内蒙古通辽市脑梗死和冠心病危险因素对比分析

目的探索内蒙古通辽市人群脑梗死与冠心病危险因素的分布差异。方法选择内蒙古通辽市2级以上综合医院共10家,抽取3级综合医院3家,2级综合医院3家。对所选医院2003年到2005年病案室神经内科和心血管内科所有符合调查的病历进行回顾性调查分析。结果当地人群脑梗死和冠心病的基线资料除既往糖尿病史没有统计学意义外,其它各项调查指标均有统计学意义。单因素Logistic回归分析结果,13个因素中性别、吸烟、饮酒、高血压、胆固醇等8个有统计学意义。对这8个变量进行多因素Logistic逐步回归分析,性别、民族、既往高血压史、胆固醇、吸烟、高血压6个变量具有统计学意义。结论有统计学意义的因素除吸烟外,其它5项对脑梗死的影响,相对于冠心病较大。     

脑出血昏迷患者继发多器官功能障碍综合征的危险因素分析

目的探讨脑出血昏迷患者继发多器官功能障碍综合征(MODS)的危险因素。方法抽取2014-11—2017-01荥阳市人民医院91例脑出血昏迷患者,根据是否继发MODS分为观察组(n=34)与对照组(n=57)。对2组一般资料[年龄、性别、出血部位(小脑、丘脑、脑叶)、血压、血肿量]、既往病史(糖尿病、高血压、脑卒中、冠心病)、相关评分[昏迷指数(GCS)、病情严重程度评分(APACHE?Ⅱ)]进行对比,分析脑出血昏迷患者继发MODS的危险因素。随访3个月,对比2组预后情况。结果观察组性别、出血部位、既往高血压史、脑卒中史及血压(SBP、DBP)与对照组比较,差异均无统计学意义(P0.05),观察组年龄、既往糖尿病史、冠心病史、血肿量及GCS评分、APACHE?Ⅱ评分与对照组比较,差异均有统计学意义(P0.05)。经Logistic多因素回归分析,年龄、糖尿病史、血肿量及GCS评分、APACHE?Ⅱ评分是脑出血昏迷患者继发MODS的重要危险因素(P0.05)。随访3个月后观察组预后情况较对照组更差,差异有统计学意义(P0.05)。结论脑出血昏迷患者继发MODS预后较差,年龄、既往糖尿病史、血肿量及GCS评分、APACHE?Ⅱ评分是引起脑出血昏迷患者继发MODS的危险因素。     

吸烟与青年脑大动脉粥样硬化性狭窄的相关性分析

目的探讨吸烟与青年缺血性卒中患者脑大动脉粥样硬化性狭窄的相关性。方法2002～2004年于我院神经内科行血管造影检查的青年(18～49岁)脑卒中(包括短暂性脑缺血发作及脑梗死)患者93例,其中73例患者可能存在颅内或颅外大动脉粥样硬化性狭窄作为狭窄组,20例患者无大动脉狭窄作为无狭窄组,对两组患者的吸烟及其他危险因子进行调查。研究变量包括:人口学因子(如年龄、性别)、既往病史(包括高血压、糖尿病、长期吸烟及饮酒史)、实验室检测因子(血浆三酰甘油、高密度脂蛋白、低密度脂蛋白、同型半胱氨酸及血纤维蛋白原)。结果单变量分析发现,两组患者的长期吸烟率、高密度脂蛋白降低率、同型半胱氨酸及三酰甘油的升高率、高密度脂蛋白、纤维蛋白原水平间差别均无显著性意义(P＞0．05)。多变量Logistic回归分析发现,长期吸烟(OR=4．367, 95% CI 1．028-18．554,P=0．046)及血三酰甘油水平升高(OR=3．274,95% CI 1．083-9．900,P=0．036)与青年卒中患者脑大动脉粥样硬化性狭窄的发生有关。结论长期吸烟及血三酰甘油水平升高可能是青年卒中患者脑大动脉粥样硬化性狭窄的独立危险因子,应进行大样本的队列研究加以证实。     

伴智能障碍的脑白质疏松症患者相关危险因素分析

目的分析伴智能障碍的脑白质疏松症(LA)患者的相关危险因素。方法 207例LA患者分为伴有智能障碍组和无智能障碍组,对患者的性别、年龄、高血压病史、糖尿病史、冠心病史及既往脑梗死病史等进行相关因素分析和Logistic回归分析。结果两组年龄、高血压病史、糖尿病史、既往脑梗死病史和LA的严重程度均有显著差异。多因素回归分析最终入选模型的变量是年龄、高血压病史、既往脑梗死病史和重度LA。结论高龄、高血压病史、既往脑梗死病史和重度LA,对LA是否伴智能障碍有独立的提示作用。     

