Email Alert | RSS

北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (6): 993-999. doi: 10.19723/j.issn.1671-167X.2023.06.006

• 论著 • 上一篇    下一篇

体重指数与类风湿关节炎临床特征的相关性分析

张警丰,金银姬,魏慧,姚中强,赵金霞*()   

  1. 北京大学第三医院风湿免疫科, 北京 100191
  • 收稿日期:2023-08-18 出版日期:2023-12-18 发布日期:2023-12-11
  • 通讯作者: 赵金霞 E-mail:zhao-jinxia@163.com
  • 基金资助:
    北京大学第三医院临床队列建设项目(BYSYDL2022017)

Correlation analysis between body mass index and clinical characteristics of rheumatoid arthritis

Jing-feng ZHANG,Yin-ji JIN,Hui WEI,Zhong-qiang YAO,Jin-xia ZHAO*()   

  1. Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-08-18 Online:2023-12-18 Published:2023-12-11
  • Contact: Jin-xia ZHAO E-mail:zhao-jinxia@163.com
  • Supported by:
    the Clinical Cohort Construction Program of Peking University Third Hospital(BYSYDL2022017)

RICH HTML

 6   

PDF (PC)

148

摘要：

目的: 分析超重和肥胖类风湿关节炎(rheumatoid arthritis，RA)患者的临床特点，并分析体重指数(body mass index，BMI)与疾病特征的相关性。方法: 回顾性收集2015年1月至2020年12月于北京大学第三医院风湿免疫科住院的RA患者的病例资料，包括人口学特征、疾病活动度、关节外表现、合并症、实验室指标和治疗用药等。根据WHO定义，BMI≥30 kg/m2为肥胖组，25≤BMI < 30 kg/m2为超重组，18.5≤BMI < 25 kg/m2为体质量正常组，BMI < 18.5 kg/m2为体质量减低组。分析超重和肥胖RA患者的临床特征。统计学方法符合正态分布的定量资料采用 t检验，非正态分布的定量资料采用Wilcoxon秩和检验。定性资料采用χ2检验，1≤理论频数 < 5采用校正四格表χ2检验，理论频数 < 1采用确切概率法。采用Logistic回归校正混杂因素分析超重和肥胖是否与合并症有关。结果: 共纳入481例RA患者，平均BMI值为(23.28±3.75) kg/m2。BMI < 18.5 kg/m2 31例(6.5%)，18.5≤BMI < 25 kg/m2 309例(64.2%)，合计340例(70.7%)。超重者(25≤BMI < 30 kg/m2)119例(24.7%)，肥胖者(BMI≥30 kg/m2)22例(4.6%)，两者合计141例(29.3%)。超重和肥胖RA患者罹患高血压(57.4% vs. 39.1%，P < 0.001)、糖尿病(25.5% vs. 15.0%，P=0.006)、高脂血症(22.7% vs. 10.9%，P=0.001)、脂肪肝(28.4% vs. 7.4%，P < 0.001)、骨关节炎(39.0% vs. 29.4%，P=0.040)的比例较体质量正常和减低者明显增高，合并骨质疏松(59.6% vs. 70.9%，P=0.016)、贫血(36.2% vs. 55.6%，P < 0.001)的比例较体质量正常和减低者明显降低，但两者在合并冠状动脉性心脏病(5.7 % vs. 7.6%，P=0.442)、脑血管疾病(6.4% vs. 8.8%，P=0.372)以及外周动脉粥样硬化(9.2% vs. 7.6%，P=0.565)方面差异则无统计学意义。超重和肥胖RA患者的中位C反应蛋白(C- reactive protein，CRP，1.52 mg/dL vs. 2.35 mg/dL，P=0.008)、中位红细胞沉降率(erythrocyte sedimentation rate，ESR，34.0 mm/h vs. 50.0 mm/h，P=0.003)、疼痛视觉模拟评分(visual analogue scale，VAS，3.66±3.08 vs. 4.40±2.85, P=0.011)以及28个关节疾病活动度评分(disease activity score 28，DAS28，5.05±1.60 vs. 5.45±1.52，P=0.010)均低于体质量正常和减低组。多因素回归分析发现超重和肥胖是高血压、糖尿病、高脂血症、脂肪肝的独立危险因素，同时对骨质疏松和贫血具有保护性作用。结论: RA患者中超重和肥胖者疾病活动度更低，超重和肥胖与高血压、糖尿病、高脂血症具有相关性，但与心脑血管疾病不具有相关性。

