缺血性卒中患者的牛津郡社区卒中项目分型与危险因素的关系

Relationship between the Oxfordshire community stroke project classification and the risk factors for stroke in patients with ischemic stroke

目的探讨缺血性卒中患者牛津郡社区卒中项目(OCSP)的分型及各亚型与卒中危险因素的关系。方法前瞻性连续登记发病到入院<2周的缺血性卒中患者932例。根据OCSP分型标准,将其分为完全前循环梗死(TACI)、部分前循环梗死(PACI)、腔隙性梗死(LACI)及后循环梗死(POCI)4组。记录患者的性别、年龄、民族以及高血压、糖尿病、高脂血症、吸烟、饮酒史情况。分析不同危险因素对各卒中亚型发生风险的影响。结果①932例中,LACI组为463例(49.7%)、PACI组为326例(35.0%)、POCI组为78例(8.4%)、TACI组为65例(7.0%)。②年龄、高血压、糖尿病、高脂血症、脑出血、吸烟史在各亚型组间的差异无统计学意义。POCI组中,男性比例最高(75.6%);TACI组中,回族(21.5%)、缺血性卒中(36.9%)、心房颤动(20.0%)及短暂性脑缺血发作(TIA)患者(21.5%)的比例最高(21.5%);LACI组中,饮酒者比例最高(50.3%)。③糖尿病、高血压、高脂血症、吸烟、饮酒、缺血性卒中、TIA、脑出血、心房颤动史对POCI发生的相对危险性差异均无统计学意义;糖尿病、高血压、高脂血症、吸烟史对各型卒中发生的相对危险性差异也均无统计学意义。饮酒史和TIA史增加了LACI的风险(OR=1.488,95%CI:1.148～1.928;OR=1.686,95%CI:1.155～2.462);缺血性卒中史增加了PACI和TACI的风险(OR=1.466,95%CI:1.058～2.032;OR=2.472,95%CI:1.453～4.205);脑出血史和心房颤动增加了TACI(OR=2.570,95%CI:1.036～6.379);OR=4.266,95%CI:2.174～8.368)的风险。结论 OCSP各亚型中,LACI亚型的发生率最高;不同的危险因素可能增加OCSP不同亚型的发生风险。

Objective To investigate the relationship between Oxfordshire community stroke project （OCSP） classification （and each subtype） and the risk factors for stroke. Methods Nine hundred thirty-two consecutive patients with ischemic stroke from the symptom onset to admission 〈 2 weeks were registered. The patients were divided into 4 groups according to the OCSP classification criteria： total anterior circulation infarction （TACI）, partial anterior circulation infarction （PACI）, lacunar infarction （LACI）, and posterior circulation infarction （POCI）. The gender, age, nationality of the patients as well as the history of hypertension, diabetes, hyperlipidemia, smoking, and alcohol consumption were recorded. The effects of different risk factors on each subtypes of stroke were analyzed. Results ①Among the 932 patients, there were 463 patients （49. 7% ） in the LACI group, 326 （35.0%） in the PACI group,78（8.4% ） in POCI group, and 65 （7. 0% ） in the TACI group. ②There were no significant differences in age, hypertension, diabetes, hyperlipidemia, cerebral hemorrhage, and history of smoking among all sub- type groups. The proportion of male was the highest （75.6%） in the OCSP group; the proportions of Muslim （21.5%）, ischemic stroke （36. 9% ）, atrial fibrillation （20. 0%）, and TIA （21.5%） patients were the highest in the TACI group （21.5%） ; the proportion of alcoholic drinkers was the highest in the LACI group （50.3%）. ③There were no significant differences on the relative risk of the occurrence of POCI in patients with history of diabetes, hypertension, hyperlipidemia, smoking, alcohol consumption, ischemic stroke, TIA, cerebral hemorrhage, and atrial fibrillation. There were no significant differences on the relative risks of the occurrence of all types of stroke in patients with history of diabetes, hypertension, hyperlipidemia, and smoking. The history of alcohol consumption and TIA increased the risk of LACI （OR, 1. 488, 95% CI 1. 148 - 1. 928 ; OR, 1. 686, 95% CI 1. 155 - 2. 462） ; the history of ischemic stroke increased the risks of PACI and TACI （ OR, 1. 466, 95% CI 1. 058 - 2. 032 ; OR, 2. 472, 95% CI 1. 453 - 4. 205 ） ; the history of intracerebral hemorrhage increased the risk of TACI （ OR, 2. 570, 95% CI 1. 036 - 6. 379）; atrial fibrillation increased the risk of TACI （OR, 4. 266, 95% CI 2. 174 - 8. 368）. Conclusion The incidence of the LACI subtype was the highest among all the OCSP subtypes. The different risk factors may increase the risks of different subtypes of OCSP.