Changes in liver function of Tibetans with different BMI during the early stage of migration to plain
-
摘要:
目的 探讨不同体质量指数(BMI)的世居高原藏族大学生移居平原初期肝脏功能变化规律，为世居高原藏族脱适应研究提供科学依据和理论基础。 方法 选取从高原(西藏)初入平原(陕西)的3 035名藏族大学生为研究对象，进行脱适应症状筛查。将受试者分为体重偏轻、体重正常、超重及肥胖4组，分别于初入平原3，6，9 d检测肝脏功能指标。采用χ2检验比较各组肝功能指标异常率，采用二元Logistic回归分析BMI与肝功能指标异常的关系。 结果 超重藏族男生与肥胖藏族男女生的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(GGT)，超重藏族男生和肥胖藏族女生的总胆汁酸(TBA)在脱适应初期均高于体重正常组(P值均 < 0.05)。在脱适应3，6，9 d，指标总体呈上升趋势的包括超重组男、女生直接胆红素(DBIL)、肥胖组女生血清总蛋白(TP)、球蛋白(GLOB)(P值均 < 0.05)。超重组男生ALT(13.9%)，肥胖组男、女生ALT(34.3%，26.7%)、GGT(11.4%，13.3%)和女生AST(10.0%)肝功能指标异常率高于体重偏轻(2.8%，3.5%，0，1.0%，1.5%)、正常组(3.5%，3.4%，0.9%，3.6%，4.1%)(χ2值分别为48.07，20.55，20.55，17.93，10.23，P值均 < 0.05)。二元Logistic回归分析显示，在校正年龄和性别因素后，超重与ALT(OR=2.10，95%CI=1.20~3.62)异常呈正相关，肥胖与ALT(OR=5.50，95%CI=4.23~7.40)、GGT(OR=4.10，95%CI=2.03~6.74)异常均呈正相关(P值均 < 0.05)。 结论 世居高原藏族大学生移居平原初期，肝脏功能指标变化与BMI相关。超重肥胖者肝功能损伤指标异常率较高。肥胖高危人群从高原移居平原地区时需进行健康检查及医务监督。 Abstract:Objective To explore the changes in liver function of Tibetan youth living in plateau with different body mass index (BMI) during the early stage of migration to the plain, and to provide scientific basis for high attitude de-adaptation. Methods A total of 3 035 Tibetan youth who firstly migrated to the plain (Shaanxi) from the plateau (Tibet) were selected as the research subjects, and were screened for symptoms of plateau de-adaptation. Participants were divided into four groups: underweight, normal weight, overweight and obese, and received liver function test on the 3rd, 6th, 9th dayafter migration, respectively. Chi-square test was used to detect the abnormal rate of liver function indicators among each group, and binary Logistic regression analysis was used to explore the relationship between BMI and abnormal liver function indicators. Results The alanine aminotransferase(ALT), Aspartate aminotransferase(AST), γ-glutamyl transpeptidase (GGT) of overweight Tibetan male and obese Tibetan male and female adolescents, the total bile acid (TBA) of overweight Tibetan male and obese Tibetan female were higher than those of the normal weight group at the early stage of de-adaptation(P < 0.05). With the de-adaptation for 3, 6, 9 days, the indexes showed an overall upward trend, including: direct bilirubin (DBIL) in overweight male and female adolescents, total protein (TP) and globulose (GLOB) in obese female adolescents(P < 0.05). The abnormal rate of overweight group (male ALT: 13.9%), obesity group (male and female ALT, GGT: 34.3%, 26.7%, 11.4%, 13.3%; female AST: 10.0%) was significantly higher than that in underweight (2.8%, 3.5%, 0, 1.0%, 1.5%) and normal group(3.5%, 3.4%, 0.9%, 3.6%, 4.1%)(χ2=48.07, 20.55, 20.55, 17.93, 