CN110428901A - Stroke onset Risk Forecast System and application - Google Patents
Stroke onset Risk Forecast System and application Download PDFInfo
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Abstract
The present invention provides a kind of stroke onset Risk Forecast System and applications.The present invention provides the compositions of the reagent material for the following risk factors information for taking individual and/or instrument and equipment to prepare the application in forecasting system for assessing individual stroke onset risk first: whether the age gender, smokes, blood pressure level and treatment condition, whether suffers from blood lipid measured value under diabetes, residence and fasting state.The present invention also provides a kind of for assessing the forecasting system of individual stroke onset risk, especially suitable for Chinese adult, can accurate evaluation individual cerebral apoplexy 10 years and lifelong onset risk, can identify high-risk individuals.
Description
Technical field
The present invention relates to a kind of stroke onset Risk Forecast System and applications, specifically, the present invention relates to adopt
The composition of the reagent material and/or instrument and equipment that take individual risk factor information is in preparation for assessing individual stroke onset
Application in the forecasting system of risk, further relate to it is a kind of for assessing the forecasting system of individual stroke onset risk, it is especially suitable
For Chinese adult.
Background technique
Cerebral apoplexy is the primary cause of death of China.Estimate according to Global disease burden, China in 2013 is by brain soldier
In caused dead up to 1,920,000.Risk of stroke prediction model can be used to identify the high-risk individuals in crowd, for for high-risk
Individual takes appropriate prevention intervention to provide important foundation.Therefore, the accurate and easy-to-use brain soldier of a assessment is developed
Middle onset risk prediction model, is of great significance to the primary prevention of Chinese cerebral apoplexy.Although having developed both at home and abroad at present
For the risk forecast model of atherosclerotic cardiovascular disease, as the PCE model in the U.S., the SCORE model in Europe and
Chinese atherosclerotic cardiovascular disease predicts (China-PAR) model, but in Chinese adult, there are no specifically for
The 10 years risks and lifetime risk prediction model of stroke onset.
Well-known stroke onset risk forecast model is that U.S.'s risk of stroke that not Framingham researchs and develops is commented in the world
Estimate model (FSRP).Hereafter, consecutive publications can be used for assessing the prediction models of cerebral apoplexy 10 years onset risks in the world, such as
ARIC risk of stroke calculator, QStroke model etc..But since risk factors of stroke and spectrum of disease are in Chinese and western people
The model of the difference of group, external demographic data exploitation is not appropriate for directly applying to Chinese population.Thus, it is necessary to develop a
10 years risk forecast models suitable for common Chinese adult stroke onset.On the other hand, 10 years wind of stroke onset
Danger is generally all lower for 10 years risks of 50 years old young people of age <, morbidity mainly by age effects, but its middle part
The still possible lifetime risk with higher of people is divided (the accumulation wind of cerebral apoplexy to occur from individual current age to 85 years old this period
Danger).Unlike 10 years risk profiles of cerebral apoplexy, lifetime risk can be with cardiovascular risk factors in Chinese middle-aged adults
Horizontal raising presentation significantly increases.Therefore, it will be pre- to 10 years risks for developing the lifetime risk prediction model of stroke onset
Survey the important supplement of model.Before this, research has evaluated age, gender, blood pressure level and whether suffer from diabetes to brain both at home and abroad
The influence of stroke lifetime risk, but these results of study cannot provide everyone specific risk profile value, i.e., can not use
In the lifetime risk assessment of the stroke onset of individuation.
Summary of the invention
It is an object of the present invention to establish the 10 years risks of stroke onset for being suitable for Chinese adult and lifelong wind
Dangerous forecasting system and method.
Inventor utilizes the individual data items of China-PAR cohort study object, establishes suitable for Chinese adult
10 years risks of stroke onset and lifetime risk prediction model, can accurate evaluation individual cerebral apoplexy 10 years and lifelong morbidity
Risk can identify high-risk individuals, mention for the morbidity of further individuation preventing brain stroke and individuation health guidance and intervention
For basis.
Specifically, on the one hand, the present invention provides take individual following risk factors information reagent material and/or
The composition of instrument and equipment is preparing the application in the forecasting system for assessing individual stroke onset risk:
Age, gender, waistline, whether smoke, blood pressure level and treatment condition, whether suffer from diabetes, cerebral apoplexy family history,
Blood lipid measured value under residence and fasting state.
The risk factors information that possible technique any in this field takes individual can be used, for example, can be using measurement
Method, or inquiry or questionnaire mode etc..In the present invention, take individual risk factors information reagent material and/
Or the composition of instrument and equipment includes various detection reagent materials used in the risk factors information process for take individual
And/or the combination of instrument and equipment, and/or investigation questionnaire etc., it also may include that virtual materials and/or instrument and equipment are (such as logical
It crosses artificial inquiry and obtains relevant information etc.).
On the other hand, the present invention also provides a kind of for assessing the forecasting system of individual stroke onset risk, wraps
It includes data and takes unit and data analysis unit；
It is for taking individual risk constraints data that the data, which take unit,；Specifically, the individual risk because
Whether element includes the age, gender, waistline, smokes, blood pressure level and treatment condition, whether suffers from diabetes, cerebral apoplexy family history, occupies
Blood lipid measured value under residence and fasting state；
The data analysis unit is that the data for taking unit to take data are analyzed and processed, and obtains cerebral apoplexy
Onset risk scoring.
