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CN 34-1304/R ISSN 1674-3679

2021 Vol. 25, No. 3

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Standard-Guideline-Consensus
Guideline on optimal blood pressure range for Chinese oldest old
Chinese Preventive Medicine Association
2021, 25(3): 249-256, 372. doi: 10.16462/j.cnki.zhjbkz.2021.03.001
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Abstract:
Literature Review
Lifestyle and cardiovascular disease
LYU Jun
2021, 25(3): 257-258. doi: 10.16462/j.cnki.zhjbkz.2021.03.002
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Most of the epidemiological evidence about the relationship between lifestyle and cardiovascular disease comes from cohort studies in Western countries. In recent years, there is a rapid increase in the high quality of research evidence relevant to the Chinese. Future research on lifestyle and cardiovascular disease may extend to assess the impact of lifestyle on cardiometabolic multimorbidity, enhance the development and external validation of prediction models for cardiovascular disease risk in the Chinese population, and increase the application of loci identified from genome-wide association studies into epidemiological research.
Lifestyle and Cardiovascular Disease
Association of lifestyle change with incident stroke and its subtypes
ZHANG Hai-qing, HE Mei-an, ZHANG Xiao-min
2021, 25(3): 259-265. doi: 10.16462/j.cnki.zhjbkz.2021.03.003
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  Objective  To explore the association of lifestyle and its changes with incident stroke in the middle-aged and older population.  Methods  A total of 18 293 participants who were free of cardiovascular diseases, cancer, or missing data on lifestyle at baseline were selected and followed until December 2018 from Dongfeng-Tongji cohort. The healthy lifestyle score included the sum of five factors: non-smoking, moderate physical activity, balanced diet, normal weight, and appropriate sleep duration. Cox regression was adopted to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) of lifestyle and its changes with stroke.  Results  During the 9.5- years of follow-up, 1 549 (8.5%) stroke events were documented. Comparing with ≤1 score group at baseline, the HR (95% CI) of stroke was 0.83 (0.72-0.95), 0.72 (0.63-0.83), and 0.54 (0.45-0.66) for those with scores of 2, 3, and ≥4, respectively, after adjustment of confounders. The results of five- year lifestyle change (baseline to 2013 follow-up) showed that maintenance of ≥4 scores in healthy lifestyle had 0.39- fold (HR=0.39, 95% CI: 0.23-0.67) risk for incident stroke, compared to maintenance of ≤1 score group. Increment in healthy lifestyle score from 2-3 to ≥4 had 0.55- fold (HR=0.55, 95% CI: 0.37-0.81) risk of incident stroke; improvement from ≤1 to ≥4 scores showed no protective effects for stroke (HR=1.17, 95% CI: 0.58-2.36).  Conclusions  Among middle-aged and older Chinese adults, early improvement and long-term maintenance of a healthy lifestyle are most beneficial for preventing and controlling stroke.
Progress in research on the association between lifestyle and cardiometabolic multimorbidity
HAN Yu-ting, SUN Zhi-jia, LYU Jun, LI Li-ming
2021, 25(3): 266-270. doi: 10.16462/j.cnki.zhjbkz.2021.03.004
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Multimorbidity is common among the aging population. It significantly decreases the quality of life and increases the complexity and costs for disease treatment and management. With the acceleration of population aging, multimorbidity has gradually become the main threat to health. Prior studies have demonstrated that some diseases often co-occur due to shared risk factors and pathogenic pathways. Cardiometabolic multimorbidity is one of the most common and stable multimorbidity profiles. Adherence to a healthy lifestyle, as a crucial way for health management and disease management, has proven to be efficient for preventing single cardiometabolic diseases. In recent years, researchers have been exploring the association between lifestyle factors and the risk of cardiometabolic multimorbidity. In this article, the definition, distribution, and mechanism of cardiometabolic multimorbidity are reviewed and current evidence from prospective studies on association for the combined lifestyle factors with cardiometabolic multimorbidity is discussed.
