应用ROC曲线分析评价血脂及载脂蛋白对老年冠心病的诊断价值

评价诊断价值的基本指标是灵敏度（Ｓｅ）和特异度（Ｓｐ），ＲＯＣ曲线是以Ｓｅ为纵坐标．（１－Ｓｐ）为横坐标绘成的曲线，曲线下的面积反映试验诊断准确性的大小。通过对２１４例老年冠心病（ＣＨＤ）患者和１７２例健康老年人血清胆固醇（ＴＣ）、甘油三酯（ＴＧ）、载脂蛋白ＡＩ和Ｂ（ＡｐｏＡ、ＡｐｏＢ）水平的观察，结果显示两组间有显著性差异（Ｐ＜０．０５或Ｐ＜０．０１）。应用ＲＯＣ曲线分析，各指标曲线下面积在０．５６～０７２之间，对老年ＣＨＤ辨别力的强弱依次为ＡｐｏＡ＿１／ＡｐｏＢ、ＡｐｏＢ、ＡｐｏＡ＿１、ＴＧ和ＴＣ，提示ＡｐｏＡ＿１／ＡｐｏＢ为最有价值的指标。     

老年冠心病患者血胰岛素水平与血脂及血糖的关系

观察老年冠心病患者血胰岛素水平与血清脂质的关系,对９７年老年冠心病患者及４８例老年对照组的血脂、血糖及胰岛素进行了测定。老年冠心病患者血清甘油三脂（ＴＧ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）水平显著高于对照组;而高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）水平极显著低于对照组（Ｐ〈０．０１）;血清胆固醇（ＴＣ）、载脂蛋白ＡＩ（ＡｐｏＡＩ）、载脂蛋白Ｂ（ＡｐｏＢ）及脂蛋白（ａ）「Ｌｐ（ａ）」水平两组比较无显著性差异;老年冠心病组血胰岛素（ＩＮＳ）水平高于对照组,其差异有极显著性意义;而空腹血糖（ＦＰＧ）水平显著高于对照组;胰岛素敏感性指数（ＩＳＩ）冠心病组显著低于对照组。     

不稳定心绞痛与急性心肌梗死血脂变化比较

目的：探讨不稳定心绞痛（ＵＡＰ）和急性心肌梗死（ＡＭＩ）之间血脂变化。方法：对１０９例ＵＡＰ和１４３例ＡＭＩ病人血脂值进行统计学处理分析。结果：ＵＡＰ组ＴＧ（１７１．２±１４６．９）ｍｇ／ｄｌ高于ＡＭＩ组（１３６．９±８４）ｍｇ／ｄｌ（Ｐ＜０．０１）及ＴＧ／ＨＤＬ－Ｃ（５．５±６．２）比（４．１±３．３）和ＬＤＬ－Ｃ／ＨＤＬ－Ｃ（４．０±１．９）比（３．６±１．６）高于ＡＭＩ组（两者均Ｐ＜０．０５）。结论：ＵＡＰ病人ＬＤＬ－Ｃ／ＨＤＬ－Ｃ比值增高可能与其血管病变严重性相关     

调整血脂对冠心病预后的影响

目的：探讨长期调脂治疗对冠心病患者预后的影响。方法：对８６例伴有高脂血症的冠心病患者进行（３．１±０．７）年的调脂治疗（观察组）,并以同期未进行调脂治疗的１１３例为对照（对照组）。结果：与治疗前相比,治疗后观察组血ＴＣ、ＴＧ、ＬＤＬ－Ｃ、ＡｐｏＢ１００明显下降,ＨＤＬ－Ｃ、ＡｐｏＡ１明显增高（Ｐ＜０．０１）。随诊观察表明,心脏事件的发生率观察组为２７．９１％,并随观察时间的延长而逐渐下降（Ｐ＜０．０５）,对照组为８７．６１％,且随观察时间的延长而逐渐增高（Ｐ＜０．０１）。结论：长期的调脂治疗对冠心病患者的预后具有明显的改善作用。     

