脑卒中高危人群筛检手段的多中心前瞻性研究与评价

冯子健; 李克莉; 金连梅; 倪大新; 许真; 王英

Abstract

冯子健,李克莉,金连梅,倪大新,许真,王英.脑卒中高危人群筛检手段的多中心前瞻性研究与评价[J].Chinese journal of Epidemiology,2008,29(2):105-109

脑卒中高危人群筛检手段的多中心前瞻性研究与评价

Multiple center collaborative research on high risk population screening measure

Received:October 25, 2007 Revised:June 06, 2012

DOI：

KeyWord: 脑卒中高危人群队列研究筛检试验

English Key Word: stroke High risk population Cohort study Screening test

FundProject:国家"十五"科技攻关滚动课题资助项目(2004BA703B12)

Author Name	Affiliation
FENG Zi-jian	Office for Disease Control and Emergency Response
LI Ke-li	Office for Disease Control and Emergency Response
Jin Lian-mei	Office for Disease Control and Emergency Response
NI Da-xin	Office for Disease Control and Emergency Response
XU Zhen	Chinese Center for Disease Control and Prevention, Beijing 100050, China
WANG Ying	中国疾病预防控制中心病毒病预防控制所

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Abstract:

目的验证脑血管血液动力学综合积分筛检脑卒中高危个体的效能及其作为预测因子的相对危险度.方法在北京、上海、唐山和福州市共设立5个中心,以整群的方法抽取人群中年龄≥40岁的人群作为目标人群,选择既往无脑卒中病史者作为研究对象,进行脑卒中危险因素基线调查、脑血管血液动力学检测、脑卒中发病随访.结果共随访48 481人年,随访过程中新发脑卒中182例,脑卒中发病3.75/1000人年.单因素分析结果显示,血液动力学积分值＜75分的调整卒中相对危险度(RR)为9.3,且积分值降低与脑卒中RR值升高具有显著的剂量反应关系;多因素分析结果显示,血液动力学积分是进入Cox回归方程中最强的因素.筛检试验评价显示,血液动力学积分筛检卒中高危人群的敏感度、特异度、准确度、Youden指数分别为80.77%、67.55%、67.65%和0.48,受试者工作特征曲线下面积(AUC)为0.806.结论脑血管血液动力学积分值是脑卒中最强的独立预测因子,筛检脑卒中高危人群具有良好的效能.

English Abstract:

objective To validate efficacy of cerebrovascular hemodynamic synthesized score (CVHS)for scfeening high risk population of stroke and relative risk(RR)for predIcting stroke．Methods Participants aged≥40 years and free of stroke were cluster sampled from Beijing,Shanghai,Fuzhou and Tangshan city in 5 centers.Investigation of risk factors of stroke and examination of cerebrovascular hemodynamic were carried out during baseline,and stroke incidence was surveyed during follow up．26 690 peopie aged≥40 years were recruited,and 24 253 people agreed to participate(90．87%)with the effect as 23 741, Cerebral blood vessel analyzer (CBA) CV 300 was used to measure cerebrovascular hemodynamic synthesized index,including quantity of mean bloOd flow(Q_mean),velocity of maximum blood flow(V_max), velocity of minimus blood flow(V_min), velocity of mean blOOd flow(V_mean), pulse wave Velocity(Wv),characteristic impedance of cerebrovascular net(Zcv),dilatation index(DI),resistance of Vascular(RV),development resistance(DR),capillary pressure(Cp), differential pressure(Dp)．The CVHS was calculated by software according to the index measured directly.ResuIts There were 48 481 person-year f0110wed and 1 82 stroke incjdence occurred.Incidence of stroke was 3．75／1 000 person-vear in the mujtipie source people who aged≥40 years.Uni-variant analysis indicated that age and gender adjusted relative risk(RR)for stroke of low CVHS(<75)was 9.3,There was stronificant dosage response between CVHS and RR of stroke．Multiple(bx regression showed that CVHS was the strongest predictive factor.Screening test evaluation showed that sensitivity, specificity, accuracy and Youden index of CVHS for screening were 80．77%,67．55%,67．65%and O,48,respectively．The area under ROC curve(AUC) was 0．806．ConcIusion It seems that CVHS was the strongest and independent predictor of stroke and the efficacy for screening high risk population was also satisfactory.This kind of screening test could be an useful measure for preventing of the stroke occurrence．

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