Association between lifestyle and incident risk of cardiovascular diseases in Chinese middle-aged and older adults: a review based on Dongfeng-Tongji Cohort
ZHANG Hai-qing, WU Tang-chun, ZHANG Xiao-min
2021, 25(3): 271-275, 283. doi: 10.16462/j.cnki.zhjbkz.2021.03.005
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Chronic diseases including cardiovascular disease (CVD) are becoming more and more serious due to accelerated aging in China. How to reduce the occurrence of CVD has been the primary problem of public health. The association between multiple lifestyles and CVD has been systematically explored based on the Dongfeng-Tongji cohort, which focused on the health of middle-aged and older people. The baseline survey was completed in 2008-2010 and followed-up was executed over 10 years until December 2018. Results showed that single or multiple healthy lifestyles could decrease the risk of CVD. For example, moderate alcohol each time had a 24% reduced risk of coronary heart disease (CHD) than those who never drink. Regular consumption of green tea was associated with an 11% lower risk of CHD compared with no green tea consumption. The risk of CVD could be reduced by 18% when the amount of physical activity was up to 3-5 times of WHO recommended value. Adherence to ≥4 healthy lifestyles had a 39% reduced risk of CVD. The risk of CVD and CHD subsequently decreased by 26% and 20%, respectively, with an improvement to ≥4 healthy lifestyles from 2 during a 5- year period. In contrast, poor lifestyles could increase the risk of CVD. Longer sleep duration was linked with a 33% and 23% increased CHD and stroke, respectively. Napping duration >90 minutes was associated with a 25% elevated risk of both CHD and stroke, respectively. The risk of CVD and CHD increased by 76% and 68%; the risk of stroke increased by 1.54 fold when ≥4 healthy lifestyles were reduced to ≤1. These findings suggest that adherence to multiple healthy lifestyles can reduce the risk of CVD in middle-aged and older adults to a certain extent, providing a theoretical footstone for the formulation of public health policies.
Influence of fruit and vegetable consumption on blood pressure progression among hypertensive patients in rural China
HE Zhi, LIU Fang-chao, LI Jian-xin, CAO Jie, CHEN Ji-chun, HU Dong-sheng, SHEN Chong, GU Shu-jun, ZHAO Ying-xin, HUANG Jian-feng, CHEN Shu-feng, LU Xiang-feng, GU Dong-feng
2021, 25(3): 276-283. doi: 10.16462/j.cnki.zhjbkz.2021.03.006
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  Objective  To evaluate the relationship of fruit and vegetable consumption with blood pressure (BP) progression among hypertensive patients in rural China, using a prospective cohort study.  Methods  Baseline examination of the Community Intervention of Metabolic Syndrome in China & Chinese Family Health Study (CIMIC) was conducted in 2007-2008 to collect information on diet consumption, physical activity, BP, and so on. Participants were followed up during 2012-2015. Diet consumption was calculated from food frequency questionnaires. Participants were divided into two groups by whether meeting the recommended intake of total fruit and vegetable (total F&V), fruit, or vegetable consumption (Yes or No), and were also classified into four groups according to their quartiles (Q1-Q4), respectively. Three stages of hypertension were ascertained according to BP levels, and BP progression was defined as an increment of ≥1 stage of hypertension from baseline to the follow-up visit. Logistic regression models were used to estimate the odds ratios (ORs) and their corresponding confidence intervals (CIs) for the relationship of fruit and vegetable intake with the risk of BP progression.  Results  Among 25 080 participants with hypertension at baseline, 4 112 patients had BP progression during the average follow-up of 5.8 years, with the progression rate of 16.4%. Participants who met the recommended total F&V intake had a 17% (OR=0.83, 95% CI: 0.77-0.90) reduction in the risk of BP progression compared with those who did not. Compared with the lowest group of total F&V consumption (Q1), the ORs (95% CIs) of BP progression were 0.86 (0.78-0.95), 0.77 (0.69-0.86) and 0.69 (0.61-0.77) for the Q2, Q3 and Q4 group, respectively (χ2trend=43.02, P < 0.001). Analyses of vegetable and fruit consumption showed similar results. Furthermore, each increment of 100 g/d in total F&V and vegetable intake was associated with a 4% (OR=0.96, 95% CI: 0.94-0.98) and 5% (OR=0.95, 95% CI: 0.93-0.97) lower risk of BP progression, respectively. The association of fruit with BP progression was not significant (OR=0.97, 95% CI: 0.93-1.01).  Conclusions  Increasing the intake of fruit and vegetable could reduce the risk of BP progression and is beneficial for the management of hypertension patients.
