Correlation Research On Risk Factors,Secondary Prevention Status In Young Ischemic Stroke Patients

Background:With the development of the society, changes in lifestyle, work and survival pressure, the youth Ischemic stroke(IS) incidence is increasing in recent years, which is shown in domestic and abroad report in recent years. Youth IS refers to the young ischemic stroke patients, aged 18 to 45 years old, about 5%-10% in all cases of cerebral apoplexy. The current study on the risk factor and active prevention of youth IS takes high attention of medical workers in domestic and abroad.Youth IS is different from old age IS for risk factors, secondary prevention standards compliance and prognosis. So it is meaningful to learn and study the youth IS risk factor, the secondary prevention and its relationship with prognosis, especially the influence of sleep quality on youth IS pathogenesis and prognosis, secondary prevention standard and standard compliance and prognosis, on the prevention and control and reduce the incidence, morbidity of the disease. Existing research shows that sleep disorders and stroke risk factors closely related to the onset of diabetes, high blood pressure, obesity. Related studies shows that sleep quality and the onset of ischemic stroke and prognosis have the close relationship. Current research about the sleep quality and the youth IS is more about after cerebral infarction complicated with mechanism of the influence factors of sleep disorder. There isn’t much report about the sleep quality role in IS, whether it is factor of youth IS and prognosis of stroke onset.A large number of clinical trials have demonstrated that positive clinical secondary prevention can significantly improve the prognosis of patients with ischemic stroke. At present, China secondary prevention, adherence to antiplatelet drugs is only about 70.0%, statin adherence even worse, only 22.3% of young IS compliance status of secondary prevention of poor compliance, the young IS incidence and poor prognosis major reasons. Restore youth IS neurological impairment and life skills are important prognostic IS observed indicators of youth. Conducted a study on the current domestic and international ischemic stroke prognosis, but due to different sample sources, different selected variables and different statistical methods, outcomes, and so there are some differences in the results. Young patients with poor self-control IS, IS impact on youth and family social incidence increased year by year, the current status quo is not optimistic and the secondary prevention standard was deeply worried.This study extracted young patients 236 cases of IS starting from Puyang City People’s Hospital in northern China to observe the young IS risk factors, quality of sleep for young IS incidence and prognosis, and secondary prevention of Young IS relationship with prognosis, intended to provide guidance for clinical prevention of youth IS.This study selected from June 2011 to February 2013 in a row, prospectively enrolled stay Puyang City People’s Hospital of Neurology, 236 patients were in the starting age of stroke patients between the ages of 18-45 as the observation group. Ischemic stroke in elderly patients hospitalized while extracting the same period in the 46-70 year-old age of 231 cases observed in the elderly as a group, select the ages of 18-45 years old youth volunteers as a youth in the control group 179 cases, male to female ratio and age match the proportion of the observation group. Establish a sound baseline data, IS incidence and prognostic factors may be relevant databases. All cases hospitalization, treatment options, treatment analysis no significant differences by Power test, comparable. Have established a complete personal database file selected patients after admission, by a specially trained data residency is responsible for collecting, log in and follow-up, management and quality control of the database, when pressed on the phone to the hospital underwent follow-up. The database was established control studies and prospective cohort study of young ischemic stroke risk factors, the status of secondary prevention standards, standards compliance and its relationship with prognosis studies laid a solid foundation.Part I: Reconsideration for ischemic risk factors in youthObjective:Reconsideration for ischemic risk factors, To analyze influence of sleep quality on the youth IS.Methods:Continuous included from June 2011 to February 2013 Check Puyang City People’s Hospital Department of Neurology in 236 cases. In the first episode of stroke patients aged between 18-45 years of age as the observation group. While extracting the same period of hospitalization in older age as a control group, matched the ratio of male to female ratio and age group between 46-70 years of age was observed. All included patients are in line with 2007 AHS / ASA ischemic stroke clinical diagnostic criteria. While extracting the same period in the age of 18-45 year-olds volunteers as a control group, the ratio of male to female ratio and age matched with the case group.Establish a sound baseline data, youth IS incidence and prognosis possible related factors database. Pittsburgh Sleep Quality Index(Pittsburgh sleep quality index, PSQI) questionnaire to assess sleep quality score.Comparison between groups using univariate and multivariate Logistic regression analysis of risk factors related to the incidence of youth IS.Results:1. Get the observation group were valid cases 223 cases, 170 cases were male, 76.2%, female 53 cases, 23.8%; youth in the control group of 158 people, including men and 111 cases, accounting for 70.3%, female 47 cases, accounting for 29.7%.2. Univariate analysis showed that the incidence of youth IS related factors: hypertension, hyperlipidemia, diabetes, family history of stroke, high homocysteine, quality of sleep, drinking, smoking history.3. Logistic multivariate analysis, the risk factors in order were: hypertension, hyperlipidemia, smoking history, the same type of high quality of sleep, family history of stroke, drinking. IS onset of sleep quality in youth-related risk factors among the first five.Conclusion:The results of this study showed that young ischemic stroke risk factors differed from previous studies at home and abroad. The quality of sleep was a possible risk factor in the pathogenesis and prognosis of youth IS.Part II: Correlation Analysis of Sleep Quality and Youth Ischemic