心房颤动脑梗死患者OCSP临床分型与预后的研究

Classification and prognosis of cerebral infarction patients with atrial fibrillation according to OCSP criteria

目的探讨心房颤动脑梗死患者的牛津郡社区卒中项目OCSP临床分型及预后。方法采用前瞻性队列研究,将1019例脑梗死患者分为心房颤动脑梗死组(房颤组)91例和无心房颤动脑梗死组(无房颤组)928例;又按OCSP临床分型标准分为完全前循环梗死44例、部分前循环梗死552例、后循环梗死300例和腔隙性梗死123例。进行随访并比较2组预后。结果与无房颤组比较,房颤组患者完全前循环梗死比例明显增加,后循环梗死、腔隙性梗死比例明显减少(P<0.01);美国卫生研究院卒中量表评分及改良Rankin评分明显升高(P<0.05,P<0.01)。2组部分前循环梗死比例差异无统计学意义(P>0.05)。房颤组患者预后不良率为71.4%,发病1年时复发率为31.3%,病死率为30.0%;无房颤组患者预后不良率38.4%,发病1年时复发率为16.5%,病死率为10.3%,差异有统计学意义(P<0.01)。结论心房颤动脑梗死患者较无心房颤动患者预后差。

Objective To investigate the classification and prognosis of cerebral infarction patients with atrial fibrillation（AF） according to OCSP criteria.Methods One thousand and nineteen cerebral infarction patients with AF were divided into AF group（n=91） and non-AF group（n=928） according to the prospective cohort study and into total anterior circulation infarction（TACI） group（n=44）,partial anterior circulation infarction（PACI） group（n=552）,posterior circulation infarction（POCI） group（n=300）,and lacunar circulation infarction（LACI） group（n=123） according to the OCSP criteria.The patients were followed up,during which their prognosis was compared.Results The percentage of TACI was significantly higher while that of POCI and LACI was significantly lower in AF group than in non-AF group（P〈0.01）.The modified Rankin score and NIHSS were significantly higher in AF group than in non-AF group（P〈0.01）.No significant difference was found in PACI between the two groups.The unfavourable prognosis rate,recurrent rate and mortality were significantly higher in AF group than in nonAF group（71.4% vs 38.4%,31.3% vs 16.5%,30.0% vs 10.3%,P〈0.01）.Conclusion The prognosis of cerebral infarction patients with AF is poorer than that of those without AF.