Logistic regression analysis on risk factors for vascular dementia following cerebral infarction in 403 patients from Chongqing City——Hospital and family follow-up studies

BACKGROUND: Studies have demonstrated that the risk factors of vascular dementia following stroke are greatly different in region, race and other aspects. OBJECTIVE: To analyze the conditions and incidental risk factors of vascular dementia in patients with acute cerebral infarction from Chongqing City. DESIGN: Case analysis. SETTING: Department of Neurology, Daping Hospital, Third Military Medical University of Chinese PLA. PARTICIPANTS: Altogether 546 inpatients with acute ischemic stroke admitted to Department of Neurology, Daping Hospital, Third Military Medical University of Chinese PLA between May 1999 and December 2002 were involved in this study. The involved patients, including 295 males and 251 females, aged 55–94 years, dwelled in Chongqing over 5 years. They were admitted to hospital within 48 hours of attack of acute ischemic stroke, and survived for over 3 months. Informed consents were obtained from all the involved subjects. METHODS: ① Following the same standard, cognitive and social function evaluations were conducted by one physician on admission and 3 months after admission. Unified questionnaire, consisting of general characteristics, vascular risk factors, stroke characteristics, neurological physical sign, and other 28 factors of involved subjects, was used in all the patients. According to the investigation results, the patients were assigned into 2 groups: dementia group and non-dementia group. ②Ischemic stroke was diagnosed according to acute ischemic brain disorder > 24 hours and CT or MRI imageology. ③ Neurophysiological examination was conducted in all the patients at 7 to 10 days after stroke (score was two SD less than or equaled to normal level was considered as abnormal). ④Diagnosis and statistics of dementia were carried out with Mini-Mental State Examination and The Diagnostic and Statistical Manual of Mental Disorders-Ⅳ (published by American Psychiatric Association) on admission and 3 months after admission. Neurologic deficit scoring was carried out with the National Institutes of Health Stroke Scale. ⑤ Chi-square test was used for categorical variable, and t test for quantitative variable between dementia group and non-dementia group. Dementia-related factors were performed multiple-factor Logistic regression model analysis. MAIN OUTCOME MEASURES: Incidence of dementia and dementia-related risk factors of patients. RESULTS: Altogether 546 patients with stroke were involved in this study, 403 of them participated in the final analysis, and 143 dropped out. A total of 342 were followed-up in the hospital and 61 at home. At 3 months after cerebral infarction, vascular dementia occurred in 87 (21.6%) of 403 patients. The main risk factors were age (OR 1.179; 95%CI 1.130–1.230), low education level (OR 1.806; 95%CI 1.024–3.186), daily alcohol drinking (OR 3.447; 95%CI 1.591–7.468), stroke history (OR 2.531; 95%CI 1.419–4.512), atrial fibrilation(OR 3.475; 95%CI 1.712–7.057), dysphonia (OR 5.873; 95%CI 2.620–13.163) and left carotid artery infarction (OR 1.975; 95%CI 1.152–3.388). CONCLUSION: The incidence of vascular dementia is determined by synthetic action of multiple risk factors. Dysphonia is the most important influencing factor.     

颅脑外伤后脑梗死危险因素分析

目的分析探讨颅脑外伤后脑梗死的发生机制以及危险因素。方法采用回顾性研究方法,调查110例颅脑外伤病例,分析颅脑外伤后脑梗死的相关因素。结果颅脑损伤后并发脑梗死与GCS评分、年龄、有无蛛网膜下腔出血、有无脑疝、是否有高血压病史有关,差异有统计学意义(P<0.05),与患者性别、受伤原因以及类型无关,差异无统计学意义(P>0.05)。结论中、重型颅脑外伤患者有脑疝、蛛网膜下腔出血及高龄、合并高血压病史易发生外伤性脑梗死。对脑外伤的及早综合治疗,积极预防脑梗有助于改善患者预后,降低致残及死亡率,提高患者的生存质量。     

