左心房大小对冠心病患者合并缺血性脑卒中的影响研究

Influence of Left Atrial Size on the Occurrence of Ischemic Cerebral Infarction in Patients With Coronary Heart Disease

目的探讨左心房大小对冠心病(CHD)患者合并缺血性脑卒中(IS)的影响。方法选取2009年1月—2015年1月到中山大学附属第五医院就诊的CHD患者387例。根据是否合并IS,将患者分为CHD+IS组(n=201)和CHD组(n=186)。收集两组患者的一般资料,并进行超声心动图检查。采用二分类Logistic回归分析探讨CHD患者合并IS的影响因素,采用受试者工作特征(ROC)曲线探讨各影响因素的预测价值。结果两组患者性别、吸烟史比例、平均体表面积、合并糖尿病和高脂血症比例、用药情况比较,差异无统计学意义(P>0.05);CHD+IS组患者的平均年龄、合并高血压比例及颈动脉斑块比例高于CHD组,差异有统计学意义(P<0.05)。两组患者左心室内径(LVD)比较,差异无统计学意义(P>0.05);CHD+IS组患者的左心房内径(LAD)、左心室质量(LVW)、左心房内径指数(LADi)高于CHD组,左心室射血分数(LVEF)低于CHD组,差异有统计学意义(P<0.05)。二分类Logistic回归分析结果显示,高血压、颈动脉斑块、LAD及LADi对CHD患者合并IS的影响有统计学意义(P<0.05),ROC曲线下面积(AUC)分别为0.522、0.592、0.859、0.864(P<0.05)。结论高血压、颈动脉斑块、LAD及LADi是CHD患者合并IS的影响因素,其中LADi的预测价值较大,建议临床上将左心房大小作为CHD患者合并IS的预测指标。

Objective To investigate the influence of left atrial size on the occurrence of ischemic stroke（ IS） in patients with coronary heart disease（ CHD）. Methods From January 2009 to January 2015,we enrolled 387 patients who received treatment in the Fifth Affiliated Hospital of Sun Yat- sen University. According to whether the patients were combined with IS,the patients were divided into CHD ＋ IS group（ n = 201） and CHD group（ n = 186）. General data of the two groups were collected,and echocardiography was conducted. Binary Logistic regression analysis was conducted on the influencing factors for the occurrence of IS in CHD patients. ROC curve was employed to investigate the predictive value of each influencing factor. Results The two groups were not significantly different in gender,proportion of patients with smoking history,average body surface area,the proportion of patients combined with diabetes,the proportion of patients combined with hyperlipemia,and drug administration（ P〉0. 05）; CHD ＋ IS group had higher average age, higher proportion of patients combined with hypertension and higherproportion of patients combined with carotid plaque than CHD group（ P〈0. 05）. The two groups were not significantly different in LVD（ P〉0. 05）; CHD ＋ IS group was higher in LAD,LVW and LADi and lower in LVEF than CHD group（ P〈0. 05）. Binary Logistic regression analysis showed that hypertension, carotid plaque, LAD and LADi had significant influence on the occurrence of IS in CHD patients,and the AUC were 0. 522,0. 592,0. 859,0. 864（ P〈0. 05）.Conclusion Hypertension,carotid plaque,LAD and LADi are influencing factors for the occurrence of IS in CHD patients,and LADi has larger predictive value. It is recommended that left atrial size be considered as a predictive index for IS in CHD patients.