本文選題：心腦血管病 + 危險(xiǎn)因素�。� 參考：《蘇州大學(xué)》2014年博士論文

【摘要】：研究背景和目的 1、描述蒙古族研究對(duì)象的心腦血管危險(xiǎn)因素的分布特征。 2、探討蒙古人群中糖尿病或空腹血糖異常與腦卒中及冠心病的關(guān)系。 3、不同的高血壓亞型可能有不同的臨床意義和對(duì)心腦血管病有不同的影響。本研究的目的之一是探討蒙古人群不同的高血壓亞型與心腦血管病的關(guān)系。 4、在前瞻性隊(duì)列研究的基礎(chǔ)上,采用巢式病例對(duì)照研究的方法,探討蒙古族人群基線白介素-6(IL-6)、假性血友病因子(vWF)、同型半胱氨酸(Hcy)、內(nèi)皮素-1(ET-1)、細(xì)胞粘附分子-1(ICAM-1)和E-選擇素(E-selectin)與心腦血管病發(fā)病的關(guān)系。 5、Framingham心腦血管危險(xiǎn)性評(píng)分是一個(gè)實(shí)用的、用來(lái)預(yù)測(cè)人群心腦血管危險(xiǎn)性的工具,但在蒙古族人群中還沒(méi)有運(yùn)用這個(gè)評(píng)分系統(tǒng)預(yù)測(cè)人群心腦血管危險(xiǎn)性及其適用性的研究報(bào)道。我們研究的目的是評(píng)價(jià)Framingham心腦血管危險(xiǎn)性評(píng)分在蒙古人群中預(yù)測(cè)心腦血管危險(xiǎn)性的效能。 研究對(duì)象和方法 1、選擇2589名20歲及以上內(nèi)蒙古的蒙古族人群作為研究對(duì)象,并對(duì)其進(jìn)行社會(huì)人口學(xué)情況、心腦血管疾病危險(xiǎn)因素基線資料收集,描述研究對(duì)象的人口學(xué)特征和心腦血管危險(xiǎn)因素的分布特征。 2、對(duì)所有研究對(duì)象進(jìn)行為期10年的隨訪觀察,以發(fā)現(xiàn)腦卒中和冠心病的新發(fā)病例。分析基線血糖水平以及是否患有糖尿病與腦卒中和冠心病發(fā)生的關(guān)系,用Cox比例風(fēng)險(xiǎn)模型計(jì)算風(fēng)險(xiǎn)比(Hazard ratio, HR)和95%可信區(qū)間(95%CI)。 3、根據(jù)研究對(duì)象基線的收縮壓和舒張壓水平,將研究對(duì)象分為血壓正常者、單純收縮期高血壓(ISH)、單純舒張期高血壓(IDH)和收縮期／舒張期復(fù)合型高血壓(SDH)。分析基線不同高血壓亞型與心腦血管事件的關(guān)系,用Cox比例風(fēng)險(xiǎn)模型計(jì)算風(fēng)險(xiǎn)比HR和95%CI。 4、針對(duì)蒙古族人群進(jìn)行為期10年的隨訪觀察,將隨訪過(guò)程中發(fā)現(xiàn)的新發(fā)心腦血管病患者作為研究的病例,選擇與病例年齡、性別和居住地相同的健康人為對(duì)照,開展巢式病例對(duì)照研究。檢測(cè)病例和對(duì)照基線時(shí)IL-6、vWF、Hcy、ET-1、ICAM-1和E-selectin的水平。按各標(biāo)志物水平的三分位為將研究對(duì)象分為三組,第三分位者定義為標(biāo)志物水平升高,處于第一、二分位者為標(biāo)志物水平正常。采用Logistic回歸分析的方法,分析這些基線標(biāo)志物水平升高與心腦血管疾病的關(guān)系,計(jì)算OR和95%CI。 5、在蒙古族人群前瞻性隊(duì)列研究的基礎(chǔ)上。根據(jù)Framingham評(píng)分公式,對(duì)所有研究對(duì)象進(jìn)行了風(fēng)險(xiǎn)預(yù)測(cè)。我們運(yùn)用Hosmer-Lemeshow檢驗(yàn)和C統(tǒng)計(jì)量對(duì)Framingham評(píng)分進(jìn)行評(píng)價(jià)。計(jì)算各危險(xiǎn)評(píng)分的歸因危險(xiǎn)度百分比。 研究結(jié)果 1、研究人群基線特征的描述 研究人群基線平均SBP和DBP分別為129.8mmHg和84.5mmHg;高血壓患病率為37.4%,男性(45.6%)顯著高于女性(31.7%),P0.01；研究人群的超重(28BMI≥24)和肥胖(BMI≥28)的比例分別為20.14%和6.69%,男性組超重(16.8vs.22.5%)和肥胖(5.2vs.7.7%)的比例均顯著低于女性的相應(yīng)比例,P值均0.05。吸煙率為44.4%，男性的吸煙率(64.0%)顯著高于女性(30.8%),P0.01；飲酒率為33.5%,男性的飲酒率(64.6%)顯著高于女性(11.7%),P0.01。高TC、高TG和高FPG的患病率分別為10.2%、17.5%和21.94%。 