A Longitudinal Cohort Study on the Effect of Serum Bilirubin on the Progression of Carotid Atherosclerosis in Healthy People

doi:10.12114/j.issn.1007-9572.2022.0050

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (13): 1576-1581.DOI: 10.12114/j.issn.1007-9572.2022.0050

Special Issue: 全民健康最新文章合辑

• Original Research·Population Health & Epidemiological Study • Previous Articles Next Articles

A Longitudinal Cohort Study on the Effect of Serum Bilirubin on the Progression of Carotid Atherosclerosis in Healthy People

1. School of Graduate, Hebei Medical University, Shijiazhuang 050000, China
2. Department of Neurology, Hebei General Hospital, Shijiazhuang 050000, China

Received:2022-01-17 Revised:2022-03-04 Published:2022-04-12 Online:2022-04-22
Contact: Hebo WANG
About author:
QIN L, GU Y S, LI L, et al. A longitudinal cohort study on the effect of serum bilirubin on the progression of carotid atherosclerosis in healthy people[J]. Chinese General Practice, 2022, 25 (13) : 1576-1581.

健康体检人群血清胆红素水平对颈动脉粥样硬化进展影响的队列研究

1．050000　河北省石家庄市，河北医科大学研究生学院
2．050000　河北省石家庄市，河北省人民医院神经内科

通讯作者: 王贺波
作者简介:
秦璐，谷永胜，李琳，等.健康体检人群血清胆红素水平对颈动脉粥样硬化进展影响的队列研究[J].中国全科医学，2022，25（13）：1576-1581.[www.chinagp.net] 作者贡献：秦璐负责文章的构思与设计、论文撰写；秦璐、谷永胜、王贺波负责研究的实施与可行性分析、结果的分析与解释；秦璐、谷永胜、李琳、张凯华负责数据收集；秦璐、谷永胜、李琳、张凯华、姚文涛负责数据整理；秦璐、谷永胜负责统计学处理；秦璐、吴宗锴、何伟亮、王贺波负责论文的修订；秦璐、牛小莉、李俐涛负责英文的修订；王贺波负责文章的质量控制及审校，并对文章整体负责，监督管理。
基金资助:
河北省自然科学基金重点项目(H2020307041)

Abstract

Abstract:

Background

Cross-sectional studies have shown that the level of bilirubin in vivo is related to the progression of atherosclerosis, but the data from large-scale studies in China and even in the world are very limited.

Objective

To investigate the effect of serum total bilirubin (TBIL) and indirect bilirubin (IBIL) on the progression of carotid atherosclerosis in healthy people.

Methods

Retrospective cohort study was adopted to select 11 394 healthy people who had continuous physical examination and carotid intima-media thickness (cIMT) ≤1 mm displayed by carotid artery ultrasound examination as the research subjects in Hebei General Hospital from January 2010 to December 2019. Demographic characteristics, past medical history, physical examination, laboratory examination results of previous physical examination, carotid artery ultrasound and other information of subjects were collected. The subjects were divided into the progressive carotid atherosclerosis group and the non-progressive group according to whether cIMT increased during follow-up. The Cox proportional regression model was used to explore the effect of bilirubin on the progression of carotid atherosclerosis, and Cox regression analysis was performed by gender, age, body mass index (BMI) , hypertension, diabetes, smoking and alcohol consumption.

Results

1 586 cases of carotid atherosclerosis progression were detected in 10 years, with a cumulative incidence rate of 13.9%. The results of Cox regression analysis showed that for every 1 standard deviation increase in TBIL and IBIL levels, the risk of carotid atherosclerosis progression decreased by 6.6% and 17.4%, respectively〔HR (95%CI) =0.934 (0.881, 0.990) ; HR (95%CI) =0.826 (0.777, 0.877) 〕 after adjustment for age, sex, BMI, smoking, alcohol consumption, hypertension, diabetes, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, triglyceride, alanine aminotransferase and estimated glomerular filtration rate. Subgroup analysis showed that there was no statistical difference in the protective effects of TBIL and IBIL on different subgroups.

