心脑血管病自动化风险评估系统的建立及其初步应用效果分析

Establishment and preliminary evaluation of an automatic cardiovascular risk assessing program

目的建立武汉地区居民患冠心病和脑卒中的自动化风险评估系统,并评价分析其初步临床应用效果。方法以中国心血管病预防指南推荐的中国成人缺血性心血管病风险评估模型为标准（包含危险因素有性别、年龄、收缩压、体重指数、吸烟史、总胆固醇）,从医院信息系统数据库中提取体检者的这些危险因素数值,将心脑血管病风险评估模型公式编入计算机程序,再将危险因素值代入程序算出绝对风险及各种危险因素致病作用程度。然后,将评估结果以报告单格式制作成电子表格供医生和体检者阅读和打印,最终建立心脑血管病自动化风险评估系统。运用该系统对2014年1月至6月在武汉亚洲心脏病医院体检中心的706名体检者（30岁以下组88名、31-40岁组155名、41-50岁组172名、51-60岁组203名、61岁以上组88名）进行患心血管病的风险评估,以评价预测各年龄组的平均风险率。结果自建的自动化风险评估系统运行6个月间未发生故障,危险因素的数值提取无误,计算结果准确,报告单实时产生。医生和体检者均表示通过报告单可以理解心脑血管病风险是否升高以及导致其升高的主要危险因素是什么。经中国成人缺血性心血管病风险评估模型评估,在440名男性中,30岁以下组、31-40岁组、41-50岁组、51-60岁组、61岁以上组的平均风险分别为0.43%、0.96%、2.27%、4.05%、7.35%;在266名女性中,相同的5个年龄组的平均风险分别为0.05%、0.15%、0.62%、1.80%、5.44%。结论本研究所建立的自动化风险评估系统运行稳定可靠,报告单内容全面,容易理解,可替代人工的风险评估,还可减轻医生工作负担,有利于在临床上推广心脑血管病风险评估。随成人年龄的增长,患心血管病的风险可能会不断升高,因此随着年龄的增长需逐渐加强心血管病的预防。

Objective To establish an automatic cardiovascular risk assessing program and to evaluate its effects. Methods Chinese ischemic cardiovascular risk model was used as the standard. The values of the risk factors （including gender, age, systolic blood pressure, height, weight, smoking status, total cholesterol） were acquired from the data bank of hospital information system. The risk prediction functions were translated into computer programs. The absolute risk and the magnitude of the risk factors were calculated by computer program using the values of risk factors. Finally, the risk report was generated for clients to read and print. The automatic risk assessment was performed in 706 clients in Wuhan Asia Heart Hospital from January to June 2014. There were 88, 155, 172, 203, 88 people in 〈 30, 31-40, 41-50, 51-60, and 〉 61 years old groups respectively. The average risk was calculated in each age group. Results The automatic cardiovascular risk assessing program ran without problems in the 6 months. The data were extracted correctly. The results were accurate. The reports were generated immediately. Clients and doctors indicated that, by reading the report, they could understand whether the risk was high and what the major risk factors were. In male participants, the average risks were 0.43%, 0.96%, 2.27%, 4.05%, and 7.35% in 〈30, 31-40, 41-50, 51-60, and 〉61 years old groups respectively. In female participants, the average risks were 0.05%, 0.15%, 0.62%,1.80%, and 5.44% in 〈30, 31-40, 41-50, 51-60, and 〉61 years old groups respectively. Conclusions The results show that the automatic cardiovascular risk assessing program is stable and reliable, and the report is complete and easy to understand. It suggest that the automatic cardiovascular risk assessing program can replace manual cardiovascular risk assessment, and the automatic program reduces doctors＇ burden and facilitate the promotion of cardiovascular risk assessment in clinic. The survey of the clients＇ risks suggests that the cardiovascular risk may increase with age. Therefore, people need to enhance the prevention of cardiovascular diseases with the increase of age.