中华疾病控制杂志

The applicability of the global activity limitation indicator in the elderly population of China

ZHANG Wenling, CAI Yue, JIANG Yu

2024, 28(9): 993-998. doi: 10.16462/j.cnki.zhjbkz.2024.09.001

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Objective To compare other health measurement indicators and verify the effectiveness of the global activity limitation indicator (GALI) to measure activity limitations in the elderly population in China, providing a basis for promoting the application of GALI in China. Methods Using data from the 2018 Chinese longitudinal healthy longevity survey (CLHLS), logistic regression and predictive models were used to analyze the correlation between GALI and activities of daily living (ADL), instrumental activities of daily living (IADL), and physical performance test (PPT). Additionally, the study explored the association between GALI and depressive symptoms. Results The logistic regression results showed that the GALI activity was significantly associated with those who reported one or more ADL limitations (OR=13.355, 95% CI: 12.471-14.311), IADL limitations (OR=5.321, 95% CI: 5.085-5.567), and physical dysfunction as measured by PPT (OR=4.073, 95% CI: 3.905-4.249), respectively (all P < 0.001). Individuals with depressive symptoms were more likely to report GALI limitation (OR=2.311, 95% CI: 2.211-2.416, P < 0.001). Conclusions GALI proves to be an effective instrument for assessing the general status of physical activity limitations among the elderly in China. And it may also reflect the impact of psychological factors, such as depressive symptoms. Thus, it has certain application prospects in China′s health measurement and monitoring index system.

Study of the impact of experiencing early parental death on the lifespan of the elderly in China

SHEN Wenda, ZHANG Xuxi, SUN Xinying, FENG Xinglin, ZENG Yi

2024, 28(9): 999-1004. doi: 10.16462/j.cnki.zhjbkz.2024.09.002

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Objective To explore the impact of early parental death (i.e., death of father or mother) on the life span of the elderly in China. Methods The tracking data from the Chinese longitudinal healthy longevity survey (CLHLS) from 2002 to 2021 were utilized to acquire information on individual mortality/loss to follow-up outcomes and variables such as early parental death. Differences between groups were assessed using the χ² test. Univariate survival analysis employed the Kaplan-Meier method, while multivariate survival analysis employed the accelerated failure time model(AFT), with the risk of occurrence expressed as the time ratio (TR). Sensitivity analysis was conducted by multiple linear regression. Results A total of 10 278 individuals were recruited as study participants, of whom 7 738 passed away, with an average age of 92.49±9.35 years. 358 survived and 2 182 were lost to follow-up. The Kaplan-Meier analysis revealed a P-value of 0.002 and the median survival time for non-early parental death was 95 years old (95% CI: 94.654-95.346) whereas the median survival time for early parental death was 94 years old (95% CI: 93.494-94.506). with the difference was statistically significant. After adjusting for control variables, the AFT model analysis indicated that the average lifespan of those who had experienced early parental death was 0.994 2 that of those who had not (95% CI: 0.990 3-0.998 2, P=0.004), indicating that experiencing early parental death reduces an individual′s average lifespan by 0.58%. Conclusions Experiencing early parental death will lead to a shortened life span. It is necessary to study and intervene the early parental death as a risk factor, thereby narrowing the health gap and improving the national health level.

Resampling classification model for predicting blood glucose control in middle-aged and elderly diabetic patients in China

WANG Ping, ZHANG Le, HONG Xiaorui, ZHU Suling, ZHAO Xuejing

2024, 28(9): 1005-1009. doi: 10.16462/j.cnki.zhjbkz.2024.09.003

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Objective This study aims to improve the prediction performance of blood glucose control classification models for diabetic patients by employing resampling algorithms. Methods Blood glucose control data of diabetic patients in the China health and retirement longitudinal study (CHARLS) database were resampled. We compared the classification performance of logistic regression (LR), support vector machines (SVM), and random forests (RF) before and after resampling. We utilized stratified 5-fold cross-validation and area under curve (AUC) to determine the optimal parameters of the models. The performance of the classification models before and after resampling was evaluted using metrics such as accuracy, sensitivity, specificity, precision, geometric mean (G-mean), F1 score, and AUC. Results All three resampling algorithms, including ADASYN, synthetic minority over-sampling technique and edited nearest neighbors (SMOTE-ENN), and synthetic minority over-sampling technique tomek (SMOTE-Tomek), enhanced the prediction performance of three classification models when dealing with imbalanced blood glucose control data in diabetic patients. These algorithms exhibited varying degrees of improvement in AUC values, with adaptive synthetic sampling (ADASYN) increasing the AUC value of the logistic classification model by 2.13%, SMOTE-ENN by 3.05%, and SMOTE-Tomek by 2.13%, respectively. Conclusions ADASYN, SMOTE-ENN, and SMOTE-Tomek can better deal with the imbalanced blood glucose control data in diabetic patients and improve the performance of blood glucose control classification models.

