Pub Date : 2024-07-01DOI: 10.3760/cma.j.cn121430-20240226-00161
Jiawen Yuan, Dexiang Wang, Yuhao Hang, Qinyun Lu, Jian Wang, Jun Lu, Lu Cheng
Objective: To explore the causal relationship between thyroid dysfunction and sepsis based on the bidirectional two-sample Mendelian randomization (MR) method.
Methods: The genome-wide association study (GWAS) dataset were selected to screen single nucleotide polymorphisms (SNP) associated with thyroid dysfunction as instrumental variable (IV) for genetic variation, using hypothyroidism and hyperthyroidism as exposure factor and sepsis as outcome factor. Potential causal relationship between thyroid dysfunction and sepsis was analyzed using a bidirectional two-sample MR method primary analysis method of inverse-variance weighted (IVW). Potential pleiotropic analysis of SNP was performed using the MR Egger regression intercept test. Sensitivity analysis was performed using the "leave one out" test. Reverse MR method was used to prove the causal relationship.
Results: The GWAS data were screened based on the three main assumptions of MR, resulting in 101 SNP strongly associated with hypothyroidism and 10 SNP strongly associated with hyperthyroidism entering the MR analysis. The results of the MR using the IVW method showed that the risk of sepsis in individuals with hypothyroidism was 2.293 times higher than those without hypothyroidism [odds ratio (OR) = 2.293, 95% confidence interval (95%CI) was 1.199-4.382, P = 0.012]. There was no significant difference in the risk of sepsis between hyperthyroid and non-hyperthyroid populations (OR = 1.049, 95%CI was 0.999-1.100, P = 0.560). MR Egger regression intercept test showed that the included SNP did not have pleiotropy, and the MR-PRESSO test did not find outliers. Sensitivity analysis suggested that the results of MR were stable. The results of the reverse MR analysis showed that the reverse causal relationship between hyperthyroidism and sepsis was not proved (OR = 0.996, 95%CI was 0.988-1.004, P = 0.338), which further confirmed the robust MR analysis result.
Conclusions: The results of the bidirectional two-sample MR analysis show that hypothyroidism can increase the risk of sepsis onset, while there is no causal relationship between hyperthyroidism and sepsis.
{"title":"[Causal relationship between thyroid dysfunction and sepsis: a bidirectional two-sample Mendelian randomization].","authors":"Jiawen Yuan, Dexiang Wang, Yuhao Hang, Qinyun Lu, Jian Wang, Jun Lu, Lu Cheng","doi":"10.3760/cma.j.cn121430-20240226-00161","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240226-00161","url":null,"abstract":"<p><strong>Objective: </strong>To explore the causal relationship between thyroid dysfunction and sepsis based on the bidirectional two-sample Mendelian randomization (MR) method.</p><p><strong>Methods: </strong>The genome-wide association study (GWAS) dataset were selected to screen single nucleotide polymorphisms (SNP) associated with thyroid dysfunction as instrumental variable (IV) for genetic variation, using hypothyroidism and hyperthyroidism as exposure factor and sepsis as outcome factor. Potential causal relationship between thyroid dysfunction and sepsis was analyzed using a bidirectional two-sample MR method primary analysis method of inverse-variance weighted (IVW). Potential pleiotropic analysis of SNP was performed using the MR Egger regression intercept test. Sensitivity analysis was performed using the \"leave one out\" test. Reverse MR method was used to prove the causal relationship.</p><p><strong>Results: </strong>The GWAS data were screened based on the three main assumptions of MR, resulting in 101 SNP strongly associated with hypothyroidism and 10 SNP strongly associated with hyperthyroidism entering the MR analysis. The results of the MR using the IVW method showed that the risk of sepsis in individuals with hypothyroidism was 2.293 times higher than those without hypothyroidism [odds ratio (OR) = 2.293, 95% confidence interval (95%CI) was 1.199-4.382, P = 0.012]. There was no significant difference in the risk of sepsis between hyperthyroid and non-hyperthyroid populations (OR = 1.049, 95%CI was 0.999-1.100, P = 0.560). MR Egger regression intercept test showed that the included SNP did not have pleiotropy, and the MR-PRESSO test did not find outliers. Sensitivity analysis suggested that the results of MR were stable. The results of the reverse MR analysis showed that the reverse causal relationship between hyperthyroidism and sepsis was not proved (OR = 0.996, 95%CI was 0.988-1.004, P = 0.338), which further confirmed the robust MR analysis result.</p><p><strong>Conclusions: </strong>The results of the bidirectional two-sample MR analysis show that hypothyroidism can increase the risk of sepsis onset, while there is no causal relationship between hyperthyroidism and sepsis.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120759","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}
Pub Date : 2024-07-01DOI: 10.3760/cma.j.cn121430-20240207-00118
Junyu Ma, Shanshan Zhai, Xiaocong Sun, Chen Li, Jun Duan
<p><strong>Objective: </strong>To investigate the accuracy and reproducibility of diaphragmatic excursion (DE) measurements through hepato-renal/spleno-renal section as a novel method for assessing diaphragmatic function.</p><p><strong>Methods: </strong>Twelve healthy participants were recruited. Each participant underwent DE measurements performed by four operators with varying levels of experience using traditional methods (liver/spleen section) and novel methods (hepato-renal/spleno-renal section), respectively. Among them, two experienced operators were critical care clinicians, and diaphragmatic ultrasound was performed in more than 50 cases. The other two inexperienced operators were respiratory therapists, with less than 10 cases of diaphragmatic ultrasound operations, who received a 2-hour theoretical and operational training before the study. Operators initially used the conventional method with a 1.5-6.0 MHz convex probe in M-mode, placing the sampling line perpendicular to the diaphragm at the point of maximum excursion, and the liver/spleen section DE was determined during normal breathing of participant. Then, they used the novel method with a 1.6-4.5 MHz