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期刊信息/Journal information
中华流行病学杂志
中华流行病学杂志

李立明

月刊

0254-6450

lxbonly@public3.bta.net.cn

010-58900730

102206

北京市昌平区昌百路155号传染病所B115

中华流行病学杂志/Journal Chinese Journal of EpidemiologyCSCD北大核心CSTPCD
查看更多>>中华医学会主办。本刊是流行病学及其相关学科的高级专业学术期刊, 是国内预防医学和基础医学核心期刊、国家科技部中国科技论文统计源期刊，2004-2009年被中国科学技术信息研究所和中国科技论文与引文数据库(CSTPCD)定为“百种中国杰出学术期刊”，并被美国国立图书馆医学文献联机数据库（Medline）和美国化学文摘（CA）收录。读者对象为医学（预防医学、临床医学、基础医学及流行病学科研与教学）和健康相关学科的科研、疾病控制、临床、管理和教学工作者。本刊设有述评、论著（原著）包括现场调查、监测、实验室研究、临床研究、基础理论与方法，疾病控制、国家课题总结、国外杂志华人研究导读、文献综述、问题与探讨等重点栏目。
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    上海市50岁及以上人群维生素D水平与握力的关联研究

    董俣君郭雁飞阮晔孙双圆...
    393-400页
    查看更多>>摘要：目的 探讨上海市≥50岁人群维生素D水平与握力的关系。 方法 数据来源于WHO全球老龄化与成人健康研究我国上海市2018-2019年数据，采用logistic回归模型分析维生素D水平与握力的关系，进一步按照性别、年龄及乳制品摄入情况进行分层；采用限制性立方样条曲线绘制维生素D水平与低握力的剂量-反应曲线。 结果 共4 391人纳入研究，其中男性2 054人（46.8%）；年龄（67.02±8.81）岁；低握力1 421人（32.4%）；维生素D不足及缺乏分别为1 533人（34.9%）和401人（9.1%）。在调整相关混杂因素后，logistic回归分析结果显示，维生素D缺乏的人群发生低握力的风险更高（OR=1.41，95%CI：1.09~1.83）；在男性中，调整相关混杂因素后，维生素D缺乏与低握力发生风险呈显著正相关（OR=1.67，95%CI：1.12~2.50），而女性中两者之间无关联（OR=1.30，95%CI：0.97~1.74）；在60~69岁及≥80岁年龄组中，调整相关混杂因素后，维生素D缺乏与低握力发生风险呈显著正相关（OR=1.57，95%CI：1.05~2.35；OR=2.40，95%CI：1.08~5.31），在乳制品摄入<250 ml/d的人群中，调整相关混杂因素后，二者之间呈显著正相关（OR=1.57，95%CI：1.17~2.09），而在乳制品摄入≥250 ml/d的人群中无明显关联。限制性立方条样图显示，低握力的发生风险可能随维生素D含量的上升而降低，但差异无统计学意义（P>0.05）。 结论 维生素D水平与握力存在一定的关系，维生素D缺乏人群出现低握力的风险更高。 Objective To understand the association between vitamin D level and grip strength in people aged ≥50 years in Shanghai. Methods Data were obtained from the WHO's Study on Global Ageing and Adult Health in Shanghai during 2018-2019. Logistic regression model was used to analyze the association between vitamin D level and grip strength, and a stratified analysis was conducted for different gender, age and dairy product intake groups. Restricted cubic spline was used to evaluate the dose-response association between vitamin D level and low grip strength. Results A total of 4 391 participants were included in the study, including 2 054 men (46.8%), with an average age of (67.02±8.81) years. And 1 421 individuals (32.4%) had low grip strength 1 533 individuals (34.9%) had vitamin D deficiency, and 401 individuals (9.1%) had vitamin D deficiency. After adjusted for confounding factors, the logistic regression results analysis showed that individuals with vitamin D deficiency had a higher risk for low grip strength (OR=1.41, 95%CI: 1.09-1.83). In men, after adjusting for confounding factors, vitamin D deficiency was positively associated with the risk for low grip strength (OR=1.67, 95%CI: 1.12-2.50), but there was no significant association between vitamin D level and grip strength in women (OR=1.30, 95%CI: 0.97-1.74). In age group 60-69 years and ≥80 years, there was significant association between vitamin D deficiency and low grip strength after adjusting for confounding factors (OR=1.57, 95%CI: 1.05-2.35 OR=2.40, 95%CI: 1.08-5.31). In people who had daily intake of dairy product <250 ml, there was positive association between vitamin D deficiency and low grip strength, but there was no significant association in people who had daily dairy product ≥250 ml after adjusting for confounding factors. The restrictive cubic spline demonstrated that risk of low grip strength might decreased with the increase of vitamin D levels, however, the difference was not significant ( P>0.05). Conclusions This study demonstrated that there is association between vitamin D level and grip strength. People with vitamin D deficiency have higher risk for low grip strength.

