Total cholesterol to high-density lipoprotein ratio and nonalcoholic fatty liver disease in a population with chronic hepatitis B

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is characterized by hypertriglyceridemia,increased low-density lipoprotein cholesterol levels,and reduced highdensity lipoprotein cholesterol(HDL-C)particles.Previous studies have shown that the total cholesterol to high-density lipoprotein cholesterol ratio(TC/HDL-C)was superior to other lipid metabolism biomarkers for predicting NAFLD risk and could be a new indicator of NAFLD.However,the association between TC/HDL-C and NAFLD in patients with hepatitis B virus(HBV)has not yet been determined.AIM To investigate the association between TC/HDL-C and NAFLD in a population with chronic hepatitis B(CHB).METHODS In this study,183 HBV-infected patients were enrolled.All participants underwent blood chemistry examinations and abdominal ultrasound.Univariate and multivariate logistic regression models,curve fitting analysis,and threshold calculation were used to assess the relationship between TC/HDL-C and NAFLD.RESULTS The overall prevalence of NAFLD was 17.49%(n=32)in the 183 CHB participants.The TC/HDL-C of non-NAFLD and NAFLD patients were 3.83±0.75 and 4.44±0.77,respectively(P<0.01).Logistic regression analysis showed that TC/HDL-C was not associated with NAFLD after adjusting for other pertinent clinical variables.However,at an optimal cutoff point of 4.9,a non-linear correlation between TC/HDL-C and NAFLD was detected.The effect size of the left and right sides of the inflection point were 5.4(95%confidence interval:2.3-12.6,P<0.01)and 0.5(95%confidence interval:0.1-2.2,P=0.39),respectively.On the left side of the inflection point,TC/HDL-C was positively associated with NAFLD.However,no significant association was observed on the right side of the inflection point.CONCLUSION This study demonstrated a non-linear correlation between TC/HDL-C and NAFLD in a population with CHB.TC/HDL-C was positively associated with NAFLD when TC/HDL-C was less than 4.9 but not when TC/HDL-C was more than 4.9.

A physically active lifestyle is related to a lower level of skin autofluorescence in a large population with chronic-disease(LifeLines cohort)

Background:Physical activity(PA)has substantial health benefits and is important in combatting chronic diseases,which have been associated with elevated levels of advanced glycation endproducts(AGEs).AGEs play a role in the aging process,and an association between PA and AGEs has been reported.We aimed to investigate the relationship between PA and AGE accumulation in a general population and in a population with chronic diseases.Methods:This large cross-sectional population study used data from adult participants in the LifeLines project,with participant information drawn from the LifeLines database as well data from patients with diabetes mellitus or renal and/or cardiovascular diseases.Tissue AGE accumulation was assessed non-invasively by skin-autofluorescence(SAF)using an AGE reader(DiagnOptics Technologies BV,Groningen,the Netherlands).PA was assessed using the short questionnaire to assess health-enhancing physical activity(SQUASH).Multivariate linear regression analyses were adjusted for age,body mass index,sex,and smoking status.Results:Data from 63,452 participants(general population n=59,177,chronic disease n=4275)were analyzed.The general population was significantly younger(43.58±11.77 years,mean±SD)and had significantly lower SAF(1.90±0.42 arbitrary units(AU))compared to the population with chronic disease(age:55.51±12.07 years;SAF:2.27±0.51 AU).In the group with chronic disease,more hours of moderate to vigorous physical activities per week were associated with lower SAF(β=-0.002,95%confidence interval(95%CI):-0.002 to-0.001).For the general population,there was no association between hours of moderate to vigorous activity and SAF(β=3.2×10^(-5),95%CI:0.000-0.001,p=0.742).However,there was an association in the general population between total hours of PA per week and SAF(β=4.2×10^(-4),95%CI:0.000-0.001,p<0.001),but this association was not found in the chronic disease population(β=-3.2×10^(-4),95%CI:-0.001 to 0.000,p=0.347).Conclusion:Our study demonstrates that an inverse relationship exists between PA and AGE accumulation in the population with chronic disease.More hours of moderate to vigorous activity is associated a significantly decreased SAF.More PA is associated a lower SAF,even after for the established predictors(age,body mass index,smoking status,and sex).Our findings could help to promote health and prolong longevity.

