缺血性脑卒中的病因分型与危险因素

目的探讨缺血性脑卒中病因分型与不同危险因素的关系。方法回顾性分析连续登记的急性缺血性卒中患者,记录其危险因素,并按急性卒中治疗试验（TOAST）标准将缺血性卒中分为5种类型分析相关危险因素对其发生风险的影响。结果在纳入分析的205例患者中,大动脉粥样硬化性卒中（LAA）100例（48．9％）、心源性卒中（CE）17例（8．3％）、小动脉闭塞性卒中（SAO）38例（18．5％）、其他原因所致卒中（SOE）12例（5．8％）、不明原因卒中（SUE）38例（18．5％）。分析显示,高血压与LAA的发生有关（OR=2．40,P=0．0028）;心房颤动对CE发生有显著作用（OR=365．90,P〈0．0001）;饮酒与SAO的发生可能有一定关联（OR=2．73,P=0．036）,而白细胞则在CE患者显著升高（OR=8．00,P=0．0013）。结论不同类型缺血性脑卒中与不同的危险因素有关。该结果对临床个体化预防与治疗有一定提示意义。     

脑出血患者预后影响因素的多因素分析

目的探讨脑出血患者早期死亡及致残的危险因素。方法回顾性收集2004年9月-2006年6月南京医科大学附属南京第一医院神经内科住院的312例急性脑出血病例,采用电话或写信等方式随访患者发病后3月的生存及残疾情况。采用Logistic回归分析对影响患者死亡及致残的27项危险因素进行单因素和多因素分析。结果脑出血患者周一周二就诊病死率及致残率较其他时间低。影响脑出血患者死亡的危险因素有年龄（P=0．012）、意识障碍（P=0．016）、入院时收缩压（P=0．018）、尿素氮（P=0．036）、低蛋白血症（P=0．000）、合并感染（P=0．000）、合并消化道出血（P=0．031）;影响脑出血患者致残的危险因素有性别（P=0．023）、年龄（P=0．000）、意识障碍（P=0．000）、合并感染（P=0．031）。结论高龄、有意识障碍、入院时收缩压高、尿素氮高、有低蛋白血症、合并感染、合并消化道出血是脑出血患者死亡的独立危险因素。性别、年龄、有意识障碍、合并感染是脑出血患者致残的独立危险因素。     

急性脑卒中患者营养不良、卒中后并发症及不良预后的危险因素分析

目的 探讨影响急性脑卒中患者营养不良、卒中后并发症及不良预后的危险因素.方法 收集122例急性脑卒中患者的一般资料,进行营养状况和神经功能缺损程度评估.3个月后采用改良Rankin量表(mRS)评估预后.分析各因素与急性脑卒中患者营养不良、卒中后并发症及不良预后的关系.结果 随访结束时,共91例患者纳入本次研究.年龄及NIHSS评分为入院时营养不良的危险因素(P＜ 0.05～0.001);年龄、高胆固醇血症、入院营养不良、鼻饲为7d时营养不良的危险因素(P＜0.05 ～0.001).多因素Logistic回归分析显示,入院营养不良为7d发生营养不良的独立预测因素(OR=14.15,95％CI:3.32～61.76,P＜0.001).年龄、入院NIHSS评分、入院营养不良、鼻饲、7d时NIHSS评分、7d时营养不良及营养状况恶化为发生并发症的危险因素(均P＜0.01).多因素Logistic回归分析显示,入院NIHSS评分及入院营养不良为并发症的独立预测因素(OR=1.11,95％CI:1.04 ～ 1.48,P＜0.05;OR=6.56,95％CI:1.18 ～42.72,P＜0.05).年龄、入院NIHSS评分、7d时NIHSS评分、7d时营养不良及营养状况恶化为预后不良的危险因素(P ＜0.05 ～0.01).多因素Logistic回归分析显示,7d时营养不良及7d时NIHSS评分为预后不良的独立预测因素(OR =-4.32,95％CI:1.15 ～ 18.89,P＜0.05;OR=1.81,95％CI:1.21 ～2.43,P＜0.01).结论 入院营养不良为7d发生营养不良的独立危险因素,入院NIHSS评分及营养不良为并发症的独立危险因素,7d时营养不良及NIHSS评分为预后不良的独立危险因素.     

