1.Analysis of serological and molecular genetic characteristics of a Chinese pedigree with a B(A)06 subtype.
Dongdong TIAN ; Ding ZHAO ; Wei LI ; Zhihao LI ; Jiali YANG ; Yongfang ZHANG ; Liuchuang ZHENG
Chinese Journal of Medical Genetics 2026;43(3):220-227
OBJECTIVE:
To explore the serological and molecular genetic characteristics of a family with subtype B(A)06.
METHODS:
A neonatal hyperbilirubinemia patient who was treated at Henan Children's Hospital on June 15, 2023 due to "yellowing of the skin and gradual aggravation", and was found to have inconsistent ABO forward and reverse typing through blood type testing, was selected as the research subject. Six milliliters of peripheral blood were collected from the newborn and her family members (grandfather, grandmother, father, mother and aunt) respectively. ABO blood group identification was performed by the blood group serological method. Human genomic DNA was extracted using the nucleic acid extraction or purification reagent BT-01. ABO gene exons 2 to 7 were amplified by PCR. The PCR-specific products that were successfully amplified were sequenced by Sanger method. Taking ABO*A1.01 as the reference sequence, the ABO gene sequences of the newborn and her family members were analyzed to determine the ABO genotype. The procedures followed in this study were approved by the Ethics Committee of Henan Children's Hospital (Ethics No.: 2022-K-L036).
RESULTS:
The serological results of ABO blood group showed that the newborn, her grandfather, father and aunt were all incompatible with the forward and reverse typing. The blood group phenotype of the newborn was AwB or B(A), the blood group phenotype of the grandfather was A2B or B(A), the blood group phenotype of the father and aunt were A2B, and the blood group phenotype of the grandmother and mother were both O. The screening test results of hemolytic disease of the newborn showed that the free test detected IgG anti-A1 antibody, while the elution test, direct antiglobulin test and antibody screening results were all negative. The Sanger sequencing results showed that the newborn had variations of c.261delG, c.297A>G, c.526C>G, c.657C>T, c.703G>A, c.796C>A and c.930G>A. Her grandfather had variations of c.297A>G, C.526C>G, c.657C>T, c.703G>A, c.796C>A, c.803G>C and c.930G>A. Her grandmother had variations of c.106G>T, c.188G>A, c.189C>T, c.220C>T, c.261delG, c.297A>G, c.646T>A, c.681G>A, c.771C>T and c.829G>A. Her father and aunt had variations of c.106G>T, c.188G>A, c.189C>T, c.220C>T, c.261delG, c.297A>G, c.526C>G, c.646T>A, c.657C>T, c.681G>A, c.703G>A, c.771C>T, c.796C>A, c.829G>A and c.930G>A. Her mother had variations of c.106G>T, c.188G>A, c.189C>T, c.220C>T, c.261delG, c.297A>G, c.646T>A, c.681G>A, c.771C>T, and c.829G>A.The genotype of the newborn was ABO*BA.06/ABO*O.01.01, her grandfather was ABO*BA.06/ABO*B.01, her grandmother was ABO*O.01.02/ABO*O.01.02, her father and aunt were ABO*BA.06/ABO*O.01.02, and her mother was ABO*O.01.01/ABO*O.01.02. The ABO*BA.06 allele of the newborn, grandfather, father and aunt was caused by the c.803C>G variation in exon 7 based on the ABO*B.01 allele. The ABO*BA.06 allele can be stably inherited in this family.
CONCLUSION
The blood type of neonatal patients with B(A)06 subtype can be accurately determined by gene sequencing technology. If the forward typing is ≤ 3+ agglutination intensity in newborn ABO blood group identification, the reason should be carefully analyzed, and the molecular biology technology and family gene sequencing results should be used to jointly determine if necessary.
