Identification of risk factors and construction of a nomogram predictive model for post-stroke infection in patients with acute ischemic stroke

BACKGROUND Post-stroke infection is the most common complication of stroke and poses a huge threat to patients.In addition to prolonging the hospitalization time and increasing the medical burden,post-stroke infection also significantly increases the risk of disease and death.Clarifying the risk factors for post-stroke infection in patients with acute ischemic stroke(AIS)is of great significance.It can guide clinical practice to perform corresponding prevention and control work early,minimizing the risk of stroke-related infections and ensuring favorable disease outcomes.AIM To explore the risk factors for post-stroke infection in patients with AIS and to construct a nomogram predictive model.METHODS The clinical data of 206 patients with AIS admitted to our hospital between April 2020 and April 2023 were retrospectively collected.Baseline data and post-stroke infection status of all study subjects were assessed,and the risk factors for poststroke infection in patients with AIS were analyzed.RESULTS Totally,48 patients with AIS developed stroke,with an infection rate of 23.3%.Age,diabetes,disturbance of consciousness,high National Institutes of Health Stroke Scale(NIHSS)score at admission,invasive operation,and chronic obstructive pulmonary disease(COPD)were risk factors for post-stroke infection in patients with AIS(P<0.05).A nomogram prediction model was constructed with a C-index of 0.891,reflecting the good potential clinical efficacy of the nomogram prediction model.The calibration curve also showed good consistency between the actual observations and nomogram predictions.The area under the receiver operating characteristic curve was 0.891(95%confidence interval:0.839–0.942),showing predictive value for post-stroke infection.When the optimal cutoff value was selected,the sensitivity and specificity were 87.5%and 79.7%,respectively.CONCLUSION Age,diabetes,disturbance of consciousness,NIHSS score at admission,invasive surgery,and COPD are risk factors for post-stroke infection following AIS.The nomogram prediction model established based on these factors exhibits high discrimination and accuracy.

Association of Fibrin Monomer Polymerization Function, Cerebrovascular Risk Factors and Ischemic Cerebrovascular Disease in Old People

In order to investigate the association of fibrin monomer polymerization function (FMPF) with traditional cerebrovascular risk factors and ischemic cerebrovascular disease in old people. 1∶1 paired case-control comparative study was performed for FMPF and traditional cerebrovascular risk factors on 110 cases of old ischemic cerebrovascular disease and 110 controls matched on age, sex and living condition. The results showed that cerebrovascular risk factors were more prevalent in case group than in control group. In the case group, FMPF was significantly higher than in control group. There was a significant positive correlation between hypertension and fibrin monomer polymerization velocity (FMPV), hypertension and fibrinogen (Fbg), alcohol consumption and Fbg, but no significant correlation between diabetic mellitus, smoking and FMPF was found. Among the parameters of blood lipids, there were significant positive correlations between total cholesterol (TC) and parameters of FMPF to varying degrees, triglycerides (TG) and FMPV, TG and Fbg. Our results also showed there were significant linear trends between TC and FMPV (P<0. 001), TC and Fbg (P=0. 0087), TG and FMPV/Amax (maximum absorbance)(P=0. 0143) respectively. Multiple logistic regression analysis revealed that FMPF in case group remained significantly higher than control group after adjustment of all risk factors that were significant in univariate analysis. It was concluded that there is a possible pathophysiological link between FMPF and cerebrovascular risk factors. An elevated FMPF is associated with ischemic cerebrovascular disease and an independent risk factor of this disease. In old people, detection of FMPF might be a useful screening to identify individuals at increased cerebrothrombotic risk.

