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2024,23(10):729-733, DOI: 10.11915/j.issn.1671-5403.2024.10.161
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Objective To investigate and analyze the correlation of negative emotions and self-perceived burden with quality of life in the elderly patients with chronic heart failure (CHF). Methods A total of 94 non-elderly patients with CHF (non-elderly group) and 122 elderly patients with CHF (elderly group) admitted to the First Affiliated Hospital of Nanjing Medical University from February 2020 to December 2022 were enrolled in the study. The clinical characteristics, negative emotions [self-rating anxiety scale (SAS), self-rating depression scale (SDS)], and self-perceived burden [Chinese Version of Self-Perceived Burden Scale (SPBS)] and quality of life [Minnesota Living with Heart Failure Questionnaire (MLHFQ)] were compared between the two groups. SPSS 22.0 was used for data analysis. According to the data type, t test, analysis of variance, or Chi-square test was employed for comparison between groups. Pearson linear correlation analysis was used to analyze the correlation between negative emotions, self-perceived burden, and quality of life in the elderly CHF inpatients, and multivariate linear regression analysis was employed to analyze the factors affecting their quality of life. Results Compared with the non-elderly group, the elderly group had a higher comorbidity, higher New York Heart Association (NYHA) classes and longer hospital stay; in medication, the elderly group had a lower rate of β-blocker use, a higher rate of digoxin use, and a higher proportion of users of ≥ 3 drugs; the differences were statistically significant (P<0.05). Pearson correlation analysis showed that the scores of SAS, SDS and SPBS in the elderly group were positively correlated with total MLHFQ scores (P<0.05). Multivariate linear regression analysis showed that NYHA classes, CHF course, annual hospitalization frequency, exercise frequency, anxiety, depression, and self-perceived burden were factors affecting the quality of life in the elderly CHF patients (P<0.05). Conclusion Compared with the non-elderly patients, the etiology and comorbidity of the elderly CHF inpatients are more complex, and the CHF is more serious. Anxiety, depression, and self-perceived burden have negative predictive effects on the quality of life in elderly CHF patients.
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Peng Honglei, Wang Heng, Zhai Chaoyang, Xu Dan
2024,23(10):734-738, DOI: 10.11915/j.issn.1671-5403.2024.10.162
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Objective To investigate the physical activity in the elderly patients with chronic kidney disease (CKD) and to analyze the mediating effect of psychological distress on the relationship between physical activity and quality of life. Methods A total of 512 elderly patients with stage 1-3 CKD admitted to Zhongnan Hospital of Wuhan University from January 2020 to January 2023 were selected as the subjects (CKD group). In addition, 120 elderly people who were admitted to the hospital for physical examination were collected as the control group. The international physical activity questionnaire short form Chinese version (IPAQ-S-C) was used to investigate the amount of physical activity in the two groups. Of 632 questionnaires distributed, 598 (94.62%) were recovered as valid, including 490 in the CKD group and 108 in the control group. SPSS 24.0 was used for data analysis. According to the data type, t test, Chi-square test or rank sum test was employed for between-group comparison. The influencing factors of low physical activity in the elderly CKD patients were analyzed by logistic regression analysis. Spearman rank correlation analysis was used to evaluate the correlation between physical activity and quality of life in the elderly CKD patients. Three-step mediating effect test was used to evaluate the mediating effect of psychological distress on the relationship between physical activity and quality of life. Results The physical activity in the CKD group was significantly lower than that in the control group, and the difference was statistically significant (P<0.05). Logistic regression analysis showed that primary school education or below (OR=3.397,95%CI 2.016-5.726), unmarried/divorced/widowed (OR=2.442,95%CI 1.264-4.720), severe fatigue (OR=2.038,95%CI 1.037-4.005) and significant psychological distress (OR=8.265,95%CI 6.001-11.382) were risk factors for low physical activity in the CKD elderly patients(P＜0.05). Three-step mediating effect test showed that psychological distress played a mediating role in the effect of physical activity on quality of life, with a mediating effect of 0.09, and the mediating effect accounted for 26.8% of the total effect. Conclusion Insufficient physical activity is obvious in the elderly patients with stage 1-3 CKD and affect the quality of life, and psychological distress plays a mediating role in it.
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Shao Yuanyuan, Ge Dongming, Ge Mulian, Liu Lili
2024,23(10):739-742, DOI: 10.11915/j.issn.1671-5403.2024.10.163
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Objective To explore the correlation of emotional disorders and social status with quality of life in elderly patients with hemifacial spasm. Methods A total of 220 elderly patients with hemifacial spasm admitted to our hospital from June 2021 to June 2023 were recruited and surveyed with related questionnaires. Finally, 204 valid questionnaires were collected. Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were used to evaluate the emotional disorders of patients, social avoidance and distress scale (SADS) was employed to assess the social status, and hemifacial spasm scale 8 items (HFS-8) was performed to estimate the quality of life. The patients were divided into mild-to-moderate group (grade 1-2,120 cases) and severe group (grade 3-4, 84 cases) according to the severity of spasm. SPSS statistics 24.0 was used for data analysis. According to data type, student′s t test or Chi-square test was applied for intergroup comparison. Logistic regression analysis was conducted to identify the influencing factors of severe spasm in elderly patients with hemifacial spasm. Pearson correlation analysis was utilized to evaluate the correlation of emotional disorders and social status with quality of life in elderly patients with hemifacial spasm. Results Logistic regression analysis showed that disease course >5 years (OR=4.332,95%CI 2.622-7.158; P<0.05) and significant increase of radial diffusivity (RD) of right lower longitudinal tract and lower fronto-occipital tract (OR=5.109,95%CI 3.173-8.225; P<0.05) were risk factors of severe spasm in elderly patients with hemifacial spasm. Pearson correlation analysis indicated that in the elderly patients with hemifacial spasm, HAMA score was positively correlated with HAMD score, social avoidance, social distress, SADS total score and HFS-8 score (r=0.566,0.602,0.597,0.632,0.649; P<0.05); HAMD score was also positively correlated with social avoidance, social distress, total SADS score and HFS-8 score (r=0.681,0.655,0.703,0.684; P<0.05); social avoidance score of SADS was positively correlated with social distress, total SADS score and HFS-8 score (r=0.766,0.795,0.633; P<0.05); social distress score was positively correlated with total SADS score and HFS-8 score (r=0.801,0.608; P<0.05); total SADS score was positively correlated with HFS-8 score (r=0.655; P<0.05). Conclusion Emotional disorders and social disorders are significantly correlated with poor quality of life in elderly patients with hemifacial spasm. Patients with significantly increased RD of right lower longitudinal tract and lower fronto-occipital tract and disease course >5 years are more prone to severe spasm, which can provide new ideas for clinical treatment.