Specific embodiment according to the present invention, the forecasting system and related application of stroke onset risk of the invention
In, the individual is Chinese adult.
Specific embodiment according to the present invention, the forecasting system and related application of stroke onset risk of the invention
In, the stroke onset risk is 10 years risks and/or lifetime risk.
Specific embodiment according to the present invention, the forecasting system and related application of stroke onset risk of the invention
In, the individual is sex.The risk factors of male individual include: the age, treatment after-contraction pressure, do not treat contraction
Whether pressure total cholesterol, high-density lipoprotein cholesterol, smokes, whether suffers from diabetes, residence south or the north, town and country, brain
Stroke family history.The risk factors of female individual include: the age, treatment after-contraction pressure, do not treat systolic pressure, total cholesterol, height
Whether density lipoprotein-cholesterol smokes, whether suffers from diabetes, residence south or the north, residence city or rural area, waist
It encloses.
In the present invention, the judgement in residence south or the north is accustomed to dividing according to Chinese tradition, usually using the Changjiang river as boundary.
Specific embodiment according to the present invention, the forecasting system and related application of stroke onset risk of the invention
In, the stroke onset risk score that data analysis unit obtains, which meets, to be obtained according to following model formation 1 and/or formula 2
Numerical value:
1-S10 exp(IndX B-MeanX B)Formula 1；
In formula 1, S10For 10 years survival rates of baseline；MeanX'B, each variable specific value of study population and its parameter product
The sum of average value；IndX'B is the sum of products of individual each variable specific value and corresponding parameter (being shown in Table 2)；
In formula 2, F (a, t；Z) be covariant be Z object in age a to period at age t cerebral apoplexy accumulation morbidity
Risk；βZ0, the average value of the sum of each variable specific value of study population and its parameter product；β Z is that the object that covariant is Z is each
The corresponding parameter of variable specific value (being shown in Table 3) sum of products；F(a；Z0) and F (t；Z0) it is that covariant is in crowd's average water
Flat Z0When, age a and the corresponding cerebral apoplexy cumulative morbidity of age t.
In some specific embodiments of the invention, 10 years survival rate S of baseline10, male 0.9807, Nv Xingwei
0.9891。
In some specific embodiments of the invention, the sum of each variable specific value of study population and its parameter product
Average value MeanX'B, male 159.84, and women 98.79.
In some specific embodiments of the invention, the sum of each variable specific value of study population and its parameter product
Average value β Z0, male 17.51, and women 19.67.
Specific embodiment according to the present invention, the forecasting system and related application of stroke onset risk of the invention
In, the scoring for meeting the numerical value obtained according to formula 1 is cerebral apoplexy 10 years onset risks scoring, meets and obtains according to formula 2
The scoring of numerical value is the lifelong onset risk scoring of cerebral apoplexy.
Specific embodiment according to the present invention, the forecasting system and related application of stroke onset risk of the invention
In, the height of stroke onset risk score reflects the height of individual stroke onset risk.
In some specific embodiments of the invention, 10 years risk scores of Chinese adult stroke onset >=
7.0% or lifetime risk scoring >=25.0% individual, be risk of stroke " high-risk ".
The forecasting system of stroke onset risk of the invention may also include individuation health guidance unit, be used for root
Individuation health guidance is provided according to the risk score of data analysis unit.
The forecasting system of stroke onset risk of the invention, can be virtual bench, adopt as long as being able to achieve the data
Take the function of unit and data analysis unit.The data take unit to can be including various detection reagent materials
And/or detecting instrument equipment etc.；The data analysis unit can be any information that may be implemented to take data unit
It is analyzed and processed and obtains operation instrument, module or the virtual unit of risk score, be also possible to various possibility in advance
Appraisal result and the corresponding data drawing list of the formulations such as corresponding risk class and/or corresponding health guidance etc..