Living with liver disease in the era of COVID-19-the impact of the epidemic and the threat to high-risk populations

The cardinal symptoms of severe acute respiratory syndrome coronavirus 2 infection as the pandemic began in 2020 were cough,fever,and dyspnea,thus characterizing the virus as a predominantly pulmonary disease.While it is apparent that many patients presenting acutely to the hospital with coronavirus disease 2019(COVID-19)infection have complaints of respiratory symptoms,other vital organs and systems are also being affected.In fact,almost half of COVID-19 hospitalized patients were found to have evidence of some degree of liver injury.Incidence and severity of liver injury in patients with underlying liver disease were even greater.According to the Centers of Disease Control and Prevention,from August 1,2020 to May 31,2022 there have been a total of 4745738 COVID-19 hospital admissions.Considering the gravity of the COVID-19 pandemic and the incidence of liver injury in COVID-19 patients,it is imperative that we as clinicians understand the effects of the virus on the liver and conversely,the effect of underlying hepatobiliary conditions on the severity of the viral course itself.In this article,we review the spectrum of novel studies regarding COVID-19 induced liver injury,compiling data on the effects of the virus in various age and high-risk groups,especially those with preexisting liver disease,in order to obtain a comprehensive understanding of this disease process.We also provide an update of the impact of the new Omicron variant and the changing nature of COVID-19 pathogenesis.

Heart failure and left ventricular dysfunction in older patients with chronic kidney disease: the China Hypertension Survey (2012‒2015)

Background Heart failure(HF)is a leading cause of hospitalization and mortality for older chronic kidney disease(CKD)patients.However,the epidemiological data is scarce.We aimed to determine the prevalence of left ventricular(LV)dysfunction and HF,and to explore the risk factors for HF among those patients.Methods This is a cross-sectional analysis of the China Hypertension Survey conducted between October 2012 and December 2015.A total of 5,808 participants aged≥65 years were included in the analysis.Self-reported history of HF and any other cardiovascular diseases was acquired.2-D and Doppler echocardiography were used to assess LV dysfunction.CKD was defined as either estimated glomerular filtration rate(eGFR)<60 mL/min per 1.73 m2 or urinary albumin to creatinine ratio(ACR)≥30 mg/g.Results Among CKD patients aged≥65 years,the weighted prevalence of HF,heart failure with preserved ejection fraction(HFpEF),heart failure with mid-range ejection fraction(HFmrEF),and heart failure with reduced ejection fraction(HFrEF)was 4.8%,2.5%,0.8%,and 1.7%,respectively.The weighted prevalence of HF was 5.0%in patients with eGFR<60 mL/min per 1.73 m2,and was 5.9%in patients with ACR≥30 mg/g.The prevalence of LV systolic dysfunction was 3.1%,and while it was 8.9%for moderate/severe diastolic dysfunction.Multivariate analysis showed that smoking was significantly associated with the risk of HF.Furthermore,age,smoking,and residents in rural areas were significantly associated with a risk of LV diastolic dysfunction.Conclusions The prevalence of HF and LV dysfunction was high in older patients with CKD,suggesting that particular strategies will be required.

Individual Income Status Correlates with Chronic Kidney Disease in Japan beyond Metabolic Risk Factors: Cross Sectional Study

Background: Chronic kidney disease (CKD) is a pre-condition for end-stage kidney disease (ESKD) undergoing hemodialysis, as well as a risk factor for cardiovascular disease. Therefore, it is vital that CKD prevention measures be established. In particular, socioeconomic status (SES), as represented by income, contributes to non-communicable diseases like CKD. The purpose of this study was to examine the independent association between CKD and individual SES in Japan, with consideration of other metabolic risks. Methods: In the present study, we analyzed the 2011 National Health and Nutrition Survey by the Ministry of Health, Labor, and Welfare. Specifically, we analyzed 3,557 people out of 8,762 whose serum creatinine was measured. Logistic regression analysis was used to calculate the odds ratio (OR) of CKD by income distinction, after adjustment for age and metabolic risks (obesity, diabetes mellitus, dyslipidemia, and hypertension), which were assessed at the medical examination. Results: CKD was found in 385 participants (10.8%) and was associated with greater age, obesity, higher levels of low-density lipoprotein cholesterol, triglyceride, and glycated hemoglobin, and lower levels of hemoglobin and high-density lipoprotein cholesterol. The adjusted model indicated a significant association between lower income and CKD: the OR of the low income group (<2 million yen) was 1.33 (95% confidence interval: 1.01 - 1.78) in comparison with the high income group. Conclusions: The results of the present study indicate a substantial relationship between individual lower income status and CKD in Japan, where healthcare is easy to access. To prevent ESKD and cardiovascular diseases, early detection of CKD and its metabolic risks is necessary, especially among the socioeconomically vulnerable population.

