Table of Content

20 September 2024, Volume 27 Issue 27

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Commentary

The Impact of Long COVID on Cardiovascular System: Clinical Manifestations, Mechanisms, and Principles of Diagnosis and Treatment

ZHONG Minshan, SUN Wei, KONG Xiangqing

2024, 27(27):  3325-3330.  DOI: 10.12114/j.issn.1007-9572.2024.0058

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The outbreak of COVID-19 has had a huge impact globally. After the infection, a considerable number of patients have been affected by a series of lingering symptoms or sequelae with strong heterogeneity, which we temporarily refer to as long COVID. Compared to the well-studied cardiovascular complications caused by COVID-19 during the acute phase, the cardiovascular sequelae in long COVID require greater attention. This review includes the clinical manifestations, mechanisms, and principles of diagnosis and management of cardiovascular sequelae in long COVID, aiming to improve the disease's understanding and reduce its harm scientifically.

Treatment Strategies for Atrial Fibrillation with Long Interval: Consensus and Controversy

WANG Xiaorui, ZHENG Ruoyao, SUN Fengzhi, ZHANG Shulong

2024, 27(27):  3331-3335.  DOI: 10.12114/j.issn.1007-9572.2023.0826

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Atrial fibrillation (AF) is the most common arrhythmia in cardiovascular disease, and it often coexists and interacts with sick sinus syndrome. In the past, pacemaker implantation combined with antiarrhythmic drugs was preferred for symptomatic atrial fibrillation with long interval treatment. However, in recent years, more and more studies have shown that compared with pacemaker implantation, radiofrequency ablation can reduce the hospitalization rate related to tachycardia, effectively control atrial fibrillation, and improve patient prognosis and hospitalization rate of heart failure. However, some patients present intrinsic sinus node dysfunction (SND), and SND may progress and worsen in some patients with atrial fibrillation. Therefore, the first-line treatment strategy for patients with atrial fibrillation with long interval remains controversial. This article reviews the selection of long-term intermittent treatment strategies for atrial fibrillation.

Article

Values and Preferences of Pharmacotherapy in Patients with Primary and Secondary Prevention of Atherosclerotic Cardiovascular Disease: a Mixed-methods Study

LI Shenghan, DU Heyue, AN Kang, HE Longtao, LI Jing, LI Sheyu

2024, 27(27):  3336-3343.  DOI: 10.12114/j.issn.1007-9572.2024.0056

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Background

Pharmacotherapy is the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular diseases (ASCVD), but the values and preferences of community patients for pharmacotherapy remain unclear.

Objective

To understand the values and preferences surrounding pharmacotherapy among community patients at risk of or undergoing treatment for ASCVD, which would help clarify the individualized treatment burden and provide patient-centered clinical practice.

Methods

This study employed a sequential exploratory mixed-methods design. Firstly, we recruited eligible patients in West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District, Chengdu City from November 2021 to January 2022. for a focus group discussion, aiming to collect qualitative insights into their experience, values, and preferences for medication use. The software MAXQDA 2020 was used to support qualitative data analysis, and Colaizzi's seven-step approach was further used to identify themes. After completing the qualitative phase, a questionnaire was designed based on the emergent themes to further quantitatively analyze the values and preferences regarding pharmacotherapy.

Results

Four themes emerged from the qualitative data, including knowledge and use of medications, barriers of medication use, facilitators of medication use, and need for medical services. A total of 186 valid questionnaires were collected in the quantitative study (response rate of 93.5%). The quantitative data showed a commonality in missed dose and confirmed the existence of social stigma and treatment burden in this group of participants. Although preferences in medication use were highly heterogeneous, participants generally preferred taking fewer medications with less frequency, and were less likely to use injectable medications.

Conclusion

The study suggests that it may be appropriate to increase the use of compound preparations, and make treatment plans in accordance with patients' daily lives and work to reduce the treatment burden of pharmacotherapy. In addition, we should be active in managing the misconceptions and improper practices in pharmacotherapy in order to improve patients' medication adherence.

A Cross-sectional Study of the Association of cMetS and Other Obesity Indicators with Cardiometabolic Co-morbidities in People over 35 Years of Age in Anhui Province

HAN Zheng, WANG Weiqiang, PAN Yaojia, FU Fanglin, SUN Meng

2024, 27(27):  3344-3350.  DOI: 10.12114/j.issn.1007-9572.2024.0018

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Background

With the gradual aging of China's population and the gradual rise of chronic disease co-morbidities, cardiometabolic co-morbidities (CMM) have become one of the most damaging co-morbidities. Current studies on prediction and intervention methods for CMM have focused on individual cardiovascular diseases and lifestyle, while studies on CMM as a whole are lacking.

Objective

To explore the association of Continuous Metabolic Syndrome Score (cMetS) and other obesity indicators with CMM, and to further confirm whether these indicators can be used as a simple indicator for screening CMM, as well as to estimate the threshold for prediction of CMM in the middle-aged and elderly population in Anhui Province.

Methods

The study included 131 390 participants from the Anhui Province Cardiovascular Disease High-Risk Population Early Screening and Comprehensive Intervention Project from 2017 to 2021, divided into CMM (779 males, 866 females) and non-CMM groups (53 020 males, 76 725 females). General patient information and biochemical markers were collected, and the waist-to-height ratio (WHtR), WHT.5R, body roundness index (BRI), and cMetS were calculated. Differences in CMM prevalence by gender and age group were compared using the Bonferroni method. Multivariate Logistic regression analysis was employed to investigate the factors influencing CMM. Receiver operating characteristic (ROC) curves for predicting CMM using cMetS and obesity indices were plotted, and the area under the ROC curve (AUC) was calculated. The value of different indices in predicting CMM status was assessed using paired sample tests.

Results

In the male cohort, the CMM group showed higher values for age, BMI, waist circumference (WC), mean arterial pressure (MAP), fasting plasma glucose (FPG), triglycerides (TG), diabetes, ischemic heart disease, stroke, WHtR, WHT.5R, BRI, and cMetS than the non-CMM group. Smoking and alcohol consumption, as well as total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C), were higher in the non-CMM group (P<0.05). In females, similar trends were observed, with lower levels of TC and HDL-C in the CMM group (P<0.05). The prevalence of CMM varied across different age groups in both male and female patients (P<0.05). Multivariate Logistic regression analysis indicated that increases in cMetS, WHtR, WHT.5R, BRI, and BMI are risk factors for CMM in both genders (P<0.05). ROC curve analysis showed that in males, the AUC for cMetS was higher than that for WHtR (Z=6.16, P<0.001), BRI (Z=6.16, P<0.001), WHT.5R (Z=7.21, P<0.001), and BMI (Z=9.36, P<0.001). Similar findings were observed for females, with cMetS outperforming the other indices.

