Chinese General Practice

Heart Failure with Preserved Ejection Fraction：Diagnosis and Treatment Strategies　

LIU Wei，WEI Ran

2021, 24(3): 253-258. DOI: 10.12114/j.issn.1007-9572.2020.00.603

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HFpEF accounts for about 50% of heart failure cases.With the aging of population，its incidence and mortality tend to increase year by year.On the basis of recent developments and recommendations from definitive guidelines/ consensuses regarding HFpEF，we introduced and analyzed the diagnostic procedures and treatment strategies for HFpEF，aiming to provide assistance and guidance to Chinese primary care physicians.However，we believe that there are still many problems and challenges in this field：the pathogenesis of HFpEF is still unclear，there is a lack of effective treatment methods，and a large number of clinical trials have shown negative results，and so on.Further clinical studies are needed to provide evidence for HFpEF treatment and reducing the incidence and mortality of related cardiovascular events.

Strategies of TCM Syndrome Differentiation to Encounter Asymptomatic Cases Infected with Coronavirus，Even if without Symptoms Macrocosmically　

DING Jianwen，LIU Baohou

2021, 24(3): 259-266. DOI: 10.12114/j.issn.1007-9572.2020.00.575

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Against the backdrop of COVID-19 pandemic tending to be basically contained in China but continuously spreading in many other countries，increasing studies have found that there is a certain amount of asymptomatic cases infected with coronavirus，and they are contagious，whose diagnoses have posed great challenges both to COVID-19 containment and TCM syndrome differentiation and treatment due to lack of obvious clinical symptoms and signs.We analyzed the syndrome classification，pathogenesis，perspectives and principles of TCM syndrome differentiation for asymptomatic cases infected with coronavirus，and proposed that such cases could be diagnosed and treated by micro syndrome differentiation，disease identification，constitutional differentiation，and “preventive treatment of disease”and so forth，even if without symptoms macrocosmically.

Effect of Sodium-glucose Co-transporter 2 Inhibitor on Ventricular Remodeling　

LI Zhao，CHENG Gong

2021, 24(3): 267-271. DOI: 10.12114/j.issn.1007-9572.2020.00.638

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Ventricular remodeling is a pathophysiological process associated with the progression of cardiovascular diseases，the more severe of ventricular remodeling，the worse of prognosis of cardiovascular diseases，and it will eventually lead to heart failure and death.However，there are limited available drugs to delay or reverse ventricular remodeling clinically.As a new type of oral hypoglycemic drug，sodium-glucose co-transporter 2（SGLT-2）inhibitor has been indicated a protective effect on cardiovascular system by many studies.This paper selectively analyzed the effect of SGLT-2 inhibitor on ventricular remodeling in acute myocardial infarction，diabetic cardiomyopathy，hypertensive heart disease and heart failure，so as to provide a reference for more scientific and reasonable application of SGLT-2 inhibitor.

Novel Advances in the Mechanism of Cardiovascular Benefit of Sodium-glucose Co-transporter 2 Inhibitors　

CHEN Xuefeng，RONG Chunli，YAO Wenjing，ZHANG Yantao，BAI Wenlou，JIA Yongjian，HAO Ziqiang，QI Xiaoyong

2021, 24(3): 272-279. DOI: 10.12114/j.issn.1007-9572.2020.00.557

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Sodium-glucose co-transporter 2 inhibitors （SGLT2i），a new class of drugs approved for the treatment of diabetes，which lower the renal glucose threshold via inhibiting SGLT-2，and promote urinary glucose excretion，thus reducing the level of glucose in the plasma.Currently，FDA-approved SGLT2i for diabetes include canagliflozin，empagliflozin，dapagliflozin and so on.Several recently completed large clinical trials have demonstrated that SGLT2i have cardioprotective and renoprotective effects besides hypoglycemic effect.Subgroup analysis from these trials indicated a significant reduction in the progression of nephropathy and the readmission rate of heart failure with SGLT2i.This article explores the mechanism of cardiovascular befits of SGLT2i by reviewing the latest relevant human clinical trials and animal experiments，aiming to provide guidance for further application of SGLT2i in treating cardiovascular disease，especially heart failure，to improve the prognosis of such patients.

Effects of Dapagliflozin and Linagliptin on Metabolic Indices and PR Interval among Patients with Type 2 Diabetes Mellitus　

ZHANG Dongming，CUI Tingting，ZHANG Jin，CAO Huifang，WANG Limei

2021, 24(3): 280-284. DOI: 10.12114/j.issn.1007-9572.2020.00.631

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Background　Metabolic disorder is an important risk factor for cardiovascular complications associated with type 2 diabetes mellitus（T2DM），a major cause of death in T2DM patients，and PR interval extension is a key marker of subclinical phase of development of such diseases.Objective　To investigate the effects of dapagliflozin and linagliptin on metabolic indices and PR interval among T2DM patients.Methods　80 T2DM inpatients recruited from Department of Endocrinology，the Second Affiliated Hospital of Zhengzhou University during October 2018 to June 2019 were equally randomized into dapagliflozin group and linagliptin group，receiving oral administration of dapagliflozin 10 mg/d，and linagliptin 5 mg/d，respectively，besides maintaining previous antihypertensive or lipid-lowering therapies during a consecutive 24-week treatment.Body weight，blood pressure，HbA1c，fasting plasma glucose （FPG），total cholesterol （TC），triglyceride （TG），high-density lipoprotein cholesterol （HDL-C），low-density lipoprotein cholesterol （LDL-C），serum uric acid （SUA） and PR interval before and after treatment，as well as treatment-emergent adverse reactions were collected..Results　Finally，70 cases（each group had 35 cases） completed the study.There were no significant intergroup differences in mean post-treatment body weight，systolic blood pressure，diastolic blood pressure，FPG，TC，TG，HDL-C，LDL-C，SUA and PR interval（P>0.05），but mean post-treatment HbA1c level was much lower in dapagliflozin group （P<0.05）.Dapagliflozin group showed significantly decreased body weight，HbA1c，FPG，TG and SUA，and much reduced PR interval after treatment （P<0.05），but showed insignificant changes in systolic blood pressure，diastolic blood pressure，TC，HDL-C and LDL-C （P>0.05）.Linagliptin group demonstrated significantly decreased HbA1c and FPG after treatment （P<0.05），but demonstrated insignificant changes in body weight，systolic blood pressure，diastolic blood pressure，TC，TG，HDL-C and LDL-C，SUA and PR interval （P>0.05）.No serious adverse reactions or acute cardiovascular and cerebrovascular events occurred during treatment for both groups.Conclusion　Both dapagliflozin and linagliptin could reduce the blood glucose level，but dapagliflozin had better effects on reducing the body weight，TG and SUA，and shortening the PR interval.

