| Background The burden of disease report showed in 1990 that cerebrovascular disease in our country is located in cause of death overall second [1], 2004-2005 the third national cause of death review sample survey report shows, cerebrovascular disease was promoted to the first death, burden of disease report 2010 show cerebrovascular disease cause of death remains the first [1]. Previous studies have found that 1 year after stroke recurrence rate is 4% ~ 14% and the rate of death and disability rate were higher than those of the first onset and recurrence, the more the number of disability is high [2-3], and the latest a based on Chinese International Stroke Registry data [4] shows China’s middle-aged ischemic stroke within 1 year recurrence rate up to 17.7%, about 34% of patients for lack of stroke recurrence in patients with stroke and recurrent stroke death or disability risk is patients with a first episode of 9.4 times [5].Therefore, early recurrence risk assessment, and intervention of risk factors can prevent the recurrence of cerebral vascular disease, the overall prevention of the disease is very important.Objective Through the first-ever ischemic stroke patients for a period of 1 year of following-up, to understand local area first ischemic stroke subtypes according to different patients within 1 year within 1 year after the recurrence of cerebral infarction patients and the incidence of secondary prevention drug compliance, and to find out the risk factors of recurrence, more effective secondary prevention, reduce the rate of recurrence of cerebral infarction, reduce mortality rate of disability.Methods A retrospective into 2013 July 1, 2014 to August 31 in Department of Neurology; the First Affiliated Hospital of Suzhou University Hospital, age in 22 85 year old first acute ischemic stroke, records of patients with sex, age, past history(hypertension,diabetes, atrial fibrillation, smoking history), time of onset, the fiber protein, C-reactive protein, low density lipoprotein, high density lipoprotein, triglyceride, total cholesterol and imaging information shown in the lesion site, size and vascular lesions. According to TOAST classification criteria for the classification, within 1 year of follow-up incidence of cerebral infarction recurrence time and 1 year drug use situation, divided into recurrence group and non recurrence group, with univariate analysis and multivariate analysis to determine the predictors of 1-year recurrence of cerebral infarction after first ischemic stroke.Results 1) 282 cases of acute ischemic stroke patients, 35 cases of recurrence, the recurrence rate was 12.41%. Among them 3, 6, 9 months and 1 years, respectively,10,14,7,4 cases, the cumulative recurrence rate was 4.96%, 8.51%, 10.99%, 12.41%respectively.2) SAO, CES, LAA, SOE, SUE were 102 cases, 102 cases, 36 cases, 5 cases, 37 cases recurren patients including 19 cases, 8 cases, 6 cases, 0 cases,2 cases, the recurrence rate was18.6%、16.6%、7.8%、0、5.4% respectively. LAA recurrence rate was significantly higher than that of SAO(?2=5.057, P=0.025) group, and CES recurrence rate difference was not statistically significant( ? 2=0.056, P=0.812). SAO and CES subtype of the recurrence rate is also no significant difference(?2=2.142,P=0.143).3) 64 cases at the same time to take the Carotid artery ultrasonography,TCD and DSA examination of patients, with DSA as the gold standard, carotid ultrasound and DSA comparison of the rate of 77.8%;TCD and DSA comparison of the rate of 70.4%. for the vascular stenosis(moderate or severe), carotid artery ultrasound, TCD and DSA with rate was 85.1% and 75.5% respectively.4) 282 cases of patients with carotid artery and moderate or severe stenosis in 42 cases and 10 recurrent cases(23.8%) and 240 cases of carotid artery without stenosis and mild recurrence in patients with 25 cases(13.0%) of the carotid artery and moderate or severe stenosis recurrence rate was significantly higher than that of not or lightly suffering from mild stenosis recurrence rate, the difference is statistically significant(?2 = 5.90, P =0.015). There was no significant difference in the recurrence rate between the middle and above vertebral basilar artery with no stenosis or mild stenosis(P> 0.05). There was no significant difference in the distribution of stable plaques and unstable plaques between recurrence group and non recurrence group(P > 0.05).5) The use of antiplatelet agents, statins and antihypertensive drugs were94%,91%,61%,after 3 months the use of rates were 81%, 75%,61% respectively,after 1years,respectively declining to 57%, 56%, 72%. Insist on taking antiplatelet drugs in patients with the relapse rate was 9.8%, lower than the 19.2% taking(?2=4.6l, P=0.032);Adherence to statin use recurrence rate was 8.1%, lower than did not insist on taking the18.2%(?2=6.50,P=0.011);182 patients with hypertension, adhere to the antihypertensive drug therapy for 157 cases, adhere to the medication group, the recurrence rate and did not adhere to the medication group, the difference was not statistically significant(P > 0.05).The rate of anticoagulation therapy was only 8.3%. The regular use of antiplatelet and statin therapy patients still have 6.1% patients relapse; adhere to the antihypertensive drug group relapse rate and did not adhere to the medication group difference was not statistically significant(P > 0.05). The rate of anticoagulation therapy was only 8.3%6) patients discontinued the main reason: intelligent declined 18%; consciously rehabilitation withdrawal 38%; worry too much about 18% of drug adverse reaction;prescription unopened 10%; community to dispensing 16%..7) COX risk regression model to find out the risk factors of hypertension,atrial fibrillation,low density lipoprotein and carotid artery stenosis, and the discontinuation of statin therapy is an independent risk factor for recurrence in patients with cerebral infarction in 1 years.Conclusion: 1) the recurrence rate of acute ischemic stroke patients in Suzhou area in1 years was high(12.41%), and the recurrence rate was the highest in the firstly 3 months.2) TOAST type of LAA recurrence rate is the highest, followed by CES.3) Carotid ultrasound and transcranial Doppler ultrasound in the detection rate of carotid artery disease is higher,in particular, moderate or above.4) Local area first ischemic stroke patients discharged from hospital,3 months to 1year core drugs(antiplatelet agents and statins)treatment rate gradually decreased, doctors,patients and community due to various reasons lead to secondary prevention of the core drug compliance is poor. Anticoagulation therapy in patients with atrial fibrillation was low.Even if the regular use of anti platelet and statins, there are still minority patients relapse.5) The independent risk factors for recurrence of cerebral infarction in patients with primary cerebral infarction in 1 years, including hypertension, atrial fibrillation, low density lipoprotein and carotid artery stenosis, and the use of statins.There are many risk factors for the recurrence of patients with cerebral infarction,clinical should attach great importance to, we must do a good job in the secondary prevention of the risk factors and reduce the recurrence of cerebral infarction. |
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