Prevalence and associated factors of chronic orthostatic intolerance in communities
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摘要:
目的 探讨社区中老年人群慢性直立不耐受综合征(orthostatic intolerance，OI)的患病率及相关影响因素，为制定社区OI患者干预措施提供科学依据。 方法 采用整群随机抽样的方法，于2021年1—9月抽取吉林省长春市3个社区卫生服务机构，对年龄≥40岁的546名户籍居民进行病史采集、直立不耐受问卷评定及卧立位血压测量，应用SPSS 26.0统计学软件对社区慢性OI患病情况进行描述性统计分析，采用多因素logistic回归模型分析影响OI患病率的相关因素。 结果 本研究人群OI总体患病率为15.8%(86/546)，在各亚型中，直立性低血压(OH)、体位性心动过速综合征(POTS)、直立性高血压(OHT)患病率分别为10.6%(58/546)、0.7%(4/546)、4.4%(24/546)，OH患病率明显高于其他2个亚型(χ2=56.840，P < 0.001)。按年龄分层，OI患病率随年龄增长呈上升趋势(χ2=7.919，P=0.048)，70岁以上高龄人群患病率最高(20.6%，28/136)。多因素logistic回归分析结果显示，年龄≥60岁、高血压、卧位收缩压≥140 mmHg(1 mmHg=0.133 kPa)是慢性OI的独立危险因素。 结论 社区中老年人群慢性OI患病率较高，临床分型以OH为主，老年人群、伴有高血压尤其是卧位收缩压控制不良者慢性OI患病风险高，应对重点人群加强防控。 Abstract:Objective To investigate the prevalence and associated factors of chronic orthostatic intolerance (OI) in community-dwelling middle-aged and elderly people. Methods From January to September 2021, a random cluster sample of 546 registered residents aged ≥40 years in three community health services in Changchun was conducted. Data included medical history, questionnaire and blood pressure in supine and standing positions. SPSS 26.0 software was used for descriptive statistical analysis. Factors associated with OI were analyzed by multivariate logistic regression models. Results The overall prevalence of OI was 15.8%(86/546), and among the subtypes, the prevalence of orthostatic hypotension (OH), postural orthostatic tachycardia syndrome (POTS) and orthostatic hypertension (OHT) were 10.6%(58/546), 0.7%(4/546) and 4.4%(24/546), respectively. The prevalence of OH was significantly higher than the other two subtypes(χ2=56.840, P < 0.001). Stratified by age, the prevalence of OI tended to increase with age(χ2=7.919, P=0.048), with the highest prevalence in those aged ≥70 years old(20.6%, 28/136). Multi-factor logistic regression analysis showed that age≥60 years, hypertension, and supine systolic blood pressure ≥140 mmHg (1 mmHg=0.133 kPa) in the prone position were independent risk factors for chronic OI. Conclusion There is a high prevalence of chronic OI in the middle-aged and elderly population in communities. OH is the main clinical type. Elderly people, hypertension and supine systolic hypertension are at high risk of developing chronic OI. Therefore, prevention and control of OI should be strengthened in key populations. -
Key words:
- Orthostatic intolerance /
- Orthostatic hypotension /
- Prevalence
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表 1 546名社区中老年人群直立不耐受综合征患病率情况
Table 1. Prevalence of orthostatic intolerance syndrome in 546 middle-aged and elderly people in community
