脑梗死复发的影响因素分析
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摘要
目的探讨影响脑梗死复发的因素,为脑梗死的二级预防提供依据。方法选取2013年10月1日至12月31日在哈尔滨医科大学附属第一医院神经内科住院治疗的262例首次发病的脑梗死患者为调查对象,随访2年,根据患者的预后结局将患者分为未复发组(173例)和复发组(89例),通过单因素和多因素分析探讨可能影响脑梗死复发的因素。结果单因素分析显示,与复发组相比,未复发组患者初中及以上的比例和规律服用抗血小板聚集药的比例较高[84. 39%(146/173)比56. 18%(50/89),37. 57%(65/173)比20. 22%(18/89)],糖尿病比例较低[25. 43%(44/173)比40. 45%(36/89)](P <0. 05),两组饮酒和体质指数构成比较差异有统计学意义(P <0. 05);多因素Logistic回归分析显示,年龄、文化程度、抗血小板聚集药、饮酒、糖尿病、体质指数、颅内外动脉狭窄是影响脑梗死复发的因素(P <0. 05)。结论年龄越大、文化程度越低、颅内外动脉狭窄、肥胖和超重、糖尿病、不规律或未用抗血小板聚集药的脑梗死患者复发风险大,积极控制可以改变的因素,重视二级预防可改善患者预后。
Objective To explore the factors affecting the recurrence of cerebral infarction,in order to provide evidence for secondary prevention. Methods A total of 262 patients with cerebral infarction for the first time who were hospitalized in the Department of Neurology of the First Affiliated Hospital of Harbin Medical University from Oct. 1 st to Dec. 31 st in2013 were included in the study. The patients were followed up for 2 years,and were divided into a non-recurrence group(173 cases) and a recurrence group(89 cases) according to their prognostic outcomes. Univariate and multivariate analyses were conducted to explore the factors that may affect the recurrence of cerebral infarction. Results Univariate analysis showed that compared with the recurrence group,the rate of junior secondary schools and above education and regularity of antiplatelet aggregation drugs in the non-recurrence group were higher[84. 39%(146/173) vs 56. 18%(50/89),37. 57%(65/173) vs 20. 22%( 18/89) ],the rate of diabetes was lower[25. 43%( 44/173) vs 40. 45%(36/89) ](P < 0. 05),there was a significant difference between the two groups in alcohol drinking and body mass index(P < 0. 05). Multivariate Logistic regression analysis showed that age,education level,antiplatelet drugs,alcohol consumption,diabetes,body mass index and intracranial arterial stenosis were the factors affecting the recurrence of cerebral infarction(P < 0. 05). Conclusion Patients with cerebral infarction who are older,with lower education level,intracranial and extracranial artery stenosis,obesity and overweight,diabetes,irregular use or no use of anti-platelet aggregation drugs have a high risk of recurrence. Positive control of the changeable factors and attention to the secondary prevention can improve the prognosis of the patients.
Objective To explore the factors affecting the recurrence of cerebral infarction,in order to provide evidence for secondary prevention. Methods A total of 262 patients with cerebral infarction for the first time who were hospitalized in the Department of Neurology of the First Affiliated Hospital of Harbin Medical University from Oct. 1 st to Dec. 31 st in2013 were included in the study. The patients were followed up for 2 years,and were divided into a non-recurrence group(173 cases) and a recurrence group(89 cases) according to their prognostic outcomes. Univariate and multivariate analyses were conducted to explore the factors that may affect the recurrence of cerebral infarction. Results Univariate analysis showed that compared with the recurrence group,the rate of junior secondary schools and above education and regularity of antiplatelet aggregation drugs in the non-recurrence group were higher[84. 39%(146/173) vs 56. 18%(50/89),37. 57%(65/173) vs 20. 22%( 18/89) ],the rate of diabetes was lower[25. 43%( 44/173) vs 40. 45%(36/89) ](P < 0. 05),there was a significant difference between the two groups in alcohol drinking and body mass index(P < 0. 05). Multivariate Logistic regression analysis showed that age,education level,antiplatelet drugs,alcohol consumption,diabetes,body mass index and intracranial arterial stenosis were the factors affecting the recurrence of cerebral infarction(P < 0. 05). Conclusion Patients with cerebral infarction who are older,with lower education level,intracranial and extracranial artery stenosis,obesity and overweight,diabetes,irregular use or no use of anti-platelet aggregation drugs have a high risk of recurrence. Positive control of the changeable factors and attention to the secondary prevention can improve the prognosis of the patients.
引文
[1]中华医学会神经病学分会脑血管病学组缺血性脑卒中二级预防指南撰写组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010[J].中华神经科杂志,2010,43(2):154-160.
[2]单青婷,方琪.抗血小板药在缺血性脑卒中防治中的应用及其研究进展[J].实用医学杂志,2015,31(19):3121-3123.
[3]王力,张茁.缺血性脑卒中二级预防的循证医学证据[J].中华老年心脑血管病杂志,2007,9(8):574-576.
