生活方式变化与新发脑卒中及其亚型的关联

张海庆; 何美安; 张晓敏

doi:10.16462/j.cnki.zhjbkz.2021.03.003

生活方式变化与新发脑卒中及其亚型的关联

doi: 10.16462/j.cnki.zhjbkz.2021.03.003

430030 武汉，华中科技大学同济医学院公共卫生学院劳动卫生与环境卫生学系

基金项目:

国家自然科学基金 81973128

详细信息

通讯作者:
张晓敏，E-mail: mingxz117@163.com

中图分类号: R183.4
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出版历程
- 收稿日期: 2021-01-28
- 修回日期: 2021-02-18
- 刊出日期: 2021-03-10

Association of lifestyle change with incident stroke and its subtypes

Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

Funds:

National Natural Scientific Foundation of China 81973128

More Information

Corresponding author: ZHANG Xiao-min, E-mail: mingxz117@163.com

摘要

摘要: 目的探讨中老年人群生活方式及变化与新发脑卒中的关联。方法选取东风同济队列基线(2008-2010年)无心血管病、癌症及生活方式无缺失，且随访至2018年12月的18 293名研究对象。健康生活方式评分包括不吸烟、适度锻炼、均衡膳食、正常体重和适宜睡眠时长5项因素之和。采用Cox回归评估生活方式及变化与脑卒中的风险比(hazard ratio, HR)和95% CI值。结果平均9.5年随访后，新发脑卒中病例共1 549(8.5%)。校正混杂变量后，与基线生活方式评分≤1相比，2、3和≥4分组的新发脑卒中的HR(95% CI)分别为0.83(0.72~0.95)、0.72(0.63~0.83)和0.54(0.45~0.66)。5年间生活方式评分变化(基线至2013随访)结果显示，5年间生活方式评分一直维持在≥4分是维持≤1分新发脑卒中的0.39倍(HR=0.39, 95% CI: 0.23~0.67)；当从基线2~3分提高至随访≥4分是维持≤1分新发脑卒中的0.55倍(HR=0.55, 95% CI: 0.37~0.81)，但是从基线≤1分提高至随访≥4分并无保护作用(HR=1.17, 95% CI: 0.58~2.36)。结论在中老年人群中，尽早改善并长期保持健康生活方式对于脑卒中防控效益最大。
- 健康生活方式 /
- 脑卒中及亚型 /
- 东风同济队列 /
- 中老年人群
Abstract: Objective To explore the association of lifestyle and its changes with incident stroke in the middle-aged and older population. Methods A total of 18 293 participants who were free of cardiovascular diseases, cancer, or missing data on lifestyle at baseline were selected and followed until December 2018 from Dongfeng-Tongji cohort. The healthy lifestyle score included the sum of five factors: non-smoking, moderate physical activity, balanced diet, normal weight, and appropriate sleep duration. Cox regression was adopted to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) of lifestyle and its changes with stroke. Results During the 9.5- years of follow-up, 1 549 (8.5%) stroke events were documented. Comparing with ≤1 score group at baseline, the HR (95% CI) of stroke was 0.83 (0.72-0.95), 0.72 (0.63-0.83), and 0.54 (0.45-0.66) for those with scores of 2, 3, and ≥4, respectively, after adjustment of confounders. The results of five- year lifestyle change (baseline to 2013 follow-up) showed that maintenance of ≥4 scores in healthy lifestyle had 0.39- fold (HR=0.39, 95% CI: 0.23-0.67) risk for incident stroke, compared to maintenance of ≤1 score group. Increment in healthy lifestyle score from 2-3 to ≥4 had 0.55- fold (HR=0.55, 95% CI: 0.37-0.81) risk of incident stroke; improvement from ≤1 to ≥4 scores showed no protective effects for stroke (HR=1.17, 95% CI: 0.58-2.36). Conclusions Among middle-aged and older Chinese adults, early improvement and long-term maintenance of a healthy lifestyle are most beneficial for preventing and controlling stroke.
- Healthy lifestyle /
- Stroke and subtypes /
- Dongfeng-Tongji cohort /
- Middle-aged and older adults

