首发缺血性卒中后再发不同类型卒中预测因素的回归性分析

Multiple regression analysis of the risk factors to predict different recurrent stroke types after initial ischemie stroke

目的探讨首发缺血性卒中患者再发卒中的类型及与相关危险因素之间的关系。方法收集2004年1月至2009年12月在我院神经科住院诊治的再发卒中患者361例。患者的首发卒中类型必须为缺血性卒中，收集并记录患者的吸烟、大量饮酒、高血压、糖尿病、高脂血症、心脏病、头颅外伤、偏头痛、心血管疾病家族史及相关药物使用史。通过Logistic多因素回归分析确定与再发卒中类型和部位相关的独立危险因素。结果361例首发缺血性卒中患者中，有321例复发卒中类型为缺血性卒中，其中前循环梗死234例，后循环梗死75例，其余12例为前后循环分水岭梗死或前后循环多发性梗死；余40例患者复发卒中类型为颅内出血。Logistic多因素回归分析显示首发卒中年龄较大（OR=1．036，95％CI1．006～1．067，P=0．02）及合并高脂血症（OR=2．253，95％CI1．092～4．647，P=0．028）为复发缺血性卒中的独立危险因素。在亚组分析中，Logistic多因素回归分析显示心房颤动史（OR=4．217，95％CI1．489～11．942，P=0．007）为复发梗死位于后循环的独立危险因素。结论年龄及高脂血症是预测首发缺血性脑梗死后再发缺血性卒中的独立预测因子，这一结果有助于临床医生评估首发缺血性卒中患者再发卒中的可能类型，从而适当调整二级预防措施。

Objective To respectively analyze the patterns and possible predictors of recurrent strokes among patients with initial ischemic stroke. Methods Three hundred and sixty-one patients with recurrent strokes （acute ischemic stroke or intracerebral hemorrhage ） after initial ischemic strokes were collected from Jan 2004 to Dec 2009. The data about conventional risk factors such as smoking, heavy alcohol drinking, hypertension, diabetes, hyperlipidemia, heart diseases, head trauma, migraine, family history of cardiovascular disease, and the use of preventive medications were collected and analyzed among patients with different types of recurrent strokes. Results Patients （ n = 361 ） were divided into ischemic stroke group （n =321 ） and hemorrhagic stroke group （n =40） according to the recurrent stroke type. The ischemic stroke group was further divided into the anterior circulation stroke subgroup （ n = 234 ） , the posterior circulation stroke subgroup （ n = 75 ） and watershed cerebral infarction or multiple infarction subgroup （n = 12） . Multivariate logistic regression analysis revealed that older age at initial stroke onset （ OR = 1. 036,95% C1 1. 006-1. 067 ,P = 0. 02 ） and hyperlipidemia （ OR = 2. 253,95% C1 1. 092-4. 647, P =0. 028 ） were both the independent risk factors for the recurrent ischemic stroke. Comparing the subgroups, multivariate logistic regression analysis showed that atrial fibrillation （ OR = 4. 217,95% CI 1. 489-11. 942 ,P = 0. 007 ） was the independent risk factor for the recurrent ischemic stroke in the posterior circulation territory. Conclusion Aging and hyperlipidemia are possible predictors of recurrent ischemic stroke after the initial ischemie stroke which would be useful for individualized secondary prevention of stroke.