Table of Content

20 July 2023, Volume 26 Issue 21

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Hot Topics

Research Hotspots and Evolutionary Trends on Multimorbidity in China from 2002 to 2022

ZHENG Xiao, TIAN Feng, CHEN Yiming, XUE Benli, SHI Lei, ZHANG Chichen

2023, 26(21):  2567-2573.  DOI: 10.12114/j.issn.1007-9572.2023.0066

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Background

Multimorbidity have become a major character in the course of chronic diseases that brings a challenge for public health development in China. The development of multimorbidity research in China is in an early stage with fewer literature, and there is a lack of systematic and comprehensive literature analysis.

Objective

To conduct a bibliometric and visual analysis of research hotspots and evolutionary trends in the field of multimorbidity in China, grasp the research frontiers and development directions in the field, thereby providing a reference for future research directions.

Methods

CNKI (Chinese data source) and WOS (foreign data source) were searched for the literature in the field of multimorbidity researches published by Chinese researchers from 2002 to 2022. CiteSpace software was used to analyze the spatial and temporal distribution of multimorbidity and explore the research hotspots and evolutionary trends in the field of multimorbidity by plotting the collaboration network map of institutions and co-occurrence map of keywords for researches in the field of multimorbidity published by Chinese researchers.

Results

The number of published literatures in the field of multimorbidity showed an increasing trend from 2002 to 2022. The top 5 Chinese keywords were "comorbidity (342 times) " "older adults (161 times) " "depression (155 times) " "chronic diseases (106 times) " "diabetes (94 times) " ; and the top 5 English keywords were "prevalence (126 times) " "older adults (92 times) " "multimorbidity (91 times) " "health (75 times) " "disease (71 times) " . There were 4 development stages in the research development history of multimorbidity: the initial stage of research, the researchers focused on the comorbidity characteristics but did not define it in a uniform way; the second stage of research, the researchers focused on comorbidity and chronic disease in older adults, discovered the high prevalence of multimorbidity in the elderly population; the third stage of research, the domestic researches on multimorbidity developed rapidly, involving influencing factors, comorbidity patterns, polypharmacy, quality of life and debilitation; the fourth stage of research, the definition of multimorbidity is becoming clearer, showing a trend of research diversification.

Conclusion

Researches in the field of multimorbidity is becoming increasingly diversified. Researchers should focus on the prevention and treatment of complex multimorbidity, and construct health management strategies and community intervention programs for multimorbidity population in China.

Analysis of Research Hotspots of Multiple Chronic Conditions in the Elderly in 2010-2021

FENG Jia, WANG Jie, YU Dan, LIU Yongheng, ZHAO Weidong, TIAN Hongyuan

2023, 26(21):  2574-2580.  DOI: 10.12114/j.issn.1007-9572.2023.0085

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Background

With the acceleration of population aging, multiple chronic diseases have become common in the elderly, and the research on multiple chronic diseases in the elderly is also increasing. However, few studies have been conducted to analyze its progress and hotspots.

Objective

To analyze the hotspots of multiple chronic diseases in the elderly at home and abroad, revealing the hotspots in frontiers research, so as to provide a reference for related researchers to track cutting-edge information.

Methods

The literatures related to multiple chronic diseases in the elderly were retrieved from Web of Science, Scopus, CNKI, Wanfang Data, VIP, PubMed, Chinese Medical Association Journal Full-text database, and APA-PsycINFO database of the American Psychological Association with the retrieval time of 2010-2021, based on text mining technology and bibliometrics method, etc. CiteSpace 6.1.3, PASW 18, BICOMB 2.04 and other software were used to analyze and visualize the trends in number of papers published, sources, authors, institutions, keywords and other aspects of literature publication. Strategic coordinate maps were drawn to analyze research hotspots in the field.

Results

Finally, 9 392 literatures related to multiple chronic diseases in the elderly were involved, including 5 776 literatures in foreign language and 3 616 literatures in Chinese. The numbers of literatures related to multiple chronic diseases in the elderly both in foreign language and Chinese have increased exponentially in the past decade, with the annual growth rate of 13.27% in Chinese literature and 15.84% in foreign literature, suggesting the development stage of multiple chronic diseases in the elderly. Five mainstream research hotspots have been identified in both Chinese and foreign literatures. There are more literatures related to multiple chronic disease such as chronic obstructive pulmonary disease, diabetes mellitus, hypertension, and respiratory diseases. The foreign literatures have focused more on the psychiatric comorbidity, followed by somatic comorbidities such as diabetes mellitus, hypertension, and heart failure.

Conclusion

The analysis results shows that the field of multiple chronic diseases in the elderly is in a rapid development stage. Analysis of foreign literature shows that psychiatric comorbidity is a relatively hot topic but not mature enough, research results related to multiple chronic diseases in the elderly are abundant and diversified, but the research depth is in sufficient. Domestic literature analysis shows that chronic obstructive pulmonary disease combined with respiratory diseases in the elderly is at the core of the field, and there is a lack of studies related to psychiatric comorbidity such as depression and mutiple chronic diseases such as health situation, nursing and health care, which may become the main direction of research development in the future.

Original Research

Occurrence Status and Influencing Factors of Cognitive Dysfunction in Population Aged 60 and Above

YU Yanxue, BAI Ruyu, YU Wenlong, GUO Xia, WU Li'e

2023, 26(21):  2581-2588.  DOI: 10.12114/j.issn.1007-9572.2023.0004

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Background

With the accelerated aging process, the incidence of dementia is increasing year by year, but there is no effective cure and the prognosis is poor. The cognitive function is still plastic during subjective cognitive decline (SCD) , which as a preclinical stage of dementia, it is of great significance for the prevention and management of dementia to investigate the prevalence and influencing factors of SCD.

Objective

To investigate the prevalence and risk factors of SCD, MCI and dementia in population aged 60 and above in Baotou, Inner Mongolia.

Methods

From June 2021 to September 2022, a cross-sectional survey was conducted involving 1 120 objects in 21 neighborhood councils and 17 village committees randomly selected from 3 banner counties (Hondlon District, Jiuyuan District and Guyang County) of Baotou City, Inner Mongolia Autonomous Region by using the combination of multistage sampling, cluster sampling and random sampling. General information of the study subjects were collected by questionnaire and their cognitive function was assessed. According to cognitive function, the study subjects were divided into the normal group (n=206) , SCD group (n=491) , MCI group (n=320) and dementia group (n=103) . Multivariate Logistic regression was used to analyze the influencing factors of cognitive function.

