背景:中国林县是世界食管癌、贲门癌最高发地区之一,该地区居民普遍存在营养素缺乏.近年来,国际上围绕帕金森病的病因进行许多研究,认为遗传因素、年龄、环境因素、饮食营养因素、吸烟等是帕金森病的危险因素.越来越多的研究认为原发性高血压可能与血管性帕金森综合征发病有关,长期高血压更易导致血管性帕金森综合征.目的:探讨林县营养缺乏人群高血压与临床很可能帕金森病之间的关系,为早期防治帕金森病提供理论依据.设计:横断面调查.对象:来源于参加林县营养干预试验且1985年试验开始进入队列时的55岁及以上人群,共计4 335人.方法:采用前瞻性队列研究方法.①病例的筛查:采用美国哥白县帕金森病问卷调查与简单的神经系统体格检查相结合的办法.②帕金森病的诊断:以英国帕金森病协会脑库临床诊断标准作为此次筛查帕金森病的临床诊断标准.在凋查中对具有帕金森症状的对象,还进一步作临床很可能帕金森病、临床可能帕金森病的诊断.其中临床很可能帕金森病的诊断标准:必须具备下列症状之中的两项(静止性震颤,肌张力增高,运动迟缓,姿势反射受损)或出现下列症状之一(静止性震颤,肌张力增高,运动迟缓)且是单侧起病,即可诊断为临床很可能帕金森病.临床可能帕金森病的诊断标准:出现下列症状之一(静止性震颤,肌张力增高,运动迟缓,姿势反射受损)即可诊断为临床可能帕金森病.③高血压的判定:收缩压≥140 mm Hg或舒张压≥90 mm Hg为高血压.资料处理采用线性趋势检验及非条件Logistic回归.主要观察指标:病例确诊情况、高血压与临床很可能帕金森病的关系.结果:参加1985/1991林县营养干预试验的林县居民中55岁及以上老年人4 335人参加了1999/2000帕金森病筛查,男2 008人(46.32%),女2 327人(53.68%).1985年研究对象经问卷调查、严格体检后合格者方可进入队列.①病例确诊情况:参加1999/2000林县帕金森病筛查的55岁及以上老年人4 459人,临床确诊的帕金森病患者46人,临床很可能帕金森病患者118人,临床可能帕金森病患者78人.为更好地探讨临床很可能帕金森病,剔除帕金森病、临床可能帕金森病患者,只研究临床很可能帕金森病患者118人与正常4 217人之间的关系.依照前述高血压确诊标准,确诊高血压患者2 035人.②高血压与临床很可能帕金森病有统计学关联,其RR值是1.648(1.147～2.368),用年龄、性别、吸烟、饮酒等可能的混杂因素进行调整后为1.668(1.145～2.432),上述关联依然存在(χ2=7.463,P=0.006).性别分析显示,女性高血压与临床很可能帕金森病统计学上差异显著(χ2=9.669,P=0.002),其RR值调整前为2.347(1.347～4.091),经混杂因素进行调整后为2.346(1.327～4.150),关联依然存在,表明女性高血压可能是患临床很可能帕金森病的危险因素.男性高血压与临床很可能帕金森病尚未显示出统计学关联(χ2=0.697,P=0.404),但RR值也呈现了增加的趋势.③随血压的增高,其对应的RR值也随之增加,经线性趋势检验(χ2=11.325,P=0.003),而且当血压≥140/90mmHg时,高血压未调整及调整后的RR值均具有统计学意义;表明血压与临床很可能帕金森病存在剂量-反应关系.在收缩压、舒张压分别统计时显示,收缩压与临床很可能帕金森病存在剂量-反应关系;当收缩压≥140 mm Hg时,高血压未调整及调整后的RR值均具有统计学意义(χ2=8.007,P=0.018).而舒张压调整前、后的RR值虽然有所增加,均未显示出统计学意义(χ2=2.569,P=0.277),说明在女性人群中,高血压与临床很可能帕金森病之间的关联性主要是由收缩压引起的.结论:在林县营养缺乏地区,高血压是55岁以后女性居民罹患临床很可能帕金森病的危险因素之一,并且患临床很可能帕金森病的危险性随血压的增高而增加.
