北京人群颈动脉粥样硬化流行病学研究

1、北京人群颈动脉粥样硬化,流行病学研究,武阳丰,中国医学科学院,阜外心血管病医院,美国心脏协会第五次预防会议推荐对,45,岁以上无,症状个体进行颈动脉超声检查,2003,年欧洲高血压协会欧洲心脏病学协会将颈,动脉内中膜厚度,IMT,0.9mm,作为心血管病,靶器官损害的征象之一列入高血压治疗指南,在常用的无创检查方法中，颈动脉超声检查安全,无创、重复性好而且费用相对低廉,研,究,背,景,根据研究目的和研究方法的不同，可以将,颈动脉粥样硬化方面的研究划分为,3,个层面,相关因素,颈动脉粥样硬化,心血管病事件,横断面研究,横断面研究前瞻性研究,前瞻性研究,Relation of carotid in

2、tima-media thickness (IMT) with cardiovascular events in,asymptomatic subjects,Study,Number,Of,subjects,Sex,Age,Follow-up,years,Events,Risk,ratio,95,CI,Kuopio,1.257,M,42,3,AMI,2.18,0.70-6.74,IMT,Rotterda,m,7.983,M,W,55,2.7,AMI,stroke,1.41,1.25-1.82,1.43,1.16-1.78,ARIC,15.792,M,W,45-64,4-7,CHD,1.46 (

3、1.22-1.74,women,1.08 (0.91-1.27) men,Hodis,et,al,146,M,40-59,8.8,CHD,2.2,1.4-3.6,for,0.03,mm/year,CHS,5858,M,W,41,6,AMI,and,stroke,2.9,2-4,几项国外研究结果,本研究的两个部分,横断面调查,前瞻性研究,了解颈动脉颈动脉粥样硬化现况,研究颈动脉粥样硬化与心血管病的关系,研究颈动脉粥样硬化的相关因素,评价心血管病危险因素水平及其变化情况,对,9,年后颈动脉粥样硬化的影响,研,究,目,的,样,本,人,群,资料完整者,2002,年,危险因素,随访调查,2002,年,颈

4、动脉粥样,硬化调查,中美研究,93-94,年危险,因素调查,应答率,85.7,受检率,86.2,资,料,收,集,颈动脉超声检查方法,仪器,ACUSON-ASPEN,全数字电脑多功能超,声诊断仪，线阵式探头，探头频率,7.5,10.0MHz,方法,IMT,斑块、狭窄,图,1,颈总动脉内径及,IMT,图,2,颈总动脉斑块,颈动脉超声检查质量控制措施,培训超声医师,严格遵照工作手册,一台超声诊断仪,质控试验,20,例研究对象,医师之间重复性,医师自身变异性,测量指标,R,IMT,0.69,内径,0.83-0.90,斑块面积,0.955,斑块,0.950,测量指标,R,IMT,0.69,内径,0.69

5、-0.81,斑块面积,0.833,斑块,0.696,颈动脉超声检查受检者与未受检者基线特征的比较,男,女,基线特征,受检者,n=426,未受检者,n=201,P,受检者,n=776,未受检者,n=223,P,年龄,47.4,9.1,49.2,9.6,0.026,48.0,7.5,48.8,8.5,0.157,BMI,kg/m,2,23.9,3.3,23.5,3.2,0.174,24.7,3.6,24.8,3.9,0.713,SBP,mmHg,130.7,19.7,131.2,19.6,0.801,126.6,20.6,126.8,23.5,0.915,DBP,mmHg,84.7,11.9,85

6、.3,11.7,0.586,79.3,11.2,79.8,12.1,0.568,TC,mg/dl,172.1,32.7,171.7,30.5,0.900,174.8,32.1,173.6,34.2,0.617,TG,mg/dl,113.8,74.6,119.5,102.6,0.438,106.3,73.5,108.6,72.1,0.677,HDL-C (mg/dl,47.6,11.5,47.5,11.0,0.909,49.4,10.9,48.7,10.3,0.367,空,腹,血,糖,mg/dl,83.8,10.1,84.1,10.4,0.731,83.1,10.1,81.9,10.1,0.11

7、1,现吸烟率（,76.3,75.1,0.571,27.8,20.4,0.054,研究人群基本特征,变量,男,n=426,女,n=776,P,年龄,56.0,9.1,56.7,7.4,0.254,BMI,kg/m,2,25.3,3.5,26.1,3.7,0.000,SBP,mmHg,133.7,21.4,132.0,22.0,0.208,DBP,mmHg,81.2,12.4,76.3,10.3,0.000,TC,mg/dl,185.7,30.9,196.3,35.6,0.000,TG,mg/dl,135.7,127.1,136.7,91.5,0.875,HDL-C,mg/dl,44.8,11.3

