老年人焦虑与跌倒风险的Meta分析

目的系统评价老年人焦虑与跌倒风险的相关性。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、Psyc INFO、中国知网(CNKI)、万方(Wangfang)、维普(VIP)数据库,检索时间均为建库至2021年2月10日。两名研究者根据纳入和排除标准独立筛选文献,并且进行数据提取和质量评价,采用Rev Man 5.3软件进行meta分析。结果最终纳入13项队列研究,共计13 118名患者。文献质量评价均处于中高水平。meta分析结果显示:老年人焦虑与跌倒风险呈正相关性(OR=1.51,95%CI:1.28～1.79,P0.001)。亚组分析显示:不同研究设计类型[前瞻性队列研究(OR=1.48)、回顾性队列研究(OR=1.62)]、地区或国家[澳大利亚(OR=2.13)、欧洲(OR=1.99)、亚洲(OR=1.39)]、研究环境[社区环境(OR=1.57)]、样本量[≤500(OR=1.47)、500(OR=1.53)]中老年人焦虑与跌倒风险均呈正相关性。结论焦虑增加老年人跌倒的风险,可在老年人的常规护理中开展焦虑水平检测,以有效减少老年人跌倒风险。     

幽门螺杆菌高毒力株感染与动脉粥样硬化性脑梗死发病风险的Meta分析

目的评估幽门螺杆菌（Hp）细胞毒素相关蛋白A（CagA）血清抗体阳性菌株（以下简称CagA阳性株）感染与动脉粥样硬化性脑梗死（ACI）发病风险的相关性。方法通过文献检索收集相关文献,按统一的纳入和排除标准获取文献,应用RevMan 4.2软件对纳入文献进行Meta分析。结果共检索到10篇符合纳入标准的文献,均为病例对照研究。病例组共纳入研究对象907例,对照组共纳入966例;将纳入人群分为中国人群和欧洲高加索人群进行亚组分析。CagA阳性株感染与ACI发病风险Meta分析结果显示,总体人群OR为2.66（2.17~3.26）、中国人群亚组OR为2.60（1.93~3.49）、欧洲高加索人群亚组OR为2.71（2.05~3.59）;CagA血清抗体阴性Hp感染与ACI发病风险Meta分析结果显示,总体人群OR为0.74（0.49~1.10）、中国人群亚组OR为0.81（0.45~1.48）、欧洲高加索人群亚组OR为0.64（0.37~1.09）。漏斗图及失效安全数法提示未见明显发表偏倚,结果稳定可靠。结论CagA阳性株慢性感染可能是ACI动脉粥样硬化性脑梗死发病危险因素之一,但CagA阳性株根除性治疗是否会影响ACI等动脉粥样硬化性疾病的发病过程,有待进一步研究证实。     

国内HPV16感染与宫颈癌发病风险的Meta分析

[目的]利用Meta分析来评价人乳头状病毒HPV16感染与宫颈癌发病风险的关系。[方法]检索1990～2006年中国期刊网、维普科技期刊网等,追溯检索已发表的论文文献,纳入标准为涉及HPV16感染与宫颈癌发病风险评估的独立病例对照研究。[结果]将14个研究结果加权合并,累计病例1544例,HPV感染率47.80%;累计对照695例,HPV感染率11.08%;合并OR=9.30(95%CI:4.11～21.01)。[结论]国内HPV16感染与宫颈癌发病有关联,HPV16感染增加了宫颈癌的发病危险性。     

便秘与帕金森关系的meta分析

目的 系统评价便秘与帕金森之间的关系。方法 计算机检索中国知网、万方、维普、Pubmed、Web of science、Cochrane Library等中英文数据库,检索时限从建库至2020年5月。文献检索采用主题词结合自由词的方式,并对纳入的文献进行质量评价与数据提取,采用Stata 14.0软件进行meta分析。结果 最终纳入11篇文献,纳入文献质量评价均在中等及以上。meta分析显示便秘与帕金森诊断之间呈正相关（OR = 2.41,95%CI:2.02～2.88,P＜0.001),同时,亚组分析显示不同地区［英国（OR = 1.85）、美国（OR = 3.20）］、性别［男（OR = 3.08）、女（OR = 2.19）］、随访时间［0～5年（OR = 2.43）、6～10年（OR = 2.23）、＞10年（OR = 2.68）］、研究类型［病例对照（OR = 2.15）、队列研究（OR = 2.80）］中便秘均与帕金森诊断之间呈正相关。结论 便秘与患帕金森的风险增加有关。     

