Table of Content

15 September 2022, Volume 25 Issue 26

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Special Research Report

National Essential Public Health Services Programs over the Past Decade Research Report One：Significance and Experiences of Implementing National Essential Public Health Services Programs

Lili YOU, Yuanli LIU

2022, 25(26):  3203-3208.  DOI: 10.12114/j.issn.1007-9572.2022.0441

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The National Essential Public Health Services Programs (NEPHSP) is a systematic and overall basic public service system arrangement made by the Chinese government at the national level aiming at the main health problems existing in urban and rural residents and targeting at key population key diseases and the whole population. Year of 2019 is the tenth anniversary of the NEPHSP implementation. This article summarized the significance of implementing NEPHSP based on a 10-year evaluation of NEPHSP from four aspects: universal health coverage, Healthy China 2030 strategy, China's deepening health system reform and major institutional innovation. At the same time, several main experiences of successful projects were summarized, including the following five aspects: establishing and improving a strong project organization and management system, steadily increasing strength of financial support, following the principle of gradual implementation of projects, advocating and encouraging local exploration in accordance with local conditions, and adhering to clear reward and punishment performance appraisal. From the historical perspective, this paper summarized the implementation of the great project led by the Chinese government in order to introduce the Chinese way, Chinese practice and Chinese experience of primary health care work in the new era at home and abroad.

National Essential Public Health Services Programs over the Past Decade Research Report Two：Progress and Achievements of the Implementation of National Essential Public Health Services Programs over the Past Decade

Lili YOU, Jinhong ZHAO, Xinyue CHEN, Linghe YANG, Meicen LIU, Yuting PAN, Siqi ZHANG, Yuanli LIU

2022, 25(26):  3209-3220.  DOI: 10.12114/j.issn.1007-9572.2022.0407

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Background

The national essential public health services programs (NEPHSP) is an important project led by the Chinese government to benefit the people, which is a Chinese practice towards universal health coverage. In 2009, the project was rolled out across the country, and its coverage and influence are second to none in the field of public health in China. It is necessary to review the 10-year progress of the project and clarify its effectiveness to maintain its sustainable development.

Objective

To systematically sort out and summarize the progress and achievements of the NEPHSP made over the past decade (2009-2019) .

Methods

We collected the monitoring data (2009-2016) of basic public health projects in 31 provinces (autonomous regions and municipalities directly under the central government) through correspondence, analyzed the monitoring data of the national basic public health service management platform (2017-2019) and the relevant indicators of the China Health Statistical Yearbook (2010-2020) , and analyzed the coverage of basic public health services in the country over the past ten years from the perspective of providers. From November to December 2019, a ten-year assessment survey of the national essential public health services was carried out in Zhejiang Province, Shanxi Province and Chongqing city to investigate the residents' awareness, utilization, satisfaction and self-assessment benefit rates of NEPHSP from the perspective of the consumers.

Results

During the past decade, the coverage of various service items of basic public health in China has increased significantly: (1) the rate of construction of health file, the rate of construction of electronic health file, and the utilization rate of health file have increased from 48.78%, 35.07% and 22.14% in 2009 to 88.25%, 86.82% and 55.34% in 2019, with an average annual growth rate of 6.41%, 10.92% and 15.62% respectively; (2) A total of 6.311 billion printed health education materials were distributed nationwide, about 337million audio-visual health education materials were broadcasted, and a total of 1.144 billion people attended health education lectures; (3) By 2019, there were about 109 million registered hypertensive patients and about 31 357 100 diabetes patients nationwide. The standardized management rate of hypertensive / diabetes patients has increased by 29.28% and 27.25% respectively in the past decade. The blood pressure / blood glucose control rate in the population managed for hypertension / diabetes has increased by 16.84% and 24.69% respectively in the past decade, with an average annual growth rate of 3.28% and 5.56% respectively. The gap in each indicator among the eastern, central and western regions was gradually narrowing; (4) The rates of early pregnancy enrollment, antenatal examination, postpartum visit and system management increased by 6.06%, 4.60%, 7.79% and 9.40% respectively. The ten-year rates of neonatal visit and health management of 0-6-year-old children increased by 14.09% and 17.82% respectively, with an average annual growth rate of 1.74% and 2.30%. In 2019, the national elderly health management rate was 67.41%, an increase of 26.23% over 2009, with an average annual growth rate of 5.96%. The average annual growth rate of TCM health management services for the elderly and children was 15.00% and 12.97%, respectively; (5) The rate of establishing vaccination certificates and the vaccination rate of all kinds of vaccines among residents were stable at more than 90%; The standardized management rate of patients with severe mental disorders reached 89.17% in 2019, the management rate of pulmonary tuberculosis patients and the regular drug taking rate of pulmonary tuberculosis patients had been stable at more than 95% since 2015; (6) In 2019, the awareness rate of the national essential public health services programs for participating residents in the survey was 85.4%, the service utilization rate was 98.7%, the service satisfaction of the key groups was more than 90%, and the self-assessment service benefit rate was more than 85%; (7) The service capacity of primary medical and health service institutions had been improved, and the number of institutions had shown a continuous upward trend. The number of personnel in primary medical and health institutions, the proportion of doctors and nurses, and the proportion of Bachelor degree or above had all increased year by year.

Conclusion

Over the past decade, as an important part of basic health services in China, the population coverage of basic public health services had increased significantly, the goal of wide service coverage had been basically achieved, the health management level of the focused population had been significantly improved, the effect of health management had been presented, the residents' sense of access to basic public health services had been gradually improved, and the service capacity of basic medical and health institutions had been continuously improved. The comprehensive implementation of basic public health services in China is an important initiative towards the goal of "universal health coverage".

National Essential Public Health Services Programs over the Past Decade Research Report Three：Challenges and Recommendations of Implementation National Essential Public Health Services Programs over the Past Decade

Lili YOU, Xinyue CHEN, Linghe YANG, Jinhong ZHAO, Yuting PAN, Siqi ZHANG, Yuanli LIU

2022, 25(26):  3221-3231.  DOI: 10.12114/j.issn.1007-9572.2022.0406

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As an important measure to deepen the reform of the medical and pharmaceutical health system, the national essential public health services programs has been carried out for more than ten years. Therefore, it is of great significance to evaluate the effect and remaining problems of the programs over the decade of implementation period (2009-2019) and to further promote the country's basic public health services. With reference to Donabedian quality theory, this paper summarized and analyzed the key problems existing in China's basic public health services from the aspects of project objectives, project contents, operation mechanisms, implementation processes and effects, and make relevant suggestions from six aspects, mainly as follows: based on scientific reasoning, dynamically adjusting the programs; suggestion that the national basic public health services should be graded and managed by classification; timely revision of project specifications to improve service quality and efficiency; gradually promoting the effectiveness-oriented evaluation and assessment system; improving operational mechanisms and promoting sustainable development; fully playing the role of county medical community, and enhancing service coordination; establishing a scientific and long-term monitoring mechanism for national essential public health services programs. It provides reference for further improvement and optimization of national essential public health services progjects.

