2025年 · 第138卷第23期

出版日期 2025-12-05电子版￥0.00元

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Special Article

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2024年中国心血管健康与疾病年度报告：数据与趋势

Mingbo Liu, Xinye He, Xiaohong Yang, Zengwu Wang

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003902

摘要

Review Article

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cGAS-STING：从免疫学和肿瘤学的角度

Xiangxiang Liu, Chengshi Ding, Jun Lu, Na Zhang

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003889

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卵巢衰老中的线粒体功能障碍

Shuxin Ma, Guangyu Li, Yingying Qin

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003801

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幽门螺杆菌胃癌的感染状况与演变

Wenlin Zhang, Yuxin Zhang, Jing Ning, Weiwei Fu, Shigang Ding

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003903

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哮喘中的血脂异常：可治疗的特征，还是只是一种常见的合并症？

Ke Deng, Ji Wang, Brian G. Oliver, Lisa G. Wood, Gang Wang

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003843

摘要

Original Article

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1990-2021年全球、地区和国家因不孕而残疾的患病率和年数：2021年全球疾病负担研究结果

Rui Lin, Yuan Lin, Guangfu Jin, Qiufen Sun, Zhibin Hu

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003838

摘要

Background: Infertility is a burdensome, often overlooked condition. This study aimed to investigate the global distribution and trends in the burden of infertility from 1990 to 2021. Methods: We obtained data on the prevalence and years lived with disability (YLDs) related to infertility from the Global Burden of Disease 2021 study and evaluated them by calculating the estimated annual percentage change in age-standardized rates. We investigated the relationship between sociodemographic index (SDI) and the burden of infertility on the global, regional, and national levels. Results: In 2021, there were 143,261,562 female and 55,481,380 male infertility cases worldwide, respectively. In China, female and male infertility cases accounted for 23.59% and 21.47% of the global totals, reaching 33,795,944 and 11,909,889, respectively. Compared with 2019, the global number of female and male infertility cases increased by 5,286,227 in females and 2,017,271 in males. In contrast, China saw a decline in both female and male infertility cases, with reductions of 698,735 and 154,591, respectively. From 1990 to 2021, the age-standardized prevalence rate (ASPR) and age-standardized YLDs rate (ASYR) for female infertility both increased by 0.59% annually, whereas these two corresponding indicators for male infertility increased by 0.50% annually worldwide. The burden of female infertility was consistently higher than that of male infertility and demonstrated a faster rate of increase. East Asia had the highest ASPR and ASYR for female infertility, whereas Eastern Europe had the highest metrics for male infertility. A horizontal S-shaped association was observed between the SDI and ASPR and ASYR of infertility, with a rapid decline in the infertility burden when the SDI exceeded 0.7. Conclusions: The global burden of infertility has increased over the years, with a higher burden on women and underdeveloped regions. These findings emphasize the need to prioritize healthcare for patients with infertility to address the rising burden.

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1990-2021年中国哮喘负担的增长：2021年全球疾病负担研究分析

Xiaoyang Wang, Tianli Wei, Junmei Xu, Yingxue Ding

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003658

摘要

Background: Asthma, one of the most widespread chronic respiratory diseases, has placed a considerable economic and social stress on China. This study examines the burden of asthma in China from 1990 to 2021 and forecasts future trends, providing guidance for establishing focused preventive and regulatory strategies. Methods: Utilizing data from the Global Burden of Disease Database 2021, the analysis of trends in asthma burden was conducted for China from 1990 to 2021. Key indicators such as incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were analysed. The investigation applied the estimated annual percentage change (EAPC), average annual percentage change (AAPC), and age–period–cohort model (APCM) to evaluate these trends. Furthermore, predictions for incidence and mortality in 2035 were generated using the Bayesian APCM and the Nordpred model. Results: In 2021, there were 25,015,668 prevalent asthma cases in China, alongside 3,934,875 new cases and 26,233 deaths. The age-standardized incidence rate and age-standardized death rate for 2021 were 364.17 (95% uncertainty interval [95% UI]: 283.22–494.1) per 100,000 population and 1.47 (95% UI: 1.15–1.79) per 100,000 population, respectively. The age-standardized rates (ASRs) for incidence were detected to be elevated in the 0–4 years age group, and the prevalence was significantly higher in the 5–9 years age group compared to other cohorts. ASR for incidence and prevalence of asthma in China were lower than that in the global average. Between 1990 and 2021, the ASR of incidence, prevalence, mortality, and DALYs demonstrated a downward trajectory, with EAPC values of −1.17, −1.57, −4.69, and −2.98, respectively. People aged 0–9 years and over 60 years experienced a disproportionately higher disease burden. Projections indicate that the ASRs for incidence will continue to rise, whereas the death will continue to decline by 2035. Conclusions: Between 1990 and 2021, a general reduction in the asthma burden in China was observed. However, the burden remains particularly high among people aged 0–9 years and over 60 years, underscoring the need for targeted interventions and policies to address the ongoing challenges of asthma.