母乳喂养与婴儿HCV感染关系的meta分析

目的探讨母乳喂养与婴儿HCV感染的关系。方法为了获取适于meta分析的文献,对中国生物医学数据库、维普数据库、方正数据库、PUBMED数据库和MEDLINE进行检索。纳入标准依据Abdolmaleky HM[1]方法,用Rev-Man4.2软件对纳入文献采用固定效应模型或随机效应模型计算OR值。χ2检验每组OR值异质性,联系的强度采用OR值进行评价。结果对中国生物医学数据库和MEDLINE进行检索后共有120篇文献,37篇为综述,被舍弃。对其余文献进行仔细阅读后,只有6篇文献符合本次研究标准,meta分析OR值0.6(95%CI=0.22-1.60),证实母乳喂养与婴儿HCV感染无关。结论母乳喂养不是婴儿感染HCV的危险因素。     

多囊卵巢综合征与子宫内膜癌罹患风险系统评价

目的 探索多囊卵巢综合征(PCOS)和子宫内膜癌(EC)的相关性,以确定PCOS是否会增加EC的患病风险。方法 遵循meta分析方法,检索Pubmed、Cochrane、Medline、万方、CNKI等数据库,收集有关多囊卵巢综合征与子宫内膜癌发病风险的研究文献,利用纽卡斯尔-渥太华量表(Newcastle-Ottawa-Scale,NOS)对纳入文献进行质量评价,并应用STATA 12.0软件计算纳入的病例对照研究中的比值比(OR)及95%置信区间(95%CI),对纳入的队列研究进行系统评价。 结果 共检索出442篇文献,最终纳入7篇符合标准的文献(4篇病例对照研究,3篇队列研究)。病例对照研究的Meta分析表明,PCOS与EC并无显著相关性(OR=1.82,95%CI=0.84~3.93,I²=64.6%,P=0.037)。结论 目前证据提示PCOS与EC发病风险相关性并不显著,但由于两者关系较复杂,影响因素较多,建议进行设计更为合理的临床研究。     

孕期抑郁与妊娠期糖尿病发病风险关系的meta分析

目的 系统评价孕期抑郁与妊娠期糖尿病发病风险之间的关系。方法 检索Web of Science、PubMed、CBM、CNKI、万方及维普数据库中关于孕期抑郁与妊娠期糖尿病关系的研究，检索时限为建库至2021年12月25日。进行纳入文献的资料提取、质量评价。采用Stata16.0软件进行分析。结果 共纳入7项队列研究，共含13 139名孕妇。meta分析结果显示孕期抑郁可增加妊娠期糖尿病发病风险(OR=1.412,95%CI:1.186～1.682)。亚组分析进一步提示，研究国家[美国(OR=1.728,95%CI:1.276～2.338)、澳大利亚(OR=1.850,95%CI:1.140～3.001)]、研究类型[前瞻性研究(OR=1.356,95%CI:1.124～1.636)、回顾性研究(OR=1.850, 95%CI:1.140～3.001)]、是否校正BMI[是(OR=1.379,95%CI:1.138～1.671)、否(OR=1.580, 95%CI:1.040～2.400)]、糖尿病诊断方式[未描述(OR=1.639,95%CI:1.288～2.085)]、抑郁评估工具...     

