2012年广州市海珠区居民脑卒中患病率及相关危险因素调查分析

目的了解广州市海珠区18岁以上社区居民脑卒中患病率及高血压、糖尿病等常见危险因素在人群中的分布。方法 2012年12月采用KishGrid表法分层抽样后问卷调查的方法,在海珠区瑞宝社区抽取1000人为调查对象,采用χ2检验和t检验对结果进行统计分析。结果海珠区居民脑卒中、冠心病的患病率均较2008年有明显上升（3.4%vs1.6%,18.5%vs4.5%）,而高血压病、糖尿病、血脂异常、肥胖率和吸烟率均较2008年下降（16.2%vs22.9%,7.0%vs9.2%,37.9%vs59.7%,6.2%vs7.1%,18.2%vs24.6%）,差异有统计学意义（P〈0.05）。男性高血压患病率、吸烟率和饮酒率分别为20.0%、29.0%和11.2%,与女性11.9%、5.8%和5.1%相比较高,差异有统计学意义（P〈0.05）。结论海珠区脑卒中患病率上升呈年轻化趋势,冠心病患病率较前增高,应提倡早期对心脑血管疾病相同危险因素进行筛查并控制预防。     

儿童动脉缺血性脑卒中的研究进展

近年来，神经影像学的发展为脑卒中的诊断提供了可靠依据，脑卒中逐步被认为是儿童一个重要的致病、致死原因。儿童脑卒中的发病率要比以往想象的要多，且一半以上的儿童动脉缺血性脑卒中（AIS）幸存者中有认知或者运动残疾，危害性极大，需要引起临床医生的足够重视。本文就儿童AIS的流行病学、危险因素、病因和发病机制、诊断、治疗、预后及复发危险性进行较全面阐述，并指出了相关研究方向。     

2004年-2009年20706例住院儿童各年龄组疾病谱比较

住院患者疾病分布对于了解地区一定时期内疾病构成及其变化具有非常重要的参考价值。为了解不同年度、不同年龄段儿童的疾病特点,为今后儿童疾病预防和临床医疗提供科学依据,     

老年糖尿病合并脑卒中的临床分析

目的 探讨老年糖尿病合并脑卒中的情况及危险因素.方法 老年糖尿病合并脑卒中患者121例,观察缺血性及出血性脑卒中的比例.结果 缺血性脑卒中/出血性脑卒中比例为6.12∶1,缺血性脑卒中以腔梗占多数.结论 血糖控制不佳、高血压、高血脂是老年糖尿病合并脑卒中的主要危险因素,并影响预后.     

试述血脂与缺血性脑卒中危险因素的相关分析

本文将主要分析血脂与缺血性脑卒中的危险因素,为防治脑卒中提供理论依据。笔者将收集缺血性脑卒中患者的个人疾病史、生活方式以及生化指标等方面的资料,采用SPSS11.5统计软件进行统计分析,以此找出血脂是缺血性脑卒中的危险因素。     

脑卒中的研究进展

脑卒中是我国人群中主要的死亡和致残原因.临床上,根据血流动力学特征将脑卒中分为缺血型与出血型两型.约80%的脑卒中属于缺血型.缺血型卒中可进一步分为大血管阻塞造成的卒中和脑内小血管阻塞造成的卒中.出血型卒中分为蛛网膜下腔出血及脑内血肿.近年来,倾向于认为脑血管病是一个多基因多因素的疾病.     

缺血性脑卒中影响因素的条件Logistic回归分析

目的应用条件Logistic回归模型探讨深圳市缺血性脑卒中的危险因素，为制定相关政策和措施提供科学依据。方法采用1：1配比的病例对照研究设计，选择深圳市两家综合性医院的309例缺血性脑卒中患者为病例组，同时选择年龄、性别匹配309例健康者作为对照组，对研究因素进行单因素及多因素条件Logistic回归分析。结果高血压、吸烟、家庭压力和高血糖是缺血性脑卒中的危险因素。OR值分别为3．507、5．420、3．990和1．183；而饮茶、体育锻炼是缺血性脑卒中的保护因素，OR值分别为0．250、0．100。结论在脑卒中的社区防治中，应尽早、及时地控制高血压、吸烟和体重，同时培养健康的生活方式是预防缺血性脑卒中发生的重要措施。     

高血压并发脑卒中危险因素的调查

高血压是最常见的心血管病,是心脑血管病诸多危险因素中最重要的独立危险因素.不良生活方式、吸烟、饮酒、高盐高脂饮食、精神心理应激等因素与高血压病(essential hypertension,H)都是引起脑卒中的主要因素.本文就某地区人群EH患者发生脑卒中的危险因素与其它地区是否存在差异,分析高致病因素,结合针对性干预,对早期预报、有效预防EH患者发生脑卒中的意义报告如下.     

