葡萄胎危险因素的多因素分析

目的探讨葡萄胎发病的可能危险因素.方法以1990年1月至2000年5月期间在上海市国际和平妇婴保健院住院的经病理诊断的全部葡萄胎患者97例及同期住院的正常产妇97名作为研究对象,进行病例对照研究,调查所得的可疑危险因素在STATA6.0软件包非条件logistic回归模型中进行多因素分析.结果除滋养细胞疾病既往史与肿瘤家族史外,受教育程度、初潮年龄、流产史、口服避孕药史、孕期感染史、孕期用药史、孕龄均进入模型.在考虑其他因素的情况下,怀孕前有流产史的研究对象患葡萄胎的危险性是没有流产史的研究对象的2.239倍(95%CI1.167～4.296,P=0.015);孕龄小于25岁的研究对象患葡萄胎的危险性是孕龄在25～30岁的研究对象的2.731倍(95%CI1.266～5.892,P=0.010).结论既往有流产史和怀孕年龄小于25岁是葡萄胎发病的可能危险因素.     

Multivariate analysis of cholesterol distribution for monitoring the risk of coronary heart disease

The screening of people for potential coronary heart disease and the monitoring of subjects considered at risk have been performed for some time by measuring total serum cholesterol and its constituent lipoproteins. However, these measurements vary substantially within subjects, making such assessments imprecise. It has been suggested that greater consistency can be achieved by analysing the joint distribution of the individual lipoproteins or of transformed variables derived from them. In this paper we present the results of a laboratory experiment to investigate these ideas with a view to improving current methods of monitoring patients at risk. Nested, random-effects, multivariate analysis of variance and the log-ratio analysis of compositions are used to include information on all three lipoproteins simultaneously, and ratios of generalized variances are used to assess and compare the different response variables. The multivariate approach is seen to be far superior to the usual methods. Recommendations are made for routine monitoring and the practical implications are discussed.     

2型糖尿病危险因素的多因素logistic回归分析

目的：探讨多种因素与2型糖尿病发生的关系。方法：对南京地区汉族106例2型糖尿病患者和102例正常对照者解偶联蛋白3（UCP3）,激素敏感脂酶（HSL）和蛋白酷氨酸磷酸化酶1B（PTP－1B）基因的微卫星标记多态性进行分析,并结合临床参数进行多因素非条件logistic回归分析,结果：单因素非条件logistic回归分析结果有显著意义的变量为年龄,收缩压,空腹胰岛素,胆固醇,甘油三酯,高密度脂蛋白,低密度脂蛋白,载脂蛋白B,脂蛋白（α）,UCP3等位基因1,3,6和7,HSL等位基因5和9。多因素非条件logistic回归分析发现,2型糖尿病的发病与UCP3等位基因6和7,收缩夺,载脂蛋白B,脂蛋白（α）呈正相关,与HSL等位基因5,高密度脂蛋白呈负相关,均具有统计学意义。结论：UCP3基因等位基因6和7,收缩压,载脂蛋白B,脂蛋白（α）在南京地区汉族人群2型糖尿病的发病中可能起一定的作用。而HSL基因等位基因5,高密度脂蛋白可能起一定的保护作用。     

北京和南京两地代谢综合征危险因素分析

目的分析北京和南京两地人群代谢综合征的危险因素。方法采用整群抽样对北京和南京的6123人进行流行病学调查,应用IDF（2005）定义。采用多因素Logistic回归分析可能存在的危险因素。结果男性和女性的年龄标化患病率分别为19．5％和33．6％。多因素条件Logis—tic回归结果,女性（OR=1．49;95％CI（1．40,1．59））、年龄增长（OR=1．23;95％CI（1．16,1．31））、低体力活动（OR=1．76;95％a（1．13,2．76））、糖尿病家族史（OR：1．33;95％CI（1．11,1．60））、高血压家族史（OR=1．46;95％CI（1．29,1．65））、年龄性别交互作用（OR=1．29;95％a（1．21,1．40））、居住在城市（OR=1．09;95％CI（1．02,1．18））均是代谢综合征的危险因素。居住在南京（OR=0．76;95％CI（0．71,0．81））是代谢综合征的保护因素。结论代谢综合征是多重危险因素共同作用的结果,其中女性、慢病家族史、低体力活动是其重要的危险因素。     

A new calculation of the carcinogenic risk of obstetric X-raying

The association between obstetric X-raying and childhood cancer was first identified by the Oxford Survey of Childhood Cancers in 1956. The present re-analysis exploits the case-control matching of the study while incorporating the effects of important risk determinants, notably year of birth, trimester of exposure and number of films exposed. The decline in risk over time is closely mirrored by the estimated decline in dose per film and, by constraining these two relationships to be parallel, time-invariant estimates of the extra risk per mGy are obtained. For example, it is now estimated that irradiating 10(6) foetuses with 1 mGy of X-rays would, in the absence of other causes of death, yield 175 extra cases of cancer and leukaemia in the first 15 years of life.     

