Sacco R L, Hauser W A, Mohr J P, Foulkes M A
Neurological Institute, Columbia-Presbyterian Medical Center, New York, N.Y.
Stroke. 1991 Mar;22(3):305-11. doi: 10.1161/01.str.22.3.305.
Little is known about outcome after cerebral infarction for different ethnic groups. Of 590 stroke patients hospitalized from 1983 to 1986 at the Neurological Institute, cerebral infarction over age 39 years occurred in 135 whites, 177 blacks, and 82 Hispanics. Outcome after cerebral infarction differed by ethnicity. The 1-month mortality rate was similar in whites and blacks and least in Hispanics. Whites had a slightly greater risk of recurrent stroke or death than blacks or Hispanics until 6 months after infarction, when their risk stabilized, while the risk in blacks and Hispanics continued to rise for the entire year of follow-up. By 1 year, the rate of recurrent stroke or death was 34.8 +/- 4.2% in whites, 31.1 +/- 3.6% in blacks, and 21.4 +/- 4.8% in Hispanics (p = 0.04). Differences were found in the distribution of various stroke risk factors in the three ethnic groups. A Cox proportional hazards model demonstrated that the ethnic differences in stroke risk factors and infarct subtype were responsible for the ethnic differences in outcome. An abnormal first electrocardiogram was a risk factor for stroke recurrence or death in all three ethnic groups, while a nonlacunar infarct subtype and a history of diabetes were significant only in Hispanics. Understanding the associations of stroke determinants with ethnicity may lead to more focused secondary prevention of recurrent stroke.
对于不同种族群体脑梗死的预后情况，人们了解甚少。1983年至1986年期间，在神经学研究所住院的590名中风患者中，39岁以上的脑梗死患者有135名白人、177名黑人以及82名西班牙裔。脑梗死的预后因种族而异。白人及黑人的1个月死亡率相近，而西班牙裔的死亡率最低。在梗死发生后的6个月内，白人复发性中风或死亡的风险略高于黑人和西班牙裔，之后其风险趋于稳定，而黑人和西班牙裔在整个随访年度内风险持续上升。到1年时，白人复发性中风或死亡的发生率为34.8 +/- 4.2%，黑人为31.1 +/- 3.6%，西班牙裔为21.4 +/- 4.8%（p = 0.04）。在这三个种族群体中，各种中风危险因素的分布存在差异。Cox比例风险模型表明，中风危险因素和梗死亚型的种族差异是导致预后种族差异的原因。首次心电图异常是所有三个种族群体中风复发或死亡的危险因素，而非腔隙性梗死亚型和糖尿病史仅在西班牙裔中具有显著性。了解中风决定因素与种族的关联可能会使复发性中风的二级预防更具针对性。
