增龄与肾功能不全对老年人营养状况的影响

目的评价不同肾功能水平老年患者的营养状态及其影响因素。方法回顾性分析2016年9月至2017年2月在南京医科大学第一附属医院老年肾科住院的患者189例。依据微型营养评估简表(MNA-SF)评分结果分为3组:营养正常组(12~14分)、营养不良危险组(8~11分)和营养不良组(0~7分)。比较各组临床资料。采用SPSS 20.0软件进行数据分析。根据数据类型分别采用t检验或X~2检验比较组间差异。营养不良发生的危险因素采用logistic回归分析。结果 189例患者中,营养不良组10例,占5.3%;营养不良风险组58例,占30.7%;营养正常组121例,占64.0%。与营养正常组相比,营养不良风险组和营养不良组患者的体质量指数(BMI)、白蛋白(ALB)、红细胞计数、血红蛋白(Hb)和淋巴细胞计数百分比均显著降低(P0.05),而营养不良组患者的中性细胞计数百分比显著增加(P0.05)。不同营养状况患者的年龄分布、肾功能及贫血状况差异均有统计学意义(P0.05)。多因素回归分析表明,高龄(OR=1.06,95%CI 1.00~1.12)、低估算肾小球滤过率(OR=0.97,95%CI 0.94~1.00)、低BMI(OR=0.76,95%CI0.65~0.87)、低ALB(OR=0.93,95%CI 0.86~0.99)和贫血(OR=2.46,95%CI 1.60~3.32)是患者发生营养不良及营养不良风险的危险因素。结论增龄与肾功能不全可能增加营养不良风险及营养不良的发生率,且营养不良也与患者的BMI、ALB水平及贫血严重程度相关。     

中老年糖尿病高危人群血脂异常现状调查

目的探讨广州市中老年糖尿病高危人群血脂异常的分布情况及其危险因素。方法选取广州市5个社区年龄≥45岁且无糖尿病史居民619名,采用芬兰糖尿病风险积分(FINDRSC)表筛查糖尿病高危人群,FINDRSC≥9分者即为糖尿病高危人群并纳入研究。结果共208例糖尿病高危人群纳入研究。血脂异常患病率75.0%。单纯型血脂异常者占22.6%,混合型血脂异常者占52.4%。Logistic回归分析显示,WC(OR=1.063,95%CI:1.018~1.111)、臀围(OR=1.077,95%CI:1.022~1.134)、BMI(OR=1.154,95%CI:1.035~1.286)、FPG(OR=2.050,95%CI:1.316~3.195)、2hPG(OR=1.115,95%CI:1.012~1.228)、高血压(OR=2.220,95%CI:1.093~4.513)和FINDRSC(OR=1.320,95%CI:1.093~1.594)进入回归方程。结论广州市糖尿病高危人群血脂异常患病率较高,肥胖、高血压、高血糖和FINDRSC是血脂异常的危险因素。     

老年创伤骨折患者伤情特点及血栓形成的危险因素

目的探讨老年创伤骨折患者伤情特点及深静脉血栓(DVT)形成的危险因素。方法选取2012年1月至2016年6月海南西部中心医院收治的老年创伤骨折患者1046例,根据术后1周内是否发生DVT分为两组:DVT组(n=132)和非DVT组(n=914)。采用SPSS 17.0软件进行数据分析。根据数据类型分别采用t检验或x~2检验进行组间比较。采用单因素及多因素logistic回归分析创伤骨折患者发生DVT的相关危险因素。应用ROC曲线评估术前D-二聚体、纤维蛋白原(FIB)和C-反应蛋白(CRP)水平预测DVT发生的价值。结果 1046例老年创伤骨折患者,跌倒伤是首位致伤原因,占20.9%(219/1046),DVT的总发生率为12.6%(132/1046),临床表现以患肢肿胀、浅静脉曲张、疼痛和压痛为主。单因素筛选出有统计学意义的因素进行多因素logistic回归分析显示,年龄≥70岁(OR=2.725,95%CI 1.842~4.027)、高血压(OR=1.584,95%CI 1.163-2.158)、坠落伤(OR=3.142,95%CI2.106~4.685)、髋骨骨折(OR=2.847,95%CI 1.875~4.326)、粉碎性骨折(OR=2.054,95%CI 1.463~2.884)、≥3处骨折(OR=2.162,95%CI 1.572~2.976)、骨折后休克(OR=3.063,95%CI2.074~4.527)、手术时间≥2 h(OR=2.151,95%CI0 1.518~3.046)、D-二聚体≥3.5 mg/L(OR=2.396,95%CI1.668~3.442)、FIB≥6.0 g/L(OR=1.638,95%CI 1.274~2.106)及CRP≥26.0 mg/L(OR=1.084,95%CI 1.012~1.468)是老年创伤骨折患者发生DVT的独立危险因素。D-二聚体[曲线下面积(AUC)=0.736,95%CI0.672~0.806]的最佳阈值为3.25 mg/L时,灵敏度和特异度分别为87.2%和58.3%;FIB(AUC=0.682,95%CI 0.617~0.754)的最佳阈值为5.84 g/L时,灵敏度和特异度分别为78.5%和62.5%;CRP(AUC=0.705,95%CI 0.635~0.783)的最佳阈值为26.73 mg/L时,灵敏度和特异度分别为81.3%和55.2%。结论老年创伤骨折患者DVT发生率较高,影响DVT发生的危险因素较多,应针对高危人群采取预防措施以减少DVT的发生。     

