山西省五寨县心血管病高危人群中医体质类型及危险因素分析

目的分析山西省五寨县心血管病高危人群的中医体质类型与危险因素,为贫困地区心血管病高危人群的中医药特色防控提供依据。方法以山西省五寨县199例心血管病高危人群为研究对象,男126例,女73例,年龄29~90岁,采用预先制定的调查问卷筛查心血管病危险因素,收集病人的相关临床指标,并进行中医体质判定和分类,分析心血管病高危人群中医体质类型与心血管病危险因素的关系。结果199例心血管病高危人群中,阴虚质25例(12.56%),阳虚质16例(8.04%),血瘀质48例(24.12%),痰湿质33例(16.58%),湿热质21例(10.55%),气郁质14例(7.04%),气虚质42例(21.11%)。痰湿质人群的体质指数明显高于其他体质人群,湿热质人群的空腹血糖明显高于其他体质人群,差异均有统计学意义(P<0.05)。结论山西省五寨县心血管病高危人群中最常见的中医体质类型依次为血瘀质、气虚质、痰湿质,中医体质类型与心血管病危险因素具有一定的相关性,可基于中医体质进行心血管病早期综合干预。     

结直肠腺瘤危险因素的倾向评分匹配分析

目的:探讨内镜下结直肠息肉切除术后结直肠腺瘤发生的危险因素。方法:回顾性分析2014年1月至2019年12月在四川大学华西医院日间手术中心接受内镜下结直肠息肉切除术的6 430例患者(20 351枚息肉)资料。根据是否包含≥1枚腺瘤性息肉,将患者分为腺瘤患者组(4 573例)和非腺瘤患者组(1 857例);根据结直肠息...     

心血管疾病高危人群的早期筛查模型

心血管疾病是一个重大的公共卫生问题。目前有多种心血管病高危人群早期筛查模型,例如Framingham、China-PAR、SCORE和QRISK模型等。本文对目前一些心血管病高危人群筛查模型作一综述。     

胸骨上段小切口主动脉瓣手术临床效果：一项倾向评分匹配分析

目的 对比研究传统正中开胸与胸骨上段小切口主动脉瓣置换手术的临床效果。方法 使用倾向评分匹配法,筛选了2016-2019年间在我院实施主动脉瓣手术的患者共62例,其中31例实施了微创主动脉瓣置换,31例采用胸骨正中开胸手术,比较两种手术方式的临床效果。结果 经过倾向评分匹配之后,两组患者术前基本资料差异无统计学意义。手术结果显示微创手术组患者手术中主动脉阻断时间以及体外循环时间均较正中开胸组患者延长（57.3±5.4min vs 55.2±6.8min;91.2±9.6min vs 90.7±7.2）,然而两者之间差异无统计学意义（p值分别为0.177以及0.835）。然而,微创手术组患者术后24 h引流量明显少于正中开胸组（337.7±87.5ml vs 390.9±114.7ml）,两者差异具有统计学意义（P=0.044）。此外,微创组患者伤口疼痛评分明显低于正中开胸组（3.52±1.15 vs 5.00±1.61）,两者差异具有统计学意义（p<0.05）。结论 本研究结果显示,胸骨上段小切口主动脉瓣置换可以获得与传统正中开胸手术一样的效果,手术方式时安全有效的。     

黑龙江省心血管病人群监测1984～1988年资料分析

本文对黑龙江省内城乡913,779自然人口进行五年的心血管病人群监测。人口死因前三位为心脏病、恶性肿瘤、脑卒中。年平均总死亡率男551/10万,女407/10万;心血管病死亡率男213/10万;女197/10万;冠心病死亡率男34/10万,女21/10万;急性心梗发病率男27/10万,女10/10万,死亡率男4/10万,女3/10万;冠心病猝死率1小时内男13/10万,女6/10万,1～24小时内男7/10万,女4/10万;脑卒中发病率男281/10万,女178/10万,死亡率男94/10万,女71/10万。通过五年监测,各项死亡率、脑卒中发病率、急性心梗和脑卒中病死率有逐年下降趋势。     

