1.Clinical study of aortic valve calcification in elderly patients
Kang LI ; Chongqing YANG ; Anhuai LU ; Fang WANG ; Yan LI ; Guodong TANG ; Meiqian ZHU ; Defa CHU
Chinese Journal of Geriatrics 2012;(12):1051-1053
Objective To evaluate the incidence of aortic valve calcification,and the correlation between valve function and commonly encountered disease in the aged patients.Methods Totally 996 patients who underwent ultrasonic cardiography (UCG) in our hospital were included.They were divide into elderly group and non elderly group,and the elderly group was divided into calcification subgroup and non calcification subgroup.The calcification,stenosis and regurgitation of aortic valve were detected by UCG,and risk factors of calcification were evaluated by Logistic regression analysis.Results The incidence of calcification was higher in elderly group than in non elderly group [71.8% (526/733) vs.14.6% (34/233),x2=237.10,P<0.01].In elderly group,the incidence of aortic valve stenosis was 2.1% (11/526) in calcification subgroup and 1.9% (4/207) in non calcification subgroup (x2=0.81,P>0.05).In elderly group,the incidence of aortic valve regurgitation was 63.3% (333/526) in calcification subgroup and 19.3% (40/207) in non calcification subgroup (x2=116.10,P<0.01).The hazard ratio of aortic valve calcification in different diseases were as follows:hypertension (OR=2.06,95%CI:1.400-3.031),coronary heart disease (OR=3.46,95%CI:2.217-5.384),diabetes mellitus (OR = 2.66,95%CI:1.652-4.278),renal dysfunction (OR= 2.34,95% CI:1.415-3.869),osteoporosis (OR= 2.33,95%CI:1.119-4.838).Conclusions The incidence of calcification,mainly causing aortic valve regurgitation,is high in elderly patients.Patients with hypertension,coronary heart disease,diabetes mellitus,renal dysfunction and osteoporosis are prone to the development of aortic valve calcification.
2.The role of comprehensive geriatric assessment in patients with chronic heart failure and sarcopenia
Yingji ZHOU ; Jiqun CHEN ; Lianhai MIAO ; Zhziyong YANG ; Shitao SONG ; Wenling SONG ; Yunfeng ZHANG ; Defa ZHU
Clinical Medicine of China 2023;39(4):292-298
Objective:To investigate the therapeutic effect of comprehensive geriatric assessment(CGA) in elderly patients with chronic heart failure(CHF) complicated with sarcopenia, and to provide a theoretical reference for clinical application.Methods:This study was a prospective randomized controlled study. 110 elderly CHF patients with myopenia admitted to the Third People's Hospital of Hefei from January 2019 to February 2022 were selected. Using the random number table method, 56 cases were divided into an observation group and 54 cases into a control group. Before treatment, the control group of patients underwent a selective single assessment based on the hospital's requirements and the patient's actual situation, including a fall risk assessment, nutritional risk screening checklist assessment, and routine medication to improve cardiac function and prognosis; Before treatment, the patients in the observation group were assessed with CGA, including the assessment of physical function, mental and psychological status, multiple drug management, pain, Sleep disorder, and social environment. According to the assessment results, individual diagnosis and treatment plans were formulated, implemented, and dynamically adjusted. The two groups were treated for 12 weeks. The general information, treatment compliance, B-type brain natriuretic peptide (BNP) level, left ventricular Ejection fraction (LVEF), 6 min walking distance (6MWD), arm strength of upper limbs and 6 m walking speed, clinical efficacy and prognosis of the two groups were compared before and after treatment. The measurement data is represented by xˉ± s, group t-tests are used for inter group comparison, and paired t-tests are used for intra group comparison before and after treatment; Counting data is represented as an example (%), and inter group comparisons are made using χ 2 test, non parametric rank sum test was used for inter group comparison of hierarchical data. Results:There was no statistically significant difference in gender, age, course of CHF, smoking, alcohol consumption, number of comorbidities, cardiac function grading, and treatment compliance between the two groups of patients (all P>0.05), indicating comparability. Before treatment, there was