Relationship between physical activity and risk of dyslipidemia in middle-aged and elderly population

HU Jiakang, GE Qiong, LAI Wenhao, LUO Shiwen, LU Quqin

2024, 28(9): 1010-1014. doi: 10.16462/j.cnki.zhjbkz.2024.09.004

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Objective The 2020 survey data from the China health and retirement longitudinal study (CHARLS) were analyzed to investigate the current status of dyslipidemia among the middle-aged and elderly population in China, and to reveal the relationship between physical activity and the risk of dyslipidemia. It will provide a reference for the formulation of policies related to dyslipidemia in this demographic. Methods This study included 12 132 middle-aged and elderly individuals aged 45 to 74 with complete information. Participants were divided into quartile groups based on their level of physical activity. We used a logistic regression model to analyze the relationship between physical activity and the risk of dyslipidemia among the middle-aged and elderly adults, and conducted a sensitivity analysis after excluding participants with other chronic diseases. Results Among the 12 132 participants, 1 187 had dyslipidemia, with a detection rate of 9.78% (95% CI: 9.26%-10.31%). After adjusting for confounders, middle-aged and elderly individuals in the high-level physical activity group have a reduced risk of dyslipidemia compared to the low-level physical activity group (OR=0.796, 95% CI: 0.668-0.950), consistent with the results of the sensitivity analysis (OR=0.734, 95% CI: 0.571-0.944). Conclusions High-level physical activity can reduce the risk of dyslipidemia in middle-aged and elderly people, so strengthening physical activity can be used as a favorable means to promote cardiovascular and cerebrovascular health in middle-aged and elderly people.

Comparative analysis of physical fitness of 60-69 years old people in Anhui Province in different years

CHEN Yao, CHEN Wei, SUN Peng, CHEN Qinyi, MA Rui, LIU Wenjuan, YE Dongqing, FAN Yinguang

2024, 28(9): 1015-1022. doi: 10.16462/j.cnki.zhjbkz.2024.09.005

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Objective To understand the physical fitness difference of the elderly aged 60-69 years old between 2014 and 2020 in Anhui Province, to provide basic data and theoretical basis for physical fitness control and prevention. Methods A total of 6 168 and 5 462 elderly adults were selected from 16 cities in Anhui Province in 2014 and 2020 by multi-stage sampling method, respectively. A questionnaire survey and physical examination were conducted in community health service centers according to the national physical fitness monitoring. Multiple linear regression analysis was used to compared the change between 2014 and 2020 after controling confounding factors. Results The physical form, physical function and physical fitness indices of the elderly people aged 60-69 years old in Anhui province were different in various group including gender, age group, regional distribution and urban-rural area (all P < 0.05). The results of multiple linear regression showed that, compared to 2014, the grip strength of the elderly adults in Anhui Province decreased (β=-0.677, 95% CI: -0.946--0.411), while height (β=1.278, 95% CI: 1.053-1.504), weight (β=2.012, 95% CI: 1.697-2.354), BMI (β=0.416, 95% CI: 0.295-0.538), waist circumference (β=2.529, 95% CI: 2.172-2.885), hip circumference (β=1.147, 95% CI: 0.856-1.438), waist-to-hip ratio (β=0.016, 95% CI: 0.014-0.019), body fat percentage (β=0.423, 95% CI: 0.301-0.545), duration of one-leg standing with eyes closed (β=0.157, 95% CI: 0.147-0.168) and choice reaction time (β=0.031, 95% CI: 0.020-0.042) increased significantly in 2020 (all P < 0.001). Conclusions The increasing prevalence of obesity, impaired nerve conduction velocity, and diminished reaction capacity among the elderly population in Anhui Province is becoming a serious concern. Targeted diet and physical exercise guidance should be carried out to reduce obesity and improve comprehensive physical fitness of the elderly.

