Table of Content

20 June 2026, Volume 41 Issue 6

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Antiplatelet therapy in the acute phase of ischemic stroke

Ouyang Qian, Zhao Ying, Meng Heng, Xu Anding

2026, 41(6):  485-492.  doi:10.3969/j.issn.1004-583X.2026.06.001

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The acute phase of ischemic stroke is a high-risk period for neurological deterioration and early recurrence. The primary goal of antiplatelet therapy is to inhibit platelet activation as early as possible, thereby reducing the risk of ischemic events while strictly controlling bleeding complications. In patients with non-cardioembolic acute ischemic stroke, antiplatelet therapy should be initiated as early as possible after intracranial hemorrhage has been excluded, in order to reduce the risks of early stroke progression, recurrence, and other vascular events. This article systematically reviews the development of acute-phase antiplatelet therapy over the past 30 years and the latest research advances, with the aim of providing a theoretical basis and reference for the precise selection of antiplatelet agents and the development of individualized treatment strategies in clinical practice.

Systematic review and meta-analysis of the prognostic value of the C-reactive protein-albumin-lymphocyte index in patients with lung cancer

Tang Jia, Xu Yizhou, Wu Jiao, Zhang Jian

2026, 41(6):  493-498.  doi:10.3969/j.issn.1004-583X.2026.06.002

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Objective To systematically evaluate the association between the C-reactive protein-albumin-lymphocyte (CALLY) index and prognosis in patients with lung cancer. Methods A computer-based search was conducted in PubMed, Web of Science, the Cochrane Library, Embase, CNKI, VIP, and Wanfang Data, with the search period extending from database inception to April 27, 2026. Study quality was assessed using the Newcastle-Ottawa Scale. Stata 15.0 was used to calculate pooled hazard ratios and 95% confidence intervals. The prognostic value of the CALLY index for overall survival and recurrence-free survival in patients with lung cancer, as reported by multivariable Cox regression analyses, was examined. Results A total of 6 retrospective cohort studies involving 2 459 patients with lung cancer were included. The meta-analysis showed that a high CALLY index was associated with better overall survival (HR=0.59, 95%CI: 0.49-0.69, P<0.01) and recurrence-free survival (HR=0.64, 95%CI: 0.50-0.80, P<0.01) in patients with lung cancer. Conclusion The pretreatment CALLY index is a valuable potential biomarker for predicting overall survival and recurrence-free survival in patients with lung cancer and may support clinical prognostic assessment.

Association between the triglyceride-glucose index and platelet-lymphocyte ratio combined index and incident atherosclerotic coronary heart disease

