中国脑卒中的发病与趋势——三大城市的研究结果

Incidence aud Trends of Stroke and Its Subtypesin China Results From Three Large Cities

分析1991～2000年北京、上海、长沙3城市社区年登记的卒中病例,了解3大城市90年代脑卒中及其亚型的发病率和变化趋势。经年龄标化后北京初发脑卒中的发病率为135．0/10万人年、上海为76．1/10万人年、长沙为150．0/10万人年,其中北京缺血性卒中的发病率最高,其次为上海和长沙;而长沙颅内出血的发生率最高,其次是北京和上海;蛛网膜下腔出血的顺序同脑出血。社区≥50岁的人群总卒中和颅内出血年龄标化后的发病率普遍高于西方国家。从10年变化趋势来看,北京、上海、长沙3大城市颅内出血的年下降率分别为12．0%、4．4%和7．7%,而脑缺血的年增长率除长沙外北京和上海分别为5．0%和7．7%。这种颅内出血减少和缺血性卒中增加的现象反映出中国人群脑卒中危险因素的变化情况。

Objective To examine the incidence and trends of stroke and its major subtypes during the 1990s in 3 cit- ies in China.Methods Stroke cases registered between 1991 to 2000 were initially identified through the stroke surveillance net- works established in Beijing,Shanghai,and Changsha,and then confirmed by neurologists.Results The age-standardized incidence rates per 100000 person years of overall first-ever stroke were 135.0(95% CI,126.5 to 144.6)in Beijing,76.1 (70.6 to 82.6)in Shanghai,and 150.0(141.3 to 160.0)in Changsha during the 1990s.Incidence of ischemic stroke(IS) was highest in Beijing,followed by Changsha and Shanghai;for intracerebral hemorrhage(ICH),the highest rate was found in Changsha,followed by Beijing and Shanghai.The same order as ICH was also observed for subarachnoid hemorrhage.The age -adjusted incidence of overall stroke and ICH for individuals_55 years of age in our populations was generally higher than that from Western populations.During the 1990s,ICH incidence decreased significantly at a rate of 12.0% per year in Beijing, 4.4% in Shanghai,and 7.7% in Changsha;in contrast,except for Changsha,IS incidence increased in Beijing(5.0% per year)and Shanghai(7.7%).Conclusion There is a geographic variation in the incidence of stroke and its subtypes among these 3 cities,but the incidence of overall and hemorrhagic stroke in China is generally higher than that in the Western countries. Interestingly,the decrease in ICH and increase in IS daring the past decade may reflect some underlying changes of risk factors inChinese populations.