急性脑梗死伴发或并发心脏病对预后影响的前瞻性研究

Cardiac Dysfunction Concomitant with Acute Cerebral Infarction and its Effect of Outcome:A Prospective Study of 150 Consecutive Cases

目的观察急性缺血性卒中患者入院时的心脏伴发、并发症的发生情况,以及住院期间的变化与转归情况,探讨其对患者近期和远期预后的影响。方法在上海17家二级、三级医院中,连续收集发病48h内入院的150例急性脑梗死患者,记录患者基本情况、既往心脑血管病史、牛津郡社区卒中项目(Oxfordshire Community Stroke Project Classification,OCSP)分型和TOAST(the Trial of ORG 10172 in Acute Stroke Treatment)分型。分别在入院时和入院第7天对所有入选患者进行常规12导联心电图、心肌酶谱、心肌标志物检查。选取出院当天和发病第(90±2)天这两个时间点,分别予以改良Rankin’s评分(mRS),作为评估近期和远期预后的指标。结果(1)急性脑梗死患者中,99例(72.8%)存在心电图异常,90例(81.8%)出现心肌酶谱和心肌标志物的改变。(2)近期预后不良患者中出现心电图异常的比例远远高于预后正常患者(82.0%vs65.3%,P=0.030);其中入院时心电图的异常在近期预后不良和良好的两组患者中的比例显著不同(74.2%vs48.1%,OR=2.451,P=0.002),但在远期预后中没有统计学差异。(3)心肌酶谱、心肌标志物异常发生率在近期预后中没有明显的差异性,而在远期预后中,预后不良患者心肌酶谱、心肌标志物异常率远高于预后良好患者(90.2%vs67.1%,OR=4.628,P=0.005),以入院时差异为显著。(4)心电图异常以心肌缺血性表现为主,而心肌酶谱、心肌标志物的变化以乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶和肌红蛋白为显著。结论急性脑梗死伴发心电图和心肌酶谱异常及心肌标志物的发生率较高。脑梗死后心电图及心肌酶谱和心肌标志物的异常,尤其是在急性脑梗死48h内出现的异常均与患者的预后密切相关。急性脑梗死伴发心脏功能紊乱是预后不良的重要因素。

Objective To investigate the occurrence rates of cardiac complication after acute cerebral infarction, as well as the impact of cardiac complication on short-term and long-term effect. Methods We selected 150 consecutive inpatients suffering from cerebral infarction from 17 hospitials in shanghai. All these inpatients were examined within 48 hours of the onset of symptoms. The tests were performed on their admission to hospital, and thereafter on the seventh day. These tests incldue 12-lead ECG, serum level of enzymes including lactate dehydrogenase(LDH), creatine kinase(CK), creatine kinase isoenzyme-MB(CK-MB), aspartic acid transaminase(AST), troponin T(TnT), myoglobin(MHb). The patients will be followed up when they were discharged from hospitals using mRS, and 90±2 days later. Results Our study showed that 72.8% ECG were already abnormal while 81.8% in serum enzymes in patients with acute cerebral infarct. The abnormal ECG detected in patients with unfavourable short-term outcome reached to 82.0%, with a signifi cant prevalence compared to 65.3% in favourable short-term outcome ones(P<0.05). Abnormality of serum level of enzymes showed no significant difference between patients with favourable or unfavourable short-term outcomes. While 90 days later, the serum level of enzymes indicated a higher ratio of abnormal conditions in patients with unfavourable outcome than those with favourlable outcome, especially the enzymes test taken on admission.Conclusion Our results indicate the high incidence of cardiac complication after acute cerebral infarction, and it will lead to an unfavourable prognosis of cerebral infarction, espetially when the abnormalisitions apperent during the fi rst 48 hours.