早期糖尿病患者血清唾液酸及载脂蛋白的研究

检测２０例早期Ⅱ型糖尿病（ＮＩＤＤＭ）患者血清唾液酸（ＳＡ）,载脂蛋白（Ａｐｏ）ＡＩ、Ｂ、ＣⅠ、ＣⅡ,脂蛋白（ａ）［Ｌｐ（ａ）］、胆固醇（ＴＣ）、甘油三酯（ＴＧ）、空腹血糖（ＦＰＧ）水平,与１３０例健康组比较,其ＳＡ、ＡｐｏＢ、ＡｐｏＡⅠ／ＡｐｏＢ比值、ＴＣ、ＴＧ、ＦＰＧ有极显著性意义（Ｐ＜０．０５～０．０１）,而ＡｐｏＡⅠ、ＡｐｏＣⅠ、ＣⅡ和Ｌｐ（ａ）差异虽然不显著（Ｐ＞０．０５）,但前两者有下降趋势,后两者有升高趋势。结果显示,ＮＩＤＤＭ患者早期可能已发生了细胞代谢紊乱、脂质代谢异常及血液循环障碍     

NIDDM患者血浆纤溶酶原激活物抑制剂-1(PAI-1)与并发冠心病关系的探讨

为明确血浆纤溶酶原激活物抑制剂－１（ＰＡＩ－１）在ＮＩＤＤＭ发生冠心病中所起的作用，并分析其影响因素。将６０例ＮＩＤＤＭ患者分为冠心病（ＣＡＤ）组和非ＣＡＤ组，用底物发光法检测血浆ＰＡＩ－１及组织型纤溶酶原（ｔ－ＰＡ），同时检测血糖、血胰岛素、血脂等指标。结果表明：ＣＡＤ组血浆ＰＡＩ－１活性水平明显高于非ＣＡＤ组，分别为１０．０６±２．５与８．０８±２．６２，单位Ａｕ／ｍｌ，Ｐ＜０．０１。两组ｔ－ＰＡ相似。在ＣＡＤ组，血浆ＰＡＩ－１活性与空腹胰岛素、胰岛素敏感指数均相关，相关系数分别为０．２４（Ｐ＜０．０５）与－０．３（Ｐ＜０．０１），且与甘油三酯呈正相关（ｒ＝０．２４，Ｐ＜０．０５），和ＡｐｏＢ正相关（ｒ＝０．５１，Ｐ＜０．０５）。血浆ＰＡＩ－１活性水平的升高与ＮＩＤ－ＤＭ发生ＣＡＤ危险性存在相关。胰岛素抵抗状态、高胰岛素血症、高ＴＧ水平都可刺激血浆ＰＡＩ－１活性的升高，而高血糖对其无直接的作用。ＡｐｏＢ参与ＰＡＩ－１活性改变这一过程，并在ＣＡＤ发生中可能介导其它脂质异常刺激ＰＡＩ－１升高的作用。     

脑出血病人血脂水平的研究

本文采用病例对照的方法分析了脑出血病人，急性期血中总胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）、低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）含量。结果发现：病例组血清ＴＣ明显低于对照组（ｔ＝２．２４０２，Ｐ＜０．０５），病例组ＨＤＬ－Ｃ明显低于对照组，ｔ＝６．４７２７，Ｐ，＜０．００１。未显示ＴＧ及ＬＤＬ－Ｃ病例组与对照组有明显差异（Ｐ＞０．０５）。以上指标与年龄无明显关系。     

