Adverse Pregnancy Outcomes and Its Associated Factors in Gestational Diabetes Mellitus with Isolated Fasting Hyperglycemia

doi:10.12114/j.issn.1007-9572.2022.0264

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (26): 3270-3274.DOI: 10.12114/j.issn.1007-9572.2022.0264

Special Issue: 内分泌代谢性疾病最新文章合辑；孕产妇健康研究最新文章合辑

• Original Research • Previous Articles Next Articles

Adverse Pregnancy Outcomes and Its Associated Factors in Gestational Diabetes Mellitus with Isolated Fasting Hyperglycemia

1. No.2 Department of Obstetrics, Northwest Women's and Children's Hospital, Xi'an 710061, China
2. Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Xi 'an Jiaotong University Health Science Center, Xi'an 710061, China

Received:2021-12-22 Revised:2022-05-30 Published:2022-09-15 Online:2022-07-06
Contact: Jing JI
About author:
WEI J X, MI Y, LUO X, et al. Adverse pregnancy outcomes and its associated factors in gestational diabetes mellitus with isolated fasting hyperglycemia[J]. Chinese General Practice, 2022, 25 (26) : 3270-3274, 3280.

单纯空腹血糖升高妊娠期糖尿病孕妇不良妊娠结局及其影响因素研究

1．710061　陕西省西安市，西北妇女儿童医院产二科
2．710061　陕西省西安市，西安交通大学医学部基础医学院生理学与病理生理学系

通讯作者: 计静
作者简介:
作者贡献：魏君香、米阳、计静提出研究思路、目标、方案、设计及研究题目；魏君香起草并撰写论文；魏君香和罗肖选取研究对象、收集数据并进行指标检验；贺译平、李志斌仔细审校数据分析过程，并对论文结果进行分析和解读，提出修改意见；全体作者参与论文修改和审校；魏君香和计静负责最终版本修订，并对论文整体负责。魏君香，米阳，罗肖，等.单纯空腹血糖升高妊娠期糖尿病孕妇不良妊娠结局及其影响因素研究[J].中国全科医学，2022，25（26）：3270-3274，3280.[www.chinagp.net]
基金资助:
陕西省重点研发计划项目(2021SF-009，2022SF-125，2021ZDLSF02-14); 国家自然科学基金资助项目(81871190)

Abstract

Abstract:

Background

Due to possible neglect of elevated fasting glucose, poor intra-pregnancy glycemic control may occur in gestational diabetes mellitus (GDM) women with isolated fasting hyperglycemia, but whether it is related to adverse pregnancy outcomes, and associated factors need to be evaluated further.

Objective

To explore the prevalence of adverse pregnancy outcomes in GDM with simple isolated fasting hyperglycemia and its influencing factors.

Methods

A total of 411 GDM patients with isolated fasting hyperglycemia who had prenatal examination in Northwest Women and Children's Hospital between June 2020 and March 2021 were selected, and followed up until delivery. Clinical data and pregnancy outcomes (normal and adverse) were collected. Multivariate Logistic regression was used to examine the factors associated with adverse pregnancy outcomes.

Results

Among the 411 cases, 245 received standardized glycemic management, 157 (38.2%) of whom achieved adequate glycemic control, but other 88 cases (21.4%) still had poor glycemic control; the other 166 cases (40.4%) did not receive standardized blood glucose management. Three hundred and twenty-three (78.6%) patients had adverse pregnancy outcomes, and other 88 (21.4%) had normal pregnancy outcomes. Patients with normal and adverse pregnancy outcomes had statistically significant differences in mean maternal age, prevalence of pre-pregnancy maternal obesity, intra-pregnancy glycemic management, mean fasting glucose, one- and two-hour plasma glucose level during the OGTT, prevalence of HbA_1c≥5.5%, serum total protein, serum albumin, prevalence of hypoproteinemia and the AUC of the time-blood glucose curve of the OGTT (P<0.05) . Multivariate Logistic regression analysis showed that pre-pregnancy maternal overweight or obesity〔OR=2.89, 95%CI (1.45, 5.78) , P=0.003〕, intra-pregnancy glycemic management 〔poor glycemic control: OR=3.64, 95%CI (1.64, 8.06) , P=0.001; non-management: OR=3.46, 95%CI (1.91, 6.25) , P<0.001〕, prenatal HbA_1c〔OR=2.38, 95%CI (1.06, 5.34) , P=0.035〕, hypoproteinemia〔OR=2.25, 95%CI (1.15, 4.41) , P=0.018〕, and elevated AUC of the time-blood glucose curve of the OGTT〔OR=1.23, 95%CI (1.03, 1.47) , P=0.024〕 were associated with increased risk of adverse pregnancy outcomes.

