青岛市糖尿病危险评分筛查代谢综合征的效果评估

目的使用青岛市糖尿病危险评分表构建用于代谢综合征(MS)发生风险的预测工具,为代谢综合征的早期筛查方法、干预措施的制定提供科学依据。方法随机抽取青岛地区7 500名35~75岁常住居民作为研究对象进行调查,以青岛糖尿病危险评分值为自变量,以是否患有代谢综合征为结局变量绘制ROC曲线,计算灵敏度和特异度,并根据最大约登指数判断最佳切点。结果青岛市糖尿病危险评分筛查代谢综合征的最佳切点为14.50,曲线下面积(AUC)为0.77(95%CI0.75~0.78),灵敏度为73.67%,特异度为68.42%。其中男性的最佳切点为14.50,AUC为0.76(95%CI0.74~0.78),灵敏度为72.13%,特异度为69.28%;女性的最佳切点为15.50,AUC为0.77(95%CI0.75~0.78),灵敏度为74.68%,特异度为68.24%。青岛糖尿病危险评分表筛查代谢综合征的AUC明显高于腰高比。结论青岛市糖尿病危险评分筛查代谢综合征的准确性较高,是开展社区筛查和健康促进的最佳模型。     

急性生理和慢性健康状况Ⅱ评分和腹部CT胰外炎症评分对急性胰腺炎预后的评估价值

目的 评估急性生理和慢性健康状况Ⅱ评分(APACHE-Ⅱ评分)及腹部CT胰外炎症评分(EPIC评分)对急性胰腺炎(AP)预后的预测价值.方法 回顾性研究入院24 h内行腹部CT检查和急性生理指标检查的AP患者147例.用受试者工作特征(ROC)曲线分析各评分标准预测重症AP的敏感度、特异度、约登指数及ROC曲线下面积(AUC),分析各评分标准对重症AP的预测能力.结果 147例患者中重症AP 43例.轻症和重症AP患者两种评分差异均有统计学意义(P<0.01). EPIC评分预测重症AP的敏感度0.893,特异度0.870,AUC最大.EPIC评分预测局部并发症的AUC最大,EPIC评分与APACHE-Ⅱ评分预测全身并发症的AUC相当.结论 APACHE-Ⅱ评分与EPIC评分相结合能在入院24h内有效预测AP的预后.     

老年患者导尿管相关尿路感染风险预测评分模型构建与验证

目的构建老年患者导尿管相关尿路感染(CAUTI)风险预测评分模型,为筛选高危人群,有效预防与控制老年患者泌尿系统感染提供依据。方法采用回顾性研究方法,收集2015年1月1日—2017年11月30日住院期间曾留置导尿管的老年患者病历资料(2015—2016年数据作为建模组,2017年数据作为验证组),构建logistic回归模型进行危险因素分析,根据OR值赋予各危险因素相应的分值,建立感染风险评分模型,利用受试者工作特征(ROC)曲线评价模型的预测效果。依据建立的感染风险评分模型对验证组病例进行评分,利用ROC曲线评价模型的预测效果。结果 logistic回归分析结果表明,年龄(≥80岁)、肾功能障碍、联用抗菌药物、特殊类抗菌药物使用天数(≥15 d)、术后住院时间(≥15 d)、导尿管置管天数(≥7 d)是老年患者发生CAUTI的独立危险因素,风险评分模型中相应的分值分别为3、3、3、5、7、9分。评分15分为高风险人群,评分模型在建模组数据中的曲线下面积(AUC)为0.91(95%CI:0.90～0.93,P0.05),灵敏度84.8%,特异度85.3%。依据验证组患者风险得分情况绘制ROC曲线,AUC为0.92(95%CI:0.88～0.95,P0.05),灵敏度84.7%,特异度86.6%。结论建立的风险评分模型在建模组和验证组均具有较好的判别效度,可用于识别老年患者CAUTI易感高危人群,以期早期预防与控制。     