phased array probe to observe diaphragmatic movement cranio-caudally along the mid-axillary line, employing anatomic M-mode with the sampling line placed perpendicular to the diaphragm at the level of the renal midpoint, and the DE of the hepato-renal/spleno-renal section was measured during normal breathing. The liver and hepato-renal sections were used to assess the right diaphragm, and spleen and spleno-renal sections were used to assess the left diaphragm. Correlation analysis of DE measurements from different sections was conducted using the Deming method, while consistency was assessed using the Bland-Altman method. The consistency of clinical acceptability was defined as the absence of fixed and proportional bias, with a difference of two standard deviations less than 40% of the mean measurement value. Percentage consistency limit = two standard deviations of the differences between measurements/mean measurement value×100%.</p><p><strong>Results: </strong>Four operators performed image scans of DE in all four sections for each of the twelve subjects, with a high DE acquisition rate of 100% (48/48) for hepato-renal and spleno-renal sections, followed by the liver section [91.7% (44/48)] and the spleen section [66.7% (32/48)], particularly for the left diaphragm assessment, where the DE acquisition rate of spleno-renal section was significantly higher than that of traditional spleen section (P < 0.01). The overall measurement results showed that no significant difference was found in DE determined via the hepato-renal and spleno-renal sections using the novel method (cm: 1.64±0.10 vs. 1.55±0.14, P > 0.05), and they were significantly higher than those determined via the conventional liver and spleen sections (cm: hepato-renal section vs. liver section was 1.64±0.10 vs. 1.44±0.0
目的研究通过肝肾/脾肾切片测量膈肌偏移（DE）的准确性和可重复性，以此作为评估膈肌功能的一种新方法：方法：招募了 12 名健康参与者。方法：招募了 12 名健康参与者，由四名经验不同的操作员分别使用传统方法（肝脏/脾脏切片）和新型方法（肝肾/脾肾切片）进行膈肌外展测量。其中，两名经验丰富的操作员是重症监护临床医生，对 50 多个病例进行了膈肌超声检查。另外两名经验不足的操作者是呼吸治疗师，膈肌超声操作不足 10 例，他们在研究前接受了 2 小时的理论和操作培训。操作员最初使用传统方法，在 M 模式下使用 1.5-6.0 MHz 凸探头，将取样线垂直于膈肌的最大偏移点，在受试者正常呼吸时测定肝/脾切面 DE。然后，他们采用新方法，使用 1.6-4.5 MHz 相控阵探头沿腋中线观察膈肌的颅内运动，采用解剖 M-模式，将取样线垂直于肾中点水平的膈肌，在正常呼吸时测量肝肾/脾肾切面的 DE。肝脏和肝肾切片用于评估右侧膈肌，脾脏和脾肾切片用于评估左侧膈肌。采用戴明法对不同切片的膈肌测量值进行相关性分析，并采用布兰-阿尔特曼法评估一致性。临床可接受性的一致性定义为没有固定偏差和比例偏差，两个标准差小于平均测量值的 40%。一致性限值百分比=测量值/平均测量值的两个标准差×100%：四名操作者分别对12名受试者的四个切面进行了DE图像扫描，肝肾切面和脾肾切面的DE采集率高达100%（48/48），其次是肝脏切面[91.7%（44/48）]和脾脏切面[66.7%（32/48）]，尤其是在左侧膈肌评估中，脾肾切面的DE采集率明显高于传统脾脏切面（P<0.01）。总体测量结果显示，使用新方法通过肝肾切片和脾肾切片确定的 DE 无明显差异（cm：1.64±0.10 vs. 1.55±0.14，P > 0.05），且明显高于传统肝脏和脾脏切片的测定值（cm：肝-肾切片对肝切片的测定值为 1.64±0.10 对 1.44±0.09，脾-肾切片对脾切片的测定值为 1.55±0.14 对 1.09±0.14，均 P <0.01）。相关性分析显示，肝肾切片与脾肾切片之间、肝脏切片与肝肾切片之间、肝脏切片与脾肾切片之间的DE相关性良好（r值分别为0.62、0.59和0.42，均P＜0.01）。一致性分析表明，肝-肾切片与脾-肾切片之间以及肝切片与肝-肾切片之间的DE一致性良好（一致性限均小于40%）。然而，脾脏切片与其他三个切片所测得的 DE 值没有相关性，也没有不一致性（所有百分比一致性限值均大于 40%）。四位操作者在肝脏、脾脏、肝肾和脾肾切片中测量的 DE 差异无统计学意义（厘米：肝脏切片为 1.49±0.34、1.44±0.37、1.43±0.30 和 1.40±0.27；肝肾切片为 1.10±0.36、1.05±0.36 和 1.40±0.27）。36、1.05±0.18、1.09±0.22 和 1.06±0.26；肝肾切片 1.67±0.43、1.57±0.34、1.63±0.32 和 1.66±0.36；脾肾切片 1.45±0.33、1.48±0.34、1.50±0.24 和 1.65±0.26；所有 P >0.05）。根据临床可接受的一致性限值范围，四位操作者在所有四个切片中测量的 DE 均显示出良好的一致性（所有一致性限值均小于 40%）：通过肝-肾/脾-肾切片测量 DE 的新方法准确、可重复性高、采集率高，是肝/脾切片传统方法的可行替代方法。
{"title":"[Validation study of a novel diaphragmatic excursion measurement method: evaluation of diaphragmatic excursion by phased-array probe in hepato-renal/spleno-renal section].","authors":"Junyu Ma, Shanshan Zhai, Xiaocong Sun, Chen Li, Jun Duan","doi":"10.3760/cma.j.cn121430-20240207-00118","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240207-00118","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the accuracy and reproducibility of diaphragmatic excursion (DE) measurements through hepato-renal/spleno-renal section as a novel method for assessing diaphragmatic function.</p><p><strong>Methods: </strong>Twelve healthy participants were recruited. Each participant underwent DE measurements performed by four operators with varying levels of experience using traditional methods (liver/spleen section) and novel methods (hepato-renal/spleno-renal section), respectively. Among them, two experienced operators were critical care clinicians, and diaphragmatic ultrasound was performed in more than 50 cases. The other two inexperienced operators were respiratory therapists, with less than 10 cases of diaphragmatic ultrasound operations, who received a 2-hour theoretical and operational training before the study. Operators initially used the conventional method with a 1.5-6.0 MHz convex probe in M-mode, placing the sampling line perpendicular to the diaphragm at the point of maximum excursion, and the liver/spleen section DE was determined during normal breathing of participant. Then, they used the novel method with a 1.6-4.5 MHz phased array probe to observe diaphragmatic movement cranio-caudally along the mid-axillary line, employing anatomic M-mode with the sampling line placed perpendicular to the diaphragm at the level of the renal midpoint, and the DE of the hepato-renal/spleno-renal section was measured during normal breathing. The liver and hepato-renal sections were used to assess the right diaphragm, and spleen and spleno-renal sections were used to assess the left diaphragm. Correlation analysis of DE measurements from different sections was conducted using the Deming method, while consistency was assessed using the Bland-Altman method. The consistency of clinical acceptability was defined as the absence of fixed and proportional bias, with a difference of two standard deviations less than 40% of the mean measurement value. Percentage consistency limit = two standard deviations of the differences between measurements/mean measurement value×100%.</p><p><strong>Results: </strong>Four operators performed image scans of DE in all four sections for each of the twelve subjects, with a high DE acquisition rate of 100% (48/48) for hepato-renal and spleno-renal sections, followed by the liver section [91.7% (44/48)] and the spleen section [66.7% (32/48)], particularly for the left diaphragm assessment, where the DE acquisition rate of spleno-renal section was significantly higher than that of traditional spleen section (P < 0.01). The overall measurement results showed that no significant difference was found in DE determined via the hepato-renal and spleno-renal sections using the novel method (cm: 1.64±0.10 vs. 1.55±0.14, P > 0.05), and they were significantly higher than those determined via the conventional liver and spleen sections (cm: hepato-renal section vs. liver section was 1.64±0.10 vs. 1.44±0.0","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120774","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}
