脑梗死患者复发危险因素及中医药保护作用的真实世界研究  

A real-world study on the risk factors of recurrence and the protective effect of Traditional Chinese Medicine in patients with cerebral infarction

作　　者：王世华 张莉 吴晓雯 文天才[4] 艾艳珂[1] 孙嫄嫄 刘佳[1] 何丽云[1] WANG Shihua;ZHANG Li;WU Xiaowen;WEN Tiancai;AI Yanke;SUN Yuanyuan;LIU Jia;HE Liyun(Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;Weifang Hospital of Traditional Chinese Medicine,Weifang 261041,China;The First Clinical Medical College of Shandong University of Traditional Chinese Medicine,Jinan 250014,China;Data Center of Traditional Chinese Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China;Weifang Fangzi District People's Hospital,Weifang 261206,China)

机构地区：[1]中国中医科学院中医临床基础医学研究所,北京100700 [2]潍坊市中医院,潍坊261041 [3]山东中医药大学第一临床医学院,济南250014 [4]中国中医科学院中医药数据中心,北京100700 [5]潍坊市坊子区人民医院,潍坊261206

出　　处：《科技导报》2023年第14期92-100,共9页Science & Technology Review

基　　金：中国中医科学院科技创新工程项目(CI2021A00702-2)。

摘　　要：为了探索脑梗死首次发作的患者复发的危险因素,为改善脑梗死患者预后、降低脑梗死患者复发率提供科学依据,在山东省某中医院住院电子病历系统中,回顾性检索2017-2019年首次因脑梗死住院的患者,依据脑梗死有无复发将患者划分2组,运用Mann-Whitney U检验、χ^(2)检验进行统计分析、二元Logistic回归模型和Cox比例风险回归模型分别对影响脑梗死患者复发的危险因素和影响复发天数的因素进行探索。最终纳入首次因脑梗死发作住院的患者4597例,其中“脑梗死有复发组”患者618例(13.44%),“脑梗死无复发组”患者3979例(86.56%),二元Logistic回归模型分析显示住院天数(OR=1.035)、合并2型糖尿病(OR=2.695)、出院带中药汤剂(OR=3.272)、血小板计数(PLT)(OR=2.628)是导致脑梗死患者复发的危险因素。Cox比例风险回归模型分析结果显示首次发病时住院天数(HR=1.009)是影响脑梗死患者复发天数的促进因素,出院带中药汤剂(HR=0.509)是影响脑梗死患者复发天数的阻碍因素。研究证明脑梗死患者出院后使用中药汤剂调理可延缓脑梗死复发天数,同时应注重患者合并疾病的治疗,保证患者病情稳定后办理出院,出院时应制定完善的出院医嘱,包括合并疾病的用药、抗血小板治疗等,改善患者预后、降低复发及再入院率,减轻患者的疾病负担。This study used electronic medical record(EMR)data to explore the risk factors for recurrence in patients with the first attack of cerebral infarction(CI).It expected to provide a scientific basis for improving the prognosis and reducing the recurrence rate of patients with CI.In this study,a retrospective search was performed for patients with the first attack of CI from 2017 to 2019 in the inpatient EMR system of a Traditional Chinese Medicine(TCM)hospital in Shandong.Patients were divided into 2 groups according to the recurrence of CI.The Mann-Whitney U Test and the chi-square test were used for statistical analysis.And the binary Logistic regression model and the Cox proportional hazards model were used to explore the risk factors affecting the recurrence of patients with CI and the factors affecting the recurrence days of patients with CI,respectively.Finally,4597 patients with the first attack of CI were included,including 618 patients(13.44%)in the"recurrent CI group"and 3979 patients(86.56%)in the"non-recurrent CI group".Binary Logistic regression analysis showed that LOS(OR=1.035),type 2 diabetes mellitus(T2D)(OR=2.695),CMD(OR=3.272)and PLT(OR=2.628)were risk factors for recurrence in patients with CI.The results of Cox proportional hazards model analysis showed that the LOS at the first onset(HR=1.009)were the promoting factors affecting the recurrence days of patients with CI,and the CMD(HR=0.509)was the hindering factor affecting the recurrence days of patients with CI.This study proved the treatment of patients with CI with TCM decoction after discharge can delay the recurrence of CI.At the same time,attention should be paid to the treatment of patients with combined diseases,and the patients should be discharged after their condition being stable.When the patient was discharged from the hospital,a complete discharge doctor's order should be formulated to prevent recurrence,including medication for comorbid diseases,antiplatelet therapy,etc.In turn,it can improve the prognosis,reduce the recurrence,

关 键 词：脑梗死复发 危险因素 二元Logistic回归模型 COX比例风险回归模型 

分 类 号：R277.7[医药卫生—中医学]