超高龄缺血性脑卒中患者生存预后及危险因素分析  

Long term prognosis and risk factors analysis for very elderly ischemic stroke patients

作　　者：徐蕾[1] 乔金雨 何清华[2] 董敏[3] 龚涛[1] 马欣昕[1] 胡夏生[1] 刘银红[1] XU Lei;QIAO Jinyu;HE Qinghua;DONG Min;GONG Tao;MA Xinxin;HU Xiasheng;LIU Yinhong(不详;Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院神经内科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]北京医院内分泌科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [3]北京医院心内科,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中国神经免疫学和神经病学杂志》2021年第3期229-232,共4页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨超高龄缺血性脑卒中患者生存预后及危险因素。方法回顾性分析2006年1月至2016年12月就诊于北京医院、首次发作缺血性脑卒中并≥80岁的住院患者67例,随访至2019年12月死亡37例、存活30例。收集并分析所有患者发病时性别构成、年龄、BMI(体重指数)、血管危险因素(糖尿病、高血压、血脂异常、缺血性心脏病、心房颤动)、美国国立卫生研究院卒中量表(NIHSS)评分、生存时间、死亡原因。采用Cox回归分析研究各危险因素对生存时间的影响。结果67例患者中首次卒中发作1个月内死亡3例(4.5%),12月内死亡7例(10.4%),5年内死亡21例(31.3%),10年内死亡35例(52.2%)。死亡原因分析显示,脑卒中首次发作导致死亡3例(8.1%),均在发病6个月内死亡;脑卒中复发导致死亡8例(21.6%),发生在首次卒中发作后6个月到10年间;心血管疾病导致死亡6例(16.2%),卒中首次发作6个月内2例、3年以上4例;非血管性疾病导致死亡20例(54.1%),卒中首次发作后5~10年死亡10例,占该类死亡原因的50%。Cox回归分析显示年龄(HR=1.198,P=0.000)、BMI(HR=0.886,P=0.033)、NIHSS评分(HR=1.133,P=0.001)对患者的生存时间有影响。结论超高龄老人缺血性脑卒中早期死亡原因以血管性疾病为主,长期死亡原因为非血管疾病导致居多;年龄、BMI、NIHSS评分对超高龄老人缺血性脑卒中后的死亡风险有一定预测价值。Objective To investigate the survival prognosis and risk factors of death in very elderly patients with ischemic stroke.Methods A retrospective analysis was conducted on 67 patients≥80 years of age,who developed first-ever ischemic stroke and were treated at the Beijing Hospital between January 2006 and December 2016.Until December 2019,37 patients of them were dead and 30 patients of them were alive.The data of sex,age,body mass index(BMI),vascular risk factors(diabetes mellitus,hypertension,dyslipidemia,ischemic heart disease and atrial fibrillation),National Institutes of Health Stroke Scale(NIHSS),survival time and causes of death were obtained.The impact of baseline factors on survival time was analyzed by Cox regression analysis.Results Among 67 patients with ischemic stroke,3(4.5%)died within the first month,7(10.4%)died in the first year,21(31.3%)died in 5 years and 35(52.2%)died in ten years.Causes of death included first stroke(3 patients;8.1%),recurrent stroke(8 patients;21.6%),cardiovascular causes(6 patients;16.2%),novascular causes(20 patients;54.1%).Cox regression analysis revealed that age(HR=1.198;P=0.000),BMI(HR=0.886;P=0.033)and NIHSS(HR=1.133;P=0.001)were significant risk factors for survival time after stroke.Conclusions The major cause of death of the older patients with ischemic stroke was vascular disease in the early stage and was novascular disease in the late stage.Age,BMI and NIHSS could give some help for predicting the risk of death after ischemic stroke in the older patients.

关 键 词：卒中 脑缺血 超高龄 危险因素 死亡原因 比例危险度模型 

分 类 号：R743.33[医药卫生—神经病学与精神病学]