1.Effects of methyl oxofulnonone A ameliorates hyperglucose-induced H9c2 cardiomyocyte injury
Ming-hui OUYANG ; Xiao-tong GUO ; Ting LIU ; Li-ying CHENG ; Zi-chang NIU ; Hao-ping MAO
The Chinese Journal of Clinical Pharmacology 2025;41(1):45-49
Objective To investigate the effect and mechanism of methyl oxofulnonone A(META)on high glucose(HG)-induced H9c2 cell injury.Methods H9c2 cells were divided into control group(normal culture),model group(55 mmol·L-1 glucose)and experimental-L,-M,-H groups(55 mmol·L-1 glucose+12.5,25.0,50.0 μmol·L-1 META).Cell viability was detected by cell counting kit-8;intracellular reactive oxygen species(ROS)level was detected by DCFH-DA fluorescent probe;intracellular adenosine triphosphate(ATP)content was detected by luciferase;and autophagy-related protein expression was detected by Western blotting.Results The optical density values of 72-hour cells in the control group,model group and experimental-M,-H groups were 0.91±0.03,0.61±0.01,0.69±0.02 and 0.72±0.03;the ROS levels were(40.75±1.53)%,(43.73±1.30)%,(30.87±1.27)%and(28.28±1.43)%;the ATP contents were(8.16±0.71),(4.03±0.29),(5.29±0.31)and(5.83±0.31)nmol·mg-1;the relative expression levels of autophagy-related gene 5 protein were 1.05±0.06,1.46±0.09,0.98±0.11 and 0.89±0.09;the relative expression levels of ubiquitin-binding protein were 1.05±0.10,0.55±0.13,0.89±0.04 and 0.98±0.04;the ratios of microtubule-associated protein 1 light chain 3 11/Ⅰ protein were 1.09±0.09,1.82±0.05,1.67±0.29 and 1.09±0.15,respectively.Among the above indicators,there were statistically significant differences between the model group and the control and experimental-M,-H groups(P<0.05,P<0.01).Conclusion META significantly ameliorates H9c2 cardiomyocyte damage caused by high glucose,ameliorates oxidative stress,protects mitochondrial respiration and inhibits autophagy.
2.Effects of methyl oxofulnonone A ameliorates hyperglucose-induced H9c2 cardiomyocyte injury
Ming-hui OUYANG ; Xiao-tong GUO ; Ting LIU ; Li-ying CHENG ; Zi-chang NIU ; Hao-ping MAO
The Chinese Journal of Clinical Pharmacology 2025;41(1):45-49
Objective To investigate the effect and mechanism of methyl oxofulnonone A(META)on high glucose(HG)-induced H9c2 cell injury.Methods H9c2 cells were divided into control group(normal culture),model group(55 mmol·L-1 glucose)and experimental-L,-M,-H groups(55 mmol·L-1 glucose+12.5,25.0,50.0 μmol·L-1 META).Cell viability was detected by cell counting kit-8;intracellular reactive oxygen species(ROS)level was detected by DCFH-DA fluorescent probe;intracellular adenosine triphosphate(ATP)content was detected by luciferase;and autophagy-related protein expression was detected by Western blotting.Results The optical density values of 72-hour cells in the control group,model group and experimental-M,-H groups were 0.91±0.03,0.61±0.01,0.69±0.02 and 0.72±0.03;the ROS levels were(40.75±1.53)%,(43.73±1.30)%,(30.87±1.27)%and(28.28±1.43)%;the ATP contents were(8.16±0.71),(4.03±0.29),(5.29±0.31)and(5.83±0.31)nmol·mg-1;the relative expression levels of autophagy-related gene 5 protein were 1.05±0.06,1.46±0.09,0.98±0.11 and 0.89±0.09;the relative expression levels of ubiquitin-binding protein were 1.05±0.10,0.55±0.13,0.89±0.04 and 0.98±0.04;the ratios of microtubule-associated protein 1 light chain 3 11/Ⅰ protein were 1.09±0.09,1.82±0.05,1.67±0.29 and 1.09±0.15,respectively.Among the above indicators,there were statistically significant differences between the model group and the control and experimental-M,-H groups(P<0.05,P<0.01).Conclusion META significantly ameliorates H9c2 cardiomyocyte damage caused by high glucose,ameliorates oxidative stress,protects mitochondrial respiration and inhibits autophagy.
