【摘要】：腦卒中是目前危害人類健康的重要疾病之一,世界范圍內(nèi)腦卒中已成為第二大死亡原因和殘疾的首要原因,它具有高發(fā)病率、高復(fù)發(fā)率、高致殘率和高致死率的特點(diǎn)。本次研究將分為以下三部分,進(jìn)而探討相關(guān)危險(xiǎn)因素與腦卒中發(fā)病及預(yù)后之間的關(guān)系。第一部分：利用隨訪10年的前瞻性隊(duì)列探討高血壓及飲酒,吸煙及心率的獨(dú)立效應(yīng)和累積效應(yīng)與腦卒中發(fā)病的關(guān)系。第二部分：利用腦卒中患者預(yù)后的前瞻性隊(duì)列探討基線維生素D水平及傳統(tǒng)危險(xiǎn)因素與腦卒中患者住院期間及3個(gè)月內(nèi)結(jié)局的關(guān)系。第三部分：利用Meta分析方法合并關(guān)于銀屑病與腦卒中發(fā)病的隊(duì)列研究,探討銀屑病與腦卒中發(fā)病風(fēng)險(xiǎn)的關(guān)聯(lián)性。 第一部分 研究目的 依據(jù)腦卒中發(fā)病的前瞻性隊(duì)列資料,探討高血壓及飲酒,吸煙及心率的獨(dú)立效應(yīng)和累積效應(yīng)與腦卒中發(fā)病的關(guān)系。 材料與方法 本課題組于2002-2003年選擇內(nèi)蒙古通遼市科左后旗朝魯吐鄉(xiāng)和奈曼旗固日班花鄉(xiāng)共32村作為調(diào)查現(xiàn)場(chǎng),2589人簽署知情同意書,并接受了間卷調(diào)查、體格檢查、測(cè)量血壓和采集血標(biāo)本。間卷調(diào)查包括人口統(tǒng)計(jì)學(xué)特征、高血壓家族史、吸煙和飲酒等情況,進(jìn)行三次血壓的測(cè)量及身高、體重、腰圍、臀圍的測(cè)量。實(shí)驗(yàn)室檢測(cè)包括空腹血糖、胰島素、甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL-C),低密度脂蛋白膽固醇(LDL-C)由相應(yīng)公式計(jì)算得到。我們分別于2008年、2009年、2010年和2012年對(duì)參與基線研究的2589名研究對(duì)象進(jìn)行了隨訪調(diào)查,收集腦卒中的發(fā)病資料。 我們采用多因素Cox回歸模型分析腦卒中發(fā)病的危險(xiǎn)因素。根據(jù)血壓與飲酒狀態(tài)將研究對(duì)象分為四組,運(yùn)用Kaplan-Meier方法繪制四組人群的腦卒中事件累計(jì)發(fā)病曲線并采用log-rank檢驗(yàn)進(jìn)行組間比較。以非高血壓／不飲酒組作為參比組,利用多因素Cox回歸模型分析非高血壓／飲酒組,高血壓／不飲酒組以及高血壓／飲酒組腦卒中發(fā)生的風(fēng)險(xiǎn)比(HR)及95%可信區(qū)間(95%CI)。應(yīng)用ROC曲線方法比較傳統(tǒng)危險(xiǎn)因素加血壓/飲酒狀態(tài)與單純傳統(tǒng)危險(xiǎn)因素的曲線下面積,從而分析血壓/飲酒狀態(tài)對(duì)腦卒中事件發(fā)生的預(yù)測(cè)效率。類似的,將所有研究對(duì)象按照吸煙與心率狀態(tài)分為四組,運(yùn)用Kaplan-Meier方法繪制四組人群的缺血性腦卒中事件累計(jì)發(fā)病曲線并采用log-rank檢驗(yàn)進(jìn)行組間比較。以不吸煙/心率80組作為參比組,利用多因素Cox回歸模型分析不吸煙/心率≥80組,吸煙/心率80組以及吸煙/心率≥80組缺血性腦卒中發(fā)生的風(fēng)險(xiǎn)比(HR)及95%可信區(qū)間(95%CI)。應(yīng)用ROC曲線方法比較傳統(tǒng)危險(xiǎn)因素加吸煙/心率狀態(tài)與單純傳統(tǒng)危險(xiǎn)因素的曲線下面積,從而分析吸煙/心率狀態(tài)對(duì)缺血性腦卒中事件發(fā)生的預(yù)測(cè)效率。 結(jié)果 年齡增加、男性、高血壓是腦卒中發(fā)生的獨(dú)立危險(xiǎn)因素,而飲酒與腦卒中發(fā)生無顯著性關(guān)聯(lián)。非高血壓/不飲酒組、非高血壓/飲酒組、高血壓/不飲酒組以及高血壓/飲酒組的腦卒中累計(jì)發(fā)病率分別是1.5%,2.8%,7.4%及12.5%(P0.001)。同非高血壓/不飲酒組相比,非高血壓/飲酒組、高血壓/不飲酒組和高血壓/飲酒組的腦卒中HR(95%CI)分別是1.02(0.47-2.21)、2.61(1.43-4.75)和2.78(1.49-5.21),高血壓/飲酒組的HR值高于其他各組。