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20 February 2023, Volume 37 Issue 2 Previous Issue    Next Issue

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Ameta-analysis and sequential analysis of the effects of Guanxinping on coronary heart disease JI Jia-lin, LIU Jing, WANG Xue-li, FENG Hong-lin, HAN Xu 2023, 37 (2):  128-133.  doi: 10.3969/j.issn.1003-9198.2023.02.006 Abstract ( 121 )   PDF (1951KB) ( 1206 )   Save Objective To systematically evaluate the clinical efficacy of Guanxinping on coronary heart disease(CHD),and provide evidence-based medicine basis for clinical medication. Methods The related literatures were searched in databases such as Chinese National Knowledge Infrastructure (CNKI), Cochrane Library, VIP, Embase, Wanfang database, China Biology Medicine (CBM),PubMed. The time limit was from the establishment of the database to June 2022.Two researchers independently selected literatures based on the inclusion criteria, and collected randomized controlled trials(RCT) and case-control studies of Guanxinping(the experimental group). After screening the literatures and extracting the data, the quality of RCTs were evaluated by the bias risk assessment tool recommended by Cochrane System Reviewer Manual 5.1.0. A Meta-analysis was performed by RevMan 5.3 and Stata 15.0. A trial sequential analysis was performed by TSA 0.9, and publication bias assessment was performed by Stata 15.0. Results A total of 25 studies were included, with a total sample of 1968 cases. The Meta-analysis results showed that the comprehensive clinical effect (OR=2.78,95%CI:2.11-3.68)、electrocardiogram curative effect (OR=2.63,95%CI:2.01-3.45) and traditional Chinese medicine(TCM) syndrome curative effect (OR=3.27,95%CI:2.29-4.66) of Guanxinping on CHD were significantly better than those in the control group. The sequential analysis of trials showed that the clinical total efficiency of Guanxinping on CHD was confirmed. Conclusions The clinical efficacy of Guanxinping on CHD is significant, and has potential value of clinical application. References | Related Articles | Metrics

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Predictive value of geriatric nutritional risk index combined with PCTc and NLR for short-term prognosis in elderly patients with sepsis XIA Jing-ying, ZHANG Qian 2023, 37 (2):  134-137.  doi: 10.3969/j.issn.1003-9198.2023.02.007 Abstract ( 115 )   PDF (1102KB) ( 1214 )   Save Objective To investigate the predictive value of geriatric nutritional risk index (GNRI) combined with procalcitonin clearance rate (PCTc) and neutrophil-to-lymphocyte ratio (NLR) for short-term prognosis in the elderly patients with sepsis. Methods Ninety-seven patients with sepsis admitted to our hospital from October 2018 to November 2021 were enrolled, and the patients were divided into the death group (n= 42) and the survival group (n= 55) according to the 28-day survival state. The basic clinical data of patients were collected, and the levels of GNRI, PCTc and NLR were compared between the two groups. Spearman’s correlation coefficient was used to analyze the correlation between GNRI, PCTc, NLR and APACHE Ⅱ score. The predictive value of GNRI, PCTc and NLR for short-term mortality in the elderly patients with sepsis was analyzed by receiver operating characteristic(ROC) curve. Results The levels of GNRI and PCTc were significantly lower and the levels of NLR and APACHE Ⅱ score were significantly higher in the death group than those in the survival group (P<0.05). Correlation analysis showed that GNRI, PCTc were negatively correlated with APACHE Ⅱ score(r=-0.357,-0.401,P＜0.001), and NLR was positively correlated with APACHE Ⅱ score(r=0.367,P＜0.001). The area under the curve (AUC) of GNRI combined with PCTc and NLR for predicting short-term death in sepsis patients was 0.850 (95%CI: 0.763-0.914, P<0.001), with a sensitivity of 85.71% and a specificity of 72.73%. Conclusions The levels of GNRI and PCTc are decreased and the level of NLR is increased in the elderly patients with sepsis. The combination of the three indexes has certain predictive value for short-term death in the elderly patients with sepsis. References | Related Articles | Metrics