深圳市光明新区公明办事处1996-2006年住院病人疾病谱分析

目的分析辖区内住院病人疾病谱,了解居民患病的主要模式、对卫生服务需求的变化情况及其特点。方法将辖区医院1996-2006年住院病历进行综合性分析。结果1996-2006年辖区内医院住院人次数呈上升趋势,从1996年的2232人次,上升至2006年的18666人次,11年间增长736.29%。目前导致居民住院的最主要健康问题是损伤和中毒,妊娠、分娩和产褥期健康问题,呼吸系统疾病,消化系统疾病。在损伤和中毒类疾病中,手、腕损伤居首位,占该类疾病的44.46%,占所有住院人次的13.20%。结论应根据住院病人疾病谱,针对性地提高公共卫生和医疗救治服务的水平,扩大服务范围;同时应进一步了解损伤类疾病的数量和构成比不断上升的原因,并采取必要的控制措施。     

脑卒中复发的相关危险因素分析及护理干预

目的 调查并分析脑卒中复发的相关危险因素,进而提出有针对性的护理干预措施.方法 随机选取2008年10月～2009年9月在本院神经内科明确诊断为脑卒中的住院病例168例,其中首发病例(对照组)98例,复发病例(观察组)70例,比较高血压病、冠心病、糖尿病、高脂血症等发病危险因素在两组间的差异.结果 各危险因素中,复发组伴高血压病、冠心病发病率明显高于首发组,有显著性统计学差异(P＜0.05).结论 高血压病和冠心病是增加脑卒中复发的主要危险因素,而高血压病则是最重要的因素(P＜0.01).为此,护理工作者应该采取有针对性的护理干预措施,最大限度地减少脑卒中复发的机会.     

儿童再发川崎病77例临床特征回顾性分析

目的探讨再发川崎病（KD）的临床特点及其预后。方法收集1994年1月至2012年10月重庆医科大学附属儿童医院收治的KD再发病例,比较初发时和复发时的临床特征、实验室指标和随访资料。并选取5～10年未再发KD病例作为对照组,探讨KD再发可能的危险因素。结果19年间收治KD4875例,其中再发KD77例,再发1次74例,再发2次3例,男：女为1．4：1。再发平均间隔时间1．6年,1年以内再发45．4％（35／77）。发热病程再发时较初发时缩短（7．6±3．1）vs（8．9±3．8）d,P〈0．05;WBC和CRP水平再发时较初发时显著降低,（14．3±5．7）vs（16．2±5．4）×10^9·L^-1和（61±58）vs（95±76）mg·L^-1,P均〈0．05。急性期（病程≤30d）冠状动脉病变（CAL）发生率初发时为17．8％（13／73）,再发时为13．3％（10／75）;应用IVIG后亚急性期（病程〉30d）CAL发生率初发时为11．O％（8／73）,再发时为9．3％（7／75）,组间比较差异均无统计学意义。7例初发时与再发时均有CAL,其中l例初发时与再发时均合并冠状动脉瘤（CAA）。52例KD再发患儿有出院后随访资料,随访时间平均2．1年,其中1例再发时合并左侧冠状动脉主干小型CAA的患儿随访中出现新发部位左前降支瘤样扩张,冠状动脉内径回缩至正常后4年7个月再次出现左侧冠状动脉扩张。多因素Logistic分析显示,年龄〈3岁、性别、热程〉10d、并发CAL及WBC〉20×10^9·L^-1均与KD再发无统计学关联。结论KD再发多发生在1年内。再发KD的CAL总发生率并未升高,初发时合并CAL患儿,再发时更易发生CAL。     