代谢相关性脂肪性肝病患者发生明显肝纤维化的危险因素研究

目的分析经肝活检确诊的代谢相关性脂肪性肝病(metabolic associated fatty liver disease, MAFLD)患者发生明显肝纤维化的危险因素。方法回顾性分析193例经肝活检确诊的MAFLD患者发生明显肝纤维化的危险因素。结果与MAFLD伴无/轻微肝纤维化(F0~1)患者比较,MAFLD伴明显肝纤维化(F2~4)患者中女性比例更高、年龄更大、肥胖更多见、伴高血压病者更多(P均<0.05);与MAFLD伴无/轻微肝纤维化(F0~1)患者比较,MAFLD伴明显肝纤维化(F2~4)患者外周血中血红蛋白水平及血小板计数更低(P<0.05),血清中白蛋白及尿酸水平更低(P<0.05),而TBA及空腹血糖水平更高(P<0.05)。单因素回归分析发现,女性(OR=2.277, 95%CI:1.181~4.390)、高血压病(OR=3.305, 95%CI:1.606~6.801)、BMI(OR=1.083, 95%CI:1.006~1.167)、年龄(OR=1.030,95%CI:1.006~1.055)、血红蛋白(OR=0.978,95%CI:0.958~0.997)及血小板计数(OR=0.998,95%CI:0.989~1.000)是MAFLD患者发生明显肝纤维化的危险因素,而多因素回归分析发现,高血压病(OR=2.662,95%CI:1.092~6.489)、BMI(OR=1.163,95%CI:1.062~1.275)及血小板计数(OR=0.993,95%CI:0.987~0.999)是MAFLD患者发生明显肝纤维化的独立危险因素。结论高血压、BMI及血小板计数是肝活检确诊的MAFLD患者发生明显肝纤维化的独立危险因素。     

克罗恩病术后腹腔感染性并发症的危险因素分析

背景:克罗恩病(CD)术后腹腔感染性并发症(IASCs)的处理棘手,其预防对于术后CD患者尤为重要。目前国内尚缺乏分析CD术后并发IASCs危险因素的大样本研究。目的:分析CD术后并发IASCs的危险因素,为制订相应预防措施提供参考。方法:回顾性收集1999年-2014年在南京军区南京总医院因CD并发症接受手术治疗者的临床资料。将入选患者分为IASCs组和非IASCs组,选择30个相关影响因素变量,采用单因素和多因素(Logistic回归)方法分析术后并发IASCs的危险因素。结果:716例次手术纳入分析,IASCs发生率为5.7%(41例)。单因素和多因素分析显示,肠切除一期吻合术(OR=1.656,95%CI:1.261~3.279)、术前白蛋白30 g/L(OR=1.457,95%CI:1.152~2.368)、术前CRP10 mg/L(OR=8.641,95%CI:3.376~16.364)、术前激素≥3个月(OR=3.785,95%CI:1.237~4.671)和术中合并腹腔脓肿/感染(OR=1.784,95%CI:1.155~3.826)是CD患者术后并发IASCs的独立危险因素,肠造口术(OR=0.125,95%CI:0.062~0.561)和术前肠内营养≥1个月(OR=0.147,95%CI:0.078~0.781)则为独立保护因素。结论:营养不良、疾病处于活动期和术前使用激素时间过长是CD术后并发IASCs的危险因素,合并上述危险因素者应尽量避免手术;如必须手术,则应选择肠造口术,避免肠切除一期吻合术;术前合理使用肠内营养有望减少术后IASCs的发生。     

