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Objective:To explore the clinical features and prognosis of central nervous system involvement in patients with microscopic polyangiitis (MPA).Methods:We retrospectively investigated the clinical data of 138 MPA patients hospitalized with MPA in Tianjin Medical University General Hospital from January 1, 2010 to November 1, 2019. Patients were divided into two groups according to whether they had the central nervous system (CNS) involvement or not and then Kaplan-Meier survival curve was used to analyze the survival rate between the two groups, Logistic regression model analysis was adopted to analyze risk factors, and P<0.05 was considered statistically significant. Results:①29 patients (21.0%)among the 138 MPA had CNS-affected, including 13(44.8%) males and 16(55.2%) females. CNS involvement was present at the diagnosis of MPA in 20 cases (69.0%) and after the diagnosis of MPA in 9 cases (31.0%). ②The clinical manifestations were motor impairment in 14 cases (48.3%), sensory impairment in 10 cases (34.5%), speech loss in 9 cases (31.0%), headache in 8 cases (27.6%), consciousness disorder in 7 cases (24.1%), dysphagia and bucking in 4 cases (13.8%), cranial nerves involvement in 3 cases (10.3%). The imaging manifestations of the head included infarction, hemorrhage, infarction with hemorrhage and linear dural thickening. Five patients received lumbar puncture. One patient showed elevation of cerebrospinal fluid pressure, 1 patient had elevated protein and 5 patients showed elevation of LDH.③Eighteen patients received glucocortoid combined with cyclophosphamide. CNS symptoms recurred in 6 patients, four patients had recurrent cerebral infarction. ④Median survival time was 55 months in the CNS affected group [95% CI=(14.215, 95.785)] and 86 months in the N-CNS group [95% CI=(24.378, 147.622)]. Kaplan-Meier survival curve showed that there was no significant difference in survival rate between the two groups ( χ2=0.07, P=0.794) . Conclusion:The central nervous system involvement of microscopic polyangiitis is not uncommon. The clinical manifestations are various, with motor impairment the most. The most common imaging manifestation is cerebral infarction and the patients mainly presenteas multiple cerebral infarction. However, the CNS involvement of microscopic polyangiitis is not associated with mortality.
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Objective:To explore the association of the total gestational weight gain (GWG) and GWG in different trimesters with adverse pregnancy outcomes during the second pregnancy in women with history of gestational diabetes mellitus (GDM).Methods:This retrospective cohort study recruited 441 singleton pregnant women with a history of GDM who gave birth at Beijing Obstetrics and Gynecology Hospital of Capital Medical University from January 2017 to December 2018 as the GDM history group. Another 1 637 singleton pregnant women without a history of GDM who gave birth at the same period were selected through the mechanical sampling method as the control group. Independent sample t-test and Chi-square test were used to compare the differences in general conditions, GWG and perinatal outcomes between the two groups. Based on the Institute of Medicine guidelines for GWG, the subjects were further divided into three subgroups: inadequate GWG, adequate GWG and excessive GWG groups. Multivariate logistic regression analysis was used to compare the pregnancy outcome in women with the same GWG in different periods of pregnancy between the two groups. Results:(1) Women with GDM history had lower GWG before and after oral glucose tolerance test (OGTT) and the whole pregnancy than those without [(6.3±3.3) vs (7.9±3.7) kg, (4.8±2.6) vs (5.6± 2.6) kg, (11.8±4.6) vs (14.4± 4.6) kg; t=8.074, 5.183, 10.277; all P<0.001]. The incidence of GDM, gestational hypertension, and large for gestational age (LGA) in the GDM history group were higher than those in the control group [46.5% (205/441) vs 18.1% (296/1 637), 8.4% (37/441) vs 5.4% (88/1 637), 12.9% (57/441) vs 9.7% (158/1 637); χ2=153.181, 5.583, 4.013; all P<0.05]. (2) Before OGTT: