Background Congenital heart disease (CHD) is a leading cause of neonatal morbidity and mortality, with a complex aetiology involving genetic and environmental factors. Cardiac transcription factors, such as NKX2.5, GATA4 and TBX5, are essential for heart development, and their gene polymorphisms may contribute to CHD. Additionally, maternal periconceptional environmental exposures may influence CHD risk. Limited studies explore gene-gene and gene-environment interactions in CHD pathogenesis.Methods A hospital-based case-control study analyzed 585 CHD cases and 600 controls. Associations between transcription factor gene polymorphisms, maternal environmental exposures and CHD risk were assessed using logistic regression, multiplicative interaction models and model-based multifactor dimensionality reduction.Results Several transcription factor gene polymorphisms were significantly associated with CHD risk. Specifically, NKX2.5 (rs118026695), GATA4 (rs12458) and TBX5 (rs11067101, rs6489956) increased CHD risk, while NKX2.5 (rs703752) and GATA4 (rs4841588, rs904018) reduced risk. Gene-gene interactions among these loci further modulated CHD risk. Maternal environmental factors, such as gestational diabetes, pre-gestational diabetes, adverse pregnancy history, certain medications and lifestyle factors, were associated with higher CHD risk, certain gene-environment interactions showed suggestive associations with CHD risk, with some combinations reaching statistical significance prior to multiple testing correction.Conclusion Infant NKX2.5, GATA4 and TBX5 gene polymorphisms significantly affect CHD risk, and maternal periconceptional environmental exposures may further influence this risk through certain gene-environment combinations. These findings provide insights into CHD aetiology and highlight the need for preventive strategies. Further studies are necessary to validate these results and clarify underlying mechanisms.

General health checks (GHCs) are widely used for disease prevention, however, their clinical effectiveness, psychological impact, and economic value remain debated. This study systematically evaluated the effectiveness and cost-effectiveness of GHCs in adults to update and expand upon existing reviews. We searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, SinoMed, CNKI, and WanFang from inception to July 1, 2025. Three reviewers independently screened titles and abstracts, and two reviewers assessed full-text eligibility, with disagreements resolved through discussion or consultation with a senior reviewer. We included randomized controlled trials, nonrandomized controlled trials, observational studies with control groups, mixed-methods studies, and economic evaluations comparing GHCs with usual care in adults. Risk of bias was assessed using Cochrane RoB 2.0, ROBINS-I, and other validated tools. The certainty of evidence was evaluated using the GRADE approach. Due to substantial heterogeneity, findings were synthesized narratively. We included 74 articles representing 56 unique studies (22 RCTs, 5 NRCTs, 25 observational studies, 3 economic evaluations, 1 mixed-methods study), involving more than 17 million participants. RCTs generally did not show a significant reduction in all-cause mortality (76.9

目的 探究我国中老年人慢性病共病模式和影响因素.方法 使用中国健康与养老追踪调查(China health and retirement longitudinal study,CHARLS)2018年数据,纳入≥45岁人群19486名,采用系统聚类分析和Apriori算法探究慢性病共病模式,二分类logistic回归分析共病模式的影响因素.结果 我国≥45岁人群慢性病共病患病率为55.8％(95％CI:55.1％～56.5％).研究得到高血压和关节炎两种共病模式,高血压共病模式以高血压为核心,包括血脂异常、糖尿病、心脏病、中风、记忆问题、情感问题;关节炎共病模式以关节炎为核心,包括肺部疾病、哮喘、胃部疾病、肝脏疾病、肾脏疾病.高血压、血脂异常、心脏疾病、关节炎、胃部疾病处于重要地位,胃部疾病是两种共病模式的桥梁疾病.高龄是两种共病模式的共同危险因素,重度体力活动是高血压共病模式的保护因素,是关节炎共病模式的危险因素.高龄会促使两共病模式的单病种人群进展为共病,中重度体力活动对高血压共病模式的单病种人群进展为共病具有保护作用.结论 我国≥45岁人群中超五成存在慢性病共病.高血压、关节炎和胃部疾病是共病模式的核心疾病.应重点防控高血压、血脂异常、心脏疾病、关节炎、胃部疾病.高血压共病模式人群要每周进行中高度身体活动,关节炎共病模式人群可以在医师指导下进行适度身体活动.两共病模式的单病种人群要警惕高龄带来的共病风险,高血压共病模式的单病种人群可增加体力活动以延缓共病风险.

