职业紧张因素与高血压发病关系的配对病例对照研究

目的探讨职业紧张与高血压的关系以及引起高血压发病的主要职业紧张因素.方法应用职业紧张因素测试表(OSI),对96例高血压患者1∶1配对病例对照研究进行多因素条件Logistic回归分析.结果在控制了非职业紧张因素条件下,职业紧张仍与高血压发病关系密切(OR=2.707,95%CI1.389～5.275),而且随着职业紧张程度的增加,患高血压的危险性也增加.引起男性铁路乘务人员高血压发病的主要职业紧张因素是职务特征.结论进一步证实了职业紧张是引起男性铁路乘务人员高血压发病的重要危险因素,以及造成这个职业人群高血压发病的主要职业紧张因素是职务特征.     

列车乘务人员职业紧张与高血压,冠心病关系的研究

目的： 研究职业紧张与高血压、冠心病之间的关系以及引起高血压、冠心病发病的主要职业紧张因素。方法： 应用职业紧张因素测试表（ＯＳＩ）,对５８３ 名男性列车乘务人员进行职业紧张与高血压、冠心病关系的人群调查,并进行多因素非条件Ｌｏｇｉｓｔｉｃ回归分析。结果： 在控制了非职业紧张因素条件下,职业紧张与高血压（ＲＲ＝ １．９７７,９５％ ＣＩ：１．３５３～２．８８７）、冠心病（ＲＲ＝ ２．０９２,９５％ ＣＩ：１．２５８～３．４８０）都有独立的相关关系,而且随着职业紧张程度的增加,患高血压、冠心病的危险性也增高,引起列车乘务人员高血压发病的主要职业紧张因素是职业特征和组织结构与气氛;引起冠心病发病的主要职业紧张因素是职务特征和经历与成就。结论： 职业紧张是引起高血压、冠心病发病的重要危险因素之一     

职业紧张对血糖、血脂影响的研究

目的 探讨职业紧张与血糖、血脂之间的关系。方法 应用职业紧张测量表(OSI)于2002年对福州铁路系统及福州某工厂共289名男性职工进行职业紧张与血脂、血糖关系的人群调查，并进行LSD检验及又生分析；结果 在控制了非职业紧张因素的条件下，职业紧张与血糖升高(RR＝2．46)、血脂升高(RR＝1．23)都有独立的相关关系，并且与常见的主要危险因素有协同作用。结论 职业紧张是引起男性职工血糖、血脂升高的重要危险因素之一。     

职业紧张对血糖、血脂影响的研究

目的探讨职业紧张与血糖、血脂之间的关系.方法应用职业紧张测量表(OSI)于2002年对福州铁路系统及福州某工厂共289名男性职工进行职业紧张与血脂、血糖关系的人群调查,并进行LSD检验及叉生分析.结果在控制了非职业紧张因素的条件下,职业紧张与血糖升高(RR=2.46)、血脂升高(RR=1.23)都有独立的相关关系,并且与常见的主要危险因素有协同作用.结论职业紧张是引起男性职工血糖、血脂升高的重要危险因素之一.     

血清尿酸与四年后血压变化及高血压发病的关系

目的 探讨中年人群血清尿酸（SUA）与四年后血压变化及高血压（HYP）发病的关系。方法 在1984年在基线调查的35－39岁血压正常（低于235／85mmHg）、有SUA值的1656名男女中,1988年有1480人（男性609,女性871）参加了复查,以此为队列人群,观察高血压的发病率及血压变化。结果 随访四年高血压发病率为13．1％。无论男女,按尿酸四分位分析显示高血压发病率随分位数增加而升高。多元Logistic回归分析,当控制年龄后在男性UA增加1个标准差（1．14mg/dl）是显著地增加HYP发病危险（HYP发病相对危险RR＝1．40,95％可信限1．12－1．74）。当BMI、吸烟、饮酒和基线SBP加入模型,SUA与HYP发病的关系减弱但仍有统计学显著性（RR＝1．28,95％可信限1．01－1．61）。多元线性回归分析,在男性基线年龄、SUA、BMI、和体重变化与4年的SBP变化呈正的显著关联。在女性SUA与高血压发病及血压变化均无显著关联。结论 结果表明在男性SUA对血压升高及高及高血压发病是个独立于体重指数（BMI）、吸烟和饮酒的危险因素。     

