Table of Content

15 November 2025, Volume 28 Issue 32

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Standard·Strategy·Guide

Interpretation of Report on Cardiovascular Health and Diseases in China 2024

LIU Mingbo, HE Xinye, YANG Xiaohong, WANG Zengwu

2025, 28(32):  3989-4008.  DOI: 10.12114/j.issn.1007-9572.2025.0199

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Cardiovascular diseases (CVD) and their risk factors are exerting an increasingly significant impact on public health, and the incidence rate of CVD continues to rise. The economic burden brought by CVD to residents and society is increasing, and it has become a major public health problem, and it is urgent to strengthen the government-led CVD prevention and control work. This article provides an interpretation of essentials from the newly published Report on Cardiovascular Health and Diseases in China (2024) , aiming to offer scientific evidence for CVD prevention, treatment, and the formulation of relevant policies.

Original Research·Multimorbidity Section

Influence of Multiple Chronic Conditions on Health Impairment in Middle-aged and Elderly People

SHI Xiaojie, YANG Xiaohua, MA Chunfang, TANG Rong

2025, 28(32):  4009-4014.  DOI: 10.12114/j.issn.1007-9572.2024.0403

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Background

China's population aging intensifies, and the prevalence rate of chronic diseases among middle-aged and old people is rising sharply. The comorbidities of chronic diseases are closely related to the impaired health of middle-aged and elderly people, threatening the health of middle-aged and elderly people. However, at present, there are few relevant studies on the middle-aged and elderly groups in Ningxia.

Objective

To explore the relationship between multiple chronic conditions and health impairment in middle-aged and elderly people in Ningxia.

Methods

From June to August 2022, a multi-stage stratified random sampling method was used to select 2 000 middle-aged and elderly people from 10 districts (counties) in Yinchuan City, Shizuishan City and Guyuan City of Ningxia Hui Autonomous Region for a questionnaire survey. The questionnaire covered three parts: basic information of middle-aged and elderly people, the prevalence of chronic diseases, and the situation of health impairment. The Logit model and propensity score matching (PSM) were used to analyze the impact of chronic disease comorbidity on health impairment among middle-aged and elderly people in Ningxia region.

Results

A total of 1 997 valid questionnaires were collected, with an effective recovery rate of 99.85%. The prevalence of multimorbidity among middle-aged and elderly people in Ningxia was 20.93% (418/1 997) , and the prevalence of health impairment was 12.52% (250/1 997) . There were statistically significant differences in the prevalence of health impairment among middle-aged and elderly people with different genders, ages, marital statuses, educational levels, living alone status, smoking history, weekly exercise frequency, per capita annual household income, and whether they had received economic support from their children (P<0.05) . The Logit model results showed that gender, age, educational level, drinking history, weekly exercise frequency, and multimorbidity were the influencing factors of health impairment among middle-aged and elderly people (P<0.05) . Compared with non-multimorbid individuals, the probability of health impairment among multimorbid middle-aged and elderly people was 6.6% higher. After controlling for other factors that could affect the health impairment of middle-aged and elderly people, the average treatment effect of multimorbidity on health impairment was 0.246.

Conclusion

The coexistence of chronic diseases among middle-aged and elderly people increases the risk of health impairment. To reduce the risk of health impairment among middle-aged and elderly people, efforts should be made to enhance the prevention, treatment and publicity of chronic disease coexistence, and raise their awareness of self-management of chronic disease coexistence.

Treatment Burden of Disabled Persons with Multimorbidity in the Community and Its Influencing Factors

YAN Ming, DONG Jiahui, LU Yiting, ZHAO Yang, FANG Lizheng, XU Zhijie

2025, 28(32):  4015-4023.  DOI: 10.12114/j.issn.1007-9572.2024.0334

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Background

The prevalence of multimorbidity is high among disabled persons, and the problem of their treatment burden is particularly severe. However, the treatment burden for disabled persons with multimorbidity in the community and its influencing factors have not been well studied.

Objective

This study aimed to elucidate the current situation and factors influencing the treatment burden of multimorbidity among disabled persons living in the community. The findings were intended to inform the formulation of policies for managing community-based multimorbidity and to enhance the quality of healthcare services.

Methods

This study was conducted in a community in Hangzhou from November 2023 to January 2024, a random sampling method was employed to select disabled individuals with chronic comorbidities participating in community rehabilitation programmes within a specific neighbourhood as survey subjects. Relevant information about disabled persons was collected through home visits using tools such as the General Information Questionnaire, Objective and Subjective Social Isolation Scale, Center for Epidemiologic Studies Depression Scale (CES-D) , European Quality of Life Five Dimension Five Level Scale Questionnaire (EQ-5D-5L) , and Multimorbidity Treatment Burden Questionnaire (MTBQ) . The analysis of the collected data was performed using both descriptive statistics and ordinal logistic regression to delineate the current status of treatment burden and to identify its significant influencing factors.

