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Objective:To explore the clinical characteristics of hypertriglyceridemic pancreatitis and the correlation between triglyceride (TG) levels and the severity of severe acute pancreatitis (SAP).Methods:A retrospective analysis was conducted on the clinical data of 132 SAP patients admitted to Beijing Friendship Hospital of Capital Medical University from January 2020 to December 2021. They were divided into biliary acute pancreatitis (BAP) group, hypertriglyceridemic pancreatitis (HTGP) group, and alcohol-induced acute pancreatitis (AAP) group based on their etiology. The clinical data and laboratory test results of each group were compared, and the correlation between TG levels and the severity of SAP disease was analyzed.Results:The proportion of male patients, body mass index, length of hospital stay, ICU occupancy rate, C-reactive protein (CRP), TG, and total cholesterol (TC) levels in the HTGP group were significantly higher than those in the BAP and AAP groups. The age of onset, serum calcium (Ca), oxygenation index (PaO 2/FiO 2, P/F), and prothrombin time activity (PTA) in the HTGP group were significantly lower than those in the BAP and AAP groups, and the differences were statistically significant (all P<0.05). There was a negative correlation between TG levels and Ca, P/F, PTA in SAP patients ( r=-0.410, -0.341, -0.365, all P<0.01). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of TG for early prediction of multiple organ dysfunction in SAP patients was 0.868, with a sensitivity of 87% and a specificity of 78%. Conclusions:Patients in the HTGP group have a lower onset age, with more males, obese patients, and critically ill patients. Laboratory indicators such as CRP, TG, and TC levels are higher, while levels of Ca, P/F, and PTA are lower; The serum TG level is correlated with the severity of SAP disease and can be used as one of the early indicators for predicting multiple organ dysfunction in SAP.
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Objective:To evaluate the risk factors of mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:A total of 97 patients with AECOPD in the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from January 2018 to January 2019 were prospectively selected and followed up for 2.5 years. According to the prognosis, they were divided into survival group (82 cases) and death group (15 cases). Logistic regression analysis was used to screen the independent risk factors for death. The area under receiver operating characteristic curve (AUC) was used to analyze the prediction accuracy. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to analyze the predictive value of the prediction model for 2.5-year mortality in AECOPD patients.Results:Drinking history ( OR=4.975, P=0.046), past long-term β receptor blockers ( OR=5.486, P=0.029) and creatine kinase isoenzyme (CK-MB) level ( OR=2.008, P=0.049) were independent risk factors for death in patients with AECOPD. The AUC was 0.729, 0.715 and 0.710 respectively. The weight values of the three in the prediction model were 5, 5 and 1 respectively and the AUC was 0.834. Kaplan Meier survival analysis showed that 8 points of the prediction model could predict the 2.5-year survival rate in AECOPD patients (Log Rank P<0.001). The risk of death in AECOPD patients with score >8 was significantly higher than that of patients with score ≤8 ( HR=12.471, 95% CI: 3.735-41.643, P<0.001). Conclusions:Drinking history, past long-term β receptor blockers and CK-MB levels are independent risk factors for 2.5-year mortality in patients with AECOPD. The combination of these three factors has high predictive value for the prognosis of patients.
