Abstract:Objective To investigate the relationship between C-reactive protein-albumin-lymphocyte(CALLY)index and disease activity in patients with Takayasu arteritis,and to evaluate its predictive value for disease activity.Methods Medical records of 92 hospitalized patients with Takayasu arteritis admitted to the Department of Rheumatology and Immunology,Beijing Anzhen Hospital,Capital Medical University from January 2016 to April 2024 were collected and retrospectively analyzed.Patients were divided into inactive group(41 cases)and active group(51 cases)according to the Indian Takayasu Arteritis Score 2010.Logistic regression model was used to analyze the relationship between CALLY index and disease activity,subgroup analysis was performed to assess the correlation in different populations,and the predictive ability of CALLY index was evaluated by restricted cubic spline(RCS)and receiver operating characteristic(ROC)curve analysis.Results The CALLY index in the active group was significantly lower than that in the inactive group[0.6(0.4,1.2)vs 2.2(0.8,5.3),P＜0.001].Multivariate Logistic regression analysis showed that after adjusting for confounding factors such as smoking,drinking and erythrocyte sedimentation rate,the CALLY index was negatively correlated with disease activity risk(odds ratio=0.67,95％confidence interval:0.50-0.90,P=0.008).Analysis by CALLY tertile grouping showed that compared with Q,group(left interval of the lowest tertile),both Q2 and Q3 groups showed significant protective effects,with a trend test P＜0.001.RCS curve analysis showed a linear negative correlation between CALLY index and disease activity(P overall=0.013,P nonlinear=0.579).ROC curve analysis showed that the area under the curve(AUC)of CALLY index was 0.737(95％confidence interval:0.629-0.828),which was better than the controlling nutritional status score(AUC=0.631)and prognostic nutritional index(AUC=0.651).Subgroup analysis showed that the negative correlation between CALLY index and disease activity was more significant in female,non-hypertensive,non-diabetic,non-coronary heart disease,non-stroke,non-drinking,non-smoking patients,and those with body mass index＜25 kg/m2.In stratifications by different hypertension,diabetes,stroke states,drinking habit,age(cut-off at 45 years)and body mass index(cut-off at 25 kg/m2),the association between CALLY index and disease activity remained relatively consistent across subgroups,and no significant interaction effect was observed(all P for interaction＞0.05).Conclusion There is an independent negative correlation between CALLY index and disease activity in Takayasu arteritis,with good predictive value.It can be used as an effective and simple tool for clinical evaluation of disease activity in Takayasu arteritis.
Abstract:Objective To investigate the correlation between serum levels of endothelin-1(ET-1)and vascular endothelial growth factor A(VEGF-A)and reduced bone mass in patients with chronic kidney disease(CKD).Methods A total of 362 CKD patients admitted to the Affiliated Hospital of Shandong Second Medical University from January 2022 to January 2023 were retrospectively enrolled and divided into the reduced bone mass group(182 cases)and the osteoporosis group(180 cases)according to the diagnosis of reduced bone mass.Meanwhile,180 healthy subjects who underwent physical examination during the same period at this hospital were selected as the control group.Serum levels of ET-1 and VEGF-A were compared among the three groups.Multivariate Logistic regression analysis was used to identify the influencing factors of reduced bone mass in CKD patients,and Pearson correlation analysis was applied to analyze the correlation between serum ET-1 and VEGF-A levels and reduced bone mass in CKD patients.Results There were statistically significant differences in the proportions of hypertension and diabetes,fasting blood glucose,femoral neck T-score,average bone mineral density(BMD)of L1-4,serum calcium,femoral neck BMD,25-hydroxyvitamin D3[25-(OH)D3],24 h urinary protein excretion,estimated glomerular filtration rate(eGFR),serum phosphorus,parathyroid hormone(PTH),ET-1 and VEGF-A among the three groups(all P＜0.05).In reduced bone mass group,serum levels of ET-1 and VEGF-A were correlated with body mass index,hypertension,diabetes,cardiovascular disease,PTH and serum phosphorus(all P＜0.05).Multivariate Logistic regression analysis showed that diabetes,hypertension,serum calcium,serum phosphorus,25-(OH)D3,PTH,ET-1 and VEGF-A were all independent influencing factors for reduced bone mass in CKD patients(all P＜0.001).Pearson correlation analysis revealed that reduced bone mass in CKD patients was positively correlated with ET-1 and negatively correlated with VEGF-A levels(r=0.444,-0.502,both P＜0.001).Conclusion Serum levels of ET-1 and VEGF-A are abnormal in CKD patients and associated with reduced bone mass,early monitoring of these indicators has clinical significance.