In some specific embodiments of the invention, the present invention also provides a kind of individual stroke onset risks of assessment
Electronic equipment, including first memory, first processor and storage can transport on the first memory and on first processor
Capable computer program realizes the scoring process included the following steps when the first processor executes described program:
Individual gender information is received, judges men and women；
If being judged as male, obtain the following risk factors information of individual: the age, does not treat contraction at treatment after-contraction pressure
Whether pressure total cholesterol, high-density lipoprotein cholesterol, smokes, whether suffers from diabetes, residence south or the north, residence
City or rural area, cerebral apoplexy family history；
Based on acquired individual risk factor information, individual 10 years risks and/or lifetime risk scoring are calculated；
Wherein, the process of the individual 10 years risk scores of calculating includes:
The sum of products IndX'B:Ln (age) of the following corresponding parameter of variable specific value is calculated, year；Ln (is controlled
Treat after-contraction pressure), mmHg；Ln (does not treat systolic pressure), mmHg；Ln (total cholesterol), mg/dL；(high-density lipoprotein gallbladder is solid by Ln
Alcohol), mg/dL；It smokes (1=is that 0=is no)；Diabetes (1=is that 0=is no)；Residence south or the north (north 1=, 0=
South)；Residence city or rural area (city 1=, the rural area 0=)；Cerebral apoplexy family history (1=is that 0=is no)；Ln (age) ×
Smoking；Ln (age) × Ln (treatment after-contraction pressure)；Ln (age) × Ln (not treating systolic pressure)；Ln (age) × cerebral apoplexy man
Race's history (1=is that 0=is no)；
Based on the IndX'B being calculated and following model formation 1 is combined, obtains the specific value of formula 1 as individual 10
Year risk score；
1-S10 exp(IndX B-MeanX B)Formula 1；
In formula 1, S10For 10 years survival rates of baseline；MeanX'B, each variable specific value of study population and its parameter product
The sum of average value；IndX'B is the sum of products of individual each variable specific value and corresponding parameter (being shown in Table 2)；
Wherein, calculating the process that individual lifetime risk scores includes:
Each corresponding parameter of variable specific value (being shown in Table 3) sum of products β Z:Ln of object that covariant is Z is calculated (to control
Treat after-contraction pressure), mmHg；Ln (does not treat systolic pressure), mmHg；Ln (total cholesterol), mg/dL；(high-density lipoprotein gallbladder is solid by Ln
Alcohol), mg/dL；It smokes (1=is that 0=is no)；Diabetes (1=is that 0=is no)；Residence south or the north (north 1=, 0=
South)；Residence city or rural area (city 1=, the rural area 0=)；Cerebral apoplexy family history (1=is that 0=is no)；
Based on the β Z being calculated and following model formation 2 is combined, obtains the specific value of formula 2 as the lifelong wind of individual
Danger scoring；
In formula 2, F (a, t；Z) be covariant be Z object in age a to period at age t cerebral apoplexy accumulation morbidity
Risk；βZ0, the average value of the sum of each variable specific value of study population and its parameter product；β Z is that the object that covariant is Z is each
The corresponding parameter of variable specific value (being shown in Table 3) sum of products；F(a；Z0) and F (t；Z0) it is that covariant is in crowd's average water
Flat Z0When, age a and the corresponding cerebral apoplexy cumulative morbidity of age t.
On the other hand, the present invention also provides a kind of electronic equipments for assessing individual stroke onset risk, including first
Memory, first processor and storage are on the first memory and the computer program that can run on first processor, described
The scoring process included the following steps is realized when first processor executes described program:
Individual gender information is received, judges men and women；
If being judged as female, obtain the following risk factors information of individual: the age, does not treat contraction at treatment after-contraction pressure
Whether pressure total cholesterol, high-density lipoprotein cholesterol, smokes, whether suffers from diabetes, residence south or the north, residence
City or rural area, waistline；
Based on acquired individual risk factor information, individual 10 years risks and/or lifetime risk scoring are calculated；
Wherein, the process of the individual 10 years risk scores of calculating includes:
The sum of products IndX'B:Ln (age) of the following corresponding parameter of variable specific value is calculated, year；Ln (is controlled
Treat after-contraction pressure), mmHg；Ln (does not treat systolic pressure), mmHg；Ln (total cholesterol), mg/dL；(high-density lipoprotein gallbladder is solid by Ln
Alcohol), mg/dL；Ln (waistline), cm；It smokes (1=is that 0=is no)；Diabetes (1=is that 0=is no)；Residence south or the north
(north 1=, the south 0=)；Residence city or rural area (city 1=, the rural area 0=)；Ln (age) × Ln (treatment after-contraction
Pressure)；Ln (age) × Ln (not treating systolic pressure)；Ln (age) × Ln (high-density lipoprotein cholesterol)；
Based on the IndX'B being calculated and following model formation 1 is combined, obtains the specific value of formula 1 as individual 10
Year risk score；
1-S10 exp(IndX B-MeanX B)Formula 1；
In formula 1, S10For 10 years survival rates of baseline；MeanX'B, each variable specific value of study population and its parameter product
The sum of average value；IndX'B is the sum of products of individual each variable specific value and corresponding parameter (being shown in Table 2)；
Wherein, calculating the process that individual lifetime risk scores includes:
Each corresponding parameter of variable specific value (being shown in Table 3) sum of products β Z:Ln of object that covariant is Z is calculated (to control
Treat after-contraction pressure), mmHg；Ln (does not treat systolic pressure), mmHg；Ln (total cholesterol), mg/dL；(high-density lipoprotein gallbladder is solid by Ln
Alcohol), mg/dL；Ln (waistline), cm；It smokes (1=is that 0=is no)；Diabetes (1=is that 0=is no)；Residence south or the north
(north 1=, the south 0=)；Residence city or rural area (city 1=, the rural area 0=)；
Based on the β Z being calculated and following model formation 2 is combined, obtains the specific value of formula 2 as the lifelong wind of individual
Danger scoring；
In formula 2, F (a, t；Z) be covariant be Z object in age a to period at age t cerebral apoplexy accumulation morbidity
Risk；βZ0, the average value of the sum of each variable specific value of study population and its parameter product；β Z is that the object that covariant is Z is each
The corresponding parameter of variable specific value (being shown in Table 3) sum of products；F(a；Z0) and F (t；Z0) it is that covariant is in crowd's average water
Flat Z0When, age a and the corresponding cerebral apoplexy cumulative morbidity of age t.
Specific embodiment according to the present invention, the electronic equipment of the individual stroke onset risk of assessment of the invention,
Described in first processor execute described program when can also be achieved according to 10 years risks of individual stroke onset and/or lifetime risk
Scoring provides the process of individuation health guidance.
