Health-related risky behaviors and their risk factors in adolescents with high-functioning autism

BACKGROUND Health-related risky behaviors generally refer to behaviors that have a negative impact on health and quality of life.Health-related risky behaviors in adolescents with high-functioning autism(HFA)have not been well understood so far.Adolescents with HFA may have more health-related risky behaviors than neurotypical adolescents.AIM To investigate health-related risky behaviors and their risk factors with HFA.METHODS This is an observational study.Our study enrolled 110 adolescents aged 12-19-years-old meeting Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria for HFA.They were recruited from Peking University Sixth Hospital.There were also 110 age,sex and nationality matched controls enrolled who came from a public school in Beijing,China.Both groups completed the Adolescents Health-related Risky Behavior Inventory.Nonparametric tests were carried out for comparison of the Adolescents Health-related Risky Behavior Inventory scores between the two groups.Expression recognition,the Inventory of Subjective Life Quality for Child and Adolescent,Chinese Wechsler Intelligence Scale for Children,Wechsler Intelligence Scale for Adult-Chinese Revised,Theory of Mind test and Autism Spectrum Screening Questionnaire were assessed in the autism group to explore factors associated with health-related risky behaviors.Multivariate regression analysis was conducted to explore the risk factors of health-related risky behaviors in the HFA group.RESULTS The results showed that the total score of the Adolescents Health-related Risky Behavior Inventory and scores of“aggression and violence,”“suicide and selfinjury,”“health compromising behavior”and“unprotected sex”subscales in the HFA group were significantly higher than those in the control group(Z range-4.197 to-2.213,P<0.05).Among the associated factors,poor emotional experience(B=-0.268,P<0.001),depression(B=-0.321,P<0.001),low score of intelligence(B=-0.032,P=0.042),low score of Theory of Mind test(B=-1.321,P=0.003)and poor adaptation to school life(B=-0.152,P=0.006)were risk factors.These risky behaviors may promote the occurrence of health-related risky behaviors in adolescents with HFA.CONCLUSION This study showed that adolescents with HFA were more likely to be involved in health-related risky behaviors.Different health-related risky behaviors have different reasons.

Risk factors in familial forms of celiac disease

Celiac disease has been reported in up to 2% of some European populations. A similar risk has been identified in the America and Australia where immigration of Eu-ropeans has occurred. Moreover, an increasing number of celiac disease patients are being identified in many Asian countries, including China and India. Finally, celiac disease has also been detected in Asian immigrants and their descendants to other countries, such as Canada. Within these so-called "general" celiac populations, however, there are specific high risk groups that have an even higher prevalence of celiac disease. Indeed, the single most important risk factor for celiac disease is having a first-degree relative with already-defined celiac disease, particularly a sibling. A rate up to 20% or more has been noted. Risk is even greater if a specific family has 2 siblings affected, particularly if a male carries the human leukocyte antigen-DQ2. Both structural changes in the small bowel architecture occur along with func-tional changes in permeability, even in asymptomatic first-degree relatives. Even if celiac disease is not evident, the risk of other autoimmune disorders seems significantly increased in first-degree relatives as well as intestinal lymphoma. Identification of celiac disease is important since recent long-term studies have shown that the mortality of celiac disease is increased, if it is unrecognized and untreated.

Association between Cardiovascular Disease Risk Factor Knowledge and Lifestyle

Objective: To relate cardiovascular risk factor knowledge to lifestyle. Methods: In this cross-sectional study, food consumption and lifestyle characteristics were recorded using mailed questionnaires. The dietary pattern was described using the Mediterranean Diet Score (MDS). An open ended questionnaire without predefined choices or answers was used to capture cardiovascular knowledge. Results: Lack of physical activity, smoking and eating too much fat were the 3 most cited potential cardiovascular risk factors, while being overweight, eating too much salt and a low consumption of fruits and vegetables were the least cited risk factors. Age, Body Mass Index, physical activity, smoking, income and dietary habits were not consistently associated with knowledge of risk factors. A low socioeconomic position as measured by the indicator education was associated with a lower knowledge of established and modifiable cardiovascular risk factors. Conclusions: Risk factor knowledge, an essential step in prevention of CVD, is not systematically associated with a healthier lifestyle. The findings of this study confirm that there is a gap between risk factor knowledge and lifestyle.