10.23, P < 0.05). Binary Logistic regression analysis showed that after adjusting for age and gender, overweight was positively correlated with abnormal ALT(OR=2.10, 95%CI=1.20-3.62). Obesity was positively correlated with abnormal ALT(OR=5.50, 95%CI=4.23-7.40) and GGT(OR=4.10, 95%CI=2.03-6.74)(P < 0.05). Conclusion During the early stage of migration to the plain among Tibetan youth living on the plateau, changes in liver function indicators are related to BMI. Overweight and obese Tibetans have a higher abnormal rate of liver damage indicators. It is suggested that individuals with high risk of obesity should undergo health examination and medical supervision when migrates from plateau to plain. -
Key words:
- Body mass index /
- Liver /
- Regression analysis /
- Students /
- Minority groups
1) 利益冲突声明 所有作者声明无利益冲突。 -
表 1 不同性别藏族大学生移居平原初期肝脏损伤程度指标比较(x±s, U/L)
Table 1. Changes of liver damage indicators in Tibetan students with different genders at the early stage of migration to plain(x±s, U/L)
性别 脱适应时间/d 统计值 体重偏轻 体重正常 ALT AST ALP GGT ALT AST ALP GGT 男(n=1 188) 3 21.18±18.04 21.55±13.48 121.26±41.63 19.81±8.22 21.88±17.82 20.47±10.63 107.55±35.87 22.50±13.41 6 27.24±21.56 26.75±11.21 94.62±29.20 34.12±11.56 28.21±43.29 25.89±26.07 92.12±31.14 34.46±11.49 9 19.70±11.05 16.86±4.99 88.44±35.17 19.72±9.48 25.85±24.89 18.61±10.87 84.58±26.16 22.56±14.52 F值 0.98 12.33 25.27 31.51 3.10 8.13 42.09 41.23 P值 0.38 < 0.01 < 0.01 < 0.01 0.04 < 0.01 < 0.01 < 0.01 女(n=1 847) 3 16.25±18.68 18.46±7.25 87.11±25.87 14.36±7.24 16.06±11.86 18.02±7.23 83.68±23.18 14.94±8.24 6 21.59±11.70 21.76±6.85 89.04±24.71 30.01±11.79 18.65±9.42 23.32±8.88 90.35±25.12 33.76±10.78 9 15.36±8.78 15.53±4.70 77.15±20.28 13.04±6.69 16.79±16.26 15.45±6.38 75.65±21.00 13.70±11.00 F值 2.49 19.68 9.69 83.31 2.64 82.04 32.67 347.29 P值 0.08 < 0.01 < 0.01 < 0.01 0.07 < 0.01 < 0.01 < 0.01 性别 脱适应时间/d 统计值 超重 肥胖 ALT AST ALP GGT ALT AST ALP GGT 男(n=1 188) 3 35.14±28.71 23.20±10.72 107.13±47.30 34.76±21.14 47.86±30.94 23.40±11.04 93.05±10.43 38.50±25.55 6 50.79±45.30 29.60±16.65 101.28±25.85 38.74±9.08 50.84±28.82 27.59±12.17 100.18±14.88 38.80±16.44 9 38.86±29.09 22.16±12.16 78.40±20.41 33.67±29.90 54.57±50.63 25.14±13.79 79.10±23.54 44.15±43.82 F值 0.21 0.16 6.88 0.21 0.20 0.22 5.34 0.09 P值 0.81 0.85 < 0.01 0.81 0.82 0.80 0.01 0.92 女(n=1 847) 3 19.50±10.87 18.89±8.17 86.09±25.68 18.97±10.65 36.68±26.39 24.84±13.24 90.54±20.72 36.06±39.00 6 20.01±9.37 20.86±6.77 94.40±26.09 33.78±12.13 22.37±3.92 23.45±7.57 62.00±4.38 25.51±15.48 9 16.84±9.13 14.42±5.05 73.48±19.42 13.74±5.21 26.18±17.77 17.12±6.18 85.99±15.60 20.01±7.49 F值 1.23 8.79 7.27 39.77 0.88 1.68 2.14 0.94 P值 0.30 < 0.01 < 0.01 < 0.01 0.43 0.21 0.14 0.40 