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Li Shanshan, Qi Rui, Yang Zhe, Tao Yuxiu, Yu Huihui, Wang Jing, Ni Chunpinng
2024,23(10):743-747, DOI: 10.11915/j.issn.1671-5403.2024.10.164
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Objective To determine the effect of self-efficacy on self-management behavior in type 2 diabetes mellitus (T2DM) patients based on propensity score matching (PSM). Methods All T2DM patients who were consecutively hospitalized in the endocrinology departments of 3 tertiary grade A hospitals in Xi′an City from December 2022 to June 2023 were recruited in this study. All the participants were surveyed with Self-Efficacy for Diabetes and Summary of Diabetes Self Care Activities. PSM was used to balance covariates related to self-management behavior, and logistic regression was used to analyze the impact of self-efficacy on self-management behavior. Results A total of 356 T2DM patients were enrolled, of which 285 (80.0%) had a low-to-medium self-efficacy level and 297 (83.4%) had a low-to-medium self-management behavior. There were significant differences between the low-to-medium level and high level patients in self-management behavior in terms of self-efficacy, marital status, years of illness, exercise or not, drinking or not (P<0.05). After PSM for the covariates at a ratio 1∶1, no statistical differences were observed in marital status and years of illness between the two groups. But significant difference was observed in the score of self-care activities among the patients with different levels of self-efficacy no matter before or after PSM (all P<0.05). Logistic regression analysis showed that before PSM, self-efficacy level, exercise or not, and drinking or not were independent risk factors for self-management behaviors (P<0.05); after PSM, self-efficacy level was an independent risk factor for self-management behaviors(P<0.05). Conclusion The level of self-efficacy affects self-management behavior in T2DM patients. And physicians should highlight the importance of their relationship in clinical practice.
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Zhou Zhaozhao, Bai Ling, Wu Yao, Guo Min, Dang Pei, Du Yanyan, Yang Miaomiao
2024,23(10):748-751, DOI: 10.11915/j.issn.1671-5403.2024.10.165
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Objective To analyze the correlation between emotional disorders and body nutrition and quality of life in the elderly after acute stroke. Methods A total of 160 elderly patients with acute stroke in subacute stage were included in the Second Affiliated Hosoital of Xi′an Jiaotong University from March 2021 to June 2023. The Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), mini nutritional assessment (MNA), and MOS 36-item short-form health survey scale (SF-36) were used to evaluate anxiety, depression, nutritional status and quality of life respectively. The relationship between post-stroke comorbid anxiety and depression (PSCAD) and objective indicators of nutritional status, MNA and SF-36 was analyzed. SPSS 22.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test, Rank sum test or χ2 test, depending on data type. Results The 160 patients scored (15.57±3.67) points on HAMA and (13.54±4.23) points on HAMD, and 56 were classified as having PSCAD. Body mass index, upper arm muscle mass circumference, prealbumin and NMA score in the PSCAD group were lower than those in the non-PSCAD group (P<0.05). The difference between the two groups in NMA grading was statistically significant (P<0.05). The PSCAD group scored lower in physical strength, physical pain, general health, vitality, social function, emotional function, and mental health of SF-36 scale than the non-PSCAD group (P<0.05). Pearson correlation analysis showed that HAMA and HAMD were negatively correlated with NMA, physical strength, physical pain, general health, vitality, social function, emotional function, and mental health (P<0.05). Conclusion The nutritional status and quality of life of the elderly patients with acute stroke and PSCAD are significantly affected in multiple dimensions. Anxiety and depression are closely related to nutritional status and quality of life.
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Shu Xiaojuan, Chen Xiantao, Song Xiaoping, Dong Xinyao, Jing Xiuping
2024,23(10):752-756, DOI: 10.11915/j.issn.1671-5403.2024.10.166
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Objective To investigate the changes in the intestinal neurotransmitters, mental and psychological state, and quality of life in the elderly patients with slow-transit constipation (STC). Methods A total of 115 elderly STC patients in the Department of Anorectal Surgery of Guang′an Hospital of West China Hospital affiliated to Sichuan University from December 2020 to December 2022 were included in the observation group, and 90 age-matched elderly individuals without gastrointestinal diseases in the Physical Examination Department during the same period were enrolled as the control group. Peripheral venous blood was collected from the subjects to detect the levels of intestinal neurotransmitters including serum substance P (SP), nitric oxide (NO), and 5-hydroxytryptophan (5-HT). The symptom check-list 90 (SCL-90) was used to assess the mental and psychological status of the subjects, and MOS short-form-36 health survey (SF-36) was used to assess their quality of life. The patients in the observation group were given mental and psychological intervention for 6 months, and the serum intestinal neurotransmitters, SCL-90 scores and SF-36 scores were evaluated before and after the intervention. SPSS 20.0 was used for data processing and analysis. Pearson correlation coefficient was used to analyze the correlation between levels of serum neurotransmitters and SCL-90 dimensions in the elderly STC patients. Results The levels of serum SP and 5-HT in the observation group were significantly lower than those in the control group, the NO level was significantly higher than that in the control group, and the differences were statistically significant (P<0.05). The scores for somatization, interpersonal sensitivity, depression and anxiety and total score on SCL-90 in the observation group were significantly higher than the control group, the scores for RP, GH, VT and MH and total score on SF-36 were significantly lower than those in the control group, and the diffe-rences were statistically significant (P<0.05). Pearson correlation analysis indicated that serum SP in the observation group was negatively correlated with scores for somatization, interpersonal sensitivity, and anxiety of SCL-90 (r=-0.243, -0.276, -0.311; P<0.05), that serum NO level was positively correlated with scores for somatization and anxiety (r=0.247,0.283; P<0.05), and that serum 5-HT level was negatively correlated with interpersonal sensitivity and anxiety (r=-0.369, -0.363; P<0.05). After mental and psychological intervention, the levels of serum SP and 5-HT in the observation group increased significantly, the serum NO level decreased significantly, and the average SCL-90 score decreased significantly, and the total SF-36 score increased significantly (P<0.05 for all). Conclusion The quality of life in the elderly STC patients declined significantly compared with that of the control group without gastrointestinal diseases, and the mental and psychological disorders worsen, featuring decreased secretions of intestinal excitatory transmitters and increased secretion of inhibitory transmitters. There is a correlation between serum neurotransmitters levels and mental and psychological disorders in the elderly STC patients. Adjusting the patient′s mental and psychological status can improve the abnormal levels of intestinal neurotransmitters and improve the quality of life of the patient.
