山东省六市九医院脑卒中危险因素的病例对照研究

doi:10.3969/j.issn.1006-9771.2024.07.013

摘要/Abstract

摘要：

目的探讨山东省六市九医院脑卒中患病的危险因素，比较半岛地区和内陆地区居民脑卒中患病危险因素的异同。
方法选取2022年12月至2023年10月在9所山东大学齐鲁医院康复医学专科联盟医院脑卒中患者作为病例组，以同时期在相关医院进行健康体检的人群作为对照组，两组研究对象样本数相同，按照年龄和性别进行匹配，并收集社会人口学信息和既往疾病史，分析脑卒中的危险因素。
结果最终纳入438例。居住在内陆(OR = 2.07, 95%CI 1.26~3.40, P = 0.04)、吸烟(P = 0.007)、饮酒(OR = 6.67, 95%CI 1.16~38.37, P = 0.019)、抑郁(OR = 2.16, 95%CI 1.03~4.53, P = 0.042)、高血压(OR = 4.15, 95%CI 2.34~7.39, P < 0.001)是发生脑卒中的危险因素。对半岛和内陆居民进行分层分析，吸烟(OR = 3.35, 95%CI 1.11~10.10, P = 0.013)和高血压(OR = 2.79, 95%CI 1.12~6.95, P = 0.004)是半岛地区居民脑卒中可能的危险因素，肥胖(腰围超标)(OR = 1.08, 95%CI 1.03~1.13, P = 0.001)、抑郁(OR = 4.27, 95%CI 1.38~13.23, P = 0.013)和高血压(OR = 4.8, 95%CI 2.21~10.43, P < 0.001)是内陆地区居民脑卒中可能的危险因素。
结论高血压是山东省六市九医院脑卒中患病最可能的危险因素，此外，居住在内陆、吸烟、饮酒也可能会使脑卒中的患病风险增加。半岛地区和内陆地区居民脑卒中可能的危险因素存在差异。

关键词: 脑卒中, 危险因素, 病例对照研究

Abstract:

Objective To investigate the risk factors of stroke in nine hospitals of six cities of Shandong, and compare the differences between residents of peninsula and inland areas.
Methods Stroke patients in nine hospitals belonging to the Rehabilitation Medicine Alliance of Qilu Hospital of Shandong Universityfrom December, 2022 to October, 2023 were selected as the case group. The control group consisted of individuals undergoing health check-ups at the same hospitals during the same period. The sample size of both groups was equal, matched by age and gender, and demographic information and medical history were collected, and the risk factors of stroke were analyzed.
Results A total of 438 cases were included. Residence in the inland (OR = 2.07, 95%CI 1.26 to 3.40， P = 0.04), smoking (P = 0.007), alcohol consumption (OR = 6.67, 95%CI 1.16 to 38.37， P = 0.019), depression (OR = 2.16, 95%CI 1.03 to 4.53， P = 0.042) and hypertension (OR = 4.15, 95%CI 2.34 to 7.39, P < 0.001) were possible risk factors of stroke. However, smoking (OR = 3.35, 95%CI 1.11 to 10.10， P = 0.013) and hypertension (OR = 2.79, 95%CI 1.12 to 6.95， P = 0.004) were possible risk factors for the prevalence of stroke among residents in peninsula areas, and obesity (excess waist circumference) (OR = 1.08, 95%CI 1.03 to 1.13， P = 0.001), depression (OR = 4.27, 95%CI 1.38 to 13.23， P = 0.013) and hypertension (OR = 4.8, 95%CI 2.21 to 10.43; P < 0.001) were possible risk factors for the prevalence of stroke among residents in the inland areas.
Conclusion Hypertension is the most likely risk factor for stroke in nine hospitals of six cities of Shandong Province. Additionally, living inland, smoking and alcohol consumption may also increase the risk of stroke. There are differences in possible risk factors for stroke between peninsula and inland residents, and targeted stroke prevention and control measures should be implemented for different regions.

Key words: stroke, risk factor, case-control study

中图分类号:

R743.3

任晓民, 魏慧, 岳寿伟, 尹森. 山东省六市九医院脑卒中危险因素的病例对照研究[J]. 《中国康复理论与实践》, 2024, 30(7): 839-847.

REN Xiaomin, WEI Hui, YUE Shouwei, YIN Sen. Risk factors of stroke in nine hospitals of six cities in Shandong, China: a case-control study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 839-847.

