Objective The objective of this study was to assess whether the weight-adjusted-waist index(WWI) is associated with the prevalence of asthma and age when first asthma onset appears in US adults. Methods For analysis we selected participants from the National Health and Nutrition Examination Survey(NHANES)database between 2001 and 2018. A dose-response curve was calculated using logistic regression,subgroup analysis,and a dose-response curve. Results The study included 44480 people over the age of 20,including 6061 reported with asthma, and the increase in asthma prevalence was 15% associated with each unit increase in the WWI, after adjusting for all confounders(odds ratio(OR)=1.15,95% CI:1.11,1.20). The sensitivity analysis was performed by trichotomizing the WWI, and compared to the lowest tertile, the highest tertile WWI group displayed a 29% increase in asthma prevalence(OR=1.29,95% CI:1.19,1.40). A nonlinear correlation was found between the WWI index and the risk of asthma onset, with a threshold saturation effect indicating an inflection point of 10.53 (log-likelihood ratio test, P<0.05), as well as a positive linear correlation with age at first asthma onset. Conclusions A higher WWI index was associated with an increased prevalence of asthma and an older age of first asthma onset.
目的 探究老年急性心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)术后室性心律失常风险评分标准的构建及验证.方法 选择2020年1月至2022年12月于中国科学技术大学附属第一医院急诊行PCI治疗的184例老年急性心肌梗死(AMI)患者为研究对象.采用计算机产生随机数法以2:1的比例分为训练集(n=123)和测试集(n=61).训练集患者依据PCI术后是否发生室性心律失常分为室性心律失常组(n=46)和非室性心律失常组(n=77).经独立样本t检验及x2检验分析两组患者病历资料;通过多因素Logistic及逐步回归方法进一步筛选危险因素;基于赤池信息准则(AIC)采用向后逐步回归,选择最小AIC值构建室性心律失常风险预测模型并进行内外部验证;根据回归分析纳入变量的OR值构建风险评分标准及确定风险分层,并采用受试者工作特征(receiver operating characteristic,ROC)曲线评估评分标准实际应用价值.结果 训练集中非室性心律失常组与室性心律失常组指标比较,并进行多因素Logistic分析显示,心电图J波、TIMI血流分级0级、Killip Ⅳ级、发病至PCI治疗时间≥6h及UA≥436.77 μmol/L均是老年AMI急诊PCI术后室性心律失常的独立危险因素(P＜0.05).训练集和测试集校准曲线显示,预测模型具有良好的准确性和区分度.对各影响因素进行风险评分,总分在3～26分,低危组＜9分,中危组9～20分,高危组＞20分.高危组患者PCI术后室性心律失常率显著高于中危组和低危组(64.04％vs.25.09％和10.87％,P＜0.05),该风险评分标准训练集的AUC为0.850(95％CI0.810～0.892),测试集的 AUC 为 0.846(95％CI0.802～0.871).结论 通过风险预测模型制定的评分标准对老年AMI患者急诊PCI术后室性心律失常有良好的预测性.
Objective To explore the application value of global registry of acute coronary events (GRACE) score and modified early warning score(MEWS) in patients with acute cardiogenic chest pain.Methods A total of 662 patients with acute cardiogenic chest pain were collected from Jan 2015 to Dec 2016.The clinical data,including GRACE score,MEWS score,time required for scorings,and emergency hospitalization and death within 30 days were collected,then analyzed and compared the predictive ability of the two scores on the severity and prognosis.Results The mean time of GRACE scoring was(78.76 ± 10.85)min,which was significantly more than MEWS (4.55 ± 1.77) min(t =108.456,P ＜0.001).Four hundreds and twelve of the 662 patients were be in hospital by emergency,and 250 were detained for observation.The GRACE score of the patients in hospital by emergency was (150.22 ± 36.91),was significantly higher than the observation (96.36 ± 44.09) (t =16.892,P ＜ 0.001).The MEWS score of the patients in hospital by emergency was (5.46 ± 2.20),was significantly higher than the observation (3.15 ± 1.83) (t =13.932,P ＜ 0.01).Thirty-five of the 662 patients were died within 30 days,while 627 patients were survival within 30 days.The GRACE score of the patients died within 30 days was (171.69 ± 39.53),it was significantly higher than the patients survival within 30 days (127.55 ± 46.91) (t =5.458,P ＜ 0.001).The MEWS score of the patients died within 30 days was (5.66 ± 2.01),was significantly higher than the patients survival within 30 days (4.53 ± 2.36) (t =2.780,P =0.006).There were significant differences in AUC of GRACE score for patients were be in hospital by emergency (AUC =0.826) and 30-day death (AUC =0.751),and the AUC of MEWS for patients were be in hospital by emergency and 30 day death were 0.785 and 0.643,the GRACE score was superior to the MEWS in determining patients' emergency hospitalization and mortality within 30 days.Conclusion Both of the GRACE and MEWS scores can help evaluate the severity and prognosis of patients with acute cardiogenic chest pain,while the MEWS more quickly and the GRACE more accurate.
Objective To explore the relationship between hypovolemia and ARDS in the early stage of severe acute pancreatitis.Methods Sixty-nine cases of severe acute pancreatitis were divided into low CVP group and normal CVP group according to the CVP.The data of the ARDS rate,hydrothorax rate,APACHEⅡscore,PMN level,Endotoxin level,PaO2 /FiO2 of the two groups were collected and compared.Results The patients of ALI and hydrothorax in low CV group were 29,22,respectively,while 6,8 in control group,there was significant difference between two groups (P <0.05 ).There was significant difference (P <0.05 )in the APACHE Ⅱ score,PMN level,Endotoxin level, PaO2 /FiO2 in low CVP group compared with control group .It's a univariate linear relationship bettwen CVP level and Endotoxin level in low CVP group,so was Endotoxin level and PaO2 /FiO2 .The two linear equations were Y(Endotox-in)=5.27 -8.491X(CVP)and Y(PaO2 /FiO2 )=250.464 -2.062X(Endotoxin).Conclusions Hypovolemia state rises the level of endotoxin and inflammatory cells at the early stage of SAP,it's closely associated with ARDS.
Objective Emergency diagnosis of acute pulmonary embolism,research on effective treatments.Methods The study selected 46 cases of patients with a-cute pulmonary embolism in our hospital,with the help of various auxiliary examination means,such as blood gas analysis,According to the severity of the thrombolytic and anticoagulant therapy.Study the therapeutic effect.Results 10 cases of specific changes in SI Q Ⅲ T Ⅲ typical,22 cases of hypoxemia and hypocapnia,11,21 D-two mer positive,11 cases of pulmonary perfusion defect,3 cases of pulmonary artery thrombosis,8 cases with pulmonary low density filling defect;46 cases of patients af-ter treatment,effective 40 cases,invalid in 6 cases,of which 2 cases died,the total effective rate of the treatment was 87%.Conclusion The diagnosis is of high value in the diagnosis of acute pulmonary embolism ,thrombolytic therapy and anticoagulant therapy in treatment of acute pulmonary embolism in a very good effect .