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Fu Xingnan, Chen Cailian, Li Chunlian
2024,23(10):757-762, DOI: 10.11915/j.issn.1671-5403.2024.10.167
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Objective To explore the differences in negative emotions and quality of life between gastric ulcer patients and healthy volunteers, compare the clinical characteristics of elderly patients and young and middle-aged patients with gastric ulcer, and analyze the factors affecting the quality of life of gastric ulcer patients in different age groups. Methods A total of 315 patients with gastric ulcers admitted to the Department of General Medicine of Qionghai Traditional Chinese Medicine Hospital from January 2020 to January 2022 were included in the observation group, and 180 healthy examinees at the Health Examination Department were included in the healthy control group. According to age, the patients in the observation group were divided into the young and middle-aged group (aged 33-59 years; n=163) and the elderly group (aged ≥ 60 years; n=152). The short-form-36 health survey (SF-36) and hospital anxiety and depression scale (HADS) were used to evaluate the quality of life and emotions of anxiety and depression in the subjects. The clinical characteristics were analyzed in the young, middle-aged and elderly patients with chronic gastric ulcers. SPSS 22.0 was used for data analysis. A multiple linear regression model was employed to analyze the factors affecting the quality of life of the young, middle-aged and elderly patients with gastric ulcer. Results The scores for physical function, body pain, general health, social function, emotional funciton, mental health, and total score on SF-36 scale in the observation group were lower than those in the healthy control group; the scores for anxiety and depression, and the detection rates of anxiety, depression and anxiety coupled with depression were higher than those in the healthy control group; and the differences were statistically significant (P<0.05). The scores for body pain, emotional function, mental health, and total score on SF-36 scale in the elderly group were higher than those in the young and middle-aged group; the scores for anxiety and depression, and the detection rates of anxiety, depression and anxiety coupled with depression were lower than those in the young and middle-aged group; the differences were statistically significant (P<0.05). Compared with the young and middle-aged group, the proportion of patients with concurrent underlying disease in the elderly group was higher; the proportion of patients with abdominal pain was lower; the proportions of patients with hematemesis or melena, anemia/fatigue, atypical symptom helicobacter pylori infection and gastrointestinal bleeding were higher; the differences were statistically significant (P<0.05). Multivariate linear regression analysis indicated that the social life event over load (β=-0.135, P<0.001) and anxiety (β=-0.213, P<0.001) were factors affecting the quality of life in the young and middle-aged patients with gastric ulcer, and that the family monthly income (β=0.175, P<0.001) and gastric ulcer-related complication (β=-0.278, P<0.001) were factors affecting the quality of life in the elderly patients with gastric ulcer. Conclusion The quality of life in patients with gastric ulcer is significantly lower than that in healthy people, and the detection rates of anxiety and depression are higher. Compared with young and middle-aged patients, the disease has less impact on body pain, emotional function of elderly patients with gastric ulcer, and the detection rates of anxiety and depression are lower in elderly patients with gastric ulcer, but the overall quality of life of patients with gastric ulcer in different age groups does not differ significantly. The influencing factors of quality of life in patients with gastric ulcer in different age groups are also different.
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Gu Yanlin, Wu Najing, Xu Qiaoling
2024,23(10):763-767, DOI: 10.11915/j.issn.1671-5403.2024.10.168
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Objective To investigate the correlation of Helicobacter pylori (Hp) infection with lipid metabolism disorder and thyroid nodules in the elderly people on physical examination. Methods A cross-sectional study was conducted on 371 elderly population who underwent physical examination in the Affiliated Hospital of Jiangnan University from March 2021 to August 2023. Hp infection, lipid metabolism and thyroid nodules were examined after enrollment. According to Hp infection, the patients were divided into the positive group and the negative group. The blood lipids levels and thyroid examination results were compared between the two groups. Pearson analysis was used to investigate the correlation of Hp infection with lipid metabolism and thyroid nodules. SPSS 25.0 was used for statistical analysis. Data comparison between two groups was performed using t test, one-way analysis of variance, or χ2 test depending on data type. Results Among 371 subjects on physical examination, 213 (57.41%) were positive for Hp infection. The levels of total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) in the positive group were significantly increased, and the level of high-density lipoprotein cholesterol (HDL-C) was significantly decreased; the incidence rates of hyper-TC-emia, hyper-TG-emia, hyper-LDL-C-emia and hypo-HDL-C-emia in the positive group were significantly higher than those in the negative group (P<0.05), and the differences were statistically significant (P<0.05). The detection rate of thyroid nodules was significantly higher in the positive group than that in the negative group (P<0.05), and there was no statistically significant difference in the thyroid imaging reporting and data system gradings between the two groups. The 14C value of Hp-infected people was positively correlated with the levels of TC, TG and LDL-C (r=0.398,0.471,0.503; P<0.05), and was negatively correlated with HDL-C (r=-0.426; P<0.05). Conclusion Hp infection in the elderly population on physical examination is related to lipid metabolism disorders and thyroid nodules, and there is a close relationship between the levels of blood lipids.
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Chen Jiajia, Xue Yuan, Wang Quan
2024,23(10):768-771, DOI: 10.11915/j.issn.1671-5403.2024.10.169
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Objective To explore the distribution and influencing factors of intraoperative acquired pressure injury (IAPI) in elderly patients with hip fractures. Methods A total of 238 elderly patients undergoing hip fracture surgery in our hospital from January 2022 to June 2023 were recruited, and according to IAPA occurrence or not, they were divided into IAPA group (n=41) and control group (n=197). SPSS 22.0 was used for data analysis. Depending on data type, independent sample t test or Chi-square test was applied for intergroup comparison. Logistic regression model was established to analyze the influencing factors for the occurrence of IAPA in the elderly patients with hip fractures. Results Among the 238 patients, 41 cases developed IAPI, with an incidence rate of 17.23%. The common sites were sacrococcygeal region (21 cases, 51.22%), heel (9 cases, 21.95%) and sole (5 cases, 12.20%). There were 19 patients (46.34%) of IAPI stage 1,13 patients (31.71%) of stage 2,5 patients (12.20%) of stage 3 and 4 patients (9.76%) of stage 4. Binary logistic regression analysis showed that age (OR=1.143, 95%CI 1.045-1.251), body mass index (BMI) ≤18.5 kg/m2 or >28 kg/m2 (OR=1.652, 95%CI 1.038-2.629), diabetes mellitus (OR=2.073, 95%CI 1.186-3.624), time from fracture to surgery (OR=1.201, 95%CI 1.039-1.388) and frequency of turning over ≥3 times per day (OR=0.388, 95%CI 0.209-0.721) were independent influencing factors for IAPI in elderly patients undergoing hip fracture surgery (P<0.05). Conclusion The incidence of IAPI is quite high in elderly patients undergoing hip fracture surgery, and the injuries are common in sacrococcygeal region, heel and sole. Age, BMI, diabetes mellitus, time from fracture to surgery and frequency of turning over per day are the influencing factors for IAPI occurrence.
