Cunha Denise de Aquino, Camargos Sarah, Passos Valéria Maria de Azeredo, Mello Carla de Meirelles, Vaz Luiz Sérgio, Lima Luciano Romero Soares de
Adult Health Sciences Post Graduation Program, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Sarah Network Rehabilitation Hospitals, Belo Horizonte, Minas Gerais, Brazil.
Adult Health Sciences Post Graduation Program, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
J Stroke Cerebrovasc Dis. 2019 Feb;28(2):513-520. doi: 10.1016/j.jstrokecerebrovasdis.2018.10.032. Epub 2018 Nov 19.
The aim of this study was to evaluate heterotopic ossification (HO) prevalence after stroke, describing clinical features and investigating predictors of HO and its severity.
A cross-sectional study was carried out in 7 rehabilitation centers (Sarah Network) from 2004 to 2013.
Among 17,794 stroke cases, 235 patients (1.3%) presented clinical and radiological evidence of HO. A log-binomial model with robust variance estimated the prevalence ratio of 1.3% in 10 years. A multinomial logistic regression was performed to investigate the predictors of HO and its severity. The presence of hemorrhagic stroke (prevalence ratio [PR] = 4.75; 95% confidence interval [CI] PR = 3.38; 6.68) and ischemic stroke with hemorrhagic transformation (PR = 3.08; 95% CI PR = 1.63; 5.81), male sex (PR = 1.60; 95% CI PR = 1.16; 2.22), spasticity (PR = 13.78; 95% CI PR = 8.59; 22.10), and cognitive impairment (PR = 1.88; 95% CI PR = 1.36; 2.60) were independently associated with HO. Patients with HO were younger (P < .0001) and presented a shorter time of disease (P = .013). Young adult patients were more likely to develop severe HO (odds ratio = 2.80, 95% CI 1.09; 7.20) than were elderly patients. Severe HO was also related to heavy alcohol consumption (2.45; 1.03-5.84) and involved 2 or more joints (5.34; 1.85-15.36). There was an association with use of invasive ventilation (6.30; 2.13-18.63) at the acute stroke phase and patients were dependent on activities of daily living after stroke (3.90; 1.00-15.19).
Despite the small prevalence of HO after stroke, this 10-year multicenter study was able to identify several associated factors related to the management and severity of stroke as well as the hemorrhagic subtype.
本研究旨在评估卒中后异位骨化（HO）的患病率，描述其临床特征，并探究HO及其严重程度的预测因素。
2004年至2013年在7个康复中心（莎拉网络）开展了一项横断面研究。
在17794例卒中病例中，235例患者（1.3%）有HO的临床和影像学证据。采用稳健方差估计的对数二项模型估计10年患病率为1.3%。进行多项逻辑回归以探究HO及其严重程度的预测因素。出血性卒中（患病率比[PR]=4.75；95%置信区间[CI] PR=3.38；6.68）、伴有出血转化的缺血性卒中（PR=3.08；95% CI PR=1.63；5.81）、男性（PR=1.60；95% CI PR=1.16；2.22）、痉挛（PR=13.78；95% CI PR=8.59；22.10）和认知障碍（PR=1.88；95% CI PR=1.36；2.60）与HO独立相关。HO患者更年轻（P<.0001）且病程较短（P=.013）。与老年患者相比，年轻成年患者更易发生严重HO（比值比=2.80，95% CI 1.09；7.20）。严重HO还与大量饮酒（2.45；1.03 - 5.84）以及累及2个或更多关节（5.34；1.85 - 15.36）有关。与急性卒中期使用有创通气（6.30；2.13 - 18.63）以及卒中后患者日常生活活动依赖（3.90；1.00 - 15.19）存在关联。
尽管卒中后HO患病率较低，但这项为期10年的多中心研究能够识别出与卒中管理、严重程度以及出血亚型相关的若干因素。
