上海市社区全科门诊中老年人群脑卒中风险筛查与危险因素分析  

Screening of stroke risks among middle-aged and elderly people in Shanghai community generaloutpatient clinics

作　　者：祝翊倩 罗剑锋[2] 陈冬冬[3] 张敏[4] 寿涓 徐荣 顾杰 杨华 Zhu Yiqian;Luo Jianfeng;Chert Dortgdortg;Zhang MiTt;Shou Juan;Xu Rong;Gu Jie;Yang Hua(Department of Neurosurgery,Huashan North Hospital Fudan University,Shanghai 201907,China;Statistics Center,School of Public Health,Fudan University,Shanghai 200032,China;Huajing Town Community Health Service Center,Xuhui District,Shanghai 200231,China;Department of Internal Medicine,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Department of General Practice,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属华山医院北院神经外科,上海201907 [2]复旦大学公共卫生学院生物统计教研室,上海200032 [3]上海市徐汇区华泾镇社区卫生服务中心,200231 [4]上海中医药大学附属岳阳中西医结合医院内科,200437 [5]复旦大学附属中山医院全科医学科,上海200032

出　　处：《中华全科医师杂志》2018年第10期798-802,共5页Chinese Journal of General Practitioners

基　　金：上海市老年基金会社会基金项目（S16034）

摘　　要：目的分析上海市社区全科门诊中老年人群脑卒中高危情况及相关危险因素。方法2017年1—7月，采用方便抽样法选取上海市普陀区、杨浦区、浦东新区10家社区卫生服务中心全科门诊就诊的45-75岁患者，利用问卷和临床测量结果筛查是否为脑卒中高危人群，多元logistic回归法分析脑卒中高危的影响因素。结果纳入全科门诊就诊患者1750例，筛查出脑卒中高危人群l094例，检出率62．5％。男性（66．7％，473／709）较女性（59．7％，621／1041）、未婚／离婚／丧偶者（75．0％，90／120）较已婚／同居者（61．6％，1004／1630）、独居者（72．1％，70／97）较非独居者（61．9％，1024／1653）脑卒中高危人群比例更高，差异均有统计学意义（χ=8．969、8．571、4．081，均P〈0．01）。与非高危人群相比，高危人群BMI、收缩压、舒张压、空腹血糖、糖化血红蛋白、TC、TG、血肌酐、血同型半胱氨酸水平更高，更易出现颈动脉斑块或狭窄，差异均有统计学意义（P〈0．05）。多元logistic回归分析显示，未婚／离婚／丧偶、BMI、收缩压、空腹血糖、总胆固醇和颈动脉斑块或狭窄与脑卒中高危呈正相关（OR=2．015、1．173、1．013、1，456、1．139、1．026、2．103，P〈0．05）。结论上海社区全科门诊中老年人群中脑卒中高危检出率较高，后期可针对未婚／离婚／丧偶、BMI、收缩压、空腹血糖、TC升高，存在颈动脉斑块或狭窄等危险因素的人群进行着重的干预。Objective To screen stroke risks among middle-aged and elderly people in community outpatient clinics in Shanghai. Methods A stroke risk screening was conducted among people aged 45-75 years selected with convenient sampling method from 10 community health service centers in Putuo district, Yangpu district and Pudong New Area of Shanghai during January to July 2017. The questionnaire and clinical measurement were used for screening. Multivariate logistic regression analysis was used to analyze the risk factors in subjects with high stroke risk. Results In this study, 1 094 individuals with high stroke risk were screened out from 1 750 participants （62.5%）. The proportion of high risk cases was higher among men （66.7%, 473/709） than that among women （59.7%, 621/1 041）, unmarried, divorced or widowed （75.0%, 90/120）than married or cohabitants（61.6%, 1 004/1 630）, living alone （72.1%, 70/97） than living with others（61.9%, 1 024/1 653） （χ2=8.969, 8.571, 4.081; P〈0.01）. Compared with non-high-risk subjects,the high-risk subjects had higher BMI, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycated hemoglobin, total cholesterol, triglycerides, serum creatinine and homocysteine, and were more likely to have carotid plaques or stenosis, the difference was statistically significant （P〈0.05）. Multiple logistic regression analysis showed that unmarried/divorce/widowed, high BMI, systolic blood pressure, fasting blood glucose, total cholesterol, and carotid plaque or stenosis were positively associated with high stroke risk（OR=2.015, 1.173, 1.013, 1.456, 1.139, 1.026, 2.103; P〈0.05）. Conclusions The proportion of high stroke risk individuals among middle-aged and elderly people is higher in community general practice outpatient clinics in Shanghai. Patients with high BMI, systolic blood pressure, fasting blood glucose and total cholesterol, and carotid plaque or stenosis, as well as those unmarried/divorced/widower should be the subjects for stroke i

关 键 词：脑卒中 中老年人 社区卫生中心 高危 

分 类 号：R743.3[医药卫生—神经病学与精神病学]