Studies of evidence-based medicine have provided much important evidence, clarified problems, and guided the clinical practice in the treatment of renal diseases. As examples, several therapeutic problems in renal hypertension, renal anemia and low protein diet for the patients with chronic kidney disease are discussed in this paper.
ObjectiveTo observe the effect of mild anemia on prognosis of hyperplastic diabetic retinopathy (PDR) treated by pars plana vitrectomy (PPV). MethodsA retrospective case-control study. From January 2021 to December 2022, 147 PDR patients with 147 eyes who received PPV treatment at Shenyang He Eye Hospital were included in the study. There were 147 eyes in 147 cases, 82 eyes in 82 males and 65 eyes in 65 females. Age was 25-79 (53.54±12.74) years old. A hemoglobin (Hb) of 90 to 120 g/L in men and 90 to 110 g/L in women was defined as mild anemia. According to Hb results, the patients were divided into mild anemia group and non-anemia group, with 39 cases (39 eyes) and 108 cases (108 eyes), respectively. The best corrected visual acuity (BCVA) test was performed using the international standard logarithmic visual acuity scale before and after the surgery, which was statistically converted to minimum resolved logarithmic (logMAR) visual acuity. The logMAR BCVA of the affected eye was 0.2-2.5 (1.60±0.62) before surgery. According to whether the BCVA improved by more than 3 lines 6 months after surgery, the affected eyes were divided into BCVA improved by more than 3 lines and BCVA improved by less than 3 lines, 117 eyes and 30 eyes, respectively. The patient's body mass index (BMI), BCVA at 6 months after surgery, and the occurrence of neovascular glaucoma (NVG) and recurrence of vitreous hemorrhage (RVH) were recorded. Independent sample t test was used for comparison between groups. Multivariate logistic regression analysis was performed to analyze the influencing factors of increased BCVA ≥3 rows after surgery. ResultsSix months after surgery, the logMAR BCVA of patients in mild anemia group and non-anemia group were 0.97±0.87 and 0.68±0.63, respectively. BCVA increased ≥3 in 26 (66.7%, 26/39) and 91 (84.3%, 91/108) eyes, respectively. logMAR BCVA (t=2.234) and BCVA increased by ≥3 rows of eyes (χ2=5.460) between the two groups, the differences were statistically significant (P=0.027, 0.019). Logistic regression analysis showed that baseline logMAR BCVA [odds ratio (OR) =4.291, 95% confidence interval (CI) 1.918-9.600, P＜0.001)], BMI (OR=1.248, 95%CI 1.057-1.472, P=0.009), the number of retinal laser photocoagulation during surgery (OR=1.001, 95%CI 1.000-1.002, P=0.038), mild anemia (OR=0.360, 95%CI 0.131-0.993, P=0.048), postoperative NVG (OR=0.156, 95%CI 0.033-0.726, P=0.018) and RVH (OR=0.264, 95%CI 0.086-0.808, P=0.020) were independent factors for BCVA improvement ≥3 lines after PPV. ConclusionsMild anemia has a certain effect on BCVA improvement after PPV of PDR. Mild anemia, post-operative NVG and RVH were independent risk factors for increasing BCVA ≥3 lines after PPV in PDR patients.
Objective To determine the best threshold value of hemoglobin A2 (HbA2) for diagnosis of β-thalassemia (β-thal) carriers by using high performance liquid chromatography (HPLC), and to improve the application value of HbA2 as a diagnostic index for β-thal carriers to reduce the rates of missed diagnosis and misdiagnosis. Methods Using reverse dot blot (RDB) as a gold standard method, HbA2 results of 1 007 β-thal carriers and 606 normal controls in the past two years determined by HPLC were divided into true positive, false positive, true negative, and false negative based on the different threshold values of HbA2 results. Then, the evaluation indexes such as sensitivity, specificity, positive and negative likelihood ratio, and Youden’s index were evaluated. Next, the receiver operator characteristic (ROC) curve was drawn to determine the best threshold value of HbA2 for diagnosis of β-thal carriers by HPLC. Results If ≥4.0% was taken as the threshold value of HbA2 for diagnosis of β-thal carriers by HPLC, the evaluation indexes values were shown as follows: sensitivity 99.21%, specificity 99.34%, positive likelihood ratio 150.30, negative likelihood ratio 0.008, and Youden’s index 0.99. The Youden’s index was better than the other threshold values, and the corresponding tangent point was the peak point of the ROC curve. Conclusion When ≥4.0% serves as the best threshold value of HbA2 for diagnosis of β-thal carriers using HPLC, integrated evaluation performance of the corresponding sensitivity and specificity is the most ideal, and the authenticity of the diagnostic test is the best.
