我国城市居民对多种癌症联合筛查的频率倾向及支付意愿

目的 了解我国城市居民对常见癌种（肺、胃、食管、肝、结直肠和乳腺癌）联合筛查的频率倾向及支付意愿。方法 2012-2014年基于城市癌症早诊早治项目的13个省份现场,面对面调查不同付费假设下,实际参加项目的居民倾向的筛查频率、对长期推行每3年1次联合筛查的支付意愿和支付额度等。结果 最终完成合格访谈31 029人,年龄（55.2±7.5）岁,近5年家庭人均年收入M值为2.5万元。对于多种癌症联合筛查服务,若完全免费,93.9%的居民选择每1~3年1次的频率;完全自费时对应的比例为67.3%。假设将每3年1次的联合筛查长期推行且需个人部分付费时,76.7%的居民愿意付费,但支付额度超过500元者（联合筛查人均费用约1 500元）仅占11.2%。其余23.3%无支付意愿者主要认为费用难以承受（71.7%）和认为没必要筛查（40.4%）。结论 我国城市参加过癌症筛查的居民对多种癌症联合筛查倾向"高频"模式,提示大范围推广的潜在接受程度较高,但需科学评价与正确引导。尽管多数居民对联合筛查有支付意愿但支付额度有限,提示应加强居民对自我健康的责任管理意识,建立筛查服务共付机制时应设置合理比例。     

Long-Term Body Mass Index Variability,Weight Change Slope,and Risk of Cardiovascular Outcomes: 7-Year Prospective Study in Chinese Hypertensive Subjects

BackgroundThe relationship between long-term body mass index (BMI) variability, weight change slope, and risk of cardiovascular outcomes in Chinese hypertensive patients has not been fully elucidated.MethodsA total of 20,737 patients with hypertension and three BMI measurements between 2006 and 2011 were included. Average real variability (ARV) was used to evaluate variability, and the subjects were divided into three groups: tertile 1 with BMI_ARV ≤0.86; tertile 2 with 0.86 < BMI_ARV ≤ 1.60; and tertile 3 with BMI_ARV >1.60. Cox proportional-hazards models were used to analyze the risk of cardiovascular and cerebrovascular diseases (CVD) in each group.ResultsThere were 1,352 cases of CVD during an average follow-up of 6.62 years. The 7-year cumulative incidence rates of CVD, stroke, and myocardial infarction (MI) in tertile 3 were 7.53, 6.13, and 1.56%, respectively. After adjustment for average BMI, weight change slope, and other traditional risk factors, the hazard ratio (HR) values for CVD, stroke, and MI in the highest tertile were 1.21 (95% CI 1.05–1.39), 1.21 (95% CI 1.04–1.38), and 1.20 (95% CI 0.88–1.62), respectively. Subgroup analysis showed that the HR values for CVD in tertile 3 were 1.71 (95% CI 1.06–2.75) and 0.98 (95% CI 0.61–1.58) in the positive and the negative weight change subjects, respectively.ConclusionsHigher BMI variability was associated with increased risk of CVD in hypertensive subjects with weight gain but not in those with weight loss, independent of traditional cardiovascular risk factors.     

Analysis of factors associated with the lumbar spine and proximal femur bone mineral density in coal miners: a cross-sectional survey

Background

Chinese coal miners are at high risk of occupational disease becausethey work underground during most of the daylight hours and are exposed to weight-bearing activity. But data concerning bone mineral density (BMD) and risk factors of BMD is lacking. We aim to identify the factors associated with low bone BMD in coal miners.

8d与10d序贯疗法根除幽门螺杆菌的疗效比较

目的:比较雷贝拉唑、阿莫西林、克拉霉素、奥硝唑组成的8d与10d序贯疗法根除幽门螺杆菌(H.pylori)的疗效.方法:将经胃镜检查确诊为慢性胃炎和消化性溃疡,且H.pylori阳性的217例患者随机分为2组,8d组(n=104)方案:前4d,雷贝拉唑+阿莫西林;后4d,雷贝拉唑+克拉霉素+奥硝唑.10d组(n=113)方案:前5d,雷贝拉唑+阿莫西林;后5d,雷贝拉唑+克拉霉素+奥硝唑.根除治疗后复查14C-尿素呼气试验,比较两组H.pylori根除率.结果:8d组和10d组H.pyloriITT根除率分别为89.3%和91.2%,PP根除率分别为92.0%和93.7%.两种分析方法比较两组的根除率差异均无统计学意义(P>0.05),但8d序贯疗法降低了成本-效果比,减轻了患者的经济负担.两种方案症状缓解率及不良反应发生率的差异无统计学意义(P>0.05).结论:8d序贯疗法可以获得较高的H.pylori根除率和症状缓解率,且经济、安全,是一种可供选择的一线治疗方案.     

