Table of Content

21 January 2018, Volume 39 Issue 1

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The Second Grade National Prize for Science and Technology Progress——the innovation and application of key technologies in the diagnosis and treatment of brain glioma

Zhang Chuanbao, Jiang Tao

2018, 39(1):  1-5.  doi:10.3969/j.issn.1006-7795.2018.01.001

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Glioma, the most common primary intracranial malignant tumor, is characterized by high disability rate, high incidence of seizure, diverse treatment response and poor survival, keeping as one of the most incurable cancers. Leading by professor Tao Jiang, this program established the new diagnosis and treatment system by building China Glioma Multi-omics database, new standard for molecular diagnosis, classification and treatment, precisive surgical techniques. By applying this program, the gross total resection rate of gliomas in functional areas has increased to 67%, long-term dysfunction rate reduced to 3.8%. The post-operative seizure rate of gliomas in motor functional areas has reduced from 26.7% to 16.1% and the 3-year survival has increased to 22%.

Epidemiology of sepsis in China

Du Bin, Weng Li

2018, 39(1):  6-8.  doi:10.3969/j.issn.1006-7795.2018.01.002

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As the leading cause of death in intensive care unit (ICU) patients, epidemiology of sepsis remains poorly understood until the recent years.The prevalence of severe sepsis was reported as 8.7% in critically ill patients in surgical ICUs, and 37.3% in general ICUs, with the latter similar to the average prevalence of sepsis in European ICUs. However, ICU-based prevalence of sepsis was prone to underestimation, as up to 86% of septic patients might be managed in general wards rather than in ICU. Population-based epidemiology of sepsis was studied in only one cohort study of all hospitalized adults in a subdistrict of Beijing, which reported the standardized incidence of sepsis as 461 cases per 100 000 population, corresponding to 4.86 million cases per year in China. In addition, based on National Mortality Surveillance System, the preliminary data from an ongoing study showed that 14.5% of all deaths was attributable to infection, corresponding to standardized mortality of 76.8 deaths per 100 000 population, or more than 1 million deaths in 2015. Moreover, data on long-term outcomes were available for only 33 sepsis survivors, which suggested lower quality of life during a follow-up of up to 6 years. The above data suggested that the disease burden of sepsis was high in China, which was important for the design of relevant health care policies, allocation of limited health resources, and development of prevention measurements.

Prediction of 14 day mortality in patients with hyperlactatemia septic shock by different lactate markers

Li Wen, Ren Shan, Jiang Li, Zhu Bo, Jiang Qi, Xi Xiuming

2018, 39(1):  9-13.  doi:10.3969/j.issn.1006-7795.2018.01.003

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Objective To explore which lactate marker (initial lactate value, lactate clearance and area under the lactate curve) is the best predictor of early mortality in patients with septic shock.Methods According to the prognosis, the patients were divided into nonsurvival and survival group, We compared with the difference between the predicted markers of lactate, and evaluated which kind of lactate marker was the best for early mortality in patients with septic shock.Results The receiver operating characteristic (ROC) curve showed that the area under curve(AUC) of the lactate and 24 h lactate could effectively predict the 14-day mortality. The predicted value was significantly higher than the initial lactate value and lactate clearance rate and the area under curve of the lactate (AUC=0.72,P=0.001).Conclusion Twenty-four hour lactate is the best predictor of 14-day mortality in patients with septic shock, and is superior to other lactate markers.

Acute kidney injury after liver transplantation: incidence and risk factors

Yue Zhu, Li Ang, Liu Pei, Bai Jing, Zhuang Haizhou, Duan Meili

2018, 39(1):  14-20.  doi:10.3969/j.issn.1006-7795.2018.01.004

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Objective To investigate clinical characteristics and risk factors of acute kidney injury (AKI) in patients following liver transplantation. The clinical outcomes of patients with AKI were also studied.Methods This was a retrospective observational study with data collected from intensive care unit (ICU) at Beijing Friendship Hospital, Capital Medical University. All the adult patients following liver transplantation admitted to ICU from June 1, 2013 to October 31, 2016 were included. Patients under kidney transplantation at the same time or ever for kidney transplantation or underwent retransplantation or with end stage renal dysfunction relying on renal replacement therapy or diagnosed as AKI before transplantation were excluded. AKI was diagnosed and classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Information recorded from patients' charts included demographic characteristics, previous history of hypertension, diabetes mellitus, previous liver disease, and model for end-stage liver disease (MELD) score. Preoperative laboratory values were also recorded:creatinine, albumin, total bilirubin(Tbil),alanine transaminase (ALT) and aspartate transaminase (AST). From the intraoperative period, we recorded the following data:duration of surgery, cold/warm ischemia time, fluid balance. Postoperative factors included:days in ICU, overall in-hospital stay and 28 days mortality rates. Univariate analysis was used to identify the difference between the two groups, and then logistic regression analysis was used to estimate the risk factors of acute kidney injury, and receiver operating characteristic(ROC) curve was used to form prediction model.Results Among the 279 patients after liver transplantation, 124 patients were adult(≥ 18 years),with 68 (54.8%) developed AKI according to KDIGO category:66.2% belonged to the stage 1, 13.2%(n=9) to the stage 2, and 20.6% (n=14) to the stage 3. Multivariate logistic regression analysis revealed that the development of AKI was associated with intraoperative hypotension duration(odd ratio,OR=1.020), excessive loss of blood(OR=1.036) and fluid balance during surgery(OR=1.015). The cut off value was 27.5 min, 32.5 mL/kg, and 31.2 mL/kg. Area under curve(AUC) was 0.662 (P=0.002, 95% CI:0.567-0.757), 0.637 (P=0.009, 95% CI:0.540-0.734), 0.624 (P=0.017, 95% CI:0.526-0.723).Conclusion The incidence rate of AKI was 54.8%. The risk factors were intraoperative hypotension duration and excessive loss of blood and fluid balance during operation. AKI is independently associated with longer duration of hospitalization.

