广东地区住院患者缺血性卒中复发的相关因素分析

发布时间：2018-10-08 16:32

【摘要】：研究背景和目的缺血性脑卒中是临床常见的脑血管疾病,具有较高的复发性,且复发者病情更严重,其致残率和病死率更高。对缺血性脑卒中复发风险进行科学的分层分析,寻找缺血性脑卒中复发的危险因素对临床开展卒中二级预防具有重要的指导意义。本研究通过分析广东地区811例急性缺血性脑卒中住院患者临床资料,来探讨缺血性脑卒中复发的危险因素,旨在为缺血性脑卒中复发的防治决策提供参考依据。研究方法回顾性分析急性缺血性脑卒中患者临床资料。依据是否复发分为复发组(n=160)和无复发组(n=651);依据中国缺血性卒中亚型(CISS)标准将复发组患者分为以下5型:大动脉粥样硬化(LAA)、心源性卒中(CS)、穿支动脉病(PAD)、其他病因(OE)、不确定病因(UE)。计数资料间比较用卡方(χ2)检验,计量资料间较用t检验。研究结果1.一般临床及生化数据分析复发组与无复发组比较,年龄(71.7±5.3:62.1±6.2岁)、同型半胱氨酸(HCY)(4.1±1.1:4.4±1.2mg/dL)、脂蛋白 A(288.9±89.7:292.5±102.5 ng/ml)三者差异有显著性(t=4.159、2.897、2.956,P=0.015、0.049、0.0470.05),其它指标如性别、体重指数、血压、血糖、血脂水平在两组间比较差异无显著性。2.既往病史数据分析复发组与非复发组间比较,患者高血压史[83.8%(134/160):52.1%(339/651)]、糖尿病史[40.6%(65/160):29.6%(193/651)]、高脂血症[59.4%(95/160):47.9%(312/651)]、不稳定斑块[70.0%(112/160):52.5%(342/651)]、吸烟史[30.6%(49/160):20.9%(136/651)]、抗血小板药物依从性[51.6%(83/160):62.8%(409/651)]、高同型半胱氨酸血症[27.5%(44/160):19.0%(124/651)],组间差异有显著性(χ2=48.366、13.153、12.742、15.899、12.923、12.457、11.569,P=0.000、0.022、0.026、0.000、0.024、0.029、0.0410.05);而城乡居民、冠心病史、房颤、饮酒史、适量锻炼、家族史在两组差异无显著性。3.多因素回归分析Logistic回归分析结果显示年龄、高血压、糖尿病、高脂血症、吸烟史、HCY、不稳定斑块、高同型半胱氨酸血症及抗血小板药物依从性与缺血性脑卒中复发存在相关性。4.复发在CISS各型中的分布根据CISS分型标准将160例缺血性脑卒中复发患者分为5型,即LAA、CS、PAD、OE、UE。LAA 组中共 61 例(38.1%)患者,CS 组中共 18 例(11.3%)患者,PAD组中共52例(32.5%)患者,OE组中共11例(6.9%)患者,UE组中共18例(11.3%)患者。5.CISS各型与危险因素间的关系LAA、CS、PAD、OE、UE亚型间高血压史、高脂血症、不稳定斑块间比较差异显著(χ2=18.898、12.515、11.752,P=0.001、0.014、0.0190.05);而平均年龄、HCY、糖尿病史、吸烟史、高同型半胱氨酸血症、抗血小板药物依从性比较无统计学差异(χ2=1.925、0.168、1.258、0.401、0.845、0.236,P=0.129、0.954、0.869、0.982、0.932、0.9940.05)。结论年龄、高血压、糖尿病、高脂血症、吸烟史、HCY、不稳定斑块、高同型半胱氨酸血症及抗血小板药物依从性是缺血性脑卒中复发的独立危险因素。对诱发缺血性脑卒中复发的危险因素进行积极干预,可有效降低缺血性脑卒中复发风险,改善患者临床预后。
[Abstract]:Background and objective Ischemic stroke is a common clinical cerebrovascular disease with a higher recurrence rate and mortality. Scientific stratification analysis of the risk of ischemic stroke recurrence and finding out the risk factors of ischemic stroke recurrence have important guiding significance for clinical secondary prevention of stroke. In this study, the clinical data of 811 inpatients with acute ischemic stroke in Guangdong area were analyzed to explore the risk factors for recurrence of ischemic stroke, in order to provide a reference for the decision-making of prevention and treatment of ischemic stroke recurrence. Methods the clinical data of patients with acute ischemic stroke were retrospectively analyzed. According to the Chinese (CISS) standard of ischemic stroke, the recurrent patients were divided into the following five types: large artery atherosclerosis (LAA), cardiogenic stroke, (CS), perforating artery disease, (PAD), other etiological factors, (OE), (OE), uncertain etiology (UE)., according to the Chinese criteria for ischemic stroke subtype (CISS), the recurrence group was divided into the following five types: atherosclerosis (LAA), cardiogenic stroke, (CS), perforating artery disease, (PAD), other etiological factors, (UE). Chi-square test was used to compare the counting data and t test was used to measure the data. Results 1. General clinical and biochemical data analysis: age (71.7 卤5.3: 62.1 卤6.2), homocysteine (HCY) (4.1 卤1.1: 4.4 卤1.2mg/dL, lipoprotein A (288.9 卤89.7: 292.5 卤102.5 ng/ml) were significantly different from those in non-recurrence group (t = 4.1592.8972.956P 0.0150.040.049.47 ng/ml), other parameters such as gender, body mass index, blood pressure, blood glucose, There was no significant difference in blood lipid level between the two groups. The data of past medical history were compared between relapsed group and non-recurrent group. 鎮ｈ，

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