冠心病病例对照研究

选择发病前已检测过血脂、血压、身高、体重等现患CHD 病人56例,按1:2配比进行病例对照研究,结果表明高血压、高胆固醇血症及大量吸烟是CHD 的危险因素。高血压与CHD 的联系强度最大,其次为高胆固醇血症,再次为大量吸烟。高血压与高胆固醇血症并存对CHD 有协同促进作用。     

Heart attacks and the Newcastle earthquake.

OBJECTIVE: To test the hypothesis that stress generated by the Newcastle earthquake led to increased risk of heart attack and coronary death. DESIGN: A natural experiment. SUBJECTS: People living in the Newcastle and Lake Macquarie local government areas of New South Wales, Australia. INTERVENTION: At 10.27 a.m. on 28 December 1989 Newcastle was struck by an earthquake measuring 5.6 on the Richter scale. OUTCOME MEASURES: Myocardial infarction and coronary death defined by the criteria of the WHO MONICA Project and hospital admissions for coronary disease before and after the earthquake and in corresponding periods in previous years. Well established, concurrent data collection systems were used. RESULTS: There were six fatal myocardial infarctions and coronary deaths among people aged under 70 years after the earthquake in the period 28-31 December 1989. Compared with the average number of deaths at this time of year this was unusually high (P = 0.016). Relative risks for this four-day period were: fatal myocardial infarction and coronary death, 1.67 (95% confidence interval [Cl]: 0.72, 3.17); non-fatal definite myocardial infarction, 1.05 (95% Cl: 0.05, 2.22); non-fatal possible myocardial infarction, 1.34 (95% Cl: 0.67, 1.91); hospital admissions for myocardial infarction or other ischaemic heart disease, 1.27 (95% Cl: 0.83, 1.66). There was no evidence of increased risk during the following four months. CONCLUSION: The magnitude of increased risk of death was slightly less than that previously reported after earthquakes in Greece. The data provide weak evidence that acute emotional and physical stress may trigger myocardial infarction and coronary death.     

贵阳市老年人的膳食营养与冠心病的调查研究

为研究膳食营养状况与冠心病及其危险因素之间的关系，我们对１１８７例不同职业、年龄在６０岁以上的老年人的膳食营养状况进行了调查。提示膳食营养状况对高血压、肥胖、高脂血症以及冠心病的发生起重要的作用。     

中青年冠状动脉病变程度与危险因素相关性研究

目的探讨中青年（〈60岁）冠心病患者冠状动脉病变程度与危险因素相关性。方法对168例选择性冠状动脉造影患者一般资料、血生化指标、GAG结果进行回顾性讨论：分析冠脉病变支数与易患因素关系,比较危险因素聚集个数与冠脉病变支数、冠脉阻塞积分的关系。结果中青年冠心病中有近98．21％有传统的冠心病易患因素,其中男性占（83eO／o）其次为吸烟占72o％,高血压占577％,早发冠心病家族史274％,糖尿病101％。冠脉病变支数与性别、高血压、2型糖尿病、吸烟及血清Tc、TG、LDL-c水平呈正相关。与HDL-C水平呈负相关,冠心病家族吏、BMI、UA水平与冠脉病变支数无显著相关性。随着危险因素个数的增加,冠脉病变支数及狭窄程度均增高,呈正相关性。结论男性、吸烟、高血压、糖尿病、高脂血症是中青年冠心病主要易患因素,冠脉病变程度不仅与冠心病危险因素水平有相关性,还与危险因素累积数量有关,危险因素越多,冠脉病变支数越多,狭窄程度越重。     

