The Ability of Baseline Triglycerides and Total Cholesterol Concentrations to Predict Incidence of Type 2 Diabetes Mellitus in Chinese Men and Women:A Longitudinal Study in Qingdao, China

Objectives The purpose of this study was to assess the association between triglycerides(TG),total cholesterol(TC)at baseline,and type 2 diabetes mellitus(T2DM)incidence in a general Chinese population.Further,it aimed to evaluate the ability of TG and TC to predict T2DM incidence.Methods Qingdao Diabetes Prevention Program participants recruited between 2006 and 2009 were followed up in 2012–2015.TG,TC,and T2DM status were measured.Cox proportional hazards models were used to estimate the association between TG,TC,and T2DM incidence.The receiver operating characteristic(ROC)curve was used to evaluate the ability of TG and TC to identify T2DM participants.Results The incidence of T2DM significantly increased with TG in women and TC in both men and women(Ptrend<0.05).Univariate Cox regression indicated that higher TG{borderline high TG[hazards ratio(HR):2.05;95%confidence interval(CI):1.40,3.00]and hypertriglyceridemia[HR:2.64;95%CI:1.68,4.15]}and TC[hypercholesterolemia(HR:2.05;95%CI:1.43,2.95)]were significantly associated with increased risk of T2DM incidence in women but not in men.Multivariate Cox regression showed that hypertriglyceridemia in women(HR:1.78,95%CI:1.07,2.97),borderline high TC in men(HR:1.61,95%CI:1.04,2.48),and hypercholesterolemia in women(HR:1.68,95%CI:1.81,2.61)had a higher significant risk of T2DM incidence.The optimal cutoff values of TG were>1.15 and>1.23 mmol/L in men and women,respectively.For TC,they were>5.17 and>5.77 mmol/L in men and women,respectively.The area under the ROCs of TG and TC were 0.54(0.51–0.57)and 0.55(0.52–0.58),respectively,in men,and 0.60(0.58–0.62)and 0.59(0.56–0.61),respectively,in women.Conclusion Elevated TG and TC were risk factors for T2DM incidence.However,no predictive capacity was found for both factors to identify T2DM incidence in Chinese men and women.Hence,TG and TC levels in both Chinese men and women might be used for decreasing the incidence of T2DM but no clinical predictive capacity for T2DM.

Comparison of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol for the prediction of thin-cap fibroatheroma determined by intravascular optical coherence tomography

Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibroatheroma has not yet been established. Methods It was a single center, retrospective observational study. In total, we recruited 421 patients(82.4% men;mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography(OCT). The thinnest-capped fibroatheroma(TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve(AUC) of receiver-operating characteristic(ROC) curve was assessed. Results OCT was performed in 421 patients(TCFA group(n = 109), non-TCFA group(n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group(2.95 ± 1.20 vs. 2.43 ± 0.92, P < 0.05), as was TC/LDL in TCFA and non-TCFA group(4.57 ± 1.58 vs. 4.04 ± 1.13, P < 0.05). Both LDL-C/HDL-C(OR: 1.002(1.002-1.003), P < 0.05) and TC/HDL-C(OR: 1.001(1.001-1.004), P < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/HDL-C and TC/HDL-C had no significant difference statistically(LDL-C/HDL-C AUC: 0.63;TC/HDL-C AUC: 0.61;P = 0.10) for the prediction of TCFA. Conclusions LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.

Association between apolipoprotein E promoter-219G/T polymorphism and total cholesterol level in patients with Alzheimer disease

