前 言 本文件按照GB/T 1.1-2020《标准化工作导则第1部分:标准化文件的结构和起草规则》的规定起草. 请注意本文件的某些内容可能涉及专利.本文件的发布机构不承担识别专利的责任. 本文件由中华预防医学会提出并归口. 本文件起草单位:中国疾病预防控制中心病毒病预防控制所、国家儿童医学中心(北京)/首都医科大学附属北京儿童医院、首都儿科研究所、温州医科大学附属育英儿童医院、国家儿童健康与疾病临床医学研究中心/重庆医科大学附属儿童医院、中国医学科学院病原生物学研究所、长春市儿童医院、河南省疾病预防控制中心、甘肃省疾病预防控制中心、深圳市儿童医院、中日友好医院.
Objective To observe the BleeMACS score and GRACE score during dual antiplatelet therapy(DAPT)in patients with ST-elevation myocardial infarction(STEMI),and to investigate their values to the prediction of bleeding during one-year DAPT after percutaneous coronary intervention(PCI)in patients with STEMI.Methods Totally 404 STEMI patients underwent PCI followed by DAPT in Henan Provincial People's Hospital from March 2018 to June 2019,and were divided into bleeding group(n=18)and non-bleeding group(n=386)according to the occurrence of bleeding within one-year DAPT.The age,body mass index,smoking history,previous medical history,Killip classification,prehospital cardiac arrest,diseased vessel,out-of-hospital medication,postadmission laboratory examination,BleeMACS score and GRACE score were compared between two groups.ROC curve,category-free net reclassification improvement(NRI),integrated discrimination improvement(IDI)and decision curve analysis(DCA)were used to evaluate the efficiencies of BleeMACS score and GRACE score on predicting bleeding during one-year DAPT after PCI in STEMI patients.Results Among 404 STEMI patients,18 patients(4.46％)developed bleeding during one-year DAPT after PCI.The patients were older in bleeding group[73.80(64.44,77.79)years]than in non-bleeding group[61.50(50.91,68.63)years](P＜0.05).The level of serum creatinine,BleeMACS score and GRACE score were higher in bleeding group[88.00(66.00,103.00)μmol/L,21.00(15.00,27.00),161.00(135.00,187.00)]than those in non-bleeding group[67.00(56.00,79.00)μmol/L,9.00(7.00,18.00),139.00(120.00,160.00)](P＜0.05),and the body mass index was lower in bleeding group[23.48(22.89,24.61)kg/m2]than that in non-bleeding group[24.49(23.60,25.85)kg/m2](Z=-2.212,P=0.027).The AUCs of BleeMACS score and GRACE score for predicting bleeding during one-year DAPT after PCI were 0.749(95％CI:0.633-0.866,P＜0.001)and 0.685(95％CI:0.555-0.814,P＜0.001),with the sensitivities of 72.2％and 66.7％,and the specificities of 81.3％and 74.6％,respectively.The AUCs of two scores showed no significant differences(Z=0.065,P=0.435).Compared with GRACE score,NRI of BleeMACS score was 0.155(Z=0.640,P=0.519),and IDI was 0.015(Z=0.760,P=0.450).The DCA showed that BleeMACS score added more benefit than GRACE score in the threshold probability intervals of 1.8％to 4％and 5％to 12％.Conclusion Both BleeMACS score and GRACE score can be used to predict bleeding during DAPT after PCI in STEMI patients,and BleeMACS score achieves more clinical benefit.