Results

The median age of the study subjects was 68.0 (63.0, 73.0) years and the median number of years of education was 9.0 (5.0, 11.4) years. Absence of spouse〔OR=2.542, 95%CI (1.139, 5.674) , P=0.023〕, obesity〔OR=6.058, 95%CI (2.281, 16.093) , P<0.001〕, predominant vegetarian type of diet〔OR=3.037, 95%CI (1.868, 4.936) , P<0.001〕, nightly sleep duration <6 hours〔OR=1.662, 95%CI (1.099, 2.516) , P=0.016〕, smoking history〔OR=1.971, 95%CI (1.231, 3.157) , P=0.005〕, diabetes history〔OR=1.975, 95%CI (1.140, 3.422) , P=0.015〕, coronary heart disease history〔OR=3.501, 95%CI (1.016, 12.062) , P=0.047〕, and vision loss history〔OR=2.454, 95%CI (1.638, 3.677) , P<0.001〕were risk factor for the prevalence of SCD in population aged 60 and above. Rural residence〔OR=2.636, 95%CI (1.231, 5.641) , P=0.013〕, absence of spouse〔OR=2.843, 95%CI (1.228, 6.582) , P=0.015〕, obesity〔OR=5.626, 95%CI (2.046, 15.475) , P=0.001〕, predominant vegetarian type of diet〔OR=3.832, 95%CI (2.212, 6.640) , P<0.001〕, predominant meat type of diet〔OR=2.619, 95%CI (1.536, 4.465) , P<0.001〕, smoking history〔OR=1.912, 95%CI (1.133, 3.227) , P=0.015〕, diabetes history〔OR=2.544, 95%CI (1.378, 4.697) , P=0.003〕, coronary heart disease history〔OR=3.945, 95%CI (1.110, 14.016) , P=0.034〕, and vision loss history〔OR=2.846, 95%CI (1.780, 4.551) , P<0.001〕were risk factors for the prevalence of MCI in population aged 60 and above, education level of junior high school〔OR=0.180, 95%CI (0.103, 0.314) , P<0.001〕, high school and above〔OR=0.075, 95%CI (0.041, 0.136) , P<0.001〕were protective factors for MCI in population aged 60 and above. Rural residence〔OR=5.511, 95%CI (2.306, 13.170) , P<0.001〕, absence of spouse〔OR=2.987, 95%CI (1.152, 7.746) , P=0.024〕, obesity〔OR=7.303, 95%CI (2.436, 21.890) , P<0.001〕, predominant vegetarian type of diet〔OR=7.025, 95%CI (3.626, 13.609) , P<0.001〕, predominant meat type of diet〔OR=2.255, 95%CI (1.102, 4.616) , P=0.026〕, nightly sleep duration<6 hours〔OR=2.164, 95%CI (1.206, 3.883) , P=0.010〕, smoking history〔OR=2.661, 95%CI (1.415, 5.004) , P=0.002〕, diabetes history〔OR=2.186, 95%CI (1.033, 4.624) , P=0.041〕, coronary heart disease history〔OR=6.830, 95%CI (1.809, 25.783) , P=0.005〕and vision loss history〔OR=3.267, 95%CI (1.785, 5.979) , P<0.001〕were risk factors for the prevalence of dementia in population aged 60 and above. Age 60-69 years〔OR=0.211, 95%CI (0.074, 0.597) , P=0.003〕, 70-79 years〔OR=0.218, 95%CI (0.077, 0.620) , P=0.004〕, education level of junior high school〔OR=0.473, 95%CI (0.229, 0.977) , P=0.043〕, high school and above〔OR=0.227, 95%CI (0.105, 0.493) , P<0.001〕were protective factors for the prevalence of dementia in population aged 60 and above.

Conclusion

The prevalence rates of SCD, MCI and dementia among the older adults aged 60 and above in Baotou region of Inner Mongolia is at a high national level. Rural residents, old age, absence spouse, low education level, obesity, predominant vegetarian or meat type of diet, sleep less than 6 hours per night, smoking, diabetes, coronary heart disease and vision loss are the main risk factors of the prevalence of SCD, MCI and dementia among the older adults in this region.

The Association and Predictive Value of Lipid Ratios to Metabolic Syndrome: a Multistage Cross-sectional Study

ZHOU Shiyu, CHEN Shaolin, DENG Renli, DAI Mi, LIU Tao, TIAN Kunming

2023, 26(21):  2589-2596.  DOI: 10.12114/j.issn.1007-9572.2023.0027

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Background

With the growing incidence of metabolic diseases, there has been increasing attention given to the prevention and control of metabolic syndrome (MS) . As important screening markers of MS, the relationship between lipid ratios and MS has become a hot research topic.

Objective

To analyse the association and predictive value of triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio, total cholesterol/HDL-C (TC/HDL-C) ratio, low-density lipoprotein cholesterol/ HDL-C (LDL-C/HDL-C) ratio and non-HDL-C to the risk of MS in populations included in a multistage cross-sectional study in Guizhou Province.

Methods

This study retrospectively selected natural populations (totally 21 727 cases) from Guizhou who attended the National Survey of Chronic Diseases and Risk Factors in Surveillance Regions 2010, China Chronic Disease and Risk Factor Surveillance 2013, and two waves of China Adult Chronic Disease and Nutrition Surveillance (2015 and 2018) . Baseline data were collected, and according to MS prevalence included in which, subjects were divided into MS group (n=4 981) and non-MS group (n=16 746) . The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C for MS in males and females, respectively. The Delong test was used to compare the values of area under the ROC curve (AUC) of lipid ratios in predicting MS. Multivariate Logistic regression was used to analyze the association of lipid ratios with MS measured using odds ratio (OR) with 95% confidence interval (CI) , and to identify factors associated with MS among subjects stratified by survey time, age, sex, body mass index (BMI) , smoking and alcohol consumption.

Results

There were statistically significant differences in mean age, sex ratio, distribution of ethnicities, education level and marital status, prevalence of smoking and alcohol consumption, and mean BMI, TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C between MS group and non-MS group (P<0.05) . TG/HDL-C ratio had a higher AUC value than TC/HDL-C ratio (Z=17.822, P<0.001) , LDL-C/HDL-C ratio (Z=23.813, P<0.001) and non-HDL-C (Z=27.608, P<0.001) . The value of AUC of TG/HDL-C ratio was higher in males than that in females (Z=4.299, P<0.001) . And the value of AUC of LDL-C/HDL-C ratio in males was lower than that in females (Z=2.061, P=0.039) . Multivariate Logistic regression analysis showed that in <60 years old, ≥60 years old, male, female, BMI<24.0 kg/m², BMI≥24.0 kg/m², smoking, non-smoking, drinking and non-drinking groups, TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C were associated with the prevalence of MS (P<0.05) .

Conclusion

TG/HDL-C ratio has a good predictive value for MS. TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C are associated factors of MS, which should be paid more attention clinically in females, individuals with BMI<24.0 kg/m², non-smokers or non-drinkers.

