الملخص
Objective:To investigate the correlation between the trajectory of triglyceride-glucose index multiplied by body mass index (TyG×BMI) and the incidence of new-onset non-alcoholic fatty liver disease (NAFLD).Methods:It was a retrospective cohort study. A total of 2 304 subjects who underwent health examinations at the Health Management Center of the First Affiliated Hospital of Zhengzhou University from 2017 to 2019 were included as the study population. Based on the TyG×BMI values from the health examinations, a latent class modeling approach was used to determine four distinct TyG×BMI trajectory groups: low-stable, moderate-stable, high-stable, and extremely high-stable group. The incidence of NAFLD was followed-up during the 2020 and 2021 health examinations for each group. The differences in NAFLD incidence among different TyG×BMI trajectory groups were compared using the log-rank test, and the correlation between different TyG×BMI trajectories and the incidence of new-onset NAFLD was analyzed using Cox proportional hazards regression models.Results:The incidence of NAFLD increased with the elevation of TyG×BMI trajectories. The cumulative incidence rates of NAFLD for the low-stable, moderate-stable, high-stable, and extremely high-stable groups was 13.00%, 16.70%, 20.10% and 26.60%, respectively, with statistically significant differences ( χ2=35.155, P<0.01). Compared with the low-stable group, the high-stable and extremely high-stable groups had higher risks of NAFLD (HRs for high-stable group was 1.564, 1.428, 1.426, 1.289, respectively; HRs for extremely high-stable group was 2.121, 1.670, 1.659, 1.607, respectively; all P<0.05). After adjusting for various confounding factors such as gender, waist circumference, BMI, blood glucose, blood lipids and liver function in model 4, the risks of NAFLD for the high-stable and extremely high-stable groups were still 1.389 and 1.607 times higher than that in the low-stable group (95% CIs: 1.035-1.864, 1.207-2.140). Conclusion:The risk of NAFLD increases with the elevation of TyG×BMI trajectories, suggesting that TyG×BMI can serve as a predictive index for NAFLD.
الملخص
Objective:To investigate the mediation effect of triglyceride glucose index(TyG) on the relation between thyroid nodules and visceral fat area.Methods:A total of 9 324 individuals at the Health Management Center of the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2021 were selected, and the basic information, biochemical indicators, color ultrasound of thyroid were also collected. According to the cut-off value of visceral fat area(VFA) of 100 cm 2 and body mass index(BMI) of 24 kg/m 2, they were divided into four groups: VFA(-)BMI(-), VFA(-)BMI(+ ), VFA(+ )BMI(-), and VFA(+ )BMI(+ ). Chi-square test was used to compare the incidence rate among the four groups, and multivariate logistic regression analysis to indentify influencing factors. TyG and VFA were quartiled, and multivariate logistic regression analysis was used to explore the effects of TyG and VFA on thyroid nodules. The regression coefficient test was used to analyze whether TyG mediated the association between VFA and thyroid nodules. Results:Multivariate logistic regression analysis revealed that compared with VFA(-)BMI(-) group, the VFA(+ )BMI(-) group had the highest risk of thyroid nodules( OR=1.283, 95% CI 1.064-1.546, P=0.009), followed by VFA(+ )BMI(+ ) group( OR=1.245, 95% CI 1.028-1.508, P=0.025). When using TyG and VFA Q1 group as reference, the Q4 group showed an increased risk of thyroid nodule by 1.584 times(95% CI 1.208-2.077, P=0.001) and 1.573 times(95% CI 1.249-1.982, P<0.001), respectively. Mediation analysis indicated that VFA had a direct impact on the incidence rate of thyroid nodules( β=0.162, 95% CI 0.140-0.186, P<0.001). TyG partially mediated the effect of VFA on the incidence rate of thyroid nodules( β=0.103, 95% CI 0.087-0.121, P<0.001), accounting for 38.87% of the total effect. Conclusions:VFA is an independent risk factor for thyroid nodules regardless of BMI. Among individuals with visceral obesity but normal BMI, the incidence rate of thyroid nodules was the highest. In addition, TyG partially mediates the risk of thyroid nodules in patients with visceral obesity. The evaluation of visceral obesity might be of great significance in the early screening and prevention of thyroid nodules.
