| Objective:Ischemic stroke onset season there is a lack of research of relationship with prognosis.Prospective cohort study methods this study was to explore the different season of ischemic cerebral apoplexy patients with the disease after 3 months the relationship between different endings,including death,cardiovascular events,and disability.Subjects and methods:1.Subjects:In June 2011 to December 2013,included in 7 consecutive province hospital first 22 cooperation,a total of 1717 patients with a diagnosis of ischemic stroke.2.Methods:Multicenter,prospective cohort study methods,the training of qualified investigators was hospitalized patients with baseline data are recorded with a unified design of the questionnaire,including demographic data,lifestyle factors,individual diseases and medical history,physical examination,routine blood test data,etc.By a unified training neural physicians use Modified Rankin ’s scale(MRs)scale and the National Institute of Health stroke scale(NIHSS)scores stroke scale to evaluate patients for 3 months ending and record the corresponding score.If the patient died or cardiovascular events,time will be completed by the attending physician.Main research outcomes defined as death and disability(mRS 3 or higher),secondary outcomes defined as cardiovascular events and in death,the center of cerebrovascular events including the recurrence of stroke,myocardial infarction,heart failure,pulmonary embolism,and peripheral vascular disease.3.Statistical analysis:Epidata3.1 is adopted to establish the database,all questionnaire after double double record for verification.Using SAS 9.4 software for statistical analysis.Using t test and chi-square test and wilcoxon rank sum test-compare different seasons of baseline in patients with ischemic stroke.Using chi-square test to compare different occurrence season ending.Using Logistic regression model to analyze different seasons associated with ischemic stroke in patients with different endings.Results:1.Research into 1717 cases of patients with ischemic stroke.Average age was 63.01 + /-11.37 years,including 1134 men(66.05%)and women(33.95%)for 583 people.The object of study in 521 cases of ischemic cerebral apoplexy spring,accounted for 30.34%;In the summer of 383 cases,accounting for 22.31%;In the fall of 312 cases,accounting for 18.17%;The winter of 501 cases(29.18%).2.3 months lost to 56 patients,1661 patients were included in the result analysis.All patients with ischemic stroke 3 months,deaths of 48 cases,accounted for 2.89%;Cardiovascular events in 64 cases,accounting for 3.85%;Death and disability in 369 cases,accounting for 22.22%.After multiariable logistic regression analysis found that compared with the onset of spring group,autumn onset group a 52% increase in the risk of death and disability,the OR(95% CI)was 1.52(1.01,2.27).The onset of winter set their risk of cardiovascular events was 2.18 times that of the onset of spring group OR(95% CI)was 2.18(1.12,4.22).3.Subgroup analysis results(1)In age < 65,1020 cases of ischemic cerebral apoplexy patients,the onset of winter of ischemic cerebral apoplexy patients with cardiovascular events among patients taking risk is the onset of spring of 2.34 times,the OR(95% CI)was 2.34(1.01,5.39).But death,death,and risk of cardiovascular events and death and disability with no statistically significant difference were observed in the spring set of reference(P > 0.05).In the age of 65 OR 641 cases of ischemic cerebral apoplexy patients,autumn onset of ischemic stroke in patients with their risk of death and disability,is 2.26 times that of patients with the onset of spring the OR(95% CI)was 2.26(1.24,4.13).(2)On NIHSS score < 5 points in ischemic stroke patients,in the spring as the reference group,summer,autumn,winter three quarters of the disease risk of ischemic stroke in patients with multiple endings differences were no statistically significant(P > 0.05).On admission NIHSS score of 5 OR more points,was adjusted by multiple factors,found that reference to the spring group,autumn morbidity in patients with a 64% increase in the risk of death and disability,the OR(95% CI)was 1.64(1.04,2.59).The onset of winter is still higher than the risk of cardiovascular events in patients with ending the onset of spring group,3.83 times,the OR(95% CI)was 3.83(1.47,9.96).(3)Subgroups with location points,the case in the majority with Inner Mongolia,jilin,and liaoning province,a total of 1193 cases,accounting for 71.82%.After multiple factors regression analysis found that reference to the spring group,the onset of winter cardiovascular events,death and cardiovascular events in patients with ending the happening of the risk is higher than the onset of spring group,3.36 times and 2.08 times,its the OR(95% CI)were 3.36(1.48,7.67)and 1.48(1.15,3.76).(4)According to the progress of the course of subgroup analysis,found that patients with ischemic stroke at different season have more influence on the prognosis of chronic convalescence.Coming on to 14 days or discharge stage,in the spring as the reference group,summer,autumn and winter season onset of ischemic stroke in patients with no statistically significant difference were observed in the various risk ending(P > 0.05).In 14 days OR discharged to the 3 months period,the logistic multifactor regression analysis found that reference to the spring group,autumn morbidity in patients with a 64% increase in the risk of death and disability,the OR(95% CI)was 1.64(1.11,2.43).Winter disease in patients with cardiovascular event,end the risk of death and cardiovascular events is higher than the onset of spring group,2.72 times and 2.54 times,the OR(95% CI)was 2.72(1.04,7.12)and 1.04(1.18,5.47).4.Included in the analysis of the three months ending mostly in patients with cerebral thrombosis patients,a total of 876 cases,accounting for 52.74%;Cerebral embolism patients 100 cases,accounting for 6.02%;Patients with lacunar infarction 626 cases,accounting for 37.69%.Reference in patients with cerebral thrombosis,and spring,autumn onset in patients with a 93% increase in the risk of death and disability,the OR(95% CI)was 1.93(1.19,3.15).The onset of winter is higher than the risk of cardiovascular events in patients with end spring group,3.13 times,the OR(95% CI)was 3.13(1.16,8.43).Two cases cerebral embolism patients and patients with lacunar cerebral infarction cases co.,LTD.,in the subtype of the two groups,group for reference to spring,after adjustment of confounding factors,summer,autumn,winter season three of death and cardiovascular events and death and disability were no significant statistical difference(P > 0.05).Conclusions:1.The incidence of ischemic cerebral apoplexy patients compared to the spring,autumn onset patients 3 months can increase the incidence of death and disability,winter will increased incidence of cardiovascular events in patients with poor outcome.2.In the age of 65 or more patients with ischemic stroke or admission in patients with severe neurologic deficits,compared to patients with the onset of spring,autumn 3 months of death and disability in patients with disease risk or winter disease patients were associated with increased risk of cardiovascular events.3.The winter for the prognosis of ischemic stroke 3 months are mainly concentrated in the influence of chronic convalescence hospital 14 days or 3 months.Compared to the onset of spring autumn disease patients will increase the risk of death and disability of chronic convalescence;Spring winter disease patients compared with patients who will add to this stage cardiovascular events,death,and risk of cardiovascular events.4.In patients with cerebral embolism,compared to the onset of spring autumn onset patients 3 months increase in the incidence of death and disability. |
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