The Mediating Effect of Waist Circumference and Fasting Plasma Glucose on the Association between Obstructive Sleep Apnea Syndrome and Arterial Stiffness in a Population Aged 40-65 Years

DING Xiaoyun, JIN Juzhen, YANG Jin, ZHOU Jing, HU Jin, MENG Yue, LIANG Xiaoxian, GAI Yun, WANG Junhua, WANG Ziyun

2023, 26(21):  2597-2602.  DOI: 10.12114/j.issn.1007-9572.2023.0119

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Background

Obstructive sleep apnea syndrome (OSAS) is a sleep-related disease. Evidence has shown that OSAS may increase the risk of developing arterial stiffness (AS) , but the mechanism of action still needs to be further explored.

Objective

To explore the mediating effect of waist circumference (WC) and fasting plasma glucose (FPG) on the association between OSAS and AS.

Methods

A total of 1 053 health examinees were selected from Physical Examination Center, the First People's Hospital of Fuquan City from March 23 to November 30, 2022. General demographic data were collected. The risk of OSAS was assessed using the STOP-Bang Questionnaire (high or low risk of OSAS was diagnosed by STOP-Bang score ≥4 points or <4 points) . AS was assessed, and 553 cases with AS and 500 without were assigned to AS and non-AS groups, respectively. Multivariate Logistic regression analysis was used to explore the factors associated with AS. FPG was converted to exponential form (-2.576 1) to obtain the exponential value of FPG (FPGa) . Multiple linear model was used to analyze the relationship of OSAS with WC and FPGa. The mediation effect of WC and FPG between OSAS and AS was analyzed using Hayes Process models 4 and 6 in R.

Results

AS and non-AS groups had statistically significant differences in mean age, sex ratio, prevalence of smoking and hypertension, mean body mass index, WC, neck circumference, FPG, triglyceride, and high-density lipoprotein cholesterol as well as the level of OSAS risk (P<0.05) . Multivariate Logistic regression analysis showed that compared with individuals with low-risk OSAS, the risk of AS increased in those with high-risk OSAS (P<0.05) , and the risk of AS increased by 0.048 times for every 1 cm increase in WC and 0.512 times for every 1 mmol/L increase in FPG (P<0.05) . Multiple linear regression analysis showed that OSAS was associated with WC and FPGa (P<0.05) , and WC was an associated factor of FPGa (P<0.05) . The chained multimediator model showed that OSAS directly affected the incidence of AS〔β=0.661, 95%CI (0.284, 1.038) 〕. The indirect mediation effect value (β) of the "OSAS→WC→AS" path was 0.224〔95%CI (0.073, 0.398) 〕, accounting for 20.86% of the total effect. The indirect mediation effect value (β) of the "OSAS→FPGa→AS" path was 0.115〔95%CI (0.024, 0.216) 〕, accounting for 10.71% of the total. The indirect mediation effect value (β) of the "OSAS→WC→FPGa→AS" path was 0.074〔95%CI (0.036, 0.126) 〕, accounting for 6.89% of the total.

Conclusion

WC and FPG may partially mediate the relationship between OSAS and AS. In addition, they are involved in the process of "OSAS→WC→FPGa→AS" as chained mediators. People with high risk of OSAS should actively control WC to reduce the possibility of developing central obesity, and regulate FPG to prevent the occurrence of AS.

Effect of an Internet-based Intervention on Motor Behavior in Patients after Percutaneous Coronary Intervention

WANG Dan, WANG Jianhui, DONG Jianxiu, CHANG Wenhong, QIN Lu, LIU Qi, CHEN Chen

2023, 26(21):  2603-2608.  DOI: 10.12114/j.issn.1007-9572.2023.0055

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Background

During the containment of COVID-19, the traditional face-to-face interventions conducted at the rehabilitation center were plagued by many limitations, while internet-based interventions can overcome the limitations of geographic location, working hours and transportation, with less medical costs.

Objective

To examine the effects of internet-based interventions on knowledge, attitude/belief and practice (KAP) toward rehabilitation exercises, physical activity (PA) level, and exercise compliance inpatients after PCI.

Methods

The subjects were 76 patients who received their first PCI in Department of Cardiology, Tangshan Gongren Hospital from November 2021 to June 2022. They were randomly and equally divided into two groups to receive either internet-based intervention with routine nursing (experimental group) or routine nursing (control group) . Before and three months after the intervention, the Rehabilitation Exercise Knowledge-Belief-Practice Scale for Patients with Coronary Heart Disease (REKBPCHD) , the International Physical Activity Questionnaire-Short Form (IPAQ-SF) , and Patients' Exercise Log were used to assess the KAP level, PA level, and exercise adherence, respectively. The impact of network intervention on exercise adherence in patients after PCI by univariate Logistic regression analysis.

Results

After 3 months of intervention, a significant increase was found in the average total score of REKBPCHD, and the average scores of the knowledge dimension, attitude dimension and practice dimension of the scale in the experimental group (P<0.05) , and the increase was more notable than that in the control group (P<0.05) . Moreover, both post-intervention low PA level and total PA level in the experimental group were higher than those in the control group (P<0.05) . Both post-intervention low PA level and total PA level were higher than the baseline levels in the experimental group (P<0.05) . The post-intervention exercise compliance of experimental group were higher than that in the control group (P=0.003) . Univariate Logistic regression analysis showed that the risk of non-adherence to exercise in the experimental group was relatively lower than that in the control group〔OR=0.143, 95%CI (0.034, 0.594) , P=0.007〕.

Conclusion

Theinternet-based intervention can effectively improve the KAP level toward rehabilitation, PA level, and exercise adherence in patients after PCI.

Correlation between Allostatic Load Level and Depression among Women in Early Pregnancy

WANG Minghuan, LI Yuhong, YUAN Dehui, YU Min, HAN Baoliang, YU Qiaozhi, YANG Fangfang, ZHANG Qin

2023, 26(21):  2609-2613.  DOI: 10.12114/j.issn.1007-9572.2023.0017

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Background

Chronic stress is known to be associated with the onset of depression, allostatic load (AL) may play a significant role in the pathogenesis of depression as a comprehensive physiological index to evaluate response to the chronic stress.

Objective

To identify the association between AL level and depression among women in early pregnancy.

Methods

630 Women in early pregnancy who underwent prenatal examination in the 901 Hospital, Joint Logistic Support Force of the Chinese People's Liberation Army, Jin'an Maternal and Child Health Care Hospital from November 2021 to June 2022 were selected as the research subjects by using convenience sampling method, and were divided into the depression group (n=162) and non-depression group (n=468) according to presence or absence of depression. The general information questionnaire, Pregnancy-specific Anxiety Questionnaire and Edinburgh Postnatal Depression Scale were used for questionnaire survey, AL-related data were collected by physical examination and laboratory tests. Multivariate Logistic regression model was used to analyze the association between AL level and depression among women in early pregnancy.

