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Objective:To investigate an association between glycosylated hemoglobin(HbA1c)level and non-alcoholic fatty liver(NAFL)in the elderly.Methods:In this retrospective case-control study, 5 186 elderly individuals aged 65 years and over meeting the inclusion conditions via health physical examination were successively selected from January to December 2018.They were divided into NAFL group(n=1 731)and non-NAFL group(n=3 455). Waist circumference, body mass index, smoking history, diastolic blood pressure, glomerular filtration rate, serum levels of triglyceride, low density lipoprotein cholesterol, alanine aminotransferase, aspartic aminotransferase, fasting blood glucose and HbA1c were compared between the two groups, and their correlations with NAFL were analyzed.Results:The prevalence of NAFL was 33.4%(1, 731/5, 186). The values of waistline, body mass index, smoking history, diastolic blood pressure, triglyceride, total cholesterol, low density lipoprotein cholesterol, glomerular filtration rate, alanine aminotransferase, aspartate aminotransferase, fasting glucose and HbA1c were higher in the NAFL group than in non-NAFL group(all P<0.05). While levels of creatinine, urea nitrogen and age were lower in the NAFL group than in non-NAFL group( P<0.05). According to the quartile of HbA1c level, these subjects were divided into Q1 to Q4 groups(HbA1c<5.7%, 5.7≤HbA1c<6.0%, 6.0%≤HbA1c<6.5%, HbA1c≥6.5%), and the prevalence of NAFL in the Q1 to Q4 were 22.8%(225/1 120), 27.9%(398/1 429), 36.5%(514/1 409), 45.9%(564/1 228)respectively.The prevalence of NAFL was increased along with the increase in the level of HbA1c( P<0.01). Multivariate Logistic regression analysis showed that after adjusting for age, gender and metabolic components, the risk for developing NAFL was gradually increased in Q2 group, Q3 group, Q4 group versus Q1 group as the following OR value: OR=1.274, 95% CI: 1.004-1.616; OR=1.639, 95% CI: 1.294-2.077; OR=1.787, 95% CI: 1.337-2.389, respectively, all P<0.01. Conclusions:The prevalence of NAFL is positively associated with HbA1c levels in the elderly and HbA1c is an independent risk factor for NAFL disease.
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The introduction of evidence-based medicine in general practice teaching can effectively improve the clinical decision-making ability of general practitioners, promote the transformation of general practice service mode, and enrich the connotation of general practice. The ways to implement the idea of evidence-based medicine into general practice education include strengthening the teaching staff of evidence-based medicine in general practice, innovating the teaching methods of evidence-based medicine in general practice, and introducing the evaluation and examination of evidence-based medicine skills into the assessment system of general practitioners. Evidence-based medicine education in general practice teaching still faces many problems. It is necessary to continuously strengthen the connotation construction of evidence-based medicine teaching for general practitioners, continuously improve the teaching methods of evidence-based medicine for general practitioners, and scientifically carry out assessment of evidence-based medicine teaching for general practitioners.
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Total 732 subjects aged 30-60 years undergoing health check-up at Beijing Hospital Medical Examination Center in 2009,who had no history of non-alcoholic fatty liver disease (NAFLD) were recruited in the study.According to the quartile of hemoglobin (HGB) level,the subjects were divided into 4 groups:Q1:HGB ≤ 131 g/L (n =192),Q2:HGB ＞ 131 g/L and ≤ 140 g/L (n =178),Q3:HGB ＞ 140 g/L and ≤152 g/L (n =184),Q4:HGB ＞ 152 g/L (n =178).All participants were followed up for 4 years,the prevalence rates of NAFLD in groups Q1,Q2,Q3 and Q4 were 8.3％ (16/192),17.4％ (31/178),23.4％ (43/184) and 25.3％ (45/178),respectively (P ＜0.05).Logistic regression showed that the rates of NAFLD in groups Q2,Q3 and Q4 were 2.32 (1.22-4.41),3.36 (1.81-6.21) and 3.72(2.02-6.87) times higher as group Q1 (P ＜ 0.05).Multiple logistic regression analysis showed that the hemoglobin level,TG and BMI were the independent risk factors of NAFLD.
