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CN 34-1304/R ISSN 1674-3679

2021 Vol. 25, No. 8

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Literature Review
Research advances in the epidemiology of autoimmune diseases
FANG Xin-yu, LENG Rui-xue, FAN Yin-guang, ZHANG Qin, PAN Hai-feng, YE Dong-qing
2021, 25(8): 869-873. doi: 10.16462/j.cnki.zhjbkz.2021.08.001
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Autoimmune diseases (AIDs) are a heterogeneous group of diseases characterized by the loss of self-tolerance, which leads to prolonged inflammation and subsequent tissue damage. The exact etiology and pathogenesis of this type of disease have not been fully elucidated. As incurable diseases, AIDs significantly affects the labor force and the quality of life of patients and even threatens the lives of cases. Autoimmune diseases have become one of the major health problems worldwide, constituting a heavy burden to society and are often debilitating and disabling for affected individuals. In the past decades, epidemiological research of AIDs has made remarkable achievements, which greatly promoted the diagnosis, treatment, prognosis, and etiology of AIDs. This article provides an overview of the development of AIDs epidemiological research, aiming to offer some new insights and references for the formulation of AIDs prevention and control strategies and future research directions.
Advance in Epidemiologic Studies on Autoimmune Diseases
Identifying rheumatoid diseases-associated gut microbiota using microbiota-related gene set enrichment analysis
HE Pei, WANG Man-li, CAO Rong-rong, DONG Chen-yue, DENG Fei-yan, LEI Shu-feng
2021, 25(8): 874-878,986. doi: 10.16462/j.cnki.zhjbkz.2021.08.002
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  Objective  This study aims to detect the association between gut microbiota and rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS).  Methods  The microbiota-related gene set enrichment analysis (GSEA) was applied to identify rheumatoid diseases-related gut microbiota using published genome-wide association study (GWAS) and GWAS of gut microbiota summary statistic data.  Results  Several associations between three rheumatoid diseases and gut microbiota were identified (all P < 0.05). Thereinto, Ruminococcaceae_UCG-009 was significantly associated with RA, SLE and AS (all P < 0.05). For RA and SLE, association signals were observed for Intestinibacter and Candidatus_Soleaferrea (all P < 0.05).  Conclusion  This study found that part of the gut microbiota could be novel regulators of rheumatoid diseases via the effects of its metabolites, and may provide novel clues for revealing the roles of gut microbiota in rheumatology.
Research advance on the role of meteorological factors in inflammatory immune diseases
CHEN Yue, LENG Rui-xue, PAN Hai-feng
2021, 25(8): 879-884,992. doi: 10.16462/j.cnki.zhjbkz.2021.08.003
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With the intensification of global climate change and human activities, the role of environmental factors in human health is gradually highlighted. Air pollution and meteorological factors, as the main components of environmental factors, have attracted widespread attention to their impact on human health. Inflammatory immune diseases are a group of chronic inflammatory diseases that cause damage to multiple organ systems and are mainly influenced by genetic and environmental factors. Recent studies have shown that the role of air pollutants such as particulate matter, nitrogen dioxide, and ozone are strongly associated with the onset of inflammatory immune diseases. However, the impact of meteorological factors on these diseases remains to be fully elucidated. A large number of epidemiological studies have shown that meteorological factors may induce onset and recurrence of inflammatory immune diseases. The specific mechanism is still not elucidated fully and probably includes oxidative stress, inflammation, production of proinflammatory cytokines, T cell imbalance, etc, eventually leading to multiple organ system damage. In addition, the synergistic or antagonistic effects of meteorological factors and air pollutants, as well as the interaction between environmental factors and genetic susceptibility may influence the development of inflammatory immune diseases. In this review, we summarized the epidemiologic and pathogenic evidence linking meteorological factors to common inflammatory immune diseases. The information obtained may be beneficial for further elucidating the pathogenesis of inflammatory immune disease and making proper preventive strategies for these diseases.
