Does Age at Onset of First Major Depressive Episode Indicate the Subtype of Major Depressive Disorder?: The Clinical Research Center for Depression Study

Purpose

The purpose of this study was to evaluate the effects of age at onset of the first major depressive episode on the clinical features of individuals with major depressive disorder (MDD) in a large cohort of Korean depressed patients.

Materials and Methods

We recruited 419 MDD patients of age over 18 years from the Clinical Research Center for Depression study in South Korea. At the start of the study, the onset age of the first major depressive episode was self-reported by the subjects. The subjects were divided into four age-at-onset subgroups: childhood and adolescent onset (ages <18), early adult onset (ages 18-44), middle adult onset (ages 45-59), and late onset (ages 60+). Using analysis of covariance (ANCOVA) and ordinal logistic regression analysis with adjusting the effect of age, the relationships between clinical features and age at onset of MDD were evaluated.

Results

There was an apparent, but inconsistent correlation between clinical features and age at onset. Earlier onset MDD was significantly associated with higher proportion of female gender [adjusted odds ratio (AOR)=0.570, p=0.022], more previous suicide attempts (AOR=0.635, p=0.038), greater number of previous depressive episodes (F=3.475, p=0.016) and higher scores on the brief psychiatric rating scale (F=3.254, p=0.022), its negative symptom subscale (F=6.082, p<0.0001), and the alcohol use disorder identification test (F=7.061, p<0.0001).

Conclusion

Early age at onset may increase the likelihood of distinguishable MDD subtype, and age at onset of the first major depressive episode is a promising clinical indicator for the clinical presentation, course, and outcome of MDD.     

Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis

Purpose

Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA.

Materials and Methods

A total of 304 patients with HA admitted to our institution between July 2009 and June 2011 were enrolled consecutively. Patients with complications defined as acute liver failure (ALF) were evaluated, and mortality was defined as death or liver transplantation.

Results

The mean age of patients (204 males, 100 females) was 32 years. Eighteen (5.9%) patients had progressed to ALF. Of the patients with ALF, 10 patients (3.3%) showed spontaneous survival while 8 (2.6%) died or underwent liver transplantation. Multivariate regression analysis showed that Model for End-Stage Liver Disease (MELD) and systemic inflammatory response syndrome (SIRS) scores were significant predictive factors of ALF. Based on receiver operating characteristics (ROC) analysis, a MELD ≥23.5 was significantly more predictive than a SIRS score ≥3 (area under the ROC: 0.940 vs. 0.742, respectively). In addition, of patients with a MELD score ≥23.5, King''s College Hospital criteria (KCC) and SIRS scores were predictive factors associated with death/transplantation in multivariate analysis.

Conclusion

MELD and SIRS scores ≥23.5 and ≥3, respectively, appeared to be related to ALF development. In addition, KCC and SIRS scores ≥3 were valuable in predicting mortality of patients with a MELD ≥23.5.     

床边超声测定检查在危重症患者液体复苏的应用价值研究

目的 探讨床边超声检查对危重症患者液体复苏的指导意义。方法 选取2018年3月～2019年7月收治的80例危重症患者作为研究对象,随机将研究对象分为床边超声组和对照组两组,每组各40例。床边超声组采用床边超声的测定参数值进行指导危重症患者的液体复苏治疗,对照组患者选择脉搏指示剂持续心排血量法(PICCO)对患者液体复苏治疗予以相关指导。两组患者均在早期进行液体复苏治疗,且均进行有效的综合治疗,最后比较患者液体复苏前后下腔静脉(IVC)内径、呼吸变异指数(RVI)、左室舒张末期容积(LVEDV);同时比较患者血管外肺水指数(EVLWI)、液体复苏前后的胸腔内血容量指数(ITBVI)、中心静脉压(CVP)以及两组患者液体复苏前后的心率、收缩压及舒张压、液体复苏治疗后各时间点即治疗后6 h、12 h、24 h的达标率。结果 患者进行液体复苏后,其中床边超声组的各参数除RVI均升高,两组患者的心率、收缩压及舒张压在复苏前差异无统计学意义(P0.05)。两组患者心率在复苏6 h后较复苏前明显下降,收缩压、舒张压较复苏前明显升高,差异有统计学意义(P0.05)。复苏24 h,床边超声组心率明显优于对照组,差异有统计学意义(P0.05)。结论 对危重症患者进行液体复苏采用床边超声具有重要的指导作用。     