3.Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients (version 2024)
Yao LU ; Yang LI ; Leiying ZHANG ; Hao TANG ; Huidan JING ; Yaoli WANG ; Xiangzhi JIA ; Li BA ; Maohong BIAN ; Dan CAI ; Hui CAI ; Xiaohong CAI ; Zhanshan ZHA ; Bingyu CHEN ; Daqing CHEN ; Feng CHEN ; Guoan CHEN ; Haiming CHEN ; Jing CHEN ; Min CHEN ; Qing CHEN ; Shu CHEN ; Xi CHEN ; Jinfeng CHENG ; Xiaoling CHU ; Hongwang CUI ; Xin CUI ; Zhen DA ; Ying DAI ; Surong DENG ; Weiqun DONG ; Weimin FAN ; Ke FENG ; Danhui FU ; Yongshui FU ; Qi FU ; Xuemei FU ; Jia GAN ; Xinyu GAN ; Wei GAO ; Huaizheng GONG ; Rong GUI ; Geng GUO ; Ning HAN ; Yiwen HAO ; Wubing HE ; Qiang HONG ; Ruiqin HOU ; Wei HOU ; Jie HU ; Peiyang HU ; Xi HU ; Xiaoyu HU ; Guangbin HUANG ; Jie HUANG ; Xiangyan HUANG ; Yuanshuai HUANG ; Shouyong HUN ; Xuebing JIANG ; Ping JIN ; Dong LAI ; Aiping LE ; Hongmei LI ; Bijuan LI ; Cuiying LI ; Daihong LI ; Haihong LI ; He LI ; Hui LI ; Jianping LI ; Ning LI ; Xiying LI ; Xiangmin LI ; Xiaofei LI ; Xiaojuan LI ; Zhiqiang LI ; Zhongjun LI ; Zunyan LI ; Huaqin LIANG ; Xiaohua LIANG ; Dongfa LIAO ; Qun LIAO ; Yan LIAO ; Jiajin LIN ; Chunxia LIU ; Fenghua LIU ; Peixian LIU ; Tiemei LIU ; Xiaoxin LIU ; Zhiwei LIU ; Zhongdi LIU ; Hua LU ; Jianfeng LUAN ; Jianjun LUO ; Qun LUO ; Dingfeng LYU ; Qi LYU ; Xianping LYU ; Aijun MA ; Liqiang MA ; Shuxuan MA ; Xainjun MA ; Xiaogang MA ; Xiaoli MA ; Guoqing MAO ; Shijie MU ; Shaolin NIE ; Shujuan OUYANG ; Xilin OUYANG ; Chunqiu PAN ; Jian PAN ; Xiaohua PAN ; Lei PENG ; Tao PENG ; Baohua QIAN ; Shu QIAO ; Li QIN ; Ying REN ; Zhaoqi REN ; Ruiming RONG ; Changshan SU ; Mingwei SUN ; Wenwu SUN ; Zhenwei SUN ; Haiping TANG ; Xiaofeng TANG ; Changjiu TANG ; Cuihua TAO ; Zhibin TIAN ; Juan WANG ; Baoyan WANG ; Chunyan WANG ; Gefei WANG ; Haiyan WANG ; Hongjie WANG ; Peng WANG ; Pengli WANG ; Qiushi WANG ; Xiaoning WANG ; Xinhua WANG ; Xuefeng WANG ; Yong WANG ; Yongjun WANG ; Yuanjie WANG ; Zhihua WANG ; Shaojun WEI ; Yaming WEI ; Jianbo WEN ; Jun WEN ; Jiang WU ; Jufeng WU ; Aijun XIA ; Fei XIA ; Rong XIA ; Jue XIE ; Yanchao XING ; Yan XIONG ; Feng XU ; Yongzhu XU ; Yongan XU ; Yonghe YAN ; Beizhan YAN ; Jiang YANG ; Jiangcun YANG ; Jun YANG ; Xinwen YANG ; Yongyi YANG ; Chunyan YAO ; Mingliang YE ; Changlin YIN ; Ming YIN ; Wen YIN ; Lianling YU ; Shuhong YU ; Zebo YU ; Yigang YU ; Anyong YU ; Hong YUAN ; Yi YUAN ; Chan ZHANG ; Jinjun ZHANG ; Jun ZHANG ; Kai ZHANG ; Leibing ZHANG ; Quan ZHANG ; Rongjiang ZHANG ; Sanming ZHANG ; Shengji ZHANG ; Shuo ZHANG ; Wei ZHANG ; Weidong ZHANG ; Xi ZHANG ; Xingwen ZHANG ; Guixi ZHANG ; Xiaojun ZHANG ; Guoqing ZHAO ; Jianpeng ZHAO ; Shuming ZHAO ; Beibei ZHENG ; Shangen ZHENG ; Huayou ZHOU ; Jicheng ZHOU ; Lihong ZHOU ; Mou ZHOU ; Xiaoyu ZHOU ; Xuelian ZHOU ; Yuan ZHOU ; Zheng ZHOU ; Zuhuang ZHOU ; Haiyan ZHU ; Peiyuan ZHU ; Changju ZHU ; Lili ZHU ; Zhengguo WANG ; Jianxin JIANG ; Deqing WANG ; Jiongcai LAN ; Quanli WANG ; Yang YU ; Lianyang ZHANG ; Aiqing WEN
Chinese Journal of Trauma 2024;40(10):865-881
Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.