Pub Date : 2024-07-01DOI: 10.3760/cma.j.cn121430-20231218-01092
Bin Xu, Shishuai Meng
<p><strong>Objective: </strong>To investigate the characteristic of circulating microparticle in patients with acute myocardial infarction (AMI) and its possible mechanism of promoting coagulation.</p><p><strong>Methods: </strong>A prospective case-control study was conducted. The patients with coronary heart disease admitted to the second department of cardiology in Harbin First Hospital from June to November 2023 were enrolled, and they were grouped according to whether the patients occurred AMI or not. On the day of admission, disseminated intravascular coagulation (DIC) score was calculated. At the same time, fasting venous blood was collected, and the levels of D-dimer, fibrin degradation product (FDP) and the activities of major coagulation factors were detected. The level of circulating microparticle was determined by microparticle trapping method. The microparticle carrying tissue factor (TF<sup>+</sup>MP) level was detected by tissue factor (TF) dependent F Xa production assay. Spearman correlation method was used to analyze the correlation among the indicators.</p><p><strong>Results: </strong>A total of 52 patients with coronary heart disease were enrolled, including 26 patients in AMI group and 26 patients in non-AMI group. There was no significant difference in gender, age, body mass index (BMI), underlying diseases, smoking history, and pre-admission treatment of patients between the two groups, indicating that the baseline data of the two groups were balanced and comparable. Compared with the non-AMI group, the DIC score and D-dimer, FDP levels in the AMI group were significantly increased [DIC score: 3 (3, 4) vs. 3 (2, 3), D-dimer (mg/L): 8.80 (6.84, 15.66) vs. 2.13 (1.64, 3.86), FDP (mg/L): 30.13 (19.30, 52.54) vs. 20.00 (13.51, 28.37), all P < 0.01], indicating that the degree of coagulation activation in AMI patients was more severe. The consumption of major coagulation factors in the coagulation pathway in the AMI group was heavier than that in the non-AMI group [F II: 59.45% (49.65%, 71.25%) vs. 63.65% (49.98%, 73.22%), F V: 96.95% (73.50%, 112.78%) vs. 105.05% (73.48%, 131.48%), F VII: 42.30% (36.98%, 51.98%) vs. 53.40% (46.58%, 69.88%), F X: 60.90% (48.22%, 80.82%) vs. 73.50% (56.80%, 85.98%), F XI: 82.45% (62.90%, 99.10%) vs. 92.40% (73.90%, 114.25%), F XII: 29.90% (12.42%, 42.38%) vs. 34.65% (16.32%, 48.20%), all P < 0.05]. The circulating TF<sup>+</sup>MP level in the AMI group was significantly higher than that in the non-AMI group [nmol/L: 0.13 (0.06, 0.20) vs. 0.08 (0.04, 0.15), P < 0.05]. There was no significant difference in the level of circulating microparticle between AMI group and non-AMI group [nmol/L: 1.24 (0.71, 3.77) vs. 1.35 (0.73, 2.14), P > 0.05]. Correlation analysis showed that circulating TF<sup>+</sup>MP level in the patients with coronary heart disease was significantly positively correlated with coagulation indicator DIC score (r = 0.307, P = 0.027), D-dimer (r = 0.696, P < 0.001) and FDP (r = 0.582
目的：研究急性心肌梗死（AMI）患者循环微粒的特征及其促进凝血的可能机制：研究急性心肌梗死（AMI）患者循环微粒的特征及其促进凝血的可能机制：方法：进行前瞻性病例对照研究。方法：这是一项前瞻性病例对照研究，以 2023 年 6 月至 11 月哈尔滨市第一医院心内二科收治的冠心病患者为研究对象，根据患者是否发生急性心肌梗死进行分组。入院当天，计算弥散性血管内凝血（DIC）评分。同时采集空腹静脉血，检测 D-二聚体、纤维蛋白降解产物（FDP）的水平和主要凝血因子的活性。微颗粒捕获法测定了循环微颗粒的水平。通过组织因子（TF）依赖性 F Xa 生成试验检测携带组织因子（TF+MP）的微颗粒水平。采用斯皮尔曼相关法分析各指标之间的相关性：共纳入52例冠心病患者，其中AMI组26例，非AMI组26例。两组患者在性别、年龄、体重指数（BMI）、基础疾病、吸烟史、入院前治疗等方面无明显差异，表明两组患者的基线数据均衡，具有可比性。与非 AMI 组相比，AMI 组的 DIC 评分和 D-二聚体、FDP 水平明显升高[DIC 评分：3（3，4） vs. 3（2，3），D-二聚体（mg/L）：8.80（6.84，15.66）vs.2.13（1.64，3.86），FDP（mg/L）：30.13（19.30，52.54）vs.20.00（13.51，28.37），均P＜0.01]，说明AMI患者凝血活化程度更严重。AMI 组凝血途径中主要凝血因子的消耗量比非 AMI 组重[F II：59.45%（49.65%，71.25%） vs. 63.65%（49.98%，73.22%); F V: 96.95% (73.50%, 112.78%) vs. 105.05% (73.48%, 131.48%); F VII: 42.30% (36.98%, 51.98%) vs. 53.40% (46.58%, 69.88%); F X: 60.90% (48.22%, 80.82%) vs. 73.50% (56.80%, 85.98%); F XI：82.45% (62.90%, 99.10%) vs. 92.40% (73.90%, 114.25%)，F XII: 29.90% (12.42%, 42.38%) vs. 34.65% (16.32%, 48.20%)，所有 P <0.05]。AMI 组的循环 TF+MP 水平明显高于非 AMI 组 [nmol/L: 0.13 (0.06, 0.20) vs. 0.08 (0.04, 0.15)，P < 0.05]。AMI 组与非 AMI 组的循环微粒水平无明显差异 [nmol/L: 1.24 (0.71, 3.77) vs. 1.35 (0.73, 2.14)，P > 0.05]。相关性分析显示，冠心病患者循环 TF+MP 水平与凝血指标 DIC 评分（r = 0.307，P = 0.027）、D-二聚体（r = 0.696，P＜0.001）和FDP（r＝0.582，P＜0.001）呈显著正相关，与外源性通路因子FⅦ（r＝-0.521，P＜0.001）和普通通路因子F X（r＝-0.332，P＝0.016）呈显著负相关：AMI患者的循环TF+MP水平明显高于非AMI患者。TF+MP可能在激活外凝血途径、加剧凝血因子消耗和促进AMI发生时血栓形成方面发挥重要作用。
{"title":"[Study on the procoagulant characteristics of microparticles in acute myocardial infarction].","authors":"Bin Xu, Shishuai Meng","doi":"10.3760/cma.j.cn121430-20231218-01092","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231218-01092","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the characteristic of circulating microparticle in patients with acute myocardial infarction (AMI) and its possible mechanism of promoting coagulation.</p><p><strong>Methods: </strong>A prospective case-control study was conducted. The patients with coronary heart disease admitted to the second department of cardiology in Harbin First Hospital from June to November 2023 were enrolled, and they were grouped according to whether the patients occurred AMI or not. On the day of admission, disseminated intravascular coagulation (DIC) score was calculated. At the same time, fasting venous blood was collected, and the levels of D-dimer, fibrin degradation product (FDP) and the activities of major coagulation factors were detected. The level of circulating microparticle was determined by microparticle trapping method. The microparticle carrying tissue factor (TF<sup>+</sup>MP) level was detected by tissue factor (TF) dependent F Xa production assay. Spearman correlation method was used to analyze the correlation among the indicators.