左房增大增加原发性高血压患者发生缺血性脑卒中的危险

Left Atrial Diameter Enlargement Aggravates the Risk of Ischemic Stroke in Essential Hypertensive Patients

目的探讨左房内径及其各参数对原发性高血压(EH)患者发生缺血性脑卒中(IS)的预测作用,为EH患者脑卒中的防治提供依据。方法收集住院EH患者950例,分为EH非IS组与EH+IS组,采用多因素分析方法探讨EH患者IS发生与左房内径等因素的相关性,比较左房内径各参数对IS的预测作用。结果共收入EH无脑卒中并发症患者624名,EH+IS组326名。通过logistic条件逐步回归分析,发现EH患者发生IS的独立危险因素为糖尿病(OR=1.701,P=0.027),血清总胆固醇(TC,OR=1.415,P=0.001),血清纤维蛋白原(Fg,OR=1.172,P=0.05),左室后壁厚度(PWT,OR=1.312,P=0.001),左房内径(LAD,OR=1.398,P=0.001),二尖瓣口舒张早期和舒张晚期流速峰值比值(E/A)(OR=0.024,P=0.001)。排除其他影响因素[如年龄、性别、体质量指数(BMI)、吸烟、饮酒史、糖尿病、TC、Fg、PWT]后,左房内径仍与IS相关(OR=1.209)。不同左房参数在EH病人发生IS的危险评估依次为LAD/体表面积(OR=1.291)>LAD/身高(OR=1.274)>LAD(OR=1.209)。结论左房内径能独立预测EH患者发生IS的危险。

Objective To evaluate the association between echocardiographic left atrial diameter（LAD） and ischemic stroke（IS） in hypertensive patients. Methods This cohort study was retrospectively conducted in 326 hypertensive patients with new onset IS and 624 hypertensive patients without IS. LAD was measured by echoeardiography. IS was confirmed by CT or MRI. Results Logistic regression analysis revealed diabetes [DM, odds ratio（ OR） = 1. 701, P = 0. 027], serum total cholesterol （TC, OR=1. 415, P = 0. 001 ）, serum fibrinogen （Fg, OR=1. 172, P=0.05）, LVPW thickness （PWT, OR=1.312, P=0.001）, LAD（OR=1.398, P=0.001）, E/A （OR = 0. 024, P = 0.001 ） were independent risk factors for IS in hypertensive patients. After adjusting for confounding factors（such as age, gender, BMI, smoke, drinking, DM, TC, Fg and PWT）, LAD remained significantly correlated with IS（OR= 1. 209）. The sequence of importances in LA parameters for predicting IS in hypertensive patients among was： LAD/BSA（OR=1. 291）〉LAD/H （OR=1. 274）〉LAD（OR=1. 209）. Conclusion Left atrial diameter was independent risk factor for ischemic stroke in hypertensive patients.