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血清免疫参数作为宫颈癌同步放化疗治疗结果的预测因素

Lihua Chen, Weilin Chen, Yingying Lin, Xinran Li, Yu Gu, Chen Li, Yuncan Zhou, Ke Hu, Fuquan Zhang, Yang Xiang

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003553

摘要

Background: Concurrent chemo-radiotherapy (CCRT) is the standard treatment for locally advanced cervical cancer (LACC), but there are still many patients who suffer tumor recurrence. However, valuable predictors of treatment outcomes remain limited. This study aimed to assess the value of the serum immune biomarkers to predict the prognosis. Methods: We reviewed cervical cancer patients treated with CCRT between January 2014 and May 2018 at Peking Union Medical College Hospital. The systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and lactate dehydrogenase (LDH) were calculated using blood samples. The relationship between immune markers and the treatment outcome was analyzed. The area under the receiver operating characteristic (ROC) curve was used to evaluate the predictive efficiency. The Cox proportional hazards model and log-rank were used to predict overall survival (OS) and disease-free survival (DFS). Results: This study included 667 patients. Among them, 195 (29.2%) patients were defined as treatment failure, including 127 (19.0%) patients with pelvic failure, 94 (14.1%) distant failure, and 25 (3.7%) concurrent pelvic and distant failure. It revealed that the tumor stage, size, metastatic lymph nodes (MLNs), and serum immune biomarkers, such as SII, SIRI, and LDH, were significantly related to treatment outcomes. We demonstrated that the optimal cut-off of the SII, SIRI, and LDH were 970.4 × 109/L, 1.3×109/L, and 207.52 U/L, respectively. Importantly, this study presented that LDH level had the highest OR (OR =4.2; 95% CI [2.3-10.8]). Furthermore, the OS and DFS for patients with pre-SII ≥970.5 ×109/L. were significantly worse than those with pre-SII <970.5 × 109/L. Similarly, pre-SIRI ≥1.25×109/L and pre-LDH ≥207.5 U/L were related to poor survival outcomes. Conclusions: This study demonstrated that the baseline SII, SIRI, and LDH levels can be used to accurately and effectively predict the treatment outcomes after CCRT and long-term prognosis. Our results may offer additional prognostic information in clinical, which helps to detect the potential recurrent metastasis in time.

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外来体PPAR α来源于癌细胞诱导CD8⁺肝细胞癌T细胞耗竭miR-27b-3p/TOX轴

Wenjun Zhong, Nianan Luo, Yafeng Chen, Jiangbin Li, Zhujun Yang, Rui Dong

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003894

摘要

Background: Cluster of differentiation 8 positive (CD8+) T cells play a crucial role in the response against tumors, including hepatocellular carcinoma (HCC), where their dysfunction is commonly observed. While the association between elevated peroxisome proliferator-activated receptor alpha (PPARα) expression in HCC cells and exosomes and unfavorable prognosis in HCC patients is well-established, the underlying biological mechanisms by which PPARα induces CD8+ T cell exhaustion mediated by HCC exosomes remain poorly understood. Methods: Bioinformatics analyses and dual-luciferase reporter assays were used to investigate the regulation of microRNA-27b-3p (miR-27b-3p) and thymocyte selection-associated high mobility group box (Tox) by Pparα. In vitro and in vivo experiments were conducted to validate the effects of HCC-derived exosomes, miR-27b-3p overexpression, and Pparα on T cell function. Exosome characterization was confirmed using transmission electron microscopy, Western blotting, and particle size analysis. Exosome tracing was performed using small animal in vivo imaging and confocal microscopy. The expression levels of miR-27b-3p, Pparα, and T cell exhaustion-related molecules (Tox, Havcr2, and Pdcd1) were detected using quantitative reverse transcription polymerase chain reaction analysis, Western blotting analysis, immunofluorescence staining, and flow cytometry analysis. Results: Pparα expression was significantly increased in HCC and negatively correlated with prognosis. It showed a positive correlation with Tox and a negative correlation with miR-27b-3p. The overexpressed Pparα from HCC cells was delivered to CD8+ T cells via exosomes, which absorbed miR-27b-3p both in vitro and in vivo, acting as "miRNA sponges". Further experiments demonstrated that Pparα can inhibit the negative regulation of Tox mediated by miR-27b-3p through binding to its 3′untranslated regions. Conclusions: HCC-derived exosomes deliver Pparα to T cells and promote CD8+ T cell exhaustion and malignant progression of HCC via the miR-27b-3p/TOX regulatory axis. The mechanisms underlying T-cell exhaustion in HCC can be utilized for the advancement of anticancer therapies.