EPIDEMIOLOGY BASED PLANNING OF AN INFORMATION,EDUCATION AND COMMUNICATION STRATEGY FOR CORONARY RISK PREVENTION

A population based cross-sectional analytical study was undertaken on a randomly selected sample of 2400 army personnel at Delhi to assess the prevalence of well-established coronary risk factors (tobacco use, systemic arterial hypertension, overweight, dietary risk, and lack of regular physical exercise) and their association with certain determinant variables, viz, age, social status, education, and occupation. Data analysis through mathematical models indicated that age more than 35 years, Junior Commissioned Officer rank, and education more than 10th standard were independent and significant predictors of the presence of at least 2 coronary risk factors. These variables were used for identifying high risk target audience. The study indicated that a much higher proportion of target audience desired that the Regimental Medical Officers should provide them with health education regarding coronary risk factor prevention and that the mode of communication should be “small group discussions” of 4 to 5 persons. The linear trend analysis showed a highly significant result in respect of both these variables (p < 0.01). Based on these findings, an information, education and communication strategy was planned and pilot-tested in the field and recommendations were submitted.KEY WORDS: Health education, Ischaemic heart disease, Prevalence, Risk factors     

不同人群冠状动脉病变增龄性对比研究

目的:探讨军人与非军人冠心病(coronary heart disease,CHD)的危险因素及流行病学特征,评价增龄、职业差异与CHD的相关性。方法:入选军人临床拟诊冠心病患者221例,非军人临床拟诊冠心病患者1 060例,按军人和非军人及年龄分组,进行冠状动脉病变、危险因素分析。结果:军人和非军人冠心病组年龄差异有统计学意义(P<0.001),两组病变危险因素,累及血管支数、病变部位、Gensini积分差异无统计学意义(P>0.05)。军人和非军人中随着年龄增长,Gensini总积分逐渐增加,非军人70～岁年龄段Gensini总积分与军人80～岁组相比差异无统计学意义(P>0.05)。结论:随着增龄,冠脉病变程度逐渐加重。在相同危险因素、相同动脉粥样硬化病变程度,非军人比军人年龄提前10岁左右,提示除传统危险因素外,社会生活环境、不同职业水平也是冠心病的危险因素。     

Is elevated serum cholesterol level a risk factor for coronary heart disease in the elderly?

Since serum cholesterol is a major component in the causal pathway of atherosclerosis, a pathological process that usually progresses with age, we have evaluated reported findings of a diminished association between serum cholesterol level and coronary heart disease in the elderly. In the Honolulu (Hawaii) Heart Program, 1480 men aged 65 years and older and free of coronary heart disease were followed up for an average of 12 years. Incidence rates of coronary heart disease increased progressively from the lowest to the highest quartile of serum cholesterol level. The independent role of serum cholesterol level as a predictor of coronary heart disease risk was evaluated with other major risk factors using a Cox multivariate regression model. The upper-lower quartile relative risk for serum cholesterol level was 1.64 (95% confidence interval, 1.14 to 2.36). The relative risk for middle-aged men was also 1.64. The results suggest that serum cholesterol level is an independent predictor of coronary heart disease, even among men older than 65 years. Thus, an elevated serum cholesterol level in the elderly should be regarded, as in middle-aged men, to be an indicator for further evaluation of lipoprotein levels and possible intervention.     

Determinants of elevated blood lead levels among working men in Greater Beirut

This cross-sectional study reports the blood lead levels (BLL) among different working groups in Beirut and identifies the risk factors associated with elevated BLLs. A total of 579 men of 18 years of age or older (response rate 96%) working in Greater Beirut were interviewed. Of those, 315 (54.4%) provided a blood sample of which 291 were analyzed for lead. The mean BLL of the 134 men working in white-collar jobs (offices, retail shops) was 12.7 microg/dl (SD 3.7); statistically significantly lower than the mean BLL (18.4 microg/dl; SD 9.8) of the 157 men working in blue-collar occupations (such as gas station attendants, painters, mechanics). A blood lead level of 15 microg/dl or more was associated with blue-collar jobs, number of cigarettes smoked, commuting > or = 3 km to work, years in current occupation, and younger age. A BLL of at least 20 microg/dl was associated with eating lunch at work, in addition to blue-collar jobs, smoking, commuting, years of work, and younger age. The study findings suggest that environmental exposure (those not otherwise exposed to occupational lead) is mainly determined by smoking and exposure to leaded gasoline (commuting). Occupational exposure to lead is prevalent among a wide spectrum of Lebanese workers. Physicians are called upon to inquire more about the potential for lead exposure, especially among blue-collar workers. A policy action to improve working conditions and to phase out the use of leaded gasoline is recommended.     

