北京市1680名社区居民血清同型半胱氨酸与代谢综合征关系的横断面研究

目的 分析血清同型半胱氨酸(Hcy)与代谢综合征(MS)间的关系.方法 1680名北京市社区居民纳入调查.MS依据NCEP-ATP Ⅲ标准定义.以多因素logistic回归分析计算MS发病危险比值比(OR),多元线性回归分析Hcy与各指标间的相关关系.结果 校正性别、年龄后MS组Hcy水平高于非MS组(17.99 μmol/Lvs.17.18 μmol/L,P=0.007),随着MS组分由0个增加至4或5个,Hcy水平逐渐升高为16.71、16.94、17.62、18.20和17.82 μmol/L(线性趋势P=0.044).MS的5个组分中,表现为腹型肥胖、高血压和高甘油三酯血症者,其Hcy水平相应较高.多元logistic回归分析显示,Hcy最高四分位水平(Hcy Ⅳ)与MS发生相关.校正年龄、性别、肌酐、肾小球滤过率(eGFR)、低密度脂蛋白胆固醇(LDL-C)、尿酸、吸烟、饮酒、运动等因素后,与Hcy最低四分位水平(Hcy Ⅰ)相比,HcyⅣ的MS发生风险OR=1.379(1.005～1.892).排除性别及年龄因素,偏相关分析显示Hcy与体重指数(BMI)、腰围、血压、LDL-C、甘油三酯、尿酸、肌酐、eGFR呈正相关,与高密度脂蛋白胆固醇呈负相关.多元线性回归分析显示,年龄、男性、BMI、LDL-C、肌酐、尿酸与Hcy水平呈独立正相关.结论 高Hcy水平是MS发生的相关因素,Hcy与年龄、男性、BMI、LDL-C、肌酐、尿酸独立相关.     

老年人血清NT-proBNP与代谢综合征关系的研究

目的分析老年人血清N末端B型利钠肽前体(NT-proBNP)与代谢综合征(MS)之间的关系。方法选取2007～2009年解放军总医院在北京市石景山区进行的横断面研究数据库中的老年人(≥60岁)993例,比较MS不同组分间校正年龄、性别因素后NT-proBNP水平,多元线性回归分析NT-proBNP与各指标间的相关关系,以多因素logistic回归分析计算老年人NT-proBNP水平≥125 ng/L的独立危险因素。结果校正性别、年龄后,老年人MS组分中三酰甘油(TG)水平较高者血清NTproBNP水平反而较低(32.51 ng/L vs 38.73 ng/L,P=0.001)。多元线性回归分析显示,老年人NT-proBNP水平与女性、年龄、收缩压呈正相关,与舒张压、三酰甘油、总胆固醇、LDL-C、eGFR呈负相关。多元logistic回归分析显示,MS组分个数(OR=1.581,P=0.034)是老年人NT-ProBNP水平≥125 ng/L的独立危险因素。结论老年人NT-proBNP水平与MS无关;在MS组分中,老年人NT-proBNP水平与收缩压呈正相关,与舒张压、甘油三酯呈负相关。MS组分个数是老年人NT-ProBNP水平≥125 ng/L的独立危险因素。     

