Homepage
请稍候...
Responsible Institution:National Health Commission of the People’s Republic of China
Sponsor:Chinese Medical Doctor Association
Honorary Editor-in-Chief:Wu Yiling
Editor-in-Chief:Jia Zhenhua
Managing Director:Ma Zhi
Editing:Editorial Board of Chinese Journal of Difficult and Complicated Cases
Publishing:Publishing House of Chinese Journal of Difficult and Complicated Cases
Address:238 Tianshan Street,Shijiazhuang,Hebei Province,China
Post Code:050035
Phone Number:0311-85901735
E-mail:ynbzz@163.com
 
    Current issue
Issue 12 in 2022    Publication date:2022-12-18
 
Li Hui,Liu Guobing,Liu Pei,Duan Yong,Zeng Haitao.

Objective To investigate the relationship between serum endostatin, complement C1 q/tumor necrosis factor related protein 3(CTRP3), fibroblast growth factor 21(FGF21) and the clinical efficacy of heart failure with preserved ejection fraction(HFpEF) and the value of predicting poor prognosis.Methods From May 2019 to February 2022, 158 HFpEF patients(HFpEF group) and 107 volunteers(healthy control group) with normal cardiac function were selected from the Cardiovascular Department of Changsha Third Hospital/Changsha Hospital Affiliated to Hunan University of Traditional Chinese Medicine. Patients with HFpEF were treated with conventional anti heart failure therapy. According to the efficacy, they were divided into 122 effective subgroups and 36 ineffective subgroups. 152 follow-up patients were divided into 122 good prognosis subgroups and 30 poor prognosis subgroups according to the prognosis. The levels of serum Endostatin, CTRP3 and FGF21 in each group were compared, and the echocardiographic characteristics of HFpEF patients with different prognosis were compared; Multivariate logistic regression analysis was used to analyze the risk factors affecting the poor prognosis of HFpEF patients. The subjects' work characteristic curve(ROC) was used to analyze the value of serum Endostatin, CTRP3, FGF21 in predicting the poor prognosis of HFpEF patients.Results The serum Endostatin and FGF21 levels in HFpEF group were higher than those in healthy control group, while the serum CTRP3 levels were lower than those in healthy control group(t/P=9.585/<0.001, 13.798/<0.001, 42.478/<0.001). The level of serum Endostatin and FGF21 in the ineffective subgroup was higher than that in the effective subgroup, and the level of serum CTRP3 was lower than that in the effective subgroup(t/P=32.125/<0.001, 9.681/<0.001, 21.620/<0.001). Atrial fibrillation, NYHA class IV ratio, serum Endostatin, FGF21, N-terminal pro brain natriuretic peptide(NT-proBNP) levels, early diastolic peak flow(E)/late diastolic peak flow(A) ratio, and early diastolic myocardial velocity(e ') ratio of E/mitral annulus in the subgroup with poor prognosis were higher than those in the subgroup with good prognosis [t(χ2)/P=23.149/<0.001, 7.557/0.006, 22.081/<0.001, 5.234/<0.001, 9.840/<0.001, 8.216/<0.001, 5.087/<0.001], serum CTRP3, left ventricular ejection fraction(LVEF), e 'were lower than the subgroups with good prognosis(t/P=12.597/<0.001, 2.963/0.004, 5.978/<0.001). Multivariate logistic regression analysis showed that atrial fibrillation and elevated serum Endostatin, FGF21, NT-proBNP were risk factors for poor prognosis of HFpEF patients [OR(95%CI)=2.241(1.445-3.475),1.047(1.014-1.081),1.034(1.005-1.063),1.063(1.028-1.100)],and elevated CTRP3 was a protective factor [OR(95%CI)=0.954(0.933-0.976)];The AUC of serum Endostatin, CTRP3, FGF21 and their combination to predict the prognosis of HFpEF patients were 0.741, 0.703, 0.654 and 0.837, respectively. The diagnostic efficacy of their combination was higher than that of single index(Z/P=3.963/<0.001,4.617/<0.001,3.422/<0.001).Conclusion The increase of serum Endostatin and FGF21 levels and the decrease of serum CTRP3 levels in HFpEF patients are related to the clinical efficacy of anti-heart failure and poor prognosis, and are risk factors for poor prognosis in HFpEF patients.