Conclusion

In both genders, cMetS and other obesity indices are closely associated with CMM, with cMetS being a superior identifier. cMetS serves as a novel marker for diagnosing CMM, highlighting its significance in the prevention of this condition.

Impact of Thyroid Dysfunction on Cardiac Structure and Function in Patients with Coronary Artery Disease Post-percutaneous Coronary Intervention: a Large Single-center Retrospective Cohort Study

WANG Kaiyang, YU Xiaolin, MA Ling, TAO Jing, YONG Jiahui, YANG Yining

2024, 27(27):  3351-3358.  DOI: 10.12114/j.issn.1007-9572.2024.0028

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Background

Thyroid dysfunction is common in patients with coronary artery disease (CAD) following percutaneous coronary intervention (PCI). However, its impact on cardiac structure and function within the context of chronic comorbidities remains unclear.

Objective

To investigate the effects of thyroid dysfunction on cardiac structure and function in CAD patients post-PCI.

Methods

Data were sourced from the "Xinjiang People's Hospital Cardiovascular Specialty Big Data Analysis Platform-Yidu Cloud" including clinical data of CAD patients post-PCI from 2013 to 2022. Thyroid function, echocardiography, and biochemical indices were measured. Patients were classified based on diagnostic criteria into clinical hyperthyroidism group (n=263), clinical hypothyroidism group (n=357), and a control group of euthyroid patients (n=300). Spearman rank correlation was used to explore the relationship between thyroid function and cardiac structure/function. Multivariate Logistic regression and unconditional multivariate Logistic regression analyses were conducted to investigate factors affecting cardiac systolic and diastolic dysfunction. Receiver operating characteristic (ROC) curves were plotted to determine the diagnostic value of thyroid function indices for cardiac dysfunction and to calculate the area under the ROC curve (AUC) .

Results

Significant differences were observed among the three groups in age, gender, diastolic blood pressure (DBP), systolic blood pressure (SBP), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), cystatin C (CysC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), B-type natriuretic peptide (BNP), fasting glucose (GLU), lipoprotein (a) (LPa), thyroxine (T₄), free thyroxine (FT₄), triiodothyronine (T₃), free triiodothyronine (FT₃), thyroid-stimulating hormone (TSH), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPOAb) (P<0.05). Significant differences were also found in aortic diameter (AOd), right ventricular diameter (RVd), left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVSd), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), and stroke volume (SV) (P<0.05). Spearman rank correlation analysis showed positive correlations of LVEF with FT₃, T₃, and TSH (P<0.05) ; AOd with FT₃ and T₃, and negative correlations with TgAb and TSH (P<0.05) ; LVDd with FT₃, and negative correlations with TgAb and TSH (P<0.05) ; LVSd with FT₃, T₃, T₄, and TSH (P<0.05) ; SV with FT₃, T₃, and negative correlation with TgAb (P<0.05) ; RVd with FT₃, and negative correlation with TSH (P<0.05) ; interventricular septal thickness (IVSd) with TgAb (P<0.05) ; LVEDV with FT₃, and negative correlations with TgAb and TSH (P<0.05) ; left ventricular posterior wall thickness (LVPWd) with TgAb (P<0.05). Multivariate Logistic regression indicated that FT₃ and TSH were factors affecting cardiac systolic dysfunction (P<0.05), while T₄ influenced cardiac diastolic dysfunction (P<0.05). ROC curve analysis revealed that the AUCs for predicting cardiac systolic dysfunction were 0.621 (95%CI=0.581-0.662) for FT₃ and 0.632 (95%CI=0.594-0.670) for TSH; for predicting cardiac diastolic dysfunction, the AUC for T₄ was 0.590 (95%CI=0.510-0.670). Stratified analysis indicated no significant differences in the impact of FT₃ on cardiac systolic dysfunction between different ages and genders (P_trend>0.05), whereas TSH showed differences (P_trend<0.05). The protective effects of FT₃ and TSH on cardiac systolic function were more significant in females and individuals aged≥60 years (P<0.05). The influence of T₄ on cardiac diastolic dysfunction differed by age and gender (P_trend<0.05) .

Conclusion

Thyroid dysfunction significantly affects cardiac structure and function in CAD patients post-PCI. FT₃ and TSH primarily influence cardiac systolic function, while T₄ mainly affects diastolic function. Greater attention should be given to the impact of thyroid function on cardiac function in females and individuals aged<60 years to prevent diastolic dysfunction and high-output low-resistance heart failure.

Relationship between Atherogenic Index of Plasma and Serum Lp-PLA2 Levels and Left Ventricular Hypertrophy in Patients with Hypertension

QIN Ruidan, ZHANG Juan, LIANG Yingying, LYU Lulu, LI Yike

2024, 27(27):  3359-3364.  DOI: 10.12114/j.issn.1007-9572.2023.0804

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Background

Hypertension is a common chronic non-communicable disease in clinical practice, and its prevalence is on the rise globally due to population aging and changes in human lifestyles. Prolonged high blood pressure can lead to damage to various target organs such as the heart, brain, kidneys, and retina, severely threatening human health and being a major cause of global disease burden. The left ventricle, as the primary target of end-organ damage, its structural changes are also the pathological basis for the development of many cardiovascular diseases.

Objective

This study aims to explore the relationship between the atherogenic index of plasma (AIP) and serum lipoprotein-associated phospholipase A2 (Lp-PLA2) levels and left ventricular hypertrophy (LVH) in patients with primary hypertension.

Methods

A total of 167 patients with primary hypertension who visited the Department of Cardiovascular Medicine at the Second Affiliated Hospital of Zhengzhou University from October 2021 to June 2023 were enrolled in this study. Baseline data of the patients were collected, and fasting venous blood biochemical markers were measured. Echocardiograms were conducted within 24 hours of admission to calculate left ventricular mass (LVM) and left ventricular mass index (LVMI). Patients were divided into non-left ventricular hypertrophy (NLVH) group (87 patients) and LVH group (80 patients) based on LVMI. Pearson correlation test and Spearman rank correlation analysis were used to investigate the correlation between serum Lp-PLA2 level, AIP and echocardiographic parameters. Multivariate Logistic regression analysis was used to explore the influencing factors of LVH in hypertensive patients. Receiver operating characteristic (ROC) curve was plotted to explore the diagnostic value of serum Lp-PLA2 level and AIP in hypertensive patients with LVH, and the area under ROC curve (AUC) was calculated.

