1.Construction and validation of machine learning predictive models for the risk of metabolic associated fatty liver disease
Linjie QIU ; Haiyan REN ; Yan REN ; Meijie LI ; Chacha ZOU ; Zijing WU ; Jin ZHANG
Journal of Clinical Hepatology 2026;42(4):848-855
ObjectiveTo investigate the value of predictive models established based on machine learning methods in predicting the risk of metabolic associated fatty liver disease (MAFLD), and to analyze its key risk factors. MethodsA retrospective analysis was performed for the 50 variables of 2 168 healthy individuals who underwent physical examination in Department of Health Assessment, Xiyuan Hospital, China Academy of Chinese Medical Sciences, from January 2021 to December 2024, including body composition, past history, and laboratory tests, and according to whether they were diagnosed with MAFLD or not, they were divided into MAFLD group with 265 individuals and non-MAFLD group with 1 903 individuals. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Randomly split the research data into a training set and a validation set in a 70% to 30% ratio. Predictive factors were screened from the training set data using univariate analysis, LASSO regression, and multivariate Logistic regression analysis. Predictive models were then constructed using seven machine learning methods: Logistic regression, decision tree, random forest (RF), eXtreme gradient boosting, light gradient boosting machine, support vector machine, and artificial neural network. Model performance was evaluated by plotting receiver operating characteristic curve for the validation set and calculating the area under the curve (AUC), sensitivity, specificity, and Youden index for each model. Furthermore, the SHapley Additive exPlanation (SHAP) method was used to analyze the contribution of variables in the optimal model. ResultsThe prevalence rate of MAFLD among the 2 168 subjects was 12.22% (265/2 168). Smoking, diastolic blood pressure, phase angle, visceral fat area, muscle fat ratio, waist-to-hip ratio, aspartate aminotransferase, non-HDL-C/HDL-C ratio, triglyceride-glucose index, and gallstones were independent risk factors for MAFLD (all P<0.05). The seven predictive models of support vector machine, eXtreme gradient boosting, decision tree, light gradient boosting machine, artificial neural network, RF, and Logistic regression had an AUC of 0.738, 0.754, 0.757, 0.786, 0.795, 0.796, and 0.815, respectively, in the validation set, among which the RF model had the best discriminatory ability (AUC=0.796, 95% confidence interval: 0.754 — 0.839), with a sensitivity of 81.01%, a specificity of 63.16%, and a Youden index of 44.17%. The SHAP analysis showed that visceral fat area, waist-to-hip ratio, and diastolic blood pressure were the top three predictive factors in terms of importance. ConclusionThe RF model, constructed based on body composition and clinical indicators, has a good performance in predicting the risk of MAFLD, and its interpretability can help to identify high-risk individuals in the early stage in clinical practice.
2.Xianglian Huazhuo Prescription Regulates miR-34b-5p/PFKFB1 Signaling Pathway to Inhibit Glycolysis and Ameliorate Chronic Atrophic Gastritis
Yuxi GUO ; Pengli DU ; Ziqi JIN ; Yican LIN ; Yanru DU ; Haiyan BAI ; Xinran YANG ; Danyang ZHAO ; Qian YANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(21):29-38
ObjectiveTo investigate the mechanism by which Xianglian Huazhuo prescription (XLHZ) ameliorates chronic atrophic gastritis (CAG) through regulating glycolysis via the microRNA-34b-5p (miR-34b-5p)/6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 1 (PFKFB1) signaling pathway. MethodsBioinformatic screening was performed to identify the target genes of miR-34b-5p. In the animal experiments, a mouse model of CAG was established through a combination of N-methyl-N′-nitro-N-nitrosoguanidine (MNNG), ranitidine, and irregular feeding. The mice were randomized into the following groups: normal, model, Morodan group (2 g·kg-1), and high-, medium-, and low-dose XLHZ groups(7.2,3.8,1.9 g·kg-1). In the cell experiments, GES-1 cells were treated with MNNG for the modeling of CAG and grouped as follows: GES-1, MNNG+GES-1, MNNG+GES-1+XLHZ(10%), MNNG+GES-1+miR-34b-5p mimics, MNNG+GES-1+miR-34b-5p inhibitor, MNNG+GES-1+PFKFB1 inhibitor, and MNNG+GES-1+PFKFB1 mimics+XLHZ(10%). The general conditions of mice were observed. Real-time PCR was adopted to measure