RESUMO
OBJECTIVE：To systematically evaluate the effects of phenytoin on 3 kinds of cardiovascular disease-related factors （Folic acid ，vitamin B 12 and homocysteine）in epilepsy patients ，and to provide evidence-based reference for clinical treatment of epilepsy. METHODS ：Retrieved from PubMed ，Google scholar ，CJFD，VIP and Wanfang database ，observational studies about using phenytoin （trial group ） versus using no antiepileptics （control group ） on the levels of folic acid ，vitamin B 12 and homocysteine in serum were collected during Jan. 1991-Jan. 2019. After data extraction of included literatures ，quality evaluation with evaluation criteria for cross-sectional study （AHRQ）scale，Rev Man 5.3 and Stata 11 softwares were used for statistical analysis. RESULTS ：A total of 10 studies were included ，involving 745 patients. Meta-analysis showed that the folic acid level of trial group was significantly lower than control group [SMD ＝－0.90，95％CI（－1.18，－0.62），P＜0.001]；the level of homocysteine in trial group was significantly higher than control group [SMD ＝1.22，95％CI（0.73，1.71），P＜0.001]. There was no significant difference in the levels of vitamin B 12 between 2 groups [SMD ＝－ 0.19，95％ CI（－ 0.39，0.02），P＞0.05]. CONCLUSIONS：Phenytoin can reduce the level of folic acid and increase the level of homocysteine in epilepsy patients.
RESUMO
Objective By investigating the obesity of the adult population in Hunan,we explored the relationship between body mass index (BMI) [including waist circumference (WC),waist-to-hip ratio (WHR),waist-to-body ratio (WHtR) and H-type hypertension] in predicting H-type hypertension.Methods A multi-stage random sampling method was used to conduct a questionnaire survey,physical examination and laboratory testing on 4 012 adults ＞ 30 years old in 6 districts of Hunan Province.The receiver operator characteristic (ROC) curve was used to evaluate the predictive effects of BMI,WC,WHR and WHtR on H-type hypertension.Results ROC curve analysis indicated that the area under curve (AUC) of the evaluation of H-type hypertension of WC,WHtR,WHR and BMI in men were:0.637,0.640,0.601,0.639,of which the largest were combination of WC + BMI and WHtR + BMI,both being 0.647.In women,the AUC of individual indexes WC,WHtR,WHR and BMI for evaluating H-type hypertension were 0.660,0.670,0.660 and 0.604 respectively.The combination of WHtR and WHR had the largest AUC,which was 0.675.The WC for evaluating H-type hypertension in youth people had the largest AUC (0.732);the WC + BMI,WHR + BMI for evaluating H-type hypertension in middle-aged people had the largest AUC,all being 0.687;the WC predicted the largest AUC of H-type hypertension in elderly people (0.590).Conclusions WC,WHtR,WHR and BMI are important predictors of H-type hypertension.The optimal indicators for different genders and ages are different,and the combined indicators are better than the individual indicators.
