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[The present and future of complement inhibition therapies]. 补体抑制疗法的现状和未来。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20230524-00269
Y Tan, M H Zhao
补体是天然免疫的重要组成部分,其活化参与了脏器损伤。随着对补体在疾病发生和发展中所发挥作用的深入认识,针对补体成分的多种治疗手段应运而生。本文以肾脏疾病为例,介绍补体靶向治疗的现状,有望为补体介导的疾病的治疗开启新篇章。.
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引用次数: 0
[Erythrocytosis after hematopoietic stem cell transplantation: report of 3 cases and literature review]. 【造血干细胞移植后红细胞增多3例报告并文献复习】。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20221226-00958
L L Qin, X D Mo, T T Han, W Han, X J Huang, L P Xu

This is a report of three cases of three male patients. One of the patients had myelodysplastic syndrome, and two had aplastic anemia; their ages were 28, 32, and 21 years old, respectively. Two patients underwent sibling allogeneic hematopoietic stem cell transplantation, and one underwent haploidentical hematopoietic stem cell transplantation. All the patients showed elevated hemoglobin and hematocrit at 6, 16, and 9 months after transplantation, with normal white blood cells and platelets and no splenomegaly. All causes of secondary polycythemia were ruled out. Bone marrow morphology showed no erythroid hyperplasia. The PCR result for BCR-ABL (P210, P230, P190, and variants) was negative, and there were no mutations at the amino acid site 617 of JAK2, exon 12 of JAK2, exon 9 of CALR, and amino acid site 515 of MPL. All three patients had hypertension. One patient was treated with amlodipine, and the other two patients were treated with angiotensin receptor blockers. The durations of erythrocytosis for these three patients were 6 years and 3 months, 4 years and 7 months, and 5 years and 3 months, respectively through December 2022. There was no tendency for spontaneous remission. Erythrocytosis after hematopoietic stem cell transplantation is a rare complication. Previous reports in the literature suggest that the mechanism of post-transplant erythrocytosis in recipients of allogeneic hematopoietic stem cell transplantation may be different from that of recipients of other transplants.

本文报告三例男性患者。其中一名患者患有骨髓增生异常综合征,两名患有再生障碍性贫血;他们的年龄分别为28岁、32岁和21岁。2例患者接受同胞异基因造血干细胞移植,1例患者接受单倍体造血干细胞移植。所有患者在移植后6、16、9个月血红蛋白和红细胞压积升高,白细胞和血小板正常,未见脾肿大。所有继发性红细胞增多症的病因均已排除。骨髓形态未见红系增生。BCR-ABL (P210、P230、P190及变体)PCR结果均为阴性,JAK2的617氨基酸位点、JAK2的12外显子、CALR的9外显子、MPL的515氨基酸位点均未发现突变。3例患者均有高血压。1例患者用氨氯地平治疗,另外2例患者用血管紧张素受体阻滞剂治疗。3例患者红细胞增多持续时间分别为6年3个月、4年7个月、5年3个月,截止2022年12月。没有自发缓解的倾向。造血干细胞移植后的红细胞增多症是一种罕见的并发症。以往的文献报道表明,异基因造血干细胞移植受者移植后红细胞增多的机制可能与其他移植受者不同。
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引用次数: 0
[Clinical features of non-cirrhotic portal hypertension in patients with common variable immunodeficiency]. 【常见可变免疫缺陷患者非肝硬化门脉高压的临床特点】。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20220819-00610
J Wu, X X Han, H Di, Y Yin, Y D Han, Y Wang, Y Zhang, X J Zeng

We wished to summarize the clinical features of common variable immunodeficiency (CVID) complicated by non-cirrhotic portal hypertension (NCPH) and to deepen our understanding of it. The case data of CVID complicated with NCPH admitted to Peking Union Medical College Hospital from January 1983 to May 2021 were analyzed retrospectively to summarize their clinical characteristics. Six patients with CVID combined with NCPH (three of each sex; 16-45 years) were assessed. Four patients had portal hypertension. All patients had anemia, splenomegaly, a normal serum level of albumin and transaminases, and possibly increased levels of alkaline phosphatase and gamma-glutamyl transpeptidase. Two patients were diagnosed with esophagogastric fundic varices by gastroscopy. Two patients underwent splenectomy (which improved hematologic abnormalities partially). Four patients had autoimmune disease. Two cases were diagnosed with nodular regenerative hyperplasia (NRH) upon liver biopsy. Six patients were administered intravenous immunoglobulin-G (0.4-0.6 g/kg bodyweight) once every 3-4 weeks as basic therapy. Often, CVID complicated with NCPH has: (1) The manifestations of portal hypertension as the primary symptom. (2) Autoimmune-related manifestations. Imaging can provide important diagnostic clues. The etiology may be related to hepatic NRH and splenomegaly due to recurrent infections.

