北京和加拿大安大略省卒中/短暂性脑缺血发作基线和住院治疗的比较--来自中国国家卒中登记和加拿大卒中登记研究的结果

摘要

目的旨在比较中国北京和加拿大安大略省卒中/短暂性脑缺血发作（transient ischemic attack，TIA）住院患者的基线特征、卒中治疗和住院结局的差异。　　方法中国国家卒中登记于2007年9月～2008年8月在北京地区的11个研究中心连续收集了1775例急性卒中及TIA患者。加拿大安大略省的数据来源于2007年4月～2008年3月安大略省的11个卒中中心的3551例卒中及TIA患者。本研究对北京地区患者的基线特征、卒中治疗和住院结局的数据进行了分析，并与加拿大卒中登记研究中安大略省的数据进行比较。　　结果①基线信息：北京地区的患者较安大略省的患者年轻（64.5±12.9 vs 70.2±15.3，P＜0.001），并且男性较多（64.8% vs 51.6%，P＜0.001）；既往史有吸烟、饮酒、卒中、高血压的比例北京地区均高于安大略省（P均＜0.001），而既往史有TIA、高脂血症、心房颤动的人数安大略省高于北京地区（P均＜0.001）。②院前信息：与安大略省的患者相比，北京地区的患者使用救护车到达急诊的比率较低（33.5% vs 78.4%，P＜0.001），并且2.5 h内到达急诊的比例较低（21.0% vs 42.4%，P＜0.001）。③治疗情况：北京地区的患者中，进行影像学检查的比例低于安大略省（93.9% vs 99.2%，P＜0.001），并且进入卒中单元治疗的比例较低（23% vs 64.7%，P＜0.001）。在缺血性卒中的患者中，北京地区的患者进行溶栓治疗的比例较低（8.1% vs 17.4%，P＜0.001），然而伴有心房颤动的患者中，给与抗凝治疗的比例两者无明显的差异（75.9% vs 75.5%，P=0.945）。北京地区和安大略省地区缺血性卒中患者出院给予抗栓治疗的比例相近（77.0% vs 77.9%，P=0.544）。④结局事件：与安大略省地区相比，北京地区患者住院期间新发卒中的比例较低（3.4% vs 5.1%，P＜0.001），然而住院期间肺炎的发生率较高（12.5% vs 7.6%，P＜0.001）。北京地区患者的住院死亡率、7 d死亡率和30 d死亡率均显著低于安大略省地区（7.7% vs14.7%，5.7% vs9.3%，7.9% vs15.9%，P均＜0.001）。　　结论北京和安大略地区的卒中/TIA住院患者在基线信息、住院治疗和结局方面有较大的差异。认识到这些差异将有助于提高中国卒中住院治疗的质量，有助于更好地制订卒中的控制和预防策略。%Objective To compare baseline characteristics, key performance in stroke care and outcomes for stroke or transient ischemic attack (TIA) in China, Beijing with those in Ontario, Canada. Methods The China National Stroke Registry (CNSR)-Beijing consecutively recruited 1775 patients with acute stroke or TIA from 11 stroke centers in Beijing between September 2007 and August 2008. We analyzed data from the CNSR-Beijing and compared the results with the data from the Ontario Stroke Registry, which contained 3551 stroke or TIA patients from 11 stroke centers in Ontario, Canada between April 2007 and March 2008. Results Patients in Beijing were younger than those in Ontario (mean±SD of age in years:64.5±12.9 vs 70.2±15.3, P<0.001) and were more likely to be male (64.8%vs 51.6%, P<0.001). Compared with patients in Ontario, those in Beijing were less likely to present to the Emergency Department (ED) via ambulance (33.5%vs 78.4%, P<0.001) and to arrive to the ED within 2.5 hours of stroke onset (21.0%vs 42.4%, P<0.001). Patients in Beijing were less likely than those in Ontario to undergo neuroimaging (93.9%vs 99.2%, P<0.001) or to be admitted to a stroke unit (23%vs 64.7%, P<0.001). Among patients with ischemic stroke, those in Beijing were less likely to receive thrombolysis than those in Ontario (8.1%vs 17.4%, P<0.001), while those with atrial ifbrillation were similar to be prescribed oral anticoagulants at discharge (75.9%vs 75.5%, P=0.945). A similar proportion in Beijing and Ontario were prescribed antithrombotics at discharge (77.0%vs 77.9%, P=0.544) in ischemic stroke patients. New strokes during hospitalization were significantly lower in Beijing than in Ontario (3.4%vs 5.1%, P=0.006), whereas pneumonia after stroke was more frequent (12.5%vs 7.6%, P<0.001). Case-fatality rates were lower in Beijing than those in Ontario in-hospital (7.7%vs 14.7%), at 7 days (5.7%vs 9.3%), and at 30 days (7.9%vs 15.9%) after stroke (P<0.001 for all comparisons). Conclusion There are substantial differences in demographics, hospital care and outcomes after stroke between Beijing and Ontario. Awareness of these differences may be helpful in improving the quality of hospital care, stroke control and prevention strategies in China.