卒中后痴呆发病和死亡风险及影响因素研究  

Study on risk factors of incidence and mortality of dementia after stroke

作　　者：王爱民 黄一铭 王凤琳 张文婧 徐雅琪 郭贵雅 宋旺辰 石福艳 王素珍 WANG Aimin;HUANG Yiming;WANG Fenglin;ZHANG Wenjing;XU Yaqi;GUO Guiya;SONG Wangchen;SHI Fuyan;WANG Suzhen(Department of Health Statistics,School of Public Health,Shandong Second Medical University,Weifang,Shandong 261053,China)

机构地区：[1]山东第二医科大学公共卫生学院卫生统计学教研室,山东潍坊261053

出　　处：《中国预防医学杂志》2024年第7期852-858,共7页Chinese Preventive Medicine

基　　金：国家自然科学基金资助项目(82003560);山东省自然科学基金项目(ZR2023MH313)。

摘　　要：目的研究卒中后发生痴呆及死亡的风险及其影响因素,为降低卒中后痴呆发生风险提供科学依据。方法基于英国生物银行(UK Biobank)数据库构建随访队列,采用多状态模型进行卒中和痴呆转归风险预测及影响因素分析。结果在不考虑协变量影响的情况下,6种转归路径中,由痴呆到死亡的累积风险最高,其次为卒中→死亡、卒中→痴呆。卒中后发生痴呆的概率风险是基线状态发生痴呆的4.1倍。年龄(≥45岁)、男性、有当前或既往吸烟史、有时或经常午睡、低体力活动、中心性肥胖和当前饮酒是基线人群3种转归状态(卒中、痴呆和死亡)的影响因素。当前饮酒状态可降低基线人群发生卒中、痴呆和死亡的风险。高龄(≥65岁)[风险比(hazard ratio,HR)=14.15,95%置信区间(confidence interval,CI):1.97~101.39]、有时午睡(HR=1.55,95%CI:1.19~2.02)和中心性肥胖(HR=1.43,95%CI:1.05~1.95)是卒中人群发展为痴呆的危险因素;高体力活动是卒中患者发生痴呆的保护因素(HR=0.72,95%CI:0.52~0.99)。年龄(≥55岁)、男性(HR=1.40,95%CI:1.26~1.56)、当前吸烟(HR=1.25,95%CI:1.06~1.47)和有时午睡(HR=1.14,95%CI:1.03~1.27)是痴呆患者发生死亡的危险因素。结论高龄(≥65岁)、有时午睡和中心性肥胖会增加卒中人群发生痴呆的风险,高体力活动会降低痴呆的发生风险。多状态模型可用于展示疾病转移的影响因素及程度,揭示疾病进程的变化规律。Objective To investigate the risk of dementia following a stroke and explore the factors influencing the occurrence,providing a scientific basis for reducing the risk of post-stroke dementia.Methods A follow-up cohort was constructed based on the UK Biobank database,and multi-state models were used to predict the risk of stroke and dementia transitions and analyze influencing factors.Results Among six transition paths,the cumulative risk of transitioning from dementia to death was the highest,followed by stroke to death and stroke to dementia.The risk of developing dementia after stroke was 4.1 times higher than that at baseline.Factors influencing the three transition states(stroke,dementia,and death)in the baseline population included age(over 45years),male gender,current or previous history of smoking,occasional or frequent napping,low physical activity,central obesity,and current alcohol consumption.Current alcohol use reduced the risk of stroke,dementia,and death in the baseline population.Elder(over 65 years old)[hazard ratio(HR)=14.15,95% confidence interval(CI):1.97-101.39],occasional napping(HR=1.55,95%CI:1.19-2.02)and central obesity(HR=1.43,95%CI:1.05-1.95)were the risk factors in the development of dementia in stroke patients.High physical activity was a protective factor against dementia in stroke patients(HR=0.72,95%CI:0.52-0.99).Older age(over 55 years),male gender(HR=1.40,95%CI:1.26-1.56),current smoking(HR=1.25,95%CI:1.06-1.47),and sometimes napping(HR=1.14,95%CI:1.03-1.27)were identified as risk factors for mortality in patients with dementia.Conclusions Older age(over 65 years),occasional napping,and central obesity can increase the risk of dementia in stroke individuals,while high physical activity decreases the risk of dementia occurrence.The multi-state model can be used to show the influencing factors and degree of disease metastasis and reveal the changing law of disease process.

关 键 词：卒中 痴呆 多状态模型 风险因素 

分 类 号：R255.2[医药卫生—中医内科学] R749.16[医药卫生—中医学]