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目的了解上海市奉贤社区脑卒中危险因素暴露水平并探讨各危险因素与脑卒中发病间的关系。方法2003与2004年整群抽取上海市奉贤区两个社区≥40岁本市户籍常住人口10 565人建立脑卒中队列研究人群,调查高血压病、心脏病、糖尿病、脑卒中家族史、吸烟、饮酒等危险因素暴露状况,并进行脑血管血液动力学指标(CVHI)检测,以统一方法对CVHI进行积分,积分值<75分为异常,随访脑卒中新发病例共78例,对研究因素进行单因素和多因素Cox回归分析。结果2003年基线调查显示,该社区高血压病、心脏病、糖尿病、脑卒中家族史、肥胖(BMI≥28 kg/m~2)、吸烟、饮酒、CVHI积分异常等八项的暴露率分别为21.14%、6.72%、1.88%、5.63%、4.17%、34.96%、17.81%、29.43%。通过2—3年脑卒中病例随访,单因素分析显示,这八项的相对危险度(RR)及其95%CI分别为:高血压病2.76(1.76～4.32)、心脏病2.19(1.16～4.14)、糖尿病1.52(0.38～6.19)、脑卒中家族史1.58(0.69～3.62)、肥胖1.24(0.45～3.38)、吸烟1.75(1.12～2.73)、饮酒2.10(1.30～3.39)、CVHI积分异常12.72(7.02～23.06)。多因素Cox回归分析显示,被筛选进入回归方程的因素是吸烟和CVHI积分异常。结论高血压病、心脏病、吸烟、饮酒、CVHI积分异常与脑卒中发病有显著的病因学联系,CVHI积分异常和吸烟是脑卒中独立的预测因子。
Objective To understand the risk factors of stroke in Shanghai Fengxian community and to explore the relationship between risk factors and the incidence of stroke. Methods A total of 10 565 permanent residents registered in two communities in Fengxian District of Shanghai Municipality in 2003 and 2004 were enrolled in this study. The research population of stroke cohort was established to investigate the prevalence of hypertension, heart disease, diabetes, family history of stroke, smoking, Drinking and other risk factors, and CVHI was used to detect CVHI. The CVHI was integrated by a uniform method. The score was less than 75 points. A total of 78 new cases of stroke were followed up. The study factors Univariate and multivariate Cox regression analysis. Results The baseline survey in 2003 showed that the exposure rates of eight items of hypertension, heart disease, diabetes, family history of stroke, obesity (BMI≥28 kg / m ~ 2), smoking, alcohol consumption and CVHI score were 21.14%, 6.72%, 1.88%, 5.63%, 4.17%, 34.96%, 17.81%, 29.43%. According to the follow-up of 2-3 years of stroke, univariate analysis showed that the relative risk (RR) and 95% CI of the eight items were: hypertension 2.76 (1.76-4.32), heart disease 2.19 (1.16-4.14 ), Diabetes 1.52 (0.38 ~ 6.19), stroke family history 1.58 (0.69 ~ 3.62), obesity 1.24 (0.45 ~ 3.38), smoking 1.75 (1.12 ~ 2.73), drinking 2.10 (1.30 ~ 3.39), CVHI score 12.72 7.02 ~ 23.06). Multivariate Cox regression analysis revealed that the factors that were screened into the regression equation were smoking and abnormal CVHI scores. Conclusion Hypertension, heart disease, smoking, alcohol consumption, CVHI score abnormalities have a significant etiological relationship with stroke incidence. CVHI score abnormalities and smoking are independent predictors of stroke.