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Association between subclinical hypothyroidism and death in elderly patients after percutaneous coronary intervention WEI Mei, GUO Qi-feng, DUAN Li-nan, YIN Ya-juan, LIU Gang, ZHENG Ming-qi, LIU Yong-sheng 2023, 37 (2):  138-141.  doi: 10.3969/j.issn.1003-9198.2023.02.008 Abstract ( 110 )   PDF (1081KB) ( 1225 )   Save Objective To investigate the association between subclinical hypothyroidism (SCH) and death in the elderly patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Methods A total of 1665 elderly CAD patients aged ≥65 years old who underwent PCI were retrospectively analyzed. All patients received a follow-up for the mortality and medication after discharge for 4 years. Results The final cohort included 166 patients with SCH(9.97%) and 1499 patients (90.03%) with normal thyroid function (ET). A total of 46 patients died during the follow-up period, and the mortality rate was 2.76%. The 4-year cumulative all-cause mortality in SCH group and ET group was 12.65% and 1.67%, respectively. Kaplan-Meier analysis showed that all-cause mortality in SCH group was significantly higher than that in ET group. Cox proportional regression model analysis showed that age, hypertension, diabetes, smoking, left main coronary artery disease and SCH were the independent risk factors for death of the elderly CAD patients undergoing PCI. Conclusions SCH is an independent risk factor for the mortality of the elderly patients after PCI. References | Related Articles | Metrics

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Correlation between serum sCD163/sTWEAK ratio and adverse cardiovascular events in elderly hospitalized patients with community acquired pneumonia LIU Hang-xu, SUN Cheng-long, FENG Zai-bang, JIN Yu 2023, 37 (2):  142-146.  doi: 10.3969/j.issn.1003-9198.2023.02.009 Abstract ( 103 )   PDF (1065KB) ( 1162 )   Save Objective To analyze the association of soluble haemoglobin scavenger receptor (sCD163)/soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK) ratio with adverse cardiovascular events (CVE) in the elderly hospitalized patients with community acquired pneumonia (CAP). Methods A total of 154 CAP patients admitted to our hospital were selected and divided into the CVE group and the non-CVE group. The 30-day survival of all patients was recorded,and the patients were further divided into the death group and the survival group. Multivariate Logistic regression was used to analyze the related factors affecting the occurrence of CVE. COX regression model was used to analyze the influencing factors of death within 30 days of admission in the elderly patients with CAP. Results The proportion of patients with hypertension, coronary heart disease, chronic heart failure, chronic kidney disease, altered consciousness age, pneumonia severity index(PSI)score≥grade Ⅳ, acidosis, hypoalbuminemia and the levels of white blood cell count, platelet count, sCD163, sTWEAK and sCD163/sTWEAK ratio in the CVE group were significantly higher than those in the non-CVE group (P<0.05).Multivariate Logistic regression analysis showed that age, chronic heart failure, PSI score and sCD163/sTWEAK ratio were the independent risk factors for CVE (P＜0.05).The serum sCD163/sTWEAK ratio of CAP patients in the death group was higher than that in the survival group (P<0.05),and sCD163/sTWEAK ratio≥0.35 was an independent risk factor for death within 30 days of admission in the elderly patients with CAP. Conclusions With the increase of serum sCD163/sTWEAK ratio, the risk of CVE and 30-day mortality in CAP patients increase. References | Related Articles | Metrics

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Incidence rate and risk factors of frailty syndrome in elderly patients with essential hypertension ZHAO Can, LIU Shan-shan, LI Jing-bing, WANG Shao-ying, WANG Li-di 2023, 37 (2):  147-150.  doi: 10.3969/j.issn.1003-9198.2023.02.010 Abstract ( 112 )   PDF (1035KB) ( 1320 )   Save Objective To investigate the incidence rate of frailty syndrome (FS) and the related risk factors in the elderly patients with essential hypertension(EH). Methods A total of 200 elderly patients with EH who were admitted to the Eighth People’s Hospital of Hebei Province from March 2019 to March 2021 were selected and divided into the frailty group (87 cases) and the non-frailty group (113 cases) according to the Fried Frailty Phenotype Definition Scale. The incidence rate of FS and its related risk factors in the elderly patients with EH were observed and analyzed. Results Of 200 patients, 87 cases presented with FS, with an incidence rate of 43.50%. There were statistically significant differences in age, marital status, educational level, body mass index(BMI), hyperglycemia, hyperlipidemia, smoking history, drinking history, cognitive function, depression state and sleep disorder between the two groups (P<0.05). Logistic regression analysis showed that abnormal BMI, smoking history, poor sleep quality, depressive symptoms, hyperglycemia and hyperlipidemia and cognitive dysfunction were the independent risk factors of FS in the elderly EH patients (P<0.05). Conclusions The incidence rate of FS in the elderly patients with EH is high. Effective monitoring and intervention to the risk factors are important to improve the quality of life of the patients. References | Related Articles | Metrics

