脑梗死患者复发相关危险因素分析及复发预测模型构建

目的探讨复发性脑梗死患者的相关危险因素，构建脑梗死复发的预测模型。方法回顾性分析2008年1月1日至2011年12月31日确诊的初发性脑梗死（FirstCerebralInfarction，FCI）患者的病历信息资料，并对患者的复发情况进行追踪随访；运用Kaplan-Meier法计算患者的复发率，描绘患者的无复发生存曲线；采用多因素Cox回归分析筛选影响患者复发的独立危险因素，并建立患者复发预测模型。结果共纳入符合条件的脑梗死患者367例，随访1-54个月，中位随访时间22个月。随访期间74例（20．2％）患者复发，无复发生存时间1～32个月，1年、2年、3年累积无复发生存率分别为80．O％、66．3％、52．0％。多因素Cox比例风险回归模型分析发现，年龄≥60岁、高血压病史、糖尿病史、冠心病史、总胆固醇≥5．17mmoL／L是脑梗死患者复发的独立危险因素（P〈0．05）。脑梗死患者复发风险函数模型表达式为：坼）=hoexp（2．559X1＋1．978X2＋1．901X2＋1．33IX4＋1．719Xs）。结论脑梗死复发是多因素影响的结果，年龄≥60岁、高血压病史、糖尿病史、冠心病史、总胆固醇≥5．17mmoL／L是主要危险因素。针对可控因素进行干预和治疗是预防脑梗死复发的重要途径之一。

Study on the risk factors in recurrent cerebral infarction and the establishment of prediction model.

Objective To explore the risk factors of recurrent cerebral infarction and establish prediction model for recurrent cerebral infarction. Methods We retrospectively reviewed the charts of patients diagnosed with first cerebral infarction during the period from January 1, 2008 to December 31, 20 l I and followed up the patients. Ka- plan-Meier method was used to estimate recurrence rates and to plot relapse-free survival curves of patients at differ- ent levels of predictive factors. Multivariate Cox proportional hazards model was used to select independent risk fac- tors of patients＇ relapse and establish prediction model for recurrent cerebral infarction. Results A total of 367 cases of cerebral infarction were included, followed up for 1 to 54 months, with a median follow-up time of 22 months. Dur- ing the follow-up, 74 patients （20.2%） relapse, with the relapse-free survival time of 1-32 months. The 1--year, 2--year, 3-year cumulative recurrence-free survival rates were 80.0%, 66.3%, 52.0%, respectively. Multivariate Cox proportion- al hazards regression analysis found that age ≥60 years, history of hypertension, diabetes, coronary heart disease, to- tal cholesterol ≥ 5.17 mmol/L were the independent risk factors for recurrence with cerebral infarction （P〈0.05）. The risk of recurrence in patients with cerebral infarction function model expression was. Conclusion Recurrent cerebral infarction is the result of many factors. Age ≥ 60 years, history of hypertension, diabetes, coronary heart disease, total cholesterol ≥5.17 mmol/L are the major risk factors. Intervention and treatment of the controllable factors is one of the important ways to prevent the recurrence of cerebral infarctione.