脑血流动力学与缺血性卒中发病风险的关系

目的探讨脑血管血流动力学指标（CVHI）积分与缺血性脑卒中发病风险的关系。方法以巢式病例-对照研究设计,选择东北地区队列人群中新发生的151例缺血性卒中病例为研究对象,并将年龄、性别作为匹配条件,在同一人群中随机选取同等数量的非卒中个体为对照,分析和比较CVHI积分值降低及卒中常见危险因素暴露与缺血性卒中发病的风险。结果单因素分析显示,CVHI积分、高血压病史、心脏病史、卒中家族史与缺血性卒中发病风险具有显著的病因学联系（P〈0.05）,其OR（95%CI）分别为6.75（3.93～11.62）、3.44（2.01～5.90）、1.77（1.01～3.10）、2.04（1.12～3.72）。CVHI积分值与缺血性卒中发病风险具有显著的剂量反应关系,随积分值降低,发病风险上升（趋势χ^2=48.48,P=0.001）。多因素Logistic回归分析显示,被筛选进入方程的因素分别为CVHI积分、高血压病史、卒中家族史,其中CVHI作用最强,OR（95%CI）为6.122（3.474～10.789）。结论CVHI积分值降低与缺血性卒中发病风险增加密切相关,可能是其独立的预测因子。     

基于巢式病例对照设计开发宫颈癌发病风险预测模型

目的 基于宁波市鄞州区域健康信息平台,使用巢式病例对照的研究设计构建宫颈癌发病风险预测模型。方法 2018年10月31日前建档的25~75岁无宫颈癌史的常住女性中,至少随访3年的过程中新发生的宫颈癌患者纳入病例组,以1∶10的比例匹配对照组,预测因子提取时间限制在结局发生前。变量选择采用Lasso-logistic回归,选择β不为0的变量拟合logistic回归模型并用Bootstrap法进行内部验证。模型的区分度用受试者工作曲线下面积（AUROC）评价,校准度用校准曲线图和Hosmer-Lemeshow检验来评价。结果 最终模型纳入的预测因子包括年龄、吸烟状况、宫颈炎史、HPV检测情况和液基薄层细胞检查情况。内部验证500次Bootstrap的AUROC为0.740（95%CI：0.739~0.740）,校准曲线与理想曲线几乎重合,Hosmer-Lemeshow检验P=0.991,模型区分度和校准度均较好。结论 本研究开发了一个简便且实用的宫颈癌发病风险预测模型,模型的可解释性强,内部验证区分度良好,校准度良好,可以用于一般人群,为个人对自身宫颈癌发病风险的评估提供依据。     

传统及联合脂质代谢指标与糖尿病发病关系的巢式病例对照研究

目的:探讨脂质参数与糖尿病发病的关系,并将传统脂质参数与联合脂质参数进行比较,以期探讨、识别和预测糖尿病患者的最佳替代指标。方法:以金昌队列为基础,采用巢式病例对照研究方法,排除恶性肿瘤和相关内分泌、循环系统疾病后抽取随访期内新发糖尿病者1 025例作为病例组,然后按照年龄±2岁、性别进行1∶1匹配获得对照组1 025...     

血清叶酸与口腔癌发病关联的病例对照研究

目的  探讨血清叶酸与口腔癌发病的关系。 方法  采用病例对照的研究方法, 收集福建医科大学附属第一医院2010年9月-2018年1月经病理确诊的口腔癌新发病例225例为病例组, 收集同时期社区和医院体检的健康人群225例为对照组。采用非条件Logistic回归分析模型, 分析血清叶酸与口腔癌发病风险的OR及其95%CI值, 并进行分层分析和相乘交互作用分析。 结果  病例组血清叶酸中位数为5.7 ng/ml, 低于对照组的8.2 ng/ml(P < 0.001), 差异有统计学意义; 无论性别、吸烟与否及摄入蔬菜水果的频次多少, 血清叶酸水平与口腔癌的发病风险均存在负相关; 叶酸与性别、吸烟、摄入蔬菜、水果在口腔癌的发生中存在相乘交互作用。 结论  高血清叶酸水平与口腔癌的发病风险呈负相关, 保证适量叶酸摄入、减少烟草消耗和适量增加蔬菜水果可能降低口腔癌的发病风险。     

肺炎链球菌脑膜炎发病相关因素的巢式病例对照研究

肺炎链球菌是儿童细菌性脑炎/脑膜炎的主要病原体之一.由于我国缺乏规范的肺炎链球菌脑膜炎检测系统，其发病情况、危险因素等尚不清楚.本研究拟探索肺炎链球菌脑膜炎的发病与危险因素，为科学防控提供依据.     