Results

A total of 630 pregnant women in early pregnancy were enrolled with the depression incidence of 25.7% (162/630) , including 427 pregnant women (67.8%) with low AL level (AL<3) and 203 (32.2%) with high AL level (AL≥3) . Multivariate Logistic regression analysis showed that high AL level was the risk factor for depression among women in early pregnancy〔OR=1.651, 95%CI (1.096, 2.489) , P<0.05〕.

Conclusion

There is a positive association between AL level and depression among women in early pregnancy, high AL level will increase the risk of depression.

Study on the Predictive Value of Abdominal Fat Content and Distribution in the Acute Pancreatitis and Its Severity

HU Xiaofei, ZHAO Ping, CAO Tinghua, PENG Lanlan

2023, 26(21):  2614-2619.  DOI: 10.12114/j.issn.1007-9572.2022.0735

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Background

Acute pancreatitis (AP) is a common acute abdominal abdomen, and severe AP has considerable mortality. Early and accurate identification of AP is critical for the prevention, treatment and prognosis evaluation of AP. Studies have shown that obesity is associated with the incidence and clinical outcome of AP. However, there is a lack of obesity-related quantitative indices for the diagnosis and evaluation of AP.

Objective

To investigate the relationship of abdominal fat content and distribution with AP and its severity, providing a scientific basis for the prevention, diagnosis and treatment of AP.

Methods

One hundred AP patients (including 75 with non-severe AP and 25 with severe AP) and 100 non-AP patients〔AP was diagnosed by Chinese Guidelines for the Management of Acute Pancreatitis (Shenyang, 2019) 〕were selected from Department of General Surgery, the Southwest Hospital of AMU from January 2019 to June 2021. Clinical data were collected, including sex, age, underlying disease (hypertension, diabetes or hyperlipidemia) , history of biliary tract disease, BMI, areas of CT-assessed abdominal subcutaneous adipose tissue (SAT) , visceral adipose tissue (VAT) and total abdominal adipose tissue (TAT) , and calculated VAT/SAT ratio and VAT/TAT ratio. Multivariate Logistic regression analysis was conducted to identify factors associated with AP and its severity. ROC analysis was conducted to estimate the diagnostic value and efficiency of BMI, and indices related to abdominal fat content and distribution for the prevalence and severity of AP.

Results

The proportion of BMI and hyperlipidemia in AP group was higher than that in non-AP group (P<0.05) . VAT, TAT, VAT/SAT and VAT/TAT in AP group were higher than those in non-AP group (P<0.05) . VAT, TAT, VAT/SAT and VAT/TAT in severe AP subgroup were higher than those in non-severe AP subgroup (P<0.05) . Multivariate Logistic analysis showed that BMI〔OR=1.985, 95%CI (1.616, 2.438) 〕, VAT〔OR=1.126, 95%CI (1.088, 1.165) 〕, TAT〔OR=1.028, 95%CI (1.019, 1.038) 〕 were associated with AP (P<0.05) . BMI〔OR=7.543, 95%CI (2.576, 22.088) 〕and TAT〔OR=1.074, 95%CI (1.038, 1.111) 〕were associated with the severity of AP (P<0.05) . For predicting AP, the AUC of BMI was 0.833〔95%CI (0.777, 0.888) , P<0.001〕, with 90.0% sensitivity and 62.0% specificity when the optimal cut-off value was chosen as 17.610 kg/m²; the AUC of VAT was 0.939〔95%CI (0.909, 0.969) , P<0.001〕, with 84.0% sensitivity and 89.0% specificity when the optimal cut-off value was chosen as 104.250 cm²; the AUC of TAT was 0.800〔95%CI (0.739, 0.860) , P<0.001〕, with 83.0% sensitivity and 66.0% specificity when the optimal cut-off value was chosen as 184.995 cm². When it comes to predicting the severity of AP, the AUC of TAT was 0.910〔95%CI (0.844, 0.976) , P<0.001〕, with 84.0% sensitivity and 84.0% specificity when the optimal cut-off value was chosen as 201.357 cm², and the AUC of BMI was 0.928〔95%CI (0.856, 1.000) , P<0.001〕, with 88.0% sensitivity and 89.3% specificity when the optimal cut-off value was chosen as 21.180 kg/m².

Conclusion

CT-assessed abdominal fat content and distribution may be closely associated with AP and its severity. It is suggested to include CT quantitative measurement of abdominal fat content and distribution in the AP diagnosis, severity assessment and treatment system since the two indicators reflect relevant information that could be used as scientific evidence.

Association between ACAT-1 rs1044925 SNP and Acute Coronary Syndrome and Change of Serum Lipid Level in Response to Atorvastatin Treatment

WANG Zhou, DENG Jinlong, WU Dongfeng

2023, 26(21):  2620-2625.  DOI: 10.12114/j.issn.1007-9572.2022.0069

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Background

Previous studies have shown that the rs1044925 single nucleotide polymorphism (SNP) of ACAT-1 gene is associated with the risk of coronary heart disease and ischemic stroke, and both are correlated to the level of blood lipid.

Objective

To observe the relationship between rs1044925 SNP of ACAT-1 gene and acute coronary syndrome (ACS) , and the relationship between rs1044925 SNP and the change of serum lipids level in response to atorvastatin treatment in patients with ACS.

Methods

111 patients diagnosed with ACS and treated with percutaneous coronary intervention (PCI) in the Department of Geriatric Cardiovascular, People's Hospital of Guangxi Zhuang Autonomous from January 2016 to January 2018 were selected in ACS group (67 males and 44 females) . All patients were treated with atorvastatin 20 mg per night, Clopidogrel 75 mg, once a day (or tegranolol 90 mg, twice a day) , and Aspirin 100 mg, once a day. Atorvastatin 20 mg/night was routinely used after PCI. The control group consisted of 338 healthy people in the same time period (170 males and 168 females) . ACAT-1 rs1044925 SNP was genotyped by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) . The baseline blood lipid levels of ACS group and control group were detected. The blood lipid parameters of the ACS group were measured after treatment of atorvastatin for one year averagely.

