Evaluating a simplified method for identifying high-risk individuals for cardiovascular diseases in the resource-constrained rural areas of China

目的 评价中国农村健康行动(CRHI)项目中提出的心血管病高危个体检出标准(CRHI标准)是否适宜在我国农村地区使用.方法 选择河北省两县各12个村随机抽取的2 036名≥20岁成年人进行体格检查和问卷调查.以《中国成人血脂异常防治指南》中的高危定义作为“金标准”,评价采用CRHI标准检出心血管病高危个体[有冠心病或卒中病史者;或高龄(男性≥50岁,女性≥60岁)且患有糖尿病者;或高龄且SBP≥160 mmHg者]的灵敏度和特异度以及阳性和阴性预测值等.结果 CRHI标准与“金标准”的符合率为92.9％,灵敏度和特异度分别为77.2％和98.5％,约登指数为0.76,阳性和阴性预测值分别为94.7％和92.5％.按CRHI标准,心血管病高危个体检出率为21.3％,随年龄增长呈显著升高趋势(P＜0.001).其中60岁以上人群检出率约为44％.结论 CRHI标准简便易行,适宜我国医疗卫生资源缺乏的农村地区检出心血管病高危人群.This research project aimed to evaluate whether a simplified method for identifying high-risk individuals for cardiovascular diseases proposed by the China Rural Health Initiative (CRHI) was feasible in the rural areas in China.2 036 adults, aged 20 years or older were stratified-randomly sampled from 12 villages in Luquan county and Anguo county (Hebei province) respectively, to receive physical examination and filling in administered questionnaires. "Gold Standard" was used on high risk in Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults to evaluate the CRHI standards:people with a history of coronary heart disease or stroke, or elderly as men ≥50 years or women ≥60 years with diabetes, or elderly with systolic blood pressure ≥160 mmHg. Sensitivity, specificity, positive and negative predictive values related to the identification of high-risk individuals for cardiovascular diseases were assessed.The concordance rate between the CRHI standard and the gold standard was 92.9% , with sensitivity as 77.2%, specificity as 98.5%, Youden's Index as 0.76, positive predictive value as 94.7% and negative predictive value as 92.5%. Under CRHI standard, 21.3% of the adults were identified as high risk. The rate was increasing with age (P < 0.001), reaching 44% among those who were over 60 years old.The CRHI standard seemed simple and easy and was suitable for identifying high-risk individuals for cardiovascular diseases in the resource-constrained rural areas.美国国立卫生研究院心肺血研究所联邦基金; 美国联合健康集团慢性病行动联合资助; a grant from the United States National Heart,Lung,and Blood Institute,National Institutes of Health,Department of Health and Human Services; Additional Support was Received from the United Health Group Chronic Disease InitiativePubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)09981-9843