Stroke：南京大学附属金陵医院徐格林等发现中国卒中带

20世纪60年代，研究者发现美国东南部地区卒中的死亡率较高，称之为“卒中带”。在中国，卒中已成为各类疾病中死亡数最高的疾病。来自南京大学附属金陵医院（即南京军区总医院）的徐格林等教授研究了中国的“卒中带”情况，研究结果在线发表在在2013年5月14日的Stroke上。该研究的目的是想确定在中国是否存在有某些地区卒中发病率较高--中国卒中带，如果有的话，可能的病因及可干预的因素有哪些。

该研究系统性综述了1980年至2010年中国境内所有卒中研究的发病情况，包含了符合高质量研究标准的临床试验。不同省区对比，省区高发病率定义为卒中发病率较高的三分之一及该省内超过三分之一的区域卒中发病率在全国所有高发病率前七分之二的区域范围内，该研究同时系统分析了中国不同区域的主要血管性危险因素，社会经济水平及人口学特点。

中国34个行政省区中涉及32个省（香港及澳门除外）的9项符合条件的研究数据纳入系统性综述，其中范围涉及347个区域中的52%。九个省（黑龙江、西藏、吉林、辽宁、新疆、河北、内蒙古、北京及宁夏）的卒中发病率较高，列于全国前三分之一之列，由此中国的西部及北部构成中国卒中带。中国卒中带的卒中发病率为每十万人236.2人，相比卒中带外的发病率（每十万人109.7人）具有明显统计学意义（率比为2.16,95%可信区间为2.10-2.22）。人群中高血压及较高体重（体重指数大于25）发生率，卒中带区域明显高于其他区域（分别为15.3%比10.3%, P<0.001和21.1%比12.3%, P=0.013）。高血压及高体重指数与局部区域卒中发病情况明显相关（Spearman等级相关分析显示相关指数分别为R=0.642, P<0.001和R=0.438, P=0.014）。

研究结果显示，中国的北部及西部9省区卒中发病率较高，为中国卒中带。卒中带的产生，至少部分由人群高血压及高体重指数引起。中国卒中带区域人群降低血压及减轻体重或可减少卒中发病率的地理区域差异。

与卒中相关的拓展阅读：

• PLoSOne：我国肥胖人群缺血性卒中风险增加
• Stroke:重视卒中后疼痛综合征
• [CSC 2013]赵钢：脑卒中神经保护研究进展
• 《缺血性卒中侧支循环评估与干预中国专家共识》发布
• Circulation：卒中和脑出血对感染性心内膜炎有负面影响
• Stroke:糖尿病患者卒中发生风险增高 更多信息请点击：有关卒中更多资讯

Is There a Stroke Belt in China and Why?
Background and Purpose
In 1960s, a stroke belt with high stroke mortality was discovered in the southeast United States. In China, where stroke is the leading cause of death, we aimed to determine whether a focal region of high stroke incidence (stroke belt) exits and, if so, the possible causal and modifiable factors.
Methods
We systematically reviewed all studies of stroke incidence in China between 1980 and 2010, and included those which met our criteria for a high-quality study. Criteria for a provincial region of high stroke incidence were ranking in the top one third of all provinces for stroke incidence and ranking of more than one third of prefectural regions within the province in the top two sevenths of all prefectural regions for stroke incidence. We also reviewed regional distribution of major vascular risk factors, socioeconomic status, and demographic profiles in China.
Results
Nine eligible studies provided data on the incidence of stroke in 32 of 34 provincial regions of China (with Hong Kong and Macao as exceptions) and 52% of the 347 prefectural regions. Nine provincial regions (Heilongjiang, Tibet, Jilin, Liaoning, Xinjiang, Hebei, Inner Mongolia, Beijing, and Ningxia) met our criteria for a region of high stroke incidence and constitute a stroke belt in north and west China. The incidence of stroke in the stroke belt was 236.2 per 100 000 population compared with 109.7 in regions outside the belt (rate ratio, 2.16; 95% confidence interval, 2.10–2.22). The mean population prevalence of hypertension and overweight (body mass index, >25) was greater in the stroke belt than that in other regions (15.3% versus 10.3%, P<0.001; 21.1% versus 12.3%, P=0.013, respectively). The prevalence of hypertension and overweight also correlated significantly with regional stroke incidence (R=0.642, P<0.001; R=0.438, P=0.014, respectively, by Spearman rank correlation).
Conclusions
A stroke belt of high stroke incidence exists in 9 provincial regions of north and west China. The stroke belt may be caused, at least in part, by a higher population prevalence of hypertension and excess body weight. Lowering blood pressure and body weight in the stroke belt may reduce the geographic disparity in stroke risk and incidence in China.