of general practice residents. In this paper, we used a patient with fatigue as the main manifestation as a teaching case to introduce the Murtagh safe diagnostic strategy proposed by John Murtagh, a famous Australian general medicine expert, to inspire the diagnosis and differential diagnosis of fatigue for the general practice residents in the general practice teaching clinic: (1) What are the common diseases that cause fatigue? (2) What are the important diseases that should not be ignored? (3) What are the easily missed diseases of fatigue? (4) Are there underlying easily masked diseases? (5) Is there something the patient is not saying? Combined with the history, physical examination and laboratory findings, a preliminary diagnosis of antineutrophil cytoplasmic antibody-associated vasculitis causing rapidly progressive glomerulonephritis is highly probable. The timely referral got nephropathology which confirms the etiology of the fatigue was antineutrophil cytoplasmic antibody-associated glomerulonephritis, and achieved satisfactory outcome. Based on the Murtagh safe diagnostic strategy, the instructor helped the general practice residents to construct a systematic knowledge framework for the identification and analysis of fatigue, so as to improve their clinical logical thinking ability and the ability to solve practical clinical problems. Using the mind mapping as an auxiliary tool, the diagnosis and differential diagnosis of the Murtagh safe diagnostic strategy were concretized and visualized, so as to optimize the teaching effect.

Original Research

Hypertriglyceridemic-waist Phenotype and the Risk of Type 2 Diabetes Mellitus: a Prospective Cohort Study

ZHU Ling, ZHAO Fouxi, WANG Jiangtao, DU Yu, WU Yanli, ZHANG Ji, LIU Tao

2025, 28(06):  681-687.  DOI: 10.12114/j.issn.1007-9572.2024.0189

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Background

Hypertriglyceridemic-waist phenotype is a risk factor for type 2 diabetes mellitus (T2DM). The risk of T2DM may vary in different genders, regions, age groups, and overweight /obese people.

Objective

To explore the risk of T2DM by hypertriglyceridemic-waist phenotype in different genders, regions, ages, and overweight /obese people, and to provide a scientific basis for the prevention and control of T2DM.

Methods

This was a prospective cohort study involving 9 280 permanent residents over 18 years in 12 districts (counties) of Guizhou province in 2010 selected by multi-stage stratified cluster random sampling. From 2016 to 2020, 8 163 residents were followed up, and finally 6 743 eligible participants were enrolled after excluding those with baseline T2DM, lacking sufficient clinical data, lost to follow-up and deaths. Participants were assigned into 4 groups based on their baseline waist circumference (WC) and serum triacylglycerol (TG) levels: Normal WC and TG group (NWNT, WC<90 cm in men and WC<85 cm in women, TG<1.7 mmol/L), normal WC and high TG group (NWHT, WC<90 cm in men and WC<85 cm in women, TG≥1.7 mmol/L), large WC and normal TG group (EWNT, WC≥90 cm in men or WC≥85 cm in women, TG<1.7 mmol/L) and large WC and high TG group (EWHT, WC≥90 cm in men or WC≥85 cm in women, TG≥1.7 mmol/L). A Cox proportional hazards regression model was used to analyze the correlation between hypertriglyceridemic-waist phenotype grouping and new-onset T2DM.

Results

The median follow-up period was 6.58 years. Among 6 743 participants, new-onset T2DM was observed in 706 (10.47%) individuals. After adjusting confounding factors, the Cox proportional hazards regression analysis showed that the risk of T2DM was 1.486 times in the EWHT group than the NWNT group (HR=1.486, 95%CI=1.185-1.865, P=0.001). Multivariate Cox proportional hazards regression analysis showed that in the subgroups of male gender, rural region, aged<45 years, and overweight /obese, the risk of T2DM in the EWHT group was 1.792 (HR=1.792, 95%CI=1.297-2.476, P<0.001), 1.483 (HR=1.483, 95%CI=1.115-1.971, P=0.007), 1.540 (HR=1.540, 95%CI=1.083-2.190, P=0.016), and 1.614 (HR=1.614, 95%CI=1.123-2.321, P=0.010) times higher than the NWNT group, respectively.

Conclusion

After a median follow-up time of 6.58 years in a large cohort, the hypertriglyceridemic-waist phenotype is the risk of T2DM in Guizhou Province, which is more significant in males, rural areas, aged<45 years, and overweight /obese people. Therefore, health education should be strengthened for high-risk populations. Weight control through reasonable diet and appropriate exercise, and reducing serum triacylglycerol levels are necessary and effective methods to prevent the incidence of T2DM.

Relationship between Ethnic Minority Speciality Diets and Cardiovascular Disease: Based on the Cohort Study of Natural Populations Living in Ethnic Minority Aggregation Areas in the Southwest Region

WANG Yuan, XIAO Fei, ZHANG Yuxin, ZHOU Enhui, ZHONG Jianqin, HU Yuxin, HONG Feng

2025, 28(06):  688-696.  DOI: 10.12114/j.issn.1007-9572.2024.0255

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Background

Cardiovascular disease (CVD) is one of the major chronic diseases that cause death and disability, and is an important public health problem in China. At present, there are few studies on the effect of ethnic minority speciality diets on CVD.

Objective

To analyse the current situation of CVD prevalence among ethnic minorities in Guizhou Province, and to explore the relationship between ethnic speciality diets and the risk of CVD.