the expression levels of miRNA-34b-5p and PFKFB1 mRNA in the gastric mucosa of mice in each group. Dual luciferase reporter gene was used to verify the targeting interaction between miR-34b-5p and PFKFB1 in GES-1 cells exposed to MNNG. The cell-counting kit-8 (CCK-8) was used to screen the drug-containing serum concentration. Real-time PCR was employed to verify the transfection efficiency. Fluorescent probes were used to detect the expression and nuclear translocation of hypoxia-inducible factor-1α (HIF-1α) in each group of cells. The protein levels of HIF-1α, hexokinase 2 (HK2), PFKFB1, phosphofructokinase 1 (PFK1), and lactate dehydrogenase (LDHA) in the gastric mucosa of mice were determined by Western blot. The levels of glucose consumption and lactate in the serum and cells were measured by biochemical methods. Enzyme-linked immunosorbent assay (ELISA) was adopted to measure the content of adenosine triphosphate (ATP) in the gastric mucosa tissue and cells. ResultsThe animal experiments showed that compared with the normal group, the model group exhibited symptoms including mental fatigue, lethargy, sparse and dull fur, a tendency to curl up, sluggish responses, reduced food and water intake, and slow body weight gain. In addition, the model group showed decreased expression of miRNA-34b-5p (P<0.01), increased mRNA level of PFKFB1 (P<0.01), upregulated protein levels of HIF-1α, HK2, PFKFB1, PFK1, and LDHA (P<0.01), and increased glucose consumption, lactate content, and ATP content (P<0.01). Compared with the model group, the XLHZ group and Morodan group showed improved mental state, gradually improved fur, increased activity, food and water intake, and body weight. HE showed that each treatment group exhibited well arranged and increased gastric mucosal glands, reduced inflammatory cells, and recovered gastric pits. Transmission electron microscopy showed that the size of mitochondria in each treatment group returned to normal, with no obvious irregular shape, complete and clear cristae, and uniform matrix. Furthermore, each treatment group showed increased expression of miRNA-34b-5p (P<0.05), reduced mRNA level of PFKFB1 (P<0.05), downregulated protein levels of HIF-1α, HK2, PFKFB1, PFK1, and LDHA (P<0.05), and decreased glucose consumption, lactic acid, and ATP (P<0.05). The cell experiments showed that the expression and nuclear translocation of HIF-1α were reduced in all groups after treatment (P<0.05). The cell transfection efficiency was satisfactory (P<0.05). miR-34b-5p exhibited an effect comparable to that of XLHZ, effectively inhibiting glycolysis, whereas PFKFB1 promoted glycolysis and reversed the protective effect of XLHZ in CAG mice (P<0.05). ConclusionXLHZ could regulate the miR-34b-5p/PFKFB1 axis to inhibit glycolysis, thereby ameliorating MNNG-induced gastric mucosal atrophy.
3.Xianglian Huazhuo Prescription Regulates miR-34b-5p/PFKFB1 Signaling Pathway to Inhibit Glycolysis and Ameliorate Chronic Atrophic Gastritis
Yuxi GUO ; Pengli DU ; Ziqi JIN ; Yican LIN ; Yanru DU ; Haiyan BAI ; Xinran YANG ; Danyang ZHAO ; Qian YANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(21):29-38
ObjectiveTo investigate the mechanism by which Xianglian Huazhuo prescription (XLHZ) ameliorates chronic atrophic gastritis (CAG) through regulating glycolysis via the microRNA-34b-5p (miR-34b-5p)/6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 1 (PFKFB1) signaling pathway. MethodsBioinformatic screening was performed to identify the target genes of miR-34b-5p. In the animal experiments, a mouse model of CAG was established through a combination of N-methyl-N′-nitro-N-nitrosoguanidine (MNNG), ranitidine, and irregular feeding. The mice were randomized into the following groups: normal, model, Morodan group (2 g·kg-1), and high-, medium-, and low-dose XLHZ groups(7.2,3.8,1.9 g·kg-1). In the cell experiments, GES-1 cells were treated with MNNG for the modeling of CAG and grouped as follows: GES-1, MNNG+GES-1, MNNG+GES-1+XLHZ(10%), MNNG+GES-1+miR-34b-5p mimics, MNNG+GES-1+miR-34b-5p inhibitor, MNNG+GES-1+PFKFB1 inhibitor, and MNNG+GES-1+PFKFB1 mimics+XLHZ(10%). The general conditions of mice were observed. Real-time PCR was adopted to measure the expression levels of miRNA-34b-5p and PFKFB1 mRNA in the gastric mucosa of mice in each group. Dual luciferase reporter gene was used to verify the targeting interaction between miR-34b-5p and PFKFB1 in GES-1 cells exposed to MNNG. The