Objective To observe the expression of adenosine triphosphate(ATP)in CD4+T lymphocytes in septic patients,and to investigate its value to the prediction of prognosis of septic patients.Methods Fifty-five septic patients in Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University from October 2021 to August 2022 were divided into sepsis group(n=29)and septic shock group(n=26)according to the severity of the disease.The clinical data such as blood lactate,total bilirubin and sequential organ failure assessment(SOFA)score were recorded in two groups.Within 24 h after diagnosis,the percentages of CD4+and CD8+T lymphocyte as well as CD4+and CD8+T lymphocyte subsets in peripheral blood were detected by flow cytometry in two groups.The ATP levels in CD4+and CD8+T lymphocytes were detected by chemiluminescence assay.The 28-day mortality was compared between two groups.ROC curves were plotted to evaluate the efficiency of ATP in CD4+T lymphocytes on predicting poor prognosis of septic patients.ATP in CD4+T lymphocytes was ≤133.60 μg/L(optimal cut-off value)in 14 patients with septic shock,among whom 8 patients(4 survived,4 died)were detected the ATP level in CD4+T lymphocytes in peripheral blood at one week after diagnosis.The ATP levels in CD4+T lymphocytes were compared in 24 h after diagnosis and in one week after diagnosis between the survived and died septic shock patients.Results The blood lactate level,total bilirubin,creatinine and SOFA score were higher in septic shock group[2.08(1.43,4.26)mmol/L,26.56(11.93,101.14)μmol/L,207.50(98.75,257.75)μmol/L,11.00(8.00,14.75)]than those in sepsis group[1.50(1.09,1.88)mmol/L,16.00(8.20,23.48)μmol/L,103.00(78.00,164.00)μmol/L,7.00(4.00,11.00)](P＜0.05),the ATP level in CD4+T lymphocytes and platelet count were lower in septic shock group[99.68(45.95,357.29)μg/L,63.50(28.50,102.75)× 109/L]than those in sepsis group[236.90(137.20,414.70)μg/L,170.00(121.00,212.00)× 109/L](Z=-2.158,P=0.031;Z=-3.642,P＜0.001),the patients were younger in septic shock group[(53.46±14.35)years]than in sepsis group[(64.07± 16.33)years](t=2.545,P=0.014),and the percentages of CD4+T lymphocytes,CD8+T lymphocytes and CD4+and CD8+T lymphocyte subsets as well as ATP level in CD8+T lymphocytes showed no significant differences between two groups(P＞0.05).When the optimal cut-off value of ATP level in CD4+T lymphocytes was 133.60 μg/L,the AUC for predicting poor prognosis of septic patients was 0.689(95％CI:0.543-0.802,P=0.029),with a sensitivity of 77.14％,and a specificity of 65.10％.The mortality rate was higher in septic shock group(57.69％)than that in septic group(20.69％)(x2=7.952,P=0.005).The ATP level in CD4+T lymphocytes was higher in one week after diagnosis[275.84(164.01,378.89)μg/L]than that in 24 h after diagnosis[42.24(33.00,75.18)μg/L]in the survived septic shock patients(Z=3.896,P=0.030),and showed no significant difference in one week after diagnosis[52.08(15.06,87.57)μg/L]and in 24 h after diagnosis[36.70(15.98,106.84)μg/L]in the died septic shock patients(Z=0.050,P=0.963).Conclusions The ATP level in CD4+T lymphocytes can be used to evaluate the cellular immune function of septic patients.The more severe the disease,the lower the ATP level.The patients with persistently low ATP level have a poor prognosis.The ATP level in CD4+lymphocytes has a predictive value for poor prognosis of septic patients.
Acute and chronic hepatitis and their complications caused by hepatitis B virus infection pose a serious threat to human health.Autophagy and hepatitis B virus are closely correlated and influence each other.Hepatitis B virus uses autophagy related mechanisms to promote its replication in cells and enhance infectivity and destructiveness.Autophagy can effectively suppress and clear hepatitis B virus by the immune system.In this process,multiple autophagy targets are involved,and may become a breakthrough in the development of hepatitis B new drugs and in the treatment hepatitis B.This paper reviews the research progress of the role of autophagy in hepatitis B virus replication and clearance.
Objective To analyze the clinical data of the patients with multiple glomus tumors,and to discuss their clinical and imaging features.Methods Nine patients with multiple glomus tumors received resection after ultrasound,X-ray and MRI scan examination in Henan Provincial People's Hospital from January 2018 to June 2023.The clinical data were collected as the age of onset,age of diagnosis,previous diagnosis and treatment duration,symptoms and signs as well as the tumor location and number.The clinical and imaging features were analyzed.Results The onset age ranged from 7 to 48 years old,and the age of diagnosis ranged from 13 to 54 years old.Their misdiagnosis and mistreatment lasted for 1 to 38 years.The patients were misdiagnosed with growing pains,muscle strain,myofasciitis,tenosynovitis,vasculitis,or venous malformation.The glomus tumors were located in hand in 1 case,thigh in 1 case,and calf and/or foot in 7 cases.The clinical manifestations included intermittent episodes of severe pain,pressure pain and cold sensitivity in 9 cases,local soft tissue swelling in 8,and thinning of the affected limb in 7.There were totally 118 glomus tumors in 9 patients,including 35 of subcutaneous,15 of muscular,and 68 of interosseous.The long diameter was 2.4 to 45.0 mm.The ultrasound featurespresented as hypoechoic masses with clear boundaries,regular morphology,and abundant blood flow signals and local edema in surrounding tissues,scattering in subcutaneous,muscular,and interosseous tissues.X-ray showed no abnormal skeletal changes in lesion area.The MRI appearance showed multiple low signal areas on T1 weighted images,multiple uneven moderate-high signal mass shadows on T2 weighted images,and significant high signal liquid shadows around.Conclusions Multiple glomus tumors clinically present as intermittent episodes of severe pain,pressure pain,cold sensitivity and local soft tissue swelling,which can be considered as the clinical tetralogy of multiple glomus tumors.The ultrasound features include multiple hypoechoic mass with clear boundary,regular morphology,abundant blood flow signal mass inside,and local surrounding tissue edema.MRI images are featured by multiple masses with low T1 signals and high T2 signals,as well as local edema imaging in surrounding tissues.