This study aimed to investigate the relationships between maternal FA supplementation and nine single-nucleotide variants of the GATA4 gene in non-chromosomal CHD and further explore the gene–environment interactions associated with CHD. A total of 585 CHD patients and 600 controls were recruited in the case–control study. Maternal FA (FA-containing multivitamin) supplementation information and nine polymorphisms of the GATA4 gene were collected in this study. Adjusted ORs (aOR) and their 95% confidence intervals (CIs) were calculated using proper statistical methods to analyze the relationships between the two main exposures of interest with respect to CHD. After adjusting the suspicious confounding factors, a significantly increased risk for CHD in offspring was found with non-FA supplementation before/during the pregnancy to CHD in offspring (aOR = 1.58, 95% CI: 1.01–2.48). We suggested taking FA supplementation before/during the pregnancy to prevent CHD in offspring, especially in the preconception period (aOR = 0.53, 95% CI: 0.32–0.90). The genetic results showed that the polymorphisms of rs4841588, rs12458, and rs904018 under specific genotypes and genetic models were significantly related to CHD. The gene–environment interaction between rs10108052 and FA supplementation before/during pregnancy could increase the risk of CHD (aOR = 5.38, 95% CI: 1.67–17.09, Pinteraction = 0.004). Relationships between maternal FA supplementation and specific polymorphisms of the GATA4 gene, as well as the gene–environment interaction, were significantly associated with CHD in offspring.

Objective To explore the trajectory of the development of permanent caries in 12- to 16-year-old students in Liuyang and to provide a reference for the prevention and management of caries. Methods Primary and secondary school students who were registered within the Liuyang jurisdiction were screened for caries from September to November by the Liuyang Center for Disease Control and Prevention. A total of 7 297 students between the ages of 12 and 16 years with complete permanent dentition caries monitoring records and traceable deciduous dentition caries monitoring records were selected from 2013 to 2019, and a zero-inflated negative binomial-latent class growth model (ZINB-LCGM) was established to describe the trajectory of the development of individual caries using the decayed missing filled teeth (DMFT) indicators. Results DMFT of 12- to 16-year-old students in Liuyang were mainly decayed teeth (DT), with the majority occurring in the first permanent molar. According to the ZINB-LCGM model, the students were classified into three latent categories, "slow growth pattern" (28.55%), "rapid growth pattern" (6.59%), and "stable pattern" (64.86%), which followed different nonlinear caries growth trajectories. Females with deciduous teeth caries were more likely to have trajectories showing a “rapid growth pattern” and a “slow growth pattern”. There were significant differences in the trajectories between men and women, as well as between those with and without primary dentition caries. Conclusion The trajectory of the development of caries in 12-16-year-old students shows heterogeneity in terms of different developmental patterns of latent categories, suggesting that females with deciduous dental caries should receive more attention.

目的 探讨浏阳市12～16岁学生恒牙龋病的发展轨迹,为制定龋齿防治措施提供参考.方法 浏阳市疾病预防控制中心每年9～11月开展中小学生龋齿筛查,对象为辖区范围内所有在籍中小学生,选取2013～2019年龋齿监测记录完整且过往乳牙龋监测记录可查的12～16岁学生7297名,利用龋失补指数(de-cayed missing filled teeth,DMFT)建立零膨胀负二项-潜类别增长模型(zero-inflated negative binomial-latent class growth model,ZINB-LCGM)描述个体恒牙龋病轨迹间的动态变化.结果 浏阳市12～16岁学生DMFT构成中以龋坏牙(decayed teeth,DT)为主,最好发于第一恒磨牙.根据ZINB-LCGM模型,将恒牙龋发展轨迹分为三个潜类别:"缓慢增长型"(28.55％)、"快速增长型"(6.59％)、"平稳型"(64.86％),不同潜类别间遵循不同的非线性增长轨迹,有乳牙龋的女性更容易表现出"缓慢增长型"和"快速增长型"恒牙龋轨迹.男、女性和有、无乳牙龋的轨迹间均有显著性差异.结论 12～16岁学生龋病轨迹有群体异质性,遵循不同的发展模式,需重点关注女性、曾经患乳牙龋的学生群体.