关键词: 类风湿关节炎, 体重指数, 疾病活动度

Abstract:

Objective: To analyze the clinical features of overweight and obese rheumatoid arthritis (RA)patients, and the relationship between body mass index (BMI) and disease characteristics. Methods: The demographic data, extra-articular manifestations, comorbidities, and disease activity of RA patients admitted to the Rheumatology and Immunology Department of Peking University Third Hospital from January 2015 to December 2020 were collected, and the above characteristics of overweight and obese RA patients were retrospectively analyzed. According to the WHO, BMI≥30 kg/m2 referred to obese individuals, 25≤BMI < 30 kg/m2 referred to overweight individuals, 18.5≤BMI < 25 kg/m2 referred to normal individuals, BMI < 18.5 kg/m2 referred to reduced body mass individuals. t test was used for the quantitative data in accordance with normal distribution. Wilcoxon rank sum test was used for the quantitative data of non-normal distribution. The qualitative data were analyzed by chi square test. But while 1≤theoretical frequency < 5, Chi square test of corrected four grid table was used. And Fisher exact probability method was used when theoretical frequency < 1. Analyzing whether overweight or obesity was associated with comorbidities using Logistic regression adjusted confounding factors. Results: A total of 481 RA patients were included in this study, with an average BMI value of (23.28±3.75) kg/m2.Of the patients, 31 cases (6.5%) were with BMI < 18.5 kg/m2, 309 cases (64.2%) with 18.5≤ BMI < 25 kg/m2, amounting to 340 cases (70.7%). There were 119 overweight individuals (25≤ BMI < 30 kg/m2, 24.7%) and 22 obese individuals (BMI≥30 kg/m2, 4.6%), totaling 141 (29.3%).The proportion of the overweight and obese RA patients suffering from hypertension (57.4% vs. 39.1%, P < 0.001), diabetes (25.5% vs. 15.0%, P=0.006), hyperlipidemia (22.7% vs. 10.9%, P=0.001), fatty liver (28.4% vs. 7.4%, P < 0.001), osteoarthritis (39.0% vs. 29.4%, P=0.040) was significantly higher, and the proportion of the patients with osteoporosis(59.6% vs. 70.9%, P=0.016) and anemia (36.2% vs. 55.6%, P < 0.001) was significantly lower. However, there was no difference between the two groups in coronary heart disease (5.7% vs. 7.6%, P=0.442), cerebrovascular disease (6.4% vs. 8.8%, P=0.372) and peripheral atherosclerosis (9.2% vs. 7.6%, P=0.565).The median C-reactive protein (CRP, 1.52 mg/dL vs. 2.35 mg/dL, P=0.008), median erythrocyte sedimentation rate (ESR, 34.0 mm/h vs. 50.0 mm/h, P=0.003), pain visual simulation score (VAS) (3.66±3.08 vs. 4.40±2.85, P=0.011), and 28 joint disease activity scores (DAS-28, 5.05±1.60 vs. 5.45±1.52, P=0.010) in the overweight and obese RA group were all lower than those in the normal and reduced weight groups. Multivariate regression analysis showed that overweight and obesity was an independent risk factor for hypertension, diabetes, hyperlipidemia and fatty liver, and had protective effects on osteoporosis and anemia. Conclusion: In RA patients, RA disease activity is lower in overweight and obesity patients. Overweight and obesity is associated with hypertension, diabetes and hyperlipidemia, but not with cardiovascular and cerebrovascular diseases.

