目的 建立自回归移动平均(autoregressive integrated moving average,ARIMA)模型并对广州市2021年肺结核月报告发病数进行预测,为广州市肺结核防控提供参考.方法 通过《中国疾病预防控制信息系统》中的《传染病报告信息管理系统》,收集广州市2010年1月至2019年12月肺结核月报告发病数据,通过时间序列分析建立ARIMA模型,并对2021年广州市肺结核发病情况进行预测.再通过2010-2018年报告发病数据重新拟合模型,检验模型参数的稳定性和预测的准确性.结果 2010-2019年广州市肺结核共报告发病115 887例,并呈逐年下降趋势,报告发病数具有明显的季节性,在每年3-5月报告发病例数出现高峰,报告发病低谷则为2月份.广州市肺结核发病数拟合最佳模型为ARIMA(1,1,1)×(0,1,1)12(P残差检验=0.693,AIC=1215.300),该模型拟合的2020年1-12月的预测值与实际值的平均绝对百分比误差(MAPE)=7.29％.通过2010-2018年的报告发病数据拟合最优模型仍为ARIMA(1,1,1)×(0,1,1)12(P残差检验=0.847,AIC=1089.260),该模型拟合的2019年1-12月的预测值与实际报告值的MAPE为4.91％.广州市2021年肺结核预测发病数为8270例,月平均报告发病数为689例,报告发病水平较2020年略有上升.结论 ARIMA(1,1,1)×(0,1,1)12模型对广州市肺结核报告发病患者例数有较好的预测效果,可用于广州市肺结核的短期预期和动态分析.

目的 探讨出生体重及分娩方式对小学生超重肥胖和腹型肥胖的影响,为预防儿童肥胖提供依据.方法 依托广州市中小学生常规体检,采用分层整群抽样方法,抽取3所小学3 361名学生,对学生及家长进行问卷调查.应用Logis-tic回归模型分析分娩方式、出生体重与学生超重肥胖和腹型肥胖的关系.应用相乘交互项和Delta法探讨交互作用.结果 广州市小学生的超重肥胖率为21.33％,腹型肥胖率为12.08％.多因素Logistic分析表明,与顺产的学生相比,经剖宫产者的超重肥胖风险增加了44％(OR= 1.44,95％CI=1.16～1.80);高出生体重的学生超重肥胖风险较正常体重者增加62％(OR=1.62,95％CI=1.09～2.42).调整多因素后,未观察到出生体重和出生方式与学生腹型肥胖之间的关联性(P值均＞0.05).经剖宫产出生与父母肥胖对学生的超重肥胖(RERI=0.33,95％CI=0.02～0.65)和腹型肥胖(RER1=0.39,95％CI= 0.12～0.65)存在相加交互作用.结论 剖宫产及高出生体重与小学生超重肥胖风险增高有关联.剖宫产出生方式与父母肥胖可能协同促进儿童肥胖发生.

Objective:To analyze the current status of body composition and development patterns of children and adolescents aged 6-17 years in Guangzhou.Methods:This was a cross-sectional study involving 8 169 school students from 3 elementary schools and 3 middle schools in Guangzhou from March to December 2019.The fat-free mass (FFM) and fat mass (FM) were measured by the bioelectrical impedance analysis.The fat-free mass index (FFMI) and fat mass index (FMI) were calculated via the height standardization. T test was used to compare quantitative variables between groups.The growth pattern of body composition was described using the Hattori chart. Results:A total of 4 431 boys (54.24%) and 3 738 girls (45.76%) were involved in this study.FFM and FM both increased with age between boys and girls.Except for boys aged 11 years, FFM in boys were significantly higher than that in girls with the same age (all P<0.05). In the age of 7-10 years, FM in boys were significantly higher than that in girls with the same age, while it was significantly higher in girls aged 12 years and older than that of boys at the same age (all P<0.05). The Hattori chart showed that the difference in body composition between genders occurred after 11 years old.In contrast to girls, increases in the weight and body mass index (BMI) in boys were mainly attributed to the FFM development. Conclusions:The development of FFM and FM in children and adolescents varies with age, accompanied with the gender-specific features.FFM in boys is higher than that of girls at the same age.The weight gain in boys is mainly attributed to the development of fat-free tissues, and thus the utility of BMI may lead to the overestimation of obesity.

