慢性病防治

·編者按·

隨著我國社會(huì)經(jīng)濟(jì)的迅速發(fā)展，居民生活質(zhì)量的不斷提高，城市化、工業(yè)化、老齡化等進(jìn)程不斷推進(jìn)，我國人群的疾病譜和死因譜發(fā)生了重大變化?！吨袊用駹I養(yǎng)與慢性病狀況報(bào)告（2015 年）》指出，以糖尿病、心腦血管疾病、癌癥及慢性呼吸系統(tǒng)疾病等為代表的慢性非傳染性疾?。ㄒ韵潞喎Q慢性?。┑幕疾÷手鹉晟仙?，已成為威脅我國居民健康的“頭號(hào)公敵”。慢性病由于其發(fā)病率高、死亡率高、知曉率低、控制率低，并且病因復(fù)雜、病程長，常需長期甚至終身治療，對(duì)人群健康影響顯著，社會(huì)負(fù)擔(dān)增加明顯，嚴(yán)重吞噬著我國經(jīng)濟(jì)發(fā)展的成果。因此，加強(qiáng)對(duì)慢性病的防控顯得尤為重要，這不僅是我國重要的公共衛(wèi)生問題，也是當(dāng)前世界面臨的重大健康威脅。

本專題得到專家潘安教授（華中科技大學(xué)公共衛(wèi)生學(xué)院）的大力支持。

·熱點(diǎn)數(shù)據(jù)排行·

截至 2017 年 2 月 20 日，中國知網(wǎng)（CNKI）和 Web of Science（WOS）的數(shù)據(jù)報(bào)告顯示，以“慢性?。╟hronic diseases）”“防治（prevention and treatment）”為詞條可以檢索到的期刊文獻(xiàn)分別為 1038 條與 13084 條，本專題將相關(guān)數(shù)據(jù)按照：研究機(jī)構(gòu)發(fā)文數(shù)、作者發(fā)文數(shù)、期刊發(fā)文數(shù)、被引用頻次進(jìn)行排行，結(jié)果如下。

研究機(jī)構(gòu)發(fā)文數(shù)量排名（CNKI）

研究機(jī)構(gòu)發(fā)文數(shù)量排名（WOS）

作者發(fā)文數(shù)量排名（CNKI）

作者發(fā)文數(shù)量排名（WOS）

期刊發(fā)文數(shù)量排名（CNKI）

期刊發(fā)文數(shù)量排名（WOS）

根據(jù)中國知網(wǎng)（CNKI）數(shù)據(jù)報(bào)告，以“慢性?。╟hronic diseases）”“防治（prevention and treatment）”為詞條可以檢索到的高被引論文排行結(jié)果如下。

國內(nèi)數(shù)據(jù)庫高被引論文排行

根據(jù)Web of Science統(tǒng)計(jì)數(shù)據(jù)，以“慢性?。╟hronic diseases）”“防治（prevention and treatment）”為詞條可以檢索到的高被引論文排行結(jié)果如下

國外數(shù)據(jù)庫高被引論文排行

·經(jīng)典文獻(xiàn)推薦·

基于 Web of Science 檢索結(jié)果，利用 Histcite 軟件選取 LCS（Local Citation Score，本地引用次數(shù)）TOP50文獻(xiàn)作為節(jié)點(diǎn)進(jìn)行分析，得到本領(lǐng)域推薦的經(jīng)典文獻(xiàn)如下。

來源出版物：American Journal of Respiratory and Critical Care Medicine, 2013, 187(4): 347-365 and classification system, and (3) identify a collaborative research agenda and plan that would improve the evidence base and facilitate implementation of the definition and classification of CKD. The K/DOQI definition and classification were accepted, with clarifications. CKD is defined as kidney damage or glomerular filtration rate (GFR) ＜60 mL/min/1.73 m2for 3 months or more, irrespective of cause. Kidney damage in many kidney diseases can be ascertained by the presence of albuminuria, defined as albumin-to-creatinine ratio ＞30 mg/g in two of three spot urine specimens. GFR can be estimated from calibrated serum creatinine and estimating equations, such as the Modification of Diet in Renal Disease (MDRD) Study equation or the Cockcroft-Gault formula. Kidney disease severity is classified into five stages according to the level of GFR. Kidney disease treatment by dialysis and transplantation should be noted. Simple, uniform classifications of CKD by cause and by risks for kidney disease progression and CVD should be developed.