Abstract:Traditional endoscopic submucosal dissection is limited in clinical use due to long preoperative examination time,slow dissection speed,high incidence of complications,and differences in the level of surgeons.Artificial intelligence can provide accurate diagnosis and evaluation of lesions,accurate preoperative preparation and decision-making,intelligent traction,etc.,to assist clinicians in fast and safe surgical operations.At the same time,artificial intelligence can also assist in pathological diagnosis,teaching and training,prediction of complications and postoperative management.This article reviews the application status and research progress of artificial intelligence in endoscopic submucosal dissection,aiming to change the current clinical diagnosis and treatment mode and provide a new paradigm for intelligent endoscopic submucosal dissection.
Abstract:Coronary atherosclerotic heart disease is one of the major diseases threatening human health.There is a mutual promoting relationship between the decline of renal function and the occurrence and development of coronary atherosclerotic heart disease.The ratio of serum creatinine to cystatin C(CCR)is a new marker for evaluating renal function.Compared with a single index,CCR has obvious advantages.In recent years,CCR has also attracted much attention in the study of coronary atherosclerotic heart disease.Domestic and foreign studies have found that the reduction of CCR is related to the risk of coronary atherosclerotic heart disease and the severity of coronary artery disease,the risk of adverse cardiovascular events,the risk of adverse events during and after coronary artery reconstruction,and aortic sclerosis.Therefore,it can be used as an effective index for the early diagnosis,condition evaluation and prognosis of coronary atherosclerotic heart disease.This article summarizes the relationship between CCR and the occurrence and development of coronary atherosclerotic heart disease,and reviews its research progress in coronary atherosclerotic heart disease,in order to provide a new direction for the diagnosis and treatment of coronary atherosclerotic heart disease.
Abstract:Cardiogenic shock is a serious and fatal complication of acute myocardial infarction.About 5％-10％of patients with acute myocardial infarction will develop cardiogenic shock,and the mortality rate is as high as 40％-50％.Timely and effective revascularization can maximize the rescue of ischemic myocardium,restore heart pump function,and significantly improve the survival rate of patients.Percutaneous coronary interven-tion is currently the main revascularization method.In percutaneous coronary intervention,the choice of vascular approach has an important impact on the prognosis of patients and the incidence of complications.At present,radial artery and femoral artery are commonly used interventional access.Radial artery approach has significant advantages in reducing bleeding complications,but femoral artery approach still plays an irreplaceable role in complex operations and mechanical support.Most access studies recommend that radial access should be preferred when conditions permit,and femoral access should be selected in certain circumstances,but the best access for patients with cardiogenic shock is still inconclusive.This article will briefly review the related research and clinical practice of the choice of percutaneous coronary intervention approach in patients with acute myocardial infarction complicated with cardiogenic shock.
