新发现！颅脑外伤会导致五年内中风风险升高

编辑翻译：菁菁

译文校对：奇奇

文献于2021年4月首次发表在最新的《国际中风期刊》（International Journal of Stroke）。文献阐述了颅脑外伤患者在受伤后长达五年时间内的中风风险。

伯明翰大学团队主导的一项新的系统评价发现，颅脑外伤患者的中风风险在受伤后四个月内最高，并且在受伤后长达五年的时间里仍然很高。

颅脑外伤（TBI）是一个全球性的健康问题，每年影响全球超过6000万人。TBI的发病率上升与多种因素相关，包括老年人跌倒次数增加，军事冲突，运动伤害和道路交通事故。但是，重症监护和影像学的进步已经使TBI相关死亡率降低。

此前的研究已发现，TBI与痴呆症、帕金森氏症、癫痫症等神经系统疾病的长期风险相关联，并且TBI已被提议作为中风的独立危险因素。

这项最新的综述汇总了来自四个国家的18项研究，并于2021年4月9日发表在《国际中风杂志》上，这是调查伤后中风风险系列研究中的第一篇。

美国国立卫生研究院外科手术重建和微生物学研究中心设在伯明翰NHS基金会信托大学医院，其资助了一项调查。调查表明，与未经历TBI的患者相比，TBI患者的中风风险增加了86％。该研究发现，在受伤后的前四个月中风风险可能最高，且在长达五年的时间里仍然很高。

重要的是，研究结果表明，无论损伤的严重程度或亚型如何，TBI都是中风的危险因素。这一点特别值得注意，因为70％至90％的TBI是轻度的。这表明，即使是轻度TBI、且患者已康复，也应将TBI视为慢性病。

研究人员还发现，使用抗凝剂（例如VKA和他汀类药物）可以帮助降低TBI后的中风风险，而使用某些类型的抗抑郁药会增加TBI后的中风风险。

研究主要作者、伯明翰大学应用健康研究所的格蕾丝·特纳博士说：“在世界范围内，中风是导致死亡的第二大因素和导致残疾的第三大因素。但是，应急治疗可以预防中风相关的死亡和长期失能。”

“我们调查发现的证据表明，TBI后卒中风险的降低与卒中预防药物VKA和他汀类药物相关。但是，正如先前的研究所说，当患者经历TBI时，卒中预防药物通常会停止使用。”

她说需要更多的研究来调查TBI后中风预防药物的有效性，以帮助告知临床医生处方信息并促进共同的决策。

特纳博士补充说：“我们的综述结果显示，应告知TBI患者中风风险增加的可能性。患者在受伤后的前四个月中风风险最高，这是对患者及其护理人员开展关于中风风险和症状教育的关键时期。"

“临床医生也应在最初的四个月内给出建议，对中风预防药物的使用和患者生活方式进行指导，以减轻与TBI相关的中风风险。”

英文原文

Traumatic brain injuries can increase risk of stroke for up to five years, finds study

Stroke risk for patients with traumatic brain injuries is at its highest in the four months following injury and remains significant for up to five years post-injury, finds a new systematic review led by a team at the University of Birmingham.

Traumatic brain injury (TBI) is a global health problem affecting over 60 million people a year worldwide. Incidences of TBI are rising due to a range of factors including increased falls in the elderly, military conflict, sports injuries and road traffic accidents. However, advances in critical care and imaging have led to a reduction in TBI-related mortality.

Previous studies have associated TBI with a long-term risk of neurological diseases including dementia, Parkinson's and epilepsy, and TBI has been proposed as an independent risk factor for stroke.

This latest review, which brings together 18 studies from four countries and publishes today (April 9) in the International Journal of Stroke, is the first of its kind to investigate post-injury stroke risk.

Funded by the National Institute for Health Research's Surgical Reconstruction and Microbiology Research Centre based at University Hospitals Birmingham NHS Foundation Trust, the review showed that TBI patients have an 86% increased risk of stroke compared to patients who have not experienced a TBI. Stroke risk may be at its highest in the first four months post-injury, but remains significant for up to five years, found the review.

Significantly, the findings suggest that TBI is a risk factor for stroke regardless of the severity or subtype of the injury. This is particularly noteworthy because 70% to 90% of TBI's are mild and suggests that TBI's should be considered a chronic condition even if it is mild and patients recover well.

Researchers also found that the use of anti-coagulants, such as VKA's and statins, could help to reduce stroke risk post-TBI, while the use of some classes of anti-depressants are associated with increased stroke risk post-TBI.Lead author Dr. Grace Turner, of the University of Birmingham's Institute of Applied Health Research, said: "Stroke is the second leading cause of death and third leading cause of disability worldwide, however, urgent treatment can prevent stroke related death and long-term disability.

"Our review found some evidence to suggest an association between reduced stroke risk post-TBI and the stroke prevention drugs VKAs and statins but, as previous studies have found, stroke prevention drugs are often stopped when an individual experiences a TBI.

She said more research is required to investigate the effectiveness of stroke prevention drugs post-TBI to help inform clinicians' prescribing and facilitate shared decision making.

Dr. Turner added: "As our review has shown, TBI patients should be informed of the potential for increased stroke risk and with the risk of stroke at its highest in the first four months post-injury, this is a critical time period to educate patients and their care givers on stroke risk and symptoms.

"This initial four-month period should also be used by clinicians to administer stroke prevention medication and lifestyle advice to mitigate the excess risk of stroke associated with TBI."

参考文献 

Grace M Turner et al. Stroke risk following traumatic brain injury: Systematic review and meta-analysis, International Journal of Stroke (2021). 

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