我们希望总结共同可变免疫缺陷(CVID)合并非肝硬化门静脉高压症(NCPH)的临床特点,加深我们对它的认识。回顾性分析1983年1月至2021年5月北京协和医院收治的CVID合并NCPH病例资料,总结其临床特点。CVID合并NCPH 6例(男女各3例;16-45岁)进行评估。4例患者有门静脉高压症。所有患者均有贫血、脾肿大,血清白蛋白和转氨酶水平正常,碱性磷酸酶和γ -谷氨酰转肽酶水平可能升高。2例患者经胃镜检查诊断为食管胃底静脉曲张。2例患者行脾切除术(部分改善血液学异常)。4名患者患有自身免疫性疾病。2例经肝活检诊断为结节性再生增生(NRH)。6例患者静脉注射免疫球蛋白g (0.4-0.6 g/kg体重)作为基础治疗,每3-4周1次。CVID合并NCPH通常有:(1)以门静脉高压症为主要症状。(2)自身免疫相关表现。影像可以提供重要的诊断线索。病因可能与复发性感染引起的肝脏NRH和脾肿大有关。
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引用次数: 0
[The triglyceride glucose index predicts the risk of nonfatal cardio-cerebrovascular disease in the Beijing community: a prospective cohort study]. [甘油三酯葡萄糖指数预测北京社区非致命性心脑血管疾病的风险:一项前瞻性队列研究]。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20221110-00842
Y H Wang, H Z Liu, J Du, L Zang, K Chen, W H Yan, Q H Guo, J M Ba, W J Gu, Z H Lyu, J T Dou, Y M Mu

Objective: To explore the characteristics of the association between the triglyceride glucose (TyG) index and nonfatal cardio-cerebrovascular disease risk in a community population. Method: This was a prospective cohort study. From December 2011 to April 2012, the first investigation was conducted among subjects with more than 40-year old who were from Shijingshan district and Pingguoyuan community in Beijing. The second investigation was conducted from April to October 2015. All the subjects were divided into three groups according to the tertile of the TyG index at baseline. The multivariate Cox proportional risk regression model was established to explore the correlation between the TyG index and nonfatal cardio-cerebrovascular disease risk and the Kaplan-Meier survival curve of the TyG index group was drawn. Subgroup analyses were performed according to age, gender, body mass index, type 2 diabetes mellitus (T2DM), hypertension, and hyperlipidemia to determine the correlation characteristics between the TyG index and nonfatal cardio-cerebrovascular disease among subgroups. Results: A total of 9 577 subjects were finally included to analyze. The mean follow-up time of this study was (34.14±3.84) months. During the follow-up, 363 subjects (3.8%) occurred nonfatal cardio-cerebrovascular disease. The multivariate Cox regression analysis results showed that the hazard ratio (HR) of nonfatal cardio-cerebrovascular disease in the high TyG index group was 1.54 (95%CI 1.19-1.98), 1.60 (95%CI 1.23-2.10), and 1.57 (95%CI 1.20-2.05) in the three models, compared with the low TyG index group. The Kaplan-Meier analysis showed that the risk of nonfatal cardio-cerebrovascular disease increased from the low-TyG index group to the high-TyG index group (P=0.015). In the six subgroups analysis, only gender was shown to have a significant interaction effect with the TyG index and nonfatal cardio-cerebrovascular disease risk. In the female population, the risk of nonfatal cardio-cerebrovascular disease is significantly increased with the increase in the TyG index level (P<0.001). Conclusions: A high TyG index is independently related to the increased risk of nonfatal cardio-cerebrovascular disease in the Beijing community population. Gender has a significant interaction with the TyG index and nonfatal cardio-cerebrovascular disease risk. Therefore, the TyG index may be a useful marker to predict the nonfatal cardio-cerebrovascular disease risk of a community population.