从腰夹脊穴论治中风后平衡功能障碍针刺思路探析

平衡功能障碍是中风后常见后遗症,增加了患者跌倒的风险及患者的病痛和负担,延缓了康复的进程,影响功能的恢复。针刺治疗是治疗中风后平衡功能障碍的重要方法,临床多以脏腑辨证和经络辨证为基础,多采用头皮针、体针、芒针等方法,虽取得一定疗效,但仍存在相应的局限性,缺乏现代学理论依据;本文从经络辨证和现代医学核心肌群理论出发,选取处于腰部核心肌群的夹脊穴,既可以通督脉、调摄膀胱经之背俞穴,入络脑室,从而达到整体治疗、调整阴阳的目的,又可以松解神经,进而缓解肌痉挛,降低肌张力,提高平衡功能。最后提出以针刺腰部夹脊穴治疗中风后平衡功能障碍,期待在临床治疗中取得更好的效果。     

班布特罗联合噻托溴铵粉治疗慢性阻塞性肺气肿的临床研究

目的探讨班布特罗联合噻托溴铵粉治疗慢性阻塞性肺气肿的临床疗效。方法以2017年6月—2018年6月在平煤神马医疗集团总医院进行治疗的100例慢性阻塞性肺气肿患者为研究对象,根据住院号的先后分为对照组(50例)和治疗组(50例)。对照组用吸入器吸入噻托溴铵粉吸入剂,18μg/次,1次/d;治疗组在对照组的基础上口服盐酸班布特罗片,初始10 mg/次,1次/d,根据临床效果,在用药1～2周后可增加到20 mg/次,1次/d。两组患者均连续治疗2周。观察两组患者的临床疗效,同时比较两组的肺功能、血气指标、血清学指标、圣乔治呼吸问卷(SGRQ)评分和慢性阻塞性肺疾病(CAT)评分。结果治疗后,对照组和治疗组总有效率分别为80.00%、96.00%,两组比较差异具有统计学意义(P0.05)。两组患者的一秒用力呼气容积(FEV_1)、用力肺活量(FVC)和FEV_1/FVC水平均显著升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组肺功能指标水平显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的动脉血氧分压(pO_2)、血氧饱和度(SaO_2)显著升高,二氧化碳分压(pCO_2)显著降低,同组治疗前后比较差异具有统计学意义(P0.05);治疗后,治疗组的血气指标水平显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组血清白细胞介素-4(IL-4)、转化生长因子-β1(TGF-β1)、人分泌型卷曲相关蛋白-1(SFRP-1)、肿瘤坏死因子-α(TNF-α)、基质金属蛋白酶-9(MMP-9)、血管黏附蛋白-1(VAP-1)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组血清学指标均显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者的SGRQ评分显著降低,CAT评分显著升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组SGRQ评分、CAT评分均显著优于对照组,两组比较差异具有统计学意义(P0.05)。结论班布特罗联合噻托溴铵粉治疗慢性阻塞性肺气肿疗效显著,能够有效改善患者肺功能,促进机体炎症因子水平降低,提高患者生活质量,具有一定临床推广应用价值。     

