非瓣膜性房颤患者缺血性卒中的危险因素及其与短期预后的关系

Risk factors of ischemic stroke in the patients with non-valvular atrial fibrillation and their relationship with short-term prognosis

目的探讨非瓣膜性房颤(NVAF)患者缺血性卒中(IS)的危险因素及其与短期预后的关系。方法选取2017年9月至2019年9月我院收治的NVAF合并IS患者113例为观察组,选取同期未合并IS的NVAF患者200例为对照组。记录两组临床资料及颈动脉粥样硬化(CAS)检出率。采用多因素Logistic回归分析CAS与IS的关系,记录IS短期预后的危险因素,采用偏相关分析评估CAS与IS短期预后的关系。结果观察组年龄、收缩压、舒张压、高血压、抗血小板药物及他汀类药物用药率均高于对照组(P<0.05)。观察组动脉内中膜厚度(IMT)增厚(78.7%vs. 62.00%)和颈动脉斑块检出率(69.03%vs. 48.00%)均高于对照组(P<0.05)。IMT增厚、颈动脉斑块、稳定性斑块、不稳定性斑块均是CAS患者发生IS的危险因素(P<0.05)。IS短期预后情况的年龄、收缩压、舒张压、高血压、他汀类药物用药率比较,差异均有统计学意义(P<0.05)。卒中再发、转归不佳、死亡情况的抗血小板药物用药率比较,神经功能缺损、转归不佳、死亡情况的颈动脉斑块检出率比较,差异均有统计学意义(P<0.05)。抗血小板药物和他汀类药物均与卒中再发、神经功能缺损、转归不佳、死亡均呈负相关(r=-0.631、-0.572、-0.610、-0.514,P<0.05;r=-0.729、-0.605、-0.636、-0.537,P<0.05),颈动脉斑块与神经功能缺损、转归不佳、死亡均呈正相关(r=0.580、0.553、0.625,P<0.05)。结论 NVAF患者具有较大的CAS风险,且与IS的发生密切相关。同时,CAS与NVAF患者IS短期预后具有一定的关系,CAS患者发生不良预后的几率更大。

Objective To explore the risk factors of ischemic stroke( IS) in the patients with non-valvular atrial fibrillation( NVAF) and their relationship with short-term prognosis. Methods A total of 113 NVAF patients combined with IS admitted to our hospital from September 2017 to September 2019 were selected as the observation group. At the same time,200 NVAF patients without IS admitted to our hospital in the same period were selected as the control group. The clinical data and carotid atherosclerosis( CAS) detection rate of the two groups were recorded. Multivariate Logistic regression was used to analyze the relationship between CAS and IS,the risk factors of short-term prognosis of IS were recorded,and partial correlation analysis was used to evaluate the relationship between CAS and short-term prognosis of IS. Results The age,systolic blood pressure,diastolic blood pressure,hypertension,the application rates of antiplatelet drugs and statins in the observation group were all significantly higher than those in the control group,and the differences were statistically significant( P< 0. 05). The thickening of intima-media thickness( IMT,78. 7% vs. 62. 00%) and the detection rate of carotid plaque( 69. 03% vs. 48. 00%) in the observation group were higher than those in the control group( P< 0. 05). The thickening of IMT,carotid plaque,stable plaque,and unstable plaque were all risk factors for IS in CAS patients( P< 0. 05). There were statistically significant differences in age,systolic blood pressure,diastolic blood pressure,hypertension and the application rates of statins drug in the short-term prognosis of IS( P< 0. 05). There were statistically significant differences in the application rates of antiplatelet drugs in the patients with IS relapse,adverse outcomes and death,and there were also statistically significant differences in the detection rate of carotid plaque in the patients with deterioration of neurological function,adverse outcomes and death( P<0. 05). Antiplatelet drugs and statins drugs were negatively correlated with IS relapse,the deterioration of neurological function,adverse outcomes and death( r =-0. 631,-0. 572,-0. 610,-0. 514,P<0. 05 and r =-0. 729,-0. 605,-0. 636,-0. 537,P< 0. 05),and carotid plaques were positively correlated with deterioration of neurological function,adverse outcomes and death( r = 0. 580,0. 553,0. 625,P< 0. 05). Conclusions The patients with NVAF have a higher risk of CAS,which is closely related to the occurrence of IS. At the same time,CAS has a certain relationship with the short-term prognosis of IS in the patients with NVAF,and the patients with CAS have a greater chance of developing poor prognosis.