血壓/飲酒狀態(tài)+傳統(tǒng)危險(xiǎn)因素的ROC曲線下面積0.687顯著高于單純傳統(tǒng)危險(xiǎn)因素的ROC曲線下面積0.663(P=0.005)。 吸煙是缺血性腦卒中發(fā)生的獨(dú)立危險(xiǎn)因素,而心率與缺血性腦卒中發(fā)生無顯著性關(guān)聯(lián)。不吸煙/心率80組、不吸煙/心率≥80組、吸煙/心率80組以及吸煙/心率≥80組的缺血性腦卒中累計(jì)發(fā)病率分別是1.41%、1.98%、3.97%及5.77%(P0.001)。同不吸煙/心率80組相比,不吸煙/心率≥80組、吸煙/心率80組和吸煙/心率≥80組的缺血性腦卒中HR(95%CI)分別是1.42(0.62-3.28)、2.11(1.06-4.23)和2.86(1.33-6.14),吸煙/心率≥80組的HR值高于其他各組。吸煙/心率狀態(tài)+傳統(tǒng)危險(xiǎn)因素的ROC曲線下面積0.755顯著高于單純傳統(tǒng)危險(xiǎn)因素的ROC曲線下面積0.739(P=0.018)。 結(jié)論 本研究結(jié)果顯示,年齡增加、男性和高血壓是影響腦卒中發(fā)病的獨(dú)立危險(xiǎn)因素。吸煙是缺血性腦卒中發(fā)病的獨(dú)立危險(xiǎn)因素。飲酒可能在一定程度上放大了高血壓對(duì)于腦卒中發(fā)病的風(fēng)險(xiǎn),而心率較快可能在一定程度上放大了吸煙對(duì)缺血性腦卒中發(fā)病的風(fēng)險(xiǎn)。血壓/飲酒狀態(tài)、吸煙/心率狀態(tài)可以提高腦卒中和缺血性腦卒中發(fā)病風(fēng)險(xiǎn)的預(yù)測(cè)效率 研究目的 根據(jù)腦卒中患者預(yù)后的前瞻性隊(duì)列探討基線維生素D水平及傳統(tǒng)危險(xiǎn)因素與缺血性腦卒中患者住院期間及3個(gè)月內(nèi)結(jié)局的關(guān)系。 材料與方法 本研究以參加中美合作“急性缺血性腦卒中降血壓隨機(jī)對(duì)照試驗(yàn)”的急性缺血性腦卒中患者作為研究人群,以其中資料完整,已完成3個(gè)月隨訪并且檢測(cè)了血清25(OH)D水平的3002例缺血性腦卒中患者作為研究對(duì)象。采用統(tǒng)一設(shè)計(jì)的調(diào)查表收集患者的人口統(tǒng)計(jì)學(xué)信息、生活方式、臨床特征、實(shí)驗(yàn)室檢查、疾病史等資料,應(yīng)用LIAISON全自動(dòng)化學(xué)發(fā)光儀測(cè)定患者入院24小時(shí)內(nèi)血清維生素25(OH)D濃度。在患者住院期間和發(fā)病3個(gè)月后對(duì)其進(jìn)行評(píng)估,記錄死亡、心血管事件、中風(fēng)再發(fā)的情況,并進(jìn)行神經(jīng)功能(NIHSS評(píng)分)和生活自理程度的評(píng)價(jià)(MRs評(píng)分),以死亡、殘疾(MRs3)、心血管事件以及中風(fēng)再發(fā)作為研究結(jié)局。運(yùn)用多因素Cox回歸模型分析維生素D水平及傳統(tǒng)危險(xiǎn)因素與患者住院期間及3個(gè)月內(nèi)死亡和心腦血管事件的關(guān)系,計(jì)算HR和95%CI。運(yùn)用多因素logistic回歸模型分析維生素D水平及傳統(tǒng)危險(xiǎn)因素與住院期間及3個(gè)月內(nèi)殘疾與復(fù)合結(jié)局的關(guān)系,計(jì)算OR和95%CI。運(yùn)用logistic回歸模型對(duì)維生素D水平及傳統(tǒng)危險(xiǎn)因素與復(fù)合結(jié)局的關(guān)系進(jìn)行線性趨勢(shì)檢驗(yàn)。按照傳統(tǒng)危險(xiǎn)因素的不同水平將缺血性腦卒中患者分為若干亞組,進(jìn)而分析維生素D水平在每一亞組中與缺血性腦卒中患者預(yù)后的關(guān)聯(lián)性。 結(jié)果 住院期間,同年齡55歲的患者相比,年齡≥55歲的患者發(fā)生死亡及心腦血管事件的HR(95%CI)是1.84(0.64-5.32),發(fā)生殘疾與復(fù)合結(jié)局的OR(95%CI)分別是1.55(1.22-1.98)和1.56(1.23-1.98)。