低度醋液营养及生物学作用的实验研究

对高脂血症大鼠模型随机分成Ａ、Ｂ两组。Ａ为对照组，Ｂ为醋液组。在高脂饲料喂饲下，每天另行灌喂含０．４８％醋酸的醋液０．５ｍｌ／１００ｇ体重，实验期为５周。结果表明：Ｂ组大鼠在实验中期（第３周）血清总胆固醇（ＴＣ）及其与高密度脂蛋胆固醇（ＨＤＬ－Ｃ）比值（ＴＣ／ＨＤＬ－Ｃ）明显低于对照组（Ｐ＜０．０５）。两组的ＨＤＬ－Ｃ和甘油三脂（ＴＧ）水平差异无统计学意义。其他营养与生物学作用的观察指标如血清总蛋白、白蛋白、血红蛋白以及血清钙与耐力测试等，醋液组与对照组比较差别也无显著意义（Ｐ＞０．０５）。提示，低度醋液对实验初至中期（前３周）大鼠血清ＴＣ及ＴＣ／ＨＤＬ－Ｃ有降低作用，但不能降低ＴＧ，对ＨＤＬ－Ｃ也无作用。     

腰/臀比值与糖、脂代谢相关性研究

测定２２６例ＮＩＤＤＭ、３８９例ＩＧＴ患者体质指数（ＢＭＩ）及腰／臀比值（ＷＨＲ），并与１５３例糖耐量正常对照组作了比较。结果显示：ＮＩＤＤＭ组、ＩＧＴ组ＢＭＩ、ＷＨＲ均显著高于对照组（Ｐ＜０．０１）；ＮＩＤＤＭ组ＷＨＲ显著高于ＩＧＴ组（Ｐ＜０．０１），两组间ＢＭＩ无显著性差异（Ｐ＞０．０５）。另外，ＮＩＤＤＭ组、ＩＧＴ组的ＦＩｎｓ、２ｈＢＧ、２ｈＩｎｓ、ＴＧ、ＳＢＰ、ＤＢＰ及高血压患病率均显著高于正常组（Ｐ＜０．０１）；ＮＩＤＤＭ组ＦＢＧ、ＦＩｎｓ、２ｈＢＧ、ＴＧ及高血压患病率显著高于ＩＧＴ组（Ｐ＜０．０１），而ＩＤ１、２ｈＩｎｓ、ＩＤ２显著低于ＩＧＴ组（Ｐ＜０．０１）。ＮＩＤＤＭ组Ｃｈ明显高于对照组（Ｐ＜０．０５），而ＩＧＴ组Ｃｈ与对照组相比无显著性差异（Ｐ＞０．０５）。相关分析结果示ＷＨＲ与ＩＤ１、ＩＤ２、Ｃｈ、ＴＧ、ＳＢＰ、ＤＢＰ，均呈正相关。提示ＷＨＲ是体脂分布对糖、脂及胰岛素代谢影响较重要的指标。     

食物中可溶性纤维对大鼠脂质水平的影响

用５种不伺膳食纤维喂饲高胆固醇膳ＳＤ大鼠４周，观察对大鼠血、肝胆固醇、甘油三酯水平和肝组织学的影响。结果显示，瓜儿豆胶组至实验２周末，燕麦和沙棘皮组实验期末血清ＴＣ、ＬＤＬ－Ｃ及肝ＴＣ水平显著低于其它各组（Ｐ＜０．０５）；燕麦组血清ＨＤＬ－Ｃ显著高于高脂无纤维素对照组（Ｐ＜０．０５）；ＨＤＬ－Ｃ／ＬＤＬ－Ｃ比值燕麦和豆胶组显著高于其它各组（Ｐ＜０．０５），ＨＤＬ－Ｃ／ＴＣ值除琼脂组外，各组均明显高于对照组（Ｐ＜０．０５）；豆胶组大鼠摄食量及体重增长显著低于其它各组（Ｐ＜０．０５）。镜检发现豆胶、燕麦和沙棘皮有良好抗肝脂肪变的作用。提示：可溶性纤维能有效地降低血和肝胆固醇水平，因其成分不同降脂作用有异，其中瓜儿豆胶、燕麦食物作用明显且迅速。     

