Table of Content

20 February 2025, Volume 40 Issue 2

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Association between D-dimer and the long-term prognosis of advanced cancer patients receiving PD-1/PD-L1 inhibitors: A meta-analysis

Ye Qian, Liu Shenxiang

2025, 40(2):  101-106.  doi:10.3969/j.issn.1004-583X.2025.02.001

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Objective The study aims to analyze the associations between pretreatment D-dimer (D-D) levels and the long-term prognosis of advanced cancer patients receiving programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors. Methods Relevant literatures published up to October 20, 2024, were retrieved from databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Pubmed, Web of Science, and Cochrane Library. Six literatures were ultimately included in the analysis. Results The advanced cancer patients receiving PD-1/PD-L1 inhibitors with high D-D levels had significantly shorter progression free survival (PFS) (univariate analysis: HR=1.89, 95%CI: 1.33-2.67, P=0.0004; multivariate analysis: HR=1.79, 95%CI: 1.18-2.72, P=0.006) and overall survival (OS) (univariate analysis: HR=2.02, 95%CI: 1.60-2.56, P<0.00001; multivariate analysis: HR=2.08, 95%CI: 1.63-2.65, P<0.00001) than those with normal D-D levels. Conclusion D-D may serve as a potential biomarker for predicting the prognosis of advanced cancer patients receiving PD-1/PD-L1 inhibitors.

Risk prediction models for weaning failure from mechanical ventilation: A systematic review

Hu Feifei, Wang Fang, Wang Yongni, Huang Shini, Ming Yao

2025, 40(2):  107-116.  doi:10.3969/j.issn.1004-583X.2025.02.002

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Objective To systematically evaluate the risk prediction models for mechanical ventilation weaning failure. Methods Computerised searches of PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wanfang and VIP databases were conducted to collect risk prediction models for weaning failure from mechanical ventilation from the establishment of the database to February 2025. The risk of bias and applicability of risk prediction models were evaluated using the prediction model risk of bias assessment tool (PROBAST) after the literatures were independently screened and data extracted by two researchers. Results Twenty-one literatures representing 44 risk prediction models for weaning failure from mechanical ventilation were included. The number of predictors ranged from 3-21, with the most common predictors being the duration of mechanical ventilation, age, and the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ). The area under the receiver operating characteristic curve (AUC) of the included models ranged 0.689-0.926. The models had a good overall predictive performance, but the overall risk of bias was high. Conclusion Currently, the risk prediction models for weaning failure from mechanical ventilation has well overall predictive performance, but the clinical applicability of the model requires further validation because most studies have not been externally validated and there are variations in the definitions of outcome metrics.

Study on the relationship between platelet/lymphocyte ratio and coronary plaque characteristics in coronary heart disease patients combined with type 2 diabetes mellitus by virtual histology intravascular ultrasound

Hu Songlin, Di Ya, Liu Canzhang, Yan Jie

2025, 40(2):  117-121.  doi:10.3969/j.issn.1004-583X.2025.02.003

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Objective The relationship between platelet/lymphocyte ratio (PLT/LYM, PLR) and the characteristics of coronary plaque in coronary heart disease (CHD) patients combined with type 2 diabetes mellitus (T2DM) was studied by virtual histology intravascular ultrasound (VH-IVUS). Methods A total of 86 CHD patients combined with T2DM who were hospitalized in the First Ward of the Cardiovascular Department of the Affiliated Hospital of North China University of Science and Technology from March 2023 to March 2024 and underwent coronary intervention therapy (PCI) and intravascular ultrasound (VH-IVUS) examination were recruited. The patients were divided into two groups based on the median PLR levels: high PLR group (n=43) and low PLR group (n=43). The relationship between PLR and coronary plaque characteristics in CHD patients combined with T2DM was explored by VH-IVUS. Results Blood PLR levels in all patients ranged from 37.22 to 331.76, with a median of 119.22. The plaque area, outer elastic membrane area, necrotic tissue volume ratio, adipose tissue volume ratio, plaque burden, and total plaque volume in the low PLR group were all significantly lower than those in the high PLR group (P<0.05). Pearson correlation analysis showed that plaque area (r=0.398, P=0.000), outer elastic membrane area (r=0.299, P=0.005), plaque load (r=0338, P=0.001), and total plaque volume (r=0.263, P=0.014) were positively correlated with PLR. Conclusion PLR level can be used as a study index to determine plaque area and plaque volume.