Original Research

Influencing Factors of TyG and Its Combination with Obesity Indicators for New-onset Ischemic Stroke in Middle-aged and Elderly Population: a 10-year Follow-up Prospective Cohort Study

Ying MIAO, Yu WANG, Pijun YAN, Xue BAI, Pan CHEN, Qin WAN

2022, 25(26):  3232-3239.  DOI: 10.12114/j.issn.1007-9572.2022.0337

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Background

In recent decades, ischemic stroke is increasingly prevalent, which has become the second leading cause of death and disability in the world. Insulin resistance and obesity are closely related to the development of ischemic stroke. At present, a number of studies have confirmed that obesity is associated with a variety of metabolic diseases and the role of insulin resistance played in the pathogenesis. But it is still unclear whether TyG, an indicator of insulin resistance, and TyG combined with obesity indicators can be used to predict ischemic stroke.

Objective

To assess the influencing factors of TyG, and its combination with different obesity indicators for new-onset ischemic stroke in a cohort of middle-aged and elderly people during a 10-year follow-up .

Methods

A prospective cohort design was used. The cohort included 9 406 middle-aged and elderly individuals who attended the 2011 Epidemiological Survey on Cancer Risk in Type 2 Diabetics conducted in six communities in Luzhou (including Qiancao, Xiaoshi, Longmatan, Baolaiqiao, Dashanping and Yutang) . Baseline data were collected, including TyG and its combination with different obesity indicators〔TyG-waist circumference (WC) , TyG-waist-to-height-ratio (WHtR) , TyG-body mass index (BMI) , and TyG-waist-to-hip-ratio (WHR) 〕. A 5-year follow-up initiated since June to November 2016, and a 10-year follow-up initiated since April to June 2021 were conducted, with new-onset ischemic stroke incidence (obtained through Luzhou Health Commission and Luzhou Center for Disease Control & Prevention) as an endpoint. For assessing the predictive value of baseline TyG, TyG-WC, TyG-WHtR, TyG-BMI, and TyG-WHR for new-onset ischemic stroke, patients were divided into quartiles of TyG〔Q1 (n=2 351) , Q2 (n=2 351) , Q3 (n=2 352) , Q4 (n=2 352) 〕, quartiles of TyG-WC〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHtR〔Q1 (n=2 349) , Q2 (n=2 349) , Q3 (n=2 348) , Q4 (n=2 348) 〕, and quartiles of TyG-BMI〔Q1 (n=2 351) , Q2 (n=2 352) , Q3 (n=2 352) , Q4 (n=2 351) 〕, quartiles of TyG-WHR〔Q1 (n=2 343) , Q2 (n=2 343) , Q3 (n=2 342) , Q4 (n=2 342) 〕, respectively. Multivariate Logistic regression analysis was used to explore the relationship between TyG, TYG-WC, TYG-WTHR, TYG-BMI, TYG-WHR and new ischemic stroke in the elderly.

Results

During the follow-up period, 527 (5.6%) of the 9 406 middle-aged and elderly people had new-onset ischemic stroke. After adjusting for multiple confounding variables, multivariate Logistic regression analysis showed that the risk of new ischemic stroke in the fourth quartile group of TyG was 1.569 times higher than that in the first quartile group of TyG〔OR=1.569, 95%CI (1.007, 2.437) , P=0.046〕. The risk of new ischemic stroke increased by a factor of 1.467, 2.012, and 2.132 in the second, third and fourth quartile groups of TyG-WC〔 OR=1.467, 95%CI (1.010, 2.131) , P=0.044; OR=2.012, 95%CI (1.270, 3.187) , P=0.003; OR=2.132, 95%CI (1.119, 4.063) , P=0.021〕compared with that in the first quartile group of TyG-WC. The risk of new ischemic stroke increased by a factor of 1.481, 1.548, and 1.705 in the second, third and fourth quartile groups of TyG-BMI 〔OR=1.481, 95%CI (1.071, 2.048) , P=0.018; OR=1.548, 95%CI (1.066, 2.247) , P=0.022; OR=1.705, 95%CI (1.054, 2.759) , P=0.030〕compared with that in the first quartile group of TyG-BMI.

Conclusion

The risk of new-onset ischemic stroke in middle-aged and elderly type 2 diabetics in Luzhou increased with the elevation of TyG-WC and TyG-BMI, so TyG-WC and TyG-BMI may be predictors of new-onset ischemic stroke in this population.

Baseline Triglyceride and Risk of Acute Pancreatitis in a Nonobese Health Check-up Population: a Prospective Cohort Study

Afang SU, Yinjie WANG, Fengfei WANG, Xiujuan ZHAO, Yingying XIN, Shuohua CHEN, Guoling ZHU, Shan WANG, Xiaozhong JIANG, Jie ZHANG, Shouling WU

2022, 25(26):  3240-3245.  DOI: 10.12114/j.issn.1007-9572.2022.0215

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Background

Hypertriglyceridemia has been increasingly valued as a risk factor for acute pancreatitis (AP) . However, the relationship between obesity and AP has not yet been confirmed, whether baseline triglyceride (TG) affects the risk of AP in non-obese people is still inconclusive.

Objective

To explore the association between baseline serum triglyceride (TG) and the risk of AP in a nonobese cohort from Kailuan Group.

Methods

A prospective cohort study was performed among in-service and retired workers of Kailuan Group (non-obese, without a history of AP, with complete TG information) who first attended the annual health screening for workers of the group as a benefit conducted between 2006 and 2007 or between 2008-2009. The cumulative incidence of AP across serum TG tertile groups: 〔Q1 group (TG≤0.96 mmol/L) , Q2 group (0.96 mmol/L<TG<1.52 mmol/L) , Q3 group (TG≥1.52 mmol/L) 〕was described using Kaplan-Meier curve, and compared by the Log-rank test. The new AP event, death or the end of follow-up (December 31, 2020) was taken as the end point of follow-up. Cox regression model was used to estimate the association of baseline TG levels and new incidence of AP.

