中国医药
中國醫藥
중국의약
CHINA MEDICINE
2014年
6期
769-773
,共5页
包柄楠%周迎生%刘军%霍勇
包柄楠%週迎生%劉軍%霍勇
포병남%주영생%류군%곽용
脑卒中%高血压%糖尿病%十年发病风险%危险因素
腦卒中%高血壓%糖尿病%十年髮病風險%危險因素
뇌졸중%고혈압%당뇨병%십년발병풍험%위험인소
Stroke%Hypertension%Diabetes%10-year stroke risk%Risk factors
目的 分析高血压合并糖尿病患者脑卒中十年发病风险相关危险因素特征.方法 2011年10月至2012年6月,对全国23省市三甲医院心内科门诊入选的96 729例高血压患者,根据美国弗莱明翰心脏研究中“脑卒中十年发病风险评分量表”计算所得脑卒中十年发病风险概率,分为低危组(≤5％,1 223例)、中危组(≥6％且≤9％,2 768例)和高危组(≥10％,11 923例),分析比较合并糖尿病与不合并糖尿病患者脑卒中危险因素.结果 低、中、高危组合并糖尿病患者脑卒中十年发病风险为(4.3 ±0.8)％、(7.6 ± 1.1)％和(25.7 ± 16.0)％,分别是不合并糖尿病患者的1.16倍、1.04倍和1.28倍.低危组合并糖尿病患者中,收缩压水平、左心室肥厚和吸烟比例均明显低于不合并糖尿病患者[收缩压(122 ±12)mmHg(1 mmHg =0.133 kPa)比(132 ± 18)mmHg]、左心室肥厚0％(0例)比0.8％(218例)、吸烟1.9％(123例)比4.6％(1 277例),均P＜0.05],但年龄大于不合并糖尿病患者[(54±7)岁比(53 ±9)岁,P＜0.05];当排除年龄评分影响因素后,合并糖尿病患者脑卒中十年发病风险仍高于不合并糖尿病患者(3.9％比3.2％,P＜0.05).中危组合并糖尿病患者中,年龄、收缩压水平、左心室肥厚、吸烟及心房颤动比例明显低于不合并糖尿病患者[(58 ±7)岁比(59 ± 10)岁、(132±16) mmHg 比(139 ± 19) mmHg、1.2％(33例)比3.5％(628例)、8.1％(223例)比18.5％(3 355例)和0.4％(10例)比1.7％(315例),均P＜0.05].高危组糖尿病患者中,仅其他心血管疾病比例高于不合并糖尿病患者(65.5％比61.0％)(P＜0.05).当排除该项评分影响因素后,合并糖尿病患者剩余脑卒中十年发病风险仍然高于不合并糖尿病患者(19.5％比15.1％,P＜0.05).糖尿病危险因素评分对女性高血压患者脑卒中十年发病风险低、中、高危组总评分的贡献率分别是男性的1.40、2.18和1.93倍;所有危险因素中,收缩压评分对高血压患者脑卒中十年发病风险总评分的贡献率最高(男性44.4％,女性52.0％).结论 糖尿病是高血压患者脑卒中十年发病风险增加的重要影响因素,糖尿病评分对女性高血压患者脑卒中十年发病风险的贡献率高于男性.
目的 分析高血壓閤併糖尿病患者腦卒中十年髮病風險相關危險因素特徵.方法 2011年10月至2012年6月,對全國23省市三甲醫院心內科門診入選的96 729例高血壓患者,根據美國弗萊明翰心髒研究中“腦卒中十年髮病風險評分量錶”計算所得腦卒中十年髮病風險概率,分為低危組(≤5％,1 223例)、中危組(≥6％且≤9％,2 768例)和高危組(≥10％,11 923例),分析比較閤併糖尿病與不閤併糖尿病患者腦卒中危險因素.結果 低、中、高危組閤併糖尿病患者腦卒中十年髮病風險為(4.3 ±0.8)％、(7.6 ± 1.1)％和(25.7 ± 16.0)％,分彆是不閤併糖尿病患者的1.16倍、1.04倍和1.28倍.低危組閤併糖尿病患者中,收縮壓水平、左心室肥厚和吸煙比例均明顯低于不閤併糖尿病患者[收縮壓(122 ±12)mmHg(1 mmHg =0.133 kPa)比(132 ± 18)mmHg]、左心室肥厚0％(0例)比0.8％(218例)、吸煙1.9％(123例)比4.6％(1 277例),均P＜0.05],但年齡大于不閤併糖尿病患者[(54±7)歲比(53 ±9)歲,P＜0.05];噹排除年齡評分影響因素後,閤併糖尿病患者腦卒中十年髮病風險仍高于不閤併糖尿病患者(3.9％比3.2％,P＜0.05).中危組閤併糖尿病患者中,年齡、收縮壓水平、左心室肥厚、吸煙及心房顫動比例明顯低于不閤併糖尿病患者[(58 ±7)歲比(59 ± 10)歲、(132±16) mmHg 比(139 ± 19) mmHg、1.2％(33例)比3.5％(628例)、8.1％(223例)比18.5％(3 355例)和0.4％(10例)比1.7％(315例),均P＜0.05].高危組糖尿病患者中,僅其他心血管疾病比例高于不閤併糖尿病患者(65.5％比61.0％)(P＜0.05).噹排除該項評分影響因素後,閤併糖尿病患者剩餘腦卒中十年髮病風險仍然高于不閤併糖尿病患者(19.5％比15.1％,P＜0.05).糖尿病危險因素評分對女性高血壓患者腦卒中十年髮病風險低、中、高危組總評分的貢獻率分彆是男性的1.40、2.18和1.93倍;所有危險因素中,收縮壓評分對高血壓患者腦卒中十年髮病風險總評分的貢獻率最高(男性44.4％,女性52.0％).結論 糖尿病是高血壓患者腦卒中十年髮病風險增加的重要影響因素,糖尿病評分對女性高血壓患者腦卒中十年髮病風險的貢獻率高于男性.
