重庆市脑卒中与多重慢性疾病关联的前瞻性队列研究

A Prospective Cohort Study on the Association between Stroke and Multiple Chronic Diseases in Chongqing

摘要: 目的：本研究旨在探讨脑卒中与多重慢性病之间的关联，为多重慢性病患者的精准医疗和干预提供科学依据。方法：研究基于重庆市脑卒中高危人群筛查和干预项目，采用多阶段分层整群随机抽样方法，纳入2017~2019年间参与基线调查的40岁以上常住人口33,827人。通过问卷调查、体格检查和实验室检查收集基线数据，并在2024年对研究对象进行随访，记录脑卒中发生情况。使用SPSS 26.0和R 4.3.1进行统计分析，采用多因素Logistic回归分析脑卒中与多重慢性病的独立关联。结果：共纳入33,827名研究对象，随访期间确诊986例新发脑卒中病例。单因素分析表明，性别、年龄、饮食习惯、心脏病、高血压、糖尿病等因素与脑卒中发生显著相关。多变量模型显示，年龄 ≥ 65岁(OR = 3.43, 95%CI: 2.92~4.03)、男性(OR = 1.52, 95%CI: 1.28~1.81)、多食肉食(OR = 1.50, 95%CI: 1.19~1.90)、素食为主(OR = 1.21, 95%CI: 1.01~1.46)、食用蔬菜3~4天/周(OR = 1.26, 95%CI: 1.03~1.53)、患心脏病(OR = 1.50, 95%CI: 1.15~1.95)、患高血压(OR = 1.42, 95%CI: 1.20~1.68)、患糖尿病(OR = 1.24, 95%CI: 1.03~1.50)、身高(OR = 0.98, 95%CI: 0.98~0.99)、收缩压(OR = 1.01, 95%CI: 1.00~1.01)、脉搏(OR = 1.01, 95%CI: 1.00~1.02)、FBG (OR = 1.06, 95%CI: 1.02~1.10)为脑卒中的独立危险因素。此外，患有一种慢病(OR = 1.29, 95%CI: 1.06~1.58)和患有≥2种慢性病(OR = 1.78, 95%CI: 1.43~2.22)高风险相关，在三种多因素模型中均有统计学意义(P < 0.05)。结论：重庆市脑卒中发病水平较高，高龄、不均衡饮食、蔬菜食用不足、较矮身高、高收缩压、脉搏、FBG、以及患心脏病、高血压、糖尿病是脑卒中的危险因素，多重慢性病是脑卒中发生的独立危险因素。

Abstract: Aim: This study aims to explore the association between stroke and multiple chronic diseases to provide a scientific basis for precision medicine and interventions for patients with multiple chronic diseases. Methods: The study is based on the Chongqing Stroke High-Risk Population Screening and Intervention Project. A multi-stage stratified cluster random sampling method was employed to enroll 33,827 permanent residents aged 40 years and above who participated in the baseline survey between 2017 and 2019. Baseline data were collected through questionnaires, physical examinations, and laboratory tests. Follow-up was conducted in 2024 to record the incidence of stroke. Statistical analysis was performed using SPSS 26.0 and R 4.3.1, with multivariate logistic regression used to analyze the independent association between stroke and multiple chronic diseases. Results: A total of 33,827 subjects were included in the study, with 986 new stroke cases diagnosed during the follow-up period. Univariate analysis indicated that gender, age, dietary habits, heart disease, hypertension, and diabetes were significantly associated with stroke incidence. The multivariable model showed that age ≥65 years (OR = 3.43, 95%CI: 2.92~4.03), male gender (OR = 1.52, 95%CI: 1.28~1.81), high meat consumption (OR = 1.50, 95%CI: 1.19~1.90), primarily vegetarian diet (OR = 1.21, 95%CI: 1.01~1.46), vegetable consumption 3~4 days/week (OR = 1.26, 95%CI: 1.03~1.53), heart disease (OR = 1.50, 95%CI: 1.15~1.95), hypertension (OR = 1.42, 95%CI: 1.20~1.68), diabetes (OR = 1.24, 95%CI: 1.03~1.50), height (OR = 0.98, 95%CI: 0.98~0.99), systolic blood pressure (OR = 1.01, 95%CI: 1.00~1.01), pulse rate (OR = 1.01, 95%CI: 1.00~1.02), and fasting blood glucose (OR = 1.06, 95%CI: 1.02~1.10) were independent risk factors for stroke. Additionally, having one chronic disease (OR = 1.29, 95%CI: 1.06~1.58) and having ≥2 chronic diseases (OR = 1.78, 95%CI: 1.43~2.22) were high-risk factors, significant in all three multivariable models (P < 0.05). Conclusion: The incidence of stroke in Chongqing is high. Advanced age, unbalanced diet, insufficient vegetable consumption, shorter height, high systolic blood pressure, pulse rate, fasting blood glucose, as well as heart disease, hypertension, and diabetes are risk factors for stroke. Multiple chronic diseases are independent risk factors for stroke.