社区高龄人群动脉粥样硬化性心血管疾病影响因素的相关性分析-东南大学学报医学版

社区高龄人群动脉粥样硬化性心血管疾病影响因素的相关性分析

作者：王蕾¹ 吴晓² 顾一航² 胡心怡¹ 沙江明² 邵荣² 顾静彧² 王琳² 张恬² 蒋文竹² 江黎明² 殷泉忠²

单位：1. 南通大学附属江阴医院, 江苏江阴 214400;
2. 南通大学附属江阴医院全科医学科, 江苏江阴 214400

分类号：R543.5

出版年·卷·期（页码）：2022·41·第一期（88-95）

摘要：

目的：分析高龄人群（≥75岁）发生动脉粥样硬化性心血管疾病（ASCVD）事件的危险因素，为指导全科医生对社区中有ASCVD患病高风险的高龄人群进行早期干预提供理论依据。方法：选取2018年1月至2021年3月期间在江阴市城南、城中以及华士社区卫生服务中心门诊就诊的高龄人群作为研究对象，共入选319例。采用二元Logistic逐步回归分析探究社区高龄人群的ASCVD风险的影响因素。结果：对照组98例，病例组221例，病例组中年龄、婚姻状况、睡眠质量情况、体力活动情况、失能情况、是否痴呆、颈动脉超声评分、血压控制水平、家族史、合并高血压、收缩压、总胆固醇、共病指数、服用药物数量与对照组比较差异有统计学意义（P<0.05）。病例组中性别、吸烟史、饮酒史、合并糖尿病、体重指数、舒张压、高密度脂蛋白、低密度脂蛋白、甘油三酯、空腹血糖、糖化血红蛋白、尿酸、肌酐、尿素氮与对照组比较差异无统计学意义（P>0.05）。经Logistic回归分析结果显示，血压控制水平、颈动脉超声评分、共病指数、服用药物数量是社区高龄人群ASCVD风险的影响因素（P<0.05）。结论：血压控制水平、共病指数、服用药物数量是高龄人群ASCVD发病的影响因素，也是相对可控因素，社区全科医生应加强对血压控制不达标、合并多种疾病、服用药物多的高龄人群进行ASCVD风险评估。

Objective: To analyze the risk factors of atherosclerotic cardiovascular disease(ASCVD) events in the elderly(≥ 75 years), and provide a theoretical basis for guiding general practitioners to early intervention in the community with the elderly at high risk of ASCVD. Methods: A total of 319 cases were selected as the research objects of the elderly who visited the outpatient clinics of Jiangyin City's Chengnan, Chengzhong and Huashi Community Health Service Center from January 2018 to March 2021. Binary Logistic stepwise regression analysis was used to explore the influencing factors of ASCVD risk in the elderly in the community. Results: There were 98 cases in the control group and 221 cases in the case group. In the case group, age, marital status, sleep quality, physical activity, disability, dementia, carotid ultrasound score, blood pressure control level, family history, combined hypertension, systolic blood pressure, total cholesterol, comorbidity index, excessive medication were different from those in the control group(P<0.05).Compared with the control group, the gender, smoking history, a history of drinking, combined with diabetes, body mass index, diastolic blood pressure, high-density lipoprotein, low density lipoprotein, triglyceride, fasting blood-glucose, glycated hemoglobin, uric acid, creatinine, urea nitrogen in the case group had no significant differences(P>0.05).Logistic regression analysis showed that blood pressure control level, carotid ultrasound score, comorbidity index, and excessive medication were the influencing factors for ASCVD risk in the elderly in the community(P<0.05). Conclusion: Blood pressure control level, comorbidity index, and excessive medication are the influencing factors and relatively controllable factors for the incidence of ASCVD in the elderly population. Community general practitioners should strengthen ASCVD risk assessment for elderly population with substandard blood pressure control, multiple diseases, and excessive medication.