同白細(xì)胞8.5×109/L的患者相比,白細(xì)胞≥8.5×109/L患者發(fā)生死亡及心腦血管事件的HR(95%CI)是2.58(1.09-6.12),發(fā)生殘疾與復(fù)合結(jié)局的OR(95%CI)分別是1.32(1.06-1.65)和1.36(1.09-1.69)。同血糖水平7.0mmol/L的患者相比,血糖水平≥7.0mmol/L的患者發(fā)生死亡及心腦血管事件的HR(95%CI)是3.64(1.56-8.5),發(fā)生殘疾與復(fù)合結(jié)局的OR(95%CI)分別是1.44(1.16-1.77)和1.46(1.18-1.80)。同25(OH)D20ng/ml的患者相比,25(OH)D20ng/ml的患者發(fā)生死亡及心腦血管事件的HR(95%CI)是0.82(0.29-2.34),發(fā)生殘疾與復(fù)合結(jié)局的OR(95%CI)分別是1.09(0.84-1.40)和1.09(0.85-1.40)。年齡、白細(xì)胞以及血糖水平與住院期間不良結(jié)局的風(fēng)險(xiǎn)之間存在劑量反應(yīng)關(guān)系(P0.05),25(OH)D水平與住院期間不良結(jié)局風(fēng)險(xiǎn)之間無明顯的劑量反應(yīng)關(guān)系(P0.05)。 發(fā)病3個(gè)月內(nèi),同年齡55歲的患者相比,年齡≥55歲的患者發(fā)生死亡及心腦血管事件的HR(95%CI)是1.72(1.03-2.85),發(fā)生殘疾與復(fù)合結(jié)局的OR(95%CI)分別是1.61(1.24-2.10)和1.65(1.28-2.12)。同白細(xì)胞8.5×109/L的患者相比,白細(xì)胞≥8.5×109/L患者發(fā)生死亡及心腦血管事件的HR(95%CI)是2.18(1.54-3.09),發(fā)生殘疾與復(fù)合結(jié)局的OR(95%CI)分別是1.35(1.07-1.69)和1.48(1.19-1.83)。同血糖水平7.0nmol/L的患者相比,血糖水平≥7.0mmol/L的患者發(fā)生死亡及心腦血管事件的HR(95%CI)是1.28(0.90-1.84),發(fā)生殘疾與復(fù)合結(jié)局的OR(95%CI)分別是1.30(1.04-1.63)和1.28(1.04-1.59)。同收縮壓水平16OmmHg的患者相比,收縮壓水平≥16Ommol/L的患者發(fā)生死亡及心腦血管事件的HR(95%CI)是1.53(1.07-2.20),發(fā)生殘疾與復(fù)合結(jié)局的OR(95%CI)分別是1.33(1.07-1.65)和1.33(1.08-1.63)。與25(OH)D≥20ng/ml的患者相比,25(OH)D20ng/ml的患者發(fā)生死亡及心腦血管事件的HR(95%CI)是1.08(0.69-1.70),發(fā)生殘疾與復(fù)合結(jié)局的OR(95%CI)分別是1.16(0.88-1.52)和1.17(0.90-1.51)。年齡、白細(xì)胞、收縮壓水平以及血糖水平與發(fā)病3個(gè)月內(nèi)不良結(jié)局的風(fēng)險(xiǎn)之間存在劑量反應(yīng)關(guān)系(P0.05),25(OH)D水平與發(fā)病3個(gè)月內(nèi)不良結(jié)局風(fēng)險(xiǎn)之間無明顯的劑量反應(yīng)關(guān)系(P0.05)。亞組分析顯示,在男性患者、血脂異�；颊吆臀鼰熁颊咧�,25(OH)D20ng/ml的對(duì)象3個(gè)月內(nèi)發(fā)生復(fù)合結(jié)局的風(fēng)險(xiǎn)顯著高于25(OH)D≥20ng/ml的對(duì)象,其OR(95%CI)分別是1.49(1.09-2.05),1.65(1.08-2.51)和1.64(1.03-2.61)。 結(jié)論 本次腦卒中預(yù)后的前瞻性隊(duì)列研究發(fā)現(xiàn),年齡增大、基線時(shí)血糖和白細(xì)胞計(jì)數(shù)水平升高顯著增加缺血性腦卒中患者住院期間及3個(gè)月內(nèi)不良結(jié)局發(fā)生的風(fēng)險(xiǎn)；基線收縮壓水平升高顯著增加缺血性腦卒中患者3個(gè)月內(nèi)不良結(jié)局的風(fēng)險(xiǎn)；這些因素與患者預(yù)后均存在劑量反應(yīng)關(guān)系。