 
Li Min,Li Yuhuan,Luo Jie,Zhang Junjie,Zheng Yongqiang.

Objective To analyze the expression level of endothelial cell specific molecule-1(ESM-1), endothelin-1(ET-1) and their relationship with cognitive function in patients with Parkinson's disease. Methods From January 2019 to March 2021, 103 patients with Parkinson's disease diagnosed and treated by the Department of Neurology of Yichang Second People's Hospital/Second People's Hospital of Three Gorges University in Hubei Province were selected as the Parkinson's group, and 97 patients with physical examination in hospitals at the same time were selected as the healthy control group. The clinical data of the subjects were collected, and the serum ESM-1 and ET-1 levels of the subjects were detected by ELISA. The cognitive function of the subjects was evaluated by Montreal Cognitive Assessment Scale(MoCA). Pearson's method was used to analyze the correlation between the serum ESM-1 and ET-1 levels of Parkinson's disease patients and the total MoCA score. Logistic regression was used to analyze the influencing factors of cognitive dysfunction in Parkinson's disease patients. Results There was no significant difference in age, years of education, body mass index, male, hyperlipidemia, hypertension, diabetes, smoking, drinking and family history between the two groups(P>0.05). The serum ESM-1 level, MoCA scale language, attention, visual space and executive ability, naming, delayed memory, abstract thinking, orientation and total score in Parkinson's group were lower than those in the healthy control group(t=6.382, 15.873, 46.561, 22.847, 30.155, 44.552, 26.094, 8.356, 25.573,P<0.001), and the serum ET-1 level was higher than that in the healthy control group(t=9.520,P<0.001); In Hoehn Yahr stage Ⅲ, Ⅳ and Ⅴ Parkinson's disease patients, the serum ESM-1 level decreased in turn, and the serum ET-1 level increased in turn(F=18.146, 21.854, P<0.001); The serum ESM-1 level in patients with Parkinson's disease was positively correlated with the total MoCA score(r=0.416, P<0.001), and the serum ET-1 level was negatively correlated with the total MoCA score(r=-0.358,P<0.001); Logistic regression analysis showed that high Hoehn Yahr stage, high UPDRS Ⅲ score and high serum ET-1 level were independent risk factors for cognitive dysfunction in patients with Parkinson's disease [OR(95%CI)=1.670(1.232-2.263), 1.362(1.033-1.796), 1.813(1.307-2.515)], and high serum ESM-1 was an independent protective factor [OR(95% CI)=0.624(0.486-0.802)].Conclusion The expression of ESM-1 in serum of patients with Parkinson's disease decreased, and the expression of ET-1 increased. Both levels were related to MoCA score, which was an independent risk factor for cognitive impairment in patients with Parkinson's disease.

 
Wang Jing,Chen Lei,Wang Junli,Chen Guohua,Mei Junhua.