氯吡格雷停药后脑卒中再发临床探讨

目的 通过定期随访并督导脑卒中患者出院后口服氯吡格雷进行二级预防，观察其对卒中复发率的影响。方法将294例动脉粥样硬化性脑血栓形成的出院患者随机分为2组，A组180例，B组114例。2组患者均在出院后督导口服氯吡格雷片75mg／d，A组坚持治疗1a，B组坚持治疗3个月，均随访1a。结果将2组病人在随访1a内复发病例进行统计，A组的复发率（2．22％）明显低于B组的复发率（14．04％）。结论坚持服用氯吡格雷治疗，在预防脑卒中再发中起重要作用。     

脑卒中相关感染患者血清皮质醇及血浆IFN—γ IL-4 IL-10水平变化

目的分析脑卒中相关感染患者血清皮质醇、血浆γ干扰素（IFN-γ）、白细胞介素-4（IL-4）、白细胞介素-10（IL-10）水平,为临床诊疗提供依据。方法选取脑卒中患者144例,根据患者入院后是否有发生感染分为感染组50例和非感染组94例。比较2组患者第1天和第7天的血清皮质醇、血浆IFN-γ、IL-4、IL-10水平。通过Pearson相关分析探讨各指标的相关性。通过Logistic回归分析探讨脑卒中相关感染和各指标的相关性。结果感染组入院第1天和入院第7天的血清皮质醇、血浆IL-4、血浆IL-10的检测结果均显著高于非感染组,而IFN-7的检测结果则显著低于非感染组（P〈0．05）。入院第l大的血清皮质醇与IL-4、IL-10呈正相关（r=0．301,0．038,均P〈0.05）,而和血浆IFN-γ呈负相关（r=-0．303,P〈0．05）。入院第7犬的血清皮质醇和血浆IFN-γ、IL-4、IL-10之间不存在相关性。入院第1天的皮质醇水平高是脑卒中相关感染的独立危险因素（OR值-0．895,95％CI为0．821～1．002,P〈0．05）。结论血浆IFN-γ、IL-4、IL-10和血清皮质醇的浓度变化和脑卒中相关感染的发生相关,且血清皮质醇浓度高是脑卒中相关感染发生的独立危险因素。     

急性脑梗塞与脑出血相关因素的对比研究

目的:探讨不同危险因素在脑卒中发生的情况及不同危险因素在脑梗死与脑出血间的差异。方法:将收治的卒中患者共408例,其中脑梗死281例,脑出血127例,均预先对各项资料进行编码,输入计算机数据库。所有患者均进行系统的临床和辅助检查,生化指标为集体测定,脑卒中诊断经过MRI或CT确诊。结果:1、高血压、吸烟是脑卒中最重要的危险因素。2、脑出血患者首诊舒张压(P=0．014)、缓解期舒张压(P=0．006)、HDL(P=0．034)、较脑梗塞患者高,其差别有统计学意义;其TC(P=0．047)、吸烟(P=0．007)、心脏病病史(P=0．020)、糖尿病病史(0．000)、卒中家族史(P=0．033)、心脏病家族史(P=0．040)较脑梗塞患者低或少,其差别有统计学差异。3、与脑梗塞相比,吸烟(OR=0. 226,95％CI=0．107—1．623)、糖尿病病史(OR=0．094,95％CI=0．023—2．401)、心脏病病史(OR=0．046,95％CI=0．236-0．905)对脑出血危险较小;高血压病史(OR=1．096,95％CI=0．542-0.895)是脑出血唯一危险因素。结论:高血压、吸烟是脑卒中最重要的危险因素;脑梗塞与脑出血的危险因素并不完全一致。     