    维生素D握力中老年人

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    孕期应激生活事件暴露水平对儿童2~6岁内情绪与行为问题的影响

    洪佳仪魏倩井光壮叶佩琪...
    401-407页
    查看更多>>摘要：目的 研究母亲孕期应激生活事件暴露水平对儿童2~6岁内情绪与行为问题的影响。 方法 上海亲子队列于2016-2018年招募待产孕妇建卡并随访，本研究纳入来自队列的2 524对母子，使用量表于孕早、晚期评估母亲应激生活事件暴露水平，儿童2~6岁内评估情绪与行为问题。使用多因素二元logistic回归模型及广义估计方程分析孕期应激生活事件暴露水平对儿童2~6岁内情绪与行为问题发生风险的影响及作用关键期。 结果 孕期应激生活事件暴露水平持续较低、仅孕早期较高、仅孕晚期较高、持续较高的母亲分别占61.8%、13.2%、13.2%和11.8%。儿童3~6岁的情绪症状、多动问题、同伴交往及困难总分异常检出率在持续较高组中最高。广义估计方程结果显示，与孕期应激生活事件暴露水平持续较低组相比，仅孕早期较高组的儿童2~6岁内品行问题（aOR=1.41，95%CI：1.07~1.87）异常发生风险显著增加，孕期应激生活事件暴露水平持续较高组的儿童情绪症状（aOR=1.41，95%CI：1.09~1.83）、同伴交往（aOR=1.46，95%CI：1.15~1.86）及困难总分（aOR=1.51，95%CI：1.17~1.93）异常发生风险均显著增加。 结论 母亲孕期应激生活事件暴露增加儿童2~6岁内情绪与行为问题异常发生风险，孕早期可能是暴露关键期。 Objective To investigate the influence of prenatal stressful life event (SLE) exposure on child emotional and behavioral problem at age 2-6 years and identify the most risk exposure period. Methods A total of 2 524 mother-child pairs were selected from Shanghai Maternal-Child Pairs Cohort based on pregnant women form 2016 to 2018 in Shanghai. Prenatal SLE exposure was assessed by Life Events Scale for Pregnant Women Questionnaire during the first and third trimester of pregnancy. Child emotional and behavioral problem was evaluated by Strengths and Difficulties Questionnaire at age 2-6 years. Multivariate binary logistic regression model and generalized estimating equation were conducted to quantify the association between prenatal SLE exposure and child emotional and behavioral problem at age 2-6 years, and identify the pregnancy period with strongest adverse effect. Results The 2 524 mother-child pairs were divided into 4 groups: group with consistent low exposure to SLE (61.8%), group with high exposure to SLE in the first trimester (13.2%), group with high exposure to SLE in the third trimester (13.2%) and group with consistent high exposure to SLE (11.8%). The detection rates of emotional problem, hyperactivity, peer interaction problem and total difficulty score in children aged 3-6 years were highest in the group with consistent high exposure to SLE. Generalized estimating equation analysis showed that after controlling the confounding factors, compared with the consistent low exposure group, the children in the group with high exposure to SLE in the first trimester had significant increased risk for conduct problem at age 2-6 years (aOR=1.41, 95%CI:1.07-1.87). The children in the group with consistent high exposure to SLE were at increased risk for emotional problem, peer interaction problem, and high total difficulty score with the aOR of 1.41 (95%CI: 1.09-1.83), 1.46 (95%CI: 1.15-1.86) and 1.51(95%CI: 1.17-1.93). Conclusion These findings indicated that prenatal exposure to SLE have adverse effect on child emotional and behavioral problem at age 2-6 years, especially the exposure in the first trimester.

