發(fā)布時間：2018-06-02 19:03

  本文選題：單純收縮期高血壓 + 單純舒張期高血壓�。� 參考：《蘇州大學(xué)》2014年碩士論文

【摘要】：研究背景： 目前國內(nèi)尚未見有關(guān)大樣本的蒙古族人群高血壓亞型與腦卒中發(fā)病關(guān)系的前瞻性研究的相關(guān)報道。 研究目的： 了解農(nóng)牧區(qū)內(nèi)蒙古族人群腦卒中的發(fā)病率及分布特征；了解蒙古族人群中各個血壓亞型的患病率與分布特征；探討高血壓亞型與腦卒中發(fā)病的關(guān)系，為人群腦卒中危險性評估以及危險因素的控制提供流行病學(xué)依據(jù)。 研究對象與方法： 1、基線調(diào)查：2002-2003年選擇蒙古族居民集中的內(nèi)蒙古自治區(qū)科左后旗朝魯吐鄉(xiāng)和奈曼旗固日班花鄉(xiāng)共32個村作為本研究的現(xiàn)場，在此居住的20歲及以上蒙古族居民共2589人簽署知情同意書，并接受了問卷調(diào)查、體格檢查、血壓測量和血標(biāo)本的采集。 問卷調(diào)查內(nèi)容包括：社會人口學(xué)情況、高血壓家族史、吸煙和飲酒情況。采用標(biāo)準(zhǔn)化調(diào)查方法測量血壓和身高、體重、腰圍和臀圍。采集清晨空腹靜脈血，現(xiàn)場分離血清，血標(biāo)本低溫運至實驗室并于-80℃保存，用于甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、胰島素(INS)、C-反應(yīng)蛋白(CRP)、E-選擇素（E-selectin）和細(xì)胞間黏附分子-1(ICAM-1)等指標(biāo)的檢測。 2、隨訪調(diào)查：調(diào)查組分別于2008年10月、2009年8月、2010年8月和2012年8月對參與基線研究的2589名研究對象進(jìn)行了隨訪調(diào)查，結(jié)局事件定義為從基線到最后一次隨訪期間首次發(fā)生的腦卒中事件。采取入戶調(diào)查和查閱監(jiān)測資料、醫(yī)院病歷記錄相結(jié)合的方法，采用標(biāo)準(zhǔn)設(shè)計的調(diào)查表，對每位研究對象進(jìn)行調(diào)查，收集觀察期內(nèi)發(fā)生腦卒中事件的相關(guān)資料。 3、統(tǒng)計分析：用Epidata3.0軟件建立數(shù)據(jù)庫，應(yīng)用SAS9.3軟件和SPSS16.0軟件進(jìn)行統(tǒng)計分析。所有分析均為雙側(cè)檢驗，檢驗水準(zhǔn)α=0.05。 研究結(jié)果： 1、在納入的2589名研究對象中，男性1064人，女性1525人。血壓正常組有1621人；單純收縮期高血壓（ISH）組有121人，占總?cè)巳旱?.67%；單純舒張期高血壓（IDH）組有272人，占總?cè)巳旱?0.51%；復(fù)合型高血壓（SDH）有575人，占到22.21%。其中，男性人群中ISH、IDH、SDH的患病率分別是4.3%、16.4%、24.9%；而女性人群中ISH、IDH、SDH的患病率則分別是4.9%、6.4%、20.3%。 2、在10年的隨訪中，2589個研究對象中新發(fā)腦卒中124例，其中76例為缺血性腦卒中，46例為出血性腦卒中，2例分型不清。血壓正常組、ISH組、IDH組和SDH組缺血性腦卒中的發(fā)病率分別是1.4%、5.0%、2.2%和7.3%；缺血性腦卒中的發(fā)病率分別是0.5%、1.7%、0.7%和5.9%。 3、血壓正常組、ISH組、IDH組和SDH組缺血性腦卒中的發(fā)病密度分別為145/10萬、573/10萬、244/10萬和858/10萬，四組間發(fā)病密度的差異具有統(tǒng)計學(xué)意義（P0.05）；出血性腦卒中的發(fā)病密度分別為53/10萬、191/10萬、81/10萬和694/10萬，四組間發(fā)病密度的差異也具有統(tǒng)計學(xué)意義（P0.05）。 4、缺血性腦卒中Cox回歸分析：結(jié)果顯示，單因素時，與血壓正常組相比，ISH組、IDH組和SDH組發(fā)生缺血性腦卒中的風(fēng)險比（harzard ratio, HR）及95%置信區(qū)間（confidence interval, CI）分別是3.939（1.597-9.715）、1.660（0.673-4.095）和6.030（3.600-10.100）。在調(diào)整了年齡、性別、吸煙、飲酒、血糖、血脂等因素時，，各高血壓亞型發(fā)生缺血性腦卒中的HR（95%CI）分別是3.623（1.445-9.086）、1.510（0.598-3.816）和5.367（3.049-9.446）。 5、出血性腦卒中Cox回歸分析：結(jié)果顯示，單因素時，與血壓正常組相比，ISH組、IDH組和SDH組發(fā)生出血性腦卒中的HR（95%CI）分別是3.605（0.766-16.974）、1.522（0.323-7.167）和13.385（6.196-28.915）。在調(diào)整了年齡、性別、吸煙、飲酒、血糖、血脂等因素時，各高血壓亞型發(fā)生出血性腦卒中的HR（95%CI）分別是4.501（0.923-21.950）、1.59（60.326-7.806）和16.08（36.873-37.635）。 6、按性別分層的Cox回歸分析：結(jié)果顯示，在男性人群中，單因素時，ISH組和IDH組與發(fā)生腦卒中的危險存在關(guān)聯(lián)，HR（95%CI）分別是4.56（51.823-11.433）和5.923（3.476-10.093）。經(jīng)多因素調(diào)整后，ISH和SDH與腦卒中的發(fā)生仍有關(guān)聯(lián)，HR（95%CI）分別是5.001（1.950-12.826）和7.771（4.354-13.871）。在女性人群中，無論是調(diào)整還是未調(diào)整，僅有SDH組與發(fā)生腦卒中的危險性存在關(guān)聯(lián)，HR（95%CI）分別是9.483（4.737-18.985）和6.138（2.873-13.111），具有統(tǒng)計學(xué)意義（P0.05）。