2010－2018年安徽省吸毒人群丙型肝炎病毒感染状况及危险行为分析

目的了解安徽省吸毒人群丙型肝炎病毒（HCV）感染状况和危险行为特征,为制定预防吸毒人员感染HCV措施提供依据。方法对2010 — 2018年安徽省吸毒人员进行问卷调查和血清学检测,采用趋势性检验分析HCV抗体阳性率和多元logistic回归分析HCV感染的影响因素。结果2010 — 2018年安徽省共调查18 925名吸毒者,吸毒人群HCV抗体阳性率分别为35.2%、34.9%、39.1%、30.4%、22.5%、20.1%、20.5%、18.6%和19.1%（趋势χ2＝458.635,P＜0.001）,多元logistic回归分析显示来源于社区（aOR＝1.310,95%CI:1.074 ~ 1.597）;美沙酮门诊（aOR＝3.182,95%CI:1.434 ~ 7.062）;20 ~（aOR＝2.246,95%CI:1.134 ~ 4.450）、30 ~（aOR＝5.283,95%CI:2.669 ~ 10.458）、40 ~（aOR＝7.158,95%CI:3.565 ~ 14.375）、50 ~（aOR＝3.125,95%CI:1.205 ~ 8.102）;在婚（aOR＝1.708,95%CI:1.296 ~ 2.252）、离异或丧偶（aOR＝1.818,95%CI:1.354 ~ 2.442）;注射吸毒史（aOR＝5.370,95%CI:4.239 ~ 6.804）和最近一年商业性行为中有时使用安全套（aOR＝1.254,95%CI:1.037 ~ 1.517）和从未使用安全套（aOR＝1.282,95%CI:1.021 ~ 1.610）是吸毒者感染HCV的高危因素。结论安徽省吸毒人群HCV感染率较高,整体呈下降趋势,需采取有效措施减少感染HCV的危险行为。     

应用log-binomial回归和logistic回归分析法定传染病报告质量影响因素

目的 探讨广西壮族自治区（广西）医疗机构法定传染病报告质量影响因素,并比较log-binomial回归与logistic回归模型估计关联强度的差异。方法 采用多阶段分层抽样方法抽取广西县级以上医疗机构为调查对象,开展现场调查收集信息,在R v3.3.3中拟合log-binomial回归和logistic回归模型。结果 共抽查法定报告传染病2 458例,平均报告率为95.08%,及时报告率为97.74%,报告卡填写完整率为77.60%,准确率为61.24%,网络直报录入信息一致率为95.27%,身份证填报完整率为75.59%。多变量log-binomial回归分析结果表明认真开展自查工作（PR=1.03,95%CI:1.01~1.05）和按要求开展培训（PR=1.08,95%CI:1.02~1.15）能有效促进法定传染病报告率的提高;设置项目齐全的门诊日志（PR=1.21,95%CI:1.07~1.37）、认真开展自查工作（PR=1.09,95%CI:1.03~1.14）、建立奖惩制度（PR=2.03,95%CI:1.49~2.78）和按要求开展培训（PR=1.18,95%CI:1.02~1.37）均能有效促进报告卡完整率的提高。在定性判别影响因素对结局事件发生概率影响时,logistic回归和log-binomial回归结果基本一致,但结局发生频率和其在比较组间差值每增加1.00%,logistic回归估计值OR相较于PR分别增加高0.65%（95%CI:0.34%~0.95%）和1.31%（95%CI:0.20%~2.41%）。结论 广西县级以上医疗机构法定传染病报告质量仍有待提高,进一步改进院内自查方法,加强培训工作,落实奖惩制度,规范设置诊疗日志,加强医务人员传染病报告法律意识,是提高报告质量的重中之重。此外,log-binomial回归应被推广应用于横断面或队列研究中定量估计暴露与结局变量的关联强度。     

沙利度胺治疗克罗恩病疗效的系统评价

目的利用现有的文献评价沙利度胺治疗克罗恩病的疗效与安全性,为临床治疗提供参考依据。方法利用计算机检索关于沙利度胺治疗克罗恩的相关文献,严格按照纳入排除标准进行文献筛选后进行系统性评价。结果最终符合纳入标准的研究共18项,患者总数为381例。Meta分析结果显示:临床缓解的合并RR=0.88,95%CI 0.53~1.48,合并率为46.8%,95%CI 34.6%~59.6%;实现激素减量的合并RR=1.97,95%CI 0.55~7.09,其合并率66.3%,95%CI 35.4%~87.6%;生物制剂治疗失败后取得临床缓解的合并RR=1.72,95%CI 0.88~3.36,其总体率为63.2%,95%CI46.8%~77.1%;实现瘘管闭合的合并RR=0.69,95%CI 0.38~1.26,其总体率为41%,95%CI 27.5%~55.8%;实现黏膜愈合的合并RR=0.50,95%CI 0.23~1.11,其总体率为33%,95%CI 18.7%~52.6%。一共有64.5%的患者发生了不良反应,其中25.2%的患者因不良反应而停药。结论沙利度胺治疗克罗恩病有一定疗效,但使用时需注意其不良反应。     

