Chinese General Practice

Interpretation of the Essential Updates in 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

Yifang GUO

2022, 25(17): 2051-2054. DOI: 10.12114/j.issn.1007-9572.2022.0288

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The American Heart Association (AHA) , American College of Cardiology (ACC) and Heart Failure Society of America (HFSA) jointly released the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure (hereinafter referred to as the 2022 Guideline) . In the light of the latest evidence, the essentials updated in the 2022 Guideline encompass the prevention, stages, classification, drug treatment and device-based treatment of heart failure. The 2022 Guideline is content-enriched, evidence-based, practical, and easily operable, which may greatly contribute to clinical practice in China. In response to the most concerns of clinicians, we overviewed and discussed the updates in stages, classification and drug treatment of heart failure in the new guideline.

"Double Six Definitions" in Guideline-recommended Methods for Estimating the Stability of Warfarin Anticoagulation: Practical Exploration and Reconsideration

Xiao LUO, Yanmei CHEN, Qingxia HUANG, Ling CHEN, Yun LUO, Mingqing YUAN

2022, 25(17): 2055-2060. DOI: 10.12114/j.issn.1007-9572.2022.0066

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Background

The stability of anticoagulation is a key indicator for assessing the efficacy of warfarin in atrial fibrillation, which is an important anticoagulation therapy for the disease. Existing studies show that the eligible rate of stability of warfarin anticoagulation is rather unsatisfactory, and there are few studies on how to effectively calculate the stability of the treatment. Moreover, methods recommended in guidelines for estimating the stability of warfarin anticoagulation have limitations, with no effective suggestions for calculating stability of warfarin anticoagulation in the early stage of treatment.

Objective

To assess the practical efficacy of "double six definitions" in guideline-recommended method for estimating the stability of warfarin anticoagulation〔using INR data monitored for at least six months but excluding the data within the first six weeks〕, providing a reference for improving the method for calculating the stability of warfarin anticoagulation.

Methods

Participants with persistent non-valvular atrial fibrillation (n=126) were recruited from Jiujiang No.1 People's Hospital from January 2019 to December 2020. All of them received warfarin anticoagulant therapy and outpatient or inpatient follow-ups for understanding the coagulation status. The stability of warfarin anticoagulation was described using time in therapeutic range (TTR) calculated by different methods, namely using INR data in a 7-12-month follow-up period with or without removal of INR data in the first 6 weeks, and INR data in 12 consecutive months of follow-up with or without removal of INR data in the first 6 weeks, and the results were compared with the TTR calculated by "double six definitions".

Results

Calculating the TTR using INR data of 7-12 months: there were no significant differences between the TTR calculated using INR data of 7, 8, 9, 10, 11 or 12 months with and without the first 6-week INR data (P>0.05) . Calculating the TTR using INR data of 12 consecutive months: when INR data in the first 6 weeks of follow-up were removed, the TTR at the first and second months of follow-up could not be calculated using the set formula, and it was deemed to be 0. There was significant difference between TTR calculated with and without INR data in the first 6 weeks at 1- or 2-month follow-up (P<0.001) . There was no significant difference between TTR calculated with and without INR data in the first 6 weeks at 3-, 4-, 5-, 6-, 7-, 8-, 9-, 10-, 11- or 12-month follow-up (P > 0.05) . The TTR calculated using INR data of 7 to 12 months of follow-up was similar to that calculated using INR data at one time point of the second half period (7 to 12 months) within the 12-month follow-up under the condition of removing the INR data of the first 6 weeks (P>0.05) , and the same thing was found when the INR data of the first 6 weeks were not removed (P>0.05) . Furthermore, there were no significant differences in TTR calculated using INR data of 7 to 12 months of follow-up and using INR data of 12 consecutive months of follow-up regardless of whether the INR data of the first 6 weeks were removed or not (P>0.05) .

Conclusion

In the calculation of the stability of warfarin anticoagulation in atrial fibrillation, the INR data in the first 6 weeks might be included, and the baseline follow-up time for monitoring INR might not necessarily be greater than 6 months.

Screening Value of Smartphone App Snoring Analysis Software for Obstructive Sleep Apnea hypopnea Syndrome

Ruiling LIANG, Chenyang LI, Rui ZHAO, Bing ZHOU, Xiaosong DONG, Fang HAN

2022, 25(17): 2061-2066. DOI: 10.12114/j.issn.1007-9572.2022.0068

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Background

The prevalence of obstructive sleep apnea hypopnea syndrome (OSAHS) is high. The development of telemedicine and mobile applications play an important role in the diagnosis and screening of OSAHS patients.

Objective

To evaluate the value of smartphone snoring analysis software Mianyun Sara in screening of Chinese adults with OSAHS.

Methods

One hundred and thirty patients〔mean age (49.7±17.4) years old, 70% male and 30% female, mean body mass index (28.2±5.0) kg/m²〕who were admitted to the Sleep Center of Peking University People's Hospital from April to December 2020 were selected and underwent overnight monitoring with Mianyun Sara and polysomnography (PSG) simultaneously. The relevant indicators generated by Mianyun Sara's automatic analysis and the relevant indicators interpreted by sleep professional technicians according to the recommended guidelines, the agreement between the apnea hypopnea index (AHI) derived from this method and PSG were evaluated, as well as the sensitivity and specificity of the diagnosis of OSAHS.

Results

(1) The total sleep time (TST) monitored by Mianyun Sara was 523.67 (497.50, 542.64) min, and the TST monitored by PSG was 408.25 (364.25, 462.50) min, the difference was statistically significant (Z=-9.540, P<0.001) . The AHI monitored by Mianyun Sara was 15.83 (6.18, 27.49) times/h, and the AHI monitored by PSG was 18.25 (6.15, 35.68) times/h, the difference was statistically significant (Z=-2.601, P=0.009) . (2) There was a positive correlation between the AHI obtained by the two monitoring methods (r=0.645, P<0.001) . Bland-Altman analysis showed that the AHIs measured by Mianyun Sara and PSG were statistically consistent, with an average difference of -5.7 times/h, and the 95% consistency limit of (-40.5, 29.2) times/h. (3) Taking AHI≥5 times/h as the gold standard for the diagnosis of OSAHS, Mianyun Sara's optimal diagnostic value for OSAHS was AHI>8.34 times/h, with a corresponding sensitivity of 83.81% and a specificity of 92.00%. The area under the curve (AUC) was 0.91 (0.84, 0.95) , the positive predictive value (PPV) was 97.8%, and the negative predictive value (NPV) was 57.5%, at different AHI thresholds (5, 15, 30 times/h) , the sensitivity/specificity corresponding to the best diagnostic value were 83.8%/92.0%, 88.2%/74.1% and 64.9%/91.4%, respectively.

