钠盐摄入与脑卒中发生风险关系的Meta分析

目的 探讨钠盐摄入与脑卒中发生风险的关系。方法 对关于钠盐摄入与脑卒中发生风险的前瞻性队列研究进行Meta分析。结果 共纳入10篇文献,与低钠盐摄入组相比,高钠盐摄入组发生脑卒中的风险显著增高15%(RR:1.15,95%CI:1.01～1.31),差异具有统计学意义(P = 0.04)。敏感性分析显示总体研究结果比较稳定,单个研究不会对总体结果产生显著影响。结论 钠盐摄入与脑卒中发病风险呈正相关,适当减少钠盐的摄入有利于预防脑卒中的发生。     

脑血管血液动力学积分与脑卒中风险的队列研究

目的　探讨脑血管血液动力学指标 (CVHI)和其他脑卒中危险因素与脑卒中发病风险的关系。方法　以整群抽样的方法选择东北、华北等六大行政区 35岁及以上的队列人群 2 5 355人 ,进行脑卒中常见危险因素的基线调查 ,同时进行CVHI检测 ,并对检测结果进行积分。随访 7年中共发生脑卒中患者 2 2 8例 ,以脑卒中的发病作为观察终点 ,按危险因素暴露和CVHI积分分组 ,计算暴露与否发病的相对危险度 (RR)及其可信区间 (CI) ,并用Cox回归进行多因素分析。结果　单因素分析显示 :高血压、心脏病、糖尿病、高血压病家族史、脑卒中家族史、超重或肥胖、饮酒史、吸烟史、CVHI积分 <75分的RR值分别为 3 .2 3(2 .48～ 4 .2 0 )、2 .53(1 .92～ 3 .33)、2 .38(1 .55～ 3 .64)、1 .32(1 .0 2～ 1 .72 )、1 .82 (1 .37～ 2 .41 )、1 .62 (1 .2 5～ 2 .1 1 )、1 .48(1 .0 7～ 2 .0 4 )、1 .76(1 .34～ 2 .31 )和 7.30(5 .43～ 9.80 ) ;多因素Cox回归分析显示 :被筛选进入回归方程的因素分别为 :CVHI积分异常、脑卒中家族史、吸烟、高血压病史、年龄和性别 ;CVHI积分的剂量反应关系分析显示 ,脑卒中的风险随着CVHI的积分降低而显著上升 ;协同作用分析显示 ,当CVHI积分 <75分和高血压合并出现时 ,脑卒中的RR值为 1 2 .55 ,表现     

八问两查预测脑卒中发生风险

近日,在“2012心血管病患者脑卒中一级预防实践项目”的启动会上,中华预防医学会会长王陇德院士给出了脑卒中风险评估的“8＋2”法则：其中“8”指的是每个人都应该问自己8个问题,“2”是指高危人群要做两项检查。通过“8＋2”,能让绝大多数人了解自己发生脑卒中的风险,减少很多因脑卒中致死、致残的悲剧。     

钙摄入与肥胖

有研究显示高膳食钙特别是源于奶制品的钙摄入可以降低体重、减少肥胖发生的危险性,其机制可能存在多方面。更好地了解钙和奶制品对肥胖的影响,仍有待于进一步深入研究。     

钙摄入与高血压：人类研究

当前对钙与高血压关系的研究较炎广泛，深入，钙与高血压，酶和激素对钙与高血压的影响，以及年龄，性别，ｐＨ，高盐饮食和体重等因素与钙和高血压的相关研究普遍受到重视。     

钙摄入与心血管疾病

钙是人体必需的矿物质元素。一直以来,文献报道钙摄入有利于降低血压,保护心血管;而近年来,不少文献报道钙摄入可能增加心血管疾病发生风险,补钙安全性受到了质疑。本文针对钙摄入引起心血管疾病发生相关文章进行综述,为进一步研究钙摄入与心血管疾病之间关系以及合理补钙提供理论依据。     