2、血糖水平和糖尿病與心腦血管病事件 經(jīng)過(guò)年齡、吸煙、飲酒、收縮壓、舒張壓、BMI、C-反應(yīng)蛋白和血脂的調(diào)整,與非糖尿病者相比,糖尿病者(FPG≥7.0mmol/L)發(fā)生心腦血管病(腦卒中+冠心病)的HR(95%CI)為2.71(1.68,4.37)；與非糖尿病者相比,糖尿病者(FPG≥7.0mmol/L)發(fā)生腦卒中的HR(95%CI)為2.04(1.01,4.13),與非糖尿病者相比,糖尿病者(FPG、7.0mmol/L)發(fā)生冠心病的HR(95%CI)為3.78(1.95,7.33)。 3、高血壓亞型與心腦血管事件 經(jīng)年齡、性別調(diào)整后,與血壓正常者相比,高血壓前期、ISH、IDH和SDH所對(duì)應(yīng)的心腦血管病的HR (95%CI)分別是1.75(0.92-3.33),2.11(0.95-4.70),2.14(1.01-4.56)和5.31(2.86-9.77)；調(diào)整其他心腦血管危險(xiǎn)因素后,與血壓正常者相比,高血壓前期、ISH、IDH和SDH所對(duì)應(yīng)的心腦血管病的HR (95%CI)分別是1.78(0.92-4.60),2.06(0.92-4.60),2.16(1.01-4.63)和5.19(2.77-9.72)。 4、炎癥標(biāo)志物與心腦血管病關(guān)系 與Hcy14.19μmol/L、ICAM-1409.87ng/ml、ET-10.75ng/L、 E-seletin18.13ng/ml(水平正常)相比,無(wú)論調(diào)整前還是調(diào)整后,Hcy≥14.19μmol/L、 ICAM-1≥409.87ng/ml、ET-1≥0.75ng/L和E-seletin≥18.13ng/ml者發(fā)生心腦血管疾病的危險(xiǎn)性均無(wú)統(tǒng)計(jì)學(xué)意義。與vWF13.86pg/ml(水平正常)相比,調(diào)整前,vWF≥13.86pg/ml者發(fā)生心腦血管疾病的危險(xiǎn)性O(shè)R(95%CI)為1.542(0.922,2.577),接近于具有統(tǒng)計(jì)學(xué)意義。調(diào)整多因素后,vWF≥13.86pg/ml者發(fā)生心腦血管疾病的危險(xiǎn)性O(shè)R(95%CI)為2.369(1.25,4.493),具有統(tǒng)計(jì)學(xué)意義。與vWF相似,經(jīng)多因素調(diào)整后,與IL-624.63pg/ml(水平正常)相比,IL-6≥24.63者發(fā)生心腦血管疾病的危險(xiǎn)性O(shè)R(95%CI)為1.634(1.009,2.647),也具有統(tǒng)計(jì)學(xué)意義。 5、Framingham心腦血管危險(xiǎn)性評(píng)分在蒙古族人群中的適用性 經(jīng)過(guò)23292人年的隨訪,我們共發(fā)現(xiàn)200個(gè)心腦血管事件。Framingham評(píng)分的預(yù)測(cè)發(fā)病率為8.52%,研究人群實(shí)際的發(fā)病率為7.72%(95%CI：6.73%-8.82%),兩者比較接近。經(jīng)Hosmer-Lemeshow檢驗(yàn),x2=9.22,P=0.324),表示Framingham評(píng)分有較好的預(yù)測(cè)性：C statistic:0.81,95%CI:0.78-0.84,表明有較好的分辨率。將研究對(duì)象按照評(píng)分大小分為4組(0-4.9%、5-9.9%、10-19.9%、20%-)。以0-4.9%風(fēng)險(xiǎn)組為參比,5-9.9%、10-19.9%、20%-的歸因危險(xiǎn)度百分比分別為61.39%,79.04%和83.66%。 研究結(jié)論 1、蒙古族人群具有較高的高血壓患病率以及超重／肥胖、吸煙、飲酒、血脂異常、高血糖患病率。 2、在蒙古族人群中,糖尿病是心腦血管病的獨(dú)立危險(xiǎn)因素。本研究結(jié)果提示,積極治療糖尿病和控制血糖水平是預(yù)防心腦血管事件的重要措施。 3、IDH和SDH可顯著的增加心腦血管病的危險(xiǎn)性,本研究提示,對(duì)于IDH的對(duì)象開展積極的血壓監(jiān)測(cè)和積極的降壓治療是蒙古族人群心腦血管病預(yù)防的重要戰(zhàn)略。 4、IL-6和vWF是蒙古族人群心腦血管病發(fā)病的獨(dú)立危險(xiǎn)因素。 5、在蒙古族人群人群中,實(shí)際的心腦血管病發(fā)病率與Framingham評(píng)分預(yù)測(cè)的發(fā)病率接近,Framingham評(píng)分可以預(yù)測(cè)和評(píng)價(jià)蒙古族人群的心腦血管疾病的風(fēng)險(xiǎn)。
[Abstract]:Background and purpose of research
1, the distribution characteristics of the cardiovascular risk factors of the Mongolian research subjects were described.