RESUMO
Objective To investigate the relationship between methylenetetrahydrofotate reductase (MTHFR)C677T polymorphisms and H-type hypertension and increased plasma homocysteine (Hcy) levels. Methods From September 2013 to June 2014,4 012 permanent residents aged ≤30 year from 12 natural villages or communities in 6 regions of Hunan province were extracted according to the cluster random sampling method. Using computer random number table,571 residents were randomly selected as the research objects. According to the blood pressure and Hcy levels,571 residents were divided into 3 groups:a common hypertension group (n = 190),an H-type hypertension group (n = 94),and a normal blood pressure group (n = 287 ). Amplification refractory mutation system-polymerase chain reaction (ARMS-PCR)method was used to detect the MTHFR C677T polymorphisms in all the research objects and the penotyping was performed. Hcy levels were detected at the same time. Results There were significant differences in recessive model (CC + CT,TT)genotype frequencies among the H-type hypertension group (n = 66[70. 2%],n = 28[29. 8%]),common hypertension group (n = 156[82. 1%],n = 34[17. 9%]), and normal blood pressure group (n = 235[81. 9%],n = 52[18. 1%])(χ2 = 6. 797,P = 0. 033),and there were no significant differences in CC,CT,and TT genotype frequencies among the 3 groups (P >0. 05). In the recessive model,there were significant differences in TT genotype frequencies between the H-type hypertension group and the normal blood pressure group or the common hypertension group (χ2 = 5. 812,P = 0. 016;χ2 = 5. 212,P = 0. 022). There was no significant difference in TT genotype frequencies between the common hypertension group and the normal blood pressure group (P > 0. 05). The CC + CT and TT genotype Hcy levels of the MTHFR C677T recessive model in the H-type hypertension group were 17. 1 ±1. 6 and 19. 0 ±2. 9 μmol/ L respectively. There was significant difference between the genotypes (t = - 3. 115,P = 0. 004). The logistic regression analysis of MTHFR C677T recessive model genotype showed that after adjusting for sex and age,the residents with recessive model TT genotype had higher risk of H-type hypertension (OR,1. 946,95% CI 1. 172 -3. 232,P = 0. 01). Conclusion The TT MTHFR C677T gene mutation in this population may be an important genetic factor for the increased Hcy levels and the onset of H-type hypertension.
RESUMO
Objective To survey the prevalence of chronic obstructive pulmonary disease (COPD)in urban areas of Hunan province and relevant risk factors and provide a basis of the prevention and treatment for COPD. Methods A questionnaire survey was conducted among 4248 residents, aged over 15, by a simple cluster random sampling method in Changsha, Hunan, Wulipai street North Station community. All the respondents filled out an unified epidemiological survey questionnaire. All of the respondents received examination for lung function. Those respondents showed FEV1/FVC ＜70% were further examined by ECG,X ray inspection for differential diagnosis. The data of epidemiological survey was analyzed by multivariate logistic regression method. Results The response rate was 92%. The total prevalence of COPD was 4. 81%.The prevalence of COPD in the males was 6. 6%, and 3. 0% in the females. The prevalence of COPD in the males was significantly higher than that in the females (x2 = 29. 915, P ＜ 0. 01). The prevalence increased with age increasing (P ＜0. 01). The more the education was, the lower the prevalence of COPD was. Risk factors analyzed with non-conditional logistic were as follow. The odd ratio (OR) for COPD in the age was 1.92(P ＜0. 01) and the odd ratio (OR) for COPD in the sex was 1.81 (P ＜0. 01). The weak lighting in house increased the risk with the OR of 4. 25(P ＜0. 01) and pet feeding further increased the risk with the OR of 12.08(P ＜0. 01). The odd ratio (OR) for COPD in the smokers was 1.74(P ＜0. 01) and the prevalence of COPD was related with smoking intensity (branch years of cigarette). Smoking intensity above 500 increased the risk of COPD. The passive smoking increased the risk with the OR of 16. 39(P ＜0. 01). The odd ratio (OR) for COPD in the paternal family history with chronic pulmonary disease was 2. 13(P ＜0. 01) and 2. 11 (P ＜ 0. 01) in the maternal family history. The odd ratio (OR)for COPD in the education degree was 0. 52(P ＜ 0. 01). Conclusions The prevalence of COPD was high in Changsha city, which might be attributed to the risk factors such as house lighting, pet feeding, cooking,aged, male, smoking, passive smoking, and family history. The education degree was the protective factor of COPD. We should intervene the relevant risk factors of COPD so that the prevalence of COPD might be cut down.
RESUMO
Objective To evaluate the role and safety of continuous vano-venous hemofiltration(CVVH) in treating critical patients. Methods We summarized 109 cases of critical patients treated by CVVH in our ICU from 2002 to 2006. Results The therapy time ranged from 18 to 72 hours. Of all patients, there were 13 cases of hypotension, 5 cases of filter occlusion,2 cases of bleeding and 3 cases of local or blood infection. Conclusion CVVH can be appli-Gated in critical patients with good safety and efficiency. High-quality management plays an important role in the carry--out of CVVH.