缺血性脑卒中复发危险因素分析及预测模型的构建  

Risk factors on the recurrence of ischemic stroke and the establishment of a Cox＇ s regression model

作　　者：安雅臣[1] 陈云霞[1] 王玉浔[1] 赵晓晶[1] 王艳[2] 张江[1] 李春玲[1] 彭延波[1] 高素玲[1] 常丽莎[1] 张丽[1] 薛新宏[1] 陈瑞英[1] 王大力[1] 

机构地区：[1]河北联合大学附属医院神经内科,唐山063000 [2]河北省唐县人民医院

出　　处：《中华流行病学杂志》2011年第8期816-820,共5页Chinese Journal of Epidemiology

基　　金：本研究得到河北联合大学博硕科研基金（BS05006）资助

摘　　要：目的探讨影响缺血性脑卒中复发的危险因素并建立Cox比例风险回归模型。方法回顾性收集2008--2009年河北联合大学附属医院神经内科确诊的连续性初发缺血性脑卒中患者为研究对象，同时随访患者的复发情况，于2010年6月30日完成随访工作，应用Kaplan—Meier法进行复发率分析，应用Cox比例风险回归模型对影响患者复发的危险因素进行单因素和多因素分析，建立复发模型。结果随访期间共79例患者复发，患者1年复发率为12．75％，2年复发率为18．87％，经Cox比例风险回归模型单因素及多因素分析显示，年龄（X1）（RR=1．025，95％C1：1．003～1．048）、高血压史（X2）（RR=1．976，95％CI：1．014～3．851）、家族卒中史（X3）（RR：2．647，95％CI：1．175～5．961）、总胆固醇（X4）（RR=1．485，95％CI：1．214～1．817）、ESRS评分（X5）（RR=1．327，95％CI．1．057～1．666）和病情进展（X6）（RR=1．889，95％CI：1．123～3．178）是影响患者复发的独立危险因素，建立复发模型的个体预后指数（PI）为0．025X1＋0．681X2＋0．973X3＋0．3953X4＋0．283X5＋0．636X6。PI值越小，复发危险性越低；PI值越大，复发危险性越高。结论年龄、高血压史、家族卒中史、总胆固醇、ESRS评分和病情进展是缺血性脑卒中患者复发的独立危险因素，并成功建立复发模型及个体PI方程。Objective To investigate the risk factors and establish the Cox＇ s regression model on the recurrence of ischemic stroke. Methods We retrospectively reviewed consecutive patients with ischemic stroke admitted to the Neurology Department of the Hebei United University Affiliated Hospital between January 1,2008 and December 31,2009. Cases had been followed since the onset of ischemic stroke. The follow-up program was finished in June 30, 2010. Kaplan-Meier methods were used to describe the recurrence rate. Monovariant and multivariate Cox＇ s proportional hazard regression model were used to analyze the risk factors associated to the episodes of recurrence. And then, a recurrence model was set up. Results During the period of follow-up program, 79 cases were relapsed, with the recurrence rates as 12.75% in one year and 18.87% in two years. Monovariant and multivariate Cox＇ s proportional hazard regression model showed that the independent risk factors that were associated with the recurrence appeared to be age （X,） （RR = 1.025,95% CI： 1.003-1.048）, history of hypertension （X2） （RR= 1.976, 95% CI： 1.014-3.851 ）, history of family strokes （X3） （RR= 2.647,95%CI： 1.175-5.961 ）, total cholesterol amount （X4） （RR： 1.485,95%CI： 1.214-1.817）, ESRS total scores （Xs） （RR= 1.327, 95%CI： 1.057-1.666） and progression of the disease （X6） （RR= 1.889, 95%CI： 1.123-3.178）. Personal prognosis index （PI） of the recurrence model was as follows： PI=0.025X1 ＋ 0.681X2 ＋ 0.973X3 ＋ 0.395X4 ＋ 0.283X5＋0.636X6. The smaller the personal prognosis index was, the lower the recurrence risk appeared, while the bigger the personal prognosis index was, the higher the recurrence risk appeared. Conclusion Age, history of hypertension, total cholesterol amount, total scores of ESRS, together with the disease progression were the independent risk factors associated with the recurrence episodes of ischemic stroke. Both recurrence model and the personal prognosis index equa

关 键 词：脑卒中 缺血性 复发 危险因素 COX回归模型 预后指数 

分 类 号：R743.3[医药卫生—神经病学与精神病学]