目的:本研究旨在构建中医住院按病种付费管理的绩效评价指标体系,确定指标及权重,为中医按病种付费绩效评价提供参考.方法:利用文献研究法初步构建指标池,运用德尔菲法进行两轮专家咨询,确定评价指标体系,采用层次分析法确定指标权重.结果:经两轮专家咨询后,建立了中医住院按病种付费管理绩效评价指标体系,包含3 个一级指标、10 个二级指标、29 个三级指标.专家积极程度、权威程度、意见协调程度均较好.层次分析法结果显示指标一致性程度较高.结论:初步构建了中医住院按病种付费管理绩效评价指标体系,具有较高的科学性和可靠性,可用于中医住院按病种付费管理的绩效评价,但仍需在今后的推广应用过程中不断进行动态调整.

To exhaustively explore the association of infant genetic polymorphisms of methionine synthase ( MTR ) gene with the risk of non-syndromic congenital heart disease (CHD). A hospital-based case–control study involving 620 CHD cases and 620 health controls was conducted from November 2017 to March 2020. Eighteen SNPs were detected and analyzed. Our date suggested that the genetic polymorphisms of MTR gene at rs1805087 (GG vs. AA: aOR = 6.85, 95% CI 2.94–15.96; the dominant model: aOR = 1.77, 95% CI 1.35–2.32; the recessive model: aOR = 6.26, 95% CI 2.69–14.54; the addictive model: aOR = 1.81, 95% CI 1.44–2.29) and rs2275565 (GT vs. GG: aOR = 1.52, 95% CI 1.15–1.20; TT vs. GG: aOR = 4.93, 95% CI 1.93–12.58; the dominant model: aOR = 1.66, 95% CI 1.27–2.17; the recessive model: aOR = 4.41, 95% CI 1.73–11.22; the addictive model: aOR = 1.68, 95% CI 1.32–2.13) were significantly associated with the higher risk of CHD. And three haplotypes of G-A-T (involving rs4659724, rs95516 and rs4077829; OR = 5.48, 95% CI 2.58–11.66), G-C-A-T-T-G (involving rs2275565, rs1266164, rs2229276, rs4659743, rs3820571 and rs1050993; OR = 0.78, 95% CI 0.63–0.97) and T-C-A-T-T-G (involving rs2275565, rs1266164, rs2229276, rs4659743, rs3820571 and rs1050993; OR = 1.60, 95% CI 1.26–2.04) were observed to be significantly associated with risk of CHD. Our study found that genetic polymorphisms of MTR gene at rs1805087 and rs2275565 were significantly associated with higher risk of CHD. Additionally, our study revealed a significant association of three haplotypes with risk of CHD. However, the limitations in this study should be carefully taken into account. In the future, more specific studies in different ethnic populations are required to refine and confirm our findings. Trial registration: Registration number: ChiCTR1800016635; Date of first registration: 14/06/2018.

第四次湖南省中药资源普查工作覆盖了全省122个行政区域.项目实施过程中,建立了一套行之有效的组织管理与工作机制,普查工作取得了一些成功经验.各级政府高度重视中药资源普查工作,成立了各级工作领导小组和技术专家组,协调和推进各项工作;有效实施目标管理,将中药资源普查工作完成情况纳入到各级卫生行政部门绩效考核指标,省级普查领导小组与各项目县领导小组之间签订项目任务书;确保普查经费到位;强化中药资源普查队伍建设;加强普查初期、中期和后期的全程督查指导.强化技术保障,开展"技术骨干培训""日常技术培训""巡视技术培训"的"三位一体"技术培训,规范普查技术;由驻县专家技术团队解决技术难题,完成样方内重点药材辨识、标本鉴定复核与整理和数据库集中核验.普查工作推动了成果转化,与专项课题结合,深化道地中药研究,挖掘、整理、研究民族民间医药知识,促进普查成果转化.

