脑卒中发病与预后的前瞻性队列研究
发布时间：2018-09-04 07:55
【摘要】：脑卒中是目前危害人类健康的重要疾病之一,世界范围内脑卒中已成为第二大死亡原因和残疾的首要原因,它具有高发病率、高复发率、高致残率和高致死率的特点。本次研究将分为以下三部分,进而探讨相关危险因素与脑卒中发病及预后之间的关系。第一部分：利用随访10年的前瞻性队列探讨高血压及饮酒,吸烟及心率的独立效应和累积效应与脑卒中发病的关系。第二部分：利用脑卒中患者预后的前瞻性队列探讨基线维生素D水平及传统危险因素与脑卒中患者住院期间及3个月内结局的关系。第三部分：利用Meta分析方法合并关于银屑病与脑卒中发病的队列研究,探讨银屑病与脑卒中发病风险的关联性。 第一部分 研究目的 依据脑卒中发病的前瞻性队列资料,探讨高血压及饮酒,吸烟及心率的独立效应和累积效应与脑卒中发病的关系。 材料与方法 本课题组于2002-2003年选择内蒙古通辽市科左后旗朝鲁吐乡和奈曼旗固日班花乡共32村作为调查现场,2589人签署知情同意书,并接受了间卷调查、体格检查、测量血压和采集血标本。间卷调查包括人口统计学特征、高血压家族史、吸烟和饮酒等情况,进行三次血压的测量及身高、体重、腰围、臀围的测量。实验室检测包括空腹血糖、胰岛素、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C)由相应公式计算得到。我们分别于2008年、2009年、2010年和2012年对参与基线研究的2589名研究对象进行了随访调查,收集脑卒中的发病资料。 我们采用多因素Cox回归模型分析脑卒中发病的危险因素。根据血压与饮酒状态将研究对象分为四组,运用Kaplan-Meier方法绘制四组人群的脑卒中事件累计发病曲线并采用log-rank检验进行组间比较。以非高血压／不饮酒组作为参比组,利用多因素Cox回归模型分析非高血压／饮酒组,高血压／不饮酒组以及高血压／饮酒组脑卒中发生的风险比(HR)及95%可信区间(95%CI)。应用ROC曲线方法比较传统危险因素加血压/饮酒状态与单纯传统危险因素的曲线下面积,从而分析血压/饮酒状态对脑卒中事件发生的预测效率。类似的,将所有研究对象按照吸烟与心率状态分为四组,运用Kaplan-Meier方法绘制四组人群的缺血性脑卒中事件累计发病曲线并采用log-rank检验进行组间比较。以不吸烟/心率80组作为参比组,利用多因素Cox回归模型分析不吸烟/心率≥80组,吸烟/心率80组以及吸烟/心率≥80组缺血性脑卒中发生的风险比(HR)及95%可信区间(95%CI)。应用ROC曲线方法比较传统危险因素加吸烟/心率状态与单纯传统危险因素的曲线下面积,从而分析吸烟/心率状态对缺血性脑卒中事件发生的预测效率。 结果 年龄增加、男性、高血压是脑卒中发生的独立危险因素,而饮酒与脑卒中发生无显著性关联。非高血压/不饮酒组、非高血压/饮酒组、高血压/不饮酒组以及高血压/饮酒组的脑卒中累计发病率分别是1.5%,2.8%,7.4%及12.5%(P0.001)。同非高血压/不饮酒组相比,非高血压/饮酒组、高血压/不饮酒组和高血压/饮酒组的脑卒中HR(95%CI)分别是1.02(0.47-2.21)、2.61(1.43-4.75)和2.78(1.49-5.21),高血压/饮酒组的HR值高于其他各组。血压/饮酒状态+传统危险因素的ROC曲线下面积0.687显著高于单纯传统危险因素的ROC曲线下面积0.663(P=0.005)。 吸烟是缺血性脑卒中发生的独立危险因素,而心率与缺血性脑卒中发生无显著性关联。不吸烟/心率80组、不吸烟/心率≥80组、吸烟/心率80组以及吸烟/心率≥80组的缺血性脑卒中累计发病率分别是1.41%、1.98%、3.97%及5.77%(P0.001)。同不吸烟/心率80组相比,不吸烟/心率≥80组、吸烟/心率80组和吸烟/心率≥80组的缺血性脑卒中HR(95%CI)分别是1.42(0.62-3.28)、2.11(1.06-4.23)和2.86(1.33-6.14),吸烟/心率≥80组的HR值高于其他各组。吸烟/心率状态+传统危险因素的ROC曲线下面积0.755显著高于单纯传统危险因素的ROC曲线下面积0.739(P=0.018)。 结论 本研究结果显示,年龄增加、男性和高血压是影响脑卒中发病的独立危险因素。吸烟是缺血性脑卒中发病的独立危险因素。饮酒可能在一定程度上放大了高血压对于脑卒中发病的风险,而心率较快可能在一定程度上放大了吸烟对缺血性脑卒中发病的风险。