太原市脑卒中发病时间规律及其相关因素研究

发布时间：2018-02-25 07:12

本文关键词： 脑出血脑梗死时间规律危险因素　出处：《山西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨太原市脑出血和脑梗死发病的季节、星期和昼夜分布,及其与传统危险因素的关系,以期更好地指导脑卒中诊治的医疗资源配置,制定更合理的脑卒中预防策略。方法:回顾性连续收集2013年1月1日至2014年12月31日发病并入住山西医科大学第一医院和山西省人民医院神经内科的脑出血和脑梗死患者的病历资料,包括其发病时间和传统危险因素。统计学方法采用频数分布拟合优度X2检验比较发病时间分布是否存在差异;如不同时间段发病差异有统计学意义,则采用多项Logistic回归分析不同时段发病规律及其与脑卒中传统危险因素的相关性。P0.05认为差异有统计学意义。结果:1.共纳入符合诊断标准脑出血患者403例,脑出血夏季发病人数(91例)较少,但四季发病间差异无统计学意义(P=0.604);星期发病分布表明星期一发病(45例)较少,星期五(75例)较多,但差异无统计学意义(P=0.170)。脑出血昼夜发病存在统计学差异(P0.001),与夜间发病相比较(OR=1),上午、下午和晚上发病风险分别3.63(95%CI:2.45-5.36)、2.56(95%CI:1.70-3.86)和2.97(95%CI:1.99-4.43)。按照不同危险因素分层比较,及调整各危险因素后显示,脑出血发病呈上午和晚上两个高峰,且此双峰独立于传统脑出血危险因素。2.共纳入脑梗死患者2132例,脑梗死夏季发病人数(497例)较少,但四季发病间差异无统计学意义(P=0.056);星期发病分布提示星期二发病(274例)较少,星期日(326例)较多,差异亦无统计学意义(P=0.416)。脑梗死昼夜发病不同时间段存在统计学差异(P0.001),且与夜间发病相比较,上午、下午和晚上发病的优势比分别为3.73(95%CI:3.09-4.49)、2.96(95%CI:2.44-3.58)和1.89(95%CI:1.54-2.32)。依据是否存在危险因素分层及调整各危险因素后结果表明,脑梗死昼夜发病分布呈上午和下午双高峰,且此双峰与传统危险因素无相关性。结论:1.本研究中脑出血发病季节和星期分布差异无统计学意义,而其发病昼夜分布存在统计学差异。脑出血发病昼夜分布特征如下:夜间发病比例最低,上午和晚上为脑出血发病的两个高峰,而且此双高峰模式独立于性别、年龄、以及是否合并脑出血传统危险因素。其确切机制有待进一步研究。2.本研究中脑梗死发病四季和星期分布差异无统计学意义,但其发病昼夜分布差异有统计学意义。脑梗死发病昼夜分布特征如下:夜间发病比例最低,上午和下午为其发病的两个高峰,且此双高峰模式与患者性别、年龄及是否存在脑梗死传统危险因素不相关。其具体机制尚需深入研究。
[Abstract]:Objective: to investigate the distribution of seasonal, week and night distribution of cerebral hemorrhage and cerebral infarction in Taiyuan and its relationship with traditional risk factors in order to better guide the allocation of medical resources for the diagnosis and treatment of stroke. To formulate more reasonable strategies for the prevention of stroke. Methods: to collect the cerebral hemorrhage and cerebral hemorrhage from January 1st 2013 to December 31st 2014 and to be admitted to the first Hospital of Shanxi Medical University and the Department of Neurology of Shanxi people's Hospital. Medical records of patients with infarction, Including its onset time and traditional risk factors. The frequency distribution goodness of fit X2 test was used to compare the difference of onset time distribution. Multiple Logistic regression analysis was used to analyze the incidence of cerebral hemorrhage in different periods and its correlation with traditional risk factors of stroke. The results showed that the difference was statistically significant. Results 1. 403 patients with intracerebral hemorrhage who met the diagnostic criteria were included. The incidence of intracerebral hemorrhage in summer (91 cases) was less, but there was no significant difference between four seasons (P < 0. 604). The distribution of weekly morbidity showed that there were fewer cases on Monday and 75 cases on Friday). However, there was no statistical difference in the diurnal incidence of cerebral hemorrhage (P 0.001). Compared with nocturnal onset, the risk of cerebral hemorrhage was 3.63 ~ 95CI: 2.45-5.36 in the morning, 2.5695CI1.70-3.86 in the afternoon and 2.9795CIw 1.99-4.430.Compared with different risk factors and adjusted for various risk factors, The incidence of intracerebral hemorrhage showed two peaks in the morning and evening, and the two peaks were independent of the traditional cerebral hemorrhage risk factors .2.2132 cases of cerebral infarction were included, and 497 cases of cerebral infarction occurred in summer). However, there was no significant difference between the four seasons (P < 0.056), but the distribution of weekly incidence indicated that there were 274 cases of disease on Tuesday and 326 cases on Sunday). There was also no significant difference in the incidence of cerebral infarction between day and night (P 0.001), and in the morning, compared with nocturnal onset, there was a significant difference in the incidence of cerebral infarction in different time periods (P 0.001). The odds ratios of afternoon and evening morbidity were 3.73995 CI: 3.09-4.49C: 2.96C95 CI: 2.44-3.58) and 1.899CI95 CI: 1.54-2.320.The results showed that the incidence of cerebral infarction appeared double peak in the morning and afternoon according to the stratification of risk factors and adjustment of various risk factors. There was no correlation between the two peaks and the traditional risk factors. Conclusion 1. There was no significant difference in the seasonal and weekly distribution of cerebral hemorrhage in this study. The diurnal distribution of cerebral hemorrhage is as follows: the nocturnal incidence rate is the lowest, morning and evening are the two peaks of cerebral hemorrhage, and this double peak pattern is independent of sex and age. The exact mechanism of this study is to be further studied. 2. There is no significant difference in the distribution of the four seasons and weeks after the onset of cerebral infarction in this study. The diurnal distribution characteristics of cerebral infarction were as follows: the nocturnal incidence rate was the lowest, the morning and afternoon were the two peaks of the onset, and the double peak pattern was the gender of the patients. Age and the existence of traditional risk factors for cerebral infarction are not related.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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