Table of Content

30 June 2023, Volume 38 Issue 6

Previous Issue    Next Issue

Role of cardiac markers in children

ZHANG Xin, MA Lijuan

2023, 38(6):  505-509.  DOI: 10.3969/j.issn.1673-8640.2023.06.001

Asbtract ( 161 )   HTML ( 100)   PDF (872KB) ( 168 )  

References | Related Articles | Metrics

In the recent years，an increasing number of studies have confirmed the diagnostic value and clinical application prospects of cardiac markers in different diseases，such as myocarditis，cardiomyopathy，congenital heart disease（CHD） and heart failure among children. In addition，it has made new progress in judging cardiac function，the degree of myocardial injury，the occurrence of complications and the effect of diagnosis and treatment of immune-related and other systemic diseases. Children's tissues and organs are still in growth and development stage，there are differences in the determination results of cardiac markers in children with different ages，especially in newborns，which makes the interpretation of determination reports more challenging. Therefore，future researches should focus on new analytical methods，the establishment of biological reference intervals for different ages and more evidence-based research in the diagnosis and treatment of children. Related guidelines or expert consensus should be issued to promote the clinical standard application of cardiac marker determination results in children.

Clinical application of cardiac troponin determination in pediatric cardiac involvement related diseases

YANG Qiong, XU Fen, LIN Yahui

2023, 38(6):  510-517.  DOI: 10.3969/j.issn.1673-8640.2023.06.002

Asbtract ( 84 )   HTML ( 86)   PDF (905KB) ( 141 )  

References | Related Articles | Metrics

Cardiac troponin （cTn） is a sensitive and specific marker of myocardial injury. In adults，cTn is widely used in the diagnosis of acute and chronic myocardial injury and risk stratification. Being different from adults，the prevalence of myocardial infarction and coronary heart diseases in children is low，and myocarditis，pericarditis and congenital heart disease（CHD） are common in children. Cardiac injury can occurred secondary to infection，trauma and cancer drug therapy in children. The indicator，cTn，is useful in all these clinical conditions with proper interpretations based on the pediatric patients. This review focuses on the clinical application of cTn determination in children.

Application progress of BNP and NT-proBNP in neonates

YIN Ya, PAN Yuan, ZHOU Hongwei, SHEN Wei

2023, 38(6):  518-523.  DOI: 10.3969/j.issn.1673-8640.2023.06.003

Asbtract ( 96 )   HTML ( 9)   PDF (869KB) ( 89 )  

Figures and Tables | References | Related Articles | Metrics

B-type natriuretic peptide（BNP） and N-terminal pro-B-type natriuretic peptide（NT-proBNP） are blood markers secreted by cardiomyocytes and sensitive indicators reflecting cardiac structure and function. There is no consensus on the reference ranges of plasma levels of BNP and NT-proBNP in neonates，but many studies have explored the application in the diagnosis assessment，therapeutic monitoring and prognostic evaluation for neonatal cardiovascular diseases. This review mainly summarizes the above aspects in order to provide guidance for clinical application.

Changes and clinical roles of perioperative NT-proBNP and PCT in children with congenital heart disease

LI Li, SUN Haiyan, LI Yuanrui, DOU Min, TANG Wen, JIANG Limin, SHEN Lisong

2023, 38(6):  524-531.  DOI: 10.3969/j.issn.1673-8640.2023.06.004

Asbtract ( 72 )   HTML ( 13)   PDF (910KB) ( 58 )  

