两种工具预测健康体检者卒中风险的应用比较
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摘要
目的比较汇集队列风险方程(pooled cohort risk equation,PCE)和改良Framingham卒中风险评估量表(revised Framingham stroke risk profile,R-FSP)在健康体检人群卒中风险评估中的应用。方法随机抽取2017年1-12月于宜宾市第二人民医院健康管理中心体检的40～70岁健康体检者1277例,采用R-FSP和PCE评估其10年卒中风险,并比较R-FSP和PCE在卒中风险评估应用中的一致性。结果用R-FSP和PCE评估1277例健康体检者的10年卒中风险概率分别为5.8%和6.1%,男性高于女性[R-FSP(6.0%vs 5.5%,t=3.184,P=0.002),PCE(6.5%vs 5.7%,t=4.700,P=0.000)],BMI≥24 kg/m~2者高于BMI<24 kg/m~2者[R-FSP(5.5%vs6.5%),PCE(5.9%vs6.8%)],3个年龄段(40～49岁、50～59岁和60～70岁)体检者卒中风险差异也有统计学意义[R-FSP(3.6%vs 5.9%vs 9.2%,F=7.213,P=0.003),PCE(4.0%vs 6.0%vs 9.9%,F=11.628,P=0.000)]。R-FSP和PCE评估卒中风险结果有高度一致性,其Pearson相关系数和组内相关系数(intraclass correlation coefficient,ICC)分别为0.719和0.757(P<0.05)。结论 R-FSP和PCE预测卒中风险结果一致,研究者可以根据实际情况选择合适的预测工具。
Objective To compare the application of pooled cohort risk equations(PCE) and revised Framingham stroke risk profile(R-FSP) in assessing stroke risk in healthy people through physical examination, to provide a reference for preventing stroke more effectively.Methods A total of 1277 healthy people(40～70 years) through physical examination were selected randomly from No.2 Peoples' s Hospital from January to December 2017. The 10-year stroke risk of all subjects were evaluated using R-FSP and PCE, and the consistency of R-FSP and PCE in predicting stroke risk were compared.Results The stroke risk assessed by R-FSP and PCE in 1277 subjects were 5.8% and 6.1% respectively. Male had a higher stroke risk than female(R-FSP: 6.0% vs 5.5%, t=3.184, P=0.002; PCE: 6.5% vs 5.7%, t=4.700, P=0.000), people with a BMI ≥24 kg/m~2 had a higher risk than those with BMI <24 kg/m~2(R-FSP: 5.5% vs 6.5%; PCE: 5.9% vs 6.8%), and different ages(40～49 years, 50～59 years and 60～70 years) had different risks(R-FSP: 3.6% vs 5.9% vs 9.2%, F=7.213, P=0.003; PCE: 4.0% vs 6.0% vs 9.9%, F=11.628, P=0.000). R-FSP and PCE had high consistency in assessing the stroke risk, with Pearson correlation coefficient and intraclass correlation coefficient being 0.719 and 0.757 respectively(P<0.05). Conclusions The R-FSP and PCE are similar in assessing the stroke risk. The users can choose any appropriate tool to predict stroke risk according to the conditions.
Objective To compare the application of pooled cohort risk equations(PCE) and revised Framingham stroke risk profile(R-FSP) in assessing stroke risk in healthy people through physical examination, to provide a reference for preventing stroke more effectively.Methods A total of 1277 healthy people(40～70 years) through physical examination were selected randomly from No.2 Peoples' s Hospital from January to December 2017. The 10-year stroke risk of all subjects were evaluated using R-FSP and PCE, and the consistency of R-FSP and PCE in predicting stroke risk were compared.Results The stroke risk assessed by R-FSP and PCE in 1277 subjects were 5.8% and 6.1% respectively. Male had a higher stroke risk than female(R-FSP: 6.0% vs 5.5%, t=3.184, P=0.002; PCE: 6.5% vs 5.7%, t=4.700, P=0.000), people with a BMI ≥24 kg/m~2 had a higher risk than those with BMI <24 kg/m~2(R-FSP: 5.5% vs 6.5%; PCE: 5.9% vs 6.8%), and different ages(40～49 years, 50～59 years and 60～70 years) had different risks(R-FSP: 3.6% vs 5.9% vs 9.2%, F=7.213, P=0.003; PCE: 4.0% vs 6.0% vs 9.9%, F=11.628, P=0.000). R-FSP and PCE had high consistency in assessing the stroke risk, with Pearson correlation coefficient and intraclass correlation coefficient being 0.719 and 0.757 respectively(P<0.05). Conclusions The R-FSP and PCE are similar in assessing the stroke risk. The users can choose any appropriate tool to predict stroke risk according to the conditions.
引文
[1]FEIGIN V L,ROTH G A,NAGHAVI M,et al.Global burden of stroke and risk factors in 188countries,during 1990-2013:a systematic analysis for the Global Burden of Disease Study 2013[J].Lancet Neurol,2016,15(9):913-924.