An Analysis of Risk Factors Affecting Cerebrovascular Disease

Background: Cerebrovascular disease is a worldwide health problem. Stroke, a type of cerebrovascular disease, caused by sudden loss of blood flow to parts of the brain, is the world’s second-leading cause of death and third-leading cause of disability. It is critical to analyze risk factors to prevent cerebrovascular disease. Data and Methods: The risk factors for cerebrovascular disease were analyzed using data from 2,678,054 medical checkups obtained from the JMDC Claims Database. Logit models were used, and the odds ratio (OR) and confidence interval (CI) were calculated. The sample period was from January 2005 to September 2019. Results: Age and heart disease history were very important nonmodifiable factors. The OR comparing persons aged 70 to those aged 50 was 2.05 with a 95% CI of 1.92 - 2.05. A heart disease history was also an especially important factor (OR 2.29, 95% CI 2.18 - 2.41). Among the modifiable factors, triglyceride level and recent large weight change were very important factors, changing the risk of cerebrovascular disease by about 30%. Other significant modifiable factors were diastolic blood pressure, urine protein, having breakfast, walking ability and smoking;each of these changed the risk of cerebrovascular disease by about 10%. Taking medications to control hypertension, hyperglycemia and hypercholesterolemia respectively increased the risk of cerebrovascular disease. In particular, taking antihypertensive medications nearly doubled the risk (OR 1.93, 95% CI 1.86 - 2.00). Conclusion: It is very important for individuals with risk factors to improve their physical conditions to prevent cerebrovascular disease. Taking medications to control blood pressure, glucose level, and cholesterol might introduce risks for cerebrovascular disease. Since all medications have side effects, it is necessary to carefully manage the use of these medications to minimize the negative side effects. Limitations: The dataset was observatory. There were no experimental interventions. Further, the dataset contains only information of Japanese individuals, and the results might differ in other countries. As the data comprised claims from employment-based health insurance, the dataset includes no subjects aged 76 or over and relatively few aged 70 - 75. We need to analyze data of other countries and elderly people.

Distributions of ischemic heart disease risk factors in patients who were admitted for angioplasty in Iran

The aim of this study was to study the prevalence of different risk factors of coronary artery disease (CAD) in Patients who were admitted for angioplasty. Methods: A cross-sectional study was conducted on 333 patients who were admitted with diagnosis as a CAD and candidates for angioplasty in Imam Khomeini hospital, Ahvaz city, Iran 2011. The prevalence of different risk factors was determined using descriptive statistics. Results: The prevalence of CAD risk factors in overall subjects were: 1) 45.3% hypertension (considering >140/90 mmHg);2) 34.5% high cholesterol (>240 mg/dl);3) 27.6% diabetic mellitus (>126 mg/dL);4) family history of heart disease: 20.7%;5) smokers: 19.9%. Conclusion: This data have shown the prevalence of IHD (Ischemic Heart Disease) risk factors specially about hypertension in patients with IHD was high, so could require urgent decision making to national control program of non-communicable diseases in Iran.

Effects of hypoxia-inducible factor 1 on ischemic cerebrovascular disease

Hypoxia-inducible factor 1, a nuclear transcription factor, is induced by hypoxia. Hypoxia-inducible factor 1, a heterodimeric DNA-binding protein, is composed of hypoxia-inducible factor 1α and hypoxia-inducible factor 1βsubunits, which are family members of the basic helix-loop-helix-PER, ARNT, SIM （PAS） protein. O2 concentration regulates hypoxia-inducible factor 1 activity via this subunit. Hypoxia-inducible factor 1α plays a major role in response to hypoxia and transcriptional activation, as well as in the target gene specificity of the DNA enhancer. Hypoxia-inducible factor 1β cannot be induced by hypoxia. This effect may be due to hypoxia-inducible factor 1 stability and activated conformation due to dimerization. Previous studies have shown that hypoxia-inducible factor 1 mRNA expression increases in the penumbra following ischemia/hypoxia. Hypoxia-inducible factor 1 plays an important role in brain tissue injury after ischemia by affecting a series of target genes, elevating tolerance to hypoxia, and ensuring survival of neural cells. This article summarizes the structure, function, expression, regulatory mechanisms, biological effects, and significance of hypoxia-inducible factor 1 in patients with ischemic cerebrovascular disease. As a transcriptional activator, hypoxia- inducible factor 1 plays a key role in hypoxic responses by stabilizing the internal environment. It also has been shown to regulate the expression of several genes. The regulatory effects of hypoxia-inducible factor 1 in patients with ischemic cerebrovascular disease have been described. The present review re-examined the concept of brain protection at the level of gene regulation.