天津市滨海新区心血管病高危人群慢性病患病现况及相关危险因素分析

目的 分析心血管病高危人群的慢性病患病及知晓、治疗和控制现况并分析相关影响因素。方法 2019年2～10月采用整群随机抽样的方法在天津市滨海新区21个街道(镇)中随机抽取4个街道(镇),对其中的6 305位常住居民进行问卷调查、体格检查,根据疾病史、血压和血脂水平及心血管病风险评估结果筛选出心血管病高危对象纳入研究。对心血管病高危人群的高血压、糖尿病、血脂异常的患病、知晓、治疗和控制现况分别分析,多因素logistic回归分析探索相关影响因素。结果 共筛选出心血管病高危对象1 494例。在心血管病高危人群中,高血压患病率、知晓率、治疗率、控制率分别为72.49%、87.53%、81.44%、39.70%;糖尿病患病率、知晓率、治疗率和控制率分别为35.48%、86.98%、80.19%、32.64%;血脂异常的患病率、知晓率、治疗率和控制率分别为59.84%、57.61%、45.30%、14.09%。高血压、糖尿病、血脂异常的患病率、知晓率及治疗率均随着年龄的增长而升高(均为P<0.05)。多因素logistic回归分析结果显示,年龄≥50岁、超重/肥胖是高血压、糖尿病患病主要危...     

右胸前外侧小切口微创主动脉瓣置换的倾向评分匹配研究

目的：总结右胸前外侧小切口微创主动脉瓣置换的技术和结果。 方法：回顾性研究我院2010年1月至2017年6月单纯主动脉瓣置换患者资料,分为微创组（N=65）和常规组（正中开胸,N=182）,胸骨上段小切口患者予以排除。微创组采用股动静脉插管建立体外循环,右侧第三肋间胸骨旁小切口,直视下置换主动脉瓣。采用Logistic模型对患者的性别、年龄、体重指数、主动脉瓣病变类别、心脏射血分数、心功能等级进行倾向评分匹配 （Propensity score matching）,匹配比例1:1,研究微创主动脉瓣置换技术的对临床结局的影响。 结果：全组患者3例死亡,均为常规组病人（3/182,1.6%）,微创组无中转开胸、无二次手术。进行倾向评分匹配后得出新的常规对照组（N=65）,术前资料与微创组无差异;与该组相比,微创组体外循环时间和主动脉阻断时间显著延长（103.6±37.2 vs 88.3±27.2 min, P=0.01; 68.3±18.6 vs 48.8±18.9 min, P<0.01）;微创组术后ICU停留1.9±0.4天,住院8.4±1.8天,均显著低于常规组（2.4±0.9天,10.6±3.2天,P<0.01）;微创组术后第一天引流量较少（281±53 vs 432±88ml,P<0.01）。两组间死亡率、深部切口感染率及输血率无显著差异（0 vs 1.5%, P=0.32; 0 vs 3.1%, P=0.15; 23.1% vs 35.4%, P=0.13）。 结论：经右胸前外侧小切口微创主动脉瓣置换技术安全可行。该技术尽管增加体外循环时间和主动脉阻断时间,但可减少引流,加速术后康复。     

绵阳市MSM人群的生存质量及其影响因素研究

目的了解绵阳市男男性行为人群（MSM）的生存质量及其影响因素。方法采用滚雪球抽样法招募MSM,在MSM活动场所,用生存质量测定量表WHOQOL-BREF中文版进行生存质量及相关因素的寻问式匿名现场调查。结果共调查400人,平均（28.19±10.48）岁,生理、心理、社会关系、环境领域得分分别为（15.03±1.48）、（13.16±1.35）、（15.22±1.78）、（13.26±1.30）,总得分（14.82±1.90）。经多因素分析,影响生理领域的因素有：近1年是否接受过同伴教育、性病检查或治疗、HIV咨询或检测,近6个月性伴是否主要是男朋友、主要是偶然性伴,是否不知道近6个月性伴的健康状况,近6个月有否无保护性主动肛交、是否以家庭型认识性伴,认识当地MSM朋友数;影响心理领域的因素有：职业、收入、性取向,近1年是否做过HIV检测并知道结果、接受过性病检查或治疗、HIV知识信息来自咨询服务,认识当地MSM朋友数,近6个月有否无保护性口交;影响社会关系领域的因素有：是否本地户籍、近1年是否做过HIV检测并知道结果、近6个月有否无保护性口交、近6个月性伴数;影响环境领域的变量有：参加调查的目的、职业、认识当地MSM朋友数、近6个月是否以公园型认识性伴、近6个月性伴有无健康问题。结论 MSM人群总体生存质量不高,受人口特征、社会活动网络、性行为及预防性服务影响。减少社会歧视,积极开展HIV防治有利于改善MSM的生存质量。     