Circadian and Workday and Off-day Variations of Treatment of Patients with Acute Myocardial Infarction　

CHENG Lianchao，ZHOU Minggang，HE Dan，TONG Lan，ZHANG Cui，WANG Yanfeng，CAI Lin

2021, 24(3): 285-291. DOI: 10.12114/j.issn.1007-9572.2020.00.542

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Background　Patients presented to hospital during off-hours may experience poorer quality of care and clinical outcomes.However，in China，few studies examined the variations in clinical processes and outcomes across presentation times and days in patients with acute myocardial infarction（AMI）.Objective　This study aimed to comparatively analyze the impact of daytime and nighttime presentations and workday and off-day presentations on treatment efficiency and in-hospital mortality in AMI patients.Methods　We consecutively enrolled 2 109 AMI patients admitted to 11 tertiary general hospitals in Chengdu with accreditation as chest pain centers during January 2017 to June 2019.Patients were stratified into daytime group （n=1 235） and night-time group （n=874） according to admission time，while were divided into workday group （n=1 442） and off-day group （n=667） according to admission date.Clinical characteristics，treatment efficiency of STEMI patients with emergent PCI （including S-to-B time，S-to-D time，FMC-to-B time，D-to-B time，compliance rate of FMC-to-B time and D-to-B time），and in-hospital mortality were investigated between different groups.Multivariate regression analysis was used to analyze the influencing factors of in-hospital mortality.Results　Compared to STEMI patients with emergent PCI in daytime group，those in nighttime group had dramatically longer average S-to-B，FMC-to-B and D-to-B time，and much lower compliance rates of D-to-B and FMC-to-B time（P<0.05），while there was no obvious difference in the treatment efficiency between such patients in workday group and off-day group（P>0.05）.In-hospital mortality of AMI patients，non-STEMI patients，and STEMI patients underwent emergent PCI in nighttime group was significantly higher than that of those in daytime group （P<0.05）.But the in-hospital mortality was similar in AMI patients in workday and off-day groups，and so was that in non-STEMI patients，STEMI patients，and STEMI patients with and without emergent PCI in the two groups（P>0.05）.Multivariate Logistic regression analysis revealed that age 〔OR=1.051，95%CI（1.023，1.080）〕，diagnosis〔OR=2.820，95%CI（1.163，6.841）〕，cardiogenic shock 〔OR=7.463，95%CI（4.066，13.697）〕，sudden cardiac arrest 〔OR=5.729，95%CI（1.616，20.314）〕，multi-vessel disease 〔OR=1.889，95%CI（1.080，3.303）〕，and nighttime presentation 〔OR=1.788，95%CI（1.036，3.087）〕 were influencing factors of in-hospital death in AMI patients.Conclusion　It was proved that there was circadian difference but not workday and off-day difference in the treatment of AMI patients in Chengdu in our study.AMI patients admitted at night-time had more in-hospital treatment delays，longer total ischemic time，and higher in-hospital mortality when compared with those admitted during daytime.

Relationship between Triglyceride-glucose Index and Albuminuria in Patients with Type 2 Diabetes Mellitus　

ZHU Zhuanzhuan，ZHAO Li，LI Yanyan，XIA Hong，DAI Meiqing，GUO Chang，YU Fan，YUAN Guoyue，YANG Ling，WANG Dong

2021, 24(3): 292-297. DOI: 10.12114/j.issn.1007-9572.2020.00.543

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Background　Triglyceride-glucose （TyG） index is a simple indicator to evaluate insulin resistance.Previous studies have shown that increased TyG index increases the risk of diabetes，cardiovascular diseases and others，but the relationship between TyG index and the occurrence of albuminuria in patients with type 2 diabetes mellitus （T2DM） has not been determined.Objective　To explore the correlation between TyG index and albuminuria in T2DM patients.Methods　524 T2DM patients with complete records who were treated at the Department of Endocrinology and Metabolism，Affiliated Hospital of Jiangsu University from February 2012 to November 2019 were chosen retrospectively.Clinical data and relevant laboratory examination indices were obtained.According to calculated TyG index tertile，they were divided into low TyG （L-TyG） group （TyG<9.16，n=175），medium TyG （M-TyG） group（9.16≤TyG<9.68，n=175） and high TyG （H-TyG） group （TyG≥9.68，n=174），and in the light of urinary albumin-to-creatinine ratio （UACR），they were divided into normal group （UACR<30 mg/g，n=267），microalbuminuria group （30 mg/g≤UACR<300 mg/g，n=207） and macroalbuminuria group （UACR≥300 mg/g，n=50）.Multiple linear regression was used to analyze the correlation between TyG index and UACR.Multivariate Logistic regression was adopted to determine the relationship between TyG index and albuminuria.The ROC curve of TyG index was drawn to evaluate its predictive value for albuminuria.Results　Correlation analysis showed that TyG index was inversely correlated with T2DM duration and HDL-C （P<0.05），but was positively correlated with BMI，log-transformed HOMA-IR，HbA1c，BUN，TC，LDL-C，SUA，eGFR，and log-transformed UACR （P<0.05）.Multiple linear regression analysis showed that TyG index was independently correlated with log-transformed UACR 〔β=0.443，95%CI （0.373，0.513），P<0.001〕．Multivariate Logistic regression analysis showed that long T2DM duration 〔OR=1.003，95%CI （1.001，1.006）〕，hypertension 〔OR=2.540，95%CI （1.652，3.813）〕，high HbA1c 〔OR=1.194，95%CI （1.079，1.322）〕，high TyG index 〔OR=6.184，95%CI （3.987，9.593）〕，and low HDL-C 〔OR=0.446，95%CI （0.224，0.886）〕 were risk factors for albuminuria （P<0.05）.The AUC of TyG index for predicting albuminuria was 0.834 〔95%CI （0.799，0.865）〕，which was significantly greater than that of log-transformed HOMA-IR，FPG and TG （P<0.001）.When 9.57 was selected as the cut-off value of TyG index，the maximum Youden index was 0.53，the sensitivity was 66.1%，and the specificity was 87.3%.Conclusion　High TyG index is the risk factor for albuminuria in T2DM patients，which is expected to become a new，simple and practical biological predictor of diabetic kidney disease.