进展型脑梗死危险因素的分析

目的 探讨进展型脑梗死(PCI)的危险因素.方法 对50例PCI患者及51例非PCI患者的临床资料中21个因素进行对比分析,并用多元Logistic回归分析各因素与PCI的关系;多元相关分析各危险因素间的相关性.结果 PCI组的糖尿病史、高血压病史、TIA史、CT早期梗死征象、低蛋白血症、感染和发热的比例、入院时血糖和纤维蛋白原水平明显高于非PCI组(均P＜0.05);多元Logistic回归分析显示,糖尿病史(P=0.030)、入院时感染和发热(P=0.016)、CT早期梗死征象(P=0.009)和低蛋白血症(P=0.042)是PCI的主要危险因素;多元相关分析显示该4项因素间没有相关性.结论 糖尿病史、发病后感染和发热、低蛋白血症和CT早期梗死征象是PCI的独立危险因素.     

伴房颤的急性脑梗死患者梗死灶分布特点及相关因素分析

目的研究伴房颤的急性脑梗死患者梗死灶分布特点,并对患者的相关临床资料进行分析。方法回顾性分析78例伴房颤的急性脑梗死患者和123例单纯急性脑梗死患者临床和影像学资料,比较两组间性别构成、年龄、既往史、美国国立卫生研究院神经功能缺损评分(NIHSS)、脑梗死灶分布等差异。结果与单纯急性脑梗死患者比较,伴房颤的急性脑梗死患者入院NIHSS评分、年龄以及合并糖尿病、冠心病病史比例较高,梗死部位以累及前循环、右半球最为多见(均P0.05),而在性别构成以及合并高血压、血脂异常比例方面无统计学差异(均P0.05)。结论伴房颤的急性脑梗死患者较单纯急性脑梗死患者病情重,病灶多位于前循环和右半球,其发病与年龄以及合并糖尿病、冠心病病史密切相关。     

The G79A polymorphism of protein Z gene is an independent risk factor for cerebral venous thrombosis

Background and purpose   Protein Z (PZ), a vitamin Kdependent protein, plays a role in inhibiting coagulation. Its plasma level or PZ gene polymorphisms have been discussed as risk factors for stroke with conflicting results reported between various studies. Only one of these polymorphisms was studied in a cohort of patients suffering from cerebral venous thrombosis (CVT). Methods   We performed a retrospective genetic study comparing 100 healthy controls to 54 patients referred to our hemostasis unit after CVT occurrence. We compared the distribution of three PZ gene polymorphisms that may influence PZ plasma levels: A-13G in the promoter and G79A in intron F were tested using previously described techniques, and we developed a technique to evaluate the G-103A in intron A. Results   The G79A polymorphism was significantly more frequent in patients than in controls (p = 0.012): the presence of at least one A allele led to an odds ratio of 2.57 with a 95 % confidence interval of 1.23–5.34. The A-13G polymorphism also showed a nonsignificant trend towards a higher prevalence in patients. Conclusion   The G79A polymorphism of the PZ gene was shown to be a new independent risk factor for cerebral venous thrombosis. Nevertheless, these results have to be confirmed by a prospective study including plasma PZ evaluation.     

颅脑创伤后动静脉性脑梗死的相关风险因素

目的探讨颅脑创伤后动、静脉性脑梗死的相关风险因素。方法回顾性分析我院2012-06—2014-11收治的169例中重型颅脑创伤患者的临床资料,分别采用单因素分析和Logistic回归分析对资料进行处理,总结颅脑创伤后影响动脉和静脉损伤的风险因素。结果单因素分析发现,年龄≥60岁、瞳孔散大、中线移位≥10mm、环池消失、GCS评分≤8分、合并伤及低血压是动脉性梗死发生的危险因素(P0.05)。而合并伤、大脑浅静脉损伤及D-二聚体值增高等是静脉性梗死发生的危险因素(P0.05)。Logistic回归分析发现,低血压和瞳孔散大是导致动脉性脑梗死发生的独立危险因素(P0.05),大脑浅静脉损伤是静脉性脑梗死发生的独立危险因素(P0.05)。结论低血压和瞳孔散大是导致动脉性脑梗死发生的独立危险因素,大脑浅静脉损伤是静脉性脑梗死发生的独立危险因素,在颅脑损伤后脑梗死的防治中应加强干预。     