阻塞性睡眠呼吸暂停低通气综合征并原发性高血压患者心血管事件危险因素分析

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)并原发性高血压(EH)发生心血管事件的危险因素。方法:收集213例阻塞性睡眠呼吸暂停低通气综合征并原发性高血压患者的临床资料,根据是否发生不良心血管事件将患者分为病例组(n=57)和对照组(n=156),对两组患者的临床资料进行单因素分析,多因素logistic回归分析OSAHS并EH发生不良心血管事件的危险因素。结果:57例(26.76%)患者发生不良心血管事件,病例组与对照组在性别、年龄、体质量指数(BMI)、家族遗传病史、饮酒史、血压分级、呼吸暂停低通气指数(AHI)、空腹血糖、总胆固醇等方面的差异有统计学意义(P均<0.05),logistic多因素回归分析显示,BMI(OR=1.898,95%CI:1.157~13.142,P=0.015)、年龄(OR=4.633,95%CI:0.563~15.236,P=0.042)、AHI(OR=9.789,95%CI:1.795~40.606,P=0.005)、空腹血糖(OR=5.082,95%CI:0.654~10.632,P=0.043)、总胆固醇(P=0.041,95%CI:1.114~87.431OR=10.892)是OSAHS并EH心血管事件发生的独立高危因素。结论:年龄、BMI、AHI、空腹血糖、总胆固醇是OSAHS并EH患者发生心血管事件的独立危险因素,建议对其进行有针对性的干预,以有效降低不良心血管事件的发生率。     

急性ST段抬高型心肌梗死并发心源性休克的危险因素分析

目的探讨急性ST段抬高型心肌梗死(STEMI)患者并发心源性休克的危险因素。方法对952例急性STEMI患者资料进行回顾性分析,根据是否并发心源性休克分成两组,应用单变量及多变量log is tic回归分析STEMI患者并发心源性休克的危险因素。结果 952例急性STEMI患者中并发心源性休克42例(4.41%)。休克组住院死亡率高于非休克组(50.00%vs 5.27%,P<0.05)。多因素logistic回归分析显示糖尿病病史(OR=3.466,95%CI 1.678~7.158)、脑梗死病史(OR=5.937,95%CI:1.941~18.160)、二度/三度房室传导阻滞(OR=8.112,95%CI 2.762~23.825)、持续性室性心动过速/心室颤动(OR=14.737,95%CI 4.897~44.348)、肌酐水平(OR=1.940,95%CI 1.078~3.493)、左心室射血分数(OR=2.981,95%CI 1.321~6.725)、前降支严重病变(OR=2.721,95%CI 1.026~7.211)、2个/3个部位心肌梗死(OR=6.863,95%CI 2.683~17.557)是STEMI并发心源性休克的独立危险因素(均P<0.05)。结论糖尿病病史、脑梗死病史、房室传导阻滞、室性心动过速/心室颤动、肌酐水平、左心室射血分数、心肌梗死面积、前降支病变程度与STEMI并发心源性休克有关。     

肝移植术后新发非酒精性脂肪肝的危险因素

目的探究肝移植术后新发非酒精性脂肪肝(non-alcoholic fatty liver disease NAFLD)的危险因素。方法收集2015年5月至2019年5月于解放军总医院第五医学中心136例行肝移植患者的临床资料。比较移植术后新发NAFLD患者与无NAFLD患者的临床资料。应用logistic回归分析移植术后新发NAFLD的危险因素。结果肝移植术后1年时新发NAFLD的发病率为11.03%(15/136)。新发NAFLD患者与无NAFLD患者比较,术前BMI(27.85比23.17,P=0.003)、酒精性肝硬化(66.7%比23.1%,P=0.001)、术前高血压病史(33.3%比5.4%,P=0.016),肝移植术后1年时的ALT水平(24.0 U/L比21.5 U/L,P=0.012)差异有统计学意义。Logistic回归分析结果显示,术前酒精性肝硬化(OR=4.79,95%CI:1.35~16.98)、术前高BMI(OR=1.23,95%CI:1.05~1.46)是术后新发NAFLD的危险因素。结论肝移植术前酒精性肝硬化和高BMI是术后新发NAFLD的危险因素。     