甘肃省成年人业余锻炼情况及其影响因素分析

目的调查和分析甘肃省成年人业余锻炼情况及影响因素分析，为甘肃省成人开展身体活动指导提供理论依据。方法采用多阶段分层整群抽样方法选取具有甘肃代表性的样本，对甘肃省14个市州56个乡镇中≥18岁常住居民随机抽样开展调查。结果甘肃省成年人经常锻炼率为14.3%（标化率13.95%），男性16.0%（标化率16.28%）高于女性13.0%（标化率12.27%）（χ2=13.789，P<0.05），城市经常锻炼率（16.2%）高于农村（12.3%）（χ2=23.113，P<0.05）, 轻体力职业（22.4%）高于重体力职业（10.7%）（χ2=183.314，P<0.05），糖尿病患者（20.4%）高于非糖尿病患者（13.6%）（χ2=25.330，P<0.05），男性不吸烟人群（18.8%）高于吸烟人群（13.9%）（χ2=14.274，P<0.05）；城市、城市女性均随年龄增长而线性增加（χ2=11.992、5.707，均P<0.05），随教育水平升高城乡均呈线性上升趋势（χ2=107.668、263.053, 均P<0.05）。 Logistic回归分析结果显示，城乡、年龄、文化程度、职业、糖尿病、体质指数是影响甘肃省成人经常锻炼的主要因素，其中以农村为负向因素；男性经常锻炼的正向因素依次为年龄、糖尿病、职业、文化程度，负向因素为男性吸烟和农村；女性依次为职业、文化程度和年龄，均为正向因素。结论甘肃省成年人经常锻炼率总体较低，农村、重体力劳动者、教育水平低者更低；男性吸烟人群较低。影响经常锻炼的因素有城乡、年龄、文化程度、职业、糖尿病、体质指数、男性吸烟。针对主要影响因素及相关薄弱群体加大宣传和干预力度。     

安徽省六安市学校流行性腮腺炎暴发现场含腮腺炎成分疫苗保护效果评估

目的 评估含腮腺炎成分疫苗（MuCV）的保护效果,为流行性腮腺炎免疫策略调整提供数据支持。 方法 利用2015 – 2016年在六安市发生的流行性腮腺炎暴发现场,采用回顾性队列研究方法评估MuCV的保护效果。 结果 接种2剂MuCV的保护效果要好于仅接种1剂次,其中接种1剂、2剂和3剂MuCV的保护效果分别为49.35%（95%CI:36.03% ~ 59.89%）、66.04%（95%CI:45.54% ~ 78.83%）和85.96%（95%CI:1.80% ~ 97.99%）。接种第2剂与第1剂的时间间隔为3 ~ 4年时的保护效果最高,为78.68%（95%CI:34.30% ~ 93.08%）。MuCV随接种后时间间隔的增加其疫苗保护效果呈现下降趋势,接种1剂后4年内的保护效果最好为72.78%（95%CI:39.29% ~ 87.29%）,4 ~ 6年降至52.73%（95%CI:38.31% ~ 63.79%）,超过10年后仅为27.67%（95%CI:–24.15% ~ 57.86%）。接种1剂麻腮风、麻腮或单价流行性腮腺炎疫苗4年内能均能提供较好保护,但麻腮风疫苗感染流行性腮腺炎的累积风险随接种后时间推移高于其他两组。 结论 MuCV保护效果随接种后时间增加而衰减,4年内疫苗保护效果最好。2剂MuCV的保护效果要好于1剂,接种第2剂与第1剂时间间隔3 ~ 4年保护效果最好,应尽快建立2剂免疫策略。      

胃超声检查对胃癌诊断价值的Meta分析

目的应用Meta分析方法评价口服造影剂胃超声检查诊断胃癌的准确性。 方法检索PubMed、Web of Science、万方资源数据库、中国期刊全文数据库（CNKI）,收集2000年1月至2019年12月公开发表的胃超声检查诊断胃癌准确性的研究,根据文献纳入和排除标准筛选出符合条件的文章,并采用QUADAS-2量表对纳入的文献进行质量评价。运用R统计软件对以诊断准确性为结局指标的文献进行Meta分析,运用Stata 15软件对以四格表为结局的文献进行Meta分析。 结果最终纳入文献30篇,共3613例研究对象。胃超声检查诊断胃癌的准确性为94%（95%CI：92%~95%）,其中对早期胃癌的诊断准确性为81% （95%CI：74%~87%）。Meta回归分析发现研究设计可能是诊断准确性结果的异质性来源,亚组分析后,前瞻性设计的研究文献诊断准确性为96%（95%CI：95%~97%）。根据文献检索策略,最终纳入研究的30篇文献中,5篇可提供完整的诊断四格表数据,共计纳入研究对象1675例,5篇文献合并敏感度为0.93（95%CI：0.89~0.95）,特异度为0.98（95%CI：0.86~1.00）,阳性似然比为37.19（95%CI：6.40~216.23）,阴性似然比为0.07（95%CI：0.05~0.11）,诊断优势比为507.18（95%CI：91.18~2821.10）,综合受试者工作特征（SROC）曲线下面积为0.95（95%CI：0.92~0.96）。 结论通过Meta分析得出口服造影剂胃超声检查诊断胃癌的准确性较高,作为一种低成本、非侵入性诊断技术值得临床普及推广应用,并可对此开展健康人群胃癌初筛和风险评估研究。     

