中国儿童肥胖的遗传易感性与成年期缺血性心脏病发病风险的研究

目的分析儿童肥胖的测量学指标BMI相关基因序列变异与发生缺血性心脏病(IHD)、急性冠心病事件(MCE)的关联。方法利用中国慢性病前瞻性研究中6.9万余名具有全基因组遗传数据的样本, 剔除基线时患有冠心病、脑卒中、恶性肿瘤的个体, 最终纳入64 454人。采用既往全基因组关联研究显著性遗传位点构建儿童BMI遗传风险评分, 并根据其五分位数进行分组, 最低五分位组为低遗传风险组, 最高五分位组为高遗传风险组。采用Cox比例风险回归模型计算儿童BMI的遗传风险评分与IHD、MCE发生风险的关联。结果研究对象平均随访10.7年, 期间新发IHD 7 073例, MCE 1 845例。调整了性别、年龄、地区及前10个遗传主成分后, 与低遗传风险组相比, 高遗传风险组发生IHD、MCE的HRs值(95%CIs)分别为1.10(1.02～1.18)、1.10(0.95～1.27)。遗传风险评分每增加一个标准差, IHD的发病风险增加4%(2%～6%)(线性趋势P=0.001)。进一步调整基线BMI后, 高遗传风险组与低遗传风险组的效应值差异无统计学意义, 但遗传风险评分与IHD发病风险间仍具有线性...     

Presentation The quality of epidemiological data in coronary heart disease and atherosclerosis

There are inherent difficulties in the use of indirect observations in the epidemiology of a chronic ubiquitous disease such as atherosclerosis. Such difficulties do not condone basic errors in epidemiological methodology, the use of low quality data, a lack of precision in measurements, invalid extrapolations and inappropriate use of terminology and coronary heart disease as a surrogate or synonym of coronary atherosclerosis and bias in the interpretation of data. These errors reveal a lack of rigorous and scientific standards in the epidemiology of coronary heart disease. Analysis cannot launder such data. Independent scientists must evaluate the data in respect of precision, logic and truth.     

Family history of ischemic heart disease with respect to mean twin-pair cholesterol and subsequent ischemic heart disease in the NHLBI twin study

This study examines the independent and interactive effects of family history scores (FHxS) for the prevalence of ischemic heart disease with plasma lipids and subsequent morbidity and mortality from ischemic heart disease. FHxS were calculated for 514 sets of middle aged male twins who participated in the entry examination of the NHLBI Veteran twin study in 1969-1973. Comparison of the FHxS with the level of plasma total cholesterol and HDL cholesterol (HDLc) paralleled earlier reported findings in young adults; individuals with high total cholesterol in two exams 8-12 years apart had significantly (P less than .01) higher FHxS. The same relationship was noted when using the mean twin-pair cholesterol level at the initial exam when the twins were in their 40s. Using the pair means over two exams as the cotwins aged into their 50s, the association of FHxS with total cholesterol declined and pairs with HDLc persistently in the highest quintile at both exams had significantly (P less than .01) lower FHxS. The changes in the pattern of association of lipid fractions with FHxS with age parallel the reported age decline of total cholesterol as a risk factor for heart disease. Assessment of ischemic heart disease events up to January 1988 revealed a highly significant association (P less than .0001) of later ischemic heart disease events with FHxS. At each level of lipid categorization pairs who later had events had higher FHxS than those without any subsequent heart disease; these differences were significant in all but the low risk lipid groups (low total cholesterol, high HDLc, and low total cholesterol/HDLc ratio). We conclude that FHxS is related to total cholesterol and HDLc but also is an independent predictor of subsequent ischemic heart disease after 14-18 years of follow-up.     

