【作者】 刘勇；

【导师】 孙英贤；

【作者基本信息】 中国医科大学 ， 内科学， 2008， 硕士

【摘要】 前言随着改革开放和经济的飞速发展,农村人民的生活水平也在不断提高,生活方式和饮食习惯等有了很大的改变,随之而来的是心脑血管等相关疾病患者的与日俱增。已有的资料表明,阜新农村地区人群冠心病的标化患病率为3.58%,脑卒中的标化患病率为3.10%。因此选择这一地区进行心血管疾病主要危险因素的流行病学调查具有一定的代表性。本研究通过调查分析这一地区心血管疾病主要危险因素的流行病学特点,为进一步进行干预提供基线数据,同时可以为我国研究农村心血管疾病积累大样本的特定人群资料,有着非常重要的流行病学意义。对象与方法采用分层整群随机抽样的方法,于2004-2006年对辽宁省阜新县8个乡镇共计95个行政村内所有≥35岁常住居民45 925人进行心血管疾病主要危险因素的流行病学调查。采用统一制定的调查问卷,按标准化调查方法,经知情同意后,由培训过的医师进行入户询问调查和相关的体格检查。现场调查内容包括:一般情况,包括性别、年龄、职业、民族、吸烟史、饮酒史、饮食等,询问有无高血压、心脑血管病、糖尿病及血脂异常等病史;体格检查包括身高、体重、腰围、血压的测量。在各个阶段实施严格的质量控制,避免流行病学研究中各种偏倚的产生。采用Epidata3.1软件建立数据库,所有调查表经过严格复核后录入,应用SPSS13.0软件进行统计分析,用频数描述不同危险因素的构成情况,用非条件logistic逐步回归进行多因素分析,不同性别之间患病率的比较主要用卡方检验,P＜0.05有统计学差异。结果共完成调查45 925人,应答率84.8%,男性22 747人(49.5%),女性23 178人(50.5%),平均年龄51.22±11.82岁。其中≥65岁男性为3 380人,女性为3 365人。1、该地区农村人群高血压患病率为37.8%,超重率为29.5%,肥胖率为5.3%,吸烟率为41.4%,血脂异常、糖尿病的自述患病率分别为3.9%、0.5%。其中,男性吸烟率(66.9%)高于女性吸烟率(16.3%),差异有统计学意义(P＜0.05),男性超重及肥胖患病率显著低于女性(P＜0.05)。血脂异常、糖尿病自述患病率在性别之间差异无统计学意义。2、高血压患病率随着年龄的增加而升高。男性人群中,肥胖和超重率均以35～44岁组为高,吸烟率以45～54岁组最高。血脂异常率以≥65岁组最高;女性人群中,肥胖率以35～44岁组为高,超重率以45～54岁组为高,吸烟率随年龄增加而增高,以≥65岁组最高。血脂异常率以45～54岁组最高,各年龄段与男性相比,差异无统计学意义(P＞0.05)。3、该地区65.2%的村民至少存在一种危险因素,其中只具有1个主要危险因素的占44.2%,同时具有4个主要危险因素的占0.2%。在危险因素个数聚集的构成比中,男性均高于女性。人群中不存在同时具有5个心血管疾病主要危险因素聚集的个体。4、多因素分析结果显示年龄、性别、超重肥胖、高血压、血脂异常、吸烟、糖尿病等是冠心病的危险因素,其中血脂异常、糖尿病、高血压这三个影响因素的OR值较高。结论辽宁阜新农村地区具有心血管疾病主要危险因素的人群比例也在逐渐升高变化,但同时具备多项危险因素者比例不大。更多还原

【Abstract】 PrefaceWith the rapid development of reform and economy,the life of the rural people have gradual improvement and great changes in diets and lifestyle.But it cause cardiovascular and cerebrovascular diseases increasing steadily.Some studies show that(?)he countryside of Fuxin was a high prevalence region of cardiovascular and cerebrovascular diseases,the standardized prevalence of coronary heart disease and stroke was 3.80%and 3.10%respectively.So choosing the region for the epidemiologic study about primary risk factors of cardiovascular diseases will be certain representative.The study shows the epidemiologic characteristic of primary risk factors of cardiovascular diseases and provides baseline data for further intervening.At the same time,it accumulated a large sample of specific population data for the study of the cardiovascular diseases in the country.The present study made significant contribution to epidemiology.MethodsAn epidemiological study using stratified cluster random sampling was conducted from 2004 to 2006 in Fuxin County,Liaoning Province,including all residents aged≥35 in a total of 95 villages of eight townships.This study employed unified standard cardiovascular epidemiological methods,including questionnaire survey and physical examination of the research subjects.On site questionnaire includes:general information such as gender,age,occupation,ethnicity,smoking,drinking and diet,etc; history of hypertension,cardiovascular/cerebrovascular diseases,diabetes mellitus and dyslipidemia.The medical examinations,including height,weight,waist circumference, and blood pressure.Epidata3.1 software was used to build a database and all of the survey results were entered after rigorous review.SPSS13.0 software was used for statistical analysis,P＜0.05 was considered statistically significant.ResultsIn total 45,925 persons were surveyed,with a response rate of 84.8%,including 22,747 male(49.5%)and 23,178 female(50.5%).Their average age is 51.22±11.8 years.There are 3,380 male and 3,365 female for aged≥65 years1.The prevalence of hypertension,overweight,obesity and smoking were 37.8%, 29.5%,5.3%and 41.4%,respectively.Prevalence of self-telling lipid disorder and diabetes mellitus was 3.9%and 0.5%.The prevalence of smoking of men were significantly higher than that of women(66.9%and16.3%,P＜0.05).The prevalence of overweight and obesity of men were significantly lower than that of women(P＜0.05). Prevalence of self-telling lipid disorder and diabetes mellitus was not statistically significant in different sex.2.It was obviously different in the different age groups.No matter male or female, the prevalence of hypertension was obviously up with the age increasing.In the men, the highest prevalence rate of obesity and overweight,smoking,lipid disorder was in 35～44 years groups,45～54 years groups and≥65 year groups,respectively.In the women,the highest prevalence rate of obesity,overweight,lipid disorder was in 35～44 years groups,45～54 years groups and 45～54 years groups.The prevalence of smoking was up with the age increasing.In≥65 years groups,the prevalence of hypertension, overweight,obesity and smoking were 62.6%,20.5%,3.9%and 38.9%respectively. Prevalence of self-telling lipid disorder and diabetes mellitus was 5.9%and 0.3%.3.65.2%of subjects had at least one risk factor and 0.2%of all had four risk factors simultaneously.Nobody had five risk factors in the subject,risk4.By Logistic regression,risk factors of age,sex,overweight-obesity, hypertension,smoking,diabetes mellitus and so on were closely correlated to CHD. The OR for hyperlipidemia,diabetes mellitus and hypertension were higher than others. ConclusionThis study showed that,in the rural areas in Liaoning provice,the prevalence rate of main risk factors for cardiovascular diseases is high.Full-scale management to main risk factors for cardiovascular diseases is advised to be actively strengthened in rural area.更多还原