Abstract:The incidence and prevalence of atrial fibrillation are increasing.Early rhythm control can effectively reduce irreversible atrial remodeling and the incidence of adverse events in patients with atrial fibrillation.Sodium-glucose cotransporter 2 inhibitors(SGLT2i)can regulate myocardial multi-ion balance,reduce myocardial mitochondrial damage,inhibit myocardial oxidative stress and inflammatory response,improve renal metabolism and glucose and lipid metabolism,inhibit cardiac sympathetic hyperactivity,and reverse ventricular fibrosis.It can inhibit arrhythmia and is a potential target for preventing postoperative recurrence of atrial fibrillation.This article reviews the potential pathophysiological mechanism and research status of SGLT2i in the recurrence of atrial fibril-lation after ablation,in order to provide new ideas for the prevention and treatment of atrial fibrillation.
Abstract:Artificial intelligence(AI)is deeply integrating into the training system for cardiac surgeons.Through technologies such as image recognition,virtual reality,and machine learning,it enables objective assess-ment of complex surgical skills,personalized feedback,and immersive simulation training.Relying on platforms like Touch Surgery,dV-Trainer,and Proximie,AI can accurately replicate high-difficulty operations such as valvuloplasty and coronary artery bypass grafting,significantly improving training efficiency and fairness.It can optimize individualized surgical plans preoperatively,provide real-time assistance for key decisions intraoperatively,and conduct refined data review postoperatively,effectively enhancing surgical success rates and reducing compli-cations.In resource-scarce areas,AI also promotes the downward penetration and balanced allocation of high-quality cardiac technologies.Despite ongoing challenges including data quality,algorithmic bias,and legal-ethical issues,the deep integration of AI with cardiac surgery is emerging as a crucial engine for cultivating high-level surgical talents,bringing new opportunities to improve the quality of cardiovascular healthcare in China.
Abstract:Ventricular remodeling after myocardial infarction is a key pathological process in the progres-sion of heart failure,in which abnormal activation of the Wnt/β-catenin signaling pathway is the core molecular mechanism driving this process.As a broad-spectrum antifibrotic drug,pirfenidone has shown great potential in cardioprotection,but its specific molecular mechanism has not been fully elucidated.Therefore,this article aims to explore the effect of pirfenidone on inhibiting ventricular remodeling by regulating the Wnt/β-catenin signaling pathway,so as to provide a new perspective for cardioprotection.
Abstract:Objective To investigate the effect of Zhuyu Huoxue decoction combined with butylphthalide in the treatment of elderly patients with cerebral infarction in the recovery period.Methods A total of 120 elderly patients with cerebral infarction in recovery period admitted to Huadong Hospital Affiliated to Fudan University from March 2023 to February 2025 were selected as the research objects.According to the random number table method,they were divided into the observation group and the control group,with 60 cases in each group.The control group was treated with butylphthalide on the basis of conventional treatment.The observation group was treated with Zhuyu Huoxue decoction on the basis of the control group.Both groups were treated for 1 month.The clinical efficacy,traditional Chinese medicine syndrome scores,hemorheology indexes,brain injury markers,self-care ability of daily life,quality of life,and adverse reactions during treatment were compared between the two groups.Results After 1 month of treatment,the clinical efficacy of the observation group was better than that of the control group(P＜0.05).The scores of traditional Chinese medicine main symptom score,secondary symptoms and total syndrome in the observation group were lower than those in the control group(all P＜0.05).After treatment,the plasma viscosity and hematocrit of the two groups were lower than those before treatment,and those of the observation group was lower than those of the control group(all P＜0.05).After treatment,the levels of serum neuron-specific enolase in the two groups were lower than those before treatment,and the levels of brain-derived neurotrophic factor were higher than those before treatment,and the improvement of the two indexes in the observation group was better than that in the control group(all P＜0.05).After treatment,the modified Barthel index scores and stroke specific quality of life scale scores of the two groups were higher than those before treatment,and those of the observation group were higher than those of the control group[(79±8)vs(71±10),(163±22)vs(150±20)](all P＜0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P＞0.05).Conclusion Zhuyu Huoxue decoction combined with butylphthalide soft capsule in the treatment of elderly patients with cerebral infarction in the recovery period can improve the clinical efficacy,further improve the clinical symptoms of patients,more effectively improve hemorheology and nerve function,improve the self-care ability of daily life and quality of life of patients,and has good safety.