Clinical study of renal function recovery in sepsis-related acute kidney injury patients

Yu Shujing, Liu Pei, Lin Jin, Liu Jingfeng, Ji Xiaojun, Liu Zhuang, Dong Lei, Duan Meili

2018, 39(1):  21-27.  doi:10.3969/j.issn.1006-7795.2018.01.005

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Objective To study the renal and clinical prognosis of patients with sepsis-related acute kidney injury (AKI), aiming to analyze the related influencing factors of renal recovery.Methods Sepsis-related AKI patients were prospectively selected in intensive care unite (ICU) of Beijing Friendship Hospital, Capital Medical University from January 2016 to December 2016, their renal function and clinical outcomes were observed at 28 and 90 days. The patients were divided into renal function recovery group and renal function non-recovery group according to the outcome of the 90 day. By comparing the two groups, the early predictors of renal function outcome were summarized. Logistic regression and area under curve (AUC) of receiver operating characteristic(ROC) curve of these factors were used to evaluate the value in predicting prognosis.Results Totally 49 cases were enrolled into the research, 24 of the recovery group, and 25 of the non-recovery group. The recovery rate of renal function was 49% and the most common source of infection is lung infection in ICU. According to the comparison of variables between the two groups, that renal recovery rate is infected with age, cardiac insufficiency and hypertension, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) score, Sepsis-related Organ Failure Assessment (SOFA) Score excepting kidney, stage of Kidney Disease Improving Global Outcomes (KDIGO), numbers of organ failure, number of platelets, blood lactate, pneumonia, respiratory failure, oliguria, mechanical ventilation, vasoactive drugs and urinary tissue inhibitor of metalloproteinase-2 (TIMP-2), blood neutrophil gelatinase-associated lipocalin (NGAL), blood liver fatly acid binding protein (LFABP) of patients into the research immediately. Logistic regression analysis model showed that the influence factors of sepsis-related AKI patients are mechanical ventilation, APACHEⅡ score, stage of KDIGO, oliguria, hypoproteinemia, blood NGAL, urinary TIMP-2. APACHEⅡ, SOFA score excepting kidney, blood NGAL, urinary TIMP-2 are related to the AKI recovery.Conclusion APACHEⅡ score and SOFA score excepting kidney,blood NGAL and urinary TIME-2 after sepsis diagnosed immediately have predictive value of renal function recovery.

Outcome prediction in severe aneurysmal subarachnoid hemorrhage utilizing the Full Outline of Unresponsiveness Scale

Zhao Jingwei, Luo Xuying, Xu Ming, Shi Guangzhi, Zhou Jianxin

2018, 39(1):  28-34.  doi:10.3969/j.issn.1006-7795.2018.01.006

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Objective To explore the value of the Full Outline of Unresponsiveness Scale (FOUR) in the outcome prediction of severe aneurysmal subarachnoid hemorrhage (aSAH).Methods This is a prospective, observational cohort study. Patients who were diagnosed as aSAH with a World Federation of Neurosurgical Societies (WFNS) grade of Ⅳ or Ⅴ were consecutively included after aggressive treatment,and they were transferred to our intensive care unit for evaluation by FOUR and Glasgow Coma Scale (GCS). The follow-up was performed at 3 months after SAH ictus, based on the Modified Rankin Scale (mRS). The univariate analysis and multivariate logistic regression were applied for statistical evaluation. The receiver operating characteristic curves for the outcome prediction of FOUR and GCS scores were drawn, with area under curves (AUC) calculated, in the meanwhile, their sensitivity (SEN), specificity (SPE), positive predictive values (PPV), and negative predictive values (NPV) were assessed.Results A total of 34 patients were enrolled. Only FOUR scores were identified to be the independent risk factor for poor outcome (mRS4 to 6) (odds ratio 0.22 95% confidence interval 0.01-0.75,P<0.05). Moreover, its Scores (AUC=0.87, SEN=0.91, SPE=0.85, PPV=0.88, NPV=0.84) were all better than those of GCS scores (AUC 0.79, SEN 0.71, SPE 0.79, PPV 0.79, NPV 0.69, respectively).Conclusion In comparison with GCS scores, FOUR scale performs better in the postoperative outcome prediction in severe aSAH.

Early postoperative fluid balance is an independent risk factor of postoperative pancreatic fistula in pancreaticoduodenectomy

Liu Wei, Zhang Jin, Zhao Song, Li Wenxiong, Zheng Yue

2018, 39(1):  35-40.  doi:10.3969/j.issn.1006-7795.2018.01.007

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Objective To evaluate the association between early postoperative fluid balance(FB) and postoperative pancreatic fistula(POPF) in patients undergoing pancreaticoduodenectomy(PD).Methods A retrospective analysis of 237 consecutive patients admitted in the surgical intensive care unit(SICU) after PD was performed and the preoperative, intraoperative and postoperative clinical data were collected. The patients were divided into POPF group and Non-POPF group. Univariate Logistic regression analysis was applied to screen risk factors for POPF. A multivariate Logistic regression model was developed and included potential confounding factors. The patients were divided into 4 groups according to cumulative fluid balance postoperatively at 48 h(FB 48 h) as follows:group 1(FB 48 h ≤ 0 mL·kg^-1·h^-1), group 2(0 mL·kg^-1·h^-1 < FB 48 h ≤ 0.5 mL·kg^-1·h^-1), group 3(0.5 mL·kg^-1·h^-1 < FB 48 h ≤ 1 mL·kg^-1·h^-1) and group 4(FB 48 h>1 mL·kg^-1·h^-1). The association between FB 48 h and POPF was analyzed by Chi-square test.Results POPF occurred in 30 patients(12.6%) with grade B POPF occurred in 24 patients(10.1%), and grade C POPF occurred in 6 patients(2.5%). In multivariate Logistic regression model, sex(male)(OR=23.917, 95% CI:3.775-151.526, P=0.001), body mass index(BMI) (OR=1.313,95% CI:1.059-1.628, P=0.013), diabetes(OR=9.120, 95% CI:2.262-36.771, P=0.002), low albumin levels on admission(OR=0.876, 95% CI:0.783-0.981, P=0.022), preoperative high bilirubin level(OR=1.008, 95% CI:1.002-1.013, P=0.005) and FB 48 h(OR=4.870, 95% CI:1.906-12.443, P=0.001) were risk factors for POPF. The incidence of grade C POPF was significantly increased when FB 48 h was more than 1 mL·kg^-1·h^-1 (P=0.001).Conclusion In patients undergoing PD, FB 48 h was the independent risk factor for POPF. The incidence of grade C POPF was significantly increased when FB 48 h more than 1 mL·kg^-1·h^-1.

