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Article(id=1240738487901679879, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412363, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1734451200000, receivedDateStr=2024-12-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773744707321, onlineDateStr=2026-03-17, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773744707321, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773744707321, creator=13701087609, updateTime=1773744707321, updator=13701087609, issue=Issue{id=1240738480549065614, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773744705569, creator=13701087609, updateTime=1773744787657, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240738824918192654, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240738824922386959, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1578, endPage=1582, ext={EN=ArticleExt(id=1240738488245612837, articleId=1240738487901679879, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the burden of stroke attributed to dietary factors in China from 1990 to 2021, columnId=1228016572783063333, journalTitle=Modern Preventive Medicine, columnName=Nutrition and Food Hygiene, runingTitle=null, highlight=null, articleAbstract=
Objective

To assess the burden of stroke and its subtypes attributable to dietary factors in China from 1990 to 2021.

Methods

Utilizing the Global Burden of Disease (GBD) 2021 database, we analyzed the trends of stroke and its subtypes (ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage) caused by dietary factors in China using the Join point regression model and estimated annual percentage change (EAPC).

Results

In 2021, the number of stroke deaths attributable to dietary factors in China was 1 077 762, with an age-standardized mortality rate (ASMR) of 21.59 per 100 000. From 1990 to 2021, both the ASMR and age-standardized disability-adjusted life years (DALYs) rate (ASDR) due to dietary factors showed a declining trend, with EAPCs of -2.69 and -2.74, respectively. Ischemic stroke presented the heaviest burden, with an ASMR of 11 per 100 000. Excess sodium intake was identified as the primary dietary risk factor, with an ASMR of 8.77 per 100 000 for ischemic stroke attributable to excess sodium and an ASMR of 10.6 per 100 000 for hemorrhagic stroke. The burden of disease was significantly higher in males and individuals aged 70 and above, with mortality rates more than twice that of other age groups.

Conclusion

Over the past 32 years, the burden of stroke attributable to dietary factors in China has decreased, yet the overall numbers remain substantial.Future public health policies should focus on controlling high-sodium diets and increasing the intake of grains and fruits, particularly targeting high-risk populations such as elderly males, to further reduce the burden of stroke.

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目的

评估1990—2021年中国饮食因素对中国脑卒中及其亚型的疾病负担。

方法

通过全球疾病负担（GBD）2021数据库，评估中国因饮食因素导致的脑卒中及其亚型（缺血性脑卒中、出血性脑卒中、蛛网膜下腔出血）疾病负担的影响，使用joinpoint联结回归模型估算年均百分比变化率（EAPC）分析各指标的趋势。

结果

2021年，中国因饮食因素导致的脑卒中死亡人数为1 077 762人，年龄标准化死亡率（ASMR）为21.59/10万。1990—2021年，中国因饮食因素导致的脑卒中ASMR和年龄标准化伤残调整生命年（DALYs）率（ASDR）均呈下降趋势，EAPC分别为-2.69%和-2.74%。缺血性脑卒中负担最为沉重，ASMR为11/10万，钠摄入过量是主要的饮食风险因素，钠摄入过量归因的缺血性脑卒中ASMR为8.77/10万，出血性脑卒中ASMR为10.6/10万。男性及70岁以上人群疾病负担显著高于其他群体，其死亡率大于其他年龄段的两倍以上。

结论

过去32年，中国因饮食因素导致的脑卒中疾病负担有所减轻，但总体数量仍然很大。未来公共卫生政策应重点关注高盐饮食控制，增加谷类和水果摄入，特别针对高危人群如老年男性进行干预，以进一步降低脑卒中的疾病负担。

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王炎强，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=EBK1ExmSf565YvuJ6vTHsQ==, magXml=+aLSJtc2KlqfnunbiwtWcA==, pdfUrl=null, pdf=RVQB9hLABYmlJ8nCgkNlOA==, pdfFileSize=963554, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=C2ov1z6cTH+O6C1N7hihYw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=9HocuXS1aGmjN67RZrfGag==, mapNumber=null, authorCompany=null, fund=null, authors=