自身免疫性甲状腺疾病与幽门螺杆菌感染关系的系统评价

目的系统评价自身免疫性甲状腺疾病(Autoimmune thyroid diseases,AITDs)与幽门螺杆菌(Helicobacter pylori,Hp)感染是否有关,为AITDs的预防和治疗提供新的途径,为AITDs患者是否应积极根除Hp提供参考。方法由2名研究人员独立检索各大型数据库2019年3月之前发表的关于AITDs与Hp感染关系的中英文文献,用Stata 11软件分析,计算合并OR值及其95%CI。结果纳入16项研究进入Meta分析。发现Hp感染与AITDs的发生具有相关性(OR=2.122,95%CI:1.455～3.096);Hp细胞毒素相关蛋白(Hp-CagA)阳性菌株感染增加AITDs发生风险(OR=2.171,95%CI:1.245～3.786);格雷夫斯(Graves)病和桥本甲状腺炎(Hashimoto's thyroiditis,HT)患者更易感染Hp(GD:OR=3.738,95%CI:2.181～6.405;HT:OR=2.056,95%CI:1.513～2.794)。结论 Hp感染与AITDs的发生具有相关性,根除Hp感染可能降低甲状腺自身抗体水平。     

失眠与老年性痴呆相关性的Meta分析

目的系统评价失眠与老年性痴呆的关系。方法检索中国知网、维普、万方、PubMed、Web of Science、Embase、Cochrane Library、Medline、CINAHL PLUS等中英文数据库,筛选失眠与老年性痴呆相关性的队列研究,时限均从建库至2021年1月10日。对最终纳入的文献进行数据提取与质量评价,并通过Stata 14.0软件进行meta分析。结果本研究最终纳入10篇文献,共含236 552例样本。纳入文献质量均处于中高水平。meta分析结果显示:失眠与老年性痴呆有相关性(OR=1.31,95%CI:1.14～1.50,P0.001)。亚组分析显示:不同研究地区或国家[欧洲(OR=1.39)、美国(OR=1.12)、中国(OR=2.34)]、失眠评估工具[问卷调查(OR=1.16)、ICD-9(OR=1.54)]、痴呆诊断工具[临床诊断(OR=1.30)、ICD-9(OR=1.54)]下,失眠与老年性痴呆具有相关性。结论失眠与老年性痴呆的发生具有相关性,失眠是老年性痴呆的危险因素。     

BMI与宫颈癌发病风险的Meta分析

目的 探讨BMI与宫颈癌发病风险的关系。方法 采用系统评价方法,在EMbase、The Cochrane Library、PubMed、CNKI、WanFang Data和VIP数据库上,检索BMI与宫颈癌发病关系的文献,检索时限均从建库至2019年5月,整个过程由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用Stata 12.0软件进行Meta分析。结果 共纳入15个研究,共计1 178 773名研究对象。Meta分析结果显示:超重人群患宫颈癌的风险是正常体重人群的1.10倍（OR = 1.10,95％CI:1.04～1.16,P = 0.001）,肥胖人群患宫颈癌的风险是正常体重人群的1.34倍（OR = 1.34,95％CI:1.16～1.55,P＜0.001）,差异均有统计学意义。结论 超重和肥胖均会增加宫颈癌发病风险,超重与宫颈癌发病风险之间的相关性较弱,但肥胖与宫颈癌发病风险之间有显著的相关性。     

骨质疏松与认知障碍关系的Meta分析

目的 系统评价骨质疏松与认知障碍的关系,为认知障碍患者的预防提供循证支持。方法 计算机全面检索Embase,Web of Science,PubMed,Cochrane Library,知网,中国生物医学文献数据库,万方,维普等数据库中关于认知障碍与骨质疏松关系的队列研究及病例-对照研究,时限均自建库至2021年4月23日。所得数据采用RevMan 5.3结合Stata 15.1软件进行Meta分析。结果 最终纳入7篇文献,共77417个患者。纳入文献均为中高等质量水平。Meta分析结果显示:与对照组相比,骨质疏松组认知障碍的发病率更高（OR=1.97,95% CI:1.37～2.82,P<0.001）。同时,亚组分析结果显示,不同性别［男性（OR=1.68,95% CI:1.22～2.32,P=0.001）、女性（OR=1.76,95% CI:1.28～2.42,P<0.001）］、年龄［老年（OR=1.77,95% CI:1.26～2.50,P=0.001）、中年（OR=2.38,95% CI:1.43～3.97,P=0.001）］、测量部位［腰椎（OR=2.18,95% CI:1.49～3.20,P<0.001）、股骨颈（OR=2.41,95% CI:1.23～4.73,P=0.010）］、认知障碍严重程度［痴呆（OR=2.22,95% CI:1.63～3.03,P<0.001）］、国家［亚洲（OR=2.31,95% CI:1.61～3.30,P<0.001）］下,认知障碍与骨质疏松症呈正关联。结论 骨质疏松与认知障碍的风险增加有关。     

Risk factors for Helicobacter pylori infection in children: is education a main determinant?