经隧道式中心静脉导管行血液透析导管相关血流感染发病率及危险因素的系统评价与Meta分析CSCD

目的系统评价经隧道式中心静脉导管行血液透析导管相关血流感染(catheter-related blood stream infection,CRBSI)发病率及危险因素。方法检索从建库到2022年9月PubMed、Web of science、Embase、Cochrane Library、中国知网、维普、万方和中国生物医学文献数据库,搜集报道了CRBSI发病率和/或危险因素的临床研究。采用R语言(version 4.1.2)进行单组率和危险因素的Meta分析。结果共纳入21篇文献,6758例经隧道式中心静脉导管行血液透析的患者。Meta分析结果显示:CRBSI总发病率为14.5%,欧洲人群发病率为28.9%(95%CI:16.2%~43.5%),病例对照研究的发病率为26.3%(95%CI:14.1%~40.7%),年龄≥60岁人群发病率为22.2%(95%CI:14.5%~31.0%),导管使用时间>24个月的发病率为28.2%(95%CI:2.5%~67.2%)。年龄≥60岁(OR=1.85,95%CI:1.29~2.64)、白蛋白<30g/L(OR=2.12,95%CI:1.40~3.22)、股静脉置管(OR=2.17,95%CI:1.24~3.80)、合并糖尿病(OR=1.82,95%CI:1.37~2.40)、置管时间≥4周(OR=2.04,95%CI:1.22~3.41)是经隧道式中心静脉导管行血液透析患者发生CRBSI的重要危险因素。结论经隧道式中心静脉导管行血液透析CRBSI发生率较高,年龄≥60岁、白蛋白<30g/L、股静脉置管、合并糖尿病、置管时间≥4周是CRBSI的重要危险因素。     

单倍型造血干细胞移植和HLA相合同胞供者造血干细胞移植治疗急性B淋巴细胞白血病的回顾性比较研究北大核心CSCD

目的探讨单倍型造血干细胞移植(haplo-HSCT)治疗移植前微小残留病(Pre-MRD)阳性急性B淋巴细胞白血病(B-ALL)是否较全相合同胞造血干细胞移植(MSDT)具有生存优势,以及该作用是否受Pre-MRD的影响。方法对2009年6月至2018年6月在北京大学血液病研究所接受异基因造血干细胞移植(allo-HSCT)的998例移植前处于完全缓解(CR)的B-ALL患者进行回顾性分析,其中haplo-HSCT组788例、MSDT组210例,移植前用多参数流式细胞术(MFC)检测MRD水平。结果①全部998例B-ALL患者中,997例获得持续的完全供者嵌合状态,移植后100 d中性粒细胞、血小板植入率分别为99.9%(997/998)、95.3%(951/998),Ⅱ~Ⅳ度急性移植物抗宿主病(GVHD)发生率为26.6%(95%CI 23.8%~29.4%),3年慢性GVHD累积发生率为49.1%(95%CI 45.7%~52.4%),移植后3年白血病累积复发率(CIR)为17.3%(95%CI 15.0%~19.7%),非复发死亡率(NRM)为13.8%(95%CI 11.6%~16.0%),移植后3年无白血病生存(LFS)率、总生存(OS)率分别为69.1%(95%CI 66.1%~72.1%)、73.0%(95%CI 70.2%~75.8%)。②Pre-MRD阳性组(282例)患者移植后3年CIR高于Pre-MRD阴性组(716例)[31.6%(95%CI 25.8%~37.5%)对14.3%(95%CI 11.4%~17.2%),P<0.001]。③在Pre-MRD阳性组中,haplo-HSCT患者(219例)移植后3年CIR低于MSDT患者(63例)[27.2%(95%CI 21.0%~33.4%)对47.0%(95%CI 33.8%~60.2%),P=0.002]。④全部998例患者按照Pre-MRD结果分为阴性组(716例)、<0.01%组(46例)、0.01%~<0.1%组(117组)、0.1%~<1%组(87例)、≥1%组(32例);5组患者中,<0.01%组haplo-HSCT患者(40例)移植后3年CIR低于MSDT患者(6例)[10.0%(95%CI 0.4%~19.6%)对32.3%(95%CI 0%~69.9%),P=0.017],0.01%~<0.1%组haplo-HSCT患者(81例)移植后3年CIR也低于MSDT患者(36例)[20.4%(95%CI 10.4%~30.4%)对47.0%(95%CI 29.2%~64.8%),P=0.004];其他三组中,haplo-HSCT和MSDT患者移植后3年CIR差异无统计学意义。⑤在Pre-MRD<0.1%组(163例)中,haplo-HSCT患者(121例)移植后3年CIR低于MSDT患者(42例)[16.0%(95%CI 9.4%~22.7%)对40.5%(95%CI 25.2%~55.8%),P<0.001],3年LFS率、OS率均高于MSDT组[78.2%(95%CI 70.6%~85.8%)对47.6%(95%CI 32.2%~63.0%),P<0.001;80.5%(95%CI 73.1%~87.9%)对54.6%(95%CI 39.2%~70.0%),P<0.001],两组3年NRM差异无统计学意义[5.8%(95%CI 1.6%~10.0%)对11.9%(95%CI 2.0%~21.8%),P=0.188]。多因素分析显示,haplo-HSCT是Pre-MRD<0.1%组移植后低CIR(HR=0.248,95%CI 0.131~0.472,P<0.001)、高LFS率(HR=0.275,95%CI 0.157~0.483,P<0.001)和高OS率(HR=0.286,95%CI 0.159~0.513,P<0.001)的独立影响因素。结论haplo-HSCT治疗Pre-MRD<0.1%的B-ALL患者较MSDT具有生存优势。     