三酰甘油对代谢综合征患者餐后脂代谢的影响

目的 探讨空腹TG水平对代谢综合征患者餐后脂代谢的影响.方法 将40例代谢综合征患者分为空腹TG水平升高(≥1.70 mmol/L)组(MS+HTG组,24例)和空腹TG水平正常(＜1.70 mmol/L)组(MS-HTG组,16例),同时将20例健康者作为对照组.三组受试者分别进行口服脂肪容许量测试,于餐后2、4、6、8、10 h测定TG水平,并计算其餐后TG代谢的曲线下面积(AUC).结果 MS+HTG组餐后TG的高峰水平和餐后TG代谢的AUC[(6.83±2.81)mmol/L和(26.08±16.40)mmol/(L·10 h)]均显著高于MS-HTG组[(4.12±1.14)mmol/L和(12.71±7.05)mmol/(L·10 h)]及对照组[(3.14±1.26)mmol/L和(10.28±6.09)mmol/(L·10 h)].MS+HTG组餐后TG的高峰水平较其他两组延迟2 h.MS-HTG组餐后TG的高峰水平高于对照组(P＜0.05),MS-HTG组餐后TG代谢的AUC虽高于对照组,但差异无统计学意义.相关分析结果表明,餐后TG代谢的AUC与空腹TG水平及体重指数(BMI)相关(r=0.60,P＜0.01;r=0.27,P＜0.05).多元线性回归分析结果显示,仅空腹TG水平对餐后TG代谢的AUC有预测价值(P＜0.01).结论 代谢综合征患者的空腹TG水平及BMI与餐后高TG血症独立相关.空腹TG水平对餐后高TG血症有预测价值.空腹TG水平越高,餐后TG的清除越迟缓.     

新生儿危重病例评分和第三代小儿死亡危险评分预测危重新生儿死亡风险比较

目的 比较第三代小儿死亡危险评分(pediatric risk of mortality III score, PRISM III)和新生儿危重病例评分(neonatal critical illness score, NCIS)在预测危重新生儿死亡风险方面的优越性, 探讨更适合我国NICU应用的评分系统。方法 对2013年1-6月入住新疆石河子大学第一附属医院新生儿重症监护室(neonatal intensive care unit, NICU)的135例患儿同时采用NCIS和PRISM III两种评分系统进行评分, 根据评分将入组病例分为极危重、危重、非危重3组, 分别对各组病死率进行比较, 并描绘受试者工作特征曲线(receiver operating characteristic curve, ROC), 比较ROC曲线下面积(area under the ROC curve, AUC), 以观察两种评分系统在预测危重新生儿死亡风险的优越性。结果 NCIS评分与PRISM III评分非危重组、危重组与极危重组组间病死率比较, 差异均有统计学意义(P＜0.05);两种评分对应组组间比较, 差异均无统计学意义(P＞0.05);AUC:NCIS评分0.900, PRISM III评分0.909。结论 NCIS评分与PRISM III评分均能准确预测新生儿死亡风险, PRISM III评分在我国完全适用。     

早期异位妊娠患者β-HCG、E2和P水平变化及预测分析

目的探讨早期异位妊娠患者血清人绒毛膜促性腺激素(β-HCG)、雌激素(E2)、孕酮(P)的水平变化及其预测价值。方法选取该院(2016年01月-2017年12月)确诊的90例异位妊娠患者(病例组)、同期正常妊娠妇女90例作为对照组,检测两组的血清β-HCG、E2和P水平,并采用ROC曲线求取最佳诊断界值所对应的灵敏度、特异度等诊断学指标。结果病例组的血清β-HCG、E2和P水平均显著的低于对照组,差异具有统计学意义(P 0. 05);血清β-HCG预测异位妊娠的灵敏度为88. 18%、特异度为77. 03%、ROC曲线下面积AUC值为0. 800;血清E2预测异位妊娠的灵敏度为84. 29%、特异度为72. 06%、ROC曲线下面积AUC值为0. 777;血清P预测异位妊娠的灵敏度为82. 09%、特异度为71. 55%、ROC曲线下面积AUC值为0. 767;血清β-HCG、E2和P水平联合检测预测异位妊娠的灵敏度为95. 09%、特异度为90. 63%%、ROC曲线下面积AUC值为0. 936。结论早期异位妊娠患者血清β-HCG、E2、P的水平较低,三者联合应用对于早期诊断异位妊娠具有较高的临床     

