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目的探讨我国中年人群TC/HDL C比值对缺血性和出血性脑卒中发病的预测作用。方法采用前瞻性队列研究方法,在中美心血管病和心肺疾病流行病学合作研究4组队列人群(北京、广州两地工人和农民)中选择基线年龄35～59岁、无心肌梗死和脑卒中病史且资料完整者10121名为研究对象(男性4921名,女性5200名),平均随访15.9年。结果随访期间共发生缺血性脑卒中277例,出血性脑卒中125例。将TC/HDL C比值分为<3.0、3.0～、3.5～、4.0～和≥4.5五组,缺血性脑卒中年龄调整发病率(1/10万人年)依次为144.1、169.4、166.7、226.9和282.2,比值≥4.0增高明显;Cox回归分析显示,调整年龄、性别、地区以及舒张压、血糖、吸烟和饮酒等变量后,TC/HDL- C比值4.0～及≥4.5组,缺血性脑卒中发病相对危险性显著高于参照组(TC/HDL-C<3.0),RR分别为1.59(1.06～2.38)和1.87(1.30～2.68);TC/HDL-C比值、TC、LDL-C对缺血性脑卒中均有独立预测作用,TC/HDL-C比值五分位与缺血性脑卒中发病相对危险性关联曲线呈线性,而TC和LDL C五分位相应关联曲线呈“J”形。TC/HDL-C水平与出血性脑卒中未见明显关联趋势。结论血清TC/HDL-C比值对我国中年人群缺血性脑卒中发病有独立的预测作用,且预测能力可能优于TC或LDL-C。
Objective To investigate the predictive value of TC / HDL C ratio in middle-aged Chinese people on the incidence of ischemic and hemorrhagic stroke. Methods A prospective cohort study was conducted in a cohort of 4 cohorts of Chinese and American cardiovascular and cardiopulmonary diseases epidemiology cohorts (workers and peasants in Beijing and Guangzhou) with baseline myocardial infarction A total of 10,121 subjects with a history of stroke and complete data (4921 males and 5,200 females) were followed up for an average of 15.9 years. Results During the follow-up period, there were 277 cases of ischemic stroke and 125 cases of hemorrhagic stroke. The TC / HDL C ratio was divided into five groups (3.0, 3.0, 3.5, 4.0 and ≥4.5). The incidence of ischemic stroke adjusted for age (1/1000000 person-years) was 144.1,169.4,166.7, 226.9 and 282.2 respectively, and the odds ratio≥4.0 increased significantly. Cox regression analysis showed that the TC / HDL-C ratios of 4.0 to ≥4.5 after adjusting for age, gender, location and variables such as diastolic blood pressure, blood glucose, smoking and alcohol consumption, ischemic The relative risk of stroke was significantly higher than that of the reference group (TC / HDL-C <3.0), with RRs of 1.59 (1.06-2.38) and 1.87 There was an independent predictive effect on ischemic stroke. The relative risk-related curve of TC / HDL-C ratio and ischemic stroke incidence was linear, while the corresponding curve of TC and LDL C quatity was “J ”shape. TC / HDL-C levels and hemorrhagic stroke no significant correlation trend. Conclusions The serum TC / HDL-C ratio has an independent predictive value on the incidence of ischemic stroke in middle-aged Chinese population, and its predictive ability may be superior to TC or LDL-C.