Liu Wuzhe, Liu Siyuan, Yu Xiao, Yang Xiaodong, Sun Yazhao, Liu Dongsheng

2026, 41(6):  499-504.  doi:10.3969/j.issn.1004-583X.2026.06.003

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Objective To investigate the association between the triglyceride-glucose index and platelet-lymphocyte ratio combined index (TyG-logPLR) and incident atherosclerotic coronary heart disease (CHD). Methods This was a retrospective study. A total of 1 222 patients with angina who underwent coronary angiography for the first time at Cangzhou People’s Hospital from January 2023 to September 2025 were enrolled. Based on the presence or absence of CHD, patients were divided into a CHD group (n=566) and a non-CHD group (n=656). Logistic regression was used to analyze the association between TyG-logPLR at different levels and incident CHD. Restricted cubic spline regression was applied to assess the dose-response relationship between TyG-logPLR and incident CHD. Subgroup analyses were conducted to further explore the association between TyG-logPLR and incident CHD. Results Compared with the non-CHD group, the CHD group had significantly higher age, proportions of men, hypertension history, diabetes history, smoking history, and alcohol consumptionhistory, leukocytecount, absolute monocyte count, absolute neutrophil count, low-density lipoprotein cholesterol, triglycerides, serum creatinine, glycated hemoglobin, fasting blood glucose, TyG, and TyG-logPLR levels (P<0.05), while absolute lymphocyte count and high-density lipoprotein cholesterol levels were significantly lower (P<0.05). Logistic regression showed that, with TyG-logPLR as a continuous variable and without adjustment for confounders, the odds ratio was 1.17, with a 95% confidence interval of 1.11-1.24. After adjustment for confounders including age, sex, history of hypertension, history of diabetes, absolute monocyte count, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, serum creatinine, glycated hemoglobin, smoking history, and alcohol consumption history, each 1-unit increase in TyG-logPLR was associated with an 11% increase in the risk of incident CHD. When TyG-logPLR was analyzed as a categorical variable, using Q1 as the reference group and without adjustment for confounders, the odds ratio for Q3 was 2.31, with a 95% confidence interval of 1.67-3.20. After adjustment for confounders, each 1-unit increase in TyG-logPLR in the Q3 group was associated with a 71% increase in the risk of incident CHD. Restricted cubic spline analysis showed a nonlinear relationship between TyG-logPLR and incident CHD in the univariate logistic regression model (P-non-linear=0.023). After multivariable logistic regression adjustment, TyG-logPLR still showed a nonlinear dose-response relationship with the risk of incident CHD (P-non-linear=0.019). Subgroup analysis confirmed that the association between TyG-logPLR and CHD was consistent across most subgroups. Conclusion TyG-logPLR is an independent risk factor for the development of CHD.

Diagnostic value of serum AFP, AFP-L3, and HSP90α in differentiating hepatitis B cirrhosis from HBV-associated hepatocellular carcinoma and their relationship with HBV-DNA load

Feng Lifei, Wang Tianhui, Lv Hui

2026, 41(6):  505-510.  doi:10.3969/j.issn.1004-583X.2026.06.004

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Objective To investigate the value of serum alpha-fetoprotein (AFP), alpha-fetoprotein-L3 (AFP-L3), and plasma heat shock protein 90 alpha (HSP90α) in the differential diagnosis of hepatitis B cirrhosis and hepatitis B virus-associated hepatocellular carcinoma (HBV-HCC), and to analyze the correlation between these markers and hepatitis B virus deoxyribonucleic acid (HBV-DNA) load. Methods A total of 102 patients with HBV-HCC (HBV-HCC group), 74 patients with hepatitis B cirrhosis (hepatitis B cirrhosis group), and 80 healthy individuals undergoing physical examination during the same period (healthy group) were enrolled from August 2022 to August 2025 at the General Hospital of Anyang Iron and Steel Group Co., LTD. from August 2022 to August 2025, together with 80 healthy individuals (healthy control group), were enrolled in the study. Serum AFP, AFP-L3, and HSP90α, as well as HBV-DNA load, were measured and compared among the three groups. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of the above serum markers for hepatitis B cirrhosis and HBV-HCC. The correlations between AFP, AFP-L3, HSP90α, and HBV-DNA load were also examined in patients with hepatitis B cirrhosis and HBV-HCC. Results The levels of AFP, AFP-L3, and HSP90α were higher in the HBV-HCC group than in the hepatitis B cirrhosis group and the healthy group, and were higher in the hepatitis B cirrhosis group than in the healthy group (all P<0.05). The HBV-DNA load was higher in the HBV-HCC group than in the hepatitis B cirrhosis group (P<0.05), while no HBV-DNA was detected in the healthy group. Combined detection of serum AFP, AFP-L3, and HSP90α showed better diagnostic performance for both hepatitis B cirrhosis (area under the curve [AUC]=0.930, 95%CI: 0.891-0.969) and HBV-HCC (AUC=0.904, 95%CI: 0.861-0.947) than any single marker, with high sensitivity (93.24%, 88.24%) and specificity (90.00%, 83.78%) (P<0.05). Pearson correlation analysis showed that in patients with hepatitis B cirrhosis, serum AFP, AFP-L3, and HSP90α levels were positively correlated with HBV-DNA load (r=0.721, 0.655, 0.784, P<0.05). The same positive correlations were also observed in patients with HBV-HCC (r=0.769, 0.587, 0.658, P<0.05). Conclusion Serum AFP, AFP-L3, and HSP90α have good diagnostic value in differentiating hepatitis B cirrhosis from HBV-HCC, and the levels of these three markers are significantly correlated with HBV-DNA load.