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Objective:To evaluate the value of endogenous digitalis-like factor (EDLF) dynamic changes in predicting myocardial injury and prognosis in patients with sepsis.Methods:A total of 160 sepsis patients admitted to the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from July 2017 to January 2019 were selected and divided into the myocardial injury(MI) group ( n=75) and the non-myocardial injury (NMI) group ( n=85) according to whether there was myocardial injury. The plasma EDLF concentration was tested on the 1 st, 3 rd and 7 th day after admission. The predictive factors of MI and 90-days outcome were evaluated by logistics regression analysis. Cox proportional hazards regression model was used to estimate the prognostic value of EDLF concentration on the 90 days after admission for sepsis. Results:Septic patients with MI had increased levels of myocardial enzymes, decreased left ventricular fractional shortening index (FS) and interventricular septum (IVS) amplitude and abnormal wall motion, when compared to NMI patients (all P<0.05). EDLF concentration on the 7 th day in the MI group was significantly lower than in the NMI group ( P=0.019). Logistic regression showed that EDLF 7 th was an independent protective factor for MI and 90-day mortality in sepsis respectively ( OR=0.964, 95% CI: 0.934-0.994, P=0.021; OR=0.931, 95% CI: 0.871-0.995, P=0.036). Cox proportional hazards regression analysis suggested that EDLF 7 th concentration <26.7 pmol/L was an independent predictor of 90-day mortality in patients with sepsis ( HR=4.601, 95% CI: 1.030-20.563, P=0.046). Conclusions:EDLF 7 th may serve as a protective factor for sepsis-induced MI and adverse outcome. The exogenous supplement of cardiotonic drugs at one week after MI may be a potential treatment to improve the survival rate of septic patients.
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Objective:To summarize the clinical characteristics of patients with acute cholangitis and analyze the early warning factors of death.Methods:The clinical data of patients with acute cholangitis treated in the emergency department of Beijing Friendship Hospital from May 1, 2019 to December 5, 2020 were prospectively selected. The age, gender, vital signs, basic diseases, inflammatory indexes, organ function indexes, coagulation indexes, etiology, emergency drainage and prognosis of cholangitis were analyzed to understand the clinical characteristics of acute cholangitis and find out the strongest early warning factor of 28 day death.Results:A total of 274 patients with acute cholangitis attending the emergency department were examined, which included 265 survival patients (survival group) and 9 deaths (death group). In the death group, the proportion of diabetic patients, white blood cell counts, C-reactive protein, creatinine, international standardized ratio, D-dimer, lactate dehydrogenase, fibrinogen degradation products, Sequential Organ Failure Assessment (SOFA) score were significantly higher than those in the survival group, while the albumin level and Glasgow Coma Scale (GCS) score were significantly lower than those in the survival group (all P<0.05). Multivariate logistic regression analysis showed that GCS score, creatinine level, white blood cell counts and international standardized ratio were the risk factors of death in patients with acute cholangitis (all P<0.05). Conclusions:GCS score, creatinine level, white blood cell counts and international standardized ratio are early warning factors to judge the death of patients with acute cholangitis. GCS score is the strongest predictor of death in patients with cholangitis.
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Objective:To investigate the inhibitory effect of Qishen Huoxue granule containing serum on excessive autophagy of cardiomyocytes (H9c2) in septic rats and its protective effect on septic cardiomyocytes.Methods:Twelve SPF grade Wistar rats were gavaged with low, medium and high doses of Qishen Huoxue granule [equivalent to crude drugs 12.7, 25.4 and 50.8 g/(kg·d)]. The cultured rat embryonic cardiomyocytes (H9c2) were divided into five groups: the control group was cultured with DMEM containing 10% fetal bovine serum (FBS); lipopolysaccharide (LPS) group was treated with DMEM containing 10% FBS+ 1 μg/ml LPS; LPS+ Qishen Huoxue granule low, medium and high dose groups were pre intervened with DMEM containing 10% low, medium and high dose intragastric drug containing serum for 4 h, and then added 1 μg/ml LPS. After co-cultured for 4 h, the mRNA and protein expression of autophagy markers Beclin-1, ATG5 and LC3B were detected by real time fluorescence quantitative polymerase chain reaction (qRT-PCR) and Western blot; After 8, 12, 24 and 48 hours of co culture, the cell activity of cells in each group at different time points was detected by cell counting method (CCK-8) method.Results:The expression of autophagy markers Beclin-1, ATG5 mRNA and Beclin-1, ATG5 and LC3B protein in LPS group increased in the early stage (4 h), which was statistically significant compared with the control group ( P<0.05). However, LPS+ Qishen Huoxue granule groups could reduce the overexpression of Beclin-1, ATG5 and LC3B mRNA and protein caused by LPS ( P<0.05). CCK-8 method showed that the cell activity of LPS group LPS+ Qishen Huoxue granule low, medium and high dose groups decreased significantly at 12 h, 24 h and 48 h, which was significantly different from that of the control group ( P<0.05); The cell activity of LPS+ Qishen Huoxue granule medium dose group at 24 and 48 hours was significantly higher than that of LPS group ( P<0.05). Conclusions:The drug-containing serum of Qishen Huoxue granules at different concentrations had inhibitory effects on LPS-induced autophagy of cardiomyocytes, and the drug-containing serum obtained by intragastric administration of Qishen Huoxue granules in rats can improve the myocardial injury caused by sepsis by inhibiting autophagy.
