Sankai T, Iso H, Shimamoto T, Miyagaki T, Iida M, Tanigaki M, Naito Y, Sato S, Kiyama M, Kitamura A
Institute of Community Medicine, University of Tsukuba.
Nihon Koshu Eisei Zasshi. 1992 Jul;39(7):410-20.
Risk factors for intracerebral hemorrhage (ICH) and cerebral infarction (CI), were studied by a prospective study of 7,390 men and women aged 40-69 without a history of stroke living in three rural populations in Japan. Baseline examinations were done for populations in Akita-Ikawa and Akita-Ishizawa in 1975-1979, and for Ibaraki-Kyowa in 1981-1987, and followed until 1989 for Akita-Ikawa and Ibaraki-Kyowa and 1987 Akita-Ishizawa. There were 246 stroke cases diagnosed by clinical criteria during the follow-up period in which 74 percent (n = 181) had data from computed tomography (CT) performed within three weeks of the onset. According to these CT-findings, 181 stroke were classified as 48 with ICH, 50 with CI in penetrating artery regions (penetrating artery infarction), 33 with CI in cortical artery regions (cortical artery infarction), and 31 with subarachnoid hemorrhage while there were 19 with stroke without any evident CT abnormality. Cortical artery infarction was further classified as embolic type (n = 17) and thrombotic type (n = 9) according to clinical findings of the onset and presence of possible embolic sources such as atrial fibrillation, congenital heart disease, myocardial infarction and heart valve diseases. Using a nested case-control design, risk variables at baseline examination were compared between 131 stroke cases, 48 ICH and 83 CI, with 655 controls matched for sex, age (+/- 3), and the follow-up year. Univariate analysis showed that high blood pressure was associated with all types of stroke. From conditional logistic regression analysis significant risk variables were found to be high blood pressure for ICH and penetrating artery infarction, while atrial fibrillation and ST-T abnormality in electrocardiogram (ECG) were risk variables for cortical artery infarction. Associations with hypertensive or arteriosclerotic changes in ocular fundus were stronger for penetrating artery infarction than ICH and cortical artery infarction. ST-T abnormality in ECG was associated with embolic type cortical artery infarction and high blood pressure was associated with the thrombotic type, although the number of cases were small. Compared to controls, cortical artery infarction showed a higher mean value of serum total cholesterol for thrombotic type cortical infarction, and lower mean values for embolic type and ICH, but none of them reached statistical significance. The present study also suggests that duration of hypertension varied with type of stroke. ICH may develop due to acute effects of hypertension, while penetrating artery infarction and cortical artery infarction develop by chronic effects of hypertension.
通过对日本三个农村地区7390名年龄在40 - 69岁且无中风病史的男性和女性进行前瞻性研究，探讨了脑出血（ICH）和脑梗死（CI）的危险因素。1975 - 1979年对秋田市石川地区和秋田市石泽地区的人群进行了基线检查，1981 - 1987年对茨城县京和地区进行了基线检查，并对秋田市石川地区和茨城县京和地区随访至1989年，对秋田市石泽地区随访至1987年。随访期间，根据临床标准诊断出246例中风病例，其中74%（n = 181）在发病后三周内进行了计算机断层扫描（CT）检查并获得相关数据。根据这些CT检查结果，181例中风病例被分类为：48例脑出血，50例穿通动脉区域脑梗死（穿通动脉梗死），33例皮质动脉区域脑梗死（皮质动脉梗死），31例蛛网膜下腔出血，另有19例中风病例CT检查无明显异常。根据发病时的临床表现以及是否存在心房颤动、先天性心脏病、心肌梗死和心脏瓣膜病等可能的栓子来源，皮质动脉梗死进一步分为栓塞型（n = 17）和血栓形成型（n = 9）。采用巢式病例对照设计，对131例中风病例（48例脑出血和83例脑梗死）与655名按性别、年龄（±3岁）和随访年份匹配的对照者在基线检查时的风险变量进行了比较。单因素分析显示，高血压与所有类型的中风均有关联。条件逻辑回归分析发现，脑出血和穿通动脉梗死的显著风险变量为高血压，而心房颤动和心电图（ECG）中的ST - T异常是皮质动脉梗死的风险变量。与眼底高血压或动脉硬化改变的关联在穿通动脉梗死中比在脑出血和皮质动脉梗死中更强。心电图中的ST - T异常与栓塞型皮质动脉梗死有关，高血压与血栓形成型有关，尽管病例数较少。与对照组相比，血栓形成型皮质梗死的皮质动脉梗死血清总胆固醇平均值较高，栓塞型和脑出血的血清总胆固醇平均值较低，但均未达到统计学显著性。本研究还表明，高血压的持续时间因中风类型而异。脑出血可能是由高血压的急性作用引起的，而穿通动脉梗死和皮质动脉梗死则是由高血压的慢性作用导致的。
