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摘要:
目的 探讨中老年人群生活方式及变化与新发脑卒中的关联。 方法 选取东风同济队列基线(2008-2010年)无心血管病、癌症及生活方式无缺失,且随访至2018年12月的18 293名研究对象。健康生活方式评分包括不吸烟、适度锻炼、均衡膳食、正常体重和适宜睡眠时长5项因素之和。采用Cox回归评估生活方式及变化与脑卒中的风险比(hazard ratio, HR)和95% CI值。 结果 平均9.5年随访后,新发脑卒中病例共1 549(8.5%)。校正混杂变量后,与基线生活方式评分≤1相比,2、3和≥4分组的新发脑卒中的HR(95% CI)分别为0.83(0.72~0.95)、0.72(0.63~0.83)和0.54(0.45~0.66)。5年间生活方式评分变化(基线至2013随访)结果显示,5年间生活方式评分一直维持在≥4分是维持≤1分新发脑卒中的0.39倍(HR=0.39, 95% CI: 0.23~0.67);当从基线2~3分提高至随访≥4分是维持≤1分新发脑卒中的0.55倍(HR=0.55, 95% CI: 0.37~0.81),但是从基线≤1分提高至随访≥4分并无保护作用(HR=1.17, 95% CI: 0.58~2.36)。 结论 在中老年人群中,尽早改善并长期保持健康生活方式对于脑卒中防控效益最大。 Abstract:Objective To explore the association of lifestyle and its changes with incident stroke in the middle-aged and older population. Methods A total of 18 293 participants who were free of cardiovascular diseases, cancer, or missing data on lifestyle at baseline were selected and followed until December 2018 from Dongfeng-Tongji cohort. The healthy lifestyle score included the sum of five factors: non-smoking, moderate physical activity, balanced diet, normal weight, and appropriate sleep duration. Cox regression was adopted to estimate the hazard ratio (HR) and 95% confidence interval (95% CI) of lifestyle and its changes with stroke. Results During the 9.5- years of follow-up, 1 549 (8.5%) stroke events were documented. Comparing with ≤1 score group at baseline, the HR (95% CI) of stroke was 0.83 (0.72-0.95), 0.72 (0.63-0.83), and 0.54 (0.45-0.66) for those with scores of 2, 3, and ≥4, respectively, after adjustment of confounders. The results of five- year lifestyle change (baseline to 2013 follow-up) showed that maintenance of ≥4 scores in healthy lifestyle had 0.39- fold (HR=0.39, 95% CI: 0.23-0.67) risk for incident stroke, compared to maintenance of ≤1 score group. Increment in healthy lifestyle score from 2-3 to ≥4 had 0.55- fold (HR=0.55, 95% CI: 0.37-0.81) risk of incident stroke; improvement from ≤1 to ≥4 scores showed no protective effects for stroke (HR=1.17, 95% CI: 0.58-2.36). Conclusions Among middle-aged and older Chinese adults, early improvement and long-term maintenance of a healthy lifestyle are most beneficial for preventing and controlling stroke. -
表 1 基线研究对象根据有无脑卒中的人口学特征分布情况[n (%)]
Table 1. Characteristics of study participants according to stroke at baseline[n (%)]
变量 总脑卒中(n=1 549) IS(n=1 246) HS(n=303) 无脑卒中(n=16 744) t/χ2值a P值a F/χ2值b P值a 年龄[ (x±s), 岁] 66.47±7.41 66.60±7.45 65.90±7.23 62.40±7.62 -20.13 < 0.001 203.71 < 0.001 女性 619(39.96) 493(39.57) 126(41.58) 9 669(57.75) 182.22 < 0.001 182.63 < 0.001 受教育程度 62.53 < 0.001 66.78 < 0.001 小学及以下 575(37.48) 452(36.69) 123(40.73) 4 657(28.01) 初中或高中 835(54.43) 686(55.68) 149(49.34) 10 262(61.73) 大学及以上 124(8.08) 94(7.63) 30(9.93) 1 705(10.26) 已婚/再婚 1 375(88.88) 1 101(88.50) 274(90.43) 15 098(90.39) 3.67 0.055 4.70 0.096 健康生活方式及评分(分) 当前不吸烟 1 143(73.79) 915(73.43) 228(75.25) 13 