中华疾病控制杂志

Research progress of occupational health and occupational disease in China

DAI Yu-fei, ZHENG Yu-xin

2022, 26(8): 869-875. doi: 10.16462/j.cnki.zhjbkz.2022.08.001

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Recently, research about occupational health and occupational disease in China has made great progress in the etiology, pathogenesis, susceptibility biomarkers and risk assessment of occupational diseases, which are focused on occupational exposure, and have greatly made up for those deficiencies in China and even worldwide. At present, our country is in a stage of rapid development, and a large number of new and innovative technologies are applied in various fields to make great changes in the industrial structure, production methods and production technologies in China. Notably, the rapid development of new fields has posed new challenges to occupational health, namely the reduction of occupational health problems caused by traditional occupational harmful factors and the emergence of new problems. Occupational health and occupational medicine also urgently need to apply new concepts and technologies of medical science to establish a new health risk assessment, and then meet the needs of occupational health monitoring and the diagnosis and treatment of occupational diseases.

Study on the burden of coal workers' pneumoconiosis in China from 1990 to 2019

HUANG Xue-zan, WANG Dong-ming, LIANG Ru-yi, DONG Chao-qian, ZHANG Ying-die, CHEN Wei-hong

2022, 26(8): 876-881. doi: 10.16462/j.cnki.zhjbkz.2022.08.002

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Objective To analyze the level of disease burden and temporal trend of coal workers' pneumoconiosis (CWP) in China from 1990 to 2019. Methods The detailed data on CWP extracted from the database of the Global Burden of Disease Study 2019 (GBD 2019) was used to evaluate the disease burden and temporal trend of CWP in the Chinese population. The data included prevalent cases, incident cases, death cases, and indicators concerning disease burden such as disability-adjusted life years (DALYs). Results In China, prevalent cases of CWP decreased by 1.44% from 87 555 in 1990 to 86 296 in 2019; incident cases of CWP decreased by 8.73% from 5 450 in 1990 to 4 974 in 2019; deaths of CWP decreased by 21.61% from 1 661 in 1990 to 1 302 in 2019; DALYs of CWP decreased by 27.70% from 57 206.70 person-years in 1990 to 41 359.25 person-years in 2019. The age-standardized prevalence, incidence, mortality, and DALY rates of CWP in China decreased since 1990, with AAPCs of -2.75%, -2.53%, -3.67%, and -3.73%, respectively. And the disease burden of CWP was mainly caused by male groups. Compared with 1990, more elderly workers in China in 2019 suffered from or died of CWP. The age-standardized indicators of CWP in China were all higher than those globally from 1990 to 2019, and the differences were statistically significant (all P < 0.001). Conclusions The disease burden caused by CWP in China showed a downward trend in general, indicating that the prevention and control of CWP in China had obtained certain achievements. However, the incident cases of CWP in China remained at a high level, and the age-standardized indicators were still higher than those globally. Therefore, more efforts are needed to pay attention to the prevention and control of CWP in China.

Epidemiological characteristics of hearing loss among workers exposed to noise in Chinese industrial enterprises in 2020

LI Xin-xin, LIU An-qi, WANG Dan, ZHENG Jin-nan, WANG Hong-fei, ZHANG Si-yu, YU Yue, DU Xie-yi, HU Wei-jiang

2022, 26(8): 882-887. doi: 10.16462/j.cnki.zhjbkz.2022.08.003

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Objective To understand the epidemiological characteristics of hearing loss among noise-exposed workers in Chinese industrial enterprises, and to provide a scientific basis for prevention and control strategies. Methods The occupational health files of workers exposed to noise in the three major industries of mining, manufacturing, production and supply of electricity, heat, gas and water in 2020 were obtained from the "Occupational Disease and Health Hazardous Factors Surveillance System". Hearing impairment and binaural high-frequency average hearing threshold loss were analyzed by industry, region, gender, age, working age, enterprise scale. Results A total of 3 034 500 cases were collected, and 815 800 persons with hearing impairment and 265 500 persons with high-frequency hearing loss were detected, with a detection rate of 26.88% and 8.75%, respectively. The detection rate of hearing impairment and high-frequency hearing loss in the mining industry was 29.96% and 10.11%, which were higher than those in other industries. The regions with a higher detection rate of hearing impairment were Southwest, Central South and East China, accounting for 30.21%, 29.99% and 29.90%, respectively. The regions with higher high-frequency hearing loss detection rates were Central South and Southwest, accounting for 11.12% and 9.78% respectively. The detection rates of hearing impairment and high-frequency hearing loss in males were higher than those in women, accounting for 28.60% and 9.98% respectively. The detection rates of hearing impairment and high-frequency hearing loss both showed an increasing trend with age and working age. The detection rates of hearing impairment and high-frequency hearing loss of small and micro enterprise were 37.56% and 12.36%, which were higher than those of large and medium-sized enterprises. Conclusions The detection rate of hearing impairment and high-frequency hearing loss among noise-exposed workers in Chinese industrial enterprises is relatively high. It is necessary to strengthen the control of workplace noise and individual protection of noise-exposed workers to protect workers' health.