Analysis on the trend of drinking behavior in a healthy physical examination group in urban area of Beijing from 2008 to 2018
CHEN Lu, PAN Lang, LIU Qiu-ping, LIN Yun-xin, WANG Yue-qing, LI Shuo-yu, SUN Dian-jian-yi, LYU Jun, WANG Bo, YU Can-qing, NING Yi, LI Li-ming
2021, 25(3): 284-288. doi: 10.16462/j.cnki.zhjbkz.2021.03.007
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  Objective  To describe the trend of drinking behavior in Beijing among people aged 20 years and above in a physical examination facility during 2008-2018.  Methods  Self-reported semi-quantitative questionnaires were used to collect the information on the drinking behavior of each participant when visiting the facility. Means and percentages were used to describe the characteristics of drinking behavior of the participants, and were standardized according to the Beijing population census in 2010.  Results  From 2008 to 2018, the drinking rate of both men and women decreased significantly, the standardized drinking rate of men dropped by 15.00 percents in the past 10 years, while the corresponding number of women were about 2.00 percents. Men who quit drinking were decreasing by 1 percent over 10 years. Among the daily drinkers, both genders showed a decreasing trend on the alcohol consumption, the number declined 3.21 g/d for men and 1.45 g/d for women over 10 years. Meanwhile, the percentages of excessive drinking and binge drinking decreased by 3.04 percents and 4.53 percents respectively; but such trends were not observed in men.  Conclusions  The drinking behaviors in the physical examination population in Beijing showed a decreasing trend from 2008 to 2018.
Long-term trends in unhealthy diet intake among a health examination population in urban Beijing, 2008-2018
WANG Yue-qing, SUN Dian-jian-yi, PAN Lang, LIU Qiu-ping, LIN Yun-xin, LI Shuo-yu, CHEN Lu, LYU Jun, WANG Bo, YU Can-qing, NING Yi, LI Li-ming
2021, 25(3): 289-294. doi: 10.16462/j.cnki.zhjbkz.2021.03.008
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  Objective  To describe the long-term trends in unhealthy diet intake among a health examination population aged 20 years or older in urban Beijing from 2008 to 2018 and to provide evidence for dietary intervention.  Methods  Data were collected from physical examination records at Beijing MJ Health Screening Center from 2008 to 2018. A semi-quantitative food frequency questionnaire was used to obtain dietary information of unhealthy diet, including average daily intake of sugary drinks, fried food, pickled foods, instant noodles, soy sauce and other salted seasoning. Meta regression was used to describe the long-term trends.  Results  A total of 232 702 person-times were included in the analysis. After standardizing according to gender and age, the average daily intake of fried food of urban residents in Beijing showed an increasing trend from 2008 to 2018, with the increase rate of 0.23 g per year (P < 0.001), while that of instant noodles showed a downward trend, with a decrease rate of 0.26 g per year (P < 0.001). The average daily intake of sugar-sweetened beverages and preserved foods also showed slight downward trends (all P < 0.05), while the change of that of soy sauce and other salted seasoning was not statistical significant (P=0.073). Except for pickled food, the subgroup analysis results showed that trends were more obvious in the younger group in both genders (all P < 0.05).  Conclusions  From 2008 to 2018, the average daily intake of unhealthy diet among Beijing urban residents has changed and the changes was more evident among young people, suggesting that young people may be the focus of population intervention.
Original Articles
Association between cardiovascular and cerebrovascular diseases and cognition among Chinese aged 50 years and older
LIU Qing, HUANG Zhe-zhou, GUO Yan-fei, RUAN Ye, SUN Shuang-yuan, SHI Yan, WU Fan
2021, 25(3): 295-299. doi: 10.16462/j.cnki.zhjbkz.2021.03.009
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  Objective  To investigate the association between cardiovascular and cerebrovascular diseases and cognition among Chinese aged 50 and over.  Methods  Data was collected from the World Health Organization study on global ageing and adult health wave in China. A comprehensive battery of cognitive tests was conducted to assess subjects' cognitive functions, including immediate and delayed verbal recall, digit span and verbal fluency. Cardiovascular and cerebrovascular diseases included hypertension, angina and stroke. General linear model was used to examine the association of cardiovascular and cerebrovascular diseases with cognition.  Results  A total of 12 645 adults aged 50 and over who did cognitive tests and without obvious cognitive impairment were selected as participants. Compared with people without cardiovascular and cerebrovascular diseases, people who only had angina had lower scores in immediate and delayed verbal recall and composite cognition (all P < 0.05). Participants who had both hypertension and angina had lower scores in immediate and delayed verbal recall, digit span, verbal fluency and composite cognition (all P < 0.05). Participants who had both hypertension and stroke had lower scores in immediate and delayed verbal recall, digit span and composite cognition (all P < 0.05). Participants who had both angina and stroke had lower scores in digit span and composite cognition (all P < 0.05). Participants who had all of hypertension, angina and stroke had lower score in digit span (P=0.019). The number of cardiovascular and cerebrovascular diseases was negatively associated with immediate and delayed verbal recall, digit span, verbal fluency and composite cognition (all P < 0.05).  Conclusions  Comorbid cardiovascular and cerebrovascular diseases were associated with worse cognitive function.