BACKGROUND: Many researches have suggested that apolipoprotein E (APOE) and total cholesterol metabolism are closely related with dementia. In the supposed theory, 219 site of APOE promoter region is near gene coding region, so its polymorphism may result in the abnormality of APOE gene and protein expression, and finally lead to dementia. OBJECTIVE: To observe the association between APOE promoter-219G/T polymorphisms with serum total cholesterol in patients with Alzheimer disease, and compare it with non-dementia people. DESIGN: Case-control, comparative observation. SETTING: Department of Neurology, Fengtian Hospital of Shenyang Medical College. PARTICIPANTS: Fifty-five dementia patients including 27 males and 28 females aged (66±3) years and treated in the Department of Neurology, Fengtian Hospital were selected from January 2002 to December 2005 as the Alzheimer disease group. They all diagnosed according to the DSM-Ⅳdiagnostic criteria of Alzheimer disease instituted by American Psychiatry Association in 1994. Meanwhile, 44 none-dementia patients including 21 males and 23 females aged (66±3) years were selected from other clinical departments of Fengtian Hospital as control group. All the participants were informed the detection and agreed. METHODS: Genomic DNA was extracted from the peripheral blood of all subjects, then 'NEST'PCR, DNA sequence and enzyme digestion were adopted to detect the expression of APOE promoter-219 polymorphism, following by biomedical statistics analysis based on the clinical total cholesterol level. MAIN OUTCOME MEASURES: Polymorphism of APOE promoter-219 G/T and total cholesterol level. RESULTS: All 55 dementia patients and 44 non-dementia ones were involved in the result analysis. ①Allele and genotype frequency: The T allele frequency of the Alzheimer disease group was significantly higher than that in the control group [88.2% (97/110), 54.5% (48/88)], while G allele frequency was remarkably lower than that in the control group [11.8%(13/110), 45.5%(40/88), χ2=8.2, P < 0.01]. The TT allele frequency of the Alzheimer disease group was significantly higher than that in the control group [76% (42/55), 48% (21/44)], while GT+GG allele frequency was remarkably lower than that in the control group [24%(13/55), 52%(23/44), χ2=8.7, P < 0.01]. ②Total cholesterol level: The level of the TT genotype patients in the Alzheimer group was obviously higher than that in GT+GG genotype patients (t =2.46, P < 0.05); the cholesterol level in the two genotypes of the control group was similar (P > 0.05). CONCLUSION: TT genotype and allele T in the APOE promoter-219 polymorphisms are the sensitive gene, and genotype TT has a relationship with the increase of total cholesterol level.

Disposable Electrochemical Biosensor for Amperometric Measurement of β-hydroxybutyrate and Total Cholesterol

A new type of disposable thin-film amperometric biosensor has been developed for measurement ofβ-hydroxybutyrate and total cholesterol in serum.The biosensor consists of two plain gold electrodes mounted on a Polyethylene terephthalate (PET) substrate.The reagent solution contains bienzymes (cholesterol oxidase and cholesterol esterase for total cholesterol,β-hydroxybutyrate dehydrogenase and diaphorase forβ-hydroxybutyrate respectively) with mediator (ferricyanide) were absorption at the surface of electrodes coated by electrodepositing platinum black.The presence of the mediator lowers the applied potential and eliminates the interference from other oxidizable species enhancing the sensitivity and selectivity of the biosensor without modifying the dynamic parameters of the response.The enzymes stably retains in the matrices of platinum black film improving the performance of the mediated sensor.The linearity is observed in the concentration range from 1.0×10^(-4) to 1.0×10^(-2) mM and 1.0×10^(-4) mM to 4.99×10^(-3) mM with sensitivity of 1.958μA/mM and 2.447μA/mM respectively.The optimized biosensor exhibits excellent reproducibility and stability retaining more than 90% of its original activity over a period of one month.The simple operation of the biosensor mass-produced at low cost is expected to find clinical application and homecare.

Relationship between apolipoprotein E gene polymorphism and total cholesterol level in patients with kidney diseases

AIM： To evaluate the association between apolipoprotein E （apoE） gene polymorphism and total cholesterol （TC） level in patients with kidney diseases. METHODS： A predefined literature search was performed to collect data from the electronic databases of PubMed, Embase and the Cochrane Library and eligible relevant studies reporting the association of apoE gene polymorphism with TC level in patients with kidney diseases were recruited for meta-analysis.RESULTS： Twenty-one studies were identifed for the analysis of association between apoE gene polymorphism and TC level in patients with kidney disease. Subjects with E3E4 had a higher TC than those with E3E3 [weighted mean differences （WMD）=2.14, P=0.01] and subjects with E2E3 had a lower TC than those with E3E3 （WMD=-1.93, P=0.01）. Subjects with ε2 had a lower TC than those with ε3 （ε2 vs ε3： WMD=-1.23, P=0.002; ε2 vs ε4： WMD=-2.77, P﹤0.0001） and subjects with 3 had a lower TC than those with 4 （WMD=-0.79, P=0.03）. CONCLUSION： Subjects with apoE E3E4 and ε4 had a higher TC level and subjects with apoE E2E3 and ε2 had a higher TC level in patients with kidney disease. However, more well-designed studies should be per-formed in the future to confrm these fndings.

