基于国际疾病和相关健康问题分类（ICD）编码的疾病负担测算在全球已得到广泛应用，但是目前该类研究多基于西医疾病编码。随着中医药国际化程度的提高，ICD-11纳入传统医学编码，有利于促进中医疾病诊断的完善，利于计算患病率、生存率、服药情况、救治水平，可进一步评价中医病种的疾病负担情况，促进临床诊疗决策及卫生资源的合理配置，从而进一步促进中医药的国际化。但是，ICD-11中传统医学编码不完善，和西医疾病编码、我国中医国家标准之间的映射不足对中医疾病负担测算带来新的挑战。本文立足于疾病负担测算的编码体系，分析了当前中医疾病负担测算研究中的不足、ICD-11纳入传统医学编码后对中医疾病负担测算的影响，并对ICD-11传统医学编码和西医疾病编码、我国新国家标准进行了初步比较，为未来中医疾病负担的测算编码的完善提供参考。提出未来可利用大数据技术促进中医标准化术语和ICD-11传统医学编码、ICD-11传统医学编码和西医疾病编码之间的映射，从而促进中医疾病负担的研究。

Background The 72nd World Health Assembly reviewed and adopted the International Classification of Diseases Eleventh Revision(ICD-11),which for the first time included traditional medicine originating from traditional Chinese medicine(TCM)in its chapter coding,of which the code for wasting thirst disorder is SD71(TM1).At present,wasting thirst disorder is a high clinical prevalence disease,with middle-aged and older adults being the high incidence population,and TCM constitutions bias are risk factors for wasting thirst disorder.There was no research on the burden of TCM diseases and risk factors.Objective Based on the ICD-11 chapter on traditional medicine and the national standards of TCM,the burden of wasting thirst disorder among middle-aged and elderly in Guangzhou was calculated and attributed to the TCM constitutions.The role of TCM constitutions monitoring in health management was evaluated,providing reference for the prevention and treatment of wasting thirst disorder by TCM and the application of constitutions theory.Methods A cross-sectional survey was conducted in 2020 to investigate the prevalence of wasting thirst disorder and the distribution of TCM constitutions among middle-aged and elderly in Guangzhou.The comprehensive theory of Global Burden of Disease(GBD),calculate the years of life lost(YLL),years lived with disability(YLD),and disability adjusted life year(DALY)of wasting thirst disorder in the middle-aged and elderly population in Guangzhou were used to evaluate the disease burden of wasting thirst disorder.Relative risk(RR)was used to assess the risk of different TCM constitutions for wasting thirst disorder in middle-aged and elderly people.Results A total of 1 576 middle aged and older adults in central Guangzhou were surveyed,55 were lost,1 521 valid questionnaires were recovered,and the effective response rate was 96.51%.Among them,782 were male,aged 62(56,69)years;739 were female,aged 62(55,70)years.The prevalence of wasting thirst disorder among middle-aged and elderly people in Guangzhou was 13.08%,with a standardized prevalence of 12.64%.The most distributed constitution among middle-aged and elderly people in Guangzhou were phlegm-dampness constitution,qi-deficiency constitution,and damp-heat constitution;among them,the most distributed constitutions in patients with wasting thirst disorder were phlegm-dampness constitution,yin-deficiency constitution,and qi-deficiency constitution.The DALY rate of wasting thirst disorder burden was 86.46‰,with a YLL rate of 4.86‰ and a YLD rate of 81.60‰.The proportion of single constitution and composite constitution was 48.98%and 51.02%,respectively.Yin-deficiency constitution was the risk constitution of wasting thirst disorder(RR=1.73,P<0.01),which led to a disease burden of 33 092 DALY,with a DALY rate of 10.98,accouting for 12.70%of the disease burden in the middle-aged and elderly population with wasting thirst disorder.In terms of different age groups,phlegm-dampness constitution(RR=1.62,P<0.05)and yin-deficiency constitution(RR=1.80,P<0.05)were risk constitutions in the age group of 60-69 years,in which phlegm-dampness constitution resulted in a wasting thirst disorder burden of 18 530 DALY,with a DALY rate of 18.75 ‰,accounting for 21.63%burden of wasting thirst disorder in this age group;yin-deficiency constitution led to wasting thirst disorder burden of 10 520 DALY,with a DALY rate of 10.65‰,accounting for 12.28%of burden of wasting thirst disorder in this age group;the disease burden caused by the combination of phlegm-dampness constitution and yin-deficiency constitution was 26 780 DALY,with a DALY rate of 27.10 ‰,accounting for 31.26%of the burden of wasting thirst disorder in this age group.For different genders,male phlegm-dampness constitution(RR=2.29,P<0.01)and female yin-deficiency constitution(RR=2.27,P<0.01)were risk constitutions for wasting thirst disorder.The disease burden caused by phlegm-dampness constitution in middle-aged and elderly males was 45 017 DALY,resulting in a DALY rate of 30.96‰,accounting for 36.82%of the burden of wasting thirst disorder in middle-aged and elderly males.The burden of wasting thirst disorder caused by female yin-deficiency constitution was 28 753 DALY,resulting in a DALY rate of 18.43‰,accounting for 20.79%of the burden of wasting thirst disorder among middle-aged and elderly females.Conclusion The prevalence of wasting thirst disorder among middle-aged and older adults aged≥50 in Guangzhou is relatively high,with heavy disease burden.Yin-deficiency and phlegm-dampness constitutions are risk constitutions for wasting thirst disorder in middle-aged and elderly people.TCM constitutions monitoring and management can effectively reduce the burden of wasting thirst disorder.