    孕期应激生活事件学龄前儿童情绪与行为问题队列研究

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    基于复杂网络理论的健康相关行为与慢性非传染性疾病关系研究进展

    杨淑娟余彬董舒蔡长伟...
    408-416页
    查看更多>>摘要：近年来，有关健康相关行为（健康行为）与慢性非传染性疾病（慢性病）的研究视角从专注多种健康行为与某个慢性病间“多因单果”的独立效应，逐渐转向多个健康行为与慢性病“多因多果”的复杂相互作用。复杂网络理论是系统科学的重要板块，该理论考虑了众多因素在同一网络中的博弈关系，可通过一系列复杂网络模型、指标，揭示健康行为与慢性病多个因素间如何相互作用。本文对复杂网络理论定义、发展及其在健康行为与慢性病领域的常用模型和指标、案例内容进行综述，旨在打开复杂网络理论在健康领域更广阔的运用场景，为后续健康行为与慢性病关系的研究提供可参考的思路和工具。 In recent years, the research focus on health-related behavior and chronic non-communicable diseases has shifted from the analysis on independent effects of multiple causes on a single outcome to the evaluation the complex relationships between multiple causes and multiple effects. Complex network theory, an important branch of system science, considers the relationships among factors in a network and can reveal how health-related behaviors interact with chronic diseases through a series of complex network models and indicators. This paper summarizes the definition and development of complex network theory and its commonly used models, indicators, and case studies in the field of health-related behavior and chronic disease to promote the application of complex network theory in the field of health and provide reference and tools for future research of the relationship between health-related behavior and chronic disease.

    复杂网络慢性非传染性疾病健康相关行为网络分析健康促进

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    职业人群工作环境噪声感知与心血管疾病、抑郁症状及其共病的关联

    蔡长伟杨波范云喆余彬...
    417-424页
    查看更多>>摘要：目的 分析职业人群的工作环境噪声感知与心血管疾病（CVD）、抑郁症状及其共病的关系，为身心疾病的防控提供科学依据。 方法 采用横断面调查研究设计，来自2021年10-12月四川省、贵州省28个地级市和重庆市33个区（县）中国铁路成都局集团有限公司的西南职业人群队列基线数据，通过问卷调查获取工作环境噪声感知、抑郁症状和CVD史等情况，并采用潜在剖面分析模型确定噪声感知类型，采用多分类logistic回归分析探讨不同噪声感知类型与CVD、抑郁症状及其共病的关系。 结果 共纳入30 509名研究对象，年龄为（36.6±10.5）岁，82.0%为男性。工作环境噪声直接感受、心理影响、听力/睡眠影响程度的增加均会升高单纯CVD、单纯抑郁症状及其共病的患病风险。采用潜在剖面分析，将噪声感知分为低、中、高和极高水平。与低水平噪声感知相比，噪声感知水平越高，与单纯CVD、单纯抑郁症状和CVD合并抑郁症状的关联越强，其中极高水平噪声感知与低水平相比，单纯CVD、单纯抑郁症状、CVD合并抑郁症状人群的患病风险分别增加了2.14（95%CI：1.73~2.65）倍、8.80（95%CI：7.91~9.78）倍、17.02（95%CI：12.78~22.66）倍。 结论 不同噪声感知类型与CVD和抑郁症状有关，对CVD合并抑郁症状危害更大。应降低职业人群工作环境噪声强度，减少患身心疾病的风险。 Objective To explore the association between occupational noise perception and cardiovascular disease (CVD), depression symptoms, as well as their comorbidity in occupational population and provide evidence for the prevention and control of physical and mental illnesses. Methods A cross-sectional survey design was adopted, based on baseline data in population in 28 prefectures in Sichuan Province and Guizhou Province, and 33 districts (counties) in Chongqing municipality from Southwest Occupational Population Cohort from China Railway Chengdu Group Co., Ltd. during October to December 2021. A questionnaire survey was conducted to collect information about noise perception, depressive symptoms, and the history of CVD. Latent profile analysis model was used to determine identify noise perception type, and multinomial logistic regression analysis was conducted to explore the relationship between different occupational noise perception types and CVD, depression symptoms and their comorbidity. Results A total of 30 509 participants were included, the mean age was (36.6±10.5) years, and men accounted for 82.0%. The direct perception of occupational noise, psychological effects and hearing/sleep impact of occupational noise increased the risk for CVD, depressive symptoms, and their comorbidity. By using latent profile analysis, occupational noise perception was classified into four levels: low, medium, high, and very high. As the level of noise perception increased, the association with CVD, depressive symptoms, and their comorbidity increased. In fact, very high level occupational noise perception were found to increase the risk for CVD, depressive symptoms, and their comorbidity by 2.14 (95%CI: 1.73-2.65) times, 8.80 (95%CI: 7.91-9.78) times, and 17.02 (95%CI: 12.78-22.66) times respectively compared with low-level occupational noise perception. Conclusions Different types of occupational noise perception are associated with CVD and depression symptom, especially in the form of CVD complicated with depression symptom. Furthermore, the intensity of occupational noise in the work environment should be reduced to lower the risk for physical and mental health.