下载: 导出CSV
表 2 不同性别藏族大学生移居平原初期肝脏转运与代谢功能指标比较(x±s, μmol/L)
Table 2. Comparison of liver transport and metabolism indicators in Tibetan students with different genders at the early stage of migration to plain(x±s, μmol/L)
性别 脱适应时间/d 统计值 体重偏轻 体重正常 TBIL DBIL IBIL TBA TBIL DBIL IBIL TBA 男(n=1 188) 3 20.64±8.67 6.86±3.17 13.78±5.86 5.09±3.32 21.85±10.66 7.33±3.76 14.53±7.30 5.21±3.25 6 26.01±11.43 9.14±4.64 14.87±7.86 8.79±3.29 22.44±8.88 7.70±3.32 14.73±6.54 7.42±3.28 9 22.51±11.14 7.78±5.12 13.73±6.44 5.71±2.63 21.17±9.65 7.33±5.69 12.85±5.42 6.23±3.61 F值 3.33 7.12 3.02 15.40 0.62 3.77 6.20 24.50 P值 0.04 < 0.01 0.04 < 0.01 0.54 0.02 < 0.01 < 0.01 女(n=1 847) 3 16.39±10.46 5.27±3.49 11.12±7.21 4.46±2.73 15.87±8.06 5.10±2.74 10.77±5.58 4.39±2.51 6 17.02±8.27 6.23±3.70 10.73±5.61 8.37±3.46 15.52±6.61 5.75±2.89 10.93±4.50 8.52±3.49 9 16.52±8.29 5.78±3.07 11.79±5.00 5.47±2.83 16.47±6.91 5.42±2.70 10.10±4.92 5.17±2.21 F值 0.24 3.30 0.21 32.83 1.35 7.05 1.34 195.74 P值 0.78 0.04 0.81 < 0.01 0.26 < 0.01 0.26 < 0.01 性别 脱适应时间/d 统计值 超重 肥胖 TBIL DBIL IBIL TBA TBIL DBIL IBIL TBA 男(n=1 188) 3 19.57±8.55 6.28±2.97 13.11±6.05 5.40±3.40 20.13±9.48 6.34±3.86 13.79±5.85 5.70±3.20 6 20.47±6.14 7.04±3.92 13.43±3.88 10.65±2.56 25.53±9.26 8.22±2.76 17.31±7.11 7.60±2.65 9 22.39±7.50 7.46±3.65 13.93±4.25 5.79±1.82 19.78±6.83 7.39±2.69 12.39±4.40 8.92±3.37 F值 1.36 4.45 0.43 16.42 0.46 0.51 0.77 2.70 P值 0.26 0.01 0.65 < 0.01 0.64 0.61 0.47 0.08 女(n=1 847) 3 14.65±5.20 4.53±1.98 10.12±3.63 4.95±2.40 20.35±14.53 6.43±4.49 13.92±10.07 5.59±3.92 6 16.62±6.58 5.51±2.78 11.10±4.20 7.93±3.43 16.17±13.82 5.09±4.19 11.08±9.64 6.55±1.81 9 15.76±6.62 5.74±3.07 10.02±3.98 5.02±1.73 16.85±5.19 6.02±1.80 10.83±3.60 7.03±0.81 F值 1.12 3.36 0.75 15.44 0.34 0.13 0.50 0.02 P值 0.33 0.04 0.48 < 0.01 0.72 0.88 0.61 0.98
下载: 导出CSV
表 3 不同性别藏族大学生移居平原初期肝脏合成功能指标比较(x±s)
Table 3. Comparison of liver synthesis indicators in Tibetan students with different genders at the early stage of migration to plain(x±s)
性别 脱适应时间/d 统计值 体重偏轻 体重正常 TP/(g·L-1) ALB/(g·L-1) GLOB/(g·L-1) A/G TP/(g·L-1) ALB/(g·L-1) GLOB/(g·L-1) A/G 男(n=1 188) 3 71.45±4.67 46.79±2.40 24.66±3.28 1.93±0.26 70.44±4.24 46.36±2.13 24.08±3.17 1.96±0.25 6 74.06±3.98 48.75±3.08 25.31±2.66 1.95±0.24 72.84±4.26 47.71±3.48 25.14±2.58 1.92±0.24 9 74.06±3.99 45.36±3.05 27.10±2.96 1.69±0.21 72.61±3.88 45.51±2.74 27.10±2.95 1.70±0.22 F值 3.75 19.89 21.09 36.60 29.86 30.52 82.65 94.40 P值 0.03 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 女(n=1 847) 3 70.67±3.96 45.32±2.05 25.34±3.17 1.81±0.23 70.33±4.10 44.99±2.06 25.34±3.19 2.05±6.26 6 73.64±3.91 48.05±2.91 25.60±2.41 1.89±0.20 72.39±3.91 47.29±3.24 25.11±2.34 1.90±0.22 9 71.92±4.30 44.73±3.07 27.19±3.33 1.67±0.24 71.89±4.14 