Effect of Anemia on the Prognosis of Acute Ischemic Stroke

doi:10.3969/j.issn.1673-5765.2019.02.005

Abstract

Abstract:

Objective To investigate the effect of anemia on the 2-year prognosis in patients with acute ischemic stroke. Methods Data of 131 consecutive inpatients with acute ischemic stroke from Beijing Geriatric Hospital were collected. According to whether having anemia on admission or not, all the paitents were divided into anemia and non-anemia groups. The functional prognosis, composite vascular events and mortality within 2 years were followed up. The prognosis was assessed by mRS, and the good prognosis was defined as mRS ≤2. Composite vascular events included recurrent stroke, cerebral hemorrhage and acute coronary syndrome. Logistic regression analysis was used to assess the effect of anemia on the prognosis of acute ischemic stroke. Results There were significant differences in age, hemoglobin level, severe neurological impairment and the incidence of atrial fibrillation, chronic kidney disease and peripheral vascular disease between anemia group and non-anemia group (P <0.05). Logistic regression analysis showed that anemia was a risk factor for 2-year poor prognosis (OR 5.063, 95%CI 1.887-13.590) and mortality (OR 13.266, 95%CI 1.364-128.993) after acute ischemic stroke. Conclusions Patients with acute ischemic stroke and anemia on admission had elder age, more comorbidities and severe neurological impairment. Anemia was an independent risk factor of 2-year poor prognosis and high mortality in patients with acute ischemic stroke.

Key words: Anemia; Acute ischemic stroke; Prognostic

摘要：

目的探讨贫血对急性缺血性卒中2年预后的影响。方法收集在北京市老年病医院住院的急性缺血性卒中患者131例，记录患者的一般资料和临床特征，神经功能缺损评价采用NIHSS评分。根据患者入院时有无贫血分为贫血组和非贫血组，随访患者 2年预后、复合血管事件和死亡率，其中预后采用mRS量表进行评价（mRS评分≤2分为预后良好，mRS 评分＞2分为预后不良）。复合血管事件包括再发卒中、脑出血和急性冠状动脉综合征。采用Logistic回归分析贫血对急性缺血性卒中2年预后和死亡的影响。结果与非贫血组相比，贫血组患者年龄较大，神经功能缺损较重，心房颤动、慢性肾功能不全、外周血管病患病率较高，差异有统计学意义。入院时贫血是急性缺血性卒中患者2年预后不良（OR 5.063，95%CI 1.887～13.590）、死亡（OR 13.266，95%CI 1.364～128.993）的独立危险因素。结论入院时合并贫血的急性缺血性卒中患者年龄较大，共存疾病较多，神经功能缺损较重。贫血是卒中后2年预后不良、病死率高的独立危险因素。

关键词: 贫血; 缺血性卒中; 预后

ZHANG Xiao-Dan, YOU Xiao-Fan, TIAN Yu-Jin,TIAN Fang, LUO Cheng. Effect of Anemia on the Prognosis of Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2019, 14(02): 111-115.

张晓丹，尤小凡，田玉金，田芳，骆成. 贫血对急性缺血性卒中预后的影响[J]. 中国卒中杂志, 2019, 14(02): 111-115.

References

[1] NYBO M，KRISTENSEN S R，MICKLEY H，et al.

The influence of anemia on stroke prognosis and its

relation to n-terminal pro-brain natriuretic peptide[J].

Eur J Neurol，2007，14（5）：477-482.

[2] HUANG W Y，CHEN I C，MENG L，et al. The

influence of anemia on clinical presentation and

outcome of patients with first-ever atherosclerosisrelated

ischemic stroke[J]. J Clin Neurosci，2009，16

（5）：645-649.

[3] DHARR，ZAZULIA A R，VIDEEN T O，et al. Red

blood cell transfusion increases cerebral oxygen

delivery in anemia Patients with subarachnoid

hemorrhage[J]. Stroke，2009，40（9）：3039-3044.

[4] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国急性缺血性脑卒中诊治指南

[J]. 中华神经科杂志，2015，48（4）：246-257.

[5] GOMEZ J M，CARRERA F. What should the

optimal target hemoglobin be?[J/OL]. Kidney Int

Suppl，2002，80：39-43. https：//doi.org/10.1046/

j.1523-1755.61.s80.8.x.