2, to investigate the relationship between diabetes or abnormal fasting blood glucose in Mongolia population with stroke and coronary heart disease.
3, different types of hypertension may have different clinical significance and have different effects on cardiovascular and cerebrovascular diseases. One of the purposes of this study is to explore the relationship between different hypertension subtypes and cardiovascular and cerebrovascular diseases in Mongolia population.
4, based on a prospective cohort study, a nested case-control study, to explore the Mongolian population baseline interleukin -6 (IL-6), von Willebrand factor (vWF), homocysteine (Hcy), endothelin -1 (ET-1), cell adhesion molecule -1 (ICAM-1) and E- selectin (E-selectin) relationship with the incidence of cardiovascular and cerebrovascular disease.
5, cardiovascular risk score of Framingham is a practical, for cardiovascular risk population prediction tool, but in the Mongolian population. There is no use of this scoring system in predicting the risk of cardiovascular research reports and the applicability of people. The purpose of our study was to Framingham cardiovascular risk assessment score in predicting cardiovascular risk the effectiveness of cardio in Mongolia population.
Research objects and methods
1, we selected 2589 Mongolian people aged 20 and above in Inner Mongolia as subjects. We collected sociodemographic data and baseline data of risk factors for cardiovascular and cerebrovascular diseases, and described demographic characteristics and distribution characteristics of cardiovascular and cerebrovascular risk factors.
2, were followed up for 10 years all the research object, in order to find the stroke and coronary heart disease cases. Analysis of baseline blood glucose level and with the relationship between diabetes mellitus and stroke and coronary heart disease, Cox proportional hazards model was used to calculate the risk ratio (Hazard ratio, HR) and 95% confidence intervals (95%CI).
3, according to the study of baseline systolic and diastolic blood pressure levels, the subjects were divided into normal blood pressure, systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systolic / diastolic blood pressure (SDH) composite. Analysis of the relationship between the different subtypes of hypertension at baseline and cerebrovascular events, using Cox proportional hazards HR and 95%CI. model to calculate the risk ratio
4, according to the Mongolian population were observed for a period of 10 years of follow-up, follow-up will be discovered in the process of new onset cardiovascular and cerebrovascular disease patients as the research case, case selection and age, gender and matched healthy controls, to carry out a nested case-control study. The detection of cases and controls at baseline, IL-6, vWF, Hcy, ET-1 ICAM-1, and E-selectin levels. According to the markers for three subjects were divided into three groups, third patients defined increased levels of markers in first, second points, who is the marker of normal level. Methods using Logistic regression analysis, analysis of these baseline markers increased the level of relationship with cardiovascular disease vascular disease, calculation of OR and 95%CI.
5, based on a prospective cohort study of Mongolian population. According to the Framingham score formula, to predict the risk of all the research object. We use Hosmer-Lemeshow test and C statistic of Framingham score evaluation. Calculate the risk score attributable risk percent.
Research results
1, the description of the baseline characteristics of the population
Study on the baseline mean SBP and DBP were 129.8mmHg and 84.5mmHg; the prevalence rate of hypertension was 37.4%, male (45.6%) was significantly higher than that of female (31.7%), P0.01; the study population of overweight (28BMI = 24) and obesity (BMI = 28) were 20.14% and 6.69%, male overweight and obesity group (16.8vs.22.5%) (5.2vs.7.7%) ratio were significantly lower than the corresponding proportion of women, P values were 0.05. smoking rate was 44.4%, the smoking rate of male (64%) was significantly higher than that of female (30.8%), P0.01; the drinking rate was 33.5%, the drinking rate of male (64.6%) was significantly higher than that of female (11.7%), P0.01., high TC, high prevalence rate TG and FPG were 10.2%, 17.5% and 21.94%.