Pollution Tolerance of Smoke in the Distribution of Neurotransmitter Enzyme (Acetylcholine Esterase) and Total Cholesterol in Tissues of Wistar Rats

This study was designed to assess total animal exposure to non-occupational but environmentally induced smoke through short-term landfill burning toxicity tests at the biochemical levels. Exposure to municipal land-fill burning using rat model focused primarily on inhalation exposure. The environmental monitoring consisted of 60 days exposure to refuse burning by evaluating the level of protein concentrations, neurotransmitter enzyme acetylcholine esterase (AcHE), and total cholesterol in different tissues of Wistar rats. Protein concentrations tended to decrease in the brain, liver and kidney and slightly increased in the plasma while acetylcholine esterase decreased in brain and liver and increased in the kidney. The non-depletion in total cholesterol levels in the tissues tended to be due to active mobilization towards tissue metabolism. The data were sufficient to support risk assessment for human.

A Study of Correlation of Serum Chromium Level with Glycosylated Haemoglobin (HbA1c), Total Cholesterol and Triglycerides, among Type 2 Diabetes Patients

Background: Diabetes mellitus is a common disease and it is a major cause of morbidity;several studies indicate that diabetes is a likely under reported cause of death. Chromium’s is important trace element to control diabetes mellitus and metabolism of carbohydrate, lipid and protein. Objective: The purpose of this study was to understand the relationship between serum chromium, with HbA1c, Total cholesterol and Triglycerides among type 2 diabetes patients among diabetic patients. Methodology: This is cross-sectional study done in Jabber Abu Ezz Centre for treatment and care of diabetics in Khartoum—Sudan. Four hundred subjects were enrolled in this study;one hundred subjects were normal healthy as control group, and three hundred subjects diabetic patient type 2 as test group;demographic and biochemical data were collected;serum chromium, Glycosylated Haemoglobin (HbA1c), Total cholesterol Triglycerides, were determined by using NYCOCARD READER II, spectrophotometer (Biosystem 310) and spectrophotometer 210-VGP. Result: In this study there is significant parameters level means of FBS HbA1c, Total Cholesterol, Triglycerides and Chromium of the test groups when compared with healthy control groups subjects (P = 0.001, 0.018, 0.01, 0.011, 0.004), respectively. Significant negative correlation is between FBS, HbA1c, Total Cholesterol, Triglycerides and Chromium (r = ?0.555, P value = 0.003), (r = ?0.668, P value = 0.002), (r = ?0.335, P value = 0.004) and (r = ?0.774, P value = 0.002) respectively. Conclusion: There was significant correlation between serum Chromium level with fasting blood sugaer, Glycosylated Haemoglobin (HbA1c), Total cholesterol and Triglycerides among type 2 diabetes patients.

Causal associations between intermediate very-low-density lipoprotein cholesterol-to-total lipids ratio and peptic ulcer:A bidirectional Mendelian randomization study

BACKGROUND Previous epidemiologic investigations have consistently demonstrated a strong association between the ratio of cholesterol to total lipids in medium very-lowdensity lipoprotein(VLDL)and the occurrence of peptic ulcers(PU).However,the precise causal relationship between these factors remains ambiguous.Consequently,this study aims to elucidate the potential correlation between the ratio of cholesterol to total lipids in medium VLDL and the incidence of peptic ulcer.AIM To investigate the ratio of cholesterol to total lipids in medium very-low-density lipoprotein(VLDL)association with PU via genetic methods,guiding future clinical research.METHODS Genome-wide association study(GWAS)datasets for the ratio of cholesterol to total lipids in intermediate VLDL and peptic ulcer were retrieved from the IEU OpenGWAS project(https://gwas.mrcieu.ac.uk).For the forward Mendelian randomization(MR)analysis,72 single nucleotide polymorphisms(SNPs)were identified as instrumental variables.These SNPs were selected based on their association with the ratio of cholesterol to total lipids in intermediate VLDL,with peptic ulcer as the outcome variable.Conversely,for the inverse MR analysis,no SNPs were identified with peptic ulcer as the exposure variable and the ratio of cholesterol to total lipids in intermediate VLDL as the outcome.All MR analyses utilized inverse variance weighted(IVW)as the primary analytical method.Additionally,weighted median and MR-Egger methods were employed as supplementary analytical approaches to assess causal effects.Egger regression was used as a supplementary method to evaluate potential directional pleiotropy.Heterogeneity and multiplicity tests were conducted using the leave-one-out method to evaluate result stability and mitigate biases associated with multiple testing.RESULTS The genetically predicted ratio of cholesterol to total lipids in medium VLDL was significantly associated with an elevated risk of peptic ulcer(IVW:OR=2.557,95%CI=1.274-5.132,P=0.008).However,no causal association of peptic ulcer with the ratio of cholesterol to total lipids in medium VLDL was observed in the inverse Mendelian randomization analysis.CONCLUSION In conclusion,our study reveals a significant association between the ratio of cholesterol to total lipids in medium VLDL and an elevated risk of peptic ulcers.However,further validation through laboratory investigations and larger-scale studies is warranted to strengthen the evidence and confirm the causal relationship between these factors.