44.82±2.91 27.07±2.82 1.67±0.21 F值 10.27 25.68 15.73 24.00 30.37 77.42 54.50 89.20 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 性别 脱适应时间/d 统计值 超重 肥胖 TP/(g·L-1) ALB/(g·L-1) GLOB/(g·L-1) A/G TP/(g·L-1) ALB/(g·L-1) GLOB/(g·L-1) A/G 男(n=1 188) 3 70.70±3.03 46.79±1.68 23.90±2.83 1.99±0.25 71.19±4.78 45.29±1.75 25.56±1.96 1.77±0.21 6 71.93±4.76 46.73±3.17 25.21±3.00 1.88±0.23 73.01±3.14 45.61±1.91 25.90±3.49 1.87±0.21 9 73.65±4.12 46.06±2.64 27.59±3.09 1.69±0.23 73.11±3.64 47.55±3.48 27.39±2.12 1.67±0.14 F值 6.80 1.08 16.78 15.74 0.62 1.36 2.01 3.12 P值 < 0.01 0.34 < 0.01 < 0.01 0.55 0.27 0.15 0.04 女(n=1 847) 3 70.38±3.84 45.27±2.20 25.11±2.82 1.82±0.21 65.50±0.50 42.19±3.87 23.30±3.39 1.70±0.18 6 73.57±2.51 48.33±2.56 25.25±2.24 1.93±0.23 71.51±3.01 44.91±2.35 26.60±2.37 1.85±0.43 9 72.07±3.78 44.58±2.92 27.49±2.86 1.64±0.23 72.76±2.95 44.92±3.24 27.95±2.38 1.62±0.20 F值 7.87 19.36 11.23 16.68 5.20 0.88 3.38 1.28 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 0.43 0.04 0.29
下载: 导出CSV
表 4 移居平原初期不同性别不同BMI藏族大学生肝功能指标异常率比较
Table 4. Comparison of abnormal rate of liver function index among Tibetan college students with different genders and BMI stratification during de-adaptation
性别 组别 人数 统计值 ALT AST ALP GGT TBIL DBIL IBIL TBA 男 体重偏轻 282 8(2.8) 13(4.6) 52(18.4) 0 106(37.6) 107(37.9) 99(35.1) 28(9.9) 体重正常 770 27(3.5) 35(4.5) 108(14.0) 7(0.9) 266(34.5) 271(35.2) 256(33.2) 83(10.8) 超重 101 14(13.9) 6(5.9) 19(18.8) 3(3.0) 33(32.7) 31(30.7) 32(31.7) 10(9.9) 肥胖 35 12(34.3) 5(14.3) 3(8.6) 4(11.4) 16(45.7) 15(42.9) 16(45.7) 7(20.0) χ2值 48.07 4.94 5.29 20.55 2.79 2.59 2.73 2.85 P值 < 0.01 0.18 0.15 < 0.01 0.43 0.46 0.44 0.42 女 体重偏轻 402 14(3.5) 6(1.5) 22(5.5) 4(1.0) 66(16.4) 68(16.9) 68(16.9.) 31(7.7) 体重正常 1 279 43(3.4) 53(4.1) 73(5.7) 46(3.6) 177(13.8) 160(12.5) 197(15.4) 95(7.4) 超重 136 7(5.1) 6(4.4) 8(5.9) 8(5.9) 15(11.0) 15(11.0) 15(11.0) 7(5.1) 肥胖 30 8(26.7) 3(10.0) 1(3.3) 4(13.3) 8(26.7) 7(23.3) 8(26.7) 3(10.0) χ2值 20.55 10.23 0.11 17.93 6.01 7.72 5.31 1.44 P值 < 0.01 0.02 0.99 < 0.01 0.11 0.05 0.15 0.70 注： ()内数字为异常率/%。
下载: 导出CSV
-
[1] HE B, HU M, LIANG Z, et al. Efficacy of shenqi pollen capsules for high-altitude deacclimatization syndrome via suppression of the reoxygenation injury and inflammatory response[J]. J Immunol Res, 2019, 2019: 4521231. [2] 谢忠林, 王新全, 尧梦媛, 等. 高原脱适应症研究进展[J]. 人民军医, 2020, 63(10): 957-960. doi: 10.3969/j.issn.1000-9736.2020.10.010XIE Z L, WANG X Q, YAO M Y, et al. Research progress of high-altitude deacclimatization[J]. People's Military Surgeon, 2020, 63(10): 957-960. doi: 10.3969/j.issn.1000-9736.2020.10.010 [3] HE B, LI H, HU M, et al. Association between serum interleukin-17a level and high-altitude deacclimatization syndrome[J]. Mediat Inflamm, 2016, 2016: 1732352. [4] HE B, WANG J, QIAN G, et al. Analysis of high-altitude de-acclimatization syndrome after exposure to high altitudes: acluster-randomized controlled trial[J]. PLoS One, 2013, 8(5): e62072. doi: 10.1371/journal.pone.0062072 [5] 项贵明, 王公权, 张仕运, 等. 