Thoughts about Person-Centered Care for the Adult Population with Multimorbidity

Patients with multimorbidity are becoming the norm rather than the exception. The management of patients with several chronic diseases is now the most important challenge facing health care systems in developed countries. Based on the actual medical records of ambulatory care visits, this study investigated the prevalence and patterns of multimorbidity in 55 and older population. Among a cohort comprised of 300,000 beneficiaries selected randomly from the National Health Insurance Research Database of Taiwan in 2001, 42,441 were eligible. These were followed longitudinally 10 years. The prevalence of chronic disease rose from 62.3% to 79.8% and multimorbidity rose from 57.4% to 75.7%. Multimorbidity patterns were found fell in-to four clusters: metabolic diseases, cardiac diseases, mental joints and gastrointestinal tract disorders. Hypertension and diabetes mellitus, as well as hyperplasia of the prostate in men, were the most common chronic diseases. The prevalence of chronic disease increased with age, especially high at age 75 - 79. Thought about the health care system for an ageing society is necessary. Applying the concept of customer experience and strengthening people-centered management in an integrated model of health care, enhancing knowledge and skills in the long-term management of chronic disease, revising clinical guidelines and training professionals in caring for the elderly, reinforcing preventive health services, especially in men’s health, modifying the materials for health education, and planning for health manpower resources will provide a better model to ensure the health care for people with multimorbidity.

我国患慢性病老年人社区养老服务需求研究

目的:了解我国患慢性病老年人的社区养老服务需求。方法:选取2018年中国老年人健康长寿影响因素追踪调查(CLHLS)数据,对数据进行描述性统计、单因素卡方分析和多因素二元Logistic回归分析。结果:在单因素分析中,性别、年龄、现居地、婚姻情况、自理能力、经济水平、文化程度、医疗费用支出水平等因素对是否有社区养老服务需求所得出的结果具有统计学差异(P值<0.05),二元logistic回归分析中,现居地、婚姻状况、文化程度等因素对是否有社区养老服务需求所得结果具有统计学差异(P值<0.05)。结论:患慢性病老年人的社区养老服务需求,在不同现居地、婚姻状况、文化程度等方面有着显著差异。因此,在提供服务时,要考虑慢性病的治疗和控制,同时要根据现居地、婚姻状况和文化程度的需求差异,提供患慢性病老年人有针对性的服务。

一体化护理在城市职业人群慢病健康管理中的应用效果研究

目的分析一体化护理在城市职业人群慢病健康管理中的应用效果。方法220例城市职业人群慢性病患者随机分为两组,对照组给予常规护理,观察组给予一体化护理,比较两组的疾病症状、生活质量和护理满意度。结果护理后1周、2周、1个月,观察组的SCL-90评分均低于对照组(P<0.05)。护理后,观察组的生活质量评分及护理满意度均高于对照组(P<0.05)。结论一体化护理在城市职业人群慢病健康管理中的应用可有效改善患者疾病症状,提升其生活质量,提高其护理满意度。

Associations of Polymorphism of rs9944155, rs1051052, and rs1243166 Locus Allele in Alpha-1-antitrypsin with Chronic Obstructive Pulmonary Disease in Uygur Population of Kashgar Region