Serum Apelin Level and Its Influence on Gestational Diabetes in Advanced Stages of Pregnancy　

SUN Rong，ZHANG Nana，QI Qi，ZHANG Qiu，HU Honglin

2021, 24(3): 298-303. DOI: 10.12114/j.issn.1007-9572.2020.00.546

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Background　Gestational diabetes mellitus （GDM） is one of the most common complications in pregnancy.Studies have found that a novel fat factor Apelin，the endogenous ligand of APJ receptor，is closely related to insulin resistance and participates in the process of glucose metabolism in vivo.Objective　To investigate the serum Apelin level and its possible role in glycolipid metabolism in GDM patients.Methods　From Department of Endocrinology，the First Affiliated Hospital of Anhui Medical University，196 pregnant women at 24-32 weeks of gestation were enrolled from October 2018 to May 2019.Data were recorded，including general demographic information，glycemic parameters measured by the 2-hour 75-gram oral glucose tolerance test （OGTT）〔fasting blood glucose（FBG），1-hour postprandial glucose （1 hBG），2-hour postprandial glucose （2 hBG）〕，insulin response parameters measured by the 2-hour insulin response test （IRT）〔fasting insulin（FINS），1-hour postprandial insulin （1 hINS），2-hour postprandial insulin （2 hINS）〕，and parameters of C-peptide〔fasting C-peptide（FCP），1-hour postprandial C-peptide（1 hCP），2-hour postprandial C-peptide（2 hCP）〕，serum lipid parameters（TC，TG，HDL-C and LDL-C），and calculated HOMA-IR，homeostasis model assessment of β-cell function （HOMA-β），insulin sensitivity index （ISI） modified beta-cell function index（MBCI），glucose AUC（AUC-G），insulin AUC（AUC-I），and ELISA-detected fasting serum Apelin.The Apelin level and glycolipid metabolism parameters were analyzed between those with normal and abnormal glucose metabolism（NGT and GDM groups，98 cases respectively） stratified by OGTT results，and were further analyzed between those with normal and higher LDL-C in NGT group（NGT-NL and NGT-HL subgroups，44 cases and 54 cases respectively） and in GDM group（GDM-NL and GDM-HL subgroups，49 cases respectively），respectively.Results　Compared with NGT group，GDM group showed higher average levels of FBG，1 hBG，2 hBG，FINS，1 hINS，2 hINS，FCP，2 hCP，HOMA-IR，AUC-G，and AUC-I，but lower average HOMA-β and ISI （P<0.05）.They also showed significantly lower average serum Apelin level （P<0.001）.GDM patients with normal LDL-C had lower average level of serum Apelin than NGT patients with normal or higher LDL-C（P<0.05），so did GDM patients with higher LDL-C （P<0.05）.Pearson correlation analysis showed that serum Apelin was negatively correlated with pre-pregnancy BMI，FBG，1 hBG，2 hBG，FINS，2 hINS，FCP，1 hCP，2 hCP，HOMA-IR，AUC-G，and AUC-I （P<0.05），but was positively correlated with ISI （P<0.05）.Multivariate Logistic regression analysis showed that Apelin was the influencing factor of GDM 〔OR=0.977，95%CI（0.964，0.990），P<0.001〕.Conclusion　Apelin level is negatively correlated with insulin resistance in advanced stages of pregnancy. The serum Apelin level in GDM patients is significantly reduced，and Apelin is the influencing factor of GDM in advanced stages of pregnancy.Apelin may be involved in the glucose metabolism of GDM.

Relationship between IL-17 Level and Glycolipid Metabolism in Patients with Chronic Schizophrenia　

WANG Juan，YANG Yating，ZHANG Yulong，LIU Zhiwei，ZHONG Yi，NING Xiaoshuai，LI Wenzheng，YAO Xianhu，LIU Huanzhong

