Hospital Based Case-Control Study Of Risk Factors And Prognosis Factors For Stroke

Objective: To study the risk factors and the prognosis factors of stroke, providing clinical data for prevention and control of stroke.Method: Hospital based case-control study and prognosis study was carried out. Patie nts were selected in the hospital department of internal medicine during 2013-2014 as the research object, According to the inclusion and exclusion criteria, the consecutive cases were included as the research object to carry out case-control study. Patients were devided into case group(patients with stroke) and control group(patients without stroke).According to National Institutes of Health Stroke Scale(NIHSS) patient in cases group is further divided into two clinical stages(NIHSS <4 or NIHSS ≥4). A case-control study was carried out to study the risk factors for stroke and case-case study to explore the risk factors of stroke patients with NIHSS ≥4. All stroke cases were included in the prognosis study and followed for 12 months. Different questionnaires were designed for case-control study and prognosis study. Face-to- face investigate to collect data for case-control study and data collection by telephone call in prognosis study. The modified Rankin scale(m Rs) score was used to judge the prognosis status of stroke.Results: 1.Cerebral stroke risk factors: hypertension(O R=2.204, 95%CI:1.340~3.624), diabetes mellitus(O R=2.880, 95%CI:1.328~6.247),family history of cerebral infarction(OR=2.921 95%CI:1.804~4.730), smoking(OR=2.522, 95%CI:1.558~4.083) and drinking habits(O R=2.680, 95%C I:1.597~4.497) difference was statistically significant. There were significant differences between cases and controls in the levels of apo-lipoprotein a, apolipoprotein b,triglyceride and n-HDL-C(p<0.05). The high density lipoprotein(HDL), non high lipoprotein cholesterol(n-HDL-C), cholesterol(TC) according to a certain level of stratification, TC is more than or equal to ≥6.19 groups(OR=3.883 95%C I:1.496~10.094) TC < 5.18 group compared to stroke the risk factors, with significant difference(P < 0.05). n- HDL-C is a risk factor for stroke. The3.37≤ n-HDL < 4.13 group( OR=3.633 95%CI:1.928~6.845), 4.14≤n--HDL < 4.91group(OR=4.632 95%CI:2.341~9.162), n-HDL≥4.92group(OR=5.917, 95%CI:2.681~13.056) to n-HDL-C < 3.37, there are dose effect relationship. And with the increase of non high density lipoprotein cholesterol, the risk is increased, there was significant difference(P<0.05).Physicallabor(O R=0.396,95%CI:0.244~0.644),O utgoingpersonality(O R=0.705,95% CI:0.145~0.932) is the protective factor of stroke, and the difference is statistically significant(P<0.05).2.The risk factors of stroke severity: more severity stroke(N IHSS ≥4): A case of moderate and severe stroke and mild stroke: a case study of the risk factors for moderate and severe stroke: College(undergraduate), high school(Junior), junior high schoo l education and the degree of primary and secondary education are compared, The risk of moderate and severe stroke is gradually decreased. In primary school and below the leve l of culture as a reference, Junior high school(OR=0.092, 95%CI:0.020~0.430), high school(special)(OR=0.052, 95%CI:0.012~0.232) College(research object of undergraduate(OR=0.025, 95%CI:0.005~0.121) suffering from the moderate and severe stroke risk of 0.092, 0.052, 0.025, respectively, It was the protective factor of moderate and severe stroke, and the difference was statistically significant(P<0.05). History of hypertension group( O R=5.880 95%CI:3.233~10.694) and heart disease group( OR=5.945 95%C I:2.278~15.514) and a family hypertension history group(OR=9.985 95%CI:5.405~18.445), a family diabetic history group(O R=3.919 95%CI:1.692~9.077), a relative cerebral infarction history group(O R=6.319 95%CI:3.380~11.813), a relative heart disease group(OR=7.694, 95%CI:3.544~16.701). All of these data were the risk factors of moderate and severe stroke, and the difference was statistically significant(P<0.05). Smoking habit(OR=6.047, 95%CI:3.224~11.341) and drinking habit(OR=9.922, 95%CI:5.622~17.513) were the risk factors of moderate and severe stroke, and the difference was statist ically significant(P<0.05). There were significant differences in the levels of homocysteine and apolipoprotein a in the moderate to moderate and severe stroke group and mild stroke group(P<0.05). TC≥6.19 groups(OR=3.164 95%CI:1.268~7.897)compared to TC < 5.18 groups is the risk factors of moderate and severe stroke, with significant difference(P < 0.05); n- HDL-C is a risk factor for stroke. The 3.37≤ n-HDL<4.13 group(OR=1.827, 95%CI:1.013~3.295),4.14≤n—HDL-C<4.91 group(OR=2.618, 95%CI:1.308~5.237),n-HDL-C≥4.92 group(OR=3.045, 95%CI:1.082~8.573)compared to n-HDL-C<3.37 groups is the risk factors of moderate and severe stroke, And with the increase of non high density lipoprotein cholesterol, the risk is increased, which is dose effect relationship. The difference was statistically significant(P<0.05). To introvert type, extroversion(O R=0.079, 95%CI:0.029~0.214) were protective factors in moderate and