心肌梗死与缺血性脑卒中发病危险因素的差异

心肌梗死和缺血性脑卒中是人类死亡、致残的主要原因,二者有着相似的危险因素和共同的病理基础,但不同危险因素对二者作用强度存在差异。认识各种危险因素对心肌梗死和缺血性脑卒中的作用强度、特点,有助于更有效地防治心血管疾病。     

Differentiation between Stroke Subtypes and the Causes of Monthly Variations: The Akita Stroke Registry

Objective It has been established that stroke occurrence is influenced by seasonality. Stroke is divided into three subtypes: cerebral hemorrhage (CH), cerebral infarction (CI), and subarachnoid hemorrhage (SAH). The purpose of this paper was to analyze stroke events by subtype and month, in order to clarify the biggest factors that affect seasonal differences and thereby gain insight into stroke prevention. Methods Initial stroke events in the Akita Stroke Registry from 1991 to 2010 (58,684 cases; male 30,549, female 28,135) were classified by subtype and the month of onset, and correlations were estimated based on 115 healthy volunteers'' monthly mean resting blood pressure (BP) at home and outdoor temperature measured by the Akita Meteorological Observatory in 2001. Results Systolic BP showed monthly variation in both morning and evening measurements. BP and outdoor temperature showed significant correlations with hemorrhagic stroke events by month (CH: r=0.87, r=－0.82; SAH: r=0.68, r=－0.82). Among the stroke subtypes, seasonal differences were the greatest in CH. Systolic BP was the most important factor for monthly and seasonal variation in stroke events. By comparing monthly BP variations with CH incidence throughout the year, we concluded that a decrease in home BP of 5 mmHg can reduce the risk of CH by 35%. Conclusion Our findings suggest that lowering BP would be the best strategy for CH prevention. Simple daily actions may be affected by cold stress. As physicians, we must strive to help patients lower their BP throughout the year not only with medication but with lifestyle guidance, especially in winter.     

缺血性卒中新的危险因素

近年来，缺血性卒中的新的危险因素在不断提出。文章就遗传因素、炎症因素、颈部疾病和操作、肾脏疾病、药物因素和饮食因素等方面新的危险因素做了综述。     

Risk Factors for Disability Subtypes in Older Persons

OBJECTIVES: To identify risk factors for five different subtypes of disability.
DESIGN: Prospective cohort study.
SETTING: Greater New Haven, Connecticut.
PARTICIPANTS: Seven hundred fifty-four community-living residents aged 70 and older and initially nondisabled in four essential activities of daily living (bathing, dressing, walking, and transferring).
MEASUREMENTS: Candidate risk factors were measured every 18 months for 90 months during comprehensive home-based assessments. Disability was assessed during monthly telephone interviews for up to 108 months. In participants who were nondisabled at the start of an 18-month interval, incident episodes of five different disability subtypes were determined during the subsequent 18 months: transient, short-term, long-term, recurrent, and unstable.
RESULTS: The cumulative incidence rates per 100 person-intervals were 9.8 (95% confidence interval (CI)=8.9–10.6) for transient disability, 3.8 (95% CI=3.3–4.3) for short-term disability, 7.1 (95% CI=6.4–7.8) for long-term disability, 4.7 (95% CI=4.1–5.3) for recurrent disability, and 4.4 (95% CI=3.9–5.0) for unstable disability. In a multivariate analysis, the Short Physical Performance Battery (SPPB) was associated with each of the five disability subtypes, with adjusted hazard ratios ranging from 1.10 for transient disability to 1.35 for long-term disability. The only other factors associated with short-term, long-term, and recurrent disability were stroke, visual impairment, and poor grip strength, respectively. Transient disability and unstable disability shared the same set of risk factors—depressive symptoms, stroke, and poor grip strength—in addition to the SPPB.
CONCLUSION: These results provide mixed evidence to support the distinct nature of the five disability subtypes.     

青年卒中的病因和危险因素

研究发现，青年卒中的发病率有逐渐增高的趋势，但其病因和危险因素极为复杂。文章对该领域的国内外临床研究进展进行了综述。     

Risk factors and stroke subtypes: results of five consecutive years of the Perugia Stroke Registry

To understand the etiopathogenetic mechanisms of stroke and to target prevention, we need to know how risk factors differ among etiological subtypes. Our aims were to determine the different profile of risk factors for ischemic and hemorrhagic stroke subtypes in our cohort from the Perugia Hospital-Based Stroke Registry. We analyzed the characteristics and the different risk factors of 2,395 first-ever consecutive stroke patients admitted to the Perugia Hospitals in the period between January 1, 1998 and December 31, 2002. The prevalence of cerebrovascular risk factors in each stroke subtype was analyzed independently and compared with other subtypes of stroke pooled together by means of univariate analysis and logistic regression models. Hypertension occurred in 61% of patients; familial history of stroke in 41.6%; vascular disease in 27.2%; embolic heart disease in 22.3%; cigarette smoking in 21.6%. Different potentially modifiable risk factors profiles were identified for each ischemic subtype of stroke, while in hemorrhagic lobar stroke subtypes, only male gender was an independent risk factor.     

