Xu XX, Wang LL, Tian H
… +5 more, Li L, Zheng H, Gu XY, Dai CS, Jiang L
Zhonghua Nei Ke Za Zhi
· 2025 May · PMID 40328495
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To identify factors associated with depressive symptoms in maintenance hemodialysis patients and to examine the relationship between these symptoms and mortality. Between January and December 2019, patients who received...To identify factors associated with depressive symptoms in maintenance hemodialysis patients and to examine the relationship between these symptoms and mortality. Between January and December 2019, patients who received maintenance hemodialysis in the Blood Purification Center of the Second Affiliated Hospital of Nanjing Medical University were enrolled in a prospective cohort study. Depressive symptoms were assessed using the internationally validated patient health questionnaire-8 (PHQ-8). Sleep quality and anxiety were measured with the Pittsburgh sleep quality index (PSQI) and the generalized anxiety disorder-7 (GAD-7) scale, respectively. Follow-up continued until December 31, 2022, with all-cause mortality as the primary outcome. Ordinal logistic regression was used to identify independent predictors of depression severity. Cox proportional hazards models evaluated the association between depressive symptoms and mortality. A total of 532 maintenance hemodialysis (MHD) patients completed the study. Among them, 177 (33.3%) exhibited depressive symptoms. Compared with patients without depression, those with mild or moderate-to-severe depression were older [median age: 58 (50, 66) vs. 60 (55, 65) vs. 55 (46, 64)], more likely to smoke [35.9% (51/142) vs. 40.0% (14/35) vs.26.2% (93/355)], had poorer sleep quality [PSQI: 9 (6, 13) vs. 12 (9, 17) vs. 5 (3, 9)], and higher anxiety levels [GAD-7: 1 (0, 3) vs. 3 (1, 6) vs. 0 (0, 1)], the differences among the three groups were statistically significant (all <0.05). Ordinal logistic regression identified smoking status, history of diabetes or cardiovascular disease, hemoglobin level, PSQI score, and GAD-7 score as independent predictors of depression severity (=1.60, 1.80, 1.81, 0.98, 3.67, 8.67; all <0.05). After a median follow-up of 40 (35, 44) months, 109 patients died, including 66 (60.6%) from cardio-cerebrovascular causes and 24 (22.0%) from infections. Kaplan-Meier analysis revealed significantly lower cumulative survival in the depression group compared to the non-depression group (<0.001). Cox regression analysis demonstrated that depressive symptoms remained independently associated with all-cause mortality after adjusting for confounders (=1.06, 95% 1.00-1.13, =0.048), with an even stronger association observed for patients with PHQ-8 scores≥2.9 (=1.10, 95% 1.03-1.16, =0.005). However, the associations between depression and cardio-cerebrovascular mortality (=0.111) or infection-related mortality (=0.509) were not statistically significant. Depressive symptoms are prevalent among maintenance hemodialysis patients and are independently associated with increased all-cause mortality. Smoking, comorbid diabetes or cardiovascular disease, low hemoglobin level, poor sleep quality, and anxiety are risk factors contributing to depression. Maintenance hemodialysis patients with PHQ-8 scores≥3 should be considered at heightened risk for mortality.
Zhonghua Nei Ke Za Zhi
· 2025 May · PMID 40328494
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To analyze the clinical characteristics of patients with autoimmune gastritis (AIG) and compare the associated factors between AIG and type B atrophic gastritis. A total of 59 patients were diagnosed as showing AIG at t...To analyze the clinical characteristics of patients with autoimmune gastritis (AIG) and compare the associated factors between AIG and type B atrophic gastritis. 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. 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, =-5.24, <0.05; 1.0±0.6 vs. 2.2±1.6, =-3.72, <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 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 (=0.913, 95% 0.851-0.978, =0.010). The gastrin 17 level can help distinguish AIG and type B atrophic gastritis, and is valuable for early identification of AIG.
