Kubota M, Yamaura A, Ono J, Itani T, Tachi N, Ueda K, Nagata I, Sugimoto S
Department of Neurosurgery, Chiba University School of Medicine, Japan.
J Neurol Neurosurg Psychiatry. 1997 Jan;62(1):66-70. doi: 10.1136/jnnp.62.1.66.
To estimate the influence of family history on the occurrence of stroke.
A case-control study was carried out from August 1992 to January 1994. The study population comprised 502 patients with a first stroke, aged between 20 and 70 years, who were treated at 48 affiliated hospitals. The same number of age and sex matched controls were selected from outpatients. Diagnoses were based on CT findings and clinical signs. There were 155 case-control pairs for subarachnoid haemorrhage, 158 for intracerebral haematoma, and 159 for cerebral infarction. Information about the patients and their families was obtained from a questionnaire which included the family histories of each subtype of stroke and other potential risk factors for stroke. The data were analysed focusing on the role of the family histories in the occurrence of stroke.
In univariate analysis, the family histories of subarachnoid haemorrhage and intracerebral haematoma were positively associated with each of the subtypes of stroke (odds ratios 11.24 for subarachnoid haemorrhage, 2.39 for intracerebral haematoma), whereas family history of cerebral infarction was not a significant risk factor for its occurrence (odds ratio 1.41). Family history of intracerebral haematoma was correlated with a personal history of hypertension and habitual alcohol consumption. After adjustment for potential risk factors (hypertension, diabetes, hyperlipidaemia, obesity, alcohol consumption, and regular smoking), family history of subarachnoid haemorrhage still remained the most powerful risk factor for subarachnoid haemorrhage, whereas family history of intracerebral haematoma no longer showed a significant association with haematoma.
Genetic factors play a major part in the pathogenesis of subarachnoid haemorrhage, and family history of subarachnoid haemorrhage is the strongest independent risk factor for the disease. On the other hand, family history of intracerebral haematoma was not an independent risk factor for haematoma, but it might be a good predictor, which indirectly influences the pathogenesis of intracerebral haematoma via certain hereditary components such as hypertension, and even lifestyle factors such as alcohol consumption. In cerebral infarction, genetic factors play a minor part in its pathogenesis.
评估家族史对中风发生的影响。
于1992年8月至1994年1月开展了一项病例对照研究。研究人群包括502例首次中风患者，年龄在20至70岁之间，在48家附属医院接受治疗。从门诊患者中选取了相同数量的年龄和性别匹配的对照。诊断基于CT检查结果和临床体征。蛛网膜下腔出血有155对病例对照，脑内血肿有158对，脑梗死有159对。通过一份问卷获取患者及其家族的信息，问卷包括每种中风亚型的家族史以及其他中风潜在危险因素。重点分析家族史在中风发生中的作用来对数据进行分析。
在单因素分析中，蛛网膜下腔出血和脑内血肿的家族史与每种中风亚型均呈正相关（蛛网膜下腔出血的比值比为11.24，脑内血肿为2.39），而脑梗死家族史并非其发生的显著危险因素（比值比为1.41）。脑内血肿家族史与个人高血压病史和习惯性饮酒相关。在对潜在危险因素（高血压、糖尿病、高脂血症、肥胖、饮酒和经常吸烟）进行校正后，蛛网膜下腔出血家族史仍是蛛网膜下腔出血最有力的危险因素，而脑内血肿家族史与血肿不再显示出显著关联。
遗传因素在蛛网膜下腔出血的发病机制中起主要作用，蛛网膜下腔出血家族史是该疾病最强的独立危险因素。另一方面，脑内血肿家族史并非血肿的独立危险因素，但它可能是一个良好的预测指标，通过某些遗传因素如高血压，甚至生活方式因素如饮酒间接影响脑内血肿的发病机制。在脑梗死中，遗传因素在其发病机制中起较小作用。
