中华内科杂志最新文献

{"title":"[Diagnosis, treatment, and genetic analysis of five cases of primary atypical hemolytic uremic syndrome].","authors":"W Y He, F Tian, J Li, R H Han, G Q Xing","doi":"10.3760/cma.j.cn112138-20241209-00807","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20241209-00807","url":null,"abstract":"<p><p>A retrospective analysis was conducted on the clinical characteristics, renal pathology, genetic testing, and treatment of five patients -two males and three females-diagnosed with primary atypical hemolytic uremic syndrome (aHUS) in the Department of Nephrology at the Affiliated Hospital of Qingdao University from February 2022 to June 2024. The patients' ages at disease onset ranged from 14 to 29 years. Four patients experienced prodromal infection symptoms. At disease onset, serum creatinine levels ranged from 168.5 to 1 230.2 μmol/L. All patients presented with hematuria, proteinuria, hypertension, non-immune hemolytic anemia, thrombocytopenia, elevated lactate dehydrogenase (LDH), and fragmented red blood cells in peripheral blood (0.5%-6.0%). Serum haptoglobin levels were below the normal lower limit in all cases. Four patients demonstrated decreased serum complement C3, while one maintained normal serum complement C3 throughout the course of the disease. One patient exhibited serum factor H concentrations below the normal lower limit. Another patient tested positive for anti-factor H antibodies. Renal biopsies were performed on four patients. Electron microscopy revealed typical acute-phase pathological features of aHUS in three cases, including glomerular endothelial cell swelling and widened subendothelial spaces. One patient demonstrated ischemic and atrophic changes in the glomerular capillaries, while another had concurrent membranous nephropathy. Whole-exome high-throughput sequencing related to aHUS was performed in all five patients, revealing heterozygous gene mutations in each case. Complement-related gene mutations, typically occurring in a heterozygous state, are prevalent in aHUS patients. The eight heterozygous gene variations identified in this study were absent from existing databases of known aHUS-associated pathogenic mutations. Four patients received eculizumab treatment at varying time points following diagnosis, resulting in differing clinical outcomes. The patient positive for anti-factor H antibodies was treated with rituximab. The patient with membranous nephropathy initiated combination therapy with rituximab and eculizumab after six months of eculizumab monotherapy. Following treatment, all five patients achieved complete cessation of intravascular mechanical hemolysis, with normalization of LDH and platelet levels, as well as varying degrees of renal function recovery. From a pathophysiological perspective, the timely administration of the complement C5 inhibitor eculizumab can rapidly induce clinical remission, reduce the incidence of end-stage renal disease, and improve prognosis in patients with aHUS.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 6","pages":"549-557"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical characteristics and outcomes of elderly patients with stage Ⅰ diffuse large B-cell lymphoma: a study by the Jiangsu Cooperative Lymphoma Group (JCLG)].","authors":"Y Xia, J He, W Y Gu, T Jia, T X Lu, Y L Li, J H Zhou, B Z Li, H Y Hua, P Liu, Y Q Miao, Y X Cheng, X Y Xie, Y P Zhang, W Z Wu, Z X Jia, X Z Lu, C L Wang, L Yu, M Xu, J N Shi, W F Chen, W C Zhuang, Z Qian, J Qian, H W Ni, Y F Chen, Q D Shen, J Y Li, W Y Shi","doi":"10.3760/cma.j.cn112138-20241219-00837","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20241219-00837","url":null,"abstract":"<p><p><b>Objective:</b> To summarize the clinical characteristics of elderly patients with stage Ⅰ diffuse large B-cell lymphoma (DLBCL) and analyze the factors associated with prognosis. <b>Methods:</b> A case series study was conducted by retrospectively collecting clinical data from patients aged over 60 years with newly diagnosed stage Ⅰ DLBCL across 20 medical centers in Jiangsu Province, China, between June 2010 and April 2023. The involved site, classification and treatment plan were summarized. