脑卒中高危人群颈动脉中膜内层厚度变化的影响因素研究

摘要

目的 探讨影响脑卒中高危人群颈动脉中膜内层厚度(IMT)的危险因素.方法 采用整群随机抽样方法,抽取深圳市桃源社区及流塘社区40岁以上常住居民4 202人为筛查对象,所有筛查对象均予以问卷调查及初步体格检查与实验室检查,对初筛判定为高危风险的人群进一步进行复筛,复筛内容中包括颈部血管超声等.结果 共获得具备颈部超声结果的341例高危人群数据,进一步将颈部血管超声以IMT为1.0 mm将研究对象分为IMT<1.0 mm和IMT≥1.0 mm两组进行分析比较.结果表明,具备IMT指标的341例高危人群中,IMT<1.0 mm的占43.7%,IMT≥1.0 mm的占56.3%.二分类非条件多元Logistic回归分析发现,收缩压(OR=1.621,P<0.001)、甘油三酯(1.263,P=0.040)、血清同型半胱氨酸(Hcy)(OR=1.054,P=0.049)是IMT增厚的危险因素,而女性(OR=0.560,P=0.032)是IMT增厚的保护因素.进一步分析比较两组中血清Hcy的变化,发现IMT≥1.0 mm组的Hcy平均水平高于IMT<1.0 mm组(14.39 ± 6.54 mmol/L vs 16.42 ± 9.15 mmol/L,P=0.039);并且血清Hcy水平与IMT之间存在正相关关系.结论 应定期针对社区人群进行脑卒中危险因素的筛查,尤其对于高血压患者伴有Hcy增高及甘油三酯增高的患者需进一步增加颈部血管超声的检查,以便及早进行干预,预防脑卒中的发生,降低人群发生脑血管意外的死亡率.%Objectvies To explore the risk factor of carotid artery intia-media thickness(IMT)among high risk population of stroke.Method:Using random sampling method,4202 residents aged over 40 who lvied in Taoyuan community and Liutang community of Shenzhen city were selected as screening samples.After questionnaire survey,preliminary medical examination and laboratory examination,high risk residents were further screened including neck vascular ultrasound etc.Results 341 samples were collected with neck vascular ultrasound inspection results.And all the samples were separated into two groups according to IMT(IMT < 1.0 mm or IMT ≥ 1.0 mm).The results shown that in 43.7% and 56.3% of the 341 stroke high risk samples,the IMT were < 1.0 mm and ≥1.0 mm,respectviely.Two classification of non conditional multviariate Logistic regression analysis showed that systolic blood pressure(OR=1.621,P＜0.001),triglycerides(1.263,P=0.040)and serum homocysteine(Hcy)(OR=1.054,P=0.049)were risk factors of IMT thickening,and the female(OR=0.560,P=0.032)were the protectvie factors of IMT thickening.Further comparing the HCY levels in serum between the two groups,we found that the average level of Hcy in the group IMT ≥ 1.0 mm is higher than that of the group IMT<1.0 mm(14.39±6.54 mmol/L vs 16.42±9.15 mmol/L,P=0.039).Besides,there is a positvie correlation between the serum level of Hcy and IMT.Conclusions We should screen for risk factors of stroke in community population,regularly.And hypertensvie patients accompanied with high level of Hcy and triglyceride need to take the neck vascular ultrasound examination for early intervention.So that we could prevent stroke and reduce the incidence of cerebrovascular accident.