山西省某农村地区中老年人脑卒中危险因素分析及与H型高血压的相关性研究

Risk factors for stroke and its correlation with H-type hypertension among the middle-aged and elderly in a rural area of Shanxi Province

目的了解山西省某农村地区中老年人脑卒中现状及其危险因素,重点分析H型高血压与脑卒中的相关性,为进一步改善脑卒中防控措施提供科学依据。方法于2019年12月—2020年2月,采用多阶段分层抽样方法抽取山西省太原市阳曲县1644名≥40岁常住居民进行问卷调查、体格检查及生化指标检测,采用二元logistic回归分析脑卒中危险因素,并采用单因素和多因素logistic回归分析其与H型高血压的关系。结果发放问卷1644份,回收有效问卷1627份,有效问卷回收率为98.97%。男性805例(49.48%),女性822例(50.52%);平均年龄为(58.75±9.75)岁;高中及以上文化程度占10.94%;本人年均收入在10000元以下的占64.60%。山西省阳曲县农村地区脑卒中粗患病率为5.90%,年龄标化患病率为4.96%。其中,男性、女性常住居民的脑卒中患病率分别为6.34%、5.47%;H型高血压人群脑卒中患病率为10.95%。年龄≥50岁(50~59岁:OR=3.460,95%CI:1.017~11.765;60~69岁:OR=4.669,95%CI:1.381~15.788;≥70岁:OR=8.837,95%CI:2.544~30.700)、脑卒中家族史(OR=2.412,95%CI:1.092~5.300)、糖尿病家族史(OR=2.330,95%CI:1.130~4.803)、心脏病(OR=3.240,95%CI:1.549~6.780)、高血压(OR=4.035,95%CI:2.314~7.035)、糖尿病(OR=1.888,95%CI:1.093~3.263)、血脂异常(OR=1.692,95%CI:1.066~2.686)是阳曲县≥40岁常住居民脑卒中的危险因素。校正相关因素后,H型高血压人群患脑卒中的风险增加了2.712倍。高同型半胱氨酸和高血压在脑卒中患病方面存在相乘交互作用(P<0.05),且女性人群中同型半胱氨酸升高和有高血压患脑卒中的风险增加了1.777倍。结论阳曲县农村地区脑卒中患病率较高,针对高血压、糖尿病、心脏病等疾病危险因素,应积极采取有效措施。H型高血压与脑卒中显著相关,在控制血压的同时还需降低血Hcy水平。

Objective To understand the current situation of stroke and its risk factors amongst the middle-aged and elderly in a rural area of Shanxi Province,to focus on analyzing the correlation between H-type hypertension and stroke,and to provide a scientific basis for further improvement of stroke prevention and control measures.Methods From December 2019 to February 2020,a multistage stratified sampling method was used to select 1,644 permanent residents aged 40 years and above in Yangqu County,Taiyuan City,Shanxi Province for a questionnaire survey,physical examinations and biochemical indexes detection.Binary logistic regression was employed to analyze risk factors for stroke,and their relationships with H-type hypertension were identified using univariate and multivariate logistic regression analyses.Results A total of 1,644 questionnaires were distributed,and 1,627 valid questionnaires were retrieved,with a valid questionnaire recovery rate of 98.97%.There were 805(49.48%)male cases and 822(50.52%)female cases,with the average age of(58.75±9.75)years.10.94%had a high school education or above,and 64.60%had an average annual income of less than 10,000 yuan.The crude prevalence rate of stroke in rural area of Yangqu County,Shanxi Province was 5.90%,and the age-standardized prevalence rate was 4.96%.The prevalence rates of stroke in male and female permanent residents were 6.34%and 5.47%respectively.The prevalence rate of stroke in the H-hypertensive population was 10.95%.Binary logistic regression analysis revealed that age≥50 years(50-59 years old:OR=3.460,95%CI:1.017-11.765;60-69 years old:OR=4.669,95%CI:1.381-15.788;≥70 years old:OR=8.837,95%CI:2.544-30.700),family history of stroke(OR=2.412,95%CI:1.092-5.300),family history of diabetes mellitus(OR=2.330,95%CI:1.130-4.803),heart disease(OR=3.240,95%CI:1.549-6.780),hypertension(OR=4.035,95%CI:2.314-7.035),diabetes mellitus(OR=1.888,95%CI:1.093-3.263)and dyslipidemia(OR=1.692,95%CI:1.066-2.686)were risk factors for stroke in the permanent residents aged 40 years and above in Yangqu County.After correcting for the associated factors,the risk of suffering from stroke in the H-hypertensive population was increased 2.712-fold.There was a multiplicative interaction between hyperhomocysteine and hypertension in the prevalence of stroke(P<0.05),and there was a 1.777-fold increased risk of stroke in the female population with elevated homocysteine and hypertension.Conclusion The prevalence rate of stroke in rural areas of Yangqu County is high.Effective measures should be actively taken against disease risk factors such as hypertension,diabetes and heart disease.H-type hypertension is significantly correlated with stroke,and it is necessary to reduce the blood Hcy level while controlling blood pressure.