影响北京市心肌梗死病人应用急救医疗服务的因素

目的 调查北京市急性心肌梗死(AMI)病人急救医疗服务(EMS)应用率并探讨其影响因素.方法 多中心现况调查.入选2006年1月1日至12月31日期间就诊于北京市19所医院的789例ST段抬高心肌梗死(STEMI)病人.入院1周内,通过与病人进行结构式访谈及查阅病例记录收集资料.根据到达首诊医院的转运方式将病人分为EMS组和自行转运组,对比分析两组资料.结果 仅260例(33.0%)通过EMS转运到达首诊医院,其余529例(77.0%)通过自行转运到达.多元Logistic回归分析显示,年龄≥65岁(OR 1.530,95%CI 1.050～2.230,P=0.027)、大学及以上受教育程度(OR 2.032,95%CI,1.257～3.284,P=0.004)、冠心病史(OR 0.474,95%CI 1.049～2.458,P=0.029)、症状不能耐受(OR 0.592,95%CI 1.090～2.520,P=0.008)、焦虑(OR 0.760,95%CI 1.238～3.695,P=0.006)以及将症状归于心脏病(OR 0.402,95%CI 1.020～2.171,P=0.041)是应用EMS的独立预测因素.而梗死前心绞痛显著较少了EMS应用(OR 0.626,95% CI 0.431～0.907,P=0.013).结论 北京市仅1/3的STEMI病人发病后选择EMS转运.社会人口学、冠心病史、症状特点和认知因素等影响了病人对EMS的应用.     

Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing infarction an subsequent quality care in Beijing

Background Cumulative evidence demonstrates that primary percutaneous coronary intervention(PCI)is a mperfusion strategy for ST-elevation myocardial Infarction(STEMI).This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital(SH group)or a large hospital(LH group).Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group(n=160)was significantly longer than in the LH group(n=406)(225 vs.120 minutes,P<0.001).Multivariate analysis showed that interpreting symptoms to non-cardiac origin(OR,1.996;95%CI: 1.264-3.155),absence of history of myocardial infarction(OR,1.595;95%CI:1.086-3.347),non-health insuranca coverage(OR,1.931;95%Cl:1.079-3.012)and absence of sense of impending doom (OR,4.367;95%CI:1.279-1 4.925) were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times(95% CI: 1.1 82-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients'pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.     

女性患者急诊冠状动脉介入后无复流的独立预测因素

目的在现代介入治疗时代评价女性急性ST段抬高型心肌梗死(ST-segment elevation acute myocardial infarction,STEMI)患者行急诊经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)后无复流的独立预测因素。方法入选320例STEMI并成功行PPCI的女性患者,分为无复流组和复流正常组。结果女性STEMI患者行PPCI后无复流发生率为25.3%(81/320)。经单变量和多元Logistic回归分析,发现入院收缩压<100 mmHg(1 mmHg=0.133 kPa)(OR=1.991,95%CI:1.018～3.896;P=0.004)、靶病变长度>20 mm(OR=1.948,95%CI:1.908～1.990;P=0.016)、侧支循环0～1级(OR=1.952,95%CI:1.914～1.992;P=0.019)、PPCI前血栓负荷评分≥4(OR=4.184,95%CI:1.482～11.813;P=0.007)和PPCI前主动脉内气囊反搏(intra-aortic balloon pulsation,IABP)使用(OR=1.949,95%CI:1.168～3.253;P=0.011)是女性STEMI患者PPCI后无复流的独立预测因素。无复流发生率随预测因素增加而显著升高,具有0、1、2、3、4和5个无复流独立预测因素时无复流发生率分别为0%(0/2)、10.8%(9/84)、14.5%(17/117)、37.7%(29/77)、56.7%(17/30)和81.8%(9/11)(P=0.000)。结论女性STEMI患者PPCI后无复流预测模型由5个因素组成:入院收缩压<100 mmHg、靶病变长度>20 mm、侧支循环0～1级、PPCI前血栓负荷评分≥4和PPCI前IABP使用。随着无复流预测因素增多,无复流发生率显著升高。     

Prevalence and risk factors of atrial fibrillation in preterminal inpatients aged 60 years and over

