糖尿病对缺血性卒中后1年内卒中复发风险的影响  

Effect of diabetes on the risk of stroke recurrence within one year after onset of ischemic stroke

作　　者：王炳雷[1] 郑嘉华[2] 王晓青[3] 张媛[4] 周轶聪 岳赞 王惠娟[1] Wang Binglei;Zheng Jiahua;Wang Xiaoqing;Zhang Yuan;Zhou Yicong;Yue Zan;Wang Huijuan(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Gynecology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Rehabilitation Medicine,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Neurology,Hebei General Hospital,Shijiazhuang 050051,China;Department of Neurology,Handan Central Hospital,Handan 056001,China;Department of Neurology,the Second Hospital of Baoding City,Baoding 071051,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000 [2]河北医科大学第二医院妇科,石家庄050000 [3]河北医科大学第二医院康复医学科,石家庄050000 [4]河北省人民医院神经内科,石家庄050051 [5]邯郸市中心医院神经内科,056001 [6]保定市第二医院神经内科,071051

出　　处：《国际脑血管病杂志》2019年第11期824-829,共6页International Journal of Cerebrovascular Diseases

基　　金：河北省科技计划项目(17277703D)。

摘　　要：目的探讨糖尿病对缺血性卒中发病后1年内卒中复发风险的影响。方法前瞻性纳入2016年10月至2017年8月期间在河北医科大学第二医院神经内科住院的缺血性卒中患者,收集基线临床资料,然后进行为期1年的随访。对缺血性卒中复发组与未复发组的危险因素进行比较,采用Cox比例风险回归模型确定缺血性卒中复发的独立危险因素。采用Kaplan-Meier生存分析探索危险因素对卒中复发风险的影响。结果共纳入1436例缺血性卒中患者,随访1年时,共有183例患者复发(12.74%)。复发组糖尿病、心房颤动、高同种半胱氨酸血症、出院后口服抗血小板药和他汀类药物的患者构成比以及基线空腹血糖与未复发组差异有统计学意义(P均<0.05)。多变量Cox比例风险回归分析显示,糖尿病[风险比(hazard risk,HR)1.574,95%可信区间(confidence interval,CI)1.161~2.134;P=0.003]是卒中复发的独立危险因素,出院后服用他汀类药物(HR 0.686,95%CI 0.481~0.979;P=0.038)和抗血小板药(HR 0.678,95%CI 0.467~0.983;P=0.041)是缺血性卒中复发的独立保护因素。Kaplan-Meier生存分析显示,糖尿病患者的缺血性卒中复发率显著高于非糖尿病患者(log-rank检验,P=0.003),出院后服用他汀类药物及抗血小板药患者的卒中复发率显著低于未服用相应药物的患者(log-rank检验,P均<0.001)。结论糖尿病是缺血性卒中复发的独立危险因素,而服用他汀类药物及抗血小板药是缺血性卒中复发的独立保护因素。Objective To investigate the effect of diabetes on the risk of stroke recurrence within 1 year after onset of ischemic stroke.Methods Patients with ischemic stroke admitted to the Department of Neurology,the Second Hospital of Hebei Medical University from October 2016 to August 2017 were enrolled prospectively.Their baseline clinical data were collected and they were followed up for one year.The risk factors for ischemic stroke in recurrence group and non-recurrence group were compared.Cox proportional hazard regression model was used to determine the independent risk factors for ischemic stroke recurrence.Kaplan-Meier survival analysis was used to explore the impact of risk factors on the risk of stroke recurrence.Results A total of 1436 patients with ischemic stroke were included.During the follow-up of 1 year,a total of 183 patients had recurrence(12.74%).There were significant differences in the proportion of patients with diabetes,atrial fibrillation,hyperhomocysteinemia,oral antiplatelet drugs,and statins after discharge,and baseline fasting blood glucose level between the recurrence and the non-recurrence group(all P<0.05).Multivariate Cox proportional hazards analysis showed that diabetes mellitus(hazard ratio[HR]1.574,95%confidence interval[CI]1.161-2.134;P=0.003)was an independent risk factor for stroke recurrence.Taking statins(HR 0.686,95%CI 0.481-0.979;P=0.038)and antiplatelet agents(HR 0.678,95%CI 0.467-0.983;P=0.041)after discharge were the independent protective factors for ischemic stroke recurrence.Kaplan-Meier survival analysis showed that the recurrence rate of ischemic stroke in patients with diabetes was significantly higher than that in those without diabetes(log-rank test,P=0.003).The recurrence rate of stroke in patients taking statins and antiplatelet drugs was significantly lower than that in patients who did not take the corresponding drugs(log-rank test,all P<0.001).Conclusions Diabetes is an independent risk factor for ischemic stroke recurrence,and taking statins and antiplatelet d

关 键 词：卒中 脑缺血 糖尿病 二级预防 复发 危险因素 

分 类 号：R74[医药卫生—神经病学与精神病学]