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参考文献 27

[1]	WANG W, JIANG B, SUN H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults[J]. Circulation, 2017, 135(8): 759-771. doi: 10.1161/CIRCULATIONAHA.116.025250 pmid: 28052979
[2]	王陇德, 刘建民, 杨弋, 等. 我国脑卒中防治仍面临巨大挑战——«中国脑卒中防治报告2018»概要[J]. 中国循环杂志, 2019, 34(2): 105-119.
	WANG L D, LIU J M, YANG Y, et al. The prevention and treatment of stroke still face huge challenges: brief report on Stroke Prevention and Treatment in China, 2018[J]. Chin Circul J, 2019, 34(2): 105-119.
[3]	韦湘, 宁佩珊, 程勋杰, 等. 1990-2016年不同发展水平国家≥70岁人群疾病负担趋势分析[J]. 中南大学学报(医学版), 2019, 44(2): 193-200.
	WEI X, NING P S, CHENG X J, et al. Disease burden among people aged 70 years or older in countries with different development levels from 1990 to 2016[J]. J Central South Univ (Med Sci), 2019, 44(2): 193-200.
[4]	TIAN W, ZHU G, XIAO W, et al. Stroke burden and attributable risk factors in China, 1990-2019[J]. Front Neurol, 2023, 14: 1193056.
[5]	ZHAO Y, HUA X, REN X, et al. Increasing burden of stroke in China: a systematic review and meta-analysis of prevalence, incidence, mortality, and case fatality[J]. Int J Stroke, 2023, 18(3): 259-267.
[6]	LIU L, FAN Y, WANG Z, et al. Disparity in risk factors of ischemic stroke in four coastal-area hospitals in China[J]. Heliyon, 2024, 10(2): e24745.
[7]	GUEVARA P E, ANDRADE F C. Socioeconomic and lifestyle factors associated with chronic conditions among older adults in Ecuador[J]. Rev Panam Salud Publica, 2015, 38(3): 226-232.
[8]	山东省人民政府. 走进山东[EB/OL]. (2024-06-17) [2024-07-11]. http://www.shandong.gov.cn/col/col94094/index.html.
[9]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Chinese diagnostic criteria for cerebral vascular diseases (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[10]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管病一级预防指南2019[J]. 中华神经科杂志, 2019, 52(9): 684-709.
	Chinese Society of Neurology, Chinese Stroke Society. Guidelines for the primary prevention of cerebrovascular diseases in China 2019[J]. Chin J Neurol, 2019, 52(9): 684-709.
[11]	BOEHME A K, ESENWA C, ELKIND M S. Stroke risk factors, genetics, and prevention[J]. Circ Res, 2017, 120(3): 472-495. doi: 10.1161/CIRCRESAHA.116.308398 pmid: 28154098
[12]	WANG J, WEN X, LI W, et al. Risk factors for stroke in the Chinese population: a systematic review and meta-analysis[J]. J Stroke Cerebrovasc Dis, 2017, 26(3): 509-517. doi: S1052-3057(16)30599-7 pmid: 28041900
[13]	李玫, 曹亚景, 岳福娟, 等. 河北省40岁及以上人群脑卒中患病状况及影响因素分析[J]. 中国慢性病预防与控制, 2023, 31(9): 675-679.
	LI M, CAO Y J, YUE F J, et al. Prevalence of stroke and its influencing factors in residents (≥40 years old) of Hebei Province[J]. Chin J Prevent Control Chronic Dis, 2023, 31(9): 675-679.
[14]	李慧君, 李文龙, 吴辉, 等. 河南省新乡县农村居民脑卒中流行现况及影响因素分析[J]. 现代预防医学, 2021, 48(2): 265-269, 279.