2009－2016年湖北省武汉市吸毒人群艾滋病病毒、梅毒和丙型肝炎感染状况及其影响因素分析

目的分析2009 — 2016年湖北省武汉市艾滋病监测哨点吸毒人群艾滋病病毒（HIV）、梅毒、丙型肝炎（丙肝）感染状况和变化趋势。方法2009 — 2016年每年4 — 6月，采用国家统一制定的问卷对武汉市哨点中监管场所和社区吸毒者、美沙酮门诊最近1个月吗啡尿检阳性者开展连续横断面调查，并采集调查对象血液标本进行HIV、梅毒和丙肝病毒（HCV）抗体检测。结果2009 — 2016年共监测6 408名毒品使用者。 HIV抗体阳性率平均为0.73%，维持在较低水平；梅毒为5.07%；HCV为54.35%，维持在较高水平。 不同来源及特征的吸毒人群感染情况不同。 多元logistic回归分析显示，外省户籍（OR＝4.183，95%CI:1.670 ~ 10.476，P＝0.002）、其他民族（OR＝7.754，95%CI:2.537 ~ 23.703，P＝0.000）、曾共用针具（OR＝5.908，95%CI:2.906 ~ 12.009，P＝0.000）、监管场所来源吸毒人员（OR＝2.468，95%CI:1.054 ~ 5.783，P＝0.038）是感染HIV的危险因素。 女性（OR＝2.705，95%CI:2.116 ~ 3.457，P＝0.000）、有注射毒品史（OR＝1.567，95%CI:1.133 ~ 2.165，P＝0.007）、社区来源吸毒人员（OR＝3.000，95%CI:2.265 ~ 3.973，P＝0.000）是感染梅毒的危险因素。 而女性（OR＝1.135，95%CI:1.151 ~ 1.583，P＝0.000）、本省（OR＝1.439，95%CI:1.208 ~ 1.713，P＝0.000）、传统毒品和混合毒品使用者（OR＝3.643，95%CI:2.975 ~ 4.462，P＝0.000；OR＝3.454，95%CI:2.616 ~ 4.561，P＝0.000）、有注射毒品史（OR＝4.381，95%CI:3.777 ~ 5.082，P＝0.000）、监管场所来源吸毒人员（OR＝2.075，95%CI:1.809 ~ 2.381，P＝0.000）是感染HCV的危险因素。结论武汉市吸毒人群整体HCV抗体阳性率较高，新型毒品使用者比例呈上升趋势。 在继续做好美沙酮维持治疗的同时需进一步调查当前吸毒人群HIV、梅毒和丙肝感染现况并分析影响因素。     

