目的 总结盐酸沙格雷酯治疗周围动脉炎性疾病的初步疗效。方法 2009年10月至2012年3月期间我院共收治32例周围动脉炎性疾病患者，其中血栓闭塞性脉管炎（TAO） 18例，雷诺综合征14例，经患者知情同意的情况下给予盐酸沙格雷酯治疗，给予西络他唑100mg/d以及必须的强的松治疗后加服盐酸沙格雷酯100mg，3次/d口服，治疗后3个月观察疗效。结果 18例TAO患者中有10例服用了盐酸沙格雷酯，治疗后其间歇性跛行距离〔（362±127） m〕较治疗前 〔（224±86） m〕延长；8例静息痛患者中7例症状消失，1例改善；4例溃疡患者中3例愈合，1例未愈合。8例未加服盐酸沙格雷酯患者，有6例间歇性跛行消失，2例改善；5例静息痛患者中3例症状消失，2例改善；2例溃疡患者中1例愈合，1例未愈合。14例雷诺综合征患者中8例加服盐酸沙格雷酯，雷诺症状7例消失，1例改善；3例溃疡患者完全愈合。6例未加服盐酸沙格雷酯患者雷诺症状4例消失，2例改善；1例溃疡患者未愈合。结论 从本组有限病例资料看，盐酸沙格雷酯对于治疗周围动脉炎性疾病是有效的。
ObjectiveTo investigate the relationship between the level of stromal cell-derived factor-1 (SDF-1), internal carotid artery stiffness index, and non-arteritic anterior ischemic optic neuropathy (NAION) with macular edema (ME). MethodsA retrospective study. A total of 202 patients with NAION diagnosed by ophthalmic examination in Department of Ophthalmology, The Second Affiliated Hospital of Jiamusi University from January 2023 to January 2025 were included in the study. Based on the presence or absence of ME, the patients were divided into the NAION+ME group and the NAION group, with 94 and 108 cases respectively. A prediction model was constructed based on the influencing factors. To comprehensively evaluate the predictive value of SDF-1 level and carotid artery stiffness index for NAION with ME, a multidimensional analytical approach was employed. The diagnostic performance of individual and combined markers was assessed by constructing receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC). Multivariate logistic regression analysis was performed to determine their independent predictive value. Stratified subgroup analyses were conducted to explore predictive differences across various populations. Cox proportional hazards regression models were established to evaluate long-term predictive value. Restricted cubic spline (RCS) analysis was applied to reveal potential nonlinear dose-response relationships. Mediation effect models were constructed to analyze the mediating role of carotid artery stiffness index in the association between SDF-1 level and NAION with ME. ResultsIn the NAION+ME group, systolic blood pressure (t=6.066), body mass index (t=2.804), disease duration (t=2.552), intraocular pressure (t=2.574), high-density lipoprotein (t=2.729), fasting blood glucose (t=2.022), glycosylated hemoglobin (t=7.235), SDF-1 level (t=14.319), and internal carotid artery stiffness index (t=2.633) were higher than those in the NAION group, while diastolic blood pressure was lower (P＜0.05). ROC curve analysis showed that the AUC of SDF-1 level combined with internal carotid artery stiffness index in predicting the risk of adverse prognosis was 0.894 [95% confidence interval (CI) 0.803-0.945], with a sensitivity of 87.98% and a specificity of 95.69%. Logistic regression analysis demonstrated significant independent correlations between SDF-1 level (OR=1.682, 95%CI 1.156-1.986), internal carotid artery stiffness index (OR=1.826, 95%CI 1.369-2.648), and the risk of ME in NAION patients (P＜0.05). Subgroup analysis revealed that elevated SDF-1 level and internal carotid artery stiffness index were associated with a higher risk of NAION with ME (Pfor trend＜0.05). RCS analysis demonstrated a nonlinear dose-response relationship between the continuous changes in SDF-1 level and internal carotid artery stiffness index and the risk of NAION with ME (P＜0.05). Mediation effect model analysis showed that internal carotid artery stiffness index played a mediating role between SDF-1 level and the risk of NAION with ME. ConclusionsSDF-1 level and internal carotid artery stiffness index are independent risk factors for ME in NAION patients. The combined detection of these two indicators holds significant value in predicting disease progression.
