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Article(id=1241035552527536697, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408181, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723564800000, receivedDateStr=2024-08-14, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773815533048, onlineDateStr=2026-03-18, pubDate=1735056000000, pubDateStr=2024-12-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773815533048, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773815533048, creator=13701087609, updateTime=1773815533048, updator=13701087609, issue=Issue{id=1241035543589483182, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='24', pageStart='4417', pageEnd='4608', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773815530917, creator=13701087609, updateTime=1773815686426, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241036195896029478, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241036195896029479, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241035543589483182, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=4429, endPage=4434, ext={EN=ArticleExt(id=1241035552972132947, articleId=1241035552527536697, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Prospective study on smoking status and the risk of cardiovascular disease among Huixian resident aged 30-79 years, Henan, columnId=null, journalTitle=Modern Preventive Medicine, columnName=null, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the relationship between smoking status and risk of cardiovascular diseases among Henan Huixian residents.

Methods

The baseline survey data and follow-up data of participants aged 30-79 years recruited in Huixian County, Henan, through the China Chronic Disease Prospective Research Project were used. Cox proportional hazard regression models were used to analyze the association between smoking status and risk of cardiovascular diseases.

Results

A total of 59 865 cases were included in the cohort and followed up for a total of 586 851.81 person years (average 9.20 years). We documented 17 142 cases of cardiovascular diseases, 5 959 cases of ischemic heart diseases, 7 717 cases of cerebral infarction and 1 387 cases of intracerebral hemorrhage. The smoking rate of men (65.29%) was much higher than that of women (0.34%). Cox multivariate analysis showed, compared with nonsmokers, current smokers had higher risk of cardiovascular diseases (HR=1.178, 95% CI: 1.118-1.241), ischemic heart diseases (HR=1.291, 95% CI: 1.177-1.417) and cerebral infarction (HR=1.297, 95% CI: 1.203-1.398). Among current smokers, those who smoked more than 20 cigarettes per day or those who started smoking at the age of less than 20 years old had higher risk of cardiovascular diseases, ischemic heart diseases and cerebral infarction.

Conclusion

Smoking can effectively decrease the risk of cardiovascular diseases. It is necessary to strengthen the control and intervention of smoking behavior in order to curb the epidemic trend of cardiovascular disease.

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目的

河南辉县居民吸烟与心血管病发病风险关联度分析。

方法

利用中国慢性病前瞻性研究项目在河南辉县地区招募的30～79岁研究对象的基线调查和随访数据，使用Cox比例风险回归模型分析研究人群不同吸烟状况与心血管疾病发病风险的关联。

结果

共纳入59 865例研究对象，累积随访586 851.81年,平均随访时间9.20年，随访期间新发心血管疾病17 142例，缺血性心脏病5 959例，缺血性脑卒中7 717例，出血性脑卒中1 387例。男性吸烟率（65.29%）远高于女性（0.34%）。多因素分析结果显示，与非吸烟者相比，吸烟能增加心血管疾病（HR=1.178，95% CI：1.118～1.241）的发病风险，尤其是缺血性心脏病（HR=1.291，95% CI：1.177～1.417）和缺血性脑卒中（HR=1.297，95% CI：1.203～1.398）；在当前规律吸烟者中，每日吸烟量（支/日）≥20支者和开始吸烟年龄<20岁者发生心血管疾病、缺血性心脏病、缺血性脑卒中的风险较高。

结论

吸烟能增加心血管疾病的发病风险，应加强对吸烟行为的控制和干预，遏制我国心血管疾病的流行趋势。

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孙花荣，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=uJPL4Egai5vJOqZGDHRKhQ==, magXml=cDnW8kijVFdKF8tqbjFp/w==, pdfUrl=null, pdf=XDZubgFUz5DwnHFfghH2kQ==, pdfFileSize=565686, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=oA3N4PT7ztE6grGBchzSdg==, mapNumber=null, authorCompany=null, fund=null, authors=

席瑾，主管医师，本科，研究方向：慢性非传染性疾病预防与控制

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席瑾，主管医师，本科，研究方向：慢性非传染性疾病预防与控制

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席瑾，主管医师，本科，研究方向：慢性非传染性疾病预防与控制