Correlation analysis of liver function, serum markers, TGF-β1, and HBV-DNA in patients with chronic hepatitis B

Liu Yanfen, Gong Huihui

2026, 41(6):  511-515.  doi:10.3969/j.issn.1004-583X.2026.06.005

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Objective To investigate the relationship between liver function, hepatitis B virus serum markers, serum transforming growth factor-β1 (TGF-β1) levels, and hepatitis B virus deoxyribonucleic acid (HBV-DNA) load in patients with chronic hepatitis B (CHB). Methods A total of 106 patients with CHB admitted to our hospital from April 2022 to April 2025 were enrolled. Based on serum HBV-DNA load, they were divided into a high viral load group (HBV-DNA≥2×10⁴ IU/ml, 60 cases) and a low viral load group (HBV-DNA<2×10⁴ IU/ml, 46 cases). Liver function indicators, hepatitis B virus serum markers (hepatitis B e antigen[HBeAg], hepatitis B e antibody[anti-HBe], etc.), and serum TGF-β1 levels were measured in both groups. Pearson correlation analysis was used to assess the associations between serum indicators and HBV-DNA load. Results Compared with the low viral load group, the high viral load group had significantly higher serum alanine aminotransferase(ALT), aspartate aminotransferase(AST), and total bilirubin(TBIL) levels (P<0.05). The positivity rate of HBeAg was higher, whereas the positivity rate of anti-HBe was lower in the high viral load group (P<0.05). The high viral load group also showed higher serum TGF-β1 levels and higher quantitative levels of HBeAg and anti-HBe than the low viral load group (P<0.05). In patients with CHB, HBV-DNA load was positively correlated with HBeAg, ALT, TGF-β1, and AST, and negatively correlated with anti-HBe(P<0.05). Conclusion Liver function, serum TGF-β1, and hepatitis B virus serum marker levels are correlated with HBV-DNA load in patients with CHB. These indicators may serve as auxiliary references for assessing HBV-DNA load in combination with other clinical information.

Expression levels of exosomal miR-23b and miR-152-3p in patients with colorectal cancer and their prognostic predictive value

Zhao Dan, Yang Yali, Zhang Zhiqiang

2026, 41(6):  516-521.  doi:10.3969/j.issn.1004-583X.2026.06.006

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Objective To investigate the expression levels of serum exosomal microRNA-23b (miR-23b) and microRNA-152-3p (miR-152-3p) in patients with colorectal cancer, and to analyze their associations with pathological characteristics as well as their prognostic predictive value. Methods A total of 100 patients with colorectal cancer who were diagnosed and treated at our hospital from December 2020 to December 2024 were prospectively enrolled. Serum exosomal miR-23b and miR-152-3p expression levels were measured, and their correlations with pathological characteristics were analyzed. Based on prognosis within 1 year after surgery, patients were divided into a poor-prognosis group and a good-prognosis group. Serum exosomal miR-23b and miR-152-3p expression levels were compared between the two groups, and the interaction effect of the two markers on poor prognosis was analyzed. Their prognostic predictive value was also evaluated. Results The expression levels of miR-23b and miR-152-3p were positively correlated with tumor differentiation, but negatively correlated with TNM stage and lymph node metastasis(P<0.05). Serum exosomal miR-23b and miR-152-3p expression levels were lower in the poor-prognosis group than in the good-prognosis group (P<0.05). Low miR-23b expression and low miR-152-3p expression showed a positive interaction effect on the risk of poor prognosis (P<0.05). The AUC of the combined preoperative miR-23b and miR-152-3p model for predicting prognosis was significantly higher than that of either marker alone (P<0.05). Conclusion Reduced serum exosomal miR-23b and miR-152-3p expression in patients with colorectal cancer exhibits a positive interaction effect on the risk of poor prognosis. Combined detection of these markers has better prognostic predictive value than either marker alone.

