中国农村45~75岁高血压人群血脂与脑卒中发生相关性研究

发布时间：2018-04-24 23:32

本文选题：高血压 + 血清总胆固醇　；参考：《复旦大学》2014年博士论文

【摘要】：中国脑卒中一级预防(China Stroke Primary Prevention Trial, CSPPT)研究为比较安庆与连云港两地农村45～75岁原发性高血压人群中马来酸依那普利片和马来酸依那普利叶酸片预防脑卒中发生的随机双盲对照试验。本研究前瞻性的研究基线血脂水平与总体脑卒中以及各型脑卒中发生的相关性。第一部分中国农村45～75岁高血压人群血脂异常发生率及其影响因素研究背景：血脂异常作为心脑血管事件发生的危险因素得到了广泛的关注。亚洲人群终生低血清总胆固醇水平以及亚洲人群中相对较低的冠心病发生率被认为是血脂增加心脑血管事件发生风险的有力证据。根据2011年慢性疾病代谢性危险因素全球负担研究协作组发布的报告显示：对1980至2008年间全球血脂水平变化趋势的研究中可以发现,澳大利亚、北美、欧洲人群的平均总胆固醇水平有所下降,而东亚、东南亚及环太平洋地区人群的平均总胆固醇水平均有所上升。中国人群尤其是中国农村高血压人群中血脂异常发生情况目前尚无系统研究。目的：通过CSPPT项目人群2008年入组基线血脂横断面研究,以2007年《中国成人血脂异常防治指南》推荐血脂异常界值为标准描述安庆及连云港两地农村高血压人群血脂异常发生情况。方法：本研究人群来自中国脑卒中一级预防研究中安庆及连云港两地农村原发性高血压患者的基线资料,目前共纳入20702例原发性高血压患者,进行基线血、尿生化指标、生活问卷调查、人体测量等相关指标调查。结果：本研究人群共纳入20702例原发性高血压患者,其中男性8500人,女性12201人。女性血糖及血脂水平较男性高,男性人群中目前吸烟比例较女性高。连云港地区血脂异常比例高于安庆地区。中老年人群与老年人群相比血脂异常发病率差别不大。在不同基线血压分层中,血脂异常发病率差别不大。在体质指数分层中,血脂异常发病率随体质指数水平上升而升高。第二部分中国农村45～75岁高血压人群基线血脂水平与脑卒中发生风险分析背景：血清总胆固醇水平与心血管事件发生的风险研究得到了广泛的认同。但血清总胆固醇水平与脑卒中发生的风险目前尚无定论。血清总胆固醇水平与脑卒中发生风险在不同人种、地区、性别等人群不同。另一方面,HDL-c水平被认为对缺血性卒中发生具有保护作用。但以上研究多为欧美人群以及日本及韩国研究,关于中国人群尤其是中国农村高血压人群的研究目前尚较缺乏。目的：研究中国农村45～75岁原发性高血压人群中各项基线血脂水平与总体脑卒中及其亚型发生风险的相关性。方法：在CSPPT项目人群中,通过COX比例风险模型研究基线各项血脂与总体卒中及各卒中亚型的发病关系,并对其进行了趋势性检验。其中模型一矫正性别、年龄、研究中心,模型二矫正性别、年龄、研究中心、基线收缩压、基线空腹血糖以及基线吸烟状况。结果：本研究共纳入研究20702人,平均随访时间4.6年,共有565例脑卒中发生。在经过多因素矫正后的总体卒中发生风险与不同水平血清总胆固醇水平(按血清总胆固醇水平将整体人群三分,最低分位Q1为参照,Q1,Q2,Q3)分别为：1.00,1.08(0.88,1.32)；1.20(0.98,1.47),与不同LDL-c水平(Q1,Q2,Q3)分别为：1.00,1.23(1.00,1.52),1.38(1.12,1.69),与不同HDL-c水平(Q1,Q2,Q3)分别为：1.00,1.18(0.98,1.43),1.03(0.84,1.26)；与不同血清总甘油三酯水平(Q1,Q2,Q3)分别为：1.000.97(0.79,1.18),0.98(0.80,1.20)。经过多因素校正后的缺血性卒中发生风险与不同水平血清总胆固醇水平(按血清总胆固醇水平将整体人群四分,最低分位Q1为参照,Q1,02,Q3)分别为：1.00,1.10(0.87,1.39),1.29(1.02,1.62),与不同LDL-c水平(Q1,Q2,Q3)分别为：1.00,1.24(0.97,1.58),1.54(1.21,1.94)；与不同HDL-c水平(Q1,Q2,Q3)分别为：1.00,1.09(0.88,1.34),0.95(0.76,1.18)；与不同血清总甘油三酯水平(Q1,Q2,Q3)分别为：1.00,1.05(0.84,1.31),1.11(0.88,1.39)。经过多因素校正后的出血性卒中发生风险与不同水平总胆固醇水平(按血清总胆固醇水平将整体人群四分,最低分位Q1为参照,Q1,Q2,Q3)分别为：1.00,1.15(0.74,1.78),1.02(0.62,1.66),与不同LDL-c水平(Q1,Q2,Q3)分别为：1.00,1.39(0.90,2.16),0.96(0.57,1.61)；与不同HDL-c水平(Q1,Q2,Q3)分别为：1.00,1.66(1.01,2.70),1.61(0.98,2.67)；与不同血清总甘油三酯水平(Q1,Q2,Q3,Q4)分别为：1.00,0.76(0.49,1.17),0.57(0.34,0.94)。第三部分不同危险因素分层下基线血清总胆固醇水平与脑卒中发生风险分析背景：脑卒中的发生由多种不同危险因素从多个环节增加其风险。年龄、血压、体质指数以及血脂异常是最为重要的几个脑卒中发生危险因素。不同脑卒中危险因素与血脂异常之间是否有交互作用目前研究结果尚不确切。目的：研究中国脑卒中一级预防人群中在不同年龄、血压、体质指数分层下血脂与脑卒中发生率的研究。方法：通过将中国脑卒中一级预防人群进行年龄分层、血压分层、体质指数分层,并在各层之间比较血脂水平与脑卒中发生率的相关性。结果：在年龄较高分位中,各血脂水平与脑卒中发生率的相关性较明显。在不同血压分层中,卒中前平均收缩压的分层下较高分位中血清总胆固醇水平升高与脑卒中发生率升高更明显。在体质指数较低分位中,随着血清总胆固醇水平升高出血性脑卒中发生率降低。
[Abstract]:The study of China Stroke Primary Prevention Trial (CSPPT) in China (China Stroke Trial, CSPPT) was used to compare the randomized, double-blind controlled trials of Enalapril Maleate Tablets and Enalapril Maleate and Folic Acid Tablets for prevention of stroke in 45~75 year old patients with essential hypertension in both Anqing and Lianyungang. The correlation between lipid levels and overall stroke and the occurrence of various types of stroke. The first part of the study on the incidence of dyslipidemia and its influencing factors in people aged 45~75 years in rural areas of China: the risk factors of blood lipid abnormality as a risk factor for