Zhonghua Nei Ke Za Zhi
· 2025 May · PMID 40328493
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To investigate the clinical features, diagnosis and treatment of adult eosinophilic gastroenteritis (EGE). A retrospective study was conducted to analyze the clinical manifestations, laboratory examinations, endoscopic...To investigate the clinical features, diagnosis and treatment of adult eosinophilic gastroenteritis (EGE). A retrospective study was conducted to analyze the clinical manifestations, laboratory examinations, endoscopic manifestations, histopathological characteristics, treatment and prognosis of 29 adult patients with EGE admitted to Xijing Hospital from August 2008 to August 2024. Among the 29 adult EGE cases investigated in this study, 17 cases were male and 12 were female. The mean age was (43±19) years old. The main clinical manifestations included abdominal pain (75.9%), diarrhea (58.6%), and weight loss (44.8%). The median absolute value of white blood cells in peripheral blood of the 29 patients was 7.47(6.66,12.47)×10/L, and the white blood cell count increased in 11 cases (37.9%). The median absolute value of eosinophil was 0.98 (0.21,4.76)×10/L, and the eosinophil counts increased in 18 cases (62.1%). The main endoscopic manifestations were mucosal hyperemia edema, erosion and roughness. The histopathological manifestations were characterized by abnormal infiltration of eosinophils. In addition, the most commonly involved locations were the ileocecal junction and colorectum. The treatment methods included food elimination, anti-secretory, anti-histamine, and corticosteroids. All patients were alleviated after treatment, but some patients relapsed after drug withdrawal. The main clinical manifestations of adult EGE were abdominal pain, diarrhea and weight loss. Some patients had elevated peripheral blood eosinophilia, and the main endoscopic manifestations were mucosal hyperemia and edema, erosion, and roughness. The histopathological manifestations were characterized by abnormal infiltration of eosinophils. Finally, EGE can be relieved by diet and drug therapy, but it is easy to relapse.
Multidisciplinary Consensus Working Group on Atypical Hemolytic Uremic Syndrome Diagnosis and Treatment
Zhonghua Nei Ke Za Zhi
· 2025 May · PMID 40328492
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Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, thrombocytopenia, and multi-organ damage, with the kidneys being predominantly affected. aHUS...Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy characterized by microangiopathic hemolytic anemia, thrombocytopenia, and multi-organ damage, with the kidneys being predominantly affected. aHUS results from dysregulation of the complement alternative pathway, triggered by factors including infection, pregnancy, and surgery, among others. Therefore, complement inhibitors play a crucial role in the treatment of aHUS by blocking abnormal activation of the complement system and improving patients' prognosis. This consensus, developed by the Multidisciplinary Consensus Working Group on Atypical Hemolytic Uremic Syndrome Diagnosis and Treatment, is based on the latest literature and guidelines, discusses the pathogenesis, diagnosis and differential diagnosis, and treatment strategies for aHUS, and provides a guide and reference for the standardized diagnosis and management of aHUS in China.
Expert Consensus Review Committee on Disease-Modifying Treatments for Early Alzheimer′s Disease
Zhonghua Nei Ke Za Zhi
· 2025 May · PMID 40205735
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Monoclonal antibodies targeting β-amyloid (Aβ)(represented by Lecanemab) have been approved in the United States, Japan and China for the treatment of mild cognitive impairment (MCI) due to Alzheimer's disease (AD) or mi...Monoclonal antibodies targeting β-amyloid (Aβ)(represented by Lecanemab) have been approved in the United States, Japan and China for the treatment of mild cognitive impairment (MCI) due to Alzheimer's disease (AD) or mild AD dementia, and AD treatment has moved towards the era of disease modifying therapy (DMT). In view of the lack of use experience with DMT in China, this article presents recommendations for Aβ-based DMT clinical practice based on its clinical evidence, as well as its existing usage experience and research regarding AD. These recommendations include the mechanism of action, patient selection, standardized use, effectiveness, and safety monitoring, intending to help guide the rational use in real-world clinical practice.
