| ObjectiveAcute ischemic stroke(AIS)is the most important type of cerebrovascular disease,with high mortality and disability,and is the cause of the first cause of death in China.With the development of society and the improvement of people's living standards,the recurrence rate of ischemic stroke is also gradually increasing.This study intends to find clinically feasible and effective indicators through the analysis of clinical data of patients,and provide more theoretical basis for predicting the recurrence of ischemic stroke.MethodsThis study retrospectively analyzed the clinical data of 138 patients with acute ischemic stroke admitted to Jinan Central Hospital affiliated to Shandong University from February 2018 to September 2018.Patients with acute ischemic stroke were included in the observation group,and the group was regrouped according to recurrence,including 51 patients with recurrent IS and 87 patients with initial IS.The included subjects were in conformity with the diagnostic criteria for acute ischemic stroke in the Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China 2014,and were confirmed by CT or MRI.At the same time,60 healthy controls who were examined in the hospital at the same time were selected as the control group.Firstly,the clinical data of the subjects in the acute ischemic stroke group and the control group were statistically analyzed,and the influencing factors of the incidence of recurrent IS and the initial IS group and the influencing factors of recurrent IS between different age groups were further analyzed.Results1.The proportion of age over 65 years old,hypertension,diabetes,coronary heart disease,hyperlipidemia,smoking,carotid plaque,blood glucose control failure and the levels of systolic blood pressure,diastolic blood pressure,white blood cells,neutral granulocyte/lymphocyte ratio(NLR),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fibrinogen(FIB),fasting blood glucose,homocysteine(HCY)and glycosylated hemoglobin in AIS group are statistically significant compared with the control group.(P<0.05).It is suggested that the above indicators may be risk factors affecting the onset of AIS.2.Multivariate logistic analysis showed that hypertension(odds ratio OR=4.206,95%confidence interval Cl,1.156-15.308,P=0.029),diabetes mellitus(OR=7.711,95%CI,1.788-33.263,P=0.006),hyperlipidemia(OR=9.542,95%CI,2.145-42.454,P=0.003),NLR(OR=2.746,95%CI,1.243-6.112,P=0.013)and fibrinogen(OR=14.354,95%CI,2.439-84.492,P=0.003)are meaningful indicators for the diagnosis of AIS.These five indicators are independent risk factors for the occurrence of AIS.3.From the time of recurrence,the number of relapses in less than 3 months,March to 1 year,1 year to 5 years and more than 5 years are respectively 14,22,12,3 which accounting for 27.5%,43.1%,23.5%and 5.9%respectively.Among them,the proportion of recurrent ischemic stroke is the highest in March-1 year,followed by?3 months and 1 year-5 years,and>5 years is the lowest one.4.The proportion of male patients(P=0.006)and the levels of total cholesterol(P=0.045),apolipoprotein E(P=0.018),ischemia modified albumin(P=0.000),and adenosine deaminase(P=0.005)in the IS group are statistically significant compared with the initial group(P<0.05).It is suggested that the above indicators may be risk factors for recurrent ischemic stroke.5.Multivariate logistic regression analysis showed that males(OR=2.782,95%CI,1.063-7.281,P=0.037),blood glucose control was not up to standard(OR=2.729,95%CI,1.070-6.962,P=0.036),platelets(OR?1.009,95%CI,1.001-1.016,P=0.024),total cholesterol(OR=0.638,95%CI,0.418-0.975,P=0.038),ischemic modified albumin(OR=0.961,95%CI,0.941-0.982,P=0.000)and adenosine deaminase(OR=0.885,95%CI,0.749-0.982,P=0.026)are meaningful indicators for the diagnosis of recurrent ischemic stroke.They are independent risk factors for recurrent AIS.6.All patients with ischemic stroke were classified according to TOAST,and the distribution in each type between recurrent ischemic stroke and primary ischemic stroke was compared.Statistical analysis showed that there is no statistical difference in the distribution of each type between the two groups.(P<0.05).However,the proportion of large artery atherosclerosis in the recurrent group and the initial group is the highest,accounting for 74.5%and 67.8%respectively,followed by small-artery occlusion,accounting for 23.5%and 28.7%respectively,and cardiogenic embolism is the least type,accounting for 2%and 3.4%.7.Patients with recurrent ischemic stroke were divided into two groups according to age:<65 years old group and>65 years old group.Univariate analysis showed that the proportion of patients with hyperlipidemia(P=0.008),alcohol consumption(P=0.009)and carotid artery stenosis(P=0.008)and the levels of triglycerides(P=0.033),HDL-C(P=0.022)and uric acid(P=0.010)in group?65 years old are statistically significant compared with the<65 years old group(P<0.05).It is suggested that the above factors may be risk factors for recurrent IS in patients over 65 years of age.8.Multivariate logistic regression analysis showed uric acid(OR=0.989,95%CI,0.980-0.998,P=0.014),carotid artery stenosis(OR=9.508,95%?CI,1.638-55.187,P=0.012)are independent risk factors for recurrent ischemic stroke in patients over 65 years of age.Conclusions1.AIS has the highest chance of recurrence within 5 years.2.Male,blood glucose control was not up to standard and elevated platelet level are positively associated with recurrent ischemic stroke and are independent risk factors for recurrent ischemic stroke;and levels of total cholesterol,ischemic modified albumin,adenosine deaminase are negatively correlated with it,which are protective factors for recurrence of AIS.The higher the level of the above three,the lower the risk of recurrent ischemic stroke.3.Large artery atherosclerosis is the most common type of AIS.4.Carotid artery stenosis is positively associated with recurrent ischemic stroke in patients over 65 years old,and is an independent risk factor for recurrent ischemic stroke in patients over 65 years of age.While uric acid is negatively associated with recurrent ischemic stroke in patients over 65 years old and it is a protective factor for the recurrence of ischemic stroke in patients over 65 years old. |
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