揹景:中國林縣是世界食管癌、賁門癌最高髮地區之一,該地區居民普遍存在營養素缺乏.近年來,國際上圍繞帕金森病的病因進行許多研究,認為遺傳因素、年齡、環境因素、飲食營養因素、吸煙等是帕金森病的危險因素.越來越多的研究認為原髮性高血壓可能與血管性帕金森綜閤徵髮病有關,長期高血壓更易導緻血管性帕金森綜閤徵.目的:探討林縣營養缺乏人群高血壓與臨床很可能帕金森病之間的關繫,為早期防治帕金森病提供理論依據.設計:橫斷麵調查.對象:來源于參加林縣營養榦預試驗且1985年試驗開始進入隊列時的55歲及以上人群,共計4 335人.方法:採用前瞻性隊列研究方法.①病例的篩查:採用美國哥白縣帕金森病問捲調查與簡單的神經繫統體格檢查相結閤的辦法.②帕金森病的診斷:以英國帕金森病協會腦庫臨床診斷標準作為此次篩查帕金森病的臨床診斷標準.在凋查中對具有帕金森癥狀的對象,還進一步作臨床很可能帕金森病、臨床可能帕金森病的診斷.其中臨床很可能帕金森病的診斷標準:必鬚具備下列癥狀之中的兩項(靜止性震顫,肌張力增高,運動遲緩,姿勢反射受損)或齣現下列癥狀之一(靜止性震顫,肌張力增高,運動遲緩)且是單側起病,即可診斷為臨床很可能帕金森病.臨床可能帕金森病的診斷標準:齣現下列癥狀之一(靜止性震顫,肌張力增高,運動遲緩,姿勢反射受損)即可診斷為臨床可能帕金森病.③高血壓的判定:收縮壓≥140 mm Hg或舒張壓≥90 mm Hg為高血壓.資料處理採用線性趨勢檢驗及非條件Logistic迴歸.主要觀察指標:病例確診情況、高血壓與臨床很可能帕金森病的關繫.結果:參加1985/1991林縣營養榦預試驗的林縣居民中55歲及以上老年人4 335人參加瞭1999/2000帕金森病篩查,男2 008人(46.32%),女2 327人(53.68%).1985年研究對象經問捲調查、嚴格體檢後閤格者方可進入隊列.①病例確診情況:參加1999/2000林縣帕金森病篩查的55歲及以上老年人4 459人,臨床確診的帕金森病患者46人,臨床很可能帕金森病患者118人,臨床可能帕金森病患者78人.為更好地探討臨床很可能帕金森病,剔除帕金森病、臨床可能帕金森病患者,隻研究臨床很可能帕金森病患者118人與正常4 217人之間的關繫.依照前述高血壓確診標準,確診高血壓患者2 035人.②高血壓與臨床很可能帕金森病有統計學關聯,其RR值是1.648(1.147～2.368),用年齡、性彆、吸煙、飲酒等可能的混雜因素進行調整後為1.668(1.145～2.432),上述關聯依然存在(χ2=7.463,P=0.006).性彆分析顯示,女性高血壓與臨床很可能帕金森病統計學上差異顯著(χ2=9.669,P=0.002),其RR值調整前為2.347(1.347～4.091),經混雜因素進行調整後為2.346(1.327～4.150),關聯依然存在,錶明女性高血壓可能是患臨床很可能帕金森病的危險因素.男性高血壓與臨床很可能帕金森病尚未顯示齣統計學關聯(χ2=0.697,P=0.404),但RR值也呈現瞭增加的趨勢.③隨血壓的增高,其對應的RR值也隨之增加,經線性趨勢檢驗(χ2=11.325,P=0.003),而且噹血壓≥140/90mmHg時,高血壓未調整及調整後的RR值均具有統計學意義;錶明血壓與臨床很可能帕金森病存在劑量-反應關繫.在收縮壓、舒張壓分彆統計時顯示,收縮壓與臨床很可能帕金森病存在劑量-反應關繫;噹收縮壓≥140 mm Hg時,高血壓未調整及調整後的RR值均具有統計學意義(χ2=8.007,P=0.018).而舒張壓調整前、後的RR值雖然有所增加,均未顯示齣統計學意義(χ2=2.569,P=0.277),說明在女性人群中,高血壓與臨床很可能帕金森病之間的關聯性主要是由收縮壓引起的.結論:在林縣營養缺乏地區,高血壓是55歲以後女性居民罹患臨床很可能帕金森病的危險因素之一,併且患臨床很可能帕金森病的危險性隨血壓的增高而增加.
