Journal of Haehwa Medicine (혜화의학회지)

Research Institute of Korean Medicine (대전대학교 한의학연구소)
권호 표지

The Case-Control study on the Risk Factors of Stroke

뇌졸중의 위험요인에 대한 환자-대조군 연구

  • Baek, In-Kyoung (Dept. of Korean Medicine, Graduate School of Daejeon University) ;
  • Kim, Yoon-Sik (Dept. of Korean Medicine, Graduate School of Daejeon University)
  • 백인경 (대전대학교 둔산한방병원 심계내과학교실) ;
  • 김윤식 (대전대학교 둔산한방병원 심계내과학교실)
  • Received : 2013.05.06
  • Accepted : 2013.07.09
  • Published : 2013.08.20
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this case-control study was to show the relationship between risk factor(Sex, Age, Martial Status, Educational Periods, Family history, Variables of Obesity, Smoking Status, Drinking Status, Past History, Blood Test) and the incidence of stroke. Methods: 788 stroke patients were enrolled as the case group and 450 non-stroke patients as control group from Sep.2006 to Dec.2010. Patients were hospitalized within 30 days after the onset of stroke. Risk factors and warning signs were obtained from personal interview by oriental medicine doctors who used CRF. Results: 1. Age was found to have significant relation with stroke(p<.0001). 2. Martial status(p<.0001, OR=0.44) and educational periods(p<.0001) were both significant risk factor for stroke. 3. As a result of reviewing the influence of family history, it was found to have no significant relation with stroke. Stroke was found to have significant relation with stroke(OR=1.50). 4. Female waist circumference(WC, p<.0001) and female waist-hip circumference ratio(WHR, p<.0001) were risk factors for stroke. On the other hand, male WC and male WHR showed no significant influence on stroke occurrence as an independent risk factor. 5. Both smoking status(p<.0001, current smoker OR=8.95) and drinking status(p<.0001, current drinker OR=2.50, former drinker OR=2.82) were significant risk factors for stroke. 6. As a result of reviewing the influence of past history, transient ischemic attack(p<.0001, OR=8.46), hypertension(p<.0001, OR=4.72), hyperlipidemia(0.0064), diabetes mellitus(p<.0001, OR=3.34), stroke(p<.0001, OR=50.26) were significant risk factors. On the other hand, ischemic heart disease(p=0.2332) was found to have no significant relation with stroke. 7. Increase of WBC, RBC, Platelet, TG, FBS and Cl- level were significant risk factor of stroke, On the other hand, decrease of Hgb, Hct, AST, HDL-chol, LDH, Na+ and K+ level were significant risk factor of stroke. T-chol and ALT level showed no significant influence on stroke occurrence.

