社区高血压患者规范化管理效果观察

目的：探索适合社区的高血压管理模式并进行效果评价。方法：通过对社区医生进行培训,按照高血压分级进行规范化管理,在辖区居民中进行健康知识宣传、治疗、随访、转诊、综合干预等综合规范化管理措施。结果：规范化管理1年后,社区居民血压正常比例由11.89%增加到37.30%,2级高血压患者比例由26.32%降到10.16%,3级高血压患者比例由12.70%降到3.72%,差异均有高度统计学意义（均P〈0.01）;药物治疗率和血压控制率分别由56.36%升高到89.36%和20.90%升高到57.27%;规范化管理后患者吸烟、饮酒、高盐饮食、超重等危险因素比例均较规范化管理前下降,差异均有统计学意义（均P〈0.01）。结论：对高血压患者进行非药物治疗和药物治疗并举的社区规范化管理是控制高血压的有效手段。     

高血压社区规范化管理中常用抗高血压药物的成本-效果研究

目的 评价高血压社区规范化管理中5大类常用抗高血压药物的成本-效果。方法 基于行政区域分布和经济发展水平,在我国东、中、西部选择15个省/自治区的220家社区卫生服务中心/站和卫生院,利用《中国高血压防治指南（2009年基层版）》中高血压社区规范化管理方案对卫生机构医务人员进行培训,由受训的基层医务人员对高血压患者实施规范化管理1年。资料齐全且规范化管理满1年的患者共43 039例,在接受高血压单药治疗且随访期间治疗方案不变（但允许药物剂量调整）的10 456例患者中,有10 277例服用利尿剂、钙拮抗剂、β-受体阻滞剂、血管紧张素Ⅱ受体拮抗剂（ARB）及血管紧张素转化酶抑制剂（ACEI）5大类抗高血压药物,根据性别、年龄和危险分层分组,按照1∶6∶1∶1∶3的比例进行匹配,最后入选7 032例患者作为本研究对象。受训者填写统一设计的管理病历,记录患者的社会人口学特征、合并症、高血压分级和危险分层以及抗高血压药物的日用药剂量、规格、价格、实际服用天数等药物治疗信息。采用成本-效果分析法评价抗高血压药物的成本-效果。结果 7 032例进行成本-效果分析的患者中,年人均成本为219.0（553.0）元;收缩压下降率为（10.6±8.6）%,成本-效果比为20.7;舒张压下降率为（10.0±9.6）%,成本-效果比为21.9;血压控制率为75.1%（5 281/7 032）,成本-效果比为2.9。5大类抗高血压药物的年人均成本比较,差异有统计学意义（P＜0.05）。5大类抗高血压药物的收缩压下降率、舒张压下降率、血压控制率比较,差异均有统计学意义（P＜0.05）。以收缩压下降率、舒张压下降率、血压控制率为效果指标时,ACEI的成本-效果比分别为5.0、5.3、0.9,利尿剂的成本-效果比分别为19.0、18.6、2.5,均较β-受体阻滞剂、钙拮抗剂、ARB的成本-效果比低。结论 在高血压社区规范化管理中,ACEI和利尿剂具有更好的成本-效果。     

社区高血压患者1420例健康教育综合干预效果观察

目的：探讨对社区高血压患者实施健康教育综合干预的效果。方法对社区1420例高血压患者进行为期1年的健康教育综合干预。结果患者健康教育后各项高血压相关知识知晓率均显著提高,治疗率由45.4%提高至61.3%,达标率由12.8%提高至35.1%,收缩压由（160±11）mm Hg降到（126±11）mm Hg,舒张压由（98±9）mm Hg降到（75±7）mm Hg,比较差异有统计学意义（P<0.01）。结论通过健康教育综合干预后,该社区高血压患者对高血压相关知识知晓率明显提高,治疗依从性增加,避免了引起血压升高的各种危险因素,有效降低心血管并发症的发生率和病死率,防止了脑卒中等并发症的发生,提高了患者的生存质量。     