Clinical analysis on the nosocomial infections in intensive care unit

Qi Zhili, Liu Pei, Zhuang Haizhou, Duan Meili

2018, 39(1):  41-44.  doi:10.3969/j.issn.1006-7795.2018.01.008

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Objective The study was conducted to analyze the pathogen division and drug resistance of nosocomial infection in intensive care unit (ICU), and to provide advice for the clinical application of antibiotics.Methods A retrospective survey was conducted to analyze the results of pathogens and drug susceptibility test in the patients hospitalized in ICU Beijing Friendship Hospital,Capital Medical University and contracting hospital infection during the period from January 1, 2015 to December 31, 2016.Results A total of 363 cases were reported during 2 years, out of which 271 strains were isolated. The top 5 pathogens were Klebsiella pneumoniae (16.97%), Acinetobacter baumannii (13.28%), Pseudomonas aeruginosa (12.18%), Enterococcus faecium (10.7%), and Staphylococcus aureus (5.9%).The top three infection sites were lower respiratory tract (55.7%), blood (17.6%),abdominal pelvic tissue(9.9%). The incidence of Klebsiella pneumonia in 2016 was significantly higher than that in 2015 (P<0.05).Conclusion During the study period, the most common part of nosocomial infection in ICU was in the lower respiratory tract. The incidence of Klebsiella pneumoniae increased significantly suggesting that antibiotics should be used reasonably, because most of Klebsiella pneumoniae were multi-drug resistant.

Effect of transforming growth factor-β1 on tight junction barrier function in nasal epithelial cells of chronic rhinosinusitis with nasal polyps

Jiao Jian, Zhang Luo

2018, 39(1):  45-50.  doi:10.3969/j.issn.1006-7795.2018.01.009

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Objective To investigate the epithelial tight junction (TJ) barrier integrity changes and its regulation by transforming growth factor(TGF)-β1 in Chinese patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods Air-liquid interface(ALI) cultures were established for human nasal epithelial cells from CRSwNP patients and healthy control subjects. Differentiated cells were stimulated with different concentrations of TGF-β1, transepithelial resistance(TER) and permeability of FITC-Dextran was measured over time. Additionally, TJ protein expression was examined by using immunofluorescence and TJ mRNA expression was determined by real-time PCR.Results In comparison with control subjects, epithelial TER decreased and FITC-Dextran permeability increased in CRSwNP-derived epithelial cells along with an irregular, patchy, and decreased expression of the TJ proteins occludin and zonula occludens(ZO)-1. 10 ng/mL TGF-β1 stimulation decreased epithelial TER, increased paracellular permeability, as well as disrupted TJ protein occludin and ZO-1 expression pattern in both control and CRSwNP-derived epithelial cells.Conclusion Epithelial TJ barrier integrity was disrupted in Chinese CRSwNP patients. TGF-β1 played an important role in inducing TJ barrier defects in nasal epithelium, suggesting that it might serve as a potential therapeutic target for CRSwNP treatment.

Association between single nucleotide polymorphisms in NOS2 gene and house dust mite-sensitive allergic rhinitis

Li Jingyun, Zhang Yuan, Zhang Luo

2018, 39(1):  51-56.  doi:10.3969/j.issn.1006-7795.2018.01.010

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Objective To investigate the association between single nucleotide polymorphisms(SNP) in NOS2 gene and house dust mite-sensitive allergic rhinitis(HDM-sensitive AR).Methods A total of 385 HDM-sensitive AR patients and 424 control subjects were enrolled and genomic DNA was extracted from peripheral blood leucocytes of each participant. A total of 6 reprehensive marker SNPs in NOS2 were genotyped using Sequenom iPLEX MassARRAY platform.Results The allele frequency analysis did not show any significant associations between 6 SNPs in NOS2 and HDM-sensitive AR. The genotype analysis showed the significant difference in distribution of rs3794764_(AA+AG) between HDM-sensitive AR patients and controls(P=0.047). The rs3794764_(AA+AG vs GG) presented a risk among HDM-sensitive AR patients(OR=1.413,95% CI:1.005-1.987). Multiple linear regression analysis indicated that only rs3794766 in NOS2 gene was significantly associated with total serum IgE levels in control group (P=0.019, β=-0.131,95% CI:-0.229- -0.021.Conclusion NOS2 genes variabilities might be associated with HDM-sensitive AR susceptibility in Han Chinese.

Study of fractional exhaled nitric oxide value in healthy subjects of Beijing-Tianjin-Hebei Region

Liu Chengyao, Wang Xiangdong, Liu Zhongyan, Zhang Luo

2018, 39(1):  57-62.  doi:10.3969/j.issn.1006-7795.2018.01.011

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Objective To establish measuring fractional exhaled nitric oxide (FeNO) provides an indication of airway inflammation and is used as an inflammatory marker for airway inflammation management. However, reference values and determinants of FeNO levels are not well defined in local healthy adults reference values in nonsmoking, healthy adults and to determine the factors related to FeNO levels in Beijing-Tianjin-Hebei regions.Methods This randomized multi-center study was carried on in twenty medical centers; 523 nonsmoking, healthy adults (male 221, female 302) were involved in the same period. FeNO was measured in healthy adults according to American Thoracic Society Guidelines (single breath online, exhalation flow 50 mL/s) with NIOX exhaled nitric oxide monitoring system (NIOX, Aerocrine AB, Sweden), and the correlation between related factors[such as:age, height, weight, body mass index (BMI), region and lung function] and FeNO level were investigated. Lung function was measured using spirometry, and atopic status was excluded based on the skin-prick test.Results FeNO normal values in healthy adults are similar compared with previous reports. The geometric mean of FeNO in 523 healthy adult was 16×10^-6, and 95% confidence interval (skewed distribution) was (5-26)×10^-6. FeNO correlated significantly with age, gender and regional distribution (P<0.05). However, weight, height, and BMI did not produce a significant impact on adult FeNO value (P>0.05). The normal ranges of FeNO were (5-26)×10^-6 in healthy adults of our study.Conclusion The result of this study suggests that 26×10^-6 seems to be the reference FeNO value in healthy adults in Beijing-Tianjin-Hebei regions. We believe that the presented FeNO reference values and the determining factors could be useful for research and clinical practice in the adult population of Beijing-Tianjin-Hebei regions. However, influencing factors such as age, gender and region must be considered.