高龄颈动脉狭窄患者颈动脉内膜切除术和颈动脉支架成形术的安全性比较简

目的回顾接受颈动脉内膜切除术和颈动脉支架成形术的高龄（≥70岁）颈动脉狭窄患者的临床资料,分析手术安全性。方法共691例颈动脉狭窄患者,121例行颈动脉内膜切除术、570例行颈动脉支架成形术,分析两组患者危险因素、临床特征和术后并发症发生率,评价两种手术方法之安全性。结果术后30d时,两组患者病死率（0．83％对1．05％,P=1．000）、脑卒中（4．13％对1．93％,P=0．258）和心肌梗死（0．83％对0,P=0．175）发生率差异均无统计学意义;但颈动脉内膜切除术组患者术后心脏不良事件（8．26％对1．05％,P=0．000）和脑神经损伤（4．96％对0,P=0．000）发生率高于颈动脉支架成形术组,而窦性心动过缓或低血压发生率低于颈动脉支架成形术组（0对7．54％,P=0．002）。结论高龄患者接受颈动脉内膜切除术或颈动脉支架成形术均有较高的安全性,术前应全面评价患者基础情况,以减少术后并发症发生率。     

脑卒中急性期血压监测与预后相关性的初步研究

目的探讨脑卒中急性期动态血压的变化及血压与预后的相关性。方法本研究分别对发病48 h内入院的53例脑梗死和38例脑出血患者进行24 h动态血压监测,持续10 d,并记录其他影响预后的危险因素及21 d、3个月的神经功能评分。结果脑卒中急性期血压升高的发生率为74．7%,入院4 d内血压下降显著,4～10 d时血压下降趋于平缓。多因素Logistic回归分析显示,脑卒中急性期收缩压升高是近期预后不良(OR=1．071,1．018～1．127,P =0．008)及远期(OR=1．040,1．010～1．071,P=0．009)预后不良(MRS≥3)的危险因素,对近期死亡无明显影响(OR=0．988,0．920～1．062,P=0．750)。亚组分析结果显示:脑梗死患者急性期血压与近、远期预后呈U型曲线关系,最适血压水平:收缩压140～160 mm Hg、舒张压75～80 mm Hg。经调整其他预测因子,收缩压≥160 mm Hg与140～159 mm Hg相比是近期(多因素Logistic回归分析,OR=4．682,1．23～17．823,P=0．024)和远期(OR=2．372, 1．188～4．735,P=0．014)预后不良的独立危险因素;脑出血患者急性期血压升高是近期死亡(多因素Logistic回归分析,OR=1．212 1．019～1．442 P=0．03)及远期(OR=1．27 1．019～1．583 P=0．033)预后不良的独立危险因素。结论脑卒中急性期血压升高常见,但血压有自调下降的趋势;脑梗死患者急性期收缩压≥160 mm Hg与预后不良呈显著相关,脑出血急性期血压升高是预后不良的独立危险因素。     

重度颈动脉狭窄患者介入或药物治疗效果的长期随访

目的研究重度颈动脉狭窄患者的预后及其影响因素，前瞻性评价介入治疗或药物治疗的效果。方法103例脑卒中或TIA合并重度颈动脉狭窄患者意向性分组，分为介入组与药物治疗组。前者40例择期给予脑血管内支架置入术，后者63例给予抗血小板药物治疗。随访主要终点为发病2年时功能预后（mRS评定）；次要终点为血管事件（发病1、2年或2年以上）的发生率。结果两组的基线资料（性别、年龄、病史、收缩压、血脂、NIHSS、mRS）差异无统计学意义。在随访2年时，Logistic回归表明选择介入治疗是功能预后不良（mRS 3-6分）的独立保护性因素（RR=0．13，P=0．001，95％CI 0．036-0．460）。在发病1年和2年时血管事件发生率差异有统计学意义，介入组的血管事件发生率低于药物组（1年时，介入组：药物治疗组=12．5％：42．9％，OR 0．19，95％CI 0．07-0．55，P=0．001；2年时，介入组：药物治疗组=17．5％：47．6％，OR 0．23，95％CI 0．09-0．60，P=0．002）。进一步随访（随访时间2年以上）发现，两组血管事件发生的中位数时间分别为55个月和54个月，Kaplan-Meier分析结果提示差异无统计学意义。Cox回归提示选择介入治疗或药物治疗不是血管事件发生的独立影响因素（RR=1．063，95％CI 0．40～2．83，P=0．900）。结论对于重度颈动脉狭窄患者，介入治疗较单纯药物治疗能获得较好的功能预后；介入治疗能减少脑卒中或TIA发病后1年或2年时血管事件的发生；但是随访2年以上时，介入治疗未能减少血管事件发生。     

