Recommendations for the diagnosis and treatment of rheumatic fever in China / 中华内科杂志

Rheumatic fever is an autoimmune disease characterized by recurring acute or chronic systemic connective tissue inflammation caused by group A streptococcal infection in the throat. Although rheumatic fever is common in China, there is a lack of standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of this disease in China. The aim was to standardize rheumatic fever diagnosis methods, treatment opportunities, and strategies for both short-and long-term treatment, so as to reduce irreversible damage and improve prognosis.

Meta-analysis of the relationship between the polymorphism of ACE and TNF-α gene and the susceptibility of sarcoidosis / 中国医师杂志

Objective@#To evaluate the relationship between angiotensin converting enzyme (ACE) and tumor necrosis factors-α (TNF-α) gene polymorphism and sarcoidosis.@*Methods@#Meta analysis was carried out by retrieving the studies published up to July 2018 to evaluate the relationship between ACE and TNF-α gene polymorphism and sarcoidosis. RevMan 5.3 and Stata 12.0 software were used to analyze the combined OR value and 95% confidence interval (95% CI) by recessive model and dominant model. The stability of the results was judged by ethnic subgroup analysis and sensitivity analysis.@*Results@#A total of 28 articles and 30 studies met the inclusion criteria, including 7 888 cases, 2 992 cases of sarcoidosis and 4 896 healthy controls. No significant association was found between ACE I/D and sarcoidosis using any model (P>0.05). TNF-α-308A/G was significantly associated with sarcoidosis risk (OR=1.34, 95% CI=1.13-1.58, P=0.0007). Ethnic subgroup analysis showed that the results were significantly different in both the Caucasians (OR=1.36, 95% CI=1.13-1.64, P=0.001) and the Asians (OR=4.88, 95% CI=1.43-16.99, P=0.01).@*Conclusions@#The meta-analysis identified that AA/AG genotypes at TNF-α-308 were associated with susceptibility to sarcoidosis .However, no significant correlation was found between ACE I/D and the susceptibility of sarcoidosis.

Clinical analysis of renal artery involvement inTakayasu's arteritis patients / 中华风湿病学杂志

Objective:To investigate the clinical features and influencing factors of renal artery involvement in patients with Takayasu's arteritis (TA).Methods:One hundred and five TA patients were included and their clinical features, laboratory tests, echocardiographic findings were collected and analyzed. The t-test, Mann-Whitney U test, Sperman's correlation and logistic regression were used for statistical analysis. Results:Of the 105 patients with Takayasu's arteritis, 21 (20%) patients were diagnosed to have renal artery involvement. They had higher frequency of hypertension [76%(16/21) vs 25%(21/84); χ2=19.291, P<0.01], syncope [19%(4/21) vs 4%(3/84); P=0.028] and headache [52%(11/21) vs 25%(21/84); χ2=5.944, P=0.019]. Patients with renal artery invol-vement had higher levels of creatinine [(67±30) mmol/L vs (50±14) mmol/L; t=2.436, P=0.023], lower levels of lymphocyte subsets CD3 +[1 299(1 261.5, 1 313.45)/μl vs 1 531 (1 330, 1 559.5)/μl; Z=-3.12, P=0.002], CD4 +[793.6(715, 804.32)/μl vs 914.88(794.3, 914.8)/μl; Z=-2.597, P=0.009], CD8 +[451.09(451.09, 489.5)/μl vs 552.39(459.75, 557.5)/μl; Z=-3.271, P=0.001] and glomerular filtration rate ( Z=-2.612, P=0.009). Comparison of echocardiographic parameters between the two groups showed that the diameters of left atrium [(35±4) mm vs (32±4) mm; t=3.065, P=0.003] and end-diastolic left ventricular [49.2(47.5, 52.5) vs 45.84(43.25, 47.75); Z=-3.795, P<0.01] were larger in renal artery involvement group. Abdominal aorta ( χ2=14.292, P<0.01), superior mesenteric artery ( P<0.01), inferior mesenteric artery ( P=0.038) and common iliac artery ( P=0.005), were more likely involved in patients with renal artery involvement; while the common carotid artery ( χ2=3.815, P=0.047) and subclavian artery ( P=0.022) were less affected. There was a positive correlation between creati-nine level ( r=0.282, P=0.004) and renal artery involvement in patients with arteritis, and the number of lymphocyte subsets (CD3, CD4, CD8) ( r=-0.306, P=0.002; r=-0.255, P=0.009; r=-0.321, P=0.001) was negatively correlated with renal artery involvement. Conclusion:The most common pattern of renal artery involvement is stenosis and occlusion. Hypertension, syncope, headache, kidney dysfunction and heart failure are more prevalent among patients with renal artery involvement. The number of lymphocyte subsets is low, and involvement of abdominal aorta is common. It should be assessed and treated as soon as it is discovered.