Methods

The data were obtained from the epidemiological survey database of the＂Cohort Study of Natural Populations Living in Ethnic Minority Aggregation Areas in the Southwest Region＂from July 2018 to August 2019. Multi-stage stratified sampling was adopted. A baseline survey was conducted on 18 790 Dong, Miao and Bouyei residents aged 30 to 79 in Qiandongnan Miao and Dong Autonomous Prefecture and Qiannan Bouyei Miao Autonomous Prefecture of Guizhou Province. A total of 17 085 people were included in the analysis. According to whether the survey subjects suffered from CVD, they were divided into two groups: CVD group (530 participants) and non-CVD group (16 555 participants). Face-to-face interviews were conducted by professional investigators using a special electronic questionnaire developed by the project team, which included surveys on basic information, living habits, disease history, and diet. As known from the study of ethnic minority dietary culture, the respondents were asked to recall the frequency (times/month) of eating 11 food items in the past 1 year: pickled vegetables, glutinous rice and its products, pickled fish/meat, preserved/smoked meat, white sour soup, red sour soup, cow/sheep deflated, purple-blooded meat, heartleaf houttuynia herb, fern, and oil tea. Unconditional Logistic regression model and restricted cubic spline were used to analyze the relationship between ethnic diet and CVD.

Results

The total prevalence of CVD among ethnic minorities in Guizhou province was 3.20% (530/17 085), and the prevalence of CVD among each ethnic group was 3.14% (207/6 599) for the Dong, 3.13% (158/5 043) for the Miao, and 3.03% (165/5 443) for the Bouyei. The prevalence of CVD among males (3.68%) was higher than that among females (2.80%). Multivariate Logistic regression analysis showed that glutinous rice and its products were protective factors for CVD in the general population 1 to 3 times/month (OR=0.720, 95%CI=0.553-0.937, P=0.015). In the Dong population, fern≤1 time/month (OR=2.172, 95%CI=1.162-4.059, P=0.015) was a risk factor for CVD. In the Miao population, glutinous rice and its products <1 time/month (OR=0.563, 95%CI=0.340-0.933, P=0.026) and oil tea >1 time/month (OR=0.442, 95%CI=0.202-0.967, P=0.041) were protective factors for CVD. In the Bouyei population, cow/sheep deflated≤1 time/month (OR=1.935, 95%CI=1.046-3.579, P=0.035) was a risk factor for CVD. Subgroup analyses showed that in the male population, glutinous rice and its products 1-3 times/month (OR=0.639, 95%CI=0.427-0.957, P=0.030) reduced the risk of CVD. In people <60 years old, glutinous rice and its products 1-3 times/month (OR=0.656, 95%CI=0.443-0.971, P=0.035) and heartleaf houttuynia herb <1 time/month (OR=0.642, 95%CI=0.418-0.986, P=0.043) reduced the risk of CVD, while fern >1 time/month (OR=1.655, 95%CI=1.011-2.709, P=0.045) increased the risk of CVD. In the population with normal body mass, glutinous rice and its products <1 time/month (OR=0.584, 95%CI=0.393-0.868, P=0.008) and 1-3 times/month (OR=0.666, 95%CI=0.452-0.981, P=0.039) could reduce the risk of CVD; in the overweight population, purple-blooded meat ≤1 time/month (OR=0.658, 95%CI=0.453-0.955, P=0.027) could reduce the risk of CVD; in obese population, red sour soup 1-3 times/month (OR=0.592, 95%CI=0.360-0.973, P=0.039) could reduce the risk of CVD. In non-smokers, glutinous rice and its products <1 time/month (OR=0.716, 95%CI=0.532-0.965, P=0.028) and 1-3 times/month (OR=0.711, 95%CI=0.530-0.955, P=0.023) reduced the risk of CVD, and in those who had quit smoking, fern >1 time/month (OR=7.507, 95%CI=1.324-42.556, P=0.023) increased the risk of CVD, while oil tea >1 time/month (OR=0.319, 95%CI=0.103-0.990, P=0.048) decreased the risk of CVD; among people who had quit smoking, glutinous rice and its products were consumed 1-3 times/month (OR=0.710, 95%CI=0.531-0.948, P=0.020) and red sour soup 1-3 times/month (OR=0.775, 95%CI=0.613-0.980, P=0.033) could reduce the risk of CVD, while preserved/smoked meat 1-3 times/month (OR=1.400, 95%CI=1.040-1.884, P= 0.027) could increase the risk of CVD. Glutinous rice and its products, pickled fish/meat and purple-blooded meat were all associated with the risk of developing CVD in a non-linear quantitative manner (P<0.05, P_nonlinear<0.05) .

Conclusion

The prevalence of CVD in ethnic minority populations in Guizhou Province is low. The consumption frequency of glutinous rice and its products, oil tea, heartleaf houttuynia her, purple-blooded meat, red sour soup, fern, fern, cow/sheep deflated, and preserved/smoked meat may affect the prevalence risk of CVD. Knowledge of the intake frequency of ethnic minority speciality diets should be publicized, and dietary interventions should be made to prevent and control CVD in ethnic minority populations in Guizhou Province.

Effect of Physical Activities on the Carotid Intima-media Thickening in Patients with Type 2 Diabetes Mellitus

SUN Zhenzhen, CUI Qian, LOU Qingqing, CHEN Xiaodong, FANG Dan, YAO Ping, YUAN Xiaodan

2025, 28(06):  697-704.  DOI: 10.12114/j.issn.1007-9572.2023.0914

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Background

Cardiovascular diseases are the main cause of death in patients with type 2 diabetes mellitus (T2DM). Carotid intima-media thickening (CIMT) can predict the occurrence of cardiovascular diseases. Moderate-to-high levels of physical activities (PA) improve glycemic control and reduce the incidence of cardiovascular diseases and mortality. Exploring the relationship between this modifiable lifestyle and CIMT may be an effective strategy to prevent cardiovascular diseases in the early stage.

Objective

To analyze the correlation between PA at varying levels and CIMT in T2DM patients, and to provide a scientific basis for recommending individualized PA programs to them.