目的:探讨社区人群甘油三酯葡萄糖(TyG)指数与非致死性心脑血管疾病风险的关系特点。方法:这是一项前瞻性队列研究。第一次调查于2011年12月至2012年4月在北京市石景山区和平果园社区进行,年龄在40岁以上。第二次调查于2015年4月至10月进行。根据基线时TyG指数的分位数将所有受试者分为三组。建立多因素Cox比例风险回归模型,探讨TyG指数与非致死性心脑血管疾病风险的相关性,绘制TyG指数组Kaplan-Meier生存曲线。根据年龄、性别、体重指数、2型糖尿病(T2DM)、高血压和高脂血症进行亚组分析,以确定亚组中TyG指数与非致死性心脑血管疾病的相关特征。结果:共纳入9 577例受试者进行分析。平均随访时间(34.14±3.84)个月。在随访期间,363名受试者(3.8%)发生非致死性心脑血管疾病。多因素Cox回归分析结果显示,三种模型中TyG指数高组与TyG指数低组相比,非致死性心脑血管疾病的危险比(HR)分别为1.54 (95%CI 1.19 ~ 1.98)、1.60 (95%CI 1.23 ~ 2.10)、1.57 (95%CI 1.20 ~ 2.05)。Kaplan-Meier分析显示,从tyg指数低组到tyg指数高组,非致死性心脑血管疾病的风险增加(P=0.015)。在六个亚组分析中,只有性别与TyG指数和非致死性心脑血管疾病风险有显著的相互作用。在女性人群中,随着TyG指数水平的升高,非致死性心脑血管疾病风险显著增加(p)。结论:高TyG指数与北京社区人群非致死性心脑血管疾病风险增加独立相关。性别与TyG指数和非致死性心脑血管疾病风险有显著的相互作用。因此,TyG指数可能是预测社区人群非致死性心脑血管疾病风险的有用指标。
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引用次数: 0
[A case of adolescent Fabry disease with end-stage renal disease]. [青少年法布里病合并终末期肾病1例]。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20230120-00031
M J Zhu, G X Ding, A H Zhang
男性患儿,11岁出现皮疹,12岁出现肢端疼痛,14岁发现晨起眼睑水肿、泡沫尿,15岁时肢端疼痛难忍,尿蛋白4+就诊。辅助检查示,血压137/97 mmHg(1 mmHg=0.133 kPa),尿蛋白6.94 g/24 h,血肌酐124.7 μmol/L,尿素氮7.38 mmo1/L,尿酸582 μmol/L。超声心动图检查示左心室心肌普遍性稍增厚。肾穿刺活检组织病理见大量髓样小体。α-半乳糖苷酶A活性0.31。全外显子基因检测示GLA有一个半合子突变c.974G>A(p.G325D)。诊断法布雷病,慢性肾脏病3期。2020年8月20日起启动酶替代疗法,予阿加糖酶β 40 mg(约0.9 mg/kg)每2周输注1次,2021年1月1日起阿加糖酶β 40 mg每3周输注1次。2021年7月28日调整阿加糖酶β 45 mg(约1 mg/kg)每周输注2次。经酶替代疗法治疗1年余,血肌酐进行性升高至702 μmol/L,16岁9个月时迅速进展至终末期肾病尿毒症期,予腹膜透析治疗,17岁行肾移植术,目前继续规律酶替代疗法。通过对该病病因、临床特征、诊疗等进行归纳总结,为早期诊断、治疗及后续研究提供参考依据。.
{"title":"[A case of adolescent Fabry disease with end-stage renal disease].","authors":"M J Zhu,&nbsp;G X Ding,&nbsp;A H Zhang","doi":"10.3760/cma.j.cn112138-20230120-00031","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20230120-00031","url":null,"abstract":"男性患儿,11岁出现皮疹,12岁出现肢端疼痛,14岁发现晨起眼睑水肿、泡沫尿,15岁时肢端疼痛难忍,尿蛋白4+就诊。辅助检查示,血压137/97 mmHg(1 mmHg=0.133 kPa),尿蛋白6.94 g/24 h,血肌酐124.7 μmol/L,尿素氮7.38 mmo1/L,尿酸582 μmol/L。超声心动图检查示左心室心肌普遍性稍增厚。肾穿刺活检组织病理见大量髓样小体。α-半乳糖苷酶A活性0.31。全外显子基因检测示GLA有一个半合子突变c.974G>A(p.G325D)。诊断法布雷病,慢性肾脏病3期。2020年8月20日起启动酶替代疗法,予阿加糖酶β 40 mg(约0.9 mg/kg)每2周输注1次,2021年1月1日起阿加糖酶β 40 mg每3周输注1次。2021年7月28日调整阿加糖酶β 45 mg(约1 mg/kg)每周输注2次。经酶替代疗法治疗1年余,血肌酐进行性升高至702 μmol/L,16岁9个月时迅速进展至终末期肾病尿毒症期,予腹膜透析治疗,17岁行肾移植术,目前继续规律酶替代疗法。通过对该病病因、临床特征、诊疗等进行归纳总结,为早期诊断、治疗及后续研究提供参考依据。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 8","pages":"1017-1020"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9980091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Multidisciplinary treatment in the long-term management of Fabry disease]. [法布里病长期治疗中的多学科治疗]。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20230218-00095

Fabry disease is a rare X-linked hereditary condition caused by mutations in the α-galactosidase A (GLA) gene, resulting in decreased α-GAL A enzyme activity. The clinical manifestations of Fabry disease are diverse, which leads to delays in diagnosis and treatment, thereby increasing the disease burden for patients and their families. Given its characteristics, multidisciplinary treatment (MDT) is critical for the long-term management of Fabry disease, and should include nephrology departments, cardiovascular departments, neurology departments, and pediatric department, among others. This study focuses on early screening for Fabry disease, the indication for initiating enzyme replacement therapy, pre-treatment evaluation, and monitoring to provide practical guidance for Chinese clinicians.