青海地区住院高血压患者中H型高血压的发生率及危险因素

目的分析青海地区住院高血压患者中H型高血压的发生率及相关危险因素。方法选择2014年2月至2016年12月在青海省心脑血管病专科医院高血压科住院治疗的高血压患者2058例为研究对象,分析H型高血压的发生率及相关危险因素。结果住院高血压患者中,78%(95%CI70%~86%)为H型高血压,平均血浆同型半胱氨酸(Hcy)水平为(16.0±7.7)μmol/L,多因素分析提示,男性(OR=3.406,95%CI 1.530~7.581)、藏族(OR=5.788,95%CI2.298~14.581)、高海拔居住(OR=2.907,95%CI 1.214~6.958)、吸烟(OR=4.785,95%CI2.143~10.685)为H型高血压的独立危险因素,足量蔬菜摄入(OR=0.413,95%CI 0.183~0.931)为其保护因素。结论青海地区住院高血压患者中H型高血压的发生率较高,主要危险因素为男性、藏族、高海拔居住史及吸烟。     

胰十二指肠切除术后并发胃排空延迟的危险因素分析

目的 探讨PD后发生胃排空延迟(DGE)的危险因素。方法 回顾性分析2017年1月至2017年11月间海军军医大学附属长海医院收治的385例行PD患者的临床资料,其中男性235例,女性150例。根据国际胰腺外科学组对DGE的定义,将患者分为临床相关胃排空延迟组(CR-DGE组)和非临床相关胃排空延迟组(非CR-DGE组)。采用单因素分析及logistic多因素回归分析法分析PD患者术后发生CR-DGE的危险因素。结果 385例患者中78例(20.3%)术后发生DGE,其中CR-DGE组35例(9.1%)。多因素回归分析结果显示,患者的体重指数(BMI,OR=1.117,95%CI 1.006~1.240,P=0.038)、术前血清白蛋白(OR=0.902,95%CI 0.832~0.977,P=0.012)、主胰管直径≤3 mm(OR=2.397,95%CI 1.016~5.653,P=0.046)、胰腺质软(OR=2.834,95%CI 1.093~7.350,P=0.032)以及术后发生临床相关胰瘘(OR=4.498,95%CI 1.768~11.441,P=0.002)是PD术后并发CR-DGE的独立危险因素。结论 较高的BMI、较低的术前血清白蛋白、主胰管直径≤3 mm、胰腺质软、术后发生胰瘘是PD患者术后发生CR-DGE的危险因素,早期应予以临床干预。     

Anemia at the time of diagnosis of inflammatory bowel disease: Prevalence and associated factors in adolescent and adult patients

BackgroundThe prevalence, characteristic and determinants of anemia, at the time of inflammatory bowel disease (IBD) diagnosis have yet to be fully elucidated.MethodsRetrospective cross-sectional study. Analytical data and disease characteristics obtained upon diagnosis of 1278 IBD patients [Crohn’s disease/ulcerative colitis (CD/UC): 718/560] were collected.ResultsAnemia was present in 41.2% of patients at diagnosis (47% and 33.8% of CD and UC patients, respectively; p < 0.001), being severe in 5.5%. Iron deficiency anemia represented 69.6% of cases, with no differences between CD and UC. Female sex was the strongest risk factor for anemia in both CD and UC (OR 7.11; 95%CI 4.18–12.10 and 6.55; 95%CI 3.39–12.63, respectively), followed by elevated (≥2 mg/dL) C-reactive protein (OR 4.08; 95%CI 2.39–6.97 and 4.58; 95%CI 2.26–9.27, respectively). Current smoking was a risk factor for anemia in CD (OR 2.23; 95%CI 1.24–4.02), but a protective one in UC (OR 0.36; 95%CI 0.14–0.92). A penetrating CD behavior increased the risk of anemia (OR 3.34; 95%CI 1.36–8.21); in UC, anemia increased with disease extension (E2 + E3) (OR 1.80; 95%CI 1.13–2.86).ConclusionsFemale sex and disease activity are major determinants of anemia at IBD diagnosis. Anemia is associated with disease behavior in CD and with disease extension in UC.     

