重庆市丰都县农村人口糖尿病常见危险因素的分析

目的了解重庆市丰都县农村人口糖尿病发生的危险因素。方法于2006-2007年对丰都县农村人口糖尿病发生危险因素进行调查分析。结果农村人群糖尿病发生的主要危险因素为糖尿病家族史（OR为2．568,95％CI为1．773—3．720）、高血压史（OR为1．069,95％CI为0．723～1．580）、肥胖（OR为1．854,95％CI为1．305～2．634）和高血脂（OR为1．606,95％CI为1．119—2．034）。结论需加强农村人口对糖尿病防治知识的健康教育。     

皮质下动脉硬化性脑病的危险因素分析

目的探讨皮质下动脉硬化性脑病（BD）的危险因素，以指导临床及时采取正确有效的干预措施。方法收集住院确诊的BD病人100例为BD组，另设同期住院的非脑血管病病人100例为对照组，进行成组病例对照研究。应用非条件Logistic回归模型进行单因素、多因素分析。结果单因素分析表明，16个因素与BD的发病有关（P〈0．05），其中高密度脂蛋白为保护因素。其余为危险因素。多因素分析表明，中风病史、高血压病史、肥胖（BMI≥26kg／m^2）、饮酒史、高龄是皮质下动脉硬化性脑病的独立危险因素，将多因素分析模型中中风病程、高血压病程厦饮酒年限进行分级研究，其OR值和OR的95％CI分别为21．25（4．50～100．28）、10．59（1．29～86．27）、3．02（0．86～10．61）。交互作用分析：年龄与中风病程、年龄与高血压病程的OR值和OR的95％CI分别为6．36（3．0～13．50）、2．21（1．84-4．12），年龄与饮酒年限不存在交互作用。结论高血压病痛史、中风病史、肥胖、饮酒史、高龄是皮质下动脉硬化性脑病发病的主要原因。     

脑梗死急性期血浆组织型纤溶酶原激活物对其预后的影响

目的探讨脑梗死急性期血浆中组织型纤溶酶原激活物（t—PA）水平对脑梗死预后的评估价值。方法采用前瞻性设计，将120例急性脑梗死患者分为t—PA正常组（〉1．3IU／ml）69例和t—PA降低组（≤1．3IU／ml）51例，对两组患者进行生存分析比较。在发病72h内检测血浆t—PA水平，随访1年，将死亡及再发缺血性血管病记录为终点事件。采用多元回归分析，分析t-PA、高血压、糖尿病、冠心病、高血脂、年龄、吸烟、饮酒等因素对终点事件的影响。结果①t-PA降低组患者较t-PA正常组患者终点事件发生率显著增加（28．9％，11．7％；P=0．007，log-rank检验）；②多变量回归分析显示，t-PA降低（OR=3．966；95％CI：1．753-13．285；P=0．039）、吸烟（OR=5．233；95％CI：1．991～16．227；P=0．035）及糖尿病（OR=4786；95％CI：1．591—16．709；P=0．033）与终点事件独立相关。结论脑梗死急性期t-PA降低可能是脑梗死发病1年内死亡和再发缺血性血管病的独立危险因素。     

暗娼人群接受艾滋病自愿咨询检测的内在影响因素探讨

目的为探索暗娼人群接受自愿咨询检测（VCT）的内在影响因素，提高高危人群主动接受艾滋病病毒（HIV）检测的比例。方法对暗娼人群采取非条件Logistic回归分析的方法，比较其接受VCT的内在促进因素。结果通过对服务场所、所在镇区、年龄、民族、婚姻状况、文化程度、艾滋病相关防治知识、使用安全套情况和对VCT的了解情况进行分析比较，有统计学意义的有：年龄因素（OR=1．2499，95％CI为1．0656～1．4660）；婚姻状况中已婚暗娼相对于未婚者有统计学意义（OR=5．6250，95％CI为1．4667～21．5728）；在艾滋病相关知识的掌握中，预防知识的全面掌握有利于其接受VCT；出现下身不适也有助于其接受检测（OR=7．1558，95％CI为2．3577～21．7187）；知道VCT免费（OR=15．7500，95％CI为4．4960～55．1739）和知晓检测匿名（OR=14．4000，95％CI为3．9225～52．8644）都有统计学意义；其他因素如服务场所、服务地区、民族、学历及是否使用安全套都不存在统计学意义。多因素分析仅出现下身不适（OR=15．5013，95％CI为1．5048～159．6884）和知晓检测匿名（OR=13．9291，95％CI为1．1400～170．1892）有统计学意义。结论影响暗娼人群接受VCT的内在因素应该是多方面、相互影响的，今后应深化艾滋病及VCT的宣传，强化性病门诊的监测，以利于提高VCT的接受利用程度。     