Conclusion

Pre-pregnancy maternal overweight or obesity, uncontrolled or non-management of blood glucose during pregnancy, high prenatal HbA_1c values, hypoproteinemia, and high AUC of the time-blood glucose curve of the OGTT may be high risk factors for adverse outcomes in GDM with isolated fasting hyperglycemia. To improve the rate of normal maternal and neonatal outcomes, clinical guidance should be given to pregnant women to maintain a normal pre-pregnancy weight and to standardizedly manage the blood glucose.

Key words: Diabetes, gestational, Pregnancy outcome, Isolated fasting hyperglycemia, Overweight, Glycosylated hemoglobin, Hypoproteinemia, Root cause analysis

摘要：

背景

单纯空腹血糖升高的妊娠期糖尿病（GDM）孕妇可能对仅空腹血糖升高未重视，导致妊娠期血糖管理不佳，而这种情况是否会造成不良妊娠结局，及其相关影响因素有待研究。

目的

探究单纯空腹血糖升高的GDM孕妇不良妊娠结局发生情况，并分析其影响因素。

方法

选取2020年6月至2021年3月在西北妇女儿童医院行产前检查的单纯空腹血糖升高的411例GDM孕妇为研究对象。所有孕妇随访至分娩，并根据最终分娩结局分为不良妊娠结局组和无不良妊娠结局组。收集孕妇的临床资料和不良妊娠结局发生情况，采用多因素Logistic回归分析探究单纯空腹血糖升高的GDM孕妇发生不良妊娠结局的影响因素。

结果

411例单纯空腹血糖升高的GDM孕妇中157例（38.2%）接受妊娠期规范化血糖管理并达标，88例（21.4%）接受妊娠期规范化血糖管理但未控制达标，166例（40.4%）未接受血糖管理；323例（78.6%）发生不良妊娠结局（不良妊娠结局组），88例（21.4%）妊娠结局良好（无不良妊娠结局组）。两组孕妇年龄、妊娠前超重肥胖所占比例、妊娠期血糖管理情况、空腹血糖、口服葡萄糖耐量试验（OGTT） 1 h血糖、OGTT 2 h血糖、糖化血红蛋白（HbA_1c）≥5.5%、血清总蛋白（TP）、血清白蛋白（ALB）、低蛋白血症发生率、时间-血糖曲线的曲线下面积（AUC）比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，妊娠前超重肥胖〔OR=2.89，95%CI（1.45，5.78），P=0.003〕、妊娠期血糖管理〔管理未达标：OR=3.64，95%CI（1.64，8.06），P=0.001；未管理：OR=3.46，95%CI（1.91，6.25），P<0.001〕、HbA_1c〔OR=2.38，95%CI（1.06，5.34），P=0.035〕、低蛋白血症〔OR=2.25，95%CI（1.15，4.41），P=0.018〕、时间-血糖曲线的AUC〔OR=1.23，95%CI（1.03，1.47），P=0.024〕是单纯空腹血糖升高GDM孕妇发生不良妊娠结局的影响因素。

结论

妊娠前超重肥胖、妊娠期血糖管理未达标或未管理、高HbA_1c、低蛋白血症、时间-血糖曲线的AUC是单纯空腹血糖升高GDM孕妇发生不良妊娠结局的高危因素，临床上应指导孕妇妊娠前保持正常体质量、规范化管理血糖等，以促进母婴健康。

关键词: 糖尿病, 妊娠, 妊娠结局, 单纯空腹血糖升高, 超重, 糖化血红蛋白, 低蛋白血症, 影响因素分析

Junxiang WEI,Yang MI,Xiao LUO, et al. Adverse Pregnancy Outcomes and Its Associated Factors in Gestational Diabetes Mellitus with Isolated Fasting Hyperglycemia[J]. Chinese General Practice, 2022, 25(26): 3270-3274. DOI: 10.12114/j.issn.1007-9572.2022.0264.
魏君香,米阳,罗肖等. 单纯空腹血糖升高妊娠期糖尿病孕妇不良妊娠结局及其影响因素研究[J]. 中国全科医学, 2022, 25(26): 3270-3274. DOI: 10.12114/j.issn.1007-9572.2022.0264.

