广东佛山社区人群大脑中动脉狭窄危险因素的动态分析

Risk factors of middle cerebral artery stenosis in Foshan community,Guangdong province:a longitudinal study

目的探讨广东佛山社区无症状人群大脑中动脉(MCA)狭窄的危险因素和动态变化的影响因素,为社区人群脑卒中的预防提供流行病学上的帮助。方法2002年整群随机抽取2500名社区居民进行流行病学问卷、人体测量学、经颅多普勒超声(TCD)和血浆同型半胱氨酸(Hcy)水平等各项指标的数据收集,筛选出符合入选标准的观察对象1068例。4年后对观察对象复查相同指标,存留有效样本844例。依据大脑中动脉 TCD 检查的结果将其分为狭窄组和非狭窄组。使用 SPSS13.0对各项指标进行处理。结果2002年和2006年社区无症状人群大脑中动脉患病率分别为2.73%、4.62%。2002年非狭窄组2006年狭窄患病牢为1.9%。对2002年数据的 Logistic 同归分析筛选出糖尿病史,高 Hcy 血症为大脑中动脉的危险因素;4年后的数据显示,糖尿病史、高 Hcy、高血压史和冠心病史是大脑中动脉的危险因素,婚姻状况亦可能对大脑中动脉狭窄存在影响。纵向动态分析证实,冠心病、糖尿病史和体重指数等因素的动态变化也对大脑中动脉狭窄的发生起重要作用(均 P<0.05)。结论社区无症状人群存在大脑中动脉狭窄,糖尿病史、高血压病史、冠心病史和高Hcy 血症是其危险因素。心血管疾病的发生、肥胖的改变对大脑中动脉狭窄的发生也起着一定的作用。

Objective To explore the risk factors of middle cerebral artery stenosis （MCAS） in a dynamic manner so as to supply evidence to help prevent cerebral stroke based on the results of epidemiological study. Methods 2500 residents were sampled randomly from the residents of Rongqi town and underwent questionnaire survey, physical examination, transcranial Doppler sonography （ TCD）, and detection of plasma homocysteine （Hcy） in 2002, and 1068 of them that conformed with the criteria： （1） without symptoms of brain ischemia, （2） with temporal window to conduct TCD, and （3） having undergone the questionnaire survey and blood biochemical examination, were enrolled for lone-term study. In 2006 844 of the 1068 residents remained, 277 males and 567 females, aged 60 ± 10 （ 12. 5 -88） who still conformed to the criteria. Based on the results of TCD examination of MCA the residents were divided into two groups, MCAS group and non-MCAS group. Logistic regression analysis was used to analyze the data. Results The morbidity of MCAS of the asymptomatic residents was 2. 73% in 2002 and 4. 62% in 2006. Logistic regression analysis demonstrated that history of diabetes mellitus （GM） and hyperhomocysteinemia （HHcy） were the risk factors of MCAS based on the data of 2002. But, 4 years later, history of hypertensive disease, coronary heart disease （CHD）, diabetes mellitus and HHcy were the risk factors and marriage status was also a factor. The changes of coronary heart disease, DM and BMI were the risk factors of MCAS. Conclusion MCAS exists in the asymptomatic residents. History of hypertensive disease, DM, CHD and HHcy are the risk factors of MCAS Heart attack and changes of body weight contributed to MCAS.