Clinical analysis of acute cerebrovascular disease

Objective: To analyze the clinical characteristics of acute cerebrovascular disease. Methods: 263 patients with acute cerebrovascular disease admitted in our hospital from January 2013 to January 2015 were selected as the study objects and their clinical data were analyzed. Results: The incidence of acute cerebrovascular disease was higher in males than in females (1.8:1). The morbidity of acute cerebrovascular disease was higher over 60 years old. The incidence time of acute cerebrovascular disease was 6:00-10:00, and hypertension was the primary risk factor of this disease. Conclusions: The mortality rate of acute cerebrovascular disease was high, and there were many risk factors associated with the disease. The prevention and treatment of acute cerebrovascular disease should be strengthened.

Self-reported ischemic heart disease: Prevalence, sociodemographics, health behavior, health-care utilization, and quality of life

The aim of this study was to present the prevalence of self-reported Ischemic Heart Disease (IHD) based on a national population-based survey and to characterize people with self-reported IHD with respect to health behavior, risk factors, health-care services utilization and health-related HRQoL;further to compare people with self-reported IHD to those with other chronic illness and people without chronic illness. Based on the Danish Health Interview Survey 2005 (SUSY), a sample of 10,983 persons aged 35 years or older was examined. Data was collected through personal interviews (response rate = 66.7%) and self-administered questionnaires (51.5%). The sample was divided into three mutual exclusive groups: IHD;other chronic illnesses;and no chronic illness. The prevalence of IHD was 5.6% (5.2 - 6.0). The disease was more common in men than women, and the average age was 67.5 years. People with self-reported IHD were characterized as having poorer health behaviors;more risk factors: 40% smokers, 21% sedentary lifestyle, 26% obese;higher utilization of the health-care services;and poorer HRQoL. When compared to people with other chronic diseases, people with IHD continued to show the same characteristics. The IHD group had more problems affecting their daily lives than the other two groups. The issues that affected the people with IHD have also been shown to increase the load on the health-care system. Therefore, it is important to the patients, health-care, and society that the prevalence of IHD is reduced and the burden of disease is made a priority.

Assessment of cheese sign and its association with vascular risk factors:Data from PUMCH dementia cohort

Background:In the clinic,practitioners encounter many patients with an abnormal pattern of dense punctate magnetic resonance imaging(MRI)signal in the basal ganglia,a phenomenon known as"cheese sign".This sign is reported as common in cerebrovascular diseases,dementia,and old age.Recently,cheese sign has been speculated to consist of dense perivascular space(PVS).This study aimed to assess the lesion types of cheese sign and analyze the correlation between this sign and vascular disease risk factors.Methods:A total of 812 patients from Peking Union Medical College Hospital(PUMCH)dementia cohort were enrolled.We analyzed the relationship between cheese sign and vascular risk.For assessing cheese sign and defining its degree,the abnormal punctate signals were classified into basal ganglia hyperintensity(BGH),PVS,lacunae/infarctions and microbleeds,and counted separately.Each type of lesion was rated on a four-level scale,and then the sum was calculated;this total was defined as the cheese sign score.Fazekas and Age-Related White Matter Changes(ARWMC)scores were used to evaluate the paraventricular,deep,and subcortical gray/white matter hyperintensities.Results:A total of 118 patients(14.5%)in this dementia cohort were found to have cheese sign.Age(odds ratio[OR]:1.090,95%confidence interval[CI]:1.064-1.120,P<0.001),hypertension(OR:1.828,95%CI:1.123-2.983,P=0.014),and stroke(OR:1.901,95%CI:1.092-3.259,P=0.025)were risk factors for cheese sign.There was no significant relationship between diabetes,hyperlipidemia,and cheese sign.The main components of cheese sign were BGH,PVS,and lacunae/infarction.The proportion of PVS increased with cheese sign severity.Conclusions:The risk factors for cheese sign were hypertension,age,and stroke.Cheese sign consists of BGH,PVS,and lacunae/infarction.