广州市2004-2013年户籍人口宫颈癌与宫体癌死亡趋势分析与比较

目的 分析与比较广州市2004-2013年户籍人口宫颈癌和宫体癌的死亡情况及变化趋势,为两种癌症的防治策略提供数据支持。方法 收集2004-2013年广州市两种癌症全市发病和中心城市6区的死亡及户籍人口资料,计算粗发病和死亡率及世界人口标化率（世标率）。利用Jointpoint Regression Program软件统计时间变化趋势。结果 2004-2013年广州市宫颈癌和宫体癌的年平均发病世标率分别为9.76/10万和8.54/10万;死亡世标率分别为 1.76/10万和0.95/10万;发病年龄中位数分别为47岁和52岁。死亡率宫颈癌从30~岁组逐渐上升,宫体癌从40~岁组持续上升;10年来宫颈癌和宫体癌发病均呈上升趋势,年度变化百分比（average annual percent change,APC）分别为2.97%（Z=3.134,95%CI:0.8%~5.2%）和2.03%（Z=1.804,95%CI:-0.6%~4.8%）;同期宫颈癌和宫体癌死亡也呈上升趋势,APC分别为3.35%（Z=1.323,95%CI:-2.4%~9.4%）和14.33%（Z=4.626,95%CI:6.9%~22.2%）,增长幅度分别为29.49%和216.28%。结论 广州市近10年来,虽然宫颈癌死亡率高于宫体癌,但宫体癌的死亡率上升迅速,增长速度明显高于宫颈癌。故在开展宫颈癌筛查项目的同时,重视宫体癌的防治,加强宫体癌预防措施的宣教。     

Characteristics Associated With People With Chronic Low Back Pain Meeting Physical Activity Guidelines and Recommendations for Sedentary Behavior: A Cross-Sectional Study

ObjectiveThe purpose of this study was to identify factors associated with meeting physical activity guidelines and sedentary recommendations in people with chronic low back pain (LBP).MethodsThis was a cross-sectional study including 171 people with chronic LBP. Trained assessors collected information regarding demographic, anthropometric, and clinical data. Physical activity levels and sedentary time were objectively measured using a tri-axial accelerometer. Participants were classified as being physically active (ie, performing at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week) and sedentary (ie, more than 8 hours of time spent in sedentary activities per day). Multivariable logistic regression analyses were used to determine the association of being physically active or sedentary with the range of demographic, anthropometric and clinical variables.ResultsOur results showed that although lower body mass index (odds ratio [OR] = 0.91; 95% CI: 0.85-0.98) and higher self-reported levels of leisure time physical activity (OR = 3.46; 95% CI: 1.94-6.15) were associated with being physically active, lower self-reported levels of physical activity at work (OR = 0.56; 95% CI: 0.39-0.81) was associated with being sedentary.ConclusionOur findings showed that, in people with LBP, lower body mass index and higher levels of leisure time physical activity may be important factors for identifying those physically active. In contrast, lower levels of physical activity at work may be considered when identifying sedentary people with LBP. Future studies should consider these factors when designing interventions aiming to promote physical activity and decrease sedentary behavior in this population.     

成都市无偿献血者脂肪血的人群分布及其影响因素分析

目的 探讨成都市无偿献血者中脂肪血的人群分布情况及其影响因素.方法 选择2013年3月1日至2014年3月1日于成都市血液中心某采血组献血的13 726人次献血者为研究对象.采用比浊图片法判断献血者脂肪血的发生情况.采用单因素分析和非条件多因素logistic回归分析法研究不同人口统计学特征[性别、年龄、文化程度、婚姻状况、职业、人体质量指数(BMI)]、献血季节、献血次数对脂肪血发生的影响.结果 本组13 726人次献血者所捐献血液中,脂肪血为990人次,脂肪血发生率为7.2％(990/13 726).其中,重度乳糜的脂肪血为351人次,占2.6％(351/13 726),中度乳糜的脂肪血为639人次,占4.7％(639/12 727).男性献血者脂肪血发生率为9.3％(632/6 799),高于女性的5.2％(358/6 927),并且差异有统计学意义(x2 =20.85,P＜0.05);已婚献血者脂肪血发生率为10.4％(551/5 290),高于单身者的5.2％(439/8 436),并且差异亦有统计学意义(x2=127.17,P＜0.05).不同年龄段、文化程度、职业、BMI、献血季节、献血次数的献血者脂肪血发生率比较,差别均有统计学意义(x2=24.37、61.91、23.53、101.39、10.41、11.52,P＜0.05).非条件多因素logistic回归分析结果显示,性别(OR=1.71,95％CI:1.48～1.91,P＜0.05),年龄(OR=1.20,95％CI:1.09～1.33,P＜0.05),职业(OR=0.96,95％CI:0.94～0.98,P＜0.05),BMI(OR=1.71,95％CI:1.53～1.90,P＜0.05)及献血季节(OR=0.91,95％CI:0.86～0.98,P＜0.05)是献血者发生脂肪血的独立危险因素.结论 成都市献血者脂肪血的分布具有明显倾向性,主要集中在男性、肥胖、35岁以上的献血人群,应针对这部分献血人群采取相应措施,最大程度的避免不合格血液采集,有效降低脂肪血的发生率,减少血液资源的浪费.     