Methods

This was a cross-sectional study. From January 2019 to February 2022, a total of 3 099 T2DM patients visited endocrinology clinics at two tertiary hospitals in Jiangsu Province were selected. PA level in T2DM patients was surveyed using the International Physical Activity Questionnaire (IPAQ). They were assigned into mild and lower PA group, moderate PA group and vigorous PA group. The correlation between PA and CIMT was identified by binary logistic regression. Stratified analyses were performed based on the obesity degree, blood pressure, blood lipids, and hemoglobin A_1c (HbA_1c). Restricted cubic splines were used to evaluate the dose-response relationship between PA and CIMT with PA level as the continuous variable.

Results

Compared with those in the mild and lower PA group (n=981), T2DM patients in moderate PA group (n=1 389) and vigorous PA (n=729) were significantly younger with higher HbA_1c and low-density lipoprotein cholesterol (LDL-C) (P<0.05). Binary Logistic regression analysis showed that moderate PA was negatively correlated with the risk of CIMT, and this correlation was independent of socio-demographic characteristics, lifestyle and blood lipids (OR=0.775, 95%CI=0.629-0.956, P<0.05). The results of restricted cubic spline showed a nonlinear relationship between PA level and the risk of high CIMT (P_nonlinear=0.014). Stratified analysis showed that PA was not associated with CIMT in T2DM patients with normal weight (n=996) or overweight (n=1 395) (P>0.05). However, only moderate PA was associated with CIMT in obese patients (n=708) (OR=0.614, 95%CI=0.382-0.987, P<0.05). Moderate PA was negatively associated with CIMT in patients (n=324) who did not meet any of the three indicators (blood pressure, blood lipids and HbA_1c) and those (n=1 416) who met only one indicator (P<0.05) .

Conclusion

There is a dose-response relationship between PA levels and CIMT in T2DM patients thickening. Moderate PA is significantly negatively associated with CIMT, especially in T2DM patients with poor control of obesity, blood pressure, blood lipids, and glycaemia, while vigorous PA is not correlated with CIMT.

Predictive Effect of C-reactive Protein Albumin Ratio on Long-term Adverse Cardiovascular Events in Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction

MA Juan, MA Shengzong, YAN Ru, MA Xueping, JIA Shaobin

2025, 28(06):  705-712.  DOI: 10.12114/j.issn.1007-9572.2023.0857

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Background

Acute Myocardial Infarction (AMI) remains one of the leading threats to global public health. Despite available reperfusion therapies, major adverse cardiovascular and cerebral events (MACCEs) associated with AMI continue to be a leading cause of death worldwide. This is particularly true for patients with AMI and concomitant diabetes mellitus, where coronary artery disease is more complex and severe, making early detection and prognosis of long-term outcomes for these patients challenging. Therefore, the identification of simple and accessible laboratory markers could facilitate the prediction of post-percutaneous coronary intervention (PCI) MACCEs in patients with type 2 diabetes mellitus (T2DM) and AMI.

Objective

To investigate the predictive value of the serum C-reactive protein (CRP) /albumin (Alb) ratio (CAR) for long-term MACCEs following PCI in patients with T2DM and AMI.

Methods

A total of 1 683 patients with T2DM and AMI treated at the Department of Cardiovascular Medicine, General Hospital of Ningxia Medical University between 2014 and 2019 were enrolled. General clinical data and test results were collected for these patients. Follow-ups were conducted via telephone or outpatient visits, with a median follow-up period of 5.6 years. MACCEs were defined as all-cause mortality, non-fatal myocardial infarction, recurrent unstable angina, non-fatal stroke, new-onset heart failure, or rehospitalization for worsening heart failure, and revascularization. Patients were divided into the MACCEs group (508 cases) and the non-MACCEs group (1 175 cases) based on the occurrence of MACCEs during the follow-up period. Univariate and multivariate Logistic regression analyses were performed to identify factors influencing MACCEs in patients with T2DM and AMI. Kaplan-Meier survival curves were plotted, and the Log-rank test was used for comparisons. Receiver operating characteristic (ROC) curve analysis assessed the predictive efficacy of CAR for long-term MACCEs in patients with T2DM and AMI, while the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices evaluated the improvement in prognostic assessment provided by CAR.

Results

Among the 1 683 patients, 508 (30.18%) experienced MACCEs. Multivariate Logistic regression analysis indicated that hypertension [OR (95%CI) =1.994 (1.142-3.483) ], length of coronary stent implanted [OR (95%CI) =1.031 (1.002-1.062) ], CRP [OR (95%CI) =0.950 (0.915-0.986) ], Alb [OR (95%CI) =0.933 (0.880-0.989) ], and CAR [OR (95%CI) =5.582 (1.705-18.277) ] were significant predictors of post-PCI MACCEs in patients with T2DM and AMI (P<0.05). Based on the median CAR level (0.86), patients were divided into two groups: CAR<0.86 and CAR≥0.86. The log-rank test showed that the incidence of MACCEs was significantly higher in the CAR≥0.86 group compared to the CAR<0.86 group (52.68% vs. 22.92%; χ²=65.65, P<0.001). The ROC curve indicated that the area under the curve (AUC) for CAR in predicting MACCEs in patients with T2DM and AMI was 0.728 (95%CI=0.702-0.754), with an optimal cut-off value of 0.576, sensitivity of 0.617, and specificity of 0.747. Compared to baseline models, CAR significantly improved the prediction of adverse cardio-cerebral events (NRI=0.377, IDI=0.166, C-index =0.690; P<0.05) .

Conclusion

CAR is an effective predictive marker for the risk of long-term MACCEs in patients with T2DM and AMI following PCI.