Original Articles
Epidemic trend and spatial distribution characteristics of gonorrhea in Mainland China from 2014 to 2018
YU Li, WANG Yi-hui, WANG Peng-ju, YUAN Yan, CAO Yan-wen, LI Shao-xuan, GAO Yin-yan, DING Guo-wu
2021, 25(8): 885-890,954. doi: 10.16462/j.cnki.zhjbkz.2021.08.004
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  Objective  To explore the epidemic trend and spatial distribution characteristics of gonorrhea in Mainland China from 2014 to 2018, and provide reference for identifying key prevention areas and formulating targeted prevention and control strategies.  Methods  Based on the data of gonorrhea from online reporting system in 31 provinces, municipalities and autonomous regions in Mainland China from 2014 to 2018, the spatial autocorrelation analysis, cold hot spot analysis and Kirging interpolation prediction were conducted by using geographic information system (GIS). The visualization map was drawn by ArcGIS 10.6 software.  Results  The incidence rate of gonorrhea in Mainland China showed an overall upward trend from 2014 to 2018. The spatial distribution of gonorrhea incidence from 2014 to 2018 showed spatial positive correlation (Moran'I=0.335, Z=3.581, P < 0.001), and the hot spots mainly concentrated in the southeast coastal areas including Jiangsu, Shanghai, Zhejiang and Fujian. The Kirging interpolation prediction showed that the incidence rate of gonorrhea from 2014 to 2018 was generally high in the southeast and low in the central and western regions. The regions of high incidence rate were consistent with the hot spot analysis.  Conclusion  From 2014 to 2018, the incidence of gonorrhea in Mainland China showed spatial clustering distribution. And it is necessary to strengthen the prevention and control of gonorrhea in hot spots.
Study on the relationship between early clinical symptoms and prognosis of Japanese encephalitis: based on Group LASSO Logistic regression model
LIU Yan-chen, ZHANG Xiao-shu, CUI Xu-dong, JIN Na, ZHAO Xiang-kai, ZHAO Xin, ZHENG Hong-miao, LI Juan-sheng, SHEN Xi-ping, MENG Lei, REN Xiao-wei
2021, 25(8): 891-897,934. doi: 10.16462/j.cnki.zhjbkz.2021.08.005
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  Objective  To explore the application of Group least absolute shrinkage and selection operator (LASSO) Logistic regression model in the study of the relationship between early clinical symptoms and prognosis of Japanese encephalitis (JE).  Methods  The data on JE in Gansu Province between 2017 to 2018 were collected from the infectious diseases system of China information system for diseases control and prevention. The Group LASSO Logistic regression model of the prognostic factors of JE was established. Punishment parameters were selected through the cross-validation method to screen out early symptoms that affect the prognosis of JE.  Results  Of the 866 included JE patients, 764 had prognostic outcomes, of which 22.5% were dead, 12.6% had sequelae, 17.8% were improved, and 47.1% were cured. The selected variables were consciousness disorder, respiratory failure, changes in respiratory rhythm, increased muscle tone, and history of JE vaccination.  Conclusion  Group LASSO Logistic regression model could be used to screen out early clinical symptoms that have an impact on the prognosis, which is of great significance for early detection of patients who may have a poor prognosis.
Temporal-spatial clustering analysis of pulmonary tuberculosis in Beijing from 2015 to 2019
LIU Yang, GAO Yan-lin, SHI Yun-ping, WANG Chao, XIE Chun-yan, HU Xiao
2021, 25(8): 898-904. doi: 10.16462/j.cnki.zhjbkz.2021.08.006
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  Objective  To understand the spatial and temporal distributions and the clustering areas of pulmonary tuberculosis in Beijing from 2015 to 2019, and to provide evidence for the disease prevention and control.  Methods  Descriptive epidemiologic methods were used to analyze pulmonary tuberculosis data in Beijing from 2015 to 2019 from the Chinese Disease Surveillance Information Reporting System. Time-space rescheduling scanning analysis was used to explore the spatio-temporal distribution characteristics.  Results  In total, 34 271 cases of pulmonary tuberculosis were reported in Beijing from 2015 to 2019, the annual incidence was 31.67 per 100 000. The high incidence period was from March to September every year, then decreased rapidly after a small peak in November and December, and reached the lowest level in February of the following year. The area with the highest reported incidence was Mentougou District, followed by Tongzhou District. The spatio-temporal scanning analysis detected the spatio-temporal aggregation area, when the scanning radius was 5km, the most likely clusters were detected all in Chaoyang district (RR=5.96, 5.86, 5.88, 6.12, 7.17, respectively. all P < 0.001). With the increase of scaning radius, Spatio-temporal clusters of pulmonary tuberculosis tended to move to the south west: Dongcheng, Xicheng, Fengtai and Shijingshan.   Conclusions  There were obvious spatiotemporal clusters of pulmonary tuberculosis in Beijing from 2015 to 2019. The high incidence areas were Chaoyang, Xicheng, Dongcheng, Fengtai and Shijingshan, and there was a trend of diffution in neighboring areas of the most likely gathering districts. Monitoring in key areas should be strengthened, and targeted prevention and control measures should be carried out.
