Table of Content

20 June 2023, Volume 26 Issue 18

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Review & Perspectives

The Significance of High Normal Blood Pressure for Children and Adolescents

LIU Hai, HUANG Guanhua

2023, 26(18):  2183-2189.  DOI: 10.12114/j.issn.1007-9572.2022.0834

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At present, almost all the definitions of hypertension in pediatric hypertension guidelines issued by countries and organizations are based on blood pressure percentile of 95% (P₉₅). However, a large number of research data have shown that high normal blood pressure has a higher risk of progression to hypertension and cause similar target organ damage as hypertension. The review summarized the classification methods of blood pressure of children and adolescents in different countries and organizations, the prevalence of hypertension and high normal blood pressure, the rate of progression from high normal blood pressure to hypertension, and target organ damage caused by high normal blood pressure in children and adolescents, emphasizing that pediatricians should pay greater attention to the definition of high normal blood pressure and hypertension for children and adolescents.

Standard Management of Hypertension During the Preparation for Pregnancy

TIAN Meixiang, ZHANG Zhengyi

2023, 26(18):  2190-2194.  DOI: 10.12114/j.issn.1007-9572.2022.0854

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In recent years, due to the increase of life stress, there is an increasing number of the men and women of childbearing age suffering from hypertension in China. Therefore, the standardized management of hypertension during the preparation for pregnancy has become a current focus. The standardized management of blood pressure of males and females of childbearing age during pregnancy preparation was discussed in this paper in terms of both monitoring and evaluating of hypertension during the preparation for pregnancy and application of antihypertensive drugs, emphasizing that the management of hypertension during pregnancy preparation in women should consider both maternal and fetal safety, choose relatively safe antihypertensive drugs such as methyldopa, labetalol, nifedipine, etc; the management of hypertension during pregnancy preparation in men should consider the efficacy of antihypertensive drugs and the effects on sexual function and sperm, Nebivolol, ACEI/ARB and CCB drugs are recommended, in order to provide guidance for the management of hypertension during the preparation for pregnancy reference direction for future research.

Original Research

Pressure Injuries among Adult Inpatients in 46 Tertiary Hospitals in China: Epidemiological Characteristics and Predictive Value of the Braden Scale

JIANG Qixia, ZHOU Jihong, CHEN Kesu, HONG Yanyan, PENG Qing, ZHAN Yingying, XIE Yijie, SUN Ying, WANG Zujing

2023, 26(18):  2195-2202.  DOI: 10.12114/j.issn.1007-9572.2022.0796

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Background

The Braden Scale is a globally recognized pressure injury risk prediction tool with good reliability and validity. However, due to different application populations, its optimal cut-off value is controversial. The optimal cut-off value of the scale in clinical application in China is ≤ 16 points, while most European countries and the US take ≤18 points as the cut-off value. There is insufficient research on the predictive value of the scale in hospitalized patients in China.

Objective

To carry out a cross-sectional study on the epidemiological characteristics of pressure injuries among adult inpatients in 46 tertiary hospitals in 13 provinces/autonomous regions across China, and to examine the predictive values and optimal cut-off values of the Braden Scale and its six subscales.

Methods

Established by the Eastern Theater General Hospital, the research group of this multicenter study publicly recruited 46 eligible grade A tertiary hospitals containing at least 500 beds in 13 provinces/autonomous regions of China as the multicenter research settings after qualification review and signing a bilateral agreement on participating in the research. Adult patients (≥18 years old) with hospitalization time ≥24 hours were included as the patient participants, and senior wound care nurses with at least two years of working experience (n=1 060) were included as investigators. On March 30 and May 29, 2021, the nurses used a special survey record form to record the general situation of the patients, and checked their skin of the whole body to find out if there was a pressure injury, and used the six subscales of the Braden Scale (sensory perception, moisture, activity, mobility, nutrition, friction and shear) to assess the risk of pressure injuries. ROC curves of the scale and its subscales were plotted to assess their predictive values and optimal cut-off values for pressure injuries.

Results

In total, the valid data of 60 555 patients were obtained. The prevalence of pressure injuries, and hospital-acquired pressure injuries was 1.67% (1 010/60 555), and 0.74% (448/60 555), respectively. The prevalence of pressure injuries in males was higher than that of females〔2.08% (677/32 518) vs 1.19% (333/28 037) 〕 (χ²=73.394, P<0.001). And the prevalence of pressure injuries in those hospitalized in the ICU〔10.58% (324/3 061) 〕 and those aged 80 years and over was higher〔5.98% (311/5 198) 〕. Logistic regression analysis showed that age, sex, serum albumin, hemoglobin, incontinence type, bed rest and Braden score were associated with pressure injuries (P<0.05). The area under the ROC curve (AUC) of the Braden Scale for predicting pressure injuries was 0.95〔95%CI (0.94, 0.95) 〕, with 96% sensitivity and 83% specificity, and 0.79 Youden index, as well as its corresponding optimal cut-off value of 17.50 points. In assessing the risk of pressure injuries in patients in different departments and age groups, the AUC of the Braden Scale ranged from 0.78 to 0.97, with a sensitivity ranging from 83% to 97%, a specificity ranging from 61% to 91%, and the Youden index ranged from 0.47 to 0.88, the optimal cut-off value ranged from 13.50 to 18.50 points. The AUC of the friction and shear predicting the risk of pressure injuries was 0.87, with 0.56 as the Youden index, and 1.50 points as its associated optimal cut-off value, and the AUC of mobility was 0.84, with 0.56 as the Youden index, and 2.50 points as its associated optimal cut-off value, and the AUC of activity was 0.80, with 0.54 as the Youden index, and 1.50 points as its associated optimal cut-off value.

Conclusion

The prevalence of pressure injuries, and hospital-acquired pressure injuries among adult inpatients in 46 tertiary hospitals in 13 provinces/autonomous regions across China is 1.67% (1 010/60 555), and 0.74% (448/60 555), respectively. The Braden Scale is applicable to adult inpatients in tertiary hospitals in China. The total score ≤18 points may be the optimal cut-off. Three subscales, namely friction and shear, mobility and activity have higher predictive values. In case of insufficient medical workers or special settings, the three subscales can be used to predict the risk of pressure injury, but their optimal cut-off values still need to be further verified in applications.

Association between Baseline Fasting Plasma Glucose Levels and Risk of Acute Pancreatitis in Non-obese Population: a Prospective Cohort Study

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

2023, 26(18):  2203-2208.  DOI: 10.12114/j.issn.1007-9572.2022.0884

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Background

Previous studies have shown that the risk of acute pancreatitis (AP) is increased in obesity population, while obese patients are often combined with abnormal fasting plasma glucose (FPG). It still remians controversial whether FPG independently increases the risk of AP and the relationship between FPG and the risk of AP in non-obese patients has been rarely reported in China and abroad.

