北京市1984～1999年人群脑卒中发病率变化趋势分析

目的：评估北京市城区1984－1999年16年间急性脑卒中发病率的变化趋势及强度。方法：采用世界卫生组织心血管病趋势及其决定因素的监测方案（monitoring of trends and determinants in cardiovascular diseases,简称WHO MONICA方案）中北京市城区心血管病人群监测及后续研究的资料,逐年计算急性脑卒中事件发作粗率,年龄标化发作率和首发发病粗率,年龄标化首发发病率,用线性回归方法分析发病率的变化趋势和年平均变化幅度,分析各年龄组发病专率的变化状态。结果：（1）北京市1984－1999年急性脑卒中事件的发作率和首发发病率均呈明显的上升趋势,男性年平均增长幅度分别为4．5％和4．1％,女性均为4．2％,（2）65－岁和70－74岁老年组发病率增加尤为明显;（3）1999年北京市65岁及以上老年人口的比较为10．3％,已逐渐步入老龄化社会。结论：北京市脑卒中的发病率呈明显上升趋势。老年组增加更为明显,随着人口的老龄化,人群中脑卒中病人的绝对数增加,应加强脑卒中的一级预防和二级预防。     

北京地区1984-2000年35～74岁人群复发性脑卒中事件发病变化趋势

目的 探讨1984～2000年北京地区35～74岁自然人群复发性急性脑卒中事件的变化趋势和分布特点。方法 在WHO-MONICA方案的北京地区心血管病监测人群中,于1984～2000年用统一标准化的方法登记年龄在35～74岁人群中急性脑卒中事件,脑卒中发作诊断标准采用WHO- MONICA方案的脑卒中诊断标准,在首次发生急性脑卒中事件28 d后再发生的急性脑卒中事件记为复发事件,共登记急性脑卒中13380例。结果 17年间复发性脑卒中事件的发病率由1984年的89．51/10万上升至2000年的143．34/10万,且男性发病率的年平均上升幅度（5．5%）高于女性（3．2%）。出血型脑卒中事件发病率下降了42．94%,缺血型脑卒中事件的发病率上升了153%。复发性脑卒中事件约占总事件的1/3,随时间的变化,复发性脑卒中事件在总事件中的比例呈增加趋势,男性年平均增加1．6%（P＜0．05）,女性年平均增加0．6%;复发性脑卒中事件中男性占31．7%,高于女性的26．9%（P＜0．001）。结论 北京地区1984-2000年间复发性脑卒中事件的发病率总体呈上升趋势,复发性脑卒中事件占总事件的比例随时间的变化逐年增加。     

沈飞地区职工急性冠心病事件的流行病学研究

目的了解沈飞地区2574岁人群1992-2003年急性冠心病事件发病率的分布特点及变化趋势，及可能的影响因素。方法依照北京MONICA研究中心的研究方案，1992-2003年在沈飞地区对2574岁近3万人群开展了心血管病危险因素及发病、死亡的监测工作。以沈飞地区资料为依据，按年度、性别、年龄分别计算急性冠心病事件发病率的变化趋势。结果1992-2003年沈飞地区急性冠心病事件发病率呈轻度上升变化，有统计学意义。男性合计发病率为128．5／10万，大于女性51．4／10万：其差别有统计学意义（P〈0．01）。研究初期与研究末期相比，男性6574岁组每10万人群发病率的绝对增加幅度最大，差率为307．8／10万，男性5564岁组发病率相对增加幅度最大，差率为211％，均有统计学意义。医疗救助率为73．6％，高于北京市平均水平。发病集中在冬、春季，占总发病人数的58％。结论中关村地区中老年男性急性冠心病事件发病率呈显上升，应加强这一人群冠心病防治工作。     