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(In Chinese), articleTitle=The china kadoorie biobank: related methodology and baseline characteristics of the participants, refAbstract=null), Reference(id=1241069995522847571, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, doi=null, pmid=null, pmcid=null, year=2015, volume=36, issue=11, pageStart=1200, pageEnd=1204, url=null, language=null, rfNumber=［11］, rfOrder=16, authorNames=王昕, 吕筠, 郭彧, journalName=中华流行病学杂志, refType=null, unstructuredReference=王昕，吕筠，郭彧，等．中国慢性病前瞻性研究：10个项目地区成年人群吸烟行为特征差异分析［J］．中华流行病学杂志, 2015, 36(11): 1200-1204., articleTitle=中国慢性病前瞻性研究：10个项目地区成年人群吸烟行为特征差异分析, refAbstract=null), Reference(id=1241069995627705175, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, doi=null, pmid=null, pmcid=null, year=2015, volume=36, issue=11, pageStart=1200, pageEnd=1204, url=null, language=null, rfNumber=［11］, rfOrder=17, authorNames=Wang X, Lv J, Guo Y, journalName=Chinese Journal of Epidemiology, refType=null, unstructuredReference=Wang X, Lv J, Guo Y, et al. Regional differences in adults’ smoking pattern: findings from China Kadoorie Biobank study in 10 areas in China［J］. Chinese Journal of Epidemiology, 2015, 36(11): 1200-1204. 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Influencing factors of stroke in china: a meta-analysis［J］. Modern Preventive Medicine, 2016, 43(16): 2893-2896. 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Stroke incidence and its risk factors among rural residents in Tianjin: a population-based 28-year prospective cohort study［D］. Tianjin: Medical University Of Tianjin, 2019. (In Chinese), articleTitle=Stroke incidence and its risk factors among rural residents in Tianjin: a population-based 28-year prospective cohort study, refAbstract=null), Reference(id=1241069996185547634, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, doi=null, pmid=null, pmcid=null, year=2021, volume=36, issue=10, pageStart=937, pageEnd=952, url=null, language=null, rfNumber=［14］, rfOrder=22, authorNames=王辰, 肖丹, 池慧, journalName=中国循环杂志, refType=null, unstructuredReference=王辰，肖丹，池慧．《中国吸烟危害健康报告2020》概要［J］．中国循环杂志, 2021, 36(10): 937-952., articleTitle=《中国吸烟危害健康报告2020》概要, refAbstract=null), Reference(id=1241069996282016631, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, doi=null, pmid=null, pmcid=null, year=2021, volume=36, issue=10, pageStart=937, pageEnd=952, url=null, language=null, rfNumber=［14］, rfOrder=23, authorNames=Wang C, Xiao D, Chi H, journalName=Chinese Circulation Journal, refType=null, unstructuredReference=Wang C, Xiao D, Chi H. Summary of the Health Report of Smoking in China 2020［J］. Chinese Circulation Journal, 2021, 36(10): 937-952. (In Chinese), articleTitle=Summary of the Health Report of Smoking in China 2020, refAbstract=null), Reference(id=1241069996441400192, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, doi=null, pmid=null, pmcid=null, year=2022, volume=43, issue=6, pageStart=811, pageEnd=817, url=null, language=null, rfNumber=［15］, rfOrder=24, authorNames=肖琳, 南奕, 邸新博, journalName=中华流行病学杂志, refType=null, unstructuredReference=肖琳，南奕，邸新博，等．2018年中国15岁及以上人群吸烟现况及变化趋势研究［J］．中华流行病学杂志, 2022, 43(6): 811-817., articleTitle=2018年中国15岁及以上人群吸烟现况及变化趋势研究, refAbstract=null), Reference(id=1241069996542063493, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, doi=null, pmid=null, pmcid=null, year=2022, volume=43, issue=6, pageStart=811, pageEnd=817, url=null, language=null, rfNumber=［15］, rfOrder=25, authorNames=Xiao L, Nan Y, Di XB, journalName=Chinese Journal of Epidemiology, refType=null, unstructuredReference=Xiao L, Nan Y, Di XB, et al. Study on smoking behavior and its changes among Chinese people aged 15 years and above in 2018［J］. Chinese Journal of Epidemiology, 2022, 43(6): 811-817. (In Chinese), articleTitle=Study on smoking behavior and its changes among Chinese people aged 15 years and above in 2018, refAbstract=null)], funds=[Fund(id=1241069991546647227, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, awardId=82192900; 82192901; 82192904; 81390540; 91846303, language=CN, fundingSource=国家自然科学基金(82192900; 82192901; 82192904; 81390540; 91846303), fundOrder=null, country=null), Fund(id=1241069991697642178, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, awardId=2016YFC0900500, language=CN, fundingSource=国家重点研发计划精准医学研究重点专项(2016YFC0900500), fundOrder=null, country=null), Fund(id=1241069991848637128, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, awardId=null, language=CN, fundingSource=香港Kadoorie Charitable基金, fundOrder=null, country=null), Fund(id=1241069991978660561, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, awardId=202922/Z/16/Z; 088158/Z/09/Z; 104085/Z/14/Z, language=CN, fundingSource=英国Wellcome Trust(202922/Z/16/Z; 088158/Z/09/Z; 104085/Z/14/Z), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241069982096879737, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, xref=1., ext=[AuthorCompanyExt(id=1241069982105268345, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, companyId=1241069982096879737, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Xinxiang Center for Disease Control and Prevention, Xinxiang, Henan 453000, China), AuthorCompanyExt(id=1241069982113656954, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, companyId=1241069982096879737, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.河南省新乡市疾病预防控制中心，河南 新乡 453000)]), AuthorCompany(id=1241069982218514562, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, xref=2., ext=[AuthorCompanyExt(id=1241069982256263303, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, companyId=1241069982218514562, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.河南省新乡市辉县疾病预防控制中心)]), AuthorCompany(id=1241069982373703818, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, xref=3., ext=[AuthorCompanyExt(id=1241069982382092428, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, companyId=1241069982373703818, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.河南省疾病预防控制中心)]), AuthorCompany(id=1241069982507921558, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, xref=4., ext=[AuthorCompanyExt(id=1241069982520504471, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, companyId=1241069982507921558, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.北京大学公众健康与重大疫情防控战略研究中心)]), AuthorCompany(id=1241069982608584864, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, xref=5., ext=[AuthorCompanyExt(id=1241069982616973472, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, companyId=1241069982608584864, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=5.北京大学公共卫生学院流行病与卫生统计学系)]), AuthorCompany(id=1241069982705053866, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, xref=6., ext=[AuthorCompanyExt(id=1241069982713442474, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, companyId=1241069982705053866, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=6.重大疾病流行病学教育部重点实验室（北京大学）)])], figs=[ArticleFig(id=1241069990628094581, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, language=EN, label=Table 1, caption=

