Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan..
Department of Nursing Science, Hirosaki University Graduate School of Health Science, Hirosaki, Japan.
J Stroke Cerebrovasc Dis. 2021 May;30(5):105681. doi: 10.1016/j.jstrokecerebrovasdis.2021.105681. Epub 2021 Feb 27.
A third to half of recurrent stroke occur while on antiplatelet therapy, but no study has explored factors relating to prognosis of recurrent ischemic stroke. This study aimed to clarify the risk factors to determine the clinical outcome of recurrent ischemic stroke.
A total of 1,333 consecutive acute ischemic stroke patients (first n = 492, recurrent n = 841) were enrolled. We explored factors influencing the modified Rankin Scales (mRS) at discharge that included platelet aggregability, preceding medicines, and well-known risks of biochemical data using Chi-square test or Fisher's exact probability test.
As to preceding medicines, the proportion of patients who were functionally independent (mRS 0-2) at discharge was higher in preceding P2Y12 inhibitor that suppressed ADP- and collagen-induced macro-aggregation of platelet and Xa inhibitor or warfarin in cardioembolic stroke, but lower in P2Y12 inhibitor and Xa inhibitor or warfarin in lacunar stroke compared with no medicine. Regardless of LDL-cholesterol and HA1c, the mRS at discharge ≤ 2 was increased in the third tertile of serum albumin and body mass index (BMI) in atherothrombotic stroke; serum albumin and high-density lipoprotein cholesterol (HDL-C) in lacunar stroke; and serum albumin, HDL-C and BMI in cardioembolic stroke. Logistic regression analysis identified the following independent predictors for clinical outcome: serum albumin, HDL-C, BMI, and preceding Xa inhibitor and P2Y12 inhibitor.
Regardless of well-known risk factors such as diabetes and high LDL-C, preceding treatment for Xa inhibitor or P2Y12 inhibitor, serum albumin, HDL-C, and BMI were associated with prognosis in recurrent ischemic stroke.
三分之一到一半的复发性中风发生在抗血小板治疗期间，但尚无研究探讨与复发性缺血性中风预后相关的因素。本研究旨在阐明危险因素，以明确复发性缺血性中风的临床转归。
共纳入 1333 例连续急性缺血性中风患者（首发 n=492 例，复发 n=841 例）。我们采用卡方检验或 Fisher 确切概率检验，探讨了影响出院时改良 Rankin 量表（mRS）评分的因素，包括血小板聚集率、既往用药和生化数据的已知危险因素。
就既往用药而言，在血小板 P2Y12 抑制剂（ADP 和胶原诱导的血小板大聚集受到抑制）、Xa 抑制剂或华法林能使心源性栓塞性中风患者出院时达到功能独立（mRS 0-2）的比例更高，而在腔隙性中风患者中则更低，与无用药患者相比，P2Y12 抑制剂和 Xa 抑制剂或华法林的比例更低。无论 LDL 胆固醇和糖化血红蛋白（HbA1c）如何，在动脉粥样硬化血栓性中风中，血清白蛋白和体重指数（BMI）的第三分位值较高，血清白蛋白和高密度脂蛋白胆固醇（HDL-C）在腔隙性中风中，以及血清白蛋白、HDL-C 和 BMI 在心源性栓塞性中风中，mRS 出院评分≤2 的比例均升高。Logistic 回归分析确定了以下临床转归的独立预测因素：血清白蛋白、HDL-C、BMI 以及既往 Xa 抑制剂和 P2Y12 抑制剂。
除了糖尿病和高 LDL-C 等已知危险因素外，Xa 抑制剂或 P2Y12 抑制剂、血清白蛋白、HDL-C 和 BMI 等既往治疗与复发性缺血性中风的预后相关。