袁训哲（1979—），男，硕士在读，主治医师，研究方向：缺血性脑卒中发病机制及临床研究

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袁训哲（1979—），男，硕士在读，主治医师，研究方向：缺血性脑卒中发病机制及临床研究

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袁训哲（1979—），男，硕士在读，主治医师，研究方向：缺血性脑卒中发病机制及临床研究

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注：图A死亡数和年龄标准化死亡率（ASMR）的趋势；图B伤残调整生命年（DALYs）数和年龄标准化DALYs率（ASDR）的趋势。

, figureFileSmall=qdotpMBdJsOBpe0qbw2h3w==, figureFileBig=Ay8eqXhsd/g42Ge0uDvAsw==, tableContent=null), ArticleFig(id=1241081869417116549, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738487901679879, language=EN, label=Figure 3, caption=The burden of stroke subtypes attributed to dietary factors by gender and age in China in 2021, figureFileSmall=pMXoeoui8hKgerqDqsTIRg==, figureFileBig=f66ohXqTpk0M64e0tGpzxQ==, tableContent=null), ArticleFig(id=1241081869555528589, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738487901679879, language=CN, label=图3, caption=2021年中国饮食因素归因的脑卒中各亚型在不同性别及年龄段的负担

注：图A脑卒中亚型在不同性别及年龄段的死亡率；图B脑卒中亚型在不同性别及年龄段的伤残调整生命年率。

, figureFileSmall=pMXoeoui8hKgerqDqsTIRg==, figureFileBig=f66ohXqTpk0M64e0tGpzxQ==, tableContent=null), ArticleFig(id=1241081869677163415, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738487901679879, language=EN, label=Table 1, caption=

Burden of stroke subtypes attributed to dietary factors in China from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病2021年1990—2021年2021年1990—2021年
死亡数ASMR（/10万）EAPC（95%CI）（%）DALYs数ASDR（/10万）EAPC（95%CI）（%）
缺血性脑卒中219 08111-0.96(-1.11～-0.8)5 364 980253.69-0.86(-0.96～-0.76)
出血性脑卒中203 4819.91-3.42(-3.73～-3.11)4 633 210214.82-3.58(-3.87～-3.29)
蛛网膜下腔出血性脑卒中14 2310.68-7.63(-8.29～-6.97)375 06817.32-7.43(-8.05～-6.82)
), ArticleFig(id=1241081869798798242, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738487901679879, language=CN, label=表1, caption=

1990—2021年中国饮食因素归因的脑卒中各亚型疾病负担

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病2021年1990—2021年2021年1990—2021年
死亡数ASMR（/10万）EAPC（95%CI）（%）DALYs数ASDR（/10万）EAPC（95%CI）（%）
缺血性脑卒中219 08111-0.96(-1.11～-0.8)5 364 980253.69-0.86(-0.96～-0.76)
出血性脑卒中203 4819.91-3.42(-3.73～-3.11)4 633 210214.82-3.58(-3.87～-3.29)
蛛网膜下腔出血性脑卒中14 2310.68-7.63(-8.29～-6.97)375 06817.32-7.43(-8.05～-6.82)
), ArticleFig(id=1241081869937210287, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738487901679879, language=EN, label=Table 2, caption=

Joinpoint linked regression model for the burden of stroke and its subtypes attributed to dietary factors in China from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
指标疾病AAPCAPC
AAPC(95%CI)（%）P值时间（年）APC(95%CI)（%）P值
死亡脑卒中-2.54(-2.77～-2.31)<0.012015—2021-1.94(-2.24～-1.64)<0.01
死亡缺血性脑卒中-1.01(-1.27～-0.76)<0.012015—2021-1.13(-1.44～-0.83)<0.01
死亡出血性脑卒中-3.22(-3.46～-2.99)<0.012015—2021-2.76(-3.11～-2.42)<0.01
死亡蛛网膜下腔出血性脑卒中-6.46(-6.70～-6.22)<0.012014—2021-2.67(-3.00～-2.33)<0.01
DALYs脑卒中-2.59(-2.80～-2.37)<0.012015—2021-1.86(-2.14～-1.58)<0.01
DALYs缺血性脑卒中-0.95(-1.20～-0.70)<0.012010—2021-1.19(-1.32～-1.07)<0.01
DALYs出血性脑卒中-3.37(-3.60～-3.13)<0.012015—2021-2.86(-3.21～-2.51)<0.01
DALYs蛛网膜下腔出血性脑卒中-6.34(-6.57～-6.11)<0.012013—2021-2.69(-2.98～-2.40)<0.01
), ArticleFig(id=1241081871472325560, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738487901679879, language=CN, label=表2, caption=

