有癌症病史的中风患者复发性中风和心血管疾病死亡率增加。
Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.
作者信息
Lau Kui-Kai, Wong Yuen-Kwun, Teo Kay-Cheong, Chang Richard Shek-Kwan, Hon Sonny Fong-Kwong, Chan Koon-Ho, Cheung Raymond Tak-Fai, Li Leonard Sheung-Wai, Tse Hung-Fat, Ho Shu-Leong, Siu Chung-Wah
机构信息
Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China ; Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
出版信息
PLoS One. 2014 Feb 11;9(2):e88283. doi: 10.1371/journal.pone.0088283. eCollection 2014.
BACKGROUND AND PURPOSE
Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke.
METHODS
This was a single center, observational study of 1,105 consecutive Chinese ischemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality.
RESULTS
Amongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) (p<0.01). In a Cox regression model, cancer, age and atrial fibrillation were the 3 independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval (CI): 1.54-3.80), 1.01 (1.00-1.03) and 1.35 (1.01-1.82) respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs. 2.35%/year, p = 0.08). In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02), age (HR: 1.04, 95% CI 1.02-1.06), heart failure (HR: 3.06, 95% CI 1.72-5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36) were independent predictors for cardiovascular mortality.
CONCLUSIONS
Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.
背景与目的
癌症患者发生心血管和脑血管事件的风险增加。目前尚不清楚癌症是否会增加中风复发或中风后心血管死亡的额外风险。
方法
这是一项单中心观察性研究，纳入了从香港一家大型中风康复单位连续招募的1105例中国缺血性中风患者。我们试图确定癌症患者是否有更高的中风复发风险和心血管死亡风险。
结果
在1105例患者中，58例（5.2%）患有癌症，其中74%处于缓解期。平均随访76±18个月后，241例患者发生中风复发：癌症患者中有22例（38%，年发病率13.94%/年），显著高于无癌症患者（21%，4.65%/年）（p<0.01）。在Cox回归模型中，癌症、年龄和心房颤动分别是中风复发的3个独立预测因素，风险比（HR）分别为2.42（95%置信区间（CI）：1.54 - 3.80）、1.01（1.00 - 1.03）和1.35（1.01 - 1.82）。同样，癌症患者的心血管死亡率高于无癌症患者（4.30%/年对2.35%/年，p = 0.08）。在Cox回归分析中，癌症（HR：2.08，95% CI：1.08 - 4.02）、年龄（HR：1.04，95% CI 1.02 - 1.06）、心力衰竭（HR：3.06，95% CI 1.72 - 5.47）和严重颈动脉粥样硬化（HR：1.55，95% CI 1.02 - 2.36）是心血管死亡的独立预测因素。
结论
有癌症病史的中风患者中风复发和心血管死亡风险增加。
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