东亚男性饮酒和卒中关系的前瞻性队列研究荟萃分析

Alcohol intake and stroke in Eastern Asian men： a systemic review and meta-analysis of 17 prospective cohort studies

目的 系统评价源自于中、日、韩关于饮酒和卒中关系的前瞻性队列研究,探讨东亚男性饮酒和卒中及全因死亡的关系.方法 检索Pubmed等数据库,纳入符合入选条件的前瞻性队列研究,记录研究来源国家、研究对象例数、性别、年龄（均数或中位数及间距）、随访期限、饮酒量（g/d）、与饮酒相关的卒中或死亡相对风险（RR）及95%可信区间（CI）等.根据异质性检验结果,采用随机或固定效应模型,以RR作为评价饮酒量与缺血性卒中或出血性卒中发病率及全因死亡率的风险效应指标.结果 共纳入17项前瞻性队列研究.样本量最小1 322人,最大108 461人,9项研究报道了全因死亡;7项报道了缺血性卒中、7项报道了出血性卒中.随访期间4.1～19.0年.分层比较显示每日饮酒量≤20、21～40、41～60、＞60 g/d的各组与不饮酒者比较,缺血性卒中风险（RR及95%CI）分别为0.85（0.78～0.93;P=0.0002）、0.94（0.79～1.11;P=0.46）、1.08（0.86～1.37;P=0.50）和1.24（0.96～1.59;P=0.10）;出血性卒中风险分别为0.92（0.75～1.12;P=0.40）、1.11（0.96～1.28;P=0.17）、1.20（0.92～1.56;P=0.18）和1.74（1.32～2.28;P＜0.01）;全因死亡风险分别为0.83（0.75～0.91,P=0.01）、0.93（0.87～0.99,P=0.03）、1.01（0.95～1.07;P=0.86）和1.32（1.29～1.36;P＜0.01）.结论 在东亚男性人群中,少量饮酒（≤20 g/d）降低缺血性卒中的风险,过量饮酒使卒中（尤其是出血性卒中）、全因死亡的风险明显增加.适量饮酒的范围应每日酒精量不超过40g.

Objective To assess the dose-response relationship between alcohol intake and relative risk of stroke and all-cause mortality among Eastern Asian men. Methods Potential prospective cohort studies were retrieved by searching Pubmed （ 1966 - 2000 ）, OVI D （ 1980 - 2009 ）, Embase （1980-2009）and ISI Web of Knowledge （1986 -2009） using Medical Subject Headings： alcohol drinking, ethanol,stroke, cerebrovascular disease, mortality, etc; and Koreans or Japanese or Chinese. From the relevant retrieved reports, 17 prospective cohort studies fulfilling the criteria were included into the study.Information on study design, participant characteristics, amount of alcohol intake, stroke and/or all-cause mortality outcomes, control for potential confounding factors and risk estimates was abstracted by a standardized protocol. For each study, relative risk （RR） and 95% confidence interval （CI） were extracted and pooled with either a fixed or random effect model according to the results of the test of heterogeneity.Results As data available for women were too limited to be included into our meta-analysis, this study focused on male subjects, ranging from 1322 to 108 461 subjects among these 17 cohort studies. Compared with nondrinkers, the RRs of ischemic stroke for those drinking alcohol ≤20, 21 -40, 41 -60, 〉60 g/d,were0.85 （0.78-0.93, P=0.0002）, 0.94 （0.79-1.11, P=0.46）, 1.08 （0.86-1.37, P=0.50）and 1.24 （0. 96 - 1.59, P =0. 10） respectively. Similarly, RRs of hemorrhagic stroke were 0.92 （0.75 -1.12, P=0.46）, 1.11 （0.96- 1.28, P =0. 17）, 1.20 （0.92 - 1.56, P =0.18） and 1.74 （1.32 -2.28, P〈0.01）; and those of all-cause mortality were 0.83 （0.75 -0.91, P=0.01）, 0.93（0.87-0.99, P=0.03）, 1.01 （0.95-1.07, P=0.86） and 1.32 （1.29-1.36, P〈0.01） respectively.Conclusion In Eastern Asian men, light alcohol intake （ ≤ 20 g/d） is associated with a lowered risk of ischemic stroke whereas heavy alcohol intake is associated with an elevated risk of stroke, particularly hemorrhagic stroke and all-cause mortality.