Chinese General Practice

Colorectal Cancer Screening：Current Strategies and Thoughts　

HU Xiyue，LIU Zheng*，WANG Xishan

2021, 24(33): 4165-4171. DOI: 10.12114/j.issn.1007-9572.2021.02.049

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The incidence of colorectal cancer has shown an upward trend in China. Colorectal cancer turns to be a great threat to people's health，and also brings serious negative socio-economic impacts. The screening for colorectal cancer using effective strategies has been proven efficacious for reducing colorectal cancer burden in many countries. In China，due to incomplete coverage of colorectal cancer screening programs implemented using non-uniform strategies，there is a need to develop a comprehensive colorectal cancer screening system used throughout the country. We overviewed colorectal cancer screening researches at home and abroad，and discussed the common screening strategies based on the reviewing of the latest guidelines and consensuses on colorectal cancer screening，then predicted the prospects of colorectal cancer screening in China，with a view to assisting the development of colorectal cancer screening strategies with Chinese characteristics.

Colorectal Cancer Screening Program in China：Recent Advances and Screening Dilemma　

HAN Xi，LIU Jun，MA Qi，HU Shengjuan

2021, 24(33): 4172-4176. DOI: 10.12114/j.issn.1007-9572.2021.00.480

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In recent years，the incidence and mortality of colorectal cancer （CRC） in China are increasing rapidly. But CRC screening is quite feasible，because its development from normal intestinal mucosa to abnormal growth and to malignancy can last for decades，which makes early screening and removal of precancerous colorectal lesions before cancerization become possible. Increasing countries aim to reduce high incidence and mortality of CRC and enhance its current low early diagnosis rate via implementing CRC screening programs. We reviewed recent advances in the common methods and means as well as relevant studies regarding CRC screening，providing a reference for clinical practice.

Recent Advances in Research on Cost-effectiveness of Colorectal Cancer Screening　

GUAN Yazhe，WU Siqi，ZHANG Xue，HE Yutong

2021, 24(33): 4177-4184. DOI: 10.12114/j.issn.1007-9572.2021.02.001

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Colorectal cancer is one of common cancers that threatens human health seriously. Early screening has been a global focus as an effective measure to reduce the incidence and mortality of colorectal cancer，and an important prevention and treatment strategy. The key issues for colorectal cancer screening include delivering interventions specially focusing on populations at high risk for colorectal cancer，determining the appropriate screening interval for populations with different levels of risk for colorectal cancer，raising residents' health awareness from the community level，increasing screening participation，and performing health economic evaluation of the optimal screening strategy. Introducing colorectal cancer screening guidelines helps to identify people at high risk for colorectal cancer，explore appropriate screening ages and screening intervals，and improve the recognition of valuing screening participation，consequently increasing the cost-effectiveness of colorectal cancer screening，so we summarized the recent colorectal cancer screening guidelines and studies about the cost-effectiveness of colorectal cancer screening.

Development of a Individual Rothman-Keller-type Risk Prediction Model for Colorectal Cancer in Chinese People　

QIN Chengjie，SHU Ting，YAO Qiang，LI Mandi，LIN Yidie，SUN Yue，ZHOU Ling，JIANG Min，ZHU Cairong

2021, 24(33): 4185-4190. DOI: 10.12114/j.issn.1007-9572.2021.00.575

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Background　Colorectal cancer is a malignancy seriously threatening the health of Chinese people.Effective risk prediction model for colorectal cancer is an important tool to guide people to develop a healthy lifestyle by screening morbidity risk and identifying high-risk people，to prevent or reduce the mortality of colorectal cancer. Objective　To develop a Rothman-Keller-type model for predicting and classifying individual risk of colorectal cancer suitable for Chinese population. Methods　We did a review of studies about risk factors for colorectal cancer that were collected from databases of CNKI，Wanfang Data，VIP，PubMed，EMBase，and OVID from inception to 2020-08-31 to quantitatively examine the relationship of colorectal cancer with its major risk factors，then used the results to develop a Rothman-Keller-type model for predicting individual risk of colorectal cancer in Chinese population. We applied binomial distribution function to further rate the risks. Results　In total，there were 15 risk factors included in the Rothman-Keller-type model，including family history of colorectal cancer，smoking，drinking，obesity，excessive intake of red meat，high intake of preserved food，history of appendicitis，history of diabetes，history of chronic colorectitis，history of chronic diarrhea，history of chronic constipation，and low vegetable intake，low fruit intake，use of aspirin and take of physical exercise. We generated 10 000 random data sets using binomial distribution function，and using segmented gradient comparison method，we found the risk threshold for women was 0.033 7% and for men was 0.046 3%. Conclusion　This risk prediction model is easy-to-use，which facilitates high-risk people to undergo colonoscopy，and help them to develop healthy lifestyles，promoting the prevention of colorectal cancer.

Interpretation of the Major Updates of Guidelines Regarding Hyperuricemia and Gout in Chronic Kidney Disease　

WANG Xu，LUO Dongping，RU Yanhai，GUO Xiaokai，XU Jiayun

2021, 24(33): 4191-4195. DOI: 10.12114/j.issn.1007-9572.2021.00.573

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The incidence of hyperuricemia（HUA）and gout is increasing significantly，and tends to occur at an early age with the social development and changes in patterns of life. HUA has become the second leading metabolic disease following diabetes mellitus，which is not only a common complication of chronic kidney disease（CKD），but also an important risk factor for CKD. The guidelines for the diagnosis and treatment of HUA and gout have been updated to accommodate newly emerging evidence. We interpreted the essentials of new updates regarding HUA and gout in CKD on the basis of research evidence，including the indication of initial urate-lowering therapy，selection of pharmacologic urate-lowering therapy，gout flare management，alkalinizing urine and use of vitamin C on the basis of research evidence，hoping to provide clinicians with supports for delivering comprehensive and individual therapies.