不同评分系统对急性中毒预后评估价值的比较

目的比较PSS、APACHEII、SAPSII、SOFA 4种评分系统在急性中毒预后评估中的价值。方法回顾性分析2015年1月至2016年10月收住我院急诊重症监护室EICU的231例急性中毒患者的临床资料,收集入院24h内PSS评分、APACHEII评分、SAPSII评分、SOFA评分,根据28d临床结局分为存活组和死亡组,比较两组临床资料的差异,分析两组患者的的PSS评分、APACHEII评分、SAPSII评分、SOFA评分的相关性,并对4种评分系统分值及ROC曲线下面积进行比较,评估4种评分系统的预测价值。结果与死亡组比较,存活组PSS评分、APACHEII评分、SAPSII评分、SOFA评分的差异有统计学意义(P<0.01)。PSS评分、APACHEII评分、SAPSII评分、SOFA评分之间呈明显正相关关系(P<0.01),4种评分系统的ROC曲线下面积(AUC)分别为0.833、0.887、0.843、0.843。APACHEII评分曲线下面积大于PSS评分、SAPSII评分、SOFA评分,差异有统计学意义(z=2.351,2.317,2.217;P=0.019,0.021,0.027),另3种评分曲线下面积(AUC)比较的差异无统计学意义(P>0.05)。PSS评分、APACHEII评分、SAPSII评分、SOFA评分截断值(cut-off)、灵敏度、特异度、准确率分别为(2.5,93.1%,50.9%,61.5%)、(14.5,82.8%,75.7%,77.48%)、(31.5,77.6%,76.90%,77.08%)、(5.5,77.60%,74.60%,75.35%)。结论4种评分系统均可对急性中毒患者的预后进行评估,APACHEII评分对预后的评估能力及准确率优于其他3种评分系统。     

终末期肝病模型评分与Child-Turcotte-Pugh评分对肝硬化患者手术预后的评估

目的 研究终末期肝病模型(MELD)评分及Child-Turcotte-Pugh( CTP)评分对肝硬化患者手术预后的评估.方法 入选70例行脾切除+门奇断流术的肝硬化患者,计算术前MELD评分和CTP评分,分析两者相关性及不同分组下并发症的发生情况.以受试者工作特征(ROC)曲线下面积衡量各评分的预测能力.结果 共23例(32.9％,23/70)发生术后并发症.并发症组(23例)MELD评分和CTP评分分别为(19.58 ±5.90)分和(8.84±1.87)分,无并发症组(47例)分别为(12.27±2.94)分和(6.10±1.12)分,两组比较差异有统计学意义(P＜0.01).将患者按MELD评分进行分组:＜ 14分组(30例)、14～ 23分组(28例)、＞23分组(12例),三组并发症发生率分别为10.0％(3/30)、35.7％(10/28)和83.3％(10/12),三组并发症发生率两两比较差异均有统计学意义(P＜0.05).将患者按CTP评分进行分级:A级(29例)、B级(25例)和C级(16例),三级并发症发生率分别为10.3％(3/29)、36.0％(9/25)和68.8％(11/16),三级并发症发生率两两比较差异均有统计学意义(P＜0.05).Pearson相关性分析显示,MELD评分与CTP评分有显著相关性(r=0.874,P＜ 0.01).MELD评分和CTP评分判断患者围手术期并发症的ROC曲线下面积分别为0.877 (95％ CI:0.84～0.95)和0.852(95％ CI:0.83 ～ 0.94),两者比较差异无统计学意义(U=0.157,P＞0.05).结论 MELD评分和CTP评分均能准确预测肝硬化患者围手术期并发症,临床应用宜相互结合,以进一步提高预测准确度.     

代谢综合征组分对2型糖尿病影响及预测

目的 探讨代谢综合征(MS)各组分与2型糖尿病(T2DM)发病的关系,比较MS与空腹血糖受损(IFG)在预测T2DM时的作用.方法 采用队列研究方法,对黑龙江省电业局1 318人(≥30岁)按MS和非MS分组后进行5年随访,每年定期进行问卷调查和身体检查,获取血糖(GLU)、腰围(WC)、血压(BP)等数据,进行分析比较.结果 随访5年后,MS组发病73人,非MS组发病25人,2组间差异有统计学意义;MS及其组分中GLU、WC、和BP都会增加T2DM的发病风险;MS(RR=7.83,P＜0.01)和GLU(RR=7.72,P＜0.01)较强,WC和BP相对弱一些,而高密度脂蛋白(HDL)、甘油三酯(TG)对T2MD的发病基本无影响;灵敏度等指标分析表明,MS与GLU的灵敏度、特异度均较好,阳性预测值、正确指数较高;ROC曲线分析表明,在预测T2DM时,ROC曲线下面积(Az)MS(Az_1=0.786,P=0.000)高于IFG(Az_2=0.729,P=0.000),差异有统计学意义(U=2.75,P＜0.05),表明MS和IFG对T2DM都有较高的预测价值,但MS稍高于IFG.结论 MS及其组分中的GLU、WC和BP都会增加T2DM的发病风险,特别是MS作为一个整体时预测价值较高,稍高于IFG.     

