基于China-PAR模型...体检人群的心血管病风险评估_张芮.pdf

20 Liu Y,Chen C,Liu N,et al.Efficacy and safety of ciprofolsedation in icu patients with mechanical ventilation:a clinical trialstudy protocolJ.Adv Ther,2021,38(10):5412-5423.21Wei A,Yang L,Ma S,et al.A case report of ciprofol overdoseduringanesthesia/analgesiaandliteraturereview:clinicalpresentation,blood pressure,and managementJ.J Int Med Res,2022,50(11):3000605221132466.(收稿日期:2022-10-11;修回日期:2023-03-12)(本文编辑:侯晓林)基基于于 C Ch hi in na a-P PA AR R 模模型型的的不不同同体体重重指指数数体体检检人人群群的的心心血血管管病病风风险险评评估估张 芮1,侯钦钏2,李炳宏2,曾红莲3,杨 波3,潘 佳4,朱元芳4,周 琳4,李东宇2,帅 平1,2(1.西南医科大学公共卫生学院,四川 成都 610000;2.四川省医学科学院四川省人民医院健康管理中心,四川 成都 610072;3.成都大学附属医院健康管理中心,四川 成都 610081;4.四川省自贡市第四人民医院健康体检中心,四川 自贡 643099)摘要 目的 研究不同体重指数体检人群动脉粥样硬化性心血管疾病(ASCVD)的风险分层以及危险因素状况。方法 采用横断面调查方法,选择 2018 年 1 月至 2020 年 12 月于三家三级甲等综合性医院健康管理中心进行年度健康体检的受试者 30281 例,采用 China-PAR 模型进行心血管事件风险评估,分析不同性别、年龄和体重指数(BMI)人群的心血管病风险及相关影响因素。结果 入组受检者中超重 11191 例(36.96%)、肥胖 3774 例(12.46%)。其中,男性超重、肥胖比例显著高于女性,年龄45 岁者超重、肥胖比例显著高于年龄45 岁者。该人群心血管病 10 年心血管病风险高危、中危和低危比例分别为2.03%、7.46%、90.51%。男性中、高危人群比例显著高于女性。随着年龄、BMI 水平的增长,中危、高危人群比例逐渐增加(P28 kg/m2组终生 ASCVD 风险高危比例显著高于 BMI24 kg/m2组和 24 kg/m2BMI28 kg/m2组(P0.001)。年龄升高、收缩压升高、吸烟史是超重者未来 10 年 ASCVD 风险的独立危险因素(P0.001);男性、高龄、收缩压升高、空腹血糖升高、总胆固醇升高、吸烟史是肥胖者未来 10 年 ASCVD 风险的独立危险因素(P0.05)。结论 体检人群中超重、肥胖检出率较高,超重、肥胖是ASCVD 的危险因素。对于高龄男性且合并超重或肥胖的体检人群尤其需要关注 ASCVD 的发病风险。关键词 体检人群;心血管疾病;风险评估;体重指数中图分类号 R54 文献标志码 A 文章编号 1672-6170(2023)03-0113-05Cardiovascular disease risk assessment of different body mass index in physical examinationpopulation based on China-PAR model ZHANG Rui1,HOU Qin鄄chuan2,LI Bing鄄hong2,ZENG Hong鄄lian3,YANG Bo3,PAN Jia4,ZHU Yuan鄄fang4,ZHOU Lin4,LI Dong鄄yu2,SHUAI Ping1,2(1.The School ofPublic Health,Southwest Medical University,Luzhou 646000,China;2.Health Management Center,SichuanAcademy of Medical Sciences&Sichuan Provincial Peoples Hospital,Chengdu 610072,China;3.HealthManagement Center,Affiliated Hospital of Chengdu University,Chengdu 610081,China;4.HealthExamination Center,Zigong Fourth Peoples Hospital,Zigong 643099,China)Corresponding author SHUAI PingAbstract Objective To investigate the risk stratification and risk factors of atherosclerotic cardiovascular disease(ASCVD)in people with different body mass index.Methods A cross-sectional survey was conducted.A total of 30,281 healthy people whounderwent health check-up in health management centers of three tertiary general hospitals from January 2018 to December 2020 wererandomly selected.The China-PAR model was used to assess the risk of cardiovascular events and analyze the relevant risk factors indifferent gender,age and body mass index(BMI).Results For the enrolled subjects,11,191 cases(36.96%)were overweight and3,774 cases(12.46%)were obese.Among them,the proportion of overweight and obesity in men was significantly higher than that inwomen.The proportion of overweight and obesity in those aged 45 years was significantly higher than that in those aged45 years.The 10-year risk assessment of cardiovascular disease showed that 90.51%of the population was at low risk,7.46%were at mediumrisk,and 2.03%were at high risk.The proportion of men in medium and high risk groups was significantly higher than that of women.With the increase of age and BMI,the proportion of middle and high risk groups was increased gradually(P0.001).The lifetime riskresults showed that 97.39%of the population was at low risk and 2.61%were at high risk.Among them,the lifetime high risk ratio ofASCVD in BMI 28 kg/m2group was significantly higher than that in BMI28 kg/m2group(P0.001).Increased age,increasedsystolic blood pressure and smoking history were independent risk factors for ASCVD in overweight patients(P0.001).Male,oldage,elevated systolic blood pressure,elevated fasting blood glucose,elevated total cholesterol and smoking history were independentrisk factors for ASCVD in obese patients(P0.05).Conclusions The detection rate of overweight and obesity in the physicalexamination population is high.Overweight and obesity are risk factors for ASCVD.For elderly males who are overweight or obese,it isespecially necessary to pay attention to the risk of ASCVD.311 实用医院临床杂志 2023 年 5 月第 20 卷第 3 期 Key words Health check-up population;Cardiovascular disease;Risk assessment;Body mass index 动脉粥样硬化性心血管疾病(arterioscleroticcardiovascular disease,ASCVD)是我国居民的首要死亡原因,分别占城市和农村居民死因的 41.8%、44.8%,对我国人民健康造成严重威胁1。随着我国城镇化与人口老龄化速度的加快,人民生活方式的改变,心血管疾病的发病率和病死率呈持续上升趋势,带来极大的疾病和经济负担。目前,心血管风险评估和分层已被国内外指南广泛采用,用以指导临床心血管疾病的防治。中国心血管病风险评估和管理指南(2019 年)提出了一种适合中国人群的新的动脉粥样硬化性心血管疾病风险评估模型(predictionforASCVDRiskinChina,China-PAR)2,同时指出超重肥胖是高血压、糖尿病、心血管疾病及其他代谢性疾病的潜在危险因素。多项研究指出,体重指数(body mass index,BMI)与血糖、血压、血脂、内膜中层厚度等心血管疾病的危险因素密切相关。在超重和肥胖的情况下,代谢综合征、胰岛素抵抗、高甘油三酯血症、心血管疾病等心脏代谢疾病的患病率显著增加3。本研究拟利用China-PAR 风险评估模型,分析在健康体检人群中不同体质指数人群的心血管影响因素情况,评估该人群 ASCVD 未来十年和终生发病的风险,为健康体检人群 ASCVD 的预防和控制提供参考。基金项目成都市科技局项目(编号:2021-YF05-00498-SN);四川省科技厅重点研发项目(编号:2022YFS0600);四川省人民医院院基金项目(编号:2021LY15)通讯作者帅 平1 对象与方法1.1 对象 纳入 2018 年 1 月至 2020 年 12 月于四川省人民医院、成都大学附属医院和自贡市第四人民医院健康管理中心参加年度体检且资料完善的体检人群,共计 30281 例。纳