Comparative Interpretation of 2015—2020 Chinese and International Guidelines for the Diagnosis and Treatment of Gout　

ZHANG Da，HUANG Zhifang，LI Xinlun，CUI Li

2021, 24(33): 4196-4199. DOI: 10.12114/j.issn.1007-9572.2021.02.035

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Given the increasing global prevalence of gout，relevant diagnosis and management guidelines issued by gout societies of China and foreign countries will significantly guide the standardized diagnosis and management of gout. In 2015，the American College of Rheumatology and the European League Against Rheumatism jointly released the gout classification criteria，and then the European，American and Chinese gout diagnosis and treatment guidelines have been subsequently updated. We reviewed and compared the 2015—2020 Chinese，European，and US guidelines for the diagnosis and treatment of gout，offering guidance for clinical practice.

Factors Associated with Quality of Life in Patients with Ischemic Stroke at Different Periods　

YAO Yongkun，ZHANG Zhiqiang，QI Ming，XU Jingshan，MENG Yao，LI Haohao，XING Wenlong，ZHANG Guiqing

2021, 24(33): 4200-4205. DOI: 10.12114/j.issn.1007-9572.2021.02.041

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Background　Patients are showing increasing care about quality of life as healthcare advances. Improving quality of life is a means for addressing the contradiction between increasing needs for a better life and imbalanced or inadequate socioeconomic development. Objective　To investigate the status of quality of life and associated factors in patients with ischemic stroke at different periods，providing a basis for improving quality of life of this population. Methods　One hundred and twenty patients with ischemic stroke were recruited from Department of Rehabilitation Medicine and Department of Neurology，First Affiliated Hospital，School of Medicine，Shihezi University from June 2017 to September 2019. Risk factors of stroke，quality of life assessed using the Stroke-specific Quality of Life Scale （SS-QOL） within three to five days of admission，one and three months after onset were collected. Univariate analysis and multiple linear regression analysis were used to investigate the factors influencing quality of life at the above-mentioned three periods. Results　Multiple linear regression analysis revealed that older age，having no health insurance，higher body mass index （BMI），smoking/drinking history，diabetes，hyperlipidemia，higher Modified Rankin Scale score and conservative treatment were independent risk factors of poor quality of life within three to five days of admission （P<0.05）；older age，having no health insurance，higher BMI，smoking/drinking history，hypertension，diabetes，and hyperhomocysteinemia were independent risk factors for poor quality of life at one month after admission （P<0.05）；older age，lower education level，having no health insurance，higher BMI，smoking/drinking history，hypertension，diabetes，hyperhomocysteinemia and conservative treatment were independent risk factors of poor quality of life at three months after admission （P<0.05）. Conclusion　The factors affecting the quality of life of stroke survivors in different periods are different. Only by paying attention to different influencing factors in different periods can stroke patients be better managed in the whole course of disease.

Comparative Study of Inflammatory Markers in Early Diagnosis of Diabetic Kidney Disease　

WU Hong，WANG Bin，LI Ting，NIE Yijun

2021, 24(33): 4206-4210. DOI: 10.12114/j.issn.1007-9572.2021.02.043

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Background　Diabetic kidney disease （DKD），a common diabetic complication，has become a major cause of end-stage renal disease. There are no comparative studies about the values of six inflammatory laboratory markers，heparin binding protein （HBP），C-reactive protein （CRP），serum amyloid A protein（SAA），procalcitonin （PCT），white blood cell count （WBC） and neutrophil percentage （N%），in early diagnosing DKD. Objective　To assess the values of six inflammatory markers（HBP，CRP，SAA，PCT，WBC and N%） in early diagnosis of DKD via comparing the levels of them between type 2 diabetic patients and early DKD patients. Methods　Participants were selected from Xianghu Branch，the First Affiliated Hospital of Nanchang University from May to December 2020，including 32 with simple type 2 diabetes，35 with early DKD patients and 30 physical examinees with normal examination results and without organic diseases. Fasting venous blood samples were collected for measuring HBP，CRP，SAA and PCT using quantitative immunofluorescence method，measuring WBC and N% using the automated hematology analyzer. ROC analysis was implemented to evaluate the value of HBP，CRP，and SAA in the early diagnosis of DKD. Results　There were no significant differences in mean levels of PCT，WBC，and N% among three groups（P>0.05）. The mean level of HBP was increased in simple diabetic patients compared with that of healthy controls. The mean levels of HBP，CRP，and SAA in early DKD patients were significantly higher than those of other two groups（P<0.05）. In predicting early DKD，the AUC of HBP was 0.908〔95%CI（0.841，0.975）〕 with 71.4% sensitivity，96.7% specificity and Youden index of 0.681；the AUC of CRP was 0.760〔95%CI（0.644，0.875）〕 with 48.6% sensitivity，96.7% specificity and Youden index of 0.452；the AUC of SAA was 0.836〔95%CI（0.738，0.934）〕 with 74.3% sensitivity，86.7% specificity and Youden index of 0.610. Conclusion　HBP has proved to be more effective in diagnosing DKD，which could be promoted clinically as a predictor of DKD.