Anemia in human immunodeficiency virus-infected and uninfected women in Rwanda

To determine the prevalence and risk factors of anemia among human immunodeficiency virus (HIV)-infected women in Rwanda and the influence of highly active antiretroviral therapy (HAART) on anemia, we analyzed 200 HIV-positive women and 50 HIV-negative women in a cross-sectional study. Clinical examinations and iron and vitamin B(12) assays were performed, and complete blood counts, serum folic acid levels, and CD4 cell count determined. The prevalence of anemia was significantly higher among HIV-positive women (29%) than among HIV-negative women (8%) (P < 0.001). Risk factors for anemia were lower body mass index (odds ratio [OR] = 3.4, 95% confidence interval [CI] = 2.4-4.1), zidovudine use (OR = 1.14, 95% CI = 1.01-1.29), lack of HAART (OR = 1.44, 95% CI = 1.21-1.67), oral candidiasis (OR = 1.4, 95% CI = 1.2-1.6), pulmonary tuberculosis (OR = 1.8, 95% CI = 1.7-2.2), cryptococcal meningitis (OR = 1.6, 95% CI = 1.21-1.8), Pneumocystis jiroveci pneumonia (OR = 1.41, 95% CI = 1.20-1.65) and CD4 lymphocyte count < 200 cells/μL (OR = 2.41, 95% CI = 2.01-3.07). The mean ± SD hemoglobin level of 10.9 ± 1.6 g/dL at HAART initiation significantly increased to 12.3 ± 1.5 g/dL in 8 months (P < 0.001). Anemia increases with HIV stage, and HAART is associated with a significant improvement in hemoglobin levels.     

Seroprevalence of celiac disease among United Arab Emirates healthy adult nationals: A gender disparity

AIM: To determine celiac disease (CD) prevalence and associated manifestations or risk factors in healthy adult Emiratis.METHODS: It is a cross-sectional prospective study, recruiting 1197 (573 women and 624 men) healthy Emiratis between September 2007 and April 2008 among those who went to Al Ain Hospital to undertake the prenuptial examination. Test for anti-tissue transglutaminase (tTG) IgA antibodies was used for CD diagnosis. Subjects with positive results in the anti tTG antibodies assay were also tested for anti-endomysial (EMA) IgA antibodies. A structured interview was used to collect basic demographic and clinical recall data including: information on name, contact address, age, gender, education status, previous diagnosis of CD, diagnosis of CD in 1^st degree relatives and history of “chronic diarrhea, anemia, headache, hepatitis, diabetes, tumor, and thyroid disorder”.RESULTS: Fourteen blood samples (1.17%; 14/1197) were seropositive for CD. The latent CD seropositive patients were 13 women and 1 man and therefore the seroprevalence of CD was 1:86 (14/1197) for adult Emiratis: 1:44 (13/573) for women and 1:624 for men. Binary logistic regression revealed that history of chronic anemia (crude OR = 7.09; 95%CI: 2.32-21.61; P = 0.003) and being a woman (OR = 14.46; 95%CI: 1.89-110.91; P = 0.001) were associated with CD seropositivity. Whereas, the thyroid disorder showed a positive association with CD seropositivity that approach statistical significance (OR = 11.30; 95%CI: 1.32-96.95; P = 0.09) and therefore was included in the multiple logistic regression analysis, which showed that CD seropositivity is independently associated only with history of chronic anemia (OR = 4.58; 95%CI: 1.45-14.48; P = 0.01) and being a woman person (OR = 10.47; 95%CI: 1.33-82.14; P = 0.026).CONCLUSION: Compared to men the CD seroprevalence among women was remarkably higher. The CD association with women and chronic anemia is of importance from a public health perspective.     

Diagnostic delay in inflammatory bowel disease increases the risk of intestinal surgery

AIM To investigate the factors affecting diagnostic delay and outcomes of diagnostic delay in inflammatory bowel disease(IBD) METHODS We retrospectively studied 165 patients with Crohn's disease(CD) and 130 patients with ulcerative colitis(UC) who were diagnosed and had follow up durations 6 mo at Korea University Ansan Hospital from January 2000 to December 2015. A diagnostic delay was defined as the time interval between the first symptom onset and IBD diagnosis in which the 76~(th) to 100~(th) percentiles of patients were diagnosed.RESULTS The median diagnostic time interval was 6.2 and 2.4 mo in the patients with CD and UC, respectively. Among the initial symptoms, perianal discomfort before diagnosis(OR = 10.2, 95%CI: 1.93-54.3, P = 0.006) was associated with diagnostic delays in patients with CD; however, no clinical factor was associated with diagnostic delays in patients with UC. Diagnostic delays, stricturing type, and penetrating type were associated with increased intestinal surgery risks in CD(OR = 2.54, 95%CI: 1.06-6.09; OR = 4.44, 95%CI: 1.67-11.8; OR = 3.79, 95%CI: 1.14-12.6, respectively). In UC, a diagnostic delay was the only factor associated increased intestinal surgery risks(OR = 6.81, 95%CI: 1.12-41.4).CONCLUSION A diagnostic delay was associated with poor outcomes, such as increased intestinal surgery risks in patients with CD and UC.     