围绝经期代谢综合征的风险分析及模型构建

目的 分析围绝经期妇女代谢综合征发生的风险因素并构建列线图预测模型。方法 选取2021年6月至2022年5月黑龙江中医药大学附属第一医院收治的210例围绝经期妇女为研究对象,根据是否发生代谢综合征分为代谢综合征组(n=51)和非代谢综合征组(n=159)。分析代谢综合征发生的相关指标,采用ROC曲线观察预测价值;Logistic回归确定独立危险因素;R语言软件4.0“rms”包构建列线图预测模型,校正及决策曲线进行内部验证及预测效能评估。结果 与非代谢综合征组比较,代谢综合征组患者年龄更大、初潮年龄小、月经周期长、BMI大,甲状腺功能减退症、高油高盐饮食比例较高,规律运动的比例低,差异均有统计学意义(t/χ^(2)值分别为6.813、5.551、6.618、9.436、39.227、13.372,P<0.05)。ROC曲线分析显示,年龄、初潮年龄、月经周期、BMI的曲线下面积(AUC)分别为0.794、0.738、0.761、0.779,最佳截断值分别是50岁、13岁、32天、22.15kg/m^(2)。Logistic多元回归分析显示,初潮年龄、月经周期、BMI、运动状态、甲状腺功能减退症、高油高盐饮食是围绝经期妇女发生代谢综合征的独立危险因素,OR(95%CI)值分别为1.625(1.306~1.983)、1.724(0.989~2.004)、1.833(1.658~2.265)、1.587(1.258~1.964)、1.522(1.264~1.841)、1.444(1.021~1.783),P<0.05。列线图模型预测代谢综合征的C-index为0.859(95%CI:0.647~0.943),阈值>0.18且提供临床净收益。结论 该研究构建了预测围绝经期代谢综合征发生的列线图预测模型,具有重要的临床意义。     

Continuous metabolic syndrome risk score for predicting cardiovascular disease in the Chinese population

Although the metabolic syndrome (MetS) is a predictor of cardiovascular disease (CVD), the current dichotomous definition of MetS cannot be used to evaluate context-specific identification or for efforts to reduce the risk of CVD in the population. In this study, we assigned MetS a continuous risk score for predicting the development of CVD. In total, 3,598 participants recruited from the Jiangsu Province of China were followed for a median of 6.3 years. A total of 82 participants developed CVD during the follow-up period. Receiver operating characteristic (ROC) curve was used to analyze the association between components of MetS and CVD. The results show that systolic blood pressure (SBP) was associated with CVD more intimately (area under receiver-operator characteristic curve (AUC)=0.72, 95% confidence interval (CI), 0.66-0.77) than other features of MetS. When each MetS component was assigned according to the magnitude of regression coefficients in the Cox regression hazard model, the AUC of the continuous MetS risk score (AUC=0.80, 95% CI, 0.75-0.84) exceeded that of the dichotomized definition of MetS (AUC=0.63, 95% CI, 0.56-0.69) (p<0.01). The incidence of CVD increased with the MetS risk score. This prospective cohort study suggests that the use of continuous MetS risk score would significantly improve the capability for predicting the development of CVD compared to current definition of MetS. Further, the appropriate cut-off points need to be verified in other races and regions.     

Validity of the pediatric simple metabolic syndrome score

AimsTo compare the validity of the conventional continuous metabolic syndrome score (ccMS) and pediatric simple metabolic syndrome score (PsiMS) for the prediction of MS in Korean adolescents.MethodsA total of 2983 adolescents aged 10–18 years who participated in the Korea National Health and Nutrition Examination Survey (2013–2017) were enrolled. The ccMS was calculated by aggregating the sex and age-specific z-scores of body mass index, systolic blood pressure (SBP), glucose, high-density lipoprotein cholesterol (HDL-C), and triglycerides. The PsiMS was calculated using the following formula: 〔2x(waist/height (cm)〕+〔glucose (mg/dL)/100〕+〔triglycerides (mg/dL)/150〕+〔SBP (mmHg)/130〕-〔HDL-C (mg/dL)/40〕.ResultsMean PsiMS was significantly higher in subjects with MS compared with those without MS (3.24 vs. 1.93 in boys, 3.11 vs. 1.80 in girls; P < 0.001). Both ccMS and PsiMS were significantly higher in subjects with more MS components compared to adolescents with fewer components (P-for-trend<0.001). Among the adolescents without MS but in the PsiMS quintile 5, 33.5% presented two or more MS components. The receiver operating characteristic analysis demonstrated an equally good performance of ccMS (AUC = 0.975) and PsiMS (AUC = 0.958) for identifying adolescent MS risk. PsiMS showed a good stratification of MS risk in the generalized linear model.ConclusionPsiMS is an accurate and efficient scoring system to assess and monitor the risk of adolescent MS in the research and clinical practice.     

