心血管病高危人群早发家族史与脑卒中的关联

程亭亭; 苏健; 覃玉; 崔岚; 丁帅; 缪伟刚; 周金意; 武鸣

doi:10.16462/j.cnki.zhjbkz.2020.10.004

心血管病高危人群早发家族史与脑卒中的关联

doi: 10.16462/j.cnki.zhjbkz.2020.10.004

210000 南京, 东南大学公共卫生学院流行病与卫生统计学系

基金项目:

国家重大公共卫生项目 Cai She〔2014〕No.37

详细信息

通讯作者:
武鸣，E-mail：jswuming@vip.sina.com

中图分类号: R181
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出版历程
- 收稿日期: 2020-05-19
- 修回日期: 2020-08-16
- 刊出日期: 2020-10-10

Association between early-onset family history and stroke prevalence in high-risk populations of cardiovascular disease

Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210000, China

Funds:

NNational Major Public Health Service Project Cai She〔2014〕No.37

More Information

Corresponding author: WU Ming,E-mail:jswuming@vip.sina.com

摘要

摘要: 目的了解心血管病高危人群的脑卒中早发家族史对脑卒中患病风险的影响。方法基于2015年9月至2019年6月中国心血管病高危人群早期筛查与综合干预项目（China PEACE-MPP）江苏省22 552名心血管病高危人群数据，采用Logistic回归分析模型研究早发家族史对脑卒中患病的影响，并进一步进行早发家族史与高血压、糖尿病的交互作用分析。结果与无早发家族史人群相比，有脑卒中早发家族史的人群患脑卒中的风险较高，OR值为2.04（95% CI：1.70~2.44）；对于缺血性脑卒中的发病风险来说，男性亲属型、女性亲属型和双性亲属型皆比无早发家族史人群患病风险高，OR值分别为2.18（95% CI：1.68~2.84）、1.76（95% CI：1.3~2.37）和3.12（95% CI：1.80~5.42）；对于出血性脑卒中患病风险来说，只有女性亲属型人群与脑卒中无统计学意义。研究未发现早发家族史与高血压、糖尿病存在交互作用。结论有脑卒中早发家族史的心血管病高危人群发生脑卒中的风险较高，应当及早开展生活方式干预和疾病的治疗管理。
- 心血管病高危人群 /
- 早发家族史 /
- 脑卒中
Abstract: Objective To investigate how the early-onset family history of stroke influences the stroke in high-risk populations of cardiovascular disease. Methods Based on the China Patient-centered Evaluative Assessment of Cardiac Events Million Persons Project (China PEACE-MPP) from 2015 to 2019, a total of 22 552 persons at high-risk for cardiovascular disease (CVD) were selected from eight project areas in Jiangsu. Logistic regression analysis model was used to research the impact of early-onset family history on stroke prevalence, and further analyses of the interaction between early-onset family history and hypertension or diabetes were carried on. Results Compared with people without early-onset family history, people with early-onset family history of stroke had a higher risk of stroke, with an OR value of 2.04 (95% CI:1.70-2.44). For the risk of ischemic stroke, people whose only male relatives, only female relatives and bisexual relatives suffering from stroke had a higher risk of stroke than those without early onset family history, with OR values of 2.18 (95% CI:1.68-2.84), 1.76 (95% CI:1.31-2.37) and 3.12 (95% CI:1.80-5.42), respectively. For the risk of hemorrhagic stroke, only female relatives type was not significant. No interaction between early-onset family history or hypertension and diabetes was found. Conclusions People at high risk of CVD with the early-onset family history have a higher risk of stroke. Lifestyle intervention and disease management should be carried out opportunely.
- Cardiovascular disease high-risk population /
- Early-onset family history /
- Stroke

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表 1 2015―2019年江苏省有无脑卒中家族史研究对象的基本特征分布[n(%)]

Table 1. Basic characteristics of research objects with family history or not in Jiangsu from 2015 to 2019 [n(%)]

基本特征	总人群(n=22 552)	是否脑卒中		t/X²/Z值	P值
基本特征	总人群(n=22 552)	否(n=20 831)	是(n=1 721)	t/X²/Z值	P值
年龄(岁，x±s)	59.72±8.77	59.47±8.85	62.77±7.15	184.690	＜0.001
性别				23.378	＜0.001
男	9 730(43.1)	8 888(42.7)	842(48.9)
女	12 822(56.9)	11 943(57.3)	879(51.1)
地区				3.596	0.058
城市	10 265(45.5)	9 444(45.3)	821(47.7)
农村	12 287(54.5)	11 387(54.7)	900(52.3)
文化程度				-5.897	＜0.001
小学及以下	13 077(58.0)	11 954(57.4)	1 123(65.3)
初中	6 529(29.0)	6 130(29.4)	399(23.2)
高中	2 250(10.0)	1 758(8.4)	130(7.6)
大学及以上	696(3.1)	989(4.7)	69(4.0)
BMI (kg/m²)				-3.951	＜0.001
＜24	5 577(24.7)	5 099(24.5)	478(27.8)
24~	10 440(46.3)	9 633(46.2)	807(46.9)
≥28	6 535(29.0)	6 099(29.3)	436(25.3)
吸烟	4 944(21.9)	4 591(22.0)	353(20.5)	2.168	0.141
饮酒	4 465(19.8)	4 165(20.0)	300(17.4)	6.574	0.010
高血压	12 772(56.6)	11 608(55.7)	1 164(67.6)	91.820	＜0.001
糖尿病	2 772(12.3)	2 483(11.9)	289(16.8)	35.012	＜0.001

