广西壮族孕妇血红蛋白水平变化及其对新生儿体重影响的分析

目的 探讨广西壮族孕妇血红蛋白（Hb）水平及其变化对新生儿体重的影响。方法 研究对象为2013年5月至2015年5月在平果县医院孕检并分娩的壮族孕妇。采用回顾性分析方法收集孕期保健和妊娠结局的资料。运用多元线性回归方法和非条件logistic回归方法进行分析。结果 壮族孕妇分娩的新生儿平均出生体重（3 135.92±435.84）g。经调整混杂因素后,孕早期Hb水平与新生儿体重呈正相关,Hb每增加1 g/dl,新生儿体重增加17.61（95%CI：0.60~34.67）g;孕晚期Hb水平与新生儿体重呈负相关,Hb每增加1 g/dl,新生儿体重减少19.61（95%CI：-37.53~-1.70）g。孕期Hb水平变化与新生儿体重呈负相关,孕期Hb每增加1 g/dl,新生儿体重减少32.63（95%CI：-48.93~-16.32）g。孕早期贫血组小于胎龄儿发生风险比非贫血组增加58%（OR=1.58,95%CI：1.08~2.32）;孕期Hb水平下降幅度的最高组比最低组小于胎龄儿发生风险增加87%（OR=1.87,95%CI：1.24~2.81）,并且随着孕期Hb水平下降幅度降低,小于胎龄儿发生风险逐渐升高。结论 广西壮族孕妇孕早期Hb水平与新生儿体重呈正相关,孕晚期及孕期Hb水平变化与新生儿体重呈负相关。孕早期贫血以及孕期Hb水平下降幅度过低是小于胎龄儿的危险因素。     

Interaction between smoking and body mass index and risk of oral clefts

PurposeTo examine maternal smoking and body mass index (BMI) interactions in contributing to risk of oral clefts.MethodsWe studied 4935 cases and 10,557 controls from six population-based studies and estimated a pooled logistic regression of individual-level data, controlling for study fixed effects and individual-level risk factors.ResultsWe found a significant negative smoking–BMI interaction, with cleft risk with smoking generally declining with higher BMI. For all clefts combined, the odds ratio for smoking was 1.61 (95% confidence interval [CI]: 1.39–1.86) at BMI 17 (underweight), 1.47 (95% CI: 1.34–1.62) at BMI 22 (normal weight), 1.35 (95% CI: 1.22–1.48) at BMI 27 (overweight), 1.21 (95% CI: 1.04–1.41) at BMI 33 (obese), and 1.13 (95% CI: 0.92–1.38) at BMI 37 (very obese). A negative interaction was also observed for isolated clefts and across cleft types but was more pronounced for cleft lip only and cleft palate only.ConclusionsOur findings suggest that the risk of oral clefts associated with maternal smoking is largest among underweight mothers, although the smoking–BMI interaction is strongest for cleft lip only and cleft palate only. BMI was not protective for the effects of smoking; a clinically relevant increase in smoking-related cleft risk was still present among heavier women.     

健康城市建设满意度多水平模型评价

目的了解居民对健康城市建设的满意度情况及其相关影响因素,探讨多水平模型在健康城市建设满意度评价中的适用性。方法采用按容积比例多阶段分层抽样方法,对在四川省泸州市抽取的53个乡镇/街道4 835户居民中的5 852名>18岁居民进行了城市建设满意度问卷调查,并采用多水平Logistic回归模型进行分析。结果泸州市居民对城市建设,环境卫生、空气质量、环境噪声、治安环境、交通状况和城市管理的满意率分别为86.1%、85.7%、70.2%、86.1%、90.1%、89.4%;多水平模型分析结果表明,满意度的评价在乡镇/街道水平上具有聚集性;进一步采用二水平Logistic方差成分模型分析结果显示,城市建设的满意度评价受居住地、家庭收支状况、年龄、文化程度、职业和睡眠质量6个因素的影响。结论泸州市居民对城市建设的总体满意度较好,但城市的噪声污染状况不容忽视;多水平模型在健康城市建设的满意度评价中较合理地揭示了健康城市建设满意度的影响因素。     

Prognostic Potential of B - type Natriuetic Peptide and Quality of Life in Patients with Chronic Heart Failure

Objectives To study whether change of BNP levels reflect the change of cardiac function and to investigate the short -term prognostic potential of BNP and QOL in patients with CHF.Methods 96 consecutive patients admittedwith CHF between September 2002 and January 2003 were studied, upon entry the study, BNP levels were measured,Patients administered the disease - specificquality of life questionnaire Minnesota living with heart failure questionnaire (LiHFe) within 1 day. BNP levels and administering LiHFe were repeated three months later.Results BNP levels were increased proportional to the severity of cardiac function. Physical domain and total score of LiHFe were significantly correlated to the severity of CHF ( p ＜ 0. 05 ). BNP levels were decreased in improving group ( p = 0.032). In deteriorating group BNP levels increased ( P = 0.043 ). Kaplan -meier analysis according to BNP level cutoff point 150 ng/l, the life curve of higher BNP level group was significantly lower than the lower group ( p = 0. 001 ).In univariate logistic regression, NYHA class, BNP,LVEF, LVEDD, heart size, total score of LiHFe, physical domain of LiHFe and the emotional domain of LiHFe were all significant prognostic factors of CHF (p ＜0.05 for all). While in multiple regression, only BNPlevel( p = 0. 036 ) and the emotional domain of LiHFe( p = 0. 025 ) were independent prognostic factors.Conclusions Change of BNP reflects the treatment efficacy of CHF. BNP and QOL are the two major short- time prognostic factors of the chronic heart failure patients.     

RESEARCH: Effects of Long‐Term Disease‐Modifying Antirheumatic Drugs on Endothelial Function in Patients with Early Rheumatoid Arthritis

Rheumatoid arthritis (RA) is associated with enhanced atherosclerosis and impaired endothelial function early after the onset of the disease and cardiovascular (CV) disease represents one of the leading causes of morbidity and mortality. It is well known that disease modifying antirheumatic drugs (DMARDs) are able to improve the course of the disease and the quality of life of these patients, but little is known about the effects of DMARDs on CV risk and endothelial dysfunction. Our goal was to examine the effects of long‐term therapy with DMARDs on endothelial function and disease activity in early RA (ERA). Twenty‐five ERA patients (mean age 52 ± 14.6 years, disease duration 6.24 ± 4.10 months) without evidence of CV involvement were evaluated for disease activity score (DAS‐28), 2D‐echo derived coronary flow reserve (CFR), common carotid intima‐media thickness (IMT) and plasma asymmetric dimethylarginine (ADMA) levels at baseline and after 18 months of treatment with DMARDs (10 patients with methotrexate and 10 with adalimumab). DMARDs significantly reduced DAS‐28 (6.0 ± 0.8 vs. 2.0 ± 0.7; P < 0.0001) and improved CFR (2.4 ± 0.2 vs. 2.7 ± 0.5; P < 0.01). Common carotid IMT and plasma ADMA levels did not show significant changes. The present study shows that DMARDs, beyond the well known antiphlogistic effects, are able to improve coronary microcirculation without a direct effect on IMT and ADMA, clinical markers of atherosclerosis. Treatment strategies in ERA patients with high inflammatory activity must be monitored to identify beneficial effects on preclinical markers of vascular function.