血压/饮酒状态、吸烟/心率状态可以提高脑卒中和缺血性脑卒中发病风险的预测效率 研究目的 根据脑卒中患者预后的前瞻性队列探讨基线维生素D水平及传统危险因素与缺血性脑卒中患者住院期间及3个月内结局的关系。 材料与方法 本研究以参加中美合作“急性缺血性脑卒中降血压随机对照试验”的急性缺血性脑卒中患者作为研究人群,以其中资料完整,已完成3个月随访并且检测了血清25(OH)D水平的3002例缺血性脑卒中患者作为研究对象。采用统一设计的调查表收集患者的人口统计学信息、生活方式、临床特征、实验室检查、疾病史等资料,应用LIAISON全自动化学发光仪测定患者入院24小时内血清维生素25(OH)D浓度。在患者住院期间和发病3个月后对其进行评估,记录死亡、心血管事件、中风再发的情况,并进行神经功能(NIHSS评分)和生活自理程度的评价(MRs评分),以死亡、残疾(MRs3)、心血管事件以及中风再发作为研究结局。运用多因素Cox回归模型分析维生素D水平及传统危险因素与患者住院期间及3个月内死亡和心脑血管事件的关系,计算HR和95%CI。运用多因素logistic回归模型分析维生素D水平及传统危险因素与住院期间及3个月内残疾与复合结局的关系,计算OR和95%CI。运用logistic回归模型对维生素D水平及传统危险因素与复合结局的关系进行线性趋势检验。按照传统危险因素的不同水平将缺血性脑卒中患者分为若干亚组,进而分析维生素D水平在每一亚组中与缺血性脑卒中患者预后的关联性。 结果 住院期间,同年龄55岁的患者相比,年龄≥55岁的患者发生死亡及心脑血管事件的HR(95%CI)是1.84(0.64-5.32),发生残疾与复合结局的OR(95%CI)分别是1.55(1.22-1.98)和1.56(1.23-1.98)。同白细胞8.5×109/L的患者相比,白细胞≥8.5×109/L患者发生死亡及心脑血管事件的HR(95%CI)是2.58(1.09-6.12),发生残疾与复合结局的OR(95%CI)分别是1.32(1.06-1.65)和1.36(1.09-1.69)。同血糖水平7.0mmol/L的患者相比,血糖水平≥7.0mmol/L的患者发生死亡及心脑血管事件的HR(95%CI)是3.64(1.56-8.5),发生残疾与复合结局的OR(95%CI)分别是1.44(1.16-1.77)和1.46(1.18-1.80)。同25(OH)D20ng/ml的患者相比,25(OH)D20ng/ml的患者发生死亡及心脑血管事件的HR(95%CI)是0.82(0.29-2.34),发生残疾与复合结局的OR(95%CI)分别是1.09(0.84-1.40)和1.09(0.85-1.40)。年龄、白细胞以及血糖水平与住院期间不良结局的风险之间存在剂量反应关系(P0.05),25(OH)D水平与住院期间不良结局风险之间无明显的剂量反应关系(P0.05)。 发病3个月内,同年龄55岁的患者相比,年龄≥55岁的患者发生死亡及心脑血管事件的HR(95%CI)是1.72(1.03-2.85),发生残疾与复合结局的OR(95%CI)分别是1.61(1.24-2.10)和1.65(1.28-2.12)。同白细胞8.5×109/L的患者相比,白细胞≥8.5×109/L患者发生死亡及心脑血管事件的HR(95%CI)是2.18(1.54-3.09),发生残疾与复合结局的OR(95%CI)分别是1.35(1.07-1.69)和1.48(1.19-1.83)。同血糖水平7.0nmol/L的患者相比,血糖水平≥7.0mmol/L的患者发生死亡及心脑血管事件的HR(95%CI)是1.28(0.90-1.84),发生残疾与复合结局的OR(95%CI)分别是1.30(1.04-1.63)和1.28(1.04-1.59)。同收缩压水平16OmmHg的患者相比,收缩压水平≥16Ommol/L的患者发生死亡及心脑血管事件的HR(95%CI)是1.53(1.07-2.20),发生残疾与复合结局的OR(95%CI)分别是1.33(1.07-1.65)和1.33(1.08-1.63)。与25(OH)D≥20ng/ml的患者相比,25(OH)D20ng/ml的患者发生死亡及心脑血管事件的HR(95%CI)是1.08(0.69-1.70),发生残疾与复合结局的OR(95%CI)分别是1.16(0.88-1.52)和1.17(0.90-1.51)。