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医学论文范文:动脉硬化性脑梗死复发的危险因素分析
【摘要】 目的：探讨脑梗死复发的危险因素。方法 ：随访观察769例脑梗死患者，比较有复发的脑梗死患者和无复发的脑梗死患者首次卒中时的危险因素、血同型半胱氨酸（Hcy)、可溶性黏附分子（SICAM-1)、细胞因子水平、颈动脉粥样硬化的严重程度、狭窄程度及斑块类型、首次卒中后危险因素控制情况。结果 ：769例脑梗死患者在随访期有156例（占20.3%)复发，出院后正规服阿斯匹林的患者复发率低于未正规服阿斯匹林的患者（P <0.05)；首次卒中后戒烟者及血压、血糖、血胆固醇控制在正常范围的患者复发率低于控制不好的患者；多变量Logistic回归分析表明，年龄、血清白蛋白/球蛋白比例、血糖、纤溶酶原活性、Hcy、sICAM-1、IL-6水平及颈动脉粥样硬化的严重程度、狭窄程度、斑块类型以及首次卒中后是否戒烟，血压、血糖和血胆固醇是否控制在正常水平，出院后是否正规服用阿斯匹林是脑梗死复发密切相关的危险因素。结论 ：与脑梗死复发相关的危险因素多，首次卒中后戒烟、控制好血压、血糖和血胆固醇以及出院后正规服用阿斯匹林在降低脑梗死复发中起重要作用。
【关键词】 脑梗死；预后；颈动脉粥样硬化；细胞因子；同型半胱氨酸
Analysis of risk factors for recurrence of atherosclerotic cerebral infarction CHI Wan-zhang，YI Xing-yang，CHI Li-fen，PAN Ji-bao，ZHANG Shun-kai. Department of Neurology，Rui’an People’s Hospital，Wenzhou，325200
Abstract: Objective: To explore the risk factors for recurrence of cerebral infarction. Methods: 769 patients with cerebral infarction were following-up observed. The risk factor of stroke， the levels of blood homocysteine (Hcy)， soluble intercellular adhesion molecule， cytokine， the grade of carotid atherosclerosis， stenosis， and types of plaque and the situation of controlling the first post-stroke risk factors were compared between patients with recurrent cerebral infarction and non recurrent cerebral infarction of the firstr stroke. Results:Of 769 patients with cerebral infarction， 156 patients (20.3%) relapsed during follow-up periods. The incidence of recurrence was lower in patients of regular use of aspirin than those of no regular use after discharge （P <0.05)， The incidence of recurrence was lower in patients of giving up smoking and controlling normal of blood glucose， blood pressure，blood cholesterol than those of continuing smoking and poor control after stroke. The multivariable logistic regression analysis showed that the age， blood glucose， the A/G ratio， and the levels of HCY， sICAM-1， IL-6， plasminogen， the grade of carotid atherosclerosis， stenosis， and types of plaque，and whether or not to give up smoking， whether or not to control normal blood glucose，blood pressure， blood cholesterol， whether or not to regular use of aspirin after first stroke were closely related to cerebral infarction recurrence risk factors. Conclusion:There are many risk factors related to cerebral infarction recurrence. To give up smoking， control blood pressure， blood glucose and blood cholesterol， as well as regular use of aspirin after the first stroke play important roles. in the reduction of recurrence of cerebral infarction
Key words: cerebral infarction；prognosis；atherosclerosis；cytokine；homocysteine
脑梗死复发率高，复发的脑梗死患者预后不良。脑梗死复发的研究国内外虽较多，但多为回顾性的或病侧对照研究，前瞻性研究国内较少。本研究对脑梗死复发的危险因素进行多因素分析，并探讨其可能的机制医.学.全.在.线www.med126.com。
1 资料和方法
1.1 研究对象 脑梗死组：为2000年8月至2005年12月在我院住院首次发病的脑梗死患者。脑梗死的诊断符合第四届全国脑血管病会议修订的标准，全部病例均经头颅CT或MRI扫描证实，根据临床及影像学将脑梗死分成动脉粥样硬化性血栓性脑梗死和腔隙性脑梗死。排除标准：①年龄≥80岁；②心源性或其他原因的脑栓塞；③不能分类的脑梗死；④出血性脑血管病或瘤卒中；⑤伴严重的心、肝、肾疾病；⑥不愿参与该研究的患者；⑦短暂性脑缺血发作（TIA)患者。符合上述诊断标准及排除标准的脑梗死患者共791例，其中22例因外地定居等原因失访，因此共769例纳入分析。男432例，女337例，年龄45～79岁，平均（69.8±21.2)岁。出院后正规服阿斯匹林677例（100 mg，每日1次)，其中在此基础上服辛伐他汀者有320例，未正规服阿斯匹林92例。健康对照组：为60名健康体检者，年龄44～78岁，平均（67.7±21.3)岁。
