急性缺血性卒中在日本：一项全国性研究的结果
日本国立心血管中心
日本的卒中死亡率自20世纪70年代以来开始下降。这种下降主要是由于高血压性脑出血中高血压治疗的改进，以及营养和环境的改变。
日本的156家医院参加了这项全国性研究。该研究开始于1999年5月，结束于2000年4月。共有16922例病人，入院时病程均在7天以内。研究内容主要包括基本的临床特点，出院时的情况及神经放射检查结果。研究结果如下：
病人的平均年龄为70.6岁，National institute of health stroke scale 的中位评分是5，平均分是8。
参加研究的病人中有36.9%为发病3 h以内，49.5%为发病6 h以内。只有2.5%的病人接受了静脉内溶栓。研究显示UK治疗组较对照组的预后要好。18.8%的病人在卒中单元或ICU接受治疗，这些病人的预后较其它病人要好。
, 百拇医药
参与研究的病人中36.3%为腔隙性梗塞，31.1%为动脉血栓性卒中，20.4%为心源性卒中。在大城市中动脉血栓性卒中的数量高于腔隙性梗塞，而且作为卒中危险因素的糖尿病及高脂血症的数量在该地区也是最高的。
60.8%的病人接受了MRA检查，33.7%的病人接受了颈动脉超声的检查，17.1%的病人接受了血管造影检查。
Shakir Husain,1959年生于印度。曾在瑞士苏黎世大学医院，德国及法国做访问学者，主要从事神经血管介入治疗等工作。现任印度Sir Ganga Ram 医院和St.Stephen医院神经科学系神经血管组顾问介入神经放射学家及顾问卒中神经病学家。主要从事脑和脊髓血管成像，动脉瘤的介入治疗，脑和脊髓动静脉瘤的栓塞等工作。所从事研究包括：卒中的介入治疗效果的研究；无症状性颈动脉狭窄与卒中的危险因素等。曾为Journal of Neurology, Neurosurgery and Psychiatry工作及撰写文章。现任印度脑血管外科杂志的编委。已发表及待发表文章26篇。
, 百拇医药
Acute ischemic stroke in Japan: Results of a nation-wide survey
Takenori Yamaguchi, M.D. for J-MUSIC
National Cardiovascular Center, Osaka, Japan
Stroke-related mortality in Japan began to decrease in early 1970s, and is the third leading cause following total cancer and heart diseases in 2003, although it is still higher than those in the Western countries. This rapid decrease in stroke mortality is mainly attributed to that in hypertensive intracerebral hemorrhage, probably due to improved management of hypertension and changes in nutritional and environmental factors.
, 百拇医药
We carried out a nation-wide hospital survey on acute ischemic stroke in cooperation with 156 hospitals all over Japan from May 1999 to April 2000 (Japan Multicenter Stroke Investigators’ Collaboration, J-MUSIC). During the period of one year, 16,922 patients who were consecutively admitted to each participating hospital within 7 days of stroke onset were registered prospectively, and clinical data including baseline characteristics, outcome at discharge and results of neuroradiological examinations were collected at the central office (National Cardiovascular Center) using the common data-sheets.
, http://www.100md.com
The results of the survey are summarized as follows.
Mean age of the subjects was 70.6 years old, and men (68.7 y.o.) were significantly younger than women (73.6 y.o.). Men predominated women with a ratio of 3 to 2 (61.3% vs 38.7%). 43.4% of the patients arrived at the hospital using an ambulance service, but 17.0% of them did by walk. A median score of National Institute of Health Stroke Scale was 5, and its mean score was 8.0 (±7.9).
, 百拇医药
Patients who visited the hospital ≤ 3 hours after onset were 36.9% of the total, and those who came ≤ 6 hours were 49.5%. But, intravenous thrombolysis was done in only 2.5%, as rt-PA has not been approved in Japan because of several reasons. As a substitute for intravenous rt-PA, intra-arterial superselective application of urokinase (UK) was frequently performed in cardioembolic stroke patients with moderate severity. The effects of intra-arterial UK evaluated by using case-control technique in the present study appeared to be favorable, although this treatment has not widely been accepted. Proportion of patients with favorable outcome [modified Rankin scale (mRS) score≤2] was significantly larger in the UK group than in the control group (50.5% vs. 34.1%, P<0.02).