Clinical significance of serum vitamin K₂ detection in patients with stage 3-5 chronic kidney disease

Chen Tianhao, Huang Zheng

2025, 40(2):  122-127.  doi:10.3969/j.issn.1004-583X.2025.02.004

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Objective To investigate the clinical significance of serum vitamin K₂ (VitK₂) detection in patients with stage 3-5 chronic kidney disease (CKD). Methods A total of 193 patients with stage 3-5 CKD who were hospitalized in the Department of Nephrology, Tianchang City People's Hospital from September 2020 to May 2023 were selected. According to the estimated glomerular filtration rate (eGFR) staging criteria, patients were divided into G3 stage group (n=30), G4 stage group (n=47) and G5 stage group (n=116). The differences of VitK₂ and its related indexes among the three groups were compared, and the independent risk factors of VitK₂ were explored by multivariate linear regression analysis. Then, patients were divided into low VitK₂ level group (n=95) and high VitK₂ level group (n=98) with the median of serum VitK₂ as the cut-off value. The differences of abdominal aortic calcification score (AACs), death endpoint events and related detection indexes between the two groups were analyzed. Binary logistic regression model was used to explore the effect of VitK₂ on the endpoint of death. Results There were no significant differences in gender and age among G3 group, G4 group and G5 group (P>0.05), but there was a significant difference in the proportion of primary diseases (P<0.05). The primary diseases in the G3 group were mainly chronic nephritis and hypertension and G4 group were mainly chronic nephritis and diabetes, and diabetes was the dominant primary disease in the G5 group. There were significant differences in VitK₂, homocysteine (Hcy), serum phosphorus, calcium-phosphorus product, intact parathyroid hormone (iPTH), interleukin 6 (IL-6), hemoglobin (HB), total cholesterol (TC), uric acid (UA) and AACs among the three groups (P<0.05). With the increase in clinical stage of CKD, VitK₂, eGFR and HB gradually decreased, while iPTH and AACs gradually increased. Multivariate linear regression analysis showed significantly influences of eGFR, AACs, TC and UA on VitK₂ (P<0.05). The AACs and the proportion achieving the endpoint (death) were significantly higher in the low VitK₂ group than the high VitK₂ group (P<0.05). Binary logistic regression analysis indicated that after adjusting for age, VitD₃, Hcy, eGFR and other covariates, the level of VitK₂ is an independent risk factor affecting the survival of CKD (P=0.001). Conclusion The detection of serum VitK₂ has certain clinical significant in predicting AACs, and the prognosis of CKD, which comprehensively evaluates condition in patients with stages 3-5 CKD.

Analysis of lean metabolic-associated fatty liver disease among young and middle-aged people and its risk factors