    噪声感知心血管疾病抑郁症身心疾病工作环境

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    职业人群不健康生活方式与糖脂代谢异常的关联及网络分析

    马春兰余彬范云喆叶婷婷...
    425-431页
    查看更多>>摘要：目的 分析职业人群不健康生活方式对糖脂代谢异常的影响及关键影响因素，为糖脂代谢异常的预防提供科学依据。 方法 基于2021年中国铁路成都局集团有限公司西南职业人群队列的基线数据和随访数据。糖脂代谢异常以糖尿病伴1项或多项血脂异常判断，不健康生活方式根据吸烟、饮酒、不健康膳食模式、低体力活动和BMI异常进行评分。通过多因素logistic回归模型分析不健康生活方式得分与糖脂代谢异常之间的关系，采用网络分析探索影响糖脂代谢的主要生活方式。 结果 共纳入25 631名研究对象。不健康生活方式得分为2、3分人群患糖尿病伴≥1项血脂异常的风险分别为0分的1.93（95%CI：1.31~2.86）倍和2.37（95%CI：1.60~3.50）倍；不健康生活方式得分为1、2、3分人群患糖尿病伴≥2项血脂异常的风险分别为0分的1.98（95%CI：1.08~3.61）倍、2.87（95%CI：1.60~5.14）倍和3.95（95%CI：2.22~7.06）倍。网络分析发现BMI异常和HDL-C是连接不健康生活方式与糖脂代谢异常的“桥接节点”。 结论 不健康生活方式得分越高，患糖脂代谢异常的风险越大，BMI异常和HDL-C是关联不健康生活方式和糖脂代谢异常的关键因素。 Objective To understand the influence of unhealthy lifestyle on diabetic dyslipidemia and the key influencing factors in occupational population and provided scientific evidence for the prevention of diabetic dyslipidemia. Methods Based on baseline data and follow-up data of Southwest Occupational Population Cohort from China Railway Chengdu Group Co., Ltd. during 2021. Diabetic dyslipidemia was defined as diabetes plus one or more forms of dyslipidemia, and unhealthy lifestyle factors included smoking, alcohol consumption, unhealthy dietary patterns, low physical activity, and abnormal BMI. Multivariate logistic regression model was used to analyze the relationship between unhealthy lifestyle scores and diabetic dyslipidemia, network analysis was used to find and explore the key lifestyles influencing glycolipid metabolism. Results A total of 25 631 subjects were included. People with unhealthy lifestyle score 2 and 3 were 1.93 (95%CI: 1.31-2.86) times and 2.37 (95%CI: 1.60-3.50) times more likely to have diabetes with ≥1 forms of dyslipidemia than those with scores of 0 People with unhealthy lifestyle score 1, 2 and 3 were 1.98 (95%CI: 1.08-3.61) times, 2.87 (95%CI: 1.60-5.14) times and 3.95 (95%CI: 2.22-7.06) times more likely to have diabetes with ≥2 forms of dyslipidemia than those with score 0. Network analysis found that abnormal BMI and HDL-C were the "bridge nodes" that link unhealthy lifestyles with diabetic dyslipidemia. Conclusion The higher the score of unhealthy lifestyle, the higher the risk for diabetic dyslipidemia, abnormal BMI and HDL-C are key factors influencing the association between unhealthy lifestyle and diabetic dyslipidemia.