2021, 24(3): 304-310. DOI: 10.12114/j.issn.1007-9572.2020.00.493

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Background　The pathogenesis of schizophrenia is closely related to inflammation，whose stage has a strong link with metabolic level，so the relationship of IL-17，an important early inflammatory promoter，with glycolipid metabolism in schizophrenics is worth studying.Objective　To explore the relationship between plasma IL-17 level and glycolipid metabolism in patients with chronic schizophrenia.Methods　Patients with chronic schizophrenia who met the study criteria were selected from Chaohu Hospital of Anhui Medical University，Hefei Fourth People's Hospital and Maanshan Fourth People's Hospital from April to June 2018.According to the quartile of plasma IL-17 level，they were divided into high IL-17（≥ P75），and low IL-17（<P75） groups.And intergroup differences in the general data，including socio-demographic data，and clinical data 〔partial electronic medical records of hospitalization，glucose and lipid metabolism indices，Positive and Negative Syndrome Scale（PANSS） and its subscale scores〕 were analyzed.The relationships of plasma IL-17 level and glucose and lipid metabolic indices were estimated.The influencing factors of plasma IL-17 level were explored.Results　A total of 327 patients were enrolled，including 82 with high level of IL-17 〔33.20（51.82）ng/L〕 and 245 with low level of IL-17 〔2.69（2.39）ng/L〕.High and low IL-17 groups had no significant differences in sex ratio，distribution of marital status，prevalence of previous or present diabetes，average fasting blood glucose and scale and subscale scores of PANSS，and median age，years of education，duration of chronic schizophrenia，chlorpromazine equivalent，total cholesterol，triglyceride，and low-density lipoprotein（P>0.05），but showed significant differences in average age of onset，high-density lipoprotein（HDL） level，insulin and glucagon levels（P<0.05）.Spearman correlation analysis showed that plasma IL-17 level was positively correlated with HDL（rs=0.179，P=0.001） and glucagon levels（rs=0.155，P=0.005）.Binary Logistic regression analysis showed that，HDL level〔OR=6.24，95%CI（2.31，16.86），P<0.001〕 and insulin level 〔OR=1.05，95%CI（1.01，1.10），P=0.021〕 were the influencing factors of plasma IL-17 level.Conclusion　In chronic schizophrenia patients，high plasma IL-17 level was associated with higher levels of insulin，glucagon and HDL，and IL-17 may be associated with glucose and lipid metabolism.

Prevalence and Characteristics of Thyroid Diseases in Peri- and Post-menopausal Women　

JIAZIREYA·Zaiyinati，XING Shuqing，RENAGULI·Aikebaier，ZHANG Kaidi，ZHANG Yuyuan，XING Bei，WANG Xinling，GUO Yanying

2021, 24(3): 310-315. DOI: 10.12114/j.issn.1007-9572.2020.00.619

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Background　Thyroid disease is the second most-common endocrine and metabolic system disease，with increasing incidence recently.However，there are no large-scale studies on the prevalence and characteristics of thyroid diseases in peri- and post-menopausal women.Objective　To investigate the prevalence of thyroid diseases in peri- and post-menopausal women in Urumqi，and to explore the significance of thyroid function screening in this population.Methods　From May to June 2017，by use of clustering random sampling，eligible women aged 40-60 years old （n=620） were recruited from two randomly selected urban communities of Urumqi.Thyroid hormones （thyroid-stimulating hormone，free thyroxine，free triiodothyronine） and thyroid autoantibodies 〔thyroid peroxidase antibody （TPOAb），anti-thyroglobulin antibody （TGAb）〕were measured and thyroid disease was screened.The levels of thyroid-stimulating hormone and thyroid autoantibodies and the prevalence of thyroid diseases were compared across groups stratified by menstrual status （regular，peri- and post-menopausal menstruation） and by age （40-44，45-49，50-54，55-60）.Results　Of the participants，the prevalence of regular，peri- and post-menopausal menstruation was 45.8%（284/620），18.9%（117/620），and 35.3%（219/620），respectively，and the percentages of age groups of 40-44，45-49，50-54 and 55-60 were 27.9%（173/620），29.8%（185/620），18.6%（115/620），and 23.7%（147/620），respectively.The prevalence of hypothyroidism，subclinical hypothyroidism，hyperthyroidism and subclinical hyperthyroidism were 2.7%（17/620），23.9%（148/620），0.4%（3/620） and 1.0%（6/620），respectively.The prevalence of Hashimoto thyroiditis，TGAb positivity，TPOAb positivity，and thyroid nodules was 35.0% （217/620），22.6% （140/620），27.6% （171/620），and 32.4% （201/620），respectively.The mean TPOAb level，and prevalence of thyroid nodule and TPOAb positivity differed significantly across groups of regular，peri- and post-menopausal menstruation（P<0.05）.There was significant difference in the prevalence of thyroid nodules among the 4 age groups（P<0.05）.There was no significant difference in the prevalence of hypothyroidism，subclinical hypothyroidism，hyperthyroidism，subclinical hyperthyroidism，Hashimoto thyroiditis or TGAb positivity in groups of regular，peri- and post-menopausal menstruation（P>0.05）.There was no significant difference in the prevalence of hypothyroidism，subclinical hypothyroidism，hyperthyroidism，subclinical hyperthyroidism，Hashimoto thyroiditis，TPOAb positivity or TGAb positivity in different age groups（P>0.05）.Conclusion　The prevalence of subclinical hypothyroidism，Hashimoto thyroiditis or thyroid nodules in 40-60-year-old women was higher than that of general population in Urumqi，Xinjiang.The prevalence of thyroid nodules varied by menstrual status and age.The prevalence of TPOAb positivity varied by menstrual status.

