Objective To investigate the value of combined prediction of serum 25-hydroxyvita-min D[25-(OH)-D],homocysteine(Hey)and brain natriuretic peptide(BNP)for pregnancy out-comes in patients with hypertensive disorders of pregnancy(HDP).Methods A total of 200 patients with HDP were selected as research subjects and divided into gestational hypertension(GH)group(n=84),mild preeclampsia(PE)group(n=67)and severe PE group(n=49)according to the severity of the disease.Additionally,50 healthy pregnant women were selected as control group.The serum levels of 25-(OH)-D,Hey and BNP were compared among the groups,and their relationships with the severity of HDP were analyzed.According to the pregnancy outcomes of HDP patients,they were divided into poor pregnancy outcome group(n=82)and good pregnancy outcome group(n=118).The serum levels of 25-(OH)-D,Hey and BNP were compared between the poor and good pregnancy outcome groups.Logistic regression analysis was used to screen for the influencing factors of poor pregnancy outcomes in HDP patients.Results Compared with the control group,the severe PE group had the lowest serum 25-(OH)-D level,followed by the mild PE group and the GH group,with statistically significant differences(P＜0.001).Compared with the control group,the severe PE group had the highest serum Hcy and BNP levels,followed by the mild PE group and the GH group,with statistically significant differences(P＜0.001).Serum 25-(OH)-D was negatively cor-related with the severity of HDP in patients(r=-0.427,P＜0.001),while serum Hey and BNP were positively correlated with the severity of HDP in patients(r=0.585 and 0.682;P＜0.001).The serum 25-(OH)-D level in the poor pregnancy outcome group was significantly lower than that in the good pregnancy outcome group,while the serum Hcy and BNP levels were significantly higher than those in the good pregnancy outcome group(P＜0.05).Logistic regression analysis results showed that elevated serum Hey and BNP levels,severe PE and elevated systolic blood pressure were independent risk factors for poor pregnancy outcomes in HDP patients,while high 25-(OH)-D level was a protective factor(P＜0.05).The area under the curve(AUC)of the prediction model constructed based on the Logistic regression analysis results was 0.911(95％CI,0.863 to 0.947),with asensitivity of 91.46％and specificity of 75.42％.Conclusion As the severity of HDP in pa-tients increases,their serum 25-(OH)-D level decreases,while serum Hey and BNP levels in-crease.The combined prediction of serum 25-(OH)-D,Hey and BNP has a high value for predic-ting poor pregnancy outcomes in HDP patients.

Objective:To investigate the change and clinical significance of serum Cathepsin K (Cathe K), 25 hydroxyvitamin D (25 (OH) D) and matrix gla protein (MGP) in postmenopausal patients with osteoporosis.Methods:Sixty postmenopausal patients with osteoporosis admitted to the hospital from May. 2020 to May. 2023 were selected as the study group, and 75 simple menopausal women were selected to the control group at the same period. Serum Cathe K, 25 (OH) D and MGP levels of the subjects were determined by enzyme-linked immunosorbent assay (ELISA). Bone metabolism indexes [N-terminal propeptide of typeⅠprecollagen (PINP), β isomer of the C-terminal telopep-tide of typeⅠcollagen ( β-CTX), bone alkaline phosphatase, (BALP) and osteocalcin (OC) ] were detected. The levels of Cathe K, 25 (OH) D and MGP and bone metabolism indexes were compared and their correlation was analyzed by Pearson correlation. The predictive value of Cathe K, 25 (OH) D and MGP levels in osteoporosis were analyzed and their effects on osteoporosis were analyzed by multiple Logistic regression. Results:Serum Cathe K in the study group was higher [ (27.27±4.82) μg/L vs. (20.84±4.17) μg/L], 25 (OH) D and MGP were lower [ (25.81±5.33) ng/mL, (7.26±1.53) ng/mL vs. (31.62±5.92) ng/mL, (10.75±2.31) ng/mL] ( t=5.22, P<0.001; t=4.88, P<0.05; t=7.58, P<0.05) ; The bone metabolism indexes PINP, β-CTX and OC in the study group were higher, while BALP was lower; Pearson correlation analysis showed that Cathe K was positively correlated with PINP, β-CTX and OC, and negatively correlated with BALP ( r=0.53, 0.45, 0.61, -0.75, P<0.05) ; 25 (OH) D was negatively correlated with PINP, β-CTX, OC, and positively correlated with BALP ( r=-0.41, -0.63, -0.43, 0.38, P<0.05) ; MGP was positively correlated with PINP, β-CTX and OC, and negatively correlated with BALP ( r=-0.77, -0.59, -0.61, 0.52, P<0.05) ; The area under the curve of serum Cathe K, 25 (OH) D and MGP for predicting osteoporosis were 0.715, 0.694 and 0.789, respectively. Conclusion:The abnormal levels of serum Cathe K, 25 (OH) D and MGP in postmenopausal patients with osteoporosis can be used to predict the occurrence of osteoporosis, and are closely related to the bone metabolism indexes of patients, which can provide a reference for the treatment of patients.