To investigate potential risk factors associated with Helicobacter pylori (Hp) infection, we performed a case-control study in 167 consecutively selected hospitalized children in Salvador, Brazil. Hp infection was identified by the presence of IgG against Hp in serum samples. Data were gathered using a structured questionnaire, 38.3% children were found to be seropositive and classified as cases, and 61.7% were seronegative controls. After multivariate analysis, independent variables associated with Hp infection included: the educational attainment of the child's provider > or = 11 years (OR 0.1, 95% CI 0.01-0.9), poor garbage disposal service (OR 2.2, 95% CI 1.0-4.9), thumb sucking (OR 4.6, 95% CI 1.1-19.8), brushing teeth more than once a day (OR 5.6, 95% CI 1.8-17.7), having a pet dog (OR 2.5, 95% CI 1.0-6.1), and a history of chronic urticaria (OR 4.0, 95% CI 1.5-10.8). The risk factors identified are consistent with some, but not all, previous studies supporting either oral-oral or faecal-oral transmission of Hp. Our data suggested that a higher educational attainment might play an important role in preventing Hp infection.     

Paternal occupation and congenital anomalies in offspring.

This paper presents the results of an exploratory case-control study of paternal occupation as a risk factor for birth defects in offspring. With the use of a population-based registry in British Columbia, 14,415 liveborn children with birth defects were identified for the period, 1952-1973. Two controls were matched to each case by using the birth files of British Columbia. Paternal occupation was obtained from the birth certificate. The analysis included 20 birth defect categories. Paternal occupations found to be associated with an increased odds ratio (OR) of birth defects include janitors [hydrocephalus (OR = 5.04), ventricular septal defects (OR = 2.45), other heart defects (OR = 2.35)], forestry and logging workers [congenital cataract (OR = 2.28), atrial septal defects (OR = 2.03), syndactyly (OR = 2.03)], painters [spina bifida (OR = 3.21), patent ductus arteriosus (OR = 2.34), cleft palate (OR = 3.36)], printers [atresia of the urethra (OR = 4.50), clubfoot (OR = 2.18)], and plywood mill workers [patent ductus arteriosus (OR = 2.52), pyloric stenosis (OR = 4.12), dislocated hip (OR = 2.71)]. This study has several limitations and the results must be viewed with caution. Nonetheless, the study provides new leads for further evaluation of the role of father's occupation in the etiology of birth defects.     

Healthcare-associated infection among residents of long-term care facilities: a cohort and nested case-control study

Knowledge of infection control measures in nursing homes is limited. This study aimed to assess the incidence of, and potential risk factors for, healthcare-associated infection in long-term care facilities in Norway. Incidence of healthcare-associated infection was recorded prospectively in six long-term care facilities located in two major cities in Norway between 1 October 2004 and 31 March 2005. For each resident with an infection we aimed for two controls in a nested case-control study to identify potential risk factors. Incidence of infection was 5.2 per 1000 resident-days. Urinary and lower respiratory tract infections were the most common. Patients confined to their beds [odds ratio (OR=2.7)], who stayed <28 days (OR=1.5), had chronic heart disease (OR=1.3), urinary incontinence (OR=1.5), an indwelling urinary catheter (OR=2.0) or skin ulcers (OR=1.8) were shown to have a greater risk for infection. Age, sex and accommodated in a two- versus single-bed room were not significant factors. Incidence of infection in nursing homes in Norway is within the range reported from other countries. This study identified several important risk factors for healthcare-associated infection. There is a need to prevent infection by implementing infection control programmes including surveillance in long-term care facilities.     

