宜宾地区体检人群非酒精性脂肪肝患病率调查

目的 调查宜宾地区常规体检人群非酒精性脂肪肝(NAFLD)患病情况。方法 通过体检调查2 005名常规体检者非酒精性脂肪肝的患病率并比较病例组和对照组的常见体检指标和生化指标。结果 宜宾地区常规体检人群非酒精性脂肪肝患病率为20.85%,男性高于女性(χ2=19.86,P<0.05);病例组体重指数(BMI)、腰臀比(WHR)、甘油三酯(TG)、总胆固醇(TC)、谷丙转氨酶(ALT)、血压(BP)等指标高于对照组(P<0.05)。结论 宜宾地区NAFLD患病率较高,加强社区健康教育,改变居民行为生活方式对预防NAFLD至关重要。     

代谢综合征各组分与非酒精性脂肪肝发生的回顾性巢式病例对照研究

目的 研究天津市体检人群非酒精性脂肪肝（NAFLD）自然新发情况及与基线代谢综合征各组分指标间的关系。方法 采取回顾性巢式病例对照研究,收集2011年（基线）和2013年均在天津市第一中心医院健康体检中心接受体检的3 842人的体检结果,包括体格检查、生化指标测定结果、饮酒史、用药史及B超诊断结果等。分析基线（2011年）无脂肪肝人群到2013年NAFLD自然新发情况,并采用主成分改进的Logistic回归分析基线代谢综合征各组分指标与新发NAFLD间的关联性。结果 基线无NAFLD的1 226人中2年内有224人新发生NAFLD,累积发病率为18.30%,根据全国2010年人口普查人口结构进行标化,年均标化发病率为8.17%,其中男性为10.91%,女性为5.36%;单因素分析显示:新发NAFLD组基线体重指数（BMI）、收缩压（SBP）、舒张压（DBP）、空腹血糖（FBG）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、极低密度脂蛋白胆固醇（VLDL-C）、丙氨酸转氨酶（ALT）与尿酸（UA）水平均高于对照组,高密度脂蛋白胆固醇（HDL-C）水平低于对照组（P ＜0.05）;主成分改进的Logistic回归进行多因素分析显示:基线BMI（OR = 1.211）、TG（OR = 1.446）、LDL-C（OR = 1.216）、UA（OR = 1.001）是NAFLD发生的独立危险因素,HDL-C（OR = 0.394）是独立保护因素。结论 在天津市体检人群中,基线MS各组分指标与NAFLD的发生密切相关,并且基线BMI、TG、LDL-C、UA是NAFLD发生的独立危险因素,HDL-C是独立保护因素,可以认为NAFLD是代谢综合征在肝脏的表现。     

广西城乡居民膳食摄入水平与糖代谢异常的关系

目的探讨广西城乡居民膳食摄入水平与糖代谢异常的关系。方法按照多阶段随机抽样法，分别抽取广西4个城市和4个农村共2281名18岁及以上城乡居民进行调查，内容包括膳食调查、体格检查和血糖检测。结果共检出糖尿病37例，空腹血糖受损（IFG）26例，糖代谢异常患病率为2．8％。其中城市1020人，糖尿病26例，IFG15例，糖代谢异常患病率为4．0％；农村1261人，糖尿病11例，IFG11例，糖代谢异常患病率1．7％，城市居民糖代谢异常率高于农村，差别有统计学意义（P〈0．01）。单因素分析显示，城市居民糖代谢异常者畜肉、畜禽肉、腌菜、油脂摄入量高于血糖正常人群。差别有统计学意义（P〈0．05）；农村糖代谢异常者酒摄入量高于血糖正常人群，差别有统计学意义（P〈0．01）。经Logistic多因素分析显示，腌菜（OR=1．36）、油脂（0R=1．33）是广西城乡居民糖代谢异常的膳食危险因素，而薯类食物是保护因素（OR=0.80）。结论膳食因素与广西城乡居民糖代谢异常发生关系密切。     

上海市成年健康体检人群非酒精性脂肪肝检出现状及危险因素分析

目的 探析上海市成年健康体检人群非酒精性脂肪肝（NAFLD）的检出现状及相关危险因素。方法选取2020年1—12月在华东疗养院行健康体检的成年人为研究对象,收集其基本资料和体检结果。采用Logistic回归模型分析NAFLD发生的可能相关危险因素。结果 共纳入14 346名健康体检者,男7 623人,女6 723人,年龄18～90岁,平均（46.04±11.97）岁。共检出NAFLD 5 567例,总检出率为38.8%。多因素Logistic回归分析结果显示,女性NAFLD检出风险较男性低（OR=0.623）,年龄每增加1岁（OR=1.036）、中心性肥胖（OR=1.403）、饮食以荤食为主或高糖高盐饮食（OR=1.713）、血脂异常（OR=3.433）、空腹血糖增高（OR=3.664）、肝功能异常（OR=4.403）、高血压（OR=1.936）、尿酸增高（OR=2.712）的健康体检者NAFLD检出风险较高。结论 上海市成年健康体检人群NAFLD检出较高,男性、年龄增加、中心性肥胖、荤食为主或高糖高盐饮食、肝功能异常、空腹血糖增高、血脂异常、尿酸增高、高血压是NAFLD发生的危险因素...     