Baseline characteristics of smoking status among different gender populations

, figureFileSmall=null, figureFileBig=null, tableContent=
特征男性吸烟情况女性吸烟情况
非吸烟者
（n=7 362）		已戒烟
（n=1 674）		当前规律吸烟
（n=16 997）		非吸烟者
（n=33 697）		已戒烟
（n=21）		当前规律吸烟
（n=114）
年龄（岁）51.42±11.7653.56±10.9250.67±10.3349.93±9.8858.58±9.3755.62±11.04
婚姻（%）
已婚91.5092.0593.2992.5390.4886.84
其他8.507.956.717.479.5213.16
文化程度（%）
未正规上过小学5.765.734.3818.9342.8626.32
小学29.4934.1130.1138.4233.3347.37
初中41.0639.3744.2831.6619.0518.42
高中及以上23.6920.7921.2310.994.767.89
家庭年收入（元，%）
<10 00042.0437.6938.7041.9042.8646.49
10 000～19 99941.9244.6843.6745.4552.3842.98
20 000～34 99912.9713.6213.5710.564.766.14
≥35 0003.074.004.072.090.004.39
饮酒情况（%）
不饮酒10.088.186.0625.9328.5711.40
偶尔饮酒69.9354.9056.2372.8061.9080.70
已戒酒3.107.357.360.274.761.75
当前饮酒16.9029.5730.351.004.766.14
膳食摄入（每天吃占比%）
新鲜蔬菜3.153.414.710.874.762.63
新鲜水果99.8499.7099.7499.79100.00100.00
红肉类2.422.572.373.094.762.63
体力活动（MET-h/d）22.66±18.9820.71±17.9623.15±19.2215.89±10.9114.61±9.2812.56±8.32
BMI23.96±3.1724.56±3.2623.48±3.1224.74±3.5625.52±3.8724.66±4.25
腰臀比0.92±0.060.93±0.060.92±0.060.89±0.060.92±0.060.91±0.07
闭经---46.7185.7167.54
家族史
急性心梗3.223.173.4828.9633.334.39
脑卒中29.1628.0829.743.069.5220.18
疾病史
高血压6.748.546.528.254.769.65
糖尿病1.862.091.222.529.522.63
), ArticleFig(id=1241069990737146494, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, language=CN, label=表1, caption=

不同性别人群吸烟状况的基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
特征男性吸烟情况女性吸烟情况
非吸烟者
（n=7 362）		已戒烟
（n=1 674）		当前规律吸烟
（n=16 997）		非吸烟者
（n=33 697）		已戒烟
（n=21）		当前规律吸烟
（n=114）
年龄（岁）51.42±11.7653.56±10.9250.67±10.3349.93±9.8858.58±9.3755.62±11.04
婚姻（%）
已婚91.5092.0593.2992.5390.4886.84
其他8.507.956.717.479.5213.16
文化程度（%）
未正规上过小学5.765.734.3818.9342.8626.32
小学29.4934.1130.1138.4233.3347.37
初中41.0639.3744.2831.6619.0518.42
高中及以上23.6920.7921.2310.994.767.89
家庭年收入（元，%）
<10 00042.0437.6938.7041.9042.8646.49
10 000～19 99941.9244.6843.6745.4552.3842.98
20 000～34 99912.9713.6213.5710.564.766.14
≥35 0003.074.004.072.090.004.39
饮酒情况（%）
不饮酒10.088.186.0625.9328.5711.40
偶尔饮酒69.9354.9056.2372.8061.9080.70
已戒酒3.107.357.360.274.761.75
当前饮酒16.9029.5730.351.004.766.14
膳食摄入（每天吃占比%）
新鲜蔬菜3.153.414.710.874.762.63
新鲜水果99.8499.7099.7499.79100.00100.00
红肉类2.422.572.373.094.762.63
体力活动（MET-h/d）22.66±18.9820.71±17.9623.15±19.2215.89±10.9114.61±9.2812.56±8.32
BMI23.96±3.1724.56±3.2623.48±3.1224.74±3.5625.52±3.8724.66±4.25
腰臀比0.92±0.060.93±0.060.92±0.060.89±0.060.92±0.060.91±0.07
闭经---46.7185.7167.54
家族史
急性心梗3.223.173.4828.9633.334.39
脑卒中29.1628.0829.743.069.5220.18
疾病史
高血压6.748.546.528.254.769.65
糖尿病1.862.091.222.529.522.63
), ArticleFig(id=1241069990858781317, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, language=EN, label=Table 2, caption=