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Objective To analyze the effect of Chinese diabetes risk score in health checkup of elderly population and to explore the risk factors of abnormal glucose metabolism in the elderly patients.Methods Chinese diabetes risk score(C-DRs)screening,glucose tolerance test(OGTT),blood biochemical parameters and history collection were performed in 1 181 elderly people participating the health checkup.The area under the ROC curve(AUC)was used to evaluate the accuracy of the screening method.The effect of different cumulative C-DRs on screening target population was reflected by the Gordon index.Multivariate logistic regression analysis was used to analyze relevant risk factors for the glucose metabolic abnormalities.Results The AUC of screening for diabetes was 0.749(95%CI:0.715-0.782),and the best cut-point value was 32.5 points.The sensitivity was 86.50%,the specificity was 60.84%,and the Gordon index was 0.47(P=0.000).The AUC of screening for the pre-diabetes was 0.760(95%CI:0.733-0.787),and the best cut-point was 33.5 points.The sensitivity was 70.89%,the specificity was 68.72%,and the Gordon index was 0.40(P=0.000).The AUC of screening for MS was 0.797(95% CI:0.772-0.823),and the best cut-point value was 32.5 points.The sensitivity was 83.62%,the specificity was 64.90%,and the Gordon index was 0.49(P=0.000).The AUC of screening for insulin resistance was 0.609(95%CI:0.645-0.734),and the best cut-point value was 30.5 points.The sensitivity was 81.25%,the specificity was 44.81%,and the Gordon index was 0.26(P=0.000).Multiple logistic regression analysis showed that age over 80 years,abdominal obesity(waist circumference,male ≥ 90 cm,female ≥ 85 cm),hypertension,hypertriglyceridemia,family history of diabetes were risk factors for abnormality of glucose metabolism in the elderly.The odd ratio values of the above were 1.557,1.543,1.495,1.569,1.625,1.715(all P<0.05).Conclusions Chinese diabetes risk score may be used to screen for diabetes,metabolic syndrome and insulin resistance in the elderly population.Old age,abdominal obesity,hypertension,hypertriglyceridemia and family history of diabetes are independent risk factors for abnormal glucose metabolism in the elderly population.
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Objective To evaluate the prevalence and risk factors of progressive liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).Methods A total of 2 054 subjects who underwent health check up and were diagnosed as NAFLD in 9 institutions were included in the study.Blood routine and biochemical findings were collected to calculate aspartate aminotransferase-to-platelet ratio index (APRI).Subjects were divided into three groups according to diagnostic threshold of liver fibrosis:APRI ＜0.43 group,APRI 0.43-0.53 group and APRI ≥ 0.54 group.The correlation between APRI and biochemical variables was analyzed,and the risk factors of progressive fibrosis were also analyzed.Results Among 2 054 subjects (male/female 1 598/456) there were 61 cases with APRI ≥ 0.98 (2.97％,progressive fibrosis),318 with APRI ≥0.54 (15.48％),1 475 with APRI ＜ 0.43 (71.81％),261 with APRI 0.43-0.53 (12.71％).Logistic stepwise regression analysis showed that TG (P =0.002,OR =1.095,95％CI:1.033-1.161),2 hPG(P =0.000,OR =1.103,95％ CI:1.058-1.151,BUN(P =0.034,OR =1.215,95 ％ CI:1.014-1.454) were risk factors,and H DL-C (P =0.034,OR =0.353,95 ％ CI:O.135-0.924) was a protective factor for the progression of fibrosis.Conclusion The progressive fibrosis in patients with NAFLD is closely associated to blood glucose and lipid metabolism disorder.
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Objective To investigate the relationship between serum uric acid and the risk of nonalcoholic fatty liver disease.Methods A cohort study was performed among individuals who had physical examination at Beijing Hospital medical examination center during 2009.A total of 732 subjects without nonalcoholic fatty liver disease,30-60 years old,were selected.Subjects were divided into 4 groups (Q1,Q2,Q3,Q4) according to serum uric acid level.Theincidence of NAFLD in each group in 2013 were observed.Serum alanine aminotransferase,aspartate aminotransferase,triglycerides,total cholesterol,high density lipoprotein-cholesterol,low density lipoprotein-cholesterol,fasting plasma glucose,and imaging examinations were determined.Cumulative incidence ofNAFLD was compared between each group and effect of baseline serum uric acid on new-onset NAFLI was assessed by logistic regression analysis.Results The cumulative incidence of NAFLD increased irconjunction with the increase of baseline serum uric acid in 4 groups (Q1 8.70％,Q2 13.04％,Q3 19.23％,Q4 32.97％,x2=37.865,P＜0.05).Logistic regression showed that the incidence of nonalcoholic fattyliver disease was increased along with elevated levels of serum uric acid.Subjects in the Q2,Q3,Q4 groups showed an increased risk of NAFLD,relative risks were 1.575 (0.807-3.074);2.580 (1.329-54.701);5.164 (2.838-9.397),compared to those in Q1 group.Moreover,after adjustment for baseline factors (e.g.Age,sex),risk of NAFLD remained higher,with odds ratio at 1.234,and the difference was statistically significant.Conclusions Serum uric acid was found to be correlated with the prevalence of nonalcoholic fatty liver disease.Serum uric acid appeared to be an independent risk factor for NAFLD.