A dynamical model study on the transmission of COVID-19 in Urumqi City
LIAO Ying, ZHANG Xue-liang, JIAO Hai-yan, WANG Lei
2021, 25(8): 905-911, 922. doi: 10.16462/j.cnki.zhjbkz.2021.08.007
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  Objective  To fit the epidemic situation of COVID-19 in Urumqi City, Xinjiang Uygur Autonomous Region in July 2020, so as to provide the quantitative and theoretical basis for the prevention and control of epidemic.  Methods  A dynamical model with stage control strategy was proposed using compartmental modeling method, based on the tracking and isolation measures taken during the COVID-19 epidemic in July 2020 in Urumqi City. The nonlinear least square method was applied to fit this dynamical model by using multi-source data: the cumulative number of confirmed cases, cured cases and asymptomatic cases of COVID-19 from Health Committee of Xinjiang from July to September 2020.  Results  The parameters of the model were estimated as follows: the rate of diagnosis was 0.6, the infectivity coefficients of latent exposure group and asymptomatic infection group were 0.78 and 0.99 respectively, and the proportion of asymptomatic infection group was 0.4. Parameter sensitivity analysis showed that increasing close tracking and isolation and reducing contact could effectively control the number of new confirmed cases.  Conclusion  The results show that the model has good fitting effect with the actual data; asymptomatic infection is more infectious; the trend of daily effective reproduction number shows that the government control measures are appropriate with great effect; the relevant departments should increase the close tracking and isolation, and continuously emphasize that reducing contact can effectively control the epidemic of COVID-19.
A report on vector surveillance in Guangzhou from 2017 to 2019
HE Tao, LI Xiao-ning, CHEN Zong-qiu, JIANG Yi-min, LIU Jie, Wang Xiu-juan, YANG Zhi-cong
2021, 25(8): 912-917. doi: 10.16462/j.cnki.zhjbkz.2021.08.008
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  Objective  To understand the composition, density and seasonal fluctuation of vector populations in Guangzhou in recent years, so as to provide scientific basis for vector control.  Methods  According to the "National Vector Monitoring Program" and "Guangzhou Vector Monitoring Program", a monthly monitoring of mouses, cockroaches, mosquitoes and flies was carried out in Guangzhou from 2017 to 2019, and the vector density and seasonal fluctuation of different habitats were statistically analyzed.  Results  From 2017 to 2019, the overall mouses density was 2.42%. The highest overall density of mouses was in urban residential area, with the peak of its density concentrated in August to October. The overall cockroach infestation rate was 13.79% and the overall density was 0.58 insects per sheet. In three years, the infestation rate and density of cockroaches were higher in farmer's market than other habitats (P < 0.001). The peaks in cockroach infestation rate and density in farmer's market were in September and October, respectively. The overall adult mosquito density was 2.75 mosquitoes per (lamp·night), and statistically significant differences were found in adult mosquito density among different habitats in three years (χ2 =51.277, P < 0.001). The density of adult mosquitoes in farm household and livestock shed was higher than that in urban habitats, and the peaks were in April and July, respectively. The total fly density was 1.17 flies per cage, and the difference of fly density among different habitats in three years was statistically significant (χ2 =22.427, P < 0.001). The highest fly density was in the farmer's market from 2017 to 2019, and its peak was concentrated in August.  Conclusion  The vector density and seasonal fluctuation trends of different habitats in Guangzhou are different. Long-term, systematic and continuous vector monitoring and control should be carried out in accordance with actual conditions.