老年高血压患者动态脉压对冠脉介入术的预后评价

目的：探讨动态脉压（Ambulatory Pulse Pressure,PP）水平对老年高血压患者冠脉介入（Percutaneous Coronary Intervention,PCI）术患者的危险分层和预后评价。方法：入选老年高血压患者,同时符合冠心病诊断标准,并且接受PCI治疗的138例患者,并进行动态血压监测,根据PP〉60 mm Hg和≤60 mm Hg分为两组,分别为52例和86例,观察患者临床特征和冠状动脉病变的严重程度,并随访平均（18.6±4.3）个月主要心血管事件。结果：与PP≤60 mm Hg组比较,PP〉60 mm Hg组多见男性和糖尿病史多,C型病变和三支病变常见。两组间比较,围手术期并发症发生率、住院期非致死性心肌梗死发生率和远期心源性死亡发生率在PP〉60 mm Hg组显著增加,分别为16.8%vs8.8%,5.2%vs2.3%和1.3%vs0.8%,均为P〈0.05。多因素logistic分析PCI术后住院期间主要不良心血管事件（major cardiovascular events,MACE）发生率与动态PP、DBP和糖尿病有关[OR分别1.043（95%CI1.038-1.163）,-1.014（95%CI-1.138-1.013）,1.011（95%CI0.008-1.023）],远期MACE发生率与糖尿病史、心梗史有关[OR分别为1.126（95%CI 1.067-1.232）,1.121（95%CI 1.044-1.241）]。结论：动态PP是最为方便的反映动脉僵硬的参数,与PCI围手术期及远期MACE发生率增加密切相关,可作为全身心血管疾病的一个危险信号,指导早期干预。     

糖尿病患者社区规范化管理干预效果评价

目的　探讨社区规范化管理对提升2型糖尿病患者血糖达标率的管理效果。方法　选取2008年北京市朝阳区将台社区卫生服务中心的151例2型糖尿病患者,进行社区规范化管理,每年进行4次健康体检,收集收缩压、舒张压、空腹血糖（FPG）、餐后2 h血糖（2 hPG）及糖化血红蛋白（HbA1c）等资料。到2016年,规范化管理满8年且资料齐全的患者共计111例,其中单纯糖尿病患者44例（39.6%,单纯糖尿病组）,糖尿病合并高血压患者67例（60.4%,糖尿病合并高血压组）。对调查对象2008年与2016年两次数据进行比较分析。结果　单纯糖尿病组女性舒张压与管理前组相比有所下降,糖尿病合并高血压组收缩压和舒张压与管理前相比均有所下降,差异有统计学意义（95%CI不包括0）。单纯糖尿病组女性FPG与管理前相比有所下降,单纯糖尿病组、糖尿病合并高血压组2 hPG、HbA1c与管理前相比有所下降,差异有统计学意义（95%CI不包括0）。糖尿病的整体达标率由2008年的34.2%（38/111）上升至2016年的60.4%（67/111）,差异有统计学意义（χ2=15.198,P<0.001）。其中,单纯糖尿病组的血糖达标率由31.8%（14/44）上升至56.8%（25/44）,糖尿病合并高血压组的血糖达标率由35.8%（24/67）上升至62.7%（42/67）,差异有统计学意义（χ2=5.272,P=0.018;χ2=10.942,P<0.001）。单纯糖尿病组除男性、年龄≥60岁、受教育程度为高中及以上、饮食规律、有高血压家族史者管理后血糖达标率与管理前无差异,服药依从性差患者血糖达标率低于管理前外,其他亚组血糖达标率均高于管理前,差异有统计学意义（95%CI不包括0）。糖尿病合并高血压组除吸烟、服药依从性差、有糖尿病家族史者管理后血糖达标率与管理前无差异外,其他亚组血糖达标率均高于管理前,差异有统计学意义（95%CI不包括0）。结论　在社区开展糖尿病规范化管理可以改善糖尿病患者的血压、血糖水平,提高糖尿病的控制效果。     