Background The approval of the International Classification of Diseases 11th Revision (ICD-11) has for the first time included a chapter about traditional medicines that includes TCM. Disease weight (DW) is a weight coefficient that quantifies the health loss caused by non-fatal diseases and injuries, and is an important parameter to measure the burden of disease. Objective Based on the traditional medicine chapter of ICD-11, this study investigates the DW of wasting thirst disorder, which provides a reference for the measurement of TCM disease burden, and lays a foundation for establishing a statistical network that is consistent with international standards and reflects TCM health service information. Methods From June 1, 2020 to June 1, 2021, the Visual Analogue Scale (VAS) method was adopted to conduct a survey on the DW of each lower category of wasting thirst disorder among clinical Chinese medicine practitioners and healthy people. The EQ-5D-3L with VAS scale was adopted to conduct a DW survey among patients. In addition, the survey results were demonstrated with expert intentions. Results The survey on DW of wasting thirst disorder among TCM practitioners shows that the DWs were 0.300 (0.185, 0.380) for wasting thirst disorder involving the upper-jiao, 0.430 (0.368, 0.568) for wasting thirst disorder involving the middle-jiao, 0.585 (0.510, 0.738) for wasting thirst disorder involving the lower-jiao, and 0.725 (0.660, 0.908) for consciousness loss caused by wasting thirst disorder. The survey on DW of wasting thirst disorder among patients shows that the VAS conversion weights of patients were 0.310 (0.225, 0.373) for diabetes involving the upper-jiao, 0.395 (0.335, 0.453) for wasting thirst disorder involving the middle-jiao, 0.445 (0.360, 0.513) for wasting thirst disorder involving the lower-jiao, and 0.590 (0.550, 0.698) for consciousness loss caused by wasting thirst disorder;the investigator assigned weights are 0.152 (0, 0.311) for wasting thirst disorder involving the upper-jiao, 0.240 (0, 0.275) for wasting thirst disorder involving the middle-jiao, 0.380 (0.186, 0.622) for wasting thirst disorder involving the lower-jiao, and 0.484 (0.311, 0.814) for consciousness loss caused by wasting thirst disorder. The survey on DW of wasting thirst disorder among healthy people shows that the DWs were 0.210 (0.150, 0.390) for wasting thirst disorder involving the upper-jiao, 0.345 (0.260, 0.510) for wasting thirst disorder involving the middle-jiao, 0.425 (0.313, 0.748) for wasting thirst disorder involving the lower-jiao, and 0.640 (0.380, 0.898) for consciousness loss caused by wasting thirst disorder. There were significant differences between the DWs by different methods of wasting thirst disorder involving the upper-jiao, wasting thirst disorder involving the middle-jiao, wasting thirst disorder involving the lower-jiao, and consciousness loss caused by wasting thirst disorder (H=153.883, 76.561, 34.575, 74.014, P<0.001). There were significant differences between VAS DW for traditional Chinese medicine practitioner survey, patient VAS conversion DW, investigator assignment DW, and VAS DW for healthy population survey involved by three jiao of wasting thirst disorder and consciousness loss caused by wasting thirst disorder (H=10.543, 35.692, 19.924, 16.327, P<0.05). Through expert intention argumentation, the method of calculating DWs for wasting thirst disorder according to the classification of wasting thirst disorder involving the upper-jiao, wasting thirst disorder involving the middle-jiao, wasting thirst disorder involving the lower-jiao, and consciousness loss caused by wasting thirst disorder under the standardized framework was agreed upon. Experts qualitatively agreed that the DW of wasting thirst disorder involving the upper-jiao, wasting thirst disorder involving the middle-jiao, wasting thirst disorder involving the lower-jiao, and consciousness loss caused by wasting thirst disorder gradually increased. And they basically agreed with the DW in the investigation of traditional Chinese medicine practitioners. Conclusion A preliminary exploration was conducted to investigate the DW of wasting thirst disorder, using the VAS method and the EQ-5D-3L, based on the ICD-11 chapter on traditional medicine and the national standards of traditional Chinese medicine, providing a reference for calculating the burden of traditional Chinese medicine diseases. The research results have been supported by expert intention analysis. The DW of wasting thirst disorder in Guangzhou is relatively heavy, and attention should be paid to the loss of healthy life years caused by disability in wasting thirst disorder, to improve the quality of life of patients.