缺血性卒中并发高钠血症危险因素的分析

目的探讨缺血性卒中患者并发高钠血症的危险因素，为早期干预提供依据。方法回顾性分析连续入院的缺血性卒中患者322例的临床资料。患者入院后1h内采用离子电极法测量血液生化指标。其中高钠血症43例，非高钠血症279例，记录可能影响血钠水平的9项危险因素，进行X^2或t检验，并采用多元Logistic回归分析，筛选出独立的危险因素。终点指标以发病后4周的病死率作为判断。结果缺血性卒中患者并发高钠血症危险因素的多因素分析显示，使用大剂量甘露醇（OR=4．9，95％ CI：2．40-9．71）、大脑中线结构损害（OR=3．9，95％ CI：2．00～7．65）、血糖增高（OR=1．4，95％CI：1．18～1．69）3项因素进入模型（P〈0．05）。高钠血症组4周病死率为67．4％（29／43），明显高于非高钠血症组的17．2％（48／279），两组比较差异有统计学意义（X^2=51．68，P〈0．01）。结论引起高钠血症的主要危险因素是大剂量甘露醇、大脑中线损害和血糖增高。高钠血症患者预后差，生存率低。     

急性脑梗死早期患者血糖水平对预后的影响

目的：观察急性脑梗死早期患者血糖水平对预后的影响。方法104例发病72 h内入院的急性脑梗死患者,入院后立即行血清葡萄糖测试,采用美国国立卫生研究院卒中量表（ NIHSS）进行评分,运用改良Rankin残障量表评分（mRs）评估预后。结果104例急性脑梗死患者中,43例（41．3％）出现高血糖,高血压（OR＝3．655,95％CI：1．218～10．969,P＜0．05）、糖尿病（OR＝17．714,95％CI：3．568～87．939,P＜0．05）、NIHSS评分（OR＝2．731,95％CI：1．637～5．458,P＜0．05）为急性脑梗死后高血糖的独立危险因素。 NIHSS评分（OR＝0．322,95％CI：0．181～0．572,P＜0．05）、高血糖（OR＝6．782,95％CI：1．654～26．373,P＜0．05）为预后不良的独立危险因素。结论部分急性脑梗死患者早期血糖升高,高血糖为急性脑梗死预后不良的独立危险因素。     

不列颠哥伦比亚省以人口为基础的耐药结核病危险因素研究

背景：加拿大不列颠哥伦比亚的省级结核病（TB）工作。 目的：调查不列颠哥伦比亚省抗结核药物耐药的相关危险因素，并确定不同耐药类别危险因素的特征是否有所不同。 设计：应用省级结核病服务的人群资料，所有在1990-2001年间结核分枝杆菌培养阳性的病例均被包括在本研究中。应用Logistic回归分析评估耐药的危险因素。 结果：在3041个合格结核病例中，295例（10％）耐药。耐药性的重要危险因素为青年、国外出生、少数民族、TB复发和初次诊断的地点。国外出生的研究对象（OR=3．18，95％CI：2．26-4、49）出现耐药的危险性是加拿大出生研究对象的3倍多。不同种族人群中，华裔（OR=2．32，95％CI：1．51-3．57）、东南亚裔（OR=2．92，95％CI：1．88-4．52）和其他亚裔（OR=4．40，95％CI：2．77-7．01）出现耐药的危险性是高加索裔的2-4倍。复发病例（OR=2．69，95％CI：1．91-3．77）出现耐药的危险性是新病例的3倍。 结论：本文对大人群基础队列中的耐药结核病危险因素进行了分析和定量评价，并确定了发达国家的耐药结核病高危病人群体。     

颅内动静脉畸形血管构筑特征与出血的相关性分析

目的探讨颅内动静脉畸形（AVM）首次出血相关的血管构筑特征。方法回顾性研究277例颅内AVM患暂（281个颅内畸形团）的临床表现，其中出血组畸形团167个（59.4％），非出血组114个（40.6％），分析、比较两组患者脑血管造影的血管构筑特征，采用单因素和多闪素分析模式对其进仃统计学分析。结果单因素统计分析表明，小畸形团（〈30mm）、幕下畸形、深部畸形、单支深静脉引流、单支静脉引流、引流静脉直径／供血动脉直径r≤2与出血表现具有卡相性；引流静脉扩张、狭窄及合并颅内动脉瘤与畸形出血无关。当采用多因素回归分析时，只有小畸形团（OR：3．72；95％CI：1．76～7．85）、幕下畸形（OR：6．54；95％CI：2．07～20．72）、r≤2（OR：2．55；95％CI：1．32～4．94）与出血表现相关（P〈0．01），当r≤1．5时，OR为7．08（95％CI：2．90～17．27，P〈0．001）。结论位于幕下、小畸形团、引流静脉直径／供血动脉直径r≤2是颅内AVM出血的高危因素，当r≤1．5时，颅内AVM出血的风险更大。     