Predictive value of the platelet-to-lymphocyte ratio for recurrent peritoneal dialysis-associated peritonitis

Wang Tao, Gao Yuwei, Wang Xinghua, Hu Xiuhong, Cui Hongrui, Xu Baozhen, Yang Hongjuan

2026, 41(6):  522-528.  doi:10.3969/j.issn.1004-583X.2026.06.007

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Objective Platelet-to-lymphocyte ratio (PLR) is a biomarker for the prognosis of many diseases. Currently, there are no studies on patients with recurrent peritoneal dialysis-associated peritonitis (RPDAP, definedas ≥2 peritoneal dialysis-associated peritonitis [PDAP] episodes within 1 year). This study aims to explore the predictive value of the PLR for RPDAP. Methods This single-center, retrospective cross-sectional study reviewed patients diagnosed with PDAP at the First Hospital of Hebei Medical University from January 2017 to December 2022. Patients were categorized by PDAP frequency during follow-up into the idiopathic peritoneal dialysis-associated peritonitis group (IPDAP group; one PDAP episode within 1 year) and RPDAP group. Demographic and laboratory data were collected. Associations between PLR and RPDAP were assessed by univariate logistic regression, and the predictive performance of baseline PLR for RPDAP was evaluated using receiver operating characteristic (ROC) curve analysis. Results A total of 83 PDAP patients were included: 56 in the IPDAP group and 27 in the RPDAP group. Compared with the IPDAP group, the RPDAP group had lower body mass index (BMI) and longer dialysis vintage (both P<0.05). The main causes of PDAP were improper technique and enteric infections. The proportion of drug-resistant organisms was higher in the RPDAP group (P<0.05). Treatment effective rate in the RPDAP group was 40.71%, significantly lower than 82.14% in the IPDAP group (P<0.05). Treatment failure requiring catheter removal occurred in 44.44% of RPDAP patients, significantly higher than 14.28% in the IPDAP group (P<0.05). There was no significant difference in mortality between the two groups (P>0.05). Compared with the IPDAP group, the RPDAP group had higher PLR and lower hemoglobin and albumin levels (all P<0.05). Univariate logistic regression identified lower BMI, longer dialysis vintage, higher PLR, and lower hemoglobin and albumin as factors associated with RPDAP (all P<0.05). The ROC curve for baseline PLR predicting RPDAP yielded an area under the curve (AUC) of 0.611 (95%CI: 0.560-0.662, P<0.05). The optimal PLR cutoff was 165.1, with specificity 79.8% and sensitivity 68.2%. Conclusion PLR has modest predictive value for RPDAP and may serve as a potential predictive biomarker for RPDAP in peritoneal dialysis patients.

Association of serum spexin and TSH levels with peripheral neuropathy in euthyroid patients with type 2 diabetes mellitus

