陕北地区非瓣膜病性心房颤动患者缺血性脑卒中的多因素分析

Mult-factor analysis of ischemic stroke in patients with non valvular atrial fibrillation from northern Shaanxi region

目的:对陕北地区非瓣膜病性心房颤动患者缺血性脑卒中的危险因素进行多因素临床分析。方法:选择非瓣膜性心房颤动患者551例为研究对象,分为非瓣膜病性心房颤动组(432例)及非瓣膜病性心房颤动伴缺血性脑卒中组(119例)。将收集到的各项临床及辅助检查资料先进行单因素分析,再将单因素分析中具有显著性差异的因子进行多因素Logistic回归分析,得出危险因素,建立回归方程。结果:非瓣膜病性房颤患者发生脑卒中的独立危险因素为:年龄(>60岁),房颤病程(>1年),左房附壁血栓,血浆凝血酶原时间国际标准化比值(INR)降低,高敏C反应蛋白(hsCRP)水平升高,P均<0.05。建立了预测非瓣膜病性心房颤动患者脑卒中发生概率的Logistic回归方程。工作特征曲线(ROC)显示年龄(>60岁),房颤病程(>1年),hsCRP水平升高有一定预测价值(曲线下面积均>0.7);左房附壁血栓,INR降低预测价值较高(曲线下面积均>0.9)。结论:本研究所探讨出的危险因素及回归方程对于非瓣膜病性房颤伴缺血性脑卒中高危患者的筛选及早期的一级预防有一定的指导意义。

Objective： To make a multi-factor analysis of risk factors for ischemic stroke in patients with non valvular atrial fibrillation （NVAF） from northern Shaanxi region. Methods： A total of 551 NVAF patients were enrolled and divided into NVAF group （n = 432） and NVAF ＋ ischemic stroke group （n = 119）. At first, single factor analysis was performed on all collected clinical and auxiliary examination data, and then multi- factor Logistic regression analysis was performed on those factors with significant difference in single factor analysis and establish regression equation. Results： Independent risk factors of stroke in NVAF patients were age （〉60 years）, course of atrial fibrillation （〉1 year）, left atrial parietal thrombus, decreased international normalized ratio （INR） and increased high sensitive C reactive protein （hsCRP） level, P〈0.05 all. Logistic regression equation, which predicted probability happening cerebral stroke in NVAF patients, was established. Performance curve （ROC） indicated that age （〉60 years）, course of atrial fibrillation （〉1 year） and increased hsCRP possessed certain predictive value （AUC〉0.7 all） ; left atrial parietal thrombus and decreased INR possessed high predictive value （AUC〉0.9 both）. Conclusion： Risk factors and regression equation explored in this study could provide some guidance for screening and early primary prevention for patients with non valvular atrial fibrillation in high - risk of ischemic cerebral stroke.