Results

There was no statistical difference in serum TC between the ACS group and the control group (P>0.05) , but there were statistical differences in the levels of TG, HDL-C, LDL-C, ApoAI, and ApoB (P<0.05) between the two gruops. There was no statistical difference in the distribution of ACAT-1 rs1044925 SNP genotype and allele frequency between the ACS group and the control group (P>0.05) . There was no statistical difference in the levels of TC, TG, HDL-C, LDL-C, ApoAI and ApoB among each genotype group of ACAT-1 rs1044925 SNP in the control group (P>0.05) . After atorstatin treatment, the serum TC, LDL-C, ApoAI, ApoB and lipoprotein (Lp) (α) levels in ACS patients were statistically different from baseline levels (P<0.05) . There was no statistical difference in the levels of TC, TG, HDL-C, LDL-C, ApoAI, and ApoB at baseline among the genotypes from starting point and one year later in the ACS group (P>0.05) . There was no statistical difference in the baseline of Lp (α) level among genotypes (P>0.05) in ACS patients, but after 1 year of treatment, the Lp (α) level of each genotype was statistically different (P<0.05) . Comparing baseline levels with the levels of TC, LDL-C, ApoAI, ApoB, Lp (α) after treatment in patients with AA genotype and comparing baseline levels with the levels of TC, LDL-C, ApoB levels in patients with AC/CC genotype after treatment, the differences were statistically significant (P<0.05) . Comparing the decrease in the levels of TC, LDL-C, ApoB with the increase of level in ApoAI after atorvastatin treatment between different genotypes, there was no statistical difference (P>0.05) . There was statistical difference among the decrease in the levels of Lp (α) after atorvastatin treatment among different genotypes (P<0.05) .

Conclusion

This study demonstrates that the ACAT-1 rs1044925 SNP is not significantly associated with ACS. However, ACS patients with rs1044925 SNP AA genotype have better decreasing effect in Lp (α) level than patients with AC/CC genotype after atorvastatin treatment.

Associations of Muscle and Adipose Tissue with Bone Mineral Density in Premenopausal and Postmenopausal Women Undergoing Physical Examination

XU Haina, AN Miaomiao, ZHU Yan, WU Chunyan, RAN Limei

2023, 26(21):  2626-2631.  DOI: 10.12114/j.issn.1007-9572.2022.0778

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Background

The associations of muscle and adipose tissue with bone mineral density (BMD) in perimenopausal women has been studied, but there are differences in site distribution, which lead to that the effect of muscle and adipose tissue on BMD and the site of action are still unclear.

Objective

To analyze the relationships of BMD in lumbar spine, femoral neck, total hip and adipose, muscle tissue in perimenopausal women, and provide theoretical basis for improving the quality of life of middle-aged and elderly and preventing and treatment of osteoporosis (OP) .

Methods

2 355 women aged 40-60 years who underwent medical examination in the Health Management Center, Affiliated Hospital of Guizhou Medical University from January 2018 to October 2021 were retrospectively selected and divided into pre-menopausal women (n=1 261) and post-menopausal women (n=1 094) according to whether they were menopausal or not. BMD of lumbar spine, femoral neck, and total hip were measured by Dual energy X-ray Absorptiometry (DXA) . Adipose and muscle tissue were measured by Bioelectrical Impedance Analysis (BIA) . To explore the association of adipose and muscle tissue with BMD of different site in perimenopausal women by Pearson correlation and multiple linear regression analysis. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of appendicular lean mass (ALM) for postmenopausal OP.

Results

Pearson correlation analysis showed that adipose mass, total body muscle mass, trunk muscle mass and ALM were positively correlated with BMD of lumbar spine, femoral neck and total hip in premenopausal, postmenopausal and overall women (P<0.05) .Multiple linear regression analysis showed that total body muscle mass and trunk muscle mass were the influencing factors of femoral neck BMD in overall female (β=-0.051, 0.099, P<0.05) , ALM was an influencing factor of BMD of lumbar spine, femoral neck and total hip in overall female (β=0.244, 0.199, 0.199, P<0.05) ; total body muscle mass was an influencing factor for BMD of femoral neck and total hip in postmenopausal women (β=-0.125, -0.075, P<0.05) . Trunk muscle mass was an influencing factor for BMD of femoral neck in postmenopausal women (β=0.150, P<0.05) . ALM was the influencing factor for BMD of lumbar spine, femoral neck and total hip in postmenopausal women (β=0.226, 0.216, 0.188, P<0.05) . ROC curve analysis showed that the AUC of ALM for predicting OP of total hip in postmenopausal women was 0.825〔95%CI (0.742, 0.908) 〕, with 81.82% sensitivity and 76.59% specificity when the cut-off value was 16.24 kg. The AUC of ALM for predicting OP of femoral neck in postmenopausal women was 0.760〔95%CI (0.692, 0.829) 〕, with 75.61% sensitivity and 61.89% specificity when the cut-off value was 16.68 kg. The AUC of ALM for predicting OP of lumbar spine in postmenopausal women was 0.641〔95%CI (0.603, 0.679) 〕, with 60.85% sensitivity and 60.17% specificity, when the cut-off value was 17.20 kg. The best site of ALM for predicting OP in postmenopausal women was the total hip (Z_{femoral neck}=-9.89, P<0.05) .

Conclusion

ALM is positively correlated with BMD of lumbar spine, femoral neck and total hip in postmenopausal women. ALM can predict the occurrence of OP at different body parts of postmenopausal women, of which the optimal site of prediction for OP is the total hip.

The Analysis of Clinicopathological Characters and Short-term Prognosis in Idiopathic Membranous Nephropathy Patients with Immunoglobulin G4 Combined with Other Different Immunoglobulin G Subtypes Deposition

SUN Shuaigang, SHENG Xiaoxiao, ZHANG Wenhui, TIAN Huijuan, ZHAI Yaling

2023, 26(21):  2632-2638.  DOI: 10.12114/j.issn.1007-9572.2022.0847

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Background

The immunoglobulin (Ig) G subtype deposited pathologically in patients with idiopathic membranous nephropathy (IMN) is mainly IgG4, and the deposition of IgG1, IgG2 and IgG3 can also be detected. At present, there has been no report on the damage effect of different IgG subtypes in IMN on the pathological of kidney.

Objective

The purpose of the study was to investigate the clinicopathological characters and short-term prognosis in IMN patients with IgG4 combined with other different IgG subtypes deposition.

Methods

604 patients diagnosed with IMN in the First Affiliated Hospital of Zhengzhou University from January 2015 to June 2018 were included in the study, the baseline information, pathological test results of renal tissue specimens and treatment protocols of the patients were collected. According to the test results of IgG subtypes in renal pathology, the patients were divided into the simple IgG4 deposition group (n=259) , IgG4 combined with IgG1 deposition group (n=259) , IgG4 combined with IgG2 deposition group (n=29) , and IgG4 combined with IgG3 deposition group (n=57) . Starting from the date of percutaneous renal biopsy, the follow-up was performed until 2018-11-06. Kaplan-Meier survival curves of patients with different IgG subtypes were plotted, Log-rank test was used for survival curve comparison.

