急性缺血性卒中1年血管源性死亡危险因素分析

Analysis of Risk Factors of 1-Year Vascular Death in Patients with Acute Ischemic Stroke

目的分析急性缺血性卒中患者随访1年血管源性死亡的相关影响因素,为早期评估高危急性缺血性卒中患者、积极控制危险因素、降低死亡率提供临床依据。方法回顾性纳入2014年1月-2018年9月于河北省任丘康济新图医院神经内科住院的急性缺血性卒中患者,收集患者临床基线资料及实验室检查结果。采用多因素Cox回归分析方法分析急性缺血性卒中患者1年内血管源性死亡的危险因素。结果研究共纳入符合入排标准的急性缺血性卒中患者3661例,随访1年内死亡患者160例(4.4%),其中血管源性死亡136例(3.7%),其中包括缺血性血管性死亡3.1%(114例),出血性血管性死亡0.1%(4例),心源性血管性死亡0.2%(8例),其他血管性死亡0.3%(10例),非血管源性死亡0.7%(24例)。非血管源性死亡患者作为删失数据,最终共纳入急性缺血性卒中患者3637例。多因素Cox回归分析显示年龄>60岁(OR 1.084,95%CI 1.062~1.105,P<0.001)、颈动脉狭窄(OR 1.835,95%CI 1.288~2.614,P=0.001)、入院时NIHSS评分(OR 1.200,95%CI 1.164~1.237,P<0.001)、脂蛋白a(OR 1.001,95%C I 1.000~1.001,P<0.001)、白细胞计数(OR 1.093,95%CI 1.031~1.159,P=0.003)、纤维蛋白原水平(OR 1.092,95%CI 1.025~1.164,P=0.006)、血肌酐(OR 1.004,95%CI 1.001~1.007,P=0.009)是血管源性死亡的独立危险因素。HDL-C(OR 0.378,95%CI 0.208~0.686,P=0.001)是血管源性死亡的保护因素。结论急性缺血性卒中1年内血管源性死亡的危险因素为高龄、颈动脉狭窄、入院时NIHSS评分、脂蛋白a水平、白细胞计数、纤维蛋白原及血肌酐水平。高密度脂蛋白为其保护因素。

Objective To investigate the risk factors for 1-year vascular death in patients with acute ischemic stroke(AIS).Methods This retrospective study enrolled consecutive AIS patients admitted to Department of Neurology of Renqiu Kangjixintu Hospital in Hebei Province from January 2014 to September 2018.Baseline clinical data and laboratory test results were collected.Multivariate Cox regression analysis was used to analyze the risk factors for 1-year vascular death in AIS patients.Results 3661 patients were included.There were 160 deaths(4.4%)within 1 year,136(3.7%)of whom were vascular death,and 24(3.7%)were non-vascular death.Of all vascular deaths,ischemic cause accounted for 3.1%(n=114),hemorrhagic cause accounted for 0.1%(n=4),cardiogenic cause accounted for 0.2%(n=8)and other vascular cause accounted for 0.3%(n=10).The non-vascular death data were processed as censored data,and a total of 3637 patients were included in the final analysis.Multivariate Cox regression analysis showed that age over 60 years(OR 1.084,95%CI 1.062-1.105,P<0.001),carotid stenosis(OR 1.835,95%CI 1.288-2.614,P=0.001),NIHSS score at admission(OR 1.200,95%CI 1.164-1.237,P<0.001),lipoprotein a level(OR 1.001,95%CI 1.000-1.001,P<0.001),leukocyte counts(OR 1.093,95%CI 1.031-1.159,P=0.003),fibrinogen level(OR 1.092,95%CI 1.025-1.164,P=0.006),serum creatinine level(OR 1.004,95%CI 1.001-1.007,P=0.009)were independent risk factors for vascular death.HDL-C(OR 0.378,95%CI 0.208-0.686,P=0.001)was a protective factor for vascular death(P<0.05).Conclusions Elder age,carotid artery stenosis,NIHSS score at admission,leukocyte counts,the level of lipoprotein a,fibrinogen and serum creatinine were independent risk factors for 1-year vascular death in AIS patients,while HDL-C was a protective factor.