Conclusion

TBIL and IBIL levels are independent protective factors for the progression of carotid atherosclerosis in healthy subjects. Elevated bilirubin levels reduce the risk of carotid atherosclerosis progression, with IBIL being more potent in preventing carotid atherosclerosis progression.

Key words: Atherosclerosis, Carotid artery disease, Bilirubin, Carotid intima-media thickness, Cohort studies

摘要：

背景

横断面研究表明，体内胆红素水平与动脉粥样硬化的进展有关，但国内乃至世界的大样本纵向研究数据有限。

目的

探讨血清总胆红素（TBIL）和间接胆红素（IBIL）水平对健康体检人群颈动脉粥样硬化进展的影响。

方法

采用回顾性队列研究方法，选取2010年1月至2019年12月于河北省人民医院接受健康体检且基线颈动脉超声检查显示颈动脉内膜-中膜厚度（cIMT）≤1 mm的健康体检者11 394例为研究对象。采集研究对象人口学特征、既往史、体格检查结果，以及历次体检的实验室检查结果、颈动脉超声等信息。将研究对象按随访过程中cIMT是否增加分为颈动脉粥样硬化进展组和非进展组。运用Cox比例风险回归模型探讨胆红素对颈动脉粥样硬化进展的影响，并按性别、年龄、体质指数（BMI）、高血压、糖尿病、吸烟、饮酒特征进行亚组Cox回归分析。

结果

10年间检出颈动脉粥样硬化进展者1 586例，累积发生率为13.9%。Cox回归分析结果显示，在调整年龄、性别、BMI、吸烟、饮酒、高血压、糖尿病、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、三酰甘油、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、估算的肾小球滤过率后，TBIL和IBIL水平每升高1个标准差，颈动脉粥样硬化进展的风险分别下降6.6%和17.4%〔HR（95%CI）分别为0.934（0.881，0.990）、0.826（0.777，0.877）〕。亚组分析显示，TBIL和IBIL对于不同亚组人群的保护作用无统计学差异（P>0.05）。

结论

TBIL和IBIL水平是健康体检人群颈动脉粥样硬化进展的独立保护因素，胆红素水平升高可降低颈动脉粥样硬化进展的风险，其中，IBIL对于预防颈动脉粥样硬化进展的作用更强。

关键词: 动脉粥样硬化, 颈动脉疾病, 胆红素, 颈动脉内膜-中膜厚度, 队列研究

Lu QIN,Yongsheng GU,Lin LI, et al. A Longitudinal Cohort Study on the Effect of Serum Bilirubin on the Progression of Carotid Atherosclerosis in Healthy People[J]. Chinese General Practice, 2022, 25(13): 1576-1581. DOI: 10.12114/j.issn.1007-9572.2022.0050.
秦璐,谷永胜,李琳等. 健康体检人群血清胆红素水平对颈动脉粥样硬化进展影响的队列研究[J]. 中国全科医学, 2022, 25(13): 1576-1581. DOI: 10.12114/j.issn.1007-9572.2022.0050.

