Chen Xin Wee, Nazri Shafei Mohd, Abdul Aziz Zariah, Nazifah Sidek Norsima, Imran Musa Kamarul
Public Health Medicine Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
PeerJ. 2020 Feb 14;8:e8378. doi: 10.7717/peerj.8378. eCollection 2020.
Diabetes and dyslipidemia are significantly associated with stroke recurrence, yet the evidence for this relationship is conflicting. Consequently, the parameters in the glucose and lipid profiles may inform us regarding their relationship with stroke recurrence, thus enhancing the physicians' clinical decision-making.
This study sought to investigate whether glucose and lipid profiles could prognosticate stroke recurrence in Malaysia.
We conducted a retrospective hospital-based study where we analyzed the first-ever stroke cases regarding about which the Malaysia National Stroke Registry was informed between 2009 and 2017, that fulfilled this study's criteria, and that were followed for stroke recurrence. Using the Cox proportional hazard regression analysis, we estimated the adjusted hazard ratios (HRs), which reflected the prognostic effect of the primary variables (i.e., glucose and lipid profiles on the first-stroke admission) on stroke recurrence.
Among the 8,576 first-ever stroke patients, 394 (4.6%) experienced a subsequent first stroke recurrence event. The prognostic effect measured by univariable Cox regression showed that, when unadjusted, ten variables have prognostic value with regards to stroke recurrence. A multivariable regression analysis revealed that glucose was not a significant prognostic factor (adjusted HR 1.28; 95% CI [1.00-1.65]), while triglyceride level was the only parameter in the lipid profile found to have an independent prognostication concerning stroke recurrence (adjusted HR: 1.28 to 1.36).
Triglyceride could independently prognosticate stroke recurrence, which suggests the role of physicians in intervening hypertriglyceridemia. In line with previous recommendations, we call for further investigations in first-ever stroke patients with impaired glucose and lipid profiles and suggest a need for interventions in these patients.
糖尿病和血脂异常与中风复发显著相关，但这种关系的证据存在矛盾。因此，血糖和血脂谱参数可能会让我们了解它们与中风复发的关系，从而改善医生的临床决策。
本研究旨在调查血糖和血脂谱是否能预测马来西亚中风的复发情况。
我们开展了一项基于医院的回顾性研究，分析了2009年至2017年间首次中风且符合本研究标准并接受中风复发随访的病例，这些病例已告知马来西亚国家中风登记处。使用Cox比例风险回归分析，我们估计了调整后的风险比（HR），该风险比反映了主要变量（即首次中风入院时的血糖和血脂谱）对中风复发的预后影响。
在8576例首次中风患者中，394例（4.6%）经历了随后的首次中风复发事件。单变量Cox回归测量的预后效果显示，未经调整时，有10个变量对中风复发具有预后价值。多变量回归分析显示，血糖不是一个显著的预后因素（调整后的HR为1.28；95%CI[1.00 - 1.65]），而甘油三酯水平是血脂谱中唯一被发现与中风复发具有独立预后关系的参数（调整后的HR：1.28至1.36）。
甘油三酯可独立预测中风复发，这表明医生在干预高甘油三酯血症方面的作用。根据先前的建议，我们呼吁对首次中风且血糖和血脂谱受损的患者进行进一步研究，并建议对这些患者进行干预。
