自发性脑出血发病危险因素的Logistic回归分析

Logistic regression analysis of risk factors for spontaneous intracerebral hemorrhage

目的:分析抚顺地区自发性脑出血发病的危险因素。方法:①选择2002-09/2005-08抚顺市第二医院神经内外科和重症监护病房收治的自发性脑出血患者250例,男202例,女48例,年龄37～79岁。脑力劳动105例,有高血压史153例,情绪行为障碍87例,高胆固醇血症5例,冠心病31例,心电图异常者62例,吸烟47例,嗜酒55例,有糖尿病史23例,超重79例。均符合中华神经科学会、中华神经外科学会《各类脑血管疾病诊断要点》中自发性脑出血诊断标准,且经CT或MRI检查证实;均对检查项目知情同意;居住地为抚顺市望花区。②于患者入院后1周内进行一般资料和住院资料及自发性脑出血危险因素调查。高血压史:在发病前至少2次或以上收缩压>140mmHg(1mmHg=0.133kPa)或舒张压>90mmHg。情绪行为障碍表现为符合美国精神疾病诊断分类与统计手册(第四版)抑郁症诊断标准。高胆固醇血症:总胆固醇≥6.5mmol/L;糖尿病诊断以1999年世界卫生组织、国际糖尿病联合会公布为标准;超重定义为体质量指数≥25kg/m2。③采用多因素非条件Logistic回归分析对自发性脑出血发病的可能相关因素进行分析。以OR>1为自发性脑出血发生的危险因素;OR<1为自发性脑出血发生的保护因素。结果:自发性脑出血患者250例均进入结果分析。自发性脑出血患者脑力劳动OR=2.568,P=0.000;高血压OR=6.513,P=0.000;情绪行为障碍OR=4.053,P=0.000;心电图异常OR=13.397,P=0.000;糖尿病OR=4.013,P=0.006;超重OR=4.179,P=0.000;以上因素为自发性脑出血发生的危险因素。高胆固醇血症OR=0.150,P=0.005,为自发性脑出血发生的保护因素。结论:脑力劳动、高血压史、糖尿病史、情绪行为障碍、心电图异常、超重是抚顺市望花地区人群自发性脑出血发病的危险因素。

AIM： To explore the risk factors of spontaneous intracerebral hemorrhage （SICH） in Fushun. METHODS： （1）We studied 250 SICH patients admitted to Department of Neurology and Neurosurgery Ward as well as Intensive Care Unit in the Second Hospital of Fushun between September 2002 and August 2005, including 202 males and 48 females, aging 37-79 years. There were 105 cases of mental labor, 153 cases with hypertensive history, 87 cases with emotional or behavioral disorders, 5 cases with hypercholesterolemia, 31 cases with coronary heart disease, 62 cases presenting electrocardiographic abnormality, 47 cases of smoking history, 55 cases of alcohol history, 23 cases of diabetic mellitus history, and 79 cases over-weighted. All the subjects living in Fushun city Wanghua area accorded the diagnosis criterion of SICH by Chinese Society of Neurology and Chinese Society of Neurosurgery, and were confirmed by CT or MRI. Additionally they were all informed of the detection items and then consented. （2）Totally 250 consecutive patients with SICH were surveyed on general data, hospitalization data and risk factors of SICH one week later. Hypertensive history： More than or equal to 2 appearances of systolic pressure 〉 140 mm Hg （1 mm Hg=0.133 kPa） or diastolic pressure 〉 90 mm Hg. Emotional or behavioral disorders were assessed with Diagnostic and Statical Manual of Mental Disorders （DSM-Ⅳ） for depression. Hypercholesterolemia was detected as total cholesterol ≥ 6.5 mmol/L; Diabetic mellitus was identified by the criterion of International Diabetes Federation and World Health Organization in 1999; Overweight was defined as body mass index ≥ 25 kg/m^2. （3）The risk factors of SICH were analyzed under multivariate and unconditional Logistic retrospective analysis. OR 〉 1 was taken as the risk factor of SICH whereas OR 〈 1 as the protective factor of SICH. RESULTS： All the 250 SICH patients were involved in the result analysis. SICH was associated with mental labor （OR = 2.568, P=0.000）, hypertension （OR=6.513, P=0.000）, emotional or behavioraldisorders （OR=4.053, P=0.000）, electrocardiographic abnormality （OR =13.397, P =0.000）, diabetic mellitus （OR =4.013, P =0.006） and overweight （OR = 4.179, P =0.000）. But hyperlipidemia （OR =0.150, P =0.005） was the protective factor for SICH. CONCLUSION： Hypertension, emotional or behavioraldisorders, overweight, diabetic mellitus, electrocardiographic abnormality and mental labor are the risk factors for SICH in Fushun Wanghua area.