年龄、白细胞、收缩压水平以及血糖水平与发病3个月内不良结局的风险之间存在剂量反应关系(P0.05),25(OH)D水平与发病3个月内不良结局风险之间无明显的剂量反应关系(P0.05)。亚组分析显示,在男性患者、血脂异常患者和吸烟患者中,25(OH)D20ng/ml的对象3个月内发生复合结局的风险显著高于25(OH)D≥20ng/ml的对象,其OR(95%CI)分别是1.49(1.09-2.05),1.65(1.08-2.51)和1.64(1.03-2.61)。 结论 本次脑卒中预后的前瞻性队列研究发现,年龄增大、基线时血糖和白细胞计数水平升高显著增加缺血性脑卒中患者住院期间及3个月内不良结局发生的风险；基线收缩压水平升高显著增加缺血性脑卒中患者3个月内不良结局的风险；这些因素与患者预后均存在剂量反应关系。对所有对象而言,尚未发现基线25(OH)D水平影响缺血性脑卒中患者住院期间及3个月内的结局,但亚组分析结果提示,在男性患者、血脂异常患者和吸烟患者中,维生素D缺乏增加了缺血性脑卒中患者3个月内发生不良结局的风险。 研究目的 利用Meta分析方法合并关于银屑病与脑卒中发病的队列研究,探讨银屑病与脑卒中发病风险的关联性。 材料与方法 通过检索MEDLINE (Pubmed), EMBASE与Cochrane Library等数据库,收集2013年10月之前公开发表的有关于银屑病与脑卒中的队列研究的相关文献。随机效应模型被用来对各个研究的效应值进行合并。 结果 5项队列研究最终被纳入本次Meta分析。3项研究为前瞻性队列,1项研究为回顾性队列,1项为回顾-前瞻混合队列。随机效应模型的合并结果显示,银屑病导致脑卒中的风险(RR)及其95%可信区间为1.18(1.02-1.37)。Eagger线性检验(P=0.778),Begger秩相关检验(P=1.00)提示我们的研究不存在潜在的发表偏倚。 结论 综上所述,我们的研究结果说明银屑病将显著提高脑卒中的发病风险,银屑病很有可能是独立于高血压、糖尿病等传统危险因素以外的脑卒中发病的又一危除因素。
[Abstract]:Stroke is one of the most important diseases endangering human health. Stroke has become the second leading cause of death and disability worldwide. It has the characteristics of high incidence, high recurrence rate, high disability rate and high fatality rate. The relationship between prognosis. Part I: Prospective cohort study of hypertension and alcohol consumption, smoking and heart rate over a 10-year follow-up period was used to explore the relationship between independent and cumulative effects and stroke incidence. Part II: Prospective cohort study of stroke prognosis was used to explore baseline vitamin D levels and traditional risk factors in stroke patients. Part III: To explore the association between psoriasis and stroke risk by using Meta-analysis combined with a cohort study on psoriasis and stroke.
Part one
research objective
Based on the prospective cohort data of stroke incidence, the relationship between hypertension, alcohol consumption, smoking, heart rate and stroke incidence was investigated.