Risk factors associated with recurrent stroke: A retrospective hospital-based study

Objective:To determine the prevalence of the recurrent stroke and its risk factors in the city of Ahvaz,Iran.Methods:The present study investigated the medical records of 389 ischemic stroke patients admitted to the Department of Neurology,Ahvaz Hospitals from March 2015 to January 2016.Patients'information was collected.Patients who suffered recurrent stroke but survived were followed up for at least 12 months after the first attack,and their medical records were collected.Results:The incidence rate of recurrent stroke was 14.91%(n=58).There was a significant relationship between the incidence rate of recurrent ischemic stroke with atrial fibrillation(OR=2.012,P<0.05)and ischemic heart disease(OR=1.695,P<0.05).However,there was no significant relationship between recurrent stroke and age,sex,dyslipidemia,diabetes,hypertension,and cigarette smoking(P>0.05).Conclusions:Patients with a history of atrial fibrillation and ischemic heart disease were at a higher risk of recurrent ischemic stroke.The incidence can be reduced by better treatment of atrial fibrillation and active follow-up.

Changing profiles of cardiovascular disease and risk factors in China:a secondary analysis for the Global Burden of Disease Study 2019

Background:Understanding the changing profiles of cardiovascular disease(CVD)and modifiable risk factors is essential for CVD prevention and control.We aimed to report the comprehensive trends in CVD and risk factors in China from 1990 to 2019.Methods:Data on the incidence,death,and disability-adjusted life years(DALYs)of total CVD and its 11 subtypes for China were obtained from the Global Burden of Disease Study 2019.The CVD burden attributable to 12 risk factors was also retrieved.A secondary analysis was conducted to summarize the leading causes of CVD burden and attributable risk factors.Results:From 1990 to 2019,the number of CVD incidence,death,and DALYs considerably increased by 132.8%,89.1%,and 52.6%,respectively.Stroke,ischemic heart disease,and hypertensive heart disease accounted for over 95.0%of CVD deaths in 2019 and remained the top three causes during the past 30 years.Between 1990 and 2019,the age-standardized rate of stroke decreased significantly(percentage of decreased incidence:-9.3%;death:-39.8%;DALYs:-41.6%),while the rate of ischemic heart disease increased(percentage of increased incidence:11.5%;death:17.6%;DALYs:2.2%).High systolic blood pressure,unhealthy diet,tobacco,and air pollution continued to be the major contributors to CVD deaths and DALYs(attributing to over 70%of the CVD burden),and the high body mass index(BMI)-associated CVD burden had the largest increase between 1990 and 2019.Conclusions:The significant increases in the number of CVD incident cases,deaths,and DALYs suggest that the CVD burden is still a concern.Intensified strategies and policies are needed to maintain promising progress in stroke and to reduce the escalating burden of ischemic heart disease.The CVD burden attributable to risk factors has not yet made adequate achievements;even worse,high BMI has contributed to the increasing CVD burden.