法布里病是一种罕见的x连锁遗传病,由α-半乳糖苷酶a (GLA)基因突变引起,导致α-半乳糖苷酶a酶活性下降。法布里病的临床表现多种多样,导致诊断和治疗延误,从而增加了患者及其家属的疾病负担。鉴于其特点,多学科治疗(MDT)对于Fabry病的长期治疗至关重要,应包括肾脏病科、心血管科、神经科和儿科等。本研究旨在探讨Fabry病的早期筛查、启动酶替代治疗的指征、治疗前评估和监测,为我国临床医生提供实践指导。
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引用次数: 0
[Distribution characteristics of plasma renin concentration in patients with aldosterone-producing adenoma]. 【醛固酮产生性腺瘤患者血浆肾素浓度分布特点】。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20230105-00007
J Y Liang, Y Jing, H Shen, X J Chen, W J Luo, Y Song, Y Wang, J B Hu, S M Yang, F F Wu, Q F Li

Objective: To analyze the distribution characteristics of plasma renin concentration (PRC) in patients with aldosterone-producing adenoma (APA) and its impact on diagnosis. Methods: In this retrospective case series, clinical data from 200 patients with APA (80 men and 120 women; mean age 45.6 years) in the First Affiliated Hospital of Chongqing Medical University from November 2013 to January 2022 were evaluated. PRC was determined by automated chemiluminescence immunoassay. The distribution characteristics of PRC were analyzed, and 8.2 mU/L was used as the low renin cutoff to evaluate whether renin was suppressed. Results: The median PRC was 1.6 mU/L (range, 0.4-41.5 mU/L). There were 116 patients with APA with PRC of ≤2 mU/L, 41 patients with 28.2 mU/L) in 8.0% (16/200) of the patients with APA. And PRC was not suppressed in 2.5% (5/200) of the patients with APA, resulting in a primary aldosteronism negative screening outcome. Conclusions: Although most patients with APA have low PRC, there are a small number (8%) of patients whose PRC has not been fully suppressed, which can lead to missed diagnoses during primary aldosteronism screening. While primary aldosteronism is highly suspected, further investigations are required to determine the diagnosis, even if PRC is not fully suppressed at screening.

目的:分析醛固酮生成性腺瘤(APA)患者血浆肾素浓度(PRC)的分布特征及其对诊断的影响。方法:回顾性分析200例APA患者的临床资料(男性80例,女性120例;对2013年11月至2022年1月在重庆医科大学第一附属医院住院的患者(平均年龄45.6岁)进行评估。采用自动化学发光免疫分析法测定PRC。分析PRC的分布特征,并以8.2 mU/L作为低肾素临界值评价肾素是否被抑制。结果:中位PRC为1.6 mU/L(范围0.4 ~ 41.5 mU/L)。在8.0%(16/200)的APA患者中,PRC≤2 mU/L的有116例,28.2 mU/L的有41例。2.5%(5/200)的APA患者PRC未被抑制,导致原发性醛固酮增多症筛查结果阴性。结论:尽管大多数APA患者的PRC较低,但仍有少数(8%)患者的PRC未被完全抑制,这可能导致在原发性醛固酮增多症筛查中漏诊。虽然原发性醛固酮增多症高度可疑,但需要进一步调查以确定诊断,即使PRC在筛查时未被完全抑制。
{"title":"[Distribution characteristics of plasma renin concentration in patients with aldosterone-producing adenoma].","authors":"J Y Liang,&nbsp;Y Jing,&nbsp;H Shen,&nbsp;X J Chen,&nbsp;W J Luo,&nbsp;Y Song,&nbsp;Y Wang,&nbsp;J B Hu,&nbsp;S M Yang,&nbsp;F F Wu,&nbsp;Q F Li","doi":"10.3760/cma.j.cn112138-20230105-00007","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20230105-00007","url":null,"abstract":"<p><p><b>Objective:</b> To analyze the distribution characteristics of plasma renin concentration (PRC) in patients with aldosterone-producing adenoma (APA) and its impact on diagnosis. <b>Methods:</b> In this retrospective case series, clinical data from 200 patients with APA (80 men and 120 women; mean age 45.6 years) in the First Affiliated Hospital of Chongqing Medical University from November 2013 to January 2022 were evaluated. PRC was determined by automated chemiluminescence immunoassay. The distribution characteristics of PRC were analyzed, and 8.2 mU/L was used as the low renin cutoff to evaluate whether renin was suppressed. <b>Results:</b> The median PRC was 1.6 mU/L (range, 0.4-41.5 mU/L). There were 116 patients with APA with PRC of ≤2 mU/L, 41 patients with 2<PRC≤4 mU/L. PRC was not suppressed (PRC>8.2 mU/L) in 8.0% (16/200) of the patients with APA. And PRC was not suppressed in 2.5% (5/200) of the patients with APA, resulting in a primary aldosteronism negative screening outcome. <b>Conclusions:</b> Although most patients with APA have low PRC, there are a small number (8%) of patients whose PRC has not been fully suppressed, which can lead to missed diagnoses during primary aldosteronism screening. While primary aldosteronism is highly suspected, further investigations are required to determine the diagnosis, even if PRC is not fully suppressed at screening.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 8","pages":"972-978"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Analysis of risk factors associated with acute Stanford type B aortic dissection complicated with pleural effusion and observation of the curative effect after intracavitary repair]. [急性Stanford B型主动脉夹层合并胸腔积液的危险因素分析及腔内修复后疗效观察]。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20220904-00653