Materials and methods
From 2002 to 2003, our research group selected 32 villages in Chaolutu Township, Kezuo Houqi Township, Tongliao City, Inner Mongolia, and Guri Banhua Township, Naiman Banner, as the investigation sites. 2589 people signed informed consent forms and received a cross-sectional survey, physical examination, blood pressure measurement and blood sample collection. The cross-sectional survey included demographic characteristics, family history of hypertension, smoking and drinking. Laboratory tests included fasting blood glucose, insulin, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) calculated by the corresponding formula. We calculated them in 2008, 2009, 2010 and 201, respectively. In the 2 year, 2589 subjects who participated in the baseline study were followed up to collect data on the onset of stroke.
Multivariate Cox regression model was used to analyze the risk factors of stroke. The subjects were divided into four groups according to blood pressure and alcohol consumption. The cumulative incidence curves of stroke events were plotted by Kaplan-Meier method and compared between groups by log-rank test. Multivariate Cox regression model was used to analyze the risk ratio (HR) and 95% confidence interval (95% CI) of stroke in non-hypertension/alcohol drinking group, hypertension/alcohol drinking group and hypertension/alcohol drinking group. Similarly, all subjects were divided into four groups according to smoking and heart rate status. The cumulative incidence curves of ischemic stroke events were plotted by Kaplan-Meier method and compared between groups by log-rank test. Multivariate Cox regression model was used to analyze the risk ratio (HR) and 95% confidence interval (95% CI) of ischemic stroke in non-smoking/heart rate (> 80 group), smoking/heart rate (> 80 group) and smoking/heart rate (> 80 group). ROC curve method was used to compare the area under the curve of traditional risk factors plus smoking/heart rate status and simple traditional risk factors. The predictive efficiency of heart rate for ischemic stroke events.
Result
The cumulative incidence of stroke was 1.5%, 2.8%, 7.4% and 12.5% (P 0.001) in the non-hypertension / non-drinking group, non-hypertension / non-drinking group, hypertension / non-drinking group and hypertension / drinking group, respectively. Compared with the non-hypertension/alcohol drinking group, the stroke HR (95% CI) of hypertension/alcohol drinking group and hypertension/alcohol drinking group were 1.02 (0.47-2.21), 2.61 (1.43-4.75) and 2.78 (1.49-5.21), respectively. The HR value of hypertension/alcohol drinking group was higher than that of other groups. The area under ROC curve of blood pressure/alcohol status+traditional risk factors was 0.687 significantly higher than that of simple traditional risk factors. The area under the ROC curve of risk factors was 0.663 (P=0.005).
The cumulative incidence of ischemic stroke was 1.41%, 1.98%, 3.97% and 5.77% in non-smoking/heart rate group, non-smoking/heart rate group, smoking/heart rate group and smoking/heart rate group, respectively (P 0.001). HR (95% CI) of ischemic stroke was 1.42 (0.62-3.28), 2.11 (1.06-4.23) and 2.86 (1.33-6.14) in non-smoking/heart rate (>80), smoking/heart rate (>80) and smoking/heart rate (>80), respectively. The HR of smoking/heart rate (>80) group was higher than that of other groups. The area under ROC curve of smoking/heart rate status + traditional risk factors was 0.755 significantly higher than that of single group. The area under the ROC curve of pure traditional risk factors was 0.739 (P=0.018).
conclusion
Smoking is an independent risk factor for ischemic stroke. Alcohol consumption may magnify the risk of hypertension for stroke to some extent, while faster heart rate may magnify the effect of smoking on ischemia to some extent. Risk of stroke. Blood pressure / alcohol status, smoking / heart rate status can improve the predictive efficiency of stroke and ischemic stroke risk
research objective
To explore the relationship between baseline vitamin D levels and traditional risk factors and the outcomes of ischemic stroke patients during hospitalization and within 3 months according to a prospective cohort of stroke patients.