Background Atrial fibrillation is a common arrhythmia and a major risk factor for ischaemic stroke. We investigated the prevalence of atrial fibrillation and its relation to age, gender and underlying heart disease in patients aged 60 years and over who died during hospitalization.
Methods Between 1955 and 2005, 1519 autopsies of in-hospital deaths in Beijing Hospital were performed. Among them, 540 cases met criteria of age ≥60 years and full clinical history including electrocardiogram, echocardiogram, myocardial perfusion images and detailed cardiac pathology records from autopsy.
Results Atrial fibrillation occurred in 193 of 540 patients and prevalence increased with age （10.5% in patients younger than 60 years, 39.6% （80-89 years） and 54.8% （≥ 90 years）） being higher in patients with underlying heart disease than without heart disease （P 〈0.0001）. Coronary artery disease （CAD）, congestive heart failure, cardiac valve dysfunction and chronic renal failure were associated with a higher prevalence of atrial fibrillation （P 〈0.001）. CAD with anterior myocardial infarction or left anterior descending artery disease was also associated with an increased prevalence of atrial fibrillation （P 〈0.05）. Following autopsy, clinical misdiagnosis of CAD increased with age and missed clinical diagnosis of CAD decreased with age. Multivariate Logistic regression analysis revealed independent predictors of atrial fibrillation： age （OR=1.335, 95% CI： 1.114-1.600, P 〈0.0001）, underlying heart disease （OR=2.019, 95% CI： 1.244-3.278, P 〈0.005）, chronic heart failure （OR=1.873, 95% CI： 1.272-2.757, P 〈0.005）, mitral regurgitation （OR=2.163, 95% CI： 1.093-4.278, P 〈0.05） and mitral stenosis （OR=33.575, 95% CI： 2.852-395.357, P 〈0.05）.
Conclusions A high prevalence of atrial fibrillation was found in Chinese patients ≥60 years who died in hospital, especially when associated with underlying heart disease. The independent risk factors of atrial fibr     

主动脉夹层围手术期死亡危险因素的预测分析

目的 探讨预测主动脉夹层围手术期死亡危险因素.方法 回顾性分析2003年1月至2008年6月复旦大学附属中山医院心外科主动脉夹层361例患者的病历资料,对患者转归进行单因素以及多因素回归分析.结果 单因素分析提示高血压病史(OR 0.465,95%CI 0.229-0.947,P=0.035),急性病程(OR 7.897,95% CI 1.874～33.275,P=0.005),Stanford A型(OR 2.758,95%CI1.054～7.213,P=0.039),神经系统症状阳性(OR 0.275,95% CI 0.140～0.541,P<0.001),手术与否(OR 8.206,95%CI 4.205～16.012,P<0.001)与转归相关,多因素回归分析提示急性病程(OR8.178,95% CI 1.796～37.242,P=0.007)、Stanford A型(OR 3.236,95% CI 1.104～9.487,P=0.032)、神经系统症状阳性(OR 0.350,95% CI 0.159～0.770,P=0.009)以及手术与否(OR 9.429,95% CI 4.456～19.952,P<0.001)对预后有重要影响.结论 高血压病史、急性病程、Stanford A分型、神经系统症状阳性是主动脉夹层围手术期死亡预测因素,手术与否是患者转归的决定性因素.     

Impact of patients’ symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction

Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI. Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction （STEMI） admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review. Results The median （25%, 75%） prehospital delay was 140 （75, 300） minutes. Only 264 （33.0%） arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain （71.4%）, radiating arm or shoulder pain （68.7%）, shortness of breath or dyspnea （65.5%）, and loss of consciousness （52.1%）. The most common symptoms experienced were central or left chest pain （82.1%）, sweats （71.8%）, shortness of breath or dyspnea （43.7%）, nausea or vomiting （32.3%）, and radiating pain （29.4%）. A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport （86.5% vs. 52.9%, P 〈0.001） and had longer prehospital delays （medians, 180 vs. 120 minutes, P 〈0.001） compared to those who interpreted their symptoms as cardiac in origin. Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emerqency medical service （EMS）.     

Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count: insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion

Background  Myocardial tissue-level perfusion failure is associated with adverse outcomes following ST-elevation myocardial infarction (STEMI) despite successful epicardial recanalization. We have developed a new quantitative index—thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC)—for assessing myocardial tissue level perfusion. However, factors affecting this novel index of myocardial perfusion are currently unknown.