pregnant women with GDM history of different GWG categories had a higher risk of developing GDM [ OR and 95% CI for inadequate, adequate and excessive GWG were 4.02 (2.35-6.88), 3.92 (2.65-5.79) and 3.33 (2.11-5.25), respectively, all P<0.001]. Except for women with inadequate GWG, pregnancy with a history of GDM also had a higher risk of preeclampsia [ OR and 95% CI were 3.62 (1.47-9.23) and 2.22 (1.07-5.57) for adequate and excessive GWG, respectively, both P<0.05]. After OGTT: pregnant women with GDM history of different GWG categories had a higher risk of developing GDM [ OR and 95% CI for inadequate, adequate and excessive GWG were 2.48 (1.60-3.84), 4.63 (2.92-7.35) and 4.22 (2.73-6.51), respectively, all P<0.001]. Pregnant women with a history of GDM with excessive GWG had an increased risk of preeclampsia ( OR=2.46, 95% CI: 1.10-5.51, P<0.05). During pregnancy: pregnant women with GDM history of different GWG categories had a higher risk of developing GDM [ OR and 95% CI were 3.02(2.00-4.59), 4.08(2.76-6.04) and 2.66(1.54-4.59) for inadequate, adequate and excessive GWG, respectively, all P<0.001]. Women with GDM history had an increased risk of large for gestational age (LGA) in those with inadequate GWG and postpartum hemorrhage in those with excessive GWG [ OR and 95% CI were 1.94 (1.09-4.21) and 2.93 (1.31-6.55), respectively, both P<0.05]. Conclusions:The total GWG and GWG in different periods during the second pregnancy in women with a history of GDM are lower than those without, but with a higher risk of adverse outcomes. Even in women with the same range of GWG, GDM history still increases the risk of adverse pregnancy outcomes.
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Objective@#To investigate the clinical featuresand related factors of anti-neutrophil cytoplasmic antibody associated vasculitis (AVV) with interstitial lung disease (ILD), and to explore the high-resolution computed tomography (HRCT) of the chest features between different anti-neutrophil cytoplasmic antibody (ANCA) serotypes.@*Methods@#Clinical date of 125 patients diagnosed with AAV by Tianjin Medical University General Hospital from January 1, 2010 to April 30, 2017 were analyzed retrospectively. Clinical manifestations between AAV patients with ILD or those without ILD (NILD) were compared. Patients who were complicated with ILD were divided into myeloperoxidase (MPO)-ANCA positive subset and proteimase (PR3)-ANCA positive subset, and the pulmonary computed tomographic mani-festation was compared among the two subsets. The count data was analyzed by t test, chi-square test/Fisher exact probality. Logistic regression model was applied to analyze the related factors.@*Results@#Of the 125 AAV patients, 86(68.8%) patients were complicated with inter-stitial lung disease, and the mean age of ILD subgroup was higher than that of the NILD subgroup [(66±11) years vs (56±15) years, t=-3.78, P=0.001]. Com-pared with NILD patients, ILD patients had more symptoms (χ2=4.676, P=0.031). The serum levels of carcinoe-mbryonic antigen (t=-1.908, P=0.012), carbohydrate antigen 19-9 (t=-2.286, P=0.025) and carbohydrate antigen 153 (t=-2.857, P=0.007) were higher than the NILD pa-tients. In addition, MPO-ANCA positivesubgroup was more likely to present with pulmonary fibrosis (χ2=7.736, P=0.005), reticular shadow (χ2=9.762, P=0.002) and honeycombing (χ2=4.278, P=0.039) than PR3-ANCA positive subgroup on CT images of all ILD patients. Multivariate Logistic regressive analysis showed that patients who were older than 65 years [OR(95%CI): 3.305(1.280, 8.531), P=0.013], and Birmin-gham vasculitis activity(BVAS) score higher than or equal to 15 [OR(95%CI): 3.249(1.280, 8.247), P=0.013] were risk factors for AAV patients with ILD, while the probability of PR3-ANCA positive patients complicated with ILD was low [OR(95%CI): 0.063(0.005, 0.851), P=0.037].@*Conclusion@#ILD is a very common clinical feature in AAV, especially for elders. The increase of serum CEA, CA199 and CA153 levels may be an early warning sign of interstitial lung disease. Pulmonary HRCT may more likely to present with pulmonary fibrosis in patients with MPO-ANCA positive.