Interaction between family history of diabetes and dyslipidemia on risk of diabetes
LI Min, QI Zhi-gang, GU Yun-juan, ZHENG Hui-yan, GE Qi-wei, QIN Gang, WANG Yin-chu, WANG Yu-qi, CHU Min-jie, ZHUANG Xun
2021, 25(3): 300-305. doi: 10.16462/j.cnki.zhjbkz.2021.03.010
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  Objective  To explore the interaction between family history of diabetes and dyslipidemia on the risk of diabetes.  Methods  Based on the data of 13 382 residents surveyed by the project "National Demonstration Zone for Comprehensive Prevention and Control of Chronic Diseases" in Chongchuan District, Nantong City, Jiangsu Province in 2018, 3 209 blood glucose information were obtained. Logistic regression analysis was utilized to analyze the correlation of family history and dyslipidemia on the risk of diabetes, and an additive model was conducted to evaluate the impact of their interaction effect on diabetes. The gender difference of their interaction was also explored.  Results  The prevalence of diabetes was 17.3%, the standardized prevalence was 12.9%. The proportion of individuals who had family history and dyslipidemia was 8.8% and 7.6% respectively. After adjusting confounding factors such as age, smoking, alcohol consumption and high fat diet, it showed that family history and dyslipidemia had synergistic effects on the risk of diabetes. When family history and dyslipidemia existed concurrently, the risk of diabetes for males and females was 15.24 times (95% CI: 4.57-50.82) and 9.84 times (95% CI: 4.58-21.12) higher than normal. In male, the RERI, AP%, S, AP×(AB)% was 6.59, 43.2%, 1.86 and 46.3% respectively; In female, the RERI, AP%, S, AP×(AB)% was 4.22, 42.9%, 1.91, and 47.7% respectively.  Conclusions  Family history of diabetes and dyslipidemia has synergistic impact on risk of diabetes, and the interaction effect among males may be stronger than females.
Correlation between sleep duration and overweight/obesity among children and adolescents aged 7-18 in Henan Province
WANG Yi-ran, HUANG Xiao-pei, YAN Hui, HOU Yu-wei, ZHANG Yao-dong
2021, 25(3): 306-310, 358. doi: 10.16462/j.cnki.zhjbkz.2021.03.011
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  Objective  To analyze the relationship between sleep duration and overweight/obesity among children and adolescents aged 7-18 in Henan Province, in order to provide support for effective control of overweight and obesity.  Methods  Questionnaire survey and physical examination were conducted among 18 823 students with a stratified cluster sampling method in eight cities of Henan Province in 2019. Chi-square test, rank sum test, One-way Analysis of Variance and Logistic regression model were used for data analysis.  Results  Among the respondents, 11 185 were with normal weight, 4 415 were with overweight and 3 223 were with obesity. There were 10 073 boys and 8 750 girls. The average age of the respondents was (11.6±4.1) years old and the average sleep time was (8.19±1.27) h/d. The difference in gender, age and sleep duration among the three groups were statistically significant (all P < 0.001). The detection of overweight and obesity among boys and girls increased with the decrease of sleep duration (all Ptrend < 0.05), and the detection of overweight and obesity in boys was higher than that of girls under different sleep duration (all P < 0.05). Multivariate Logistic regression analysis was performed on the population of elementary school, junior high school and high school population respectively, the results showed that with the decrease of sleep time, the risk of overweight and obesity in children and adolescents increased (all P < 0.05).  Conclusions  Insufficient sleep is a risk factor of overweight and obesity among children and adolescents in Henan Province. Adequate sleep duration can reduce the incidence of overweight and obesity.
