Kiyohara Yutaka, Kubo Michiaki, Kato Isao, Tanizaki Yimihiro, Tanaka Keiichi, Okubo Ken, Nakamura Hidetoshi, Iida Mitsuo
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka City, 812-8582 Japan.
Stroke. 2003 Oct;34(10):2343-7. doi: 10.1161/01.STR.0000091845.14833.43. Epub 2003 Sep 18.
There have been very few population-based cohort studies of long-term prognosis and risk factors for death after stroke. We examined the 10-year prognosis, causes, and risk factors of death after stroke in a Japanese cohort.
During a 26-year follow-up of a cohort of 1621 subjects > or =40 years of age, 333 subjects developed first-ever stroke and were prospectively followed up for 10 years after onset. During these 10-year follow-up periods, 268 of the 333 stroke patients died. Of those, 239 (89.2%) underwent autopsy.
The risk of death was greatest in the first year after first-stroke onset in both sexes (men, 40.3%; women, 43.7%). Thereafter, the survival curves decreased gradually, and risk of death reached 80.7% for men and 80.2% for women by the end of the 10-year follow-up. The 30-day case fatality rate was substantially greater in patients with cerebral hemorrhage (63.3%) or subarachnoid hemorrhage (58.6%) than in patients with cerebral infarction (9.0%). The risk of dying after the first stroke was twice the risk for stroke-free subjects. The most common cause of death was the index stroke in the first year. Thereafter, the impact of the first stroke gradually decreased, while that of recurrent stroke increased. Multivariate analysis revealed that age, lower body mass index, and hemorrhagic stroke were significant risk factors for death after stroke.
Our findings suggest that the risk of death after first-ever stroke is high, in part because of the larger proportion of hemorrhagic stroke in Japanese relative to stroke victims in Western countries.
基于人群的关于卒中后长期预后及死亡风险因素的队列研究非常少。我们在一个日本队列中研究了卒中后10年的预后、死因及死亡风险因素。
在对1621名年龄≥40岁的受试者进行的26年随访中，333名受试者首次发生卒中，并在发病后进行了10年的前瞻性随访。在这10年的随访期间，333名卒中患者中有268人死亡。其中，239人（89.2%）接受了尸检。
男女首次卒中发作后的第一年死亡风险最高（男性为40.3%；女性为43.7%）。此后，生存曲线逐渐下降，到10年随访结束时，男性的死亡风险达到80.7%，女性为80.2%。脑出血（63.3%）或蛛网膜下腔出血（58.6%）患者的30天病死率显著高于脑梗死患者（9.0%）。首次卒中后死亡的风险是无卒中受试者的两倍。最常见的死因在第一年是首发卒中。此后，首发卒中的影响逐渐降低，而复发性卒中的影响增加。多因素分析显示，年龄、较低的体重指数和出血性卒中是卒中后死亡的显著风险因素。
我们的研究结果表明，首次卒中后的死亡风险很高，部分原因是相对于西方国家的卒中患者，日本出血性卒中的比例更大。