Figures and Tables | References | Related Articles | Metrics

Objective To evaluate the changes of perioperative N-terminal pro-B-type natriuretic peptide（NT-proBNP） and procalcitonin（PCT） levels in children with simple and complex congenital heart disease（CHD）. Methods Totally，96 children with CHD（≤6 years old）（38 simple CHD patients and 58 complex CHD patients） who underwent cardiac surgery in Xinhua Hospital of Shanghai Jiao Tong University School of Medicine from January 2020 to November 2021 were enrolled. The clinical data of these CHD patients and the NT-proBNP and PCT results at 24 h before operation（T1） and 4 h after operation（T2），24 h after operation（T3） and 48 h after operation（T4）were collected. The changes of perioperative NT-proBNP and PCT were analyzed，and the correlations were evaluated. The perioperative NT-proBNP and PCT levels in predicting the prolongation of intensive care unit（ICU） stay and hospital stay were evaluated by Logistic regression analysis. Results The levels of NT-proBNP and PCT at T3 and T4 were higher than those at T1 and T2. The levels of NT-proBNP at T1，T2，T3 and T4 were negatively correlated with age and body mass（P<0.01），and that in complex CHD children was higher than that of simple CHD children. NT-proBNP levels at T3 and T4 were positively correlated with extracorporeal circulation time and aortic occlusion time（P<0.05），and NT-proBNP at T4 was positively correlated with operation time（P<0.05）. At T4，PCT was negatively correlated with age and body mass（P<0.05），and that in complex CHD children was higher than that in simple CHD children. Multivariate Logistic regression analysis showed that NT-proBNP at T3 [odds ratio（OR）=1.23] and PCT at T4（OR=1.13） were independent factors for the length of ICU stay. NT-proBNP at T3（OR=1.12） and PCT at T4（OR=1.12） were independent factors on the length of hospital stay. Conclusions Perioperative NT-proBNP and PCT levels in children with CHD are increased and then decreased after operation，and they play roles in predicting the prolongation of ICU stay and hospital stay.

Roles of lymphocyte subsets，inflammatory factors and NT-proBNP in diagnosis of Kawasaki disease

LIU Yanan, XIA Min, HU Shaohua, ZHENG Yue, ZHANG Hong

2023, 38(6):  532-537.  DOI: 10.3969/j.issn.1673-8640.2023.06.005

Asbtract ( 75 )   HTML ( 11)   PDF (1120KB) ( 92 )  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the changes and roles of lymphocyte subsets，inflammatory factors and myocardial marker in children with acute Kawasaki disease（KD）. Methods From October 2016 to March 2019，222 acute KD children and 177 non-KD children with infection and fever were enrolled from Children's Hospital of Shanghai. Lymphocytes were determined by flow cytometry. The levels of 13 inflammatory factors [interleukin（IL）-8，IL-1β，IL-2，IL-6，IL-10，IL-4，IL-5，IL-12P70，IL-17A，IL-18，tumor necrosis factor-alpha（TNF-α），interferon-gamma （INF-γ）and sCD25] were determined flow cytometry and immunofluorescence technique Peripheral blood lymphocytes were determined by flow cytometry. The expressions of inflammatory cytokines and lymphocytes in peripheral blood of children with KD in acute phase and non-KD patients with fever-infected were compared. The expressions of inflammatory factors were compared before and after intravenous injection gamma globulin （IVIG） in children with KD. The changes of cardiac markers，including cardiac troponin I （cTnI），myoglobin （MYO） and N-terminal pro-B-type natriuretic peptide （NT-proBNP），in 145 children with KD in acute phase were determined，and the correlations were analyzed. Results Compared with children with infection and fever，other inflammatory factors except IL-2 were increased in children with KD（P<0.05）. Peripheral blood CD3⁺CD4⁺ T cell percentage，CD16⁺CD56⁺ natural killer cell percentage，CD4/CD8 were increased，and CD3⁺CD8⁺ T cell percentage was decreased （P<0.05）. The absolute value of CD16⁺CD56⁺ natural killer cells was increased，and the absolute value of CD3⁺CD8⁺ T cells was decreased （P<0.05）. After treatment，serum IL-8，IL-1β，IL-2，IL-6，IL-10，IL-18，TNF-α and sCD25 were decreased（P<0.05）. There was no significant increase of cTnI and MYO in peripheral blood of children with KD. There was a significant increase of NT-proBNP in peripheral blood of 62% children，which was positively correlated with IL-6，IL-10，IL-17A，IL-18，TNF-α，INF-γ，sCD25，the percentage and absolute value of CD19⁺ B cells，CD4/CD8，and which was negatively correlated with the percentage of CD3⁺CD8⁺ T cells. Conclusions There is up-regulation of inflammatory factors and imbalance of lymphocyte subsets in acute KD. The determination of NT-proBNP combined with immune cells and inflammatory factors can assist clinical diagnosis and treatment.