1990—2021年中国因饮食因素导致的脑卒中及其亚型疾病负担的joinpoint联结回归模型

, figureFileSmall=null, figureFileBig=null, tableContent=
指标疾病AAPCAPC
AAPC(95%CI)（%）P值时间（年）APC(95%CI)（%）P值
死亡脑卒中-2.54(-2.77～-2.31)<0.012015—2021-1.94(-2.24～-1.64)<0.01
死亡缺血性脑卒中-1.01(-1.27～-0.76)<0.012015—2021-1.13(-1.44～-0.83)<0.01
死亡出血性脑卒中-3.22(-3.46～-2.99)<0.012015—2021-2.76(-3.11～-2.42)<0.01
死亡蛛网膜下腔出血性脑卒中-6.46(-6.70～-6.22)<0.012014—2021-2.67(-3.00～-2.33)<0.01
DALYs脑卒中-2.59(-2.80～-2.37)<0.012015—2021-1.86(-2.14～-1.58)<0.01
DALYs缺血性脑卒中-0.95(-1.20～-0.70)<0.012010—2021-1.19(-1.32～-1.07)<0.01
DALYs出血性脑卒中-3.37(-3.60～-3.13)<0.012015—2021-2.86(-3.21～-2.51)<0.01
DALYs蛛网膜下腔出血性脑卒中-6.34(-6.57～-6.11)<0.012013—2021-2.69(-2.98～-2.40)<0.01
), ArticleFig(id=1241081871631709120, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738487901679879, language=EN, label=Table 3, caption=

Disease burden of stroke subtypes attributed to various dietary factors in China in 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
风险因素疾病ASMR（/10万）PAF(%)ASDR（/10万）
钠摄入过多缺血性脑卒中8.7713.59190.04
出血性脑卒中10.6015.38241.38
蛛网膜下腔出血性脑卒中0.7415.7920.19
谷类摄入不足缺血性脑卒中1.712.6349.99
水果摄入不足缺血性脑卒中0.630.9717.95
出血性脑卒中3.234.6979.40
蛛网膜下腔出血性脑卒中0.245.107.45
纤维摄入不足缺血性脑卒中0.240.378.46
出血性脑卒中0.861.2524.04
蛛网膜下腔出血性脑卒中0.071.482.53
红肉摄入过多缺血性脑卒中0.180.279.74
加工肉摄入过多缺血性脑卒中0.160.253.40
含糖饮料摄入过多缺血性脑卒中0.080.121.63
蔬菜摄入不足缺血性脑卒中0.050.081.11
多不饱和脂肪酸摄入不足缺血性脑卒中0.010.020.29
), ArticleFig(id=1241081871761732558, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738487901679879, language=CN, label=表3, caption=