Zhonghua Nei Ke Za Zhi
· 2025 Apr · PMID 40159071
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This study aimed to determine the prevalence of Fabry disease in patients with kidney disease and observe its clinical features. A total of 1 693 patients in the Renal Department of Shandong Provincial Hospital Affiliate...This study aimed to determine the prevalence of Fabry disease in patients with kidney disease and observe its clinical features. A total of 1 693 patients in the Renal Department of Shandong Provincial Hospital Affiliated to Shandong First Medical University with proteinuria or renal insufficiency were included from June 2020 to December 2023. The α-galactosidase A level in males and globotriaosylsphingosine (Lyso-GL-3) level in females were detected, and GLA gene detection was performed in those with abnormalities. The GLA gene mutation rate was 0.297% (3/1 010) in males, 1.025% (7/683) in females, and 0.591% (10/1 693) overall. The prevalence of Fabry disease was 0.297% (3/1 010) in males, 0.293% (2/683) in females, and 0.295% (5/1 693) overall. The clinical manifestations of Fabry patients with kidney disease are complex and varied, with high heterogeneity. The pathogenicity of GLA gene mutations in patients with kidney disease requires further comprehensive analysis. Some GLA gene mutations are non-pathogenic and are mostly found in females. Patients with primary or secondary kidney disease should not be ignored regarding screening for Fabry disease.
Ren ZZ, Jia SS, Zhong XL
… +3 more, Zhang YF, Li TT, Qiu F
Zhonghua Nei Ke Za Zhi
· 2025 Apr · PMID 40159070
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This study investigated the expression of C-X-C motif chemokine receptor 3 (CXCR3) on CD45RO⁺ T cells in the peripheral blood of patients with Alzheimer's disease (AD) and its association with clinical features. A total...This study investigated the expression of C-X-C motif chemokine receptor 3 (CXCR3) on CD45RO⁺ T cells in the peripheral blood of patients with Alzheimer's disease (AD) and its association with clinical features. A total of 41 AD patients and 30 age-and sex-matched healthy controls (HCs) were recruited from the Department of Neurology at the Medical Division of PLA General Hospital between September 2022 and March 2024. Flow cytometry was used to quantify CXCR3 expression on CD45RO⁺ T cell subsets in peripheral blood. Dementia severity in AD patients was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Spearman correlation analysis examined the relationship between CD45RO⁺CXCR3⁺ T cell levels and cognitive function in the AD group. Receiver operating characteristic (ROC) curve analysis determined the predictive utility of CD45RO⁺CXCR3⁺ T cells for AD, quantified by the area under the curve (AUC). Compared to healthy controls, AD patients exhibited significantly elevated levels of CD8⁺CD45RO⁺CXCR3⁺ T cells [17.8% (7.2%, 40.3%) vs. 8.2% (5.1%, 12.3%), =-2.59, <0.05]. However, no significant differences were observed for CD4⁺CD45RO⁺CXCR3⁺ T cells, CD4⁺CD45RO⁻CXCR3⁺ T cells, or CD8⁺CD45RO⁻CXCR3⁺ T cells (>0.05). Spearman correlation analysis revealed a negative correlation between CD8⁺CD45RO⁺CXCR3⁺ T cell levels and cognitive scores (MMSE: =-0.72, <0.05; MoCA: =-0.70, <0.05). ROC analysis demonstrated an AUC of 0.81 for CD8⁺CD45RO⁺CXCR3⁺ T cells in predicting AD, with a sensitivity of 59.0% and specificity of 93.3%. CXCR3 expression is significantly upregulated on CD8⁺CD45RO⁺ T cells in AD patients, and its levels correlate with cognitive impairment severity. These findings suggest that CD8⁺CD45RO⁺CXCR3⁺ T cells may serve as a potential biomarker for AD diagnosis and progression monitoring.