Abnormal Changes of Serum Thyroid Hormones and Antibodies in Type 2 Diabetic Patients　

YU Yuanyuan，XUE Qidan，WANG Shuang，YU Xiaosong，WU Bin

2021, 24(3): 316-321. DOI: 10.12114/j.issn.1007-9572.2020.00.604

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Background　The prevalence of abnormal changes of thyroid hormones and elevated thyroid antibodies has been recently found to be higher in type 2 diabetics than that of non-type 2 diabetics.As thyroid disease-induced harm on physical health in the real world is similar to that of diabetes-related complications and comorbidities in type 2 diabetics，treating diabetes via improving abnormal changes of thyroid hormones and antibodies has become a concern issue.Objective　To explore the abnormal changes of serum thyroid hormones and antibodies in type 2 diabetics.Methods　172 type 2 diabetics（type 2 diabetes group） were recruited from Department of General Medicine，the First Hospital of China Medical University from April 2018 to March 2019，and were compared to 160 non-type 2 diabetics（control group）.Data were collected，including gender，age，duration of diabetes，HbA1c，history of hypertension，TC，TG，LDL，HDL，TPOAb，TGAb，TSH，FT3，and FT4.Thyroid hormones and antibodies were compared between diabetics and control groups，and were compared between the diabetics by duration of type 2 diabetes〔<1 year（n=19），1-10 years（n=69），>10 years（n=84）〕，HbA1c〔≤6.5%（n=67），6.5%<HbA1c<9.0%（n=84），≥9.0%（n=21）〕，gender〔men（n=90） and women（n=82）〕 and prevalence of hypertension〔hypertension（n=110） and non-hypertension （n=62）〕.Results　Type 2 diabetes group had higher average levels of TPOAb and TGAb and lower average level of FT3 than the control group （P<0.05）.TGAb and FT3 differed significantly among diabetics by the duration of diabetes（P<0.05）.In particular，those with over 10 years' duration of diabetes had higher average TGAb level than those had less than 1-year duration（P<0.05），and had lower average level of FT3 than those with 1-10-year duration（P<0.05）.TGAb level differed significantly among diabetics by the HbA1c level （P<0.05）.In particular，those with HbA1c greater than 6.5% but lower than 9.0% had higher average TGAb than those with HbA1c≤6.5% （P<0.05）.The average TGAb and TSH levels of male diabetics were lower than those of female diabetics （P<0.05）.The average FT4 level of hypertensive diabetics was higher than that of non-hypertensive diabetics （P<0.05）.Spearman correlation analysis showed that TGAb was positively correlated with age，duration of diabetes，and HbA1c （P<0.05）；TSH was positively correlated with TG （P<0.05）；FT3 was negatively correlated with age and duration of diabetes （P<0.05），but was positively correlated with TC and HDL （P<0.05）.Conclusion　Type 2 diabetics are more likely to have thyroid hormone abnormalities and elevated thyroid antibodies，which may be associated with the duration of diabetes，HbA1c，gender，and hypertension.As a result，type 2 diabetics，especially women with long duration of diabetes，poor glycemic control，and hypertension should pay more attention to the screening of thyroid hormones and antibodies.

Predictive Value of Non-high-density Lipoprotein Cholesterol，Triglyceride-glucose Index，and Ratio of Triglyceride to High-density Lipoprotein Cholesterol in Metabolic Syndrome：a Comparative Study　

ZHENG Hui，CHENG Yang，YIN Donghua，YIN Hongli，GU Liubao，SHEN Zhixiang

2021, 24(3): 322-326. DOI: 10.12114/j.issn.1007-9572.2020.00.564

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Background　Anthropometric indices，blood glucose，and blood lipid-related indices have been proposed by relevant studies as simple predictors for metabolic syndrome（MS） used in primary care，but predictive values of these indices are still controversial，and have been studied insufficiently in Chinese population.Objective　To compare the predictive value of non-high-density lipoprotein cholesterol （non-HDL-C），triglyceride-glucose （TyG） index and triglyceride-to-high density lipoprotein cholesterol ratio（TG/HDL-C） in MS and to determine a simple screening indicator for MS.Methods　A total of 9 375 health examinees were selected from Jiangsu Province Geriatric Hospital from April to October 2017.The demographic and anthropometric indices，and biochemical indices including serum glucose and lipids，as well as calculated non-HDL-C，TyG index and TG/HDL-C were obtained and compared by the prevalence of MS identified by the diagnostic criteria recommended by Chinese Diabetes Society，Chinese Medical Association.The receiver operating characteristic （ROC） curve was fit to estimate the predictive value of non-HDL-C，TyG index and TG/HDL-C ratio for MS.Results　Of the participants，1 792（19.1%） had MS and 7 583（80.9%） did not.MS group had higher non-HDL-C，TyG index and TG/HDL-C ratio in comparison with non-MS group （P<0.05）.Non-HDL-C，TyG index and TG/HDL-C ratio elevated linearly with the number increase of metabolic syndrome components （P<0.05）.The AUC of non-HDL-C，TyG index，and TG/HDL-C ratio for predicting MS were 0.623，0.846，and 0.800，respectively，with the optimal threshold corresponding to Youden's index of 3.71 mmol/L，1.53，and 1.27，respectively.Conclusion　The findings of this study suggest that non-HDL-C，TyG index，and TG / HDL-C ratio could be simple screening indicators for MS.

Risk Factors of Carotid Atherosclerosis in Patients with Acute Ischemic Stroke　

GAO Suying，YAN Yinglin，YU Kai，ZHANG Guangbo，JI Ruijun，WANG Yongjun，LI Fang，ZHANG Na，ZHU Donglei