Figures/Tables 5

References 29

[1]	KISA A, KISA S, GBD 2019 Stroke Collaborators. Global，regional，and national burden of stroke and its risk factors，1990—2019：a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol，2021，20(10):795-820. DOI：10.1016/S1474-4422(21)00252-0.
[2]	ZHOU M, WANG H, ZENG X，et al. Mortality，morbidity，and risk factors in China and its provinces，1990—2017：a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet，2019，394(10204):1145-1158. DOI：10.1016/S0140-6736(19)30427-1.
[3]	LIBBY P, BURING J E, BADIMON L，et al. Atherosclerosis[J]. Nat Rev Dis Primers，2019，5(1):56. DOI：10.1038/s41572-019-0106-z.
[4]	YANG C W, GUO Y C, LI C I，et al. Subclinical atherosclerosis markers of carotid intima-media thickness，carotid plaques，carotid stenosis，and mortality in community-dwelling adults[J]. Int J Environ Res Public Health，2020，17(13):4745. DOI：10.3390/ijerph17134745.
[5]	AMOR A J, ORTEGA E, PEREA V，et al. Relationship between total serum bilirubin levels and carotid and femoral atherosclerosis in familial dyslipidemia[J]. Arterioscler Thromb Vasc Biol，2017，37(12):2356-2363. DOI：10.1161/ATVBAHA.117.310071.
[6]	TANG L H, HUANG C, FENG Y Q. Serum total bilirubin concentration is associated with carotid atherosclerosis in patients with prehypertension[J]. Clin Exp Hypertens，2019，41(7):682-686. DOI：10.1080/10641963.2018.1539094.
[7]	KAWAMOTO R, NINOMIYA D, HASEGAWA Y，et al. Mildly elevated serum bilirubin levels are negatively associated with carotid atherosclerosis among elderly persons[J]. PLoS One，2014，9(12):e114281. DOI：10.1371/journal.pone.0114281.
[8]	WAGNER K H, SHIELS R G, LANG C A，et al. Diagnostic criteria and contributors to Gilbert's syndrome[J]. Crit Rev Clin Lab Sci，2018，55(2):129-139. DOI：10.1080/10408363.2018.1428526.
[9]	中国高血压防治指南修订委员会. 中国高血压防治指南（2018年修订版）[J]. 中国心血管杂志，2019，24(1):24-56. DOI：10.3969/j.issn.1672-5301.2019.03.001.
[10]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南（2020年版）[J]. 中华糖尿病杂志，2021，13(4):315-409. DOI：10.3760/cma.j.cn115791-20210221-00095.
[11]	ZHOU B F. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults：study on optimal cut-off points of body mass index and waist circumference in Chinese adults[J]. Biomed Environ Sci，2002，15(1):83-96.
[12]	LEVEY A S, CORESH J, GREENE T，et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate[J]. Ann Intern Med，2006，145(4):247-254. DOI：10.7326/0003-4819-145-4-200608150-00004.
[13]	LAPENNA D, CIOFANI G, PIERDOMENICO S D，et al. Association of serum bilirubin with oxidant damage of human atherosclerotic plaques and the severity of atherosclerosis[J]. Clin Exp Med，2018，18(1):119-124. DOI：10.1007/s10238-017-0470-5.
[14]	TAO X, WU J, WANG A，et al. Lower serum indirect bilirubin levels are inversely related to carotid intima-media thickness progression[J]. Curr Neurovasc Res，2019，16(2):148-155. DOI：10.2174/1567202616666190412153735.
[15]	BERGMANN K, OLENDER K, SIODMIAK J，et al. Relationship of total bilirubin and C-reactive protein with traditional and novel risk factors for cardiovascular disease in apparently healthy subjects[J]. Clin Chem Lab Med，2014，52(11):e234. DOI：10.1515/cclm-2014-0890.
[16]	LI Y, MENG S Y, MENG C C，et al. Decreased serum bilirubin is associated with arterial stiffness in men[J]. Nutr Metab Cardiovasc Dis，2013，23(4):375-381. DOI：10.1016/j.numecd.2011.09.004.
[17]	OUYANG Q, WANG A, TIAN X，et al. Serum bilirubin levels are associated with poor functional outcomes in patients with acute ischemic stroke or transient ischemic attack[J]. BMC Neurol，2021，21(1):373. DOI：10.1186/s12883-021-02398-z.
[18]	WANG J, ZHANG X, ZHANG Z，et al. Baseline serum bilirubin and risk of first stroke in hypertensive patients[J]. J Am Heart Assoc，2020，9(12):e015799. DOI：10.1161/JAHA.119.015799.
[19]	HOEKSTRA L T, DE GRAAF W, NIBOURG G A，et al. Physiological and biochemical basis of clinical liver function tests：a review[J]. Ann Surg，2013，257(1):27-36. DOI：10.1097/SLA.0b013e31825d5d47.
[20]	VÍTEK L, OSTROW J D. Bilirubin chemistry and metabolism，harmful and protective aspects[J]. Curr Pharm Des，2009，15(25):2869-2883. DOI：10.2174/138161209789058237.
[21]	ROCA L, CALLIGARIS S, WENNBERG R P，et al. Factors affecting the binding of bilirubin to serum albumins：validation and application of the peroxidase method[J]. Pediatr Res，2006，60(6):724-728. DOI：10.1203/01.pdr.0000245992.89965.94.
[22]	BÄCK M, YURDAGUL A, TABAS I，et al. Inflammation and its resolution in atherosclerosis：mediators and therapeutic opportunities[J]. Nat Rev Cardiol，2019，16(7):389-406. DOI：10.1038/s41569-019-0169-2.
[23]	MAZZONE G L, RIGATO I, OSTROW J D，et al. Bilirubin inhibits the TNF alpha-related induction of three endothelial adhesion molecules[J]. Biochem Biophys Res Commun，2009，386(2):338-344. DOI：10.1016/j.bbrc.2009.06.029.
[24]	THAKKAR M, EDELENBOS J, DORÉ S. Bilirubin and ischemic stroke：rendering the current paradigm to better understand the protective effects of bilirubin[J]. Mol Neurobiol，2019，56(8):5483-5496. DOI：10.1007/s12035-018-1440-y.
[25]	PEJENAUTE Á, CORTÉS A, MARQUÉS J，et al. NADPH oxidase overactivity underlies telomere shortening in human atherosclerosis[J]. Int J Mol Sci，2020，21(4):1434. DOI：10.3390/ijms21041434.
[26]	LUO M, TIAN R, LU N. Nitric oxide protected against NADPH oxidase-derived superoxide generation in vascular endothelium：critical role for heme oxygenase-1[J]. Int J Biol Macromol，2019，126:549-554. DOI：10.1016/j.ijbiomac.2018.12.252.
[27]	BOON A C, HAWKINS C L, COOMBES J S，et al. Bilirubin scavenges chloramines and inhibits myeloperoxidase-induced protein/lipid oxidation in physiologically relevant hyperbilirubinemic serum[J]. Free Radic Biol Med，2015，86:259-268. DOI：10.1016/j.freeradbiomed.2015.05.031.
[28]	KINDERLERER A R, POMBO GREGOIRE I, HAMDULAY S S，et al. Heme oxygenase-1 expression enhances vascular endothelial resistance to complement-mediated injury through induction of decay-accelerating factor：a role for increased bilirubin and ferritin[J]. Blood，2009，113(7):1598-1607. DOI：10.1182/blood-2008-04-152934.
[29]	GROSS M D, BIELINSKI S J, SUAREZ-LOPEZ J R，et al. Circulating soluble intercellular adhesion molecule 1 and subclinical atherosclerosis：the coronary artery risk development in young adults study[J]. Clin Chem，2012，58(2):411-420. DOI：10.1373/clinchem.2011.168559.