我国7省市城区40岁及以上居民支气管扩张症的患病情况及危险因素调查

 目的 了解我国7省市城区支气管扩张症的患病状况及危险因素。方法 本研究为横断面调查。采用多阶段整群随机抽样方法,在北京市、上海市、广东省、辽宁省、天津市、重庆市和陕西省各抽取一个城市街道作为调查点,对≥40岁的人群进行问卷调查和肺功能检测,询问既往是否被医生诊断过支气管扩张症、是否有呼吸症状及可能的危险因素等。结果 全国7省市城区共抽样≥40岁的居民14 337人,完成有效调查10 811人,调查应答率为75.4%。1.2%（135/10 811）的≥40岁居民曾诊断患有支气管扩张症,其中男性为1.5%（65/4382）,女性为1.1%（70/6429）,男女间差异无统计学意义（P=0.070）;支气管扩张症患病随年龄增加而增多;各地区间支气管患病情况差异无统计学意义（P=0.103）,经多因素logistic逐步回归分析校正混杂因素后,各地区间的支气管扩张症的患病情况差异有统计学意义（Wald值为22.116,P=0.001）;多因素logistic逐步回归分析还显示,年龄越大、有呼吸疾病家族史、有儿童时期呼吸道感染史、燃煤暴露、既往患慢性咽炎、肺结核、心脏病和肺癌与支气管扩张症相关;儿童时期感染≥2种呼吸道疾病的人群、家族中≥2人患呼吸疾病的人群患支气管扩张症的相对危险度增加。结论 我国城区≥40岁人群支气管扩张症患病多,其患病与年龄、有呼吸疾病家族史、有儿童时期呼吸道感染史、燃煤暴露、既往患慢性咽炎、肺结核、心脏病和肺癌等因素有关。     

Prevalence of irritable bowel syndrome in Korea: population-based survey using the Rome II criteria

BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder in the West. But information on the prevalence of IBS in Asia is still lacking, especially in Korea. Therefore, the aims of the present study were to estimate the prevalence of IBS in the general population of Korea and also to investigate characteristics of IBS and health-care-seeking behavior of IBS patients. METHODS: Telephone interview survey was conducted by Gallup, Korea using a validated questionnaire based on the Rome II criteria. The response rate of the telephone interview survey was 25.2% (n = 1066, 535 male and 531 female responders). A random sample of gender and age (between 18 and 60 years), based on a per capita ratio was obtained. RESULTS: Among 1066 subjects, the prevalence of IBS was 6.6% (70 subjects; 7.1%, male; 6.0%, female). The difference in IBS prevalence by gender was not significant. The prevalence was higher among those in their 20s (P = 0.036). Among 70 subjects with IBS, 10/20 IBS subjects sought health care due to abdominal pain. Among the risk factors of IBS, marital status had a significant difference; the following risk factors are arranged in descending order: age (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 0.85-2.25), alcohol intake (OR: 1.38, 95%CI: 0.81-2.35), gender (OR: 1.19, 95%CI: 0.73-1.94), demographics (OR: 1.09, 95%CI: 0.53-2.25), income (OR: 0.88, 95%CI: 0.54-1.45), education level (OR: 0.81, 95%CI: 0.46-1.40), smoking (OR: 0.64, 95%CI: 0.37-1.12), and marital status (OR: 0.59, 95%CI: 0.35-0.99). CONCLUSIONS: The prevalence of IBS in the Korean population is 6.6%, and the male:female ratio is similar. Also, IBS is more frequent in younger subjects. Irritable bowel syndrome subjects visited a physician mostly due to abdominal pain.     