非酒精性脂肪肝相关危险因素分析

[目的]通过流行病学调查,分析NAFLD的相关危险因素,为NAFLD的防治提供理论依据。[方法]805人依据体检情况分为NAFLD组和非NAFLD组,分析年龄、性别、体重指数(BMI)、血压、血脂、血糖等因素与NAFLD的相关性。[结果]①男性NAFLD患病率大于女性(P﹤0.01);女性NAFLD患病率随年龄增长呈升高趋势(P﹤0.01)。②对NAFLD危险因素指标进行Logistic多因素逐步回归分析,结果显示TG、BMI、FBG、男性、DBP是NAFLD形成的主要危险因素;TG、BMI、FBG、年龄、DBP是女性NAFLD形成的主要危险因素,TG、BMI、FBG、DBP是男性NAFLD形成的主要危险因素。[结论]NAFLD形成的主要危险因素包括TG、BMI、FBG、DBP、男性;女性NAFLD形成的主要危险因素包括TG、BMI、FBG、年龄、DBP;男性NAFLD形成的主要危险因素包括TG、BMI、FBG、DBP。     

北京市3 87名肥胖中学生非酒精性脂肪肝等代谢异常罹患状况调查

目的 了解北京市城区中学生常规体检筛查肥胖人群中非酒精性脂肪肝(NAFLD)等代谢异常的罹患状况。方法 采用现况调查方法,对北京市西城、海淀区8所中学常规体检筛查出387名12～17岁肥胖学生进行临床健康风险评估,内容包括问卷调查、体格测量、检查黑棘皮症和腹部肝脏超声,以及空腹血糖、血脂(TC、TG、HDL—C和LDL—C)、肝功能血生化指标检测。采用2010年中华医学会肝脏病学分会脂肪肝和酒精性肝病学组推荐的NAFLD诊断标准。用SPSS16．0软件进行统计分析,利用t检验、x²检验、协方差分析及多因素logistic回归分析。结果 387名肥胖中学生的NAFLD检出率为45．0％;糖尿病和空腹血糖受损(IFG)患病率为o．8％和49．1％;随着肥胖程度增加,NAFLD患病率、黑棘皮症检出率、血脂紊乱和肝功能损害程度呈上升趋势。肥胖合并NAFLD中高TC、高LDL．C、低HDL．C、高TG、IFG、肝功能异常和黑棘皮症检出率分别为6．3％、4．0％、37．9％、22．8％、46．0％、17．8％和28．5％,NAFLD组高TG、肝功能异常、黑棘皮症的患病率高于非NAFLD组,差异有统计学意义(P<0．001)。多因素分析显示,肥胖学生BMI每增加1 kg／m2,发生NAFLD的风险增加40％;有黑棘皮症的肥胖学生发生NAFLD风险是无黑棘皮症的2．74倍(95％CI：1．36～5．52),高TG可增加肥胖学生罹患NAFLD的风险(OR=2．75,95％CI：1．48。5．11)。结论 以学校常规体检来源的肥胖学生中NAFLD检出率较高,同时伴有血脂、血糖等代谢异常。高BMI、高TG和黑棘皮症独立作用于NAFLD。     

不同类型非酒精性脂肪肝与糖脂代谢的相关分析

目的评价不同程度肝脏脂质浸润对糖脂代谢的影响，并进行非酒精性脂肪肝（NAFLD）的相关因素分析。方法根据NAFLD患者是否伴有肝脏转氨酶升高及是否同时合并糖代谢异常，将受试对象253例分为单纯脂肪肝（FL）组、脂肪性肝炎（NASH）组、单纯脂肪肝合并糖调节受损（FLI）组、脂肪性肝炎合并糖调节受损（NSI）组和对照（NC）组，分析5组间糖脂代谢、舒张压（DBP）、收缩压（SBP）、体质指数（BMI）及腰围（WC）等方面的差异，并探讨各因素与NAFLD间的相关性。结果与NC组比较，其余4组WC、SBP、空腹血糖（FPG）、30min血糖（BG）、2hBG、空腹胰岛素（FINS）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）、稳态模型胰岛素抵抗指数（HOMA-IR）明显升高，而高密度脂蛋白胆固醇（HDL-C）降低，差别有统计学意义（P〈0．05）。除对照组外，其余4组间比较，WC、LDL-C差别无统计学意义（P〉0．05）；NASH组与FL组、NSI组与FLI组比较，2hBG、TG、HDL-C差别无统计学意义（P〉0．05）；NSI组和FLI组比较，FINS无统计学意义（P〉0．05），其他各项指标均有统计学意义（P〈0．05）；FLI组与FL组、NSI组与NS组间比较，SBP、FBG、30minBG、2hBG、FINS、TG、HDL-C差别有统计学意义（P〈0．05）。进一步进行相关性分析发现，NAFLD与HOMA-IR间有独立的相关性归0．31，P〈0．05）。结论随着NAFLD并发NASH和（或）合并糖代谢异常可以进一步加重机体代谢紊乱，NAFLD患者尽管具有与NC组相似的BMI，WC和胰岛素抵抗指数（IR）仍明显增加，提示WC与NAFLD和IR间有明确的相关性，其作为中心性肥胖的指标优于BMI。     