Objective

To explore the association between baseline FPG level and the risk of AP in non-obese population.

Methods

Using a prospective cohort study method, a total of 102 512 non-obese cases from the Kailuan study cohort who completed physical examination for the first time in KaiLuan General Hospital and its 10 affiliated hospitals from 2006 to 2009 were enrolled as study subjects. Epidemiological data, anthropometric data, laboratory test indicators and other information of the subjects were collected. The study subjects were divided into 4 groups according to the FPG quartile: the first quartile group (group Q1, FPG≤4.66 mmol/L, n=25 929) ; the second quartile group (group Q2, 4.66 mmol/L≤FPG<5.10 mmol/L, n=25 797) ; the third quartile group (group Q3, 5.10 mmol/L≤FPG<5.67 mmol/L, n=25 162) ; the fourth quartile group (group Q4, FPG≥5.67 mmol/L, n=25 624). The Kaplan-Meier method was used to plot the survival curves of new-onset AP in non-obese population. The cumulative incidence of AP in non-obese population in different FPG level groups were calculated and Log-rank method was used for inter-group test. The Cox proportional hazard regression model was used to analyze the influencing factors for the new-onset AP in non-obese population and the correlation between different FPG level groupings and new-onset AP in non-obese population.

Results

The median follow-up time in this study was (12.8±2.4) years with the cumulative incidence of 320 cases and incidence density of 2.44 cases per 10 000 person-years in AP. There were statistically significant differences in the cumulative incidence of AP among the 4 FPG level groups (χ²=13.96, P<0.001). The results of Cox proportional hazard regression analysis showed that advanced age〔HR=1.02, 95%CI (1.01, 1.03), P=0.001〕, high triacylglycerol (TG) level〔HR=1.22, 95%CI (1.13, 1.30), P<0.001〕, history of cholithiasis〔HR=2.79, 95%CI (1.88, 4.13), P<0.001〕were risk factors for new-onset AP in non-obese population. Years of education ≥9 years〔HR=0.65, 95%CI (0.47, 0.90), P<0.001〕was the protective factor for new-onset AP in non-obese population. The HR for new-onset AP in group Q4 was 1.40 〔95%CI (1.02, 1.92), P=0.038〕. After excluding the population applying hypoglycemic drugs, the conclusions were unchanged, the HR for new-onset AP in group Q4 was 1.40 〔95%CI (1.02, 1.92), P=0.036〕.

Conclusion

Advanced age, high TG levels, and history of cholithiasis are risk factors for new-onset AP, years of education ≥9 years is the protective factor for new-onset AP. And the risk of AP increases when FPG ≥5.67 mmol/L in non-obose population.

Research on the Construction of Adherence and Its Influencing Factors of Patients with Percutaneous Coronary Intervention in Phase Ⅰ Cardiac Rehabilitation

CHEN Yilin, LIN Ping, HAN Yongkui, WANG Yini

2023, 26(18):  2209-2216.  DOI: 10.12114/j.issn.1007-9572.2022.0790

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Background

The importance of phase Ⅰ cardiac rehabilitation after percutaneous coronary intervention (PCI) has been confirmed, but there is suboptimal adherence among patients. Therefore, investigating the adherence of PCI patients to phaseⅠ cardiac rehabilitation and the influencing factors can provide a theoretical foundation for improving the adherence of patients.

Objective

To clarifythe influencing factors of the adherence of PCI patients to phaseⅠ cardiac rehabilitation and the effect pathways by the structural equation model construction, in order to provide the oretical support for improving the adherence of PCI patients to phase Ⅰ cardiac rehabilitation.

Methods

Patients with PCI enrolled in the Cardiac Rehabilitation Center of the Second Hospital of Harbin Medical University from August to December in 2021 were selected as the research objects by convenience sampling. The general demographic information questionnaire, therapy adherence questionnaire, health belief of coronary heart disease questionnaire, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiexy Disorde-7 (GAD-7), Family Adaptability and Cohesion Evaluation Scale (FACES), Chronic Illness Resource Survey (CIRS), Gensini score were used to investigate the patients by the end of phaseⅠ cardiac rehabilitation. Spearman rank correlation analysis was used to verify the correlations between health belief, depression, anxiety, family adaptability and cohesion, chronic illness resource utilization and cardiac rehabilitation adherence, respectively. Based on correlation analysis, the hypothetical model of the influencing factors of the adherence of PCI patients to phaseⅠ cardiac rehabilitation was constructed combined with Anderson's model of health service utilization. Maximum likelihood method was used to fit and modify the model constantly. Structural equation model was used to analyze the relationship among influencing factors.

Results

A total of 443 questionnaires were distributed and 430 valid questionnaires were returned, with a valid return rate of 97.06%. The results of multiple linear regression analysis showed that health belief (β=0.427), depression (β=-0.057), anxiety (β=-0.130), family adaptability and cohesion (β=0.242), chronic illness resource (β=0.140) were independent factors of the adherence to phaseⅠcardiac rehabilitation of PCI patients (P<0.05). The results of the correlation analysis showed that cardiac rehabilitation adherence score of PCI patients was positively correlated with health beliefs, family adaptability and cohesion, chronic illness resource utilization (P<0.05) and negatively correlated with depression and anxiety (P<0.05). A structural equation model of the adherence of PCT patients to phaseⅠ cardiac rehabilitation was constructed using health belief, depression, anxiety, family adaptability and cohesion, chronic illness resource and the model fits well: χ²/df=3.092<5, standardized root mean square residual (SRMR) =0.070<0.080, goodness of fit indices (GFI) =0.981, adjusted goodness of fitindices (AGFI) =0.936, comparative fit index (CFI) =0.992, normed fit indexes (NFI) =0.989, with all of them>0.9. The results of the intermediate effects test showed that health belief, family adaptability and cohesion, chronic illness resource had positive direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation (β=0.395, 0.277, 0.152, P<0.01) ; health belief, family adaptability and cohesion had a positive indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through chronic disease resource utilization (β=0.057, 0.065, P<0.01). Depression and anxiety had a direct negative effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation (β=-0.055, -0.116, P<0.05) .

Conclusion

The adherence of PCI patients to phaseⅠ cardiac rehabilitation is influenced by multiple factors. There are complex pathway relationships among the influencing factors. Health belief, family adaptability and cohesion, chronic illness resource have a positive direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation; depression and anxiety have a negative direct effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation; health beliefs, family adaptability and cohesion have a positive indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through chronic illness resource utilization, and have a negative indirect effect on the adherence of PCI patients to phaseⅠ cardiac rehabilitation through anxiety and depression.