Expression of cytokines and immunoglobulin antibodies in the early asymptomatic and late symptomatic stage of allergic rhinitis mouse model

Yang Jun, Wang Min, Zhang Luo

2018, 39(1):  63-68.  doi:10.3969/j.issn.1006-7795.2018.01.012

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Objective To investigate the expression of interleukin-4 (IL-4), IL-17, IL-6 and immunoglobulin antibodies in early stage of allergic rhinitis (AR) response and their association with allergic symptoms.Methods At early stage (day 16) and late stage (day 30) of ovalbumin (OVA)-induced allergic rhinitis (AR) mouse model, nasal symptoms were measured; nasal mucosa was collected to detect the gene expression of interferon-γ(IFN-γ), IL-4, IL-17 and IL-6; serum was collected to detect the levels of OVA-specific IgE, IgG1, IgG2a and protein expression of IFN-γ, IL-4, IL-17 and IL-6.Results The number of nasal rubbings and sneezes was increased significantly in late stage compared to early stage and control, and had no significant difference between early stage and control. The level of serum OVA-specific IgE was significantly higher in early stage and late stage than that in control, but has no significant difference between early stage and late stage. Serum OVA-specific IgG1and IgG2a, gene expression of IL-17 and IL-6 in nasal mucosa, and serum IL-17 and IL-6 protein had similar expression patterns. These variables were significantly higher in early stage and late stage than those in control, and significantly higher in late stage than those in early stage. Gene expression of IL-4 in nasal mucosa and serum IL-4 protein levels in late stage was significantly higher than those in control.Conclusion IL-17, IL-6, and allergen specific IgG1 and IgG2a may be involved in the early stage of host against allergen response, and their levels may be associated with allergic symptoms.

Research progress of NADPH oxidase in inflammatory diseases of respiratory tract

Zheng Kaili, Wang Xiangdong, Zhang Luo

2018, 39(1):  69-73.  doi:10.3969/j.issn.1006-7795.2018.01.013

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Nico-tinamide adenine dinucleotide phosphate (NADPH) oxidase was first found in the respiratory burst of phagocytic cells. It was also found that NADPH oxidase was expressed in epithelial cells, endothelial cells and other non-phagocytic cells. NADPH oxidase is closely related with reactive oxygen species (ROS) production, intracellular redox reaction,oxidative stress and signal transduction. It also has certain correlation with the occurrence and development of manychronic diseases, such as cardiovascular diseases, respiratory diseases and so on. This article briefly reviews the research progress of NADPH oxidase in inflammatory diseases of respiratory tract.

Evaluation of biological characteristics of two u87 glioma cell lines after STR typing technique

Zhang Wenli, Kong Fanhong, He Lu, Dong Chengya, Wang Yajie

2018, 39(1):  74-78.  doi:10.3969/j.issn.1006-7795.2018.01.014

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Objective To detect cell biological characteristics of the two U87 glioma cell lines[U-87 MG Glioblastoma-Astrocytoma Human in American Type Culture Collection (ATCC) database and U-87 MG in Deutsche Sammlung von Mikroorganismen und Zellkulturen (DSMZ) database] which were identified by short tandem repeats (STR) typing technique, and to evaluate the possibility of two cells for follow-up research.Methods By CCK-8 method, scratch test, transwell assay, and combined with the morphological characteristics were done to investigate the proliferation, migration and invasion ability of the two tumor cell lines.Results (1) CCK-8 method:the cell growth curve showed no statistical difference in proliferation ability(P>0.05). (2) Scratch wound test:the migration ability of two cell lines is no statistical difference (P>0.05). (3) Transwell assay:the migration ability of two cell lines is no significant difference (P> 0.05), and the invasive ability of U-87 MG in DSMZ database is significantly higher than that of U-87 MG Glioblastoma-AstrocytomaHuman in ATCC database (P<0.05).Conclusion Both two U87 cell lines represent the biological properties of brain gliomas and can be used for subsequent experimental studies. The proliferation ability and migration ability of the two cell lines are not significantly different, and the difference of invasive ability is statistically significant. We can choose the appropriate cell line for experimental purposes.

Effect of Qingdu decoction on the protein expressions of Bax, Bcl-2 in rats with severe liver injury

Jin Shuang, Gao Lianyin, Zhao Mengpei, Che Niancong, Zhang Qiuyun, Du Yuqiong

2018, 39(1):  79-83.  doi:10.3969/j.issn.1006-7795.2018.01.015

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Objective To observe the effects of Qingdu decoction on the protein expressions of Bax,Bcl-2 and the apoptosis of liver cells in rats with severe liver injury and explore the mechanism of Qingdu decoction on treating hepatocyte apoptosis of the chronic severe hepatitis.Methods The severe liver injury rat model was induced by thioacetamide (TAA),and treated with Qingdu decoction. And then the hepatocyte apoptotic index(AI) was determined by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL) assay and the protein level of Bax,Bcl-2 in hepatic tissue was detected by Western blotting.Results The AI in model group was significantly increased when compared to that of in normal group (P<0.05).Compared to the model group,the AI was decreased significantly in each group of Qingdu decoction (P<0.01 or P<0.05).To the severe liver injury rat model, Qingdu decoction can cause the inhibition of the protein expressions of Bax (P<0.01),and dramatically increase the protein expressions of Bcl-2(P<0.01)。Conclusion Qingdu decoction can regulate the protein expression level of Bax and Bcl-2,decrease AI, alleviate the degree of liver injury and apoptosis.