Results

Patients in the LVH group had higher age, duration of hypertension, levels of N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), left ventricular posterior wall thickness (LVWPT), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDd), left atrial end-systolic diameter (LAESd), Lp-PLA2 levels, AIP, LVM, and LVMI compared to the NLVH group (P<0.05). Correlation analysis showed that LVMI was positively correlated with Lp-PLA2, AIP, NT-proBNP, hs-CRP, age, and duration of hypertension (P<0.05). LVWPT was positively correlated with Lp-PLA2, AIP, NT-proBNP, hs-CRP, and duration of hypertension (P<0.05). IVST was positively correlated with Lp-PLA2, AIP, hs-CRP, age, and duration of hypertension (P<0.05). LVEDd was positively correlated with Lp-PLA2, AIP, NT-proBNP, hs-CRP (P<0.05). Multivariate Logistic regression analysis showed that elevated hs-CRP (OR=1.249, 95%CI=1.007-1.548, P=0.043), elevated NT-proBNP (OR=1.009, 95%CI=1.002-1.017, P=0.011), increased AIP (OR=14.557, 95%CI=1.220-173.753, P=0.034), and increased Lp-PLA2 (OR=1.042, 95%CI=1.024-1.059, P<0.001) were risk factors for LVH in hypertensive patients. ROC curve results showed that the AUC for diagnosing hypertension combined with LVH using AIP, Lp-PLA2, and combined testing were 0.649 (95%CI=0.566-0.733), 0.780 (95%CI=0.705-0.854), and 0.804 (95%CI=0.733-0.874), respectively.

Conclusion

Serum Lp-PLA2 levels and AIP are closely related to changes in the morphological structure of the left ventricle. Combined testing of both can aid in the early clinical diagnosis of left ventricular hypertrophy in hypertensive patients, providing guidance for clinical diagnosis and treatment.

Correlation between Serum Complement C1q/Tumor Necrosis Factor-related Protein 5 Levels and the Severity of Coronary Artery Lesions and Myocardial Fibrosis Markers in Patients with Acute Coronary Syndrome

LI Yong, LI Zhanhu, JIN Bowei, LI Yuan, ZHANG Hongbo, SU Yakun, YAN Xiaoju

2024, 27(27):  3365-3371.  DOI: 10.12114/j.issn.1007-9572.2023.0904

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Background

Acute coronary syndrome (ACS) represents a common cardiovascular disease that poses a significant threat to human health, with severe coronary artery lesions and myocardial fibrosis affecting patient prognosis. The use of non-invasive serological markers to assess the severity of coronary artery lesions and myocardial fibrosis can aid in the early risk stratification and management of ACS patients.

Objective

This study aimed to explore the relationship between serum levels of complement C1q/tumor necrosis factor-related protein-5 (CTRP5) and the severity of coronary artery lesions, as well as myocardial fibrosis markers in ACS patients, to provide guidance for the clinical assessment of coronary artery lesion severity and myocardial fibrosis.

Methods

A total of 184 patients with obstructive stenosis admitted to the Department of Cardiology, Hengshui People's Hospital from February 2021 to February 2022 were selected, along with 100 ACS patients without significant obstructive stenosis undergoing coronary angiography in the same period as controls. General patient data were collected, Doppler echocardiograms were performed, and serum levels of CTRP5, procollagen type Ⅰ (PC Ⅰ), and procollagen type Ⅲ (PC Ⅲ) were measured. The patients with obstructive stenosis were divided into unstable angina (UA) group (n=67), ST-segment elevation myocardial infarction (STEMI) group (n=57), and non-ST-segment elevation myocardial infarction (NSTEMI) group (n=61) ; based on the number of coronary artery lesions, they were categorized into single-vessel disease group (n=42), double-vessel disease group (n=69), and triple-vessel disease group (n=73). According to the SYNTAXⅡ score, they were classified into low-risk (n=77), intermediate-risk (n=73), and high-risk (n=34) groups. Based on the median levels of PCⅠ, patients were divided into low PCⅠ level group (n=95) and high PC I level group (n=89) ; similarly, based on PCⅢ median levels, into low PCⅢ level group (n=93) and high PCⅢ level group (n=91). Multiuariate Logistic regression analysis was used to explore the influencing factors of coronary artery lesion severity. Receiver operating characteristic (ROC) curves were drawn to analyze the diagnostic value of serum CTRP5 for coronary artery lesion severity.

Results

In ACS patients, white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, fasting blood glucose (FBG), high-sensitivity cardiac troponin Ⅰ, serum CTRP5, hypersensitive C-reactive protein (hs-CRP), PC Ⅰ, and PC Ⅲ levels were higher than in control patients (P<0.05). Serum CTRP5 and hs-CRP levels in the NSTEMI and STEMI groups were higher than in the UA group (P<0.05). The triple-vessel disease group had higher serum CTRP5, PC Ⅰ, PC Ⅲ, and hs-CRP levels than the single-vessel and double-vessel disease groups (P<0.05). High-risk group patients had higher serum CTRP5, PCⅠ, PCⅢ, and hs-CRP levels compared to low-risk and intermediate-risk groups (P<0.05). The high PC I level group had higher serum CTRP5 and hs-CRP levels compared to the low PC Ⅰ level group (P<0.05). The high PC Ⅲ level group had higher serum CTRP5 and hs-CRP levels compared to the low PC Ⅲ level group (P<0.05). Multivariate Logistic regression analysis showed that increased levels of FBG, hs-CRP, and CTRP5 were risk factors for multivessel coronary artery disease (P<0.05). The areas under the ROC curve (AUC) for predicting multivessel coronary artery disease by serum CTRP5, hs-CRP, and FBG were 0.736 (95%CI=0.678-0.794), 0.687 (95%CI=0.625-0.748), and 0.649 (95%CI=0.585-0.713), respectively.

Conclusion

Serum CTRP5 levels have good predictive value for the severity of coronary artery lesions in ACS patients, and elevated levels of CTRP5 are potentially associated with the occurrence of myocardial fibrosis.