Incidence patterns and risk factors of work-related musculoskeletal disorders in medical industry in China

XU Qing, LING Rui-jie, LIU Yi-min, ZHANG Hua-dong, LI Gang, WANG Ru-gang, LIU Ji-xiang, ZENG Qiang, LI Tian-lai, JIA Ning, WANG Zhong-xu

2022, 26(8): 888-896. doi: 10.16462/j.cnki.zhjbkz.2022.08.004

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Objective This study aimed to investigate the prevalence of work-related musculoskeletal disorders (WMSDs) in China's medical industry and explore the occupational hazard factors of adverse ergonomics and the incidence pattern of WMSDs in different jobs. Methods A cross-sectional survey of 6 854 employees from the medical industry in China was conducted. Statistical analysis of disease results was carried out according to the American NIOSH method. Latent class analysis (LCA) was used to analyze the multi-site incidence patterns of WMSDs in major jobs, and logistic regression was used to determine the adverse ergonomic factors. Results The overall prevalence of WMSDs was 56.1%, of which 54.15% were doctors, 58.66% were nurses, 51.04% were nurses, 54.05% were technicians, and 48.48% were pharmacists. According to LCA results, the main incidence modes of WMSDs in doctors and nurses were torso type and neck-shoulder type; Technicians and pharmacists were neck-shoulder types; Nursing workers were mild pain type and neck-shoulder type. Multivariate logistic regression results showed that the risk of neck-shoulder typed doctors mainly came from long-term wrist bending (OR=1.383, P=0.036), and frequent sitting (OR=2.110, P=0.020), and frequent uncomfortable working posture (OR=2.023, P=0.001). The main risks of torso typed doctors were limited leg posture (OR=1.413, P=0.044) and frequent uncomfortable working posture (OR=4.402, P < 0.001). The risk of neck-shoulder typed nurses mainly came from neck tilt (OR=2.218, P=0.024) and long and frequent sitting work (OR=1.533, P=0.006). Torso typed nurses have the risk of frequent sitting positions for a long time (OR=1.883, P < 0.001), and frequent uncomfortable working positions (OR=2.137, P < 0.001). Conclusions Compared with mainstream countries and regions in the world, the prevalence of WMSDs in China's medical industry is at a moderate level. However, ergonomic hazards and awkward working posture in the industry are relatively high. Besides, the ergonomic level of the neck, shoulder, upper and lower back is higher, which is mainly related to occupational factors such as keeping neck posture unchanged and lowering the head for a long time during work; tilting the neck forward greatly; bending wrists, sitting, keeping turn-back frequently; limited leg space; and uncomfortable working posture. The risk of musculoskeletal injury should be reduced by strengthening education and training, increasing auxiliary assistance facilities and improving work organization mode.

Study on the effects of long working hours and commuting time on menstrual abnormalities among Chinese female nurses

JIANG Zhao-qiang, YU Chang-yan, JIN Ming-ying, LIU Shuang, CHEN Jun-fei, FENG Ling-fang, LI Yong-xin, XU Hua-dong, ZHOU Jian-hong, YE Yan, MEI Liang-ying, YU Wen-lan, LOU Jian-lin

2022, 26(8): 897-901. doi: 10.16462/j.cnki.zhjbkz.2022.08.005

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Objective To evaluate the effects of long-time work and commuting time on the menstrual status of female nurses, and to provide a basis for relevant departments to reasonably allocate the working hours of nurses. Methods A questionnaire survey was conducted among 8 904 female nurses in China from May to November 2016. Demographic, occupational and menstrual data were collected. The effects of long-time work and commuting time on menstrual abnormalities were analyzed by binary logistic regression models. Results The working time of female nurses was (8.2±1.1) h, and the median commuting time was 1.0 (0.5, 1.0) h; The abnormal rate of menstruation was 41.0%. Working time > 8 h had a significant impact on all indexes of menstrual abnormalities of female nurses, and had the greatest impact on the change of menstrual duration (OR=1.651, 95% CI: 1.403-1.942, P < 0.001). Commuting time > 1 h had a significant impact on all indicators of menstrual abnormalities, among which it had the greatest impact on the change of menstrual duration (OR=1.368, 95% CI: 1.178-1.588, P < 0.001). Conclusion Long working hours and long commuting time increase the risk of abnormal menstruation in female nurses, and it is the influencing factor of abnormal menstruation.