目的 研究中国老年人步速现状及慢步速的影响因素.方法 选取2015年"中国健康与养老追踪调查(CHARLS)"数据库中年龄≥60岁、进行过步速测量、基本数据无缺失的老年人为研究对象.比较不同人口学特征研究对象的步速差异,使用多因素logistic回归分析老年人慢步速的影响因素.结果 本研究共纳入研究对象7267例,其中男性3615例,女性3652例;研究对象总人群的平均步速为(0.76±0.22)m/s;多因素logistic回归分析结果显示:年龄(OR70～79岁=2.26、OR≥80岁=6.34);女性(OR=1.50);文化程度(OR小学=0.76、OR初中=0.55、OR高中及以上=0.47);肥胖(OR=1.43);疾病史(OR高血压=1.28、OR慢性肺部疾病=1.34、OR症状性膝骨关节炎=1.18)是老年人慢步速的影响因素(均P<0.05).结论 中国老年人平均步速为(0.76±0.22)m/s,高龄、女性、文化程度较低、肥胖、既往患高血压、慢性肺部疾病、症状性膝骨关节炎是我国老年人慢步速的影响因素.

目的 探讨母亲胱硫醚β-合成酶(cystathionineβsynthase,CBS)基因多态性与子代先心病(congenital heart disease,CHD)及其亚型的关联,为CHD遗传易感标志物的研究提供流行病学依据.方法 以464例单纯CHD患儿母亲为病例组,504例正常儿童母亲为对照组,开展病例对照研究.通过问卷调查,收集研究对象的基本信息.完成调查问卷后,采集5ml血液,用于CBS基因多态性的检测.利用多因素logistic回归模型评估CBS基因多态性与CHD及亚型的关联;利用Haploview 4.2软件的四配子法构建单倍型,评估单倍型与CHD的关联;利用广义多因子降维法(GMDR)分析基因-基因交互作用与CHD的关联.结果 多因素logistic回归分析结果显示,母亲CBS基因位点rs2851391和rs234714的多态性与子代CHD及其两种亚型(ASD和PDA)的发病存在关联;且经FDR调整后,关联仍然具有统计学意义(QFDR<0.05).5个SNP位点均与VSD的发生无关(QFDR>0.05).GMDR分析结果显示,5个SNP位点的基因-基因交互作用模型与子代CHD的发生无关(P>0.05).rs1051319和rs2851391位点构成的单倍型G-T可能与子代CHD的发生有关(QFDR<0.05).结论 母亲CBS基因多态性与子代CHD、ASD和PDA的发生有关,CBS基因位点构成的单倍型(G-T)也与子代CHD的发生有关.

目的 分析长沙市气象因素与手足口病发病的关联及其滞后效应.方法 收集2016-2019年长沙市手足口病日发病数据及同期气象数据,对其进行关联性分析,采用分布滞后非线性模型分析气象因素对手足口病发病的滞后效应.结果 2016-2019年长沙市共报告手足口病122788例,年平均发病率为395.09/10万,4～7月和11～12月是每年手足口病发病高峰期.以中位数18.2℃为参考值,日均气温在28.5℃时对手足口病发病的总体效应最高(RR=2.70,95％CI:2.04～3.58),低温(P5=3.2℃)情况下滞后2d时RR最大,为1.19(95％CI:1.09～1.30),高温(P95=30.7℃)情况下滞后0d时RR最大,为1.14(95％CI:1.04～1.26).以中位数1002.10hPa为参考值,日均气压在991hPa时对手足口病发病的总体效应最高(RR=2.35,95％CI:1.84～3.02),低压(P5=988.7hPa)情况下滞后5d时RR最大,为1.10(95％CI:1.06～1.13),高压(P95=1015.8hPa)情况下滞后2d时RR最大,为1.10(95％CI:1.05～1.16).结论 日均气温、日均气压与手足口病发病呈非线性关系,并存在明显的滞后效应,高温、低压对手足口病发病的影响更为显著.