The forecasting system and related application of stroke onset risk of the invention, through other external queue verifications, prediction effect
Fruit is good, and the 10 years risks and lifetime risk suitable for Chinese adult stroke onset are predicted.
It is pre- to compensate for Chinese the past risk of stroke for the forecasting system and related application of stroke onset risk of the invention
Survey the deficiency of model.For example, different from previous risk forecast model, this model novelty incorporates waistline variable, as female
Property stroke onset risk prediction index, prompt in Chinese women cerebral apoplexy primary prevention, should more pay attention to prevention center
Property it is fat.In male's predictive variable, it is included in prediction index of the cerebral apoplexy family history as onset risk for the first time.In addition, male,
Female Model incorporates the variable that can embody Chinese stroke onset and Characteristics of risk factors: residence south or the north occupy
Residence town and country.The two variables can further promote the predictive ability of this model.
This model has a following clinical meaning: this model can 10 years risks to individual stroke onset and lifetime risk into
Row rapid evaluation is applied to cerebral apoplexy primary prevention.The primary prevention guide of cardiovascular and cerebrovascular diseases is pointed out both at home and abroad, accurate 10 years
Risk assessment is the important foundation stone of primary prevention.Even if the multiple risk factor levels of an especially young people increase, brain soldier
10 years risks of middle morbidity are still lower, but its lifetime risk be likely to be at it is high-risk.Therefore, in the high risk population of stroke of China
In screening and prevention work, need to pay attention to simultaneously the 10 years risks and lifetime risk assessment of stroke onset.And it is of the present invention
10 years and lifetime risk prediction model of stroke onset are exactly carried out using the observations that Chinese population long term follow-up obtains
Research and development, the potential high risk individual suitable for identifying stroke onset Chinese adult.
In conclusion the 10 years risks and lifetime risk of the Chinese adult stroke onset that the present invention develops predict mould
Type takes individuation prevention and treatment to provide foundation as early as possible, is also community to Chinese adult cerebral apoplexy high risk individual is accurately identified
Cardiovascular and cerebrovascular diseases prevention and control provide effective assessment tool.
Detailed description of the invention
Fig. 1 is 10 years risk models (A, males of stroke onset in ChinaMUCA (1992-1994) queue；B, female
Property) and lifetime risk model * (C, male；D, women) calibration write music line.Abscissa is the predicted value of stroke onset risk,
Ordinate is the observed value of stroke onset risk (risk is as a percentage).* the verifying of lifetime risk model is to predict to tire out
15 years stroke onset risks of product indicate.
Specific embodiment
For a clearer understanding of the present invention, the present invention is further described referring now to the following example.Embodiment is only used for
It explains without limiting the invention in any way.Test method without specific conditions is known to fields in embodiment
Conventional method and normal condition, or according to condition proposed by manufacturer.
Embodiment
The present embodiment utilizes the individual data items of China-PAR cohort study object, establishes suitable for Chinese adult
10 years risks of stroke onset and lifetime risk prediction model, these models can be with cerebral apoplexy 10 years of one object of accurate evaluation
With lifelong onset risk, high-risk individuals can be identified, intervene for the prevention of further individuation and basis is provided.
Crowd
It does not suffer from the individual data items data of cardiovascular disease using China-PAR queue, develops and verify stroke onset
10 years and lifetime risk prediction model.In China-PAR queue, China's angiocarpy epidemic disease multicenter joint study
(ChinaMUCA) (1998) and Asia cardiovascular disease international cooperating research (InterASIA) are included together as derivative queue, altogether
21320 people are counted, for constructing 10 years risks and lifetime risk prediction model.In addition, using ChinaMUCA (1992-1994) team
Column verify above-mentioned risk forecast model.
The determination of baseline health data collecting and stroke onset
It is detected using questionnaire survey, physical examination and blood biochemistry, has collected following baseline variables information: age, gender, waist
It encloses, whether smoke, blood pressure level and treatment condition, whether suffer from diabetes, cerebral apoplexy family history, residence south or the north, occupy
It is blood lipid under residence town and country and fasting state, blood sugar measured.Diabetes are defined as fasting blood-glucose >=126mg/dL or
Use insulin or hypoglycemic drug.
Stroke onset event is defined as: because cerebral vessels rupture or block due to cause neurological dysfunction acute attack and
Duration is more than 24 hours.Including Ischemic Stroke, hemorrhagic apoplexy and prepattern cerebral apoplexy, transient cerebral ischemia is free of
Breaking-out.Because the other diseases death except cerebral apoplexy is defined as competitive events.
The baseline characteristic of derivative cohort crowd
The baseline characteristic of derivative cohort crowd is referring to table 1.
The baseline characteristic of the derivative cohort crowd of table 1.
The foundation and application of 10 years risk forecast models of cerebral apoplexy
Using Cox proportional hazards regression models, 10 years risk forecast models of cerebral apoplexy are constructed in male and female respectively.