Investigation on infectious disease-specific health literacy of Chinese expatriates in engineering construction enterprises
XIE Yan, ZHANG Xue-jun, XIE Zheng, HUANG Yang-mu
2021, 25(8): 918-922. doi: 10.16462/j.cnki.zhjbkz.2021.08.009
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  Objective  To investigate the infectious disease-specific health literacy (IDSHL) level of Chinese expatriates in engineering construction enterprises and its influencing factors, providing evidence-based recommendation for infection prevention and control practices.  Methods  A cluster sampling design was adopted to select employees of China National Petroleum Pipeline Engineering Corporation who participated in overseas training from September to December 2019. A self-designed questionnaire was conducted to explore the IDSHL level and influencing factors among employees.  Results  Overall, the employee's IDSHL rate was 51.5%. Univariate analysis showed that the IDSHL rate of female employees was higher than that of male employees (χ2 =4.559, P=0.045), IDSHL rate of those aged < 50 was higher than those aged ≥50 (χ2 =6.027, P=0.015), and IDSHL rate of managers was higher than operators (χ2 =53.025, P < 0.001). Multivariate logistic regression analysis showed that education level and occupation type were the main factors influencing IDSHL. Compared with employees with primary school education, IDSHL rates were higher in those with junior high school (OR=3.847, 95% CI: 0.476-31.086, P=0.206), high school/technical secondary school/vocational high school (OR=7.439, 95% CI: 0.932-59.377, P=0.058), junior college/ university (OR=15.887, 95% CI: 1.992-126.673, P=0.009) education and those have master's degree or above (OR=14.581, 95% CI: 1.681-126.479, P=0.015). IDSHL rates of managers were higher than operators (OR=1.588, 95% CI: 1.105-2.281, P=0.012).  Conclusion  The IDSHL level of Chinese expatriates in engineering construction enterprises is relatively low, and the main influencing factors are education level, occupation type and age. Our study recommends that enterprises should carry out health education training on infectious diseases prevention and control before their employees go abroad. The training should pay more attention on those with high school education or less, operators and employees over 50 years old.
Smoking affects the development of rheumatoid arthritis through the IRF4 signaling pathway
LIANG Xin-tong, QIAN Long, CHENG Lin, LI Dong-xu, XU Zhou-zhou
2021, 25(8): 923-927,961. doi: 10.16462/j.cnki.zhjbkz.2021.08.010
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  Objective  To compare the expression levels of interferon regulatory factor 4 (IRF4) and Rho-associated protein kinase 2 (ROCK2) mRNA in peripheral blood mononuclear cell (PBMC) of smoking and non-smoking rheumatoid arthritis (RA) patients and healthy control (HC) subjects, and to investigate whether smoking is involved in RA pathogenesis through the IRF4 signaling pathway.  Methods  Real-time fluorescence quantitative PCR (RT-qPCR) method was used to detect the expression levels of aryl hydrocarbon receptor (AHR), cytochrome P4501A1 (CYP1A1) and ROCK2, IRF4 mRNA in PBMC, and to analyze the correlation between ROCK2, IRF4 mRNA and AHR, CYP1A1 mRNA expression levels, as well as the correlation between the expression levels of each mRNA and clinical indicators such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-cyclic citrulline peptide antibody (A-CCP), rheumatoid factor (RF) and disease activity score in 28 joints scores in RA patients.  Results  ROCK2 and IRF4 mRNA expressions were higher in RA group than in HC group, and the differences were statistically significant (all P < 0.05); IRF4 mRNA expression levels was higher in RA smoking group than in RA non-smoking group, and the difference was statistically significant (P=0.011); IRF4 mRNA expression levels in PBMC of healthy smokers was higher than that of healthy non-smokers, and the difference was statistically significant (P=0.004). CYP1A1 mRNA was positively correlated with ROCK2 and IRF4 mRNA expression levels in the RA smoking group, while ROCK2 and IRF4 mRNA expression levels were positively correlated with ESR, A-CCP, RF and swollen joint count. Conclusions ROCK2 and IRF4 mRNA expression levels was increased in PBMC of RA patients, suggesting that both may be involved in the pathogenesis of RA. Smoking may be involved in the pathogenesis of RA by activating AHR leading to high IRF4 expression.
Identification for biomarkers of skin lesions and lupus nephritis in patients with systemic lupus erythematosus
XIA Yuan-rui, FAN Yin-guang, FANG Xin-yu, YE Dong-qing
2021, 25(8): 928-934. doi: 10.16462/j.cnki.zhjbkz.2021.08.011
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  Objective  To explore protein biomarkers of skin lesions and lupus nephritis (LN) in patients with systemic lupus erythematosus (SLE), so as to provide evidence for diagnosis and control of the SLE.  Methods  High-throughput protein chip technology was used to identify serum protein biomarkers for SLE, and the biomarkers were analyzed individually and jointly for the two complications of skin lesions and LN to find the best diagnostic indicators.  Results  The separate indicators transcription factor 5 (SP5), ribosomal protein L7a (RPL7A) and combined panel of (RPL7A +small nuclear ribonucleoprotein polypeptide C(SNRPC)) had the highest diagnostic value between skin lesions group and its control group. Compared with non-LN group, SP5 and (SP5+ribosomal protein L35(RPL35)) had the highest diagnostic value in LN group.  Conclusion  SP5 can be used as a protein biomarker for diagnosis of skin lesions and LN in SLE patients.