高原脱适应人群肝肾功能监测及结果分析[J]. 国际检验医学杂志, 2012, 33(20): 2512-2513. doi: 10.3969/j.issn.1673-4130.2012.20.033XIANG G M, WANG G Q, ZHANG S Y, et al. Analysis of liver and renal function of immigrants deadaptated from high altitude[J]. Int J Laborat Med, 2012, 33(20): 2512-2513. doi: 10.3969/j.issn.1673-4130.2012.20.033 [6] YAN L, WANG P, ZHAO C, et al. Toxic responses of liver in Lateolabrax maculatus during hypoxia and re-oxygenation[J]. Aquat Toxicol, 2021, 236: 105841. doi: 10.1016/j.aquatox.2021.105841 [7] 尚凯茜, 夏宗敬, 罗朝志, 等. 右美托咪定对高原脱适应藏族患者血流动力学的影响[J]. 中国高原医学与生物学杂志, 2019, 40(3): 152-157.SHANG K X, XIA Z J, LUO C Z, et al. Effects of dexmedetomidine on hemodynamics in Tibetan patients during plateau de-adaptation[J]. Chin High Altitud Med Biol, 2019, 40(3): 152-157. [8] 李年华, 高亮, 李彬, 等. 慢性重复低氧暴露人群返回平原健康体检结果分析[J]. 西南国防医药, 2017, 27(10): 1113-1114. doi: 10.3969/j.issn.1004-0188.2017.10.030LI N H, GAO L, LI B, et al. Analysis of health examination results of chronic repeated hypoxic exposure population returning to plain[J]. Med J Natl Defending Forces Southwest China, 2017, 27(10): 1113-1114. doi: 10.3969/j.issn.1004-0188.2017.10.030 [9] 周其全, 杨生岳, 袁振才, 等. 高原移居人群返回平原后脱适应症的诊断标准: 多中心、随机对照研究[J]. 解放军医学杂志, 2012, 37(2): 146-155.ZHOU Q Q, YANG S Y, YUAN Z C, et al. A research in diagnostic criteria of high altitude de-adaptation for plateau migrants returning to the plains: a multicenter, randomized controlled trial[J]. Med J Chin People's Liberat Army, 2012, 37(2): 146-155. [10] 季成叶. 中国学生超重肥胖BMI筛查标准的应用[J]. 中国学校卫生, 2004, 25(1): 125-128. doi: 10.3969/j.issn.1000-9817.2004.01.089JI C Y. Application of BMI screening criteria for overweight and obesity in Chinese students[J]. Chin J Sch Health, 2004, 25(1): 125-128. doi: 10.3969/j.issn.1000-9817.2004.01.089 [11] 国家卫生健康委员会. 临床常用生化检验项目参考区间: WS/T 404-2018[S]. 2018-11-01.National Health Commission of the PRC. Reference intervals for common clinical biochemistry tests: WS/T 404-2018[S]. 2018-11-01. [12] ZHOU Q, YANG S, LUO Y, et al. A randomly-controlled study on the cardiac function at the early stage of return to the plains after short-term exposure to high altitude[J]. PLoS One, 2012, 7(2): e31097. doi: 10.1371/journal.pone.0031097 [13] TIRABASSI J N, OLEWINSKI L, KHODAEE M. Variation of traditional biomarkers of liver injury after an ultramarathon at altitude[J]. Sports Health, 2018, 10(4): 361-365. doi: 10.1177/1941738118764870 [14] JORGE L H. Abnormal liver enzyme levels[J]. Postgrad Med, 2016, 93(2): 119-132. [15] 张雅鸿, 袁振才, 郭瑞林. 