Keywords

References

  1. Change in deaths and death rates for condensed list of 103 causes by sex(2000-2010): Statistics Korea. http://kostat.go.kr. 2011.
  2. 대한뇌졸중학회. 뇌졸중. 이퍼블릭, pp.47-48, p.61, 2009.
  3. 유경호, 배희준, 권순억 등. 한국 뇌졸중 자료 은행에 등록된 10,811명의 급성기 허혈성 뇌졸중 환자 분석 :병원기반 다의료기관 전향적 자료등록 연구. 대한신경과학회지, 24(6): 535-543, 2006.
  4. Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurology, 2:43-53, 2003. https://doi.org/10.1016/S1474-4422(03)00266-7
  5. 정우상, 선종주, 정재한 등. 뇌혈관 한의학 기반 연구사업 등록자료를 통한 363명의 급성기 뇌경색 환자의 기초 임상자료 분석. 대한한의학회지, 28(1):35-41, 2007.
  6. 김혜미, 이인환, 신애숙 등. 한국인의 허혈성 뇌졸중의 위험요인에 대한 비교고찰 : 다기관 연구. 대한한방내과학회지, 31(4):870-879, 2010.
  7. 유경호, 마효일, 정승철, 이병철. Web-based multicenter integrated stroke databank system. 대한뇌졸중학회지, 3:25, 2001.
  8. 이병철, 정승철, 황성희 등. 한림 뇌졸중 등록 자료를 통한 1,129명의 급성 뇌졸중 환자의 임상 양상. 대한뇌졸중학회지, 1(1):21-25, 1999.
  9. 신현수, 강병갑, 조현경. 중풍 환자의 연령에 따른 중풍 위험인자의 분포 및 상관관계 연구 - 병력과 중풍 가족력 중심으로. 동의생리병리학회지, 25(4):734-742, 2011.
  10. 강경원, 강병갑, 차민호 등. 중풍 발생 위험인자에 대한 환자-대조군 연구. 한국한의학연구원논문집, 13(2):65-69, 2007.
  11. 박병주. 노인 인구에서 음주와 뇌졸중 발생 간의 관련성 규명을 위한 코호트내 환자-대조군 연구. 서울대학교, 2003.
  12. 손연희, 정현윤, 김도경 등. 환자-대조군 연구를 통한 뇌경색 위험인자에 대한 통계적 고찰. 동의생리병리학회지, 23(5):1199-1205, 2009.
  13. Hough R, ifitikhar ul haq. Internal medicine, 도서출판 한우리, pp.97-101, 289-290, 2000.
  14. 이병철, 유경호. 국내 뇌졸중의 역학. 대한의사협회지, 45(12):1415-1421, 2002.
  15. 김민지, 강경원, 유병찬 등. 환자-대조군 연구를 통한 중풍 전조증상에 대한 통계적 고찰. 대한한방내과학회지, 28(4):816-829, 2007.
  16. 장문원. 가족력과 병력이 중풍 발병에 미치는 영향에 대한 환자-대조군 연구. 대전대학교 대학원 한의학석사학위논문, 2011.
  17. Andersen KK, Cristensen RHB, Olsen TS. Stroke outcome is influenced by martial status; better survival of patients with a spouse. 4th World Congress of the International Society of Physical and Rehabilation Medicine, Seoul: June:78-79, 2007.
  18. 유병찬. 뇌졸중의 각 유형별 위험요인과 전조증상에 대한 환자-대조군 연구. 대전대학교 대학원 한의학박사학위논문, 2007.
  19. 유영대. 출혈성 뇌졸중과 허혈성 뇌졸중의 위험인자 비교분석 : 흡연, 음주, 비만, 식습관을 중심으로. 조선대학교대학원 운동치료학석사학위논문, 2002.
  20. Hurbert HB, Feileib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease; a 26-years follow up of participants in the Framingham Heart Study Circulation, 67:968-977, 1983. https://doi.org/10.1161/01.CIR.67.5.968
  21. Ellekjaer EF, Wyller TB, Scerre JM, Holmen J. Lifestyle factor and risk of cerebral infartion. Stroke, 23:829-834, 1992. https://doi.org/10.1161/01.STR.23.6.829
  22. Shinton R, Sagar G, Beevers G. Body fat and stroke; unmasking the hazards of overweight and obesity. Journal of Epidemiology Community Health, 49(3):259-264, 1995. https://doi.org/10.1136/jech.49.3.259
  23. Rexrode KM, Hennekens CH, Willett WC, et al. A prospective study of body mass index, weight change, and risk of stroke in women. JAMA, 277(19):1539-1545, 1997. https://doi.org/10.1001/jama.1997.03540430051032
  24. Nakayama K, Koyohara Y, Kato I, et al. Effect of body mass index on morbidity and mortality in a general Japanese population; the Hisayama Study. Nippon Rone Igakkai Zasshi, 34(11):935-941, 1997. https://doi.org/10.3143/geriatrics.34.935
  25. Larsson B, Svardsudd K, Welin L, et al. Abdominal adipose tissue distribution, obesity and risk of cardiovascular disease and death; a 13 year follow up of participants in the study of men born in 1913. B Med J, 288:1401-1404, 1984. https://doi.org/10.1136/bmj.288.6428.1401
  26. Ferland M, Despres JP, Tremblay A, et al. Assessment of adipose tissue distribution by computed axial tomography on obese women; association with body density and anthropometric measurement. Br J Nutr, 61:139-148, 1989. https://doi.org/10.1079/BJN19890104