Abstract:Whipple's disease is a systemic infectious disease caused by the Gram-positive bacterium Tropheryma whipplei(TW).This article analyzed the clinical characteristics,auxiliary examinations,diagnosis and treatment process,and prognosis of a 5-month-old male infant with TW pneumonia,and reviewed relevant literature to improve pediatric clinicians' understanding of this disease.The infant presented with chronic cough.Tropheryma whipplei was detected by metagenomic next-generation sequencing of bronchoalveolar lavage fluid(BALF-mNGS).The patient improved after treatment with penicillin combined with compound sulfamethoxazole and achieved a favorable prognosis during regular follow-up.TW pulmonary infection lacks specific clinical manifestations and is difficult to detect by routine examinations.Early application of BALF-mNGS is recommended for pathogen identification,so as to conduct targeted anti-infection treatment timely,improve survival rate and reduce recurrence rate.
Abstract:Against the background of deepening the reform of science and technology evaluation system,medical research institutes are in urgent need of establishing an evaluation system conforming to their own development rules.This paper analyzes the classified performance evaluation system for researchers.Through refined indicator design and salary linkage with strong incentives,the system effectively implements the strategies targeting the global scientific and technological frontiers,major economic fields,national major needs and people's life and health,as well as the principle of classified evaluation,and presents clear guidance for research activities.Nevertheless,it also faces potential challenges in supporting long-cycle research,balancing team and individual contributions,and guaranteeing the development of young scholars.This study puts forward systematic optimization suggestions including introducing milestone evaluation,setting up Annual Outstanding Team Award and establishing career pathways for young scholars,so as to provide theoretical reference and practical examples for similar medical research institutes to construct a dynamic,accurate and inclusive performance management system.
Abstract:Objective To evaluate the clinical efficacy of moist exposed burn ointment(MEBO)combined with triamcinolone acetonide and econazole nitrate cream in the treatment of severe incontinence-associated dermatitis(IAD)complicated with fungal infection.Methods Patients with severe I AD complicated with fungal infection who were treated in the Department of Rehabilitation Medicine,the First Affiliated Hospital of Guangxi University of Science and Technology from June 2021 to December 2023 were enrolled and divided into observation group and control group by random number table method.A total of 103 patients were finally included,with 48 cases in the control group and 55 cases in the observation group.The control group was treated with MEBO applied to the damaged skin and surrounding erythema;the observation group was treated with triamcinolone acetonide and econazole nitrate cream on the erythema around the skin lesions and MEBO on the damaged skin,for a total of 7 d.The skin lesion score and pain score before and after treatment were compared between the two groups,and the curative effect was calculated as the outcome of the study.Results In the control group,the skin lesion score on admission was(6.1±1.1),which decreased to(3.5±1.2)after treatment,with a difference of(2.6±1.8).In the observation group,the skin lesion score on admission was(6.1±1.2),which decreased to(2.2±1.2)after treatment,with a difference of(3.9±1.5).There was no significant difference in skin lesion score on admission between the two groups(P=0.878).The skin lesion score after treatment in the observation group was lower than that in the control group,and the difference in skin lesion score before and after treatment was greater than that in the control group(all P＜0.001).The total effective rate of the observation group was higher than that of the control group[89.1％(49/55)vs 56.2％(27/48)](P=0.002).In the control group,the pain score on admission was(5.1±1.6),which decreased to(3.2±1.6)after treatment,with a difference of(1.8±2.1).In the observation group,the pain score on admission was(4.8±1.5),which decreased to(2.1±1.1)after treatment,with a difference of(2.7±1.9).There was no significant difference in pain score on admission between the two groups(P=0.423).The pain score after treatment in the observation group was lower than that in the control group(P＜0.001),and the difference in pain score before and after treatment was greater than that in the control group(P=0.025).Conclusion MEBO combined with triamcinolone acetonide and econazole nitrate cream has a significant effect in the treatment of severe IAD complicated with fungal infection,which can improve skin lesions and relieve pain,providing an effective option for skin care and infection treatment in patients with severe IAD.
