男性工人胆固醇水平与总死亡率关系的定群随访研究

A Cohort Study of Serum Total Cholesterol Levels and Total \;Mortality among Population of Men Workers

目的 :分析胆固醇与冠心病、脑血栓、脑出血、肿瘤、心脑血管疾病及肿瘤以外的其它疾病的关系。方法 :在 1974,1979,1980三个年份对北京某钢厂三个人群年龄在 18至 74岁 (平均 45 .3岁 )的 4814名男性工人进行了心脑血管疾病的基线调查 ,并测定了血清总胆固醇水平。随访终点为 1993年 ,平均随访 14.5年。将基线血清胆固醇水平按百分数的四分位数法分成四组。采用 L ogistic回归分析方法 ,控制变量为 :年龄、吸烟、饮酒、收缩压、舒张压等变量。结果 :共有 35 1名工人死亡。死亡原因分别是 ,冠心病 40名(11.4% ) ,脑血栓 2 3名 (6 .5 5 % ) ,脑出血 47名 (13.39% ) ,肿瘤 12 7名 (36 .18% ) ,其它疾病 114名 (32 .48% ) .疾病总死亡率与各组胆固醇呈 U 型关系。以最高胆固醇组做参照 ,L ogistic分析结果 :其它胆固醇组冠心病死亡率危险均小于最高组 ,从最低组到次高组发生冠心病的相对危险分别减少了约 75 % (P<0 .0 5 ) ,41% ,2 2 %。对脑血栓而言 ,最高组与最低组没有差别 ,但收缩压、舒张压的相对危险度都为 1.0 2 7,收缩压 P值为 0 .0 48,舒张压没有差别。胆固醇各组与最高组相比 ,脑出血的死亡相对危险度分别是 2 .3(P=0 .0 5 0 6 ) ,1.72 ,1.13;舒张压的相对危险度 1.0 5 8(P<0 .0 1)。其它疾病相?

Purpose: The purpose of this investigation is to quantitatively examine the associations between serum cholesterol level and causes of death. Methods: For an average of 14.5 years , total 4818 men workers of three chort population aged 18～74 (average 45.3 years ) enrolled in 1974, 1979, 1980 separately were followed up at ending year of 1993. Serum total cholesterol level(TC) was measured at baseline. Subjects were divided into 4 groups according to quartiles of TC level. Using logistic model to analysis the relative risk, controlled variates including systolic blood pressure, diastolic blood pressure, age, state of smoke and drink. Results:There were total 351 deaths, 40(11.4%) coronary heart disease(CHD), 23(6.55%), 47(13.39%) non haemorrhagic and haemorrhagic stroke separately, 127 (36.18%)cancer,114(32.46%) other diseases. An U shaped relation between total serum cholesterol concentration and total mortality was found. The average concentration of serum cholesterol among 4814 population are 186.87 mg/dl;186.76 mg/dl for normal population,212.76 mg/dl for CHD,207.84 mg/dl for non haemorrhagic strroke,181.72 mg/dl for heamorrhage stroke,178.41 mg/dl for tumor,189.32 mg/dl for other causes of death. Logistic regression analysis,using the highest TC group(fourth quartile) as reference, showed that there were grade decreases for CHD in four TC groups. From first quartile TC(forth qutile) as reference,showed that there were grade decreases for CHD in four TC groups,from first quartile group to third,the risk of CHD decrease 75%,41%,22% respectively. For stroke, TC seems not to related to the occurrence of non haemorrhagic stroke in four groups. The RR of mortality of haemorrhage stroke was 2.3,1.72,1.13 in first to third quartile,. \;With the increasing systolic and diastolic blood pressure level,both of relative risk for non haemorrhage stroke were 1.027,only had significance with SBP( P =0 048);for haemorrhage stroke,the relative risk with increasing DBP were 1.058( P =0 008). \;For cancer,relative risk risk of first quartile is 1.75( P =0 025).\;The RR of other disease was 1.3 in low quartile of TC. Conclusion:There were a U shaped relations basically between serum total cholesterol level and total mortality . There are a positive relation for CHD; inverse relations for haemorrhagic stroke, and tumor. In addition, blood pressure may be an important effecting factor for CHD, non haemorrhagic and haemorrhagic stroke occurrence among eastern population.