Surgical Site Infection (SSI) in the National Referral General Hospital of Ndjamena (Chad): Survey about Risk Factors

The risk to develop an infection after surgery depends on several factors. Those factors may be interdependent or not, depending on the nature of the surgery and the general condition of the patient. The aim of the present study was to identify the factors involved in the occurrence of the Surgical Site Infections (SSI) in the National referral general hospital of N’djamena (Chad). We first realized an interview in the emergency services and in the general surgery of the hospital. The information collected allowed us to draw up survey sheets. An investigation was then conducted on 152 patients who had surgery and were hospitalized during the study period. The frequency of the SSI was 33.6% (51/152). The main risk factors that we identified were the duration of hospitalization, the category of the hospitalization room, the urgent aspect of the surgical intervention, the patient’s nutritional status and the associated diseases with diabetes, which was present in 52.38% (11/21) of cases of associated pathologies. Analysis of the antibiotic prophylaxis administered to patients showed that ciprofloxacin was more effective in SSI prevention. Indeed, this antibiotic showed the fewest cases of infection with only 1.9% of patients having developed SSI. Our results show a very high frequency of SSI at the National referral general hospital of N’djamena. Poor hospital practices and factors associated to patients seem to be the most factors implicated in the SSI.

Construction and validation of a severity prediction model for metabolic associated fatty liver disease

Objective:To analyze the independent risk factors for the occurrence of moderate-to-severe metabolic-associated fatty liver disease(MAFLD),to construct a prediction model for moderate-to-severe MAFLD,and to verify the validity of the model.Methods:In the first part,278 medical examiners who were diagnosed with MAFLD in Medical Examination Center at the Second Affiliated Hospital of Hainan University from January to May 2022 were taken as the study subjects(training set),and they were divided into mild MAFLD group(200)and moderate-severe MAFLD group(78)based on ultrasound results.Demographic data and laboratory indexes were collected,and risk factors were screened by univariate and multifactor analysis.In the second part,a dichotomous logistic regression equation was used to construct a prediction model for moderate-to-severe MAFLD,and the model was visualized in a line graph.In the third part,the MAFLD population(200 people in the external validation set)from our physical examination center from November to December 2022 was collected as the moderate-to-severe MAFLD prediction model,and the risk factors in both groups were compared.The receiver operating characteristic(ROC)curves,calibration curves,and clinical applicability of the model were plotted to represent model discrimination for internal and external validation.Results:The risk factors of moderate-to-severe MAFLD were fasting glucose(FPG),blood uric acid(UA),triglycerides(TG),triglyceride glucose index(TyG),total cholesterol(CHOL),and high-density lipoprotein(HDL-C).UA[OR=1.021,95%CI(1.015,1.027),P<0.001]and FPG[OR=1.575,95%CI(1.158,2.143),P=0.004]were independent risk factors for people with moderate to severe MAFLD.The visualized line graph model showed that UA was the factor contributing more to the risk of moderate to severe MAFLD in this model.The ROC curves showed AUC values of 0.8701,0.8686 and 0.7991 for the training set,internal validation set and external validation set,respectively.The curves almost coincided with the reference line after calibration of the model calibration degree with P>0.05 in Hosmer-Lemeshow test.The decision curve analysis(DCA)plotted by the clinical applicability of the model was higher than the two extreme curves,predicting that patients with moderate to severe MAFLD would benefit from the prediction model.Conclusion:The prediction model constructed by combining FPG with UA has higher accuracy and better clinical applicability,and can be used for clinical diagnosis.