北京部分地区15年脑卒中事件变化趋势—WHO—SINO—MONICA研究

目的 探讨脑卒中在北京地区变化趋势。方法 采用北京地区心血管病人群监测（WHO MONICA方案）诊断标准，通过三级监测网对人群脑卒中发病进行登记监测。结果 ①北京人群15年间（1984－1988年）脑卒中标化发病率呈显著上升的趋势（＋9．0％／年，P＝0．039）。男性为（＋11．4％／年，P＝0．027），女性为（＋8．2％／年），但无显著性差异；人群脑卒中首次发作标化发病率也呈上升的趋势（＋9．1％／年，P＝0．023），男性较女性上升更明显。②人群脑卒中标化死亡呈显著下降的趋势（－6．6％／年，P＝0．042）。城市人群较农村人群下降明显。③人群脑卒中病死率下降趋势明显（－16．7％／年，P＝0．014）。女性较男性更明显。结论 人群脑卒中发病率15年来呈显著上升的趋势，主要是首次发生率的增加，并且与高血压患病率相平等，人群高血压的防治势在必行。     

江苏农村监测人群心血管病发病趋势分析及预测

参照ＷＨＯ－Ｍｏｎｉｃａ方案，１９８３～１９９２年对江苏省海门县３７万自然人群中的冠心病急性事件，脑卒中发病及其防治效果进行了连续１０年监测，初步摸清了该县主要心血管病的发病概况。监测表明该人群急性心肌梗塞、冠心病猝死和脑卒中的年均发病率分别为２．５１／１０万、６．１４／１０万和７７．４７／１０万。同时以灰色预测模型ＧＭ（１．１）对脑卒中的发病趋势进行了预测。     

上海市1999～2001年监测人群脑卒中发病现状分析

目的 了解上海市1999-2001年心脑血管疾病防治点社区监测人群中脑卒中发病现状及变化趋势，探索降低社区人群脑卒中发病率的有效措施。方法 利用上海市1999-2001年心脑血管疾病防治监测网络系统收集的脑卒中新发病例登记报告及汇总资料进行统计分析，并对监测人群脑卒中发病率进行趋势分析。结果 上海市1999-2001年120万监测人群，脑卒中3年平均发病率为154.84/10万（标化发病率为77.00/10万），市区和郊区脑卒中3年平均发病率分别为174.92/10万（标化发病率为75.88/10万）和133.77/10万（标化发病率为84.71/10万），3年来全市监测人群脑卒中总发病率呈下降趋势，其中市区下降较明显，而郊区略有上升，无论市区和郊区均以缺血性脑卒中发病率最高，脑卒中发病率男性均高于女性，35岁以上各年龄组发病率随年龄增长呈几何级数啬 ，60岁以上发病人数占总发病人数的88.79%。结论 3年来上海市监测人群脑卒中总发病率呈下降趋势，可能与上海市在心脑血管疾病防治点社殴开展以控制高血压为主的社区人群综合性干预措施有关。建议以点带面加强全市社区人群脑卒中的防治工作。尤其要加强郊区人群的脑卒中防治工作，并以60岁以上人群为重点防治对象。     

2012-2015年宁波市北仑区脑卒中发病状况流行特征分析

目的了解2012-2015年宁波市北仑区居民脑卒中发病状况的流行特征,为该地区脑卒中的防治提供科学依据。方法本研究资料来源于2012-2015年浙江省慢性病监测信息管理系统北仑区脑卒中发病监测数据库。用Excel 2003建立数据库,用SPSS 18.0统计软件分析该区脑卒中发病率和发病类型的状况和变化趋势,以及年龄和性别差异。结果2012-2015年北仑区脑卒中发病率分别为214.00/10万、206.72/10万、243.28/10万和251.32/10万,男性脑卒中发病率高于女性,从40岁开始,发病率差异逐渐加大。脑卒中发病率随年龄增加而上升,40岁后迅速升高。脑卒中发病类型主要为脑梗死、脑血栓形成、脑出血、脑栓塞及蛛网膜下腔出血。脑梗死的构成比例总体呈上升趋势,脑血栓形成和脑栓塞的构成比例总体呈下降趋势,脑出血和蛛网膜下腔出血大体保持平稳态势。从2013年开始,女性脑梗死的发病比例高于男性,2012-2015年男性脑出血的发病比例一直高于女性。结论宁波市北仑区2012-2015年居民脑卒中的发病率呈缓慢上升趋势,发病率和发病类型具有性别和年龄特征,应针对不同年龄、性别人群发病特征采取有针对性的干预措施。     