Results

A total of 235 disabled persons were surveyed, with 220 valid questionnaires recovered, yielding a response rate of 93.6%. The mean age of the disabled persons was (71.1±10.2) years, with a roughly equal gender distribution, including 109 females (49.5%) . Six types of disabilities were included, among which physical disability accounted for the largest proportion (164 cases, 74.5%) ; grade 3 disability was the most common (100 cases, 45.5%) . Sixty-eight cases (30.9%) were in the abnormal BMI range group, and 120 cases (54.5%) took ≥3 types of medications. Regarding the MWI, 83 cases (37.7%) scored over 3-6 points (excluding 3 points) , and 78 cases (35.5%) scored >6 points. A total of 41 types of chronic diseases were included, with hypertension having the highest prevalence (118 cases, 53.6%) . The median Barthel Index of disabled persons was 75 (55, 90) , with 76.3% of disabled persons experiencing moderate to severe disability. The mean score of depressive symptoms was (15.8±8.8) , and 53.1% had depressive tendencies or depression. Seventy-two cases (32.7%) had objective social isolation (score of 3-5 points) , and 100 cases (45.5%) had subjective social isolation (score of 19-27 points) . The median health utility value for quality of life was 0.48 (0.23, 0.74) , and 125 cases (56.8%) had self-rated health status≤50 points. Seventy-five cases (34.1%) had moderate multimorbidity treatment burden (10-<22 points) , and 93 cases (42.3%) had high multimorbidity treatment burden (≥22 points) . Ordinal Logistic regression analysis showed that Barthel index (OR=0.957, 95%CI=0.936-0.978) , taking 3 types of medications (OR=2.517, 95%CI=1.454-4.362) , higher MWI (>3-6 points: OR=3.908, 95%CI=1.931-7.909; >6 points: OR=2.954, 95%CI=1.468-5.948) , subjective social isolation≥20 points (OR=1.906, 95%CI=1.112-3.271) , objective social isolation 3-5 points (OR=1.863, 95%CI=1.009-3.435) , presence of depressive symptoms (OR=4.711, 95%CI=2.625-8.457) , and self-rated health status ≤50 points (OR=4.609, 95%CI=2.524-8.423) were influencing factors for the severity of multimorbidity treatment burden of chronic diseases in disabled persons (P<0.05) .

Conclusion

The majority of disabled persons within this community bear a high level of treatment burden due to multimorbidity. Policies catering to the management of chronic illnesses and the provision of healthcare services for this demographic ought to take into account the factors influencing treatment burden. Particularly, there is a need for improvement in daily living capabilities and mental health status, along with addressing polypharmacy and social isolation issues.

Research on Influencing Factors of Disability in the Elderly with Chronic Disease Comorbidities

CHEN Yingying, WEN Yong, SHU Xingyu

2025, 28(32):  4024-4030.  DOI: 10.12114/j.issn.1007-9572.2024.0611

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Background

With the deepening of population aging, the rising prevalence of multimorbidity and disability poses a significant threat to the quality of life among middle-aged and older adults. Existing research, both domestic and international, rarely explores influencing factors of disability specifically in older adults with multimorbidity and seldom analyzes the impact of variable interactions on disability.

Objective

This study aimed to investigate factors influencing disability status in older adults with multimorbidity, reveal the contribution of various variables and their intrinsic relationships to disability, and provide empirical support for developing targeted prevention and control strategies.

Methods

From November 2023 to December 2024, based on the health ecological model theory and data from the China Health and Retirement Longitudinal Study (CHARLS 2020) , an indicator system of influencing factors was constructed. Kruskal-Wallis tests, multinomial Logistic regression, and Decision tree models were employed to analyze the impact of variables on disability status.

Results

The study included 9 124 middle-aged and elderly individuals with chronic disease comorbidity. Among them, 5 355 (58.7%) had no impairment in physical functioning, 3 442 (37.7%) had mild impairment, and 327 (3.6%) had moderate or greater impairment. Multinomial Logistic regression analysis showed age <80 years, male, primary education, mild/moderate/severe depression, self-rated health as very poor/poor/fair, visual impairment, no history of falls, no history of hip fractures, fewer sites of bodily pain, current or former smoker, alcohol consumption, no exercise or low exercise intensity, minimal night-time sleep, and low/moderate personal annual income are factors associated with preserved physical functioning in older adults with chronic disease comorbidity (P<0.05) ; Self-rated health as very poor, abnormal vision, no history of falls, no history of hip fractures, lack of exercise, and non-participation in social activities were factors associated with moderate or greater impairment of physical functioning in older adults with chronic disease comorbidity (P<0.05) . The decision tree model identified self-rated health as the primary influencing factor for disability status, followed by depression, number of pain sites, physical activity level, age, and history of falls (P<0.05) . Model comparison showed that the area under the curve (AUC) for multinomial Logistic regression was higher than that for the Decision tree model across all disability levels: no impairment [0.808 (95%CI=0.800-0.817) vs. 0.768 (95%CI=0.759-0.778) ], mild impairment [0.773 (95%CI=0.764-0.783) vs. 0.734 (95%CI=0.724-0.745) ], and moderate-to-severe impairment [0.891 (95%CI=0.875-0.907) vs. 0.833 (95%CI=0.812-0.854) ].

Conclusion

Age, gender, education level, depression, self-rated health, vision, fall history, hip fracture history, number of bodily pain sites, smoking status, alcohol consumption, physical activity level, nighttime sleep duration, social participation, and personal annual income significantly influence disability status in older adults with multimorbidity. Relevant authorities should implement effective preventive measures across these dimensions to reduce the disability rate. While the logistic regression model demonstrates slightly better predictive performance, both models offer distinct advantages: logistic regression clearly demonstrates the dependence between independent and dependent variables, while the decision tree elucidates the impact of variable interactions. Both models can be utilized for supplementary analysis in future research.