血清小而密低密度脂蛋白胆固醇和总抗氧化能力水平与脑梗死患者认知功能障碍的相关性分析

目的:探究脑梗死患者血清小而密低密度脂蛋白胆固醇(small dense low-density lipoprotein cholesterol, sdLDL-C)和总抗氧化能力(total antioxidant capacity, T-AOC)水平变化及其与认知功能障碍发生的关系。方法:选择148例脑梗死患者,依据发病后7 d是否出现认知功能障碍,分为非障碍组(n=77)和障碍组(n=71);分别采用过氧化氢酶法和比色法测定两组血清sdLDL-C和T-AOC水平,并进行比较;Pearson相关系数法分析脑梗死患者血清sdLDL-C、T-AOC水平与蒙特利尔认知评估(MoCA)评分相关性;二元Logistic回归分析影响脑梗死患者认知功能障碍发生的危险因素。结果:与非障碍组相比,障碍组血清sdLDL-C水平明显升高(P<0.05),T-AOC水平明显降低(P<0.05)。相关性分析显示,血清sdLDL-C水平与MoCA评分呈负相关(r=-0.516,P<0.05),T-AOC水平与MoCA评分呈正相关(r=0.446,P<0.05)。Logistic回归分析显示,高血压、糖尿病、病情严重程度、血清sdLDL-C和T-AOC是脑梗死患者认知功能障碍发生的独立影响因素(P<0.05)。结论:脑梗死患者血清sdLDL-C水平升高,T-AOC水平降低,二者是影响脑梗死患者并发认知功能障碍的独立影响因素。

急性病毒性肝炎患者凝血四项、血脂指标水平及其预后评估价值分析

目的分析急性病毒性肝炎(AVH)患者凝血四项、血脂指标水平及其评估预后的价值。方法选取2020年1月1日至2022年1月31日收治的300例AVH作为研究组,300例体检健康人员作为对照组。比较2组一般资料、凝血四项[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、血脂指标[总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)]。研究组均行常规抗病毒、护肝治疗,比较研究组不同治疗效果患者治疗前后凝血四项、血脂指标,并分析治疗前凝血四项、血脂指标与治疗效果的相关性及预测治疗效果的价值。结果研究组外周血PT、APTT、TT长于对照组,FIB、TC、HDL-C、LDL-C水平低于对照组,TG水平高于对照组(P<0.01)。研究组治疗效果为无效患者治疗前、治疗后外周血PT、APTT、TT长于有效、显效患者,有效患者长于显效患者(P<0.05);FIB、TC、HDL-C、LDL-C水平低于有效、显效患者,有效患者低于显效患者,TG水平高于有效、显效患者,有效患者高于显效患者(P<0.05);研究组治疗后外周血PT、APTT、TT、TG水平与治疗效果呈负相关,FIB、TC、HDL-C、LDL-C与治疗效果呈正相关(P<0.05,P<0.01);治疗前凝血四项与血脂指标联合预测AVH患者治疗效果的曲线下面积为0.937(95%CI为0.903,0.962),预测敏感度、特异度分别为85.21%、88.61%,明显优于凝血四项、血脂指标单独预测(P<0.01)。结论AVH患者凝血四项、血脂指标存在明显异常,且治疗前凝血四项与血脂指标联合检测在预测治疗效果方面具有较高价值。

