北京市社区慢病患者心脑血管疾病风险预测研究  

Risk Prediction of Cardiovascular and Cerebrovascular Diseases on Community Patients with Chronic Disease in Beijing

作　　者：张艳春 秦江梅 杨晓倩[2] 张丽芳 林春梅[2] 

机构地区：[1]国家卫生计生委卫生发展研究中心,北京市100191 [2]石河子大学医学院,新疆石河子市832003

出　　处：《中国全科医学》2017年第5期590-594,共5页Chinese General Practice

基　　金：国家自然科学基金青年基金资助项目(71303173)

摘　　要：目的基于北京市社区慢病患者的危险因素,测算心脑血管疾病患病风险,分析慢病管理的形势与挑战,比较城乡差别,提出加强社区慢病管理的对策。方法根据分层整群抽样原则,于2015年9月分别对北京市西城区1个城市街道和平谷区1个农村乡镇的社区卫生服务中心进行现场调研,纳入两个社区卫生服务中心管理的所有高血压、糖尿病患者7 535例作为研究对象。运用世界卫生组织(WHO)/国际高血压学会(ISH)心脑血管疾病风险预测图对未患心脑血管疾病者未来10年发生心脑血管疾病的风险进行测算。结果回收有效问卷7 215份,有效回收率为95.75%。其中城市3 589例,农村3 626例。未患心脑血管疾病者4 378例,其中城市1 796例,农村2 582例。城市和农村慢病患者年龄、吸烟率、慢病分布、高脂血症患病率、体质指数(BMI)≥23 kg/m2所占比例比较,差异均有统计学意义(P<0.05)。未患心脑血管疾病者患心脑血管疾病风险<10%(低风险)、10%~19%(中风险)、20%~29%(高风险)、30%~40%(高风险)和>40%(高风险)分别为2 342例(53.49%)、953例(21.77%)、815例(18.62%)、186例(4.25%)和82例(1.87%)。城市患病风险高于农村,差异有统计学意义(χ~2=171.665,P<0.05)。患者低风险、中风险、高风险和已患心脑血管疾病者分别为2 342例(32.46%)、953例(13.21%)、1 083例(15.01%)和2 837例(39.32%)。城市患者中,已患心脑血管疾病者为1 793例(49.96%)。结论社区卫生服务机构在高危患者管理中发挥着重要作用;社区心脑血管疾病形势严峻,城市任务更艰巨;需强化分级诊疗与分工协作,深化社区慢病管理,提高社区医患双方的风险管理意识。Objective To measure the risk of developing cardiovascular and cerebrovascular diseases, analyze the situation and challenges of chronic disease management, compare the difference between urban and rural areas, and put forward strategies to strengthen the community chronic disease management based on risk factors of community chronic disease in Beijing. Methods With stratified clustering sampling method, field research was conducted in two community health service centers, which was selected from a city street in Xicheng District and a rural township in Pinggu District in Beijing respectively in September 2015. Patients with hypertension and diabetes mellitus （7 535 cases） under the management of these two community health service centers were included as research objects in the study. The risk prediction charts of cardiovascular and cerebrovascular disease of World Health Organization （WHO） /International Society of Hypertension （ISH） were used to estimate the risk of cardiovascular and cerebrovaseular disease in the future 10 years of patients without such diseases. Results A total of 7 215 effective questionnaires were collected with an effective response rate of 95.75% i There were 3 589 urban cases and 3 626 rural cases. The number of patients not suffering from cardiovascular and cerebrovascular diseases was 4 378, of which 1 796 in urban area and 2 582 in rural. There were significant differences in age, smoking rate, distribution of chronic disease, prevalence of hyperlipidemia and the proportion of BMI greater than or equal to 23 kg/m2 between patients in urban and rural areas （ P 〈 O. 05 ）. The number and proportion of the risk of patients without cardiovascular and cerebrovascular diseases developing such diseases less than 10% （low risk） , between 10% and 19% （ medium risk） , between 20% and 29% （ high risk）, between 30% and 40% （high risk）, and greater than 40% （high risk） were 2 342 （53.49%）, 953 （21.77%）, 815 （18.62%）, 186 （4.25%） and 82 （1.87

关 键 词：社区卫生服务 慢性病 WHO/ISH心脑血管疾病风险预测图 

分 类 号：R197[医药卫生—卫生事业管理]