Yang JS, Zhang H, Li M
… +6 more, Sun F, Zhou B, Zhao QQ, Wan YH, Zhu J, Zhang JL
Zhonghua Nei Ke Za Zhi
· 2025 Apr · PMID 40159069
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This study investigates the utility of ultrasound in diagnosing eosinophilic fasciitis (EF). A retrospective analysis was conducted on the clinical and ultrasound data of 109 EF patients seen at the center between Janua...This study investigates the utility of ultrasound in diagnosing eosinophilic fasciitis (EF). A retrospective analysis was conducted on the clinical and ultrasound data of 109 EF patients seen at the center between January 1, 2006, and March 31, 2024. The diagnostic efficacy of ultrasound for EF was evaluated by comparing forearm fascia ultrasound findings among EF patients, systemic sclerosis (SSc) patients, and healthy controls (HC). Among the 109 EF patients (male-to-female ratio 2.2︰1), the median age of onset was 36 (29, 48) years, with a median disease duration of 7 (3, 12) months. The study also included 20 SSc patients [median age 49 (35, 61) years] and 20 HC individuals [median age 48 (29, 54) years]. Ultrasound assessments of forearm fascia in EF patients revealed a median fascial thickness of 1.9 (1.4, 2.4) mm. The median fascial thickness was 0.8 (0.7, 0.9) mm in SSc patients and 0.7 (0.5, 0.9) mm in HC individuals. Fascial thickness in EF patients was greater than in SSc (=-11.16,<0.001) and HC groups (=-11.87, <0.001). There was a correlation between fascia thickness and C-reactive protein (=0.148, =0.004), erythrocyte sedimentation rate (=0.143, =0.005), and immunoglobulin G (=0.120, =0.020) in EF patients. Receiver operating characteristic (ROC) curve analysis demonstrated a sensitivity of 84.0% and specificity of 95.9% for EF diagnosis, with an area under the curve (AUC) of 0.921 and a cut-off value of 1.005 mm. Ultrasound detection of forearm fascial thickening (>1 mm) aids in diagnosing eosinophilic fasciitis, indicating that ultrasound is a supplementary diagnostic tool for EF.
Wang HF, Wang HR, Lin YC
… +3 more, Bai JM, Li M, Huang XS
Zhonghua Nei Ke Za Zhi
· 2025 Apr · PMID 40159068
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To evaluate serum 25-hydroxyvitamin D [25(OH)D] as a potential biomarker for amyotrophic lateral sclerosis (ALS) severity and to identify risk factors influencing ALS prognosis. This study included 217 ALS patients hosp...To evaluate serum 25-hydroxyvitamin D [25(OH)D] as a potential biomarker for amyotrophic lateral sclerosis (ALS) severity and to identify risk factors influencing ALS prognosis. This study included 217 ALS patients hospitalized at the Department of Neurology, First Medical Center, Chinese PLA General Hospital, between October 2018 and October 2021, who met the revised El Escorial diagnostic criteria. A cross-sectional analysis assessed differences in clinical indicators-including the ALS Functional Rating Scale-Revised (ALSFRS-R) and forced vital capacity percentage (FVC%)-across different serum 25(OH)D levels. The correlation between 25(OH)D levels and individual ALSFRS-R components was also examined. Conduct a prospective cohort study to identify independent risk factors affecting the survival time of ALS patients. Among three groups categorized by serum 25(OH)D levels, there were significant differences in the proportion of males (=10.51, <0.05). Serum 25(OH)D levels correlated positively with lower limb function scores in the ALSFRS-R (=0.05, <0.05), but they were not identified as an independent risk factor for survival (=0.98, 95% 0.93-1.04, >0.05). In contrast, delayed diagnosis(=0.94, 95% 0.89-0.99, <0.05) and reduced FVC%(=0.94, 95% 0.97-0.99, <0.05) were independent predictors of shorter survival. Serum 25(OH)D levels differ by gender distribution and may be linked to better lower limb function in ALS patients. However, their role in prolonging survival remains uncertain.