Results

24-h urine protein in IgG4 combined with IgG1 deposition group was higher than that in the simple IgG4 deposition group (P<0.05) ; the white blood cell count, neutrophil count, monocyte count and 24-h urine protein in the IgG4 combined with IgG3 deposition group were higher than those in the simple IgG4 group (P<0.05) . The positive deposition rates of C3, C4 and λ in the IgG4 combined with IgG1 deposition group were higher than those in the simple IgG4 deposition group (P<0.05) ; the positive deposition rate of C3 in the IgG4 combined with IgG2 deposition group was higher than that in the simple IgG4 deposition group (P<0.05) ; the positive deposition rates of C3, C4 and C1q, semi-quantitative scores of renal tubular atrophy and renal interstitial fibrosis were significantly different between the IgG4 combined with IgG3 deposition group and the simple IgG4 deposition group (P<0.05) . Log-rank test results showed no significant difference in cumulative response rates among the four groups (χ²=0.684, P=0.408) .

Conclusion

The renal clinical and pathological changes were more serious in IgG4 combined with other different IgG subtypes patients than those with IgG4 alone, patients with IgG3 deposition had a more prominent clinicopathological phenotype. There was no significant difference in remission rate after 6 months of follow-up, which may be related to the different intensity of inflammatory response caused by different capacities to fix complement of different IgG subtypes.

Mechanism of Glucagon-like Peptide-1 Receptor Agonist Improving Liver Lipid Deposition in a Rat Model of Insulin Resistance Induced by High-fructose Diet

GAO Zhe, DUAN Kaixin, LYU Xiuqin, MA Huijuan, ZHANG Zhimei, SONG Guangyao

2023, 26(21):  2639-2646.  DOI: 10.12114/j.issn.1007-9572.2023.0062

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Background

The incidence rate of nonalcoholic fatty liver disease is increasing year by year, but there is still no effective cure. Clinical and basic studies show that a type of hypoglycemic drug, namely glucagon-like peptide-1 (GLP-1) receptor agonists can improve liver lipid deposition, but the specific mechanism is unknown.

Objective

To explore the mechanism of GLP-1 receptor agonists improving liver lipid deposition in a rat model of insulin resistance induced by high-fructose diet.

Methods

This experiment was carried out from January to April 2016. Thirty-six Wistar rats were randomly divided into a control group (ND) receiving a normal diet and a model group receiving a high-fructose diet. After 8 weeks, a hyperinsulinemic-euglycemic clamp test was performed in the model group to verify the formation of insulin resistance. The rats in the model group were further randomized into a high-fructose (HFD) subgroup and a high fructose with exenatide (HFD+Ex) subgroup. The changes of glucose and lipid levels, insulin resistance, liver lipid deposition, the expression and nuclear translocation of β-catenin and lipid synthesis pathway related factors were observed in HFD+Ex subgroup at four weeks after receiving subcutaneous abdominal injection of exenatide injection. Further changes in cell lipid deposition and lipid synthesis pathway related factors were observed after inhibiting the expression of β-catenin with small interfering RNA (siRNA) by transfection techniques in HepG2 cells. HepG2 cells were treated with 25 mmol/L fructose, 100 nmol/L exendin-4, and non-transfected HepG2 cells were used as controls. ALL of the cells were divided into normal control group (Con) , high-fructose (HF) group, high fructose with exendin-4 (HF+Ex4) group, high fructose with exendin-4 and control siRNA (HF+Ex4+Si-control) group, and high fructose with exendin-4 and β-catenin siRNA (HF+Ex4+Si-β-catenin) group. After the experiment, the rats' weight and liver index, serum concentrations of triglyceride (TG) , total cholesterol (TC) , free fatty acid (FFA) , alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , fasting blood glucose (FBG) , fasting insulin (FINS) and liver TG concentration were measured, and the area under the plasma glucose curve (AUC_glu) , and glucose infusion rate (GIR) were calculated, and lipid droplets in liver tissues were observed using Oil Red O staining. The protein expression levels of sterol regulatory element binding protein 1 (SREBP-1) and the key enzymes for downstream lipid synthesis, fatty acid synthase (FAS) , acetyl coenzyme A carboxylase (ACC) , stearoyl-CoA desaturase 1 (SCD-1) and β-catenin of liver tissues and HepG2 cells were also measured.

Results

(1) After 8-week high-fructose feeding, the model group had significantly higher weight, liver index and liver TG concentration, and lower GIR than the ND group (P<0.05) . After 4 weeks of drug intervention, HFD subgroup demonstrated higher weight, liver index, TG, FFA, ALT, FBG, FINS and AUC_glu, and lower GIR than the ND group (P<0.05) . HFD+Ex subgroup showed lower weight, liver index, FFA, ALT, FBG, FINS, and AUC_glu, and higher GIR than HFD subgroup (P<0.05) . (2) Compared with ND group, HFD subgroup demonstrated higher concentration of TG in the liver (P<0.05) , and a large number of red lipid droplets in liver cells. HFD+Ex subgroup had lower concentration of TG in the liver (P<0.05) and reduced red lipid droplets in liver cells compared with HFD subgroup. (3) Compared with ND group, the expression of SREBP-1, FAS, SCD-1 and ACC in liver of rats in HFD subgroup increased (P<0.05) . Compared with HFD subgroup, the protein expression of SREBP-1, FAS, SCD-1 and ACC in HFD+Ex subgroup decreased (P<0.05) . (4) Compared with ND group, the expression levels of total protein and nuclear protein of β-catenin in liver of rats in HFD subgroup were significantly decreased (P<0.05) . Compared with HFD subgroup, the expression levels of total protein and nuclear protein of β-catenin increased in HFD+Ex subgroup (P<0.05) . (5) Compared the HepG2 cells treated with HF, HF+Ex4 group had higher expression levels of total protein and nuclear protein of β-catenin and lower levels of serum TG, and so did HF+Ex4+Si-control group (P<0.05) . Compared with HF+Ex4 group, HF+Ex4+Si-β-catenin group had down-regulated expression of total protein and nuclear protein of β-catenin (P<0.05) . The levels of serum TG of HepG2 cells in HF+Ex4+Si-β-catenin group was higher than that in HF+Ex4 group (P<0.05) . (6) HF+Ex4 group had lower protein expression levels of SREBP-1, ACC, FAS, and SCD-1 of HepG2 cells than HF group, and so did the HF+Ex4+Si-control group (P<0.05) . The protein expression levels of SREBP-1, ACC, FAS, and SCD-1 of HepG2 cells in HF+Ex4+Si-β-catenin group were higher than those in HF+Ex4 group (P<0.05) .

Conclusion

GLP-1 receptor agonists may regulate β-catenin expression to improve liver lipid deposition in rats with insulin resistance, which are potential new drugs for nonalcoholic fatty liver disease. β-catenin may be an important target for drug treatment.