Conclusion

Mianyun Sara has a good screening value for adult OSAHS patients and there is close agreement between Mianyun Sara and PSG.

A Method for Measuring Loop Gain and Its Clinical Significance in Patients with Obstructive Sleep Apnea

Ning DING, Xilong ZHANG

2022, 25(17): 2066-2070. DOI: 10.12114/j.issn.1007-9572.2022.0032

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The pathogenesis of obstructive sleep apnea (OSA) has been explained from both anatomic and non-anatomic perspectives. Previous studies have indicated that OSA is most closely associated with anatomic factors related to upper airway obstruction, but its association with non-anatomic factors for upper airway obstruction has been increasingly understood and valued. The non-anatomic parameters for evaluating therapeutic effect include pharyngeal critical closing pressure, arousal threshold, loop gain and dilator muscle dysfunction, namely PALM. Monitoring and analyzing the weight of these four factors in the pathogenesis of OSA may contribute to the guidance of individualized treatment. Loop gain is a method for measuring the gain or sensitivity of negative feedback loop of respiratory control system to estimate the ventilation volume obtained by increasing the driving force of respiration to some extent. Higher loop gain may lead to hypocapnia and inhibition of upper airway respiratory drive, thereby aggravating the severity of OSA. We detailed a method for measuring loop gain and its clinical significance in patients with OSA.

Analysis on the Status of Evaluation Indicators of Clinical Randomized Controlled Trials on Sleep Apnea Hypopnea Syndrome Treated by Traditional Chinese Medicine in Recent 6 Years

Wangwang TIAN, Zhiwan WANG

2022, 25(17): 2071-2081. DOI: 10.12114/j.issn.1007-9572.2022.0204

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Background

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common disorder. At present, there are great differences in evaluation indicators of clinical randomized controlled trials (RCTs) on OSAHS treated by traditional Chinese medicine (TCM ) . Therefore, it is of great significance to further explore the evaluation indicators of clinical RCTs of OSAHS.

Objective

To analyze the evaluation indicators of clinical RCTs on OSAHS treated by TCM, in order to provide reference for the selection of appropriate Chinese medicine for the treatment of OSAHS in RCTs outcome indicators.

Methods

The RCTs in the TCM treatment of OSAHS were retrieved from CNKI, WanFang Data, VIP, CBM, PubMed and other data bases from 2015-01-01 to 2021-10-20. The basic characteristics of the collected literature included the first author, sample size, gender, age, course of disease, intervention measures, TCM syndrome type, course of treatment, and outcome indicators. According to the functional attributes, the evaluation indicators were divided into TCM syndrome, physical and chemical indicators, life quality indicators, long-term prognosis indicators, safety events indicators, and Western medicine signs indicators. The quality of the included literature was evaluated using a systematic bias risk assessment tool recommended by the Cochrane Collaboration, and the literature quality was evaluated using RevMan 5.4 software.

Results

A total of 41 RCTs were included, including 2 971 patients, involving 270 outcomes of 70 indicators, which were classified as TCM syndrome, physical and chemical indicators, safety events indicators, Western medicine signs indicators, and quality of life indicators. Among them, physical and chemical indicators, symptoms and signs indicators are the most, quality of life indicators are less. There are 14 items of 2 kinds of combination indicators, 16 items of 3 kinds of combination indicators and 7 items of 4 kinds of combination indicators. The measurement time ranged from 7 days to 6 months, and the most was 1 month (15 RCTs, 36.59%) , followed by 3 months (11 RCTs, 31.70%) .

Conclusion

At present, there are large differences in evaluation indicators of TCM treatment of OSAHS, relatively insufficient attention on TCM syndrome score, poor attention on quality of life indicators, no unified standard for evaluation indicators, large span of measurement time points, and no long-term prognostic indexes.

Systemic Immune-inflammatory-nutritional Index and Survival in Elderly NSCLC Patients with Non-surgical Treatment

Jianhua XIE, Miaomiao LIU, Lili PENG, Rongsan ZHANG, Hongzhen ZHANG

2022, 25(17): 2082-2089. DOI: 10.12114/j.issn.1007-9572.2022.0102

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Background

In China, elderly patients with non-small cell lung cancer (NSCLC) accounts for the highest percentage of lung cancer patients, and most of them are found to have no surgical possibilities at the time of diagnosis. Moreover, these patients are increasing as aging advances. Increasing their survival rate will help to reduce the overall mortality of lung cancer patients. So identifying effective prognostic indicators in NSCLC patients with non-surgical treatment is of great significance in prognostic stratification, which also contributes to clinical studies aiming at improving the survival rate of such patients via prognostic stratification-based treatments.

Objective

To investigate the relationship between systemic immune-inflammatory-nutritional index (SIINI) and survival in non-surgically treated elderly patients with NSCLC.

Methods

Patients (n=231, ≥65 years old) with first treatment for NSCLC were retrospectively recruited from Hebei General Hospital from January 1, 2014 to June 30, 2018. Clinical characteristics were collected, mainly including age, sex, prevalence of smoking, baseline diseases, BMI, pathology, differentiation, and clinical stage of NSCLC. Some calculated data based on baseline routine blood test parameters, and/or serum albumin, and/or BMI using different approaches were also collected, including neutrophil to lymphocyte ratio (NLR) , derived NLR (dNLR) , platelet to lymphocyte ratio (PLR) , prognostic nutrition index (PNI) , systemic immune-inflammation index (SII) , advanced lung cancer inflammatory index (ALI) and SIINI 〔using a formula proposed in clinical retrospective studies, in which all variables are measured before treatment: (neutrophil count×platelet count×hemoglobin level) / (lymphocyte count×BMI×serum albumin level) 〕. Post-treatment follow-up was conducted till February 1, 2020 through outpatient reexamination, telephone or text messages with death as the endpoint. For assessing prognostic values of NLR, dNLR, PLR, PNI, SII, ALI and SIINI, ROC analysis was performed with defined optimal cut-off value and the area under the curve (AUC) for each indicator (if the AUC value is less than 0.5, then the optimal cut-off value is defined using the median value, by which the AUC value is defined as large or small when it is greater or less than the value) . The survival curves were comparatively analyzed by different patient characteristics. Cox regression analysis was applied to identify the influencing factors of survival. The survival rate curve was visualized using GraphPad Prism 8.0.2.