TG、ApoB、HDL-C预示NIDDM发生脑梗塞可能性探讨

目的：探讨非胰岛素依赖性糖尿病（ＮＩＤＤＭ）患者发生脑梗塞的血脂预示因素。方法：对正常人组、非ＮＩＤＤＭ脑梗塞组、ＮＩＤＤＭ无脑梗塞组、ＮＩＤＤＭ脑梗塞组进行血糖、糖化血红蛋白Ａ１ｃ、血脂、纤维蛋白原的测定，并加以比较。结果：甘油三酯、载脂蛋白Ｂ、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）在ＮＩＤＤＭ脑梗塞组与ＮＩＤＤＭ无脑梗塞组间有显著差异，低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）各组间无显著差异，其余指标ＮＩＤＤＭ脑梗塞组与非ＮＩＤＤＭ脑梗塞组无显著差别。结论：ＮＩＤＤＭ患者是发生脑梗塞的高危人群，其中甘油三酯、载脂蛋白－Ｂ显著升高，ＨＤＬ－Ｃ显著降低，可能是预示ＮＩＤＤＭ患者发生脑梗塞的重要预示因素，总胆固醇、载脂蛋白Ａ１、脂蛋白（ａ）、纤维蛋白原可能仅是次要危险因素。     

妊娠高血压综合征与血脂、载脂蛋白及脂蛋白(a)的关系

目的探讨妊娠高血压综合征(简称妊高征)患者血脂代谢水平的变化及其临床意义。方法测定正常孕妇及妊高征患者的血清甘油三脂(TG)、总胆固醇(TC)、载脂蛋白AI(ApoAI)、载脂蛋白B(ApoB)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及脂蛋白(a)水平。结果妊高征组血清TG(P<0.01)、ApoB(P<0.01)、LDL-C(P<0.05)及LP(a)(P<0.05)较正常孕妇显著升高,ApoAI、HDL-C则显著降低(P<0.05),TC在两组间差别无显著性意义(P>0.05)。在轻、中、重妊高征患者之间,ApoAI(P<0.05)及HDL-C(P<0.01)依次降低,组间比较有显著性意义,LDL-C(P<0.01)及LP(a)(P<0.01)依次升高,组间有极显著性差异。TG、TC和ApoB组间比较,差别无显著性意义。结论血脂代谢异常可能在妊娠高血压疾病的发病中起一定作用。     

Smoking change in relation to changes in blood pressure,weight, and cholesterol

The relationship of change in cigarette smoking status to change in body weight, and systolic and diastolic blood pressure, and blood serum cholesterol levels during the first 3 years of the Multiple Risk Factor Intervention Trial (MRFIT) is examined. Over 4,000 of the 6,428 special intervention men were retrospectively categorized as hypertensive and nonhypertensive smokers, reducers, quitters, and nonsmokers. Comparisons among the groups of men were completed using analysis of covariance. The results indicated no evidence for a relationship of change in smoking status to change in systolic or diastolic blood pressure. Hypertension medication use and decreases in body weight were related to decreases in systolic and diastolic blood pressure. Body weight decreased significantly in smokers, nonsmokers, and reducers in contrast to quitters for whom the average weight change was minimal. For blood serum cholesterol, quitters and nonsmokers showed a greater reduction than smokers and reducers and the expected positive relationship between change in body weight and serum cholesterol level occurred. Quitters emerged as a group of men who demonstrated a positive response to intervention across multiple modalities.     