Humans
;
ABO Blood-Group System/genetics*
;
Female
;
Pedigree
;
Male
;
Infant, Newborn
;
Asian People/genetics*
;
Genotype
;
China
;
Blood Grouping and Crossmatching
;
Hyperbilirubinemia, Neonatal/blood*
;
East Asian People
2.Two cases of Non-classic adrenal hyperplasia: Diagnostic strategies and genetic variant analysis.
Qigang ZHANG ; Xia ZHAN ; Qing SHENG ; Mi YU ; Yinbao LU
Chinese Journal of Medical Genetics 2026;43(4):273-280
OBJECTIVE:
To investigate the clinical characteristics, steroid hormone profiles, and genetic variants in two female patients with Non-classic adrenal hyperplasia (NCAH).
METHODS:
Clinical data and samples were collected from two patients who had visited Huaian Maternal and Child Health Care Hospital Affiliated to Medical College of Yangzhou University on September 27, 2022 and June 25, 2023, respectively, with an initial diagnosis of Polycystic ovary syndrome (PCOS) and suspected NCAH. Seven steroid hormones in dried blood spots were analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Single base variants and repeat/deletions in the CYP21A2 gene were analyzed by using a classic congenital adrenal hyperplasia (CAH) gene assay, and 10 related genes were analyzed by third-generation sequencing (TGS) should the variants be unclear. This study has been approved by the Medical Ethics Committee of the hospital (Ethics No.: 2025003).
RESULTS:
Patient 1 was a 14-year-old girl, and patient 2 was a 23-year-old woman with insulin resistance. Both patients had hirsutism, acne, bilateral polycystic ovarian morphology, in addition with significantly elevated serum testosterone by chemiluminescence. The steroid hormone profiles of both patients suggested a significant increase in 17-hydroxyproesterone, normal cortisol and 11-deoxycortisol. Patient 2 additionally showed a significant rise in 21-deoxycortisol. The presentation of both patients was indicative of NCAH, which was also evidenced by their respective medical histories. Sanger sequencing of long fragment PCR amplification combined with multiplex ligation-dependent probe amplification (MLPA) revealed that patient 1 harbored a mild c.92C>T (p.P31L) variant and a severe variant with a large segmental deletion in CYP21A2. Patient 2 was finally confirmed by TGS to carry mild CYP21A2 variants in the 5' untranslated region (5' UTR) promotor region (c.-126C>T, c.-113G>A, c.-110T>C) and a severe c.293-13C/A>G variant. The promotor region variants had resulted in decompression of the long fragment P1X/P2 amplification, leading to homozygous result of Sanger sequencing for c.293-13C/A>G, which in turn halved the amplification signal for the wt-113 SNP probe. In addition, the wtI2G-A probe was enhanced by interference in the MLPA assay.
CONCLUSION
This study demonstrated that NCAH should be excluded when PCOS is accompanied by a significant increase in serum testosterone, that mass spectrometry of steroid hormone profiles containing 17-hydroxyprogesterone is useful for the detection of NCAH, and that TGS is advantageous in confirming the diagnosis of NCAH when compared with conventional genetic testing methods.
Humans
;
Female
;
Adrenal Hyperplasia, Congenital/blood*
;
Adolescent
;
Steroid 21-Hydroxylase/genetics*
;
Young Adult
;
Genetic Variation
;
Adult
3.Incidental findings from cell-free fetal DNA-based non-invasive prenatal testing: Research progress on maternal tumors.
Zhuangping ZHANG ; Xinni SHU ; Yaping HOU
Chinese Journal of Medical Genetics 2026;43(4):301-306
Non-invasive prenatal testing (NIPT) based on fetal free DNA is a non-invasive technique to screen for common fetal aneuploidies by analyzing cell-free fetal DNA (cffDNA) in the peripheral blood of pregnant women. This technique has opened a new era of prenatal screening for its high safety and reliability. In recent years, it has been shown that NIPT can not only screen for fetal aneuploidies, but may also reveal maternal genomic abnormalities. The incidental detection of maternal tumors has aroused widespread concern in the clinical settings. The aim of this review is to systematically summarize the research progress of NIPT technique in incidental detection of maternal tumors, and to discuss its clinical significance, technical challenges, and future development direction. It has been found that multiple chromosome aneuploidies (MCAs) in NIPT detection is one of the important biomarkers suggesting occult maternal malignant tumors. In this paper, the relevant progress of NIPT technique in the incidental discovery of maternal tumors were reviewed in order to provide a reference for individualized and standardized application of NIPT technique in maternal health monitoring.