الملخص
Objective:To explore the relationship between the long-term dynamic change in alanine aminotransferase(ALT) level and metabolic associated fatty liver disease(MAFLD).Methods:A retrospective study was conducted on 6 864 subjects who underwent four consecutive physical examinations from 2017 to 2020 in a cohort study of physical examination population in Henan Province. The relation between ALT level and the shift of MAFLD risk was analyzed using a multi-state Markov model, and the bidirectional relationship between ALT level and MAFLD was explored using a random intercept cross-lagged model.Results:Multi-state Markov model after adjusting for confounding factors showed that the risk of MAFLD in ALT Q2, Q3, Q4 group was gradually higher than that in Q1 group; Compared with health status, non-alcoholic fatty liver disease and MAFLD status gradually increased the risk of ALT shifting from normal to abnormal. The random intercept cross-lagged model after adjusting for confounding factors showed that there was a significant positive bidirectional relationship between MAFLD and ALT level. The cross-lag effect of MAFLD→ALT level was 0.083(95% CI 0.078-0.087), and the cross-lag effect of ALT→MAFLD was 0.044(95% CI 0.039-0.050). And with the extension of time, the cross-lag effect gradually decreased. Conclusions:There is a significant bidirectional relationship between the long-term dynamic change of ALT level and MAFLD. The occurrence of MAFLD is more likely to increase the risk of elevated ALT level, emphasizing the need for enhanced early prevention and treatment of MAFLD.
الملخص
Objective:To explore the association between glutamyl transpeptidase (GGT) trajectories and new-onset metabolic syndrome to provide insights for the prevention and treatment of metabolic syndrome.Methods:A total of 3 209 subjects who met the inclusion criteria were enrolled in the study cohort of physical examination population. The GGT levels before follow-up were classified by R LCTMtools program into 3 GGT trajectory groups: low-stable group, medium-stable group and high-stable group. Cox proportional hazards regression model was used to analyze the correlation between different GGT trajectories and new-onset metabolic syndrome.Results:At the end of follow-up in 2020, the cumulative incidence of metabolic syndrome was 7.0%, and the incidence of metabolic syndrome in the low-stable group, medium-stable group and high-stable group were 3.9%, 11.4%, and 15.0%, respectively, showing a growth trend ( P<0.001). After adjusting for multiple confounding factors by Cox proportional hazards regression model, the risk of metabolic syndrome in medium-stable group and high-stable group increased in the total population. The hazard ratios (95% CI)for the high stable group in males and the medium-stable group in females were 1.67(1.07-2.60) and 3.29(1.14-9.53), respectively, compared with their respective low-stable group. Conclusion:Elevated longitudinal trajectory of GGT is a risk factor for new-onset metabolic syndrome, the risk of metabolic syndrome in the total population increased with the increase of long-term GGT level. It is recommended to maintain the long-term level of GGT at about 28 U/L in males and 14 U/L in females, respectively, to achieve the goal of early prevention of metabolic syndrome.
الملخص
Objective:To investigate the correlation between fasting plasma glucose (FPG) and new-onset carotid plaque through latent class trajectory models.Methods:A total of 953 observation objects came from the first affiliated hospital of Zhengzhou University in accordance with the inclusion criteria. According to the FPG values of the observed subjects during the annual physical examination from January 2017 to December 2019, the following four different FPG trajectories groups were determined by latent class trajectory modelling tools: the low-stable group, the medium stable group, the medium-high stable group, and the high stable group. Carotid plaque incidence in each group was followed up in 2020 to compare the differences of the cumulative incidences of the four groups. The Cox proportional risk regression model was used to analyze the correlation between different FPG trajectories and new-onset carotid plaque.Results:The incidence of carotid plaque increased with the increase of FPG trajectories by 11.13%, 19.70%, 23.44%, 23.81%, respectively, with significance ( P<0.001). After adjusting gender, age, BMI and other confounding factors with the cox proportional risk regression model, the risk of carotid plaque in the FPG medium stable group, medium and high stable group, high-stable group was still 1.895 (95% CI: 1.296-2.769), 2.273 (95% CI: 1.241-4.161), 2.527 (95% CI: 1.219-5.241) times of the low stable group (all P<0.05). Conclusion:The long-term high FPG levels are independent risk factors for the incidence of carotid plaque, and controlling FPG at a low level steadily can reduce the risk of carotid plaque.
الملخص
Through analyzing the current situation of mediation of doctor-patient disputes,this paper cleared the connotation of mediation of doctor-patient disputes and explored diversified measures of mediating medical dis-putes.It included changing the concept of medical education actively and deepening the reform of medical system constantly,improving the level of hospital management actively and cracking down the occupational medical trouble and hospital scalper,taking litigation as backed mediation mechanism and playing the advantage role of people in mediation,taking initiative to communicate the mission knowledge and playing the role of media fully,and thus to reduce the occurrence of doctor-patient disputes from the source.