化滞柔肝颗粒联合硫普罗宁治疗非酒精性脂肪肝的临床研究

目的探讨化滞柔肝颗粒联合硫普罗宁片治疗非酒精性脂肪肝的临床疗效。方法选取2016年6月—2018年6月在青岛市第六人民医院进行治疗的100例非酒精性脂肪肝患者作为研究对象,根据用药的不同将患者分为对照组(50例)和治疗组(50例)。对照组患者口服硫普罗宁片,2片/次,3次/d;治疗组患者在对照组治疗的基础上口服化滞柔肝颗粒,1袋/次,3次/d。两组均治疗8周。观察两组患者的临床疗效,同时比较两组治疗前后的血脂水平、肝功能指标和血清学指标。结果治疗后,对照组总有效率为82.00%,显著低于治疗组的96.00%,两组比较差异具有统计学意义(P0.05)。治疗后,两组总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平均明显降低,高密度脂蛋白胆固醇(HDL-C)水平显著增高(P0.05);治疗后,治疗组血脂水平显著优于对照组(P0.05)。治疗后,两组丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和γ-谷氨酰转肽酶(γ-GT)水平均明显降低(P0.05);治疗后,治疗组肝功能指标显著低于对照组(P0.05)。治疗后,两组瘦素(LEP)、摄食抑制因子-1(NSF-1)、成纤维细胞生长因子-21(FGF-21)、硫氧还蛋白相互作用蛋白(TXNIP)、低氧诱导因子-1α(HIF-1α)水平均显著降低(P0.05);治疗后,治疗组血清学指标显著低于对照组(P0.05)。结论化滞柔肝颗粒联合硫普罗宁片治疗非酒精性脂肪肝疗效确切,可改善患者肝功能,降低血脂和血清因子水平,具有一定的临床应用价值。     

达格列净联合比格列酮治疗2型糖尿病的临床研究

目的探讨达格列净片联合吡格列酮片治疗2型糖尿病的临床疗效。方法选取2018年1月—2019年1月深圳市第二人民医院收治的86例2型糖尿病患者纳入本研究,根据用药方案之间的差异将患者分为对照组和治疗组,每组各43例。对照组于早饭前口服吡格列酮片,2片/次,1次/d。治疗组在对照组的基础上于早晨口服给予达格列净片,0.5片/次,1次/d。两组患者均治疗3个月。观察两组患者临床疗效,同时比较治疗前后两组患者血糖指标、氧化应激指标水平。结果治疗后,对照组、治疗组总有效率分别为72.1%、90.7%,两组总有效率比较差异具有统计学意义(P0.05)。治疗后,两组空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)水平均显著降低,胰高血糖素样肽1(GLP-1)水平显著升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组血糖指标均明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组谷胱甘肽过氧化物酶(GSH-PX)、超氧化物歧化酶(SOD)、总抗氧化能力(T-Aoc)水平均显著升高,丙二醛(MDA)水平显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组氧化应激指标均明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论达格列净片联合吡格列酮片治疗2型糖尿病具有较好的临床疗效,可改善患者血糖水平,缓解氧化应激状态,具有一定的临床推广应用价值。     

益气和胃胶囊联合瑞巴派特治疗慢性非萎缩性胃炎的临床研究

目的探讨益气和胃胶囊联合瑞巴派特片治疗慢性非萎缩性胃炎的临床疗效。方法选取2018年2月—2018年10月在荆州市中心医院进行治疗的94例慢性非萎缩性胃炎患者为研究对象,根据用药方案的不同分为对照组和治疗组,每组各47例。对照组口服瑞巴派特片,0.1g/次,3次/d;治疗组在对照组基础上口服益气和胃胶囊,2.0g/次,3次/d。两组均治疗4周。观察两组的临床疗效,比较两组的症状积分、血清学指标水平、胃黏膜炎症积分、胃黏膜炎症病理积分。结果治疗后,对照组和治疗组的总有效率分别为80.85%、95.74%,两组比较差异有统计学意义(P0.05)。治疗后,两组胃脘痞胀、胃脘疼痛、食欲不振、嗳气积分均明显降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗后治疗组症状积分明显低于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组胃泌素(GAS)、胃动素(MTL)、前列腺素E2(PGE2)水平均显著升高,表皮生长因子(EGF)水平显著降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗后,治疗组血清学指标明显优于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组胃黏膜炎症积分、胃黏膜炎症病理积分均明显降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗后,治疗组胃黏膜炎症积分、胃黏膜炎症病理积分明显低于对照组,两组比较差异有统计学意义(P0.05)。结论益气和胃胶囊联合瑞巴派特片特治疗慢性非萎缩性胃炎具有较好的临床疗效,可改善患者临床症状、胃黏膜炎症及病理情况,促进机体血清GAS、MTL、EGF、PGE2水平增高,具有一定的临床推广应用价值。