The Value of CT-FFR in Predicting Major Adverse Cardiovascular Events in Patients with Obstructive Coronary Artery Disease

WANG Rui, OUYANG Lina, WU Qian, NIU Yuanyuan, LI Guilan, ZHU Li

2025, 28(06):  713-719.  DOI: 10.12114/j.issn.1007-9572.2024.0112

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Background

At present, FFR is the ＂gold standard＂ index for evaluating the function and physiology of coronary blood flow. CT-fractional flow reserve (CT-FFR) reflects the hemodynamic changes of coronary artery lesions, it has higher diagnostic and differential ability in distinguishing lesion-specific ischemia compare with FFR.

Objective

To evaluate the value of CT-FFR in predicting the incidence of MACE in patients with stable chest pain caused by coronary artery obstruction.

Methods

This study included 116 patients who underwent coronary CT angiography (CCTA) examination for stable chest pain in the General Hospital of Ningxia Medical University from January 2017 to June 2021, and were followed up for a median of 2 (0, 25) months. The subjects were divided into MACE group (n=55) and non-MACE group (n=61) according to whether occurred major adverse cardiovascular events (MACE) during the follow-up period. The differences of the degree of coronary artery stenosis and CT-FFR between the two groups were compared, and the patients were classified according to the median of degree of coronary artery stenosis and CT-FFR, and compared the total incidence of MACE and the incidence of MACE within 3 months, 3 to 6 months and after 6 months. Spearman rank correlation analysis was used to analyze the correlation between the degree of coronary artery stenosis and CT-FFR, and multivariate Logistic regression analysis was used to explore the influencing factors of MACE. The ROC curves of stenosis degree, CT-FFR and the combination of the two index on the occurrence of MACE in patients with stable chest pain caused by coronary artery obstruction were drawn, and compared the predictive performance of different indexes according to the area under ROC curve (AUC) .

Results

The median degree of coronary lumen stenosis in 116 patients was 70% (60%, 80%), and the median CT-FFR was 0.79 (0.74, 0.85). The degree of coronary lumen stenosis in the MACE group was higher than that in the non-MACE group (Z=-4.41, P<0.001), and CT-FFR was lower (Z=-5.54, P<0.001). The incidence of MACE in patients with coronary artery stenosis between 70% and 90% was higher than that in patients with coronary artery stenosis between 50% and 69% (χ²=19.221, P<0.001). The incidence of MACE in CT-FFR≤0.8 patients was higher than that in CT-FFR>0.8 (χ²=30.025, P<0.001). The incidence of MACE in patients with different degrees of coronary artery stenosis combined with different CT-FFR was significantly different (χ²=37.789, P<0.001). The incidence of MACE was higher in patients with stenosis between 70% and 90% within 3 months than that in patients with stenosis between 50% and 69%, and the incidence of MACE in patients with CT-FFR≤0.8 within 3 months was higher than that in patients with CT-FFR>0.8. The incidence of MACE in patients with stenosis between 70% and 90% and CT-FFR≤0.8 within 3 months of follow-up was higher than that in other categories (P<0.05). Spearman rank correlation analysis showed that the degree of coronary lumen stenosis was negatively correlated with CT-FFR (r_s=-0.532 6, P<0.001). Multivariate Logistic regression analysis showed that the degree of coronary lumen stenosis between 70% and 90% (OR=3.085, 95%CI=1.147-8.298, P=0.026), CT-FFR≤0.8 (OR=6.527, 95%CI=2.560-16.641, P<0.001) were risk factors for MACE. The value of coronary lumen stenosis combined with CT-FFR in predicting MACE was higher (AUC=0.812, 95%CI=0.731-0.892, P<0.001) .

Conclusion

The degree of coronary artery stenosis between 70% and 90%, CT-FFR≤0.8 may be the risk factors of MACE in patients. Compared with the degree of stenosis, CT-FFR has a beneficial value in predicting the incidence of MACE in patients with stable chest pain caused by coronary artery obstruction, and the prediction performance is better when the degree of stenosis is combined with CT-FFR.

Correlation between Triglyceride Glucose Index and Atrial Fibrillation in Patients with Chronic Heart Failure

BAI Lu, ZHANG Qiang, LIU Fangfang, SUN Caihong, FEI Sijie, XIN Caifeng

2025, 28(06):  720-728.  DOI: 10.12114/j.issn.1007-9572.2024.0100

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Background

Insulin resistance (IR) is associated with atrial fibrillation (AF) and atrial remodeling, and the correlation of triacylglycerol glucose (TyG) index, a novel, simple, and valuable indicator of IR, with the development of AF in patients with chronic heart failure (CHF) has been poorly studied.

Objective

To investigate the correlation between TyG index and AF in patients with CHF.

Methods

A total of 417 CHF patients hospitalized in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Zhengzhou University from January 2021 to January 2022 were retrospectively selected for the study, and the CHF patients were divided into two groups according to whether they developed AF: the AF group (138 patients) and the non-AF group (279 patients). The TyG index was categorized into four levels based on quartiles: Q1 (TyG index ≤8.20), Q2 (8.20<TyG index≤8.44), Q3 (8.44<TyG index≤8.84), and Q4 (TyG index>8.84). Patients' baseline data, including TyG index and basic information, laboratory test indexes, and echocardiographic data, were collected through the hospital's electronic medical record system. The LASSO regression algorithm was used for variable screening, and multivariate Logistic regression was used to analyze the correlation between TyG index and the risk of AF occurrence in patients with CHF and to construct a regression model. The predictive value of TyG index for the occurrence of AF in CHF patients was also analyzed using the subject work characteristics curve. Restricted cubic spline plots of the correlation between TyG index and the risk of developing AF in CHF patients were plotted.

