中国18城市新生儿死因研究

我们于1988年5月～1989年4月对我国18城市19所医院住院分娩的60960例活产婴进行了前瞻性调查研究.60960例中死亡556例,总死亡率9.12‰,其中死亡率男高于女,早产、低体重儿高于过期产儿和足月、正常体重儿,三胎和双胎高于单胎.前6位死因依次为窒息(或羊水胎粪吸入)、呼吸系统疾病、感染、畸形、颅内出血和硬肿症.并对各种死因在不同孕周、体重以及不同日龄组中的分布特点及主要防治对策进行了分析讨论.     

国人缺血性心血管病发病危险的评估方法及简易评估工具的开发研究

目的 研究开发适合我国人群疾病特点且方便临床使用的心血管病发病危险度评估方法和评估工具。方法 依据中美心肺血管疾病流行病学合作研究队列随访资料，采用Cox比例风险模型拟合最优预测模型，并校正人群危险因素长期变化趋势的影响，采用独立人群回代检验和计算ROC曲线下面积来检验模型的预测能力。进一步建立简易预测模型，并据此制定适合我国人群的心血管病综合危险度简易评估工具。结果 中美心肺血管疾病流行病学合作研究1983～1984年基线调查年龄35～59岁，剔除基线患有冠心病、脑卒中及主要危险因素资料不全者后男女共计9903人，截止到2000年平均随访15．1年，共发生冠心病事件105例、缺血性脑卒中266例、缺血性心血管病360例。基线年龄、性别、血压、血清总胆固醇、体重指数、吸烟和糖尿病与冠心病、缺血性脑卒中和缺血性心血管病(ischemic cardiovascular diseases，ICVD)事件发病有互相独立的显著关联，且联系的方向和规律一致。据此建立的分性别ICVD事件10年发病危险预测模型，经过校正人群危险因素的长期变化趋势，证明能够很好地用于1992～1994年新建立队列的ICVD发病预测，其ROC曲线下面积(AUC)男性最优模型为0．799，女性最优模型为0．844。简易模型的AUC与最优模型几乎相同。结论 初步开发的ICVD事件10年发病危险预测模型和简易评估工具具有令人满意的预测能力，也能够较好地反映国人发生心血管病的综合危险。     

Efficacy of folic acid when added to statin therapy in patients with hypercholesterolemia following acute myocardial infarction: a randomised pilot trial

BACKGROUND: Folic acid is assumed to have favourable effects on vascular endothelium, directly as well as indirectly through its effect on homocysteine metabolism. However, the clinical value of folic acid in secondary prevention after acute myocardial infarction (MI) has never been tested. Thus, a randomised, open-label, multicentre trial was performed in order to study the effect of folic acid 5 mg o.d. when added to statin therapy on the incidence of recurrent major clinical events up to 1 year post-MI. METHODS: A total of 283 patients with a total cholesterol >6.5 mmol/l (251 mg/dl) (mean 7.3 mmol/l) were included. All patients received 40 fluvastatin. In 140 of the 283 patients, folic acid (5 mg o.d.) was instituted at discharge, and the remaining 143 patients served as controls. Other secondary prevention measures for both groups were advocated. The primary endpoint was a composite consisting of all vascular events, including death, recurrent MI, strokes, and unplanned invasive coronary interventions. RESULTS: At baseline, the two groups were well-matched for all clinical and demographic parameters. After 1 year of treatment, no difference was noticed in the primary endpoint between the two groups. These endpoints occurred in 43 patients (31%) in the folic acid group, as opposed to 45 patients (31%) in the control group. All separate cardiovascular events were also equally distributed between both groups. Total cholesterol levels decreased to a similar extent in the two groups (to 5.5 and 5.7 mmol/l, in folic acid and control groups, respectively). CONCLUSIONS: In this medium-size pilot study, folic acid did not demonstrate any beneficial additive effects on cardiovascular mortality or morbidity in post-MI patients with hypercholesterolemia who were treated with statin therapy. Larger trials, possibly targeting at selected populations, must be awaited before definitive conclusions regarding the potentially favourable effects of folic acid supplementation in secondary prevention can be drawn.