Relationship between Affective Symptoms and Malnutrition Severity in Severe Anorexia Nervosa

Background

Very few studies have investigated the relationship between malnutrition and psychological symptoms in Anorexia Nervosa (AN). They have used only body weight or body mass index (BMI) for the nutritional assessment and did not always report on medication, or if they did, it was not included in the analysis of results, and they did not include confounding factors such as duration of illness, AN subtype or age. The present study investigates this relationship using indicators other than BMI/weight, among which body composition and biological markers, also considering potential confounders related to depression and anxiety.

Methods

155 AN patients, (DSM-IV) were included consecutively upon admission to inpatient treatment. Depression, anxiety, obsessive behaviours and social functioning were measured using various scales. Nutritional status was measured using BMI, severity of weight loss, body composition, and albumin and prealbumin levels.

Results

No correlation was found between BMI at inclusion, fat-free mass index, fat mass index, and severity of weight loss and any of the psychometric scores. Age and medication are the only factors that affect the psychological scores. None of the psychological scores were explained by the nutritional indicators with the exception of albumin levels which was negatively linked to the LSAS fear score (p = 0.024; beta = −0.225). Only the use of antidepressants explained the variability in BDI scores (p = 0.029; beta = 0.228) and anxiolytic use explained the variability in HADs depression scores (p = 0.037; beta = 0.216).

Conclusion

The present study is a pioneer investigation of various nutritional markers in relation to psychological symptoms in severely malnourished AN patients. The clinical hypothesis that malnutrition partly causes depression and anxiety symptoms in AN in acute phase is not confirmed, and future studies are needed to back up our results.     

Relationship between Bone Mineral Density and Serum Osteoprotegerin in Patients with Chronic Heart Failure

Purpose

Heart failure (HF) had been reported with increased risk of hip fractures. However, the relationship between circulating biomarkers and bone mineral density (BMD) in chronic HF remained unclear.

Methods

This is a cross-sectional study which recruited stable chronic HF from registry of the Heart Failure Center of National Taiwan University Hospital. Patients underwent dual-energy x-ray absorptiometry (DEXA) measurements at hip and lumbar spines and biochemical assessments including B-type natriuretic peptide (BNP-32), myostatin, follistatin and osteoprotegerin (OPG).

Results

A total of 115 stable chronic HF individuals with left ventricular ejection fraction (EF) <45% (74% of male, mean age at 59) were recruited with 24 patients in NYHA class I, 73 patients in NYHA class II and 18 patients in NYHA class III. Results of BMD showed that Z scores of hip in NYHA III group (−0.12±1.15) was significantly lower than who were NYHA II (0.58±1.04). Serum OPG was significantly higher in subjects of NYHA III (9.3±4.6 pmol/l) than NYHA II (7.4±2.8 pmol/l) or NYHA I (6.8±3.6 pmol/l) groups. There’s a significant negative association between log transformed serum OPG and trochanteric BMD (R = −0.299, P = 0.001), which remained significant after multivariate analysis.

Conclusions

Our study demonstrated an inverse association between serum OPG and trochanteric BMD in patients with HF. OPG may be a predictor of BMD and an alternative to DEXA for identifying at risk HF patients for osteoporosis.     

The Relationship between Parental Depressive Symptoms,Family Type,and Adolescent Functioning

It is evident that parental depressive symptoms negatively influence adolescent behavior and various psychosocial outcomes. Certain family types like families with a chronically ill parent and single parent families are more vulnerable to parental depressive symptoms. However, the relationship between these symptoms, family type, and adolescent functioning remains largely unclear. This study examined relations between self-report of parental depressive symptoms and adolescent functioning in 86 two-parent families including a parent with a chronic medical condition, 94 families with healthy single parents, and 69 families with 2 healthy parents (comparison group). Parents completed the Beck Depression Inventory. Adolescents filled in the Youth Self-Report measuring problem behavior, and other instruments measuring psychosocial outcomes (stress, grade point average, school problems, and self-esteem). Multilevel analyses were used to examine the effects of family type, parental depressive symptoms, adolescents'' gender and age, and interaction effects on adolescent functioning. The results indicated that adolescents with chronically ill and single parents had a lower grade point average (p<.01) than the comparison group. Adolescents of single parents reported more internalizing problems (p<.01) and externalizing problems (p<.05) than children from the other family types. Parental depressive symptoms were strongly related to child report of stress (p<.001). Adolescents of depressed chronically ill parents were particularly vulnerable to internalizing problems (interaction effect, p<.05). Older children and girls, and especially older girls, displayed more internalizing problems and stress. It can be concluded that growing up with a chronically ill parent in a family with 2 parents may have less impact on adolescent problem behavior than growing up in a single parent family. Health practitioners are encouraged to be attentive to the unique and combined influence of family type and parental depressive symptoms on adolescent functioning. Older and female adolescents deserve particular attention.     

