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Jingdong book

流行病学·第三巻（第3版）

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Jingdong book

流行病学·第三巻（第3版）

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《流行病学·第三巻（第3版）》第一版于1979年由人民卫生出版社作为国庆30周年献礼出版了上、中册，以后陆续出版了下册和续编。第二版是1995年出版，分三卷。第一卷为总论，第二卷为传染病，第三卷为非传染病。主编均为天津医科大学耿贯一教授。随着科学技术的进步、基础理论和实际应用技术的发展，流行病学在国内外发展迅速，流行病学方法进展很快，分支学科日益增多，从理论、概念，到技术、方法和手段，都有了深刻的变化，第二版内容已显陈旧，难以反映当前学科发展水平和现状。近几年，流行病学及相关工作者需要更新、更实用、更全面的专著作为案头书，方便查找，随时指导工作。本书的修订不仅集中全国的流行病学专家，同时涉及疾病预防控制的很多领域，是一次理论和实践的结合。
Catalogue

第一章 慢性非传染性疾病流行病学概述
第一节 慢性病的概念和定义
第二节 流行特征和疾病负担
一、时间趋势
二、地区分布
三、人群分布
四、疾病负担
第三节 病因与危险因素
一、病因
二、危险因素
第四节 慢性病防治策略与措施
一、预防和控制慢性病已成为全球战略行动
二、中国慢性病防治体系的构建和防治策略的转变
三、全人群、高危人群和病人管理相结合的策略
四、WH0和西太区慢性病防治策略
五、慢性病预防控制措施
第五节 慢性病社区综合防治
一、慢性病社区综合防治概念
二、慢性病社区综合防治内容

第二章 慢性病及其危险因素监测
第一节 慢性病发病监测
一、监测人群
二、监测病例定义及监测内容
三、资料收集方式与途径
四、质量控制
五、资料整理与分析
第二节 慢性病患病监测
一、调查对象和抽样方法
二、调查内容和方法
三、质量控制
四、资料整理与分析
第三节 死因监测
一、监测内容和方法
二、监测资料整理和分析
三、质量控制。
第四节 行为危险因素监测
一、监测目的
二、抽样方法及样本量
三、监测内容
四、监测方法
五、数据管理与分析
六、质量控制
七、报告及反馈

第三章 高血压
第一节 概述
一、高血压的定义和分类
二、高血压的危险
三、继发性高血压
第二节 流行特征
一、高血压的发病率
二、高血压的患病率
三、高血压患病的分布特征
四、儿童与青少年高血压的流行特点
第三节 病因和危险因素
一、年龄
二、高血压家族史和遗传因素
三、超重和肥胖
四、高钠、低钾膳食
五、低钙饮食
六、不均衡饮食方式
七、饮酒
八、精神紧张
九、其他危险因素
第四节 预防策略与措施
一、高血压的预防策略
二、高血压的初级预防
三、高血压的二级预防
四、高血压预防和控制的障碍

第四章 冠心病
第一节 概述
一、冠心病的定义
二、冠心病的诊断分类标准
第二节 流行特征
一、死亡顺位、死亡率和变化趋势
二、发病率及变化趋势
……
第五章 心脏性猝死
第六章 心力衰竭
第七章 瓣膜性心脏病
第八章 心肌病
第九章 颅内肿瘤
第十章 头颈部癌
第十一章 鼻咽癌
第十二章 甲状腺癌
第十三章 肺癌
第十四章 食管癌
第十五章 乳腺癌
第十六章 胃癌
第十七章 原发性肝癌
第十八章 胆囊癌
第十九章 胰腺癌
第二十章 结直肠癌
第二十一章 肾肿癌
第二十二章 膀胱癌
第二十三章 前列腺癌
第二十四章 卵巢癌
第二十五章 子宫颈癌
第二十六章 骨肿癌
第二十七章 白血病
第二十八章 淋巴癌
第二十九章 皮肤癌
第三十章 慢性阻塞性肺病
……
第七十七章 农药中毒
第七十八章 有机溶剂中毒
索引
Book Abstract

