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Stroke:决定短暂性脑缺血发作和卒中后痴呆风险的方法学因素

2015-05-11 李志行 译 MedSci原创

队列研究和实验性研究中的认知结果经常仅来源于面对面的临床评估。然而,认知障碍与发病率和死亡率的增加关系十分密切,导致较为严重的临床失访。在缺乏先前以人群为基础的数据的情况下,我们希望明确在检测短暂性脑缺血发作和卒中后痴呆风险时的损耗作用。研究方法:我们招募了2002年至2007年进入牛津血管(OXVASC)研究的短暂性脑缺血发作或卒中患者,对其临床和认知方面的基线数据进行评估并随访至2014年。针

队列研究和实验性研究中的认知结果经常仅来源于面对面的临床评估。然而,认知障碍与发病率和死亡率的增加关系十分密切,导致较为严重的临床失访。在缺乏先前以人群为基础的数据的情况下,我们希望明确在检测短暂性脑缺血发作和卒中后痴呆风险时的损耗作用。

研究方法:
我们招募了2002年至2007年进入牛津血管(OXVASC)研究的短暂性脑缺血发作或卒中患者,对其临床和认知方面的基线数据进行评估并随访至2014年。针对痴呆的诊断是通过面对面的临床访谈,对部分无法参与临床的患者以家庭访问和电话评估等方式做为补充。

研究结果:
1236名患者(平均年龄/标准差,75.2/12.1岁;582位男性)中527位(43%)患者在5年随访中死亡。生存者的随访评估率(临床研究、家访、电话)在1月、6月、12月和5年里分别为92%、89%、87%和84%。有260位患者出现痴呆症状,其中有110位(42%)在诊断期间没有进行面对面的临床随访。事件后痴呆的5年累积发病率总计为29%(26%–32%) ,但是只有17% (14% to 19%)的患者接受了临床评估,相比之下,没有接受临床评估的患者占到了45% (39%–51%)。

将一些无法获取的患者排除在临床随访之外可以减少事件后痴呆的测量风险。应用多手段随访,包括家庭访问、电话评估和问卷等方式大体评估基础治疗记录会增加发现长期痴呆结局的可能。

原始出处:
Sarah T. Pendlebury, DPhil, Ping-Jen Chen, BM BCh, Sarah J.V. Welch, RGN, Fiona C. Cuthbertson, BSc, Rose M. Wharton, MSc, Ziyah Mehta, DPhil, Peter M. Rothwell, FMedSci, for the Oxford Vascular Study
Methodological Factors in Determining Risk of Dementia After Transient Ischemic Attack and Stroke
Stroke 2015; first published on May 7 2015 as doi:10.1161/STROKEAHA.115.009065

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    2015-05-13 huaxipanxing

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