3种预测工具评估住院高血压患者脑卒中风险
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摘要
目的采用3种预测工具评估住院高血压患者脑卒中风险。方法选择高血压患者356例,采用脑卒中风险初筛量表、改良Framingham卒中风险评估量表(M-FSP)和汇集队列风险方程(PCE)评估脑卒中风险,并比较M-FSP和PCE在脑卒中风险评估应用中的一致性。结果脑卒中风险初筛量表评估男性脑卒中高危风险明显高于女性(28. 8%vs 17. 2%,P <0. 05);≥60岁脑卒中高危风险明显高于<60岁(30. 1%vs 15. 3%,P <0. 01)。M-FSP评估患者10年脑卒中风险(12. 6±7. 1)%,男性脑卒中风险明显高于女性[(14. 5±9. 6)%vs (10. 1±8. 9)%,P <0. 01];≥60岁脑卒中风险明显高于<60岁[(18. 8±12. 1)%vs (9. 4±7. 6)%,P <0. 01]。PCE评估患者10年脑卒中风险(13. 3±9. 2)%,男性脑卒中风险明显高于女性[(16. 5±11. 9)%vs (8. 9±7. 8)%,P <0. 01];≥60岁脑卒中风险明显高于<60岁[(29. 9±19. 5)%vs (11. 2±9. 3)%,P <0. 01]。相关性分析显示,男性和女性的r值分别为0. 647和0. 609,≥60岁和<60岁的r值分别为0. 577和0. 702(P <0. 01)。结论脑卒中风险初筛量表可以对个体脑卒中风险进行初筛和归类,M-FSP和PCE均能预测脑卒中发生风险。
Objective To provide the preventive strategy and evidence for reducing the incidence of cerebral stroke( CS) by assessing the risk of CS in hospitalized hypertension patients with 3 predictive tools.Methods The risk of CS in 356 hypertension patients admitted to our hospital was assessed according to the stroke risk initial screening scale( SRISS),modified Framingham stroke profile( M-FSP) and pooled corhort risk equation( PCE). The consistency of M-FSP and PCE in assessing the risk of CS was compared. Results SRISS showed that the incidence of high risk CS was significantly higher in male patients than in female patients and in ≥60 years old patients than in < 60 years old patients( 28. 8% vs 17.2%,P < 0. 05; 30. 1% vs 15. 3%,P < 0. 01). M-FSP and PCE revealed that the 10-year incidence of CS was significantly higher in male patients than in female patients and in ≥60 years old patients than in <60 years old patients( 14. 5% ± 9. 6% vs 10. 1% ± 8. 9%,18. 8% ± 12. 1% vs 9. 4% ± 7. 6%,P < 0. 01;16. 5% ± 11. 9% vs 8. 9% ± 7. 8%,29. 9% ± 19. 5% vs 11. 2% ± 9. 3%,P < 0. 01). Correlation analysis displayed that the r value was 0. 647 for male patients and 0. 609 for female patiens,and was 0. 577 for ≥60 years old patients and 0. 702 for < 60 years old patients( P < 0. 01). Conclusion SRISS can be used to screen and classify the risk of CS. M-FSP and PCE can predict the risk of CS.
Objective To provide the preventive strategy and evidence for reducing the incidence of cerebral stroke( CS) by assessing the risk of CS in hospitalized hypertension patients with 3 predictive tools.Methods The risk of CS in 356 hypertension patients admitted to our hospital was assessed according to the stroke risk initial screening scale( SRISS),modified Framingham stroke profile( M-FSP) and pooled corhort risk equation( PCE). The consistency of M-FSP and PCE in assessing the risk of CS was compared. Results SRISS showed that the incidence of high risk CS was significantly higher in male patients than in female patients and in ≥60 years old patients than in < 60 years old patients( 28. 8% vs 17.2%,P < 0. 05; 30. 1% vs 15. 3%,P < 0. 01). M-FSP and PCE revealed that the 10-year incidence of CS was significantly higher in male patients than in female patients and in ≥60 years old patients than in <60 years old patients( 14. 5% ± 9. 6% vs 10. 1% ± 8. 9%,18. 8% ± 12. 1% vs 9. 4% ± 7. 6%,P < 0. 01;16. 5% ± 11. 9% vs 8. 9% ± 7. 8%,29. 9% ± 19. 5% vs 11. 2% ± 9. 3%,P < 0. 01). Correlation analysis displayed that the r value was 0. 647 for male patients and 0. 609 for female patiens,and was 0. 577 for ≥60 years old patients and 0. 702 for < 60 years old patients( P < 0. 01). Conclusion SRISS can be used to screen and classify the risk of CS. M-FSP and PCE can predict the risk of CS.
引文
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[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. DOI:10.3969/j. issn. 1673-5765. 2014. 01. 003.
[19] Lee CH,Woo YC,Lam JK,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. DOI:10. 1016/j. jacl.2015. 06. 005.
[20] Chia YC,Lim HM,Ching SM. Validation of the pooled cohort risk score in an Asian population-a retrospective cohort study[J].BMC Cardiovasc Disord,2014,14:163. DOI: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]. Int J Cardiol,2018,265:237. DOI:10. 1016/j. ijcard. 2018. 04. 063.
