军队男性老年人脑卒中发病与死亡因素的队列研究

A Cohort Study on Stroke and its Determinants in Retired Military Male Veterans,Xi'an,China

目的了解军队男性老年人群脑卒中发病与死亡相关因素。方法从2005年6月30日至2006年6月30日对1987年建立的西安市22所军队干休所离退休干部队列人群进行了再次调查,统计学方法主要应用多元Cox比例风险模型进行多因素分析,由SPSS13.0软件完成。结果至2005年6月30日脑卒中发病186人,调整发病率为984.43/10万人年,其中新发脑梗死157人,新发脑出血29人;至2006年6月30日脑卒中死亡69人,死亡率为357.02/10万人年,其中脑梗死死亡26人,脑出血死亡43人;队列研究结果显示,年龄、收缩压、舒张压、既往脑动脉硬化和高血压病史与脑卒中发病相关,HR值(95%CI)分别为1.037(1.002～1.072)、1.087(1.012～1.169)、1.186(1.050～1.340)、1.515(1.006～2.281)和1.571(1.052～2.347);脑卒中死亡相关因素为年龄、收缩压、吸烟、高血压家族史、卒中家族史、体质指数、卒中、高脂血症和高血压既往病史,HR值(95%CI)分别为1.072(1.017～1.131)、4.283(1.706～10.753)、2.180(1.019～4.665)、2.069(1.066～4.014)、2.069(1.066～4.014)、0.858(0.779～0.946)、10.034(3.366～29.912)、3.351(1.194～9.406)和2.366(1.247～4.491)。结论西安地区军队男性老年人群脑卒中发病以缺血性为主,脑卒中死亡以出血性为主;发病率和死亡率均低于全国水平;控制血压、总胆固醇、总胆红素和体重水平,戒烟,控酒,预防脑动脉硬化、高脂血症和高血压可以降低该人群脑卒中发病风险。

Objective To know the stroke incidence and its death-related factors in the retired old male military veterans in Chinese army in Xi＇an, China. Methods An epidemiological survey, from June 30th, 2005 to June 30th, 2006, was carried out in a cohort, which was set up in 1987 and included 1 268 Chinese retired military veterans from 22 health centers, Xi＇an. The data for epidemiological analysis were entered （double entry.） into computer and organized by Epidata3.0. Multivariate Cox proportional hazard regression model was used to compute hazard ratio （HR） and 95% confidence interval （CO, non conditional logistic regression model was for odd ratio （OR） and 95%CI, and the statistic analysis worked out by SPSS 13.0. Results Up to June 30th, 2005, 186 new cases of stroke had appeared. Adjusted morbidity was 984.43 per 100 000 person years. Among them, 157 were cerebral infarction and 29 were cerebral hemorrhage. Up to June 30th, 2006, 69 cases of stroke had died, and its adjusted mortality was 357.02 per 100 000 person years. Among them, 26 were cerebral infarction and 43 were cerebral hemorrhage. A cohort study showed that age, SBP, DBP, diseases history of CAS, hypertension were associated with new cases of stroke, their HRs （95%CIs） were 1.037 （1.002-1.072）, 1.087（1.012-169）, 1.186（1.050-1.340）, 1.515（1.006-2.281）and 1.571（1.052-2.347）, respectively. Age, SBP, smoking, family history of hypertension and stroke, BMI, diseases history of stroke, Hyperlipidemia and hypertension were associated with stroke death, theirHRs （95%CI） were 1.072 （1.017-1.131）, 4.283 （1.706-10.753）, 2.180 （1.019-z4.665）, 2.069 （1.066-4.014）, 2.069 （1.066-4.014）, 0.858 （0.779-0.946）, 10.034 （3.366-29.912）, 3.351 （1.194-9.406） and 2.366 （1.247- 4.491）, respectively. Conclusion In the study, most of new stroke cases were cerebral infarction and nearly all the death cases with stroke were cerebral hemorrhage in the cohort. Compared with national level, morbidity and mortality of stroke were in a low level. To reduce the risk of stroke, some measurements, such as controlling blood pressure, TC, TBIL and weight, quitting smoking, restricting alcohol intake, preventing CAS, HL and hypertension should be advocated.