2种心血管病风险预测方法对社区高血压患者的危险分层评估  

Comparison of risk levels based on the stratification suggested by the different guidelines

作　　者：陈绍行[1] 钱岳晟[1] 张瑾[1] 胡亚蓉[1] 张怡[1] 陆晓红[1] 李华[1] 朱理敏[1] 王建骏 季辉 冯晓帆 付敏捷 鲍慧琳 徐娴 朱鼎良[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院高血压科,上海市高血压研究所,200025 [2]上海淮海社区卫生服务中心 [3]上海白玉社区卫生服务中心

出　　处：《中华高血压杂志》2011年第4期336-341,共6页Chinese Journal of Hypertension

基　　金：上海市科委重点攻关课题(074119501)

摘　　要：目的比较2种心血管病风险预测方法对社区高血压患者危险分层的影响。方法上海淮海和白玉社区卫生服务中心门诊高血压患者1464例通过问卷调查和生化检查了解心血管病的危险因素,包括年龄、性别、吸烟和糖尿病史以及血压、空腹血糖和血脂水平等。除外已有靶器官受损和心血管事件的高血压患者。应用2005年《中国高血压防治指南》和2007年WHO/ISH《心血管疾病预防指南》10年心血管事件风险预测工具进行危险分层的评估。结果按照2005年《中国高血压防治指南》方法,1464例社区高血压患者评估为低危、中危、高危和很高危的比例分别是2.3%、31.9%、52.9%和12.9%,而按照2007年WHO/ISH《心血管疾病预防指南》方法评估,分别为81.6%、12.7%、3.8%和1.9%,2种方法的评估结果差异有统计学意义(P<0.01)。2005年《中国高血压防治指南》方法的危险分层级别高于WHO/ISH指南方法(P<0.01)。社区高血压患者的年龄、收缩压和总胆固醇水平以及糖尿病可能是影响2种方法危险分层结果的因素。结论社区高血压患者采用不同的心血管风险预测方法得到不同的危险分层结果。在已经服用降压药物的社区高血压患者中,2005年《中国高血压防治指南》方法可能高估危险分层级别。Objective To comparison the cardiovascular disease risk levels based on the stratification suggested by the different guidelines in the community of hypertensive outpatients.Methods 1464 hypertensive outpatients were enrolled in the Huaihai and Baiyu Community Health Centers,Shanghai.The cardiovascular disease risk factors were investigated,including age,gender,history of smoking,diabetes and arterial blood pressure.Fasting blood glucose and lipids were measured.The patients who had the target organ damage and other cardiovascular events were excluded.The stratification of cardiovascular disease risk levels were assessment using the 10-year cardiovascular event risk prediction tools,according to the 2005 ＂Chinese Hypertension Prevention and Treatment Guidelines＂ and the 2007 WHO/ISH ＂Guidelines for Prevention of Cardiovascular Disease＂.Results In accordance with the 2005 ＂Chinese Hypertension Prevention and Treatment Guideline＂ method,proportion of low risk,medium risk,high risk and very high risk were 2.3%,31.9%,52.9% and 12.9% respectively in the 1464 outpatient hypertensives of community,while according to 2007 WHO/ISH ＂Guidelines for Prevention of Cardiovascular Disease＂,the ratio of the stratification of risk levels were evaluated 81.6%,12.7%,3.8% and 1.9%.Significant difference was found between the two kinds of assessment methods（P〈0.01）.The percent of the high risk patient based on 2005 ＂Chinese Hypertension Prevention and Treatment Guidelines＂ was higher than that of WHO/ISH risk prediction charts on the stratification of cardiovascular risk levels（P〈0.01）.The factors of results of 2 methods on the risk stratification may be related to age,systolic blood pressure,total cholesterol levels and diabetes.Conclusions Using different cardiovascular risk prediction methods have different results of risk stratification for the outpatients with hypertension in the communities.Application the method of the Guide for hypertension prevention and treatment in China may be overestimated

关 键 词：高血压 心血管病 危险因素 危险分层 

分 类 号：R544.1[医药卫生—心血管疾病]