衰弱对住院老年冠心病患者短期预后的影响:前瞻性队列研究

目的探讨衰弱对住院老年冠心病患者短期预后的影响。方法前瞻性收集并分析2017年12月至2018年11月在北京协和医院住院治疗的老年冠心病患者临床资料。根据是否合并衰弱,将患者分为衰弱组和非衰弱组。对两组患者随访,终点事件包括非常规就诊、主要不良心脑血管事件(major adverse cardiac and cerebral events,MACCE)、全因死亡。采用多因素Cox回归分析衰弱与冠心病患者预后的关系。绘制两组无MACCE的Kaplan-Meier生存曲线,并采用Log-Rank检验进行比较。结果共345例符合纳入和排除标准的老年冠心病患者入选本研究,包括稳定性冠心病250例,急性冠状动脉综合征95例。衰弱组74例(21.4%),其中轻度衰弱38例、中度衰弱36例,非衰弱组271例(78.6%)。中位随访时间351(300, 394)d,失访3例。与非衰弱组比较,衰弱组非常规就诊发生率(36.1%比21.5%)、全因死亡率(11.1%比4.1%)均升高(P均<0.05),MACCE发生率(9.7%比4.8%)无显著差异(P>0.05)。多因素Cox回归分析结果显示,轻度和中度衰弱是稳定性冠心病患者全因死亡的危险因素(HR=4.169,95%CI:1.055～16.474,P=0.042),对其非常规就诊(HR=1.704,95%CI:0.947～3.066,P=0.075)、MACCE(HR=1.268,95%CI:0.331～4.863,P=0.729)无显著影响。在急性冠状动脉综合征患者中,轻度和中度衰弱对其非常规就诊(HR=1.159,95%CI:0.342～3.924,P=0.812)、MACCE(HR=0.822,95%CI:0.092～7.369,P=0.861)及全因死亡(HR=1.445,95%CI:0.210～9.964,P=0.708)均无显著影响。Kaplan-Meier生存曲线显示,衰弱组和非衰弱组患者的无MACCE生存曲线无显著差异(P>0.05)。结论住院老年冠心病患者合并轻中度衰弱的比率较高,其可能增加稳定性冠心病患者近期死亡风险。     

Studies of water quality and cardiovascular disease in the United Kingdom

The British Regional Heart Study aims at determining factors responsible forthe marked regional variations in cardiovascular disease in Great Britain.PHASE I is a retrospective study of cardiovascular mortality with water quality(hardness and more than 20 other water parameters have been studied), climate, air pollution, socio-economic and genetic factors. An association between water hardness and cardiovascular mortality is reaffirmed, towns with soft water tending to have higher death rates than towns with hard water. This relationship is somewhat weakened after allowing for climatic and socio-economic factors but remains statistically significant for both coronary heart disease and stroke. After adjustment for other factors, soft water areas (around 0.25 mmol/1) have a 10–15% higher cardiovascular mortality than areas of medium hardness (around 1.70 mmol/1) whereas any further increase beyond 1.70 mmol/1 has little extra lowering effect on cardiovascular mortality.PHASE II and III are cross-sectional and prospective surveys of over 7500 middle-agedmen from 25 towns which will further explore these geographic variations.     

The effect of various temperature indicators on different mortality categories in a subtropical city of Brisbane, Australia

Background

The relationship between temperature and mortality has been explored for decades and many temperature indicators have been applied separately. However, few data are available to show how the effects of different temperature indicators on different mortality categories, particularly in a typical subtropical climate.

Objective

To assess the associations between various temperature indicators and different mortality categories in Brisbane, Australia during 1996-2004.

Methods

We applied two methods to assess the threshold and temperature indicator for each age and death groups: mean temperature and the threshold assessed from all cause mortality was used for all mortality categories; the specific temperature indicator and the threshold for each mortality category were identified separately according to the minimisation of AIC. We conducted polynomial distributed lag non-linear model to identify effect estimates in mortality with one degree of temperature increase (or decrease) above (or below) the threshold on current days and lagged effects using both methods.