组别	例数	年龄（±s，岁）	性别〔n（%）〕		BMI（±s，kg/m²）	吸烟史〔n（%）〕		饮酒史〔n（%）〕		高血压〔n（%）〕^d		糖尿病〔n（%）〕^d
组别	例数	年龄（±s，岁）	女	男	BMI（±s，kg/m²）	无	有	无	有	有	无	有	无
进展组	1 586	52.5±11.1	477（30.08）	1 109（69.92）	24.99±3.04	1 027（64.75）	559（35.25）	820（51.70）	766（48.30）	509（32.09）	1 077（67.91）	189（11.98）	1 388（88.02）
非进展组	9 808	47.9±12.5	3 485（35.53）	6 323（64.47）	24.66±3.25	7 031（71.69）	2 777（28.31）	5 088（51.88）	4 720（48.12）	2 529（25.80）	7 274（74.20）	619（6.36）	9 113（93.64）
检验统计量值		15.05^a	17.68^b		4.07^a	1.99^b		0.01^b		141.32^b		42.47^b
P值		<0.001	<0.001		<0.001	0.158		0.919		<0.001		<0.001
组别	WBC（±s，×10⁹/L）	NEUT（±s，×10¹²/L）	LDL-C（±s，mmol/L）	HDL-C（±s，mmol/L）	TC（±s，mmol/L）	TG 〔M（QR），mmol/L〕	ALT 〔M（QR），mmol/L〕	AST 〔M（QR），mmol/L〕	Scr（±s，μmol/L）	BUN（±s，mmol/L）	eGFR〔±s，ml·min^-1·（1.73 m²）^-1〕
进展组	6.22±1.56	4.74±0.46	3.00±0.87	1.24±0.32	5.00±0.91	1.32（1.05）	18.00（11.00）	19.00（6.00）	78.96±14.43	5.06±1.30	84.69±12.25
非进展组	6.19±1.57	4.74±0.47	2.73±0.84	1.25±0.32	4.77±0.89	1.22（1.01）	18.00（12.00）	19.00（6.00）	79.14±18.12	4.96±1.31	90.49±13.91
检验统计量值	0.80^a	0.47^a	11.38^a	1.09^a	9.00^a	4.32^c	2.32^c	2.71^c	0.44^a	2.74^a	17.15^a
P值	0.426	0.638	<0.001	0.277	<0.001	<0.001	0.021	0.007	0.660	0.006	<0.001

