非瓣膜性房颤所致轻中型卒中复发危险因素分析  

Analysis of Risk Factors for Recurrence of Mild and Moderate Stroke Caused by Non-Valvular Atrial Fibrillation

作　　者：张献文 郑燎源 经煜 张圆和 唐宇凤 Zhang Xianwen;Zheng Liaoyuan;Jing Yu(Department of Neurology,Mianyang Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Mianyang,Sichuan 621000,China)

机构地区：[1]电子科技大学附属绵阳医院·四川省绵阳市中心医院神经内科,四川绵阳621000

出　　处：《四川医学》2024年第3期225-229,共5页Sichuan Medical Journal

基　　金：四川省医学科研课题计划(编号:S21023)。

摘　　要：目的分析非瓣膜性房颤(AF)所致轻中型卒中患者1年复发的危险因素。方法选择2019年1月至2020年6月在我院住院治疗的非瓣膜性AF所致轻中型卒中患者。根据纳入及排除标准共纳入研究对象165例。收集研究对象的临床资料,在研究对象发病1年时对患者进行随访,主要评估指标为1年内急性缺血性卒中复发情况。根据1年内急性缺血性卒中复发与否分为复发组和非复发组,比较两组的差异。结果165例患者中21例在1年内复发,复发率为12.7%,轻型卒中复发率为7.3%,中型卒中复发率为20.3%,中型卒中复发率明显高于轻型卒中。单因素分析显示,复发组卒中严重程度、入院前的CHA2DS2-VASc评分、高脂血症比例高于非复发组,使用口服抗凝药物比例低于非复发组,差异有统计学意义(P<0.05)。多因素分析显示,CHA2DS2-VASc评分(OR 0.532,95%CI 0.357~0.792,P=0.00)、口服抗凝药治疗(OR 5.589,95%CI 1.685~18.548,P=0.00)、高脂血症(OR 0.123,95%CI 0.033~0.463,P=0.00)与非瓣膜性AF所致轻中型卒中的复发相关。结论非瓣膜性AF所致轻中型卒中复发风险较高,中型卒中的复发风险较轻型卒中大,起病前CHA2DS2-VASc评分高、未坚持服用口服抗凝药物、合并高脂血症的患者复发风险较高。Objective To explore risk factors of 1-year recurrence in patients with mild and moderate stroke caused by non-valvular atrial fibrillation.Methods From January 2019 to July 2020,patients with mild and moderate stroke caused by non-valvular atrial fibrillation were selected.According to the inclusion and exclusion criteria,total 165 subjects were included.Clinical data of subjects were collected and the patients were followed up one year after the onset of disease.The main evaluation index was the recurrence of acute ischemic stroke within one year.According to the recurrence of acute ischemic stroke within one year,patients were divided into recurrent group and non-recurrent group,and differences were compared.Results 21 patients relapsed within 1 year,the recurrence rate was 12.7%,the recurrence rate of mild stroke was 7.3%,and the recurrence rate of medium stroke was 20.3%.The recurrence rate of medium stroke was significantly higher than that of mild stroke.Univariate analysis showed that stroke severity,CHA2DS2-VASc score before admission and proportion of hyperlipidemia in the recurrence group were higher than those in non-relapse group,and the proportion of oral anticoagulants used was lower than that in non-relapse group with statistically significant difference(P<0.05).Multivariate analysis showed that CHA2DS2-VASc score(OR 0.532,95%CI 0.357~0.792,P=0.00),oral anticoagulant therapy(OR 5.589,95%CI 1.685~18.548,P=0.00),and hyperlipidemia(OR 0.123,95%CI 0.033~0.463,P=0.00)were associated with recurrence of mild and moderate stroke caused by non-valvular atrial fibrillation.Conclusion The risk of recurrence of mild and moderate stroke caused by non-valvular atrial fibrillation is higher,and the risk of recurrence of moderate stroke is higher than that of mild stroke.Patients with high CHA2DS2-VASc score,not taking oral anticoagulants and complicated with hyperlipidemia have a higher risk of recurrence.

关 键 词：心源性卒中 轻中型卒中 卒中复发 非瓣膜性心房颤动 

分 类 号：R743.33[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]