【摘要】 目的　研究在中国中年队列人群中 ,基线脉压 (PP)对冠心病和脑卒中发病的预测价值。方法　中美心血管病和心肺疾病流行病学合作研究于 1983～ 1984年对北京和广州工人和农民人群10 0 76人进行了心血管病危险因素的基线调查。按照统一的随访方案和诊断标准对冠心病和脑卒中事件的发病进行随访登记。到 1997年底 ,平均随访 13年 ,共发生冠心病事件 72例 ,脑卒中事件 2 5 9例。按PP的 4分位组计算年龄性别调整发病率 (1/ 10 0 0 0人年 )和RR值。用Cox比例风险模型调整多项危险因素后分析 ,PP对于冠心病和脑卒中发病的相对危险。结果　冠心病和脑卒中事件的年龄性别调整发病均随PP的 4分位而增高 ,最高和最低 4分位组相比 ,冠心病发病的相对危险为 4 6 8,脑卒中发病的相对危险为 6 83。多因素Cox回归显示 ,PP增加一个标准差 ,冠心病和脑卒中发病的相对危险是 1 5 4和 1 6 7,低于相应收缩压 (SBP)的 1 6 9和 2 0 3,以及舒张压 (DBP)的 1 6 1和 2 17。在多因素模型中同时控制SBP ,则PP和冠心病和缺血型卒中的关联不再显著 ,而与脑卒中 ,尤其是出血型卒中呈显著负关联。而同时控制DBP ,则PP和DBP均与冠心病和脑卒中发病呈显著正关联。结论在中国中年人群中 ,PP虽然对于冠心病和脑卒中发病呈显著正关联 ,但预更多还原

【Abstract】 Objective To explore the predictive value of pulse pressure to incidence of coronary heart disease(CHD) and stroke in middle-aged Chinese cohort. Methods Baseline survey of middle-aged urban and rural men and women of Beijing and Guangzhou was carried out in 1983-1984 according to a uniform protocol and international standardized methods of the PRC-USA Collaborative Study of Cardiovascular and Cardiopulmonary disease. From 1991,the cohort was followed up till the end of 1997. Events of coronary heart disease and stroke were the primary end points . The predictive value of baseline pulse pressure to incidence of coronary heart disease and stroke was analyzed prospectively using Cox regression model after adjusting for age, sex, site, serum total cholesterol, body mass index, fasting blood glucose, smoking and alcohol drinking. The relative risk of one standard deviation change of pulse pressure was compared with those of the same change of systolic and diastolic blood pressure. Results The incidence of CHD and stroke increased with the quartiles of pulse pressure after adjusting for age and sex. The relative risks of CHD and stroke for the highest quartile were 4.68 and 6.83 compared with the lowest quartile. Cox regression analysis showed that after adjusting for other risk factors, pulse pressure alone may predict the events of CHD and stroke, but the effects were weaker than systolic and diastolic blood pressure. Further adjusting for systolic blood pressure, the association of pulse pressure with CHD and ischemic stroke was no longer significant, and showed a significant negative association with hemorrhagic stroke. Further adjusting for diastolic blood pressure, the association of pulse pressure with incidence of CHD and stroke remained significantly positive. Conclusion In the middle-aged Chinese cohort, pulse pressure alone may predict the incidence of CHD and stroke events, but the effects were weaker than systolic and diastolic blood pressure. Results of entering systolic blood pressure or diastolic blood pressure with pulse pressure in the Cox regression model, illustrated the relative importance of both systolic and diastolic blood pressure in prediction of long-term incidence of cardiovascular disease in middle-aged Chinese cohort.更多还原