Humans
;
Female
;
Pregnancy
;
Cell-Free Nucleic Acids/blood*
;
Prenatal Diagnosis/methods*
;
Incidental Findings
;
Neoplasms/genetics*
;
Noninvasive Prenatal Testing/methods*
;
Aneuploidy
;
Fetus/metabolism*
4.The correlation between quality of life (QOL) and medication adherence to antihypertensive medications among middle-aged Filipino adults.
Aiella Antonia B. Recto ; Alexandria H. Requierme ; Katrina Nicole D. Requizo ; Armando Miguel I. Reyes ; Dean Adrian G. Reyes ; John Andrew N. Reyes ; Marcellus Francis L. Ramirez
Journal of Medicine University of Santo Tomas 2026;10(1):1837-1847
INTRODUCTION
Hypertension is a serious public health issue that puts individuals at risk for various morbidity and mortality indicators. One of the most crucial factors in managing blood pressure and preventing complications is medication adherence which is linked to several determinants. This study explored the correlation between medication adherence among middle-aged hypertensive adults and the different domains of quality of life (QOL), which includes physical, psychological, social relationship and environment.
METHODSThis cross-sectional study involved 96 Filipino residents of Brgy. San Jose, Navotas City aged 35 to 65 years old diagnosed with hypertension and prescribed anti-hypertensive medications. Pearson’s correlation coefficient was used to calculate the correlation between different domains of QOL as well as the overall QOL score.
RESULTSResults revealed a statistically significant but weak positive correlation between overall QOL and medication adherence (r = 0.336, p<0.001). Among the QOL domains, environmental domain had the strongest correlation with adherence (r = 0.446, p = 0.00), followed by physical health (r = 0.443, p = 0.01) and psychological well-being (r = 0.382, p = 0.01). The social relationship domain showed negligible correlation (r = 0.163, p = 0.4).
CONCLUSIONThe study demonstrates that while medication adherence is modestly associated with better perceived QOL, especially in physical, psychological and environmental aspects, other factors likely influence both outcomes. These findings highlight the need for holistic, community-based interventions that address not only medication adherence but also environmental and psychosocial barriers to care in managing hypertension.
Human ; Adult: 25-44 Yrs Old ; Middle Aged: 45-64 Yrs Old ; Aged: 65-79 Yrs Old ; Quality Of Life ; Public Health ; Medication Adherence ; Antihypertensive Agents ; Blood Pressure ; Interpersonal Relations
5.Quality of care among patients with acute heart failure at the emergency room and adherence of physicians at the University of the Philippines – Philippine General Hospital to the division of cardiovascular medicine – heart failure pathway:A retrospective cohort study.
Mark John D. Sabando ; Felix Eduardo R. Punzalan ; Frances Dominique V. Ho ; Tam Adrian P. Aya-ay ; Kevin Paul Da. Enriquez ; Marie Kirk A. Maramara ; Ronald Allan B. Roderos ; Lauren Kay M. Evangelista
Acta Medica Philippina 2026;60(2):22-32
OBJECTIVES
Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.
METHODSThis was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.
RESULTSTwo hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid - stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.
CONCLUSIONOverall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.
Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult ; Albumins ; Blood ; Blood Urea Nitrogen ; Calcium ; Cardiology ; Chart ; Charts ; Cohort Studies ; Critical Care ; Critical Pathways ; Diagnostic Equipment ; Disease ; Diuretics ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Equipment And Supplies ; Evaluation Studies As Topic ; Feedback ; Heart ; Heart Diseases ; Heart Failure ; Hormones ; Hospitals ; Hospitals, General ; Humans ; Hypertension ; Indicators And Reagents ; Infection ; Infections ; Inpatients ; Intensive Care Units ; Internal Medicine ; Lead ; Magnesium ; Male ; Medicine ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Nitrogen ; Overall ; Oxygen ; Partial Thromboplastin Time ; Patients ; Peptides ; Philippines ; Physicians ; Potassium ; Prothrombin ; Prothrombin Time ; Quality Of Health Care ; Referral And Consultation ; Sodium ; Statistics ; Tertiary Care Centers ; Thorax ; Thromboembolism ; Thromboplastin ; Thyroid Gland ; Time ; Troponin ; Troponin I ; Universities ; Urea ; Urinalysis ; Urine ; Venous Thromboembolism ; Vital Signs ; Work ; Workforce
6.Comparison of Longer and Shorter Hemodialysis Duration on Nutritional Status and Quality of Life of Hemodialysis Patients
Nur Samsu ; Devi Santi Fatmawati ; Farida Wibisono ; Kartin Kartin ; Wahyu Wulandari ; Ayu Radyan Sephani ; Renny Tandya ; Angelina Gemilang Kartikasari Kosasih
Acta Medica Indonesiana 2026;58(1):15-25
Abstract
Background: Important determinants of dialysis adequacy are blood flow rate (BFR) and dialysis time. This study aimed to evaluate the impact of BFR and duration of dialysis session on nutritional status and quality of life (QoL) in hemodialysis (HD) patients. Methods: Real-world evidence studies (RWE) of 3 HD units that differ in BFR and/or dialysis time. Group I, HD 5 hours and BFR 200-250 mL/minute; group II, HD 4 hours and BFR 270-320 mL/minute, and group III, HD 4 hours and BFR 200-250 mL/minute. All HD units use the same dialysate flow and dialysis frequency. The 3-point Subjective Global Assessment (SGA) scale is used to assess nutritional status, while QOL is assessed using the SF-36. Results: There were 291 chronic HD patients with an average age of 51 (12.3) years, 50.5% were male. The proportion of SGA classes between groups did not differ significantly. Group I was associated with significantly higher PF and RP domain scores of PC and VT domain scores of MC compared to Group III. On the other hand, Group II was associated with significantly lower VT and MH domain scores of MC compared to Group I, while the other domains were not significantly different. In general, Group III had the lowest SF-36 scores compared to the other 2 groups. Conclusion: Duration of HD was not associated with nutritional status. Compared with 4-hour HD but with a faster BFR, 5-hour HD was associated with higher Mental Component QOL scores, but not Physical Component scores.
subjective global assessment
;
SF-36 questionnaire
;
blood flow rate
;
dialysis time
7.Real-World Continuous Glucose Monitoring Patterns in Malaysian Adults With Type 2 Diabetes: A Single-Centre Study
Ryan Jia Xian Koh ; Siti Nabilah Atiqah Othman ; Maszariffah Mashor ; Azni Abdul Latif ; Ooi Chuan Ng
Journal of the ASEAN Federation of Endocrine Societies 2026;41(S1):45-46
Introduction:
Malaysia has one of the highest diabetes prevalence rates
in Asia (1 in 5), with >50% fail to achieve optimal glycemic
control. Continuous glucose monitoring (CGM) provides
detailed insights beyond hemoglobin A1c (HbA1c),
capturing daily glucose fluctuations and variability. Realworld data describing CGM patterns and their clinical
associations in Malaysian adults with type 2 diabetes
mellitus (T2DM) are limited.
Methodology:
This cross-sectional study analyzed CGM data from 25
Malaysian adults with T2DM, standardized over 14 days.
CGM metrics included time in range (TIR), time above
range (TAR), time below range (TBR), mean glucose,
and coefficient of variation (CV). Weekday–weekend
comparisons were performed, and correlations with
age, diabetes duration, HbA1c, body mass index (BMI),
treatment regimen, and complications were assessed.