Comparison of Prevalence and Comorbidity of Hypertension, Diabetes and Dyslipidemia in Xinjiang Residents

LIU Chunyan, DENG Zhaohui, SONG Yingbo, YANG Fang, SHI Qian, LI Yongxin, ZHANG Xin

2025, 28(32):  4031-4037.  DOI: 10.12114/j.issn.1007-9572.2024.0620

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Background

Hypertension, diabetes, and dyslipidemia-commonly referred to as the "three highs" —are significant risk factors for cardiovascular and cerebrovascular diseases. Co-managing these conditions is crucial for reducing the morbidity and mortality associated with cardiovascular and cerebrovascular diseases; however, there is a notable lack of relevant research on the comorbidities of the "three highs" in Xinjiang.

Objective

To analyze the comparison of prevalence and comorbidity of hypertension, diabetes and dyslipidemia in Xinjiang residents, thereby providing data support for the co-management of the "three highs" within the local population.

Methods

Data were collected from the baseline of the Chronic Disease Prevention and Control Project of the Xinjiang Production and Construction Corps. A total of 5 673 residents aged 18 years and older participated in a questionnaire survey, physical examination, and laboratory examination conducted in 2022. In this study, the survey data of 4 990 eligible residents (87.96%) were included. The prevalence of the "three highs" (hypertension, hyperglycemia, and hyperlipidemia) and the comorbidity rate were analyzed. Multivariate Logistic regression analysis was employed to identify the risk factors associated with comorbidity of the "three highs" .

Results

A total of 4 990 cases were included in the study, comprising 2 043 (40.94%) Han individuals, 2 666 (53.43%) Uygur individuals, and 281 (5.63%) from other ethnic groups. The standardized prevalence rates for hypertension, diabetes, and dyslipidemia were 32.66%, 14.03%, and 39.20%, respectively. The standardized prevalence of comorbidities was as follows: hypertension with diabetes (8.83%) , hypertension with dyslipidemia (15.31%) , and diabetes with dyslipidemia (8.05%) . The standardized comorbidity rate of the "three highs" was 5.36%. The rates of comorbidity for two and three diseases increased with age and body mass index (BMI) while decreasing with higher levels of education (P<0.05) . The dyslipidemia of the residents primarily characterized by elevated triglyceride levels (TG) (16.47%, 822/4 990) and low high-density lipoprotein cholesterol (HDL-C) levels (15.29%, 763/4 990) , with the prevalence of high total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) being significantly lower in men than in women (P<0.05) . Results from multivariate Logistic regression analysis indicated that age, BMI grade, and educational level were influencing factors for the comorbidity of "three highs" (P<0.05) .

Conclusion

The prevention and control of comorbidities associated with the "three highs" in Xinjiang remains challenging. Advanced age, overweight/obesity, and low educational attainment were risk factors for the comorbidity of the "three highs" . The joint management of the "three highs" and the comprehensive management of risk factors are crucial for the prevention and control of chronic diseases in the region.

Original Research

Efficacy of Five-body Balance Exercise on Obesity-related Hypertension Based on the Rehabilitation Model of "Hospital-Gym-Community" : a Randomized Controlled Trial

YANG Yingtian, LYU Qianyu, WU Qian, HOU Xinzheng, SONG Jianjun, YE Xuejiao, YANG Chenyan, WANG Shihan

2025, 28(32):  4038-4046.  DOI: 10.12114/j.issn.1007-9572.2024.0421

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Background

Obesity-related hypertension (ORH) , as a long-term persistent chronic disease, is growing in prevalence in China. Exercise is an important means of prevention and treatment for ORH, but due to the limitations of space, distance and cost in exercise rehabilitation, exercise completion and compliance are mostly difficult to ensure, and the health benefits of exercise are greatly reduced. Therefore, it is important to explore appropriate exercise prescription and management models.

Objective

To evaluate the clinical efficacy and safety of five-body balance exercise based on the "hospital-gym-community" model for patients with ORH.

Methods

This was a prospective randomised controlled study. 84 ORH patients recruited at Guang'anmen Hospital, China Academy of Traditional Chinese Medicine from June 2022 to December 2023 were selected and randomly divided into the experimental group (n=42) and the control group (n=42) by using the SPSS 26.0 online random number generator. Subjects in both groups received the same lifestyle intervention. The control group was provided with moderate-intensity aerobic exercise, and the experimental group was provided with the five-body balance exercise training based on the "hospital-gym-community" rehabilitation model for a period of 6 months. Systolic blood pressure (SBP) , diastolic blood pressure (DBP) , mean arterial pressure (MAP) , waist circumference (WC) , body weight (BW) , BMI, hip circumference (HC) , waist-to-hip ratio (WHR) , waist-to-height ratio (WHtR) , fasting blood glucose (GLU) , total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , very low-density lipoprotein cholesterol (VLDL-C) , triglycerides (TG) , serum ceramides (Cer) , Self-rating Anxiety Scale (SAS) , Self-rating Depression Scale (SDS) , Short-form Health Survey-36 (SF-36) , and Pittsburgh Sleep Quality Index (PSQI) were observed before and after the intervention in the two groups of subjects. The major adverse cardiovascular events (MACE) and exercise injuries that occurred during the intervention were also recorded.