无心房颤动的缺血性卒中患者抑郁状态与血管危险因素的关系

目的:探讨无心房颤动的缺血性卒中患者抑郁状态与血管危险因素之间的关系。方法:对59例无心房颤动的缺血性卒中患者随访12-18个月(平均13个月),采用24项Hamilton抑郁量表(HAMD)对患者进行评分,得分<8分为无抑郁症状,8-17分为抑郁状态,>17分为抑郁。收集患者单项血管危险因素、血管危险因素总数以及三项血管危险因素数目之和(高血压、心脏病及糖尿病),分析卒中后抑郁与血管危险因素的关系。结果:抑郁的发生与心脏病家族史、既往卒中史以及三项血管危险因素数目之和有关(P<0.05)。结论:无心房颤动的缺血性卒中患者卒中后抑郁的发生与血管危险因素有关,但相关性不强。     

急性脑卒中患者院内死亡的危险因素分析

目的探讨急性脑卒中患者发生院内死亡的危险因素,以减少急性脑卒中的病死率。方法选取2001年8月—2011年8月我院神经科住院急性脑卒中患者2028例,对患者的病历资料进行详细的调查,对引起院内死亡的多种危险因素进行分析。结果 2028例急性脑卒中患者中死亡71例,病死率为3.5%;年龄、性别、院前时间、血压、并发症、总胆固醇、三酰甘油、低密度脂蛋白、高密度脂蛋白水平与急性脑卒中患者院内死亡关系密切。结论临床医生应对急性脑卒中患者发生院内死亡的危险因素给予高度重视,可有效降低病死率。     

进展性缺血性卒中的危险因素分析

目的：探讨进展性缺血性卒中的危险因素，为其预防提供依据。方法：回顾性分析2002年8月-20004年8月收治的166例进展性缺血性卒中病例，并以同期住院的65例非进展性缺血性卒中患者作为对照组。对两组患者的年龄、性别、血脂水平、血纤维蛋白原水平、血糖水平、发热、白细胞增多、平均动脉压、糖尿病史和CT早期梗死征象进行比较。结果：进展组患者的糖尿病史（P〈0．05）、CT早期梗死征象（P〈0.05）、发热（P〈0．01）和白细胞增多（P〈0．001）的比例显著较高，血糖（P〈0．05）和纤维蛋白原（P〈0．05）水平明显高于对照组；多变量logistic回归分析表明，糖尿病史（P=0．029）、发热（P=0.0146）、白细胞增多（P=0．005）和CT早期梗死征象（P=0．0027）是缺血性卒中早期病情加重的独立预测因素。结论：糖尿病史、发热、白细胞增多和CT早期梗死征象是进展性缺血性卒中的独立危险因素。     

The Perugia hospital-based Stroke Registry: report of the 2nd year

This study reports the characteristics of stroke patients admitted to our hospital in the period Jan 1st, 1998-Dec 31st 1999. Seven hundred and ninety seven consecutive subjects (412 males; mean age 71 +/- 13 years) with a first-ever stroke were registered. Two-thirds of patients (65%) were admitted to the Stroke Unit (SU). The remaining part was managed in six general medicine wards (GM) or other services [neurosurgery and intensive care units (ICU+ NS)]. Ischemic stroke occurred in 534 subjects (67%). The high prevalence (30.1%) of haemorrhages can be partly explained by the presence of specialized neurosurgical services. Athero-thrombotic infarctions occurred in 21.7% of patients, lacunar in 24.7%, cardioembolic in 18.1%, other determined in 6.1%, and other undetermined in 27.5%. Overall hospital mortality was 10%. In cerebral hemorrhage mortality was 18% (44/240) vs. 6.3% (32/534) in ischemic stroke (p < 0.05). The distribution of stroke types and mortality was similar to other previous reports.     

抑郁——卒中的独立危险因素

卒中后出现抑郁已得到广泛认识,但抑郁影响卒中发生的研究近年来才兴起。了解抑郁影响卒中发生的流行病学特征及其作用机制,有助于疾病的预防和治疗,并为进一步研究提供基础。     

The Intersection of Sex,Marital Status,and Cardiovascular Risk Factors in Shaping Stroke Incidence: Results from the Health and Retirement Study