CK-MB/CK ratio in differentiating false positive results of CK-MB activity method in children

HUANG Yihou, ZHANG Lei, YE Zhicheng, CHENG Fangying

2023, 38(6):  538-542.  DOI: 10.3969/j.issn.1673-8640.2023.06.006

Asbtract ( 89 )   HTML ( 11)   PDF (880KB) ( 94 )  

Figures and Tables | References | Related Articles | Metrics

Objective To evaluate the ratio of creatine kinase MB isoenzyme（CK-MB） to creatine kinase（CK） for differentiating false increased results of CK-MB activity method in children. Methods Totally，304 samples with positive results of CK-MB activity method （higher than reference interval）were collected and randomized into a training set and a validation set by 1∶1. All the samples were determined by CK-MB mass assay. Positivity by mass assay was the standard of true positivity by active method. The clinical disease spectrum of children with false increased results of CK-MB activity method was analyzed. Receiver operating characteristic（ROC） curve analysis was used to evaluate the efficiency of CK-MB/CK in differentiating false increased results of CK-MB activity method. Results Among the 304 samples，141 cases of false positivity were determined by CK-MB activity method. The top 3 diseases were gastroenteritis（28 cases，19.9%），cardiovascular disease（27 cases，19.1%） and tumor（25 cases，17.7%）. In training set，the area under curve（AUC） of CK-MB/CK in differentiating true positive results of CK-MB activity method was 0.921 [95% confidence interval（CI）0.866-0.958，P<0.001]. Using 0.30 as CK-MB/CK cut-off value，the sensitivity of CK-MB/CK in differentiating true positive results of CK-MB activity method was 97.56%（95%CI 91.50%-99.70%）. In validation set，the AUC was 0.919（95%CI 0.862-0.956，P<0.001），and using 0.30 as CK-MB/CK cut-off value，the sensitivity was 97.53%（95%CI 91.40%-99.70%）. Conclusions CK-MB/CK can be used to determine the false increased results of CK-MB activity method. Gastroenteritis，cardiovascular disease and tumor children are prone to false positive results of CK-MB activity method. The positive results of CK-MB activity method in children with such diseases should be objectively judged according to clinical practice.

Relationship between Krebs von den Lungen-6 and acute lung injury in patients with Standford aortic type A dissection

YUAN Ye, LIU Tao, LIU Hua

2023, 38(6):  543-547.  DOI: 10.3969/j.issn.1673-8640.2023.06.007

Asbtract ( 50 )   HTML ( 5)   PDF (872KB) ( 41 )  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the relationship between serum Krebs von den Lungen-6（KL-6） and acute lung injury in Standford aortic type A dissection. Methods A total of 78 patients in Taihe Hospital of Shiyan from May 2019 to May 2021 were diagnosed as Standford aortic type A dissection. According to the oxygenation index during static oxygen inhalation，the patients were classified into lung injury group（30 cases） and non-lung injury group（48 cases）. The clinical data and laboratory determination results of all the patients were collected，and serum KL-6 levels were determined at 12 h before surgery（T1），after induction of anesthesia（T2），after surgery（T3） and 12 h after surgery（T4）. Stepwise Logistic regression analysis was used to assess the risk factors for acute lung injury in Standford aortic type A dissection. Pearson correlation analysis was used to evaluate the correlation among all the indicators. Results Serum KL-6 level of patients in lung injury group was higher than that of non-lung injury group at each time point（P<0.001）. Serum KL-6 levels of the 2 groups at T3 and T4 time points were higher than those at T1 and T2 time points（P<0.05）. For lung injury group and non-lung injury group，the case number of dissection stage （acute stage） and the case number of involving superior mesenteric artery，white blood cell（WBC），high-sensitivity C-reactive protein（hs-CRP） and serum KL-6 levels had statistical significance between lung injury and non-lung injury groups（P<0.05）. Multivariate Logistic regression analysis showed that hs-CRP [odds ratio（OR）=2.063，95% confidence interval（CI） 1.104-3.854] and serum KL-6（OR=2.555，95%CI 1.272-5.133） are independent risk factors for acute lung injury in Standford aortic type A dissection（P<0.05）. Pearson correlation analysis results showed that serum KL-6 and hs-CRP were negatively correlated with oxygenation index（r=-0.561 and -0.368，P<0.01）. Conclusions Serum KL-6 levels are correlated with the occurrence of acute lung injury in Standford aortic type A dissection.