Results

The optimal cut-off values using NLR, dNLR, PLR, PNI, SII, ALI and SIINI in assessing the prognosis were 3.30, 2.51, 179.99, 273.65, 736.54, 46.05 and 102.89, respectively. The survival curves varied significantly by age, sex, prevalence of smoking, pathology, differentiation, and clinical stage of NSCLC, NLR, dNLR, PLR, ALI, SII, PNI and SIINI (P<0.05) . Further analysis indicated that the difference between the survival curves of 65-70-year-olds and 76-and-over-year-olds was statistically significant (P<0.05) . The survival curves between those with low or moderate differentiation and those with high differentiation were significantly different (P<0.05) . The survival curves of patients with stageⅠ NSCLC were different from those of patients with stage Ⅱ, Ⅲ or Ⅳ NSCLC (P<0.05) . Cox regression analysis revealed that ≥76 years old (P<0.001) , highly differentiated NSCLC (P<0.001) , stage Ⅲ NSCLC (P=0.012) and Ⅳ NSCLC (P<0.001) and SIINI (P=0.001) were prognostic factors of patients. Moreover, there existed significant differences in survival curves by NLR, dNLR, PLR, ALI, SII, PNI, and SIINI (P<0.05) .

Conclusion

We found that SIINI, a new indictor calculated based on immunity, inflammation and nutrition factors, is effective in predicting the overall survival in non-surgically treated elderly patients with NSCLC, and it may be superior to NLR, dNLR, PLR, PNI, SII, ALI in terms of survival prediction-related application and in-depth research.

Efficacy of Traditional Bigu Health-preserving Regimen in Healthy People: a Crossover Trial Using Real-world Data

Binyang HUANG, Xiaorui LIU, Luping YANG, Mengxiao LI, Shuang ZHENG, Anren ZHANG

2022, 25(17): 2090-2095. DOI: 10.12114/j.issn.1007-9572.2022.0046

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Background

Bigu is a health-preserving regimen with a long history advocating appropriately reducing food intake in China, whose efficacy has been confirmed in practical treatment of some diseases currently. However, the applicability of Bigu in human experiments is poor due to nonforcible control of dietary intake in the participants.

Objective

To assess the effect of medicine-qi intake type of Bigu in healthy people using real-world data.

Methods

Two hundred and eighty healthy volunteers were recruited from Sichuan Nursing Vocational College from November 2018 to September 2020, and equally divided into two groups (A and B, with 140 cases in each) after being matched using k-nearest neighbor propensity score approach based on their demographics, and received a two-round Bigu trial: in the first round, group A received 10-day diet-restriction type of Bigu, while group B received 10-day medicine-qi intake in combination with diet-restriction type of Bigu. Then, after one-month washout period, the second round was conducted, during which group A received 10-day medicine-qi intake in combination with diet-restriction type of Bigu, while group B received 10-day diet-restriction type of Bigu. Comparisons were performed between two groups in terms of incidence of adverse reactions and number of dropouts in two rounds of Bigu, and subjective hunger sensation, weight, BMI, morning blood pressure, and fasting fingerstick glucose on the first and 10th days of two rounds of Bigu.

Results

After being assigned by PSM, there were 72 males and 80 females in group A; 61 males and 67 females in group B. In the first round, the incidence of adverse reactions in group A was 65.7% (92/140) , and the trial discontinuation rate was 48.6% (68/140) ; the incidence of adverse reactions in group B was 42.9% (60/140) , and the trial discontinuation rate was 20.0% (28/140) . The incidence of adverse reactions and trial discontinuation rate in group A were higher than those in group B, and the difference was statistically significant (P<0.05) . In the second round, the incidence of adverse reactions in group A was 29.2% (41/140) , and the trial discontinuation rate was 13.6% (19/140) ; the incidence of adverse reactions in group B was 60.0% (84/140) , and the trial discontinuation rate was 42.1% (59/140) . The incidence of adverse reactions and trial discontinuation rate in group A were lower than those in group B, and the difference was statistically significant (P<0.05) . The subjective hunger sensation score at the end of the first round was higher than that before the beginning, and the subjective hunger sensation score in group B at the end was lower than that before the beginning, and the difference was statistically significant (P<0.05) . The subjective hunger sensation score at the end in the second round of group A was lower than that before the beginning, and the difference was statistically significant (P<0.05) . The body weight, BMI, systolic blood pressure, diastolic blood pressure, and fasting blood glucose of groups A and B at the end of the 2-round test were all lower than those before the start of the test, and the difference was statistically significant (P<0.05) .

Conclusion

This real-world trial demonstrates that the medicine-qi intake type of Bigu may reduce the subjective hunger sensation, and incidence of adverse reactions as well as enhanced the completion rate of Bigu in healthy population, which may be used as a recommended scheme for the promotion of Bigu.

Epidemiological Characteristics of Hemorrhagic Fever with Renal Syndrome and Its Relationship with Meteorological Factors in Guangdong from 2015 to 2021

Jing TAN, Xiaoling HUANG, Ping HUANG, Lijun LIANG

2022, 25(17): 2096-2101. DOI: 10.12114/j.issn.1007-9572.2022.0289

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Background

Hemorrhagic fever with renal syndrome (HFRS) is a severe acute infectious disease and there are still some control deficiencies according to the epidemic report.

Objective

To analyze the epidemiological characteristics of HFRS in Guangdong from 2015 to 2021, and explore its impacts by meteorological factors.

Methods

The HFRS and meteorological data in Guangdong from 2015 to 2021 were collected from the China Disease Prevention and Control Information System and the National Meteorological Science Data Center, respectively. HFRS case information includes the region reported, current address, date of onset, date of death, age, sex and occupation. The population information includes the resident population and sex ratio. Meteorological data includes AP, ARH, AT, MaT, MRH, MiT, PR and SD. SPSS 23.0 was used for descriptive statistical analysis and tested to learn the correlation between HFRS cases and meteorological factors with ARIMA.

Results

The average annual incidence of HFRS in Guangdong from 2015 to 2020 was 0.23/100, 000, showing a fluctuating downward trend. The confirmed cases of HFRS in Guangdong totalled 1 627 as its fatality rate was 0.18%. The ratio of clinical cases vs confirmed cases was 1∶2.36 (690/1 627) , as the number of cases in Guangzhou, Dongguan and Shenzhen accounted for 63.24% (1 029/1 627) . The temporal-spatial clusterings featured in Guangzhou clustering (38.3%, of which Guangzhou accounted for 75.6%) and Dongguan clustering (61.7%, of which Dongguan accounted for 27.8%) . The incidence peaks were in January and March to May. The sex ratio (male/female) was 3.11∶1 and these coefficient of variations (CV) were 30% and 41%, respectively, the later suggested a greater chance of susceptibility in females. The 25-50 year-old group accounted for 62.75%, where the statistical differences existed among the yearly age-groups (P=0.031) . The occupations included mainly housework and unemployed, business service, labor and farmer, occupied 70.68%. The results included that HFRS cases were significantly correlated with relative humidity (ARH, MRH; Lag4M) , sunshine duration and precipitation (SD, PR; Lag2M) (P<0.05) . The ARIMA (1, 1, 0) (R²_stationary=0.710) predicted the HFRS cases in the first half of 2021, with (61±18) % of the agreement rate between the fitted value and the measured value.

