青年缺血性卒中或短暂性脑缺血发作患者卒中复发风险及其预测因子

Risk of stroke recurrence and its predictors in young patients with ischemic stroke or transient ischemic attack

目的：调查青年缺血性卒中／短暂性缺血发作（TIA）患者的长期卒中复发风险及其预测因子。方法前瞻性连续纳入2008年8月至2013年7月于中山大学附属第一医院神经内科住院的青年（18～45岁）缺血性卒中或TIA（发病2周内）312例患者资料，并对所有患者进行长期规律随访（发病后第3、6、12个月进行随访，发病第1年后每6个月随访1次），以调查卒中复发情况。运用Kaplan-Meier曲线分析全体患者的卒中累积复发率。失访患者的最后联系时间作为删失数据被纳入分析。卒中复发相关危险因素的单因素分析采用Log-rank检验，采用多变量Cox比例风险回归检测可能与卒中复发相关的危险因素（调整年龄和性别），选择Log-rank检验结果P≤0.1的变量纳入多变量回归分析方程。结果312例患者中，缺血性卒中294例，TIA18例。平均随访（34＆#177;19）个月，34例患者出现卒中复发，其中缺血性卒中23例、TIA 7例和脑出血4例。发病后1、3和6年的卒中累积复发率分别是6.2％、10.3％和16.4％。多变量Cox比例风险回归分析结果显示，高血压（RR＝2.159，95％CI：1.048～4.447，P ＝0.037）和心源性栓塞（RR ＝2.869，95％CI：1.119～7.357，P ＝0.028）是卒中复发的独立预测因子。结论青年缺血性卒中／TIA患者的6年卒中复发风险不高，但第1年复发风险相对较高；高血压和心源性栓塞是卒中复发的独立预测因子，在临床实践中应予以重视。

Objective To investigate the risk of long-term recurrence of stroke and its predictors in young patients with ischemie stroke/transient ischemic attack （TIA）. Methods The clinical data of the consecutive young patients （18-45 years） with ischemic stroke/TIA （within 2 weeks after onset） admitted to the department of neurology in the First Affiliated Hospital of Sun Yat-Sen University between August 2008 and July 2013 were enrolled prospectively. All patients were regularly followed up for a long time （The patients were followed up at the 1 st ,6 th ,and 12 th month after onset;then they were followed up once for every 6 months） in order to investigate stroke recurrence. The Kaplan-Meier curves were used to analyze the cumulative stroke recurrence rate of all patients. The last contact time for patients lost to follow was used as censored data to be enrolled in the analysis. The univariate analysis of the related risk factors for stroke recurrence using Log-rank test. Multivariate Cox proportional hazard regression was used to detect the related risk factors associated with stroke recurrence （adjusting for age and sex）. The variables of the results of Log-rank test P≤0.1 was selected and enrolled in the multivariate regression analysis. Results A total of 312 patients were enrolled in the analysis, including 294 with ischemic stroke and 18 with TIA. Their mean follow-up time was 34 ± 19 months. Thirty-four patients had recurrent stroke, including 23 with ischemic stroke,7 with TIA,and 4 with cerebral hemorrhage. The cumulative recurrence rates of stroke at 1,3, and 6 years after onset were 6.2% , 10.3%, and 16.4%, respectively. The results of multivariate Cox proportional hazards regression analysis showed that hypertension （risk ratio [ RR] 2. 159 ;95% confidence interval [ CI] 1. 048 - 4.447, P = 0. 037） and cardioembolism （RR,2. 869 ;95% CI 1.119 -7. 357, P = 0. 028） were the independent predictors for stroke recurrence. Conclusion The overall 6-year risk of recurrent stroke is not high in the Chinese young patients with ischemic stroke/TIA, but the risk of stroke recurrence is relatively higher in the first year. Hypertension and cardioembolism are the potential predictors of stroke recurrence;therefore,attention should be paid in clinical practice.