Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610044, China.
National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610044, China.
Curr Med Sci. 2020 Aug;40(4):708-718. doi: 10.1007/s11596-020-2240-y. Epub 2020 Aug 29.
Several studies have indicated that stroke survivors with multiple lesions or with larger lesion volumes have a higher risk of stroke recurrence. However, the relationship between lesion locations and stroke recurrence is unclear. We conducted a prospective cohort study of first-ever ischemic stroke survivors who were consecutively enrolled from January 2010 to December 2015. Stroke recurrence was assessed every 3 months after post-discharge via telephone interviews by trained interviewers. Lesion locations were obtained from hospital-based MRI or CT scans and classified using two classification systems that were based on cerebral hemisphere or vascular territory and brain anatomical structures. Flexible parametric survival models using the proportional hazards scale (PH model) were used to analyze the time-to-event data. Among 633 survivors, 63.51% (n=402) had anterior circulation ischemia (ACI), and more than half of all ACIs occurred in the subcortex. After a median follow-up of 2.5 years, 117 (18.48%) survivors developed a recurrent stroke. The results of the multivariate PH model showed that survivors with non-brain lesions were at higher risk of recurrence than those with right-side lesions (HR, 2.79; 95%CI, 1.53, 5.08; P=0.001). There was no increase in risk among survivors with left-side lesions (HR, 0.97; 95%CI, 0.53, 1.75; P=0.914) or both-side lesions (HR, 1.24; 95%CI, 0.75, 2.07; P=0.401) compared to those with right-side lesions. Additionally, there were no associations between stroke recurrence and lesion locations that were classified based on vascular territory and brain anatomical structures. It was concluded that first-ever ischemic stroke survivors with non-brain lesion had higher recurrence risk than those with right-side lesion, although no significant associations were found when the lesion locations were classified by vascular territory and brain anatomical structures.
一些研究表明，多发性病变或病变体积较大的中风幸存者中风复发的风险更高。然而，病变位置与中风复发之间的关系尚不清楚。我们对 2010 年 1 月至 2015 年 12 月连续收治的首次缺血性中风幸存者进行了前瞻性队列研究。通过训练有素的访谈者进行电话访谈，在出院后每 3 个月评估中风复发情况。病变位置是通过医院的 MRI 或 CT 扫描获得的，并使用基于大脑半球或血管区域和大脑解剖结构的两种分类系统进行分类。使用比例风险比例（PH 模型）的灵活参数生存模型分析时间事件数据。在 633 名幸存者中，63.51%（n=402）为前循环缺血（ACI），超过一半的所有 ACI 发生在皮质下。中位随访 2.5 年后，117（18.48%）名幸存者发生复发性中风。多变量 PH 模型的结果表明，无脑部病变的幸存者比右侧病变幸存者的复发风险更高（HR，2.79；95%CI，1.53，5.08；P=0.001）。左侧病变幸存者（HR，0.97；95%CI，0.53，1.75；P=0.914）或双侧病变幸存者（HR，1.24；95%CI，0.75，2.07；P=0.401）的风险没有增加与右侧病变相比。此外，根据血管区域和大脑解剖结构对病变位置进行分类时，与中风复发之间没有关联。因此，首次发生缺血性中风且无脑部病变的幸存者复发风险高于右侧病变的幸存者，尽管当根据血管区域和大脑解剖结构对病变位置进行分类时，未发现显著关联。