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[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(4):4-67.
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[11]程阅凤,林丽,董慧,等.脑梗死患者复发的影响因素分析[J].医学综述,2017,23(21):4352-4355.
[12]王娟.复发性脑梗死相关因素研究[J].中国全科医学,2013,16(3):246-248.
[13]Kishore A,Vail A,Majid A,et al.Detection of atrial fibrillation after ischemic stroke or transient ischemic attack:A systematic review and meta analysis[J].Stroke,2014,45(2):520-526.
[14]杜万良,孙海欣,贾茜,等.美国心脏协会/美国卒中协会卒中一级预防指南[J].中国卒中杂志,2011,6(8):659-664.
[15]何国英,张春生.脑梗死复发危险因素分析[J].华南国防医学志,2015,29(5):396-397.
[16]Yang Y,Shi YZ,Zhang N,et al.The disability rate of 5-year poststroke and its correlation factors:A national survey in China[J].PLo S One,2016,11(11):e0165341.
[17]Zhuang H,Kim YS,Koehler RC,et al.Potential mechanism by which resveratrol,a red wine constituent,protects neurons[J].Ann N Y Acad Sci,2003,993:276-286.
[18]皇甫春梅,于俊杏,赵华玲,等.体质量指数与脑梗死的相关性研究[J].山西医药杂志,2018,47(9):987-990.
[19]陈燕璇.脑梗死复发患者可控危险因素自我管理的分析[D].南宁:广西医科大学,2017.
[20]Prospective Studies Collaboration,Whitlock G,Lewington S,et al.Body-mass index and cause-specific mortality in 900 000 adults:Collaborative analyses of 57 prospective studies[J].Lancet,2009,373(9669):1083-1096.
[21]张文婷,张敏,徐文安,等.大动脉粥样硬化性脑梗死患者阿司匹林抵抗与脑梗死复发的相关性研究[J].中华老年心脑血管病杂志,2013,15(10):1011-1014.
[22]Gorelick PB,Wong KS,Bae HJ,et al.Large artery intracranial occlusive disease:A large worldwide burden but a relatively neglected frontier[J].Stroke,2008,39(8):2396-2399.
[23]Kasner SE,Chimowitz MI,Lynn MJ,et al.Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis[J].Circulation,2006,113(4):555-563.
[24]Gupta A,Chazen JL,Hartman M,et al.Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion:Asystematic review and meta-analysis[J].Stroke,2012,43(11):2884-2891.
[25]孙会成,荣阳,孙卓,等.再发性脑梗死的临床特征与病因分析[J].中国现代医生,2008,46(28):54-55.
[26]濮月华,邹昕颖,王伊龙,等.颅内外动脉粥样硬化相关因素的差异[J].中国卒中杂志,2018,13(5):455-462.
[27]Matsumoto K,Sera Y,Nakamura H,et al.Correlation between common carotid arterial wall thickness and ischemic stroke in patients with type 2 diabetes mellitus[J].Metabolism,2002,51(2):224-247.
[28]曾倩,龙秀英,宋春江.复发性脑梗死相关危险因素分析[J].中国实用神经疾病杂志,2018,21(1):37-39.
[29]Antithrombotic Trialists'Collaboration.Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death,myocardial infarction,and stroke in high risk patients[J].BMJ,2002,324(7329):71-86.
[30]Antithrombotic Trialists'(ATT)Collaboration,Baigent C,Blackwell L,et al.Aspirin in the primary and secondary prevention of vascular disease:Collaborative meta-analysis of individual participant data from randomised trials[J].Lancet,2009,373(9678):1849-1860.
[31]CAPRIE Steering Committee.A randomised,blinded,trial of clopidogrel versus aspirin in patients at risk of ischaemic events(CAPRIE).CAPRIE steering committee[J].Lancet,1996,348(9038):1329-1339.
[32]张云云,龚柳.缺血性脑卒中二级预防的研究[J].上海医药,2018,39(17):22-24.
[33]Wang Y,Wang Y,Zhao X,et al.Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J].N Engl J Med,2015,369(1):11-19.
[34]Joubert J,Reid C,Barton D.Integrated care improves risk-factor modification after stroke:Initial results of the integrated care for the reduction of secondary stroke model[J].J Neurol Neurosurg Psychiatry,2009,80(3):279-284.
[2]单青婷,方琪.抗血小板药在缺血性脑卒中防治中的应用及其研究进展[J].实用医学杂志,2015,31(19):3121-3123.
[3]王力,张茁.缺血性脑卒中二级预防的循证医学证据[J].中华老年心脑血管病杂志,2007,9(8):574-576.
[4]中华医学会第四届全国脑血管病学术会议.各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[5]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(4):4-67.
[6]中华人民共和国卫生部疾病预防控制司.中国成人超重和肥胖症预防控制指南[M].北京:人民卫生出版社,2006:3.
[7]Samuels OB,Joseph GJ,Lynn MJ,et al.A standardized method for measuring intracranial arterial stenosis[J].AJNR Am J Neuroradiol,2000,21(4):643-646.
