社区中年人群十年缺血性心血管病风险评估及干预效果研究

Ten-year Risk Assessment of Ischemic Cardiovascular Disease and the Intervention Effect in Middle-age Population:a Community-based Study

目的采用《国人缺血性心血管病(ICVD)十年发病危险度评估表》评估社区45~59岁居民10年ICVD的发病风险,并评价社区干预的效果。方法 2013年10月—2014年3月,按照随机整群抽样原则,随机选取上海市沪东社区33个居委会中的5个居委会,其中年龄为45~59岁的常住人口均纳入本研究。调查受试者基本情况,测量身高、体质量,检测总胆固醇水平,采用《国人缺血性心血管病(ICVD)十年发病危险度评估表》评估10年ICVD发病危险度。将发病危险度在中危及以上人群归为需进行社区干预者,进行为期1年的干预。干预方案采用临床干预和社区宣教相结合,并依据其自身情况进行个体化指导。结果本研究共调查690例,获得完整资料者636例,其中10年ICVD发病危险度为极低危439例,低危158例,中危30例,高危7例,极高危2例。需进行社区干预39例,实际完成干预34例。中危及以上人群干预前后体质指数比较,差异无统计学意义(P>0.05)。中危及以上人群干预后收缩压、总胆固醇水平低于干预前(P<0.05)。中危及以上人群干预前吸烟率为38.2%(13/34),经干预后有3例戒烟,干预后吸烟率为29.4%(10/34)。干预后,男性10年ICVD发病危险度为极低危3例,低危10例;女性10年ICVD发病危险度为极低危4例,低危10例,中危6例,高危1例。结论 ICVD的危险因素在中年人群中已经存在,部分已达到了亟待干预的状况,早期对无症状危险人群的社区干预具有较好的效果。

Objective To evaluate the 10-year risk of ischemic cardiovascular disease（ ICVD） in community residents aged 45-59 by using the National 10-year Risk Assessment for ICVD Scale and to investigate the community-based intervention effect. Methods From October 2013 to March 2014,by using cluster random sampling,we selected 5 from the 33 neighborhood committees in Shanghai Hudong Community,and in which the permanent residents aged 45-59 were recruited in this study. We obtained their baseline data 〔height,weight,level of total cholesterol（ TC） 〕by questionnaire survey,physical examination and laboratory testing,and assessed their 10-year risk of ICVD by using the National 10-year Risk Assessment for ICVD Scale. Those who had 10-year moderate or high or extremely high risk of ICVD and needed intervention,were given 1-year intervention,including the clinical intervention,community health education and personalized health guidance based on their own conditions. Results Of the 690 participants,we obtained the complete data of 636 participants,including 439 with10-year extremely low risk of ICVD,158 with 10-year low risk of ICVD,30 with 10-year moderate risk of ICVD,7 with 10-year high risk of ICVD,and 2 with 10-year extremely high risk of ICVD. The 39 participants with 10-year moderate or high or extremely high risk of ICVD needed the 1-year intervention,but 34 finished it finally. After the intervention,in the 34 final participants,no significant changes in their BMI were observed（ P〈0. 05）; their systolic pressure and TC level significantly decreased（ P〈0. 05）; the proportion of smokers before and after intervention were 38. 2%（ 13/34）,29. 4%（ 10/34）respectively,and 3 cases stopped smoking. After intervention,3 were found with 10-year extremely low risk of ICVD,and 10 with 10-year low risk of ICVD in male; in female,4 were found with 10-year extremely low risk of ICVD,10 with 10-year low risk of ICVD,6 with 10-year moderate risk of ICVD,and 1 with 10-year high risk of ICVD. Conclusion Middle-aged population are found to be with the risk of ICVD,and some of them need to be intervened immediately. Community-based early intervention given to the population who have the risk of ICVD but without syndromes can achieve good social and economic benefits.