Effects of aluminum exposure on delayed recall of workers

SUN Yu-han, LI Juan, ZHANG Jing-qi, GONG Yu-juan, HE Lu-yang, LU Xiao-ting, SONG Jing, NIU Qiao, WANG Lin-ping

2022, 26(8): 902-906. doi: 10.16462/j.cnki.zhjbkz.2022.08.006

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Objective To explore the impact of occupational aluminum exposure on delayed recall of workers. Methods A total of 435 workers in an aluminum factory in Shanxi province were evaluated for delayed recall using Montreal Cognitive Assessment Scale (MoCA) (Beijing Edition) and World Health Organization/University of California at Los Angeles Auditory Verbal Learning Test (AVLT). According to the blood aluminum concentration, the subjects were divided into low, medium and high exposure groups (T1, T2 and T3). Multiple logistic regression analysis was used to analyze the influencing factors of mild cognitive impairment (MCI) in aluminum exposed workers. Results All subjects are men. There were no significant differences in age, marriage, family monthly income, smoking and drinking among the three groups(P > 0.05). There were significant differences in working age and educational level among the three groups (P < 0.05). The delayed recall indexes in MoCA and AVLT of the three groups were statistically significant (P < 0.05). Multiple Logistic regression analysis showed that AVLT-LR score ≥ 6 was the protective factors of MCI (OR=0.860, 95% CI: 0.769-0.960); less education(OR=3.556, 95% CI: 1.589-7.957), more inserted words (OR=1.415, 95% CI: 1.070-1.871) and repeated words (OR=1.419, 95% CI: 1.043-1.931), no memory strategy (OR=2.124, 95% CI: 1.119-4.032) were the risk factors of MCI. Conclusions Occupational aluminum exposure can damage workers' delayed recall. The evaluation of MoCA and AVLT scales can determine the impact of delayed call and the combination of the two scales can better identify workers who may be prone to MCI.

Influencing factors of lower back work-related musculoskeletal disorders among construction workers

PENG Zhi-heng, YANG Yan, LI Gang, SHAO Hua, WANG Ru-gang, JIA Ning, WANG Zhong-xu, LIU Yi-min

2022, 26(8): 907-913. doi: 10.16462/j.cnki.zhjbkz.2022.08.007

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Objective To investigate the current situation of lower back work-related musculoskeletal disorders (WMSDs) among construction workers and to explore the influencing factors. Methods A total of 453 construction workers from 8 construction companies in Beijing, Liaoning, Shandong and Guangdong provinces were selected as the subjects. The prevalence of WMSDs in different parts of the subjects was collected by the Musculoskeletal Disorders Questionnaire, and multivariate logistic regression was used to analyze the influencing factors of WMSDs in the lower back of construction workers. Results The total prevalence of WMSDs was 43.7%. The prevalence rate was 24.1% in the lower back, 18.3% in the shoulder, 14.6% in the neck, 12.4% in the upper back, 12.1% in the wrist, 6.0% in the foot and ankle, and 5.5% in the leg, 5.1% in the knee and 5.1% in the elbow. The prevalence of multisite WMSDs was 28.9%. Multivariate logistic regression analysis showed that high school and secondary school education (refer to junior high school and below) (OR=0.390, 95% CI: 0.179-0.849, P=0.018) was a protective factor for WMSDs in construction workers. However, squatting or kneeling for a long time (OR=1.818, 95% CI: 1.053-3.138, P=0.032), carrying heavy objects (each time >20 kg) (OR=2.876, 95% CI: 1.629-5.077, P < 0.001), working in an uncomfortable posture (OR=2.619, 95% CI: 1.455-4.714, P=0.001), holding the same posture for a long time on the lower back (OR=2.913, 95% CI: 1.640-5.177, P < 0.001) and bending the knee for a long time (OR=2.958, 95% CI: 1.659-5.274, P < 0.001) were independent risk factors for WMSDs. Conclusions Construction workers are at higher risk of WMSDs, the most common of which is lower back WMSDs. The influencing factors mainly include individual characteristics, labor type and poor ergonomic factors.

