脑梗死和脑出血患者的临床特点及长期预后观察

Clinical characteristics and long-term prognosis of patients with ischemic and hemorrhagic stroke

目的探讨不同类型卒中的危险因素、病因、死亡原因和预后。方法基于华西医院卒中登记，脑卒中分为出血性和缺血性，缺血性卒中亚型是依据牛津郡社区卒中项目分类原则。分析住院患者的人口学特点、危险因素、死亡原因和1年末结局。结果2002年3月至2005年9月，共纳入1913例资料完整的卒中患者，其中脑出血599例（31．3％）；缺血眭脑卒中1314例（68．7％）。后者中完全前循环梗死209例（15．9％），部分前循环梗死417例（31．7％），后循环梗死186例（14．2％），腔隙性梗死502例（38．2％）。校正年龄和性别，多因素分析显示，房颤是完全前循环梗死的独立预测因素（OR=1．42，95％CI=1．25～2．31）；高血压和饮酒是腔隙性梗死（OR=1．24，95％CI=1．02～2．18；OR=1．12，95％CI=1．03～3．04）和脑出血（OR=1．84，95％CI：1．31～3．02；OR：1．04，95％CI=1．01～4．13）的独立预测因素。完全前循环梗死与高血压呈负相关（OR=0．62，95％CI=0．34～0．72），腔隙性梗死与房颤呈负相关（OR=0．46，95％CI=0．26～0．82），脑出血与糖尿病亦呈负相关（OR=0．56，95％CI=0．42～0．76）。以腔隙性梗死为参照，完全前循环梗死（OR：6．21，95％CI=2．86～8．42）和脑出血（OR=5．86，95％CI=2．46～8．52）明显增加患者1年死亡风险。结论不同类型卒中的危险因素、病因和结局不同。确定卒中亚型对于急性期治疗和预防有重要意义。

Objective To investigate the risk factors, pathogenesis, cause of death,and outcome of different stroke subtypes. Methods The relevant data, including demographics, baseline risk factors, cause of death, and 1-year case fatality, were analyzed among 1913 consecutive hospitalized patients with ischemic and hemorrhagic stroke, 599 （31.3%） with intracerebral hemorrhage （ICH） and 1314 with ischemic stroke （68.7%）, including 209 cases （ 15.9% ） of total anterior circulation infarction （ TACI ）, 417 cases （31.7%）of partial anterior circulation infarction （PACI）, and 186 cases （ 14.2% ） of posterior circulation infarctions （POCI）, and 502 cases （38.2%） of lacunar infarctions （ LACI）, 1098 males and 815 females, aged 64 ＋ 13 （14-98）. Results Multivariate analysis showed that when age and sex were adjusted, atrial fibrillation was the independent predictive factor of TACI [ odds ratio （OR） = 1.42,95% CI = 1.25-2.31 ）,hypertension and alcohol intake were the independent predictive factor LACI （OR = 1.24,95%CI=1.02-2.18;0R= 1.12,95%Cl=l.03-3.04）andICH （OR= 1.84,95%CI=1.31- 3.02 ; OR = 1.04,95% CI = 1.01 - 4.13 ）. A negative association was observed between hypertension and TACI （ OR = 0.62,95% CI = 0.34 - 0.72）, atrial fibrillation and LACI （ OR = 0.46,95% CI = 0.26 - 0.82）, and ICH and diabetes （OR = 0.56,95% CI=0.42 -0.76）. As compared to LACI, TACI and ICH significantly increased the risk of 1-year mortality （ OR = 6.21,95% CI = 2.86 - 8.42 ; OR = 5.86 ; 95% CI = 2.46 -8.52）. Conclusions Stroke subtypes have different risk factor profile, causes and outcome. Information on determinants of the clinical syndromes may impact on the prevention and acute phase interventions.