wg基因与心力衰竭发生的关系

心力衰竭已经成为人类健康的杀手,其发病机制有待阐明。wg基因直接调控心脏前体细胞的形成和特化过程,但其是否参与心力衰竭发生的过程尚不得而知。利用心力衰竭果蝇模型研究基因孵与心力衰竭的关系,结果表明两个孵基因突变杂合子的心力衰竭率分别高达52％和43％,而野生型对照组仅为25％,统计学分析差异显著,表明蜡可能与心力衰竭的发生有关。     

ACE、CYP11B2基因多态性与慢性心力衰竭患者醛固酮脱逸的关系

目的:研究CYP11B2-344C/T(醛固酮合成酶)及ACEI/D(血管紧张素转化酶)基因多态性与慢性心力衰竭(CHF)患者实施ACEI治疗后出现醛固酮脱逸表现的关系。方法:回顾分析2008年10月至2012年10月我科收治的252例CHF患者,全部患者应用ACEI治疗3月,醛固酮在基线以上为醛固酮脱逸,依据此标准将患者分为研究组(脱逸组,n=86)与对照组(非脱逸组,n=166),依据PCR(聚合酶链反应)及RFLP(片段长度限制多态性)等方法分别检测两组CYP11B2及ACE基因型,比较两组基因型频率的分布。结果:252例患者中,共86例出现醛固酮脱逸,发生率为34.1%。全部受试患者CYP11B2基因型及ACE基因型频率与Weinberg-Hardy平衡均相符(P均0.05)。研究组ACE I/D三种基因型的组间分布与对照组相较,无统计学差异(P0.05);CYP11B2基因TT型的频率与对照组相较,呈明显统计学差异(P0.05),等位基因C/T频率的组间分布同对照组相较,亦呈明显差异(P0.05)。研究组ACEI/D的基因多态性及CYP11B2-344C/T的多态性中,基因型联合组间分布与对照组相较,无统计学差异(P0.05)。结论:ACE基因多态性与CHF患者ACEI治疗后出现醛固酮脱逸无关,CYP11B2基因T等位基因及TT基因型多态性可能是CHF患者ACEI治疗后发生醛固酮脱逸的高危因素。醛固酮脱逸时,ACE、CYP11B2基因不具有协同效果。     

老年慢性心力衰竭患者甲状腺激素水平与认知功能、心功能及心血管事件的关系研究

摘要 目的：探讨老年慢性心力衰竭（CHF）患者甲状腺激素（TH）水平与认知功能、心功能及心血管事件的关系。方法：将我院2018年6月～2020年6月收治的140例老年CHF患者纳入研究,检测患者TH指标[血清三碘甲状腺原氨酸（T₃）、游离三碘甲状腺原氨酸（FT₃）、甲状腺素（T₄）、游离甲状腺素（FT₄）、促甲状腺激素（TSH）]水平。按蒙特利尔认知评估量表（MoCA）评分将患者分为认知障碍组（MoCA评分＜26分）、非认知障碍组（MoCA评分≥26分）,比较两组各TH指标与MoCA评分。比较不同纽约心脏病协会（NYHA）分级患者的TH指标与心功能指标[左室射血分数（LVEF）、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）]。根据患者住院期间是否发生心血管事件分为心血管事件组和非心血管事件组,比较两组各TH指标。经Pearson线性相关分析TH指标与MoCA评分、心功能指标的相关性。结果：认知障碍组血清T₃、FT₃水平及MoCA评分较非认知障碍组明显降低（P＜0.05）。Ⅲ级、Ⅳ级组的血清T₃、FT₃水平及LVEF较Ⅰ级、Ⅱ级组显著降低,其中Ⅳ级组低于Ⅲ级组（P＜0.05）。Ⅲ级、Ⅳ级组的LVEDD、LVESD较Ⅰ级、Ⅱ级组明显升高,且Ⅳ级组高于Ⅲ级组（P＜0.05）。心血管事件组血清T₃、FT₃水平较非心血管事件组显著降低（P＜0.05）。Pearson线性相关分析显示：血清T₃、FT₃水平与MoCA评分、LVEF呈正相关（均P＜0.05）,与LVEDD、LVESD呈负相关（均P＜0.05）。结论：老年CHF患者血清T₃、FT₃水平下调与其认知功能、心功能降低及心血管事件的发生密切相关,通过检测其血清T₃、FT₃水平,有利于进一步了解其病情变化。     