2021, 24(3): 327-332. DOI: 10.12114/j.issn.1007-9572.2020.00.401

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Background　Carotid atherosclerosis（CAS） is an important pathological basis of cerebral infarction，and factors such as immunity and inflammatory response play an important role in the formation and development of atherosclerotic plaques.With the changes in material life and diet structure in recent years，as well as the influence of the aging of population，the incidence of cerebrovascular diseases has increased year by year in China，which makes the prevention and treatment of stroke increasingly severe. Objective　To investigate the risk factors of CAS in patients with acute ischemic stroke（AIS）. Methods　A total of 4 048 patients with AIS who were admitted to the Department of Neurology of Kangji Xintu Hospital of Renqiu from January 2014 to November 2018 were selected and investigated by self-designed questionnaires.The contents of the questionnaire included the general condition，physical examination，laboratory examination and carotid ultrasound.The formation and stenosis of carotid plaques were defined as CAS，and the influence factors of CAS in patients with AIS were analyzed by univariate and multivariate Logistic regression methods. Results　The average age of the enrolled population was （64.8±11.3），which included 2 506（61.91%） males and 1 542（38.09%） females.There were 169（4.17%） cases with normal carotid artery，577（14.25%）cases with intimal thickening，2 362（58.35%）cases with plaque formation，and 940（23.22%）cases with carotid artery stenosis.Multivariate Logistic regression analysis showed that gender〔OR（95%CI）=2.785（1/790，4.333）〕，age〔OR（95%CI）=1.129（1.108，1.150）〕，educational level〔OR（95%CI）=0.632（0.425，0.942）〕，diabetes〔OR（95%CI）=2.443（1.467，4.069）〕，stroke〔OR（95%CI）=2.136（1.371，3.328）〕，smoking 〔OR（95%CI）=1.603（1.057，2.431）〕，TC〔OR（95%CI）=1.545（1.304，1.830）〕，LDL-C〔OR（95%CI）=1.893（1.365，2.596）〕，and lipoprotein a〔OR（95%CI）=1.001（1.000，1.002）〕 were independent influence factors for CAS in Patients with AIS. Conclusion　Smoking，systolic blood pressure，diastolic blood pressure，LDL-C and lipoprotein a are important risk factors for CAS that can be intervened in AIS.Active control of risk factors for stroke can delay the occurrence of CAS lesions and reduce the incidence of stroke.

Association between Physical Activity Pattern and Levator Ani Muscle Thickness in Pregnant Women　

CAI Wenzhi，LI Tiantian，WANG Jia，JIN Mei，LI Jing，CHEN Ling

2021, 24(3): 330-340. DOI: 10.12114/j.issn.1007-9572.2020.00.501

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Background　Physical activity is beneficial for women's health，such as improving the structure of pelvic floor mostly in non-pregnant populations.However，the physical activity pattern and its association with pelvic floor muscle remain to be explored in pregnant women.Objective　The aim of this study was to investigate the physical activity pattern and examine its association with levator ani muscle thickness （LA th） during pregnancy.Methods　A cross-sectional study was performed.Pregnant women in first and second trimesters receiving routine antenatal assessment from Shenzhen Hospital，Southern Medical University were enrolled from January to November 2017 by convenience sampling.Demographic and clinical information was collected through a self-administered questionnaire survey.The physical activity pattern was measured by Pregnancy Physical Activity Questionnaire.The LA th was examined by three-dimensional transperineal ultrasound.Multiple linear regression analyses were used to estimate the association between physical activity pattern and LA th with adjustment for the possible effects of confounding factors.Results　266 pregnant women participated in this study，of whom 10 were eliminated because of failing to complete the questionnaire.The final sample for analysis consisted of 256 effectively filled questionnaires.The M（P25，P75） of total energy expended on physical activity among them in first and second trimesters was 112.13（84.78，148.03） MET-h/wk.Multiple linear regression analyses showed that compared with first quartile group of energy expended on household activities，LA th at pelvic floor muscle contraction was stronger in fourth quartile group 〔β=0.699，95%CI（0.146，1.252）〕（P<0.05）.Compared with first quartile group of energy expended on moderate intensity activities，the difference between LA th at rest and at pelvic floor muscle contraction was higher in fourth quartile group 〔β=0.319，95%CI（0.117，0.522）〕（P<0.05）.Conclusion　These pregnant women in first and second trimesters did not have sufficient physical activity.Household activities and moderate intensity activities can increase LA th and improve the structure of pelvic floor muscle.Individualized care should be delivered to promote physical activity during pregnancy and improve the function of pelvic floor.

Clinical Efficacy of Acupuncture in the Treatment of Mild Anxiety：a Real World Study　

CUI Weifeng，FAN Junming，YE Jing，QING Hui

2021, 24(3): 341-347. DOI: 10.12114/j.issn.1007-9572.2020.00.567

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Background　Multiple randomized controlled trials have showed that acupuncture has good clinical efficacy in the treatment of anxiety，but related real-world study evidence is lacking so far.Objective　To explore the clinical efficacy of acupuncture in the treatment of mild anxiety based on a real-world study.Methods　A total of 276 patients with mild anxiety were selected from the Affiliated Hospital of Henan Academy of Chinese Medicine，and were first divided into acupuncture group（n=149）and non-acupuncture group（n=127）according to the prevalence of acupuncture treatment，and then the groups were matched by a 1:1 propensity score matching methodology，yielding 75 pairs.Comparison was conducted between the two groups for clinical efficacy，Hamilton Anxiety Rating Scale（HAMA）score and total score of Pittsburgh Sleep Quality Index（PSQI）before treatment and 6 and 8 weeks after treatment.Results　Pre-matching overall response rate of acupuncture group and non-acupuncture group was 91%（136/149）and 82%（104/127），respectively，showing a significant difference（P<0.05）. Furthermore，post-matching overall response rates of acupuncture and non-acupuncture groups〔97%（73/75）vs 87%（65/75）〕still had a significant difference（P<0.05）.There was significant interaction between treatment time and method on pre- and post-matching HAMA score or total score of PSQI（P<0.05）.The main effect of treatment time and method was significant on pre- and post-matching HAMA score（P<0.05）.The main effect of treatment time and method was significant on pre- and post-matching total score of PSQI（P<0.05）.Compared to non-acupuncture group，acupuncture group had lower HAMA score after 8 weeks of treatment，as well as lower total score of PSQI after 6 and 8 weeks of treatment either before or after matching（P<0.05）.Conclusion　Our real-world evidence suggests that acupuncture may be effective in reducing the severity of mild anxiety and improving the quality of life in mild anxiety patients，with high safety and feasibility.