Multivariate Cox regression analysis of smoking and the incidence of CVD

, figureFileSmall=null, figureFileBig=null, tableContent=
吸烟心血管疾病
发病例数模型1模型2模型3
基线吸烟状态
非吸烟者11 703111
已戒烟5221.078（0.980～1.187）1.057(0.960～1.164）1.011（0.918～1.113）
当前规律吸烟4 9171.168(1.110～1.230)1.150（1.091～1.211）1.178（1.118～1.241）
每日吸烟量（支/日）
<101 8821.122（1.054～1.194）1.116（1.048～1.188）1.175（1.104～1.251）
10～<209751.123（1.041～1.212）1.111（1.029～1.200）1.131（1.048～1.222）
≥202 0601.242（1.168～1.321）1.208（1.133～1.287）1.205（1.131～1.284）
开始吸烟年龄（岁）
<201 7951.253（1.176～1.336）1.215（1.139～1.297）1.238（1.160～1.321）
20～<251 7551.118（1.049～1.192）1.108（1.039～1.182）1.130（1.059～1.205）
≥251 3671.136（1.061～1.216）1.127（1.052～1.206）1.170（1.093～1.253）
吸烟缺血性心脏病
发病例数模型1模型2模型3
基线吸烟状态
非吸烟者4 163111
已戒烟1781.188（1.007～1.402）1.160（0.982～1.370）1.105（0.935～1.305）
当前规律吸烟16181.279（1.167～1.401）1.258（1.147～1.380）1.291（1.177～1.417）
每日吸烟量（支/日）
<106371.209（1.083～1.348）1.207（1.082～1.348）1.280（1.147～1.429）
10～<203121.206（1.054～1.387）1.189(1.038～1.363)1.221（1.065～1.399）
≥206691.394（1.249～1.555）1.344(1.200～1.505)1.342（1.198～1.503）
开始吸烟年龄（岁）
<205961.422(1.271～1.592)1.379（1.229～1.54701.412（1.259～1.585）
20～<255781.240(1.108～1.388)1.225(1.093～1.373)1.260（1.123～1.412）
≥254441.168(1.036～1.317)1.158(1.026～1.307)1.206（1.068～1.361）
吸烟出血性脑卒中
发病例数模型1模型2模型3
基线吸烟状态
非吸烟者873111
已戒烟601.122（0.844～1.492）1.163（0.873～1.549）1.125（0.845～1.498）
当前规律吸烟4541.003（0.854～1.177）1.015（0.862～1.195）1.043（0.885～1.229）
每日吸烟量（支/日）
<102011.075（0.889～1.300）1.072（0.885～1.299）1.128(0.931～1.367)
10～<20820.874（0.679～1.127）0.899(0.696～1.160)0.918(0.711～1.185)
≥201710.968(0.791～1.185)1.000(0.812～1.231）1.004(0.815～1.237）
开始吸烟年龄（岁）
<201500.974(0.791～1.200)0.974(0.787～1.205)0.999（0.806～1.235）
20～<251610.955(0.779～1.170)0.977(0.795～1.200)1.003（0.816～1.232）
≥251431.062(0.862～1.309)1.089(0.882～1.345)1.131（0.916～1.397）
吸烟缺血性脑卒中
发病例数模型1模型2模型3
基线吸烟状态
非吸烟者4989111
已戒烟2471.042（0.906～1.197）1.030（0.896～1.185）0.988（0.859～1.136）
当前规律吸烟24811.265（1.176～1.362）1.252（1.162～1.349）1.297（1.203～1.398）
每日吸烟量（支/日）
<109641.179(1.080～1.289)1.168(1.068～1.276)1.243（1.137～1.359）
10～<204901.226(1.101～1.367)1.224(1.097～1.365）1.251（1.121～1.395）
≥2010271.402(1.283～1.532)1.391（1.270～1.525）1.401（1.279～1.536）
开始吸烟年龄（岁）
<208821.367(1.247～1.498)1.336(1.217～1.467)1.376（1.252～1.511）
20～<258821.223(1.117～1.340)1.217(1.110～1.335)1.252(1.142～1.374)
≥257171.224(1.112～1.346)1.222(1.110～1.346)1.280(1.162～1.409)
), ArticleFig(id=1241069990976221839, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, language=CN, label=表2, caption=

