目的 利用心脏代谢指数（CMI）和轻量级梯度提升机（LightGBM）模型评估代谢综合征（MetS）患者靶器官损害风险，探究其性别特异性关联，为精准干预提供依据。方法 纳入2022年8月至2025年2月在惠州市第一人民医院住院的132例MetS患者以及健康体检者400例（即对照组，仅作为基线对比参数），以心肾损害、大血管病变为复合靶器官损害终点，选取CMI、年龄等为核心特征；构建LightGBM分类模型（70%训练集、30%测试集分层抽样），并采用100次随机拆分验证得出曲线下的面积（AUC）和95%置信区间（CI）并绘制校准曲线；以AUC评估性能，结合沙普利加性解释算法（SHAP）和偏依赖图（PDP）进行可解释性及性别分层分析。结果 基线对比显示，MetS患者CMI（6.8±2.3）高于对照组（3.2±1.1），靶器官损害（TOD）阳性率（57.6%）高于对照组（12.0%）（P均＜0.001）；LightGBM模型预测AUC达0.812，CMI为最重要预测特征（相对贡献度31.5%），且CMI与性别交互作用检验差异有统计学意义（P＜0.01）；CMI与靶器官损害呈非线性S形关联，风险拐点为5.7，高危平台期为7.5；女性风险加速阈值（CMI 5.0）早于男性（CMI 6.5）。结论 以健康人群为对照明确了MetS患者的高CMI水平与高TOD风险特征，LightGBM-SHAP框架明确了CMI的核心预测价值，性别特异性阈值为制定男女个性化早期干预策略提供量化指导，具有良好的临床应用潜力。

    Objective This study aims to use the cardiometabolic index（CMI）and the LightGBM model to assess the risk of target organ damage（TOD）in metabolic syndrome（MetS）patients，explore its gender-specific associations，and provide a basis for precise intervention．Methods MetS patients meeting diagnostic criteria and healthy individuals（the control group，used only as a baseline reference parameter）were enrolled．The composite endpoint of TOD was defined as cardiorenal damage and macro/microvascular lesions．Core features selected included CMI and age．A LightGBM classification model was constructed（70% training set，30% test set with stratified sampling），and 100 random splits were used for validation to generate the area under the curve（AUC） with 95% confidence interval（CI）and draw the calibration curve．Performance was assessed using AUC，combined with the SHAP algorithm and Partial Dependence Plot（PDP）for interpretability and gender-stratified analysis．Results Baseline comparison showed that the CMI level of MetS patients（6.8±2.3）was significantly higher than that of the control group（3.2±1.1），and the positive rate of TOD（57.6%）was significantly higher than that of the control group（12.0%）（both P＜0.001）．The LightGBM model achieved an AUC of 0.875 in prediction，with CMI as the most important predictive feature（relative contribution of 31.5%），and the interaction test between CMI and gender showed a significant difference（P＜0.01）．CMI showed a non-linear S-shaped association with TOD，with a risk inflection point at 5.7 and a high-risk plateau at 7.5．Significant gender differences were observed：the threshold for accelerated risk in females（CMI 5.0）was earlier than that in males（CMI 6.5）．Conclusions Using healthy individuals as controls clarifies the characteristics of high CMI levels and high TOD risk in MetS patients．The LightGBM-SHAP framework clarifies the core predictive value of CMI．The gender-specific thresholds provide quantitative guidance for formulating personalized early intervention strategies for males and females，demonstrating good potential for clinical application．

目的 分析广州北部区域某胸痛中心不同性别的急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的结果。方法 纳入广州市花都区人民医院2016年12月—2020年1月期间接受直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者。按照不同的性别,评估患者的危险因素、治疗时限性和主要心血管不良事件情况。结果 入选389名患者,73名(18.8%)为女性。和男性患者对比,女性患者年龄更大(69.3±10.8岁vs 55.8±13.1 岁,P＜0.05),具有更高比例的2型糖尿病(26.0% vs 17.7%,P＜0.05)、高血压病(58.9.0% vs 43.0%,P＜0.05)病史。女性患者的症状-首次医疗接触时间和总缺血时间均长于男性患者(分别为229.2 min vs 174.5 min,P＜0.05;424.9 min vs 317.4 min,P＜0.05),PCI术中出现慢血流/无复流的比例更高(26.0% vs 16.5%,P＜0.05)。女性患者主要住院心血管事件风险更高(11.0% vs 4.4%, P＜0.05),其中院内死亡率(4.1% vs 1.6%, P＜0.05)。女性患者在院期间发生心衰及心源性休克的比例更高(分别为34.2% vs 21.2%,P＜0.05; 30.1% vs 18.7%,P＜0.05)。结论 在行急诊介入治疗的急性ST段抬高型心肌梗死患者中,女性患者预后差于男性,具有更高的心血管事件风险,死亡率更高。