Meta-analysis of the relationship between the polymorphism of ACE and TNF-α gene and the susceptibility of sarcoidosis / 中国医师杂志

Objective To evaluate the relationship between angiotensin converting enzyme (ACE) and tumor necrosis factors-α (TNF-α) gene polymorphism and sarcoidosis.Methods Meta analysis was carried out by retrieving the studies published up to July 2018 to evaluate the relationship between ACE and TNF-α gene polymorphism and sarcoidosis.RevMan 5.3 and Stata 12.0 software were used to analyze the combined OR value and 95％ confidence interval (95％ CI) by recessive model and dominant model.The stability of the results was judged by ethnic subgroup analysis and sensitivity analysis.Results A total of 28 articles and 30 studies met the inclusion criteria,including 7 888 cases,2 992 cases of sarcoidosis and 4 896 healthy controls.No significant association was found between ACE I/D and sarcoidosis using any model (P ＞ 0.05).TNF-α-308A/G was significantly associated with sarcoidosis risk (OR =1.34,95％ CI =1.13-1.58,P =0.0007).Ethnic subgroup analysis showed that the results were significantly different in both the Caucasians (OR =1.36,95％ CI =1.13-1.64,P =0.001) and the Asians (OR =4.88,95％ CI =1.43-16.99,P =0.01).Conclusions The meta-analysis identified that AA/AG genotypes at TNF-α-308 were associated with susceptibility to sarcoidosis.However,no significant correlation was found between ACE I/D and the susceptibility of sarcoidosis.

Association between the changes in ideal cardiovascular health status and the decline of glomerular filtration rates in medical examination people / 中南大学学报(医学版)

Objective:To explore the association between the changes in ideal cardiovascular health (CVH) indices and the renal function.Methods:The retrospective cohort study consisted of 837 Chinese individuals from Department of Health Management in the Third Xiangya Hospital.The general information,anthropometry and blood biochemistry were obtained for all subjects from 2008 to 2014,respectively.The 6-year changes of 7 ideal CVH metrics defined by American Heart Association and the estimated glomerular filtration rate (eGFR) were calculated.Linear regression analysis was used to study the association between the changes in the ideal CVH metrics and eGFR.Covariance analysis was used to compare the levels of changes in eGFR stratified by variations of the ideal CVH metrics.Results:After 6 years' follow-up,we did not find significant difference in ideal cardiovascular health indexes between 2014 and 2008 [(3.3±1.4) items vs.(3.2±1.3) items,respectively] (P＜0.05).However,the eGFR in 2014 was significantly lower than that in 2008 [(99.8±22.7) mL/(min.1.73 m2)vs (104.3±24.9) mL/(min.1.73 m2),respectively] (P＜0.01).After adjusting for age,sex,history of hypertension and diabetes,and history of drug usage (antihypertensive,cholesterol-lowering and blood glucose-lowering medication),the changes in ideal CVH metrics were positively associated with the changes in eGFR (β=0.701,P＜0.01).With the improved change in ideal CVH metrics from ≤-2 points,-1 point,0 point,1 point to ≥ 2 points,the magnitude of decline in eGFR was gradually decreased,with significant difference (F=21.71,P＜0.01).Conclusion:The changes in ideal CVH metrics are an independent risk factor for changes of eGFR.Positive changes in ideal CVH metrics exert a favorable effect on renal function evolution.