Methods  A total of 255 consecutive STEMI patients undergoing primary angioplasty were enrolled. Myocardial tissue level perfusion was assessed by TMPFC, which measures the filling and clearance of contrast in the myocardium using cine-angiographic frame counting. We differentiate three groups with two cut off values for TMPFC: a TMPFC of 90 frames was the upper boundary of the 95% confidence interval (CI) for the TMPFC observed in normal arteries, and a TMPFC of 130 was the 75th percentile of TMPFC.

Results  STEMI patients with TMPFC >130 frames (68 patients, 26.7%) had higher clinical and angiographic risk factor profiles as well as a higher 30-day MACE rate compared with those with TMPFC ≤90 frames and those with TMPFC >90 and ≤130 frames. Multivariable analysis identified that the independent predictors of TMPFC >130 frames were age ≥75 years (OR 2.08, 95% CI 1.21 to 3.58, P=0.007), diabetes (OR 1.37, 95% CI 1.01 to 1.86, P=0.042), Killip class ≥2 (OR 1.52, 95% CI 1.05 to 2.21, P=0.027), and prolonged pain-to-balloon time (OR 1.73, 95% CI 1.07 to 2.79, P=0.013). TMPFC >130 frames was identified as the strongest independent predictor of 30-day major adverse cardiac event (MACE) (OR 2.77, 95% CI 1.21 to 6.31, P=0.008), along with age ≥75 years (OR 2.19, 95% CI 1.11 to 4.33, P=0.016), female gender (OR 1.67, 95% CI 1.03 to 2.70, P=0.038), and Killip class ≥2 (OR 1.83, 95% CI 1.07 to 3.14, P=0.021).

Conclusions  STEMI patients with poor myocardial perfusion assessed by TMPFC had higher risk factor profiles. Advanced age, diabetes, higher Killip class, and longer ischemia time were independent predictors of impaired TMPFC after primary percutaneous coronary intervention. These results emphasize that particular attention should be paid on myocardial microvascular reperfusion in STEMI patients with these risk factors.

     

Out-of-hospital cardiac arrest in Victoria: rural and urban outcomes

OBJECTIVE: To compare the survival rate from out-of-hospital cardiac arrest in rural and urban areas of Victoria, and to investigate the factors associated with these differences. DESIGN: Retrospective case series using data from the Victorian Ambulance Cardiac Arrest Registry. SETTING: All out-of-hospital cardiac arrests occurring in Victoria that were attended by Rural Ambulance Victoria or the Metropolitan Ambulance Service. PARTICIPANTS: 1790 people who suffered a bystander-witnessed cardiac arrest between January 2002 and December 2003. RESULTS: Bystander cardiopulmonary resuscitation was more likely in rural (65.7%) than urban areas (48.4%) (P = 0.001). Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65-5.17; P < 0.001), and to be discharged from hospital alive than rural patients (urban, 125/1685 [7.4%]; rural, 2/105 [1.9%]; OR, 4.13; 95% CI, 1.09-34.91). Major factors associated with survival to hospital admission were distance of cardiac arrest from the closest ambulance branch (OR, 0.87; 95% CI, 0.82-0.92), endotracheal intubation (OR, 3.46; 95% CI, 2.49-4.80), and the presence of asystole (OR, 0.50; 95% CI, 0.38-0.67) or pulseless electrical activity (OR, 0.73; 95% CI, 0.56-0.95) on arrival of the first ambulance crew. CONCLUSIONS: Survival rates differ between urban and rural cardiac arrest patients. This is largely due to a difference in ambulance response time. As it is impractical to substantially decrease response times in rural areas, other strategies that may improve outcome after cardiac arrest require investigation.     

急性ST段抬高型心肌梗死患者并发医院获得性肺炎的危险因素分析

目的研究急性ST段抬高型心肌梗死(acute ST-segment elevated myocardial infarction,STEMI)患者合并医院获得性肺炎(hospital-acquired pneumonia,HAP)的危险因素。方法回顾性分析2008年8月1日至2011年8月1日之间所有入北京通州区潞河医院的STEMI患者的病历资料,合并HAP的患者作为病例组,选取同期住院的STEMI但无HAP的患者作为对照。回顾性分析患者各项可能与HAP相关的临床指标,应用SPSS16.0软件进行数据分析。结果本研究共纳入病例组患者165例。单因素分析显示,病例组患者年龄、男性患者比例、合并慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)、长期服用激素、心脏功能差(Killip分级3级及以上)、卧床时间、大手术后、气管插管、机械通气、经鼻胃管、应用镇静、肌松药物比例明显高于对照组,病例组患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)比例低于对照组,住院天数明显长于对照组,病死率显著高于对照组。行Logistic回归分析,STEMI并发HAP的独立危险因素包括:年龄大于75岁(OR=3.205,95%CI:1.314～7.813)、合并COPD(OR=8.264,95%CI:2.165～31.250)、卧床时间(OR=2.583,95%CI:1.793～3.713)及未行PCI治疗(OR=0.361,95%CI:0.213～0.613)。结论高龄(大于75岁),合并COPD,卧床时间、机械通气大于48 h及未行PCI治疗是发生HAP的独立危险因素。     