Results

Eventually 37 subjects in the experimental group and 36 subjects in the control group completed the trial. After 6 months of rehabilitation, SBP, DBP, MAP, WC, BW, BMI, HC, WHR, WHtR, LDL-C, Cer, SAS, SDS, and PSQI in the experimental group were lower than those in the control group (P<0.05) , SF-36 was higher than that in the control group (P<0.05) , and there was no statistically significant difference between GLU, TC, VLDL-C, TG in the experimental group and the control group (P>0.05) . After intervention, SBP, DBP, MAP, WC, BW, BMI, HC, WHR, WHtR, GLU, LDL-C, VLDL-C, TG, Cer, SAS, SDS, and PSQI were lower than before the intervention in the experimental group (P<0.05) , SF-36 was higher compared to the pre-intervention in the experimental group (P<0.05) , and the difference in TC before and after the intervention was not statistically significant (P>0.05) . There were no MACE or exercise injuries in both groups.

Conclusion

The five-body balance exercise based on the "hospital-gym-community" rehabilitation model can promote the blood pressure and morphological indexes of patients with ORH, improve the quality of life, and its efficacy is better than the conventional aerobic exercise, with good safety. It also reduces serum Cer levels, reflecting to some extent the potentially beneficial effects of the exercise programme in reducing cardiovascular risk.

Association between Relative Fat Mass and Cardiovascular Disease in Middle-aged and Elderly Population: a Cross-sectional and Longitudinal Study Based on CHARLS

CHEN Huilong, LIAO Yunchu, LIU Yuwei, KONG Zhenghui, HUANG Xinghui, XU Jiahui, QI Na, WANG Yuanping, LIANG Wenjian

2025, 28(32):  4047-4054.  DOI: 10.12114/j.issn.1007-9572.2025.0070

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Background

In recent years, an association has been found between the relative fat mass (RFM) and cardiovascular disease (CVD) . However, nationwide cohort studies on RFM and the risk of CVD in the Chinese population are scant.

Objective

To analyze the association between RFM and the risk of CVD in middle-aged and elderly Chinese population (≥ 45 years old) using the data of China Health and Retirement Longitudinal Study (CHARLS) .

Methods

This was a cross-sectional, longitudinal study using data available from CHARLS 2011-2018. In the cross-sectional study, 12 867 middle-aged and elderly individuals aged 45 years or older were included. A total of 11 171 middle-aged and elderly individuals who were not diagnosed with CVD in the cross-sectional study in 2011 were included in the longitudinal study and followed up until 2018. Multivariate Logistic regression and restricted cubic splines (RCS) were used to analyze the cross-sectional association between RFM and CVD. Kaplan-Meier curves, multivariate Cox proportional hazards regression models, and RCS were used to analyze the longitudinal association between different baseline RFM levels in 2011 and the risk of incident CVD. Subgroup analysis was used to investigate the association between RFM and risk of CVD across subgroups, and sensitivity analysis was used to verify the stability of the model.

Results

Multivariate Logistic regression analysis showed that RFM was a risk factor for CVD (OR=1.03, 95%CI=1.02-1.04, P<0.05) . Compared with the Q1 group, Q2 group (OR=1.26, 95%CI=1.07-1.49) , Q3 group (OR=1.78, 95%CI=1.47-2.16) and Q4 group (OR=1.81, 95%CI=1.49-2.19) had a significantly higher risk of CVD (P<0.05) . During the follow-up period, a total of 1 655 (14.9%) individuals were diagnosed with CVD for the first time. Multivariate Cox regression analysis showed that RFM was a risk factor for CVD (HR=1.03, 95%CI=1.02-1.04, P<0.05) . Compared with Q1' group, the Q2' group (HR=1.31, 95%CI=1.12-1.52) , the Q3' group (HR=1.34, 95%CI=1.12-1.61) and the Q4' group (HR=1.79, 95%CI=1.49-2.14) had a significantly higher risk of new onset of CVD. Subgroup analysis showed that RFM had an interaction with marital status (P=0.022) . The results of sensitivity analysis were consistent with the trends of the above results.

Conclusion

Higher levels of RFM are associated with an increased risk of CVD, suggesting that RFM may be of potential value in CVD prevention and treatment.

Research on the Screening Effect and Strategy of Fasting Plasma Glucose and Glycosylated Hemoglobin for Type 2 Diabetes and Prediabetes Mellitus

ZHANG Lei, ZHANG Huanyu, CHEN Kaiyue, LI Xiaohong, GUO Ying

2025, 28(32):  4055-4061.  DOI: 10.12114/j.issn.1007-9572.2024.0704

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Background

Currently, hospital physical examination centers or communities mainly use fasting plasma glucose and glycosylated hemoglobin as indicators to evaluate blood glucose levels. Previous studies explored the diagnostic value of detecting these two indicators separately or in combination, but these studies often only focus on the accuracy of the indicators and ignore their practical value. Based on the real situation, the study constructs a screening strategy for type 2 diabetes and prediabetes mellitus to detect and manage the population with abnormal glucose metabolism at an early stage.

Objective

Use fasting blood glucose and glycosylated hemoglobin indicators to form screening strategies and screening thresholds for type 2 diabetes and prediabetes mellitus in the physical examination population, so as to improve the detection rate of diabetes and prediabetes in the population.

Methods

527 subjects who underwent physical examinations and two-hour postprandial blood glucose testing at Wusong Central Hospital of Baoshan District of Shanghai from September to November 2023. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, screening cost, and cost-effectiveness of different screening thresholds in the two screening processes of fasting plasma glucose and fasting plasma glucose combined with glycosylated hemoglobin were compared.