Background： Previous studies conducted in various geographical and ethnical populations have shown that Alpha-1 -antitrypsin （Alpha-1-AT） expression affects the occurrence and progression of chronic obstructive puh-nonary disease （COPD）. We aimed to explore the associations of rs9944155AG, rsl051052AG, and rs1243166AG polymorphisms in the A lpha-1-A T gene with the risk of COPD in Uygur population in the Kashgar region. Methods： From March 2013 to December 2015. a total of 225 Uygur COPD patients and 198 healthy people were recruited as cases and controls, respectively, in Kashgar region. DNA was extracted according to the protocol of the DNA genome kit, and Sequenom MassARRAY single-nucleotide polymorphism technology was used for genotype determination. Serum concentration of Alpha-1-AT was detected by enzyme-linked immunosorbent assay. A logistic regression model was used to estimate the associations of polymorphisms with COPD. Results： The rs1243166-G allele was associated with a higher risk of COPD （odds ratio [OR] = 2.039, 95% confidence interval [CI]： 1.116-3.725, P = 0.019）. In cases, Alpha-1-AT levels were the highest among participants can-yiug rs1243166 AG genotype, followed by AA and GG genotype （χ2 = 11.89, P = 0.003）. Similarly, the rs1051052-G allele was associated with a higher risk of COPD （OR = 19.433, 95% CI： 8.783-43.00, P 〈 0.001）. The highest Alpha-1-ATlevels were observed in cases carrying rs1051052 AA genotype, followed by cases with AG and GG genotypes （χ2= 122.45, P 〈 0.001）. However, individuals with rs9944155-G allele exhibited a lower risk of COPD than those carrying the rs9944155-A allele （OR = 0.121, 95% CI： 0.070-0.209, P 〈 0.001 ）. in both cases and controls, no significant difference in Alpha-l-AT levels was observed among various rs9944115 genotypes. Conclusions： rs 1243166, rs9944155, and rs 1051052 sites of Alpha- I-A Tmay be associated with the COPD morbidity in Uygur population. While rs 1243166-G allele and rs1051052-G allele are associated with an increased risk of developing COPD, rs9944155-G allele is a protect locus in Uygur population. Alpha1-AT levels in Uygur COPD patients were lower than those in healthy people and differed among patients with different rs 1051052 AG and rs 1243166 AG genotypes.

Comment on review article:Chronic hepatitis C virus infection cascade of care in pediatric patients

An enhanced cascade of care should include a younger population,helping to achieve the goal of the World Health Organization with a focus on elimination in the pediatric population.Furthermore,enhanced screening and awareness efforts and continued education of health care providers will improve the outcomes of chronic hepatitis C virus(HCV)infection in the pediatric population.The present work discusses and comments on the topic"cascade of care in HCV chronic pediatric patients".

社区人群空腹血糖受损对估算肾小球滤过率的影响研究

背景估算肾小球滤过率(eGFR)是反映慢性肾脏病严重程度的量化指标之一。研究表明糖尿病前期血糖升高可增加慢性肾脏病风险,但对eGFR直接影响报道较少。目的探讨社区人群中空腹血糖(FPG)受损患者血糖水平对eGFR的影响。方法选择2020年1-12月于南昌大学第二附属医院体检中心体检的人群,收集一般资料与临床资料(包括既往史、性别、年龄、体质指数、血压、尿酸、血脂、FPG、尿常规、血肌酐),经相应纳入标准与排除标准筛选,最终纳入28601例受试者。根据FPG水平将受试者分为FPG升高组(5.6 mmol/L≤FPG<7.0 mmol/L)、FPG正常组(3.9 mmol/L≤FPG<5.6 mmol/L),比较两组一般资料与临床资料。为明确FPG对eGFR影响,采用个案匹配控制对两组受试者进行多因素(性别、年龄、平均动脉压、尿酸、总胆固醇、体质指数)匹配,采用Mann-Whitney U秩和检验比较匹配后两组一般资料。采用Spearman秩相关检验分析FPG与eGFR在FPG升高组、FPG正常组及匹配后FPG升高组、FPG正常组间的相关性。结果共获得FPG正常组患者25539例、FPG升高组患者3062例。两组年龄、平均动脉压、尿酸、胆固醇、体质指数、eGFR比较,差异有统计学意义(P<0.05);经多因素匹配后,两组年龄、平均动脉压、尿酸、胆固醇、体质指数比较,差异无统计学意义(P>0.05),FPG升高组eGFR较FPG正常组更高(P<0.05)。相关性分析显示,全人群中FPG对eGFR呈负相关(r_(s)=-0.047,P<0.05),匹配人群中FPG对eGFR影响呈正相关(r_(s)=0.065,P<0.05),且匹配人群FPG升高亚组中相关系数进一步增加(r_(s)=0.127,P<0.05)。结论FPG受损会引起eGFR升高,这为糖尿病前期血糖升高出现的肾小球高滤过状态提供可能的临床推断。