Development of a depression in Parkinson's disease prediction model using machine learning

BACKGROUND It is important to diagnose depression in Parkinson’s disease(DPD)as soon as possible and identify the predictors of depression to improve quality of life in Parkinson’s disease(PD)patients.AIM To develop a model for predicting DPD based on the support vector machine,while considering sociodemographic factors,health habits,Parkinson's symptoms,sleep behavior disorders,and neuropsychiatric indicators as predictors and provide baseline data for identifying DPD.METHODS This study analyzed 223 of 335 patients who were 60 years or older with PD.Depression was measured using the 30 items of the Geriatric Depression Scale,and the explanatory variables included PD-related motor signs,rapid eye movement sleep behavior disorders,and neuropsychological tests.The support vector machine was used to develop a DPD prediction model.RESULTS When the effects of PD motor symptoms were compared using“functional weight”,late motor complications(occurrence of levodopa-induced dyskinesia)were the most influential risk factors for Parkinson's symptoms.CONCLUSION It is necessary to develop customized screening tests that can detect DPD in the early stage and continuously monitor high-risk groups based on the factors related to DPD derived from this predictive model in order to maintain the emotional health of PD patients.

老年慢性阻塞性肺疾病急性加重病人呼吸机相关性肺炎诺莫图模型的预测价值

目的筛选老年慢性阻塞性肺疾病(COPD)急性加重病人发生呼吸机相关性肺炎(VAP)的危险因子,验证以此构建的诺莫图预测模型的价值。方法以2016年12月至2021年11月聊城市第二人民医院收治的374例老年COPD病人为研究对象,按6∶4的比例,采用随机数字表法分为建模集(n=225)与验证集(n=149)。分析VAP的影响因素,建立诺莫图模型并评估其预测价值。结果VAP组病人年龄[(70.56±6.33)岁比(68.01±6.06)岁]、急性生理和慢性健康(APACHEⅡ)评分[(20.44±6.89)分比(12.20±4.60)分]、序贯器官衰竭(SOFA)评分[(7.65±3.32)分比4.12±1.82)分]、有吸烟史比例(71.9%比54.8%)、合并基础疾病≥3种比例(45.6%比18.5%)、过去90 d使用抗生素比例(63.2%比40.5%)、呼吸机通气时长≥4 d比例(77.2%比40.5%)、再次插管比例(80.7%比46.4%)较非VAP组升高(P<0.05)。logistic回归分析结果示,合并基础疾病≥3种(OR=2.78,P=0.027)、APACHEⅡ评分(OR=9.46,P<0.001)、SOFA评分(OR=2.99,P=0.010)、过去90 d使用抗生素(OR=2.71,P=0.015)、呼吸机通气时长≥4 d(OR=3.24,P=0.006)、再次插管(OR=3.65,P=0.004)是发生VAP的独立危险因素。建模集及验证集校准曲线结果均显示,构建的诺莫图预测模型校准度较好,ROC曲线下面积分别为0.87[95%CI:(0.82,0.93)]、0.83[95%CI:(0.75,0.92)]。结论通过合并基础疾病≥3种、APACHEⅡ评分、SOFA评分、过去90 d使用抗生素、呼吸机通气时长≥4 d、再次插管等危险因素建立的诺莫图模型对老年COPD急性加重病人发生VAP具有较好的预测价值。

代谢相关脂肪性肝病患者发生肌少症性肥胖的风险因素和预测模型构建

目的:探讨代谢相关脂肪性肝病(MAFLD)患者肌少症性肥胖(SO)发生的危险因素,构建预测模型。方法:回顾性选择2018年6月至2023年6月我院收治的410例MAFLD患者,根据SO检出情况将MAFLD患者分为SO组(32例)和非SO组(378例)。多因素Logistic回归分析MAFLD患者发生SO的危险因素并构建预测模型,通过Hosmer-Lemeshow检验和受试者工作特征(ROC)曲线验证预测模型性能。结果:SO组年龄大于非SO组(P<0.05),男性、糖尿病、Child-Pugh分级C级、每周运动频率3次以下比例高于非SO组(P<0.05),BMI、HbA1C、HOMA-IR、hs-CRP高于非SO组(P<0.05),白蛋白低于非SO组(P<0.05)。年龄偏大、高hs-CRP、高HOMA-IR、Child-Pugh分级C级是MAFLD患者发生SO的危险因素(P<0.05)。预测模型预测MAFLD患者发生SO的曲线下面积为0.829(95%CI=0.783~0.872),Hosmer-Lemeshow检验P>0.05。结论:老龄、炎症、胰岛素抵抗、肝功能是MAFLD患者发生SO的相关因素,基于上述风险因素构建的预测模型具有较高的预测MAFLD患者发生SO的效能。