MR-NIRF Fe₃O₄-Cy5.5-NGR bimodel contrast agents ovarian cancer cells

Zhang Zixin, Meng Ying, Liang Yuting

2018, 39(1):  84-91.  doi:10.3969/j.issn.1006-7795.2018.01.016

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Objective To synthesize magnetic resonance (MR) and near-infrared fluorescence (NIR) bimodel contrast agents Fe₃O₄-Cy5.5-NGR and verify the targeting ability in virto on ES-2 ovarian cancer cells.Methods Fe₃O₄-Cy5.5-NGR as experimental group and Fe₃O₄-Cy5.5 as control group, physical and chemical properties with transmission electron microscope (TEM), infrared spectroscopy (FITR) and ultraviolet spectrophotometer (UV-general physical and chemical properties 2600). ES-2 human ovarian cancer clear cell subculture lines for CD13 immunohistochemical staining and the expression of CD13 on cell surface. Co-incubate contrasting agents and ES-2 cells cytotoxicity and specific binding ability under flow cytometer. susceptibility of Fe₃O₄-Cy5.5-NGR and Fe₃O₄-Cy5.5 as magnetic nanoparticles on 7.0TMR.Results Fe₃O₄-Cy5.5-NGR is sharper than Fe₃O₄-Cy5.5, the mean diameter is (8.93 ±0.773)nm for NGR-connected agent and (7.48 ±0.695) nm for the other. Excitation wavelength for both agents is 628.0 nm and reflected wavelength is 675.2 nm; Fe₃O₄-Cy5.5-NGR and Fe₃O₄-Cy5.5 got specific peaks at 2 882 cm^-1 and 1 632 cm^-1; NGR-connected agents had another peaks at 841 cm^-1. No cytotoxicity displayed after co-incubate under CCK-8 text. High fluorescence on cell surface and slightly at the location of nucleus and fiber matrix with CD13 immunohistochemical staining. The values of r2 are 155.49 mmol·L^-1·s^-1, 180.74 mmol·L^-1·s^-1 for Fe₃O₄-Cy5.5-NGR Fe₃O₄-Cy5.5 seperatly. The fluorescence intensity of Fe₃O₄-Cy5.5-NGR is relatively high than Fe₃O₄-Cy5.5 in different concentrations(40, 80 and 160 μmol), the number were 3.1, 1.65 and 1.26 times, respectively.Conclusion Fe₃O₄-Cy5.5-NGR performed well on targeting ability as MRI-NIRF bimodal contrast agent in vitro on ES-2 cells, which may use in ovarian cancer xenografts on nude mice experiments.

Analysis of effect of growth hormone treatment on idiopathic short status children to near-adult height

Wu Di, Feng Guoshuang, Gong Chunxiu

2018, 39(1):  92-97.  doi:10.3969/j.issn.1006-7795.2018.01.017

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Objective To evaluate the effects of growth hormone(GH) treatment in idiopathic short status (ISS) children with baseline height ≤ -2 SD on near-adult height(NAH) outcomes.Methods ISS children were included in the current analyses if they had a baseline height ≤ -2 SD and were treated by GH and had been discontinued and attained adult height or NAH. The main outcome measures included near-adult height(NAH)standard deviation scores-target HtSDS in response to GH treatment(△HtSDS=NAHtSDS-T HtSDS), and analysis of correlation with △HtSDS.Results A total of 176 cases of ISS into the group, 106 males and 70 females. Mean chronological age at baseline of male and female were (12.9±2.12)years and (12.1±1.72)years, bone age were (9.5 ±2.53) years and (10.1 ±2.16) years, respectively. The current average ages were 16.74 years and 16.56 years. The follow-up period was 0.27-8.80 years. Mean HtSDS baseline to NAH male:-3.31 to -1.98 and female:-2.86 to -1.39. There were significant difference between baseline to NAH of HtSDS, both male and female were P=0.000. Analysis of non-inferiority test showed that male NAHtSDS were shorter than target HtSDS, while female were not shorter than target HtSDS. Percentages of patients reaching near-adult height>-2SD were male55.7% (59/106),female 71.4% (50/70). Baseline HtSDS, sex and duration of treatment were significantly correlated with △ HtSDS, P values were 0.005, 0.000, 0.027, when analyzed by multiple linear regression.Conclusion Despite a relatively advanced children age, the majority of GH-treated patients in this study attained mean near-adult HtSDS within the normal range(HtSDS>-2SD). Female, higher baseline HtSDS, longer duration of GH treatment would likely have resulted in greater adult height achieved in ISS children.

Clinical study of low maxillary sinus floor elevation and implant placement by osteotome with or without graft materials

Tang Dezheng, Ma Pan, Liu Changying, Chen Ming, Li Jun

2018, 39(1):  98-102.  doi:10.3969/j.issn.1006-7795.2018.01.018

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Objective To observe the endo-sinus bone gain around the apex of implants and the survival rate in low maxillary sinus by osteotome sinus floor elevation and simultaneous implants placement with or without graft materials.Methods Total of 60 low maxillary sinus with residual bone height between 2-4 mm. Patients were randomly assigned into two groups. Trial group:30 patients received 30 implants by sinus lift technique with graft materials; Control group:30 patients received 30 implants by sinus lift technique without bone materials, after 2-week and 3-year loading, cone beam computed tomography(CBCT) was used to measure the endo-sinus bone around the apex of implants and check the survival rate of implants.Results During the operation, 1 cases of maxillary sinus mucosa perforation were found in the trial group, the perforation rate was 3.3%; the perforation rate of the control group was 0%, there was no significant difference between the two groups(P>0.05).The 3-year CBCT indicated that the trial group mean bone height was (4.46±0.98)mm, the control group mean bone height was (3.36±0.73)mm,there was significant difference between the two groups(P<0.05).There was no implant loose in trial group, implant survival rate was 100%; there was 1 implant loose in control group at 2 month after surgery, implant survival rate was 96.7%, there was no significant difference between the two groups(P>0.05).Conclusion The study suggested low maxillary sinus used osteotome sinus floor elevation and simultaneous implants placement with or without bone materials, the new bone formation around the implants with bone graft materials were better than that without bone graft materials, but there was no significant difference between the implant survival rates.

