Namale G, Kamacooko O, Makhoba A, Mugabi T, Ndagire M, Ssanyu P, Ddamulira J B M, Yperzeele L, Cras P, Ddumba E, Seeley J, Newton R
MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
St. Francis Hospital Nsambya Affiliated to Uganda Martyrs University, Kampala, Uganda.
Public Health Pract (Oxf). 2021 Apr 23;2:100128. doi: 10.1016/j.puhip.2021.100128. eCollection 2021 Nov.
We examined HIV sero-positivity and risk factors in patients admitted with ischaemic stroke (IS) and haemorrhagic stroke (HS) in Kampala, Uganda.
We conducted a matched case-control study between December 2016 and December 2018 at St Francis Hospital, Nsambya.
The study population comprised of stroke cases (adults aged ≥18 years with IS or HS confirmed by neuroimaging) and controls (age- and sex-matched stroke-free adults aged ≥18 years who were recruited from the same hospital as the cases). A comprehensive assessment for sociodemographic, lifestyle and clinical factors was performed using the World Health Organization (WHO) STEP-wise approach to Surveillance (STEPS) for stroke risk factor surveillance. We used conditional logistic regression to identify risk factors associated with IS or HS.
We enrolled 137 matched case-control pairs; 48 (35%) were men, and the mean ages were 62.4 years (SD ± 14.8) for cases and 61.1 years (SD ± 14.1) for controls. Of stroke patients, 86 (63%) had IS and 51 (37%) had HS. Overall, HIV sero-positivity was 10% among stroke cases versus 7% among controls. HIV sero-positivity was not significantly associated with stroke (unadjusted odds ratio [uOR] = 1.49, 95% confidence interval [CI] 0.59-3.78). A self-reported family history of diabetes mellitus was associated with an increased risk of all stroke (adjusted odds ratio [aOR] = 4.41, 95% CI 1.47-13.2), as well as for IS and HS separately (aOR = 3.66, 95% CI 1.09-12.4 and aOR = 4.99, 95% CI 1.02-24.4, respectively). High blood pressure (≥140/90 mmHg) was associated with an increased risk of all stroke (aOR = 12.3, 95% CI 42-44.1), and this was also true for IS and HS individually (aOR = 6.48, 95% CI 1.15-36.7 and aOR = 5.63, 95% CI 1.74-18.2, respectively).
No association was found between HIV sero-positivity and stroke occurrence among Ugandan stroke patients. Hypertension and a self-reported family history of diabetes mellitus were significant risk factors for both IS and HS. Interventions to reduce hypertension and diabetes mellitus in the Ugandan population are urgently required. Much larger studies are required to demonstrate if any association exists between HIV and stroke.
我们对乌干达坎帕拉因缺血性卒中（IS）和出血性卒中（HS）入院的患者进行了HIV血清阳性率及危险因素调查。
2016年12月至2018年12月期间，我们在恩桑比亚的圣弗朗西斯医院开展了一项配对病例对照研究。
研究人群包括卒中病例（年龄≥18岁，经神经影像学确诊为IS或HS的成年人）和对照（年龄和性别与病例匹配、年龄≥18岁且无卒中的成年人，与病例来自同一家医院）。采用世界卫生组织（WHO）的逐步监测方法（STEPS）对卒中危险因素进行监测，对社会人口学、生活方式和临床因素进行全面评估。我们使用条件逻辑回归来确定与IS或HS相关的危险因素。
我们纳入了137对配对病例对照；48例（35%）为男性，病例组的平均年龄为62.4岁（标准差±14.8），对照组为61.1岁（标准差±14.1）。在卒中患者中，86例（63%）为IS，51例（37%）为HS。总体而言，卒中病例中HIV血清阳性率为10%，对照组为7%。HIV血清阳性与卒中无显著关联（未调整优势比[uOR]=1.49，95%置信区间[CI]0.59 - 3.78）。自我报告的糖尿病家族史与所有卒中风险增加相关（调整后优势比[aOR]=4.41，95%CI 1.47 - 13.2），IS和HS单独分析时也是如此（aOR分别为3.66，95%CI 1.09 - 12.4和aOR = 4.99，95%CI 1.02 - 24.4）。高血压（≥140/90 mmHg）与所有卒中风险增加相关（aOR = 12.3，95%CI 4.2 - 44.1），IS和HS单独分析时也是如此（aOR分别为6.48，95%CI 1.15 - 36.7和aOR = 5.63，95%CI 1.74 - 18.2）。
在乌干达卒中患者中，未发现HIV血清阳性与卒中发生之间存在关联。高血压和自我报告的糖尿病家族史是IS和HS的重要危险因素。迫切需要在乌干达人群中开展干预措施以降低高血压和糖尿病的发病率。需要开展更大规模的研究来证明HIV与卒中之间是否存在关联。