    糖脂代谢异常职业人群网络分析不健康生活方式

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    职业人群不健康行为生活方式与高尿酸血症的关系及高血压、血脂异常的效应修饰作用

    王梓航胡玉麒杨波范云喆...
    432-439页
    查看更多>>摘要：目的 探索不健康行为生活方式与高尿酸血症的关系，以及高血压、血脂异常的效应修饰作用，为预防高尿酸血症提供理论依据。 方法 采用横断面调查研究设计，基于2021年10-12月来自四川省、贵州省28个地级市和重庆市33个区（县）中国铁路成都局集团有限公司的西南职业人群队列基线数据，通过问卷调查、体格测量及实验室生化检测收集研究对象的人口学特征、行为生活方式、慢性非传染性疾病患病情况。不健康行为生活方式得分根据吸烟、饮酒、膳食模式、体力活动和低体重/超重状况进行评分，分值越高不健康行为生活方式越多。采用多因素logistic回归模型分析不健康行为生活方式评分、吸烟状况、饮酒状况等与高尿酸血症的关系，采用分层分析探索高血压等疾病对不健康行为生活方式与高尿酸血症之间关系的修饰效应。 结果 共纳入11 748名研究对象，高尿酸血症患病率为34.4%。多因素logistic回归分析显示，现在吸/既往吸烟、现在饮/既往饮酒及BMI异常是高尿酸血症患病的危险因素，不健康行为生活方式对高尿酸血症患病风险呈现累积效应，随着得分的升高，高尿酸血症患病风险升高，OR值由1.64（95%CI：1.34~2.00）上升至2.89（95%CI：2.39~3.50）。分层分析结果显示，在高血压及血脂异常人群中，不健康行为生活方式对高尿酸血症患病风险影响更大。 结论 多种不健康行为生活方式的共存会升高高尿酸血症患病风险，这一效应在高血压、血脂异常人群中更明显。及时纠正不健康行为生活方式，并控制高血压和血脂异常，降低患高尿酸血症的风险。 Objective To understand the relationship between unhealthy lifestyle and hyperuricemia, as well as the modification effects of hypertension and dyslipidemia in occupational population and provide a theoretical basis for the prevention of hyperuricemia. Methods A cross-sectional survey design was adopted, based on baseline data from the Southwest Occupational Population Cohort from China Railway Chengdu Group Co., Ltd., which included the population in 28 prefectures from Sichuan Province and Guizhou Province, and 33 districts (counties) from Chongqing Municipality between October and December 2021. This study collected the information about the demographics characteristics, lifestyles, and prevalence of chronic non-communicable diseases of the study subjects through questionnaire, physical measurement and laboratory biochemical test. The unhealthy lifestyle score was scored based on smoking, alcohol consumption, dietary patterns, physical activity, and low weight or overweight, with higher scores being associated with more unhealthy lifestyles. The multivariate logistic regression model was used to analyze the relationship between unhealthy lifestyle score, smoking, alcohol consumption, other factors and hyperuricemia, and the stratified analysis was used to explore the modification effect of hypertension and other diseases on the relationship between unhealthy lifestyle and hyperuricemia. Results A total of 11 748 participants were included in this study, the prevalence of hyperuricemia was 34.4%. Multivariate logistic regression model showed that current/previous smoking, current/previous alcohol consumption and BMI abnormality were risk factors for hyperuricemia, and the unhealthy lifestyle score showed a "cumulative" effect on the risk for hyperuricemia, with higher score increasing the risk of hyperuricemia, and the OR increased from 1.64 (95%CI: 1.34-2.00) to 2.89 (95%CI: 2.39-3.50). Stratified analysis showed that unhealthy lifestyles had a greater impact on the risk for hyperuricemia in people with hypertension and dyslipidemia. Conclusions The coexistence of multiple unhealthy lifestyles might increase the risk of hyperuricemia, and this effect was stronger in participants with hypertension and dyslipidemia. Timely correction of unhealthy lifestyles, and control of hypertension and dyslipidemia might reduce the risk for hyperuricemia.