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method, and Cox regression model. <b>Results:</b> The study included 255 patients with a median age of 69 years, of whom 130 (51.0%) were male, 66 (25.9%) were aged ≥75 years and 26 (10.1%) had a high Charlson Comorbidity Index (CCI) score of ≥2. Extranodal involvement was observed in 163 (63.9%) patients, with the stomach (37.4%, 61/163), intestine (19.0%, 31/163), testes (11.0%, 18/163), and breast (7.4%, 12/163) being the most frequently affected sites. The non-germinal center B-cell (non-GCB) subtype was prevalent in 63.7% of patients (142/223), with no significant difference between the nodal and extranodal groups (<i>P</i>=0.681). Furthermore, 73.9% (184/249) and 11.7% (29/249) of patients received the R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-miniCHOP regimen, respectively. The overall 3-year PFS rate was 81.5%, and the 3-year OS rate was 85.6%. Patients aged ≥75 years (<i>HR</i>=2.910, 95%<i>CI</i> 1.565-5.408, <i>P</i>=0.001) and/or with a CCI score ≥2 (<i>HR</i>=2.324, 95%<i>CI</i> 1.141-4.732, <i>P</i>=0.020) had a significantly poorer PFS. Incorporating age ≥75 years and CCI score ≥2 into the stage-modified international prognostic index (sm-IPI) can better stratify the prognosis of elderly patients with stage Ⅰ DLBCL. The 3-year PFS rate was 48.7% in the high-risk group versus 85.7% in the low-risk group (<i>P</i><0.001). <b>Conclusions:</b> Our findings show that the elderly patients with stage Ⅰ DLBCL were predominantly characterized by extranodal involvement (particularly in the stomach and intestinal tract) and non-GCB subtype. Age ≥75 years and CCI ≥2 were identified as independent prognostic factors. The newly established sm-IPI-75-CCI incorporating these factors demonstrated superior prognostic discrimination compared to conventional risk assessment systems.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 6","pages":"504-513"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case of paroxysmal nocturnal hemoglobinuria treated with eculizumab in unintended pregnancy].","authors":"G X Xu, J J Zhu, W B Li, J Jin, H Y Tong","doi":"10.3760/cma.j.cn112138-20250101-00001","DOIUrl":"10.3760/cma.j.cn112138-20250101-00001","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 6","pages":"561-563"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Collagenous colitis: a case report].","authors":"S D Zhang, Z H Deng, K K Tang, Z Y Gao, X M Zhang, H Gu","doi":"10.3760/cma.j.cn112138-20241021-00699","DOIUrl":"10.3760/cma.j.cn112138-20241021-00699","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 6","pages":"564-567"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Neutrophil-to-lymphocyte ratio, monocyte-to-high-density lipoprotein cholesterol ratio, and their correlation and predictive value for cardiovascular calcification in patients on maintenance hemodialysis].","authors":"M H Tang, N N Wang, L Liu","doi":"10.3760/cma.j.cn112138-20250201-00062","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250201-00062","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the correlation between the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), and cardiovascular calcification in patients on maintenance hemodialysis (MHD), and to evaluate their predictive value for cardiovascular calcification. <b>Methods:</b> This retrospective case-control analysis was conducted on the clinical data of 362 patients with chronic kidney disease who underwent regular hemodialysis for >3 months at the Hemodialysis Center of the Second People's Hospital of Hefei from December 2018 to December 2023. Patients were divided into a cardiovascular calcification group (216 cases) and a cardiovascular non-calcification group (146 cases). The cardiovascular calcification group was further categorized according to different calcification sites, with 69 cases in the vascular calcification group, 79 in the valve calcification group, and 68 in the vascular and valve calcification group. Spearman correlation analysis was used to assess the correlation between cardiovascular calcification and various indicators. Risk factors for cardiovascular calcification in patients with MHD were analyzed using binary logistic regression analysis. The predictive value of the NLR and MHR for cardiovascular calcification was analyzed using the receiver operating characteristic (ROC) curve. <b>Results:</b> This study enrolled 362 cases, including 233 males and 129 females aged 29-89 years. Age, the NLR, and the MHR were positively correlated with cardiovascular calcification in patients on MHD (<i>r</i>=0.338, 0.383, and 0.391, respectively, all <i>P</i><0.05). In contrast, serum magnesium was negatively correlated with cardiovascular calcification (<i>r</i>=-0.169, <i>P</i><0.05). Age (<i>OR</i>=1.063, 95%<i>CI</i> 1.036-1.092, <i>P</i><0.001), male sex (<i>OR</i>=2.017, 95%<i>CI</i> 1.104-3.685, <i>P</i>=0.023), neutrophil count (<i>OR</i>=1.737, 95%<i>CI</i> 1.326-2.276, <i>P</i><0.001), the NLR (<i>OR</i>=1.722, 95%<i>CI</i> 1.310-2.263, <i>P</i><0.001), and the MHR (<i>OR</i>=1.352, 