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Objective To investigate the clinical featuresand related factors of anti-neutrophil cytoplasmic antibody associated vasculitis (AVV) with interstitial lung disease (ILD),and to explore the highresolution computed tomography (HRCT) of the chest features between different anti-neutrophil cytoplasmic antibody (ANCA) serotypes.Methods Clinical date of 125 patients diagnosed with AAV by Tianjin Medical University General Hospital from January 1,2010 to April 30,2017 were analyzed retrospectively.Clinical manifestations between AAV patients with ILD or those without ILD (NILD) were compared.Patients who were complicated with ILD were divided into myeloperoxidase (MPO)-ANCA positive subset and proteimase (PR3)-ANCA positive subset,and the pulmonary computed tomographic mani-festation was compared among the two subsets.The count data was analyzed by t test,chi-square test/Fisher exact probality.Logistic regression model was applied to analyze the related factors.Results Of the 125 AAV patients,86 (68.8％) patients were complicated with inter-stitial lung disease,and the mean age of ILD subgroup was higher than that of the NILD subgroup [(66±11) years vs (56±15) years,t=-3.78,P=0.001].Com-pared with NILD patients,ILD patients had more symptoms (x2=4.676,P=0.031).The serum levels of carcinoe-mbryonic antigen (t=-1.908,P=0.012),carbohydrate antigen 19-9 (t=-2.286,P=0.025) and carbohydrate antigen 153 (t=-2.857,P=0.007) were higher than the NILD pa-tients.In addition,MPO-ANCA positivesubgroup was more likely to present with pulmonary fibrosis (x2=7.736,P=0.005),reticular shadow (x2=9.762,P=0.002) and honeycombing (x~=4.278,P=0.039)than PR3-ANCA positive subgroup on CT images of all ILD patients.Multivariate Logistic regressive analysis showed that patients who were older than 65 years [OR(95％CI):3.305(1.280,8.531),P=0.013],and Birmingham vasculitis activity(BVAS) score higher than or equal to 15 [OR(95％CI):3.249(1.280,8.247),P=0.013] were risk factors for AAV patients with ILD,while the probability of PR3-ANCA positive patients complicated with ILD was low [OR (95％CI):0.063 (0.005,0.851),P=0.037].Conclusion ILD is a very common clinical feature in AAV,especially for elders.The increase of serum CEA,CA199 and CA153 levels may be an early warning sign of interstitial lung disease.Pulmonary HRCT may more likely to present with pulmonary fibrosis in patients with MPO-ANCA positive.
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Objective To examine the association of pre-pregnancy obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with the risk of large for gestational age (LGA), and assess the dynamic changes in population attributable risk percent (PAR%) for having these exposures. Methods A retrospective cohort study was conducted to collect data on pregnant women who received regular health care and delivered in Beijing Obstetrics and Gynecology Hospital from January to December in 2011, 2014 and 2017, respectively. Information including baseline characteristics, metabolic indicators during pregnancy, pregnancy complications, and pregnancy outcomes were collected. Multivariate logistic regression model was constructed to assess their association with LGA delivery. Adjusted relative risk and prevalence of these factors were used to calculate PAR%and evaluate the comprehensive risk. Results (1) The number of participants were 11 132, 13 167 and 4 973 in 2011, 2014 and 2017, respectively. Corresponding prevalence of LGA were 15.19% (1 691/11 132), 14.98% (1 973/13 167) and 16.21% (806/4 973). No significant change in the prevalence of LGA was observed across all years investigated (all P>0.05). (2) According to results from multivariate logistic regression model, advanced maternal age, multiparity, pre-pregnancy overweight or obesity, GWG, GDM and serum triglyceride level≥1.7 mmol/L in the first trimester were associated with high risk of LGA (all P<0.05). Among these factors, pre-pregnancy overweight or obesity, excessive GWG and multiparity were common risk factors of LGA. GDM was not associated with risk of LGA in 2017 database. (3) Dynamic change of PAR% in these years were notable. PAR% of GWG for LGA decreased (32.6%, 27.2% and 22.2% in 2011, 2014 and 2017, respectively), while PAR% of pre-pregnancy overweight or obesity showed an upward trend (4.2%, 3.3% and 8.4%). In addition, PAR% of multiparity increased as well (3.5%, 6.3% and 15.9%). (4) Further analysis showed that excessive GWG in the first and second trimesters contributed the most (20.2% and 19.0% in 2014 and 2017). Conclusions Excessive GWG, pre-pregnancy overweight or obesity and multiparity are the important risk factors what contribute to LGA. PAR% of excessive GWG for LGA decrease in recent years. However, GWG in the first and second trimesters is a critical factor of LGA. Appropriate weight management in pre-pregnancy, the first or second trimester is the key point to reduce the risk of LGA.