利用Framingham脑卒中概率模型估计老年人群的脑卒中风险

目的 探索Framingham脑卒中概率模型在社区老年人群中的应用。方法 调查对象为参与上海市某社区体检的5 148名55岁及以上老年人。通过问卷调查收集健康状况及其相关危险因素的信息。测量血压、身高、体重和腰围。空腹采血检测血糖和血脂。结果 男性和女性对象的10年脑卒中平均概率分别为9.75%和6.22%(P<0.05)。除年龄因素外,男性老年人脑卒中的风险增高可能与吸烟率和房颤患病率较高有关。除血压和空腹血糖等风险模型相关变量外,腰围身高比和血清三酰甘油水平与脑卒中概率模型估计风险增加相关(OR=1.598,95%CI:1.371~1.864;OR=1.487,95%CI:1.225~1.783)。结论 除脑卒中模型中相关危险因素变量外,还要重视体重和血清三酰甘油的控制。对于男性老年人而言,戒烟是降低脑卒中风险的重要措施。     

中国八城市成人钙摄入状况研究

目的通过横断面调查,了解中国八城市成人钙摄入情况、钙的餐次分布和钙的食物来源。方法采用立意抽样和分层随机抽样相结合的多阶段抽样方法,通过问卷调查获得其一般情况,通过24h膳食回顾调查获得其膳食情况。结果有效调查对象1716人,膳食总钙摄入量为351.4(203.6,566.9)mg/d,均值为467.1 mg/d;食物中的钙(不包含膳食补充剂)的摄入量为325.6(191.7,497.5)mg/d,均值为402.7mg/d,不同年龄组和南北方之间钙摄入量存在差异。补充含钙膳食补充剂占总调查人群的10.6%,平均摄入量为367.3(250.0,650.1)mg/d,女性补充率为12.8%,高于男性(P0.001);50岁及以上人群的含钙补充剂补充率为14.2%,高于18~49岁年龄组(P0.001)。调查对象整体钙摄入量低于EAR的比例为85.2%,高于RNI的为8.5%。就食物来源,本研究膳食钙主要来源于蔬菜和奶类食品,分别占25.5%和22.8%;豆类、肉类和谷类对膳食钙的贡献率均超过10%。早餐钙的摄入量较少,中位数为63.5 mg/d;午餐和晚餐的钙摄入相近,中位数分别为73.3、72.0 mg/d;三餐钙的摄入量差异有显著性(P0.05)。结论城市成年人膳食钙摄入不足的发生率仍旧较高,含钙补充剂在成年人群中使用率低;应该合理安排餐次,调整饮食结构,增加富含钙食物摄入以提高钙的摄入水平。     

正常成人摄入相对低钙时的钙代谢平衡研究

<正> 近年来,钙的营养功能及其对健康的影响日益受到重视;摄取适量的钙是保证人体健康所必需的。我国规定正常人的钙供给量(RDA)为800mg/d,但根据我国1982年营养调查结果,全国27个省、市、自治区中,有15个省、市、自治区的平均钙摄入量为400mg左右。摄入此相对低钙饮食时一般并无缺钙表现,血钙亦在正常范围内。为了解我国正常成人摄入钙在400mg/d时的钙代谢情况,我们利用代谢平衡的方法进行了研究。 对象和方法     

基于人群的身体活动水平与脑卒中发病风险的队列研究

目的:探讨≥40岁成年人身体活动水平对脑卒中发病的影响。方法:通过宁波市2015年具有人群代表性的成年人慢性病监测调查获得身体活动和人口特征基线数据,利用2015-2019年宁波市慢性病监测信息协同管理系统获得脑卒中发病数据,将数据库进行匹配形成队列。身体活动按照每周身体活动量（METs）分为低、中等和高强度身体活动。...     