Clinical Characteristics of Acute Pulmonary Embolism Complicated with Thrombocytopenia: a Retrospective Study

WANG Wuchao, LIU Siqi, LIU Qianqian, ZHU Jihong

2024, 27(27):  3372-3377.  DOI: 10.12114/j.issn.1007-9572.2023.0385

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Background

Acute pulmonary embolism (APE) is a serious cardiovascular disease. In recent years, there has been an increasing detection rate of patients with APE accompanied by thrombocytopenia, presenting a dual challenge of thrombosis and bleeding. Current research is mainly based on successful case reports, with a certain research gap in clinical evaluation and treatment options.

Objective

To explore the clinical characteristics and prognosis of APE patients complicated with thrombocytopenia, so as to provide a basis for clinical diagnosis and treatment.

Methods

A total of 21 patients with APE accompanied by thrombocytopenia who were admitted to the Emergency Department, Peking University People's Hospital from January 2015 to January 2020 were included as the study subjects and categorized into the severe bleeding group (n=7) and mild/no bleeding group (n=14) based on their bleeding conditions; as well as the multiple-site thrombosis group (n=7) and pulmonary artery thrombosis groups (n=14) based on the presence of thrombosis at sites other than the pulmonary artery; and into the death group (n=5) and survived group (n=16) based on their survival status. Clinical data were collected and compared between groups.

Results

A total of 21 APE patients with thrombocytopenia were included in this study, involving 7 males and 14 females, with an average age of (63.2±18.9) years. The etiologies included immune thrombocytopenic purpura (5 cases), antiphospholipid syndrome (4 cases), eosinophilia (3 cases), drug-related thrombocytopenia (2 cases), systemic lupus erythematosus (2 cases), cancer-associated thrombocytopenia (2 cases), and 3 cases of unknown etiology. Nineteen patients received anticoagulant therapy. Fibrinogen and fibrinogen/albumin ratios were higher in the pulmonary artery thrombosis group than in the multi-site thrombosis group (P<0.05). The proportion of males and mean platelet volume were lower in the severe bleeding group than in the mild/no bleeding group, and the proportion of multi-site thrombus and centrocyte/lymphocyte ratio were higher than the mild/no bleeding group (P<0.05). The proportion of anticoagulation therapy and platelet count in the death group were lower than those in the survival group, and the proportion of heart rate, mean platelet volume/platelet ratio, and cancer-associated thrombocytopenia were higher than those in the survival group (P<0.05) .

Conclusion

APE patients with thrombocytopenia are at risk for multiple thrombotic events. Anticoagulant therapy contributes to improved clinical prognosis. Anticoagulation therapy based on platelet count is not significantly associated with serious bleeding events. Platelet count, platelet-related parameters, and other coagulation-related parameters contribute to the interpretation of thrombotic burden, bleeding risk, and clinical prognosis.

Diagnostic Value of Serum NLRP3 Levels and Contrast Agent Dosage in Contrast-induced Nephropathy after Percutaneous Coronary Intervention in Patients with Acute ST-elevation Myocardial Infarction

TILAKEZI Tuersun, WEI Haiyan, NUERBAHAER Remutula, YANG Heyin

2024, 27(27):  3378-3382.  DOI: 10.12114/j.issn.1007-9572.2024.0026

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Background

Acute ST-elevation myocardial infarction (STEMI) represents a critical cardiovascular emergency, with percutaneous coronary intervention (PCI) being the preferred treatment. Post-PCI, patients are prone to developing contrast-induced nephropathy (CIN), significantly increasing the risk of adverse events. Thus, early diagnosis and treatment are crucial.

Objective

This study aims to investigate the diagnostic value of serum levels of NOD-like receptor pyrin domain-containing 3 (NLRP3) and the dosage of contrast agents for CIN following PCI in patients with STEMI.

Methods

The study included 257 patients diagnosed with STEMI and undergoing emergency PCI at the First People's Hospital of Kashi from June to December 2022. Based on the occurrence of CIN within 24 to 48 hours post-PCI, participants were divided into two groups: 61 in the CIN group and 196 in the non-CIN group. Basic clinical data of patients were collected, along with the dosage of contrast agents used during the procedure. On the second day of hospitalization, fasting venous blood was drawn to assess renal function indicators, lipid profiles, blood glucose, and serum NLRP3 levels, alongside echocardiographic evaluation of the left ventricular ejection fraction (LVEF). Multivariate Logistic regression analysis was utilized to explore factors influencing CIN development. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic value of serum NLRP3 levels and contrast agent dosage for CIN.

Results

The CIN group showed a lower proportion of males, lower preoperative levels of uric acid and albumin, and higher levels of contrast agent dosage and NLRP3 compared to the non-CIN group (P<0.05). The multivariate Logistic regression analysis indicated that increased contrast agent dosage (OR=1.008, 95%CI=1.001-1.015, P=0.017) and elevated serum NLRP3 levels (OR=1.139, 95%CI=1.054-1.230, P=0.001) are risk factors for CIN. ROC curve analysis revealed that the area under curve (AUC) for contrast agent dosage, serum NLRP3 levels, and their combined use in diagnosing CIN post-PCI in acute myocardial infarction were 0.797 (95%CI=0.716-0.879), 0.885 (95%CI=0.828-0.942), and 0.939 (95%CI=0.896-0.981), respectively.

Conclusion

In patients with STEMI, contrast agent dosage and serum NLRP3 levels are risk factors for CIN following PCI and can serve as predictive indicators. The combined use of these factors offers a more definitive diagnostic value for CIN.

Impact of LncRNA MALAT1 in the Placentas of Pre-pregnancy Overweight/Obese Women on Maternal and Infant Metabolism

ZHANG Jin, ZHANG Rui, CHI Jingjing, LI Ya, BAI Wenpei

2024, 27(27):  3383-3387.  DOI: 10.12114/j.issn.1007-9572.2023.0461

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Background

Pre-pregnancy obesity can have a range of effects on both the mother and the fetus, possibly due to abnormalities in maternal-fetal metabolism. Therefore, exploring the mechanisms is essential to improve fetal prognosis.

Objective

To investigate the alterations of factors associated with obesity and glucose metabolism in the placentas of pregnant women with different BMI levels before pregnancy.

