健康体检人群中脑卒中高危人群筛查状况及预防干预效果评价

Screening of high-risk population with stroke among healthy population receiving physical examination and prevention intervention assessment

目的了解健康体检人群中脑卒中高危人群的相关危险因素筛查状况及评估健康预防干预的效果。方法按照"卫生部脑卒中筛查与防治工程"的筛查标准,对4 376例≥40岁的受检者进行筛查,通过问卷调查表、体格检查、实验室检测[血脂(TC、TG、LDL、HDL)、血糖(GLU)、尿酸(UA)、同型半胱氨酸(Hcy)]及颈血管彩超检查,筛查出脑卒中高危组865例,非高危组3 511例,对其相关危险因素进行调查分析,随后对脑卒中高危人群给予个性化健康预防干预方案,并连续随访1a后评价预防干预效果。结果健康体检人群中脑卒中高危人群检出率19.77%,女性检出率6.44%,男性检出率13.32%。脑卒中高危组人群的高血压病、心房颤动、体质量指数(BMI)、血脂异常、糖尿病、有脑卒中家族史、很少进行体育活动及吸烟的比例均明显高于非高危组(P<0.01)。脑卒中高危组人群的TC、TG、GLU、UA、Hcy水平和颈动脉内中膜增厚及斑块均明显高于非高危组(P<0.01),LDL、HDL差异则无统计学意义(P>0.05)。干预后的脑卒中高危人群的TC、TG、LDL、HDL、GLU、UA、Hcy水平较干预前明显改善(P<0.01或0.05)。结论在健康体检人群中进行脑卒中高危人群筛查及对相关危险因素进行全面预防干预,更有助于实行脑卒中的一级与二级预防,降低脑卒中发病率,对脑卒中防治意义重大。

Objective To understand the screening of relevant risk factors of high-risk population with stroke and assess the effect of prevention intervention. Methods According to the screening criteria of＂Stroke Screening and Prevention and Control Project by Ministry of Health＂, 4376 cases with the age of ≥40 years were screened. 865 cases with high risk of stroke and 3511 cases without high risk of stroke were screened out through questionnaire, physical examination, laboratory test （Blood fat （TC, TG, LDL, HDL）, Glucose （GLU）, uric acid （UA） and homocysteine （Hcy）） and carotid color doppler ultrasonography. Their risk factors were investigated and analyzed. Then personalized health prevention intervention plan was provided for high-risk population with stroke, and preventive intervention effect was assessed after 1 a of follow-up. Results Among healthy population, the detection rate of high-risk of stroke was 19.77%, that of female was 6.44%, and that of male was 13.32%. Of the population with high risk of stroke, the proportion of hypertension, atrial fibrillation, body mass index （BMI）, dyslipidemia, diabetes, family history of stroke, rarely sports and smoking were significantly higher than those of the population without high risk of stroke （P〈0.01）; the level of TC, TG, GLU, UA, Hcy, carotid intima-media thickness and plaques were significantly higher than those of the population without high risk of stroke （P〈0.01）, and there was no statistical difference in LDL and HDL （P〉0.05）. After intervention, the levels of TC, TG, LDL, HDL, GLU, UA and Hcy in the population with high risk of stroke were significantly improved compared with those before intervention （P〈0.01 or 0.05）. Conclusion In healthy population, screening the population with high risk of stroke and carrying out comprehensive preventive intervention in relevant risk factors will help to implement the primary and secondary prevention of stroke, and reduce the incidence of stoke, which can be of great significance in preventing and treating stroke.