ＳＴＥＭＩ合并致死性心律失常的死亡危险因素分析

本文旨在探讨ＳＴ段抬高的急性心肌梗死（ＳＴＥＭＩ）合并致死性心律失常患者的死亡危险因素。 方法　选取在２０１２年３月—２０１４年３月间于经我院诊断为急性心肌梗死（ＡＭＩ）的病人共８２５例作为研究对 象。采用单变量及多变量Ｌｏｇｉｓｔｉｃ回归分析符合要求患者的基础状态和住院治疗方案与３０ｄ死亡率的相关性。 结果　８２５例患者３０ｄ死亡率为１５４％,平均年龄（６８４±９５）岁,其中男性患者为７９９％。统计学分析显示 年龄（ＯＲ＝１０７７,９５％ＣＩ：１０３８～１１１０）、心率（ＯＲ＝１０３４,９５％ＣＩ：１００３～１０５２）、ＫｉｌｌｉｐＩＩＩ、ＩＶ级（ＯＲ＝ ８６８７、２５００５,９５％ＣＩ：３０７６～２０５４、７７８３～３５６７４）、糖尿病史（ＯＲ＝３８１２,９５％ＣＩ：１６４３～８３２１）、ＡＣＥＩ （ＯＲ＝０５６４,９５％ＣＩ：０２７６～０８８９）、他汀类药物（ＯＲ＝０７６２,９５ＣＩ：０３５８～０８４７）、收缩压（ＯＲ＝０９８０,９５％ ＣＩ：０１４２～０９９７）、再灌注治疗（ＯＲ＝０４０３,９５％ＣＩ：０１２９～０９８４）是患者３０ｄ病死率的危险因素。结论　 ＳＴＥＭＩ并发致死性心律失常患者３０ｄ死亡率高的相关因素为高龄、心率及收缩压高、ＫｉｌｌｉｐＩＩＩ级与ＩＶ级、有糖 尿病史、未使用ＡＣＥＩ和他汀类药物以及未进行再灌注治疗。     

Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China

Background:Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.Methods:We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.Results:The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56–4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84–0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17–0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33–5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01–1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48–17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83–6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27–0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.Conclusions:Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.     

Guideline-discordant care in acute myocardial infarction: predictors and outcomes

OBJECTIVES: To determine (i) factors which predict whether patients hospitalised with acute myocardial infarction (AMI) receive care discordant with recommendations of clinical practice guidelines; and (ii) whether such discordant care results in worse outcomes compared with receiving guideline-concordant care. DESIGN: Retrospective cohort study. SETTING: Two community general hospitals. PARTICIPANTS: 607 consecutive patients admitted with AMI between July 1997 and December 2000. MAIN OUTCOME MEASURES: Clinical predictors of discordant care; crude and risk-adjusted rates of inhospital mortality and reinfarction, and mean length of hospital stay. RESULTS: At least one treatment recommendation for AMI was applicable for 602 of the 607 patients. Of these patients, 411(68%) received concordant care, and 191 (32%) discordant care. Positive predictors at presentation of discordant care were age > 65 years (odds ratio [OR], 2.5; 95% CI, 1.7-3.6), silent infarction (OR, 2.7; 95% CI, 1.6-4.6), anterior infarction (OR, 2.5; 95% CI, 1.7-3.8), a history of heart failure (OR, 6.3; 95% CI, 3.7-10.7), chronic atrial fibrillation (OR, 3.2; 95% CI, 1.5-6.4); and heart rate >/= 100 beats/min (OR, 2.1; 95% CI, 1.4-3.1). Death occurred in 12.0% (23/191) of discordant-care patients versus 4.6% (19/411) of concordant-care patients (adjusted OR, 2.42; 95% CI, 1.22-4.82). Mortality was inversely related to the level of guideline concordance (P = 0.03). Reinfarction rates also tended to be higher in the discordant-care group (4.2% v 1.7%; adjusted OR, 2.5; 95% CI, 0.90-7.1). CONCLUSIONS: Certain clinical features at presentation predict a higher likelihood of guideline-discordant care in patients presenting with AMI. Such care appears to increase the risk of inhospital death.     