    不健康行为生活方式高尿酸血症职业人群高血压血脂异常

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    职业人群的体质指数和血脂水平在饮酒行为与高血压关联间的中介效应

    董舒余彬杨波范云喆...
    440-446页
    查看更多>>摘要：目的 探讨职业人群饮酒行为与高血压及SBP、DBP的关联，分析体质指数（BMI）和血脂水平的中介作用，为职业人群的高血压预防提供参考。 方法 基于西南地区职业人群队列，通过问卷调查、体格和血生化检查收集人口学特征、行为生活方式、血压和血脂等情况。采用logistic回归分析和线性回归分析饮酒行为与高血压及SBP、DBP的关联，采用因果中介分析估计BMI、HDL-C、LDL-C、TG和TC的独立和联合中介效应，并结合网络分析探索饮酒行为、BMI、血脂水平与高血压之间的相互关联。 结果 共纳入22 887名研究对象，其中新发高血压1 825名。Logistic回归分析发现，与从不饮酒人群相比，现在饮/既往饮酒可使高血压风险增加33%（OR=1.33，95%CI：1.19~1.48）；饮酒行为可使SBP（β=1.05，95%CI：0.69~1.40）和DBP（β=1.10，95%CI：0.83~1.38）增加。联合中介分析发现，BMI和血脂介导了饮酒行为与高血压及SBP、DBP间21.91%、28.40%和22.64%的效应，其中BMI和TG为主要的中介因素，也是饮酒行为、BMI、血脂水平和血压网络中边权和桥强度中心性最高的2个中介节点。 结论 饮酒行为与患高血压风险升高有关，BMI和TG是重要的中介因素和网络中关键节点，提示应重点关注饮酒行为、BMI和TG，有助于职业人群的高血压预防。 Objective To investigate the association between alcohol consumption and hypertension and SBP, DBP and the mediating effects of body mass index (BMI) and lipid level in occupational population, and provide reference for the intervention and prevention of hypertension. Methods Based on the data of Southwest Occupational Population Cohort from China Railway Chengdu Group Co., Ltd., the information about the demographic characteristics, behavior and lifestyle, blood pressure and lipids level of the participants were collected through questionnaire survey, physical examination and blood biochemical test. Logistic/linear regression was used to analyze the association between alcohol consumption and hypertension, SBP and DBP. The individual and joint mediating effects of BMI, HDL-C, LDL-C, TG, and TC were explored through causal mediating analysis. A network analysis was used to explore the correlation between alcohol consumption, BMI and lipid levels, and hypertension. Results A total of 22 887 participants were included, in whom 1 825 had newly detected hypertension. Logistic regression analysis found that current/former drinkers had a 33% increase of risk for hypertension compared with never-drinkers (OR=1.33, 95%CI:1.19-1.48). Similarly, alcohol consumption could increase SBP (β=1.05, 95%CI:0.69-1.40) and DBP (β=1.10, 95%CI:0.83-1.38). Overall, BMI and lipid levels could mediate the associations between alcohol consumption and hypertension, SBP and DBP by 21.91%, 28.40% and 22.64%, respectively. BMI and TG were the main mediators, and they were also the two nodes with the highest edge weight and bridge strength centrality in the network of alcohol consumption, BMI, lipid levels and hypertension. Conclusions Alcohol consumption was associated with increased risk for hypertension, and BMI and TG were important mediators and key nodes in the network. It is suggested that paying attention to the alcohol consumption, BMI and TG might help prevent hypertension in occupational population.