Isotemporal Substitution of Sedentary Behavior by Different Physical Activity Intensities on Pain and Disability of Patients With Chronic Low Back Pain: A Cross-Sectional Study

ObjectiveTo investigate the association of isotemporal substitution modeling (ISM) of time spent in sedentary activities with physical activity in different intensities on pain and disability of patients with chronic low back pain (LBP).DesignObservational and cross-sectional study. Device-measured physical activity levels were assessed using an actigraph. Pain intensity was measured using the 11-point numeric rating scale, and disability was measured using the Roland Morris Disability Questionnaire. The ISM was used to estimate the theoretical substitution association of reallocating time from 1 exposure variable to an equal amount of time in another exposure variable while holding total activity time constant.SettingsOutpatient physical therapy clinic.ParticipantsThis study included data from 358 patients (N=358) with chronic LBP aged between 18 and 60 years.Main Outcome MeasuresPain and disability.ResultsOur results suggest that replacing 60 minutes of sedentary behavior with 60 minutes of vigorous activity in a week is significantly associated with a decrease in pain (β=?1.67; 95% confidence interval [CI], ?3.18 to ?0.15). Additionally, replacing 60 minutes of light physical activity (β=?1.67; 95% CI, ?3.18 to ?0.16) or moderate activity (β=?1.67; 95% CI, ?3.21 to ?0.13) with the same amount of time of vigorous activity per week may also favorable reductions in pain. For the analysis of disability, no significant associations (P>.05) for disability in any of the isotemporal models were found.ConclusionsOur results showed that replacing 60 minutes of sedentary behavior with equal amounts of vigorous activity per week was associated with reductions in pain intensity. Similarly, replacing a light or moderate activities with vigorous activity was also associated with reductions in pain intensity. Finally, no significant associations were observed between time spent in sedentary activities with physical activity in different intensities for disability.     

浙江省温州地区围生儿先天性心脏病相关因素病例对照研究

目的 探讨温州地区先天性心脏病（CHD）发病的相关影响因素,为CHD的病因学研究和制定预防措施提供科学依据。方法 本研究采用1:1病例对照研究,通过自行设计的调查问卷进行调查,采集温州地区2015-2016年围生儿中500名CHD患儿和500名正常儿童母亲的相关信息,采用单因素和多因素条件logistic回归分析进行CHD的相关因素分析。结果 单因素和多因素条件logistic回归分析结果显示,大专及以上文化程度、单胎妊娠、服用叶酸等为保护因素,OR值分别为0.741（95%CI:0.551~0.996）、0.191（95%CI:0.083~0.441）和0.528（95%CI:0.368~0.757）;接触化学物质、孕早期感冒、服促排卵药、接触宠物、居屋装修、染发、饮酒、异常生育史、丈夫吸烟9项为危险因素,OR值分别为9.033（95%CI:1.116~73.129）、1.616（95%CI:1.193~2.189）、17.333（95%CI:7.197~136.751）、2.679（95%CI:1.089~6.593）、15.240（95%CI:5.945~39.068）、3.030（95%CI:1.656~5.546）、8.448（95%CI:1.043~68.432）、3.028（95%CI:1.655~5.538）和1.336（95%CI:1.008~1.772）。结论 积极做好预防工作,针对危险因素进行有效干预,降低CHD的发生率,提高人口素质。     

右心室舒张末期内径对慢性心力衰竭患者预后的影响

目的 探讨右心室舒张末期内径(RVDD)对慢性心力衰竭(CHF)患者预后的影响.方法 回顾性分析我院2005年1月1日至2010年5月31日因CHF住院患者的临床资料,对所有入选患者电话随访.根据患者预后分为存活组和死亡组,通过组间单因素比较及多因素Logistic回归分析等方法评价各因素与CHF患者死亡的相关性.结果 共1552例患者纳入本次研究,平均年龄(64.62±10.45)岁,男性879例(56.64％),平均随访3年,存活组和死亡组分别为1113例(71.71％)和439例(28.29％).2组组间基线资料比较发现性别、年龄、收缩压(SBP)、心功能分级、肌酐、左心室射血分数(LVEF)、左心室舒张末期内径(LVDD)及RVDD差异有统计学意义,此8项指标经多因素Logistic回归分析结果显示RVDD(OR=1.11,95％ CI 1.07～1.14,P＜0.01)、年龄(OR=1.03,95％CI1.02 ～ 1.05,P＜0.01)、肌酐(OR=1.03,95％CI 1.01 ～1.06,P＜0.01)、LVEF(OR=0.93,95％cI0.92～0.97,P＜0.01)、LVDD(OR=1.13,95％CI 1.09 ～I.17,P＜0.01)以及心功能分级(OR=1.17,95％CI 1.12 ～1.24,P＜0.01)与CHF患者死亡相关.通过ROC曲线检验RVDD的预测效能,计算曲线下面积(ROC)为0.805(95％CI0.798 ～0.812,P＜0.01).结论 RVDD增大将增加CHF患者死亡风险.RVDD可作为CHF患者死亡的独立预测因素.     