[8]Grant EG,Benson CB,Moneta GL,et al.Carotid artery stenosis:Grayscale and dopplerultrasound diagnosis--Society of radiologists in ultrasound consensus conference[J].Ultrasound Q,2003,19(4):190-198.
[9]贾建平,陈生弟,崔丽英,等.神经病学[M].7版.北京:人民卫生出版社,2013:170-212.
[10]Katsanos AH,Spence JD,Bogiatzi C,et al.Recurrent stroke and patentforamen ovale:A systematic review and meta-analysis[J].Stroke,2014,45(11):3352-3359.
[11]程阅凤,林丽,董慧,等.脑梗死患者复发的影响因素分析[J].医学综述,2017,23(21):4352-4355.
[12]王娟.复发性脑梗死相关因素研究[J].中国全科医学,2013,16(3):246-248.
[13]Kishore A,Vail A,Majid A,et al.Detection of atrial fibrillation after ischemic stroke or transient ischemic attack:A systematic review and meta analysis[J].Stroke,2014,45(2):520-526.
[14]杜万良,孙海欣,贾茜,等.美国心脏协会/美国卒中协会卒中一级预防指南[J].中国卒中杂志,2011,6(8):659-664.
[15]何国英,张春生.脑梗死复发危险因素分析[J].华南国防医学志,2015,29(5):396-397.
[16]Yang Y,Shi YZ,Zhang N,et al.The disability rate of 5-year poststroke and its correlation factors:A national survey in China[J].PLo S One,2016,11(11):e0165341.
[17]Zhuang H,Kim YS,Koehler RC,et al.Potential mechanism by which resveratrol,a red wine constituent,protects neurons[J].Ann N Y Acad Sci,2003,993:276-286.
[18]皇甫春梅,于俊杏,赵华玲,等.体质量指数与脑梗死的相关性研究[J].山西医药杂志,2018,47(9):987-990.
[19]陈燕璇.脑梗死复发患者可控危险因素自我管理的分析[D].南宁:广西医科大学,2017.
[20]Prospective Studies Collaboration,Whitlock G,Lewington S,et al.Body-mass index and cause-specific mortality in 900 000 adults:Collaborative analyses of 57 prospective studies[J].Lancet,2009,373(9669):1083-1096.
[21]张文婷,张敏,徐文安,等.大动脉粥样硬化性脑梗死患者阿司匹林抵抗与脑梗死复发的相关性研究[J].中华老年心脑血管病杂志,2013,15(10):1011-1014.
[22]Gorelick PB,Wong KS,Bae HJ,et al.Large artery intracranial occlusive disease:A large worldwide burden but a relatively neglected frontier[J].Stroke,2008,39(8):2396-2399.
[23]Kasner SE,Chimowitz MI,Lynn MJ,et al.Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis[J].Circulation,2006,113(4):555-563.
[24]Gupta A,Chazen JL,Hartman M,et al.Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion:Asystematic review and meta-analysis[J].Stroke,2012,43(11):2884-2891.
[25]孙会成,荣阳,孙卓,等.再发性脑梗死的临床特征与病因分析[J].中国现代医生,2008,46(28):54-55.
[26]濮月华,邹昕颖,王伊龙,等.颅内外动脉粥样硬化相关因素的差异[J].中国卒中杂志,2018,13(5):455-462.
[27]Matsumoto K,Sera Y,Nakamura H,et al.Correlation between common carotid arterial wall thickness and ischemic stroke in patients with type 2 diabetes mellitus[J].Metabolism,2002,51(2):224-247.
[28]曾倩,龙秀英,宋春江.复发性脑梗死相关危险因素分析[J].中国实用神经疾病杂志,2018,21(1):37-39.
[29]Antithrombotic Trialists'Collaboration.Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death,myocardial infarction,and stroke in high risk patients[J].BMJ,2002,324(7329):71-86.
[30]Antithrombotic Trialists'(ATT)Collaboration,Baigent C,Blackwell L,et al.Aspirin in the primary and secondary prevention of vascular disease:Collaborative meta-analysis of individual participant data from randomised trials[J].Lancet,2009,373(9678):1849-1860.
[31]CAPRIE Steering Committee.A randomised,blinded,trial of clopidogrel versus aspirin in patients at risk of ischaemic events(CAPRIE).CAPRIE steering committee[J].Lancet,1996,348(9038):1329-1339.
[32]张云云,龚柳.缺血性脑卒中二级预防的研究[J].上海医药,2018,39(17):22-24.
[33]Wang Y,Wang Y,Zhao X,et al.Clopidogrel with aspirin in acute minor stroke or transient ischemic attack[J].N Engl J Med,2015,369(1):11-19.
[34]Joubert J,Reid C,Barton D.Integrated care improves risk-factor modification after stroke:Initial results of the integrated care for the reduction of secondary stroke model[J].J Neurol Neurosurg Psychiatry,2009,80(3):279-284.