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Objective:To explore the related factors influencing prognosis of patients with grade Ⅲ cholangitis with myocardial injury.Methods:91 patients with grade III cholangitis complicated with myocardial injury treated in the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from June 2015 to December 2020 were collected retrospectively. They were divided into endoscopic retrograde cholangiopancreatography (ERCP) group ( n=75) and non-ERCP group ( n=16) according to whether ERCP was performed. According to 28-day survival patients were divided into survival group ( n=56) and death group ( n=35). The level of serum cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), N terminal pro-brain natriuretic peptide (NT-proBNP), white blood cell (WBC), platelet (PLT), serum creatinine (Scr), alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), International Standardized Ratio (INR), Glasgow Coma Score (GCS) at different time points were detected and the risk factors influencing the prognosis of patients were analyzed. Results:The cTnT ( P=0.018), NT-proBNP ( P<0.001), PLT ( P=0.016), GCS score ( P=0.07) on day 3 and cTnI ( P=0.027), cTnT ( P=0.002), CK-MB ( P=0.046), NT-proBNP ( P<0.001), PLT ( P=0.041), GCS score ( P<0.001) on day 7 in the ERCP group were significantly different with the non-ERCP group respectively. The survival rate within 28 days of the ERCP group was significantly different from that in the non-ERCP group ( P<0.001). The cTnT ( P=0.006) on day 1, the cTnT ( P=0.021), NT-proBNP ( P=0.02), WBC ( P=0.037), GCS score ( P<0.001) on day 3, and the cTnI ( P=0.029), cTnT ( P=0.008), CK-MB ( P<0.001), PLT ( P=0.008), NT-proBNP ( P=0.004), GCS ( P<0.001) on day 7 in survival group were significantly different from the death group. Logistic regression showed that the mean value of myocardial injury markers and ERCP process were significantly correlated with the 28 days survival rate. Conclusions:In patients with Grade Ⅲ cholangitis-related myocardial injury, the levels of myocardial injury markers, NT-proBNP, platelet (PLT) and Glasgow Coma Score (GCS) are related to mortality. ERCP for patients can significantly improve 28 days survival and prognosis.
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Objective:To explore the clinical features of ultrasound intervention combined with antibiotics in the treatment of Klebsiella pneumoniae liver abscess, and to provide a reference for clinical treatment.Methods:The clinical data of 100 patients with Klebsiella pneumoniae liver abscess treated in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2015 to November 2020 were analyzed retrospectively. The patient's gender, age, abscess diameter, number of abscesses, abscess separation, air cavity formation and length of hospital stay were recorded. The blood white blood cell (WBC), neutrophil percentage (GR%), platelet count (PLT), C-reactive protein (CRP), procalcitonin (PCT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), prothrombin activity (PTA) before and after treatment were analyzed.Results:After treatment, the infection indexes (WBC, GR%, PLT, CRP, PCT) were significantly decreased, and the liver function indexes (ALT, AST, TBIL, PTA) were significantly improved ( P<0.05). Patients were divided into two groups according to diabetes. The results showed that the diabetic group was prone to air cavity formation (χ 2=8.632, P=0.003), and there was no significant difference between other clinical indicators among the groups ( P>0.05). Diabetes mellitus group was divided into two groups based on hemoglobin A1c (HbA1c) 9%. The results showed that the HbA1c>9% group was younger ( t=2.861, P=0.006), more male (χ 2=6.81, P=0.013), and more prone to form multiple abscesses (χ 2=10.304, P=0.001), while the other clinical indicators were not statistically significant. Conclusions:Ultrasound intervention combined with antibiotics can effectively treat liver abscess. Patients with diabetes are prone to air cavity formation, which should be paid more attention in clinic.