OBJECTIVES:Stroke is the main cause of death in Chinese residents, bringing a heavy economic burden to patients. This study aims to explore the characteristics and the factors influencing the hospitalization cost for stroke, and to provide scientific evidence for reducing the economic burden on stroke patients.METHODS:The data were mainly obtained from the Shanghai Statistics Center for Health. Using the coding system of International Classification of Diseases (ICD)-10, we retrospectively collected the stroke-related first hospitalization records of stroke patients in J district, Shanghai during January 1, 2016 to December 31, 2019 whose main diagnostic disease codes were I61-I63. After cleaning and arranging the data, we counted the first hospitalization cost and length of hospital stay (LOS) of the patients. Univariate analysis was performed using non-parametric tests, and the factors influencing stroke hospitalization cost were further analyzed by multiple linear regression fitting path model.RESULTS:A total of 3 901 stroke patients were included. Ischemic and hemorrhagic stroke patients accounted for 92.59% and 7.41%, respectively, of which the mean hospitalization cost per patient were 12 397.35 yuan and 28 814.72 yuan, respectively, and the mean LOS per patient were 13 days and 19 days, respectively. Hospitalization cost for ischemic stroke mainly consisted of medicine fees, diagnosis fees, and service fees, accounting for 44.70%, 29.92%, and 15.42%, respectively, and hospitalization cost for hemorrhagic stroke mainly consisted of medicine fees, diagnosis fees, consumables fees, and service fees, accounting for 38.76%, 18.33%, 17.59%, and 15.38%, respectively. From 2016 to 2019, the proportion of medicine fees for ischemic stroke was decreased by 19.38 percentage points, and the diagnosis fees and service fees were increased by 8.43 percentage points and 9.04 percentage points, respectively; the proportions of medicine fees and consumables fees for hemorrhagic stroke were decreased by 7.54 percentage points and 13.43 percentage points, respectively, and the proportions of diagnostic fees and service fees were increased by 6.87 percentage points and 10.15 percentage points, respectively. Path analysis results showed that the main direct factors influencing hospitalization cost were the LOS, hospital level, operation, and year, and the main indirect factors were age and hospital level (all P<0.05).CONCLUSIONS:The cost burden of stroke patients in Shanghai is relatively heavy, and we should continue to promote the medical reform policy and consolidate the achievements of medical reform. Hospitals should strengthen clinical pathway management and patient health education to improve medical efficiency and reduce invalid hospitalization days. Government departments should continue to improve the medical insurance system, enhance the supervision to medical insurance, and promote health equity.

ObjectiveTo estimate the association of selected maternal and fetal characteristics with the risk of perinatal mortality in South China.MethodsA prospective cohort study was conducted from March 2013 to December 2019. The exposures of interest were maternal sociodemographic characteristics, lifestyle and habits during early pregnancy, and complications of pregnancy. Their effects on the development of perinatal death were analyzed in our study.ResultsA total of 44,048 eligible pregnant women were included in the analysis. Of these, 596 fetuses were perinatal deaths (perinatal mortality was 13.5 per 1,000 births). After adjustment, maternal obesity, being employed, history of gestational hypertension, taking antidepressants during early pregnancy, history of gestational diabetes mellitus, gestational diabetes mellitus, infertility drug treatment and assisted reproductive techniques, history of neonatal death, preterm birth, and congenital malformations all significantly increased the risk of perinatal death. Ethnic minority, income > 5,000, multiparous women, and cesarean section associated with reduced risk of perinatal death.ConclusionSome factors of maternal sociodemographic characteristics, abnormal pregnancy history, lifestyle and habits during early pregnancy, and complications of pregnancy were associated with the risk of perinatal death.