项目 人数 患病[例(%)] χ2值 P值 项目 人数 患病[例(%)] χ2值 P值 性别 0.785 0.221 缺乏运动 0.317 0.328 男性 310 45(14.5) 是 196 33(16.8) 女性 236 41(17.4) 否 350 53(15.1) 年龄(岁) 7.919 0.048 高血压 4.403 0.036 40~49 97 7(7.2) 是 199 40(20.1) 50~59 191 30(15.7) 否 347 46(13.3) 60~69 122 21(17.2) 糖尿病 0.495 0.482 ≥70 136 28(20.6) 是 114 20(17.5) 文化程度 0.849 0.065 否 432 66(15.3) 小学及以下 237 41(17.3) 冠心病 1.698 0.163 初中 231 35(15.2) 是 31 6(19.4) 高中及以上 78 10(12.8) 否 515 80(15.5) 城乡 0.415 0.300 血脂异常 1.726 0.119 城市 265 39(14.7) 是 152 29(19.1) 农村 281 47(16.7) 否 394 57(14.5) 现在吸烟 0.635 0.259 卒中 0.209 0.647 是 131 17(13.0) 是 85 12(14.1) 否 415 69(16.6) 否 461 74(16.1) 大量饮酒 0.809 0.240 降压药物治疗 0.005 0.947 是 43 9(20.9) 是 103 16(15.5) 否 503 77(15.3) 否 443 70(15.8) BMI 0.262 0.053 ＜18.5 9 3(33.3) 18.5~23.9 325 46(14.2) 24.0~27.9 167 28(16.8) ≥28.0 45 9(20.0) 
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表 2 546名社区中老年人群直立不耐受问卷评分结果[M(P25, P75), 分]
Table 2. Results of orthostatic intolerance questionnaire among 546 middle-aged and elderly people in community[M(P25, P75), points]
组别 例数 头晕 头痛 眩晕 恶心 多汗 视物模糊 OI组 86 3.00(2.00, 4.00) 1.00(0.00, 2.00) 1.00(0.00, 2.00) 1.00(0.00, 3.00) 1.00(0.00, 2.00) 1.00(0.00, 2.00) 非OI组 460 0.00(1.00, 2.00) 0.00(0.00, 0.85) 0.00(0.00, 1.00) 0.00(0.00, 1.00) 0.00(0.00, 0.81) 0.00(0.00, 1.00) Z值 -4.158 -2.748 -2.030 -2.916 -2.959 -3.028 P值 < 0.001 0.006 0.042 0.004 0.003 0.002 组别 例数 注意力不集中 手部震颤 心悸 胸部不适 总分 OI组 86 1.00(0.00, 1.00) 1.00(0.00, 1.00) 0.63(0.00, 1.00) 1.00(0.00, 1.00) 12.00(6.00, 18.00) 非OI组 460 0.00(0.00, 0.17) 0.00(0.00, 0.00) 0.00(0.00, 0.17) 0.00(0.00, 0.00) 3.37(2.00, 5.75) Z值 -2.331 -4.231 -2.201 -2.806 -4.644 P值 0.020 < 0.001 0.028 0.005 < 0.001
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表 3 OI常见亚型与非OI组卧立位血压及心率检测结果
Table 3. Blood pressure and heart rate in lying position of common subtypes of OI and non-OI group
组别 例数 收缩压(x±s, mmHg) 舒张压(x±s, mmHg) 心率(x±s, 次/min) 卧位 立位 卧位 立位 卧位 立位 OH组 58 147.97±17.42 124.86±20.12 85.36±13.41 81.97±16.75 75.55±13.62 84.81±13.52 OHT组 24 141.54±28.71 166.54±29.22 83.54±11.63 95.38±16.89 74.38±13.20 85.13±15.09 非OI组 460 133.67±17.97 133.58±19.26 80.64±10.05 87.27±10.38 73.80±11.59 84.96±12.39 F值 14.296 8.718 4.722 5.299 0.248 0.725 P值 < 0.001 < 0.001 0.004 < 0.001 0.891 0.706
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表 4 变量赋值方法
Table 4. Methods of variable assignment
变量 赋值方法 年龄 40~49岁=0，50~59岁=1, 60~69岁=2，≥70岁=3 直立不耐受问卷评分 ＜10分=0，≥10分=1 患有高血压 否=0，是=1 收缩压 ＜140 mmHg=0, ≥140 mmHg=1 舒张压 ＜90 mmHg=0, ≥90 mmHg=1
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表 5 OI相关危险因素的logistic回归分析
Table 5. Logistic regression analysis of OI related risk factors
变量 B SE Waldχ2 P值 OR(95%CI) 年龄(岁) 60~69 1.770 0.649 7.821 0.005 5.871(1.694~20.320) ≥70 2.215 0.671 10.903 0.001 9.163(2.467~30.104) 高血压 1.601 0.537 8.893 0.003 4.962(1.436~14.201) 卧位收缩压≥140 mmHg 1.301 0.497 6.844 0.009 3.675(1.392~9.734)
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