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Objective:To evaluate the value of shock index and platelet count in early identification of grade 3 acute cholangitis.Methods:This study is a retrospective case-control study. A total of 750 patients who met the diagnostic criteria of acute cholangitis were treated in Beijing Friendship Hospital Affiliated to Capital Medical University from January 2018 to December 2020. They were divided into grade 1, grade 2 and grade 3 groups according to the 2018 Tokyo Guidelines. The age, gender, etiology, complications, Charlson comorbidity index (CCI), vital signs, blood routine indexes, C-reactive protein, lactic acid and consciousness of patients in each group were compared, and the effective indexes for differentiating grade 3 cholangitis were selected. Logistic regression and receiver operating characteristic curve (ROC) analysis were used to screen the indexes with high specificity and sensitivity for early identification of acute cholangitis.Results:There were significant differences in age, CCI score, incidence of acute cholecystitis, all-cause mortality, shock index, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiration, lactic acid, white blood cell count, neutrophil count, lymphocyte count, granulocyte ratio, C-reactive protein, hematocrit, platelet count, thrombocytocrit and platelet distribution width among the three groups ( P<0.05). ROC curve analysis showed that platelet count and thrombocytocrit were more effective in predicting grade 3 cholangitis ( P<0.05). Logistic regression analysis showed that shock index and platelet were significantly correlated with grade 3 cholangitis ( P<0.05). For patients without unconsciousness, the area under curve (AUC) value of shock index alone was 0.621 for differentiating grade 3 cholangitis; The sensitivity was 47.6%, and the specificity was 71.3%. The AUC value of combined shock index and platelet for differentiating grade 3 cholangitis was 0.861, with a specificity of 95.6% and sensitivity of 71%. Conclusions:Shock index combined with platelet can be used as a good indicator for early differentiation of severe acute cholangitis without conscious disorder.
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Objective:To investigate the correlation between serum calcium level and patients with acute obstructive suppurative cholangitis (AOSC).Methods:The clinical data of 104 patients with AOSC treated in the emergency room of Beijing Friendship Hospital Affiliated to Capital Medical University from June 2019 to February 2020 were retrospectively selected, of which 53 patients with severe sepsis were included in group A, 51 patients with simple AOSC were included in group B, and 50 patients with non infectious severe diseases hospitalized in the same period were selected as control and included in group C. The levels of serum calcium, C-reactive protein (CRP), procalcitonin (PCT) and D-dimer (D-D) were compared in the three groups. Pearson analysis was used to analyze the correlation between serum calcium and CRP, PCT and D-D.Results:The levels of serum calcium in group A were significantly lower than those in group B and group C, and the levels of inflammatory related factors CRP, PCT and D-D were significantly higher than those in group B and group C ( P<0.01), with significant difference. In AOSC group, serum calcium was negatively correlated with CRP, PCT and D-D levels ( r=-0.550, -0.479, -0.431, P<0.05). Conclusions:Patients with AOSC are prone to hypocalcemia under infection, and the level of serum calcium is negatively correlated with infection inflammatory indexes CRP, PCT and D-D, indicating that the level of calcium is related to the severity of infection. Hypocalcemia should be found in time in clinical work, and the severity of the disease should be evaluated as soon as possible.
