非心源性缺血性卒中近期再发危险因素分析

Risk Factors of Recent Stroke Recurrence in Non-cardiogenic Ischemic Stroke Patients

目的探讨首发非心源性缺血性卒中且二级预防药物依从性好的患者近期再发的相关危险因素。方法采用回顾性队列研究方法,纳入2014年1月-2016年4月首发非心源性缺血性卒中患者,根据随访1年是否有缺血性卒中再发分为再发组和对照组。对相关危险因素进行多因素回归分析。结果共纳入258例非心源性缺血性卒中患者,27例(10.5%)1年内再次发生缺血性卒中。多因素回归分析显示:年龄[比值比(odds ratio,OR)1.66,95%可信区间(confidence interval,CI)1.28～2.13,P<0.001]、高血压病史(OR 3.23,95%CI 2.27～3.92,P<0.001)、糖尿病史(OR 2.23,95%CI2.11～3.01,P<0.001)、冠状动脉粥样硬化性心脏病(OR 1.36,95%CI 1.17～2.09,P=0.043)、慢性阻塞性肺病(OR 1.42,95%CI 1.11～2.09,P=0.031)、阻塞性睡眠呼吸暂停低通气综合征(OR 2.86,95%CI 2.22～3.56,P<0.001)、糖化血红蛋白(OR 2.67,95%CI 2.21～3.31,P<0.001)、C反应蛋白(OR 1.32,95%CI 1.36～1.66,P=0.046)、同型半胱氨酸(OR 2.52,95%CI 2.05～3.55,P<0.001)、出院时的Barthel指数(OR 2.10,95%CI 1.87～2.53,P<0.001)等是缺血性卒中再发的危险因素。结论高龄、高血压病、糖尿病、冠状动脉粥样硬化性心脏病、慢性阻塞性肺病、阻塞性睡眠呼吸暂停低通气综合征、日常生活能力下降、高糖化血红蛋白、高C反应蛋白、高同型半胱氨酸血症等是非心源性缺血性卒中1年再发的独立危险因素。

Objective To explore the related risk factors of recent stroke recurrence in non-cardiac ischemic stroke patients with good compliance with secondary preventive medication.Methods Patients with non-cardiac ischemic stroke who were admitted into our hospital from January 2014 to April 2016 were included in the retrospective cohort study, and the recurrence group and the control group were divided according to the follow-up period of 1 year. Multi-factors regression analysis was used to analyze the related factors.Results A total of 258 patients with ischemic stroke were enrolled, of all patients, 27 ones（10.5%） had recurrent stroke. Multi-factors regression analysis showed that age [odds ratio（OR） 1.66, 95% confidence interval（CI） 1.28-2.13, P0.001], hypertension（OR 3.23, 95%CI 2.27-3.92, P0.001）, diabetes（OR 2.23, 95%CI 2.11-3.01, P 0.001）, coronary atherosclerotic heart disease（OR 1.36, 95%CI 1.17-2.09, P =0.043）, chronic obstructive pulmonary disease（OR 1.42, 95%CI 1.11-2.09, P =0.031）, obstructive sleep apnea hypopnea syndrome（OR 2.86, 95%CI 2.22-3.56, P 0.001）, glycosylated hemoglobin（OR 2.67, 95%CI 2.21-3.31, P 0.001）, C reactive protein（OR 1.32, 95%CI 1.36-1.66, P =0.046）, homocysteine（OR 2.52, 95%CI 2.05-3.55, P 0.001） and activities of daily living（OR 2.10, 95%CI 1.87-2.53, P 0.001） were related to the recurrence of ischemic stroke.Conclusion Senior age, hypertension, diabetes, coronary atherosclerotic heart disease, chronic obstructive pulmonary disease, obstructive sleep apnea hypopnea syndrome, decreased daily living ability, high glycosylated hemoglobin, high C reactive protein, high homocysteine, are the independent risk factors for the recurrence of ischemic stroke.