2021年中国因各饮食因素导致的脑卒中各亚型的疾病负担

, figureFileSmall=null, figureFileBig=null, tableContent=
风险因素疾病ASMR（/10万）PAF(%)ASDR（/10万）
钠摄入过多缺血性脑卒中8.7713.59190.04
出血性脑卒中10.6015.38241.38
蛛网膜下腔出血性脑卒中0.7415.7920.19
谷类摄入不足缺血性脑卒中1.712.6349.99
水果摄入不足缺血性脑卒中0.630.9717.95
出血性脑卒中3.234.6979.40
蛛网膜下腔出血性脑卒中0.245.107.45
纤维摄入不足缺血性脑卒中0.240.378.46
出血性脑卒中0.861.2524.04
蛛网膜下腔出血性脑卒中0.071.482.53
红肉摄入过多缺血性脑卒中0.180.279.74
加工肉摄入过多缺血性脑卒中0.160.253.40
含糖饮料摄入过多缺血性脑卒中0.080.121.63
蔬菜摄入不足缺血性脑卒中0.050.081.11
多不饱和脂肪酸摄入不足缺血性脑卒中0.010.020.29
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1990—2021年中国饮食因素归因的脑卒中疾病负担分析
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袁训哲 1, 2 , 王小璐 1 , 王彬 1 , 李健 1 , 耿建红 1 , 王炎强 1
现代预防医学 | 营养与食品卫生 2025,52(9): 1578-1582
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现代预防医学 | 营养与食品卫生 2025, 52(9): 1578-1582
1990—2021年中国饮食因素归因的脑卒中疾病负担分析
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袁训哲1, 2, 王小璐1, 王彬1, 李健1, 耿建红1, 王炎强1
作者信息
  • 1.山东第二医科大学附属医院，山东第二医科大学临床医学院神经内二科，山东 潍坊 261031
  • 2.潍坊滨海经济技术开发区人民医院神经内科，山东 潍坊 262737

    • 袁训哲（1979—），男，硕士在读，主治医师，研究方向：缺血性脑卒中发病机制及临床研究

通讯作者:

王炎强，E-mail:
Analysis of the burden of stroke attributed to dietary factors in China from 1990 to 2021
Xun-zhe YUAN1, 2, Xiao-lu WANG1, Bin WANG1, Jian LI1, Jian-hong GENG1, Yan-qiang WANG1
Affiliations
  • Department of Neurology Ⅱ, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang 261031
出版时间: 2025-05-10 doi: 10.20043/j.cnki.MPM.202412363
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摘要
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目的

评估1990—2021年中国饮食因素对中国脑卒中及其亚型的疾病负担。

方法

通过全球疾病负担（GBD）2021数据库，评估中国因饮食因素导致的脑卒中及其亚型（缺血性脑卒中、出血性脑卒中、蛛网膜下腔出血）疾病负担的影响，使用joinpoint联结回归模型估算年均百分比变化率（EAPC）分析各指标的趋势。

结果

2021年，中国因饮食因素导致的脑卒中死亡人数为1 077 762人，年龄标准化死亡率（ASMR）为21.59/10万。1990—2021年，中国因饮食因素导致的脑卒中ASMR和年龄标准化伤残调整生命年（DALYs）率（ASDR）均呈下降趋势，EAPC分别为-2.69%和-2.74%。缺血性脑卒中负担最为沉重，ASMR为11/10万，钠摄入过量是主要的饮食风险因素，钠摄入过量归因的缺血性脑卒中ASMR为8.77/10万，出血性脑卒中ASMR为10.6/10万。男性及70岁以上人群疾病负担显著高于其他群体，其死亡率大于其他年龄段的两倍以上。

结论

过去32年，中国因饮食因素导致的脑卒中疾病负担有所减轻，但总体数量仍然很大。未来公共卫生政策应重点关注高盐饮食控制，增加谷类和水果摄入，特别针对高危人群如老年男性进行干预，以进一步降低脑卒中的疾病负担。

脑卒中  /  饮食因素  /  饮食结构  /  疾病负担
Objective

To assess the burden of stroke and its subtypes attributable to dietary factors in China from 1990 to 2021.

Methods

Utilizing the Global Burden of Disease (GBD) 2021 database, we analyzed the trends of stroke and its subtypes (ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage) caused by dietary factors in China using the Join point regression model and estimated annual percentage change (EAPC).

Results

In 2021, the number of stroke deaths attributable to dietary factors in China was 1 077 762, with an age-standardized mortality rate (ASMR) of 21.59 per 100 000. From 1990 to 2021, both the ASMR and age-standardized disability-adjusted life years (DALYs) rate (ASDR) due to dietary factors showed a declining trend, with EAPCs of -2.69 and -2.74, respectively. Ischemic stroke presented the heaviest burden, with an ASMR of 11 per 100 000. Excess sodium intake was identified as the primary dietary risk factor, with an ASMR of 8.77 per 100 000 for ischemic stroke attributable to excess sodium and an ASMR of 10.6 per 100 000 for hemorrhagic stroke. The burden of disease was significantly higher in males and individuals aged 70 and above, with mortality rates more than twice that of other age groups.