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图 1 5年间生活方式评分变化相对于≤1分与新发脑卒中关联的亚组分析

注：A表示按照年龄分层；B表示按照性别分层；C表示按照高血压分层；D表示按照高脂血症分层；E表示按照T2DM分层。T2DM表示2型糖尿病；模型调整年龄、性别、受教育程度、婚姻状况、脑卒中家族史；分层分析时分层变量本身未纳入模型。

Figure 1. Subgroup analyses of the association between lifestyle change during five-year period and incident stroke compared to ≤1 scores

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表 1 基线研究对象根据有无脑卒中的人口学特征分布情况[n (%)]

Table 1. Characteristics of study participants according to stroke at baseline[n (%)]

变量	总脑卒中(n=1 549)	IS(n=1 246)	HS(n=303)	无脑卒中(n=16 744)	t/χ²值^a	P值^a	F/χ²值^b	P值^a
年龄[ (x±s), 岁]	66.47±7.41	66.60±7.45	65.90±7.23	62.40±7.62	-20.13	< 0.001	203.71	< 0.001
女性	619(39.96)	493(39.57)	126(41.58)	9 669(57.75)	182.22	< 0.001	182.63	< 0.001
受教育程度					62.53	< 0.001	66.78	< 0.001
小学及以下	575(37.48)	452(36.69)	123(40.73)	4 657(28.01)
初中或高中	835(54.43)	686(55.68)	149(49.34)	10 262(61.73)
大学及以上	124(8.08)	94(7.63)	30(9.93)	1 705(10.26)
已婚/再婚	1 375(88.88)	1 101(88.50)	274(90.43)	15 098(90.39)	3.67	0.055	4.70	0.096
健康生活方式及评分(分)
当前不吸烟	1 143(73.79)	915(73.43)	228(75.25)	13 753(82.14)	65.33	< 0.001	65.86	< 0.001
适度锻炼(7~ < 10 h/周)	388(25.05)	310(24.88)	78(25.74)	4 289(25.62)	0.24	0.625	0.34	0.846
均衡膳食^c	598(38.61)	473(37.96)	125(41.25)	7 622(45.52)	27.40	< 0.001	28.47	< 0.001
正常体重(18.5~ < 24 kg/m²)	594(38.35)	465(37.32)	129(42.57)	7 611(45.46)	28.96	< 0.001	31.68	< 0.001
适宜睡眠时长(7~8 h/d)	796(51.39)	635(50.96)	161(53.14)	9 271(55.37)	9.08	0.003	9.55	0.009
≤1	369(23.82)	305(24.48)	64(21.12)	2 764(16.51)	90.97	< 0.001	95.53	< 0.001
2	540(34.86)	442(35.47)	98(32.34)	5 332(31.84)
3	462(29.83)	359(28.81)	103(33.99)	5 577(33.31)
≥4	178(11.49)	140(11.24)	38(12.54)	3 071(18.34)
脑卒中家族史	51(3.38)	41(3.38)	10(3.38)	761(4.65)	5.14	0.023	5.14	0.077
高血压	1 083(69.92)	859(68.94)	224(73.93)	8 091(48.32)	264.47	< 0.001	266.89	< 0.001
高脂血症	878(56.68)	722(57.95)	156(51.49)	8 338(49.80)	26.88	< 0.001	30.95	< 0.001
T2DM	381(24.60)	321(25.76)	60(19.80)	2 558(15.28)	91.32	< 0.001	97.74	< 0.001
注：IS表示缺血型脑卒中；HS表示出血型脑卒中；T2DM表示2型糖尿病；连续性变量以x±s表示；分类变量以n(%)表示；^a表示比较总脑卒中与无脑卒中两组间差异；^b表示较IS、HS与无脑卒中三组间差异；^c表示均衡膳食至少有以下4项：每天吃蔬菜、每天吃水果、每周吃红肉1~6 d、每周吃豆类≥4 d、每周吃鱼≥1 d和经常饮茶。