Results

Among the 527 subjects, 74 individuals (14.0%) were diagnosed with type 2 diabetes mellitus, 141 individuals (26.8%) were identified as having prediabetes mellitus, and 312 individuals (59.2%) exhibited normal blood glucose levels. In the screening strategy using fasting plasma glucose alone, the maximum Youden index of 0.461 corresponded to a fasting plasma glucose screening threshold of 5.4 mmol/L, with a sensitivity of 54.42%, a specificity of 91.67%, and a cost-effectiveness of 233.97 yuan per person. When the screening threshold for fasting plasma glucose was 5.9 mmol/L, the sensitivity was 33.02%, the specificity wasi 99.68%, Youden index was 0.327, and the cost-effectiveness was 212.55 yuan per person. In the screening strategy combining fasting plasma glucose and glycosylated hemoglobin, the maximum Youden index of 0.433 corresponded to a glycosylated hemoglobin screening threshold of 6.1%, with a sensitivity of 51.63%, a specificity of 91.67%, and a cost-effectiveness of 480.23 yuan per person; When the screening threshold for glycosylated hemoglobin for abnormal glucose metabolism was 5.9%, the sensitivity was 73.95%, the specificity was 65.71%, the Youden index was 0.370, and the cost-effectiveness was 475.62 yuan per person.

Conclusion

When using fasting plasma glucose as a single indicator to screen individuals with abnormal glucose metabolism, lowering the screening threshold for fasting plasma glucose has good screening effectiveness and cost-effectiveness. Glycosylated hemoglobin can serve as a good supplementary screening tool. Supplementing the use of glycosylated hemoglobin screening for individuals with normal fasting plasma glucose can significantly detect individuals with abnormal glucose metabolism status, thereby improving their compliance with glucose tolerance tests and providing more possibilities for optimizing screening strategies.

The Predictive Value of Combined Detection of Brachial-ankle Pulse Wave Velocity, Serum Total Cholesterol and N-terminal Pro-B-type Natriuretic Peptide for Coronary Heart Disease in Patients with Essential Hypertension

DAI Tiangu, HE Qing, GAO Xuefei, ZHANG Gaoyu, FAN Jiarong, WANG Zihan, XIAO Xiang, LI Lin

2025, 28(32):  4061-4066.  DOI: 10.12114/j.issn.1007-9572.2025.0033

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Background

Primary hypertension is a critical risk factor for coronary heart disease (CHD) , with approximately 20% of patients comorbid with CHD and a doubled risk of cardiovascular events. Traditional prediction models relying on single indicators exhibit limitations.

Objective

To evaluate the predictive power of combined brachial-ankle pulse wave velocity (baPWV) , serum total cholesterol (TC) , and N-terminal pro-B-type natriuretic peptide (NT-proBNP) detection for CHD risk in patients with primary hypertension.

Methods

A total of 310 patients with primary hypertension admitted to the Department of Integrative Cardiology of China-Japan Friendship Hospital from September 2020 to January 2022 were included. Based on CHD comorbidity, patients were divided into a hypertension-only group (n=116) and a hypertension-CHD group (n=194) . General clinical data, baPWV, serum TC, and NT-proBNP levels were collected. Binary Logistic regression analysis identified independent risk factors for CHD, and receiver operating characteristic (ROC) curves was used to assess the predictive efficacy of single and combined indicators.

Results

The hypertension-CHD group exhibited significantly higher baPWV, TC, and NT-proBNP levels compared to the hypertension-only group (P<0.05) . Binary Logistic regression analysis revealed that baPWV (OR=1.016, 95%CI=1.001-1.031) , TC (OR=2.723, 95%CI=1.648-4.498) , and NT-proBNP (OR=1.006, 95%CI=1.001-1.010) were independent risk factors for CHD (P<0.05) . ROC analysis showed that the areas under the curve (AUCs) for baPWV, TC, and NT-proBNP in predicting CHD were 0.647, 0.760, and 0.693, respectively (P<0.05) . Combined detection achieved the highest AUC of 0.825 (P<0.05) .

Conclusion

The multidimensional model integrating baPWV (vascular elasticity) , TC (lipid metabolism) , and NT-proBNP (myocardial injury) significantly improves CHD risk identification in hypertensive patients (AUC>0.8) . This noninvasive combined detection strategy serves as a complementary risk stratification tool to traditional coronary angiography, offering evidence-based insights for early intervention.

Comparative Study on the Potential of Non-invasive Models in Evaluating Liver Fibrosis in Patients with Chronic Hepatitis B Combined with Non-alcoholic Fatty Liver Disease

YANG Bingqing, YANG Tianyuan, HOU Chenxue, WANG Qi

2025, 28(32):  4067-4074.  DOI: 10.12114/j.issn.1007-9572.2024.0560

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Background

Liver fibrosis is a major risk factor for overall and liver-specific mortality of chronic hepatitis B (CHB) combined with non-alcoholic fatty liver disease (NAFLD) . Combination of type 2 diabetes mellitus (T2DM) or hyperuricemia (HUA) accelerates the progression of liver fibrosis in CHB patients combined with NAFLD. Therefore, accurately assessing the stage of liver fibrosis using non-invasive diagnostic models is crucial for effective treatment and control of CHB combined with NAFLD disease progression.