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Objective:To evaluate direct bilirubin /total bilirubin(D/T), B-mode ultrasound(BUS), multislice spiral computed tomography (MSCT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the diagnosis of choledocholithiasis abdominal pain (CAP).Methods:We retrospectively analyzed the materials of patients who were diagnosed with choledocholithiasis abdominal pain by above imagines in the emergency department of Beijing Friendship Hospital during March 2016 to December 2018. The stones were taken out by endoscopic retrograde cholangiopancreatography or surgical operation as the golden standard.Results:Among 256 patients, 195 cases, 138 cases, 107 cases and 26 cases were diagnosed by EUS, MRCP, CT and BUS, respectively. The sensitivity were 0.86, 0.62, 0.45, 0.13, respectively. The specificity were 0.86, 0.81, 0.75, 0.87. The positive predictive value were 0.97, 0.96, 0.91, 0.83.The negative predictive value were 0.55, 0.19, 0.21, 0.16. The accuracy rate were 0.88, 0.64, 0.48, 0.30, respectively. The sensitivity of D/T and D/T combined with EUS in the diagnosis of CAP were 0.57 and 0.67, and the accuracy were 0.16 and 0.56, respectively.Conclusions:EUS has a high diagnostic value for CAP. MRCP is superior to CT in the value of diagnosis of CAP. BUS in imaging diagnosis of CAP value is relatively low, but D/T combined with BUS can improve the sensitivity and accuracy of diagnosis for CAP.
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Nuclear medicine can not only display the anatomical structure of organs or lesions, but also provide the information of blood flow, function, metabolism and receptor density of organs and lesions in digestive system . It is not only complementary to computer tomography (CT) and magnetic resonance imaging (MRI) in organic diseases of digestive system, but aslo has unique clinical value in functional diseases of digestive system.
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Objective:To investigate whether platelet and coagulation-related indicators can be used as early indicators of severity of acute pancreatitis.Methods:A total of 142 patients with acute pancreatitis admitted to Beijing Friendship Hospital from 2017 to 2018 were included in this study. According to the Ranson score, they were divided into mild group and severe group. Severe pancreatitis was used as the outcome index. Univariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed on single indicators with statistically significant differences between mild and severe patients to determine the discriminative value of disease severity.Results:According to the Ranson score, 142 patients were divided into severe and mild groups, 43 patients with severe disease, and 99 patients with mild disease. There was a statistically significant difference in platelet, fibrinogen (FIB), and D-Dimer between the two groups on the first day of admission ( P<0.05). The area under ROC curve and 95% CI of platelets (PLT) , FIB and D-Dimer were 0.61 (0.52, 0.71), 0.70 (0.59, 0.80) and 0.72 (0.62, 0.82), respectively. Multivariate logistic regression models of PLT, FIB and D-Dimer were fitted, and ROC curve was analyzed. The area of ROC curve of PLT combined with D-Dimer was 0.74 (0.65, 0.83), and the area of ROC curve of FIB combined with D-Dimer was 0.75 (0.66, 0.85). Conclusions:Platelet, FIB and D-Dimer can be used as independent risk factors to judge the severity of pancreatitis. The early predicative value of FIB combined with D-Dimer on the severity of the disease is higher than that of the PLT combined with D-Dimer.
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Objective To research the effect of Qishenghuoxue granules in the treatment of sepsis combined with myocardial injury.Methods A total of 63 patients with sepsis combined with myocardial injury were randomly divided into two groups:33 cases in control group (conventional therapy for 7 d) and 30 cases in observation group (Qishenhuoxue granule for 7 d).Thromboxane A2 (TXA2),prostaglandin I2 (PGI2),endothelin 1 (ET-1) and other cytokines were detected by enzyme-linked immunosorbent assay (ELISA).At the same time blood pressure,pulse,echocardiography were recorded.The mortality rate at the 28th day and the above values were statistically analyzed.Results On the 7th day after the intervention of Qishenhuoxue granule,N-terminal pro-brain natriuretic peptid (NT-proBNP) and troponin T (TNT) in the observation group and the control group were significantly lower than those on the 1 st day,but there was no significant difference between the two groups at the same time point (P ＞0.05);On the 7th day after the intervention of Qishenhuoxue granule,the levels of angiotensin Ⅱ (Ang-Ⅱ) and ET-1 in the observation group were significantly lower than those in the control group (P ＜ 0.01),but there was no significant difference between the two groups in cardiac function index and 28 day mortality.Conclusions The Chinese herbal preparation Qishenhuoxue granule could reduce the blood levels of Ang-Ⅱ and ET-1,but its effect on improving myocardial injury is still worthy of further study.