Lifestyle and blood glucose level state of type 2 diabetes dwelled in rural-urban communities

Lu Tong, Cai Xiaxia, Wang Huanying, Li Jingjie, Liu Lan, Yu Huanling

2018, 39(1):  103-111.  doi:10.3969/j.issn.1006-7795.2018.01.019

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Objective To investigate the lifestyle and blood glucose level of patients with type 2 diabetes in rural-urban communities.Methods A total of 96 patients with type 2 diabetes mellitus aged 50 to 65 treated with lifestyle intervention and/or oral hypoglycemic agents registered in the community health service station were randomly selected by the method of random number table. Their dietary and physical activity habits were investigated with a questionnaire and the physical examination was carried out. Fasting blood plasma glucose (FPG), glycosylated serum protein (GSP), glycosylated hemoglobin A1c (HbA1c), fasting insulin (FINS), fasting plasma C-peptide (FC-P), triglyceride (TG), total cholesterol(TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and 2 h postprandial serum glucose (2 h-PG) and insulin (2 h-INS) levels were measured by commercial kits.Results 1The mean course of disease of subjects was (77.88±63.26) months. The ratios of smoking and alcohol drinking were 63.9% and 52.8% respectively in male subjects. The physical activity of subjects was mostly high intensity physical activity, with mean energy intake of (2 193.98±987.77)kcal (1 cal=4.184 J) per day. The mean body mass index (BMI), and waist circumference (WC) were (28.05±4.23)(kg/m²) and (91.98±10.88)cm respectively. The average daily intake of grains and tubers, fruits, aquatic products, milk, soybeans and nuts were lower than the recommended amount. The intake of aquatic products was 3.45 (0.83,14.29) g per day; while the intakes of eggs, greases and salts were higher than the recommended amount. 2The overall compliance rates of FPG, 2 h-PG, HbA1c and TC levels of subjects in this study were 42.7%, 37.5%, 44.8% and 41.7%, respectively.Conclusion The blood glucose levels of patients with type 2 diabetes in rural-urban communities are not well controlled, and an active lifestyle intervention should be given for them.

Mental health status and its impact factors among hypertension patients over 65 years old in Taihu, Tongzhou, Beijing area: a cross-sectional study

Li Xiuna, Zhou Yujie

2018, 39(1):  112-119.  doi:10.3969/j.issn.1006-7795.2018.01.020

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Objective To investigate the mental health status of hypertension patients aged 65-year-old or above and to explore the potential impact factors.Methods A cross-sectional study was designed, with 1 500 hypertension patients participated in. Logistic regression and linear regression were applied respectively according to the dependent variables.Results The response rate was 93.9%, and 502 (35.6%) patients had anxiety and 426(30.2%) patients had depression symptoms. The average subjective well-being score was 64.755±15.321. Results of multiple analysis on anxiety showed that the degree of independence(OR=0.094, P<0.001), side-effects of anti-hypertension drugs(OR=0.002, P<0.001), satisfaction on control of hypertension(OR=0.055, P=0.001), sleeping quality(OR=0.173, P<0.001) and drug therapy compliance(OR=0.038, P<0.001) were statistically significant. Results of multiple analysis on depression showed marital status(OR=2.408, P=0.007), degree of independence(OR=0.354, P<0.001), knowledge of hypertension(OR=1.719, P=0.042), history of cerebrovascular diseases(OR=0.347, P=0.026), side-effects of anti-hypertension drugs(OR=0.291, P=0.001), satisfaction on control of hypertension(OR=0.306, P=0.002), sleeping quality(OR=0.233, P<0.001) and drug therapy compliance(OR=0.241, P=0.001) were statistically significant. Results of multiple analysis on subjective well-being showed that marital status(β=-3.432, P<0.001), degree of independence(β=5.814, P<0.001), environment satisfaction(β=0.748, P=0.001), anxiety(β=-0.454, P<0.001), depression(β=-0.718, P<0.001), history of cerebrovascular diseases(β=3.896, P<0.001), side-effects of anti-hypertension drugs(β=-5.788, P<0.001), satisfaction on control of hypertension(β=5.292 P<0.001), sleeping quality(β=1.052, P<0.001), drug therapy compliance(β=3.893, P<0.001) were statistically significant.Conclusion The mental health of hypertension patients aged 65-year-old or above in Taihu, Tongzhou, Beijing area was good. Anxiety and depression comes up together; By choosing anti-hypertension drugs with small side effect, improving the knowledge of hypertension, improving the sleeping and compliance of taking drugs, the probability of getting anxiety or depression will decline. Anxiety and depression had negative effect on subjective well-being.

Comparison on clinical efficacy of CPAP and Auto-CPAP in patients with severe OSAHS