Keywords: chronic kidney disease; glomerular filtration rate; proteinuria; albuminuria; KDIGO

來源出版物：Kidney International, 2005, 67(6): 2089-2100

Abstract: Chronic kidney disease (CKD) is a worldwide public health problem, with adverse outcomes of kidney failure, cardiovascular disease (CVD), and premature death. A simple definition and classification of kidney disease is necessary for international development and implementation of clinical practice guidelines. Kidney Disease: Improving Global Outcomes (KDIGO) conducted a survey and sponsored a controversies conference to (1) provide a clear understanding to both the nephrology and nonnephrology communities of the evidence base for the definition and classification recommended by Kidney Disease Quality Outcome Initiative (K/DOQI), (2) develop global consensus for the adoption of a simple definition

Abstract: Chronic diseases are the largest cause of death in the world. In 2002, the leading chronic diseasescardiovascular disease, cancer, chronic respiratory disease, and diabetes-caused 29 million deaths worldwide. Despite growing evidence of epidemiological and economic impact, the global response to the problem remains inadequate. Stakeholders include governments, the World Health Organization and other United Nations bodies, academic and research groups, nongovernmental organizations, and the private sector. Lack of financial support retards capacity development for prevention, treatment, and research in most developing countries. Reasons for this include that up-to-date evidence related to the nature of the burden of chronic diseases is not in the hands of decision makers and strong beliefs persist that chronic diseases afflict only the affluent and the elderly, that they arise solely from freely acquired risks, and that their control is ineffective and too expensive and should wait until infectious diseases are addressed. The influence of global economic factors on chronic disease risksimpedes progress, as does the orientation of health systems toward acute care. We identify 3 policy levers to address these impediments: elevating chronic diseases on the health agenda of key policymakers, providing them with better evidence about risk factor control, and persuading them of the need for health systems change. A more concerted, strategic, and multisectoral policy approach, underpinned by solid research, is essential to help reverse the negative trends in the global incidence of chronic disease.

來源出版物：JAMA-Journal of the American Medical Association, 2004, 291(21): 2616-2622

Abstract: We review the rationale for the use of synthetic oleanane triterpenoids (SOs) for prevention and treatment of disease, as well as extensive biological data on this topic resulting from both cell culture and in vivo studies. Emphasis is placed on understanding mechanisms of action. SOs are noncytotoxic drugs with an excellent safety profile. Several hundred SOs have now been synthesized and in vitro have been shown to: 1) suppress inflammation and oxidative stress and therefore be cytoprotective, especially at low nanomolar doses, 2) induce differentiation, and 3) block cell proliferation and induce apoptosis at higher micromolar doses. Animal data on the use of SOs in neurodegenerative diseases and in diseases of the eye, lung, cardiovascular system, liver, gastrointestinal tract, and kidney, as well as in cancer and in metabolic and inflammatory/autoimmune disorders, are reviewed. The importance of the cytoprotective Kelch-like erythroid cellderived protein with CNC homology-associated protein 1/nuclear factor (erythroid-derived 2)-like 2/antioxidant response element (Keap1/Nrf2/ARE) pathway as a mechanism of action is explained, but interactions with peroxisome proliferator-activated receptor gamma (PARP gamma), inhibitor of nuclear factor-kappa B kinase complex (IKK), janus tyrosine kinase/signal transducer and activator of transcription (JAK/STAT), human epidermal growth factor receptor 2 (HER2)/ErbB2/neu, phosphatase and tensin homolog (PTEN), the phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) pathway, mammalian target of rapamycin (mTOR), and the thiol proteome are als SOs to reactive cysteine residues in specific molecular targets triggers biological activity. Ultimately, SOs are multifunctional drugs that regulate the activity of entire networks. Recent progress in the earliest clinical trials with 2-cyano-3, 12-dioxooleana-1, 9(11)-dien-28-oic acid (CDDO) methyI ester (bardoxolone methyI) is also summarized.

來 源 出 版 物 ： Pharmacological Reviews, 2012, 64(4): 972-1003

The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report

Chobanian, AV; Bakris, GL; Black, HR; et al.