Tong Mingxia, Chen Ke, Xiang Xiaocong, Zhou Lifeng

2025, 40(2):  128-132.  doi:10.3969/j.issn.1004-583X.2025.02.005

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Objective To explore the metabolic-associated fatty liver disease (MAFLD) in young and middle-aged people and its risk factors. Methods From January 2022 to December 2023, clinical data of 16 173 young and middle-aged people receiving physical examinations in the Health Management Center of Nanchong Central Hospital were collected. Lean MAFLD and risk factors in them were analyzed. Results All lean MAFLD patients were male, and most of them aged 45-59 years with a body mass index (BMI) ranging from 20-23 kg/m². There were significant differences in age, gender, BMI, blood pressure, fasting plasma glucose (FPG), blood lipids and blood uric acid (UA) between the two groups (P<0.05). The detection rate of abnormal glucose metabolism in the lean MAFLD group was 12.5%, which was significantly higher than that in the lean non-MAFLD group (P<0.001). The detection rates of abnormal lipid metabolism, hypertriglyceridemia, low high density lipoprotein and mixed hyperlipidemia were 62.8%, 33.7%, 17.6% and 18.4%, respectively, which were significantly higher than those in the lean non-MAFLD group (P<0.001). Hypercholesterolemia was detected in 7.4% of lean MAFLD, which was significantly lower than that in lean non-MAFLD group (P<0.001). The detection rate of UA metabolic abnormalities was 26.9%, which was significantly higher than that of lean non-MAFLD group (P<0.001). Multivariate logistic regression analysis showed that gender, age, BMI, hypertension, abnormal glucose metabolism, triglyceride (TG), mixed hyperlipidemia, high-density lipoprotein cholesterol (HDL-C) and hyperuricemia were the independent risk factors of lean MAFLD. Conclusion Interventions on the related risk factors should be conducted as early as possible. Strengthening the early health education for the physical examination population, and taking measures against the risk factors of MAFLD are expected to reduce the incidence of MAFLD.

Correlation between thyroid hormone sensitivity and non-alcoholic fatty liver in type 2 diabetes mellitus patients with normal thyroid function

Shi Shuangwei, Rao Xiaojuan, Xie Liran, Fang Yifan, Wang Shanshan

2025, 40(2):  133-137.  doi:10.3969/j.issn.1004-583X.2025.02.006

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Objective To analyze the correlation between thyroid hormone sensitivity and non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus (T2DM) patients with normal thyroid function. Methods This was a cross-sectional study. A retrospective analysis was performed to assess 330 T2DM patients with normal thyroid function who were hospitalized in the Department of Endocrinology, the Fifth Affiliated Hospital of Zhengzhou University from December 2023 to May 2024. According to the presence or absence of NAFLD, the patients were divided into NAFLD group (n=112) and non-NAFLD group (n=218). All patients underwent examinations like abdominal ultrasound, blood biochemistry, visceral fat area (VFA), and abdominal subcutaneous fat area (SFA). The correlations between the thyroid feedback quantile-based Index (TFQI), thyrotroph thyroxine resistance index (TT4RI), thyroid-stimulating hormone index (TSHI), free triiodothyronine/free thyroxine (FT3/FT4) with NAFLD were explored. Results Compared with non-NAFLD group, in NAFLD group had significantly higher proportions of smokers, and higher levels of body weight, body mass index, VFA, SFA, systolic/ diastolic blood pressure, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA₁c), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), FT3, TFQI, and FT3/FT4 (P<0.05), and significantly lower level of high density lipoprotein cholesterol (HDL-C) (P<0.05). Spearman correlation analysis showed that TFQI was positively correlated with TG and LDL-C (P<0.05), and negatively correlated with HDL-C (P<0.05). TT4RI was positively correlated with TC, TG, FPG, and HbA₁c (P<0.05). TSHI was positively correlated with TC, TG, FPG, and HbA₁c (P<0.05). FT3/FT4 was positively correlated with TC, TG, LDL-C, FPG, and HbA₁c. Multivariate logistic regression analysis showed that TG, VFA, HbA₁c, and FT3/FT4 were independent risk factors for the occurrence of NAFLD in T2DM patients (P<0.01). By drawing the receiver operating characteristic curve, it was found that the area under the curve of FT3/FT4 for evaluating NAFLD in T2DM patients was 0.679, with a sensitivity of 70.47% and a specificity of 65.09%. Conclusion An increase in FT3/FT4 in T2DM patients with normal thyroid function is associated with an increased risk of NAFLD.