Conclusion

The HFRS epidemic in Guangdong from 2015 to 2021 showed a fluctuating downward trend; high humidity and precipitation might increase the level of HFRS epidemic in the next seasonal quarter. For the clustered HFRS epidemic areas in both Guangzhou and Dongguan, the current HFRS prevention and control mission is to strengthen field protection to HFRS and improve the laboratory diagnosis rate of clinical HFRS cases.

Yellow Wine Polyphenolic Compounds Regulate SIRT3 Expression to Alleviate Doxorubicin-induced Myocardial Injury

Shimin SUN, Zhenzhu SUN, Jufang CHI, Hangyuan GUO

2022, 25(17): 2102-2109. DOI: 10.12114/j.issn.1007-9572.2022.01.605

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Background

Doxorubicin (DOX) , a common and powerful anthracycline antitumor agent, has been widely used in the treatment of various tumors, especially solid tumors. However, its strong cardiotoxicity-induced irreversible cardiomyopathy and congestive heart failure limit its clinical application. Yellow Wine Polyphenols Compounds (YWPC) are polyphenols extracted from Shaoxing yellow rice wine which have anti-inflammatory and antioxidant activities, and can alleviate DOX-induced myocardial injury, but the mechanism of actions is still unclear.

Objective

To explore the mechanism of YWPC reducing DOX-induced myocardial injury via in vitro and in vivo experiments.

Methods

SD rats were used for an in vivo experiment and divided into four groups: control group (intervened with normal saline) , YWPC group (intervened with YWPC and normal saline) , DOX group (intervened with DOX and normal saline for establishing a DOX-induced myocardial injury model) and DOX+YWPC group (intervened with DOX, YWPC and normal saline for observing the myocardial protective effect of YWPC in a DOX-induced myocardial injury model) . When the experiment ended, all rats were sacrificed and cardiac tissues were taken out for examining myocardial fiber morphology using Masson's trichrome staining, myocardial cell apoptosis using TUNEL assay, pathological changes using immunohistochemical assay, and levels of proteins (Bcl-2 and Bax) involved in apoptosis as well as expression level of SIRT3 using Western blotting. And the serum lactate dehydrogenase (LDH) was also measured. Cardiomyocyte H9C2 cells of rats were used for an in vitro experiment and divided into five groups: control group, YWPC group (intervened with YWPC and normal saline) , DOX group (intervened with DOX for establishing a DOX-induced myocardial injury model within 24 hours) and three DOX+YWPC (1 mg/L, 10 mg/L, 100 mg/L) groups〔first intervened with DOX for establishing a DOX-induced myocardial injury model within 24 hours, then with YWPC for observing the myocardial protective effect of three concentrations of YWPC (1 mg/L, 10 mg/L, 100 mg/L) , respectively〕. Viability of H9C2 cells was measured by CCK-8 assay. Apoptosis, and SIRT3 expressed in H9C2 cells were measured by Western blotting. Then another batch of the same H9C2 cells were took and divided into control group, DOX group, DOX+YWPC group, DOX+3-TYP group and DOX+YWPC+3-TYP group, and SIRT3 inhibitor 3-TYP was used to inhibit the activity of SIRT3 protein in the latter two groups. Then apoptosis level and SIRT3 protein expressed in H9C2 cells were detected by Western blotting for further assessing the effect of SIRT3 in reducing DOX-induced myocardial injury.

Results

In vivo experiment: (1) Under the microscope, Masson's trichrome-stained myocardial fibers of rats in DOX group were disordered and intersected with a large number of blue collagen fibers. The myocardial texture of DOX+YWPC group was partially restored with decreased blue collagen fibers. DOX group had higher proportion of collagen fibers distributed in cardiovascular tissues, and higher serum LDH than control and DOX+YWPC groups (P<0.05) . DOX group had lower ratio of Bcl-2/Bax and level of expression of SIRT3 than control and DOX+YWPC groups (P<0.05) . The apoptotic myocardial cells with a patch distribution appearing as bright green dots were significantly increased in DOX group at first, but were decreased after YWPC treatment. In vitro experiment: (1) The absorbance value, Bcl-2/Bax ratio and expression level of SIRT3 in DOX group were lower than those of control group, DOX+YWPC (1 mg/L) group, DOX+YWPC (10 mg/L) group and DOX+YWPC (100 mg/L) group (P<0.05) . (2) The Bcl-2 /Bax ratio and expression level of SIRT3 in DOX or DOX+3-TYP group were lower than those in control group (P<0.05) . (3) The Bcl-2/Bax ratio in DOX+YWPC+3-TYP group was lower than that in DOX+YWPC group (P<0.05) . (4) The expression level of SIRT3 was similar in DOX+YWPC and DOX+YWPC+3-TYP groups (P>0.05) .

Conclusion

DOX-induced myocardial injury in in vitro and in vivo experiments with rats may be alleviated by YWPC via improving the expression level of SIRT3, and the effect may be reduced if the expression level of SIRT3 protein is inhibited.

Performance of Serum m3AchR-Ab for Alpha-fetoprotein-negative Hepatocellular Carcinoma Diagnosis

Tuoheti YAKUFU·, Kainan ZHANG, Hui ZHAO, Dawuti WUBULITALIFU·, Rui ZHANG, Renyong LIN, Guodong LYU

2022, 25(17): 2110-2114. DOI: 10.12114/j.issn.1007-9572.2022.0036

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Background

Alpha-fetoprotein (AFP) is a common diagnostic marker for hepatocellular carcinoma (HCC) , a highly malignant cancer, but its sensitivity is only 41%-65%, and the rate of missed diagnosis is relatively high. Therefore, there is an urgent need to develop new diagnostic markers and methods to improve the detection rate of AFP-negative and other types of HCC.

Objective

To assess the diagnostic efficacy of muscarinic acetylcholine receptor m3 autoantibody (m3AchR-Ab) in AFP-negative HCC, and to explore the diagnostic value of m3AchR-Ab in HCC.

