缺血性脑卒中高危人群颈动脉超声筛查及行为影响因素

Carotid ultrasound screening of ischemic cerebral apoplexy in high-risk group and exploration of behavioral influence factors

目的 应用健康管理平台筛查缺血性脑卒中高危人群颈动脉粥样硬化病变及其相关危险因素,探讨改变行为影响因素的新模式.方法 对健康体检人群开展颈动脉超声筛查,分析1 152例颈动脉粥样硬化者不同性别、年龄及不同病变时期相关危险因素的差异.结果 40 ～ 49岁年龄段的高危人群以轻微病变为主,70岁以上人群严重病变者显著增加（P＜0.01）.轻微病变期男性51例显著高于女性21例（P＜0.01）,严重病变期男性36例,女性29例,差异无统计学意义（P＞0.05）.分别以轻微病变期和严重病变期为应变量,以高血压、超重、血脂异常、糖尿病、吸烟、体育活动较少、为自变量进行逐步Logistic回归分析,显示轻微病变与超重、高血压、血脂异常相关,严重病变期的危险因素包括超重、高血压、血脂异常、糖尿病、吸烟、体育活动少.女性高血压、血脂异常者检出率高于男性,女性检出率分别为83.8％、44.1％,男性检出率分别为67.6％ 、31.0％ （P＜ 0.05）,男性吸烟检出率高于女性,男性检出率为20.7％,女性检出率为0.7％（P＜0.01）.结论 尽早发现颈动脉粥样硬化病变及相关危险因素,对轻微病变者的行为影响因素早期干预,促使动脉粥样硬化延缓进展.借助健康管理中心平台,可开展零级预防的脑卒中防控新模式.

Objective To investigate carotid atherosclerosis and its relevant risk factors of ischemic cerebral apoplexy in high-risk population and to explore new modes of behavioral influencing factors based on health management platform.Methods Using the carotid ultrasound screening of personnel undergoing physical examination,the differences of the related risk factors were studied among 1 152 cases of carotid atherosclerosis with differ ent gender and different age and different disease periods.Results High-risk population between 40-49 years wasmainly focused on mild lesions,and the numbers of serious lesions increased significantly among people older than 70;male patients numbered 51 were significantly much more than the females numbered 21 （P＜0.01）during mild lesion period,there was no statistical significance between male numbered 36 and female numbered 29 during serious lesion period （P＞0.05）.Setting mild and serious period respectively as the dependent variables,and hypertension,overweight,dyslipidemia,diabetes mellitus,smnoking,physical activity and atrial fibrillation as the independent variables to conduct logistic regression analysis,it showed that mild lesions were related to overweight,hypertension and dyslipidemia.The risk factors of serious lesion period included hypertension,overweight,diabetes mellitus,dyslipidemia,atrial fibrillation,smoking and lack of physical activity.The female detection rates of hypertension and dyslipidemia in female patients,which were 83.8％ and 44.1％ respectively,were higher than those in male patients,which were 67.6％ and 31.0％ respectively.The detection rates of smoking and arterial fibrillation in female patients,which were 0.7％ and 0.3％ respectively,were lower than those in male patients,which were 20.7％ and 1.0％ respectively.Conclusions Early detection of carotid atherosclerosis lesions and its relevant risk factors as soon as possible,and early intervention influencing factors to mild lesions to prevent the atherosclerosis from getting worse.A new model of zero level prevention can be developed to control of ischemic stroke based on health management platform.