Objective:To evaluate the correlation of active inflammatory changes of the symphysis pubis on magnetic resonance imaging (MRI) scans with clinical factors in patients with axial spondyloarthritis.Methods:We retrospectively evaluated 112 patients with axial spondyloarthritis (ax-SpA) in our hospital from February 2014 to November 2020. Patients were divided into 4 groups: symphysis pubis + sacroiliac arthritis, symphysis pubis + non-sacroiliac arthritis, non-symphysis pubis + sacroiliac arthritis, and non symphysis pubis + non-sacroiliac arthritis group. Intra-group correlation coefficient ( ICC) was used to analyze the correlation between MRI active inflammation of the symphysis pubis and the sacroilioarthritis. Age, sex, symptom duration, smoking, body mass index, human leukocyte antigen (HLA)-B27 positive rate, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) among the four groups were compared by one-way analysis of variance (ANOVA) and Chi-square test. Results:The proportion of active inflammation of the symphysis pubis was 35.7% (40/112). There was no correlation between active inflammation of the symphysis pubis and sacroilioarthritis ( r=-0.06, P=0.559). Twenty-four patients of the 69 patients with sacroilioarthritis had active inflammation of the symphysis pubis, 16 patients of the 43 patients without sacroilioarthritis had active inflammation of the symphysis pubis. In patients without active inflammation of the sacroiliac joint, the CRP and ESR of the active inflammation of the symphysis pubis group was (49±60) mg/L, (40±19) mm/1 h, statistically higher than that of the non-active inflammation group (19±22) mg/L, (22±37) mm/1 h ( t=2.36, P=0.023; t=2.88, P=0.006). In patients who had active inflammation of the symphysis pubis, the symptom duration of the non-active inflammation of the sacroiliac joint, was (14±9) years, which was significantly longer than that of the active inflammation group (5±4) years ( t=4.07, P=0.001). Conclusion:There is no correlation between active inflammatory changes of the symphysis pubis and bone marrow edema of the sacroiliac joint. Therefore, in ax-SpA patients with inflammatory low back pain and/or hip/groin pain, and also with high levels of CRP, ESR, but no active inflammatory changes of the sacroiliac joint on MRI scans, active inflammation of the symphysis pubis should be considered.

Objective:To analyze the clinical features of patients with cardic involvement in eosinophilic granulomatosis with polyangiitis (EGPA), and to enhance the understanding.Methods:We retrospectively reviewed the clinical data of 16 patients with EGPA with cardiac involvement in Bethune hospital of Shan-xi from Jan 2012 to Jun 2019. T test, rank sum test and χ2 test were used for statistical analysis. Results:16 patients with cardiac involvement. There were 11 males and 9 female. The age of 16 patients with cardiac involvement ranged from 14 to 82 years old, and the average age of onset was (58±14) years. Compared with patients without cardiac invo-lvement was (41±15) years, the difference between the two groups was statistically significant ( t=3.230 , P<0.01). The analysis suggested that age was related to whether or not cardiac involvement. Cardiac related clinical symptoms occurred in 4 patients (25%). One patient presented with cardiac involvement as the initial symptom. The other 12 patients presented abnormal electrocardiogram (ECG), cardiac ultrasound or cardiac magnetic resonance imaging (MRI), including 10 patients (62%) with abnormal ECG, 13 patients (81%) with abnormal cardiac ultrasound examination, and1patient with cardiac MRI suggesting endocarditis. Among 16 patients with EGPA cardiac involvement, 14 presented with pulmonary involvement, 10 cases with nasal involvement, 9 cases with perip-heral neurological involvement, 9 cases with skin involvement, 6 cases with gastrointestinal involvement, 2 cases with kidney damage. Eosinophils (EO) were increased in all 16 patients, with a median value of 2.46 (1.49, 3.94) ×10 9/L, and EO was associated with cardiac involvement. Analysis of perinuclear anti-neutrophil cytoplasmic antibo-dies (pANCA) positive rate showed that only 2 of the 16 patients were positive. There was statistically significant difference ( P=0.017) compared with the group without cardiac involvement (8 patients were positive). All 16 patients were treated with glucocorticoid, 12 patients received immunosuppressive therapy, and 10 patients were treated with cyclophosphamide. During the ollow-up, 1 case died of heart failure, 1 case died of cerebral hemorrhage, 3 cases were lost to follow-up, and the other 11 cases were all stable after discharge. Conclusion:EGPA patients have a high incidence of cardiac involvement, and all cardiac stru-ctures can be involved, and most cardic involvement happens in ANCA negative patients. Cardiac involvement is one of the factors with poor prognosis.