湖南地区≥30岁社区人群高同型半胱氨酸血症现状及影响因素分析

目的了解湖南地区≥30岁社区人群血浆同型半胱氨酸(Hcy)水平现状及相关影响因素,为湖南地区心脑血管疾病防治提供科学依据。方法采用分层整群随机抽样方法,于2013年6月—2014年5月对湖南地区≥30岁常住居民4 012人进行调查。内容包括人口学特征、体格检查和实验室检测等资料。通过χ2检验和多因素logistic回归分析,探讨高同型半胱氨酸血症(HHcy)现状及影响因素。结果调查人群总Hcy水平为(13.77±7.68)μmol/L,HHcy患病率为35.4%,其中男性为45.3%,女性为28.5%。HHcy组与非HHcy组人群性别、年龄、吸烟、饮酒、高血压患病率及尿酸、肌酐、甘油三酯(TG)、胆固醇(TC)含量差异有统计学意义(均P 0.01);Pearson积差相关分析结果显示,Hcy水平分别与年龄、肌酐、尿酸、TC、TG呈正相关(r=0.068、0.072、0.138、0.109、0.266,均P 0.01)。多因素logistic回归分析结果显示,男性(OR=1.307,95%CI=1.078～1.585)、吸烟(OR=1.294,95%CI=1.053～1.589)、高血压(OR=3.707,95%CI=3.195～4.302)、高胆固醇(OR=1.276,95%CI=1.175～1.386)、高甘油三酯(OR=3.993,95%CI=2.960～5.388)、高尿酸(OR=1.002,95%CI=1.001～1.003)、高肌酐血症(OR=1.004,95%CI=1.001～1.008)是HHcy的影响因素。结论 HHcy患病率男性高于女性,并随年龄增长而升高。男性、吸烟、高血压、高胆固醇、高甘油三酯、高尿酸、高肌酐血症是HHcy的影响因素。     

高血压患者血浆同型半胱氨酸与年龄、性别、尿酸及血脂的相关性分析

目的 对高血压患者的血浆同型半胱氨酸(Hcy)与年龄(Age)、性别(Sex)、血脂及血浆尿酸(UA)的相关性进行分析研究.方法 依托社区综合防治项目,采用生化酶法对2 350名高血压患者,其中男1 190人,女1 160人,进行血浆同型半胱氨酸、尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)检测,并采用多元回归方法进行相关性分析.结果 统计显示年龄、性别和尿酸对Hcy的影响差异有统计学意义,而TC、TG和LDL对Hcy无影响.年龄每增加1岁,log(Hcy)平均增加0.0055 μmol/L;和男性相比,女性log(Hcy)平均低0.324 μmol/L; UA每增加1μmol/L,log(Hcy)增加0.0005 μmol/L.结论 一定范围内,同型半胱氨酸与尿酸呈正相关,与TC、TG和LDL未发现明显相关.     

轻中度高血压人群中血清肌酐水平及其影响因素

目的 了解中国轻中度高血压人群血清肌酐(serum creatinine,Scr)水平及其影响因素.方法 从哈尔滨、沈阳、北京、西安、上海和南京6个地区入选480例年龄在18～75岁无慢性肾病史的轻中度原发性高血压患者,测定血清肌酐水平,451例患者纳入最终统计分析.结果 总人群平均血清肌酐水平约68 μmol/L,男性77.9μmol/L,女性61 μmol/L,男性高于女性(P＜0.001);在男性和女性人群中Scr均与血浆同型半胱氨酸(homocysteine,Hcy)和尿酸(uric acid,UA)水平呈正相关;其他相关因素具有性别差异,女性人群中血清肌酐水平与高密度脂蛋白(high-density lipoprotein cholesterol,HDL-C)呈负相关,而男性人群中,血清肌酐水平与年龄呈正相关.结论 轻中度高血压人群的血清肌酐水平男性高于女性,且与同型半胱氨酸和尿酸水平独立相关,血清肌酐水平的升高可能是性别、年龄、血浆同型半胱氨酸、尿酸和高密度脂蛋白等因素综合作用的结果.     