Results

The study included a total of 102 358 subjects. Q1, Q2 and Q3 groups had significant differences in sex ratio, average age, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) , and prevalence of smoking, drinking, previous hypertension, previous diabetes, previous cholelithiasis, as well as having at least 9 years of education (P<0.05) . Three hundred and sixteen cases developed AP during an average follow-up of (12.8±2.4) years, with an incidence density of AP of 2.41 per 10 000 person-years. The incidence density was 1.82, 2.22, and 3.17 per 10 000 person-years in Q1, Q2, and Q3 groups, respectively. The cumulative incidence of AP was 2.33%, 2.85% and 4.07%, respectively, in Q1, Q2, and Q3 groups, with statistically differences detected by the log-rank test (χ²=17.27, P<0.001) . By the analysis based on COX regression model 3, the HR of developing AP in Q3 group was 1.66〔95%CI (1.25, 2.19) 〕times higher than in Q1 group after adjusting for sex, age, HDL-C, TC, smoking, drinking, education level, history of hypertension, history of diabetes and history of cholelithiasis, and it was 1.68〔95%CI (1.25, 2.24) 〕times higher than in Q1 group after further excluding the cases suffering from AP within 1 year of follow-up.

Conclusion

A baseline serum TG level of ≥ 1.52 mmol/L may increase the risk of AP in nonobese people.

Predictive Value of Toll-like Receptor 4 in Peripheral Blood Mononuclear Cells in Combination with Serum Procalcitonin for Sepsis

Yuanhui HU, Dongling TANG, Pingan ZHANG

2022, 25(26):  3246-3251.  DOI: 10.12114/j.issn.1007-9572.2022.0194

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Background

Sepsis is an infection-caused systemic inflammatory response syndrome, with relatively high morbidity and fatality rate. Early diagnosis and treatment are vital for prevention and treatment of sepsis. However, there are no simple clinical biomarkers that could rapidly and effectively detecting sepsis.

Objective

To assess the combined predictive value of toll-like receptor 4 (TLR4) in peripheral blood mononuclear cells and serum procalcitonin (PCT) for sepsis.

Methods

One hundred and ten sepsis patients (sepsis group) , 113 patients with infection but without sepsis (non-sepsis group) , and 95 healthy individuals (control group) were recruited from Renmin Hospital of Wuhan University from October 2020 to November 2021. Sepsis patients were divided into non-shock subgroup and shock subgroup according to the shock situation. Laboratory indicators, TLR4 in peripheral blood mononuclear cells and serum PCT of three groups were collected and analyzed. The quick Sepsis-related Organ Failure Assessment (qSOFA) score, infectious pathogens, and sites of infection of sepsis and non-sepsis groups were comparatively analyzed. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to analyze the diagnostic value of TLR4 mRNA and PCT, alone and in combination, for sepsis.

Results

The levels of red blood cell (RBC) count, white blood cell (WBC) count, neutrophil count, hemoglobin (Hb) , hematocrit (HCT) , platelet count, alanine aminotransferase (ALT) , aspartate aminotransferase (AST) and direct bilirubin (DBiL) differed significantly across the three groups (P<0.05) . Sepsis group had significantly elevated levels of WBC count, neutrophil count, ALT, AST and DBiL, and significantly decreased levels of RBC count, Hb, HCT and platelet count compared with other two groups (P<0.05) . Sepsis and non-sepsis groups had significant difference in qSOFA score (Z=-3.128, P=0.002) . Gram-negative bacteria were the most prevalent pathogenic microorganism in both sepsis and non-sepsis groups, and lung was the most infected site. There were significant differences between the two groups in infected pathogenic microorganisms and infected sites (P=0.033, 0.003) . The levels of TLR4 mRNA in peripheral blood mononuclear cells and PCT showed a successive decrease in sepsis group, non-sepsis group and control group (P<0.01) . The TLR4 mRNA levels in peripheral blood mononuclear cells of patients with sepsis induced by gram-positive bacteria, gram-negative bacteria, fungi and other pathogens in sepsis group were 0.154 (0.302) , 0.139 (0.493) , 0.119 (0.206) and 0.151 (0.336) , respectively, with no significant differences (H=0.378, P=0.945) . The level of TLR4 mRNA differed significantly between shock subgroup (n=75) 〔0.210 (0.330) 〕 and non-subgroup hose without (n=35) 〔0.118 (0.323) 〕 (Z=1.473, P=0.026) . For the prediction of sepsis, the AUC of TLR4 mRNA level was 0.813, with sensitivity of 80.00%, specificity of 68.97% and Youden index of 0.489 7, when the optimal cutoff value was defined as 0.056; the AUC of PCT was 0.818, with sensitivity of 87.63%, specificity of 75.94% and Youden index of 0.635 6, when the optimal cutoff value was defined as 0.070 μg/L; the AUC of TLR4 mRNA combined with PCT was 0.888, with sensitivity of 68.04%, sensitivity of 93.10% and Youden index of 0.611 4.

Conclusion

Multiple routine blood indicators and biomarkers abnormalities were found in sepsis patients. TLR4 mRNA level was associated with the severity of sepsis. TLR4 mRNA in peripheral blood mononuclear cells and serum PCT could be used as auxiliary predictors of sepsis, the combination of TLR4 mRNA and PCT could improve the predictive efficiency in sepsis, indicating a high clinical application value.

Efficacy and Safety of Xiezhuoxiaozheng Therapy in Diabetic Kidney Disease: a Clinical Study

Hanwen YANG, Yaoxian WANG, Qiaoru WU, Jiale ZHANG, Runze YAN, Xiaona WANG, Zhen WANG, Weiwei SUN

2022, 25(26):  3252-3257.  DOI: 10.12114/j.issn.1007-9572.2022.0193

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Background

The incidence of diabetic kidney disease (DKD) is increasing, which has become a major cause of end-stage renal disease. DKD has an insidious onset, and progresses rapidly since the presence of proteinuria, it is difficult to slow down its progression with conventional therapy especially when renal function is significantly impaired. Therefore, it is urgently necessary to explore an effective treatment for delaying the progression of advanced DKD. The Xiezhuoxiaozheng therapy, proposed by Professor WANG Yaoxian in accordance with the pathogenesis of advanced DKD manifested by turbid poison and mass signs and symptoms (zhengjia) , has proven to be effective in clinical treatment of advanced DKD.

Objective

To assess the clinical efficacy and safety of Xiezhuoxiaozheng therapy in advanced DKD based on the theory of "latent internal heat causing renal collateral mass".

Methods

A real-world, prospective cohort study design was used to investigate the clinical efficacy and safety of Xiezhuoxiaozheng therapy for advanced DKD in seven hospitals (Dongzhimen Hospital, Beijing University of Chinese Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing Hospital of Traditional Chinese Medicine, Wangjing Hospital of CACMS, Xiyuan Hospital of CACMS, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, and Beijing Fangshan District Hospital of Traditional Chinese Medicine) from 2016 to 2020. Patients with DKD who met the inclusion criteria were recruited and divided into a control group (basic western medical treatment) and a test group (basic western medical treatment plus Xiezhuoxiaozheng therapy) taking the method of Xiezhuoxiaozheng and eliminating symptoms as the exposure factor, and received 24-week interventions. At baseline, and the end of 4, 12, and 24 weeks of interventions, serum creatinine (Scr) , blood urea nitrogen (BUN) , 24-hour urine protein, and total cholesterol (TC) , estimated glomerular filtration rate (eGFR) were measured, TCM symptom score was assessed. HbA_1c was measured at baseline, and the end of 12, and 24 weeks of interventions. Adverse events were recorded during treatment, and safety was evaluated.