8、,47.2,10.7,0.000,空腹血糖,mg/dl,97.6,37.8,93.4,26.0,0.023,现吸烟率（,59.4,17.0,0.000,高血压（,45.1,42.3,0.190,血脂异常（,50.5,56.9,0.019,糖尿病（,9.6,8.6,0.320,脑卒中患病率（,6.3,3.7,0.038,心梗患病率（,0.9,0.5,0.388,横,断,面,研,究,结,果,颈动脉粥样硬化指标的分布特征,各年龄组人群颈动脉,IMT,均值,IMT,分布范围,0.48,1.23mm,均值,0.71,0.10mm,0.60,0.64,0.68,0.72,0.76,0.80,0.84,43

9、-44.9,45-49.9,50-54.9,55-59.9,60-64.9,65-69.9,70-73,男,女,年龄,颈动脉近端、远端和窦部,IMT,均值的比较,0.62,0.64,0.66,0.68,0.7,0.72,0.74,0.76,0.78,0.8,左,右,男性,0.62,0.64,0.66,0.68,0.7,0.72,0.74,0.76,0.78,0.8,左,右,近端,远端,窦部,女性,斑块检出率,36.9%(444/1202,男,47.2,女,31.3,年龄,斑,块,0,10,20,30,40,50,60,70,80,90,43-44.9,45-49.9,50-54.9,55-59

10、.9,60-64.9,65-69.9,70-73,男,女,斑块检出率随年龄的变化,IMT,0,10,20,30,40,50,60,70,80,90,100,0.6,0.6-0.64,0.65,0.69,0.70,0.74,0.75,0.79,0.80,0.84,0.85,男,女,斑块,斑块检出率随,IMT,的变化,斑块数目,0,14,块,斑块面积,0,2.040cm,2,年龄,0.10,0.30,0.50,0.70,0.90,1.10,1.30,1.50,1.70,43,44.9,45,49.9,50,54.9,55,59.9,60,64.9,65,69.9,70-73,男,女,平均,数目,平

11、均斑块数目随年龄的变化,0,2,4,6,8,10,12,43-44.9,45-49.9,50-54.9,55-59.9,60-64.9,65-69.9,70-73,男,女,年龄,平均,面积,平均斑块面积随年龄的变化,斑块检出部位的构成,近端,远端,窦部,男性,女性,75,11,14,13,13,74,年龄与狭窄,0,1,2,3,4,5,6,7,男,女,60,60,血管狭窄率,2.0%(24/1202,男,3.3,女,1.3,颈动脉粥样硬化指标与心血管病,不同人群年龄调整,IMT,均值,0.55,0.60,0.65,0.70,0.75,0.80,IMT(mm,男,女,无症状人群,缺血性脑卒中,心

12、绞痛,心肌梗塞,不同人群斑块检出率,0.00,20.00,40.00,60.00,80.00,100.00,斑块(,男,女,无症状人群,缺血性脑卒中,心绞痛,心肌梗塞,心血管病传统危险因素,与颈动脉粥样硬化指标的关系,心血管病传统危险因素与,IMT,的相关分析,简单相关,偏相关（控制年龄,相关因素,男,女,合计,男,女,合计,年龄（岁,0.419,0.446,0.419,SBP(mmHg,0.362,0.353,0.357,0.287,0.227,0.259,DBP(mmHg,0.132,0.127,0.160,0.237,0.167,0.234,TC(mg/dl,0.209,0.176,0.

13、156,0.222,0.064,0.090,LnTG(mg/dl,0.065,0.157,0.117,0.118,0.076,0.092,HDL-C(mg/dl,0.057,0.087,0.092,0.113,0.082,0.116,血糖,mg/dl,0.188,0.140,0.167,0.217,0.103,0.162,心血管病传统危险因素与,IMT,多元线性回归分析,男（标化,B,女（标化,B,相关因素,SBP,模型,DBP,模型,SBP,模型,DBP,模型,年龄,岁,0.366,0.464,0.340,0.430,SBP/DBP(mmHg,0.236,0.179,0.225,0.154,

14、TC(mg/dl,0.165,0.159,未进入,未进入,HDL-c(mg/dl,0.108,0.105,未进入,未进入,血糖,mg/dl,0.135,0.144,0.074,0.087,吸烟（否,是,未进入,未进入,0.087,0.080,有斑块组和无斑块组心血管病危险因素的比较,男,女,合计,相关因素,有斑块,无斑块,有斑块,无斑块,有斑块,无斑块,年龄,岁,59.6,8.9,52.8,8.1,60.6,6.8,55.0,7.0,60.1,7.8,54.3,7.4,SBP,mmHg,137.8,21.4,130.0,20.8,139.5,22.9,128.5,20.6,138.7,22.2