脑血管疾病风险人群湿证相关特征的流行病学调查

【目的】探究广东地区脑血管疾病风险人群与中医湿证相关的流行病学特征。【方法】采用横断面研究的方法,调查330例广东常住居民脑血管疾病风险相关的临床资料,进行中医湿证诊断、量化评分及脑卒中风险评级,总结湿证分布规律并分析其影响因素。【结果】(1)诊断为湿证的研究对象共306例(占92.73%),风险组诊断为湿证人群的占比为93.82%(258/275),略高于健康组的87.27%(48/55),但差异无统计学意义(χ2=2.91,P=0.112),而风险组的湿证量化得分高于健康组,差异有统计学意义(Z=-2.24,P=0.025)。(2)在具有脑血管疾病危险因素的研究对象中,评价时间(χ2=26.11,P=0.001)、脑卒中风险等级(χ2=8.85,P=0.031)、脑卒中或短暂性脑缺血发作(TIA)病史(χ2=9.28,P=0.015)是脑血管病风险人群湿证等级的影响因素。【结论】湿证是广东地区人群常见的中医证候;具有脑血管疾病危险因素,尤其是脑卒中高风险人群、脑卒中或TIA病史患者,其湿证程度明显增高;未来在广东开展脑卒中预防工作应考虑湿证的评估与干预。

HIV/AIDS肺脾气虚证相关心脑血管疾病风险因素探析

目的通过检测血脂四项、血管内皮损伤因子、炎症相关因子,并结合前期的基因芯片结果,初步探讨人类免疫缺陷病毒(HIV)/艾滋病(AIDS)肺脾气虚证相关心脑血管疾病风险因素及机制,为中医药早期干预心脑血管疾病提供依据。方法2020年9月—2020年11月选取河南省某地区确诊的20例HIV/AIDS肺脾气虚证患者作为研究对象,同地区20例HIV抗体阴性作为健康对照组。检测CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)计数,并计算CD_(4)^(+)/CD_(8)^(+)比值;检测血脂四项甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C);检测氧化低密度脂蛋白(Ox-LDL)、载脂蛋白A-I(ApoAⅠ)、载脂蛋白A-Ⅱ(ApoAⅡ)、载脂蛋白B(ApoB)、锌-α2-糖蛋白1(AZGP1)、可溶性血栓调节蛋白(sTM)、血管性血友病因子(vWF)、脂联素、瘦素(LEP)、超敏C反应蛋白(Hs-CRP)、单核细胞趋化因子1(MCP-1)、肿瘤坏死因子α(TNF-α)。结果HIV/AIDS肺脾气虚证患者与健康对照组比较CD_(4)^(+)降低,CD_(4)^(+)/CD_(8)^(+)比值倒置,TC降低,sTM、AZGP1、Ox-LDL、Hs-CRP升高。结论HIV/AIDS肺脾气虚证患者存在炎性反应、血脂异常的表现,罹患心脑血管疾病风险增加。为中医药早期干预心脑血管疾病的发生提供新思路。

脑血管疾病风险人群湿证相关的肠道菌群特征及影响因素研究

【目的】研究脑血管疾病风险人群湿证相关肠道菌群的特征及其影响因素。【方法】基于2021年10月至2023年2月在广东开展的脑血管疾病风险人群湿证相关的流行病学调查,纳入60例研究对象(包括脑血管疾病风险组41例和健康对照组19例),进行湿证诊断与脑卒中风险评级,收集粪便样本,采用高通量16S rRNA测序技术及生物信息学方法分析菌群特征。【结果】(1)共53例诊断为湿证(88.33%),风险组与健康组间及低、中、高危3组间在湿证诊断量化得分的组间比较有统计学差异(P=0.016;P=0.041)。(2)湿证组与非湿证组的肠道菌群物种种类及丰度无显著性差异。(3)在已诊断为湿证的人群中,健康组与风险组的Alpha多样性无显著性差异,而Beta多样性分析有显著性差异;LEfSe分析发现梭杆菌和乳杆菌富集于风险组;相关性分析提示差异菌与糖尿病、血脂异常、肥胖3个危险因素以及颈动脉内-中膜厚度(IMT)相关。(4)在已诊断为湿证且有脑血管疾病危险因素的人群中,低、中、高危3组的Alpha多样性无显著性差异,而Beta多样性分析则提示有显著性差异;LEfSe分析发现,Acidaminococcaceae、Phascolarctobacterium、Butyricimonas明显富集于低危组,Veillonellaceae明显富集于中危组,Ruminococcus 2、Alloprevotella明显富集于高危组;相关性分析提示,差异菌与高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白细胞计数(WBC)、中性粒细胞计数(NEUT)相关。【结论】以湿证为主的广东地区人群,湿证程度与脑卒中风险有关,且呈现与亚临床动脉粥样硬化、炎性反应、脂质代谢相关的特征菌群。

