Chung Wei-Sheng, Lin Cheng-Li, Chen Yung-Fu, Ho Feng-Ming, Hsu Wu-Huei, Kao Chia-Hung
Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan.
Eur J Clin Invest. 2014 Nov;44(11):1025-33. doi: 10.1111/eci.12336. Epub 2014 Oct 1.
We conducted a nationwide population-based cohort study to investigate the effects of asthma on the risk of stroke development in an Asian population.
Newly diagnosed asthmatic patients aged ≥ 18 years were identified, and asthma-free controls were randomly selected from the general population and frequency matched according to age, sex and index year using records obtained from the National Health Insurance Research Database between 2000 and 2010. Both cohorts were followed up until the end of 2011 to measure the incidence of stroke. The risk of stroke was analysed using Cox proportional hazard regression models, including factors such as sex, age and comorbidities.
We followed the asthmatic patients for 104 697 person-years and followed the nonasthmatic people for 426 729 person-years. The incidence density rate of stroke increased in all of the groups of asthmatic patients compared with that of the controls when stratified according to sex, age and comorbidities. The hazard ratio (HR) of stroke was 1·37-fold greater for the asthmatic cohort, compared with that for the nonasthmatic cohort, after adjusting for sex, age and comorbidities. The adjusted HR of developing stroke substantially increased with older age and the increased frequency of asthmatic exacerbation and hospitalization. The patients receiving beta-2 agonists as a treatment exhibited a significantly greater risk of stroke compared with the patients receiving only inhaled corticosteroids, after adjusting for covariates.
Asthma may be an independent risk factor for stroke, and its severity exhibits a dose response of stroke development.
我们开展了一项基于全国人群的队列研究，以调查哮喘对亚洲人群中风发病风险的影响。
确定年龄≥18岁的新诊断哮喘患者，并从普通人群中随机选取无哮喘的对照者，根据2000年至2010年间从国民健康保险研究数据库获取的记录，按年龄、性别和索引年份进行频数匹配。两个队列均随访至2011年底，以测量中风发病率。使用Cox比例风险回归模型分析中风风险，包括性别、年龄和合并症等因素。
我们对哮喘患者随访了104697人年，对非哮喘患者随访了426729人年。根据性别、年龄和合并症分层时，所有哮喘患者组的中风发病密度率均高于对照组。在调整性别、年龄和合并症后，哮喘队列中风的风险比（HR）比非哮喘队列高1.37倍。随着年龄增长以及哮喘加重和住院频率增加，发生中风的调整后HR大幅上升。在调整协变量后，接受β-2激动剂治疗的患者与仅接受吸入性糖皮质激素治疗的患者相比，中风风险显著更高。
哮喘可能是中风的独立危险因素，其严重程度对中风发生呈现剂量反应关系。