Figures/Tables 3

References 22

[1]	International Diabetes Federation. Hyperglycemia in Pregnancy[R/OL]// IDF Diabetes Atlas：8th ed. Brussels：International Diabetes Federation. （2019-01-08）[2021-07-10].
[2]	JUAN J, YANG H X. Prevalence，prevention，and lifestyle intervention of gestational diabetes mellitus in China[J]. Int J Environ Res Public Health，2020，17(24):9517. DOI：10.3390/ijerph17249517.
[3]	GAO C H, SUN X, LU L，et al. Prevalence of gestational diabetes mellitus in mainland China：a systematic review and meta-analysis[J]. J Diabetes Investig，2019，10(1):154-162. DOI：10.1111/jdi.12854.
[4]	黄铭钧，李瑞满. 妊娠期糖尿病的影响因素及其对不良妊娠结局的影响[J]. 暨南大学学报：自然科学与医学版，2017，38(3):264-268. DOI：10.11778/j.jdxb.2017.03.013.
[5]	LIU B, CAI J, XU Y，et al. Early diagnosed gestational diabetes mellitus is associated with adverse pregnancy outcomes：a prospective cohort study[J]. J Clin Endocrinol Metab，2020，105(12):dgaa633. DOI：10.1210/clinem/dgaa633.
[6]	LI M F, MA L, YU T P，et al. Adverse maternal and neonatal outcomes in pregnant women with abnormal glucose metabolism[J]. Diabetes Res Clin Pract，2020，161:108085. DOI：10.1016/j.diabres.2020.108085.
[7]	International Association of Diabetes and Pregnancy Study Groups Consensus Panel, METZGER B E, GABBE S G，et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J]. Diabetes Care，2010，33(3):676-682. DOI：10.2337/dc09-1848.
[8]	中华医学会妇产科学分会产科学组，中华医学会围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南（2014）[J]. 中华妇产科杂志，2014，49(8):561-569. DOI：10.3760/cma.j.issn.0529-567x.2014.08.001.
[9]	肖京荣. 孕晚期低蛋白血症的原因及其对妊娠结局的影响[J]. 当代医学，2014，20(34):42. DOI：10.3969/j.issn.1009-4393.2014.34.031.
[10]	HIERSCH L, SHAH B R, BERGER H，et al. Oral glucose tolerance test results in pregnancy can be used to individualize the risk of future maternal type 2 diabetes mellitus in women with gestational diabetes mellitus[J]. Diabetes Care，2021，44(8):1860-1867. DOI：10.2337/dc21-0659.
[11]	AMERICAN DIABETES ASSOCIATION. 2. classification and diagnosis of diabetes：Standards of medical care in diabetes-2020[J]. Diabetes Care，2020，43(Suppl 1):S14-31. DOI：10.2337/dc20-S002.
[12]	LEWANDOWSKA M, WIECKOWSKA B, SAJDAK S. Pre-pregnancy obesity，excessive gestational weight gain，and the risk of pregnancy-induced hypertension and gestational diabetes mellitus[J]. J Clin Med，2020，9(6):E1980. DOI：10.3390/jcm9061980.
[13]	王雪影，周莉. 妊娠期糖尿病患者孕前体重指数及孕期体重增加量与妊娠结局及产科并发症关系研究[J]. 中国实用妇科与产科杂志，2020，36(8):757-761. DOI：10.19538/j.fk2020080119.
[14]	CHOI H, LIM J Y, LIM N K，et al. Impact of pre-pregnancy body mass index and gestational weight gain on the risk of maternal and infant pregnancy complications in Korean women[J]. Int J Obes（Lond），2022，46(1):59-67. DOI：10.1038/s41366-021-00946-8.
[15]	HU C J, YAN Y L, JI F J，et al. Maternal obesity increases oxidative stress in placenta and it is associated with intestinal microbiota[J]. Front Cell Infect Microbiol，2021，11:671347. DOI：10.3389/fcimb.2021.671347.
[16]	DITCHFIELD A M, DESFORGES M, MILLS T A，et al. Maternal obesity is associated with a reduction in placental taurine transporter activity[J]. Int J Obes（Lond），2015，39(4):557-564. DOI：10.1038/ijo.2014.212.
[17]	KIM J Y, TFAYLI H, BACHA F，et al. Β-cell function，incretin response，and insulin sensitivity of glucose and fat metabolism in obese youth：relationship to OGTT-time-to-glucose-peak[J]. Pediatr Diabetes，2020，21(1):18-27. DOI：10.1111/pedi.12940.
[18]	TUTINO G E, TAM C H, OZAKI R，et al. Long-term maternal cardiometabolic outcomes 22 years after gestational diabetes mellitus[J]. J Diabetes Investig，2020，11(4):985-993. DOI：10.1111/jdi.13209.
[19]	李鑫伟，张颖，周海峰. 妊娠期糖尿病患者分娩前糖化血红蛋白水平与妊娠结局的相关性研究[J]. 中国基层医药，2021，28(8):1197-1201. DOI：10.3760/cma.j.issn.1008-6706.2021.08.017.
[20]	黄立. 晚孕期孕妇合并低蛋白血症的不良妊娠结局及其影响因素评价[J]. 实用妇科内分泌电子杂志，2020，7(1):47,51. DOI：10.16484/j.cnki.issn2095-8803.2020.01.041.
[21]	MORIKAWA M, MAYAMA M, SAITO Y，et al. Hypoproteinemia as a parameter of poor perinatal/neonatal outcomes in women with preeclampsia diagnosed as hypertension plus proteinuria[J]. Pregnancy Hypertens，2020，21:111-117. DOI：10.1016/j.preghy.2020.05.012.
[22]	RINGHOLM L, DAMM P, MATHIESEN E R. Improving pregnancy outcomes in women with diabetes mellitus：modern management[J]. Nat Rev Endocrinol，2019，15(7):406-416. DOI：10.1038/s41574-019-0197-3.

