脑血管血液动力学积分与脑卒中风险的队列研究

黄久仪; 王桂清; 沈凤英; 曹奕丰; 王艳; 郭佐; 杨永举; 冯春红; 樊舜英; 徐晓斌; 田文生

Abstract

黄久仪,王桂清,沈凤英,曹奕丰,王艳,郭佐,杨永举,冯春红,樊舜英,徐晓斌,田文生.脑血管血液动力学积分与脑卒中风险的队列研究[J].Chinese journal of Epidemiology,2003,24(2):89-93

脑血管血液动力学积分与脑卒中风险的队列研究

A cohort study on cerebral vascular hemodynamics accumulative score and risks of stroke

Received:August 05, 2002

DOI：

KeyWord: 脑卒中血液动力学危险因素队列研究

English Key Word: Stroke Hemodynamics Risk factors Cohort study

FundProject:国家自然科学基金资助项目(39370612);上海市科技发展基金资助项目(934113060;944912014)

Author Name	Affiliation
HUANG Jiuyi	Shanghai Institute of Cerebral Vascular Disease Prevention and Care, Shanghai 200433, China
WANG Guiqing	Shanghai Institute of Cerebral Vascular Disease Prevention and Care, Shanghai 200433, China
SHEN Feng ying	Shanghai Institute of Cerebral Vascular Disease Prevention and Care, Shanghai 200433, China
CAO Yifeng	Shanghai Institute of Cerebral Vascular Disease Prevention and Care, Shanghai 200433, China
WANG Yan	Shanghai Institute of Cerebral Vascular Disease Prevention and Care, Shanghai 200433, China
GUO Zuo	Shanghai Institute of Cerebral Vascular Disease Prevention and Care, Shanghai 200433, China
YANG Yongju	Shanghai Institute of Cerebral Vascular Disease Prevention and Care, Shanghai 200433, China
FENG Chunhong	Shanghai Institute of Cerebral Vascular Disease Prevention and Care, Shanghai 200433, China
FAN Shunying	中国矿业大学校医院
XU Xiaobin	吉林省延吉电业局医院
TIAN Wensheng	河北省唐山地区脑中风防治中心

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Abstract:

目的探讨脑血管血液动力学指标(CVHI)和其他脑卒中危险因素与脑卒中发病风险的关系。方法以整群抽样的方法选择东北、华北等六大行政区35岁及以上的队列人群25355人,进行脑卒中常见危险因素的基线调查,同时进行CVHI检测,并对检测结果进行积分。随访7年中共发生脑卒中患者228例,以脑卒中的发病作为观察终点,按危险因素暴露和CVHI积分分组,计算暴露与否发病的相对危险度(RR)及其可信区间(CI),并用Cox回归进行多因素分析。结果单因素分析显示:高血压、心脏病、糖尿病、高血压病家族史、脑卒中家族史、超重或肥胖、饮酒史、吸烟史、CVHI积分<75分的RR值分别为3.23(2.48～4.20)、2.53(1.92～3.33)、2.38(1.55～3.64)、1.32(1.02～1.72)、1.82(1.37～2.41)、1.62(1.25～2.11)、1.48(1.07～2.04)、1.76(1.34～2.31)和7.30(5.43～9.80);多因素Cox回归分析显示:被筛选进入回归方程的因素分别为:CVHI积分异常、脑卒中家族史、吸烟、高血压病史、年龄和性别;CVHI积分的剂量反应关系分析显示,脑卒中的风险随着CVHI的积分降低而显著上升;协同作用分析显示,当CVHI积分<75分和高血压合并出现时,脑卒中的RR值为12.55,表现为相加模型作用。结论 CVHI积分值降低是脑卒中最强的独立危险因素, 尤其与高血压同时出现时, 在脑卒中的发病中可能起重要作用。

English Abstract:

Objective To estimate relative risk(RR)of cerebral vascular hemodynamics indexes (CVHI) accumulative score as well as some other risk factors of stroke. Methods A cohort study was carried out in 25 355 participants aged 35 and over in Northeast of China from 1994 to 2001. In the baseline survey, exposure rates of hypertension, diabetes, family history of stroke and hypertension, etc. were collected and CVHI was examined. CVHI accumulative score was synthesized according to contribution of single index. During the 7 year following up, 228 stroke cases were identified and stroke coming on was defined as the endpoint of observation. Uni variable and multiple variables analysis were curried out for estimating RR of CVHI and other risk factors of stroke. Results Uni variables analysis indicated that RR (95% confidence interval, CI)of Hypertension, heart diseases, diabetes, family history of hypertension and stroke, overweight or obesity, alcohol intake, cigarette smoking and CVHI 75 scores were 3.23(2.48-4.20), 2.53(1.92-3.33), 2.38 (1.55-3.64), 1.32(1.02-1.72), 1.82(1.37-2.41), 1.62(1.25-2.11), 1.48(1.07-2.04), 1.76(1.34-2.31)and 7.30(5.43-9.80)respectively. Cox regression analysis showed that CVHI below 75 points, family history of stroke, cigarette smoking, heart disease, hypertension, age and sex were the factors being selected in equation. There was a significant dosage response between the decrease of CVHI score and the increase of stroke risk. RR of stroke reached 12.55 when CVHI below 75 points and history of hypertension appeared in the same individuals. Conclusion Abnormality of CVHI score seemed to be the most important and independent factor among stroke risk factors. Decrease of CVHI score might serve as a marker of high risk and play important role in stroke, especially coexistence with hypertension.

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