北京市2012年手足口病病原学监测重症病例危险因素分析

目的 分析北京市2012年手足口病病原学监测数据,了解北京市手足口病重症病例分布特征及危险因素,为调整防制策略提供依据.方法 对北京市18个区县疾控中心上报的手足口病病原学数据进行统计,采用现况研究的方法,利用EXCEL录入数据库,将所有病原学监测阳性病例分为重症病例组和轻症病例组,运用SPSS17.0软件分析患儿进展为重症病例的影响因素及因素间交互作用.结果 单因素分析中,年龄、居住地、是否为托幼儿童及EV71阳性对病例是否进展为重症病例有影响.多因素分析显示,年龄≤3岁（OR =4.58,95％CI 2.90 ～ 7.09）、散居儿童（OR =2.7,95％CI 1.72 ～4.26）、流行季病例（OR=2.46,95％CI 1.40 ～4.34）、居住地为郊区病例（OR=5.84,95％ CI 2.33～14.63）及EV71阳性（OR=2.77,95％CI 1.94 ～3.98）为手足口病例进展为重症病例的危险因素.交互作用分析显示居住地与年龄和看护类型、看护类型与性别、EV71与年龄和看护类型对于是否重症存在协同作用.结论 年龄≤3岁、居住在郊区、EV71阳性为手足口病例进展为重症病例的危险因素.     

Retrospective analysis of clinical and pathomorphological features of lupus nephritis in children

PurposeThe aim of the study was to evaluate the clinical course and pathomorphological correlations in Polish children with the diagnosis of lupus nephritis (LN).MethodsWe retrospectively analyzed the medical records of 39 children hospitalized due to LN in 7 pediatric nephrology units in Poland between 2010 and 2019. Demographic data, clinical symptoms at the onset of LN and laboratory parameters were reviewed. We analyzed Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), histological LN findings with the activity (IA) and chronicity index (IC).ResultsWe examined 32 girls and 7 boys, median age at LN onset was 14.75 (IQR 13.0–16.0) years, SLEDAI of 22.0 (IQR 18.0–27.0) points; LN histological class: IV (59.4%), III (18.9%), III/V (10.8%), IV/V (8.1%), VI (2.7%); IA 8.0 (IQR 6.0–11.0) points, IC 1.05 (IQR 0–2.0) points.Children with nephrotic (n ​= ​22) and non-nephrotic (n ​= ​17) proteinuria differed in median Hb level (9.55, IQR 8.3–11.2 vs 10.9, IQR 10.1–11.6 ​g/L; P ​< ​0.05), albumin level (2.5, IQR 2.1–3.19 vs 3.6, IQR 3.4–4.1 ​g/dL; P ​< ​0.001), proteinuria (5.76, IQR 3.0–7.5 vs 1.08, IQR 0.53–1.50 ​g/day; P ​< ​0.0001), eGFR (53.9, IQR 27.0–68.8 vs 96.7, IQR 73.8–106.2 ​mL/min/1.73 ​m²; P ​< ​0.01) and occurrence of hypertension (77% vs 23%; P ​< ​0.01).In multivariate analysis Hb level (β ​= ​8.0; 95%CI, 1.90–14.11) was the significant predictor of eGFR<90 ​mL/min/1.73 ​m².ConclusionsProliferative forms of LN in children may have a varying clinical presentation.Children with LN with nephrotic range proteinuria have lower Hb level, lower eGFR and higher occurrence of hypertension. Hb level is the significant predictor of eGFR<90 ​mL/min/1.73 ​m² in children with LN.     

脑卒中发生前血液动力学指标的异常变化

目的分析和探讨脑卒中发生前脑血管血液动力学指标的异常变化,为卒中高危状态的识别提供参考。方法在基线调查和检测后,收集前瞻性研究人群中随访新发的脑卒中患者(200例)作为试验组,在同一人群中选择基线调查时病程在1年以内的卒中患者(227例)作为对照组,分析和比较两组间脑血管血液动力学指标及其积分值的差异。结果试验组卒中发生前的血液运动学指标普遍低于对照组,血液动力学指标则普遍高于对照组,除最小流速舒张压与临界压的差值外,其他指标两组间有显著的统计学差异(P<0.05)。试验组的血液动力学积分值(51.32±31.37)显著低于对照组(58.44±31.63),P<0.05。结论脑卒中发生前脑血管血液动力学损害程度高于病程1年内的卒中患者,可能是脑卒中的重要预警信号。     