severe stroke, And there were statistically significant differences between the two groups(P<0.05).3.Multivariate logistic regression analysis showed that risk factors for stroke include hypertension(OR=2.243, 95%CI:1.299~3.871), history of diabetes(O R=2.633, 95%CI:1.453~4.781) drinking habits(OR=2.576, 95%CI:1.678~3.955) is tshe risk factor for stroke. Previous occupation(physical labor)(OR=0.886, 95%CI:0.820~0.958), personality type(O R=0.628, 95%CI:0.414~0.954) is the protective factor of stroke.Before the single factor analysis of the first degree relatives of cerebral infarction, smoking habits, triglycerides, non high density lipoprote in cholesterol, apolipoprotein b, apolipoprotein a in the Logistic regression analysis failed to show a significant role. Multivariate conditional Logistic regression showed that the risk factors for more severity stroke(NIHSS ≥4) were: Homocysteine(O R=1.909, 95%CI: 1.072~3.401), apolipoprotein(O R=1.974,95%CI:1.179~3.306).Personalitytypes(outward)(OR=0.797,95%CI:0.346~0.892), degree of education(high)(O R=0.508, 95%C I: 0.298~0.865) a re the protective factors of more severity stroke(NIHSS ≥4), History of hypertension, history of cerebral infarction, heart disease, and a family history of hypertension, history of heart disease, diabetes, smoking history, drinking habits in multivariate logistic regression analysis failed to show significant effect.4.Univariate analysis of prognostic factors in patients with stroke Days > 21 days(OR= 3.15295%CI: 1.686~5.893), high emotional group(OR=6.681, 95%CI:3.479~12.832), Self care ability high score(O R=7.529, 95%CI:3.911~14.491), health status high score group(O R=5.676, 95%CI:2.997~10.748), Taking statins(OR=14.672,95%C I:7.288~ 29.539), high mental status group(O R=8.567,95%CI:4.318~16.999), The diet of high packet(O R=9.018,95%CI:4.440~18.314),High level of sleep in the night(O R=7.280, 95%CI:3.791~13.982), no abnormal muscle strength(O R=21.088, 95%CI:6.385~69.651), and no abnormal sensation function(O R=11.019, 95%CI:4.542~26.972), No abnormal funct ion of language(O R=8.397, 95%C I:4.343~16.234), no abnormal swallowing function(OR=8.443, 95%CI:4.191~16.614),no abnormal reaction(OR=5.297, 95%CI: 2.727~10.286) without cardiac symptoms(OR=2.440, 95%CI:1.238~4.808) with good prognosis associated with stroke(P<0.05).Re hospitalization(O R=0.14595%CI:0.044 ~0.481) was associated with poor prognosis(P<0.05). Other factors were independe nt of the prognosis(P > 0.05).5.Multivariate analysis of the prognosis of stroke showed that high score of self-care ability was related to the prognosis of the patients(OR=1.388, 95%C I:1.205~ 1.598), Individuals with strong self- care ability had a good prognosis, and no abnormal muscle strength was associated with good prognosis(O R=9.555, 95%CI:2.752~33.204). Re hospitalization was associated with poor prognosis(OR=0.212, 95%C I:0.570~0.792).Conclusion: 1.History of hypertension, history of diabetes, history of cerebral infarction, smoking and drinking habits are the risk factors of stroke. The levels of apolipoprotein a, apolipoprotein b, n-HDL-C, and glycerol three were different in stroke patients and non stroke patients. Have statistical significance(P<0.05). The high density lipoprotein(HDL), non high lipoprotein cholesterol(n-HDL-C), cholesterol(TC) followed by a hierarchical index, TC≥6.19 group and TC < 5.18 group compared to the risk factors of stroke, a statistically significant difference(P < 0.05); n-HDL-C is a risk factor for stroke. The dose effect relationship was increased with the increase of non high density lipoprotein cholesterol. Physical labor,Outgoing personality is a protective factor for stroke, and the difference is statistically significant(P<0.05).2. History of hypertension, heart disease and their first degree relatives(history of hypertension, diabetes, history of cerebral infarction, heart disease), drinking and smoking are the risk factors of moderate and severe stroke. Elevation of homocysteine and elevated apolipoprotein A are risk factors of moderate and severe stroke. TC≥6.19 group and TC < 5.18 group compared to severe stroke risk factors, there is significant difference(P < 0.05). The risk factors of stroke is n-HDL-C. The dose effect relationship was increased with the increase of non high density lipoprotein cholesterol. High degree of education, personality outward is the protective factor of more severity stroke(NIHSS ≥4).3. Cumulative length of stay > 21 days, emotional high achievers, Self care ability high score, high health group, taking statins, spirit of high packet, accepts high status group food, night sleep in high packet, strength no abnormal, sensory function without exception, language function amounts, swallowing function no abnormal, reaction without exception, no cardiac symptoms and good prognosis associated. Re hospitalization was associated with poor prognosis during the follow-up period.Multivariate analysis showed that: the self- care ability was high, and the muscle strength was not associated with a good prognosis. Re hospitalization was associated with poor prognosis.