Mitochondrial DNA copy number in peripheral blood mediates the association between polycyclic aromatic hydrocarbons exposure and blood lipid levels among coke oven plant workers

ZHAO Xin-yu, LIU Lu, GUO Lan, FENG Quan, WANG Yong, WEI Jia-jun, YANG Jin

2022, 26(8): 914-921. doi: 10.16462/j.cnki.zhjbkz.2022.08.008

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Objective To investigate the mediating role of mitochondrial DNA copy number (mtDNAcn) in the association between exposure to polycyclic aromatic hydrocarbons (PAHs) and blood lipid levels in coke-oven plant workers. Methods Eleven urine biomarkers of PAHs exposure of 661 coking plant workers were determined by high performance liquid chromatography with tandem mass spectrometry (HPLC-MS/MS). Relative mtDNAcn was measured based on RT-PCR. The dose-effect relationship between PAHs and mtDNAcn in peripheral blood and blood lipid parameters by the generalized linear regression model, and mediating effect analysis was used to analyze the role of mtDNAcn in PAHs exposure and abnormal blood lipid levels. Results The participants were divided into three groups by tertiles (T1-T3) of urinary PAHs hydroxy metabolites concentration. The results of generalized linear regression showed that mtDNAcn decreased with the increase of 2-hydroxynaphthalene (2-OHNAP) and 2-hydroxyphenanthrene (2-OHPHE) after adjusting for confounding factors (β=-0.240, 95% CI: -0.400--0.081; β=-0.236, 95% CI: -0.412--0.059), and compared with individuals with the lowest levels of urinary 2-OHPHE, those in the highest tertile subgroups of 2-OHPHE had increased TC levels (β=0.335, 95% CI: 0.084-0.587). Compared with individuals with the lowest levels of urinary 2-hydroxyfluorene (2-OHFLU) those in the highest tertile subgroups of 2-OHFLU had increased TG levels 0.357 (β=0.357, 95% CI: 0.102-0.612). Compared with individuals with the lowest levels of urinary 1-hydroxynaphthalene (1-OHNAP) those in the middle of the highest tertile subgroups of 1-OHNAP had decreased HDL-C levels (β=-0.232, 95% CI: -0.430--0.035, β=-0.615, 95% CI: -0.858--0.373). The results of mediating effect analysis showed that the effect of 2-OHPHE on TC levels may be mediated by the reduction of mtDNAcn, with a mediation ratio of 12.61%. Conclusions PAHs exposure in coke-oven plant workers may adversely affect blood lipids by decreasing mtDNAcn in peripheral blood.

Interaction effects between tobacco exposure and overweight on abnormal blood pressure in coking workers

WANG Yong, ZHAO Xin-yu, LIU Lu, FENG Quan, WEI Jia-jun, GUO Lan, YANG Jin

2022, 26(8): 922-926. doi: 10.16462/j.cnki.zhjbkz.2022.08.009

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Objective To analyze the interaction effects between tobacco exposure and overweight on abnormal blood pressure in coke-oven workers. Methods In this cross-sectional study, we collected basic information and urine sample of 700 workers in a coking plant in Shanxi Province in 2017. Polycyclic aromatic hydrocarbons (PAHs) and tobacco metabolites in the urine of workers were detected by high performance liquid chromatography-mass spectrometry. Least absolute shrinkage and selection operator regression was used to screen out the optimal risk factors associated with hypertension. Modified poisson regression was used to analyze the association between tobacco exposure and abnormal blood pressure. The interaction effects of tobacco metabolites and overweight on abnormal blood pressure in coke-oven workers was studied by interaction effects analysis. Results The logarithmic value of urine tobacco metabolites were divided into 3 groups according to the tertile (T1, T2 and T3). The modified poisson regression model showed that for each unit increase in urinary nicotine concentration in T3 (≥36.76 ng/mL), compared with T1 (< 1.54 ng/mL), the risk of abnormal blood pressure increased 1.46 (PR=2.46, 95% CI: 1.17-5.18, P=0.036). The median body mass index (BMI) of workers with abnormal blood pressure (25.85 kg/m²) was higher than that of those with normal blood pressure(24.19 kg/m²). Interaction effects analysis showed that overweight people with high nicotine levels had a significantly higher risk of hypertension than non-overweight people with low urinary nicotine levels (PR=5.12, 95% CI: 1.76-14.92, P=0.042). Conclusions BMI and urine-nicotine levels have an interactive effect on abnormal blood pressure in coke-oven workers. Controlling smoking and body weight is important to prevent hypertension in coke oven workers.