Differentially Expressed Proteins and Their Regulation between Liver-gallbladder Damp-heat Syndrome and Spleen-stomach Damp-heat Syndrome in Chronic Hepatitis B　

DAN Lijuan，CHAI Shaozhu，LI Guiyu，SU Yue，ZOU Jiaxi，WEN Li

2021, 24(3): 348-354. DOI: 10.12114/j.issn.1007-9572.2020.00.572

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Background　Liver-gallbladder damp-heat and spleen-stomach damp-heat syndromes，two most common syndromes in chronic hepatitis B（CHB），are difficult to be distinguished due to a similar manifestation of damp-heat.So finding the essence of difference and distinguishable biomarkers of them are of great significance to enrich the modern scientific connotation of TCM syndromes and improve the clinical precision differentiation and treatment.Objective　To investigate the differentially expressed proteins and their regulation as well as potentially distinguishable objective markers between liver-gallbladder damp-heat and spleen-stomach damp-heat syndromes in CHB.Methods　From the General Hospital of Western Theater Command PLA，30 hepatology and gastroenterology outpatients with CHB〔15 with liver-gallbladder damp-heat syndrome（subgroup A）and 15 with spleen-stomach damp-heat syndrome（subgroup B）〕，and 10 heath examinees（control group）were recruited during January 2018 to January 2019.ELISA was used to detect the target proteins and bioinformatics analysis was conducted，involving CEACAM1，MCP-1，SDF-1，ORM2，MSN，FCN2，VCAM-1，IGF-1，NOTCH2，β-APP，ACO1，SORD and ALDH1A1.ROC analysis was conducted to explore the value of differentially expressed proteins in distinguishing liver-gallbladder damp-heat and spleen-stomach damp-heat syndromes in CHB.Results　The mean expression levels of CEACAM1，MCP-1，SDF-1，ORM2，MSN，FCN2，VCAM-1，IGF-1，NOTCH2，β-APP，ACO1，SORD and ALDH1A1 in subgroups A and B were significantly lower than those in control group（P<0.05）.Subgroup B had higher mean expression levels of CEACAM1，MCP-1，MSN and VCAM-1，and lower mean expression levels of SDF-1，ORM2，FCN2，IGF-1，NOTCH2 and β-APP than subgroup A（P<0.05）.Taking inter-subgroup differences reaching a significance level of P<0.01 as a criterion to further screen the differentially expressed proteins，only CEACAM1，SDF-1，MSN and IGF-1 of above-mentioned 10 proteins were enrolled，specifically，subgroup B had higher mean expression levels of CEACAM1 and MSN and lower mean expression levels of SDF-1 and IGF-1（P<0.01）.Bioinformatics analysis results showed that，there were relatively close associations of CEACAM1，MCP-1，SDF-1，ORM2，MSN，FCN2，VCAM-1，IGF-1，NOTCH2 and β-APP between liver-gallbladder damp-heat and spleen-stomach damp-heat syndromes in CHB，moreover，the above-mentioned 10 differentially expressed proteins participated in multiple signaling pathways together.ROC curve analysis results showed that，in distinguishing the two syndromes，the AUC of CEACAM1 was 0.73〔95%CI（0.54，0.87）〕with sensitivity of 86.67% and specificity of 56.25%，the AUC of SDF-1 was 0.70〔95%CI（0.51，0.85）〕with sensitivity of 86.67% and specificity of 56.25%，and the AUC of MSN was 0.72〔95%CI（0.53，0.86）〕with sensitivity of 80.00% and specificity of 56.25%.Conclusion　Liver-gallbladder damp-heat and spleen-stomach damp-heat syndromes in CHB have objective differences，with CEACAM1，SDF-1，MSN and IGF-1 as major differentially expressed proteins.The biological mechanism for the differences may be correlated with oxidative stress response mediated by NF-κB and AGE-RAGE signaling pathways.Moreover，CEACAM1，SDF-1 and MSN may be used as potential biomarkers for distinguishing liver-gallbladder damp-heat and spleen-stomach damp-heat syndromes in CHB.

Clinical，Serum Inflammatory Cytokine，Immune，and Oxidative Stress Responses to Rougan Huaxian Granules with Transplantation of Bone Mesenchymal Stem Cells in Decompensated Cirrhosis Patients　

LYU Yanhang，WU Shanshan，WANG Zhenchang，YE Xuejin，FU Yanqing，DUAN Guijiao，SU Xiaowen，NONG Xiaoxin