组别	例数	年龄（±s，岁）	性别〔n（%）〕		BMI（±s，kg/m²）	吸烟史〔n（%）〕		饮酒史〔n（%）〕		高血压〔n（%）〕^d		糖尿病〔n（%）〕^d
组别	例数	年龄（±s，岁）	女	男	BMI（±s，kg/m²）	无	有	无	有	有	无	有	无
进展组	1 586	52.5±11.1	477（30.08）	1 109（69.92）	24.99±3.04	1 027（64.75）	559（35.25）	820（51.70）	766（48.30）	509（32.09）	1 077（67.91）	189（11.98）	1 388（88.02）
非进展组	9 808	47.9±12.5	3 485（35.53）	6 323（64.47）	24.66±3.25	7 031（71.69）	2 777（28.31）	5 088（51.88）	4 720（48.12）	2 529（25.80）	7 274（74.20）	619（6.36）	9 113（93.64）
检验统计量值		15.05^a	17.68^b		4.07^a	1.99^b		0.01^b		141.32^b		42.47^b
P值		<0.001	<0.001		<0.001	0.158		0.919		<0.001		<0.001
组别	WBC（±s，×10⁹/L）	NEUT（±s，×10¹²/L）	LDL-C（±s，mmol/L）	HDL-C（±s，mmol/L）	TC（±s，mmol/L）	TG 〔M（QR），mmol/L〕	ALT 〔M（QR），mmol/L〕	AST 〔M（QR），mmol/L〕	Scr（±s，μmol/L）	BUN（±s，mmol/L）	eGFR〔±s，ml·min^-1·（1.73 m²）^-1〕
进展组	6.22±1.56	4.74±0.46	3.00±0.87	1.24±0.32	5.00±0.91	1.32（1.05）	18.00（11.00）	19.00（6.00）	78.96±14.43	5.06±1.30	84.69±12.25
非进展组	6.19±1.57	4.74±0.47	2.73±0.84	1.25±0.32	4.77±0.89	1.22（1.01）	18.00（12.00）	19.00（6.00）	79.14±18.12	4.96±1.31	90.49±13.91
检验统计量值	0.80^a	0.47^a	11.38^a	1.09^a	9.00^a	4.32^c	2.32^c	2.71^c	0.44^a	2.74^a	17.15^a
P值	0.426	0.638	<0.001	0.277	<0.001	<0.001	0.021	0.007	0.660	0.006	<0.001

性别		例数	TBIL	IBIL
颈动脉粥样硬化进展组
	男	1 109	15.34±4.69	11.38±3.64
	女	477	12.16±3.86	9.79±3.01
	t值		-11.04	-9.00
	P值		<0.001	<0.001
非进展组
	男	6 323	15.38±4.63	11.55±3.69
	女	3 485	11.90±4.01	9.69±3.19
	t值		-29.64	-26.15
	P值		<0.001	<0.001

