左房增大对急性缺血性脑卒中预后的影响  

Effect of left atrial enlargement on the prognosis of acute ischemic stroke

作　　者：张小峰 徐文灯 武剑[1] Zhang Xiaofeng;Xu Wendeng;Wu Jian(Department of Neurology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院神经内科,清华大学临床医学院,北京102218

出　　处：《中华医学杂志》2022年第9期671-674,共4页National Medical Journal of China

基　　金：首都卫生发展科研专项(首发2020‑1‑2241);北京市医院管理局临床医学发展专项(XMLX202140);清华大学精准医学科研计划(20219990033)。

摘　　要：目的探讨左房增大对于急性缺血性脑卒中患者预后的影响。方法本研究纳入北京清华长庚医院2019年1月至2020年4月入院的急性缺血性脑卒中患者,通过超声心动图评价患者左房大小,将患者分为左房增大组和无左房增大组;对入组患者进行电话/门诊随访;以1年内缺血性脑卒中复发、3个月功能独立、良好预后作为预后指标;分别对两组患者一般变量及左房大小进行单因素分析及构建Cox风险比例模型,评估左房增大对于急性缺血性脑卒中预后的风险。结果本研究共纳入187例患者,其中男135例,女52例,年龄(66.6±13.4)岁;43.3%(81/187例)的患者左房增大,11.2%(21/187)的患者在1年内出现复发;87.7%(164/187)的患者具有3个月的功能独立;78.6%(147/187)的患者具有3个月的良好预后;左房增大组患者1年内复发比例明显高于无左房增大组(18.5%比6.6%,P=0.020);在3个月功能独立及良好预后方面,左房增大组与无左房增大组比例相当;矫正年龄及性别因素后,具有左房增大的急性缺血性脑卒中患者具有较高的1年内复发的风险(HR=2.739,95%CI:1.100~6.816);在3个月良好预后及功能独立方面无明显影响;矫正所有潜在变量后,具有左房增大的急性缺血性脑卒中患者仍具有较高的1年复发的风险(HR=2.449,95%CI:0.948~6.326)。结论在急性缺血性脑卒中人群中43.3%的患者存在左房增大;具有左房增大的急性缺血性脑卒中具有较高的复发风险。Objective To investigate the effect of left atrial enlargement on the prognosis of patients with acute ischemic stroke.Methods Patients with acute ischemic stroke who were admitted to Beijing Tsinghua Changgung Hospital from January 2019 to April 2020 were included in the study.The left atrial size of the patients was measured by echocardiography.Patients were divided into left atrial enlargement group and normal left atrial group.Telephone/outpatient follow‐up was conducted for enrolled patients.The functional independence,good prognosis within 3 months and recurrent ischemic stroke within one year was taken as the prognostic indicators.Univariate analysis and Cox proportional hazard model were performed to evaluate the prognosis risk of left atrial enlargement for acute ischemic stroke.Results Totally,187 patients were included in the study,including 135 males and 52 females,with an average age of(66.6±13.4)years.There were 43.3%(81/187)of patients who showed left atrial enlargement,11.2%(21/187)of patients suffered recurrence within 1 year,87.7%(164/187)of patients achieved functional independence at 3 months,and 78.6%(147/187)of patients had a favorable prognosis at 3 months.The recurrence rate in the left atrial enlargement group was significantly higher than that in the non‐enlargement group(18.5%vs 6.6%,P=0.020).In terms of functional independence and good prognosis at 3 months,the left atrial enlargement group was similar to normal left atrial group.After adjustment for age and sex,acute ischemic stroke patients with left atrial enlargement had a higher 1‐year risk of recurrence(HR=2.739,95%CI:1.100-6.816).However,there was no significant effect on good prognosis and functional independence at 3 months.After adjustment for all potential variables,acute ischemic stroke patients with left atrial enlargement still had a higher 1‐year risk of recurrence(HR=2.449,95%CI:0.948-6.326).Conclusions Left atrial enlargement occurs in 43.3%of patients with acute ischemic stroke.Acute ischemic stroke with left

关 键 词：脑梗死 左房增大 预后 队列研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]