慢性心力衰竭合并贫血的研究进展

心力衰竭是是临床上常见的急症,也是心血管疾病当中许多器质性心脏病晚期的并发症,其有较高的发病率和死亡率,并且严重影响着心血管疾病患者的生活质量。近些年来越来越多的国内外研究证明慢性心力衰竭患者常合并贫血,并且发病率随着心脏损害程度加重而增加。贫血与慢性心衰患者的生活质量及预后密切相关,其发病原因是多因素且较复杂的,治疗也是多方面的,本文主要概括近些年来国内外研究对慢性心力衰竭合并贫血有关的认识和进展。     

慢性心力衰竭患者血清hs-cTnT及galectin-3水平及其临床意义

目的:探讨慢性心力衰竭(chronic heart failure,CHF)患者半乳糖凝集素-3(Galactose lectin-3,galectin-3)和高敏肌钙蛋白-T(high-sensitivity cardiac troponin T,hs-c Tn T)的水平,并评估其对CHF患者近期预后的预测价值。方法:选取CHF住院患者共220例,按美国纽约心脏病协会(NY-HA)心功能分级分为Ⅱ~Ⅳ级,检测患者血清galectin-3、hs-c Tn T、氨基末端B型脑钠肽前体(NT-pro BNP)水平和动态心电图及超声心动图变化。出院90d后随访,记录主要心脏不良事件(MACE)的发生情况。结果:CHF患者血清galectin-3、hs-c T-n T水平均随心功能分级增高而升高(P0.05);相关性分析显示galectin-3与hs-c Tn T正相关(r=0.822,P0.05);发生MACE组血清galectin-3、hs-c Tn T水平高于未发生MACE组[(19.9±4.42)ng/m L vs(17.4±3.46)ng/m L及(0.030±0.015)ng/m L vs(0.022±0.011)ng/m L,P均0.05];galectin-3≥22.885ng/m L组恶性心律失常及MACE发生率更高(分别为78.6%vs9.9%及85.71%vs 18.68%,P均0.05),hs-c Tn T阳性组恶性心律失常及MACE发生率亦更高(分别为24.7%vs 3.6%及33.8%vs10.7%,P均0.05)。结论:血清galectin-3、hs-c Tn T与CHF的严重程度相关,对评估CHF患者的近期预后有重要参考价值。     

参附注射液对老年慢性心衰患者血清NT-proBNP、H-FABP及CRP 水平的影响

目的:探讨参附注射液对老年慢性心衰患者脑钠肽(NT-proBNP)、心脏型脂肪酸结合蛋白(H-FABP)及C-反应蛋白(CRP)的影响。方法:收集我院收治的慢性心力衰竭患者70例,随机分为对照组和实验组,每组各35例,对照组患者均给予相应常规对症治疗,实验组患者在对照组基础上给予参附注射液静脉滴注,治疗结束后观察并比较两组患者治疗前后血清NT-proBNP、H-FABP及CRP水平的变化以及治疗效果。结果:与治疗前相比,两组患者治疗后血清NT-proBNP、H-FABP及CRP水平与治疗前相比均降低(P0.05);实验组患者治疗后血清NT-proBNP、H-FABP及CRP水平与对照组患者相比较低(P0.05)。实验组临床总有效率与对照组相比较高,但差异无统计学意义(P0.05)。结论:参附注射液能够降低老年慢性心衰患者血清NT-proBNP、H-FABP及CRP水平,提高临床疗效。     