Associations of urinary polycyclic aromatic hydrocarbon metabolites with neurobehavioral function changes in coke oven workers

FU Meng-meng, WANG Hui-min, YAO Xi-yuan, MA Yi-fei, NIE Ji-sheng

2022, 26(8): 927-933. doi: 10.16462/j.cnki.zhjbkz.2022.08.010

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Objective To investigate the associations between urinary polycyclic aromatic hydrocarbons (PAHs) metabolites and changes in coke oven workers' neurobehavioral function. Methods In 2017, 672 workers in a coking plant in Shanxi Province were investigated for basic conditions, neurobehavioral function tests and urinary PAHs detection. With follow-up in 2021, a total of 461 workers completed neurobehavioral functional tests. Neurobehavioral function was measured by neurobehavioral core test battery questionnaire. The concentrations of urinary PAHs metabolites and cotinine were determined by high-performance liquid chromatography-mass spectrometry. Generalized linear models and generalized estimation equations were used to analyze the association between urinary PAHs metabolites and neurobehavioral function. Results A total of 461 participants completed the investigation, the age was 34 (30, 46) years, and 69.2% was male at baseline. In the longitudinal study, forward digit span (β=-0.50, 95% CI: -0.81--0.18, P=0.002) and total digit span scores (β=-0.77, 95% CI: -1.38--0.16, P=0.014) were significantly lower in the 2-hydroxynaphthalene (2-OHNAP) high-exposure group; the mean reaction time (β=26.90, 95% CI: 7.86-45.93, P=0.006) was significantly longer in the 2-hydroxynaphthalenc (2-OHNAP) high-exposure group, the preferred hand (β=-1.30, 95% CI: -2.43--0.17, P=0.024) and non-preferred hand Santa Ana dexterity test (β=-1.19, 95% CI: -2.23--0.15, P=0.025) scores were significantly reduced in the 2-OHFLU high-exposure group. Conclusion Long-term exposure to polycyclic aromatic hydrocarbons reduces neurobehavioral function in coke oven workers.

Association between overweight, obesity, central obesity and hypertension among adults aged 35 and over in Jiangsu Province

GU Yi-bin, GU Shu-jun, ZHANG Qiu-yi, CHEN Lu-lu, SU Jian, CUI Lan, TAO Ran, ZHOU Jin-yi, QIN Yu

2022, 26(8): 934-938. doi: 10.16462/j.cnki.zhjbkz.2022.08.011

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Objective To understand the relationship between overweight, obesity, central obesity and hypertension among adults in Jiangsu Province, and to provide scientific basis for prevention of obesity and hypertension. Methods A total of 117 691 residents aged 35-75 years from 8 sites of Jiangsu Province were recruited and received questionnaire surveys, physical examinations and laboratory tests during January 22, 2016 and April 8, 2019. The relationship of overweight, obesity, central obesity and hypertension was analyzed by non-conditional logistic regression. Results The prevalence of hypertension was 57.79%, with a standardization rate of 26.79%. After adjusting for confounders, overweight, obesity and central obesity increased the risk of hypertension. Compared with participants without overweight/obesity and central obesity, the risk of being hypertension increased by 90.7% (OR=1.907, 95% CI: 1.849-1.968) in those with overweight/obesity only, by 69.2% (OR=1.692, 95% CI: 1.566-1.828) in those with central obesity only, by 2.171 times (OR=3.171, 95% CI: 3.075-3.270) in those with both overweight/obesity and central obesity. Conclusion The prevalence of hypertension is relatively high in Jiangsu adults aged ≥35 years. Overweight, obesity, and central obesity increase the risk of hypertension.

Association between metabolic syndrome and aortic arch calcification: Guangzhou Biobank Cohort Study

LU An-ting, ZHANG Wei-sen, JIANG Chao-qiang, JIN Ya-li, CHENG Kar-keung, LAM Tai-hing, Xu Lin