椰油和牛脂对大鼠血脂浓度的影响及可能机制的初步探讨

目的观察椰油和牛脂对大鼠血脂浓度的影响并初步探讨其可能机制。方法选取18只Wistar雄性大鼠，实验分2组，分别喂饲含10％椰油或牛脂的纯合成饲料21d。实验开始和结束时，测血浆总胆固醇(STC)、总甘油三脂(STG)、低密度脂蛋白胆固醇(LDLC)、高密度脂蛋白胆固醇(HDLC)、载脂蛋白A(ApoA)和载脂蛋白B(ApoB)浓度。实验结束前，收集3d粪便，测定脂肪、钙、磷、镁消化率、粪胆汁酸排出量。结果同实验开始时相比，牛脂组的大鼠血浆总胆固醇浓度显升高(P＜0．05)，而椰油组大鼠却不明显；两组大鼠ApoA浓度均显升高，HDLC、STG和ApB浓度显降低(P＜0．01)；椰油组大鼠的LDLLC/HDLC比值显降低(P＜0．01)。同椰油组相比，牛脂组大鼠的脂肪、钙和镁的消化率显降低(P＜0．01)，粪胆汁酸浓度显下降(P＜0．01)。结论同摄入椰油相比，摄入牛脂可明显升高大鼠血浆总胆固醇浓度。其机制可能为组成椰油和牛脂的脂肪酸碳链长度不同导致了胆汁酸肠肝循环的速率不同，从而，引起粪胆汁酸排出量的变化，进而调整了血浆胆固醇浓度。因此，摄入含有大量中短链脂肪酸的油脂(如椰油)有利于心血管疾病的预防。     

Teens' images of smoking and smokers

The authors used qualitative and quantitative data to identify and interpret specific images teens have about smoking and smokers. Qualitative data were collected in 1996 from 793 teenagers participating in 125 focus groups at eight different sites across the United States. Most focus groups were homogeneous with respect to gender, ethnicity, and smoking status. Ages ranged from 12 to 18 years, and about half of the participants were female. The majority of participants (62%) were white and African American, the remainder (38%) were Hispanic, American Indian, and Asian/Pacific Islander. Groups were comprised of smoking and nonsmoking teens. Focus group activities were used to elicit image-related discussions about attitudes, beliefs, and perceptions of smoking. Investigators identified seven consistent and distinctive image themes: Appearance (smoking is dirty and unattractive), Activity (nonsmokers have busy, active lives), Drugs and sex (smokers are substance abusers and are sexually active), Rebellion (smokers belong to rebellious groups), Affect (smokers are depressed, angry, and stressed-out), In control (nonsmokers have self-control and are independent), and Pride (nonsmokers are proud of themselves, their families, and their heritage). A large scale, multi-site qualitative research approach can increase understanding of teen smoking. The identification of distinctive images of smoking can help researchers develop more sophisticated models of the processes of teen smoking than currently exist.     

Cigarette smoking during pregnancy in rural Nepal. Risk factors and effects of beta-carotene and vitamin A supplementation

OBJECTIVE: We examined risk factors of smoking and the association between smoking and pregnancy-related and 6-month infant mortality in rural Nepal, where 30% women reported smoking during pregnancy. DESIGN: Cross-sectional analysis of risk factors associated with smoking status and health consequences of smoking, using prospective data collected as part of a randomized community trial to examine the effect of maternal vitamin A or beta-carotene supplementation on maternal mortality. SETTING: Rural, southeastern plains of Nepal. SUBJECTS AND METHODS: A total of 17 767 women contributed at least one pregnancy during 3.5 y of the study. Data on cigarette or bidi (rolled tobacco) smoking were collected using a 7-day recall, twice during pregnancy. Associations between smoking status and maternal diet, morbidity profile, household socioeconomic status and serum concentration of retinol, carotenoids and tocopherols were examined. Further, relative risk (RR) and 95% confidence intervals (CI) were calculated to estimate supplement effects on pregnancy-related mortality, stratified by smoking status during pregnancy. RESULTS: Smokers were more likely to be older, illiterate and poor compared to nonsmokers. Fruit and vegetable consumption among smokers and nonsmokers did not vary. However, smokers were more likely to consume meat/fish/eggs and less likely to consume milk than nonsmokers. They were also more likely to report symptoms of vaginal bleeding, edema, severe headache and convulsions during pregnancy relative to nonsmokers. Mortality per 100,000 pregnancies appeared to be higher among smokers than nonsmokers in the placebo group (915 vs 584, RR=1.57, 95% CI: 0.80-3.08). beta-Carotene supplementation reduced pregnancy-related mortality both among smokers (RR=0.31 95% CI: 0.11-0.89) and nonsmokers (RR=0.41, 95% CI: 0.19-0.89). Similar results obtained with vitamin A supplementation were not statistically significant. Infant mortality up to 6 months was approximately 30% higher among smokers compared to nonsmokers in the placebo group both before and after adjusting for confounding factors. Neither supplement given to women reduced infant mortality. CONCLUSIONS: Cigarette smoking during pregnancy is associated with an increased risk of maternal and infant mortality in rural Nepal. beta-Carotene and to some extent vitamin A may reduce the risk of pregnancy-related mortality, but not infant mortality, among both smokers and nonsmokers.     