</p><p><strong>Results: </strong>A total of 52 patients with coronary heart disease were enrolled, including 26 patients in AMI group and 26 patients in non-AMI group. There was no significant difference in gender, age, body mass index (BMI), underlying diseases, smoking history, and pre-admission treatment of patients between the two groups, indicating that the baseline data of the two groups were balanced and comparable. Compared with the non-AMI group, the DIC score and D-dimer, FDP levels in the AMI group were significantly increased [DIC score: 3 (3, 4) vs. 3 (2, 3), D-dimer (mg/L): 8.80 (6.84, 15.66) vs. 2.13 (1.64, 3.86), FDP (mg/L): 30.13 (19.30, 52.54) vs. 20.00 (13.51, 28.37), all P < 0.01], indicating that the degree of coagulation activation in AMI patients was more severe. The consumption of major coagulation factors in the coagulation pathway in the AMI group was heavier than that in the non-AMI group [F II: 59.45% (49.65%, 71.25%) vs. 63.65% (49.98%, 73.22%), F V: 96.95% (73.50%, 112.78%) vs. 105.05% (73.48%, 131.48%), F VII: 42.30% (36.98%, 51.98%) vs. 53.40% (46.58%, 69.88%), F X: 60.90% (48.22%, 80.82%) vs. 73.50% (56.80%, 85.98%), F XI: 82.45% (62.90%, 99.10%) vs. 92.40% (73.90%, 114.25%), F XII: 29.90% (12.42%, 42.38%) vs. 34.65% (16.32%, 48.20%), all P < 0.05]. The circulating TF<sup>+</sup>MP level in the AMI group was significantly higher than that in the non-AMI group [nmol/L: 0.13 (0.06, 0.20) vs. 0.08 (0.04, 0.15), P < 0.05]. There was no significant difference in the level of circulating microparticle between AMI group and non-AMI group [nmol/L: 1.24 (0.71, 3.77) vs. 1.35 (0.73, 2.14), P > 0.05]. Correlation analysis showed that circulating TF<sup>+</sup>MP level in the patients with coronary heart disease was significantly positively correlated with coagulation indicator DIC score (r = 0.307, P = 0.027), D-dimer (r = 0.696, P < 0.001) and FDP (r = 0.582","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120772","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}
Pub Date : 2024-07-01DOI: 10.3760/cma.j.cn121430-20230901-00735
Ruichi Chen, Yao Lu, Aiqing Wen
Sepsis is a common and severe infectious disease, and its associated coagulation dysfunction can cause disseminated intravascular coagulation (DIC) and organ failure, leading to a significant increase in mortality. Pyroptosis is a form of programmed cell death mediated by caspase-1 in the classical pathway and caspase-4/caspase-5/caspase-11 in the non-classical pathway, along with the effector molecule gasdermin (GSDM) family. Recent studies have shown that pyroptosis plays an important role in the development of coagulation disorders in sepsis. Pyroptosis leads to the formation of cytoplasmic membrane pores, cell swelling and membrane rupture, as well as the release and enhanced activity of procoagulant contents, strongly promoting the development of systemic coagulation activation and DIC in sepsis. Therefore, exploring the role and molecular mechanisms of pyroptosis in sepsis-related coagulation disorders is of great significance for the prevention and treatment of sepsis. This article provides a review of the mechanisms involved in pyroptosis and coagulation disorders in sepsis, as well as the role and mechanisms of pyroptosis in sepsis-associated coagulation disorders to provide new ideas for sepsis related research.
{"title":"[Research progress on the role of pyroptosis in sepsis-related coagulation disorder].","authors":"Ruichi Chen, Yao Lu, Aiqing Wen","doi":"10.3760/cma.j.cn121430-20230901-00735","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20230901-00735","url":null,"abstract":"<p><p>Sepsis is a common and severe infectious disease, and its associated coagulation dysfunction can cause disseminated intravascular coagulation (DIC) and organ failure, leading to a significant increase in mortality. Pyroptosis is a form of programmed cell death mediated by caspase-1 in the classical pathway and caspase-4/caspase-5/caspase-11 in the non-classical pathway, along with the effector molecule gasdermin (GSDM) family. Recent studies have shown that pyroptosis plays an important role in the development of coagulation disorders in sepsis. Pyroptosis leads to the formation of cytoplasmic membrane pores, cell swelling and membrane rupture, as well as the release and enhanced activity of procoagulant contents, strongly promoting the development of systemic coagulation activation and DIC in sepsis. Therefore, exploring the role and molecular mechanisms of pyroptosis in sepsis-related coagulation disorders is of great significance for the prevention and treatment of sepsis. This article provides a review of the mechanisms involved in pyroptosis and coagulation disorders in sepsis, as well as the role and mechanisms of pyroptosis in sepsis-associated coagulation disorders to provide new ideas for sepsis related research.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120771","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}
Pub Date : 2024-07-01DOI: 10.3760/cma.j.cn121430-20240422-00366
Kaiqiang Zhong, Rui Chen, Jun Li, Xiaotu Xi
Sepsis is a prevalent critical illness observed in emergency intensive care unit (ICU), characterized by life-threatening organ dysfunction caused by infection-induced inflammatory immune disorders in the body. The suppression of immune function plays a crucial role in the development and progression of sepsis. Traditional Chinese medicine theory of "acute deficiency syndrome" in sepsis shares similarities with the concept of "immunosuppression". According to this theory, ginseng is frequently utilized in clinical treatment of sepsis due to its ability to invigorate vitality and strengthen the body, playing a crucial role in tonifying deficiency and improving the overall health of patients. This paper provides a detailed discussion of the pathophysiological mechanisms of sepsis immune dysfunction and its correlation with "acute deficiency syndrome" in traditional Chinese medicine. It summarizes the current state of modern pharmacological research on ginseng's impact on the body's immune function, discusses relevant research progress and shortcomings regarding ginseng's therapeutic effects on immunosuppression in sepsis, and proposes future research directions.