2, blood sugar level and diabetes and cardio cerebrovascular disease events
After age, smoking, alcohol consumption, systolic blood pressure, diastolic blood pressure, BMI, C- reactive protein and blood lipid regulation, compared with non diabetes, diabetes (FPG = 7.0mmol/L) occurrence of cardiovascular and cerebrovascular disease (stroke and coronary heart disease) HR (95%CI) 2.71 (1.68,4.37); compared with non diabetic patients. Diabetes (FPG = 7.0mmol/L) stroke HR (95%CI) 2.04 (1.01,4.13), compared with non diabetes, diabetes mellitus (FPG, 7.0mmol/L) the occurrence of coronary heart disease HR (95%CI) 3.78 (1.95,7.33).
3, hypertension subtype and cardio cerebral vascular event
By age, sex adjusted, compared with normal blood pressure in pre hypertension, ISH, corresponding to IDH and SDH HR cardiovascular disease (95%CI) were 1.75 (0.92-3.33), 2.11 (0.95-4.70), 2.14 (1.01-4.56) and 5.31 (2.86-9.77); the adjustment of other cardiovascular risk factors, compared to with normal blood pressure in pre hypertension, ISH, corresponding to IDH and SDH HR cardiovascular disease (95%CI) were 1.78 (0.92-4.60), 2.06 (0.92-4.60), 2.16 (1.01-4.63) and 5.19 (2.77-9.72).
4, the relationship between inflammatory markers and cardiovascular and cerebrovascular diseases
With Hcy14.19 mol/L, ICAM-1409.87ng/ml, ET-10.75ng/L, E-seletin18.13ng/ml (normal), whether before or after adjustment adjustment, Hcy = 14.19 mol/L, ICAM-1 = 409.87ng/ml, ET-1 = 0.75ng/L and the risk of E-seletin was larger than 18.13ng/ml in the occurrence of cardiovascular diseases were not statistically significant. And vWF13.86pg/ml (normal) compared to before the adjustment OR, the risk of vWF was larger than 13.86pg/ml in the occurrence of cardiovascular diseases (95%CI) 1.542 (0.922,2.577), close to statistically significant. After multivariate adjustment, the risk of OR vWF was larger than 13.86pg/ml incidence of cardiovascular and cerebrovascular diseases (95%CI) 2.369 (1.25,4.493), with statistical significance. Similar to vWF, the after multivariate adjustment, and IL-624.63pg/ml (normal) compared to the risk of OR IL-6 more than 24.63 cases of cardiovascular and cerebrovascular diseases (95%CI) 1.634 (1.009,2.647), also has statistical significance.
5, Framingham cardio cerebral vascular risk score in Mongolian population
After 23292 years of follow-up, we found a total of 200 rate of predicting the incidence of cardiovascular events in.Framingham score was 8.52%, the incidence of the study population actual rate was 7.72% (95%CI:6.73%-8.82%), the two were close. By Hosmer-Lemeshow test, x2=9.22, P=0.324), said a good prediction of Framingham score: C statistic:0.81,95%CI:0.78-0.84, show good the resolution of the research object. According to the scores were divided into 4 groups (0-4.9%, 5-9.9%, 10-19.9%, 20%-). The 0-4.9% risk group as a reference, 5-9.9%, 10-19.9%, 20%- of the attributable risk percentage were 61.39%, 79.04% and 83.66%.
research conclusion
1, the Mongolian population has a high prevalence of hypertension and overweight / obesity, smoking, drinking, dyslipidemia and the prevalence of hyperglycemia.
2, diabetes mellitus is an independent risk factor for cardiovascular and cerebrovascular diseases in Mongolian population. The results suggest that active treatment of diabetes and blood glucose control are important measures to prevent cardiovascular and cerebrovascular events.
3, IDH and SDH can significantly increase the risk of cardiovascular and cerebrovascular diseases. This study suggests that active blood pressure monitoring and active antihypertensive therapy for IDH are important strategies for prevention and treatment of cardiovascular and cerebrovascular diseases in Mongolian population.
4, IL-6 and vWF are independent risk factors for the pathogenesis of cardio cerebral vascular disease in Mongolian people.
5, in the Mongolian population, the incidence of actual cardiovascular and cerebrovascular diseases is close to the incidence predicted by the Framingham score. Framingham score can predict and evaluate the risk of cardiovascular and cerebrovascular diseases in Mongolian population.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R54;R743

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 ;Outline of the Report on Cardiovascular Disease in China,2010[J];Biomedical and Environmental Sciences;2012年03期

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本文編號(hào)：1772062