Diagnostic value of IP-10 in rheumatoid arthritis: a systematic review and Meta-analysis
LI Qing-ru, FANG Xin-yu, XIA Yuan-rui, GUO Heng-sheng, WANG Jun-ping, MAO Yan-mei, SHUAI Zong-wen, YE Dong-qing
2021, 25(8): 935-942. doi: 10.16462/j.cnki.zhjbkz.2021.08.012
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  Objective  We aimed to analyze the changes of interferon-inducible protein 10 (IP-10) in rheumatoid arthritis (RA) and evaluate the diagnostic value of IP-10 in RA and its correlation with disease activity.  Methods  We collected articles related to our research topic through an electronic literature search from the Cochrane Library, Scopus, and Pubmed (up to Sep16th, 2020). Quality assessment of diagnostic accuracy studies (QUADAS-2) tool was used to assess the quality of collected articles, and quantitative and comprehensive analysis was conducted.  Results  17 studies were finally included in this study. IP-10 level in RA patients was higher than health controls [pooled standard mean difference (SMD) = 0.93, 95% CI= 0.51-1.35]. Besides, IP-10 levels in RA patients differed from osteoarthritis (OA) controls, with a pooled SMD and 95% CI being 3.84 (0.76-6.92). We found no significant difference in IP-10 levels between RA patients and systemic lupus erythematosus (SLE) controls. The pooled diagnostic odds ratio (DOR) value for IP-10 to diagnose RA was 65.70 (1.52-2 844.43) and AUC value was 0.899 6.  Conclusion  IP-10 levels differ from RA patients to HC and OA controls, it may be a potential diagnostic biomarker.
Role of RIPK1 in the pathogenesis of rheumatoid arthritis and analysis of its geneticsusceptibility
LI Xin-ya, LIU Ya-lin, TANG Yu-jie, LI Xiao-lin, TAO Jin-hui
2021, 25(8): 943-947. doi: 10.16462/j.cnki.zhjbkz.2021.08.013
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  Objective  To analyze the role of receptor interacting protein kinase 1 (RIPK1) in the pathogenesis of rheumatoid arthritis (RA) and exploring the association between gene polymorphism and genetic susceptibility to RA.  Methods  The mRNA level of RIPK1 in peripheral blood mononuclear cells (PBMC) of RA and healthy controls was detected by quantitative real-time PCR (qRT-PCR), and its role in the pathogenesis of RA was analyzed. Single nucleotide polymorphism (SNP) sites were screened in RIPK1 regulatory region and protein modification functional region, which include rs111393904, rs115041708, rs1158343326, rs116040763, rs11660010, rs116696494, rs1186968649, rs1189800403, rs1193251671, rs1255389565, rs138277932, rs17548629, rs200610530, rs547953577, rs557588787, rs561972571, rs760405932, rs77736895 and rs934053809. The association between RIPK1 gene polymorphism and RA susceptibility was analyzed by iMLDR.  Results  A total of 88 RA patients and 85 healthy controls were selected, and the expression level of RIPK1 gene in the samples was analyzed. It was found that the expression level of RIPK1 gene in the RA group was lower than that in the healthy control group (Z=3.152, P < 0.000 1). According to the active degree, RA patients were divided into RA active group (50 cases) and RA stable group (38 cases). It was found that the expression level of RIPK1 gene in the RA active group was lower than that in the RA stable group (Z=2.987, P=0.008 4) and healthy control group (Z=4.247, P < 0.000 1). There was no significant difference exist between the RA disease stable group and the healthy control group (Z=0.584, P>0.999 0). A total of 103 RA patients and 90 healthy controls were selected to extract DNA from the PBMC of each group. The genotyping results showed that the difference in genotype and allele frequency of the above SNP loci in RIPK1 gene in RA patients was not statistically significance compared with the healthy controls (all P>0.05).  Conclusion  RIPK1 may have a protective effect on RA disease activity, but its genetic polymorphism may not be associated with RA genetic susceptibility.