Predictive Value of Lipid Accumulation Product and Visceral Fat Index for Adult Metabolic Syndrome　

DUAN Shaojie，LIU Zunjing，CHEN Jialiang，YAO Shukun

2021, 24(33): 4211-4217. DOI: 10.12114/j.issn.1007-9572.2021.02.038

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Background　Lipid accumulation product （LAP） and visceral fat index （VAI） are important indicators that reflect the body fat distribution and the degree of visceral fat accumulation，which are closely connected to obesity-related chronic metabolic diseases. Objective　To explore the correlation of LAP and VAI with adult metabolic syndrome （MS），and to evaluate the predictive value of them for MS. Methods　Participants were 708 physical examinees who were recruited from Physical Examination Center，China-Japan Friendship Hospital from September 2018 to May 2019，including 249 with MS，and 459 without. LAP，VAI and physical and biochemical indicators were compared between by MS and non-MS participants. Then the prevalence of MS and its components was compared between LAP quartile groups（177 cases in each group） and between VAI quartile groups（177 cases in each group）. Multivariate Logistic regression was used to estimate the association of LAP and VAI with MS. Sex-specific analysis using the ROC curve was performed to measure the predictive value of LAP，VAI，waist circumference and body mass index for adult MS. Results　LAP and VAI were highly positively correlated with MS prevalence （Cramer's V=0.585，0.577）. Multivariate Logistic regression analysis showed that after adjusting for various risk factors，the risk of MS in the third or fourth quartile of LAP was still statistically higher than that of the first quartile of LAP（P<0.001）. And MS risk in the third or fourth quartile of VAI was still statistically higher than that of the first quartile of VAI （P<0.001）. ROC analysis showed that in predicting the risk of MS in men，the AUC of LAP was 0.831〔95%CI（0.795，0.867）〕with a cutoff point of 52.03，and the AUC of VAI was 0.825〔95%CI（0.788，0.863）〕 with a cutoff point of 1.99. As for predicting the risk of MS in women，the AUC of LAP was 0.887〔95%CI（0.834，0.940）〕 with a cutoff point of 54.84，and that of VAI was 0.886〔95%CI（0.827，0.945）〕with a cutoff point of 2.54. Conclusion　Both LAP and VAI were highly positively correlated with adult MS，indicating that the risk of MS increased with the growth of LAP and VAI. Since LAP and VAI demonstrated good predictive value for MS，their combination with waist circumference and body mass index may effectively screen MS.

Risk Factors and a Predictive Scoring Model Development for Prolonged Length of Stay in Patients with Peptic Ulcer Bleeding　

ZHANG Qinglin，ZHANG Guoqiang，ZHAN Qiang，NIE He，TANG Liang

2021, 24(33): 4217-4222. DOI: 10.12114/j.issn.1007-9572.2021.02.042

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Background　Peptic ulcer bleeding （PUB） is a common cause of hospitalization in the gastroenterology department. The length of stay （LOS） is a key factor in assessing disease severity，diagnosis and treatment as well as management quality，yet the studies on LOS of PUB are rare. Objective　To investigate the risk factors of prolonged LOS in PUB patients，and based on this，to develop a predictive scoring model，providing a reference for bettering clinical intervention and management of PUB. Methods　A total of 485 discharged PUB inpatients were selected from Department of Gastroenterology，Wuxi People's Hospital from 2018 to 2019，and two thirds of them were randomly assigned to the training set，and the rest to the validation set. Prolonged LOS was defined as more than the 75th percentile of LOS for all participants （over eight days）. Multivariate Logistic regression analysis based on a backward elimination was carried out to determine the risk factors for prolonged LOS. Then the risk factors were scored according to the regression coefficient，and used to develop a predictive scoring model. The ROC with corresponding AUC of the predicitve scoring model for predicting the prolonged LOS in the training set and the validation set was analyzed，respectively，Results　Of the cases in the training set（n=323），75 had prolonged LOS，and 248 had normal LOS. Of the cases in the validation set（n=162），34 had prolonged LOS，and the other 128 had normal LOS. Multivariate Logistic regression analysis based on a backward elimination showed that age≥ 60 years〔OR=2.810，95%CI（1.567，5.040）〕，increased WBC and/or NE〔OR=2.491，95%CI（1.310，4.738）〕，ForrestⅠA-ⅡC peptic ulcers〔OR=1.960，95%CI（1.098，3.498）〕，blood transfusion 〔OR=3.367，95%CI（1.664，6.812）〕 and renal dysfunction 〔OR=4.809，95%CI（1.456，15.884）〕were associated with increased risk of prolonged LOS （P<0.05）. The AUC of the predictive scoring model for predicting the prolonged LOS for patients in the training set was 0.77〔95%CI（0.71，0.84）〕，and that for those in the validation set was 0.76〔95%CI（0.66，0.86）〕；the optimal cut-off value was 2.45 for both. Conclusion　Age≥60 years，increased WBC and/or NE，ForrestⅠA-ⅡC peptic ulcers，blood transfusion and renal dysfunction were independent risk factors for prolonged LOS of PUB. Based on these risk factors，an easy-to-use predictive scoring model with a good discriminative ability was developed，which has the potential to optimize the evaluation and management of PUB hospitalization.

