慢性病患者10年心脑血管疾病发病平均风险评估及其与眼底病变的关系研究

Ten-year Average Risk Assessment of Cardio-cerebrovascular Diseases and Fundus Lesions in Chronic Disease Patients

背景心脑血管疾病是严重威胁人群健康的疾病之一,既往已有少部分关于缺血性心血管病的研究,但动脉粥样硬化性心血管病(ASCVD)与眼底损害相关报道较少。目的探讨某社区慢性病患者10年心脑血管疾病发病风险及其与眼底病变的关系。方法于2017年2-8月采用分层随机抽样法选取苏州市某社区卫生服务中心在管的慢性病(高血压、糖尿病)患者2 080例为研究对象,依据《中国心血管病预防指南(2017)》中心脑血管病风险预测模型进行风险评估,并根据评估情况将患者分为3组,分别为低危组227例、中危组919例、高危组934例,分析风险分层与眼底病变的关系。结果 2 080例慢性病患者中吸烟、超重或肥胖、高血脂、高血压、糖尿病者占比分别为22.74%(473/2 080)、67.74%(1 463/2 080)、35.58%(740/2 080)、94.28%(1 961/2 080)、24.76%(515/2 080);男性吸烟、超重或肥胖者占比高于女性,差异有统计学意义(P<0.05);不同年龄段慢性病患者吸烟、超重或肥胖、高血压和糖尿病者占比比较,差异有统计学意义(P<0.05)。慢性病患者10年心脑血管疾病发病风险低危组、中危组、高危组占比分别为10.91%(227/2 080)、44.18%(919/2 080)、44.90%(934/2 080)。不同性别、年龄、吸烟、BMI、血脂异常、高血压、糖尿病史情况慢性病患者心脑血管疾病风险分组比较,差异有统计学意义(P<0.05)。2 080例慢性病患者Keith-Wagener眼底分级正常93例(4.47%),Ι级899例(43.22%),Ⅱ级950例(45.67%),Ⅲ级127例(6.11%),Ⅳ级11例(0.53%)。眼底异常检出率为52.31%(1 987/2 080),低危组、中危组、高危组眼底异常检出率分别为45.37%(103/227)、51.25%(471/919)、55.03%(514/934),3组眼底异常检出率比较,差异有统计学意义(χ2=7.564,P=0.023)。高危组慢性病患者眼底异常检出率高于低危组[OR=1.473,95%CI(1.101,1.972),P=0.009]。结论慢性病患者10年心脑血管疾病发病风险较大,高危组人群眼底视网膜病变明显高于低危组。

Background Cardiovascular and cerebrovascular diseases seriously threaten people’s health.There are a few studies on ischemic cardiovascular disease,but few studies about atheroselerotic cardiovascular disease and fundus lesions.Objective To investigate the relationship between 10-year risk of cardio-cerebrovascular diseases(CCVD)and fundus lesions in chronic disease patients from a community.Methods From February to August,2017,by using stratified random sampling,2 080 patients with chronic diseases(consisting mainly of hypertension and diabetes)who received management from a community health center in Suzhou were enrolled.Risk of CCVD was assessed by the CCVD risk prediction model in the Chinese Guidelines for the Prevention of Cardiovascular Diseases(2017).According to the assessment results,patients were divided into low-risk group(n=227),medium-risk group(n=919) and high-risk group(n=934).The relationships between different levels of risks for CCVD and fundus lesions were analyzed.Results The rates of smoking,overweight or obesity,hyperlipidemia,hypertension and diabetes were 22.74%(473/2 080),67.74%(1 463/2 080),35.58%(740/2 080),94.28%(1 961/2 080) and 24.76%(515/2 080),respectively.Males had higher prevalence rates of smoking,and overweight or obesity than females(P<0.05).The prevalence rates of smoking,overweight or obesity,hypertension,and diabetes differed significantly by age group(P<0.05).The prevalence rates of 10-year risk of CCVD in low-,medium-and high-risk groups were 10.91%(227/2 080),44.18%(919/2 080) and 44.90%(934/2 080),respectively.The prevalence rate of risk of CCVD varied obviously by sex,age,smoking,BMI,blood lipid level,hypertension history,and diabetes history(P<0.05).Keith-Wagener-Barker classification showed that fundus was normal in 93 cases(4.47%),grade Ιin 899 cases(43.22%),grade Ⅱ in 950 cases(45.67%),grade Ⅲ in 127 cases(6.11%) and grade Ⅳ in 11 cases(0.53%).The overall prevalence rate of fundus abnormalities was 52.31%(1 987/2 080).And the prevalence rates of fundus abnormalities in low-,medium-and high-risk groups were 45.37%(103/227),51.25%(471/919),and 55.03%(514/934),respectively,showing significant difference(χ2=7.564,P=0.023).The 10-year risk of ASCVD in chronic disease patients was 22.7%(10.91%),91.9%(44.18%) and 93.4%(44.90%) respectively.The detection rate of fundus abnormalities in high-risk group was higher than that in low-risk group[OR=1.473,95%CI(1.101,1.972),P=0.009].Conclusion Chronic diseases are associated with higher 10-year risk of CCVD.Medium-risk and high-risk of CCVD are associated with increased risk of fundus lesions.