短信指导及电话随访护理模式在心血管病高危人群血脂管理中的应用价值

目的 探索短信指导及电话随访护理模式在心血管病高危人群血脂管理中的应用价值。方法 选取我院2021年1月至2021年9月收治的1000例心血管病高危患者,随机分为对照组和研究组,每组500例。对照组给予常规护理,研究组在常规护理的基础上给予短信指导联合电话随访,对比两组患者疾病健康知识掌握评分、健康生活方式养成情况评分及血脂水平和并发症率及基础疾病复发率。结果 研究组患者疾病健康知识掌握情况评分、健康生活方式养成情况评分显著高于对照组,各项血脂指标水平显著优于对照组,并发症率及基础疾病复发率显著低于对照组,差异有统计学意义（P <0.05）。结论 短信指导及电话随访护理模式在心血管高危人群中,可有效提高其疾病健康知识掌握水平,帮助其控制血脂水平,减少并发症和基础疾病复发,值得临床推广。     

Association between periodontal disease and diabetes using propensity score matching: The seventh Korea National Health and Nutrition Examination Survey

The association between periodontitis and diabetes have been assessed by many cross-sectional studies, in which controlling confounding factors is important. Propensity score matching (PSM) may help address this issue. Therefore, we evaluated this relationship in a (PSM) analysis of individuals representing the general Korean population. Periodontitis was significantly associated with diabetes before PSM (odds ratio [OR] = 1.53; 95 % confidence interval (CI) = 1.31–1.80) and after PSM (OR = 1.52; 95 % CI = 1.28–1.80). This study showed the association between periodontitis and diabetes using PSM, suggesting that periodontitis may be positively related with diabetes. We included 9508 adults who were aged ≥ 19 years from the Korea National Health and Nutrition Examination Survey VII (2016–2018) and performed logistic regression analyses before and after PSM. The PSM was based on periodontal disease (yes or no) using a 1:1 match ratio and included 5858 individuals (2929 per group). Confounding variables, such as age, sex, marital status, occupation, education, income, smoking and drinking habits, obesity, hypertension, hypercholesterolemia, and hypertriglyceridemia, were matched and adjusted in the logistic regression analysis.     

腹腔镜与开腹肝切除术治疗区域型肝胆管结石病的倾向性评分匹配研究

目的比较腹腔镜与开腹肝切除术治疗区域型肝胆管结石病的临床疗效。方法选取2010年1月-2017年6月咸阳市第一人民医院收治的87例肝胆管结石病患者,其中38例行腹腔镜肝切除术(腹腔镜组),49例行开腹肝切除术(开腹组)。利用倾向性评分匹配,均衡2组患者的混杂因素,比较匹配后的围手术期相关指标。计量资料2组间比较采用t检验,计数资料2组间比较采用χ~2检验或Fisher精确检验。结果共27对患者匹配成功。2组患者的肝切除类型、联合胆总管探查术、术中肝门阻断率、手术时间、术中输血率、术中结石清除率及术后结石清除率﹑术后总并发症及严重并发症发生率比较,差异均无统计学意义(P值均>0.05)。但腹腔镜组患者的手术出血量和住院时间均低于开腹组[(126.4±18.7)ml vs(143.2±24.1)ml;(11.7±2.3)d vs(13.4±1.9)d],差异均有统计学意义(t值分别为2.862、2.961,P值分别为0.006、0.004)。结论腹腔镜肝切除术治疗区域型肝胆管结石病效果与开腹手术相当,且具有术中出血量少、术后恢复快等优势。     

基于倾向性评分匹配法的血浆D-二聚体升高与新型冠状病毒肺炎重症化相关性研究

目的 评估血浆D-二聚体(D-dimer,D-D)与新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)重症化的相关性.方法 回顾性分析2020年1月20日—2月8日在阜阳市第二人民医院住院的102例COVID-19患者的临床资料,将患者按血浆D-D是否升高分为D-D不升高组与D-D持...     

