缺血性脑卒中再发相关危险因素分析

Analysis of risk factors related to recurrent ischemic stroke

目的探讨包括脑白质疏松(LA)在内的相关危险因素与缺血性脑卒中再发的关系。方法连续收集2010年1月至2014年12月在我院保健科、神经内科发病72 h内住院首发急性缺血性卒中患者751例,随访3年,入选患者701例,随访中再发患者124例为再发组;首发缺血性卒中患者577例为未再发组,比较分析两组患者危险因素。结果再发组患者LA程度高于未再发组(Z=-2.307,P=0.021);再发组血糖、血压、血脂控制达标率低于未再发组(均P<0.05)。Spearson相关分析与缺血性卒中再发患者呈正相关的因素为LA(r=0.451,P=0.007)、年龄(r=0.334,P=0.015)、血压(r=0.812,P=0.001)、血糖(r=0.637,P=0.002)、低密度脂蛋白胆固醇(LDL-C)(r=0.674,P=0.000)、总胆固醇(r=0.748,P=0.003)、三酰甘油(r=0.878,P=0.004)、吸烟(r=0.380,P=0.008);与脑卒中再发无明显相关的因素为性别(r=0.032,P=0.115)。二分类Logistics回归与缺血性卒中再发呈正相关因素为年龄(B=0.142,P=0.000)、血压(B=0.135,P=0.000)、LDL-C(B=1.141,P=0.001)、三酰甘油(B=0.367,P=0.036)、血糖(B=0.385,P=0.000);与缺血性卒中再发无相关的因素为LA(B=22.221,P=0.997)、总胆固醇(B=0.081,P=0.867)、吸烟(B=21.434,P=0.995)。结论年龄、高血糖、高血压、三酰甘油是缺血性卒中患者复发的独立危险因素,LA、总胆固醇、吸烟是缺血性卒中复发的混杂因素。进行积极危险因素干预治疗,对预防缺血性卒中复发有重要意义。

Objective To investigate the relationship between risk factors including leukoaraiosis(LA)and recurrent ischemic stroke.Methods A total of 751 patients with first-episode acute ischemic stroke hospitalized within 72 h of onset in the Department of Health and Neurology of our hospital from January 2010 to December 2014 were consecutively selected and followed up for 3 years.Eventually,701 patients were included in the study,with 124 patients with recurrence in the recurrence group and 577 patients without recurrence in the non-recurrence group.Associated risk factors were compared and analyzed between the two groups.Results The severity of LA in the recurrence group was significantly greater than that in the non-recurrence group(Z=-2.307,P=0.021).The rates of successful control of blood glucose,blood pressure and blood lipids in the recurrence group were significantly lower than those in the non-recurrence group,(all P<0.05).Pearson correlation analysis showed that factors positively correlated with ischemic stroke recurrence were LA(r=0.451,P=0.007),age(r=0.334,P=0.015),blood pressure(r=0.812,P=0.001),blood glucose(r=0.637,P=0.002),low density lipoprotein cholesterol(LDL-C)(r=0.674,P=0.000),total cholesterol(r=0.748,P=0.003),triacylg lycerol(r=0.878,P=0.004)and smoking(r=0.380,P=0.008),and one factor not significantly correlated with ischemic stroke recurrence was gender(r=0.032,P=0.115).The binary-class logistic regression analysis showed that factors positively correlated with ischemic stroke recurrence included age(B=0.142,P=0.000),blood pressure(B=0.135,P=0.000),LDL-C(B=1.141,P=0.001),triacylg lycerol(B=0.367,P=0.036)and blood glucose(B=0.385,P=0.000);factors not significantly correlated with ischemic stroke recurrence included LA(B=22.221,P=0.997),total cholesterol(B=0.081,P=0.867)and smoking(B=21.434,P=0.995).Conclusions Age,hyperglycemia,hypertension and triacylglycerol are independent risk factors and LA,total cholesterol and smoking are confounding factors for ischemic stroke recurrence.Active intervention is of great significance for preventing the recurrence of ischemic stroke.