老年高血压合并高脂血症并发缺血性心脏病的高危因素探讨

目的 探讨老年高血压合并高脂血症并发缺血性心脏病的高危因素.方法 选取2009年2月～2011年2月入住某院的老年高血压患者96例,其中并发高脂血症的54例患者为观察组,未并发高脂血症的的42例患者对照组.观察患者年龄、家族史、吸烟史、饮食控制情况、糖尿病史、高血压病史时间、甘油三酯水平、总胆固醇水平、血尿酸水平、血清超敏c反应蛋白水平、心电图、冠状动脉造影等.结果 观察组患者缺血性心脏病发生率明显高于对照组(x2=4.22,P＜0.05)；多因素Logistic回归分析发现老年高血压合并高脂血症患者并发缺血性心脏病的危险性与年龄、吸烟、高甘油三酯血症、高胆固醇血症、高水平超敏c反应蛋白、高尿酸血症有关.结论 年龄、吸烟、高甘油三酯血症、高胆固醇血症、高水平超敏c反应蛋白、高尿酸血症是老年高血压合并高脂血症患者并发缺血性心脏病的高危因素.     

Serum insulin and ECG abnormalities suggesting coronary heart disease in the populations of Mauritius and Nauru: Cross-sectional and longitudinal associations

Cross-sectional associations between insulin and ECG abnormalities suggestive of ‘possible’ and ‘probable’ coronary heart disease (CHD) in the populations of Nauru (n = 568) and Mauritius (n = 3280) have been examined in both non-diabetic and diabetic subjects. Additionally, the longitudinal relationship between baseline insulin and incident ECG abnormalities has been explored in non-diabetic Nauruans (n = 177) over 5 years. Age-adjusted mean 2-hour serum insulin was generally higher in subjects with ECG abnormalities than those with a normal ECG, but the difference was significant only for non-diabetic Mauritian men (p < 0.01). There was no clear association between prevalence of ECG abnormalities and quintiles of fasting or 2-hr insulin in Mauritians, and in non-diabetic Nauruans there was a non-significant positive association between prevalence of ECG abnormalities and tertiles of 2-hr insulin. Logistic regression analyses showed a slight positive association between 2-hr insulin and ECG abnormalities in non-diabetic Mauritians (p = 0.06 in males, p = 0.09 in females), and non-diabetic male Nauruans (p = 0.054) independent of possible confounders. Fasting insulin was not associated in any group. In longitudinal analyses in Nauruans there were no significant differences in mean baseline fasting or 2-hr serum insulin between subjects who maintained a normal ECG and those who developed abnormalities consistent with ‘possible CHD’ (there were no changes suggestive of ‘probable CHD’). The incidence of ECG changes suggesting ‘possible CHD’ was slightly higher in the upper tertile of baseline fasting insulin in both sexes and 2-hr insulin in females, but when other factors were accounted for, multiple logistic regression analyses did not support this finding. Data from the populations of Mauritius and Nauru do not support a major role for serum insulin in ECG abnormalities suggestive of CHD.     

Application of the Minnesota Code in evaluating electrocardiographic features of ischemic heart disease in patients exposed to carbon disulphide

Summary We examined 81 men exposed for a long time to carbon disulphide (CS₂) and tested the possible electrocardiographic (ECG) changes of ischemic heart disease (I.H.D.). The subjects were examined twice in two years. In order to make the ECG evaluation more objective, the Minnesota Code was applied. Two obligatory ECG examinations and only one submaximal effort test were carried out. For comparative evaluation, the control group was examined once. We proved that, in spite of the accepted opinion concerning the atheromatous action of CS₂, this compound does not cause ECG symptoms of I.H.D. in a higher percentage of exposed persons. It also does not cause any significant increase in I.H.D. symptoms in dynamic ECG observations.     