Flavonol intake and stroke risk: A meta-analysis of cohort studies

ObjectiveEpidemiologic findings are inconsistent regarding the association between flavonol intake and the risk for stroke. The aim of this study was to determine whether an association exists between them in observational studies.MethodsWe searched the PubMed and EMBASE databases for studies conducted from 1966 to August 2013. Prospective cohort studies that provided relative risk (RR) estimates with 95% confidence intervals (CIs) for the association between flavonol intake and risk for stroke were included. A random effects model was used to combine study-specific risk estimates.ResultsThe meta-analysis included eight studies, with 5228 stroke cases among 280 174 participants. The summary RR indicated a significant association between highest flavonol intake and reduced risk for stroke (summary RR, 0.86; 95% CI, 0.75–0.99). Furthermore, an increase in flavonol intake of 20 mg/d was associated with a 14% decrease in the risk for developing stroke (summary RR, 0.86; 95% CI, 0.77–0.96). Subgroup analyses suggested a significant inverse association between highest flavonol intake and stroke risk among men (summary RR, 0.74; 95% CI, 0.56–0.97) but not women (summary RR, 0.99; 95% CI, 0.85–1.16).ConclusionsHigher dietary flavonol intake is associated with a reduced risk for stroke, especially among men. Our results support recommendations for higher consumption of flavonol-rich foods to prevent stroke.     

Risk of leukaemia among pesticide manufacturing workers: a review and meta-analysis of cohort studies

PURPOSE: The purpose of this paper is to review available cohort studies and to estimate quantitatively the association between occupational exposure in plants manufacturing pesticides and leukaemia. METHODS: Following a systematic literature search, relative risks were extracted from 14 studies published between 1984 and 2004. Fixed effect analyses were carried out as heterogeneity between studies was not detected. Meta-analyses were performed on the whole set of data and separate analyses were conducted for specific chemical classes of pesticides as well as type of leukaemia. RESULTS: The meta-rate ratio estimate for all studies was 1.43 (95% confidence interval [CI] 1.05-1.94). After stratification by chemical class, consistent increases in the risk of leukaemia were found in all groups but statistical significance was found only for phenoxy herbicides unlikely to have been contaminated with dioxins and furans. This last finding appears equivocal in view of the existing literature. The separate analysis conducted on leukaemias from the myeloid lineage showed the highest relative risk (6.99; 95% CI 1.96-24.90). There was no obvious indication of publication bias. CONCLUSION: The overall meta-analysis among pesticide manufacturing workers provides quantitative evidence to consider occupational exposure to pesticides as a possible risk factor for leukaemia but available data are too scarce for causality ascertainment. Epidemiological evidence did not allow identifying a specific pesticide or chemical class that would be responsible for the increased risk. Exposure to pesticides may be a significant risk factor for specifically developing myeloid leukaemia and there is a need for additional large well-conducted studies with clear definition of exposure and of leukaemia type(s).     

慢性阻塞性肺疾病患者死亡危险因素队列研究的系统综述和荟萃分析

目的  系统评价慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者死亡危险因素。方法  检索PubMed、Cochrane Library、Web of Science、Embase、中国知网、维普网、万方数据知识服务平台和中国生物医学文献数据库有关COPD患者死亡危险因素的研究,再筛选文献、提取数据和质量评价,并进行荟萃分析。结果  纳入15篇队列研究,纽卡斯尔-渥太华(Newcastle-Ottawa Scale, NOS)量表评分7~9分。荟萃分析结果显示：高龄(HR=1.074, 95% CI: 1.048~1.101, P＜0.001)、吸烟(HR=1.390, 95% CI: 1.298~1.490, P＜0.001)、低BMI(HR=1.434, 95% CI: 1.190~1.727, P＜0.001)、高改良英国医学研究学会呼吸困难指数(modified British medical research council, mMRC)(HR=1.597, 95% CI: 1.550~1.646, P＜0.001)、高Charlson共病指数(Charlson comorbidity index, CCI)(HR=1.191, 95% CI: 1.096~1.294, P＜0.001)、Ⅳ级COPD(HR=2.114, 95% CI: 1.681~2.658, P＜0.001)与COPD患者死亡关联有统计学意义。女性(HR=1.091, 95% CI: 0.781~1.522, P=0.610)、低去脂体重指数(fat free mass index, FFMI)(HR=3.025, 95% CI: 0.268~34.203, P=0.371)与COPD患者死亡关联无统计学意义。描述性分析结果显示高N端脑钠肽前体(N-terminal pro-brain nitric peptide, NT-proBNP)、铜绿假单孢菌(pseudomonas aeruginosa, PA)阳性可能是COPD患者死亡的危险因素。结论  高龄、吸烟、低BMI、高mMRC、高CCI、Ⅳ级COPD是COPD患者死亡的独立危险因素,女性和低FFMI不是COPD患者死亡的危险因素,高NT-proBNP、PA感染与COPD患者的死亡关系还需进一步研究证明。     

