36:378 第 38 回日本脳卒中学会講演シンポジウム 原著 36: 378 384, 2014 1 2 要旨 1999 2012 10 31 29 26 80 30 TIA 2 t-pa Key words: stroke registry, stroke subtype, onset-visit time, chronological change はじめに 4 12 23 27 1 Japan Standard Stroke Registry Study Group JSSRS group 93 2003 2005 2009 2 4 2012 14 1 2 2013 12 30 2014 1 7 対象と方法 1999 1 2012 12 107,336 59 41 70.5±12.9 49 7 50 14 60 25 70 31 80 23 70 93 8 5 24 2 2 11 19 5 15 2 1999 2004 I 2005 2008 II 2009 2012 III 3 χ 2 SPSS 18.0 結果 1 31 29 26 TIA
36:379 Fig. 1 7 14 6 Fig. 1 TIA 4 6 60 80 20 5 60 25 70 50 80 19 60 9 80 30 60 20 13 Fig. 2 I 25 III 28 I 13 II 15 III Fig. 2 14 I 7 II 6 III 5 Fig. 3
36:380 脳卒中 36 巻 5 号 (2014:9) Fig. 3 Fig. 4 2 (Fig. 4) 7 (79,707 ) 2 ( 53 ) (52 ) AVM (46 ) (45 ) TIA(44 ) (2 14 ) (Fig. 5) 2 TIA II III 3 NIHSS 4 5 10 11 16 17 22 23 5 (Fig. 6) 23 25
36:381 Fig. 5 2 Fig. 6 20 23 TIA 4 90 72 4 TIA TIA I III 4 23 Fig. 7 4 modified Rankin Scale mrs Fig. 8 TIA mrs 2
36:382 脳卒中 36 巻 5 号 (2014:9) Fig. 7 Fig. 8 ADL
36:383 93 mrs 2 53 73 mrs 2 40 mrs 5 32 mrs 2 32 mrs 5 38 mrs 2 51 mrs 5 33 TIA mrs 2 I 52 III 57 mrs 5 I 16 III 12 考案 2009 4 2007 47,000 63,000 107,336 1961 J-MUSIC Fukuoka Stroke Registry 10 31 29 26 2004 J-MUSIC 5 Fukuoka Stroke Registry 2011 27 26 6 3 14 BAT 7 AVM TIA 4 2005 t-pa 2 2005 2008 2009 8 9 t-pa t-pa t-pa 参考文献 1 21 2
36:384 脳卒中 36 巻 5 号 (2014:9) 2003 3) ( ): 2005 2005 4) ( ): 2009 2009 5)Kimura K, Kazui S, Minematsu K, et al: Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. A hospital-based prospective registration study. Cerebrovasc Dis 18: 47 56, 2004 6) : (Fukuoka Stroke Registry; FSR) 102: 285 292, 2011 7)Toyoda K, Yasaka M, Iwade K, et al: Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease: a prospective, multicenter, observational study. Stroke 39: 1740 1745, 2008 8)Adams HP, del Zoppo G, Alberts MJ, et al: Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 38: 1655 1711, 2007 9)Johnsen SP, Svendsen ML, Hansen ML, et al: Preadmission oral anticoagulant treatment and clinical outcome among patients hospitalized with acute stroke and atrial fibrillation: a nationwide study. Stroke 45: 168 175, 2014 Abstract Epidemiology of acute stroke in Japan: Japan Standard Stroke Registry Study Shuhei Yamaguchi, M.D., Ph.D. 1) and Shotai Kobayashi, M.D., Ph.D. 2) 1) Department of Neurology, Faculty of Medicine, Shimane University 2) Shimane University Background: Stroke is still a heavy burden to our society. We have developed a stroke databank system since 1999 to standardize stroke therapy in acute stage and verify the evidence of treatment in Japanese stroke patients. Methods: We analyzed the data of more than 100,000 patients with acute stroke registered in Japan Standard Stroke Registry from 1999 to 2012. We focused on the chronological changes in stroke patient data. Results: Ischemic stroke was divided into three subtypes; 31% of patients had atherosclerotic, 29% had lacunar stroke, and 26% had cardioembolic stroke. Only the prevalence of cardioembolic stroke increased over the years. The incidence of cardioembolic stroke was high in aged people; 30% of stroke patients of more than 80 years had cardioembolic stroke. The time interval between stroke onset and hospital visit did not change chronologically except for transient ischemic attack, which showed increased ratio of early visit within 2 hours after stroke onset. The severity of illness became milder in recent years for ischemic stroke, but not for hemorrhagic stroke. On the other hand, modified Rankin Scale at discharge improved only for atherosclerotic stroke in recent years, while other types of stroke did not show improvement in prognosis at discharge. Conclusion: These data indicate the importance for prevention of cardioembolic stroke in aged people and social education for early detection of stroke symptoms and hospital visit. Key words: stroke registry, stroke subtype, onset-visit time, chronological change (Jpn J Stroke 36: 378 384 2014)