Predictive Efficacies of SOFA Score, CURB-65 Score and PSI Score for 28-day Mortality in Patients with Severe Pneumonia: a Comparative Study

ZHANG Kang, JI Wenshuai, KONG Xinxin, DU Chen, XIE Kai, WANG Haifeng

2023, 26(18):  2217-2222.  DOI: 10.12114/j.issn.1007-9572.2022.0880

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Background

Severe pneumonia is a common critical respiratory illness with high mortality and heavy social burden. Early and accurate assessment of the condition and prognosis of patients with severe pneumonia contributes to clinical decision-making. The Sequential Organ Failure Assessment (SOFA), CURB-65 score, and Pneumonia Severity Index (PSI) score can reflect the severity of pneumonia in different aspects, but there is no consensus on which one of them has the highest performance in predicting the prognosis of severe pneumonia.

Objective

To explore the predictive efficacy of SOFA, CURB-65 and PSI scores for short-term prognosis of patients with severe pneumonia.

Methods

This was a multicenter, prospective observational study. Inpatients with severe pneumonia were selected from the ICU and department of respiratory and critical medicine of 11 hospitals (including the First Affiliated Hospital of Henan University of Traditional Chinese Medicine and other 10 hospitals) from December 2017 to March 2022. The patients were divided into survival group and death group according to the 28-day mortality after diagnosis to compare clinical characteristics and SOFA, CURB-65 and PSI scores assessed on the day of hospitalization. The receiver operating characteristic (ROC) curve was used to assess the performance of three risk scores for predicting the 28-day mortality. The predictive efficacy of the risk scores was evaluated using the Hosmer-Lemeshow test and calibration plot. Optimal risk scores were stratified using X-tile 3.6 to determine the optimal threshold. Kaplan-Meier survival curves of the patients were plotted and compared using the Log-rank test.

Results

A total of 240 patients were included, among whom 57 (23.8%) died within 28 days after diagnosis. Compared with the survival group, the death group had greater average age and lower average platelet count (P<0.05). And the SOFA, CURB-65 and PSI scores in the death group were higher (P<0.05). ROC analysis demonstrated that the values of AUC of SOFA score, CURB-65 score and PSI score were 0.741〔95%CI (0.663, 0.820) 〕, 0.627〔95%CI (0.544, 0.710) 〕, and 0.621〔95%CI (0.539, 0.703) 〕, respectively, all were greater than 0.6, indicating that the three scores had good predictive value for 28-day mortality in severe pneumonia (P<0.001), and the AUC of SOFA score was higher than that of CURB-65 score (Z=2.492, P=0.013) or PSI score (Z=2.775, P=0.006). Both the Hosmer-Lemeshow test and calibration plot suggested that the SOFA score was more accurate. Kaplan-Meier survival analysis showed that 28-day mortalities in low-risk (0-5), moderate-risk (6-8), and high-risk (9-18) patients stratified by SOFA score using the X-tile 3.6 were 12.0% (17/142), 28.8% (19/66), and 65.6% (21/32) respectively (χ²=37.93, P<0.001) .

Conclusion

SOFA, CURB-65 and PSI score are all suitable for predicting 28-day mortality of patients with severe pneumonia, with SOFA score being more valuable for clinical application.

Impact of Elevated Fasting Blood Glucose on Urodynamic Parameters in Patients with Benign Prostatic Hyperplasia

LYU Cuicui, WANG Qihua, XIAO Yao, JIANG Jing, LIU Xiaoyun

2023, 26(18):  2223-2226.  DOI: 10.12114/j.issn.1007-9572.2022.0662

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Background

Benign prostatic hyperplasia (BPH) is a major cause of lower urinary tract symptoms in middle-aged and elderly men, while abnormal blood glucose can also lead to functional and organic changes in urinary system. However, there is still a lack of relevant research on the effect of abnormal blood glucose on urodynamic parameters of BPH patients.

Objective

To explore the impact of elevated fasting blood glucose (FBG) on urodynamic parameters of BPH patients.

Methods

The clinical data of 95 older male patients with BPH who were hospitalized in Department of Urology, Second Affiliated Hospital of Dalian Medical University from January to December, 2021 were analyzed retrospectively. They were divided into hyperglycemic group (n=11) and normal FBG group (n=84) according to the admission FBG level to compare clinical indicators.

Results

We found that the two groups had no statistically significant differences in average age, BMI, total prostate-specific antigen (tPSA), the volume, length, width and height of the prostate, and glycosylated hemoglobin (P>0.05). It was noticed that the mean course of diabetes in the hyperglycemic group was longer〔2 (0, 10) years vs 0 (0, 0) years, u=705.500, P=0.025〕. The average FBG level of the hyperglycemic group was significantly higher than that of the normal FBG group 〔 (8.9±2.1) mmol/L vs (5.4±0.7) mmol/L, t=-11.263, P<0.001〕. As for urodynamic parameters, the International Prostate Symptom Score (IPSS), IPSS voiding (IPSS-V), quality life (Qol) score, post-voiding residual volume (PVRV), maximum urine flow rate and detrusor pressure at Q-max were similar between the groups (P>0.05). However, the average scores on IPSS-storage〔 (13.7±1.4) scores vs (11.4±3.3) scores, t=-2.316, P=0.023〕 and bladder first sensation volume〔 (147.8±76.9) ml vs (100.2±48.0) ml, t=-2.532, P=0.014〕in the hyperglycemic group were significantly higher.

Conclusion

We demonstrated that elevated FBG has significant adverse effects on subjective and objective urodynamic parameters of BPH patients, which may lead to impaired first sensation volume of bladder and more severe storage symptoms. These patients often have a long course of diabetes, so more clinical attention should be given to their blood glucose control. It is of prominent significance to take active comprehensive intervention for symptomatic management of BPH.

Clinical Value of Systemic Immune-inflammation Index in the Diagnosis of Diabetic Kidney Disease in Community-dwelling Elderly Patients with Type 2 Diabetes

ZHAO Lizhen, LI Weimin, JIANG Ruixia

2023, 26(18):  2227-2231.  DOI: 10.12114/j.issn.1007-9572.2022.0873

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Background

Diabetic kidney disease (DKD) is a common diabetic complication, which is mainly characterized by damage in renal microvessels. Early diagnosis and active prevention of DKD are the key to improving the prognosis. The blood inflammatory index may be related to DKD.

Objective

To explore the value of systemic immune-inflammation index (SII) for the diagnosis of DKD in elderly type 2 diabetes mellitus (T2DM) patients in the community.

Methods

A retrospective study was conducted with 327 elderly patients with T2DM who underwent routine physical examination in Community Medical Department, Beijing Chao-yang Hospital (West Branch), Capital Medical University from January to December 2021. They were divided into non-DKD group (n=112) and DKD group (n=215) by the prevalence of DKD. The general data and laboratory examination data of the two groups were collected and compared. Pearson correlation analysis and Spearman rank correlation analysis were used to assess the correlation of urinary albumin/creatinine ratio (UACR) with other various indicators. Multivariate Logistic regression analysis was used to explore the influencing factors of DKD in the patients. The diagnostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and SII for DKD in these patients was evaluated by using the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) with corresponding 95%CI was calculated.