cell-counting kit-8 (CCK-8) was used to screen the drug-containing serum concentration. Real-time PCR was employed to verify the transfection efficiency. Fluorescent probes were used to detect the expression and nuclear translocation of hypoxia-inducible factor-1α (HIF-1α) in each group of cells. The protein levels of HIF-1α, hexokinase 2 (HK2), PFKFB1, phosphofructokinase 1 (PFK1), and lactate dehydrogenase (LDHA) in the gastric mucosa of mice were determined by Western blot. The levels of glucose consumption and lactate in the serum and cells were measured by biochemical methods. Enzyme-linked immunosorbent assay (ELISA) was adopted to measure the content of adenosine triphosphate (ATP) in the gastric mucosa tissue and cells. ResultsThe animal experiments showed that compared with the normal group, the model group exhibited symptoms including mental fatigue, lethargy, sparse and dull fur, a tendency to curl up, sluggish responses, reduced food and water intake, and slow body weight gain. In addition, the model group showed decreased expression of miRNA-34b-5p (P<0.01), increased mRNA level of PFKFB1 (P<0.01), upregulated protein levels of HIF-1α, HK2, PFKFB1, PFK1, and LDHA (P<0.01), and increased glucose consumption, lactate content, and ATP content (P<0.01). Compared with the model group, the XLHZ group and Morodan group showed improved mental state, gradually improved fur, increased activity, food and water intake, and body weight. HE showed that each treatment group exhibited well arranged and increased gastric mucosal glands, reduced inflammatory cells, and recovered gastric pits. Transmission electron microscopy showed that the size of mitochondria in each treatment group returned to normal, with no obvious irregular shape, complete and clear cristae, and uniform matrix. Furthermore, each treatment group showed increased expression of miRNA-34b-5p (P<0.05), reduced mRNA level of PFKFB1 (P<0.05), downregulated protein levels of HIF-1α, HK2, PFKFB1, PFK1, and LDHA (P<0.05), and decreased glucose consumption, lactic acid, and ATP (P<0.05). The cell experiments showed that the expression and nuclear translocation of HIF-1α were reduced in all groups after treatment (P<0.05). The cell transfection efficiency was satisfactory (P<0.05). miR-34b-5p exhibited an effect comparable to that of XLHZ, effectively inhibiting glycolysis, whereas PFKFB1 promoted glycolysis and reversed the protective effect of XLHZ in CAG mice (P<0.05). ConclusionXLHZ could regulate the miR-34b-5p/PFKFB1 axis to inhibit glycolysis, thereby ameliorating MNNG-induced gastric mucosal atrophy.
4.Expert consensus on infection prevention and control of Creutzfeldt-Jakob disease in medical institutions
Tianxiang GE ; Yangyang JIA ; Chunhui LI ; Jianrong HUANG ; Xiujuan MENG ; Xiaodong GAO ; Jingping ZHANG ; Fu QIAO ; Lijuan XIONG ; Hui LIANG ; Wei LI ; Haiyan LOU ; Wenjuan WU ; Tianxin XIANG ; Jiansen CHEN ; Biao ZHU ; Kaijin XU ; Zhihui ZHOU ; Hongliu CAI ; Meihong YU ; Yan ZHANG ; Yanwan SHANGGUAN ; Haiting FENG ; Hangping YAO ; Lei GUO ; Tieer GAN ; Weihong ZHANG ; Jimin SUN ; Ye LU ; Qun LU ; Meng CAI ; Jin SHEN ; Yunsong YU ; Anhua WU ; Liu-yi LI ; Tingting QU
Chinese Journal of Infection Control 2025;24(4):437-450
Creutzfeldt-Jakob disease(CJD)is a rapidly progressive and fatal neurodegenerative disorder caused by prions,with certain infectivity and iatrogenic transmission risks.With the rapid progress and application of new dia-gnostic biomarkers and detection methods,as well as the construction and improvement of surveillance and reporting systems,the detection of CJD in patients domestically and internationally has shown an increasing trend year by year.Due to its long incubation period and heterogeneity of early symptoms,early identification and diagnosis of the disease is difficult,increasing the risk of transmission within medical institutions.Currently,there is a lack of con-sensus on the infection prevention and control of CJD.In order to timely identify and diagnose CJD as well as effec-tively block its transmission in medical institutions,this consensus summarizes 15 clinical concerns and formulates 24 specific recommendations based on the latest domestic and international research findings and clinical evidence,as well as combines with clinical practice,aiming to standardize healthcare-associated infection prevention and control measures for CJD and reduce its transmission risk in medical institutions.