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Objective@#To examine the association of pre-pregnancy obesity, excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) with the risk of large for gestational age (LGA), and assess the dynamic changes in population attributable risk percent (PAR%) for having these exposures.@*Methods@#A retrospective cohort study was conducted to collect data on pregnant women who received regular health care and delivered in Beijing Obstetrics and Gynecology Hospital from January to December in 2011, 2014 and 2017, respectively. Information including baseline characteristics, metabolic indicators during pregnancy, pregnancy complications, and pregnancy outcomes were collected. Multivariate logistic regression model was constructed to assess their association with LGA delivery. Adjusted relative risk and prevalence of these factors were used to calculate PAR%and evaluate the comprehensive risk.@*Results@#(1)The number of participants were 11 132, 13 167 and 4 973 in 2011, 2014 and 2017, respectively. Corresponding prevalence of LGA were 15.19% (1 691/11 132), 14.98% (1 973/13 167) and 16.21% (806/4 973). No significant change in the prevalence of LGA was observed across all years investigated (all P>0.05). (2)According to results from multivariate logistic regression model, advanced maternal age, multiparity, pre-pregnancy overweight or obesity, GWG,GDM and serum triglyceride level≥1.7 mmol/L in the first trimester were associated with high risk of LGA (all P<0.05). Among these factors, pre-pregnancy overweight or obesity, excessive GWG and multiparity were common risk factors of LGA. GDM was not associated with risk of LGA in 2017 database. (3) Dynamic change of PAR% in these years were notable. PAR% of GWG for LGA decreased (32.6%, 27.2% and 22.2% in 2011, 2014 and 2017, respectively), while PAR% of pre-pregnancy overweight or obesity showed an upward trend (4.2%, 3.3% and 8.4%). In addition, PAR% of multiparity increased as well (3.5%, 6.3% and 15.9%). (4) Further analysis showed that excessive GWG in the first and second trimesters contributed the most (20.2% and 19.0% in 2014 and 2017).@*Conclusions@#Excessive GWG, pre-pregnancy overweight or obesity and multiparity are the important risk factors what contribute to LGA. PAR% of excessive GWG for LGA decrease in recent years. However, GWG in the first and second trimesters is a critical factor of LGA. Appropriate weight management in pre-pregnancy, the first or second trimester is the key point to reduce the risk of LGA.
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Objective To investigate the association between third-trimester gestational weight gain rate (GWGR) and both maternal and neonatal health outcomes in a normal glucose tolerance obstetric population.Methods This was a retrospective cohort study of full-term singleton live births (n=1 967) in women with a normal oral glucose tolerance test (OGTT) tested at 24-28 gestational weeks,who gave birth at Beijing Obstetrics and Gynecology Hospital,Capital Medical University,between January and December in 2013.The subjects were divided into three groups based on third-trimester GWGR category of the 2009 Institute of Medicine (IOM) guidelines.Each group was divided into three subgroups by pre-pregnancy body mass index (BMI):low (＜18.5),normal (≥ 18.5-＜25.0),and high (≥ 25.0).One-way analysis of variance,Chi-square or Fisher's exact test,Logistic regression and corrected analysis were performed for statistical analysis.Results (1) Of the 1 967 women analyzed,third-trimester weight gain distribution was normal in 575(29.2％),excessive in 982(49.9％),and insufficient in 410(20.8％).No significant differences were found in terms of age,parity,education level,family history of diabetes or hypertension among the GWGR groups (all P＞0.05).