老年住院患者急性肾损伤后肾科医师会诊率及早期会诊影响因素分析

目的了解非肾科病房老年人急性肾损伤(AKI)后的肾科医师会诊率,比较邀请肾科医师会诊和没有邀请会诊的2组老年AKI患者的临床特征,分析影响肾科医师早期会诊的因素。方法回顾性分析2007年1月1日至2015年12月31日就诊于解放军总医院老年病房住院患者的病历资料639例。根据有无邀请肾科医师会诊分为2组:会诊组(n=154)和未会诊组(n=485),其中会诊组又依据会诊时间的早晚分为2个亚组:早期会诊组(n=95)和延迟会诊组(n=59)。早期会诊定义为AKI发生后48 h内邀请会诊,晚期会诊定义为AKI发生48 h后邀请会诊。采用SPSS 17.0软件进行统计分析。采用多因素logistic分析影响会诊及会诊时间的相关因素。结果 639例患者,中位年龄87(84,91)岁。24.1%(154/639)的患者邀请了肾科医师会诊,中位会诊时间是AKI发生后2(1,4)d;其中61.7%(95/154)的患者为早期会诊,中位会诊时间是AKI发生后1(1,2)d。多因素logistic回归分析显示,邀请肾科医师会诊的患者伴有慢性阻塞性肺疾病(COPD)病史的比例较高(OR=1.685,95%CI 1.057~2.687,P=0.028)、AKI诊断时间早(OR=0.899,95%CI 0.821~0.985,P=0.022)、血肌酐(SCr)峰值水平(OR=1.005,95%CI 1.002~1.007,P0.001)和血尿素氮(BUN)水平(OR=1.020,95%CI 1.001~1.039,P=0.036)均较未邀请肾科医师会诊的患者高。肾科医师会诊有38.3%(59/154)是滞后的(48 h),中位会诊时间是AKI发生后4(3,8)d。多因素logistic回归分析显示,AKI诊断时间较晚(OR=1.214,95%CI 1.041~1.416,P=0.013)、尿量不减少(OR=0.115,95%CI 0.014~0.953,P=0.045)和尿酸水平不高(OR=0.997,95%CI 0.994~0.999,P=0.014)是影响肾科医师早期会诊的独立危险因素。结论 AKI诊断时间不仅影响肾科医师会诊,也是导致会诊不及时的原因,早期诊断AKI有助于肾科医师的早期会诊。     

Infliximab trough level combined with inflammatory biomarkers predict long-term endoscopic outcomes in Crohn’s disease under infliximab therapy

BACKGROUNDInfliximab trough level (ITL) severely affects therapeutic outcomes of Crohn’s disease (CD) patients under infliximab (IFX). Recently, frontier research has focused on identifying ITL based on different therapeutic targets. Although previous studies have elaborated clinical value of ITL monitoring on short-term outcomes in CD patients during therapy, studies contraposing the predictive value of ITL on long-term endoscopic outcomes in CD patients are still scarce domestically and overseas. AIMTo explore the predictive value of ITL in combination with inflammatory biomarkers on long-term endoscopic outcomes in CD with clinical remission during IFX maintenance therapy.METHODSCD patients with endoscopic remission under long-term IFX maintenance therapy in the First Affiliated Hospital of Zhejiang Chinese Medicine University from January 2012 to December 2020 were collected. ITL and inflammatory biomarkers were continuously monitored during the therapy. The Step I study was conducted from weeks 14 to 54 of IFX treatment. The Step II study was conducted from weeks 54 to 108 of IFX treatment. Endoscopic outcomes were defined as endoscopic activity (Crohn’s disease endoscopic index of severity score > 2 points or Rutgeerts score > i1) and endoscopic remission (Crohn’s disease endoscopic index of severity score ≤ 2 points or Rutgeerts ≤ i1). Endoscopic relapse free survival was defined as endoscopic remission at the beginning of the study stage and maintaining endoscopic remission during the study stage.RESULTSAt week 14, low ITL [odds ratio (OR) = 0.666, 95% confidence interval (CI): 0.514-0.862, P < 0.01] and high fecal calprotectin (FCP) level (OR = 1.002, 95%CI: 1.001-1.004, P < 0.01) increased the risk of endoscopic activity at week 54. At week 54, low ITL (OR = 0.466, 95%CI: 0.247-0.877, P < 0.01) and high C-reactive protein (CRP) level (OR = 1.590, 95%CI: 1.007-2.510, P < 0.01) increased the risk of endoscopic activity at week 108. At week 14, ITL ≤ 5.60 μg/mL [area under the curve (AUC) = 0.83, 95%CI: 0.73-0.90, P < 0.001] and FCP > 238 μg/g (AUC = 0.82, 95%CI: 0.72-0.89, P < 0.001) moderately predicted endoscopic activity at week 54. ITL ≤ 5.60 μg/mL in combination with FCP > 238 μg/g indicated 82.0% possibility of endoscopic activity. At week 54, ITL ≤ 2.10 μg/mL (AUC = 0.85, 95%CI: 0.72-0.93, P < 0.001) and CRP > 3.00 mg/L (AUC = 0.73, 95%CI: 0.60-0.84, P = 0.012) moderately predicted moderate endoscopic activity at week 108. ITL ≤ 2.10 μg/mL in combination with CRP > 3.00 mg/L indicated 100.0% possibility of endoscopic activity. From weeks 14 to 54 of IFX treatment, patients with ITL > 5.60 μg/mL had higher rate of endoscopic relapse free survival than those with ITL ≤ 5.60 μg/mL (95.83% vs 46.67%). From weeks 54 to 108 of IFX treatment, patients with ITL > 2.10 μg/mL had higher rate of endoscopic survival free relapsed rate than those with ITL ≤ 2.10 μg/mL (92.68% vs 30.77%).CONCLUSIONCombination of ITL, CRP, and FCP contribute to long-term endoscopic prognosis monitoring. During IFX maintenance treatment, low ITL, high CRP level, and high FCP level were independent risk factors of CD patients with clinical remission in adverse endoscopy outcomes within 1-year follow-up.     

