北京市1680名社区居民血清同型半胱氨酸与代谢综合征关系的横断面研究

目的 分析血清同型半胱氨酸(Hcy)与代谢综合征(MS)间的关系.方法 1680名北京市社区居民纳入调查.MS依据NCEP-ATP Ⅲ标准定义.以多因素logistic回归分析计算MS发病危险比值比(OR),多元线性回归分析Hcy与各指标间的相关关系.结果 校正性别、年龄后MS组Hcy水平高于非MS组(17.99 μmol/Lvs.17.18 μmol/L,P=0.007),随着MS组分由0个增加至4或5个,Hcy水平逐渐升高为16.71、16.94、17.62、18.20和17.82 μmol/L(线性趋势P=0.044).MS的5个组分中,表现为腹型肥胖、高血压和高甘油三酯血症者,其Hcy水平相应较高.多元logistic回归分析显示,Hcy最高四分位水平(Hcy Ⅳ)与MS发生相关.校正年龄、性别、肌酐、肾小球滤过率(eGFR)、低密度脂蛋白胆固醇(LDL-C)、尿酸、吸烟、饮酒、运动等因素后,与Hcy最低四分位水平(Hcy Ⅰ)相比,HcyⅣ的MS发生风险OR=1.379(1.005～1.892).排除性别及年龄因素,偏相关分析显示Hcy与体重指数(BMI)、腰围、血压、LDL-C、甘油三酯、尿酸、肌酐、eGFR呈正相关,与高密度脂蛋白胆固醇呈负相关.多元线性回归分析显示,年龄、男性、BMI、LDL-C、肌酐、尿酸与Hcy水平呈独立正相关.结论 高Hcy水平是MS发生的相关因素,Hcy与年龄、男性、BMI、LDL-C、肌酐、尿酸独立相关.     

轻中度高血压人群中血清肌酐水平及其影响因素

目的 了解中国轻中度高血压人群血清肌酐(serum creatinine,Scr)水平及其影响因素.方法 从哈尔滨、沈阳、北京、西安、上海和南京6个地区入选480例年龄在18～75岁无慢性肾病史的轻中度原发性高血压患者,测定血清肌酐水平,451例患者纳入最终统计分析.结果 总人群平均血清肌酐水平约68 μmol/L,男性77.9μmol/L,女性61 μmol/L,男性高于女性(P＜0.001);在男性和女性人群中Scr均与血浆同型半胱氨酸(homocysteine,Hcy)和尿酸(uric acid,UA)水平呈正相关;其他相关因素具有性别差异,女性人群中血清肌酐水平与高密度脂蛋白(high-density lipoprotein cholesterol,HDL-C)呈负相关,而男性人群中,血清肌酐水平与年龄呈正相关.结论 轻中度高血压人群的血清肌酐水平男性高于女性,且与同型半胱氨酸和尿酸水平独立相关,血清肌酐水平的升高可能是性别、年龄、血浆同型半胱氨酸、尿酸和高密度脂蛋白等因素综合作用的结果.     

高血压患者血浆同型半胱氨酸与年龄、性别、尿酸及血脂的相关性分析

目的 对高血压患者的血浆同型半胱氨酸(Hcy)与年龄(Age)、性别(Sex)、血脂及血浆尿酸(UA)的相关性进行分析研究.方法 依托社区综合防治项目,采用生化酶法对2 350名高血压患者,其中男1 190人,女1 160人,进行血浆同型半胱氨酸、尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)检测,并采用多元回归方法进行相关性分析.结果 统计显示年龄、性别和尿酸对Hcy的影响差异有统计学意义,而TC、TG和LDL对Hcy无影响.年龄每增加1岁,log(Hcy)平均增加0.0055 μmol/L;和男性相比,女性log(Hcy)平均低0.324 μmol/L; UA每增加1μmol/L,log(Hcy)增加0.0005 μmol/L.结论 一定范围内,同型半胱氨酸与尿酸呈正相关,与TC、TG和LDL未发现明显相关.     

不同性别2型糖尿病患者血尿酸与BMI血压血脂的相关性研究

目的 了解不同性别2型糖尿病(T2DM)患者血尿酸(SUA)与体质量指数(BMI)、血压、血脂相关性。方法 选择T2DM 患者360例(男242 例, 女118 例),测定血压、身高、体质量、空腹血浆葡萄糖( FBG) 、三酰甘油(TG) 、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、SUA、肌酐(Cr)。先按男女性别分组,再按SUA水平分为高尿酸组(男性≥420 mol/L,女性≥360 mol/L)、尿酸正常组,比较组间数据差别。结果 不同性别的高尿酸组BMI、TG均显著高于尿酸正常组,估计肾小球滤过率(eGFR)显著低于尿酸正常组,女性高尿酸组⑴舒张压(DBP)显著高于尿酸正常组,不同性别的高尿酸组年龄、病程、SBP、TC、FBG、HDL-C、LDL-C与尿酸正常组相比差异无统计学意义。⑵不同性别的组中,SUA与BMI、TG均呈显著正相关,与 HDL-C、eGFR呈显著负相关,女性组中,SUV与DBP也呈显著正相关,不同性别组的SUA均与年龄、病程、FBG、 SBP、TC、LDL-C无明显相关性。结论 2型糖尿病患者血尿酸的控制与血脂及体质量的控制有关,对于女性患者还应重视舒张压的控制。     