Tongduxingshen Acupuncture Improves the Cognitive Function and Psycho-behavioral Symptoms in Patients with Post-stroke Mild Cognitive Impairment　

WANG Yan，BAI Yanjie，ZHANG Ming，GAO Jing，ZHANG Yongchuang，LI Xiaoxiao

2021, 24(33): 4223-4228. DOI: 10.12114/j.issn.1007-9572.2021.02.044

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Background　Post-stroke mild cognitive impairment （PSMCI） often leads to declined quality of life and other adverse outcomes，which has become a hot topic in international stroke research. Objective　To observe the effect of Tongduxingshen acupuncture on improving cognitive function and psycho-behavioral symptoms in PSMCI patients. Methods　Eligible patients with PSMCI（n=60） who were treated in Rehabilitation Center，the First Affiliated Hospital of Henan University of Chinese Medicine from January 2019 to January 2020 were selected，and equally randomized into control group （routine treatment plus routine cognitive rehabilitation training） and study group〔routine treatment plus routine cognitive rehabilitation training and Tongduxingshen acupuncture（once daily，five times per week）〕，received four consecutive weeks of treatment. Montreal Cognitive Assessment （MoCA） and its subscales，Neuropsychiatric Inventory （NPI），and Activity of Daily Living Scale （ADL） scores were compared between the two groups before and after treatment. Results　The mean total MoCA score showed a more significant increase in the study group after treatment （P<0.05）. There was no statistically significant difference between the mean post-treatment naming scores of the two groups（P>0.05）. The mean scores of post-treatment executive function/visuospatial ability，attention and calculation，delayed recall，language abilities and abstraction，and orientation scores in the study group were higher than those in the control group（P<0.05）. The study group had lower mean NPI-1 and NPI-2 scores and higher mean ADL scores than the control group after treatment （P<0.05）. Conclusion　Tongduxingshen acupuncture could effectively improve the cognitive function and psycho-behavioral symptoms as well as activities of daily living in PSMCI patients.

Correlation between Serum FGF21 Level and Diabetic Peripheral Neuropathy　

LI Yong，QI Licui，ZHANG Ran，YANG Qiwen，CHEN Shuchun

2021, 24(33): 4229-4233. DOI: 10.12114/j.issn.1007-9572.2021.02.032

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Background　Fibroblast growth factor 21 （FGF21） is a pleiotropic endocrine metabolism regulator，which can facilitate the regeneration of peripheral nerve axons and myelin sheaths in mice by inhibiting oxidative stress and inflammation. However，there are few studies on the correlation between FGF21 and diabetic peripheral neuropathy （DPN） in humans，and the mechanism of action is still unclear. Objective　To explore the correlation between serum FGF21 level and DPN. Methods　A total of 200 patients with type 2 diabetes were recruited from Hebei General Hospital from November 2019 to November 2020，including 109 with DPN and 91 without. Serum FGF21 was detected using ELISA，and other clinical data were collected. Pearson and Spearman rank correlation analysis was used to examine the correlation between serum FGF21 and various indicators. Binary Logistic regression analysis was performed to identify the influencing factors of DPN in type 2 diabetes. Results　The average serum FGF21 in patients with DPN was significantly higher than that in those without （P<0.05）. Correlation analysis showed that FGF21 was positively correlated with fasting plasma glucose，glycosylated hemoglobin，malondialdehyde，and TNF-α （r=0.184，r=0.156，rs=0.164，r=0.175，P<0.05），and was negatively correlated with the superoxide dismutase （r=-0.189，P<0.05）. Binary Logistic regression analysis showed that course of type 2 diabetes〔OR=1.499，95%CI（1.085，1.935）〕，malondialdehyde〔OR=1.242，95%CI（1.062，1.452）〕，TNF-α〔OR=1.036，95%CI（1.012，1.060）〕 and FGF21〔OR=1.007，95%CI（1.002，1.012）〕 were independent influencing factors for DPN in type 2 diabetes （P<0.05）. Conclusion　FGF21 is an independent influencing factor of DPN in type 2 diabetes，which can affect DPN by regulating glucose metabolism，inhibiting oxidative stress and inflammation.

Possible Mechanism of Action of Hyperglycemia Caused by Partial Pancreatectomy on Gut Floras in a Rat Model　