Optimistic biases in public perceptions of the risk from radon.

Survey data were obtained from a random sample of 657 homeowners in New Jersey and also from 141 homeowners who had already monitored their homes for radon. People who had not tested tended to believe that they were less at risk than their neighbors, and they interpreted ambiguous predictors of home radon levels in ways that supported their beliefs of below-average risk. Residents who had already tested their homes were relatively accurate about the probability of health effects. In both groups less than half of those who knew that radon can cause lung cancer were willing to admit that it would be serious if they suffered health effects from this source. The optimistic biases of the public may hamper attempts to encourage home radon monitoring and to promote appropriate mitigation measures in homes with elevated radon concentrations.     

Multivariate risk assessment and risk score cards in hypertension

Cardiovascular disease represents the leading cause of morbidity and mortality in Western countries, and hypertension-related cardiovascular events affect about 37 million people per year, worldwide. In this perspective, hypertensive patients are at increased risk to experience cardiovascular events during life-long period, and treatment of high blood pressure represents one of the most effective strategies to reduce global cardiovascular risk. However, due to its multifactorial pathophysiology and its frequent association with other relevant risk factors and clinical conditions, treatment of hypertension requires an integrated approach, including life-style measures, antihypertensive drugs and other therapies. Yet, worldwide general practitioners continue to focus their attention on the management of a single risk factor, eg, blood pressure, rather than to global cardiovascular risk profile. In this view, modem strategies of cardiovascular prevention in hypertensive patients should move from a single risk factor based approach toward a more comprehensive risk evaluation in the individual patient. In other words, it is important to define the global cardiovascular risk to manage hypertensive patients at high-risk, rather than to focus on the high level of a single risk factor, for reducing cardiovascular morbidity and mortality in the general population, as well as in hypertensive population.     

Lung cancer attributable to indoor radon exposure in france: impact of the risk models and uncertainty analysis

OBJECTIVE: The inhalation of radon, a well-established human carcinogen, is the principal-and omnipresent-source of radioactivity exposure for the general population of most countries. Scientists have thus sought to assess the lung cancer risk associated with indoor radon. Our aim here is to assess this risk in France, using all available epidemiologic results and performing an uncertainty analysis. METHODS: We examined the exposure-response relations derived from cohorts of miners and from joint analyses of residential case-control studies and considered the interaction between radon and tobacco. The exposure data come from measurement campaigns conducted since the beginning of the 1980s by the Institute for Radiation Protection and Nuclear Safety and the Directorate-General of Health in France. We quantified the uncertainties associated with risk coefficients and exposures and calculated their impact on risk estimates. RESULTS: The estimated number of lung cancer deaths attributable to indoor radon exposure ranges from 543 [90% uncertainty interval (UI) , 75-1,097] to 3,108 (90% UI, 2,996-3,221) , depending on the model considered. This calculation suggests that from 2.2% (90% UI, 0.3-4.4) to 12.4% (90% UI, 11.9-12.8) of these deaths in France may be attributable to indoor radon. DISCUSSION: In this original work we used different exposure-response relations from several epidemiologic studies and found that regardless of the relation chosen, the number of lung cancer deaths attributable to indoor radon appears relatively stable. Smokers can reduce their risk not only by reducing their indoor radon concentration but also by giving up smoking.     

Validation of a geologically based radon risk map: are the indoor radon concentrations higher in high-risk areas?

Since geographically coded information is frequently used in studies of the relationships between environmental factors and illness at the population level and by authorities for promotion of mitigation, knowledge about the validity of proxy measures is essential. This study was an evaluation of a geologically based map describing the risk for high radon levels, which was used by the municipal authorities to determine the necessity of remedial actions. Annual mean radon gas concentrations for a random sample of one-family homes selected from high-risk areas (n = 252) were compared with those of a random sample of homes from normal and low-risk areas (n = 259). No difference in geometric mean radon concentration was found between the areas, 101 Bq m(-3) and 103 Bq m(-3), respectively. The proportion of homes in each area with radon gas concentrations above the current Swedish administrative limit value for mitigation (400 Bq m(-3)) was similar, approximately 10%. We conclude that the radon risk map was unsuitable for identifying areas of concern. The findings also indicate that geologically based and geographically coded information as a proxy for human exposures can be safely used for scientific and administrative purposes only following validation.     

