老年人缺血性中风存活与康复的相关因素。
Factors Associated With Ischemic Stroke Survival and Recovery in Older Adults.
作者信息
Winovich Divya Thekkethala, Longstreth William T, Arnold Alice M, Varadhan Ravi, Zeki Al Hazzouri Adina, Cushman Mary, Newman Anne B, Odden Michelle C
机构信息
From the School of Biological and Population Health Sciences, Oregon State University, Corvallis (D.T.W., M.C.O.); School of Medicine, Oregon Health and Science University, Portland (D.T.W.); Department of Neurology (W.T.L.), and Department of Biostatistics (A.M.A.), University of Washington, Seattle; Department of Oncology, John Hopkins University, Baltimore, MD (R.V.); Department of Public Health Sciences, University of Miami, Coral Gables, FL (A.Z.A.H.); Department of Pathology and Laboratory Medicine, and Department of Medicine, University of Vermont, Burlington (M.C.); and Department of Epidemiology, University of Pittsburgh, PA (A.B.N.).
出版信息
Stroke. 2017 Jul;48(7):1818-1826. doi: 10.1161/STROKEAHA.117.016726. Epub 2017 May 19.
BACKGROUND AND PURPOSE
Little is known about factors that predispose older adults to poor recovery after a stroke. In this study, we sought to evaluate prestroke measures of frailty and related factors as markers of vulnerability to poor outcomes after ischemic stroke.
METHODS
In participants aged 65 to 99 years with incident ischemic strokes from the Cardiovascular Health Study, we evaluated the association of several risk factors (frailty, frailty components, C-reactive protein, interleukin-6, and cystatin C) assessed before stroke with stroke outcomes of survival, cognitive decline (≥5 points on Modified Mini-Mental State Examination), and activities of daily living decline (increase in limitations).
RESULTS
Among 717 participants with incident ischemic stroke with survival data, slow walking speed, low grip strength, and cystatin C were independently associated with shorter survival. Among participants <80 years of age, frailty and interleukin-6 were also associated with shorter survival. Among 509 participants with recovery data, slow walking speed, and low grip strength were associated with both cognitive and activities of daily living decline poststroke. C-reactive protein and interleukin-6 were associated with poststroke cognitive decline among men only. Frailty status was associated with activities of daily living decline among women only.
CONCLUSIONS
Markers of physical function-walking speed and grip strength-were consistently associated with survival and recovery after ischemic stroke. Inflammation, kidney function, and frailty also seemed to be determinants of survival and recovery after an ischemic stroke. These markers of vulnerability may identify targets for differing pre and poststroke medical management and rehabilitation among older adults at risk of poor stroke outcomes.
背景与目的
关于促使老年人中风后恢复不佳的因素，我们知之甚少。在本研究中，我们试图评估中风前的衰弱指标及相关因素，作为缺血性中风后不良预后易感性的标志物。
方法
在心血管健康研究中，选取年龄在65至99岁的首次发生缺血性中风的参与者，我们评估了中风前评估的几个风险因素（衰弱、衰弱组分、C反应蛋白、白细胞介素-6和胱抑素C）与生存、认知功能下降（改良简易精神状态检查表得分≥5分）及日常生活活动能力下降（功能受限增加）等中风预后的相关性。
结果
在717例有生存数据的首次发生缺血性中风的参与者中，步行速度慢、握力低和胱抑素C与较短的生存期独立相关。在年龄<80岁的参与者中，衰弱和白细胞介素-6也与较短的生存期相关。在509例有恢复数据的参与者中，步行速度慢和握力低与中风后的认知功能和日常生活活动能力下降均相关。C反应蛋白和白细胞介素-6仅与男性中风后的认知功能下降相关。衰弱状态仅与女性的日常生活活动能力下降相关。
结论
身体功能指标——步行速度和握力——与缺血性中风后的生存及恢复始终相关。炎症、肾功能和衰弱似乎也是缺血性中风后生存及恢复的决定因素。这些易感性标志物可能为中风预后不佳风险的老年人在中风前后不同的医疗管理和康复确定目标。
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