Logarithm conversion is carried out to continuous variable first before constructing model.Secondly, by Major cardiovascular risk factor, including year
Whether systolic pressure when not treating after age, treatment or smokes, whether suffers from diabetes and total cholesterol is directly entered model.It is added
The variable that comprehensive distinguishing improves index (IDI) >=6% after model is also included in model.Finally, male and female is divided to construct cerebral apoplexy
10 years risk forecast models of morbidity, 10 years risk forecast models of male are included in 14 variables (age, treatment after-contraction altogether
Whether pressure does not treat systolic pressure, total cholesterol, high-density lipoprotein cholesterol, smokes, whether suffering from diabetes, residence south
Or the north, residence town and country, cerebral apoplexy family history, age × whether smoke, age × treatment after-contraction pressure, age × do not treat
Systolic pressure, age × cerebral apoplexy family history)；10 years risk forecast models of women are included in 13 variables, the model with male altogether
Compare, be newly included in two variables (waistline, age × high-density lipoprotein cholesterol), and cerebral apoplexy family history, the age × whether
Smoking, age × cerebral apoplexy family history are not included in, and dependent variable is identical as the model of male.
Male, women stroke onset 10 years risk profiles are included in variable and its parameter is as shown in table 2.
Variable needed for 10 years risk forecast models of 2. stroke onset of table and corresponding parameter
Note: Ln, natural logrithm conversion；N/A, the variable are not included in model；MeanX'B respectively becomes in this study population
Measure the average value of the sum of specific value and its parameter product；S10, 10 years survival rates of baseline.
If an adult, it is known that the age of itself, treatment untreated shrink the specific of the variables such as voltage levels
Numerical value, multiplied by parameter corresponding to variables different in table 2, can calculating IndX'B, (i.e. each variable of the adult is specifically counted
It is worth and the sum of products of corresponding parameter), IndX'B is substituted into following equation 1, acquires 10 years risks of stroke onset:
1-S10 exp(IndX B-MeanX B)Formula 1
Wherein, S10For 10 years survival rates of baseline, male 0.9807, and women 0.9891；MeanX'B is this study population
The average value of the sum of each variable specific value and its parameter product, male 159.84, and women is 98.79 (being shown in Table 2)；IndX'B
For the sum of products of some individual each variable specific value and corresponding parameter (being shown in Table 2).
The foundation and application of cerebral apoplexy lifetime risk prediction model
Divide the lifetime risk prediction model of male and female building stroke onset.10 years risks of stroke onset are pre-
Survey the variable be included in model and be directly used in the modeling of cerebral apoplexy lifetime risk, but the age not as predictive variable, and as model
Basal latency function.After cerebral apoplexy accumulation morbidity function after determining correction competitive risk, using correction competitive risk
Son distribution risk algorithm calculates cerebral apoplexy of the individual from current age until 85 years old and accumulates onset risk, the i.e. lifelong wind of cerebral apoplexy
Danger.
Male, variable is included in the prediction of women cerebral apoplexy lifetime risk and its parameter is as shown in table 3.
Variable needed for 3. cerebral apoplexy lifetime risk prediction model of table and corresponding parameter
| Variable | Male | Women | |
| Ln (treatment after-contraction pressure), mmHg | 3.88 | 2.75 | |
| Ln (does not treat systolic pressure), mmHg | 3.83 | 2.69 | |
| Ln (total cholesterol), mg/dL | 0.30 | 0.11 | |
| Ln (high-density lipoprotein cholesterol), mg/dL | -0.63 | -0.31 | |
| Ln (waistline), cm | N/A | 1.71 | |
| Whether smoke (1=is that 0=is no) | 0.27 | 0.51 | |
| Whether suffer from diabetes (1=is that 0=is no) | 0.21 | 0.41 | |
| Residence south or the north (north 1=, the south 0=) | 0.39 | 0.52 | |
| Residence town and country (city 1=, the rural area 0=) | -0.35 | -0.25 | |
| Cerebral apoplexy family history (1=is that 0=is no) | 0.40 | N/A | |
| βZ0 | 17.51 | 19.67 |
Note: Ln, natural logrithm conversion；N/A, the variable are not included in model；βZ0, each variable of study population specifically counts
The average value of value and the sum of its parameter product.
The lifetime risk of stroke onset is acquired by following formula:
Wherein, F (a, t；Z) be covariant be Z object in age a (i.e. baseline age) to age t (i.e. lifetime risk meter
The cut-off age of calculation, this model are 85 years old) cerebral apoplexy in period accumulates onset risk.βZ0It is specific for each variable of study population
The average value of the sum of numerical value and its parameter product, wherein male is 17.51, and women 19.67.β Z is the object that covariant is Z
Each variable specific value and its coefficient (being shown in Table 3) sum of products.F(a；Z0) and F (t；Z0) it is that covariant is in crowd's average level
Z0When, age a and the corresponding cerebral apoplexy cumulative morbidity of age t.
Risk stratification based on 10 years risks and lifetime risk prediction model of stroke onset
By 10 years Risk parameters of stroke onset in study population and the 90%th quantile of lifetime risk estimated value
(10 years Risk parameters are 7.0%, and lifetime risk estimated value is 25.0%), as judging the critical of cerebral apoplexy high risk
Value, that is, define 10 years risk >=7.0% of Chinese adult stroke onset or the individual of lifetime risk >=25.0%, is brain soldier
Risk " high-risk ".
Model accuracy verifying
By another independent crowd ChinaMUCA (1992-1994) as verifying queue, to 10 years wind of stroke onset
The accuracy of danger and lifetime risk forecast result of model is verified.ChinaMUCA (1992-1994) is containing 14123 researchs pair
As baseline characteristic is as shown in table 4.