Results

The course of T2DM in DKD group was longer than that in non-DKD group (P<0.05). Moreover, the proportion of patients with hypertension history, fasting plasma glucose (FPG), low-density lipoprotein (LDL), blood urea nitrogen, serum creatinine (Scr), UACR, neutrophils, platelets, NLR, PLR and SII in DKD group were higher than those in non-DKD group (P<0.05). Correlation analysis showed that course of T2DM, FPG, triacylglycerol, LDL, neutrophils, platelets, NLR, PLR and SII were positively related with UACR (r=0.716, 0.114, 0.113, 0.144, 0.533, 0.226, 0.538, 0.430, 0.494, P<0.05). Multivariate Logistic regression analysis showed that course of T2DM〔OR=1.300, 95%CI (1.173, 1.441), P<0.001〕, LDL〔OR=2.565, 95%CI (1.320, 4.985), P=0.005〕, Scr〔OR=1.093, 95%CI (1.046, 1.143), P<0.001〕, NLR〔OR=2.565, 95%CI (1.320, 4.985), P=0.005〕and SII〔OR=1.011, 95%CI (1.007, 1.015), P<0.001〕were associated with DKD in elderly. In diagnosing DKD in these patients, the AUC of NLR was 0.755〔95%CI (0.696, 0.814) 〕, the optimal cut-off value was 2.49, with a sensitivity of 72.1% and a specificity of 70.5%; the AUC of PLR was 0.689〔95%CI (0.624, 0.754) 〕, the optimal cut-off value was 112.81, with a sensitivity of 90.2%, and a specificity of 43.8%; the AUC of SII was 0.836〔95%CI (0.791, 0.881) 〕, the optimal cut-off value was 492.08, with a sensitivity of 80.5% and a specificity of 73.2%.

Conclusion

The course of T2DM, LDL, Scr, NLR and SII may be the influencing factors of DKD in community-dwelling elderly T2DM patients. Moreover, SII has great clinical diagnostic value for DKD in this population.

Familial Hypercholesterolemia in 45-year-old and Younger Patients with Acute Coronary Syndrome: Clinical Characteristics and Influencing Factors of Blood Lipid Control Effect

GAO Yang, WANG Yunxia, GAO Chuanyu

2023, 26(18):  2232-2237.  DOI: 10.12114/j.issn.1007-9572.2022.0780

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Background

Acute coronary syndrome (ACS) is an acute and critical disease, which has tended to occur in younger people in recent years. Familial hypercholesterolemia (FH) is a hereditary disease characterized by early-onset atherosclerosis. Previous studies have found that the detection rate of FH in young ACS patients is not low, but there are still few studies on the follow-up of lipid-lowering efficacy. At the same time, the reasons of non-attainment for the LDL-C in ≤ 45-year-old ACS patients remain to be analyzed.

Objective

To study the detection rate and clinical characteristics of FH in ACS patients aged ≤ 45 years, and to observe the short-term lipid-lowering effect and analyze the risk factors for non-attainment of lipid targets.

Methods

ACS inpatients aged ≤ 45 years with available follow-up blood lipid records were recruited from Fuwai Central China Cardiovascular Hospital from October 2019 to October 2021. Clinical data were collected through the electronic medical record system. Venous blood samples were collected for laboratory test after eight-hour fasting. Gensini score was used to evaluate the severity of coronary artery disease, Gensini score ≥75% was defined as severe coronary artery stenosis. The Dutch Lipid Clinical Network (DLCN) criteria were used to diagnose FH. According to the DLCN score, the subjects were divided into possible FH group (n=57) and non-FH group (n=223). The low-density lipoprotein cholesterol (LDL-C) was followed up to observe the effect of lipid-lowering therapy. LDL-C<1.4 mmol/L was considered as blood lipid control. Multivariate Logistic regression analysis was used to analyze the factors affecting the attainment of LDL-C target level.

Results

In this study, 280 patients were eventually enrolled. Statin treatment history, family history of coronary heart disease, proportion of high risk coronary heart disease, premature coronary heart disease, type of ACS, total cholesterol, baseline LDL-C and proportion of severe coronary artery stenosis were significantly different between the two groups (P<0.05). LDL-C in follow-up, LDL-C change, LDL-C reduction in FH group were higher than those in non-FH group, the rate of attain of blood lipif was lower than that in non-FH group (P<0.05). Multivaliate Logistic regression analysis showed that receiving coronary artery bypass grafting (CABG) treatment〔OR=4.32, 95%CI (1.21, 15.42) 〕and elevated baseline LDL-C〔OR=2.22, 95%CI (1.62, 3.03) 〕were risk factors for the attainment of blood lipid level (P<0.05), while statins combined with evolocumab〔OR=0.10, 95%CI (0.03, 0.40) 〕was the protective factor (P<0.05) .

Conclusion

The possible FH is not uncommon in ACS patients aged ≤45 years (20.36%), and its detection rate increases in those also with acute myocardial infarction, which is worthy of clinical attention. The rate of attaining the target LDL-C level is still lower than that of non-FH group. And the rate of attaining the blood lipid level is even more lower in those receiving CABG treatment or with elevated baseline LDL-C level. The use of statins combined with evolocumab can increase the rate of attaining the target LDL-C level.

Association between Air Pollutant Exposure and Dyslipidemia in Middle-aged and Elderly People in Mining Areas

FENG Shuidong, LI Junyan, DENG Shuxiang, CHEN Limou, CAO Mengyue, TANG Yan, TANG Peng, LIU Jun, SHEN Minxue, YANG Fei

2023, 26(18):  2238-2244.  DOI: 10.12114/j.issn.1007-9572.2022.0809

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Background

Dyslipidemia has become one of the global public health issues. However, the relationship between air pollution and dyslipidemia has been rarely reported.

Objective

To explore the relationship between air pollutant exposure and dyslipidemia in middle-aged and elderly people in mining areas.

Methods

A total of 1 965 residents over 45 years old were sampled using cluster random sampling from mining areas in western Hunan from 2018 to 2019. The general data and lipid indices were obtained by using an interviewer-administered questionnaire survey, a physical examination and a laboratory test. The level of air pollution of the mining area was calculated by inverse distance weighted interpolation, and the average daily dose (ADD_total) of air pollutants of each resident was calculated, and used to divide them into Q1 group (0.5-0.7 m³·kg^-1·d^-1, n=172), Q2 group (>0.7-0.9 m³·kg^-1·d^-1, n=870), Q3 group (>0.9-1.1 m³·kg^-1·d^-1, n=717), and Q4 group (>1.1 m³·kg^-1·d^-1, n=172). Unconditional Logistic regression was used to analyze the relationship between ADD_total and dyslipidemia.