Materials and methods
In this study, 3002 patients with acute ischemic stroke who participated in the Sino-US cooperative randomized controlled trial of lowering blood pressure for acute ischemic stroke were selected as the subjects. The data were complete, and the patients were followed up for 3 months and the serum 25 (OH) D levels were measured. A uniform design survey was used. Serum vitamin 25 (OH) D levels were measured by LIAISON automatic chemiluminescence meter during hospitalization and 3 months after onset of stroke. Neurological function (NIHSS) and self-care (MRS) were assessed, and death, disability (MRs3), cardiovascular events and stroke recurrence were taken as the study outcomes. Multivariate Cox regression model was used to analyze the relationship between vitamin D levels and traditional risk factors and death and cardiovascular and cerebrovascular events during hospitalization and within 3 months. HR and 95% CI were calculated. Multivariate logistic regression model was used to analyze the relationship between vitamin D level and traditional risk factors, disability and multiple outcomes during hospitalization and within 3 months. OR and 95% CI were calculated. The linear trend test was used to examine the relationship between vitamin D level and traditional risk factors and multiple outcomes. Patients with ischemic stroke were divided into several subgroups according to different levels of risk factors, and the correlation between vitamin D level and prognosis of ischemic stroke patients in each subgroup was analyzed.
Result
During hospitalization, HR (95% CI) was 1.84 (0.64-5.32) for death and cardiovascular and cerebrovascular events in patients over 55 years of age. OR (95% CI) for disability and complex outcomes was 1.55 (1.22-1.98) and 1.56 (1.23-1.98), respectively. Compared with patients with leukocytes over 8.5 *109/L, patients with leukocytes over 8.5 *109/L died and had cardio-cerebral events. HR (95% CI) for vascular events was 2.58 (1.09-6.12), OR (95% CI) for disability and complex outcomes was 1.32 (1.06-1.65) and 1.36 (1.09-1.69), respectively. Compared with patients with 7.0 mmol/L of blood glucose, HR (95% CI) for death and cardiovascular and cerebrovascular events was 3.64 (1.56-8.5) for patients with disability and complex outcomes (95% CI). Compared with 25 (OH) D20ng/ml patients, the HR (95% CI) of 25 (OH) D20ng/ml patients was 0.82 (0.29-2.34), and the OR (95% CI) of disability and complex outcome was 1.09 (0.84-1.40) and 1.09 (0.85-1.40) respectively. There was a dose-response relationship between the risk of good outcomes (P 0.05). There was no significant dose-response relationship between 25 (OH) D level and the risk of adverse outcomes during hospitalization (P 0.05).
HR (95% CI) was 1.72 (1.03-2.85) and OR (95% CI) was 1.61 (1.24-2.10) and 1.65 (1.28-2.12) respectively. Compared with patients with leukocytes of 8.5 *109/L, patients with leukocytes of more than 8.5 *109/L died and patients with leukocytes of more than 8.5 *109/L died. HR (95% CI) for cardiovascular and cerebrovascular events was 2.18 (1.54-3.09), OR (95% CI) for disability and complex outcomes was 1.35 (1.07-1.69) and 1.48 (1.19-1.83). Compared with patients with 7.0 nmol/L of blood glucose, HR (95% CI) for death and cardiovascular and cerebrovascular events was 1.28 (0.90-1.84) for patients with disability and complex outcomes. R (95% CI) was 1.30 (1.04-1.63) and 1.28 (1.04-1.59), respectively. Compared with patients with systolic blood pressure level of 16OmmHg, the HR (95% CI) of death and cardiovascular and cerebrovascular events in patients with systolic blood pressure level (>16Ommol/L) was 1.53 (1.07-2.20), and the OR (95% CI) of disability and complex outcomes was 1.33 (1.07-1.65) and 1.08-1.63 (25 (OH) D (>20ng/ml), respectively. HR (95% CI) was 1.08 (0.69-1.70), and OR (95% CI) was 1.16 (0.88-1.52) and 1.17 (0.90-1.51) for disability and complex outcomes, respectively, in 25 (OH) D20ng/ml patients. There was a dose-response relationship between age, leukocyte, systolic blood pressure, and the risk of adverse outcomes within three months of onset. There was no significant dose-response relationship between 25 (OH) D and the risk of adverse outcomes within 3 months (P 0.05). Subgroup analysis showed that the risk of compound outcomes within 3 months in 25 (OH) D20ng/ml subjects was significantly higher in male patients, dyslipidemia patients and smokers than in 25 (OH) D > 20ng/ml subjects, with OR (95% CI) of 1. 49 (1.09-2.05), 1.65 (1.08-2.51) and 1.64 (1.03-2.61).