L F Zheng, D J Meng, Y S Wang, T N Zhou, X Z Wang

Objective: To investigate the risk factors of acute Stanford type B aortic dissection (TBAD) complicated with pleural effusion (PE) and the short-term and long-term outcomes of thoracic endovascular aortic repair (TEVAR). Methods: A case-control study. The clinical and imaging data of 1 083 patients with acute TBAD admitted to the General Hospital of Northern Theater Command from April 2002 to December 2020 were retrospectively analyzed, including 211 cases with pleural effusion and 872 cases without pleural effusion. The baseline analysis of the two groups of patients was performed. The risk factors associated with pleural effusion were analyzed by binary logistic regression, and the results were expressed as odds ratio (OR) and 95% confidence interval (CI). According to the quantity of pleural effusion, they were simultaneously divided into small pleural effusion group and medium large pleural effusion group, to compare the short-term and long-term effects of TEVAR patients with different amounts of pleural effusion. Results: The incidence of pericardial effusion (17.5% vs. 3.8%, P<0.001), anemia (21.3% vs. 12.5%, P=0.001), aortic spiral tear (49.8% vs. 37.8%, P=0.002), dissection tear over diaphragm (57.8% vs. 48.1%, P=0.011), serum creatinine [85 (69, 111) vs. 81 (67, 100) μmol/L, P=0.011] and white blood cell levels[(11.3±4.2)×109/L vs. (10.3±4.2)×109/L, P=0.002] in acute TBAD pleural effusion group were significantly higher than those in non-pleural effusion group, and the hemoglobin level was significantly lower than that in non-pleural effusion group [(128±20) vs. (133±17) g/L, P<0.05]. Logistic stepwise regression analysis showed that pericardial effusion (OR=5.038,95%CI 2.962-8.568,P<0.001), anemia (OR=2.047,95%CI 1.361-3.079,P=0.001), spiral tear (OR=1.551,95%CI 1.030-2.336, P=0.002) and elevated white blood cell (OR=1.059,95%CI 1.011-1.102, P=0.005) were independent risk factors for TBAD complicated with pleural effusion. The incidences of all-cause death (4/19 vs. 1.5% vs. 0.9%, P<0.001), aortogenic death (4/19 vs. 0.7% vs. 0.7%, P<0.001) and aortic related adverse events (4/19 vs. 1.5% vs. 1.1%, P<0.001) in patients with large pleural effusion during TEVAR operation were significantly higher than those in patients with small pleural effusion and those without pleural effusion, and the differences were statistically significant. At 1 month follow-up after TEVAR, the incidence of all-cause death (4/16 vs. 3.3% vs. 1.6%, P<0.001), aortogenic death (4/16 vs. 0.8% vs.0.7%, P<0.001), aorta related adverse events (4/16 vs. 4.1% vs. 4.7%, P=0.013) and overall clinical adverse events (4/16 vs.9.8% vs. 6.7%, P=0.014) in the medium and large thoracic group were significantly higher than those in the sma

目的:探讨急性Stanford B型主动脉夹层(TBAD)合并胸腔积液(PE)的危险因素及胸血管内主动脉修复术(TEVAR)的近期和远期疗效。方法:病例-对照研究。回顾性分析2002年4月至2020年12月北方战区总医院收治的1 083例急性TBAD患者的临床及影像学资料,其中有胸腔积液211例,无胸腔积液872例。对两组患者进行基线分析。采用二元logistic回归分析与胸腔积液相关的危险因素,结果以比值比(OR)和95%置信区间(CI)表示。根据胸腔积液量同时分为小胸腔积液组和中大胸腔积液组,比较不同胸腔积液量TEVAR患者的近期和远期疗效。结果:急性TBAD胸腔积液组心包积液(17.5% vs. 3.8%, PP=0.001)、主动脉螺旋撕裂(49.8% vs. 37.8%, P=0.002)、横膈膜夹层撕裂(57.8% vs. 48.1%, P=0.011)、血清肌酐[85 (69,111)vs. 81 (67, 100) μmol/L, P=0.011]、白细胞水平[(11.3±4.2)×109/L vs(10.3±4.2)×109/L, P=0.002]的发生率均显著高于非胸腔积液组;血红蛋白水平明显低于非胸腔积液组[(128±20)∶(133±17)g/L, POR=5.038,95%CI 2.962 ~ 8.568,POR=2.047,95%CI 1.361 ~ 3.079,P=0.001]、螺旋撕裂(OR=1.551,95%CI 1.030 ~ 2.336, P=0.002)和白细胞升高(OR=1.059,95%CI 1.011 ~ 1.102, P=0.005)是TBAD合并胸腔积液的独立危险因素。中、大胸组全因死亡发生率(4/19 vs. 1.5% vs. 0.9%, PPPPPP=0.013)和总临床不良事件发生率(4/16 vs.9.8% vs. 6.7%, P=0.014)均显著高于小胸液组和无胸液组,差异有统计学意义。TEVAR术后随访1年,中、大胸组全因死亡发生率(4/15比4.9%比3.9%,P=0.004)、主动脉源性死亡发生率(4/15比2.5%比2.1%,PP=0.012)、总临床不良事件发生率(5/15比18.9%比13.1%,P=0.029)均显著高于小胸膜积液组和无胸膜积液组,差异有统计学意义。结论:单中心资料显示心包积液、贫血、螺旋撕裂和白细胞升高是急性TBAD合并胸腔积液的独立危险因素;TBAD患者TEVAR术后合并中度胸膜积液的早期(1个月)和长期(1年)全因死亡率、主动脉死亡率、主动脉不良事件和总体临床不良事件发生率均显著高于TBAD患者,且中度和大量胸膜积液是TEVAR术后近期和长期主动脉相关不良事件的独立危险因素。