The framingham risk score, diet, and inflammatory markers in Korean men with metabolic syndrome

The Framingham risk score (FRS) has been used to assess the risk of a cardiovascular event and to identify patients for risk factor modifications. Therefore, the purpose of this study was to evaluate the relationship of the FRS with dietary intake and inflammatory biomarkers. We conducted a cross-sectional study of 180 men (49.2 ± 10.2 years) with MS. Serum levels of high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and adiponectin were examined. Participants were asked to complete the food frequency questionnaire (FFQ) using the previous 1 year as a reference point. The absolute cardiovascular disease (CVD) risk percentage over 10 years was calculated to estimate the FRS, which was classified as low risk (< 10%), intermediate risk (10-20%), and high risk (> 20%). Mean intake of polyunsaturated fatty acids was lower in subjects who had > 20% FRS than in subjects who had < 10% FRS (3.7 ± 1.9 g/day vs. 4.7 ± 1.9 g/day; P < 0.05). Significant differences in the Index of Nutritional Quality of protein, phosphorus, iron, vitamin A, vitamin B₁, niacin, vitamin B₆, and vitamin C were observed between the > 20% FRS group and the < 10% FRS group (P < 0.05). IL-6 concentrations were significantly lower in subjects with a < 10% FRS than in subjects who were 10-20% FRS or > 20% FRS (0.91 ± 0.26 vs. 1.48 ± 033 vs. 2.72 ± 0.57 pg/mL, respectively; P < 0.05). IL-6 and dietary intake of polyunsaturated fatty acids together explained 6.6% of the variation in FRS levels in a stepwise multiple regression model. Our results provide some evidence that dietary intake in the higher CVD risk group was inferior to that in the lower risk group and that dietary fat intake and IL-6 were associated with FRS and MS in Korean men.     

中国11省市代谢综合征不同组分及其组合 形式与心血管病发病的关系

目的 研究代谢综合征(MS)不同组分及其组合形式与心血管病(CVD)发病危险的关系.方法 "中国多省市心血管病前瞻性队列研究"在11省市共人选35～64岁男女两性30 378人,1992-2004年随访期间共发生急性CVD事件809例.采用<中国成人血脂异常防治指南>中定义的MS新标准分析MS的分布特征和MS各组分不同组合与CVD发病的关系.结果 (1)根据新标准,中国人群MS患病率为11.8%,男女分别为12.4%和9.0%,男性高于女性(P＜0.001).(2)调整其他危险因素后,CVD危险随MS组分个数的增加而增加.仅有1个组分时,只有血压升高显著增加CVD危险;有2个组分时,10种组合中的5种显著增加CVD危险;≥3个组分(即MS)存在时共有16种组合,除4种罕见组合外,其他12种均显著增加CVD危险,其中危险最高的前7位均具有"腹部肥胖+血压升高"的特征.结论 MS各组分的不同组合形式所具有的CVD发病危险有很大差异,≥3组分,特别是包含腹部肥胖和血压升高者,可以较好地检出CVD危险较高的个体.     