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痛风发病率和患病率的全球负担和趋势

Shuai Jin, Yuhan Wang, Shuangtong Yan, Xiaomin Fu, Xiaodong Hu, Zhaohui Lyu, Hongzhou Liu

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003631

摘要

Background: Gout is a chronic disease primarily caused by elevated urate levels, severely affecting joint health. Its global distribution varies, and updated data for China are lacking. This study aimed to analyze the current burden and trends of gout globally and in China, examining the burden by gender, age, and risk factors while providing future predictions. Methods: This descriptive epidemiological secondary analysis utilized data from the Global Burden of Disease, Injuries, and Risk Factors (GBD) 2021 study. Age-standardized incidence rate (ASIR), prevalence rate (ASPR), and disability-adjusted life years (DALYs) rates (ASDR) were used to assess the gout burden. Trends from 1990 to 2021 were analyzed across global regions, genders, and sociodemographic index (SDI) levels. The burden in China was further examined by gender, age, and associated risk factors. The Bayesian age–period–cohort (BAPC) model was used to predict future trends. Gout burden in China and the United States was compared. Results: In 2021, gout affected 57 million people globally, with 9.4 million new cases and 1.75 million DALYs. From 1990 to 2021, the ASIR, ASPR, and ASDR increased by 17.2%, 21.9%, and 21.3%, respectively. Males experienced a significantly higher burden, with greater ASIR, ASPR, and ASDR increasing with higher SDI levels. In China, male ASIR, ASPR, and ASDR were over 2.8 times those of females, and the burden increased with age. In 2021, 31.4% of gout-related DALYs in China were attributed to high body mass index and 7.6% to kidney dysfunction. Between 1990 and 2021, the high body mass index-related burden of gout rose annually for both genders, while the kidney dysfunction-related gout burden remained stable. By 2050, the burden of gout in China is expected to continue increasing, with a slower rise in females and a decline in males after an initial increase. However, the overall burden will remain substantial. In comparison, the gout burden will be higher in the United States than in China. Conclusions: Gout is becoming a significant health burden globally and in China, particularly among Chinese males and older individuals. With the aging population and lifestyle changes exacerbating the issue, effective strategies and measures are essential to prevent or reduce gout-related health issues.

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中国老年人使用潜在不适当药物的处方率、医疗保健利用和支出：一项全国性横断面研究

Zinan Zhao, Mengyuan Fu, Can Li, Zhiwen Gong, Ting Li, Kexin Ling, Huangqianyu Li, Jianchun Li, Weihang Cao, Dongzhe Hong 等

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003426

摘要

Background: The use of potentially inappropriate medications (PIMs) is a major concern for medication safety as it may entail more harm than potential benefits for older adults. This study aimed to explore the prescribing rate, healthcare utilization, and expenditure of older adults using PIMs in China. Methods: A cross-sectional analysis was conducted using a national representative database of all medical insurance beneficiaries across China, extracting ambulatory visit records of adults aged 65 years and above between 2015 and 2017. Descriptive analysis was conducted to measure the rate of patients exposed to PIM, prescribing rate of each PIM, average annual outpatient visits per patient, average total medication costs for each visit, average annual cost of PIMs for each patient, and average annual medication costs for each patient. Generalized linear model with logit link function and binomial distribution was used to examine the adjusted associations between PIMs and independent variables. Results: In total, 845,278 (33.2%) participants were identified to be exposed to at least one PIM. Patients aged 75–84 years (38.1%, 969,809/2,545,430) and ≥85 years (37.9%, 964,718/2,545,430) were more likely to be prescribed with PIMs. Beneficiaries of the Urban Employee Basic Medical Insurance (UEBMI) and living in eastern and southern regions were more frequently prescribed with PIMs. Compared with patients without PIM exposure (7.5 visits, drug cost of RMB 1545.0 Yuan), patients with PIM exposure showed higher adjusted average annual number of outpatient visits (10.7 visits, β = 3.228, 95% confidence interval [CI] = 3.196–3.261) and higher annual drug costs (RMB 2461.8 Yuan, Coef. = 916.864, 95% CI = RMB 906.292–927.436 Yuan). Conclusions: The results showed that the use of PIM among older adults was common in China. This study suggests that the use of PIM could be considered as a clear target, pending multidimensional efforts, to promote rational prescribing for older adults.