A cross-lagged study of somatic symptoms and mental states in patients with chronic heart failure
LI Chen-hao, ZHU Xiao-fang, TIAN Jing, YAN Jing-jing, ZHANG Qing, HAN Qiang, HAN Qing-hua, ZHANG Yan-bo
2021, 25(3): 311-316. doi: 10.16462/j.cnki.zhjbkz.2021.03.012
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  Objective  The cross-lagged regression model was used to investigate the interaction between somatic symptoms and mental states in patients with chronic heart failure (CHF).  Methods  A six-month longitudinal follow-up was conducted amongst 262 patients with chronic heart failure who were admitted to the Department of Cardiology of two of the top three hospitals in Shanxi Province from November 2017 to December 2018. The patient-reported outcomes instrument for CHF (patient-reported outcome measure for chronic heart failure, CHF-PROM) was used for two measurements (T1 and T2), Cross-lagged regression model was used to analyze the relationship between somatic symptoms and mental states.  Results  The physical symptoms and mental states of patients with chronic heart failure were stable. There was a positive correlation between physical symptoms and mental states (r=0.331, P < 0.001; r=0.445, P < 0.001). Cross-lagged regression analysis showed that after controlling for T1 somatic symptoms, T1 mental states could predict T2 somatic symptoms (β=0.163, P=0.010); Further analysis of the psychological state of each dimension showed that T1 anxiety predicted somatic symptoms of T2 (β=0.183, P=0.004) after controlling for T1 somatic symptoms.  Conclusions  Mental states are the antecedents of somatic symptoms, which can positively predict somatic symptoms. Further analysis showed that anxiety is the antecedent variable of somatic symptoms and anxiety has a significant positive predictive effect on somatic symptoms.
Current status and clustering analysis of risk factors in high-risk groups of esophageal cancer in Yangzhong City, Jiangsu Province
FENG Xiang, SONG Tong-qiu, QIAN Dong-fu, ZHOU Qin, SHI Ai-wu, WEI Wen-qiang, ZHOU Jin-yi, HUA Zhao-lai
2021, 25(3): 317-322. doi: 10.16462/j.cnki.zhjbkz.2021.03.013
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  Objective  To analyze the prevalence and clustering of esophageal cancer risk factors and explore the influencing factors of its clustering among high-risk groups of esophageal cancer in Yangzhong, Jiangsu Province.  Methods  Relying on the early diagnosis and treatment of upper gastrointestinal cancer and esophageal cancer-specific disease cohort project, we used multi-stage stratified cluster sampling and 2 591 high-risk populations aged 40 to 69 years old were selected for a one-to-one interview survey. Univariate Logistic regression analysis and multivariate Logistic regression analysis were used to explore the influencing factors of risk clustering.  Results  The prevalence rates of smoking, drinking, hot diet intake, eating too fast, indoor air pollution, teeth loss among participants were 22.27%, 17.79%, 16.79%, 26.94%, 18.45%, 32.15% and 40.22%, respectively. The most common clustering patterns of risk factors were indoor air pollution + teeth loss, smoking + drinking and eating too fast + teeth loss. Multivariate Logistic regression analysis showed that the risk factors clustering was higher among men, older, low-educated, and rural high-risk groups (all P < 0.05).  Conclusions  The exposure of some risk factors among high-risk populations of esophageal cancer in Yangzhong City is still at a relatively high level, and there is an apparent clustering of risk factors. Males, the elder, residents with low education level and in rural areas are the key groups for the prevention and control of esophageal cancer.
A systematic review and Meta-analysis on the carcinogenic risk difference of HBV subtypes
WU Ming-shan, LIU Zhen-qiu, WU Xue-fu, SHI Ting-ting, ZHANG Xin, ZHANG Tie-jun
2021, 25(3): 323-328. doi: 10.16462/j.cnki.zhjbkz.2021.03.014
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  Objective  To explore the risk difference and potential mechanisms on the hepatocellular carcinogenesis of different HBV genotypes.  Methods  Literatures were retrieved from PubMed, Web of Science, Embase databases Wanfang data and CNKI. Data were synthesized by meta-analysis methods. HBV sequences were obtained from NCBI-GenBank and the mutation frequency of different HBV genotypes were calculated.  Results  A total of 1 066 studies were retrieved via literature search. Finally, 17 studies were included in the Meta-analysis after eligibility screening. The total number of study subjects was 16 288, including 3 613 liver cancer patients. Patients with HBV C genotype had a higher risk of liver cancer than genotypes A, B, and D. While no significant difference in the risk of liver cancer across genotypes A, B and D was observed. The frequency of mutations indicated that most mutations were more frequently occurred in genotype C compared with other genotypes.  Conclusions  HBV genotype C is associated with a higher risk of hepatocellular carcinoma than other genotypes, which might due to more risk mutations genotype C HBV possessed.