Inflammatory properties of diet mediate the effect of depressive symptoms on Framingham risk score in men and women: Results from the National Health and Nutrition Examination Survey (2007-2014)

Depression is common in patients with cardiovascular disease (CVD) and associated with inflammation. Inflammation contributes to the development of CVD and can be modulated by diet. However, the role of inflammatory properties of diet in the relationship between depressive symptoms and CVD risk is not well understood. We hypothesized that the inflammatory properties of diet mediate the relationship between depressive symptoms and CVD risk in men and women. Cross-sectional data collected by the National Health and Nutrition Examination Survey (2007–2014) were used for the study. Depressive symptoms scores, inflammatory properties of diet, and CVD risk were measured by the Patient Health Questionnaire-9 (PHQ-9), the Dietary Inflammatory Index (DII), and the Framingham risk score (FRS), respectively. Generalized linear models were used for the mediation analysis. There were significant differences in the proportions of men and women in the depressed group (PHQ-9 ≥ 10; 5.24 ± 0.65% vs 9.36 ± 0.87%, P < .001) and high CVD risk group (FRS >20%; 16.47 ± 0.79% vs 6.03 ± 0.32%, P < .001). The DII partially mediated the relationship between depressive symptoms and CVD risk in men (indirect effect: 0.06, P = .010) but fully mediated the relationship between depressive symptoms and CVD risk in women (indirect effect: 0.10, P < .001). These findings confirmed our hypothesis that inflammatory properties of diet at least partially mediate the relationship between depressive symptoms and CVD risk in men and women. Our findings suggest that interventions designed to reduce depressive symptoms should contain strategies to reduce pro-inflammatory and increase anti-inflammatory properties of diet to decrease CVD risk.     

代谢综合征组分影响心脑血管疾病发生的前瞻性研究

目的 探讨代谢综合征(MS)组分聚集对人群心脑血管疾病发生风险的影响.方法 2004年对广西南宁市部分事业单位7917名进行MS流行病学横断面调查,并在此基础上采用整群抽样方法随机抽取其中一个事业单位500名无心脑血管疾病史的中老年人纳入研究,根据MS组分的聚集数量分为4组,随访3.5年,每年定期测量血糖、血压、血脂等生理生化指标,并按WHO-MONICA方案心血管病事件(CVD)的诊断标准确定发生的心血管病事件和死亡事件,作为终点事件.结果 (1)MS组分数量多的组别,其体重指数、腰围、收缩压、舒张压、空腹血糖、餐后血糖、甘油三酯生理生化指标的均数高于MS组分数量少的组别.(2)4个组别人群心脑血管疾病的发生率分别为2.97%、4.19%、7.97%、11.88%.(3)logistic回归分析:相对于非MS人群,MS人群发生心脑血管事件的RR=2.389(95%CI:1.2～4.756);相对于0组,1、2、MS组人群发生心脑血管事件的RR值分别为1.41、2.68、4.00,调整年龄和性别后Cox模型分析:相对于0组,1、2、MS组的人群发生心脑血管事件的RR值分别为1.29、2.47、3.67.(4)Kaplan-Meier分析:MS组人群患心脑血管疾病的累积风险高于0、1、2组人群.随访42个月结束时,MS组人群患心脑血管疾病的累积风险达12.7%.结论 随着MS组分聚集的增加,患者发生心脑血管疾病的风险增加;随着自然病程进展,MS组分聚集越多的患者发生心脑血管疾病的累积风险越大.     

11省市代谢综合征患者中心脑血管病发病率队列研究

目的　探讨队列人群代谢综合征与心脑血管病发病率的关系。方法　采用 1 1省市队列人群 (35～ 64岁 )共 2 7739人于 1 992年进行基线危险因素调查的资料 ,计算队列人群代谢综合征患者在观察终点心脑血管病事件的人年标化发病率 ,用Cox回归模型预测危险因素水平与发病率之间的相关性。结果　 (1 ) 1 1省市队列人群代谢综合征患者心脑血管病人年标化发病率明显高于无代谢综合征者 (分别为 652 .3 1 0万和 2 0 6 .7 1 0万 ,二者RR =3 .1 2 ,P <0 .0 0 1 ) ;(2 )有高血压、低高密度脂蛋白和高腰围者心脑血管病人年标化发病率最高 (男性 91 0 .2 1 0万 ,女性 930 .7 1 0万 ) ;(3)男性年龄、吸烟、体重指数、总胆固醇和代谢综合征是心脑血管病发病的最重要的预测因素 ,女性为年龄、体重指数和代谢综合征。结论　 1 1省市队列人群代谢综合征患者心脑血管病人年标化发病率明显高于无代谢综合征者 ,代谢综合征是心脑血管病发病的最重要的预测因素 (尤其脑血管病 ) ,心脑血管病危险因素的一级和二级预防势在必行     

