蒙古族人群心脑血管病发病危险因素及Framingham评分预测的适用性研究

发布时间：2018-04-19 07:02

本文选题：心脑血管病 + 危险因素　；参考：《苏州大学》2014年博士论文

【摘要】：研究背景和目的 1、描述蒙古族研究对象的心脑血管危险因素的分布特征。 2、探讨蒙古人群中糖尿病或空腹血糖异常与脑卒中及冠心病的关系。 3、不同的高血压亚型可能有不同的临床意义和对心脑血管病有不同的影响。本研究的目的之一是探讨蒙古人群不同的高血压亚型与心脑血管病的关系。 4、在前瞻性队列研究的基础上,采用巢式病例对照研究的方法,探讨蒙古族人群基线白介素-6(IL-6)、假性血友病因子(vWF)、同型半胱氨酸(Hcy)、内皮素-1(ET-1)、细胞粘附分子-1(ICAM-1)和E-选择素(E-selectin)与心脑血管病发病的关系。 5、Framingham心脑血管危险性评分是一个实用的、用来预测人群心脑血管危险性的工具,但在蒙古族人群中还没有运用这个评分系统预测人群心脑血管危险性及其适用性的研究报道。我们研究的目的是评价Framingham心脑血管危险性评分在蒙古人群中预测心脑血管危险性的效能。研究对象和方法 1、选择2589名20岁及以上内蒙古的蒙古族人群作为研究对象,并对其进行社会人口学情况、心脑血管疾病危险因素基线资料收集,描述研究对象的人口学特征和心脑血管危险因素的分布特征。 2、对所有研究对象进行为期10年的随访观察,以发现脑卒中和冠心病的新发病例。分析基线血糖水平以及是否患有糖尿病与脑卒中和冠心病发生的关系,用Cox比例风险模型计算风险比(Hazard ratio, HR)和95%可信区间(95%CI)。 3、根据研究对象基线的收缩压和舒张压水平,将研究对象分为血压正常者、单纯收缩期高血压(ISH)、单纯舒张期高血压(IDH)和收缩期／舒张期复合型高血压(SDH)。分析基线不同高血压亚型与心脑血管事件的关系,用Cox比例风险模型计算风险比HR和95%CI。 4、针对蒙古族人群进行为期10年的随访观察,将随访过程中发现的新发心脑血管病患者作为研究的病例,选择与病例年龄、性别和居住地相同的健康人为对照,开展巢式病例对照研究。检测病例和对照基线时IL-6、vWF、Hcy、ET-1、ICAM-1和E-selectin的水平。按各标志物水平的三分位为将研究对象分为三组,第三分位者定义为标志物水平升高,处于第一、二分位者为标志物水平正常。采用Logistic回归分析的方法,分析这些基线标志物水平升高与心脑血管疾病的关系,计算OR和95%CI。 5、在蒙古族人群前瞻性队列研究的基础上。根据Framingham评分公式,对所有研究对象进行了风险预测。我们运用Hosmer-Lemeshow检验和C统计量对Framingham评分进行评价。计算各危险评分的归因危险度百分比。研究结果 1、研究人群基线特征的描述研究人群基线平均SBP和DBP分别为129.8mmHg和84.5mmHg;高血压患病率为37.4%,男性(45.6%)显著高于女性(31.7%),P0.01；研究人群的超重(28BMI≥24)和肥胖(BMI≥28)的比例分别为20.14%和6.69%,男性组超重(16.8vs.22.5%)和肥胖(5.2vs.7.7%)的比例均显著低于女性的相应比例,P值均0.05。吸烟率为44.4%，男性的吸烟率(64.0%)显著高于女性(30.8%),P0.01；饮酒率为33.5%,男性的饮酒率(64.6%)显著高于女性(11.7%),P0.01。高TC、高TG和高FPG的患病率分别为10.2%、17.5%和21.94%。 2、血糖水平和糖尿病与心脑血管病事件经过年龄、吸烟、饮酒、收缩压、舒张压、BMI、C-反应蛋白和血脂的调整,与非糖尿病者相比,糖尿病者(FPG≥7.0mmol/L)发生心脑血管病(脑卒中+冠心病)的HR(95%CI)为2.71(1.68,4.37)；与非糖尿病者相比,糖尿病者(FPG≥7.0mmol/L)发生脑卒中的HR(95%CI)为2.04(1.01,4.13),与非糖尿病者相比,糖尿病者(FPG、7.0mmol/L)发生冠心病的HR(95%CI)为3.78(1.95,7.33)。 