2021, 24(3): 355-362. DOI: 10.12114/j.issn.1007-9572.2020.00.570

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Background　The transplantation of bone mesenchymal stem cells（BMSCs）brings hope to patients with liver cirrhosis.However，as the containing of BMSCs is very little in bone marrow and their ability of homing to the liver is limited，the clinical application of this technique is limited.The traditional Chinese medicine（TCM）mobilization program of recruiting endogenous stem cells can promote BMSCs homing to the liver，demonstrating the key role of TCM in maintaining or promoting normal regenerative repair of the body.Objective　To investigate the clinical，serum inflammatory cytokine，immune，and oxidative stress responses to Rougan Huaxian Granules with transplantation of BMSCs in decompensated cirrhosis patients.Methods　From May 2016 to May 2019，120 decompensated cirrhosis patients were selected from Liver Disease Division，the First Affiliated Hospital of Guangxi University of Chinese Medicine，and Department of Spleen，Stomach and Liver Diseases，Guangxi International Zhuang Medical Hospital，and were randomly divided into groups A，B and C，with 40 cases in each group，receiving comprehensive medical treatment，comprehensive medical treatment with BMSCs transplantation and 1-year post-transplantation antiviral therapy，and BMSCs transplantation with Rougan Huaxian Granules based on comprehensive medical treatment，respectively.Clinical response，pre- and post-treatment major TCM syndrome scores，liver function markers，prothrombin time，serum inflammatory cytokines，humoral and cellular immune markers，oxidative stress markers，and treatment-emergent adverse reactions and/or complications of the three groups were collected.Results　Finally，all the participants were included for analysis except 2 and 1 dropouts in groups A and B，respectively.Group C had significantly better clinical response than groups A and B，respectively（P<0.05）.The mean scores of hypochondriac pain，poor appetite，general lassitude and icterus in group C were significantly lower than those in groups A and B（P<0.05）.Group C had lower mean post-treatment serum levels of ALT，AST，total bilirubin，TNF-α，IL-2，IL-12，IgG，IgE and malondialdehyde，and CD8+ cell percentage，and significantly higher mean post-treatment levels of IFN-γ，IL-10，IgA，IgM，SOD and glutathione peroxidase，CD3+ cell percentage，CD4+ cell percentage and CD4+/CD8+ cell ratio，as well as significantly shorter mean prothrombin time than those in groups A and B（P<0.05）.There were 4 cases with complications in group A（3 with abdominal effusion，and 1 with gastrointestinal hemorrhage），and 2 cases with complications in group B（1 with hepatic encephalopathy and 1 with abdominal effusion），but no adverse reactions and/or complications occurred in group C.Conclusion　In treating patients with decompensated cirrhosis，Rougan Huaxian Granules combined with BMSCs could effectively relieve the clinical symptoms and signs，improve the liver function，coagulation and immune functions，and reduce the inflammatory and oxidative stress responses.

A Case of Angelman Syndrome with Pyridoxin-dependent Epilepsy and Literature Review　

CHEN Xianrui，XU Jinping，YAO Yonghua，CHEN Ling

2021, 24(3): 363-366. DOI: 10.12114/j.issn.1007-9572.2020.00.551

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Angelman syndrome is a rare neurodevelopmental disorder characterized by developmental delay，mental retardation，severe speech impairment，gait ataxia，seizures，and exuberant behavior with happy demeanor.Pyridoxine（vitamin B6）-dependent epilepsy is a rare autosomal recessive hereditary disease condition characterized by intractable and recurrent neonatal seizures，which is uniquely alleviated by high doses of pyridoxine.We reported the clinical manifestations and genetic characteristics of a case of Angelman syndrome with pyridoxin-dependent epilepsy.And relevant literature was also reviewed to improve the awareness of this rare disease.Early identification of gene mutations will be beneficial to timely diagnosis，intervention delivery and prognosis evaluation for Angelman syndrome and pyridoxin-dependent epilepsy.

Niemann-Pick Disease Type C2：a Case Report and Literature Review　

MAO Chunting，YANG Jun，SHI Jun，MIAO Hongjun，LI Jun

2021, 24(3): 367-371. DOI: 10.12114/j.issn.1007-9572.2020.00.561

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Niemann-Pick disease （NPD） is a group of lysosomal storage disorder with autosomal recessive inheritance.At present，there is no universally accepted effective treatment，and clinical interventions consist of mainly symptomatic treatments.The main clinical manifestations of NPD type C are severe infant jaundice，psychomotor retardation，hypotonia，aphasia，diffuse pulmonary lesions and hepatosplenomegaly.NPD type C2，in particular，is very rare，and respiratory distress is its most prominent symptom.In this paper，the clinical manifestations and gene sequencing results of an infant case of NPD type C2 were summarized，with relevant literature was reviewed，aiming to improve pediatrician's understanding of the disease to reduce the possibilities of missed diagnosis and misdiagnosis.

Advances in Serum Biological Markers for Early Diagnosis of Acute Mesenteric Ischemia　

SUN Xuan，LI Linye

2021, 24(3): 372-375. DOI: 10.12114/j.issn.1007-9572.2020.00.563

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Acute mesenteric ischemia（AMI） is one of the most severe acute abdomens with high mortality.It is difficult to make an early diagnosis of AMI，often，a confirm diagnosis is made when the patient's condition progresses to irreversible intestinal necrosis，or combines with other organ damage，mostly found by an exploratory laparotomy since there are no symptoms and signs specific to AMI.Multi-slice CT scan has proved to be a good imaging modality for AMI diagnosis with high specificity and sensitivity，but for non-obstructive mesenteric ischemia，it is still incapable.As serum biomarkers have not been widely used in the diagnosis of mesenteric ischemia，this article summarizes some traditional biomarkers such as procalcitonin，D-dimer，and L-lactic acid，as well as some emerging biomarkers more sensitively to pathophysiological changes of early mesenteric ischemia，including ischemia-modified albumin（an oxidative stress index），and intestinal fatty acid binding protein（a marker of intestinal injury） and SM22（a kind of muscle protein），to provide assistance for early diagnosis of AMI.

Latest Advances in Blood Pressure Variability and Prognosis in Patients with Ischemic Stroke after Intravenous Thrombolysis　

QIN Qixiong，LIANG Zhijian

2021, 24(3): 376-380. DOI: 10.12114/j.issn.1007-9572.2020.00.550

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Short-term blood pressure variability （BPV） after intravenous thrombolysis is an important factor for symptomatic intracranial hemorrhage，poor prognosis and death in patients with acute ischemic stroke.A "sudden drop" in blood pressure may indicate recanalization after intravenous thrombolysis.Short-term BPV may affect the prognosis of stroke by affecting the continuous cerebral blood flow supply around ischemic penumbra.At present，most studies show that maintaining post-thrombolysis systolic blood pressure at 141-150 mm Hg may be beneficial to improve the prognosis of patients with stroke.However，the optimal blood pressure management for patients with ischemic stroke after intravenous thrombolysis has not been determined，especially the indication and extent of depressurization，which is still a great controversy.This article reviews the BPV and prognosis in patients with ischemic stroke after intravenous thrombolysis.

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