本文選題：高血壓 + 血清總膽固醇��； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：中國腦卒中一級預(yù)防(China Stroke Primary Prevention Trial, CSPPT)研究為比較安慶與連云港兩地農(nóng)村45～75歲原發(fā)性高血壓人群中馬來酸依那普利片和馬來酸依那普利葉酸片預(yù)防腦卒中發(fā)生的隨機(jī)雙盲對照試驗(yàn)。本研究前瞻性的研究基線血脂水平與總體腦卒中以及各型腦卒中發(fā)生的相關(guān)性。第一部分中國農(nóng)村45～75歲高血壓人群血脂異常發(fā)生率及其影響因素研究背景：血脂異常作為心腦血管事件發(fā)生的危險(xiǎn)因素得到了廣泛的關(guān)注。亞洲人群終生低血清總膽固醇水平以及亞洲人群中相對較低的冠心病發(fā)生率被認(rèn)為是血脂增加心腦血管事件發(fā)生風(fēng)險(xiǎn)的有力證據(jù)。根據(jù)2011年慢性疾病代謝性危險(xiǎn)因素全球負(fù)擔(dān)研究協(xié)作組發(fā)布的報(bào)告顯示：對1980至2008年間全球血脂水平變化趨勢的研究中可以發(fā)現(xiàn),澳大利亞、北美、歐洲人群的平均總膽固醇水平有所下降,而東亞、東南亞及環(huán)太平洋地區(qū)人群的平均總膽固醇水平均有所上升。中國人群尤其是中國農(nóng)村高血壓人群中血脂異常發(fā)生情況目前尚無系統(tǒng)研究。目的：通過CSPPT項(xiàng)目人群2008年入組基線血脂橫斷面研究,以2007年《中國成人血脂異常防治指南》推薦血脂異常界值為標(biāo)準(zhǔn)描述安慶及連云港兩地農(nóng)村高血壓人群血脂異常發(fā)生情況。方法：本研究人群來自中國腦卒中一級預(yù)防研究中安慶及連云港兩地農(nóng)村原發(fā)性高血壓患者的基線資料,目前共納入20702例原發(fā)性高血壓患者,進(jìn)行基線血、尿生化指標(biāo)、生活問卷調(diào)查、人體測量等相關(guān)指標(biāo)調(diào)查。結(jié)果：本研究人群共納入20702例原發(fā)性高血壓患者,其中男性8500人,女性12201人。女性血糖及血脂水平較男性高,男性人群中目前吸煙比例較女性高。連云港地區(qū)血脂異常比例高于安慶地區(qū)。中老年人群與老年人群相比血脂異常發(fā)病率差別不大。在不同基線血壓分層中,血脂異常發(fā)病率差別不大。在體質(zhì)指數(shù)分層中,血脂異常發(fā)病率隨體質(zhì)指數(shù)水平上升而升高。第二部分 中國農(nóng)村45～75歲高血壓人群基線血脂水平與腦卒中發(fā)生風(fēng)險(xiǎn)分析背景：血清總膽固醇水平與心血管事件發(fā)生的風(fēng)險(xiǎn)研究得到了廣泛的認(rèn)同。但血清總膽固醇水平與腦卒中發(fā)生的風(fēng)險(xiǎn)目前尚無定論。血清總膽固醇水平與腦卒中發(fā)生風(fēng)險(xiǎn)在不同人種、地區(qū)、性別等人群不同。另一方面,HDL-c水平被認(rèn)為對缺血性卒中發(fā)生具有保護(hù)作用。但以上研究多為歐美人群以及日本及韓國研究,關(guān)于中國人群尤其是中國農(nóng)村高血壓人群的研究目前尚較缺乏。目的：研究中國農(nóng)村45～75歲原發(fā)性高血壓人群中各項(xiàng)基線血脂水平與總體腦卒中及其亞型發(fā)生風(fēng)險(xiǎn)的相關(guān)性。方法：在CSPPT項(xiàng)目人群中,通過COX比例風(fēng)險(xiǎn)模型研究基線各項(xiàng)血脂與總體卒中及各卒中亞型的發(fā)病關(guān)系,并對其進(jìn)行了趨勢性檢驗(yàn)。其中模型一矯正性別、年齡、研究中心,模型二矯正性別、年齡、研究中心、基線收縮壓、基線空腹血糖以及基線吸煙狀況。結(jié)果：本研究共納入研究20702人,平均隨訪時(shí)間4.6年,共有565例腦卒中發(fā)生。在經(jīng)過多因素矯正后的總體卒中發(fā)生風(fēng)險(xiǎn)與不同水平血清總膽固醇水平(按血清總膽固醇水平將整體人群三分,最低分位Q1為參照,Q1,Q2,Q3)分別為：1.00,1.08(0.88,1.32)；1.20(0.98,1.47),與不同LDL-c水平(Q1,Q2,Q3)分別為：1.00,1.23(1.00,1.52),1.38(1.12,1.69),與不同HDL-c水平(Q1,Q2,Q3)分別為：1.00,1.18(0.98,1.43),1.03(0.84,1.26)；與不同血清總甘油三酯水平(Q1,Q2,Q3)分別為：1.000.97(0.79,1.18),0.98(0.80,1.20)。經(jīng)過多因素校正后的缺血性卒中發(fā)生風(fēng)險(xiǎn)與不同水平血清總膽固醇水平(按血清總膽固醇水平將整體人群四分,最低分位Q1為參照,Q1,02,Q3)分別為：1.00,1.10(0.87,1.39),1.29(1.02,1.62),與不同LDL-c水平(Q1,Q2,Q3)分別為：1.00,1.24(0.97,1.58),1.54(1.21,1.94)；與不同HDL-c水平(Q1,Q2,Q3)分別為：1.00,1.09(0.88,1.34),0.95(0.76,1.18)；與不同血清總甘油三酯水平(Q1,Q2,Q3)分別為：1.00,1.05(0.84,1.31),1.11(0.88,1.39)。經(jīng)過多因素校正后的出血性卒中發(fā)生風(fēng)險(xiǎn)與不同水平總膽固醇水平(按血清總膽固醇水平將整體人群四分,最低分位Q1為參照,Q1,Q2,Q3)分別為：1.00,1.15(0.74,1.78),1.02(0.62,1.66),與不同LDL-c水平(Q1,Q2,Q3)分別為：1.00,1.39(0.90,2.16),0.96(0.57,1.61)；與不同HDL-c水平(Q1,Q2,Q3)分別為：1.00,1.66(1.01,2.70),1.61(0.98,2.67)；與不同血清總甘油三酯水平(Q1,Q2,Q3,Q4)分別為：1.00,0.76(0.49,1.17),0.57(0.34,0.94)。第三部分不同危險(xiǎn)因素分層下基線血清總膽固醇水平與腦卒中發(fā)生風(fēng)險(xiǎn)分析背景：腦卒中的發(fā)生由多種不同危險(xiǎn)因素從多個(gè)環(huán)節(jié)增加其風(fēng)險(xiǎn)。年齡、血壓、體質(zhì)指數(shù)以及血脂異常是最為重要的幾個(gè)腦卒中發(fā)生危險(xiǎn)因素。不同腦卒中危險(xiǎn)因素與血脂異常之間是否有交互作用目前研究結(jié)果尚不確切。目的：研究中國腦卒中一級預(yù)防人群中在不同年齡、血壓、體質(zhì)指數(shù)分層下血脂與腦卒中發(fā)生率的研究。方法：通過將中國腦卒中一級預(yù)防人群進(jìn)行年齡分層、血壓分層、體質(zhì)指數(shù)分層,并在各層之間比較血脂水平與腦卒中發(fā)生率的相關(guān)性。結(jié)果：在年齡較高分位中,各血脂水平與腦卒中發(fā)生率的相關(guān)性較明顯。在不同血壓分層中,卒中前平均收縮壓的分層下較高分位中血清總膽固醇水平升高與腦卒中發(fā)生率升高更明顯。在體質(zhì)指數(shù)較低分位中,隨著血清總膽固醇水平升高出血性腦卒中發(fā)生率降低。