钢铁工人血常规指标及尿酸水平与代谢综合征发病风险的相关性

目的研究钢铁工人血常规指标和尿酸水平与代谢综合征(MS)的关联。方法采用病例对照研究方法,选取内蒙古某钢铁企业接触噪声和高温危害因素的男性作业人员607人作为接害组,该企业不接触噪声与高温的行政和管理岗位的男性作业人员312人作为对照组。采集两组血标本,检测血常规和尿酸水平,分析接害组与对照组血常规指标[白细胞计数(WBC)、红细胞计数(RBC)、血小板计数(PLT)、红细胞分布宽度(RDW)及血红蛋白含量(Hb)]和尿酸水平(UA)与MS的相关性。结果接害组和对照组间吸烟、饮酒、腰围(WC)、收缩压(SBP)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、WBC、RBC、PLT、Hb、RDW、体质量指数(BMI)及UA方面比较差异均有统计学意义(均P<0.05)。接害组MS总体患病率为39.04%,高于对照组的23.08%,差异有统计学意义(P<0.05)。两组MS患者和非MS患者WBC、RBC、PLT、RDW及UA比较差异均有统计学意义(均P<0.05)0多因素logistic回归分析发现WBC、RBC、RDW、PLT及UA是接害组MS的危险因素(均P<0.05)。结论钢铁工人MS患病率较高,红细胞计数增高、红细胞分布宽度增大及血小板计数升高是MS发生的危险因素。     

肝硬化患者血清球蛋白与Child分级相关性研究

目的探讨血清球蛋白对肝硬化病情预后的关系。方法检测30例肝硬化患者和25例正常对照组血清球蛋白、胆碱脂酶的水平,并与白蛋白、胆红素、凝血酶原时间作对比分析。结果发现肝硬化患者血清球蛋白均显著高于正常对照组(P<0.01),血清球蛋白与肝硬化Ch ild分级相关性差异有统计学意义。结论血清球蛋白的高低不仅能反映肝功能损害程度,更能反映肝组织纤维化程度。     

肌酐清除率与单纯性肾囊肿相关性的巢式病例对照研究

目的  探讨金昌队列人群基线肌酐清除率(creatinine clearance rate, Ccr)与随访单纯性肾囊肿(simple renal cysts, SRCs)之间的相关性,为SRCs的防治提供科学依据。方法  基于金昌队列,采用巢式病例对照研究方法,研究对象包括859名SRCs病例和859名按照随访时间、年龄、性别、高血压匹配的对照。分别使用单因素和多因素条件logistic回归分析模型分析基线Ccr与随访SRCs之间的关联,计算OR和95%CI值。然后应用限制性立方样条分析基线Ccr与随访SRCs之间的剂量-反应关系。结果  调整混杂因素后多因素条件logistic回归分析模型结果显示,基线Ccr < 60.00 mL·min^-1·1.73m^-2、60.00~ < 70.00 mL·min^-1·1.73m^-2者发生SRCs的风险分别是Ccr≥80.00 mL·min^-1·1.73m^-2者的2.10倍(95% CI: 1.13~3.89)、1.57倍(95% CI: 1.03~2.39)。限制性立方样条结果显示,金昌队列人群基线Ccr与随访SRCs之间存在反向非线性剂量-反应关系。结论  低Ccr是SRCs的独立危险因素,当基线Ccr < 80.00 mL·min^-1·1.73m^-2时,金昌队列人群SRCs的发病风险随Ccr降低而增加。     

人血清Corin蛋白水平与妊娠期高血压病例对照研究

目的 探讨人血清Corin蛋白水平与妊娠期高血压疾病(HDCP)的关系.方法 对2016-2017年在昆山市第一人民医院产检的HDCP患者100例,按照年龄、孕周、居住社区等匹配进行病例对照研究,收集孕妇基本特征,采集血样,分析血清Corin蛋白水平和妊娠期高血压的关系.结果 病例组和对照组在初检孕周、初检血压、初检谷丙转氨酶、初检血糖、入院血压、血清Corin蛋白水平、孕次和尿蛋白阳性率等方面差异均有统计学意义(P值均＜0.05),在年龄、身高、初检体重、初检肌酐、入院孕周、胎次等方面差异均无统计学意义(P值均＞0.05).按血清Corin蛋白水平进行四分位,与血清Corin蛋白水平＜P25相比,血清Corin蛋白水平P25～P50者发生HDCP的风险是1.80倍(95％CI:0.773～4.166),P50～P75者发生风险是2.66倍(95％CI:1.149～6.156),P75～P100者发生风险是3.71倍(95％CI:1.578～8.710),随着Corin蛋白水平的增高,发生HDCP的风险不断增加.结论 Corin蛋白水平增加HDCP的发病危险.     