Objective To explore the prognostic value of multimodal monitoring on cerebral neck hemodynamics and neurological function in patients with acute cerebral infarction. Methods Seventy-eight patients with acute cerebral infarction admitted to the Department of Neurology of Wuhan First Hospital from August 2019 to March 2021 were selected as the subjects for multimodal MR monitoring. They were grouped according to the modified Rankin Scale(mRS), perfusion abnormalities and carotid stenosis. To compare the changes of cerebral and neck hemodynamics in patients with acute cerebral infarction in each group, Spearman method was used to analyze the correlation between the degree of carotid stenosis and the prognosis of neurological function and cerebral and neck hemodynamics in patients with acute cerebral infarction. Results There was no significant difference in relative regional cerebral blood flow(rCBF) between the patients with good prognosis(n=40) and those with poor prognosis(n=38)(P>0.05). The relative mean transit time(rMTT) and contrast medium peak time(rTTP) of patients with poor prognosis were significantly higher than those with good prognosis(t/P=10.58/<0.001, 12.646/<0.001, 6.635/<0.001); The rCBV value decreased with the increase of the stage, and the difference was statistically significant(F/P=8.125/0.002). There was no significant difference in rCBF, rMTT, rTTP between patients with different stages of cerebral neck blood flow(P>0.05); The rMTT and rTTP values increased gradually with the severity of carotid stenosis(F/P=3.015/0.001, 2.926/0.009), but there was no significant difference between rCBV and rCBF(P>0.05); Spearman correlation analysis showed that the rMTT and rTTP values in patients with acute cerebral infarction were positively correlated with the prognosis of neurological function and the degree of carotid stenosis(rMTT:r/P=0.851/<0.001,0.789/<0.001; rTTP:r/P=0.986/<0.001,0.450/0.004).Conclusion Multimodal MR monitoring can effectively evaluate the cerebral carotid hemodynamics and the degree of carotid stenosis in patients with acute cerebral infarction, and has important clinical significance in the diagnosis and prevention of poor prognosis.

 
Jiang Lili,Fu Jie,Zheng Aihua,Liu Jun.

Objective To analyze the relationship between serum microRNA-216 a(miR-216 a), angiopoietin like protein 4(ANGPTL4) levels and the severity and prognosis of neonatal acute respiratory distress syndrome(ARDS). Methods One hundred and sixty ARDS neonates admitted to the Neonatal Intensive Care Unit of Bozhou People's Hospital from July 2019 to March 2022 were selected as the ARDS group. According to the oxygen index(OI), they were divided into 62 mild subgroups, 53 moderate subgroups, and 45 severe subgroups. According to the prognosis, they were divided into 103 good subgroups and 57 poor subgroups. In addition, 36 healthy neonates in the same period were selected as the healthy control group. The levels of serum miR-216 a and ANGPTL4 in each group were compared. Spearman correlation coefficient was used to analyze the correlation between serum miR-216 a, ANGPTL4 and OI in ARDS neonates. Multivariate logistic regression was used to analyze the influencing factors of poor prognosis in ARDS neonates. Subjects' work characteristic curve(ROC) was used to analyze the predictive value of serum miR-216 a and ANGPTL4 levels for poor prognosis in ARDS neonates. Results The serum miR-216 a level in the ARDS group was lower than that in the healthy control group, while the serum AngPTL4 level was higher than that in the healthy control group(t/U=21.964, 9.242,P<0.001). The level of serum miR-216 a in mild, moderate and severe subgroups decreased in turn, and the level of ANGPTL4 increased in turn(F/H=55.257, 85.768,P<0.001). Spearman correlation coefficient analysis showed that the serum miR-216 a level of ARDS neonates was negatively correlated with OI, and the ANGPTL4 level was positively correlated with OI(rs=-0.635, 0.693,P<0.001). Multivariate logistic regression analysis showed that prolonged gestational age, increased Apgar score and increased serum miR-216 a were independent protective factors for poor prognosis of ARDS neonates [OR(95%CI)=0.855(0.761-0.960),0.685(0.495-0.947),0.864(0.784-0.952)], prolonged mechanical ventilation time, increased OI and increased serum ANGPTL4 were independent risk factors [OR(95%CI)=1.289(1.063-1.562),1.891(1.190-3.004),1.314(1.152-1.498)].ROC curve analysis showed that the area under the curve of serum miR-216 a, ANGPTL4 and their combination to predict the poor prognosis of ARDS neonates were 0.796, 0.792 and 0.902 respectively, and their combined predictive value was higher than that of their individual prediction(Z/P=3.818/< 0.001, 3.484/0.001). Conclusion The lower serum miR-216 a level and the higher ANGPTL4 level in ARDS neonates are closely related to the aggravation of the disease and poor prognosis, which can be used as an auxiliary predictor of poor prognosis in ARDS neonates.