脑卒中高危人群颈动脉粥样硬化的危险因素分析

目的:探讨脑卒中高危人群颈动脉粥样硬化发生的相关危险因素。方法:选取2012年4月至2013年4月蒲黄榆社区、王佐镇、花乡、方庄街道筛查中的脑卒中高危人群8 045例,将人群分为有无颈动脉内膜中层增厚组、有无斑块形成组,分别对比2组人群存在的危险因素分布情况;根据吸烟、高血压、糖尿病3个危险因素的有无,将颈动脉内膜中层增厚人群分为3组,分别为同时合并3个危险因素组、合并1至2个危险因素组、不合并危险因素组,另外斑块形成人群同上分为3组,依次进行危险因素的相互比较。结果:单因素分析:颈动脉内膜中层增厚与斑块形成均与年龄、脑卒中病史、高血压、糖尿病、吸烟、冠心病、体育锻炼层增厚呈正相关;均与受教育程度、脑卒中家族史、常吃水果呈负相关。另外内膜中层增厚还与TIA呈负相关,与常吃蔬菜呈负相关;斑块形成还与饮酒、常喝牛奶或酸奶呈正相关,与明显超重、瓣膜性心脏病呈负相关。多因素分析:颈动脉内膜中层增厚与斑块形成均与受教育程度呈负相关,与年龄、脑卒中、糖尿病病史、吸烟、体育锻炼呈正相关。另外内膜增厚还与饮酒习惯成负相关,与明显超重成正相关;斑块形成与饮用高度白酒呈正相关。中医症状分析:根据危险因素多少分组比较发现多个症状存在差异;中医证型分析:在内膜中层增厚人群的2组比较中,痰湿证、内火证均有差异,而气虚证在同时合并3个危险因素与不合并危险因素的人群比较中有统计学意义。而在斑块形成的2组人群比较中,痰湿证和内火证均有差异。结论:吸烟、高血压病、糖尿病等多个危险因素对颈动脉内膜中层增厚及斑块形成发挥重要的影响作用,通过分析我们可通过控制上述可干预因素达到早期防治脑卒中的目标。

Risk Factors for Carotid Atherosclerosis Among High Risk Populations of Stroke

To observe the risk factors associated with carotid atherosclerosis occurred in high risk populations of stroke. Methods:To select 8,045 high risk cases of stroke from Puhuangyu, Wangzuo, Huaxiang and Fangzhuang community health service centers who enrolled from April 2012 to April 2013. The patients were divided into groups with and without carotid intima media thickening, with and without plaque, then were compared to observe the distribution of risk factors. The group with carotid intima media thickening or formation of plaque were divided into 3 groups according to risk factors as smoking, hypertension and diabetes. The three groups are: a group that simultaneously exposed to the three risk factors, a group exposed to two risk factors and a group that exposed to no risk factors. Besides, patients with formation of plague were also divided into three groups as above, and the risk factors were compared. Results:Univariate analysis: formation of carotid artery intima media thickening and plaques were positively associated with age, history of stroke, hypertension, diabetes, smoking, coronary heart disease, physical activity and were negatively associated with education level, family history of stroke, dietary habits of eating fruits. Intima media thickening also negatively correlated with TIA and eating vegetables. Plaque formation also positively associated with alcohol consumption, milk or yogurt eating and negatively associated with significantly overweight and valvular heart disease. Multivariate analysis: formation of carotid artery intima media thickening and plaques were positively correlated with the level of education and were negatively correlated with age, stroke, diabetes, smoking and physical activity. Intimal thickening was negatively correlated with drinking habits and positively correlated with significantly overweight. Plaque formation was positively correlated with drinking high spirits. TCM symptoms analysis: comparison among groups presenting different symptoms. Syndromes analysis: the situation of phlegm, endogenous fire were significantly different in comparison of intima media thickening crowd, and the situation of qi deficiency were significantly different between patients exposed to three risk factors and exposed to no factors. The situation of phlegm, endogenous fire were different within the groups of plaque formation crowd. Conclusion:Smoking, hypertension, diabetes and other risk factors was crucial in carotid intima media thickening and plaque formation. Through controlling these risk factors, it is able to prevent stoke at an early stage.