基线高敏C-反应蛋白水平与心源性猝死的相关性研究

目的 探讨血清高敏C-反应蛋白(hs-CRP)水平与心源性猝死(SCD)事件风险的相关性.方法 采用回顾性巢式病例对照研究方法,选择SCD患者80例,对照组160例.比较两组间基线hs-CRP水平,分析不同基线hs-CRP水平与SCD事件的相关性.结果 SCD患者基线hs-CRP水平(1.26 mg/L)高于对照组(0.59 mg/L) (P＜ 0.001);hs-CRP四分位数水平较高者(＞2.01 mg/L)发生SCD事件的风险是较低者(＜0.31 mg/L)的8.18倍(95％ CI 2.75～24.40,P＜ 0.001),对hs-CRP以3 mg/L及以第80百分位点为临界值分组后进行统计分析,hs-CRP与SCD事件相关性依然存在,OR值分别为4.26 (95％ CI 1.98～9.15,P＜ 0.001),3.86(95％ CI 1.71～8.72,P＜0.001).结论 基线hs-CRP水平与SCD事件风险有相关性,hs-CRP水平较高者发生SCD的风险增加,hs-CRP≥3mg/L者SCD事件发生风险明显增加.     

苏州成人血清维生素D、甲状旁腺激素、钙与血糖升高的关系

目的探讨血清25-羟基维生素D(25-OH-D)、甲状旁腺激素(PTH)及血清钙与血糖升高之间的关系。方法于2013年按照整群随机抽样的方法从苏州市4个社区抽取621名40～75岁成年居民,收集人口统计学等资料,测量身高、体重和血压,检测空腹血糖、25-OH-D、PTH、钙、磷等指标。结果与25-OH-D10.0μg/L者相比,25-OH-D介于10.0～19.9μg/L及≥20.0μg/L者的空腹血糖水平及血糖升高发生率均偏低(P0.001)。PTH≥65.0 ng/L者与65.0 ng/L者的血糖水平及血糖升高发生率差异无统计学意义。与血清钙为2.03～2.54 mmol/L者相比,血清钙≥2.54 mmol/L者的血糖水平均较高(P0.001),而血糖升高者比例却随着血清钙浓度的增加而增加。多因素Logistic回归分析发现,25-OH-D为10.0～19.9μg/L组及≥20.0μg/L组血糖升高的危险性分别为10.0μg/L组的0.467倍(95%CI 0.311～0.703,P0.001)和0.402倍(95%CI 0.205～0.790,P=0.008);血清钙≥2.54 mmol/L组血糖升高的危险性是2.03～2.54 mmol/L组的1.884倍(95%CI 1.272～2.791,P=0.001)。结论维生素D缺乏、血清钙浓度的升高会增加血糖升高的危险性。     

Association between chronic periodontitis and serum lipid levels

Regarding the high prevalence of hyperlipidaemia, which is one of the major risk factors of cardiovascular disease, and uncertain reports about the relation between periodontal disease and serum lipid profile, this study was conducted to assess this relation. The historical cohort study was conducted on 52 cases including 26 persons with chronic periodontitis as case group, and 26 healthy subjects as control group. Both groups had the same age and weight ranges, sex, and diet, without any periodontal treatment history in the past six months, underling systemic disease such as diabetes, anti-hyperlipidemic drugs or active tobacco smoking history. Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Triglyceride (TG) and Total Cholesterol (CHOL) were measured by direct enzymatic assay. TG level was 128.4 +/- 71.1 mg/dl in control group and 165.2 +/- 83.7 in case group indicating a significantly higher level in case group (P<0.05). In control group, 30.8 percent and in case group, 61.5 percent had abnormal serum cholesterol levels, which presents a significantly higher level in case group (P<0.03). Other serum level indices did not show any significant difference. Although it seems that patients with chronic periodontal disease are more susceptible to hyperlipidemia, it is doubtful that the former causes an increase in serum lipid levels, so we suggest studying the effects of treating chronic periodontitis on serum lipid level.     