急性大血管闭塞性脑梗死的危险因素分析

目的探讨急性大血管闭塞性(LVO)脑梗死的危险因素。方法根据影像学检查将206例急性脑梗死患者分为前循环脑梗死组及后循环脑梗死组,进一步分为LVO亚组及非LVO亚组。收集患者的临床资料并进行分析。结果与前循环脑梗死组非LVO亚组比较,LVO亚组女性、心房纤颤、意识障碍、凝视、面瘫、上肢瘫痪、下肢瘫痪、感觉障碍、失语比率及NIHSS评分显著升高(均P<0.05),共济失调比率显著降低(P<0.05)。与后循环脑梗死组非LVO亚组比较,LVO亚组心房纤颤、意识障碍比率及NIHSS评分显著升高(均P<0.05)。多因素Logistic回归分析显示,女性、心房纤颤是前循环大血管闭塞的独立危险因素(OR=0.498,95%CI:0.254～0.979;OR=2.484,95%CI:1.259～4.899),凝视、失语对预测前循环大血管闭塞有统计学意义(OR=4.487,95%CI:1.791～11.243;OR=5.113,95%CI:1.773～14.744)。结论女性、心房纤颤是前循环大血管闭塞的独立危险因素,凝视、失语对预测前循环大血管闭塞有统计学意义。     

胰岛素抵抗与脑梗死危险因素关系的研究

目的：研究胰岛素抵抗与动脉硬化性脑梗死危险因素的关系。方法：用常规方法测定９１例脑梗死患者和８０例健康人群的空腹血糖、胰岛素、血脂、组织行溶酶原激活物（ｔ－ＰＡ）、组织型纤溶酶原激活物抑制剂（ＰＡＩ－１）的血压水平。结果：脑梗死组的胰岛素敏感性指数（ＩＳＩ）显著低于正常对照组,ＩＳＩ与收缩压、舒张压、ＴＧ、ＡＰＯＢ、ＰＡＩ－１水平负相关,与ＨＤＬ正相关。结论：胰岛素抵抗与高血压、高ＴＧ、低ＨＤＬ血     

Anticardiolipin antibodies are an independent risk factor for ischemic stroke

Abstract

Our aim was to determine if anticardiolipin antibodies are an independent risk factor for ischemic stroke and to determine their influence on stroke type and clinical outcome. We prospectively studied 194 consecutive patients with ischemic stroke admitted within 48 h of stroke. A control group consisted of 7 00, age and sex matched, healthy individuals. Neurological and functional status was assessed on admission, at 30 days, and at 1 year. IgC anticardiolipin antibodies were significantly more frequent in stroke patients (25.3%) than controls (6%, p < 0.05). A multivariate analysis suggested that anticardiolipin antibodies are an independent risk factor for ischemic stroke in addition to hypertension and atrial fibrillation (RR=2.94, p < 0.05). Elevated IgG anticardiolipin antibodies were associated with cognitive impairment as measured by the Mini Mental State Examination at 30 days and at 7 year. IgC anticardiolipin antibodies did not correlate with stroke recurrence, or mortality at 30 days or 7 year. [Neurol Res 1999; 21: 653-657]     