Table 4.ChinaMUCA (1992-1994) cohort study object baseline feature
The 10 years risks and lifetime risk model of stroke onset are applied to ChinaMUCA (1992-1994), using state
Common C statistic and calibration degree χ on border2Judge the prediction effect of this model.C statistic is close or larger than 0.8, calibration degree χ2
Close to or smaller than 20, it is believed that the prediction effect of model is good.
Therefore, 10 years risk models of stroke onset are verified, i.e., ChinaMUCA (1992-1994) is verified
The individual variable value of nearly 1.4 ten thousand people substitutes into parameter list (being shown in Table 2) and formula 1 in queue, male as the result is shown, Female Model C system
Metering is respectively 0.830 (95%CI:0.799-0.862), 0.834 (95%CI:0.805-0.863), calibration degree χ2Respectively
20.6 (P=0.014), 13.7 (P=0.132), prediction effect is good.
The lifetime risk model of stroke onset is verified, i.e., in ChinaMUCA (1992-1994) verifying queue
The individual variable value of nearly 1.4 ten thousand people is updated to parameter list (being shown in Table 3) and formula 2, male as the result is shown, Female Model C statistic
Respectively 0.778 (95%CI:0.752-0.804), 0.800 (95%CI:0.775-0.825), calibration degree χ2Respectively 9.9 (P
=0.358), 20.5 (P=0.015), prediction effect is good.
Prediction of the 10 years risks and lifetime risk of the above stroke onset in ChinaMUCA (1992-1994) queue
Effect, summary are shown in Table 5.
5. stroke onset of table, 10 years risks and lifetime risk prediction model are in ChinaMUCA (1992-1994) queue
Prediction effect
95%CI, 95% confidence interval
* because can not it is observed that crowd all living to 85 years old when stroke onset situation, therefore lifetime risk predicts mould
The verifying of type is indicated with the stroke onset risk for predicting accumulation 15 years.
10 years risk forecast models are used using event number after the adjustment of Kaplan-Meier method, lifetime risk prediction model
Event number after correction competitive risk.
In addition, drawing " calibration write music line ", the predicted value of 10 years risks and lifetime risk model of stroke onset is found
With actual observed value, all it is 45 ° of cornerwise surroundings for being tightly distributed in Fig. 1, it is preferable illustrates that predicted value and observed value have
Consistency (see Fig. 1).
1: one 45 years old male is illustrated, does not receive antihypertensive drug therapy at present and systolic pressure is 140mmHg, total gallbladder is solid
Alcohol is 240mg/dL, high-density lipoprotein cholesterol 40mg/dL, and smoking does not suffer from diabetes, lives in cities of Northern China,
With cerebral apoplexy family history, then the calculating of its " IndX'B " are as follows:
Ln(45)×35.58+Ln(140)×29.49+Ln(240)×0.29–Ln(40)×0.64+1×4.72+0×
0.30+1×0.32–1×0.38+1×7.56–Ln(45)×1×1.10–Ln(45)×Ln(140)×6.40–Ln(45)×1
× 1.84=161.09
Formula 1 is substituted into, then the risk of cerebral apoplexy occurs in coming 10 years for the male are as follows:
1-0.9807exp(161.09-159.84)=6.6%
The man can be assessed the risk of cerebral apoplexy occurs in coming 10 years is " low danger ".
2: one 45 years old women are illustrated, does not receive antihypertensive drug therapy at present and systolic pressure is 140mmHg, total gallbladder is solid
Alcohol is 240mg/dL, high-density lipoprotein cholesterol 40mg/dL, waistline 90cm, and non-smoking suffers from diabetes, lives in China
North city, " IndX'B " are as follows:
Ln(45)×19.97+Ln(140)×25.06+Ln(240)×0.16-Ln(40)×11.35+Ln(90)×1.60
+ 0 × 0.51+1 × 0.50+1 × 0.50-1 × 0.23-Ln (45) × Ln (140) × 5.59+Ln (45) × Ln (40) × 2.75=
100.27
Formula 1 is substituted into, then the risk of cerebral apoplexy occurs in coming 10 years for the women are as follows:
1-0.9891exp(100.27-98.79)=4.7%
The women can be assessed the risk of cerebral apoplexy occurs in coming 10 years is " low danger ".
3: one 45 years old males are illustrated, does not receive antihypertensive drug therapy at present and systolic pressure is 140mmHg, total gallbladder is solid
Alcohol is 240mg/dL, high-density lipoprotein cholesterol 40mg/dL, and smoking does not suffer from diabetes, lives in cities of Northern China,
With cerebral apoplexy family history, then the calculating of its " β Z " are as follows:
Ln(140)×3.83+Ln(240)×0.30–Ln(40)×0.63+1×0.27+0×0.21+1×0.39–1×
0.35+1 × 0.40=18.91
Corresponding F (45 at male 45 years old and 85 years old；Z0) and F (85；Z0), respectively 5.607 × 10-3With 1.081 × 10-1。
Substitute into formula 2, then the lifelong onset risk of male's cerebral apoplexy (until 85 years old) are as follows:
It is " high-risk " that the lifelong onset risk of male's cerebral apoplexy (until 85 years old), which can be assessed,.
