不同血压水平对青年人群早发脑卒中风险的影响  

Relationship between blood pressure and the risk of early-onset stroke in young people

作　　者：李刘欣 朱辰蕊[2] 林黎明[2] 李慧英[2] 魏晓明[2] 杜鑫[2] 陈朔华[2] 刘妍[2] 季春鹏[2] 吴寿岭[2] 黄喆[2] LI Liu-xin;ZHU Chen-rui;LIN Li-ming;LI Hui-ying;WEI Xiao-ming;DU Xin;CHEN Shuo-hua;LIU Yan;JI Chun-peng;WU Shou-ling;HUANG Zhe(Graduate School,North China University of Science and Technology,Tangshan,Hebei 063000,China;Department of Cardiology,Kailuan General Hospital)

机构地区：[1]华北理工大学研究生院,河北唐山063000 [2]开滦总医院心内科

出　　处：《中华高血压杂志》2022年第11期1061-1068,共8页Chinese Journal of Hypertension

摘　　要：目的 探讨不同血压水平对青年人群早发脑卒中风险的影响。方法 选取2006—2012年度首次参加健康体检且年龄≤40岁、既往无脑卒中及心肌梗死病史的开滦集团员工作为观察对象,以首次健康体检时点为随访起点,以发生脑卒中、死亡或随访结束(2020-12-31)为随访终点。根据2017年美国心脏病学会(ACC)/美国心脏协会(AHA)高血压管理指南将血压进行分级,采用Kaplan-Meier法计算不同血压水平组脑卒中的累积发病率,并采用Log-rank检验进行组间比较。使用Cox比例风险回归模型和部分分布竞争风险模型分析不同血压水平对脑卒中及其亚型发病风险的影响。结果 符合纳入标准的观察对象36 073人,年龄(30.8±5.7)岁,其中男性27 892人,占观察对象的77.32%。Cox比例风险回归模型分析显示,随着血压的升高,发生脑卒中、缺血性脑卒中和出血性脑卒中的风险逐渐增加。以血压<120/80 mm Hg为参照,校正年龄、性别等因素后,高血压1级组发生脑卒中、缺血性脑卒中及出血性脑卒中的HR(95%CI)分别为1.52(1.05~2.20)、1.32(0.87~2.00)和2.51(1.15~5.47),高血压2级发生脑卒中、缺血性脑卒中及出血性脑卒中的HR(95%CI)分别为2.57(1.75~3.77)、2.26(1.47~3.47)和4.77(2.09~10.85)。部分分布竞争风险模型分析结果与Cox比例风险回归模型结果一致。敏感性分析结果显示,排除基线服用降压药、降糖药或降脂药后,高血压1级组可增加出血性脑卒中的发病风险,HR(95%CI)分别为2.46(1.13~5.38)、2.51(1.15~5.47)和2.51(1.15~5.47),而对缺血性脑卒中的影响无统计学意义。结论 在年龄≤40岁青年人群中,高血压1级和2级均可增加脑卒中风险,其中与出血性脑卒中发病风险的关联更大。Objective To investigate the effect of different blood pressure levels on the risk of early-onset stroke in young people. Methods Kailuan Group employees aged 40 and below who participated in the first physical examination in 2006-2012 and had no previous history of stroke or myocardial infarction were recruited. The follow-up began from the first physical examination and ended when stroke or death occurred or on December 31, 2020. Blood pressure was graded by 2017 American College of Cardiology(ACC)/American Heart Association(AHA) hypertension guidelines. The cumulative incidence rate of stroke was calculated by Kaplan-Meier method and compared among groups with different blood pressure using Log-rank test. The effect of different blood pressure levels on the risk of stroke and its subtypes was examined with Cox proportional hazard regression model and a partial distributed competitive risk model. Results A total of 36 073 subjects aged(30.8±5.7) years met the inclusion criteria. Among them, 27 892 were males, accounting for 77.32%. Cox proportional hazard regression model analysis showed that the risk of stroke, ischemic stroke and hemorrhagic stroke increased gradually with elevated blood pressure. Taking blood pressure <120/80 mm Hg as reference, HR(95%CI) for stroke, ischemic stroke, and hemorrhagic stroke was 1.52(1.05-2.20), 1.32(0.87-2.00), and 2.51(1.15-5.47) respectively in grade 1 hypertension, and 2.57(1.75-3.77), 2.26(1.47-3.47), and 4.77(2.09-10.85) respectively in grade 2 hypertension, after adjusting for age, gender and other factors. The results of partial distributed competitive risk model were consistent with those of Cox proportional risk regression model. Sensitivity analysis showed that after excluding the use of antihypertensive, hypoglycemic or hypolipidemic medicines at baseline, the incidence risk of hemorrhagic stroke increased in the grade 1 hypertension group, with HR(95%CI) of 2.46(1.13-5.38), 2.51(1.15-5.47) and 2.51(1.15-5.47) respectively, while the effect of grade 1 hypertension

关 键 词：血压水平 2017年美国心脏病学会/美国心脏协会高血压管理指南 脑卒中 青年 

分 类 号：R743.3[医药卫生—神经病学与精神病学]