NT-proBNP在慢性充血性心力衰竭中的表达及与NYHA分级和LVEF的关系

目的:探讨血浆氨基末端脑钠肽前体(NT-proBNP)在慢性充血性心力衰竭(CHF)中的表达及与心功能分级(NYHA)和左室射血分数(LVEF)的关系。方法:选择我院收治的100例CHF患者作为研究组,同时选择同期在我院体检的健康者100例作为对照组,分别检测两组NT-proBNP及LVEF,并对研究组患者NT-proBNP与NYHA分级和LVEF进行相关性分析。结果:研究组NT-proBNP水平明显高于对照组,LVEF水平明显低于对照组,差异均有统计学意义(t=9.82,7.63;P0.01)。研究组血浆NT-proBNP水平随着NYHA分级的升高而显著升高,同时LVEF水平随NYHA分级的升高而显著下降(P0.01)。研究组NT-proBNP水平与NYHA分级呈正相关性(r=0.812,P0.01),与LVEF呈明显负相关性(r=-0.623,P0.01)。结论:血浆NT-proBNP水平可早期反映出局部心脏结构改变造成的心功能变化,可与NYHA及LVEF联合检测作为临床诊断CHF的指标。     

慢性心力衰竭患者营养状况的评估

目的:了解慢性心力衰竭患者的营养状况,并对常用的营养检测指标进行评估。方法:对48例心功能Ⅲ~Ⅳ级(NYHA分级)的慢性心力衰竭患者进行了营养状况的评估,并进行分组(营养正常组28例,营养不良组20例),同时对营养不良的常用检测指标进行评价。结果:本研究营养不良的发生率为41.7%,除运铁蛋白外,体重、中上臂肌围、三头肌皮褶厚度(TSF)、白蛋白、总淋巴细胞计数(TLC)、肌酐/身高指数在两组间差异均有统计学意义(P0.05~0.001)。结论:严重慢性心力衰竭患者营养不良的发生率高,肌酐/身高指数、中上臂肌围、TSF、白蛋白及TLC五项指标在用于慢性心衰患者的营养评估时具重要的参考意义,其敏感性和特异性均大于50%。     

慢性心力衰竭患者生活质量与社会支持的关系及其影响因素分析

目的:探讨慢性心力衰竭(CHF)患者生活质量与社会支持的关系及其影响因素。方法:选取我院于2019年1月～2020年5月期间收治的230例CHF患者纳入研究组,选取同期来我院行常规心血管体检的健康志愿者100例作为对照组。采用明尼苏达州心力衰竭生活质量问卷(MLHFQ)评价两组生活质量,选用社会支持评定量表对两组的社会支持进行评价。采用Pearson相关性分析CHF患者生活质量与社会支持的相关性,采用单因素以及多因素Logistic回归分析CHF患者的生活质量的影响因素。结果:研究组的症状、体力、情绪、社会经济、总分均高于对照组(P0.05)。研究组客观支持、个体对支持的利用度、主观支持、总分均高于对照组(P0.05)。Pearson相关性分析结果表明,CHF患者生活质量总分与社会支持总分呈正相关(P0.05)。单因素分析结果可知,CHF患者生活质量与年龄、性别、文化程度、日常生活能力、病程、心功能分级、主要照顾者身份、照顾者健康状况有关(P0.05),而与婚姻状况、居住情况无关(P0.05)。多因素Logistic回归分析结果显示:年龄、文化程度、日常生活能力、主要照顾者身份及照顾者健康状况为CHF患者生活质量的影响因素(P0.05)。结论:CHF患者的生活质量与社会支持密切相关,且年龄、文化程度、日常生活能力、主要照顾者身份及照顾者健康状况为CHF患者生活质量的影响因素,临床医护人员应采取有针对性的干预措施以提高CHF患者的生活质量。     

NT-ProBNP Levels in Saliva and Its Clinical Relevance to Heart Failure

Background

Current blood based diagnostic assays to detect heart failure (HF) have large intra-individual and inter-individual variations which have made it difficult to determine whether the changes in the analyte levels reflect an actual change in disease activity. Human saliva mirrors the body’s health and well being and ∼20% of proteins that are present in blood are also found in saliva. Saliva has numerous advantages over blood as a diagnostic fluid which allows for a non-invasive, simple, and safe sample collection. The aim of our study was to develop an immunoassay to detect NT-proBNP in saliva and to determine if there is a correlation with blood levels.

