河北省任丘市老年居民颈动脉内-中膜厚度与新发缺血性脑血管病的关系

Relationship between carotid artery intima-media thickness and new ischemic cerebrovascular disease in elderly residents of Renqiu City,Hebei Province

目的应用彩色多普勒超声检测颈动脉内-中膜厚度（CIMT）并探讨其与新发缺血性脑血管病的关系。方法 2012年5月至2013年10月课题组采取整群随机抽样法,前瞻性连续纳入任丘市60~70岁户籍居民4 412名进行面对面健康问卷调查、人体测量、实验室检测、颈部血管彩色多普勒超声检查等,根据是否新发缺血性脑血管病,将2013年发生缺血性脑血管病者分为病例组（251例）,未出现新发缺血性脑血管病者为对照组（4 161例）。比较两组基线资料及CIMT水平等单因素分析,并分析缺血性脑血管的相关危险因素。结果 （1）病例组高血压病、脑血管病史、服用抗血小板聚集药物、颈动脉斑块检出比例高于对照组[62.2%（156例）比44.2%（1 838例）,45.0%（113例）比14.9%（622例）,55.0%（138例）比40.0%（1 663例）,65.7%（165例）比54.5%（2 266例）,均P〈0.05],收缩压、胰岛素及CIMT水平高于对照组[158（141,177）mm Hg比152（137,169）mm Hg,8.07（4.77,12.48）μU/L比6.93（4.27,11.60）μU/L,0.950（0.900,1.000）mm比0.925（0.900,1.000）mm,均P〈0.05],胆固醇水平低于对照组[4.59（4.17,5.26）mmol/L比4.78（4.20,5.36）mmol/L,P〈0.05],组间差异均有统计学意义。（2）多因素Logistic回归分析结果显示,高血压病史、脑血管病史、CIMT增厚是新发缺血性脑血管病的独立危险因素（高血压：OR=1.534,95%CI：1.166~2.017,P=0.002;脑血管病史：OR=3.940,95%CI：2.997~5.180,P=0.000;CIMT增厚：OR=12.122,95%CI：2.327~63.163,P=0.003）。结论任丘市CIMT、高血压病、脑血管病史是缺血性脑血管病的独立危险因素,对CIMT的监测很重要。

Objectives To detect the carotid artery intima-media thickness （CIMT） with color Doppler ultrasound and to investigate the relationship between CIMT and new ischemic cerebrovascular disease. Methods From May 2012 to October 2013, the cluster random sampling method was used to consecutiveIy enroll 4 412 60-70 year old residences in Reqiu City for prospective study, including face to face health questionnaire survey, human body measurement, laboratory test, and neck vascular color Doppler ultrasonography. According to whether having new ischemic cerebrovascular disease, the patients who had ischemic cerebrovascular disease in 2013 were divided into either a case group （ n = 251 ） or a control group （n =4 161 ）. The single factor analysis,such as baseline data and CIMT levels in both groups were compared, and the related risk factors for isehemic cerebrovascular disease were analyzed. Results （1） The detection rates of hypertension, cerebrovascular disease, taking antiplatelet agents, carotid artery plaque of the casegroup were higher than those of the control group （62.2% In = 156] vs. 44.2% In = 1 838] ,45.0% [n=113] vs. 14.9% [n=622],55.0% [n=138] vs. 40.0% [n=1663],and65.7% [n=165] vs. 54.5% [ n = 2 266 ], all P 〈 0. 05 ）. The systolic blood pressure, insulin, and CIMT levels were higher than those of the control group （158 [ 141,177] mmHg vs. 152 [ 137,169] mmHg,8.07 [4.77,12.48] μU/L vs. 6.93 [ 4.27,11.60 ] μU/L, 0. 950 [ 0. 900, 1. 000 ] mm vs. 0. 925 [ 0. 900, 1. 000 ] mm, all P 〈 0. 05 ）. The cholesterol level was lower than that of the control group （4.59 [4.17,5.26] mmol/L vs. 4.78 [4.20,5.36] mmol/L,P 〈 0.05 ）. There were significant differences between the 2 groups. （2） Multivari- ate logistic regression analysis showed that histories of hypertension and cerebral vascular disease and CIMT thickening were the independent risk factors for new isehemie cerebrovaseular disease （hypertension： OR, 1. 534,95% CI 1. 166 -2. 017 ,P = 0. 002; history of cerebral vascular disease： OR,3. 940,95% CI 2. 997 - 5. 180,P =0. 000;and CIMT thickening：OR,12. 122,95%CI 2. 327 -63. 163,P =0. 003）. Conclusion CIMT, hypertension,and cerebrovascular disease are the independent risk factors for ischemie cerebrovascular disease in Renqiu City, and the monitoring of CIMT is very important.