Key words: Rheumatoid arthritis, Body mass index, Disease activity

中图分类号: 

  • R593.2

表1

超重和肥胖与体质量正常和减低RA患者人口学资料及疾病特点比较"

Items Total BMI＜25 kg/m2 BMI≥25 kg/m2 t/Z/χ2 P
Age/years, $\bar x \pm s$ 58.6±14.1 58.6±15.0 58.7±11.8 -0.135 0.893
Age of onset/years, $\bar x \pm s$ 49.8±15.8 49.9±16.2 49.7±14.7 0.067 0.947
Course of disease /years, M(IQR) 5.0 (12.0) 5.0 (13.0) 5.0 (12.0) -0.270 0.787
Women, n (%) 356 (74.0) 246 (72.4) 110 (78.0) 1.661 0.198
Men, n (%) 125 (26.0) 94 (27.6) 31 (22.0) 1.661 0.198
Smoking, n (%) 90 (18.7) 67 (19.7) 23 (16.3) 0.755 0.385

表2

超重和肥胖与体质量正常和减低RA患者疾病活动度及治疗情况的比较"

Items Total BMI＜25 kg/m2 BMI≥25 kg/m2 t/Z P
CRP/(mg/dL), M(IQR) 2.12 (5.77) 2.35 (6.53) 1.52 (3.61) -2.665 0.008
ESR/(mm/h), M(IQR) 43.0 (54.0) 50.0 (54.0) 34.0 (50.8) -2.953 0.003
TJC, M(IQR) 10.0 (17.0) 10.0 (16.0) 9.0 (18.0) -1.352 0.176
SJC, M(IQR) 5.0 (11.0) 5.5 (12.0) 4.0 (11.0) -1.521 0.128
VAS, $\bar x \pm s$ 4.18±2.93 4.40±2.85 3.66±3.08 2.551 0.011
DAS28, $\bar x \pm s$ 5.34±1.55 5.45±1.52 5.05±1.60 2.602 0.010
Bone erosion, n (%) 125 (33.1) 92 (35.2) 33 (28.2) 1.811 0.195
DMARDs, n (%) 453 (94.2) 320 (94.1) 133 (94.3) 0.008 0.929
NSAIDs, n (%) 170 (35.3) 120 (35.3) 50 (35.5) 0.001 0.972
GC, n (%) 226 (47) 157 (46.2) 69 (48.9) 0.305 0.581
Biologic agent, n (%) 31 (6.5) 21 (6.2) 10 (7.1) 0.133 0.716

表3

超重和肥胖与体质量正常和减低RA患者关节外表现的比较"

Total BMI＜25 kg/m2 BMI≥25 kg/m2 χ2 P
Rheumatoid vasculitis, n (%) 2 (0.4) 2 (0.6) 0 (0.0) 0.833 >0.999
Rheumatoid nodules, n (%) 28 (5.8) 21 (6.2) 7 (5.0) 0.267 0.605
Peripheral neuropathy, n (%) 9 (1.9) 8 (2.4) 1 (0.7) 1.467 0.294
Pericarditis, n (%) 10 (2.1) 7 (2.1) 3 (2.1) 0.002 1.000
Pleural effusion, n (%) 15 (3.1) 9 (2.6) 6 (4.3) 0.853 0.391
Interstitial lung disease, n (%) 103 (21.4) 72 (21.2) 31 (22.0) 0.039 0.844
Anemia, n (%) 240 (49.9) 189 (55.6) 51 (36.2) 15.032 < 0.001

表4

超重和肥胖与体质量正常和减低RA患者实验室检查比较"

Items Total BMI＜25 kg/m2 BMI≥25 kg/m2 t/Z P
White blood cell /(109/L)，$\bar x \pm s$ 6.9±2.6 6.8±2.7 7.2±2.4 -1.349 0.178
Hemoglobin/(g/L), $\bar x \pm s$ 112.0±17.9 110.3±17.1 116.0±19.1 -3.158 0.002
Platelet/(109/L), M(IQR) 263 (141.5) 259 (146) 274 (128) -0.905 0.365
Total cholesterol/(mmol/L), $\bar x \pm s$ 4.3±1.0 4.2±1.0 4.5±1.1 -2.790 0.006
Triglyceride/(mmol/L), $\bar x \pm s$ 1.3±0.8 1.3±0.8 1.4±0.7 -1.839 0.067
Low-density lipoprotein cholesterol/(mmol/L), $\bar x \pm s$ 2.7±0.8 2.6±0.8 2.9±0.8 -2.879 0.004
High-density lipoprotein cholesterol/(mmol/L), $\bar x \pm s$ 1.1±0.3 1.1±0.3 1.1±0.4 -1.070 0.285
RF positive, n (%) 322 (66.9) 230 (67, 6) 92 (65.2) 0.259 0.611
Anti-CCP positive, n (%) 331 (68.8) 235 (69.1) 96 (68.1) 0.050 0.824

