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Secular Trends of Stroke Subtypes in Taiwan ~ National Taiwan University Hospital Stroke Registry, 1995~2018

中風類型的年代變遷:1995-2018年臺大醫院中風登錄研究

摘要


Background and Purpose: Stroke registries can provide important information on risk factors, pathogenesis, treatment and prognosis over time. Here, we report the secular trends of stroke subtypes between 1995 and 2018 from a hospital-based stoke registry in Taiwan. Methods: The National Taiwan University Hospital (NTUH) Stroke Registry began in January 1995, recruiting all patients with stroke onset within 10 days of hospital arrival or stroke occurrence during hospitalization. The 24-year period until 2018 was divided into 1995-1999, 2000-2004, 2005-2009, 2010- 2014 and 2015-2018. We analyzed the secular changes in stroke subtypes, risk factors and etiologies. Results: There were 27,743 patients with 31,975 admissions to NTUH for stroke during the study period. Of these patients, 22,803 (male, 57.9%; mean age, 64.5 ± 15.5 years) had first-ever stroke. The percentage of cerebral infarcts increased slightly from 70.5% in 1995-2009 to 72.9% in 2010-2018, but the percentage of intracerebral hemorrhage decreased (23.9% to 21.3%). In patients with cerebral infarct, cardioembolism significantly increased from 19.9% in 1995-1999 to 28.5% in 2015-2018, as did atrial fibrillation (from 17.6% in 1995-1999 to 25.7% in 2015-2018, p < 0.001). The percentage of those receiving intravenous or intra-arterial reperfusion therapies increased significantly from 2005, reaching 12.4% in 2015-2018. In patients with intracerebral hemorrhage, the percentage of those with cerebral amyloid angiopathy and medication-related hemorrhage increased significantly (10.2% to 12.9% and 3% to 5.5%, respectively, both p < 0.001), but the percentage of those with hypertensive angiopathy decreased significantly (57.7% to 50.8%, p = 0.008) over time. Conclusions: Over 24 years, rates of cardioembolism in cerebral infarct and cerebral amyloid angiopathy in intracerebral hemorrhage among first-ever acute stroke patients increased.

並列摘要


背景與目的:中風登錄可提供相關風險因子、機轉、治療和預後的重要資訊。本研究探討1995至2018年的臺大醫院中風登錄的中風亞型的年代變遷長期趨勢。方法:臺大醫院中風登錄於1995年1月開始,所有到院前10日或住院中發生中風均納入,至2018年將24年期間分為5個時期:1995-1999、2000-2004、2005-2009、2010-2014和2015-2018。分析了缺血中風,腦出血中風與蜘蛛膜下腔出血、及中風亞型及危險因子的長期年代變化。結果:24年期間的初發中風共有22,803例(男性57.9%;平均年齡64.5 ± 15.5歲)。腦梗塞的百分比從1995-2009年的70.5%輕微增加到2010-2018年的72.9%(72.9%),而腦出血的百分比則相對下降(23.9%至21.3%)。腦梗塞的心因性栓塞從1995-1999年的19.9%顯著地增加到2015-2018年的28.5%,伴隨著心房顫動也明顯增加(1995-1999年為17.6%,2015-2018年為25.7%,p < 0.001)。2005年之後,靜脈或動脈内再灌注治療的百分比顯著增加,並在2015-2018年達到12.4%。腦出血的腦澱粉樣血管病變和藥物相關性出血顯著增加(分別為10.2%至12.9%和3.0%至5.5%,p < 0.001),但高血壓性血管病顯著下降(57.7%至50.8%,p = 0.008)。結論:1995至2018年間,初發中風患者的心因性腦栓塞和澱粉樣血管病變的腦出血顯著逐漸增加。

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