首次脑卒中患者生存率分析

Analysis of survival rate among patients with first-ever stroke

目的了解首次脑卒中患者的生存情况及其影响因素,为提高脑卒中患者生存质量和改善预后提供依据。方法通过杭州市慢性病监测管理系统收集萧山区2017年首次报告的脑卒中新发病例的人口学信息、疾病史、吸烟史和饮酒史等资料;以脑卒中死亡为结局事件,连续随访观察5年。采用Kaplan-Meier法计算生存率,采用多因素Cox比例风险回归模型分析首次脑卒中患者生存时间的影响因素。结果纳入3886例首次脑卒中患者,其中脑梗死、脑内出血、蛛网膜下腔出血和脑卒中未特指为出血或梗死(未特指)的病例分别占86.93%、11.45%、1.06%和0.57%。男性2047例,占52.68%;女性1839例,占47.32%。发病年龄为(72.01±11.61)岁。截至2022年12月31日随访结束,因脑卒中死亡906例,随访时间M(QR)为62.00(35.00)个月。1年生存率为87.35%(95%CI:86.30%~88.41%),3年生存率为82.11%(95%CI:80.88%~83.34%),5年生存率为76.64%(95%CI:75.26%~78.02%)。多因素Cox比例风险回归分析结果显示,发病年龄≥75岁(HR=5.543,95%CI:3.822~8.039)、诊治医院级别为乡镇级(HR=5.934,95%CI:4.027~8.743)、有高血压史(HR=1.566,95%CI:1.317~1.863)、有慢性缺血性心脏病史(HR=1.611,95%CI:1.362~1.906)、有吸烟史(HR=1.455,95%CI:1.190~1.778)、有饮酒史(HR=1.323,95%CI:1.067~1.641)和脑卒中亚型为脑内出血(HR=3.442,95%CI:2.923~4.053)和未特指(HR=6.843,95%CI:4.353~10.756)与首次脑卒中患者较高死亡风险有关。结论首次脑卒中患者5年生存率为76.64%,受到发病年龄、诊治医院级别、脑卒中亚型、疾病史、吸烟和饮酒的影响。

Objective To understand the survival status and influencing factors of first-ever stroke patients,so as to provide evidence for improving the quality of life and prognosis of stroke patients.Methods Demographic information,medical history,smoking history,and alcohol consumption history of newly diagnosed stroke cases first reported in 2017 in Xiaoshan District were collected through the Hangzhou Chronic Disease Surveillance and Management System.Pa⁃tients were followed up for 5 years,with stroke death as the outcome event.The survival rate was calculated using the Kaplan-Meier method,and factors affecting survival time of first-ever stroke patients were identified using a multivari⁃able Cox proportional hazard regression model.Results A total of 3886 patients first-ever stroke patients were includ⁃ed,the cases of cerebral infarction,intracerebral hemorrhage,subarachnoid hemorrhage,and stroke unspecified as to whether it was hemorrhagic or ischemic(unspecified)accounted for 86.93%,11.45%,1.06%and 0.57%,respectively.There were 2047 males(52.68%)and 1839 females(47.32%),with a mean onset age of(72.01±11.61)years.By the end of the follow-up on December 31,2022,906 patients died from stroke,with a median follow-up time of 62.00(in⁃terquartile range,35.00)months.The 1-year survival rate was 87.35%(95%CI:86.30%-88.41%),the 3-year survival rate was 82.11%(95%CI:80.88%-83.34%),and the 5-year survival rate was 76.64%(95%CI:75.26%-78.02%),respec⁃tively.Multivariable Cox proportional hazard regression analysis showed that onset age of≥75 years(HR=5.543,95%CI:3.822-8.039),being treated at township-level hospitals(HR=5.934,95%CI:4.027-8.743),history of hypertension(HR=1.566,95%CI:1.317-1.863),history of chronic ischemic heart disease(HR=1.611,95%CI:1.362-1.906),smoking histo⁃ry(HR=1.455,95%CI:1.190-1.778),alcohol consumption history(HR=1.323,95%CI:1.067-1.641),stroke subtype of in⁃tracerebral hemorrhage(HR=3.442,95%CI:2.923-4.053)and unspecified(HR=6.843,95%CI:4.353-10.756)were associ⁃ated with higher mortality risk among first-ever stroke patients.Conclusion The 5-year survival rate of first-ever stroke patients was 76.64%,which was influenced by age of onset,hospital level for diagnosis and treatment,stroke sub⁃type,medical history,smoking and alcohol consumption.