郑州地区缺血性心脑血管病患者二级预防用药现状及用药依从性调查

目的 探讨缺血性心脑血管病患者二级预防用药现状,并对影响其用药依从性的相关因素进行分析。方法 纳入2021年1月至2022年1月于郑州市某医院接受治疗的缺血性心脑血管病患者作为研究对象,对该人群进行二级预防用药情况的问卷调查,采用描述性分析方法对用药类型及用药依从性等结果进行分析,并采用单、多因素分析方法对该人群二级预防用药依从性的影响因素进行分析。结果 本研究共对763例缺血性心脑血管病患者进行调查,有效调查患者750例,有效率为98.29%。其中缺血性心脏病患者306例,缺血性脑卒中患者422例,22例患者合并缺血性心脏病及缺血性脑卒中。750例缺血性心脑血管病患者中198例患者自报服用抗血小板药或他汀类药物,占比为26.40%,仅服用抗血小板类药物和仅服用他汀类药物的患者占比分别为45.95%(91/198)、29.29%(58/198)。112例患者依从性较好,服药依从率为56.57%。二分类Logistic回归分析结果显示性别（OR=2.289）、年龄（OR=0.624）、文化程度（OR=2.020）、工作情况（OR=3.391）、家庭年收入（OR=1.723、2.164）、...     

1990-2019年江苏省居民缺血性心脏病及其危险因素疾病负担变化趋势

目的  探讨1990-2019年江苏省居民缺血性心脏病(ischemic heart disease,IHD)及其危险因素疾病负担变化趋势。方法  基于2019年全球疾病负担(global burden of disease, GBD)研究,利用早死损失寿命年(years of life lost, YLL)、伤残损失寿命年(years lived with disability, YLD)、伤残调整寿命年(disability-adjusted of life years, DALY)和人群归因分值(population attributable fraction, PAF)分析1990-2019年江苏省人群IHD疾病负担和归因疾病负担变化趋势,并采用分解法将年龄相关DALY分解为人口增长、年龄构成、年龄别患病率和疾病严重程度4个因素。结果  1990-2019年江苏省居民IHD患病数、死亡数和DALY均呈增长趋势;标化YLL率和DALY率呈下降趋势,2010-2019年年均降幅高于1990-2010年。2019年江苏省IHD DALY较1990年增长了75.78%;归因于年龄别患病率、年龄构成、人口增长和疾病严重程度增长率依次为52.06%、46.12%、23.52%和-45.92%。2019年,IHD 26种危险因素归因DALY占IHD总DALY的92.75%;其中环境/职业、行为和代谢危险因素比例分别为38.21%、68.03%和79.07%。2019年IHD归因标化DALY率前5位的危险因素分别为高收缩压、高低密度脂蛋白胆固醇、烟草、室外颗粒物污染和钠摄入过多。近30年间室外颗粒物污染、高BMI、红肉摄入过多、加工肉摄入过多和饮酒5个危险因素年均变化率(annual rate of change, ARC)呈上升趋势,ARC分别为1.29%、1.76%、0.36%、0.32%和4.19%。2010-2019年有10种IHD危险因素的标化DALY率顺位上升,8种危险因素的顺位下降。结论  1990-2019年江苏省居民IHD疾病负担总体增加,人口老龄化和年龄别患病率是江苏省IHD DALY增长的主要原因。加强对高血压、高血脂和肥胖的预防和控制,戒烟限酒、减少红肉和加工肉摄入水平,改善室外空气污染是今后江苏省IHD防治的重点。     

Effects of annual influenza vaccination on mortality and hospitalization in elderly patients with ischemic heart disease: a nationwide population-based study

Objective

The effects of influenza vaccination on ischemic heart disease (IHD) patients remain controversial. The purpose of this study was to evaluate the effects of influenza vaccination on all-cause mortality and hospitalization for cardiovascular disease in elderly IHD patients.

Methods

Elderly patients (> 65 years old) with IHD, including ischemic heart failure and coronary artery disease between January 1997 and September 2002 were identified by using the Taiwan National Health Insurance Research Database. The association between influenza vaccination and all-cause mortality and hospitalization due to cardiovascular disease was analyzed.

Results

We included 5048 patients. During the influenza season, influenza vaccination was associated with a reduced risk of all-cause mortality [hazard ratio (HR), 0.42; 95% confidence interval (CI) 0.35-0.49] and hospitalization for cardiovascular disease (HR, 0.84; 95% CI, 0.76-0.93). During the non-influenza season, vaccination was associated with a reduced risk of mortality (HR, 0.78; 95% CI, 0.68-0.90) in elderly IHD patients.