Risk factors for tuberculosis infection among household contacts in Bangkok, Thailand

A cross-sectional study was conducted to determine the prevalence of tuberculosis infection and risk factors for tuberculosis infection among household contacts aged less than 15 years in Bangkok, Thailand, between August 2002 and September 2003. During the study period, 342 index cases with sputum smear positive pulmonary tuberculosis patients were recruited into the study and their 500 household contacts aged under 15 years were identified. The prevalence of tuberculosis infection among household contacts was found to be 47.80% (95%CI = 43.41-52.19). In multivariate analysis, a generalized estimating equation (GEE) was used to determine the risk factors for tuberculosis infection among household contacts. The results indicated that the risk of tuberculosis infection was significantly associated with close contact (adjusted OR = 3.31, 95%CI = 1.46-7.45), exposure to female index case (adjusted OR = 2.75, 95%CI = 1.25-6.08), exposure to mother with tuberculosis (adjusted OR = 3.82, 95%CI = 1.44-10.14), exposure to father with tuberculosis (adjusted OR = 2.55, 95%CI = 1.19-5.46), exposure to index case with cavitation on chest radiograph (adjusted OR = 4.43, 95%CI = 2.43-8.05), exposure to index case with 3+ sputum smear grade (adjusted OR = 3.85, 95%CI = 1.92-7.70), and living in crowded household (adjusted OR = 2.63, 95%CI = 1.18-5.85). The distribution of tuberculosis infection and risk factors among contact cases are significant for health care staff in strengthening and implementing tuberculosis control programs in Thailand.     

Comorbidities,repeated hospitalizations,and age ≥ 80 years as indicators of anemia development in the older population

Anemia represents a common condition among the elderly; however, its prevalence and causes are not well known. This retrospective analysis was performed on 981 patients aged ≥?60 in Poland over 2013–2014. The prevalence of anemia was 17.2% and increased with age. The predominant causes of anemia were the following: anemia of chronic disease (33.1%), unexplained anemia (28.4%), deficiency anemia (22.5%, including iron deficiency 13%), and chemo-/radiotherapy-induced anemia (8.9%). In the multivariate logistic regression model, factors increasing the risk of anemia were the following: age?≥?80 years (OR 2.29; 95%CI 1.19–4.42; P?=?0.013), the number of comorbidities (two diseases OR 2.85; 95%CI 1.12–7.30; P?=?0.029, three diseases OR 6.28; 95%CI 2.22–17.76; P?=?0.001, four diseases OR 4.64; 95%CI 1.27–17.01; P?=?0.021), and hospitalizations (OR 1.34; 95%CI 1.13–1.58; P?=?0.001). After a 2-year follow-up, the cumulative survival among patients without anemia in relation to the group with anemia was 90.76 vs. 78.08% (P?<?0.001). In the multivariate model, anemia (HR 3.33, 95%CI 1.43–7.74, P?=?0.005), heart failure (HR 2.94, 95%CI 1.33–6.50, P?=?0.008), and cancer (HR 3.31, 95%CI 1.47–7.49, P?<?0.004) were all significantly correlated with mortality. In patients ≥?60 years, the incidence of anemia increases with age, number of comorbidities, and frequency of hospitalizations and has an adverse impact on survival.