静止性脑梗死风险预测量表的构建和验证

【摘要】
目的 调查与静止性脑梗死（silent brain infarction，SBI）相关的独立影响因素，构建SBI风险预测量
表并验证。
方法 在单中心横断面研究中，前瞻性连续纳入无神经系统疾病既往史的体检者，收集其人口学
信息，高血压、糖尿病等血管危险因素，血脂、糖化血红蛋白、血浆同型半胱氨酸等化验结果录入数
据库。采用标准影像学操作规范进行头颅MRI扫描，并由影像学医师盲法判读，将受试者分为SBI组
和无SBI组。将所有受试者按照3∶1比例随机分为训练集和验证集，在训练集中采用单因素和多因素
Logistic回归分析SBI的独立影响因素，构建SBI预测量表。在训练集和验证集中应用ROC曲线检验量表
的区分度，应用Hosmer-Lemeshow分析检验量表的校准度。
结果 共有633例研究对象纳入研究，平均年龄52.0±10.5岁，女性272例（43.0%）。训练集（475
例）和验证集（158例）两个样本集合的基线特征均衡。校正混杂因素后多因素分析显示，年龄≥45
岁（OR 8.37，95%CI 1.12～62.80，P =0.039），高血压（OR 2.30，95%CI 1.08～4.90，P =0.032），同型半
胱氨酸（Q2～Q3：OR 6.89，95%CI 0.89～53.10，P =0.064；Q4：OR 13.6，95%CI 1.74～105.87，P =0.013）
与SBI风险独立相关。根据OR 值构建SBI危险评分（SBI risk score，SBI-RS）量表，量表赋值为：年龄
≥45岁赋值8分；有高血压赋值2分；同型半胱氨酸根据四分位分层分别赋值为0分、7分和14分。SBIRS
在训练集和验证集中ROC曲线显示曲线下面积分别为0.77（95%CI 0.69～0.84，P＜0.001）和0.76
（95%CI 0.63～0.88，P＜0.001），区分度良好。Hosmer-Lemeshow相关分析提示SBI-RS具有较好的校准度
（P＞0.05）。
结论 在健康体检人群中，SBI -RS具有较好的区分度和校准度，可以帮助识别SBI高危人群。     

Comparison of Marker Intervals and Number of Sib Pairs Used for Linkage Analysis on Simulated Nuclear Family Data

Using a two‐stage global scan design, we analyzed general population replicates 1 and 42 of the Genetic Analysis Workshop (GAW) 12 simulated data set using three methods: revisited Haseman‐Elston (HER), maximum likelihood variance estimation (ML), and variance components (VC). Three marker densities, 5‐, 10‐, and 15‐cM intervals, were examined in the first‐stage scan. We found that the 10‐cM interval appears to be the most cost‐effective approach in genotyping without sacrificing power when using a first stage significance level of 0.01. Subsequently, we performed the second‐stage scan at 1‐cM intervals for those putative positive regions identified in the first‐stage scan at a significance level of 0.01. We also compared the power to detect linkage using different numbers of sib pairs for a genome‐wide scan at a 10‐cM interval and found that power decreases nonlinearly as the number of sib pairs decreases. © 2001 Wiley‐Liss, Inc.     

Inter-cohort differences in coronary heart disease mortality in the 25-year follow-up of the seven countries study

Sixteen cohorts of men aged 40–59 years at entry were examined with the measurement of some risk factors and then followed-up for mortality and causes of death for 25 years. These cohorts were located in the USA (1 cohort), Finland (2), the Netherlands (1), Italy (3), the former Yugoslavia (5), Greece (2), and Japan (2), and included a total of 12,763 subjects.Large differences in age-adjusted coronary heart disease (CHD) death rates were found, with extremes of 45 per 1000 in 25 years in Tanushimaru, Japan, to 288 per 1000 in 25 years in East Finland. In general, higher rates were found in the US and Northern European cohorts as compared to the Southern European and Japanese cohorts. However, during the last 10 years of follow-up large increases of CHD death rates were found in some Yugoslavian areas. Out of 5 measured entry characteristics treated as age-adjusted levels (serum cholesterol, systolic blood pressure, cigarette smoking, body mass index and physical activity at work), only serum cholesterol was significant in explaining cohort differences in CHD death rates.Over 50% of the variance in CHD death rates in 25 years was accounted for by the difference in mean serum cholesterol. This association tended to decline with increasing length of follow-up, but this was due to the great changes in mean serum cholesterol in the two Jugoslavian cohorts of Velika Krsna and Zrenjanin. When these two cohorts were excluded the association increased with time.Changes in mean serum cholesterol between year 0 and 10 helped in explaining differences in CHD death rates from year 10 onward.It can be concluded that this study suggests that mean serum cholesterol is the major risk factor in explaining cross-cultural differences in CHD.     

