脑梗死和脑出血1年复发风险比较和危险因素分析

Comparison for recurrence of cerebral infarction and cerebral hemorrhage in one year and analysis of risk factors

目的比较脑梗死和脑出血患者发病1年内的复发风险及临床危险因素分析。方法选择2017年9月至2019年6月深圳市中医院针灸科住院的脑卒中患者816例(脑梗死592例、脑出血224例)。收集与脑卒中复发相关的人口学特征和危险因素控制情况等并随访1年,采用Kaplan-Meier法比较脑梗死和脑出血的复发风险,对脑梗死和脑出血复发的危险因素进行单因素分析,再使用逐步回归法建立与复发相关Cox比例风险回归模型。结果校正性别和年龄后,两组K-M曲线比较,差异有统计学意义(P<0.05)。对于脑梗死而言,有卒中家族史的患者其复发风险是无卒中家族史患者的1.872倍(95%CI:1.063~3.311,P=0.031),血压控制欠佳的患者其复发风险是血压控制良好患者的1.464倍(95%CI:1.058~2.018,P=0.020)。对于脑出血而言,有卒中家族史的患者其复发风险是无卒中家族史的4.685倍(95%CI:1.372~16.003,P=0.014),血糖控制欠佳的患者其复发风险是血糖控制良好的2.961倍(95%CI:1.459~6.010,P=0.003),现仍饮酒患者的复发风险是不饮酒的2.719倍(95%CI:1.223~6.046,P=0.014)。结论在发病1年内的脑卒中患者中,脑梗死比脑出血的复发率高。血压控制不佳是脑梗死复发的独立风险因素,而血糖控制不良、饮酒行为是脑出血复发的独立风险因素,需针对上述因素进行干预,以降低脑卒中复发风险。

Objective To compare the recurrence risk of cerebral infarction and cerebral hemorrhage within one year and to analyze the clinical risk factors.Methods Eight hundred and sixteen stroke patients(592 cases of cerebral infarction and 224 cases of cerebral hemorrhage)hospitalized in the Department of Acupuncture and Moxibustion,Shenzhen Traditional Chinese Medicine Hospital from September 2017 to June 2019 were included.The demographic characteristics and control of risk factor of stroke were collected and followed up for one year.The recurrence risk of cerebral infarction and cerebral hemorrhage were compared by Kaplan-Meier method.The risk factors of cerebral infarction and cerebral hemorrhage recurrence were analyzed by single factor analysis,and then the Cox proportional risk regression model related to recurrence was established by stepwise regression method.Results After correction of age and gender,comparison of K-M curves between two groups showed statistically significant difference(P<0.05).For cerebral infarction,the risk of recurrence was 1.872 times higher in patients with family history of stroke than patients without family history of stroke(95%CI:1.063-3.311,P=0.031),and 1.464 times higher in patients with poor blood pressure control than in patients with good blood pressure control(95%CI:1.058-2.018,P=0.020).For intracerebral hemorrhage,patients with family history of stroke had 4.685 times higher risk of recurrence than those without family history of stroke(95%CI:1.372-16.003,P=0.014),and patients with poor blood glucose control had 2.961 times higher risk of recurrence than those with good blood glucose control(95%CI:1.459-6.010,P=0.003),the risk of recurrence in patients who still drank alcohol was 2.719 times that of those who did not drink alcohol(95%CI:1.223-6.046,P=0.014).Conclusion The recurrence rate of cerebral infarction is higher than that of cerebral hemorrhage in stroke patients with one-year onset.Poor blood pressure control is an independent risk factor for recurrence of cerebral infarction,while poor glycemic control and alcohol consumption behavior are independent risk factors for recurrence of cerebral hemorrhage,and interventions targeting these factors are needed to reduce the risk of stroke recurrence.