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One-year mortality of elderly patients with femoral neck fracture receiving surgery and the construction of its prediction model LU Jun-song, LYU Guo-rong, TIAN Long, HE Tao, YAN Chun, CHEN Lu, YANG Zhi-Qiang 2023, 37 (2):  151-155.  doi: 10.3969/j.issn.1003-9198.2023.02.011 Abstract ( 105 )   PDF (1246KB) ( 1250 )   Save Objective To investigate the 1-year mortality of the elderly patients with femoral neck fracture receiving surgery, and to construct a predictive model. Methods A total of 208 elderly patients with femoral neck fractures who were treated with surgery in our hospital from February 2019 to May 2020 were enrolled in this study. The clinical data were collected for retrospective analysis. According to the survival of the patients, they were divided into the survival group and the death group. The clinical data of the two groups were compared, and Logistic regression analysis was used to evaluate the influencing factors of 1-year survival. A nomogram prediction model was constructed based on the results of the multivariate analysis. Results There were significant difference in age, comorbidities before admission, pre-fracture Harris hip score, American stroke association (ASA) grade, fracture type, the levels of white blood cell(WBC), hemoglobin (Hb),albumin and activated partial thromboplastin time between the survival group and the death group(P<0.05). Multivariate Logistic regression analysis showed that ≥2 kinds of comorbidities before admission, ASA grade Ⅲ-Ⅳ, and intracapsular fracture were the risk factors for 1-year death in the elderly patients with femoral neck fracture. Increased hemoglobin and pre-fracture Harris hip score were the protective factors (P<0.05). The β value of each factor was used to construct a one-year mortality prediction model for the elderly patients with femoral neck fracture: Prob=1/(1+e-Y), Y=0.389×pre-hospital comorbidities -0.385×pre-fracture Harris hip score+0.371×ASA grade+0.415×fracture type-0.386×Hb. Nomogram model was constructed based on this formula. The receiver operating characteristic(ROC)curve of the model was drawn, and the area under the ROC curve was 0.964(95% CI: 0.936-0.992). The internal verification results of the Bootstrap method showed that the mean absolute error was 0.016, and the model performance fitted the ideal model. Conclusions The 1-year mortality of the elderly patients with femoral neck fracture is mainly affected by the comorbidities, ASA classification, fracture type, Hb and pre-fracture Harris hip score. The nomogram model constructed with the above factors can effectively predict the 1-year mortality risk of the elderly patients with femoral neck fracture receiving surgery with high discrimination and accuracy. References | Related Articles | Metrics

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Predictive value of subjective cognitive declineon postoperative delirium SUN Qiang, WU Bo, MAO Meng, WANG Fei, JI Mu-huo 2023, 37 (2):  156-159.  doi: 10.3969/j.issn.1003-9198.2023.02.012 Abstract ( 103 )   PDF (1053KB) ( 1398 )   Save Objective To explore the predictive value of subjective cognitive decline (SCD) on postoperative delirium (POD). Methods A total of 156 elderly patients scheduled for non-cardiac surgeries were selected. The development of SCD was assessed by Subjective Cognitive Decline Questionnaire(SCD-Q9 )one day before surgery. Peripheral venous blood samples were collected to detect the levels of serum biomarkers before anesthesia induction. The patients received POD assessment using Chinese version of Confusion Assessment Method 1-3 d after operation. Then the patients were divided into the POD group and the non-POD group. Multiple Logistic regression analysis was used to analyze the risk factors for POD. The receiver operating characteristic curve(ROC) was drawn and the area under the curve (AUC) was calculated to evaluate the predictive value of SCD on POD. Results Compared with the non-POD group, the incidence of SCD, serum levels of interleukin-6 (IL-6) and neurofilament light were significantly increased in the POD group (P<0.05). Logistic regression analysis showed that SCD (OR=1.952,95% CI:1.183-3.532,P < 0.05) and preoperative serum IL-6 (OR=1.103, 95% CI:1.052-1.154,P<0.05) were the risk factors for the development of POD. Preoperative SCD and serum IL-6 showed an AUC of 0.768 (95% CI:0.692-0.845,P<0.001) and 0.865 (95% CI:0.784-0.945,P＜0.001) to predict POD respectively. Conclusions Preoperative SCD is a significant risk factor for POD, which could be used to predict the incidence of POD. References | Related Articles | Metrics