[Abstract]:The study of China Stroke Primary Prevention Trial (CSPPT) in China (China Stroke Trial, CSPPT) was used to compare the randomized, double-blind controlled trials of Enalapril Maleate Tablets and Enalapril Maleate and Folic Acid Tablets for prevention of stroke in 45~75 year old patients with essential hypertension in both Anqing and Lianyungang. The correlation between lipid levels and overall stroke and the occurrence of various types of stroke. The first part of the study on the incidence of dyslipidemia and its influencing factors in people aged 45~75 years in rural areas of China: the risk factors of blood lipid abnormality as a risk factor for cardiovascular events. The relatively low incidence of coronary heart disease in Asian populations is considered to be a powerful evidence of the risk of blood lipid increases in cardio - cerebrovascular events. A report released by the 2011 global burden study group on metabolic risk factors of chronic diseases showed that Australia was found in the study of changes in global blood lipid levels between 1980 and 2008. The average total cholesterol levels in big, North American and European populations have declined, while the average total cholesterol levels in East Asia, Southeast Asia and the circum Pacific are rising. There is no systematic study on the abnormal blood lipid in Chinese people, especially in rural hypertension population in China. Objective: through the CSPPT project population in 2008 A cross-sectional study of blood lipids in the baseline of the group, with the guidelines for the prevention and control of dyslipidemia in Chinese adults in 2007 and the value of blood lipid abnormity as the standard to describe the incidence of blood lipid abnormality in the rural hypertension population in Anqing and Lianyungang. Methods: the population of this study came from the primary prevention of stroke in China, in Anqing and Lianyungang. The baseline data of the blood pressure patients were included in 20702 patients with primary hypertension. The baseline blood, urine biochemical index, life questionnaire, and anthropometry were investigated. Results: 20702 cases of primary hypertension were included in this study, including 8500 male and 12201 female. The blood glucose and blood lipid level of women were more than men. The proportion of smoking in the male population is higher than that of the female. The abnormal blood lipid ratio in the Lianyungang area is higher than that in the Anqing area. The abnormal blood lipid abnormality rate of the middle-aged and old people is not significant. In the different baseline blood pressure stratification, the abnormal incidence of dyslipidemia is not significant. In the physical index stratification, the abnormal incidence of blood lipid is associated with the body mass index. The level of serum total cholesterol and the risk of cardiovascular events were widely recognized in the second part of the 45~75 year old hypertensive population in rural China: the level of serum total cholesterol and the risk of cardiovascular events were widely recognized. However, the risk of serum total cholesterol and the incidence of stroke is still not conclusive. The level of cholesterol and the risk of stroke are different in different people, regions and sex. On the other hand, the level of HDL-c is considered to have protective effects on ischemic stroke. However, most of the studies are in Europe and the United States and in Japan and South Korea. Research on Chinese people, especially in rural areas of China, is still scarce. Objective: To study the correlation between baseline blood lipid levels and the overall risk of