症状性颅内外动脉粥样硬化性狭窄卒中复发的危险因素分析与高危人群识别

doi:10.3969/j.issn.1006-7795.2026.01.006

首都医科大学学报 ›› 2026, Vol. 47 ›› Issue (1): 43-53.doi: 10.3969/j.issn.1006-7795.2026.01.006

症状性颅内外动脉粥样硬化性狭窄卒中复发的危险因素分析与高危人群识别

田雪^1,2,3，夏雪^1,2,3，周全^1,2,3，杨味滋^1,2,3，郝允逸^1,2,3，孙悦^1,2,3，王安心^1,2,3，张彤^1,2*

1.首都医科大学附属北京天坛医院神经病学中心，北京 100070; 2.首都医科大学附属北京天坛医院国家神经系统疾病临床医学研究中心，北京 100070; 3.首都医科大学附属北京天坛医院北京市神经外科研究所流行病学研究室，北京 100070

收稿日期:2025-10-24 修回日期:2025-11-18 出版日期:2026-02-21 发布日期:2026-02-02
通讯作者: 张彤 E-mail:skyscorpion0168@hotmail.com
基金资助:
四大慢病重大专项（2023ZD0505201）。

Analysis of risk factors and identification of high-risk patients for recurrent stroke in symptomatic intracranial and extracranial atherosclerotic stenosis

Tian Xue^1,2,3, Xia Xue^1,2,3, Zhou Quan^1,2,3, Yang Weizi^1,2,3, Hao Yunyi^1,2,3, Sun Yue^1,2,3, Wang Anxin^1,2,3, Zhang Tong^1,2*

1.Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 2.National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 3.Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2025-10-24 Revised:2025-11-18 Online:2026-02-21 Published:2026-02-02
Supported by:
This study was supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project (2023ZD0505201).

摘要/Abstract

摘要： 目的筛选我国症状性颅内外动脉粥样硬化性狭窄卒中复发相关的危险因素，进而识别高复发风险人群。方法本研究基于第三次中国国家卒中登记研究，纳入颅内外动脉狭窄50%以上的卒中患者，收集患者的一般人口学资料、既往史、院前急救、入院查体、入院评分、影像学检查、入院诊断及实验室检测指标。研究结局为随访3个月内卒中复发。采用Cox比例风险回归确定影响症状性颅内外动脉粥样硬化性狭窄卒中复发的危险因素。基于确定的危险因素构建症状性颅内外动脉粥样硬化性狭窄3个月卒中复发的预测模型，并与传统ESSEN评分量表进行预测效能比较。结果共纳入3 944例症状性颅内外动脉狭窄的卒中患者，中位年龄64岁，男性患者2 673例（67.8%），3个月随访期间共有324例（8.7%）患者出现卒中复发。逐步多因素Cox比例风险回归模型结果显示：年龄≥75岁（HR=1.36,95% CI:１．０６～１．７６，P=0.016）、发病到入院时间<72 h（HR=1.64，95% CI：1.14～2.35，P=0.007）、入院美国国立卫生院卒中量表（National Institutes of Health Stroke Scale，NIHSS）＞5（HR=3.38，95% CI：1.13～10.14，P=0.029）、非腔隙性梗死（HR=1.71，95% CI：1.13～2.57，P=0.011）及血浆白细胞介素-6（HR=1.02，95% CI：1.00～1.05，P=0.040）是症状性颅内外动脉粥样硬化性狭窄患者3个月卒中复发的危险因素。基于上述因素构建的新模型对症状性颅内外动脉粥样硬化性狭窄患者3个月卒中复发的预测能力优于ESSEN评分量表，C统计量由0.557增加至0.616（P=0.003），综合判别指数（integrated discrimination improvement，IDI）为0.79%（95% CI：0.44%～1.14%, P<0.001）和净重新分类指数（net reclassification improvement，NRI）为21.34%（95% CI：10.88%～31.80%,P<0.001）均有增加，且差异均有统计学意义。结论在我国症状性颅内外动脉狭窄的卒中患者中，年龄≥75岁、发病到入院时间<72 h、入院NIHSS＞5分、非腔隙性梗死特征及血浆白细胞介素-6浓度升高是卒中复发的危险因素。基于上述危险因素构建的预测模型，在识别复发高风险人群的能力优于传统模型。