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Li Dong, Zhou Rong, Song Chunjian, Lu Jun
2024,23(10):772-776, DOI: 10.11915/j.issn.1671-5403.2024.10.170
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Objective To explore the influencing factors of low back pain relief efficacy in elderly patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP) and construct a nomogram model for the efficacy and analyze its predictive effect. Methods A total of 218 elderly OVCF patients undergoing PKP treatment in our hospital from January 2020 to December 2022 were enrolled in this study. After admission, they all underwent PKP treatment after completion of examinations. Japanese Orthopaedic Association (JOA) low back pain scale was used to evaluate the efficacy after 6 months of follow-up. According to the efficacy, they were divided into effective group (n=187) and ineffective group (n=31). The efficacy of PKP for elderly OVCF patients was analyzed and then a nomogram model was constructed to predict the PKP efficacy. SPSS statistics 23.0 was used for data analysis. Depending on data type, t test or Chi-square test was applied for comparison between groups. Multivariate logistic regression analysis was performed to confirm the influencing factors for PKP treatment efficacy in elderly OVCF patients. Rstudio program package in R software was employed to construct a nomogram prediction model, and the consistency between the predicted results and the actual observation results was verified by Boot strap method. Receiver operating characteristic (ROC) curve was drawn to evaluate the value of the nomogram in the prediction of PKP efficacy. Results At 6 months after surgery, JOA score indicated that the surgery was effective in 187 cases (85.78%). Multivariate logistic regression analysis suggested that age (OR=1.887, 95%CI 1.273-2.798), number of fractured vertebral bodies (OR=2.980,95%CI 1.291-6.882), time from fracture to surgery (OR=1.281, 95%CI 1.128-1.456), preoperative Cobb angle (OR=0.687, 95%CI 0.523-0.902) and standardized anti-osteoporosis treatment (OR=2.596,95%CI 1.228-5.489) were all influencing factors of PKP efficacy in elderly patients with OVCF (P<0.05). Hosmer-Lemeshow fit test revealed that the nomogram model in predicting the efficacy of PKP had a χ2=1.685 and a P=0.247, suggesting that the model had good accuracy. ROC curve analysis showed that the ROC area under the curve of the nomogram model in predicting ineffective PKP treatment in elderly OVCF patients was 0.816 (95%CI 0.617-0.894; P<0.001). Conclusion The influencing factors for PKP efficacy in elderly OVCF patients are age, number of fractured vertebral bodies, preoperative Cobb angle, time from fracture to surgery and standardized anti-osteoporosis treatment. Our nomogram model based on these factors has good value in prediction of treatment efficacy.
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Zhao Xiaomin, Chen Yanpeng, Tong Zhenzhen
2024,23(10):777-780, DOI: 10.11915/j.issn.1671-5403.2024.10.171
Abstract:
Objective To evaluate the vision-related quality of life in the elderly patients with diabetic retinopathy (DR) and analyze its influencing factors. Methods A total of 330 elderly DR patients (DR group) and 310 elderly non-DR patients with type 2 diabetes mellitus (non-DR group) were selected from Department of Ophthalmology of the First Affiliated Hospital of Hebei North University from May 2020 to May 2023. The scores of 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) were compared between the two groups. The multivariate linear regression model was used to analyze the independent influencing factors of NEI-VFQ-25 scores in the DR patients, and the correlation between anxiety, depression, self-management ability and vision-related quality of life in them was analyzed. SPSS 22.0 was used for statistical analysis. and t- or F-test was used for comparison of quantitative data. Pearson correlation coefficient was used to analyze the correlation between anxiety, depression, self-management ability, and visual related quality of life. A multiple linear regression model was used to analyze the influencing factors of vision-related quality of life in the DR elderly patients. Results Totally, 640 questionnaires were distributed, and 560 valid questionnaires were collected. The analysis found that the total score of NEI-VFQ-25 in the DR group was (64.79±14.21) points, and the subscale scores and total score of NEI-VFQ-25 were lower than those in the non-DR group (P<0.05). Multivariate linear regression analysis showed that severe lesion (β=-0.253; P<0.001), complicated diabetic macular edema (DME) (β=-0.224; P<0.001), anxiety (β=-5.207; P=0.005), depression (β=-5.534; P=0.004), and low self-management ability (β=-6.942; P<0.001) could significantly negatively predict vision-related quality of life in the elderly DR patients, and that blood glucose control (β=4.406; P=0.009) could significantly positively predict vision-related quality of life in the DR elderly patients, and the regression equation was significant (F=24.817; P<0.001). Pearson correlation analysis showed that NEI-VFQ-25 score in the elderly DR patients was negatively correlated with Hamilton anxiety scale score and Hamilton depression scale score (r=-0.512, -0.488; P<0.001) and was positively correlated with the score of adult health self-management skill rating scale (r=0.652; P<0.001). Conclusion The vision-related quality of life in the elderly DR patients is reduced. The severity of lesion, DME, anxiety, depression and low self-management ability are negative predictors, and blood glucose control standard is a positive predictor.
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Huo Yuting, Lou Jingsheng, Mi Weidong
2024,23(10):783-786, DOI: 10.11915/j.issn.1671-5403.2024.10.173
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With the acceleration of aging, there are more and more elderly patients receiving various types of surgical treatment year after year. Perioperative nosocomial infection has become one of the main problems affecting the prognosis and rehabilitation of elderly patients. It is of great importance to study the incidence and risk factors of postoperative infectious complications (PICs) for prevention of the diseases. Although, in recent years, great achievements have been made in the researches in many countries, there are still many challenges in providing practical clinical guidance and developing specific therapeutic measures. In this article, we reviewed and summarized the current status and progresses of PICs for the elderly population.