“The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure” provides a new guideline for hypertension prevention and management. The following are the key messages: (1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (＜140/90 mm Hg or ＜130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a patent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician’s judgment remains paramount.來源出版物：JAMA-Journal of the American Medical Association, 2003, 289(19): 2560-2572Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease GOLD executive summaryVestbo, Jorgen; Hurd, Suzanne S; Agusti, Alvar G; et al.

Chronic obstructive pulmonary disease (COPD) is a global health problem, and since 2001, the Global Initiative for Chronic Obstructive Lung Disease (GOLD)has published its strategy document for the diagnosis and management of COPD. This executive summary presents the main contents of the second 5-year revision of the GOLD document that has implemented some of the vast knowledge about COPD accumulated over the last years. Today, GOLD recommends that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation. The document highlights that the assessment of the patient with COPD should always include assessment of (1) symptoms, (2) severity of airflow limitation, (3) history of exacerbations, and (4) comorbidities. The first three points can be used to evaluate level of symptoms and risk of future exacerbations, and this is done in a way that splits patients with COPD into four categories-A, B, C, and D. Nonpharmacologic and pharmacologic management of COPD match this assessment in an evidence-based attempt to relieve symptoms and reduce risk of exacerbations. Identification and treatment of comorbidities must have high priority, and a separate section in the document addresses management of comorbidities as well as COPD in the presence of comorbidities. The revised document also contains a new section on exacerbations of COPD. The GOLD initiative will continue to bring COPD to the attention of all relevant shareholders and will hopefully.

COPD; clinical assessment; COPD management; exacerbations; comorbidities

Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO)

Levey, AS; Eckardt, KU; Tsukamoto, Y

The global burden of chronic diseases: Overcoming impediments to prevention and control

Yach, D; Hawkes, C; Gould, CL; et al.

Synthetic oleanane triterpenoids: Multifunctional drugs with a broad range of applications for prevention and treatment of chronic disease

Liby, Karen T.; Sporn, Michael B

典

文章題目第一作者來源出版物1 T h e s e v e n t h r e p o r t o f t h e j o i n t n a t i o n a l c o m m i t t e e o n p r e v e n t i o n , d e t e c t i o n , e v a l u a t i o n , a n d t r e a t m e n t o f h i g h b l o o d p r e s s u r e : T h e J N C 7 r e p o r t C h o b a n i a n , A V J A M A -J o u r n a l o f t h e A m e r i c a n M e d i c a l A s s o c i a t i o n , 2 0 0 3 , 2 8 9 ( 1 9 ) : 2 5 6 0 -2 5 7 2 G l o b a l s t r a t e g y f o r t h e d i a g n o s i s , m a n a g e m e n t , a n d p r e v e n t i o n A m e r i c a n J o u r n a l o f R e s p i r a t o r y a n d 2 o f c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e G O L D e x e c u t i v e V e s t b o , C r i t i c a l C a r e M e d i c i n e , 2 0 1 3 , 1 8 7 ( 4 ) : s u m m a r y J o r g e n 3 4 7 -3 6 5 D e f i n i t i o n a n d c l a s s i f i c a t i o n o f c h r o n i c k i d n e y d i s e a s e -A 3 p o s i t i o n s t a t e m e n t f r o m K i d n e y D i s e a s e : I m p r o v i n g G l o b a l L e v e y , A S K i d n e y I n t e r n a t i o n a l , 2 0 0 5 , 6 7 ( 6 ) : O u t c o m e s ( K D I G O ) 2 0 8 9 -2 1 0 0 4 T h e g l o b a l b u r d e n o f c h r o n i c d i s e a s e s : O v e r c o m i n g Y a c h , D J A M A -J o u r n a l o f t h e A m e r i c a n M e d i c a l i m p e d i m e n t s t o p r e v e n t i o n a n d c o n t r o l A s s o c i a t i o n , 2 0 0 4 , 2 9 1 ( 2 1 ) : 2 6 1 6 -2 6 2 2 S y n t h e t i c o l e a n a n e t r i t e r p e n o i d s : M u l t i f u n c t i o n a l d r u g s w i t h 5 a b r o a d r a n g e o f a p p l i c a t i o n s f o r p r e v e n t i o n a n d t r e a t m e n t o f L i b y , K a r e n T P h a r m a c o l o g i c a l R e v i e w s , 2 0 1 2 , 6 4 ( 4 ) : c h r o n i c d i s e a s e 9 7 2 -1 0 0 3