目的:评价重组人红细胞生成素(Recombinant human erythropoietin injection, rHuEpo)治疗肿瘤化疗相关性贫血的疗效和安全性,以及对生存质量的影响。方法:采用随机分组方式,分为治疗组和对照组,分别于1～3周期化疗后6～24小时开始。治疗组(40例)行rHuEpo 治疗,150 U/kg皮下注射每周3次,疗程4～8周;对照组(24例)未用rHuEpo 治疗,其他治疗如中药及支持治疗两组均相同。所有64例患者若出现严重贫血则给予输血治疗,以保证化疗顺利进行。观察rHuEpo 对患者血红蛋白(Hb)、红细胞容积(Hct)、RBC、KPS评分、体重改善情况的影响以及rHuEpo 的毒副反应。结果:与对照组相比,治疗组治疗后Hb水平显著提高,8周有效率70%;2周内网织红细胞计数显著提高;应用无严重副反应发生,生存质量改善。结论:rHuEpo 治疗肿瘤化疗相关性贫血的疗效肯定,副反应少,能够改善患者生存质量。
Objective To investigate the diagnostic value of the series parameters of reticulocyte in children with different types of anemia. Methods From January to August 2015, the reticulocyte parameters of 150 children with different types of anemia treated in the People’s Hospital of Dujiangyan were retrospectively analyzed. Another 150 healthy children aged 1-10 years examined in the same hospital at the same period were as the control group. Mindray BC-6900 automatic blood cell analyzer and suited reagent were used to determine the absolute value of reticulocyte (RET#), percentage of reticulocyte (RET%), immature reticulocyte ratio (IRF), low fluorescent intensity reticulocyte percentage (LFR%), moderate fluorescent intensity reticulocyte percentage (MFR%), and height fluorescent intensity reticulocyte percentage (HFR%). The data were statistically analyzed. Results Compared with the control group, RET%, RET# and IRF results in iron deficiency anemia group, hemolytic anemia group, aplastic anemia group, recent hemorrhagic anemia group, renal anemia group, leukemia and chemotherapy group had statistical difference (P<0.05). Compared with the control group, LFR%, MFR%, HFR% results in hemolytic anemia group and aplastic anemia group had statistical difference (P<0.05). LFR%, MFR% and HFR% results of other types of anemia had no statistical differences (P>0.05). Conclusion The series parameters of the reticulocyte, having an important reference value, can be used in the diagnosis of children with different types of anemia as a reference index, early diagnosis and early treatment of children with different anemia, which also can be used as a method to diagnose different types of anemia.
ObjectiveTo investigate the incidence of perioperative anemia and the influencing factors of preoperative anemia in patients with colorectal cancer.MethodsThe clinicopathological data of 1 250 patients with colorectal cancer who underwent surgery in our hospital from January 1, 2019 to December 31, 2019 were analyzed retrospectively. According to the preoperative hemoglobin level, patients were divided into anemia group and non-anemia group. Univariate analysis and multivariate logistic regression analysis were used to explore the influencing factors of preoperative anemia in patients with colorectal cancer, and the effects of preoperative anemia on intraoperative blood transfusion, postoperative complications, and postoperative hospital stay were analyzed.ResultsThe incidence of preoperative anemia in patients with colorectal cancer was 40.6% (508/1 250), and the incidence of preoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 66.0% (192/291), 41.1% (139/338), and 28.5% (177/621), respectively. The incidence of postoperative anemia in patients with colorectal cancer was 69.4% (867/1 250), and the incidence of postoperative anemia in patients with right colon cancer, left colon cancer, and rectal cancer was 81.8% (238/291), 68.9% (233/338), and 63.8% (396/621), respectively. Multivariate logistic regression analysis showed that age >60 years old, nutritional risk screening 2002 ≥3, right colon cancer, T3–4 stage, and M1 stage were risk factors for preoperative anemia in patients with colorectal cancer (P<0.05). The rate of intraoperative blood transfusion and the incidence of postoperative complications in the preoperative anemia group of patients with colorectal cancer were higher than those in the non-anemia group (P<0.05). The postoperative hospital stay in the preoperative anemia group of patients with colon cancer was longer than that in the non-anemia group (P<0.05).ConclusionsThe incidence of perioperative anemia in patients with colorectal cancer is high. Advanced age, high nutritional risk, right colon cancer, T3–4 stage, and distant metastasis were the risk factors of preoperative anemia in patients with colorectal cancer. Preoperative anemia can increase the demand for intraoperative blood transfusion and the incidence of postoperative complications in patients with colorectal cancer, and prolong postoperative hospital stay of colon cancer patients.