Shen L, Zhang H, Lu Q
… +14 more, Li SS, Gao C, Mei YZ, Yue H, Yu XT, Yao Q, Huo YN, Zeng YH, Jiang Y, Xie ZJ, Chao AJ, Jin XL, Mao L, Zhang ZL
Zhonghua Nei Ke Za Zhi
· 2025 Apr · PMID 40159067
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To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] levels and 24-h urinary calcium excretion (24-h UCaE) and hypercalciuria in Chinese adults. This cross-sectional study was conducted from March...To investigate the association between serum 25-hydroxyvitamin D [25(OH)D] levels and 24-h urinary calcium excretion (24-h UCaE) and hypercalciuria in Chinese adults. This cross-sectional study was conducted from March 2022 to March 2023 in nine cities in China and included 1 239 residents. Demographic characteristics were collected through questionnaires and physical examinations, fasting blood samples were assessed for bone metabolism indicators, and 24-h urine samples were used to determine the 24-h UCaE. Multiple linear regression analysis was used to explore the relationship between serum 25(OH)D and 24-h UCaE and bone metabolism indexes. The relationship between serum 25(OH)D and hypercalciuria was analyzed using a multiple logistic regression model combined with restricted cubic spline modeling. The mean participant age was (47.9±18.1) years, of which 453 (36.6%) were male. The percentages of vitamin D sufficiency, insufficiency, and deficiency were 7.6% (94/1 239), 29.0% (359/1 239), and 63.4% (786/1 239), respectively. The multiple linear regression model showed that after adjusting for the covariates the 24-h UCaE gradually increased with higher levels of 25(OH)D ( overall <0.001, nonlinear <0.001). The logistic regression analysis revealed that compared with the vitamin D deficient group, the for the prevalence of hypercalciuria in the vitamin D sufficient and vitamin D insufficient groups were 3.290 (95% 1.745 to 6.202) and 3.742 (95% 2.458 to 5.697), respectively. The results of the restricted cubic spline modeling showed a positive nonlinear relationship between 25(OH)D and the prevalence of hypercalciuria ( overall <0.001, nonlinear <0.001). The prevalence of hypercalciuria increased when 25(OH)D was >17.00 μg/L and peaked at 26.71 μg/L, after which there was a decreasing trend in the prevalence of hypercalciuria with increasing 25(OH)D. Associations between serum 25(OH)D levels and urinary calcium excretion and the prevalence of hypercalciuria were observed in the Chinese adult population.
Shi M, Zhang Y, Fan WQ
… +4 more, Chen Y, Xie YT, Deng C, Li X
Zhonghua Nei Ke Za Zhi
· 2025 Apr · PMID 40159066
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To examine the effect of cumulative hemoglobin A (HbA) levels and insulin dosage on insulin resistance (IR)-related metabolic disturbances in newly diagnosed patients with type 1 diabetes (T1D). This retrospective cohor...To examine the effect of cumulative hemoglobin A (HbA) levels and insulin dosage on insulin resistance (IR)-related metabolic disturbances in newly diagnosed patients with type 1 diabetes (T1D). This retrospective cohort study included T1D patients admitted to the Second Xiangya Hospital of Central South University from November 2015 to March 2023. Clinical data collected comprised age, sex, disease duration, insulin dosage, body mass index, waist circumference, blood pressure, HbA levels, islet autoantibodies, and fasting blood lipid profiles. IR-related metabolic disturbances assessed were overweight, obesity, central obesity, hypertension, and dyslipidemia. Cox regression and cluster analyses were applied to assess the influence of cumulative HbA and insulin dosage on these metabolic disturbances. A total of 235 patients were included, with 97 males (41.3%) and 138 females (58.7%). The median age was 19.8 (13.3, 31.1) years, and the median follow-up duration was 30.8 (20.8, 45.6) months. During follow-up, 41.6% (72/173) of patients developed IR-related metabolic disturbances. Multivariate Cox regression analysis revealed that a cumulative HbA ≥60 mmol/mol was an independent risk factor for any IR-related metabolic disturbance [ (95%): 1.739 (1.067-2.835) ] and for triglyceride abnormalities [ (95%): 3.277 (1.176-9.127)]. Additionally, a cumulative insulin dosage ≥0.5 U·kg·d was identified as an independent risk factor for overweight, obesity, or central obesity [ (95%): 2.374 (1.059-5.323)]. Cluster analysis further identified that patients with higher levels of cumulative HbA and insulin dosage, particularly those with adolescent-onset diabetes, had the highest likelihood of developing hypertension (=2.460, 95% 1.008-6.005), overweight/obesity/central obesity (=2.707, 95% 1.062-6.900), triglyceride abnormalities (=5.495, 95% 1.842-16.391), high-density lipoprotein cholesterol abnormalities (=11.054, 95% 4.107-29.751), and any IR-related metabolic disturbance (=5.833, 95% 2.602-13.077). Elevated cumulative HbA and insulin dosage levels in T1D patients are associated with an increased risk of developing IR-related metabolic disturbances. These findings underscore the urgent need for novel therapeutic strategies tailored to this population.