對(duì)所有對(duì)象而言,尚未發(fā)現(xiàn)基線25(OH)D水平影響缺血性腦卒中患者住院期間及3個(gè)月內(nèi)的結(jié)局,但亞組分析結(jié)果提示,在男性患者、血脂異�；颊吆臀鼰熁颊咧�,維生素D缺乏增加了缺血性腦卒中患者3個(gè)月內(nèi)發(fā)生不良結(jié)局的風(fēng)險(xiǎn)。 研究目的 利用Meta分析方法合并關(guān)于銀屑病與腦卒中發(fā)病的隊(duì)列研究,探討銀屑病與腦卒中發(fā)病風(fēng)險(xiǎn)的關(guān)聯(lián)性。 材料與方法 通過檢索MEDLINE (Pubmed), EMBASE與Cochrane Library等數(shù)據(jù)庫,收集2013年10月之前公開發(fā)表的有關(guān)于銀屑病與腦卒中的隊(duì)列研究的相關(guān)文獻(xiàn)。隨機(jī)效應(yīng)模型被用來對(duì)各個(gè)研究的效應(yīng)值進(jìn)行合并。 結(jié)果 5項(xiàng)隊(duì)列研究最終被納入本次Meta分析。3項(xiàng)研究為前瞻性隊(duì)列,1項(xiàng)研究為回顧性隊(duì)列,1項(xiàng)為回顧-前瞻混合隊(duì)列。隨機(jī)效應(yīng)模型的合并結(jié)果顯示,銀屑病導(dǎo)致腦卒中的風(fēng)險(xiǎn)(RR)及其95%可信區(qū)間為1.18(1.02-1.37)。Eagger線性檢驗(yàn)(P=0.778),Begger秩相關(guān)檢驗(yàn)(P=1.00)提示我們的研究不存在潛在的發(fā)表偏倚。 結(jié)論 綜上所述,我們的研究結(jié)果說明銀屑病將顯著提高腦卒中的發(fā)病風(fēng)險(xiǎn),銀屑病很有可能是獨(dú)立于高血壓、糖尿病等傳統(tǒng)危險(xiǎn)因素以外的腦卒中發(fā)病的又一危除因素。
[Abstract]:Stroke is one of the most important diseases endangering human health. Stroke has become the second leading cause of death and disability worldwide. It has the characteristics of high incidence, high recurrence rate, high disability rate and high fatality rate. The relationship between prognosis. Part I: Prospective cohort study of hypertension and alcohol consumption, smoking and heart rate over a 10-year follow-up period was used to explore the relationship between independent and cumulative effects and stroke incidence. Part II: Prospective cohort study of stroke prognosis was used to explore baseline vitamin D levels and traditional risk factors in stroke patients. Part III: To explore the association between psoriasis and stroke risk by using Meta-analysis combined with a cohort study on psoriasis and stroke.
Part one
research objective
Based on the prospective cohort data of stroke incidence, the relationship between hypertension, alcohol consumption, smoking, heart rate and stroke incidence was investigated.
Materials and methods