经皮椎体强化术中骨水泥漏的多因素分析

目的探讨经皮椎体强化术中骨水泥漏的危险因素,为临床预防骨水泥漏的发生提供依据。方法回顾2010年1月—2014年6月我科收治的431例（667节段椎体）行椎体强化术患者的病史资料,以是否并发骨水泥漏将患者分为两组,记录患者的年龄、性别、体重指数（body mass index,BMI）、疾病种类、手术方式、手术节数、手术节段、骨水泥注入量及手术医师资历。将上述可能与并发骨水泥漏相关的因素先行单因素分析,筛选出有统计学差异的因素再行多因素Logistic回归,分析其与椎体强化骨水泥漏的关系。结果 431例（667节段椎体）患者中78例（109节段椎体）发骨水泥漏,发生率为16.34%（109/667）,椎体成形术漏的发生率为23.8%（81/260）,椎体后凸成形术为8.58%（28/298）。骨水泥漏相关因素单因素分析,采用卡方检验,结果显示骨水泥漏与不漏两组病例年龄、性别、体重指数、医师资历方面差异无统计学意义（P〉0.05）;疾病类型、手术方式、手术节段数、手术节段、骨水泥量差异方面有统计学意义（P〈0.05）;多因素Logistic回归分析显示,手术方式（OR=3.393,95%CI=1.416-8.138）、疾病类型（OR=1.621,95%CI=1.084-2.424）、手术节段数（OR=2.388,95%CI=1.043-5.465）、骨水泥量（OR=2.162,95%CI=1.024-4.565）是骨水泥漏的危险因素（OR〉1）。结论疾病类型、手术方式、手术节段数、骨水泥量对椎体强化术中骨水泥漏有重要影响。     

Evaluation of the carcinogenic risk of the phenoxyherbicide MCPA to an urodele amphibian

To evaluate the carcinogenic potential of the phenoxyherbicide 2-methyl-4-chlorophenoxy-acetic acid (MCPA) in the crested newt, Triturus cristatus carnifex, a long-term study has been carried out exposing the animals by the percutaneous route. Two hundred adult newts were divided into one control and three experimental groups of 20 females and 30 males each. The control group was kept in tap water and the experimental groups were kept for 4 days a week in an aqueous solution of Agroxone 3, a commercial formulation of MCPA, at concentrations equivalent to 100, 200, and 400 ppm of the active ingredient. Treatment was continued for 1 year, after which all the animals were kept under observation for approximately another year. Surviving female newts were killed 22-24 months after the beginning of experimentation, whereas the male newts were killed after 28 months, at the end of 18 weeks of exposure to the tumour promoter 12-O-tetradecanoylphorbol-13-acetate. Under experimental conditions, there was no carcinogenic activity of MCPA. Putative preneoplastic nodules of the liver and tumor-like lesions of the lower jaw were occasionally observed among the animals that survived more than 22 months after the beginning of experimentation. However, no significant differences in frequency between control and experimental groups were found.     

Residential radon and risk of lung cancer: a combined analysis of 7 North American case-control studies

BACKGROUND: Underground miners exposed to high levels of radon have an excess risk of lung cancer. Residential exposure to radon is at much lower levels, and the risk of lung cancer with residential exposure is less clear. We conducted a systematic analysis of pooled data from all North American residential radon studies. METHODS: The pooling project included original data from 7 North American case-control studies, all of which used long-term alpha-track detectors to assess residential radon concentrations. A total of 3662 cases and 4966 controls were retained for the analysis. We used conditional likelihood regression to estimate the excess risk of lung cancer. RESULTS: Odds ratios (ORs) for lung cancer increased with residential radon concentration. The estimated OR after exposure to radon at a concentration of 100 Bq/m3 in the exposure time window 5 to 30 years before the index date was 1.11 (95% confidence interval = 1.00-1.28). This estimate is compatible with the estimate of 1.12 (1.02-1.25) predicted by downward extrapolation of the miner data. There was no evidence of heterogeneity of radon effects across studies. There was no apparent heterogeneity in the association by sex, educational level, type of respondent (proxy or self), or cigarette smoking, although there was some evidence of a decreasing radon-associated lung cancer risk with age. Analyses restricted to subsets of the data with presumed more accurate radon dosimetry resulted in increased estimates of risk. CONCLUSIONS: These results provide direct evidence of an association between residential radon and lung cancer risk, a finding predicted using miner data and consistent with results from animal and in vitro studies.     

