高血压患者不良生活习惯与心血管疾病死亡和全因死亡风险关系的研究

目的 探讨吸烟对饮酒高血压患者心血管疾病死亡(CVDM)和全因死亡(ACM)风险的影响,分析吸烟量和饮酒量同时升高对饮酒高血压患者死亡和全因死亡风险是否存在协同作用.方法 选取2004年1~12月我院老年病科诊治的饮酒高血压患者1000例.收集所有患者的人口统计学信息、吸烟信息及个人疾病史等资料,随访记录患者的CVDM和ACM.采用COX比例风险模型分析吸烟指标对饮酒高血压患者CVDM和ACM风险的影响.结果 在CVDM风险和ACM发生风险方面:每日吸烟量>10支高于1~10支,累计吸烟量≥20包/年高于0.1~19包/年,吸烟年限>35年高于1~35年,开始吸烟年龄<20岁高于>20岁,差异均具有统计学意义(P<0.05);当每日饮酒量>200 ml/d,累计饮酒量≥20(盅/年),饮酒年限>35年或饮酒开始年龄≤20岁患者的CVDM风险分别为RR=2.352、2.693、2.254、2.336;ACM风险分别为RR=3.092、2.346、1.936、2.018.结论 吸烟可增加饮酒高血压患者CVDM和ACM风险,风险的大小与吸烟量和吸烟年限呈剂量反应关系;饮酒量和吸烟量同时升高可进一步增加此风险.     

Risk of death due to hepatocellular carcinoma among drinkers and ex-drinkers. Univariate analysis of JACC study data

Hazard ratios (HR) of death due to hepatocellular carcinoma (HCC) were analyzed by gender and age strata (40-59 and 60-79) among drinkers and ex-drinkers in 66,974 eligible subjects from a a large cohort of male and female subjects aged 40-79 years, based on information about several drinking related characteristics. The HR of dying from HCC for ex-drinkers was 4 to 8 times higher than for those who had never consumed alcohol at the baseline survey. When the subjects were restricted to those without history of liver disease (LD), the HR was still high for ex-drinkers among younger males, though the difference was not statistically significant. It appeared that the earlier drinking habits were established, the higher the HR, especially for younger males without LD. Among total current drinkers, the amount ingested per occasion and the cumulative amount ingested at the baseline did not show significantly increased HRs. Among subjects without LD, larger amounts ingested per occasion and larger cumulative amount seemed to have higher HRs in older male current drinkers. Frequent drinking and later age (50 to 79) at cessation of drinking were associated with higher HRs among both genders and both age strata. After restricting the analysis to subjects without LD, many of these increased HRs remained among males. The results suggested that the association between alcohol drinking history and HR of HCC differs depending on the presence of LD. Major confounders other than age and gender associated with both drinking and HCC, e.g. smoking, hepatitis virus infection, or history of diabetes, were not considered in this analysis, and the observed associations might be confounded by any of these factors. To clarify the net association between alcohol drinking and HCC, further analysis is needed to control potential confounders, including past history of liver disease, and to consider probable effect modifiers.     