不同性别2型糖尿病患者血尿酸与BMI血压血脂的相关性研究

目的 了解不同性别2型糖尿病(T2DM)患者血尿酸(SUA)与体质量指数(BMI)、血压、血脂相关性。方法 选择T2DM 患者360例(男242 例, 女118 例),测定血压、身高、体质量、空腹血浆葡萄糖( FBG) 、三酰甘油(TG) 、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、SUA、肌酐(Cr)。先按男女性别分组,再按SUA水平分为高尿酸组(男性≥420 mol/L,女性≥360 mol/L)、尿酸正常组,比较组间数据差别。结果 不同性别的高尿酸组BMI、TG均显著高于尿酸正常组,估计肾小球滤过率(eGFR)显著低于尿酸正常组,女性高尿酸组⑴舒张压(DBP)显著高于尿酸正常组,不同性别的高尿酸组年龄、病程、SBP、TC、FBG、HDL-C、LDL-C与尿酸正常组相比差异无统计学意义。⑵不同性别的组中,SUA与BMI、TG均呈显著正相关,与 HDL-C、eGFR呈显著负相关,女性组中,SUV与DBP也呈显著正相关,不同性别组的SUA均与年龄、病程、FBG、 SBP、TC、LDL-C无明显相关性。结论 2型糖尿病患者血尿酸的控制与血脂及体质量的控制有关,对于女性患者还应重视舒张压的控制。     

西安市中小学教师血尿酸水平与代谢综合征及相关组分的分析

目的了解西安市中小学教师高尿酸血症(HUA)流行特征,分析不同尿酸(UA)水平与代谢综合征(MS)及各组分的相关性。方法采用横断面调查方法,于2017年1月—2019年1月收集西安市某三级甲等医院体检科接受健康检查的中小学教师3 515人的一般检查[身高、体重、体质指数(BMI)和血压]及实验室生化检查[UA、空腹血糖(FBG)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)]资料。根据男女高尿酸诊断标准分为高尿酸血症(HUA)组与尿酸正常(NUA)组,比较MS及其组分因HUA所致的分布差异;运用四分位数将男女UA水平进行划分,探讨不同性别的UA水平对MS及其各组分的影响。采用Pearson相关分析不同性别人群UA水平与各指标的相关性。多因素分析采用非条件logistic回归。结果 (1)调查对象中共检出HUA患者690人,粗患病率为19.63%,其中男性患病率为23.23%,女性患病率为7.38%,男性患病率高于女性患病率为(χ~2=98.290,P0.01);(2)HUA组年龄、BMI、收缩压(SBP)、舒张压(DBP)、TG、总胆固醇(TC)、LDL-C、FBG的水平均高于NUA组,HDL-C水平低于NUA组,差异均有统计学意义(均P0.05);UA水平与BMI、DBP、TG、TC、HDL-C、LDL-C值呈正相关,与HDL-C呈负相关(均P 0. 05),其中UA水平和BMI、TG的相关程度最高(r=0.327、0.240);(3)多元logistic回归分析显示,UA是男性肥胖(OR=2.87,95%CI:2.21～2.74)、高血压(OR=1.85,95%CI:1.39～2.46)、血糖异常(OR=5.74,95%CI:3. 64～9.05)、高TG血症(OR=2.66,95%CI:2.04～3.47)、MS(OR=2.58,95%CI:1.87～3.57)发生的独立危险因素;是女性肥胖(OR=6.73,95%CI:3.32～13.64)、血糖异常(OR=8.52,95%CI:0.85～85.38)、低高密度脂蛋白胆固醇血症(OR=2.67,95%CI:1.17～6.09)、MS(OR=5.05,95%CI:1.39～18.41)发生的独立危险因素。结论在西安中小学教师群体中HUA的患病率较高,MS及其组分患病率均随着UA水平的升高而升高,HUA是MS及各组分发生的独立危险因素,在该人群中应做好相关健康知识的宣教,提升健康理念及行为,减少HUA、MS及并发症的发生。     

