Stroke 2011 Nov;42 (11): 3034-9. [IF:5.756]
Lung cancer and incidence of stroke: a population-based cohort study.
Chen PC , Muo CH , Lee YT , Yu YH , Sung FC .
MPH, Professor, China Medical University and Hospital, 91 Hsueh Shih Road, Taichung 404, Taiwan. fcsung@mail.cmu.edu.tw.
中国医科大学，中国医科大学附属医院
Abstract
Stroke is a known cerebrovascular complication in lung cancer patients; however, whether lung cancer patients are at elevated risk of developing stroke relative to the noncancer population remains unclear. The present study used population-based claims data from the Taiwan National Health Insurance, which identified 52 089 patients with an initial diagnosis of lung cancer between 1999 and 2007, and 104 178 matched noncancer subjects from all insured subjects age 20 years and older. Subsequent occurrence of stroke was measured until 2008, and the association between lung cancer and the hazard of developing stroke was estimated using Cox proportional hazard models. The incidence of stroke was 1.5 times higher (25.9 versus 17.4 per 1000 person-years) in the lung cancer group compared with the comparison group. The multivariate-adjusted hazard ratio (HR) comparing lung cancer patients with the noncancer group was 1.47 (95% CI, 1.39-1.56) for stroke, 1.78 (95% CI, 1.54-2.05) for hemorrhagic stroke, and 1.43 (95% CI, 1.34-1.51) for ischemic stroke. The risk of stroke fell over time, decreasing after 1 year of follow-up for men and after 2 years of follow-up for women. Within the first year of follow-up, the risk of stroke peaked during the first 3 months for men and within 4 to 6 months for women. Lung cancer is associated with increased risk of subsequent stroke within 1 year after diagnosis for men and 2 years after diagnosis for women.
摘要
脑卒中是肺癌患者的脑血管并发症之一，而肺癌患者得脑卒中的风险是否高于非癌症人群，目前尚不清楚。台湾中国医药大学对此进行了一项研究，研究资料基于台湾全民健保的人群就医档案，对象是1999年到2007年间的52089位肺癌的患者和104178位非癌症的20岁以上投保人，随访并确定截止到2008年时脑卒中的发生率，用考克斯比例风险模型分析肺癌和脑卒中发病率的联系和发生脑卒中的危险因素。研究的结果显示：肺癌组脑卒中的发生率是非癌症组的1.5倍（每年每千人分别为25.9人和17.4人）。行多变量校正分析后，肺癌组和非癌症组的脑卒中风险比为1.47，出血性卒中为1.78，而缺血性卒中为1.43。另外，卒中发生的风险随时间推移而下降，男性1年以后发病率明显降低，女性则在2年后。在随访第一年内，发病风险达到顶峰的时间为男性3个月，女性4~6个月。因此认为，肺癌与男性1年内、女性2年内发生脑卒中的风险增高有关。