conclusion
This prospective cohort study of stroke prognosis found that increased age, elevated baseline blood glucose and white blood cell count significantly increased the risk of adverse outcomes during hospitalization and within three months in patients with ischemic stroke, and elevated baseline systolic blood pressure significantly increased the risk of adverse outcomes within three months in patients with ischemic stroke. For all subjects, baseline 25 (OH) D levels were not found to affect the outcome of ischemic stroke during hospitalization and within three months, but subgroup analysis indicated that vitamin D deficiency increased ischemic stroke in men, dyslipidemia and smokers. The risk of adverse outcomes was within 3 months.
research objective
Meta-analysis was used to explore the association between psoriasis and stroke risk in a cohort study of psoriasis and stroke.
Materials and methods
By searching MEDLINE (Pubmed), EMBASE and Cochrane Library databases, we collected the literature published before October 2013 on the cohort study of psoriasis and stroke. Random effect models were used to merge the effects of each study.
Result
Five cohort studies were eventually included in the Meta-analysis.Three studies were prospective, one retrospective, and one prospective. test
【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R743.3
[Abstract]:Stroke is one of the most important diseases endangering human health. Stroke has become the second leading cause of death and disability worldwide. It has the characteristics of high incidence, high recurrence rate, high disability rate and high fatality rate. The relationship between prognosis. Part I: Prospective cohort study of hypertension and alcohol consumption, smoking and heart rate over a 10-year follow-up period was used to explore the relationship between independent and cumulative effects and stroke incidence. Part II: Prospective cohort study of stroke prognosis was used to explore baseline vitamin D levels and traditional risk factors in stroke patients. Part III: To explore the association between psoriasis and stroke risk by using Meta-analysis combined with a cohort study on psoriasis and stroke.
Part one
research objective
Based on the prospective cohort data of stroke incidence, the relationship between hypertension, alcohol consumption, smoking, heart rate and stroke incidence was investigated.
Materials and methods
From 2002 to 2003, our research group selected 32 villages in Chaolutu Township, Kezuo Houqi Township, Tongliao City, Inner Mongolia, and Guri Banhua Township, Naiman Banner, as the investigation sites. 2589 people signed informed consent forms and received a cross-sectional survey, physical examination, blood pressure measurement and blood sample collection. The cross-sectional survey included demographic characteristics, family history of hypertension, smoking and drinking. Laboratory tests included fasting blood glucose, insulin, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) calculated by the corresponding formula. We calculated them in 2008, 2009, 2010 and 201, respectively. In the 2 year, 2589 subjects who participated in the baseline study were followed up to collect data on the onset of stroke.
Multivariate Cox regression model was used to analyze the risk factors of stroke. The subjects were divided into four groups according to blood pressure and alcohol consumption. The cumulative incidence curves of stroke events were plotted by Kaplan-Meier method and compared between groups by log-rank test. Multivariate Cox regression model was used to analyze the risk ratio (HR) and 95% confidence interval (95% CI) of stroke in non-hypertension/alcohol drinking group, hypertension/alcohol drinking group and hypertension/alcohol drinking group. Similarly, all subjects were divided into four groups according to smoking and heart rate status. The cumulative incidence curves of ischemic stroke events were plotted by Kaplan-Meier method and compared between groups by log-rank test. Multivariate Cox regression model was used to analyze the risk ratio (HR) and 95% confidence interval (95% CI) of ischemic stroke in non-smoking/heart rate (> 80 group), smoking/heart rate (> 80 group) and smoking/heart rate (> 80 group). ROC curve method was used to compare the area under the curve of traditional risk factors plus smoking/heart rate status and simple traditional risk factors. The predictive efficiency of heart rate for ischemic stroke events.
