中老年缺血性脑卒中共病现状及共病模式分析:基于河南省三甲医院数据

Analysis of the Current Status of Ischemic Stroke Co-morbidity and Co-morbidity Patterns in Middle-aged Based on Data from Tertiary Hospitals in Henan Province

背景中老年缺血性脑卒中患者同时患有多种慢性病,且这种共病状态对患者的健康生活水平产生了较大影响。目前有关缺血性脑卒中共病现状及共病模式的研究尚少。目的了解河南省中老年缺血性脑卒中共病现状,并探索缺血性脑卒中共病之间的关联性,为缺血性脑卒中共病的管理及防控措施提供参考依据。方法选取2021—2022年在河南省人民医院就诊的45岁以上缺血性脑卒中患者为研究对象,统计其慢性病患病情况,比较不同人口学特征下缺血性脑卒中的共病情况,并采用聚类分析方法探究中老年人群缺血性脑卒中的共病模式。结果本研究共纳入1685例中老年缺血性脑卒中患者,其中90.0%(1516/1685)患者至少共患1种慢性病;13.6%(230/1685)共患2种慢性病,26.9%(454/1685)共患3种慢性病,49.4%(832/1685)共患4种及以上慢性病。共患病中患病率高的慢性病为高血压1047例(62.1%)、血脂异常755例(44.8%)。在缺血性脑卒中患者中,与男性相比,女性共病患病率较高(χ^(2)=14.516,P<0.05);随着年龄增加,共病患病率呈上升趋势(χ^(2)_(趋势)=148.889,P<0.001);随着受教育程度升高,共病患病率呈下降趋势(χ^(2)_(趋势)=30.890,P<0.001)。聚类分析得出4种共病模式,分别为心血管代谢模式(高血压、血脂异常、心脏病发作和糖尿病)、以肝-肺-胃肠道-泌尿疾病为特征模式(慢性肺部疾病、肾脏疾病、肝脏疾病、消化系统疾病和泌尿系统疾病)、精神-退行性疾病模式(神经或精神问题、关节炎或风湿病、与记忆相关的疾病)、癌症。结论河南省中老年缺血性脑卒中人群中共病患病率较高,其共病模式包括心血管代谢模式、以肝-肺-胃肠道-泌尿疾病为特征模式、精神-退行性疾病模式、癌症,其中心血管代谢模式与缺血性脑卒中关联较大,应加强对其筛查与预防。

Background Middle-aged and elderly ischemic stroke patients suffer from multiple co-morbid chronic diseases,and this co-morbidity status has a great impact on the patients'healthy living standard.Currently,there are few studies on the current status of ischemic stroke co-morbidities and the analysis of co-morbidity patterns.Objective To understand the current status of ischemic stroke co-morbidities in middle-aged and elderly people in Henan Province,and explore the association between ischemic stroke co-morbidities,so as to provide a reference basis for the management of ischemic stroke comorbidities,as well as the preventive and control measures.Methods Ischemic stroke patients over 45 years of age attending Henan Provincial People's Hospital from January 2021 to December 2022 were selected for the study,with their chronic disease prevalence counted,the status of ischemic stroke co-morbidities was compared by different demographic characteristics,and the co-morbidity patterns of ischemic stroke in the middle-aged and elderly population were investigated using cluster analysis.Results A total of 1685 middle-aged and elderly ischemic stroke patients were enrolled in this study,of whom 90.0%(1516/1685)had at least 1 co-morbid chronic disease;13.6%(230/1685)had 2 co-morbid chronic diseases,26.9%(454/1685)had 3 co-morbid chronic diseases,and 49.4%(832/1685)had 4 or more co-morbid chronic diseases.The chronic diseases with high prevalence were hypertension in 1047 cases(62.1%)and dyslipidemia in 755 cases(44.8%).Among ischemic stroke patients,the prevalence of co-morbidities was higher in females compared with males(χ^(2)=14.516,P<0.05);the prevalence of co-morbidities tended to increase with age(χ^(2)_(trend)=148.889,P<0.001);and the prevalence of co-morbidities tended to decrease with higher education(χ^(2)_(trend)=30.890,P<0.001).Cluster analysis showed four patterns of co-morbidity,which were cardiovascular-metabolic patterns(hypertension,dyslipidemia,heart attack,and diabetes mellitus),patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders(chronic lung disease,renal disease,hepatic disease,gastrointestinal disorders,and urinary disorders),psychiatric-degenerative patterns(neurological or psychiatric problems,arthritis or rheumatism,disorders related to memory),and cancer.Conclusion The prevalence of co-morbidities of ischemic stroke in middle-aged and elderly people in Henan province is high,and their co-morbidity patterns include cardiovascular-metabolic patterns,patterns characterized by hepato-pulmonary-gastrointestinal-urinary disorders,psychiatric-degenerative patterns,and cancers,among which cardiovascular-metabolic patterns are more associated with ischemic stroke,and the screening and prevention of which should be better controlled.