脑卒中高危人群中颈动脉粥样硬化的现况调查及危险因素分析

目的了解脑卒中高危人群颈动脉粥样硬化(Carotid atherosclerosis,CAS)的发病情况及相关的危险因素。方法对海口市美兰区40岁以上的居民筛查,筛选出脑卒中高危人群进一步颈部血管超声检查、实验室检查。分CAS组和非CAS组,统计分析CAS的发病率及相关危险因素。结果 CAS检出率44.7%。性别、年龄、吸烟、肥胖、高血压、高血脂、糖尿病、既往脑卒中史,高Hcy和FBS在2组比较差异有统计学意义(P<0.05)。结论年龄、男性、吸烟、超重、高血压、高血脂、糖尿病、既往脑卒中史,高Hcy和FBS均为海口市美兰区脑卒中高危患者CAS的独立危险因素。     

无症状性脑梗死相关危险因素分析

目的探讨无症状性脑梗死相关危险因素。方法对安阳地区医院神经内科门诊2007-01～2008-01首次就诊经头颅MRI/CT证实有腔隙性梗死灶,临床无特异性症状89例患者,分别记录患者的性别、年龄、既往史、实验室检查结果、颈动脉多普勒超声检查,并对上述数据进行统计学分析。结果 13项数据运用Logistic回归法进行分析,相关危险因素显示有统计学意义的变量是高血压史、糖尿病史、高脂血症史、吸烟史、高同型半胱氨酸血症,颈动脉多普勒超声检查发现颈动脉粥样硬化性狭窄。可认为高血压、糖尿病、高脂血症、吸烟史、高同型半胱氨酸症、颈动脉狭窄患者无症状性脑梗死发病率高。结论高龄、高血压、糖尿病、高脂血症、吸烟、高同型半胱氨酸症、颈动脉狭窄可能是无症状性脑梗死患者的危险因素。     

脑卒中及其危险因素分析

目的 调查脑卒中危险因素分布情况.方法 回顾性分析2128例脑卒中患者不同危险因素的发生率,以及年龄、性别、血压、血糖、心脏病、吸烟、血清甘油三酯(TG)浓度、总胆固醇(TC)浓度、高密度脂蛋白胆固醇(HDL-C)浓度、低密度脂蛋白胆固醇(LDL-C)浓度对脑梗死和脑出血影响的差异.结果 脑卒中危险因素的发生率从高到低依次为高血压病、高血脂症、吸烟、糖尿病、心脏病;且年龄＞60岁、高血压病、糖尿病、心脏病、吸烟、TG＞3.36 mmol/L、HDL-C＜1.04 mmol/L导致脑梗死的风险分别为脑出血的2.02、0.67、3.05、5.16、1.34、1.29、1.61倍.结论 相对于脑出血,与脑梗死显著相关的因素依次有心脏病、糖尿病、年龄＞60岁、低HDL-C、吸烟、高TG;相对于脑梗死,与脑出血显著相关的是高血压病.     

脑小血管病各亚型相关危险因素分析

目的：研究脑小血管病各亚型的危险因素,为其有效防治提供依据。方法连续入组脑小血管病患者216例,均行MRI常规序列和GRE-T2*WI检查,依据结果将其分为腔隙性梗死（LI）、脑白质病变（WML）及脑微出血（CMBs）三种亚型,登记所有患者基线资料,应用非条件Logistic回归模型完成单因素及多因素分析。结果非条件 Logistic回归分析显示与LI有统计学意义的相关变量为高血压、血脂异常、糖尿病;与WML有统计学意义的相关变量为LI、高血压、血脂异常、脑动脉狭窄、高同型半胱氨酸血症;与CMBs有统计学意义的相关变量为年龄、LI、WML、性别、脑出血、高血压。结论 LI的危险因素为高血压、血脂异常、糖尿病;WML的危险因素为LI、高血压、血脂异常、脑动脉狭窄、高同型半胱氨酸血症;CMBs的危险因素为年龄、LI、WML、性别、脑出血、高血压。     