5.Reliability and validity of the Chinese version of the Consultation and Relational Empathy (CARE) measure in Mandarin speaking population
Feiyue WANG ; Yun WEI ; Haiyan YU ; Yanli LIU ; Yali ZHAO ; Xiaoqin LU ; Guanghui JIN
Chinese Journal of General Practitioners 2025;24(6):713-721
Objective:To evaluate the reliability and validity of the Chinese version of Consultation and Relational Empathy (CARE) Measure in the Mandarin speaking population.Methods:From March to June 2018, patient interviews and expert consultations were conducted to explore problems of CARE in Mandarin context and preliminary revisions were made to the measure, then the final adapted tool was developed. A questionnaire survey on the validity of the measure was conducted from July to August 2018, among 373 patients from three community health service centers in Beijing Chaoyang District, selected by convenience sampling. The questionnaire included general information of participants and the revised CARE measure. The results of the survey were analyzed for the reliability and validity of Chinese version of CARE measure.Results:In the culture adaptation stage, 30 word-changes and 13 phrase-changes were made to improve the cultural adaptation of CARE. A total of 373 valid questionnaires were were collected with a valid recovery rate of 100.0%. The participants had a mean age of (60.8±13.12) years, with females of 68.6% (256/373), junior high school or high school education of 58.7% (219/373), and retirees of 71.3% (266/373). The results showed that there was a significant difference in scores of each item between the high group (top 27%) and the low group (bottom 27%) ( P<0.001). There was a positive correlation between each item and the total score, with a correlation coefficient between 0.817 and 0.868 ( P<0.001). The reliability analysis results show that the Cronbach′s α of the revised CARE was 0.960. In the content validity analysis, among the 10 items, the proportion of patients who considered the item "not applicable" was between 1.1% and 4.8%, and the proportion who considered the item "important" was between 92.8% and 96.2%. In exploratory factor analysis, KMO=0.944 and Bartlett′s sphericity test P<0.001. One common factor with an eigenvalue>1 was extracted, and the cumulative variance explained by which was 73.85%, with the load value of each item of 0.815-0.909. Conclusion:The revised Chinese version of CARE measure shows good reliability and validity and it can be applied in primary care settings for Mandarin speaking population.
