老年急性心肌梗死合并缺血性脑卒中患者的临床特征分析  

Clinical characteristics analysis of elderly patients with acute myocardial infarction complicated with ischemic stroke

作　　者：宋俊贤[1] 崔淯夏[1] 王萌 陈江天[1] 陈红[1] Song Junxian;Cui Yuxia;Wang Meng;Chen Jiangtian;Chen Hong(Department of Cardiovascular Diseases,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心血管内科,100044

出　　处：《中华老年心脑血管病杂志》2024年第12期1438-1442,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：首都卫生发展科研专项(首发2020-2-4084)。

摘　　要：目的探讨老年急性心肌梗死合并缺血性脑卒中患者的临床特征,为制定更精准的防治策略提供依据。方法回顾性连续入选2018年1月至2019年12月于北京大学人民医院心血管内科住院的老年急性心肌梗死患者439例。根据是否合并缺血性脑卒中,将患者分为缺血性脑卒中组55例和非缺血性脑卒中组384例;进一步将其中114例完成头颅CT血管造影检查的患者分为缺血性脑卒中患者27例和非缺血性脑卒中患者87例,分析患者临床特征和颅内动脉病变特点,应用颅内动脉钙化总积分以评价颅内动脉钙化水平和动脉粥样硬化的程度。结果与非缺血性脑卒中组比较,缺血性脑卒中组患者合并高血压、糖尿病、肾功能不全、入院前阿司匹林/氯吡格雷和他汀类药物使用、糖化血红蛋白、B型脑钠肽水平、3支病变、Gensini评分显著增高,血红蛋白、血小板计数和估算肾小球滤过率显著降低,差异有统计学意义(P<0.05,P<0.01)。缺血性脑卒中患者颅内动脉钙化、重度钙化、颈内动脉颅内段钙化、颅内动脉狭窄≥50%比例显著高于非缺血性脑卒中患者(92.6%vs 78.2%,P=0.041;40.7%vs 21.8%,P=0.037;81.5%vs 62.1%,P=0.039;55.6%vs 35.6%,P=0.042)。二元logistic回归分析显示,糖尿病是急性心肌梗死患者缺血性脑卒中的独立危险因素(OR=2.187,95%CI:1.205~3.970,P=0.010)。结论老年急性心肌梗死合并缺血性脑卒中患者共存疾病多,病情以及冠状动脉与颅内动脉病变重;并且合并糖尿病的老年急性心肌梗死患者发生缺血性脑卒中的风险明显增加。Objective To investigate the clinical characteristics of elderly patients with acute myocardial infarction(AMI)complicated with ischemic stroke and provide reference for the formulation of more precise prevention and treatment strategies.Methods A retrospective study was conducted on 439 consecutive AMI patients admitted to our department from January 2018 to December 2019.They were divided into ischemic stroke group(n=55)and non-ischemic stroke group(n=384)based on having concomitant ischemic stroke or not.For the 114 patients who completed head CT angiography,they were assigned into ischemic stroke patients(n=27)and non-ischemic stroke patients(n=87).The clinical characteristics and intracranial arterial lesions were analyzed in the patients.Total score of intracranial artery calcification was used to evaluate the level of intracranial artery calcification and the degree of atherosclerosis.Results The ischemic stroke group had significantly larger proportions of concomitant hypertension,diabetes and renal dysfunction,pre-admission usage of aspirin/clopidogrel and statin,higher levels of glycosylated hemoglobin(HbA1c)and B-type brain natriuretic peptide,more 3-vessel lesions and elevated Gensini score,but decreased hemoglobin level,platelet count and estimated glomerular filtration rate when compared with the non-ischemic stroke patients(P<0.05,P<0.01).The proportions of intracranial artery calcification,severe calcification,intracranial artery carotid calcification,and intracranial artery stenosis≥50%were obviously higher in the ischemic stroke patients than the non-ischemic stroke patients(92.6%vs 78.2%,P=0.041;40.7%vs 21.8%,P=0.037;81.5%vs 62.1%,P=0.039;55.6%vs 35.6%,P=0.042).Binary logistic regression analysis showed that diabetes was an independent risk factor for ischemic stroke in the elderly AMI patients(OR=2.187,95%CI:1.205-3.970,P=0.010).Conclusion The elderly AMI patients complicated with ischemic stroke have more comorbidities,and severer disease condition,coronary artery disease and intracranial a

关 键 词：心肌梗死 卒中 冠状动脉疾病 颅内动脉疾病 

分 类 号：R743.3[医药卫生—神经病学与精神病学]