表5

超重和肥胖与体质量正常和减低RA患者合并症的比较"

Items Total BMI＜25 kg/m2 BMI≥25 kg/m2 χ2 P
Hypertension, n (%) 214 (44.5) 133 (39.1) 81 (57.4) 13.558 < 0.001
Diabetes mellitus, n (%) 87 (18.1) 51 (15.0) 36 (25.5) 7.462 0.006
Hyperlipidemia, n (%) 69 (14.3) 37 (10.9) 32 (22.7) 11.319 0.001
Fatty liver, n (%) 65 (13.5) 25 (7.4) 40 (28.4) 37.664 < 0.001
Coronary heart disease, n (%) 34 (7.1) 26 (7.6) 8 (5.7) 0.591 0.442
Cerebrovascular disease, n (%) 39 (8.1) 30 (8.8) 9 (6.4) 0.797 0.372
Peripheral atherosclerosis, n (%) 39 (8.1) 26 (7.6) 13 (9.2) 0.331 0.565
Osteoporosis, n (%) 325 (67.6) 241 (70.9) 84 (59.6) 5.816 0.016
Osteoarthritis, n (%) 155 (32.2) 100 (29.4) 55 (39.0) 4.202 0.040
Secondary Sjögren’s syndrome, n (%) 60 (12.5) 45 (13.2) 15 (10.6) 0.616 0.433
Venous thrombosis, n (%) 19 (4.0) 15 (4.4) 4 (2.8) 0.652 0.420

表6

超重和肥胖与合并症的相关性"