慢性阻塞性肺疾病病人呼吸机相关性肺炎91例的病原谱及其列线图预测模型

目的分析慢性阻塞性肺疾病(COPD)病人呼吸机相关性肺炎(VAP)病原菌感染特点,构建列线图预测模型。方法选择2019年1月至2021年12月在南充市第二人民医院接受机械通气治疗的193例慢性阻塞性肺疾病急性加重期(AECOPD)病人,根据有无VAP将病人分为两组,在单因素分析基础上行多因素logistic回归分析,构建列线图预测模型,以ROC曲线分析模型预测价值,并以计算机模拟充分采样(bootstrap)法进行内部验证。结果该研究的193例中共91例(47.15%)病人出现VAP,91例病人中共分离出病原菌108株,其中革兰阴性菌占72.22%,革兰阳性菌占15.74%,真菌占12.04%,单一感染62例,混合感染29例。单因素分析基础上行多因素分析结果显示:年龄≥60岁、气道干预方式为气道切开、合并糖尿病、机械通气时间≥4 d、使用抗菌药物联合用药、使用抑酸剂、有吸烟史及APACHEⅡ评分≥15分为AECOPD病人VAP发生的危险因素(P<0.05)。根据上述因素以R语言建立列线图预测模型,受试者操作特征(ROC)曲线下面积0.84,95%CI为(0.78,0.90),Bootstrap法对列线图进行内部验证,平均绝对误差为0.02,预测曲线与标准曲线基本拟合。结论AECOPD病人VAP发生率较高,主要因感染革兰阴性菌所致,VAP的发生率受病人年龄、气道干预方式、合并糖尿病情况、机械通气时间、糖皮质激素使用情况、抗菌药物联合用药、抑酸剂使用情况、吸烟史及APACHEⅡ评分的影响,以上述因素构建的列线图模型具有较高的区分度与准确度。

代谢相关脂肪性肝病与颈动脉粥样硬化斑块及狭窄的关联分析

目的分析代谢相关脂肪性肝病(MAFLD)与颈动脉粥样硬化斑块的相关性。方法随机纳入2014年7月—2022年12月在昆明医科大学第二附属医院住院期间同时完善腹部超声、头颈动脉CT血管成像的1107例患者。收集基线资料、临床诊断,根据病史、临床检验及影像学指标分为MAFLD组(n=499)和非MAFLD组(n=608)。颈动脉斑块根据CT值分为钙化斑块、非钙化斑块及混合斑块。根据北美症状性颈动脉内膜剥脱试验(NASCET)标准,颈动脉狭窄分为:正常血管、轻微狭窄、轻度狭窄、中度狭窄、重度狭窄及闭塞。符合正态分布的计量资料两组间比较采用成组t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U秩和检验;计数资料两组间比较采用χ^(2)检验。采用单因素和多因素Logistic回归分析颈动脉粥样硬化的影响因素。结果MAFLD组患者钙化斑块、非钙化斑块、混合斑块的比例均高于非MAFLD组(74.3%vs 63.3%、27.1%vs 17.1%、27.3%vs 20.7%),差异均有统计学意义(P值均<0.05);MAFLD组患者颈动脉轻度狭窄、中度狭窄、重度狭窄及闭塞的比例均高于非MAFLD组(50.9%vs 44.9%、14.6%vs 8.4%、6.6%vs 3.5%),差异均有统计学意义(P值均<0.05)。单因素Logistic回归分析结果显示,MAFLD是颈动脉钙化斑块、非钙化斑块和混合斑块的危险因素,也是颈动脉轻度、中度、重度狭窄及闭塞的危险因素(P值均<0.05)。校正混杂因素后,多因素Logistic回归分析结果显示MAFLD仍是颈动脉钙化斑块、非钙化斑块、混合斑块以及颈动脉中度狭窄的独立危险因素(P值均<0.05)。结论MAFLD是颈动脉中度狭窄,颈动脉钙化斑块、非钙化斑块及混合斑块的独立危险因素。

