Ferro J M, Crespo M
Department of Neurology, Hospital St Maria, Lisbon, Portugal.
Stroke. 1994 Aug;25(8):1611-6. doi: 10.1161/01.str.25.8.1611.
We undertook this study to describe the risk of stroke recurrence and functional and occupational status in the long-term follow-up of young adults with ischemic strokes and to identify possible predictors for stroke recurrence, disability, and working status.
A cohort of 215 patients aged < or = 45 years with ischemic cerebral events (43 transient ischemic attacks, 135 minor strokes, 37 major strokes), evaluated at our institution from May 1985 through March 1992, was followed for a mean of 43.1 months (SD, 39.7 months; range, 1 to 228 months). Information on death and recurrent cerebral vascular events, functional disability (Rankin Scale), retirement, and working status was obtained from direct observation, mail questionnaire, and telephone interviews.
Four patients (2%) with major strokes died acutely. Information on stroke recurrence and disability was available for 184 (87%) of the survivors and on retirement and working status for 140 (67%) of the patients. Two patients died from cancer. Seven transient ischemic attacks and eight strokes (two hemorrhagic) occurred during follow-up. Patients with strokes of unknown cause experienced no recurrent strokes, contrasting with two deaths and eight strokes in those whose stroke cause was identified (difference between proportions: 8%; 95% confidence interval, 3 to 13). Eighty-eight patients had a complete recovery, and only 21 were disabled (Rankin grades 4 or 5). Logistic regression analysis identified the severity of the initial stroke (Rankin grade > 3) as the only significant predictor of disability (odds ratio, 10.7; 95% confidence interval, 3.7 to 30.6). Of the survivors, 73% were working, and only 18% were retired. Disability at follow-up was the best (but nonsignificant) predictor of retirement (odds ratio, 1.6; 95% confidence interval, 0.8 to 3.4).
Ischemic stroke in young adults has a low acute mortality and few recurrences, more so if the cause is not identified. The majority of patients return to an active professional life. Severity of the initial stroke is the major predictor of independence. The relation between disability and return to work or retirement is less clear.
我们开展这项研究，旨在描述年轻缺血性脑卒中患者长期随访中的卒中复发风险、功能及职业状况，并确定卒中复发、残疾及工作状态的可能预测因素。
对1985年5月至1992年3月在我们机构评估的215例年龄≤45岁的缺血性脑事件患者（43例短暂性脑缺血发作、135例轻度卒中、37例重度卒中）进行随访，平均随访43.1个月（标准差39.7个月；范围1至228个月）。通过直接观察、邮寄问卷和电话访谈获取有关死亡、复发性脑血管事件、功能残疾（Rankin量表）、退休及工作状态的信息。
4例（2%）重度卒中患者急性死亡。184例（87%）幸存者有卒中复发及残疾信息，140例（67%）患者有退休及工作状态信息。2例患者死于癌症。随访期间发生7例短暂性脑缺血发作和8例卒中（2例为出血性）。病因不明的卒中患者未出现复发性卒中，而病因明确的患者中有2例死亡和8例卒中（比例差异：8%；95%置信区间，3%至13%）。88例患者完全康复，仅21例残疾（Rankin分级4或5级）。逻辑回归分析确定初始卒中的严重程度（Rankin分级>3级）是残疾的唯一显著预测因素（比值比，10.7；95%置信区间，3.7至30.6）。幸存者中，73%在工作，仅18%退休。随访时的残疾是退休的最佳（但不显著）预测因素（比值比，1.6；95%置信区间，0.8至3.4）。
年轻成人缺血性卒中急性死亡率低，复发少，病因不明者更是如此。大多数患者恢复积极的职业生活。初始卒中的严重程度是独立的主要预测因素。残疾与重返工作或退休之间的关系尚不清楚。
