中老年自然人群颈动脉粥样硬化现况调查暨传统心血管病危险因素与颈动脉粥样硬化的关系
摘要
中老年自然人群颈动脉粥样硬化现况调查
目的：
了解我国中老年自然人群颈动脉颈动脉粥样硬化现况，研究我国中老年自然人群颈动脉粥样硬化与心血管病的关系，研究我国中老年自然人群颈动脉粥样硬化的相关因素，探讨预防颈动脉粥样硬化发生的措施。
方法：
2002年9月对北京石景山区43～73岁农村居民1202人进行心血管病随访和危险因素横断面调查及颈动脉超声检查。应答率为85.7％。受检率为86.2％。抽取20名研究对象重复进行颈动脉超声检查，以评价医师之间和医师本身的重复性。两名医师测量IMT和血管内径的结果无显著差异，IMT相关系数为0.69，血管内径相关系数为0.83～0.90；斑块检出的一致率达到97.5％(κ=0.950)，斑块面积亦无显著差异，两医师相关系数为0.955；P＜0.01。医师对同一研究对象前后两次测量IMT和血管内径的结果无显著差异，IMT相关系数为0.69，血管内径相关系数为0.69～0.81；斑块检出的一致率达到85％(κ=0.696)，斑块面积亦无显著差异，医师相关系数为0.833；P＜0.01。采用SPSS10.0统计软件包进行数据分析。将P＜0.05设为统计学显著水平。
结果：
1．颈动脉粥样硬化指标的分布特征：
(1) IMT：全部人群IMT在0.48～1.23mm之间，均值为0.71±0.10mm，男性为0.73±0.10mm(0.48～1.11mm)，女性为0.70±0.09mm(0.48～1.23mm)，男性厚于女性(P＜0.01)；无论男女，IMT均随年龄增大呈现增厚趋势，P＜0.01；颈动脉窦部IMT均值最厚，远端次之(p＜0.01)。
(2) 斑块：全部人群斑块阳性率为36.9％(444／1202)，男性(47.2％)明显高于女性(31.3％)。随年龄增加，男女斑块阳性率均呈上升趋势，P＜0.01。硬斑检出率为24.0％(288／1202)，软斑检出率为24.5％(295／1202)，混合斑检出率为31.9％(384／1202)。斑块平均数目和平均面积均随年龄增加而呈现增大趋势，
Objective
The aim of this study was to describe the distribution of carotid atherosclerosis in the middle-aged and senile population in China; to evaluate the relationship of carotid atherosclerosis to cardiovascular disease; and to explore its relative factors.
Methods
A cross-sectional study on cardiovascular disease and relative risk factors was carried out in 1394 subjects, aged 43-73, in suburban in Beijing in Sep, 2002. The response rate was 85.7%. Carotid lesions were detected and evaluated high-resolution B-mode ultrasonography in 1202 subjects, with the participation rate 86.2%.
The inter- and intra-reproducibility of the measurements were assessed for the intima-media thickness (IMT), vessel interior diameter and plaque in 20 subjects. There was no statistically significant difference between two technicians for IMT, interior diameter and plaque areas, with r=0.69, r=0.83-0.90 and r=0.95, respectively. As for plaque, the coincidence rate was 97.5% between the two technicians (κ =0.950).The intra-reproducibility was evaluated between the first and the second measurements by each technician. The correlation was 0.69 for IMT, 0.69-0.81 for interior diameter and 0.83 for plaque area. 85% of the first plaque coincided with the second one (κ=0.696).
SPSS 10.0 software package was used for the analysis. Plaque number and plaque area were converted into natural logarithms to make their distribution canonical before further analysis. A value of p<0.05 was considered statistically significant.