Family history as a risk factor for stroke in young women

BACKGROUND: Family history of stroke (FHS) is associated with risk of stroke in middle-aged to elderly populations. However, few studies have examined this association in younger women or by stroke type. A population-based, case-control study was conducted to examine the association of FHS and risk of stroke in young women, and to determine whether the association is independent of other stroke risk factors. METHODS: Cases were women aged 18 to 44 years, with first, nonfatal ischemic (n =49) and hemorrhagic (n = 63) strokes in western Washington State in 1991 to 1995. Demographically similar community controls (n = 446) were identified through random-digit telephone dialing. Information on FHS in first-degree relatives (parents and siblings) and other risk factors was obtained through an interview. Person-years (P-Y) at risk of stroke for relatives of each subject were included in polytomous logistic regression models to adjust for family size. The analysis was conducted between 1999 and 2000. RESULTS: After adjustment for age and P-Y, FHS in first-degree relatives was significantly associated with an increased risk of hemorrhagic (odds ratio [OR]=2.6, 95% confidence interval [CI]=1.5-4.3) and ischemic stroke (OR=2.1, 95% CI=1.2-3.9). FHS remained associated with risk of hemorrhagic stroke (OR=2.4, 95% CI=1.4-4.1) and ischemic stroke (OR=1.8, 95%CI=0.9-3.5) after further adjustment for diabetes, hypertension, hypercholesterolemia, body mass index, physical activity, smoking, alcohol, and family history of myocardial infarction. Findings were similar when associations with parental and sibling FHS were examined separately. CONCLUSIONS: Family history of stroke is a risk factor for both hemorrhagic and ischemic strokes among young women.     

安徽省某胃癌高发县40~69岁居民食盐及腌渍食物摄入与幽门螺杆菌感染状况的调查与分析

  目的   了解安徽省某胃癌高发县40~69岁常住居民食盐及腌渍食物摄入与幽门螺杆菌(helicobacter pylori, Hp)感染之间的关系。   方法   2015年7月-2018年8月在安徽省庐江县40~69岁居民中进行问卷调查和Hp血清学检测, 问卷着重调查食盐摄入量及腌渍食物食用频率, 按性别分析Hp感染与危险因素之间的关系, 单因素及多因素Logistic回归模型分析探讨相关影响因素。   结果   调查对象整体Hp感染率为50.07%, 男性居民年龄、体质指数(body mass index, BMI)、婚姻状况、文化程度、工作、劳动强度、经济收入与Hp感染均无关(均有P > 0.05), 女性居民BMI与Hp感染相关(χ2=13.454, P=0.001)。男性居民中, 饮酒是Hp感染的危险因素(OR=1.789, 95% CI:1.188~2.694, P=0.003), 但调整饮酒变量后的多因素分析显示男性食盐摄入量高及腌渍食物摄入频率高对Hp感染均无影响(均有P > 0.05);女性调查对象调整BMI变量后, 食盐摄入量高(≥9 g/d)是女性感染Hp的危险因素(OR=1.462, 95% CI:1.060~2.015, P=0.021), 腌渍食物摄入频率高(≥1次/d)是女性感染Hp的危险因素(OR=1.560, 95% CI:1.021~2.383, P=0.040)。   结论   在安徽省某胃癌高发县, 食盐摄入量高(≥9 g/d)及腌渍食物摄入频率高(≥1次/d)是40~69岁当地女性居民感染Hp的危险因素。     