参考文献：

[1] 范利, 邹晓.我国老年慢性病管理及预防保健的重要意义[J].中国临床保健杂志, 2020, 23(2):145-147.
[2] 《中国心血管健康与疾病报告2019》编写组.《中国心血管健康与疾病报告2019》要点解读[J].中国心血管杂志, 2020, 25(5):401-410.
[3] 李红梅, 王显.TLR4/MyD88/NF-κB信号通路与动脉粥样硬化性心血管疾病的相关性研究进展[J].中国循证心血管医学杂志, 2017, 9(9):1132-1134.
[4] 胡洁, 陈庆伟, 贺无恙.增龄与动脉粥样硬化性心血管疾病临床类型的相关性分析[J].临床心血管病杂志, 2018, 34(11):1081-1085.
[5] MARQUES D S P, LIMA M J, NEVES P M, et al.Prevalence of cardiovascular risk factors and other comorbidities in patients with hypertension in Portuguese primary health care populations:the PRECISE study[J].Rev Port Cardiol, 2019, 38(6):427-437.
[6] LI L, WANG L, LIU S S, et al.Association between coronary atherosclerotic plaque composition and cardiovascular disease risk[J].Biomed Environ Sci, 2019, 32(2):75-86.
[7] 王庭俊, 蔡晓琪, 张玲玉, 等.两种模型预测的心血管病发病风险与动脉僵硬度的相关性[J].中华高血压杂志, 2020, 28(8):736-743.
[8] YANG X, LI J, HU D, et al.Predicting the 10-year risks of atherosclerotic cardiovascular disease in Chinese population:the China-PAR Project(Prediction for ASCVD Risk in China)[J].Circulation, 2016, 134(19):1430-1440.
[9] 郭远林, 陈纪林.2019年欧洲血脂异常管理指南对我国临床实践的启示[J].中国循环杂志, 2020, 35(2):105-108.
[10] 吕筠, 吴曼, 郭彧, 等.基于超大人群队列的心脑血管疾病的病因研究进展:国家自然科学基金重大项目阶段性研究成果综述[J].中国科学基金, 2019, 33(4):322-326.
[11] 伍莎, 彭道泉.动脉粥样硬化性心血管病一级预防的血脂管理[J].中国医学前沿杂志(电子版), 2019, 11(5):15-20.
[12] WANG Y, ZHANG J F, CHEN S Z, et al.ACC/AHA risk score for predicting the presence and severity of coronary artery disease in a Chinese population:a cross-sectional study[J].Chin Med J(Engl), 2020, 133(22):2753-2755.
[13] 中国老年医学学会高血压分会, 国家老年疾病临床医学研究中心中国老年心血管病防治联盟.中国老年高血压管理指南2019[J].中国心血管杂志, 2019, 24(1):1-23.
[14] 国家老年医学中心.中国老年糖尿病诊疗指南(2021年版)[J].中华糖尿病杂志, 2021, 13(1):14-46.
[15] 张小宁, 陈爽.中国老年人失能情况及影响因素研究[J].中国全科医学, 2019, 22(31):3841-3844.
[16] TANG Y, MENG L, LI D, et al.Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus[J].Chin Med J(Engl), 2014, 127(20):3543-3547.
[17] REN Y J, SU M, LIU Q M, et al.Validation of the simplified Chinese-character version of the international physical activity questionnaire-long form in urban community-dwelling adults:a cross-sectional study in Hangzhou, China[J].Biomed Environ Sci, 2017, 30(4):255-263.
[18] 中国高血压防治指南修订委员会, 中国高血压联盟, 中华医学会心血管病学分会中国医师协会高血压专业委员会, 等.中国高血压防治指南(2018年修订版)[J].中国心血管杂志, 2019, 24(1):24-56.
[19] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志, 2011, 39(7):579-616.
[20] 王增武.2019ACC/AHA心血管疾病一级预防指南解读[J].中国循环杂志, 2019, 34(z1):82-85.
[21] DZIEGIELEWSKA-GESIAK S, PLOCINICZAK A, WILEMSKA-KUCHARZEWSKA K, et al.The relationship between plasma lipids, oxidant-antioxidant status, and glycated proteins in individuals at risk for atherosclerosis[J].Clin Interv Aging, 2019, 14:789-796.
[22] YU Z, REBHOLZ C M, WONG E, et al.Association between hypertension and kidney function decline:the Atherosclerosis Risk in Communities(ARIC) Study[J].Am J Kidney Dis, 2019, 74(3):310-319.
[23] MCDOOM M M, PALTA P, VART P, et al.Late life socioeconomic status and hypertension in an aging cohort:the Atherosclerosis Risk in Communities Study[J].J Hypertens, 2018, 36(6):1382-1390.
[24] ODDEN M C, RAWLINGS A M, ARNOLD A M, et al.Patterns of cardiovascular risk factors in old age and survival and health status at 90[J].J Gerontol A Biol Sci Med Sci, 2020, 75(11):2207-2214.
[25] ODDEN M C, SHLIPAK M G, WHITSON H E, et al.Risk factors for cardiovascular disease across the spectrum of older age:the cardiovascular health study[J].Atherosclerosis, 2014, 237(1):336-342.
[26] GRASGRUBER P, SEBERA M, HRAZDIRA E, et al.Food consumption and the actual statistics of cardiovascular diseases:an epidemiological comparison of 42 European countries[J].Food Nutr Res, 2016, 60:31694.
[27] MENG F, ZHAO Y, TITUS T, et al.Brain of the blind:transcriptomics of the golden-line cavefish brain[J].Curr Zool, 2018, 64(6):765-773.
[28] YI C, LIN J, CAO P, et al.Prevalence and prognosis of coexisting frailty and cognitive impairment in patients on continu- ous ambulatory peritoneal dialysis[J].Sci Rep, 2018, 8(1):17305.
[29] 李景, 张明智, 张循, 等.颈动脉粥样斑块超声指标与冠状动脉粥样硬化的相关性分析[J].中国循证心血管医学杂志, 2018, 10(5):581-584.
[30] 任燕妮, 吴波, 姚炜, 等.动脉超声检查与冠脉造影Gensini评分的相关性[J].海南医学, 2021, 32(3):339-342.
[31] 赵平, 常培叶, 刘喜, 等.颈动脉超声检查预测冠状动脉硬化的价值[J].心血管康复医学杂志, 2013, 22(1):71-73.
[32] 张杰, 王晓娜, 肖文凯, 等.高龄动脉粥样硬化性心血管疾病患者他汀疗效分析[J].解放军医学院学报, 2020, 41(5):440-445.
[33] 杨明, 董晓雯, 洪华山.他汀在75岁及以上老人进行心血管疾病一级预防的现状[J].中国临床药理学与治疗学, 2020, 25(9):1074-1080.
[34] 何旭瑜, 杜明轩, 黎励文.他汀类药物对老年人心血管事件一级预防的疗效及安全分析[J].中华老年心脑血管病杂志, 2018, 20(7):681-685.

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