伴心房纤颤急性脑梗死患者的临床特点及预后  

Characteristics and outcome of acute ischemic stroke patients with atrial fibrillation

作　　者：李慎军[1] 王树才[1] 谷明明[1] 曹秉振[1] 

机构地区：[1]济南军区总医院神经内科,济南250031

出　　处：《中华医学杂志》2015年第43期3509-3513,共5页National Medical Journal of China

摘　　要：目的 探讨伴心房纤颤急性脑梗死患者的临床特点及预后.方法 前瞻性收集2010年8月至2013年11月到济南军区总医院神经内科住院的急性脑梗死患者965例,记录其年龄、性别、血清白蛋白、血肌酐、美国国立卫生研究院卒中量表（NIHSS）评分等基线资料.根据病史、既往心电图、查体、住院期间心电图和（或）24 h动态心电图确定其有无心房纤颤.在发病后180 d通过电话随访,采用改良Rankin量表（mRS）对其预后进行评价（mRS评分≤2分为预后良好,mRS评分＞2分为预后不良）.其中死亡包括各种原因引起的死亡.用多元回归分析分析心房纤颤与预后的关系.结果 本研究中,11.71％ （113/965）患者有心房纤颤,其中,9.7％ （11/113）有心脏瓣膜病.仅4例有心脏瓣膜病的心房纤颤患者发病前口服华法林,非瓣膜病性心房纤颤患者无1例口服华法林.14.2％ （16/113）例患者发病前口服阿司匹林.与无心房纤颤的急性脑梗死患者相比,伴心房纤颤的急性脑梗死患者患糖尿病（26.55％比9.74％,P=0.028）、心力衰竭（12.37％比11.03％,P=0.000）、复发性脑梗死（31.86％比21.83％,P=0.023）、完全前循环型（51.33％比19.37％,P=0.000）比例高,NIHSS的中位数高[11（14）比5（5）,P=0.000];吸烟（20.35％比37.32％,P=0.000）、饮酒（13.27％比27.58％,P=0.001）、部分前循环型（24.78％比36.74％,P=0.012）、腔隙性脑梗死（0比17.61％,P=0.000）、心肌梗死（11.50％比11.74％,P=0.041）比例低.心房纤颤是预后不良（OR =2.227,95％ CI：1.262 -3.933,P=0.006）的独立预测因子.结论 目前心房纤颤患者口服抗凝药物的比例低.伴心房纤颤的脑梗死患者,梗死程度重,容易复发,完全前循环型脑梗死比例高;腔隙性脑梗死比例低.心房纤颤是急性脑梗死患者预后不良的独立预测因子.Objective To evaluate clinical characteristics and outcome of acute ischemic stroke patients with atrial fibrillation.Methods Consecutive acute ischemic stroke patients who were hospitalized in the neurology department of General Hospital of Jinan Military Region were prospectively recruited from August 2010 to November 2013.The baseline datum including age, sex, National Institute of Health Stroke Scale （NIHSS）, type of Oxfordshire Community Stroke Project （OCSP： total anterior circulation infarct, partial anterior circulation infarction, posterior circulation infarction and lacunar infarction）, serum creatinine, serum albumin levels etc.were recorded.Atrial fibrillation （AF） was defined as a history of persistent atrial fibrillation or paroxysmal atrial fibrillation, supported by past electrocardiogram or diagnosed by the attending physicians based on physical examination, electrocardiogram and/or 24-hour electrocardiogram monitoring during hospitalization.Outcome was assessed by modified Rankin Scale （mRS） which was obtained 180 days after stroke by telephone interview （mRS ≤2 reflected good prognosis, and mRS 〉 2 reflected unfavorable prognosis）, and death defined as all-cause mortality.Multivariate regression model was used to analyze predictors of mortality and disability.Results Of the 965 patients included in this study, 113 （11.71%） had AF;valvular AF was observed in 11 patients （9.7%） among them.Only 4 patients with valvular AF and none of the patients with non-valvular AF took warfarin before the stroke event.14.2% （16/113） acute ischemic stroke patients with AF took aspirin.Compared to patients without AF, patients with AF had a higher NIHSS score on admission （median 11 vs 5, P =0.000）;were more often with diabetes （26.55% vs 9.74%, P =0.028）, congestive heart failure （12.37% vs 11.03%, P =0.000）, prior stroke （31.86% vs 21.83% , P =0.023）, total anterior circulation infarct subtype （51.33% vs 19.37%, P =0.000）;they were less often smokers （

关 键 词：脑梗死 心房纤颤 预后 

分 类 号：R541.75[医药卫生—心血管疾病]