老年高血压患者伴急性脑血管病诱发多器官功能衰竭与年龄的相关研究:5798例分析

Relationship of age with induction of multiple organ dysfunction syndrome in hypertension patients complicated by acute cerebral vascular disease:analysis of 5798 cases

目的回顾性分析年龄与老年高血压患者伴急性脑血管病（ACVD）诱发老年多器官功能不全综合征（MODSE）的相关性,探讨年龄和ACVD对老年高血压患者发生MODSE的预测价值。方法回顾性分析1993年1月至2008年12月16年间因高血压住院或住院期间出现高血压的19 996例60岁以上患者的病历资料,调查各年龄段老年高血压患者中因ACVD诱发MODSE的发病率,并采用Spearman等级相关分析、Pearsonχ~2检验及Scheffe法对发病率进行统计分析。结果在19 996例高血压病例中,5798例为ACVD,发病率为29.0%;ACVD中2885例并发了MODSE,发病率49.8%,较非ACVD患者中MODSE的发病率（16.5%）显著升高3.02倍（χ~=22365.04,RR=5.022;95%CI4.692～5.375;P=0.000）。年龄与老年高血压患者并发ACVD和ACVD患者诱发MODSE发病率亦密切相关（r=0.964和r=1.000;均P=0.000）。ACVD和非ACVD患者在不同年龄段发生MODSE的风险均有差异（χ~2=570.13和225.62,均P=0.000）。分别以69,79,89岁为年龄分界,高于年龄分界点的ACVD患者MODSE的发病率均较低于年龄分界点者升高。79岁是ACVD患者易发MODSE显著的年龄分界点。结论增龄是ACVD诱发老年高血压患者发生MODSE的重要因素。79岁是ACVD诱发老年高血压患者发生MODSE明显的分界年龄。

Objective To retrospectively analyze the relationship between age and induction of multiple organ dysfunction syndrome in the elderly（MODSE） in patients with hypertension complicated by acute cerebral vascular disease（ACVD）,and to determine the predictive roles of age and ACVD in occurrence of MODSE in elderly patients with hypertension.Methods Medical history data of 19996 cases（aged over 60 years） admitted to Chinese PLA General Hospital because of hypertension or developing hypertension during hospital stay from January 1993 to December 2008 were analyzed retrospectively.The incidence of MODSE induced by ACVD in patients with hypertension at different ages were investigated.Analysis included Spearman rank correlation,Pearson test and Scheffe test.Results Among 19996 cases of hypertension,ACVD was diagnosed in 5798 cases （29.0%）,of which,MODSE was reported in 2885 cases（49.8%）,significantly higher than that in non-ACVD cases（16.5%;3.02 folds;χ~2 = 2365.04,RR = 5.022;95%CI 4.692-5.375;P = 0.000）.Age was positively correlated with the incidence of ACVD and MODSE in patients with hypertension（r = 0.964,1.000,P = 0.000）.Both ACVD cases and non-ACVD cases had different risk categories of MODSE in various age groups：60-69 years group,70-79 years group,and 80-89 years group（χ~2=570.13,225.62;P = 0.000）.There was statistical difference in incidence of MODSE induced by ACVD between hypertension patientsand79 years old.Conclusion Age plays critical role in the incidence of MODSE induced by ACVD in elderly patients with hypertension.The age of 79 years was the cutoff point.