中国人群中父母脑卒中史与脑卒中发病关系的前瞻性研究

目的探讨中国人群中父母脑卒中史与子代脑卒中发病的关系。方法1992—1994年在全国12组人群中分别整群随机抽取1000～2000人进行心血管病危险因素调查，并对心血管事件的发生情况进行随访观察，随访至2005年6月，平均随访10．8年。结果15131例随访对象共发生脑卒中事件370例。在控制了年龄、性别后，父母双方均无脑卒中史者、仅父母一方有脑卒中史者、父母双方均有脑卒中史者发生脑卒中的相对危险分别为1．00、1．74（1．33～2．29）和3．61（1．86～7．01）。在进一步控制了基线时的吸烟、饮酒、总胆固醇、高密度脂蛋白胆固醇、空腹血糖、体重指数和收缩压后，上述各组发生脑卒中的相对危险分别为1．00、1．34（1．02～1．77）和2．50（1．29～4．87）。结论父母有脑卒中史者具有较高的发生脑卒中危险性，父母双方均有脑卒中者脑卒中发病危险的增加尤为显著。     

Mortality and risk factors for stroke and its subtypes in a cohort study in Japan

OBJECTIVE: To estimate stroke mortality and evaluate risk factors for total stroke deaths and its two principal subtypes in a cohort study in Japan. METHODS: A total of 9651 subjects aged 40 or over and free of stroke were analyzed in a cohort study conducted in Fukuoka Prefecture, Japan. The follow-up period was from 1986 to 2003. Mortality rate per 100,000 person-years of stroke was estimated. The Cox proportional hazards model was used to estimate the hazard ratios and 95% confidence interval. RESULTS: A total of 226 stroke deaths were recorded during 132,972 years of follow-up. Among these, 47 were intracerebral hemorrhage and 109 were cerebral infarction. Stroke mortality rates were 209.4 per 100,000 person-years in males, and 140.5 in females. The results showed that advanced age, male gender, low body mass index (BMI), history of diabetes, hypertension, and transfusion were associated with an increased risk of mortality from total stroke. CONCLUSION: We confirmed that advanced age, male gender, low BMI, history of diabetes, history of hypertension and history of transfusion were associated with an increased risk of total stroke mortality. In addition, the magnitude of these associations differed between the two principal stroke subtypes.     

上海市奉贤社区脑卒中危险因素队列研究基线调查和随访分析

目的 了解上海市奉贤社区脑卒中危险因素暴露水平并探讨各危险因素与脑卒中发病间的关系.方法　2003与2004年整群抽取上海市奉贤区两个社区≥40岁本市户籍常住人口10 565人建立脑卒中队列研究人群,调查高血压病、心脏病、糖尿病、脑卒中家族史、吸烟、饮酒等危险因素暴露状况,并进行脑血管血液动力学指标(CVHI)检测,以统一方法对CVHI进行积分,积分值＜75分为异常,随访脑卒中新发病例共78例,对研究因素进行单因素和多因素Cox回归分析.结果　2003年基线调查显示,该社区高血压病、心脏病、糖尿病、脑卒中家族史、肥胖(BMI≥28 kg/m2)、吸烟、饮酒、CVHI积分异常等八项的暴露率分别为21.14%、6.72%、1.88%、5.63%、4.17%、34.96%、17.81%、29.43%.通过2-3年脑卒中病例随访,单因素分析显示,这八项的相对危险度(RR)及其95%CI分别为:高血压病2.76(1.76～4.32)、心脏病2.19(1.16～4.14)、糖尿病1.52(0.38～6.19)、脑卒中家族史1.58(0.69～3.62)、肥胖1.24(0.45～3.38)、吸烟1.75(1.12～2.73)、饮酒2.10(1.30～3.39)、CVHI积分异常12.72(7.02～23.06).多因素Cox回归分析显示,被筛选进入回归方程的因素是吸烟和CVHI积分异常.结论 高血压病、心脏病、吸烟、饮酒、CVHI积分异常与脑卒中发病有显著的病因学联系,CVHI积分异常和吸烟是脑卒中独立的预测因子.