目的：
了解我国中老年自然人群颈动脉颈动脉粥样硬化现况，研究我国中老年自然人群颈动脉粥样硬化与心血管病的关系，研究我国中老年自然人群颈动脉粥样硬化的相关因素，探讨预防颈动脉粥样硬化发生的措施。
方法：
2002年9月对北京石景山区43～73岁农村居民1202人进行心血管病随访和危险因素横断面调查及颈动脉超声检查。应答率为85.7％。受检率为86.2％。抽取20名研究对象重复进行颈动脉超声检查，以评价医师之间和医师本身的重复性。两名医师测量IMT和血管内径的结果无显著差异，IMT相关系数为0.69，血管内径相关系数为0.83～0.90；斑块检出的一致率达到97.5％(κ=0.950)，斑块面积亦无显著差异，两医师相关系数为0.955；P＜0.01。医师对同一研究对象前后两次测量IMT和血管内径的结果无显著差异，IMT相关系数为0.69，血管内径相关系数为0.69～0.81；斑块检出的一致率达到85％(κ=0.696)，斑块面积亦无显著差异，医师相关系数为0.833；P＜0.01。采用SPSS10.0统计软件包进行数据分析。将P＜0.05设为统计学显著水平。
结果：
1．颈动脉粥样硬化指标的分布特征：
(1) IMT：全部人群IMT在0.48～1.23mm之间，均值为0.71±0.10mm，男性为0.73±0.10mm(0.48～1.11mm)，女性为0.70±0.09mm(0.48～1.23mm)，男性厚于女性(P＜0.01)；无论男女，IMT均随年龄增大呈现增厚趋势，P＜0.01；颈动脉窦部IMT均值最厚，远端次之(p＜0.01)。
(2) 斑块：全部人群斑块阳性率为36.9％(444／1202)，男性(47.2％)明显高于女性(31.3％)。随年龄增加，男女斑块阳性率均呈上升趋势，P＜0.01。硬斑检出率为24.0％(288／1202)，软斑检出率为24.5％(295／1202)，混合斑检出率为31.9％(384／1202)。斑块平均数目和平均面积均随年龄增加而呈现增大趋势，
Objective
The aim of this study was to describe the distribution of carotid atherosclerosis in the middle-aged and senile population in China; to evaluate the relationship of carotid atherosclerosis to cardiovascular disease; and to explore its relative factors.
Methods
A cross-sectional study on cardiovascular disease and relative risk factors was carried out in 1394 subjects, aged 43-73, in suburban in Beijing in Sep, 2002. The response rate was 85.7%. Carotid lesions were detected and evaluated high-resolution B-mode ultrasonography in 1202 subjects, with the participation rate 86.2%.
The inter- and intra-reproducibility of the measurements were assessed for the intima-media thickness (IMT), vessel interior diameter and plaque in 20 subjects. There was no statistically significant difference between two technicians for IMT, interior diameter and plaque areas, with r=0.69, r=0.83-0.90 and r=0.95, respectively. As for plaque, the coincidence rate was 97.5% between the two technicians (κ =0.950).The intra-reproducibility was evaluated between the first and the second measurements by each technician. The correlation was 0.69 for IMT, 0.69-0.81 for interior diameter and 0.83 for plaque area. 85% of the first plaque coincided with the second one (κ=0.696).
SPSS 10.0 software package was used for the analysis. Plaque number and plaque area were converted into natural logarithms to make their distribution canonical before further analysis. A value of p<0.05 was considered statistically significant.
引文
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3 Mannami T, Konishi M, Baba S, et al. Prevalence of asymptomatic carotid atherosclerotic lesions detected by high-resolution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city: the Suita study. Stroke 1997; 28: 518-525.
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7 Bots ML, Hoes AW, Koudstaal PJ, et al. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997; 96: 1432-1437.
8 Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993. Am J Epidemiol 1997; 146: 483-494.
9 Hodis HN, Mack W, LaBree L, et al. The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med 1998; 128: 262-269.
10 O'Leary DH, Polak JF, Kronmal RA, et al. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults: Cardiovascular Health Study. N Engl J Med 1999; 340: 14-22.
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14 Raitakari OT, Juonala M, Kahonen M, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood. The Cardiovascular Risk in Young Finns Study. JAMA 2003; 290: 2277-2283.
15 Stensland-Bugge E, Bonaa KH, Joakimsen O, et al. Sex differences in the relationship of risk factors to subclinical carotid atherosclerosis measured 15 years later. The Tromso Study. Stroke 2000; 31: 574-592.
16 Joakimsen O, Bonaa KH, Stensland-Bugge E, et al. Age and sex differences in the distribution and ultrasound morphology of carotid atherosclerosis. The Tromso Study. Arte Thro Vas Biol 1999; 19: 3007-3022.
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18 刘芳 杨浣宜 李建蓉等．国人颈动脉内膜-中膜厚度与心血管疾病的相关性研究．中国超声医学杂志 2003；19(1)：30-32．
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20 李世军，李长育，夏稻子，叶建珏．高血压病人颈动脉粥样硬化与胰岛素抵抗关系的探讨．中国心血管杂志 2002年03期．
21 许竹梅，赵水平．超声检测原发性高血压患者颈动脉粥样硬化．心肺血管病杂志 2000年01期．
22 王星，吕玲环，王磌，周建房．彩色多普勒超声对脑梗塞患者颈动脉粥样硬化斑块的诊断价值．中国超声医学杂志 2000年09期．
23 丁建平，华扬，凌晨，段春，张蕾．彩超对急性脑梗塞患者颈动脉粥样硬化斑块的研究．中国医学影像技术??2000年09期．
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27 国家“十五”攻关“冠心病、脑卒中综合危险度评估及干预方案的研究”课题组．国人缺血性心血管病发病危险的评估方法及简易评估工具的开发研究．中华心血管病杂志 2003；31(12)：893-901．
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