Self exposure to secondhand smoke among prenatal smokers, abstainers, and nonsmokers

PURPOSE: Prenatal smoking cessation will not eliminate health risks if women continue to be exposed to passive smoking. This study compared the risks of secondhand smoke (SHS) exposure for low-income prenatal nonsmokers, abstainers, and smokers. METHODS: A questionnaire was administered to 225 pregnant women. Exposure to six sources of SHS was compared across smoking groups using chi-square and multivariate logistic regression. RESULTS: In adjusted analyses, patterns of SHS exposure were consistent. Abstainers were at lower risk of exposure than smokers for all sources except for having a partner who smoked. Abstainers were at higher risk of exposure than nonsmokers for most sources. For example, 11.7% of nonsmokers were exposed to < 4 hours of SHS daily compared with 33.3% of abstainers (adjusted odds ratio = .32, 95% confidence interval = .12-.88). Mean number of exposures for nonsmokers, abstainers, and smokers were 1.4, 2.7, and 4.2, respectively (p < .001). DISCUSSION: Interventions need to address the full range of health risks posed by cigarette smoke exposure during pregnancy.     

Smoking and mental health: cross-sectional and cohort studies in an occupational setting in Japan

BACKGROUND: The relationship between smoking and mental health remains unclear. METHODS: We carried out a cross-sectional study and a cohort study on the possible association of smoking and mental health in 782 workers. Using a questionnaire including the 30-item General Health Questionnaire (GHQ-30) and items related to the smoking state, the association between smoking and mental health was evaluated separately in males and females. The subjects were classified into smokers and nonsmokers, and changes in the GHQ score during a 2-year follow-up period were evaluated. To control potential confounding factors, multiple regression analyses were performed. RESULTS: The cross-sectional study showed no difference in the GHQ score between smokers and nonsmokers among males but a significantly higher GHQ score for smokers than nonsmokers among females. This difference among females was confirmed to be significant by multiple regression analysis. The 2-year cohort study showed a decrease in the GHQ score in each group and no reduction in the difference in the GHQ score between smokers and nonsmokers among females. CONCLUSIONS: No difference was observed in mental health between smokers and nonsmokers in males. However, in females, smokers showed poorer mental health than nonsmokers, and this difference remained unchanged even after 2 years.     

Health behaviors, risk factors, and health indicators associated with cigarette use in Mexican Americans: results from the Hispanic HANES.

BACKGROUND: Cigarette smokers often engage in other, potentially deleterious, health behaviors. Such behaviors have not been well documented in Mexican American smokers. METHODS: Data from the Southwestern sample of the Hispanic Health and Nutrition Examination Survey (HHANES) were employed to investigate differences in health behaviors, risk factors and health indicators between cigarette smokers and nonsmokers among Mexican Americans. Differences between those smoking less than 10 and 10 or more cigarettes per day were also examined by age group and gender. RESULTS: Positive associations between smoking status and heavy coffee and alcohol consumption were found across gender and age groups. Less consistent was the finding that smokers weighed less than nonsmokers. Lower systolic and diastolic blood pressures in middle-aged smokers, and higher levels of depressive symptomatology among smoking women were found. Those smoking 10 or more cigarettes per day were more likely to report heavy coffee consumption, with younger men reporting greater activity limitation due to poor health. Middle-aged men and women in the 10+ category were generally in better health than lighter smokers. CONCLUSIONS: Modest associations between cigarette smoking, health behaviors and risk factors found in other studies were confirmed in this Mexican American population. Few significant associations between smoking and health status were noted.