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摘要:
目的 通过了解内蒙古地区不同特征居民的脑出血(intracerebral hemorrhage, ICH)发病情况, 分析ICH发病的影响因素, 为制定内蒙古地区居民ICH的预防措施提供科学依据。 方法 采用多阶段分层整群抽样抽取6个城市(盟市)建立队列研究人群, 随访数据取自2015年12月1日-2021年12月31日, 随访内容包括一般情况、疾病史及治疗史、体格检查和实验室检测。采用单因素和多因素Cox回归分析性别、年龄、血压等因素与ICH发病的关联。 结果 共纳入36 367名研究对象, 随访期间首发ICH事件共计385例(1.05%)。多因素Cox回归分析显示: 年龄增加(HR>1.000, P < 0.05)、蒙古族(HR=1.768, P < 0.05)和高血压(HR=1.492, P < 0.05)为ICH发病的危险因素; 女性(HR=0.434, P < 0.05)和高教育水平(HR < 1.000, P < 0.05)为ICH发病的保护因素。 结论 在内蒙古地区, 男性、年龄增加、高血压、低教育水平、蒙古族与ICH发病风险相关。 Abstract:Objective To elucidate the incidence of intracerebral hemorrhage (ICH) among residents of different demographics in Inner Mongolia and analyze the influencing factors, thereby providing a scientific basis for the prevention of ICH in this region. Methods Multi-stage stratified cluster sampling was used to establish a study population from six cities.Follow-up data were collected from December 1, 2015, to December 31, 2021, encompassing general information, medical history, treatment history, physical examination, and laboratory tests.Univariate and multivariate Cox regression analyses were utilized to examine the correlation of sex, age, and blood pressure with ICH incidence. Results The study comprised 36 367 participants, among which 385 cases (1.05%) of initial ICH were recorded during the follow-up period.Multivariate Cox regression analysis identified increasing age (HR>1.000, P < 0.05), Mongolian ethnicity (HR=1.768, P < 0.05), and hypertension (HR=1.492, P < 0.05) as risk factors for ICH onset.In contrast, being female (HR=0.434, P < 0.05) and having a higher education level (HR < 1.000, P < 0.05) emerged as protective factors. Conclusions In Inner Mongolia, the risk of ICH is closely associated with certain factors, including being male, advancing age, hypertension, low education level, and Mongolian ethnicity.This study underscores the importance of targeted interventions to prevent ICH in populations at risk in this region. -
Key words:
- Intracerebral hemorrhage /
- Influencing factors /
- Cohort study /
- Inner Mongolia
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表 1 研究对象基本特征[例数(占比/%)]
Table 1. Baseline characteristics of the participants (population/%)
变量 合计 女性 男性 年龄组/岁 35~ < 45 3 619(9.95) 1 793(49.54) 1 826(50.46) 45~ < 55 10 676(29.36) 6 064(56.80) 4 612(43.20) 55~ < 65 13 914(38.26) 8 016(57.61) 5 898(42.39) ≥65~75 8 158(22.43) 4 463(54.71) 3 695(45.29) 民族 汉族 32 844(90.31) 18 404(56.03) 14 440(43.97) 蒙古族 2 894(7.96) 1 590(54.94) 1 304(45.06) 其他 629(1.73) 342(54.37) 287(45.63) 教育水平 未上学或小学肄业 6 675(18.35) 5 239(78.49) 1 436(21.51) 小学 7 718(21.22) 4 603(59.64) 3 115(40.36) 初中 10 943(30.10) 5 563(50.84) 5 380(49.16) 高中或中专 7 002(19.25) 3 334(47.61) 3 668(52.39) 大学及以上 4 029(11.08) 1 597(39.64) 2 432(60.36) 吸烟 9 294(25.56) 1 413(15.20) 7 881(84.80) 饮酒 4 358(11.98) 320(7.34) 4 038(92.66) 高血压 18 406(50.62) 10 573(57.40) 7 833(42.60) 糖尿病 8 828(24.27) 4 636(52.51) 4 192(47.49) BMI/(kg·m-2) ① 26.35±3.48 26.29±3.55 26.44±3.40 SBP/mmHg ① 155.73±22.56 157.02±23.03 154.10±21.83 DBP/mmHg ① 91.27±12.93 89.82±12.83 93.10±12.83 TG/(mmol·L-1) ② 1.55(1.10, 2.25) 1.60(1.14, 2.28) 1.48(1.04, 2.21) HDL-C/(mmol·L-1) ② 1.30(1.07, 1.58) 1.39(1.17, 1.66) 1.18(0.97, 1.45) LDL-C/(mmol·L-1) ② 2.55(1.93, 3.05) 2.57(2.03, 3.23) 2.40(1.81, 2.82) 注:1. TG:三酰甘油。2. HDL-C:高密度脂蛋白胆固醇。3. LDL-C:低密度脂蛋白胆固醇。
