非瓣膜性心房颤动患者颈动脉粥样硬化与缺血性卒中的相关性分析

The association between carotid atherosclerosis and ischemic stroke in patients with nonvalvular atrial fibrillation

目的:探讨不同颈动脉粥样硬化指标与非瓣膜性心房颤动(房颤)患者缺血性卒中的相关性。方法:采用病例对照研究方法,选择2015年1月至2017年12月新诊断为缺血性卒中的397例非瓣膜性房颤患者作为病例组(缺血性卒中组),选择同期入院而未诊断为缺血性卒中的3038例非瓣膜性房颤患者作为对照组。比较两组间一般临床资料、颈动脉粥样硬化指标检出率的差异。采用单因素、多因素logistic回归分析颈动脉粥样硬化指标与缺血性卒中的相关性。结果:缺血性卒中组检出颈动脉内膜增厚、颈动脉斑块、稳定性斑块、不稳定斑块、中重度狭窄的比例均高于对照组(82.1%比64.4%、69.3%比50.3%、43.6%比30.6%、25.7%比19.7%、7.3%比4.0%,P值均<0.05)。多因素校正后检出颈动脉内膜增厚、颈动脉斑块、稳定性斑块、不稳定性斑块、中重度狭窄的调查对象既往发生缺血性卒中的危险性分别是未检出颈动脉粥样硬化患者的1.766、2.111、1.892、2.256、1.824倍。结论:颈动脉粥样硬化与非瓣膜性房颤患者缺血性卒中相关,其中颈动脉不稳定斑块与缺血性卒中的相关程度最高。

Objective To investigate the relationship between indicators of carotid atherosclerosis and onset of ischemic stroke in patients with non-valvular atrial fibrillation(NVAF).Methods This is a case-control study,a total of 397 NVAF patients with newly diagnosed ischemic stroke(case group)and 3038 NVAF patients without ischemic stroke(control group)from January 2015 to December 2017 were included in the study.Differences in general clinical features and carotid atherosclerosis indexes between the two groups were compared.Univariate and multivariate logistic regressions were used to analyze the correlation between carotid atherosclerosis indexes and ischemic stroke.Results Proportions of patients with carotid intima thickening,carotid plaque,stable plaque,unstable plaque,and moderate to severe stenosis were higher in the ischemic stroke group than those in the control group(82.1%vs.64.4%,69.3%vs.50.3%,43.6%vs.30.6%,25.7%vs.19.7%,and 7.3%vs.4.0%,respectively,all P<0.05).After adjustment of age,gender,heart failure,hypertension,low density lipoprotein-cholesterol and drug use,multivariate analyses showed that subjects with carotid intima thickening,carotid plaque,stable plaque,unstable plaque,moderate to severe stenosis had 1.766,2.111,1.892,2.256 and 1.824 times the risk for the development of ischemic stroke compared with the subjects without any carotid atherosclerosis indicators.Conclusion Carotid atherosclerosis,especially with unstable carotid plaque,is associated with ischemic stroke in patients with NVAF.