研究人群吸烟状况与心血管疾病发病风险的多因素Cox分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
吸烟心血管疾病
发病例数模型1模型2模型3
基线吸烟状态
非吸烟者11 703111
已戒烟5221.078（0.980～1.187）1.057(0.960～1.164）1.011（0.918～1.113）
当前规律吸烟4 9171.168(1.110～1.230)1.150（1.091～1.211）1.178（1.118～1.241）
每日吸烟量（支/日）
<101 8821.122（1.054～1.194）1.116（1.048～1.188）1.175（1.104～1.251）
10～<209751.123（1.041～1.212）1.111（1.029～1.200）1.131（1.048～1.222）
≥202 0601.242（1.168～1.321）1.208（1.133～1.287）1.205（1.131～1.284）
开始吸烟年龄（岁）
<201 7951.253（1.176～1.336）1.215（1.139～1.297）1.238（1.160～1.321）
20～<251 7551.118（1.049～1.192）1.108（1.039～1.182）1.130（1.059～1.205）
≥251 3671.136（1.061～1.216）1.127（1.052～1.206）1.170（1.093～1.253）
吸烟缺血性心脏病
发病例数模型1模型2模型3
基线吸烟状态
非吸烟者4 163111
已戒烟1781.188（1.007～1.402）1.160（0.982～1.370）1.105（0.935～1.305）
当前规律吸烟16181.279（1.167～1.401）1.258（1.147～1.380）1.291（1.177～1.417）
每日吸烟量（支/日）
<106371.209（1.083～1.348）1.207（1.082～1.348）1.280（1.147～1.429）
10～<203121.206（1.054～1.387）1.189(1.038～1.363)1.221（1.065～1.399）
≥206691.394（1.249～1.555）1.344(1.200～1.505)1.342（1.198～1.503）
开始吸烟年龄（岁）
<205961.422(1.271～1.592)1.379（1.229～1.54701.412（1.259～1.585）
20～<255781.240(1.108～1.388)1.225(1.093～1.373)1.260（1.123～1.412）
≥254441.168(1.036～1.317)1.158(1.026～1.307)1.206（1.068～1.361）
吸烟出血性脑卒中
发病例数模型1模型2模型3
基线吸烟状态
非吸烟者873111
已戒烟601.122（0.844～1.492）1.163（0.873～1.549）1.125（0.845～1.498）
当前规律吸烟4541.003（0.854～1.177）1.015（0.862～1.195）1.043（0.885～1.229）
每日吸烟量（支/日）
<102011.075（0.889～1.300）1.072（0.885～1.299）1.128(0.931～1.367)
10～<20820.874（0.679～1.127）0.899(0.696～1.160)0.918(0.711～1.185)
≥201710.968(0.791～1.185)1.000(0.812～1.231）1.004(0.815～1.237）
开始吸烟年龄（岁）
<201500.974(0.791～1.200)0.974(0.787～1.205)0.999（0.806～1.235）
20～<251610.955(0.779～1.170)0.977(0.795～1.200)1.003（0.816～1.232）
≥251431.062(0.862～1.309)1.089(0.882～1.345)1.131（0.916～1.397）
吸烟缺血性脑卒中
发病例数模型1模型2模型3
基线吸烟状态
非吸烟者4989111
已戒烟2471.042（0.906～1.197）1.030（0.896～1.185）0.988（0.859～1.136）
当前规律吸烟24811.265（1.176～1.362）1.252（1.162～1.349）1.297（1.203～1.398）
每日吸烟量（支/日）
<109641.179(1.080～1.289)1.168(1.068～1.276)1.243（1.137～1.359）
10～<204901.226(1.101～1.367)1.224(1.097～1.365）1.251（1.121～1.395）
≥2010271.402(1.283～1.532)1.391（1.270～1.525）1.401（1.279～1.536）
开始吸烟年龄（岁）
<208821.367(1.247～1.498)1.336(1.217～1.467)1.376（1.252～1.511）
20～<258821.223(1.117～1.340)1.217(1.110～1.335)1.252(1.142～1.374)
≥257171.224(1.112～1.346)1.222(1.110～1.346)1.280(1.162～1.409)
), ArticleFig(id=1241069991110439578, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, language=EN, label=Table 3, caption=

Multivariate Cox regression analysis of smoking and the incidence of CVD in male

, figureFileSmall=null, figureFileBig=null, tableContent=
吸烟心血管疾病缺血性心脏病
发病例数HR值（95% CI)发病例数HR值（95% CI)
基线吸烟状态
非吸烟者1 99816151
已戒烟5141.020（0.925～1.125）1731.088（0.918～1.291）
当前规律吸烟4 8731.190（1.128～1.255）1 5981.280（1.163～1.409）
每日吸烟量（支/日）
<101 7891.163（1.091～1.241）5941.256（1.122～1.407）
10～<2017521.150（1.064～1.244）5771.215（1.057～1.397）
≥201 3321.247（1.169～1.331）4271.353（1.204～1.521）
开始吸烟年龄（岁）
<201 8531.267（1.186～1.355）6251.414（1.256～1.591）
20～<259631.150（1.077～1.228）3061.261（1.122～1.416）
≥252 0571.162(1.084～1.247)6671.179（1.041～1.336）
吸烟出血性脑卒中缺血性脑卒中
发病例数HR值（95% CI)发病例数HR值（95% CI)
基线吸烟状态
非吸烟者21919571
已戒烟581.083（0.809～1.451）2461.004（0.871～1.156）
当前规律吸烟4511.045（0.884～1.235）2 4591.303（1.207～1.408）
每日吸烟量（支/日）
<101501.115（0.917～1.355）8801.241（1.133～1.359）
10～<201610.933（0.720～1.219）8801.255（1.123～1.403）
≥201401.032(0.834～1.277）6991.407（1.281～1.545）
开始吸烟年龄（岁）
<201991.010（0.813～1.255）9471.388（1.261～1.528）
20～<25811.021（0.829～1.258）4861.254（1.142～1.377）
≥251711.124（0.907～1.394）1 0261.273（1.153～1.405）
), ArticleFig(id=1241069991253045925, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241035552527536697, language=CN, label=表3, caption=