Results:
Participants had a mean age of 56.2 ± 13.2 years (52%
male), mean HbA1c 9.4 ± 2.7%, diabetes duration 10.7 ±
9.0 years, and BMI 29.8 ± 9.4 kg/m². Mean TIR, TAR, TBR,
mean glucose, and CV were similar between weekdays
and weekends (p >0.34 for all). TIR >70% was achieved by
52% of participants on weekdays and 48% on weekends,
with no statistically significant difference (p = 0.75). Longer
diabetes duration correlated with lower TIR (r = −0.62, p <0.001), higher mean glucose (r = 0.58, p = 0.002), and greater
variability (r = 0.54, p = 0.004). Older age was associated with
lower TIR (r = −0.48, p = 0.014) and higher mean glucose (r
= 0.44, p = 0.025). Higher HbA1c correlated with lower TIR
(r = −0.36, p = 0.04), higher TAR (r = 0.35, p = 0.05), greater
variability (r = 0.51, p = 0.006), and increased target organ
damage (ρ = 0.55, p = 0.004). BMI was not associated with
TIR (r = −0.18, p = 0.38). Participants with ≥2 complications
had lower TIR (55.8 ± 28.4% vs 76.7 ± 19.2%, p = 0.073), while
insulin the
Conclusion
In Malaysian adults with T2DM, CGM metrics were similar
between weekdays and weekends, indicating lifestyle
differences had minimal impact on glycemic control. Longer
diabetes duration, older age, higher HbA1c, multiple
complications, and insulin therapy identified patients at
highest risk for poor glycemic control, greater variability,
and hypoglycemia. These findings support the use of
CGM for risk stratification, individualized monitoring,
and therapy optimization to reduce complications and
hypoglycemia risk.
Adult
;
Blood Glucose
;
Blood Glucose Self-Monitoring
;
Continuous Glucose Monitoring
;
Diabetes Mellitus, Type 2
8.Blood Pressure Improves After Bariatric Surgery Across Patient Subgroups
Liyana Ahmad Zamri ; Nur Azlin Zainal Abidin ; Farah Huda Mohkiar ; You Zhuan Tan ; Fazliana Mansor ; Yue Tsen Poh ; Shu Yu Lim ; Gee Tikfu
Journal of the ASEAN Federation of Endocrine Societies 2026;41(S1):58-59
Introduction:
Hypertension is common in obesity and increases
cardiovascular risk. Bariatric surgery improves metabolic
health, but subgroup differences in blood pressure response
remain unclear. This study examined 1-year changes in
systolic blood pressure (SBP) and diastolic blood pressure
(DBP) after bariatric surgery across sex, age group, and
diabetes status.
Methodology:
This study included 32 obese adults undergoing bariatric
surgery, with blood pressure measured at baseline, 6
and 12 months. Generalized estimating equation models
were used to evaluate changes in SBP and DBP over time,
adjusting for age, sex, surgery type, diabetes category,
baseline body mass index, antihypertensive medication
use, and baseline blood pressure. Interaction terms were
tested to assess differences in blood pressure trajectories
across subgroups.
Results:
Participants were predominantly female (67.4%), with a
mean age of 36.9 ± 6.2 years and a mean body mass index
of 40.7 ± 8.8 kg/m². Hypertension and diabetes were present
in 40.6 and 31.3% of participants, respectively. There was a
significant time effect for both SBP (p <0.001) and DBP (p
= 0.004). At 12 months post-surgery, mean SBP decreased
by 15 mmHg and DBP by 7.9 mmHg compared with
baseline (both p <0.001). No significant interactions were
observed between time and sex, diabetes category, or age
category, indicating that blood pressure improvements
were comparable across subgroups.
Conclusion
Bariatric surgery was associated with clinically meaningful
reductions in both SBP and DBP, with similar improvement
patterns observed across demographic and metabolic subgroups. These findings support the effectiveness of bariatric
surgery as a strategy for blood pressure reduction and
cardiovascular risk management in patients with obesity.