急性脑梗死患者脑动脉狭窄的分布及危险因素分析

目的分析急性脑梗死患者脑动脉狭窄的具体分布特点以及相关危险因素。方法选取焦作煤业集团中央医院2010-02—2017-02收治的516例急性脑梗死脑动脉狭窄患者为研究对象,所有患者经DSA(数字减影血管造影)证实,将其归为观察组,再选取同时期焦作煤业集团中央医院诊治的386例无脑动脉狭窄的脑梗死患者为对照组,分析观察组患者的脑动脉狭窄分布情况,同时对脑动脉狭窄形成的影响因素行单因素与多因素Logistic回归分析,明确影响脑动脉狭窄的相关危险因素。结果320例为单纯颅内动脉狭窄,构成比为62.0%;88例为单纯颅外动脉狭窄,构成比为17.1%;108例为颅内合并颅外动脉狭窄,构成比为20.9%。376例为前循环动脉狭窄,构成比为72.9%;140例为后循环动脉狭窄,构成比为27.1%。脑动脉狭窄以颅内动脉狭窄、前循环动脉狭窄为主。多因素Logistic回归分析显示,脑动脉狭窄形成的独立危险因素包括尿酸(UA)、收缩压、吸烟(P<0.05)。结论急性脑梗死患者脑动脉狭窄以颅内动脉狭窄、前循环动脉狭窄为主,UA、收缩压、吸烟为脑动脉狭窄形成的独立危险因素。     

左心室舒张功能减低是青年高血压病患者罹患脑梗死的独立预测因素——一项回顾性调查研究

目的探讨左心室舒张功能减低与青年高血压病患者急性脑梗死的相关性。方法收集2014年10月~2018年2月宝鸡市第二中医医院神经内科收治的青年急性脑梗死同时患有高血压病的患者92例(观察组),同时选取同期患有高血压病的青年体检患者98例(对照组)。对两组患者都进行心脏彩色多普勒检查,观察患者的左心室舒张功能,并分析左心室舒张功能减低与急性脑梗死的关系。结果 190例青年高血压病患者中,左心室舒张功能正常者18例,占9. 47%,左心室舒张功能减低者172例,占90. 53%,其中127例为左心室舒张功能减低1级,占66. 84%(127/190),55例为左心室舒张功能2级,占28. 95%(55/190),8例为左心室舒张功能3级,占4. 21%(8/190)。观察组患者IVRT、Ea/Aa及A’值分别为(114. 97±10. 16)、(0. 79±0. 11)和(5. 21±1. 03),对照组分别为(72. 86±8. 75)、(1. 3±0. 25)和(5. 02±0. 82),差异有统计学意义(P 0. 05)。观察组患者左心室舒张功能减低IVRT、Ea/Aa及A’值和急性脑梗死发生之间有相关关系(r=0. 53,r=0. 61,r=-0. 59)。结论青年左心室舒张功能减低与高血压病有关,左室舒张功能减低可能是青年高血压病患者罹患急性脑梗死的独立预测因素。     

Hospitalization for depression is associated with an increased risk for myocardial infarction not explained by lifestyle, lipids, coagulation, and inflammation: the SHEEP Study.

BACKGROUND: Depression is considered a risk factor for coronary heart disease (CHD) in initially CHD-free populations. Subclinical CHD or other somatic causes of depressive symptoms might account for the association, however. METHODS: In this case-control study, patients had had their first acute myocardial infarction (AMI). The study included 1799 cases, aged 45-70 years, and 2339, age-, gender-, and hospital-catchment-area-matched control subjects. We calculated odds ratios (OR) with 95% confidence intervals (CI) by multivariate logistic regressions to assess the AMI risk associated with a hospitalization for depression. RESULTS: Forty-seven cases and 22 control subjects had been hospitalized for depression. After adjustment for matching criteria and socioeconomic status, the OR for AMI was 2.9 (1.8-4.9) for ever hospitalized for depression. Patients hospitalized for depression before or after the median time, 15 years and 2 months, between the first hospitalization for depression and AMI, were at similar risk. Adjustment for lifestyle, lipid profile, coagulation, inflammation, prior cardiovascular events, and comorbidity only partly decreased the observed association. CONCLUSIONS: Depression was associated with increased risk for AMI. Subclinical CHD or other somatic causes are unlikely to account for our findings, which also appear not to be explained by established risk factors for AMI.     