Drug treatments in the secondary prevention of ischaemic stroke

Stroke is an important cause of death and disability. However, about two thirds of cerebrovascular events are initially minor. They carry a high risk of potentially severe recurrent events, but they also offer an opportunity for secondary prevention to avoid such recurrences. As most recurrent events occur within a short time after the initial presentation, secondary prevention has to be started as soon as possible. Dramatic risk reduction can be achieved with well-established drugs if used in a timely manner. A standard secondary preventive regimen will address multiple vascular risk factors and will usually consist of an antiplatelet agent, a lipid lowering drug, and an antihypertensive agent. Depending on the risk factor profile of each patient, this will have to be adjusted individually, for example, taking into account the presence of cardioembolism or of stenotic disease of the brain-supplying arteries. In recent years, the approach to treating these risk factors has evolved. In addition to absolute blood pressure, blood pressure variability has emerged as an important contributing factor to stroke risk, which is affected differently by different antihypertensive agents. New oral anticoagulants reduce the risk of cerebral haemorrhage and the need for regular blood checks. The best antiplatelet regimen for stroke prevention is still uncertain, and treatment of dyslipidaemia may change if trials with cholesteryl ester transfer protein (CETP) inhibitors, which increase levels of HDL-cholesterol, are successful. This article reviews the current evidence for drug treatments in the secondary prevention of ischaemic stroke.     

上海市7岁以下儿童智力低下流行病学调查

目的　为了解上海市智力低下的现状 ,探索危险因素 ,减少发生率 ,上海市儿童保健所于 1997年 5月首次进行 7岁以下儿童该病流行病学调查。方法　采用综合按比例整群抽样方法 ,在上海市所有的 2 0个区县抽取 6岁以下儿童数的 1 2 %为调查对象。诊断为智力低下儿童按 1:2进行配对病例 -对照研究 ,并用Logistic进行回归分析。结果　智力低下患病率 6 87‰ ,3岁组以下患病率明显低于 3岁组以上。市区、郊区患病率有显著性差异。智力低下的儿童神经精神发育明显落后于正常儿童 ,多因素分析最主要的危险因素是出生体重、新生儿期患病住院、新生儿吸氧抢救、新生儿期疾病、父母文化和父母患病。结论　轻度MR占 5 1 14 % ,与 1987年的 70 6 %相比 ,下降了 19 4 6 %。说明轻度智力低下经过干预可以接近正常。在危险因素的研究中发现 ,父母遗传素质起着主要的作用。对一些说话晚、走路晚的孩子要作为高危人群定期检查发现异常及早干预。加大优生优育宣教力度 ,增加妇幼保健的投入 ,减少智力低下的发生。     

Relationship between chronic kidney disease and risk of coronary heart disease in Korean men

There have been many epidemiological researches of chronic kidney disease (CKD), accompanied by an increase in the incidence of coronary heart disease (CHD). However, as far as we know, little research has been done to examine the extent of the relationship between CKD and CHD as estimated by Framingham risk score (FRS) in Korean men. CKD was defined as either proteinuria or an eGFR of < 60 mL/min per 1.73 m(2). The FRS has been used to predict the 10-yr risk of coronary events and usually divided into three levels of risk < 10% (low), 10%-19% (intermediate) and ≥ 20% (high). We defined FRS ≥ 10% as more-than-a-moderate CHD risk group and FRS ≥ 20% as a high CHD risk group, respectively. After adjusting for covariates, multivariable-adjusted logistic regression analyses showed a strong statistical significant relationship between CKD and high risk of CHD (adjusted OR, 1.95 [95% CI, 1.32-2.87]). Dipstick urinalysis and eGFR can be readily measured in most clinical settings. The measurement of kidney function may represent a relatively inexpensive and efficient way to identify individuals at higher risk for CHD.     