Conclusion

Influenza vaccination was associated with a reduced risk of all-cause mortality in elderly IHD patients throughout the whole year, as well as a reduced risk of hospitalization during the influenza season.     

1990－2017年中国人群缺血性心脏病疾病负担及其危险因素变化趋势研究

目的 探讨1990－2017年中国人群缺血性心脏病（IHD）疾病负担及其危险因素的变化趋势。方法 基于2017年全球疾病负担（GBD）中国研究开放数据，利用伤残损失寿命年（YLD）、早死损失寿命年（YLL）、伤残调整寿命年（DALY）等指标对1990－2017年中国不同性别和年龄人群IHD疾病负担变化趋势进行描述，并结合人群归因分值（PAF）分析IHD危险因素的变化情况。结果 2017年，IHD的YLD率、YLL率、DALY率分别为74.2/10万、2 057.2/10万、2 131.0/10万。YLD率为女性高于男性，YLL率和DALY率则为男性高于女性。与IHD有关的24种可改变危险因素中，导致DALYs、PAF、DALY率排名前5位的危险因素均为高血压（1 642.9万人年、54.6%、1 163.1/10万）、高LDL-C（1 394.1万人年、46.3%、987.0/10万）、钠摄入过多（1 090.0万人年、36.2%、771.1/10万）、吸烟（864.7万人年、28.7%、612.2/10万）、坚果摄入不足（745.2万人年、24.8%、527.6/10万）。IHD DALY率由1990年1 116.4/10万增至2017年2 131.0/10万，增长率为90.9%。与1990年相比，2017年15~49岁和≥70岁人群IHD的YLD率增加，且≥70岁人群YLD率的2007－2017年年均增长率（0.4%）高于1990－2007年年均增长率（0.2%）。但YLL率和DALY率的2007－2017年年均增长率（0.6%、0.6%）低于1990－2007年年均增长率（1.3%、1.2%）。与1990年相比，2017年归因于加工肉摄入过多（929.7%）、高糖饮料摄入过多（822.7%）、高BMI（327.3%）的DALYs增幅较大；PAF值增幅最大的为高糖饮料摄入过多（400.0%）。2007－2017年，有8种IHD危险因素的DALY率顺位上升，7种危险因素的DALY率顺位下降。结论 IHD所致伤残负担增大，尽管其所致的过早死亡得到了有效控制，但仍为疾病负担的主要来源，≥70岁人群中表现尤为明显。IHD对男性患者的影响主要为早死所致疾病负担，对女性主要为失能所致负担。加强对高血压的预防和控制、减少吸烟和改善不合理膳食习惯等行为危险因素是防控IHD的优先措施。     

Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985 to 1990

Coronary heart disease and stroke death rates were compared for six ethnic groups (non-Hispanic white, Hispanic, African-American, Chinese, Japanese, and Asian Indian) by sex and age (25 to 44, 45 to 64, 65 to 84, and 25 to 84 years old) using California census and 1985 to 1990 death data. African-American men and women in all age groups had the highest rates of death from coronary heart disease, stroke, and all causes (except for coronary heart disease in the oldest men). Hispanics, Chinese, and Japanese in all age-sex groups had comparatively low death rates for coronary heart disease and stroke, although stroke was proportionally an important cause of death for Chinese and Japanese groups. Coronary heart disease was an important cause of death for Asian Indians although death rates were generally not higher than those for other ethnic groups. Ethnic differences were most marked for women and younger age groups.     

维生素E与阿尔茨海默病关系的Meta分析

摘要:目的 系统评价维生素E与阿尔茨海默病发病的关系。方法 电子检索PubMed、EMBase、万方数据库、中国期刊全文数据库（CNKI）、维普数据库中有关维生素E与阿尔茨海默病关系的病例对照研究,检索时间截止至2015年9月。由2名研究者按照严格的纳入和排除标准筛选文献并进行质量评价。运用Stata11.0软件进行Meta分析。结果 共纳入15篇文献,包含研究对象1 702例,其中阿尔茨海默病患者660例,对照1 042例。经Meta分析显示,阿尔茨海默病患者维生素E水平低于对照组,WMD = -5.86 μmol/L (95%CI : -7.76 μmol/L ～-3.95 μmol/L,P ＜ 0.001)。漏斗图及Egger’s检验显示无发表偏倚,剪补法显示结果比较稳健。结论 维生素E可能是阿尔茨海默病的危险因素。     