no statistically significant difference in plasma BNP, LVEF, 6MWD, upper limb grip strength, and 6-meter walking speed between the two groups of patients (all P>0.05); After treatment, the BNP of both groups of patients was lower than before treatment and the observation group was lower than the control group. LVEF, 6MWD, upper limb grip strength, and 6-meter walking speed were all higher than before treatment and the observation group was higher than the control group [(343.45±34.95) ng/L vs (387.09±46.96) ng/L, (49.61±7.11)% vs (42.94±5.72)%, (348.92±37.73) m vs (297.74±43.48) m, (22.64±3.82) kg vs (19.48±3.88) kg, (0.97±0.10) m/s vs (0.83±0.12) m/s], The differences were statistically significant ( t-values were 5.51, -5.40, -6.60, -4.31, -6.60, all P<0.001). After 12 weeks of treatment, there was no statistically significant difference in clinical efficacy between the two groups of patients ( P=0.216), but the overall poor prognosis rate in the follow-up observation group was lower than that in the control group [7.14%(4/56) vs 22.22% (12/54)], and the difference was statistically significant (χ 2=5.03, P=0.025). Conclusions:Developing, implementing, and dynamically adjusting the individualized treatment plan involving CGA can improve the prognosis of elderly CHF patients with sarcopenia, help improve cardiac function, increase grip strength and somatic function, and reduce the risk of major adverse cardiovascular events ,all-cause mortality in elderly patients with CHF combined with sarcopeni and has certain clinical application value.
3.Analysis of urinary iodine level in Hashimoto thyroiditis patients
Xiaodie Li ; Yongxia Xu ; Fen Wang ; Wenlu Guo ; Wei Jia ; Xuefeng Wang ; Lang Lang ; Defa Zhu
Acta Universitatis Medicinalis Anhui 2024;59(1):144-148
Objective :
To analyze the difference of urinary iodine level in Hashimoto thyroiditis ( HT) patients, and to explore the possible relationship between urinary iodine level and HT under different iodine nutritional sta- tus,so as to provide some references for reasonable iodine intake in HT patients.
Methods :
A total of 101 hospi- talized HT patients were selected as HT group and divided into 3 groups according to thyroid function : HT group with hyperthyroidism (41 cases) .There were 25 cases in HT group with normal thyroid function.There were 35 cases in HT combined with hypothyroidism group.In addition,30 healthy subjects were selected as control group. Serum levels of thyroid stimulating hormone(TSH) ,triiodothyronine(T3 ) ,thyroxine (T4 ) ,thyroid peroxidase an- tibody (TPOAb) and thyroglobulin antibody (ATG) were detected by chemiluminescence assay.The size and mor- phological structure of thyroid organs were examined by ultrasonography.Urinary iodine was determined by catalytic spectrophotometry with arsenic and cerium.The nutritional status of iodine was classified into iodine deficiency ( < 100 μg/ L) ,iodine adequacy( 100 -199 μg/ L) ,iodine adequacy (200 -299 μg/ L) and iodine excess ( ≥ 300 μg/ L) .Non-parametric test was used to compare urinary iodine level between HT group and control group,one- way ANOVA and t test were used to compare urinary iodine level between HT group and control group ,and Spearman correlation analysis was used to compare the correlation between urinary iodine level and T3 ,T4 ,TSH, ATG and TPOAb under different iodine nutrition status.
Results :
Compared with control group,ATG and TPOAb levels in HT group increased (P<0. 001) ,and urinary iodine levels increased (P<0. 05) ,with statistical signifi- cance.Compared with the control group in different thyroid function states,only the HT group with hypothyroidism increased the urinary iodine level (P<0. 01) ,and the difference was statistically significant.Spearman correlation analysis showed that urine iodine level was positively correlated with ATG and TPOAb levels in iodine excess condi- tion (P<0. 05) ,and urine iodine level was positively correlated with TSH level in iodine sufficient condition and iodine excess condition in HT patients (P<0. 05) .
Conclusion
The urinary iodine level of HT patients was high- er than that of normal people.When the urinary iodine level of residents is ≥ 300 μg/ L,iodine intake is prone to HT.When the urinary iodine level of HT patients is ≥ 200 μg/ L,iodine consumption is prone to hypothyroidism, and iodine intake should be limited.