753(82.14) 65.33 < 0.001 65.86 < 0.001 适度锻炼(7~ < 10 h/周) 388(25.05) 310(24.88) 78(25.74) 4 289(25.62) 0.24 0.625 0.34 0.846 均衡膳食c 598(38.61) 473(37.96) 125(41.25) 7 622(45.52) 27.40 < 0.001 28.47 < 0.001 正常体重(18.5~ < 24 kg/m2) 594(38.35) 465(37.32) 129(42.57) 7 611(45.46) 28.96 < 0.001 31.68 < 0.001 适宜睡眠时长(7~8 h/d) 796(51.39) 635(50.96) 161(53.14) 9 271(55.37) 9.08 0.003 9.55 0.009 ≤1 369(23.82) 305(24.48) 64(21.12) 2 764(16.51) 90.97 < 0.001 95.53 < 0.001 2 540(34.86) 442(35.47) 98(32.34) 5 332(31.84) 3 462(29.83) 359(28.81) 103(33.99) 5 577(33.31) ≥4 178(11.49) 140(11.24) 38(12.54) 3 071(18.34) 脑卒中家族史 51(3.38) 41(3.38) 10(3.38) 761(4.65) 5.14 0.023 5.14 0.077 高血压 1 083(69.92) 859(68.94) 224(73.93) 8 091(48.32) 264.47 < 0.001 266.89 < 0.001 高脂血症 878(56.68) 722(57.95) 156(51.49) 8 338(49.80) 26.88 < 0.001 30.95 < 0.001 T2DM 381(24.60) 321(25.76) 60(19.80) 2 558(15.28) 91.32 < 0.001 97.74 < 0.001 注:IS表示缺血型脑卒中;HS表示出血型脑卒中;T2DM表示2型糖尿病;连续性变量以x±s表示;分类变量以n(%)表示;a表示比较总脑卒中与无脑卒中两组间差异;b表示较IS、HS与无脑卒中三组间差异;c表示均衡膳食至少有以下4项:每天吃蔬菜、每天吃水果、每周吃红肉1~6 d、每周吃豆类≥4 d、每周吃鱼≥1 d和经常饮茶。 表 2 生活方式评分与脑卒中及其亚型的风险比和CI
Table 2. HR and 95% CI for incident stroke and subtypes by lifestyle score
变量 健康生活方式评分(分) 每增加1分 P值 ≤1 2 3 ≥4 脑卒中 病例数/人年 369/28 710 540/55 445 462/57 881 178/31 552 模型1 1 0.76(0.66~0.87) 0.62(0.54~0.71) 0.43(0.36~0.52) 0.79(0.75~0.82) < 0.001 模型2 1 0.83(0.72~0.95) 0.72(0.63~0.83) 0.54(0.45~0.66) 0.84(0.80~0.88) < 0.001 IS 病例数/人年 305/30 690 442/58 247 359/60 315 140/32 739 模型1 1 0.77(0.66~0.89) 0.60(0.52~0.70) 0.43(0.35~0.52) 0.78(0.74~0.82) < 0.001 模型2 1 0.84(0.72~0.98) 0.70(0.59~0.82) 0.52(0.43~0.65) 0.83(0.78~0.87) < 0.001 HS 病例数/人年 64/31 867 98/59 860 103/61 594 38/33 178 模型1 1 0.81(0.59~1.12) 0.83(0.61~1.14) 0.57(0.38~0.85) 0.88(0.79~0.98) 0.022 模型2 1 0.85(0.62~1.18) 0.95(0.69~1.31) 0.72(0.48~1.08) 0.95(0.85~1.06) 0.336 注:IS表示缺血型脑卒中;HS表示出血型脑卒中;模型1未调整因素;模型2调整年龄、性别、受教育程度、婚姻状况、脑卒中家族史。 表 3 5年间生活方式评分变化与脑卒中及其亚型的关联
Table 3. The association of lifestyle change during five-year period with stroke and its subtype
5年间生活方式评分变化 脑卒中 IS HS 2008-2010年 2013年 病例数/人年 HR (95% CI)值a 病例数/人年 HR (95% CI)值a 病例数/人年 HR (95% CI)值a ≤1 ≤1 62/4 037 1.00 54/4 189 1.00 8/4 329 1.00 ≤1 2~3 89/7 101 0.92(0.66~1.28) 71/7 379 0.86(0.59~1.24) 18/7 537 1.32(0.57~3.06) ≤1 ≥4 10/624 1.17(0.58~2.36) 7/659 0.87(0.37~2.04) 3/661 2.81(0.75~10.61) 2~3 ≤1 84/6 489 0.95(0.68~1.33) 67/6 735 0.88(0.60~1.27) 17/6 901 1.37(0.59~3.21) 2~3 2~3 312/33 780 0.73(0.55~0.98) 247/34 784 0.67(0.49~0.92) 65/35 277 1.17(0.56~2.45) 2~3 ≥4 51/7 912 0.55(0.37~0.81) 43/8 037 0.55(0.36~0.84) 8/8 148 0.62(0.22~1.74) ≥4 ≤1 10/676 1.12(0.57~2.21) 8/714 0.98(0.46~2.09) 2/724 1.76(0.37~8.31) ≥4 2~3 48/8 762 0.45(0.30~0.67) 37/9 005 0.40(0.25~0.62) 11/9 059 0.80(0.31~2.05) ≥4 ≥4 18/4 419 0.39(0.23~0.67) 16/4 480 0.41(0.23~0.73) 2/4 512 0.34(0.07~1.64) 注:IS表示缺血型脑卒中;HS表示出血型脑卒中;a模型调整年龄、性别、受教育程度、婚姻状况、脑卒中家族史。 -
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