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CN 34-1304/R ISSN 1674-3679

2023 Vol. 27, No. 4

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Original Articles
5-year all-cause mortality survival analysis and interpretable study in patients with coronary artery disease combined with chronic heart failure
ZHANG Weichang, TIAN Jing, YANG Hong, HAN Qinghua, ZHANG Yanbo
2023, 27(4): 373-378. doi: 10.16462/j.cnki.zhjbkz.2023.04.001
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  Objective   To investigate the risk factors for all-cause mortality in patients with coronary heart disease combined with chronic heart failure by using machine learning algorithms and shapley additive explanations (SHAP).  Methods   A total of 2 648 patients diagnosed with coronary heart disease combined with chronic heart failure in two tertiary hospitals in Shanxi Province were selected for the study. The Cox, random survival forests (RSF), and XGBoost models were constructed using the variables screened by XGBoost; SHAP was applied to analyze the model interpretability.  Results   The prediction model created using XGBoost had the highest predictive performance with a concordance index (C-index) of 0.902 (0.900-0.915). The model showed that higher age, NTproBNP, systolic blood pressure, and creatinine were associated with a higher risk of death. Diabetes, central nervous system disorders, and statins significantly influenced patient prognosis.  Conclusions   The survival analysis prediction model constructed by XGBoost can more accurately assess the poor prognosis of patients and, in combination with SHAP, can provide a clear interpretation of individualized risk prediction for patients. It is helpful to assist doctors in personalizing clinical treatment for patients.
A prospective cohort study of socioeconomic status, healthy lifestyle and the incidence of hypertension
LIN Shenrong, SU Xu, WU Yanli, LI Xuejiao, WANG Yiying, ZHOU Jie, LIU Tao
2023, 27(4): 379-384. doi: 10.16462/j.cnki.zhjbkz.2023.04.002
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  Objective   To explore the relationship between socioeconomic status (SES), healthy lifestyle, and the incidence of hypertension, and to provide reference basis for the prevention and control of hypertension.  Methods   A total of 9 280 permanent residents aged 18 and over in 12 counties (cities and districts) of Guizhou Province were investigated by stratified cluster random sampling in 2010. All populations in this cohort were followed up from 2016 to 2020. T-test and χ2 test were used for univariate analysis. And Cox proportional hazards regression was used in analyzing the impact of socioeconomic status and healthy lifestyle on the incidence of hypertension.  Results   The adequate sample size of the final cohort study was 3 401. Among them, 765 had hypertension, and the incidence density was 32.53/1 000 person-years. The results of multivariate Cox regression showed that compared with the population with low SES (< 9 points), the risk of hypertension in the people with high SES (≥9 points) decreased by 29.9% (HR=0.701, 95% CI: 0.584-0.842). Compared to the population with ≤2 healthy lifestyles, the incidence risk of people with 4, 5, and more healthy lifestyles decreased by 25.7% (HR=0.743, 95% CI: 0.581-0.950) and 39.2% (HR=0.608, 95% CI: 0.455-0.812), respectively. However, the difference in hypertension risk in the population with low SES and those with 3, 4, 5, or more healthy lifestyles was not statistically significant (all P>0.05) compared to those with low SES and ≤2 healthy lifestyles. The risk of hypertension in the population with high SES and have 3, 4, 5 or more healthy lifestyles was reduced by 36.3% (HR=0.637, 95% CI: 0.446-0.909), 44.0% (HR=0.560, 95% CI: 0.391-0.802) and 55.8% (HR=0.442, 95% CI: 0.295 -0.662), respectively.  Conclusions   The population with low SES is critical in preventing and controlling hypertension in Guizhou Province. Various measures should be taken to improve their socioeconomic status and simultaneously carry out health education and health promotion.