Analysis of healthy lifestyle status of 22 083 high-risk populations of cardiovascular disease in Jiangsu Province
PAN Zi-rui, SUN Zhong-ming, WEN Jin-bo, QIN Yu, SU Jian, CUI Lan, ZHOU Jin-yi, WU Ming, TAO Ran
2021, 25(8): 948-954. doi: 10.16462/j.cnki.zhjbkz.2021.08.014
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  Objective  To investigate the distribution characteristics of healthy lifestyle in urban and rural high-risk populations of cardiovascular disease (CVD)in Jiangsu Province.  Methods  Based on the data of national CVD screening and comprehensive intervention project during 2015-2018 in Jiangsu Province, we analyzed the healthy lifestyle status and its distribution among high-risk population of CVD in Jiangsu province.  Results  Among the 22 083 high-risk populations of CVD, the proportions of participants with non-smoking, non-excessive drinking, healthy diet, active physical activity, healthy weight and healthy body fat were 79.85%, 91.55%, 8.31%, 25.02%, 24.41% and 28.24%, respectively. The average score of healthy lifestyle was (2.57±1.05) points among all participants. 84.96% of the participants had 2-4 healthy lifestyles, and only 0.20% had all healthy lifestyles. The results indicated that participants of female, in low age group, of rural residents and with high education were more likely having high proportion of 4 or more healthy lifestyles when compared with its corresponding groups (all P < 0.05). Among the 4 types of high risk, participants with high blood pressure had the highest score (2.58±1.04), and participants with the risk of CVD ≥20% had the lowest score (2.38±1.04).  Conclusion  Participants with high risk of CVD had extremely low proportion of related lifestyles that are healthy in Jiangsu Province. Different groups and regions of participants with high risk of CVD had a statistical different healthy lifestyle. Comprehensive intervention measures should be taken to prevent the transition of participants from high-risk to disease.
Study on the association between pulse pressure and renal function decline among middle-aged and elderly people
YANG Xue-ying, TIAN Jing, DAI Qiao-yun, WANG Yong-hong, ZHANG Jun-hui, JIAO Kai-lei, MA Xu, ZHAO Jun
2021, 25(8): 955-961. doi: 10.16462/j.cnki.zhjbkz.2021.08.015
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  Objective  To explore the association between pulse pressure (PP) and renal function decline among middle-aged and elderly people.  Methods  A total of 46 605 middle-aged and elderly people (aged ≥45 years old) who participated in the physical examination in the First Affiliated Hospital of Chongqing Medical University from January 1, 2015 to December 31, 2019 were selected as the study objects. According to their PP levels, they were divided into four groups (PP < 40 mm Hg, 40- < 50 mm Hg, 50- < 60 mm Hg, and ≥60 mm Hg). Unconditional Logistic regression model was used to analyze the association between PP and renal function decline.  Results  The age of the 46 605 people included in this study was 54(48, 60) years old, and 27.37% of them had renal function decline (26.45% were mild, and 0.92% were moderate-severe). Compared with the same age group, the risk of renal function decline increased by 11% and 28% in PP < 40 mm Hg and PP≥60 mm Hg groups among middle-aged and elderly people, respectively. The results of age stratification analysis showed that among middle-aged people aged 45- < 60 years old, the risk of renal function decline increased by 13% (OR=1.13, 95% CI: 1.05-1.22) only in the PP < 40 mm Hg group, while among elderly people aged ≥60 years old, the risk increased by 12% (OR=1.12, 95% CI: 1.02-1.24) and 66% (OR=1.66, 95% CI: 1.48-1.86) in the PP=50- < 60 mm Hg and PP≥60 mm Hg groups, respectively. Restrictive cubic spline results suggested that the association between PP and renal function decline was non-linear, and the risk of renal function decline increased when PP < 42 mm Hg in middle-aged people and PP>55 mm Hg in elderly people. The results of correlation analysis between PP and different degrees of renal function decline showed that the risk of mild renal function decline was increased by 13% (OR=1.13, 95% CI: 1.05-1.22) only in middle-aged people with PP < 40 mm Hg group, while the risk of mild renal function decline was increased by 11%(OR=1.11, 95% CI: 1.01-1.23) in elderly people with PP=50- < 60 mm Hg group, and the risk of mild and moderate-severe renal function decline was increased by 61%(OR=1.61, 95% CI: 1.43-1.81)and 179%(OR=2.79, 95% CI: 1.94-4.02) in elderly people with PP≥60 mm Hg group, respectively.  Conclusions  The effect of PP on the risk of renal function decline and its degrees was not the same in middle-aged people and elderly people. Special attention should be paid to the renal function of middle-aged people with decreased PP and elderly people with increased PP.
