脑血管功能积分预测10年首发脑卒中风险方法的建立  

Establishment and evaluation of a method for predicting 10-year risk of first stroke with cerebrovascular function score

作　　者：黄久仪[1] 郭吉平[1] 曹奕丰[1] 王艳[1] 杨永举[1] 俞学海[1] Huang Jiuyi;Guo Jiping;Cao Yifeng;Wang Yan;Yang Yongju;Yu Xuehai(Shanghai Institute of Cerebrovascular Disease Prevention,Shanghai 201203,China)

机构地区：[1]上海市脑血管病防治研究所,201203

出　　处：《中华神经科杂志》2021年第5期434-440,共7页Chinese Journal of Neurology

基　　金：国家自然科学基金(30771851,81573248);国家“十五”攻关滚动项目(2004BA703B12);上海市卒中预防与诊治重大项目(03DZ19701)。

摘　　要：目的:建立脑血管功能积分与10年首发脑卒中风险对照表,为脑卒中高危人群筛查提供新的手段。方法:2003年初以整群抽样的方法在上海市某社区建立了40岁及以上人群脑卒中危险因素研究队列,基线调查时以统一的问卷对常见的脑卒中危险因素进行调查,并进行脑血管功能指标检测。基线调查分别于2003年4—6月和2004年12月至2005年1月完成,以后逐年随访脑卒中的发病及全死因死亡,随访时间截至2014年12月31日。按基线脑血管功能积分值分组,统计首发脑卒中的10年累积发病率,建立积分-风险对照表,评估不同分值段10年首发脑卒中风险,分析脑血管功能积分在脑卒中发病中的作用强度。结果:纳入研究的队列人群共计10565人,随访(10.26±2.00)年,随访期间发生首发脑卒中350例。男女首发脑卒中10年累积发病率均随着脑血管功能积分值降低而呈显著上升趋势(趋势χ2=296.125,P<0.01)。10年首发脑卒中发病风险高于5%和高于10%对应的脑血管功能积分的界值男性分别为<70分和<40分,女性分别为<30分和<20分。脑血管功能积分按25分1段分组,从上而下各组首发脑卒中的发病率男性分别为1.9%、4.7%、10.8%、15.2%,女性分别为1.6%、4.4%、4.8%、11.4%;与积分值≥75分组比,积分值后3段的相对危险度(95%CI)男性分别为2.61(1.67~4.07)、6.46(4.22~9.89)、9.74(6.53~14.52),女性分别为2.82(1.93~4.12)、3.15(1.99~4.99)、8.12(5.65~11.68)。多因素分析结果显示,被筛选进入回归方程的因素分别为脑血管功能积分、年龄、高血压史、脑卒中家族史和吸烟史,其中脑血管功能积分的作用最强。结论:首发脑卒中的发病风险随着脑血管功能积分值降低而呈显著的上升趋势。脑血管功能积分能够预测10年首发脑卒中的发病风险。Objective To establish a 10-year comparison table of cerebrovascular function score and first stroke risk,and to provide a new method for screening of high-risk population of stroke.Methods In the beginning of 2003,a cohort for studing stroke risk factors in those aged 40 years and over was established in a community of Shanghai by cluster sampling.The common risk factors of stroke were investigated with a unified questionnaire,and the cerebrovascular function(cerebral vascular hemodynamic indexes,CVHI)was measured.The baseline study was completed from April to June 2003 and December 2004 to January 2005,respectively.The incident of first stroke and all cause of death were followed up year by year.The follow-up period was up to December 31,2014.The 10-year incidence of first stroke was calculated according to the baseline score of cerebrovascular function,and the score-risk control table was established to estimate 10-year first stroke risk in each score group.The role of cerebrovascular function score in stroke was also estimated.Results The follow-up term of 10565 participants was(10.26±2.00)years,and 350 patients had first stroke during the follow-up.The trend 10-year incidence of first stroke both in men and women was significantly increased with the decrease of the score of cerebrovascular function(trendχ²=296.125,P<0.01).As the 10-year risk of first stroke was higher than 5%and higher than 10%,the corresponding CVHI score was lower than 70 and 40 points in males and lower than 30 and 20 points in females.When the scores of cerebral vascular function were divided by every 25 points,incidence of first stroke in each group from top to bottom was 1.9%,4.7%,10.8%,15.2%in males and 1.6%,4.4%,4.8%,11.4%in females,respectively.As compared to the top,the relative risk(95%CI)of first stroke in the lower groups was 2.61(1.67-4.07),6.46(4.22-9.89),9.74(6.53-14.52)for males and 2.82(1.93-4.12),3.15(1.99-4.99),8.12(5.65-11.68)for females,respectively.Multivariate analysis showed that the factors being selected into th

关 键 词：卒中 队列研究 脑血管功能积分 风险评估 

分 类 号：R743.3[医药卫生—神经病学与精神病学]