上海市城乡结合部社区卒中再发患者影响因素的研究

目的分析影响上海市城乡结合部社区卒中再发的危险因素。方法2012年1月-2012年12月以上海浦东新区城乡结合部3个社区（周浦、康桥、航头）居民中的卒中患者为调查对象，共纳入符合标准的患者892例。其中480例有卒中再发史（再发组），412例无再发史（首发组）。采用横断面问卷调查方法，收集患者的一般情况、卒中常见危险因素，血压控制、药物二级预防、康复治疗等资料。结果单因素分析显示，再发组中有高血压、冠心病、心房颤动、糖尿病、高脂血症、体质量指数≥24kg／m^2患者的比率高于首发组，年龄高于首发组，差异均有统计学意义，P〈0．05，或P〈0．01；而收缩压控制≤140mmHg、规范服用活血化瘀类药、进行康复治疗患者的比率低于首发组，差异均有统计学意义，均P〈0．01。多因素Logistic回归分析显示，年龄（OR=1．032，95％CI：1．015～1．050）、高血压（OR=2．782，95％C1：1．812～4．271）、冠心病（OR=1．654，95％CI：1．138～2．404）、糖尿病（OR=1．803，95％CI：1．200～2．709）、体质量指数≥24kg／m。（OR=1．438，95％CI：1．074～1．926）是影响卒中再发的独立危险因素，而康复治疗为卒中再发的保护因素（OR=0．832，95％CI：0．696～0．996）。均P〈0．05，或P〈0．01。结论社区卒中二级预防应加强对高血压、冠心病、糖尿病、超重或肥胖等因素的治疗与控制，康复治疗可降低卒中再发的风险。

Study of the risk factors for influencing recurrence of stroke in patients in the communities of ruraland urban fringe of Shanghai

Objective To analyze the risk factors for influencing stroke recurrence in the communi- ties of rural and urban fringe of Shanghai. Methods A total of 892 patients with stroke in community res- idents, who met the inclusion criteria, were surveyed in 3 communities （Tongpu, Kangqiao and Hangtou） of rural and urban fringe of Shanghai from January 2012 to December 2012. Among them 480 patients had a history of stroke recurrence （recurrence stroke group） and 412 did not have a history of stroke recurrence （first-ever stroke group）. A cross-sectional questionnaire survey was used to collect the data, such as the patients＇ general conditions, common risk factors for stroke, blood pressure control, drug seconda- ry prevention, and rehabilitation treatment, etc. Results Univariate analysis showed that the rates of the patients with hypertension, coronary heart disease, atrial fibrillation, diabetes, hyperlipidemia, and BMI ≥24 in the recurrence stroke group were higher than those in the first-ever stroke group. The differ- ences were statistically significant （P 〈0.05 or P 〈0.01 ） , while the rates of the patients whose systolic pressure was controlled less than 140 mm Hg, who taking blood-activating and stasis-eliminating drugs regu-lady, and who underwent rehabilitation treatment were lower than those in the first-ever stroke group. The differences were statistically significant （ P 〈 0.01 ）. Multivariate logistic regression analysis showed that age （ OR = 1. 032, 95% CI 1. 015 to 1. 050）, hypertension （ OR = 2. 782, 95.0% CI 1. 812 to 4. 271 ）, coronary heart disease （ OR = 1. 654, 95% CI 1. 138 to 2. 404）, diabetes （ OR = 1. 803, 95% CI 1. 200 to 2. 709）, and BMI ≥ 24 （OR = 1. 438, 95% CI I. 074 to 1. 926） were the risk factors for affecting stroke recurrence, while the rehabilitation treatment was a protective factor for stroke recurrence （ OR = 0. 832, 95% CI 0. 696 to 0. 996 ; P 〈 0.05 or P 〈 0.01 ）. Conclusions The secondary prevention of stroke in communities should strengthen the treatment and control of the independent influencing factors including hy- pertension, coronary heart disease, diabetes, over-weight or obesity. Rehabilitation treatment may reduce the risk of stroke recurrence.