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Acute cholangitis (AC) is a morbid condition with acute inflammation and infection in the bile duct,which meets the diagnostic criteria of sepsis 3.0.AC mortality rate is high without treatment in time,and it is a main disease in emergency department.The occurrence and development of sepsis depend on the regulation of nerve and immunity system,and cholinergic anti-inflammatory pathway plays an important role in connecting nerve and immune function.The biliary tract is innervated by vagus nerves,which can be excited when the pressure increases in the biliary tract.The research on the role of vagus nerves and cholinergic anti-inflammatory pathway (CAIP) in sepsis caused by acute cholangitis is more advantageous than other infectious diseases.
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Objective To explore the clinical value of liver function indicators in predicting the severity of disease in patients with acute pancreatitis (AP),and to provide a reference for clinical treatment.Methods A retrospective study was conducted and 142 patients with acute pancreatitis were included.The disease severity was evaluated according to the RANSON score and the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,and severe pancreatitis was used as the outcome index.Univariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed on single indicators that were statistically significant between mild and severe patients to determine the distinguishing value for disease severity.Results The RANSON score was graded:43 cases of severe patients (RANSON≥3) and 99 cases of mild patients (RANSON ＜3);the difference in albumin (ALB) levels between the two groups was statistically significant (P ＜ 0.05).Univariate logistic regression analysis and ROC curve analysis were performed on ALB (OR =0.88,P ＜0.001).The area under the ROC curve and its 95％ CI were 0.73 (0.63,0.83).APACHE Ⅱ score classification:94 cases of severe patients (APACHE Ⅱ score≥8) and 48 cases of mild patients (APACHE Ⅱ score ＜8).The difference in alanine aminotransferase (ALT) levels in the two groups were statistically significant (P ＜0.05).Univariate factor logistic regression analysis and ROC curve analysis were performed on ALT (OR =1.001,P =0.314).The area under the ROC curve and its 95％ CI were 0.61 (0.50,0.71).Conclusions ALB and ALT are valuable biomarkers for predicting the severity of AP.
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There were no obvious symptoms,no specific biochemical diagnostic indicators,and early detection and diagnosis were difficult in the early stage of cholangiocarcinoma.With the development of molecular biology,more and more biomarkers have been found in cholangiocarcinoma.It is of great significance for the early detection of cholangiocarcinoma if specific biomarkers or highly specific biomarkers can be found.
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Objective To improve the awareness of emergency biliary obstruction (BO) disease,and to further improve the diagnosis and treatment ability of BO patients.Methods Data of the etiology,clinical manifestations,imaging data,laboratory tests,and emergency treatment outcomes in 63 BO patients were retrospectively analyzed.Results Common bile duct stones were the most common cause of BO patients (63.49％),followed by cholangiocarcinoma (19.05％);the most common clinical manifestations of BO patients were jaundice (90.48％),abdominal pain (87.30％),and fever (53.97％);the diagnostic ability of computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) in patients with BO was significantly higher than that of ultrasound (P ＜ 0.05),but there was no significant difference between CT and MRCP (P =1.000);compared with benign group,hemoglobin and albumin in malignant group were significantly lower,while total bilirubin and direct bilirubin were higher,with statistically significant difference (P ＜ 0.05).Most patients in BO patients improved after treatment,and the mortality rate of BO patients was 3.17％ (2/63) at the end of emergency visit.Conclusions Common bile duct stones and cholangiocarcinoma are still the most common causes of emergency BO patients.The most common clinical manifestations of patients with emergency BO are jaundice,abdominal pain,and fever.Better than abdominal ultrasound,CT and MRCP have comparable diagnostic capabilities in the diagnosis of emergency BO patients.Anemia,hyperbilirubinemia and hypoproteinemia are alarm indicators for malignant tumors in emergency BO patients.Most patients can temporarily get better at the end of emergency visit.