Abstract:Objective To investigate the clinical effect of transcutaneous electrical acupoint stimulation(TEAS)combined with auricular point pressing with beans in the treatment of postoperative pain in liver cancer patients after transarterial chemoembolization(TACE).Methods A total of 207 liver cancer patients who underwent TACE in the Second Affiliated Hospital of Naval Medical University from January to December 2023 were enrolled and divided into control group(103 cases,treated with TEAS)and observation group(104 cases,treated with auricular point pressing with beans on the basis of control group)according to random number table method.The clinical efficacy,postoperative pain degree,liver function indexes,quality of life and safety were compared between the two groups after different treatments.Results The total effective rate of the observation group was higher than that of the control group,with statistically significant difference[94.2％(98/104)vs 81.6％(84/103)](x2=7.832,P=0.005).At 7 d after operation,the visual analogue scale score,alanine aminotransferase,aspartate aminotransferase and total bilirubin levels in the observation group were lower than those in the control group,and the quality of life scale score of liver cancer patients was higher than that in the control group(all P＜0.05).There was no statistically significant difference in the total incidence of adverse reactions between the observation group and the control group(P＞0.05).Conclusion TEAS combined with auricular point pressing with beans has an outstanding effect in the treatment of postoperative pain in liver cancer patients after TACE,which can significantly reduce postoperative pain degree,improve liver function and quality of life with favorable safety.
Abstract:Objective To observe the clinical effect of acupuncture combined with traditional Chinese medicine hot compress at Sishi hour on post-stroke shoulder-hand syndrome(SHS),and its influence on pain score of affected limb,hemorheology and upper limb function.Methods This was a prospective randomized controlled trial.A total of 126 patients with post-stroke SHS admitted to the First Hospital of Hunan University of Chinese Medicine from January 2023 to August 2025 were enrolled.Patients were randomly divided into control group and observation group by random number table method,with 63 cases in each group.One patient in the control group withdrew voluntarily,and 62 cases were finally included.The control group received conventional medication and rehabilitation training,while the observation group was treated with conventional medication and acupuncture combined with traditional Chinese medicine hot compress.Both groups were treated for 8 consecutive weeks.The visual analogue scale(VAS)score,Fugl-Meyer upper limb motor function(U-FMA)score,SHS assessment scale(SHSS)score,traditional Chinese medicine syndrome score,clinical efficacy,root mean square of surface electromyography(sEMG)of upper limb muscles,hemorheological indexes and adverse reactions were compared between the two groups.Results After treatment,the VAS score,SHSS score,traditional Chinese medicine syndrome score,plasma viscosity,whole blood low-shear viscosity and platelet aggregation rate in both groups were lower than those before treatment,and those in the observation group were lower than those in the control group(all P＜0.05).The U-FMA score and root mean square of upper limb muscle sEMG in both groups were higher than those before treatment,and those in the observation group were higher than those in the control group(all P＜0.05).The total effective rate of the observation group was higher than that of the control group[90.5％(57/63)vs 77.4％(48/62)](x2=3.964,P=0.046).There was no significant difference in the incidence of adverse reactions between the two groups(P=1.000).Conclusion Acupuncture combined with traditional Chinese medicine hot compress at Sishi hour can improve hemorheology,relieve pain of affected limb and promote the recovery of upper limb function in patients with post-stroke SHS.