Call-to-needle times for thrombolysis in acute myocardial infarction in Victoria

OBJECTIVE: To determine the proportion of patients in Victoria treated within the British Heart Foundation 90-minute call-to-needle (CTN) time benchmark for thrombolysis of ST-elevation myocardial infarction (STEMI), and to validate the British Heart Foundation 90-minute benchmark with respect to mortality. DESIGN: Cohort study. SETTING: 20 hospitals and two ambulance services in the State of Victoria, Australia. PARTICIPANTS: 1147 patients with STEMI transported to hospital by ambulance and eligible for thrombolysis. MAIN OUTCOME MEASURES: CTN time, and in-hospital mortality. RESULTS: Median CTN time was 83 minutes (mean, 93.2 min; range, 29-894 min). Median door-to-needle (DTN) time was 37 minutes (mean, 46.5 min; range, 0-853 min). 61% of patients received thrombolysis within the 90-minute benchmark. Patients with CTN times > 90 minutes had an increased risk of dying (relative risk, 1.8; 95% CI, 1.3-2.7). Factors associated with CTN time < 90 minutes were lower DTN time, prior notification of the receiving hospital and transport time less than 20 minutes. CONCLUSION: The British Heart Foundation CTN time benchmark is being met for 61% of eligible STEMI patients in Victoria. Strategies to reduce CTN time should be region-specific, and should include attempts to reduce DTN and to enhance ambulance-hospital communication. Prehospital thrombolysis may be appropriate for some regions.     

急性心肌梗死患者院前延迟影响因素的系统评价及防控对策

目的 探讨急性心肌梗死患者院前延迟的影响因素,并明确应对策略,旨在缩短院前延迟时间。 方法 经Pubmed、Embase等十大数据库检索相关文献,用NOS量表评价纳入文献19篇,均为流行病调查研究,以Rev Man 5.3软件进行统计分析。 结果 通过Meta分析将影响因素归纳为3大类。①社会因素:年龄[OR=1.090,95%CI(1.060～1.130),P＜0.001]、性别[OR=1.180,95%CI(1.050～1.330),P=0.006]、文化水平[OR=1.410,95%CI(1.190～1.670),P＜0.001]、居住地区[OR=1.350,95%CI(0.990～1.840),P=0.060];②临床因素:糖尿病史[OR=1.380,95%CI(1.220～1.560),P＜0.001]、心绞痛史[OR=1.370,95%CI=1.050～1.770,P=0.020]、心肌梗死史[OR=1.080,95%CI(0.640～1.830),P=0.760]、PCI史[OR=0.760,95%CI(0.670～0.860),P＜0.001];③其他因素: 夜间发病[OR=1.630,95%CI(1.340～1.970),P＜0.001]、就诊方式[OR=0.640,95%CI(0.570～0.710),P＜0.001]、未将症状归因于心脏[OR=3.100,95%CI(1.620～5.940),P＜0.001]。 结论 高龄、女性、糖尿病史、心绞痛史、夜间发病、未将症状归因于心脏是其危险因素,高学历、PCI史、EMS就诊是其保护因素,居住地区、心肌梗死史与急性心肌梗死患者院前延迟无关。采取切实有效地干预措施,能够缩短院前延迟时间,降低患者院外死亡率。      