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Zhu Xiaonan, Wang Yanan, Wei Jing
2024,23(10):787-792, DOI: 10.11915/j.issn.1671-5403.2024.10.174
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Retinal vein occlusion (RVO) is a common clinical retinal vascular disease, especially in the elderly population. In the context of population aging, there are more and more elderly suffering from RVO. However, up to now, the pathogenesis of RVO has not been fully revealed, and its clinical treatment mainly adopts etiological treatment and symptomatic treatment. A standardized treatment regimen has not been developed yet. Based on this, we conducted a systematic literature review on RVO in the elderly in order to provide important guidance for the early prevention and treatment management of RVO. In this article, we reviewed the diagnostic criteria, pathogenesis and risk factors, clinical treatment of RVO in the elderly.
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Fan Jiaxu, Qiao Junpeng, Fei Haicheng, Cheng Fang, Chen Xueyu, Zhao Yun, Jia Hongying
2024,23(10):793-796, DOI: 10.11915/j.issn.1671-5403.2024.10.175
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As population ageing is intensifying globally, the problem of cognitive disorders such as Alzheimer′s disease and other related dementias due to ageing is becoming more pronounced. These problems not only seriously affect the health and quality of life of older people, but also bring a heavy burden to society. More and more studies have found that, in addition to common risk factors such as age, gender and various chronic diseases, lipid levels play an increasingly important predictive role in identifying cognitive dysfunction and preventing dementia. In this paper, we reviewed the literature on the correlation between blood lipid levels and cognitive impairment, and focused on the effect of lipid levels on cognitive impairment, their action mechanism, and the traditional and non-traditional relationship between them, with a view to providing new ideas and references for the clinical diagnosis and prevention of cognitive impairment.
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Wang Xueping, Wen Lingling, He Yuxuan, Zheng Zhenzhen
2024,23(10):797-800, DOI: 10.11915/j.issn.1671-5403.2024.10.176
Abstract:
High-quality medical papers not only show scientific research results, but also play roles in medical science development and continuity. It would undoubtedly be of great significance for medical staffs to receive medical paper writing training to improve their ability in paper writing and get their academic papers published. It is one of most important responsibilities of medical journals to support medical talents cultivation. Experienced medical editors are best candidates for the medical paper writing course teaching job. We have taught the course for years, and reflected profoundly for the posts. In this paper, we discussed the necessity of the course for medical staffs, teachers′ quality requirements, course contents design, etc. aiming to put forward some suggestions for medical editors′ competence development.
Volume 23,2024 Issue 10
Clinical Research
Review
Editor Forum
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Correlation of platelet derived-miR-126 and ticagrelor platelet activity
Abstract:
Objective To analyze the effect of platelet miR-126 on the antiplatelet reactivity of ticagrelor and its regulatory mechanism, identify the factors that affect the efficacy of ticagrelor, provide evidence for individualized antiplatelet therapy with P2Y12 receptor antagonists. Methods ACS patients received aspirin combined with ticagrelor were recruited continuously in PLA General Hospital from January 2019 to January 2020. After three days of stable antiplatelet treatment, thromboelastogram (TEG) was used for the detection of platelet reactivity. We selected 50 patients with high ADP% (high antiplatelet reactivity, HAPR) and 50 patients with low ADP% (low antiplatelet reactivity, LAPR). Platelet RNA from peripheral blood was measured miR-126 expression by using quantitative PCR. Results This study included 272 ACS patients treated with ticagrelor, with 49 patients in both the HAPR and LAPR groups completing platelet miR-126 detection. Both groups had a skewed distribution of ADP% [HAPR: 94.50 (92.95, 97.42); LAPR: 67.40 (57.00, 75.05); Mann-Whitney U test: p < 0.001]. Univariate analysis revealed significantly higher miR-126 expression in platelets in the HAPR group [2.97 (0.16-31.37)] compared to the LAPR group [1.00 (0.17-3.31)] (Mann-Whitney U test: p < 0.001). Multivariate analysis identified platelet miR-126 as an independent factor for ticagrelor antiplatelet response (OR: 1.991, 95% CI: 1.265-3.135, P = 0.003). Conclusion Platelet miR-126 is independently correlated with ticagrelor antiplatelet reactivity in ACS patients. Keywords: platelet, miR-126, ticagrelor, acute coronary syndrome, antiplatelet reactivity
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Analysis of factors influencing different levels of fear of falling among community-dwelling older people
Abstract:
Objective To explore the influencing factors of different levels of fear of falling in the elderly, and to provide a reference for reducing the fear of falling in the elderly and developing precise intervention programs. Methods From July 2023 to February 2024, 207 elderly people who attended the outpatient clinic of a tertiary hospital in Beijing were selected as the study subjects by continuous sampling method, and were investigated by using a general information questionnaire, the International Falls Efficacy Scale, the Connor-Davidson resilience scale, the Social Support Rating Scale, the Simple Coping Style Scale, and the Pittsburgh Sleep Quality Index. The patients were divided into three groups according to the classification criteria of the degree of fear of falling, and the differences in the indicators of the three groups were compared. SPSS29.0 software was used for statistical analysis. ANOVA and non-parametric tests were used to compare the differences between groups, and unordered multicategorical logistics regression was used to analyse the influencing factors of different levels of fear of falling. Results The fear of falling score in this study was 21.0 (17.0, 32.0), with 113 cases (54.59%) having a low level of fear of falling, 48 cases (23.19%) having a medium level of fear of falling, and 46 cases (22.22%) having a high level of fear of falling. The results of the univariate analysis showed that there were differences in having a fall in the last year, fracture due to falls, having a neurological disorder, use of walking aids, hearing impairment, somatosensory impairment, psychological resilience, and sleep quality (P < 0.05). The logistic regression results indicated that fracture due to falls, somatosensory impairment, and the level of psychological resilience were common factors influencing moderate and high levels of fear of falling (P < 0.001; P < 0.01; P = 0.028); neurological disorders were independent influences on moderate-level fear of falling (OR = 1.644, 95% CI 1.226-2.204); and older adults who had a fall in the last year, used a walking aid, had hearing impairment, and had poorer sleep quality were more likely to have a high-level fear of falling (OR = 1.808, 95% CI 1.435-2.278; OR=9.709, 95% CI 7.032-13.405; OR=2.360, 95% CI 1.955-2.849; OR=3.569, 95% CI 1.052-1.094). Conclusion Heterogeneity in fear of falling among older adults suggests healthcare professionals should focus on those with lower psychological resilience and higher fall risk, incorporate resilience assessment into fear management, and develop individualized interventions to reduce fear.