男性吸烟状况与心血管疾病发病风险的多因素Cox分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
吸烟心血管疾病缺血性心脏病
发病例数HR值（95% CI)发病例数HR值（95% CI)
基线吸烟状态
非吸烟者1 99816151
已戒烟5141.020（0.925～1.125）1731.088（0.918～1.291）
当前规律吸烟4 8731.190（1.128～1.255）1 5981.280（1.163～1.409）
每日吸烟量（支/日）
<101 7891.163（1.091～1.241）5941.256（1.122～1.407）
10～<2017521.150（1.064～1.244）5771.215（1.057～1.397）
≥201 3321.247（1.169～1.331）4271.353（1.204～1.521）
开始吸烟年龄（岁）
<201 8531.267（1.186～1.355）6251.414（1.256～1.591）
20～<259631.150（1.077～1.228）3061.261（1.122～1.416）
≥252 0571.162(1.084～1.247)6671.179（1.041～1.336）
吸烟出血性脑卒中缺血性脑卒中
发病例数HR值（95% CI)发病例数HR值（95% CI)
基线吸烟状态
非吸烟者21919571
已戒烟581.083（0.809～1.451）2461.004（0.871～1.156）
当前规律吸烟4511.045（0.884～1.235）2 4591.303（1.207～1.408）
每日吸烟量（支/日）
<101501.115（0.917～1.355）8801.241（1.133～1.359）
10～<201610.933（0.720～1.219）8801.255（1.123～1.403）
≥201401.032(0.834～1.277）6991.407（1.281～1.545）
开始吸烟年龄（岁）
<201991.010（0.813～1.255）9471.388（1.261～1.528）
20～<25811.021（0.829～1.258）4861.254（1.142～1.377）
≥251711.124（0.907～1.394）1 0261.273（1.153～1.405）
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河南辉县地区30～79岁人群吸烟与心血管疾病发病风险的前瞻性研究
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席瑾 1 , 孙花荣 2 , 姜琳珂 1 , 杜永芳 1 , 冯石献 3 , 栾旭波 1 , 穆永娟 1 , 郭晓新 1 , 裴培 4 , 孙点剑一 4, 5, 6
现代预防医学 | 流行病与统计方法 2024,51(24): 4429-4434
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现代预防医学 | 流行病与统计方法 2024, 51(24): 4429-4434
河南辉县地区30～79岁人群吸烟与心血管疾病发病风险的前瞻性研究
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席瑾1, 孙花荣2 , 姜琳珂1, 杜永芳1, 冯石献3, 栾旭波1, 穆永娟1, 郭晓新1, 裴培4, 孙点剑一4, 5, 6
作者信息
  • 1.河南省新乡市疾病预防控制中心，河南 新乡 453000
  • 2.河南省新乡市辉县疾病预防控制中心
  • 3.河南省疾病预防控制中心
  • 4.北京大学公众健康与重大疫情防控战略研究中心
  • 5.北京大学公共卫生学院流行病与卫生统计学系
  • 6.重大疾病流行病学教育部重点实验室（北京大学）

    • 席瑾，主管医师，本科，研究方向：慢性非传染性疾病预防与控制

通讯作者:

孙花荣，E-mail:
Prospective study on smoking status and the risk of cardiovascular disease among Huixian resident aged 30-79 years, Henan
Jin XI1, Hua-rong SUN2 , Lin-ke JIANG1, Yong-fang DU1, Shi-xian FENG3, Xu-bo LUAN1, Yong-juan MU1, Xiao-xin GUO1, pei PEI4, Dian-jian-yi SUN4, 5, 6
Affiliations
  • Xinxiang Center for Disease Control and Prevention, Xinxiang, Henan 453000, China
出版时间: 2024-12-25 doi: 10.20043/j.cnki.MPM.202408181
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摘要
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目的

河南辉县居民吸烟与心血管病发病风险关联度分析。

方法

利用中国慢性病前瞻性研究项目在河南辉县地区招募的30～79岁研究对象的基线调查和随访数据，使用Cox比例风险回归模型分析研究人群不同吸烟状况与心血管疾病发病风险的关联。

结果

共纳入59 865例研究对象，累积随访586 851.81年,平均随访时间9.20年，随访期间新发心血管疾病17 142例，缺血性心脏病5 959例，缺血性脑卒中7 717例，出血性脑卒中1 387例。男性吸烟率（65.29%）远高于女性（0.34%）。多因素分析结果显示，与非吸烟者相比，吸烟能增加心血管疾病（HR=1.178，95% CI：1.118～1.241）的发病风险，尤其是缺血性心脏病（HR=1.291，95% CI：1.177～1.417）和缺血性脑卒中（HR=1.297，95% CI：1.203～1.398）；在当前规律吸烟者中，每日吸烟量（支/日）≥20支者和开始吸烟年龄<20岁者发生心血管疾病、缺血性心脏病、缺血性脑卒中的风险较高。

结论

吸烟能增加心血管疾病的发病风险，应加强对吸烟行为的控制和干预，遏制我国心血管疾病的流行趋势。

吸烟  /  心血管疾病  /  队列研究
Objective

To analyze the relationship between smoking status and risk of cardiovascular diseases among Henan Huixian residents.

Methods

The baseline survey data and follow-up data of participants aged 30-79 years recruited in Huixian County, Henan, through the China Chronic Disease Prospective Research Project were used. Cox proportional hazard regression models were used to analyze the association between smoking status and risk of cardiovascular diseases.

Results

A total of 59 865 cases were included in the cohort and followed up for a total of 586 851.81 person years (average 9.20 years). We documented 17 142 cases of cardiovascular diseases, 5 959 cases of ischemic heart diseases, 7 717 cases of cerebral infarction and 1 387 cases of intracerebral hemorrhage. The smoking rate of men (65.29%) was much higher than that of women (0.34%). Cox multivariate analysis showed, compared with nonsmokers, current smokers had higher risk of cardiovascular diseases (HR=1.178, 95% CI: 1.118-1.241), ischemic heart diseases (HR=1.291, 95% CI: 1.177-1.417) and cerebral infarction (HR=1.297, 95% CI: 1.203-1.398). Among current smokers, those who smoked more than 20 cigarettes per day or those who started smoking at the age of less than 20 years old had higher risk of cardiovascular diseases, ischemic heart diseases and cerebral infarction.

Conclusion

Smoking can effectively decrease the risk of cardiovascular diseases. It is necessary to strengthen the control and intervention of smoking behavior in order to curb the epidemic trend of cardiovascular disease.