stroke and its subtype in 45~75 year old people with essential hypertension in Chinese rural areas. Methods: in the CSPPT project population, the relationship between baseline blood lipids and the incidence of stroke and stroke subtypes was studied by a COX proportional risk model. Trend test. One of them corrected sex, age, research center, model two to correct sex, age, research center, baseline systolic blood pressure, baseline fasting blood glucose, and baseline smoking. Results: a total of 20702 people were enrolled in this study, with an average follow-up time of 4.6 years, with a total of 565 stroke patients. The risk and the level of serum total cholesterol at different levels (total population three, minimum Q1, Q1, Q2, Q3) were 1.00,1.08 (0.88,1.32), 1.20 (0.98,1.47), respectively, and different LDL-c levels (Q1, Q2, Q3), respectively, 1.38. 1.00,1.18 (0.98,1.43), 1.03 (0.84,1.26), and different serum total triglyceride levels (Q1, Q2, Q3), respectively, 1.000.97 (0.79,1.18), 0.98 (0.80,1.20). The risk of ischemic stroke after multiple factor correction and the level of serum total cholesterol at different levels (four points of the whole population according to the total serum cholesterol level, the lowest score. " Position Q1 as reference, Q1,02, Q3), respectively: 1.00,1.10 (0.87,1.39), 1.29 (1.02,1.62), and different LDL-c levels (Q1, Q2, Q3) respectively: 1.00,1.24 (0.97,1.58), 1.54 respectively. .05 (0.84,1.31), 1.11 (0.88,1.39). The risk of hemorrhagic stroke after multiple factor correction and the level of total cholesterol at different levels (the overall population four, the lowest level of Q1 as reference, Q1, Q2, Q3) were respectively 1.00,1.15 (0.74,1.78), 1.02 (0.62,1.66), respectively, and different LDL-c levels (Q1, Q3), respectively: 39 (0.90,2.16), 0.96 (0.57,1.61), and different HDL-c levels (Q1, Q2, Q3), respectively, 1.00,1.66 (1.01,2.70), 1.61 (0.98,2.67), respectively, and different serum total triglyceride levels (Q1, Q2, Q3, 0.57), respectively. The levels of serum total cholesterol in the third part of different risk factors and the incidence of cerebral apoplexy Risk analysis background: the occurrence of stroke is increased by a variety of risk factors from multiple links. Age, blood pressure, body mass index and dyslipidemia are the most important risk factors for stroke. Whether there is an interaction between the risk factors of stroke and dyslipidemia is not exact. A study of the incidence of blood lipid and stroke in different age, blood pressure, and body mass index in Chinese stroke primary prevention population. Methods: the correlation between the level of blood pressure and the incidence of stroke was compared between the people of the first level of stroke and the stratification of the blood pressure and the body mass index. Results: the correlation between the levels of blood lipids and the incidence of stroke was obvious in the higher age division. In the different levels of blood pressure, the increase of total serum total cholesterol level and the incidence of stroke increased in the higher subdivision of the average systolic pressure before stroke. In the lower BMI, the level of total serum cholesterol was raised. The incidence of high hemorrhagic stroke was reduced.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R544.1;R743.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 胡榮城;;膽固醇是老年婦女死亡的危險(xiǎn)因素[J];國外醫(yī)學(xué)(老年醫(yī)學(xué)分冊);1990年06期