性别		例数	TBIL	IBIL
颈动脉粥样硬化进展组
	男	1 109	15.34±4.69	11.38±3.64
	女	477	12.16±3.86	9.79±3.01
	t值		-11.04	-9.00
	P值		<0.001	<0.001
非进展组
	男	6 323	15.38±4.63	11.55±3.69
	女	3 485	11.90±4.01	9.69±3.19
	t值		-29.64	-26.15
	P值		<0.001	<0.001

自变量		b	SE	Wald χ²值	P值	HR（95%CI）
模型1
	TBIL	-0.025	0.025	-0.996	0.319	0.975（0.927，1.025）
	IBIL	-0.095	0.026	-3.602	<0.001	0.910（0.864，0.958）
模型2
	TBIL	-0.074	0.027	-2.725	0.006	0.929（0.880，0.979）
	IBIL	-0.147	0.028	-5.311	<0.001	0.863（0.818，0.911）
模型3
	TBIL	-0.060	0.027	-2.218	0.027	0.941（0.892，0.993）
	IBIL	-0.135	0.028	-4.842	<0.001	0.874（0.828，0.923）
模型4
	TBIL	-0.069	0.030	-2.299	0.021	0.934（0.881，0.990）
	IBIL	-0.191	0.031	-6.191	<0.001	0.826（0.777，0.877）
模型5
	TBIL	-0.093	0.046	-2.007	0.044	0.912（0.833，0.998）
	IBIL	-0.174	0.047	-3.699	<0.001	0.841（0.767，0.922）

A Longitudinal Cohort Study on the Effect of Serum Bilirubin on the Progression of Carotid Atherosclerosis in Healthy People

健康体检人群血清胆红素水平对颈动脉粥样硬化进展影响的队列研究

RichHTML

PDF

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 29

Related Articles 15

Recommended Articles

Metrics

Comments

分层因素		TBIL		IBIL
分层因素		HR（95%CI）	P值	HR（95%CI）	P值
年龄（岁）			0.455		0.236
	<60	0.920（0.861，0.984）		0.807（0.752，0.865）
	≥60	0.970（0.859，1.096）		0.879（0.777，0.995）
性别			0.868		0.659
	女	0.942（0.833，1.064）		0.846（0.745，0.960）
	男	0.931（0.871，0.995）		0.819（0.764，0.877）
BMI（kg/m²）			0.248		0.268
	<24	0.975（0.888，1.070）		0.861（0.782，0.949）
	≥24	0.908（0.842，0.979）		0.803（0.742，0.868）
饮酒史			0.691		0.729
	无	0.980（0.846，1.005）		0.815（0.745，0.891）
	有	0.944（0.872，1.022）		0.833（0.767，0.905）
吸烟史			0.540		0.511
	无	0.922（0.855，0.994）		0.813（0.752，0.879）
	有	0.957（0.872，1.050）		0.848（0.770，0.934）
高血压			0.202		0.217
	无	0.959（0.893，1.029）		0.848（0.788，0.912）
	有	0.883（0.794，0.981）		0.781（0.700，0.871）
糖尿病			0.075		0.105
	无	0.949（0.893，1.010）		0.838（0.786，0.893）
	有	0.792（0.656，0.958）		0.708（0.583，0.859）