GUO Laili，WANG Jing，LI Tingting，BAI Xiuping

2021, 24(33): 4234-4240. DOI: 10.12114/j.issn.1007-9572.2021.02.040

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Background　Recent rapid development of sequencing technology improves the understanding of the close association between gut floras and an increasing number of diseases. The relationship of gut floras with diabetes，a primary disease threatening human health，has attracted extensively attention. Objective　To explore the changes of gut floras in a rat model with elevated blood glucose due to partial pancreatectomy and the possible mechanism. Methods　Forty male SD rats were equally randomized into four groups：group A（no interventions），group B（treated with open total splenectomy），group C（treated with open total splenectomy and partial pancreatectomy），and group D〔treated with open total splenectomy，partial pancreatectomy，and administration of insulin glargine injection（0.1 U/kg），once daily at one week after the surgery〕. The oral glucose tolerance test was performed in all groups at the first and fourth weeks after the initiation of the study to test the blood glucose. The rats were sacrificed at the end of the fourth week of study，and the ileal tissues were taken out for pathologically examining morphological changes. The NF-κB p65 expression 〔expressed as average optical density（AOD）〕 in ileal tissues was detected using immunohistochemistry. Gut floras in fecal specimens were assessed by sequencing the 16S rRNA V3-V4 variable regions using the Illumina MiSeq （PE300） sequencing platform. The changes in gut microbiota were analyzed comparatively. Results　The rat model of stable hyperglycemic was successfully created by using partial pancreatectomy. Dark brown staining was seen in the mucosal，submucosal，and muscular layers of the ileal intestine in group C under microscopy. The AOD value of NF-κB p65 expression in group C was more elevated than that of group A or B （P<0.05）. Sequencing of gut floras of four groups of rats found that the relative distribution of the gut flora of each group at the phylum level was significantly different. Group C had decreased abundance of Firmicutes，increased number of Bacteroides and increased abundance of Proteus compared with groups A and B，and so did group D. The α-diversity expressed by dilution curve showed that the order of species richness from low to high was：group A<group D<group B<group C. The community distribution was relatively concentrated in each group，indicating that the group's specimen repeatability was good and stable. The species composition of groups A and B were the most similar，which were located in the same quadrant. The specimens of groups C and D were clustered in the other two quadrants，respectively. Conclusion　Elevated blood glucose may activate the NF-κB signaling pathway，leading to inflammatory changes in the intestines，which would result in intestinal flora disorders，mainly presented as significantly decreased abundance of Firmicutes，and considerably increased abundance of Bacteroides and Proteus at the phylum level.

Predictive Value of Cervical Length and Fetal Membrane Thickness for Preterm Delivery in Twin Pregnancy　

MIAO Jingjing，YU Hongxia，SHAO Wenjia，WANG Chenyu，WANG Yanhua，LUO Yingying，LI Huixia

2021, 24(33): 4240-4245. DOI: 10.12114/j.issn.1007-9572.2021.02.045

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Background　Preterm delivery is a most common serious complication in pregnancy，which occurs at a higher rate in twin pregnancy. Effective prediction and timely delivery of interventions will greatly reduce the preterm delivery rate and improve the neonatal health in twin pregnancy. Objective　To examine the predictive value of transvaginal ultrasound-measured cervix length（CL），and transabdominal ultrasound-measured fetal membrane thickness for preterm delivery in twin pregnancy. Methods　A total of 177 women with twin pregnancy who were treated at the Second Affiliated Hospital of Zhengzhou University from September 2019 to January 2021 were selected. All measured CL by transvaginal ultrasound，fetal membrane thickness and deepest vertical pocket （DVP） by transabdominal ultrasound，received observation of the opening of cervical internal orifice at 20 to 24 weeks gestation，and received observation of uterine malformation assessment based on the results of previous color Doppler ultrasonography，and these 5 indicators were compared by the prevalence of preterm delivery（assessed by the gestational week of delivery in accordance with outpatient follow-up or telephone follow-up result）. The receiver operating characteristic （ROC） curve of CL，fetal membrane thickness，and their combination for predicting preterm delivery was plotted and analyzed，respectively. Results　In the light of the follow-up，47 cases had preterm delivery，and 130 had term delivery. The term delivery group had longer mean CL〔（32.9±4.8） mm vs （24.9±3.1） mm〕，and thinner mean fetal membrane thickness〔（1.19±0.11） mm vs （1.37±0.22） mm〕than preterm delivery group（P<0.05）. There were no statistically significant differences in DVP，and percentages of opening cervical orifice and uterine malformation between the two groups （P>0.05）. Binary Logistic regression analysis showed that shorter CL〔OR=0.612，95%CI（0.510，0.733）〕 and increased fetal membrane thickness〔OR=2.005，95%CI（1.439，2.795）〕were associated with preterm delivery in twin pregnancy（P<0.05）. The AUC of CL，fetal membrane thickness and their combination for predicting preterm delivery in twin pregnancy was 0.914，0.789，and 0.946，respectively，suggesting that the combination of CL with fetal membrane thickness had greater AUC than each of them alone （P<0.05）. Conclusion　Either CL or fetal membrane thickness could effectively predict preterm delivery in twin pregnancy，and the combined application of them may have a higher predictive effect.

Value of Fasting Fingerstick Glucose as a Screening Test for Diabetes and Prediabetes　

