贵州省部分少数民族人群脑血管血流动力学指标的影响因素分析

Influencing factors of cerebrovascular hemodynamics indexes in some minority populations in Guizhou province

目的分析少数民族(土家族、布依族、侗族、苗族)人群脑血管血流动力学指标(CVHI)的影响因素,为少数民族人群脑卒中早期预警提供依据。方法选取2017年4月—2019年4月于贵州医科大学附属医院健康管理中心进行体检的少数民族人群为研究对象,调查民族、年龄、性别、既往病史(高血压、高脂血症、糖尿病)及女性月经情况,测量身高、体重等生理指标及血糖、血脂、血尿酸等生化指标,进行CVHI和双侧臂踝脉搏波传导速度(baPWV)检测,计算CVHI积分值,分为CVHI正常组(≥75分)和异常组(<75分),描述人群分布特征,分析CVHI的相关影响因素。结果共纳入少数民族人群1236名,年龄(52.0±9.0)岁,男性575名(46.52%)、女性661名(53.48%)。少数民族CVHI异常率为35.11%,各民族CVHI异常率由高到低依次为布依族(38.22%)、苗族(37.93%)、侗族(32.70%)、土家族(32.36%),差异无统计学意义。少数民族CVHI异常率,女性(43.57%)高于男性(25.39%)、绝经者(47.48%)高于未绝经者(39.51%),既往有高血压(57.66%)、糖尿病(76.19%)、高血脂病史者(54.00%)高于正常者(32.30%、35.31%、34.74%),P均<0.05。少数民族人群CVHI异常组的年龄、BMI、收缩压、舒张压以及空腹血糖、三酰甘油、baPWV的水平高于正常组,身高低于正常组,差异具有统计学意义(P均<0.05)。相关性分析显示,身高(r=0.309)与CVHI积分值正相关,收缩压(r=-0.239)、舒张压(r=-0.189)、baPWV(r=-0.184)与CVHI积分值负相关,差异均有统计学意义(P均<0.001)。多因素Logistic回归分析显示,高龄[OR(95%CI):1.992(1.405~2.825)]、女性[OR(95%CI):2.240(1.750~2.866)]、高血压病史[OR(95%CI):3.363(1.665~6.791)]、绝经[OR(95%CI):1.384(1.016~1.885)]及收缩压[OR(95%CI):1.031(1.019~1.044)]、体质指数[OR(95%CI):1.091(1.048~1.135)]、空腹血糖[OR(95%CI):1.169(1.017~1.344)]和baPWV[OR(95%CI):1.002(1.001~1.002)]升高为脑血流动力学异常的危险因素,高身高[OR(95%CI):0.936(0.920~0.952)]为保护因素。结论少数民族人群CVHI异常率较高,高龄、女性、既往高血压病史以及绝经及收缩压、体质指数、空腹血糖、baPWV升高是CVHI异常的主要危险因素。应加强少数民族聚集地的健康管理,控制体重,定期监测血压、血糖、血脂水平,进行CVHI检测。

Objective This study aimed to analyze the influencing factors of cerebral hemodynamics index(CVHI)and provide evidence on early warning of stroke in ethnic minorities(Tujia,Buyi,Dong,Miao).Methods From April 2017 to April 2019,ethnic minorities were examined in the Health Management Center of the Affiliated Hospital of Guizhou Medical University to determine the nationality,age,sex,medical history(such as hypertension,hyperlipidemia,and diabetes)and menstruation in women;measure physiological indexes,such as height and weight,and biochemical indexes,such as blood glucose,blood lipid,and serum uric acid levels;and conduct CVHI and bilateral arm ankle pulse wave conduction velocity(baPWV)detection.The CVHI integral was calculated and divided into normal CVHI group(≥75 points)and abnormal CVHI group(<75 points)to describe the characteristics of population distribution and analyze the related influencing factors of CVHI.Results A total of 1236 individuals belonging to ethnic minorities[age,52.0±9.0 years;575 men(46.52%)and 661 women(53.48%)]were included in the study.In ethnic minorities,35.11%had abnormal CVHI.There was no significant difference in abnormal CVHI among ethnic groups,from highest to lowest,in Buyi nationality(38.22%),Miao nationality(37.93%),Dong nationality(32.70%),and Tujia nationality(32.36%).Minority women,menopausal patients,and patients with history of hypertension,diabetes,and hyperlipidemia more frequently had abnormal CVHI than men and non-menopausal and normal women(43.57%,47.48%,and 57.66%,76.19%,and 54.00%vs.25.39%,39.51%,and 32.30%35.31%,and 34.74%,P<0.05).The mean BMI,systolic blood pressure(SBP),diastolic blood pressure(DBP),and FPG and TG levels,baPWV in the abnormal CVHI group were higher than those in the normal CVHI group,and height was lower the abnormal CVHI group than that in the normal group(P<0.05).The correlation analysis showed that height(r=0.309)was positively correlated with CVHI integral and SBP(r=-0.239),DBP(r=-0.189),and baPWV(r=-0.184)were negatively correlated with CVHI integral(P<0.001).The higher the height,the higher the CVHI and the lower the risk of stroke,and the higher the SBP,DBP,and baPWV,the lower the CVHI score and the higher the risk of stroke.The factor logistic regression analysis showed that old age(OR,1.992;95%CI,1.405-2.825);female sex(OR,2.240;95%CI,1.750-2.866);history of hypertension(OR,3.363;95%CI,1.665-6.791),menopause(OR,1.384;95%CI,1.016-1.885),and high SBP(OR,1.031;95%CI,1.019-1.044),BMI(OR,1.091;95%CI,1.048-1.135),FPG level(OR,1.169;95%CI,1.017-1.344),and baPWV(OR,1.002;95%CI,1.001-1.002)were risk factors for abnormal CVHI,and increased height(OR,0.936;95%CI 0.920-0.952)was the protective factor.Conclusion Individuals in ethnic minorities frequently have abnormal CVHI.The main risk factors of CVHI are the elderly,female,history of hypertension,menopause,systolic blood pressure,body mass index,fasting blood glucose and baPWV.It is necessary to strengthen the health management of ethnic minority gathering places,controling body weight,regularly monitoring of blood pressure and blood glucose and lipid levels,and examing cerebral vascular hemodynamics.