{"title":"[Current research status and prospects of ginseng's regulatory effect on immune dysfunction caused by \"acute deficiency syndrome\" of sepsis].","authors":"Kaiqiang Zhong, Rui Chen, Jun Li, Xiaotu Xi","doi":"10.3760/cma.j.cn121430-20240422-00366","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240422-00366","url":null,"abstract":"<p><p>Sepsis is a prevalent critical illness observed in emergency intensive care unit (ICU), characterized by life-threatening organ dysfunction caused by infection-induced inflammatory immune disorders in the body. The suppression of immune function plays a crucial role in the development and progression of sepsis. Traditional Chinese medicine theory of \"acute deficiency syndrome\" in sepsis shares similarities with the concept of \"immunosuppression\". According to this theory, ginseng is frequently utilized in clinical treatment of sepsis due to its ability to invigorate vitality and strengthen the body, playing a crucial role in tonifying deficiency and improving the overall health of patients. This paper provides a detailed discussion of the pathophysiological mechanisms of sepsis immune dysfunction and its correlation with \"acute deficiency syndrome\" in traditional Chinese medicine. It summarizes the current state of modern pharmacological research on ginseng's impact on the body's immune function, discusses relevant research progress and shortcomings regarding ginseng's therapeutic effects on immunosuppression in sepsis, and proposes future research directions.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120762","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}
Pub Date : 2024-06-01DOI: 10.3760/cma.j.cn121430-20231011-00861
Hongyan Xiao, Huaping Liang, Junyu Zhu
Infection is a common medical problem at present. Different pathogens can lead to different infections. Severe infections can ultimately lead to sepsis, resulting in multiple organ dysfunction and the high mortality of patients. Therefore, studying the occurrence and development of severe infections is essential to improve the survival rate of patients. More and more studies have revealed the important role of connection between intestine and liver in infectious diseases. The maintenance of intestinal mechanical barrier and biological barrier function and the regulation of intestinal flora metabolites can reduce infectious liver injury. Bile acids are important metabolites in the liver, which can inhibit the progression of certain infectious intestinal injuries and promote intestinal damage caused by certain pathogens. In this article, the mechanism of action of the intestinal-liver axis in infection was reviewed to find a new target for the treatment of clinical infection.
{"title":"[Role and mechanism of intestinal-liver interaction in infectious intestinal/liver injury].","authors":"Hongyan Xiao, Huaping Liang, Junyu Zhu","doi":"10.3760/cma.j.cn121430-20231011-00861","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231011-00861","url":null,"abstract":"<p><p>Infection is a common medical problem at present. Different pathogens can lead to different infections. Severe infections can ultimately lead to sepsis, resulting in multiple organ dysfunction and the high mortality of patients. Therefore, studying the occurrence and development of severe infections is essential to improve the survival rate of patients. More and more studies have revealed the important role of connection between intestine and liver in infectious diseases. The maintenance of intestinal mechanical barrier and biological barrier function and the regulation of intestinal flora metabolites can reduce infectious liver injury. Bile acids are important metabolites in the liver, which can inhibit the progression of certain infectious intestinal injuries and promote intestinal damage caused by certain pathogens. In this article, the mechanism of action of the intestinal-liver axis in infection was reviewed to find a new target for the treatment of clinical infection.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591593","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}
<p><strong>Objective: </strong>To investigate the dynamic changes of diaphragm and limb skeletal muscle in patients with sepsis by bedside ultrasound and their correlation with the ratio of blood urea/creatinine ratio (UCR) in 7 days after intensive care unit (ICU) admission.</p><p><strong>Methods: </strong>A prospective observational study was conducted. A total of 55 patients with sepsis admitted to ICU of General Hospital of Ningxia Medical University from June 2022 to February 2023 were selected as the research objects. General information, laboratory indicators [urea, serum creatinine (SCr), and UCR] on days 1, 4, and 7 of ICU admission, and prognostic indicators were observed. Bedside ultrasound was used to assess the dynamic changes of diaphragm morphology [including diaphragmatic excursion (DE), end-inspiratory diaphragm thickness (DTei), and end-expiratory diaphragm thickness (DTee)] on days 1, 4, and 7 of ICU admission, as well as limb skeletal muscle (quadriceps femoris) morphology [including rectus femoris-muscle layer thickness (RF-MLT), vastus intermedius-muscle layer thickness (VI-MLT), and rectus femoris-cross sectional area (RF-CSA)]. Diaphragm thickening fraction (DTF) and RF-CSA atrophy rate were calculated, and the incidence of diaphragm and limb skeletal muscle dysfunction was recorded. The correlation between ultrasound morphological parameters of diaphragm and quadriceps and UCR at each time points in 7 days after ICU admission was analyzed by Pearson correlation.</p><p><strong>Results: </strong>A total of 55 patients with sepsis were included, of which 29 were in septic shock. As the duration of ICU admission increased, the incidence of diaphragm dysfunction in patients with sepsis increased first and then decreased (63.6%, 69.6%, and 58.6% on days 1, 4, and 7 of ICU admission, respectively), while the incidence of limb skeletal muscle dysfunction showed an increasing trend (54.3% and 62.1% on days 4 and 7 of ICU admission, respectively), with a probability of simultaneous occurrence on days 4 and 7 of ICU admission were 32.6% and 34.5%, respectively. The UCR on day 7 of ICU admission was significantly higher than that on day 1 [121.77 (95.46, 164.55) vs. 97.00 (70.26, 130.50)], and RF-CSA atrophy rate on day 7 was significantly higher than that on day 4 [%: -39.7 (-52.4, -22.1) vs. -26.5 (-40.2, -16.4)]. RF-CSA was significantly lower on day 7 compared to day 1 [cm<sup>2</sup>: 1.3 (1.0, 2.5) vs. 2.1 (1.7, 2.9)], with all differences being statistically significant (all P < 0.05). Pearson correlation analysis showed that RF-CSA on day 7 of ICU admission was negatively associated with the UCR on the same day (r = -0.407, P = 0.029).</p><p><strong>Conclusions: </strong>Diaphragmatic dysfunction in patients with sepsis occurred early and can be improved. Limb skeletal muscle dysfunction occurred relatively later and progresses progressively. The RF-CSA on day 7 of ICU admission may be a reliable measure of limb skeletal musc