（二）环境因素
1．生物因素生物因素是指病原体（包括各种微生物和寄生虫）以及各种有害的动植物。感染可导致多种肿瘤和心血管疾病。流行病学研究发现，约有15％~20％的恶性肿瘤与病原体感染，特别是病毒感染有关。幽门螺旋杆菌感染是慢性胃炎的主要病因之一，且与胃癌密切相关；慢性阻塞性肺疾病（COPD）的起病与感冒等呼吸道感染有密切关系，且反复呼吸道病毒感染和继发性细菌感染是导致COPD病变发展和加重的重要原因；乙型肝炎病毒感染是原发性肝癌的原因，人乳头瘤病毒与宫颈癌有关，EB病毒与人类鼻咽癌有关；还有柯萨奇病毒与1型糖尿病发病的关系比较肯定，母亲妊娠3个月内感染风疹病毒是婴儿先天性心脏病的病因之一。
2．理化因素自然环境中的理化因素对慢性病发病的影响可分为两类。
一类是自然存在的，如地理、气候、土壤等。在寒冷季节，心血管疾病和呼吸系统疾病高发，对老年人健康的危害尤其严重；过量紫外线（太阳光）照射，是引起人类皮肤癌的明确病因；有研究报道环境中某些微量元素（如硒）和矿物质在机体内的富集和缺乏，与某些地方性心血管疾病（如克山病）、甲状腺肿和恶性肿瘤的发生有关。有研究报告了加拿大纽芬兰省某城市饮用软水的人群心脑血管疾病的死亡率高于饮用硬水的人群，可能的原因是软水中含钙较少，但这一结论还有待证实。
另一类理化因素与人类社会的发展密切相关，影响最大的是各种化学污染物，如环境中的三废（废气、废液、废渣）含有多种致癌物，是引起肺癌等恶性肿瘤的原因之一；垃圾焚烧产生的苯并芘、二嗯英等，可引起肺癌、皮肤癌等多种恶性肿瘤；职业环境中的砷及砷化合物、石棉、联苯胺、沥青焦油、氯乙烯、苯等职业化学物质可导致肺癌、膀胱癌、白血病、皮肤癌和肝血管肉瘤等。此外，吸烟与这些职业因素有很强的协同致肺癌效应。
3．社会因素社会因素包括社会制度、社会经济发展水平、生产劳动及生活居住条件、风俗习惯、医疗卫生条件、宗教、文化、教育水平等。大多数慢性病在不同经济水平的国家和地区间、不同文化水平和职业人群中的分布存在差异，表明社会因素对慢性病的发病和转归存在影响。肥胖、糖尿病、高血压、冠心病、脑卒中等被称为“富贵病”，是因为这些慢性病在发达或富裕的国家和地区发病率较高；而风湿性心脏病、宫颈癌、食管癌等则与贫穷与医疗卫生水平落后有关。
研究社会因素在慢性病发病中的作用，一个重要的启发在于个体是属于社会的，促进个体行为的改变最有效的办法是促使整个人群的行为规范和社会人文环境发生一致的改变。
（三）机体因素
1．年龄与性别年龄是慢性病发病的重要影响因素。除了少数发病年龄较早的慢性病，如1型糖尿病患者多为青少年，发病年龄多在20岁以下，多数慢性病都在中老年期发病，而且发病与死亡随年龄增大而升高，提示了慢性病发病过程中环境与遗传因素的累积效应。但随着社会发展和生活方式变化，近年来慢性病发病有年轻化的趋势，与不健康的生活方式密切相关。
多数慢性病存在性别上的差异。女性高发某些恶性肿瘤如胆囊癌、甲状腺癌等，而大多数慢性病则是男性较女性多发，造成这种性别差异的原因主要是男女性的性激素差异。女性在绝经期前由于有雌激素的保护作用，动脉粥样硬化的发病率低于同年龄组男性，但在绝经期后这种差异消失。社会工作压力较大，吸烟、饮酒等不健康行为较普遍，是男性多发慢性病的重要原因。
2．遗传因素几乎所有的慢性病都是遗传因素和环境因素共同作用的结果。遗传因素在糖尿病、心脑血管疾病、精神疾病以及部分恶性肿瘤的发病中有重要作用。慢性病有多基因遗传、基因微效性和累积效应等特点，导致慢性病多表现为晚发，即致病因素随着个体发育作用到一定年龄后才表现出疾病效应。
遗传因素在不同慢性病发病中的作用有较大差异，如心脑血管疾病、糖尿病受遗传因素的影响较大，而恶性肿瘤则相对较小。
……

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Jingdong book