Result
The cumulative incidence of stroke was 1.5%, 2.8%, 7.4% and 12.5% (P 0.001) in the non-hypertension / non-drinking group, non-hypertension / non-drinking group, hypertension / non-drinking group and hypertension / drinking group, respectively. Compared with the non-hypertension/alcohol drinking group, the stroke HR (95% CI) of hypertension/alcohol drinking group and hypertension/alcohol drinking group were 1.02 (0.47-2.21), 2.61 (1.43-4.75) and 2.78 (1.49-5.21), respectively. The HR value of hypertension/alcohol drinking group was higher than that of other groups. The area under ROC curve of blood pressure/alcohol status+traditional risk factors was 0.687 significantly higher than that of simple traditional risk factors. The area under the ROC curve of risk factors was 0.663 (P=0.005).
The cumulative incidence of ischemic stroke was 1.41%, 1.98%, 3.97% and 5.77% in non-smoking/heart rate group, non-smoking/heart rate group, smoking/heart rate group and smoking/heart rate group, respectively (P 0.001). HR (95% CI) of ischemic stroke was 1.42 (0.62-3.28), 2.11 (1.06-4.23) and 2.86 (1.33-6.14) in non-smoking/heart rate (>80), smoking/heart rate (>80) and smoking/heart rate (>80), respectively. The HR of smoking/heart rate (>80) group was higher than that of other groups. The area under ROC curve of smoking/heart rate status + traditional risk factors was 0.755 significantly higher than that of single group. The area under the ROC curve of pure traditional risk factors was 0.739 (P=0.018).
conclusion
Smoking is an independent risk factor for ischemic stroke. Alcohol consumption may magnify the risk of hypertension for stroke to some extent, while faster heart rate may magnify the effect of smoking on ischemia to some extent. Risk of stroke. Blood pressure / alcohol status, smoking / heart rate status can improve the predictive efficiency of stroke and ischemic stroke risk
research objective
To explore the relationship between baseline vitamin D levels and traditional risk factors and the outcomes of ischemic stroke patients during hospitalization and within 3 months according to a prospective cohort of stroke patients.
Materials and methods
In this study, 3002 patients with acute ischemic stroke who participated in the Sino-US cooperative randomized controlled trial of lowering blood pressure for acute ischemic stroke were selected as the subjects. The data were complete, and the patients were followed up for 3 months and the serum 25 (OH) D levels were measured. A uniform design survey was used. Serum vitamin 25 (OH) D levels were measured by LIAISON automatic chemiluminescence meter during hospitalization and 3 months after onset of stroke. Neurological function (NIHSS) and self-care (MRS) were assessed, and death, disability (MRs3), cardiovascular events and stroke recurrence were taken as the study outcomes. Multivariate Cox regression model was used to analyze the relationship between vitamin D levels and traditional risk factors and death and cardiovascular and cerebrovascular events during hospitalization and within 3 months. HR and 95% CI were calculated. Multivariate logistic regression model was used to analyze the relationship between vitamin D level and traditional risk factors, disability and multiple outcomes during hospitalization and within 3 months. OR and 95% CI were calculated. The linear trend test was used to examine the relationship between vitamin D level and traditional risk factors and multiple outcomes. Patients with ischemic stroke were divided into several subgroups according to different levels of risk factors, and the correlation between vitamin D level and prognosis of ischemic stroke patients in each subgroup was analyzed.
Result
During hospitalization, HR (95% CI) was 1.84 (0.64-5.32) for death and cardiovascular and cerebrovascular events in patients over 55 years of age. OR (95% CI) for disability and complex outcomes was 1.55 (1.22-1.98) and 1.56 (1.23-1.98), respectively. Compared with patients with leukocytes over 8.5 *109/L, patients with leukocytes over 8.5 *109/L died and had cardio-cerebral events. HR (95% CI) for vascular events was 2.58 (1.09-6.12), OR (95% CI) for disability and complex outcomes was 1.32 (1.06-1.65) and 1.36 (1.09-1.69), respectively. Compared with patients with 7.0 mmol/L of blood glucose, HR (95% CI) for death and cardiovascular and cerebrovascular events was 3.64 (1.56-8.5) for patients with disability and complex outcomes (95% CI). Compared with 25 (OH) D20ng/ml patients, the HR (95% CI) of 25 (OH) D20ng/ml patients was 0.82 (0.29-2.34), and the OR (95% CI) of disability and complex outcome was 1.09 (0.84-1.40) and 1.09 (0.85-1.40) respectively. There was a dose-response relationship between the risk of good outcomes (P 0.05). There was no significant dose-response relationship between 25 (OH) D level and the risk of adverse outcomes during hospitalization (P 0.05).