吸烟、饮酒的糖尿病危险性分析

目的：了解吸烟、饮酒在糖尿病发病风险中的作用,及其对糖尿病及IGT患者餐后血糖、血压、BMI及WHR的影响。方法：利用广东省1998年对全省11742名抽样 群进行的糖尿病流行病学调查数据,做多元Logistic回归分析和广义线性模型方差分析。结果：调查人群中,糖尿病主要独立预测因素为年龄（OR＝2．053,1．568－2．687）、家族史（OR＝3．210,2．019－5．104）职业运动量（OR＝1．644,1．217－2．221）、WHR（OR＝2．255,1．690－3．008）、BMI（OR＝2．538,1．905－3．381）和高血压（OR＝3．088,2．246－4．245）。吸烟和饮酒的独立风险作风不显著,调整年龄,运动、家族史、经济水平等其他因素后,每日吸烟＞25支或每周饮酒7次的相对危险度（OR）分别为1．037（0．367－1．535）和1．261（0．718－2．214）。但吸烟、饮酒和年龄、职业反动量及家族史有明显的相乘交互作用,每日吸烟＞25支明显增加50岁以上人群和低职业运动量人群的糖尿病患者病险,每周饮酒＞7次除增加职业运动量较低人群患病风险外,使50岁以下人群的患病危险性增加1．42倍,并大幅增加糖尿病家族史人群的相对危险性（OR＝8．61,2．14－34．63）,在糖尿病及IGT患者中,当前吸烟者的BMI低于已戒烟和不吸烟者,WHR则高于不吸烟者,当前饮酒者BMI较已戒酒者低,但WHR差异不明显。结论：大量吸烟、饮酒是糖尿病可变的、非独立的危险因素,与年龄、少运动和家族史等主要危险因素有明显的相乘交互作用,吸烟可能导致糖尿病及IGT患者体脂异常分布。     

Prevalence of smoking and drinking habits among Form Six students in Petaling District, Selangor

Smoking and alcohol intake patterns may persist from adolescence to adulthood. The aims of this study are to determine the prevalence and factors associated with smoking and drinking habits among Form Six students. This was a cross-sectional study conducted in January 2003 among Form Six students from government schools in the Petaling District, Selangor. A hundred and thirty six self-administered questionnaires were distributed to students selected through multistage stratified sampling. Response rate in this study was 90.1% (136/151). The respondents were mainly Chinese 60 (44.1%) and female 88 (64.7%). The prevalence of smoking was 22.8%, whereas the prevalence of alcohol intake was 47.8%. Only 33.1% of the respondents practiced undetermined activities and 1.5% have undetermined characters. There were significant associations between smoking and males (Adjusted OR 2.56, 95% CI 1.02-6.43) and smoking and alcohol intake (Adjusted OR 2.74, 95% CI 1.11-6.78). Alcohol intake has significant negative association with Malays (Adjusted OR 0.83, 95% CI 0.03-0.27). Smoking habits among adolescents were associated with males and alcohol intake. However, only alcohol intake was negatively associated with Malays. Program interventions to reduce behavioral problems, particularly smoking and alcohol intake should be emphasized.     

Risk of death due to hepatocellular carcinoma among smokers and ex-smokers. Univariate analysis of JACC study data

Hazard ratios (HR) of death due to hepatocellular carcinoma (HCC) were analyzed by gender and age strata (40-59 and 60-79) among smokers and ex-smokers in 65,528 eligible subjects from a large cohort of males and females aged 40-79 years, based on information about several smoking-related characteristics. Both current smokers and ex-smokers among total older males had hazard ratios (HR) for dying from HCC that were 2 to 4 times higher than those who had never smoked at the baseline survey. When subjects were restricted to those without history of liver disease (LD), older male (60-79) ex-smokers presented a statistically significant HR of 5.0. Earlier age at start of smoking (15 to 19) showed a significantly increased HR of 4 to 8 for both current and ex-smokers. Moderate number of cigarettes smoked per day showed an increased HR, and later age at cessation of smoking had a higher HR compared to earlier cessation. Larger cumulative amount of smoking resulted in an elevated HR of 11 times than in those who had never smoked. Cigarette smoking was suggested to be an important risk factor for death from HCC regardless of whether the smoking habit was in the past or was continuing at present. To eliminate confounding effects and interaction with other risk factors of HCC and to clarify the net association between smoking habits and HCC, farther careful analysis using multivariate models is needed.     

A comparison of smoking and drinking behaviours in pregnant women: who abstains and why

Changes in alcohol and nicotine usage during pregnancy are reported for a sample of 112 pregnant women, 35 of whom smoked cigarettes before pregnancy and 86 of whom drank alcohol before pregnancy. Striking differences were observed among the patterns of cigarette smoking compared with those of drinking. One hundred per cent of drinkers reported a reduced intake of alcohol but only 57% of the smokers reported a decrease in cigarette smoking. Forty per cent of the smokers reported that they had "tried and failed" to cut down on their cigarette consumption yet none of the drinkers reported such a failure. A reduction in drinking during pregnancy was related directly to an antenatal emotional attachment to the fetus and related inversely to feelings of irritability towards the fetus. In the case of smoking, this relationship did not emerge, and it seemed probable that a psychological and a physiological dependence on nicotine may override the effect of an emotional attachment to the fetus. Implications for the prevention of smoking are discussed.     