目的 了解广州市2008-2019年伤害死亡特征及疾病负担情况,为当地制定伤害防控措施提供参考.方法 测算伤害死亡率、早死寿命损失年(YLL)、伤残寿命损失年(YLD)和伤残调整寿命年(DALY),评估广州市居民伤害的死亡特征和疾病负担状况,采用年度变化百分比(APC)和平均年度变化百分比(AAPC)分析死亡率及疾病负担的变化趋势.结果 2008-2019年广州市伤害粗死亡率为27.38/10万,标化死亡率为27.82/10万.伤害死亡前10位死因分别为跌倒、道路伤害、自残、异物吸入、溺水、中毒、接触机械力、药物治疗的副作用、人际暴力和其他意外伤害.广州市居民伤害DALY率为9.26‰,YLL率为4.53‰,YLD率为4.73‰.伤害DALY率前5位死因依次为跌倒(4.12‰)、道路伤害(2.76‰)、自残(0.74‰)、溺水(0.29‰)、异物吸入(0.26‰).男性伤害DALY率为10.87‰,女性为7.64‰.5～14岁的DALY率最低(3.20‰),80岁及以上年龄段的DALY率最高(47.03‰).2008-2019年广州市伤害DALY率呈上升趋势(AAPC=9.41,P＜0.05).结论 广州市伤害死亡和疾病负担呈上升趋势,需进一步加强防控.跌倒、道路伤害、自残是伤害防控的重点死因;男性、高龄老人是伤害防控重点人群.