SONG Rongwei，YU Jie，WU Chunxiang，ZHANG Xiayun，CAI Ning，WANG Zhongwang，WU Wenjing

2021, 24(33): 4246-4250. DOI: 10.12114/j.issn.1007-9572.2021.02.021

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Background　The prevalence of diabetes remains high in China. What's more，there may be a large number of people who may have undiagnosed prediabetes or diabetes. Stable and reliable screening methods will help to identify diabetes and prediabetes patients more quickly and effectively. Objective　To evaluate the effect of fasting fingerstick glucose（FFG） in the screening for diabetes and prediabetes in high-risk populations. Methods　A stratified sampling survey was conducted in 10 communities of Shanghai's Putuo District according to the population distribution of the district in 2017. A questionnaire developed based on the 2017 Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes was used for screening residents at high risk for diabetes，which named Diabetes Risk Assessment for Shanghai Community Residents. Then these high risk people underwent laboratory tests to measure FFG and fasting venous blood glucose （FVBG），and received oral glucose tolerance test to determine whether they had prediabetes or diabetes. ROC analysis and performance table of screening test were used to determine the optimal cut-off value of FFG for screening diabetes and prediabetes，and evaluate its effect. Results　A total of 13 057 individuals at high risk for diabetes were identified，among whom 108 cases without FVBG were excluded，and the other 12 949 cases were finally included，including 3 182 （24.57%） diagnosed with diabetes and prediabetes〔1 380 （10.66%） with diabetes，and 1 802 （13.92%） with prediabetes〕. There was a strong correlation between FFG and FVBG（rs=0.722，P<0.001）. The ROC analysis showed that the AUC of FFG to predict diabetes and prediabetes was 0.923 8. When 5.7 mmol/L was taken as the cut-off value of the FVBG test，the Youden Index reached the largest value （0.70），and the sensitivity，specificity，positive predictive value，negative predictive value and Kappa value were 88.62%，81.10%，60.44%，95.63% and 0.83，respectively. The cut-off value of FFG in diagnosing diabetes and prediabetes was 5.7 mmol/L either in men or women，and that ranged 5.6-5.8 mmol/L in different age groups，all were similar to that for the overall population. Conclusion　FFG measurement is a rapid，accurate，reliable and stable test and has high potential to be used as a pre-screening for diabetes and prediabetes. The recommended cut-off value of FFG for screening for diabetes and prediabetes is 5.7 mmol/L，but it could be adjusted within a certain range according to needs of screening.

Impact of Continuous Glucose Monitoring and Time-in-range on Pregnancy Outcome in Patients with Gestational Diabetes Mellitus　

FU Wei，LI Qingju，LI Jun，FU Yanqin，ZHANG Qi

2021, 24(33): 4251-4254. DOI: 10.12114/j.issn.1007-9572.2021.02.022

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Background　Gestational diabetes mellitus （GDM） is a common clinical disease with a morbidity about 12.8%-16.7% in China，which may lead to significantly increased risk of maternal and fetal complications due to poor blood glucose control or imprecise blood glucose monitoring in pregnancy. Continuous glucose monitoring （CGM） system detects the glucose concentration in the intercellular fluid through a probe，reflecting the changes of blood glucose，which makes up for the deficiency of traditional capillary glucose monitoring，and could better monitor in-pregnancy blood glucose，promoting the improvement of maternal and infant outcomes. Objective　To explore the impact of CGM and time-in-range（TIR） on pregnancy outcome in patients with GDM. Methods　One hundred and twenty GDM inpatients who were hospitalized in Department of Endocrinology of the Second Affiliated Hospital of Zhengzhou University from September 2019 to March 2021，were selected and divided into ambulatory glucose monitoring group （n=80） and capillary glucose monitoring group （n=40） according to the glucose monitoring method. Gestational outcomes were compared between ambulatory glucose monitoring and capillary glucose monitoring groups，and between two subgroups of ambulatory glucose monitoring patients divided by the average value of TIR monitored by the CGM system within 72 hours （TIR≥85%，and TIR<85%）. Results　Ambulatory glucose monitoring and capillary glucose monitoring groups had no significant differences in the incidence of abnormal amniotic fluid，incidence of intrauterine infection，length of newborns，incidence of neonatal hyperbilirubinemia and incidence of asphyxia（P>0.05）. Ambulatory glucose monitoring group had statistically lower incidence of cesarean section，premature delivery，placental abruption，premature rupture of membranes，pregnancy-induced hypertension，low-weight infants，and macrosomia，and lower average weight of newborns，as well as greater average gestational age of newborns（P<0.05）. Two TIR subgroups had no significant differences in the incidence of premature delivery，placental abruption，premature rupture of membranes，abnormal amniotic fluid，intrauterine infection，pregnancy-induced hypertension，macrosomia，neonatal hyperbilirubinemia and asphyxia（P>0.05）. TIR≥85% subgroup demonstrated statistically lower incidence of cesarean section，lower average weight and length of newborns，as well as greater average gestational age of newborns（P<0.05）. Conclusion　The data of CGM for GDM patients may support the clinical treatment，benefiting the improvement of maternal and infant outcomes，and the benefit may be greater when TIR≥85%.

Development of a Blood Glucose Benchmark Report Based on the Information Glucose Monitoring System　

