P波指数对缺血性卒中后心房颤动的预测价值研究  

Predictive Value of P-Wave Indices for Atrial Fibrillation Detected after Stroke

作　　者：杨晓萌[1] 吴越阳 尤佳[3] 姜勇 黄馨莹 王拥军[1,2,4] YANG Xiaomeng;WU Yueyang;YOU Jia;JIANG Yong;HUANG Xinying;WANG Yongjun(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;China National Clinical Research Center for Neurological Diseases,Beijing 100070,China;Institute of Science and Technology for Brain-Inspired Intelligence,Fudan University,Shanghai 200433,China;Beijing Institute for Brain Disorders,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,北京100070 [2]国家神经系统疾病临床医学研究中心 [3]复旦大学类脑人工智能科学与技术研究院 [4]北京脑重大疾病研究院脑卒中研究所

出　　处：《中国卒中杂志》2022年第1期80-84,共5页Chinese Journal of Stroke

基　　金：国家自然科学基金青年基金(82001237);国家自然科学基金面上项目(81870905);国家自然科学基金联合基金项目(U20A20358);中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-029)。

摘　　要：目的探讨P波指数对缺血性卒中后心房颤动的预测价值。方法本研究基于中国国家卒中登记Ⅲ研究于2015年8月-2018年3月收录的缺血性卒中患者的数据库,选择其中既往和入院时心电图均无心房颤动的患者,依据住院期间的心电图及24 h心电监测结果将患者分为窦性心律组和缺血性卒中后心房颤动组。比较两组的一般临床资料、既往病史、病灶影像学特点、超声心动图特征(左心房直径和左心室射血分数)、P波指数[PR间期、P波时限、V1导联P波终末电势(P wave terminal force in lead V1,PTFV1)]的差异,采用多因素logistic回归模型及ROC评估不同类型的P波指数对缺血性卒中后心房颤动的预测价值。结果研究共纳入12248例缺血性卒中患者,平均年龄61.7±11.1岁,缺血性卒中后新发心房颤动54例(0.4%)。多因素分析显示PTFV1增加1000μV·ms(OR 1.19,95%CI 1.06~1.35,P=0.004)或PTFV1>4000μV·ms(OR 2.20,95%CI 1.16~4.15,P=0.016)与缺血性卒中后心房颤动的发生独立相关。PTFV1增加1000μV·ms预测缺血性卒中后心房颤动的AUC为0.604(95%CI 0.528~0.679)。结论PTFV1是缺血性卒中后心房颤动的有效预测指标,应在临床工作中加以关注。Objective To investigate the relationship between P-wave indices and atrial fibrillation(AF)detected after stroke(AFDAS).Methods This study was based on the database of ischemic stroke patients enrolled in the Third China National Stroke Registry(CNSRⅢ)from August 2015 to March 2018.The patients without AF history and AF diagnosis by ECG at admission were included this study.These patients were divided into two groups according to the results of ECG and 24-hour Holter monitor during the hospitalization:sinus rhythm group and AFDAS group.The baseline data including the general clinical features,disease history,imaging characteristics of lesions and echocardiography(diameter of left atrial,left ventricular ejection fraction),P-wave indices(PR interval,P-wave duration,PTFV1)between the two groups were compared.Multivariate logistic regression analysis and receiver operator characteristic curve were used to analyze the effect of P-wave indices on AFDAS.Results A total of 12248 patients were finally included,with a mean age of 61.7±11.1 years old and 54 cases(0.4%)with AFDAS.Multivariate analysis showed that PTFV1 increased by 1000μV·ms(OR 1.19,95%CI 1.06-1.35,P=0.004)and PTFV1>4000μV·ms(OR 2.20,95%CI 1.16-4.15,P=0.016)was strongly associated with AFDAS.The AUC of PTFV1 increased by 1000μV·ms in predicting AFDAS was 0.604(95%CI 0.528-0.679).Conclusions PTFV1 was an effective predictor for AF detected after stroke.

关 键 词：P波指数 缺血性卒中 心房颤动 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]