    饮酒行为高血压体质指数血脂中介分析网络分析

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    效应修饰作用分析方法与案例解析系列（三）：个体数据Meta分析中的效应修饰

    刘凤琪杨智荣武珊珊赵厚宇...
    447-454页
    查看更多>>摘要：简要介绍个体数据Meta分析在效应修饰作用方面的独特优势、整体分析思路及现有分析方法，除了常见的Meta回归和亚组分析外，还介绍了利用部分个体数据合并集合水平数据的分析方法，并总结以上方法的报告现状。以“钠-葡萄糖协同转运蛋白2抑制剂对2型糖尿病患者SBP的影响”作为案例，分别展示上述方法在个体数据Meta分析中的实际应用及结果解读，总结各方法的优势和局限性。 This paper briefly introduces the unique advantages, overall analysis ideas and existing analysis methods of individual patient data Meta-analysis in terms of effect modification. In addition to Meta-regression and subgroup analysis, this paper also introduces the analysis methods based on part of individual patient data integrated with aggregated data and summarizes the current reporting of the above mentioned methods. In addition, the application and results interpretation of the above mentioned methods in individual patient data Meta-analysis are presented in this paper by taking "Effects of sodium-glucose cotransporter 2 inhibitors on SBP in patients with type 2 diabetes" as an example and by introducing their advantages and limitations.

    效应修饰作用个体数据多水平网状Meta回归

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    发热伴出疹症候群监测预警研究进展

    林帆郭玉清吴彦霖李开明...
    455-463页
    查看更多>>摘要：目的 对发热伴出疹症候群（RFS）监测预警研究进行系统综述，为我国RFS监测与防控提供参考。 方法 以“发热”“出疹”“监测”以及 “fever” “rash” “surveillance”为中英文检索词并补充其自由词，系统检索中国知网、万方数据知识服务平台、PubMed、Web of Science数据库，语种限定为中文及英文，对纳入文献信息进行摘录整理及汇总描述。 结果 共纳入36篇文献，中英文分别为21篇和15篇。RFS病原学监测共19篇，病原体主要包括麻疹病毒、水痘-带状疱疹病毒、风疹病毒、肠道病毒、人类B19病毒、登革病毒、A组链球菌、伤寒/副伤寒沙门菌、人疱疹病毒、腮腺炎病毒和腺病毒；重大活动/突发自然灾害监测8篇，监测时段集中在2010-2015年，包括运动会、世界博览会、地震、热带风暴和宗教集会等；异常病例/聚集性疫情监测预警8篇，以国外研究为主，监测症候群范围广，监测场所为医疗机构，主要依靠《国际疾病分类》第九版（ICD-9）编码或患者主诉中诊断及症状进行自动判别预警；仅1篇针对预测研究，为蒙古国开展的基于传染病监测数据预测研究。36篇文献的分析方法包括描述性分析法、基于时间的预警模型（如回归分析法、固定阈值法、休哈特控制图法及累积和控制图法）和时间序列分析方法。 结论 未来RFS监测体系方向应聚焦已知病原和可能的未知病原监测预警相结合的模式，可进一步完善预警系统设计，实现无感化病例监测与早期预警，应用当下的信息抓取技术和智能建模方法，提高RFS监测预警的敏感度和特异性。 Objective To introduce the progress in research of rash and fever syndrome (RFS) surveillance and early warning both at home and abroad, and provide reference for surveillance and prevention of RFS in China. Methods The keywords "fever" "rash" and "surveillance" and others were used for a literature retrieval by using China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, PubMed and Web of Science. The languages of literatures were limited in Chinese and English. The key information of the literatures were collected and analyzed with Excel. Results A total of 36 study papers (21 in Chinese and 15 in English) were included. The studies mainly focused on the pathogen surveillance of RFS (n=19). The pathogens included measles virus, varicella-zoster virus, rubella virus, enterovirus, human B19 virus, dengue virus, streptococcus group A, Salmonella typhi andSalmonella paratyphoid,human herpesvirus, mumps virus and adenovirus. Eight studies were about the surveillance in major events, such as sport game, World Expo and religious gathering, or sudden natural disasters, such as earthquake and tropical storm, during 2010-2015. Eight studies focused on case or epidemic surveillance, most of which were studies from other counties. The surveillance sites were medical institutions. RFS was diagnosed according to the International Classification of Diseases, 9th (ICD-9) and symptoms descripted in chief-complaint. Only one study in Mongolia conducted RFS epidemic prediction. The analysis methods of 36 papers included simple descriptive analysis, time-based early warning models (such as regression analysis, fixed threshold method, Hugh Hart control chart method and cumulative sum control chart method) and time series analysis method. Conclusions In the future, RFS surveillance system should cover both known pathogens and emerging pathogens. Automatic surveillance using information capture and intelligent modelling can be applied to improve the sensitivity and specificity of RFS surveillance and early warning.