PENG Yanqiong，XIE Nan，JING Min，WANG Daimei，WU Yan

2021, 24(33): 4255-4260. DOI: 10.12114/j.issn.1007-9572.2021.02.046

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Background　Growing prevalence of diabetes contributes to increasing attentions given to inpatient glycemic management. However，the lack of recognized definition and measurement of performance indicators，as well as the standardized blood glucose benchmark report has affected the continuous quality improvement of glycemic management in hospitals. Objective　To develop a blood glucose benchmark report based on an information glucose monitoring system （IGMS），providing methodological guidance for developing such reports，and a blood glucose benchmark for medical workers for reference. Methods　Patients with diabetes or hyperglycemia （no history of diabetes but with peripheral blood glucose levels exceeding 11.1 at any random time） were selected during October 2019 to March 2020 from non-intensive care units （10 medical and 7 surgical units） equipped with IGMS （for automatically uploading blood glucose data and reviewing blood glucose data on demand），Suining Central Hospital. The blood glucose data on the first day of hospitalization were excluded. Three models of population，patient and patient-day were used to report the incidence of ideal blood glucose，hyperglycemia and hypoglycemia. The ratio of days，frequency and management timeliness of patients were additionally added for hypoglycemia report. Our internal glucose data were analyzed by quartiles and compared with the blood glucose data of medical institutions in the United States，Australia，Chongqing and Guangdong Province. Results　The average blood glucose，ideal blood glucose ratio，and average hyperglycemia differed significantly across the three models（P<0.001）. The ratios of hyperglycemia （>10.0 mmol/L，≥15.0 mmol/L，≥16.7 mmol/L），and hypoglycemia （≤3.9 mmol/L，<3.0 mmol/L，<2.8 mmol/L，<2.2 mmol/L） at any random time of the three models were statistically different （P<0.001）. Of the patients in 17 wards of our hospital，312 cases （3.9%） had hypoglycemia （≤3.9 mmol/L） occurring more than 3 times at any random time，202（2.5%） had hypoglycemia occurring more than 3 days，446（5.6%） remeasured blood glucose ≤15 minutes，and 2 187（27.5%） remeasured blood glucose >30 minutes. The patient-day percentages of patients in lower and upper quartiles of hyperglycemia （≥15.0 mmol/L） at any random time were 38.6% and 21.5%，respectively. The patient-day percentages of patients in lower and upper quartiles of hypoglycemia（≤3.9 mmol/L） at any random time were 5.5% and 2.1%，respectively. The patient-day percentages of patients in lower and upper quartiles of ideal blood glucose were 38.0% and 58.1%，respectively. Statically significant differences（P<0.05） were found in average hyperglycemia，hyperglycemia at any random time（>10.0 mmol/L，≥15.0 mmol/L，≥16.7 mmol/L），and hypoglycemia at any random time（≤3.9 mmol/L，<3.0 mmol/L，<2.8 mmol/L，<2.2 mmol/L） across diabetic or hyperglycemic patients in our 17 wards，and in medical institutions of the United States，Australia and Chongqing. The average blood glucose，ideal blood glucose，hyperglycemia （≥16.7 mmol/L） at any random time，and hypoglycemia （≤3.9 mmol/L） at any random time in diabetic or hyperglycemic patients in the Endocrine Ward of our hospital were significantly different from those of diabetic or hyperglycemic patients in an Endocrine Ward in Guangdong Province（P<0.05）. Conclusion　IGMS contributes to the creation of comprehensive and standardized glucose report in medical institutions. The selection of model varies by the purpose of creation：the population model is more suitable for drug management and risk management for individuals，the patient model is more suitable for individualized nursing evaluation，and the patient-day model is more suitable for deciding the quality direction and goal to be improved for a unit.

Risk Factors for Type 2 Diabetic Kidney Disease：a Systematic Review　

FANG Fengzhen，LI Zhuangmiao，CHEN Tingyu

2021, 24(33): 4261-4267. DOI: 10.12114/j.issn.1007-9572.2021.00.487

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Background　Diabetic kidney disease （DKD） has gradually become a noticeable global issue in recent years. As proved，early assessment and intervention of risk factors can prevent or delay the development of DKD. Objective　To systematically review the risk factors of type 2 DKD. Methods　The databases of the Cochrane Library，PubMed，Web of Science，SinoMed，CNKI，VIP and Wanfang Data were electronically searched for cohort studies and case-control studies on the risk factors related to type 2 DKD. The retrieval time was from the inception to April 2020. Two researchers screened literature，extracted data，and evaluated the bias risk of the eligible studies separately. RevMan 5.3 was used for Meta-analysis. Results　In all， three cohort studies and nine case-control studies were included. Meta-analysis showed that older age〔SMD=0.34，95%CI （0.23， 0.46）〕，male〔OR=1.51， 95%CI （1.20， 1.90）〕，smoking〔OR=1.64， 95%CI （1.30， 2.07）〕，hypertension〔OR=2.01， 95%CI （1.73， 2.34）〕，elevated systolic blood pressure〔SMD=0.37，95%CI （0.12，0.63）〕，elevated glycosylated hemoglobin 〔SMD=0.41，95%CI （0.02，0.80）〕，elevated total cholesterol〔SMD=0.14，95%CI （0.06，0.22）〕，elevated serum creatinine〔SMD=0.73，95%CI （0.39，1.07）〕，vitamin D deficiency〔OR=4.06，95%CI （2.11，7.78）〕，non-alcoholic fatty liver disease〔OR=3.53，95%CI （1.61，7.74）〕，associated retinopathy〔OR=2.16，95%CI （1.55，3.01）〕，and insulin therapy〔OR=2.63， 95%CI （1.79，3.85）〕 were associated with increased risk of type 2 DKD（P<0.05）. The prolonged duration of type 2 diabetes〔SMD=-0.44， 95%CI（-0.54， -0.34）〕 and elevated HDL-C〔SMD=-0.20， 95%CI （-0.30， -0.10）〕 were associated with reduced risk of type 2 DKD（P<0.05）. Conclusion　Male，older age，smoking，diabetic retinopathy，hypertension，non-alcoholic fatty liver disease，abnormal somatic factors（including elevated total cholesterol，systolic blood pressure，glycosylated hemoglobin，serum creatinine，as well as vitamin D deficiency） and insulin therapy are risk factors for type 2 DKD，which need to be verified by more high-quality large-sample studies due to limited quality and quantity of included studies.

