首发缺血性卒中患者再发卒中的类型及相关预测因素研究

Study of the Patterns and Predictors of Recurrent Stroke among Patients with Initial Ischemic Stroke

目的分析首发缺血性卒中患者再发卒中的类型及可能预测缺血性卒中再发卒中类型的危险因素。方法收集2008年1月-2012年12月收治的首发缺血性卒中再发卒中患者的临床资料,回顾性收集患者的一般人口学信息、生活史、既往病史和实验室检测结果等,统计首发缺血性卒中患者再发卒中的类型,并通过logistic多因素回归分析确定可预测缺血性卒中再发的危险因素。结果共纳入237例首发缺血性卒中再发卒中患者,其中198例复发卒中类型为缺血性卒中,39例复发卒中类型为颅内出血,前者包括前循环梗死137例,后循环梗死52例,其余9例为前后循环多发性梗死。logistic多因素回归分析显示首发卒中年龄较大[OR=1.968,95%CI(1.533,2.152),P=0.009]、经常情绪波动[OR=1.345,95%CI(1.121,1.783),P=0.011]、高脂血症[OR=1.436,95%CI(1.216,1.732),P=0.018]和心房颤动史[OR=3.417,95%CI(2.927,4.897),P=0.005]为复发卒中类型为缺血性卒中的独立危险因素。结论首发缺血性卒中患者再发卒中以缺血性卒中最为常见,其中高龄、经常情绪波动、高脂血症和心房颤动史是再发卒中类型为缺血性卒中的独立预测因子。

Objective To analyze the patterns of recurrent strokes among patients with initial ischemic stroke and investigate the possible predictors of recurrent ischemic stroke. Methods Patients with recurrent strokes after initial ischemic strokes hospitalized in our hospital between January 2008 and December 2012 were included in the study, and the data of general demographic information, life history, past medical history and laboratory test results were all retrospectively analyzed. The patterns of recurrent strokes in patients with initial ischemic stroke were analyzed, and multivariate logistic regression analysis was used to investigate the independent risk factors for recurrent ischemic stroke. Results A total of 237 patients were included in this study, including 198 patients with recurrent ischemic stroke and 39 patients with recurrent hemorrhagic stroke. Among patients with recurrent ischemic stroke, there were 137 patients with anterior circulation stroke, 52 with posterior circulation stroke and 9 with multiple infarction. Multivariate logistic regression analysis showed that older age at initial stroke onset [0R=1.968, 95%CI （1.533, 2.152）, P=0.009], frequent mood swings [OR=1.345, 95%CI （1.121, 1.783）, P^0.011], hyperlipidemia [0R=1.436, 95%CI （1.216, 1.732）, P=0.018] and atrial fibrillation [0R=3.417, 95%CI （2.927, 4.897）, P=0.005] were independent risk factors for recurrent ischemic stroke. Conclusion Ischemic stroke is the most common pattern of recurrent strokes; and aging, frequent mood swings, hyperlipidemia and atrial fibrillation are possible predictors of recurrent ischemic stroke after the initial ischemic stroke.