THR、MHR和NHR对冠状动脉狭窄程度和行PCI的预测价值

目的 探讨总胆固醇与高密度脂蛋白胆固醇比值(THR)、单核细胞与高密度脂蛋白胆固醇比值(MHR)和中性粒细胞与高密度脂蛋白胆固醇比值(NHR)对患者冠状动脉狭窄程度和行经皮冠状动脉介入(PCI)治疗的预测价值。方法 回顾性选取2021年6月至2023年6月在新疆医科大学第一附属医院行冠状动脉造影的患者,严格纳入排除标准筛选,共纳入6 281例患者,分为PCI组和non-PCI组,收集所有患者的临床资料、实验室检查结果及介入治疗资料。采用Pearson相关性分析评估THR、MHR和NHR与冠状动脉狭窄程度之间的关联。使用二元Logistic逐步回归和受试者工作特征(ROC)曲线评估THR、MHR和NHR单一指标和联合指标对冠心病患者行PCI治疗的影响因素和预测价值。结果 与Non-PCI组比较,PCI组年龄偏大,男性占比、患糖尿病占比、THR、MHR、NHR、Gensini评分高于Non-PCI组,既往支架植入比例少于Non-PCI组(P<0.05)。Pearson相关分析结果显示,THR(r=0.351,P<0.001)、MHR(r=0.192,P<0.001)和NHR(r=0.236,P<0.001)水平与冠状动脉狭窄程度的Gensini评分均存在显著正相关关系。多因素Logistic回归结果显示,年龄>50岁、男性、患糖尿病、THR、MHR、NHR是冠心病患者行PCI独立危险因素,既往支架植入史是冠心病患者行PCI的保护因素。ROC曲线结果显示,THR、MHR和NHR三者联合曲线下面积(AUC)最大(AUC=0.809,95%CI:0.798~0.820)。结论 THR、MHR和NHR与冠状动脉狭窄程度具有相关性,对评估冠心病行PCI治疗有较强的临床应用价值。

降脂消胰汤内服与灌肠联合西药治疗高脂血症性胰腺炎疗效及对患者血脂、凝血功能的影响

目的:研究降脂消胰汤内服与灌肠联合西药治疗对高脂血症性胰腺炎(HLP)患者血脂水平、凝血功能及预后的影响。方法:选取128例HLP患者,按随机数字表法分为两组,中医组64例,对照组61例(随访过程脱落3例)。对照组采用常规西药治疗,中医组在此基础上采用降脂消胰汤内服和灌肠治疗,比较两组患者临床疗效、血脂水平、凝血功能和预后情况。结果:中医组HLP患者治疗总有效率为95.31%,高于对照组的83.61%(P<0.05)。治疗后,中医组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)低于对照组,高密度脂蛋白(HDL)高于对照组(P<0.05)。治疗后,中医组血管性血友病因子(vWF)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D-二聚体(D-dimer)均低于对照组(P<0.05)。中医组禁食禁水时间、住院总时间均短于对照组,SAP转化率低于对照组(P<0.05)。结论:降脂消胰汤内服与灌肠联合西医治疗HLP可提高患者临床疗效,有效改善血脂水平和凝血功能。

总胆固醇与高密度脂蛋白胆固醇比值同肩袖撕裂的相关性

目的 探讨总胆固醇与高密度脂蛋白胆固醇比值同肩袖撕裂发生的相关性。方法 选取2018年1月至2023年6月期间在昆山市中医医院骨科住院行肩关节镜手术治疗的患者797例,其中男259例,女538例;年龄40~79岁,平均(58.86±8.73)岁。按照是否存在肩袖撕裂分为肩袖撕裂组559例及非肩袖撕裂组238例。收集患者基本信息及实验室检查结果,使用多因素Logistics回归分析探讨总胆固醇与高密度脂蛋白胆固醇比值同肩袖撕裂发生的相关性。结果 肩袖撕裂组的年龄、空腹血糖、中性粒细胞、总胆固醇与高密度脂蛋白比值高于非肩袖撕裂组。肩袖撕裂组的血红蛋白、高密度脂蛋白、血清镁及血清磷水平低于非肩袖撕裂组。多因素Logistic回归分析结果表明,总胆固醇与高密度脂蛋白比值同肩袖撕裂的发生有关。肩袖撕裂的患病率在总胆固醇与高密度脂蛋白比值四个四分位呈升高的趋势(21.65%、24.15%、25.76%及28.44%)。结论 血脂异常与肩袖撕裂具有相关性,总胆固醇与高密度脂蛋白比值越高,肩袖撕裂发生的风险越大。

