急性缺血性脑卒中伴心房颤动的预后研究

Outcomes of ischemic stroke patients with atrial fibrillation

目的探讨合并心房颤动pLF）的急性缺血性脑卒中患者的预后。方法选择天津市环湖医院神经内科自2005年6月至2013年12月连续收治的急性缺血性脑卒中患者6695例，依据合并AF有无将其分为AF组（n=583）及非AF组（n=6112）。收集患者脑卒中亚型、脑卒中严重程度、既往病史、脑卒中危险因素、实验室检查结果及发病后3、12、36个月预后等临床资料．分析2组患者发病后3、12和36个月死亡率、预后不良发生率及复发率等的差异。结果AF患病率为8．7％。AF组平均发病年龄及女性（45．8％vs.33．0％）、重度脑卒中（34．8％vs.8.3％1比例显著高于非AF组，差异均有统计学意义（P〈0．05）。AF组高血压（63．8％vs.73．3％）、糖尿病（24．9％vs.32.3％）、血脂异常（26．1％vs.31．5％）、动脉狭窄（17．2％vs.23．4％）、吸烟（22．6％vs.39．0％）及饮酒（7．5％vs.18．9％）比例显著低于非AF组，差异均有统计学意义（P〈0．05）。多因素分析显示：校正发病年龄、性别、脑卒中亚型、脑卒中严重程度及其他相关危险因素后，AF组与非AF组发病后3个月的死亡率、预后不良发生率比较差异无统计学意义（P〉0．05），但AF组复发率显著高于非AF组，差异有统计学意义（P〈0．05）；AF组发病后12、36个月的死亡率、预后不良发生率及复发率显著高于非AF组，差异均有统计学意义（P〈0．05）。结论合并AF的急性缺血性脑卒中患者远期预后明显较差，故应对其开展规范化的抗凝治疗以降低脑卒中复发率、减少脑卒中负担。

Objective To assess the outcomes ofischemic stroke patients with atrial fibrillation （AF）. Methods Six thousand six hundred and ninety-five patients with acute ischemic stroke, admitted to our hospital from May 2005 to December 2013, were recruited consecutively. These patients were divided into combined AF group （n=583） and non-combined AF group （n=6112）. The clinical data, including stroke subtypes, stroke severity, risk factors of stroke, NIHSS scores and Barthel index, and outcomes, including mortality, unfavourable prognosis and recurrence at 3, 12, and 36 months after stroke were analyzed. Results The prevalence rate of AF in the patients enrolled in this study was 8.7% （583/6695）. There was a higher frequency of AF in female than that in male, with significant difference （45.8% vs. 33.0%, P〈0.05）. The patients from combined AF group were older than those without AF. The percentage of severe stroke in AF patients （34.8%） was significantly higher than that in non-combined AF group （8.3%, P〈0.05）. The patients with AF were less likely than the patients without AF to have hypertension （63.8% vs. 73.3%）, diabetes （24.9% vs. 32.3%）, dyslipidemias （26.1% vs. 31.5%）, artery stenosis （17.2% vs. 23.4%）, current smoking （22.6% vs. 39.0%）, and alcohol consumption （7.5 % vs. 18.9%）, with significant differences （P〈0.05）. After adjusting age, gender, stroke subtype, and severity, and risk factors, multivariate analysis showed that there was a higher recurrence risk in combined AF group at 3 months after stroke than that in non-combined AF group （P〈0.05）; patients with AF had significantly higher mortality, dependency, and recurrence rates at 12 and 36 months after stroke than those without AF （P〈0.05）. Coneluslon The long-term prognosis of patients with stroke complicated with AF is poor; therefore, normalized anticoagulant therapy should be taken to decrease the recurrence rate and burdens of stroke in China.