基层老年慢性病患者心血管疾病综合发生风险的影响因素研究  

A Study on the Factors Influencing the Comprehensive Risk of Cardiovascular Disease in Elderly Patients with Chronic Disease in Primary Care

作　　者：余新艳[1] 苏鹏 袁晓静[3] 姜清茹[1] 杨建云 赵旭东 王一凡 张海澄[7] YU Xinyan;SU Peng;YUAN Xiaojing;JIANG Qingru;YANG Jianyun;ZHAO Xudong;WANG Yifan;ZHANG Haicheng(Health Examination Center of the First People's Hospital of Yinchuan,Yinchuan 750001,China;School of Public Health,North China University of Science and Technology,Tangshan 063210,China;Xuzhou Central Hospital,Xuzhou 221000,China;Jingcheng Community Health Service Station of the First People's Hospital of Yinchuan City,Yinchuan 750001,China;Xinhua Street Community Health Service Center of the First People's Hospital of Yinchuan,Yinchuan 750001,China;Mingde Community Health Service Station,Qianjin Street,the First People's Hospital of Yinchuan,Yinchuan 750001,China;Department of Cardiology,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]宁夏回族自治区银川市第一人民医院健康管理体检中心,750001 [2]华北理工大学公共卫生学院,河北省唐山市063210 [3]江苏省徐州市中心医院,221000 [4]宁夏回族自治区银川市第一人民医院景城社区卫生服务站,750001 [5]宁夏回族自治区银川市第一人民医院新华街社区卫生服务中心,750001 [6]宁夏回族自治区银川市第一人民医院前进街明德社区卫生服务站,750001 [7]北京大学人民医院心内科,北京市100044

出　　处：《中国全科医学》2024年第10期1186-1193,1200,共9页Chinese General Practice

基　　金：国家社会科学基金重大项目(18ZDA086-4);银川市科技创新重点重大专项(2021-SF-009)。

摘　　要：背景心血管疾病是造成我国居民死亡和疾病负担的首要病因,防控形势严峻。心血管疾病风险影响因素管理是预防心血管疾病的重要基础。但目前国内外应用单导联可穿戴心电设备针对基层老年慢性病患者心血管疾病发生风险的影响因素调查研究较少,且在既往研究中也未以整体观对患者包含不同数量风险的变量重要性进行排序。目的分析基层管理的65岁以上老年慢性病患者心血管疾病综合发生风险的影响因素,为基层心血管疾病综合防控提供客观依据及帮助。方法选取2021年12月—2022年9月宁夏回族自治区26家基层医疗卫生机构的3039例65岁以上+高血压、糖尿病、冠心病其中至少1种慢性病的患者为研究对象。依据72 h心电图分析结果划分为正常组632例、风险组2407例。分析两组患者基本资料,确定最佳λ值,绘制模型,采用LASSO回归和多因素Logistic回归分析探讨老年慢性病患者心血管疾病综合风险影响因素;并对影响心血管疾病综合风险及包含不同数量风险的变量排序。结果两组患者年龄、性别、BMI、教育程度、职业、城乡分布、吸烟、运动、冠心病+糖尿病、高血压+冠心病及糖尿病比较,差异均有统计学意义(P<0.05);最佳λ值为0.01568531。LASSO回归和多因素Logistic回归模型分析显示年龄、BMI、城乡分布、吸烟、高血压+冠心病+糖尿病是心血管疾病综合风险的影响因素(P<0.05)。受试者工作特征曲线下面积(AUC)=0.650(95%CI=0.627~0.673,P<0.001)。影响综合风险及不同数量风险种类变量排序前五位的分别为:年龄、BMI、城乡分布、饮茶、运动;年龄、高血压+冠心病、性别、城乡分布、吸烟;年龄、高血压+冠心病、性别、BMI、城乡分布;糖尿病+冠心病、年龄、高血压+冠心病、高血压+冠心病+糖尿病、高血压+糖尿病。结论年龄、BMI、城乡分布、吸烟、高血压合并冠心病及糖Background Cardiovascular disease is the primary cause of death and Disease burden of Chinese residents,and the situation of prevention and control is grim.Management of risk factors for cardiovascular disease is an important foundation for preventing cardiovascular disease.However,there is currently limited research on the influencing risk factors of cardiovascular disease risk in elderly patients with chronic disease in primary care using single lead wearable electrocardiogram devices both domestically and internationally,and previous studies have not ranked the importance of variables containing different quantities of risk in patients from a holistic perspective.Objective The aim of this study is to analyze the influencing factors of the comprehensive risk of cardiovascular disease in elderly patients with chronic disease aged 65 and above in primary care in Ningxia,and to provide objective basis and assistance for the comprehensive prevention and control of cardiovascular disease in primary care.Methods From December 2021 to September 2022,totally 3039 patients over 65 years old with hypertension,diabetes and coronary heart disease,including at least one chronic disease,from 26 primary care health center in Ningxia were selected as the research subjects.According to the analysis of the 72 hour electrocardiogram,there were 632 cases in the normal group and 2407 cases in the risk group.Analyze the basic information of two groups of patients to determine the bestλValue,draw a model,and use LASSO regression and multivariate Logistic regression to analyze the comprehensive risk factors of cardiovascular disease in elderly patients with chronic diseases;and rank the variables that affect the overall risk of cardiovascular disease and include different numbers of risks among patients.Results The differences in age,gender,BMI,education level,occupation,urban-rural distribution,smoking,exercise,coronary heart disease combined with diabetes,hypertension combined with coronary heart disease and diabetes between the tw

关 键 词：慢性病 基层医疗卫生机构 老年人 心血管疾病 影响因素分析 变量排序 

分 类 号：R36[医药卫生—病理学]