非心源性缺血性卒中复发危险因素分析

Risk Factors Analysis of Noncardiogenic Ischemic Stroke Recurrence

目的分析非心源性缺血性卒中患者1年复发的危险因素。方法连续入选1978例发病7 d内的非心源性缺血性卒中患者。收集患者的人口学信息、血管病危险因素和发病时的主要症状及体征,评价患者的头颅磁共振成像结果,包括梗死灶的部位、数量、急性梗死灶的分布特征及责任动脉、责任动脉有无严重狭窄、缺血性卒中的病因分型。随访患者1年内有无缺血性卒中或短暂性脑缺血发作(transient ischemic attack,TIA)的复发,通过多元Cox回归分析缺血性卒中患者复发的危险因素。结果 95例(4.8%)患者1年内缺血性卒中或TIA复发。冠状动脉粥样硬化性心脏病病史、缺血性卒中病史、缺血性卒中发病前3个月内反复TIA、责任脑动脉狭窄程度≥70%和后循环缺血性卒中是1年内复发的危险因素。结论后循环梗死、有责任脑动脉严重狭窄及缺血性心脑血管病病史的非心源性缺血性卒中患者复发的风险较高。

Objective To investigate the risk factors of noncardiogenic ischemic stroke（IS） recurrence at 1 year after onset of IS.Methods A total of 1978 noncardiogenic IS patients with onset of symptoms 7 days were enrolled consecutively. Demographic information, vascular risk factors, main symptoms and signs of onset were collected. The cerebral magnetic resonance imaging（MRI） results of these patients were evaluated, including locations, numbers of infarction focus, distribution characteristics culprit cerebral artery of acute infarcts and having severe stenosis or not, and etiological subtypes of IS. Cox regression analysis was used to identify risk factors associated with IS or TIA recurrence within 1 year.Results A total of 95 patients（4.8%） experienced recurrent IS or TIA within 1 year after IS or TIA. History of coronary heart disease, history of IS, repeated TIAs within 3 months before stroke, culprit artery stenosis ≥70%, and posterior circulation IS were risk factors for recurrent IS or TIA within 1 year.Conclusion Patients with noncardiogenic IS who have posterior circulation infarction, severe culprit artery stenosis and history of ischemic cardiocerebrovascular diseases are at higher risk of stroke recurrence.