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Objective@#To research the effect of Qishenghuoxue granules in the treatment of sepsis combined with myocardial injury.@*Methods@#A total of 63 patients with sepsis combined with myocardial injury were randomly divided into two groups: 33 cases in control group (conventional therapy for 7 d) and 30 cases in observation group (Qishenhuoxue granule for 7 d). Thromboxane A2 (TXA2), prostaglandin I2 (PGI2), endothelin 1 (ET-1) and other cytokines were detected by enzyme-linked immunosorbent assay (ELISA). At the same time blood pressure, pulse, echocardiography were recorded. The mortality rate at the 28th day and the above values were statistically analyzed.@*Results@#On the 7th day after the intervention of Qishenhuoxue granule, N-terminal pro-brain natriuretic peptid (NT-proBNP) and troponin T (TNT) in the observation group and the control group were significantly lower than those on the 1st day, but there was no significant difference between the two groups at the same time point (P>0.05); On the 7th day after the intervention of Qishenhuoxue granule, the levels of angiotensin Ⅱ (Ang-Ⅱ) and ET-1 in the observation group were significantly lower than those in the control group (P<0.01), but there was no significant difference between the two groups in cardiac function index and 28 day mortality.@*Conclusions@#The Chinese herbal preparation Qishenhuoxue granule could reduce the blood levels of Ang-Ⅱ and ET-1, but its effect on improving myocardial injury is still worthy of further study.
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Acute cholangitis (AC) is a morbid condition with acute inflammation and infection in the bile duct, which meets the diagnostic criteria of sepsis 3.0. AC mortality rate is high without treatment in time, and it is a main disease in emergency department. The occurrence and development of sepsis depend on the regulation of nerve and immunity system, and cholinergic anti-inflammatory pathway plays an important role in connecting nerve and immune function. The biliary tract is innervated by vagus nerves, which can be excited when the pressure increases in the biliary tract. The research on the role of vagus nerves and cholinergic anti-inflammatory pathway (CAIP) in sepsis caused by acute cholangitis is more advantageous than other infectious diseases.
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Objective@#To explore the clinical value of liver function indicators in predicting the severity of disease in patients with acute pancreatitis (AP), and to provide a reference for clinical treatment.@*Methods@#A retrospective study was conducted and 142 patients with acute pancreatitis were included. The disease severity was evaluated according to the RANSON score and the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and severe pancreatitis was used as the outcome index. Univariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed on single indicators that were statistically significant between mild and severe patients to determine the distinguishing value for disease severity.@*Results@#The RANSON score was graded: 43 cases of severe patients (RANSON≥3) and 99 cases of mild patients (RANSON<3); the difference in albumin (ALB) levels between the two groups was statistically significant (P<0.05). Univariate logistic regression analysis and ROC curve analysis were performed on ALB (OR=0.88, P<0.001). The area under the ROC curve and its 95% CI were 0.73 (0.63, 0.83). APACHE Ⅱ score classification: 94 cases of severe patients (APACHE Ⅱ score≥8) and 48 cases of mild patients (APACHE Ⅱ score<8). The difference in alanine aminotransferase (ALT) levels in the two groups were statistically significant (P<0.05). Univariate factor logistic regression analysis and ROC curve analysis were performed on ALT (OR=1.001, P=0.314). The area under the ROC curve and its 95% CI were 0.61 (0.50, 0.71).@*Conclusions@#ALB and ALT are valuable biomarkers for predicting the severity of AP.