3、高血压亚型与心脑血管事件经年龄、性别调整后,与血压正常者相比,高血压前期、ISH、IDH和SDH所对应的心脑血管病的HR (95%CI)分别是1.75(0.92-3.33),2.11(0.95-4.70),2.14(1.01-4.56)和5.31(2.86-9.77)；调整其他心脑血管危险因素后,与血压正常者相比,高血压前期、ISH、IDH和SDH所对应的心脑血管病的HR (95%CI)分别是1.78(0.92-4.60),2.06(0.92-4.60),2.16(1.01-4.63)和5.19(2.77-9.72)。 4、炎症标志物与心脑血管病关系与Hcy14.19μmol/L、ICAM-1409.87ng/ml、ET-10.75ng/L、 E-seletin18.13ng/ml(水平正常)相比,无论调整前还是调整后,Hcy≥14.19μmol/L、 ICAM-1≥409.87ng/ml、ET-1≥0.75ng/L和E-seletin≥18.13ng/ml者发生心脑血管疾病的危险性均无统计学意义。与vWF13.86pg/ml(水平正常)相比,调整前,vWF≥13.86pg/ml者发生心脑血管疾病的危险性OR(95%CI)为1.542(0.922,2.577),接近于具有统计学意义。调整多因素后,vWF≥13.86pg/ml者发生心脑血管疾病的危险性OR(95%CI)为2.369(1.25,4.493),具有统计学意义。与vWF相似,经多因素调整后,与IL-624.63pg/ml(水平正常)相比,IL-6≥24.63者发生心脑血管疾病的危险性OR(95%CI)为1.634(1.009,2.647),也具有统计学意义。 5、Framingham心脑血管危险性评分在蒙古族人群中的适用性经过23292人年的随访,我们共发现200个心脑血管事件。Framingham评分的预测发病率为8.52%,研究人群实际的发病率为7.72%(95%CI：6.73%-8.82%),两者比较接近。经Hosmer-Lemeshow检验,x2=9.22,P=0.324),表示Framingham评分有较好的预测性：C statistic:0.81,95%CI:0.78-0.84,表明有较好的分辨率。将研究对象按照评分大小分为4组(0-4.9%、5-9.9%、10-19.9%、20%-)。以0-4.9%风险组为参比,5-9.9%、10-19.9%、20%-的归因危险度百分比分别为61.39%,79.04%和83.66%。研究结论 1、蒙古族人群具有较高的高血压患病率以及超重／肥胖、吸烟、饮酒、血脂异常、高血糖患病率。 2、在蒙古族人群中,糖尿病是心脑血管病的独立危险因素。本研究结果提示,积极治疗糖尿病和控制血糖水平是预防心脑血管事件的重要措施。 3、IDH和SDH可显著的增加心脑血管病的危险性,本研究提示,对于IDH的对象开展积极的血压监测和积极的降压治疗是蒙古族人群心脑血管病预防的重要战略。 4、IL-6和vWF是蒙古族人群心脑血管病发病的独立危险因素。 5、在蒙古族人群人群中,实际的心脑血管病发病率与Framingham评分预测的发病率接近,Framingham评分可以预测和评价蒙古族人群的心脑血管疾病的风险。
[Abstract]:Background and purpose of research
1, the distribution characteristics of the cardiovascular risk factors of the Mongolian research subjects were described.
2, to investigate the relationship between diabetes or abnormal fasting blood glucose in Mongolia population with stroke and coronary heart disease.