From 2002 to 2003, our research group selected 32 villages in Chaolutu Township, Kezuo Houqi Township, Tongliao City, Inner Mongolia, and Guri Banhua Township, Naiman Banner, as the investigation sites. 2589 people signed informed consent forms and received a cross-sectional survey, physical examination, blood pressure measurement and blood sample collection. The cross-sectional survey included demographic characteristics, family history of hypertension, smoking and drinking. Laboratory tests included fasting blood glucose, insulin, triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) calculated by the corresponding formula. We calculated them in 2008, 2009, 2010 and 201, respectively. In the 2 year, 2589 subjects who participated in the baseline study were followed up to collect data on the onset of stroke.
Multivariate Cox regression model was used to analyze the risk factors of stroke. The subjects were divided into four groups according to blood pressure and alcohol consumption. The cumulative incidence curves of stroke events were plotted by Kaplan-Meier method and compared between groups by log-rank test. Multivariate Cox regression model was used to analyze the risk ratio (HR) and 95% confidence interval (95% CI) of stroke in non-hypertension/alcohol drinking group, hypertension/alcohol drinking group and hypertension/alcohol drinking group. Similarly, all subjects were divided into four groups according to smoking and heart rate status. The cumulative incidence curves of ischemic stroke events were plotted by Kaplan-Meier method and compared between groups by log-rank test. Multivariate Cox regression model was used to analyze the risk ratio (HR) and 95% confidence interval (95% CI) of ischemic stroke in non-smoking/heart rate (> 80 group), smoking/heart rate (> 80 group) and smoking/heart rate (> 80 group). ROC curve method was used to compare the area under the curve of traditional risk factors plus smoking/heart rate status and simple traditional risk factors. The predictive efficiency of heart rate for ischemic stroke events.