Methods

Participants (n=257) were selected from the First Affiliated Hospital of Xinjiang Medical University, including 90 with confirmed diagnosis of HCC, 89 with liver cirrhosis, hepatic hemangioma or other benign liver diseases, and 78 healthy controls. ELISA was the technique used for measuring the serum m3AchR-Ab level in venous blood samples of all cases stored in the serum repository of the hospital from November 2011 to September 2015. Serum m3AchR-Ab levels were compared in the three groups. The associations of serum m3AchR-Ab level with gender, age, size (the maximum diameter) of HCC, number and TNM stage of HCC, prevalence of lymph node metastasis, distant metastasis and HBsAg positivity in HCC patients were analyzed. The efficacy of m3AchR-Ab in the diagnosis of AFP-negative HCC was evaluated by the receiver operating characteristic (ROC) curve.

Results

HCC patients had higher serum m3AchR-Ab level than benign liver disease patients and healthy controls (P<0.05) . The level of m3AchR-Ab was correlated with the size and TNM stage of HCC, as well as prevalence of lymph node metastasis and HBsAg positivity (P< 0.05) . The area under the ROC curve of serum m3AchR-Ab in the diagnosis of AFP-negative HCC was 0.69〔95%CI (0.54, 0.83) 〕, with 64.00% sensitivity and 91.02% specificity when 74.00 ng/ml was chosen as the optimal cut-off value. The area under the ROC curve of m3AchR-Ab with AFP in serum in diagnosing HCC was 0.90〔95%CI (0.85, 0.95) 〕, with 90.00% sensitivity and 88.02% specificity.

Conclusion

Serum m3AchR-Ab level is a potential diagnostic maker for AFP-negative HCC, and its combination with serum AFP level could produce higher diagnostic efficiency for HCC, which may be a reference for further research on novel diagnostic markers for HCC.

Inflencing Factors for Pulmonary Nodular Growth Predicted by Artificial Intelligence-based Follow-up

Jiuchun WU, Tian LI, Xiaodong LI, Yue ZHUO, Yujiao ZHANG, Jingyu LIU

2022, 25(17): 2115-2120. DOI: 10.12114/j.issn.1007-9572.2022.0005

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Background

Lung cancer ranks first in terms of incidence and mortality rates among cancers, with a 5-year survival rate of less than 20%. Many ways have been used to screen for early lung cancer, among which artificial intelligence (AI) has greatly improved the detection rate. However, how to use AI technologies to effectively manage atypical lung nodules to timely find early lung cancer, and to identify associated factors of lung nodule growth, which is an issue significantly associated with the guidance of clinical management of lung nodules.

Objective

To investigate the influencing factors of pulmonary nodules growth identified by AI-based follow-up and relevant clinical value.

Methods

A total of 175 patients with pulmonary nodules admitted to the Third Affiliated Hospital of Jinzhou Medical University in April 2019 were selected for a retrospective study. General clinical data, and AI-based analysis of imaging information related to pulmonary nodules was collected. The growth of pulmonary nodules〔solid nodules (in 82 cases) and ground-glass nodules (in 93 cases) classified by AI-based analysis〕 were observed by regular follow-ups. The influencing factors of pulmonary nodules growth were explored by Cox regression analysis.

Results

Patients with solid nodules had higher prevalence of solid components, and mean CT quantitative parameters of nodules than those with ground-glass nodules (P<0.001) . Multivariate Cox regression analysis showed that average diameter〔HR=2.185, 95%CI (1.079, 4.425) , P=0.030〕, volume〔HR=1.001, 95%CI (1.000, 1.001) , P=0.022〕, malignant probability〔HR=2.232, 95%CI (1.036, 4.806) , P=0.040〕and surface signs〔HR=2.125, 95%CI (1.006, 4.489) , P=0.048〕 of the nodule were associated with solid nodular growth. The average diameter〔HR=2.458, 95%CI (1.053, 5.739) , P=0.038〕, volume〔HR=1.001, 95%CI (1.000, 1.002) , P=0.010〕, prevalence of solid components〔HR=1.022, 95%CI (1.002, 1.041) , P=0.030〕, malignant probability〔HR=2.386, 95%CI (1.174, 4.850) , P=0.016〕, surface signs〔HR=3.026, 95%CI (1.492, 6.136) , P=0.002〕, mean CT quantitative parameters〔HR=1.002, 95%CI (1.000, 1.003) , P=0.045〕 of the nodule were associated with the growth of ground-glass nodules.

Conclusion

The growth of pulmonary nodules was affected by many factors, such as original nodule size, mean CT quantitative parameters, presence of surface signs and malignant probability. It is suggested that clinicians determine the effective follow-up time based on the inflencing factors of pulmonary nodules growth identified by AI technologies, so as to detect the growth of pulmonary nodules as soon as possible and deliver treatment measures timely.

Does Atrial Fibrillation Increase the Risk of New Onset Myocardial Infarction?

Yujing HAO, Jie YU, Quanle HAN, Ruiying MAO, Jing YU, Lihua SONG, Shouling WU

2022, 25(17): 2121-2126. DOI: 10.12114/j.issn.1007-9572.2022.0056

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Background

Atrial fibrillation is the most obvious arrhythmia in medical practice. Atrial fibrillation has been listed as one of the eight fastest-growing causes of death since 1990. Epidemiological investigation shows that the highest incidence of atrial fibrillation is 9% in people over 65 years old and 17% in people over 80 years old; more than 60% of patients with hypertension will develop atrial fibrillation after the age of 60. Atrial fibrillation increases the risk of ischemic stroke, heart failure, chronic kidney disease, cognitive impairment and dementia, but it is unclear whether it increases the risk of new onset myocardial infarction.

Objective

To investigate whether atrial fibrillation increases the risk of new onset myocardial infarction.

Methods

From June 2006 to October 2007, 96 750 employees of Kailuan Group in Tangshan, Hebei Province (Kailuan population) were selected for the study, including 458 patients with atrial fibrillation (atrial fibrillation group) and 96 292 patients without atrial fibrillation (non atrial fibrillation group) . The general information of patients was recorded, including age, gender, personal history (smoking history, drinking history) , past medical history (hypertension, coronary heart disease, diabetes, dyslipidemia) , anthropometric parameters (weight, height, blood pressure, etc.) . Total cholesterol (TC) , triglyceride (TG) , high density lipoprotein cholesterol (HDL-C) , low density lipoprotein cholesterol (LDL-C) and fasting blood glucose (FPG) were collected. The patients were followed up every 2 years, respectively, that was from 2008 to 2009, 2010 to 2011, 2012 to 2013, 2014 to 2015, and 2016 to 2017. The median follow-up was 10 years, and the end point was new onset myocardial infarction. Multivariate Cox regression model was used to analyze the effect of atrial fibrillation on new onset myocardial infarction.

