缺血性中风后残疾恢复的速率、程度及预测因素。

Rate, degree, and predictors of recovery from disability following ischemic stroke.

作者信息

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

机构信息

Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Australia.

出版信息

Neurology. 2007 May 8;68(19):1583-7. doi: 10.1212/01.wnl.0000260967.77422.97.

DOI:10.1212/01.wnl.0000260967.77422.97

PMID:17485645

Abstract

OBJECTIVE

To determine the rate, degree, and predictors of recovery from disabling ischemic stroke.

METHODS

Patients with ischemic stroke enrolled in the Management of Atherothrombosis With Clopidogrel in High-Risk Patients (MATCH) study underwent long-term prospective assessment of their modified Rankin Scale (mRS) score. Disability (functionally dependent state) was defined as mRS > or = 3, and recovery (functionally independent state) was defined as mRS < 3. The timing and the independent predictors of recovery were determined using a Cox proportional hazards multiple regression analysis.

RESULTS

Of 7,599 patients enrolled with ischemic stroke or TIA, 1,662 (21.8%) were disabled (mRS > or = 3) at baseline (median of 14 [0 to 96] days after stroke onset). Disability was moderate (mRS 3) in 931 (56%) patients, severe (mRS 4) in 691 (42%), and very severe (mRS 5) in 40 (2%). By 18 months, 877 (52.8%, 95% CI 50% to 55%) patients had recovered, 589 (63%, 60% to 66%) with moderate disability, 281 (41%, 37% to 44%) with severe disability, and 7 (17%, 7 to 33%) with very severe disability. Median time to recovery was 3 months for patients with moderate disability and 18 months for severe disability; 82.5% of severely disabled patients remained so at 18 months. Predictors of recovery were moderate disability (mRS 3) at baseline compared with severe (mRS 4: hazard ratio [HR] 2.13, 1.86 to 2.44) or very severe disabling stroke (HR 5.88, 2.86 to 12.5); younger women (aged <65 years, compared with > or =75 years; HR 1.85, 1.47 to 2.33); decreasing time (days) between the qualifying event and the baseline assessment (HR 1.01, 1.01 to 1.02); and the absence of previous ischemic stroke (HR 1.61, 1.35 to 1.92), concurrent peripheral artery disease (HR 1.61, 1.23 to 2.13), or diabetes (HR 1.30, 1.10 to 1.54).

CONCLUSIONS

Half of patients with disabling ischemic stroke recovered within 18 months, and recovery was greatest within 6 months. Significant predictors of recovery included the severity of the index stroke and no history of ischemic stroke, peripheral artery disease, or diabetes.

摘要

目的

确定致残性缺血性卒中的恢复率、恢复程度及预测因素。

方法

纳入“高危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，对其改良Rankin量表（mRS）评分进行长期前瞻性评估。残疾（功能依赖状态）定义为mRS≥3，恢复（功能独立状态）定义为mRS<3。采用Cox比例风险多元回归分析确定恢复的时间及独立预测因素。

结果

在7599例纳入研究的缺血性卒中或短暂性脑缺血发作（TIA）患者中，1662例（21.8%）在基线时（卒中发作后中位时间14[0至96]天）存在残疾（mRS≥3）。931例（56%）患者为中度残疾（mRS 3），691例（42%）为重度残疾（mRS 4），40例（2%）为极重度残疾（mRS 5）。至18个月时，877例（52.8%，95%可信区间50%至55%）患者恢复，中度残疾患者中589例（63%，60%至66%）恢复，重度残疾患者中281例（4 l%，37%至44%）恢复，极重度残疾患者中7例（17%，7%至33%）恢复。中度残疾患者恢复的中位时间为3个月，重度残疾患者为18个月；82.5%的重度残疾患者在18个月时仍为重度残疾。恢复的预测因素包括与重度（mRS 4：风险比[HR]2.13，1.86至2.44）或极重度致残性卒中（HR 5.88，2.86至12.5）相比，基线时为中度残疾（mRS 3）；年轻女性（年龄<65岁，与≥75岁相比；HR 1.85，1.47至2.33）；从符合条件事件至基线评估的时间（天数）减少（HR 1.01，1.01至1.02）；以及无既往缺血性卒中（HR 1.61，1.35至1.92）、并发外周动脉疾病（HR 1.61，1.23至2.13）或糖尿病（HR 1.30，1.10至1.54）。