[1]	JIAN Yingchun, ZENG Yongqin, ZHANG Haiping, WANG Zhengdi, AN Ke, YAN Rui. Recent Advances in Mitochondrial Dysfunction in Chronic Metabolic Diseases [J]. Chinese General Practice, 2026, 29(18): 2577-2584.
[2]	LIU Daiyue, LIU Xincan, LAN Zhenzhen. Research Progress on Postprandial Hyperlipidemia and Its Therapeutic Approaches [J]. Chinese General Practice, 2026, 29(18): 2546-2553.
[3]	JIN Chunhua, ZHANG Yawen, LI Lianxi. Association between Serum Bilirubin Within the Normal Range and Carotid Plaques in Elderly Patients with Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2026, 29(15): 1986-1991.
[4]	QIU Yanli, GAO Yongyin, BIAN Xueyan, WANG Xue, LI Yue. The Predictive Value of Estimated Pulse Wave Velocity for All-cause and Cardiovascular-related Mortality in Cancer Patients [J]. Chinese General Practice, 2026, 29(14): 1890-1897.
[5]	SUN Qinyu, DENG Yifan, YANG Tianxiao, FANG Zhen, JI Jun, HE Shenghu, ZHANG Jing. Clinical Study of HbA_1c/ApoA-1, TyG-BMI and Their Combination to Predict the Severity of Coronary Artery Calcification [J]. Chinese General Practice, 2026, 29(09): 1137-1145.
[6]	ZHU Chenrui, LI Na, WU Yuntao, ZHAO Haiyan, HUANG Zhe, LIU Yan, JI Chunpeng, WU Shouling. The Impact of Serum Uric Acid Levels on New-onset Atrioventricular Block: a Prospective Cohort Study [J]. Chinese General Practice, 2026, 29(05): 583-590.
[7]	ZENG Minghui, KUAI Wentao, CHEN Lin, HAN Jiaxin, XU Lianxin, GE Liying, DAI Rongrong, MI Yuqiang, XU Liang. Effect of Type 2 Diabetes Mellitus on the Efficacy of Nucleoside (Acid) Analogues in the Treatment of Chronic Hepatitis B [J]. Chinese General Practice, 2025, 28(35): 4414-4420.
[8]	WANG Biyou, GAO Ying, YOU Junfang, LIU Li, ZHANG Qing, SU Haiyan. Canonical Correlation Analysis of Lipid Ratios and Inflammatory Markers in Individuals at Risk of Cardiovascular Disease [J]. Chinese General Practice, 2025, 28(33): 4132-4139.
[9]	LIAO Jiaojiao, WANG Zhaoyu, LI Zhaoji, ZHAO Wei, ZHAN Siyan, WANG Peng, TAO Liyuan. Predictive Value of Dynamic Changes in Non-high-density Lipoprotein Cholesterol for Carotid Intima-media Thickening: an Ambidirectional Cohort Study [J]. Chinese General Practice, 2025, 28(31): 3932-3941.
[10]	SU Qing, XU Yao, LI Yihang, WANG Liyan, CAI Yefeng, NI Xiaojia. Quality Evaluation of Methodology on the Changes in Traditional Chinese Medicine Syndromes of Stroke and Risk Population [J]. Chinese General Practice, 2025, 28(29): 3694-3702.
[11]	DENG Jie, QI Qi, WU Xinyu, HAN Quanle, LI Lei, JIANG Yue, YU Jing, WU Ruojie, WU Shouling, LI Kangbo. Cohort Study on the Association between the Atherogenic Index of Plasma and the Risk of Incident Heart Failure in a Physical Examination Population [J]. Chinese General Practice, 2025, 28(29): 3645-3652.
[12]	XIANG Xinyue, ZHANG Bingqing, OUYANG Yuqin, TANG Wenjuan, FENG Wenhuan. Impact of Short-term Medical Weight Loss on Atherosclerotic Cardiovascular Disease Risk in Patients with Obesity [J]. Chinese General Practice, 2025, 28(26): 3229-3239.
[13]	DING Xiang, LIU Jian, CHEN Xiaolu, ZHANG Xianheng. Chinese Herbal Medicine may be Associated with Lower Readmissions in Rheumatoid Arthritis Patients with Streptococcal Infection: a Matched Cohort Study [J]. Chinese General Practice, 2025, 28(24): 3005-3012.
[14]	YANG Ji, ZHANG Yao, ZHAO Yingqiang, ZHANG Qiuyue. Evaluation of the Effectiveness of TCM Three-level Prevention and Control Model in the Management of Patients with Coronary Heart Disease and Stroke: a Single-center, Prospective Cohort Study [J]. Chinese General Practice, 2025, 28(22): 2750-2761.
[15]	GAO Haijun, REN Jiayu, WANG Ruolin, ZHOU Huiya, QU Peng. Research Progress on the Role of Endothelial Cell Injury and Dysfunction in Atherosclerosis [J]. Chinese General Practice, 2025, 28(21): 2697-2704.