StrokeObjective:To observe the comparison the sleep quality of youth IS the effect of prognosis, and analyzes its reason.Methods:1. A research object continuity collected prospectively from June 2011 to February 2013 Check Puyang City People’s Hospital, Department of Neurology at the age of 223 cases of first stroke patients between the ages of 18-45 as the observation group, all included cases are in line with 2007 AHS / ASA ischemic stroke clinical diagnostic criteria. While extracting the same period in the age of 18-45 year-olds volunteers as a control group, the ratio of male to female ratio and age matched with the case group.2. Study groups were observed after the first two days and was discharged three months(90 ± 3 d) conduct the Pittsburgh Sleep Quality Index(Pittsburgh sleep quality index, PSQI) questionnaire score after admission, the U.S. National Institutes of Health Stroke Scale(the NIH stroke scale, NIHSS) score, modified Rankin scale(MRS) score assessment after his admission after the onset of the disease and the prognosis of March, the establishment of a complete personal database files, management and quality control of the database.3. univariate analysis, univariate analysis of the relevant factors into meaningful Logistic regression model, using multivariate regression analysis, the NIHSS score as prognostic factors in modified Rankin Scale(MRS) as a prognostic evaluation indicators to P <0.05 was considered statistically significant.4. Analysis of risk factors associated with youth IS using univariate and multivariate Logistic regression analysis;. Performed correlation analysis of prognostic factors in multivariate Logistic regression and analysis of the impact of sleep quality on young ischemic stroke incidence and prognosis.Results:1. Get in the observation group were valid cases 223 cases, 170 cases were male, 76.2%, female 53 cases, 23.8%; youth in the control group of 158 people, including men and 111 cases, accounting for 70.3%, female 47 cases, 29.7%.2. Univariate analysis showed that the incidence of youth IS related factors: hypertension, hyperlipidemia, diabetes, family history of stroke, high homocysteine, quality of sleep, drinking, smoking history.3. Logistic multivariate analysis, the risk factors in order were: hypertension, hyperlipidemia, smoking history, the same type of high quality of sleep, family history of stroke, drinking. IS onset of sleep quality in youth-related risk factors among the first five.4. Youth outcomes in stroke patients with the following factors: NIHSS score, quality of sleep, the same type of high cysteine hyperlipidemia(Hcy). Poor sleep quality and youth IS positively correlated with poor prognosis(OR: 1.829; 95% CI: 1.014 ~ 3.301). In addition, NIHSS score and the same type of high cysteine hyperlipidemia(Hcy) also with young stroke three months MRS score related.Conclusion:Poor quality of sleep is a possible risk factor in the pathogenesis and prognosis of youth IS. Improving sleep quality plays an important role in prevention and control of youth IS.Part III: The analysis of young ischemic stroke secondary prevention standard status and standards compliance and short-term prognosisObjective:To analyse the young Ischemic stroke(IS) secondary prevention standard present situation and the relationship between the standard compliance and its prognosis.Methods:1. Continuous, prospectively collected from June 2011 to February 2013 Check Puyang City People’s Hospital Department of Neurology at the age of first stroke patients between the ages of 18-45 as the observed object, and the establishment of baseline data and ischemic patients stroke prognostic factors that may be relevant database, all included in the cases are in line with 2007 AHS / ASA ischemic stroke clinical diagnostic criteria.2. In 1 and 3 months after the onset of the patients were followed and recorded modified Rankin(MRS) scores. And secondary prevention patients and health knowledge missionary.3. To develop the relevant indicators of individual drugs and other programs for each patient according to international and domestic ischemic stroke secondary prevention guidelines and strategies.4. Current Situation standard secondary prevention of ischemic stroke5. Analyze the relationship between the secondary prevention of ischemic stroke and its prognosis compliance standards.Results:1. Get in the observation group were valid cases 223 cases, 170 cases were male(76.2%) and 53 females(25.6%).2. Secondary prevention related indicators compliance rate comparison shows that, after discharge in March and January-related risk factors were lower compliance rate comparison, showing extension of standard compliance decreased over time. Regular medication after discharge in March, limit alcohol, sleep quality, blood pressure compliance rates were 52%, 57%, 55.2%, 51.6%, with statistical significance(p <0.05) difference compared with January after discharge, visible above 4 term compliance with poor compliance; quit after discharge in March(65%), hyperlipidemia( 71.3%), sugar( 84.3%), homocysteine( 62.3%) showed no compliance rate than in January after discharge significant difference the difference was not statistically significant(p> 0.05), indicating that the four standards compliance is good.3. Different Youth March for secondary prevention in patients with IS compliance analysis shows good compliance standards 1,3 month no significant difference,(p> 0.05); standards compliance in general, the difference was statistically 1,3 month significance(p <0.05), poor compliance standards, 1,3 month difference was significant(p <0.01), show different compliance standards have different groups of patients over time to extend the standard compliance.4. Young patients after discharge March IS different secondary prevention standards compliance and prognosis is relatively good compliance with the general visibility compared to its high proportion of self-care outcomes, the difference was statistically significant(P <0.05). Good compliance of patients, the prognosis was significantly higher than the proportion of self-care in patients with poor compliance, the difference was statistically significant(P <0.01). NOTE With the reduction in compliance, the prognosis of patients dependent youth IS proportion gradually increased.Conclusion:The compliance status of secondary prevention in youth IS was poor. And secondary prevention of adherence was positively correlated with their prognosis.