目的:分析深圳市龙华区青少年超重、肥胖流行现状,影响因素及中医体质分布规律.方法:采用分层整群随机抽样法,对深圳市龙华区837名中学生进行体格检查和问卷调查.分性别、分年龄段统计超重、肥胖人数,评估学生的生长发育情况;调查学生每周食用油炸及甜食次数,每周运动超30 min次数,每天睡眠时长,父、母亲体质量指数,以及父、母亲文化程度;判定学生的中医体质类型.结果:共获得789名学生的有效问卷,有效率94.27％,其中超重检出率19.77％,肥胖检出率6.34％.青少年营养状态均良好,生长发育均正常.男生超重、肥胖总检出率高于女生,差异有统计学意义(P＜0.05).年龄越小,超重、肥胖总检出率越高,差异有统计学意义(P＜0.05).每周食用油炸及甜食次数越多、每周运动超30min次数越少和每天睡眠时长越短,超重、肥胖总检出率均越高,差异均有统计学意义(P＜0.05).阳性率变量纳入Logistic回归模型校正后显示,性别、年龄、每周食用油炸及甜食次数、每周运动超30 min次数、每天睡眠时长均是影响超重、肥胖发生的独立危险因素.青少年中医体质分布占比由多到少依次是湿热质、平和质、痰湿质、气郁质、阴虚质、阳虚质、气虚质、特禀质、血瘀质.其中超重、肥胖青少年的中医体质以阴虚质为主.与平和质相比,中医体质按影响青少年发生超重、肥胖的程度从高到低依次是痰湿质、阳虚质、阴虚质、气郁质、湿热质.结论:深圳市龙华区青少年超重、肥胖总检出率较高,尤其是男生.性别、年龄、每周食用油炸及甜食次数、每周运动超30 min次数、每天睡眠时长、体质偏颇均是影响该地区青少年超重、肥胖的独立因素.深圳市龙华区青少年的中医体质类型主要有湿热质、平和质、痰湿质等,其中影响超重、肥胖发生的主要中医体质类型为痰湿质、阳虚质、阴虚质,尤以痰湿质为最.

目的:以DRGs为代表的按病种付费改革已成为当前医疗保障改革的主要方向,完善中医按病种付费有助于深化医保支付方式改革,优化中医医疗服务的资源配置.方法:文章从中医医保支付方式改革的现状及现行中医DRGs实践中存在的问题,试探讨未来中医医疗机构推动DRGs按病种付费等相关工作的实施途径.结果与结论:中医DRGs的实践需要遵循中医药的发展规律,重视中医临床路径研究、科学遴选中医优势病种,构建中医医疗机构与医保机构间的价格谈判机制,规范中医院病案首页和疾病诊断编码,加强中医医疗机构建设,设立中医按病种付费改革专项资金,以助推中医药事业的传承与创新发展.

This study was aimed to investigate the application of micro ribonucleic acid (miRNA) combined with nanographene particles in molecular diagnosis of depression. After the sheet-shaped graphene oxide was mixed with a solvent to form a solution, it was atomized at high temperature to form droplets and extract nanographene oxide, which was applied to an electrochemical sensor. 90 patients with depression were selected as the research objects and they were randomly divided into control group and experimental group, patients from the two groups received the miRNA molecular diagnosis and the miRNA molecular diagnosis combined with nanographene electrochemical sensor dopamine detection method, respectively. As a result, the diagnostic sensitivity (82.4%), specificity (90.3%), and accurate index (71.3%) of patients from the experimental group were higher obviously than those of the control group (54.3%, 72.8%, and 55.6%) ( P <0.05). The expression levels of MiR-92b-5p and MiR-19a-3p in patients with depression were higher markedly than the levels of the normal population ( P <0.05). The detection rates of mild depression, moderate depression, and severe depression in patients from the experimental group were 97.3%, 96.5%, and 91.2%, which were higher greatly than the rates of the control group (84.3%, 85.4%, and 83.2%) ( P <0.05). Besides, the false positive rate (11.2%) and false negative rate (5.6%) of patients from the experimental group were sharply lower than the rates of the control group (31.5% and 16.4%) ( P <0.05). In short, miRNA combined with nanographene electrochemical sensors could accurately diagnose depression with high accuracy and sensitivity, which could be applied in the clinical diagnosis.