Replacing Sedentary Behavior Time With Physical Activities,Recommended Physical Activity,and Incident Coronary Heart Disease

ObjectiveTo prospectively analyze the associations with coronary heart disease (CHD) risk of reallocating time from sedentary behavior to various physical activities using the isotemporal substitution model, particularly according to whether the participants meet the recommended physical activity level.MethodsWe included 455,298 UK Biobank participants free of CHD at baseline (March 13, 2006, to October 10, 2010). Sedentary behavior time was quantified by summing up the time spent on television watching, computer (not at work), and driving. Physical activities were categorized as daily-life activities (walking for pleasure, light do-it-yourself, and heavy do-it-yourself) and structured exercise (strenuous sports and other exercise).ResultsDuring a median follow-up of 11 years, 20,162 incident CHD cases were documented. Sedentary behavior time was significantly associated with a higher risk of CHD, independent of physical activity. Replacing 30 min/d of sedentary behavior with an equal time of various physical activities was associated with a 3% to 12% risk reduction of CHD. Replacing 1 h/d of sedentary behavior with different types of physical activities was associated with a 6% to 23% risk reduction of CHD. Sedentary behavior to strenuous sports reallocations showed the largest benefit. Reallocations of sedentary behavior to various physical activities showed particularly greater benefits among those who did not meet the physical activity recommendations.ConclusionsReplacing sedentary behavior time with various daily-life activities or structured exercise is associated with significant reductions in CHD risk.     

Television Viewing and Low Leisure-Time Physical Activity in Adolescence Independently Predict the Metabolic Syndrome in Mid-Adulthood

OBJECTIVE

We investigated whether television (TV) viewing and low leisure-time physical activity in adolescence predict the metabolic syndrome in mid-adulthood.

RESEARCH DESIGN AND METHODS

TV viewing habits and participation in leisure-time physical activity at age 16 years were assessed by self-administered questionnaires in a population-based cohort in Northern Sweden. The presence of the metabolic syndrome at age 43 years was ascertained in 888 participants (82% of the baseline sample) using the International Diabetes Federation criteria. Odds ratios (ORs) and CIs were calculated using logistic regression.

RESULTS

The overall prevalence of the metabolic syndrome at age 43 years was 26.9%. Adjusted OR for the metabolic syndrome at age 43 years was 2.14 (95% CI 1.24–3.71) for those who reported “watching several shows a day” versus “one show/week” or less and 2.31 (1.13–4.69) for leisure-time physical activity “several times/month” or less compared with “daily” leisure-time physical activity at age 16 years. TV viewing at age 16 years was associated with central obesity, low HDL cholesterol, and hypertension at age 43 years, whereas low leisure-time physical activity at age 16 years was associated with central obesity and triglycerides at age 43 years.

CONCLUSIONS

Both TV viewing and low leisure-time physical activity in adolescence independently predicted the metabolic syndrome and several of the metabolic syndrome components in mid-adulthood. These findings suggest that reduced TV viewing in adolescence, in addition to regular physical activity, may contribute to cardiometabolic health later in life.Current public health guidelines recommend moderate-intensity aerobic physical activity for a minimum of 30 min on 5 days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on 3 days each week to promote and maintain health (1). Aside from this, sedentary behavior such as prolonged sitting during commuting and in the workplace and the domestic environment has recently emerged as a distinct contributor to adverse health effects, particularly for cardiometabolic outcomes (2). On the physical activity continuum, sedentary behaviors do not simply exist at one end but, rather, are a class of behaviors that can coexist and compete with physical activity (3). Changes in television (TV)-viewing levels (a common leisure-time sedentary behavior) have been associated with concurrent changes in cardiometabolic biomarkers that are independent of the protective effects of regular moderate- to vigorous-intensity physical activity (4). Generally, evidence for a physical activity–independent link between TV viewing and cardiometabolic outcomes has been generated from cross-sectional analyses. Few longitudinal studies have been conducted, and a recently published review concluded that there is insufficient evidence to conclude that a definitive longitudinal relationship exists between sedentary behavior, markers of cardiometabolic health, and metabolic conditions (2). Moreover, there is a lack of prospective studies that have examined the relationship between sedentary behaviors during childhood or adolescence and adult cardiometabolic risk. One of the few longitudinal studies with a life course perspective showed that TV viewing in childhood was associated with raised cholesterol and overweight in adulthood (5). However, the individuals were not followed longer than up to age 26 years. Thus, although interventions to reduce TV viewing in children have shown promising short-term results (6), uncertainty remains as to whether preventive actions during childhood and adolescence may have an impact on cardiometabolic risk in adulthood.The aim of this study was to investigate whether TV viewing and low leisure-time physical activity in adolescence predict the metabolic syndrome in mid-adulthood. We also aimed to examine the extent to which leisure-time physical activity in mid-adulthood mediates the relationships of TV viewing and low leisure-time physical activity in adolescence with the metabolic syndrome in mid-adulthood.     