老年人血清NT-proBNP与代谢综合征关系的研究

目的分析老年人血清N末端B型利钠肽前体(NT-proBNP)与代谢综合征(MS)之间的关系。方法选取2007～2009年解放军总医院在北京市石景山区进行的横断面研究数据库中的老年人(≥60岁)993例,比较MS不同组分间校正年龄、性别因素后NT-proBNP水平,多元线性回归分析NT-proBNP与各指标间的相关关系,以多因素logistic回归分析计算老年人NT-proBNP水平≥125 ng/L的独立危险因素。结果校正性别、年龄后,老年人MS组分中三酰甘油(TG)水平较高者血清NTproBNP水平反而较低(32.51 ng/L vs 38.73 ng/L,P=0.001)。多元线性回归分析显示,老年人NT-proBNP水平与女性、年龄、收缩压呈正相关,与舒张压、三酰甘油、总胆固醇、LDL-C、eGFR呈负相关。多元logistic回归分析显示,MS组分个数(OR=1.581,P=0.034)是老年人NT-ProBNP水平≥125 ng/L的独立危险因素。结论老年人NT-proBNP水平与MS无关;在MS组分中,老年人NT-proBNP水平与收缩压呈正相关,与舒张压、甘油三酯呈负相关。MS组分个数是老年人NT-ProBNP水平≥125 ng/L的独立危险因素。     

2015年中国15省份18~59岁成年居民血清尿酸水平及高尿酸血症患病状况

目的 探讨我国成年居民血清尿酸水平及高尿酸血症患病状况。方法 本文数据来自2015年中国居民营养状况变迁的队列研究。将参加本次调查并有完整调查数据的8 217名18~59岁成年居民作为研究对象。采用问卷调查的方式收集调查对象的人口统计学资料,使用德国罗氏尿酸试剂检测盒,通过酶法在全自动生化分析仪上（德国罗氏C701/702）统一检测调查人群空腹血清尿酸。分析研究对象在不同人口统计学特征下血清尿酸水平及高尿酸血症的患病情况。结果 结果显示,2015年我国18~59岁成年居民血清尿酸平均水平为288.0 μmol/L,加权后高尿酸血症患病率为9.8%。其中男性血清尿酸平均水平为329.7 μmol/L,加权后高尿酸血症患病率为15.1%,女性血清尿酸平均水平为254.3 μmol/L,加权后高尿酸血症患病率为5.8%;城市居民血清尿酸平均水平为298.5 μmol/L,加权后高尿酸血症患病率为10.9%,农村居民血清尿酸平均水平为281.9 μmol/L,加权后高尿酸血症患病率为9.1%。男性血清尿酸水平及高尿酸血症患病率随年龄增长呈下降趋势,而女性血清尿酸水平及高尿酸血症患病率随年龄增长呈升高的趋势。结论 不同地区、性别、年龄、家庭收入和文化程度的成年居民血清尿酸水平及高尿酸血症患病率存在一定差异,建议针对不同的人口学特征因素采取精准的防控措施。     

体重指数与儿童青少年体能指数关联性研究

目的 探讨体重指数(BMI)与儿童青少年体能指数(PFI)之间的关联.方法 以安徽省参加2010年全国学生体质健康调查的7～18岁汉族学生共8941人为研究对象.按性别、年龄分层后,将研究对象依据BMI百分位数分为5组:很低(BMI＜P₅)、较低(P₅≤BMI＜P₁₅)、正常(P₁₅≤BMI＜ P₈₅)、较高(P₈₅≤BMI＜P₉₅)、很高(BMI≥P₉₅).对各体能测试成绩进行标准化,将其Z分相加算出PFI.用方差分析比较不同BMI组PFI的差异.用线性回归模型分析不同性别不同学龄段学生BMI与PFI的关联.结果 8941名学生中BMI很低、较低、正常、较高、很高组的PF1分别为-1.77、-0.91、0.32、-0.17、-0.54,呈倒“U”形分布;BMI正常组的PFI显著高于其他各组(P值均＜0.05).回归分析显示PFI与BMI呈正相关,与BMI²呈负相关,表明PFI是BMI的二次函数,随着BMI的增高PFI呈现先上升后下降的抛物线变化趋势.结论 BMI与儿童青少年PFI呈现抛物线变化趋势.     