Evidence-based Medicine

Effects of Different Intervention Measures for Breech Presentation/Transverse Lie Position on Maternal and Neonatal Outcomes: a Network Meta-analysis

WANG Xueyan, TIAN Jinhui, ZHANG Li, ZHAI Jinguo

2023, 26(21):  2647-2658.  DOI: 10.12114/j.issn.1007-9572.2022.0627

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Background

Untimely and ineffectively treated breech or transverse lie position of a fetus may increase the rate of cesarean section, and the risk of uterine rupture and other serious childbirth complications, endangering the lives of mothers and newborns. However, at present, there is no conclusion on the effectiveness and selection priority of different interventions for it during childbirth.

Objective

To perform a network meta-analysis of the impact of different interventions for breech or transverse lie position on maternal and neonatal outcomes.

Methods

We searched the Cochrane Library, PubMed, Web of Science, Embase, CINAHL, CBM, CNKI, VIP, and Wanfang Data Knowledge Service Platform for randomized controlled trials (RCTs) of the effects of different interventions for breech or transverse lie position on maternal and neonatal outcomes from inception to March 2022. Two researchers independently completed literature screening and data extraction, and quality assessment. R 4.1.1 and Stata 16.0 were used for data analysis and graph drawing. Consistency test and convergence analysis of the studies were performed. SUCRA was used to rank the effectiveness of each intervention and determine the most effective one.

Results

A total of 36 RCTs were included, including 7 419 parturients. The interventions involved were: knee-chest position, moxibustion/stimulation of Zhiyin acupoint, and external cephalic version (ECV) under different types of uterine contraction inhibitors/anesthesia. Network meta-analysis showed that compared with moxibustion/stimulation to Zhiyin acupoint, the success rate of moving a breech or transverse lie position to a head position was lower by usual nursing〔RR=0.54, 95%CI (0.32, 0.86) , P<0.05〕. The success rate of moving a breech or transverse lie position to a head position without uterine contraction inhibitor before ECV was lower than that using β₂-adrenergic receptor agonists〔RR=0.60, 95%CI (0.38, 0.62) , P<0.05〕. The vaginal delivery rate with calcium channel blockers but without uterine contraction inhibitors was lower than that using β₂-adrenergic receptor agonists〔RR=0.60, 95%CI (0.39, 0.89) , P<0.05; RR=0.60, 95%CI (0.39, 0.95) , P<0.05〕. The success rate of moving a breech or transverse lie position to a head position by ECV without anesthesia was lower than that using intravenous anesthesia〔RR=0.71, 95%CI (0.53, 0.96) , P<0.05〕 or intraspinal anesthesia〔RR=0.65, 95%CI (0.49, 0.85) , P<0.05〕. Compared with non-anesthesia, the use of intravenous anesthesia and intraspinal anesthesia during ECV could reduce the post-ECV pain score〔WMD=-1.97, 95%CI (-2.49, -1.46) , P<0.05; WMD=-3.80, 95%CI (-5.10, -2.50) , P<0.05〕. The three top interventions for terms of effectiveness ranked by SUCRA were: moxibustion/stimulation to Zhiyin acupoint, the use of β₂-adrenergic receptor agonists to suppress uterine contractions before ECV, and the use of spinal anesthesia during ECV.

Conclusion

Based on the results of network meta-analysis and SUCRA ranking, moxibustion/stimulation to Zhiyin acupoint, the use of β₂-adrenergic receptor agonists to inhibit uterine contractions before ECV, and the implementation of ECV under spinal anesthesia for moving a breech or transverse lie position to a head position during late pregnancy have a good effect on improving the maternal and neonatal outcomes, but this conclusion still needs to be further verified by more high-quality, large-sample studies.

Meta-analysis of Risk Factors for Urinary Tract Infection in Neurogenic Bladder

HE Manlan, YUAN Ping, HE Lei, CHEN Lu

2023, 26(21):  2659-2665.  DOI: 10.12114/j.issn.1007-9572.2022.0746

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Background

Urinary tract infection is the most common complication in patients with neurogenic bladder, which severely affects the treatment effect and quality of life of patients. Early identification of its related factors and delivery of targeted measures of prevention and intervention are of great significance to improve the prognosis of patients. Recent studies on influencing factors of urinary tract infection in neurogenic bladder are increasing but have controversial results, and there is a lack of relevant systematic reviews and support from evidence-based medicine.

Objective

To systematically assess the risk factors of urinary tract infection in neurogenic bladder.

Methods

Databases of PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, CQVIP, and SinoMed were searched for literature on risk factors of urinary tract infection in patients with neurogenic bladder from inception to June 2022. The quality of the included literature was assessed using the Newcastle-Ottawa Scale (NOS) . RevMan 5.3 was used for meta-analysis.

Results

A total of 13 articles with 3 319 cases were included. The NOS score of the articles ranged from 6 to 8. Meta-analysis results showed that advanced age〔OR_≥60=2.50, 95%CI (1.83, 3.41) , P<0.000 01; OR_≥65=2.13, 95%CI (1.40, 3.25) , P=0.000 4〕, diabetes〔OR=3.17, 95%CI (2.58, 3.89) , P<0.000 01〕, hypoalbuminemia〔OR=2.26, 95%CI (1.67, 3.06) , P<0.000 01〕, number of strokes ≥2〔OR=3.30, 95%CI (1.70, 6.41) , P=0.000 4〕, indwelling catheter〔OR=2.88, 95%CI (2.09, 3.95) , P<0.000 01〕, frequency of intermittent catheterization ≥2 times/week〔OR=2.44, 95%CI (1.62, 3.68) , P<0.000 1〕, frequency of bladder irrigation≥3 times/week〔OR=2.63, 95%CI (1.66, 4.17) , P<0.000 1〕, duration of bladder function training intervention≥2 weeks〔OR=2.75, 95%CI (1.69, 4.46) , P<0.000 1〕, duration of rehabilitation intervention >7 d〔OR=3.03, 95%CI (1.42, 6.48) , P=0.004〕were associated with increased risk of urinary tract infection in neurogenic bladder; Male〔OR=0.78, 95%CI (0.63, 0.96) , P=0.02〕was associated with decreased risk of urinary tract infection in neurogenic bladder.

Conclusion

Older age, complicated with diabetes, hypoalbuminemia, number of strokes ≥2, indwelling catheter, frequency of intermittent catheterization ≥2 times/week, frequency of bladder irrigation ≥3 times/week, duration of bladder function training intervention ≥2 weeks, and duration of rehabilitation intervention >7 d may be the risk factors for urinary tract infection in neurogenic bladder. To prevent or reduce the risk of urinary tract infection in these patients, clinical workers should identify the aforementioned high-risk factors as early as possible, and provide the patients with interventions targeting the controllable factors.

