缺血性卒中首发患者复发危险因素分析

Analysis on risk factors of ischemic stroke recurrence in first episode patients

目的研究缺血性卒中患者卒中复发的危险因素以及不同TOAST分型复发情况，为预防缺血性卒中复发提供依据。方法连续收集2014年10月1日-2015年2月1日在河北医科大学第二医院神经内科住院治疗的首次发作的缺血性卒中患者，采用自行设计问卷，问卷内容包括患者一般人口学资料、既往疾病史、化验结果、影像学资料等信息，将患者发病入院作为起始事件，采用电话联系方式对患者跟踪随访1年，以卒中复发、失访、死亡为终点事件，随访内容包括复发情况、口服药物服用情况等。结果本研究共收集501例，其中资料不全者28例，失访23例，最终450例纳入研究。男性306例，女性144例；年龄16～81岁，中位年龄59．5岁；复发组76例，未复发组374例；TOAST分型中大动脉粥样硬化型327例（72．7％），小动脉闭塞型92例（20．4％），心源性栓塞型18例（4．0％），其他明确病因型5例（1．1％），不明病因型7例（1．5％）。随访3个月卒中复发率4．9％，6个月累积复发率8．4％，1年累积复发率16．9％。回归分析显示缺血性卒中复发危险因素为高同型半胱氨酸血症（OR=2．376，95％CI=1．349～4．183）、TIA史（OR=2．791，95％CI=1．538～5．066）、抗血小板药物依从性不好（OR=1．941，95％CI=1．116～3．374）、心源性栓塞型（OR=6．639，95％CI=2．322～18．982）。结论缺血性卒中具有一定的复发率，高同型半胱氨酸、TIA、颈动脉斑块形成、抗血小板药物依从性不好是缺血性卒中复发的独立危险因素，TOAST分型可以作为卒中复发的预测因子，其中心源性栓塞型是缺血性卒中复发的独立危险因素。

Objective To explore the risk factors of ischemic stroke recurrence and the recurrence of different TOAST subtypes, and to provide the basis for the prevention of ischemic stroke recurrence. Methods The first episode ischemic stroke cases were collected continually from the Neurology Department of the Second Hospital of Hebei Medical University between October 1st, 2014 and February 1st, 2015. Self- designed questionnaires were used in research, including general demographic data, medical history, test results and other information. The patients were communicated by phone for 1 year, from the onset, to the recurrence of stroke, lost to follow-up, or death. Follow-up contents includes recurrence, drug taking and other medical situations. Results This study collected 501 cases in total, including 28 cases with incomplete data and 23 lost to follow up cases. Eventually, 450 available cases were used in research including 306 male and 144 female, aged from 16 to 81. The average age is 59.5 years old. There were 76 cases in recurrence group, and 374 cases in non recurrence group. In TOAST types, 327 （72.7%） cases were large artery atherosclerosis, 92 （20.4%） cases were small artery occlusion, 18 （4.0%） cases were cardioembolism, 5 （1.1%） cases were stroke of other determined cause, 7 （1.5%） were stroke of undetermined cause. The recurrence rates of 3 monthes, 6 monthes, 1 year were 4.9%, 8.4% and 16.9% respectively. Results of the Logistic regression with single factor and multi factors showed that hyperhomocysteinemia （OR=2.376, 95%CI=1.349-4.183）, transient ischemic attack （OR=2.791, 95% CI=1.538-5.066）, bad compliance of antiplatelet drugs （OR=1.941, 95%CI=1.116- 3.374）, cardioembolism （OR=1.941, 95%CI=1.116-3.374）were the risk factors of ischemic stroke recurrence. Conclusions Ischemic stroke has a certain recurrence rate. Hyperhomocysteinemia, transient ischemic attack, bad compliance of antiplatelet drugs are the independent risk factors of ischemic stroke recurrence.TOAST types can be used as predictor for recurrence of ischemic stroke, and cardioembolism is the independent risk factors of ischemic stroke recurrence.