中关村地区1984-2000年出血性脑卒中和缺血性脑卒中发病率变化趋势及病因因素探讨

目的评估北京中关村地区人群1984—2000年16年间出血性脑卒中及缺血性脑卒中发病率变化趋势,探索脑卒中危险因素的线索。方法采用北京MONICA监测方案及后续研究资料,按其统计方法,用2000年全国人口年龄构成比计算标化发病率,并分析性别、年龄别在监测初、中、末期发病率变化。结果(1)中关村地区1984—2000年脑卒中年平均发病率男性378.16/10万大于女性209.95/10万(P<0.01)。(2)女性脑卒中发病率、标化发病率呈下降趋势(P<0.05)。(3)人群缺血性脑卒中年平均发病率251.33/10万大于出血性脑卒中年平均发病率41.47/10万(P<0.01)。(4)两型脑卒中发病率随年龄增大而上升(P<0.01)。(5)人群血清胆固醇水平1984与1993年相比个别年龄组呈上升(P<0.05)。结论中关村地区脑卒中防治重点是中老年人群缺血性脑卒中,人群血清胆固醇水平变化是病因因素中监测重点。     

江苏省部分地区女性脑卒中发病与死亡监测

目的了解江苏省部分地区女性人群脑卒中发病率和死亡率以及发病率与危险因素强度之间的联系。方法采用女性脑卒中人群监测(MONICA)诊断标准，通过三级监测网对目标人群脑卒中发病进行登记监测，并分析女性脑卒中死亡率、发病率以及出血型脑卒中发病危险因素水平的地区差异。结果苏北、苏南监测区女性脑卒中标化发病率均高于江苏全省，苏南监测区女性脑卒中标化发病率与全国高发区相近；苏南监测区首次发作出血型脑卒中病例，口服避孕药史者的比率、平均收缩压、平均舒张压值、平均发病年龄均高于苏北监测区，且差异有统计学意义；2个代表监测区1997～2003年国产复方口服避孕药(COC)使用率趋势与脑卒中发病率趋势有较好的一致性。结论女性人群脑卒中的防治工作应成为女性健康服务的重要内容，在不同的地区合理控制女性人群脑卒中发病危险因素，是预防女性脑卒中发病的重要环节。     

北京部分地区15年心脑血管病死亡率变化趋势

目的：探讨北京地部分地区1984－1998年影响人群健康的主要疾病及变化趋势的方向、强度。方法：采用北京部分地区心脑血管病人群监测（MONICA研究）资料,分析主要疾病构成,心血管病死亡率（年龄标化率）;用回归分析的方法计算心血管病死亡率的年均变化率。结果1984－1998年心脑血管病死亡昆北京地区人群第1位的死亡原因（占总死亡人数的46．0％）,第2位死因为癌症（占总死亡人数的26．5％）;本人群冠心病死亡比例15期间有显著增加的趋势（年均0．52％）本人群总死亡率（年均－2．9％）、心脑血管病死亡率呈上升趋势,但差异无显著性,结心血管病为人群经1位死亡原因,冠心病死亡率呈上升的趋势,人群心血管病的预防已成为当务之急。     

甘肃省兰州地区新生儿甲状腺功能减低的筛查

甘肃省是地方性甲状腺肿的高发区 ,为了解新生儿甲状腺功能减低 (甲减 )在人群中的分布情况 ,我们对 1996～ 1999年在我院出生的新生儿进行了筛查。1.研究对象与方法 :(1)研究对象 :凡是 1996～ 1999年在我院出生的新生儿均为筛查对象 ,共计 8896例。经询问其母亲均无甲状腺疾病及内分泌系统疾病〔其中 5例曾患甲状腺功能亢进 (甲亢 )已治愈〕。产妇中 2 2 .8%来自市区 ,5 0 .8%来自郊区 ,2 6 .3%来自较远地、县 ;1/3有职业 ,2 /3是农村妇女。 2 0 %为初中以上文化程度 ,75 %为初中以下文化程度 ,5 %是文盲。(2 )方法 :①标本收集和处理 :对…     