Prevalence of cardiovascular disease and its influencing factors among the Uygur population in rural areas of Xinjiang
WANG Yuxiang, MA Rulin, GUO Heng, ZHANG Xianghui, HE Jia, WANG Xinping, HU Yunhua, MA Jiaolong, GUO Shuxia
2023, 27(4): 385-391. doi: 10.16462/j.cnki.zhjbkz.2023.04.003
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  Objective   To analyze the prevalence of cardiovascular diseases (CVD) in the Uygur population in Xinjiang and its influencing factors, to provide a scientific basis for the future prevention and treatment of CVD.  Methods   A total of 16 321 Uyghur adults in two representative areas of Xinjiang in 2010 and 2016 were selected as the research subjects. Relevant data were collected through questionnaires, physical examinations, and biochemical tests. And CVD was chosen as the outcome event.  Results   A total of 16 321 people were investigated, the prevalence of CVD was 10.22%, and the standardized prevalence was 9.75%. The prevalence of females (12.88%) was higher than that of males (7.56%) (P < 0.001) and increased with age(Ptrend < 0.001). Multivariate logistic regression analysis showed that CVD was related to age, female, married, BMI, larger waist circumference, hypertension, chronic kidney disease, hypertension and CVD family history, SBP, DBP, glutamyltransferase (GGT), and uric acid (UA).  Conclusions   The Uyghur population has a higher prevalence of CVD. Advanced age, female, married, obesity, larger waist circumference; hypertension, chronic kidney disease, hypertension, and CVD family history. Abnormal SBP, DBP, GGT, and UA are the risk factors for CVD. Traditional and non-traditional factors should be screened, and CVD prevention and treatment must be carried out according to the characteristics of the Uyghur population.
Relationship between blood lipid level and hypertension in Xinjiang oil workers based on restricted cubic spline model
MUHEIYATI Guliman, MEI Yujie, TAO Ning
2023, 27(4): 392-398. doi: 10.16462/j.cnki.zhjbkz.2023.04.004
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  Objective   To investigate the relationship between low-density lipoprotein (LDL), cholesterol (TC), and triglyceride glucose index (TyG) and the risk of hypertension in oil workers in Xinjiang.  Methods   From April to June 2021, 2 500 workers aged 18 to 65 years and with ≥1 year of service at six oilfield bases in Karamay, Xinjiang, were selected as the study population. The relationship between LDL, TC and TyG indices and hypertension in oil workers was analyzed by logistic regression models combined with restricted cubic splines.  Results   Comparison of age, smoking, alcohol consumption, hypertension, BMI, TC, triglycerides (TG), high-density lipoprotein (HDL), LDL, fasting glucose (FPG), TyG, and uric acid (UA) in different sex groups showed statistically significant differences (all P < 0.001). After correcting for relevant confounders, the risk of hypertension in the group with elevated LDL margins was 1.45 times higher than in the normal group. Compared with the normal TC group, the risk of hypertension was increased by 27% and 46% in the borderline elevated TC group and the elevated group, respectively. The risk of hypertension was 3.24 times higher in the highest quartile of TyG (Q4) than in the lowest quartile (Q1). The results of the stratified analysis showed that in men, the risk of hypertension was 1.37 and 1.43 times higher in the group with elevated marginal LDL and elevated TC, respectively, than in the normal group; in women, the risk of hypertension was 2.71 and 2.72 times higher in the group with elevated marginal LDL and elevated TC than in the normal group, respectively. The risk of hypertension was 2.65 times higher in the Q4 group than in the Q1 group in men and 4.60 times higher in the Q4 group than in the Q1 group in women. The results of restricted cubic splines showed that the dose response relationships between LDL, TC, and TyG indices and the risk of hypertension were inconsistent in both sexes.  Conclusions   Higher LDL, TC, and TyG indices are risk factors for hypertension in oil workers in Xinjiang, and hypertension can be effectively prevented by controlling lipid and blood glucose indices.
A follow-up study on blood pressure control of patients with high blood pressure in high cardiovascular risk population in Jiangsu Province
WU Xun, SU Jian, CHEN Lulu, CUI Lan, TAO Ran, ZHOU Jinyi, QIN Yu
2023, 27(4): 399-405. doi: 10.16462/j.cnki.zhjbkz.2023.04.005
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  Objective   To investigate the follow-up control of blood pressure in hypertensive patients with a high risk of cardiovascular disease and to provide a theoretical basis and reference for the prevention and treatment of hypertension and cardiovascular disease.  Methods   A total of 20 091 hypertensive patients in the high-risk cardiovascular disease population who participated in the project from 2016 to 2019 were selected as the research subjects. And their blood pressure control was analyzed during two follow-up visits. Blood pressure control was examined by a generalized estimation equation.  Results   The blood pressure control rate in hypertensive patients with a high risk of cardiovascular disease was 37.8% at the first follow-up, and 32.8% at the second follow-up. Smokers, urban residents, and people with higher education levels and higher annual household income were more likely to have their blood pressure controlled; While those with hypertension awareness, alcohol consumption, and higher BMI were more difficult to control (all P < 0.05).  Conclusions   The blood pressure control level of hypertensive patients in a high-risk population of cardiovascular disease in Jiangsu Province needs to be improved. And the prevention and control of blood pressure in a high-risk population should be strengthened. Standardized blood pressure management and effective intervention measures should be carried out to improve the control effect.