Results

The annual average concentration of PM_2.5 in the two mining areas exceeded the National Air Quality Standard (Ⅱ). The prevalence rate of dyslipidemia was 25.3% (498/1 965). There were statistically significant differences in mean age and body mass index (BMI), prevalence of smoking and hypertension between patients with normal and dyslipidemia (P<0.05). The detection ratios of abnormal triglyceride (TG) and high density lipoprotein cholesterol in Q1 to Q4 groups were statistically significant different (P<0.05). After adjusting for age, sex, hypertension, BMI, smoking, diabetes, drinking and other factors, unconditional Logistic regression analysis found that Q2, Q3 and Q4 groups had a greater risk of abnormal TG (P<0.05), and Q4 group also had a greater risk of abnormal total cholesterol (TC) (P<0.05), compared with group Q1 (with the lowest concentration of ADD_total) .

Conclusion

The air pollutants in the two mining areas were mainly PM_2.5, the ADD_total of air pollutants was positively correlated with TC and TG anomalies, which provides a reference for further research on the relationship between air pollutant exposure and dyslipidemia.

Phenotypic Characteristics and Recurrence Factors of MOG-IgG Associated Disorders in Children

WANG Xin, ZHAO Ruibin, YANG Huafang, LIU Chong, LIU Tian, LU Cui, CHEN Didi

2023, 26(18):  2244-2249.  DOI: 10.12114/j.issn.1007-9572.2022.0671

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Background

The prevalence of anti-myelin oligodendrocyte glycoprotein (MOG) -IgG associated disorders (MOGAD) is significantly higher in children than that in adults. The characteristics and associations of phenotypes and recurrence risk in children are still unclear.

Objective

To examine the phenotypic features and recurrence factors of MOG-IgG positivity in central nervous system inflammatory demyelinating diseases in children.

Methods

A follow-up study on 54 children with MOGAD diagnosed in Children's Hospital of Hebei Province from December 2017 to December 2021 was performed. Phenotypic features at each demyelinating attack, laboratory tests, imaging characteristics, MOG-IgG titers in serum/cerebrospinal fluid (CSF), efficacy, and high risk factors for recurrence were analyzed. The MOG-IgG was tested using cell-based immunofluorescence assay. All patients were followed up until March 31, 2022.

Results

In our study, the median age of onset was 6.0 (4.0, 8.0) years and the male to female ratio was 1∶1.07. Serum MOG-IgG titers were 1∶10-1∶320. Acute disseminated encephalomyelitis (ADEM) was the most common phenotype (44.4%, 24/54), followed by optic neuritis (ON) (25.9%, 14/54) and non-ADEM-like meninges /encephalitis (20.4%, 11/54). Ten cases (18.5%) were positive for MOG-IgG in serum and CSF, and 2 (3.7%) were positive for both NMDAR-IgG in CSF and MOG-IgG in serum. Brain MRI showed new lesions during the 76.9% (60/78) of the 78 attacks in total, and the most common locations were cortical white matter (66.7%, 40/60) and optic nerve (35.0%, 21/60). Forty patients (74.1%, 40/54) experienced one episode, the main phenotypes were ADEM (57.5%, 23/40) and non-ADEM-like meninges/encephalitis (25.0%, 10/40). Fourteen patients (25.9%, 14/54) had two or more episodes, and the initial phenotype of them was ADEM with ON (57.1%, 8/14) or ON (21.4%, 3/14). Compared with recrudescent cases, non-recrudescent cases had much lower prevalence of ON or ADEM with ON as the primary phenotype (P<0.05). All the children received first-line immunoregulation therapy at the time of the initial attack. Of the 14 relapsed cases, 2 (14.3%) were improved after mycophenolate mofetil treatment, one (7.1%) was better after rituximab treatment, and the other 11 (78.6%) had improved symptoms and imaging manifestations after being treated with methylprednisone pulse therapy combined with gamma globulin again. MOG-IgG titers were not increased in the recurrent children. After treatment, 28 (51.9%) children were completely improved, while 11 (20.4%) children had various neurological sequelae, among which visual dysfunction〔54.5% (6/11) 〕 was the most common.

Conclusion

The clinical phenotypes of MOGAD in children are diverse, among which the common phenotypes are ADEM, ON and non-ADEM-like meninges/encephalitis. Brain damages detected by MRI are extensive. The initial phenotypes of ADEM with ON and ON are prone to relapse. Most children have a good prognosis, but some may be accompanied by neurological after effects.

Intestinal Flora in Children with Henoch-Schönlein Purpura Nephritis: Composition and Abundance Analysis and Clinical Significance

ZHANG Li, ZHANG Jianjiang, DOU Wenjie, ZENG Huiqin, WANG Qin

2023, 26(18):  2250-2255.  DOI: 10.12114/j.issn.1007-9572.2022.0656

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Background

The number of studies about the status of intestinal flora in children with Henoch-Sch?nlein purpura (HSP) is limited, and there are no reports on changes of intestinal flora in children with Henoch-Sch?nlein purpura nephritis (HSPN) at the early stage of the disease.

Objective

To investigate the changes of intestinal flora in HSPN children and their association with the development of the disease.

Methods

Thirty-seven newly treated children with HSP (test group) were selected from Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University from July to September 2019, and compared to 12 healthy children (control group) in terms of the status of intestinal flora. The test group was further divided into non-renal injury subgroup (13 cases) and renal injury subgroup (24 cases) according to the prevalence of renal injury during a 6-month follow-up. General data and stool specimens were collected from the affected children and healthy children. High-throughput sequencing was used to sequence and analyze the intestinal flora of all subjects. Alpha diversity (Shannon index, Chao1 index, ACE index) analysis was used to explore the richness and diversity of the microbial communities within the samples. Principal coordinate analysis (PCoA) was used to explore the differences in community structure among the groups, linear discriminant analysis effect size (LEfSe) analysis were used to identify species with significant differences.

Results

Alpha diversity analysis results showed that there was no statistically significant difference in Shannon index, Chao1 index and ACE index among the three groups (P>0.05). PCoA showed that the composition of intestinal flora varied across renal injury and non-renal injury subgroups and the control group (P<0.05). Further Adonis analysis revealed that the intestinal flora composition varied significantly between non-renal injury subgroup and the control group (F=2.172, P=0.006), and between renal injury subgroup and the control group (F=2.217, P=0.006), as well as between renal injury and non-renal injury subgroups (F=1.590, P=0.045). LEfSe analysis showed, compared with the control group, the test group had significantly decreased abundance of Blautia, Chryseobacterium, Agathobacter and Roseburia (P<0.05), and significantly increased abundance of Megamonas and Enterococcus (P<0.05). Compared with non-renal injury subgroup, renal injury subgroup had significantly reduced abundance of Christensenella and Bacteroides (P<0.05), and significantly increased abundance of Lactobacillus and Rothia (P<0.05) .

