复发性缺血性中风后残疾恢复的时间框架和预测因素。

Time frame and predictors of recovery from disability following recurrent ischemic stroke.

作者信息

Hankey G J, Spiesser J, Hakimi Z, Carita P, Gabriel S

机构信息

Stroke Unit, Department of Neurology, Royal Perth Hospital, 197 Wellington St., Perth, Australia, 6000.

出版信息

Neurology. 2007 Jan 16;68(3):202-5. doi: 10.1212/01.wnl.0000250327.73031.54.

DOI:10.1212/01.wnl.0000250327.73031.54

PMID:17224574

Abstract

OBJECTIVE

To assess the rate, degree, and predictors of recovery from a disabled to nondisabled state in patients disabled after recurrent ischemic stroke.

METHODS

Patients with ischemic stroke enrolled in the Management of Atherothrombosis with Clopidogrel in High Risk Patients (MATCH) Study underwent prospective assessment of their modified Rankin score (mRS) at 1, 3, 6, 12, and 18 months after enrollment and after recurrent stroke. Patients disabled (defined as mRS > or = 3) after recurrence were analyzed for recovery (defined as mRS < 3) during the 18 months, and predictors of recovery were sought using a Cox proportional-hazard multiple regression analysis.

RESULTS

Three hundred forty-five (54%) of 637 patients were disabled after recurrent ischemic stroke; 115 (33%) patients had been disabled and 230 (66%) nondisabled before stroke recurrence. At recurrence, the degree of disability was moderate (mRS 3) in 135 (39%) patients, severe (mRS 4) in 139 (40%), and very severe (mRS 5) in 71 (21%). After 12 months' median follow-up, 117 (34%, 95% CI: 29 to 39%) had recovered: 68 (50%, 42 to 59%) of 135 moderately disabled, 45 (32%, 25 to 41%) of 139 severely disabled, and 4 (6%, 2 to 14%) of 71 very severely disabled; 70 (20.3%) patients died. From recurrence, median time to recovery was 6 months (mRS 3) and 18 months (mRS 4); 94% with very severe disability had not recovered at 18 months. Independent predictors of recovery were moderate disability at recurrence (mRS 3) compared with severe (mRS 4: hazard ratio [HR] 1.5; 95% CI 1.04 to 2.3) or very severe disability (mRS 5: HR 7.6; 2.7 to 20) and a nondisabled vs disabled state before recurrence (HR 4.0; 2.3 to 6.8).

CONCLUSIONS

The rate of recovery from recurrent ischemic stroke was greatest in the first 6 months; one-third of patients recovered within 12 months. The significant predictors of recovery were a nondisabled state before recurrence and increasing severity of the recurrent stroke.

摘要

目的

评估复发性缺血性卒中后致残患者恢复至非残疾状态的比例、程度及预测因素。

方法

入选高风险患者氯吡格雷治疗动脉粥样硬化血栓形成（MATCH）研究的缺血性卒中患者，在入组时及复发性卒中后1、3、6、12和18个月接受改良Rankin量表（mRS）的前瞻性评估。对复发性卒中后致残（定义为mRS≥3）的患者分析其在18个月内的恢复情况（定义为mRS<3），并采用Cox比例风险多元回归分析寻找恢复的预测因素。

结果

637例患者中有345例（54%）在复发性缺血性卒中后致残；115例（33%）患者在卒中复发前已致残，230例（66%）未致残。复发时，135例（39%）患者残疾程度为中度（mRS 3），139例（40%）为重度（mRS 4），71例（21%）为极重度（mRS 5）。经过12个月的中位随访，117例（34%，95%CI：29%至39%）患者恢复：135例中度残疾患者中的68例（50%，42%至59%），139例重度残疾患者中的45例（32%，25%至41%），71例极重度残疾患者中的4例（6%，2%至14%）；70例（20.3%）患者死亡。从复发开始，恢复的中位时间为6个月（mRS 3）和18个月（mRS 4）；94%的极重度残疾患者在18个月时未恢复。恢复的独立预测因素为复发时中度残疾（mRS 3）与重度（mRS 4：风险比[HR]1.5；95%CI 1.04至2.3）或极重度残疾（mRS 5：HR 7.6；2.7至20）相比，以及复发前非残疾与残疾状态（HR 4.0；2.3至6.8）。