中国住院卒中患者院前危险因素水平及院前治疗控制现状  

The prevalence and status of pre-hospital treatments of risk factors among patients with stroke in China

作　　者：唐美莲[1] 孙佳艺[1] 王薇[1] 刘静[1] 巢宝华 刘军[1] 曹雷 齐玥[1] 王瑛[1] 赵冬[1] 

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所流行病研究室,100029 [2]国家卫生和计划生育委员会脑卒中筛查与防治工程委员会

出　　处：《中华内科杂志》2015年第12期995-1000,共6页Chinese Journal of Internal Medicine

基　　金：“十二五”国家科技支撑计划（2011BAI08B01）

摘　　要：目的了解我国住院卒中患者院前多重危险因素水平及治疗、控制现状。方法多中心横断面研究。连续收集2011年1至5月全国25个省市41家医院住院的急性期卒中病例相关信息，分析患者院前卒中危险因素及其知晓、治疗、控制情况。结果共收集20570例住院卒中病例，年龄（63．0±12．9）岁，其中男性13062例（63．5％），首发卒中15329例（74．5％），缺血型卒中17052例（82．9％）。（1）住院卒中患者患高血压比例为75．5％、高LDL—C血症为53．5％，糖尿病为37．3％，心房颤动为6．5％。75．2％患者合并≥2个危险因素，43．O％患者合并I〉3个危险因素。（2）根据Framingham卒中风险评分量表计算院前危险因素水平，53．3％首发卒中患者属于卒中高风险人群，25．9％属于卒中低风险人群；但〈65岁卒中患者中42．1％按院前危险因素分层属于卒中低风险人群。（3）在高血压、糖尿病及高LDL—C血症3种主要卒中危险因素中，首发卒中患者高血压的知晓率较高（70．3％），但接受治疗者的控制率仅为20．1％，糖尿病和高LDL—C血症的知晓率、治疗率和控制率均较低；复发性卒中患者高血压和糖尿病的知晓率为83．0％和70．2％，但治疗率和控制率较低；高LDL—C血症的知晓、治疗和控制情况相对其他两种危险因素最差。结论多数首发和复发卒中患者院前合并多重危险因素，而治疗、控制状况不佳，反映了卒中一级预防和二级预防措施的落实较差。应采用联合用药，加强卒中患者危险因素的联合控制。同时，65岁以下人群的“高危”界定标准可能需要进一步的研究。Objective To analyze the distribution and treatment of risk factors in hospitalized stroke patients before stroke onset. Method This was a muhi-center cross-sectional study. Patients with acute stroke were collected from 41 hospitals in 25 provinces in China from January to May in 2011. Results A total of 20 570 stoke patients （ 13 062 men, 7 508 women） aged （ 63.0 ± 12.9 ） years were enrolled and analyzed in this study. Among them, 15 329 were first-onset stroke, and 17 052 were ischemic stroke. （1） Of all the subjects, 75.5% were with hypertension, 53.5% with elevated LDL-C, 37.3% with diabetes, and 6.5% with atrial fibrillation. 75.2% of them had two or more above risk factors and 43.0% had three or more risk factors. （2） According to the current definition, 53.3% of the first-onset stroke patients were classified as at high risk and 25.9% were classified as at low risk. Noticeably, 42.1% of the patients below 65 years old were at low risk by the same definition. （3） The awareness rate of hypertension was 70.3% in the first-onset stroke patients. However, only 20. 1% of the patients reached the target of blood pressure control in the treatment. Although the awareness rate of hypertension and diabetes among recurrent stroke patients were relatively high, the treatment and control rates of these risk factors were still low. Compared with the other two risk factors, the awareness, treatment and control rates of elevated LDL-C were much lower. Conclusions Majority of the stroke patients are complicated with multiple risk factors before stroke onset, suggesting a great needs for improving the primary and secondary prevention of stroke in China. In addition, the definition for risk classification of stroke may need to be modified for subjects under 65 years old.

关 键 词：卒中 危险因素 治疗 控制 

分 类 号：R743.3[医药卫生—神经病学与精神病学]