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Analysis of the risk factors of gallstone disease in community eldely LI Lin-yue, XU Ye-min, ZHANG Yun, ZHANG Zhi-mei, LU Li-ping, FENG Xin-yi, DENG Bin, WANG Shao-dan 2023, 37 (2):  160-163.  doi: 10.3969/j.issn.1003-9198.2023.02.013 Abstract ( 95 )   PDF (1040KB) ( 1140 )   Save Objective To investigate the epidemic characteristics of gallstone in community elderly of Yangzhou, and to explore the risk factors of gallstone. Methods A total of 5377 elderly people who underwent physical examination in Community Health Service Centre of West New Town in Yangzhou from June to September 2020 were enrolled. The subjects were divided into the gallstone group and the control group according to the results of abdominal ultrasound examination. Basic information and blood biochemical parameters were collected and compared in the two groups. Binary Logistic regression analysis was used to analyze the risk factors of gallstone. Results A total of 1167 cases presented with gallstone, with an incidence rate of 21.7%. There were significant differences in gender, living in urban areas, abdominal obesity, diabetes, fatty liver, body mass index (BMI), fasting plasma glucose (FPG),total cholesterol (TC),triglycerides (TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),alanine aminotransferase (ALT) between the two groups (P<0.05). Logistic regression analysis showed that female, living in urban areas, abdominal obesity, fatty liver, BMI, FPG were the independent risk factors for gallstone (P<0.05). Conclusions The potential risk factors of gallstone in the community elderly people are female, living in urban areas, abdominal obesity,fatty liver, FPG and BMI. Focusing on the risk factors is important to prevent gallstone in the elderly. References | Related Articles | Metrics

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Value of lung CT combined with NLR and ALB in predicting the clinical prognosis of elderly patients with chronic obstructive pulmonary disease combined with type Ⅱ respiratory failure TANG Lan, YU Jia, MEI Kai 2023, 37 (2):  164-167.  doi: 10.3969/j.issn.1003-9198.2023.02.014 Abstract ( 126 )   PDF (1042KB) ( 1389 )   Save Objective To explore the value of pulmonary CT combined with neutrophil to lymphocyte ratio (NLR) and albumin (ALB) in predicting the clinical prognosis of the elderly patients with chronic obstructive pulmonary disease (COPD) combined with type Ⅱ respiratory failure. Methods A total of 108 COPD patients combined with type Ⅱ respiratory failure diagnosed in our hospital from December 2019 to December 2021 were enrolled and followed up for 3 months. According to the prognosis, the patients were divided into the survival group (97 cases) and the death group (11 cases). Lung CT was performed in all patients to determine the maximum abnormal end-inspiratory volume (Vcin)and the maximum abnormal end-expiratory volume(Cvex), and the level of NLR and serum ALB were collected and compared in the two groups. The value of Vcin, Cvex combined with NLR and ALB in predicting the prognosis of COPD patients with type Ⅱ respiratory failure was analyzed. Results The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score and the levels of arterial carbon dioxide partial pressure(PaCO2), Vcin, Cvex and NLR in the survival group were significantly lower and the level of ALB was significantly higher than those in the death group (P<0.05). ROC curve showed that the area under curve (AUC) of Vcin and Cvex for predicting the clinical prognosis of COPD patients combined with type Ⅱ respiratory failure was 0.69 and 0.65, and the sensitivity and specificity were 72.56%, 66.74% and 66.43%, 62.59%, respectively; And the AUC of NLR and ALB for predicting the clinical prognosis were 0.68, 0.67, the sensitivity and specificity were 64.58%, 63.67% and 61.37%, 62.54%, respectively. The AUC of Vcin, Cvex combined with NLR and ALB for predicting the clinical prognosis was 0.81, and the sensitivity and specificity were 85.42% and 81.39%, respectively. Conclusions The sensitivity and specificity of lung CT combined with NLR and ALB in predicting the clinical prognosis of elderly COPD patients with type Ⅱ respiratory failure are more than 80%, which has high application value for clinical evaluation of the prognosis. References | Related Articles | Metrics