Methods

A total of 100 singleton pregnant women who delivered in Beijing Shijitan Hospital, Capital Medical University in 2019 were selected as the study subjects. The clinical data were collected based on the electronic medical record system. The subjects were divided into the low/normal body mass group (n=57) and overweight/obese group (n=43) based on their pre-pregnancy body mass. The expression of long non-coding RNA metastasis-associated Lung adenocarcinoma transcript 1 (LncRNA MALAT1), serum amyloid A3 (SAA3), and interleukin 6 (IL-6) mRNA in placental tissue were measured using reverse transcription-polymerase chain reaction.

Results

The age of the subjects ranged from 22 to 43 years, with an average age of (32.7±4.2) years, including 61 primiparas, 21 with gestational diabetes mellitus (GDM), 14 with low body mass, 43 with normal body mass, 26 with overweight, and 17 with obese. The proportion of GDM and neonatal body mass in the overweight/obese group was higher than that in the low/normal body mass group, and the weight gain during pregnancy was lower than that in the low/normal body mass group, with statistically significant differences (P<0.05). The expression of LncRNA MALAT1 mRNA in placental tissue was higher in the overweight/obese group than the low/normal body mass group, with a statistically significant difference (P<0.05). The mRNA expression of LncRNA MALAT1, SAA3, and IL-6 mRNA in the placental tissue of obese pregnant women were higher than those of normal pre-pregnancy body mass, with statistically significant difference (P<0.05) .

Conclusion

Excessive pre-pregnancy BMI has a more significant impact on mother and child during pregnancy, overshadowing the effects of controlling weight gain during pregnancy. In obese pregnant women, LncRNA MALAT1 may regulate glucose and lipid homeostasis through SAA3 and IL-6, involving inflammatory changes and oxidative stress, thereby affecting fetal metabolism, which deserves more in-depth exploration.

A Long-term Study on the Long-term Impact of Demographic Factors on the Burden of Ischemic Heart Disease in China from 1990 to 2019

ZHANG Xinyue, ZHANG Liangwen, FANG Ya

2024, 27(27):  3388-3394.  DOI: 10.12114/j.issn.1007-9572.2024.0049

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Background

The disease burden of ischemic heart disease is becoming heavier, and the influence of metabolic factors is gradually increasing, and there is still insufficient research in exploring the disease burden caused by metabolic factors and its change trend.

Objective

To analyzes the long-term impact and trend of the disease burden of ischemic heart disease caused by metabolic factors in China from 1990 to 2019, so as to provide solid and powerful scientific support and basis for the prevention and control of ischemic heart disease.

Methods

Based on the data of the Global Burden of Disease Study in 2019, the mortality rate, disability adjusted life year (DALY) and corresponding normalized indicators attributed to metabolic factors in ischemic heart disease of different ages and sexes in China from 1990 to 2019 were obtained. The Joinpoint model was used to systematically evaluate the temporal trend of disease changes.

Results

The mortality rate and DALY rate of ischemic heart disease attributed to metabolic factors in the whole population of China increased from 38.01/100 000 and 944.68/100 000 in 1990 to 103.34/100 000 and 1 972.50/100 000 in 2019, respectively. Compared with 1990, in 2019, the mortality rate of ischemic heart disease, DALY rate and corresponding standardized indicators attributed to metabolic factors were significantly higher in males than in females, and higher in the older age group than in the lower age group. In terms of gender, during the period of 1990—2019, the standardized mortality rate of men with IHD attributed to metabolic factors in China was gradually higher than the global level, while the standardized mortality rate of the whole population and women was always lower than the global level. The standardized DALY rates of all three are significantly lower than the global level. In terms of age, the DALY rate attributed to high body mass index in 1990—2019 showed an upward trend and dominated the population, and renal insufficiency gradually became prominent in the elderly population.

Conclusion

Since 1990, the overall burden of ischemic heart disease in China has shown an upward trend. The burden of ischemic heart disease caused by metabolic factors is increasing, and it is necessary to continue to increase the publicity of ischemic heart disease prevention and control, especially for key groups such as men and the elderly, carry out targeted health management, better guide the formulation of health policies, improve the utilization efficiency of health resources, and optimize the layout and structure of medical services, so as to better meet the public health needs, reduce the burden of ischemic heart disease in China to a greater extent, and help achieve the goal of healthy China.

Analysis of the Proportion and Trend of Outpatient Visits for Pediatric Allergic Diseases in Beijing from 2014 to 2021

HOU Xiaoling, HUANG Huijie, JIANG Nannan, LI Ang, KONG Qin, WEI Mian, XIANG Li

2024, 27(27):  3395-3400.  DOI: 10.12114/j.issn.1007-9572.2024.0006

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Background

The prevalence of allergic diseases is rapidly increasing among the global population, affecting 10%-40% of people worldwide. Allergic diseases often begin in childhood. So far, data for analyzing the trends in the incidence of pediatric allergic diseases in China over the past decade are scant. This study aims to provide an epidemiological support for the prevention and management of pediatric allergic diseases in China by mining electronic medical record data from a single-center institution.

Objective

To analyze the annual proportion and trend of outpatient visits for allergic diseases among children aged 0-18 years in the Beijing Children's Hospital, Capital Medical University from 2014 to 2021.

Methods

A retrospective analysis of outpatient electronic medical records from the hospital information system of Beijing Children's Hospital, Capital Medical University from 2014 to 2021 was conducted to examine the annual proportional composition and changes in the trend changes of allergic diseases. The gender- and age-based proportions of different allergic diseases including eczema, urticaria, allergic rhinitis, bronchial asthma, allergic cough, allergic conjunctivitis, food allergies, drug allergies, pollen allergy, and anaphylaxis were calculated. The trend of changes in the proportion of allergic diseases with stable annual composition ranking in the top 10 was further analyzed.

Results

From 2014 to 2021, there were a total of 1 231 890 outpatient visits for pediatric allergic diseases in our center. After excluding missing data, a total of 1 231 863 eligible cases were included, involving 727 082 (59.0%) boys and 504 781 (41.0%) girls. The majority of children visited for allergic diseases were under the age of 3 years (46.9%). Non-IgE mediated allergic diseases, such as henoch-schoenlein purpura, bronchitis, and respiratory tract infections were excluded, and the remaining 1 208 265 cases included in the disease spectrum analysis. From 2016 to 2021, the proportion of outpatient visits for pediatric allergic diseases in Beijing Children's Hospital, Capital Medical University showed an upward trend. From 2014 to 2017, the top 5 allergic diseases visited in the outpatient department were eczema, urticaria, allergic rhinitis, bronchial asthma, and allergic cough. From 2018 to 2021, allergic rhinitis, eczema, urticaria, allergic conjunctivitis, and bronchial asthma ranked the top 5. The trend analysis for an annual proportion of pediatric allergic diseases showed that the ratios of allergic rhinitis, allergic conjunctivitis, and food allergies among all allergic diseases from 2014 to 2021 showed an increasing trend, with peak ratios of 45.4%, 11.1% and 2.8%, respectively. The ratios of urticaria, eczema, and bronchial asthma showed a decreasing trend, with peak ratios of 46.5%, 24.9% and 11.3%, respectively.