脑血栓形成复发的危险因素研究

目的：探讨脑血栓形成复发的危险因素。方法：收集首发441例脑血栓形成患者的临床资料,采用前瞻性队列研究,随访1年,记录终点事件。结果：脑血栓形成1年复发率为t3．8％;年龄（P=0．002,OR=1．044,95％CI=1．015～1．073）、高血压病史（P=0．040,OR=I．944,95％CI=1．032～3．663）、纤维蛋白原（P=0．000,OR=I．932,95％CI=1．386～2．666）为影响脑血栓形成复发的因素。结论：高龄、高血压病史及纤维蛋白原升高是脑血栓形成复发的重要危险因素。     

Symptom, family, and service predictors of children's psychiatric rehospitalization within one year of discharge

OBJECTIVE: To investigate predictors of readmission to inpatient psychiatric treatment for children aged 5 to 12 discharged from acute-care hospitalization. METHOD: One hundred nine children were followed for 1 year after discharge from inpatient care. Time to rehospitalization was the outcome of interest. Predictors of readmission, examined via the Cox proportional hazards model, were symptom and family factors assessed at admission, aspects of psychiatric treatment, and demographic variables. RESULTS: The Kaplan-Meier rehospitalization risk within 1 year of discharge, taking into account known readmissions and censored observations, was 0.37. Most readmissions (81%) occurred within 90 days of discharge. Four variables contributed simultaneously to predicting readmission risk. More severe conduct problems, harsh parental discipline, and disengaged parent-child relations conferred a higher risk for rehospitalization; these risks were attenuated when parents disclosed higher stress in their parenting roles. CONCLUSIONS: Findings showed that psychiatric rehospitalization of children is common, most likely in the trimester after discharge, and highly related to both child symptoms and family factors measurable at admission. Results suggest that efforts to improve postdischarge outcomes of children should target the initial period following inpatient care, address vigorously the complex treatment needs of those with severe conduct problems, and aim to improve parent-child relations.     

Factors affecting time to rehospitalization for patients with major depressive disorder

Major depressive disorder is a common psychiatric condition. Hospitalization is usually indicated for patients with more severe symptoms and severe functional impairment. Rehospitalization is known as the re-emergence of significant depressive symptoms. The purpose of the present study was to investigate the risk factors affecting time to rehospitalization. Rehospitalization status was monitored for all patients with major depressive disorder discharged from Kai-Suan Psychiatric Hospital between 1 January 2002 and 31 December 2003. Patients were followed up with respect to rehospitalization until 31 December 2004. The Kaplan-Meier method was used to calculate the median time to rehospitalization. Risk factors associated with rehospitalization were examined on Cox proportional hazards regression. Three hundred patients were recruited. Median time to readmission was 174 days (SD = 37). Comorbid alcohol abuse/dependence (hazard ratio [HR] = 1.841, 95% confidence interval [CI] = 1.229-2.758, P < 0.01), comorbid personality disorders (HR = 1.530, 95%CI = 1.053-2.223, P < 0.05), and the number of previous hospitalizations (HR = 1.121, 95%CI = 1.056-1.190, P < 0.001) were found to be predictors of the shorter time to rehospitalization over the 360-day study. Further research should be carried out to test risk factors in a prospective study, and to study the cost-effectiveness of interventions to reduce risk factors and rehospitalizations.     

Long-term prognosis and prognostic determinants of patients with first attack of mild and moderate ischemia at Beijing community hospitals

A total of 710 patients with first-ever ischemic stroke were consecutively recruited between January 2003 and December 2004 from five community hospitals/stations in five districts of Beijing, China. As of December 31, 2008, a total of 2 477 person-years were followed-up. During the five-year follow-ups, 117 adverse events occurred, including all-cause death and acute cardiovascular events (recurrent stroke, acute myocardial infarction, and sudden death). The five-year cumulative mortality rate was 2.18/100 person-years (54 cases), with 3.88/100 person-years (96 cases) of acute cardiovascular events and 3.02/100 person-years (75 cases) of recurrent stroke. Multiple factor analyses using the Cox proportional hazards ratio models showed that age, diabetes, and dependence of activities of daily living were independent predictors for death, acute cardiovascular disease events, or recurrent stroke. The results demonstrated that recurrent stroke was a major vascular disease that affected the prognosis of mild or moderate stroke patients. Secondary prevention of stroke patients should include active management of vascular risk factors and rehabilitation.     