Effect of community public health comprehensive intervention on blood pressure control among people at different risk of cardiovascular disease in Anhui Province
NIU Mixue, XING Xiuya, FU Lianguo, ZHANG Luan, CHNE Yeji, WANG Huadong, XU Jingqiao, LIU Zhirong
2023, 27(4): 406-412. doi: 10.16462/j.cnki.zhjbkz.2023.04.006
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  Objective   To analyze the effect of comprehensive community public health intervention on blood pressure control among people with different cardiovascular disease (CVD) risks.  Methods   Comprehensive intervention data of community public health in Anhui Province were collected from 2016 to 2020 (including baseline, 3-month, and 12-month follow-up data). The 10-year cardiovascular disease risk assessment model recommended by China's CVD risk assessment and management guidelines was utilized to divide subjects into high-risk and low-risk CVD. The effects of the comprehensive community public health intervention on blood pressure control between the groups were compared.  Results   A total of 3 755 subjects were followed up, 645 patients with a high risk of CVD were detected, and the standardized detection rate was 10.9%. At the 12-month follow-up compared to baseline, SBP and DBP decreased by 16.47 mm Hg (95% CI: -18.09--14.86) and 2.66 mm Hg (95% CI: -3.63--1.69) for the high-risk group, and by 10.43 mm Hg (95% CI: -11.16--9.70) and 2.41 mm Hg (95% CI: -2.81--2.01) respectively for the low-risk group. In addition, at the 3-month follow-up compared to baseline, SBP and DBP decreased by 12.27 mm Hg (95% CI: -13.88--10.65) and 3.66 mm Hg (95% CI: -4.54--2.77) for high-risk CVD group, and by 6.05 mm Hg (95% CI: -6.80--5.30) and 2.61 mm Hg (95% CI: -3.00--2.23) respectively for the low-risk group. At the same time, the decrease in SBP for the high-risk CVD group after 3 months of follow-up and for both types of blood pressure after 12 months of follow-up were significantly more significant than those of the low-risk group (t=-5.100, t=-5.873, t=-2.729; all P < 0.05).  Conclusions   The comprehensive community public health intervention was effective at improving the blood pressure in both CVD risk groups but more effective for the high-risk group. Therefore, paying more attention to low-risk CVD populations is vital in designing future public health interventions.
Impacts of implementing congenital heart disease screening program among infants on the disease report rate in Shanghai: an interrupted time series analysis
CHE Beibei, ZHENG Xubin, XU Houqin, ZHU Liping, LI Bingying, XU Biao
2023, 27(4): 413-418. doi: 10.16462/j.cnki.zhjbkz.2023.04.007
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  Objective  To evaluate the changes in overall and subtype-specific report rate of congenital heart disease (CHD) among infants before and after implementing a municipal screening program in Shanghai.  Methods  Based on the Shanghai Birth Defects Surveillance System, all CHD infants diagnosed within 42 days after birth were included in this study from January 2014 to December 2017. Pre- (January 2014 to May 2016) and post-program (June 2016 to December 2017) phases were defined according to the date of implementing the CHD screening program. The interrupted time series (ITS) analysis was used to evaluate the impact of the screening program on overall and subtype-specific CHD report rates.  Results  In total, there were 849 981 live births in Shanghai between 2014 and 2017, of whom 3 571 were confirmed with CHD. In the pre-program phase, the average monthly report rate of CHD was 42.97 (95% CI: 41.19-44.82) per 10 000 live births, while decreasing to 40.60 per 10 000 live births (95% CI: 38.51-42.78) in post-program-phase. ITS analysis found that both the pre and post-phase presented an increasing trend of CHD report rate (RR=1.013, 95% CI: 1.005-1.021); While the overall reported rate of CHD was negatively associated with the screening implementation (RR=0.706, 95% CI: 0.573-0.869). Regarding specific clinical subtypes, the report rates of patent foramen ovale (RR=0.646, 95% CI: 0.461-0.904) and other CHD subtypes (RR=0.458, 95% CI: 0.296-0.708) were significantly decreased along with the CHD screening. However, the proportion of infants with critical CHD increased significantly among total reported cases after implementing the screening program (pre-program phase vs. post-program phase: 6.77% vs. 10.64%, P < 0.001).  Conclusions  After the CHD screening program's implementation, the observed decrease in hospital-based CHD report rate among infants within 42 days of birth was mainly attributed to the deceased report of mild and self-curable CHD. By contrast, the proportion of infants with critical CHD, i.e., those who should be critically concerned and timely intervened, was increasing. Findings from this study suggest that the CHD screening program in infants has established a standardized diagnostic procedure and brought about better screening efficiency and optimal use of health resources in Shanghai.