The spatio-temporal characteristics of hand-foot-mouth disease in Shaanxi Province, 2013-2017
BAI Yao, CHEN Zhi-jun, CHEN Bao-zhong, LIU Kun, SHAO Zhong-jun
2021, 25(3): 329-334. doi: 10.16462/j.cnki.zhjbkz.2021.03.015
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  Objective  To obtain the spatial-temporal dynamical features of hand-foot-mouth disease(HFMD) in Shaanxi Province, so as to provide evidence for the development of relative prevention and control programs on HFMD.  Methods  Surveillance data of HFMD was collected from the China Information System for Diseases Control and Prevention from 2013 to 2017. Related data on population was obtained from Shaanxi Statistical Yearbook. Statistical tools as R 3.4.1, ArcGIS 10.2 and Satscan 9.2 software were used to analyse the spatial-temporal characteristics of the disease.  Results  A total of 284 225 cases of HFMD were reported in Shaanxi Province from 2013 to 2017, with an average annual incidence as 150.45 per 100 000. 70.69% of the total cases were identified between April and July. Counties with high incidence were mainly distributed in the mid-east parts of Guanzhong area(Central Shaanxi Plain). The spatial distribution of severe as well as death cases were basically consistent with the total cases. Through temporal and spatial scan statistics, we identified that there were four hot spots in Shaanxi Province, the most likely clustering area was fixed to the central and southeast counties of Shaanxi province which were around Xi'an City from 2013 to 2017 (RR=2.25, 95% CI: 2.18-3.11, P < 0.001), but the location of the secondary clustering area was not fixed. The predominant epidemic pathogen of HFMD was other enteroviruses from 2013 to 2017.  Conclusions  Significant spatial-temporal aggregation of HFMD was seen in Shaanxi Province. In recent years, other enteroviruses have became the main pathogeny, and multiple pathogens have been circulating alternately. Specific measures should be taken for different periods and regions to control the disease effectively.
Association of body mass index with activities of daily life among middle-aged and older Chinese
LI Hui-qi, ZHOU Yan-feng, PAN An
2021, 25(3): 335-340. doi: 10.16462/j.cnki.zhjbkz.2021.03.016
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  Objective  To examine the association between BMI and the incidence of disability assessed by instrumental activities of daily living (IADL) among middle-aged and older Chinese.  Methods  This study was based on the China health and retirement longitudinal study 2011-2015 (baseline to second follow-up visits). After excluding participants with IADL-defined disability at baseline, 8 955 participants were included in the study. Binary Logistic liner regression model was performed to determine the association bewteen BMI and incidence of IADL-defined disability.  Results  During 4 years of follow-up, 2 186 (24.41%) participants developed disability (18.79% in men and 29.89% in women). The incidence rates of disability were 42.64%, 25.13%, 19.85% and 23.49% in the underweight, normal weight, overweight and obesity groups, respectively. Compared with participants with normal weight, the adjusted odds ratio of disability in participants who were underweight, overweight and obese were 1.381 (95% CI: 1.117-1.707, P=0.003)、0.830 (95% CI: 0.727-0.948, P=0.006) and 0.985 (95% CI: 0.819-1.185, P=0.874), respectively.  Conclusions  Compared with participants with normal weight, underweight was positively associated with risk of disability, and there was an inverse association between overweight and disability, while no significant association was observed between obesity and disability.
Characteristics of population susceptible to hepatitis B infection in Guangzhou, 2008 and 2018
LU Ying, HUANG Yong, WANG Hui, YANG Qiong-ying, ZHANG Zhou-bin, ZHANG Chun-huan
2021, 25(3): 341-345. doi: 10.16462/j.cnki.zhjbkz.2021.03.017
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  Objective  To compare the epidemiological characteristics of hepatitis B virus susceptible population aged 1-59 in Guangzhou in 2008 and 2018, and to evaluate the effect of immunization strategy.  Methods  A two-stage cluster sampling method was used to conduct the seroepidemiological survey of hepatitis B among permanent residents aged 1-59 in Guangzhou in 2008 and 2018.  Results  In the two surveys the prevalence rates of HBV susceptibility were 17.34% (95% CI: 16.29%-18.39%) and 19.77% (95% CI: 18.54%-21.01%) among the population aged 1 to 59 years, and were 23.93% and 36.22% among the population aged 7 to 16 years. The prevalence rates of single anti-HBc positivity were 6.63% (95% CI: 5.94%-7.33%) and 2.76% (95% CI: 1.62%-3.91%) in two surveys among the population aged 1 to 59 years, the difference was statistically significant. The positive rate of single anti-HBc decreased by 81.73% in the population with history of hepatitis B vaccine immunization.  Conclusions  Efforts should be made to strengthen the implementation of catch-up vaccination, booster vaccination and revaccination in susceptible population, including the single anti-HBc positive population.