青少年高血压与代谢综合征的危险因素

目的 探讨青少年高血压与代谢综合征（MS）各组分之间的关系及其危险因素分析。方法通过分层整群随机抽样，共抽取12～18岁青少年3953人，以12～15岁为青春前期（n=1698），16～18岁为青春期（n=2255），测量身高、体质量、腰围、臀围、血压、空腹血糖（FPG）、三酰甘油（TG）、胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）及低密度脂蛋白胆固醇（LDL-C）水平。结果1）总调查人群中高血压患病率为6．2％。2）13～18岁超重肥胖者血压高于体质量正常者（P〈0．05）。3）男、女性青春期舒张压（DBP）异常检出率均高于青春期前（P〈0．05），青春期女性收缩压（SBP）异常检出率高于男性（P〈0．05）。4）高血压组体质量、体质量指数（BMI）、腰臀比（WHR）、SBP、DBP、FPG、TG及LDL-C均高于正常对照组，HDL-C稍低于对照组（P〈0．05）。5）高血压组超重肥胖、高TG、低HDL-C、MS及高血压家族史检出率高于正常对照组（P〈0．05），两组间高FPG、糖尿病家族史检出率差异无统计学意义。6）Logistic多因素回归分析显示，女性高SBP危险性是男性的2．10倍（95％CI为1．47～2．98）；年龄每增加1岁，DBP升高的危险性增加1．22倍（95％CI为1．08～1．38）；有高血压家族史青少年高SBP的危险性是无家族史的1．64倍（95％CI为1．17～2．30）；BMI每增加1kg／m。，SBP升高的危险性增加1．24倍（95％CI为1．20～1．28），DBP升高的危险性增加1．19倍，（95％CI是1．15～1．23）（P〈0．01）。结论青少年高血压与MS密切相关，家族史、超重肥胖是引发青少年高血压的主要危险因素，要重视青少年心血管疾病的一级预防。     

广州市医院严重急性呼吸综合征超级传播事件相关环境因素的研究

目的 探讨严重急性呼吸综合征（severe acute respiratory syndrome，SARS）病区的各环境因素在超级传播事件（SSE）中所起的作用。方法 以发生SSE的35个病区和没有SSE发生的51个病区作为研究对象，采用回顾性病例对照研究方法，运用单因素分析和多因素Logistic回归分析进行比较。结果有4个危险因素在SSE的发生中起重要作用，P均＜0．05，按OR值从大到小排列结果依次为：病房里没用排气扇（OR值：8．11，95％CI：2，23～29．44）；员工出现上呼吸道感染症状仍然在岗工作（OR值：7．13，95％CI：1．67～30．43）；病床之间的最短距离≤1．0m（OR值：5．77，95％CI：1．37～24，36）；病房里有复苏抢救操作（OR值：4．84，95％CI：1．42～16．56）。结论 病房里病床距离≤1．0m、病房的通风不良、病房有复苏抢救工作及病房工作人员出现上呼吸道感染症状后仍然在岗工作是医院SARSSSE发生的重要危险因素。     

Lower risk but high risk

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Use of risk factors in determining individual coronary risk

The "Deutschland SCORE" has low predictive power and greatly overestimates the true risk of coronary heart disease in Germany. Widespread use of this score would lead to massive over-treatment. For this reason, we cannot recommend this score for general use.     