老年高血压社区健康教育干预模式构建与应用

目的：探讨老年高血压患者社区健康教育干预模式,为进一步做好高血压社区防治提供科学依据。方法将广州军区广州总医院2010年1月~2012年12月收治的60例老年高血压患者随机分为干预组和对照组,每组30例。对照组进行药物降压治疗,干预组在进行药物降压治疗的同时开展健康教育干预,比较两组老年高血压患者治疗效果。结果干预后干预组患者收缩压从干预前的（164±10）mm Hg（1 mm Hg=0.133 kPa）下降为（132±7）mm Hg,舒张压从干预前的（98±12）mm Hg下降为（81±10）mm Hg,干预后血压下降效果明显（P〈0.01）;干预后血压正常人数与高血压危险因素知晓人数调查结果显示,干预组分别为29例和28例,而对照组分别为11例和8例,差异均有高度统计学意义（均P〈0.01）;干预后不良生活习惯或行为改变情况调查显示,干预组患者高盐高脂饮食和吸烟人数均为4例,而对照组分别为11例和21例,差异有高度统计学意义（P〈0.01）;干预后两组患者规律运动例数、限酒与体重控制例数比较,差异有高度统计学意义（均P〈0.01）。结论药物治疗配合社区健康教育是高血压防治的有效干预模式。     

高血压治疗策略的转变:需个体化及多元化

2006年中国心血管病年度报告中披露,中国高血压患病人数已达2.0亿[1],但高血压的控制率仍处于低水平.几十年来高血压的治疗从单纯的血压控制到危险因素的综合控制,治疗药物的选择从单一药物治疗过渡到联合治疗,血压目标从70年代的血压降至160/95 mm Hg,到血压应低于140/90mill Hg,继而循证医学又证实高危的高血压患者血压应降至130/80 mm Hg以下[2].     

北京市15个社区2型糖尿病患者合并高血压率及血压达标的调查

目的 了解北京市社区2型糖尿病患者高血压的患病率、血压控制达标率.方法 2008年8月至2009年7月采用多极抽样方法与患者自愿原则,纳入北京市4个城区中15个社区卫生服务中心的2849例2型糖尿病患者为研究对象,行体格检查及相关的实验室检查.结果 2型糖尿病患者高血压的患病率为70.8％ （2016/2849）.入组前已合并高血压者1966例,其中血压＜140/90 mm Hg（1mm Hg=0.133 kPa）者占54.8％ （1077/1966）,血压达标（＜130/80 mm Hg）率17.8％（350/1966）.血压达标与未达标者间TG、空腹血糖、腰围、糖化血红蛋白水平差异有统计学意义（F值分别为23.51、23.26、39.00和22.91,均P＜0.01）.1198例行尿微量白蛋白检测,糖尿病合并高血压者较单纯糖尿病者尿微量白蛋白升高更多（P＜0.01）.结论 北京社区2型糖尿病患者高血压的患病率较高,血压达标率低;应加强糖尿病合并高血压患者多重危险因素控制和有效的社区管理.     

社区严重精神障碍患者规律面访情况及其影响因素研究

背景严重精神障碍患者因自知力欠缺及高复发性、高致残性等特点，对社会稳定造成严重威胁。做好社区面访管理工作意义重大，通过定期面访患者本人，可以更好地综合评估患者病情，以便及时采取措施，提高管理服务质量。目的了解社区严重精神障碍患者规律面访情况及其影响因素，为提高社区患者的面访服务管理质量提供参考依据。方法2020年10—12月，利用2019年底江苏省严重精神障碍管理系统中建档管理的无锡市严重精神障碍患者基础档案及随访管理信息，分析当年度无锡市社区严重精神障碍患者规律面访情况，采用Logistic回归分析规律面访的影响因素。结果共纳入27 778例研究对象，其规律面访率为81.08%（22 523/27 778）。Logistic回归分析结果显示，非本地户籍〔OR（95%CI）=0.704（0.640，0.775）〕、年龄≤44岁〔OR（95%CI）=0.522（0.472，0.578）〕、学历为高中及以上〔高中/中专OR（95%CI）=0.493（0.446，0.545），大专及以上OR（95%CI）=0.470（0.415，0.532）〕、目前有正式工作〔OR（95%CI）=0.715（0.668，0.766）〕、未婚〔OR（95%CI）=0.746（0.665，0.838）〕、经济状况为非贫困〔OR（95%CI）=0.587（0.517，0.666）〕、没有进行抗精神病药物治疗〔OR（95%CI）=0.491（0.440，0.548）〕、服药时长0~10年〔OR（95%CI）=0.881（0.778，0.998）〕、不是"以奖代补"监护补助对象〔OR（95%CI）=0.807（0.704，0.926）〕、不参加社区康复服务〔OR（95%CI）=0.844（0.716，0.996）〕是患者规律面访的消极影响因素（P<0.05）。结论无锡市社区严重精神障碍患者规律面访率尚需进一步提高，应重点关注非本地户籍、年龄≤44岁、高中及以上学历、目前有正式工作、未婚、经济非贫困、没有进行抗精神病药物治疗、服药时长0~10年、不是监护补助对象和不参加社区康复服务的社区严重精神障碍患者。可通过制定倾斜性政策、开展宣传教育、降低患者病耻感、改善患者疾病认知、加强患者社会支持等措施提高患者规律面访率。     