Results

(1) There were significant differences in age, body mass index (BMI) , systolic blood pressure (SBP) , LDL-C, FPG, diabetes, smoking, drinking and new onset myocardial infarction between atrial fibrillation group and non atrial fibrillation group (P<0.05) . (2) Multivariate Cox regression analysis showed that atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.841, 95%CI (1.118, 2.869) , P<0.05〕. After adjusting for age and gender (male) , atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.635, 95%CI (1.049, 2.547) , P<0.05〕, after further adjustment for BMI, SBP, LDL-C, FPG, smoking and drinking, atrial fibrillation increased the risk of new onset myocardial infarction compared with non atrial fibrillation〔RR=1.381, 95%CI (1.087, 1.573) , P<0.05〕; drinking was the protective factor of new onset myocardial infarction 〔RR=0.664, 95%CI (0.572, 0.770) , P<0.05〕.

Conclusion

Atrial fibrillation is an independent risk factor of new onset myocardial infarction.

Predictive Value of Monocyte to High-density Lipoprotein Cholesterol Ratio for Nonalcoholic Fatty Liver Disease Merged with Metabolic Syndrome in Community Residents and Associated Factors Assessed Using Multivariate Regression Tree Analysis

Jilin MA, Xueping ZHANG

2022, 25(17): 2126-2134. DOI: 10.12114/j.issn.1007-9572.2021.02.007

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Background

Nonalcoholic fatty liver disease (NAFLD) is rarely detected at early stage, and often found when merged with metabolic disorders. Currently, the predictive value of noninvasive indicators for NAFLD with metabolic syndrome (MS) has been rarely reported.

Objective

To assess the predictive value of monocyte to high-density lipoprotein cholesterol ratio (MHR) for NAFLD with MS in community residents, and to evaluate the associated factors using multivariate regression tree analysis.

Methods

From June to December 2020, among 9 812 permanent community residents (>45 years) who underwent physical examination in Songjiang District Sijing Community Health Center, 5 727 eligible individuals were selected, including 4 652 with MS, diabetes, hypertension and dyslipidemia and other metabolic disorders〔1 948 with no NAFLD and MS (controls) , 1 248 with NAFLD (NAFLD cases) , 1 456 with both NAFLD and MS (MAFLD cases) 〕, and 1 075 without metabolic disorders (healthy controls) . General data, anthropometric parameters, blood pressure, biochemical parameters and routine blood test results of all participants were collected. Spearman rank correlation analysis was performed to assess the correlation of MHR and lipid accumulation product (LAP) index with NAFLD and MS. ROC analysis was conducted to analyze the optimal cutoff value of noninvasive indicators〔including neutrophil to lymphocyte ratio (NLR) , platelet to lymphocyte ratio (PLR) , lymphocyte to monocyte ratio (LMR) and MHR〕for NAFLD with MS. Factors associated with the predictive value of above-mentioned noninvasive indicators for NAFLD with MS were identified using multivariate regression tree analysis.

Results

The prevalence rates for metabolic disorders and NAFLD in this group were 76.61% (7 517/9 812) and 27.59% (2 704/9 812) , respectively. The controls, NAFLD cases, MAFLD cases, and healthy controls had significant differences in female ratio, mean age, BMI, waistline, hipline, waist-to-hip ratio, systolic and diastolic blood pressure, fasting blood glucose, total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, HDL-C, total bilirubin, serum uric acid, ALT, AST, ALT/AST ratio, GGT, eGFR, white blood cell count, neutrophil count, monocyte count, lymphocyte count, platelet count, NLR, PLR, LMR, MHR, alcoholic fatty liver disease to NAFLD index, LAP index, and atherogenic index of plasma, and distribution of waistline and BMI, as well as prevalence of hypertension and dyslipidemia (P<0.01) . Spearman rank correlation analysis showed that, MHR was positively correlated with the grouping (r_s=0.342, P<0.001) ; LAP index was also positively correlated with the grouping (r_s=0.580, P<0.001) . ROC analysis found that, in the prediction of NAFLD with MS, the AUC of NLR was 0.528〔95%CI (0.511, 0.545) 〕with 74.66% sensitivity, and 31.52% specificity when the optimal cutoff value was chosen as 2.192, that of PLR was 0.581〔95%CI (0.564, 0.598) 〕with 59.82% sensitivity, and 53.95% specificity when the optimal cut-off value was chosen as 115.470, and that of LMR was 0.546〔95%CI (0.529, 0.563) 〕with 51.79% sensitivity, and 56.62% specificity when the optimal cut-off value was chosen as 0.193, and that of MHR was 0.695〔95%CI (0.679, 0.711) 〕with 69.51% sensitivity, and 60.63% specificity when the optimal cut-off value was chosen as 0.292. Multivariate regression tree analysis revealed that sex, BMI, waistline, triacylglycerol, and fasting blood glucose were associated with the predictive value of MHR for NAFLD with MS.

Conclusion

The value of MHR for predicting NAFLD with MS in physical examinees in the community is relatively high, but it may be significantly influenced by sex, BMI, waistline, triacylglycerol and fasting blood glucose.

Association of Preoperative Glycosylated Hemoglobin with the Prognosis of Adult Patients Undergoing Cardiac Surgery: a Meta-analysis

Husheng LI, Feng HUANG, Yuting GAO, Yiyan WANG, Jiaqi WANG, Jing WU

2022, 25(17): 2135-2144. DOI: 10.12114/j.issn.1007-9572.2022.01.602

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Background

The association between preoperative glycosylated hemoglobin (HbA_1c) and prognosis of adult patients undergoing cardiac surgery has attracted attentions of scholars. However, due to various reference values of preoperative HbA_1c, the prognostic threshold of preoperative HbA_1c used for these patients is different.

Objective

To perform a Meta-analysis to examine the association between preoperative HbA_1c and prognosis in adult patients undergoing cardiac surgery.

Methods

Databases of CNKI, Wanfang Data, Medline, EMBase, The Cochrane Library were searched to collect case-control studies, prospective or retrospective cohort studies on the association between preoperative HbA_1c and prognosis in adults undergoing cardiac surgery from January 1st, 2000 to September 10th, 2021. Studies screening, data extraction, and risk of bias assessment were performed by two researchers independently. RevMan 5.4.1 was used to perform the Meta-analysis.