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Influence factors of gastrointestinal intolerance and its correlation with quality of life in elderly patients with acute cerebral infarction after EN treatment
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Abstract: Objective To investigate the influence factors of gastrointestinal intolerance and its correlation with quality of life in elderly patients with acute cerebral infarction after EN treatment. Methods The general clinical data of 160 elderly patients with acute cerebral infarction who received enteral nutrition (EN) support therapy in our hospital from January 2021 to December 2023 were reviewed. Gastrointestinal intolerance after EN treatment was included in the observation group (n=69), and gastrointestinal intolerance after EN treatment was included in the control group (n=91). The general clinical data and life quality of the two groups were recorded, and the data were analyzed by SPSS 20.0 statistical software. According to the data type, T-test or χ2 test were used to compare the data between the groups, and Logistic regression was used to analyze the related factors affecting gastrointestinal intolerance after EN treatment in the elderly with acute cerebral infarction. Spearman method was used to analyze the correlation between gastrointestinal intolerance and quality of life in elderly patients with acute cerebral infarction after EN treatment. Result There were significant differences in blood glucose, serum albumin, use of sedative drugs, use of vasoactive drugs, intra-abdominal pressure, central venous pressure, EN onset time, nervous dysfunction, bed time, emotional tension, and secondary infection after cerebral infarction between the two groups（χ2=7.364、5.807、4.874、7.453、8.616、9.233、11.284、6.200、4.690、9.889、5.149、8.247，P＜0.05）; Logistic regression analysis found that blood glucose ≥11mmol/L (OR: 6.253, 95%CI: 1.604-24.367), serum albumin < 35g/L (OR: 4.679, 95%CI: 1.189-18.413), internal abdominal pressure ≥15mmHg (OR: 3.823, 95%CI: 1.207-12.103), central venous pressure ≥12cmH2O (OR: 4.683, 95%CI: 1.209-18.144), EN onset time ≥3d (OR: 3.939, 95%CI: 1.164-13.331), neurological disorders (OR: 5.468, 95%CI: 1.331 ~ 22.470), emotional stress (OR: 3.995, 95%CI: 1.180 ~ 13.519), secondary infection after cerebral infarction (OR: 4.100, 95%CI: 1.209-13.903) Independent risk factors affecting gastrointestinal intolerance in elderly patients with acute cerebral infarction after EN treatment (P < 0.05); After treatment, the scores of material life status, psychological function, physical function and social function in the observation group were higher than those in the control group (t=11.665, 8.952, 7.856, 10.383, P < 0.05). Spearman correlation analysis showed that gastrointestinal intolerance was significantly negatively correlated with quality of life in elderly patients with acute cerebral infarction after EN treatment (r=-0.734, -0.664, -0.484, -0.628, P < 0.05). Conclusion Blood glucose ≥11mmol/L, serum albumin < 35g/L, internal abdominal pressure ≥15mmHg, central venous pressure ≥12cmH2O, EN initiation time ≥3d, nervous dysfunction, emotional tension and secondary infection after cerebral infarction are independent risk factors for gastrointestinal intolerance after EN treatment. Clinical management of the above factors should be strengthened to lay the foundation for nutritional support and improvement of life quality.
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DU YaHAO, ZHENG YueHong, TIAN Cui, et al
2010,9(3):217-221, DOI:
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Objective To investigate the relationship of apoptosis and autophagy of vascular smooth muscle cells (SMC) with the pathogenesis of abdominal aortic aneurysm (AAA). Methods In situ terminal transferase-mediated dUTP nick end-labeling(TUNEL) was used to detect the apoptosis of SMC of AAA and human normal aorta. The expression of LC3 was measured by immunohistochemistry. RNA extraction from the tissue of AAA and human normal aorta was performed. The mRNA levels of autophagy-related genes Beclin1,Atg4b,Bnip3,and Vps34 are tested by RT-PCR. Results The number of TUNEL-positive SMC in AAA was higher than that in normal aorta (P<0.05). The expression level of LC3 protein was significantly increased in AAA compared with that in normal aorta (P<0.05). The mRNA expression levels of Beclin1,Atg4b,Bnip3 and Vps34 were markedly up-regulated in AAA compared with that in normal aorta (P<0.05). Conclusion The apoptosis and autophagy of vascular SMC play an important role in the pathogenesis of AAA.
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2018,17(8):613-616, DOI: 10.11915/j.issn.1671-5403.2018.08.141
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C-X-C chemokine receptor 2 (CXCR2) is a member of chemokine family, and has been much sought after both in preclinical and clinical research because its activation by its ligands plays an important role in the pathophysiology of a range of cardiovascular diseases, including hypertension, cardiac remodeling, atherosclerosis, and abdominal aortic aneurysm. This review focuses on the progress made in the studies about roles of CXCR2 in cardiovascular diseases.
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2010,9(2):138-141, DOI:
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Objective To investigate the efficacy of indapamide/felodipine combination in decreasing blood pressure in elderly patients with hypertension.Methods A total of 150 consecutive elderly cases of hypertension,average age (65.4 ± 3.6) years,were randomized into 3 groups:indapamide group (1.5 mg/d),felodipine group (5 mg/d),and indapamide (1.5 mg/d)/felodipine (5 mg/d) combination group,with 50 in each group.The treatment duration was 3 months.The average 24-hour,daytime and night-time systolic blood pressure/diastolic blood pressure and systolic blood pressure/diastolic blood pressure load,as well as mean heart rate,were determined at baseline and after 3 months.Results The average 24-hour,daytime and night-time systolic blood pressure/diastolic blood pressure,and blood pressure load were significantly decreased in all groups after treatment for 3 months,which was more significant in combination group than in single drug treatment group.The mean heart rate showed no significant change after 3 months of treatment.Conclusion Combination of calcium antagonist with long-acting diuretics at low dose provides substantial and stable antihypertensive benefit,and has few side effects.The regimen is strongly recommended for elderly patients with hypertension.?更多
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HAN Ping, YANG Zhanqing, LI Zijian, et al
2011,10(5):478-480, DOI:
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Prostate cancer is an important health concern for male population in China and deserves great attention. The onset of prostate cancer tended to be insidious and it developed slowly. The early diagnosis of prostate cancer may achieve satisfactory outcome. Currently, prostate cancer has low early detection rate and high mortality. Large scale epidemiological survey is necessary to screen out the specific risk factors of prostate cancer, including case-control study, randomized follow-up visit etc. We need a guideline for early diagnosis of prostate cancer suitable for Chinese population to improve the sensitivity and specificity of early diagnosis of prostate cancer in China.