Research on the application value of stepped screening on hypertension with self-report health measurement questionnaire / 中华健康管理学杂志

Objective To explore the application value of stepped screening on hypertension with self-report health measurement questionnaire by comparing the accuracy of the different levels of screening. Methods A total of 6 715 subjects with hypertension (average age of 53.47 ± 11.07 years) were selected from those who completed the physical examination in the department of health management in the Third Xiangya Hospital of Central South University for questionnaire survey, routine inspection and special inspection for hypertension. And the patients were divided into four groups based on their hypertension risk levels: the questionnaire survey group, routine inspection group, questionnaire + routine inspection group and questionnaire+routine inspection+special inspection group. The results were compared respectively to calculate the sensitivity, specificity, positive predictive value and coincidence rate of single inspection and joint inspection. Results Nearly 90.00%of the subjects had hypertension associated with the risk factors, while 20.83% of the subjects had hypertension associated with other clinical diseases (the highest percentage was seen in hypertension with diabetes as 14.88%). According to the guidelines of stratification, 3.41% of the patients were at low risk, 23.78% at moderate risk, 47.85% at high risk, and 24.96% at extremely high risk. Sensitivity and specificity of routine inspection were 95.56%and 45.51%in judgment of moderate risk, which became 100.00%and 45.51%after addition of questionnaire survey;as a result, thesensitivity increased. Sensitivity and specificity of routine inspection were 15.03%and 96.28%in judgment of high risk, which became 30.03% and 99.14% after addition of questionnaire survey; as a result, the sensitivity doubled. Sensitivity and specificity of routine inspection were 15.03%and 100.00%in judgment of extremely high risk, and the sensitivity increased to 94.45%after addition of questionnaire survey, while the specificity remained unchanged. Conclusion Addition of questionnaire on the basis of routine physical examination could greatly increase the detection rate of hypertension patients at different risk levels, and increase the sensitivity as well as specificity for detection of moderate risk, high risk and extremely high risk. Therefore, health information and data acquired from the questionnaire and data obtained from the medical inspection equipment are equally important and suggest health management (physical examination) institutions to take questionnaire as a necessary and primary screening in physical examination and chronic disease screening.

Association of metabolic syndrome with serum cystatin C in people undergoing health examination / 中南大学学报(医学版)

OBJECTIVE@#To investigate the relationship between metabolic syndrome (MetS) and cystatin C in people undergoing healthy examination.
@*METHODS@#A total of 6 783 subjects were analyzed. They were divided into MetS group (n=1 578), metabolic disturbance (MetD) group (n=3 617) and healthy control (HC) group (n=1 588). The general information, anthropometry, blood sample and urine sample were collected for all the subjects. Multiple logistic regression analysis was used to identify risk factors for MetS and analysis of covariance was used to investigate the correlation between the number of metabolic disturbance components and cystatin C.
@*RESULTS@#Compared with the HC group, the level of cystatin C significantly increased in MetS and MetD group; compared with MetD group, the level of cystatin C significantly increased in MetS group (P<0.05). After correction by age, sex, smoking, alcohol intake, menopause, waist circumference, body mass index, blood pressure, plasma cholesterol, fasting plasma glucose, estimated glomerular filtration rate, serum uric acid, microalbuminria, high sensitive C-reaction protein and homocysteine, the cystatin C was closely related with MetS (OR=1.951, 95% CI 1.265-3.009, P<0.05). Similarly, the OR value of risk with MetS was increased with the quartile of cystatin C level (P<0.05). In addition, with the increase in metabolic disturbance components, the level of cystatin C was also increased significantly (P<0.01).
@*CONCLUSION@#Serum cystatin C in our study was significantly associated with MetS. Moreover, the level of cystatin C may be correlated with severity of MetD.