Cognitive health and distribution of mild cognitive impairment of women aged 45-65 in communities of Shanghai: a cross-sectional study based on Montreal cognitive assessment

HUANG Yu, CHEN Hong, JIN Chenyang, ZHANG Yuge, JIANG Weili, ZHAO Qi, ZHU Liping, XU Biao

2024, 28(9): 1023-1029. doi: 10.16462/j.cnki.zhjbkz.2024.09.006

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Objective To investigate the cognitive level of women aged 45-65 in the community in Shanghai, and to describe the distribution of mild cognitive impairment (MCI) and its influencing factors. Methods The study subjects were women aged 45-65 in communities of 8 districts in Shanghai who volunteered to participate in the "bone health cohort". General information questionnaire was used to collect demographic information, lifestyle, menopausal status, reproductive history and chronic disease. Montreal cognitive assessment (MoCA) was used to measure cognitive function and screen for patients with MCI. Multivariate Logistic regression was used to analyze the influencing factors of MCI. Results A total of 2 205 women aged 45-65 in communities completed the questionnaire interview and MoCA-B assessment. The average score of MoCA-B was (26.47±3.14), points and the prevalence of mild cognitive impairment (MCI) was 10.25%. The results of the multivariate Logistic regression showed that the incidence of MCI was positively correlated with age (OR=2.393, 95% CI: 1.345-4.256). Compared to those with the education level of primary school or below, women completed junior high school (OR=0.375, 95% CI: 0.240-0.585), senior high school or technical school (OR=0.185, 95%CI: 0.115-0.298) and college or above (OR=0.067, 95% CI: 0.033-0.135) had a reduced risk ofMCI. The risk ofMCI in participating women living in urban areas (OR=0.563, 95% CI: 0.405-0.785) was significantly lower than those living in rural areas, and women having a balanced diet (OR=0.678, 95% CI: 0.466-0.986) also had a significantly lower risk of MCI than those having a vegetarian diet. Conclusions The prevalence of MCI among women aged 45-65 in communities of Shanghai was 10.25%. Age, education, living area and dietary habit were associated with MCI prevalence. Cognitive function assessment on women at peri-menopausal and early menopausal stage in community could provide basic evidences for developing early intervention strategies to prevent MCI and its progression.

Investigation of awareness and vaccination willingness for recombinant zoster vaccine among 50 years adults in Wuzhong District, Suzhou

ZHANG Jinhua, DUAN Yuanyuan, CAO Lina, SUN Jue, LI Hongmei

2024, 28(9): 1030-1036. doi: 10.16462/j.cnki.zhjbkz.2024.09.007

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Objective To investigate the awareness and vaccination willingness rates of recombinant zoster vaccine (RZV) and the influencing factors among adults aged ≥50 years in Wuzhong District, Suzhou City. Methods Residents aged 50 years in Changqiao Sub-district of Wuzhong District were exported from Jiangsu Province vaccination integrated service management information system. According to the proportion of 1/15 of age stratification (50- < 60, 60- < 70, 70 and above), 1 267 people were randomly selected as the survey sample to participate in the telephone questionnaire survey in August 2022.The awareness and vaccination willingness rates of RZV were calculated, and the influencing factors were analyzed by logistic regression model. Results Among 1 147 respondents, 516 (45.0%) were males, and the 60-69 age group accounted for the largest proportion (40.2%). The rates of awareness and vaccination willingness of RZV were 41.33% (n=474) and 28.95% (n=332), respectively. The results of multivariate logistic regression showed that age, occupation, marital status, history of herpes zoster in family members and relatives and friends were associated with the awareness of RZV0. Females (OR=1.683, 95% CI: 1.234-2.296), participants having family members (OR=1.778, 95% CI: 1.175-2.690) and close friends being medical workers (OR=1.956, 95% CI: 1.115-3.434), history of HZ (OR=1.944, 95% CI: 1.366-2.767), and having family members with history of HZ (OR=2.337, 95% CI: 1.698-3.218), history of trivalent or quadrivalent influenza vaccine(split virion), inactivated (influenza vaccine for short) (OR=2.549, 95% CI: 1.813-3.582), and awareness of RZV (OR=4.431, 95% CI: 3.235-6.069) were willing to get RZV (all P < 0.05). Conclusions The rates of awareness and vaccination willingness of RZV are low. Female, having medical workers in family members and close friends, HZ history among participants and family members are promoting factors for RZV vaccination willingness.

