【摘要】 目的 初步评价某社区老年人群卒中一级干预方案的实施效果。方法 选择上海市奉贤区某社区2019年参加社区老年健康体检并于2021年再次参加健康体检的老年人群作为研究对象。纳入社区人群的年龄≥60岁。以社区卫生服务中心为依托，以社区老年人年度健康体检结果为数据来源。在体检过程中进行一般情况调查，并进行卒中风险评估、卒中高危人群筛查、结合风险评估结果进行首诊干预，针对高危个体进行长期干预管理。卒中风险评估指标为脑血管功能积分，75～100分为非高危，50～<75分为轻度危险，25～<50分为中度危险，0～<25分为重度危险。干预2年后结合体检进行脑血管功能复检，比较干预前后脑血管功能积分及血压、身高、体质量、血脂、血糖、糖化血红蛋白的变化。结果 (1)完成2019年筛查和2021年复检的某社区老年人群共计2 333名，其中男1 039名，女1 294名。(2)与2019年初筛的结果比较，2021年男性收缩压(<140、140～159、≥160 mmHg)、舒张压(<90、90～99、≥100 mmHg)和女性舒张压(<90、90～99、≥100 mmHg)的分布均有改善，干预前后的差异均有统计学意义[58.5%(608/1 039)、31.7%(329/1 039)、9.8%(102/1 039)比54.1%(562/1 039)、32.5%(338/1 039)、13.4%(139/1 039),χ~2=7.610,P=0.022;78.4%(815/1 039)、16.8%(175/1 039)、4.7%(49/1 039)比65.2%(677/1 039)、24.7%(257/1 039)、10.1%(105/1 039),χ~2=48.693,P<0.01;76.7%(993/1 294)、18.9%(245/1 294)、4.3%(56/1 294)比68.2%(883/1 294)、23.6%(306/1 294)、8.1%(105/1 294),χ~2=28.166,P<0.01],但女性健康体检人群干预前后收缩压水平分布的差异无统计学意义(P>0.05)。(3)与2019年初筛的结果比较，2021年男性和女性三酰甘油、低密度脂蛋白降低，空腹血糖水平升高，差异均有统计学意义[男性：1.15(0.81,1.62) mmol/L比1.20(0.85,1.76) mmol/L,Z=-3.983;(2.44±0.65) mmol/L比(2.66±0.70) mmol/L,t=-14.800;4.9(4.5,5.6) mmol/L比4.8(4.4,5.4) mmol/L,Z=5.180;女性：1.39(1.01,1.99) mmol/L比1.44(1.03,1.98) mmol/L,Z=-2.593;(2.67±0.68) mmol/L比(2.96±0.74) mmol/L,t=-18.788;5.0(4.6,5.6) mmol/L比4.9(4.5,5.5) mmol/L,Z=2.258;均P<0.05],男性和女性总胆固醇、糖化血红蛋白的差异均无统计学意义(均P>0.05)。(4)干预前后2 333名老年人群的脑血管功能积分值的分布发生显著变化(χ~2=11.351,P=0.010),其中中度危险[2019、2021年分别为15.0%(350例)、13.2%(308例)]和重度危险[2019、2021年分别为9.9%(231例)、7.8%(183例)]比例下降，非高危[2019、2021年分别为58.9%(1 374例)、60.9%(1 421例)]和轻度危险[2019、2021年分别为16.2%(378例)、18.0%(421例)]比例上升。结论 对某社区老年人健康体检结果的初步分析表明，实施卒中高危人群筛查与干预管理方案后，对降低血压、血脂等危险因素的暴露水平有一定作用，卒中的风险等级有所下降。更多还原

【Abstract】 Objective To evaluate the effect of primary stroke prevention program in a community elderly population. Methods The elderly population in a community in Fengxian District of Shanghai who participated in the community health physical examination for the elderly in 2019 and again in 2021 were selected as the research objects. The age of the population recruited in the community is ≥60 years. Based on the community health service center, the annual physical examination results of the elderly in the community were used as data sources. A general investigation was conducted during the examination. The prevention program also included screening high-risk population of stroke during physical examination, first-visit intervention combined with risk assessment results, and long-term intervention management for high-risk individuals. The risk assessment index of stroke was cerebrovascular function score, and 75-100 points were non high risk, 50-< 75 points were mild risk, 25-< 50 points were moderate risk, and 0-< 25 points were severe risk. After 2 years intervention, combined with physical examination, the cerebrovascular function was re-examined, and the changes of cerebrovascular function score, blood pressure, height, body weight, blood lipid, blood glucose and glycosylated hemoglobin A1 c were compared before and after intervention. Results(1) A total of 2 333 patients completed the 2019 screening and 2021 reexamination, including 1 039 males and 1 294 females.