6.Prevalence and influencing factors of arteriosclerosis in different examination items in health check-up population
Yujing JIN ; Ying GAO ; Wei WEI ; Haiyan SU ; Qing ZHANG
Chinese Journal of Health Management 2025;19(5):329-334
Objective:To analyze the prevalence and influencing factors of arteriosclerosis in different examination items in health check-up population.Methods:It was a cross-sectional study. A total of 4 479 subjects who underwent fundus, carotid artery color ultrasound and arteriosclerosis detector examinations in the Health Management Center at Tianjin Medical University General Hospital from January to December 2019 were selected as the study objects. The data including age, gender, family history and biochemical indicators were collected. The detection outcomes of arteriosclerosis and the distribution in different age and gender subgroups were analyzed. Kappa consistency test was used to analyze the consistency of different examination items of arteriosclerosis examination. The multiple logistic regression model was used to analyze the influencing factors of different examination items of arteriosclerosis detection. Results:Among the 4 479 subjects included in the analysis, 2 450 were male and 2 029 were female, with a mean age of (44.48±8.12) years. Arteriosclerosis was detected in one examination item in 1 167 cases (26.05%), 1 042 cases (23.26%) in two examination items, and 617 cases (13.78%) in three examination items, respectively. Among patients aged ≤40 years, 149 cases (18.91%) were detected with arteriosclerosis. In the age group of 40<-60 years, arteriosclerosis was detected in 2 660 patients (72.40%). All patients >60 years old exhibited arteriosclerosis, with 16 cases (94.12%) showing ≥2 items of arteriosclerosis. The results of fundus and carotid artery color Doppler ultrasound, fundus and arteriosclerosis detector, carotid artery color Doppler ultrasound and arteriosclerosis detector all demonstrated moderate consistency ( Kappa=0.32, 0.34, 0.24; all P<0.01). Logistic regression analysis revealed that the age ( OR=2.07, 95% CI: 1.97-2.17), male ( OR=1.60, 95% CI: 1.14-2.23), body mass index ( OR=1.10, 95% CI: 1.05-1.15), and systolic blood pressure ( OR=1.02, 95% CI: 1.01-1.03) were positively correlated with fundus arteriosclerosis (all P<0.05). Similarly, age ( OR=1.13, 95% CI: 1.12-1.14), male ( OR=2.53, 95% CI: 2.07-3.09), systolic blood pressure ( OR=1.02, 95% CI: 1.01-1.03), and low-density lipoprotein cholesterol ( OR=1.61, 95% CI: 1.16-2.23) were positively correlated with cervical arteriosclerosis, while high-density lipoprotein cholesterol ( OR=0.48, 95% CI: 0.32-0.72) was negatively correlated with cervical arteriosclerosis (all P<0.05). Furthermore, age ( OR=1.09, 95% CI: 1.08-1.11), male ( OR=1.55, 95% CI: 1.25-1.92), systolic blood pressure ( OR=1.08, 95% CI: 1.07-1.09), diastolic blood pressure ( OR=1.02, 95% CI: 1.00-1.03), postprandial blood glucose ( OR=1.09, 95% CI: 1.03-1.15), homocysteine ( OR=1.02, 95% CI: 1.00-1.03), and fibrinogen ( OR=1.26, 95% CI: 1.04-1.52) were positively correlated with systemic arterial stiffness (all P<0.05). Conclusions:The detection rates of arteriosclerosis in different examination items among the health check-up population vary. Age, male gender and systolic blood pressure are positive correlation factors for the three detection items of arteriosclerosis. For the examinees with aggregated risk factors, the multi-site and combined screening mode has certain significance for the early diagnosis and screening of arteriosclerotic diseases.
7.Clinical pathway for integrated traditional Chinese and Western medicine in the diagnosis and treatment of acute pancreatitis
Yuan ZHANG ; Hao WANG ; Haiyan YIN ; Shengwei JIN ; Bangjiang FANG ; Guiwei LI ; Xijing ZHANG ; Hongmei GAO ; Donghao WANG ; Changsong WANG ; Keliang XIE ; Lai JIANG ; Yan QU ; Zhaocai ZHANG ; Jianying KAN ; Daihua YU ; Junling LIU ; Jun LI ; Weiwei AN ; Yong CHEN ; Jianbo YU
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care 2025;32(3):257-261
Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.