Results

Akaike's Information Criterion was minimized when mean temperature was used for all non-external deaths and deaths from 75 to 84 years; when minimum temperature was used for deaths from 0 to 64 years, 65-74 years, ≥ 85 years, and from the respiratory diseases; when maximum temperature was used for deaths from cardiovascular diseases. The effect estimates using certain temperature indicators were similar as mean temperature both for current day and lag effects.

Conclusion

Different age groups and death categories were sensitive to different temperature indicators. However, the effect estimates from certain temperature indicators did not significantly differ from those of mean temperature.     

Mortality associated with exposure to carbon monoxide in WHO European Member States

In closed environments, the concentration of carbon monoxide (CO) can easily rise to health‐threatening levels. CO‐related incidents are often caused by poor condition or inappropriate use of indoor combustion devices as well as structure fires but are also due to suicides. To evaluate the incidence of CO poisoning in Europe, national data on CO‐related mortality and morbidity were compiled from Member States of the WHO European Region using a standardized data collection form. National data on CO poisoning were provided by 28 Member States. Within the maximum reporting period (1980–2008), a total of 140 490 CO‐related deaths were reported (annual death rate of 2.2/100 000). The number of hospital admissions available from six countries was 31 473. Unintentional CO deaths accounted for 54.7% of the CO‐related deaths (35.9%: unintentional inhalation; 18.8%: related to structure fires). The intentional deaths related to CO exposure account for 38.6% of all CO‐related deaths (38.1%: suicides; 0.5%: homicides). CO exposure is preventable but causes a substantial amount of deaths in many European countries. More efficient measures and policies to prevent CO poisoning and better reporting of CO mortality are necessary.     

慢性肾脏病4-5期非透析患者死亡的危险因素分析

目的 探讨慢性肾脏病（CKD）4-5期非透析患者死亡的主要原因、临床特点及其危险因素.方法 收集萍乡市人民医院2010年5月至2013年5月201例CKD4-5期非透析患者的一般资料,其中CKD4期125例,CKD5期76例.对CKD4-5期非透析患者死亡的危险因素进行多因素Logistic回归分析.结果 201例患者中,死亡69例（34.3%）,其中CKD4期31例,CKD5期38例.主要死亡原因：心血管疾病21例（30.4%）,脑血管疾病18例（26.1%）,感染16例（23.2%）,其他14例（20.3%）.多因素Logistic回归分析结果显示,低肾小球滤过率（eGFR,OR=0.206,P=0.029）、高C反应蛋白（CRP,OR=3.624,P=0.017）、高血尿酸（OR=2.158,P=0.018）、低白蛋白（OR=0.509,P=0.032）及高血磷（OR=1.479,P=0.021）均为CKD4-5期非透析患者死亡的危险因素.结论 CKD4-5期非透析患者病死率较高,心血管疾病是最常见的死因,低eGFR、高CRP、高血尿酸、低白蛋白水平及高磷血症是患者死亡的独立危险因素.     

Exposure-response functions for health effects of ambient air pollution applicable for China -- a meta-analysis