VSIR is a critical immunomodulatory receptor that inhibits T cell effector function and maintains peripheral tolerance. However, the mechanism by which VSIR participates in tumor immunity in the pan-cancer tumor microenvironment remains unclear. This study systematically explored the prognostic and immune profile of VSIR in the tumor microenvironment of 33 cancers. We compared the expression patterns and molecular features of VSIR in the normal and cancer samples both from the public databases and tumor chips. VSIR level was significantly related to patients’ prognosis and could be a promising predictor in many tumor types, such as GBM, KIRC, SKCM, READ, and PRAD. Elevated VSIR was closely correlated with infiltrated inflammatory cells, neoantigens expression, MSI, TMB, and classical immune checkpoints in the tumor microenvironment. Enrichment signaling pathways analysis indicated VSIR was involved in several immune-related pathways such as activation, proliferation, and migration of fibroblast, T cell, mast cell, macrophages, and foam cell. In addition, VSIR was found to widely express on cancer cells, fibroblasts, macrophages, and T cells in many tumor types based on the single-cell sequencing analysis and co-express with M2 macrophage markers CD68, CD163 based on the immunofluorescence staining. Finally, we predicted the sensitive drugs targeting VSIR and the immunotherapeutic value of VSIR. In sum, VSIR levels strongly correlated with the clinical outcome and tumor immunity in multiple cancer types. Therefore, therapeutic strategies targeting VSIR in the tumor microenvironment may be valuable tools for cancer immunotherapy.

Background It is inconclusive nowadays for the association between infant's gender and their mothers' risk of developing postpartum depression (PPD). In addition, a complete overview is missing. A meta-analysis of cohort and case-control studies was performed to address the question of whether women who gave birth to a female infant were at an increased risk of developing PPD, compared with those giving birth to a male infant. Methods Unrestricted searches were conducted, with an end date parameter of 31 January 2018, of PubMed, Embase, Google Scholar, Cochrane Libraries, and Chinese databases, to identify studies that met pre-stated inclusion criteria. Reference lists of retrieved articles were also reviewed. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Results Twenty-three studies involving 119,736 women were included for analysis. Overall, mothers who gave birth to a female infant experienced a significantly increased risk of developing PPD compared with the reference group (OR = 1.15, 95%CI: 1.01-1.31;p = .03). However, substantial heterogeneity (p < .00001;I-2= 75%) was observed across studies. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. No evidence of publication bias was observed. Conclusions Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, the present study suggests women giving birth to a girl are associated with a higher risk of developing PPD when compared with those giving birth to a boy. Improving family and social communication and reducing gender preference should be important components of any such interventions.Statement of significance Problem or issueInterestingly, the known risk factors leading to PPD are basically the same in different regions and cultures, but the gender of the infant seems to be an exception. What is already knownSome studies conducted in traditional western countries indicated that there is a weak or null association between infant's gender and risk of PPD, while others suggested a positive association. In contrast, studies conducted in Nigeria, India, Turkey and China showed that mothers giving birth to a female infant were at a higher risk of developing PPD. What this paper addsToday, the association between infant's gender and risk of developing postpartum depression (PPD) is still uncertain; additionally, a complete overview is missing. Our study represents the first meta-analysis of risk of PPD associated with infant's gender.

随着经济社会的飞速发展,人民群众在享受着现代文明带来的便利的同时,也面临着各类突发公共卫生事件的挑战[1].突发公共卫生事件时刻危害着人民生命财产安全、影响着社会稳定.2003 年重症急性呼吸综合征(severe acute respiratory syn-drome,SARS)简称"非典",中国卫生部将之定位甲种传染病,极大威胁民众生命健康;2016 年 6 月,人感染 H7N9 禽流感共造成我国 770 人发病,315 例患者病死;2020 年初,世界范围内出现新型冠状病毒肺炎(Corona Virus Disease 2019,COVID-19),简称新冠肺炎,COVID-19 大流行是 21 世纪最严重的全球健康危机[2-4].提升卫生应急素养是降低突发公共卫生事件对健康损害的重要途径,做好应急准备、提升卫生应急素养,对改善个人健康状况、维护社会秩序具有重要意义.本研究从卫生应急素养的评估工具、评估结果、影响因素三方面综述国内外卫生应急素养的研究进展,旨在提高公众对卫生应急素养的认知.