8.Clinical characteristics and efficacy of glyceryl phenylbutyrate treatment in 20 pediatric patients with urea cycle disorder
Wenjuan QIU ; Chengkai SUN ; Yuan XIAO ; Xiaoyan HUANG ; Cui SONG ; Jin WU ; Haiyan WEI ; Liwen WU ; Dan YU ; Hongwei DU ; Chen LIU ; Xuefan GU
Chinese Journal of Pediatrics 2025;63(9):1005-1010
Objective:To investigate the clinical characteristics of urea cycle disorder (UCD), the efficacy and safety of glyceryl phenylbutyrate (GPB) therapy in pediatric patients with UCD.Methods:This study was a retrospective, single-arm, multicenter clinical study. The clinical data of 20 pediatric patients with UCD who received GPB treatment at 9 hospitals nationwide between December 2021 and August 2024 were collected. The clinical manifestations, laboratory results, and molecular genetic characteristics were analyzed, ammonia levels and other laboratory results were evaluated pre-post GPB therapy by paired t-tests or Wilcoxon tests. Results:Among the 20 pediatric patients with UCD, there were 8 males and 12 females, and the onset age was 2.8 (1.4, 5.7) years. The ammonia levels were 174 (125, 342) μmol/L at first onset. The symptoms included vomiting in 6 cases, drowsiness in 5 cases, epilepsy in 5 cases, developmental delay in 5 cases, psychiatric and behavioral abnormalities in 3 cases, and lethargy in 1 case, and 18 cases exhibited abnormal liver function. Twenty cases included 6 UCD subtypes, with 11 cases being ornithine transcarbamylase deficiency. A total of 27 variants were identified, 11 (41%) of which were novel. The age of patients who began GPB therapy was 4.0 (1.5, 6.6) years. Ten cases stopped GPB after 4.2 (3.4, 5.3) months, with 4 patients undergoing liver transplantation and 6 discontinuing for financial reasons. The remaining ten patients continued GPB therapy for 11.6 (8.6, 14.0) months. The duration of GPB treatment was 6.0 (4.2, 12.3) months, at the final visit, the levels of ammonia, platelets and aspartate aminotransferase were lower compared to those of pre-treatment (all P<0.05). The serum albumin level was higher than that of pre-treatment ( P=0.016). Two patients suffered only one episode of acute hyperammonaemia, with ammonia levels of 232 and 141 μmol/L, respectively. Nine cases experienced adverse effects potentially related to GPB, decreased appetite in 6 cases, vomiting in 3 cases, abnormal skin oil odor in 2 cases, somnolence, fatigue and diarrhea each in 1 case, with symptoms improved within 6 (3, 10) days. Conclusions:UCD primarily manifests with neurological and gastrointestinal symptoms, and early diagnosis of UCD could be achieved through the analysis of ammonia. GPB may effectively reduce ammonia levels in UCD pediatric patients, with favorable safety and tolerability.
9.Fundus imaging features of glucocorticoid-related central serous chorioretinopathy
Bo JIN ; Pei LIU ; Shu LI ; Chenyu LU ; Guangqi AN ; Haiyan ZHU ; Liping DU ; Xuemin JIN
Chinese Journal of Ocular Fundus Diseases 2025;41(5):358-363
Objective:To compare and observe the fundus imaging characteristics of eyes with glucocorticoid-related central serous chorioretinopathy (CSC).Methods:A retrospective clinical study. A total of 149 CSC patients with 166 eyes diagnosed at Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University from March 2021 to October 2024 were included in the study. The duration of the disease from the appearance of symptoms to treatment was less than 3 months. All affected eyes underwent best-corrected visual acuity (BCVA), fundus color photography, swept-source optical coherence tomography (SS-OCT), and fundus fluorescein angiography (FFA) examinations. BCVA was tested using an international standard vision chart and converted into logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical analysis. The SS-OCT instrument measured subfoveal choroidal thickness (SFCT), central macular thickness (CMT), choroidal vascular volume (CVV), and the width and height of flat irregular pigment epithelial detachment (FIPED). FIPED, subretinal fibrin, and choroidal layer strong reflective spots were identified from SS-OCTA B-scan images; multiple leakages (leak points >3) were identified from FFA images. Based on the presence or absence of a clear history of glucocorticoid administration before the onset, patients were divided into glucocorticoid-related and non-glucocorticoid-related groups, comprising 41 patients with 53 eyes and 108 patients with 113 eyes, respectively. Clinical and fundus imaging characteristics of the two groups were compared. The comparison of quantitative data between the two groups was performed using independent samples t test or non-parametric independent samples Wilcoxon test; the comparison of qualitative data was performed using χ2 test. Results:Compared with the non-glucocorticoid-related group, the glucocorticoid-related