慢性乙型病毒性肝炎肝硬化发生肝细胞癌的危险因素分析

?目的: 探讨慢性乙型病毒性肝炎肝硬化发生肝细胞癌（HCC）的危险因素。方法: 研究对象为317例慢性乙肝患者,包括183例慢乙肝肝硬化患者（肝硬化组）和134例慢乙肝相关HCC患者（HCC组）,对其性别、年龄、吸烟及饮酒习惯、伴发疾病、实验室检查指标等资料进行比较,探讨慢乙肝肝硬化发生HCC的危险因素。结果: HCC组患者男性所占比例、年龄、有长期大量饮酒习惯、血HBV DNA阳性、合并糖尿病（DM）及高血压所占比例均高于肝硬化组,两组比较P均<0.05。Logistic回归分析显示,男性、年龄较大、血HBV DNA阳性、DM是慢乙肝肝硬化患者发生HCC的独立危险因素（OR分别为0.326、1.055、2.988、2.031,P均<0.05）。结论: 男性、年龄升高、血HBV DNA阳性、DM是慢乙肝肝硬化患者发生HCC的独立危险因素。     

饮茶习惯与原发性肝癌关系的现况调查

采用大样本的流行病学现况调查方法对肝癌高低发区男性人群饮茶习惯与肝癌死亡率的关系进行了探讨，结果显示，不同地区男性人群的饮茶率及每周饮茶量与原发性肝癌的死亡率显著负相关，相关系数分别为－０．９２和－０．９１．即饮茶率及饮茶量较高的地区，肝癌死亡率相对较低。饮茶人群中肝癌的累积死亡率为１２０．０５／１０万，显著的低于非饮茶人群（２４５．５３／１０万），在对吸烟、饮酒因素分层后仍可得到同样结果。说明饮茶可能具有一定的防癌作用。     

颈动脉狭窄支架置入术患者生活习惯与术后并发症相关性分析及护理对策

目的针对患者术后并发症与生活习惯的相关性进行分析,并对并发症提出相应的护理措施。方法对60患者的生活习惯进行分类,分析每种不同生活习惯患者的并发症发生率,采用多因素Logistic回归分析不同生活方式与患者发生并发症的关系,同时针对不同的并发症提出相应的护理对策。结果吸烟≥10根/d、每日饮酒以及运动时间〈3 h/周者并发症发生率显著高于吸烟〈10根/d、不饮酒或极少饮酒以及运动时间〉3 h/周的患者（P〈0.05）;每日均摄入肥肉和以动物油为主的患者并发症发生率显著高于非每日摄入肥肉和以植物油为主的患者（P〈0.05）。吸烟、饮酒、每日摄入肥肉和摄入动物油是并发症发生的危险因素,而摄入水果以及每日运动则是并发症发生的保护因素。结论戒烟、戒酒、低脂饮食并配合适当的运动是可减少颈动脉狭窄支架置入术术后并发症发生率的健康生活方式。     

Modifying risk of developing lung cancer by changing habits of cigarette smoking

Data from a hospital based case-control study of lung cancer in Western Europe were used to examine changes in the risk of developing lung cancer after changes in habits of cigarette smoking. Only data for subjects who had smoked regularly at some time in their lives were included. The large size of the study population (7181 patients and 11 006 controls) permitted precise estimates of the effect of giving up smoking. Risks of developing lung cancer for people who had given up smoking 10 or more years before interview were less than half of those for people who continued to smoke. The reduction in risk was seen in men and women and in former smokers of both filter and non-filter cigarettes but varied by duration of smoking habit before giving up. The protective effect of giving up became progressively greater with shorter duration of smoking habit. The risks after not smoking for 10 years for both men and women who had previously smoked for less than 20 years were roughly the same as those for lifelong non-smokers. Reducing the number of cigarettes smoked a day or switching from non-filter to filter cigarettes also lowered the risk of developing lung cancer but not to the extent associated with giving up smoking.     

