Zhang Jun-Fang, Jing Jing, Meng Xia, Pan Yuesong, Wang Yi-Long, Zhao Xing-Quan, Lin Jin-Xi, Han Xin-Sheng, Song Bin-Bin, Jia Zheng-Chang, Wu Song-Di, Chen Xiao-Fei, Xue Wen-Jun, Anderson Craig S, Wu Yun-Cheng, Wang Yong-Jun
Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2021 Apr 14;12:652941. doi: 10.3389/fneur.2021.652941. eCollection 2021.
To determine the association between serum phosphate level and 1-year clinical outcomes in patients with acute ischemic stroke and transient ischemic attack. We included 7,353 patients with acute ischemic stroke and transient ischemic attack from the China National Stroke Registry III for analysis. Participants were divided into 4 groups according to serum phosphate quartiles. Composite end point included recurrent stroke, myocardial infarction, other ischemic vascular events, and all-cause mortality. Poor functional outcome is defined as modified Rankin Scale score of 3 to 6. Multivariable Cox regression or logistic regression was used to evaluate the independent association of serum phosphate with 1-year all-cause mortality, recurrent stroke, composite end point and poor functional outcome. The mean age of the included 7,353 patients was 62.5 years, and 68.6% of them were men. Plotting hazard ratios over phosphate levels suggested a U-shaped association especially for recurrent stroke and composite end point, and therefore the third quartile group was set as reference group. Compared with the third quartile of phosphate (1.06-1.20 mmol/L), the adjusted hazard ratios/odds ratios (95% CI) of the lowest quartile (<0.94 mmol/L) were 0.98 (0.67-1.42) for all-cause mortality, 1.31 (1.05-1.64) for stroke recurrence, 1.26 (1.02-1.57) for composite end point, and 1.27 (1.01-1.61) for poor functional outcome, and the adjusted odds ratio of the highest quartile (≥1.2 mmol/L) was 1.40 (1.11-1.77) for poor functional outcome. Serum phosphate may be an independent predictor of stroke recurrence, composite end point and poor functional outcome after ischemic stroke.
确定急性缺血性卒中与短暂性脑缺血发作患者血清磷水平与1年临床结局之间的关联。我们纳入了中国国家卒中登记系统Ⅲ中的7353例急性缺血性卒中和短暂性脑缺血发作患者进行分析。参与者根据血清磷四分位数分为4组。复合终点包括复发性卒中、心肌梗死、其他缺血性血管事件和全因死亡率。功能预后不良定义为改良Rankin量表评分为3至6分。采用多变量Cox回归或逻辑回归评估血清磷与1年全因死亡率、复发性卒中、复合终点和功能预后不良的独立关联。纳入的7353例患者的平均年龄为62.5岁，其中68.6%为男性。绘制磷水平的风险比表明存在U型关联，尤其是对于复发性卒中和复合终点，因此将第三四分位数组设为参照组。与磷的第三四分位数（1.06 - 1.20 mmol/L）相比，最低四分位数（<0.94 mmol/L）的调整后风险比/比值比（95%CI）对于全因死亡率为0.98（0.67 - 1.42），对于卒中复发为1.31（1.05 - 1.64），对于复合终点为1.26（1.02 - 1.57），对于功能预后不良为1.27（1.01 - 1.61），而最高四分位数（≥1.2 mmol/L）对于功能预后不良的调整后比值比为1.40（1.11 - 1.77）。血清磷可能是缺血性卒中后卒中复发、复合终点和功能预后不良的独立预测因素。
