非瓣膜性房颤患者缺血性脑卒中危险因素暴露水平与聚集分析

Analysis on the level of exposure and the cluster of risk factors to stroke for patients with non valvular atrial fibrillation

目的了解非瓣膜性心房颤动（房颤）患者缺血性脑卒中危险因素暴露水平及危险因素个体聚集情况，为制定房颤患者脑卒中预防策略提供依据。方法2006年采用两阶段抽样方法，先从北京市城区选择8所三级医院和7所二级医院（社区卫生服务中心），再由内科医生对门诊随机抽取的非瓣膜性房颤患者采取统一问卷调查。结果583例非瓣膜性房颤患者中缺血性脑卒中患者133例，患病率22．8％，其中78例发生在房颤诊断后，与房颤相关的缺血性脑卒中患病率为13．4％。年龄（x。=17．040，P〈0．001）、房颤病程（x2=33．300，P〈0．001）、高血压病（x2=9．933，P=0．002）、糖尿病（x2=8．038，P=0．005）、冠心病（x2=5．046，P=0．025）、血脂异常（x2=8．192，P=0．004）的暴露水平在脑卒中和非脑卒中患者问差异有统计学意义。多因素logistic回归分析显示：年龄、房颤病程、糖尿病、血脂异常增加脑卒中患病危险，OR值分别为1．06、2．08、1．82、1．79，95％CI不包含1。调整年龄、性别、房颤病程的影响后，具有3个和4个危险因素者脑卒中患病危险分别为没有危险因素的4．36倍和4．51倍。结论年龄、房颤病程、糖尿病病史、血脂异常增加房颤患者脑卒中的患病危险，多个危险因素的聚集致脑卒中的患病危险进一步增加；房颤患者预防脑卒中发生除抗凝和抗血小板治疗外，还应有效控制血压、血糖和血脂。

Objective To analyze the level of exposure and cluster of risk factors to stroke for patients with non valvular atrial fibrillation. Methods A questionnaire survey was conducted among 583 patients with non valvular atrial fibrillation, randomly selected from 8 general hospitals and 7 community health service centers located in the 8 districts in Beijing city in 2006. Results 133 patients attacked stroke and the prevalence of stroke in the total 583 patients was 22.8 %. 78 patients attacked stroke after being diagnosed as atrial fibrillation with the prevalence related to atrial fibrillation as 14.3%. The levels of exposure related to age, duration of atrial fibrillation, histories of hypertension, diabetes and dyslipdemia were significantly different between stroke and non-stroke patients （P〈 0.05）. Data from multiple variables logistic regression analysis showed that age, duration of atrial fibrillation, history of dyslipdemia and history of diabetes increased the risk of stroke with odds ratio as 1.06,2.08,1.82,1.79 respectively （95 % CI was not including 1）. The risk of stroke among those having 3 or 4 risk factors was 4.36 and 4.51 times of those without risk factor after adjusting for age, sex and duration of atrial fibrillation. Conclusion Age, duration of atrial fibrillation, history of dyslipdemia and history of diabetes were the main risk factors related to stroke and the clustering of risk factors would further increase the risk. It is important to control blood pressure, blood surge and lipid besides therapy of anticoagulation or antiplatelet for patients with nonvalvular atrial fibrillation.