Conclusion

Intestinal flora disorders were found in HSP children, the intestinal flora of children with HSPN at the early stage of the disease were different from those of HSP children without renal injury, suggesting that the intestinal flora disorder at the early stage of the disease may be closely related to the development of HSPN.

Efficacy and Prognostic Effect of Daratumumab-based Chemotherapy Regimen in Multiple Myeloma: a Real-world Study

WANG Jun, WU Jiafei, WANG Yijing, ZHENG Boyue, WANG Yu, JIANG Chuanyan, LI Hui

2023, 26(18):  2256-2262.  DOI: 10.12114/j.issn.1007-9572.2022.0878

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Background

Multiple myeloma (MM) is a common hematologic malignancy. With the emergence of a variety of new drugs, the survival rates of patients have increased, however, further discussion on how to achieve deeper and faster remission and reduce recurrence of patients is still needed.

Objective

To investigate the efficacy and safety of daratumumab in the chemotherapy of MM.

Methods

73 MM patients treated with daletumab in Sichuan Provincial People's Hospital from January 2020 to July 2022 were included as study subjects. Baseline information of the included patients were collected through the electronic medical record system. All patients were treated with daletumab based regimen and followed up through outpatient and inpatient review and telephone once a month when it is not time for review, with the time of first use of darettuzumab since 2020-01-01 as the starting point, death, disease recurrence or end of follow-up as the ending point. Follow-up was up to 2022-07-31 with a median follow-up time of 6.5 (0.5, 26.5) months. Overall response rate (ORR) and complete response rate were used to evaluate the efficacy of the patients. Kaplan-Meier curves were plotted for different drug use, initial renal function, drug administration, cytogenetic risk stratification and M protein types, and compared by Log-rank test.

Results

The median age of the patients was 64 (30, 86) years, including 38 males and 35 females. 28 MM patients were treated with first-line darettuzumab, 13 were switched from other regiments to darettuzumab due to adverse reactions, and 32 patients had relapsed and refractory multiple myeloma (RRMM). 18 patients were lost during follow-up, and a total of 55 patients were available for efficacy assessment. After one course of treatment with the darettuzumab-based chemotherapy regimen, ORR was 72.7% with the complete response rate of 30.9%, including 3.6% (2/55) achieved strin-gent complete response (sCR) and 27.3% (15/55) achieved complete response (CR), 10.9% (6/55) achieved very good partial response (VGPR), 30.9% (17/55) achieved partial response (PR), 9.1% (5/55) achieved minimal response (MR), 12.7% (7/55) achieved stable disease (SD), and 5.5% (3/55) achieved disease progression (PD). The median progress free survival (PFS) of the patients was 6.0 (0.5, 26.5) months, and the median overall survival was 16 (3, 103) months. There was no statistically significant difference in the PFS survival curve between patients treated first-line with darettuzumab and RRMM patients (χ²=3.676, P=0.055). The difference of PFS survival curve between patients with normal and impaired renal function was statistically significant (χ²=12.51, P=0.004). There was a statistically significant difference in the survival curve of patients treated with daletumab + bortezomib + dexamethasone and those treated with daletumab + dexamethasone (χ²=6.691, P=0.009). There was no statistically significant difference in PFS survival curves between patients with non-high risk and high-risk cytogenetic classification (χ²=0.328, P=0.567). There was no statistically significant difference in PFS survival curves among patients with M protein types of IgA, IgG, IgD, light chain, double clone and non-secretory (P>0.05). The main adverse reactions of the patients were infusion reaction and myelosuppression, of which 21 patients had adverse infusion reactions at the first infusion, 21 patients had leukopenia, 40 patients had anemia and 16 patients had thrombocytopenia.

Conclusion

Darettuzumab has good curative effect in MM patients, which can be used as the first-line treatment for newly diagnosed patients, improve the clinical prognosis of RRMM patients, and prolong the survival time of patients.

Clinical Effect and Safety of PD-1 Inhibitors plus Fruquintinib as Later-line Treatment for Metastatic Colorectal Cancer

CHEN Lulu, ZHANG Liping, LI Jingwen, DONG Wenjie, WU Xin'ai

2023, 26(18):  2262-2267.  DOI: 10.12114/j.issn.1007-9572.2022.0892

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Background

The incidence of colorectal cancer is high, and metastatic colorectal cancer has entered a new era of targeted immunotherapy. Due to the limited choices of effective later-line treatment and the substantial reduction of physical quality caused by long-term treatment of patients who have experienced more than three lines of treatment, the choice of later-line treatment with less adverse reactions and better clinical effect needs to be further explored.

Objective

To observe the clinical effect and safety of fruquintinib plus programmed death receptor-1 (PD-1) inhibitors in the third-line and above treatment of mCRC.

Methods

The clinical data of 75 patients with metastatic colorectal cancer admitted in the First Affiliated Hospital of Zhengzhou University from June 2020 to March 2022 were collected and analyzed retrospectively. The patients were divided into the fruquintinib alone group (n=28) and the PD-1 inhibitor plus fruquintinib group (n=47). The treatment regimen was: the patients in the fuquitinib alone group took oral furoquitinib capsules at 5 mg/d once for 3 consecutive weeks with a 1-week stop in 28-day cycles, the patients in the PD-1 inhibitor plus fruquintinib group were injected intravenously with carrilizumab/sindilizumab/pabrolizumab 200 mg and treprolizumab 240 mg from the first day in 21-day cycles, and fruquintinib was used in the same way as the fruquintinib alone group. The main observation indexes were objective response rate (ORR), disease control rate (DCR), progression-free survival time (PFS) and incidence of adverse reactions in the two groups.

Results

As of the last follow-up (2022-05-31), the ORR of the fruquintinib alone group and the PD-1 inhibitor plus fruquintinib group were 7.1% and 14.9%, the DCR of the fruquintinib alone group and the PD-1 inhibitor plus fruquintinib group were 67.9% and 89.4%, the DCR of patients in the PD-1 inhibitor plus fruquintinib group was significantly higher than that in the furoquinitinib alone group (χ²=5.345, P=0.021). The median PFS of the PD-1 inhibitor plus fruquintinib group and fruquintinib alone group were 6.4 months (IQR: 4.0-13.1) and 4.5 months (IQR: 2.9-8.2) ; there was significant difference in PFS between the two groups (χ²=5.504, P=0.019). Most of the adverse reactions during the treatment of the two groups were grade 1-2. The incidence of hypothyroidism in the PD-1 inhibitor plus fruquintinib group was significantly higher than that in the fruquintinib alone group (P<0.05). In addition, there was no significant difference in the incidence of other adverse reactions between the two groups (P>0.05) .