4.Kaixin San ameliorating doxorubicin-induced neurotoxicity by activating AMPK signaling pathway.
Ying-Chao WU ; Jia-Qi CUI ; Hui WANG ; Da-Jin PI ; Li-Guo CHEN ; Ming-Zi OUYANG ; Qian-Jun CHEN
China Journal of Chinese Materia Medica 2024;49(24):6763-6772
The study explored the pathological mechanism of doxorubicin chemotherapy-induced neurotoxicity and the intervention methods of traditional Chinese medicine. BALB/c mice were selected to establish tumor-bearing mouse models by orthotopic injection of 4T1 triple-negative breast cancer cells. After randomization, the mice were treated with doxorubicin chemotherapy or doxorubicin chemotherapy + Kaixin San(KXS). The lesions in the prefrontal cortex of mice were observed by pathological examination, and the lesion information was obtained by long non-coding RNA sequencing. The occurrence of lesions was determined by Western blot and biochemical indicators. In addition, neuroblastoma cells and microglia cells were used to construct in vitro models, and drug-containing serum and p-AMPK dephosphorylation inhibitors were used to further verify the accuracy of animal experiments. Pathological results showed that KXS could alleviate doxorubicin-induced neuronal degeneration in the prefrontal cortex. The long non-coding RNA sequencing suggested that neuronal degeneration and the intervention process of KXS were related to ferroptosis, immune diseases, AMPK signaling pathway, etc. Western blot and biochemical indicators confirmed that this process was directly related to the activation of the AMPK/HIF-1α/ACSL4 signaling pathway to alleviate ferroptosis of neurons and immune response of glial cells. In conclusion, KXS could alleviate doxorubicin-induced neurotoxicity by activating the AMPK signaling pathway and reducing the ferroptosis of neurons and immune response of glial cells.
Animals
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Doxorubicin/toxicity*
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Mice
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AMP-Activated Protein Kinases/genetics*
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Signal Transduction/drug effects*
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Mice, Inbred BALB C
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Drugs, Chinese Herbal/administration & dosage*
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Female
;
Humans
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Cell Line, Tumor
;
Neurotoxicity Syndromes/genetics*
5.SILENCING OF COXIELLA BURNETII DOTB BASED ON CRISPR INTERFERENCE
Chun-Yu ZHOU ; Ming-Liang ZHAO ; Ru-Xi CHENG ; Shan ZHANG ; Na-Na LI ; Yong-Hui YU ; Xuan OUYANG ; Jun JIAO ; Xiao-Lu XIONG ; Jia-Ning ZHANG
Acta Parasitologica et Medica Entomologica Sinica 2024;31(1):6-11
Objective A recombinant plasmid for CRISPR interference(CRISPRi)that incorporates dCas9 from Streptococcus pyogenes was constructed to investigate the function of Coxiella burnetii genes through a prompt,simple method.Methods A single guide RNA(sgRNA)sequence targeting C.burnetii dotB was integrated into a recombinant plasmid,which was then transformed into C.burnetii using electroporation.Next,dCas9 expression was induced with dehydrated tetracycline(aTC)to inhibit the transcription of dotB.Results The results demonstrated that dCas9 can be expressed normally in the CRISPRi system through aTC induction.Suppression of dotB was observed at the transcriptional and translational levels.In addition,the intracellular reproduction of C.burnetii significantly decreased after the suppression of dotB expression.Conclusion Silencing technology for the C.burnetii gene based on CRISPRi was established in this study,providing support for studying the biological functions of C.burnetii genes.