4: one 45 years old women are illustrated, does not receive antihypertensive drug therapy at present and systolic pressure is 140mmHg, total gallbladder is solid
Alcohol is 240mg/dL, high-density lipoprotein cholesterol 40mg/dL, waistline 90cm, and non-smoking suffers from diabetes, lives in China
North city, " β Z " are as follows:
Ln(140)×2.69+Ln(240)×0.11–Ln(40)×0.31+Ln(90)×1.71+0×0.51+1×0.41
+ 1 × 0.52-1 × 0.25=21.15
Corresponding F (45 at women 45 years old and 85 years old；Z0) and F (85；Z0), respectively 1.684 × 10-3With 7.720 × 10-2。
Substitute into formula 2, then the lifelong onset risk of women cerebral apoplexy (until 85 years old) are as follows:
It is " high-risk " that the lifelong onset risk of women cerebral apoplexy (until 85 years old), which can be assessed,.
Claims (10)
1. the composition of the reagent material and/or instrument and equipment of taking the following risk factors information of individual is in preparation for assessing
Application in the forecasting system of individual stroke onset risk:
Whether whether the age gender, smoke, blood pressure level and treatment condition, suffer under diabetes, residence and fasting state
Blood lipid measured value.
2. application according to claim 1, wherein the individual is Chinese adult；
The stroke onset risk is 10 years risks and/or lifetime risk.
3. application according to claim 1 or 2, wherein the individual is sex；
The risk factors of male individual include: the age, treatment after-contraction pressure, do not treat systolic pressure, total cholesterol, high density lipoprotein level
Whether white cholesterol smokes, whether suffers from diabetes, residence south or the north, town and country, cerebral apoplexy family history；
The risk factors of female individual include: the age, treatment after-contraction pressure, do not treat systolic pressure, total cholesterol, high density lipoprotein level
Whether white cholesterol smokes, whether suffers from diabetes, residence south or the north, town and country, waistline.
4. a kind of for assessing the forecasting system of individual stroke onset risk comprising data take unit and data to analyze
Unit；
It is for taking individual risk factor information that the data, which take unit,；Wherein the individual is sex；Male
The risk factors of individual include: age, treatment after-contraction pressure, not treat systolic pressure, total cholesterol, high-density lipoprotein gallbladder solid
Whether alcohol smokes, whether suffers from diabetes, residence south or the north, town and country, cerebral apoplexy family history；The risk of female individual because
Whether element includes: the age, treatment after-contraction pressure, does not treat systolic pressure, total cholesterol, high-density lipoprotein cholesterol, smoke, be
It is no to suffer from diabetes, residence south or the north, town and country, waistline；
The data analysis unit is that the information for taking unit to take data is analyzed and processed, and obtains stroke onset
Risk score.
5. forecasting system according to claim 4, wherein the stroke onset risk score symbol that data analysis unit obtains
Close the numerical value obtained according to following model formation 1 and/or formula 2:
1-S10 exp(IndX′B-MeanX′B)Formula 1；
In formula 1, S10For 10 years survival rates of baseline；MeanX'B, the sum of each variable specific value of study population and its parameter product
Average value；IndX'B is the sum of products of individual each variable specific value and corresponding parameter (being shown in Table 2)；
In formula 2, F (a, t；Z) be covariant be Z object in age a to period at age t cerebral apoplexy accumulation morbidity wind
Danger；βZ0, the average value of the sum of each variable specific value of study population and its parameter product；β Z is that the object that covariant is Z respectively becomes
Measure the corresponding parameter of specific value (being shown in Table 3) sum of products；F(a；Z0) and F (t；Z0) it is that covariant is in crowd's average level
Z0When, age a and the corresponding cerebral apoplexy cumulative morbidity of age t.
6. forecasting system according to claim 5, wherein the scoring for meeting the numerical value obtained according to formula 1 is cerebral apoplexy
Onset risk scoring in 10 years, the scoring for meeting the numerical value obtained according to formula 2 is the lifelong onset risk scoring of cerebral apoplexy；
Preferably, the height of stroke onset risk score reflects the height of individual stroke onset risk.
7. forecasting system according to any one of claim 4 to 6, wherein 10 years wind of Chinese adult stroke onset
The individual of danger scoring >=7.0% or lifetime risk scoring >=25.0%, for risk of stroke " high-risk ".