①使用(x ±s)表示。②使用[M(P25, P75)]表示。表 2 不同特征研究对象ICH发病情况
Table 2. Incidence of ICH in study populations with different characteristics
变量 ICH/例数(占比/%) 未发生ICH/例数(占比/%) 人年发病率/10万人年-1 $ \chi^2$值 P值 年龄组/岁 37.147 <0.001 35~ < 45 7(0.20) 3 612(99.80) 55.99 45~ < 55 96(0.90) 10 580(99.10) 283.85 55~ < 65 166(1.18) 13 748(98.82) 388.46 ≥65~75 116(1.42) 8 042(98.58) 501.18 性别 34.952 <0.001 女 158(0.78) 20 178(99.22) 250.64 男 227(1.40) 15 084(98.60) 467.90 民族 10.016 0.007 汉族 330(1.00) 32 514(99.00) 326.45 蒙古族 47(1.62) 2 847(98.38) 542.97 其他 8(1.27) 621(98.73) 438.79 教育水平 52.479 <0.001 未上学或小学肄业 107(1.60) 6 568(98.40) 516.29 小学 110(1.43) 7 608(98.57) 425.06 初中 93(0.85) 10 850(99.15) 293.78 高中或中专 58(0.83) 6 944(99.17) 275.70 大学及以上 17(0.42) 4 012(99.58) 138.55 吸烟 5.306 0.021 是 118(1.27) 9 176(98.73) 420.72 否 267(0.99) 26 806(99.01) 319.69 饮酒 10.835 0.001 是 67(1.54) 4 291(98.46) 478.45 否 318(0.99) 31 691(99.01) 325.94 高血压 15.078 <0.001 是 272(1.15) 18 134(98.85) 376.42 否 113(0.61) 17 848(99.39) 198.54 糖尿病 0.179 0.672 是 97(1.10) 8 731(98.90) 347.67 否 288(1.05) 27 251(98.95) 344.23 注:1. ICH:脑出血。 表 3 ICH发病的影响因素分析
Table 3. Factors on the incidence of ICH
变量 单因素Cox回归 多因素Cox回归 HR值 95% CI P值 HR值 95% CI P值 年龄组/岁 35~ < 45 1.000 1.000 45~ < 55 4.844 2.249~10.435 < 0.001 4.489 2.080~9.688 < 0.001 55~ < 65 6.674 3.133~14.217 < 0.001 5.401 2.522~11.568 < 0.001 ≥65~75 8.722 4.067~18.704 < 0.001 6.221 2.876~13.456 < 0.001 性别 男 1.000 1.000 女 0.533 0.435~0.653 < 0.001 0.434 0.349~0.540 < 0.001 民族 汉族 1.000 1.000 蒙古族 1.684 1.240~2.286 0.001 1.768 1.299~2.405 < 0.001 其他 1.371 0.680~2.765 0.378 1.562 0.774~3.155 0.213 教育水平 未上学或小学肄业 1.000 1.000 小学 0.818 0.627~1.067 0.139 0.719 0.547~0.947 0.019 初中 0.581 0.440~0.767 < 0.001 0.519 0.387~0.696 < 0.001 高中或中专 0.544 0.395~0.749 < 0.001 0.470 0.335~0.659 < 0.001 大学及以上 0.273 0.164~0.456 < 0.001 0.254 0.149~0.433 < 0.001 是否吸烟 否 1.000 是 1.320 1.063~1.639 0.012 是否饮酒 否 1.000 是 1.435 1.103~1.868 0.007 是否高血压 否 1.000 1.000 是 1.879 1.349~2.616 < 0.001 1.492 1.068~2.084 0.019 是否糖尿病 否 1.000 是 1.002 0.796~1.261 0.988 BMI/(kg·m-2) 0.988 0.960~1.016 0.390 LDL-C/(mmol·L-1) < 1.93 1.000 1.93~ < 2.55 0.959 0.726~1.266 0.758 2.55~ < 3.05 0.943 0.710~1.253 0.687 ≥3.05 0.877 0.659~1.166 0.367 HDL-C/(mmol·L-1) < 1.07 1.000 1.000 1.07~ < 1.30 0.778 0.581~1.041 0.092 0.793 0.590~1.064 0.122 1.30~ < 1.58 0.728 0.542~0.978 0.035 0.746 0.522~1.009 0.057 ≥1.58 1.061 0.818~1.375 0.657 1.059 0.809~1.387 0.677 TG/(mmol·L-1) < 1.10 1.000 1.10~ < 1.55 0.879 0.679~1.137 0.325 1.55~ < 2.25 0.683 0.516~0.904 0.008 ≥2.25 0.693 0.520~0.924 0.012 注:1. ICH:脑出血。2. TG:三酰甘油。3. HDL-C:高密度脂蛋白胆固醇。4. LDL-C:低密度脂蛋白胆固醇。5. LDL-C、HDL-C、TG等数值指标以中位数和四分位数分组。 -
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