Results

Patients in the AF group had higher BMI, New York Heart Association cardiac function class Ⅲ-Ⅳ, proportion of hypertension, serum uric acid (SUA), triacylglycerol, blood urea nitrogen (BUN), fasting blood glucose, N-terminal B-type natriuretic peptide precursor, TyG index, left atrial diameter (LAD), the proportions of β-blockers, calcium antagonists, and diuretics were higher than those in the non-AF group; total cholesterol (TC), endogenous creatinine clearance (Ccr), left ventricular ejection fraction, and the proportion of angiotensin-converting enzyme inhibitors/angiotensin Ⅱ receptor blockers (ACEI/ARB) class of drug use was lower than that of the non-AF group (P<0.05). The results of multivariate Logistic regression analysis showed that the combination of hypertension (OR=1.749, 95%CI=1.048-2.918, P=0.032), elevated BUN (OR=1.269, 95%CI=1.104-1.457, P=0.001), elevated SUA (OR=1.002, 95%CI=1.000-1.005, P=0.047), elevated TyG index (OR=2.360, 95%CI=1.397-3.987, P=0.001), elevated LAD (OR=1.065, 95%CI=1.034-1.097, P<0.001), and use of diuretics (OR=4.019, 95%CI=2.140-7.548, P<0.001) were risk factors for the development of AF in patients with CHF; Ccr (OR=0.985, 95%CI=0.975-0.996, P=0.006), TC (OR=0.587, 95%CI=0.445-0.775, P<0.001), and the proportion of ACEI/ARB class of drug (OR=0.427, 95%CI=0.253-0.718, P= 0.001) were protective factors for the development of AF in patients with CHF. After fully adjusting for confounders, the risk of AF occurrence in CHF patients at the Q2, Q3, and Q4 levels of TyG index was 1.902, 2.060, and 2.841 times higher than that at the Q1 level (P<0.05). Restricted cubic spline analysis showed a linear positive correlation between TyG index and the risk of developing AF (P_nonlinear=0.494). The area under the curve of TyG index and LASSO-Logistic regression model for predicting the development of AF in patients with CHF were 0.661 (95%CI=0.608-0.724, P<0.001), 0.843 (95%CI=0.803-0.882, P<0.001). In addition, the correlation between TyG index and AF was consistent across subgroups.

Conclusion

The TyG index is independently associated with the AF in patients with CHF, with significant clinical value in predicting AF.

Comparative Study of Pathogenic Bacteria in Patients of Bronchiectasis with and without Chronic Obstructive Pulmonary Disease

WU Jun, ZHANG Ling, GU Dongwei, ZHENG Lei, ZHAO Zhuxiang, ZHAO Ziwen

2025, 28(06):  729-736.  DOI: 10.12114/j.issn.1007-9572.2023.0851

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Background

There are a large number of patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis in China, which are chronic respiratory diseases with high morbidity and mortality. Bronchiectasis-COPD overlap syndrome (BCOS) is a special clinical subtype, but it is easy to be ignored. Infection often contributes to their acute exacerbation, but related etiological studies are relatively scarce.

Objective

To analyze the distribution and drug resistance characteristics of pathogens in bronchiectasis patients without and with COPD, and to compare the differences between them.So as to provide references for rational use of antimicrobial agents.

Methods

A total of 584 patients with bronchiectasis who were hospitalized in the Department of Pulmonary and Critial Care Medicine of Ma'anshan People's Hospital from January 2016 to January 2023 were enrolled. The patients were divided into two groups according to whether they combined with COPD or not: BE group (335 cases without COPD) and BCOS group (249 cases with COPD). A retrospective analysis was performed on the composition, antimicrobial susceptibility results and changes of pathogens on patients, and analyze the difference of distribution and drug resistance between the two groups.

Results

A total of 299 strains were isolated from 584 patients with bronchiectasis, 146 strains from BE group, among them, Gram-negative bacilli 87 strains (59.59%), Gram-positive bacteria 3 strains (2.05%), Mycobacterium 9 strains (6.16%), Fungus 47 strains (32.19%). Meanwhile, 153 strains from BCOS group, among them, Gram-negative bacilli 80 strains (52.29%), Gram-positive bacteria 1 strains (0.65%), Mycobacterium 2 strains (1.31%), Fungus 70 strains (45.75%). The composition ratio of Candida albicans were significantly higher in BCOS group than BE group (χ²=5.274, P=0.022). The resistance rates of Pseudomonas aeruginosa to imipenem in BE group and BCOS group were 10.64%, 25.53%, piperacillin tazobactam 6.98%, 15.91%, ciprofloxacin 12.77%, 21.28%, amicacin 2.13%, 2.13%, respectively. The resistance rates of Klebsiella pneumoniae to imipenem were 0, 14.29%, piperacillin tazobactam 0, 14.29%, ciprofloxacin 15.38%, 35.71%, amikacin 0, 7.14%, respectively. The resistance rate of Pseudomonas aeruginosa to ampicillin/sulbactam in BCOS group was significantly lower than that in BE group (P=0.026). The isolation rates of ESBLs-producing enterobacteriaceae (χ²=4.357, P=0.037) and carbapenem-resistant Pseudomonas aeruginosa in BCOS group were higher than BE group (χ²=5.593, P=0.018). From 2016 to 2022, the isolation strains of Pseudomonas aeruginosa in patients with bronchiectasis was the highest, and showed a trend of first decreasing and then increasing. The isolation strains of Klebsiella pneumoniae increased significantly in 2021 and 2022, second only to Pseudomonas aeruginosa. The isolation strains of Mycobacterium from 2020 to 2022 and Aspergillus from 2021 to 2022 showed an upward trend.

Conclusion

As a special phenotype, BCOS has its own characteristics of pathogen distribution and drug resistance, which deserves attention. Pseudomonas aeruginosa is the most common pathogen isolated from patients with bronchiectasis and BCOS currently. In recent years, the isolation strains of Klebsiella pneumoniae is second only to Pseudomonas aeruginosa. The detection of Mycobacterium and Aspergillus has significantly higher than before, which should be taken seriously, especially in BE patients.