Results

A total of 59 cases completed the study, including 36 in the test group and 23 in the control group. The intervention duration had significant main effect on eGFR, Scr, and BUN levels in both groups (P<0.05) . The intervention therapy and duration had significant interaction effect on the change in the TCM symptom score in both groups (P<0.05) . The control group had increased BUN level at the end of 12 weeks of intervention, and increased BUN, Scr and heat syndrome score at the end of 24 weeks of intervention (P<0.05) . In contrast, the test group had increased eGFR at the end of 4 weeks of intervention (P<0.05) . The test group had higher eGFR and lower Scr, BUN and TCM symptom score at the end of intervention than did the control group (P<0.05) . The incidence of adverse reactions was 21.74% (5/23) in the control group and 8.33% (3/36) in the experimental group. There was no significant difference between the two groups (χ²=2.15, P=0.14) .

Conclusion

For advanced DKD, Xiezhuoxiaozheng therapy combined with usual western medicine treatment may be superior to usual western medicine treatment alone in delaying the decrease of eGFR, slowing down the increase of Scr and BUN levels, protecting kidney function, reducing the heat syndrome score and improving the TCM symptoms, which could improve the clinical efficacy.

Efficacy of China-produced Camrelizumab with Apatinib for First-line Treatment in Middle and Advanced Stages of Primary Liver Cancer

Jinfa XU, Wencan SONG, Zhongxian ZHENG, Yu BAO, Gaoyan HUA, Qing CAI, Weiwei SHI, Xiufang ZHANG, Jianhua ZHANG, Zhou TONG, Guoan XIA, Fei LIU, Lintao LIU, Kesheng XIAO

2022, 25(26):  3258-3262.  DOI: 10.12114/j.issn.1007-9572.2022.0208

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Background

Targeted therapies and immunotherapies, represented by programmed cell death protein 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) inhibitors, have demonstrated high efficacies in multiple cancers. China-produced PD-1/PD-L1 inhibitors have been approved for use recently.

Objective

To investigate the efficacy and safety of China-produced camrelizumab, a PD-1 inhibitor, in combination with apatinib in the first-line treatment of middle and advanced stages of primary liver cancer.

Methods

Eighty-six patients with middle and advanced stages of primary liver cancer were selected from the oncology department of four hospitals in Chizhou (the People's Hospital of Chizhou, Chizhou Second People's Hospital, Dongzhi County People's Hospital, Shitai County People's Hospital) from June 2018 to January 2021. All patients were initially treated with apatinib mesylate tablets and intravenous infusion of China-produced camrelizumab, and followed up till August 31, 2021 with disease progression or all-cause death as the endpoint. Clinical efficacies were assessed at the end of the first and third months of treatment. The treatment-emergent adverse events were counted.

Results

There were no dropouts due to serious treatment-emergent adverse events. The overall response rate (ORR) and disease control rate (DCR) in the patients were 58.14% (50/86) and 65.12% (56/86) , respectively, at the end of the first month of treatment, and were 76.74% (66/86) and 82.56% (68/86) , respectively, at the end of the third month of treatment. The follow-up period for them ranged from four to 26 months, with a mean value follow-up time of (12±6) months. A total of 35 patients died during the follow-up. The median progression-free survival was 8〔95%CI (5.18, 11.89) 〕 months, and the median overall survival was 12〔95%CI (8.97, 15.97) 〕 months in all patients. The major treatment-emergent adverse events included gastrointestinal reactions〔52 (60.47%) 〕, secondary hypertension〔31 (36.05%) 〕, hand-foot syndrome〔18 (20.93%) 〕 and proteinuria〔12 (13.95%) 〕, among which gastrointestinal reactions (6.98%) in six cases, secondary hypertension (2.33%) in two cases and hand-foot syndrome (1.16%) in one case were grade 3-5 adverse events.

Conclusion

For middle and advanced stages of primary liver cancer, China-produced camrelizumab with apatinib as the first-line treatment has good effect with controllable adverse events.

Prognostic Value of Lactate Dehydrogenase in Advanced Esophageal Squamous Cell Carcinoma Patients with Immunotherapy

Yan LI, Kunlun WANG, Hui YANG, Erjiang ZHAO, Bingxu LI, Shenglei LI, Xiaotao DONG, Ling YUAN

2022, 25(26):  3263-3269.  DOI: 10.12114/j.issn.1007-9572.2022.0293

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Background

The overall efficacy of immunotherapy is unsatisfactory in patients with advanced esophageal squamous cell carcinoma (ESCC) , since only a few cases could obtain benefits from the therapy. Therefore, it is of great importance to select effective prognostic indicators.

Objective

To investigate the prognostic value of lactate dehydrogenase (LDH) in advanced ESCC patients with immunotherapy.

Methods

This study enrolled patients diagnosed with advanced ESCC by pathological and imaging examinations in Henan Cancer Hospital from October 2016 to October 2019. Data were collected, including baseline data obtained from the electronic medical record system, LDH level at the 8th week of immunotherapy, and results〔containing death, disease remission, progression-free survival (PFS) and overall survival (OS) 〕 of a follow-up until August 31, 2021. Log-rank test was used to compare Kaplan-Meier curves of PFS and OS by baseline LDH. Multivariate Cox regression analysis was used to analyze the potential factors associated with PFS and OS.

Results

Of the 44 cases enrolled, a higher objective response rate was found in those with lower baseline LDH (n=28, baseline LDH<200 U/L) instead of those with higher baseline LDH (n=16, baseline LDH≥200 U/L) (χ²=8.522, P=0.013) . Eight patients with disease progression (PD) had higher ?LDH than 36 patients without PD (t=2.394, P=0.021) . At the end of follow-up, 9 patients (20.5%) survived, with a median PFS of 6 (2, 11) months, and a median OS of 11 (7, 18) months. PFS was significantly different in those with higher and lower baseline LDH levels (χ²=6.790, P=0.009) . OS was also significantly different in those with higher and lower baseline LDH levels (χ²=12.327, P<0.001) . The baseline LDH〔HR=2.686, 95%CI (1.274, 5.664) , P=0.009〕was associated with the PFS after immuotherapy. And the multivariate analyses showed that baseline LDH〔HR=17.440, 95%CI (2.254, 134.962) , P=0.001〕, hemoglobin〔HR=0.005, 95%CI (<0.001, 0.120) , P=0.001〕, monocyte count〔HR=0.066, 95%CI (0.008, 0.525) , P=0.010〕were associated with the OS after immunotherapy (P<0.05) .