Abstract:Objective To investigate the clinical effect of Feining granules combined with ambroxol hydrochloride in the treatment of acute exacerbation of chronic bronchitis and its influence on inflammatory factors.Methods A total of 105 patients with acute exacerbation of chronic bronchitis admitted to the First Affiliated Hospital of Wenzhou Medical University from April 2023 to June 2025 were selected for the study.Patients were divided into control group(52 cases)and observation group(53 cases)by random envelope method.The control group received intravenous ambroxol hydrochloride for injection,15 mg per time,twice a day.On the basis of the control group,the observation group was given oral Feining granules,5 g per time,three times a day,for 2 consecutive weeks.The clinical efficacy of the two groups was observed,and the remission time of clinical symptoms,pulmonary function indexes[forced expiratory volume in one second(FEV,),forced vital capacity(FVC),peak expiratory flow(PEF)and FEV1/FVC ratio],serum inflammatory factors[interleukin-4(IL-4),IL-6,IL-8 and tumor necrosis factor-α(TNF-α)]and adverse reactions were compared between the two groups.Results The total clinical effective rate of the observation group was significantly higher than that of the control group[94.3％(50/53)vs 80.8％(42/52)](P=0.035).The remission time of cough,expectoration,wheezing and wheeze rales in the observation group was significantly shorter than that in the control group[(3.71±0.85)d vs(5.37±1.09)d,(3.46±0.45)d vs(4.65±0.71)d,(2.15±0.26)d vs(3.85±0.78)d,(1.96±0.34)d vs(3.12±0.59)d](all P＜0.001).After treatment,FEV1,PEF and FEV1/FVC ratio in both groups and FVC in observation group were higher than those before treatment,and those in the observation group were higher than those in the control group(all P＜0.05).After treatment,the serum levels of IL-4,IL-6,IL-8 and TNF-α in both groups were lower than those before treatment,and the serum inflammatory factor levels in the observation group were significantly lower than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P=0.979).Conclusion The combination of Feining granules and ambroxol hydrochloride has an outstanding clinical effect on acute exacerbation of chronic bronchitis.It can shorten the remission time of clinical symptoms,improve pulmonary function and inflammatory response with high safety.
Abstract:Objective To explore the effects of intermittent hypoxic exposure combined with aerobic exercise on physical function in overweight or obese children.Methods A total of 38 overweight or obese children(26 boys and 12 girls)were recruited in Beijing Xiaotangshan Hospital from July 2023 to August 2024.A self-controlled before-and-after study design was adopted.All participants received a 3-week intervention of intermittent hypoxic exposure combined with aerobic exercise.Changes in body weight,body mass index,fat mass,body fat percentage,blood lipids,serum uric acid and fatty liver status were compared before and after intervention.Results After intervention,the overall levels of body weight,body mass index,fat mass,body fat percentage,serum total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol and serum uric acid were significantly lower than those before intervention(all P＜0.05).Among the 38 children,16 cases were complicated with fatty liver(6 boys and 10 girls).Before intervention,the severity of fatty liver was mild in 3 cases(18.8％)and moderate in 13 cases(81.2％).After intervention,there were 5 cases without fatty liver(31.3％),10 mild cases(62.5％)and 1 moderate case(6.2％).The severity of fatty liver was significantly improved after intervention(Z=-2.646,P=0.008).Conclusion Intermittent hypoxic exposure combined with aerobic exercise can help improve body shape and regulate physical metabolic function in overweight or obese children.
Abstract:Thioredoxin interacting protein,also known as vitamin D3 upregulated protein,is an inhibitor of the thioredoxin system.In recent years,numerous studies have confirmed that thioredoxin interacting protein is involved in multiple pathophysiological processes such as oxidative stress,inflammatory response,pyroptosis,and metabolic disorders,and is associated with the occurrence and development of various cardiovascular diseases including atherosclerosis,hypertension,heart failure,diabetic cardiomyopathy,and myocardial ischemia/reperfusion injury.This article aims to elaborate the research progress of thioredoxin interacting protein in the field of cardio-vascular diseases in recent years.