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Objective To select health individual and test serum total bilirubin and direct bilimbin in order to provide a reference range for the establishment of appropriate reference interval in this region.Methods From October to December in 2009,314 of physical examination population of Beijing Hospital were selected by questionnaire and laboratory test excluding liver and gallbladder diseases or metabolic diseases.Roche and Prodia reagents were used to test TBIL and DBIL,respectively.Reference interval was calculated by sex group and compared with the existing reference interval.Results The level of TBIL had a significant difference between different genders(P ＜ 0.01).The level of TBIL had a significant difference between two kinds of reagents(P ＜ 0.01).Using Roche reagent,the reference interval of TBIL was 7.1 ～ 27.2 μmol/L for man,and 4.8 ～ 20.9 μmol/L for woman,and the reference interval of DBIL was 1.4 ～6.8 μmol/L for man,and 0.9 ～5.7 μmol/L for woman.Using Prodia reagent,the reference interval of TBIL was 9.5 ～ 35.7 μmol/L for man,and 6.8 ～ 28.9 μmol/L for woman,and the reference interval of DBIL was 1.3 ～ 7.0 μmol/L for man,and 1.0 ～ 6.6 μmol/L for woman.Conclusions The level of TBIL and DBIL in physical examination population was higher than the existing reference interval.It is necessary to modify the existing reference interval and establish reasonable reference interval for different regions and gender,respectively.
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The health check-up results of 11 514 subjects in 2011 at Beijing Hospital were retrospectively analyzed,including the results of 13C urea breath test for detection of Helicobacter pylori (Hp) and HbA1c test.The results showed that the prevalence rate of Hp infection was significantly higher in females (31.77％) than that of males (29.36％) (x2 =7.355,P ＜0.05) ; the highest prevalence was found in 35-60 y age group (31.17％).Hp positive rates in subjects with body mass index (BMI) ≥28kg/m2 and central obesity were 31.55％ and 30.44％,respectively; there were no significant differences from those with normal weight and non central obesity.Subjects with positive Hp infection had higher levels of HbA1 c,compared to those with negative Hp infection (t =-2.276,P =0.01).In subjects with BMI ≥24 kg/m2 and central obesity,HbA1c level was higher in Hp positive subjects than that in Hp negative ones (P ＜0.05).Diabetes mellitus was positively associated with Hp infection (OR 1.282; 95％ CI 0.941-1.799),particularly in obese patients (OR 1.459 ; 95 ％ CI 1.070-2.071).The results indicate that Hp may be involved in the impairment of glucose regulation,particularly in those with higher body mass index.
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Objective To explore the direct association between metabolic syndrome (MS) and gamma glutamyltransferase (GGT) or alanine aminotransferase (ALT) in Beijing men and women.Methods We investigated the medical check-up data from the 14,204 physical examination population (male 9524,female 4680) of year 2008.A cross-sectional study was carried out to explore the direct association between MS and GGT or ALT.MS was defined by the Chinese Diabetes Society (2004).Chisquare test was performed to analyze the categorical variables.The receiver operating characteristic curve (ROC) was plotted to obtain area under curve (AUC) and the cutoff point of GGT and ALT.Results The prevalence of MS was significantly higher in subjects with the highest quartile of GGT or ALT than the subjects with the lowest quartile of GGT or ALT.For male,the prevalence of MS is 7.57％ in the lowest GGT quartile and 29.04％ in the highest GGT quartile.For female,the prevalence of MS is 1.28％ in the lowest GGT quartile and 17.86％ in the highest GGT quartile.For male,the prevalence of MS is 9.27％ in the lowest ALT quartile and 21.88％ in the highest ALT quartile.For female,the prevalence of MS is 3.52％ in the lowest ALT quartile and 14.70％ in the highest ALT quartile (P ＜0.01).The optimal cutoff points of GGT to diagnose MS were 31 U/L in men and 18 U/L in women.The optimal cutoff points of ALT to diagnose MS were 23 U/L in men and 19 U/L in women.Conclusions The prevalence of MS increases with the increase in serum levels of GGT or ALT even through the normal range of GGT or ALT in Chinese men and women.