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SUN Bao-Hua, Li Fang-Da, NIE Hao, LIU Duan, ZHENG Yue-Hong
2018,17(8):621-625, DOI: 10.11915/j.issn.1671-5403.2018.08.143
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Ubiquitin-proteasome system (UPS) is the primary non-lysosomal pathway of protein degradation in eukaryotic cells, whose proteolytic activities are closely associated with subunits β1, β2, β5. Subunits β1, β2, β5 can be replaced respectively by subunits β1i, β2i and low-molecular-mass proteasome 7 (LMP7 or β5i), with β5i being most active and the new structure being called immunoproteasome. β5i plays an important role in autoimmune diseases, cardiovascular and cerebrovascular diseases, obesity and metabolic diseases, and tumor. This article introduced the latest progress in β5i in relation to the above diseases in view of providing effective intervention targets for drug therapy and improving the prognosis of the diseases.
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2018,17(2):153-155, DOI: 10.11915/j.issn.1671-5403.2018.02.034
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Cardiovascular disease (CVD) has emerged as the leading cause of death worldwide. Acute coronary syndrome (ACS), one of the most harmful cardiovascular events, is, in most cases, triggered by the rupture of a vulnerable plaque followed by thrombosis formation at the rupture site. Deep understanding of vulnerable plaque formation can greatly impact therapeutic approaches for both prevention and treatment of acute cardiovascular events. In the article, we reviewed the concept, characteristics and the pathological mechanisms of vulnerable plaque.
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2012,11(11):856-857, DOI: 10.3724/SP.J.1264.2012.00219
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2017,16(8):624-628, DOI: 10.11915/j.issn.1671-5403.2017.08.147
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Frailty is defined as a syndrome of reserve and function decline caused by various reasons, and is associated with adverse outcomes, such as falls, depression, disability, mortality, and so on. There is no gold standard for frailty yet, but frailty assessment tools can help to screen frailty and predict the health outcomes. The frailty tools have wide application, and each frailty tool is targeted to a specified population. Thus, assessment of frailty in clinical practice can provide physicians strategies for early screening and management of diseases, so as to avoid or delay the adverse outcomes.
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2012,11(1):74-78, DOI: 10.3724/SP.J.1264.2012.00018
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Establishment of aging animal model is an effective way to study the aging process of human being. It has been a focus to establish different aging models for research of aging and anti-aging agents according to the physiological characteristics and natural attributes of various animals. Compared with other aging models, including naturally aging model, ozone induced aging model, thymus removed aging model, and aging SAMP model, D-galactosis induced aging model has been widely used because of its easy feasibility, low lost, and stable performance. In this paper, regarding its application and development, we reviewed the D-galactosis induced aging models from the following aspects: the mechanism and the dosage of the D-galactose to induce aging, the specific protocols, and the evaluation for successful establishment. In addition, we summarized some indexes to assess aging, such as behavioral, biochemical, morphological and molecular biological indices. In summary, subcutaneous injection of 120～125mg/(kg?d) of D-galactose once per day for 6 to 8 weeks is a reliable and stable way to establish the aging model.
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CAI Ruikang, DANG Yuping, XU Canlong
2011,10(6):566-569, DOI:
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Senile pruritus, a common chronic skin disease in the elderly, is a serious disease affecting the health of elderly patients because of its endurable itching and lack of effective treatment. The pathogenesis of senile pruritus is complex, which is mainly due to a series of physiological or pathological changes caused by aging, including the degeneration of the skin and the changes in immune function and endocrine system. Currently, the integrated traditional Chinese medicine and western medicine is ideal for therapy of senile pruritus. In this paper, we reviewed the etiology, pathogenesis and treatment of senile pruritus.
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【ABSTRACT】Objective To discuss the curative effect of zoledronic acid and alpha D3 combined treatment in the aged with severe osteoporosis. Methods 120 patients were randomly divided into two groups, the treatment group (n=60) were taken Caltrate D added Zoledronic Acid and Alpha D3 treatment for 24 weeks, and the control group (n=60) received Caltrate D only. Results In the treatment group (excluded the drop-out cases), the bone pain eased faster than that of the control group(n=57), and the improvement of bone mineral density also significantly better than the control group (n=53) (P<0.05). The levels of plasma calcium, phosphorus in both groups, and alkaline phosphatase in the control group were no significant differences between pre and post treatment (P>0.05). But the alkaline phosphatase in the treatment group decreased significantly after treatment (P<0.05). Conclusion Zoledronic Acid combined Alpha D3 can significantly relieve pain and other symptoms, reduce bone mass lose, and improve bone mineral density of severe osteoporosis patients.
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WANG Wei, LI Fang-Da, NIE Hao, ZHENG Yue-Hong
2017,16(10):762-765, DOI: 10.11915/j.issn.1671-5403.2017.10.178
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Abdominal aortic aneurysms (AAAs) is a medical problem with high mortality rate, and so it is of great significance to understand its pathogenesis. One of main characteristics of the disease is extensive infiltration of macrophages, neutrophils and T-lymphocytes. Much evidence has confirmed that T lymphocytes are closely associated with the pathogenesis, but their role in the progression remains unclear. This article reviewed the possible roles of T lymphocytes in the pathogenesis of AAAs, and provided effective drug treatment strategies for the disease which still lacks of effective drug intervention.
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LIU Zi-Qi1, LIU Ai-Ping2, WANG Pei-Yu2*
2015,14(07):547-550, DOI: 10.11915/j.issn.1671-5403.2015.07.125
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Diabetes mellitus (DM) is a group of metabolic diseases characterized with high blood sugar levels, which is induced by a variety of factors, such as genetic factors, environmental factors, behavior and life styles, and other factors. Its pathological mechanism is insufficient insulin secretion or insulin resistance caused by structural damage and/or dysfunction of islet β-cell. Evidence shows that China has become the country with the largest number of DM patients in the world. Many nationwide epidemiological surveys concerning DM indicated that its prevalence increases gradually, and varies among different regions and population. To understand the present status of the epidemiological survey on DM research in China and to provide references for the corresponding prevention and control strategies, we reviewed the reports on national large-scale investigation and epidemiological trends related with DM prevalence in China.
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2014,13(10):788-791, DOI: 10.3724/SP.J.1264.2014.000182
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Various ion currents on the myocardial cell membrane take part in cardiac electric activity under both physiological and pathological conditions. Cardiac sodium current (INa) is involved in the depolarization and repolarization of cardiomyocyte action potential (AP), and exerts an important effect on the conduction of AP. So, it is of great importance to explore the interactions, effects, and especially, clinical significance of INa with other ion channel currents. This study reviewed the interaction of INa with other cardiac currents, and elucidated the mechanism of cardiac arrhythmias from the perspective of ion flow interaction.
