蒙古族人群高血压亚型与脑卒中发病关系的队列研究

发布时间：2018-06-02 19:03

本文选题：单纯收缩期高血压 + 单纯舒张期高血压　；参考：《苏州大学》2014年硕士论文

【摘要】：研究背景：目前国内尚未见有关大样本的蒙古族人群高血压亚型与脑卒中发病关系的前瞻性研究的相关报道。研究目的：了解农牧区内蒙古族人群脑卒中的发病率及分布特征；了解蒙古族人群中各个血压亚型的患病率与分布特征；探讨高血压亚型与脑卒中发病的关系，为人群脑卒中危险性评估以及危险因素的控制提供流行病学依据。研究对象与方法： 1、基线调查：2002-2003年选择蒙古族居民集中的内蒙古自治区科左后旗朝鲁吐乡和奈曼旗固日班花乡共32个村作为本研究的现场，在此居住的20岁及以上蒙古族居民共2589人签署知情同意书，并接受了问卷调查、体格检查、血压测量和血标本的采集。问卷调查内容包括：社会人口学情况、高血压家族史、吸烟和饮酒情况。采用标准化调查方法测量血压和身高、体重、腰围和臀围。采集清晨空腹静脉血，现场分离血清，血标本低温运至实验室并于-80℃保存，用于甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、胰岛素(INS)、C-反应蛋白(CRP)、E-选择素（E-selectin）和细胞间黏附分子-1(ICAM-1)等指标的检测。 2、随访调查：调查组分别于2008年10月、2009年8月、2010年8月和2012年8月对参与基线研究的2589名研究对象进行了随访调查，结局事件定义为从基线到最后一次随访期间首次发生的脑卒中事件。采取入户调查和查阅监测资料、医院病历记录相结合的方法，采用标准设计的调查表，对每位研究对象进行调查，收集观察期内发生脑卒中事件的相关资料。 3、统计分析：用Epidata3.0软件建立数据库，应用SAS9.3软件和SPSS16.0软件进行统计分析。所有分析均为双侧检验，检验水准α=0.05。研究结果： 1、在纳入的2589名研究对象中，男性1064人，女性1525人。血压正常组有1621人；单纯收缩期高血压（ISH）组有121人，占总人群的4.67%；单纯舒张期高血压（IDH）组有272人，占总人群的10.51%；复合型高血压（SDH）有575人，占到22.21%。其中，男性人群中ISH、IDH、SDH的患病率分别是4.3%、16.4%、24.9%；而女性人群中ISH、IDH、SDH的患病率则分别是4.9%、6.4%、20.3%。 2、在10年的随访中，2589个研究对象中新发脑卒中124例，其中76例为缺血性脑卒中，46例为出血性脑卒中，2例分型不清。血压正常组、ISH组、IDH组和SDH组缺血性脑卒中的发病率分别是1.4%、5.0%、2.2%和7.3%；缺血性脑卒中的发病率分别是0.5%、1.7%、0.7%和5.9%。 3、血压正常组、ISH组、IDH组和SDH组缺血性脑卒中的发病密度分别为145/10万、573/10万、244/10万和858/10万，四组间发病密度的差异具有统计学意义（P0.05）；出血性脑卒中的发病密度分别为53/10万、191/10万、81/10万和694/10万，四组间发病密度的差异也具有统计学意义（P0.05）。 4、缺血性脑卒中Cox回归分析：结果显示，单因素时，与血压正常组相比，ISH组、IDH组和SDH组发生缺血性脑卒中的风险比（harzard ratio, HR）及95%置信区间（confidence interval, CI）分别是3.939（1.597-9.715）、1.660（0.673-4.095）和6.030（3.600-10.100）。在调整了年龄、性别、吸烟、饮酒、血糖、血脂等因素时，，各高血压亚型发生缺血性脑卒中的HR（95%CI）分别是3.623（1.445-9.086）、1.510（0.598-3.816）和5.367（3.049-9.446）。 5、出血性脑卒中Cox回归分析：结果显示，单因素时，与血压正常组相比，ISH组、IDH组和SDH组发生出血性脑卒中的HR（95%CI）分别是3.605（0.766-16.974）、1.522（0.323-7.167）和13.385（6.196-28.915）。在调整了年龄、性别、吸烟、饮酒、血糖、血脂等因素时，各高血压亚型发生出血性脑卒中的HR（95%CI）分别是4.501（0.923-21.950）、1.59（60.326-7.806）和16.08（36.873-37.635）。 6、按性别分层的Cox回归分析：结果显示，在男性人群中，单因素时，ISH组和IDH组与发生脑卒中的危险存在关联，HR（95%CI）分别是4.56（51.823-11.433）和5.923（3.476-10.093）。经多因素调整后，ISH和SDH与脑卒中的发生仍有关联，HR（95%CI）分别是5.001（1.950-12.826）和7.771（4.354-13.871）。在女性人群中，无论是调整还是未调整，仅有SDH组与发生脑卒中的危险性存在关联，HR（95%CI）分别是9.483（4.737-18.985）和6.138（2.873-13.111），具有统计学意义（P0.05）。女性人群中ISH组和IDH组与脑卒中发生的危险性均无统计学意义。 7、利用Kaplan-Meier过程绘制不同血压亚型的脑卒中累积发病率随时间变化的曲线图。结果显示，除了血压正常组，ISH、IDH、SDH组均表现出脑卒中的累积发病率随着时间的推移呈现上升的趋势。在各个时间段，SDH组的累积发病率均是最高，ISH组次之，经Log-rank检验，P0.05。结论 1、本研究现场内的蒙古族居民具有较高的脑卒中发病率，男性发病率高于女性，随着随访时间的增加，脑卒中的发病率升高，脑卒中已成为威胁当地居民健康的重要疾病和公共卫生问题。 2、蒙古族人群中复合型高血压患病率最高，其次是单纯舒张期高血压，单纯收缩期高血压的患病率最低。 3、单纯收缩期高血压和复合型高血压在老年人群中患病率最高，而单纯舒张期高血压在青壮年人群中患病率最高。 4、单纯收缩期高血压和复合型高血压可增加缺血性脑卒中的发病风险。 5、复合型高血压可增加出血性脑卒中的发病风险。