CASE-CONTROL STUDY ON MYOCARDIAL INFARCTION

This case-control study was made in olrder to study the risk factors for coronary heart disease (CHD). Patients who survived acute stage of myocardial infarct.ion (Ml) diagnosed with certainty clinically were chosen as index cases. Controls were matched in sex and occupation, with an age difference olC less than 5 years. They were free from evidence of CHD and had negative electrocardiographic exercise tests. Altogether, 200 consecutive Mi cases ad- mitted to our hospitals were investigated. They included 179 males and 21 females. Average ages of patients and controls were 60.5 and 60.3 years. Association of hypertension xvith myocardial infarction is far greater than with controls. rl:hc. relative risk is 5.5-7.6 depending on the hyper- tension diagnostic criteria. There is also a higher association between cigarette smoking and Ml with relative risk at 3.6. No association is found with serum cholesterol level, body weight index, quantities of meat or rice intake, sleep, physical exercise, past history of diabetes mellitus or CHD family history. Hypertension and smoking are apparently the Ml risk factors Jn this part of China. - 873 -     

The impact of diabetes on survival following myocardial infarction in men vs women. The Framingham Study

The impact of diabetes on recurrent myocardial infarction (MI) and fatal coronary heart disease was examined in survivors of an initial MI using 34-year follow-up data in the Framingham Study. Among nondiabetic patients, the risk of fatal coronary heart disease was significantly lower in women compared with men (relative risk, 0.6). In the presence of diabetes, however, the risk of recurrent MI in women was twice the risk in men. In addition, the effect of diabetes doubled the risk of recurrent MI in women (relative risk, 2.1) but had an insignificant effect in men. Increased susceptibility to cardiac failure among diabetic women was an important factor in determining survivorship. Women with diabetes developed cardiac failure four times more often (16%) than women without diabetes (3.8%). Furthermore, when cardiac failure developed, 25% of diabetic women experienced a recurrent MI or fatal coronary event, more than doubling the rate when diabetes was absent. We conclude that in the diabetic patient who survives an MI, cardiac failure is a common occurrence, warranting early detection and vigorous management in periods of convalescence and follow-up. In addition, when cardiac failure appears, control of diabetes assumes added importance, particularly in women, where its effect on survivorship is considerable.     

冠心病风险因素识别及其预测模型构建

目的：利用逻辑回归分析识别冠心病发作的危险因素,使用常见机器学习算法构建冠心病风险预测模型,为冠心病的早期预防与筛查提供理论参考。方法：通过对Kaggle发布的冠心病数据进行预处理和特征筛选后进行逻辑回归分析识别主要危险因素,选用逻辑回归、支持向量机、线性判别分析、决策树和随机森林5种常见机器学习算法进行冠心病发病预测。结果：性别、年龄、平均每日吸烟量、总胆固醇水平、收缩压和血糖水平是10年内冠心病发作的主要危险因素。选用的5种机器学习算法准确率与稳定性良好。与基于统计的线性判别分析相比,决策树与随机森林并未表现出明显的优越性。结论：机器学习技术适用于冠心病发作风险的预测,能够为冠心病的防控提供参考依据。     