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2014,13(04):294-295, DOI: 10.3724/SP.J.1264.2014.00068
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2013,12(11):877-880, DOI: 10.3724/SP.J.1264.2013.00223
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Postoperative cognitive dysfunction (POCD), one of severe postoperative complications in elderly patients, greatly increases the risk of postoperative morbidity and mortality, and severely reduces the quality of life at the same time in these patients. However, since the pathogenesis of POCD remains unclear, effective treatment has not been defined yet. Recent evidences suggest that postoperative inflammation be the main mechanism for POCD. This article reviewed the inflammatory mechanisms of POCD based on basic and clinical researches, and also introduced some anti-inflammatory drugs which are beneficial to POCD treatment.
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WANG Xiao-Jing, CHEN Hai-Ping*
2014,13(05):396-400, DOI: 10.3724/SP.J.1264.2014.00092
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Chronic kidney disease (CKD) is a global public health problem. In 2002, National Kidney Foundation (NKF)’s Kidney Disease Outcomes Quality Initiative (K/DOQI) published a guideline, which introduced a definition and classification system for CKD. This guideline plays an important role in the diagnosis, treatment and prognosis improvement for CKD. However, lots of evidence from clinical and epidemiological trials caused plenty of debates and controversies towards the applicability of present K/DOQI-CKD definition and classification system. These problems included high prevalence of CKD, disproportionately high prevalence in CKD stage 3, and high prevalence of CKD in the elderly. What’s more, whether patients with simple renal cyst should be diagnosed as CKD or not have not reached a consensus yet. So Kidney Disease: Improving Global Outcomes (KDIGO) published another guideline in 2012. The new one revised the definition of CKD, established a combined staging system concerning causes, glomerular filtration rate (GFR) and albuminuria, made a risk stratified model to estimate prognosis, and recommended the application of CKD-EPI to estimate GFR.
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2013,12(02):108-110, DOI: 10.3724/SP.J.1264.2013.00029
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The pathogenesis of hyperthyroidism is relatively complicated. In clinical practice, diffuse toxic goiter accompanied with hyperthyroidism (as known as Graves￠ disease) is more common. The pharmaceutical treatment of Graves￠ disease includes antithyroid drugs (ATD), iodine, β-blocker, glucocorticoids and lithium carbonate. ATD are the main treatment for hyperthyroidism, and Methimazole (MMI) and propylthiouracil (PTU) are the two drugs which are most commonly used currently. Generally, ATD are safe and effective, though their clinical adverse reactions are also relatively common. These reactions are usually reversible and disappeared spontaneously when the drug is discontinued. However, the serious rare side effects also occur sometimes. MMI is usually preferred over PTU because it has significantly fewer adverse reactions in a dose-dependent fashion. MMI is the first choice for treating mild and moderate hyperthyroidism. Iodine is mainly used in hyperthyroidism crisis and before operation. Glucocorticoids are mainly used for Graves￠ ophthalmopathy and hyperthyroidism crisis. β-blocker is used to control the symptoms at initial treatment. Lithium carbonate is not commonly used, and only suitable for short-term treatment. The clinicians should evaluate comprehensively and individually to choose appropriate agents for better outcome, and closely monitor their efficiency and side effects.
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WANG Xu-Yun, XI Shao-Zhi, LIU Jia, JING Jing, CHEN Yun-Dai, YIN Tong*
2016,15(03):231-236, DOI: 10.11915/j.issn.1671-5403.2016.03.056
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Objective To analyze the reasons associated with ticagrelor withdrawal and the impact on clinical outcomes in ticagrelor-treated patients with coronary artery disease (CAD). Methods Totally 642 consecutive CAD patients treated by ticagrelor and aspirin in the Department of Cardiology, Chinese PLA General Hospital from January 2014 to July 2015 were recruited. The incidence and the reasons of ticagrelor withdrawal were recorded and analyzed during the hospitalization, at discharge, as well as 3-month after discharge. In the patients treated by percutaneous coronary intervention (PCI), the occurrence of ischemic events [including major ischemic events (cardiovascular death, non-fatal myocardial infarction, ischemic stroke, defined or probable stent thrombosis, coronary revascularization) and secondary ischemic events (readmission of unstable angina)] and bleeding events [including Thrombolysis In Myocardial Infarction trial (TIMI) defined major and minor bleedings] were followed up for 6 months. Results Ticagrelor withdrawal occurred in 164 patients (25.55%), with 42 patients (25.61%) in-hospital, 7 patients(4.27%) at discharge and 115 patients (70.12%) after discharge, respectively. The distributions of ticagrelor withdrawal were 78.05% in unstable angina, 13.41% in ST-elevation myocardial infarction (STEMI), 4.27% in non-STEMI, 4.27% in stable CAD, respectively. The reasons for ticagrelor withdrawal in-hospital and at discharge were mainly attributed to ticagrelor-related dyspnea (32.65%), bleeding (22.45%) and PCI for non-complex coronary lesions (18.37%). Drug unavailability (68.70%) and cost consideration (16.52%) were the major reasons for ticagrelor withdrawal after discharge. Besides 10 dead patients, other patients with ticagrelor withdrawal undertook the alteration of the antiplatelet therapy under the guidance of physicians, with 153 switched to clopidogrel on top of aspirin treatment, 1 to aspirin alone. After 6-month follow-up in PCI patients (n＝499), compared with patients under continuous ticagrelor treatment, patients withdrawing ticagrelor had a higher risk of major ischemic events (4.58% vs 0.82%, HR 6.62, 95%CI 1.17?37.36, P＝0.032) and composited ischemic events (11.45% vs 4.89%, HR 2.46, and 95%CI 1.03?5.89, P＝0.043). No significant difference was found for the risk of composited bleeding events between these patients (16.03% vs 17.12%, HR 0.92, and 95%CI, 0.49?1.73, P＝0.795). Conclusion About one third of ticagrelor treated CAD patients undertake the ticagrelor withdrawal during hospitalization, discharge and within 3 months after hospitalization. Ticagrelor withdrawal in-hospital and at-discharge might be attributed mainly to ticagrelor-related dyspnea, bleeding and non-complex lesions for PCI. Drug unavailability and cost consideration might be the main reasons for out-hospital ticagrelor withdrawal. Ticagrelor withdrawal within 3-months in PCI treated CAD patients might be correlated with increased risk of major and composited ischemic events.