Analysis of amniotic fluid chromosome karyotype and genome copy number variation in critical or high-risk pregnant women by Down's screening

HAN Xue, WEN Liu, WAN Yang

2023, 38(6):  548-552.  DOI: 10.3969/j.issn.1673-8640.2023.06.008

Asbtract ( 54 )   HTML ( 5)   PDF (914KB) ( 34 )  

Figures and Tables | References | Related Articles | Metrics

Objective To analyze amniotic fluid chromosome karyotype and genome copy number variation in critical or high-risk pregnant women by Down's screening，and to provide a reference for prenatal diagnosis of critical or high-risk pregnant women. Methods A total of 450 critical or high-risk pregnant women by Down's screening in Fuyang People's Hospital from December 2019 to October 2021 were enrolled. All of them underwent amniocentesis，and chromosomal karyotype and chromosomal microarray analysis（CMA） or genome copy number variation sequencing（CNV-seq） were performed. Results Chromosomal karyotype analysis detected 40 abnormal karyotypes，accounting for 8.89%，including 29（6.44%） cases of trisomy 18/21-syndrome，11（2.44%） cases of non-trisomy 18/21 chromosome abnormalities [3（0.67%） cases of autosome abnormalities and 8（1.78%） cases of sex chromosome abnormalities]. A total of 76 cases of chromosomal abnormalities were detected by CMA or CNV-seq，of which 35 cases were consistent with karyotype analysis and 41 were inconsistent [including 2 cases of balanced chromosomal translocation，2 cases of complex sex chromosome structure chimerism，12 cases of pathogenic and suspected pathogenic copy number variation（CNV） and 25 cases of unknown clinical significance]. A total of 23（5.11%） cases of non-trisomy 18/21 chromosome abnormalities were detected by chromosomal karyotype analysis combined with copy number variation. Conclusions In addition to trisomy 18/21-syndrome，the critical or high-risk of Down's screening can also be used to indicate the chromosome abnormalities of non-trisomy 18/21. The amniotic fluid chromosomal karyotype analysis combined with CMA or CNV-seq in prenatal diagnosis can improve the detection rate of chromosome abnormalities.

Results of non-invasive prenatal testing-plus in 5 696 pregnant women

ZHANG Chu, WANG Jianhong, LI Rui, XIAO Yanhua, WANG Heng, ZHANG Pinxiao, XU Ningxin, XIA Banban

2023, 38(6):  553-558.  DOI: 10.3969/j.issn.1673-8640.2023.06.009

Asbtract ( 71 )   HTML ( 7)   PDF (876KB) ( 30 )  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the value of non-invasive prenatal testing-plus（NIPT-plus） in prenatal screening. Methods The results of NIPT-plus，interventional prenatal diagnosis and follow-up outcome in 5 696 pregnant women in Maternal and Child Health Hospital of Jiaozuo from December 2019 to June 2021 were analyzed to study the status of NIPT-plus on detecting chromosome aneuploidy and copy number variation（CNV）. Results Totally，5 685 cases were determined among the 5 696 pregnant women，and the determination rate of high-risk in chromosomal abnormality was 2.60%（148/5 685） by NIPT-plus. NIPT-plus had higher positive predictive values on 21-trisomy and 18-trisomy（65.22% and 66.67%） than sex chromosome abnormality high-risk（25.00%）and chromosome microdeletions/microduplications（26.83%）. The consistency rates of the results of microdeletions and microduplications in NIPT-plus and prenatal diagnosis were 43.75%（7/16）and 40.00%（10/25），respectively. The rate of pregnancy termination in microdeletion pregnant women was higher than that in microduplication pregnant women. Conclusions NIPT-plus has high positive predictive value in screening 21-trisomy and 18-trisomy. There is a low positive predictive value for sex chromosome abnormality and CNV by NIPT-plus. It is necessary to combine the results of interventional prenatal diagnosis. When necessary，CNV diagnosed by prenatal diagnosis should verify the source in order to provide correct genetic counseling for pregnant women.