高血压合并焦虑、抑郁的发病率和相关危险因素分析

目的　通过调查了解目前高血压病人的焦虑、抑郁状况。方法　在随机抽取的北京市9 所医院的心血管内科门诊,对连续就诊的高血压病人进行访问,填写焦虑自评量表和抑郁自评量表,评定高血压患者中焦虑和抑郁的发病率,并识别相关的危险因素。结果　共入选2 274例高血压患者,其中男性1 025例(45.1%),女性1 249 例(54.9%),焦虑发生率38.5%, 抑郁发生率5.7%,其中男性的焦虑发生率为31.5%,抑郁发生率为3.7%,女性的焦虑发生率为42.7%,抑郁发生率为7.4%。高血压伴发焦虑的独立危险因素为:女性、低年龄组、独身、高教育程度、无业、低收入、病程时间长、高血压分级水平高、有冠心病;高血压伴发抑郁的独立危险因素为高龄、独身、女性、病程时间长、低收入、低教育程度、冠心病、糖尿病。结论　高血压患者中焦虑的发病率高于抑郁。女性、独身、病程时间长、低收入及合并有冠心病是焦虑和抑郁的共同危险因素;此外,低龄、高教育程度、体力劳动者容易发生焦虑。高龄、低教育程度亦是抑郁的危险因素。     

Associations between symptoms of irritable colon and psychological and social conditions and lifestyle

In a survey of risk factors for coronary heart disease 14 102 middle aged men and women answered a questionnaire on lifestyle, diet, and health, including symptoms of functional abdominal disorders. The overall prevalence of reports of one or both of the abdominal symptoms of "bloating and rumbling" or "cramping abdominal pain" was 28% in men and 35% in women. Only a weak negative association between age and prevalence of reported pain was found in both sexes. Women reported abdominal symptoms, especially cramping abdominal pain, significantly more commonly than men. In a multiple regression analysis abdominal symptoms were much more strongly associated with symptoms of mental stress such as depression, sleeping difficulties, problems of coping, and the use of analgesics than with lifestyle, dietary, and social variables together. The association was stronger in subjects reporting both symptoms. This strong and consistent association between functional abdominal disorders and psychological and social problems suggests that action other than prescribing drugs, diets, or radiography is required.     

颈动脉超声在冠心病诊断中的应用

目的：通过颈动脉超声和冠脉造影对粥样板块和颈动脉硬化级别对比,探讨颈动脉超声在冠心病诊断中的价值。方法对我院2010年1月~2013年12月间收治且经冠脉造影检查确诊为冠心病患者108例,另选30例健康体检者进行对比研究。收集冠脉造影检查数据,并对所有患者行颈动脉超声检查,观察粥样斑块数量、颈动脉硬化级别、IMT。结果两种检查粥样斑块数量、颈动脉硬化级别同组间对比差异不显著（P〉0.05）;不同组别同种检查粥样斑块数量、颈动脉硬化级别对比,均存在显著差异（P〈0.05）。以冠脉造影检查为金标准,颈动脉超声诊断IMT敏感度为86.58%,特异性为61.54%,诊断符合率为80.56%;颈动脉超声诊断粥样斑块敏感度为89.66%,特异性为57.14%,诊断符合率为83.33%。结论颈动脉超声可作为临床预测冠心病检查,缺乏数据依据,应加强两者间数据关系研究,以提高确诊率,相信随着研究的不断深入,定可作为无创、准确的冠心病检查方法。     

气温日较差对淄博市冠心病入院人数的短期影响

目的 探究气温日较差(DTR)对淄博市每日因冠心病入院人数的影响。方法 利用2015年至2019年淄博市每日因冠心病入院人数、每日的气象和空气污染数据。在调整长期趋势、气象变量、节假日效应等影响因素后,采用广义加性模型探究DTR对每日因冠心病入院人数的影响。同时,按年龄、性别进行亚组分析,识别脆弱人群。结果 研究期间淄博市上报的冠心病入院人数共计21 105人。DTR显著增加冠心病入院的人数。在滞后1 d时,单日效应达到最大,相应的RR值为1.053(95%CI:1.026～1.081);在累积滞后4 d时,累积效应达到最大,相应的RR值为1.076(95%CI:1.016～1.139)。不同性别、年龄组之间DTR的效应未见明显差异。结论 较大的DTR会增加冠心病的入院风险。相关部门应开展DTR与冠心病相关知识的健康教育,同时针对温差变化较大的天气,提高预报精准度,引导群众做好个人防护以减少DTR的影响。     

