北京农村老年人慢性病及老年综合征分析

目的 应用《社区老年健康综合评估量表》在北京市农村社区分析农村老年人慢性病及老年综合征的患病情况。方法 2014年5~10月在北京市密云县巨各庄镇30个行政村/居委会符合条件的2122例常住老年人,采用《社区老年健康综合评估量表》对该人群进行横断面调查慢性病发生情况,以高血压、糖尿病和血脂异常为慢性病分析指标。最终纳入1836例,合格率86.5%,年龄60~92(69.4±6.8)岁,其中男性713例,女性1123例。结果女性老年人慢性病患病率明显高于男性(64.1%vs 35.9%,P=0.000),总人群中,患病率最高的慢性病为慢性疼痛,高达23.9%。女性患有≥2种老年综合征比例明显高于男性(19.2%vs 10.5%,P0.01)。通过老年健康综合评估,入选者高血压、糖尿病、血脂异常的检出率分别提高了14.9%、13.2%和29.1%。51.3%老年人患有老年综合征。结论 通过开展社区老年健康综合评估,能显著提高农村老年人主要慢性病的检出率,发现重要的老年综合征和主要健康危险因素。     

上海地区中老年体检人群慢性病及共病流行病学分析

目的探讨中老年体检人群慢性病及共病患病分布特征及其影响因素。方法选取上海市某医院中老年体检者资料4 394份。分析体检者慢性病及共病的患病情况,采用X^2检验对性别、年龄与体质指数等慢性病影响因素进行分析,利用多分类Logistic回归进行慢性病共病影响因素分析。结果体检人群中慢性病患病率为85.82%,患病率排名前5位的慢性病依次为高脂血症(52.50%)、高血压(39.03%)、高尿酸血症(30.41%)、脂肪肝(22.23%)和糖尿病(9.95%)。体检人群中34.21%患有一种慢性病,51.62%患有2种及以上慢性病。患有任2种慢性病为1421例(32.34%),最常见组合为高血压+高脂血症(20.39%);患有任3种慢性病为670例(15.25%),最常见组合为高血压+高脂血症+高尿酸血症(5.69%)。多分类Logistic回归结果显示,以45~54(岁)组为对照,65岁及以上组患2种及以上慢性病风险较高(P=0.038),OR值为1.42(1.02~1.97)。以BMI正常组为对照,超重组和肥胖组患2种及以上慢性病的风险较高(P均<0.001),OR值分别为1.55(1.28~1.88)和1.90(1.39~2.60)。结论中老年居民慢性病及共病患病率较高,年龄偏大及超重或肥胖可能增加慢性病及其共病患病风险,应根据慢性病患病特点进行干预。     

社区老年人群清晨高血压患病现况调查

目的了解老年人群清晨高血压患病现况。方法入选宁波市某社区年龄≥60岁的老年健康体检人群5569例,将有高血压的2572例分为:男性60~69岁组451例,70~79岁组364例,≥80岁组192例;女性60~69岁组946例,70~79岁组431例,≥80岁组188例。将非高血压2997例按上述方法分为:男性60~69岁组578例,70~79岁组448例,≥80岁组241例;女性60~69岁组773例,70~79岁组601例,≥80岁组356例。分析清晨高血压患病情况。结果 5569例老年人群清晨高血压患病率为33.0%。女性收缩压/舒张压≥140/90mm Hg(1mm Hg=0.133kPa)者明显高于男性(28.3%vs 17.6%,P<0.01);男性单纯收缩压≥140mm Hg比例高于女性(70.6%vs 57.6%,P<0.01)。无高血压患者中,女性清晨高血压总患病率明显高于男性(22.5%vs 16.9%,P=0.000),60~69岁组女性清晨高血压患病率高于男性(P=0.000),而≥80岁组中男性患病率高于女性(P=0.001)。结论上午健康体检常规测量血压是发现清晨高血压最有效、简便的方法,老年女性更应关注清晨血压。     