Zhonghua Nei Ke Za Zhi
· 2025 Apr · PMID 40159065
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To analyze the characteristics of cardiovascular and cerebrovascular diseases in patients with primary aldosteronism (PA) and compare them with age-, sex-, and blood pressure-matched patients with essential hypertension...To analyze the characteristics of cardiovascular and cerebrovascular diseases in patients with primary aldosteronism (PA) and compare them with age-, sex-, and blood pressure-matched patients with essential hypertension (EH). This cross-sectional study was conducted at the West China Hospital of Sichuan University. Patients with PA and EH between December 2018 and December 2021 were included. Demographic characteristics, stroke events, coronary artery diseases, peripheral vascular diseases, and cardiac structure and function indicators were analyzed. Propensity score matching (PSM) was used to balance non-study data. The -test, chi-square test, and Wilcoxon signed-rank test were used for data comparison. The cardiovascular and cerebrovascular damage in the patients with unilateral and bilateral PA were also compared. A total of 336 and 369 patients with PA and EH, respectively, were enrolled in this study. One hundred and ninety-eight patients from each group were included after PSM; no significant differences were found in terms of age, gender, and blood pressure. The prevalence of stroke in the PA group was considerably higher than that in the EH group [12.6% (25/198) vs. 5.6% (11/198), =0.014], due to the significantly greater risk of ischemic stroke [10.0% (20/198) vs. 4.5% (9/198), =0.029]. The prevalence of hemorrhagic stroke, coronary artery disease, peripheral arterial stenosis, aorta atherosclerosis, and aneurysm in the PA group were also higher than those in the EH group, but there was no statistical significance (all >0.05). More patients with PA had concurrent left ventricular hypertrophy [22.2% (44/198) vs. 9.1% (18/198)], left atrial enlargement [40.4% (80/198) vs. 30.3% (60/198)], ventricular septal thickening [50.0% (99/198) vs. 36.9% (73/198)], and aortic widening [21.7% (43/198) vs. 13.1% (26/198)] than those with EH (all <0.05). Compared with the bilateral PA group, the unilateral PA group had higher prevalence of left ventricular hypertrophy [28.3% (51/180) vs. 13.4% (11/82), =0.013]. Compared with well-matched patients with EH, patients with PA have significantly higher risks of cardiovascular and cerebrovascular diseases, which are mainly manifested in increased prevalence of stroke and severe damage to the cardiac structure. Patients with unilateral PA may suffer more severe cardiac damage than those with bilateral PA.
Chinese Endocrinologist Association, Chinese Endocrine Hypertension Collaborative Group
Zhonghua Nei Ke Za Zhi
· 2025 Apr · PMID 40159064
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Endocrine hypertension is a common form of secondary hypertension. Affected patients often present without specific symptoms or signs, making the condition easy to overlook or misdiagnose. Early screening can greatly enh...Endocrine hypertension is a common form of secondary hypertension. Affected patients often present without specific symptoms or signs, making the condition easy to overlook or misdiagnose. Early screening can greatly enhance the level of diagnosis while prompt treatment can improve the prognosis of patients. Based on clinical evidence and practice, the Chinese Endocrinologist Association and the Chinese Endocrine Hypertension Collaboration Group reached this consensus after extensive discussions on target populations, screening methods, interpretation of screening results, and other issues related to endocrine hypertension.