Joint frailty models for zero-inflated analysis of different outcomes in patients with coronary heart disease complicated with chronic heart failure
LI Jing, TIAN Jing, YAN Jing-jing, REN Jia, HAN Qing-hua, ZHANG Yan-bo
2021, 25(8): 962-967. doi: 10.16462/j.cnki.zhjbkz.2021.08.016
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  Objective  Joint frailty models for zero-inflated was established to explore the influential factors of different outcomes for patients with coronary heart disease complicated with chronic heart failure to reduce the incidence of adverse outcomes.  Methods  The sample includes patients with coronary heart disease complicated with chronic heart failure in two tertiary hospitals of Shanxi Province from 2014 to 2015. The electronic medical record information of patients during hospitalization and their follow-up information were collected, and joint frailty models for zero-inflated was established to analyze the influential factors.  Results  A total of 2 221 patients were included in this study. 1 312 patients had no incident (59.07%), 669 patients were re-hospitalized (31.47%) and 307 patients died (13.82%). Gender, occupation and BMI were common influential factors for different outcomes of patients with coronary heart disease complicated with chronic heart failure. Old myocardial infarction and prolonged QRS interval were influential factors to reduce the possibility of patients not being hospitalized again. Advanced age, NYHA grade ≥ Ⅲ and valvular disease were risk factors for rehospitalization and death. Prolonged QRS interval was a risk factor of death; on the contrary, coronary artery bypass grafting was a protective factor to reduce mortality.  Conclusions  Joint frailty models for zero-inflated can analyze the influential factors of non-rehospitalization, rehospitalization and death for patients with coronary heart disease complicated with chronic heart failure simultaneously, and provide a theoretical reference for the identification, intervention and treatment of high-risk patients.
Analysis of factors associated with diabetes mellitus in Shanxi Province based on Bayesian network model
WANG Xu-chun, ZHAI Meng-meng, REN Hao, LI Mei-chen, QUAN Di-chen, ZHANG Jie, CHEN Li-min, QIU Li-xia
2021, 25(8): 968-974. doi: 10.16462/j.cnki.zhjbkz.2021.08.017
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  Objective  For the survey data on diabetes in Shanxi Province in 2015, a Bayesian network model of diabetes-related factors was constructed using the max-min hill-climbing (MMHC) algorithm to explore the network relationships between diabetes and its related factors, and the strength of each influencing factor on diabetes was reflected through network model inference.  Methods  Single-factor analysis and multi-factor logistic regressions were used to initially screen the variables for survey data on diabetes mellitus among residents aged 18 years and above in Shanxi Province. Afterwards, a Bayesian network was constructed with the MMHC algorithm, and the parameters were estimated by great likelihood estimation.  Results  The detection rate of diabetes mellitus in Shanxi Province in 2015 stood at 9.5%. After logistic regression feature screening, eight variables, namely age, occupation, average daily oil intake, hypertension, hyperlipidaemia, BMI and heart rate, were finally entered into the model. The Bayesian network model demonstrated that age, hyperlipidaemia and hypertension were directly related to diabetes; BMI was indirectly related to diabetes by hyperlipidaemia, and the average daily oil intake indirectly affected diabetes by BMI and hyperlipidaemia.  Conclusion  Bayesian network models can well reveal the complex network relationships between diabetes and its associated factors and have a good applicability and prospects in the analysis of disease-related factors.
Relationship between medium-chain saturated fatty acids and risk of oral cancer
SU Jue, LI Yan-ni, FAN Yi, WANG Si-jie, XU Ming-ming, ZHOU Nan, HE Qi-xuan, YU Dao-xuan, LYU Ji-rong, CHEN Qing, WANG Jing, SHI Bin, QIU Yu, LIN Li-song, ZHENG Xiao-yan, PAN Li-zhen, CHEN Fa, HE Bao-chang, LIU Feng-qiong
2021, 25(8): 975-980. doi: 10.16462/j.cnki.zhjbkz.2021.08.018
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Abstract:
  Objective  To investigate the association between dietary medium-chain saturated fatty acids and the risk of oral cancer.  Methods  A case-control study was conducted in 225 patients with diagnosed oral cancer and 527 controls. All participants were recruited from the First Affiliated Hospital of Fujian Medical University from November 14, 2013 to March 21, 2019. The median daily intake of all kinds of fatty acids after energy correction in the control group was divided into groups. Unconditional Logistic regression analysis stratified analysis and multiplicative interaction analysis were performed, stratified analysis and multiplicative interaction analysis were performed to investigate the relationship between medium chain saturated fatty acids and the risk of oral cancer.  Results  Compared with the low-level group, the total medium-chain saturated fatty acids, octanoic acid, decanoic acid, undecanoic acid and lauric acid in the high-level group may increase the risk of oral cancer. The adjusted OR and 95% CI were 3.19 (95% CI: 2.17-4.69), 2.54 (95% CI: 1.75-3.69)、2.56 (95% CI: 1.76-3.71)、5.00 (95% CI: 3.27-7.64) and 3.09 (95% CI: 2.10-4.54), respectively. Stratified analysis showed that octanoic acid and decanoic acid were risk factors of oral cancer among non-smokers, and they may also increased the risk of oral cancer regardless of drinking status. There was a positive correlation between the daily intake of total medium-chain saturated fatty acids, undecanoic acid and lauric acid and the risk for oral cancer regardless of smoking and drinking status. In addition, there were multiplicative interactions between medium-chain saturated fatty acids and smoking or drinking status.  Conclusion  A higher level of dietary medium-chain saturated fatty acids may increase the risk of oral cancer.