Results

A total of 35 cohort studies involving 35 826 adult cardiac surgery patients were included. The prognosis of these cases was analyzed by the control level of preoperative HbA_1c. Meta-analysis revealed that adults with preoperative HbA_1c < 5.5% had lower early postoperative mortality than those with preoperative HbA_1c ≥5.5%〔RR=0.39, 95%CI (0.18, 0.84) , P=0.02〕. A lower rate of postoperative sternal wound infection was found in those with preoperative HbA_1c< 6.0% rather than those with preoperative HbA_1c≥6.0%〔RR=0.47, 95%CI (0.24, 0.91) , P=0.02〕, in those with preoperative HbA_1c<6.5% rather than those with preoperative HbA_1c≥6.5%〔RR=0.48, 95%CI (0.34, 0.69) , P<0.000 1〕, in those with preoperative HbA_1c<7.0% rather than those with preoperative HbA_1c≥7.0%〔RR=0.37, 95%CI (0.26, 0.52) , P<0.000 01〕, in those with preoperative HbA_1c< 7.5% rather than those with preoperative HbA_1c≥7.5%〔RR=0.22, 95%CI (0.13, 0.35) , P<0.000 01〕, or in those with preoperative HbA_1c<8.0% rather than those with preoperative HbA_1c ≥8.0%〔RR=0.23, 95%CI (0.14, 0.38) , P<0.000 01〕. A lower incidence of postoperative cerebrovascular events was observed in those with preoperative HbA_1c< 6.5% rather than those with preoperative HbA_1c≥6.5%〔RR=0.70, 95%CI (0.52, 0.94) , P=0.02〕, in those with preoperative HbA_1c<7.0% rather than those with preoperative HbA_1c≥7.0%〔RR=0.52, 95%CI (0.39, 0.69) , P<0.000 01〕, in those with preoperative HbA_1c<7.5% rather than those with preoperative HbA_1c≥7.5%〔RR=0.50, 95%CI (0.32, 0.80) , P=0.003〕, or in those with preoperative HbA_1c<8.0% tather than those with preoperative HbA_1c ≥8.0% 〔RR=0.47, 95%CI (0.29, 0.75) , P=0.002〕. A lower incidence of postoperative acute kidney injury was found in those with preoperative HbA_1c< 6.0% rather than those with preoperative HbA_1c≥6.0%〔RR=0.40, 95%CI (0.18, 0.92) , P=0.03〕, in those with preoperative HbA_1c<6.5% rather than those with preoperative HbA_1c≥6.5%〔RR=0.78, 95%CI (0.71, 0.84) , P<0.000 01〕, in those with preoperative HbA_1c<7.0% rather than those with preoperative HbA_1c≥7.0%〔RR=0.66, 95%CI (0.55, 0.78) , P<0.000 01〕, in those with preoperative HbA_1c<7.5% rather than those with preoperative HbA_1c≥7.5%〔RR=0.73, 95%CI (0.65, 0.82) , P<0.000 01〕, or in those with preoperative HbA_1c<8.0% rather than those with preoperative HbA_1c ≥8.0%〔RR=0.75, 95%CI (0.67, 0.84) , P<0.000 01〕. A shorter mean length of stay was found in those with preoperative HbA_1c< 6.0% rather than those with preoperative HbA_1c≥6.0%〔MD=-0.61, 95%CI (-1.23, 0.00) , P=0.05〕, in those with preoperative HbA_1c<6.5% rather than those with preoperative HbA_1c≥6.5%〔MD=-0.93, 95%CI (-1.58, -0.29) , P=0.005〕, or in those with preoperative HbA_1c<7.0% rather than those with preoperative HbA_1c≥7.0%〔MD=-0.81, 95%CI (-1.11, -0.51) , P<0.000 01〕.

Conclusion

Existing evidence shows that preoperative HbA_1c less than 5.5% can effectively reduce early postoperative mortality of adult cardiac surgery patients. Better control of preoperative HbA_1c level may be associated with reduced risk of postoperative complications and improved prognosis. Therefore, attention should be paid to the patient's HbA_1c before cardiac surgery. For those with high HbA_1c, it is suggested to take interventions to reduce blood glucose preoperatively in accordance with clinical manifestations and functions of organs if it is necessary.

Efficacy of Attention Bias Modification in Individuals with Depression: a Meta-analysis

Haisha XIA, Xiaobo LIU, Xinyun GOU, Wenjing TANG, Dongling ZHONG, Yuxi LI, Zhong ZHENG, Juan LI, Rongjiang JIN

2022, 25(17): 2145-2151. DOI: 10.12114/j.issn.1007-9572.2022.0182

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Background

Attention bias modification (ABM) , a newly emerging focus in emotion modification research, is a treatment to reduce individuals' attention bias toward negative stimuli to improve their abnormal cognition via repeated computer-based attention trainings toward neutral or positive stimuli. Recent studies about depression treated using ABM are increasing, but based on insufficient evidence with various efficacy assessment indicators.

Objective

To systematically assess the effect of ABM in patients with depression.

Methods

Databases including PubMed, The Cochrane Library, EMBase, CBM, CNKI, WanFang Data and VIP were searched from inception to December 31st, 2021 for randomized controlled trials (RCTs) regarding depressive patients treated by ABM (experimental group with computer-based ABM trainings) compared with placebo trainings under the same conditions (control group with no interventions or sham ABM trainings) . Primary outcome measures included Hamilton Rating Scale for Depression (HAMD/HRSD) , Beck Depression Inventory (BDI) and Center for Epidemiologic Studies Depression Scale (CES-D) . Secondary outcome measures included the State-Trait Anxiety Inventory (STAI-T) and Ruminative Responses Scale (RRS) . Two researchers independently performed literature enrollment, and extracted data, and evaluated the risk of bias using Risk of Bias 2 (RoB 2.0) tool. RevMan 5.4 and Stata 12.0 were used for Meta-analysis.

Results

Thirteen RCTs involving 968 patients were included, among which one had two trials. Risk of bias was low in seven RCTs, unclear in four, and high in two. Meta-analysis showed that the overall improvement of depression, anxiety and rumination in the experimental group was better than that in the control group (P<0.05) . Further analysis indicated that two groups had no significant differences in mean scores of BDI and HAMD within a follow-up period of less than two months (P>0.05) . When the follow-up time was prolonged to at least two months, the mean BDI score was still similar in both groups (P>0.05) .

Conclusion

ABM treatment could improve depressive, anxiety symptom and rumination in patients with depression, but its long-term effect needs to be studied further.

