天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (4): 474-477.doi: 10.11958/20150102

• 临床研究 • 上一篇    下一篇

非瓣膜性房颤缺血性卒中患者临床特征分析

肖瑞1,2 ， 齐新2 ， 周钧1,2 ， 贾文军2 ， 庞洪波3 ， 刘克强2△   

  1. 1天津中医药大学研究生院 （邮编300193）； 2天津市人民医院心内科； 3天津市残疾人康复服务指导中心
  • 收稿日期:2015-08-10 修回日期:2015-11-12 出版日期:2016-04-15 发布日期:2016-05-20
  • 通讯作者: △通讯作者 E-mail: kentliu999@126.com E-mail:Kentliu999@126.com
  • 作者简介:肖瑞 （1985）， 男， 博士在读， 主要从事冠心病的中西医结合防治研究
  • 基金资助:
    天津市卫计委中医、 中西医结合科研课题 （2015068）

The clinical characteristic analysis of ischemic stroke in patients with non-valvular atrial fibrillation

XIAO Rui 1,2 , QI Xin2 , ZHOU Jun1,2 , JIA Wenjun2 , PANG Hongbo3 , LIU Keqiang2△   

  1. 1 The Graduate School of Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; 2 Tianjin Union Hospital; 3 Tianjin Disabled Persons Rehabilitation Guidance Center
  • Received:2015-08-10 Revised:2015-11-12 Published:2016-04-15 Online:2016-05-20
  • Contact: △Corresponding Author E-mail: kentliu999@126.com E-mail:Kentliu999@126.com

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摘要： 摘要： 目的 对非瓣膜性心房颤动合并缺血性卒中患者进行临床特征分析， 为缺血性卒中防治提供临床依据。方法 198 例缺血性卒中患者按有无心房颤动分为合并组 （71 例） 与非合并组 （127 例）； 比较 2 组临床特征及相关生化指标， 并使用 CHADS2 与 CHA2DS2-VASc 评分系统对合并房颤组患者进行危险分层， 寻找合并心房颤动缺血性卒中的相关危险因素并进行分析。结果 合并组年龄、 住院时间、 高血压史、 心率、 同型半胱氨酸 （Hcy） 高于非合并组；总胆固醇 （TC）、 三酰甘油 （TG） 及极低密度脂蛋白胆固醇 （VLDL-C） 均低于非合并组 （P < 0.05）。合并组 CHA2DS2- VASc 评分均处于中高危水平。高龄、 较快心率为非瓣膜性房颤缺血性脑卒中的独立危险因素。ROC 曲线示年龄（AUC=0.761， 临界值=72.50 岁） 及心率 （AUC=0.612， 临界值=76.50 次/min） 对非瓣膜性房颤缺血性卒中均具有预测诊断价值。年龄的敏感度 （70.4%） 和特异度 （71.1%） 最高， 最佳临界值为 72.5 岁。结论 非瓣膜性房颤缺血性卒中患者临床特征为较高年龄、 较快的心率、 较高 CHA2DS2-VASc 评分以及较高的 Hcy 水平。

关键词: 心房颤动, 卒中, 脑缺血, 年龄, 心率, 早期诊断, CHA2DS2-VASc 评分, 同型半胱氨酸, 危险因素, 非瓣膜性心房颤动

Abstract: Abstract: Objective To analyze the clinical and laboratory characteristics of the ischemic stroke in patients with non-valvular atrial fibrillation (AF), and to provide evidence for the prevention of ischemic stroke. Methods A total of 198 patients with ischemic stroke were chosen and divided into two groups: with AF (71 patients)/ and without AF (127 patients) groups. Clinical data and biochemical markers were collected and compared in two groups. CHADS2 and CHA2DS2-VASc score systems were used to determine the risk levels in patients with AF. Finally, related risk factors of ischemic stroke with AF were determined and analyzed. Results The values of age, length of hospital stay, the hypertention history, heart rate and plasma homocysteine (Hcy) were significantly higher in the with-AF group than those in the without-AF group (P < 0.05). The levels of total cholesterol (TC), triglyceride (TG) and very low density lipoprotein cholesterol (VLDL-C) were sig⁃ nificantly lower in the with-AF group than those of the without-AF group (P < 0.05). CHA2DS2-VASc scores reached to the moderate-to-high risk level in the with-AF group. Multiple-factor logistic regression analysis showed that age and heart rate were the independent risk factors of the ischemic stroke in patients with non-valvular AF. ROC analysis indicated that age (AUC=0.761, cut-off point=72.50 years old) and heart rate (AUC=0.612, cut-off point =76.50 bit/min) had predictive and di⁃ agnostic value for the ischemic stroke in patients with non-valvular AF. The age of these patients had the best sensitivity (70.4%) and specifity (71.1%), and the cut-off point of which was 72.50 years old. Conclusion The characteristics of isch⁃ emic stroke in patients with non-valvular AF includes older age, faster heart rate, higher CHA2DS2-VASc scores and higher Hcy level.

Key words: atrial fibrillation, stroke, brain ischemia, age, heart rate, early diagnosis, CHA2DS2-VASc score, homocysteine, risk factor, non-valvular atrial fibrillation