女性人群中ISH組和IDH組與腦卒中發(fā)生的危險性均無統(tǒng)計學(xué)意義。 7、利用Kaplan-Meier過程繪制不同血壓亞型的腦卒中累積發(fā)病率隨時間變化的曲線圖。結(jié)果顯示，除了血壓正常組，ISH、IDH、SDH組均表現(xiàn)出腦卒中的累積發(fā)病率隨著時間的推移呈現(xiàn)上升的趨勢。在各個時間段，SDH組的累積發(fā)病率均是最高，ISH組次之，經(jīng)Log-rank檢驗，P0.05。 結(jié)論 1、本研究現(xiàn)場內(nèi)的蒙古族居民具有較高的腦卒中發(fā)病率，男性發(fā)病率高于女性，隨著隨訪時間的增加，腦卒中的發(fā)病率升高，腦卒中已成為威脅當(dāng)?shù)鼐用窠】档闹匾膊『凸残l(wèi)生問題。 2、蒙古族人群中復(fù)合型高血壓患病率最高，其次是單純舒張期高血壓，單純收縮期高血壓的患病率最低。 3、單純收縮期高血壓和復(fù)合型高血壓在老年人群中患病率最高，而單純舒張期高血壓在青壯年人群中患病率最高。 4、單純收縮期高血壓和復(fù)合型高血壓可增加缺血性腦卒中的發(fā)病風(fēng)險。 5、復(fù)合型高血壓可增加出血性腦卒中的發(fā)病風(fēng)險。
[Abstract]:Research background:
At present, there is no report on the prospective study of the relationship between hypertension subtypes and stroke incidence in Mongolian population.
The purpose of the study is:
To understand the incidence and distribution characteristics of stroke in Inner Mongolia population in agricultural and pastoral areas, understand the prevalence and distribution characteristics of each subtype of blood pressure in Mongolian population, explore the relationship between hypertension subtype and stroke, and provide epidemiological basis for the risk assessment of stroke and the control of risk factors in the population.
Research objects and methods:
1, the baseline survey: in 2002-2003 years, 32 villages of the Inner Mongolia Autonomous Region co - Zuo - Zuo and Naiman Banner in Linghai were selected as the site of this study. A total of 2589 people, aged 20 and above, signed the informed consent book, and received a questionnaire survey, physical examination, blood pressure measurement and blood standard. The collection of this.
The questionnaire survey included social demography, family history of hypertension, smoking and drinking. Blood pressure and height, weight, waist circumference and hip circumference were measured by a standardized method of investigation. Early morning venous blood was collected, serum was separated, blood samples were transported to the laboratory at low temperature and stored at -80, used for triglyceride (TG) and total cholesterol (TC). The detection of high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), insulin (INS), C- reactive protein (CRP), E- selectin (E-selectin) and intercellular adhesion molecule -1 (ICAM-1), etc.
2, follow up: a follow-up survey was conducted in October 2008, August 2009, August 2010, and August 2012 for 2589 subjects involved in the baseline study. The outcome event was defined as the first stroke event from the baseline to the last follow-up. A household survey and monitoring data were taken, and the hospital records were recorded. A standardized design questionnaire was used to collect data from each subject and collect data on stroke events during the observation period.