Conclusion

Over the past 32 years, the burden of stroke attributable to dietary factors in China has decreased, yet the overall numbers remain substantial.Future public health policies should focus on controlling high-sodium diets and increasing the intake of grains and fruits, particularly targeting high-risk populations such as elderly males, to further reduce the burden of stroke.

Stroke  /  Dietary factors  /  Dietary structure  /  Disease burden
袁训哲, 王小璐, 王彬, 李健, 耿建红, 王炎强. 1990—2021年中国饮食因素归因的脑卒中疾病负担分析. 现代预防医学, 2025 , 52 (9) : 1578 -1582 . DOI: 10.20043/j.cnki.MPM.202412363
Xun-zhe YUAN, Xiao-lu WANG, Bin WANG, Jian LI, Jian-hong GENG, Yan-qiang WANG. Analysis of the burden of stroke attributed to dietary factors in China from 1990 to 2021[J]. Modern Preventive Medicine, 2025 , 52 (9) : 1578 -1582 . DOI: 10.20043/j.cnki.MPM.202412363
正文
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脑卒中是全球范围内导致死亡和致残的主要原因之一，已成为重大的公共健康问题。本课题组既往研究显示，颗粒物污染和低温是缺血性脑卒中的重要环境和职业风险因素[1]。吸烟和高钠饮食被确定为关键行为风险因素。近年研究表明，饮食模式的改变可能对脑卒中的预防和控制产生重要影响[2]。明确饮食风险因素对脑卒中各亚型负担的影响，对于改善居民的健康状况、减少脑卒中疾病负担具有重要意义。本研究基于GBD数据，旨在评估1990—2021年饮食因素对中国脑卒中及其亚型疾病负担的影响，并探讨因饮食因素导致的死亡率及伤残调整生命年（DALY）变化趋势。
1　资料与方法
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1.1　资料获取
本研究数据来自全球疾病负担（Global Burden of Disease，GBD）2021数据库（https://vizhub.healthdata.org/gbd-results/），该数据库由华盛顿大学卫生指标与评估研究所（Institute for Health Metrics and Evaluation, IHME）创建[3]，涵盖1990—2021年204个国家和地区的371种疾病，包括发病率、患病率、死亡率、伤残调整生命年（DALY）、健康预期寿命等关键指标。
从GBD 2021数据库提取与饮食因素相关的中国脑卒中各亚型的死亡和DALY数据，包括缺血性脑卒中、出血性脑卒中以及蛛网膜下腔出血。对中国因饮食因素归因的各脑卒中亚型进行了性别和年龄的分组分析。将患者按年龄分为25～49岁、50～69岁和70岁及以上三组，更精细地了解不同性别和年龄群体在饮食因素归因的脑卒中负担中的差异特征。
1.2　统计分析
本研究使用RStudio软件（版本4.4.1）处理所有数据，分析统计均为双侧检验，检验水准α=0.05。主要指标与饮食因素引起的各脑卒中亚型的疾病负担相关，包括死亡人数、死亡率、DALY、DALY率及其32年的变化趋势。根据之前的研究所示，基于每年的年龄标化率（ASR）计算了估计年度百分比变化率（EAPC）[1]。EAPC假设ASR与时间之间存在线性关系，模型形式为y=α+βx+ε，其中y表示log10(ASR)，x表示日历年，β表示回归系数[4]。EAPC计算公式为EAPC=100×(exp^β-1)。当EAPC和其95%置信区间（CI）的上限均为负值时，表明该率呈下降趋势；相反，当EAPC和其95%CI的下限均为正值时，表明该率呈上升趋势[5]。