3, different types of hypertension may have different clinical significance and have different effects on cardiovascular and cerebrovascular diseases. One of the purposes of this study is to explore the relationship between different hypertension subtypes and cardiovascular and cerebrovascular diseases in Mongolia population.
4, based on a prospective cohort study, a nested case-control study, to explore the Mongolian population baseline interleukin -6 (IL-6), von Willebrand factor (vWF), homocysteine (Hcy), endothelin -1 (ET-1), cell adhesion molecule -1 (ICAM-1) and E- selectin (E-selectin) relationship with the incidence of cardiovascular and cerebrovascular disease.
5, cardiovascular risk score of Framingham is a practical, for cardiovascular risk population prediction tool, but in the Mongolian population. There is no use of this scoring system in predicting the risk of cardiovascular research reports and the applicability of people. The purpose of our study was to Framingham cardiovascular risk assessment score in predicting cardiovascular risk the effectiveness of cardio in Mongolia population.
Research objects and methods
1, we selected 2589 Mongolian people aged 20 and above in Inner Mongolia as subjects. We collected sociodemographic data and baseline data of risk factors for cardiovascular and cerebrovascular diseases, and described demographic characteristics and distribution characteristics of cardiovascular and cerebrovascular risk factors.
2, were followed up for 10 years all the research object, in order to find the stroke and coronary heart disease cases. Analysis of baseline blood glucose level and with the relationship between diabetes mellitus and stroke and coronary heart disease, Cox proportional hazards model was used to calculate the risk ratio (Hazard ratio, HR) and 95% confidence intervals (95%CI).
3, according to the study of baseline systolic and diastolic blood pressure levels, the subjects were divided into normal blood pressure, systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systolic / diastolic blood pressure (SDH) composite. Analysis of the relationship between the different subtypes of hypertension at baseline and cerebrovascular events, using Cox proportional hazards HR and 95%CI. model to calculate the risk ratio
4, according to the Mongolian population were observed for a period of 10 years of follow-up, follow-up will be discovered in the process of new onset cardiovascular and cerebrovascular disease patients as the research case, case selection and age, gender and matched healthy controls, to carry out a nested case-control study. The detection of cases and controls at baseline, IL-6, vWF, Hcy, ET-1 ICAM-1, and E-selectin levels. According to the markers for three subjects were divided into three groups, third patients defined increased levels of markers in first, second points, who is the marker of normal level. Methods using Logistic regression analysis, analysis of these baseline markers increased the level of relationship with cardiovascular disease vascular disease, calculation of OR and 95%CI.
5, based on a prospective cohort study of Mongolian population. According to the Framingham score formula, to predict the risk of all the research object. We use Hosmer-Lemeshow test and C statistic of Framingham score evaluation. Calculate the risk score attributable risk percent.
Research results
1, the description of the baseline characteristics of the population
Study on the baseline mean SBP and DBP were 129.8mmHg and 84.5mmHg; the prevalence rate of hypertension was 37.4%, male (45.6%) was significantly higher than that of female (31.7%), P0.01; the study population of overweight (28BMI = 24) and obesity (BMI = 28) were 20.14% and 6.69%, male overweight and obesity group (16.8vs.22.5%) (5.2vs.7.7%) ratio were significantly lower than the corresponding proportion of women, P values were 0.05. smoking rate was 44.4%, the smoking rate of male (64%) was significantly higher than that of female (30.8%), P0.01; the drinking rate was 33.5%, the drinking rate of male (64.6%) was significantly higher than that of female (11.7%), P0.01., high TC, high prevalence rate TG and FPG were 10.2%, 17.5% and 21.94%.
2, blood sugar level and diabetes and cardio cerebrovascular disease events
After age, smoking, alcohol consumption, systolic blood pressure, diastolic blood pressure, BMI, C- reactive protein and blood lipid regulation, compared with non diabetes, diabetes (FPG = 7.0mmol/L) occurrence of cardiovascular and cerebrovascular disease (stroke and coronary heart disease) HR (95%CI) 2.71 (1.68,4.37); compared with non diabetic patients. Diabetes (FPG = 7.0mmol/L) stroke HR (95%CI) 2.04 (1.01,4.13), compared with non diabetes, diabetes mellitus (FPG, 7.0mmol/L) the occurrence of coronary heart disease HR (95%CI) 3.78 (1.95,7.33).