Diverging trends in the incidence and mortality of stroke during the period 1986-2002: a study from the stroke register in Kaunas, Lithuania

AIMS: The aim of the present study was to explore the longitudinal stroke trends in the middle-aged Lithuanian population. METHODS: All stroke events in the studied population were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients aged 25 to 64 years who experienced a stroke between 1986 and 2002. RESULTS: A flat trend was observed in both the incidence and the attack rates of stroke among men during the 17-year study period, while among women, the incidence of stroke increased by 1.7%/year, and the attack rates by 2.3%/year. The 28-day case fatality and mortality rates of stroke decreased significantly in both sexes. The decline in case fatality explained 100% of the decline in mortality. Among the types of stroke, cerebral infarction contributed most to the decline in the mortality in men. In women, the mortality from cerebral infarction and intracerebral haemorrhage declined similarly to that from all types of strokes. CONCLUSIONS: Findings from our study indicating no positive changes in the incidence of stroke but instead an increase among middle-aged women in Kaunas are disturbing. These results suggest a need for the intensification of appropriate strategies for stroke prevention by the public health officials in Lithuania.     

A population-based study of the proportion by type of stroke determined by computed tomography scan]

To investigate the proportion by type of stroke in communities, a stroke surveillance was conducted in three rural populations between 1979 and 1987. Among 411 stroke patients aged 40 and over determined by the modified Millikan's stroke criteria, the type of stroke was analyzed using computed tomography (CT) criteria for 273 patients who were examined by CT. 1. Incidence rates of stroke determined by the modified Millikan's criteria did not vary among the three populations in all age-sex groups except for men aged 60-69. 2. The proportion of stroke patients who had CT examinations was 84-88% for men and women aged 40-69 in the three communities. 3. According to the CT criteria, the proportion by type of stroke in patients aged 40-69 in the three communities was 32% for cerebral hemorrhage, 16% for subarachnoid hemorrhage, 42% for cerebral infarction and 10% for unspecified stroke without CT abnormalities. Among the total with cerebral infarction, the proportion with cerebral infarction in penetrating artery regions, mostly lacunar infarction, was 65% and that of infarction in cortical artery regions, mostly thromboembolic infarction, was 35% for patients aged 40-69. 4. Cerebral infarction in cortical artery regions was classified further into embolic, thrombotic and unspecified types based on CT findings, the presence of embolic origin, and symptoms at the onset. The proportion of these three types of infarction were similar in patients aged 40-69. Compared with hospital-based studies in Japan, the present population-based study showed a higher proportion of cerebral infarction and infarction in penetrating artery regions. This study also indicated that the proportion of cerebral hemorrhage and infarction in penetrating artery regions was higher and that of infarction in cortical artery regions lower in Japanese than in Caucasians.     

急性脑梗死静脉溶栓治疗的临床分析

目的:通过对急性脑梗死静脉溶栓病例分析,探究阿替普酶(rt-PA)静脉溶栓的有效率及其影响因素.方法:回顾性分析发病6小时内使用rt-PA静脉溶栓的急性脑梗死患者26例,分析其疗效的影响因素.结果:26例溶栓病例的总有效率达65.38%;2h内、2~4.5h及4.5~6h内溶栓有效率分别为100%、53.3%及66.6%.溶栓前NIHSS评分4~10分者有效率为100%,11~20分者有效率为50%,20分以上者均无效(0%);超过80岁溶栓有效率为60%;总的脑出血并发症发生率为11.53%.结论:急性脑梗死患者,溶栓时间窗越早,溶栓前NIHSS评分越低,预后越好;高龄不是静脉溶栓绝对禁忌症;溶栓后脑出血发生率较低.     