社区高血压建档管理180例效果观察

目的:探讨对社区高血压人群进行专项建档管理的效果.方法:对180例社区高血压患者分级并建立健康档案,进行专项管理、治疗及随访,从而分析专项建档管理的效果.结果:162例高血压患者血压控制在正常高值,Ⅰ级高血压8例,Ⅱ级高血压6例,4例血压不稳定.患者知道高血压的标准(97.2%)、不良生活习惯对血压的影响(92.0%)、易引起高血压的危险因素(90.0%)、高血压对人体的危害(86.1%)、非药物措施在高血压治疗中的作用(83.3%).结论:对社区高血压患者建立专病档案、进行规范化管理并且使血压控制达标,以期最大限度地降低心脑血管病发病及死亡总危险.     

Long-term effects of bone marrow-derived cells transplantation in patients with acute myocardial infarction: a meta-analysis

Background  The long-term effects of bone marrow-derived cells (BMC) transplantation in patients with acute myocardial infarction (AMI) have not been established. The present meta-analysis of randomized controlled trials with follow-up ³2 years was performed to investigate the long-term effects of BMC therapy in patients after AMI.

Methods  Specific terms were used to conduct a systematic literature search of MEDLINE, EMBASE, the Cochrane Library and the Cochrane Central Register of Controlled Trials, and the China Biological Medicine Disk database from their inception to March 2012. A standardized protocol was used to extract information, and random effect model was used to analyze all data except major adverse events.

Results  Five trials comprising 510 patients were included. Compared with controls, BMC therapy significantly improved left ventricular ejection fraction (LVEF) (4.18%, 95% CI: 2.02% to 6.35%, P=0.0002), while mildly but not significantly reduced left ventricular end-systolic volume (–4.47 ml, 95% CI: –10.92 to 1.99, P=0.17) and left ventricular end-diastolic volume (–2.29 ml, 95% CI: –9.96 to 5.39, P =0.56). Subgroup analysis revealed that significant improvement of LVEF induced by BMC therapy could be observed in patients with baseline LVEF £42%, but disappeared in those with baseline LVEF >42%. There were trends in favor of BMC therapy for most major clinical adverse events, though most differences were not significant.

Conclusions  Intracoronary BMC infusion in patients with AMI seems to be safe and may further improve LVEF on top of standard therapy; especially the beneficial effects could last for long term. The findings need to be validated in the future.

     

Immunosuppressive therapy in lung injury due to paraquat poisoning: a meta-analysis

INTRODUCTION: Immunosuppressive therapy has been shown to improve outcomes in patients with paraquat poisoning. The objective of this study was to evaluate the efficacy of immunosuppressive therapy in the management of lung injury due to paraquat poisoning. METHODS: We searched the MEDLINE, OVID, and CINAHL databases for relevant studies published from 1980 to 2006. We included studies if (a) the study design was a randomised controlled trial, observational study with historical controls or observational study; (b) the study population included patients with paraquat poisoning, and received immunosuppressive therapy; and (c) the study provided data on mortality. We calculated the survival rate with 95 percent confidence intervals (CI) for observational studies, and relative risk and 95 percent CI for dichotomous outcomes. RESULTS: 12 studies--four non-randomised, six non-randomised comparing historical controls, and two randomised controlled trials--had employed immunosuppressive therapy in the management of paraquat poisoning. The survival rate in the four non-randomised studies (39 patients) was 74.4 percent (95 percent CI 58.9-85.4). The relative risk of immunosuppressive therapy in decreasing mortality with paraquat poisoning was 0.55 (95 percent CI 0.39-0.77) and 0.6 (95 percent CI 0.27-1.34) for the non-randomised studies (comparing historical controls) and randomised controlled studies, respectively. There was significant heterogeneity and evidence of publication bias. CONCLUSION: One out of four patients (95 percent CI 3-5) were successfully treated with immunosuppressive therapy for paraquat poisoning. However, due to significant heterogeneity and publication bias, a large randomised controlled trial will be required to affirm the role of immunosuppression in paraquat poisoning.     

