缺血性进展性脑卒中发病率与相关危险因素的单因素分析

Univariate analysis of the incidence rate and related risk factors of progressive ischemic stroke

目的:探讨牛津郡社区卒中项目分型各亚型缺血性脑卒中患者的进展性脑卒中发病率和相关危险因素。方法:选择2003-03/12大连医科大学附属第二医院神经内科病房连续收治的首次发病的急性缺血性脑卒中患者256例,均自愿参加观察。按牛津郡社区卒中项目分型将所有患者分为4个亚型,完全前循环梗死型、部分前循环梗死型、腔隙性梗死型及后循环梗死型分别为55,30,107和64例。将各亚型患者分别分为进展组和非进展组(进展性脑卒中的诊断标准为起病6h后虽经常规治疗病情仍在进行性加重,加拿大脑卒中量表评分下降1分或更多,并行头颅CT检查排除脑梗死后出血;发病后神经功能稳定或好转的患者进入非进展组)。比较各亚型患者进展性脑卒中的发病率,选择发病率最高的亚型,分析进展性脑卒中的发生与15个可能的危险因素的关系。结果:纳入脑卒中患者256例,全部进入结果分析,无脱落。①各亚型患者进展性脑卒中的发病率比较:完全前循环梗死型患者进展性脑卒中的发病率显著高于部分前循环梗死型、腔隙性梗死型及后循环梗死型患者[38.2%,13.3%,20.6%,18.8%(χ2=9.074,P<0.05)]。②完全前循环梗死型进展组和非进展组患者各危险因素的比较:进展组患者相应颈动脉粥样硬化发生率和入院时随机血糖水平显著高于非进展组[48%,15%;(8.6±2.2)mmol/L,(6.6±2.8)mmol/L(χ2=7.090,t=-2.866,P<0.01)]。结论:各亚型患者进展性脑卒中的发病率不同,完全前循环梗死型最高。进展性脑卒中的发病与多种因素相关,相应颈动脉粥样硬化和入院时高血糖是完全前循环梗死型进展性脑卒中的危险因素。

To investigate incidence rate and related risk factors of progressive stroke in patients with ischemic stroke of clinical categories according to the classification of the Oxfordshire community stroke project （OCSP）. METHOUS：Between March and December 2003,256 inpatients with the first attack of ischemic stroke,who were treated in the Department of Neurology, the Second Affiliated Hospital of Dalian Medical University, were classified into the following 4 clinical subgroups according to the definition of OCSP：total anterior circulation infarcts （TACI,n =55）,partial anterior circulation infarcts （PACI,n=30）, lacunar infarcts （LACI,n=107）, and posterior circulation infarct（POCI,n=64）.The patients of each subtype were divided into progressive group and non-progressive group respectively （the diagnostic standards for progressive stroke were that the severity was still progressively aggravated after routine treatment at 6 hours after attack;the score of Canadian neurological scale was decreased by 1 points or more,and hemorrhage after cerebral infarction was excluded by cranial CT examination; the patients with stable or ameliorated neurological function were involved in the non-progressive group）. The incidence rote of progressive stroke was compared among the patients of each subtype, and that with the highest incidence rate was selected, the association between the occurrence of progressive stroke and the 15 possible risk factors was analyzed. RESULTS：All the 256 stroke patients were involved in the analysis of results.① Comparison of the incidence rate of progressive stroke among the subtypes：It was significantly higher in the patients with TACI than in those with PACI, LACI and POCI （38.2%, 13.3%, 20.6%, 18.8%, X^2=9.074, P 〈 0.05）, ② Comparison of the risk factors between the progressive group and non-progressive group in the patients with TACI： The incidence rate of corresponding carotid atherosclerosis and the random blood glucose level at admission were significantly higher in the progressive group than in the non-progressive group [48%,15%; （8.6±2.2）, （6.6±2.8） mmol/L, X^2=7.090, t=-2.866, P 〈 0.01]. CONCLUSION：The incidence rate of progressive stroke is different in the patients of different subtypes, and it is the highest in those with TACI. The attack of progressive stroke is associated with various factors, corresponding carotid atherosclerosis and the higher blood glucose at admission are the risk factors for the progressive stroke of TACI.