摘要
目的：采用彩色多普勒血流显像（CDFI）对我国卒中高危人群进行筛查，建立中国人群卒中发病危险的预测模型，以早期防治卒中。方法采用横断面研究，于2011年7月—2012年4月，41家基地医院首次联合对我国6个省市40个项目区715286人进行常规体格检查及心脑血管疾病相关危险因素调查。对其中61860例患者进行颈动脉CDFI筛查，高危人群（暴露于≥3项危险因素）有49386例。筛查记录双侧颈动脉内－中膜厚度（IMT）情况、斑块数量及颈动脉狭窄程度。并对颈动脉IMT是否增厚、有无颈动脉斑块和颈动脉狭窄程度（分为狭窄率0～49％与≥50％）分别与卒中危险因素进行多因素Logistic回归分析。结果（1）Logistic回归分析显示，高血压、心房颤动、吸烟、缺乏体育锻炼是颈动脉 IMT增厚的独立危险因素（高血压，OR ＝1.17，95％CI：1.12～1.22；心房颤动，OR＝1.15，95％CI：1.09～1.21；吸烟，OR＝1.13，95％CI：1.08～1.17；缺乏体育锻炼，OR＝1.12，95％CI：1.08～1.16）。（2）高血压、心房颤动、吸烟、糖尿病是颈动脉斑块及颈动脉狭窄率≥50％发生的独立危险因素（颈动脉斑块，高血压：OR ＝1.55，95％CI：1.47～1.62；心房颤动：OR ＝1.13，95％CI：1.06～1.21；吸烟：OR＝1.16，95％CI：1.11～1.22；糖尿病：OR＝1.30，95％CI：1.24～1.37。颈动脉狭窄率≥50％，高血压：OR＝1.78，95％CI：1.55～2.03；心房颤动：OR＝1.59，95％CI：1.39～1.81；吸烟：OR＝1.33，95％CI：1.20～1.48；糖尿病：OR＝1.30，95％CI：1.17～1.45）。单纯肥胖不增加颈动脉粥样硬化性斑块及颈动脉狭窄率≥50％的发生率（OR分别为0．78、0.83，95％CI分别为0．75～0．82、0.75～0.92）。结论颈部血管超声检查可作为卒中高危人群筛查及危险因素检测有价值的手段，对早期诊断及治疗颈动脉粥样硬化性疾病具有重要的指导意义。
Objectives To screen the high-risk population of stroke in China using color Doppler flow imaging （CDFI）and to establish a stroke risk prediction model in Chinese population in order to prevent and treat stroke early. Methods Forty-one base hospitals and 715 286 people in the project areas of the first 6 provinces of China conducted routine physical examinations and investigated the related risk factors for cardiocerebrovascular diseases from July 2011 to April 2012 using a cross-sectional study,among them 61 860 patients underwent carotid CDFI screening,and 49 386 of them were high-risk＆amp;nbsp;population （exposed to≥3 risk factors）. The bilateral common carotid interma-media thickness （IMT）,the number of plaques and the degree of carotid stenosis were screened and documented. And whether carotid IMT thickening or not,with or without carotid plaques,and degree of carotid artery stenotic rate 0-49% and≥50% were performed by multivariate logistic regression analysis with the risk factors for stroke,respectively. Results （1）Logistic regression analysis showed that hypertension,atrial fibrillation,smoking,and lack of physical exercise were the independent risk factors for carotid IMT thickening （hypertension：OR,1. 17;95%CI 1. 12-1. 22;atrial fibrillation：OR,1. 15;95%CI 1. 09-1. 21;smoking：OR,1. 13;95%CI 1. 08-1. 17;and lack of physical exercise：OR,1. 12;95%CI 1.08-1. 16）. （2）Hypertension,atrial fibrillation, smoking,and diabetes were the independent risk factors for carotid plaque and carotid artery stenosis rate≥50%（carotid plaque,hypertension：OR,1. 55;95%CI 1. 47-1. 62;atrial fibrillation：OR,1. 13;95%CI 1.06-1. 21;smoking：OR,1. 16;95%CI 1. 11-1. 22;and diabetes：OR,1. 30;95%CI 1. 24-1. 37）. Carotid stenosis rate≥50%,hypertension：OR,1. 78;95%CI 1.55-2. 03;atrial fibrillation：OR,1. 59;95%CI 1. 39-1. 81;smoking：OR,1. 33;95%CI 1. 20-1. 48;and diabetes：OR,1. 30;95%CI 1. 17-1. 45. Simple obesity did not increase the incidences of carotid atherosclerotic plaque and carotid artery stenosis ≥50%（OR,0. 78, 0.83;95%CI 0. 75-0. 82 ,0. 75-0. 92,respectively）. Conclusions Neck vascular ultrasound can be used as a valuable means for screening high-risk population and detecting risk factors of stroke. It has an important clinical significance for the early diagnosis and treatment of carotid atherosclerosis disease.
出处
《中国脑血管病杂志》
CAS
2014年第12期617-623,共7页
Chinese Journal of Cerebrovascular Diseases
基金
2011国家医改专项:卒中筛查与防治工程项目,项目组织单位:国家卫生和计划生育委员会卒中防治工程委员会
关键词
卒中
颈动脉狭窄
颈动脉超声
筛查
颈动脉内-中膜增厚
多中心研究
Stroke
Carotid artery stenosis
Carotid ultrasonography
Screening
Carotid intima-media thickness
Multicenter study
