不同类型心房纤颤患者急性缺血性脑卒中的临床特点分析

Analysis of clinical features of acute ischemic stroke in patients with different types of atrial fibrillation

目的心房纤颤（AF）是急性缺血性脑卒中（AIS）的一种重要危险因素。不同类型的AF危险因素及发病机制皆存在差异。比较阵发性心房纤颤（Pa AF）与持续性心房纤颤（Pe AF）患者AIS的临床特点,以明确两者发病机制存在的差别。方法242例AIS患者,其中男性103例,女性139例;年龄53~86岁,平均年龄为78.4岁。根据AF特点分为Pa AF组（57例）与Pe AF组（185例）,分别比较两组患者的基本信息、危险因素、临床特点和影像学特点。结果与Pa AF组相比,Pe AF组患者年龄较大,女性患者所占比例偏高。Pe AF组入院时美国国立卫生院神经功能缺损（NIHSS）评分与出院时改良Rankin量表（m RS）评分皆高于Pa AF组。大脑中动脉（MCA）狭窄在Pa AF患者更普遍,而Pe AF组更多伴随左心房增大。结论与Pa AF相比,Pe AF患者AIS短期预后差。这可能与不同亚型AIS在两组中的不同发病率有关,也与两组患者左心房产生的血栓结构及体积存在差异相关。

Objective To compare the clinical characteristics of acute ischemic stroke（AIS） in patients with paroxysmal atrial fibrillation（Pa AF） or persistent atrial fibrillation（Pe AF）, and clarify the difference in underlying pathogenesis. Methods A total of242 AIS patients were enrolled, which included 103 males and 139 females, aged 53- 86 years old with mean age of 78.4. They were divided into Pe AF group（n = 185） and Pa AF group（n = 57） by different AF characteristics. The demographic characteristics,cerebrovascular risk factors, clinical, echocardiography and neuroradiological data were compared between 2 groups. Results Compared with Pa AF group, the patients in Pe AF group were older than those in Pa AF group, and the proportion of females in Pe AF group was higher than that in Pa AF group. The Pe AF group was associated with higher National Institutes of Health Stroke Scale（NIHSS） scores on admission and higher modified Rankin Scale（m RS） at discharge. The middle cerebral artery（MCA） stenosis in Pa AF group were much more common than that in Pe AF group, and larger left atrial dimension（LAD） existed in Pe AF group.Conclusion It is demonstrated that AIS patients with Pe AF have poorer short-term outcome than Pa AF. It could be related to different AIS subtypes with different incidence, and thrombus structure and volume difference with left atrial between 2 groups.