办公室人群中汇总列队公式与国人十年缺血性心血管病风险评估方法的对比研究

Comparison of pooled cohort equations and the Chinese ten-year appraisal method of ischemic cardiovascular disease in office staff

目的：探讨2013年美国心脏病学会/美国心脏协会（ACC/AHA）推荐的汇总队列公式（pooled cohort e-quations, PCE）是否适用于评估国人心血管病风险。方法对999名40~75岁办公室人员，分别应用PCE和国人十年缺血性心血管病（ischemic cardiovascular disease，ICVD）评估方法（以下简称“国人法”）进行评估，分别比较十年心血管疾病绝对风险、相对风险及理想风险。结果国人法绝对风险值低于PCE法（1.5 vs.2.84，P=0.000）；绝对风险分层，非低危检出率国人法低于PCE法（2% vs.24.2%，P=0.000）；相对风险值国人法较PCE 法高（秩和263818，Z=-14.636，P=0.000）；相对风险分层，相对风险≥1比例国人法高于PCE法（94.6%vs.80.5%，P=0.000）；理想风险值国人法低于PCE法（秩和-499500，Z=-27.383，P=0.000）；将PCE法总胆固醇值调整同国人法后，理想风险国人法高于PCE法（秩和161187，Z=-8.879，P=0.000）。结论 PCE法较国人法高估了部分人的绝对风险，低估了相对风险，PCE法理想风险值较国人法高，但其理念和相关内容值得思考和借鉴。

Objective To investigate if Pooled Cohort Equations （PCE） recommended by American College of Cardiology/American Heart Association （ACC/AHA） in 2013 is applicable to evaluate risks of cardiovascular disease among Chinese. Methods A total of 999 office staffs aged 40~75 years was enrolled in this cross sectional study. PCE and the Chinese ten-year appraisal method for ischemic cardiovascular disease （hereinafter referred to as＂Chinese Method＂） were adopted to assess absolute risk, relative risk and ideal risk respectively. Results Absolute risk value of Chinese Method was lower than that of PCE （1.5 vs. 2.84, P=0.000）;non-low risk rate of absolute risk stratification of Chinese Method was also lower than that of PCE （ 2%vs. 24.2%, P=0.000）;relative risk value of Chinese Method was higher than that of PCE （Sum of ranks 263818, Z= -14.636, P= 0.000）; relative risk stratification ：rate of relative risk≥1 of Chinese Method was higher than that of PCE （94.6% vs. 80.5%, P= 0.000）; ideal risk value of Chinese Method was lower than that of PCE （Sum of ranks -499500, Z= 27.383, P= 0.000）; after adjusting for the total cholesterol value of PCE same to Chinese Method, ideal risk value of Chinese Method was higher than that of PCE （Sum of ranks 161187, Z= -8.879, P= 0.000）. Conclusion PCE overestimate the absolute risk of ischemic cardiovascular disease in some people compared to Chinese Method, while it underestimate the relative risk. Although the ideal risk value of PCE is higher than Chinese method, the idea and relevant content is worth for our consideration and using for references.