Conclusion

Baseline LDH may be used as a prognostic marker after immunotherapy in patients with advanced ESCC, and a lower baseline LDH may be associated with longer PFS and OS.

Adverse Pregnancy Outcomes and Its Associated Factors in Gestational Diabetes Mellitus with Isolated Fasting Hyperglycemia

Junxiang WEI, Yang MI, Xiao LUO, Yiping HE, Zhibin LI, Jing JI

2022, 25(26):  3270-3274.  DOI: 10.12114/j.issn.1007-9572.2022.0264

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Background

Due to possible neglect of elevated fasting glucose, poor intra-pregnancy glycemic control may occur in gestational diabetes mellitus (GDM) women with isolated fasting hyperglycemia, but whether it is related to adverse pregnancy outcomes, and associated factors need to be evaluated further.

Objective

To explore the prevalence of adverse pregnancy outcomes in GDM with simple isolated fasting hyperglycemia and its influencing factors.

Methods

A total of 411 GDM patients with isolated fasting hyperglycemia who had prenatal examination in Northwest Women and Children's Hospital between June 2020 and March 2021 were selected, and followed up until delivery. Clinical data and pregnancy outcomes (normal and adverse) were collected. Multivariate Logistic regression was used to examine the factors associated with adverse pregnancy outcomes.

Results

Among the 411 cases, 245 received standardized glycemic management, 157 (38.2%) of whom achieved adequate glycemic control, but other 88 cases (21.4%) still had poor glycemic control; the other 166 cases (40.4%) did not receive standardized blood glucose management. Three hundred and twenty-three (78.6%) patients had adverse pregnancy outcomes, and other 88 (21.4%) had normal pregnancy outcomes. Patients with normal and adverse pregnancy outcomes had statistically significant differences in mean maternal age, prevalence of pre-pregnancy maternal obesity, intra-pregnancy glycemic management, mean fasting glucose, one- and two-hour plasma glucose level during the OGTT, prevalence of HbA_1c≥5.5%, serum total protein, serum albumin, prevalence of hypoproteinemia and the AUC of the time-blood glucose curve of the OGTT (P<0.05) . Multivariate Logistic regression analysis showed that pre-pregnancy maternal overweight or obesity〔OR=2.89, 95%CI (1.45, 5.78) , P=0.003〕, intra-pregnancy glycemic management 〔poor glycemic control: OR=3.64, 95%CI (1.64, 8.06) , P=0.001; non-management: OR=3.46, 95%CI (1.91, 6.25) , P<0.001〕, prenatal HbA_1c〔OR=2.38, 95%CI (1.06, 5.34) , P=0.035〕, hypoproteinemia〔OR=2.25, 95%CI (1.15, 4.41) , P=0.018〕, and elevated AUC of the time-blood glucose curve of the OGTT〔OR=1.23, 95%CI (1.03, 1.47) , P=0.024〕 were associated with increased risk of adverse pregnancy outcomes.

Conclusion

Pre-pregnancy maternal overweight or obesity, uncontrolled or non-management of blood glucose during pregnancy, high prenatal HbA_1c values, hypoproteinemia, and high AUC of the time-blood glucose curve of the OGTT may be high risk factors for adverse outcomes in GDM with isolated fasting hyperglycemia. To improve the rate of normal maternal and neonatal outcomes, clinical guidance should be given to pregnant women to maintain a normal pre-pregnancy weight and to standardizedly manage the blood glucose.

Effects of Music Therapy Assisted Anagliptin on Glycolipid Metabolism in Patients with Type 2 Diabetes

Meixin LI, Xin ZHENG, Xiaoying ZHANG, Xiaoxia DU

2022, 25(26):  3275-3280.  DOI: 10.12114/j.issn.1007-9572.2022.0271

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Background

Music therapy, as an emerging treatment, has a gradually evolving role in the rehabilitation of chronic diseases and is gaining increasing attention. But there are few studies on the effects of music therapy on diabetes rehabilitation.

Objective

To observe the effects of music assisted anagliptin on glycolipid metabolism in patients with type 2 diabetes.

Methods

Sixty five type 2 diabetic patients with poor glycemic control on oral agents who visited the outpatient clinic of Department of Endocrinology, Boai Hospital, China Rehabilitation Research Center, from October 2019 to February 2021 were selected. Patients were divided into group A (n=35) and group B (n=30) by random numbers, and patients in both groups maintained their original diet and exercise habits. Group A was treated with anagliptin tablets in combination with the original treatment (drug type, dose unchanged) , while group B was given music adjuvant therapy on the basis of group A. Patients in both groups were treated continuously for 12 weeks. Fasting plasma glucose (FPG) , glycated hemoglobin (HbA_1c) , low-density lipoprotein cholesterol (LDL-C) , total cholesterol (TC) , triacylglycerol (TG) , high-density lipoprotein cholesterol (HDL-C) , uric acid (UA) , 2 h postprandial plasma glucose (2 hPG) , hypersensitivity C-reactive protein (hs-CRP) , free fatty acids (FFA) , insulin resistance index (HOMA-IR) , β Cell function secretion index (HOMA-β) before and 12 weeks after treatment were compared between the two groups. The patients were observed for the occurrence of adverse reactions during the treatment.

Results

One patient was eliminated from the trial because of adverse drug reactions during the course of the trial in both groups, and 34 and 29 patients finally completed the trial in groups A and B, respectively. Patients in group B had lower 2 hPG than those in group A after 12 weeks of treatment (P<0.05) . FPG, HbA_1c, and 2 hPG were lower in both groups after 12 weeks of treatment whereas HOMA-β were higher after treatment (P<0.05) ; LDL-C and TC of group B patients after 12 weeks of treatment were lower (P<0.05) . No hypoglycemic events occurred in either group.

Conclusion

Music-assisted alagliptin can reduce postprandial blood glucose and improve lipid profile of type 2 diabetes patients more than that without music-assisted alagliptin. It also needs to be emphasized that the effects of music therapy must be based on diet control, proper exercise, and rational medication.