80岁以上高龄老年人主要慢性病的疾病谱调查与分析

目的为加强慢性病管理,针对高龄老年人主要慢性病的疾病谱进行调查,从而为制定相应的保健措施提供基础数据。方法于2012年5月~2014年12月,采用《老年健康综合评估量表》对北京市军队干休所5530例高龄老年人进行调查,其中男性5077例,女性453例,年龄80~104(87.1±3.9)岁。80~84岁老年人2119例(38.3%),85~89岁老年人2370例(42.9%),≥90岁老年人1041例(18.8%)。统计基本信息、慢性病种类及相关生化检查。结果调查对象中,人均慢性病数量为(4.2±2.1)种,患有5~6种慢性病女性高龄老年人的比例明显低于男性(21.0%vs 30.7%,P=0.000)。≥90岁高龄老年人患≥7种(24.9%vs 11.7%、15.0%,P=0.000)、5~6种慢性病(31.6%vs 29.4%、29.7%,P=0.034)的比例明显高于80~84岁、85~89岁人群。高血压、冠心病的患病率超过半数,分别为64.6%和56.8%,共有14种慢性病患病率≥10.0%。结论≥80岁高龄老年人合并多种慢性病情况严重,主要为心脑血管疾病和代谢相关性疾病。     

长春市某社区60岁以上老年人体检结果

目的通过对60岁以上老年居民的健康体检结果进行分析,揭示体检人群疾病发生率。方法对体检人群进行一般体检、血常规、尿常规、肝肾功能、血糖、B超、心电图检查等项目检查。结果目标人群中异常率较高,体质指数超标1 085例(57.23%),B超异常745例(39.3%),高血脂672例(35.45%),高血压584例(30.81%),心电图异常354例(18.67%),高血糖141例(7.44%)。男性在肥胖、高血脂、高血压、高血糖方面患病率高于女性。年龄越大,高血压、心电异常检出率越高。60~64岁老人组在体质指数检出率最高,而70~79岁组高血糖、B超异常检出率明显高于80~89岁老人。结论老年人是慢性病的高危人群,社区卫生中心根据每年体检结果,及时采取有效的行为干预措施,可以改善和提高老年居民的健康状况和生活质量。     

成都地区60岁以上干部人群慢性疾病现状调查

目的了解成都地区60岁以上干部人群慢性病患病情况及相关因素。方法于2007、2008、2009年5月进行慢性病问卷调查,调查当天在华西医科大学体检中心进行体格检查。结果 60岁以上成都市干部人群患病率为92.68%。其中患1种慢性病的占24.39%,同时患2种33.15%,患3种及以上35.14%。患病率随着年龄的增加而升高(P0.05)。排位前11位的疾病中,前列腺增生、高血压、糖尿病、冠心病、慢性阻塞性肺疾病、胆囊炎胆结石与年龄组呈线性上升趋势,但脂肪肝、高脂血症和痛风患病率呈逐年下降趋势。慢性阻塞性肺疾病及痛风患病率男性高于女性(P0.05);糖尿病、高脂血症、胆囊炎患病率女性高于男性(P0.05)。2007~2009年3年间收缩压及舒张压值呈逐年下降趋势(P0.05),血糖、血脂、血尿酸、血肌酐及尿素氮呈逐年上升趋势(P0.05),3年间成都地区60岁以上干部人群慢性病患病谱前3顺位均为前列腺增生、高血压、糖尿病。高血压患病率有所下降,糖尿病有所上升。结论成都地区60岁以上干部人群慢性病以代谢性疾病和血管性疾病为主,多病共存成为老年慢性病的特点。     

新疆乌鲁木齐市米东区成人慢性病现状调查

目的分析新疆乌鲁木齐市米东区成人慢性病患病现状,为慢性病防控提供科学依据。方法以乌鲁木齐市米东区18岁以上常住居民为调查对象,采用分层整群抽样方法(CDFT),通过问卷和体格检查进行调查,数据用Spss软件进行统计学分析。结果 2014年12月─2015年1月共调查乌鲁木齐市米东区18岁以上常住居民1 008人,其中男性405人、女性603人;检出患各类慢性病617人、平均患病率61.21%;患病率位居前五位的疾病分别为高血压(36.11%)、颈腰部疾病(21.33%)、糖尿病(18.15%)、口腔疾病(13.19%)和骨关节疾病(13.10%);男性患病251人、患病率61.98%,女性患病366人、患病率60.70%,差异无统计学意义(χ~2=0.167,P>0.001);不同年龄(χ~2=183.245)、文化程度(χ~2=50.259)、职业(χ~2=77.514)和婚姻状况(χ~2=51.691)人群慢性病患病率差异有统计学意义(P<0.001);患1种慢性病275人、占27.3%,同时患2种慢性病131人、占13.0%,同时患3种慢性病84人、占8.3%,患4种及以上127人、占12.6%;患有2种及以上慢性病共计342人、占33.9%,患病组和正常组的腰围((t=-3.727))、身高(t=2.331)、体重(t=-3.411)和BMI(t=-5.698)比较,差异有统计学意义(P<0.001)。结论乌鲁木齐市米东区成人慢性病患病率较高,多病共患的比例亦较高,应采取有效的预防和控制措施,保障人民群众的身体健康。     