原发性胆汁性胆管炎合并代谢相关脂肪性肝病的临床特征及危险因素分析

目的分析原发性胆汁性胆管炎(PBC)合并代谢相关脂肪性肝病(MAFLD)的临床特征及危险因素,探讨两种疾病合并时的相互影响。方法选取2019年1月—2022年12月于昆明医科大学第一附属医院确诊为PBC和MAFLD的患者187例,分为PBC组70例,PBC合并MAFLD组38例,MAFLD组79例。收集病例的一般资料、临床症状、血清学指标、瞬时弹性纤维成像(FibroScan)及非侵入性纤维化指标,分析比较三组间的不同特点。计量资料三组间比较采用单因素方差分析或KruskalWallis H检验;计数资料组间比较使用χ^(2)检验或Fisher精确检验。多因素分析采用二元Logistic回归分析。结果三组在性别、年龄、身高、体质量、BMI、自身免疫性疾病病史方面差异均有统计学意义(P值均<0.05)。PBC合并MAFLD组以女性患者多见(89.5%),平均年龄为(57.26±12.72)岁,BMI为(23.35±3.70)kg/m2;PBC组中自身免疫性疾病病史检出率为25.7%(18例)。三组乏力、纳差、瘙痒、黄疸、静脉曲张、腹水、脾大发生率比较,差异均有统计学意义(P值均<0.05)。PBC合并MAFLD组患者常见的症状为乏力、纳差、腹痛、腹胀,分别为18例(47.4%)、15例(39.5%)、14例(36.8%)、16例(42.1%);MAFLD组患者常见的症状为腹痛、腹胀,分别为34例(43%)、32例(40.5%);PBC组患者常见的症状及并发症为乏力、纳差、黄疸、腹痛、腹胀、静脉曲张、腹水、脾大,分别为37例(52.9%)、25例(35.7%)、25例(35.7%)、18例(25.7%)、25例(35.7%)、19例(27.9%)、23例(32.9%)、44例(62.9%)。PBC合并MAFLD组的CAP值高于PBC组(P<0.05);PBC组的LSM值、APRI、FIB-4均高于MAFLD组(P值均<0.05)。将不存在多重共线性的因素纳入回归分析,以PBC组为参照组,FIB-4(OR=0.218,95%CI:0.069~0.633)、自身免疫性疾病病史(OR=0.229,95%CI:0.067~0.810)为PBC合并MAFLD的独立影响因素(P值均<0.05);以MAFLD组为参照组,ALT(OR=0.157,95%CI:0.025~1.000)、TBil(OR=0.995,95%CI:0.990~0.999)为PBC合并MAFLD的独立影响因素(P值均<0.05)。结论PBC合并MAFLD临床表现并不特异,但PBC患者的临床表现更为严重,且肝功能失代偿发生率更高。两种疾病合并不一定会加重PBC的疾病进展。

合并MAFLD的慢性HBV感染者显著肝纤维化的无创模型建立与验证

目的 探究合并代谢相关性脂肪性肝病(metabolic associated fatty liver disease,MAFLD)的慢性HBV感染患者发生显著肝纤维化的危险因素,构建并验证预测肝组织显著肝纤维化的无创模型,为临床启动抗纤维化治疗提供思路。方法 回顾性收集2015年1月至2020年12月就诊于广东省中医院肝病科收治的合并MAFLD的慢性HBV感染患者445例,根据入院时间分为训练队列(n=274)和验证队列(n=171)。训练队列中根据病理结果分为无/轻微肝纤维化组(<S_(2)期,n=106)和显著肝纤维化组(≥S_(2)期,n=168),比较两组患者临床指标,多因素Logistic回归方法筛选显著肝纤维化的危险因素,ROC曲线评价无创模型的预测效能,并在验证队列中验证。结果 445例患者中,肝组织显著纤维化287例(63.08%),其中训练队列168例(61.31%)、验证队列119例(69.59%)。训练队列中,≥S_(2)期组患者的年龄、ALT、AST、ALP、GGT、PT、HBsAg、HBV DNA、LSM均高于<S_(2)组,WBC、RBC、PLT、TG、Urea均低于<S_(2)组(P<0.05)。多因素分析显示,年龄、GGT、HBV DNA、LSM均是显著肝纤维化的独立危险因素(P<0.05),Urea是保护因素(P<0.05)。根据年龄、GGT、Urea、HBV DNA和LSM建立无创模型Y=0.063×年龄(岁)+0.016×GGT(U/L)+0.246×HBV DNA(lg IU/L)+0.245×LSM(kPa)-0.484×Urea(mmol/L)-3.578,在训练队列中预测肝组织显著纤维化预测效能均高于APRI、FIB-4(P<0.05),取敏感度与特异度最大时的点的临界值Y=0.70,此时预测敏感度为62.5%,特异度为92.5%;在验证队列中,预测效能均高于APRI、FIB-4(P<0.05)。结论 年龄、GGT、Urea、HBV DNA和LSM是合并MAFLD的慢性HBV感染患者发生显著肝纤维化的危险因素,由这些参数建立的无创模型对预测该人群发生显著肝纤维化有一定准确性。