Conclusion

Compared with fruquintinib alone, PD-1 inhibitor plus fruquintinib has prolonged survival time and reduced incidence of severe adverse reactions in patients with metastatic colorectal cancer, making it an effective and safe treatment.

Research Methodology

A Review of Studies on Patient-reported Outcomes and Disease-specific Health-related Quality of Life Instruments for Irritable Bowel Syndrome

WU Xiaoyu, WAN Chonghua, CHEN Ying, RUAN Yanqin, WENG Yijie, XU Xiaojiang

2023, 26(18):  2268-2276.  DOI: 10.12114/j.issn.1007-9572.2022.0787

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Scale assessment for irritable bowel syndrome (IBS) has been widely implemented in clinical practice, how to choose an appropriate assessment tool is very important. In view of this, we used literature research methodology to search patient-reported outcomes and disease-specific health-related quality of life instruments for IBS, summarized their main contents and psychometric properties, then put forward recommendations on the selection of the instruments. A total of 37 commonly used instruments for IBS were retrieved, which have proven to have good reliability, validity and responsiveness, and can be better applied in clinical practice. We suggest medical professionals and researchers choose an assessment instrument for IBS according to the purpose and content of their research.

Research of the Measurement Properties of the Chinese Version of the Gastrointestinal Symptom Rating Scale for Patients with Gastrointestinal Diseases

QIN Yuning, ZHAO Tianyi, LIU Fengbin, WANG Xin, CAO Xue, SUN Minglin, LAI Keyun, DI Luyao, GE Zhishan, LIU Song, XING Ying, YANG Lei, YUE Lihong, ZOU Meimei, HE Liyun, LI Hongjiao

2023, 26(18):  2277-2285.  DOI: 10.12114/j.issn.1007-9572.2022.0820

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Background

Gastrointestinal symptoms as a common clinical evaluation index require a universal evaluation tool, and the Gastrointestinal Symptom Rating Scale (GSRS) has been widely applicated in domestic studies. However, the versions used are not standardized Chinese versions and their measurement performance has not been reported yet.

Objective

To explore the measurement performance of the Chinese version of the GSRS, in order to provide an objective basis for expanding the application of the scale.

Methods

From October 2021 to March 2022, patients with irritable bowel syndrome (IBS), chronic enteritis and chronic gastritis who attended outpatient clinics of splenogastroenterology or gastroenterology in 45 hospitals (community health service centers), including Jilin Provincial People's Hospital and Beijing Changping District Urban Community Health Service Center, etc. The Chinese version of GSRS was used to evaluate the gastrointestinal symptoms of the included patients on treatment days 0, 3, 7 and 14. Reliability and validity analyses were conducted on the Chinese version of GSRS, and the paired Wilcoxon signed rank sum test was applied to compare the changes in the scores of patients before and after treatment. Additionally, effect size (ES), standardized response mean (SRM), and score change rate (CR) were used to assess the responsiveness of the scales.

Results

A total of 554 patients were included and followed up, including 127 patients (22.93%) with IBS, 244 (44.04%) patientswith chronic enteritis and 183 (33.03%) patients with chronic gastritis. The Cronbach's alpha coefficient for the Chinese version of GSRS was 0.896, the Guttman Split-half coefficient was 0.920, the Spearman-Brown coefficient was 0.926, the intraclass correlation coefficient (ICC) for the two retest results was 0.589, and the Spearman correlation coefficient was 0.662. The content validity index for each item ranged from 0.78 to 1.00. The content validity index (CVI) for the scale-level universal agreement was 0.73, and the average CVI was 0.96. Exploratory factor analysis extracted a total of three common factors with eigenvalues>1, and the rate of cumulative variance contribution is 60.721%.The validation factor analysis demonstrated that the data samples did not fit the initial model M0 well, and each fit index of model M1 is within the acceptable range after correction according to the modification indicator hints in the acceptable range: χ²/df<3.000, root mean square error of approximation (RMSEA) <0.800, and each fit index >0.900. The total Chinese version of GSRS scores of patients after 14 d of treatment are lower than the total Chinese version of GSRS scores before treatment (P<0.001), with ES=1.03, SRM=1.01, and CR=74.32%.

Conclusion

The Chinese version of GSRS has a high level of measurement performance with good reliability and responsiveness, which is suitable for measuring a general population with gastrointestinal symptoms and evaluating the treatment effectiveness of them.

Evidence-based Medicine

Meta-analysis of the Relationship between Dietary Inflammatory Index and Upper Gastrointestinal Cancer Risks

ZHAI Leilei, ZHAO Shupeng, YAO Ping

2023, 26(18):  2286-2292.  DOI: 10.12114/j.issn.1007-9572.2022.0861

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Background

Dietary components can produce a variety of bioactive substances that maintain a low inflammatory state in the body and participate in the formation of the tumor microenvironment. The dietary inflammatory index (DII) is a new indicator to quantify the inflammatory potential of diet. High DII score is closely associated with the risk of colorectal cancer, but its relationship with upper gastrointestinal cancer (UGIC) is unclear.

Objective

This study was conducted to assess the relationship between DII and the risk of UGIC, providing a scientific basis for dietary guidance.

Methods

We did a systematic search of PubMed, Web of Science, Embase and the Cochrane Library for studies on the association of DII score and UGIC published in English, and Wanfang Data, CNKI and VIP for those published in Chinese, from inception to October 10, 2022. Two researchers performed literature screening, data extraction, and quality evaluation separately. RevMan 5.4.1 was used for meta-analysis and subgroup analysis.

Results

A total of 11 case-control studies including 9 051 participants were included in this study. Meta-analysis showed that high DII score were associated with an increase in the risk of UGIC〔OR=1.81, 95%CI (1.65, 1.97), P<0.05〕. High DII score also significantly increased the risk of esophageal and gastric cancers〔OR=2.20, 95%CI (1.69, 2.86) ; OR=1.79, 95%CI (1.44, 2.24), P<0.05〕. Subgroup analysis showed that high DII score increased the risk of UGIC by 131% in the European population〔OR=2.31, 95%CI (1.78, 3.00), P<0.05〕, and 98% in the Asian population〔OR=1.98, 95%CI (1.55, 2.53), P<0.05〕. High DII score increased the risk of UGIC by 161% in women〔OR=2.61, 95%CI (1.79, 3.79), P<0.05〕. Moreover, high DII score increased the risk of UGIC by 47% in H. pylori-negative populations〔OR=1.47, 95%CI (1.08, 1.99), P<0.05〕, and 90% in H. pylori-positive populations〔OR=1.90, 95%CI (1.33, 2.71), P<0.05〕. High DII score was associated with a 195% increased risk of UGIC in the population with interviewer-administered Food Frequency Questionnaire (FFQ) 〔OR=2.95, 95%CI (1.96, 4.43), P<0.05〕, and a 68% increased risk of UGIC in the population with self-administered FFQ〔OR=1.68, 95%CI (1.53, 1.85), P<0.05〕. High DII score was associated with a 101% increased risk of UGIC in the population with a higher number of DII components (>30) 〔OR=2.01, 95%CI (1.57, 2.57), P<0.05〕, and a 125% increased risk of UGIC in the population with a lower number of DII components (<30) 〔OR=2.25, 95%CI (1.58, 3.22), P<0.05〕. In addition, high DII score increased the risk of UGIC by 123% in the population with energy-adjusted diet〔OR=2.23, 95%CI (1.85, 2.68), P<0.05〕, and 70% in the population without energy-adjusted diet〔OR=1.70, 95%CI (1.53, 1.88), P<0.05〕. The funnel plot of the literature was asymmetric, showing that there was a certain publication bias.