6.Mechanism of Proteoglycan TPG-1 from Trametes robiniophila Inhibiting Growth of Human Hepatoma SK-HEP-1 Cells
Ai-lin YANG ; Hui-ming HUANG ; Ya-xin LIU ; Li-shan OUYANG ; Hai-tao FAN ; Peng-fei TU ; Zhong-dong HU
Chinese Journal of Experimental Traditional Medical Formulae 2022;28(1):72-78
ObjectiveProteoglycan TPG-1 isolated from Trametes robiniophila(Huaier) has proved to have anti-hepatoma activity, and this paper aims to explore the molecular mechanism. MethodHuman hepatoma SK-HEP-1 cells were treated with TPG-1 (0, 0.05, 0.1, 0.25, 0.5, 1 g·L-1). Then cell survival was detected by methyl thiazolyl tetrazolium (MTT) and apoptosis by flow cytometry. In addition, expression of genes in SK-HEP-1 cells treated with or without TPG-1 was examined by DNA microarray to preliminarily explore the anti-hepatoma molecular mechanism of TPG-1. ResultTPG-1 inhibited the proliferation of SK-HEP-1 cells as compared with the blank group (P<0.01). After treatment with 1 g·L-1 TPG-1 for 48 h, the apoptosis rate of SK-HEP-1 cells increased (P<0.01), and TPG-1 promoted the cleavage of cysteinyl aspartate specific proteinase (Caspase)-3 and Caspase-7, the key mediators of apoptosis (P<0.01). Additionally, TPG-1 (1 g·L-1) suppressed the migration of SK-HEP-1 cells (P<0.05). A total of 971 differentially expressed genes (DEGs) were identified in SK-HEP-1 cells after treatment with TPG-1, with 486 up-regulated and 485 down-regulated. These DEGs were mainly involved in the Gene Ontology (GO) terms of interleukin-6 (IL-6) biosynthesis, antigen processing and presentation, superoxide dismutase activity, positive regulation of mitogen-activated protein kinase kinase kinase (MAPKKK) cascade, nature killer (NK) cell chemotaxis, and chemokine biosynthesis, and the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways of nucleotide-binding oligomerization domain (NOD)-like receptor signaling pathway, apoptosis, Toll-like receptor signaling pathway, retinoic acid-inducible gene-Ⅰ (RIG-Ⅰ)-like receptor signaling pathway, T-cell receptor signaling pathway, and chemokine signaling pathway. Western blot results showed that TPG-1 (1 g·L-1) activated mitogen-activated protein kinase (MAPK) signaling pathway in SK-HEP-1 cells (P<0.01). ConclusionProteoglycan TPG-1 inhibited the proliferation and migration, and induced apoptosis of human hepatoma SK-HEP-1 cells. Up-regulation of MAPK signaling pathway may be responsible for the growth inhibition of human hepatoma SK-HEP-1 cells by TPG-1.
7.Effect of Aqueous Extract of Trametes robiniophila on Proliferation of Human Prostate Cancer VCaP Cells
Ai-lin YANG ; Ya-xin LIU ; Hui-ming HUANG ; Li-shan OUYANG ; Jin-xin XIE ; Dong-xiao LIU ; Long-yan WANG ; Peng-fei TU ; Zhong-dong HU
Chinese Journal of Experimental Traditional Medical Formulae 2022;28(1):79-84
ObjectiveTo investigate effect of aqueous extract of Trametes robiniophila (TRM,Huaier) on autophagy of human prostate cancer VCaP cells and Lamin B1 expression, so as to uncover its role in the proliferation of VCaP cells. MethodThe inhibitory effect of 0, 2, 4, 6, 8, 10 g·L-1 TRM aqueous extract on the proliferation of human prostate cancer VCaP cells at different time points were determined by cell counting kit-8 (CCK-8) assay. Acridine orange staining was conducted for analyzing the effect of TRM aqueous extract on the formation of autolysosomes in VCaP cells. After medication, the expression of microtubule-associated protein Ⅰ light chain 3 (LC3), autophagy-related protein 3 (Atg3), autophagy-related protein 5 (Atg5), and autophagy-related protein 7 (Atg7) in VCaP cells were detected by Western blot. The effect of TRM aqueous extract alone and its combination with autophagy inhibitor bafilomycin A1 on the proliferation of VCaP cells were assayed by CCK-8 assay. RNA interference technology was used to explore the role of Lamin B1 in anti-proliferation of VCaP cells by TRM. ResultCompared with the blank group, TRM aqueous extract inhibited the proliferation of human prostate cancer VCaP cells in a time- and concentration-dependent manner (P<0.01). Acridine orange staining showed that TRM aqueous extract promoted the formation of autolysosomes in VCaP cells. As revealed by Western blotting, TRM aqueous extract up-regulated the expression levels of LC3-Ⅱ, Atg3, Atg5, and Atg7 in contrast to those in the blank group (P<0.05). All these indicated that TRM aqueous extract induced the autophagy of VCaP cells. In addition, autophagy inhibition impaired the sensitivity of VCaP cells to TRM aqueous extract (P<0.05). The comparison with the blank group showed that TRM aqueous extract inhibited Lamin B1 protein expression in VCaP cells (P<0.01), which in turns weakened the sensitivity of VCaP cells to TRM aqueous extract. ConclusionTRM aqueous extract inhibited the proliferation of human prostate cancer VCaP cells possibly by inducing autography and down-regulating Lamin B1 expression. This study has provided a theoretical basis for the clinical application of TRM.