Blood Pressure
;
Bariatric Surgery
9.Vitamin D and bone metabolism characteristics in knee osteoarthritis with osteoporosis patients.
Xue-Zong WANG ; Yu LU ; Dao-Fang DING ; Yu-Xin ZHENG ; Yue-Long CAO
China Journal of Orthopaedics and Traumatology 2025;38(4):352-357
OBJECTIVE:
To investigate the characteristics of Vitamin D (VitD) and bone metabolism in patients with knee osteoarthritis (KOA) concurrent with osteoporosis (OP).
METHODS:
A retrospective analysis was performed on 240 patients who were admitted to the orthopedics department between March 2019 and March 2024. Patients were stratified into four distinct groups according to their respective disease categories.There were 90 patients in the simple KOA group, comprising 13 males and 77 females, age ranged from 50 to 91 years old with an average of (68.48±8.96) years old. There were 90 patients in the simple OP group, comprising 7 males and 83 females, age ranged from 52 to 88 years old with an average of (69.60±8.94 )years old. There were 30 patients in the KOA with OP group, comprising 1 male and 29 females, age ranged from 51 to 91 years old with an average of(69.03±7.93) years old. There were 30 patients in the physical examination group, comprising 5 males and 25 females, age ranged from 53 to 79 years old with an average of(64.93±6.51) years old. The general data and the levels of osteocalcin (OC), β-CrossLaps, parathyroid hormone(PTH) and VitD in each group were observed.
RESULTS:
The level of VitD in KOA with OP group (19.62±10.38) ng·ml-1 and OP group (20.65±10.50) ng·ml-1 was lower than that in physical examination group (27.46±8.00) ng·ml-1 and KOA group (24.01±9.11) ng·ml-1 (P<0.05). There were significant differences in β- CrossLaps and PTH levels among the four groups (P<0.001, P=0.019, respectively), while there was no significant difference in OC levels (P=0.763). Compared with the two simple disease groups, the KOA with OP group had higher levels of β - CrossLaps(0.81±0.30) ng·ml-1 (P<0.001). There were significant differences in β-CrossLaps and PTH between the simple KOA group(0.54±0.22) ng·ml-1, (46.03±18.08) pg·ml-1 and the physical examination group (0.44±0.19) ng·ml-1, (36.65±9.63) pg·mL-1(P=0.038;P=0.006). There was a significant difference in PTH between the OP group(43.85±14.30) ng·ml-1, and the physical examination group, P=0.004. There was a significant difference in Kallgren-Lawrence grading between KOA with OP group and KOA group (P=0.006). Within KOA with OP group, the differences of β-CrossLaps and VitD levels among different K-L grades were statistically significant (P=0.016). The level of OC, β-CrossLaps and PTH within KOA with OP group was significantly different at different VitD levels (P=0.013, P=0.033, P=0.046).
CONCLUSION
Patients with KOA complicated by OP exhibit greater disturbances in bone metabolism and reduced VitD levels, particularly reflected by elevated β-CrossLaps. These findings underscore the importance of early monitoring of bone turnover and VitD supplementation in advanced-stage KOA with bone loss.
Humans
;
Female
;
Male
;
Middle Aged
;
Aged
;
Vitamin D/blood*
;
Osteoporosis/complications*
;
Aged, 80 and over
;
Osteoarthritis, Knee/complications*
;
Retrospective Studies
;
Bone and Bones/metabolism*
;
Parathyroid Hormone/metabolism*
;
Osteocalcin/metabolism*
10.Predictive value of combined examination of coagulation and fibrinolysis indexes for deep venous thrombosis after proximal femoral nail anti-rotation in elderly patients with femoral intertrochanteric fracture.
Hong-Feng ZHANG ; An-Ji HE ; Xi-Lin ZHAO
China Journal of Orthopaedics and Traumatology 2025;38(4):371-377
OBJECTIVE:
To investigate the prognostic significance of combined coagulation and fibrinolysis marker analysis in predicting the development of deep venous thrombosis (DVT) following proximal femoral anti-rotation intramedullary nail (PFNA) surgery in elderly patients with intertrochanteric femur fractures.