沧州农村地区老年人群体质量指数和腰围与高血压的相关性研究

目的探讨沧州农村地区老年人群体质量指数和腰围与高血压患病率的关系。方法按照整体随机抽样方法,对沧州某农村地区年龄60⁸9岁1560例居民进行问卷调查、医学体检,根据高血压诊断标准分为高血压组868例和非高血压组692例。以不同体质量指数及腰围分层,比较高血压患病率及相关危险因素。结果高血压组超重(33.6%vs 10.8%)、肥胖(38.8%vs 9.7%)、腹型肥胖(36.6%vs 19.4%)、超重伴腹型肥胖(23.3%vs6.1%)检出率明显高于非高血压组(P<0.01)。而腰围异常老年人群患高血压风险度是腰围正常者的2.41倍(95%CI:1.90689岁1560例居民进行问卷调查、医学体检,根据高血压诊断标准分为高血压组868例和非高血压组692例。以不同体质量指数及腰围分层,比较高血压患病率及相关危险因素。结果高血压组超重(33.6%vs 10.8%)、肥胖(38.8%vs 9.7%)、腹型肥胖(36.6%vs 19.4%)、超重伴腹型肥胖(23.3%vs6.1%)检出率明显高于非高血压组(P<0.01)。而腰围异常老年人群患高血压风险度是腰围正常者的2.41倍(95%CI:1.906³.042,P=0.000)。相关因素分析发现,不良饮食习惯、吸烟、饮酒为该地区老年人群超重或肥胖的高危因素。结论沧州农村地区老年人群超重和肥胖形势严峻,体质量指数和腰围与高血压关系密切,不良生活习惯为其高危因素,改善不良饮食结构是高血压等慢性疾病防治的根本。     

山西省老年人群不同肥胖类型与慢性病危险因素

目的了解山西省老年人群不同类型肥胖现状及其与慢性病的关系。方法利用2010年山西省国民体质监测的数据,以山西省11个地市、60⁶9岁的老年人4 957人作为研究对象。采用体重指数(BMI)和腰围(WC)作为不同类型肥胖的测量指标。利用非条件logistic回归模型分析肥胖和各种慢性病之间的关系。结果山西省老年人群中超重率为44.64%,肥胖率为16.78%,向心性肥胖率为64.90%。55.21%患有一种及以上慢性疾病。高血压患病率(20.25%)居首位。分别调整BMI和WC,高血压、高脂血症、糖尿病、冠心病及骨关节疾病的患病率随BMI和WC的增高而上升。与正常BMI组相比,肥胖组患5种疾病的OR值为1.1769岁的老年人4 957人作为研究对象。采用体重指数(BMI)和腰围(WC)作为不同类型肥胖的测量指标。利用非条件logistic回归模型分析肥胖和各种慢性病之间的关系。结果山西省老年人群中超重率为44.64%,肥胖率为16.78%,向心性肥胖率为64.90%。55.21%患有一种及以上慢性疾病。高血压患病率(20.25%)居首位。分别调整BMI和WC,高血压、高脂血症、糖尿病、冠心病及骨关节疾病的患病率随BMI和WC的增高而上升。与正常BMI组相比,肥胖组患5种疾病的OR值为1.17².24;WC≥95 cm(男)、≥90 cm(女)组与WC正常组相比,5种疾病的OR值为1.072.24;WC≥95 cm(男)、≥90 cm(女)组与WC正常组相比,5种疾病的OR值为1.07¹.99,趋势检验P值均<0.05。消化性溃疡的患病率随BMI增高而下降,肥胖组与正常BMI组相比,OR值为0.381.99,趋势检验P值均<0.05。消化性溃疡的患病率随BMI增高而下降,肥胖组与正常BMI组相比,OR值为0.38¹.17;而消化性溃疡与WC无关。慢性支气管炎与BMI和WC均无关。结论高血压、高脂血症及骨关节疾病在肥胖组中患病率较高。糖尿病、冠心病患病率与向心性肥胖呈正相关。     

南宁市中老年人群高血压患病及相关因素调查

目的:了解南宁市中老年人群高血压患病及其相关因素情况,为进一步综合防治提供科学依据。方法:随机抽取市区部分事业单位≥40岁工作人员共11226例,年龄(57·03±8·62)岁。按统一要求测定血压、体质指数、腰围、血糖、血脂及血尿酸等有关项目。结果:南宁市≥40岁人群高血压标化患病率为16·82%,其中1级高血压占75·15%,2级占20·60%,3级占4·27%;男性高于女性。血糖、血脂异常,超重、肥胖及及腰围增大的检出率高血压组不仅显著高于非高血压组,而且正常血压高值组也较正常血压组明显增高。结论:南宁市≥40岁成人高血压患病率仍有一定程度的增长,而正常血压高值人群增长明显。高血压或正常偏高血压者伴多代谢异常情况均较正常血压组明显增高。     