[22] Topel ML,Shen J,Morris AA,et al. Comparisons of the Framingham and pooled cohort equation risk scores for detecting subclinical vascular disease in blacks versus whites[J]. Am J Cardiol,2017,121(5):564-569. DOI:10. 1016/j. amjcard. 2017. 11.031.
[23]温程娟,任力杰,胡诗雨.卒中危险因素初筛表的信度及效度研究[J].中国卒中杂志,2016,11(3):202-206. DOI:10.3969/j. issn. 1673-5765. 2016. 03. 008.
[2] Hecht H,Blaha MJ,Berman DS,et al. Clinical indications for coronary artery calcium scoring in asymptomatic patients:expert consensus statement from the Society of Cardiovascular Computed Tomography[J]. J Cardiovasc Tomogr,2017,11(2):157-168.DOI:10. 1016/j. jcct. 2017. 02. 010.
[3]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743. DOI:10.16439/j. cnki. 1673-7245. 2011. 08. 009.
[4] Goldstein LB,Bushnell CD,Adams RJ,et al. Guidelines for the primary prevention of stroke:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke,2011,42(2):517-584. DOI:10. 1161/STR.0b013e3181fcb238.
[5]孙佳艺,巢宝华,徐新娟,等.中国三甲医院高血压患者脑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. DOI:10. 16439/j. cnki. 1673-7245.2014. 10. 004.
[6]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中风险评估量表使用专家共识[J].中华神经科杂志,2016,49(7):519-525. DOI:10. 3760/cma. j. issn. 1006-7876. 2016. 07. 003.
[7] Benjamin EJ,Virani SS,Callaway CW,et al. Heart disease and stroke statistics-2018 update:a report from the American Heart Association[J]. Circulation,2018,137(12):e67-e492.DOI:10. 1161/CIR. 0000000000000558.
[8] Guan T,Ma J,Li M,et al. Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013[J]. Neurology,2017,89(1):53-61. DOI:10. 1212/WNL.0000000000004056.
[9] 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. DOI:10. 1016/j.jstrokecerebrovasdis. 2016. 12. 002.
[10] Tsai CF,Anderson N,Thomas B,et al. Comparing risk factor profiles between intracerebral hemorrhage and ischemic stroke in Chinese and White populations:systematic review and meta-analysis[J]. PLo S One,2016,11(3):e0151743. DOI:10. 1371/journal. pone. 0151743.
[11] Yang Q,Zhang B,Deng P,et al. Assessing cardiovascular health using life's simple 7 in a Chinese population undergoing stroke prevention[J]. Chin Med J(Engl),2015,128(18):2450-2456.DOI:10. 4103/0366-6999. 164928.
[12] Fahey M,Crayton E,Wolfe C,et al. Clinical prediction models for mortality and functional outcome following ischemic stroke:a systematic review and meta-analysis[J]. PLo S One,2018,13(1):e0185402. DOI:10. 1371/journal. pone. 0185402.
[13] Hasan TH,Habib KR,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]. J Medicine,2018,19(2):91-94. DOI:10. 3329/jom. v19i2.37226.
[14] Dufouil C,Beiser A,Mclure LA,et al. Revised Framingham stroke risk profile to reflect temporal trends[J]. Circulation,2017,135(12):1145-1159. DOI:10. 1161/CIRCULATIONAHA. 115.021275.
[15]马丽珍,李学军,陈路,等.脑卒中高危人群的风险评估研究[J].中国全科医学,2015,18(10):1150-1152. DOI:10.3969/j. issn. 1007-9572. 2015. 10. 012.
[16] Bos D,Ikram MA,Leening MJG,et al. The revised Framingham stroke risk profile in a primary prevention population:The Rotterdam Study[J]. Circulation,2017,135(22):2207-2209. DOI:10. 1161/CIRCULATIONAHA. 117. 028429.
[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. DOI:10. 3969/j. issn.1009-0126. 2016. 08. 022.
[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. DOI:10.3969/j. issn. 1673-5765. 2014. 01. 003.
[19] Lee CH,Woo YC,Lam JK,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. DOI:10. 1016/j. jacl.2015. 06. 005.
[20] Chia YC,Lim HM,Ching SM. Validation of the pooled cohort risk score in an Asian population-a retrospective cohort study[J].BMC Cardiovasc Disord,2014,14:163. DOI: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]. Int J Cardiol,2018,265:237. DOI:10. 1016/j. ijcard. 2018. 04. 063.
[22] Topel ML,Shen J,Morris AA,et al. Comparisons of the Framingham and pooled cohort equation risk scores for detecting subclinical vascular disease in blacks versus whites[J]. Am J Cardiol,2017,121(5):564-569. DOI:10. 1016/j. amjcard. 2017. 11.031.
[23]温程娟,任力杰,胡诗雨.卒中危险因素初筛表的信度及效度研究[J].中国卒中杂志,2016,11(3):202-206. DOI:10.3969/j. issn. 1673-5765. 2016. 03. 008.