上海市社区老年居民主要慢性病共病流行情况

目的 分析上海市≥60岁社区居民常见慢性病共病流行情况和模式,为制定防治策略提供依据。方法 利用2017年上海市慢性病及其危险因素监测中12 507名≥60岁调查对象数据,基于多阶段复杂抽样加权,计算超重肥胖、高血压、糖尿病、血脂异常、慢阻肺、慢性肾脏疾病和慢性消化系统疾病等7种慢性病患病率和共病患病率,采用关联规则分析7种慢性病的共病模式及关联强度。结果 94.37%的老年居民至少患有纳入7种慢性病中的1种,高血压患病率最高,为58.75%(95%CI:55.96%~61.49%),其次为超重肥胖50.01%(95%CI:47.65%~52.37%)。共病(患慢性病种数≥2种)患病率为65.91%(95%CI:63.17%~68.54%),75~79岁组共病患病率最高,不同年龄组共病患病率差异有统计学意义(χ^(2)=7.75,P<0.05)。关联规则分析显示,总体指向高血压的关联规则最多,{糖尿病}→{高血压}为首位强关联规则,其次为{血脂异常}→{高血压}和{慢性消化系统疾病}→{超重肥胖}。随着年龄增长,产生的符合条件的强关联规则越多,共病模式也越多。75~79岁组产生1条常见三元共病模式,为糖尿病+超重肥胖+高血压。≥80岁组产生2条常见三元共病模式,为血脂异常+超重肥胖+高血压和慢性消化系统疾病+高血压+超重肥胖。结论 上海市老年人慢性病共病患病率较高,常见慢性病共病情况普遍,慢性病间关联复杂,需重视社区老年居民慢性病多病共存管理,满足老年人群公共卫生需求。

健康人群和慢性阻塞性肺疾病患者的血清维生素D与血嗜酸性粒细胞计数的关系

目的探讨健康人群和慢性阻塞性肺疾病(COPD)患者血清维生素D缺乏情况及与血嗜酸性粒细胞(EOS)的关系。方法收集南方医科大学南方医院体检中心2017年10月~2021年12月的健康人6163名,男性3781名,女性2382名。根据血清25(OH)D水平分为严重缺乏组(<10 ng/mL)、缺乏组(<20 ng/mL)、不足组(<30 ng/mL)和正常组(≥30 ng/mL)。回顾性纳入2021年4月~2021年6月在我院呼吸科门诊就诊的COPD患者67人为疾病组,并1∶1选取了同期在我院体检中心的67人作为对照组。记录血常规、体质量指数(BMI)等数据。结果健康人群血清25(OH)D(<30 ng/mL)总体缺乏率(包括缺乏和不足)为85.31%,女性缺乏率为89.29%,显著高于男性。6、7、8月份血清25(OH)D水平明显高于12、1、2月份。健康人中血EOS水平在血清25(OH)D严重缺乏组最低,不足组和缺乏组次之,正常组最高(P<0.05)。多重回归分析显示年龄更大、BMI更高及维生素D水平升高均是血EOS升高的危险因素。COPD组(19.66±7.87 ng/mL)血清25(OH)D水平低于健康对照组(26.39±9.28 ng/mL),差异具有统计学意义(P<0.05)。血清25(OH)D水平降低是COPD发生的危险因素。回归分析显示COPD血清25(OH)D水平与血EOS、性别及BMI无明显相关。结论南方地区健康人群和COPD患者血清维生素D水平普遍缺乏,维生素D水平与性别、BMI及血EOS水平关系在健康及疾病状态下不一致。

