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目的探讨多个危险因素聚集与急性缺血性脑卒中患者出院结局不良的关系。方法采用回顾性队列研究的方法,连续纳入内蒙古兴安盟人民医院2009年6月1日~2012年5月31日住院急性缺血性脑卒中患者为研究对象,共计3 440例。收集人口统计学、生活方式和实验室检查资料。结局不良定义为患者出院时MRs(Modified Rankin’s scale,MRs)≥3分,结局良好定义为患者出院时MRs≤2分。对结局良好组和结局不良组的急性缺血性脑卒中患者入院时基线资料进行比较。危险因素的分析采用两分类非条件logistic回归方法,计算比值比(Odds ratio,OR)及95%可信区间(95%Confident interval,95%CI)。结果 3 440例患者中有结局不良者359例,发生率为10.44%。单因素非条件logistic分析显示,年龄、体温、高血压病、高血糖、脑卒中病史、吸烟、饮酒、高纤维蛋白原及高甘油三脂9个因素与发生结局不良有关系(P均<0.05),其OR(95%CI)分别为1.24(1.12~1.38)、1.89(1.49~2.38)、1.68(1.35~2.10)、1.56(1.24~1.97)、1.59(1.27~2.00)、1.45(1.18~1.77)、1.39(1.13~1.70)、2.37(1.75~3.23)、0.44(0.32~0.62)。在校正了年龄、体温、脑卒中病史、高甘油三脂因素后对其余5种独立危险因素(包括高血压病、高血糖、吸烟、饮酒、高纤维蛋白原)的聚集性分析显示,相对于未暴露于上述危险因素者,暴露于任1~5个上述危险因素和聚集于上述2、3、4、5个均与结局不良发生率有关系,调整后的OR分别为1.659、1.997、3.093、4.854、25.980(P<0.0001),趋势性χ2检验表明,随着危险因素聚集个数的增加,急性缺血性脑卒中患者结局不良发生率也随之增高(P<0.0001)。结论高血压病、高血糖、吸烟、饮酒、高纤维蛋白原5个危险因素聚集可增加急性缺血性脑卒中患者出院结局不良发生率的风险,且存在着剂量反应关系。
Objective To explore the relationship between the aggregation of multiple risk factors and the poor discharge outcomes in patients with acute ischemic stroke. Methods A retrospective cohort study was conducted in consecutive inpatients with acute ischemic stroke in our hospital from June 1, 2009 to May 31, 2012 in Xing’an League People’s Hospital of Inner Mongolia for a total of 3440 cases. Collect demographics, lifestyle and laboratory tests. Outcomes were defined as patients having a MRL of ≥3 at discharge, and a good outcome was defined as MRs ≤ 2 at discharge. Baseline data were compared at admission to patients with acute ischemic stroke who had a good outcome or poor outcome. Risk factors were analyzed using a two-category non-conditional logistic regression model to calculate Odds ratio (OR) and 95% Confidence interval (95% CI). Results Among 3404 patients, 359 had unacceptable outcomes, with an incidence of 10.44%. Univariate non-conditional logistic analysis showed that 9 factors such as age, body temperature, hypertension, hyperglycemia, history of stroke, smoking, drinking, high fibrinogen and high triglyceride were associated with poor outcome (all P <0.05 ) With OR (95% CI) of 1.24 (1.12-1.38), 1.89 (1.49-2.38), 1.68 (1.35-2.10), 1.56 (1.24-1.97), 1.59 1.77), 1.39 (1.13-1.70), 2.37 (1.75-3.23), 0.44 (0.32-0.62). Aggregation analysis of the remaining five independent risk factors (including hypertension, smoking, drinking, high-fibrinogen) after correcting for age, body temperature, history of stroke, and triglyceride showed that relative to Those who were not exposed to the above risk factors were exposed to any one to five of the above risk factors and the above-mentioned 2, 3, 4, and 5 were associated with a poor outcome. The adjusted ORs were 1.659, 1.997 and 3.093, respectively , 4.854,25.980 (P <0.0001). The trend χ2 test showed that the incidence of adverse outcomes in patients with acute ischemic stroke also increased as the number of risk factors increased (P <0.0001). Conclusions The five risk factors of hypertension, hyperglycemia, smoking, drinking and high fibrinogen accumulation can increase the risk of adverse outcomes of discharge outcomes in patients with acute ischemic stroke and there is a dose-response relationship.