    发热伴出疹症候群监测预警系统综述

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    我国消除丙型肝炎的普通人群HCV检测策略的成本效果分析

    刘鹏程徐迪丁国伟赵靓...
    464-472页
    查看更多>>摘要：目的 分析我国消除丙型肝炎（丙肝）的普通人群HCV检测策略的成本效果，明确最佳成本效果的HCV检测年龄。 方法 运用TreeAge pro 2019软件构建决策树马尔科夫模型，以1年为周期，模拟10万名20~59岁各年龄组人群HCV检测和治疗结果，以全社会角度分析策略间比较的成本效果和效益。效果指标为增量成本效果比（ICER），效益指标为净货币效益（NMB），以我国2022年人均国内生产总值（85 698元）为意愿支付阈值。通过单因素敏感性分析和概率敏感性分析评估结果可靠性。 结果 在20~59岁人群HCV检测有成本效果，在40~49岁年龄组进行HCV检测成本效果最佳。20~59岁年龄组人群HCV检测策略与未HCV检测策略比较，增量成本为161.24元/人，增量效用为0.003 6质量调整寿命年（QALYs）/人，ICER为45 197.26元/QALY，ICER小于意愿支付阈值，具有成本效果。各年龄组人群HCV检测策略与未HCV检测策略比较，ICER为42 055.06~53 249.43元/QALY，NMB为96.52~169.86元/人，其中40~49岁年龄组的ICER最低，NMB最高。单因素敏感性分析结果显示，贴现率、丙肝抗体（抗-HCV）检测成本、人群抗-HCV阳性率和直接抗病毒药物治疗成本对经济学评价影响较大，但改变参数取值，结论不变。概率敏感性分析结果表明模型分析结果稳定。 结论 医疗机构探索动员20~59岁普通人群进行HCV检测具有较好的成本效果，以40~49岁年龄组人群的HCV检测成本效果最佳。在我国普通人群中实施HCV检测的“愿检尽检”策略，能降低人群丙肝疾病负担。 Objective To evaluate the cost-effectiveness of hepatitis C screening in general population in China, and find the age group in which hepatitis C screening can achieve the best cost-effectiveness. Methods A decision-Markov model was constructed by using software TreeAge pro 2019 to simulate the outcomes of hepatitis C disease pregression of 100 000 persons aged 20-59 years. The cost-effectiveness of the strategies were evaluated from societal perspectives by using incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). One-way sensitivity analysis and probability sensitivity analysis were used to evaluate the uncertainty of parameters and model. Results Hepatitis C screening was cost-effective in people aged 20- 59 years and the cost effectiveness was best in age group 40-49 years. Compared with non-screening strategy of hepatitis C in people aged 20-59 years, the incremental cost was 161.24 yuan, the incremental utility was 0.003 6 quality adjusted life years (QALYs)/per person, ICER was 45 197.26 yuan/QALY, ICER was less than the willing payment threshold. The ICER and NMB in all age groups were 42 055.06-53 249.43 yuan/QALY and 96.52-169.86 yuan/per person. Hepatitis C screening in people aged 40-49 years had the best cost-effectiveness. The results of one-way sensitivity analysis showed that the discount rate, anti-HCV detection cost, anti-HCV infection rate and the cost of direct antiviral agents were the main factors influencing economic evaluation. The results of the probability sensitivity analysis indicated that the model analysis was stable. Conclusions Implementing hepatitis C screening based on medical institutions is cost-effective in people aged 20- 59 years, especially in those aged 40-49 years. Implementing the HCV screening strategy of be willing to test as far as possible in general population can reduce hepatitis C disease burden in China.

    丙型肝炎普通人群检测成本效果马尔科夫模型

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