Clinical value of serum DKK-1 detection in carotid intima-media thickening in patients with rheumatoid arthritis

Zhan Yaping, Zhang Ke, Li Wengen, He Chunmei, Yang Dashan

2025, 40(2):  138-142.  doi:10.3969/j.issn.1004-583X.2025.02.007

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Objective To investigate the clinical value of serum Dickkopf-related protein 1 (DKK-1) in the carotid intima-media thickness (cIMT) in patients with rheumatoid arthritis (RA). Methods A total of 82 patients diagnosed with RA in the Department of Rheumatology and Immunology, Meizhou People's Hospital from December 2022 to January 2024 were included. According to cIMT, patients were divided into cIMT thickening group (n=29) and cIMT normal group (n=53). The clinical data of the two groups were compared, and the risk factors of cIMT thickening in RA patients were explored by multivariate logistic regression analysis. Finally, the clinical data of RA patients with cIMT thickening and normal cIMT were compared under different disease activity. Results There were significant differences in age, sex, history of cerebrovascular disease, total cholesterol and serum DKK-1 levels between groups (P<0.05). Multivariate logistic regression analysis showed that serum DKK-1 level, male and advanced age were independent risk factors for cIMT thickening in RA patients (P<0.05). The results of subgroup analysis prompted that there was no significant difference in gender, age, C-reactive protein, erythrocyte sedimentation rate, course of disease, rheumatoid factor, anti-cyclic citrullinated peptide antibody, interleukin-6, and serum DKK-1 levels between cIMT thickening and cIMT normal patients in RA patients with low disease activity (P>0.05). In RA patients with moderate disease activity, the level of anti-cyclic citrullinated peptide antibody was significantly higher in the cIMT thickening group than the cIMT normal group (P<0.05). In RA patients with high disease activity, there were significant differences in age, course of disease and serum DKK-1 level between cIMT thickening and cIMT normal groups (P<0.05). Conclusion Serum DKK-1 level is an independent risk factor for cIMT thickening in RA patients, which may play a clinical predictive role in early atherosclerosis of RA.

Analysis of risk factors for multidrug-resistant bacterial infection in patients with decompensated cirrhosis

Qian Chenying, Yan Wenjun, Huang Yan, Zhao Zhi

2025, 40(2):  143-146.  doi:10.3969/j.issn.1004-583X.2025.02.008

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Objective To investigate the risk factors for concurrent multidrug-resistant bacterial infections in patients with decompensated cirrhosis. Methods A retrospective cohort study was conducted on the clinical data of 133 patients with decompensated cirrhosis hospitalized from January 2017 to December 2020, in which 33 cases who developed multidrug-resistant bacterial infections were set up as the infected group, and the remaining 100 cases who did not develop multidrug-resistant bacterial infections were set up as the non-infected group. All the clinical features and biochemical indicators that might cause multi-drug resistant bacteria infection were collected, and the risk factors for the development of multi-drug resistant bacteria infection in decompensated cirrhosis patients were analyzed by univariate and multivariate Logistic regression analyses. Results Among the 133 study subjects, 33 (24.81%) had multidrug-resistant bacterial infections, and the dominant (16 cases) was infected with Carbapenem-resistant Acinetobacter baumannii (CRAB). Univariate analysis showed that the length of stay, mechanical ventilation, ICU admission, hormone use, invasive operation, comorbid septic shock, and albumin level were significantly associated with multidrug-resistant organisms (MDRO)(P<0.05). Multivariate logistic regression analysis further concluded that the length of stay≥10 d and the comorbid septic shock were independent risk factors for multidrug-resistant bacterial infections. Conclusion Patients with decompensated cirrhosis who are hospitalized for ≥10 d or in septic shock are at a greater risk of multidrug-resistant bacterial infections, and they should be evaluated for early interventions in clinical practice.