3, hypertension subtype and cardio cerebral vascular event
By age, sex adjusted, compared with normal blood pressure in pre hypertension, ISH, corresponding to IDH and SDH HR cardiovascular disease (95%CI) were 1.75 (0.92-3.33), 2.11 (0.95-4.70), 2.14 (1.01-4.56) and 5.31 (2.86-9.77); the adjustment of other cardiovascular risk factors, compared to with normal blood pressure in pre hypertension, ISH, corresponding to IDH and SDH HR cardiovascular disease (95%CI) were 1.78 (0.92-4.60), 2.06 (0.92-4.60), 2.16 (1.01-4.63) and 5.19 (2.77-9.72).
4, the relationship between inflammatory markers and cardiovascular and cerebrovascular diseases
With Hcy14.19 mol/L, ICAM-1409.87ng/ml, ET-10.75ng/L, E-seletin18.13ng/ml (normal), whether before or after adjustment adjustment, Hcy = 14.19 mol/L, ICAM-1 = 409.87ng/ml, ET-1 = 0.75ng/L and the risk of E-seletin was larger than 18.13ng/ml in the occurrence of cardiovascular diseases were not statistically significant. And vWF13.86pg/ml (normal) compared to before the adjustment OR, the risk of vWF was larger than 13.86pg/ml in the occurrence of cardiovascular diseases (95%CI) 1.542 (0.922,2.577), close to statistically significant. After multivariate adjustment, the risk of OR vWF was larger than 13.86pg/ml incidence of cardiovascular and cerebrovascular diseases (95%CI) 2.369 (1.25,4.493), with statistical significance. Similar to vWF, the after multivariate adjustment, and IL-624.63pg/ml (normal) compared to the risk of OR IL-6 more than 24.63 cases of cardiovascular and cerebrovascular diseases (95%CI) 1.634 (1.009,2.647), also has statistical significance.
5, Framingham cardio cerebral vascular risk score in Mongolian population
After 23292 years of follow-up, we found a total of 200 rate of predicting the incidence of cardiovascular events in.Framingham score was 8.52%, the incidence of the study population actual rate was 7.72% (95%CI:6.73%-8.82%), the two were close. By Hosmer-Lemeshow test, x2=9.22, P=0.324), said a good prediction of Framingham score: C statistic:0.81,95%CI:0.78-0.84, show good the resolution of the research object. According to the scores were divided into 4 groups (0-4.9%, 5-9.9%, 10-19.9%, 20%-). The 0-4.9% risk group as a reference, 5-9.9%, 10-19.9%, 20%- of the attributable risk percentage were 61.39%, 79.04% and 83.66%.
research conclusion
1, the Mongolian population has a high prevalence of hypertension and overweight / obesity, smoking, drinking, dyslipidemia and the prevalence of hyperglycemia.
2, diabetes mellitus is an independent risk factor for cardiovascular and cerebrovascular diseases in Mongolian population. The results suggest that active treatment of diabetes and blood glucose control are important measures to prevent cardiovascular and cerebrovascular events.
3, IDH and SDH can significantly increase the risk of cardiovascular and cerebrovascular diseases. This study suggests that active blood pressure monitoring and active antihypertensive therapy for IDH are important strategies for prevention and treatment of cardiovascular and cerebrovascular diseases in Mongolian population.
4, IL-6 and vWF are independent risk factors for the pathogenesis of cardio cerebral vascular disease in Mongolian people.
5, in the Mongolian population, the incidence of actual cardiovascular and cerebrovascular diseases is close to the incidence predicted by the Framingham score. Framingham score can predict and evaluate the risk of cardiovascular and cerebrovascular diseases in Mongolian population.

【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R54;R743

【参考文献】