[2]NIEWADA M,MICHEL P.Lifestyle modification for stroke prevention:facts and fiction[J].Curr Opin Neurol,2016,29(1):9-13.
[3]GOFF D C J R,LLOYD-JONES D M,BENNETT G,et al.2013 ACC/AHA guideline on the assessment of cardiovascular risk:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J].Circulation,2014,129(25 suppl 2):S49-S73.
[4]中国超重肥胖医学营养治疗专家共识编写委员会.中国超重/肥胖医学营养治疗专家共识(2016年版)[J].中华糖尿病杂志,2016,8(9):525-540.
[5]DUFOUIL C,BEISER A,MCLURE L A,et al.Revised Framingham stroke risk profile to reflect temporal trends[J].Circulation,2017,135(12):1145-1159.
[6]孙佳艺,巢宝华,徐新娟,等.中国三甲医院高血压患者卒中十年发病风险的流行病学研究[J].中华高血压杂志,2014,22(10):964-968.
[7]MUNTNER P,COLANTONIO L D,CUSHMAN M,et al.Validation of the atherosclerotic cardiovascular disease pooled cohort risk equations[J].JAMA,2014,311(14):1406-1415.
[8]BENJAMIN E J,VIRANI S S,CALLAWAY C W,et al.Heart disease and stroke statistics-2018 update:a report from the American Heart Association[J/OL].Circulation,2018,137(12):e67-e492.https://doi.org/10.1161/CIR.0000000000000558.
[9]CHEN Z,JIANG B,RU X,et al.Mortality of stroke and its subtypes in China:results from a nationwide population-based survey[J].Neuroepidemiology,2017,48(3-4):95-102.
[10]WANG J,WEN X,LI W,et al.Risk factors for stroke in the Chinese population:a systematic review and meta-analysis[J].J Stroke Cerebrovasc Dis,2017,26(3):509-517.
[11]MOK Y,SANG Y,BALLEW S H,et al.American Heart Association's Life's Simple 7 at middle age and prognosis after myocardial infarction in later life[J/OL].J Am Heart Assoc,2018,7(4):e007658.https://doi.org/10.1161/JAHA.117.007658.
[12]PARMAR P,KRISHNAMURTHI R,IKRAM M A,et al.The Stroke Riskometer~(TM) App:validation of a data collection tool and stroke risk predictor[J].Int JStroke,2015,10(2):231-244.
[13]HASAN T H,HABIB K R,NUZHAT E,et al.Association of National Institute Health Stroke Scale(NIHSS)Score on admission with the outcome of acute ischemic stroke at discharge from hospital[J].JMed,2018,19(2):91-94.
[14]BOS D,IKRAM M A,LEENING M J G,et al.The revised Framingham stroke risk profile in a primary prevention population:the Rotterdam Study[J].Circulation,2017,135(22):2207-2209.
[15]黄久仪,曹奕丰,郭吉平,等.应用改良弗明汉卒中风险评估工具预测中国人卒中的风险[J].中国脑血管病杂志,2013,10(5):228-232.
[16]黄晓芸,付文金,梅志忠,等.改良FSP、CVHI联合Lp-PLA2预测脑卒中[J].新医学,2017,48(7):467-471.
[17]郭咏娣,武剑.508例脑卒中风险人群的颈动脉粥样硬化与Framingham卒中风险评分的相关性研究[J].中华老年心脑血管病杂志,2016,18(8):863-865.
[18]王拥军.变革创新,开启ASCVD防治新时代--2013AHA/ACC降低成人动脉粥样硬化性心血管疾病风险胆固醇治疗指南述评[J].中国卒中杂志,2014,9(1):9-12.
[19]LEE C H,WOO Y C,LAM J K,et al.Validation of the pooled cohort equations in a long-term cohort study of Hong Kong Chinese[J].J Clin Lipidol,2015,9(5):640-646.
[20]CHIA Y C,LIM H M,CHING S M.Validation of the pooled cohort risk score in an Asian populationa retrospective cohort study[J/OL].BMC Cardiovasc Disord,2014,14:163.https://doi.org/10.1186/1471-2261-14-163.
[21]WANG H,SUN Y,YI X,et al.Evaluation of the Framingham risk score and pooled cohort risk equation for prediction of cardiovascular risk in low resource areas:insights from Asian rural population[J/OL].Int J Cardiol,2018,265:237.https://doi.org/10.1016/j.ijcard.2018.04.063.
[22]TOPEL M L,SHEN J,MORRIS A A,et al.Comparisons of the Framingham and pooled cohort equation risk scores for detecting subclinical vascular disease in blacks versus whites[J].Am JCardiol,2017,121(5):564-569.
[23]YANG X,LI J,HU D,et al.Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population:the China-PARproject(prediction for ASCVD risk in China)[J].Circulation,2016,134(19):1430-1440.
[24]唐迅,张杜丹,何柳,等.China-PAR模型在北方农村人群中预测动脉粥样硬化性心血管疾病发病风险的应用[J].北京大学学报(医学版),2017,49(3):439-445.,,,:,
[2]NIEWADA M,MICHEL P.Lifestyle modification for stroke prevention:facts and fiction[J].Curr Opin Neurol,2016,29(1):9-13.