[Abstract]:Research background:
At present, there is no report on the prospective study of the relationship between hypertension subtypes and stroke incidence in Mongolian population.
The purpose of the study is:
To understand the incidence and distribution characteristics of stroke in Inner Mongolia population in agricultural and pastoral areas, understand the prevalence and distribution characteristics of each subtype of blood pressure in Mongolian population, explore the relationship between hypertension subtype and stroke, and provide epidemiological basis for the risk assessment of stroke and the control of risk factors in the population.
Research objects and methods:
1, the baseline survey: in 2002-2003 years, 32 villages of the Inner Mongolia Autonomous Region co - Zuo - Zuo and Naiman Banner in Linghai were selected as the site of this study. A total of 2589 people, aged 20 and above, signed the informed consent book, and received a questionnaire survey, physical examination, blood pressure measurement and blood standard. The collection of this.
The questionnaire survey included social demography, family history of hypertension, smoking and drinking. Blood pressure and height, weight, waist circumference and hip circumference were measured by a standardized method of investigation. Early morning venous blood was collected, serum was separated, blood samples were transported to the laboratory at low temperature and stored at -80, used for triglyceride (TG) and total cholesterol (TC). The detection of high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), insulin (INS), C- reactive protein (CRP), E- selectin (E-selectin) and intercellular adhesion molecule -1 (ICAM-1), etc.
2, follow up: a follow-up survey was conducted in October 2008, August 2009, August 2010, and August 2012 for 2589 subjects involved in the baseline study. The outcome event was defined as the first stroke event from the baseline to the last follow-up. A household survey and monitoring data were taken, and the hospital records were recorded. A standardized design questionnaire was used to collect data from each subject and collect data on stroke events during the observation period.
3, statistical analysis: using Epidata3.0 software to build a database, using SAS9.3 software and SPSS16.0 software for statistical analysis. All the analyses are both bilateral test, the level of test is alpha =0.05.