Objective: To evaluate the consistency between bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) in the measurement of body composition in children and adolescents aged 7-17 years. Methods: Fat-free mass (FFM) and fat mass (FM) were measured by both BIA and DXA in 1 431 children. The consistency between the methods was evaluated by intra-class correlation coefficients (ICCs) and Bland-Altman analysis. Logarithmic transformation of both measurements was performed before Bland-Altman analysis. Results: The ICCs for FFM were 0.986 and 0.974 and ICCs for FM were 0.854 and 0.926 in boys and girls respectively. In boys, the mean ratio of FFMs by BIA and DXA was 1.04, with limits of Agreement (LoA) of 0.95-1.14, and in girls, the mean ratio of FFMs by BIA and DXA was 1.02, with the LoA of 0.90-1.15. The LoA of FFM became narrower with age in both boys and girls. Both boys and girls had the wide LoAs for FM (0.40-1.27 and 0.48-1.48, respectively). Additionally, the LoA ranges for FFM and FM narrowed with the increase of BMI level in both boys and girls. Conclusion: For all children, BIA showed good consistency with DXA for FFM, whereas significant errors occurred in FM measurement. The consistency between BIA and DXA was better for obese children than for underweight or normal-weight children.

目的 分析2014-2019年广州市涂阳肺结核患者流行病学特征,为制定肺结核防治措施提供科学依据.方法 通过《中国疾病预防控制信息系统》的子系统《结核病信息管理系统》,收集广州市2014-2019年登记的24 344例涂阳肺结核患者的信息,包括户籍、性别、职业、患者发现方式、治疗分类等,应用季节指数对时间序列进行季节效应分析,应用莫兰指数(Moran I)对地理信息作全局空间自相关分析.结果 2014-2019年广州市涂阳肺结核年均登记率为28.53/10万(24 344/8533.38万);各区年均登记率在20.49/10万?43.74/10万,平均登记率呈现"西高东低"的特征;越秀区涂阳肺结核年均登记率最高(43.74/10万,3069/701.68万);广州市涂阳肺结核总登记率由2014年的38.39/10万(5022/1308.05万)下降至2019年的21.39/10万(3274/1530.59万),差异有统计学意义(x2趋势 =1110.440,P＜0.01).涂阳肺结核患者中,男17 331例,女7013例,男女比例为2.47 ∶ 1;流动人口占比由2014年的30.19％(1516/5022)上升至2019年的47.62％(1559/3274),差异有统计学意义(x2趋势=12.197,P＜0.01);职业以家政待业占比最高,为36.59％(8908/24 344);因症就诊是发现涂阳肺结核患者的主要方式,占48.66％(11 846/24 344);复治患者涂阳率达68.16％(2894/4246).涂阳肺结核流行期为每年的1月(季节指数为110.40)和3?8月(季节指数为分别为108.00、105.70、112.90、104.50、110.40、106.90);全局空间自相关分析发现,广州市涂阳肺结核患者整体无空间聚集性(2014-2019年Moran I值分别为-0.180、-0.160、0.180、0.141、-0.097和-0.095,Z值分别为-0.440、-0.391、1.382、1.038、-0.006和0.032,P 值分别为0.374、0.393、0.101、0.158、0.472和0.463).结论 广州市涂阳肺结核整体流行水平呈下降趋势,涂阳肺结核呈现季节变化规律,不同地区的涂阳肺结核流行情况不同,应将流动人口作为肺结核防治的重点人群.

