老年缺血性脑卒中合并心房颤动及冠心病患者的6年预后随访研究  

A Six-year Follow-up Study on the Prognosis in Elderly Patients with Ischemic Stroke Combined with Atrial Fibrillation and Coronary Heart Disease

作　　者：董敏[1] 徐蕾[2] 何清华[3] 裴作为 曲祎玫 杨杰孚[1] 汪芳[1] DONG Min;XU Lei;HE Qinghua;PEI Zuowei;QU Yimei;YANG Jiefu;WANG Fang(Department of Cardiology,Beijing Hospital/National Center of Gerontology/Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Neurology,Beijing Hospital/National Center of Gerontology/Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Endocrinology,Beijing Hospital/National Center of Gerontology/Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院心内科国家老年医学中心中国医学科学院老年医学研究院,北京市100730 [2]北京医院神经内科国家老年医学中心中国医学科学院老年医学研究院,北京市100730 [3]北京医院内分泌科国家老年医学中心中国医学科学院老年医学研究院,北京市100730

出　　处：《中国全科医学》2021年第17期2148-2156,共9页Chinese General Practice

基　　金：十三五国家科技重大新药创制专项课题(2017ZX09304026);首都卫生发展科研专项(重点)(首发2016-1-4051)。

摘　　要：背景近年来,心房颤动(简称房颤)合并冠心病患者在临床上越来越受到关注,新近的临床研究主要集中于脑卒中和血栓栓塞事件的预防和治疗。目的评估老年缺血性脑卒中合并房颤及冠心病患者的远期生存率,分析影响预后的危险因素。方法本研究为回顾性队列研究,回顾性分析2012年1月—2014年10月首次因急性缺血性脑卒中入住北京医院神经内科病房的患者406例,从中选取同时满足房颤和冠心病诊断标准的60岁以上老年患者共计164例作为脑血管病组,并从心内科同期住院患者中选取年龄、性别、共病种类与其相匹配的房颤合并冠心病但无脑血管病患者164例作为非脑血管病组。收集两组患者的临床资料:包含人口统计学信息、疾病种类、用药种类、血压、心率、合并心脏基础疾病及其他疾病、实验室指标、超声心动图结果、治疗方案;分别通过CHA2DS2-VASc评分、CHADS2评分评估患者的脑卒中及血栓栓塞发生风险,应用HAS-BLED评分评估出血风险,并在其出院后通过定期电话随访、门诊及住院志查询等方式随访至少6年,记录其死亡、再住院次数及主要不良心血管事件(MACE)发生情况,探讨影响其远期预后的因素。结果脑血管病组合并高脂血症比例、慢性胃肠病比例低于非脑血管病组,LVEDD、CHA2DS2-VASc评分、CHADS2评分、HAS-BLED评分高于非脑血管病组(P<0.05)。脑血管病组164例患者失访2例(失访率1.2%),死亡80例(49.4%),根据生存结局分为死亡组(80例)和存活组(82例)。死亡组患者年龄大于存活组,收缩压、舒张压、合并高血压比例、合并高脂血症比例、血清蛋白、使用他汀类药物比例低于存活组,心率和合并陈旧性心肌梗死、心力衰竭、慢性肾病比例及纽约心脏病协会(NYHA)心功能分级、D-二聚体、N末端B型钠尿肽前体(NT-proBNP)高于存活组(P<0.05)。多因素Cox比例风险回归模型分析结�Background In recent years,patients with atrial fibrillation and coronary heart disease have attracted more and more attention in clinic.Recent clinical studies mainly focused on the prevention and treatment of stroke and thromboembolic events.Objective To evaluate the long-term survival rate of elderly patients with ischemic stroke combined with atrial fibrillation and coronary heart disease,and analyze the risk factors which affected the prognosis.Methods We conducted a retrospective cohort study.A retrospective analysis of 406 patients over 60 years admitted to hospital due to acute ischemic stroke for the first time were enrolled,and 164 patients with atrial fibrillation and coronary heart disease were selected from them as cerebrovascular disease group,164 patients without cerebrovascular disease but with atrial fibrillation and coronary heart disease matched with age,gender and comorbidities were selected from concurrent hospitalized patients in the Department of Cardiology as non-cerebrovascular disease group.The clinical data,including demographic information,types of diseases,types of medications,blood pressure,heart rate,cardiovascular diseases and other diseases of the two groups were collected,laboratory test,echocardiographic parameters,treatment plan.The CHA2 DS2-VASc score and CHADS2 score were used to assess the risk of stroke and thromboembolism,and the HAS-BLED score was used to assess the risk of bleeding.The patients were followed up for at least 6 years by telephone,outpatient and inpatient records after discharge,to record the death,readmission and major adverse cardiovascular events(MACE),and to explore the factors that affect his long-term prognosis.Results Compared with non-cerebrovascular disease group,the proportion of hyperlipidemia and chronic gastrointestinal disease in cerebrovascular disease group was lower.LVEDD,CHA2 DS2-VASc score,CHADS2 score,and the HAS-BLED score in cerebrovascular disease group were higher(P<0.05).In the 164 patients with cerebrovascular disease group,2 cases

关 键 词：脑缺血 卒中 心房颤动 冠心病 老年人 死亡 主要不良心血管事件 随访研究 

分 类 号：R743.31[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]