葡萄糖激酶调节蛋白基因rs780094 多态性与儿童青少年血脂关系的研究

目的 探讨葡萄糖激酶调节蛋白（GCKR）基因rs780094 的多态性与儿童青少年血脂水平的关系。方法 选取1 026 名7～18 岁中小学生为研究对象。由专职人员记录学生一般情况和既往病史,检测身高、体重,并采集清晨空腹肘静脉血,测定血清TC、TG、HDL-C和LDL-C水平。利用基质支持的激光释放/电离飞行时间质谱分析（MALDI-TOF MS）进行GCKR 基因rs780094 位点的基因型检测。采用多元线性回归和多元logistic 回归分析基因多态性与血脂水平的关系。结果 调整年龄、年龄的平方和性别,GCKR基因rs780094 多态性A等位基因与TC、TG和LDL-C 的水平增加存在相关性（b＝0.06 mmol/L,P＝0.037;b＝0.09 mmol/L,P＜0.001;b＝0.05 mmol/L,P＝0.040）;rs780094 多态性与TG、LDL-C 异常也存在相关性（OR＝1.60,95%CI：1.30～1.97,P＜0.001;OR＝1.35,95%CI：1.02～1.80,P＝0.036）。结论 GCKR 基因rs780094 位点的多态性与儿童青少年血脂水平有关,A等位基因可能是血脂增高的遗传因素。     

高敏C反应蛋白与儿童肥胖及代谢综合征相关代谢异常的关系

目的 探讨儿童时期高敏C反应蛋白（hsCRP）与肥胖及MS相关代谢异常的关系,并比较其联系强度。方法 在历史队列中选取成功随访并参与hsCRP 及各项指标检测的403 名儿童作为研究对象。体格检查包括身高、体重、WC、血压、体脂含量百分比（Fat%）、血生化指标（hsCRP、TG、TC、LDL-C、HDL-C、FPG）等。对hsCRP 和TG 测定值分别取以10 为底的对数（lgCRP、lgTG）转化为近似正态分布,分析lgCRP 和代谢异常之间的关系。采用偏相关分析、协方差分析,并控制儿童出生体重等因素。计算各代谢指标的Z 分值,与lgCRP 做线性回归分析。结果 （1）lgCRP 与HDL-C水平呈负相关,与其他体量及代谢指标存在明显正相关;控制BMI后,除LDL-C 外,其他指标和lgCRP 的相关性消失。（2）lgCRP 在是否高FPG 组间、是否低HDL-C 组间、是否高TC组间差异不明显（P＞0.05）,在其他代谢异常组间的差异有统计学意义（P＜0.05）;控制BMI后,lgCRP 与高血压、高TG的联系消失,与MS的联系被削弱。（3）线性回归分析比较各代谢指标与hsCRP 的联系强度,可见WC、BMI、Fat%与肥胖相关的指标与hsCRP 的联系最密切（β值分别为0.294、0.289 和0.277）,其次是SBP、HDL-C、DBP、lgTG 和LDL-C。控制BMI后,只有LDL-C与hsCRP的线性关系仍存在,但已被大大削弱,其他指标与hsCRP的线性关系消失。结论 hsCRP与肥胖、血脂代谢、MS均相关;WC是与hsCRP的联系最密切的指标;肥胖是hsCRP最强且独立的影响因素     

糖尿病前期受高尿酸血症影响的相关因素分析

目的探讨高尿酸血症影响糖尿病前期(PDM)的相关因素及其两者的关系。方法在2009年2月至2叭0年2月哈尔滨医科大学附属第二医院未使用噻嗪类药物的20~75岁PDM患者中, 随机抽取157例, 按尿酸水平分为正常尿酸(NuA)组(8l例)和高尿酸(HUA)组(76例), 对两组临床资料应用t检验以及Pearson相关分析进行统计分析, 比较两组间BMI、腰围身高比(WSR)、TC、TG、HDL-C、LDL.C、稳态模型胰岛素抵抗指数(HOMA.IR)、糖化血红蛋白(HbAlc)的差异以及各指标与尿酸的相关性。结果(1)HUA组BMI为(27.74±2.88)kg/m, ²、WSR为(0.55 4-0.41)、TC为(6.61±0.73)mmol/L、TG为(3.944-1.97)mmoI/L、LDL.C为(3.604-0.45)mmol/L、HOMA。IR为(3。09±1。20), 均高于NUA组, 差异有统计学意义(P<0。05);(2)PDM患者的尿酸水平与TG、TC、LDL-C及HOMA-IR呈正相关(分别为r=0.29, r=0.33, r=0.49, r=0.51, P<0.05), 与HbAlc呈负相关(r=-0.30, P<0.05)。结论PDM患者血尿酸水平受BMI、TC、TG、LDL-C、HOMA.IR等因素影响。体内HUA状态与胰岛素抵抗密切相关, 促使PDM患者进展为糖尿病, 并引发血脂代谢紊乱。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.