(2) Compared with the results of the initial screening in 2019, the proportion of systolic(<140,140-159 and ≥160 mmHg) and diastolic blood pressure levels(<90,90-99 and ≥100 mmHg)increased in males and diastolic blood pressure levels(<90,90-99 and ≥100 mmHg)increased in females in 2021 were significantly lower, with statistically significant differences before and after intervention(58.5%[608/1 039], 31.7%[329/1 039], 9.8%[102/1 039]vs. 54.1%[562/1 039], 32.5%[338/1 039], 13.4%[139/1 039], respectively, χ~2=7.610, P=0.022; 78.4%[815/1 039], 16.8%[175/1 039], 4.7%[49/1 039]vs. 65.2%[677/1 039], 24.7%[257/1 039], 10.1%[105/1 039], respectively, χ~2=48.693, P<0.01; 76.7%[993/1 294], 18.9%[245/1 294], 4.3%[56/1 294]vs. 68.2%[883/1 294], 23.6%[306/1 294], 8.1%[105/1 294], respectively, χ~2=28.166, P<0.01). However, there was no statistical significance in systolic blood pressure of healthy females before and after intervention(P> 0.05).(3) Compared with screening results at the beginning of 2019, triacylglycerol and low-density lipoprotein decreased, and fasting glucose levels increased in males and females in 2021, with statistically significant differences(males: 1.15[0.81, 1.62] mmol/L vs. 1.20[0.85, 1.76] mmol/L,Z=-3.983 mmol/L; [2.44±0.65] mmol/L vs. [2.66±0.70] mmol/L, t=-14.800; 4.9 [4.5, 5.6] mmol/L vs. 4.8 [4.4, 5.4] mmol/L, Z=5.180; females: 1.39 [1.01, 1.99] mmol/L vs. 1.44 [1.03, 1.98] mmol/L, Z=-2.593; [2.67±0.68] mmol/L vs. [2.96±0.74] mmol/L, t=-18.788; 5.0 [4.6, 5.6] mmol/L vs. 4.9 [4.5, 5.5] mmol/L, Z=2.258; all P< 0.05). There were no significant differences in total cholesterol and glycosylated hemoglobin A1 c between males and females(all P> 0.05).(4) Before and after intervention, the distribution of cerebral vascular function score changed significantly(χ~2=11.351, P=0.010), the proportion of moderate(in 2019 and 2021, it was 15.0%[350 cases]and 13.2% [308 cases] respectively)and severe risk(in 2019 and 2021, it was 9.9%[231 cases]and 7.8%[183 cases] respectively)decreased, the proportion of non-high risk(in 2019 and 2021, it was 58.9%[1 374 cases]and 60.9%[1 421 cases] respectively)and mild risk(in 2019 and 2021, it was 16.2%[378 cases]and 18.0%[421 cases] respectively)increased. Conclusion The preliminary analysis of the health examination results of the elderly in a community showed that the primary stroke prevention program in the population with high-risk of stroke had a certain effect on reducing the exposure level of blood pressure, blood lipid and other risk factors, and the risk level of stroke has decreased.更多还原