在航渔民烟酒嗜好与相关疾病

目的:探讨20～50岁渔民吸烟和饮酒嗜好与相关疾病的关系。方法:调查54例20～50岁渔民既往疾病史、进行体格检查,并采用Russell吸烟原因问卷、酒精依赖性疾患识别测验问卷AUDIT-I和AUDIT-Ⅱ进行检测,对所患的疾病、吸烟饮酒的数量和问卷结果进行统计学分析。结果:渔民组吸烟和饮酒的比率、年限、消费的数量及对烟酒的依赖远较对照组高(P<0.01～0.001);高血压、肝炎的发生率较对照组明显增高(P<0.02～0.0001)。患肝肿大、溃疡与吸烟之间,及患肝炎、肝硬化、肥胖、溃疡病与饮酒间呈明显相关(P<0.05～0.01)。结论:渔民是吸烟饮酒群体,吸烟饮酒相关疾病的发生率明显增高。普及医学、心理卫生知识是纠正其烟酒嗜好的有效方法。     

湖南省怀化地区城乡饮酒吸烟状况及其影响因素研究

目的了解湖南省怀化地区居民酒精、烟草使用状况及相关影响因素。方法采用分层、随机与整群抽样相结合的方法,使用定式检查问卷调查湖南怀化地区城市、农村社区中7837人(15～65岁)的酒烟使用情况。结果城市饮酒率(45.9%)高于农村(39.6%),但农村饮酒者的平均每次饮酒量、年平均消耗纯酒精量、饮酒频度、饮酒种类均显著高于或多于城区;城市、农村以及总样本人群年平均消耗纯酒精分别为2.6L,3.8L,3.2L。农村吸烟率(35.9%)高于城市(28.7%),城市吸烟者平均吸烟支数(13.3±8.1)支/d,农村(16.5±6.5)支/d。结论农村地区的饮酒、吸烟问题较城市更为严重。对农村地区的酒精、烟草的知识宣传和烟、酒使用控制上亟待进一步加强。     

Use of a questionnaire in general practice to increase the recognition of patients with excessive alcohol consumption

A self administered questionnaire, the health survey questionnaire, was designed to detect excessive alcohol consumption and mailed to patients who were registered with two general practices. Replies were received from 2572(75%) of 3452 patients. Excessive consumption was taken as 42 units of alcohol per week or more for men and 21 units per week or more for women: 1 unit = approximately 10 g ethanol and is equivalent to a half pint of beer, one glass of wine, or one standard measure of spirits. One hundred and twenty men (11%) and 68 women (5%) were identified by their responses to the questionnaire as excessive drinkers. According to their responses, roughly half of these expressed some concern about their drinking. In the practice where a disease register was kept 18 patients had been recorded as heavy drinkers before the study, and an additional 74 were detected by the questionnaire. Within 12 months after the questionnaire survey three groups of respondents were reviewed: (a) the excessive drinkers, (b) those who indicated concern about drinking but did not exceed the limits for excessive consumption, and (c) a random sample of those who were in neither of these two categories. Patients in these three groups were interviewed in a standard fashion to determine their alcohol consumption. Breath alcohol measurement was also carried out and a blood sample taken for the estimation of mean cell volume, gamma glutamyltranspeptidase activity, and serum aspartate transaminase activity. There were highly significant correlations between estimates of consumption obtained by the questionnaire and those obtained at interview except among the women who were excessive consumers, whose responses to the questionnaire indicated levels of consumption that were much higher than those to which they admitted at interview. Stated weekly consumption at interview that was above the limits set for the study was used as the standard measure for comparing the questionnaire with the other indicators of excessive drinking. The questionnaire had a considerably greater estimated sensitivity in detecting male excessive consumers than any of the blood tests. Among the women it apparently performed less well, although the numbers stating excessive consumption at interview were small. Breath alcohol measurement was positive in only a few of the excessive drinkers. The use of this simple and inexpensive instrument is likely to prove widely acceptable to patients in general practice and should result in a considerable increase in the recognition by general practitioners of patients with excessive alcohol consumption.     