{"title":"[Dynamic changes of diaphragm and limb skeletal muscle in patients with sepsis assessed by bedside ultrasound and their correlation with blood urea/creatinine ratio].","authors":"Jinlan Ma, Yuhan Xia, Ting Wang, Jing Chen, Hongxiao Yang, Huan Ding","doi":"10.3760/cma.j.cn121430-20230803-00577","DOIUrl":"10.3760/cma.j.cn121430-20230803-00577","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the dynamic changes of diaphragm and limb skeletal muscle in patients with sepsis by bedside ultrasound and their correlation with the ratio of blood urea/creatinine ratio (UCR) in 7 days after intensive care unit (ICU) admission.</p><p><strong>Methods: </strong>A prospective observational study was conducted. A total of 55 patients with sepsis admitted to ICU of General Hospital of Ningxia Medical University from June 2022 to February 2023 were selected as the research objects. General information, laboratory indicators [urea, serum creatinine (SCr), and UCR] on days 1, 4, and 7 of ICU admission, and prognostic indicators were observed. Bedside ultrasound was used to assess the dynamic changes of diaphragm morphology [including diaphragmatic excursion (DE), end-inspiratory diaphragm thickness (DTei), and end-expiratory diaphragm thickness (DTee)] on days 1, 4, and 7 of ICU admission, as well as limb skeletal muscle (quadriceps femoris) morphology [including rectus femoris-muscle layer thickness (RF-MLT), vastus intermedius-muscle layer thickness (VI-MLT), and rectus femoris-cross sectional area (RF-CSA)]. Diaphragm thickening fraction (DTF) and RF-CSA atrophy rate were calculated, and the incidence of diaphragm and limb skeletal muscle dysfunction was recorded. The correlation between ultrasound morphological parameters of diaphragm and quadriceps and UCR at each time points in 7 days after ICU admission was analyzed by Pearson correlation.</p><p><strong>Results: </strong>A total of 55 patients with sepsis were included, of which 29 were in septic shock. As the duration of ICU admission increased, the incidence of diaphragm dysfunction in patients with sepsis increased first and then decreased (63.6%, 69.6%, and 58.6% on days 1, 4, and 7 of ICU admission, respectively), while the incidence of limb skeletal muscle dysfunction showed an increasing trend (54.3% and 62.1% on days 4 and 7 of ICU admission, respectively), with a probability of simultaneous occurrence on days 4 and 7 of ICU admission were 32.6% and 34.5%, respectively. The UCR on day 7 of ICU admission was significantly higher than that on day 1 [121.77 (95.46, 164.55) vs. 97.00 (70.26, 130.50)], and RF-CSA atrophy rate on day 7 was significantly higher than that on day 4 [%: -39.7 (-52.4, -22.1) vs. -26.5 (-40.2, -16.4)]. RF-CSA was significantly lower on day 7 compared to day 1 [cm<sup>2</sup>: 1.3 (1.0, 2.5) vs. 2.1 (1.7, 2.9)], with all differences being statistically significant (all P < 0.05). Pearson correlation analysis showed that RF-CSA on day 7 of ICU admission was negatively associated with the UCR on the same day (r = -0.407, P = 0.029).</p><p><strong>Conclusions: </strong>Diaphragmatic dysfunction in patients with sepsis occurred early and can be improved. Limb skeletal muscle dysfunction occurred relatively later and progresses progressively. The RF-CSA on day 7 of ICU admission may be a reliable measure of limb skeletal musc","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591583","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}
Pub Date : 2024-06-01DOI: 10.3760/cma.j.cn121430-20240326-00287
Miao Wu, Jiawei Bai, Yan Yan, Xinyu Xie, Chengtai Ma, Xianjin Du
Although the understanding of sepsis has evolved from "sepsis 1.0" to "sepsis 3.0", and the consensus on clinical management of sepsis has been continuously updated, the incidence rate and mortality of sepsis remain high. Therefore, in-depth investigation of the pathogenesis and related influencing factors of sepsis is of great significance for revealing the nature of sepsis and improving the clinical outcome of sepsis patients. This review will focus on the key issues in the basic research of sepsis, and summarize the recent advances and challenges in this field, mainly including genetic polymorphism, microorganisms, high-mobility group box 1 (HMGB1), endothelial dysfunction, immunotherapy, and biomarkers, aiming to provide new insights for the diagnosis and treatment of sepsis.
{"title":"[Basic research in sepsis: advances and challenges].","authors":"Miao Wu, Jiawei Bai, Yan Yan, Xinyu Xie, Chengtai Ma, Xianjin Du","doi":"10.3760/cma.j.cn121430-20240326-00287","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240326-00287","url":null,"abstract":"<p><p>Although the understanding of sepsis has evolved from \"sepsis 1.0\" to \"sepsis 3.0\", and the consensus on clinical management of sepsis has been continuously updated, the incidence rate and mortality of sepsis remain high. Therefore, in-depth investigation of the pathogenesis and related influencing factors of sepsis is of great significance for revealing the nature of sepsis and improving the clinical outcome of sepsis patients. This review will focus on the key issues in the basic research of sepsis, and summarize the recent advances and challenges in this field, mainly including genetic polymorphism, microorganisms, high-mobility group box 1 (HMGB1), endothelial dysfunction, immunotherapy, and biomarkers, aiming to provide new insights for the diagnosis and treatment of sepsis.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591551","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}
Pub Date : 2024-06-01DOI: 10.3760/cma.j.cn121430-20240219-00146
Jingyan Gao, Chaohui Wang, Xiaoyun Fu, Bao Fu
Objective: To analyze the clinical characteristics and prognosis of acute pancreatitis (AP) in children, and provide reference for clinical prevention and treatment of AP in children.
Methods: Based on the electronic medical record system of the Affiliated Hospital of Zunyi Medical University, the clinical data of children with AP in the hospital from January 2011 to December 2020 were retrospectively analyzed. According to the severity of the disease, the children were divided into mild acute pancreatitis (MAP) group and severe acute pancreatitis (SAP) group. The general data, laboratory tests and outcomes indicators of the two groups were collected and compared. The epidemiological characteristics of children with AP were analyzed. Multivariate Logistic regression was used to analyze the risk factors of SAP in children.