group had a smaller male-to-female ratio and a higher bilateral incidence, and the differences were statistically significant ( χ2=4.925, 17.849; P<0.05). The logMAR BCVA for the glucocorticoid-related and non-glucocorticoid-related groups were 0.45±0.33 and 0.21±0.21, respectively; SFCT were (644.43±131.91) and (507.26±121.79) μm; CMT were (389.51±233.45) and (362.59±140.85) μm; CVV were (4.44±1.07) and (3.67±0.82) mm 3; FIPED incidence were 58.49% (31/58) and 20.35% (23/113), respectively; FIPED width and height were (1 122.01±533.98) and (742.90±388.79) μm, and (99.13±92.17) and (33.01±15.99) μm; subretinal fibrin were observed in 24 (45.28%, 24/53) and 15 (13.27%, 15/113) eyes; choroidal strong reflections were found in 38 (71.70%, 38/53) and 45 (39.82%, 45/113) eyes; multiple leak points were identified in 35 (66.03%, 35/53) and 40 (35.40%, 40/113) eyes, respectively. Compared with the non-glucocorticoid-related group, the glucocorticoid-related group had worse BCVA ( Z=-4.984), thicker SFCT ( t=6.586), larger CVV ( t=5.160), higher incidence of FIPED ( χ2=23.908), and greater width and height of FIPED ( t=2.895, Z=-3.703). The glucocorticoid-related group also had a significantly increased incidence of subretinal fibrin, choroidal strong reflections, and multiple leak points, with all differences being statistically significant ( χ2=20.565, 14.663, 13.675; P<0.05); however, the comparison of CMT showed no statistically significant difference ( Z=-0.651, P>0.05). Conclusion:Compared with non-glucocorticoid-related CSC, glucocorticoid-related CSC patients have poorer vision, are more likely to affect both eyes, show no gender bias; choroidal vascular dilation is more significant, and damage to the outer retina and retinal pigment epithelium is more severe.
10.Evaluation of the efficacy of a customized surgical approach for congenital optic disc pit with maculopathy
Haiyan ZHU ; Ju GUO ; Pengyi ZHOU ; Qianqian ZHAI ; Bo JIN ; Kunpeng XIE ; Liping DU ; Xuemin JIN
Chinese Journal of Ocular Fundus Diseases 2025;41(5):386-392
Objective:To observe the curative effect of a personalized surgical scheme based on scanning source optical coherence tomography (SS-OCT) image features in the treatment of congenital optic disc pit (ODP) with maculopathy (ODP-M).Methods:A prospective interventional cohort study. From September 2019 to May 2024, 15 patients with 15 eyes who were diagnosed with ODP-M by ophthalmology examination in Department of Ophthalmonogy of The First Affiliated Hospital of Zhengzhou University were included in the study. Best corrected visual acuity (BCVA) and SS-OCT were performed in all affected eyes. Standard E word visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. The center retinal thickness (CRT) was measured by SS-OCT examination of macular area using VG200D of Henan SVision Imaging Technology Co., LTD. According to the morphological characteristics of ODP and the splitting, edema and detachment of macular region, combined with the degree of pulling of the boundary membrane between the posterior vitreous cortex and macular region, a personalized surgical method was designed. Class I: pars plana vitrectomy combined with macular boundary film stripping, ODP boundary film packing and vitreous cavity gas filling. Class Ⅱ: pars plana vitrectomy combined with non-retained macular boundary film stripping or ODP inner boundary film packing, vitreous cavity gas filling. Class Ⅰ and Class Ⅱ operations were performed in 10 and 5 eyes of 15 eyes, respectively. The postoperative follow-up time was >6 months. Follow-up time was performed with the same equipment before surgery. BCVA changes, CRT reduction rate and complications were observed. BCVA and CRT were compared before and after operation by paired sample t test. Results:There were 15 eyes in 15 cases, 4 eyes in 4 males and 11 eyes in 11 females. The age was (28.87±16.5) years. logMAR BCVA of the affected eye was 0.94±0.51. CRT was (697.80±301.80) μm. At the last follow-up, the logMAR BCVA was 0.53±0.49. CRT was (392.53±167.55) μm. Compared with before operation, BCVA and CRT were significantly improved, and the difference was statistically significant ( t=3.23, 3.25; P=0.006, 0.006). After surgery, transient intraocular hypertension occurred in 2 eyes, and the intraocular pressure returned to normal level after 3 to 7 days without special treatment. Two eyes underwent an unexpected second operation. Among them, one eye underwent Class Ⅰ surgery, the tunnel at ODP was closed after surgery, and there was a small amount of subretinal fluid in the macular area. Class Ⅱ surgery was performed in 1 eye with retinal reattachment. Conclusion:Personalized surgical treatment of ODP-M based on SS-OCT image features can reduce CRT and improve visual acuity.

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