为解决估计EAPC在捕捉局部变化方面的局限性，将95%不确定性区间（UI）的宽度除以3.92计算GBD估算的标准误差。应用Delta方法计算这些标准误差，构建了95%CI进行趋势分析。使用joinpoint联结回归模型来研究由饮食因素引起的脑卒中亚型疾病负担的时间趋势。数据分析和可视化使用了Joinpoint软件，采用对数线性模型，显著性水平设定为α=0.05[6-7]。联结回归模型中采用默认建模方法为网格搜索法（GSM），通过蒙特卡洛置换法进行模型选择[6]。联结回归模型提供了年百分比变化率（APC）和研究期间的平均年百分比变化率（AAPC），并附有其95%CI[8]。将特别报告最接近2021年的APC值，以体现最近几年中国因饮食因素导致的各脑卒中亚型疾病负担的趋势。
采用人群归因分值（PAF）估算特定风险因素（如高盐饮食）引起的事件比例[9]。此估算有助于量化，如果消除这些风险因素，能预防疾病负担，从而评估其对公共健康的影响。
2　结果
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2.1　中国饮食因素导致的脑卒中的疾病负担
2021年，中国因饮食因素导致的脑卒中死亡人数为436 793人，年龄标准化死亡率（ASMR）为21.59/10万。中国因饮食因素导致脑卒中年龄标准化DALYs率为485.83/10万，中国DALY 总数达到10 373 258人。1990—2021年中国因饮食因素导致脑卒中死亡和DALY 趋势均呈现下降趋势。见图1。
2.2　中国因饮食因素导致的各亚型脑卒中的疾病负担
2021年，因饮食因素导致的缺血性脑卒中死亡人数为219 081人，ASMR为11/10万；出血性脑卒中死亡人数为203 481人，ASMR 为9.91/10万；蛛网膜下腔出血死亡人数为14 231人，ASMR 为0.68/10万。
因饮食因素导致的缺血性脑卒中DALY 总数5 364 980人，ASDR为253.69/10万；出血性脑卒中DALY 总数4 633 210人，ASDR为214.82/10万；蛛网膜下腔出血DALY 总数375 068人，ASDR 为17.32/10万。1990—2021年，饮食因素导致的各亚型脑卒中死亡和DALY 负担均呈下降趋势，蛛网膜下腔出血的下降速度最快，下降最慢的是缺血性脑卒中。见图2，表1、2。
2.3　中国不同性别及年龄段归因于饮食因素的脑卒中疾病负担
对于缺血性脑卒中、出血性脑卒中及蛛网膜下腔出血，各年龄段的男性死亡和DALY负担均高于女性。随着年龄的增长，三种亚型的脑卒中疾病负担均逐渐加重，70岁及以上人群负担最为严重；缺血性脑卒中在男性中的疾病负担最为沉重，其次出血性脑卒中男性患者，随后缺血性脑卒中女性患者。蛛网膜下腔出血的疾病负担相对较轻，在各年龄段中也表现出类似的性别差异和逐渐增加的趋势。见图3。
2.4　中国因不同类型饮食因素归因的各脑卒中亚型的疾病负担
中国饮食因素在各脑卒中亚型中的影响差异显著。表3所示，2021年，钠摄入过多是导致缺血性脑卒中和出血性脑卒中最主要的饮食风险因素。谷类摄入不足与缺血性脑卒中也有较强关联。水果摄入不足和纤维素摄入不足主要对出血性脑卒中负担产生显著影响，谷类摄入不足、红肉摄入过多及加工肉摄入过多、含糖饮料摄入过多、蔬菜摄入不足、多不饱和脂肪酸摄入不足多影响缺血性脑卒中，其中多不饱和脂肪酸摄入不足的影响最小。
3　讨论
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本文基于GBD数据库对中国饮食因素对脑卒中及其各亚型的疾病负担进行了系统性分析。研究发现，2021年中国因饮食因素导致的脑卒中ASMR为21.59/10万，年龄标准化DALYs率（ASDR）为485.83/10万。1990—2021年中国因饮食因素导致的脑卒中各亚型的ASMR和ASDR均呈下降趋势。表明中国通过饮食干预防控脑卒中方面取得了一定的积极成果。