A risk score predicted coronary heart disease and stroke in a Chinese cohort

BACKGROUND AND OBJECTIVE: This article aims to address two issues: first, whether risk scores derived from Caucasian cohorts can accurately predict coronary heart disease (CHD) in a Chinese population; second, derivation and validation of a new risk prediction score for cardiovascular disease (CVD) from a Chinese cohort. METHODS: A cohort of 4,400 male steelworkers (18-74 years old) recruited between 1974-1980 was followed up for an average 13.5 years. A Cox model was used to predict 10 year risk of CHD, ischemic, and hemorrhagic stroke based on blood pressure, age, total cholesterol, body mass index, and smoking status. RESULTS: The prediction rule from the European Recommendations greatly overestimates the risk of CHD in Orientals. The new models had good predictive ability, with the area under receiver operating characteristic curves (AUCs area) in the derivation set being 0.76, 0.72, and 0.82 for CHD, ischemic, and hemorrhagic stroke separately; AUCs in the validation set were equally good, at 0.76, 0.78, and 0.82, respectively. CONCLUSION: The risk stratification rules derived from Caucasian cohorts overestimates the CHD risk in Orientals, and we derive a specific risk stratification rule for CHD, ischemic and hemorrhagic stroke for Chinese men.     

The DHHS Office on Women's Health Initiative to Improve Women's Heart Health: focus on knowledge and awareness among women with cardiometabolic risk factors

Abstract Background: The diversity of the U.S. population and disparities in the burden of cardiovascular disease (CVD) require that public health education strategies must target women and racial/ethnic minority groups to reduce their CVD risk factors, particularly in high-risk communities, such as women with the metabolic syndrome (MS). Methods: The data reported here were based on a cross-sectional face-to-face survey of women recruited from four participating sites as part of the national intervention program, Improving, Enhancing and Evaluating Outcomes of Comprehensive Heart Care in High-Risk Women. Measures included baseline characteristics, sociodemographics, CVD related-knowledge and awareness, and Framingham risk score (FRS). Results: There were 443 of 698 women (63.5%) with one or more risk factors for the MS: non-Hispanic white (NHW), 51.5%; non-Hispanic black (NHB), 21.0%; Hispanic, 22.6%. Greater frequencies of MS occurred among Hispanic women (p<0.0001), those with less than a high school education (70.0%) (p<0.0001), Medicaid recipients (57.8%) (p<0.0001), and urbanites (43.3%) (p<0.001). Fewer participants with MS (62.6%) knew the leading cause of death compared to those without MS (72.1%) (p<0.0001). MS was associated with a lack of knowledge of the composite of knowing the symptoms of a heart attack plus the need to call 911 (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.17-0.97, p=0.04). Conclusions: Current strategies to decrease CVD risk are built on educating the public about traditional factors, including hypertension, smoking, and elevated low-density lipoprotein cholesterol (LDL-C). An opportunity to broaden the scope for risk reduction among women with cardiometabolic risk derives from the observation that women with the MS have lower knowledge about CVD as the leading cause of death, the symptoms of a heart attack, and the ideal option for managing a CVD emergency.     

心房颤动患者预后评分系统的构建和比较

目的构建心房颤动人群预后预测工具,并对其预测能力进行比较评估。方法连续性纳入275例新发心房颤动患者,随访终点包括卒中和全因死亡。收集相关基线资料,检测患者基线血浆N末端B型利钠肽原(N-terminal pro B-type natriuretic peptide,NT-proBNP)、高敏肌钙蛋白T(high-sensitivity cardiac troponin T,hs-cTnT)、生长分化因子15(growth differentiation factor-15,GDF-15)浓度。运用Cox比例风险模型构建卒中和死亡风险评分系统。应用C-统计量和校准图比较评分系统的预测能力。结果多因素Cox回归显示,糖尿病、短暂性脑缺血发作(transient ischemic attack,TIA)、卒中史、血浆NT-proBNP浓度与心房颤动患者卒中风险独立相关;年龄、心衰史、血浆hs-cTnT和GDF-15浓度与心房颤动患者全因死亡风险独立相关。我们构建的卒中风险评分系统预测能力与国外年龄、生物标志物和临床病史(age,biomarker,clinical history,ABC)卒中评分以及CHA2DS2-VASc评分相当,死亡风险评分系统与国外ABC死亡评分相当,优于CHA2DS2-VASc评分。结论本研究构建的心房颤动患者卒中和死亡风险预测评分系统表现出较好的预测性能,此评分系统的列线图可望作为临床决策的辅助工具。