中国东部地区缺血性脑卒中病例对照研究及健康教育启示

目的探索中国东部地区缺血性脑卒中发病因素中可以干预的一些因素,为降低中国东部地区缺血性脑卒中患者的发病率和病死率提供建议。方法对2013年1月~2016年8月在福建中医药大学附属第二人民医院体检中心、福建中医药大学附属人民医院体检中心、福建中医药大学附属康复医院、福建省立医院、福建中医药大学附属温州市中医院、河南中医学院第一附属医院、山东中医药大学第二附属医院、广州中医药大学附属第一医院,参加义诊的出院后403例缺血性脑卒中患者和403例健康体检者进行回顾性的病例对照研究。回顾性分析两组的基本情况(年龄、性别、腰围、婚姻、教育程度、腰围、BMI、舒张压、收缩压)、既往史(心脏病史、高血压病史、糖尿病史、高血脂病史、TIA病史)、个人史(吸烟史、饮酒史)和家族史(家族心脏病、家族糖尿病、家族高血压、家族脑卒中)等20个因素。对各相关因素进行单因素的χ2检验,对差异有统计学意义的因素作为自变量进行Logistic回归分析。结果缺血性脑卒中的发病是许多因素共同作用的结果 ,对两组的20个危险因素进行χ~2检验,其中有统计学意义的因素有6个,分别是高血压病、糖尿病、心脏病、血脂异常、肥胖、TIA病史。BMI、高血压、心脏病、糖尿病、高血脂及TIA疾病史与缺血性脑卒中呈正相关(P0.05),其中病例组的TIA病史及高血压病史对缺血性脑卒中发病的影响最大,其相对危险度为对照组的6.42及3.62倍。两组在血压、腰围、吸烟、饮酒、家族史等方面比较,差异无统计学意义(P0.05)。以缺血性脑卒中是否发生为因变量,将上述有统计学意义的单因素作为自变量进行多因素的Logistic回归分析,经回归分析得出:心脏病、BMI、TIA、高血压病史4个因素是影响本地区缺血性脑卒中患者的独立危险因素(P0.05),其中TIA病史与高血压仍然是最重要的独立危险因素,OR值分别为4.57、3.90倍。结论在缺血性脑卒中的综合防治中,应从健康的生活方式出发,及时控制高血压、心脏病、服用抗血小板药物,做到一二级预防相结合。

Case-control study and inspiration to health education of ischemic stroke in eastern China

Objective To explore preventable risk factors of ischemic stroke in eastern China, and provide advices for decreasing the morbidity and mortality of ischemic stroke in eastern China. Methods 403 patients with ischemic stroke,who attended free clinic and were discharged, and 403 healthy checkup people were selected from Medical examination center of the Second people''s Hospital Affiliated to Fujian University of traditional Chinese Medicine, MEC of People''s Hospital Affiliated to Fujian University of traditional Chinese Medicine, Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fujian Provincial Hospital, Wenzhou Traditional Chinese Medicine Hospital Affiliated to Fujian University of traditional Chinese Medicine, the First affiliated Hospital Of Henan University of TCM, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine from November 2015 to June 2017 to do a retrospective case-control study. We retrospected and analyzed 20 factors, including basic information (age, sex, marriage, education, waist circumference, BMI, diastolic blood pressure, systolic blood pressure), past medical history (heart disease, hypertension,diabetes, hyperlipidemia, the history of TIA), personal history (the history of smoking and drinking) and family history (family heart disease, family diabetes, family hypertension, family stroke) of each group. Then we did single factor chisquare test analysis for each factor and used Logistic regression analysis for statistically significant factors. Results The incidence of ischemic stroke is the result of many factors. After chi-square tests for 20 factors, we found six statistically significant factors including hypertension, diabetes, heart disease, dyslipidemia, obesity, and the history of TIA. BMI,hypertension, heart disease, diabetes, hyperlipidemia, and the history of TIA had positive correlations with ischemic stroke (P<0.05). The history of TIA and hypertension in case group had the greatest impact on the incidence of stroke and the risks of stroke in case group were 6.42 and 3.62 times as high as those in control group respectively (OR value were 6.4 and 3.6). There was no significant differences between the two groups in blood pressure, waist circumference,smoking, drinking and family history (P>0.05). With the incidence of ischemic stroke as dependent variable, the above statistical significant single factors were used as independent variables in multivariate Logistic regression analysis. The four factors including heart disease, BMI, the history of TIA and hypertension were independent risk factors of ischemic stroke in the local area(P<0.05), and the history of TIA and hypertension were still the most important independent risk factors as OR values were 4.57 and 3.90 times respectively. Conclusion In the comprehensive prevention and treatment of ischemic stroke, we should start from a healthy lifestyle. What is more, controlling hypertension, heart disease, and taking antiplatelet drugs in time should be done to achieve the combination of primary prevention and secondary prevention.