Effect of Hyaluronic Acid Oligosaccharides on Diabetic Cutaneous Ulcer Wound Healing by Activating Nrf2 Signaling Pathway

Zhongyuan HU, Xiuhua ZHANG, Shuaiguang LI, Huarong SHAO, Fei LIU, Bin GUO

2022, 25(26):  3281-3289.  DOI: 10.12114/j.issn.1007-9572.2022.0217

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Background

Excessive levels of oxidative stress and long-term inflammatory state seriously affect wound healing in diabetic patients. At present, there are biological agents, traditional Chinese medicines, stem cell therapy etc. used in treating diabetic cutaneous ulcer (DCU) . Due to lack of sufficient evidence of safety and effectiveness, these methods are not widely applied in clinical treatment. Thus new drugs need to be discovered urgently. Hyaluronic acid oligosaccharide (o-HA) is a potential drug for the treatment of DCU because of its antioxidant and anti-inflammatory properties.

Objective

To observe the effect of o-HA on DCU wound healing and explore its influence on oxidative stress Nrf2 signaling pathway.

Methods

This experiment was conducted from April to December, 2021. Ninety SPF male mice of six-week-old from Kunming were selected. Ten of them were reserved as the normal control group (NC group) and the rest were injected with streptozotocin (STZ) by abdomen to induce diabetes mouse model. Sixty diabetic mice modeled successfully were divided into 6 groups according to random number table with ten in each group, namely the diabetic model group (DM group) , the recombinant human epidermal growth factor positive control group (rhEGF group) , the blank matrix negative group (matrix group) , low-dose o-HA treatment group (0.5% o-HA group) , medium-dose o-HA treatment group (1% o-HA group) and high-dose o-HA treatment group (2% o-HA group) . The DCU model was established in all mice by way of the full-thickness skin excision ring splint. The wounds in NC and DM group were not treated. For the other groups, the corresponding medicines were evenly applied to and around the wounds after daily disinfection. The mice in rhEGF group were administered once a day while the mice in the 0.5%, 1% and 2% o-HA group were medicated twice a day for consecutive 14 days. The wound healing condition of DCU mice was recorded after being treated on the first, the 7th and the 14th day. The morphological changes of granulation tissue, collagen fiber formation and angiogenesis in mice wounds were observed by HE staining, Masson staining and CD34 immunohistochemical staining. The serum SOD and MDA levels of mice were examined by the kits. The Nrf2, HO-1 and NQO1 protein expression in wound tissue of mice were detected by Western-blotting after the administration of 14 days.

Results

On the seventh day of administration, the wound healing rate of rhEGF group and 1% o-HA group was higher than that of DM group and the wound healing rate of 0.5% o-HA group and 2% o-HA group was lower than that of NC group and higher than that of DM group. On the 14th day of administration, the wound healing rate of rhEGF group, 0.5% o-HA group, 1% o-HA group and 2% o-HA group was higher than that of DM group (P<0.05) . The histomorphology showed that the granulation tissue of the wound, collagen fiber and density of neovascularization were significantly increased after o-HA ointment intervention. The level of MDA in the rhEGF group, 0.5% o-HA group, 1% o-HA group and 2% o-HA group was lower than that of DM group, and the level of SOD in these four groups was higher than that of DM group; the level of MDA in 0.5% o-HA and 2% o-HA groups was higher than that of NC group (P<0.05) . The levels of Nrf2, HO-1 and NQO1 protein expression in both rhEGF group and 1% o-HA group were higher than those of NC and DM group; the levels of Nrf2 and NQO1 protein expression in 0.5% o-HA group were higher than those of DM group, and the level of HO-1 protein expression was higher than that of NC and DM group; the level of HO-1 protein expression in 2% o-HA group was higher than that of NC and DM group, and the level of NQO1 protein expression was higher than that of DM group (P<0.05) .

Conclusion

o-HA has a potential healing effect for DCU wound in mice, and the healing effect of 1% o-HA ointment is the most remarkable. It can help wound healing by accelerating wound closure and re-epithelization, promoting angiogenesis and affecting the Nrf2 pathway. With advantages of high safety and good stability, o-HA has great potential in clinical diabetic wound healing.

Correlation between Nonalcoholic Fatty Liver Disease and Early Left Ventricular Diastolic Dysfunction

Fangyuan CONG, Qian XUE, Lihua DENG, Luying ZHU, Jingtong WANG

2022, 25(26):  3290-3297.  DOI: 10.12114/j.issn.1007-9572.2022.0252

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Background

As the most common chronic liver disease, nonalcoholic fatty liver disease (NAFLD) has been reported to be associated with significant changes in myocardial structure and function, but it is still a controversial issue whether it is an independent risk factor for abnormalities in cardiac structure and function.

Objective

To assess the correlation of NAFLD with early left ventricular diastolic dysfunction by comparing left ventricular structure and functional indices between NAFLD and non-NAFLD patients.

Methods

A total of 519 inpatients from Geriatric Medicine Unit, Peking University People's Hospital were enrolled during 2018 to 2020, and divided into NAFLD group and non-NAFLD group according to the results of abdominal ultrasound or CT examination. Left ventricular structural and functional indices of two groups were comparatively analyzed. Early left ventricular diastolic dysfunction was defined as the ratio of the peak velocity of the early filling (E) wave to the atrial contraction (A) wave <1. Multivariate Logistic regression was used to assess the correlation between NAFLD and early left ventricular diastolic dysfunction. FIB-4 index was used to assess the risk of liver fibrosis in NAFLD patient〔low risk (<1.30) , medium risk (1.30-3.25) , and high risk (>3.25) 〕. NAFLD patients were divided into low-risk subgroup (n=81) and medium-high risk subgroup (n=100) according to whether FIB-4 index <1.30.

Results

Compared with the non-NAFLD patients (n=338) , NAFLD patients had lower E/A ratio〔 (0.79±0.25) vs (0.87±0.34) , t=2.607, P=0.009) 〕 and greater end-diastolic interventricular septal thickness〔 (0.92±0.13) cm vs (0.89±0.13) cm, t=-2.525, P=0.012〕. Multivariate Logistic regression analysis showed that NAFLD was independently associated with the risk of early left ventricular diastolic dysfunction〔OR=2.941, 95%CI (1.736, 4.981) , P<0.001〕. NAFLD patients with medium-high risk subgroup had lower E/A ratio〔 (0.75±0.21) vs (0.84±0.28) , t=2.275, P=0.024〕 and higher left ventricular mass index than did those with low-risk subgroup〔 (80.22±14.92) g/m² vs (74.72±16.83) g/m², t=-2.327, P=0.021〕.

Conclusion

NAFLD may be an independent risk factor for early left ventricular diastolic dysfunction. The higher risk of advanced fibrosis in NAFLD patients, the worse was the left ventricular diastolic function.