Objective

To compare the efficacy of five non-invasive diagnostic models[fibrosis-4 (FIB-4) , aspartate aminotransferase-to-platelet ratio index (APRI) , aspartate-to-alanine aminotransferase ratio (AAR) , S index, and gamma-glutamyl transpeptidase to platelet ratio index (GPRI) ] in diagnosing advanced liver fibrosis in CHB patients combined with NAFLD and T2DM/HUA, and to assess their feasibility for grassroots implementation.

Methods

One hundred and ninety-five CHB patients combined with NAFLD diagnosed by clinical evidence and liver pathology admitted in the Beijing Ditan Hospital, Capital Medical University from 2008 to 2021 were retrospectively recruited. They were divided into CHB&NAFLD (n=46) , CHB&NAFLD&T2DM (n=80) , and CHB&NAFLD&HUA groups (n=69) based on the comorbidities of T2DM or HUA. Using pathological results as the gold standard for diagnosis of liver fibrosis, DeLong's test was used to compare the area under the receiver operating characteristic curve (AUC) and diagnostic performance of five non-invasive indicators for the assessment of liver fibrosis progression in the three groups. Additionally, clinical utility of each model was evaluated using decision curve analysis (DCA) .

Results

In the CHB&NAFLD group, the AUC of FIB-4 in diagnosing liver fibrosis was 0.740, and that of AAR was 0.468, with an AUC difference of 0.272. In the CHB&NAFLD&T2DM group, FIB-4 also exhibited the highest diagnostic performance (AUC=0.677) , while the S index had the lowest AUC (0.588) . In the CHB&NAFLD&HUA group, FIB-4 maintained the highest diagnostic performance (AUC=0.753) , while AAR had the lowest AUC (0.609) . Although FIB-4 performed the best in all three groups, its diagnostic performance was significantly lower in the CHB&NAFLD&T2DM group compared to the CHB&NAFLD group (P<0.001) and CHB&NAFLD&HUA group (P<0.001) . DCA showed that FIB-4 had a slightly higher clinical net benefit in the CHB&NAFLD and CHB&NAFLD&HUA groups. The optimal cut off value for FIB-4 in the CHB&NAFLD&T2DM group was 1.425, which was higher than that in the CHB&NAFLD group (cut off=1.117) and the CHB&NAFLD&HUA group (cut off=1.305) .

Conclusion

The FIB-4 index is practical for assessing liver fibrosis in CHB patients combined with NAFLD and T2DM/HUA at the grassroots level. However, FIB-4 has a lower diagnostic efficacy and higher cutoff value in assessing liver fibrosis in CHB&NAFLD patients combined with T2DM than CHB&NAFLD and CHB&NAFLD&HUA patients. These results suggest that it is necessary to evaluate CHB&NAFLD patients with T2DM in combination with their specific characteristics and optimize the diagnostic strategy to improve accuracy.

Diagnostic Value of the Triglyceride Glucose-body Mass Index for Type 2 Diabetes Mellitus Combined with Metabolic Dysfunction-associated Fatty Liver Disease

YANG Jian, WU Chuan'an, ZHOU Hairong, TIAN Feng, CHI Chunhua

2025, 28(32):  4075-4081.  DOI: 10.12114/j.issn.1007-9572.2024.0705

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Background

The global prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) is rapidly increasing, and its risk significantly inflates when being combined with type 2 diabetes mellitus (T2DM) . The triglyceride glucose-body mass index (TyG-BMI) , as a noninvasive marker of insulin resistance, has demonstrated predictive value for MAFLD in non-diabetic populations, yet its diagnostic efficacy in T2DM patients remains unclear.

Objective

To evaluate the diagnostic utility of TyG-BMI in MAFLD combined with T2DM.

Methods

From 2022 to 2023, a total of 1 347 T2DM patients aged 18 years or above were recruited from the Health Management Center of the People's Hospital of Longhua, Shenzhen. Based on whether combined with MAFLD, patients were divided into two groups: the T2DM-only group (n=601) and the T2DM combined with MAFLD group (n=746) . Clinical data were compared between the two groups. Logistic regression analysis was performed to evaluate the correlations of triglyceride glucose index (TyG) , body mass index (BMI) , and TyG-BMI with T2DM combined with MAFLD. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of TyG, BMI, serum uric acid to creatinine ratio (SUA/Scr) , and TyG-BMI in T2DM combined with MAFLD.

Results

Compared with the T2DM-only group, patients in the T2DM combined with MAFLD group showed significantly higher proportion of men, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , total cholesterol (TC) , triglycerides (TG) , aspartate aminotransferase (AST) , alanine aminotransferase (ALT) , uric acid (UA) , fasting plasma glucose (FPG) , glycated hemoglobin (HbA_1c) , BMI, TyG, SUA/Scr, and TyG-BMI levels (P<0.05) , while significantly lower level of blood urea nitrogen (BUN) , high-density lipoprotein cholesterol (HDL-C) and age (P<0.05) . After adjusting for confounders, multivariate Logistic regression analysis showed that TyG (OR=2.989, 95%CI=2.278-3.922, P<0.001) , BMI (OR=1.395, 95%CI=1.324-1.470, P<0.001) , and TyG-BMI (OR=1.039, 95%CI=1.034-1.044, P<0.001) were influencing factors for T2DM combined with MAFLD. ROC curve analysis demonstrated that the sensitivity of TyG, BMI, SUA/Scr, and TyG-BMI in predicting T2DM complicated with MAFLD was 74.7%, 73.7%, 62.0%, and 85.8%, respectively; the specificity was 60.7%, 71.3%, 55.0%, and 66.3%, respectively; and the area under the ROC (AUC) was 0.739, 0.793, 0.608, and 0.833, respectively. The results of Delong test indicated that the AUC of TyG-BMI for T2DM complicated with MAFLD was significantly larger than that of BMI, TyG, and SUA/Scr (Z=8.224, 12.501, and 5.632, respectively; P<0.001) .