关键词: 症状性颅内外动脉狭窄, 卒中复发, 危险因素, 高危人群, 二级预防, 队列研究

Abstract: Objective To screen and validate risk factors associated with stroke recurrence in Chinese patients with symptomatic intracranial and extracranial atherosclerotic stenosis and to identity patients at high-risk of stroke recurrence. Methods This study utilized data from the Third China National Stroke Registry. Patients with stroke and ≥50% intracranial or extracranial arterial stenosis were included. The data collected included demographic characteristics, medical history, prehospital care, physical examination findings on admission, admission scores, imaging information, discharge diagnoses, and laboratory parameters. The primary outcome was ascertained as stroke recurrence within 3 months. Cox proportional hazards regression was used to identify independent risk factors for stroke recurrence in symptomatic intracranial and extracranial atherosclerotic stenosis patients. A prediction model for 3-month stroke recurrence was developed based on the identified factors and its predictive performance was compared with the traditional ESSEN score. Results Among 3 944 enrolled patients (median age 64 years, 67.8% male), 324 (8.7%) patients experienced stroke recurrence within 3 months. Multivariable Cox regression analysis identified the following independent risk factors for recurrence: age≥75 years (HR=1.36, 95% CI: 1.06-1.76, P=0.016), time from onset to admission <72 h (HR=1.64, 95% CI: 1.14-2.35, P=0.007), admission National Institutes of Health Stroke Scale (NIHSS) >5 (HR=3.38, 95% CI: 1.13-10.14, P=0.029), non-lacunar infarction (HR=1.71, 95% CI: 1.13-2.57, P=0.011), and elevated plasma interleukin-6 level (HR=1.02, 95% CI: 1.00-1.05, P=0.040). The novel prediction model demonstrated superior discriminative ability compared to the ESSEN score, with the C-statistic increasing from 0.557 to 0.616 (P=0.003). Significant improvements were also observed in integrated discrimination improvement (IDI=0.79%, 95% CI： 0.44%-1.14%, P<0.001) and net reclassification index (NRI=21.34%, 95% CI: 10.88%-31.80%, P<0.001).Conclusion In Chinese patients with symptomatic intracranial and extracranial atherosclerotic stenosis, age≥75 years, onset-to-admission time <72 h, admission NIHSS >5, non-lacunar infarction, and elevated plasma interleukin-6 levels are independent risk factors for 3-month stroke recurrence. The prediction model incorporating these factors outperforms the conventional ESSEN score in identifying patients at high-risk of stroke recurrence.

Key words: symptomatic intracranial and extracranial arterial stenosis, stroke recurrence, risk factors, high-risk population, secondary prevention, cohort study

中图分类号:

R743

田雪, 夏雪, 周全, 杨味滋, 郝允逸, 孙悦, 王安心, 张彤. 症状性颅内外动脉粥样硬化性狭窄卒中复发的危险因素分析与高危人群识别[J]. 首都医科大学学报, 2026, 47(1): 43-53.

Tian Xue, Xia Xue, Zhou Quan, Yang Weizi, Hao Yunyi, Sun Yue, Wang Anxin, Zhang Tong. Analysis of risk factors and identification of high-risk patients for recurrent stroke in symptomatic intracranial and extracranial atherosclerotic stenosis[J]. Journal of Capital Medical University, 2026, 47(1): 43-53.

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症状性颅内外动脉粥样硬化性狭窄卒中复发的危险因素分析与高危人群识别

Analysis of risk factors and identification of high-risk patients for recurrent stroke in symptomatic intracranial and extracranial atherosclerotic stenosis

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