葛根素治疗缺血性心脏病的临床疗效研究

目的探讨葛根素治疗缺血胜心脏病的临床疗效。方法将60例患者随机分为治疗组和西药对照组（每组各30例）。两组患者均长期常规给予西药,治疗绀加用葛根素。观察治疗前后患者临床症状、静息心电网的变化。结果临床疗效：治疗组总有效率为93．3％,对照组总有效率为73．3％。治疗组症状改善显效率及总有效率均明显优于对照组,两组比较差异均有统计学意义（P〈0．05）。心电图疗效：治疗组有效率86．7％,对照组有效率63．3％。治疗组心电图改善屁效率及总有效率均明显优于对照组,两组比较差异均有统计学意义（P〈0．05）。结论葛根素对改善IHD患者的症状疗效明显,其机理可能与葛根素具有降血脂、抗动脉粥样硬化及改善心肌缺血有关。     

BIA法评估44例CKD患者的营养状况及分析

摘要:目的　运用生物电阻抗分析（Bioelectric Impedance Analysis,BIA）评价慢性肾脏病（Chronic Kidney Disease,CKD）患者的营养状况,并将其和生化指标评估结果对比,为早期发现CKD患者营养不良状态、及时给予营养干预提供有效参考。方法　随机选择2014年11月-12月期间在某三甲医院CKD管理中心注册的CKD患者57例,根据其浮肿指数、依从性等共纳入研究对象44例,应用BIA法评估研究对象的营养状况并与生化指标评价结果比较。结果　BIA和生化检查营养不良率（含营养不良风险）分别为45.4%和25%,且差异有统计学意义（χ2＝4.034,P＜0.05）。女性身体细胞量、细胞内水分和蛋白质的质量均显著高于男性（P＜0.05）,而男、女性ALB水平差异无统计学意义。在ALB水平正常的CKD患者中,其体细胞量、细胞内水分、蛋白质、骨骼肌、体脂肪均低于正常范围。BIA营养不良的研究对象的骨骼肌量和血清白蛋白（serum Albumin,ALB）水平显著相关（r＝0.58,P＜0.05）。结论　CKD患者营养不良率较高;与生化检查相比,BIA可早期发现CKD患者的营养不良状态和营养不良风险,有利于医生对营养不良患者及时采取有效的营养干预。     

叶酸与维生素B12对2型糖尿病大鼠心肌组织凋亡 相关蛋白表达的影响

摘要:目的　观察2型糖尿病大鼠心肌凋亡相关蛋白Bax、Bcl-2和Caspase-3的表达变化及叶酸、维生素B12的干预作用。方法　6周龄SD大鼠60只,糖尿病造模成功后,随机分为对照组（A组）、模型组（B组）、叶酸和维生素B12干预组（C组）。12周后取血检测各组同型半胱氨酸（Hcy）、叶酸、维生素B12的水平;取大鼠心肌组织,免疫组化法检测Bax,Bcl-2,Caspase-3的表达,并用计算机图像分析系统测平均灰密度值。结果　12周后B组Hcy明显增高,与A组和C组比较,差异均有统计学意义（P＜0.01）,C组叶酸、维生素B12与A组和B组比较,差异均有统计学意义（P＜0.01）;心肌组织中,B组Bax、Caspase-3的表达明显高于A组（P＜0.01）,Bcl-2的表达明显低于A组（P＜0.01）;C组Bax、Caspase-3的表达较B组明显下降（P＜0.01）,Bcl-2的表达明显高于B组（P＜0.01）;A组与C组Bax、Caspase-3、Bcl-2的表达差异无统计学意义（P＞0.05）。结论　2型糖尿病大鼠血液中Hcy的升高,可能在促进心肌细胞凋亡过程中发挥重要作用,而叶酸、维生素B12的干预可以有效缓解病变进程。     