Abstract:Objective To compare and analyze the value of magnetic resonance hysterosalpingography(MR-HSG)and hysterosalpingo-contrast sonography(HyCoSy)in evaluating tubal patency.Methods A total of 165 infertility patients treated in Baishan Central Hospital,Jilin Province from March 2022 to December 2024 were retrospectively enrolled,including 76 cases in the MR-HSG group undergoing MR-HSG examination and 89 cases in the HyCoSy group undergoing HyCoSy examination.Tubal examination results and consistency with laparoscopic findings were compared between the two groups.Receiver operating characteristic(ROC)curves were drawn to compare the diagnostic efficacy of the two methods.Pain during contrast examination and incidence of intraoperative and postoperative adverse reactions were also evaluated.Results In the MR-HSG group(76 patients,152 fallopian tubes),51 tubes were patent,36 were partially obstructed,and 65 were obstructed,with a positive rate of 57.2％(87/152).In the HyCoSy group(89 patients,178 fallopian tubes),65 tubes were patent,44 were partially obstructed,and 69 were obstructed,with a positive rate of 61.2％(109/178).Taking laparoscopic chromopertubation as the gold standard,the sensitivity,specificity and Youden index of MR-HSG in judging tubal patency were 90.32％,94.92％and 0.852,respectively,with an AUC of 0.926(95％confidence interval:0.878-0.974,P＜0.001),showing good consistency with laparoscopic results(Kappa=0.837).The sensitivity,specificity and Youden index of HyCoSy were 90.18％,87.88％and 0.781,respectively,with an AUC of 0.890(95％confidence interval:0.835-0.946,P＜0.001),also showing good consistency(Kappa=0.773).The VAS score in the MR-HSG group was higher than that in the HyCoSy group[(2.1±0.5)vs(1.9±0.4),P＜0.05].The incidence of adverse reactions was 10.5％(8/76)in the MR-HSG group and 5.6％(5/89)in the HyCoSy group,with no statistically significant difference between groups(P=0.243).Conclusion Both MR-HSG and HyCoSy have high accuracy and reliability in evaluating tubal patency.MR-HSG has outstanding imaging advantages,while HyCoSy provides better patient experience.Appropriate examination methods should be selected clinically based on patient conditions.
Abstract:Objective To investigate the changes and clinical significance of lysyl oxidase-like protein 2(LOXL2),chemokine ligand-18(CCL-18)and chitinase-like protein 40(YKL-40)levels in patients with connective tissue disease complicated with interstitial lung disease(CTD-ILD)before and after treatment.Methods A total of 90 patients with CTD-ILD admitted to the outpatient and inpatient Departments of Rheumatology and Immunology of The First Affiliated Hospital of Hebei North University from January 2022 to January 2023 were enrolled as observation group.Meanwhile,30 patients with simple connective tissue disease were set as case control group and 30 healthy subjects as healthy control group.According to pulmonary high-resolution CT(HRCT)scores before and after treatment,the 90 patients in the observation group were divided into improved group(38 cases),stable group(31 cases)and deteriorated group(21 cases).The levels of LOXL2,CCL-18,YKL-40 and HRCT scores were compared among all groups before treatment and 12 months after treatment.Spearman correlation analysis was used to analyze the correlation between serum LOXL2,CCL-18,YKL-40 levels and HRCT scores.Receiver operating characteristic(ROC)curve was established to analyze the predictive value of LOXL2,CCL-18 and YKL-40 levels before and after treatment for disease deterioration in CTD-ILD patients.Results Before treatment,the levels of LOXL2,CCL-18,YKL-40,SP-D and KL-6 in the observation group were higher than those in the case control group and healthy control group;the levels of the above indicators in the case control group were higher than those in the healthy control group(all P＜0.05).Before treatment and 12 months after treatment,the levels of LOXL2,CCL-18,YKL-40,SP-D,KL-6 and HRCT scores in the deteriorated group were higher