The association between non-HDL-C and 10-year risk of ischemic cardiovascular disease
HU Yi, GU Huaicong, SU Hong, WANG Weiqiang
2023, 27(4): 419-424. doi: 10.16462/j.cnki.zhjbkz.2023.04.008
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  Objective  To evaluate the relationship between non-high density lipoprotein cholesterol (non-HDL-C) and the 10-year risk for ischemic cerebrovas-cular disease (ICVD).  Methods  A total of 100 893 subjects aged 35 years or older were selected from the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project in Anhui Province from 2017 to 2020. Their basic information, blood pressure, blood lipids and serum non-HDL-C levels were recorded. The 10-year risk of ICVD was predicted using a simplified assessment model for the Chinese population. The significance of non-HDL-C for ICVD risk was analyzed using multiple logistic regression and trend analysis methods, and a forest plot was drawn.  Results  The average age of the study population was (57.52±9.94) years, with 40 931 males (40.57%) and 59 962 females (59.43%). The high-risk population for ICVD was 16.94% for males, which was higher than that for females (8.45%). The risk of ICVD increased with an increase in non-HDL-C levels and age, and decreased with an increase in education and income levels (P < 0.001). Non-HDL-C was an independent risk factor for ICVD over the next 10 years (P < 0.001).  Conclusions  Non-HDL-C has certain significance in predicting the risk of ICVD over the next 10 years compared to traditional indicators. Additionally, due to its unique advantages such as not requiring consideration of fasting status, non-HDL-C is superior to traditional indicators such as LDL and TG to a certain extent.
Death risk prediction after PCI in patients with coronary heart disease and heart failure based on random forest
HAN Gangfei, TIAN Jing, HE Zixuan, ZHANG Yajing, WU Tingyu, ZHANG Yanbo, HAN Qinghua
2023, 27(4): 425-430. doi: 10.16462/j.cnki.zhjbkz.2023.04.009
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  Objective  The study's objective is to use a random forest algorithm to analyze the influencing factors of death within a year after percutaneous coronary intervention (PCI) in patients with coronary atherosclerotic heart disease (coronary heart disease, CHD) and heart failure (HF).  Methods  A total of 1 078 inpatients who accepted PCI were enrolled from the First Hospital of Shanxi Medical University and Shanxi Cardiovascular Hospital from January 2014 to July 2019. All participants were followed up for 1 year, and death was chosen as the endpoint. A random forest algorithm was used to establish a prognostic model to analyze the influencing factors of death in the first year after PCI.  Results  The random forest model showed that red blood cell distribution width (RDW), heart rate, GLU, plasma albumin, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were the top five influencing factors of death.  Conclusions  RDW, heart rate, GLU, plasma albumin, and NT-proBNP were the top five influencing factors of death within a year after PCI in patients with CHD and HF. Our results provided a theoretical basis for the clinical evaluation of the benefits and risks for patients and the selection of treatment plans for doctors.
Prevalence and determinants of dyslipidemia in Xiangxi minority areas
WANG Haoren, ZHANG Na, TIAN Mengyuan, DING Jian, TAN Hongzhuan
2023, 27(4): 431-436. doi: 10.16462/j.cnki.zhjbkz.2023.04.010
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  Objective  To understand the prevalence of dyslipidemia and its determinants in Xiangxi minority areas and to provide scientific information for the prevention and control of dyslipidemia.  Methods  Using the multi-stage random sampling method, 880 residents≥30 yeas old in Xiangxi minority areas were selected for investigation. Meanwhile, the multivariate logistic regression model was used to analyze the possible determinants.  Results  The prevalence of dyslipidemia was 38.8%, and the prevalence of high total cholesterol, high triglyceride, low high-density lipoprotein cholesterol, and high low-density lipoprotein cholesterol were 7.6%, 18.1%, 23.2%, and 3.9%, respectively. Multivariate logistic regression analysis showed that diabetes mellitus (OR=1.675) and central obesity (OR=2.316) were risk factors for dyslipidemia. While high-intensity physical activity (OR=0.715) and age≥60 years old (OR=0.616) were protective factors for dyslipidemia.  Conclusions  The prevalence of dyslipidemia is high in Xiangxi minority areas, active and targeted measures should be taken to control dyslipidemia.