单纯收缩期高血压与血清铁及影响因素分析

目的 探讨血清铁与高血压的相关危险因素的交互作用及与单纯收缩期高血压的关系。方法 采用整群抽样方法,抽取哈尔滨报社人群为调查对象,对该人群进行血压、身高、体重、腰围、臀围的测量及吸烟、饮酒的调查及血清铁的检测。结果 单纯收缩期高血压组和非高血压组的年龄构成差异有统计学意义(P<0.01),性别构成差异无统计学意义(P>0.05);2组吸烟率、饮酒率差异无统计学意义(P>0.05)。2组血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)含量、空腹血糖、体质指数(BMI)、腰臀比(WHR)差异均有统计学意义(P<0.01)。未控制混杂因素时,血清铁和超重、空腹血糖对单纯收缩期高血压存在交互作用,但调整混杂因素后,不存在交互作用。结论 血清铁与单纯收缩期高血压可能无关联。     

Coffee, caffeine, and the risk of liver cirrhosis

PURPOSE: To evaluate the effect of the consumption of caffeine-containing beverages on the risk of symptomatic liver cirrhosis (LC). METHODS: From 1994 to 1998, all the consecutive cirrhotic inpatients admitted in 19 collaborative hospitals for signs of liver decompensation in whom the diagnosis of liver cirrhosis was made for the first time (274 cases) and one or two gender, age, and place of residence pair matched individuals (458 controls) were recruited. Data on years of education, lifetime cigarette use, lifetime intake of alcohol- and caffeine-containing beverages, usual consumption of 180 food items, and on markers of hepatitis B and C viral infection were collected. RESULTS: A statistically significant trend toward lowered cirrhosis risk with increasing exposure to coffee was observed. The LC odds ratios decreased from 1.0 (reference category: lifetime abstainers from coffee) to 0.47 (95% confidence interval: 0.20, 1.10), 0.23 (0.10, 0.53), 0.21 (0.06, 0.74), and 0.16 (0.05, 0.50) in 1, 2, 3, and 4 or more cups of coffee drinkers, respectively. There was no convincing evidence that coffee consumption modifies the effects of the known risk factors of liver cirrhosis (alcohol intake and viruses infection). CONCLUSIONS: These findings support the hypothesis that coffee, but not other beverages containing caffeine, may inhibit the onset of alcoholic and nonalcoholic liver cirrhosis.     

血清网膜素-1水平与儿童非酒精性脂肪肝的关系

目的 探索网膜素-1与儿童非酒精性脂肪肝(NAFLD)的相关性,为儿童脂肪肝的防治提供参考。方法 将116名肥胖儿童分为肥胖伴脂肪肝组(61名)、肥胖不伴脂肪肝组(55名),同时选择正常体重儿童55名作为对照组,对每位儿童进行身高、体重、腰围、血压等测量,并行血脂、血糖、肝功等化验,留取静脉血清标本测血清胰岛素、网膜素-1、瘦素、脂联素水平等,判断三组间指标差异及网膜素-1与其他指标相关性。采用Logistics回归判断有无脂肪肝与其他指标的关系,采用ROC曲线评估腰围、体重指数(BMI)、网膜素-1水平对儿童脂肪肝诊断标准有无价值。结果 血清网膜素-1在肥胖伴脂肪肝患儿中水平较另两组水平低(P<0.05)。矫正年龄及腰围后网膜素-1与有无合并脂肪肝、瘦素/脂联素(LAR)、低密度脂蛋白胆固醇(LDL-C)为负相关,与脂联素呈正相关(P<0.05)。Logistics回归分析发现BMI、胰岛素抵抗指数(HOMA-IR)为脂肪肝的危险因素,网膜素-1为脂肪肝的保护因素。腰围、BMI、血清网膜素-1水平对儿童脂肪肝诊断有一定价值。结论 血清网膜素-1水平与儿童中心性肥胖、脂代谢紊乱及脂肪肝密切相关,在儿童脂肪肝的发病中有保护作用。     

血清胱抑素C水平与中老年人2型糖尿病合并脑梗死的相关性

目的探讨2型糖尿病合并脑梗死的中老年患者血清胱抑素-C(Cys-C)的变化及临床意义。方法选取中老年2型糖尿病患者126例,其中合并脑梗死的患者30例,单纯糖尿病患者96例,另选取健康对照者36例。测定所有受试者的空腹血糖(FBG)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(Hb A1C)、血清Cys-C、同型半胱氨酸(Hcy)、基质金属蛋白酶-9(MMP-9)的水平及颈动脉内膜中层厚度(CIMT)。结果 2型糖尿病合并脑梗死、单纯2型糖尿病受试者的FBG、TG、TC、LDL-C、HDL-C、Hb A1C、血清Cys-C、Hcy、MMP-9及CIMT与健康对照组比较,差异有显著统计学意义(P0.01),且2型糖尿病合并脑梗死的各指标与单纯2型糖尿病比较,差异亦有统计学意义(P0.05)。血清Cys-C水平与CIMT呈正相关。血清Cys-C可能是2型糖尿病合并脑梗死发病的独立预测因子。结论血清Cys-C可能是2型糖尿病合并脑梗死的独立预测因子,联合血清Cys-C、Hcy、MMP-9水平的测定对预测中老年人2型糖尿病合并脑梗死可能更有意义。     