Yue Yingming, Meng Kun, Qiu Xiaojian

2018, 39(1):  120-127.  doi:10.3969/j.issn.1006-7795.2018.01.021

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Objective To explore the efficacies and compliances during the treatment of continuous positive airway pressure (CPAP) or auto-continuous positive airway pressure (Auto-CPAP) in patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods A total of 116 individuals were enrolled in this study, of which, 60 patients with severe OSAHS diagnosed by the whole night polysomnography (PSG) were randomly divided into CPAP group and Auto-CPAP group(n=30,each). And 56 persons with normal PSG were selected as controls. Both groups were given a pulmonary function test(PFT). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1%, FEV1/FVC, ratio of total lung capacity(TLC) measured value to predicted value, closing capacity (CC)/functional residual capacity (FRC%), ratios of peak expiratory flow (PEF50) measured value to predicted value[PEF50, maximum midexpiratory flow (MMEF), carbon monoxide diffusing capacity(DLCO), airway resistance 5 (R5)] were obtained. Differences in those indexes between two groups were compared. With a computer-assistant diagnostic system, PSG parameter changes in CPAP group and Auto-CPAP group were monitored at 1 month,3 months,6 months. The effect of treatment were evaluated by comparison of sleep latency (SL), sleep efficiency (SE), the number of wake after sleep onset (WASO), time of Ⅰ+Ⅱ over TST, time of Ⅲ+Ⅳ and rapid eye movement (REM) over total sleep time (TST), apnea-hypopnea index (AHI), nighttime mean pulse oxygen saturation (M SaO₂) and nighttime the lowest pulse oxygen saturation (L SaO₂), as well as the mean effective pressure required for ventilation treatment, the ventilator average time nightly, Epworth Sleepiness Scale (ESS), and the PFT parameter changes.Results The differences in FVC, FEV1, FEV1%, FEV1/FVC, ratios of measured value to predicted value(TLC, DLCO, R5) were not statistically significant. The differences in CC/FRC% (P=0.038), ratio of PEF50 measured value to predicted value(P=0.041, ratio of MMEF measured value to predicted value(P=0.037) were statistically significant. At the 1 month,3 months,6 months of treatment, differences in AHI, M SaO₂, L SaO₂, SL, SE, FVC, FEV1, FEV1%, FEV1/FVC,ratios of measured value to predicted value (TLC, PEF50, MMEF, DLCO, R5),CC/FRC% and ESS were not significant differences between CPAP group and Auto-CPAP group(P>0.05 for all of above). The number of WASO, time of Ⅰ+Ⅱ over total sleep time and the effective pressure required for ventilation treatment in Auto-CPAP group were less than those in CPAP group, while the time of Ⅲ+Ⅳ and REM over total sleep time and the ventilator average time nightly in Auto-CPAP group were more than those in CPAP group(P<0.05). Parameters such as AHI, WASO, time of Ⅰ+Ⅱ over total sleep time and ESS at the 1 month, 3 months, 6 months were all lower than those before therapy, while M SaO₂, L SaO₂, time of Ⅲ+Ⅳ and REM over total sleep time were all higher than those before therapy in these two groups(P<0.05),SL and SE were slightly higher than those before treatment, but there were no significant difference(P>0.05). PFT parameters such as FVC,FEV1, FEV1%, FEV1/FVC, ratios of measured value to predicted value(TLC, PEF50, MMEF, DLCO, R5),CC/FRC% at 1 month, 3 months, 6 months showed no significant difference to those before therapy in these two groups(P>0.05). No adverse events were reported during this study.Conclusion Early pulmonary function damage in patients with severe OSAHS is mainly irreversible small airway disease. CPAP and Auto-CPAP are similar in efficacy and safety for OSAHS treatment. Patients under Auto-CPAP treatment showed a better compliance and would benefit more for sleep structure.

Can urinary calcium concentration after 1 hour fasting be used to diagnose hypercalciuria in diabetes mellitus patients?

Liu Zheng, Zhang Pengrui, Chen Zhe, Gao Xia

2018, 39(1):  128-132.  doi:10.3969/j.issn.1006-7795.2018.01.022

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Objective To explore if we can replace 24 hour urine calcium (24 hUCa) with fasting 1 hour urinary calcium (1 hUCa)concentration in diabetes mellitus patients. We explored the factors affecting 24 hUCa,and built the regression equation. Further we judged the agreement of fasting 1 hUCa concentration and 24 hUCa. Finally,we tried to find the best cut-off for fasting 1-hour urinary calcium concentration.Methods Sixty-one diabetes mellitus patients in the endocrine ward of Beijing Chaoyang Hospital, Capital Medical University were invited to attend this test.We collectd the 24 hour urine samples and the following 1 hour urine samples (fasting condition in 6 to 7 o'clock), we detected 24 hUCa, 1 hUCa, measured 24 hour urine output,detected 25-OH-vitamin D and parathyroid hormone (PTH). We did multiple regression analysis to find the factors affecting 24 hUCa,and built the regression equation. More,we judged agreement of fasting 1 hour urinary calcium concentration and 24 hUCa with Bland-Altman analysis. Finally, we made 24 hUCa >350 mg/d the cut point, and used 1 hUCa to draw receiver operating characteristic (ROC) curve, evaluated the sensitivity, the specificity, the misdiagnosis rate.Then we made the chi-square test of paired data.Results Fasting 1 hUCa concentration was the factor affecting 24 hUCa. We could build the regression equation.The agreement of fasting 1 hUCa and 24 hUCa was good. When we diagnosed hypercalciuria with 1 hUCa, choosing 24 hUCa>350 mg/d as the cut point to draw ROC curve,the area under the curve is 0.925. When 1 hUCa was 171.4 mg/L (4.285 mmol/L), it had the sensitivity of 100%、the specificity of 84.9% and the misdiagnosis rate of 50%. When we diagnosed hypercalciuria with 1 hUCa,8 true positives were found,but 8 false positives were diagnosed too. Kappa's coefficient was 0.596, that meant the agreement was ordinary.And we used McNemar method,the difference was statistically significant.Conclusion In diabetes mellitus patients,because of the high misdiagnosis rate, fasting 1 hour urinary calcium concentration can not be used to diagnose hypercalciuria. But,the sensitivity is good,thus it can be used as the primary screening test.When the result of 1 hUCa detection is positive,we should measure 24 hUCa again.

