合肥市某社区脑卒中高危人群颈动脉内中膜厚度影响因素分析

The influencing factors of carotid intima-media thickness of high-risk stroke residents in a community of Hefei

目的了解社区脑卒中高危人群颈动脉内中膜厚度(IMT)的影响因素,以期制定脑卒中早期干预策略。方法通过入户筛查方式收集2017年5~10月合肥市四里河社区40岁以上常住居民相关资料,共筛查出脑卒中高危人群762例,其中618例完成颈部血管超声检查,根据颈动脉IMT结果分为IMT正常组(213例)和IMT增厚组(405例),比较两组一般情况及空腹血糖(FPG)、糖化血红蛋白(HbA1c)、同型半胱氨酸(Hcy)、血脂等实验室检查结果,并记录两组存在高血压、糖尿病、高脂血症、心房颤动或心脏瓣膜病、吸烟、很少进行体育锻炼、明显超重或肥胖及脑卒中家族史等情况,采用logistic回归法分析脑卒中高危人群发生IMT增厚的影响因素。结果 IMT增厚组相对于IMT正常组男性占比较高且年龄相对较大(P<0.05), IMT增厚组糖尿病暴露率高于IMT正常组(P<0.05),IMT增厚组收缩压、FPG、HbA1c、Hcy水平高于IMT正常组(P<0.05)。多因素logistic回归分析结果显示,年龄(OR=1.099)、收缩压(OR=1.018)、HbA1c(OR=1.457)和Hcy(OR=1.027)是脑卒中高危人群颈部IMT增厚的危险因素,女性为保护因素(OR=0.598)。IMT增厚组的心脑血管病危险因素数目高于IMT正常组(P<0.05)。结论性别、年龄、收缩压、HbA1c和Hcy与脑卒中高危人群IMT增厚密切相关,控制上述危险因素,有助预防动脉粥样硬化的发生及进展。

Objective To provide the scientific evidence for the prevention and cure of stroke by investigating the influencing factors of the intima-media thickness in high-risk stroke residents.Methods A total of 618 permanent residents aged≥40 years in the high-risk group of stroke in Silihe community of Hefei City from May 2017 to October 2017 were enrolled in the study.All residents were examined by carotid ultrasound examination to measure carotid intima-media thickness(IMT)and were divided into normal IMT group and thickening IMT group.The biochemical indexes including fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),homocysteine(Hcy)and blood lipids were checked.The difference inthe risk factors of stroke and their number was analyzed.The risk factors of carotid atherosclerosis were analyzed by Logistic regression.Results Compared with those of normal group,the proportion of male and the average age in IMT thickening group was higher(P<0.05).The detection rate of diabetes in IMT thickening group was higher than thatin normal group(P<0.05).The levels of systolic blood pressure,FPG,HbA1c and Hcy in IMT thickening group were higher than those in normal group(P<0.05).Logistic regression analysis showed that age(OR=1.099),systolic blood pressure(OR=1.018),HbA1c(OR=1.457)and Hcy(OR=1.027)were the independent risk factors of IMT thickening,while female(OR=0.598)was the protective factor.The number of risk factors for stroke was high in IMT thickening group.Conclusions Gender,age,systolic blood pressure,HbA1c and Hcy aresignificantly correlated with IMT thickening.The more risk factors,the greater the influence of IMT.We should control the risk factors from various aspects to prevent the development of atherosclerosis.