中老年高血压患者体位性高血压和体位性低血压与靶器官损害关系分析

目的 探讨中国中老年高血压患者体位性高血压和体位性低血压与靶器官损害的关系.方法 通过阶段性随机整群抽样入选河南信阳7个社区4711例40～75岁高血压患者,进行问卷、生化指标、心脏超声、踝臂指数、卧立位血压等检查.体位性高血压定义为直立位后30 g和2min收缩压平均值升高≥20 mm Hg,体位性低血压定义为直立位后30 s和(或)2 min收缩压下降或(及)舒张压下降≥20/10 mm Hg,无上述两种异常者定义为体位性血压正常.结果 高血压患者中体位性高血压发生率16.3%,体位性低血压发生率23.8%.外周血管病在体位性高血压(10.1%)和低血压(10.7%)患者中均显著高于体位性血压正常者(7.4%)(均P＜0.05).体位性低血压患者与体位血压正常者比较左室肥厚(53.0%比43.2%,P＜0.001)和肾小球滤过率降低(38.6%比34.4%,P＜0.05)发生率更高.调整年龄、性别、BMI等其他危险因素后,体位性高血压(OR 1.39,95%CI1.05～1.84)和低血压(OR 1.45,95%CI1.13～1.86)仍显著增加外周血管病危险,体位性低血压显著增加左室肥厚危险(OR 1.46,95%CI 1.11～1.84),而体位性低血压与肾小球滤过率降低的关系无统计学意义.在女性高血压患者中,体位性收缩压变化五分位组预测左室肥厚的OR值呈J形曲线.在未治疗高血压患者中,体位性收缩压变化五分位组预测外周血管病的OR值也呈J形曲线分布.结论 中老年高血压患者合并体位性高血压和体位性低血压发生高血压靶器官损害的危险较高.

Abstract：

Objective To investigate the association of orthostatic hypertension and hypotension with hypertensive target organ damage in middle and old-aged hypertensive patients. Methods This crosssection study was conducted in 4711 hypertensive patients aged 40 - 75 years old in 7 communities of Xinyang County, Henan Province by a multistage cluster sampling method. All patients received a standardized questionnaire, physical and biochemical examinations, echocardiography, ankle-brachial blood pressure index and orthostatic blood pressure measurement. Orthostatic hypertension was defined as an elevation of systolic blood pressure by 20 mm Hg or more while orthostatic hypotension as a drop of blood pressure by 20/10 mm Hg or more. When an upright posture was assumed. Others not belonging to these two conditions were classified into orthostatic normotension. Results The prevalence of orthostatic hypertension and hypotension was 16.3% and 23.8% in hypertensive patients. Peripheral artery disease was significantly more frequent in hypertensives with orthostatic hypertension ( 10. 1% ) or hypotension ( 10. 7% ) than those with orthostatic nnrmoteasives (7.4%) ( both P ＜ 0. 05 ). Patients with orthostatic hypotension had more common left ventricular hypertrophy (53.0% vs 43. 2%, P＜0. 001 ) and a decreased estimated glomerular filtration rate ( 38.6% vs 34. 4%, P ＜0. 05 ) than did those with orthostatic nnrmotension. After controlling for age, gender, body mass index and other confounders, orthostatic hypertension was positively associated with peripheral arterial disease ( OR 1.39, 95% CI 1.05 - 1.84 ) while orthostatic hypotension was significantly associated with peripheral arterial disease ( OR 1.45, 95% CI 1.13 - 1.86) and left ventricular hypertrophy (OR 1.46, 95% CI 1.11 -1.84). But no independent association was found between orthostatic hypertenson or hypotension and a decreased estimated glomerular filtration rate in hypertensive patients. The adjusted odds ratios (OR) for left ventricular hypertrophy, as predicted by the quintiles of orthostatic systolic blood pressure changes, showed a J-shaped relationship in hypertensive women, and so did peripheral artery disease in untreated hypertensive patients. Conclusion Hypertensive patients with orthostatic hypertension or hypotension may have an elevated risk of developing target organ damage.     

Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators.

CONTEXT: The clinical use of ambulatory blood pressure (BP) monitoring requires further validation in prospective outcome studies. OBJECTIVE: To compare the prognostic significance of conventional and ambulatory BP measurement in older patients with isolated systolic hypertension. DESIGN: Substudy to the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) Trial, started in October 1988 with follow up to February 1999. The conventional BP at randomization was the mean of 6 readings (2 measurements in the sitting position at 3 visits 1 month apart). The baseline ambulatory BP was recorded with a noninvasive intermittent technique. SETTING: Family practices and outpatient clinics at primary and secondary referral hospitals. PARTICIPANTS: A total of 808 older (aged > or =60 years) patients whose untreated BP level on conventional measurement at baseline was 160 to 219 mm Hg systolic and less than 95 mm Hg diastolic. INTERVENTIONS: For the overall study, patients were randomized to nitrendipine (n = 415; 10-40 mg/d) with the possible addition of enalapril (5-20 mg/d) and/or hydrochlorothiazide (12.5-25.0 mg/d) or to matching placebos (n = 393). MAIN OUTCOME MEASURES: Total and cardiovascular mortality, all cardiovascular end points, fatal and nonfatal stroke, and fatal and nonfatal cardiac end points. RESULTS: After adjusting for sex, age, previous cardiovascular complications, smoking, and residence in western Europe, a 10-mm Hg higher conventional systolic BP at randomization was not associated with a worse prognosis, whereas in the placebo group, a 10-mm Hg higher 24-hour BP was associated with an increased relative hazard rate (HR) of most outcome measures (eg, HR, 1.23 [95% confidence interval [CI], 1.00-1.50] for total mortality and 1.34 [95% CI, 1.03-1.75] for cardiovascular mortality). In the placebo group, the nighttime systolic BP (12 AM-6 AM) more accurately predicted end points than the daytime level. Cardiovascular risk increased with a higher night-to-day ratio of systolic BP independent of the 24-hour BP (10% increase in night-to-day ratio; HR for all cardiovascular end points, 1.41; 95% CI, 1.03-1.94). At randomization, the cardiovascular risk conferred by a conventional systolic BP of 160 mm Hg was similar to that associated with a 24-hour daytime or nighttime systolic BP of 142 mm Hg (95% CI, 128-156 mm Hg), 145 mm Hg (95% CI, 126-164 mm Hg) or 132 mm Hg (95% CI, 120-145 mm Hg), respectively. In the active treatment group, systolic BP at randomization did not significantly predict cardiovascular risk, regardless of the technique of BP measurement. CONCLUSIONS: In untreated older patients with isolated systolic hypertension, ambulatory systolic BP was a significant predictor of cardiovascular risk over and above conventional BP.     

老年高血压人群发生糖代谢异常风险的10年队列研究

目的 观察老年高血压(HT)及非高血压(NHT)人群糖代谢异常的发生情况及其危险因素.方法 采用前瞻性队列研究方法,研究对象为1999至2009年在解放军总医院体检的60岁以上老年人,除外基线时已确诊2型糖尿病(T2DM)及糖调节受损(IGR)者.观察在10年中发生DM及IGR的情况及影响因素,应用COX风险比例模型分析相关危险因素,Kaplan-Meier法分析累计发病率.结果 (1) 1999年调查人数为1 136人,纳入糖耐量正常582人,其中HT组384例,NHT组198人.随访10年后,HT组发生T2DM显著高于NHT组(27.6％比18.7％,P＜0.05),HR( 95％ CI)为1.48(1.07～2.04);两组DM发病密度分别为33.8‰和20.6‰.HT组与NHT组的IGR发生率差异无统计学意义(P＞0.05);新发HT组与NHT组相比,DM及IGR的发生率差异无统计学意义(P＞0.05).(2)血脂紊乱及HT是发生T2DM的独立危险因素,HR(95％CI)分别为1.459(1.027～2.072)及1.516(1.039～2.212);同时也是发生糖代谢异常的独立危险因素,HR (95％ CI)分别为1.545(1.087～2.195)及1.524(1.044 ～2.224);HT与NHT人群T2DM及糖代谢异常的累积发生率差异均有统计学意义(均P ＜0.05).结论 老年人群合并HT后其糖尿病风险增加,是非NHT人群的1.52倍.血脂紊乱也是T2DM及糖代谢异常的独立危险因素.     