Methods

Saliva samples were collected from healthy volunteers (n = 40) who had no underlying heart conditions and HF patients (n = 45) at rest. Samples were stored at −80°C until analysis. A customised homogeneous sandwich AlphaLISA^(R) immunoassay was used to quantify NT-proBNP levels in saliva.

Results

Our NT-proBNP immunoassay was validated against a commercial Roche assay on plasma samples collected from HF patients (n = 37) and the correlation was r² = 0.78 (p<0.01, y = 1.705× +1910.8). The median salivary NT-proBNP levels in the healthy and HF participants were <16 pg/mL and 76.8 pg/mL, respectively. The salivary NT-proBNP immunoassay showed a clinical sensitivity of 82.2% and specificity of 100%, positive predictive value of 100% and negative predictive value of 83.3%, with an overall diagnostic accuracy of 90.6%.

Conclusion

We have firstly demonstrated that NT-proBNP can be detected in saliva and that the levels were higher in heart failure patients compared with healthy control subjects. Further studies will be needed to demonstrate the clinical relevance of salivary NT-proBNP in unselected, previously undiagnosed populations.     

慢性心力衰竭合并心房颤动发病的相关机制研究

目的:慢性心力衰竭(Chronic Heart Failure,CHF)是心血管系统常见的疾病,威胁患者的生存周期及生活质量。本研究针对慢性心力衰竭合并房颤的临床特征,进一步探讨其发病机制,为临床治疗提供依据。方法:将80例慢性心力衰竭患者平均分为两组,心律正常的为窦性心律组,伴有心房颤动的作为房颤组。观察并比较两组的左心室射血分数(LVEF)和二尖瓣口舒张期流速(E/A)等心脏功能指标。结果:房颤组左心室射血分数(LVEF)为(0.42±0.08);二尖瓣口舒张期流速(E/A)为(0.65±0.22);左心房内径(LAD)为(53.4±8.2)mm。窦律组左心室射血分数(LVEF)为(0.45±0.09);二尖瓣口舒张期流速(E/A)为(0.72±0.17);左心房内径(LAD)为(46.7±7.9)mm。房颤组患者的LVEF和E/A值均低于窦律组,而LAD则明显高于窦律组,差异具有统计学意义(P0.05)。房颤组醛固酮、血管紧张素(AngII)、脑钠肽(BNP)及超敏C反应蛋白(hs-CRP)均高于窦律组,差异具有统计学意义(P0.05)。结论:慢性心力衰竭合并房颤的发病与患者体内神经内分泌体液系统水平和心脏结构功能有关,具体发病机制需进一步深入研究。     

慢性心力衰竭合并心房颤动发病的相关机制研究

目的：慢性心力衰竭（Chronic Heart Failure,CHF）是心血管系统常见的疾病,威胁患者的生存周期及生活质量。本研究针对慢性心力衰竭合并房颤的临床特征,进一步探讨其发病机制,为临床治疗提供依据。方法：将80例慢性心力衰竭患者平均分为两组,心律正常的为窦性心律组,伴有心房颤动的作为房颤组。观察并比较两组的左心室射血分数（LVEF）和二尖瓣1：7舒张期流速（E／A）等心脏功能指标。结果：房颤组左心室射血分数（LVEF）为（0．42±0．08）;二尖瓣口舒张期流速（E／A）为（0．65±0．22）;左心房内径（LAD）为（53．4±8．2）min。窦律组左心室射血分数（LVEF）为（0．45±0．09）;二尖瓣口舒张期流速（E／A）为（0．72±0．17）;左心房内径（LAD）为（46．7±7．9）min。房颤组患者的LVEF和E／A值均低于窦律组,而LAD则明显高于窦律组,差异具有统计学意义（P〈0．05）。房颤组醛固酮、血管紧张素（AngII）、脑钠）]k（BNP）TZ超敏c反应蛋白（hs-CRP）均高于窦律组,差异具有统计学意义（P〈0．05）。结论：慢性心力衰竭合并房颤的发病与患者体内神经内分泌体液系统水平和心脏结构功能有关,具体发病机制需进一步深入研究。     