Chinese Herbal Formula Shenyi Improves Kidney Injury and Inhibits the Activation of the Alternative Complement Pathway in a Mouse Model of Lupus Nephritis

Keng CHEN, Yiyao DENG, Shunlai SHANG, Qinggang LI, Xiangmei CHEN

2022, 25(26):  3298-3307.  DOI: 10.12114/j.issn.1007-9572.2022.0301

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Background

Lupus nephritis (LN) is one of the serious complications of systemic lupus erythematosus. Relevant studies have shown that the traditional Chinese herbal formula Shenyi (SY) can regulate the body's immunity and inhibit renal fibrosis. At present, the efficacy and mechanism of using SY in the treatment of LN remains unclear.

Objective

To explore the therapeutic effect of compound SY on LN mice and the activation of the alternative complement pathway.

Methods

From April to July 2021, 35 SPF MRL/lpr mice (8 weeks old) and 6 SPF C57BL/6J mice (8 weeks old) were selected for experiments. MRL/lpr mice were randomly divided into MRL/lpr group (n=8) and SY low dose group (n=9) , SY middle dose group (n=9) , SY high dose group (n=9) , C57BL/6J mice were normal control group (n=6) . The low, the medium and high dose groups of SY were respectively administrated with SY decoction at the doses of 15.34, 46.02 and 92.04 g/kg by gavage. The normal control group and MRL/lpr group were respectively administrated with 0.5 ml 0.9 % sodium chloride solution by gavage. Intervention started at 12 weeks of age, once a day for 14 weeks. The animal signs, urinary protein to creatinine ratio (UPCR) , anti-dsDNA antibody (anti-dsDNA) concentration, serum antinuclear antibody (ANA) concentration, renal tissue pathology, renal tissue C3, IgG, C5b-9 immune deposition, renal tissue α-SMA, CollagenⅠ, Fibronectin and complement protein levels were observed.

Results

At the end of the intervention, 6 mice in normal control group survived, 3 mice in MRL/lpr group survived, and 5, 7 and 9 mice in SY low, the medium and high dose groups survived, respectively. (1) The quantitative scores of the signs of mice in the normal control group, the middle-dose SY group, and the high-dose SY group were lower than those in the MRL/lpr group (P<0.05) . (2) The UPCR in the normal control group and the SY dose groups at the 9th, 10th, 11th, 12th, and 13th weeks of intervention were lower than those in the MRL/lpr group (P<0.05) . (3) The serum anti-dsDNA levels in the normal control group, the low-dose SY group, and the high-dose SY group were lower than those in the MRL/lpr group after 14 weeks of intervention (P<0.05) . After 14 weeks of intervention, the serum ANA levels of mice in the normal control group and SY dose groups were lower than those in the MRL/lpr group (P<0.05) . (4) After 14 weeks of intervention, HE staining showed the deposition of immune complexes in the glomeruli of the MRL/lpr group mice, and PAS staining showed the formation of crescents in the glomeruli. HE staining showed that the glomeruli of mice in each dose group of SY were generally normal, while PAS staining showed that there were mesangial cell proliferation and a small amount of inflammatory cell infiltration in the glomeruli of the mice in the middle and high dose groups of SY. (5) The deposition of C3 and C5b-9 in the kidney tissue of mice in the normal control group and SY dose groups after 14 weeks of intervention was lower than that in the MRL/lpr group (P<0.05) . After 14 weeks of intervention, the IgG immune deposition in renal tissue of low-dose SY group and high-dose SY group was lower than that of MRL/lpr group (P<0.05) . (6) The protein levels of Collagen Ⅰ, Fibronectin, C3, C5, CD35 in kidney tissue of mice in high-dose SY group were lower than those in MRL/lpr group after 14 weeks of intervention (P<0.05) . After 14 weeks of intervention, the protein levels of Fibronectin, C3, C5 and CD35 in renal tissues of low-dose and medium-dose SY groups were lower than those in MRL/ LPR group (P<0.05) . After 14 weeks of intervention, the level of Fibronectin protein in the kidney tissue of mice in the normal control group was lower than that in the MRL/lpr group (P<0.05) .

Conclusion

SY can ameliorate lupus renal injury in MRL/lpr mice and delay disease progression, and its mechanism of action may be by inhibiting the activation of the alternative complement pathway.

Evidence-based Medicine

Efficacy of Acupuncture-based Treatment in Post-stroke Aphasia: an Overview of Systematic Reviews

Bomo SANG, Boxuan LI, Shizhe DENG, Xiaofeng ZHAO, Zhihong MENG

2022, 25(26):  3308-3315.  DOI: 10.12114/j.issn.1007-9572.2022.0197

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Background

Stroke is one of the leading causes of death and disability worldwide. The incidence of aphasia resulting from first-ever ischemic stroke is about 30%. Current guideline-recommended therapy is often challenging to achieve a satisfactory outcome, but numerous studies have shown that the treatment benefit could be increased if acupuncture therapy is used in a combined approach.

Objective

To give an overview of systematic reviews/meta-analyses of acupuncture-based treatment for post-stroke aphasia (PSA) .

Methods

Systematic reviews/meta-analyses of the efficacy of acupuncture-based treatment in PSA were searched in databases of CNKI, Wanfang Data, VIP, SinoMed, Cochrane Library, PubMed and EMBase from inception to July 2021. Literature enrollment and data extraction were performed by two researchers, respectively. The AMSTAR 2, PRISMA statement, and GRADE classification were used to evaluate methodological quality, the quality of reporting and the quality of evidence for outcome indicators, respectively. The results of overview were analysed in a comprehensive manner.

Results

A total of 12 systematic reviews/meta-analyses were included. One was of moderate methodological quality, five were of low quality and six were of critically low. Mainly due to the absence of a description of the pre-design protocol, the quality of majority of studies was rated low or critically low. The 12 studies had PRISMA scores ranging from 17 to 25, 7 of which with scores of 20-25 were considered relatively complete, and 5 with scores of 17-19 were considered to have certain defects. Fifty-four pieces of evidence were summarized from the studies, 12 of which were rated as moderate by GRADE in terms of quality, 24 were rated as low, and 18 very low.

Conclusion

In accordance with the evidence of moderate quality, compared with speech rehabilitation alone, acupuncture with speech rehabilitation could better improve the speech impairment, auditory comprehension, repetition and reading ability, and acupuncture-based treatment could better improve the overall clinical response in patients with PSA, so acupuncture therapy is recommended for clinical use. However, the efficacy of acupuncture in PSA is needs to be verified further by clinical evidence derived from more high-quality original studies using a strict evidence development process.

A Meta-analysis of the Therapeutic Effects of Acupuncture on Benign Prostatic Hyperplasia

Xueyuan YANG, Zhewen LIU, Yaling TU, Deguo LIU, Qihua CHEN

2022, 25(26):  3316-3323.  DOI: 10.12114/j.issn.1007-9572.2022.0199

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Background

With the change of modern lifestyle and the aggravation of social aging, the incidence of benign prostatic hyperplasia (BPH) is increasing year by year, which has become a major problem threatening the health of middle-aged and elderly men. At present, western medicine is mainly based on surgery and oral drugs treatment, which has certain adverse reactions and complications. However, the clinical application of filiform acupuncture in the treatment of BPH has a significant effect, but there is a lack of evidence-based evidence.