HR (95% CI) was 1.72 (1.03-2.85) and OR (95% CI) was 1.61 (1.24-2.10) and 1.65 (1.28-2.12) respectively. Compared with patients with leukocytes of 8.5 *109/L, patients with leukocytes of more than 8.5 *109/L died and patients with leukocytes of more than 8.5 *109/L died. HR (95% CI) for cardiovascular and cerebrovascular events was 2.18 (1.54-3.09), OR (95% CI) for disability and complex outcomes was 1.35 (1.07-1.69) and 1.48 (1.19-1.83). Compared with patients with 7.0 nmol/L of blood glucose, HR (95% CI) for death and cardiovascular and cerebrovascular events was 1.28 (0.90-1.84) for patients with disability and complex outcomes. R (95% CI) was 1.30 (1.04-1.63) and 1.28 (1.04-1.59), respectively. Compared with patients with systolic blood pressure level of 16OmmHg, the HR (95% CI) of death and cardiovascular and cerebrovascular events in patients with systolic blood pressure level (>16Ommol/L) was 1.53 (1.07-2.20), and the OR (95% CI) of disability and complex outcomes was 1.33 (1.07-1.65) and 1.08-1.63 (25 (OH) D (>20ng/ml), respectively. HR (95% CI) was 1.08 (0.69-1.70), and OR (95% CI) was 1.16 (0.88-1.52) and 1.17 (0.90-1.51) for disability and complex outcomes, respectively, in 25 (OH) D20ng/ml patients. There was a dose-response relationship between age, leukocyte, systolic blood pressure, and the risk of adverse outcomes within three months of onset. There was no significant dose-response relationship between 25 (OH) D and the risk of adverse outcomes within 3 months (P 0.05). Subgroup analysis showed that the risk of compound outcomes within 3 months in 25 (OH) D20ng/ml subjects was significantly higher in male patients, dyslipidemia patients and smokers than in 25 (OH) D > 20ng/ml subjects, with OR (95% CI) of 1. 49 (1.09-2.05), 1.65 (1.08-2.51) and 1.64 (1.03-2.61).
conclusion
This prospective cohort study of stroke prognosis found that increased age, elevated baseline blood glucose and white blood cell count significantly increased the risk of adverse outcomes during hospitalization and within three months in patients with ischemic stroke, and elevated baseline systolic blood pressure significantly increased the risk of adverse outcomes within three months in patients with ischemic stroke. For all subjects, baseline 25 (OH) D levels were not found to affect the outcome of ischemic stroke during hospitalization and within three months, but subgroup analysis indicated that vitamin D deficiency increased ischemic stroke in men, dyslipidemia and smokers. The risk of adverse outcomes was within 3 months.
research objective
Meta-analysis was used to explore the association between psoriasis and stroke risk in a cohort study of psoriasis and stroke.
Materials and methods
By searching MEDLINE (Pubmed), EMBASE and Cochrane Library databases, we collected the literature published before October 2013 on the cohort study of psoriasis and stroke. Random effect models were used to merge the effects of each study.
Result
Five cohort studies were eventually included in the Meta-analysis.Three studies were prospective, one retrospective, and one prospective. test
【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R743.3
【参考文献】
相关期刊论文 前5条
1 朱汉民;程群;甘洁民;杜艳萍;洪维;朱晓颖;李慧林;;上海地区人群维生素D状态研究[J];中华骨质疏松和骨矿盐疾病杂志;2010年03期
2 王炳旭,刘凤玲,韩仲岩;缺血性脑血管病患者的外周血白细胞昼夜节律性变化[J];临床神经病学杂志;1996年03期
3 姜亚军,何家声;脑缺血/再灌注期间白细胞粘附机制的研究进展[J];国外医学(脑血管疾病分册);1996年05期
4 邓晓玲;赵斌;汪健;周少华;席刚明;;C反应蛋白、白细胞计数与脑梗死体积及近期预后的关系[J];现代生物医学进展;2012年03期
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