Review & Perspectives

The Exploration of the Effects and Mechanisms of Antibiotics on Irritable Bowel Syndrome

HU Jiayan, LYU Mi, WANG Fengyun

2023, 26(21):  2666-2672.  DOI: 10.12114/j.issn.1007-9572.2022.0500

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Antibiotics are one greatest medical discoveries in the 20th century, which are extensively used to treat a variety of pathogenic microbial infections, including irritable bowel syndrome (IBS) . Although antibiotics have proven to be partially effective in improving clinical symptoms of IBS by clinical practice and several clinical studies, and nonabsorbable rifaximin has been also recommended for treating IBS without diarrhea by relevant guidelines and consensuses, the indications for the use of antibiotics in IBS are not clear, and there are concerns about the adverse effects associated with long-term antibiotic use. Meanwhile, making the balance between adverse effects and clinical benefits is difficult. However, several studies have also found that antibiotic use contributes to the development of IBS. This paper reviews recent studies on the effects of antibiotics on IBS, and summarizes that antibiotics may trigger IBS in several ways, including reducing intestinal microbial diversity, impairing epithelial barrier function and affecting cytokine production. This paper also points out the uncertainty of the indications for antibiotic application in IBS from two aspects, and argues that clinicians should pay attention to the effects of antibiotics on the development of IBS, evaluate the pros and cons of antibiotic treatment for IBS, and use antibiotics rationally and cautiously. The purpose of this article is to provide some reference for explaining the pathogenesis of IBS induced by antibiotic treatment, and for clinical application of antibiotics in IBS.

Detection and Evaluation Methods of Visceral Sensitivity in Irritable Bowel Syndrome: a Review of the Latest Developments

HOU Yujun, ZHAO Ying, JIANG Huiling, TAN Yu, ZHANG Wei, LI Ying, ZHENG Qianhua

2023, 26(21):  2673-2677.  DOI: 10.12114/j.issn.1007-9572.2022.0605

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Visceral hypersensitivity is one major pathophysiological characteristic of irritable bowel syndrome (IBS) , a common functional bowel disorder. The detection and evaluation of visceral hypersensitivity are of practical significance for the guidance of clinical diagnosis and treatment of IBS. We reviewed the latest studies on the detection and evaluation methods of visceral hypersensitivity mediated by both peripheral and central factors in IBS patients and animal models, and found some limitations in these studies such as monotonous evaluation methods, and limited applications of the methods. The possible applications of these methods in both animal experiments and clinical trials can be explored in future researches.

Correlation between 5-HT and Diarrhea-type Irritable Bowel Syndrome and Regulation by Traditional Chinese Medicine

SU Haixia, FU Zhaoyuan, GAO Yongze, YU Rongrong, ZHONG Jianchun

2023, 26(21):  2678-2685.  DOI: 10.12114/j.issn.1007-9572.2022.0460

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5-hydroxytryptamine (5-HT) is an important brain intestinal peptide that affects gastrointestinal function in patients with diarrhea-type irritable bowel syndrome. In recent years, it has been found that any abnormality in any of the signal transduction processes such as synthesis, release, binding to receptors and reuptake of 5-HT may lead to the development of diarrhoeal irritable bowel syndrome. In order to explore the potential therapeutic value of serotonin in diarrhea type irritable bowel syndrome, but also to provide a theoretical reference and basis for Chinese medicine for the prevention and treatment of diarrhea type irritable bowel syndrome. Through reviewing a large number of domestic and foreign literatures, the author found that traditional Chinese medicine (TCM) had a significant effect in the treatment of diarrhea type irritable bowel syndrome by regulating 5-HT. Therefore, the author reviewed the modern medical understanding of 5-HT, the correlation between 5-HT and diarrhea-type irritable bowel syndrome, and the research progress of TCM intervention with 5-HT in the treatment of diarrhea-type irritable bowel syndrome, in order to explore the potential therapeutic value of 5-HT in diarrhea-type irritable bowel syndrome. Meanwhile, it also provides a theoretical reference and basis for TCM in the prevention and treatment of diarrhea-type irritable bowel syndrome.

Study of Typical Cases

Tricho-rhino-phalangeal Syndrome with Growth Hormone Deficiency: a Case Report and Literature Review

CHEN Bo, LIU Qing

2023, 26(21):  2686-2689.  DOI: 10.12114/j.issn.1007-9572.2022.0414

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Tricho-rhino-phalangeal syndrome (TRPS) is a rare autosomal dominant genetic disease, which is characterized by sparse hair, pear-shaped nose, partial cone-shaped epiphyses of the phalanges of the hand (foot) and brachydactyly. We reported a patient with short stature and special facial features who was admitted to Department of Pediatrics, First Affiliated Hospital, School of Medicine, Shihezi University on January 7, 2021, and diagnosed with TRPS and growth hormone deficiency finally, and performed a literature review. The clinical data, genetic test results and diagnostic process of the pediatric case were analyzed. The gene detection showed that the heterozygous frameshift mutation of TRPS1_ex6 c.2725dupT (p.Cys909Leufs^*42) was a new mutation, and defined as a pathogenic variant according to the American College of Medical Genetics and Genomics. The patient was treated with recombinant human growth hormone after the diagnosis, and was found with increased height without treatment-related side effects such as increased intracranial pressure and hypothyroidism during a 14-month follow-up.

Phenotypically Male Congenital Adrenal Hyperplasia Patient with Huge Space-occupying Adrenal Masses: a Case Report and Literature Review

RAO Yufeng, MENG Liheng, ZHOU Jia, LIANG Xinghuan, HUANG Zhenxing, QIN Yingfen

2023, 26(21):  2690-2694.  DOI: 10.12114/j.issn.1007-9572.2022.0723

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Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic disease encompassing enzyme deficiencies in the process of adrenal steroidogenesis, which leads to adrenal cortex dysfunction. Hypersecretion of corticotrophin-releasing hormone and insufficient cortisol production often lead to enlarged adrenal glands. Existing studies have reported that most of space-occupying adrenal masses in CAH are benign, only very few are malignant. It is difficult for clinicians to distinguish the nature of space-occupying adrenal masses, and physicians have insufficient experiences in treating the disease. We reported a phenotypically male case of CAH with huge space-occupying adrenal masses and reviewed relevant literature, aiming to provide evidence on the diagnosis and treatment of this disease for clinicians. The space-occupying adrenal masses in CAH often show tumor-like hyperplasia before diagnosis and treatment or effective hormone replacement therapy, but most of them will be significantly reduced or disappear after glucocorticoid replacement therapy. But a follow-up of several years showed that space-occupying adrenal masses in the CAH patient encountered by us had no significant changes and no significant impact on the patient's body, even without effective drug intervention.