cardiovascular events. The relatively low incidence of coronary heart disease in Asian populations is considered to be a powerful evidence of the risk of blood lipid increases in cardio - cerebrovascular events. A report released by the 2011 global burden study group on metabolic risk factors of chronic diseases showed that Australia was found in the study of changes in global blood lipid levels between 1980 and 2008. The average total cholesterol levels in big, North American and European populations have declined, while the average total cholesterol levels in East Asia, Southeast Asia and the circum Pacific are rising. There is no systematic study on the abnormal blood lipid in Chinese people, especially in rural hypertension population in China. Objective: through the CSPPT project population in 2008 A cross-sectional study of blood lipids in the baseline of the group, with the guidelines for the prevention and control of dyslipidemia in Chinese adults in 2007 and the value of blood lipid abnormity as the standard to describe the incidence of blood lipid abnormality in the rural hypertension population in Anqing and Lianyungang. Methods: the population of this study came from the primary prevention of stroke in China, in Anqing and Lianyungang. The baseline data of the blood pressure patients were included in 20702 patients with primary hypertension. The baseline blood, urine biochemical index, life questionnaire, and anthropometry were investigated. Results: 20702 cases of primary hypertension were included in this study, including 8500 male and 12201 female. The blood glucose and blood lipid level of women were more than men. The proportion of smoking in the male population is higher than that of the female. The abnormal blood lipid ratio in the Lianyungang area is higher than that in the Anqing area. The abnormal blood lipid abnormality rate of the middle-aged and old people is not significant. In the different baseline blood pressure stratification, the abnormal incidence of dyslipidemia is not significant. In the physical index stratification, the abnormal incidence of blood lipid is associated with the body mass index. The level of serum total cholesterol and the risk of cardiovascular events were widely recognized in the second part of the 45~75 year old hypertensive population in rural China: the level of serum total cholesterol and the risk of cardiovascular events were widely recognized. However, the risk of serum total cholesterol and the incidence of stroke is still not conclusive. The level of cholesterol and the risk of stroke are different in different people, regions and sex. On the other hand, the level of HDL-c is considered to have protective effects on ischemic stroke. However, most of the studies are in Europe and the United States and in Japan and South Korea. Research on Chinese people, especially in rural areas of China, is still scarce. Objective: To study the correlation between baseline blood lipid levels and the overall risk of stroke and its subtype in 45~75 year old people with essential hypertension in Chinese rural areas. Methods: in the CSPPT project population, the relationship between baseline blood lipids and