Conclusion

From 2016 to 2021, the proportion of outpatient visits for pediatric allergic diseases in Beijing Children's Hospital, Capital Medical University showed an upward trend. Between 2014 and 2021, the annual proportions of allergic rhinitis, allergic conjunctivitis, and food allergies exhibited an increasing trend, while the annual proportions of eczema, urticaria, and bronchial asthma demonstrated a decreasing trend.

Analysis on Medical Security Research of Outpatient Chronic and Special Disease for Urban and Rural Residents in China

KONG Fanxin, YANG Jingyu, YAN Xuanchen, SU Bin, CHEN Mengen, YUE Wenjing, WEI Xuexuan, CONG Tianzhen

2024, 27(27):  3401-3402.  DOI: 10.12114/j.issn.1007-9572.2023.0607

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Article·Combination of Chinese and Western Medicine

Research on Evaluation Index System of Scientific and Technological Achievements in Traditional Chinese Medicine Clinical Research

LAI Honghao, GUO Jihua, YOU Liangzhen, WANG Jiabo, LIU Cunzhi, LIU Yue, LIU Baoli, SUN Xin, LI Hui, YANG Zhongqi, JI Guang, ZHAO Linhua, ZHAO Hui, SHANG Hongcai, ZENG Fang, WEI Xu, ZHANG Xiaoxiao, GE Long

2024, 27(27):  3403-3410.  DOI: 10.12114/j.issn.1007-9572.2023.0487

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Background

The effective evaluation of scientific and technological achievements in traditional Chinese medicine (TCM) is of great significance in promoting the innovative development of TCM. Previous evaluations of scientific and technological achievements in TCM often used a generalized evaluation method, leading to problems such as inappropriate indicators and limited dimensions, which is not conducive to reflecting the multiple values of achievements in a scientific and comprehensive way. Consequently, there is an urgent need to establish categorized and multi-dimensional evaluation index system for the evaluation of scientific and technological achievements in TCM in the new period.

Objective

To establish a scientific, categorized, reliable and comprehensive evaluation index system that reflects the principles of TCM and highlights its unique advantages aiming at the scientific and technological achievements in TCM, in accordance with the contemporary requirements for scientific and technological evaluation in China.

Methods

This study began in November 2022 and was completed in May 2023. A preliminary index framework was developed through literature review and focus group discussions. Delphi expert consultation was then conducted over two rounds to determine the evaluation indexes and points. The hierarchical analysis method was used to calculate the weight of each index.

Results

The final evaluation index system of scientific and technological achievements in TCM clinical research comprised 10 threshold indicators, 4 primary indicators, 17 secondary indicators, and 17 evaluation points. After testing, the positive coefficient of experts in both rounds of Delphi method implementation was 100%, the authority coefficient was 0.94 and 0.93, respectively. The Kendall's W consistency test for each level of indicators yielded two-tailed significance (P<0.05), indicated high levels of expert positivity and authority, strong consistency of expert opinion, and reliable consulting results.

Conclusion

This study constructs a scientific, reasonable, reliable and easy-to-operate evaluation index system for scientific and technological achievements in TCM clinical research. The indexes cover a wide range with highly differentiated weights and TCM characteristics, which is conducive to highlighting the core strengths while comprehensively considering the multiple value of the results. Additionally, the associated evaluation points, enhancing the operationalization of the index system, may potentially serve as a valuable reference for related evaluation activities.

The Efficacy of Yishen Quzhuo Formula Compared with Metformin in the Treatment of Polycystic Ovary Syndrome with Insulin Resistance: a Randomized Controlled Trial

LI Mengyuan, GAO Zheng, LIANG Jingqiao, ZHANG Yadong, LI Bo, XU Xin

2024, 27(27):  3411-3417.  DOI: 10.12114/j.issn.1007-9572.2024.0035

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Background

Polycystic ovary syndrome with insulin resistance (PCOS-IR) is recognized as one of the most challenging subtypes of PCOS to treat due to its intricate pathogenesis and significant individual variability. Although Metformin, as a first-line medication, can ameliorate blood glucose levels and enhance insulin sensitivity, its efficacy in regulating hormonal imbalances and improving ovarian function is limited. Additionally, its gastrointestinal side effects often hinder patient adherence.

Objective

To evaluate the efficacy and safety of Yishen Quzhuo Formula compared to metformin in the treatment of PCOS-IR.

Methods

A prospective study enrolled 102 PCOS-IR patients from June 2022 to October 2023 at the Department of Gynecology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University. Patients were randomly assigned in a 2∶1 ratio to the experimental group (n=68) treated with Yishen Quzhuo Formula or the control group (n=34) treated with metformin. The comparison was made between the two groups in terms of ovulation rate, pregnancy rate, sex hormones [follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH ratio, testosterone (T), anti-Müllerian hormone (AMH) ], glucose and lipid metabolism indicators, BMI, waist-hip ratio (WHR), and incidence of adverse reactions.

Results

After treatment, the basal body temperature (BBT) ovulation rate in the experimental group increased compared to before treatment (P<0.05). Among patients with a desire for fertility in the experimental group, 13 cases resulted in pregnancy, while in the control group, with 5 such cases, only 1 resulted in pregnancy. The comparison of pregnancy rates between the two groups after treatment showed no statistically significant difference (χ²=1.154, P>0.05). After treatment, both groups showed a decrease in LH/FSH compared to before treatment (P<0.05). Following treatment, both groups showed a decrease in fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol (TC), and triglycerides (TG) compared to before treatment (P<0.05). Following treatment, there was no statistically significant difference in high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) between the two groups compared to before treatment (P>0.05). After treatment, the waist circumference of the control group was lower than that of the experimental group (P<0.05). After treatment, the BMI, waist circumference, hip circumference, and waist hip ratio of both groups of patients decreased compared to before treatment (P<0.05). After treatment, alanine aminotransferase (ALT) and uric acid (UA) in the experimental group decreased compared to before treatment, while UA in the control group increased compared to before treatment (P<0.05). After treatment, there was no statistically significant difference in other indicators between the two groups compared to before treatment (P>0.05). During treatment, adverse reactions such as hypoglycemia, fatigue, epigastric discomfort, and diarrhea occurred in patients, with a lower incidence of adverse reactions in the experimental group (5/68, 7.35%) than in the control group (15/31, 48.39%) (χ²=20.404, P<0.001) .