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表 2 2015―2019年江苏省早发家族史与脑卒中关联的多因素分析结果

Table 2. Multivariate analysis results of association between early-onset family history and stroke in Jiangsu from 2015 to 2019

类型	调查人数	脑卒中患病人数[n(%)]	OR(95% CI)值^a	P值^a	OR(95% CI)值^b	P值^b
早发家族史
否	21 404	1 564(7.3)	1.00	－	1.00	－
是	1 148	157(13.7)	2.01(1.69~2.40)	＜0.001	2.04(1.70~2.44)	＜0.001
男性亲属型	549	80(14.6)	2.16(1.70~2.76)	＜0.001	2.15(1.68~2.76)	＜0.001
女性亲属型	499	58(11.6)	1.67(1.26~2.20)	＜0.001	1.71(1.29~2.28)	＜0.001
双性亲属型	100	19(19.0)	2.98(1.80~4.92)	＜0.001	3.18(1.90~5.31)	＜0.001
注:^a未调整因素;^b为调整年龄、性别、城乡、文化程度、体重指数、高血压、糖尿病、吸烟、饮酒。

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表 3 2015―2019年江苏省早发家族史与不同脑卒中类型关联的多因素分析结果

Table 3. Multivariate analysis results of association between early-onset family history and different stroke types in Jiangsu from 2015 to 2019

类型	调查人数	脑卒中患病人数[n(%)]	OR(95% CI)值^a	P值^a	OR(95% CI)值^b	P值^b
缺血性脑卒中
无	2 1213	1 373(6.5)	1.00	－	1.00	－
有	1 129	138(12.2)	2.01(1.67~2.42)	＜0.001	2.07(1.71~2.50)	＜0.001
男性亲属型	539	70(13.0)	2.16(1.67~2.79)	＜0.001	2.18(1.68~2.84)	＜0.001
女性亲属型	493	52(10.5)	1.70(1.27~2.28)	＜0.001	1.76(1.31~2.37)	＜0.001
双性亲属型	97	16(16.5)	2.85(1.67~4.89)	＜0.001	3.12(1.80~5.42)	＜0.001
出血性脑卒中
无	20 031	191(1.0)	1.00	－	1.00	－
有	1 010	19(1.9)	1.99(1.24~3.21)	0.005	1.84(1.13~2.98)	0.014
男性亲属型	479	10(2.1)	2.22(1.17~4.21)	0.015	1.96(1.02~3.77)	0.043
女性亲属型	447	6(1.3)	1.41(0.62~3.20)	0.407	1.36(0.60~3.10)	0.466
双性亲属型	84	3(3.6)	3.85(1.21~12.29)	0.023	3.71(1.41~12.05)	0.029
注：^a未调整因素; ^b为调整年龄、性别、城乡、文化程度、BMI、高血压、糖尿病、吸烟、饮酒。

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表 4 2015―2019年江苏省早发家族史与高血压、糖尿病对脑卒中发病的交互作用分析

Table 4. Interaction between early-onset family history and hypertension and diabetes on stroke in Jiangsu from 2015 to 2019

因素1	因素2	人数[n(%)]	OR(95% CI)值^a	交互作用指标(95% CI)
高血压	早发家族史
-	-	9 407(41.7)	1.000	－
+	+	775(3.4)	2.625(2.137~3.224)	RERI= -0.073 (-0.919~0.774)
+	-	11 997(53.2)	1.461(1.312~1.626)	AP= -0.028 (-0.353~0.298)
-	+	373(1.7)	2.237(1.631~3.068)	S= 0.957 (0.577~1.587)
糖尿病	早发家族史
-	-	18 768(83.2)	1.000	－
+	+	136(0.6)	1.866(1.150~3.029)	RERI= -0.574 (-1.559~0.411)
+	-	2 636(11.7)	1.330(1.175~1.505)	AP= -0.308 (-0.971~0.356)
-	+	1 012(4.5)	2.111(1.753~2.542)	S= 0.601 (0.206~1.754)
注：^*为调整年龄、性别、城乡、文化程度、吸烟、饮酒、BMI。

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