Assessing the benefits of projects and policies to reduce air pollution requires quantitative knowledge about the relationship between exposure to air pollution and public health. This article proposes exposure-response functions for health effects of PM10 and SO2 pollution in China. The functions are based on Chinese epidemiological studies, and cover mortality, hospital admissions, and chronic respiratory symptoms and diseases. We derive the following coefficients for acute effects: a 0.03% (S.E. 0.01) and a 0.04% (S.E. 0.01) increase in all-cause mortality per microg/m3 PM10 and SO2, respectively, a 0.04% (S.E. 0.01) increase in cardiovascular deaths per microg/m3 for both PM10 and SO2, and a 0.06% (S.E. 0.02) and a 0.10% (S.E. 0.02) increase in respiratory deaths per microg/m3 PM10 and SO2, respectively. For hospital admissions due to cardiovascular diseases the obtained coefficients are 0.07% (S.E. 0.02) and 0.19% (S.E. 0.03) for PM10 and SO2, respectively, whereas the coefficients for hospital admissions due to respiratory diseases are 0.12% (S.E. 0.02) and 0.15% (S.E. 0.03) for PM10 and SO2, respectively. Exposure-response functions for the impact of long-term PM10 levels on the prevalence of chronic respiratory symptoms and diseases are derived from the results of cross-sectional questionnaire surveys, and indicate a 0.31% (S.E. 0.01) increase per microg/m3 in adults and 0.44% (S.E. 0.02) per microg/m3 in children. With some exceptions, Chinese studies report somewhat lower exposure-response coefficients as compared to studies in Europe and USA.     

南昌市东湖区社区居民主要健康问题及影响因素现状

目的了解南昌市东湖区社区居民的健康状况及其危险因素,为制定社区居民健康维护计划及慢性病管理提供依据。方法以南昌市东湖区所辖街道、居委会为抽样单位,采用分层整群抽样方法,随机抽取了2 766户家庭,共调查8 554例居民,8 463例有效样本人群,通过面对面询问方式调查了居民的主要健康问题,并对资料进行统计分析。结果社区居民2周患病率为10.20%,疾病谱前5位为：感冒、高血压、关节炎、糖尿病及冠心病。慢性病患病率为24.67%,慢性病疾病谱前5位为：高血压、糖尿病、冠心病、慢性胃炎及关节炎。影响因素：≥18岁吸烟率为24.41%、饮酒率为15.15%、体质量超标率为25.90%（超质量21.66%,肥胖4.24%）、经常感到紧张者30.7%、3餐不规律者5.8%、饮食口味重者33.64%和体育锻炼性质以低强度为主占70.43%。结论居民的主要健康问题是慢性病患病率较高,以高血压、糖尿病、冠心病为主。恶性肿瘤成为主要的死亡问题。控制体质量、戒烟、限酒、限盐及调节压力应作为社区卫生服务工作计划的核心,以提高社区居民的健康水平。     

Sub-micrometer particulate air pollution and cardiovascular mortality in Beijing, China

Background

While the link between particulate matter and cardiovascular mortality is well established, it is not fully investigated and understood which properties of the aerosol might be responsible for the health effects, especially in polluted mega-city areas.

Objectives

Our goal was to explore the association between daily cardiovascular mortality and different particle metrics in the sub-micrometer range in Beijing, China.

Methods

We obtained daily counts of cause-specific cardiovascular deaths in the Beijing urban area for the period March 2004 to August 2005. Concurrently, continuous measurements of particle number size distributions were performed. Particle number concentrations (NC) between 0.003 μm and 0.8 μm were converted to particle mass and surface area concentrations assuming spherical particles. Semi-parametric Poisson regression models adjusting for trend, seasonality, day of the week, and meteorology were used to estimate immediate, delayed and cumulative particle effects. Additionally, effect modification by air mass origin was investigated.

Results

We observed associations between daily cardiovascular mortality and particle NC for a 2-days delay. Moreover, nearly all particle metrics showed 2-days delayed associations with ischemic heart disease mortality. The strongest association was found for particle NC in the size range 0.03-0.1 μm (7.1% increase in daily mortality with a 95%-confidence interval of 2.9%-11.5%, per an increase of 6250 particles/cm³). Results for surface and mass concentrations with a lag of two days indicated effect modification by air mass origin, whereas effects of particle NC were not modified.

Conclusions

Results show an elevated risk of cardiovascular mortality in Beijing from short-term exposure to particulate air pollution in the sub-micrometer range. Results also indicate that locally produced smaller particles and regionally transported particles may exhibit different effects in Beijing.     