2022, 26(8): 939-944. doi: 10.16462/j.cnki.zhjbkz.2022.08.012

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Objective To examine the association between metabolic syndrome (MS) and aortic arch calcification (AAC) in middle-aged and older Chinese in Guangzhou. Methods Participants were from the Guangzhou Biobank Cohort Study recruited from 2003 to 2008. Face-to-face interviews, physical examinations, laboratory measurements and chest X-ray were used to collect information. Association between MS and AAC was analyzed by logistic regression. Stratification and interaction analysis was conducted according to different baseline characteristics. Results Of 25 824 participants included in this study, the prevalence of AAC in participants with MS was higher than in those without (χ² =150.3, P < 0.001). After adjusting for multiple confounding factors, the OR (95% CI) of AAC for MS was 1.19 (1.12-1.27) compared to those without. Among the components of MS, high levels of blood pressure, fasting plasma glucose (FPG) and triglycerides (TG), and low levels of high-density lipoprotein cholesterol (HDL-C) were positively associated with AAC independently, and the OR (95% CI) was 1.33 (1.26-1.41), 1.09 (1.03-1.15), 1.07 (1.01-1.14) and 1.14 (1.06-1.23), respectively. The odds of AAC increased significantly as the number of MS components increased (P_trend < 0.001). There was an interaction between age and MS on AAC, and the risk of AAC was higher in those aged 50- < 60 years with MS. Conclusions MS and its components such as high levels of blood pressure, TG, FPG and low levels of HDL-C were risk factors for AAC. Age modified the association between MS and AAC.

Association between triglyceride, high-density lipoprotein cholesterol and type 2 diabetes mellitus: a prospective cohort study

ZHAO Ya-nan, DAI Tian, XIA Miao, YANG Hong-yan, ZHANG De-sheng, YIN Chun, HE Ying-qian, ZHANG Lu-lu, LIU Jing, WANG Min-zhen, BAI Ya-na

2022, 26(8): 945-952. doi: 10.16462/j.cnki.zhjbkz.2022.08.013

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Objective To evaluate the association between triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), TG/HDL-C and the risk of type 2 diabetes (T2D). Methods A total of 30 546 people without T2D from the Jinchang cohort baseline survey were enrolled. Cox proportional hazards regression and restricted cubic spline were used to estimate the relationship between TG, HDL-C and TG/HDL-C on the risk and dose response of T2D. Receiver operating characteristic curve was conducted to evaluate the predictive ability on the risk of T2D, and determine the optimal predictive index and its critical value. Results After adjusting for confounding factors, high TG, low HDL-C and high TG/HDL-C in the general population were risk factors for T2D, with the HRs of 1.082 (95% CI: 1.053-1.111, P < 0.001), 0.730 (95% CI: 0.595-0.897, P=0.003) and 1.061(95% CI: 1.038-1.085, P < 0.001), respectively. The predictive value of TG/HDL-C was higher than those of TG and HDL-C, and their areas under the curve were 0.652, 0.646 and 0.600, respectively. The optimal cut-offs were 1.14, 1.67 mmol/L and 1.40 mmol/L for TG/HDL-C, TG and HDL-C. Conclusions High TG, low HDL-C and high TG/HDL-C are independent risk factors for the risk of T2D. TG/HDL-C has the strongest predictive ability on the incidence of T2D.

Spatio-temporal distribution and socioenvironmental factors of acute hemorrhagic conjunctivitis in China

REN Xiang, CHEN Meng-xiang, ZHOU Nan, DAI Hao-yun, LI Guo-qun, HONG Xiu-qin, ZHA Wen-ting, LYU Yuan

2022, 26(8): 953-960. doi: 10.16462/j.cnki.zhjbkz.2022.08.014

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Objective To understand the spatio-temporal distribution and socioenvironmental factors of acute hemorrhagic conjunctivitis (AHC), and to provide a scientific basis for the prevention and control. Methods Based on the AHC incidence data in 31 provinces (autonomous regions and municipalities directly under the Central Government) in China from 2011 to 2017, spatial autocorrelation analysis was used to explore the spatio-temporal distribution characteristics, and geographical detector was used to analyze the influence of socioenvironmental factors. Results The annual incidence was relatively flat from 2011 to 2017 that mainly occurred in summer and autumn. The incidence of AHC concentrated in central and southern China and eastern China and had obvious spatial positive correlation. The incidence in Hunan Province was from high to low and high aggregation, and prevention and control efforts should be maintained. The incidence in Guizhou Province was from low to high aggregation, and attention should be paid to the spread of disease in surrounding provinces. Meteorological, social development, economic-cultural factors all affected AHC incidence to varying degrees, and the interaction of these increased the incidence risk, among which the interaction between average annual temperature and other factors has strong strengthening effect. Conclusions The spatial and temporal distribution of AHC incidence is not uneven and was affected by various social and environmental factors. The spatial autocorrelation analysis and geographical detector model can effectively explore the spatiotemporal characteristics and influencing factors of AHC, which perform important roles in the focused and targeted prevention and control.