Epidemiological characteristics and temporal-spatial clustering of scarlet fever in Nanjing from 2014 to 2019
MA Tao, HONG Lei, DU Xue-fei, JIANG Gen, LIU Yan, WANG Jun-jun, XU Qing, WANG Heng-xue, DING Jie, LIN Dan, ZHANG Min
2021, 25(3): 346-351. doi: 10.16462/j.cnki.zhjbkz.2021.03.018
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  Objective  To analyze epidemiological characteristics of scarlet fever in Nanjing, and to explore key regions for prevention and control, in order to provide strategies and measures for control and prevention of scarlet fever.  Methods  Descriptive epidemiologic methods were used to analyze scarlet fever data in Nanjing from 2014 to 2019 from the Chinese Disease Surveillance Information Reporting System. Seasonal index method and time-space rescheduling scanning analysis were used to explore the seasonal distribution and spatio-temporal distribution characteristics.  Results  A total of 1 578 scarlet fever cases were reported in Nanjing from 2014 to 2019, the median cases was 214 (120 to 596). The median reported incidence was 2.55/100 000 (1.47/100 000 to 7.06/100 000) with increasing levels of reported incidence since 2014. The seasonal distribution showed a bimodal pattern with November to January of the following year (seasonal indexs were 1.5, 2.0 and 1.0) and April to June (seasonal indexs were 1.0, 1.9 and 1.4). The median age was 6 (0 to 43) years old. The proportion of cases aged 6 to 10 years old was 61.4%, aged 3 to 5 years old was 32.1%, and aged 0 to 2 years old was 4.0%. The proportion for students was 51.2%, for preschool children was 39.9% and for scattered children was 7.1%. The Jiangbei New Area and Luhe District had a much higher incidence level than the other districts of Nanjing. The reported incidences in 2019 of Jiangbei New Area and Luhe District were 37.78/100 000 (265 cases) and 27.98/100 000 (212 cases), respectively. Nanjing Jiangbei People's Hospital in Jiangbei New Area and Luhe Hospital of Chinese Medicine in Luhe District diagnosed 58.8% and 12.2% of the reported cases, respectively. The spatio-temporal clustering regions were Jiangbei New Area in 2014 to 2018 (RR=19.4, P < 0.001) and Jiangbei New Area, Liuhe District, and Qixia District in 2019 (RR=9.5, P < 0.001).  Conclusions  It's suggested to strengthen the importance and action for prevention and control of scarlet fever, and medical institutions develop training in scarlet fever diagnosis and improve development of appropriate laboratory test capacity. Special investigation should be conducted to investigate the diagnostic quality of scarlet fever in medical institutions.
Review
Research progress of immune-inflammatory response mechanisms in ischemic stroke
LI Xue-li, LIU Zhao, YU Bo-Wen, YANG Hong
2021, 25(3): 352-358. doi: 10.16462/j.cnki.zhjbkz.2021.03.019
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Ischemic stroke is a major disease that causes human death and disability in worldwide. In the early stage of ischemic stroke, danger-/damage-associated molecular patterns (DAMPs) released by injured and dying neurons can induce microglial activation, peripheral immune cell response and increase of inflammatory mediators. This local inflammation leads to the destruction of blood-brain barrier, brain edema and microcirculation disorder, which aggravates secondary brain injury. After the acute phase, various immune cells gradually promote neuronal repairment through phenotypic changes. Combined with stroke induced immunodepression phenomenon, these factors jointly affect the final outcome of stroke. This article reviews the mechanisms of inflammatory response and immune response in the development of ischemic stroke, and provides reference for further researches and development of adjuvant therapy drugs targeting inflammatory injury in ischemic stroke.
