Exploring soluble urokinase plasminogen activator receptor and its relationship with arterial stiffness in a bi-ethnic population: the SAfrEIC-study

Introduction

Elevated soluble urokinase-type plasminogen activator receptor (suPAR) indicates an inflammatory state caused by conditions such as HIV and cancer. Recently suPAR was identified as an indicator of cardiovascular disease (CVD). CVD is highly prevalent in black South Africans, but the potential role of suPAR is unknown. We investigated suPAR as a possible marker of arterial stiffness in Africans and Caucasians.

Methods

This study involved 207 Africans and 314 Caucasians (aged 20-70 yrs). C-reactive protein (CRP) and suPAR were determined in fasting blood samples. We measured blood pressure, pulse wave velocity (PWV) and Windkessel arterial compliance (Cwk).

Results

Africans displayed higher suPAR, CRP, PWV and lower Cwk (p < 0.001) compared to Caucasians. SuPAR was elevated in Africans irrespective of gender and smoking. We found strong relationships between PWV and suPAR (r = 0.27; p < 0.001) and Cwk and suPAR (r = − 0.39; p < 0.001) in the whole group, but found no independent relationship of any arterial stiffness measure and suPAR in Africans after adjustment for confounders. Caucasian men indicated a weak significant independent association between Cwk and suPAR (β = − 0.09; p = 0.028).

Conclusion

Africans had higher levels of suPAR and arterial stiffness than Caucasians (p < 0.001), but there was no independent relationship between arterial stiffness and suPAR in the Africans. It is speculated that due to the inflammatory role of suPAR, it will have stronger relationships with atherosclerosis, which has not yet manifested in this relatively young population group. SuPAR may therefore not be an ideal early marker of cardiovascular dysfunction, but may rather indicate established CVD.     

Association of elevated NTproBNP with recurrent thromboembolic events after acute pulmonary embolism

Introduction

N-Terminal Pro-Brain Natriuretic Peptide (NTproBNP) is a predictor of adverse short-term clinical outcomes in patients with acute pulmonary embolism (APE), but its long-term prognostic value remains largely undefined. The aim of this study was to assess the value of plasma NTproBNP with regard to recurrent venous thromboembolism (VTE).

Materials and Methods

NTproBNP levels were measured in 224 consecutive patients with the first episode of acute pulmonary embolism occurring from January 2005 through October 2010. Patients were categorized into two groups by NTproBNP reference range. Follow-ups were performed at 3, 6, and 12 months and yearly thereafter. The primary end point was symptomatic, recurrent fatal or nonfatal VTE.

Results

NTproBNP was elevated in 158 (70.5%) patients and not elevated in 66 (29.5%) patients. After a mean follow-up period of 31.0 ± 19.4 months, patients with elevated NTproBNP showed an increased risk of recurrent VTE (20 patients, 12.7%) compared to those without elevated NTproBNP (only 1 patient, 1.5%) (P = 0.009). Of the 7 deaths related to pulmonary embolism, 6 occurred in patients with elevated NTproBNP compared to patients with normal NTproBNP (1 of 7 deaths). In a multivariate analysis stratified by oral anticoagulant treatment duration, elevated NTproBNP was an independent predictor of recurrent VTE (hazard ratio, 9.32; P = 0.02).

Conclusions

Elevated NTproBNP is associated with recurrent VTE in acute pulmonary embolism patients.     

重型颅脑外伤术后脑梗塞预防性治疗研究

目的：探讨重型颅脑外伤患者早期术后治疗对脑梗死发生的影响。方法：重型颅脑外伤共133例,均采用常规去骨瓣开颅术清除血肿减压,根据术后急性期（3d）内收缩压状况分为A、B、C3组（〈150mmHg,151～180mmHg,〉180mmHg）,术后行脱水及扩血管治疗。术后1、3、7d复查CT。结果：本研究病例共出现49例脑梗死,A、B、C3组分别为20、17、12例,其中死亡9例,A、C组分别为7例、2例。结论：收缩压过高或过低是重型路脑外伤患者术后脑梗塞发生及其预后的重要因素,术后急性期内维持收缩压于稍高状态（151～180mmHg）可有效减少患者脑梗死发生率,降低病死率。     

白发性细菌性腹膜炎的预后分析

目的：探讨影响肝硬化合并自发性细菌性腹膜炎（SBP）预后的独立指标并建立危险指数模型。方法回顾性分析133例SBP患者,根据死亡与否分为死亡组和生存组,用单变量（t检验）和多变量（Logistic回归）方法对两组患者的临床资料进行比较分析并建立危险指数模型。结果影响自发性细菌性腹膜炎短期预后的指标有：腹水葡萄糖、氯、尿素、肝性脑病,根据以上指标建立危险指数模型：PI =9.512-0.303×腹水葡萄糖-0.104×氯＋0.108×尿素＋0.709×肝性脑病。界值为：-0.78。受试者工作特征（ROC）曲线下面积为0.846。结论本研究建立的危险指数模型对判断自发性细菌性腹膜炎的近期预后准确性高,为临床病情评估,合理用药,改善预后提高参考。     

Presepsin在肝硬化自发性细菌性腹膜炎中的诊断价值

目的 探讨可溶性CD14分子亚型(Presepsin)在肝硬化自发性细菌性腹膜炎(SBP)患者诊断中的价值.方法 选取2016年6月至2017年10月大连医科大学附属第一医院消化内科和感染科收治的符合肝硬化和SBP诊断标准的患者63例作为研究对象,根据疾病类型分为SBP组(n=21)、肝硬化腹水组(n=22)和单纯肝硬...