Conclusion

Yishen Quzhuo Formula regulates hormone imbalance, improves glucose and lipid metabolism abnormalities, and is as effective as metformin in treating PCOS-IR. It exerts protective effects on liver and kidney function and exhibits superior tolerance over metformin in reducing adverse reactions. Given metformin's gastrointestinal side effects, patients demonstrate better tolerance and acceptance of Yishen Quzhuo Formula, thus warranting its clinical promotion and application.

Analysis and Reflection on the Outcome Indicators in Clinical Trials of Traditional Chinese Medicine for Sepsis-induced Acute Lung Injury/Acute Respiratory Distress Syndrome

XIE Liying, MAI Tong, ZHOU Gengbiao, LAI Fang, HAN Yun

2024, 27(27):  3418-3427.  DOI: 10.12114/j.issn.1007-9572.2023.0155

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Background

Traditional Chinese medicine (TCM) is effective in the treatment of sepsis-induced acute lung injury (ALI) /acute respiratory distress syndrome (ARDS). However, the lack of standard and uniform outcome indicators in the design of most published clinical trials makes it difficult to combine and compare the results of similar studies, causing the impossibility of generating high-quality evidence to guide clinical decision-making.

Objective

To analyze the use of outcome indicators in randomized controlled trials on TCM for sepsis-induced ALI/ARDS from 2017 to 2022.

Methods

CNKI, Wanfang Data, SinoMed, PubMed, Embase, Web of Science and Cochrane Library were searched for RCTs on sepsis-induced ALI/ARDS, with the intervention group treated with TCM combined with other drugs or conventional treatment, and no restrictions in the control group. The ROB.2 tool of the Cochrane Review Group was used to assess the quality of literature and the classification of outcome indicators was summarized.

Results

39 papers were included after screening, including 1 (2.56%) with low risk of bias, 3 (7.69%) with high risk of bias and 35 (89.74%) with concerns of bias. The outcome indicators in 5 RCTs were reported with a quality score of ≥5, indicating the complete reporting of outcome indicators. A total of 106 outcome indicators were reported and used for 443 times, including physicochemical testing outcome (55 types, 51.89%), TCM syndrome/sign outcome (2 types, 1.89%), symptom and syndrome outcome (13 types, 12.26%), long-term prognosis outcome (19 types, 17.92%), quality of life outcome (7 types, 6.60%), safety event outcome (8 types, 7.55%) and economic evaluation outcome (2 types, 1.89%). There were four outcome indicators with utilization rate>50%, including oxygenation index (82.05%), Acute Physiology and Chronic Health Evaluation Scoring System (58.97%), mechanical ventilation duration (51.28%) and interleukin-6 (51.28%). The composite outcome indicators of effective rate or TCM syndrome efficacy were used in 21 papers, involving a total of 12 times of effective rate, TCM syndrome score of 8 times and TCM symptom efficacy of 6 times. The total 106 outcome indicators were summarized and categorized sequentially including overall evaluation indicators (36 types, 33.96%), common indicators (36 types, 33.96%) and different focus indicators (34 types, 32.08%) .

Conclusion

At present, the selection of outcome indicators in RCTs on TCM for sepsis-induced ALI/ARDS is still nonstandard, mainly manifests in unclear differentiation between primary and secondary outcome indicators, trivialization of endpoint indicators, lack of follow-up data and characteristic indicators of TCM. A core outcome set of TCM outcome indicators for septic induced ALI/ARDS should be constructed to promote the high-quality development of TCM in the future.

Article·General Practice Tools Research

Development and Reliability and Validity Test of Cardiotoxicity Risk Assessment Scale for Breast Cancer Patients Undergoing Chemotherapy

YAO Shanshan, MA Zhuyue, SHI Yanyan, WU Yuqing, ZHANG Liuliu, CHEN Mingxia, WU Bing, CHENG Fang

2024, 27(27):  3428-3434.  DOI: 10.12114/j.issn.1007-9572.2023.0666

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Background

Cardiotoxicity is a leading cause of mortality among breast cancer patients treated with chemotherapy. Therefore, an early risk assessment is vital for the clinical prevention and treatment of cardiotoxicity in breast cancer patients treated with chemotherapy, although a recognized tool is scant in our country.

Objective

To develop a cardiotoxic risk assessment scale for breast cancer patients undergoing chemotherapy and to test its reliability and validity.

Methods

Through reviewing relevant domestic and international literatures, a pool involving items to assess the risk of cardiotoxicity in breast cancer patients treated with chemotherapy was created. Semi-structured interviews with healthcare providers at Jiangsu Cancer Hospital from September to October 2022 were performed by purposive sampling, thus primarily forming a tool of items for the cardiotoxic risk assessment scale. In addition, breast cancer patients treated with chemotherapy in Jiangsu Cancer Hospital were randomly selected for a pre-survey and validation of the reliability and validity of the scale. Ranked by the score of the cardiotoxic risk assessment scale, the top 27% of participants were assigned into the high-score group, and the remaining were in the low-score group. Cronbach's α coefficient was used to evaluate the internal consistency of the scale. Validity of the scale was verified by measuring the item-level content validity index (I-CVI) and scale-level content validity index (S-CVI). Exploratory factor analysis was performed to assess the structural validity. Receiver operating characteristic (ROC) curves were plotted, and the area under tcurve (AUC) was calculated to determine the predictive validity.