8.Anti-tumor Effect of Draconis Sanguis Petroleum Ether Fraction on Human Gastric Cancer HGC-27 and MGC-803 Cells
Hui-ming HUANG ; Ying-ying TIAN ; Dao-ran PANG ; Ya-xin LIU ; Li-shan OUYANG ; Peng-fei TU ; Jun LI ; Zhong-dong HU
Chinese Journal of Experimental Traditional Medical Formulae 2022;28(1):85-91
ObjectiveTo investigate the effect of Draconis Sanguis petroleum ether fraction (DSPEF) on the proliferation, apoptosis, migration, and autophagy of human gastric cancer HGC-27 and MGC-803 cells, and preliminarily elucidate its molecular mechanism. MethodCell counting kit-8 (CCK-8) assay was used to detect the effect of DSPEF at different concentrations (0, 20, 40, 60, 80 mg·L-1) on the proliferation of HGC-27 and MGC-803 cells after 24, 48, 72 h. Hoechst staining and flow cytometry were used to explore the effects of DSPEF at different concentrations on the apoptosis and apoptosis rate of HGC-27 and MGC-803 cells after 48 h treatment, respectively. The wound healing assay and acridine orange staining were used to investigate the effects of DSPEF on the migration and autophagy of HGC-27 and MGC-803 cells, respectively. Western blot was used to detect the expression levels of signaling pathway-related proteins in HGC-27 and MGC-803 cells treated with DSPEF for 48 h. ResultCompared with the control group, DSPEF(30 mg·L-1) inhibited the proliferation and migration of HGC-27 and MGC-803 cells in a concentration- and time-dependent manner (P<0.05), and induced the apoptosis (P<0.01) and autophagy of HGC-27 and MGC-803 cells. DSPEF (60 mg·L-1) down-regulated the protein levels of phosphorylated mammalian target of rapamycin (p-mTOR) (P<0.05, P<0.01) and down-regulated phospho-signal transducer and activator of transcription 3 (p-STAT3) in HGC-27 and MGC-803 cells (P<0.01), suggesting that DSPEF presumedly inhibited the proliferation and migration of human gastric cancer HGC-27 and MGC-803 cells and induced their apoptosis and autophagy by inhibiting the mTOR/STAT3 signaling pathway. ConclusionThe down-regulation of the mTOR/STAT3 signaling pathway may be involved in the anti-gastric cancer effect of DSPEF. This study is expected to provide a reference for the investigation of the anti-tumor effect of Draconis Sanguis.
9.Mechanism of Cancer Drug Resistance and Reversal Effect of Chinese Medicine: A Review
Hui-ming HUANG ; Ai-lin YANG ; Ying-ying TIAN ; Ya-xin LIU ; Li-shan OUYANG ; Peng-fei TU ; Zhong-dong HU
Chinese Journal of Experimental Traditional Medical Formulae 2022;28(1):92-99
Malignant tumor is a serious threat to human life and health. The prevalence and mortality of malignancies in China are increasing year by year. Conquering cancer has become a difficult problem for human beings. Chemical drug therapy combined with molecular targeted therapy is a general and preferred anti-tumor clinical scheme, but the side effects and the drug resistance of cancer cells often hinder the efficacy. Therefore, it is of great significance to study the mechanism of drug resistance and the methods to reverse drug resistance. Chinese medicine has the characteristics of complex components, multiple targets, low toxicity, etc. A large number of experimental studies have demonstrated that the effective components or extracts of Chinese medicine can inhibit the proliferation, migration, and invasion of cancer cells, and induce apoptosis, autophagy, differentiation, and senescence. In clinical practice, Chinese medicine has been applied to the protection against ttumor, adjuvant treatment, and later consolidation. The research on Chinese medicine is expected to promote drug resistance reversal and cancer therapy. Studies have shown that the combination of Chinese medicine and chemotherapy can reverse drug resistance and increase efficacy, which has become the mainstream trend of cancer treatment. This study reviewed the mechanisms of the drug resistance of cancer cells induced by self-protective autophagy, gene mutation, high expression of enzymes, abnormal signaling pathways, and abnormal expression of RNA and protein, and summarized how compounds isolated from Chinese medicine, single drug and its extract, and classic anti-cancer prescription reversed the drug resistance to lay a solid foundation for the further investigation of the anti-tumor effect of Chinese medicine.