血清高敏C反应蛋白水平与五年累积糖尿病发病风险的关系

目的 研究高敏C反应蛋白(hs-CRP)与5年糖尿病发病风险的关系.方法 研究对象来源于"中国多省市心血管病前瞻性队列研究"中的北京大学社区队列.2002年对该队列45～74岁1541人进行心血管病危险因素调查和hs-CRP水平测定,2007年进行危险因素复查,对两次资料完整且基线无糖尿病和感染性疾病的1045人进行分析.结果 研究人群5年间糖尿病的年龄标化累积发病率为8.8%,男性为9.8%,女性为8.2%.基线hs-CRP水平四分层后显示:男女两性糖尿病的累积发病率均有随hs-CRP水平升高而逐渐增加的趋势(P＜0.01).调整基线年龄、高血压、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯、血糖、吸烟和腹部肥胖后,男女两性中hs-CRP≥3mg/L者发生糖尿病危险分别是hs-CRP＜1 mg/L者的3.30倍(95%CI:1.25～8.73)和2.58倍(95%CI:1.06～6.29).男女两性基线hs-CRP水平判定糖尿病是否发病的ROC曲线下面积分别为0.619(95%CI:0.536～0.701)和0.667(95%CI:0.585～0.749).结论 基线hs-CRP水平是糖尿病发病的独立预测因素,提示慢性炎症在糖尿病发生的病理过程中发挥重要作用.

Abstract：

Objective To analyze the association between hs-CRP(high-sensitivity C-reactive protein) levels in serum and the 5-year-accumulative-risk of diabetes in a general population.Methods Participants were from the cohort of Peking University residential community in the Chinese Multi- provincial Cohort Study(CMCS). Two surveys on cardiovascular risk factors and the measurements of serum hs-CRP levels were conducted in 2002 and 2007, respectively. Individuals with incomplete information and those having infectious diseases at baseline were excluded. A total of 1045 participants aged 45 to 74 years and free of diabetes at baseline were included in this analysis.Results The age-standardized 5-year accumulative incidence rate of diabetes was 8.8% (male:9.8%, female: 8.2% ) and increased significantly with the level of hs-CRP in both women and men (P＜0.01). After adjustment for age, hypertension, low-density liproprotein cholesterol, and high-density liproprotein cholesterol, triglycerides, fasting glucose, smoking status and central obesity,people with hs-CRP≥3 mg/L had a 3.30 times higher risk of developing diabetes in men and 2.58 times for women when compared to those with hs-CRP＜1 mg/L. The areas under the receiver operating characteristic curves of baseline hs-CRP level in predicting the incidence of diabetes were 0.619(95%CI:0.536-0.701 ) in men and 0.667(95%CI:0.585-0.749) in women. Conclusion Serum hs-CRP levels could predict the incidence of diabetes, indicating that inflammation might have great importance in the onset of diabetes.     

Association between plasma 25-hydroxyvitamin D levels and fracture risk: the EPIC-Oxford study

The importance of vitamin D for bone health is well established, but few data exist on the relation between plasma levels of 25-hydroxyvitamin D and risk of fracture. The authors examined this association within the EPIC-Oxford (European Prospective Investigation into Cancer and Nutrition-Oxford cohort) study of men and women in the United Kingdom (1993-1999). Five years after recruitment, participants completed a follow-up questionnaire where fracture incidence was self-reported. Plasma 25-hydroxyvitamin D concentration was measured in 730 incident fracture cases and 1,445 matched controls. There was a clear association between plasma 25-hydroxyvitamin D concentration and month of blood draw, the highest values being during the summer months. Among women, there were significant relations between 25-hydroxyvitamin D levels and age, body mass index, marital status, use of hormone therapy, physical activity, diet group, dietary intake of vitamin D, and alcohol. Similar relations were seen among men, although often they were nonsignificant because of smaller numbers. There was no evidence of an association between plasma 25-hydroxyvitamin D and fracture risk for men or women; the relative risks associated with a doubling of plasma 25-hydroxyvitamin D were 1.15 (95% confidence interval: 0.82, 1.61) and 0.95 (95% confidence interval: 0.80, 1.13), respectively. These results were not affected by adjustment for potential confounders and were consistent across a number of subgroups.