Objective To analyze the clinical features and treatment of connective tissue disease (CTD) complicated with acquired hemophilia A (AHA).Methods A retrospective analysis of 8 cases of CTD [5 cases of systemic lupus erythematosus (SLE),2 cases of Sj(o)gren's syndrome (SS),1 case of rheumatoid arthritis (RA)] related to clinical manifestations,diagnostic methods,treatment options and outcomes.Results At the onset of AHA,active disease was shown in 7 patients with CTD,and 5 cases had bleeding symptoms in different parts.There were 3 cases of anti-phospholipid syndrome in 5 cases of SLE,2 of which had thrombosis.In 8 patients,the activated partial thromboplastin time (APTF) was prolonged by 1.7 to 3.times,FⅧ∶ C was 9.2％ to 21％ (50％ to 150％),and the factor Ⅷ inhibitor titer was increased by 7.6 to 56 BU/m1 (Bethesda method).Seven patients were treated with sufficient hormones,immunosuppressive agents,human immunoglobulin (IVIG),and blood products.Five patients had clinically improved bleeding tendency and APIT,and one patient was ineffective.Conclusion CTD is easy to combine with AHA.Glucocorticoid combined with immunosuppressive agent can effectively treat CTD-related AHA.For refractory patients,rituximab can be an alternative.

Objective Endothelial microparticles (EMPs) are direct indicator of endothelial cell activation or apoptosis,and may also reflect endothelial inflammation,increased coagulation,and vascular tone.The aim of this study is to investigate whether EMPs would be able to evaluate systemic involvement and be a new indicator of disease activity in Beh(c)et's disease (BD).Methods Thirty-nine consecutive BD patients (who fulfilled the modified International Study Group on BD in 1990 or International Criteria for BD in 2006) and 67 age and sex-matched healthy controls were enrolled (Including 37 patients with hypertension and 30 healthy subjects).The plasma levels of EMPs were measured by flow cytometry utilizing specific labels for endothelial MPs (CD31+ and CD42b-).The measurement data of each group were expressed as-x±s,and the comparison data betwen groups were analyzed by independent sample t test and analysis of variance,Spearman/Pearson correlation analysis,P＜0.05 was statistically significant.Results The levels of circulating EMPs (CD31 + and CI42b-) were significantly elevated in the case group compared with the healthy control group and hypertension (F=6.845,P＜0.05).Moreover,BD patients plasma EMPs were positively correlated with active BD (r=0.802,P＜0.05).Vascular involvement in BD patients was higher than in patients without vascular EMPs,t=4.707,P＜0.05.Gastrointestinal involvement in BD patients was more frequent than that in patients without Gastrointestinal involvement,t=2.673,P＜0.05.Conclusion Levels of circulating EMPs are elevatedd in BD patients and correlated with disease activity in BD.Elevated EMPs may be a potential indicator to predict disease activity of BD.The plasma level of EMPs is increased,which indicats increased risk of vascular and digestive tract involvement in BD.

Objective To explore the value of laparoscopic ovarian drilling in the treatment of polycystic ovarian syndrome with infertility.Methods The clinical data of 51 patients with polycystic ovarian syndrome with infertility undergone laparoscopic ovarian drilling were reviewed.The Serum concentrations of follicle-stimulating hormone(FSH),luteinizing hormone(LH),androgen(T),and estradiol(E2) were measured before and after the operation in all of the cases.Meanwhile,ovarian follicular development and pregnancy rate were observed during follow-up.Results Significantly decreased levels of FSH,LH,LH /FSH,and T were observed after the laparoscopic ovarian drilling in the patients(P