Relationship between the expression of miR-138 in peripheral blood mononuclear cells of hepatitis B virus proliferation in carriers

ZHANG Ying, JING Lijuan, LI Li

2023, 38(6):  559-562.  DOI: 10.3969/j.issn.1673-8640.2023.06.010

Asbtract ( 58 )   HTML ( 17)   PDF (876KB) ( 43 )  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the correlation between the expression of miR-138 in peripheral blood mononuclear cells（PBMC） and hepatitis B virus（HBV）proliferation in HBV carriers. Methods A total of 144 HBV carriers（HBV carrier group） and 144 healthy subjects（healthy control group） were enrolled from Dongying People's Hospital from January 2018 to January 2021. The general data，such as sex and age，hepatitis B serological markers and liver function determination results were collected. The relative expression of miR-138 in PBMC was determined，and the HBV DNA load of HBV carriers was determined. According to the results of hepatitis B serological markers，HBV carriers were classified into hepatitis B e antigen（HBeAg） negative group（63 cases） and HBeAg positive group（81 cases）. Pearson correlation analysis was used to evaluate the correlation between the relative expression of miR-138 and HBV DNA load. Results The relative expression of miR-138 in PBMC of HBV carrier group was lower than that of healthy control group（P<0.001）. The HBV DNA load in HBeAg positive group was higher than that in HBeAg negative group（P<0.001），and the relative expression of miR-138 in PBMC was lower than that in HBeAg negative group（P<0.001）. Pearson correlation analysis showed that PBMC miR-138 relative expression was negatively correlated with HBV DNA load in HBV carrier group（r=-0.841，P<0.05）. Conclusions The expression of miR-138 in PBMC of HBV carriers is down-regulated，which is related to HBV proliferation.

Relationship between thyroid hormones and bile acid subfractions and blood lipids in Graves' disease patients

JIN Suli, ZHAO Jing, ZHANG Jie, HOU Xuening, FANG Yanchao, YANG Li, MI Yujing

2023, 38(6):  563-568.  DOI: 10.3969/j.issn.1673-8640.2023.06.011

Asbtract ( 57 )   HTML ( 3)   PDF (1082KB) ( 38 )  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the relationship between thyroid hormones and bile acid subfractions and blood lipids in patients with Graves' disease（GD）. Methods Totally，43 patients with GD in the First Hospital of Hebei Medical University from October 2021 to February 2022（GD group）were enrolled，and 36 healthy subjects were used as healthy control group. Six primary bile acids [cholic acid（CA），chenodesoxycholic acid（CDCA），glycocholic acid（GCA），glycocholic chenodesoxycholic acid（GCDCA），taurocholic acid（TCA），taurochenodeoxycholic acid（TCDCA）]，nine secondary bile acids [deoxycholic acid（DCA），ursodeoxycholic acid（UDCA），lithocholic acid（LCA），glycodeoxycholic acid（GDCA），glyco-ursodeoxycholic acid（GUDCA），glycine cholic acid（GLCA），tauro-deoxycholic acid（TDCA），taurocholic acid（TLCA），tauro-ursodeoxycholic acid（TUDCA）]，thyroid function [free triiodothyronine（FT₃），free thyroxine（FT₄），high-sensitivity thyroid stimulating hormone（hs-TSH）] and biochemical parameters [fasting blood glucose（FBG），triglyceride（TG），total cholesterol（TC），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C），aspartate aminotransferase（AST），alanine aminotransferase（ALT）] were determined. Results The differences in hs-TSH，FT₃，FT₄，TC，HDL-C and LDL-C levels between GD group and healthy control group were statistically significant（P<0.05），and the differences in FBG，AST，ALT and TG levels were not statistically significant（P>0.05）. Compared with healthy control group，DCA，UDCA，GDCA，GUDCA and TUDCA were lower in GD group（P<0.05），and the differences in LCA，GLCA，TDCA，TLCA，CA，CDCA，GCA，GCDCA，TCA and TCDCA were not statistically significant（P>0.05）. Conclusions The patients with GD have altered concentrations of some bile acid subfractions and blood lipids in serum.