高原暴露人群返平原近3年肝功能检测结果分析[J]. 国际检验医学杂志, 2011, 32(14): 1622-1623. doi: 10.3969/j.issn.1673-4130.2011.14.047ZHANG Y H, YUAN Z C, GUO R L. Analysis of liver function test results of plateau exposed population in recent 3 years after returning to plain[J]. Int J Laborat Med, 2011, 32(14): 1622-1623. doi: 10.3969/j.issn.1673-4130.2011.14.047 [16] LEE H A, JUNG J Y, LEE Y S, et al. Direct Bilirubin is more valuable than total bilirubin for predicting prognosis in patients with liver cirrhosis[J]. Gut Liver, 2021, 15(4): 599-605. doi: 10.5009/gnl20171 [17] LAINE S, GARTHWAITE T, VASANKARI T, et al. Body adiposity, but not elements of objectively measured sedentary behavior or physical activity, is associated with circulating liver enzymes in adults with overweight and obesity[J]. Front Endocrinol, 2021, 12: 655756. doi: 10.3389/fendo.2021.655756 [18] 崔惠景, 张曼. 青年学生血清丙氨酸氨基转移酶异常与体质量指数的关联[J]. 中国学校卫生, 2018, 39(5): 716-718. doi: 10.16835/j.cnki.1000-9817.2018.05.022CUI H J, ZHANG M. Association between abnormal serum alanine aminotransferase and body mass index in college students[J]. Chin J Sch Health, 2018, 39(5): 716-718. doi: 10.16835/j.cnki.1000-9817.2018.05.022 [19] 王纯, 邵平. 西藏自治区世居藏族青年BMI与身体机能指标和素质指标的相关性分析[J]. 中国体育科技, 2016, 52(2): 62-70.WANG C, SHAO P. Correlation analysis between physical function and fitness index with BMI of native youth in the Tibet autonomous region[J]. Chin Sport Sci Technol, 2016, 52(2): 62-70. [20] 姚梦, 白爽, 李旭龙, 等. 综合干预对肥胖青少年糖脂代谢肝肾和心血管功能的影响[J]. 中国学校卫生, 2019, 40(4): 582-585. doi: 10.16835/j.cnki.1000-9817.2019.04.028YAO M, BAI S, LI X L, et al. Effects of comprehensive intervention on glucose and lipid metabolism, liver and kidney function and cardiovascular function in obese adolescents[J]. Chin J Sch Health, 2019, 40(4): 582-585. doi: 10.16835/j.cnki.1000-9817.2019.04.028 [21] 赵兰静, 杨亚军, 冯爱成, 等. 援藏干部血清蛋白水平变化的影响因素分析[J]. 兰州大学学报(医学版), 2020, 46(6): 73-77.ZHAO L J, YANG Y J, FENG A C, et al. Analysis of influencing factors on serum protein levels of Tibet-assisted cadres[J]. J Lanzhou Univ(Med Sci), 2020, 46(6): 73-77. [22] CHEN Z, SONG C, YAO Z, et al. Associations between albumin, globulin, albumin to globulin ratio and muscle mass in adults: results from the national health and nutrition examination survey 2011-2014[J]. BMC Geriatr, 2022, 22(1): 383. doi: 10.1186/s12877-022-03094-4 [23] ARNESEN E K, THORISDOTTIR B, LAMBERG-ALLARDT C, et al. Protein intake in children and growth and risk of overweight or obesity: a systematic review and Meta-analysis[J]. Food Nutr Res, 2022. DOI: 10.29219/fnr.v66.8242. -
点击查看大图
表(4)
计量
- 文章访问数: 431
- HTML全文浏览量: 175
- PDF下载量: 15
- 被引次数: 0