the incidence of stroke and stroke subtypes was studied by a COX proportional risk model. Trend test. One of them corrected sex, age, research center, model two to correct sex, age, research center, baseline systolic blood pressure, baseline fasting blood glucose, and baseline smoking. Results: a total of 20702 people were enrolled in this study, with an average follow-up time of 4.6 years, with a total of 565 stroke patients. The risk and the level of serum total cholesterol at different levels (total population three, minimum Q1, Q1, Q2, Q3) were 1.00,1.08 (0.88,1.32), 1.20 (0.98,1.47), respectively, and different LDL-c levels (Q1, Q2, Q3), respectively, 1.38. 1.00,1.18 (0.98,1.43), 1.03 (0.84,1.26), and different serum total triglyceride levels (Q1, Q2, Q3), respectively, 1.000.97 (0.79,1.18), 0.98 (0.80,1.20). The risk of ischemic stroke after multiple factor correction and the level of serum total cholesterol at different levels (four points of the whole population according to the total serum cholesterol level, the lowest score. " Position Q1 as reference, Q1,02, Q3), respectively: 1.00,1.10 (0.87,1.39), 1.29 (1.02,1.62), and different LDL-c levels (Q1, Q2, Q3) respectively: 1.00,1.24 (0.97,1.58), 1.54 respectively. .05 (0.84,1.31), 1.11 (0.88,1.39). The risk of hemorrhagic stroke after multiple factor correction and the level of total cholesterol at different levels (the overall population four, the lowest level of Q1 as reference, Q1, Q2, Q3) were respectively 1.00,1.15 (0.74,1.78), 1.02 (0.62,1.66), respectively, and different LDL-c levels (Q1, Q3), respectively: 39 (0.90,2.16), 0.96 (0.57,1.61), and different HDL-c levels (Q1, Q2, Q3), respectively, 1.00,1.66 (1.01,2.70), 1.61 (0.98,2.67), respectively, and different serum total triglyceride levels (Q1, Q2, Q3, 0.57), respectively. The levels of serum total cholesterol in the third part of different risk factors and the incidence of cerebral apoplexy Risk analysis background: the occurrence of stroke is increased by a variety of risk factors from multiple links. Age, blood pressure, body mass index and dyslipidemia are the most important risk factors for stroke. Whether there is an interaction between the risk factors of stroke and dyslipidemia is not exact. A study of the incidence of blood lipid and stroke in different age, blood pressure, and body mass index in Chinese stroke primary prevention population. Methods: the correlation between the level of blood pressure and the incidence of stroke was compared between the people of the first level of stroke and the stratification of the blood pressure and the body mass index. Results: the correlation between the levels of blood lipids and the incidence of stroke was obvious in the higher age division. In the different levels of blood pressure, the increase of total serum total cholesterol level and the incidence of stroke increased in the higher subdivision of the average systolic pressure before stroke. In the lower BMI, the level of total serum cholesterol was raised. The incidence of high hemorrhagic stroke was reduced.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R544.1;R743.3

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