项目		无不良妊娠结局组（n=88）	不良妊娠结局组（n=323）	检验统计量值	P值
年龄（±s，岁）		29.7±3.1	30.7±3.6	2.240^a	0.03
妊娠前超重肥胖〔n（%）〕		12（13.6）	107（33.1）	12.770^b	<0.01
妊娠期增重（±s，kg）		13.3±4.4	13.1±5.0	0.478^a	0.63
孕次≥1次〔n（%）〕		25（28.4）	62（19.2）	3.519^b	0.06
产次≥2次〔n（%）〕		44（50.0）	189（58.5）	2.042^b	0.15
妊娠期血糖管理〔n（%）〕				31.140^b	<0.01
	管理并达标	56（63.6）	101（31.3）
	管理未达标	9（10.2）	79（24.4）
	未管理	23（26.2）	143（44.3）
胰岛素使用〔n（%）〕		4（4.5）	16（5.0）	0.025^b	0.87
OGTT〔M（P₂₅，P₇₅），mmol/L〕
	空腹血糖	5.26（5.16，5.43）	5.32（5.2，5.48）	2.579	<0.01
	OGTT 1 h血糖	7.59（6.70，8.40）	8.21（7.19，9.05）	2.848	<0.01
	OGTT 2 h血糖	6.64（5.91，7.39）	7.04（6.31，7.57）	2.243	0.02
HbA_1c≥5.5%〔n（%）〕		3（3.4）	45（13.9）	7.420^b	<0.01
TC（±s，mmol/L）		6.02±1.06	5.93±1.09	0.748^a	0.45
TG（±s，mmol/L）		3.41±1.06	3.79±2.54	1.380^a	0.17
HDL-C（±s，mmol/L）		1.87±0.35	1.80±0.34	1.540^a	0.12
LDL-C（±s，mmol/L）		3.02±0.69	2.95±0.83	0.740^a	0.46
TP（±s，g/L）		64.47±4.72	62.21±6.33	3.117^a	<0.01
ALB（±s）		34.32±2.07	33.11±3.31	3.264^a	<0.01
低蛋白血症〔n（%）〕		13（14.8）	103（31.9）	10.000^b	<0.01
贫血〔n（%）〕		5（5.7）	39（12.1）	2.956^b	0.08
HOMA-IR〔M（P₂₅，P₇₅）〕		2.58（1.86，3.35）	2.51（1.90，3.32）	0.463	0.90
时间-血糖曲线的AUC≥13〔n（%）〕		59（67.0）	253（78.3）	4.815^b	0.03