Errors in Appendix B examples of WS/T 505—2017 and correction

TAN Chunyan, ZHOU Ying, MO Zhijiang

2023, 38(6):  569-573.  DOI: 10.3969/j.issn.1673-8640.2023.06.012

Asbtract ( 85 )   HTML ( 9)   PDF (866KB) ( 52 )  

Figures and Tables | References | Related Articles | Metrics

The guideline for evaluation of qualitative test performance （WS/T 505—2017） is the authoritative guide for the performance verification or methodological comparison of qualitative determination items in domestic clinical laboratories. The example analysis in the guideline is an important basis for clinical laboratories and vendors to verify the correctness of datum analysis，but there are some errors in the Appendix B examples involving methodological comparisons that may cause confusion to users. This paper analyzes and corrects errors in the Appendix B examples using the association formula disassembled three-way comparison table，analyzes and corrects calculation errors using formulas that are identical and equivalent to WS/T 505—2017 and the Clinical and Laboratory Standards Institute EP12-A2，and complements other calculation methods for result validation，with a view to helping clinical laboratories use the guideline correctly.

Expressions of ASH2L and HOXA2 in triple-negative breast cancer patients and their relationship with lymph node metastasis

CHEN Chen, DUAN Qi, LU Jiatuan, ZHAI Xiaojian, WANG Zheng, ZHANG Hao, GUO Man

2023, 38(6):  574-578.  DOI: 10.3969/j.issn.1673-8640.2023.06.013

Asbtract ( 57 )   HTML ( 3)   PDF (1335KB) ( 40 )  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the expressions of ASH2-like protein（ASH2L） and homeobox A2（HOXA2） in triple-negative breast cancer（TNBC） patients and their relationship with lymph node metastasis. Methods A total of 80 TNBC patients from Nanyang Central Hospital from June 2016 to June 2020 were enrolled，and their cancer tissue samples were collected. Totally，60 paired cancer adjacent tissue samples（≥5 cm from the edges of the tumors） were collected as controls. The clinical and pathological data were collected，and the expressions of ASH2L，HOXA2 mRNA and proteins were determined. The efficacy of ASH2L mRNA and HOXA2 mRNA in determining lymph node metastasis in TNBC patients was evaluated by receiver operating characteristic（ROC） curve. Results The relative expression levels of ASH2L mRNA，HOXA2 mRNA and protein positive rate were higher in cancer tissues than those in adjacent tissues（P<0.05）. The positive rates of ASH2L protein and HOXA2 protein in cancer tissues of TNBC patients with lymph node metastasis and TNM stage Ⅲ-Ⅳ were higher than those of TNBC patients without lymph node metastasis and TNM stage Ⅰ-Ⅱ（P<0.05）. There was no statistical significance in the positive rates of ASH2L protein and HOXA2 protein in cancer tissues from TNBC patients of different ages，tumor sizes and menopausal status（P>0.05）. The relative expression levels of ASH2L mRNA and HOXA2 mRNA in cancer tissues of TNBC patients with lymph node metastasis were higher than those without lymph node metastasis（P<0.05）. The areas under curves（AUC）of ASH2L mRNA and HOXA2 mRNA single determinations and combined determination for diagnosing lymph node metastasis in TNBC patients were 0.706，0.791 and 0.895，respectively. Conclusions The ASH2L and HOXA2 mRNA and proteins are highly expressed in cancer tissues of TNBC patients，and they are related with TNM staging and lymph node metastasis.

Correlations between the ratio of C-reactive protein to prealbumin and the prognosis of patients with acute heart failure

