缺血性卒中复发与相关因耸秦分析.doc

缺血性脑卒中复发与相关因素分析?基金项目：国家自然科学基金； 国家自然科学基金 作者单位：210002南京大学医学院临床学院 南京军区南京总医院 神经内科 通讯作者:刘新峰，E-mail: xfliu2@ 张文婷, 陈茂刚, 张敏, 王启章, 徐格林, 刘新峰 摘要 目的 观察缺血性脑卒中患者2年复发率及复发的相关危险因素。 方法 采用前瞻性的队列研究方法，共纳入首发缺血性脑卒中患者860例，根据随访2年是否复发分为复发组（106例）和无复发组（754例）。并按照TOAST标准进行病因分型，大动脉粥样硬化型(LAA) 261例，小动脉闭塞型（SAO）186例、心源性栓塞型191例、不明原因及其它病因型(UND) 222例，随访2年，观察不同病因分型脑卒中复发率的差异，并进行多因素回归分析相关因素。结果 患者随访2年，失访71例(8.3%)，死亡93例（10.8%）。共有106例患者再次发生卒中，其中29例为LAA型，22例为SAO型，36例为CES型，19例为UND型。多因素回归分析显示，年龄（OR=1.655, 95%CI: 1.286~2.131，P0.01）、高血压病史（OR=3.277, 95%CI: 2.272~4.726，P0.01）、糖尿病史（OR=1.671, 95%CI :1.208~2.311，P0.01）、纤维蛋白原（OR=1.421, 95%CI :1.114-1.813，P0.01）、TOAST分型（P0.01）及抗血小板药物依从性（OR=2.733, 95%CI :1.871~3.933，P0.01）与缺血性脑卒中复发相关。结论 不同病因型脑卒中2年复发率存在差异；纤维蛋白原、TOAST病因分型及抗血小板药物依从性也是缺血性脑卒中复发的独立危险因素。 关键词 卒中复发；TOAST分型；纤维蛋白原，抗血小板依药物从性 Recurrence and predictive factors after ischemic stroke ZHANG Wen-ting, CHEN Mao-gang, ZHANG Min, et al.(Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China) Abstract Objective To investigate the recurrence rate and predictors for stroke recurrence within 2 years. Methods This study we enrolled 860 patients with first-ever ischemic stroke from May 2005 to May 2008 reigistered in Nanjing stroke registy program(NSRP). All the patients were classified by TOAST criteria and followed-up for two years since its first episode. According to whether have the recurrent stroke ,all patients were divided into recurrent group (106 cases) and non-recurrent group (754 cases). Large-artery atheroselerosis(LAA) were 261 patients, small-artery occlusion(SAO) were 186 patients, cardioembolism(CES) were 191 patients, and other determined and undetermined causes (UND) were 222 patients, To analysis the difference of recurrence rate among the TOAST stroke criterion.Risk factors were calculated by logistic regression analysis. Results Of these patients,with 71(8.3%) dropped-out cases,93(10.8%) cases died during the period of study. In the