Result
The cumulative incidence of stroke was 1.5%, 2.8%, 7.4% and 12.5% (P 0.001) in the non-hypertension / non-drinking group, non-hypertension / non-drinking group, hypertension / non-drinking group and hypertension / drinking group, respectively. Compared with the non-hypertension/alcohol drinking group, the stroke HR (95% CI) of hypertension/alcohol drinking group and hypertension/alcohol drinking group were 1.02 (0.47-2.21), 2.61 (1.43-4.75) and 2.78 (1.49-5.21), respectively. The HR value of hypertension/alcohol drinking group was higher than that of other groups. The area under ROC curve of blood pressure/alcohol status+traditional risk factors was 0.687 significantly higher than that of simple traditional risk factors. The area under the ROC curve of risk factors was 0.663 (P=0.005).
The cumulative incidence of ischemic stroke was 1.41%, 1.98%, 3.97% and 5.77% in non-smoking/heart rate group, non-smoking/heart rate group, smoking/heart rate group and smoking/heart rate group, respectively (P 0.001). HR (95% CI) of ischemic stroke was 1.42 (0.62-3.28), 2.11 (1.06-4.23) and 2.86 (1.33-6.14) in non-smoking/heart rate (>80), smoking/heart rate (>80) and smoking/heart rate (>80), respectively. The HR of smoking/heart rate (>80) group was higher than that of other groups. The area under ROC curve of smoking/heart rate status + traditional risk factors was 0.755 significantly higher than that of single group. The area under the ROC curve of pure traditional risk factors was 0.739 (P=0.018).
conclusion
Smoking is an independent risk factor for ischemic stroke. Alcohol consumption may magnify the risk of hypertension for stroke to some extent, while faster heart rate may magnify the effect of smoking on ischemia to some extent. Risk of stroke. Blood pressure / alcohol status, smoking / heart rate status can improve the predictive efficiency of stroke and ischemic stroke risk
research objective
To explore the relationship between baseline vitamin D levels and traditional risk factors and the outcomes of ischemic stroke patients during hospitalization and within 3 months according to a prospective cohort of stroke patients.
Materials and methods
In this study, 3002 patients with acute ischemic stroke who participated in the Sino-US cooperative randomized controlled trial of lowering blood pressure for acute ischemic stroke were selected as the subjects. The data were complete, and the patients were followed up for 3 months and the serum 25 (OH) D levels were measured. A uniform design survey was used. Serum vitamin 25 (OH) D levels were measured by LIAISON automatic chemiluminescence meter during hospitalization and 3 months after onset of stroke. Neurological function (NIHSS) and self-care (MRS) were assessed, and death, disability (MRs3), cardiovascular events and stroke recurrence were taken as the study outcomes. Multivariate Cox regression model was used to analyze the relationship between vitamin D levels and traditional risk factors and death and cardiovascular and cerebrovascular events during hospitalization and within 3 months. HR and 95% CI were calculated. Multivariate logistic regression model was used to analyze the relationship between vitamin D level and traditional risk factors, disability and multiple outcomes during hospitalization and within 3 months. OR and 95% CI were calculated. The linear trend test was used to examine the relationship between vitamin D level and traditional risk factors and multiple outcomes. Patients with ischemic stroke were divided into several subgroups according to different levels of risk factors, and the correlation between vitamin D level and prognosis of ischemic stroke patients in each subgroup was analyzed.
