左心房增大与非瓣膜性心房颤动患者心源性栓塞性卒中严重程度和病灶分布的相关性  

Associations of left atrial enlargement and the severity and lesion patterns of cardioembolic stroke in patients with nonvalvular atrial fibrillation

作　　者：支立君 毕国荣[1] 

机构地区：[1]中国医科大学附属盛京医院神经内科,沈阳110072

出　　处：《国际脑血管病杂志》2017年第2期121-126,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨左心房增大与非瓣膜性心房颤动（non-valvular atrial fibrillation, NVAF）患者心源性卒中严重程度和病灶分布的相关性。 方法纳入发病48 h内确诊为心源性卒中的NVAF患者。采用美国国立卫生研究院卒中量表评价卒中严重程度，≥10分定义为中重度卒中，〈10分定义为轻度卒中。利用经胸超声心动图测量左心房内径，将患者分为正常以及轻、中、重度左心房增大组。根据弥散加权成像显示的病灶分布分为多发性梗死组和单发性梗死组。结果共纳入137例患者，包括轻度卒中86例（62.8%），中重度卒中51例（37.2%）；多发性梗死69例（50.4%），单发性梗死68例（49.6%）；左心房增大103例（75.2%），其中轻度增大35例（25.5%），中度增大40例（29.2%），重度增大28例（20.4%）。多变量logistic回归分析显示，轻度[优势比（odd ratio, OR）15.662，95%可信区间（confidence interval, CI）1.821～134.677；P＝0.012]、中度（OR 26.435，95% CI 3.201～218.319；P＝0.002）和重度（OR 75.763，95% CI 8.536～672.441；P〈0.001）左心房增大患者发生中重度卒中的风险均显著增高，而不同程度左心房增大者间病灶分布无显著统计学差异（χ2＝7.050，P＝0.07）。结论左心房增大与NVAF患者心源性卒中的严重程度独立相关，但与病灶分布无关。ObjectiveTo investigate the associations of left atrial enlargement and the severity and lesion patterns of cardioembolic stroke in patients with nonvalvular atrial fibrillation （NVAF）.MethodsThe patients with NVAF diagnosed as cardiogenic stroke within 48 h after onset were enrolled. The National Institutes of Health Stroke Scale （NIHSS） was used to evaluate the severity of stroke, and ≥10 was defined as moderate to severe stroke, and 〈10 was defined as mild stroke. Transthoracic echocardiography was used to measure the left atrial diameter. The patients were divided into normal group, mild, moderate, and severe left atrial enlargement groups. According to the lesion patterns revealed by the diffusion weighted imaging, they were divided into either a multiple infarctions group or a single infarction group.ResultsA total of 137 patients were enrolled, including 86 patients with mild stroke （62.8%）, 51 with moderate to severe stroke （37.2%）, 69 with multiple infarctions, and 68 with single infarction （49.6%）. Left atrial enlargement was found in 103 cases, in which 35 （25.5%） were mild enlargement, 40 （29.2%） were moderate enlargement, and 28 （20.4%） were severe enlargement. Multivariate logistic regression analysis showed that the risk of severe stroke in patients with mild （odds ratio [OR] 15.662, 95% confidence interval [CI] 1.821-134.677; P=0.012）, moderate （OR 26.435, 95% CI 3.201-218.319; P=0.002）, and severe （OR 75.763, 95% CI 8.536-672.441; P〈0.001） left atrial enlargement were increased significantly, and there were no significant differences in the lesion patterns among the different severity of left atrial enlargement groups （χ2=7.050, P=0.07）.ConclusionsLeft atrial enlargement may be independently associated with the severity of cardiogenic stroke in patients with NVAF, but it is not associated with the lesion patterns.

关 键 词：卒中 脑缺血 颅内栓塞 心房颤动 心脏扩大 心房 超声心动描记术 疾病严重程度指数 危险因素 

分 类 号：R541.75[医药卫生—心血管疾病]