缺血性脑卒中复发与相关因素分析

Recurrence and predictive factors after ischemic stroke

目的观察缺血性脑卒中患者2年复发率及复发的相关危险因素。方法采用前瞻性的队列研究方法,共纳入首发缺血性脑卒中患者860例,根据2年随访是否复发分为复发组(106例)和无复发组(754例)。并按照TOAST标准进行病因分型,大动脉粥样硬化型(LAA)261例,小动脉闭塞型(SAO)186例、心源性栓塞型(CES)191例、其他明确病因或不明原因型(UND)222例,随访2年,观察不同病因分型脑卒中复发率的差异,并进行多因素回归分析相关因素。结果复发组年龄、高血压、糖尿病、吸烟及纤维蛋白原水平较无复发组明显升高(P<0.05,P<0.01);抗血小板药物依从性较无复发组明显降低,差异有统计学意义(P<0.01)。复发脑卒中106例,其中LAA 29例,SAO 22例,CES 36例,UND 19例。多因素回归分析显示,年龄、高血压史、糖尿病史、纤维蛋白原、TOAST分型及抗血小板药物依从性与缺血性脑卒中复发相关。结论不同病因型脑卒中2年复发率存在差异;纤维蛋白原、TOAST病因分型及抗血小板药物依从性也是缺血性脑卒中复发的独立危险因素。

Objective To investigate the recurrence rate and predictors for stroke recurrence within 2 years. Methods In this study, 860 patients with first-ever ischemic stroke from May 2005 to May 2008 were enrolled and registered in Nanjing stroke registry program. All the patients were classified by TOAST criteria and followed-up for two years since its first episode. According to whether the recurrent stroke occurred,all the patients were divided into recurrent group（106 cases） and non-recurrent group（754 cases）. 261 patients were suffering from large artery atherosele- rosis（LAA）. 186 patients were suffering from small artery occlusion（SAO）. 191 patients were suffering from cardioembolism（CES）,and 222 patients were suffering from other determined or undetermined types（UND）. To analyse the difference of recurrence rate according to the TOAST stroke criterion, risk factors were calculated by logistic regression analysis. Results Pairwise comparison found that CES had the highest recurrence rate. In the recurrent group, age, hyperten- sion, diabetes,smoking,and fibrinogen levels were significantly higher than those without recurrent stroke（P〈0.05, P〈0.01）; compliance of anti-platelet drugs was significantly lower than that without recurrent stroke（P〈0. 01）. 106 patients suffered from recurrent stroke, among which there were 29 LAA, 22 SAO, 36 CES, and 19 UND. Pairwise comparison found that CES had the highest recurrence rate. Through logistic regression analysis, age, hypertension, diabetes, plasma fibrinogen,TOAST subtypes and compliance of anti-platelet drugs were associated with recurrence of ischemic stroke. Conclusion There is significantly different recurrence rate for var- ied subtypes of ischemic stroke. Plasma fibrinogen,TOAST criterion and compliance of anti-plate- let drugs are the independent risk factors for recurrent stroke.