BACKGROUND Type 2 diabetes mellitus (T2DM) is a leading risk factor for the development and progression of chronic kidney disease (CKD). However, an accurate and convenient marker for early detection and appropriate management of CKD in individuals with T2DM is limited. Recent studies have demonstrated a strong correlation between the neutrophil-to-lymphocyte ratio (NLR) and CKD. Nonetheless, the predictive value of NLR for renal damage in type 2 diabetic patients remains understudied. AIM To investigate the relationship between NLR and renal function in T2DM patients. METHODS This study included 1040 adults aged 65 or older with T2DM from Shanghai's Community Health Service Center. The total number of neutrophils and lymphocytes was detected, and NLR levels were calculated. CKD was defined as an estimated glomerular filtration rate ≤ 60 mL/min/1.73 m². Participants were divided into four groups based on NLR levels. The clinical data and biochemical characteristics were compared among groups. A multivariate logistic regression model was used to analyze the association between NLR levels and CKD. RESULTS Significant differences were found in terms of sex, serum creatinine, blood urea nitrogen, total cholesterol, and low-density lipoprotein cholesterol among patients with T2DM in different NLR groups (P < 0.0007). T2DM patients in the highest NLR quartile had a higher prevalence of CKD (P for trend = 0.0011). Multivariate logistic regression analysis indicated that a high NLR was an independent risk factor for CKD in T2DM patients even after adjustment for important clinical and pathological parameters (P = 0.0001, odds ratio = 1.41, 95% confidence intervals: 1.18-1.68). CONCLUSION An elevated NLR in patients with T2DM is associated with higher prevalence of CKD, suggesting that it could be a marker for the detection and evaluation of diabetic kidney disease.

目的 探讨运用决策辅助工具管理心房颤动患者心理健康的成效.方法 研究选取在我中心全科门诊就诊心房颤动患者307例,随机分为研究组和对照组,对照组151进行传统门诊就诊方式对患者进行疾病诊疗与宣教,研究组156例使用心理健康宣教手册作为决策辅助工具对患者进行心理健康宣教,并采用焦虑自评量表(GAD-7)、抑郁自评量表(PHQ-9)、躯体化症状自评量表(SSS-CN)对患者进行心理状况评估.1年后比较两组房颤患者心理量表情况.结果 基线水平显示,307例患者中焦虑、抑郁、躯体化症状分别为16.6％、29.6％和68.4％.多因素Logistic回归分析结果显示,有心肌梗死病史、伴随乏力症状是焦虑的危险因素,年龄＞65岁、高中及以上学历是保护因素(P＜0.05);合并高血压、既往心肌梗死,及伴随胸闷、胸痛、腹胀、乏力症状是抑郁的危险因素(P＜0.05);伴随胸闷、胸痛、下肢浮肿、腹胀症状是躯体化症状的危险因素,年龄＞65岁、合并高血压、糖尿病是躯体化症状的保护因素(P＜0.05).1年后再次评估,运用心理决策辅助工具宣教组患者,PHQ-9、SSS-CN评分显著优于对照组(P＜0.05).结论 对心房颤动患者运用心理决策辅助工具进行干预指导,具有良好的有效性和可行性,值得推广.

目的:以非瓣膜性心房纤维颤动继续医学教育为例,对比线上与线下继续医学教育的效果.方法:于2019年10月—2020年6月期间采用单纯随机抽样方法从上海市宝山区、浦东新区、闵行区、嘉定区、静安区、长宁区、崇明区、金山区分别抽取5～6家社区卫生服务中心,选取共43家社区卫生服务中心的935名全科医生作为调查对象.采用单纯随机抽样方法将其中13家社区卫生服务中心的全科医生设为线下组,其他30家的全科医生设为线上组,采取不同的教学方式分别进行非瓣膜性心房纤维颤动继续医学教育,比较两组全科医生培训前后房颤理论知识得分和培训后满意度情况.结果:培训后两组全科医生的房颤理论知识得分差异无统计学意义(P组间=0.537),两组全科医生组内培训前后的房颤理论知识得分差异有统计学意义(P前后<0.001),两组全科医生培训与时间的交互作用差异无统计学意义(P交互=0.354).两组全科医生在培训知识量接受程度、培训内容难易接受程度和临床思维能力提高程度方面的满意度差异有统计学意义(P<0.05),线上组满意度均高于线下组.结论:建议可开展分层级、分批次、分时段的培训形式,对自学能力较强的学员,可以线上教学为主、线下教学为辅,其他学员则可采用线上、线下混合的教学方式,通过科学组织继续医学教育,促使社区全科医生合理利用时间,有效提升岗位胜任力,为社区居民提供更优质的医疗服务.

