江苏省江阴地区急性缺血性脑卒中二级预防横断面调查及卒中复发因素分析

Cross-sectional survey of secondary prevention of stroke in Jiangyin area of Jiangsu Province and analysis of ischemic stroke recurrence factors

目的调查江苏省江阴地区缺血性脑卒中药物二级预防现况,探讨影响脑卒中复发的因素。方法纳入2015年1月1日~2016年12月31日我科收治的急性缺血性脑卒中患者300例,收集其一般资料及抗血小板聚集药物/抗凝药物、他汀类药物及降压、降糖药物的使用情况并进行分析。以急性缺血性脑卒中复发作为主要终点事件,采用二元logistic回归分析探讨脑卒中复发的影响因素。结果300例缺血性脑卒中患者中,合并心房颤动44例,其中使用抗凝药物患者比例为20.5%。在不合并房颤患者中,使用抗血小板聚集药物者比例为55.1%。他汀类药物使用患者比例为39.7%。合并高血压病患者225例,使用降压药物患者比例为81.8%。合并2型糖尿病患者95例,使用降糖药物比例为47.4%。脑卒中年复发率为20.3%。多因素二元logistic分析结果显示,年龄增加、合并非瓣膜性心房颤动为急性缺血性脑卒中复发的独立危险因素,文化程度较高为其保护因素(P<0.05)。结论江阴地区缺血性卒中二级预防中抗栓药物、他汀类药物使用率较低,尤其是抗凝药物,需加强二级预防依从性宣传教育。患者年龄、文化程度及非瓣膜性心房颤动与缺血性卒中复发相关。

Objective To investigate the status of secondary prevention of ischemic stroke in Jiangyin area and explore the factors affecting stroke recurrence.Methods A total of 300 patients with acute ischemic stroke admitted to our department from January 1,2015 to December 31,2016 were included.Their general data and the use of antiplatelet aggregation/anticoagulant drugs,statins,hypertension drugs and diabetes drugs were collected and analyzed.With acute ischemic stroke recurrence as the primary end point,the influencing factors of stroke recurrence were investigated by binary logistic regression analysis.Results Of the 300 patients,44 were associated with atrial fibrillation,of which 20.5%were treated with anticoagulant drugs.Among patients without atrial fibrillation,antiplatelet aggregation was used in 55.1%patients.The proportion of statin users was 39.7%.Of the 225 patients with hypertension,81.8%were treated with antihypertensive drugs.There were 95 patients with type 2 diabetes mellitus,47.4%of whom used hypoglycemic drugs.The annual recurrence rate of stroke was 20.3%.Multivariate binary analysis showed that,age increasing and the combination with non-valvular atrial fibrillation were independent risk factors for recurrence of acute ischemic stroke,while higher educational level was the independent protective factor(P<0.05).Conclusion The use of antithrombotic drugs and statins in the secondary prevention of ischemic stroke in Jiangyin is low,especially anticoagulant drugs.It is necessary to strengthen secondary prevention compliance education.Age,education and non-valvular atrial fibrillation are associated with ischemic stroke recurrence.