Comparative study on the clinical efficacy of different antiviral drugs in the treatment of COVID-19

Wu Wanfeng, Wang Yunyun, Yang Daokun

2025, 40(2):  147-152.  doi:10.3969/j.issn.1004-583X.2025.02.009

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Objective To explore the clinical efficacy of different antiviral drugs in the treatment of Coronavirus Disease 2019 (COVID-19). Methods A total of 456 COVID-19 patients admitted to Jincheng People's Hospital from February 2023 to June 2023 were selected for the study. According to the random number method, they were randomly divided into group A (treated with azvudine, n=152), group B (treated with nirmatrelvir/ritonavir, n=152) and group C (treated with simnotrelvir/ritonavir, n=152). The clinical efficacy, symptom and sign recovery time, mortality, lung imaging, complete blood count (white blood cell count [WBC], absolute neutrophil count [ANC], and lymphocyte count [LYC]), CT values (mRNA levels) of the ORF1ab and N genes, and adverse events were observed. Results There were no significant differences in the clinical efficacy, symptom and sign recovery time, CT values of the ORF1ab and N genes, mortality, time required for lung imaging improvement, and negative conversion time of nucleic acid testing among groups A, B and C (P>0.05). After treatment, WBC and ANC significantly decreased, and LYC significantly increased in all the three groups, although intergroup comparisons did not show significant differences (P>0.05). The total incidence of adverse events was 15.12%(23/152) in group A, 16.44%(25/152) in group B, and 13.80% (21/152) in group C. There was no significant difference in the total incidence of adverse events among groups A, B and C (P>0.05). Conclusion Azvudine, nirmatrelvir/ritonavir, and simnotrelvir/ritonavir have significant antiviral effects against COVID-19, although leading to some adverse events and medication restrictions. Therefore, when using the above drugs in clinical practice, the specific conditions and medication risks of patients should be fully considered, and a strict compliance and medication guidance are essential, aiming to ensure patient's safety and efficacy.

Construction of a prediction model for refractory mycoplasma pneumoniae pneumonia in children based on lung ultrasound score

Li Dengfeng, Huang Jiahu, Li Tingjun, Lv Yong, Jin Zhenzhen, Lian Shaofeng

2025, 40(2):  153-157.  doi:10.3969/j.issn.1004-583X.2025.02.010

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Objective To construct a prediction model of pediatric refractory mycoplasma pneumoniae pneumonia (RMPP) based on lung ultrasound score (LUS) and inflammation index. Methods The clinical data of children with mycoplasma pneumoniae pneumonia (MPP) hospitalized in the Respiratory Department of Shanghai Children's Hospital, Pediatrics Departmen of the First Affiliated Hospital of University of Science and Technology of China or Jieshou People's Hospital from June 2023 to January 2024 were retrospectively analyzed, and the children were assigned into RMPP group and non-RMPP group according to the diagnostic criteria. The independent risk factors of RMPP were screened by univariate and multivariate logistic regression analysis, and the predictive model was constructed, and the predictive efficiency of the model was verified by receiver operating characteristic curve (ROC). Results A total of 876 children with MPP were included, including 498 in RMPP group and 378 in non-RMPP group. Binary Logistic regression analysis showed that LUS (OR=1.276, 95%CI 1.196-1.362), C-reactive protein (CRP, OR=1.098, 95%CI 1.062-1.119), D-dimer (D-D, OR=2.683, 95%CI 1.923-3.742) and lactate dehydrogenase (LDH, OR=1.015, 95%CI 1.013-1.018) were independent risk factors for RMPP in children (P<0.05). The ROC showed good predictive value of LUS or each inflammatory index alone in predicting RMPP, while, the combined predictive efficacy was the best, with an area under the ROC curve (AUC) of 0.969 (95%CI 0.958-0.979), a sensitivity of 97.4% and a specificity of 84.7%. Conclusion The regression model based on LUS combined with inflammatory indicators has a good predictive efficacy and provides a good basis for clinical diagnosis of children with RMPP. It is convenient for pediatricians to identify and intervene early and improve the dangerous outcome of RMPP.