脑血管病后癫痫的临床特征及危险因素分析

目的探讨脑血管病后癫痫(PSE)的临床特点及相关危险因素。方法分析528例脑血管病患者的临床特征,随访癫痫发作的情况,包括发作时间、发作类型、病变部位及预后等,通过单因素及多因素统计分析PSE发作的相关危险因素。结果 PSE与性别、年龄、高血压史、糖尿病史、冠心病史、房颤、吸烟史等因素无明显相关性,而与既往卒中病史、累及皮质、多脑叶病灶呈相关性。结论既往患者有卒中病史、脑出血患者以及病灶累及多脑叶、皮质者更容易继发癫痫。     

缺血性卒中患者颅内动脉狭窄的相关危险因素分析

目的 探讨颅内动脉狭窄的狭窄程度、相关危险因素与缺血性脑卒中的关系,为缺血性卒中的防治提供重要依据.方法 90例缺血性卒中患者根据全DSA检查结果分为非狭窄组(狭窄<30%)与颅内动脉狭窄组(狭窄≥30%或闭塞),分析颅内动脉狭窄程度与年龄、性别、高血压、糖尿病、高脂血症、冠心病、家族史、总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白胆同醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白 A1(ApoA1)、载脂蛋白B(ApoB)、血清脂蛋白(Lpa)等相关危险因素的关系.结果 (1)本组患者颅内动脉狭窄发生率为67.78%,发生率最高为大脑巾动脉,其次颈内动脉颅内段和椎基底动脉颅内段,发生率最低为大脑后动脉.(2)有高血压、糖尿病的缺血性卒中患者容易发生颅内动脉狭窄,其同归系数、OR值、P值分别为1.659、5.256、0.002,1.657、5.241、0.046.(3)颅内动脉狭窄组HDL-C含量[(0.99±0.30)mmol/L]比非狭窄组[(1.30±0.50)mmol/L]明显降低,差异有统计学意义(t=3.603,P=0.001).(4)年龄、性别、吸烟、既往卒中史、脑血管病家族史、TC、TG、LDL-C、ApoA1、ApoB、Lpa在两组间比较差异无统计学意义(P>0.05).结论 缺血性卒中患者颅内血管狭窄的主要危险因素有高血压、糖尿病,保护因素有HDL-C.     

Risk factors for intracerebral hemorrhage and coronary heart diseases over a 3-year period in patients admitted to some hospitals of Tongliao city of Nei Monggol Autonomous Region

BACKGROUND: Intracerebral hemorrhage(ICH) and coronary heart disease (CHD) have the same pathological base, atherosclerosis, and the similar risk factors,such as smoking ,drinking, hypertension, hyperlipemia, diabetes mellitus, etc; but the distributions of two diseases are very different in the populations. This may be related to the exposure of risk factors and different effects of risk factors on two diseases. OBJECTIVE: To analyze the distribution difference of risk factors for ICH and CHD in the populations of Tongliao city of Nei Monggol Autonomous Region. DESIGN: Retrospective analysis. SETTING: School of Radiation Medicine and Public Health, Soochow University; Tongliao Hospital, Nei Monggol Autonomous Region. PARTICIPANTS: Random sampling was used to select 6 hospitals from 10 hospitals affiliated to Tongliao City of Nei Monggol Autonomous Region. Totally 1 672 medical records of patients with ICH and 2 195 medical records of patients with CHD admitted to Department of Neurology and Department of Cardiovascular Internal Medicine of above-mentioned 6 hospitals between January 2003 and December 2005 were collected according to the investigation need. METHODS: The subjects, whose medical records were involved, were performed retrospective analysis with pre-prepared questionnaire "Stroke and Coronary Heart Disease Epidemiologic Questionnaire". The main contents included: ①Social demography condition: The distributions of gender, age, nationality, etc. ②Previous history of disease: hypertension, diabetes mellitus, etc. ③Related risk factors: systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, smoking, drinking and glucose (GLU). The database of Epidata was transformed to SPSS database. Single-and multiple-factor non-conditional Logistic regression analysis were performed on the data, and OR value and 95% CI were calculated. The distribution differences of risk factors for two diseases were compared. MAIN OUTCOME MEASURES: Single- and multi-factor non-conditional Logistic regression analysis results of each factor of patients. RESULTS: Single-factor non-conditional Logistic regression analysis showed that statistical significance existed in gender, age, nationality, smoking, drinking, history of hypertension, history of diabetes mellitus, hypertension, triglyceride (TG), and GLU ten factors（OR =0.199, OR 95% CI 0.142–0.280 to OR =7.484, OR 95% CI 6.186–9.054, P < 0.01）. ②The results of multiple-factor non-conditional Logistic regression analysis showed 8 factors including age, gender, smoking, hypertension, history of hypertension, history of diabetes mellitus, GLU and TG（OR =0.203, OR 95% CI 0.114–0.361 to OR =8.262,OR 95% CI 5.466–12.491, P < 0.01）. CONCLUSION: ICH and CHD are the diseases induced by various risk factors. Significant difference exists in gender, age, smoking, hypertension, history of hypertension, GLU, history of diabetes mellitus and TG.     