美国预防临床服务指南工作组《无心血管疾病危险因素成年人预防心血管疾病的健康饮食和身体活动:行为咨询干预推荐声明》解读

2022年美国预防临床服务指南工作组(USPSTF)更新其2017年《无心血管疾病危险因素成年人预防心血管疾病的健康饮食和身体活动:行为咨询干预推荐声明》建议,对促进无心血管疾病危险因素的成年人健康行为咨询干预的益处和危害证据进行综述,得出结论与2017年指南推荐一致。行为咨询干预对无心血管疾病危险因素的成年人具有微小净获益,建议临床医生根据个体情况决定是否向无心血管疾病危险因素的成年人提供或推荐行为咨询干预,以促进合理膳食和身体活动(C级)。本文结合我国心血管疾病防治现状,对该指南进行全面解读,以期为我国成年人心血管疾病预防实践提供参考。

中国儿童代谢相关脂肪性肝病流行现状及危险因素研究进展

儿童代谢相关脂肪性肝病(MAFLD)是最常见的慢性肝脏疾病之一,可增加肝纤维及肝硬化等肝脏疾病、心血管代谢疾病及死亡的发生风险。近年,中国人群MAFLD患病率逐年升高且呈现低龄化趋势,已成为严重的公共卫生问题,亟待采取切实有效的防治措施。但是,目前我国儿童MAFLD的流行现状尚不清楚,且危险因素复杂、发病机制不清。本研究系统综述中国儿童MAFLD流行现状及相关危险因素,为制定儿童MAFLD的防治策略提供循证依据。

基于红外热成像技术探讨心脏表面温度与代谢相关脂肪性肝病诊断的相关性

目的:基于红外热成像技术探讨心脏表面温度与代谢相关脂肪性肝病(MAFLD)的相关性。方法:选取2021年7月至2022年12月在柳州市中医医院(柳州市壮医医院)体检的430例患者为研究对象,采集一般资料、生理、生化、医用红外热成像等信息。根据采集结果,分为脂肪肝组及非脂肪肝组。Spearman相关系数法及Logistic回归分析影响MAFLD的危险因素。运用随机森林及决策树分析上焦(心脏)温度与MAFLD的相关性。结果:采用Spearman相关系数法和Logistic回归,发现年龄、性别、上焦(心脏)、腋-眼、中焦-下焦、腋-胁这6个变量是影响MAFLD的危险因素。运用随机森林和决策树发现,当上焦(心脏)温度在30.34℃及以下时,患MAFLD的风险为100%。当上焦(心脏)的温度为30.34~31.38℃且年龄>41岁时,患MAFLD的风险较高。当上焦(心脏)温度为31.38~32.51℃且双腋窝-双胁肋的温度差值为0.63~1.33℃时,患MAFLD的风险较高。当上焦(心脏)温度为32.51~33.6℃、年龄>37岁的男性时,患MAFLD的风险较高。且该模型总预测准确率97.4%。结论:上焦(心脏)凉偏离与MAFLD发生风险正相关,上焦(心脏)表面温度越低,患MAFLD的风险越高。在临床上,可对持续上焦(心脏)凉偏离的人群进行健康管理,以延缓MAFLD的发生与进展。