Association of Nutritional Factors with Thyroid Autoantibody Titer in Hashimoto's Thyroiditis

Huina WAN, Guoyu ZHANG, Hong WAN, Yu FU, Zejin WANG, Shuxun YAN, Ying WANG

2022, 25(17): 2152-2158. DOI: 10.12114/j.issn.1007-9572.2021.01.419

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As the most common autoimmune thyroid disease, Hashimoto's thyroiditis (HT) is also the primary cause of hypothyroidism, leading to increased risk of mental diseases, and even myxedema and coma. However, there are few studies on clinical treatments for HT. Thyroid autoantibodies produced in serum due to autoimmune disorders, may be significantly involved in the diagnosis and prognosis of HT. Evidence has suggested that the controlling for the intake of nutrient elements (such as appropriate selenium supplementation and iodine intake) may improve thyroid function by notably reducing the thyroid autoantibody titer, indicating the treatment may be positive in treating HT. But the correlations of various nutritional factors with HT treatment are still controversial. We reviewed recent developments in the treatment of HT, then summarized the influence of controlling for the intake of various nutritional factors (such as selenium, iodine, iron and vitamin D) on the treatment of HT, and concluded that the controlling may help to reduce thyroid autoantibody titers, and improve the therapeutic effect, and may be a reference for clinical treatment of HT.

Latest Advances in the Role of JAK/STAT Signaling Pathway in Autoimmune Rheumatic Diseases

Fanni XIAO, Yufeng QING, Quanbo ZHANG

2022, 25(17): 2159-2164. DOI: 10.12114/j.issn.1007-9572.2022.0275

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The Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway is a ubiquitously expressed intracellular signal transduction pathway involved in cell proliferation, differentiation, apoptosis, immune regulation and other biological processes. Existing evidence indicates that continuous activation of this signaling pathway is closely related to the pathogenesis and clinical manifestations of many autoimmune rheumatic diseases. We reviewed the latest advances in mechanisms of JAK/STAT signal transduction, and the roles of the pathway in development of autoimmune rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, and gout, suggesting that JAK/STAT signaling pathway may be a therapeutic target for autoimmune rheumatic diseases, which may offer new ideas and directions for clinical treatment.

Advances in the Epidemiology and Prevention of Skin Injuries in Older Adults

Qixia JIANG, Yingying ZHAN, Yuxuan BAI

2022, 25(17): 2164-2168. DOI: 10.12114/j.issn.1007-9572.2022.0253

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Aging has become a global issue. Due to skin aging, coexistence of multiple chronic diseases, disability and semi-disability, older people are prone to various skin injuries, such as pressure injury, moisture-associated skin damage, skin tear, dry skin. These skin injuries may be single or multiple, and multiple types of injuries may coexist, which impair the quality of life and even threaten the life. Skin health in older people has become a global focus, and the prevention of which has been regarded as a priority in clinical nursing and management. We reviewed recent advances in the epidemiology, types and prevention of skin injuries in older adults, providing a reference for the prevention and management of skin injuries in older Chinese adults.

Discovery of Posture Secret in the Treatment of Persistent Genital Arousal Disorder/Genito-pelvic Dysesthesia: a Case Report and Literature Review

Yunxu ZHANG, Li SU, Yanyun Xing, Xiaolin LIU, Qiang WANG

2022, 25(17): 2169-2172. DOI: 10.12114/j.issn.1007-9572.2022.0096

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Persistent genital arousal disorder (PGAD) and genito-pelvic dysesthesia (GPD) jointly known as persistent genital arousal disorder/genito-pelvic dysesthesia syndrome (PGAD/GPD) , which was a unique disorder characterized by spontaneous or secondary genital arousal and dysesthesia in the genital and pelvic areas discovered abroad in recent years. In addition, no relevant reports on PGAD/GPD have been found in CNKI, WanFang Data, and VIP. Discovery of posture secret (DPS) is a manual therapy technique with the 4R principle as the core developed from the integration of various mainstream posture correction techniques in the world, which has unique curative effect on improving musculoskeletal pain and abnormal posture. This article reports a domestic case of complete remission of symptoms of PGAD/GPD treated with DPS, and reviews relevant foreign literature on PGAD/GPD, in order to raise the attention of domestic peers.

Investigation of the Report Format for Spirometry in China and Recommendations for Improvement

Lijuan LIANG, Wujun JIANG, Wenya CHEN, Ruibo HUANG, Peitao YE, Yongyi PENG, Xuedong LEI, Jianling LIANG, Yi GAO, Jinping ZHENG

2022, 25(17): 2173-2178. DOI: 10.12114/j.issn.1007-9572.2021.01.415

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Background

Spirometry is the most common and extensively used pulmonary function test method, whose quality control is the cornerstone for its promotion and application. The report format is a key factor associated with the quality control of spirometry, but it is generally various in China, which is not conducive to the popularization and application of spirometry.

Objective

To assess the current status of report formats for spirometry in Chinese mainland.

Methods

The reports of spirometry were collected from some hospitals in China between April 2016 and December 2018, which are composed of four parts, including the general demographic information, test indicators, graphs, and results evaluation. The key and/or essential information for each part is as follows: (1) the general demographicinformation part: sex, height, BMI, age and the reference source; (2) test indicators part: forced vital capacity (FVC) , forced expiratory volume in 1 second (FEV₁) , the ratio of FEV₁/FVC or FEV₁/VCmax, maximal mid-expiratory flow〔FEF_25%-75%, forced expiratory flow at 50% (FEF_50%) , forced expiratory flow at 75% (FEF_75%) 〕, peak inspiratory flow (PIF) and forced expiratory time (FET) ; (3) graphs part: flow-volume curve (F-V curve) and volume-time curve (V-T curve) ; (4) results evaluation part: subjects cooperation, test quality control level, and physician interpretation. The differences in the report format of spirometry were compared by region and hospital level in this study.

Results

In total, 1 562 spirometry reports from 1 562 hospitals (one from each hospital) across China were enrolled, but only 0.4% provided all key indicators. (1) For the general demographic information part, only 27.7% reports provided complete key indicators, which differed significantly by regions and the level of hospitals (P<0.05) . Moreover, the part showed the reference source only accounted for 28.2%. (2) Furthermore, in the test indicators part, 91.9% of the total reports provided all key indicators. More than 90.0% reports listed FEF_25%-75%, FEF_50% and/or FEF_75%, while the PIF and FET was reported in 36.4%, 46.0%, respectively. (3) In terms of the graphs part, 73.4% reports provided key indicators, but 26.6% did not report the important information like V-T curve. (4) Finally, in the results evaluation part, the report without lacking key indicators were only accounted for 1.6%, and there were great differences between hospitals of different levels (P<0.05) . What's more, only 14.9% clearly showed the quality control of spirometry.

Conclusion

There were great differences of the report formats for spirometry analyzed and the 2019 Standard for pulmonary function examination report. Lack of the key information such as the reference resource, inspiratory phase indicators, the indicators about quality control and quality control of test would seriously affect the clinical value of spirometry. Therefore, it is suggested to add the program of report format standards during the standardized trainings of pulmonary function testing, and strengthen the understanding and application of various indicators of spirometry among pulmonary function practitioners.

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