血压水平与高血压脑卒中发病风险的关系研究

目的探讨血压与其他危险因素并存时对于高血压脑卒中患病率的影响,从而有效预防处于危险状态人群卒中的初发以及卒中幸存者的卒中再发。 方法选择自2014年5月至2015年5月在徐州市中心医院心内科住院治疗2 396例原发性高血压患者的病例资料,包括年龄、性别、体质指数(BMI)、血压、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、空腹血糖(GLU)、同型半胱氨酸(Hcy)以及疾病既往史等,采用Logistic回归模型,引入交叉乘积项分析血压与其他危险因素对于原发性高血压脑卒中患病率的影响。 结果2 396例原发性高血压患者中,与血压达标者相比,未达标者空腹GLU的水平显著升高[(6.13±1.91) mmol/L对比(6.45±2.24) mmol/L,t=2.652,P=0.003],而HDL-C的含量显著降低[(39.27±11.97) mmol/L对比(36.28±11.45) mmol/L,t=4.702,P=0.000],合并糖尿病、脑卒中及高同型半胱氨酸血症的比例明显增加(χ²分别为4.910,140.630,44.284,P<0.05)。在年龄45~74岁以及BMI、空腹GLU、非HDL-C、TG、Log Hcy的不同分层中,高血压患者随着血压水平的升高,脑卒中的患病率逐渐增加(P<0.05)。 结论血压与Hcy的交互作用能够增加高血压患者脑卒中的患病率。对于高血压合并脑卒中患者,年龄与性别对非HDL-C、TG水平的影响存在交互。     

蛛网膜下腔出血患者继发症状性脑血管痉挛的相关危险因素分析

目的 研究探讨动脉瘤性蛛网膜下腔出血（subarachnoid hemorrhage,SAH）继发症状性脑血管痉挛 （symptomatic cerebral vasospasm,SCVS）的相关危险因素,为SCVS的防治提供参考。 方法 回顾性分析96例SAH患者临床资料,对性别、年龄、高血压史、糖尿病史、Fisher分级等影响因 素进行统计学分析。 结果 96例患者中发生SCVS的患者共39例,单因素分析结果显示SCVS组与非SCVS组在年龄、高血 压、吸烟、脑室内积血、Hunt-Hess分级、Fisher分级、数字减影血管造影（digital subtraction angiography, DSA）显示血管痉挛程度、尼莫地平使用等方面差异有显著性;多因素Logistic回归分析结果显示：低 龄、高血压史、Fisher分级是发生SCVS的危险因素,其比值比（odds ratio,OR）分别为0.567、1.982和 2.713;而尼莫地平的使用是SCVS发生的保护因素,OR为0.799。 结论 SAH后SCVS是多种因素共同作用的结果,其中低年龄、高血压史、Fisher分级是SCVS的独立危 险因素,尼莫地平使用为保护因素。     

颈内动脉闭塞患者危险因素的Logistic回归分析

目的探讨颈内动脉闭塞的相关危险因素。方法回顾性分析2003年1月～2008年3月北京友谊医院收治的94例颈内动脉闭塞患者的危险因素,并与2007年1月～2007年6月收治的105例（无颈内动脉闭塞）缺血性脑血管病患者（对照组）的危险因素进行比较,并进行多因素Logistic回归分析。结果2组间缺血性脑血管病常见的危险因素如高血压病、高脂血症、糖尿病、高龄和饮酒史,无统计学差异（P〉0．05）,而性别、脑卒中病史及吸烟史3个因素在2组间具有统计学意义（P〈0．05）。将男性、脑卒中病史及吸烟史3个变量代入Logistic回归方程行多因素分析显示,3种相关危险因素中性别与颈内动脉闭塞相关性最高（P=0．041）,吸烟史和脑卒中病史为仅次于性别的危险因素。结论性别、脑卒中病史及吸烟史是颈内动脉闭塞的重要相关危险因素,临床应加强脑卒中的二级预防,并加强戒烟宣传等工作。     

Aneurysmal and clinical characteristics as risk factors for intracerebral haematoma from aneurysmal rupture