METHODS:
A retrospective analysis was conducted on the clinical data of 80 elderly patients who underwent PFNA treatment for intertrochanteric fractures between April 2019 and April 2023. There were 26 males and 54 females. The patients' ages ranged from 60 to 85 years old, with a mean age of (76.4±5.6) years old. According to the occurrence of DVT following PFNA, patients were categorized into two groups. The DVT group were 29 patients, comprising 10 males and 19 females with a mean age of (76.9 ± 6.1)years old. And the non-DVT group were 51 patients, consisting of 16 males and 35 females with a mean age of (75.3 ± 6.9 )years old. The prothrombin time (PT), activated partial thromboplastin time(APTT), thrombin time(TT), plasma fibrinogen (FIB), plasma thrombin-antithrombin complex(TAT), and D-dimer levels were compared between the two groups immediately post- PFNA surgery, as well as at 3 and 7 days postoperatively. Pearson correlation analysis was conducted to evaluate the relationship between plasma FIB, TAT, and D-dimer levels in patients who developed DVT. Multivariate logistic regression analysis was employed to assess the association between each coagulation and fibrinolysis index following PFNA surgery in elderly patients and the incidence of DVT. The area under the receiver operating characteristic (ROC) curve (AUC) was utilized to determine the predictive value of PT, APTT, TT, FIB, TAT, and D-dimer for postoperative DVT occurrence.
RESULTS:
There were no statistically significant differences in PT, APTT, and TT between the two groups immediately post-surgery, at 3 days, and at 7 days (P>0.05). At immediately, 3 days and 7 days postoperatively in DVT group, FIB were (4.68±1.77), (6.73±2.02), (8.81±2.86) g·L-1, TAT were (10.64±2.30), (12.88±3.45), (14.96±4.87) μg·L-1 respectively. D-dimer were (635.00±100.88), (720.02±168.09), (810.47±170.19) μg· L-1, respectively.In the DVT group FIB were (3.46±0.47), (3.55±0.52), (3.67±0.48) g·L-1, TAT were (8.58±3.37), (8.69±3.48), (8.80±3.50) g·L-1, D-dimer were (588.36±96.68), (589.58±96.45), (591.11±95.50) g·L-1. The difference between the two groups was statistically significant (P<0.05). Pearson correlation analysis revealed significant positive correlations between FIB and D-dimer(r=0.428, 0.523, P<0.05), FIB and TAT(r=0.517, 0.411, P<0.05), as well as TAT and D-dimer(r=0.602, 0.596, P<0.05). Multivariate Logistic regression analysis revealed that FIB OR=3.252, 95% CI(0.640, 3.975), P<0.01, TAT OR=1.461, 95% CI(1.059, 2.011), P<0.05, and D-dimer OR=3.830, 95%CI (2.032 to 7.213), P<0.01 were significantly associated with the development of DVT following PFNA surgery. The combined detection of PT, APTT, TT, FIB, TAT, and D-dimer demonstrates significantly greater predictive value for the occurrence of DVT following PFNA surgery compared to individual index detection (P<0.01).
CONCLUSION
The combined detection of PT, APTT, TT, FIB, TAT and D-D has a high predictive value for DVT in elderly patients with femoral intertrochanteric fracture after PFNA, which is of vital importance in the early diagnosis of DVT and early prevention of pulmonary embolism and other serious complications.
Humans
;
Male
;
Female
;
Venous Thrombosis/diagnosis*
;
Aged, 80 and over
;
Aged
;
Fibrinolysis
;
Retrospective Studies
;
Blood Coagulation
;
Hip Fractures/blood*
;
Fracture Fixation, Intramedullary/adverse effects*
;
Middle Aged
;
Postoperative Complications/blood*
;
Bone Nails/adverse effects*


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