Predictive value of preoperative routine examination for the prognosis of patients with pT2N0M0 or pT3N0M0 colorectal cancer

BACKGROUND In recent years,the incidence of colorectal cancer(CRC)has been increasing.With the popularization of endoscopic technology,a number of early CRC has been diagnosed.However,despite current treatment methods,some patients with early CRC still experience postoperative recurrence and metastasis.AIM To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations.METHODS A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study.Results of blood routine test,liver and kidney function tests and tumor markers were collected before surgery.Patients were followed up through disease-specific database and telephone interviews.Tumor recurrence,metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis.RESULTS We comprehensively compared the predictive value of preoperative blood routine,blood biochemistry and tumor markers for disease-free survival(DFS)and overall survival(OS)of CRC.Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS[hazard ratio(HR)=0.995,95% confidence interval(CI):0.991-0.999,P=0.015],while serum carcinoembryonic antigen(CEA)level(HR=1.008,95%CI:1.001-1.016,P=0.027)and serum total cholesterol level(HR=1.538,95%CI:1.026-2.305,P=0.037)were independent risk factors for OS.The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL.Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level,the difference between the two groups was not statistically significant(P=0.075).CONCLUSION For patients with T2N0M0 or T3N0M0 CRC,preoperative platelet count was a protective factor for DFS,while serum CEA level was an independent risk factor for OS.Given that these measures are easier to detect and more acceptable to patients,they may have broader applications.

术后脂代谢对胃癌根治术后早期吻合口瘘发生的预测价值

目的 探讨术后血脂指标对胃癌根治术患者术后早期吻合口瘘发生的预测价值。方法 回顾性收集41例胃癌根治术后10 d内发生吻合口瘘的患者临床资料,纳入发生组;另收集同期医院胃癌根治术后10 d内未发生吻合口瘘的患者临床资料,纳入未发生组。所有患者术后1 d均完成血脂指标[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]检查。统计2组一般基线资料,比较2组术后早期血脂指标,并绘制受试者工作特征(ROC)曲线,分析术后血脂指标对胃癌根治术后吻合口瘘的预测价值。结果 发生组合并2型糖尿病、合并低蛋白血症例数占比高于未发生组,差异有统计学意义(P<0.05)。发生组术后1 d时血清TC、LDL-C均高于未发生组,差异有统计学意义(P<0.05)。初步表明合并2型糖尿病、合并低蛋白血症、术后早期血清TC、LDL-C高与胃癌根治术患者术后发生吻合口瘘有关。绘制ROC曲线结果显示,术后1 d时血清TC、LDL-C预测胃癌根治术患者术后发生吻合口瘘的曲线下面积(AUC)均≥0.7,均有一定的预测价值。结论 胃癌根治术患者术后早期血清TC、LDL-C水平高与其吻合口瘘发生存在一定关系,术后早期联合检测二者水平可用于预测胃癌根治术后吻合口瘘发生风险。

青年首发抑郁症患者继发精神病性症状的危险因素

目的 探讨青年首发重度抑郁症(major depression disorder, MDD)患者继发精神病性症状的相关危险因素。方法 收集232例首发抑郁症患者首诊时的一般人口学资料、汉密尔顿抑郁量表(Hamilton depression scale, HAMD-17)、汉密尔顿焦虑量表(Hamilton anxiety scale, HAMA)得分,于次日采集肘静脉血并检测患者血糖、血脂、甲状腺功能、泌乳素和25-羟基维生素D[25(OH)D]水平,经过1年随访,根据患者是否继发精神病性症状,分为伴有精神病性症状的重度抑郁症组(PMD组,n=46)和不伴有精神病性症状的重度抑郁症组(MDD组,n=186),比较组间差异并分析各指标与精神病性症状的相关性,并探讨与青年首发PMD发生相关的危险因素。结果 PMD组未婚人数占比高于MDD组(P<0.05);PMD组HAMD-17量表得分高于MDD组(P<0.05);PMD组血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及促甲状腺激素(TSH)水平高于MDD组,高密度脂蛋白胆固醇(HDL-C)及25(OH)D水平低于MDD组(P<0.05)。相关性分析显示HAMD-17评分(r=0.345)、TC(r=0.148)、LDL-C(r=0.162)及TSH水平(r=0.134)与精神病性症状呈正相关(P<0.05),已婚(r=-0.208)、HDL-C(r=-0.258)及25(OH)D水平(r=-0.276)与精神病性症状呈负相关(P<0.05)。多因素Logistic回归分析显示,未婚、HAMD-17量表得分、高TC、低HDL-C及低25(OH)D水平为MDD患者精神病性症状的独立危险因素(P<0.05)。ROC曲线提示由婚姻状况、HAMD-17得分、血清TC、HDL-C及25(OH)D水平组成的联合指标能够较好地预测MDD患者精神病性症状的发生(AUC=0.887)。结论 血清脂代谢及25(OH)D水平可能是预测青年MDD患者继发精神病性症状的的生物标志物。

