Objective To systematically review the risk factors of stroke-associated pneumonia (SAP) and its pathogenetic characteristics in Chinese stroke patients. Methods The Web of Science, PubMed, Embase, CNKI, WanFang Data, and VIP databases were electronically searched to collect studies on the risk factors of stroke patients with concurrent SAP or studies on the pathogenetic characterization of stroke patients with concurrent SAP from the time of database inception to August 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 18 software. Results A total of 52 papers were included, all of which were retrospective studies, comprising 44 715 stroke patients, including 11 740 patients with SAP. Meta-analysis results showed that the prevalence of concomitant SAP in stroke patients was 29%. The length of hospital stay (≥14 days), invasive manipulation, dysphagia, age ≥60 years, chronic obstructive pulmonary disease (COPD), and nasogastric feeding, Glasgow Coma scale (GCS) score (≤8), history of smoking, diabetes mellitus, impaired consciousness, indwelling gastric tube, and hypoproteinaemia were risk factors for SAP episodes in stroke patients. Ventilator-assisted ventilation (≥3 days) and mechanical ventilation (≥24 hours) were independent risk factors for pulmonary infection in stroke patients. Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Stenotrophomonas maltophilia, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Staphylococcus haemolyticus, Enterococcus, Pseudomona albicans, Pseudomonas tropicalis, and Pseudomona glabrata were the common causative organisms in stroke patients with concomitant SAP. Conclusion In clinical practice, the above risk factors should be focused on and included in the stroke assessment system to achieve earlier prevention or diagnosis of stroke-complicated SAP. The common pathogens in stroke-complicated SAP should be examined and medicated for better therapeutic effects.
Objective To summarize the clinical and genetic characteristics of patients with erythropoietic protoporphyria (EPP) and explore treatment strategies for this disease. Methods We systematically searched Chinese and English databases (PubMed, China National Knowledge Infrastructure, Wanfang, VIP database, and China Biomedical Literature Service System) for case reports on Chinese (including overseas Chinese) EPP patients published up to November 2025. Data from 7 genetically confirmed patients diagnosed at the Second Hospital of Hebei Medical University were retrospectively analyzed. A descriptive comparison was conducted between the aggregated data of Chinese patients and published large-scale foreign studies with clear population representativeness. Results A total of 46 EPP patients were included, with 44 from China and 2 from Singapore, comprising 40 males (87.0%) and 6 females (13.0%). The median age at onset was 4 years, the median age at diagnosis was 26 years, and the median diagnostic delay was 18.5 years. Patients who initially presented with cutaneous manifestations (n=14) had a significantly shorter diagnostic delay than those presenting with hepatic or other manifestations (n=32) (7 vs. 24.5 years, Z=–2.160, P=0.031). Liver function impairment was present in 92.9% (39/42) of patients. Genetically, 50.0% (23/46) of patients exhibited compound heterozygous pathogenic variants in the FECH gene, and 78.3% (36/46) carried the c.315-48T>C variant. Strict photoprotection served as the cornerstone of management. Patients with concomitant liver disease received additional treatments such as ursodeoxycholic acid, glucocorticoids, plasma exchange, or liver transplantation. Notably, two patients from the Second Hospital of Hebei Medical University showed significant clinical improvement following therapeutic phlebotomy. There were differences in the clinical and genetic characteristics of EPP patients between Chinese and other ethnic groups. Conclusions Chinese (including Singaporean Chinese) EPP patients are characterized by male predominance, a high prevalence of the c.315-48T>C variant, frequent liver injury, and significant diagnostic delay. EPP should be suspected in cases of unexplained photosensitivity accompanied by hepatic dysfunction. Therapeutic phlebotomy may represent a valuable exploratory option for EPP patients.