배경:중국림현시세계식관암、분문암최고발지구지일,해지구거민보편존재영양소결핍.근년래,국제상위요파금삼병적병인진행허다연구,인위유전인소、년령、배경인소、음식영양인소、흡연등시파금삼병적위험인소.월래월다적연구인위원발성고혈압가능여혈관성파금삼종합정발병유관,장기고혈압경역도치혈관성파금삼종합정.목적:탐토림현영양결핍인군고혈압여림상흔가능파금삼병지간적관계,위조기방치파금삼병제공이론의거.설계:횡단면조사.대상:래원우삼가림현영양간예시험차1985년시험개시진입대렬시적55세급이상인군,공계4 335인.방법:채용전첨성대렬연구방법.①병례적사사:채용미국가백현파금삼병문권조사여간단적신경계통체격검사상결합적판법.②파금삼병적진단:이영국파금삼병협회뇌고림상진단표준작위차차사사파금삼병적림상진단표준.재조사중대구유파금삼증상적대상,환진일보작림상흔가능파금삼병、림상가능파금삼병적진단.기중림상흔가능파금삼병적진단표준:필수구비하렬증상지중적량항(정지성진전,기장력증고,운동지완,자세반사수손)혹출현하렬증상지일(정지성진전,기장력증고,운동지완)차시단측기병,즉가진단위림상흔가능파금삼병.림상가능파금삼병적진단표준:출현하렬증상지일(정지성진전,기장력증고,운동지완,자세반사수손)즉가진단위림상가능파금삼병.③고혈압적판정:수축압≥140 mm Hg혹서장압≥90 mm Hg위고혈압.자료처리채용선성추세검험급비조건Logistic회귀.주요관찰지표:병례학진정황、고혈압여림상흔가능파금삼병적관계.결과:삼가1985/1991림현영양간예시험적림현거민중55세급이상노년인4 335인삼가료1999/2000파금삼병사사,남2 008인(46.32%),녀2 327인(53.68%).1985년연구대상경문권조사、엄격체검후합격자방가진입대렬.①병례학진정황:삼가1999/2000림현파금삼병사사적55세급이상노년인4 459인,림상학진적파금삼병환자46인,림상흔가능파금삼병환자118인,림상가능파금삼병환자78인.위경호지탐토림상흔가능파금삼병,척제파금삼병、림상가능파금삼병환자,지연구림상흔가능파금삼병환자118인여정상4 217인지간적관계.의조전술고혈압학진표준,학진고혈압환자2 035인.②고혈압여림상흔가능파금삼병유통계학관련,기RR치시1.648(1.147～2.368),용년령、성별、흡연、음주등가능적혼잡인소진행조정후위1.668(1.145～2.432),상술관련의연존재(χ2=7.463,P=0.006).성별분석현시,녀성고혈압여림상흔가능파금삼병통계학상차이현저(χ2=9.669,P=0.002),기RR치조정전위2.347(1.347～4.091),경혼잡인소진행조정후위2.346(1.327～4.150),관련의연존재,표명녀성고혈압가능시환림상흔가능파금삼병적위험인소.남성고혈압여림상흔가능파금삼병상미현시출통계학관련(χ2=0.697,P=0.404),단RR치야정현료증가적추세.③수혈압적증고,기대응적RR치야수지증가,경선성추세검험(χ2=11.325,P=0.003),이차당혈압≥140/90mmHg시,고혈압미조정급조정후적RR치균구유통계학의의;표명혈압여림상흔가능파금삼병존재제량-반응관계.재수축압、서장압분별통계시현시,수축압여림상흔가능파금삼병존재제량-반응관계;당수축압≥140 mm Hg시,고혈압미조정급조정후적RR치균구유통계학의의(χ2=8.007,P=0.018).이서장압조정전、후적RR치수연유소증가,균미현시출통계학의의(χ2=2.569,P=0.277),설명재녀성인군중,고혈압여림상흔가능파금삼병지간적관련성주요시유수축압인기적.결론:재림현영양결핍지구,고혈압시55세이후녀성거민리환림상흔가능파금삼병적위험인소지일,병차환림상흔가능파금삼병적위험성수혈압적증고이증가.