Objective We investigated sex-based outcomes after primary percutaneous coronary intervention (PPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) in a chest pain center of northern Guangzhou. Methods From December 2016 to January 2020, consecutive STEMI patients who underwent PPCI in Guangzhou Huadu District People's Hospital were recruited. Risk factors, time variables, and major cardiovascular adverse events (MACE) were assessed according to gender. Results A total of 389 patients were enrolled,with 73(18.8%)women. Compared to men, women patients presented higher risk profiles with old age(69.3±10.8 years vs 55.8±13.1 years,P＜0.05),diabetes (26.0% vs 17.7%,P＜0.05), hypertension (58.9.0% vs 43.0%,P＜0.05).Women had longer symptom onset to first medical contact time and total ischemic time than men had(229.2min vs 174.5min,P＜0.05;424.9min vs 317.4min,P＜0.05).During PCI procedure,women presented higher ratio of slow flow/no reflow(26.0% vs 16.5%,P＜0.05).Women had increased major adverse events(11.0% vs 4.4%, P＜0.05), and higher in-hospital mortality(4.1% vs 1.6%, P＜0.05).Women presented more heart failure incidence (34.2% vs 21.2%,P＜0.05),and cardiac shock incidence(30.1% vs 18.7%,P＜0.05). Conclusion Women with acute STEMI who underwent PPCI had worse outcomes compared to men.They had higher MACE and in-hospital mortality.

目的 了解广东省某区级三甲综合医院住院老年人慢性非传染性疾病(慢非病)疾病谱及性别差异随年度推移的变化。方法 回顾性分析南方医科大学附属南海医院2006—2014年老年人出院资料。结果 住院老年人疾病谱中名列前位的疾病除了肺炎、急性胃肠道疾病,余为慢非病。慢非病比例逐年下降(65.8%~57.8%, P<0.01),疾病谱明显变化:脑血管疾病由第一位占21.3%降至17.0%居第二,恶性肿瘤从10.4%升至18.8%居第一。性别有差异:男性慢阻肺和恶性肿瘤的构成比多于女性;慢非病比非慢非病、男性比女性慢非病的人均住院总费用高(P<0.05)。结论 总结9年来南海区三甲综合医院住院诊治的慢非病居高及攀升病种、性别差异,制定措施优化医疗资源配置、减轻社会经济负担。

Objective To analyze the alteration of disease distribution and gender-differences of chronic non-communicable diseases (NCD) in hospitalized elderly from a large Comprehensive Hospital of Guangdong province. Methods Retrospective observational study including profile of discharged elderly in Nanhai hospital attached to Southern medical university from the year 2006 to 2014. Results In the top rank of diseases in hospitalized elderly, all were NCDs other than pneumonia and acute gastrointestinal diseases. The proportion of NCD accounted for all hospitalized elderly was reduced year by year, changed from 65.8% to 57.8%, P<0.01. Disease distribution of NCD altered obviously, showing that cerebrovascular disease (CVD) decreased from the first 21.3% to the second 17.0%, malignancy increased from 10.4% to 18.8% ranking as the first. Gender-differences did exist. Greater constituent ratio of chronic obstructive pulmonary disease (COPD) and malignancy were found in men than women yearly. NCD showed higher hospitalized expenses than non-NCD per capita, that of men were higher than women (P<0.05). Conclusion Summarizing the top and increasing rank of NCD and gender-differences in hospitalized elderly in a large comprehensive hospital, Nanhai district, Foshan city of 9 years, policy and program could be guided to optimize the distribution of medical resources and try to reduce the output of social economic burden.