Residential radon and risk of lung cancer in Eastern Germany

BACKGROUND: There is suggestive evidence that residential radon increases lung cancer risk. To elucidate this association further, we conducted a case-control study in Thuringia and Saxony in Eastern Germany during 1990-1997. METHODS: Histologically confirmed lung cancer patients from hospitals and a random sample of population controls matched on age, sex and geographical area were personally interviewed with respect to residential history, smoking, and other risk factors. One-year radon measurements were performed in houses occupied during the 5-35 years prior to the interview. The final analysis included a total of 1,192 cases and 1,640 controls. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by logistic regression. RESULTS: Measurements covered on average 72% of the exposure time window, with mean radon concentrations of 76 Bq/m3 among the cases and 74 Bq/m3 among the controls. The smoking- and asbestos-adjusted ORs for categories of radon (50-80, 80-140 and >140 Bq/m*3, compared with 0-50 Bq/m3) were 0.95 (CI = 0.77 to 1.18), 1.13 (CI = 0.86 to1.50) and 1.30 (CI = 0.88 to 1.93). The excess relative risk per 100 Bq/m? was 0.08 (CI = -0.03 to 0.20) for all subjects and 0.09 (CI = -0.06 to 0.27) for subjects with complete measurements for all 30 years. CONCLUSIONS: Our data indicate a small increase in lung cancer risk as a result of residential radon that is consistent with the findings of previous indoor radon and miner studies.     

The estimation of the carcinogenic risk in relation to anthropogenic pollution of the atmosphere

The paper assesses an additional risk of aerogenic exposure in the establishment of a poor epidemiological situation in the context of cancer morbidity, which accounts for 2 cases per 1000 individuals in the most polluted area. The analysis made it possible to reveal the areas showing an increased additional cancer risk by individual nosological entities and to determine the directions of hygienic and epidemiological studies.     

Multivariate segregation analysis using the mixed model

Most major genes involved in the etiology of complex diseases are likely to have pleiotropic effects on a number of intervening quantitative traits. Methods of segregation analysis that incorporate the additional information from such multiple traits will exhibit greater power for detecting the effects of major genes and allow explicit tests of major locus pleiotropy hypotheses. In this study, we present a new method for multivariate segregation analysis that utilizes a multivariate generalization of Hasstedt's [1982] technique for calculating approximate mixed model likelihoods on pedigrees. The method is based on a simplification of the multivariate conditional likelihood via a transformation that simultaneously orthogonalizes the residual additive genetic and environmental covariance matrices. This transformation allows the multivariate conditional likelihood to be factored into the product of independent univariate conditional likelihoods. Resulting computations are relatively fast, making it feasible to analyze multiple traits in extended pedigrees. We demonstrate our method with a bivariate analysis of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein AI (apo AI) serum levels in 585 pedigreed baboons.     

HBV不同基因型致癌风险差异的系统综述和Meta分析

目的  探究不同基因型的HBV引发肝细胞癌(简称“肝癌”)风险差异及其潜在机制。 方法  通过检索数据库PubMed、Web of Science、Embase、中国知网(China national knowledge infrastructure, CNKI)及万方数据获取相关数据,利用Meta分析的方法进行数据整合。从National Center for Biotechnology Information(NCBI)Genbank数据库获取HBV的DNA序列,并分析不同基因型的HBV危险突变发生频率。 结果  共检出相关文献1 066篇,经筛检纳入符合要求文献17篇。总调查人数为16 288例,其中肝癌患者3 613例。Meta分析结果显示,感染HBV C基因型患者罹患肝癌风险较A、B及D基因型高,而感染A、B及D基因型的患者发生肝癌风险差异无统计学意义(均有P＞0.05)。HBV DNA突变频率分析结果显示,C基因型中危险突变发生频率高于其他基因型。 结论  HBV C基因型与其他主要基因型相比,发生肝癌的风险更高,这可能归因于C基因型发生危险突变的频率更高。