出血性脑梗死的相关危险因素分析

目的探讨出血性脑梗死的相关危险因素。方法回顾性分析本院2007-09~2010-08收住的685例脑梗死患者的临床资料。结果出血性脑梗死组患者在大面积梗死、房颤、高血压、高血糖等方面的发生率均高于同期非出血性脑梗死组。结论大面积梗死、房颤、高血压、高血糖等是出血性脑梗死的相关危险因素。     

2型糖尿病患者伴发脑梗死危险因素的研究

目的 探讨2型糖尿病伴发脑梗死的危险因素。方法 对32例2型糖尿病伴发脑梗死患者（A组）及30例单纯2型糖尿病患者（B组）分别询问生活习惯、病史，检测血脂、血糖、体质量、身高，超声检测颈总动脉内-中膜厚度（CCA—IMT）、斑块的发生率等，并进行相关性分析。结果 A、B两组间患者在年龄、吸烟史、糖尿病病程、以及高密度脂蛋病白、空腹血糖水平比较差异有显著性（均P〈0．05）；体质量指数、血总胆固醇、纤维蛋白原、糖化血红蛋水平的比较差异具有极显著性（均P〈0.01）；CCA—IMT及斑块发生率的比较差异也具有显著性（P〈0．05～0．01）；CCA—IMT与年龄、糖尿病病程、血纤维蛋白原、空腹血糖、糖化血红蛋白水平明显正相关（r分别为0．58、0.37、0．45、0.39、0．48，均P〈0．01），与血高密度脂蛋白水平呈负相关（r=-0．41，P〈0．05）。结论 观察空腹血糖、糖化血红蛋白、高密度脂蛋白、纤维蛋白原，监测CCA—IMT及斑块情况，适时干预，对2型糖尿病患者预防脑梗死并发症是有价值的。     

Etiology of and risk factors for cerebral infarction in young adults in western Norway: a population-based case-control study

We sought to study the etiology of and risk factors for cerebral infarction in young adults in Hordaland County, Norway. All patients aged 15-49 years living in Hordaland County with a first-ever cerebral infarction during 1988-97 were included. Etiology was analyzed in subgroups defined by sex, age (<40 years versus >/=40 years), circulation territory (anterior versus posterior circulation) and short-term functional outcome [modified Rankin score (mRS) 2]. A questionnaire was used to evaluate possible risk factors amongst the patients compared with an age- and sex-matched control group. The distribution of etiology was significantly different in all subgroups. Atherosclerosis was frequent amongst men (22.8% vs. 4.2%) and patients >/= 40 years (20.8% vs. 2.7%). All patients with microangiopathy had favorable short-term outcome. Significant risk factors were smoking more than 15 cigarettes per day (P < 0.001), hypertension (P = 0.001), and myocardial infarction (P = 0.035). Modifiable risk factors were frequent.     

阿替普酶溶栓治疗急性脑梗死早期神经功能恶化的相关危险因素分析

目的 分析阿替普酶溶栓治疗急性脑梗死早期神经功能恶化的相关危险因素。方法 选择2013年1月-2018年6月本院神经内科收治的发病4.5 h内给予阿替普酶溶栓治疗的急性脑梗死患者114例,根据阿替普酶治疗后是否发生早期神经功能恶化(Early neurologic deterioration,END)分为恶化组(43例)和非恶化组(71例),收集2组临床基线资料,分析阿替普酶溶栓治疗患者发生END的危险因素。结果 恶化组饮酒人数、吞咽功能障碍人数、责任大血管闭塞数、心源性脑栓塞数、白细胞计数、TC、LDL-C、脂蛋白(a)、ApoB、肌酐水平等指标均显著高于非恶化组(P均<0.05),而HDL-C水平明显低于非恶化组(P<0.05),而其它基线资料比较无明显差异(P均>0.05); Logistic回归分析显示脂蛋白(a)、HDL-C水平、责任大血管闭塞、心源性脑栓塞均与患者溶栓后发生END显著相关(P<0.05)。结论 脂蛋白(a)及HDL-C水平异常、责任大血管闭塞、心源性脑栓塞等均为溶栓治疗急性脑梗死END的独立危险因素。