首发卒中患者6年后预后及其危险因素的前瞻性研究

Six-year follow-up analysis on prognosis factors of stroke patients in Huainan area

目的分析脑卒中患者复发及生存的影响因素,为脑卒中的二级预防的改善提供科学依据。方法以2010年1-12月淮南市第一人民医院神经内科就诊的880例脑卒中首发病例为研究对象,前瞻性随访患者患病后6年的复发、死亡及其他结局。成运用COX模型分析影响该地区首发脑卒中患者复发的危险因素及生存率。结果随访期间共144例患者脑卒中复发,6年累积复发率为16.38%;在144例复发患者中65例死亡,占总复发患者的45%。其中1年生存率为89.19%,3年生存率为82.24%,6年生存率为79.17%。影响患者复发的危险因素包括:年龄≥65岁、房颤、吸烟、饮酒、高低密度脂蛋白-胆固醇(LDL-C)血症、糖尿病、高血压;同时合并3个及以上危险因素的卒中患者具更高的复发危险;服用他汀类药物及抗凝、抗血小板药物可减少随访期间内的脑卒中复发(P<0.01)。影响患者复发死亡的主要因素有年龄、文化程度、诊治医院级别、病情严重程度、出院时情况、再次复发和脑卒中类型及社会家庭支持等(P<0.01)。患者多于复发后死亡,且大多数为院外死亡(P<0.01)。结论出院后坚持二级预防规范化治疗者预后好;复发患者生存率比未复发者低。

Objective To describe survival conditions of patients with stroke and to analyze the factors asso-ciated with survival,a six-year follow-up study was carried out. Methods Based on the First Hospital of Huainan Hospital stroke register database from Jan, 2010 to Dec, 2010, 880 stroke patients were selected in the Department of Neurology, the First Affiliated Hospital of Anhui University of Science and Technol-ogy. The cases were followed up since the onset of stroke, and data collection would include case history, illness and survival conditions. COX regression was used for prognostic factors analyses. Results A total number of 144 patients had been dead during the period of study and among them. 65 cases died from stroke.The survival rate was 89.19% in one year, 82.24% in three years and 79.17% in five years.Multiva-riate analysis identified atrial fibrillation,hypertension, hyperlipemia, diabetes, driking and smoking as the risk factors of stroke recurrence at 6 year, and patients with three or two more risk factors have a higher recurrence rate than others （P 〈0.01）. Effect of the model showed that age, educational level, both quality on diagnosis and treatment of the hospitals, clinical types of hypertension and stroke etc were related to survival of stroke （P 〈0.01）. Conclusion Patients persisting secondary prevention of stroke had better prognosis.