中老年男性人群卒中风险评估及相关危险因素分析
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摘要
目的探讨应用脑血管功能积分值检测评估中老年男性人群卒中风险及与相关危险因素暴露水平的关系。方法选取完成健康体检并行脑血流动力学检测的280例45岁以上男性人群为研究对象,以脑血管功能积分值(cerebral vascular functional accumulative scores,CVFAS)75分为截点,分为卒中高危组(<75分,82例)和卒中低危组(≥75分,198例),分析不同年龄段CVFAS变化和卒中高危个体检出率,并比较卒中高危组和低危组之间危险因素暴露水平,分析CVFAS与危险因素的相关性。结果本研究人群CVFAS随着年龄增加而逐渐降低,卒中高危个体检出率达29.3%(82/280),并随着年龄递增而上升,70岁以上达60.0%。卒中高危组的年龄、吸烟史、高血压史、糖尿病史、腰围、体脂含量、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、空腹血糖、TC、LDL-C、Hcy、肱踝脉搏波传导速度(brachial-ankle pulse wave velocity,baPWV)、颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)均高于低危组,HDL-C低于低危组,差异均有统计学意义。相关性分析显示,CVFAS与年龄(r=-0.314,P=0.007)、腰围(r=-0.295,P=0.009)、体脂含量(r=-、空腹血糖(r=-0.289,P=0.009)、Hcy(r=-0.216,P=0.014)、baPWV(r=-0.349,P=0.005)、CIMT(r=-0.209,P=0.013)负相关,与HDL-C正相关(r=0.258,P=0.011)。Logistic回归分析显示,年龄(OR 1.257,95%CI 1.118～1.359,P=0.001)、高血压病史(OR 1.524,95%CI 1.259～1.894,P<0.001)、体脂含量(OR 1.493,95%CI 1.214～1.876,P=0.001)、SBP(OR 1.897,95%CI 1.684～2.697,P=0.001)、空腹血糖(OR 1.356,95%CI 1.214～1.651,P=0.001)、LDL-C(OR 1.675,95%CI 1.149～1.524,P=0.002)为CVFAS异常的独立危险因素。结论CVFAS降低(<75分)与卒中危险因素暴露水平密切相关,运用CVFAS检测评估筛查卒中高危人群,是简便、可行的检查手段。
Objective To evaluate stroke risk profile using cerebral vascular functional accumulative scores(CVFAS) and analyze the relationship between the score and exposure level of risk factors in middle-aged and old male population.Methods A total of 280 male people aged more than 45 years who had completed health checkup and cerebral hemodynamic examination from People's Liberation Army General Hospital No. 8 Medical Center from February 2016 to November 2016 were included in this study.All subjects were divided into two groups according to the cut off point of CVFAS, high-risk group(CVFAS<75 score, n=82) and low-risk group(CVFAS≥75 score, n=198). To analyze the change of CVFAS and the detection rate of high-risk individuals of stroke in different age groups, compare the exposure level of risk factors between the two groups, and analyze the correlation between CVFAS and risk factors of stroke.Results The CVFAS score gradually decreased with age, the detection rate of high-risk individuals of stroke was 29.3%(82/280), this rate increased with age and reached up to 60.0% in people over70 years. Compared with low-risk group, the proportion of smoking, hypertension, diabetes were all much more higher in high-risk group(all P<0.05), in addition, the levels of age, waist circumference(WC), body fat(BF), systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting plasma glucose(FPG), TC, LDL-C, Hcy, brachial-ankle pulse wave velocity(baPWV), carotid intimamedia thickness(CIMT) were also far more higher in high-risk group, but HDL-C were much lower in high-risk group(P <0.05). Correlation analysis showed a negative correlation between CVFAS and age(r =-0.314, P =0.007), WC(r =-0.295, P =0.009), BF(r =-0.324, P =0.006), SBP(r =-0.387,0.005), DBP(r=-0.327, P=0.006), TC(r=-0.219, P=0.014), LDL-C(r=-0.325, P=0.006), FPG(r=-0.289,P =0.009), Hcy(r =-0.216, P =0.014), baPWV(r =-0.349, P =0.005), CIMT(r =-0.209, P =0.013) and a positive correlation with HDL-C(r=0.258, P=0.011). Logistic regression analysis revealed that age(OR 1.257, 95%CI 1.118-1.359, P =0.001), hypertention(OR 1.524, 95%CI 1.259-1.894, P <0.001),BF(OR 1.493, 95%CI 1.214-1.876, P =0.001), SBP(OR 1.897, 95%CI 1.684-2.697, P =0.001), FPG(OR 1.356, 95%CI 1.214-1.651, P =0.001), LDL-C(OR 1.675, 95%CI 1.327-1.956, P <0.001), Hcy(OR 1.295, 95%CI 1.158-1.413, P =0.001), baPWV(OR 1.258, 95%CI 1.149-1.524, P =0.002] were independent risk factors of CVFAS abnormality.Conclusions The decreased CVFAS(CVFAS<75 score) was closely correlated with the exposure levels of risk factors in high-risk individuals of stroke. Using CVFAS to screen the high-risk individuals of stroke is a convenient and feasible method, which is helpful to early prevention of stroke.