颞浅动脉-大脑中动脉搭桥术治疗闭塞性脑血管疾病的现状及研究进展

闭塞性脑血管疾病的发生与动脉粥样硬化引起的血管管腔闭塞有关,导致脑供血不足,继而出现神经功能障碍。脑血管搭桥术是临床上治疗闭塞性脑血管疾病的主要手段之一,患者经治疗后可改善患侧脑供血,因此近年来该治疗方法受到广泛关注。但目前对于脑血管搭桥术在治疗闭塞性脑血管疾病中的应用还存在诸多需要探讨的问题。本文就颞浅动脉-大脑中动脉(superficial temporal artery-middle cerebral artery,STA-MCA)搭桥术在治疗闭塞性脑血管疾病中的现状及研究进展进行综述,旨在为该治疗手段在临床上的应用提供参考。

衰弱对老年短暂性脑缺血发作患者预后的影响

目的 探讨衰弱对老年短暂性脑缺血发作(TIA)患者随访2年预后的影响,并分析预后的相关因素。方法 本研究为纵向队列研究,连续纳入2018年1月—2022年12月在本院诊治的老年TIA患者。依据是否合并衰弱,按照1:1:1,选择同期入院、年龄、病史匹配的患者分为衰弱前期组、衰弱组,两组各132例,另选取同期132例未伴衰弱患者纳入对照组。针对三组患者进行连续随访24个月,并以脑血管病相关事件的发生情况为主要观察指标,包括新发卒中、再发TIA、全因死亡情况等。通过Kaplan-Meier生存分析、Log-rank检验分析患者预后,并建立回归模型对脑血管事件相关因素进行分析。结果 衰弱组和衰弱前期组的超敏C反应蛋白(hs-CRP)明显高于对照组(P<0.05)。中位随访时间(22.4±2.3)个月,共有68例(17.2%)脑血管事件,包括15例(3.8%)全因死亡,33例(8.3%)再发TIA,20例(5.1%)新发卒中。就三组再发TIA率而言,衰弱组、衰弱前期组、对照组分别为7.6%、4.5%、3.0%,P=0.027;脑血管事件发生率分别为27.3%、15.2%、9.1%,P=0.016。采用多因素Cox比例风险回归模型,结果显示衰弱(HR=2.114,95%CI:1.128~3.962,P=0.021)和衰弱前期(HR=1.526,95%CI:1.042~2.235,P=0.030)仍然是发生脑血管事件的独立相关因素。结论 衰弱可显著增加老年TIA患者再发TIA的风险,且为脑血管事件的独立相关因素。