Association of obesity with recurrent stroke and cardiovascular events

Background and purposeThe relation between obesity and stroke recurrence is still under debate. In this study, we investigated whether initial obesity was associated with recurrent stroke and major cardiovascular events over a long period of time.Materials and methodsFive-years follow-up data of the Ege Stroke Registry for stroke recurrence and cardiovascular events related to obesity were analyzed. Data include age, gender, stroke severity, neuroimaging studies, cardiovascular risk factors. Within the inclusion period, all of the included patients were followed until censoring (10th of December 2011) or readmission because of recurrent stroke, cardiovascular event or death, whichever came first. The Kaplan-Meier method was used for survival analysis. Cox proportional hazard model was applied to identify predictors of stroke and all major vascular events.ResultsOf 9285 eligible patients for evaluation, 5158 (56%) were male and 3068 (33%) with a prior stroke were obese at baseline. Among 2198 patients with recurrent stroke, 843 (38%) had obesity while 2229 (62%) had no obesity (HR, 1.36; 95% CI, 1.23–1.50; P < 0.001). Overall major vascular events (recurrent stroke, cardiovascular events, and death) occurred in 1464 obese patients (48%) and in 2182 non-obese patients (35%) (HR, 1.69; 95%CI, 1.55–1.84). Cox hazard model showed that being obese was associated with increased recurrent stroke risk compared with those without obesity (HR, 0.85; 95%CI, 0.76–0.94; P < 0.001), being obese was not associated with cardiovascular events (HR, 1.09; 95%CI, 0.95–1.26; P = 0.22).ConclusionsOur results showed that obesity is a significant risk factor for recurrent stroke, although obesity was not associated significantly with myocardial infarction and death after 5-years of first stroke. Further clinical goal-directed weight reduction outcome trials in this area will be critical to validate the most effective approaches and, ultimately, to guide policy is certainly needed.     

Association of hyponatremia in acute stroke stage with three-year mortality in patients with first-ever ischemic stroke

Background: Hyponatremia is the most common electrolyte disorder in hospitalized patients, and is frequently a marker of a significant underlying disease. The prognostic value of hyponatremia in patients with acute first-ever ischemic stroke is not known. We aimed to analyze whether hyponatremia in the acute stroke stage contributed to the risk of mortality or recurrent stroke in these patients. Methods: We studied 925 patients presenting with acute first-ever ischemic stroke between 2002 and 2004. Sodium levels were obtained on arrival at the emergency room within 3 days of acute stroke onset. Hyponatremia was defined as a serum sodium concentration of 134 mmol/l or less. Clinical presentation, stroke risk factors, associated medical disease, and outcome were recorded. All patients were followed for 3 years for survival analysis. A multivariate Cox proportional hazards model was used to identify risk factors for 3-year mortality in these patients. We also constructed Kaplan-Meier survival curves, and compared groups with hyponatremia and normonatremia by means of log rank tests for significant differences. Results: Among the patients with acute first-ever ischemic stroke, 107 (11.6%) were hyponatremic. Among stroke risk factors, the prevalence of diabetes mellitus was significantly higher among hyponatremic patients (p < 0.001). Prevalence of chronic renal insufficiency was also higher in the hyponatremic group (p = 0.002). Clinical presentations, such as the length of acute ward stay, initial impaired consciousness, and clinical course in acute stroke were similar among normo- and hyponatremic patients. Among the complications, pneumonia and urinary tract infection were significantly higher in hyponatremic than in normonatremic patients. After multivariate logistic regression analysis, diabetes mellitus and chronic renal insufficiency were associated with hyponatremia in these patients. Kaplan-Meier analysis indicated that the survival rate was significantly lower in hyponatremic patients than in normonatremic patients (log rank test; p value <0.001). After multivariate Cox proportional hazards model analysis, hyponatremia was a significant predictor of 3-year mortality in these patients after adjustment for related variables (p value = 0.003, hazard ratio = 2.23, 95% confidence interval: 1.30-3.82). Conclusion: Hyponatremia in the acute stroke stage is a predictor of 3-year mortality in patients with acute first-ever ischemic stroke that is independent of other clinical predictors of adverse outcome.     