Smoking  /  Cardiovascular diseases  /  Cohort study
席瑾, 孙花荣, 姜琳珂, 杜永芳, 冯石献, 栾旭波, 穆永娟, 郭晓新, 裴培, 孙点剑一. 河南辉县地区30～79岁人群吸烟与心血管疾病发病风险的前瞻性研究. 现代预防医学, 2024 , 51 (24) : 4429 -4434 . DOI: 10.20043/j.cnki.MPM.202408181
Jin XI, Hua-rong SUN, Lin-ke JIANG, Yong-fang DU, Shi-xian FENG, Xu-bo LUAN, Yong-juan MU, Xiao-xin GUO, pei PEI, Dian-jian-yi SUN. Prospective study on smoking status and the risk of cardiovascular disease among Huixian resident aged 30-79 years, Henan[J]. Modern Preventive Medicine, 2024 , 51 (24) : 4429 -4434 . DOI: 10.20043/j.cnki.MPM.202408181
正文
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心血管疾病（CVD）是我国居民死亡的首位原因，平均每5例死亡就有2例归因于CVD。目前我国CVD发病率和死亡率仍在逐年攀升，疾病负担不断加重[1-2]。大量研究表明吸烟是CVD发病和死亡的重要行为危险因素，但国内关于吸烟与CVD发病的大规模、长随访、数据完善的队列研究有限[3-7]，本研究利用中国慢性病前瞻性研究项目（CKB）在河南辉县的调查数据，探究吸烟与心血管疾病发病风险间的前瞻性关联。
1 对象与方法
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1.1 研究对象
本研究依托河南辉县CKB项目，招募30～79岁自愿参加项目的常住居民，于2004—2008年完成基线调查[8-10]，共63 356名研究对象进入队列。剔除自报患有恶性肿瘤、冠心病、脑卒中、闭经情况缺失的研究对象，最终59 865人纳入分析。
本研究经过中国疾病预防控制中心伦理审查委员会批准，审批号005/2004，所有研究对象均享有知情同意权并签署了知情同意书。
1.2 调查内容和方法
基线调查包括问卷调查、健康检查。问卷调查由调查员面对面询问研究对象，包括社会人口学特征（年龄、文化程度等）、健康相关行为（吸烟、饮酒、膳食、体力活动等）、健康状况（疾病史、家族史）。健康检查包括身高、体重、腰围等，由培训合格的调查员按照规范要求使用统一采购和调试的器材进行测量。
1.3 变量定义
吸烟分为非吸烟者、已戒烟、当前规律吸烟[11]，其中因病戒烟者积累的吸烟危害已增加了心血管疾病的发病风险，因此将因病戒烟者归为当前规律吸烟；吸烟者每日吸烟量=(过滤嘴香烟量+无滤嘴香烟量+2×雪茄量)+5/3×(手卷烟/旱烟量+烟斗/水烟量)。膳食摄入（红肉、蔬菜、水果）是指过去一年内调查对象的食用频率，分为几乎不吃、1～3次/月、1～3次/周、4～6次/周、每天吃。
1.4 发病结局
通过河南省慢病监测信息管理系统、死因登记报告信息系统、医保信息系统、社区定向监测等多种途径收集除非致死性高血压外的心血管疾病（I00-I09，I16-I25，I27-I88，I95-I99）、缺血性心脏病（I20-I25）、出血性脑卒中(I61)和缺血性脑卒中(163)。
1.5 统计分析
使用SPSS 22.0进行统计分析。计量资料以均数±标准差（$\overline{x}\pm s$）表示，组间比较采用方差检验；计数资料以构成比（%）表示，组间比较采用卡方检验。计算随访人年数和发病密度，随访人年数是从调查对象完成基线调查开始到CVD发病或失访、死亡或随访截止日期2017年12月31日（以最早发生的事件为准）。多因素Cox回归分析调整可能的混杂因素，评估吸烟与心血管疾病发病风险的关系，检验水准ɑ=0.05。
2 结果
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2.1 基本情况
纳入分析共59 865例。平均年龄（50.43±10.32）岁；男性26 033例，女性33 832例，男女比1∶1.30；按基线吸烟状态分为非吸烟者（41 059人）、已戒烟（1 695人）和当前规律吸烟（17 111人）；三组的年龄、婚姻状况、文化程度、家庭年收入、饮酒情况，新鲜水果、红肉类膳食摄入，腰围、BMI、腰臀比，高血压、糖尿病患病情况以及急性心梗/脑中风家族史差异有统计学意义（P值均<0.05）。男性吸烟率65.29%远高于女性0.34%，男性吸烟者每天吸烟量为(15.31±10.79)支，开始吸烟年龄为(22.19±7.38)岁；女性吸烟者的每天吸烟量为(8.20±7.74)支，开始吸烟年龄为(32.94±13.11)岁。见表1。
2.2 吸烟与心血管病发病风险的关联分析
累积随访586 851.81年，平均随访时间9.20年。共观察到CVD发病17 142例，缺血性心脏病5 959例，缺血性脑卒中7 717例，出血性脑卒中1 387例。多因素Cox回归分析纳入可能存在的混杂因素，Cox比例风险模型成立（P<0.001）。结果显示与非吸烟者相比，当前规律吸烟者发生心血管疾病（HR=1.178）、缺血性心脏病（HR=1.291）、缺血性脑卒中（HR=1.297）的风险较高；发生出血性卒中的风险差异尚无统计学意义（P<0.05）。未发现戒烟者与非吸烟者发生各类CVD疾病风险的关联（P<0.05）。在当前规律吸烟者中，每日吸烟量（支/日）≥20支者发生心血管疾病（HR=1.205）、缺血性心脏病（HR=1.342）、缺血性脑卒中（HR=1.401）的风险较高；且每日吸烟量越大，发生缺血性脑卒中的风险越高（χ趋势2=42.749，P<0.05)。开始吸烟年龄<20岁者发生心血管疾病（HR=1.238）、缺血性心脏病（HR=1.412）、缺血性脑卒中（HR=1.376）的风险较高；开始吸烟年龄越早，发生缺血性心脏病的风险越高（χ趋势2=12.906，P<0.05)。见表2。
