脑梗死和脑出血患者的临床特点及长期预后观察

目的 探讨不同类型卒中的危险因素、病因、死亡原因和预后.方法 基于华西医院卒中登记,脑卒中分为出血性和缺血性,缺血性卒中亚型是依据牛津郡社区卒中项目分类原则.分析住院患者的人口学特点、危险因素、死亡原因和1年末结局.结果 2002年3月至2005年9月,共纳入1913例资料完整的卒中患者,其中脑出血599例(31.3%);缺血性脑卒中1314例(68.7%).后者中完全前循环梗死209例(15.9%),部分前循环梗死417例(31.7%),后循环梗死186例(14.2%),腔隙性梗死502例(38.2%).校正年龄和性别,多因素分析显示,房颤是完全前循环梗死的独立预测因素(OR=1.42,95% CI=1.25～2.31);高血压和饮酒是腔隙性梗死(OR=1.24,95% CI=1.02～2.18;OR=1.12,95% CI=1.03～3.04)和脑出血(OR=1.84,95% CI=1.31～3.02;OR=1.04,95% CI=1.01～4.13)的独立预测因素.完全前循环梗死与高血压呈负相关(OR=0.62,95% CI=0.34～0.72),腔隙性梗死与房颤呈负相关(OR=0.46,95% CI=0.26～0.82),脑出血与糖尿病亦呈负相关(OR=0.56,95% CI=0.42～0.76).以腔隙性梗死为参照,完全前循环梗死(OR=6.21,95% CI=2.86～8.42)和脑出血(OR=5.86,95% CI=2.46～8.52)明显增加患者1年死亡风险.结论 不同类型卒中的危险因素、病因和结局不同.确定卒中亚型对于急性期治疗和预防有重要意义.

Clinical characteristics and long-term prognosis of patients with ischemic and hemorrhagic stroke

OBJECTIVE: To investigate the risk factors, pathogenesis, cause of death, and outcome of different stroke subtypes. METHODS: The relevant data, including demographics, baseline risk factors, cause of death, and 1-year case fatality, were analyzed among 1913 consecutive hospitalized patients with ischemic and hemorrhagic stroke, 599 (31.3%) with intracerebral hemorrhage (ICH) and 1314 with ischemic stroke (68.7%), including 209 cases (15.9%) of total anterior circulation infarction (TACI), 417 cases (31.7%) of partial anterior circulation infarction (PACI), and 186 cases (14.2%) of posterior circulation infarctions (POCI), and 502 cases (38.2%) of lacunar infarctions (LACI), 1098 males and 815 females, aged 64 +/- 13 (14-98). RESULTS: Multivariate analysis showed that when age and sex were adjusted, atrial fibrillation was the independent predictive factor of TACI odds ratio (OR) = 1.42, 95% CI = 1.25-2.31), hypertension and alcohol intake were the independent predictive factor LACI (OR = 1.24, 95% CI = 1.02-2.18; 0R = 1.12, 95% CI = 1.03-3.04) and ICH (OR = 1.84, 95% CI = 1.31-3.02; OR = 1.04, 95% CI = 1.01-4.13). A negative association was observed between hypertension and TACI (OR = 0.62, 95% CI = 0.34-0.72), atrial fibrillation and LACI (OR = 0.46, 95% CI = 0.26-0.82), and ICH and diabetes (OR = 0.56, 95% CI = 0.42-0.76). As compared to LACI, TACI and ICH significantly increased the risk of 1-year mortality (OR = 6.21, 95% CI = 2.86-8.42; OR = 5.86; 95% CI = 2.46-8.52). CONCLUSIONS: Stroke subtypes have different risk factor profile, causes and outcome. Information on determinants of the clinical syndromes may impact on the prevention and acute phase interventions.