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表 2 生活方式评分与脑卒中及其亚型的风险比和CI

Table 2. HR and 95% CI for incident stroke and subtypes by lifestyle score

变量	健康生活方式评分(分)				每增加1分	P值
变量	≤1	2	3	≥4	每增加1分	P值
脑卒中
病例数/人年	369/28 710	540/55 445	462/57 881	178/31 552
模型1	1	0.76(0.66~0.87)	0.62(0.54~0.71)	0.43(0.36~0.52)	0.79(0.75~0.82)	< 0.001
模型2	1	0.83(0.72~0.95)	0.72(0.63~0.83)	0.54(0.45~0.66)	0.84(0.80~0.88)	< 0.001
IS
病例数/人年	305/30 690	442/58 247	359/60 315	140/32 739
模型1	1	0.77(0.66~0.89)	0.60(0.52~0.70)	0.43(0.35~0.52)	0.78(0.74~0.82)	< 0.001
模型2	1	0.84(0.72~0.98)	0.70(0.59~0.82)	0.52(0.43~0.65)	0.83(0.78~0.87)	< 0.001
HS
病例数/人年	64/31 867	98/59 860	103/61 594	38/33 178
模型1	1	0.81(0.59~1.12)	0.83(0.61~1.14)	0.57(0.38~0.85)	0.88(0.79~0.98)	0.022
模型2	1	0.85(0.62~1.18)	0.95(0.69~1.31)	0.72(0.48~1.08)	0.95(0.85~1.06)	0.336
注：IS表示缺血型脑卒中；HS表示出血型脑卒中；模型1未调整因素；模型2调整年龄、性别、受教育程度、婚姻状况、脑卒中家族史。

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表 3 5年间生活方式评分变化与脑卒中及其亚型的关联

Table 3. The association of lifestyle change during five-year period with stroke and its subtype

5年间生活方式评分变化		脑卒中		IS		HS
2008－2010年	2013年	病例数/人年	HR (95% CI)值^a	病例数/人年	HR (95% CI)值^a	病例数/人年	HR (95% CI)值^a
≤1	≤1	62/4 037	1.00	54/4 189	1.00	8/4 329	1.00
≤1	2~3	89/7 101	0.92(0.66~1.28)	71/7 379	0.86(0.59~1.24)	18/7 537	1.32(0.57~3.06)
≤1	≥4	10/624	1.17(0.58~2.36)	7/659	0.87(0.37~2.04)	3/661	2.81(0.75~10.61)
2~3	≤1	84/6 489	0.95(0.68~1.33)	67/6 735	0.88(0.60~1.27)	17/6 901	1.37(0.59~3.21)
2~3	2~3	312/33 780	0.73(0.55~0.98)	247/34 784	0.67(0.49~0.92)	65/35 277	1.17(0.56~2.45)
2~3	≥4	51/7 912	0.55(0.37~0.81)	43/8 037	0.55(0.36~0.84)	8/8 148	0.62(0.22~1.74)
≥4	≤1	10/676	1.12(0.57~2.21)	8/714	0.98(0.46~2.09)	2/724	1.76(0.37~8.31)
≥4	2~3	48/8 762	0.45(0.30~0.67)	37/9 005	0.40(0.25~0.62)	11/9 059	0.80(0.31~2.05)
≥4	≥4	18/4 419	0.39(0.23~0.67)	16/4 480	0.41(0.23~0.73)	2/4 512	0.34(0.07~1.64)
注：IS表示缺血型脑卒中；HS表示出血型脑卒中；^a模型调整年龄、性别、受教育程度、婚姻状况、脑卒中家族史。

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