Tian Xiaofei, Rao Xiaojuan, Shi Shuangwei, Fang Yifan

2026, 41(6):  529-533.  doi:10.3969/j.issn.1004-583X.2026.06.008

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Objective To analyze the association of serum spexin and thyroid-stimulating hormone (TSH) levels with diabetic peripheral neuropathy (DPN) in euthyroid patients with type 2 diabetes mellitus (T2DM). Methods A retrospective analysis was performed on 391 patients with T2DM hospitalized in the Department of Endocrinology of the Fifth Affiliated Hospital of Zhengzhou University from January 2025 to December 2025. Among them, 184 patients with DPN were included in the study group, and 207 patients without DPN were included in the control group. Thyroid function tests were completed in all patients, and the results were normal. Clinical data and biochemical indicators were collected for both groups. Multivariate logistic regression was used to identify risk factors for DPN in patients with T2DM, and receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of spexin and TSH for DPN. Results Compared with the control group, the study group had lower body mass index (BMI) and serum spexin levels, and the differences were statistically significant (t=3.671, 6.902, P<0.05). In the study group, diabetes duration, glycated hemoglobin A₁c (HbA₁c), triglycerides (TG), TSH, and homocysteine (Hcy) were all higher than those in the control group, with statistically significant differences (P<0.05). Logistic regression analysis showed that diabetes duration, HbA₁c, TSH, and spexin were independent risk factors for DPN in patients with T2DM (P<0.05). ROC analysis showed that the areas under the curve(AUC) for serum spexin and TSH in predicting DPN in patients with T2DM were 0.685 and 0.713, respectively. The AUC for their combined prediction was 0.749, which was higher than that of either marker alone (P<0.05). Conclusion In euthyroid patients with T2DM, serum spexin and TSH are independent risk factors for DPN. Combined detection of these two markers has certain predictive value for identifying whether T2DM is complicated by DPN.

Association between plasma free metanephrines and the SDHB phenotype in pheochromocytoma and paraganglioma

Wang Liyang, Xiang Dandan, Ding Ran

2026, 41(6):  534-538.  doi:10.3969/j.issn.1004-583X.2026.06.009

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Objective To investigate the association between plasma free metanephrines (MNs) and the succinate dehydrogenase subunit B (SDHB) phenotype in pheochromocytoma and paraganglioma (PPGL). Methods A total of 190 patients with PPGL treated at our hospital from March 2021 to March 2025 were enrolled as the study group. In addition, 100 healthy individuals who underwent physical examination at the same hospital during the same period and had normal results were selected as the control group. Baseline data were collected for both groups. Plasma metanephrine (MN) and normetanephrine (NMN) levels were measured using high-performance liquid chromatography-tandem mass spectrometry. SDHB protein expression in the study group was detected by immunohistochemical EnVision two-step method. The correlation between MN/NMN levels and the SDHB phenotype (loss/positive) was analyzed, along with their associations with clinicopathological characteristics. Results Plasma MN and NMN levels were significantly higher in the study group than in the control group (P<0.05). Among the 190 patients with PPGL, SDHB loss was observed in 68 cases (35.79%), of which paraganglioma (PGL) accounted for 83.82% (57/68), significantly higher than pheochromocytoma (PCC) (16.18%, 11/68) (P<0.05). The plasma NMN level in the SDHB-loss group was significantly higher than that in the SDHB-positive group ([7.53±1.95] nmol/L vs [5.19±1.26] nmol/L, P<0.05), whereas no statistically significant difference in MN level was found between the two groups (P>0.05). SDHB loss was associated with age, hypertension, tumor location, tumor type, vascular invasion, Ki-67 proliferation index, metastasis, and plasma NMN level (P<0.05). Conclusion Plasma NMN level is closely associated with the SDHB phenotype in PPGL. SDHB loss is more common in PGL, and patients with SDHB loss often have elevated NMN levels. SDHB loss is also significantly associated with adverse clinicopathological features, including age, hypertension, tumor location, tumor type, vascular invasion, Ki-67 proliferation index, and metastasis.

Incidence and risk factors of Na⁺/K⁺ imbalance in children with febrile urinary tract infection