	LI H J, LI W L, WU H, et al. Prevalence and influence factors of stroke among rural residents in Xinxiang County, Henan Province[J]. Mod Prevent Med, 2021, 48(2): 265-269, 279.
[15]	李娜, 王浩, 阮钰涵, 等. 1990-2019年浙江省脑卒中疾病负担和危险因素变化趋势研究[J]. 疾病监测, 2022, 37(7): 901-906.
	LI N, WANG H, RUAN Y H, et al. Disease burden of stroke and related risk factors in Zhejiang, 1990-2019[J]. Dis Surveil, 2022, 37(7): 901-906.
[16]	亓建羽, 王晨冉, 刘咪, 等. 1990-2017年中国与不同社会人口学指数地区脑卒中疾病负担和危险因素的比较分析[J]. 中华预防医学杂志, 2021, 55(8): 958-964.
	QI J Y, WANG C R, LIU M, et al. Analysis on disease burden of stroke in China and the regions with different sociodemographic index from 1990 to 2017[J]. Chin J Prevent Med, 2021, 55(8): 958-964.
[17]	FEIGIN V L, ROTH G A, NAGHAVI M, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet Neurol, 2016, 15(9): 913-924. doi: S1474-4422(16)30073-4 pmid: 27291521
[18]	孙宁, 黄富表, 叶婷. 青壮年脑卒中患者不良生活方式调查[J]. 中国康复理论与实践, 2022, 28(1): 24-31. doi: 10.3969/j.issn.1006-9771.2022.01.004
	SUN N, HUANG F B, YE T. Lifestyle for young and middle-aged stroke patients: 268 cases investigation[J]. Chin J Rehabil Theory Pract, 2022, 28(1): 24-31.
[19]	HARSHFIELD E L, GEORGAKIS M K, MALIK R, et al. Modifiable lifestyle factors and risk of stroke: a mendelian randomization analysis[J]. Stroke, 2021, 52(3): 931-936. doi: 10.1161/STROKEAHA.120.031710 pmid: 33535786
[20]	CAPRIO F Z, SOROND F A. Cerebrovascular disease: primary and secondary stroke prevention[J]. Med Clin North Am, 2019, 103(2): 295-308.
[21]	KLEIN J, DIABA-NUHOHO P, GIEBE S, et al. Regulation of endothelial function by cigarette smoke and next-generation tobacco and nicotine products[J]. Pflugers Arch, 2023, 475(7): 835-844.
[22]	SHAH R S, COLE J W. Smoking and stroke: the more you smoke the more you stroke[J]. Expert Rev Cardiovasc Ther, 2010, 8(7): 917-932. doi: 10.1586/erc.10.56 pmid: 20602553
[23]	WU Y, WANG Z, ZHENG Y, et al. The impact of comprehensive tobacco control policies on cardiovascular diseases in Beijing, China[J]. Addiction, 2021, 116(8): 2175-2184. doi: 10.1111/add.15406 pmid: 33404152
[24]	JIANG C H, ZHU F, QIN T T. Relationships between chronic diseases and depression among middle-aged and elderly people in China: a prospective study from CHARLS[J]. Curr Med Sci, 2020, 40(5): 858-870.
[25]	SHEN R, ZHAO N, WANG J, et al. Association between level of depression and coronary heart disease, stroke risk and all-cause and cardiovascular mortality: data from the 2005-2018 National Health and Nutrition Examination Survey[J]. Front Cardiovasc Med, 2022, 9: 954563.
[26]	LI G H, CHEUNG C L, CHUNG A K, et al. Evaluation of bi-directional causal association between depression and cardiovascular diseases: a Mendelian randomization study[J]. Psychol Med, 2022, 52(9): 1765-1776.
[27]	BUCCIARELLI V, CATERINO A L, BIANCO F, et al. Depression and cardiovascular disease: the deep blue sea of women's heart[J]. Trends Cardiovasc Med, 2020, 30(3): 170-176.

