影响大动脉粥样硬化性脑梗死复发的危险因素

目的 研究首发大动脉粥样硬化性脑梗死患者复发的危险因素.方法 连续入组在神经内科就诊的首发缺血性卒中患者,并经CTA或MRA证实为大动脉粥样硬化性脑梗死.所有入组患者进行1年随访,根据随访期间是否复发脑梗死分为缺血性卒中复发组和非复发组,比较两组患者的临床资料,并通过单因素方差分析、Cox回归模型确定复发性缺血性卒中的独立预测因素.结果256例符合纳入标准,全部病例完成随访,30例(11.7%)随访期间发生缺血性脑血管事件.单因素方差分析显示,复发组与非复发组在饮酒习惯(P=0.028)、吸烟(P=0.007)、高密度脂蛋白胆固醇(P=0.045)、缺血性心脏病(P=0.002)、抗高血压药物(P=0.036)和他汀类药物(P=0.016)使用方面的差异有统计学意义.Cox回归分析显示不规则使用他汀类药物(HR=0.410, P=0.043)、吸烟(HR=2.253,P=0.043)、高密度脂蛋白胆固醇(HR=0.327,P=0.029)、缺血性心脏病(HR=8.566,P<0.001)与缺血性脑卒中复发相关.结论 不规则使用他汀类药物、低高密度脂蛋白水平、吸烟和既往有冠心病患者缺血性卒中复发风险较高.

Risk factors for recurrence of large atherosclerotic cerebral infarction

Objective To explore the risk factors for recurrence of large atherosclerotic cerebral infarction in first-episode patients. Methods The consecutive patients with acute cerebral infarction diagnosed in the Department of Neurology were screened for large atherosclerotic cerebral infarction by CTA/MRA examination,and all the confirmed patients were followed up for 1 year.The patients were divided into recurrent ischemic stroke group and non-recurrent group according to occurrence of cerebrovascular events during the follow-up.Results A total of 256 eligible patients were included in this study,and all of them completed the follow-up. During the 1-year follow-up, 30 (11.7%) patients had ischemic cerebrovascular stroke events. Univariate analysis showed significant differences in alcohol drinking (P=0.028), smoking (P=0.007), high-density lipoprotein cholesterol (HDL; P=0.045), ischemic heart disease (P=0.002), antihypertensive agents (P=0.036) and statin use (P=0.016) between the recurrent group and non-recurrent group.Cox regression analysis showed that irregular use of statins(RR=0.410, P=0.043), smoking (RR=2.253, P=0.043), HDL (RR=0.327, P=0.029), and ischemic heart disease (RR=8.566, P<0.001) were correlated with recurrent ischemic stroke.Conclusion The first-episode patients with irregular use of statins,low HDL levels, smoking and ischemic heart disease are at higher risks for having ischemic stroke recurrence.