RESUMO
Objective:The decline in nutritional status in patients with severe pneumonia may contribute to an increase in in-hospital mortality. Enteral nutrition support can improve the nutritional status of patients, and is relatively easy to manage, with low cost and fewer serious complications. On the other hand, adverse reactions such as gastric retention and gastric microbiota translocation may increase the incidence of nosocomial pneumonia and increase the uncertainty of patient prognosis. There is no predictive model for in-hospital death in severe pneumonia patients receiving enteral nutrition support. The objective of this study was to investigate the risk factors of in-hospital death in patients with severe pneumonia receiving enteral nutrition support and to establish a prognostic model for such patients.Methods:This was a single-center retrospective study. Patients with severe pneumonia who were hospitalized in Peking Union Medical College Hospital and received enteral nutrition support were included from January 1, 2015 to December 31, 2020. The primary endpoints were in-hospital mortality rate and unordered discharge rate. The independent risk factors were determined using univariate and multifactorial logistic regression analysis, the nomogram scoring model was constructed, and the decision curve analysis (DCA) was performed.Results:A total of 632 severe pneumonia patients who received enteral nutrition support were included. Patients were divided into death and survival groups according to the presence or absence of in-hospital death, and 24 parameters were found with significant differences between groups. Nine parameters were independent predictors of mortality, namely the duration of ventilator use, the presence of malignant hyperplasia diseases, the maximal levels of platelet and prothrombin during hospitalization, and the nadir levels of alanine aminotransferase, serum albumin, sodium, potassium, and blood glucose. Based on these variables, a risk prediction scoring model was established (ROC = 0.782; 95% CI: 0.744 to 0.819, concordance index: 0.772). Calibration curves, DCA, and clinical impact curve were plotted to evaluate the goodness of function, accuracy, and applicability of the predictive nomogram, using the training and test sets. Conclusion:This study summarized the clinical characteristics of patients with severe pneumonia receiving enteral nutrition support and developed a scoring model to identify risk factors and establish prognostic models.
RESUMO
Objective:To investigate the efficacy and safety of liraglutide combined with metformin in the treatment of overweight or obese patients with type 2 diabetes, and to analyze the factors influencing the response to liraglutide.Methods:Seventy-three overweight or obese patients with well-controlled type 2 diabetes on metformin were selected and treated with liraglutide at 1.8 mg/d in addition to metformin at 1500 mg/d for 48 weeks. Relevant data were collected before and after treatment, including blood glucose, glycosylated hemoglobin (HbA1c), fasting insulin, serum lipid, body weight, waist circumference, hip circumference, body mass index (BMI), homeostatic model assessment for β-cell function (HOMA-β) and homeostatic model assessment for insulin resistance (HOMA-IR). Changes in metabolic markers, incidence of side effects, weight loss efficacy and corresponding influencing factors were evaluated.Results:After 48 weeks of treatment, fasting blood glucose, 2-hour postprandial blood glucose, HbA1c, fasting insulin, HOMA-IR, blood lipid, waist circumference, hip circumference and BMI decreased significantly compared with baseline ( P < 0.05). The most common side effects were tolerable gastrointestinal adverse events. The average weight loss after the initial 4-week treatment was 3.99 kg, accounting for 48.8% of the total weight loss, and then the change displayed a more subdued trend during the remaining treatment period. After the 48-week treatment, 73.1% and 34.6% of the patients lost more than 5% and 10% of body weight, respectively. Absolute weight loss was positively correlated with baseline weight and weight loss within the initial 4-week treatment was an independent predictor of weight loss ≥ 5% at the 48th week. Conclusions:Liraglutide combined with metformin is safe and effective in the treatment of overweight or obese patients with type 2 diabetes mellitus. Weight loss is significant during the initial 4 weeks and the early response seems to be a predictor for better long-term effect on weight loss.
RESUMO
Objective To summarize the clinical and pathologic characteristics of patients with RosaiDorfman disease (RDD) mimicking immunoglobulin (Ig) G4-related disease (IgG4-RD).Methods Retrospectively analyze the clinical manifestations,laboratory tests,pathologic features,treatment and prognosis of RDD patients whose clinical presentations mimicked IgG4-RD in Peking Union Medical College Hospital during January 2015 to June 2017.Results Six RDD patients mimicking IgG4-RD were described,which accounted for 1.5％ of the 450 registered IgG4-RD patients.All patients were male,with the median age of 53 year and the median disease duration of 12 months.All patients had extra-nodal involvements,of which the locations included spinal cord (3/6),intracranial (2/6),skin (2/6) and liver (1/6).Increased serum IgG4 (＞1 350 mg/L) was found in 4 cases (1 360-6 410 mg/L).Seven specimens were obtained from these patients.The number of IgG4-positive plasma cells was found to be more than 50 per HPF in 3 cases,30 per HPF in 1 case.The IgG4/IgG ratio was 40％ in 2 specimens,between 10％ and 30％ in 2 specimens and 10％ in 2 specimens.All patients were treated by glucocorticoids and 4 of them were treated with combined cyclophosphamide.Five patients got partial remission by these treatments while 1 patient withdrew from further follow up.Conclusion RDD is one of the mimics of IgG4-RD.There are several differences in lab tests and pathologic features between RDD and IgG4-RD.Before the IgG4-RD is diagnosed,RDD should be excluded by specific pathologic manifestations at the first place.