{"title":"[Analysis of risk factors associated with acute Stanford type B aortic dissection complicated with pleural effusion and observation of the curative effect after intracavitary repair].","authors":"L F Zheng,&nbsp;D J Meng,&nbsp;Y S Wang,&nbsp;T N Zhou,&nbsp;X Z Wang","doi":"10.3760/cma.j.cn112138-20220904-00653","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20220904-00653","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the risk factors of acute Stanford type B aortic dissection (TBAD) complicated with pleural effusion (PE) and the short-term and long-term outcomes of thoracic endovascular aortic repair (TEVAR). <b>Methods:</b> A case-control study. The clinical and imaging data of 1 083 patients with acute TBAD admitted to the General Hospital of Northern Theater Command from April 2002 to December 2020 were retrospectively analyzed, including 211 cases with pleural effusion and 872 cases without pleural effusion. The baseline analysis of the two groups of patients was performed. The risk factors associated with pleural effusion were analyzed by binary logistic regression, and the results were expressed as odds ratio (<i>OR</i>) and 95% confidence interval (<i>CI</i>). According to the quantity of pleural effusion, they were simultaneously divided into small pleural effusion group and medium large pleural effusion group, to compare the short-term and long-term effects of TEVAR patients with different amounts of pleural effusion. <b>Results:</b> The incidence of pericardial effusion (17.5% vs. 3.8%, <i>P</i><0.001), anemia (21.3% vs. 12.5%, <i>P</i>=0.001), aortic spiral tear (49.8% vs. 37.8%, <i>P</i>=0.002), dissection tear over diaphragm (57.8% vs. 48.1%, <i>P</i>=0.011), serum creatinine [85 (69, 111) vs. 81 (67, 100) μmol/L, <i>P</i>=0.011] and white blood cell levels[(11.3±4.2)×10<sup>9</sup>/L vs. (10.3±4.2)×10<sup>9</sup>/L, <i>P</i>=0.002] in acute TBAD pleural effusion group were significantly higher than those in non-pleural effusion group, and the hemoglobin level was significantly lower than that in non-pleural effusion group [(128±20) vs. (133±17) g/L, <i>P</i><0.05]. Logistic stepwise regression analysis showed that pericardial effusion (<i>OR</i>=5.038,95%<i>CI</i> 2.962-8.568,<i>P</i><0.001), anemia (<i>OR</i>=2.047,95%<i>CI</i> 1.361-3.079,<i>P</i>=0.001), spiral tear (<i>OR</i>=1.551,95%<i>CI</i> 1.030-2.336<i>, P</i>=0.002) and elevated white blood cell (<i>OR</i>=1.059,95%<i>CI</i> 1.011-1.102, <i>P</i>=0.005) were independent risk factors for TBAD complicated with pleural effusion. The incidences of all-cause death (4/19 vs. 1.5% vs. 0.9%, <i>P</i><0.001), aortogenic death (4/19 vs. 0.7% vs. 0.7%, <i>P</i><0.001) and aortic related adverse events (4/19 vs. 1.5% vs. 1.1%, <i>P</i><0.001) in patients with large pleural effusion during TEVAR operation were significantly higher than those in patients with small pleural effusion and those without pleural effusion, and the differences were statistically significant. At 1 month follow-up after TEVAR, the incidence of all-cause death (4/16 vs. 3.3% vs. 1.6%, <i>P</i><0.001), aortogenic death (4/16 vs. 0.8% vs.0.7%, <i>P</i><0.001), aorta related adverse events (4/16 vs. 4.1% vs. 4.7%, <i>P</i>=0.013) and overall clinical adverse events (4/16 vs.9.8% vs. 6.7%, <i>P</i>=0.014) in the medium and large thoracic group were significantly higher than those in the sma","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 8","pages":"964-971"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10282722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Correlation of cognitive function with intracranial lesions and the degree of depression and anxiety in patients with neuromyelitis optica spectrum disorders]. [视神经脊髓炎谱系障碍患者认知功能与颅内病变及抑郁、焦虑程度的相关性]。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20221013-00757