Mediating effect analysis of smoking on the association between socioeconomic status and hypertriglyceridemia
ZHENG Yang, WU Han, LIU Xiaoxia, WANG Yingquan, LIU Danni, SU Qiuyun, YANG Qundi, SHI Yan, FU Chen
2023, 27(4): 437-442. doi: 10.16462/j.cnki.zhjbkz.2023.04.011
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  Objective  To examine the mediating effects of smoking on the relationship between socioeconomic status (SES) and hypertriglyceridemia, and to further provide the scientific basis for preventing and treating hypertriglyceridemia.  Methods  A total of 5 557 adult residents from the Shanghai Chronic Disease and Risk Factors Surveillance in 2017 were included in the study. The participants were investigated with questionnaires, body measurements, and laboratory testing. The chi-square and Wilcoxon rank sum tests were used to explore the distributional differences in qualitative and quantitative data, respectively. Mediation effect analysis was adopted to study the effects of SES on hypertriglyceridemia mediated by smoking.  Results  SES was associated with smoking (OR=0.86, 95% CI: 0.81-0.91, P < 0.001), and there was a positive association between smoking and hypertriglyceridemia (OR=1.29, 95% CI: 1.04-1.59, P=0.019); SES did not have a direct effect on hypertriglyceridemia, but smoking was found to have a mediating effect on the association between SES and hypertriglyceridemia (Zmediation=-2.086, P=0.037).  Conclusions  The association between SES and hypertriglyceridemia was significantly completely mediated by smoking. Targeted tobacco control measures and campaigns should be carried out for better hypertriglyceridemia prevention.
Association between 24 h urinary sodium excretion, urinary potassium excretion, sodium-potassium ratio and microalbuminuria
PAN Ningning, TAO Xuke, LIU Min, LI Yuan, ZHANG Puhong, BAI Yamin, XU Jianwei
2023, 27(4): 443-447. doi: 10.16462/j.cnki.zhjbkz.2023.04.012
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  Objective  To analyze the association between 24 h urinary sodium excretion, urinary potassium excretion, sodium-potassium ratio, and microalbuminuria (MAU) among general people in China.  Methods  In 2018, a baseline survey was conducted in 12 counties of Heilongjiang, Hebei, Sichuan, Hunan, Jiangxi, and Qinghai Provinces. Subjects aged from 18 to 75 were selected as study subjects. All participants accepted the questionnaire survey, physical measurement, and 24 h urine collection. A multivariate logistic regression model was used to analyze the association between 24 h urinary sodium excretion, urinary potassium excretion, sodium-potassium ratio, and MAU.  Results  A total of 2 604 subjects were finally included in the analysis. The age of subjects was (47.32±12.78) years old, including 1 287 males (49.42%) and 231 (8.87%) MAU. The 24h urine volume was (1 614.80±645.16) ml/d, urinary sodium excretion was (193.07±78.87) mmol/d, urinary potassium excretion was (40.18±16.59) mmol/d, and sodium-potassium ratio was (5.18±2.19), respectively. With the increase of 24 h urinary sodium excretion and sodium-potassium ratio, the prevalence of MAU showed an upward trend (Ptrend < 0.05). Multivariate logistic regression analysis showed that the higher urinary sodium excretion group (Q5) compared to the lowest group (Q1) was associated with an increased risk of MAU (OR=2.211, 95% CI: .359-3.597). Compared with the lowest group (Q1), the higher sodium-potassium ratio group (Q5) was associated with an increased risk of MAU (OR=2.498, 95% CI: 1.546-4.038).  Conclusions  The 24h urinary sodium and sodium-potassium ratio were positively associated with the prevalence of MAU, while 24h urinary potassium excretion is not related to the prevalence of MAU.