Analysis of Clinical Characteristics and Risk Factors of Systemic Sclerosis Combined with Sjögren's Syndrome

ZOU Songyan, ZHANG Riyi, LI Xiaodong, MU Yinyu

2025, 28(06):  737-741.  DOI: 10.12114/j.issn.1007-9572.2024.0156

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Background

Systemic sclerosi (SSc) is a heterogeneous disease, often accompanied by Sjögren's syndrome (SS). Some symptoms of SSc patients are similar to SS, and SS is easily missed in the clinical diagnosis and treatment.

Objective

To explore the clinical and laboratory characteristics of SSc combined with SS and the risk factors of overlapping incidence.

Methods

A retrospective study was conducted on SSc patients hospitalized and treated at the Ningbo Medical Center Lihuili Hospital from 2019 to 2023. Baseline data and laboratory test results of the patients were collected. Patients were divided into two groups based on the presence or absence of SS: the SSc group (n=91) and the SSc with SS group (n=36). Multivariate Logistic regression analysis was used to explore the risk factors for SSc with SS.

Results

The proportion of female patients, disease duration, blood involvement, limited cutaneous systemic sclerosis (lcSSc), and the proportion of autoimmune liver disease in the SSc with SS group were higher than in the SSc group, while the proportion of lung involvement and the use of cyclophosphamide were lower (P<0.05). The SSc with SS group had lower platelet distribution width, complement C4, and anti-Scl-70 antibody detection rates compared to the SSc group, while the detection rates of alkaline phosphatase, glutamyl transpeptidase, immunoglobulin M (IgM), anti-centromere protein B antibodies (anti-CENP-B antibodies), anti-Sjögren's syndrome A/Ro52 antibodies (anti-SSA/Ro52 antibodies), anti-Sjögren's syndrome A/Ro60 antibodies (anti-SSA/Ro60 antibodies), anti-Sjögren's syndrome B antibodies (anti-SSB antibodies), and anti-mitochondrial M2 antibodies (AMA-M2) were higher in the SSc with SS group (P<0.05). Multivariate Logistic regression analysis showed that elevated IgM (OR=3.796, 95%CI=1.021-14.115), positive anti-SSA/Ro52 antibodies (OR=15.099, 95%CI=1.750-130.264), and positive anti-CENP-B antibodies (OR=11.681, 95%CI=1.662-82.097) are independent risk factors for SSc with SS (P<0.05) .

Conclusion

The SSc combined with SS patients have the characteristics of both. When SSc patients have high IgM, positive anti-SSA/Ro52 and anti-CENP-B antibodies and corresponding clinical symptoms, systematic and comprehensive examinations such as labial gland biopsy should be performed to prevent missed diagnosis.

Bidirectional Regulation of Keratinocyte Proliferation and Apoptosis by Metformin via NLRP3 Inflammasome Pathway

TIAN Ke, LENG Qiufeng, LYU Jing, MIAO Guoying, WANG Xinhui, XIE Hui, LIU Qu, YAO Chunxia

2025, 28(06):  742-750.  DOI: 10.12114/j.issn.1007-9572.2024.0042

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Background

Lichen planus is a chronic inflammatory disease of the skin and mucosa. Due to its unknown etiology, many patients have poor treatment effect, which seriously affects the quality of life. It is necessary to further study the pathogenesis of lichen planus to provide a new target for drug screening.

Objective

To investigate the effects of metformin on keratinocyte proliferation and apoptosis through NLRP3 inflammasome pathway.

Methods

Experiment period: 2020 to 2023. In vitro experiment, human immortalized keratinocytes (HaCaT) were divided into 4 groups: control group, lipopolysaccharide group (LPS group: 5 μg/mL), metformin group (Met group: 10 mmol/L), LPS combined with metformin group (LPS+Met group: metformin was treated with 10 mmol/L after LPS 5 μg/mL stimulation for 2 hours). In vivo experiments, BALB/c mice were used as research objects to induce psoriatic dermatitis model by applying imiquimod on the back skin, and metformin cream was prepared for treatment. The mice were randomly divided into 3 groups: control group, imiquimod group (IMQ group), and imiquimod plus metformin group (IMQ+Met group). Each group has 10 mice. Mice in the control group were smeared with petroleum jelly on the back, mice in the IMQ group were smeared with imiquimod ointment on the back, mice in the IMQ+Met group were smeared with metformin cream after 12 h of IMQ ointment. Once a day for seven consecutive days. Cell counting kit-8 (CCK-8) and flow cytometry were used to detect the effects of metformin on the proliferation and apoptosis of HaCaT cells. Western Blotting, enzyme-linked immunosorbent assay (ELISA) and Caspase-1 activity assay were used to detect the expression and activity of NOD-like receptor protein 3 (NLRP3) inflammasome pathway protein in HaCaT cells treated with metformin. Finally, hematoxylin-eosin (HE) staining and immunohistochemistry were used to detect the anti-inflammatory effect of metformin on imiquimod-induced psoriatic dermatitis in mice.

