论文部分内容阅读
目的探讨累积血压暴露[累积收缩压(cumSBP)和累积舒张压(cumDBP)]对脑卒中的预测价值。方法采取前瞻性队列研究方法,以参加2006-2007、2008-2009、2010-2011年开滦集团健康体检的无脑卒中病史的职工53 582人为观察对象,以脑卒中发生为终点事件。依据cumSBP(mm Hg·年)和cumDBP(mm Hg·年)四分位分组:cumSBP第1四分位组(<480)、cumSBP第2四分位组(480~<520)、cumSBP第3四分位组(520~<560)、cumSBP第4四分位组(≥560),cumDBP第1四分位组(<320)、cumDBP第2四分位组(320~<340)、cumDBP第3四分位组(340~<360)、cumDBP第4四分位组(≥360)。用寿命表法计算总人群不同cumSBP、cumDBP的累积脑卒中发生率,并采用Cox比例风险模型分析cumSBP、cumDBP第4四分位组对脑卒中事件的影响。结果观察对象53 582人中,男性41 171人(76.8%),女性12 411人(23.2%),年龄(49.0±11.8)岁。随访(2.99±0.40)年,共发生脑卒中事件526例。总人群脑卒中事件累积发生率随着cumSBP、cumDBP的增高而呈上升趋势。多因素Cox比例风险回归模型分析显示,与cumSBP第1四分位组相比,cumSBP第3、4四分位组发生脑卒中事件的HR值(95%CI)分别为1.69(1.21~2.35)、2.03(1.47~2.80);与cumDBP第1四分位组相比,cumDBP第3、4四分位组发生脑卒中事件的HR值(95%CI)分别为1.46(1.07~1.98)、1.86(1.41~2.46)。结论高cumSBP和高cumDBP是发生脑卒中事件的危险因素。
Objective To investigate the predictive value of cumulative blood pressure exposure (cumulative systolic blood pressure (cumSBP) and cumulative blood pressure (cumDBP)] on stroke. Methods A prospective cohort study was conducted to investigate the prevalence of stroke in the Kailuan Group from 2006 to 2007, 2008 - 2009 and 2010-2011. A total of 53 582 workers without a history of stroke were enrolled in this study. Based on the quartiles of cumSBP (mm Hg · year) and cumDBP (mm Hg · year), the first quartile of cumSBP (<480), the second quartile of cumSBP (480 to <520), the third cumSBP Quartile (520 to 560), cumSBP fourth quartile (≥560), cumDBP first quartile (<320), cumDBP second quartile (320-340), cumDBP Third quartile (340 ~ <360), fourth quartile of cumDBP (≥360). The cumulative incidence of cumulative stroke with cumSBP and cumDBP was calculated using the life table method and the impact of cumSBP and cumDBP fourth quartile on stroke was analyzed using the Cox proportional hazards model. Results Among 53 582 subjects, 41 171 (76.8%) were male and 12 411 (23.2%) were female, with an age of (49.0 ± 11.8) years. Follow-up (2.99 ± 0.40) years, a total of 526 cases of stroke events. The cumulative incidence of stroke in the general population increased with the increase of cumSBP and cumDBP. In the multivariate Cox proportional hazards regression analysis, HR scores (95% CI) for the incidence of stroke in the 3,4 and 4 quartiles of cumSBP were 1.69 (1.21 to 2.35) , 2.03 (1.47 ~ 2.80). Compared with the first quartile of cumDBP, the HR (95% CI) of the incidence of stroke in the third and fourth quartiles of cumDBP were 1.46 (1.07-1.98) and 1.86 (1.41 ~ 2.46). Conclusions High cumSBP and high cumDBP are risk factors for stroke.