心房颤动患者复发性缺血性卒中的危险因素

Risk factors for recurrent ischemic stroke in patients with atrial fibriUalion

目的探讨心房颤动患者复发性缺血性卒中的危险因素。方法回顾性纳入合并心房颤动的缺血性卒中患者，收集其人口统计学和临床资料，对首发卒中组与复发性卒中组的卒中相关危险因素进行比较，采用多变量logistic回归分析确定心房颤动患者复发性缺血性卒中的独立危险因素。结果共纳入504例合并心房颤动的缺血性卒中患者，其中男性245例（48.6%），女性259例（51.4%），平均年龄（76.67±8.26）岁；首发卒中组314例（62.3%），复发性卒中组190例（37.7%）。复发卒中组高血压（78.9%对69.4%；χ^2＝5.446，P＝0.020）、糖尿病（38.9%对26.8%；χ^2＝8.181，P＝0.004）和年龄〉75岁（68.9%对60.2%；χ^2＝3.915，P＝0.048）的患者比例以及基线收缩压[（153.30±26.02）mmHg对（148.13±26.40）mmHg，1 mmHg＝0.133 kPa；t＝－2.141，P＝0.033]均显著高于首发卒中组。多变量logistic回归分析表明，高血压[优势比（odds ratio, OR）1.734，95%可信区间（confidence interval, CI）1.121～2.682；P＝0.013]、糖尿病（OR 1.757，95% CI 1.188～2.597；P＝0.005）、年龄〉75岁（OR 1.680，95% CI 1.132～2.494；P＝0.010）是心房颤动患者复发性缺血性卒中的独立危险因素。结论高血压、糖尿病和年龄〉75岁是心房颤动患者复发缺血性卒中的独立危险因素。

Objective To investigate the risk factors for recurrent isehemic stroke in patients with atrial fibrillation. Methods The ischemic stroke patients with atrial fibrillation were enrolled retrospectively. Their demographic and clinical data were collected. The relative risk factors for strokes were compared in the first-ever stroke group and the recurrent stroke group. Multivariate logistic regression analysis was used to determine the independent risk factors for recurrent ischemic stroke in patients with atrial fibrillation. Results A total of 504 ischemic stroke patients with atrial fibrillation were enrolled, including 245 males （48. 6%）. and 259 females （51.4%）. The average age was 76. 67 ± 8.26 years. There were 314 patients （62.3%） in the first-ever stroke group and 190 （37. 7%） in the recurrent stroke group. The proportions of hypertension （78.9% vs. 69. 4% ; χ^2 = 5. 446, P = 0. 020）, diabetes mellitus （38.9% vs. 26. 8% ; χ^2= 8. 181, P =0. 004）, and age 〉75 years （68.9% vs. 60. 2% ;χ^2 =3. 915, P =0. 048）, as well as the baseline systolic blood pressure （153.30 ± 26.02 mmHg vs. 148. 13 ± 26. 40 mmHg, 1 mmHg = 0. 133 kPa; t = -2. 141, P= 0. 033） in the recurrent stroke were significantly higher than those in the first-ever stroke group. Multivariable logistic regression analysis showed that hypertension （odds ratio [ OR] 1. 734, 95% confidence interval [CI] 1. 121-2. 682; P=0. 013）, diabetes （OR 1. 757, 95% CI 1. 188-2. 597; P=0. 005）, and age 〉75 years （OR 1. 680, 95% C1 1. 132-2.494; P = 0. 010） were the independent risk factors for recurrent ischemic stroke in patients with atrial fibrillation. Conclusion Hypertension, diabetes, and age 〉 75 years were the independent risk factors for recurrent ischemic stroke in patients with atrial fibrillation.