特发性血小板减少性紫癜患者感染的危险因素及预防措施

目的　探讨ITP患者感染的危险因素 ,提出预防感染的相关措施。方法　对 6 7例ITP住院患者进行回顾性调查 ,对患者感染部位、性别、年龄、合并糖尿病情况、住院天数、使用激素及丙种球蛋白情况进行评估及统计学处理。结果　感染以呼吸系统最多 ,其次为泌尿道感染 ;年龄大、合并糖尿病、住院天数长 (>4周 )、应用激素量大与感染发生呈正相关 ,并进行Logistic多元回归分析 (P值分别 >0 .0 5、<0 .0 5、<0 .0 5、<0 .0 5 ) ,OR值分别约 1.385、9.16 9、8.90 0、18.6 6 7。结论　应用激素量大、合并糖尿病、住院天数长 (>4周 )是ITP患者感染的主要危险因素 ,其中应用激素量大最为重要 ,合并糖尿病次之 ;必须控制易患因素 ,有效地预防感染。     

2型糖尿病患者高危因素分析

目的 分析2型糖尿病患者各种高危险因素控制状况及其与慢性并发症的关系。方法 记录464例50岁以上的2型糖尿病患者收缩压、舒张压、血脂、糖化血红蛋白和体质指数，按有无并发症分为两组进行分析。结果 有并发症组糖尿病病程、血压、总胆固醇、低密度脂蛋白胆固醇和血纤维蛋白原明显增高。Wald卡方分析显示糖尿病病程和收缩压有统计学意义。多数患者这些危险因素未得到很好的控制。结论 糖尿病患者存在着多种高危因素，有慢性并发症者更为严重，应注意综合治疗。     

云南陆良县农村已婚育龄妇女阴道炎的危险因素分析

对云南省陆良县的２２８７例已婚育龄妇女阴道炎患病情况及其危险因素进行了分析，通过Ｌｏｇｉｓｔｉｃ回归多因素和卡方检验单因素分析。结果表明：陆良县的阴道炎患病率为１０．２３％，Ｌｏ－ｇｉｓｔｉｃ回归筛选出的主要危险因素是职业、目前是否使用避孕方法、妊娠次数、每月性交次数及月经期间用不洁水洗下身；单因素卡方检验筛选出的主要危险因素为年龄、文化程度、职业、结婚年龄、妊娠次数、人流次数、自然流产数、总死产数、死流产总数、目前是否使用避孕方法、过去是否用过避孕方法、每月性交次数及月经期间用不洁水洗下身。     

Risk-Taking among Adolescents Who Say They Can Get a Handgun

In a survey of 5657 community-residing adolescents, those who said they could get a handgun in two days reported similar and those who said they could not get a handgun reported fewer risk behaviors and less violence perpetration and victimization than adolescents who have their own handgun. Adolescents who said they could get a handgun reported more exposure to and experience with firearms than those who said they could not get a handgun. Risk reduction efforts regarding adolescents should be expanded to include adolescents who say they can get a handgun.     

大肠癌高发区嘉善县大肠癌危险因子的调查研究

在大肠癌高发区嘉善县进行了病例对照调查,以探索大肠癌的致癌危险因子。病例160名(结肠癌61名,直肠癌99名),对照320名。调查询问项目分食物项目和非食物项目。计算结果表明,在非食物方面,RR数值达到显著水平的有:肠息肉、腹泻、粘液血便、精神刺激、阑尾炎、阑尾切除和家族肿瘤史等;在食物方法,对照组比病例组摄入的粗纤维和维生素C的量多,且达到显著水平。     

Failure of oral implants: aetiology, symptoms and influencing factors

The use of oral implants opened a wide range of prosthetic treatment possibilities in edentulous patients. Although the reported success rates of oral implants are high, failures do occur. This paper reviews the current knowledge about the aetiology, the signs and symptoms and the possible influencing factors of implant failure. Possible causes of implant failure are thought to be infection of the periimplant tissues, occlusal overload, or a combination of both. Nevertheless, pinpointing one of these as the aetiological factor in a particular case is difficult and should be handled reluctantly. Although the cause might seem obvious, influencing factors could play a role as well. Gaining insight into these processes might stimulate the adoption of preventive action and therefore increase the predictability of the treatment outcome with oral implants. Received: 4 April 1997 / Accepted: 27 November 1997