父母高血压史与心血管病发病关系的前瞻性研究

目的探讨我国人群中父母高血压史与子代心血管病发病的关系。方法1992—1994年在全国12组人群中分别整群随机抽取1000—2000人进行心血管病危险因素调查,并对心血管事件的发生情况进行随访观察,随访至2005年6月,平均随访10．8年。结果15131例随访对象共发生心血管事件448例,其中冠心病事件82例,脑卒中事件370例,4例既发生冠心病事件又发生脑卒中事件。在控制了年龄、吸烟、饮酒后,男性和女性父母双方均无高血压史者、仅父母一方有高血压史者、父母双方均有高血压史者发生心血管病的相对危险分别为：男性：1．00,1．34（1．01—1．78）,2．58（1．62—4．11）;女性：1．00,1．77（1．27—2．45）,2．55（1．44—4．54）。在进一步控制了总胆固醇、高密度脂蛋白胆固醇、空腹血糖、体重指数和收缩压后,男性和女性上述各组发生心血管病的相对危险分别为：男性：1．00,1．01（0．76—1．35）,1．72（1．07—2．75）;女性：1．00,1．31（0．94—1．84）,1．76（0．98—3．15）。结论父母有高血压史者具有较高的发生心血管病的危险性,父母双方均有高血压史者心血管病发病危险的增加尤为显著。遗传因素对子代的影响在很大程度上是通过我们目前已知的危险因素而起作用。因而父母有高血压史者强化对传统的危险因素的控制,对于预防心血管病发病、提高生活质量可能具有更重要的意义。     

男性脑梗死患者首次发作的危险因素分析

目的探讨与男性首次脑梗死发病关系最密切的危险因素。方法采用病例对照的研究方法对首次脑梗死发作的210例40～72岁男性患者的临床资料进行调查,应用Logistic回归模型进行数据分析。结果单因素分析显示首次脑梗死发病与脑卒中家族史、高血压病史、糖尿病、冠心病、血糖、总胆固醇以及hsCRP水平有关。进一步行Logistic回归多因素分析,结果显示仅有脑卒中家族史（OR=4．604,95％CI1．796—11．802）、高血压病史（OR=3．392,95％CI1．271—9.048）、总胆固醇（OR=1．412,95％CI1．055—1．889）以及hs-CRP值（OR=1．057,95％CI1．017—1．098）与男性首次脑梗死发病显著相关（P均〈0．05）。结论高血压病史、脑卒中家族史、高胆固醇血症及高hs—CRP水平是男性首次脑梗死发病的最重要的原因。     

不同职业人群与心血管发病危险因素的关系

目的探讨不同职业人群与心血管发病危险因素的关系。方法选择3370名不同职业人群进行健康检查，测定血压、心电图、胆固醇、甘油三酯的含量，应用职业紧张测试表OSI测量职业紧张评分，根据职业紧张评分将队列分为高、中、低职业紧张暴露组。结果职业紧张度高-教师组与职业紧张度中-有害作业高温工人心血管发病率明显高于职业紧张度低-营业人员，差异有显著性（P〈0．005），并且随年龄、工龄的增加，心血管发病率也增高。结论职业紧张是职业人群发生心血管疾病的危险因素之一；职业紧张引起心血管疾病是在长期慢性紧张刺激下发生发展的。     