Alcohol and stroke: a community case-control study in Asturias, Spain.

The relationship between alcohol consumption and stroke is uncertain. Heavy alcohol consumption has been associated with an increased risk of stroke, while light drinking appears to be protective. However, the evidence is not uniform. We sought to examine the relationship between alcohol consumption and stroke, according to stroke type. We performed a population-based case-control study from September 1990 to December 1991. The study comprised 467 incident cases of stroke and 477 controls aged between 40 and 85. Case was defined following WHO criteria and control was randomly selected from the study base population. Alcohol exposure was obtained by medical interview. We found that consumption of less than 30 g/day of alcohol was protective against all stroke types combined, the multivariated adjusted odds ratio (OR) was 0.58 (95% confidence interval [CI], 0.41-0.83). Moderate alcohol drinking is also protective against all cerebral infarction combined (OR = 0.53; 95% CI, 0.35-0.80) and cortical infarction (OR = 0.40; 95% CI, 0.18-0.86). Drinking up to 30 g/day of alcohol has a borderline protective effect on deep cerebral infarction (OR = 0.40; 95% CI, 0.16-1.02) and has no effect on intracerebral hemorrhage (OR = 0.88; 95% CI, 0.44-1.74). Heavy alcohol drinking, over 140 g/day, is a risk factor for all stroke types combined (OR = 3.2; 95% CI, 1.1-9.7), all cerebral infarction combined (OR = 5.0; 95% CI, 1.5-16.3), small deep cerebral infarction (OR = 9.7; 95% CI, 2.6-36.7), intracerebral hemorrhage (OR = 6.2; 95% CI, 1.3-24.0), and is marginally associated with superficial cerebral infarction (OR = 4.6; 95% CI, 1.0-20.6). The relationship between alcohol and stroke depends on the alcohol dose and the pathology of the disease. Atherosclerosis of the large and medium cerebral arteries is found mainly in superficial cerebral infarction, and this type of stroke shows a J-shaped relationship with alcohol similar to that found in coronary heart disease, suggesting that they are similar diseases. On the other hand, arteriosclerosis of the penetrating arteries has been found in deep cerebral infarction and intracerebral hemorrhage, while atherosclerosis is not prominent. This may explain why alcohol does not have a protective effect on cerebral hemorrhage whereas heavy drinking is a strong risk factor in these two types of stroke.     

The FINMONICA Stroke Register. Community-based stroke registration and analysis of stroke incidence in Finland, 1983-1985.

In the early 1980s, a standardized community-based stroke register was started in three geographic areas in Finland: North Karelia and Kuopio in eastern Finland and Turku/Loimaa in southwestern Finland. The results from the first 3 years, 1983-1985, confirmed the high incidence of stroke in Finland. The incidence of stroke was higher in eastern Finland than in the southwestern part of the country. The age-standardized annual incidence among men aged 25-74 years varied from 206 per 100,000 population in southwestern Finland to 322 per 100,000 population in the province of Kuopio in eastern Finland. Among women aged 25-74, incidence was 119 and 187 per 100,000 population in these two areas, respectively. The age-standardized male:female ratio in incidence was 1.7, slightly higher than that previously reported in Finland. Out of 3,574 stroke events registered, 78% were first events without a history of previous stroke. People aged 65-74 years accounted for 45% of all events among men and 62% of all events among women. The authors' experience shows that the geographic variation in stroke incidence and attack rates is difficult to assess even within a country with a relatively uniform health care system. Rigorous standardization and quality control is needed for the assessment of long-term trends; this is the primary goal of the FINMONICA Stroke Register. The findings of this study suggest that the incidence of stroke is still high in Finland, although mortality from stroke has steeply declined during the past 15-20 years. The number of stroke survivors in Finland may actually be increasing. Since the occurrence of stroke is high in Finland as compared with other countries, intensified primary and secondary prevention measures are needed to reduce it.