Results: A total of 227 children with AP were enrolled, including 161 in MAP group and 66 in SAP group. The median age of children with AP was 12.00 (8.00, 16.00) years old, and 126 cases (55.51%) were male. The main initial clinical symptoms were abdominal pain, nausea, vomiting and abdominal distension (97.36%, 61.67% and 14.10%, respectively), 21 cases (9.25%) were admitted to intensive care unit (ICU), and 4 cases (1.76%) died in hospital due to sepsis, multiple organ dysfunction or traumatic shock. The epidemiological characteristics showed that the first onset age of AP was mainly 7-17 years old (85.02%); the main etiologies were biliary tract disease (29.96%), viral infection (29.07%) and idiopathic factors (19.82%). From 2011 to 2020, the number of children with AP showed a fluctuating trend, and from 2018 to 2020, the number of children with AP increased for three consecutive years. Compared with MAP group, the age of SAP group was significantly older, the proportion of female, the proportion of rural source, acute physiology and chronic health evaluation II (APACHE II), body mass index (BMI), and the levels of white blood cell count (WBC), C-reactive protein (CRP), hospitalization expenses, the proportion of AP caused by traumatic factors and drug factors in SAP group were significantly higher (all P < 0.05). The level of blood calcium and the proportion of AP caused by virus infection were significantly lower, and the length of hospital stay in SAP group was significantly longer (all P < 0.05). The multivariate Logistic regression analysis showed that APACHE II score [odds ratio (OR) = 1.495, 95% confidence interval (95%CI) was 1.293-1.728] and age (OR = 1.352, 95%CI was 1.182-1.546) were closely related to SAP in children (all P < 0.001).
Conclusions: Children with AP mostly occurs in preschool and adolescence, and the overall mortality is relatively low; biliary tract disease, viral infection and idiopathic factors are common causes; APACHE II score and age may be risk factors for SAP in children.
目的：分析儿童急性胰腺炎（AP）的临床特点及预后，为临床防治儿童急性胰腺炎提供参考：分析儿童急性胰腺炎（AP）的临床特点及预后，为儿童急性胰腺炎的临床防治提供参考：基于遵义医学院附属医院电子病历系统，对该院2011年1月至2020年12月收治的急性胰腺炎患儿的临床资料进行回顾性分析。根据病情严重程度，将患儿分为轻度急性胰腺炎（MAP）组和重度急性胰腺炎（SAP）组。收集并比较了两组患儿的一般数据、实验室检查和结果指标。分析了急性胰腺炎患儿的流行病学特征。采用多元 Logistic 回归分析儿童 SAP 的风险因素：共有 227 名 AP 患儿入组，其中 MAP 组 161 名，SAP 组 66 名。AP患儿的中位年龄为12.00（8.00，16.00）岁，126例（55.51%）为男性。最初的主要临床症状为腹痛、恶心、呕吐和腹胀（分别占97.36%、61.67%和14.10%），21例（9.25%）被送入重症监护室（ICU），4例（1.76%）因败血症、多器官功能障碍或创伤性休克而在医院死亡。流行病学特征显示，AP的首次发病年龄主要为7-17岁（85.02%）；主要病因为胆道疾病（29.96%）、病毒感染（29.07%）和特发性因素（19.82%）。2011年至2020年，AP患儿人数呈波动趋势，2018年至2020年，AP患儿人数连续三年增加。与MAP组相比，SAP组年龄明显偏大，女性比例、农村生源比例、急性生理学与慢性健康评价Ⅱ（APACHEⅡ）、体重指数（BMI）以及白细胞计数（WBC）、C反应蛋白（CRP）水平、住院费用、外伤因素和药物因素导致AP的比例均明显偏高（均P＜0.05）。SAP 组的血钙水平和病毒感染引起的 AP 比例明显降低，住院时间明显延长（均 P < 0.05）。多变量 Logistic 回归分析显示，APACHE II 评分[几率比（OR）= 1.495，95% 置信区间（95%CI）为 1.293-1.728]和年龄（OR = 1.352，95%CI 为 1.182-1.546）与儿童 SAP 密切相关（均为 P <0.001）：结论：儿童 AP 多发生在学龄前和青少年时期，总死亡率相对较低；胆道疾病、病毒感染和特发性因素是常见原因；APACHE II 评分和年龄可能是儿童 SAP 的危险因素。
{"title":"[Clinical characteristics and prognosis of 227 children with acute pancreatitis].","authors":"Jingyan Gao, Chaohui Wang, Xiaoyun Fu, Bao Fu","doi":"10.3760/cma.j.cn121430-20240219-00146","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240219-00146","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the clinical characteristics and prognosis of acute pancreatitis (AP) in children, and provide reference for clinical prevention and treatment of AP in children.</p><p><strong>Methods: </strong>Based on the electronic medical record system of the Affiliated Hospital of Zunyi Medical University, the clinical data of children with AP in the hospital from January 2011 to December 2020 were retrospectively analyzed. According to the severity of the disease, the children were divided into mild acute pancreatitis (MAP) group and severe acute pancreatitis (SAP) group. The general data, laboratory tests and outcomes indicators of the two groups were collected and compared. The epidemiological characteristics of children with AP were analyzed. Multivariate Logistic regression was used to analyze the risk factors of SAP in children.</p><p><strong>Results: </strong>A total of 227 children with AP were enrolled, including 161 in MAP group and 66 in SAP group. The median age of children with AP was 12.00 (8.00, 16.00) years old, and 126 cases (55.51%) were male. The main initial clinical symptoms were abdominal pain, nausea, vomiting and abdominal distension (97.36%, 61.67% and 14.10%, respectively), 21 cases (9.25%) were admitted to intensive care unit (ICU), and 4 cases (1.76%) died in hospital due to sepsis, multiple organ dysfunction or traumatic shock. The epidemiological characteristics showed that the first onset age of AP was mainly 7-17 years old (85.02%); the main etiologies were biliary tract disease (29.96%), viral infection (29.07%) and idiopathic factors (19.82%). From 2011 to 2020, the number of children with AP showed a fluctuating trend, and from 2018 to 2020, the number of children with AP increased for three consecutive years. Compared with MAP group, the age of SAP group was significantly older, the proportion of female, the proportion of rural source, acute physiology and chronic health evaluation II (APACHE II), body mass index (BMI), and the levels of white blood cell count (WBC), C-reactive protein (CRP), hospitalization expenses, the proportion of AP caused by traumatic factors and drug factors in SAP group were significantly higher (all P < 0.05). The level of blood calcium and the proportion of AP caused by virus infection were significantly lower, and the length of hospital stay in SAP group was significantly longer (all P < 0.05). The multivariate Logistic regression analysis showed that APACHE II score [odds ratio (OR) = 1.495, 95% confidence interval (95%CI) was 1.293-1.728] and age (OR = 1.352, 95%CI was 1.182-1.546) were closely related to SAP in children (all P < 0.001).</p><p><strong>Conclusions: </strong>Children with AP mostly occurs in preschool and adolescence, and the overall mortality is relatively low; biliary tract disease, viral infection and idiopathic factors are common causes; APACHE II score and age may be risk factors for SAP in children.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141591552","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}