间隙连接蛋白37基因C1019T多态性与冠心病易感性的关联研究

目的研究中国北方汉族人群中间隙连接蛋白37（CX37）基因C1019T多态性与冠心病的关系。方法采用聚合酶链反应-限制性片段长度多态性（PCR-RFIJP）结合聚丙烯酰胺凝胶电泳（PAGE）技术,检测了514例经冠脉造影确诊的冠心病患者和400例造影正常的健康对照者CX37基因C1019T多态性位点的基因型和等位基因分布。结果CX37C1019T基因型（CC型,TC型和TT型）在冠心病组分布频率分别为22．37％,53．31％,24．32％,在对照组为17．75％,46．50％和35．75％（P=0．0007）。C等位基因频率在冠心病组明显高于正常对照组（49．03％vs41．00％,OR=1．38,95％可信区间为1．15～1．66,P=0．0006）。C等位基因携带者（CC＋TC）在冠心病组和对照组分别为75．68％和64．25％（P=0．0002）。与TT纯合子相比,（CC＋TO）基因型冠心病患病风险显著增加（OR=1．73,95％可信区间为1．30～2．30）。对性别进行亚组分析显示,男性人群中冠心病组C等位基因频率明显高于对照组（49．37％vs39．60％,OR=1．49,95％可信区间为1．18～1．89,P=0．0009）,C等位基因携带者（CC＋TC）冠心病患病风险是TT型的1．96倍（95％可信区间为1．38～2．78）,而女性人群中两组间基因分布频率差异无统计学意义（P=0．24）。结论CX37基因C等位基因可能与中国北方汉族人群冠心病的发生相关联。     

Clinical predictors of sleep disordered breathing in children at moderate altitude

BACKGROUND: Validated clinical indicators of sleep disordered breathing (SDB) in children are scarce and none generated at moderate altitude where hypoxemic complications could be frequent and oximetry evaluation might be very efficient. METHODS: A total of 158 children consecutively referred to a sleep clinic in Mexico City (2240 m) for suspected sleep apnea underwent clinical evaluation and nocturnal monitoring of pulse oximetry, snoring and body position. RESULTS: Mean age was 4.9 years (SD 2.5) and 68.4% were males. A total of 84% of children were found with more than five desaturations per hour (>/=4%) while 63% and 34% had more than 10 and 20 desaturations, respectively. Based on logistic regression models, age 相似文献   

A comparison of general practice encounters with patients from English-speaking and non-English-speaking backgrounds

OBJECTIVE: To determine whether doctor-patient encounters in general practice with patients from a non-English-speaking background (NESB) differ from encounters with patients of English-speaking background (ESB) in terms of the type of practice where the encounters occur and the type of problems managed. DESIGN AND SETTING: A national cross-sectional survey of GP-patient encounters from a sample of all active registered GPs in Australia. PARTICIPANTS: A random sample of 1047 GPs recruited in the 12 months from April 1999 to March 2000, each providing details of 100 consecutive patient encounters. MAIN OUTCOME MEASURES: GP demographics, practice characteristics, patient demographics (including whether the patient mainly spoke a language other than English at home), and problems managed at the encounter. RESULTS: After adjusting for significant predictors, encounters with NESB patients were significantly more likely to occur at solo practices than practices of five or more GPs (odds ratio [OR], 2.15; 95% CI, 1.49-3.09), in metropolitan practices (OR, 6.34; 95% CI, 4.04-9.96), and with GPs who mostly consulted in a language other than English (OR, 5.44; 95% CI, 3.78-7.83). NESB encounters were relatively more likely to involve a respiratory problem (OR, 1.14; 95% CI, 1.04-1.26), endocrine/metabolic problem (OR, 1.41; 95% CI, 1.22-1.63) or digestive problem (OR, 1.14; 95% CI, 1.02-1.27), and relatively less likely to involve a psychological problem (OR, 0.73; 95% CI, 0.61-0.88) or social problem (OR, 0.67; 95% CI, 0.49-0.92). CONCLUSION: Differences in morbidity management rates between encounters with NESB patients and ESB patients may reflect both differences in underlying prevalences of some disorders in the population of general practice patients, as well as different reasons among the two groups for attending general practice.     

儿童偏矮身材的中医体质分布及风险预测模型构建

目的 调查北京市海淀区学龄前儿童偏矮身材的中医体质和其他影响因素并构建风险预测模型,为儿童偏矮身材的防治提供参考。方法 运用整群抽样和问卷调查方法,共纳入1 612例北京市海淀区学龄前儿童作为研究对象。偏矮身材影响因素的效应大小用比值比（odds ratio,OR）及其95%置信区间（confidence interval,CI）表示。使用STATA 14.0进行统计分析,采用R软件绘制列线图风险预测模型。结果 儿童偏矮身材检出率为14.0%。偏矮身材组和正常身高组阴虚质的分布差异有统计学意义（P<0.05）。多因素Logistic回归分析显示偏矮身材的显著影响因素是父亲身高（OR=0.90,95% CI为0.87~0.93,P=0.000）、母亲身高（OR=0.89,95% CI为0.86~0.92,P=0.000）、出生身长（OR=0.92,95% CI为0.87~0.97,P=0.002）、出生体质量（OR=0.48,95%CI为0.36~0.65,P=0.000）、母乳喂养时间大于12个月（OR=1.51,95% CI为1.11~2.05,P=0.008）、阴虚质（OR=1.19,95% CI为1.01~1.39,P=0.038）。根据显著影响因素构建列线图风险预测模型,一致性指数为71.0%（P<0.001）。结论 儿童偏矮身材可能是遗传、出生情况、母乳喂养和中医体质多因素影响作用的结果。     

