中老年人群脑卒中风险评估及其危险因素相关性分析

Assessment of stroke profile and correlation analysis of related risk factors in middle-aged and old population

目的探讨采用脑血管血流动力学积分值(cerebrovascular hemodynamic accumulative score,CVHAS)工具对中老年人群首发脑卒中风险评估及其危险因素的相关性分析。方法选取2017年2月~2019年12月在解放军总医院京中医疗区旃坛寺门诊部完成健康体检并行CVHAS检测的1580名中老年人群,分为45~54岁、55~64岁、65~74岁、≥75岁4个年龄段,以CVHAS值75分为截断点,分为脑卒中高危组(<75分,450例)和脑卒中低危组(≥75分,1130例),分析不同性别、不同年龄段CVHAS值变化和脑卒中高危人群检出率,比较脑卒中高危组和低危组之间危险因素暴露水平,采用多因素logistic回归分析CVHAS值与危险因素的相关性。结果总体人群平均CVHAS为(80.3±9.2)分,男性为(79.1±9.4)分,低于女性(82.3±8.5)分;总体脑卒中高危人群比例为28.5%(450/1580),男性为29.7%(285/960),高于女性26.6%(165/620),差异有统计学意义(P<0.05)。4个年龄组人群比较,随着年龄的增长,男性和女性CVHAS值均呈下降趋势,而脑卒中高危人群比例呈增高趋势,差异均有统计学意义(P<0.01)。45~54岁、55~64岁年龄段男性CVHAS值低于女性,脑卒中高危人群比例高于女性,差异均有统计学意义(P<0.05)。65~74岁、≥75岁年龄段男性与女性组间差异均无统计学意义(P>0.05)。脑卒中高危组的年龄、吸烟史、高血压史、糖尿病史、腰围(WC)、体脂含量(BF)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(Hcy)、肱踝脉搏波传导速度(baPWV)均显著高于低危组,差异有统计学意义(P<0.05);两组饮酒史、脑卒中家族史、体质量指数(BMI)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、血尿酸(UA)比较,差异均无统计学意义(P>0.05)。相关性分析显示,CVHAS与年龄、WC、BF、SBP、DBP、TC、LDL-C、FPG、Hcy、baPWV呈负相关(r=-0.314、-0.295、-0.324、-0.387、-0.327、-0.319、-0.325、-0.389、-0.416、-0.349,P<0.01),与BMI、HDL-C、TG、UA无明显相关(P>0.05)。多因素logistic回归分析显示,年龄、吸烟史、高血压病史、糖尿病史、BF、SBP、FPG、LDL-C、Hcy、baPWV为脑卒中风险的独立危险因素。结论中老年人群中脑卒中高危人群比例较高,CVHAS值降低与脑卒中危险因素暴露水平密切相关,CVHAS检测是一种简便、准确的工具,可用于筛查、评估首发脑卒中高危人群,有助于脑卒中早期预防。

Objective To evaluate the stroke profile and analyze its correlation with risk factors in middle-aged and old population guided by the cerebrovascular hemodynamic accumulative scores(CVHAS).Methods A total of 1580 cases aged more than 45 years were chosen by health checkup and CVHAS from February 2017 to Decenber 2019,they were divided into four age brackets(45~54、55~64、65~74、≥75years)and two groups according to the cut point of CVHAS:high-risk group(<75 score,450 cases)and low-risk group(≥75 score,1130 cases),analyze the changes of CVHAS and detection rate of high-risk individuals of stroke in different age brackets and different gender,compare the exposure level of risk factors between the two groups,analyze the correlation between CVHAS and risk factors of stroke by multiple factor logistic regression analysis.Results The average of CVHAS of all population was 80.3±9.2,male(79.1±9.4)was lower than female(82.3±8.5);the detection rate of high-risk individuals of stroke of all population was 28.5%(450/1580),male(29.7%,285/960)was higher than female(26.6%,165/620),(P<0.05).comparison among 4 age brackets,the average of CVHAS were decreasing with age(P<0.01);the detection rate of high-risk individuals of stroke were increasing with age in male and female(P=0.001).The average of CVHAS of male in 45~54、55~64 years was lower than that of femal,the detection rate of high-risk individuals of stroke of male in 45~54、55~64 years was higher than that of femal(P<0.05);the differences were not significant between male and female in 65~74、≥75years.Compared with low-risk group,the proportion of history of smoking、hypertension、diabetes was significantly higher in the high-risk group(P<0.05),in addition,the levels of age、waist circumference(WC)、body fat(BF)、systolic blood pressue(SBP)、diastolic blood pressure(DBP)、fasting plasma glucose(FPG)、total cholesterol(TC)、low density lipoprotein cholesterol(LDL-C)、homocysteine(Hcy)、brachial-ankle pulse wave velocity(baPWV)were significantly higher(P<0.05);the proportions of history of drinking wine and family history of stroke、the levels of body mass index(BMI)、high density lipoprotein cholesterol(HDL-C)、triglyceride(TG)、uric acid(UA)were no significances between two groups(P>0.05).Correlation analysis showed a negative correlation between CVHAS and age、WC、BF、SBP、DBP、TC、LDL-C、FPG、Hcy、baPWV(r=-0.314,-0.295,-0.324,-0.387,-0.327,-0.319,-0.325,-0.389,-0.416,-0.349,P<0.01).Multiple factor Logistic regression analysis indicated that age,history of smoking、hypertention、diabetes,BF,SBP,DBP,LDL-C,FPG,Hcy,baPWV are the independent risk indicators of decreased CVHAS.Conclusions The propotion of high-risk of stroke in middle-aged and old population is higher,The decreased CVHAS(<75)has a significant correlation with exposure levels of risk factors in stroke.Evaluating and screening high-risk individuals of stroke in middle-aged and old population guided by the CVHAS is convenient and accurate,the application of CVHAS is favorable for the primary prevention of stroke.