非瓣膜病性心房颤动伴缺血性卒中的复发分析

A study on the recurrence of ischemic stroke in nonvalvular atrial fibrillation

目的探讨非瓣膜病性心房颤动(房颤)伴缺血性卒中患者的复发及其影响因素。方法回顾性分析1992-2002年住院非瓣膜病性房颤伴缺血性卒中患者386例,随访收集有关临床资料,进行复发分析并研究其复发的相关因素。结果非瓣膜病性房颤伴缺血性卒中患者的10年累计复发率为34%,Cox 回归单因素分析发现,高血压、糖尿病、短暂性脑缺血发作(TIA)、高脂血症、附壁血栓是非瓣膜病性房颤伴缺血性卒中患者复发的危险因素,Cox 回归多因素分析发现高血压病,TIA 发作史与附壁血栓为非瓣膜病性房颤合并缺血性卒中复发的独立危险因素;而阿司匹林与华法林治疗对非瓣膜病性房颤合并缺血性卒中复发有保护作用。结论高血压病、TIA 发作史与附壁血栓为非瓣膜病性房颤合并缺血性卒中复发的独立危险因素,阿司匹林与华法林治疗对非瓣膜病性房颤合并缺血.陛卒中复发有保护作用。

Objective To study the recurrence of ischemic stroke in patient with nonvalvular atrial fibrillation （NVAF） and to determine the recurrence related factors of ischemic stroke in patients with NVAF. Methods The clinical data of 386 NVAF patients with ischemic stroke treated in our hospital from January 1992 to February 2002 were included in this study. The basic clinical information of each patient was recorded. Analysis of recurrence and recurrence related factors of ischemic stroke in patients with NVAF was conducted. Results Overall the 10-year recurrence rate of ischemic stroke in patients with NVAF was 34%. Hypertension, diabetes mellitus, transient ischemic attack （TIA）, hyperlipemia and mural thrombus in left atrium were significantly correlated with the recurrence rate by univariate Cox proportional hazards regression analysis; but aspirin therapy, warfarin therapy and hypertension control were protective factors for the recurrence of ischemic stroke in patients with NVAF. Multivariate Cox proportional hazards regression analysis revealed that hypertension, TIA and mural thrombus in left atrium were independent recurrence related factors for ischemic stroke in patients with NVAF; but aspirin therapy and warfarin therapy were protective factors for the recurrence. Conclusions Hypertension, TIA and mural thrombus in left atrium were independent recurrence related factors for ischemic stroke in patient with NVAF; but aspirin therapy and warfarin therapy were protective factors for the recurrence.