我国五省市、自治区慢性肾脏病患者心血管疾病的危险因素调查

目的了解我国慢性肾脏病(CKD)患者心血管疾病(CVD)的危险因素。方法利用我国五个省市、自治区七家三级甲等医院2002至2003年收治的1239例慢性肾脏病病人有关心血管疾病的资料库,用多因素Logistic回归分析该组患者人口学资料、生活方式、疾病和用药史、体检及实验室参数与各类心血管疾病的关系;同时对主要危险因素的普遍性进行分析。结果(1)血清C反应蛋白(CRP)显著增高(>10mg/L)是慢性肾脏病患者发生冠状动脉疾病(CAD)的危险因素(OR2.13,95%可信区间[CI]1.32～3.43);本组慢性肾脏病患者CRP>10mg/L者占21.5%。(2)女性(OR2.99,CI2.09～4.26)、贫血(OR2.06,CI1.19～3.57)和收缩期高血压(OR1.016,CI1.00～1.02)是左心室肥厚(LVH)的主要危险因素;本组慢性肾脏病病人收缩压控制在140mmHg以下者占54.2%,血红蛋白维持≥110g/L者仅15%。(3)钙磷乘积增加与慢性肾脏病患者的充血性心力衰竭(CHF)有关(OR1.023,CI1.01～1.03);本组病人中25.9%钙磷乘积≥55。(4)低白蛋白血症(OR6.01,CI1.25～28.96)和舒张压增高(OR1.049,CI1.00～1.09)是慢性肾脏病合并脑卒中(CVA)的主要危险因素;低白蛋白血症的患病率为37.3%。(5)传统危险因素如糖尿病增加慢性肾脏病患者CAD(OR2.34)、CHF(OR1.97)和脑卒中(OR4.40)的危险性;年龄增加是CAD(OR1.04)和脑卒中(OR1.22)的危险因素;而高血压则与左心室肥厚(OR1.016)、CHF(OR1.02)和脑卒中(OR1.04)的发生有关。结论慢性肾脏病患者具有不同于一般人群的心血管疾病危险因素,探讨对微炎症和营养不良的干预方法,加强对贫血、高血压和钙磷代谢紊乱的控制是改善我国慢性肾脏病患者心血管疾病预后的关键。     

急性ST段抬高型心肌梗死合并急性肾损伤的危险因素及其对预后的影响

目的：探讨急性ST段抬高型心肌梗死(STEMI)患者并发急性肾损伤(AKI)的危险因素及其对预后影响。方法选择我院2009年7月至2014年6月急性STEMI住院患者302例,根据是否发生AKI将患者分成AKI组和非AKI组。分析AKI发生的相关危险因素,观察住院期间主要不良心血管事件(充血性心力衰竭、恶性心律失常、心源性休克)发生率及死亡率。随访观察出院后1年全因死亡率。结果 STEMI患者并发AKI 75例,发病率为24.83%。多因素Logistic回归分析结果显示,左心室射血分数(LVEF)降低(OR=0.013,95%CI：0.000~0.327)、KillipⅣ级(OR=20.050,95%CI：6.520~61.654)、利尿剂(OR=3.102,95%CI：1.250~7.697)是AKI发生的独立危险因素;与非AKI组患者比较,AKI组患者住院期间主要不良心血管事件发生率及住院死亡率(5.28%vs 13.33%)显著升高,两组间比较差异均有统计学意义(P<0.05)。两组患者随访1年的生存曲线结果显示,AKI组患者全因死亡率明显高于非AKI组,两组间比较差异有统计学意义(P=0.003)。结论 LVEF降低、KillipⅣ级及利尿剂应用是STEMI患者并发AKI的独立危险因素;STEMI患者并发AKI增加住院不良心血管事件发生率及死亡率,降低患者1年生存率。