The results of the study:
1 of the 2589 subjects included, 1064 were male and 1525 were female, 1621 were normal blood pressure groups, 121 in the group of simple systolic hypertension (ISH), 4.67% in the total, 272 in the group of simple diastolic hypertension (IDH), 10.51% in the total population, and 575 in SDH, which accounted for 22.21%., and ISH, IDH in the male population. The prevalence of SDH was 4.3%, 16.4% and 24.9% respectively, while the prevalence of ISH, IDH and SDH in women was 4.9%, 6.4%, and 20.3%. respectively.
2, during the 10 year follow-up, 124 cases of new stroke were found in 2589 subjects, of which 76 were ischemic stroke, 46 was hemorrhagic stroke, and 2 were poorly typed. The incidence of ischemic stroke in the normal blood pressure group, the ISH group, the IDH group and the SDH group were 1.4%, 5%, 2.2%, and 7.3% respectively; the incidence of ischemic stroke was 0.5%, 1.7%, 0.7%, respectively. And 5.9%.
3, in the normal blood pressure group, the ISH group, the IDH group and the SDH group, the incidence of ischemic stroke was 145/10 million, 573/10 million, 244/10 Vanward 858/10 million, and the difference between the four groups was statistically significant (P0.05); the incidence of hemorrhagic stroke was 53/10 million, 191/10 million, 81/10 Vanward 694/10 million, and the difference between the four groups was different. It also has statistical significance (P0.05).
4, Cox regression analysis of ischemic stroke: the results showed that the risk of ischemic stroke in group ISH, IDH and SDH (harzard ratio, HR) and 95% confidence interval (confidence interval, CI) were 3.939 (1.597-9.715), 1.660 (0.673-4.095) and 6.030, compared with the normal blood pressure group, and the age was adjusted. When sex, smoking, drinking, blood sugar, blood lipid and other factors, the HR (95%CI) of ischemic stroke in the hypertensive subtypes was 3.623 (1.445-9.086), 1.510 (0.598-3.816) and 5.367 (3.049-9.446), respectively.
5, Cox regression analysis of hemorrhagic stroke: the results showed that, when compared with the normal blood pressure group, the HR (95%CI) of hemorrhagic stroke in the ISH group, the IDH group and the SDH group was 3.605 (0.766-16.974), 1.522 (0.323-7.167) and 13.385 (6.196-28.915) in the single factor, and the hypertension subgroups were adjusted for the factors of age, sex, smoking, drinking, blood sugar and blood lipids. The incidence of hemorrhagic stroke in HR (95%CI) was 4.501 (0.923-21.950), 1.59 (60.326-7.806) and 16.08 (36.873-37.635) respectively.
6, Cox regression analysis by sex stratification: the results showed that in the male population, in the single factor, the ISH and IDH groups were associated with the risk of stroke, and HR (95%CI) was 4.56 (51.823-11.433) and 5.923 (3.476-10.093), respectively. After multiple factors, ISH and SDH were associated with stroke, HR (95%CI) was 5.001 (1.950-12.826), respectively. And 7.771 (4.354-13.871). In the female population, no matter the adjustment or adjustment, only the SDH group was associated with the risk of stroke, and HR (95%CI) was 9.483 (4.737-18.985) and 6.138 (2.873-13.111), respectively, and was statistically significant (P0.05). There was no statistical significance in the risk of ISH and IDH group and stroke in female population.
7, the cumulative incidence of stroke in different blood pressure subtypes was plotted by Kaplan-Meier process. The results showed that the cumulative incidence of stroke in the ISH, IDH and SDH groups showed an upward trend with time. The cumulative incidence of the SDH group was the highest in each time period, the group ISH was the highest in the group ISH. Second, by Log-rank test, P0.05.
conclusion
1, the Mongolian residents in this study have higher incidence of stroke, the incidence of male is higher than that of women. With the increase of follow-up time, the incidence of stroke increases. Stroke has become an important disease and public health problem that threatens the health of the local residents.
2, the prevalence of compound hypertension was the highest among Mongolian population, followed by diastolic hypertension, and the lowest prevalence of isolated systolic hypertension.
3, isolated systolic hypertension and complex hypertension have the highest prevalence among the elderly, while diastolic hypertension has the highest prevalence among young adults.
4, isolated systolic hypertension and complex hypertension can increase the risk of ischemic stroke.
5, complex hypertension can increase the risk of hemorrhagic stroke.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3;R544.1

【参考文献】