Ambient sulfate concentration and chronic disease mortality in Beijing

In this study, ecological analysis was used to assess the relationship between ambient air pollution and human mortality. All the data on environmental measures and related factors, population size and number of deaths were collected for the city of Beijing, PR China and its eight districts for the years 1980-1992. In this study the concentration of SO(4)2- was selected as a main indicator of environmental pollution for the following reasons: (i) SO(4)2- data are available to cover all urban and suburban areas in Beijing compared with other air pollutants during the study period; (ii) SO(4)2- levels indicate the concentration of sulfide (include sulfate) and acid fog in the air, and they are significantly lower in cleaner districts than in others; and (iii) analyses showed that SO(4)2- levels are significantly correlated with daily mean concentrations of sulfur dioxide and nitrogen oxide, annual coal combustion, number of households using gas fuel, counts of motor vehicles and population density. Age-standardised mortality rates due to specific diseases were calculated using the Chinese population census data in 1990. Statistically significant correlations were observed between SO(4)2- concentration and total mortality and mortality due to cardiovascular disease, malignant tumour and lung cancer (r > 0.50 in all cases). The correlations were not only found between the current SO(4)2- concentration and these mortalities, but also for SO(4)2- levels measured up to 12 years prior to death, which may suggest long-term effects of air pollution. No significant correlations were observed for mortality from respiratory diseases and cerebrovascular diseases (r = 0.30-0.50). This study indicates that the concentration of SO(4)2- in air is a useful air pollution indicator in the areas where coal is used as the main source of energy. Areas with high levels of SO(4)2- experienced higher mortality due to a variety of chronic diseases.     

Short term effects of air pollution on hospitalizations for cardiovascular diseases in eight French cities: the PSAS program

INTRODUCTION: Short term associations between air pollution indicators and hospitalizations for cardiovascular diseases have been suggested by epidemiological and clinical studies. The present study aims at estimating the association between particles with diameter <10 microm (PM(10)), nitrogen dioxide (NO(2)) and ozone and hospitalizations for cardiovascular diseases in eight French cities during the 1998-2003 period. METHODS: The daily number of hospitalizations in each city was extracted from the French hospital information system (PMSI) for cardiovascular diseases, cardiac diseases, ischemic heart diseases and stroke. Excess relative risks (ERRs) of hospitalization associated with a 10 microg/m(3) increase in pollutant levels were estimated in each city by fitting a Poisson regression model, controlling for well-known confounding factors and temporal trends. City-specific results were then combined by inverse variance weighting. RESULTS: Daily number of hospitalizations for cardiovascular diseases was associated with PM(10) levels (for a 10 microg/m(3) increase, ERR=0.8%, 95% CI: [0.2, 1.5]), with NO(2) (1.1%, [0.6, 1.6]) but not with ozone (0.1% [-0.2%, 0.5%]). Associations were stronger in people aged 65 years and over, and when only hospitalizations for ischemic heart diseases were considered. No association was found between strokes and air pollution levels. DISCUSSION: Our study suggests that the ambient levels of air pollutants currently experienced in the eight French cities, which are close to European air quality guidelines, are yet linked to a short term increase of hospitalizations for cardiovascular diseases. These results are consistent with epidemiological and toxicological data on the cardiovascular effects of air pollution.     