Takayasu arteritis (TA) is a primary, chronic, non-specific, inflammatory disease of the aorta and its larger branches. The pulmonary artery trunk and its branches could be impacted by TA, which could cause stenosis or occlusion of lesion vessels. TA also affects the normal function of the aortic valve and other heart valves, mainly due to valvular insufficiency. Aortic regurgitation caused by TA is mainly treated by surgical operation. In this review, the examination technique, operation timing, operation method and prognosis of aortic valve involved in TA are discussed systematically.
Objective To construct and evaluate a screening and diagnostic system based on color fundus images and artificial intelligence (AI)-assisted screening for optic neuritis (ON) and non-arteritic anterior ischemic optic neuropathy (NAION). MethodsA diagnostic test study. From 2016 to 2020, 178 cases 267 eyes of NAION patients (NAION group) and 204 cases 346 eyes of ON patients (ON group) were examined and diagnosed in Zhongshan Ophthalmic Center of Sun Yat-sen University; 513 healthy individuals of 1 160 eyes (the normal control group) with normal fundus by visual acuity, intraocular pressure and optical coherence tomography examination were collected from 2018 to 2020. All 2 909 color fundus images were as the data set of the screening and diagnosis system, including 730, 805, and 1 374 images for the NAION group, ON group, and normal control group, respectively. The correctly labeled color fundus images were used as input data, and the EfficientNet-B0 algorithm was selected for model training and validation. Finally, three systems for screening abnormal optic discs, ON, and NAION were constructed. The subject operating characteristic (ROC) curve, area under the ROC (AUC), accuracy, sensitivity, specificity, and heat map were used as indicators of diagnostic efficacy. ResultsIn the test data set, the AUC for diagnosing the presence of an abnormal optic disc, the presence of ON, and the presence of NAION were 0.967 [95% confidence interval (CI) 0.947-0.980], 0.964 (95%CI 0.938-0.979), and 0.979 (95%CI 0.958-0.989), respectively. The activation area of the systems were mainly located in the optic disc area in the decision-making process. ConclusionAbnormal optic disc, ON and NAION, and screening diagnostic systems based on color fundus images have shown accurate and efficient diagnostic performance.
ObjectiveTo enhance the understanding of Takayasu’s arteritis (TA) with pulmonary vascular involvement through the analyses on clinical features.MethodsA retrospective study was conducted to analyze the clinical records of patients diagnosed as TA with pulmonary vascular involvement admitted to Beijing Anzhen Hospital from January 2007 to August 2017.ResultsIn recent 10 years, there were 233 patients diagnosed as TA in Beijing Anzhen Hospital, 17 of them were involved with pulmonary arterial, which accounted for 7.3%. Fourteen patients were females, 3 patients were males. The age ranged from 16 to 59 years with an average of (40±13) years. Among the 17 patients, dyspnea (15 cases, 88.2%) was the most common symptom, and unequal blood pressure of upper limbs (9 cases, 52.9%) was the main sign. Thirteen patients had pulmonary hypertension by echocardiographic examination. Angiographic data showed that multi-lobular and multi-segmental pulmonary branches were predominantly affected. Unilateral involvement of pulmonary artery was more common than bilateral involvement, while the right pulmonary arteries were more often affected than the left. Thirteen patients received hormone and immunosuppressive therapy, 11 patients received anticoagulation or antiplatelet therapy, and 5 patients received targeted treatment of pulmonary artery pressure.ConclusionsThe clinical manifestation of TA is unspecific and misdiagnosis rate is relatively high. Improving the understanding of TA is necessary so as to reduce the misdiagnosis rate at an early stage and ameliorate the prognosis.