多指标评估门诊就诊原发性高血压患者心血管疾病发病风险研究  

Risk Factors of Cardiovascular Diseases in Outpatient Patients with Primary Hypertension Assessed According to a Variety of Parameters

作　　者：邓利群[1] 王茜[2] 张冬花[2] 左惠娟 林运[2] DENG Liqun;WANG Qian;ZHANG Donghua;ZUO Huijuan;LIN Yun(Department of General Practice,Beijing Anzhen Hospital,Capital Medical University,100029 Beijing,China;No.15 Ward,Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,100029 Beijing,China;Department of Community Health Research,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing Anzhen Hospital,Capital Medical University,100029 Beijing,China)

机构地区：[1]首都医科大学附属北京安贞医院全科医学科,北京市100029 [2]首都医科大学附属北京安贞医院心内科十五病房,北京市100029 [3]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人群防治研究室,北京市100029

出　　处：《中国全科医学》2021年第32期4080-4085,共6页Chinese General Practice

基　　金：北京市卫生和计划生育委员会科技成果和适宜技术推广项目(TG-2015-33)。

摘　　要：背景血脂异常、原发性高血压、糖尿病、肥胖、吸烟、不健康饮食及身体活动不足等是动脉粥样硬化性心血管疾病(ASCVD)可改变的危险因素,并用于进行10年风险评估。而上述4项行为因素以及3项生理和生化指标维持理想状态可明显降低人群ASCVD的发生。目的分析门诊就诊原发性高血压患者ASCVD的危险因素水平、危险分层以及理想心血管健康行为和因素,综合反应ASCVD发病风险。方法选择2016年6月至2017年6月在首都医科大学附属北京安贞医院就诊的>35岁的原发性高血压患者3451例为研究对象,采用面对面询问和现场测量、血液生化检查收集患者的基本信息,采用武阳丰教授建立的国人10年ASCVD风险评估预测模型(以下简称预测方法)及《中国心血管病预防指南》提供的方法(以下简称指南方法)对ASCVD发病风险进行评估及危险分层,理想的心血管健康定义采用美国心脏协会(AHA)的建议(包括7项理想的健康因素和行为)。计算Kappa值,评估两种方法对ASCVD危险分层结果的一致性。结果≥55岁的原发性高血压患者,两种工具判断的ASCVD不同危险人群的构成比较,差异有统计学意义(χ^(2)=10.608,P=0.005),预测模型方法判断ASCVD为高危的比例高于指南方法初评的结果(χ^(2)=4.219,P=0.04)。<55岁的原发性高血压患者,两种工具判断的ASCVD不同危险人群的构成比较,差异有统计学意义(χ^(2)=534.350,P<0.001);预测模型方法评估以低危为主(76.3%),高危的比例仅为6.6%,指南方法初评高危比例达到29.5%。对中危患者进行余生风险评估,66例患者(13.0%)调整为高危,最终高危患者比例达到34.5%。预测模型方法判断为低危、中危和高危的患者,指南方法同样评估为低危、中危和高危的比例分别为51.9%、44.5%和56.0%,一致率为50.8%,经内部一致性检验,Kappa值为0.261(u=17.010,P<0.001)。仅2.4%患者具有5项健康行为和因素,70.4%具�Background Dyslipidemia,primary hypertension,diabetes,obesity,smoking,unhealthy diet and lack of physical activity are risk factors that can be changed for atherosclerotic cardiovascular diseases(ASCVD),which are used to assess 10-year risk of ASCVD.Maintaining the four behavioral factors,three physiological and biochemical parameters above in an ideal state can significantly reduce the incidence of ASCVD in the population.Objective To analyze the level of risk factors,risk stratification,ideal cardiovascular health behaviors and factors of ASCVD in outpatient patients with primary hypertension and to comprehensively reflect the risk of ASCVD.Methods Three thousand four hundred and fifty-one patients with primary hypertension and aged over 35 years old who were treated in Beijing Anzhen Hospital,Capital Medical University from June 2016 to June 2017 were enrolled as the research objects.The basic information of the patients was collected by face-to-face inquiry,on-site measurement and blood biochemical tests.The 10-year risk assessment and prediction model of ASCVD(hereinafter referred to as prediction tool method)proposed by Professor Wu Yangfeng and the method provided by the Chinese guidelines for cardiovascular disease prevention(hereinafter referred to as the guideline method)were used for risk evaluation of ASCVD and risk stratification.The definition of ideal cardiovascular health is based on the recommendations of the American Heart Association(AHA)(including 7 ideal health factors and behaviors).The Kappa value was calculated,and the consistency of the two methods in the risk stratification of ASCVD was evaluated.Results For patients with primary hypertension and aged ≥55 years old,there was significant difference in the proportions of different populations at risk of ASCVD judged by the two methods(χ^(2)=10.608,P=0.005),and the proportion of high-risk ASCVD judged by the prediction model was higher than that preliminarily judged by the guideline method(χ^(2)=4.219,P=0.04).For the patients with prima

关 键 词：心血管疾病 原发性高血压 危险分层 理想心血管健康 影响因素分析 

分 类 号：R54[医药卫生—心血管疾病]