Association analysis between air pollution and lung cancer burden and prediction of disease burden based on PCA-GAM in China

MA Qianqian, CHEN Baozhan, TAN Zhongke, WANG Zhenbo

2024, 28(9): 1037-1042. doi: 10.16462/j.cnki.zhjbkz.2024.09.008

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Objective To explore the time series characteristics of the disease burden of lung cancer and air pollution in China, and to analyze their correlation and predict the disease burden of lung cancer, and provide a reference for lung cancer prevention and control. Methods The data of disease burden such as the incidence and death of lung cancer in China from 1990 to 2019, and air pollution data from 1970 to 2015 were collected. Grey correlation analysis and generalized additive model were used to study the association between air pollution and lung cancer disease burden, and to predict the lung cancer disease burden from 2020 to 2022. Results From 1990 to 2019, the compound annual growth rate of the incidence of lung cancer in China was 3.48%, and the compound annual growth rate of the mortality rate was 3.15%. The lag times of PM_2.5, PM₁₀, BC, OC, SO₂, NH₃, NOx, CO, and NMVOC sequences most correlated with the incidence of lung cancer were 19 years, 19 years, 19 years, 19 years, 13 years, 20 years, 10 years, 19 years, 4 years. While the lag times of the sequences with the greatest correlation between the above air pollutants and lung cancer mortality were 19 years, 19 years, 19 years, 19 years, 12 years, 12 years, 10 years, 19 years, and 4 years, respectively. Nonparametric effect analysis showed a curvilinear correlation between pollutants such as PM_2.5 and the disease burden of lung cancer. It is predicted that the incidence rate of lung cancer in China from 2020 to 2022 will be 59.547/100 000, 59.838/100 000 and 58.026/100 000 respectively; The mortality rates of lung cancer will be 53.465/100 000, 54.106/100 000, and 53.458/100 000, respectively. Conclusions There is a hysteresis effect on the incidence and death of lung cancer caused by air pollution, and they are curvilinearly positively correlated. The disease burden of lung cancer in China has shown a fluctuated trend from 2020 to 2022.

Interactive effects of oxidant air pollutants and temperature on disease mortality in a region of China

LIU Ying, LIU Jiatong, WANG Jinxia, HU Yong, DONG Xuehao, WANG Faxuan, ZHANG Yajuan

2024, 28(9): 1043-1052. doi: 10.16462/j.cnki.zhjbkz.2024.09.009

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Objective To explore the individual and interactive effects of oxidant air pollutants and temperature on mortality from respiratory and circulatory diseases in a defined Chinese region. Methods Using information from 2014 to 2018 in a Chinese region, including 188 039 death cases, air pollutant concentrations, and meteorological records. A Poisson generalized additive model (GAM) and a distributed lag nonlinear model (DLNM) were applied to assess the impacts of atmospheric oxidative pollutants and temperature on mortality form respiratory and circulatory diseases. And the interactions between temperature and pollutants were evaluated using a bivariate response surface model and stratification method. Results For each 10 μg/m³ increase in O₃, NO₂, and O_x, the maximum cumulative excess risks of death from circulatory diseases were 0.82% (95% CI: 0.30%-1.34%), 1.58% (95% CI: 0.28 %-2.90 %) and 1.11% (95% CI: 0.51%-1.72%), respectively. Corresponding values for respiratory diseases were 0.53% (95%CI: 0.31%-1.37%), 2.66% (95% CI: 1.07%-4.27%) and 1.22% (95% CI: 0.22%-2.23%). The difference between the effects of high and low temperature on mortality of the two diseases was large, with an immediate effect of high temperature and a lagging effect of low temperature. The interaction effect and direction were evaluted using the relative excess risk due to interaction(RERI). Interaction studies showed that there was a synergistic amplification of the risk of death from circulatory diseases in the population by high temperature with high concentrations of NO₂ (RERI=0.118, 95% CI: 0.031-0.206). And low temperature with high concentrations of O₃ (RERI=0.127, 95% CI: 0.104-0.150), and O_x (RERI=0.025, 95% CI: 0.002-0.049) had a synergistic amplification effect on the risk of death from respiratory diseases in the population. Conclusions High temperature, low temperature and atmospheric oxidative pollutants (O₃, NO₂ and O_x) all increase the risk of death from circulatory and respiratory diseases in the population. There is a synergistic amplification of the risk of death from circulatory and respiratory diseases in the population by high temperature and high concentrations of NO₂ and low temperature and high concentrations of O₃ and O_x, respectively.