Conclusion

A pro-inflammatory diet with higher DII score may exacerbate the risk of UGIC, especially in esophageal cancer patients and in the female population.

Dysphagia Incidence after Cardiac Surgery: a Meta-analysis

LIU Lu, JIANG Yunlan, PENG Hanmei, LU Yutong, LIU Mingting, LIAO Shiqin

2023, 26(18):  2293-2300.  DOI: 10.12114/j.issn.1007-9572.2022.0603

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Background

Dysphagia incidence after cardiac surgery is increasing due to increased complexity of the surgery and number of older patients, which has become one of the most severe complications of cardiac surgery, affecting patients' physical health and recovery.

Objective

To perform a review of available evidence on the incidence of dysphagia after cardiac surgery.

Methods

Databases of PubMed, Embase, Cochrane Library, CINAHL, Web of Science, CBM, CNKI, Wanfang Data, and VIP were searched from inception to May 2022 for published studies on the incidence of dysphagia after cardiac surgery. Two researchers independently conducted a literature enrollment, quality assessment, and data extraction. Meta-analysis was conducted using Stata 15.0.

Results

Fifteen studies with 7 880 patients were included. The meta-analysis revealed that the overall incidence of dysphagia after cardiac surgery was 13.3%〔95%CI (10.1%, 16.5%) 〕. Further region-specific analysis indicated that, the incidence of dysphagia following cardiac surgery in Asia, North America, and Oceania was 16.6%〔95%CI (10.4%, 22.8%) 〕, 10.0%〔95%CI (6.1%, 13.8%) 〕, and 17.4%〔95%CI (12.3%, 23.5%) 〕, respectively. According to sex-specific analysis, the incidence of dysphagia following cardiac surgery was 16.9%〔95%CI (11.8%, 21.9%) 〕, and 16.4%〔95%CI (11.1%, 21.8%) 〕 in male and female patients, respectively. The analysis based on age group indicated that the dysphagia incidence following cardiac surgery in patients aged <70 years and ≥70 years was 10.9%〔95%CI (8.6%, 13.5%) 〕 and 28.4%〔95%CI (19.7%, 37.9%) 〕, respectively. And analysis based on NYHA class found that the dysphagia incidence was 11.8%〔95%CI (7.4%, 16.3%) 〕 in patients with NYHA classⅠ or Ⅱ, and was 21.0%〔95%CI (11.0%, 30.9%) 〕 in those with NYHA class Ⅲ or Ⅳ. In accordance with analysis based on the duration of perioperative endotracheal intubation, the incidence of dysphagia following cardiac surgery in patients with <12 hours, 12-24 hours, 25-48 hours and >48 hours was 1.0%〔95%CI (0.3%, 1.8%) 〕, 6.4%〔95%CI (4.4%, 8.3%) 〕, 16.8%〔95%CI (9.5%, 24.1%) 〕, and 55.0%〔95%CI (28.0%, 82.0%) 〕, respectively. In addition, chronic kidney disease, chronic lung disease, previous history of cerebrovascular accident, atrial fibrillation, heart failure, intraoperative transesophageal echocardiography, perioperative stroke and sepsis were associated with a higher incidence of dysphagia after cardiac surgery. The results of the meta-analysis were robust, as shown by sensitivity analysis. Both Begg's and Egger's tests yielded P-value<0.05, indicating that publication bias existed in the studies.

Conclusion

Current evidence indicates that the incidence of dysphagia after cardiac surgery is high (13.3%), therefore, prompt postsurgical screening and treatment of dysphagia should be administered.

Study of Typical Cases

A Mutation in the Insulin Receptor Substrate 2 Gene May Be Associated with Maturity-onset Diabetes of the Young: a Case Report with Genetic Analysis

REN Yumei, XU Min, YE Meilei, ZHANG Qiu, HU Honglin

2023, 26(18):  2301-2305.  DOI: 10.12114/j.issn.1007-9572.2022.0717

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Maturity-onset diabetes of the young (MODY) belongs to a kind of monogenic diabetes characterized by pancreatic β-cell dysfunction and high level of genetic heterogeneity. As of August 2022, 14 genes responsible for MODY have been identified clearly. In this paper, a case of suspected MODY was reported. A mutation in the insulin receptor substrate 2 (IRS2) gene was identified by exome sequencing, and also found in 11 family members of the patient. It is proposed that IRS2 gene may be a new candidate gene for MODY, informing the diagnosis and treatment of MODY.

Autosomal Dominant Alport Syndrome Caused by a Novel COL4A4 Gene Mutation: a Case Report and Literature Review

GUO Ting, ZHANG Jian, DING Ying, YANG Xiaoqing, ZHAI Wensheng, SONG Chundong, ZHANG Xia, ZHANG Bo, GAO Xuguang, LIU Liya

2023, 26(18):  2306-2310.  DOI: 10.12114/j.issn.1007-9572.2022.0528

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Alport syndrome (AS) is one of the important causes of chronic kidney disease and end-stage renal disease. It is the second most common inherited kidney disease after autosomal dominant polycystic kidney disease. Autosomal dominant inheritance is a very rare mode of inheritance in AS, and patients with autosomal dominant forms of AS (ADAS) were previously reported to progress to end-stage renal disease at a later age. This article reported a patient who was diagnosed with ADAS in the Pediatric Nephrology Department of the First Affiliated Hospital of Henan University of CM on September 5, 2019 because of abnormal urine test findings for 4 years. The clinical data and genetic test results were reviewed. We reported the clinical, renal pathology and gene mutation of a ADAS family caused by the new mutation c.3506-3528del (p.G1169Efs^*13) of COL4A4 gene (One family member developed end-stage renal disease at the age of 31). We also summarized the literature reports of Chinese ADAS, and made a comprehensive analysis of the relationship between the gene, clinical phenotype and prognosis of the disease. Due to the low incidence of ADAS, this family report expands the gene mutation spectrum of AS, and helps to improve clinicians' awareness and timely diagnosis and treatment of rare-onset ADAS.