목적 분석고혈압합병당뇨병환자뇌졸중십년발병풍험상관위험인소특정.방법 2011년10월지2012년6월,대전국23성시삼갑의원심내과문진입선적96 729례고혈압환자,근거미국불래명한심장연구중“뇌졸중십년발병풍험평분량표”계산소득뇌졸중십년발병풍험개솔,분위저위조(≤5％,1 223례)、중위조(≥6％차≤9％,2 768례)화고위조(≥10％,11 923례),분석비교합병당뇨병여불합병당뇨병환자뇌졸중위험인소.결과 저、중、고위조합병당뇨병환자뇌졸중십년발병풍험위(4.3 ±0.8)％、(7.6 ± 1.1)％화(25.7 ± 16.0)％,분별시불합병당뇨병환자적1.16배、1.04배화1.28배.저위조합병당뇨병환자중,수축압수평、좌심실비후화흡연비례균명현저우불합병당뇨병환자[수축압(122 ±12)mmHg(1 mmHg =0.133 kPa)비(132 ± 18)mmHg]、좌심실비후0％(0례)비0.8％(218례)、흡연1.9％(123례)비4.6％(1 277례),균P＜0.05],단년령대우불합병당뇨병환자[(54±7)세비(53 ±9)세,P＜0.05];당배제년령평분영향인소후,합병당뇨병환자뇌졸중십년발병풍험잉고우불합병당뇨병환자(3.9％비3.2％,P＜0.05).중위조합병당뇨병환자중,년령、수축압수평、좌심실비후、흡연급심방전동비례명현저우불합병당뇨병환자[(58 ±7)세비(59 ± 10)세、(132±16) mmHg 비(139 ± 19) mmHg、1.2％(33례)비3.5％(628례)、8.1％(223례)비18.5％(3 355례)화0.4％(10례)비1.7％(315례),균P＜0.05].고위조당뇨병환자중,부기타심혈관질병비례고우불합병당뇨병환자(65.5％비61.0％)(P＜0.05).당배제해항평분영향인소후,합병당뇨병환자잉여뇌졸중십년발병풍험잉연고우불합병당뇨병환자(19.5％비15.1％,P＜0.05).당뇨병위험인소평분대녀성고혈압환자뇌졸중십년발병풍험저、중、고위조총평분적공헌솔분별시남성적1.40、2.18화1.93배;소유위험인소중,수축압평분대고혈압환자뇌졸중십년발병풍험총평분적공헌솔최고(남성44.4％,녀성52.0％).결론 당뇨병시고혈압환자뇌졸중십년발병풍험증가적중요영향인소,당뇨병평분대녀성고혈압환자뇌졸중십년발병풍험적공헌솔고우남성.
Objective To analyze the risk factors of 10-year stroke in Chinese outpatients with hypertension complicated with diabetes.Method A multi-center cross-sectional study was conducted from October 2011 to June 2012.Outpatients with hypertension were enrolled from 36 tertiary hospitals in 23 provinces of China.The 10-year probability of stroke was evaluated by the Framingham stroke risk profile; patients were divided into low risk group (≤ 5％,n=1 223),medium risk group (≥ 6％ and ≤ 9％,n=2 768) and high risk group (≥ 10％,n =11923) ; the characteristics of the risk factors between diabetic and non-diabetic patients were analyzed.Results The probabilities of mean 10-year risk of stroke in the low,medium and high risk group of patients with hypertension complicated with diabetes was (4.3 ±0.8)％,(7.6 ± 1.1)％ and (25.7 ± 16.0)％ ;they were 1.16,1.04 and 1.28 times higher than those patients with hypertension only.The diabetic patients in the low risk group were older and had lower levels of systolic blood pressure[(122 ± 12) mmHg],lower proportions of left ventricular hypertrophy 0 case (0％) and smoking 123 cases (1.9％) than those of the non-diabetic patients [(132 ± 18) mmHg,218 cases (0.8％) and 1 277 cases (4.6％)] (all P ＜ 0.05).After removing the score of age,the remaining 10-year stroke risk in diabetic patients(3.9％) was still higher than that in the patients with hypertension only(3.2％) (P ＜ 0.05).The diabetic patients in the medium risk group were younger and had lower levels of systolic blood pressure [(132 ± 16) mmHg],lower proportions of atrial fibrillation (0.4％)、left ventricular hypertrophy 33 cases(1.2％) and smoking 223 cases (8.1％) than the patients with hypertension only [(139 ± 19) mmHg],628 cases(3.5％) and 315 cases (1.7％) (all P ＜ 0.05).In the high risk group,the diabetic patients only had a higher proportion of other cardiovascular diseases (65.5％) than the patients with hypertension only (61.0％) (P ＜ 0.05).After removing the score of other cardiovascular diseases,the remaining 10-year stroke risk of diabetic patients (19.5％) was still higher than that of the patients with hypertension only (15.1％) (P ＜ 0.05).The contribution rates of diabetes score to the total score of 10-year stroke risk in the low,medium and high risk group of the hypertensive women were 2.1％,4.8％ and 5.8％,as 1.40,2.18 and 1.93times higher than those of the hypertensive men.Conclusion Diabetes is an important factor of 10-year stroke risk among the hypertension patients.The diabetes score makes more contribution to the 10-year stroke risk among the hypertensive women than it does among the hypertensive men.
