Woo D, Gebel J, Miller R, Kothari R, Brott T, Khoury J, Salisbury S, Shukla R, Pancioli A, Jauch E, Broderick J
Departments of Neurology, Environmental Health, and Emergency Medicine, University of Cincinnati, OH 45267-0525, USA.
Stroke. 1999 Dec;30(12):2517-22. doi: 10.1161/01.str.30.12.2517.
The aim of this study was to determine the incidence rates of ischemic stroke subtypes among blacks.
Hospitalized and autopsied cases of stroke and transient ischemic attack among the 187 000 blacks in the 5-county region of greater Cincinnati/northern Kentucky From January 1, 1993, through June 30, 1993, were identified. Incidence rates were age- and sex-adjusted to the 1990 US population. Subtype classification was performed after extensive review of all available imaging, laboratory data, clinical information, and past medical history. Case-control comparisons of risk factors were made with age-, race-, and sex-matched control subjects.
Annual incidence rates per 100 000 for first-ever ischemic stroke subtypes among blacks were as follows: uncertain cause, 103 (95% confidence interval [CI], 80 to 126); cardioembolic, 56 (95% CI, 40 to 73); small-vessel infarct, 52 (95% CI, 36 to 68); large vessel, 17 (95% CI, 8 to 26); and other causes, 17 (95% CI, 9 to 26). Of the patients diagnosed with an infarct of uncertain cause, 31% underwent echocardiography, 45% underwent carotid ultrasound, and 48% had neither. Compared with age-, race-, and sex- (proportionally) matched control subjects from the greater Cincinnati/northern Kentucky region, the attributable risk of hypertension for all causes of first-ever ischemic stroke is 27% (95% CI, 7 to 43); for diabetes, 21% (95% CI, 11 to 29); and for coronary artery disease, 9% (95% CI, 2 to 16). For small-vessel ischemic stroke, the attributable risk of hypertension is 68% (95% CI, 31 to 85; odds ratio [OR], 5.0), and the attributable risk of diabetes is 30% (95% CI, 10 to 45; OR, 4.4). For cardioembolic stroke, the attributable risk of diabetes is 25% (95% CI, 4 to 41; OR, 3.1).
Stroke of uncertain cause is the most common subtype of ischemic stroke among blacks. Cardioembolic stroke and small-vessel stroke are the most important, identifiable causes of first-ever ischemic stroke among blacks. The incidence rates of cardioembolic and large-vessel stroke are likely underestimated because noninvasive testing of the carotid arteries and echocardiography were not consistently obtained in stroke patients at the 18 regional hospitals. Most small-vessel strokes in blacks can be attributed to hypertension and diabetes.
本研究旨在确定黑人中缺血性卒中亚型的发病率。
确定1993年1月1日至1993年6月30日期间，大辛辛那提/北肯塔基5县地区187,000名黑人中住院及尸检的卒中和短暂性脑缺血发作病例。发病率按年龄和性别调整至1990年美国人口标准。在全面回顾所有可用的影像学、实验室数据、临床信息和既往病史后进行亚型分类。对危险因素进行病例对照比较，对照对象按年龄、种族和性别匹配。
黑人首次缺血性卒中亚型每100,000人的年发病率如下：病因不明，103（95%可信区间[CI]，80至126）；心源性栓塞，56（95%CI，40至73）；小血管梗死，52（95%CI，36至68）；大血管，17（95%CI，8至26）；其他病因，17（95%CI，9至26）。在诊断为病因不明梗死的患者中，31%接受了超声心动图检查，45%接受了颈动脉超声检查，48%两者均未做。与大辛辛那提/北肯塔基地区年龄、种族和性别（按比例）匹配的对照对象相比，高血压对首次缺血性卒中所有病因的归因风险为27%（95%CI，7至43）；糖尿病为21%（95%CI，11至29）；冠状动脉疾病为9%（95%CI，2至16）。对于小血管缺血性卒中，高血压的归因风险为68%（95%CI，31至85；优势比[OR]，5.0），糖尿病的归因风险为30%（95%CI，10至45；OR，4.4）。对于心源性栓塞性卒中，糖尿病的归因风险为25%（95%CI，4至41；OR，3.1）。
病因不明的卒中是黑人中最常见的缺血性卒中亚型。心源性栓塞性卒中和小血管卒中是黑人首次缺血性卒中最重要的可识别病因。心源性栓塞性卒中和大血管卒中的发病率可能被低估，因为18家地区医院的卒中患者未始终进行颈动脉无创检查和超声心动图检查。黑人中的大多数小血管卒中可归因于高血压和糖尿病。
