生活方式变化与新发脑卒中及其亚型的关联  

Association of lifestyle change with incident stroke and its subtypes

作　　者：张海庆 何美安 张晓敏[1] ZHANG Hai-qing;HE Mei-an;ZHANG Xiao-min(Department of Occupational and Environmental Health,School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院公共卫生学院劳动卫生与环境卫生学系,武汉430030

出　　处：《中华疾病控制杂志》2021年第3期259-265,共7页Chinese Journal of Disease Control & Prevention

基　　金：国家自然科学基金(81973128)。

摘　　要：目的探讨中老年人群生活方式及变化与新发脑卒中的关联。方法选取东风同济队列基线(2008―2010年)无心血管病、癌症及生活方式无缺失,且随访至2018年12月的18293名研究对象。健康生活方式评分包括不吸烟、适度锻炼、均衡膳食、正常体重和适宜睡眠时长5项因素之和。采用Cox回归评估生活方式及变化与脑卒中的风险比(hazard ratio,HR)和95%CI值。结果平均9.5年随访后,新发脑卒中病例共1549(8.5%)。校正混杂变量后,与基线生活方式评分≤1相比,2、3和≥4分组的新发脑卒中的HR(95%CI)分别为0.83(0.72~0.95)、0.72(0.63~0.83)和0.54(0.45~0.66)。5年间生活方式评分变化(基线至2013随访)结果显示,5年间生活方式评分一直维持在≥4分是维持≤1分新发脑卒中的0.39倍(HR=0.39,95%CI:0.23~0.67);当从基线2~3分提高至随访≥4分是维持≤1分新发脑卒中的0.55倍(HR=0.55,95%CI:0.37~0.81),但是从基线≤1分提高至随访≥4分并无保护作用(HR=1.17,95%CI:0.58~2.36)。结论在中老年人群中,尽早改善并长期保持健康生活方式对于脑卒中防控效益最大。Objective To explore the association of lifestyle and its changes with incident stroke in the middle-aged and older population.Methods A total of 18293 participants who were free of cardiovascular diseases,cancer,or missing data on lifestyle at baseline were selected and followed until December 2018 from Dongfeng-Tongji cohort.The healthy lifestyle score included the sum of five factors:non-smoking,moderate physical activity,balanced diet,normal weight,and appropriate sleep duration.Cox regression was adopted to estimate the hazard ratio(HR)and 95%confidence interval(95%CI)of lifestyle and its changes with stroke.Results During the 9.5-years of follow-up,1549(8.5%)stroke events were documented.Comparing with≤1 score group at baseline,the HR(95%CI)of stroke was 0.83(0.72-0.95),0.72(0.63-0.83),and 0.54(0.45-0.66)for those with scores of 2,3,and≥4,respectively,after adjustment of confounders.The results of five-year lifestyle change(baseline to 2013 follow-up)showed that maintenance of≥4 scores in healthy lifestyle had 0.39-fold(HR=0.39,95%CI:0.23-0.67)risk for incident stroke,compared to maintenance of≤1 score group.Increment in healthy lifestyle score from 2-3 to≥4 had 0.55-fold(HR=0.55,95%CI:0.37-0.81)risk of incident stroke;improvement from≤1 to≥4 scores showed no protective effects for stroke(HR=1.17,95%CI:0.58-2.36).Conclusions Among middle-aged and older Chinese adults,early improvement and long-term maintenance of a healthy lifestyle are most beneficial for preventing and controlling stroke.

关 键 词：健康生活方式 脑卒中及亚型 东风同济队列 中老年人群 

分 类 号：R183.4[医药卫生—流行病学]