慢性乙型肝炎合并代谢相关脂肪性肝病患者抗病毒治疗后预后不良情况及其影响因素分析

目的 研究慢性乙型肝炎合并代谢相关脂肪性肝病(MAFLD)患者接受抗病毒治疗后的预后情况,并分析患者预后不良的影响因素。方法 选取98例慢性乙型肝炎并发MAFLD患者,根据抗病毒治疗结果将其分为预后良好组(60例)和预后不良组(38例)。收集患者临床一般资料,应用多因素logistic回归模型分析慢性乙型肝炎并发MAFLD患者抗病毒治疗后预后不良的影响因素。结果 接受抗病毒治疗后,慢性乙型肝炎并发MAFLD患者预后不良的发生率为38.78%。预后良好组、预后不良组有糖尿病史例数比例、有高血压史例数比例、有高脂血症史例数比例、有肝硬化例数比例、终末期肝病模型(MELD)评分,以及高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇、总胆固醇、三酰甘油(TAG)、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、肌酐、血尿素氮水平差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,糖尿病史、高血压史、高脂血症史、高TAG水平、肝硬化、高MELD评分均是慢性乙型肝炎并发MAFLD患者抗病毒治疗后预后不良的独立危险因素,高HDL-C水平是保护因素(均P<0.05)。结论 慢性乙型肝炎合并MAFLD患者抗病毒治疗后预后不良较为常见,糖尿病史、高血压史、高脂血症史、高TAG水平、肝硬化、MELD评分均是慢性乙型肝炎并发MAFLD患者抗病毒治疗后预后不良的独立危险因素,高HDL-C水平是保护因素。

Symptomatic COVID-19 in University Students: A School-Wide Web-Based Questionnaire Survey during the Omicron Variant Outbreak

Aim: To detect risk and preventive factors associated with the Omicron variant infection in university students, a combination of a web-based survey and multivariate logistic regression analysis was introduced as the front-line initiatives by the school health practitioners. Design: Questionnaire survey. Methods: The school-wide web-based questionnaire survey was conducted among our university students as a part of the annual health check-up in April, 2023. The positive outcome was confined to the first symptomatic COVID-19 onset during the Omicron variant outbreak. Results: In this self-administered survey, risk or protective associations were merely estimated statistically in university students (n = 5406). In measured factors, karaoke and club/group activities could maintain the statistical significance in adjusted odds ratios (ORs) as relative risk factors, and science course, measles/ rubella (MR) vaccination, and COVID-19 vaccination remained as relative protective factors in adjusted OR analyses. Club/group activities with member gathering and karaoke sing-along sessions in university students may frequently have WHO’s three Cs. These risk factors are still important topics for the infection control of COVID-19 in university students. Together with some recent reports from other researchers, the significant protective role of MR vaccine in our survey warrants further clinical investigation. If the breakthrough infection continuously constitutes the majority of infection, real data in test-negative case-control or web-based questionnaire design continue to be important for statistical analysis to determine the minimal requirement of our strategies which may be equivalent to or replace COVID-19 vaccines.