鞍钢职工心脑血管疾病现状与发病趋势

目的分析鞍钢职工大样本人群心脑血管疾病的发病率及易患因素分布情况。方法通过对鞍钢集团95 912例职工的心脑血管疾病既往史、吸烟、血压、糖尿病、血清总胆固醇、高密度脂蛋白、体重指数、总胆固醇与高密度脂蛋白胆固醇的比值等数据的分析,前瞻性分析受检人群心脑血管疾病发病的危险分层。结果冠心病1 910例(2.00%),脑血管病607例(0.63%),吸烟19 453例(20.28%),糖尿病788例(0.82%),高血压31 698例(33.05%),高脂血症8 347例(8.70%),体重超重55 462例(57.83%),总胆固醇(TC)/高密度脂蛋白胆固醇(HDL-C)≥3.5的10 487例(10.93%);缺血性心血管病发病概率多分布于极低危(68.14%)和低危(5.75%),中危(0.865%)占很小的比例,颈动脉粥样硬化斑块发生概率多分布于高危(44.23%)、中危(23.21%)和极高危(10.51%),无低危和极低危。结论目前鞍钢职工的健康状况不容乐观,应进一步加大健康知识宣教力度。     

Concerted action of wild-type and mutant TNF receptors enhances inflammation in TNF receptor 1-associated periodic fever syndrome

TNF, acting through p55 tumor necrosis factor receptor 1 (TNFR1), contributes to the pathogenesis of many inflammatory diseases. TNFR-associated periodic syndrome (TRAPS, OMIM 142680) is an autosomal dominant autoinflammatory disorder characterized by prolonged attacks of fevers, peritonitis, and soft tissue inflammation. TRAPS is caused by missense mutations in the extracellular domain of TNFR1 that affect receptor folding and trafficking. These mutations lead to loss of normal function rather than gain of function, and thus the pathogenesis of TRAPS is an enigma. Here we show that mutant TNFR1 accumulates intracellularly in peripheral blood mononuclear cells of TRAPS patients and in multiple cell types from two independent lines of knockin mice harboring TRAPS-associated TNFR1 mutations. Mutant TNFR1 did not function as a surface receptor for TNF but rather enhanced activation of MAPKs and secretion of proinflammatory cytokines upon stimulation with LPS. Enhanced inflammation depended on autocrine TNF secretion and WT TNFR1 in mouse and human myeloid cells but not in fibroblasts. Heterozygous TNFR1-mutant mice were hypersensitive to LPS-induced septic shock, whereas homozygous TNFR1-mutant mice resembled TNFR1-deficient mice and were resistant to septic shock. Thus WT and mutant TNFR1 act in concert from distinct cellular locations to potentiate inflammation in TRAPS. These findings establish a mechanism of pathogenesis in autosomal dominant diseases where full expression of the disease phenotype depends on functional cooperation between WT and mutant proteins and also may explain partial responses of TRAPS patients to TNF blockade.     

Chronic liver inflammation: Clinical implications beyond alcoholic liver disease

Chronic alcohol exposure can lead to alcoholic liver disease, including hepatitis, cirrhosis and hepatocellular carcinoma, and chronic inflammation can simultaneously cause systemic medical illness. Recent evidence suggests that alcoholic liver disease is a predictor for liver-related diseases, cardiovascular disease, immunologic disease, and bone disease. Chronic inflammation in alcoholic liver disease is mediated by a direct inflammatory cascade from the alcohol detoxification process and an indirect inflammatory cascade in response to gut microflora-derived lipopolysaccharides (LPS). The pathophysiology of alcoholic liver disease and its related systemic illness is characterized by oxidative stress, activation of the immune cascade, and gut-liver interactions. Integrative therapeutic strategies for alcoholic liver disease include abstaining from alcohol consumption; general anti-inflammatories such as glucocorticoid, pentoxifylline, and tumour necrosis factor-α antagonist; antioxidants such as N- acetylcysteine; gut microflora and LPS modulators such as rifaximin and/or probiotics. This review focuses on the impact of chronic liver inflammation on systemic health problems and several potential therapeutic targets.     

