点击显示 收起
新研究显示，中风前共病症增加，特别是糖尿病和冠心症(CHD)，与缺血性中风妇女的中风后不佳功能有独立相关。
来自杜克大学医学中心的研究者，于美国神经学会第132届年会中发表一项前溯研究，指出中风前糖尿病和CHD是妇女中风后90天或之后失能的独立相关因素。
研究人员Cheryl Bushnell医师向Medscape Neurology & Neurosurgery表示，其他共病症对中风后失能看似有些许影响，但是CHD和糖尿病这两个状况最能解释。
Bushnell医师表示，已经相当清楚地知道，缺血性中风女性的功能性结果比男性差，收容在病院(或养老院等)的比率较高，也有较多的失能；不过，她指出，此现象背后的原因迄今尚未被研究。
【眼光放远】
Bushnell医师表示，我们之前发现中风前CHD是妇女严重中风的独立因子，这让我们假设中风前心脏病或许也会恶化中风后的功能性结果，但是我们需将眼光放远，并且检视其他共病症是否会影响妇女的中风后结果。
为了辨识特定的预测因子，研究者前溯评估133位18岁以上妇女，在2001年9月到2005年2月之间发生急性缺血性中风24小时内的基本共病状，初级结果是90天以上的中风后失能，以改良式Rankin中风等级(mRS)评估；研究者也检视中风严重度的潜在预测因子，住院后24到48小时、以及住院后7天或出院时使用美国国家卫生研究院脑中风评估量表(NIHSS)评估。
藉由医疗纪录或者自我报告提供高血压、高胆固醇血症、之前的中风或者暂时性脑缺血、CHD、郁血性心脏衰竭、心房纤维颤动、周边血管疾病、以及静脉栓塞等资讯。
此外，参与者的健康习惯，例如抽烟和喝酒以及滥用药物等也加以评估，并且计算身体质量指数。
【CHD只预测中风严重度】
使用修正版察尔森共病症严重度指标(Charlson comorbidity index)来测量共病症，且假设可以作为结果的预测因子，此效度良好的共病症指标藉由16个状况（包括CHD和糖尿病）算出一个分数预测1年死亡率。
以多变项模式调整一开始的NIHSS，失能的独立预测因子是CHD和糖尿病；只有排除糖尿病和CHD时，察尔森共病症严重度指标才变成唯一的中风后失能预测因子，占约14%的变异性。
该研究也指出，中风前CHD是唯一与初始中风严重度有关的临床因素。
根据Bushnell医师所述，该研究结果指出，需要妥善处理有糖尿病和CHD的妇女，证据显示有改善空间。
她表示，举例来说，女性若没有妥善控制她们的脂质，代表药物顺从性和血清胆固醇治疗目标不佳；她指出，根据这些结果，中风结果研究需要校正开始时的共病状态。
该研究接受国家健康研究中心和国家中风协会研究奖金赞助。
美国神经学会第132届年会：摘要S-5。发表于2007年10月7日。
CHD, Diabetes Linked to Worse Functional Outcomes in Women With Ischemic Stroke
By Caroline Cassels
Medscape Medical News
New research shows increased prestroke comorbidity, particularly diabetes and coronary heart disease (CHD), is independently associated with poorer poststroke functional status among women with ischemic stroke.
Presented here at the 132nd Annual Meeting of the American Neurological Association by researchers from Duke University Medical Center. in Durham, North Carolina, the prospective study showed prestroke diabetes and CHD were independently associated with poststroke disability in women at 90 days or more.
"It appears there is a slight influence of other comorbidities on poststroke disability, but the vast majority of it is explained by these 2 premorbid conditions [CHD and diabetes]," study investigator Cheryl Bushnell, MD, told Medscape Neurology & Neurosurgery.
It is well-known, said Dr. Bushnell, that women with ischemic stroke have poorer functional outcomes than their male counterparts, with higher rates of institutionalization and greater disability. However, she added, until now the reasons behind this phenomenon have not been investigated.
"Big Picture"
"We previously found the presence of prestroke CHD was independently associated with more severe strokes in women. This led us to hypothesize that prestroke heart disease might also be associated with worse poststroke functional outcomes. But we also wanted to look at the 'big picture' and examine whether other comorbidities might influence poststroke outcomes [in women]," said Dr. Bushnell.
To identify specific outcome predictors, the researchers prospectively assessed baseline comorbid conditions in 133 consecutive women older than 18 years who presented within 24 hours of onset of acute ischemic stroke between September 2001 and February 2005.
The primary outcome was poststroke disability at 90 days or more evaluated with the modified Rankin Scale (mRS). The researchers also examined potential predictors of stroke severity, which was assessed using the National Institutes of Health Stroke Scale (NIHSS) 24 to 48 hours after admission and at 7 days or discharge, whichever came first.
Information on hypertension, hypercholesterolemia, prior stroke or transient ischemic attack, CHD, congestive heart failure, atrial fibrillation, peripheral vascular disease, and venous thrombosis were determined by medical records or self-report.
In addition, participants' health habits, including cigarette smoking and alcohol and illicit drug use, were also assessed, and body-mass index calculated.
CHD Only Predictor of Stroke Severity
The modified Charlson Index was used to measure comorbidities and was hypothesized to be a predictor of outcome. This well-validated comorbidity index predicts 1-year mortality by weighting 16 conditions, including CHD and diabetes, and assigning a single score.
In multivariable modeling adjusted for initial NIHSS, independent predictors of disability were CHD and diabetes. It was only when diabetes and CHD were excluded that the Charlson Index became the sole predictor of poststroke disability, accounting for about 14% of the variance.
The study also revealed prestroke CHD was the only clinical factor associated with initial stroke severity.
According to Dr. Bushnell, the study results indicate a need for optimal management of women with diabetes and CHD, where evidence indicates there is room for improvement.
"We know, for example, that women are not well managed with respect to their lipids, both with respect to medication adherence and achieving target [serum cholesterol] levels," she said.
She added that, based on these results, stroke outcome studies need to be adjusted for the presence of baseline comorbid conditions.
The study was supported by a grant from the National Institutes of Health and National Stroke Association Research Fellowship.
132nd Annual Meeting of the American Neurological Association: Abstract S-5. Presented October 7, 2007.