3, statistical analysis: using Epidata3.0 software to build a database, using SAS9.3 software and SPSS16.0 software for statistical analysis. All the analyses are both bilateral test, the level of test is alpha =0.05.
The results of the study:
1 of the 2589 subjects included, 1064 were male and 1525 were female, 1621 were normal blood pressure groups, 121 in the group of simple systolic hypertension (ISH), 4.67% in the total, 272 in the group of simple diastolic hypertension (IDH), 10.51% in the total population, and 575 in SDH, which accounted for 22.21%., and ISH, IDH in the male population. The prevalence of SDH was 4.3%, 16.4% and 24.9% respectively, while the prevalence of ISH, IDH and SDH in women was 4.9%, 6.4%, and 20.3%. respectively.
2, during the 10 year follow-up, 124 cases of new stroke were found in 2589 subjects, of which 76 were ischemic stroke, 46 was hemorrhagic stroke, and 2 were poorly typed. The incidence of ischemic stroke in the normal blood pressure group, the ISH group, the IDH group and the SDH group were 1.4%, 5%, 2.2%, and 7.3% respectively; the incidence of ischemic stroke was 0.5%, 1.7%, 0.7%, respectively. And 5.9%.
3, in the normal blood pressure group, the ISH group, the IDH group and the SDH group, the incidence of ischemic stroke was 145/10 million, 573/10 million, 244/10 Vanward 858/10 million, and the difference between the four groups was statistically significant (P0.05); the incidence of hemorrhagic stroke was 53/10 million, 191/10 million, 81/10 Vanward 694/10 million, and the difference between the four groups was different. It also has statistical significance (P0.05).
4, Cox regression analysis of ischemic stroke: the results showed that the risk of ischemic stroke in group ISH, IDH and SDH (harzard ratio, HR) and 95% confidence interval (confidence interval, CI) were 3.939 (1.597-9.715), 1.660 (0.673-4.095) and 6.030, compared with the normal blood pressure group, and the age was adjusted. When sex, smoking, drinking, blood sugar, blood lipid and other factors, the HR (95%CI) of ischemic stroke in the hypertensive subtypes was 3.623 (1.445-9.086), 1.510 (0.598-3.816) and 5.367 (3.049-9.446), respectively.
5, Cox regression analysis of hemorrhagic stroke: the results showed that, when compared with the normal blood pressure group, the HR (95%CI) of hemorrhagic stroke in the ISH group, the IDH group and the SDH group was 3.605 (0.766-16.974), 1.522 (0.323-7.167) and 13.385 (6.196-28.915) in the single factor, and the hypertension subgroups were adjusted for the factors of age, sex, smoking, drinking, blood sugar and blood lipids. The incidence of hemorrhagic stroke in HR (95%CI) was 4.501 (0.923-21.950), 1.59 (60.326-7.806) and 16.08 (36.873-37.635) respectively.
6, Cox regression analysis by sex stratification: the results showed that in the male population, in the single factor, the ISH and IDH groups were associated with the risk of stroke, and HR (95%CI) was 4.56 (51.823-11.433) and 5.923 (3.476-10.093), respectively. After multiple factors, ISH and SDH were associated with stroke, HR (95%CI) was 5.001 (1.950-12.826), respectively. And 7.771 (4.354-13.871). In the female population, no matter the adjustment or adjustment, only the SDH group was associated with the risk of stroke, and HR (95%CI) was 9.483 (4.737-18.985) and 6.138 (2.873-13.111), respectively, and was statistically significant (P0.05). There was no statistical significance in the risk of ISH and IDH group and stroke in female population.
7, the cumulative incidence of stroke in different blood pressure subtypes was plotted by Kaplan-Meier process. The results showed that the cumulative incidence of stroke in the ISH, IDH and SDH groups showed an upward trend with time. The cumulative incidence of the SDH group was the highest in each time period, the group ISH was the highest in the group ISH. Second, by Log-rank test, P0.05.
conclusion
1, the Mongolian residents in this study have higher incidence of stroke, the incidence of male is higher than that of women. With the increase of follow-up time, the incidence of stroke increases. Stroke has become an important disease and public health problem that threatens the health of the local residents.
2, the prevalence of compound hypertension was the highest among Mongolian population, followed by diastolic hypertension, and the lowest prevalence of isolated systolic hypertension.
3, isolated systolic hypertension and complex hypertension have the highest prevalence among the elderly, while diastolic hypertension has the highest prevalence among young adults.
4, isolated systolic hypertension and complex hypertension can increase the risk of ischemic stroke.
5, complex hypertension can increase the risk of hemorrhagic stroke.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3;R544.1

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