社区中老年人群慢性直立不耐受综合征患病率及影响因素分析

Prevalence and associated factors of chronic orthostatic intolerance in communities

目的探讨社区中老年人群慢性直立不耐受综合征(orthostatic intolerance,OI)的患病率及相关影响因素,为制定社区OI患者干预措施提供科学依据。方法采用整群随机抽样的方法,于2021年1—9月抽取吉林省长春市3个社区卫生服务机构,对年龄≥40岁的546名户籍居民进行病史采集、直立不耐受问卷评定及卧立位血压测量,应用SPSS 26.0统计学软件对社区慢性OI患病情况进行描述性统计分析,采用多因素logistic回归模型分析影响OI患病率的相关因素。结果本研究人群OI总体患病率为15.8%(86/546),在各亚型中,直立性低血压(OH)、体位性心动过速综合征(POTS)、直立性高血压(OHT)患病率分别为10.6%(58/546)、0.7%(4/546)、4.4%(24/546),OH患病率明显高于其他2个亚型(χ2=56.840,P<0.001)。按年龄分层,OI患病率随年龄增长呈上升趋势(χ2=7.919,P=0.048),70岁以上高龄人群患病率最高(20.6%,28/136)。多因素logistic回归分析结果显示,年龄≥60岁、高血压、卧位收缩压≥140 mmHg(1 mmHg=0.133 kPa)是慢性OI的独立危险因素。结论社区中老年人群慢性OI患病率较高,临床分型以OH为主,老年人群、伴有高血压尤其是卧位收缩压控制不良者慢性OI患病风险高,应对重点人群加强防控。

Objective To investigate the prevalence and associated factors of chronic orthostatic intolerance(OI)in community-dwelling middle-aged and elderly people.Methods From January to September 2021,a random cluster sample of 546 registered residents aged≥40 years in three community health services in Changchun was conducted.Data included medical history,questionnaire and blood pressure in supine and standing positions.SPSS 26.0 software was used for descriptive statistical analysis.Factors associated with OI were analyzed by multivariate logistic regression models.Results The overall prevalence of OI was 15.8%(86/546),and among the subtypes,the prevalence of orthostatic hypotension(OH),postural orthostatic tachycardia syndrome(POTS)and orthostatic hypertension(OHT)were 10.6%(58/546),0.7%(4/546)and 4.4%(24/546),respectively.The prevalence of OH was significantly higher than the other two subtypes(χ^(2)=56.840,P<0.001).Stratified by age,the prevalence of OI tended to increase with age(χ^(2)=7.919,P=0.048),with the highest prevalence in those aged≥70 years old(20.6%,28/136).Multi-factor logistic regression analysis showed that age≥60 years,hypertension,and supine systolic blood pressure≥140 mmHg(1 mmHg=0.133 kPa)in the prone position were independent risk factors for chronic OI.Conclusion There is a high prevalence of chronic OI in the middle-aged and elderly population in communities.OH is the main clinical type.Elderly people,hypertension and supine systolic hypertension are at high risk of developing chronic OI.Therefore,prevention and control of OI should be strengthened in key populations.