Prevalence and development of mental disability in mega cities in China
LUO Ya-nan, PANG Li-hua, GUO Chao, ZHENG Xiao-ying
2021, 25(8): 981-986. doi: 10.16462/j.cnki.zhjbkz.2021.08.019
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Abstract:
  Objective  To study the prevalence and the historical development trend of mental disability in mega cities in China.  Methods  Using the Second National Disability Sample Survey in 2006, this study analyzed the demographic characteristics and the prevalence of mental disability in inner city areas and outer suburban areas of Chinese mega cities. Based on the demographic analysis technique and epidemiological analysis, this study investigated the historical development trend of the prevalence of mental disability in mega cities.  Results  The prevalence rate of mental disability in mega city areas was 0.66%, which was higher than the national average (0.63%). The prevalence of mental disability among suburban residents (0.63%) was lower than that of inner city areas residents (0.71%). Since the founding of the People's Republic of China, the prevalence of mental disability in mega cities has been on the rise. Before the reform and opening up, there was a relatively stable upward trend of the prevalence, while after that, this upward speed increased sharply.  Conclusions  The prevalence of mental disability in mega cities is higher than the national average. In mega cities, the prevalence of mental disability in inner city areas are larger than those in the suburbs. Since the founding of the People's Republic of China, the trend of the prevalence of mental disability in mega cities presented "stable upward" to "rapid rise".
Short Report
Study on iodine nutritional status of residents with different water iodine concentrations in areas supplying non-iodized salt
XU Xian, YU Chen, TIAN Cui-cui, XU Shu-dong, LIU Ting-ting, LI Wei-dong
2021, 25(8): 987-992. doi: 10.16462/j.cnki.zhjbkz.2021.08.020
Abstract(343) HTML (162) PDF(43)
Abstract:
  Objective  To explore the scope of non-iodized salt supply, and to investigate the iodine nutritional status of residents in non-iodized salt supply areas.  Methods  The urinary iodine level, thyroid volume and nodules, thyroid hormones and antibodies of adults aged 18- < 60, children aged 8- < 10 and pregnant women in villages with 4 water iodine concentrations (100- < 150 μg/L、90- < 100 μg/L、80- < 90 μg/L、70- < 80 μg/L) were investigated.  Results  A total of 822 adults, 793 children, and 87 pregnant women were surveyed. The urine iodine levels of children and adults exceeded the appropriate level in the 4 water iodine groups. The urine iodine of pregnant women was at an appropriate level except for the 70- < 80 μg/L water iodine group. All three groups were at a level greater than the appropriate amount. There was a positive relationship between urinary iodine value and drinking water iodine content in children (χ2=25.703, P < 0.001) and adults (χ2= 13.139, P=0.004) group. There was no significant difference in urine iodine concentration among pregnant women in different water iodine groups (χ2=5.178, P=0.159). The rate of goiter in children was 20.8%, and there was no significant difference in the rate of thyroid gland in children between different water iodine groups (χ2=6.361, P=0.095). The incidence of adult thyroid nodules was 16.0%, and the incidence of human thyroid nodules with different water iodine composition and there was no significant difference in the incidence of adult thyroid nodules among different water iodine groups (χ2=2.863, P=0.413). There was no significant difference in the abnormal rates of TSH, PT4, TgAb and TPOAb between pregnant women and adults in different water iodine groups (Fisher test, all P>0.05).  Conclusion  Uniodized salt should be used in areas with the drinking water iodine>70 μg/L, and the supply of uniodized salt should be strictly implemented in administrative villages with the water iodine>100 μg/L. Pregnant women can appropriately take iodine rich food to supplement iodine in areas with water iodine content of 70- < 80 μg/L.

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