口腔卫生行为与脑卒中发病的前瞻性队列研究

A prospective cohort study on the association between oral hygiene behaviors and the incidence of stroke

目的探讨贵州省人群口腔卫生行为与脑卒中发病的关系,为脑卒中的预防控制提供参考依据。方法采用分层随机整群抽样方法,2010年对抽取的贵州省12个县(市、区)18岁及以上常住居民共9280人进行基线调查,于2016―2020年对该队列所有人群进行随访。运用SPSS 21.0软件进行数据分析,计量资料以(x±s)表示,多组间比较采用单因素方差分析。计数资料以构成比和率表示,组间比较采用χ^(2)检验。采用Cox比例风险回归模型分析口腔卫生行为与脑卒中发病的关系,用Graphpad Prism 10.0.2软件绘制脑卒中发病风险森林图。结果最终纳入分析人群共7970人,脑卒中发病204人,发病密度为3.62/1000人年,多因素Cox回归分析结果显示,与每天刷牙1次以下的人群相比,每天刷牙1次可以降低34.3%的脑卒中发病风险(HR=0.657,95%CI:0.459~0.941),每天刷牙2次及以上可以降低50.8%的脑卒中发病风险(HR=0.492,95%CI:0.307~0.789)。每天刷牙2次及以上的人群缺血性脑卒中的发病风险是刷牙不足1次人群的0.515倍(HR=0.515,95%CI:0.298~0.891),口腔卫生行为与出血性脑卒中的发病无相关性。结论刷牙是脑卒中发病的保护性因素,每天刷牙2次及以上可以有效降低缺血性脑卒中的发病风险。

Objective To explore the relationship between oral health behavior and the incidence of stroke in Guizhou Province,and to provide reference for the prevention and control of stroke.Methods A total of 9280 permanent residents aged 18 years and above were selected using stratified random cluster sampling across 12 counties(cities and districts)in Guizhou Province in 2010.The cohort was followed up from 2016 to 2020.SPSS 21.0 software was used to analyze the data.The measured data were expressed as mean±standard deviation(x±s).One-way variance analysis was used for comparison among multiple groups.The count data were expressed as constituent ratio or rate.Chi-square test was used for comparison between groups.Cox proportional hazards regression model was used to analyze the relationship between oral hygiene behavior and stroke incidence.The Graphpad Prism 10.0.2 software was utilized for plotting stroke incidence risk.Results Of the 7970 individuals included in the analysis,204 experienced a stroke,with an incidence density of 3.62/1000 person-years.The results of Cox regression analysis showed that compared with the individuals who brushed their teeth less than once a day,the risk of stroke decreased by 34.3%(HR=0.657,95%CI:0.459-0.941)for those brushing teeth once a day,and by 50.8%(HR=0.492,95%CI:0.307-0.789)for those brushing twice a day or more.The risk of ischemic stroke was 0.515-fold higher in those who brushed their teeth twice or more per day than in those who brushed less than once(HR=0.515,95%CI:0.298-0.891).However,no correlation was found between oral hygiene behavior and hemorrhagic stroke.Conclusions Brushing teeth is a protective factor for stroke.Brushing teeth twice or more every day can effectively reduce the risk of ischemic stroke.