8. a kind of electronic equipment for assessing individual stroke onset risk, including first memory, first processor and it is stored in
On first memory and the computer program that can run on first processor, the first processor execute real when described program
The scoring process now included the following steps:
Individual gender information is received, judges men and women；
If being judged as male, obtain the following risk factors information of individual: the age, does not treat systolic pressure, is total at treatment after-contraction pressure
Cholesterol, high-density lipoprotein cholesterol, whether smoke, whether suffer from diabetes, residence south or the north, residence city or
Rural area, cerebral apoplexy family history；
Based on acquired individual risk factor information, individual 10 years risks and/or lifetime risk scoring are calculated；
Wherein, the process of the individual 10 years risk scores of calculating includes:
The sum of products IndX'B:Ln (age) of the following corresponding parameter of variable specific value is calculated, year；Ln is (after treatment
Systolic pressure), mmHg；Ln (does not treat systolic pressure), mmHg；Ln (total cholesterol), mg/dL；Ln (high-density lipoprotein cholesterol),
mg/dL；It smokes (1=is that 0=is no)；Diabetes (1=is that 0=is no)；Residence south or the north (north 1=, the south 0=
Side)；Residence city or rural area (city 1=, the rural area 0=)；Cerebral apoplexy family history (1=is that 0=is no)；Ln (age) × suction
Cigarette；Ln (age) × Ln (treatment after-contraction pressure)；Ln (age) × Ln (not treating systolic pressure)；Ln (age) × cerebral apoplexy family
History (1=is that 0=is no)；
Based on the IndX'B being calculated and following model formation 1 is combined, obtains the specific value of formula 1 as individual 10 years wind
Danger scoring；
1-S10 exp(IndX′B-MeanX′B)Formula 1；
In formula 1, S10For 10 years survival rates of baseline；MeanX'B, the sum of each variable specific value of study population and its parameter product
Average value；IndX'B is the sum of products of individual each variable specific value and corresponding parameter (being shown in Table 2)；
Wherein, calculating the process that individual lifetime risk scores includes:
Calculating covariant is each corresponding parameter of variable specific value (being shown in Table 3) sum of products β Z:Ln of object of Z (after treatment
Systolic pressure), mmHg；Ln (does not treat systolic pressure), mmHg；Ln (total cholesterol), mg/dL；Ln (high-density lipoprotein cholesterol),
mg/dL；It smokes (1=is that 0=is no)；Diabetes (1=is that 0=is no)；Residence south or the north (north 1=, the south 0=
Side)；Residence city or rural area (city 1=, the rural area 0=)；Cerebral apoplexy family history (1=is that 0=is no)；
Based on the β Z being calculated and following model formation 2 is combined, show that the specific value of formula 2 is commented as individual lifetime risk
Point；
In formula 2, F (a, t；Z) be covariant be Z object in age a to period at age t cerebral apoplexy accumulation morbidity wind
Danger；βZ0, the average value of the sum of each variable specific value of study population and its parameter product；β Z is that the object that covariant is Z respectively becomes
Measure the corresponding parameter of specific value (being shown in Table 3) sum of products；F(a；Z0) and F (t；Z0) it is that covariant is in crowd's average level
Z0When, age a and the corresponding cerebral apoplexy cumulative morbidity of age t.
9. a kind of electronic equipment for assessing individual stroke onset risk, including first memory, first processor and it is stored in
On first memory and the computer program that can run on first processor, the first processor execute real when described program
The scoring process now included the following steps:
Individual gender information is received, judges men and women；
If being judged as female, obtain the following risk factors information of individual: the age, does not treat systolic pressure, is total at treatment after-contraction pressure
Cholesterol, high-density lipoprotein cholesterol, whether smoke, whether suffer from diabetes, residence south or the north, residence city or
Rural area, waistline；
Based on acquired individual risk factor information, individual 10 years risks and/or lifetime risk scoring are calculated；
Wherein, the process of the individual 10 years risk scores of calculating includes:
The sum of products IndX'B:Ln (age) of the following corresponding parameter of variable specific value is calculated, year；Ln is (after treatment
Systolic pressure), mmHg；Ln (does not treat systolic pressure), mmHg；Ln (total cholesterol), mg/dL；Ln (high-density lipoprotein cholesterol),
mg/dL；Ln (waistline), cm；It smokes (1=is that 0=is no)；Diabetes (1=is that 0=is no)；Residence south or the north (1=
The north, the south 0=)；Residence city or rural area (city 1=, the rural area 0=)；Ln (age) × Ln (treatment after-contraction pressure)；Ln
(age) × Ln (does not treat systolic pressure)；Ln (age) × Ln (high-density lipoprotein cholesterol)；
Based on the IndX'B being calculated and following model formation 1 is combined, obtains the specific value of formula 1 as individual 10 years wind
Danger scoring；
1-S10 exp(IndX′B-MeanX′B)Formula 1；
In formula 1, S10For 10 years survival rates of baseline；MeanX'B, the sum of each variable specific value of study population and its parameter product
Average value；IndX'B is the sum of products of individual each variable specific value and corresponding parameter (being shown in Table 2)；
Wherein, calculating the process that individual lifetime risk scores includes:
Calculating covariant is each corresponding parameter of variable specific value (being shown in Table 3) sum of products β Z:Ln of object of Z (after treatment
Systolic pressure), mmHg；Ln (does not treat systolic pressure), mmHg；Ln (total cholesterol), mg/dL；Ln (high-density lipoprotein cholesterol),
mg/dL；Ln (waistline), cm；It smokes (1=is that 0=is no)；Diabetes (1=is that 0=is no)；Residence south or the north (1=
The north, the south 0=)；Residence city or rural area (city 1=, the rural area 0=)；
Based on the β Z being calculated and following model formation 2 is combined, show that the specific value of formula 2 is commented as individual lifetime risk
Point；
In formula 2, F (a, t；Z) be covariant be Z object in age a to period at age t cerebral apoplexy accumulation morbidity wind
Danger；βZ0, the average value of the sum of each variable specific value of study population and its parameter product；β Z is that the object that covariant is Z respectively becomes
Measure the corresponding parameter of specific value (being shown in Table 3) sum of products；F(a；Z0) and F (t；Z0) it is that covariant is in crowd's average level
Z0When, age a and the corresponding cerebral apoplexy cumulative morbidity of age t.
10. the electronic equipment of the individual stroke onset risk of assessment according to claim 8 or claim 9, wherein at described first
Reason device can also be achieved when executing described program provides individual according to 10 years risks of individual stroke onset and/or lifetime risk scoring
Change the process of health guidance.
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