, 百拇医药
18.8% were treated in a stroke (care) unit (SCU) or intensive care unit, but the remainders were managed in general wards. Outcome of acute stroke patients treated in SCU/SU has been reported to be better than those treated in a general ward by European investigators. Although only 17% were managed in SCU/ICU in the present survey, comparison of outcome between patients treated in SCU/ICU and those in general ward revealed a better outcome in the former, but only in those with NIHSS score ≥15.
, 百拇医药
Among 3 clinical categories of brain infarction, lacunar stroke was the most frequent subtype (36.3%), followed by atherothrombotic stroke (31.1%) and cardioembolic stroke (20.4%). In 2 districts (Kantoh & Kinki), where large metropolitan cities are included, the proportion of atherothrombotic stroke was larger than that of lacunar stroke. Frequencies of diabetes mellitus and hyperlipidemia as risk factor for stroke were the highest in these districts. These data indicate that life style including diet in Japan has gradually been changing (westernization), and that proportion of subtypes of brain infarction are becoming similar to that of Western countries.
, 百拇医药
For evaluation of vascular pathology, MRA was most frequently (60.8%) applied, followed by carotid ultrasonography (33.7%), conventional or digital subtraction angiography (17.1%). In 16.3% of the patients, however, vascular evaluation was not performed.
To improve the patients’ outcome, it is desirable to equip hospitals with SCU/SU, and to treat patients by a well-trained stroke team, including co-medical staffs. Public campaign for educating lay-people to recognize early signs of stroke and the importance of early treatment, contributes to increase the number of patients who have an opportunity of receiving sophisticated treatment and achieving a favorable outcome., http://www.100md.com(Takenori Yamaguchi,MD)
日本的卒中死亡率自20世纪70年代以来开始下降。这种下降主要是由于高血压性脑出血中高血压治疗的改进，以及营养和环境的改变。
日本的156家医院参加了这项全国性研究。该研究开始于1999年5月，结束于2000年4月。共有16922例病人，入院时病程均在7天以内。研究内容主要包括基本的临床特点，出院时的情况及神经放射检查结果。研究结果如下：
病人的平均年龄为70.6岁，National institute of health stroke scale 的中位评分是5，平均分是8。
参加研究的病人中有36.9%为发病3 h以内，49.5%为发病6 h以内。只有2.5%的病人接受了静脉内溶栓。研究显示UK治疗组较对照组的预后要好。18.8%的病人在卒中单元或ICU接受治疗，这些病人的预后较其它病人要好。
, 百拇医药
参与研究的病人中36.3%为腔隙性梗塞，31.1%为动脉血栓性卒中，20.4%为心源性卒中。在大城市中动脉血栓性卒中的数量高于腔隙性梗塞，而且作为卒中危险因素的糖尿病及高脂血症的数量在该地区也是最高的。
60.8%的病人接受了MRA检查，33.7%的病人接受了颈动脉超声的检查，17.1%的病人接受了血管造影检查。
Shakir Husain,1959年生于印度。曾在瑞士苏黎世大学医院，德国及法国做访问学者，主要从事神经血管介入治疗等工作。现任印度Sir Ganga Ram 医院和St.Stephen医院神经科学系神经血管组顾问介入神经放射学家及顾问卒中神经病学家。主要从事脑和脊髓血管成像，动脉瘤的介入治疗，脑和脊髓动静脉瘤的栓塞等工作。所从事研究包括：卒中的介入治疗效果的研究；无症状性颈动脉狭窄与卒中的危险因素等。曾为Journal of Neurology, Neurosurgery and Psychiatry工作及撰写文章。现任印度脑血管外科杂志的编委。已发表及待发表文章26篇。
, 百拇医药
Acute ischemic stroke in Japan: Results of a nation-wide survey
Takenori Yamaguchi, M.D. for J-MUSIC
National Cardiovascular Center, Osaka, Japan
Stroke-related mortality in Japan began to decrease in early 1970s, and is the third leading cause following total cancer and heart diseases in 2003, although it is still higher than those in the Western countries. This rapid decrease in stroke mortality is mainly attributed to that in hypertensive intracerebral hemorrhage, probably due to improved management of hypertension and changes in nutritional and environmental factors.