目的:分析青少年网络成瘾者自杀相关行为发生率的数据,为有效防控青少年自杀提供科学依据.方法:根据计算机检索中英文数据库获取的13篇文献研究数据,通过提取资料及质量评价,应用RevMan 5.4分析软件进行统计分析.结果:共纳入21524例研究对象,自杀倾向/观念/想法发生率为35.14％(95％CI:30.70％～39.58％);自杀计划发生率为17.89％(95％CI:12.77％～23.02％);自杀尝试/未遂发生率为8.85％(95％CI:6.13％～11.4％).结论:我国青少年网络成瘾者自杀相关行为发生率较总体青少年更高,社会、学校及家庭应对青少年网络使用状况予以关注并重视.

目的 了解长期居住于广州市的群众由于肺癌而承受的疾病负担,并对归因于PM2.5污染的肺癌疾病负担进行估算.方法 以2017-2019年间当地卫生信息中心发布的相关数据为主要依据,以早死寿命损失年(YLL)为评价时运用的关键指标,来实现估算目的 ;以当地环保局针对PM2.5开展相关监测后给出的具体数据为主要依据,结合比较危险因素评估理论(CRA)的相关方法,对本次所研究目标群体,估算归因于PM2.5污染的肺癌疾病负担.结果 2017-2019年间,当地群众因为肺癌而需承担疾病负担对应的具体数值分别为50180YLLs,53222YLLs,47881 YLLs,YLL率分别为每千人损失寿命8.7年、8.9年、7.8年;由PM2.5引发的部分对应的具体数值为15555.8YLLs,15487.6 YLLs,13693.97 YLLs,YLL率分别为每千人损失寿命2.7年、2.6年、2.2年.肺癌而导致的早死寿命损失年中,因为PM2.5引发的部分占29.6％.结论 随着空气质量的改善,PM2.5污染对广州市居民整体健康产生的影响相对减小,不过由于其而引发的肺癌,仍旧使当地群众不得不面对较为沉重的疾病负担,应进一步改善.

目的:分析针灸治疗神经衰弱的经穴运用特点.方法:在收集针灸治疗神经衰弱文献基础上,建立以腧穴为主的数据库,运用数据挖掘技术,总结使用经脉和穴位的规律.结果:针灸治疗神经衰弱取穴有局远配合和循经取穴的特点,以督脉和膀胱经选用的腧穴最多,交会穴和原穴等特定穴的应用广泛,建议以{安眠、神门}和{心俞、神门、内关}为基础方,局部配穴推荐使用{神庭、本神}和{百会、四神聪},远端配穴根据证型作辨证配穴组成针灸处方.结论:通过数据挖掘技术所得的研究结果可为针灸临床治疗神经衰弱的选穴、穴位配伍以及组方提供参考和根据.

目的:探讨首发青少年抑郁障碍(MDD)患者静息态脑磁图(rMEG)频谱特点. 方法:对15例首发青少年MDD患者(MDD组)及14名正常对照者(对照组)进行rMEG扫描,比较两组频谱分布特点,分析MDD组频谱分布与汉密尔顿抑郁量表(HAMD)评分的关系. 结果:①MDD组alpha频段能量左枕叶高于右侧,左颞叶低于右侧;theta频段能量左额、枕叶高于右侧;对照组alpha频段能量左枕叶高于右侧,beta频段能量左枕叶高于右侧,theta频段能量左额、颞及枕叶高于右侧,delta频段能量左颞叶高于右侧,左额叶低于右侧.②与对照组相比,MDD组alpha频段能量右中央区、颞及枕叶明显增高;beta频段能量双侧枕叶明显增高;theta频段能量右颞、枕叶明显增高;delta频段能量右颞、双顶叶明显增高;③MDD组HAMD总分与双侧颞、左顶及双侧枕叶delta频段能量呈正相关;HAMD焦虑因子与右枕叶theta频段能量及左顶、枕叶delta频段能量正相关,与左右顶叶alpha频段能量差呈正相关(P均＜0.05). 结论:首发青少年MDD患者rMEG的alpha频段能量右侧过度激活,枕叶beta频段能量左侧优势减弱,右枕叶delta频段能量增强且与抑郁程度及焦虑症状相关.

