不同心房颤动类型患者合并缺血性卒中的危险因素分析  

Analysis of risk factors for ischemic stroke in patients with different types of atrial fibrillation

作　　者：韩文兵[1] 胡元会[3] 贾秋蕾 HAN Wen-bing;HU Yuan-hui;JIA Qiu-lei(Emergency Department,Beijing University of Chinese Medicine,Beijing 110112,China;Department of cardiovascular Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 110112,China;Department of cardiovascular,Guang’anmen Hospital,Chinese Academy of traditional Chinese Medicine,Beijing 100053,China)

机构地区：[1]北京中医药大学东直门医院通州院区急诊科二区,北京市110112 [2]北京中医药大学东直门医院通州院区心血管科四区,北京市110112 [3]中国中医科学院广安门医院心内科

出　　处：《中国心血管病研究》2024年第8期707-712,共6页Chinese Journal of Cardiovascular Research

基　　金：首都卫生发展科研专项(首发2024-4-7085)。

摘　　要：目的探讨不同心房颤动(房颤)类型患者合并缺血性卒中的危险因素。方法连续入选2016年1月至2021年4月于中国中医科学院广安门医院心内科住院的非瓣膜性房颤患者751例,分为阵发性房颤(367例)和持续性房颤(384例),将不同房颤类型患者分为缺血性卒中组和非缺血性卒中组,分析不同类型房颤合并缺血性卒中的危险因素。结果在房颤合并卒中患者中,持续性房颤患者比例大于阵发性房颤(P<0.05),在阵发性房颤患者中,卒中组合并高血压、冠心病、心力衰竭(心衰)、糖尿病比例高于无卒中组,CHA2DS2-VASc评分高于无卒中组[(5.92±1.41)分比(3.97±1.26)分,P<0.05]。多因素logistics回归分析显示,冠心病(OR=3.795,95%CI 1.011~14.241,P<0.05)、糖尿病(OR=2.121,95%CI 1.272~3.536,P<0.05)是阵发性房颤合并缺血性卒中的独立危险因素。持续性房颤患者中,卒中组女性(P<0.05)、合并高血压(P=0.012)比例高于无卒中组,年龄[(79.34±6.62)岁比(74.5±9.70)岁]、左心房内径(LAD)[(49.28±4.29)mm比(42.13±3.96)mm]、CHA2DS2-VASc评分[(3.97±1.38)分比(3.61±1.37)分]高于无卒中组(P<0.05),接受抗凝治疗患者比例低于无卒中组(P<0.05),多因素logistics回归分析显示,年龄(OR=1.062,95%CI 1.025~1.100,P<0.05)、女性(OR=2.917,95%CI 1.681~5.060,P<0.05)、LAD(OR=1.165,95%CI 1.105~1.230,P<0.05)是持续性房颤合并缺血性卒中的独立危险因素,接受抗凝治疗(OR=0.332,95%CI 0.194~0.566,P<0.05)是保护因素。结论冠心病、糖尿病是阵发性房颤患者合并缺血性卒中的独立危险因素,持续性房颤患者的年龄、女性、LAD、抗凝情况与缺血性卒中密切相关,抗凝治疗。因此,对于阵发性房颤制定相应的预防策略,或积极进行节律控制、抗凝治疗,以降低缺血性卒中风险。Objective To explore the risk factors for ischemic stroke in patients with different types of atrial fibrillation(AF).Methods A total of 751 non-valvular atrial fibrillation patients who were consecutively admitted to the cardiology department of the Guang’anmen Hospital,China Academy of Chinese Medical Sciences from January 2016 to April 2021 were included.Patients were divided into two groups:the paroxysmal atrial fibrillation(367 cases)and the persistent atrial fibrillation(384 cases).The patients with different types of AF were further divided into the ischemic stroke and non-ischemic stroke groups to analyze the risk factors associated with ischemic stroke.Results Among AF patients with stroke,the proportion of those with persistent AF was higher than those with paroxysmal AF(P<0.05).In patients with paroxysmal AF,the proportion of those with hypertension,coronary heart disease,heart failure(HF)and diabetes in the stroke group was higher than in the non-stroke group,and the CHA2DS2-VASc score was higher in the stroke group[(5.92±1.41)score vs.(3.97±1.26)score,P<0.05].Multivariate logistics regression analysis showed that coronary heart disease(OR=3.795,95%CI 1.011-14.241,P<0.05)and diabetes(OR=2.121,95%CI 1.272-3.536,P<0.05)were the independent risk factors for ischemic stroke in the patients with paroxysmal AF.In the patients with persistent AF,the proportion of females(P<0.05)and those with hypertension(P=0.012)in the stroke group was higher than in the non-stroke group;age[(79.34±6.62)years vs.(74.5±9.70)years],left atrial diameter(LAD)[(49.28±4.29)mm vs.(42.13±3.96)mm]and CHA2DS2-VASc score[(3.97±1.38)score vs.(3.61±1.37)score]were all greater in the stroke group compared to the non-stroke group(P<0.05);the proportion of patients receiving anticoagulation treatment was lower in the stroke group than in the non-stroke group(P<0.05).Multivariate logistic regression analysis indicated that age(OR=1.062,95%CI 1.025-1.100,P<0.05),female sex(OR=2.917,95%CI 1.681-5.060,P<0.05)and LAD(OR=1.165,95%CI 1.

关 键 词：心房颤动 卒中 冠心病 糖尿病 年龄 女性 左心房内径 危险因素 

分 类 号：R541.7[医药卫生—心血管疾病]