A study on the effect of meteorological factors on the admissions of acute exacerbation of chronic obstructive pulmonary disease in Urumqi City

MEIHERIBAN Maimaiti, ZHENG Yanling, ZHANG Xueliang, LU Dongmei

2024, 28(9): 1053-1060. doi: 10.16462/j.cnki.zhjbkz.2024.09.010

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Objective To explore the relationship between hospitalization and meteorological factors in acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Data on COPD acute exacerbations admitted to a tertiary hospital in Xinjiang Uygur Autonomous Region from 2017 to 2021, as well as meteorological and air pollutant data from Urumqi during the same period were collected. A distributed lag nonlinear model (DLNM) was used to analyze the effect relationship between meteorological factors and COPD acute exacerbations admitted. Results The number of patients admitted to a hospital in Urumqi with acute exacerbation of COPD was used 5 510, with a male to female ratio of approximately 1∶1. The median values of average temperature, average humidity, and average wind speed were 13.98 ℃, 43.14%, and 2.98 m/s, respectively. Correlation analysis found that hospitalization during acute exacerbation of COPD was negatively correlated with average temperature, average wind speed, and average humidity (all P < 0.05); There was also a clear correlation between air pollutants and meteorological factors (all P < 0.05). The DLNM analysis results showed that the average temperature changes with the number of lag days, and both low and high temperatures might be risk factors for hospitalization during acute exacerbation of COPD; The higher the average humidity and average wind speed, the lower the risk of hospitalization during acute exacerbation of COPD, but the longer the lag days, the higher the risk of hospitalization might also increase. Conclusions Average temperature average wind speed and average humidity have a significant lag effect on hospitalization during acute exacerbation of COPD, and all show corresponding changes with the change of lag days.

Prediction of colorectal cancer mortality burden and simulation of the effectiveness of controlling risk factors in Shandong Province by 2030

QI Xiao, YAO Xue, LU Zilong, CHU Jie, XU Xiaohui, GUO Xiaolei, WANG Jinrong, WANG Suzhen

2024, 28(9): 1061-1068. doi: 10.16462/j.cnki.zhjbkz.2024.09.011

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Objective To predict the burden of mortality of colorectal cancer (CRC) in Shandong Province by 2030 and evaluate the effects of risk-controlling factors to reduce such burden of mortality. Methods We simulated different scenarios for colorectal cancer mortality through proportion change model in 2030. The scenarios were determined by the risk factors provided by the WHO targets. Our model was based on the correlation between mortality risk and the exposure factors and the theory of comparative risk assessment. Our data were from the risk factor surveillance and colorectal mortality data of Shandong Province. Results If the exposure to risk factors were to follow the existing trend, the number of deaths and mortality rate of colorectal cancer among people over 20 years old in Shandong Province in 2030 would increase by 47.68% and 35.51%, respectively, compared to 2013. Meanwhile, the standardized mortality rate and the probability of premature death would decrease by 14.48% and 10.10%, respectively. If alcohol consumption and BMI reached to the control targets, the probability of premature death would decrease by 12.11% and 11.02%, respectively, compared to 2013. If all risk factors reach to the control targets, we would be able to avoid 413.24 deaths by 2030 and decrease the probability of premature death by 13.14% (compared to 2013). Conclusions Under the existing trend, the number of deaths and the mortality rate of CRC in Shandong Province are expected to be higher in 2030 than in 2013, although the standardized mortality rate and the probability of premature death are anticipated decrease. Should the targeted reductions in risk factors be achieved, the burden of colorectal cancer could be reduced. The results suggest that measures such as alcohol control and BMI management will significantly reduce the mortality burden of CRC in Shandong Province.