Lifestyle-related risk factors and risk of future nursing home admission

BACKGROUND: While risks of disease, hospitalization, and death attributable to lifestyle-related factors such as smoking, inactivity, and obesity have been well studied, their associations with nursing home admission are less well known. These risk factors are usually established by middle age, but nothing is known about how they relate to long-term risk of nursing home admission in this age group. METHODS: Cox proportional hazards regressions were used to analyze risk of nursing home admission over 2 decades of follow-up (1971-1975 to 1992) in a nationally representative, longitudinal survey of community-dwelling adults aged 45 to 74 years at baseline. Middle-aged (45-64 years at baseline) and elderly persons (aged 65-74 years at baseline) were analyzed separately: 230 (6.5%) of 3526 middle-aged respondents and 728 (24.7%) of 2936 elderly ones had 1 or more nursing home admissions. Baseline risk factors included smoking, inactivity, obesity, elevated blood pressure, elevated total cholesterol level, and diabetes mellitus, which were defined according to national guidelines. RESULTS: All lifestyle-related factors, except total cholesterol level, were associated with higher risk of nursing home admission during follow-up in one or both age groups. Risk ratios were higher in middle-aged than in elderly persons. In those aged 45 to 64 years at baseline, diabetes more than tripled the risk of nursing home admission (relative risk, 3.25; 95% confidence interval, 2.04-5.19); smoking, inactivity, and elevated systolic blood pressure had relative risks of 1.56, 1.40, and 1.35, respectively. Obesity was a risk factor for those aged 65 to 74 years at baseline, but not for the middle-aged subjects. Persons with 2 lifestyle-related factors were at greatly increased risk, especially if 1 was diabetes. CONCLUSIONS: Lifestyle factors are important contributors to the long-term risk of nursing home admission. Modifying lifestyle, especially in middle age, may reduce the risk of admission.     

Cardiac risk assessment: matching intensity of therapy to risk

Simple RSS allow for rapid decision making in the emergency department. The data presented in this article suggest that for patients at the highest risk and the lowest risk for complications of NSTEACS, the scoring systems work well and allow effective triage and treatment. For patients at intermediate risk (30%-40% of all patients who have ACS), however, it is not clear whether early aggressive treatment with cardiac catheterization or routine conservative management should be the standard of care. The consensus guidelines are vague, and the scoring systems discriminate less well for these patients. The authors think that patients at intermediate risk are best served by initial screening with an RSS like the TRS (with risk scores of 3-4), followed by a multimarker strategy to define risk better. They also think that the next step is to design clinical trials to test strategies of care defined prospectively by risk. This step would, in the authors' opinion, begin the next round of the cycle of clinical therapeutics [31]. The treatment of patients who have NSTE ACS has been characterized in the past 2 decades by care based on evidence from many excellent clinical tri-als. The consensus panels have convened and guide patient management. Quality-improvement initiatives such as CRUSADE and GRACE give feedback to improve compliance with guidelines.The understanding of risk is developing with the help of these scoring systems. Discovery is ongoing.The next decade of acute cardiac care will focus on early identification of patients at high risk and on matching the most intensive treatments to the patients most in need. Excessive testing and care promotes cost inefficiency and, perhaps, increased hazard for some patients. New trials are needed to move these new hypotheses back into practice.     

A risk score for carotid plaque as an assessment risk of cardiovascular risk among patients with hypertension

This study aimed to describe the status of carotid plaques and develop a simple scoring system to predict the risk of carotid lesions in patients with hypertension. Basic testing for carotid plaques was carried out and used for risk score development (the training dataset, n = 2665) and validation (the test dataset, n = 1333). Independent predictors of carotid plaques from the multivariate model were assigned integer weights based on their coefficients and incorporated into a risk score. The discriminant ability of the score was tested by receiver operating characteristic analysis using the test dataset. A total of 1346 of 2665 patients were examined for carotid plaques, which were more frequent in men than in women, and increased with age. The final model included eight significant variables, and these variables were then used to develop a risk score for the prediction of carotid plaques. Receiver operating characteristic analysis demonstrated good discriminant power with a C-statistic of 0.732 (95% confidence interval: 0.713–0.751) and good calibration across quantiles of observed predicted risk (74.6%). We developed a simple risk score for the prediction of carotid plaques based on eight variables. The prediction model showed good discriminant power and calibration.     

Pre-operative risk assessment and risk reduction before surgery

Perioperative myocardial infarctions are the predominant cause of morbidity and mortality in patients undergoing noncardiac surgery. The pathophysiology of perioperative myocardial infarction is complex. Prolonged myocardial ischemia due to the stress of surgery in the presence of a hemodynamically significant coronary lesion, leading to subendocardial ischemia, and acute coronary artery occlusion after plaque rupture and thrombus formation contribute equally to these devastating events. Perioperative management aims at optimizing the patient's condition by identification and modification of underlying cardiac risk factors and diseases. During recent decades there has been a shift from the assessment and treatment of the underlying culprit coronary lesion toward a systemic medical therapy aiming at prevention of myocardial oxygen supply demand mismatch and coronary plaque stabilization. Beta-blockers, statins, and aspirin are widely used in this setting. The role of prophylactic coronary revascularization has been restricted to the same indications as the nonoperative setting. Therefore pre-operative cardiac testing is recommended only if test results will change perioperative management. In addition to the limited perioperative period, physicians should benefit from this opportunity to initiate lifestyle changes and medical therapy to lessen the impact of cardiac risk factors, as patients should live long enough after the operation to enjoy the benefits of surgery.