非糖尿病患者首次缺血性卒中后1年的功能转归和复发

Functional outcome and recurrence 1 year after first-ever ischemic stroke in non-diabetic patients

目的:探讨非糖尿病患者首发缺血性卒中后1年时转归不良和复发的危险因素。方法:利用西安卒中登记研究数据库,收集2015年1月至12月期间西安市4所三级甲等医院确诊为非糖尿病首发缺血性卒中患者的临床资料。应用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评估卒中严重程度。在确诊后1年时对患者预后(功能转归和复发情况)进行随访。采用改良Rankin量表评价功能转归,0~2分定义为转归良好,>2分为转归不良。复发定义为随访期间由脑梗死或脑出血事件引起的新发局灶性神经功能障碍,并经头颅CT或MRI证实。应用多变量logistic回归分析确定1年时临床转归的独立影响因素。采用多变量Cox比例风险模型确定1年内复发的独立影响因素。结果:共纳入1214例非糖尿病首发缺血性卒中患者。1年时随访显示,210例(17.3%)转归不良,其中88例(7.2%)死亡;47例(3.9%)复发。多变量logistic回归分析显示,年龄[优势比(odds ratio,OR)1.065,95%可信区间(confidence interval,CI)1.042~1.090;P<0.001]、心房颤动(OR 3.170,95%CI 1.588~6.327;P=0.001)、白细胞计数(OR 1.106,95%CI 1.006~1.216;P=0.037)、基线NIHSS评分(OR 1.210,95%CI 1.147~1.277;P<0.001)、卒中相关性肺炎(stroke-associated pneumonia,SAP)(OR 3.677,95%CI 1.451~9.316;P=0.006)与转归不良独立相关。多变量Cox比例风险回归分析显示,基线NIHSS评分[风险比(hazard ratio,HR)1.055,95%CI 1.003~1.109;P=0.036]和SAP(HR 7.067,95%CI 3.154~15.836;P<0.001)与复发独立相关。Kaplan-Meier生存曲线分析显示,重度卒中患者1年复发率显著高于轻中度卒中患者(log-rank检验,P<0.001),SAP患者1年复发率显著高于无SAP患者(log-rank检验,P<0.001)。结论:年龄、心房颤动、白细胞计数、基线NIHSS评分和SAP是非糖尿病患者首发缺血性卒中后1年时转归不良的独立预测因素。基线NIHSS评分和SAP是非糖尿病患者首发缺血性卒中后1年内复发的独立预测因素。

Objective To investigate the risk factors for poor outcome and recurrence at 1 year after first-ever ischemic stroke in non-diabetic patients.Methods Using Xi'an Stroke Registry Research Database,the clinical data of patients with non-diabetic first-ever ischemic stroke diagnosed in 4 tertiary A hospitals in Xi'an from January to December 2015 were collected.The National Institute of Health Stroke Scale(NIHSS)was used to evaluate the severity of stroke.Prognosis(functional outcome and recurrence)was followed up at 1 year after diagnosis.Functional outcome was assessed using the modified Rankin scale.0-2 was defined as good outcome and>2 as poor outcome.Recurrence was defined as new focal neurological dysfunction caused by cerebral infarction or cerebral hemorrhage events during follow-up and confirmed by cranial CT or MRI.Multivariable logistic regression analysis was used to identify the independent influencing factors of clinical outcomes at 1 year.Multivariable Cox proportional hazard model was used to identify the independent influencing factors of recurrence within 1 year.Results A total of 1214 non-diabetic patients with first-ever ischemic stroke were included.One year follow-up showed that 210 patients(17.3%)had a poor outcome,88(7.2%)of them died,and 47(3.9%)had recurrence.Multivariate logistic regression analysis showed that age(odds ratio[OR]1.065,95%confidence interval[CI]1.042-1.090;P<0.001),atrial fibrillation(OR 3.170,95%CI 1.588-6.327;P=0.001),white blood cell count(OR 1.106,95%CI 1.006-1.216;P=0037),baseline NIHSS score(OR 1.210,95%CI 1.147-1.277;P<0.001),and stroke associated-pneumonia(SAP;OR 3.677,95%CI 1.451-9.316;P=0.006)were independently associated with poor outcomes.Multivariate Cox proportional hazards regression analysis showed that baseline NIHSS score(hazard ratio[HR]1.055,95%CI 1.003-1.109;P=0.036)and SAP(HR 7.067,95%CI 3.154-15.836;P<0.001)were independently associated with recurrence.Kaplan-Meier survival curve analysis showed that the 1-year recurrence rate of patients with severe stroke was significantly higher than that of patients with mild to moderate stroke(log-rank test,P<0.001),and the 1-year recurrence rate of patients with SAP was significantly higher than that of patients without SAP(log-rank test,P<0.001).Conclusion Age,atrial fibrillation,white blood cell count,baseline NIHSS score and SAP are the independent predictors of poor outcomes at 1 year after first-ever ischemic stroke in non-diabetic patients.Baseline NIHSS score and SAP are the independent predictors of recurrence within 1 year after first-ever ischemic stroke in non-diabetic patients.