脑卒中患者发生急性期疲劳危险因素的Meta分析

目的系统评价脑卒中患者发生急性期疲劳的危险因素。方法计算机检索PubMed、Web of Science、EMbase、The Cochrane Library、CNKI、VIP和WanFang Data数据库,搜集脑卒中患者发生急性期疲劳危险因素的病例-对照研究、队列研究和横断面研究,检索时限均从建库至2019年4月。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入14个研究,包括2 658例研究对象,涉及危险因素13个。Meta分析结果显示:女性OR=1.54,95%CI(1.23,1.94),P=0.000 2]、农村居住地OR=1.46,95%CI(1.11,1.91),P=0.007]、糖尿病OR=1.54,95%CI(1.24,1.92),P<0.000 1]、高脂血症OR=1.41,95%CI(1.10,1.80),P=0.007]、冠心病OR=1.94,95%CI(1.30,2.89),P=0.001]、既往卒中史OR=1.54,95%CI(1.07,2.23),P<0.000 01]、卒中前疲劳OR=4.51,95%CI(3.33,6.09),P<0.000 01]、基底节区卒中OR=2.76,95%CI(1.21,6.29),P<0.000 01]、NIHSS>3分OR=2.11,95%CI(1.59,2.79),P<0.000 01]、入院血糖水平OR=1.08,95%CI(0.38,1.78),P=0.003]、卒中后睡眠障碍OR=2.40,95%CI(1.87,3.07),P<0.000 01]、卒中后疼痛OR=2.32,95%CI(1.56,3.45),P<0.000 1]和卒中后抑郁OR=3.31,95%CI(1.94,5.66),P<0.000 1]均是脑卒中患者发生急性期疲劳的危险因素。结论当前证据显示,女性、农村居住地、糖尿病、高脂血症、冠心病、既往卒中史、卒中前疲劳、基底节区卒中、NIHSS评分>3分、入院血糖水平、卒中后睡眠障碍、卒中后疼痛和卒中后抑郁是脑卒中患者发生急性期疲劳的危险因素。医务人员应对具有以上危险因素的高危患者加强防护,以降低卒中后疲劳发生率,改善患者临床预后结局。

Risk factors for acute fatigue in patients with stroke: a meta-analysis

Objectives To systematically review the risk factors of acute fatigue in patients with stroke.Methods PubMed, Web of Science, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies, cohort studies and cross-sectional studies on the risk factors of acute fatigue in patients with stroke from inception to April, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 14 studies involving 2 658 objects and 13 risk factors were included. The results of meta-analysis showed that: female(OR=1.54, 95%CI 1.23 to 1.94, P=0.000 2), rural residence(OR=1.46, 95%CI 1.11 to 1.91, P=0.007),diabetes mellitus(OR=1.54, 95%CI 1.24 to 1.92, P<0.000 1), hyperlipidemia(OR=1.41, 95%CI 1.10 to 1.80, P=0.007),coronary heart disease(OR=1.94, 95%CI 1.30 to 2.89, P=0.001), previous stroke history(OR=1.54, 95%CI 1.07 to 2.23,P<0.000 01), pre-stroke fatigue(OR=4.51, 95%CI 3.33 to 6.09, P<0.000 01), basal ganglia stroke(OR=2.76, 95%CI 1.21 to6.29, P<0.000 01), NIHSS >3(OR=2.11, 95%CI 1.59 to 2.79, P<0.000 01), admission glucose level(OR=1.08, 95%CI 0.38 to1.78, P=0.003), post-stroke sleep disorder(OR=2.40, 95%CI 1.87 to 3.07, P<0.000 01), post-stroke pain(OR=2.32, 95%CI1.56 to 3.45, P<0.000 1) and post-stroke depression(OR=3.31, 95%CI 1.94 to 5.66, P<0.000 1) were risk factors of acute fatigue in patients with stroke. Conclusions Current evidence shows that female, rural residence, diabetes mellitus,hyperlipidemia, coronary heart disease, previous stroke history, pre-stroke fatigue, basal ganglia stroke, NIHSS>3,admission glucose level, post-stroke sleep disorder, post-stroke pain and post-stroke depression are the risk factors of acute fatigue in patients with stroke. Medical staff should strengthen targeted preventive care for high-risk patients with related risk factors in order to reduce the incidence of post-stroke fatigue and improve the clinical prognosis outcome of patients.