2.3 男性吸烟与心血管病发病风险的多因素Cox回归分析
与全人群分析结果一致，男性吸烟者，特别是每日吸烟量≥20支者、开始吸烟年龄<20岁的当前规律吸烟者发生心血管疾病、缺血性心脏病、缺血性脑卒中的风险较高。
2.4 敏感性分析
剔除随访时间不足2年的发病者，进一步调整二手烟暴露情况，重复多因素Cox回归模型，结果无明显差异。
3 讨论
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我国是烟草消费大国，由此引发的疾病负担和经济成本极为沉重。河南辉县2004—2017年的研究队列中调查人群吸烟率（28.58%）整体基本与全国[3]一致，其中男性吸烟率65.29%，有46.08%的吸烟者每日吸烟量≥20支。提示我市30～79岁人群的吸烟行为较为普遍，特别是男性，重度吸烟者比例较高，控烟难度较大。吸烟作为一种可干预的行为危险因素，应加强控烟宣传和措施。
队列研究以心血管疾病发病作为结局事件，探讨吸烟与CVD发病风险的关联，结论显示吸烟能增加心血管疾病的发病风险，尤其是缺血性心脏病和缺血性脑卒中，与国内其它研究一致[3-7]。可能与香烟烟雾损伤内皮能诱导炎性介质释放，破坏内皮细胞，促进动脉粥样硬化斑块和血栓形成有关[12]。
多因素分析未发现吸烟与出血性脑卒中的发病风险关联。目前国内关于吸烟与出血性脑卒中的研究结果不太一致，2018年全国研究[3]显示吸烟者与出血性脑卒中存在正向关联（HR=1.07，95% CI：1.00～1.15）；2020年海南省[5]、2019年天津[13]、2019年中老年队列[6]中吸烟与出血性脑卒中的HR值与本研究接近，但无统计学意义。出现不同结论的原因可能是吸烟会引起血脂异常[14]，增加血液的高凝性[6]，导致吸烟对出血性脑卒中作用较弱；研究设计引起的统计偏倚；研究人群遗传背景、生活方式或环境影响的不同。
与非吸烟者相比，每日吸烟量（支/日）≥20支的当前规律吸烟者发生心血管疾病、缺血性心脏病、缺血性脑卒中的风险分别增加了20%、34%、40%；且每日吸烟量与缺血性脑卒中的发病风险存在剂量反应关系。本研究未探讨累计吸烟量与CVD发病事件的关系，可能存在吸烟时间不同，累计的吸烟危害不同，不能准确的反映出累计吸烟危害与CVD发病事件发病风险间的剂量反应关系。
与非吸烟者相比，开始吸烟<20岁的当前规律吸烟者发生心血管疾病、缺血性心脏病、缺血性脑卒中的风险分别增加了24%、41%、38%。开始吸烟年龄过早，是诱发心血管疾病的重要危险因素，本研究中38.89%的吸烟者开始吸烟年龄<20岁，提示我市居民对烟草的认知和危害知晓率较低，特别是青少年，应尽快普及过早吸烟的危害，提高控烟意识。
本研究采用大样本、长随访、基线数据完整的前瞻性队列探讨吸烟与CVD发病关联，但也存在一定的局限性：问卷调查收集基线数据，不可规避回忆偏倚；未考虑随访期间研究人群吸烟状况的变化；研究对象自报患病情况，可能存在部分已患病未确诊的情况，造成混杂偏倚。
本研究结果提示，吸烟能增加心血管疾病的发病风险，尤其是缺血性心脏病和缺血性脑卒中。加强对吸烟行为的控制和干预，对遏制我国心血管疾病的流行趋势[14-15]具有重要意义。
基金
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  • 国家自然科学基金(82192900; 82192901; 82192904; 81390540; 91846303)
  • 国家重点研发计划精准医学研究重点专项(2016YFC0900500)
  • 香港Kadoorie Charitable基金
  • 英国Wellcome Trust(202922/Z/16/Z; 088158/Z/09/Z; 104085/Z/14/Z)
文献
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2024年第51卷第24期
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doi: 10.20043/j.cnki.MPM.202408181
  • 接收时间：2024-08-14
  • 首发时间：2026-03-18
  • 出版时间：2024-12-25
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  • 收稿日期：2024-08-14
基金
国家自然科学基金(82192900; 82192901; 82192904; 81390540; 91846303)
国家重点研发计划精准医学研究重点专项(2016YFC0900500)
香港Kadoorie Charitable基金
英国Wellcome Trust(202922/Z/16/Z; 088158/Z/09/Z; 104085/Z/14/Z)
作者信息
    1.河南省新乡市疾病预防控制中心，河南 新乡 453000
    2.河南省新乡市辉县疾病预防控制中心
    3.河南省疾病预防控制中心
    4.北京大学公众健康与重大疫情防控战略研究中心
    5.北京大学公共卫生学院流行病与卫生统计学系
    6.重大疾病流行病学教育部重点实验室（北京大学）

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孙花荣，E-mail:
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https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202408181
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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