than those in the stable group and improved group,and those in the stable group were higher than those in the improved group(all P＜0.05).In the improved group,the levels of LOXL2,CCL-18,YKL-40,SP-D,KL-6 and HRCT scores at 12 months after treatment were lower than those before treatment(all P＜0.05).Before treatment,LOXL2,CCL-18 and YKL-40 were positively correlated with HRCT scores(r=0.872,0.705,0.617,all P＜0.05).At 12 months after treatment,LOXL2,CCL-18 and YKL-40 were also positively correlated with HRCT scores(r=0.462,0.507,0.481,all P＜0.05).Before treatment,the area under the curve(AUC)of LOXL2,CCL-18 and YKL-40 for predicting disease deterioration in CTD-ILD patients was 0.871,0.880 and 0.792 respectively,and the AUC of combined prediction was 0.960,which was higher than that of single indicator prediction.At 12 months after treatment,the AUC of LOXL2,CCL-18 and YKL-40 for predicting disease deterio-ration was 0.862,0.869 and 0.761 respectively,and the AUC of combined prediction was 0.960,superior to single indicator prediction.Conclusions Serum LOXL2,CCL-18 and YKL-40 are highly expressed in CTD-ILD patients,which are among the pathogenic factors of ILD.Serum LOXL2,CCL-18 and YKL-40 are conducive to the early diagnosis of CTD-ILD and have important value in evaluating disease changes after treatment.
Abstract:Objective To compare the clinical characteristics among patients with rheumatic autoimmune diseases(RADs)complicated with congenital heart disease(CHD),patients with isolated CHD and patients with isolated RADs,and to preliminarily explore the safety of immunosuppressants in the complicated population.Methods A total of 34 patients diagnosed with RADs complicated with CHD in The Second Hospital,Lanzhou University from March 2022 to June 2025 were retrospectively enrolled as the complicated group.According to a 1∶2 matching(based on age,gender,type of RADs and time of diagnosis),68 patients with isolated RADs without structural heart disease were selected as the control group(isolated RADs group)from the same period.Another 71 patients with isolated CHD(isolated CHD group)were enrolled in the same period.Baseline data,clinical symptoms,cardiac structure and function parameters,and adverse events were collected and compared among the three groups.Results Patients in the complicated group had diverse types of CHD but generally mild defects,and 91.2％(31/34)of them did not require cardiac intervention,which was in sharp contrast to the isolated CHD group,showing significant phenotypic differences.Cardiac structure and function evaluation showed that patients in the complicated group had more significant cardiac remodeling.The left ventricular end-diastolic diameter and main pulmonary artery diameter in the complicated group were significantly larger than those in the isolated CHD group[45.0(43.0,48.0)mm vs 44.0(41.0,46.0)mm,22.0(22.0,26.0)mm vs 22.0(20.0,23.0)mm](both P＜0.05).Meanwhile,the ejection fraction was significantly lower than that in the isolated CHD group 65％(63％,65％)vs 66％(64％,69％)](P＜0.05),and pulmonary artery systolic pressure was significantly higher than that in the isolated RADs group[27.5(25.0,35.0)mmHg vs 25.0(22.0,25.0)mmHg](P＜0.001).Among 30 patients in the complicated group treated with immunosuppressants,cardiac function indicators remained stable after a median follow-up of 15 months.The incidence of severe infection was 3.3％(1/30),and there were no treatment-related heart failure,thromboembolism or death events.Conclusion Cardiac defects in patients with RADs complicated with CHD are usually milder,and the vast majority do not require cardiac intervention.This is significantly different from the isolated CHD population admitted due to symptoms.In this context,immunosuppressive therapy for controlling RADs shows acceptable safety under close monitoring.A treatment strategy focusing on rheumatic immune disease management and individualized evaluation of cardiac intervention needs should be adopted for this special population.