Conclusion

TyG, BMI, and TyG-BMI all demonstrate diagnostic value in T2DM complicated with MAFLD. However, TyG-BMI exhibits superior diagnostic value than TyG, BMI, and SUA/Scr.

Pregnant and Postpartum Women's Intention to Use Traditional Chinese Medicine and Its Influencing Factors

LI Zanmei, LI Jiao, YANG Lin, MA Liangkun, XUAN Lei, YAO Weiwei

2025, 28(32):  4082-4088.  DOI: 10.12114/j.issn.1007-9572.2024.0615

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Background

Traditional Chinese medicine (TCM) has a profound theoretical basis and extensive practical application in maternal and child health. China has been actively promoting TCM integration in this field. However, insufficient perinatal TCM knowledge and safety concerns among pregnant and postpartum women pose challenges to its development. Research on TCM utilization behaviors is essential to improve service uptake in this population.

Objective

To investigate the TCM utilization patterns and intention among perinatal women, and identify influencing factors.

Methods

A cross-sectional study was conducted among 264 perinatal women receiving care at maternal and child health institutions across multiple regions of China from June to October 2023. An extended Theory of Planned Behavior (TPB) questionnaire assessed four TPB constructs (attitude, subjective norms, perceived behavioral control, intention) and past TCM use. Data were analyzed using SPSS 20.0 and AMOS 26.0, with structural equation modeling (SEM) to examine path relationships.

Results

All 264 questionnaires were valid (100% response rate) . 99 (37.5%) pregnant or breastfeeding women reported having used TCM. Multivariate Logistic regression analysis indicated that the stage of pregnancy and childbirth (OR=0.519, 95%CI=0.386-0.697) and previous history of using TCM (OR=9.399, 95%CI=4.500-19.633) were influencing factors for the use of TCM by pregnant and postpartum women (P<0.05) . Participants demonstrated relatively positive attitude (5.49±1.13) , strong usage intention (4.95±1.04) , high perceived control (5.22±1.12) , high subject norms (4.99±1.12) , and satisfaction with prior TCM experiences (4.90±1.16) . SEM indicated all TPB constructs and past experiences significantly predicted intention to use TCM (P<0.001) , with subjective norms exhibiting the strongest effect (β=0.435) .

Conclusion

Low TCM utilization rates and regional disparities exist among perinatal women, with intention heavily influenced by significant others' opinions and prior TCM experiences. It is crucial to implement tailored interventions, including region-specific TCM service reforms, enhance focus on subjective norms in perinatal care, and life cycle-oriented TCM service systems, then optimize TCM utilization and advance its role in maternal and child health.

Original Research·Clinical Tools and Methods

Collection and Determination of Clinical Questions and Outcome Indicators Based on the Guidelines for Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Hemorrhoids (2025 Edition)

ZHI Congcong, CHENG Yicheng, HUANG Zichen, WANG Xiaolong, LI Xue, ZHENG Lihua

2025, 28(32):  4089-4094.  DOI: 10.12114/j.issn.1007-9572.2025.0058

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Background

Hemorrhoids are the most common diseases in the anorectal department. Guidelines for Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Hemorrhoids (2025 Edition) is of great significance to standardize the integrated diagnosis and treatment of hemorrhoids with traditional Chinese and western medicine.

Objective

To elaborate in detail on the process of screening core clinical questions and outcome indicators for the Guidelines for Integrated Traditional Chinese and Western Medicine Diagnosis and Treatment of Hemorrhoids (2025 Edition) .

Methods

A preliminary list of questions was formed through literature analysis, expert interviews, and clinical research. Two rounds of expert consultation were conducted using the Delphi method. Data analysis was performed using SPSS Statistics 26.0 and Excel 2021. Positive coefficients, mean values, full score rates, coefficient of variation, and Cronbach's αvalues were calculated. Inclusion criteria were: clinical issue mean score ≥3 points, outcome indicator mean score≥7 points, full score rate ≥50%, and coefficient of variation <30%. Quality control standards were: expert positive coefficient≥75%, Kendall's harmony coefficient >0.7, and Cronbach's α coefficient≥0.7 as the quality control standard for the Delphi questionnaire.

Results

After preliminary investigation, 27 clinical issues (9 basic issues and 18 PICO-based clinical issues) and 9 outcome indicators were formulated. After two rounds of Delphi method surveys among 34 experts in related fields, 28 clinical issues (9 basic issues and 19 PICO-based clinical issues) and 9 key outcome indicators were formed. The positive coefficients of the two rounds of questionnaires were 85.3% and 97.0%, respectively. The Kendall's harmony coefficients were 0.837 and 0.826, respectively. The Cronbach's α coefficients of each item of clinical issues and outcome indicators were 0.929, 0.866, 0.923, and 0.803, respectively. This indicated that experts had high attention to this study, small differences, high coordination, good questionnaire reliability, and high result reliability. Finally, after discussion among the experts in the research group, 28 clinical issues (9 basic issues and 19 PICO-based clinical issues) were determined to be included in the guideline. The clinical issues cover the characteristics of traditional Chinese medicine in hemorrhoids, preoperative assessment, integrated diagnosis and treatment methods of Western medicine and traditional Chinese medicine, and perioperative management, etc.

