目的：旨在探索急性缺血性脑卒中（acute ischemic stroke, AIS）后复发的危险因素及其相互作用。方法：选取2020年3月至2023年3月在本院治疗的AIS患者143例，收集患者一般临床资料，进行随访，随访终点为脑卒中复发。失访12例。采用COX分析筛选脑卒中复发的危险因素，分析各危险因素间的相互作用。结果：单因素COX分析显示，年龄、改良Rankin评分量表（modified Rankin scale, mRS）评分、美国国立卫生研究院卒中量表（the National Institutes of Health stroke scale, NIHSS）评分、活化部分凝血酶时间、糖尿病病史是AIS老年患者预后不良的危险因素[风险比（hazard ratio, HR）>1, P<0.05]。蒙特利尔认知评估量表（Montreal cognitive assessment scale, MoCA）评分和纤维蛋白原是AIS老年患者预后良好的保护因素（HR<1, P<0.05）。多因素分析进一步表明，高mRS评分和高NIHSS评分是预后不良的独立危险因素，而高MoCA评分和高纤维蛋白原水平是独立保护因素（均P<0.05）。然而，这些因素之间未发现显著的相互作用。结论：mRS评分和NIHSS评分是AIS老年患者预后不良的独立危险因素。MoCA评分和纤维蛋白原AIS老年患者预后良好的独立保护因素。这些危险因素和保护因素之间无显著相互作用。

Objective To explore the risk or protective factors and their interactions for recurrence after acute ischemic stroke (AIS). Methods A total of 143 AIS patients admitted in our hospital from March 2020 to March 2023 were selected and followed up, and general clinical data were collected. Twelve patients were lost to follow-up. The end point of follow-up was stroke recurrence. The risk factors of stroke recurrence were screened by COX analysis, and the interaction between risk factors was analyzed. Results Univariate COX analysis showed that age, modified Rankin scale (mRS) score, the National Institutes of Health stroke scale (NIHSS) score, activated partial thrombin time and diabetes history were risk factors for poor prognosis in elderly patients with AIS [hazard ratio (HR) > 1, P < 0.05]. Montreal cognitive assessment scale (MoCA) score and fibrinogen are protective factors for good prognosis in elderly patients with AIS (HR < 1, P > 0.05). Multivariate COX analysis showed that mRS score and NIHSS score were independent risk factors for poor prognosis in elderly patients with AIS (HR > 1, P > 0.05). MoCA score and fibrinogen are protective factors for good prognosis in elderly patients with AIS (HR < 1, P > 0.05). Patients with high mRS score and high NIHSS score had worse prognosis (P < 0.001). Patients with high MoCA score and high fibrinogen level had better prognosis (P < 0.001). mRS score, NIHSS score, MoCA score and fibrinogen level had no significant interaction. Conclusions mRS score and NIHSS score are independent risk factors for poor prognosis in elderly patients with AIS. MoCA score and independent protective factor of good prognosis in elderly patients with AIS of fibrinogen. There was no significant interaction between these risk factors and protective factors.