心房颤动伴高血压患者动态动脉硬化指数与缺血性脑卒中的相关性

Correlation between ambulatory arterial stiffness index and ischemic stroke in patients with atrial fibrillation and hypertension

目的探讨心房颤动(房颤)伴高血压患者动态动脉硬化指数(AASI)与缺血性脑卒中发生的相关性,进一步探讨房颤伴高血压人群中CHA_(2)DS_(2)-VASc-AASI是否比CHA_(2)DS_(2)-VASc对缺血性脑卒中的预测更有优越性。方法共纳入241例符合入组标准的房颤伴高血压患者为研究对象,根据患者本次入院是否有新鲜脑梗塞病灶分为脑卒中组和非脑卒中组。比较两组间的临床资料和AASI的差异,对有统计学意义的因素进行多因素Logistic回归分析,通过绘制ROC曲线分析AASI、CHA_(2)DS_(2)-VASc评分、CHA_(2)DS_(2)-VASc-AASI评分对脑卒中发生的预测价值。结果脑卒中组AASI高于非脑卒中组(P<0.05),经二项分类logistic回归分析结果可得D-二聚体、纤维蛋白原、AASI及CHA_(2)DS_(2)-VASc评分是房颤伴高血压患者脑卒中发生的独立危险因素(P<0.05)。且AASI预测缺血性脑卒中的ROC曲线下的AUC值为0.677,当AASI≥0.475时发生脑卒中的风险最高。CHA_(2)DS_(2)-VASc评分和A_(2)DS_(2)-VASc-AASI评分的AUC值分别为0.760和0.800。结论房颤伴高血压患者AASI与缺血性脑卒中的发生显著相关,通过分析发现房颤伴高血压患者的CHA_(2)DS_(2)-VASc-AASI评分比CHA_(2)DS_(2)-VASc评分对缺血性脑卒中有更高的预测价值。

Objective To explore the correlation between the ambulatory arterial stiffness index(AASI)and the occurrence of ischemic stroke in patients with atrial fibrillation and hypertension,and to further explore whether CHA_(2)DS_(2) VASC AASI is superior to CHA_(2)DS_(2) VASC for the prediction of ischemic stroke in a population with atrial fibrillation and hypertension.Methods A total of 241 patients with AF and hypertension who met the entry criteria were enrolled in the study,and the patients were divided into stroke and non stroke groups according to whether they had fresh infarct lesions on the current admission.The differences of clinical data and AASI between the two groups were compared,and the statistically significant factors were subjected to multivariate logistic regression analysis,and further,the predictive values of AASI,CHA_(2)DS_(2) VASC score,and CHA_(2)DS_(2) VASC AASI score for stroke occurrence were analyzed by plotting ROC curves.Results The stroke group had higher AASI than the non stroke group(P<0.05),and D-dimer,fibrinogen,AASI as well as CHA_(2)DS_(2) VASC score were independent risk factors for incident stroke in AF patients with hypertension according to binomial logistic regression(P<0.05).And the AUC value under the ROC curve of AASI in predicting ischemic stroke was 0.677,with the highest risk of stroke when AASI≥0.475.The AUC values for the CHA_(2)DS_(2) VASC score and A_(2)DS_(2) VASC AASI score were 0.760 and 0.800,respectively.Conclusion AASI in patients with AF and hypertension were significantly associated with the development of ischemic stroke.And by further analysis,we can find that the CHA_(2)DS_(2) VASC AASI score in patients with AF associated with hypertension has a higher predictive value for ischemic stroke than the CHA_(2)DS_(2) VASC score.