1990-2019年中国和全球缺血性心脏病疾病负担变化趋势与发病预测分析

背景缺血性心脏病是全球公认死亡率最高且最为常见的心血管疾病,致使我国居民的疾病负担不断加重。进行疾病负担的变化趋势及预测分析是医疗卫生政策关注的重要议题。目的比较分析1990—2019年中国与全球缺血性心脏病的疾病负担与风险因素,预测其变化趋势,为开展缺血性心脏病的防治工作提供依据。方法基于2019年全球疾病负担报告(GBD 2019)数据库,采用Joinpoint对数线性模型分析1990—2019年中国和全球缺血性心脏病疾病负担的变化趋势,并进行趋势检验,借助R 4.3.0进行2020—2035年中国缺血性心脏病疾病负担预测。结果1990—2019年,我国缺血性心脏病标化发病率、标化死亡率和标化伤残调整生命年(DALY)率均低于全球水平,但总体均呈上升趋势,而全球均呈下降趋势。中国及全球缺血性心脏病的高发病率、高死亡率、高DALY率多发于老年人群。2020—2035年中国缺血性心脏病疾病负担预计整体呈下降态势[发病率、死亡率、DALY率的年均增长率(AAPC)分别为-0.400、-1.167、-1.318,P<0.001],中国和全球男性人群各指标的降幅均较女性更大。结论我国缺血性心脏病防治形势严峻,男性和老年人群的疾病负担尤为沉重;由伤残所致的疾病负担较重;高收缩压、高低密度脂蛋白是重要风险因素。未来应当关注我国缺血性心脏病的疾病负担增长趋势,重点加强男性及老年人群的预防干预。

心脑血管疾病的预防与管理策略

动脉粥样硬化是一种动脉壁慢性炎症性疾病,是缺血性卒中和冠心病的病理生理学基础,是心脑血管疾病的首要诱因。心脏与脑这两个器官均存在高血压、高脂血症、糖尿病等相似的危险因素;且二者共病病情更严重,预后更差。本文通过综述心脑血管疾病的病理生理学机制、危险因素防治策略以及“脑心同治”策略,为心脑血管疾病的预防与管理提供新的思路。

针刺调控缺氧诱导因子-1α信号通路改善缺血性脑血管病的作用机制

缺血性脑血管疾病是常见的神经系统疾病之一,具有高致残率,高死亡率的特点,加剧了世界范围内的医疗卫生经济负担。缺氧诱导因子-1α(HIF-1α)是低氧响应的关键因子,在缺血性脑血管病发生和发展过程中发挥重要作用,而针刺在缺血性脑血管病的治疗中同样显示出显著优势。针刺调控HIF-1α信号通路可能是针刺产生疗效的关键机制之一。既往研究初步表明针刺对HIF-1α的调控作用可能不仅与疾病的损伤类型相关,还可能与HIF-1α的表达的时效效应以及针刺的介入时机相关。

中国居民癌症等四大慢病危险因素及归因疾病负担分析

目的评估癌症、心脑血管疾病、糖尿病及慢性呼吸系统疾病(以下简称“四大慢病”)的主要危险因素及相关危险因素暴露的疾病负担。方法本研究数据来源于2019年全球疾病负担研究(Global Burden of Disease Study,GBD)数据库,通过获取2019年我国居民四大慢病的死亡病例数和伤残调整寿命年(disability-adjusted life years,DALYs),分析四大慢病归因于相关危险因素暴露的比例。结果烟草暴露是造成恶性肿瘤疾病负担最主要的危险因素,导致的DALYs占比达31.4%;心脑血管疾病的首要危险因素是高收缩压,导致的DALYs占比达55.6%。四大慢病的共同危险因素有烟草暴露、空气污染和高身体质量指数,其中烟草暴露在恶性肿瘤和慢性呼吸系统疾病中归因风险比例最高,饮食相关危险因素、饮酒和体力活动不足与恶性肿瘤、心脑血管疾病及糖尿病密切相关。对主要恶性肿瘤疾病负担的归因分析结果显示,烟草暴露归因风险比例最高的是肺癌,其次是食管癌、胃癌、肝癌及结直肠癌。结论烟草暴露、空气污染和高身体质量指数是我国居民癌症等四大慢病的共同危险因素,能为四大慢病高风险人群筛选提供重要依据。