Yang Qunlan, Wang Wenhong

2026, 41(6):  539-545.  doi:10.3969/j.issn.1004-583X.2026.06.010

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Objective To investigate the incidence and associated risk factors of Na⁺/K⁺ imbalance in children with febrile urinary tract infection (FUTI). Methods A total of 716 children with FUTI hospitalized at Tianjin Children’s Hospital from January 2022 to December 2025 were included, and their clinical data were retrospectively analyzed. Na⁺/K⁺ imbalance was classified as hyponatremia (serum sodium <135 mmol/L), hypernatremia (serum sodium >145 mmol/L), hypokalemia (serum potassium <3.5 mmol/L), hyperkalemia (serum potassium >5.5 mmol/L), and hyponatremia with hyperkalemia (serum sodium <135 mmol/L accompanied by serum potassium >5.5 mmol/L). The incidence of each type of Na⁺/K⁺ imbalance was calculated. Logistic regression was used to identify factors associated with hyponatremia, hyperkalemia, and hyponatremia with hyperkalemia. Results Among the 716 included children, 305 cases (42.6%) had hyponatremia, 55 cases (7.7%) had hyperkalemia, 12 cases (1.7%) had hypokalemia, and no cases of hypernatremia were observed. In addition, 17 cases (2.4%) had hyponatremia with hyperkalemia. In multivariable logistic regression analysis, fever duration after antibiotic treatment and CRP were both independent risk factors for hyponatremia in children with FUTI (OR=1.361, 1.007; 95%CI: 1.203-1.540, 1.004-1.010; both P<0.01). Age and congenital anomalies of the kidney and urinary tract (CAKUT) were both independent risk factors for hyperkalemia in children with FUTI (OR=0.918, 2.574; 95%CI: 0.862-0.978, 1.409-4.701; P=0.008, 0.002). CRP and CAKUT were both independent risk factors for hyponatremia with hyperkalemia in children with FUTI (OR=1.011, 3.445; 95%CI: 1.004-1.018, 1.279-9.282; P=0.002, 0.014). Even after adjusting for renal hypoplasia, pelvicalyceal dilatation, ureteral dilatation, and non-Escherichia coli infection, CAKUT remained an independent risk factor for hyponatremia with hyperkalemia in children with FUTI (OR=8.098, 95%CI: 2.196-29.863, P=0.002). Conclusion Among children with FUTI, Na⁺/K⁺ imbalance most commonly manifests as hyponatremia, followed by hyperkalemia and hyponatremia with hyperkalemia. During the course of pediatric FUTI, hyponatremia may indicate a more severe inflammatory response, and children with concomitant hyperkalemia should be evaluated for possible underlying CAKUT.

A case of diffuse pulmonary ossification diagnosed by cryobiopsy

Shi Jungang, Wei Caihong, Cui Yonghui, Guo Dan, Li Jiayue, Cai Hourong

2026, 41(6):  546-550.  doi:10.3969/j.issn.1004-583X.2026.06.011

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Objective To investigate the clinical characteristics, imaging features, pathological types, diagnosis, and diagnostic experience of diffuse pulmonary ossification (DPO). Methods A retrospective analysis was performed on one patient with DPO, and the relevant literature was reviewed. Results The patient was a middle-aged man admitted for “bilateral pulmonary nodules discovered during a routine health examination for 6 years”. He had a history of hemoptysis once and no other symptoms. During follow-up, the pulmonary nodules gradually increased in number. A diagnosis was confirmed by cryobiopsy. Because the patient had no obvious symptoms, follow-up observation was continued, and the condition remained stable. Conclusion A definite diagnosis can be established by combining the patient's medical history, imaging findings, and pathological examination. Cryobiopsy is safe, reliable, and provides adequate tissue samples, and therefore can be widely applied in the diagnosis of DPO.

Autosomal dominant hypocalcemia type 1 caused by CaSR gene variant: A case report and literature review

Cui Qingyang, Zhao Haihai, Guo Lingling, Shang Yun

2026, 41(6):  551-555.  doi:10.3969/j.issn.1004-583X.2026.06.012

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Objective To improve understanding of the clinical phenotype and genotype of autosomal dominant hypocalcemia type 1 (ADH1). Methods The clinical data of a 19-day-old female patient with ADH1 were retrospectively analyzed, and the relevant literature was reviewed. Results The female infant presented mainly with intermittent convulsions for 2 weeks, accompanied by hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels. Calcium and vitamin D supplementation were ineffective, and the family refused teriparatide. Whole-exome sequencing identified a maternally inherited heterozygous missense variant in the CaSR gene, c.649G>T. Conclusion When hypoparathyroidism is suspected clinically, potential underlying causes should be carefully investigated. Gene sequencing is helpful for identifying ADH1.