95%<i>CI</i> 1.153-1.586, <i>P</i><0.001) were identified as independent risk factors for cardiovascular calcification in patients on MHD. Serum magnesium (<i>OR</i>=0.034, 95%<i>CI</i> 0.001-0.797, <i>P</i>=0.036) was a protective factor. The combined area under the curve (AUC) of the NLR and MHR was the largest (AUC=0.804, 95%<i>CI</i> 0.759-0.850); the AUC for the NLR and MHR used alone was 0.725 (95%<i>CI</i> 0.672-0.779) and 0.730 (95%<i>CI</i> 0.677-0.783), respectively. <b>Conclusions:</b> The MHR, and the NLR are independent risk factors for cardiovascular calcification in patients with MHD. The combination of the MHR and NLR has a greater clinical predictive value for cardiovascular calcification.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 6","pages":"522-531"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Thrombotic microangiopathy caused by tyrosine kinase inhibitor in small intestine stromal tumor: a case report].","authors":"Z Q Wang, C N Gao, J Xu, X N Chen","doi":"10.3760/cma.j.cn112138-20241107-00739","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20241107-00739","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 5","pages":"441-444"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of the clinical characteristics of 59 cases of autoimmune gastritis].","authors":"L Guan, X H Zhang, Y Feng, Y L Li","doi":"10.3760/cma.j.cn112138-20240930-00634","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240930-00634","url":null,"abstract":"<p><p><b>Objective:</b> To analyze the clinical characteristics of patients with autoimmune gastritis (AIG) and compare the associated factors between AIG and type B atrophic gastritis. <b>Methods:</b> A total of 59 patients were diagnosed as showing AIG at the First Affiliated Hospital of China Medical University between January 2021 and August 2024. These patients were age-and sex-matched with 59 patients diagnosed with type B atrophic gastritis at the same center. The basic information and relevant clinical indicators of the two groups of patients were recorded. Univariate and multivariate logistic analyses were used to determine the differential factors between AIG and type B atrophic gastritis. <b>Results:</b> AIG mainly occurred in patients aged 50-70 years and showed a sex ratio of approximately 1∶3. Anti-intrinsic factor antibody (IFA)-positive results were observed in 28.8% of patients showing AIG. The pepsinogen Ⅰand pepsinogen Ⅰ/Ⅱ ratio in the IFA-positive group was significantly lower than that in the IFA-negative group [4.8 (2.8,6.3) vs.13.3 (5.8, 25.2) μg/L, <i>t</i>=-5.24, <i>P</i><0.05; 1.0±0.6 vs. 2.2±1.6, <i>t</i>=-3.72, <i>P</i><0.05]. Among the patients with AIG, 35.2% had anemia, including 1.8% with severe anemia. The relevant indicators showed no statistically significant differences between patients with and without anemia. After univariate and multivariate logistic analyses, we compared gastric function and <i>Helicobacter pylori</i> infection in patients with AIG and type B atrophic gastritis, and the gastrin 17 level was identified an independent differential factor between the two groups (<i>OR</i>=0.913, 95%<i>CI</i> 0.851-0.978, <i>P</i>=0.010). <b>Conclusion:</b> The gastrin 17 level can help distinguish AIG and type B atrophic gastritis, and is valuable for early identification of AIG.</p>","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 5","pages":"417-423"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case of renal sarcoidosis presenting with acute exacerbation of chronic renal insufficiency].","authors":"X J Tian, Q Jia, L J He, D Wang","doi":"10.3760/cma.j.cn112138-20241202-00792","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20241202-00792","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 5","pages":"436-440"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chronic kidney disease-associated pruritus combined with anxiety and depression treated with nalfurafine hydrochloride: a case report].","authors":"L Yin, H Ding, Y Y Xu","doi":"10.3760/cma.j.cn112138-20250116-00042","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20250116-00042","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 5","pages":"445-447"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The comorbidity mechanism of celiac disease and immunoglobulin A nephropathy].","authors":"Y Y Gong, X Y Liu, Y Chen","doi":"10.3760/cma.j.cn112138-20240625-00403","DOIUrl":"https://doi.org/10.3760/cma.j.cn112138-20240625-00403","url":null,"abstract":"","PeriodicalId":68309,"journal":{"name":"中华内科杂志","volume":"64 5","pages":"462-467"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}