[6] 中国高血压防治指南修订委员会. 中国高血压防治

指南：2010年修订版[M]. 3版. 北京：人民卫生出版

社，2011：2-3.

[7] KEEVIL J G，CULLEN M W，GANGNON R，et

al. Implications of cardiac risk and low-density

lipoprotein cholesterol distributions in the United

States for the diagnosis and treatment of dyslipidemia：

data from National Health and Nutrition Examination

Survey 1999 to 2002[J]. Circulation，2007，115（11）：

1363-1370.

[8] 谢锦桃，刘军，伍远征，等. 2011年美国糖尿病协会

糖尿病诊疗标准执行纲要解读[J]. 中国全科医学，

2011，14（6C）：1993-1997.

[9] 葛均波，徐永健. 内科学[M]. 8版. 北京：人民卫生出

版社，2013：188-242.

[10] 中华医学会心血管病学分会. 急性ST段抬高型心肌

梗死诊断和治疗指南[J]. 中华心血管病杂志，2010，

38（8）：675-677.

[11] 中华医学会心电生理和起搏分会心房颤动防治专家

工作组. 心房颤动：目前的认识和治疗建议-2012[J].

中华心律失常学杂志，2012，16（4）：246-289.

[12] LEVEY A S，CORESH J，BALK E，et al. National

kidney foundation practice guideline for chronic

kidney disease：evaluation，classification，and

stratification[J]. Ann Intern Med，2003，139（2）：

137-147.

[13] HIRSCH A T，HASKAL Z J，HERTZER N R，et

al. ACC/AHA 2005 Practice Guidelines for the

management of patients with peripheral arterial

disease（lower extremity，renal，mesenteric，and

abdominal aortic）：a collaborative report from the

American Association for Vascular Surgery/Society

for Vascular Surgery，Society for Cardiovascular

Angiography and Interventions，Society for Vascular

Medicine and Biology，Society of Interventional

Radiology，and the ACC/AHA Task Force on

Practice Guidelines（Writing Committee to Develop

Guidelines for the Management of Patients With

Peripheral Arterial Disease）：endorsed by the

American Association of Cardiovascular and

Pulmonary Rehabilitation；National Heart，Lung，

and Blood Institute；Society for Vascular Nursing；

TransAtlantic Inter-Society Consensus；and

Vascular Disease Foundation[J/OL]. Criculation，

2006，113（11）：e463-e654. https：//doi.org/10.1161/

CIRCULATIONAHA.106.174526.

[14] WILLIAMS L S，YILMAZ E Y，LOPER-YUNEZ A

M，et al. Retrospective assessment of initial stroke

sevenity with the NIH Stroke Scale[J]. Stroke，2000，

31（4）：858-862.

[15] 中华医学会神经病学分会. 中国缺血性脑卒中和短

暂性脑缺血发作二级预防指南2014[J]. 中华神经科

杂志，2015，48（4）：258-273.

[16] BARLAS R S，HONNEY K，LOKE Y K，et

al. Impact of Hemoglobin levels and anemia on

mortality in acute stroke analysis of UK Regional

Registry data，systematic review and metaanalysis[

J/OL]. J Am Heart Assoc，2016，5：1-16.

https：//doi.org/10.1161/JAHA.115.003019.

[17] LI Z，ZHOU T，LI Y，et al. Anemia increases the

mortality risk in patients with stroke：A metaanalysis

of cohort studies[J/OL]. Scientific Reports，

2016，6：1-8. https：//doi.org/10.1038/srep26636.

[18] 李慎军，王树才，唐吉刚，等. 急性脑梗死患者贫血

与预后的关系[J]. 中华神经科杂志，2015，48（8）：

652-656.

[19] BORIANI G，BOTTO G L，PADELETTI L，et

al. Improving stroke risk stratification using the

CHADS2 and CHA2DS2-VASc risk scores in patients

with paroxysmal atrial fibrillation by continuous

arrhythmia burden monitoring[J]. Stroke，2011，42

（6）：1768-1770.

[20] 朴建华，赖建强，荫士安，等. 中国居民贫血状况研

究[J]. 营养学报，2005，27（4）：268-271.

[21] 薛军，张磊，胡明秋，等. 老年巨幼细胞贫血患者临

床特点及防治措施的临床研究[J]. 临床荟萃，2009，

24（5）：426-427.