Correlation analysis of influenza activity level and meteorological factors in Jiangxi Province from 2017 to 2021

FU Weijie, ZHANG Chengfeng, CHENG Huijian, DING Sheng, YE Xing, HU Maohong

2024, 28(9): 1069-1074. doi: 10.16462/j.cnki.zhjbkz.2024.09.012

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Objective To analyze the correlation and interaction between the prevalence of different subtypes of influenza in Jiangxi Province, and to identify the main meteorological factors affecting the prevalence of different subtypes of influenza, so as to provide the basis for evaluating the correlation between different meteorological factors and influenza activity level, as well as for carrying out meteorological prediction and early warning of influenza. Methods The testing results of influenza-like cases (ILI) specimens from influenza sentinel hospitals in Jiangxi Province from 2017 to 2021 were collected weekly, along with meteorological data from the same period. Then, descriptive epidemiological analysis and correlation analysis were conducted using R 4.1.3 software, and generalized linear models were used for multi-factor regression analysis. Results The positive rate of ILI samples collected from sentinel hospitals of Jiangxi Province from 2017 to 2021 were 19.46%, 11.72%, 20.24%, 6.46% and 8.27%, respectively, with the highest positive rate occurring in the first quarter of each year except for the third quarter of 2017. Additionally, the dominant influenza virus subtypes varied annually. The positive rate of influenza virus nucleic acid detection was significantly associated with mean air temperature (r=-0.436, P < 0.001), sunshine hours (r=-0.165, P=0.007), maximum wind speed (r=-0.164, P=0.008), minimum air temperature (r=-0.406, P < 0.001) and the maximum temperature (r=-0.427, P < 0.001) that were all found to have a negative correlation. The subtypes of influenza, including influenza A (H1N1), influenza B virus Victoria lineage (Victoria) and influenza B virus Yamagata lineage (Yamagata for short), exhibited a negative correlation with average temperature, minimum temperature, and maximum temperature. Furthermore, H1N1 showed a negative correlation with sunshine duration and daily precipitation, while influenza Yamagata was negatively correlated with maximum wind speed. However, regression analysis revealed that the different subtypes of influenza were strongly negatively correlated with average temperature but did not show any correlation with other meteorological factors. Conclusions The correlation between influenza activity levels and meteorological factors in Jiangxi Province was clearly evident, with varying correlations observed between the positive rates of different subtypes of influenza and meteorological factors. Among these factors, average temperature was identified as the primary factor influencing influenza activity level.

SEIHRS_gv model——predicting the influenza-like illness epidemic trend based on short term data

JIN Xin, YU Jingbo, CUI Shuangshuang, WANG Yan, YU Hao

2024, 28(9): 1075-1082. doi: 10.16462/j.cnki.zhjbkz.2024.09.013

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Objective To develop a prediction model for the epidemic trend of influenza-like illness using monitoring data from Tianjin City and quantitatively evaluate the impact of epidemic prevention and control measures on the medical burden caused by influenza-like illness. Methods The data from November 6, 2023 to November 15, 2023 were used for fitting the SEIHRS_gv model, and the data from November 15, 2023 to March 31, 2024 were using for validating. Root mean square error (RMSE), mean absolute error (MAE), and coefficient of determination r-square (R²) were used to evaluate the predictive ability of the model. Results The SEIHRS_gv model could predict the trend, peak, and crucial point of influenza-like illness epidemics. Using 10 days of data for prediction, with an R² of 0.85 and an RMSE of 949.5. Increasing the intensity of epidemic prevention and control measures could reduce the number of patients seeking medical treatment. Conclusions The SEIHRS_gv model required a few days of data for prediction in this round of influenza-like illness epidemic prediction and had high accuracy in prediction results, which could serve as an efficient predictive model to evaluate the pressure of hospital visits and guide the implementation intensity of epidemic control measures.