Visibility, air quality and daily mortality in Shanghai, China

This study was designed to assess the association between visibility and air quality, and to determine whether the variations in daily mortality were associated with fluctuations in visibility levels in Shanghai, China. Mortality data were extracted from the death certificates, provided by Shanghai Municipal Center of Disease Control and Prevention, and visibility data were obtained from Shanghai Municipal Bureau of Meteorology. Air quality data (PM₁₀, PM_2.5, PM_10-2.5, SO₂, NO₂ and O₃) were obtained from Shanghai Environmental Monitoring Center. Generalized additive model (GAM) with penalized splines was used to analyze the mortality, visibility, air pollution, and covariate data. Among various pollutants, PM_2.5 showed strongest correlation with visibility. Visibility, together with humidity, was found appropriate in predicting PM_2.5 (R-squared: 0.64) and PM₁₀ (R-squared: 0.62). Decreased visibility was significantly associated with elevated death rates from all causes and from cardiovascular disease in Shanghai; one inter-quartile range (8 km) decrease in visibility corresponded to 2.17% (95%CI: 0.46%, 3.85%), 3.36% (95%CI: 0.96%, 5.70%), and 3.02% (95%CI: − 1.32%, 7.17%) increase of total, cardiovascular and respiratory mortality, respectively. The effect estimates using predicted PM_2.5 and PM₁₀ concentrations were similar to those assessed using actual concentrations. This is the first study in Mainland China assessing the association between visibility and adverse health outcomes. Our findings suggest the possibility of using visibility as a surrogate of air quality in health research in developing countries where air pollution data might be scarce and not routinely monitored.     

A retrospective cohort study of trihalomethane exposure through drinking water and cancer mortality in northern Italy

A few epidemiologic studies have suggested that consumption of drinking water with high trihalomethane content increases the risk of cancer. We investigated the mortality of a cohort of 5144 residents in Guastalla, northern Italy, who were supplied tap water with high chloroform and trihalomethane content between 1965 and 1987. Using death rates of a nearby community as reference rates, the standardized mortality ratio from all cancers between 1987 and 1999 was slightly increased for both males (1.2, 95% confidence interval 1.1-1.4) and females (1.1, 95% confidence interval 1.0-1.3). This was mainly due to a higher mortality from stomach, liver, lung, prostate and bladder cancer in males and from stomach, pancreas, breast and ovarian cancer and lymphocytic leukemia in females. We also noted excess mortality from melanoma in both males and females. Overall, our findings were consistent with an association between trihalomethane exposure and increased cancer risk at some sites. However, the point estimates were statistically imprecise, due to the limited number of deaths for some site-specific cancers. In addition, we were unable to rule out the possibility of confounding due to smoking and other life-style factors with regard to some of the excess rates.     

Short-term effect of fine particulate matter (PM2.5) on daily mortality due to diseases of the circulatory system in Madrid (Spain)

Introduction

Owing to their small size, fine particles, i.e., those having a diameter ≤ 2.5 μm (PM_2.5), have a high alveolar penetration capacity, thereby triggering a local inflammatory process with circulatory repercussion. Despite being linked to respiratory and cardiovascular morbidities, there is limited evidence of an association between this type of particulate matter and short-term increases in mortality.

Objective

The aim of this study was to analyse and quantify the short-term impact of PM_2.5 on daily mortality due to diseases of the circulatory system, registered in Madrid from 1 January 2003 to 31 December 2005.

Methods

An ecological longitudinal time-series study was conducted, with risks being quantified by means of Poisson regression models. As a dependent variable, we took daily mortality registered in Madrid from 1 January 2003 to 31 December 2005, attributed to all diseases of the circulatory system as classified under heads I00-I99 of the International Classification of Diseases-10th revision (ICD-10) and broken down as follows: I21, acute myocardial infarction (AMI); I20, I22-I25, other ischemic heart diseases; and I60-I69, cerebrovascular diseases. The independent variable was daily mean PM_2.5 concentration. The other variables controlled for were: chemical pollution (PM₁₀, O₃, SO₂, NO₂ and NO_x); acoustic and biotic pollution; influenza; minimum and maximum temperatures; seasonalities; trend; and autocorrelation of the series.