不同性别脑梗死患者危险因素的比较

目的探讨不同性别脑梗死患者危险因素的差异。方法回顾性分析2006年全国33家三级甲等医院急性脑梗死住院患者1633例,年龄为18～94岁;男993例,女640例。设计统一调查病例表,内容包括：人口统计学资料（性别、年龄、居住地、文化程度及工作状态等）、既往史及危险因素等。结果①男女脑梗死住院患者的比例为1．55：1。女性发病年龄为（66±12）岁,高于男性的（65±12）岁,两者比较,P=0．049。②青年期（18～45岁）男性脑梗死的发生率显著高于女性,分别为74．39％和25．61％（P〈0．05）,其他年龄段亦均高于女性,但差异无统计学意义（P〉0．05）。③两组患者居住地均以市区居高,差异无统计学意义;在男性患者中,中学文化程度以上卒中的发生率居高,女性文化程度低的卒中发生率居高,差异有统计学意义（χ^2=137．8,P=0．000）。女性患者无业人员高于男性,男性国家企业及退休人员患者高于女性,差异有统计学意义（χ^2=124．2,P=0．000）。④男性患者的危险因素分别为：高血压（60．8％）、高龄（41．7％）、吸烟（21．1％）、糖尿病（20．1％）;女性患者的危险因素分别为：高血压（63．9％）、高龄（44．4％）、糖尿病（24．4％）、心脏病（24．2％）。女性脑梗死患者糖尿病、心脏病的发生率高于男性,男性脑梗死患者动脉粥样硬化、吸烟、饮酒的发生率高于女性,差异有统计学意义（P〈0．05）。⑤多元Logistic回归分析,吸烟和饮酒均可以增加肥胖的危险（分别为OR=3．059,95％CI：1．978～4．731;OR=2．330,95％CI：1．221～4．445）。结论①各年龄段男性脑梗死患者所占比例均高于女性。②高血压是所有脑梗死患者的首要危险因素。③吸烟、饮酒或多种危险因素共存,可能是男性脑梗死患者比例高的主要原因,尤其在青年男性中更加显著。④文化程度低及无业女性脑梗死发生率较高。     

济南地区铁路乘务员心血管疾病危险因素调查

对济南铁路局在职男性职工8600例进行凋查，其中乘务人员4400例（观察组）、非乘务人员4200例（对照组）。采用专门设计的问卷调查表，内容包括一般情况、家族史、知晓情况、吸烟指数等；体格检查包括身高、体质量、血压；生化指标检测包括血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）、载脂蛋白A-I（ApoA-I），载脂蛋白B（ApoB）和脂蛋白（a）[Lp（a）]，对空腹血糖偏高者行餐后2h血糖测定；对每个研究对象的冠心病危险因素进行计数。结果观察组高血压、高血糖、血脂紊乱患病率及吸烟指数显著高于对照组；观察组危险因素的数目也高于对照组。认为乘务人员的心血管疾病危险因素包括吸烟、高血压、高血糖、血脂紊乱，而且有年轻化趋势；其原因与不稳定的工作环境、较大的工作压力、作息时间紊乱及噪音影响有关。     

The effect of risk factors on development of myocardial infarction among professional drivers in Kaunas

We investigated effect of risk factors on elevated first myocardial infarction risk among professional drivers. We carried out case-control study among men aged 25-64 years in Kaunas in 1997-2000. We identified myocardial infarction cases (n=448) from the myocardial infarction hospital register (International Classification of Diseases, 10-th revision, code 121). Controls (n=1777) were selected on the basis of age, gender and city district of residence. We obtained information on sociodemographic, psychosocial and behavioral factors. We used the International Standard Classification of Occupations (ISCO) to code for occupations and conducted logistic regression analysis to evaluate association of risk factors with myocardial infarction in professional drivers. Compared with other occupations being a professional driver was associated with increased risk of first myocardial infarction with odds ratio (OR) adjusted for smoking, hypertension, presence of stress, obesity and educational status 1.42 and 95% confidence intervals (CI) 1.06-1.90. However additional adjustment for exposure to occupational vibration for 20 years or more eliminated effect of this occupation (OR 0.96, 95%CI 0.67-1.37). Among drivers exposure to occupational vibration for > or =20 years was most closely related to myocardial infarction (OR 3.01, 95% CI 1.54-5.89), while hypertension was associated with OR 2.80 (95% CI 1.58-4.96).     

Hypertension,a linchpin between environmental noise exposure and the development of cardiovascular disease?