Paediatric aspects of coeliac disease: old challenges and new ones…

The concept of coeliac disease has expanded from a gastrointestinal disease with malabsorption to a systemic immunological disease with a genetic basis. Epidemiological studies indicate that environmental factors, like the infant feeding pattern, affect the clinical presentation while population-screening studies indicate that the prevalence, at least in Caucasian populations, is similar. Secondary complications, like malignancies, osteopenia - osteoporosis, gynaecological and obstetrical problems and autoimmune diseases, are common. The risk is reduced or prevented by treatment with a gluten-free diet. The basis for such a secondary prevention is: 1. early case-finding by a) knowledge about different presentations of the disease and factors affecting that, b) generous serological testing in patients with vague symptoms, c) screening of risk groups, and, 2. support for children and adolescents with coeliac disease to comply with the gluten-free diet.     

Celiac Disease: A Disorder Emerging from Antiquity,Its Evolving Classification and Risk,and Potential New Treatment Paradigms

Celiac disease is a chronic genetically based gluten-sensitive immune-mediated enteropathic process primarily affecting the small intestinal mucosa. The disorder classically presents with diarrhea and weight loss; however, more recently, it has been characterized by subclinical occult or latent disease associated with few or no intestinal symptoms. Diagnosis depends on the detection of typical histopathological biopsy changes followed by a gluten-free diet response. A broad range of clinical disorders may mimic celiac disease, along with a wide range of drugs and other therapeutic agents. Recent and intriguing archeological data, largely from the Gobleki Tepe region of the Fertile Crescent, indicate that celiac disease probably emerged as humans transitioned from hunter-gatherer groups to societies dependent on agriculture to secure a stable food supply. Longitudinal studies performed over several decades have suggested that changes in the prevalence of the disease, even apparent epidemic disease, may be due to superimposed or novel environmental factors that may precipitate its appearance. Recent therapeutic approaches are being explored that may supplement, rather than replace, gluten-free diet therapy and permit more nutritional options for future management.     

Canadian Digestive Health Foundation Public Impact Series 4: celiac disease in Canada. Incidence, prevalence, and direct and indirect economic impact

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada in 2009. The current article presents the updated findings from the study concerning celiac disease.     

Graves病患者血清中TSH抗体检测及其免疫学意义

利用~(125)I标记的人TSH(~(125)I-hTSH)作为放射性示踪配体,对29例正常人和58例Graves病患者血清中抗hTSH自身抗体(TSHab)进行了检测。正常人TSHab指数(TSHabJ)为0.85±0.22;而32例初发患者和26例接受抗甲状腺药物治疗患者的TSHabJ分别为1.47±0.35(P<0.001)和1.19±0.37(P>0.05)。SPA菌体结合沉淀试验表明:这种与hTSH结合的抗体属于IgG成分。TSHab的存在提示Graves病的免疫学发病已涉及到独特型-抗独特型反应机理。     

Simultaneous operation of concomitant diseases in the esophagus and lung

The aim of this study was to retrospectively review our experience of performing simultaneous operations on concomitant diseases in the esophagus and lungs. From January 1998 to July 2009, simultaneous operations were performed on 13 patients with concomitant esophageal and pulmonary diseases, using coordinated surgical approaches. Among the 13 patients, six had primary cancers in the esophagus and lungs, five had primary esophageal cancer accompanied by a benign pulmonary disease, one had benign diseases in both esophagus and lung, and one had primary esophageal cancer with metastasis to the left lower lung. All patients survived the operations. Two major complications occurred postoperatively. One complication was bronchopleural fistula and the other was intrathoracic gastric laceration. Both patients recovered after additional treatments. Simultaneous operation of concomitant diseases in the esophagus and lungs is feasible and safe in selected patients who have received careful preoperative assessment, well‐designed surgical approach, and proper perioperative management.     

Prevalence of Coronary Artery Disease in Patients with Valvular Heart Disease

ABSTRACT. To evaluate the usefulness of preoperative coronary angiography in patients undergoing preoperative investigation because of valvular heart disease, we performed coronary angiography in a consecutive series of 329 patients. The prevalence of significant coronary artery disease was 32%. Asymptomatic coronary artery disease was present in 13%. Angina pectoris proved to be a poor predictor of coronary artery disease in aortic valve disease. In mitral valve disease, however, the specificity was high. A cost-benefit calculation was carried out in order to assess what advantage routine coronary angiography might have. According to this, coronary angiography should be performed in all patients suffering from valvular heart disease with angina pectoris, whereas it can be omitted in younger patients without angina. A cut-off point of 60 years seems appropriate for aortic valve disease and 65 years for mitral valve disease.