Result
During hospitalization, HR (95% CI) was 1.84 (0.64-5.32) for death and cardiovascular and cerebrovascular events in patients over 55 years of age. OR (95% CI) for disability and complex outcomes was 1.55 (1.22-1.98) and 1.56 (1.23-1.98), respectively. Compared with patients with leukocytes over 8.5 *109/L, patients with leukocytes over 8.5 *109/L died and had cardio-cerebral events. HR (95% CI) for vascular events was 2.58 (1.09-6.12), OR (95% CI) for disability and complex outcomes was 1.32 (1.06-1.65) and 1.36 (1.09-1.69), respectively. Compared with patients with 7.0 mmol/L of blood glucose, HR (95% CI) for death and cardiovascular and cerebrovascular events was 3.64 (1.56-8.5) for patients with disability and complex outcomes (95% CI). Compared with 25 (OH) D20ng/ml patients, the HR (95% CI) of 25 (OH) D20ng/ml patients was 0.82 (0.29-2.34), and the OR (95% CI) of disability and complex outcome was 1.09 (0.84-1.40) and 1.09 (0.85-1.40) respectively. There was a dose-response relationship between the risk of good outcomes (P 0.05). There was no significant dose-response relationship between 25 (OH) D level and the risk of adverse outcomes during hospitalization (P 0.05).
HR (95% CI) was 1.72 (1.03-2.85) and OR (95% CI) was 1.61 (1.24-2.10) and 1.65 (1.28-2.12) respectively. Compared with patients with leukocytes of 8.5 *109/L, patients with leukocytes of more than 8.5 *109/L died and patients with leukocytes of more than 8.5 *109/L died. HR (95% CI) for cardiovascular and cerebrovascular events was 2.18 (1.54-3.09), OR (95% CI) for disability and complex outcomes was 1.35 (1.07-1.69) and 1.48 (1.19-1.83). Compared with patients with 7.0 nmol/L of blood glucose, HR (95% CI) for death and cardiovascular and cerebrovascular events was 1.28 (0.90-1.84) for patients with disability and complex outcomes. R (95% CI) was 1.30 (1.04-1.63) and 1.28 (1.04-1.59), respectively. Compared with patients with systolic blood pressure level of 16OmmHg, the HR (95% CI) of death and cardiovascular and cerebrovascular events in patients with systolic blood pressure level (>16Ommol/L) was 1.53 (1.07-2.20), and the OR (95% CI) of disability and complex outcomes was 1.33 (1.07-1.65) and 1.08-1.63 (25 (OH) D (>20ng/ml), respectively. HR (95% CI) was 1.08 (0.69-1.70), and OR (95% CI) was 1.16 (0.88-1.52) and 1.17 (0.90-1.51) for disability and complex outcomes, respectively, in 25 (OH) D20ng/ml patients. There was a dose-response relationship between age, leukocyte, systolic blood pressure, and the risk of adverse outcomes within three months of onset. There was no significant dose-response relationship between 25 (OH) D and the risk of adverse outcomes within 3 months (P 0.05). Subgroup analysis showed that the risk of compound outcomes within 3 months in 25 (OH) D20ng/ml subjects was significantly higher in male patients, dyslipidemia patients and smokers than in 25 (OH) D > 20ng/ml subjects, with OR (95% CI) of 1. 49 (1.09-2.05), 1.65 (1.08-2.51) and 1.64 (1.03-2.61).
conclusion
This prospective cohort study of stroke prognosis found that increased age, elevated baseline blood glucose and white blood cell count significantly increased the risk of adverse outcomes during hospitalization and within three months in patients with ischemic stroke, and elevated baseline systolic blood pressure significantly increased the risk of adverse outcomes within three months in patients with ischemic stroke. For all subjects, baseline 25 (OH) D levels were not found to affect the outcome of ischemic stroke during hospitalization and within three months, but subgroup analysis indicated that vitamin D deficiency increased ischemic stroke in men, dyslipidemia and smokers. The risk of adverse outcomes was within 3 months.
research objective
Meta-analysis was used to explore the association between psoriasis and stroke risk in a cohort study of psoriasis and stroke.
Materials and methods
By searching MEDLINE (Pubmed), EMBASE and Cochrane Library databases, we collected the literature published before October 2013 on the cohort study of psoriasis and stroke. Random effect models were used to merge the effects of each study.
Result
Five cohort studies were eventually included in the Meta-analysis.Three studies were prospective, one retrospective, and one prospective. test
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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