The influencing factors of unprotected sexual behavior among HIV-infected patients: a study based on Bayesian network model

WANG Jian-ping, WU Yuan-ting, YAO Tian, LAN Guang-hua, LU Hong-yan, XIANG Shao-mi, LI Shu-zhen, FENG Yong-liang, WANG Su-ping

2022, 26(8): 961-966. doi: 10.16462/j.cnki.zhjbkz.2022.08.015

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Objective To investigate the prevalence of unprotected sexual behavior among HIV-infected patients, and to explore the influencing factors of unprotected sexual behavior and their network relationships. Methods HIV-infected patients managed by two centers for Disease Control and Prevention in Guangxi were selected from March to July 2015 in a cross-sectional study. Data of general demographic characteristics, HIV treatment status, sexual behavior in the last three months, health status and drug use status were collected through face-to-face interview. Single-factor analysis and multi-factor logistic regression were used to initially screen the variables, "bnlearn" Bayesian network software package was used for model construction, and Netica software was used for model inference. Results The incidence of unprotected sexual behavior among HIV-infected patients was 47.47% (441/929). The results of multi-factor logistic regression analysis showed that age, multiple partners, education level, per capita monthly income of family, and receiving ART were influencing factors of unprotected sexual behavior. The results of Bayesian network model showed that multiple sexual partners, receiving ART therapy, education level, per capita monthly income of family, and age were directly related to unprotected sexual behavior, currently being married or cohabiting was indirectly related to unprotected sexual behavior through affecting multiple sexual partners, and occupation was indirectly related to unprotected sexual behavior through affecting per capita monthly income of family. Conclusions HIV-infected patients have a high incidence of unprotected sexual behavior. Health education should be strengthened for those having multiple sexual partners, not receiving ART, with low level of education, having low per capita monthly income of family, being older, being currently single and being unemployed, so as to reduce the occurrence of unprotected sexual behavior.

The correlation of serum S100A8 level and the prognosis in patients with community-acquired pneumonia

JIANG Ya-lin, FU Lin, ZHAO Hui

2022, 26(8): 967-973. doi: 10.16462/j.cnki.zhjbkz.2022.08.016

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Objective To explore the correlation between serum S100A8 on admission and the prognosis in patients with community-acquired pneumonia (CAP) as well as the potential risk factors of S100A8 elevation. Methods CAP patients were enrolled from December 2018 to December 2020 in the Department of Respiratory and Critical Care Medicine of Bozhou People's Hospital. Demographic characteristics and clinical information were extracted. Serum samples were collected. The levels of S100A8 and inflammatory cytokines were measured using enzyme-linked immunosorbent assay. Results All 100 patients with CAP were enrolled. The hospital stay was increased in parallel with serum S100A8 on admission among CAP patients (F=23.562, P=0.005). In addition, 10 patients with CAP died during hospitalization. Serum S100A8 level was higher in dead patients than those in alive cases (t=4.352, P=0.004). Moreover, logistic regression analysis found that serum S100A8 elevation was the risk factor of hospital stay prolonging (OR=3.111, 95% CI: 1.112-8.702, P=0.031) and mortality elevation (OR=1.214, 95% CI: 1.058-1.562, P=0.022) in CAP patients. Additionally, Pearson correlation analysis found that S100A8 level was associated with inflammatory cytokines. Further logistic regression analysis found that age (OR=1.230, 95% CI: 1.030-1.528, P=0.044), high systolic pressure (OR=1.155, 95% CI: 1.011-1.320, P=0.033) and comorbidity with renal disease (OR=2.541, 95% CI: 1.578-6.537, P=0.038) were independent risk factors of S100A8 elevation among CAP patients. Conclusions Serum S100A8 level on admission is positively correlated with adverse prognosis in CAP patients. Serum S100A8 is more prone to elevating in older and higher blood pressure patients with renal disease. Consequently, S100A8 may be used as an early serum biomarker of prognosis for CAP patients.