Association of microalbuminuria with metabolic syndrome and its components
TAO Xuke, PAN Ningning, LIU Min, JIA Ainan, BAI Yamin, XU Jianwei
2023, 27(4): 448-452. doi: 10.16462/j.cnki.zhjbkz.2023.04.013
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  Objective  To analyze the association of microalbuminuria (MAU) with metabolic syndrome and its components.  Methods  In 2017, data were derived from the final survey of the Shandong Ministry of Health Action on Salt Reduction and Hypertension Project, which was a survey conducted at four sites in the Jiangsu and Shandong Provinces. The participants, which consisted of permanent residents aged 18 to 75 years, were selected through multi-stage cluster random sampling. MAU was measured using the 24 hour urinary albumin excretion. Logistic regression was used to analyze the association between MAU and metabolic syndrome (MS) and its components.  Results  A total of 1 193 participants were included, with a mean age of (49.44±12.59) years. Of these, 558 (46.8%) were males, and 112 (9.4%) had MAU, and 375 (31.4%) had MS. Logistic regression analysis found that compared with the group without MS, group with MS had an increased risk being MAU (OR=3.188, 95% CI: 2.123-4.790). And in MS cases, the central obesity, elevated blood pressure, elevated fasting glucose were positively associated with the risk of MAU after adjusting for relevant factors. Moreover, compared with the group without MS, group with 3, 4 and 5 MS components had an increased risk being MAU (OR=4.839, 95% CI: 2.134-10.976; OR=5.185, 95% CI: 2.153-12.487; OR=7.242, 95% CI: 2.243-23.383), respectively (Ptrend < 0.001), after adjusting for relevant factors.  Conclusions  There is a positive association between MAU and the risk of MS and its components.
Trend analysis of road traffic injuries occurrence in Tianjin from 2006 to 2019
WANG Zhuo, WANG Dezheng, ZHENG Wenlong, ZHANG Shuang, WANG Xiaohe, JIANG Guohong
2023, 27(4): 453-458. doi: 10.16462/j.cnki.zhjbkz.2023.04.014
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  Objective  We aim to understand the long-term trend and distribution characteristics of road traffic injuries(RTI) in Tianjin from 2006 to 2019.  Methods  During 2006-2019, all RTI cases of first-time visit to outpatient, emergency departments and hospitalizations at all levels of healthcare in Tianjin City were collected.  Results  From 2006 to 2019, 415 032 RTI cases were reported in medical institutions at all levels healthcare institution in Tianjin, with a reported incidence of 294.00/100 000. The reported incidence of all causes of injury in Tianjin was 2 313.49/100 000, and the RTI was in third place. The reported incidence of RTI in males and females was 358.18/100 000 and 228.48/100 000, accounting for 61.20% and 38.80%, respectively. Among all RTI patients, 33.02% (137 029 cases) were inpatients, 30.37% (126 031 cases) were outpatients, 27.97% (116 101 cases) were emergency patients, and 8.64% (35 871 cases) were other patients. According to the degree of injury severity, 58.74% were mild, 33.56% were moderate, 7.04% were severe, and 0.67% were fatal. During 2006-2019, in the context of an upward trend in the overall injury incidence in Tianjin City (APC2006-2019=5.33, P < 0.001), the change in RTI was stable (APC2006-2019=1.93, P=0.08). The increasing trend of women (APC2006-2019=2.97%, P=0.001) was more evident than that of men (APC2006-2019=1.31%, P=0.25). The reported incidence of motor vehicle RTI was 233.08/100 000, accounting for 79.41% of total RTI. The reported incidence of non-motor vehicle RTI was 60.45/100 000, accounting for 20.59% of the total RTI. The standardized incidence of motor vehicle RTI showed an increasing trend (APC2006-2019=1.70%, P=0.04), among which it was stable for males (APC2006-2019=0.82%, P=0.29) and increased for females (APC2006-2019=3.22%, P < 0.001). The standardized incidence of non-motor vehicle RTI increased first and then decreased (APC2006-2014=13.02%, P=0.01; APC2014-2019=-14.52%, P=0.05), and the incidence of male increased first and then decreased (APC2006-2014=14.90%, P=0.01; APC2014-2019=-16.25%, P=0.04), while the female was more stable (APC2006-2019=2.51%, P=0.35). The incidence of urban RTI was 231.72/100 000 (APC=0.16, P=0.94), and rural RTI was 357.43/100 000 (APC=3.80%, P < 0.001).  Conclusions  The incidence of RTI was stable, while the total injury incidence showed a significant upward trend from 2006 to 2019 in Tianjin. The motor vehicle RTI incidence showed an upward trend, and non-motor vehicle incidence first increased and then decreased. The motor vehicle RTI incidence of females was increased.