Results

A linear relationship was observed between PM_2.5 levels and mortality due to diseases of the circulatory system. For every increase of 10 μg/m³ in daily mean PM_2.5 concentration, the relative risks (RR) were as follows: for overall circulatory mortality, associations were established at lags 2 and 6, with RR of 1.022 (1.005-1.039) and 1.025 (1.007-1.043) respectively; and for AMI mortality, there was an association at lag 6, with an RR of 1.066 (1.032-1.100). The corresponding attributable risks percent (AR%) were 2.16%, 2.47% and 6.21% respectively. No statistically significant association was found with other ischemic heart diseases or with cerebrovascular diseases.

Conclusion

PM_2.5 concentrations are an important risk factor for daily circulatory-cause mortality in Madrid. From a public health point of view, the planning and implementation of specific measures targeted at reducing these levels constitute a pressing need.     

Chromium, cobalt and lanthanum in lung, liver and kidney tissue from deceased smelter workers

Lung, liver and kidney tissue concentrations of chromium, cobalt and lanthanum from 66 deceased copper smelter workers have been compared with 14 controls. Samples were taken in connection with ordinary autopsies at the local hospital. Neutron activation analysis was used. The mean exposure time for the smelter workers was 30 y, the mean time to date of death after termination of exposure was 7.4 y. A four-fold increase of chromium (p = 0.001) and a two-fold increase of cobalt (p less than 0.001) and lanthanum (p = 0.013) in lung tissue was found for smelter workers compared to controls. Of the smelters nearly one third died from malignancies (approximately 10% from respiratory cancer) and approximately 45% from cardiovascular disease. In the control group nearly 80% died from cardiovascular diseases and no malignancies were found. In lung tissues the concentration of chromium, cobalt and lanthanum did not decline with time after exposure had ended, indicating a long biological half-time. The causes of death could not be related to a single factor. The findings indicate a multifactorial genesis.     

Traffic-related air pollution and cardiovascular mortality in central Taiwan

In this study, the relationship between cardiovascular mortality and traffic-related air pollutants (NO₂, CO, PM₁₀, and six volatile organic compounds (VOCs), propane, iso-butane, propylene, benzene, meta-, para-, and ortho-xylenes) was investigated. The concentrations of NO₂, PM₁₀ and CO from 1993 to 2006 were measured at a fixed-site air monitoring station, and VOC data from 2003 to 2006 were obtained from a photochemical assessment monitoring site in an urban area in central Taiwan. Outcome variables were data on mortality due to cardiovascular diseases (ICD-9-CM 410-411, 414, 430-437) from 1993 to 2006. Cardiovascular mortality averaged 1.5 cases, ranging between 0 and 9 cases per day. Daily air pollution levels ranged from 0.5 to 80.5 ppb for NO₂ and from 0.1 to 3.8 ppm for CO. From the subset of data from 2003 to 2006, daily average values ranged from 0.6 to 17.5 ppb for propane, 0.3 to 6.7 ppb for iso-butane, 0.3 to 6.7 ppb for propylene, 0.2 to 3.8 ppb for benzene, 0.3 to 26.0 ppb for m,p-xylene, and 0.02 to 7.6 ppb for o-xylene. Poisson generalized additive model was used to estimate the effects of elevated air pollutant levels on daily mortality, adjusting for meteorological conditions and temporal trends. Single-pollutant model showed that cardiovascular mortality was significantly associated with NO₂ lagged 2 days, and with propane, iso-butane, and benzene lagged 0 day. The relative risk for an interquartile range increase in air pollutant levels was 1.053 for NO₂, 1.064 for propane, 1.055 for iso-butane, and 1.055 for benzene. In conclusion, daily cardiovascular mortality showed association with data on acute exposure to traffic air pollutants in Taichung, which is an important factor to consider in studying cardiovascular mortality in urban environments.     