目的:分析老年代谢异常动脉粥样硬化性心血管疾病(ASCVD)风险等级及血脂达标的影响因素.方法:依据是否存在代谢异常,16305例60岁以上ASCVD患者被分为代谢异常组(14778例)与代谢正常组(1527例).比较两组一般临床资料,分析代谢异常因素与ASCVD风险等级的相关性及代谢异常ASCVD高危患者LDL-C水平达标的影响因素.结果:与代谢正常组比较,代谢异常组女性、城市居民比例,年龄、腰围、BMI、收缩压、舒张压、平均动脉压(MAP)、空腹血糖(FBG),总胆固醇、LDL-C、TG水平均显著升高,吸烟比例、HDL-C水平均显著降低(P＜0.05或＜0.01).Spearman相关性分析显示,ASCVD危险等级与FBG、TG呈显著正相关(r=0.206～0.365,P 均=0.001),与 HDL-C、MAP、腰围呈显著负相关(r=-0.051～-0.221,P均=0.001).多因素Logistic回归分析显示,代谢异常累积个数3、4、5种是代谢异常ASCVD高危患者的独立危险因素(OR=1.686～2.447,P＜0.05或＜0.01).结论:血脂、血糖水平等代谢异常是ASCVD的独立危险因素.

BACKGROUND:Little is known about the risk of diabetes due to higher glycemic variability and the underlying mechanisms. We aimed to examine the association of visit-to-visit variability (VVV) in fasting plasma glucose (FPG) with incident diabetes in Chinese adults and whether the association was mediated by changes in insulin resistance (IR). METHODS:We included 1856 community residents without a history of diabetes and having attended 3 examinations in 2008, 2009, and 2013 respectively. The SD, the average successive variability (ASV), the coefficient of variation (CV), and the variability independent of the mean (VIM) of three recorded FPG measurements were calculated for each participant, and SD, ASV, CV, and VIM were used as a measure of VVV in FPG. Incident diabetes was defined according to the 1999 World Health Organization criteria. IR was evaluated using the homeostatic model assessment (HOMA). RESULTS:A total of 153 (8.2%) participants developed incident diabetes at the third visit. Compared with the lowest tertile (0-5.83 mg/dl) of FPG-SD, the highest tertile (9.55-74.17 mg/dl) was associated with a 148% increased risk of diabetes (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.36-4.49), after adjustment for covariates including mean FPG at 3 visits. Mediation analyses suggested that changes in IR (ΔHOMA-IR) might mediate 17.3% of the association between increased FPG-SD and elevated diabetes risk. Similar results were found for FPG-CV, FPG-ASV, and FPG-VIM. CONCLUSIONS:The VVV in FPG was significantly associated with risks of diabetes in Chinese adults, which was partially mediated by changes in IR.

目的:探讨上海市60岁以上高血压患者动脉粥样硬化性心血管病(ASCVD)危险分层及血脂达标情况,和ASCVD高危患者LDL-C水平未达标的影响因素.方法:13735例60岁以上无ASCVD病史的体检者被分为非高血压组(7125例)与高血压组(6610例),比较两组一般资料.依据ASCVD危险分层评估,3925例LDL-C水平未达标的高血压患者被分为ASCVD低危组(554例)、中危组(42例)与高危组(3329例),比较各组间血脂水平.依据LDL-C水平是否达标,分析高血压ASCVD高危患者LDL-C水平未达标的影响因素.结果:与非高血压组比较,高血压组女性、吸烟、慢性肾脏病(CKD)比例,年龄、腰围、BMI、SBP、DBP、FBG、TC、TG水平均显著升高,农村人员、合并DM比例均显著降低(P均=0.001).与ASCVD低危组比较,ASCVD中危组、高危组TC、LDL-C、HDL-C水平均显著降低;与ASCVD中危组比较,ASCVD高危组上述血脂水平均显著升高(P<0.05或<0.01).多因素Lsgiotic回归分析显示,女性、农村人员、吸烟是ASCVD高危患者LDL-C水平未达标的独立危险因素(OR=2.169～3.643,P均=0.001),高龄、合并DM、合并CKD是其独立保护因素(OR=0.192～0.728,P<0.05或<0.01).结论:上海市60岁以上高血压ASCVD高危患者血脂达标率低、女性、农村人员、吸烟是此类患者LDL-C水平未达标的独立危险因素.

目的:调查社区全科医生对房颤的诊疗能力及继续教育对诊疗水平提升的效果.方法:随机选择962名社区全科医生,分别来自上海市的6个区域,组成6个组,比较各组调查问卷得分、培训前后对房颤认识的正确率.结果:社区全科医生对于房颤诊疗知识的掌握程度在不同区域、全科类别、年龄、学历、职称之间有显著差异,P＜0.05或＜0.01.与培训前比较,培训后全科医生对房颤主要并发症的认识(56.13％比86.63％)、抗凝治疗重要性认识(47.40％比77.01％)、CHA2DS2-VASC评分的认识(60.29％比78.40％)、抗凝治疗指征的认识(40.23％比60.69％)、抗凝药物的识别(42.83％比61.07％)、合并慢性心衰治疗的认识(3.22％比13.26％)、房颤出血评分系统的认识(43.04％比64.06％)、控制心室率药物的选择(49.06％比61.50％)和复律治疗认识的正确率(39.71％比75.19％)均显著升高(P均=0.001).结论:社区全科医生房颤诊疗水平存在不足,且受城市不同区域、学历、职称、年龄、全科类别影响;有针对性培训可显著提高诊疗能力.