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Predictive value of CK-MB, BNP and fibrinogen to albumin ratio on readmission rate in elderly patients with chronic heart failure CHENG Zhong-liang, LING Yan, LIANG Xiao-hui 2023, 37 (2):  168-172.  doi: 10.3969/j.issn.1003-9198.2023.02.015 Abstract ( 115 )   PDF (1125KB) ( 1298 )   Save Objective To investigate the predictive value of creatine kinase isoenzyme (CK-MB), B-type natriuretic peptide (BNP) and fibrinogen to albumin ratio (FAR) on readmission rate in the elderly patients with chronic heart failure (CHF). Methods A total of 132 CHF patients admitted to our hospital from March 2018 to October 2020 were enrolled. According to the New York Heart Association (NYHA)cardiac function classification, there were 55 cases of grade Ⅱ, 41 cases of grade Ⅲ and 36 cases of grade Ⅳ. All the patients were followed up for 1 year and were divided into the readmission group (45 cases) and the non-readmission group (87 cases) according to whether they were readmitted. The serum levels of C-reactive protein (CRP), procalcitonin (PCT), BNP, CK-MB and FAR in the two groups were detected and compared. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of CRP, PCT, CK-MB, BNP, and FAR for readmission in the elderly patients with CHF. Results The levels of CRP, PCT, BNP, CK-MB and FAR in grade Ⅱ, grade Ⅲ and grade Ⅳ group were significantly increased in turn (P<0.05).Compared with the non-readmission group, the levels of CRP, PCT, BNP, CK-MB and FAR were significantly higher in the readmission group (P<0.05).The ROC curve showed that the area under the curve (AUC) of CRP, PCT, BNP, CK-MB, and FAR for predicting readmission of CHF patients was 0.790, 0.785, 0.804, 0.841, and 0.869, respectively. The AUC of the combination of BNP,CK-MB and FAR to predict the readmission of CHF patients was 0.884, and the sensitivity and specificity was 82.20% and 88.50%, respectively. Conclusions The serum levels of CK-MB, BNP, and FAR are high in CHF readmission patients, and the combination detection of the three indexes shows significant clinical value in predicting CHF readmission. References | Related Articles | Metrics

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Expression and diagnostic value of hepatocyte growth factor in patients with chronic coronary syndrome YAO Jun-xiu, GUO Jin-chun, HAO Xiao-dan, LI Long-xin, YANG Xue, WANG Zhang 2023, 37 (2):  173-177.  doi: 10.3969/j.issn.1003-9198.2023.02.016 Abstract ( 105 )   PDF (1072KB) ( 980 )   Save Objective To investigate the level of serum hepatocyte growth factor (HGF) in the patients with chronic coronary syndrome (CCS) and its diagnostic value. Methods A total of 89 patients who were diagnosed or suspected as CCS and planned to undergo coronary angiography in our hospital from March to October 2020 were selected, and they were divided into the CCS group (n=56) and the non-coronary heart disease (CHD) group (n=33) according to the results of coronary angiography. The general data of all patients were collected, and the levels of blood lipid, blood glucose, renal function, B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and HGF were detected and compared between two groups. Propensity score matching (PSM) method was used to control the confounding factors, and binary Logistic regression was used to analyze the influencing factors of CCS. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficacy of HGF for CCS. Results The serum level of HGF in the CCS group was significantly higher than that in non-CHD group(P<0.05). Binary Logistic regression analysis before and after PSM showed that HGF was the risk factor for CCS(OR=1.004,95%CI:1.001-1.007,P<0.05). ROC curve analysis showed that the area under the curve (AUC) of HGF predicting CCS was 0.677 (95%CI:0.567-0.788, P<0.05), with a sensitivity of 48.2% and a specificity of 87.9%. Conclusions The level of serum HGF in the patients with CCS is significantly higher than that in the patients without CHD. The serum level of HGF shows predictive value for CCS, which may be helpful in early identification of CCS. References | Related Articles | Metrics