  27. Pouliot MC, Despres JP, Lemieux MSc, et al. Waist circumference and abdominal sagittal diameter: Best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. The American Journal of Cardiology, 73:460-468, 1994. https://doi.org/10.1016/0002-9149(94)90676-9
  28. Ross R, Leger L, Morris D, et al. Quantification of adipose tissue by MRI: relationship with anthropometric variables. American Journal of Applied Physiology, 72:787-795, 1983.
  29. Taylor RW, Keil D, Gold EJ, et al. Body mass index, waist girth, and waist-to-hip ratio as indexes of total and regional adiposity in women: evaluation using receiver operating characteristic curves. American Journal of Clinical Nutrition, 67:44-49, 1998.
  30. Folsom AR, Rasmussen ML, Chambless LE, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities Study. Diabetes Care, 22(7):1077-1083, 1999. https://doi.org/10.2337/diacare.22.7.1077
  31. Matsumoto K, Miyake S, Yano M, et al. Insulin resistance and classic risk factors in type 2 diabetic patients with different subtypes of ischemic stroke. Diabetes Care, 22(7):1191-1195, 1999. https://doi.org/10.2337/diacare.22.7.1191
  32. 정우상, 권도익, 배정면 등. 한국에서 뇌졸중과 비만 인자들과의 상관관계. 대한한의학회지, 24(4);1010-0695, 2003.
  33. Walker SP, Rimm EB, Ascherio A, et al. Body Size and Fat Distribution as Predictors of Stroke among US Men. Oxford Journals Medicine American Journal of Epidemiology, 144(12):1143-1150, 1996. https://doi.org/10.1093/oxfordjournals.aje.a008892
  34. Albala BB, Sacco RL. Lifestyle factors and stroke risk; exercise, alcohol, diet, obesity, smoking, drug use, and stress. Current Atherosclerosis Report, 2;160-166, 2000. https://doi.org/10.1007/s11883-000-0111-3
  35. Hankey GJ. Smoking and risk of stroke. Journal of Cardiovascular risk, 6:207-211, 1999.
  36. Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ, 298:89-94, 1989.
  37. WB Kannel, RB DAgostino, AJ Belanger. Fibrinogen, cigarette smoking, and risk of cardiovascular disease; insights from the Franingham study. American Heart Journal, 113:1006-1010, 1987. https://doi.org/10.1016/0002-8703(87)90063-9
  38. S Renaud, D Blanche, E Dumont, et al. Platelet function after cigarette smoking in relation to nicotine and carbon monoxide. Clinical Pharmalogy & Therapeutics, 36:389-395, 1984. https://doi.org/10.1038/clpt.1984.193
  39. JS Gill, MJ Shipley, SA Tsementzis, et al. Cigarette smoking; a risk factor for hemorrhagic and nonhemorrhagic stroke. Archives of Internal medicine, 149:2053-2057, 1989. https://doi.org/10.1001/archinte.1989.00390090099020
  40. RL Rogers, JS Meyer, TG Shaw, KF Mortel, JP Hardenberg, RR Zaid. Cigarette smoking decreases cerebral blood flow suggesting increased risk for stroke. JAMA, 250:2796-2800, 1983. https://doi.org/10.1001/jama.1983.03340200030024
  41. 정재한. 급성기 중풍환자에 대한 중풍전조증 조사 연구. 경희대학교대학원 한의학석사학위 논문, 2007.
  42. 정재한, 선종주, 민인규, 김미영, 최원우, 홍 진우, 나병조, 정우상, 문상관, 조기호, 김영석. 중풍 발병 부위별 위험요인 및 전조증상 조사 연구. 대한한방내과학회지, 28(4):808-815, 2007.
  43. Feigin VL, Wiebers DO, Nikitin YP, O'Fallon WM, Whisnant JP. Risk factors for ischemic stroke in a Russian community; a population-based case-control study, Stroke, 29:34-39, 1998. https://doi.org/10.1161/01.STR.29.1.34
  44. HJ Milionis, E Liverpoulos, J Goudevenous, ET Bairaktari, K Seferiadis, MS Elisaf. Risk Factors for first-ever acute ischemic non-embolic stroke in elderly individuals. International Journal of Cardiology, 99:269-275, 2005. https://doi.org/10.1016/j.ijcard.2004.01.013
  45. 김장락, 홍대용, 박성학. 뇌혈관질환의 위험요 인에 대한 환자 - 대조군 연구. Korean Journal of Preventive Medicine, 28(2):473-486, 1995.
  46. 최인영, 김용형, 최동준, 한창호, 이원철, 전찬용, 조기호, 최선미. 급성기 중풍환자의 사상 체질과 중풍 경고증상, 전조증상과의 상관성 연구. 대한한방내과학회지, 28(4)733-740, 2007.