Risk factors for haemorrhagic stroke: a case-control study

A hospital based pair-matched case-control study was undertaken to identify risk factors for haemorrhagic stroke. The study took place in the Government Medical College Hospital, Nagpur, India, a tertiary care hospital. The study consisted of 166 hospitalised computerised tomography scan proved cases of haemorrhagic stroke (International Classification Diseases 9, 431-432), and an age and sex matched control per case. The controls were selected from patients who attended the study hospital for conditions other than stroke. The study included hypertension, serum total cholesterol, alcohol intake, smoking, diabetes mellitus, obesity, physical inactivity, type A personality, use of anticoagulants/antiplatelets, family history of stroke, history of cardiac diseases, past history of transient ischaemic attack, history of claudication and oral contraceptive use in women, as risk factors for haemorrhagic stroke. Bivariate analysis included odds ratio (OR), 95% confidence intervals (CI) for OR and McNemar's chi2 test. Multivariate analysis was carried out by conditional multiple logistic regression analysis. Attributable Risk Percent (ARP), Population Attributable Risk Percent (PARP) and their 95% CI were estimated for significant factors. On conditional multiple logistic regression five risk factors-hypertension (OR=1.9, 95% CI 1.5-2.5), serum total cholesterol (OR=2.3, 95% CI 1.4-4.9), use of anticoagulants and antiplatelet agents (OR=3.4, 95% CI 1.1-10.4), past history of transient ischaemic attack (OR=8.4, 95% CI 2.1-33.6) and alcohol intake (OR=2.1, 95% CI 1.3-3.6) were significant. Estimates of ARP and PARP for these factors confirmed their etiological and preventable role respectively. The current study recognised the significance of five risk factors, which are preventable. These risk factors may be considered for devising effective risk factor intervention strategy for haemorrhagic stroke.     

睡眠时长与不同缺血性卒中亚型的相关性

  目的  探讨睡眠时长与不同缺血性卒中(ischemic stroke,IS)亚型的相关性。  方法  以北京市农村社区居民为研究对象,开展问卷调查、体格检查以及血生化检测。睡眠时长作为分类变量,分为睡眠时长≤ 5 h/d(< 5.5 h/d)、6 h/d(5.5~6.5 h/d)、7 h/d(6.5~7.5 h/d)、8 h/d(7.5~8.5 h/d)、≥ 9 h/d(≥ 8.5 h/d),依据急性卒中Org 10172治疗试验(trial of org 10172 in acute stroke treatment,TOAST)分型对IS进行分型,采用Logistic回归分析模型睡眠时长与不同IS亚型的相关性。  结果  共纳入6 370名研究对象,平均年龄为(58.34±9.37)岁。Logistic回归分析模型显示,在调整年龄、性别、行为生活方式、社会经济状况和健康状态后,与睡眠时长为7 h/d的相比,睡眠时长≤ 5 h/d的患IS、大动脉粥样硬化型卒中,小动脉闭塞型卒中和不明原因型卒中的风险分别是对照组的1.75倍(95%CI:1.42~2.15,P < 0.001)、1.98倍(95%CI:1.46~2.70,P < 0.001)、5.73倍(95%CI:3.34~9.83,P < 0.001)和4.43倍(95%CI:1.86~10.53,P=0.001)。然而,睡眠时长8 h/d和≥ 9 h/d仅在IS和大动脉粥样硬化型卒中中表现出有统计学意义(P < 0.05)。  结论  睡眠不足与IS、大动脉粥样硬化型卒中、小动脉闭塞型卒中和不明原因型卒中风险增加有关,而睡眠过长仅与IS和大动脉粥样硬化型卒中风险增加有关。     

硒蛋白单核苷酸多态性与幽门螺旋杆菌感染的关联性

目的 探讨硒蛋白S（selenoprotein S,SelS）rs34713741位点、硒蛋白P（selenoprotein P,Sepp1）rs7579位点单核苷酸多态性（single nucleotide polymorphisms,SNPs）与幽门螺旋杆菌（Helicobacter pylori,Hp）感染的关联性。方法 采用等位基因特异性PCR（allele - specific PCR,AS - PCR）技术检测195例Hp感染者和200例对照者SelS（rs34713741）、Sepp1（rs7579）SNPs,统计分析其与Hp感染的关系。结果 rs34713741位点SelS基因SNP与Hp感染存在关联（P＜0.05)。与C等位基因携带者相比,携带T等位基因者感染Hp风险增高1.578倍（OR = 1.578,95%CI:1.191～2.091）;与CC基因型者相比,CT和TT基因型者感染Hp风险均增高（OR = 1.890,95%CI:1.134～3.148;OR = 1.807,95%CI:1.140～2.864）;rs7579位点Sepp1基因SNP与Hp感染无关联（P＞0.05)。结论 SelS基因rs34713741位点T等位基因提高了Hp感染风险,是Hp感染遗传易感基因。