BACKGROUND: Linxian County of China is one of the areas with the highest incidence of esophageal cancer and gastric cardia cancer in the world, and nutrition-deficiency is widely existing in local people. In recent years, many researches around the world revealed that the cause of Parkinson disease (PD) is related to factors of gene, age, environment, diet, nutrition and smoking. More and more studies confirmed that primary hypertension may be in relation to vascular Parkinsonism (VP) and long-term hypertension was apt to VP.OBJECTIVE: To investigate the relationship between hypertension and clinical probable Parkinson disease (PPD) in nutrition-deficient population of Linxian County and provide a theoretical basis for early prevention and treatment of PD.DESIGN: Cross-sectional study.PARTICIPANTS: A total of 4 335 subjects aged over 55 years were selected. These subjects have taken part in the nutritional intervention study of Linxian County and first entered in the cohort study in 1985. They were enrolled in the nutritional intervention study in Linxian County in 1985.METHODS: A prospective cohort study was conducted. ①Case screening: PD questionnaire (used in American Gebai County) combined with general neurological examination were adopted. ②The diagnosis of PD: Clinical diagnostic criteria of UK Parkinson Disease Society Brain Bank were taken as the criteria for screening PD. Further evaluations were undertaken for clinical PPD and clinical possible PD on subjects who had PD symptoms.The diagnostic criteria of clinical PPD: Subjects were diagnosed as having clinical PPD if they presented any two of the following two cardinal features (resting tremor, hypermyotonia, bradykinesia and impairment of postural reflexes) or presented any one of the following features (resting tremor, hypermyotonia and bradykinesia). Diagnostic criteria of clinical possible PD: Subjects were diagnosed as having clinical possible PD when presented any one of the following four cardinal features (resting tremor, hypermyotonia, bradykinesia, and impairment of postural reflexes).③Definition of hypertension: Hypertension was defined as the systolic blood pressure (SBP) ≥ 140 mm Hg or the diastolic blood pressure (DBP) ≥ 90 mm Hg. Data were processed with linear trend test and nonconditional logistic regression.MAIN OUTCOME MEASURES: Status of final diagnoses on patients and relationship between hypertension and clinical PPD.RESULTS: A total of 4 335 subjects including 2 008 males (46.32%)and 2 327 females (53.68%) participated in the screening of PD.①Results of final diagnosis on patients: Among all the 4 459 survival participants,46 subjects were diagnosed as having PD, 118 as having clinical PPD and 78 as having clinical possible PD. After excluding patients with PD or clinical possible PD, only 118 patients were diagnosed as having clinical PPD. These patients and 4 217 normal controls were analyzed and a total of 2 035 patients had hypertension. ②There were statistical correlation between hypertension and clinical PPD, RR was 1.648 (1.147-2.638), which was 1.668 (1.145-2.432) after being adjusted by possible confounding factors including age, gender, smoking, drinking and so on, the association mentioned above still existed (χ2=7.463,P=0.006). Analysis of gender showed statistically significant differences between female patients with hypertension and clinical PPD(χ2=9.669 P=0.002), and RR before adjust ment was 2.347 (1.347-4.091), which was 2.346 (1.327-4.150) after being adjusted and correlation still existed. While there were no statistical corre lations between male patients with hypertension and clinical PPD (χ2 =0.697 ,P=0.404)but there was also an ascending trend in RR value. ③ With the blood pressure increasing, the RR value correspondingly in creased with the linear trend test (χ2=11.325 ,P=0.003). And there was sta tistical significance in raw and adjusted RR value of hypertension with the BP ≥ 140/90 mm Hg. Respective statistics of SBP and DBP showed a dose-response relationship between SBP and clinical PPD; When the SBP ≥ 140 mm Hg, there were statistical significances in values of raw RR or adjusted RR of hypertension (χ2=8.007 ,P=0.018). While there were no sta tistical significances in RR values before and after adjustment of DBP (χ2 =2.569,P=0.227). CONCLUSION: Hypertension is one of the risk factors of clinical PPD in female residents older than 55 and the incidence of getting clinical PPD is increased with the heightening of BP.