[3]GOFF D C J R,LLOYD-JONES D M,BENNETT G,et al.2013 ACC/AHA guideline on the assessment of cardiovascular risk:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J].Circulation,2014,129(25 suppl 2):S49-S73.
[4]中国超重肥胖医学营养治疗专家共识编写委员会.中国超重/肥胖医学营养治疗专家共识(2016年版)[J].中华糖尿病杂志,2016,8(9):525-540.
[5]DUFOUIL C,BEISER A,MCLURE L A,et al.Revised Framingham stroke risk profile to reflect temporal trends[J].Circulation,2017,135(12):1145-1159.
[6]孙佳艺,巢宝华,徐新娟,等.中国三甲医院高血压患者卒中十年发病风险的流行病学研究[J].中华高血压杂志,2014,22(10):964-968.
[7]MUNTNER P,COLANTONIO L D,CUSHMAN M,et al.Validation of the atherosclerotic cardiovascular disease pooled cohort risk equations[J].JAMA,2014,311(14):1406-1415.
[8]BENJAMIN E J,VIRANI S S,CALLAWAY C W,et al.Heart disease and stroke statistics-2018 update:a report from the American Heart Association[J/OL].Circulation,2018,137(12):e67-e492.https://doi.org/10.1161/CIR.0000000000000558.
[9]CHEN Z,JIANG B,RU X,et al.Mortality of stroke and its subtypes in China:results from a nationwide population-based survey[J].Neuroepidemiology,2017,48(3-4):95-102.
[10]WANG J,WEN X,LI W,et al.Risk factors for stroke in the Chinese population:a systematic review and meta-analysis[J].J Stroke Cerebrovasc Dis,2017,26(3):509-517.
[11]MOK Y,SANG Y,BALLEW S H,et al.American Heart Association's Life's Simple 7 at middle age and prognosis after myocardial infarction in later life[J/OL].J Am Heart Assoc,2018,7(4):e007658.https://doi.org/10.1161/JAHA.117.007658.
[12]PARMAR P,KRISHNAMURTHI R,IKRAM M A,et al.The Stroke Riskometer~(TM) App:validation of a data collection tool and stroke risk predictor[J].Int JStroke,2015,10(2):231-244.
[13]HASAN T H,HABIB K R,NUZHAT E,et al.Association of National Institute Health Stroke Scale(NIHSS)Score on admission with the outcome of acute ischemic stroke at discharge from hospital[J].JMed,2018,19(2):91-94.
[14]BOS D,IKRAM M A,LEENING M J G,et al.The revised Framingham stroke risk profile in a primary prevention population:the Rotterdam Study[J].Circulation,2017,135(22):2207-2209.
[15]黄久仪,曹奕丰,郭吉平,等.应用改良弗明汉卒中风险评估工具预测中国人卒中的风险[J].中国脑血管病杂志,2013,10(5):228-232.
[16]黄晓芸,付文金,梅志忠,等.改良FSP、CVHI联合Lp-PLA2预测脑卒中[J].新医学,2017,48(7):467-471.
[17]郭咏娣,武剑.508例脑卒中风险人群的颈动脉粥样硬化与Framingham卒中风险评分的相关性研究[J].中华老年心脑血管病杂志,2016,18(8):863-865.
[18]王拥军.变革创新,开启ASCVD防治新时代--2013AHA/ACC降低成人动脉粥样硬化性心血管疾病风险胆固醇治疗指南述评[J].中国卒中杂志,2014,9(1):9-12.
[19]LEE C H,WOO Y C,LAM J K,et al.Validation of the pooled cohort equations in a long-term cohort study of Hong Kong Chinese[J].J Clin Lipidol,2015,9(5):640-646.
[20]CHIA Y C,LIM H M,CHING S M.Validation of the pooled cohort risk score in an Asian populationa retrospective cohort study[J/OL].BMC Cardiovasc Disord,2014,14:163.https://doi.org/10.1186/1471-2261-14-163.
[21]WANG H,SUN Y,YI X,et al.Evaluation of the Framingham risk score and pooled cohort risk equation for prediction of cardiovascular risk in low resource areas:insights from Asian rural population[J/OL].Int J Cardiol,2018,265:237.https://doi.org/10.1016/j.ijcard.2018.04.063.
[22]TOPEL M L,SHEN J,MORRIS A A,et al.Comparisons of the Framingham and pooled cohort equation risk scores for detecting subclinical vascular disease in blacks versus whites[J].Am JCardiol,2017,121(5):564-569.
[23]YANG X,LI J,HU D,et al.Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population:the China-PARproject(prediction for ASCVD risk in China)[J].Circulation,2016,134(19):1430-1440.
[24]唐迅,张杜丹,何柳,等.China-PAR模型在北方农村人群中预测动脉粥样硬化性心血管疾病发病风险的应用[J].北京大学学报(医学版),2017,49(3):439-445.,,,:,