Serum neurotrophin profiles in dermatomyositis complicated with interstitial lung damage / 中华风湿病学杂志

Objective To investigate the profiles of serum nerve grow factor profile (NGF),neurotrophin (NT)-3,as well as brain-derived neurotrophic factor (BDNF) in patients with dermatomyositis (DM) complicated with interstitial lung damage (ILD).Methods Forty-seven patients were divided into 2 groups:ILD group (30 patients) and non-ILD group (17 patients).Twenty healthy blood donors were used as controls.Serum levels of NGF,NT-3,as well as BDNF were measured serum by enzyme-linked immunosorbent assay (ELISA).ANOVA was used to compare serum level of NTs.When a significant difference was found,the exact P-values were calculated using the student's t-test or t-test followed by Bonferroni's correction.Pearson test was used for correlation analysis.Results The serum NGF levels in healthy control group,the non-ILD group and the ILD group were (182±43),(308±72),(480±96) pg/ml respectively.There was statistically significant difference between the three groups (F=90.3,P＜0.01),and the serum NGF levels were elevated significantly in ILD and non-ILD patient groups as compared with healthy controls (t=12.9 and t=6.5 respectively,both P＜0.01).The serum level of NGF was significantly higher in ILD group than that in the non-ILD group (t=6.4,P＜0.01).There was no significant difference in the serum levels of NT-3 among the two patient groups and healthy controls.On the contrary,BDNF levels were significantly decreased in both ILD [(792± 106) pg/ml] and non-ILD patients groups [(963±93) pg/ml] when compared with healthy controls [(1 281±107) pg/ml] (t=15.9 and t=9.6 respectively,both P＜0.01).The decrease was also significant in ILD group when compared with non-ILD group (t=5.6,P＜0.01).Moreover,NGF and BDNF both showed significant correlation with serum C-reactive protein (CRP) level in ILD group by applying Pearson correlation analysis (r=0.56,P＜0.01; r=-0.48,P＜0.05 respectively).Conclusion Neurotrophins may play an import role in the pathogenesis of DM.

Application of serum thymidine kinase 1 of 26 055 cases in health screening for early detection of premalignant/early malignant tumors / 中南大学学报(医学版)

OBJECTIVE@#To determine the application of serum thymidine kinase 1 (STK1) in general health screening for early detection of premalignant/early malignant tumors.@*METHODS@#A cross sectional study was carried out in 26 055 health screenings from 8 centers of Changsha in 2011. The concentration of STK1 was determined by a sensitive chemiluminescent dot blot ECL assay.@*RESULTS@#In the elevated STK1 group 60.35% showed diseases with a higher risk of premalignant/ early cancerous progression. The positive rate of elevated STK1 (>2.0 pmol/L) was 2.61%. There was a significantly higher rate with moderate/severe type of hyperplasia of breasts and prostate with elevated STK1 than people with normal STK1 values.@*CONCLUSION@#STK1 may be a reliable marker for risk assessment of premalignant/early malignant tumors.

Helicobacter pylori infection and gastric mucosa change and blood-lipid in people undergoing the physical examination in Changsha / 中南大学学报(医学版)