孕期高同型半胱氨酸、缺锌与先天性心脏病

先天性心脏病是指胎儿在出生以前由于心血管发育障碍所导致的心血管系统的形态结构、功能及代谢异常.该病发病率较高,临床后果严重.研究其发病因素及机制具有重要意义.孕期环境因素的改变对其有重要影响.近期孕妇高同型半胱氨酸血症与缺锌已被确定均能干扰胚胎心脏正常发育,导致先天性心脏病的发生.该文就两者引起胚心异常发育的表现及作用机制进行综述.     

大剂量维生素C、维生素E对高原肺心病急性发作期患者脂质过氧化损伤的保护作用研究

目的探讨大剂量维生素C、维生素E对高原肺心病急性发作期患者脂质过氧化损伤的保护作用。方法选择高原肺心病急性发作期患者126例,分为观察组和对照组,对照组患者应用常规治疗,观察组患者在此基础上应用VitC150～250mg/(kg.d)静脉滴注,VitE100～200mg/d口服,10d为1疗程。结果①观察组患者治疗显效38例,有效22例,无效4例,有效率93.75%。对照组患者治疗显效34例,有效16例,无效12例,有效率80.65%。观察组患者治疗有效率显著高于对照组(P﹤0.05)。②治疗后,两组患者血P-LPO水平均显著降低,P-β-CAR、WB-GSH、E-SOD及E-CAT均显著升高,与治疗前相比差异有统计学意义(P﹤0.05)。治疗后,观察组患者血P-β-CAR、WB-GSH、E-SOD及E-CAT水平均显著高于对照组(P﹤0.05)。结论大剂量维生素C、维生素E对高原肺心病急性发作期患者脂质过氧化损伤具有较好的保护作用。     

社区空巢老年冠心病患者社会支持、 心理健康与生存质量的相关性研究

摘要:目的　了解社区空巢老年冠心病（Coronary Heart Disease,CHD）患者的社会支持、心理健康状况和生存质量状况其及相关性,为预防干预措施的制定和健康教育提供依据。方法　以社会支持评定量表（SSRS）、西雅图心绞痛量表（Seattle angina Scale,SQA）和症状自评量表（SCL90）为研究工具,对眉山市5家社区卫生服务中心就诊的482例空巢老年CHD患者进行问卷调查。结果　空巢老年CHD患者生存质量的总得分为60.36±10.82分;社会支持的总得分为（38.92±8.04）分;SCL-90量表总得分为（141.56±20.64）分;社会支持、心理健康状况与生存质量均呈正相关关系（P＜0.05）,差异具有统计学意义（P＜0.05）。结论　空巢老年CHD患者社会支持、心理健康和生存质量水平均较低,且都呈正相关关系,提高患者社会支持和心理健康水平将有助于其生存质量的改善。     

农村居民缺血性心脏病经济负担影响因素分析

目的 探讨云南省昆明市官渡区农村居民缺血性心脏病经济负担及其影响因素。方法 采用自行设计调查问卷对云南省昆明市官渡区随机抽取的4 011名18岁～农村常住居民进行面访调查。结果 昆明市官渡区农村居民缺血性心脏病的患病率为3.3%;男性和女性患病率分别为3.8%和2.6%,男性高于女性(χ²=2.36,P<0.05);缺血性心脏病损失34.0个伤残调整寿命年(DALYs)/千人,男性损失37.0个DALYs/千人,女性损失28.6个DALYs/千人;缺血性心脏病患者的总疾病经济负担为63 852.3万元,例均疾病经济负担为14 336.0元;例均直接、间接、无形疾病经济负担分别为7 690.8、1 246.2、5 399.0元;住院天数越长、缺血性心脏病对家庭影响越大、居住村收入水平越高的居民患缺血性心脏病的经济负担越重(P<0.05)。结论 缺血性心脏病给昆明市官渡区农村居民造成沉重经济负担;住院天数、对家庭影响程度和居住村年人均收入水平是造成经济负担的主要影响因素。