Environmental noise exposure has been considered one of the most common hazards worldwide, especially in the workplace environment, and could produce a variety of health issues. Some epidemiological evidence supports the association between occupational noise exposition and a high risk for hypertension and cardiovascular diseases. Wang et al. has conducted an observational cross-sectional study using occupational data of 4746 workers, 32.4% were exposed to high occupational noise. These exposed individuals had a moderate increase in the risk for hypertension (adjusted odds ratio [OR], 1.30; 95% confidence interval [CI], 1.05–1.62). The subgroup analyses showed that the relationship between noise and hypertension prevalence was stronger in young participants (OR, 1.70; 95% CI, 1.21–2.40). Noise exposure activates the sympathetic and endocrine systems producing an increase in blood pressure and the changes in other biological risk factors. Moreover, a recently published study showed that oxidative stress and DNA damage were significantly higher in subjects exposed to noise. Emotional stress reactions and unconscious physiological stress could also be potential mechanisms for hypertension. Finally, physiological stress caused by noise exposure may also increase indulgence in unhealthy behaviors, such as smoking and alcohol consumption, and indirectly result in an increased risk of hypertension and cardiovascular diseases. Previously published studies showed relationships between environmental noise exposure (including road traffic, railway, and aircraft noises) and the development of hypertension and cardiovascular diseases. Thus, the study by Wang et al. emphasizes the importance of environmental control in the prevention of cardiovascular diseases, not only in the workplace but also outside it.     

Psychosocial Risk Factors for Hypertension: an Update of the Literature

A growing body of research demonstrates that psychosocial factors play an important role in the development of hypertension. Previous reviews have identified several key factors (i.e., occupational stress) that contribute to the onset of hypertension; however, they are now outdated. In this review, we provide an updated synthesis of the literature from 2010 to April 2014. We identified 21 articles for inclusion in the review, of which there were six categories of psychosocial stressors: occupational stress, personality, mental health, housing instability, social support/isolation, and sleep quality. Sixteen of the studies reported an association between the psychosocial stressor and blood pressure. While several findings were consistent with previous literature, new findings regarding mediating and moderating factors underlying the psychosocial-hypertension association help to untangle inconsistencies reported in the literature. Moreover, sleep quality is a novel additional factor that should undergo further exploration. Areas for future research based on these findings are discussed.     

Methacholine responsiveness, smoking, and atopy as risk factors for accelerated FEV1 decline in male working populations.

Longitudinal lung function data from four occupational health surveys was used to explore the relationship between nonspecific bronchial responsiveness (NSBR) and the rate of decline of FEV1 (RDFEV) and to address other factors that may predict or influence RDFEV. Of the 1,203 subjects with baseline methacholine and lung function data, follow-up data were available for 733 individuals (61%). The data-available and data-unavailable groups were well matched with respect to baseline lung function, atopy, and smoking status. Compared with the unavailable group, those available for follow-up were younger (42.5 versus 37.7 yr; p less than 0.0001) and slightly less responsive to methacholine (p less than 0.01). Somewhat unexpectedly, RDFEV was lower in the 30 asthmatic subjects than in the nonasthmatics. Among the nonasthmatic subgroup (96% of those available for follow-up), age, occupational group, and baseline FEV1 (% predicted) were independent predictive factors for RDFEV. When these factors were included in the model, RDFEV was found to be increased among current smokers compared with never-smokers or ex-smokers. In the final regression model, a relationship was found between methacholine sensitivity (calculated as a dose-response slope) and RDFEV in nonasthmatics (p less than 0.05). Stratification by smoking status revealed that the relationship between RDFEV and bronchial responsiveness was confined to current smokers and that atopy was an additional risk factor in this subgroup only. This relationship was valid among current smokers in each of the three occupational groups studies. However, reinclusion of the 30 asthmatic subjects in the study population obscured the relationship between NSBR and RDFEV.(ABSTRACT TRUNCATED AT 250 WORDS)     

职业压力与高血压的研究现状及其防治

职业压力被认为是现代社会中高血压常见的病因之一，二者的关系已经被广泛研究，但是目前职业人群中高血压的发病率未见下降。本综述介绍了职业压力对血压的影响、职业压力测量模型以及职业人群高血压的防治，为进一步减少职业人群高血压的发病率以及进行高血压的早期预防提供科学依据，提高公众和个人的生活水平，共同创建更健康的工作环境。     

Cardiovascular and renal manifestations of glutathione depletion induced by buthionine sulfoximine