基质细胞衍生因子-1 与围生期心肌病患者心力衰竭的相关性研究

目的:探讨基质细胞衍生因子-1与围生期心肌病患者心力衰竭的相关性。方法:采用前瞻性研究纳入59例围生期心肌病并发心力衰竭患者,33例单纯围生期心肌病患者作为对照组。患者均接受体检、实验室检查、心电图、心脏彩超评估。选取基质细胞衍生因子-1(SDF-1)、超敏C反应蛋白(hs-CRP)、氨基末端脑钠肽前体(NT-pro BNP)、血清肌钙蛋白(TNI)及心脏彩超相关参数为评价指标。结果:(l)围生期心肌病患者循环中基质细胞衍生因子-1水平明显高于对照组;(2)循环中基质细胞衍生因子-1与超敏C反应蛋白(CRP)、氨基末端脑钠肽前体(NT-pro BNP)呈正相关,与超声心动图左心室射血分数(LVEF)呈负相关。结论:基质细胞衍生因子-1与围生期心肌病患者心力衰竭具有显著相关性。     

Calcium and Vitamin D Status in Heart Failure Patients in Isfahan, Iran

Both calcium and vitamin D play important roles in cardiac muscle contraction and performance. In this cross-sectional study, we evaluated the status of serum calcium, PTH and 25(OH)D₃ and their correlation with left ventricular Function and NYHA Functional class in 95 heart failure patients referred to Shahid Chamran Hospital, Isfahan, Iran, by colorimetric, immunoradiometric, and Immunochemiluminescent assays, echocardiography and interview respectively. The study was performed between Oct 2007 and Feb 2008. Twenty eight women and 67 men of functional classes 1, 2, or 3 participated in the study. Mean (SD) of age of the participants was 62(11)?years. Mean (SD) serum calcium and 25(OH)D₃ were 2.41(0.16)?mmol/L and 56.78(51.33)?nmol/L, respectively. The overall prevalence of low vitamin D status was 84.2%. There was no correlation between serum calcium and 25(OH)D₃ with LVEF. Interestingly, patients with hyperparathyroidism (serum PTH>65 ng/L) had lower LVEF (27% versus 32.5% p?=?0.03). NYHA functional class was worse in patients with hyperparathyroidism (p?=?0.08). Hypovitaminosis D is very prevalent in heart failure patients. Hyperparathyroidism in these patients may adversely affect cardiac function. Vitamin D3 might serve as an adjunctive treatment for heart failure patients.     

老年2 型糖尿病患者血清中25- 羟维生素D水平 与胰岛beta细胞功能的关系

目的：探讨老年2 型糖尿病患者血清中25- 羟维生素D水平与其胰岛素beta细胞功能的相关性,为老年2 型糖尿病的预防和 治疗提供理论基础。方法：选取2013 年6 月至2014 年6 月在我院接受治疗的老年2 型糖尿病患者300 例作为研究对象,另选取 同期在我院参加体检的健康志愿者300 例作为对照组。采用酶联免疫吸附法测定和比较两组研究对象血清中25-羟维生素D 的 含量,采用稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(IAI)、胰岛beta细胞的功能指数(HBCI)以及空腹胰岛beta细胞的功 能指数(FBCI)评估老年2 型糖尿病患者的胰岛beta细胞功能,并分析老年2 型糖尿病患者血清中25- 羟维生素D 水平与上述参数 的相关性。结果：老年2 型糖尿病患者血清中25-羟维生素D水平为(10.2± 0.9)ng/mL,显著低于正常对照人群(P<0.05);老年2 型 糖尿病患者血清中25- 羟维生素D 水平与HOMA-IR 呈显著正相关(r=0.438,P=0.019),与IAI 呈显著负相关(r=-0.392,P=0.023), 与HBCI和FBCI无明显相关性(P>0.05)。结论：老年2 型糖尿病患者血清中的25- 羟维生素D 水平较低,与其胰岛素beta细胞功能 障碍有关,补充25-羟维生素D 可能有助于老年2 型糖尿病的治疗和预防。