国人评估法与汇总队列公式对健康体检人群心血管疾病风险评估价值的比较研究

摘要

目的 比较2011年《中国心血管病预防指南》提出的国人缺血性心血管疾病(CVD) 10年发病危险评估方案(国人评估法)与2013年美国心脏病学会/美国心脏协会(ACC/AHA)推荐的汇总队列动脉粥样硬化性心血管病(ASCVD)风险公式(汇总队列公式)对健康体检人群CVD风险的评估价值,以期找到可更准确评估该人群CVD风险的方法.方法 选取2016年4-9月在首都医科大学附属北京朝阳医院健康体检中心行健康体检者733例,年龄40 ～ 79岁,既往无CVD.分别应用国人评估法与汇总队列公式评估所有体检者10年CVD绝对风险.以颈动脉粥样硬化斑块作为CVD的替代指标,间接反映两种评估方法对该人群CVD绝对风险的评估价值.结果 汇总队列公式评估体检者10年CVD绝对风险高于国人评估法[3.6％(6.6％)比1.5％(3.4％)],差异有统计学意义(Z=-19.122,P＜0.05).将10年CVD风险＜7.5％定义为低危组,10年CVD风险≥7.5％定义为非低危组,国人评估法与汇总队列公式低危组检出率分别为94.1％ (690/733)、73.1％ (536/733),非低危组检出率分别为5.9％ (43/733)、26.9％ (197/733);两种评估方法对是否非低危组评估一致性比较,差异有统计学意义(x2=146.306,P＜0.05).将颈动脉粥样硬化斑块作为CVD的替代指标,汇总队列公式评估体检者10年CVD绝对风险的受试者工作特征(ROC)曲线下面积(AUC)大于国人评估法｛0.770 [95％CI (0.738,0.800)]比0.717 [95％CI (0.683,0.749)]},差异有统计学意义(Z=3.935,P＜0.05).结论 汇总队列公式较国人评估法可更准确评估健康体检人群颈动脉粥样硬化斑块,从而间接说明可更准确评估该人群CVD10年风险.提示汇总队列公式可应用于临床实践,早期识别高危人群,促进CVD一级预防.%Objective To determine which one of the two methods,Chinese evaluation method for 10-year risk of ischemic cardiovascular disease (hereinafter referred to as "Chinese evaluation method") proposed in 2011 Chinese Guidelinesfor Prevention of Cardiovascular Diseases and pooled cohort equations for atherosclerotic cardiovascular diseases (ASCVD) recommended by American College of Cardiology/American Heart Association (ACC/AHA) in 2013 (hereinafter referred to as " pooled cohort equations"),can evaluate cardiovascular disease (CVD) risk more accurately for population having health examination.Methods Totally 733 individuals (40-79 years old,no history of CVD) having health examination in Physical Examination Center,Beijing Chap-Yang Hospital Affiliated to Capital Medical University from April to September 2016 were enrolled.Chinese evaluation method and pooled cohort equations were used to assess their 10-year absolute risk of CVD,respectively.We chose the carotid atherosclerotic plaque as an alternative indicator of CVD.Predicting the 10-year risk of carotid atherosclerotic plaques was supposed to indirectly reflect the values of the two assessment methods for CVD risk.Results Pooled cohort equations had higher accuracy than Chinese evaluation method in predicting the absolute risk of CVD [3.6％ (6.6％) vs 1.5％ (3.4％),Z =-19.122,P ＜ 0.05].Taking 7.5％ as the value for low-risk threshold of 10-year absolute risk of CVD,participants with 10-year absolute risk value of CVD ＜ 7.5％ and ≥7.5％ could be assigned to low-risk group and non -low-risk group,respectively.The detection rate of low-risk participants of pooled cohort equations and Chinese evaluation method was respectively 73.1％ (536/733) and 94.1％ (690/733).The detection rate of non-low-risk participants of pooled cohort equations was higher than that of Chinese evaluation method [26.9％ (197/733) vs 5.9％ (43/733),x2 =146.306,P ＜ O.05].As for the prediction of the absolute risk of carotid atherosclerotic plaques,pooled cohort equations had higher area under the receiver operating characteristic (ROC) curve (AUC) value than Chinese evaluation method did ｛0.770 [95％CI (0.738,0.800)] vs0.717 [95％CI (0.683,0.749)],Z=3.935,P＜0.05}.Conclusion Pooled cohort equations assesses the 10-year risk of carotid plaques more accurately in population having physical examination than Chinese evaluation method,which suggests that it may be more accurate to evaluate the 10-year risk of CVD.Therefore,it is advisable to use pooled cohort equations clinically to identify high-risk groups timely,by which the primary prevention of CVD can be promoted.