Medium-term Survival Following of Stroke in Yaoundé (Cameroon): a prospective observational cohort study

BackgroundWith 5.7 million deaths per year, stroke is the second cause of mortality worldwide, and 70% of these deaths occur in developing countries especially in relation to inappropriate clinical pathways and resources. The aim of our study was to assess the survival rate of stroke patients within 90 days and to identify its determinants.MethodsIt was a prospective observational cohort study over a period of 90 days after stroke. Patients were recruited between February and May 2015 in two tertiary hospitals in Yaoundé. The mortality rate was obtained by the Kaplan-Meier method. Multivariate analysis was performed using a Cox proportional hazards model.ResultsSixty-six patients were enrolled of which 54 were followed up to 90 days. The overall mortality rate was 23.2% (95% CI: 12.5–87.5), more than two-thirds of the deaths occurred within the first 30 days. The mortality rates at days 14, 30, 60 day were 9.1% (95% CI: 3.0–16.7), 14.3% (95% CI: 6.3–23.8) and 21.1% (95% CI: 10.5–31.6) respectively. High systolic blood pressure and a low Glasgow coma score on admission were independent risk factors of mortality at 90 days.ConclusionsThe stroke related mortality compels appropriate collective mobilization for an early and adequate management of stroke patients.     

Cardiovascular risk factors and 5-year mortality in the Copenhagen Stroke Study

BACKGROUND: The treatment of cardiovascular risk factors has improved over the recent years and may have improved survival. The aim of this study was to investigate the up-to-date prognostic significance of cardiovascular risk factors for 5-year survival in a large unselected ischemic stroke population. METHODS: We studied 905 ischemic stroke patients from the community-based Copenhagen Stroke Study. Patients had a CT scan and stroke severity was measured by the Scandinavian Stroke Scale on admission. A comprehensive evaluation was performed by a standardized medical examination and questionnaire for cardiovascular risk factors, age, and sex. Follow-up was performed 5 years after stroke, and data on mortality were obtained for all, except 6, who had left the country. Five-year mortality was calculated by the Kaplan-Meier procedure and the influence of multiple predictors was analyzed by Cox proportional hazards analyses adjusted for age, gender, stroke severity, and risk factor profile. RESULTS: In Kaplan-Meier analyses atrial fibrillation (AF), ischemic heart disease, diabetes, and previous stroke were associated with increased mortality, while smoking and alcohol intake were associated with decreased mortality. No association was found for hypertension or intermittent claudication. In the final Cox proportional hazard model predictors of 5-year mortality were AF (hazard ratio, HR 1.4; 95% CI 1.1-1.7), diabetes (HR 1.3; 95% CI 1.0-1.6), smoking (HR 1.2; 95% CI 1.0-1.4), and previous stroke (HR 1.4; 95% CI 1.1-1.7), after adjustment for age, gender, and stroke severity. CONCLUSIONS: AF, diabetes, smoking, and previous stroke significantly affect long-term survival. Although smoking and daily alcohol consumption appeared to be associated with improved survival in the univariate analyses, adjustment for other factors and especially age revealed the lethal effect of smoking, while the positive effect of alcohol disappeared. More focus on secondary preventive measures, such as anticoagulation for AF, smoking cessation, and proper treatment of diabetes may significantly improve long-term survival.     

Total cerebral blood flow estimated by color velocity imaging quantification ultrasound: a predictor for recurrent stroke?