血压对多态性纤维蛋白原Bβ链基因功能表达的影响

目的:研究血压对多态性血浆纤维蛋白原(Fg)Bβ链-854G/A、-455G/A、-249C/T、-148C/T、448G/A和Bc l-1G/A基因功能表达的影响。方法:选取开滦集团离退休职工1 391人进行体检和问卷调查,受检者清晨抽取静脉血标本测定血浆Fg浓度和纤维蛋白单体聚合反应速率(FMPV)、最大吸光度(Am ax)、FMPV/Am ax等反映Fg聚合功能的指标,然后立即测定血压;应用聚合酶链反应-限制性片段长度多态性技术(PCR-RFLP)检测Fg Bβ链6个多态性位点的基因型。结果:高血压状态组(HG)与正常血压组(NG)组间6个基因多态性位点等位基因及各基因型的频率分布均无显著差异(P0.05)。HG与NG的Fg浓度、FMPV/Am ax无显著差异(P0.05),但HG的FMPV、Am ax低于NG(P0.05),HG和NG的Bβ-854位点变异基因型组Fg浓度、FMPV、Am ax、FMPV/Am ax均高于野生型(P0.05),且NG的Bc l-1位点变异基因型的Fg浓度、FMPV高于野生型(P0.05),但HG的Bβ-854和Bc l-1变异基因型组的Fg、FMPV、Am ax均低于NG(P0.05)。结论:Fg Bβ-854基因位点是调控Fg功能表达的重要部位,Bc l-1的变异基因型可使血浆Fg浓度和FMPV升高;高血压状态可以明显抑制这种调控作用,并损伤纤维蛋白单体聚合成二聚体的过程,从而导致特殊类型的凝血功能障碍。     

荞麦花叶芦丁对2型糖尿病大鼠糖脂代谢及肝病理改变的影响

目的:观察荞麦花叶芦丁(RBFL)对糖尿病大鼠肝损害的保护作用并探讨其可能机制。方法:用高脂高热量饮食加小剂量链脲佐菌素(STZ)诱导大鼠2型糖尿病模型。设正常对照组、模型对照组、二甲双胍组(0.15g/kg)、荞麦花叶芦丁低剂量组(0.1g/kg)和荞麦花叶芦丁高剂量组(0.2g/kg),均灌胃给药,每天1次,连续6周。结果:与2型糖尿病模型组比较,RBFL高、低剂量组均可降低糖尿病大鼠的血糖值,RBFL可降低甘油三酯(TG)(P<0.05)和低密度脂蛋白胆固醇LDH-C(P<0.05),对血浆总胆固醇(TC)有降低趋势,RBFL可提高肝脏SOD活力(P<0.01),对血清SOD活力有提高的趋势。血清和肝脏MDA含量相对模型组均有显著性降低(P<0.01)。糖尿病组光镜下主要为肝细胞脂肪变性,大量胶原纤维形成。电镜下主要表现为包浆内含大量脂滴,线粒体空化,胶原纤维增生。RBFL治疗组肝组织病理改变明显好转。荞麦花叶芦丁的起效剂量为0.1g/kg,剂量范围为0.1g/kg到0.2g/kg。结论 :荞麦花叶芦丁对高脂饲料和STZ所致糖尿病大鼠肝脏损害具有一定的保护作用,其机制可能与降糖、降脂和抗氧化有关。     

不同TOAST分型的缺血性卒中急性期高血压的特点及其对预后的影响

目的 探讨不同病因缺血性卒中急性期未予降压干预的高血压变化特点及对预后的影响。方法 前瞻性的连续登记发病48小时内被诊断为缺血性卒中的患者,参照改良急性卒中治疗Org10172试验（Trial of Org10172 in Acute Stroke Treatment,TOAST）分型标准,将入选患者分为4组,动态监测入院14天内的血压变化,盲法随访发病后3个月的死亡、残疾情况,采用Spearman相关分析法分析影响各组患者发病后3个月死亡/残疾率的因素。结果 4组患者的平均收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）以及平均SBP、DBP随时间变化的趋势和平均血压下降幅度差异无显著性;4组患者入院4～14天内各相同时间段平均血压的最佳临界值无差异,且平均血压与发病3个月后死亡/残疾率的相关性差异无显著性;然而不同病因缺血性卒中患者发病后3个月死亡/残疾率的影响因素各不相同,24小时内SBP下降幅度与动脉粥样硬化血栓形成型、心源性栓塞型患者发病3个月的死亡/残疾率显著相关（P＝0.048,P＝0.045）。结论 不同病因缺血性卒中急性期血压变化规律并无明显差异。入院24小时内SBP降压过快可能增加动脉粥样硬化血栓形成型及心源性栓塞型患者3个月后的死亡/残疾率。