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Objective To explore the exercise risk of urban residents aged18 to 65 years old.MethodsHealth screening and cardiovascular risk stratification were performed among adults18 to 65 years old in 2010by using exercise risk assessmentrecommendedbyAmerican College of Sports Medicine.Result A total of15 498 subjects were recruited 9293 males and 6205 females,mean age (44.8 ±11.1) years,8929(57.6％ ) in the lower risk group,5323(34.3％ ) in the moderate risk group,and 1246(8.1％ ) in the higher risk group.The proportion of those in the higher risk group was increased with age.Conclusion Risk assessment and Physical Activity Readiness Questionnaires should be used before physical activity programme is initiated,especially in middle aged or elderly people.
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Objective To examine the sensitivity and specificity of glycated haemoglobin A1c (HbA1c) in predicting metabolic syndrome (MS) and its association with cardiovascular risk factors.MethodsIn 6292 adults (median age 45 years) who participated in a medical check-up program,analysis of distribution of HbA1c and its association with various cardiovascular risk factors was performed. The ability of HbA1 c to predict MS was evaluated.Anthropometric measurements were made and fasting plasma glucose,lipid profiles and HbA1c were tested. ResultsThe prevalence of MS was 11.24％.Cardiovascular risk factors were significantly increased as the serum level of HbA1c increased. HbA1c of 5.8％ predicted the presence of MS.Females showed the same cut-off of HbA1c for the prediction of MS with males ( the area under the curve of the females was higher than that of the males ). Conclusion HbA1c was increased as cardiovascular risk factors increased and HbA1c of 5.8％ may predict the presence of MS.HbA1c might be a predictive measure of MS and cardiovascular diseases in adults.
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Objective To assess the efficiency of an iontophoresis-based screening method (EZSCAN) in the detection of impaired glucose tolerance (IGT),diabetes mellitus (DM) and metabolic syndrome (MS).Methods A total of 166 subjects without medical history of dysglycaemia underwent fasting plasma glucose (FPG) and HbA1c measurement and oral glucose tolerance test (OGTT) by using traditional or EZSCAN method.Variance analysis (GLM),SNK analysis,logistic regression analysis,and ROC analysis were used to evaluate the diagnostic value of those screening techniques.Results DM,IGT,normal glucose tolerance (NGT) +MS,and NGT were found in 4,26,25 or 111 participants,respectively.For traditional test,FPG of 7.0 mmol/L showed a lower sensitivity to detect DM (0%).The sensitivity of EZSCAN to detect DM,IGT or MS was 50%,77% and 64%,respectively.Conclusions FPG may have lower sensitivity to detect DM,although EZSCAN could show higher sensitivity to detect IGT,DM,and MS.
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Objective To investigate the association of body mass index (BMI),sex and age with blood pressure in non-physical labor population from Beijing area.Methods 14 237 subjects (67.06% male) ranged from 18.0-93.0 years (mean (SD):49.8(10.2)) wero recruited in the health examination in Beijing hospital. Statistical analysis wag performed using SPSS 12.0 software.Results The average BMI wag 22.30 ks/m~2 (SD: 3.08).Systolic blood pressure and diastolic blood pressure increaged with the increasing of BMI.The prevalence of hypertension in males <60.0 years wag considerably higher than that of female (24.28% and 13.77% for male and females, respectively, P=0.000).However,there were no significant statistical differences for the pmvalence between male and female older than 60.0 years (P=0.268).Multiple logistic regression showed that in males,using the group with BMI<18.0 kg/m~2 as reference group,in the groups of BMI 18.0-23.9,24.0-27.9,≥28.0 kg/m~2, OR wag 1.709 (95% CI:0.920-3.173),3.154(1.703-5.839),5.125 (95%CI:2.805-9.696),respeetively.In females.OR for hypertension in the groups of BMI 18.0-23.9,24.0-27.9,≥28.0 kg/m~2,OR was 1.988(95%CI:1.033-3.824),5.703(2.962-10.982),14.358(95%CI:7.334-28.106),respectively.Conclusions BMI is associated with hypertension.Prevention and eontrol of the risk factom of hypertension e.g.overweight and obesity is an important public health issue in China.
