【摘要】：研究背景和目的缺血性腦卒中是臨床常見(jiàn)的腦血管疾病,具有較高的復(fù)發(fā)性,且復(fù)發(fā)者病情更嚴(yán)重,其致殘率和病死率更高。對(duì)缺血性腦卒中復(fù)發(fā)風(fēng)險(xiǎn)進(jìn)行科學(xué)的分層分析,尋找缺血性腦卒中復(fù)發(fā)的危險(xiǎn)因素對(duì)臨床開展卒中二級(jí)預(yù)防具有重要的指導(dǎo)意義。本研究通過(guò)分析廣東地區(qū)811例急性缺血性腦卒中住院患者臨床資料,來(lái)探討缺血性腦卒中復(fù)發(fā)的危險(xiǎn)因素,旨在為缺血性腦卒中復(fù)發(fā)的防治決策提供參考依據(jù)。研究方法回顧性分析急性缺血性腦卒中患者臨床資料。依據(jù)是否復(fù)發(fā)分為復(fù)發(fā)組(n=160)和無(wú)復(fù)發(fā)組(n=651);依據(jù)中國(guó)缺血性卒中亞型(CISS)標(biāo)準(zhǔn)將復(fù)發(fā)組患者分為以下5型:大動(dòng)脈粥樣硬化(LAA)、心源性卒中(CS)、穿支動(dòng)脈病(PAD)、其他病因(OE)、不確定病因(UE)。計(jì)數(shù)資料間比較用卡方(χ2)檢驗(yàn),計(jì)量資料間較用t檢驗(yàn)。研究結(jié)果1.一般臨床及生化數(shù)據(jù)分析復(fù)發(fā)組與無(wú)復(fù)發(fā)組比較,年齡(71.7±5.3:62.1±6.2歲)、同型半胱氨酸(HCY)(4.1±1.1:4.4±1.2mg/dL)、脂蛋白 A(288.9±89.7:292.5±102.5 ng/ml)三者差異有顯著性(t=4.159、2.897、2.956,P=0.015、0.049、0.0470.05),其它指標(biāo)如性別、體重指數(shù)、血壓、血糖、血脂水平在兩組間比較差異無(wú)顯著性。2.既往病史數(shù)據(jù)分析復(fù)發(fā)組與非復(fù)發(fā)組間比較,患者高血壓史[83.8%(134/160):52.1%(339/651)]、糖尿病史[40.6%(65/160):29.6%(193/651)]、高脂血癥[59.4%(95/160):47.9%(312/651)]、不穩(wěn)定斑塊[70.0%(112/160):52.5%(342/651)]、吸煙史[30.6%(49/160):20.9%(136/651)]、抗血小板藥物依從性[51.6%(83/160):62.8%(409/651)]、高同型半胱氨酸血癥[27.5%(44/160):19.0%(124/651)],組間差異有顯著性(χ2=48.366、13.153、12.742、15.899、12.923、12.457、11.569,P=0.000、0.022、0.026、0.000、0.024、0.029、0.0410.05);而城鄉(xiāng)居民、冠心病史、房顫、飲酒史、適量鍛煉、家族史在兩組差異無(wú)顯著性。3.多因素回歸分析Logistic回歸分析結(jié)果顯示年齡、高血壓、糖尿病、高脂血癥、吸煙史、HCY、不穩(wěn)定斑塊、高同型半胱氨酸血癥及抗血小板藥物依從性與缺血性腦卒中復(fù)發(fā)存在相關(guān)性。4.復(fù)發(fā)在CISS各型中的分布根據(jù)CISS分型標(biāo)準(zhǔn)將160例缺血性腦卒中復(fù)發(fā)患者分為5型,即LAA、CS、PAD、OE、UE。LAA 組中共 61 例(38.1%)患者,CS 組中共 18 例(11.3%)患者,PAD組中共52例(32.5%)患者,OE組中共11例(6.9%)患者,UE組中共18例(11.3%)患者。5.CISS各型與危險(xiǎn)因素間的關(guān)系LAA、CS、PAD、OE、UE亞型間高血壓史、高脂血癥、不穩(wěn)定斑塊間比較差異顯著(χ2=18.898、12.515、11.752,P=0.001、0.014、0.0190.05);而平均年齡、HCY、糖尿病史、吸煙史、高同型半胱氨酸血癥、抗血小板藥物依從性比較無(wú)統(tǒng)計(jì)學(xué)差異(χ2=1.925、0.168、1.258、0.401、0.845、0.236,P=0.129、0.954、0.869、0.982、0.932、0.9940.05)。結(jié)論年齡、高血壓、糖尿病、高脂血癥、吸煙史、HCY、不穩(wěn)定斑塊、高同型半胱氨酸血癥及抗血小板藥物依從性是缺血性腦卒中復(fù)發(fā)的獨(dú)立危險(xiǎn)因素。對(duì)誘發(fā)缺血性腦卒中復(fù)發(fā)的危險(xiǎn)因素進(jìn)行積極干預(yù),可有效降低缺血性腦卒中復(fù)發(fā)風(fēng)險(xiǎn),改善患者臨床預(yù)后。
[Abstract]:Background and objective Ischemic stroke is a common clinical cerebrovascular disease with a higher recurrence rate and mortality. Scientific stratification analysis of the risk of ischemic stroke recurrence and finding out the risk factors of ischemic stroke recurrence have important guiding significance for clinical secondary prevention of stroke. In this study, the clinical data of 811 inpatients with acute ischemic stroke in Guangdong area were analyzed to explore the risk factors for recurrence of ischemic stroke, in order to provide a reference for the decision-making of prevention and treatment of ischemic stroke recurrence. Methods the clinical data of patients with acute ischemic stroke were retrospectively analyzed. According to the Chinese (CISS) standard of ischemic stroke, the recurrent patients were divided into the following five types: large artery atherosclerosis (LAA), cardiogenic stroke, (CS), perforating artery disease, (PAD), other etiological factors, (OE), (OE), uncertain etiology (UE)., according to the Chinese criteria for ischemic stroke subtype (CISS), the recurrence group was divided into the following five types: atherosclerosis (LAA), cardiogenic stroke, (CS), perforating artery disease, (PAD), other etiological factors, (UE). Chi-square test was used to compare the counting data and t test was used to measure the data. Results 1. General clinical and biochemical data analysis: age (71.7 鹵5.3: 62.1 鹵6.2), homocysteine (HCY) (4.1 鹵1.1: 4.4 鹵1.2mg/dL, lipoprotein A (288.9 鹵89.7: 292.5 鹵102.5 ng/ml) were significantly different from those in non-recurrence group (t = 4.1592.8972.956P 0.0150.040.049.47 ng/ml), other parameters such as gender, body mass index, blood pressure, blood glucose, There was no significant difference in blood lipid level between the two groups. The data of past medical history were compared between relapsed group and non-recurrent group. 鎮(zhèn)ｈ，

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