Job burnout and influencing fators among medical staff during COVID-19 epidemic
ZHANG Kun, ZHANG Yifang, QU Yimin, GUI Luting, QIN Dongxu, ZHANG Keyi, YAO Changqiang, JIANG Yu
2023, 27(4): 459-464. doi: 10.16462/j.cnki.zhjbkz.2023.04.015
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  Objective  This study's objective is to understand the occurrence of burnout among medical staff in Dingzhou City, Hebei Province and Qingdao City, Shandong Province and its influencing factors in the context of theCOVID-19 epidemic.  Methods  In a cross-sectional study, a self-administered questionnaire was used to assess the level of medical workers' occupational burnout in Dingzhou City, Hebei Province and Qingdao City, Shandong Province in July-August 2021. The level of occupational burnout was evaluated using the Maslach Burnout Inventory General Survey (MBI-GS). The Kruskal-Wallis H rank sum test and Binary logistics were used to analyze the factors influencing occupational burnout among medical workers.  Results  Among the 982 respondents, 91.1% had occupational burnout, and 71.5% and 19.6% had mild to moderate and severe occupational burnout, respectively. Multivariate analysis showed that job satisfaction was generally or somewhat dissatisfied (OR=3.108, 95% CI: 1.653-5.843). People with passive coping styles were at higher risk for severe occupational burnout (OR=1.129, 95% CI: 1.071-1.191). And people with shorter sleep duration have a lower risk of severe occupational burnout (OR=0.331, 95% CI: 0.166-0.662). In Spearman correlation analysis, positive coping styles and negative coping styles of medical staff were positively correlated with occupational burnout (P < 0.001); While social support and life satisfaction were negatively associated with occupational burnout (P < 0.001).  Conclusions  Most of the medical staff in Dingzhou City, Hebei Province, and Qingdao City, Shandong Province, have high levels of job burnout. Improving care and social support such as work and life satisfaction, is necessary. At the same time, increasing the sense of identity and enthusiasm during COVID-19 epidemic prevention work and enhancing occupational health is essential.
Lactoferrin ameliorates radiation-induced intestinal injury in mice by regulating ferroptosis
GUO Yaxin, XU Jiaying, WEI Wei, LI Deming, QIN Liqiang
2023, 27(4): 465-470. doi: 10.16462/j.cnki.zhjbkz.2023.04.016
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  Objective  To explore the protective effect and mechanism of lactoferrin (Lf) on a radiation-induced intestinal injury.  Methods  Mice were randomly divided into the control group, 10 Gy group, and Lf+10 Gy group. On 7 d before irradiation, the Lf+10 Gy group was given 250 mg/kg Lf by gavage daily. Mice in the 10 Gy group and Lf+10 Gy group received 10 Gy abdominal irradiation. The mice were sacrificed 3.5 d after irradiation, and the samples were collected to determine the related indexes.  Results  Irradiation-induced intestinal injury. Lf intervention restored weight loss, hepatic oxidative stress, and pathological intestinal damage in mice. Lf significantly increased the number of Lgr5 and Ki67 positive cells, reflecting the proliferation and regeneration ability of small intestinal cells. Irradiation-induced ferroptosis in small intestinal tissue. Via the iron metabolism pathway, Lf intervention significantly downregulated the expression of intestinal divalent metal transporter (DMT1) and Fe2+ content; via the GSH/GPX4-lipid peroxidation pathway, Lf intervention significantly upregulated the intestinal solute carrier family 7 members (SLC7A11) and glutathione peroxidase 4 (GPX4) protein expression, downregulated acyl-CoA synthase long chain 4 (ACSL4) protein expression, and reduced malondialdehyde (MDA) levels.  Conclusions  Lf ameliorated radiation-induced intestinal injury, possibly due to the regulation of ferroptosis through iron metabolism and the GSH/GPX4-lipid peroxidation pathway.
Reviews
Research progress on the patterns of multimorbidity
YAN Zeyu, CHEN Dafang
2023, 27(4): 471-475. doi: 10.16462/j.cnki.zhjbkz.2023.04.017
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Abstract:
At present, the prevalence of chronic diseases and the aging of the population have accelerated. Multimorbidity has become a prominent problem, which brings great challenges to the treatment and management of chronic diseases. The study of multimorbidity patterns is performed to explore common disease combinations, which can offer insights into understanding multimorbidity characteristics and guiding clinical treatment. In this study, the progress in studies on multimorbidity patterns is reviewed.