血清同型半胱氨酸对冠状动脉粥样硬化性心脏病患者脑卒中发病的影响

目的  探讨血清同型半胱氨酸（Hcy）水平对冠状动脉粥样硬化性心脏病（以下简称冠心病）患者脑卒中发病的影响，为临床研究提供参考依据。方法  回顾性收集130例冠心病合并脑卒中的患者作为观察组，同期纳入145例仅有冠心病的患者作为对照组。抽取空腹肘正中静脉血2 ml检测血清Hcy，分析血清Hcy水平对冠心病患者脑卒中发病的影响。结果  观察组糖尿病史、高血压病史、吸烟史、体重指数≥25 kg/m2、冠心病年限患者多于对照组，Hcy及低密度脂蛋白胆固醇（LDL-C）水平明显高于对照组，差异有统计学意义（P <0.05）。多因素分析显示，糖尿病史、高血压病史、吸烟史、Hcy及LDL-C水平增高是冠心病患者脑卒中发生的高危因素（P <0.05）。冠心病患者中Hcy四分位水平最高组（>15.77μg/ml）发生脑卒中的风险是最低组（<10.33μg/ml）的1.84倍（P =0.024），校正相关危险因素后，发生风险仍存在，■为1.74倍（P =0.045）。结论  血清Hcy水平升高是冠心病患者脑卒中发生的高危因素，且随血清Hcy水平升高其发生风险进一步增加。

     

广州市居民肺癌死者的职业分析

根据1982年广州市全人口肺癌死者个案调查及人口普查资料,分析了职业因素对广州市居民肺癌死亡率的影响,结果表明:产业工人的标化死亡比(SMR)高于脑力劳动者;接触有害物质的工种,可使男性鳞癌的 SMR 增加,但对女性则未见到接触有害物质使鳞癌 SMR 高于腺癌 SMR 的倾向。吸烟与否对男性肺癌的职业 SMR 有所影响,然而对女性的影响却不明显。全人群中家务劳动者与干部的肺癌人群特异危险度(PAR)高于其他职业,可能与他们在全人口中所占比例较大有关。     

更年期女性冠心病患者心血管危险因素与干预现状的调查研究

目的 对更年期女性冠心病患者的心血管危险因素进行研究并就其干预现状进行调查.方法 纳入某社区2011年5月的更年期女性500例,经心电图及冠脉造影检查对冠心病进行筛选,确诊冠心病患者162例为冠心病组,对冠心病组患者进行危险因素研究,并计算更年期女性冠心病的发病率;未患冠心病的更年期女性为非冠心病组,对其进行危险因素干预,随访3年后对非冠心病组患者新发病率进行总结,并对比冠心病组新发病率,判定干预效果.结果 实验数据表明,更年期女性冠心病患者心血管危险因素有BMI（OR=1.499,P=0.032 ＜0.05）、高密度脂蛋白胆固醇（OR =0.012,P=0.026＜0.05）、低密度脂蛋白胆固醇（OR=13.251,P=0.016 ＜0.05）、尿酸（OR=1.021,P=0.009＜0.01）、高血压（OR =6.132,P=0.0075 ＜0.01）、糖尿病（OR =8.124,P=0.0082 ＜0.01）.对危险因素进行干预后,非冠心病组随访结果显示其新发病率（1 3.9％）明显低于原发病率（32.4％）,对比差异显著（P =0.001 ＜0.01）,具有统计学意义.结论 更年期女性冠心病患者心血管危险因素的研究及预防具有重要的临床作用和价值.     

平板运动试验阳性对冠心病的诊断价值

[目的]探讨平板运动试验阳性对冠心病的诊断价值.[方法]选取平板运动试验阳性并行冠状动脉造影(CAG)的126例患者临床资料,依据CAG结果将其分成真阳性组和假阳性组,比较两组之间在年龄、性别、冠心病危险因素、ST段偏移的导联数及偏移程度的差异;统计真阳性组患者病变支数在性别上的相关性;分析未达到目标心率患者冠状动脉病...