脑卒中相关危险因素及干预措施的建议

为探讨脑卒中患者的相关危险因素,对北京市和平里地区269例在社区卫生站就诊的脑卒中患者进行问卷调查和访谈,结果显示高血压、吸烟、饮酒、高血脂和糖尿病是重要危险因素,并且发病年龄呈现年轻化趋势。为了降低脑卒中发生率,我们针对这些危险因素,对社区卫生站和社区医护人员在预防与救治脑卒中方面提出了相应建议。     

Association between diabetes mellitus and hepatocellular carcinoma: results of a hospital- and community-based case-control study

The present study was performed to investigate the relationship between diabetes mellitus (DM) and primary hepatocellular carcinoma (HCC). Incident HCC cases were recruited in Kyushu, Japan. Ethnicity-, age-, gender-, residence-matched hospital controls and community controls were collected. Information on viral hepatitis B (HBsAg) or viral hepatitis C infection, history of blood transfusion, past histories including DM, amount of drinking or smoking, and genotypes of alcohol metabolizing enzymes was collected. Associations between these items and HCC were analyzed multivariately by conditional logistic regression analysis. Two hundred and twenty two (177 males and 45 females) case-control sets were completed between July 1995 and June 2000. Since hospital controls turned out to be a biased one or those sampled from a DM-prone population, a multivariate analysis was performed for the HCC-community controls sets, and it yielded significantly elevated odds ratio (OR)s due to past histories of DM (2.522; 95% Confidence Interval (CI) = 1.267-5.020), blood transfusion (1.747; 1.136-2.689), and unit increment of alcohol consumption (1.358; 1.096-1.684) for males. The same analyses of the HCC-community-controls sets for females, revealed an elevated but not statistically significant OR due to past histories of DM (4.195; 0.808-21.805). A multivariate analysis revealed that DM might be a risk factor for HCC.     

河北省武安市居民吸烟及饮酒与食管黏膜低级别瘤变发病关系的病例对照研究

目的探讨吸烟及饮酒对河北省武安地区食管黏膜低级别瘤变发病的影响。方法采用病例对照研究方法 ,病例组与对照组采用1∶4配比,问卷调查获取资料,χ2检验、Logistic回归及分层分析计算统计指标OR值和95%可信区间。结果吸烟是食管黏膜低级别瘤变的危险因素,OR值为2.282,95%CI为1.164-4.471,P<0.05。对吸烟组进行分层分析,每天吸烟1～10支,患食管黏膜低级别瘤变的风险是不吸烟者的3.450倍;每天吸烟≥11支,患食管黏膜低级别瘤变的风险是不吸烟者的4.025倍,吸烟与食管黏膜低级别瘤变的发病存在剂量关系。饮酒不是食管黏膜低级别瘤变发病的危险因素。结论在食管癌高发区河北省武安市,吸烟是食管黏膜低级别瘤变发生的危险因素,并且随着吸烟者吸烟剂量的增加食管黏膜低级别瘤变的发病亦呈增加的趋势。     

