Sankai T, Iso H, Imano H, Ohira T, Tanigawa T, Shimamoto T, Kitamura A, Sato S, Naito Y, Kiyama M, Okamura T, Nakagawa Y, Iida M, Komachi Y
Institute of Community Medicine, University of Tsukuba, Ibaraki.
Nihon Koshu Eisei Zasshi. 1998 Jun;45(6):552-63.
We conducted an epidemiological study of survival and disability in stroke in three Japanese communities to seek community strategies for improvement in survival and disability.
A total of 297 first-ever strokes were identified between 1988 and 1992 in three rural communities (total population = 47,000) located in Akita and Ibaraki. We analyzed survival rates and activity of daily living by sex, age-group and stroke subtypes. Successful review of computed tomography (CT) for 84 percent of the strokes (249 out of 297) was possible and the data were used for subtype analyses.
For all strokes (n = 297) survival rates were 85% for 30 day, 70% for one year, 62% for three year. The rates tended to be lower in women than in men. The rates were lowest in ages less than 60 at thirty day, and in ages 80 and older at the end of the first and third year. Intracerebral hemorrhage with ventricular rupture, subarachnoid hemorrhage and cortical cerebral infarction had lower survival rates than intracerebral hemorrhage without ventricular rupture and lacunar infarction. Based on Cox's proportional hazard model, risk ratio for death was 2.07 in ages 70-79, and 3.80 in ages 80 and older compared with ages 60-69. The risk ratio was 3.46 for intracerebral hemorrhage with ventricular rupture, 3.38 for subarachnoid hemorrhage and 2.46 for cortical cerebral infarction compared with lacunar infarction. The proportion of stroke survivors who need assistance from others in the first and third years tended to be higher in women than in men. The proportion was higher in older patients than in the younger, and higher for intracerebral hemorrhage with ventricular rupture and cortical cerebral infarction than in other subtypes of stroke. From logistic regression analysis, the odds ratio for disability in the first year was 6.55 for ages 80 and older compared with ages 60-69. The odds ratio was 5.61 for intracerebral hemorrhage with ventricular rupture, 4.53 for cortical cerebral infarction compared with lacunar infarction. In the third year the odds ratio was significant for ages 70-79, and decreased for intracerebral hemorrhage with ventricular rupture (odds ratio = 2.98), and increased for cortical cerebral infarction (odds ratio = 6.06).
Survival and disability in stroke depended on age and stroke subtypes. Even after age adjustment, stroke subtypes with large cerebral involvement had worse prognosis than stroke subtypes. Community-based hypertension control programs are important to prevent any subtypes of stroke. Stroke subtypes as well as age should be taken into account to develop effective care and medical treatments for strokes.
我们在日本三个社区开展了一项关于卒中生存及残疾情况的流行病学研究，以探寻改善生存及残疾状况的社区策略。
1988年至1992年间，在秋田和茨城的三个农村社区（总人口47,000）共识别出297例首次发生的卒中病例。我们按性别、年龄组和卒中亚型分析了生存率及日常生活活动能力。对84%的卒中病例（297例中的249例）成功进行了计算机断层扫描（CT）复查，这些数据用于亚型分析。
所有卒中病例（n = 297）30天生存率为85%，1年生存率为70%，3年生存率为62%。女性的生存率往往低于男性。30天时年龄小于60岁者生存率最低，第1年和第3年末80岁及以上者生存率最低。脑室内出血性脑出血、蛛网膜下腔出血和皮质脑梗死的生存率低于无脑室内出血性脑出血和腔隙性梗死。基于Cox比例风险模型，与60 - 69岁相比，70 - 79岁的死亡风险比为2.07，80岁及以上者为3.80。与腔隙性梗死相比，脑室内出血性脑出血的风险比为3.46，蛛网膜下腔出血为3.38，皮质脑梗死为2.46。在第1年和第3年需要他人协助的卒中幸存者比例女性往往高于男性。老年患者的比例高于年轻患者，脑室内出血性脑出血和皮质脑梗死的比例高于其他卒中亚型。经逻辑回归分析，与60 - 69岁相比，80岁及以上者第1年残疾的比值比为6.55。与腔隙性梗死相比，脑室内出血性脑出血的比值比为5.61，皮质脑梗死为4.53。在第3年，70 - 79岁的比值比有统计学意义，脑室内出血性脑出血的比值比下降（比值比 = 2.98），皮质脑梗死的比值比上升（比值比 = 6.06）。
卒中的生存及残疾情况取决于年龄和卒中亚型。即使进行年龄调整后，大脑受累程度大的卒中亚型预后仍比其他卒中亚型差。基于社区的高血压控制项目对于预防任何亚型的卒中都很重要。制定有效的卒中护理和治疗方案时应考虑卒中亚型以及年龄因素。
