急性心脑血管事件登记的方法学研究

A pilot study to explore a registry method for acute cardiovascular events

目的探索开展全国大规模人群急性心脑血管事件常规登记的工作方法。 方法在已经完成基线调查的新疆阿勒泰市自然人群（1 668人）中开展急性心肌梗死（国际疾病分类第十次修订本[ICD－10]：I21～I22）、心脏性猝死（I46.1）和脑卒中（160～164）的急性事件登记工作，发病时段为2012年10月1日至2016年6月30日。资料收集分医院病案检索登记、社区补充登记和查漏报3个阶段。研究期间的发病率按每年的事件总数计算，死亡率为发病28 d内致死性事件数×随访年数－1×该时间段的平均人口数－1（10万－1）。 结果共收集急性心脑血管事件患者42例，计46起事件，包括急性心肌梗死7起、心脏性猝死3起和脑卒中36起。其中，4家医院共登记事件28起（60.9%），社区补充登记18起（39.1%），利用新农合系统以及对目标对象的再次核实没有发现漏登记的事件。急性心脑血管事件粗发病率和标化发病率分别为742/10万和926/10万，相应的死亡率分别为194/10万和272/10万。 结论发挥基层医生的＂网底＂作用、充分利用卫生、社保等资源、预防与临床紧密结合是做好登记工作的关键。

ObjectiveTo explore a registry method for acute cardiovascular events in large-scale fields across China. MethodsThis study was based on a community-based Kazakh cohort, including 1 668 persons with complete baseline data, conducted in Altay, Xinjiang. Acute cardiovascular events included acute myocardial infarction（ICD-10： I21-I22）, sudden cardiac death （I46.1）, and incident stroke （I60-I64） that occurred during the period from Oct 1, 2012 to Jun 30, 2016. There were three stages, a hospital-based search for checking medical records of inpatients in all four local hospitals, a community-based supplementary registry, and an extra survey for reducing false negatives, to complete this registry. The incidence referred to all events within one year per 100 000 people and mortality rate was the number of fatal events within 28 days per 100 000 people. The incidence and mortality was standardized with the weights from distribution of age and gender in the Sixth National Census of China. ResultsForty two cases with 46 acute cardiovascular events including 7 acute myocardial infarctions, 3 sudden cardiac deaths, and 36 incident strokes were found. The ratio of events was 3.6∶1 for stroke and heart attacks and this ratio was 1.6∶1 for ischemic or hemorrhagic strokes. A total of 28（60.9%） events and 18（39.1%） events were collected in the hospitals and by community-based supplementary registry physicians, respectively. False negatives were not found at the last stage. The crude and standardized incidence rates were 742 and 926 per 100 000 people and the related mortality rates were 194 and 272 per 100 000 people, respectively. ConclusionPrimary Care physicians are＂net bottom＂ of a monitoring system which needs to combine preventive and clinical medicine with all kinds of governmental resources including health and social benefit.