颈动脉内中膜增厚与高血压对新发缺血性卒中的影响研究

Study on effect of carotid intima-media thickening and hypertension on new onset ischemic stroke

目的探讨颈动脉内中膜(CIMT)增厚联合高血压对新发缺血性卒中的预测价值。方法选择参加2006-2007年开滦集团健康体检的中老年人群,按人口抽样调查数据抽取其中5030例为研究对象,并于2010年对该人群进行了颈动脉超声检查。根据是否存在CIMT增厚及高血压,将研究对象分为4组。将完成2010年度健康体检时间作为随访起点,以新发缺血性卒中或至随访结束(2017年12月31日)为随访终点,建立模型。采用Log-Rank检验比较不同分组在随访期间新发缺血性卒中累积发病率的差异,多变量Cox比例风险回归研究不同分组对新发缺血性卒中事件的影响。结果随访(6.84±0.89)年,不同组缺血性卒中累积发病率分别为0.59%、2.16%、4.09%和6.56%(P<0.05);以是否存在缺血性卒中为因变量,以不同CIMT增厚和高血压组为自变量,进行多因素COX回归分析,经过校正结果显示:第3、4组发生缺血性卒中的HR(95%CI)分别是5.07(2.76,9.34)、5.05(2.59,9.85);排除药物干扰重复COX模型,进行敏感性分析,结果显示在删除降压药干扰后第4组的HR[4.56(2.11,9.84)]高于第3组[4.18(2.13,8.22)],差异有统计学意义(P<0.05)。结论CIMT增厚与高血压对新发缺血性卒中的发生起着积极的预测作用,可为临床预防缺血性卒中的发生提供帮助。

Objective To study the predictive value of carotid artery intima-media thickening combined with hypertension on new onset ischemic stroke.Methods The middle-aged and elderly people participating in the healthy physical examination in Kailuan Group during 2006-2007 were selected,among them 5030 cases were selected as the study subjects according to the data of population sample survey,and the carotid artery ultrasound examination was carried out in 2010.According to the existence of CIMT thickening and hypertension,the subjects were divided into four groups.The time of completing the physical examination in 2010 served as the follow up starting point,and the new onset ischemic stroke or until the end of follow up(December 31,2017)as the follow up terminal point,the model was established.Log-Rank test was used to compare the difference in the cumulative incidence rates of new onset ischemic stroke during follow up period among different groups.The multivariate Cox proportional risk regression was used to study the effect of different groups on new onset ischemic stroke events.Results The cumulative incidence rates of ischemic stroke after follow up for(6.84±0.89)years in different groups was 0.59%,2.16%,4.09%and 6.56%,respectively(P<0.05).With whether existing ischemic stroke as the dependent variable and the different CIMT thickening and hypertension group as the independent variable,the multivariate COX regression analysis was performed,after correcting the results showed that HR(95%CI)of ischemic stroke occurrence in the third and fourth groups were 5.07(2.76,9.34)and 5.05(2.59,9.85)respectively.After excluding the drug interference and repeated COX models,the sensitivity analysis results showed that after deleting the interference of antihypertensive drugs,HR(95%CI)of the fourth group was higher than that of the third group,and the difference was statistically significant[4.56(2.11,9.84)]vs.4.18(2.13,8.22),P<0.05].Conclusion The CIMT thickening and hypertension have the positively predictive effect on the occurrence of new onset ischemic stroke,which can provide help for preventing the occurrence of ischemic stroke in clinic.