Results

The results of CCK-8 experiment showed that the 48 h survival rate of HaCaT cells in LPS, Met and LPS+Met groups were lower than that in control group, while the 48 h survival rate of HaCaT cells in LPS+Met group was higher than that in LPS group (P<0.05). Flow cytometry results indicated that the proportions of G2/M phase and apoptosis of HaCaT cells at 48 h in LPS and Met groups were higher than those in control group, while the proportion of G2/M phase and apoptosis of HaCaT cells at 48 h in LPS+Met group were lower than those in LPS group (P<0.05). Western Blotting results demonstrated that the expression of Caspase-1 p40, Caspase-1 p20, interleukin (IL) -1β and IL-18 proteins in NLRP3 inflammasome pathway of HaCaT cells in LPS and Met groups were higher than those in control group. The expression of Caspase-1 p40, Caspase-1 p20, IL-1β and IL-18 of HaCaT cells in LPS+Met group were lower than those in LPS group (P<0.05). ELISA results showed that the levels of IL-1β, IL-18 and relative activity of Caspase-1 in NLRP3 inflammasome pathway of HaCaT cells in LPS and Met groups were higher than those in control group. The levels of IL-1β, IL-18 and relative activity of Caspase-1 of HaCaT cells in LPS+Met group were lower than those in LPS group (P<0.05). Metformin application in IMQ+Met group significantly improved the imiquimod skin damage observed by HE staining. Immunohistochemical results reported that the expressions of NLRP3, Caspase-1, IL-1β and IL-18 were significantly decreased in IMQ+Met group.

Conclusion

Metformin bidirectional regulates the proliferation and apoptosis of skin keratinocytes through the NLRP3 inflammasome pathway, and can improve the skin damage induced by imiquimod in psoriasis mice, which is expected to provide a theoretical basis for the clinical use of metformin in the treatment of lichen planus.

Original Research·Appropriate Technology

Correlation between Traditional Chinese Medicine Constitution and Blood Lipid Metabolism in Children: Based on the Shanghai Child and Adolescent Health Cohort

CHENG Lu, QIN Cun, BAI Pinqing, WANG Jianying, REN Yaping, HU Xiaojuan, ZHANG Baojun, ZHANG Lei, ZHOU Yixin

2025, 28(06):  751-755.  DOI: 10.12114/j.issn.1007-9572.2024.0262

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Background

With the rapid development of the society, the detection rate of dyslipidemia in children has gradually increased. At present, there are few data on the application of traditional Chinese medicine (TCM) constitution identification in sub-health of children, and there is a lack of clinical correlation data analysis.

Objective

To observe the trend of changes in TCM constitution and blood lipid metabolism in children, and to analyze the correlation between them, thus providing relevant basis for subsequent continuous monitoring research.

Methods

Sourced from the Shanghai Child and Adolescent Health Cohort (SCAHC), a total of 2 080 healthy primary school students in the second and third grade from Pudong New Area, Shanghai were selected as the research subjects. Using the＂Zhaoming System＂that was independently developed by Shanghai University of Traditional Chinese Medicine, physical information of included subjects in 2021 (first year) and 2022 (second year) was collected. Based on the TCM constitution classification of facial complexion and tongue appearance, clinical symptoms and signs and questionnaire information, children were divided into five types of constitution, including the spleen-deficiency constitution, balanced constitution, Qi-stagnation constitution, deficiency-heat constitution, and excess heat constitution (unbalanced constitution referred to all constitutions except for the balanced constitution). Blood samples were collected to detect on triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC). To analyze and compare the incidence of blood lipid abnormalities in children of different genders, as well as the distribution characteristics and changes of TCM constitution in different ages and genders. Multivariate Logistic regression analysis was performed to explore the correlation between TCM constitution and dyslipidemia in children.

Results

Among the 2 080 children, 1 122 (53.9%) were males and 958 (46.1%) were females, with an average age of (8.2±0.4) years. There were 522 children with dyslipidemia (25.09%), including 272 males (52.1%) and 250 females (47.9%). In 2021, there were 815 (39.2%) cases of the balanced constitution and 1 265 (60.8%) cases of the unbalanced constitution. In 2022, 764 (36.7%) children had a balanced constitution and 1 316 (63.3%) had a unbalanced constitution. There was a statistically significant difference in the distribution of TCM constitution in children between 2021 and 2022 (χ²=106.28, P<0.001). The detection rate of unbalanced constitution in boys was significantly higher than that in girls (χ²₂₀₂₁=14.073, P<0.001; χ²₂₀₂₂=20.090, P<0.001). Multivariate Logistic regression analysis, after excluding demographic factors such as gender and age, showed that elevated HDL-C in children was a contributing factor to the occurrence of balanced constitution (OR=1.624, 95%CI=1.258-2.097, P<0.001), and deficiency-heat constitution (OR=0.654, 95%CI=0.499-0.858, P=0.002) .

Conclusion

Through analyzing the changing trend in TCM constitution and blood lipid metabolism in children from the SCAHC cohort, an increased HDL-C promotes the occurrence of balanced constitution but inhibits the occurrence of deficiency-heat constitution.

Clinical Features and Genetic Analysis of Drug-resistant Epilepsy in Children

ZUO Ranran, SUN Suzhen

2025, 28(06):  756-762.  DOI: 10.12114/j.issn.1007-9572.2024.0063

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Background

At present, the proportion of DRUG-RESISTANT epilepsy (DRE) in children is still maintained at about 30%, and it is often combined with mental retardation, affecting the quality of life, so the diagnosis and treatment of DRE is still a major challenge in neurology.

Objective

Analyze the genetic and clinical characteristics of DRE in children to provide a theoretical basis for clinical genetic testing.

Methods

A retrospective analysis of 95 children with DRE who were hospitalized in Hebei Children's Hospital from 2020 to 2022. According to the genetic test results, they were divided into gene mutation positive group (44 cases) and gene mutation negative group (51 cases). Collected general information (including gender, age of onset, medication use, history of febrile convulsions, family history of epilepsy, etc.), clinical features (seizure types, epilepsy syndromes, developmental conditions), and ancillary examinations [genetic testing, video electroencephalography (VEEG) examination, neuroimaging] from the children, and analyse the genetic aetiology and clinical features of DRE.

