非瓣膜性心房颤动患者并发缺血性脑卒中的多因素分析

The risk factors analysis for ischemic stroke in chinese patients with nonvalvular atrial fibrillation

目的 探索非瓣膜性心房颤动患者并发缺血性脑卒中的危险因素及保护因素。方法 对入选的901例非瓣膜性心房颤动患者进行随访3年,收集其一般状况、相关疾病病史和服用药物的临床资料,按照随访期间是否发生缺血性脑卒中分为卒中组（n=39）和非卒中组（n=862）,并应用多因素Logistic回归分析其发生卒中的危险因素及保护因素。结果 发生缺血性脑卒中的危险因素有年龄（OR=1.087,95%CI：0.240-1.315）、心力衰竭病史（OR=2.245,95%CI：1.033-4.880）、缺血性卒中或短暂性脑缺血发作病史（OR=5.265,95%CI：2.545-10.889）、其他全身性栓塞病史（OR=5.034,95%CI：1.307-19.386）、利尿剂的应用（OR=3.505,95%CI：1.715-7.165）;保护因素有血管紧张素受体阻滞剂（ARB）的应用（P〈0.05,OR=0.316,95%CI：0.122-0.815）。结论 年龄、心力衰竭、缺血性卒中或短暂性脑缺血发作、其他全身性栓塞病史,以及利尿剂的应用,是非瓣膜性心房颤动患者并发缺血性脑卒中的独立危险因素,而ARB的应用是保护因素。

Objective To investigate the risk factors of ischemic stroke in Chinese patients with nonvalvular at- rial fibrillation. Methods According to the occurrence of ischemic stroke in three-years follow-up period among 901 pa- tients with nonvalvular atrial fibrillation were divided into two groups ： Stroke group （ n = 39） and Non - Stroke group （ n = 862）. Data for demographics, medical histories and complications, concurrent medications were recorded. Results the risk factors of ischemic stroke in patients with nonvalvular atrial fibrillation are age（ OR = 1. 087,95% CI：O. 240 - 1.315 ）, medical history of heart failure （ OR = 2.245,95 % CI： 1. 033 - 4. 880）, ischemic stroke or TIA （ OR = 5. 265, 95% CI：2. 545 - 10.889）, other systemic embolism（ OR = 5. 034,95% CI： 1. 307 - 19. 386） and diuretic （ OR = 3. 505, 95% CI： 1. 715 - 7. 165）. While application of ARB（ OR = 0. 316,95% CI：0. 122 - 0. 815 ） was the protective factor. Conclusion Age, medical history of heart failure,ischemic stroke or TIA,other systemic embolism and diuretic are the risk factors of ischemic stroke in patients with nonvalvular atrial fibrillation,while protective factor is ARB.