中国人非瓣膜性心房颤动脑卒中危险因素的病例-对照研究  

Risk factors for stroke in Chinese with non valvular atrial fibrillation:a case-control study

作　　者：胡大一[1] 孙艺红[1] 周自强[2] 李奎宝[1] 倪永斌[1] 杨光[2] 孙淑红[1] 李蕾[1] 

机构地区：[1]北京大学人民医院心内科,100044 [2]首都医科大学同仁医院心内科

出　　处：《中华内科杂志》2003年第3期157-161,共5页Chinese Journal of Internal Medicine

基　　金：卫生部科技专项基金资助(WKZ2 0 01 1 0 8)

摘　　要：目的　本研究通过回顾性病例对照研究分析中国人心房颤动 (房颤 )脑卒中的危险因素。方法　在全国 1 8家医院共登记房颤患者 4 51 1例 ,其中风湿瓣膜性房颤 1 0 86例 ,非瓣膜性房颤 342 5例。通过比较房颤合并脑卒中与房颤无脑卒中患者 ,筛选房颤发生脑卒中的危险因素。结果　中国人房颤脑卒中的患病率 2 4 81 % ,房颤合并脑卒中组年龄明显高于对照组 (P <0 0 0 1 ) ,且患病率随年龄增长而明显增加。多因素Logistic分析显示 :年龄≥ 75岁 (OR 1 76 ,95 %CI 1 0 8～ 2 98) ,高血压病史 (OR 1 52 ;95 %CI 1 2 8～ 1 80 ) ,糖尿病史 (OR 1 39,95 %CI 1 1 1～ 1 76) ,动脉收缩压升高(OR 1 71 ,95 %CI1 2 1～ 2 2 8) ,左房血栓 (OR 2 77,95 %CI 1 2 5～ 6 1 3)是脑卒中的独立危险因素。结论　中国人非瓣膜性房颤脑卒中的独立危险因素为年龄、高血压病史、糖尿病史、左房血栓、动脉收缩压升高 。Objective The aim of this study is to identify the risk factors in Chinese with nonvalvular atrial fibrillation and stroke, using case control methodology Methods A total of 4 511 adult patients diagnosed with atrial fibrillation were identified from 18 hospitals over a 2 year period There were 1 086 patients with rheumatic valvular atrial fibrillation and 3 425 patients with nonvalvular atrial fibrillation Among the nonvalvular atrial fibrillation patients,827 had ischemic stroke The data of the patients having nonvalvular atrial fibrillation with stroke was compared with those having nonvalvular atrial fibrillation without stroke ( n =2 598) The effect of each variable on stroke was assessed with a logistic regression analysis Results The studied cases with stroke and controls without stroke were similar in terms of percentage with sex, a past history of congestive heart failure, myocardial infarction, and mean left atrial size Cases were significantly older than controls (73 3±9 2 vs. 68 2±12 3, P <0 001) and more likely to have a history of hypertension(71 0% versus 51 6%, P <0 001)and diabetes(17 9% vs. 11 1%, P =0 001) There is strong evidence that left atrial(LA) thrombi make AF patients highly risky for stroke In multivariate analysis, age≥75 ( OR 1 76; 95% CI 1 08～2 98), history of hypertension( OR 1 52;95% CI 1 28～1 80), diabetes ( OR 1 39;95% CI 1 11～1 76), high systolic blood pressure ( OR 1 71;95% CI 1 21～2 28), LA thrombi ( OR 2 77;95% CI 1 25～6 13) were independently associated with stroke The lack of the association between left ventricular dysfunction and stroke is due to the relatively incorrect diagnosis of heart failure in the context of atrial fibrillation Conclusions Our analysis suggests that old age, hypertension, diabetes, high systolic blood pressure and LA thrombi detected with echocardiography are independent

关 键 词：中国人 非瓣膜性心房颤动 脑卒中 危险因素 病例-对照研究 抗凝治疗 诊断标准 

分 类 号：R541.75[医药卫生—心血管疾病] R743.3[医药卫生—内科学]