Rothman-Keller预警模型预测社区老年高血压患者脑卒中发生风险的研究

Research of Rothman-Keller risk forewarning model on stroke incidence in elder community patients with hypertensive

目的探讨在社区医院中应用Rothman-Keller预警模型预测老年高血压患者脑卒中风险的效能。方法2018年6月选取与新乡市中心医院有合作关系的4个社区医院的老年高血压患者1267例作为研究对象,根据Rothman-Keller模型收集收缩压、舒张压、高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)、同型半胱氨酸(Hcy)、高尿酸血症、空腹血糖受损/糖尿病、脑卒中家族史、颈动脉斑块阳性、规律服药、坚持体育锻炼、吸烟共12项危险因素,并比较不同特征患者脑卒中发生风险因素的差异。于2019年6月和2020年6月分别进行随访,随访主要内容为血压控制情况、脑卒中发生情况和死亡情况等。采用Rothman-Keller模型分别评估总体人群及不同性别人群老年高血压患者的脑卒中发生风险,分析该模型的应用效果。结果1267例高血压患者中,共失访54例,失访率为4.26%;随访时间为(43.40±8.22)个月。男性患者的收缩压、LDL-c、吸烟比例和颈动脉斑块阳性率高于女性患者,差异有统计学意义(P<0.05)。Rothman-Keller模型判断总人群、男性人群、女性人群并发脑卒中的灵敏度、特异度及诊断符合率分别为0.82、0.76、75.93%;0.86、0.82、81.78%;0.73、0.83、82.61%。Rothman-Keller模型判断总人群、男性人群、女性人群并发脑卒中的ROC曲线下面积分别为0.773、0.784、0.824(P<0.01)。结论Rothman-Keller模型可以很好地预测社区老年高血压患者脑卒中的发生风险,操作简便,是实用的脑卒中风险预测工具。

Objective To observe the application effect of Rothman-Keller risk forewarning model on stroke incidence in elder community patients with hypertensive.Methods A total of 1267 elder hypertensive patients were selected as research objects from 4 community hospitals cooperated with Xinxiang Central Hospital in June 2018.12 related risk factors were collected according to the Rothman-Keller model,including systolic blood pressure,diastolic blood pressure,high density liptein cholesterol(HDL-c),low density lipoprotein(LDL-c),homocysteine(Hcy),Hyperuricemia,impaired fasting glucose/diabetes,family history of stroke,carotid plaque positive,regular medication,physical exercise and smoking.The differences on risk factors were compared among patients with different characteristics.The patients were followed up in June 2019 and June 2020 respectively.The follow-up mainly included blood pressure control,stroke incidence and death.Rothman-Keller model was used to evaluate the risk of stroke in elderly patients with hypertension in the general population and different gender groups,and the application effect of the model was analyzed.Results Among 1267 patients with hypertension,54 cases were lost to follow-up,and the loss rate was 4.26%.The follow-up time was(43.40±8.22)months.The systolic blood pressure,LDL-c,the proportion of smoking and the positive rate of carotid plaque in male patients were significantly higher than those in female patients,with statistical significance(P<0.05).The sensitivity,specificity and diagnostic coincidence rate of Rothman-Keller model for stroke in general population,male population and female population were 0.82,0.76,75.93%;0.86,0.82,81.78%;0.73,0.83,82.61%,respectively.According to Rothman-Keller model,the area under the receiver operating characteristic(ROC)curve of stroke in total population,male population and female population were 0.773,0.784 and 0.824 respectively(P<0.01).Conclusions Rothman-Keller model can well predict the risk of stroke in elderly patients with hypertension in the community.It is a simple and practical prediction tool.