研究发现饮食因素归因的脑卒中各亚型有相同特点：男性负担高于女性，随年龄的升高，疾病负担呈上升趋势。推测与雌激素在多个组织中广泛保护作用有关，包括大脑、心脏及血管等[10-11]。缺血性脑卒中中，雌激素在多个环节表现出神经保护效应，通过血管的抗动脉粥样硬化效应及调节脂代谢，抑制卒中危险因素的致病病理进展[12-13]；扩张动脉及在缺血状态下直接保护脑组织与神经胶质细胞，对脑卒中的病理过程产生积极影响[14]。此外孕激素，尤其孕酮，在脑卒中后的神经保护过程中发挥了重要作用[15-16]。老年人疾病负担最为严重，与中国进入老龄化社会及受到计划生育带来的人口负增长有关[17]，因而公共卫生系统承受的卒中负担不会很快消失。研究也发现各亚型因饮食因素归因的脑卒中的疾病负担有所改善，可能归因于公众卒中意识的提高、饮食更加慎重、医疗水平的提高等方面。
2021年造成缺血性脑卒中的饮食风险因素多达九类，为钠摄入过多、谷类摄入不足、水果摄入不足、纤维摄入不足、红肉摄入过多、加工肉摄入过多、含糖饮料摄入过多、蔬菜摄入不足和多不饱和脂肪酸摄入不足。造成出血性脑卒中和蛛网膜下腔出血的有三类，为钠摄入过多、水果摄入不足和纤维摄入不足。我们发现钠摄入过多是脑卒中各亚型PAF最高的风险因素，与Lina Wang等人[18]报道相似，1990—2019年，全球因高钠摄入导致的中风负担有所下降，但中国的负担仍然很高，可能因亚洲人的盐敏感性和盐摄入量更高有关。此外，高盐饮食是导致卒中重要致病风险高血压的主要因素之一[19]。研究指出，中国居民每日减少1 g盐摄入量可使卒中风险降低约6%[20]。高盐饮食对缺血性脑卒中有多重影响机制：增加血容量、升高外周阻力，进而导致动脉硬化和血管壁压力升高[21]；增加内皮细胞中的自由基生成，导致动脉硬化和血管狭窄，增加卒中的风险[22-23]；激活多种促炎性信号通路，包括核因子κB和促炎细胞因子如肿瘤坏死因子-α和白细胞介素-9等[24-25]，这些炎症因子的释放可导致血管损伤，促进动脉粥样硬化的形成，增加脑卒中的发生风险[26]。本研究提示中国居民的粮食和膳食纤维消费量持续下降，精制粮食的消费量增加，为让国人增加全谷物和膳食纤维摄入量，减少钠盐、含糖饮料、加工肉、红肉的摄入，建议增加更具吸引力的相关的全谷物产品的供应并进行公众教育。
然而，本文也有一定的局限性。因依赖公共数据库可能会引入与数据准确性和完整性相关的偏差；公共数据库固有的局限性，未考虑缺血性脑卒中等卒中亚型各分型的流行病学（如缺血性脑卒中的TOAST分型）及缺乏对城乡间或不同地区间的疾病负担差异的分析。未来的研究应完善每种亚型的流行病学，进一步探讨这些因素的影响，以便更全面地了解中国饮食因素对脑卒中负担的影响机制。
基金
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  • 山东省医药科技项目(202303071478)
  • 山东省中医药科技项目(M-2023296)
  • 健康中国·步长致远心脑健康公益工程项目(HIGHER2023072)
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2025年第52卷第9期
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doi: 10.20043/j.cnki.MPM.202412363
  • 接收时间：2024-12-18
  • 首发时间：2026-03-17
  • 出版时间：2025-05-10
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  • 收稿日期：2024-12-18
基金
山东省医药科技项目(202303071478)
山东省中医药科技项目(M-2023296)
健康中国·步长致远心脑健康公益工程项目(HIGHER2023072)
作者信息
    1.山东第二医科大学附属医院，山东第二医科大学临床医学院神经内二科，山东 潍坊 261031
    2.潍坊滨海经济技术开发区人民医院神经内科，山东 潍坊 262737

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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