Results

Of the 95 children with DRE, 55 (57.9%) were male and 40 (42.1%) were female, with a median age of onset of 1.00 (0.50, 4.00) years and number of medications used of 3 (2, 4) ; the age of onset of the children in the mutation-positive group was younger than that in the mutation-negative group (Z=-5.322, P=0.001) ; comparing the gender of the children, history of febrile seizures, family history of epilepsy, and number of medications used in the two groups, the differences were not statistically significant (P>0.05). Epileptic syndromes were diagnosed in 38 (40.0%) of the children, of which 76.3% (29/38) had onset in the neonatal or infantile period; the percentage of epileptic syndromes was higher in the mutation-positive group than in the mutation-negative group (χ²=12.065, P=0.001). Clinical seizure types were diverse, with 2 or more seizure types being the most common, accounting for 52.6% (50/95), followed by a single focal seizure, accounting for 33.7% (32/95) ; there was no statistically significant difference in the comparison of seizure types between the two groups of children with DRE (χ²=2.920, P=0.404). Developmental screening was improved in 57 children, of whom 43 (75.4%) showed varying degrees of developmental delay after the onset of the disease, and 33 (76.7%) showed generalised developmental delay; the percentage of children with developmental delay in the mutation-positive group was higher than that in the mutation-negative group (χ²=5.728, P=0.017). Genetic variations were detected in 44 cases, resulting in a positive detection rate of 46.3%, predominantly involving ion channel-related mutations, with SCN1A being the most prevalent single-gene mutation. Ninety (94.7%) children had abnormal VEEG examinations, with focal epileptic discharges predominating; the percentage of peak dysrhythmias was higher in the mutation-positive group than in the mutation-negative group (χ²=7.425, P=0.006). Structural etiology was present in 25 (26.3%) children, including 12 in the mutation-positive group and 13 in the mutation-negative group; the difference in the structural etiology of the children with DRE was not statistically significant when comparing the two groups (χ²=0.039, P=0.844) .

Conclusion

Genetic factors are an important etiological factor for DRE in children. The young age of onset and developmental delay suggests that it is related to a genetic etiology, and genetic testing should be actively improved at an early stage, which can help in the early diagnosis of DRE and precise treatment.

Meta-analysis of the Prevalence and Factors Affecting Enuresis in Chinese Children and Adolescents

LIU Qin, CHENG Min, JIANG Fengqiong, LI Xiaoyu

2025, 28(06):  763-770.  DOI: 10.12114/j.issn.1007-9572.2024.0205

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Background

Enuresis is one of the common diseases in children and adolescents, and in recent years, enuresis has posed a great threat to the physical and mental health of children and adolescents, seriously affecting the quality of life of the affected children, and bringing a serious burden to the society and families. At present, there are still controversies about the influencing factors of enuresis in children and adolescents, and there are few relevant systematic evaluations at home and abroad.

Objective

To explore the prevalence and influencing factors of enuresis in children and adolescents in China using Meta-analysis.

Methods

Computer searches were conducted for relevant studies in the databases of CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Web of Science, and Cochrane Library from the construction of the database to May 2024. Independent screening and cross-checking by 2 investigators, cross-sectional studies were assessed using the Agency for Healthcare Research and Quality, and Meta-analysis was performed using Stata 17.0 software.

Results

A total of 27 papers were included, including 243 530 children patients. The results showed that the prevalence of enuresis in Chinese children and adolescents was 6.1% (95%CI=5.1%-7.2%), of which, male (OR=1.52, 95%CI=1.41-1.64), family history of enuresis (OR=3.46, 95%CI=2.01-5.93), constipation (OR=2.32, 95%CI=1.59-3.40), history of urinary tract infections (OR=2.33, 95%CI=1.81-3.01), and sleep disorder (OR=2.01, 95%CI=1.10-3.67), urinary frequency (OR=1.90, 95%CI=1.43-2.52), urinary urgency (OR=1.67, 95%CI=1.31-2.12), and urinary incontinence (OR=4.85, 95%CI=2.78-8.45) were risk factors for enuresis in children and adolescents (P<0.05) ; urinary training (OR=0.11, 95%CI=0.02-0.46) was a protective factor for enuresis in children and adolescents (P<0.05) .

Conclusion

The prevalence of enuresis is high in Chinese children and adolescents, and that gender, family history of enuresis, constipation, history of urinary tract infection, voiding training, sleep disorders, urinary frequency, urinary urgency, and urinary incontinence are the main influencing factors of enuresis in children and adolescents. Therefore, in the future, early identification and intervention of enuresis in children and adolescents should be carried out, parents' attention to enuresis should be raised, and the popularisation of disease education should be done to reduce the prevalence of enuresis and improve the quality of life of the affected children and their families.

Research of Typical Cases

Congential Adrenal Hyperplasia Associated with CYP17A1 Gene Mutation: a Case Report and Literature Review

DAI Yao, XUE Liping, ZHANG Shiqi, XU Min, ZHANG Qiu, HU Honglin

2025, 28(06):  771-776.  DOI: 10.12114/j.issn.1007-9572.2024.0142

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17α-hydroxylase deficiency (17-OHD) is a rare type of congenital adrenal hyperplasia (CAH), accounting for about 1% of CAH cases, with an incidence rate of 1∶50 000. This article reports on a patient with suspected 17-OHD. A gene mutation in the steroidogenic enzyme gene, CYP17A1, was identified through exome sequencing. Combined with clinical manifestations, physical examination, adrenal gland and gonadal function tests, the final diagnosis of which was CAH, and standardized treatment was provided. Therefore, based on this case, the identification and diagnosis of 17-OHD are reviewed and summarized, in order to improve clinical understanding of the disease, thereby helping to improve the clinical standardization of diagnosis and treatment of 17-OHD, which is 17-OHD, as well as providing more reference materials for the diagnosis and treatment of this disease.