Exploration and establishment of the prediction model for lung adenocarcinoma prognosis based on DNA methylation sites

LU Jing-ya, FANG Zi-han, ZENG Chang-yi, CHEN Xue-jiao, WANG Ke, WEI Sheng

2022, 26(8): 974-981. doi: 10.16462/j.cnki.zhjbkz.2022.08.017

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Abstract:
Objective To explore and build a prediction model for the prognosis of lung adenocarcinoma based on DNA methylation sites according to the public omics database and evaluate the prediction efficacy of the prediction model. Methods The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases were used for analysis and validation. The least Absolute Shrinkage and Selection Operator (LASSO) Cox regression model was performed to screen DNA methylation sites associated with the prognosis of lung adenocarcinoma. Multivariate Cox regression was used to evaluate the relationship between methylation signature and prognosis of lung adenocarcinoma. The prognostic prediction model of lung adenocarcinoma was estimated using Harrell's C statistics. Results Two methylation sites (cg02909790 and cg19378330) associated with the prognosis of lung adenocarcinoma were selected by LASSO Cox regression. Cox regression analysis showed a significant relationship between methylation signature and lung adenocarcinoma prognosis (HR=8.32, 95% CI: 2.41-28.69, P < 0.001). The C statistical value of the prognostic prediction model based on methylation signature for lung adenocarcinoma was 0.81 (95% CI: 0.78-0.83) according to Harrell's C statistical analysis. Conclusions The prediction model of lung adenocarcinoma based on cg02909790 and cg19378330 has a good prognostic prediction efficacy and may be potential personalized tumor molecular markers in the development and progression of lung adenocarcinoma.

Phylogenetic analysis of coxsackievirus A2 in China

LIANG Ruo-nan, SUN Tian-tian, JI Wang-quan, CHEN Shuai-yin, YANG Hai-yan, DUAN Guang-cai, JIN Yue-fei

2022, 26(8): 982-988. doi: 10.16462/j.cnki.zhjbkz.2022.08.018

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Abstract:
Objective To analyze the phylogenetic character of coxsackievirus A2 (CV-A2) strains in China. Methods Sequences of the VP1 region and complete genomes of CV-A2 strains in China were collected. The phylogenetic tree and analysis of amino acid mutation were conducted by MEGA 10.2.4 software. The analysis of genetic recombination was carried out through SimPlot 3.5.1 software. Results A total of 118 sequences of CV-A2 VP1 were collected, and 26 strains had complete genome sequences. CV-A2 strains mainly originated from Guangdong Province. The number of CV-A2 strains had increased rapidly since 2011. Phylogenetic tree based on the VP1 region was clustered into seven distinct lineages, and the prototype strains were a separate lineage A while most of strains gathered in lineages G. The analysis of gene recombination of CV-A2 representative strains with complete genome sequences exhibited recombinant segments. The amino acid variations were found at 22 sites of VP1 protein. Conclusion CV-A2 strains circulating in China have undergone gene recombination and mutations in the amino acid sites of the VP1 region, suggesting that monitoring the evolution of CV-A2 is of great significance for the prevention and control of hand-foot-mouth disease.

The role of different forms of Gastrin on the pathogenesis of Helicobacter pylori

YUAN Xiao-gang, HUANG Xue-mei, XIANG Li, YAO Xin-huang

2022, 26(8): 989-992. doi: 10.16462/j.cnki.zhjbkz.2022.08.019

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Abstract:
Objective To investigate the effects of Helicobacter pylori (H.pylori) infection on serum gastrin and exosome derived gastrin secretion. Methods A total of 79 patients with non-atrophic gastritis (NAG) and atrophic gastritis (AG) were collected randomly. The infection of H.pylori was detected by a 13C-urea breath test. The concentration of serum gastrin and serum exosome derived gastrin were detected by enzyme-linked immunosorbent assay(ELISA). Results There was no significant difference in serum gastrin and exosome derived gastrin between NAG and AG group(t=-0.197, P=0.844; t=0.221, P=0.826). In NAG group, serum gastrin and exosome derived gastrin in H.pylori positive subgroup were significantly lower than those in H.pylori negative subgroups (t=2.488, P=0.017; t=2.655, P=0.012). In AG group, there was no significant difference in serum gastrin concentration between H. pylori positive and negative subgroups (t=1.888, P=0.082). However, exosome derived gastrin in H.pylori positive subgroup was significantly higher than that in H.pylori negative subgroup (t=2.394, P=0.029). Conclusions H.pylori infection may lead to the decrease of serum gastrin before gastric mucosal atrophy in the early stage. Serum gastrin and exosome derived gastrin in H. pylori positive AG group are significantly increased, which is an important carcinogenic mechanisms of H. pylori infection.

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2022 Vol. 26, No. 8

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Editor

Editor-in-Chief Ye Dongqing M.D.

Assistant editor Fan Yinguang M.D.

Assistant editor Pan Haifeng M.D.

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