中国中老年人抑郁和慢性病的关联

目的:了解我国中老年人抑郁和慢性病的关联。方法:利用我国健康与养老追踪调查(China health and retirement longitudinal study,CHARLS)2011年基线数据,纳入10420名45岁及以上的中老年人,收集研究对象的人口学资料、生活习惯和慢性病患病情况。抑郁症状采用10条目的流调中心抑郁量表(10-item version of center for epidemiological studied depression,CESD-10)测量,CESD-10评分≥10定义为有抑郁症状。采用多因素Logistic回归模型分析抑郁症状和慢性病的关联。结果:纳入的10420名研究对象的平均年龄为(59.2±9.4)岁,48.2%为男性,其中3900名(37.4%)中老年人有抑郁症状。多因素Logistic回归分析结果显示,在调整所有潜在混杂因素以后,抑郁症状和糖尿病(OR=1.230,95%CI:1.080~1.401)、高血压(OR=1.335,95%CI:1.205~1.480)、心脏病(OR=1.953,95%CI:1.711~2.229)、脑卒中(OR=2.269,95%CI:1.704~3.020)均有关联(P<0.05),而未发现血脂异常和抑郁症状之间存在显著关联(P>0.05),随着共患慢性病数量的增加,抑郁症状的患病率也随之升高(P trend<0.001)。结论:我国中老年人抑郁症状和慢性病有关联,未来需要在前瞻性研究中进一步探究二者是否有因果关系。

福建客家老年人慢性病患病现状调查:主要人口学特征的差异

目的探讨福建客家老年人慢性病患病现状及主要人口学特征的差异。方法采用方便抽样法对福建省宁化县的客家老年人(≥60岁)进行问卷调查,调查内容包括一般人口学特征和老年人慢性病患病情况。采用SPSS 25.0软件进行χ2检验和二元logistic回归分析。结果共有1262人纳入最终分析样本,福建客家老年人整体慢性病的患病率为52.54%(663/1262),慢性病共病的患病率为21.79%(275/1262)。慢性病患病率较高的人群主要有超重(OR=2.29)、肥胖(OR=2.16)、家庭人均年收入为15001~30000元(OR=1.61)等人群,慢性病共病患病率较高的人群主要有超重(OR=3.81)、肥胖(OR=4.99)、丧偶(OR=1.63)等人群。慢性病患病率较低的人群主要有受教育水平为小学及以上(小学OR=0.50,初中及以上OR=0.57)、仅与老伴同住(OR=0.41)、与单个子/女同住(OR=0.42)等人群。结论福建客家老年人慢性病和慢性病共病的患病率高,超重、肥胖、未受过教育、独居等老年人的患病状况尤为突出。政府、社会、家庭应重点关注以上人群,采取针对性的慢性病控制与管理措施,提高客家老年人整体生活质量。

基于老龄化导向的社区慢病管理实践现状及思考

在社会高质量发展的时代背景下,人口老龄化形势日益严峻,居民主动健康意识不断提升,各国针对老年人群日益增长的慢病服务需求提出不同形式的管理模式,但我国老龄慢病管理还处于初步探索阶段,建设经验尚且不足。基于此,文章以国外实践经验为参考,从多方面归纳分析老龄化背景下国内慢病管理服务现状,发现当前国内老龄慢病管理以社区工作为主,以医养护一体化、中西医结合、智慧健康养老三个方面为主要服务内容,在配套政策、社区健康服务能力与建设、人群主动健康意识等方面存在不足,需要从医保医药、卫生人才建设、社区绩效考核机制、信息平台建设与健康教育等方面完善慢病服务体系,提升健康管理质量。

流动老年慢病患者健康管理服务利用现状及影响因素研究——基于城乡差异的比较分析

目的本研究对中国流动老年慢性病患者健康管理服务利用现状及影响因素进行系统分析并比较城乡差异,以期为实现基本公共卫生服务均等化、提升流动老年慢病患者生活质量和健康水平提供对策建议。方法利用2017年中国流动人口动态监测调查数据,以60岁及以上患有医生确诊慢性病的流动老年人为研究对象,在社会生态理论的指导下,采用二元logistic回归模型分析整体、农村以及城镇地区流动老年慢病患者利用健康管理服务的影响因素。结果在2158名流动老年慢病患者中,健康管理服务利用率为46.6%,农村地区利用率为47.2%、城镇地区利用率为45.9%。二元logistic回归结果显示性别、年龄、自评健康状况、两周内就诊情况、家庭月收入、是否听说过国家基本公卫项目、流动范围、流动时间、流入地区域对流动老年慢病患者利用健康管理服务产生影响(P<0.05)。结论我国流动老年慢病患者健康管理服务利用率较低,服务利用会受到个人特征、个体行为、人际层次、社会环境、流动特征等多维因素的影响,并且城乡之间存在一定差异性。

