北京市丰台区部分社区脑卒中高危人群血脂控制现状调查及中医症状证候分析

目的:调查北京市丰台区部分社区脑卒中高危人群血脂控制达标情况及用药现状,探讨分析血脂达标人群与不达标人群的中医症状及证候特点。方法:采用横断面临床流行病学调查的方法对北京市丰台区8个社区40岁以上人群进行流行病学调查,筛选出脑卒中高危人群共9 605例,记录其人口学特征、既往病史、用药信息及中医症状四诊信息,并抽取空腹血检测其三酰甘油(TG)、总胆固醇(TCHO)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平。将人群根据有无危险因素与动脉粥样硬化性心血管疾病(ASCVD)进行危险分层,分为极高危组、高危组、中危组、低危组,根据各自的LDL-C目标值(2.1 mmol/L、2.6 mmol/L、3.4 mmol/L、4.1 mmol/L)分别统计各组血脂达标率,并分析达标组与不达标组的中医症状、舌脉象及证候之间的差异。结果:在9 605例脑卒中高危人群中,血脂代谢异常患病率为80.4%,药物治疗率为32.9%,他汀类使用率为31.9%,极高危组、高危组、中危组、低危组的血脂达标率分别为15%、26.5%、58.2%、83.7%,总体达标率为43.8%。达标组形体消瘦发生率显著高于不达标组(P0.01),面色萎黄、面红、头重如裹、头晕、口渴、口苦、口黏腻、胸闷、腰膝酸软、肢体笨拙、乏力、失眠、夜尿频多、咳笑遗尿、舌质暗、脉滑发生率低于不达标组(P0.01,P0.05)。达标组的血瘀证、气虚证发生率低于不达标组(P0.01、P0.05)。结论:北京市丰台区部分社区脑卒中高危人群血脂控制达标率较低,存在不合理用药现象,血脂控制不达标人群较之达标人群,脾肾气虚证、痰湿瘀血证更为明显。

Observation on Blood Lipids Control of High Risk Population of Stroke and its TCM Syndrome in Fengtai Community

To investigate blood lipid level and medication of high risk population of stroke in eight communities of Beijing and to explore the TCM syndrome differences and distribution between patients who reached ideal LDL C and those who did not. Methods:A total of 9605 cases aged over 40 with high risk factors of stroke were recruited from eight communities of Beijing. Demographic characteristics, past medical history, drug history,TCM symptoms and four diagnostic information were obtained. Blood lipid levels were measured from fasting blood, including Triglyceride(TG), total cholesterol(TCHO), low density lipoprotein cholesterol(LDL C) and high density lipoprotein cholesterol(HDL C). According to different risk factors and whether the patient has arteriosclerotic cardiovascular disease(ASCVD), patients were divided into extremely high risk group, high risk group, medium risk group and low risk group. Different LDL C goals were set up for each groups: 2.1 mmol/L, 2.6mmol/L, 3.4mmol/L and 4.1 mmol/L. The percentages of cases achieved the goals in these four groups were calculated respectively. Besides, TCM symptoms, tongue examinations and pulse manifestations were analyzed. Results:Among 9605 residents with high risk of stroke,the percentage of cases with dyslipidemia was 80.4%, lipid lowing treatment rate was 32.9%, and statin treatment rate was 31.9%. The percentages of patients who achieved LDL C goals in extreme high risk group, high risk group, medium risk group and low risk group were 26.5%, 15%, 58.2% ,83.7% respectively, and the overall LDL C goal achieved rate was 43.8%. As for TCM symptoms, the occurrence rate of emaciation in goal achieved group was significantly higher than that in goal not achieved group(P<0.01). The occurrence rates of sallow complexion, flushing, head feeling heavy as if swathed, dizziness, insomnia, thirst, bitter taste of mouth, sticky and greasy mouth, chest tightness, soreness and weakness of waist and knees, clumsy limb, fatigue, frequent urination at night, cough laugh enuresis, dark tongue and slippery pulse in goal achieved group were lower than that in goal not achieved group (P<0.01, P<0.05). The occurrence rate of blood stasis syndrome and Qi deficiency syndrome in goal achieved group were lower than those of the goal not achieved group (P<0.05, P<0.01). Conclusion:The percentage of patients who achieved LDL C goals in communities of Beijing was relatively low, and there was a phenomenon of drug misuse. Spleen and kidney deficiency, phlegm and blood stasis syndrome were more obvious among patients who fail to control cholesterol.