Although the Virchow's triad on thrombosis includes reduced blood flow as a factor, there has been relatively little data on the importance of total cerebral blood flow on the risk of subsequent stroke. In the current study, we investigate whether total cerebral blood flow helps predict stroke recurrence. Extracranial arterial blood flow volume estimated by color velocity imaging quantification ultrasound (CVIQ) is an index of cerebral blood flow measurement. We performed a cohort study of 210 consecutive acute stroke patients. Patients were studied with transcranial Doppler and duplex ultrasound for intra- and extracranial large artery disease within 3 days of symptom onset. The association between the risk of recurrent stroke and CVIQ was analyzed with Cox proportional hazards model. Thirty-nine patients (17.7%) developed an ischemic stroke during a mean follow-up of 47.5 months. The mean extracranial blood flow volume was significantly lower for patients who had a recurrent stroke than those without (594.4+/-130.3 versus 683.8+/-176.9 mL/min; P=0.003). In a Cox proportional hazards model adjusting for potential confounding variables, extracranial blood flow volume (hazard ratio (HR) for lowest tertile, 4.1; 95% confidence interval (CI), 1.5 to 11.0) along with male sex (HR, 2.5; 95% CI, 1.3 to 5.1), diabetes (HR, 2.5; 95% CI, 1.2 to 5.0) and large artery stenosis (HR, 2.2; 95% CI, 1.1 to 4.4) were independent predictors for stroke recurrence. Our data indicated that patient with low amount of blood flow to the brain is at risk of recurrent stroke.     

Do antiphospholipid antibodies increase the long‐term risk of thrombotic complications in young patients with a recent TIA or ischemic stroke?

BACKGROUND: The purpose of our study was to determine the relative risk of thrombotic events in young patients with a recent TIA or ischemic stroke and positive antiphospholipid antibodies (aPL). METHODS: We included 128 consecutive patients aged 18-45 years with a recent TIA or ischemic stroke. All patients underwent computed tomography scanning and were screened for cardiovascular risk factors, cardiac disorders and large vessel disease. Lupus anticoagulant (LA) was screened for by an APTT-based assay and a diluted PT-assay. Anticardiolipin antibodies (aCL) were tested by enzyme-linked immunosorbent assay, using cardiolipin and anti-human IgG and IgM. Thrombotic events could be TIA, stroke, myocardial infarction, deep venous thrombosis or pulmonary embolism. Product limit estimates of the time free of TIA or stroke and of the time free of any thrombotic event were made. The relative risk was estimated by means of a Cox proportional hazards regression model. RESULTS: Of the 128 patients, 22 (17.2%) had aPL. The mean follow-up was 3 years and 3 months (range 41 days to 6 yrs). The incidence of any thrombotic event per 100 patient years of follow-up was 9.0, and the incidence of recurrent stroke or TIA was 7.9. The relative risk of any thrombotic event in patients with aPL was 0.9 (95% CI: 0.3-2.4) and for recurrent ischemic stroke or TIA 0.7 (95% CI: 0.3-2.2). CONCLUSION: In young patients with a recent TIA or ischemic stroke, aPL do not seem to be a strong risk factor for recurrent stroke or TIA, nor for other thrombotic complications.     

一次和多次住院精神分裂症患者再住院分析

目的 :比较 1次和≥ 2次住院精神分裂症患者出院后的再住院率 ,初步探讨影响再住院的相关因素。　方法 :1999年度出院的 833例住院精神分裂症患者纳入调查 ,使用自制的再住院及其相关因素调查表 ,于 2 0 0 3年 12月底前电话或入户调查出院后至少 4 8个月的情况。　结果 :6 6 4例完成调查 ,分为 1次住院组 (333例 )和多次住院组 (331例 )。用生存分析 (Kaplan Meier公式 )比较两组未再住院率 ,12个月末 (分别为 6 7 0 %和 6 1 6 % )、2 4个月末 (5 6 2 %和 4 8 9% )、36个月末 (4 6 0和 35 1% )和 4 8个月末 (4 1 1%和 2 8 7% )。Cox回归风险比例模型分析影响再住院的相关因素显示 ,与药物依从性、生活事件、自知力和家庭照顾相关 (P <0 0 5 ) ,药物依从性对再住院的贡献值 (1 719)最大。　结论 :1次住院精神分裂症患者出院后的再住院率较多次住院者低。药物依从性是影响再住院的主要因素