项目		无不良妊娠结局组（n=88）	不良妊娠结局组（n=323）	检验统计量值	P值
年龄（±s，岁）		29.7±3.1	30.7±3.6	2.240^a	0.03
妊娠前超重肥胖〔n（%）〕		12（13.6）	107（33.1）	12.770^b	<0.01
妊娠期增重（±s，kg）		13.3±4.4	13.1±5.0	0.478^a	0.63
孕次≥1次〔n（%）〕		25（28.4）	62（19.2）	3.519^b	0.06
产次≥2次〔n（%）〕		44（50.0）	189（58.5）	2.042^b	0.15
妊娠期血糖管理〔n（%）〕				31.140^b	<0.01
	管理并达标	56（63.6）	101（31.3）
	管理未达标	9（10.2）	79（24.4）
	未管理	23（26.2）	143（44.3）
胰岛素使用〔n（%）〕		4（4.5）	16（5.0）	0.025^b	0.87
OGTT〔M（P₂₅，P₇₅），mmol/L〕
	空腹血糖	5.26（5.16，5.43）	5.32（5.2，5.48）	2.579	<0.01
	OGTT 1 h血糖	7.59（6.70，8.40）	8.21（7.19，9.05）	2.848	<0.01
	OGTT 2 h血糖	6.64（5.91，7.39）	7.04（6.31，7.57）	2.243	0.02
HbA_1c≥5.5%〔n（%）〕		3（3.4）	45（13.9）	7.420^b	<0.01
TC（±s，mmol/L）		6.02±1.06	5.93±1.09	0.748^a	0.45
TG（±s，mmol/L）		3.41±1.06	3.79±2.54	1.380^a	0.17
HDL-C（±s，mmol/L）		1.87±0.35	1.80±0.34	1.540^a	0.12
LDL-C（±s，mmol/L）		3.02±0.69	2.95±0.83	0.740^a	0.46
TP（±s，g/L）		64.47±4.72	62.21±6.33	3.117^a	<0.01
ALB（±s）		34.32±2.07	33.11±3.31	3.264^a	<0.01
低蛋白血症〔n（%）〕		13（14.8）	103（31.9）	10.000^b	<0.01
贫血〔n（%）〕		5（5.7）	39（12.1）	2.956^b	0.08
HOMA-IR〔M（P₂₅，P₇₅）〕		2.58（1.86，3.35）	2.51（1.90，3.32）	0.463	0.90
时间-血糖曲线的AUC≥13〔n（%）〕		59（67.0）	253（78.3）	4.815^b	0.03

Adverse Pregnancy Outcomes and Its Associated Factors in Gestational Diabetes Mellitus with Isolated Fasting Hyperglycemia

单纯空腹血糖升高妊娠期糖尿病孕妇不良妊娠结局及其影响因素研究

RichHTML

PDF

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 22

Related Articles 15

Recommended Articles

Metrics

Comments

项目	赋值
年龄	实测值
妊娠前超重肥胖	否=0，是=1
妊娠期血糖管理	管理并达标=0，管理未达标=1，未管理=2
HbA_1c	实测值
低蛋白血症	否=0，是=1
时间-血糖曲线的AUC	实测值

变量		B	SE	Wald χ²值	P值	OR值	95%CI
年龄		0.045	0.039	1.339	0.247	1.05	（0.98，1.14）
妊娠前超重肥胖
	是	1.062	0.353	9.054	0.003	2.89	（1.45，5.78）
妊娠期血糖管理
	管理未达标	1.292	0.406	10.142	0.001	3.64	（1.64，8.06）
	未管理	1.241	0.302	16.900	<0.001	3.46	（1.91，6.25）
HbA_1c		0.868	0.412	4.430	0.035	2.38	（1.06，5.34）
低蛋白血症
	是	0.810	0.343	5.579	0.018	2.25	（1.15，4.41）
时间-血糖曲线的AUC		0.208	0.092	5.090	0.024	1.23	（1.03，1.47）

