不同亚型急性脑梗死短期不良结局危险因素分析

Analysis on risk factors of short-term poor outcome among different subtypes of acute cerebral infarction

目的探讨不同亚型急性脑梗死短期不良结局的危险因素。方法以3 231例急性脑梗死住院患者为研究对象,收集人口统计学、生活方式、疾病史、心血管病家族史、入院血压、实验室检测结果及出院结局等临床资料。将出院时美国国立卫生研究脑率中量表(NIHSS)≥10或住院期间死亡定义为不良结局。应用Logistic回归方法进行统计分析。结果脑栓塞者不良结局的发生率最高,其次是脑血栓者,腔隙性梗死者最低。吸烟(OR:1.228;95% CI:1.013～1.637;P=0.039),血脂异常(OR:1.264;95% CI:1.081～1.478;P=0.003),糖尿病(OR:1.371;95 %CI:1.075～1.747;P=0.011)与脑血栓的不良结局相关联;心房纤颤(OR:3.131;95% CI:1.206～8.128;P=0.019)和风湿性心脏病(OR:5.601;95% CI:1.561～20.091;P=0.008)与脑栓塞的不良结局相关联;年龄(1.011;95% CI,1.003～1.02))和饮酒(OR:1.428;95% CI:1.063～1.919;P=0.018)与腔隙性脑梗死的不良结局相关联。结论脑栓塞患者不良结局的发生率最高;在3种脑梗死亚型中,与短期不良结局相关联的危险因素并不相同。

Objective To investigate the risk factors of short-term poor outcome among patients suffering from acute cerebral infarction who had different subtypes of cerebral infarction. Methods A total of 3 231 acute cerebral infarction patients were included in the present study. Data on demographic characteristics, life style, risk factors, history of cardiovascular disease, admission blood pressure, and clinical outcome at discharge were collected for all participants. Poor outcome was defined as NIHSS ≥ 10 at discharge or death occuring during hospitalization. The association between poor outcome of cerebral infarction and risk factors was analyzed by using multiple logistic models. Results Incidence rate of poor outcome is the highest in the patients with cerebral embolism, next in patients with cerebral thrombosis and the lowest in patients with lacunar infarction, cerebral thrombosis was positively associated with smoking（ OR： 1. 228; 95% CI： 1. 013 - 1. 637）, dyslipidemia （OR： 1. 264; 95% CI： 1. 081 - 1. 478）, and a history of diabetes mellitus （ OR ： 1.371 ; 95 % CI ： 1. 075 - 1. 747 ） ; cerebral embolism was positively associated with a history of atrial fibrillation （ OR： 3. 131 ; 95% CI ： 1. 206 - 8. 128 ） and a history of rheumatic heart disease （ OR ： 5. 601 ; 95% CI ： 1. 561 - 20. 091 ） ; lacunar infarction is positively associated with alcohol consumption, （OR： 1. 428; 95% CI： 1. 063 - 1. 919）. Conclusion The incidence rate of poor outcome is the highest in the patients with cerebral embolism among three subtypes of cerebral infarction, there are different risk factors of poor outcome for three subtypes of cerebral infarction.