Relationship of C-peptide levels and neuropathy in type 2 diabetes mellitus

Lu Bingyan, Dong Jinglian

2018, 39(1):  133-137.  doi:10.3969/j.issn.1006-7795.2018.01.023

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Objective To investigate the relationship between the level of serum C-peptide(C-P) and neuropathy in patients with type 2 diabetes mellitus(T2DM).Methods The clinical data of 426 patients with T2DM was retrospectively analyzed. These patients were divided into three groups according to their serum C-P levels. From low to high were C-P(≤ 1.7 μg/L) in 152 cases,C-P2(1.8-2.7 μg/L)in 137 cases,C-P3(≥ 2.8 μg/L) in 137 cases.Results The levels of body mass index(BMI), triglyceride(TG), uric acid(UA) and fasting insulin(FINS) in the group of low C-P were lower than those in high C-P group(P<0.05). The levels of high density lipoprotein cholesterol(HDL-C), course and the incidence of diabetic peripheral neuropathy(DPN) and diabetic cardiac autonomic neuropathy(DCAN) were higher than those in high C-P group. The lower level of C-P, the higher incidence of complications(P<0.05). Serum C-P levels in patients with DPN and DCAN were lower than those of nondiabetic peripheral neuropathy(NDPN) and nondiabetic cardiac autonomic neuropathy(NDCAN) (P<0.05). The level of C-P was positively related to the levels of BMI, TG, UA and FINS (P<0.05), and negatively related to HDL-C, low density lipoprotein cholesterol(LDL-C), fasting plasma glucose(FPG), course, incidence of DPN and DCAN(P<0.05). Logistic regression analysis showed that the course and the low level of C-P were independent risk factors of diabetic neuropathy complications after correction of related factors.Conclusion Serum C-P level is independently associated with peripheral neuropathy and cardiac autonomic neuropathy in T2DM.

Comparison of the effect of two different tension free operations in recurrent inguinal hernia repair

Li Kai, Xu Guangzhong, Wang Tongsheng, Liu Chen, Zhu Bin

2018, 39(1):  138-142.  doi:10.3969/j.issn.1006-7795.2018.01.024

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Objective To evaluate the effect of open total extraperitioneal hernoirrhaphy(open TEP) and Lichtenstein tension-free hernioplasty in recurrent inguinal hernia repair.Methods A total of 48 patients presenting as recurrent inguinal hernia from January 2008 to June 2014, who then exposed to either open TEP (group A,n=25) or Lichtenstein (group B,n=23) were retrospectively studied. Outcome was compared between two groups in duration of the operation, blood loss, length of hospital stay (LOS), complications (urinary retention,incisional infection, incisional paresthesia, incisional pain, hematomas, seroma and recurrent hernia).Results There was no statistically significant difference between the two groups in age, sex, body mass index (BMI), duration of the operation, LOS(P>0.05). Statistically significant differences were identified between group A and group B in blood loss[(8.2±2.3)mL vs (23.8±5.5)mL,P<0.05] and total complication (8% vs 39.1%,P<0.05).Conclusion Open TEP is superior to Lichtenstein surgery and more safe and effective for the treatment of recurrent inguinal hernia.

Efficacy and safety of modified antiplatelet preparation in patients with high on-treatment platelet reactivity after endovascular coiling for unruptured intracranial aneurysms

Xia Pengfei, Wang Wei, Zou Liang, Ma Yingming

2018, 39(1):  143-147.  doi:10.3969/j.issn.1006-7795.2018.01.025

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Objective To evaluate the efficacy and safety of modified antiplatelet preparation in patients with high on-treatment platelet reactivity(HTPR) after endovascular coiling for unruptured intracranial aneurysms(UIA).Methods In the randomized, parallel designed clinical trial, 166 patients colling for UIA with HTPR were assigned to receive either 100 mg of aspirin and 75 mg of clopidogrel bisulfate once daily for 3 months(n=83) or 300 mg of aspirin and 75 mg of clopidogrel bisulfate once daily, or 100 mg of aspirin and 75 mg of clopidogrel bisulfate once daily and cilostazol twice daily for 3 months(n=83). Platelet function was serially measured at various time points by 3 assessment methods. Adverse ischemia events(stroke and intravascular thrombosis) and bleeding events were evaluated.Results Patients with HTPR was fewer in modified group compared with standard group at various time points. The adverse ischemia events occurred in fewer patients in modified group than in standard group(8.4% vs 1.2%,HR=0.132,95% CI:0.016-1.101,P=0.030). There was no statistical difference in the rate of bleeding events between modified group and standard group.Conclusion Modified antiplatelet preparation for patients with HTPR compared with standard antiplatelet preparation reduced the adverse ischemia events rate in coiling for an unruptured aneurysm without increasing bleeding.

Clinical observation on the effects of the treatment of low-dose hydrochlorothiazide combining with irbesartan on essential hypertension

Lyu Man

2018, 39(1):  148-152.  doi:10.3969/j.issn.1006-7795.2018.01.026

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Objective To observe the efficacy of low-dose hydrochlorothiazide combining with irbesartan on essential hypertension(EH), and to investigate its effects on fasting plasma glucose(FPG), blood liquid, electrolyte and uric acid(UA).Methods A total of 94 EH patients were randomly divided into control group (n=47) and study group (n=47). Control group was treated with irbesartan, while study group was treated with low-dose hydrochlorothiazide combining irbesartan. Curative effects of blood pressure and parameters of FPG, total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), Na⁺, Cl^-, K⁺ and UA were analyzed and compared between the two groups before and after 2 months of treatment.Results Compared with before treatment, blood pressure of two group were significantly decreased after treatment (P<0.05), and after treatment the systolic blood pressure and diastolic blood pressure of study group were (132.15±12.30)mmHg (1 mmHg=0.133 kPa) and (82.89±7.26)mmHg, and the systolic and diastolic blood pressure of control group were (139.85±13.89)mmHg and (88.02±8.77)mmHg, but the decrease of blood pressure of study group was more significant (P<0.05). The total effective rate of study group was 95.74%, significantly higher than that of control group (78.72%), there was statistical significance (P<0.05). Before and after treatment, the levels of FPG, blood liquid, electrolyte and UA in two groups had no significant difference (P>0.05), and those in study group also had no significant difference before and after treatment (P>0.05).Conclusion Low-dose hydrochlorothiazide combining with irbesartan in the treatment of EH, can significantly improve the crutive effect, and has no significant influence on FPG, blood liquid, electrolyte and UA.