X L Zhong, S S Jia, F Qiu

Objective: To investigate the correlation of cognitive dysfunction with intracranial lesions and symptoms of depression and anxiety in patients with neuromyelitis optica spectrum disorders (NMOSD). Methods: Thirty-one NMOSD patients (7/24 males/females) were enrolled in the Department of Neurology of the Sixth Medical Center of the PLA General Hospital from August 2019 to August 2022. The average age was 42±13 years, and the average education level was 12 (9, 12) years. There were 30 healthy controls, 11/19 males/females, with an average age of 47±9 years and an average education of 12 (9, 15) years. The general clinical data and imaging data were collected, and the subjects were assessed on their cognition, anxiety and depression using the assessment scale approved at home and abroad. A cross-sectional study was conducted on them. The t-test or Wilcoxon test was used for inter-group comparison, and Pearson test or Spearman test was used to explore the correlation between the cognition of NMOSD patients and their intracranial lesions, depression and anxiety. Results: Compared with the healthy control group, NMOSD patients had significantly lower scores on MoCA (Z=-3.10,P=0.002), CRAVLT-N7 (Z=-5.12, P<0.001), CRAVLT-N8 (t=-4.40, P<0.001), ROCF-R (t=-3.10,P<0.01), ROCF-C (Z=-2.72,P<0.01), PASAT-3 (Z=-2.71,P<0.01), PASAT-2 (Z=-3.14,P<0.01), and CWT-A (Z=-3.10,P<0.01)scales. Frontal lobe lesions were negatively correlated with PASAT-2 (r=-0.448, P=0.012) scores, temporal lobe lesions were negatively correlated with CRAVLT-N9 (r=-0.564, P=0.001), and parietal lobe lesions were negatively correlated with MoCA (r=-0.374, P=0.038), PASAT-3 (r=-0.426, P=0.017), and PASAT-2 (r=-0.459, P=0.009) scores; The scores of MoCA (r=-0.392, P=0.029), CRAVLT-N6 (r=-0.396, P=0.028), CRAVLT-N7 (r=-0.415, P=0.020), CRAVLT-N8 (r=-0.406, P=0.023), PASAT-3 (r=-0.537, P=0.002) and PASAT-2 (r=-0.495, P=0.005) scales were negatively correlated with the scores of HAMD assessment, and the scores of PASAT-3 (r=-0.499, P=0.004) and PASAT-2 (r=-0.452, P=0.011) were negatively correlated with the scores of HAMA. Conclusions: The cognitive function of patients with NMOSD is significantly reduced, involving multiple cognitive domains. The cognitive function is affected by the distribution of intracranial lesions and the degree of depression and anxiety.

目的:探讨视神经脊髓炎谱障碍(NMOSD)患者认知功能障碍与颅内病变及抑郁、焦虑症状的相关性。方法:选取解放军总医院第六医学中心神经内科2019年8月至2022年8月收治的NMOSD患者31例(男女7/24)。平均年龄42±13岁,平均文化程度12(9,12)岁。健康对照30例,男女各占11/19,平均年龄47±9岁,平均文化程度12(9,15)年。收集一般临床资料和影像学资料,采用国内外认可的评定量表对受试者的认知、焦虑、抑郁进行评定。对他们进行了横断面研究。组间比较采用t检验或Wilcoxon检验,探讨NMOSD患者认知与颅内病变、抑郁、焦虑的相关性采用Pearson检验或Spearman检验。结果:与健康对照组相比,NMOSD患者MoCA评分(Z=-3.10,P= - 0.002)、CRAVLT-N7评分(Z=-5.12, Pt=-4.40, Pt=-3.10,PZ=-2.72,PZ=-2.71,PZ=-3.14,PZ=-3.10,Pr=-0.448, P=0.012)显著降低,颞叶病变与CRAVLT-N9评分呈负相关(r=-0.564, P=0.001),顶叶病变与MoCA评分呈负相关(r=-0.374, P=0.038)、PASAT-3评分(r=-0.426, P=0.017)、PASAT-2评分(r=-0.459, P=0.009);MoCA量表(r=-0.392, P=0.029)、CRAVLT-N6量表(r=-0.396, P=0.028)、CRAVLT-N7量表(r=-0.415, P=0.020)、CRAVLT-N8量表(r=-0.406, P=0.023)、PASAT-3量表(r=-0.537, P=0.002)和PASAT-2量表(r=-0.495, P=0.005)得分与HAMD评分呈负相关,PASAT-3量表(r=-0.499, P=0.004)和PASAT-2量表(r=-0.452, P=0.011)得分与HAMA评分呈负相关。结论:NMOSD患者认知功能明显下降,涉及多个认知领域。认知功能受颅内病变分布及抑郁、焦虑程度的影响。