Effect of elevated total cholesterol level and hypertension on the risk of fatal cardiovascular disease: a cohort study of Chinese steelworkers

Background  Increased blood pressure and elevated total cholesterol (TC) level are the two most important modifiable risk factors of cardiovascular disease (CVD) in the world. Hypertension and hypercholesterolemia co-exist more often than would be expected and whether there is a synergistic impact on fatal CVD between elevated TC and hypertension need to be further examined in Chinese population.

Methods  We conducted a cohort study which recruited 5092 Chinese male steelworkers aged 18–74 years in 1974–1980 and followed up for an average of 20.84 years. Totally 302 fatal CVD events were documented by the year of 2001. Cox proportional hazards regression models were undertaken to adjust for baseline variables with fatal CVD events as the outcome variable. Additive interaction model was used to evaluate the interaction between elevated TC and hypertension.

Results  Hypercholesterolemia and hypertension were significantly associated with an increased hazard ratio (HR) of fatal CVD (1.67 (95% CI 1.18–2.38) and 2.91 (95% CI 2.23–3.80) respectively. Compared to participants with normotension and TC <240 mg/dl, the HRs were 1.11 (95% CI 0.56–2.21), 2.74 (95% CI 2.07–3.64) for hypercholesterolemia and hypertension respectively, and 5.51 (95% CI 3.58–8.46) for participants with both risk factors. There was an additive interaction with a 2.65 (95% CI 0.45–4.85) relative excess risk (RERI) between hypercholesterolemia and hypertension on CVD.

Conclusion  We found that the risk of fatal CVD was significantly associated with an additive interaction due to hypercholesterolemia and hypertension besides a conventional main effect derived from either of them, which highlights that the prevention and treatment of both risk factors might improve the individual risk profile thus reduce the CVD mortality.

     

江苏某农村地区高血压现状调查及影响因素分析

目的 了解农村居民高血压患病率、知晓率和控制率,分析患病率影响因素,为高血压防制提供科学依据。方法 采用整群抽样对江苏某县级市的8966名18岁以上农村居民开展流行病学调查,其中男性4149人,女性4817人.结果 参与调查的居民高血压患病率、知晓率、控制率分别为36.10％、55.22％和20.38％,已知患病人群的血压控制率为36.90％.初次诊断医院以村卫生室和镇医院为主（79.35％）,81.30％的患者主要选择在村卫生室测量血压.调整年龄和性别等潜在混杂因子后,高血压患病影响因素主要包括目前饮酒（OR =1.43,95％ CI：1.21～1.69）、体力劳动强度偏大（中等强度劳动,OR=1.17,95％CI：1.02～1.34;重体力劳动,OR=1.28,95％ CI：1.04～1.58）;罹患糖尿病（OR=1.95,95％ CI：1.56 ～2.43）;肥胖（OR =2.14,95％ CI：1.85～2.49）或超重（OR=4.12,95％ CI：2.97 ～5.72）;腰围偏大（OR =2.00,95％ CI：1.72～2.32）.文化程度高者患病风险降低（P ＜0.001）.结论 农村居民高血压患病率高,而知晓率和控制率偏低,迫切需要采取有针对性的预防、管理和控制措施。     