Research progress on cell-mediated immunity post influenza vaccination
XU Qiuyi, LEI Yuxuan, WEN Simin, SHU Yuelong
2023, 27(4): 476-481. doi: 10.16462/j.cnki.zhjbkz.2023.04.018
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Abstract:
Influenza is a major threat to human health, and annual vaccination is an important way to prevent influenza epidemics and reduce disease burden. Current influenza vaccines mainly induce humoral immune responses, and the evaluation for immunogenicity is mainly based on antibody levels, but the induction and evaluation of cell-mediated immunity are scarce, which is an important part of the immune response. In this review, we summarized the results of the cell-mediated immunity induced by vaccines in development, to provide a reference for improving the immunogenicity of influenza vaccines and for the evaluation methods of cell-mediated immunity.
Short Reports
Incidence trend and age-period-cohort analysis of stroke in China from 1990 to 2019
XIONG Wenjing, ZHANG Min, XU Jieru, ZHANG Yiyun, YAO Chengzhi, ZHAO Xiangling, RANG Weiqing
2023, 27(4): 482-488. doi: 10.16462/j.cnki.zhjbkz.2023.04.019
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Abstract:
  Objective  The study aims to analyze the changing trend of the incidence rate of stroke and its subtypes in Chinese population from 1990 to 2019, and to investigate the main subtypes by age-period-cohort (APC).  Methods  The data which including stroke incidence rate and its subtypes at all ages in China from 1990 to 2019 were extracted from the global burden of disease database. The changing trend of the crude and standardized incidence rates was briefly described. The APC model was further applied to analyze the age, period, and cohort effect of the incidence rate of the main stroke subtypes.  Results  From 1990 to 2019, the overall standardized incidence rate of stroke in Chinese population showed a downward trend. However, the long-term change trend of age-standardized incidence rate of ischemic stroke and hemorrhagic stroke was inconsistent. And the age-standardized incidence rate of ischemic stroke and hemorrhagic stroke was significantly higher than that of subarachnoid hemorrhage. The incidence effect coefficient of hemorrhagic stroke gradually increased with the increase of age, with the lowest in the 0- < 5 age group (effect value -3.10) and the highest in the 85- < 90 age group (effect value 1.86). The risk of the latter was 142.45 times than that of the former. The period effect increases first and then decreases with the these years. While the cohort effect decreases with the passage of time. It is worth noting that there has been a small recovery in recent years. The incidence effect coefficient of ischemic stroke in China showed a trend of first decreasing and then rapidly increasing with age. The effect coefficient of the 20- < 25 age group was the lowest (effect value -2.00), and the 80- < 85 age group had the highest effect value (effect value 1.86). The incidence risk of the 80- < 85 age group was 47.45 times than that of the 20- < 25 age group. The period effect increases with years, and the cohort effect showed a downward trend over time.  Conclusions  Although the overall standardized incidence rate of stroke in Chinese population from 1990 to 2019 showed a downward trend, its major subtypes of ischemic stroke showed an upward trend. The older people live get, the greater possibility of stroke they will have. It still needs to strengthen the prevention and control of stroke, especially ischemic stroke.
Analysis of perchlorate exposure level and its effect on thyroid function in the population of Gansu
HUANG Jiating, CHEN Ruidi, JIANG Junyue, ZHANG Lei, WANG Xiaodan, MAO Weifeng, WANG Yu
2023, 27(4): 489-496. doi: 10.16462/j.cnki.zhjbkz.2023.04.020
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Abstract:
  Objective  To explore the association between perchlorate exposure level and thyroid function in the population of Gansu, in order to provide a basis for the prevention and control of perchlorate pollution in the region.  Methods  Using the cross-sectional study design, residents who participated in voluntary clinic in two random communities in Chengguan District, Lanzhou City and Longxi County, Dingxi City, Gansu Province were selected as the subjects of this study, and questionnaires, physical and biochemical examinations were used to collect basic data and relevant information of the subjects. The multivariate linear regression and restricted cubic spline model were used to analyze the association and dose-response relationship between perchlorate exposure levels and thyroid function.  Results  A total of 100 subjects were included in the study, including 48 males and 52 females. The median average exposure level (quartile spacing) of urinary perchlorate was 23.90 (13.30-43.54) μg/g Cr. The results of multivariate linear regression analysis revealed that after adjusting the confounding factors, the level of perchlorate exposure was positively correlated with the level of serum total triiodothyronine (TT3), free triiodothyronine (FT3) and free thyroxine (FT4) levels (all P < 0.05). The restrictive cubic spline model analysis indicated a non-linear dose-response correlation between perchlorate exposure levels with serum total triiodothyronine and free thyroxine levels (all P < 0.05).  Conclusions  The population in Gansu has a high level of perchlorate exposure. There is a correlation between perchlorate exposure levels and serum total triiodothyronine and free thyroxine levels.

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