, 百拇医药
We carried out a nation-wide hospital survey on acute ischemic stroke in cooperation with 156 hospitals all over Japan from May 1999 to April 2000 (Japan Multicenter Stroke Investigators’ Collaboration, J-MUSIC). During the period of one year, 16,922 patients who were consecutively admitted to each participating hospital within 7 days of stroke onset were registered prospectively, and clinical data including baseline characteristics, outcome at discharge and results of neuroradiological examinations were collected at the central office (National Cardiovascular Center) using the common data-sheets.
, http://www.100md.com
The results of the survey are summarized as follows.
Mean age of the subjects was 70.6 years old, and men (68.7 y.o.) were significantly younger than women (73.6 y.o.). Men predominated women with a ratio of 3 to 2 (61.3% vs 38.7%). 43.4% of the patients arrived at the hospital using an ambulance service, but 17.0% of them did by walk. A median score of National Institute of Health Stroke Scale was 5, and its mean score was 8.0 (±7.9).
, 百拇医药
Patients who visited the hospital ≤ 3 hours after onset were 36.9% of the total, and those who came ≤ 6 hours were 49.5%. But, intravenous thrombolysis was done in only 2.5%, as rt-PA has not been approved in Japan because of several reasons. As a substitute for intravenous rt-PA, intra-arterial superselective application of urokinase (UK) was frequently performed in cardioembolic stroke patients with moderate severity. The effects of intra-arterial UK evaluated by using case-control technique in the present study appeared to be favorable, although this treatment has not widely been accepted. Proportion of patients with favorable outcome [modified Rankin scale (mRS) score≤2] was significantly larger in the UK group than in the control group (50.5% vs. 34.1%, P<0.02).
, 百拇医药
18.8% were treated in a stroke (care) unit (SCU) or intensive care unit, but the remainders were managed in general wards. Outcome of acute stroke patients treated in SCU/SU has been reported to be better than those treated in a general ward by European investigators. Although only 17% were managed in SCU/ICU in the present survey, comparison of outcome between patients treated in SCU/ICU and those in general ward revealed a better outcome in the former, but only in those with NIHSS score ≥15.
, 百拇医药
Among 3 clinical categories of brain infarction, lacunar stroke was the most frequent subtype (36.3%), followed by atherothrombotic stroke (31.1%) and cardioembolic stroke (20.4%). In 2 districts (Kantoh & Kinki), where large metropolitan cities are included, the proportion of atherothrombotic stroke was larger than that of lacunar stroke. Frequencies of diabetes mellitus and hyperlipidemia as risk factor for stroke were the highest in these districts. These data indicate that life style including diet in Japan has gradually been changing (westernization), and that proportion of subtypes of brain infarction are becoming similar to that of Western countries.
, 百拇医药
For evaluation of vascular pathology, MRA was most frequently (60.8%) applied, followed by carotid ultrasonography (33.7%), conventional or digital subtraction angiography (17.1%). In 16.3% of the patients, however, vascular evaluation was not performed.
To improve the patients’ outcome, it is desirable to equip hospitals with SCU/SU, and to treat patients by a well-trained stroke team, including co-medical staffs. Public campaign for educating lay-people to recognize early signs of stroke and the importance of early treatment, contributes to increase the number of patients who have an opportunity of receiving sophisticated treatment and achieving a favorable outcome., http://www.100md.com(Takenori Yamaguchi,MD)