新疆柯尔克孜族成人非酒精性脂肪肝病患病率及临床特征分析

目的探讨新疆柯尔克孜族成人非酒精性脂肪性肝病(NAFLD)的患病率及临床特征。方法选取2018年新疆维吾尔自治区阿合奇县地区常住柯尔克孜族成人全民体检数据,共19 843例,分析NAFLD患病率。经腹部B超确诊NAFLD的1 396例为病例组,按1∶3的比例选取年龄、性别、地区相匹配的4 188例非NAFLD者为对照组;分析NAFLD患者临床特征及其危险因素。结果柯尔克孜族成人NAFLD总体、男性、女性患病率分别为7.0%、7.8%、6.2%(标化后分别为6.8%、7.5%、6.0%),男性患病率高于女性(P0.01)。肥胖、糖尿病及高血压组的NAFLD患病率明显升高,分别为19.0%、20.6%、18.5%。NAFLD组的BMI、腰围、甘油三酯、AST、ALT均高于对照组(均P0.01)。NAFLD人群中有17.2%合并一种代谢紊乱疾病,62.0%合并两种代谢紊乱。Logistics回归分析显示:腰围(OR=4.08,95%CI:3.04～5.10)、空腹血糖(OR=3.76,95%CI:2.86～4.93)、BMI(OR=3.32,95%CI:2.16～4.38)是NAFLD发生的主要危险因素;而文化程度(OR=0.42,95%CI:0.24～0.69)、运动(OR=0.68,95%CI:0.45～0.96)是保护因素。结论柯尔克孜族成人NAFLD患病率低于全国水平,NAFLD患者常合并多种代谢紊乱。腰围、空腹血糖、BMI是其患NAFLD的主要危险因素,而文化程度、运动为保护因素。     

2型糖尿病合并非酒精性脂肪肝患者临床特征及相关因素分析

目的分析2型糖尿病合并非酒精性脂肪肝（NAFLD）患者的临床特点，探讨其相关因素。方法回顾性分析2008—2010年期间1007例2型糖尿病住院患者的临床资料，根据腹部B超结果分为无NAFLD组和NAFLD组。收集两组的年龄、病程等一般资料，身高、体重、体质指数（BMI）、糖化血红蛋白（HbA1c）、血脂、肝功能、肾功能、24h尿定量等检测指标的数据，进行Logistic回归分析。结果与无NAFLD组相比，NAFLD组年龄较小，糖尿病病程短，尿酸清除率降低，差异均有统计学意义（P〈0．01）；BMI、血尿酸（SUA）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰转移酶（GGT）均升高，差异均有统计学意义（P〈0．01）。Logistic回归分析显示，NAFLD的发病随年龄、病程、BMI、肝酶（ALT、AST、GGT）水平、SUA水平增加而增加，差异有统计学意义（P〈O．01）。结论肥胖的2型糖尿病患者常伴有NAFLD。合并NAFLD的2型糖尿病患者易发生肝功能损害。升高的BMI、SUA可预示2型糖尿病患者NAFLD的发生。     

代谢综合征与非酒精性脂肪肝的相关性分析

摘要:目的　通过流行病学调查,分析非酒精性脂肪性肝病（NAFLD）的相关危险因素,以探讨NAFLD与代谢综合征（MS）的相关性。方法　873人依据体检情况分为NAFLD组和非NAFLD组及MS组和非MS组,分析体重指数（BMI）、血压、血脂、血糖（FBG）等因素与NAFLD的相关性。结果　（1）NAFLD患病率41.123%,男性患病率高于女性（χ2＝21.804,P＜0.001）。MS患病率15.693%,MS组NAFLD患病率高于非MS组（χ2＝99.171,P＜0.001）。（2）NAFLD组BMI、FBG、收缩压（SBP）、舒张压（DBP）、甘油三酯（TG）、胆固醇（TC）、低密度脂蛋白（LDL-C）、谷丙转氨酶（ALT）、尿酸（UA）值均高于非NAFLD组（P＜0.001）,谷草转氨酶（AST）值高于非NAFLD组（t＝3.242,P＝0.001）,HDL-C值低于非NAFLD组（t＝3.510,P＜0.001）;超重和（或）肥胖、高血糖、高血压、高TG、低HDL-C、高尿酸血症、MS阳性率均高于非NAFLD组（P＜0.001）,肝功能异常阳性率高于非NAFLD组（t＝10.119,P＝0.002）。（3）NAFLD患病率随着MS诊断标准中诊断项目的增多呈上升趋势（χ2＝239.918,P＜0.001）。结论　MS与NAFLD密切相关,并相互影响。     

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.     

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.