前、后循环系统脑梗死危险因素和预后的对比研究

Comparative Study on Risk Factors of Patients with Anterior and Posterior Circulation Infarct and Its Prognosis

目的探讨前、后循环系统脑梗死患者的危险因素及1年期预后的差异。方法以中国国家卒中登记研究的急性脑梗死患者资料为数据来源,根据牛津郡社区卒中项目分型方法将脑梗死患者进行分型。对比分析前、后循环脑梗死的危险因素,探讨其1年期全因死亡、预后不良[改良Rankin量表（modified Rankin Scale,m RS）≥3分]和卒中复发的差异。结果共8099例新发脑梗死患者纳入本研究,其中前循环（anterior circulation infarct,ACI）梗死6415例,后循环（posterior circulation infarct,PCI）梗死1684例。ACI组患者年龄、心房颤动发生率、入院时美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分高于PCI组（均P〈0.001）。PCI组男性居多,糖尿病、高血压发生率更高（均P〈0.001）。多元回归分析显示,ACI组在出院时[优势比（odds ratio,OR）0.534,95%可信区间（confidence interval,CI）0.396~0.718,P〈0.001]、3个月（OR 0.592,95%CI 0.472~0.744,P〈0.001）、6个月（OR 0.636,95%CI 0.516~0.785,P〈0.001）、1年（OR 0.719,95%CI 0.591~0.876,P=0.001）的死亡风险均低于PCI组。ACI组在出院时预后不良的风险高于PCI组（OR 1.272,95%CI 1.075~1.505,P=0.005）,但两组患者出院后3个月、6个月、1年时的预后不良的风险无显著差异。两组患者在出院后3个月、6个月、1年的卒中复发风险无显著差异。结论在1年内,后循环梗死患者的全因死亡率高于前循环梗死,而在出院后卒中所致预后不良和卒中复发方面,两者风险相似。

Objective To investigate the differences of risk factors and one year prognosis in patients with anterior and posterior circulation infarct. Methods The acute ischemic stroke patients in the Chinese National Stroke Registry （CNSR） were categorized according to Oxfordshire Community Stroke Project （OCSP）. Anterior circulation infarct （ACI） was defined as both total and partial anterior circulation. The patients with posterior circulation infarct （PCI） were compared with the ACI group in baseline information, and also recurrent stroke, death and poor outcome （modified Rankin Scale, mRS〉_3） in 1- year follow-up after onset. Results Totally, 8099 patients with acute ischemic stroke were recruited in this study, including 6415 anterior circulation infarct （ACI） subject and 1684 posterior circulation infarct （PCI） subject. Compared with PCI group, the ACI subject were elder, had higher risk of alrial fibrillation, and higher National Institutes of Health Stroke Scale （NIHSS） score on admission （P〈0.001, respectively）. PCI group had more male patients, higher risk of hypertension and diabetes mellitus （P〈0.001, respectively）. Multi-variables analysis showed, compared with PCI group, the ACI group had lower death risk on discharge （odds ratio [OR] 0.534, 95%confidence interval [C/] 0.396-0.718, P〈0.001）, in 3-month （OR 0.592, 95%CI 0.472-0.744, P〈0.001）, 6-month （OR 0.636, 95%CI 0.516-0.785,P〈0.001） and one-year follow-up （OR 0.719, 95%6＇/0.591-0.876, P=0.001）. The incidence of severe disability at discharge in ACI were significantly higher than PCI （OR 1.272 95%CI 1.075-1.505, P=0.005）, while no significant differences were found between the two groups in 3-, 6-, and 12-month follow-up. The recurrent stroke rates in PCI were similar to those of ACI in 3-, 6-, and 12-month follow-up. Conclusion Comparing to anterior circulation stroke, posterior circulation stroke has a higher rate of all cause death during 1-year follow up. The rate of severe disability and recurrent stroke are similar between the anterior and posterior circulation stroke.