  47. 홍진우, 정우상, 선종주, 정재한, 문상관, 조기호, 고성규, 전찬용, 한창호. 급성기 뇌경색 환자들의 고혈압, 당뇨, 고지혈증 인지여부에 관한 분석 3개 한방병원기반 전향적 자료등록 연구. 대한한방내과학회지, 28(2):284-293, 2007.
  48. RF. Macko, SF Ameriso, R Barndt, W Clough, JM Weiner, M Fisher. Precipitants of Brain Infarction; Roles of Preceding Infection, Inflammation and Recent Psychological Stress. Stroke, 27:1999-2004, 1996. https://doi.org/10.1161/01.STR.27.11.1999
  49. F Buggle, S Heindl, C Steichen-Wiehn, T Banerjee, M, Maiwald, M Rohlfs, H Suhr, W Fiehn, H Becher, W Hacke. Recent Infection as a Risk Factor for Cerebrovascular Ischemia. Stroke, 26:373-379, 1995. https://doi.org/10.1161/01.STR.26.3.373
  50. CD Lee, AR Folsom, FJ Nieto, LE Chambless, E Shahar, DA Wolfe. White Blood Cell Count and Incidence of Coronary Heart Disease and Ischemic Stroke and Mortality from Cardiovascular Disease in African-American and White Men and Women. American Journal of Epidemiology, 154:758-764, 2001. https://doi.org/10.1093/aje/154.8.758
  51. 김윤식. 뇌경색환자의 혈액학적 소견 연구. 대전대학교 한의학연구소 논문집, 12(2):1-9, 2004.
  52. JP Wade, DW Taylor, HJ Barnett, VC Hachinski. Hemoglobin concentration and prognosis in symptomatic obstructive cerebrovascular disease. Stroke, 18:68-71, 2004.
  53. 하병립, 천상명, 이경미, 박경원, 김상호, 김재우, 정민호, 임영진, 차재관. 급성 뇌경색에서 혈소판 응집도의 변화. 대한신경과학회지, 21(1):14-19, 2003.
  54. 이삼열 외. 임상병리검사법. 연세대학교 출판부, p266, 2000.
  55. KS Choi, YH Yang, EK Kim, MY Jeon, JS Kim. Nutritional status in acute stroke: undernutrition versus overnutrition in different stroke subtypes. Acta Neurologica Scandinavia, 98(3):187-192, 1998.
  56. R Benfante, K Yano, LJ Hwang, JD Curb, A Kagan, W Ross. Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Stroke, 25(8)814-820, 1994. https://doi.org/10.1161/01.STR.25.4.814
  57. JM. Leppälä, J Virtamo, R Fogelholm, D Albanes, OP Heinonen. Different Risk Factors for Different Stroke Subtypes; Association of Blood Pressure, Cholesterol, and Antioxidants. Stroke, 30:2535-2540, 1999. https://doi.org/10.1161/01.STR.30.12.2535
  58. JE Rossouw, AM Gotto. Does low cholesterol cause death? Cardiovascular drugs and therapy, 7(5)789-793, 1993. https://doi.org/10.1007/BF00878932
  59. GD Smith. Low blood cholesterol and non-atherosclerotic disease mortality: where do we stand? European heart journal, 18:6-9, 1997. https://doi.org/10.1093/oxfordjournals.eurheartj.a015118
  60. E Lindenstrom, G Boysen, J Nyboe. Influence of total cholesterol, high density lipoprotein cholesterol, and triglycerides on risk of cerebrovascular disease: the Copenhagen city heart study. BMJ, 309:11-15, 1994. https://doi.org/10.1136/bmj.309.6946.11
  61. J Pedro-Botet, M Senti, X Nogues, J Rubies-Prat, J Roquer, L D'Olhaberriague, J Olive. Lipoprotein and apolipoprotein profile in men with ischemic stroke. Stroke, 23(11):1556-1562, 1992. https://doi.org/10.1161/01.STR.23.11.1556
  62. E Rizos, DP Mikhalidis. Are high density lipoprotein and triglyceride levels relevant in stroke prevention? Cardiovascular Research, 52:199-207, 2001. https://doi.org/10.1016/S0008-6363(01)00383-2
  63. RL Sacco, RT. Benson, DE Kargman, et al. High-Density Lipoprotein Cholesterol and Ischemic Stroke in the Elderly; The Northern Manhattan Stroke Study. JAMA, 285:2729-2735, 2001. https://doi.org/10.1001/jama.285.21.2729
  64. 장용석, 민지원, 유봉구, 김광수, 유경무. 급성 허혈성 뇌졸중 환자의 심전도 및 혈청 심장효소 의 변화. 대한신경과학회지, 19(3):207-212, 2001.
  65. 황민우, 이태규, 이수경, 송일병, 최봉근, 고병희. 사상체질에 따른 허혈성 뇌졸중 환자-대조군 연구. 대한한의학회지, 27(1):118-129, 2006.
  66. DM Green, AH Ropper, RA Kronmal, BM Psaty, GL Burke. Serum potassium level and dietary potassium intake as risk factors for stroke; MS and for The Cardiovascular Health Study. Neurology, 59:314-320, 2002. https://doi.org/10.1212/WNL.59.3.314