15、,128.9,20.7,DBP,mmHg,81.1,12.2,81.4,12.6,75.8,10.8,76.4,10.1,78.2,11.8,77.9,11.1,TC,mg/dl,189.3,31.7,182.5,29.9,202.8,35.1,193.4,35.5,196.7,34.2,190.2,34.3,TG,mg/dl,108.1,75.7,159.9,112.4,77.8,166.0,123.4,85.1,171.6,106.7,76.9,159.8,117.8,81.5,167.5,109.1,77.1,161.2,HDL-c,mg/dl,45.1,11.2,44.5,11.4,4

16、6.3,11.0,47.5,10.5,45.8,11.1,46.6,10.9,血糖,mg/dl,88.3,82.0,98.7,87.2,81.1,94.9,89.6,82.7,98.3,86.0,80.0,95.2,86.4,80.3,95.2,88.8,82.5,98.5,吸烟,58.0,61.4,24.3,13.7,39.5,27.8,心血管病传统危险因素与斑块检出的危险,Logistic,回归分析结果,相关因素,SBP,模型,OR(95%CI,DBP,模型,OR(95%CI,年龄（岁,1.10(1.08,1.12,1.11(1.09,1.13,SBP/DBP(mmHg,1.01(1.01

17、,1.02,未进入,Ln,血糖,mg/dl,2.21(1.27,3.83,2.47(1.43,4.28,是否吸烟,1.60(1.19,2.16,1.53(1.13,2.05,心血管病传统危险因素与斑块数目的多元回归分析,相关因素,男（标化,B,女（标化,B,SBP,模型,DBP,模型,SBP,模型,DBP,模型,年龄,岁,0.393,0.425,0.302,0.349,SBP/DBP(mmHg,0.125,未进入,0.120,未进入,TC(mg/dl,0.091,0.106,未进入,未进入,吸烟,0.103,0.100,0.113,0.097,心血管病传统危险因素与斑块面积的多元回归分析,男（

18、标化,B,女（标化,B,相关因素,SBP,模型,DBP,模型,SBP,模型,DBP,模型,年龄,岁,0.376,0.408,0.300,0.346,SBP/DBP(mmHg,0.124,未进入,0.139,未进入,TC(mg/dl,0.126,0.140,未进入,未进入,血糖,mg/dl,未进入,未进入,未进入,0.073,吸烟,0.095,0.092,0.124,0.111,心血管病传统危险因素聚集与颈动脉粥样硬化,0.62,0.64,0.66,0.68,0.70,0.72,0.74,0.76,0.78,0,1,2,3,危险因素数目,IMT(mm,男,女,0.00,0.50,1.00,1.5

19、0,2.00,2.50,0,1,2,3,危险因素数目,斑块OR,注：危险因素包括高血压、血脂异常、糖尿病和吸烟,小,结,我国中老年人群颈动脉粥样硬化流行状况较为严重,主要心血管病危险因素与颈动脉粥样硬化密切相关,尤其是年龄和血压,前,瞻,性,研,究,结,果,颈动脉粥样硬化指标的分布特征,研究人群基线特征及,9,年间的变化情况,变量,男,n=426,女,n=776,P,B,年龄,岁,47.4,9.1,48.0,7.5,0.213,B- BMI (kg/m,2,23.9,3.3,24.7,3.6,0.000,B-SBP (mmHg,130.7,19.7,126.6,20.6,0.001,B-DBP

20、 (mmHg,84.7,11.9,79.3,11.2,0.000,B-TC (mg/dl,172.0,32.7,174.8,32.1,0.158,B-TG (mg/dl,113.8,74.6,106.3,73.5,0.090,B-HDL-c (mg/dl,47.6,11.5,49.4,10.9,0.006,B,空腹血糖,mg/dl,83.8,10.2,83.3,10.1,0.287,B,现吸烟率（,67.3,32.7,0.000,BMI(kg/m,2,1.4,2.1,1.4,2.2,0.604,SBP (mmHg,2.9,19.9,5.3,17.0,0.025,DBP (mmHg,3.5,12

21、.1,3.1,9.7,0.478,TC (mg/dl,13.4,26.5,21.6,26.8,0.000,TG (mg/dl,21.7,123.3,30.3,71.9,0.128,HDL-c (mg/dl,2.8,9.1,2.2,9.3,0.274,血糖,mg/dl,13.8,35.5,10.3,22.8,0.036,吸烟率（,7.9,15.7,0.000,脑卒中发病率（,6.3,3.7,0.038,心梗发病率（,0.9,0.5,0.388,各种心血管病相关因素之间的相关矩阵,变量,B,年龄,B,BMI,BMI,B,SBP,SBP,B,DBP,DBP,B,TC,TC,B,LnTG,TG,B,H