Conclusion

The system of clinical questions and outcome indicators established based on multi-dimensional research and the Delphi method has a complete scientific framework, which can provide references for the formulation of relevant evidence-based guidelines for traditional Chinese medicine.

Defining Clinical Queries and Construction of Outcome Indexes in Guidelines on the Diagnosis and Treatment of Anal Fistula by Integrated Traditional Chinese and Western Medicine

HUANG Zichen, XIA Zhongyuan, ZHI Congcong, CHEN Ying, LIU Ningyuan, LIU Dianlong, ZHENG Lihua

2025, 28(32):  4095-4101.  DOI: 10.12114/j.issn.1007-9572.2025.0005

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Background

Guidelines for the Diagnosis and Treatment of Anal Fistula with Integrated Traditional Chinese and Western Medicine is of great significance to complete industry guidelines and standards for the diagnosis and treatment of anal fistula, in which the construction of clinical problems and outcome indicators is the key point to determine the quality of the guidelines.

Objective

To elaborate in detail on the formation process of clinical questions and outcome indicators in the Guidelines for the Diagnosis and Treatment of Anal Fistula with Integrated Chinese and Western Medicine.

Methods

First, through literature research, expert interviews and extensive clinical research, preliminary sorting out clinical problems and outcome indicators. Then, on this basis, the Delphi method expert questionnaire was designed and two rounds of expert surveys were carried out. Excel 2021 and SPSS 26.0 software were used to statistically process the questionnaire results, and the expert positive coefficient, mean, full score ratio and coefficient of variation of each clinical problem and outcome index were calculated for importance evaluation. Entries with average score ≥3 for clinical problems, average score ≥7 for outcome indicators, full score ratio ≥50%, and coefficient of variation <30% were included in the guidelines. At the same time, the expert positive coefficient ≥75%, harmony coefficient >0.7, Cronbach's α coefficients ≥0.7 were used for the quality control of Delphi questionnaire.

Results

After preliminary investigation, 26 clinical questions (7 basic questions and 19 PICO clinical questions) and 9 outcome indicators were formulated. After two rounds of Delphi method survey of 34 experts in related fields, 24 clinical questions (7 basic questions and 17 PICO clinical questions) and 8 key outcome indicators were formed. The positive coefficients of experts in the two rounds of questionnaires were 100.0% and 91.2%, the Kendall harmony coefficients were 0.722 and 0.852, and the Cronbach's α coefficients of clinical questions and outcome indicators were 0.919, 0.809 and 0.935, 0.746, respectively, indicating that experts paid high attention to this study, small disagreement, high degree of coordination, good questionnaire reliability and high reliability of results. Finally, after discussion among experts in the study group, 24 clinical questions (7 basic questions and 17 PICO clinical questions) were identified as included in the guidelines to form recommendations.

Conclusion

Through literature research, expert interviews, extensive clinical research and expert investigation of Delphi method, the clinical problems and outcome indicators of the Guidelines for the Diagnosis and Treatment of Anal Fistula with Integrated Chinese and Western Medicine were determined, and also provided a methodological reference for the construction of the core clinical problems and outcome indicators of the guidelines in the anorectal field, and had certain reference significance for the formulation of evidence-based guidelines for traditional Chinese medicine.

Review & Perspectives

Advances in Dietary Restriction on the Regulation of Organismal Immune Function

GAO Jiaxin, ZHOU Ruihan, WANG Fangfang, PANG Rizhao, ZHANG Anren

2025, 28(32):  4102-4109.  DOI: 10.12114/j.issn.1007-9572.2023.0659

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Nutritional status may influence the immune response, and dietary restriction (DR) , as an important dietary intervention, has been shown to potentially play an important regulatory role in the activation and effector functioning of immune cells and is involved in the progression of different diseases. Therefore, this review summarises the effects of DR on the functional status of innate immune cells, such as neutrophils and monocytes, as well as adaptive immune cells, such as B cells and T cells, and also discusses the impact of DR as a therapeutic strategy on immune function in disease states such as infections, chronic inflammation, and cancer.

Advances in Intervention Strategies for Advance Care Planning in Dementia Patients

ZHANG Xi, GUAN Chengguo, WANG Jing, XU Dingxin, ZHANG Bo

2025, 28(32):  4109-4116.  DOI: 10.12114/j.issn.1007-9572.2023.0615

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Advance care planning aims to allow individuals to discuss their goals and preferences for future medical and nursing care with family members and medical personnel in advance when they still have decision-making ability, so that individuals can receive medical care that meets their preferences when they lose their decision-making ability. Advance care planning in dementia population in China is still in infancy, this study aims to explore the research progress of advance care planning in dementia population, and provide theoretical references for the implementation of advance care planning in China.Relevant domestic and international databases were searched to provide an overview of the concept of advance care planning, intervention strategies, and intervention considerations for dementia patients. This review found that existing studies demonstrated the benefits of advance care planning in dementia patients; the intervention strategies were mostly based on face-to-face structured discussions about the understanding of disease, future goals of care, and care preferences of dementia patients, and the intervention considerations mainly included the timing of implementation, assessment of the decision-making capacity of dementia patients, promotion of family involvement, and training of the intervention implementer. The implementation of advance care planning in dementia population had been demonstrated to be positive overall, but the long-term effectiveness of most intervention implementation strategied requires further research.