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Associations of obesity with brain volume and cognition in elderly CEN Yan, DOU Miao-miao, WEI Qian, LU Xiao-wei 2023, 37 (2):  178-182.  doi: 10.3969/j.issn.1003-9198.2023.02.017 Abstract ( 116 )   PDF (1059KB) ( 1261 )   Save Objective To observe the relationship of obesity with brain volume and cognition in the elderly population. Methods A total of 177 patients performed with complete 3-dimensional magnetic resonance imaging in the Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2018 were retrospectively analyzed. Body mass index (BMI) and waist-to-hip ratio (WHR) were used to evaluate obesity. All patients were evaluated by Mini-Mental State Scale (MMSE) and divided into two groups, cognitively impaired group (n=76) and non-cognitive impaired group (n=101). Brain volume was automatically segmented into total volume, white matter volume, grey matter volume, and white matter hyperintensities (WMH )volume with CAT12 software. Clinical feature data and brain volume were compared between the two groups. The correlations of BMI and WHR with brain volume were assessed by the Pearson correlation coefficients. Logistic regression was applied to analyze the relationship of BMI and abdominal obesity with cognitive impairment. Moreover, univariate and multivariate generalized linear models were used to analyze the correlation between BMI and MMSE. Results There were significant differences in gender, education, MMSE, BMI, WHR, total brain volume, grey matter volume, and white matter volume between the two groups (P＜0.05). Pearson correlation analysis showed that BMI and WHR were positively correlated with white matter volume(r=0.152, 0.235, P<0.05). Logistic regression analysis showed that overweight patients(OR=0.384,95%CI:0.189-0.778, P=0.008)and obese patients (OR=0.316,95%CI:0.134-0.747, P=0.009)had a reduced risk of cognitive impairment. The generalized linear model showed that the MMSE score of patients was significantly positively related to BMI (B=0.044, 95%CI: 0.007-0.080, P=0.019) independent of age, education, smoking and brain volume. Conclusions BMI, independent of brain volume, may have a protective effect on cognitive function in the elderly. References | Related Articles | Metrics

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Implementation and effect evaluation of care plan for prevention of delirium in elderly patients XU Li, ZHANG Meng, WEI Jing-yi, GAO Lang-li, ZHANG Xue-mei 2023, 37 (2):  204-208.  doi: 10.3969/j.issn.1003-9198.2023.02.024 Abstract ( 118 )   PDF (1060KB) ( 1093 )   Save Objective To implement the care plan for prevention of delirium in the hospitalized elderly patients and evaluate its effect. Methods A care team for delirium prevention was established. A total of 447 patients were enrolled in a multi-center, randomized controlled trial, with 230 cases in the control group and 217 cases in the experimental group. The control group received routine medical treatment and nursing, and the experimental group received care plan for delirium prevention on the basis of routine medical treatment and nursing. The observation time was 2 weeks. The delirium incidence, cognitive function and self-care ability of the two groups were compared before and after intervention. Results The incidence rate of delirium in the experimental group was significantly lower than that in the control group (2.7% vs 7.3%, P<0.05). After two weeks of intervention, cognitive impairment in the experimental group was improved more than that in the control group(P<0.05), especially in the patients with mild and moderate cognitive impairment. The score of Barthel Index in the experimental group before the intervention was higher than that after the intervention (P<0.05),but there was no signicant difference between the two groups. The hospitalization time of the experimental group was less than that of the control group(P<0.05). Conclusions Care plan to prevent delirium in hospitalized elderly patients can reduce the incidence of delirium and the loss of self-care ability and prevent cognitive decline. References | Related Articles | Metrics