2010-2015年我国暗娼人群艾滋病病毒/梅毒/丙型病毒性肝炎感染状况分析

目的 了解我国2010-2015年暗娼人群艾滋病病毒（HIV）/梅毒/丙型病毒性肝炎（丙肝）抗体阳性率情况。方法 2010-2015年每年的4-6月,在全国艾滋病暗娼监测哨点开展连续横断面调查,通过匿名调查问卷收集调查对象基本人口学信息等,同时抽取静脉血进行HIV、梅毒和丙肝抗体检测,利用SPSS 18.0统计学软件进行数据整理和分析。结果 2010-2015年共监测暗娼1 180 926人,3种传染病抗体阳性率平均为HIV 0.25%（2 898/1 180 926）、梅毒2.54%（30 028/1 180 926）、丙肝0.72%（8 559/1 180 926）,逐年3种疾病抗体阳性率呈现下降趋势。不同人口学特征的暗娼人群感染情况不同,31岁年龄组、少数民族、外籍,文化程度为小学及以下、婚姻状态为离异或丧偶的暗娼人群HIV、梅毒和丙肝抗体阳性率均较高。场所来源为街头的暗娼人群,HIV/梅毒/丙肝抗体阳性率均高于其他场所来源的暗娼人群,差异有统计学意义,分别为HIV（2=2 807.11,P0.01）、梅毒（2=8 230.48,P0.01）、丙肝（2=778.30,P0.01）。多元logistic回归分析显示,吸毒（OR=17.82,95%CI:16.02~19.82）、初中及以下文化程度（OR=1.79,95% CI:1.58~2.03）、场所来源是街头/路边店（OR=2.74,95% CI:2.40~3.13）的暗娼感染HIV的风险较高。结论 我国暗娼人群整体梅毒抗体阳性率较高,31岁、文化程度较低和收入较低的街头低档暗娼HIV、梅毒和丙肝抗体阳性率均高于其他组暗娼人群。     

袢利尿剂对慢性心力衰竭患者肾功能的影响

目的 探讨袢利尿剂对慢性心力衰竭患者肾功能的影响.方法 采用病例对照研究方法,分析袢利尿剂应用与肾功能恶化发生有无统计学关联,是否为其发生的独立危险因素.以住院期间任何时间出现的肌酐值较入院时升高≥26.5 μmol/L作为肾功能恶化的标准,分为病例组(肌酐≥26.5umol/L,66例)及对照组(肌酐＜26.5 μmol/L,145例).结果 病例组袢利尿剂总剂量(385.17±49.37)mg明显大于对照组(244.50±34.82)mg(P ＜0.05),但利尿剂量与肾功能恶化的发生无独立相关性(P＞0.05),入院肌酐浓度及心功能分级与肾功能恶化的发生独立相关,OR值分别为2.248(95％CI:1.088 ～4.647)和2.485(95％ CI:1.385～4.459)(P均＜0.05).结论 袢利尿剂应用与肾功能恶化的发生无独立相关性,入院肌酐浓度偏高及心功能差为心力衰竭患者住院期间发生肾功能恶化的独立危险因素.     

2型糖尿病患者糖化血红蛋白与脉搏波传导速度及内皮依赖性血管舒张功能的关系研究

目的 探讨2型糖尿病患者不同糖化血红蛋白(HbA1c)水平与踝臂动脉脉搏波传导速度(baPWV)及内皮依赖性血管舒张功能(FMD)的关系.方法 对338例2型糖尿病患者按HbA1c水平分为正常组(A组,HbA1c≤6.0％,74例),正常高值组(B组,6.0％＜HbA1c≤6.5％,102例)和升高组162例(C组,HbA1c ＞6.5％),测量BaPWV及FMD作为反映大动脉硬度及血管舒张功能的指标.结果 与A组比较,B、C组BaPWV明显增高[(1734±343)cm/s与(1537±313)cm/s;1853±364)cm/s与(1537±313)cm/s;P均＜0.001),与B组比较,C组BaPWV明显升高[(1853±364)cm/s与(1734±343)cm/s;P=0.006).与A组比较,B、C组FMD明显减低[(4.20±3.13)％与(5.29±3.92)％;(4.09±2.79)％与(5.29±3.92)％;P均＜0.01)].直线相关分析显示,BaPWV与HbA1c水平呈正相关(r=0.53,P＜0.01),与FMD水平呈负相关(r=-0.25,P＜0.01).Logistic回归分析显示,HbA1c(OR 32.19,95％ CI 11.26 ～53.12;P ＜0.001)与年龄(OR 14.21,95％ CI 11.43～17.00;P ＜0.001)、收缩压(OR7.36,95％CI 6.12 ～8.59;P ＜0.001)和胆固醇(OR 40.31,95％ CI 9.97～70.64;P=0.009)为影响BaPWV的独立危险因素.结论 2型糖尿病患者BaPWV与HbA1c水平密切相关,将HbA1c控制在理想水平是降低大动脉硬化的手段之一.