WU Caorong, CUI Wen, TANG Binbin, HE Jingjing, LAI Zhikun

2023, 38(6):  579-583.  DOI: 10.3969/j.issn.1673-8640.2023.06.014

Asbtract ( 96 )   HTML ( 9)   PDF (904KB) ( 86 )  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the correlations between the ratio of C-reactive protein（CRP） to prealbumin（PA） and the prognosis of patients with acute heart failure（AHF）. Methods A total of 79 patients with AHF treated at the Affiliated Hospital of Traditional Chinese Medicine of Shanghai University of Traditional Chinese Medicine were enrolled retrospectively. The clinical data and laboratory determination results at admission were collected. All the patients were followed with an end date of January 2021 and a primary outcome of all-cause mortality. The optimal cut-off value of CRP/PA to predict AHF patient mortality was determined by receiver operating characteristic（ROC） curve. Pearson correlation analysis was used to determine the correlation between CRP and PA. Patient survival was evaluated by Kaplan-Meier survival curve and Log-rank χ² test. Risk factors for all-cause mortality were identified by Cox proportional hazard ratio. Results Pearson correlation analysis showed that CRP was negatively correlated with PA（r=-0.37，P=0.001）. The results of ROC curve analysis showed that the area under curve of CRP/PA to predict AHF mortality was 0.74 with an optimal cut-off value of 0.119 9. The patients were classified into CRP/PA ≤0.119 9 group（36 cases） and CRP/PA >0.119 9 group（43 cases） according to the optimal cut-off value. Kaplan-Meier survival curve analysis showed that the survival rate of CRP/PA ≤0.119 9 group was higher than that of CRP/PA >0.119 9 group（Log-rank χ²=22.27，P<0.001）. Cox regression analysis showed that after adjusting for age，sex，left ventricular ejection fraction（LVEF），serum creatinine（SCr），B-type natriuretic peptide（BNP），history of diabetes mellitus，diastolic blood pressure，total bilirubin（TB） and albumin（Alb），patients with CRP/PA >0.119 9 had a 9.03-fold increased risk of mortality than those with CRP/PA ≤0.119 9 [hazard ratio（HR）=9.03，95% confidence interval（CI） 2.88-28.29]. Conclusions High CRP/PA is related to all-cause mortality in patients with AHF，and it is helpful for risk stratification.

Role of blood lipid levels in assessment of coronary artery stenosis and its treatment in patients with coronary heart disease

WU Youhong, SONG Yunxiao, ZHU Yong, GE Wen, BIAN Xiaobo, YUAN Wenhua, ZHAO Zhiyun

2023, 38(6):  584-589.  DOI: 10.3969/j.issn.1673-8640.2023.06.015

Asbtract ( 78 )   HTML ( 8)   PDF (966KB) ( 82 )  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the value of blood lipid-related indexes in assessing the degree of coronary artery stenosis and treatment in patients with coronary heart disease. Methods Totally，470 patients diagnosed with coronary heart disease in Shanghai Xuhui Central Hospital were collected from January 2018 to December 2022. According to the degree of coronary artery stenosis，the patients were classified into grade Ⅰ group（80 cases），grade Ⅱ group（137 cases），grade Ⅲ group（204 cases） and grade Ⅳ group（49 cases）. The patients were classified into treatment groups（260 cases） and non-treatment groups（210 cases） according to whether they needed surgical or interventional treatment. The levels of low-density lipoprotein cholesterol（LDL-C），triglyceride（TG），high-density lipoprotein cholesterol（HDL-C），apolipoprotein（apo） A1，apo B，total cholesterol（TC） and lipoprotein（a） [Lp（a）] were determined. Logistic regression analysis was used to evaluate the risk factors for coronary artery stenosis or treatment in patients with coronary heart disease. LASSO regression analysis was used to establish a model for judging the treatment of coronary heart disease patients based on blood lipid indicators. Receiver operating characteristic（ROC） curve was used to evaluate the model's efficacy in determining the need for treatment in patients with coronary heart disease. Results The levels of TC，TG，LDL-C，apo A1 and apo B in grade Ⅰ group，grade Ⅱ group，grade Ⅲ group and grade Ⅳ group were increased successively（P<0.05），and serum HDL-C levels were decreased successively（P<0.05）. Lp（a） levels in grade Ⅲ and Ⅳ group were higher than those in grade Ⅰ and Ⅱ groups（P<0.001），and that in grade Ⅱ group was higher than that in grade Ⅰ group（P<0.001）. Logistic regression analysis showed increased TG and LDL-C levels were risk factors for grade Ⅱ and Ⅲ stenosis（P<0.05）. Decreased HDL-C level was a risk factor for grade Ⅱ and Ⅲ stenosis（P<0.05），and increased TC level was a risk factor for grade Ⅲ and Ⅳ stenosis（P<0.05）. The serum levels of TC，TG，LDL-C，apo A1，apo B and Lp（a） in treatment group were higher than those in non-treatment group（P<0.001），and HDL-C levels were lower in non-treatment group（P<0.001）. Logistic regression analysis showed that increased TC，TG，LDL-C，apo A1，apo B and Lp（a） levels and decreased HDL-C levels were risk factors for coronary heart disease needing treatment（P<0.01）. LASSO regression analysis showed that the area under curve of the combined determination model based on TC，TG and Lp（a） for predicting the need for treatment in patients with coronary heart disease was 0.939. Conclusions Blood lipid-related indexes can be used to evaluate the degree of coronary artery stenosis and can be used as potential indicators to guide clinical intervention treatment.