Results

Twenty healthcare providers were included in the semi-structured interviews. After two rounds of expert consultations, a 19-item cardiotoxic risk assessment scale in breast cancer patients treated with chemotherapy was developed. In this study, there were 79 patients in the low-score group and 83 in the high-score group. No significant differences in the history of smoking, endocrine treatment and immunotherapy were detected between the two groups (P>0.05). Correlation analysis showed that the history of smoking and immunotherapy was not significantly correlated with the total scores (P>0.05). Eventually, three items of smoking history, history of endocrine treatment and history of immunotherapy were removed, forming a 16-item scale. The Cronbach's α coefficient, test-retest reliability and inter-rater reliability were 0.739, 0.983 and 0.984, respectively. Content validity results showed that I-CVI ranged from 0.83 to 1.00, and S-CVI was 0.98. Predictive validity results showed the AUC of 0.887 (95%CI=0.827-0.947, P<0.001), with a cut-off value of 32.50 points, Youden's index of 0.649, specificity of 89.1%, and sensitivity of 75.9%. Exploratory factor analysis results showed a Kaiser-Meyer-Olkin (KMO) value of 0.700. Bartlett's sphericity test showed the χ² value of 1 037.898 (df=120, P<0.001). Five common factors were extracted, with a cumulative variance contribution rate of 61.991%. Risk stratification results indicated a low risk at 32-38 points, medium risk at 39-56 points, and high risk at 57 points and above.

Conclusion

The cardiotoxic risk assessment scale for breast cancer patients undergoing chemotherapy has good reliability and validity. It can better predict the high-risk population of cardiotoxicity and provide an effective assessment tool for clinicians and nurses to effectively identify the high-risk population of breast cancer patients undergoing chemotherapy.

Review & Perspectives

Research Progress on Vascular Endothelial Function and Oxidative Stress in Patients with H-type Hypertension at High Altitudes

ZHANG Ning, FAN Shiming

2024, 27(27):  3435-3439.  DOI: 10.12114/j.issn.1007-9572.2024.0040

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The low-pressure and low-oxygen environment at high altitude causes a series of changes in the metabolic level in the human body. The high altitude environment increases the level of oxidative stress and homocysteine in the body, which damages vascular endothelial cells. Hyperhomocysteinemia exacerbates oxidative stress, further aggravates the damage to the vascular endothelium, and accelerates the occurrence and development of hypertension. The combination of antioxidant drugs on the basis of traditional antihypertensive drug treatment provides a new direction for the treatment of H-type hypertension in high-altitude areas. This article reviews the relationship between vascular endothelial function and oxidative stress in patients with H-type hypertension in high-altitude areas, and explores its pathogenesis and possible treatments.

Early Warning Assessment Tools for Cardiovascular Disease Risk: a Scoping Review

ZUO Zhongqi, WANG Yu, JIN Yan, ZHANG Qingwei, YUAN Binbin, SHEN Saiya, WANG Fei, YU Man

2024, 27(27):  3440-3445.  DOI: 10.12114/j.issn.1007-9572.2023.0530

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Background

Cardiovascular disease (CVD) is a major cause of human mortality worldwide, characterized by its insidious onset, intricate and variable course, and poor prognosis. Early identification and active intervention of potentially critically ill patients is essential to improve their prognosis.

Objective

To conduct a scoping review of the research on early warning assessment tools for cardiovascular disease risk at home and abroad, summarize and analyze their assessment content and application, ultimately providing reference for the selection of appropriate early warning tools for cardiovascular disease patients in China.

Methods

CNKI, Wanfang Data, VIP, CBM, PubMed, Web of Science, Cochrane Library, Embase, CINAHL, and Scopus were systematically searched from inception to May 2023. Two investigators independently screened literature and extracted data, analyzed in terms of assessment content, study subjects, validation method, reliability and validity, and predictive efficacy.

Results

A total of 16 papers were included, comprising 7 papers on the development and validation of assessment tools and 9 papers on the localized application of these tools, involving 20 early warning assessment tools for cardiovascular disease risk. The results of the analysis showed that each assessment tool contained 3 to 17 assessment items, with the most frequently mentioned items of age, systolic blood pressure, respiratory rate, oxygen saturation, heart rate, comorbidities, level of consciousness, and gender. The results of the reliability and validity tests for 2 papers indicated robust reliability and validity, while all other studies lacked reliability and validity evaluations. Ten papers reported the area under the curve (AUC), with values ranging from 0.550 to 0.926 9.

Conclusion

Diverse early warning assessment tools for cardiovascular disease risk are available, however, their overall quality remains to be improved and there is a lack of specific assessment tools. In the future, it is imperative to conduct further validations of the reliability and validity of the existing tools, and develop localized early warning assessment tools specialized for cardiovascular diseases considering the unique characteristics of the disease, which exhibit robust reliability and validity.

Sleep Disorders among Community Dwelling Older Adults over 80 Years: a Scoping Review

WANG Guimeng, CUI Xiangshu, YU Wenjing, TENG Mengyuan, LI Jingmei

2024, 27(27):  3446-3452.  DOI: 10.12114/j.issn.1007-9572.2023.0320

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Background

With the aging and life expectancy increasing in China, sleep disorders in the elderly (≥80 years old) have received widespread attention. As one of the common problems, sleep disorders seriously affect the quality of life and physical and mental health among the elderly, and can also aggravate or induce multiple diseases.

Objective

To conduct a scoping review of studies on sleep disorders in community dwelling older adults over 80 years and provide guidance for the early diagnosis and treatment of sleep disorders in community dwelling older adults in China.

Methods

PubMed, Embase, CINAHL, Web of Science, Cochrane Library, OpenGrey, SinoMed, CNKI, Wanfang Data, and VIP databases were searched for literature on sleep disorders in community dwelling older adults from inception to March 15, 2023. Literature was independently screened by 2 investigators and basic characteristics of the literature were extracted (authors, time of publication, country, type of study, sample size, assessment tool or modality, prevalence, findings) .

Results

A total of 10 486 papers were searched, and 21 papers were finally included, of which 14 were in English and 7 were in Chinese, 16 were cross-sectional studies, 2 were quasi-experiment studies and 3 were longitudinal studies. The results of the analysis indicated that sleep disorders were more prevalent with serious adverse effects in the community dwelling older adults aged over 80 years (the prevalence rate ranged from 10.0% to 60.3%), which were assessed by nine tools or modalities, including three structured scales with the more commonly used scale being Pittsburgh Sleep Quality Index (PSQI). The influencing factors of sleep disorders were divided into three categories of social demographic factors, physical health and disease-related factors, psychological and behavioral characteristic factors. Interventions such as music therapy, therapy combined with interaction mode groups were found to be effective in improving sleep disorders. However, few prevention and intervention studies were conducted.

Conclusion

The high prevalence of sleep disorders among older people in the community is high with serious effects, there is insufficient knowledge about sleep disorders among community dwelling older adults and fewer types of assessment tools lacking specificity in China. The influencing factors of sleep disorders among older people are complex and diverse, with a lack of research on prevention and intervention.