Differing Risk Factor Profiles of Ischemic Stroke Subtypes Evidence for a Distinct Lacunar Arteriopathy?
Differing Risk Factor Profiles of Ischemic Stroke Subtypes Evidence for a Distinct Lacunar Arteriopathy?
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DOI：
10.1161/strokeaha.109.558809
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发表时间：
2010-04-01
期刊：
影响因子：
8.3
通讯作者：
Sudlow, Cathie L. M.
中科院分区：
文献类型：
--
作者：
Jackson, Caroline A.;Hutchison, Aidan;Sudlow, Cathie L. M.
背景和目的-腔隙卒中和其他缺血性卒中亚型之间的危险因素谱差异可能为腔隙动脉病提供证据，但现有研究存在局限性。我们从5个合作的前瞻性卒中登记中收集了2875名首次缺血性卒中患者的个人数据，这些登记使用类似的、公正的方法来定义风险因素并对卒中亚型进行分类，从而克服了这些问题。方法-我们比较了腔隙和非腔隙缺血性卒中的危险因素，改变了敏感性分析中的对照组，并将这些数据纳入了已发表研究的荟萃分析。结果-未调整和调整分析给出了类似的结果。我们发现与非腔隙患者相比，腔隙患者心源性栓塞源(调整后的优势比，0.33；95%CI，0.24至0.46)、同侧颈动脉狭窄(优势比，0.21；95%CI，0.14至0.30)和缺血性心脏病(优势比，0.75；95%CI，0.58至0.97)的患病率较低，而高血压、糖尿病或任何其他危险因素的患病率没有差异。结论：高血压和糖尿病在腔隙性和非腔隙性缺血性卒中中同样常见，但腔隙性卒中不太可能由心脏或近端动脉栓塞引起，腔隙性卒中缺血性心脏病的发病率较低，这为非动脉粥样硬化性动脉病变导致许多腔隙缺血性卒中提供了额外的支持。我们的发现对临床医生如何对缺血性卒中亚型进行分类，并强调需要对腔隙性卒中的具体原因和治疗进行进一步研究具有重要意义。(笔划。2010；41：624-629。)
Background and Purpose-Differences in risk factor profiles between lacunar and other ischemic stroke subtypes may provide evidence for a distinct lacunar arteriopathy, but existing studies have limitations. We overcame these by pooling individual data on 2875 patients with first-ever ischemic stroke from 5 collaborating prospective stroke registers that used similar, unbiased methods to define risk factors and classify stroke subtypes.Methods-We compared risk factors between lacunar and nonlacunar ischemic strokes, altering the comparison groups in sensitivity analyses, and incorporated these data into a meta-analysis of published studies.Results-Unadjusted and adjusted analyses gave similar results. We found a lower prevalence of cardioembolic source (adjusted odds ratio, 0.33; 95% CI, 0.24 to 0.46), ipsilateral carotid stenosis (odds ratio, 0.21; 95% CI, 0.14 to 0.30), and ischemic heart disease (odds ratio, 0.75; 95% CI, 0.58 to 0.97) in lacunar compared with nonlacunar patients but no difference for hypertension, diabetes, or any other risk factor studied. Results were robust to sensitivity analyses and largely confirmed in our meta-analysis.Conclusions-Hypertension and diabetes appear equally common in lacunar and nonlacunar ischemic stroke, but lacunar stroke is less likely to be caused by embolism from the heart or proximal arteries, and the lower prevalence of ischemic heart disease in lacunar stroke provides additional support for a nonatherosclerotic arteriopathy causing many lacunar ischemic strokes. Our findings have implications for how clinicians classify ischemic stroke subtypes and highlight the need for additional research into the specific causes of and treatments for lacunar stroke. (Stroke. 2010;41:624-629.)