(2) The mean third-trimester weight gain in the 1 967 normal OGTT women was (0.56±0.23) kg/week and the mean neonatal birth weight was (3 442±396) g.The above two parameters were linearly correlated (Y=103.839X+3383.752,r=0.621,P＜0.01).The excessive GWGR group had higher birth weight infants than the normal GWGR group [(3 463.1±417.3) vs (3 427.4±376.1) g,F=4.901,P=0.014].Women in the insufficient GWGR group had lower birth weight infants (3 375.1 ±370.1) g than those in the normal GWGR group (F=4.408,P=0.021).Compared to the normal GWGR group,the excessive GWGR group was associated with an increased risk of fetal macrosomia (OR=1.59,95％CI:1.10-2.30) and low birth weight infants (OR=2.25,95％CI:1.03-4.94),and decreased odds of normal birth weight deliveries (OR=0.81,95％CI:0.77-0.95).The insufficient GWGR group was associated with an elevated risk of low birth weight infants (OR=3.21,95％CI:2.56-7.51,P＜0.01),but not related to the risk of fetal macrosomia on normal birth weight deliveries (all P＞0.05).(3) Compared to the normal GWGR group,the excessive GWGR group had an increased incidence of cesarean section [30.2％ (297/982)vs 22.2％ (128/575)] and hypertensive disorders of pregnancy [4.0％ (39/982) vs 1.9％ (11/575)] (all P＜0.01).No significant differences in the risk of surgical delivery and pregnancy-related hypertension were observed in the insufficient GWGR group compared to the normal GWGR group.No significant differences in the odds of neonatal intensive care unit admission were noted among the three GWGR groups (P＞0.05).(4) In the normal and insufficient GWGR groups,no differences in neonatal birth weight or risk of small-for-gestational age (SGA)or large-for-gestational age (LGA) were seen in any of the BMI subgroups (all P＞0.05).In the excessive GWGR group,the high pre-pregnant BMI subgroup showed higher neonatal birth weight than the normal pre-pregnant BMI subgroup [(3 552.3±445.0) vs (3 481.8±416.1) g,P＜0.01],and the low pre-pregnant BMI subgroup showed lower neonatal birth weight (3 352.7 ± 371.2) g than the normal pre-pregnant BMI subgroup (P＜0.01).Moreover,the high pre-pregnant BMI subgroup in the excessive GWGR group had an increased risk of fetal macrosomia (OR=1.60,95％CI:1.11-2.81).Conversely,the low pre-pregnant BMI subgroup in the excessive GWGR group had a decreased risk of fetal macrosomia (OR=0.52,95％CI:0.29-0.97) (all P＜0.05).The high BMI subgroup had a greater risk of hypertensive disorders of pregnancy than the normal BMI subgroup in all GWGR groups (allP＜0.05).The incidence of surgical delivery or NICU admission was not significantly different among the three GWGR subgroups.Conclusions Excessive weight gain in third-trimester is common in normal OGTT women.Excessive gestational weight gain is associated with adverse maternal and neonatal outcomes.Thus,gestational weight gain in the third-trimester should be adequately monitored and a balance in weight gain within the range recommended by the 2009 IOM guidelines should be established in normal OGTT pregnant women.
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Objective To evaluate the preoperative nutritional status of patients with gastric cancer by using patient-generated subjective global assessment (PG-SGA) its relationship with postoperative results.Methods Make a preoperative nutrition assessment by using PG-SGA for 87 patients with gastric carcinoma who can be treated with operation.Analyze the effects of the postoperative complication,survival rate and the hospitalization time on patients.Results The number of patients of this group who can process the preoperative nutrition assessment by using PG-SGA accounts for 100％ of the total.There are 37 patients with moderate or severe malnutrition before operation (account for 39.1％).The complication incidence of patients with moderate or severe malnutrition before operation and the patients with no or mild malnutrition are 52.9％ and 5.7％ separately (P ＜ 0.01).The sensitivity and specificity of PG-SGA score for predicting complications are 85.7％ and 75.8％ respectively.And we should implement the analysis of regression to verify that the PG-SGA grade is the independent risk factor of postoperative complication by applying multiple Logistic(P ＜ 0.01).The average hospital stays of patients with moderate or severe malnutrition before operation and the patients with no or mild malnutrition are (21 ± 6) d and (16 ± 4) d separately (P ＜ 0.01).Conclusion According to the PC-SCA results,patients with moderate or severe malnutrition before operation have increased susceptibility to complication and the extension of hospital stays after the operatiou.Therefore,it is important to supply the proper nutrition support to these patients.