脑血管血流动力学积分对高血压患者卒中相对危险度的评估  

Evaluation of the relative risk of stroke in patients with hypertension using cerebrovascular hemodynamic accumulative scores

作　　者：黄久仪[1] 王桂清[1] 郭吉平[1] 曹奕丰[1] 王艳[1] 杨永举[1] 俞学海[1] 

机构地区：[1]上海市脑血管病防治研究所,201318

出　　处：《中国脑血管病杂志》2006年第12期537-541,576,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金资助项目(39370612);国家"十五"滚动基金资助项目(2004BA703B12)

摘　　要：目的以脑血管血流动力学综合评估指标，评估高血压患者卒中的相对危险度（RR）。方法选择卒中危险因素研究队列人群中年龄≥40岁的高血压患者7371例，对其危险因素基线调查、脑血管血流动力学指标（CVHI）检测、卒中随访资料进行分析，以CVHI积分值评估高血压患者的卒中危险度。结果单因素分析显示，与高血压患者卒中发病有显著性联系的危险因素分别是CVHI积分值降低、心脏病、吸烟和饮酒，其RR分别为4．93（95％CI：3.26～7．45）、1．90（95％CI：1．36～2．66）、1、99（95％CI：1．42～2．79）和1．73（95％CI：1．19～2．53）。多因素分析结果显示，被筛选进入Cox回归方程的变量分别为CVHI积分、年龄、性别、吸烟、卒中家族史和收缩压水平，其中CVHI积分的RR值（3．518，95％CI：2.119～5．841）最高。剂量反应关系分析显示，高血压患者CVHI积分值75分以下每降低15分，卒中的RR值分别为2.85、4．43、4．54、5．40、9.88。结论高血压患者卒中风险与血流动力学损害密切相关，CVHI积分可定量评估卒中的相对危险度。Objective To evaluate the relative risk （RR） of stroke in patients with hypertension using synthetic indexes of cerebrovascular hemodynamics, Methods A total of 7 371 patients with hypertension aged ≥40 years were selected from a population-based cohort study of the risk factors for stroke. Their baseline investigation of risk factors, cerebrovascular hemodynamic index （CVHI） determination and follow up data of stroke were analyzed. The RR of stroke in patients with hypertension was evaluated by CVHI scores. Results Univariate analysis indicated that hypertension complicated other risk factors had significant statistical association with the onset of stroke, they were the decrease of hemodynamic scores, heart disease, cigarette smoking and alcohol consumption, the RR were 4.93 （95% CI, 3.26-7.45 ） , 1.90 （95% CI, 1.36-2. 66）, 1.99 （95% CI, 1.42-2.79） and 1.73 （95% CI, 1.19-2. 53） respectively. Multivariate analysis indicated that the variates selected for entering Cox regression equation were hemodynamic scores, age, sex, cigarette smoking, family history of stroke and systolic blood pressure, among them the RR of hemodynamic scores was the highest. The analysis of dose response relation indicated that if the hemodynamic scores in patients with hypertension were lower than 75 points with every 15-point reduction, the RR of stroke were 2. 85, 4.43, 4. 54, 5.40, and 9.88, respectively. Conclusion The risk of stroke in patients with hypertension is closely associated with the hemodynamic injury, and the hemodynamic scores may quantificationally evaluate the relative risk of stroke.

关 键 词：高血压 中风 血液动力学过程 队列研究 

分 类 号：R544.1[医药卫生—心血管疾病] R743.3[医药卫生—内科学]