Oxidative stress contributes to the development of several cardiovascular diseases, including diabetes, renal insufficiency, and arterial hypertension. Animal studies have evidenced the association between higher blood pressure (BP) and increased oxidative stress, and treatment with antioxidants has been shown to reduce BP, while BP reduction due to antihypertensive drugs is associated with reduced oxidative stress. In 2000, it was first reported that oxidative stress and arterial hypertension were produced in normal Sprague-Dawley rats by oral administration of buthionine sulfoximine (BSO), which induces glutathione (GSH) depletion, indicating that oxidative stress may induce hypertension. The contribution of several potential pathogenic factors has been evaluated in the BSO rat model, the prototype of oxidative stress-induced hypertension, including vascular reactivity, endothelium-derived factors, renin-angiotensin system activity, TXA(2)-PGH(2) production, sodium sensitivity, renal dopamine-induced natriuresis, and sympathetic tone. This review summarizes the main factors implicated in the pathogenesis of BSO-induced hypertension and the alterations associated with GSH depletion that are related to renal function or BP control.     

佛山市南海城乡地区缺血性脑卒中患者的相关影响因素研究

目的了解佛山市南海城乡地区缺血性脑卒中患者的主要影响因素,为降低本地区缺血性脑卒中患者发病率和病死率提供科学依据。方法采用1∶2配对的病例对照研究方法,随机抽取佛山市南海区第二人民医院70例缺血性脑卒中患者作为病例组,选取与病例组同性别、年龄的非脑血管病同期住院者作为对照组,采用多因素条件Lo-gistic回归模型进行因素筛选。结果文化程度(OR=0.216～0.029)、吸烟(OR=4.982)、肥胖(OR=7.310)、高血压(OR=9.011)、糖尿病(OR=8.891)、心脏病(OR=6.111)、体育锻炼(OR=0.196)、心理自感快乐(OR=0.282)是影响本地区缺血性脑卒中患者的主要影响因素,其中文化程度、体育锻炼、心理自感快乐是其保护因素。结论在脑卒中的社区防治中,应针对其主要影响因素进行综合干预,及时的控制高血压、糖尿病是其主要环节,同时保持健康乐观的生活态度和生活方式也是有效控制脑卒中发病的重要保护因素。     

Cardiac function in alcohol-associated systemic hypertension

The pathogenesis of alcohol cardiomyopathy is obscure. Because systemic hypertension is observed in one-third of alcoholics, the relation of this finding to left ventricular (LV) function was analyzed in 66 alcoholics (26 with a blood pressure of 160/95 mm Hg or higher) 4 to 5 days after alcohol withdrawal. Hypertensive alcoholics had a more abnormal ratio of preejection period/LV ejection time (PEP/ET) (0.398 +/- 0.01 vs 0.35 +/- 0.01, p less than 0.02) than normotensive alcoholics (matched normal 0.290 +/- 0.01). Hypertensive alcoholics (transitory hypertension) with blood pressures of 120/80 mm Hg or less at time of study also had more abnormal PEP/LVET than matched normotensive alcoholics (0.415 +/- 0.03 vs 0.331 +/- 0.01, p less than 0.05). In both hypertensive (77 +/- 6 dynes/cm2 X 10(3)) and normotensive alcoholics (67 +/- 4 dynes/cm2 X 10(3) LV stress was elevated (normal 46 +/- 3 dynes/cm2 X 10(3), both p less than 0.02). However, LV mass was not increased (hypertensive 96 +/- 4 g/m2; vs normotensive 100 +/- 4 g/m2; (normal 92 +/- 5 g/m2), resulting in a markedly increased stress to mass ratio (hypertensive 0.8 +/- 0.06; Normal 0.05 +/- 0.05, p less than 0.02). Hypertensive alcoholics also had LV "hyperfunction," with an increased stress/LV end-systolic volume ratio (1.7 +/- 0.1 vs 1.3 +/- 0.1 dynes/cm2 X 10(3)/ml, p less than 0.02). Thus, hypertensive alcoholics, even those with transitory hypertension, have more abnormal cardiac function than normotensive alcoholics. Presence of hypertension with hyperdynamic LV features may be a prelude to heart failure.