[1]	ZHANG Peng, LIU Lidi, ZHANG Ying, YANG Ziyu, LIU Changming, TANG Yijun, LIAO Xiaoyang, JIA Yu. Interpretation and Clinical Implications of the 2024 Italian Guidelines for the Management of Adult Individuals with Overweight and Obesity and Metabolic Comorbidities That are Resistant to Behavioral Treatment [J]. Chinese General Practice, 2025, 28(30): 3747-3752.
[2]	QUAN Jialin, ZHU Lin, SU Yu, CHEN Zekai, CHEN Ziqi, ZHANG Zhuofan. Research on the Improvement Effect of Exercise Modes on the Executive Function of Overweight or Obese Children or Adolescents: a Network Meta-analysis [J]. Chinese General Practice, 2025, 28(27): 3422-3431.
[3]	WEI Jiaohua, PENG Huiru, PENG Jianye, TAN Wenting, HUANG Jine, FANG Li. Expression of the Serum MOTS-c and Its Correlation with Atrial Remodeling in Patients with Atrial Fibrillation [J]. Chinese General Practice, 2025, 28(26): 3271-3276.
[4]	CHOU Xintong, PENG Hanyu, MA Hui, ZHANG Zhen, SU Xian, QIU Hongyan. Maternal Preferences in Contraceptive Decision-making: an Analysis of Influencing Factors [J]. Chinese General Practice, 2025, 28(26): 3294-3299.
[5]	HU Jieman, TAN Feixiang, YUAN Anxin, CHEN Shiyu, TANG Chulei, YIN Yueheng, BA Lei, XU Qin. Analysis of the Trajectory of Postoperative Frailty and Influencing Factors in Patients with Colorectal Cancer [J]. Chinese General Practice, 2025, 28(26): 3276-3282.
[6]	YU Zizi, LIU Duli, LI Ximin, RUAN Chunyi, YIN Xiangyang, CAI Le. Analysis of the Prevalence and Self-management of Hypertension and Its Influencing Factors in Rural [J]. Chinese General Practice, 2025, 28(25): 3137-3143.
[7]	FAN Boyang, ZHANG Yu, SUN Wenning, ZHANG Huifang, WANG Yingjie, ZHANG Ao, ZHAO Yang, WANG Haipeng. Study of Behavioral Intention and Influencing Factors of Integrated Medical and Preventive Care Provided by Grassroots Doctors for Patients with Chronic Diseases [J]. Chinese General Practice, 2025, 28(25): 3144-3150.
[8]	WEI Yunhong, YANG Li, WANG Yulu, YE Qiufang, DAI Anni, HE Yan. Study on Cardiopulmonary Function During Different Exercise Stages in Patients with Obesity-related Hypertension [J]. Chinese General Practice, 2025, 28(24): 2972-2978.
[9]	WANG Rupeng, NAN Jing, HU Yiran, YANG Shenghua, JIN Zening. Predictive Value of the Triglyceride-Glucose Body Mass Index for Slow Flow/No-reflow Phenomenon in Patients with Type 2 Diabetes Mellitus and Acute Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention [J]. Chinese General Practice, 2025, 28(24): 2985-2992.
[10]	DING Zijun, ZHOU Nannan, LUO Xing, LUO Jieyu, HAO Wenjuan, ZHANG Chunjiang, JIN Xin, ZHAO Dan. Cognitive Impairment in Patients on Maintenance Hemodialysis and Its Influencing Factors: a Multicenter Cross-sectional Study [J]. Chinese General Practice, 2025, 28(23): 2885-2893.
[11]	WU Yue, WANG Xuetong, KE Bilian. Evaluation of Vision-related Quality of Life in Myopic Macular Degeneration Patients with Low Vision and Associated Factors [J]. Chinese General Practice, 2025, 28(23): 2908-2914.
[12]	WEI Xiaoxia, CHEN Nuo, WANG Juanjuan, ZHU Jingfen. The Effects of Depression and Anxiety on Smoking Behavior among Vocational School Students [J]. Chinese General Practice, 2025, 28(22): 2826-2832.
[13]	ZHAO Xiaoqing, GUO Tongtong, ZHANG Xinyi, LI Linhong, ZHANG Ya, JI Lihong, DONG Zhiwei, GAO Qianqian, CAI Weiqing, ZHENG Wengui, JING Qi. Construction and Validation of a Risk Prediction Model for Cognitive Impairment in Community-dwelling Older Adults [J]. Chinese General Practice, 2025, 28(22): 2776-2783.
[14]	HAO Aihua, ZENG Ziying, JIN Aiqiong, TANG Lingling, ZHENG Zique, MA Jingtai, ZHAO Jianguo, ZENG Weilin, XIAO Jianpeng, NIE Hui, YANG Ying. Analysis of Factors Influencing Avoidable Hospitalization for Elderly Hypertensive Patients [J]. Chinese General Practice, 2025, 28(19): 2370-2375.
[15]	ZHAO Can, SHEN Ying, XI Qian, PENG Houxuan, QIN Jinqiong, WANG Xuan, ZHENG Yanping, QIN Li, ZUO Yanli. The Hospitalization Spending and Associated Factors in Inpatients with Multimorbidity in Township Health Centers in Guangxi [J]. Chinese General Practice, 2025, 28(16): 2039-2049.