ADCY3基因多态性与超重/肥胖的关联性研究

目的探讨腺苷酸环化酶3(adenylate cyclase 3,ADCY3)基因多态性与超重/肥胖的关系,并分析其对BMI和血脂水平的影响。方法采用整群随机抽样的方法抽取浙江省宁波市当地常住居民2279人。采用标签SNP方法筛选ADCY3基因的12个位点。采用连接酶检测反应技术进行基因分型检测。采用多重线性回归模型分析ADCY3基因多态性对BMI和血脂水平的影响,采用多因素logistic回归模型分析ADCY3基因多态性与超重/肥胖的关系。结果多重线性回归分析结果显示,在调整了年龄、性别和腰围后,发现rs4665273等9个位点多态性与BMI显著正相关;rs6751537等6个位点多态性与TC显著正相关;rs1127568等3个位点多态性与TG显著正相关;rs7608976等4个位点多态性与LDL-C显著正相关。多因素logistic回归分析共纳入849例超重/肥胖者,1331例正常者。在调整了年龄、性别等因素后,结果显示rs4665273等4个位点多态性与超重/肥胖相关。结论 ADCY3基因多态性影响BMI、TC、TG和LDL-C水平,可能与超重/肥胖发生风险有关。其中,rs4665273位点的TT基因型、rs7604576位点的AA基因型、rs2278485位点的GG基因型、rs10187348位点的CC基因型是超重/肥胖的危险因素。     

脑血管病发生风险与同型半胱氨酸的相关性研究

目的 探讨脑血管病发生风险与同型半胱氨酸的相关性.方法 选取经CT证实为脑血管病患者100例,其中脑出血50例(脑出血组),脑梗死50例(脑梗死组),同时选取80例健康体检者(对照组),测定所有入选者空腹血浆同型半胱氨酸(Hcy)水平;对诱发脑血管病的相关危险因素进行多元线性回归分析,观察脑血管病与Hcy的相关性.结果 脑出血组和脑梗死组血浆Hcy水平明显高于对照组[(19.87±5.23)、(19.64±4.98)μmol/L比(14.54±3.58)μmol/L,P＜0.05];脑出血组与脑梗死组血浆Hcy水平比较差异无统计学意义(P＞0.05);对脑血管病高危因素进行多元线性回归分析显示Hcy水平与脑出血、脑梗死存在独立相关性(P＜0.01).结论 脑血管病患者血浆Hcy水平较健康人群明显升高,且Hcy与脑血管病存在独立相关性,测定血浆Hcy水平对预测及诊断脑血管病有重要意义.     

北京部分地区人群心血管疾病危险因素与慢性肾脏病的相关性分析

目的 探讨一般人群中传统心血管疾病危险因素与慢性肾脏病的相关关系.方法 2007-2008年随机对北京部分地区5100名成年人进行估计肾小球滤过率(eGFR)水平及心血管疾病危险因素的横断面调查,4515名符合入选标准并对其资料进行分析.设计统一的心血管疾病危险因素调查表,进行心血管疾病传统危险因素现况调查,测量身高、体重、血压,检测TC、TG、LDL-C、HDL-C及肌酐(Scr)指标,用简化的MDRD公式估算GFR(eGFR),并以eGFR[ml·min~(-1)·(1.73 m~2)~(-1)]<60定义为慢性肾脏病(CKD).按eGFR≥90、60-89和<60将人群分为3组,采用单因素方差分析进行组间均值的比较,X~2检验进行组间率的比较,以有无CKD为因变量(eGFR≥60为0,eGFR<60为1),以所选择的研究因素为自变量,进行单因素及多因素logistic回归分析.结果随着eGFR水平下降,心血管疾病危险因素检出率增加;单因素分析显示,年龄、吸烟情况、高血压及糖尿病病史、BMI、SBP、LDL-C及TG是CKD的危险因素,女性是其保护性因素;多因素分析表明,增龄、吸烟、高血压、高TG是CKD的重要危险因素,OR值(95%CI)分别为1.80(1.28～2.52)、1.09(1.06～1.13)、2.50(1.75～3.57)、1.73(1.18～2.54),而女性是其保护性因素.结论 北京地区一般人群心血管疾病危险因素随eGFR水平下降检出率增高,年龄、血压、TG、吸烟是CKD的危险因素.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.