Thymosin alpha-1 therapy improves postoperative survival after curative resection for solitary hepatitis B virus-related hepatocellular carcinoma: A propensity score matching analysis

Thymosin alpha-1 (Tα1) is an immunomodulatory and antiviral agent with potential effects on chronic hepatitis B and liver cancer. Its impact on solitary hepatocellular carcinoma (HCC) remains controversial, so we aimed to investigate the efficacy of Tα1 in solitary HBV-related HCC patients after curative resection.Between May 2010 and April 2016, 468 patients with solitary HBV-related HCC after curative resection were analyzed. Propensity score matching (PSM) was used to minimize confounding variables. Risk factors were identified by the Cox proportional hazards model. Recurrence-free survival (RFS) rates, overall survival (OS) rates, immunological, and virologic response were compared.The median follow up was 60.0 months. Immunological response improved in the Tα1 group compared with the control group (P < .001) but the virologic response was similar between 2 groups after 24 months. Patients with Tα1 therapy had better RFS and OS before (P = .018 and P < .001) and after (P = .006 and P < .001) propensity matching. Multivariate analysis revealed that Tα1 therapy was an independent prognostic factor for both OS (P < .001, HR = 0.308, 95% CI: 0.175–0.541) and RFS (P < .001, HR = 0.381, 95% CI: 0.229–0.633).Tα1 as an adjuvant therapy improves the prognosis of solitary HBV-related HCC patients after curative liver resection.     

A risk score for carotid plaque as an assessment risk of cardiovascular risk among patients with hypertension

This study aimed to describe the status of carotid plaques and develop a simple scoring system to predict the risk of carotid lesions in patients with hypertension. Basic testing for carotid plaques was carried out and used for risk score development (the training dataset, n = 2665) and validation (the test dataset, n = 1333). Independent predictors of carotid plaques from the multivariate model were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver operating characteristic analysis using the test dataset. A total of 1346 of 2665 patients were examined for carotid plaques, which were more frequent in men than in women, and increased with age. The final model included eight significant variables, and these variables were then used to develop a risk score for the prediction of carotid plaques. Receiver operating characteristic analysis demonstrated good discriminant power with a C-statistic of 0.732 (95% confidence interval: 0.713–0.751) and good calibration across quantiles of observed predicted risk (74.6%). We developed a simple risk score for the prediction of carotid plaques based on eight variables. The prediction model showed good discriminant power and calibration.     

Immediate breast reconstruction is oncologically safe for node-positive patients: Comparison using propensity score matching

The oncological safety of immediate breast reconstruction (IBR) in lymph node-positive patients is unclear. In the present study, the impact of IBR on recurrence based on data of patients with axillary lymph node metastases only was examined.The subjects were 232 patients who underwent breast surgery. The patients were grouped into 2 cohorts: non-IBR patients who underwent mastectomy with axillary lymph node dissection; and IBR patients with tissue expander or flap transfer and axillary lymph node dissection. The Non-IBR group included 165 patients, and the IBR group included 67 patients. For the comparison of oncological outcomes between the 2 groups, propensity score matching was performed. The propensity scores were calculated by logistic regression analysis, including age, tumor staging, human epidermal growth factor receptor 2 status, and estrogen receptor status. There was no difference in locoregional recurrence-free survival (LRRFS) between the non-IBR and IBR groups. The 5-year LRRFS rate was 78.9% in the non-IBR group and 85.1% in the IBR group. There was no difference in recurrence-free survival (RFS) between the non-IBR and IBR groups. The 5-year RFS rate was 75.6% in the non-IBR group and 78.8% in the IBR group. In all patients, the 5-year LRRFS rate was 77.3%, and the RFS rate was 70.5%. Multivariate Cox regression analysis to identify factors affecting RFS in all patients showed that estrogen receptor status and high nuclear grade were significant prognostic factors; IBR was irrelevant.This is the first report of an analysis using propensity score matching limited to node-positive breast cancer patients, and it showed that IBR is relatively safe in such patients.