目的 分析2008-2018年广州市结核病患者诊断延误趋势及影响因素,为制定防治措施提供依据.方法 通过《中国疾病预防控制信息系统》的子系统《结核病管理信息系统》,收集2008-2018年广州市登记治疗的125 180例结核病患者的信息,包括性别、年龄、民族、职业、患者来源、患者分类及并发症发生情况,采用单因素和多因素logistic回归模型分析结核病患者诊断延误的影响因素.结果 2008-2018年广州市结核病患者从初次就诊至诊断的天数的中位数(四分位数)为5(2,15)d,诊断延误率为27.43％(34 343/125 180).单因素分析结果显示,65～102岁年龄组、汉族、职业为教师/医务人员/干部、患者来源为健康检查的诊断延误率分别为29.70％(4610/15 524)、27.50％(33 829/123 013)、33.22％(1320/3974)、37.86％(1017/2686),明显高于年龄25～＜45岁(26.69％,13 585/50 894)、少数民族(23.72％,514/2167)、工人及民工(21.10％,4752/22 520)、患者来源为转诊(25.36％,14 416/56 835),差异均有统计学意义(x2值分别为65.253、15.291、879.541、570.472,P 值均＜0.001).多因素logistic回归分析结果显示,以下特征的结核病患者更容易出现诊断延误:25～＜45、45～＜65、65～102岁年龄组[以＜25岁年龄组为参照,OR(95％CI)值分别为1.072(1.033～1.110)、1.136(1.090～1.184)、1.168(1.105～1.235)];汉族[以少数民族为参照,OR(95％CI)=1.155(1.044～1.278)];职业为儿童及学生、商业服务、教师/医务人员/干部、农民、离退休人员、家政/家务/待业、其他[以工人及民工为参照,OR(95％CI)值分别为1.730(1.617～1.851)、1.784(1.683～1.890)、1.828(1.698～1.968)、1.167(1.111～1.227)、1.632(1.535～1.736)、1.436(1.378～1.497)、1.525(1.462～1.590)];患者来源为健康检查、接触者检查、因症就诊、因症推荐、追踪[以转诊为参照,OR(95％CI)值分别为1.704(1.572～1.848)、1.531(1.227～1.910)、1.031(1.003～1.060)、1.346(1.192～1.520)、1.535(1.467～1.606)].结论 2008-2018年广州市结核病患者诊断延误现象逐年上升.对上述各类诊断延误的影响因素,需要重点加强关注.

目的 探讨母亲孕期被动吸烟及女生超重肥胖对女生月经初潮年龄(age at menarche,AAM)的影响,为促进儿童青少年健康成长提供参考.方法 基于2016年中学新生体检工作,采用方便抽样法对广州市城区26所中学的2 722名初一女生进行问卷调查和体格检查.应用Logistic回归模型分析女生超重肥胖、母亲孕期被动吸烟与女生AAM的关系,采用四向分解法探讨女生超重肥胖在母亲孕期被动吸烟对女生AAM提前中的中介效应.结果 女生月经来潮率为90.82％(2 472/2 722).月经初潮中位年龄为12.00岁,初潮提前率为34.91％(863/2 472).与母亲孕期无被动吸烟的女生相比,母亲孕期被动吸烟≤3d/周的女生AAM提前的风险增加32％(OR调整=1.32,95％CI=1.06～ 1.65),母亲孕期被动吸烟＞3 d/周的女生AAM提前的风险增加58％(OR调整=1.58,95％CI=1.21～2.07).超重肥胖女生AAM提前的风险比非超重肥胖的女生增加77％(OR调整=1.77,95％CI=1.36～2.31).四向分解结果显示,母亲孕期被动吸烟导致女儿AAM提前的风险中,79.60％归因于母亲孕期被动吸烟的直接效应(P＜0.01).结论 女生超重肥胖和母亲孕期被动吸烟与女生AAM提前关联.母亲孕期被动吸烟对女生AAM提前的影响方式可能以直接作用为主.