Objective

To systematically review the clinical efficacy of acupuncture therapy in treating BPH.

Methods

The randomized controlled trials (RCTs) on acupuncture for BPH were retrieved from CNKI, VIP, Wanfang Data, SinoMed, PubMed and Cochrane Library by computer from inception to October1, 2021, including the experimental group treated by acupuncture, with or without the drugs used in the control group and the control group treated by conventional western medicine. According to inclusion and exclusion criteria, the literature was extracted and evaluated by using RevMan 5.3 software.

Results

A total of 17 articles and 1 547 patients were included. Meta-analysis results showed that the clinical effective rate and maximum urinary flow rate (Qmax) of the experimental group were higher than those of the control group〔OR=3.21, 95%CI (2.25, 4.57) , P<0.000 01; MD=2.48, 95%CI (1.26, 3.70) , P<0.000 1〕. The international prostate symptom score (IPSS) , residual urine volume (PVR) , prostate volume (PV) , and quality of life (QOL) score in the experimental group were lower than those in the control group〔MD=-2.39, 95%CI (-3.84, -0.94) , P=0.001; MD=-10.59, 95%CI (-15.20, -5.98) , P<0.000 01; MD=-3.50, 95%CI (-5.07, -1.93) , P<0.000 1; MD=-0.68, 95%CI (-0.99, -0.37) , P<0.000 1〕. The clinical effective rate and Qmax of acupuncture alone in treating BPH were higher than those of western medicine〔OR=3.53, 95%CI (2.20, 5.68) , P<0.000 01; MD=2.75, 95%CI (1.62, 3.88) , P<0.000 01〕. The PVR, PV and QOL of acupuncture alone in treating BPH were lower than those of western medicine〔MD=-9.41, 95%CI (-15.87, -2.94) , P=0.004; MD=-2.99, 95%CI (-4.86, -1.12) , P=0.002; MD=-0.74, 95%CI (-1.33, -0.15) , P=0.01〕. The clinical effective rate of acupuncture+western medicine for BPH was higher than that of western medicine〔OR=2.84, 95%CI (1.67, 4.82) , P=0.000 1〕; IPSS, PVR, PV and QOL of acupuncture+western medicine for BPH were lower than that of western medicine〔MD=-2.88, 95%CI (-3.43, -2.32) , P<0.000 01; MD=-12.25, 95%CI (-16.92, -7.57) , P<0.000 01; MD=-4.41, 95%CI (-8.03, -0.79) , P=0.02; MD=-0.59, 95%CI (-1.03, -0.15) , P=0.008〕. There were no obvious adverse reactions in both groups. The sensitivity analysis of IPSS, Qmax, PVR, PV and QOL results showed that the change effect model had no significant effect on the combined results. Funnel plot analysis was performed on RCTs of clinical response rate, IPSS, Qmax, PVR, and QOL, and the results showed that the funnel diagram of clinical response rate was basically symmetrical on both sides. The funnel plots of IPSS, Qmax, PVR, and QOL were scattered, and there was publication bias.

Conclusion

Based on the current clinical evidence, the clinical efficacy and Qmax of acupuncture therapy for BPH were higher than those of the control group, and the IPSS, PVR, PV, and QOL were lower than those of the control group. Since funnel plots of IPSS, Qmax, PVR and QOL are scattered and have publication bias, the results of this study need further verification.

Sugar-sweetened Beverage Intake and Risk of Hypertension: a Dose-response Meta-analysis

Zhenxue ZHAO, Xin WANG, Kaiwen TAN, Chunshan ZHAO

2022, 25(26):  3324-3330.  DOI: 10.12114/j.issn.1007-9572.2022.0291

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Background

Drinking sugary drinks are common in China, but inadequate intake of which can induce a variety of diseases. Many studies have reported the relationship between intake of sugary drinks and the risk of hypertension, however, there are still disputes over the specific dose-response relationship between them.

Objective

To assess the dose-response relationship between the intake of sugary drinks and the risk of hypertension.

Methods

We searched for cross-sectional and prospective studies about the intake of sugary drinks and risk of hypertension in databases of CNKI, CQVIP, SinoMed, Wanfang Data, PubMed, EMBase, Cochrane Library, and Web of Science from inception to November 2021. Two reviewers independently extracted data, and evaluated the quality of included studies. Stata 16.0 was used for meta-analysis.

Results

Sixteen studies with 316 205 subjects were included. Meta-analysis results showed that the intake of sugary drinks increased the risk of hypertension〔OR=1.12, 95%CI (1.10, 1.15) , P<0.05 〕. Subgroup analyses revealed that by the intake of sugary drinks, the risk of hypertension increased by 34% in Asian population〔OR=1.34, 95%CI (1.20, 1.51) , P<0.05〕, and increased by 11% in North American population〔OR=1.11, 95%CI (1.09, 1.14) , P<0.05〕, and rose by 82% in Oceanian population〔OR=1.82, 95%CI (1.04, 3.21) , P<0.05〕, and grew by 18% in European population〔OR=1.18, 95%CI (1.02, 1.36) , P<0.05〕. Furthermore, the intake of sugary drinks was associated with a 43% higher risk of hypertension in minors〔OR=1.43, 95%CI (1.21, 1.69) , P<0.05〕, and a 12% higher risk of hypertension in adults〔OR=1.12, 95%CI (1.09, 1.15) , P<0.05〕 . In addition, the intake of sugary drinks was associated with a 12% higher risk of hypertension in people with normal BMI〔OR=1.12, 95%CI (1.09, 1.15) , P<0.05〕, a 17% higher risk of hypertension in overweight people〔OR=1.17, 95%CI (1.00, 1.38) , P<0.05〕, and a 19% higher risk of hypertension in obese people〔OR=1.19, 95%CI (1.06, 1.34) , P<0.05〕. Dose-response analysis results showed that for every additional sugary drink (i.e. 12 ounces, about 340 g or 355 ml) per day, the risk of hypertension increases by 16%〔OR=1.16, 95%CI (1.13, 1.18) , P<0.05〕. The basically symmetrical funnel plot and the Begg's test (Z=0.23, P>0.05) and Egger's test (t=1.46, P>0.05) showed no published bias.

Conclusion

The intake of sugary drinks may be associated with increased risk of hypertension, and for every increased intake of a sugary drink (i.e. 12 ounces, about 340 g or 355 ml) per day, the risk of hypertension increased by 16%. So controlling the intake of sugar is important for preventing hypertension.