阻塞性睡眠呼吸暂停合并代谢相关性脂肪性肝病的危险因素分析及预测模型构建

目的探讨阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)合并代谢相关脂肪性肝病(metabolic associated fatty liver disease,MAFLD)人群的临床特征和危险因素,并构建预测模型,以为临床诊治提供参考。方法选取2020年1月~2022年12月湖北医药学院附属襄阳市第一人民医院收治的228例OSA患者,按照有无合并MAFLD将其分为OSA+MAFLD组(n=94)和OSA组(n=134),按照肝/脾CT值之比将OSA+MAFLD组进一步分为OSA+轻度MAFLD组(n=56)和OSA+中重度MAFLD组(n=38),收集所有患者的一般临床资料、多导睡眠监测(polysomnography,PSG)、血清学检查等相关指标及参数进行统计学分析。结果单因素分析结果显示,OSA组的年龄、高血压、糖尿病、高脂血症、体重指数(body mass index,BMI)、睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)、氧减指数(oxygen reduction index,ODI)、最长呼吸暂停时间(longest apnea time,LAT)、鼾声次数、最低血氧饱和度(lowest saturation oxygen,LSpO_(2))、平均血氧饱和度(mean oxygen saturation,MSpO_(2))、SpO_(2)<90%的时间(CT90%)、空腹血糖(fasting plasma glucose,FPG)、谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)和γ-谷氨酰转移酶(γ-glutamyltransferase,GGT)与OSA+MAFLD组比较,差异均有统计学意义(P<0.05);OSA+轻度MAFLD组的年龄、高脂血症、BMI、AHI、ODI、LAT、鼾声次数、LSpO_(2)、MSpO_(2)、CT90%、ALT与OSA+中重度MAFLD组比较,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,年龄、BMI、AHI、鼾声次数是OSA合并MAFLD发生的独立危险因素(P<0.05);年龄、BMI、AHI、ALT为OSA合并中重度MAFLD发生的独立危险因素(P<0.05);并建立Logistic回归模型:Y1=-13.183+0.083年龄+0.205BMI+0.039AHI+0.002鼾声次数,受试者工作特征曲线下面积为0.915,回归模型的敏感度为87.2%,特异性为82.8%;Y2=-44.956+0.146年龄+0.510BMI+0.056AHI+0.022ALT,受试者工作特征曲线下面积为0.924,回归模型的敏感度为78.9%,特异性为91.1%。结论在临床工作中,对年龄越大、BMI越高、AHI越高、鼾声次数越多的OSA患者更应考虑MAFLD的发生,年龄越大、BMI越高、AHI越高、ALT越高的OSA合并MAFLD患者更严重,本研究构建的联合预测模型具有更好的诊断价值,可为临床早期诊断OSA合并MAFLD提供参考。

老年慢性阻塞性肺疾病并发呼吸机相关性肺炎风险预警模型的构建与验证

目的 分析老年慢性阻塞性肺疾病(COPD)患者并发呼吸机相关性肺炎(VAP)的危险因素,构建风险预警模型并进行验证。方法 回顾性选取2020年8月至2022年12月于该院重症医学科收治的170例老年COPD患者纳入建模组,根据患者住院期间是否并发VAP分为VAP组和无VAP组;采用单因素和logistic回归分析VAP发生的独立影响因素,并根据独立影响因素构建风险预警模型;采用受试者操作特征(ROC)曲线对模型进行区分度评估,并采用Hosmer-Lemeshow检验判断模型的拟合优度,另选取73例同期老年COPD患者纳入验证组,对模型进行外部验证。结果 建模组170例老年COPD患者中41例并发VAP,发生率为24.1%。单因素及多因素分析结果显示,糖尿病史[比值比(OR)=14.821,95%可信区间(95%CI) 2.462~89.232]、联用抗菌药物(OR=6.352,95%CI 1.391~29.008)、留置胃管(OR=5.454,95%CI 1.213~24.521)、误吸(OR=7.745,95%CI 1.569~38.224)、机械通气时间>5 d(OR=8.014,95%CI 2.026~31.695)、住院时间≥14 d(OR=6.494,95%CI 1.371~30.755)和急性生理与慢性健康状况评分Ⅱ系统(APACHEⅡ)>18分(OR=16.714,95%CI 3.326~83.983)是老年COPD患者并发VAP的独立危险因素。根据独立影响因素构建的风险预警模型ROC结果显示,曲线下面积(AUC)为0.901(95%CI 0.843~0.958,P<0.001),敏感度为79.5%,特异度为91.3%。模型验证敏感度为80.0%,特异度为92.5%,总准确率为89.0%。结论 糖尿病史、联用抗菌药物、留置胃管、误吸、机械通气时间>5 d、住院时间≥14 d和APACHEⅡ评分>18分是老年COPD患者并发VAP的独立危险因素。以上述因素构建的风险预警模型经验证具有较好的预测效能,有一定的临床应用价值。

代谢相关脂肪性肝病的流行病学研究进展

代谢相关脂肪性肝病(MAFLD)已成为全球慢性肝病的主要病因之一。MAFLD发病的危险因素众多,包括年龄、性别、代谢综合征等常见的危险因素,随着疾病进展,会导致心血管疾病、慢性肾脏病及其他相关并发症。了解MAFLD的流行病学特征、危险因素及相关并发症的最新研究进展,可为了解疾病进展及相关防控策略的研究提供依据。