Exposure to Environmental Tobacco Smoke and Female Lung Cancer

A registry-based case-control study, involving 120 cases (28 males, 92 females) of lung cancer deaths, was conducted in 1985 in the city of Guangzhou to investigate whether lifestyle factors are associated with an increased incidence of lung cancer in never-smoking individuals. The cases were matched with two control groups which consisted of non-respiratory-disease-related deaths or non-respiratory-related cancer deaths. Lifestyle factors assessed in the study include: personal history of nonmalignant respiratory diseases, practice of fresh vegetable consumption, lifetime occupation and occupational exposure histories, exposure to ETS, degree of indoor air pollution, general conditions of home residence, cooking practices and environments, and family history of cancer. Conditional logistic regression analysis demonstrated a negative association between fresh vegetable consumption and lung cancer risk in both sexes, suggesting that vegetables may exert a “protective” effect against lung cancer in humans. In males, elevated risks were found between lung cancer and occupational exposure. In females, indoor air pollution and kitchen environment were associated with risk of lung cancer. No statistically significant association was observed between lung cancer and all other factors examined, including exposure to ETS. A second case-control study was performed in 1986 to investigate the possible association between spousal smoking and lung cancer deaths. Cases consisted of 75 never-smoking females and the two control groups consisted of 128 cases of deaths due to non-tumor diseases, and 126 cases of deaths due to tumors except lung cancer. When cases were matched against “death-unrelated-to-tumor” controls, the odds ratio [OR] for ETS exposure was 1.19, as gauged by whether or not there was ETS exposure; 0.72 and 1.62, when ETS was assessed based on exposure to less than 20 or to 20 or more cigarettes/day. When ETS exposure was measured by “smokingyears”, ORs of 1.39 and 1.17 were obtained based on less than or equal to 30 years of exposure, respectively. Matching cases against “tumor-other-than-lung cancer” controls show the following: OR was 1.00 based or whether or not there was ETS exposure, 0.62 and 1.36, based on exposure to less than 20 or to 20 or more cigarettes/day, and 1.13 and 0.99, based on less than or equal to 30 years of exposure. In all cases, Ors and the calculated 95% confidence interval [CI] indices show that ETS exposure was not significantly associated with female lung cancer deaths, P>0.05. In summary, both case-control studies suggest no statistically significant association between exposure to ETS and female lung cancer in this Chinese population.     

腰身指数联合血尿酸检测对冠心病严重程度的预测价值

目的探讨冠心病患者腰身指数（WHtR）、血尿酸（UA）与冠状动脉病变程度的关系,为冠心病的预防及治疗提供根据和研究材料。方法对650例拟诊为冠心病且行冠状动脉造影患者进行身高、腰围、WHtR、血压及血UA的测定。根据冠状动脉造影的诊断结果将650例患者分为单支病变组（单支组,134例）、2支病变组（2支组,174例）、3支病变组（3支组,127例）和正常组（215例）。按照WHtR及血UA值分为WHtR〉0.5组、WHtR≤0.5组及尿酸≥420μmol·L-1组、尿酸〈420μmol·L-1组。根据冠状动脉病变程度计算冠状动脉Gensini积分。结果单因素分析结果：各组年龄、WHtR、腰围、肱动脉SBP、肱动脉DBP、CHOL（胆固醇）、血UA、GLU（血糖）、LDL（低密度脂蛋白）、吸烟史、糖尿病史、高血压史等比较差异均有统计学意义（均P〈0.01）。多元直线逐步回归分析结果：将Gensini积分行平方根转化后作为因变量,以单因素分析后挑选出P〈0.05的变量作为自变量,行多元直线逐步回归分析,结果表明在排除多种因素的相互影响后,WHtR、血清UA、LDL、吸烟史、糖尿病史、高血压史对冠状动脉的病变程度有独立的预测价值（P〈0.001或P〈0.05）。各组间Gensini积分比较结果表明,随着WHtR和血UA水平的升高,Gensini积分也逐渐升高,即冠状动脉病变程度也逐渐加重（P〈0.01）。结论WHtR结合血UA检测可以很好地预测冠心病患者冠状动脉病变程度。     