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Objective To investigate the prevalence of elevated serum alanine aminotransferase ( ALT) and ALT-related dysmetabolism and risk factors. Methods A total of 12 789 adult participated,with no hepatitis B virus infection or alcohol over-intake, received health check-up, including blood pressure measurement, blood glucose and lipid profile test, liver function evaluation and ultrasonography. The subjects were then assigned into two groups according to the serum level of ALT. Metabolic composition was compared between the two groups. Results The prevalence of elevated ALT activity was 8.69%. The waist circumstance,body mass index (BMI) ,systolic blood pressure (SBP) ,diastolic blood pressure (DBP) ,total cholesterol (TC) ,triglyceride (TG) , low-density lipoprotein cholesterol (LDL-C) , urine acid (UA) , fasting blood glucose (FBG) ,HbAlc,total bilirubin (TBIL) ,-y-glutamyltransferase (GGT) ,alkaline phos-phatase ( ALP) of the elevated ALT group were significantly higher than those of the normal ALT group. However,age and high-density lipoprotein cholesterol ( HDL-C) in the elevated ALT group were lower than those in the normal ALT group ( P < 0. 05 ) . The occurrence of overweight, obesity, hyperlipidemia, impaired fasting glucose,diabetes, increased DBP, hyperuricacidemia and fatty liver in the elevated serum ALT group was significantly more than that in the normal ALT group ( P < 0. 05 ) . Multiple logistic regression analysis demonstrated that fatty liver, DBP, BMI.TC, HbAlc were risk factors of elevated serum ALT. Conclusion Non-alcoholic fatty liver disease, lipid metabolic disorders and obesity may be the main risk factors of elevated ALT.
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To explore relationship of body mass index (BMI), waist circumference (WC), blood lipid level with non-alcoholic fatty liver (NAFL) to provide evidence for its early intervention. Methods Data of 13 532 people living in Beijing undergone regular physical examinations at Beijing Hospital, including liver-ultrasonic scanning, measurements of blood lipid, height, weight, waist circumference and BMI during January to December 2007 were statistically analyzed. Results Totally, 4 807 people were diagnosed as NAFL by B-type ultrasonic scanning, with a mean age of (54 ± 14) years and median age of 53 years. Prevalence of NAFL significantly increased with changes in body building (normal weight, overweight and obesity) and age groups (X2 = 1640.394, P<0.01 ). There was statistical significance in prevalence of NAFL between groups with normal weight and overweight at varied ages ( X2 = 172.618 and 31.928, respectively, P < 0.01 ), with the highest at ages of 51 - 60 years. No statistical difference in prevalence of NAFL between varied age groups was found in those with obesity (X2 = 6.194, P =0.402). Mean of WC, BMI, serum levels of triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) were significantly higher in NAFL group than those in those without NAFL, but mean serum level of high-density lipoprotein cholesterol (HDL-C) was significantly higher in the former than that in the latter ( P < 0.05 ). Prevalence of dyslipidemia was significantly higher in NAFL group than that in those without NAFL ( X2 = 112. 974 - 895. 500, respectively, P < 0. 01 ), with the highest of hypertriglyceridemia, accounting for 54. 36 percent. Prevalence of NAFL was significantly higher in those with larger WC than that in those with normal WC in the normal weight and overweight group (X2 = 120.982 and 45.327, respectively, P<0.01). Results of logistic regression analysis showed that WC, BMI, TG and LDL-C all were risk factors for NAFL both in men and women, and HDL-C was a protective factor for NAFL only in women. Conclusions Overweight, obesity and dyslipidemia closely correlate with occurrence of NAFL Control of body weight and blood lipid level are essential for decreasing prevalence of NAFL.
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Objective To evaluate the effects of probiotics on experimental colitis of rats and to explore systemic and local changes of T regulatory cells(Tr) after the treatment. Methods The models of experimental colitis were established by enema with 2,4,6-trinitrobenzenesulphonic acid (TNBS). Live probiotics of combined bifidobacterium,lactobacillus and enterococcus (Bifico) were used. Four groups of rats were set up as negative group, TNBS alone group, probiotics group (high dosage and low dosage, with dose of 150 and 300 mg?kg-1?d-1, respectively), and combination group (probiotics plus prednisolone or sulfasalazine). Histologic scoring was used to evaluate the effect of medications; the proportions of CD4+CD25+ and CD8+CD28- Tr in peripheral blood, spleen mononuclear cells and intraepithelial lymphocytes of colon were detected by flow cytometry. Results Histopathology showed that high dosage of probiotics was effective in TNBS-induced colitis rats (2. 2?0.8 vs 3.5?0.7,P