Clinical roles of NLR，PLR，MPR and immunoglobulin determination in ASO-positive HSPN children

LIU Can, LUO Lingli, FU Min

2023, 38(6):  590-593.  DOI: 10.3969/j.issn.1673-8640.2023.06.016

Asbtract ( 57 )   HTML ( 8)   PDF (927KB) ( 36 )  

Figures and Tables | References | Related Articles | Metrics

Objective To investigate the clinical roles of neutrophil-to-lymphocyte ratio（NLR），platelet-to-lymphocyte ratio（PLR），mean platelet volume-to-platelet ratio（MPR） and immunoglobulins in children with anti-streptolysin O（ASO）-positive Henoch-Sch?nlein purpura nephritis（HSPN）. Methods Totally，110 children with Henoch-Sch?nlein purpura（HSP） were enrolled from Hunan Children's Hospital from January 2020 to January 2021 and classified into ASO group（46 cases） and uninfected group（64 cases） according to whether they were positive for ASO，and the ASO group was further classified into ASO-HSPN group（28 cases） and ASO-HSP group（18 cases） according to the presence or absence of renal lesions. Totally，98 healthy children from Hunan Children's Hospital were enrolled as healthy control group. Blood routine test was performed，IgA，IgG and IgM levels were determined，and NLR，PLR and MPR were calculated. Binary Logistic regression analysis was used to assess the risk factors for the development of HSPN in children with ASO-positive HSP. Receiver operating characteristic（ROC） curve was used to evaluate the value of each index for the diagnosis of ASO-positive HSPN. Results IgA，IgG，IgM and NLR in ASO group and uninfected group were higher than those in healthy control group（P<0.001）. There was statistical significance for MPR and PLR between uninfected group and healthy control group（P<0.01）. Compared with uninfected group，IgA，IgG and IgM in ASO group were increased（P<0.05）. The proportion of joint and kidney involvement in ASO group was slightly higher than that in uninfected group（P>0.05）. MPR in ASO-HSPN group was higher than that in ASO-HSP group（P=0.002），and the differences in the other indicators were not statistically significant between the 2 groups（P>0.05）. Binary Logistic regression analysis showed that MPR was a risk factor for the development of HSPN in children with ASO-positive HSP [odds ratio（OR）= 3.142，95% confidence interval（CI） 1.414-8.657，P=0.027]. The results of ROC curve analysis showed that the area under curve of MPR for the diagnosis of ASO-positive HSPN was 0.780，with an optimal cut-off value of 0.032. The sensitivity was 64.3%，and the specificity was 88.9%. Conclusions HSP combined with streptococcal infection can lead to severe humoral immune dysfunction. MPR has some value in the ancillary diagnosis of ASO-positive HSPN.

Research progress of exosomal non-coding RNA as biomarkers for disease diagnosis

ZHANG Min, WANG Binyu, CHI Weiqun, LIU Yu

2023, 38(6):  594-598.  DOI: 10.3969/j.issn.1673-8640.2023.06.017

Asbtract ( 75 )   HTML ( 7)   PDF (871KB) ( 64 )  

Figures and Tables | References | Related Articles | Metrics

Exosomes are nano-sized vesicles released by living cells and contain a variety of bioactive molecules，including proteins，DNA，mRNA and non-coding RNA（ncRNA）. The expression of exosomal ncRNA will change under different pathological or physiological states，and the differential expression of exosomal ncRNA suggests that it has potential as a biomarker for disease diagnosis. This review introduces the basic characteristics and functions of exosomes and the research progress of exosomal ncRNA for disease diagnosis.