公立医院作为我国社会主义医疗体系的主体,其运行效率与效益历来深受国家有关部门和社会各界的关注,随着社会主义市场经济的蓬勃发展,源自企业的绩效考核机制也被逐步引入了公立医院的管理中,本文主要通过研究绩效考核的定义、发展历程、现存的问题等,并以此基础上提出自己的一些思考与建议,希望能为我国公立医院绩效考核工作的发展和改进提供一些新的思路和方向,如有不尽人意之处还请各位专家多多批评指正.

目的 探讨糖尿病及高血压在独立与联合模式下,其并发冠心病和/或脑卒中两种心脑血管并发症的患病风险差异.方法 采用多阶段分层随机抽样方法抽取长沙市19812名18岁及以上社区居民作为调查对象.以无糖尿病无高血压人群为对照,采用多组率比较的χ2检验及多因素logistic回归模型比较糖尿病及高血压在两种模式下两种并发症的风险差异.结果 (1)在独立模式下,糖尿病(OR冠心病=2.6,95％CI:1.8～3.8、OR脑卒中=5.3,95％CI:1.7～16.7、OR冠心病+脑卒中=2.1,95％CI:0.6～7.2)与高血压(OR冠心病=4.0,95％CI:3.4～4.8、OR脑卒中=8.2,95％CI:4.9～16.2、OR冠心病+脑卒中=4.3,95％CI:2.4～7.4)均能增加心脑血管病症风险,且高血压的心脑血管并发风险>糖尿病的心脑血管并发风险,二者并发脑卒中的风险>并发冠心病的风险;(2)在联合模式下,其心脑血管并发症患病风险增加更大(OR冠心病=7.3,95％CI:5.5～9.5、OR脑卒中=8.2,95％CI:3.1～21.4、OR脑卒中+冠心病=6.2,95％CI:3.0～12.8),且二者联合主要增加的是冠心病的患病风险.结论 糖尿病及高血压在独立与联合时其心脑血管并发症风险存在差异,糖尿病合并高血压患者尤其应该注意预防冠心病发生.

Congenital heart disease (CHD) is the most common congenital disorder diagnosed in newborns. Although lots of related studies have been published, yet the pathogenesis has not been fully elucidated. A growing body of evidence indicates perturbations of the gut microbiota may contribute in a significant way to the development of obesity and diabetes. Given that maternal obesity and diabetes are well-known risk factors for CHD, maternal gut microbiota may be considered as one of the environmental factors involved in the pathogenesis of CHD. The object of this study is to explore the association between maternal gut microbiota and risk of congenital heart disease (CHD) in offspring, as well as the possible mechanisms linking gut microbiota and disease risk. A case–control study was conducted in mothers of infants with CHD (n = 101) and mothers of infants without CHD (n = 95). By applying 16S rRNA gene sequencing and metabolic approaches to 196 stool and plasma samples, we determined microbiome and metabolome profiles in mothers of infants with CHD and controls, and their association with risk of CHD in offspring. The gut microbiome of mothers of infants with CHD was characterized with lower alpha-diversity and distinct overall microbial composition compared with mothers of infants without CHD. A distinct different metabolic profile was found between mothers of infants with CHD and controls. After controlling for the possible confounders, thirty-four bacterial genera and fifty-three plasma metabolites showed distinct abundances between the two groups. The results of the Spearman correlation analyses revealed a great number of significant correlations between the abundant bacterial genera and differentially expressed metabolites. In particular, the genus Bifidobacterium and Streptococcus showed comparable moderate positive correlations with a range of metabolites that involved in lipid metabolism pathway. Our findings suggest that perturbations of maternal gut microbiota and plasma metabolites may be associated with risk of CHD in offspring, and co-variation between microbiota and metabolites may play a part in the linkage between gut microbiota and risk of CHD in offspring.