益气养阴法联合西药治疗肾病综合征的疗效及安全性的Meta分析

【目的】系统评价益气养阴法联合西药治疗肾病综合征的有效性及安全性。【方法】检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方(Wangfang)、维普(VIP)、PubMed、Web of Science、Cochrane Library、Embase等国内外主要文献数据库,筛选其中有关益气养阴法联合西药(试验组)对比单纯西药(对照组)治疗肾病综合征的临床随机对照试验(RCTs),采用Cochrane手册中的偏倚风险工具进行文献的质量评价,运用RevMan 5.3软件进行Meta分析。【结果】共纳入18个RCTs,包含1334例患者。Meta分析结果显示,益气养阴法联合西药在提高临床有效率(RR=1.24,95%CI[1.16,1.32],P<0.00001),改善24 h尿蛋白定量(24hUPRO)(MD=-0.92,95%CI[-1.09,-0.75],P<0.00001)、血清白蛋白(ALB)(MD=7.06,95%CI[4.73,9.39],P<0.00001)、尿素氮(BUN)(MD=-1.57,95%CI[-2.01,-1.13],P<0.00001)、血肌酐(SCr)(MD=-12.23,95%CI[-16.58,-7.88],P<0.00001)、总胆固醇(TC)(MD=-1.06,95%CI[-1.69,-0.43],P=0.0009)、甘油三酯(TG)(MD=-0.58,95%CI[-0.94,-0.21],P=0.002)水平,以及降低不良反应发生率(RR=0.50,95%CI[0.40,0.64],P<0.00001)方面优于单纯西药治疗。【结论】益气养阴法联合西药治疗肾病综合征在提高临床疗效及改善24hUPRO、ALB、BUN、SCr、TC、TG方面优于单纯西药治疗,且能降低激素产生的不良反应。因纳入文献较少,文献质量较低,潜在疗效需更多的高质量研究进行验证。

行择期非心脏手术的老年患者发生全身麻醉诱导后低血压的危险因素分析与预测模型建立

目的 探究行择期非心脏手术的老年患者接受全身麻醉(简称全麻)诱导后发生低血压的危险因素,并建立预测模型。方法 选取2019年2月—2021年5月在复旦大学附属中山医院青浦分院行择期非心脏手术并接受全麻的407例患者资料。按照既往文献中的低血压标准,将研究对象分为2组,即全麻诱导后血压水平较基础水平下降幅度>30%或平均动脉压(MAP)<60 mmHg(1 mmHg=0.133 kPa)的患者,纳入低血压组;而血压水平下降幅度≤30%且MAP≥60 mmHg的患者,纳入对照组。记录包括年龄、身高、体重、BMI、是否有高血压病史、是否有糖尿病病史、是否罹患冠心病、NYHA心功能分级的患者一般资料。记录入手术室后5 min(记为T_(0)点)的患者基础MAP值(即MAP_(T0)),以及全麻诱导后气管插管前(记为T_(1)点)的患者MAP值(即MAP_(T1))。同时,记录手术前获得的患者包括血糖、TG、TC、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)水平等指标;收集患者的麻醉药物诱导剂量(丙泊酚和舒芬太尼),ASA分级,是否合并使用依托咪酯诱导,以及诱导后心率下降的幅度(即ΔHR)。采用单因素分析和多因素logistic逐步回归分析研究对象发生全麻诱导后低血压的危险因素。应用危险因素及其系数建立预测模型。结果 407例患者中有211例(51.84%)发生全麻诱导后低血压。与对照组比较,低血压组身高值、体重值均显著较低(P=0.007、0.017),女性患者的占比显著较高(P=0.038),LDL、TC水平显著较高(P=0.019、0.004),合并使用依托咪酯的患者占比、患者MAP_(T0)、ΔHR均显著较高(P=0.022、0.015、<0.001)。将单因素分析中P<0.1的变量纳入多因素logistic逐步回归分析,结果显示,年龄、TC、舒芬太尼诱导剂量、MAP_(T0)、ΔHR为行非心脏择期手术的老年患者在全麻诱导期间发生低血压的危险因素。所建立的预测模型的ROC曲线的AUC为0.705, 95%CI为0.655~0.756,P<0.001,提示该模型具有较好的预测准确性。结论年龄、TC、舒芬太尼诱导剂量、MAP_(T0)、ΔHR为行非心脏择期手术的老年患者接受全麻诱导后发生低血压的危险因素,据其建立的预测模型具有较好的预测准确性。