Efficacy and Safety of Acupuncture Therapy in Treating Hyperlipidemia：a Systematic Review and Meta-analysis of Randomized Controlled Trials　

LIU Meiling，ZHANG Qingying，GUO Yi

2021, 24(33): 4268-4275. DOI: 10.12114/j.issn.1007-9572.2021.02.020

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Background　Lipid regulation is critical to preventing cardiovascular diseases. Statins recommended by domestic and international guidelines can bring down LDL-C levels. However，adverse reactions，which are observed frequently，affect patients' compliance with the recommended dose. Chinese medicine has a unique advantage in the prevention and treatment of chronic diseases. Clinical studies have revealed that acupuncture therapy is similar to statins in regulating lipids with less adverse reactions. Objective　To systematically evaluate the effectiveness and safety of acupuncture therapy in treating hyperlipidemia. Methods　Databases of CNKI，Wanfang Data，VIP，SinoMed，PubMed，and the Cochrane Library were searched from inception to December 31，2019 for randomized controlled trials（RCTs） comparing efficacy and safety in hyperlipidemia patients treated with acupuncture therapy（experimental group） and oral statins recommended by guidelines（control group）. Literature screening，data extraction and quality evaluation were performed according to Cochrane Reviewers' Handbook. Meta-analysis was performed using RevMan 5.4. Results　Fifteen RCTs with 1 347 patients were included. Meta-analysis results demonstrated that there were no statistically significant differences in overall response rate，mean post-treatment TC，LDL-C，TG and BMI between the two groups〔OR=1.28，95%CI（0.77，2.15），P=0.34；MD=-0.06，95%CI（-0.13，0.02），P=0.13；MD=0.11，95%CI（-0.07，0.28），P=0.24；MD=0.01，95%CI（-0.09，0.12），P=0.84；MD=-0.81，95%CI（-2.75，1.13），P=0.41〕. The mean HDL-C level in the experimental group was higher〔MD=0.16，95%CI（0.04，0.28），P=0.009〕. The post-treatment mean TCM symptom score and incidence of adverse reactions in the experimental group were lower〔MD=-3.19，95%CI（-4.52，-1.87），P<0.000 01；OR=0.28，95%CI（0.14，0.59），P=0.000 7〕. The clinical TCM efficacy in the experimental group outperformed that of the control group〔OR=3.86，95%CI（1.97，7.56），P<0.000 1〕. Analysis of the RCTs in terms of the overall response rate of participants presented an asymmetrical funnel graphic，indicating the presence of publication bias. Conclusion　The available clinical evidence indicates that acupuncture therapy is superior to statins for hyperlipidemia in terms of improving HDL-C and clinical TCM efficacy，reducing TCM symptom score with fewer adverse reactions. However，since quality of the included research was not high，the conclusion still needs to be tested in more high-quality，double-blind RCTs.

Advances in the Mechanism of Intestinal Electrical Stimulation in the Treatment of Patients with Type 2 Diabetes　

MENG Qiao，TAN Chang，YAO Shukun

2021, 24(33): 4276-4280. DOI: 10.12114/j.issn.1007-9572.2021.02.004

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Although there are many therapies for diabetes，poor glycemic control can occur in some diabetes patients due to various reasons. Intestinal electrical stimulation （IES），a new treatment for diabetes，has attracted wide attention of scholars. We reviewed recent studies about IES for type 2 diabetes，and concluded that IES could reduce fasting and postprandial plasma glucose levels and insulin resistance，which has proved its therapeutic value. Furthermore，we found that the glycemic control mechanism of IES may be related to delaying gastric emptying，accelerating intestinal transit，affecting gastrointestinal hormones involved in plasma glucose regulation，and regulating autonomic nervous function. It is hoped that this study could provide new ideas for future research.

Novel Advances in the Relationship between Chronic Liver Disease and Thyroid Disorder　

ZHANG Jingyi，TANG Yingmei

2021, 24(33): 4281-4286. DOI: 10.12114/j.issn.1007-9572.2021.02.024

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Thyroid disorder is common in chronic liver disease patients，which can be stratified into different types and severities. Since thyroid disorder is modified by various causation factors，such as well-known viral hepatitis，metabolic fatty liver disease，autoimmune liver disease and liver cirrhosis，differences in clinical features，diagnosis，treatment and prognosis can be found among chronic liver disease patients with thyroid disorder. We reviewed the association of thyroid disorder with different chronic liver diseases，aiming at improving clinicians' attitudes toward thyroid disease in chronic liver disease patients.

Latest Advances in Cardiovascular Risk in Primary Hyperparathyroidism　

HE Chunhua，WANG Jinfang，WANG Qingguo

2021, 24(33): 4287-4292. DOI: 10.12114/j.issn.1007-9572.2021.00.572

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Primary hyperparathyroidism（PHPT） is an endocrine disease in which parathyroid hormone is excessive secreted，causing disorders of calcium and phosphorus metabolism，and then leading to the involvement of many systems in the whole body. Hypertension，diabetes，dyslipidemia，cardiovascular endothelial dysfunction，arrhythmia and left ventricular hypertrophy are major cardiovascular risk factors for PHPT，and cardiovascular metabolic characteristics of PHPT have been widely studied. We reviewed many recent studies about PHPT with cardiovascular involvement，described and summarized the major research results，aiming to improve clinical workers' understanding of knowledge in this field and to provide help for them in developing options that maximize the benefits.

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