Items Hypertensiona Diabetes mellitusb Hyperlipidemiac Fatty liverd Osteoporosise Osteoarthritisf Anemiaf
OR(95%CI) P OR(95%CI) P OR(95%CI) P OR(95%CI) P OR(95%CI) P OR(95%CI) P OR(95%CI) P
BMI < 25 kg/m2 References References References References References References References
BMI≥25 kg/m2 2.173
(1.398, 3.378)		 0.001 1.883
(1.108, 3.199)		 0.019 2.190
(1.270, 3.776)		 0.005 4.646
(2.605, 8.283)		 < 0.001 0.578
(0.373, 0.895)		 0.014 1.563
(1.018, 2.401)		 0.041 0.516
(0.333, 0.800)		 0.003
1 Emery P , Foster W , Suarez-Almazor M . Rheumatoid arthritis[J]. Clin Evid, 2002, (7): 1101- 1121.
2 Kitas GD , Erb N . Tackling ischaemic heart disease in rheumatoid arthritis[J]. Rheumatology, 2003, 42 (5): 607- 613.
doi: 10.1093/rheumatology/keg175
3 Metsios GS , Stavropoulos-Kalinoglou A , Panoulas VF , et al. New resting energy expenditure prediction equations for patients with rheumatoid arthritis[J]. Rheumatology, 2008, 47 (4): 500- 506.
4 Bray GA , Bellanger T . Epidemiology, trends, and morbidities of obesity and the metabolic syndrome[J]. Endocrine, 2006, 29 (1): 109- 117.
doi: 10.1385/ENDO:29:1:109
5 World Health Organisation . Obesity: Preventing and managing the global epidemic. Report of a WHO Consultation[J]. World Health Organ Tech Rep Ser, 2000, 894, 1- 253.
6 Adams KF , Schatzkin A , Harris TB , et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old[J]. N Engl J Med, 2006, 355 (8): 763- 778.
doi: 10.1056/NEJMoa055643
7 Elkan AC , Engvall IL , Cederholm T , et al. Rheumatoid cache-xia, central obesity and malnutrition in patients with low-active rheumatoid arthritis: Feasibility of anthropometry, mini nutritional assessment and body composition techniques[J]. Eur J Nutr, 2009, 48 (5): 315- 322.
doi: 10.1007/s00394-009-0017-y
8 Abuhelwa AY , Hopkins AM , Sorich MJ , et al. Association between obesity and remission in rheumatoid arthritis patients treated with diseasemodifying antirheumatic drugs[J]. Sci Rep, 2020, 10 (1): 18634.
doi: 10.1038/s41598-020-75673-7
9 Kremers HM , Crowson CS , Therneau TM , et al. High ten-year risk of cardiovascular disease in newly diagnosed rheumatoid arthritis patients: A population-based cohort study[J]. Arthritis Rheum, 2008, 58 (8): 2268- 2274.
doi: 10.1002/art.23650
10 Wolfe F , Michaud K . The risk of myocardial infarction and pharmacologic and nonpharmacologic myocardial nfarction predictors in rheumatoid arthritis: A cohort and nested case-control analysis[J]. Arthritis Rheum, 2008, 58 (9): 2612- 2621.
doi: 10.1002/art.23811
11 Escalante A , Haas RW , de Rincon I . Paradoxical effect of body mass index on survival in rheumatoid arthritis: Role of comorbidity and systemic inflammation[J]. Arch Intern Med, 2005, 165 (14): 1624- 1629.
doi: 10.1001/archinte.165.14.1624
12 Naranjo A , Sokka T , Descalzo MA , et al. Cardiovascular disease in patients with rheumatoid arthritis: Results from the QUEST-RA study[J]. Arthritis Res Ther, 2008, 10 (2): R30.
doi: 10.1186/ar2383
13 Stavropoulos-Kalinoglou A , Metsios GS , Koutedakis Y , et al. Redefining overweight and obesity in rheumatoid arthritis patients[J]. Ann Rheum Dis, 2007, 66 (10): 1316- 1321.
doi: 10.1136/ard.2006.060319
14 Alvarez-Nemegyei J , Pacheco-Pantoja E , González-Salazar M , et al. Association between overweight/obesity and clinical activity in rheumatoid arthritis[J]. Reumatol Clin, 2020, 16 (6): 462- 467.
doi: 10.1016/j.reuma.2018.11.005