睡眠呼吸暂停相关心率变异与晨起血压的关联性研究

目的 探讨迷走神经调节机制在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)相关性高血压发生中的作用.方法 对104例OSAHS患者进行睡眠呼吸监测至少7 h,睡前和晨起测量血压,采用Pearson检验和Speammn检验分析体重指数(BMI)、呼吸暂停低通气指数(AHI)、夜间最低血氧饱和度(nSaO2%min)、SaO2<90%时间占总睡眠时间百分比(DT90%)、呼吸暂停期心率变异幅度(DHR)与睡前及晨起收缩压、舒张压、平均动脉压(MAP)及其差值的相关性,并对晨起收缩期高血压及舒张期高血压的危险因素进行多元逐步Logistic回归分析,计算各因素的优势比(OR)和95%可信区间(CI).结果 全组患者晨起收缩压、舒张压及MAP(mm Hg,1 mm Hg=0.133 kPa)分别为128.3±17.9、88.6±10.6和101.8±12.3,均较睡前(分别为123.5 4±17.8、82.0 4±9.6、95.8 4±11.5)升高(均P<0.01).血压满足高血压诊断者睡前为37例(35.6%),晨起为49例(47.1%).Spearman检验显示DHR与晨起舒张压相关(r=0.214,P<0.05).合并舒张期高血压患者的DHR大于不合并患者(P<0.05).排除年龄、BMI、AHI、nSaO2%min及DT90%的影响后,DHR是与晨起收缩期高血压相关的独立危险因素(OR=1.253,95%CI为1.057～1.486,P<0.01).结论 OSAHS患者呼吸暂停相关心率变异的程度与晨起舒张压相关,是晨起收缩期高血压的独立危险因素,提示迷走神经调节可能参与OSAHS相关性高血压的发生.     

河南漯河地区中老年人群类风湿关节炎危险因素及其患病情况分析

目的 通过对河南省漯河市中老年类风湿关节炎(RA)人群的调查,了解其患病相关情况及危险因素.方法 通过两阶段整群抽样的方法及问卷、实验室检测的方法对漯河地区中老年进行调查,根据2010年ACR/EULAR提出的RA分类标准对RA人群病情及其危险因素进行评估.结果 本研究中占漯河地区中老年RA的患病人群为0.71％.65～69岁和60～64岁两个年龄段的患病率较高,分别为1.13％和0.84％,标化后分别为1.10％和0.77％;从性别上看男性患病率显著低于女性(0.39％ vs.1.02％,x2=10.513,P=0.001).RA的重要危险因素包括:性别(女性)、居住楼层(一层)、吸烟和遗传因素,危险度分别为2.595(95％CI:1.407～4.784)、2.967(95％CI:1.749～6.307)、1.682(95％CI:1.206～4.039)和1.934(95％CI:1.286～4.130).结论 漯河市中老年人群RA的患病率为0.71％,女性、居住一层、吸烟和遗传因素是其危险因素.     

针刺辅助治疗改善急性胰腺炎患者胃肠功能的Meta分析

【目的】评价针刺疗法辅助治疗急性胰腺炎的疗效。【方法】检索中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、万方、Pub Med、EMBase、Cochrane Library等数据库中有关以西医常规治疗作为对照组、以西医常规治疗结合针刺疗法作为观察组的急性胰腺炎疗效观察的随机对照临床试验(RCT),对符合纳入和排除标准的入选文献的质量进行系统评价;提取相关数据,采用Rev Man5.3软件进行Meta分析。【结果】共有7项RCT合计371例AP患者纳入本研究。针刺疗法辅助治疗组的腹痛缓解时间(WMD=-1.44;95%CI:-2.38,-0.50)、腹胀缓解时间(WMD=-2.50;95%CI:-4.07,-0.73)、肛门排气恢复时间(WMD=-1.79;95%CI:-3.73,-0.14)、排便时间(WMD=-1.95;95%CI:-3.51,-0.39)、肠鸣音恢复时间(WMD=-1.39;95%CI:-2.44,-0.34)、血淀粉酶恢复正常时间(WMD=-2.09;95%CI:-3.22,-0.96)、住院时间(WMD=-3.70;95%CI:-6.04,-1.36)均明显低于对照组,除肛门排气恢复时间外,其余各指标的差异均有统计学意义(P0.05)。【结论】针刺辅助治疗急性胰腺炎能显著改善患者的胃肠功能,缩短血淀粉酶恢复时间及住院时间。但由于纳入的RCT方法学质量较低,建议开展更为严格的RCT以提供充分证据支持针刺辅助治疗AP的疗效。