文章摘要
武海滨,龚巍巍,潘劲,费方荣,王浩,胡如英,俞敏.首次脑卒中患者生存率和死亡影响因素的研究[J].中华流行病学杂志,2014,35(7):812-816
首次脑卒中患者生存率和死亡影响因素的研究
Survival rate and risk factors of mortality among first-ever stroke patients
收稿日期:2014-01-23  出版日期:2014-09-01
DOI:10.3760/cma.j.issn.0254-6450.2014.07.013
中文关键词: 脑卒中  生存分析  随访  预后
英文关键词: Stroke  Survival analysis  Follow-up study  Prognosis
基金项目:浙江省医药卫生科技计划(2012KYA046)
作者单位E-mail
武海滨 浙江省疾病预防控制中心, 杭州 310051  
龚巍巍 浙江省疾病预防控制中心, 杭州 310051  
潘劲 浙江省疾病预防控制中心, 杭州 310051  
费方荣 浙江省疾病预防控制中心, 杭州 310051  
王浩 浙江省疾病预防控制中心, 杭州 310051  
胡如英 浙江省疾病预防控制中心, 杭州 310051  
俞敏 浙江省疾病预防控制中心, 杭州 310051 myu@cdc.zj.cn 
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中文摘要:
      目的 描述首次脑卒中患者生存情况, 分析影响其死亡的相关因素。方法 收集2009 年浙江省慢性病监测信息管理系统中首次脑卒中患者, 通过主动和被动随访获得患者生存状况及死亡原因。应用Kaplan-Meier 法进行生存率分析, 采用Cox比例风险回归模型对影响患者死亡的危险因素进行单因素和多因素分析。结果 共收集患者78 189 例, 脑梗死、大脑内出血、蛛网膜下腔出血和未特指分别占61.65%、30.42%、2.32%和5.62%。随访期间, 共33 265 例患者死亡, 其中根本死因与脑卒中相关的有27 147 例(81.61%)。患者当天即因脑卒中死亡6 122 例, 病死率为7.83%;第28 天病死率为21.01%;1~4 年生存率分别为72.04%、68.92%、66.27%和64.29%;脑梗死、大脑内出血、蛛网膜下腔出血和未特指的4 年生存率分别为80.06%、50.15%、71.80%和21.41%。模型主效应显示影响患者死亡的主要因素有年龄、性别、文化程度、诊治医院级别、高血压和脑卒中类型。年龄与性别存在交互作用(P<0.001), 单独效应显示男性在75 岁之前的死亡风险高于女性, 而75 岁之后则相反。结论 急性和亚急性期脑卒中死亡风险最高, 年龄、性别、文化程度、诊治医院级别、高血压和脑卒中类型是影响其预后的危险因素。
英文摘要:
      Objective To describe the survival status and to analyze the factors associated with mortality on first-ever stroke patients. Methods The first-ever stroke patients registered in 2009 were collected from“Zhejiang provincial information system for NCDs’surveillance and management”. Survival status and the cause of death through active and passive follow-up programs, were collected. Kaplan-Meier methods were used for survival description. Monovariant and multivariant Cox’s proportional hazard regression models were used to analyze risk factors on mortality. Results A total of 78 189 patients, who suffered from cerebral infarctions(ICD-10:I63), intracerebral haemorrhages(I61), subarachnoid haemorrhages(I60)and unspecified strokes(I64), accounted for 61.65%, 30.42%, 2.32% and 5.62%, were recruited. 33 265 cases died during the period of this study. 27 147 cases were stroke related, accounted for 81.61%. 6 122 cases died on the same day, with one-day case fatality as 7.83% and the overall 28-day case fatality as 21.01%. The survival rates from one-year to four-year were 72.04% , 68.92% , 66.27% and 64.29% , respectively. The four-year survival rates of I63, I61, I60 and I64 were 80.06% , 50.15% , 71.80% and 21.41% , respectively. Effect of the model showed that the risk factors associated with mortality were age, gender, educational level, the diagnosis and quality of the hospitals on treatment, hypertension and the types of stroke incidences. Age had interacted with gender(P<0.001). Results from the‘single effect’showed that males had higher risk than females in those younger than 75 years old, but vice versa in those older than 75 of age. Conclusion Patients appeared very high risk of death in both acute and sub-acute phases. Factors including age, gender, educational level, both quality on diagnosis and treatment of the hospitals, clinical types of hypertension and stroke etc. were at risk, associated with prognosis of the disease.
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