10.Value of abnormal circadian rhythm of heart rate predicting the all-cause mortality in stage 5 chronic kidney disease patients
Wenkai REN ; Ying CUI ; Ming ZENG ; Hui HUANG ; Shaowen TANG ; Guang YANG ; Yaoyu HUANG ; Zhanhui GAO ; Fangyan XU ; Hanyang QIAN ; Jing WANG ; Chun OUYANG ; Xueyan GAO ; Yifei GE ; Yujie XIAO ; Changying XING ; Yongyue WEI ; Ningning WANG
Chinese Journal of Nephrology 2021;37(7):558-566
Objective:To investigate the predictive value of abnormal heart rate circadian rhythm for all-cause mortality in stage 5 chronic kidney disease (CKD 5) patients.Methods:The retrospective study was performed in CKD 5 patients enrolled from the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) and the Affiliated BenQ Hospital of Nanjing Medical University from February, 2011 to December, 2019. A total of 159 healthy volunteers were enrolled as the healthy control group during the same period. The circadian rhythm of heart rate was monitored by 24-hour Holter. Related indices (including 24-hour, daytime and nighttime mean heart rate, night/day heart rate ratio, 24-hour maximum heart rate, 24-hour minimum heart rate and difference between maximum and minimum of 24-hour heart rate) were calculated. Non-dipping heart rate was defined as night/day heart rate ratio greater than 0.9. Cox regression model was used to analyze the risk factors of all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve and Log-rank test were used to compare the differences of cumulative mortality between high ratio group (night/day heart rate ratio>0.91) and low ratio group (night/day heart rate ratio≤0.91). The nonlinear relationship between night/day heart rate ratio and all-cause mortality was analyzed by restricted cubic spline plot. Time-dependent receiver operating characteristic (ROC) curve was used to analyze the predictive value of night/day heart rate ratio for all-cause mortality in CKD 5 patients.Results:A total of 159 healthy volunteers and 221 CKD 5 patients were included in this study. There were 123 males (55.66%) and the age was (52.72±13.13) years old in CKD 5 patients. The total median follow-up time was 50.0 months. Compared with controls, 24-hour, nighttime mean heart rate, 24-hour minimum heart rate in CKD 5 patients were increased (all P<0.05), furthermore, the night/day heart rate ratio was higher [(0.91±0.09) vs (0.81±0.08), P<0.001], showing "non-dipping heart rate". However, the 24-hour maximum heart rate and the difference between maximum and minimum of 24-hour heart rate in CKD 5 patients were lower than controls (both P<0.05). Multivariate Cox regression analysis showed that the increased night/day heart rate ratio (per 0.1 increase, HR=1.557, 95% CI 1.073-2.258, P=0.020) was an independent influencing factor for all-cause mortality in CKD 5 patients. Kaplan-Meier survival curve analysis showed that the cumulative mortality of the high ratio group was significantly increased than that of the low ratio group (Log-rank test χ 2=7.232, P=0.007). From the restricted cubic spline plot, there was a linear effect between night/day heart rate ratio and all-cause mortality ( P=0.141), and when night/day heart rate ratio was above 0.91, the risk of all-cause mortality was significantly increased in CKD 5 patients. According to time-dependent ROC curve, the accuracy of night/day heart rate ratio in predicting all-cause mortality was 70.90% even when the survival time was up to 70.0 months. Conclusions:The circadian rhythm of heart rate in CKD 5 patients displays "non-dipping" state. High night/day heart rate ratio is an independent influencing factor for all-cause mortality in CKD 5 patients.

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