Unrealistic pessimism about risk of coronary heart disease and stroke in patients with type 2 diabetes

OBJECTIVE: We examined the accuracy of type 2 diabetes (T2D) patients' risk estimates of developing coronary heart disease (CHD)/having a stroke as a consequence of diabetes and their mood about these risks. METHODS: Patients reported their perceived risks of developing CHD/having a stroke and rated their mood about these risks using a self-report measure. Using an objective risk calculator, they were then told their actual risk of CHD and stroke and their mood was re-assessed. RESULTS: Patients' estimates of their risk of CHD/stroke were grossly inflated. A negative relationship between disease risk and mood was also seen where higher risk of actual and perceived CHD/stroke was related to worse mood. A positive relationship between mood and extent of perceptual error was further observed; the more inaccurate patients' perceptions of CHD/stroke risk were, the better their mood. Mood improved after patients were given accurate risk information. CONCLUSION: T2D patients are unrealistically pessimistic about their risk of developing CHD/stroke. These risks and the extent of perceptual risk error are associated with mood, which improves upon providing patients with accurate risk information about CHD/stroke. PRACTICE IMPLICATIONS: These results have implications for the routine communication of risk to T2D patients.     

儿童肾血管性高血压29例诊断方法的回顾性分析

目的探讨儿童肾血管性高血压（RVH）的早期诊断方法。方法回顾性分析北京大学第一医院1996年1月至2011年6月确诊的RVH患儿,分析贻误诊治情况,以及临床症状、影像学检查结果对RVH的诊断价值。结果①29例确诊RVH患儿进入分析,其中男18例,女11例。起病年龄0.5～15岁,平均年龄（7.0±4.4）岁。从首发症状出现至确诊时间为15d至7年,平均确诊时间11个月。9例（31.0%）患儿起病6个月后确诊,曾分别被误诊为胃肠炎、癫、肾脏和心脏疾病等。3例患儿以头痛伴呕吐起病,补液出现抽搐后发现高血压。首发症状以头痛（10例,34.5%）、呕吐（10例,34.5%）和抽搐（9例,31.0%）多见。起病时平均收缩压和舒张压分别为182和127mm Hg。②单侧肾动脉狭窄25例,双侧肾动脉狭窄4例。23例通过肾动脉造影确诊,其中17例单侧肾动脉狭窄患儿中10例超声检查显示双肾长径相差〉1.5cm;血管超声对肾动脉狭窄检出率为31.3%（5/16例）;CT对肾动脉狭窄检出率为50.0%（3/6例）;肾动态显像对肾功能受损检出率为93.8%（15/16例）。通过肾血管超声检查确诊4例,通过肾动脉超声检查及CT检查确诊1例,通过肾动脉超声检查和肾动脉MRA检查确诊1例。③16/18例（88.9%）卧位血浆肾素和血管紧张素水平增高。12/29例（41.4%）存在低钾血症。10/29例（34.5%）确诊为多发性大动脉炎。结论儿童RVH贻误诊断率较高,对于有头痛、呕吐和抽搐者应首先测量血压,尤其在补液治疗前。肾动态显像有助于早期发现患侧肾功能受损,血浆肾素和血管紧张素增高、低钾血症、双肾大小不对称对于诊断具有提示意义,肾血管超声和CT检查敏感度有限,可疑患儿应尽早行肾动脉造影检查。确诊RVH后应尽可能进行病因诊断,尤其应确定是否存在大动脉炎以指导治疗。     

Histopathologic spectrum of childhood tumours in a Tertiary Hospital: a ten-year review

BackgroundThere has been a growing public health burden of childhood tumours in low and middle income countries (LMICs) as the trend in epidemiological transition continues to vary.ObjectiveThe objective of this report is to determine the spectrum of childhood tumours at a tertiary hospital in Nigeria.MethodsA retrospective review of the histopathology register over the period January 2006 to December 2015.ResultsThe total paediatric tumour cases was 248, including 143 (57.7%) females and 105 (42.3%) males, aged 0 – 12 years (mean 6.1 years ± 3.97 SD). The age group 2 – 5 year cohort had the highest prevalence of tumour. The predominant tumour based on tissue of origin was epithelial neoplasms 88 (35.5%), vascular neoplasms 56 (22.6%), neural neoplasm 42 (16.9%), mesenchymal neoplasm 37 (14.9%), germ cell neoplasm 13 (5.2%) and haematopoietic neoplasms 12 (4.8%). Majority of the tumours were benign, 148 (59.7%) and malignant 100 (40.3%). The most predominant benign tumour was haemangioma 33 (13.3%) and predominant malignant tumour was lymphoma 22 (8.9%).ConclusionBenign tumours remain the commonest neoplasm of children in this hospital-based data. Development and implementation of a tumour registry would provide a more comprehensive information.