Value of ultrasound-guided attenuation parameter in the quantitative assessment of hepatic steatosis

Sun Ya, Yang Shuang

2025, 40(2):  158-161.  doi:10.3969/j.issn.1004-583X.2025.02.011

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Objective To explore the feasibility of ultrasound guided attenuation parameter (UGAP) in the quantitative detection of hepatic steatosis. Methods A total of 102 patients who underwent liver ultrasound examination in Affiliated Zhongshan Hospital of Dalian University from February 2024 to June 2024 were selected. UGAP, blood lipids and abdominal computed tomography (CT) findings were collected. The correlation of attenuation coefficient (AC) obtained by UGAP with triglycerides (TG), total cholesterol (TC) and body mass index (BMI) was analyzed. Results A total of 74 patients diagnosed with fatty liver disease were included in the study, including 30 mild cases, 18 moderate cases, and 26 severe cases, and 28 healthy subjects with normal imaging findings were selected as the control group. There were significant differences in the BMI, TG, TC, liver CT value, and liver CT/spleen CT ratio between the fatty liver group and the control group, but age was comparable. There was a significant difference in AC value between groups, so as that among the mild, moderate and severe subgroups. Conclusion UGAP has certain clinical application value in the non-invasive and quantitative evaluation of hepatic steatosis.

IgA-dominant infection-related glomerulonephritis with oxalate deposition: A case report and literature review

Zhao Hui, Zhang Pengwei, Zhang Jian, Huang Wenhui, Li Xiaoli, Ma Zhigang, Jin Fang, Tian Limin

2025, 40(2):  162-167.  doi:10.3969/j.issn.1004-583X.2025.02.012

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Objective This article reports a patient who developed immunoglobulin A (IgA)-dominant infection-related glomerulonephritis (IgA-IRGN) with oxalate deposition following skin burns, ulceration, scab formation, and healing caused by folk remedies for arthritis. To observe the clinicopathological features and explore the correlation between the heart, kidney and joint lesions. Methods After admission, the patient underwent echocardiography, knee joint magnetic resonance imaging (MRI), renal biopsy, and culture of synovial fluid from the joint cavity. The clinical and pathological characteristics were observed, and the outcomes after treatment were analyzed. Results The patient's condition improved after treatment with anti-infective therapy, proteinuria reduction, and cardiac function improvement. Conclusion IgA-IRGN is commonly seen in elderly individuals with type 2 diabetes and immunodeficiency. However, this case did not involve these underlying conditions. The patient presented with nephrotic syndrome, acute kidney injury, osteoarthritis, severe mitral regurgitation, and mitral valve prolapse. The condition is further complicated by the coexistence of multiple diseases. When the infection source of IgA-IRGN is occult, clinical misdiagnosis and missed diagnosis are common. Therefore, increased vigilance is needed during diagnosis and treatment.

Idiopathic renal hypouricemia combined with repeated acute kidney injury: A case report and literature review

Zhang Hui, Zhang Wenbo, Liang Wenqi, Huo Yanhong

2025, 40(2):  168-171.  doi:10.3969/j.issn.1004-583X.2025.02.013

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Objective To investigate the clinical characteristics and diagnostic and treatment of idiopathic renal hypouricemia (iRHUC). Methods Clinical data of a patient who suffered from exercise-induced acute kidney injury (EIAKI) twice and was finally diagnosed with iRHUC by genetic testing were retrospectively collected. The clinical characteristics, diagnostic process, treatment options and prognosis were analyzed, and the relevant literatures were reviewed. Results A 23-year-old man suffered from acute kidney injury (AKI) twice after intensive exercise. The renal function returned to normal but hypouricemia persisted. Fractional excretion of uric acid (FEUA) was significantly elevated. The mutational analysis revealed a homozygous mutation in the SLC22A12 gene, and he was finally diagnosed with iRHUC. Conclusion iRHUC cases are not commonly reported, and we should strengthen our understanding of the disease to avoid missed diagnosis and misdiagnosis, so as to guide treatment and prevent complications.