OBJECTIVES: To examine the role of sex and marital status in the distribution and consequences of cardiovascular risk factors for stroke. DESIGN: Longitudinal cohort. SETTING: U.S. national sample, community based. PARTICIPANTS: U.S. adults aged 50 and older and their spouses. MEASUREMENTS: Health and Retirement Study (HRS) participants born between 1900 and 1947 (N=22,818), aged 50 and older, and stroke‐free at baseline were followed an average of 9.4 years for self‐ or proxy‐reported stroke (2,372 events). Financial resources, behavioral risk factors, and cardiovascular conditions were used to predict incident stroke in Cox proportional hazard models stratified according to sex and marital status (married, widowed, divorced or separated, or never married). RESULTS: Women were less likely to be married than men. The distribution of risk factors differed according to sex and marital status. Men had higher incident stroke rates than women, even after full risk factor adjustment (hazard ratio (HR)=1.22, 95% confidence interval (CI)=1.11–1.34). For both sexes, being never married or widowed predicted greater risk, associations that were attenuated after adjustment for financial resources. Widowed men had the highest risk (HR=1.40, 95% CI=1.12–1.74 vs married women). Lower income and wealth were associated with similarly high risk across subgroups, although this risk factor especially affected unmarried women, with this group reporting the lowest income and wealth levels. Most other risk factors had similar HRs across subgroups, although moderate alcohol use did not predict lower stroke risk in unmarried women. CONCLUSION: Stroke incidence and risk factors vary substantially according to sex and marital status. It is likely that gendered social experiences, such as marriage and socioeconomic disadvantage, mediate pathways linking sex and stroke.     

代谢综合征及其组分与卒中风险

代谢综合征是一组心脑血管疾病代谢性危险因素的总称,其主要组分包括高血糖、高血压、血脂异常和中心性肥胖.因其与卒中危险因素存在部分重叠,从而决定了代谢综合征与卒中的密切相关性.无论单个危险因素,还是多个危险因素相互作用,都影响着卒中的发生和发展.     

高血压与脑卒中各亚型关系的研究现状

高血压是脑卒中的最重要独立危险因素。然而高血压导致脑卒中各亚型发生的机理是不同的,其危险性也存在较大差异。现阐述高血压与脑卒中各亚型的关系以及降压治疗在脑卒中防治中的作用。     

Stroke in Italy: A Disease to Prevent

Stroke, a disease determining an increasing socioeconomic burden in aging populations, represents the second cause of mortality worldwide and the third cause of mortality in western countries. In our study, crude annual incidence rate of stroke was 293/100,000. Several conditions and life-style factors have been identified as risk factors for stroke. Their recognition is important to prevent stroke. Atherothrombosis contributes a large proportion of cases; however, conventional stroke risk factors do not fully account for the risk of stroke, and often stroke victims with documented atherosclerosis may not show any conventional risk factor. A major goal is to promote prevention of stroke through identification and clarification of new risk factors and pathogenic mechanisms. Moreover, early stroke prevention requires a comprehensive multidisciplinary strategy to educate and promote adherence to preventive protocols.     

早发性动脉粥样硬化性缺血性卒中的危险因素

青年缺血性卒中的病因复杂多样，但仍以动脉粥样硬化性血栓栓塞为主。除传统危险因素，如高血压、糖尿病、吸烟、肥胖等外，近年来新发现的危险因素，如炎症、高同型半胱氨酸血症、脂蛋白（a）增高、抗磷脂抗体阳性等也都是早发性动脉粥样硬化的危险因素。文章综述了这些危险因素在青年缺血性卒中发病中的作用。     

Mild Cognitive Impairment: Incidence and Risk Factors: Results of the Leipzig Longitudinal Study of the Aged

OBECTIVES: To provide information on age‐ and sex‐specific incidence rates of mild cognitive impairment (MCI) and risk factors for incident MCI. DESIGN: Prospective longitudinal cohort. SETTING: Leipzig Longitudinal Study of the Aged, a population‐based German study of the epidemiology of dementia and mild cognitive impairment. PARTICIPANTS: At baseline, 1,692 subjects aged 75 and older were included in the sample. MEASUREMENTS: Trained psychologists and physicians conducted structured clinical interviews including neuropsychological assessment and questions about sociodemographics, familial history of dementia, activities of daily living, subjective memory impairment, and lifestyle (alcohol consumption, smoking) at participants' homes. Structured third‐party interviews were conducted with proxies. Incidence was calculated according to the person‐years‐at‐risk method. Cox proportional hazards models were used to examine the association between risk factors and incident MCI. RESULTS: During an 8‐year follow‐up period, 26.4% (n=137) of the 519 study participants (population at risk) were identified as incident MCI cases (person‐years=1,791.1). The overall incidence rate of MCI was 76.5 (95% confidence interval=64.7–90.4) per 1,000 person‐years. Older age, subjective memory impairment, impairment in instrumental activities of daily living, and antecedent lower cognitive performance were found to be significantly associated with the development of future MCI. CONCLUSION: MCI is highly incident in the elderly population. For the purpose of early detection of dementia, subjective memory impairment should be taken seriously as a possible prestage of MCI.