全国36家三级甲等医院心内科门诊高血压合并糖尿病患者卒中10年发病风险评估  

The 10-year stroke risk in hypertensive outpatients combined with diabetes in cardiovascular clinics of 36 tertiary hospitals in China

作　　者：包柄楠[1] 周迎生[1] 刘军[2] 霍勇[3] 

机构地区：[1]首都医科大学附属北京安贞医院内分泌代谢科北京市心肺血管疾病研究所,100029 [2]首都医科大学附属北京安贞医院流行病研究室,100029 [3]北京大学第一医院心血管内科,100034

出　　处：《中华内科杂志》2014年第12期941-946,共6页Chinese Journal of Internal Medicine

基　　金：北京市卫生系统高层次卫生技术人才培养计划（2013-2-006）

摘　　要：目的 评估高血压合并糖尿病患者卒中的10年发病风险,比较南、北方患者卒中的发病风险及相关危险因素.方法 2011年10月至2012年6月,采用多中心现况调查方法,在全国36家三级甲等医院心内科门诊完成15 914例患者调查.调查问卷是依据美国Framingham心脏研究中卒中10年发病风险评分量表而制定,以年龄、未治疗/治疗后的收缩压水平、吸烟、糖尿病病史、心血管疾病病史、心房颤动、左室肥厚作为调查指标,计算调查指标总分值,从卒中风险对照表中查出卒中发病概率.对发病风险分层,风险概率≤5％为低危,6％ ～9％为中危,≥10％为高危.结果 （1）15 914例患者的年龄（64.6±10.1）岁,收缩压为（138.7±19.3）mmHg（1 mmHg =0.133 kPa）;心房颤动、左心室肥厚及心血管疾病的患病比例分别为7.4％,11.2％和57.2％;吸烟者比例为17.1％.与北方患者相比,南方高血压合并糖尿病患者具有高龄,男性比例、吸烟比例和左心室肥厚比例高（P值均＜0.01）,而收缩压水平和心血管疾病比例低的特点（P值均＜0.05）.（2）南方患者的10年平均发病风险高于北方患者[（22.4±17.1）％比（19.7±15.2）％,P＜0.01];在调整了年龄、性别后,差异仍有统计学意义（P＜0.05）.（3）高血压合并糖尿病患者中,低危、中危和高危的患者比例分别为7.7％、17.4％和74.9％.其中,南方的低危、中危患者比例低于北方患者（6.7％比8.4％,15.5％比18.9％）,而高危患者的比例高于北方患者（77.7％比72.7％）,P值均＜0.01.结论 本研究中心内科门诊高血压合并糖尿病中老年患者卒中10年发病风险主要为高危风险分层患者,南方患者卒中10年平均发病风险高于北方患者.Objective To assess the estimated 10-year risk of stroke among hypertensive outpatients known with diabetes from cardiovascular clinics of 36 tertiary hospitals in China and to analyze the characteristics of the risk factors and the 10-year risk of stroke between the southern and the northern patients.Methods A multi-center prevalence survey was conducted from October 2011 to June 2012.Hypertensive outpatients known with diabetes were enrolled from cardiovascular clinics of 36 tertiary hospitals in China.A total of 15 914 outpatients were included in the final analysis.The 10-year probability of stroke was evaluated by the Framingham stroke risk profile.According to the 10-year probability of stroke,patients were divided into low risk （≤ 5％）,medium risk （6％ ～9％） and high risk （≥10％）.Results （1） Of all the hypertensive outpatients known with diabetes,the mean age was （64.6 ± 10.1） years and the mean systolic pressure was （138.7 ± 19.3） mmHg（1 mmHg =0.133 kPa）.Among them,7.4％ with atrial fibrillation,11.2％ with left ventricular hypertrophy,57.2％ with cardiovascular diseases,17.1％ smokers and 37.0％ using mono-hypoglycemic agent.The southern patients who were older with more smokers had higher proportions of men and left ventricular hypertrophy,lower Levels of systolic blood pressure,and lower proportions of other cardiovascular diseases than those of the northern patients （all P ＜ 0.05）.（2） The mean 10-year probability of stroke was （20.9 ± 16.2） ％.The southern patients had a higher mean 10-year probability of stroke than that of the northern patients [（22.4 ± 17.1）％ vs （19.7 ± 15.2）％] （P ＜ 0.01）.After adjusted by age and sex,the southern patients still had a higher mean 10-year probability of stroke （P ＜0.05）.（3） All the patients had 7.7％ with low risk,17.4％ with medium risk,and 74.9％ with high risk.The southern patients had lower proportions of low and medium risk than those of the northern patients （6.7％

关 键 词：高血压 糖尿病 脑血管意外 10年发病风险 

分 类 号：R544.1[医药卫生—心血管疾病] R587.1[医药卫生—内科学] R743.3[医药卫生—临床医学]