22、DL-c,HDL-c,B,血糖,B-BMI,0.015,BMI,0.107,0.219,B-SBP,0.330,0.229,0.090,SBP,0.029,0.055,0.167,0.366,B-DBP,0.104,0.300,0.056,0.775,0.278,DBP,0.228,0.114,0.198,0.445,0.667,0.489,B-TC,0.284,0.220,0.089,0.186,0.017,0.153,0.113,TC,0.112,0.108,0.130,0.107,0.088,0.072,0.147,0.336,B,LnTG,0.154,0.351,0.121,0.199

23、,0.008,0.197,0.074,0.421,0.137,TG,0.036,0.011,0.122,0.045,0.072,0.088,0.066,0.013,0.168,0.150,B,HDL-c,0.089,0.314,0.102,0.000,0.013,0.054,0.020,0.184,0.066,0.397,0.026,HDL-c,0.064,0.031 -0.236,0.094,0.062,0.068,0.080,0.249,0.331,0.049 -0.246,0.435,B,血糖,0.183,0.186,0.108,0.166,0.035,0.102,0.060,0.166

24、,0.037,0.180,0.016,0.094,0.060,血糖,0.021,0.206,0.205,0.096,0.065,0.114,0.077,0.096,0.047,0.164,0.065,0.137,0.044,0.106,基线危险因素及其变化与,IMT,的回归分析,单因素,调整年龄,相关因素,男,女,合计,男,女,合计,B,年龄,0.0045,0.0054,0.0049,B-SBP,0.0016,0.0013,0.0015,0.0009,0.0008,0.0009,B-DBP,0.0021,0.0017,0.0021,0.0016,0.0014,0.0018,B-TC,0.000

25、8,0.0007,0.0007,0.0007,0.0003,0.0004,B-lnTG,0.018,0.041,0.0337,0.0220,0.0197,0.023,B-HDL-C,0.0003,0.0004,0.0002,0.0003,0.0005,0.0006,B,血糖,0.0018,0.0010,0.0013,0.0011,0.0002,0.0006,SBP,0.0004,0.0005,0.0004,0.0005,0.0003,0.0003,DBP,0.0010,0.0010,0.0010,0.0017,0.0004,0.0002,TC,0.0003,0.0003,0.0004,0.00

26、01,0.0001,0.0002,TG,0.00001,0.00007,0.00003,0.00002,0.00003,0.00001,HDL-C,0.0013,0.0004,0.0008,0.0009,0.0002,0.0005,血糖,0.0004,0.0004,0.0004,0.0004,0.0003,0.0004,基线危险因素及其变化与,IMT,的多元回归分析,男（标化,B,女（标化,B,相关因素,SBP,模型,DBP,模型,SBP,模型,DBP,模型,B,年龄,岁,0.315,0.415,0.300,0.385,B-SBP/B-DBP(mmHg,0.263,0.232,0.228,0.

27、164,SBP,DBP,0.221,0.158,0.151,未进入,B-TC(mg/dl,0.190,0.185,0.078,未进入,血糖,mg/dl,0.126,0.123,0.062,未进入,B-TG(mg/dl,未进入,未进入,未进入,0.082,B,吸烟,否,是,未进入,未进入,0.093,0.072,相关因素,SBP,模型,OR(95%CI,DBP,模型,OR(95%CI,B,年龄（岁,1.09(1.07-1.11,1.10(1.08-1.12,B-SBP/B-DBP(mmHg,1.02(1.01-1.02,1.03(1.01-1.04,血糖,mg/dl,1.01(1.00-1.01

28、,1.01(1.00-1.01,B,吸烟,否,是,2.01(1.55-2.61,1.94(1.49-2.51,基线危险因素及其变化与斑块检出的危险,基线危险因素及其变化与斑块数目的多元回归分析,男（标化,B,女（标化,B,相关因素,SBP,模型,DBP,模型,SBP,模型,DBP,模型,B,年龄,岁,0.362,0.392,0.289,0.320,B-SBP/B-DBP(mmHg,0.140,0.139,0.127,未进入,B,吸烟,否,是,未进入,未进入,0.126,0.108,基线危险因素及其变化与斑块面积的多元回归分析,男（标化,B,女（标化,B,相关因素,SBP,模型,DBP,模型,SBP,模型,DBP,模型,B,年龄,岁,0.348,0.378,0.291,0.329,B-SBP/B-DBP(mmHg,0.136,0.127,0.142,0.100,B,吸烟