不良生活习惯对新疆公务员生存质量的影响研究

目的探讨不良生活习惯对新疆公务员生存质量的影响。方法采用与健康有关的生存质量测量量表(SF-36量表)和自制的生活习惯问卷对2 695名新疆公务员进行调查。结果新疆2 695名公务员中生存质量标准化总分低于60分的人数占18.33%。单因素分析显示,不同吸烟、饮酒、早餐、睡眠时间、身体锻炼、交通、工作应酬、伏案工作/操作电脑工作和环境污染等情况的新疆公务员,其生存质量低的比例间差异有统计学意义(P<0.05)。多因素分析显示,影响新疆公务员生存质量的不良生活习惯有吸烟[OR=1.395,95%CI(1.096,1.775)]、饮酒[OR=0.541,95%CI(0.425,0.687)]、乘用交通工具[OR=1.741,95%CI(1.372,2.211)]、不吃早餐[OR=0.303,95%CI(0.180,0.512)]、睡眠时间不足[OR=0.515,95%CI(0.434,0.611)]、工作应酬多[OR=1.493,95%CI(1.277,1.746)]和身体锻炼少[OR=0.758,95%CI(0.650,0.884)]。结论新疆公务员生存质量低与吸烟、乘坐交通工具多、不吃早餐、睡眠时间不足、工作应酬多和身体锻炼不足有关。     

饮酒、吸烟及其交互作用与口腔癌关系的病例对照研究

目的探讨饮酒、吸烟与口腔癌的关系。方法采用病例对照研究收集相关资料,病例为福建医科大学附属第一医院口腔科经病理确诊的新发口腔癌病例206例,对照为体检人群及其他科室患者584例。每位研究对象进行面对面的问卷调查。采用非条件Logistic回归对资料进行分析,估算饮酒、吸烟与口腔癌发病风险的调整比值比（OR）及95％可信区间（95％CI）,并分析饮酒与吸烟的交互作用。结果饮酒、吸烟可显著增加口腔癌的发病风险,调整OR值为2．06（95％CI：1．33～3．20）,2．46（1．77～3．41）;开始饮酒年龄越早、平均每天饮酒精量的增加和饮酒年限的延长,饮酒者患口腔癌的危险性增大。其中平均每天饮酒精量超过60g者与口腔癌有显著关联（P〈0．05）,调整OR值为5．98（95％CI：3．26～10．95）;吸烟且饮酒者患口腔癌的危险性是不吸烟且不饮酒者的4．77倍（95％CI：2．71～8．39）,烟酒乘积项的调整OR值为3．58（95％CI：2．45～5．24）,调整后相对超危险度比（RERI）为2．87（95％CI：0．73～5．02）、归因比（AP）为0．60（95％CI：0．33～0．87）、交互作用指数（S）为4．20（95％CI：0．95～18．66）。结论饮酒、吸烟是口腔癌的危险因素,饮酒与吸烟二者有协同作用,可增加口腔癌的发病风险。     

中学在职教师生活方式对血压血脂影响的研究

目的探讨中学在职教师的生活方式特点以及对血压、血脂的影响。方法采用教师生活方式调查表并结合年度健康体检对北京市某社区两所中学在职教师150人进行调查,对教师体重指数(BMI)、饮食习惯、体育锻炼特点、工作时间和节假日休息情况、烟酒嗜好等进行分析。结果在职教师150人中,高血压患者54人(36.0%),高脂血症患者45人(30.0%),其中合并高血压、高脂血症患者28人(18.7%)。在职教师BMI、体育锻炼、工作时间、节假日休息情况、吸烟及饮酒情况与血压、血脂均有关(χ2值分别为44.54、17.33、91.80、26.90、6.04、3.06,P<0.05)。结论中学在职教师的生活方式与高血压和高脂血症的发生率有关。     

国内饮酒与胃癌关系的Meta分析

目的探讨中国居民饮酒与胃癌发生的关系,为预防对策提供依据。方法采用M eta分析方法,对中国1991年至2005年关于饮酒与胃癌关系的27篇研究文献进行综合定量分析。累计病例5 346例,对照12 084例。一致性检验后,应用随机效应模型(D-L法)计算合并比值比(OR)及其95%的可信区间(95%C I)。结果饮酒的合并比值比(OR)及95%C I为2.03及1.74~2.37,失效安全数为554.2。饮酒高危人群患胃癌的归因危险百分比为50.74%,一般人群为17.78%。结论饮酒是我国居民胃癌发病的重要危险因素,加强节制饮酒的宣传教育,可有效降低胃癌的发病率和死亡率。