受教育程度与卒中严重程度关联性研究

Correlative study of educational level and stroke severity

目的既往关于受教育程度与卒中严重程度关系的研究较少,且这种关系的原因也尚未阐明.文中旨在探讨受教育程度与卒中严重程度的关系.方法回顾性收集2013年10月至2015年4 月于南京军区南京总医院住院的9 0 0例首次急性缺血性卒中患者临床资料.根据患者人院当天国立卫生院神经功能评分（ National Institute of Health Stroke Scale,NIHSS）将卒中分为轻型卒中（NIHSS≤3 分）和重型卒中（NIHSS〉 3 分）;按照所有患者受教育程度分为文盲/小学、初中、高中及以上3 组.将受教育程度作为社会经济状况指标,采用多因素logistic回归分析方法评估受教育程度与卒中严重程度的关系,并校正性别、短暂性脑缺血发作史、房颤、人院收缩压、空腹血糖等混杂因素.结果在纳人的9 0 0例首次发病的缺血性卒中患者中,轻型卒中组共3 6 5例（40.6%）,重型卒中组共5 3 5例（5 9 . 4 % ）.单因素分析结果显示,2 组间受教育程度差异有统计学意义（ P = 0.002）.Logistic回归分析结果显示,与受高中及以上教育程度患者相比,教育程度为小学/文盲患者（0 R =1.456、95%（1：1.049 -2.021、P = 0.025）、初中文化水平（011=1.610、95%（CI：1.126-2.304、P= 0.009）患者更倾向于患有重型缺血性卒中.结论受教育程度与缺血性脑卒中患者神经功能缺损程度具有一定关联.对低受教育程度的高危人群进行重点干预,可降低这类人群卒中的发病率及病情严重程度.

Objective Less research has been done on the relationship of educational level and stroke severity,and the causes for the relation are not fully understood. The study aimed to investigate the relationship between educational level and stroke severity. Methods Retrospective analysis was made on the characteristic data of 900 first-ever ischemic stroke patients in our department from October 2013 and April 2015. Patients were divided into mild stroke group( NIHSS≤3,n = 365) and severe stroke group( NIHSS>3,n = 535) according to the National Institute of Health Stroke Scale( NIHSS). The educational level of patients was classified into three categories: illiteracy or primary school,junior school,high school and above. Taking educational level as the marker of socioeconomic status( SES),we used multivariable logistic regression to examine the association between educational level and stroke severity,along with the adjustment in sex,previous transient ischemic attack( TIA),atrial fibrillation,blood pressure at admission,fasting blood glucose and other confounding factors. Results Of all the included patients,365( 40.6%) were mild stroke and 535( 59.4%)were severe stroke. The univariate analysis showed significant difference was found in the educational level between two groups( P =0.002). In logistic regression analysis,a higher probability of severe stroke was observed in patients with illiteracy or primary school( OR= 1.456、95%CI: 1.049,2.021、P = 0.025),junior school( OR =1.610、95%CI: 1.126,2.304、P = 0.009) compared with patients with high school and above. Conclusion Educational level is associated with the severity of ischemic stroke. Intervention in high risk population with low educational level is inclined to reduce their incidence and severity.