无心脑血管疾病危险因素成年受检者颈动脉管腔结构变化的相关因素分析

目的分析无心脑血管疾病危险因素成年受检者颈动脉管腔结构变化及其影响因素。方法回顾性连续纳入2019年12月至2021年12月多中心“脑卒中高危人群筛查脑颈动脉超声规范化评分”数据库2738例无心脑血管疾病相关危险因素的成年受检者(男787例,女1951例),分别将男性、女性分为18~29、30~39、40~49、50~59、≥60岁5组,统计比较各年龄组间颈动脉内-中膜厚度(IMT)、颈总动脉内径(D_(CCA))、颈动脉球部内径(D BULB)、颈内动脉内径(D_(ICA))及颈动脉不同节段内径之比[以颈动脉指数(CI)表示,CI_(BULB)/CCA为D_(BULB/DCCA),CI_(BULB)/ICA为D BULB/D_(ICA),CI_(ICA/CCA)为D_(ICA)/D_(CCA)]的差异性,并采用Spearman相关性分析及单因素线性回归方法分析各参数随年龄的变化情况。采用单因素分析比较男女间以及不同侧别间各CI的差异,采用Spearman相关性分析方法分析各CI与颈总动脉IMT的相关性。应用多因素线性回归方法分析CI_(BULB)/CCA、CI_(BULB)/ICA及CI_(ICA/CCA)变化的影响因素。结果(1)IMT、D_(CCA)、D BULB、D_(ICA)、CI_(BULB)/CCA及CI_(BULB)/ICA与年龄呈显著正相关性(男性r值分别为0.121、0.229、0.260、0.055、0.107、0.229,女性r值分别为0.364、0.185、0.199、0.073、0.077、0.129,均P<0.01),CI_(ICA/CCA)与年龄呈负相关性(男性r=-0.118,女性r=-0.049,均P<0.05),且年龄每增长1岁,男性IMT、D_(CCA)、D BULB、D_(ICA)分别增长0.003、0.015、0.025、0.004 mm,女性IMT、D_(CCA)、D BULB、D_(ICA)分别增长0.005、0.011、0.018、0.005 mm。(2)男性CI_(BULB)/ICA小于女性(1.47±0.21比1.51±0.22;t=-5.566,P<0.01),CI_(ICA/CCA)大于女性(0.78±0.11比0.76±0.11;t=6.629,P<0.01);左侧CI_(BULB)/CCA(1.14±0.15比1.13±0.15;t=-2.973,P<0.05)、CI_(ICA/CCA)(0.77±0.11比0.76±0.11;t=-3.946,P<0.01)大于右侧。男女性别之间CI_(BULB)/CCA及左右侧之间CI_(BULB)/ICA差异均无统计学意义(男性比女性:1.13±0.15比1.13±0.15,t=1.212,P=0.226;左侧比右侧:1.49±0.22比1.50±0.21,t=1.112,P=0.266)。CI_(BULB)/CCA、CI_(BULB)/ICA与IMT的增加呈正相关性(r值分别为0.039、0.070,均P<0.05),而CI_(ICA/CCA)与IMT的增加呈负相关性(r=-0.032,P<0.05)。(3)多因素线性回归分析结果显示,年龄(β=0.081,P<0.01)、左侧(β=0.040,P<0.05)显著正向预测CI_(BULB)/CCA,而IMT对CI_(BULB)/CCA的影响差异无统计学意义(β=0.012,P>0.05)。年龄(β=0.148,P<0.01)、女性(β=0.070,P<0.01)及IMT(β=0.030,P<0.05)为CI_(BULB)/ICA增加的独立影响因素。年龄(β=-0.063,P<0.01)、女性(β=-0.088,P<0.01)显著负向预测CI_(ICA/CCA),左侧显著正向预测CI_(ICA/CCA)(β=0.053,P<0.01),但IMT对CI_(ICA/CCA)的影响差异无统计学意义(β=-0.022,P>0.05)。结论无心脑血管疾病危险因素成年受检者的颈动脉管腔结构参数与年龄具有一定的相关性,年龄、性别、侧别及IMT为颈动脉内径比值变化的独立预测因素。