15 Goossens J , Coustet B , Palazzo E , et al. Overweight and obesity affect clinical assessment of synovitis in rheumatoid arthritis: Comparison of ultrasonography and clinical exam[J]. Clin Exp Rheumatol, 2019, 37 (1): 49- 54.
16 常玲, 徐建华, 徐胜前, 等. 类风湿关节炎患者体质指数与疾病活动性的相关性研究[J]. 安徽医科大学学报, 2016, 51 (4): 544- 547.
17 Saravana S , Gillott T . Ischaemic heart disease in rheumatoid arthritis patients[J]. Rheumatology, 2004, 43 (1): 113- 114.
doi: 10.1093/rheumatology/keg433
18 George MD , ϕstergaard M , Conaghan PG , et al. Obesity and rates of clinical remission and low MRI inflammation in rheumatoid arthritis[J]. Ann Rheum Dis, 2017, 76 (10): 1743- 1746.
19 Ajeganova S , Andersson ML , Ingia LD , et al. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A long-term followup from disease onset[J]. Arthritis Care Res (Hoboken), 2013, 65 (1): 78- 87.
20 Baker JF , England BR , Mikuls TR , et al. Obesity, weight loss, and progression of disability in rheumatoid arthritis[J]. Arthritis Care Res, 2018, 70 (12): 1740- 1747.
21 Nikiphorou E , Norton S , Young A , et al. The association of obesity with disease activity, functional ability and quality of life in early rheumatoid arthritis: Data from the early rheumatoid arthritis study/early rheumatoid arthritis network UK prospective cohorts[J]. Rheumatology (Oxford), 2018, 57 (7): 1194- 1202.
22 Mangnus L , Nieuwenhuis WP , van Steenbergen HW , et al. Body mass index and extent of MRI-detected inflammation: Opposite effects in rheumatoid arthritis versus other arthritides and asymptomatic persons[J]. Arthritis Res Ther, 2016, 18 (1): 245.
23 Stemmler F , Simon D , Liphardt AM , et al. Biomechanical pro-perties of bone are impaired in patients with ACPA-positive rheumatoid arthritis and associated with the occurrence of fractures[J]. Ann Rheum Dis, 2018, 77 (7): 973- 980.
24 Favalli EG . Understanding the role of interleukin-6 (IL-6) in the joint and beyond: A comprehensive review of IL-6 inhibition for the management of rheumatoid arthritis[J]. Rheumatol Ther, 2020, 7 (3): 473- 516.
[1] 邹雪,白小娟,张丽卿. 艾拉莫德联合托法替布治疗难治性中重度类风湿关节炎的疗效[J]. 北京大学学报（医学版）, 2023, 55(6): 1013-1021.
[2] 吴琦,蔡月明,何娟,黄文蒂,王庆文. 血脂异常与类风湿关节炎肺间质病变的相关性分析[J]. 北京大学学报（医学版）, 2023, 55(6): 982-992.
[3] 金银姬,孙琳,赵金霞,刘湘源. 血清IgA型抗鼠科肉瘤病毒癌基因同源物B1抗体在类风湿关节炎中的意义[J]. 北京大学学报（医学版）, 2023, 55(4): 631-635.
[4] 刘蕊,赵金霞,闫良. 类风湿关节炎合并下肢静脉血栓患者的临床特点[J]. 北京大学学报（医学版）, 2022, 54(6): 1079-1085.
[5] 蔡文心,李仕成,刘一鸣,梁如玉,李静,郭建萍,胡凡磊,孙晓麟,李春,刘栩,叶华,邓立宗,李茹,栗占国. 类风湿关节炎临床分层及其特征的横断面研究[J]. 北京大学学报（医学版）, 2022, 54(6): 1068-1073.
[6] 张警丰,金银姬,魏慧,姚中强,赵金霞. 类风湿关节炎患者生活质量与疾病活动度的横断面研究[J]. 北京大学学报（医学版）, 2022, 54(6): 1086-1093.
[7] 程昉,杨邵英,房星星,王璇,赵福涛. CCL28-CCR10通路在类风湿关节炎单核细胞迁移中的作用[J]. 北京大学学报（医学版）, 2022, 54(6): 1074-1078.
[8] 高超,陈立红,王莉,姚鸿,黄晓玮,贾语博,刘田. 类风湿关节炎合并纤维肌痛简易分类标准的临床验证[J]. 北京大学学报（医学版）, 2022, 54(2): 278-282.
[9] 钟华,徐丽玲,白明欣,苏茵. 类风湿关节炎患者趋化因子CXCL9和CXCL10在骨侵蚀中的作用[J]. 北京大学学报（医学版）, 2021, 53(6): 1026-1031.
[10] 张璐,胡小红,陈澄,蔡月明,王庆文,赵金霞. 类风湿关节炎初治患者颈椎失稳情况及临床特征[J]. 北京大学学报（医学版）, 2021, 53(6): 1049-1054.
[11] 罗靓,霍文岗,张钦,李春. 类风湿关节炎合并角膜溃疡的临床特点和相关因素分析[J]. 北京大学学报（医学版）, 2021, 53(6): 1032-1036.
[12] 娄雪,廖莉,李兴珺,王楠,刘爽,崔若玫,徐健. 类风湿关节炎患者外周血TWEAK基因启动子区甲基化状态及其表达[J]. 北京大学学报（医学版）, 2021, 53(6): 1020-1025.
[13] 史欣然,安美静,陈天娇,马军. 饮奶行为在家庭社会经济状况与儿童青少年体重指数间的中介作用[J]. 北京大学学报（医学版）, 2021, 53(2): 308-313.
[14] 曹迪,王燕,王柳青,孙晓麟,黄妃,孟洋,任丽丽,张学武. 血浆Dickkopf-1在类风湿关节炎患者中的表达及其与外周血T细胞亚群的相关性[J]. 北京大学学报（医学版）, 2021, 53(2): 255-260.
[15] 赵凯,常志芳,王志华,庞春艳,王永福. 基因沉默肽基精氨酸脱亚胺酶4的表达对胶原诱导关节炎小鼠肺间质病变的影响[J]. 北京大学学报（医学版）, 2021, 53(2): 235-239.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部