血清Trx1、VILIP-1对急性分水岭脑梗死患者预后不良的预测价值

目的探究血清硫氧还蛋白1(Trx1)、视锥蛋白样蛋白-1(VILIP-1)对急性分水岭脑梗死(ACWI)患者预后不良的预测价值。方法选取2019年12月至2022年12月在河北省邯郸市第一医院就诊的126例ACWI患者作为研究对象。收集所有患者的临床资料。检测所有患者甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)水平。根据随访90 d的改良Rankin量表评分将患者分为预后良好组和预后不良组。采用酶联免疫吸附试验检测ACWI患者血清Trx1、VILIP-1水平。采用多因素Logistic回归分析ACWI患者预后不良的影响因素。绘制受试者工作特征(ROC)曲线分析Trx1、VILIP-1单独及2项指标联合检测对ACWI患者预后不良的预测价值。结果随访90 d结果显示,预后良好组患者85例,预后不良组患者41例。预后不良组大面积脑梗死患者比例,美国国立卫生院卒中量表(NIHSS)评分,血清TG、TC、LDL-C水平均明显高于预后良好组,血清HDL-C水平明显低于预后良好组,差异均有统计学意义(P<0.05)。预后不良组血清Trx1水平明显低于预后良好组,血清VILIP-1水平明显高于预后良好组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,NIHSS评分升高、VILIP-1水平升高是ACWI患者预后不良的危险因素(P<0.05),Trx1水平升高是ACWI患者预后不良的保护因素(P<0.05)。ROC曲线分析结果显示,血清Trx1、VILIP-1单独检测预测ACWI患者预后不良的曲线下面积(AUC)分别为0.782、0.814,均低于2项指标联合检测预测ACWI患者预后不良的0.905(Z=2.487、2.350,P<0.05)。结论血清Trx1水平降低和VILIP-1水平升高与ACWI患者预后不良有关,二者均可辅助判断患者预后情况,且二者联合检测对ACWI患者预后不良的预测价值更高。

双向孟德尔随机化分析总胆固醇升高风险与胆石症发生风险的关系

目的 运用双向孟德尔随机化评估总胆固醇升高风险与胆石症发生风险之间的关联。方法 总胆固醇与胆石症相关的单核苷酸多态性数据来自open gwas公共数据库,对基于全基因组相关联研究(GWAS)的所有汇总数据进行二次数据分析,分别选择与总胆固醇或者胆石症密切关联的遗传位点作为暴露或者结局变量,用Egger回归法、加权中位数法、IVW随机效应模型、IVW固定效应模型等方法进行双向孟德尔随机化分析,以OR值评价总胆固醇和胆石症之间的因果关系。结果 以总胆固醇为暴露、胆石症为结局,去除异质性前总胆固醇-胆石症的总体OR=0.91,95%CI:0.85~0.97;去除异质性后总胆固醇-胆石症的总体OR=0.93,95%CI:0.89~0.97。以胆石症为暴露、总胆固醇为结局,去除异质性前胆石症-总胆固醇的总体OR=0.20,95%CI:0.06~0.65;去除异质性后胆石症-总胆固醇的总体OR=0.28,95%CI:0.10~0.83。基因预测的总胆固醇和胆石症之间存在双向因果关系。结论 本研究证实了总胆固醇与胆石症之间的双向因果关系,随着遗传上有关能使总胆固醇水平升高的等位基因的增加,发生胆石症的风险降低。反之,随着遗传上有关能使胆石症发病增高的等位基因的增加,总胆固醇水平升高的风险降低。