目的 探讨青少年首发重性抑郁障碍患者的静息态脑磁频谱分布及与症状严重程度的相关性.方法 对16例首发的青少年重性抑郁障碍患者(研究组)和14例正常健康者(对照组)进行脑磁图静息态扫描,分析两组频谱分布特点,并对研究组的各频谱能量值与汉密尔顿抑郁量表(HAMD-24)总分进行相关分析.结果 与对照组相比,研究组患者右侧中央区、颞区、枕区alpha波(t=2.058,P=0.049;t=2.356,P=0.026;t=2.469,P=0.020),左、右两侧枕区beta波(t=2.583,P=0.015;t=2.513,P=0.018),右侧颞区、枕区theta波(t=3.005,P=0.006;t=4.506,P=0.000),左右双侧顶区、右侧颞区及右侧枕区delta波(t=2.519,P=0.018;t=2.841,P=0.008;t=2.434,P=0.022;t=2.241,P=0.033)差异均有统计学意义;研究组患者右侧顶区theta波及左右侧额、颞、顶、枕区delta波与HAMD-24总分均呈正相关(r=0.518,P=0.040;r=0.540,P=0.031;r=0.524,P=0.037;r=0.653,P=0.006;r=0.569,P=0.021;r=0.539,P=0.031;r=0.655,P=0.006;r=0.519,P=0.040;r=0.609,P=0.012).结论 青少年首发重性抑郁障碍患者静息态脑磁频谱分布异常,头后部delta波能量值与抑郁障碍的严重程度呈正比,为青少年重性抑郁障碍的发病机制提供一定的电生理学依据.

Objective:To analyze the characteristics of the magnetoencephalography(MEG) and frontal asymme-try in alpha oscillations of teenagers with first-episode major depressive disorder,to explore the electrophysiological mechanism of the occurrence of depressive disorder, and to provide reference for the clinical application of MEG. Methods:Selected the adolescents(13-19 years old) patients with first-episode major depressive disorder from Oc-tober 2016 to June 2017 in Guangdong 999 brain hospital,and recruited 10 healthy volunteers as a control group.Scanned magnetic fields signals in the brain(Left and right sides of the central area, frontal lobe, temporal lobe, parietal lobe and occipital lobe) from the two groups using the 148-channel MEG system. Calculated and analyzed the spectral power. Results:Compared with the control group,the power of delta band in the left parietal lobe was increased(P<0.05) in the patient groups.The power of theta band in the right temporal lobe and parietal lobe are both increased(P<0.01)in the patient groups. For male patients,the power of delta band in the left parietal lobe was increased more than female patients(P<0.05). Frontal asymmetry in alpha oscillations was not to be proved on MEG(P >0.05). Conclusion: The present study suggests that teenagers with first-episode major depressive disorder have impaired neural activity at many bands, the changes of the power of delta and theta bands might be relevant to teenagers major depressive disorder.

Objective To explore the clinical effect of acupuncture in the treatment of primary insomnia.Methods 160 cases of primary insomnia from June 2014 to January 2016 were selected and divided into control group (80 cases) and observation group (80 cases) randomly. The cases in control group were taken estazolam orally and the observation group was taken acupuncture treatment. The sleep quality, fall-sleep time, sleeps time, sleep effciency, sleep disorders and daytime dysfunction of the two groups before and after treatment were compared by PSQI.Results Before treatment, there was no significant difference of PSQI between the two groups (P>0.05). In observation group, the sleep score improved observably and the amelioration degree was higher than control group (P<0.05). In control group, the sleep quality, fall-sleep time, sleeps time, sleep effciency improved observably (P<0.05), but there was no signiifcant difference of sleep disorders and daytime dysfunction (P>0.05). The total effective rate of treatment in observation group was better than control group (P<0.05). Conclusion Acupuncture combined with drug treatment can effectively improve the sleep quality in primary insomnia patients. The clinical effect is better than Western medicine cure especially in sleep disorders and daytime dysfunction.