心脏病史与缺血性卒中发病神经功能损害程度的相关性研究  

The association between heart disease history and symptom severity at admission in patients with ischemic stroke

作　　者：赵博特 张贵涛 王晓宇 王拥军[1,2] 刘改芬[1,2] ZHAO Bote;ZHANG Guitao;WANG Xiaoyu;WANG Yongjun;LIU Gaifen(Beijing Tian Tan Hospital,Capital Medical University,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,国家神经系统疾病临床医学研究中心,100070 [2]首都医科大学北京脑重大疾病研究院

出　　处：《心肺血管病杂志》2022年第1期13-17,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展科研专项(首发2020-1-2041);国家重点研发计划课题(2017YFC1307702);十一五国家科技支撑计划(2006BAI01A11)。

摘　　要：目的:探讨心脏病史与缺血性卒中发病神经功能损害程度的相关性。方法:从中国国家卒中登记(CNSR)研究中选取诊断为缺血性脑卒中的住院患者为研究对象,收集患者入院时的人口统计学信息、既往病史及用药情况等基本资料。将患者自我报告有心房颤动、冠心病、慢性心力衰竭、心肌梗死、心脏瓣膜病中至少一种病史者定义为有心脏病史,无其中任何一项病史则定义为无心脏病史。采用美国国立卫生研究院神经功能缺损评分(NIHSS)评估患者入院时神经功能损害程度。采用多因素Logistic回归模型分析心脏病史与患者入院时神经功能损害程度的相关性。结果:本研究共纳入11 098例缺血性卒中患者,其中2 249例(20.3%)患者有心脏病史。有心脏病史患者NIHSS评分为0~3、4~7、8~14、15~21和≥22分者所占比例分别为29.9%、25.9%、23.1%、11.8%和9.3%,无心脏病史患者NIHSS评分0~3、4~7、8~14、15~21和≥22分者所占比例分别为40.8%、30.2%、18.7%、6.2%和4.1%,两组分布差异有统计学意义(P<0.001)。校正混杂因素后,多因素Logistic回归模型结果表明,心脏病史可能与缺血性卒中患者发生重度神经功能损害(NIHSS≥8分)相关(OR=1.72,95%CI:1.54~1.92)。亚组分析显示,女性有心脏病史患者在入院时NIHSS≥8分的风险性(OR=2.19,95%CI:1.87~2.57)较男性更高(OR=1.39,95%CI:1.19~1.61)。结论:心脏病史与缺血性卒中患者入院时神经功能损害严重程度相关,心脏病史可能与发生重度神经功能损害相关。积极开展心脏病的防治将有益于降低缺血性卒中的神经功能损害程度。Objective: To investigate the association between heart disease history and symptom severity at admission in patients with ischemic stroke. Methods: Patients with ischemic stroke from the China National Stroke Registry(CNSR) were included in the study. Demographic, medical history and medication situation before admission were collected. Patients self-reported with any of the following heart diseases such as atrial fibrillation, coronary heart disease, chronic heart failure, myocardial infarction and valvular heart disease were defined as with a history of heart disease, and patients self-reported without any of the above-mentioned heart diseases were defined as without a history of heart disease. The symptom severity at admission was measured using National Institutes of Health Stroke Scale(NIHSS). The association between heart disease history and symptom severity was investigated using multivariable logistic regression with adjusting for potential confounders. Results: A total of 11 098 ischemic stroke patients were included in this study, and 2 249(20.3%) patients had a history of heart disease. The percentages of NIHSS 0-3, 4-7, 8-14,15-21 and ≥ 22 were 29.9%, 25.9%, 23.1%, 11.8% and 9.3% in the patients with a history of heart disease,respectively, whereas in the patients without a history of heart disease, the percentages of NIHSS 0-3, 4-7, 8-14,15-21 and ≥ 22 were 40.8%, 30.2%, 18.7%, 6.2% and 4.1%, respectively. There was a significant difference in the symptom severity distribution between patients with and without a history of heart disease(P<0.001).After adjusting for potential confounders, the multivariable logistic regression analysis showed that heart disease history was associated with higher symptom severity(NIHSS≥8 points)(OR=1.72, 95%CI: 1.54-1.92).In the subgroup analysis, we found that the association between heart disease history and symptom severity in female(OR=2.19, 95%CI: 1.87-2.57) were more significant than that in male(OR=1.39, 95%CI: 1.19-1.61).Conclusions: In a largescale strok

关 键 词：缺血性卒中 心脏病 美国国立卫生院神经功能缺损评分 

分 类 号：R54[医药卫生—心血管疾病]