中风将预期寿命缩短三分之一

 诸平 

据MyScience网站2022年4月15日报道，中风会将预期寿命缩短三分之一（Stroke cuts life expectancy by one third）。

近三分之二的急性中风患者未能存活超过十年，并且复发风险很高，这促使研究人员呼吁提供更好的患者护理。

澳大利亚昆士兰大学（University of Queensland）的研究人员分析了2008~2017年间澳大利亚（Australia）和新西兰（New Zealand）超过30万名因突发中风入院的患者的数据。该团队还通过比较患者的预期寿命与实际生存时间来调查中风损失了多少年。相关研究结果于2022年4月14日已经在《中风》（Stroke）杂志网站发表——Yang Peng, Linh Ngo, Karen Hay, Alaa Alghamry, Kathryn Colebourne, Isuru Ranasinghe. Long-Term Survival, Stroke Recurrence, and Life Expectancy After an Acute Stroke in Australia and New Zealand From 2008–2017: A Population-Wide Cohort Study. Stroke, Originally published 14 Apr 2022. DOI: 10.1161/STROKEAHA.121.038155. https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.038155

研究负责人、昆士兰大学流行病学家、查尔斯王子医院北区临床部（Prince Charles Hospital Northside Clinical Unit）研究员彭阳博士（Dr Yang Peng音译）表示，只有36.4%的患者存活超过10年，26.8%的患者再次中风。

彭博士说：“我们发现，与普通人群相比，中风会使患者的预期寿命平均缩短五年半。按比例来说，这意味着中风会使人的预期寿命缩短三分之一。与缺血性中风患者相比，脑出血的出血性中风患者死亡、再次中风和预期寿命缩短的风险更大，因为这是由血管破裂引起的。”

急性中风是澳大利亚最常见的住院和残疾原因之一，中风基金会（Stroke Foundation）认为，中风与高血压、胆固醇水平升高、糖尿病、吸烟和心脏病等风险因素有关。

该研究的合著者、查尔斯王子医院的中风和全科医生凯瑟琳·科勒布恩（Kathryn Colebourne）博士说，这些发现加强了共同努力改善急性中风护理的必要性。

“我们需要中风护理网络，以迅速识别中风患者，为他们提供重要的、对时间敏感的治疗，如溶栓、溶栓药物，以及血管内治疗，一种专门的程序，以清除进入大脑的血管中的血块，”凯瑟琳·科勒布恩博士说。

“我们还需要专门的中风病房为这些患者提供多学科护理，众所周知，这可以减少中风后的死亡和残疾。”

彭博士说，考虑到中风复发的患者数量，还应该关注生活方式和风险因素的改变，以进行二级预防。他说：“很少有人口研究探讨中风的长期结果。这些信息对于患者了解他们的预后以及寻求改善中风护理和预防措施的卫生专业人员至关重要。”

这项研究由澳大利亚国家心脏基金会（National Heart Foundation of Australia）资助。

上述介绍，仅供参考。欲了解更多信息，敬请注意浏览原文或者相关报道。

Abstract

BACKGROUND:

Data on long-term outcomes following an acute stroke are sparse. We assessed survival, risk of recurrent stroke and loss in life expectancy following an acute stroke using population-wide data from Australia and New Zealand.

METHODS:

We included all adults with the first stroke hospitalization during 2008 and 2017 at all public and most private hospitals. Patients were followed up to 10 years after the stroke by linkage to each region’s Registry of Deaths and subsequent hospitalizations. Flexible parametric survival modeling was used to estimate all-cause mortality, stroke recurrence, and loss in life expectancy. Competing risk model was used when estimating the risk of stroke recurrence.

RESULTS:

Three hundred thirteen thousand one hundred sixty-two patients were included (mean age 73.0±14.6 y, 52.0% males) with ischemic stroke (175 547, 56.1%) being the most common, followed by hemorrhagic stroke (77 940, 24.9%) and unspecified stroke (59 675, 19.1%). The overall survival probability was 79.4% at 3 months, 73.0% at 1 year, 52.8% at 5 years, and 36.4% at 10 years. Cumulative incidence of stroke recurrence was 7.8% at 3 months, 11.0% at 1 year, 19.8% at 5 years, and 26.8% at 10 years. Hemorrhagic stroke was associated with greater mortality (hazard ratio, 2.02 [95% CI, 1.99–2.04]) and recurrent stroke (hazard ratio, 1.63 [95% CI, 1.59–1.67]) compared with ischemic stroke. Female sex (hazard ratio, 1.10 [95% CI, 1.09–1.11]) and increasing age (≥85 years versus 18–54 years: hazard ratio, 7.36 [95% CI, 7.15–7.57]) were also associated with increased mortality. Several risk factors including atherosclerotic coronary and noncoronary vascular disease, cardiac arrhythmia, and diabetes were associated with increased risk of mortality and recurrent stroke. Compared with the general population, an acute stroke was associated with a loss of 5.5 years of life expectancy, or 32.7% of the predicted life expectancy, and was pronounced in patients with a hemorrhagic stroke (7.4 years and 38.5% of predicted life expectancy lost).

CONCLUSIONS:

In this population-wide study, death and recurrence of stroke were common after an acute stroke and an acute stroke was associated with considerable loss in life expectancy. Further improvements in treatment and secondary prevention of stroke are needed to reduce these risks.