OBJECTIVE@#To explore the relationship between the Helicobacter pylori (H.pylori) infection and gastric mucosa change and blood-lipid in people undergoing the physical examination in Changsha.@*METHODS@#A total of 2 264 people undergoing physical examination were divided into an H. pyloripositive group (n=1 068) and an H. pylori-negative group (n=1 196). Gastric mucosa change was diagnosed by gastroscopy, blood-lipid and blood sugar were detected, and the statistical analysis was performed.@*RESULTS@#The incidence rate of H.pylori infection was 47.2%. The incidence rate of gastric mucosal erosion, gastric ulcer, duodenal ulcer, gastric mucosal atrophy, gastric polyp, dyslipidemia, increase of triglyceride were (TG) and decrease of the high density lipoprotein cholesterol (HDL-C) in the H.pylori-positive group were all higher than those in the H.pylori-negative group (P<0.01 or P<0.05). In the H. pylori-positive group, the level of TG in people with gastric mucosal erosion, gastric ulcer and duodenal ulcer was higher than that in people with normal gastric mucosa or mild gastritis, and HDL-C was lower than that in people with normal gastric mucosa or mild gastritis.@*CONCLUSION@#H. pylori infection can induce the gastric mucosa injury and dyslipidemia, which may result in the occurrence and development of coronary heart disease by increasing TG and decreasing HDL-C, thus increasing the risk of atherosclerosis.

Carotid intima-media thickness and estimated glomerular filtration rate in hypertensive patients / 中南大学学报(医学版)

OBJECTIVE@#To determine the association between carotid atherosclerosis and renal function in hypertensive patients.@*METHODS@#A total of 2 809 hypertensive patients aged (56.59±10.79) years were enrolled. Carotid intima-media thickness (cIMT) was derived via B-mode ultrasonography and chronic kidney disease (CKD) was evaluated by the estimated glomerular filtration rate (eGFR) with Cockcroft- Gault method. The patients were divided into 3 groups: a normal group, a thick group, and a plaque group according to the results of carotid ultrasonography.@*RESULTS@#The eGFR of the normal group was (111.09±25.61) mL/(min.1.73m(2)), that of the thick group and the plaque group was (94.45±27.14) mL/(min.1.73m(2)) and (85.98±26.92) mL/ (min.1.73m(2)). Binary logistic analysis showed that age (OR=3.590), smoking status (OR=1.543), systolic blood pressure (OR=1.018), diastolic blood pressure (OR=0.977), fasting plasma glucose (OR=1.132), triglyceride (OR=0.873) and eGFR (OR=0.986) were significantly correlated with cIMT. Subgroup analyses on different genders showed that eGFR was a significant independent risk factor in men (OR=0.991) but not in women.@*CONCLUSION@#The thicker the cIMT, the lower the eGFR in hypertensive patients. With the development of cIMT, eGFR gradually decreases and contributes to the occurrence and development of early-stage atherosclerosis in hypertensive patients.

Diabetic cardiomyopathy in medical examination patients with impaired glucose tolerance and Type 2 diabetes / 中南大学学报(医学版)

OBJECTIVE@#To investigate the change of diabetic cardiomyopathy in patients with impaired glucose tolerance (IGT) and Type 2 diabetes (T2DM) and its influencing factors.@*METHODS@#Patients with IGT and T2DM were divided into an IGT group (n=314), a T2DM group (n=368) and an NC group (400 normal subjects). The left ventricular ejection fractions (LVEF) and the interventricular septal depth (IVSd) were measured by Doppler echocardiography. The general information and blood biochemistry were also collected during the corresponding time period.@*RESULTS@#Compared with the NC group, waist circumference (WC), bodymass index (BMI), premature family history of cardiovascular disease, the serum levels of fasting plasma glucose (FPG), HbA1c, TC, TG, hyperlipidemia, BUN and Cr significantly increased (P<0.01) in the IGT and T2DM groups. Compared with the NC group and the IGT group, the LVEF significantly decreased (P<0.01) and the IVSd significantly increased (P<0.01) in the T2DM group. The LVEF and IVSd did not have obvious difference between the NC group and the IGT group. Pearson correlation analysis showed a negative correlation between LVEF and HbA1c, TC and duration of disease (P<0.01); but a positive correlation between IVSd and WC, BMI, HbA1c and duration of disease, and a negative correlation between IVSd and HDL (P<0.05). In the multiple linear stepwise regression, HbA1c and duration of disease showed a significant association with both LVEF and IVSd (P<0.05).@*CONCLUSION@#T2DM has a close association with cardiomyopathy. HbA1c and duration of disease are the independent predictors for LVEF and IVSd.