成人法洛四联症的外科治疗

目的总结成人法洛四联症的外科治疗经验。方法自1999年6月至2009年6月共收治了161例14周岁以上的法洛四联症患者,均在全身麻醉低温体外循环下进行了外科手术治疗。其中153例行法洛四联症根治术,8例行姑息手术。结果全组死亡4例,死亡率2.48%。死于术后低心排综合征2例,术后灌注肺1例,急性肾功能衰竭1例。2次气管插管13例（8.07%）,2例术后复查心脏彩超发现室缺残余瘘。无再次开胸止血。随访139例,6~93个月,无远期死亡。结论成人法洛四联症病情复杂,外科手术治疗并发症发生率偏高,但注意在术前改善症状,术中满意矫治心脏畸形和术后积极防治并发症,远期疗效良好。     

Is the association between temperature and mortality modified by age, gender and socio-economic status?

Background

A number of studies have examined the relationship between high ambient temperature and mortality. Recently, concern has arisen about whether this relationship is modified by socio-demographic factors. However, data for this type of study is relatively scarce in subtropical/tropical regions where people are well accustomed to warm temperatures.

Objective

To investigate whether the relationship between daily mean temperature and daily all-cause mortality is modified by age, gender and socio-economic status (SES) in Brisbane, Australia.

Methods

We obtained daily mean temperature and all-cause mortality data for Brisbane, Australia during 1996-2004. A generalised additive model was fitted to assess the percentage increase in all deaths with every one degree increment above the threshold temperature. Different age, gender and SES groups were included in the model as categorical variables and their modification effects were estimated separately.

Results

A total of 53,316 non-external deaths were included during the study period. There was a clear increasing trend in the harmful effect of high temperature on mortality with age. The effect estimate among women was more than 20 times that among men. We did not find an SES effect on the percent increase associated with temperature.

Conclusions

The effects of high temperature on all deaths were modified by age and gender but not by SES in Brisbane, Australia.     

Short-term impact of particulate matter (PM2.5) on daily mortality among the over-75 age group in Madrid (Spain)

Background

The 2006 World Health Organization Air Quality Guidelines recommend using particulate matter having a diameter of under 2.5 micra (PM_2.5) rather than PM₁₀ as an indicator of air particle concentration, a pattern followed by new European directives. Nevertheless, few studies have analysed this new indicator's impact at a European level on daily mortality among a high-risk group, such as persons aged over 75 years.

Objective

This study sought to analyse and quantify the effect of PM_2.5 on daily cause-specific mortality among the over-75 age group in the city of Madrid.

Methods

Using Poisson regression with Generalized Additive Models (GAM), a longitudinal, ecological time-series study examined the following causes of death: all causes except accidents (International Classification of Diseases-9th revision (ICD 9): 1-799); circulatory causes (ICD 9: 390-459); and respiratory causes (ICD 9: 460-519). These were adjusted for other chemical, biotic and acoustic pollutants. Further control variables considered were: trend; seasonality; influenza epidemics; and autocorrelation between mortality series.

Results

A significant statistical association was detected between daily mean PM_2.5 particle concentrations and all-cause mortality in the city of Madrid. This association was not in evidence for PM₁₀ concentrations. The Relative Risks found for an increase of 25 µg/m³ in PM_2.5 concentrations were as follows: all-cause mortality, 1.057 (1.025-1.088); circulatory-cause mortality, 1.088 (1.041-1.135); and respiratory-cause mortality, 1.122 (1.056-1.189). The Attributable Risks were 5.41%, 8.12% and 10.90% respectively. This effect was observed in the short term (lags 1-2).

Conclusion

Our results indicate a strong impact of PM_2.5 concentrations on daily mortality among the over-75 age group in Madrid, and underscore the need for measures aimed at lowering the concentration levels of this primary air pollutant in large cities, particularly by reducing motor vehicle traffic, the main source of such pollutant emission in urban atmospheres.