老年心脏起搏器植入患者急性脑卒中相关危险因素的病例对照研究

A case-control study on the risk factors of acute stroke in elderly patients with pacemaker

目的探讨老年心脏起搏器植入患者发生急性脑卒中的相关危险因素并分析其影响因素。方法随机选取于2014年9月至2017年2月心内科或神经内科收治的年龄大于或等于60岁心脏起搏器植入患者合并急性脑卒中113例,按照年龄±5岁、同性别、NIHSS评分严重程度相同、同期入院的无心脏起搏器植入脑卒中患者进行1︰1配对入组113例。对226例患者的一般资料、疾病特征、合并症、临床治疗方案及临床转归等资料进行前瞻性研究,并对有房颤的患者进行CHA2DS2-VASc评分。对226例患者脑卒中的相关危险因素进行评价,并采用二元logistic回归分析影响老年心脏起搏器植入患者发生急性脑卒中的相关危险因素。结果研究组和对照组相比,高血压病、糖尿病、冠心病、心脏瓣膜病、房颤史、吸烟史、颈动脉斑块、高同型半胱氨酸血症相比较无统计学意义;研究组和对照组相比,年龄、年龄大于或等于75岁、既往心力衰竭、脑卒中发作史、BNP、新发或无症状房颤差异有统计学意义(P<0.05)。CHA2DS2-VASc评分:226例患者中有105例房颤患者(46.5%),新发或无症状房颤研究组高于对照组(P<0.05),两组房颤患者CHA2DS2-VASc评分无统计学差异。对两组差异有统计学意义的因素进行二元logistic回归分析,年龄大于或等于75岁(P=0.0270,OR=3.427)、心力衰竭史(P=0.0314,OR=2.250)、BNP(P=0.0120、OR=12.262)、新发或无症状房颤(P=0.0071,OR=18.305)与急性脑卒中相关。结论老年心脏起搏器植入患者发生急性脑卒中与患者心力衰竭和新发或无症状房颤有关,老年心脏起搏器植入患者预防急性脑卒中需密切关注患者心功能和新发或无症状房颤。

Objective To explore the risk factors of acute stroke in elderly patients with pacemaker and to analyze its influencing factors.Methods A total of113patients with acute stroke equipped with pacemaker in this hospital during September2014to February2017were randomly selected for this study,and.113elderly patients with acute stroke but without pacemakers were matched by1:1according to age and NIHSS scores admitted in the same period were allocated in control group.Their age range was not less than60years old.The clinical data including general data,characteristics of the disease,complications,regimen of clinical medication and outcome of these226patients were prospectively studied and patients complicated with auricular fibrillation were assessed and evaluated by CHA2DS2-VASc scoring.The risk factors of acute stroke were assessed in these226patients,and the influencing factors for acute stroke in patients with pacemaker were evaluated by dual logistic regression analysis.Results In comparison with the study group and control group,hypertension,diabetes mellitus,coronary heart disease,valvular heart disease,history of auricular fibrillation(AF),smoking,carotid atery plaques,hyperhomocystinemia,there was no statistical significance.In comparison with age range,there was no less than75years old,history of heart failure,history of stroke,level of BNP,onset of or asymptomatic AF,and the difference was statistically significant(P<0.05).CHA2DS2-VASc scores in:105patients with AF occupied46.5%of226patients.Patients with onset or asymptomatic AF in study group were more numerous than those in control group(P<0.05).But there was no statistical significance in CHA2DS2-VASc scores.There was statistically significant difference between these two groups by dual logistic regression analysis,which showed that age no less than75(P=0.0270,OR=3.427),history of heart failure(P=0.0314,OR=2.250),BNP(P=0.0120,OR=12.262)and onset of asymptomatic AF(P=0.0071,OR=18.305)were associated with acute stroke.Conclusion This study showed that the risk factors of acute stroke in elderly patients with pacemakers were heart failure and onset of asymptomatic AF.The risk of acute stroke in elderly patients with pacemaker,the clinicians should pay more attention on their cardiac function and the onset of AF or asymptomatic AF.