| 赵博特,王晓宇,王安琪,等.心脏病史与首发卒中预后的相关性研究[J].中国临床保健杂志,2022,25(5):619-623. |
| 心脏病史与首发卒中预后的相关性研究 |
| The association between heart disease history and prognosis in first-ever stroke patients |
| 投稿时间：2022-06-11 |
| DOI：10.3969/J.issn.1672-6790.2022.05.009 |
| 中文关键词: 中风 心脏病 危险因素 预后 |
| 英文关键词: Stroke Heart diseases Risk factors Prognosis 〖FL |
| 基金项目:首都卫生发展科研专项(首发2020-1-2041,首发2022-2G-2049)；重大慢性非传染性疾病防控研究重点 专项(2017YFC1307702) |
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| 中文摘要: |
| 目的 探讨心脏病史与首发卒中预后的相关性。方法 中国国家卒中登记(CNSR)研究中诊断为缺血性卒中且无脑血管病史的住院患者为研究对象,收集患者入院时的人口统计学信息、既往病史及用药情况等基本资料,记录随访3、6和12个月时的预后情况。预后情况包括全因死亡、卒中复发(缺血性卒中或出血性卒中)和神经功能预后情况。将患者自我报告有冠心病、心肌梗死、慢性心力衰竭、心房颤动和心脏瓣膜病中至少1种病史者归为有心脏病史组,无其中任何1项病史者归为无心脏病史组。采用改良Rankin量表(mRS)评分以评价神经功能结局,3~5分为神经功能残疾。采用单因素及多因素logistic回归模型校正可能的混杂因素,分析心脏病史与卒中预后的相关性。结果 本研究共纳入7 979例首发卒中患者,其中1 425例(17.9%)患者有心脏病史。有心脏病史组患者年龄、女性比例、高血压、高脂血症、糖尿病病史比例、入院mRS评分、美国国立卫生研究院神经功能缺损评分(NIHSS)和既往用药史比例均高于无心脏病史组,吸烟、饮酒和出院带药的比例低于无心脏病史组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果表明,心脏病史是首发卒中患者发病3、6及12个月死亡、复发和12个月神经功能残疾的危险因素,其中12个月的死亡危险、12个月复发危险和12个月神经功能残疾的危险分别为无心脏病史患者的1.51倍(OR=1.51,95%CI:1.20~1.90)、1.35倍(OR=1.35,95%CI:1.11~1.64)和1.23倍(OR=1.23,95%CI:1.01~1.50)。结论 心脏病史可能与首发卒中患者死亡、卒中复发和长期神经功能残疾风险增高相关。积极开展心脏病的预防和疾病管理将有益于改善首发卒中患者的临床预后。 |
| 英文摘要: |
| Objective To investigate the association between heart disease history and prognosis in first-ever stroke patients.Methods Patients diagnosed as first-ever ischemic stroke from the China National Stroke Registry (CNSR) were included in the study.Demographics,medical history and medication situation before admission were collected.Outcomes were followed up within 3,6 and 12 months.The outcomes included all-cause death,recurrent stroke (ischemic or hemorrhagic stroke) and functional disability.Patients self-reported with any of the following heart diseases,such as coronary heart disease,myocardial infarction,chronic heart failure,atrial fibrillation and valvular heart disease were defined as with a history of heart disease.Patients self-reported without any of the above-mentioned heart diseases were defined as without a history of heart disease.The functional disability was measured using mRS and mRS 3-5 was defined as poor functional disability.The association between heart disease history and prognosis of first-ever stroke was investigated using univariate logistic regression and multivariable logistic regression adjusted for potential confounders.Results A total of 7 979 first-ever stroke patients were included in this study,and 1 425(17.9%) patients had a history of heart disease.The age,proportion of female,medical history(hypertension,hyperlipidemia and diabetes),admission mRS,NIHSS and proportion of medication history in the group with heart disease history were higher than those without;the proportion of smoking,drinking and discharge medication in the group with heart disease history were lower than those without,all with statistical differences (P<0.05).The multivariable logistic regression analysis showed that heart disease history was associated with increased risk of death and recurrent stroke in first-ever stroke patients during the 3,6 and 12 months following-up,of which the 12-month risk of mortality and recurrence were 1.51 times (OR=1.51,95%CI:1.20-1.90) and 1.35 times (OR=1.35,95%CI:1.11-1.64) higher in patients with a history of heart disease,respectively.Heart disease history was also associated with increased risk of poor functional disability in first-ever stroke patients during the 12 months following-up (OR=1.23,95%CI:1.01-1.50).Conclusions Heart disease history is associated with increased risk of death,recurrent stroke and poor long-term functional disability in first-ever stroke patients.Active prevention and control of heart disease may be beneficial for improving the prognosis of first-ever stroke. |
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