Machine learning and Cox proportional hazards regression model for warning of persistent infection with high-risk HPV type

DING Hongmei, ZHANG Mingya, XU Xiaoqin, ZHANG Hongxiu

2024, 28(9): 1083-1089. doi: 10.16462/j.cnki.zhjbkz.2024.09.014

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Objective A prediction model of human papillomavirus based on machine learning was established to determine the factors associated with the persistent infection of high-risk human papilloma virus(HR-HPV), so as to provide early warning for the persistent infection of HR-HPV. Methods Clinical data of 4 407 women who participated in HPV testing at four health centers in Taizhou City from September 2017 to September 2019 and participated in HPV follow-up from September 2020 to September 2022 were collected. The demographic characteristics of total 4 407 subjects in this cohort study were used as the input of the machine learning model, and the change process of the results of the two HPV inspections as the output, a prediction model based on machine learning was established, including random forest and multi-layer perceptron, to predict the HPV follow-up results of the research object. Univariate Cox risk proportion regression model and multivariate Cox risk proportion regression model were used to statistically analyze 583 primary screening HR-HPV positive cases. Results The accuracy of the random forest prediction model was 84.3%, and the accuracy of the multi-layer perceptron was 80.5%. The top five viral types with persistent positive rate of HR-HPV were HPV58, multiple infections, HPV31, HPV33, and HPV52. The multivariate Cox regression analysis showed that the conversion risk of HR-HPV infection in those with junior high school education or below was 1.72 times that of those with high school education and above (HR=1.72, 95% CI: 1.03-2.87, P=0.037), and the conversion risk of HR-HPV infection in non-menopausal individuals was 2.11 times higher than that in menopausal individuals (HR=2.11, 95% CI: 1.10-4.06, P=0.025). Conclusions Machine learning and Cox regression analysis models can provide an early warning of the HR-HPV persistent infection population, which has an important clinical value for the subsequent management of HR-HPV-infected women and the prevention and control of cervical cancer.

The mediation analysis of DNA methylation in the relationship between maternal arsenic exposure and neonatal birth weight

FANG Ruiling, BAI Wenlin, CUI Yuehua, WANG Tong

2024, 28(9): 1090-1095. doi: 10.16462/j.cnki.zhjbkz.2024.09.015

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Objective To investigate whether the changes of DNA methylation level mediate the relationship between prenatal arsenic exposure and neonatal birth weight. Methods Data of this study were derived from the New Hampshire Birth Cohort Study, with 343 mother-infant pairs enrolled in the cohort from February 2012 to September 2013 and available from the GEO database under accession number GSE71678. A total of 270 maternal and infant pairs were included in this study. The Sure independence screening (SIS) strategy and mediation analysis method were employed to estimate the mediation effect of DNA methylation sites between placental arsenic exposure and birth weight. Results After adjusting for maternal age, pre-pregnancy BMI, gestational diabetes mellitus, gestational age, infant gender, and placental tissue cell composition, 25 DNA methylation sites were selected as candidate mediators. The results of mediation analysis showed that after corrected by Bonferroni method. cg14900295 located on the VENTX gene was identified as a mediator between maternal arsenic exposure and low birth weight (ACME=0.057 6, 95% CI: 0.017 6-0.106 4, P=0.000 8). After corrected by FDR method, 18 CpG loci were identified as mediators, among which cg03348978, cg02435495, cg09463047 and cg11862993 were all located on the HNF1B gene. Conclusions This study identified 18 specific sites where changes in DNA methylation levels play a crucial mediating role in the process linking prenatal arsenic exposure to low birth weight. Genes VENTX and HNF1B may be the key factors in the etiological mechanism. Therefore, these findings can provide a reference for revealing the genetic etiology mechanism of arsenic-induced low birth weight.

Establishment and bioinformatics analysis of an early prediction model for parkinson′s disease based on gut microbiota

HE Changying, WEI Yuting, CHEN Jia

2024, 28(9): 1096-1103. doi: 10.16462/j.cnki.zhjbkz.2024.09.016

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Objective To explore the construction and evaluation of an early prediction model for parkinson′s disease (PD) in the population based on gut microbiota to conduct functional analysis of gut microbiota macro-genus KO groups to explore potential therapeutic targets for PD. Methods Gut microbiota relative abundance data from the Zenodo database were standardized using Z-Score and dimensionality reduction was performed using ZicoSeq. An adaptive least absolute shrinkage and selection operator (LASSO) binary logistic regression algorithm was employed to establish the prediction model. The performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve and calibration curve, and clinical utility was assessed using decision curve analysis (DCA). Differential expression genes (DEGs) in gut microbiota macro-genus KO groups were identified using the limma package. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) analyses were performed on DEGs. DEGs were further screened using protein-protein interaction networks (PPI), support vector machine recursive feature elimination (SVM-RFE), and random forest (RF). Results The ROC curve and calibration curve of the adaptive LASSO binary logistic regression model showed good predictive performance. The DCA curve showed a significant net benefit of the model. PPI network analysis and machine learning methods identified 6 core DEGs, namely L-arabinose operon Q (araQ), mitochondrial FAD-dependent glyceraldehyde-3-phosphate dehydrogenase, dcd, SRP19, POP5, and ISYNA1. Conclusions The adaptive LASSO binary logistic regression algorithm model has significant advantages in predicting PD, enabling early detection, intervention, and treatment of PD patients. The discovery of relevant core genes provides scientific guidance and assistance for the development of PD treatments.

