房颤患者的脑血管功能变化特征及脑卒中风险分析

The characteristics of cerebrovascular function and the analysis of stroke risk in patients with atrial fibrillation

目的研究房颤患者的脑血管血流动力学变化特征和脑卒中发病风险,为脑卒中风险评估提供参考依据。方法选择2003年4月至2004年12月上海市奉贤区光明社区、钱桥社区建立的10 565例脑卒中危险因素队列人群中基线调查时明确诊断的99例房颤患者作为房颤组,以1∶2的比例在队列研究人群中随机选择年龄、性别一致的198例无房颤者作为对照组,由课题组心内科医师和经过专门培训的2名技师进行心电图及脑血管血流动力学指标(CVHI)检测,比较两组调查对象CVHI的差异,评估脑血管功能积分值作为预测因子与脑卒中发病风险的关系。用SPSS 17.0软件进行t检验、χ~2检验,分析危险因素与疾病病因学联系,计算房颤组与对照组脑卒中发病率的比值(RR值)。结果房颤组脑血管功能平均积分值为(64.59±31.77)分,低于对照组[(74.98±28.61)分],差异有统计学意义(P<0.01)。房颤组和对照组脑血管功能积分值低于最佳截断点(75分)的比例分别为55.6%和36.9%,差异有统计学意义(P<0.01)。房颤组左侧最大流速,右侧平均流速、最大流速、最小流速、舒张压与临界压差值低于对照组,右侧外周阻力高于对照组,差异均有统计学意义(P<0.05,P<0.01)。脑血管功能积分值降低与脑卒中发病风险升高有显著的病因学联系,RR值为3.96,95%CI:1.09~14.30,其作用强度明显高于房颤病史(RR=2.00,95%CI:0.66~6.04)。结论房颤患者有明显的脑血管功能损害,脑血管功能积分值对脑卒中发病风险的预测作用比房颤病史更强。

Objective To study the characteristics of cerebrovascular hemodynamic indexes（CVHI） changes and stroke risk in patients with atrial fibrillation（AF）, and to provide the reference for evaluating the stroke risk. Methods From April of 2003 to December of 2004, 99 AF patients were selected as AF group and 198 non-AF subjects as control group（matched with age and gender） from 10 565 cases in a stroke risk factor cohort study in Guangming and Qianqiao communities. ECG and CVHI were measure for two groups by two specially trained technicians, and the differences of CVHI were compared between two groups, the assessing cerebrovascular function score was served as a prediction factor for stroke risk. The t test and chi-square test were used to analyze the risk factors and to calculate the stroke relative risk（RR） between AF group and control group. The used software was SPSS 17.0. Results Average cerebrovascular function score in AF group was 64.59±31.77, which was significantly lower than that（74.98±28.61） in control group（P〈0.01）. The proportions in AF group and control group with cerebrovascular function score〈75 score were 55.6% and 36.9%, respectively. There was significant difference between two groups（P〈0.01）. The CVHI indexes（such as left side carotid Vmax, right side carotid Vmean, Vmax, Vminand DP） in AF group were significantly lower than those in control group; and the peripheral resistance of right side in AF group was significantly higher than that in control group. There was significant difference between two groups（P〈0.05, P〈0.01）. There was significant etiological relationship between low cerebrovascular function score and stroke risk（RR=3.96, 95%CI： 1.09-14.30）. The intensity of the score for stoke risk was significantly higher than that of AF history（RR=2.00, 95%CI=0.66~6.04）. Conclusion There is an obvious cerebral vascular function impairment in AF patients, and prediction value of CVHI score for stroke risk seems stronger than that of AF history.