Objective To evaluate stroke risk profile using cerebral vascular functional accumulative scores(CVFAS) and analyze the relationship between the score and exposure level of risk factors in middle-aged and old male population.Methods A total of 280 male people aged more than 45 years who had completed health checkup and cerebral hemodynamic examination from People's Liberation Army General Hospital No. 8 Medical Center from February 2016 to November 2016 were included in this study.All subjects were divided into two groups according to the cut off point of CVFAS, high-risk group(CVFAS<75 score, n=82) and low-risk group(CVFAS≥75 score, n=198). To analyze the change of CVFAS and the detection rate of high-risk individuals of stroke in different age groups, compare the exposure level of risk factors between the two groups, and analyze the correlation between CVFAS and risk factors of stroke.Results The CVFAS score gradually decreased with age, the detection rate of high-risk individuals of stroke was 29.3%(82/280), this rate increased with age and reached up to 60.0% in people over70 years. Compared with low-risk group, the proportion of smoking, hypertension, diabetes were all much more higher in high-risk group(all P<0.05), in addition, the levels of age, waist circumference(WC), body fat(BF), systolic blood pressure(SBP), diastolic blood pressure(DBP), fasting plasma glucose(FPG), TC, LDL-C, Hcy, brachial-ankle pulse wave velocity(baPWV), carotid intimamedia thickness(CIMT) were also far more higher in high-risk group, but HDL-C were much lower in high-risk group(P <0.05). Correlation analysis showed a negative correlation between CVFAS and age(r =-0.314, P =0.007), WC(r =-0.295, P =0.009), BF(r =-0.324, P =0.006), SBP(r =-0.387,0.005), DBP(r=-0.327, P=0.006), TC(r=-0.219, P=0.014), LDL-C(r=-0.325, P=0.006), FPG(r=-0.289,P =0.009), Hcy(r =-0.216, P =0.014), baPWV(r =-0.349, P =0.005), CIMT(r =-0.209, P =0.013) and a positive correlation with HDL-C(r=0.258, P=0.011). Logistic regression analysis revealed that age(OR 1.257, 95%CI 1.118-1.359, P =0.001), hypertention(OR 1.524, 95%CI 1.259-1.894, P <0.001),BF(OR 1.493, 95%CI 1.214-1.876, P =0.001), SBP(OR 1.897, 95%CI 1.684-2.697, P =0.001), FPG(OR 1.356, 95%CI 1.214-1.651, P =0.001), LDL-C(OR 1.675, 95%CI 1.327-1.956, P <0.001), Hcy(OR 1.295, 95%CI 1.158-1.413, P =0.001), baPWV(OR 1.258, 95%CI 1.149-1.524, P =0.002] were independent risk factors of CVFAS abnormality.Conclusions The decreased CVFAS(CVFAS<75 score) was closely correlated with the exposure levels of risk factors in high-risk individuals of stroke. Using CVFAS to screen the high-risk individuals of stroke is a convenient and feasible method, which is helpful to early prevention of stroke.
引文
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[16]LISAK M,DEMARIN V,TRKANJEC Z,et al.Hypertriglyceridemia as a possible independent risk factor for stroke[J].Acta Clin Croat,2013,52(4):458-463.
[17]朱小伶,王雅琴,贺雪,等.体检人群脑血管功能积分值变化及其影响因素分析[J].中华健康管理学杂志,2017,11(5):408-414.
[2]FORTMANN S P,FLORA J A,WINKLEBY M A,et al.Community intervention trials:reflections on the Stanford Five-City Project Experience[J].Am JEpidemiol,1995,142(6):576-586.
[3]WANG W Z,JIANG B,WU S P,et al.Change in stroke incidence from a population-based intervention trial in three urban communities in China[J].Neuroepidemiology,2007,28(3):155-161.
[4]中华医学会神经病学会,中华医学会神经病学分会脑血管病学组.中国脑血管病一级预防指南2015[J].中华神经科杂志,2015,48(8):629-643.
[5]脑卒中高危人群筛检手段全国多中心扩展性试验课题组.脑卒中高危人群筛检手段的多中心前瞻性研究与评价[J].中华流行病学杂志,2008,29(2):105-109.
[6]何权瀛,高莹慧.关于吸烟问题若干名词定义[J].中华结核和呼吸杂志,2009,32(1):56.
[7]杨月欣,张环美.《中国居民膳食指南(2016)》简介[J].营养学报,2016,38(3):209-217.
[8]《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014年修订版)[J].中华高血压杂志,2015,23(1):24-43.
[9]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6(7):447-498.
[10]黄久仪,王桂清,沈凤英,等.脑血管血流动力学积分与脑卒中风险的队列研究[J].中华流行病学杂志,2003,24(2):89-93.
[11]王艳,黄久仪,曹奕丰,等.上海市奉贤社区脑卒中危险因素队列研究基线调查和随访分析[J].中华流行病学杂志,2007,28(12):1171-1174.
[12]MESCHIA J F,BUSHNELL C,BODEN-ALBALAB,et al.Guidelines for the primary prevention of stroke:a statement for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(12):3754-3832.
[13]ROMERO-CORRAL A,SOMERS V K,SIERRA-JOHNSON J,et al.Accuracy of body mass index in diagnosing obesity in the adult general population[J].Int J Obes(Lond),2008,32(6):959-966.
[14]KIM S Y,GUEVARA J P,KIM K M,et al.Hyperuricemia and risk of stroke:a systematic review and meta-analysis[J].Arthritis Rheum,2009,61(7):885-892.
[15]CHAMORRO A,OBACH V,CERVERA A,et al.Prognostic significance of uric acid serum concentration in patients with acute ischemic stroke[J].Stroke,2002,33(4):1048-1052.
[16]LISAK M,DEMARIN V,TRKANJEC Z,et al.Hypertriglyceridemia as a possible independent risk factor for stroke[J].Acta Clin Croat,2013,52(4):458-463.
[17]朱小伶,王雅琴,贺雪,等.体检人群脑血管功能积分值变化及其影响因素分析[J].中华健康管理学杂志,2017,11(5):408-414.