Abstract Background Little is known about the risk of diabetes due to higher glycemic variability and the underlying mechanisms. We aimed to examine the association of visit‐to‐visit variability (VVV) in fasting plasma glucose (FPG) with incident diabetes in Chinese adults and whether the association was mediated by changes in insulin resistance (IR). Methods We included 1856 community residents without a history of diabetes and having attended 3 examinations in 2008, 2009, and 2013 respectively. The SD, the average successive variability (ASV), the coefficient of variation (CV), and the variability independent of the mean (VIM) of three recorded FPG measurements were calculated for each participant, and SD, ASV, CV, and VIM were used as a measure of VVV in FPG. Incident diabetes was defined according to the 1999 World Health Organization criteria. IR was evaluated using the homeostatic model assessment (HOMA). Results A total of 153 (8.2%) participants developed incident diabetes at the third visit. Compared with the lowest tertile (0–5.83 mg/dl) of FPG‐SD, the highest tertile (9.55–74.17 mg/dl) was associated with a 148% increased risk of diabetes (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.36–4.49), after adjustment for covariates including mean FPG at 3 visits. Mediation analyses suggested that changes in IR (ΔHOMA‐IR) might mediate 17.3% of the association between increased FPG‐SD and elevated diabetes risk. Similar results were found for FPG‐CV, FPG‐ASV, and FPG‐VIM. Conclusions The VVV in FPG was significantly associated with risks of diabetes in Chinese adults, which was partially mediated by changes in IR.

目的 :探讨亚临床甲状腺功能减退（subclinical hypothyroidsm,SCH）及促甲状腺激素（thyrotropin,thyroid stimulating hormone,TSH）水平与颈动脉内中膜厚度（carotid intima media thickness,CIMT）之间的相关性。方法 :选取上海市嘉定区6 256名40岁以上甲状腺激素水平正常的居民作为研究对象,采用化学发光酶免疫法测定其甲状腺激素和TSH水平,采用高分辨B型超声检查仪测量CIMT。根据甲状腺功能水平分组,SCH的诊断标准为TSH＞4.94μIU/L而FT4在正常范围内,分析SCH、TSH水平与CIMT间的相关性。结果:6 256名研究对象中,SCH患者为458例（7.3%）,甲状腺功能正常者（正常组）为5 798例,CIMT增厚者为2 082例（34.6%）。SCH组的CIMT显著增厚[（0.73±0.007）mm比（0.71±0.001）mm,P=0.003]。多元线性回归分析结果显示,Log10-TSH水平与CIMT呈显著正相关（β=0.02,P=0.01）,在校正了性别、年龄、体质量指数（body mass index,BMI）、目前是否吸烟、目前是否饮酒、血脂、血压、超敏C反应蛋白（hypersensitive C-reactive protein,hs-CRP）、高血压用药情况后,与正常组相比,SCH患者的CIMT增厚风险增加了28%（OR=1.28,95%CI=1.03~1.61,P=0.03）。结论:在上海市嘉定区甲状腺激素水平正常的中老年人群中,SCH患病率为7.3%,CIMT增厚者占34.6%,TSH水平与CIMT增厚呈显著正相关,SCH是CIMT增厚的独立风险因素。

目的:了解宝山区社区护士参与中医护理情况和培训需求,为家庭医生服务模式下有针对性地开展社区护士中医护理培训提供参考依据.方法:对宝山区17所社区卫生服务中心510名社区护士进行问卷调查.结果:有效应答者479人,应答率为93.92％.接受调查的479名护士中315人(56.99％)是家庭医生团队成员,其中65.76％参与社区重点人群健康管理.健康管理投入时间以预防保健岗位的护士为多,人均每周13.84个小时;护理岗位和管理岗位的护士每周分别为11.84和10.85人时数.479名社区护士中只有21.64％护士运用过中医护理服务;仅31.52％的护士接受过中医护理相关的培训;有78.08％的护士需要中医护理培训.结论:目前社区护士较少运用中医护理为居民提供服务;社区护士较少有机会接受中医护理培训,应加强社区护士的中医药护理培训,提高其为社区重点人群提供中医药服务的能力.

采用问卷、个人咨询调查法。结果:普遍存在的误区有8项,包括少吃粮食多吃菜、不能吃水果、豆制品可多吃等,并且1人同时存在多项误区。结论:加强社区糖尿病健康教育,对患者进行合理的饮食指导将更好地控制糖尿病患者血糖,减少并发症,提高生活质量,节约社会医疗资源。