摘要
背景基线总胆固醇(TC)是新发脑卒中的影响因素,而国内外尚无关于累积总胆固醇暴露值(cumTC)对新发脑卒中影响的研究。目的 探究cumTC对新发脑卒中的影响。方法 采用前瞻性队列研究方法,选取2006-2010年在开滦总医院等共计11家医院进行健康体检的开滦集团在职及离退休职工52 427例为研究对象。以研究对象完成2010年度健康体检时点为随访起点,以新发脑卒中事件、死亡或至随访结束(2017-12-31)为随访终点。依据cumTC四分位进行分组,观察各组人群基线资料和新发脑卒中发病率。经Kaplan-Meier法计算累积发病率,以LogRank法进行检验,采用Cox回归模型分析不同cumTC组对新发脑卒中事件的影响,采用似然比检验比较不同模型的拟合程度。结果 不同cumTC水平组间年龄、男性占比、收缩压(SBP)、舒张压(DBP)、体质指数(BMI)、cumTC、TC、HDL-C、FBG、脑卒中、缺血性脑卒中、吸烟、饮酒、高血压病及糖尿病检出率、服调脂药占比比较,差异有统计学意义(P<0.05)。平均随访(6.89±0.72)年,共新发脑卒中1 611例(缺血性脑卒中1 415例、出血性脑卒中229例)。第一分位组~第四分位组脑卒中累积发病率分别为2.53%(331/13 089)、2.92%(384/13 148)、4.18%(547/13 085)、4.36%(571/13 105);缺血性脑卒中累积发病率分别为2.17%(284/13 089)、2.51%(330/13 148)、3.71%(485/13 085)、3.99%(523/13 105),经Log-Rank检验,差异均有统计学意义(χ^2=73.15,P<0.001;χ^2=109.13,P<0.001)。Cox回归分析显示:校正年龄、性别、BMI、高血压、糖尿病、吸烟、饮酒、体育锻炼变量后,与cumTC第一分位组相比,第四分位组发生脑卒中、缺血性脑卒中的HR (95%CI)分别是1.27(1.10,1.48)、1.37(1.16,1.60),第三分位组发生脑卒中、缺血性脑卒中的HR(95%CI)分别是1.22(1.05,1.41)、1.27(1.08,1.50),增加校正基线TC水平、服调脂药后,经似然比检验后,模型的拟合程度并未得到优化(P>0.05)。校正
Background Baseline total cholesterol(TC) is an influencing factor of new-onset stroke,but no studies have been conducted on the effect of cumulative total cholesterol exposure(cumTC) on new-onset stroke.Objective To explore the effect of cumTC on new-onset stroke.Methods Using prospective cohort study method,52 427 working and retired employees of Kailuan Group who had physical examination in 11 hospitals including Kai Luan General Hospital from 2006 to 2010 were selected as the study objects.The starting point of the follow-up was when the objects completed the physical examination in 2010,and the end point was when new-onset stroke or deaths happened or the end of the follow-up(2017-12-31).Baseline data and the incidence of new-onset stroke in each group were observed after all objects were grouped according to the cum TC quartile.The cumulative incidence was calculated by Kaplan-Meier method and tested by Log-Rank method.Cox regression model was used to analyze the effect of different cum TC on new-onset stroke.The fitting degree of different models was compared by likelihood ratio test.Results There were significant differences in age,male proportion,systolic blood pressure(SBP),diastolic blood pressure(DBP),BMI,cum TC,TC,high-density lipoprotein cholesterol(HDL-C),fasting blood glucose(FBG),stroke,ischemic stroke,smoking,drinking,hypertension and diabetes detection rates,taking lipid-lowering drugs proportion among groups with different levels of cum TC(P<0.05).During a mean follow-up year of(6.89±0.72),there were 1 611 new cases of stroke(1 415 cases of ischemic stroke and 229 cases of hemorrhagic stroke).The cumulative incidence of stroke was 2.53%(331/13 089),2.92%(384/13 148),4.18%(547/13 085) and 4.36%(571/13 105) in the first to the fourth quartile group,respectively,and the cumulative incidence of ischemic stroke was 2.17%(284/13 089),2.51%(330/13 148),3.71%(485/13 085) and 3.99%(523/13 105),respectively.The difference was statistically significant by LogRank test(χ~2=73.15,P<0.001;χ~2=109.13,P<0.
作者
皇甫春梅
宋永健
闫丽丽
李雪梅
袁建新
杨娜
吴寿岭
HUANGFU Chunmei;SONG Yongjian;YAN Lili;LI Xuemei;YUAN Jianxin;YANG Na;WU Shouling(Division 1 of Department of Neurology,Kailuan General Hospital,Tangshan 063000,China;Graduate School of North China University of Science and Technology,Tangshan 063000,China;College of Psychology,North China University of Science and Technology,Tangshan 063000,China;Department of Cardiovascular Medicine,Kailuan General Hospital,Tangshan 063000,China)
出处
《中国全科医学》
CAS
北大核心
2020年第10期1267-1273,共7页
Chinese General Practice
关键词
总胆固醇
累积暴露值
卒中
影响因素分析
前瞻性研究
队列研究
Total cholesterol
Cumulative exposure
Stroke
Root cause analysis
Prospective studies
Cohort studies