{"title":"[Correlation of cognitive function with intracranial lesions and the degree of depression and anxiety in patients with neuromyelitis optica spectrum disorders].","authors":"X L Zhong,&nbsp;S S Jia,&nbsp;F Qiu","doi":"10.3760/cma.j.cn112138-20221013-00757","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20221013-00757","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the correlation of cognitive dysfunction with intracranial lesions and symptoms of depression and anxiety in patients with neuromyelitis optica spectrum disorders (NMOSD). <b>Methods:</b> Thirty-one NMOSD patients (7/24 males/females) were enrolled in the Department of Neurology of the Sixth Medical Center of the PLA General Hospital from August 2019 to August 2022. The average age was 42±13 years, and the average education level was 12 (9, 12) years. There were 30 healthy controls, 11/19 males/females, with an average age of 47±9 years and an average education of 12 (9, 15) years. The general clinical data and imaging data were collected, and the subjects were assessed on their cognition, anxiety and depression using the assessment scale approved at home and abroad. A cross-sectional study was conducted on them. The <i>t</i>-test or Wilcoxon test was used for inter-group comparison, and Pearson test or Spearman test was used to explore the correlation between the cognition of NMOSD patients and their intracranial lesions, depression and anxiety. <b>Results:</b> Compared with the healthy control group, NMOSD patients had significantly lower scores on MoCA (<i>Z</i>=-3.10,<i>P</i>=0.002), CRAVLT-N7 (<i>Z</i>=-5.12, <i>P</i><0.001), CRAVLT-N8 (<i>t</i>=-4.40, <i>P</i><0.001), ROCF-R (<i>t</i>=-3.10,<i>P</i><0.01), ROCF-C (<i>Z</i>=-2.72,<i>P</i><0.01), PASAT-3 (<i>Z</i>=-2.71,<i>P</i><0.01), PASAT-2 (<i>Z</i>=-3.14,<i>P</i><0.01), and CWT-A (<i>Z</i>=-3.10,<i>P</i><0.01)scales. Frontal lobe lesions were negatively correlated with PASAT-2 (<i>r</i>=-0.448, <i>P</i>=0.012) scores, temporal lobe lesions were negatively correlated with CRAVLT-N9 (<i>r</i>=-0.564, <i>P</i>=0.001), and parietal lobe lesions were negatively correlated with MoCA (<i>r</i>=-0.374, <i>P</i>=0.038), PASAT-3 (<i>r</i>=-0.426, <i>P</i>=0.017), and PASAT-2 (<i>r</i>=-0.459, <i>P</i>=0.009) scores; The scores of MoCA (<i>r</i>=-0.392, <i>P</i>=0.029), CRAVLT-N6 (<i>r</i>=-0.396, <i>P</i>=0.028), CRAVLT-N7 (<i>r</i>=-0.415, <i>P</i>=0.020), CRAVLT-N8 (<i>r</i>=-0.406, <i>P</i>=0.023), PASAT-3 (<i>r</i>=-0.537, <i>P</i>=0.002) and PASAT-2 (<i>r</i>=-0.495, <i>P</i>=0.005) scales were negatively correlated with the scores of HAMD assessment, and the scores of PASAT-3 (<i>r</i>=-0.499, <i>P</i>=0.004) and PASAT-2 (<i>r</i>=-0.452, <i>P</i>=0.011) were negatively correlated with the scores of HAMA. <b>Conclusions:</b> The cognitive function of patients with NMOSD is significantly reduced, involving multiple cognitive domains. The cognitive function is affected by the distribution of intracranial lesions and the degree of depression and anxiety.</p>","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 8","pages":"993-999"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9916580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Type 2 diabetes complicated with subcutaneous insulin resistance syndrome: a case report]. [2型糖尿病合并皮下胰岛素抵抗综合征1例]。
Pub Date : 2023-08-01 DOI: 10.3760/cma.j.cn112138-20221110-00841
L Zang, X F Wei, Q H Guo, Y L Chen, Y Q Yin, Y Cheng, W J Gu, J M Ba, J T Dou, Z H Lyu, Y M Mu
患者女性,20岁,糖尿病伴多囊卵巢综合征病史6年。发病初期使用胰岛素皮下注射治疗效果佳,后停用胰岛素使用口服药治疗。近1年因血糖异常升高再次启用胰岛素皮下注射治疗,但超大剂量胰岛素皮下注射血糖控制不佳;实验室检查示空腹胰岛素轻度升高,未发现拮抗胰岛素激素水平增高的内分泌疾病,基因检测未见异常突变;静脉胰岛素输注可将血糖控制达标。最终诊断为2型糖尿病合并皮下胰岛素抵抗综合征。使用二甲双胍、恩格列净联合肌肉注射胰岛素,患者血糖控制平稳。.
{"title":"[Type 2 diabetes complicated with subcutaneous insulin resistance syndrome: a case report].","authors":"L Zang,&nbsp;X F Wei,&nbsp;Q H Guo,&nbsp;Y L Chen,&nbsp;Y Q Yin,&nbsp;Y Cheng,&nbsp;W J Gu,&nbsp;J M Ba,&nbsp;J T Dou,&nbsp;Z H Lyu,&nbsp;Y M Mu","doi":"10.3760/cma.j.cn112138-20221110-00841","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20221110-00841","url":null,"abstract":"患者女性,20岁,糖尿病伴多囊卵巢综合征病史6年。发病初期使用胰岛素皮下注射治疗效果佳,后停用胰岛素使用口服药治疗。近1年因血糖异常升高再次启用胰岛素皮下注射治疗,但超大剂量胰岛素皮下注射血糖控制不佳;实验室检查示空腹胰岛素轻度升高,未发现拮抗胰岛素激素水平增高的内分泌疾病,基因检测未见异常突变;静脉胰岛素输注可将血糖控制达标。最终诊断为2型糖尿病合并皮下胰岛素抵抗综合征。使用二甲双胍、恩格列净联合肌肉注射胰岛素,患者血糖控制平稳。.","PeriodicalId":24000,"journal":{"name":"Zhonghua nei ke za zhi","volume":"62 8","pages":"1025-1028"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9980092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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