Pub Date : 2024-06-01DOI: 10.3760/cma.j.cn121430-20240210-00124
Na Gao, Meiping Wang, Li Jiang, Bo Zhu, Xiuming Xi
<p><strong>Objective: </strong>To investigate the epidemiological characteristics and prognosis of critically ill patients with sepsis combined with acute kidney injury (AKI) in intensive care unit (ICU) in Beijing, and to analyze the risk factors associated with in-hospital mortality among these critically ill patients.</p><p><strong>Methods: </strong>Data were collected from the Beijing AKI Trial (BAKIT) database, including 9 049 patients consecutively admitted to 30 ICUs in 28 tertiary hospitals in Beijing from March 1 to August 31, 2012. Patients were divided into non-AKI and non-sepsis group, AKI and non-sepsis group, non-AKI and sepsis group, AKI and sepsis group. Clinical data recorded included demographic characteristics, primary reasons for ICU admission, comorbidities, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II(APACHE II) within 24 hours of ICU admission, physiological and laboratory indexes, treatment in the ICU, AKI staging based on the Kidney Disease: Improving Global Outcomes (KDIGO), as well as the prognostic indicators including length of stay in ICU, length of stay in hospital, ICU and in-hospital mortality. The primary endpoint was discharge or in-hospital death. Multivariate Logistic regression analysis was used to investigate the risk factors for hospital death in ICU patients. Kaplan-Meier survival curve was drawn to analyze the cumulative survival of ICU patients during hospitalization.</p><p><strong>Results: </strong>A total of 3 107 critically ill patients were ultimately enrolled, including 1 259 cases in the non-AKI and non-sepsis group, 931 cases in the AKI and non-sepsis group, 264 cases in the non-AKI and sepsis groups, and 653 cases in the AKI and sepsis group. Compared with the other three group, patients in the AKI and sepsis group were the oldest, had the lowest mean arterial pressure (MAP), and the highest APACHE II score, SOFA score, blood urea nitrogen (BUN), and serum creatinine (SCr) levels, and they also had the highest proportion of receiving mechanical ventilation, requiring vasopressor support, and undergoing renal replacement therapy (RRT), all P < 0.01. Of these 3 107 patients, 1 584 (51.0%) were diagnosed with AKI, and the incidence of AKI in patients with sepsis was significantly higher than in those without sepsis [71.2% (653/917) vs. 42.5% (931/2 190), P < 0.01]. The highest proportion of KDIGO 0 stage was observed in the non-sepsis group (57.5%), while the highest proportion of KDIGO 3 stage was observed in the sepsis group (32.2%). Within the same KDIGO stage, the mortality of patients with sepsis was significantly higher than that of non-sepsis patients (0 stage: 17.8% vs. 3.1%, 1 stage: 36.3% vs. 7.4%, 2 stage: 42.7% vs. 17.1%, 3 stage: 54.6% vs. 28.6%, AKI: 46.1% vs. 14.2%). The ICU mortality (38.7%) and in-hospital mortality (46.1%) in the AKI and sepsis group were significantly higher than those in the other three groups. Kaplan-Meier surviva
目的研究北京市重症监护病房（ICU）中脓毒症合并急性肾损伤（AKI）重症患者的流行病学特征和预后，并分析与这些重症患者院内死亡率相关的危险因素：数据来自北京AKI试验（BAKIT）数据库，包括2012年3月1日至8月31日期间北京28家三级医院30个重症监护室连续收治的9049名患者。患者被分为非 AKI 和无败血症组、AKI 和无败血症组、非 AKI 和败血症组、AKI 和败血症组。记录的临床数据包括人口统计学特征、入住重症监护室的主要原因、合并症、器官功能衰竭序贯评估（SOFA）、入住重症监护室 24 小时内的急性生理学和慢性健康评估 II（APACHE II）、生理指标和实验室指标、重症监护室内的治疗情况、根据肾脏疾病改善全球结局（KDKI）进行的 AKI 分期：以及预后指标，包括重症监护室住院时间、住院时间、重症监护室和院内死亡率。主要终点是出院或院内死亡。多变量 Logistic 回归分析用于研究 ICU 患者住院死亡的风险因素。绘制Kaplan-Meier生存曲线分析ICU患者住院期间的累积生存率：最终共有 3 107 例重症患者入选，其中非 AKI 和无败血症组 1 259 例，AKI 和无败血症组 931 例，非 AKI 和败血症组 264 例，AKI 和败血症组 653 例。与其他三组相比，AKI 和败血症组患者年龄最大，平均动脉压（MAP）最低，APACHE II 评分、SOFA 评分、血尿素氮（BUN）和血清肌酐（SCr）水平最高，接受机械通气、需要血管加压支持和接受肾脏替代治疗（RRT）的比例也最高，所有数据均小于 0.01。在这 3 107 例患者中，有 1 584 例（51.0%）被诊断为 AKI，脓毒症患者的 AKI 发生率明显高于无脓毒症患者 [71.2% (653/917) vs. 42.5% (931/2 190)，P < 0.01]。非败血症组中 KDIGO 0 期的比例最高（57.5%），而败血症组中 KDIGO 3 期的比例最高（32.2%）。在同一 KDIGO 阶段，败血症患者的死亡率明显高于非败血症患者（0 阶段：17.8% 对 3.1%；1 阶段：36.3% 对 7.4%；2 阶段：42.7% 对 17.1%；3 阶段：54.6% 对 28.6%；AKI：46.1% 对 14.2%）。AKI 和败血症组的重症监护室死亡率（38.7%）和院内死亡率（46.1%）明显高于其他三组。Kaplan-Meier 生存曲线进一步显示，AKI 和败血症患者住院期间的累积生存率明显低于其他三组（53.9% vs. 96.9%、85.8%、82.2%，Log-Rank：χ 2 = 379.901，P < 0.001）。亚组分析显示，在存活患者中，AKI 和脓毒症组的重症监护室住院时间和总住院时间明显长于其他三组（P均<0.01）。多变量回归分析显示，年龄、APACHE II 评分和入院 24 小时内的 SOFA 评分、冠心病、AKI、脓毒症和 AKI 合并脓毒症是 ICU 患者死亡的独立风险因素（均 P <0.05）。调整协变量后，AKI、败血症和败血症合并 AKI 与较高的 ICU 和院内死亡率显著相关，其中 ICU 死亡率最高[调整后的比值比（OR）= 14.82，95% 置信区间（95%CI）为 8.10-27.12；Hosmer-Lemeshow 检验：P=0.816]和院内死亡率（调整后比值比（OR）=7.40，95%置信区间（95%CI）为4.94-11.08；Hosmer-Lemeshow检验：P=0.708）在脓毒症合并AKI患者中观察到：结论：脓毒症患者的 AKI 发生率很高，同时患有 AKI 和脓毒症的患者疾病负担更重，生理和实验室指标异常更多，重症监护室和院内死亡率显著增加。在存活的患者中，AKI 和脓毒症组的重症监护室住院时间和住院总时间也更长。年龄、入院 24 小时内的 APACHE II 评分和 SOFA 评分、冠心病、AKI 和败血症是 ICU 患者院内死亡率的独立风险因素。
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