2016-2018年上海市慢性肾脏病高风险人群流行病学调查

目的 基于2016-2018年上海市静安、闵行两区的社区卫生服务中心慢性肾脏病(chronic kidney disease,CKD)高风险人群筛查数据,分析CKD高风险人群的流行病学特征。方法 收集上海市静安、闵行两区的社区卫生服务中心CKD高风险人群的筛查资料,比较不同性别、年龄、疾病史的高风险人群CKD检出率的差异并进行影响因素分析。结果 社区慢性肾脏病高风险人群CKD检出率为14.71%,早期CKD患者(1期、2期)占多数(84.57%);女性高风险人群CKD检出率高于男性(χ^(2)=202.158,P<0.01),老年人群CKD检出率高于非老年(χ^(2)=16.294,P <0.01);筛查对象病史情况复杂,具有高血压病史的人群数量最多(61.77%),高血压者CKD检出率高于未患高血压者(χ^(2)=67.837,P<0.01),未患糖尿病者CKD检出率高于患有糖尿病者(χ^(2)=13.978,P<0.01);具有4种风险因素的高风险人群有392例,检出CKD患者84例(21.43%),检出率最高。结论 性别、年龄、高血压和糖尿病是CKD患病的影响因素,女性人群CKD检出率较高,年龄越大、患有高血压但未患有糖尿病的人群CKD的检出率越高。

河南省老年人患慢性病与社会参与能力的相关性

目的:分析河南省老年人患慢性病与社会参与能力的相关性。方法:于2019年采用多阶段分层整群抽样法抽取河南省18个市的60岁及以上老年人进行现场访谈式问卷调查。使用一般资料调查表收集老年人患慢性病情况,通过《老年人能力评估标准:MZ/T 039-2013》对其社会参与能力进行评估。采用二分类Logistic回归模型分析患慢性病对老年人社会参与能力的影响。结果:河南省老年人的社会参与能力受损检出率为20.18%(1123/5565)。患有慢性病的老年人社会参与能力受损检出率28.24%(844/2989),高于未患慢性病者[10.83%(279/2576)]。Logistic回归分析显示老年人高血压、糖尿病、冠心病、慢性阻塞性肺疾病(慢阻肺)、其他慢性病、高血压+冠心病、高血压+糖尿病、冠心病+糖尿病、高血压+慢阻肺及高血压+冠心病+糖尿病与社会参与能力受损有关联;与未患慢性病的老年人相比,患1种或多种慢性病组合共病会增加社会参与能力受损的危险性。结论:河南省老年人患慢性病与社会参与能力受损相关,患慢性病以及多种慢性病情况会增加老年人社会参与能力受损的风险。

慢性病高危风险因素与中医体质的相关性研究

目的探究慢性病高危因素人群的中医体质分布情况,以期通过调理中医体质预防慢性病的发生。方法针对当地群众的一般人口学特征、一般检查资料、慢性病高危风险因素及中医体质情况,采用横断面研究方法共收集1018份有效数据,并采用SpssStistics 20.0软件进行频数统计分析和卡方检验分析。结果经统计分析发现,具有高血压高危因素的人群居多,约占总数的66.9%,而具有糖尿病及肿瘤高危因素的人群则分别占总数的39.9%、36.0%。中医体质分布中则以平和质、阳虚质、痰湿质人群居多,分别占30.5%、22.8%、14.7%,且经卡方检验分析验证,慢病高危人群及9种体质在不同年龄段人群的分布构成比较,差异有统计学意义(P<0.05)。无高危因素人群中的平和质占比明显高于有高危因素人群,差异有统计学意义(P<0.05),湿热质及气郁质占比则明显低于高危因素人群,差异有统计学意义(P<0.05)。高血压高危人群中以痰湿质居多,占总数的8.1%;糖尿病高危人群多倾向于阳虚质及阴虚质,分别占总数的2.8%及2.1%,而肿瘤高危人群则以阳虚质多见,占总数的4.5%。结论综合各项分析结果,高血压高危人群倾向于痰湿质;糖尿病高危人群倾向于阴虚质及阳虚质;肿瘤高危人群倾向于阳虚质。