Association between dietary inflammation index and serum C reactive protein level: a Meta-analysis

MA Runze, BAHEGU Yimingniyazi, GU Yuanshen, ZHAO Hui, ANAER Gaoshao, YU Wenhui, DAI Jianghong

2024, 28(9): 1104-1111. doi: 10.16462/j.cnki.zhjbkz.2024.09.017

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Abstract:
Objective To systematically evaluate the association between the dietary inflammatory index (DII) and serum C-reactive protein (CRP) levels. Methods A search of the PubMed, Web of Science, and EMBASE databases was conducted to collect studies examining the association between the DII and CRP. The search period extended from the inception of each database until October 1, 2023. Two independent researchers performed the literature screening, data extraction, and quality assessment. Statistical analyses were conducted using R software version 4.2.2, and subgroup analyses and Meta-regression were utilized to explore the sources of heterogeneity among studies. Results A total of 20 studies were included, comprising 15 cross-sectional studies, 1 case-control study, 3 cohort studies, and 1 randomized controlled trial, with a cumulative total of 59 953 participants. The Meta-analysis indicated a significant association between the DII and serum CRP levels (OR=1.205, 95% CI: 1.101~1.319). After conducting subgroup analyses based on study design, age distribution, sample size, DII calculation methods, and dietary assessment techniques, the I² statistic was reduced (P>0.1). Conclusions Current evidence suggests that the DII may be associated with serum CRP levels. Differences in study design, age distribution, sample size, DII calculation methods, and dietary assessment techniques may be the primary factors contributing to the heterogeneity observed among the studies.

Comparison of the efficacy and safety of mycophenolate mofetil combined with leflunomide or tacrolimus induction in the treatment of lupus nephritis

SHAO Huijun, RAN Chenyu, WU Yue, LIU Qun, MA Yan, TAO Jinhui

2024, 28(9): 1112-1116. doi: 10.16462/j.cnki.zhjbkz.2024.09.018

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Objective To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in combination with either leflunomide (LEF) or tacrolimus (TAC) as induction therapy for lupus nephritis (LN). Methods Patients with refractory LN who did not respond to monotherapy with MMF or cyclophosphamide (CYC) were selected for switching to combination therapy with MMF (1 g/d) plus either LEF (20 mg/d) or TAC (2 mg/d). The remission rates, laboratory parameters, and adverse reactions were compared between the two groups. Results A total of 278 patients with LN were included, and 38 patients (19 in each group) were selected for analysis. The results showed that: (1) In terms of achieving remission in LN, at 3 months, there were 7 cases (36.84%) in the MMF+LEF group and 10 cases (52.63%) in the MMF+TAC group; at 6 months, there were 10 cases (52.63%) in the MMF+LEF group and 14 cases (73.68%) in the MMF+TAC group. However, the differences in remission rates between the two groups at 3 months and 6 months were not statistically significant (all P>0.05). (2) After 6 months of treatment, there were statistically significant differences in complement C3, C4, blood urea nitrogen, albumin, IgA, IgM, and urine total protein/creatinine ratio between the two groups (all P < 0.05). However, there were no statistically significant differences between the two groups at 3 months and 6 months (all P>0.05). (3) There were no significant differences in adverse reactions between the two groups (P>0.05). Conclusions Both the combination of MMF and LEF, as well as the combination of MMF and TAC, significantly improved the condition of LN. There were no significant differences in remission rates and safety between the two combinations.

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2024 Vol. 28, No. 9

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Editor

Editor-in-Chief Ye Dongqing M.D.

Assistant editor Fan Yinguang M.D.

Assistant editor Pan Haifeng M.D.

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