Short Reports
Continuous monitoring of evolution and variation of influenza A (H1N1) viruses in Guangzhou, 2017-2019
CAO Lan, LI Kui-biao, CHEN Yi-yun, WU Di, ZENG Qing, XIA Dan, LIU Yan-hui, DI Biao, ZHANG Zhou-bin
2021, 25(3): 359-362. doi: 10.16462/j.cnki.zhjbkz.2021.03.020
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Abstract:
  Objective  The characteristics of the evolution and variation of influenza A (H1N1) viruses in Guangzhou were monitored, which could provide research data for the scientific prevention and control of influenza A (H1N1).  Methods  The Hemagglutinin (HA) and Neuraminidase (NA) genes of 132 isolates of influenza A (H1N1) virus were sequenced isolated in Guangzhou from 2017 to 2019. The molecular characteristics of viruses in different epidemic years were analyzed.  Results  The HA and NA genes of H1N1 epidemic strains were clustered together, suggesting that they had the same evolutionary origin. The isolates in 2019 evolved from the isolates from 2017 to 2018 successively, which showed an obvious trend of evolution. The mutated antigenic sites of HA protein were at 91, 181 and 202 sites. Especially, the antigenic variations of HA protein of H1N1 epidemic strain in 2018 had diversities. In 2017 and 2019, three isolates were detected, which had H274Y resistance mutation of neuraminidase inhibitor.  Conclusions  The match between H1N1 epidemic strains from 2017 to 2019 and vaccine strains in the same year in Guangzhou was good. But, the HA and NA genes were evolving and mutating continuously. Gene polymorphisms were found at antigen sites and drug resistance sites.
Carriage and its influencing factors of Staphylococcus aureus among kindergarten children
CHEN Min-qi, WANG Xu-lin, LI Wen-yu, FU Jin-jian, YE Xiao-hua
2021, 25(3): 363-367. doi: 10.16462/j.cnki.zhjbkz.2021.03.021
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Abstract:
  Objective  To master the carriage rate and its influencing factors of Staphylococcus aureus (S. aureus) in kindergarten children.  Methods  A multi-stage stratified cluster sampling method was used to sample 1 702 healthy children from six kindergartens in Liuzhou City. Nasal swabs were taken and tested for S. aureus. Chi-squared test was used to test carriage rates between groups, and logistic regression was used to analyze the effects of multiple influencing factors.  Results  The nasal carriage rate of S. aureus in children was 16.27%. Multivariate logistic regression analysis showed that age (OR=1.72 for children aged 4 years, OR=2.68 for children aged 5 years, OR=2.95 for children aged 6 years, and OR=4.58 for children aged 7 years), having history of antibiotic use (OR=1.44), and having history of skin and soft tissue infection (OR=1.34) were risk factors for S. aureus carriage, while the nasal carriage of Streptococcus pneumoniae (OR=0.17) was a protective factor.  Conclusions  Older age, history of antibiotic use and history of skin and soft tissue infection are important influencing factors for children S. aureus carriage.
Analysis of etiological characteristics of hand-foot-mouth disease (HFMD) in Lu'an City from 2010 to 2018
YANG Wei, LI Xiu-de, CHANG Hong-wei
2021, 25(3): 368-372. doi: 10.16462/j.cnki.zhjbkz.2021.03.022
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Abstract:
  Objective  The etiogical characteristics of hand-foot-mouth disease (HFMD) in Lu'an City from 2010 to 2018 were analyzed to provide basis for the prevention and control of HFMD.  Methods  Pharyngeal swabs were collected from clinical-diagnosis-case of HFMD in all counties and districts of Lu'an City from 2010 to 2018. Quantitative real-time PCR was used to detect Enterovirus nucleic acid, and the detection results were analyzed.  Results  Among the 2 360 pharyngeal swabs collected from clinical-diagnosis-case of HFMD, 1 085 (45.97%) were positive from Enterovirus. There were 382 (35.21%) of Enterovirus 71 (EV71), 334 (30.78%) of Coxsackievirus A16 (COXA16), 169 (15.58%) of Coxsackievirus A6 (COXA6), 15 (1.38%) of Coxsackievirus A10 (COXA10), and 185 (17.05%) of other Enteroviruses. EV71 was the dominant strain from 2010 to 2014 and 2016 (χ2=188.555, P < 0.001), and COXA6 was the dominant strain in 2015 and 2017 (χ2=258.732, P < 0.001). The positive rate was significantly different in different counties (χ2=68.879, P < 0.001), with the highest rate in Yeji District (81.25%, 52/64), and the lowest rate in Huoqiu County (30.41%, 52/171). The number of patients in 1-3-year-old group was the highest, accounting for 68.11% (739/1 085) of the total positive cases in each age group. Among the 1 085 positive cases, 705 were male and 380 were female, but there was no statistical difference in the positive detection rate (χ2=1.354, P=0.245).  Conclusions  There are various types of HFMD pathogens in Lu'an City, and the dominant strains change every year. Factors such as season, age, region and gender can affect the prevalence of HFMD. Strengthening the monitoring of HFMD pathogen is helpful to prevent and control HFMD.

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