Effects of graded management of health on hypertension / 中华健康管理学杂志

Objective To evaluate the effect of graded management of health in hypertensive populations.Methods Hypertensive adults who were detected in health checkup between January 2008 and June 2011 and with no severe liver or kidney disease,chronic consumptive disease and cancer were enrolled in this investigation.Those with low or modest hypertensive risk received grade 2health management,and those with high or extreme high risk got grade 3health management.At the end of the intervention,50％ participants were randomly selected in each year(1441 in 2008,1508 in 2009,1533 in 2010,and 1601 in 2011) to compare lifestyle modification,blood pressure,blood glucose and blood lipid profiles by using multiDunnett's t test and x2 analyses.Results In both grade 2 and 3 health management groups,compared with baseline,high-salt diet,current cigarette smoking,alcohol consumption and insufficient physical activity were significantly improved after intervention (x2 values were 154.27 and 81.16,52.43 and 9.37,61.40 and 12.13,46.54 and 12.05,respectively; all P ＜ 0.05).Blood glucose in grade 2 health management group and waistline in grade 3 health management group showed no significant change.Body weight,blood glucose,blood lipid profiles and serum creatinine of grade 2 health management group were significantly declined after intervention.In both groups,systolic and diastolic blood pressure were significantly decreased(F values were 13.12 and 56.86,56.86 and 239.89,respectively; all P ＜0.05),and those with normal blood pressure were increased from 28.8％ and 23.4％ to 37.9％ and 28.2％ in grade 2 and 3 health management groups(F values were 12.78 and 22.93,respectively ; all P ＜ 0.05).Conclusion These data suggest the beneficial effects of graded management of health on blood pressure control and reduced risks of cardiovascular disease.

The level and clinical significance of interleukin-17 in primary Sj(o)gren's syndrome with interstitial lung disease / 中华风湿病学杂志

Objective To investigate the level of IL-17 and its clinical significance in patients with primary Sj(o)gren's syndrome (pSS) complicated with interstitial lung disease (ILD).Methods IL-17 levels were detected by enzyme linked immunosorbent assay (ELISA) in 53 untreated patients with pSS (25patients with only lacriminal and/or salivary gland involvement,28 with only interstitial lung disease involvement) and 15 healthy controls.The related clinical and laboratory data were recorded.ANOVA,LSDtest and Pearson test were used for statistical analysis.Results There were significant differences between the 3 groups(F=22.504,P=0.000).The mean concentration of sera IL-I7 in the patients with ILD was significantly higher than in patients with only lacriminal or salivary gland involvement (P＜0.05).There was no difference in the levels of sera IL-17 between the patients with only lacriminal and/or salivary gland involvement and healthy controls (P＞0.05).Conclusion Our results show that patients with pSS concomitant with ILD have high serum IL-17 levels,which highlight the role of IL-17 in Sj(o)gren's syndrome interstitial lung injury.

Acquired Gitelman syndrome associated with primary Sj(o)gren syndrome: two cases report and review of literature / 中华风湿病学杂志

Objective To better understand the clinical features and the diagnosis of acquired Gitelman syndrome associated with primary Sj(o)gren syndrome (SS).Methods Two cases of acquired Gitelman syndrome associated with primary SS were investigated.Literature were reviewed.Results Two women with sicca complex presented to our clinic with intermittent muscle cramping and weakness involving both lower extremities for several months.Laboratory findings showed hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria,all these met the criteria for Gitelman syndrome.Diagnostic evaluation identified primary SS as the cause of the acquired Gitelman syndrome.Conclusion Acquired Gitelman syndrome associated with SS is rare.Kidney biopsy is necessary for the diagnosis of Gitelman syndrome.Further studies are needed.