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父母近视对中国学龄儿童青少年近视的影响：一项全国性横断面调查

Xiaoran Yu, Huan Wang, Sheng Ma, Yanhui Dong, Yinghua Ma, Yi Song, Jun Ma, Zhiyong Zou

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003515

摘要

Background: Parental myopia is an important risk factor for myopia in Chinese children and adolescents. This study aimed to assess the influence of parental myopia and the severity of myopia on offspring and to evaluate whether adopting healthy lifestyles can mitigate the effects of parental myopia on offspring. Methods: This cross-sectional study analyzed data from children and adolescents aged 6–17 years with complete vision assessments and parental history of myopia from six provinces in China during 2013–2014. Parental demographic information, children’s outdoor activity time, sleep time, and sedentary time were collected via questionnaire. Parental myopia was classified as no myopia, paternal myopia, maternal myopia, and both. The offspring were categorized into 10 groups based on parental myopia prescription. Associations of the above factors with myopia in children and adolescents were evaluated by logistic regression analysis. Results: Among 40,864 children and adolescents (50.3% boys and 49.7% girls), 22,537 (55.2%) were diagnosed with myopia. In comparison to offspring devoid of parental myopia, children with one parent affected by myopia exhibited odds ratio (OR) of 1.75 (95% confidence interval [CI]: 1.62–1.88) for myopia, while those with both parents affected showed OR of 2.27 (95% CI: 2.02–2.55) after adjusted for lifestyle factors. The likelihood of myopia in offspring increased with increasing severity of parental myopia, with a 3.08-fold increase in risk observed when both parents presented high myopia. Nonetheless, children adhering to two or more healthy lifestyle factors demonstrated a diminished risk of myopia compared with those with fewer than two lifestyle factors, especially among offspring of non-myopic or mildly myopic parents. Conclusions: Parental myopia has a dose-dependent association with their offspring. Healthy lifestyles may reduce the impact of parental factors on myopia in offspring. The observed associations suggest that although the genetic burden of parental myopia cannot be ignored, healthy lifestyles and nurturing are also very important.

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中国帕金森病的发病率、死亡率和负担：基于2021年全球疾病负担研究的时间趋势分析及与全球负担的比较

Fan Gao, Xiaoyu Cheng, Junyi Liu, Yinlian Han, Chengjie Mao, Chongke Zhong, Chunfeng Liu

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003839

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LGR5与HSP90AB1相互作用，通过激活前列腺癌中的WNT/β-catenin/AR轴介导enzalutamide耐药

Ze Gao, Zhi Xiong, Yiran Tao, Qiong Wang, Kaixuan Guo, Kewei Xu, Hai Huang

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003538

摘要

Background: Enzalutamide, a second-generation androgen receptor (AR) pathway inhibitor, is widely used in the treatment of castration-resistant prostate cancer. However, after a period of enzalutamide treatment, patients inevitably develop drug resistance. In this study, we characterized leucine-rich repeated G-protein-coupled receptor 5 (LGR5) and explored its potential therapeutic value in prostate cancer. Methods: A total of 142 pairs of tumor and adjacent formalin-fixed paraffin-embedded tissue samples from patients with prostate cancer were collected from the Pathology Department at Sun Yat-sen Memorial Hospital. LGR5 was screened by sequencing data of enzalutamide-resistant cell lines combined with sequencing data of lesions with different Gleason scores from the same patients. The biological function of LGR5 and its effect on enzalutamide resistance were investigated in vitro and in vivo. Glutathione-S-transferase (GST) pull-down, coimmunoprecipitation, Western blotting, and immunofluorescence assays were used to explore the specific binding mechanism of LGR5 and related pathway changes. Results: LGR5 was significantly upregulated in prostate cancer and negatively correlated with poor patient prognosis. Overexpression of LGR5 promoted the malignant progression of prostate cancer and reduced sensitivity to enzalutamide in vitro and in vivo. LGR5 promoted the phosphorylation of glycogen synthase kinase-3β (GSK-3β) by binding heat shock protein 90,000 alpha B1 (HSP90AB1) and mediated the activation of the Wingless/integrated (WNT)/β-catenin signaling pathway. The increased β-catenin in the cytoplasm entered the nucleus and bound to the nuclear AR, promoting the transcription level of AR, which led to the enhanced tolerance of prostate cancer to enzalutamide. Reducing HSP90AB1 binding to LGR5 significantly enhanced sensitivity to enzalutamide. Conclusions: LGR5 directly binds to HSP90AB1 and mediates GSK-3β phosphorylation, promoting AR expression by regulating the WNT/β-catenin signaling pathway, thereby conferring resistance to enzalutamide treatment in prostate cancer.

Correspondence

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羟基红花黄A通过激活自噬抑制脂多糖诱导的血管平滑肌细胞衍生的泡沫细胞形成

Lin Liu, Yingyun Li, Boyu Liu, Guoting Li, Changchao Yang, Junna Song, Qingzhuo Cui, Jingshan Zhao

中华医学杂志英文版2025年 138卷 23期

DOI: 10.1097/CM9.0000000000003835

摘要