[一项关于脑血管血流动力学变化与中风风险关系的队列研究]
[A cohort study on the relationship between cerebrovascular hemodynamic changing and risk of stroke].
作者信息
Guo Ji-ping, Huang Jiu-yi, Guan Yang-tai, Chen Hai-ying, Yang Yong-ju, Tao Yin-ruo, Cao Yi-feng, Xu Ying, Yu Xue-hai
机构信息
Department of Community Prevention, Shanghai Institute of Cerebrovascular Disease Prevention and Cure, Shanghai 201318, China.
出版信息
Zhonghua Yu Fang Yi Xue Za Zhi. 2013 Apr;47(4):323-7.
OBJECTIVE
To study the role of cerebrovascular hemodynamic indexes (CVHI) changing in stroke and to provide reference for stroke prevention and risk factor study.
METHODS
From 2003 to 2004, participants aged 40 years and above in two communities in Fengxian district were recruited by cluster sampling. Risk factors of stroke and CVHI were investigated and checked during baseline investigation. A total of 10 565 individuals completed the survey and met the inclusion criterion. After baseline investigation, the cohort was followed up for stroke occurrence. Relative risk (RR) of CVHI and common risk factors were estimated by cohort study design.
RESULTS
Age of the cohort was (56.2 ± 11.4) years. 4444 (42.1%) were males and 6121 (57.9%) were females. Total follow-up duration was 67 885.7 person-years. A total of 195 stroke cases occurred and incidence density of stroke was 287.2 per 100 000 person-years. Stroke incidence in exposure groups of hypertension, heart disease and alcohol drinking was 3.47% (108/3118), 2.96% (21/710) and 2.50% (47/1882), respectively. The incidence in corresponding non-exposure group was 1.17% (87/7448), 1.77% (174/9855) and 1.70% (148/8683) respectively. There was significant difference between 2 groups (χ(2) value was 62.72, 4.56 and 4.94, respectively, P < 0.05). Stroke incidence in CVHI score < 25, 25 - 49, 50 - 74 and ≥ 75 groups was 9.12% (59/647), 5.68% (44/775), 2.52% (39/1545) and 0.72% (53/7403)(χ(2)trend = 273.57, P < 0.05), respectively. Incidence of stroke in 40 - 49, 50 - 59, 60 - 69, ≥ 70 years age group was 0.22% (8/3565), 1.28% (43/3357), 2.71% (50/1848) and 5.88% (94/1600) (χ(2)trend = 181.48, P < 0.05), respectively. Multiple Cox regression analysis indicated that RR (95%CI) value of hypertension and cigarette smoking was 1.40(1.02 - 1.92) and 1.59(1.19 - 2.12), respectively when comparing with non-exposure group. RR (95%CI) value in CVHI score < 25, 25 - 49 and 50 - 74 points group were 6.15 (4.08 - 9.26), 4.55 (2.98 - 6.96) and 2.68 (1.75 - 4.09), respectively when comparing with the score ≥ 75 points group. RR (95%CI) value in age 50 - 59, 60 - 69 and ≥ 70 years group was 4.61 (2.16 - 9.82), 7.81 (3.67 - 16.60) and 13.49(6.44 - 28.24), respectively when comparing with below 40 years group.
CONCLUSION
CVHI score is the strong independent predictive factor and hypertension, cigarette smoking and age are the independent risk factors of stroke.
目的
研究脑血管血流动力学指标（CVHI）变化在脑卒中发病中的作用，为脑卒中的预防及危险因素研究提供参考。
方法
2003年至2004年，采用整群抽样方法，选取奉贤区两个社区40岁及以上的居民。在基线调查时，对脑卒中危险因素及CVHI进行调查与检测。共有10 565名个体完成调查并符合纳入标准。基线调查后，对该队列人群进行脑卒中发病随访。采用队列研究设计估算CVHI及常见危险因素的相对危险度（RR）。
结果
该队列人群年龄为（56.2±11.4）岁。男性4444名（42.1%），女性6121名（57.9%）。总随访时间为67 885.7人年。共发生195例脑卒中病例，脑卒中发病密度为每10万人年287.2例。高血压、心脏病及饮酒暴露组的脑卒中发病率分别为3.47%（108/3118）、2.96%（21/710）和2.50%（47/1882）。相应非暴露组发病率分别为1.17%（87/7448）、1.77%（174/9855）和1.70%（148/8683）。两组间差异有统计学意义（χ²值分别为62.72、4.56和4.94，P<0.05）。CVHI评分<25、25 - 49、50 - 74及≥75分组的脑卒中发病率分别为9.12%（59/647）、5.68%（44/775）、2.52%（39/1545）和0.72%（53/7403）（χ²趋势=273.57，P<0.05）。40 - 49、50 - 59、60 - 69、≥70岁年龄组的脑卒中发病率分别为0.22%（8/3565）、1.28%（43/3357）、2.71%（50/1848）和5.88%（94/1600）（χ²趋势=181.48，P<0.05）。多因素Cox回归分析显示，与非暴露组相比，高血压和吸烟的RR（95%CI）值分别为1.40（1.02 - 1.92）和1.59（1.19 - 2.12）。与CVHI评分≥75分组相比，CVHI评分<25、25 - 49及50 - 74分组的RR（95%CI）值分别为6.15（4.08 - 9.26）、4.55（2.98 - 6.96）和2.68（1.75 - 4.09）。与<40岁组相比，50 - 59、60 - 69及≥70岁组的RR（95%CI）值分别为4.61（2.16 - 9.82）、7.81（3.67 - 16.60）和（6.44 - 28.24）13.49。
结论
CVHI评分是脑卒中的强独立预测因素，高血压、吸烟及年龄是脑卒中的独立危险因素。
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