2 鄭永標(biāo),林新堅(jiān),陳濟(jì)琛,蔡海松,林戎斌;靈芝發(fā)酵茶降低小鼠血清總膽固醇作用簡報(bào)[J];生物技術(shù);2004年01期

3 于志丹;董艷英;;長期服用丙戌酸鈉抗癲癇對小兒血清總膽固醇水平的影響及護(hù)理[J];齊齊哈爾醫(yī)學(xué)院學(xué)報(bào);2006年02期

4 蔡回朝;;兒童血清總膽固醇171例測定結(jié)果分析[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2007年10期

5 徐連蕾;;824例健康體檢者血清總膽固醇水平分析[J];工企醫(yī)刊;2013年04期

6 ;西藏日喀則地區(qū)藏族健康人180名血清總膽固醇含量調(diào)查[J];西藏醫(yī)藥;1977年01期

7 宋愛華;梁樹珊;;血清總膽固醇測定(附海南地區(qū)724例正常值的測定)[J];天津醫(yī)藥;1977年06期

8 王潤鵬 ,王雅范;高齡女性死亡率與血清總膽固醇的關(guān)系[J];日本醫(yī)學(xué)介紹;1990年10期

9 王潤鵬;王亞范;;高齡女性死亡率與血清總膽固醇的關(guān)系——血清膽固醇低值反而危險(xiǎn)性大[J];心血管病學(xué)進(jìn)展;1990年04期

10 趙棣;;青海高原藏、漢族健康成人血清總膽固醇含量調(diào)查[J];高原醫(yī)學(xué)雜志;1991年02期

相關(guān)會(huì)議論文 前4條

1 李紅霞;滿永;王抒;李健齋;;血清總膽固醇的年齡性別差異[A];中國病理生理學(xué)會(huì)動(dòng)脈粥樣硬化專業(yè)委員會(huì)五屆一次會(huì)議論文集[C];2002年

2 莊愛周;吳國友;朱杰;;探討血清總膽固醇和甘油三脂對血小板各參數(shù)檢測的影響及臨床意義[A];2007年浙江省醫(yī)學(xué)檢驗(yàn)學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2007年

3 鄧漢珍;;對413例體檢者的血清總膽固醇、甘油三酯、血糖的調(diào)查分析[A];第十屆全軍檢驗(yàn)醫(yī)學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2005年

4 李金;梁得寧;馬，

本文編號：1798769