Intracerebral haematoma (ICH) occurs in one-third of patients with aneurysmal subarachnoid haemorrhage (SAH) and is associated with poor prognosis. Identification of risk factors for ICH from aneurysmal rupture may help in balancing risks of treatment of unruptured aneurysms. We assessed potential clinical and aneurysmal risk factors for ICH from aneurysmal rupture. In all 310 SAH patients admitted to our service between 2005 and 2007, we compared clinical risk factors (gender, age, smoking, hypertension, history of SAH and family history) of patients with and without an ICH. From the latest admitted, 50 patients with and 50 without ICH, we compared the location, shape and direction of blood flow of the aneurysms on CT-angiography. Relative risks (RRs) of ICH were 1.2 (95% confidence interval, CI):0.7–1.8) for males, 1.0 (95%CI:0.7–1.4) for age ≥55 year, 1.0 (95%CI:0.6–1.6) for smoking, 0.9 (95%CI:0.5–1.5) for hypertension, 0.6 (95%CI:0.1–3.8) for history of SAH and 0.5 (95%CI:0.2–1.3) for family history of SAH. RRs of ICH were 1.8 (95%CI:1.2–2.5) for MCA aneurysms, 0.5 (95%CI:0.3–1.0) for ICA aneurysms, 0.4 (95%CI:0.1–1.3) for posterior circulation aneurysms, and 0.7 (95%CI:0.3–1.3) for multilobed aneurysms. The RRs of other aneurysmal characteristics varied between 0.9 and 1.2. Patients with MCA aneurysms are at a higher risk of developing ICH. The other aneurysmal or clinical factors have no or only minor influence on the risk of ICH after rupture and are, therefore, not helpful in deciding on treatment of unruptured aneurysms.     

Risk Factors of Intracerebral Hemorrhage: A Case-Control Study

Background: Hypertension is a well-known risk factor for intracerebral hemorrhage (ICH). On many of the other potential risk factors, such as smoking, diabetes, and alcohol intake, results are conflicting. We assessed risk factors of ICH, taking also into account prior depression and fatigue. Methods: This is a population-based case-control study of 250 primary ICH patients, conducted in Helsinki University Hospital, Finland. The controls (n = 750) were participants of the FINRISK study, a large Finnish population survey on risk factors of chronic noncommunicable diseases, matched with cases by sex and age. Ages were matched in 5-year age bands. However, as the oldest FINRISK participants were 74-year-olds, controls for the age group 75-84 were selected from the age group of 70-74 years. Patients aged greater than or equal to 85 years were excluded. Patients and controls were compared in univariate analyses. The age categories less than 70, and greater than or equal to 70 years were also analyzed separately. Binary logistic regression analysis was performed for variables with P less than .1 in univariate analysis. Results: Analyzing all cases and controls, the cases had more hypertension, history of heart attack, lipid-lowering medication, and reported more frequently fatigue prior to ICH. In persons aged less than 70 years, hypertension and fatigue were more common among cases. In persons aged greater than or equal to 70 years, factors associated with risk of ICH were fatigue prior to ICH, use of lipid-lowering medication, and overweight. Conclusions: Hypertension was associated with risk of ICH among all patients and in the group of patients under 70 years. Fatigue prior to ICH was more common among all ICH cases.     

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。     

Previous antiplatelet therapy is an independent predictor of 30–day mortality after spontaneous supratentorial intracerebral hemorrhage

Background Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes. Despite several existing outcome prediction models for ICH, there are some factors with equivocal value as well as others that still have not been evaluated. Patients and methods All patients with first ever supratentorial ICH presenting to our institution between December 1995 and December 2002 were prospectively enrolled into the study. Patients with historic modified Rankin Scale > 2 and those under anticoagulant treatment or with multiple ICH were excluded. The following parameters were analyzed in 194 consecutive patients: age, gender, past history of hypertension, diabetes mellitus, hypercholesterolemia, past history of ischemic stroke, presence of ischemic heart disease or cardioembolic disease, current antiplatelet treatment, current alcohol overuse, smoking, Glasgow Coma Scale score (GSS) at admission, volume and location (deep or lobar) of ICH, ventricular extension, glycemia and temperature at admission, and leukoaraiosis. We correlated these data with the 30–day mortality identifying the independent predictors by logistic regression analysis. Results Factors independently associated with 30–day mortality were: age, Glasgow Coma Scale score at admission, ICH volume, ventricular extension, glucose level at admission, and previous antiplatelet use. Conclusions Apart from the classical outcome predictors, the previous use of antiplatelet agents and the glucose value at admission are independent predictors of 30–day mortality in patients suffering a supratentorial ICH.