变量或选项	释义
体力工作为主	农民、搬运工、司机、家庭主妇等
脑力工作为主	企事业单位人员、学生等
介于体力和脑力劳动之间	个体户等
当前吸烟	以调查当前为时间节点(病例组以发病时为时间节点)，正在吸烟或在过去12个月内有吸烟行为
曾经吸烟	1年多前戒烟的人
曾经饮酒	以调查当前为时间节点(病例组以发病时为时间节点)，在此之前曾经饮酒，现已戒酒
适度饮酒	以调查当前为时间节点(病例组以发病时为时间节点)，目前每月饮酒0.1~3 kg
经常锻炼身体	每周定期进行4 h或更长时间的中、高强度运动
心理社会压力	家庭和工作场所的综合压力测量(长期或多次压力 vs. 过去1年没有或部分压力)
抑郁	过去12个月内连续2周或更长时间感到悲伤、忧郁或抑郁
经常失眠	每周失眠次数≥ 3次
经常熬夜	每周熬夜次数≥ 3次

变量	对照组(n = 217)	病例组(n = 221)	Z值	P值
BMI/(kg∙m^-2)	24.22(22.07, 26.53)	25.54(23.36，27.30)	-3.125	0.002
腰围/cm	87.40(80.00, 90.00)	87.40(80.00，99.50)	-2.299	0.021
臀围/cm	99.1(90.00, 101.00)	100.00(95.00，105.00)	-2.375	0.018
学历/n			-2.803	0.005
小学及以下	37	51
初中	69	73
高中或中专	46	66
大专/大学及以上	65	31
高血压病程/n			-8.553	< 0.001
0年	154	65
0~5年	38	72
6~10年	4	29
> 10年	21	55
糖尿病病程/n			-2.856	0.004
0年	178	154
0~5年	19	34
6~10年	2	13
> 10年	18	20
血脂异常病程/n			-3.457	0.001
0年	176	148
0~5年	31	48
6~10年	3	12
> 10年	7	13

变量	对照组(n = 217)	病例组(n = 221)	χ²值	P值
居住地			3.620	0.057
半岛	111	93
内陆	106	128
吸烟			13.594	0.001
从不吸烟	156	139
曾经吸烟	29	60
当前吸烟	32	22
饮酒			21.951	< 0.001
从不饮酒	133	119
曾经饮酒	30	57
适度饮酒	52	32
每月饮酒> 3 kg	2	13
是否抑郁			4.349	0.037
否	193	181
是	24	40
是否经常失眠			5.544	0.019
否	181	164
是	36	57
是否经常熬夜			3.707	0.054
否	159	179
是	58	42

变量	B	SE	Wald值	自由度	P值	OR(95%CI)
居住在内陆	0.727	0.254	8.213	1	0.004	2.07(1.26~3.40)
抑郁	0.769	0.379	4.124	1	0.042	2.16(1.03~4.53)
吸烟			9.904	2	0.007
曾经吸烟	0.752	0.398				2.12(0.97~4.63)
当前吸烟	-0.716	0.434				0.49(0.21~1.14)
饮酒			9.900	3	0.019
曾经饮酒	-0.193	0.422				0.83(0.36~1.88)
适度饮酒	-0.757	0.393				0.47(0.22~1.01)
每月饮酒> 3 kg	1.898	0.893				6.67(1.16~38.37)
高血压病程			47.204	3	< 0.001
0~5年	1.424	0.294				4.15(2.34~7.39)
6~10年	3.085	0.633				21.86(6.32~75.60)
> 10年	2.001	0.428				7.40(3.20~17.13)

变量	半岛地区		内陆地区		半岛地区		内陆地区
变量	对照组 (n = 111)	病例组 (n = 93)	对照组 (n = 106 )	病例组 (n = 128)	Z值	P值	Z值	P值
BMI/(kg∙m^-2)	24.54 (22.86,27.00)	25.46 (22.88,26.82)	24.19 (21.98,26.29)	25.57 (23.44,27.53)	-1.100	0.271	-3.238	0.001
腰围/cm	87.40 (80.00,93.00)	86.00 (75.50,90.00)	87.40 (78.00,89.00)	90.00 (80.00,102.00)	-1.240	0.215	-4.043	< 0.001
臀围/cm	99.10 (90.00,103.00)	99.10 (92.00,102.50)	99.10 (93.50,100.00)	100.00 (96.50,107.75)	-0.423	0.672	-2.875	0.004
学历/n					-2.625	0.009	-1.320	0.187
小学及以下	18	16	19	35
初中	30	37	39	36
高中或中专	25	30	21	36
大专/大学及以上	38	10	27	21
高血压病程/n					-4.564	< 0.001	-7.698	< 0.001
0年	73	30	81	35
0~5年	17	22	21	50
6~10年	4	15	0	14
> 10年	17	26	4	29
糖尿病病程/n					-0.897	0.370	-3.838	< 0.001
0年	80	60	98	94
0~5年	12	12	7	22
6~10年	2	12	0	1
> 10年	17	9	1	11
血脂异常病程/n					-4.270	< 0.001	-1.046	0.295
0年	86	46	90	102
0~5年	19	30	12	18
6~10年	3	9	0	3
> 10年	3	8	4	5