进展性房间传导阻滞对缺血性脑卒中患者预后的影响

Effects of advanced interatrial block on prognosis of patients with IS

目的 探讨进展性房间传导阻滞对缺血性脑卒中患者预后的影响。方法 回顾性分析2019年1月~2021年1月南阳医学高等专科学校第一附属医院及苏州市立医院北区门诊及住院治疗的缺血性脑卒中患者237例,根据患者首次脑卒中到随访结束期间是否发生房间传导阻滞及阻滞程度分为无房间传导阻滞组133例,不全性房间传导阻滞组56例,进展性房间传导阻滞组48例。根据美国国立卫生研究院卒中量表评分评估患者神经功能缺损情况,应用改良的Rankin量表评分评估脑卒中后功能恢复状况,分析缺血性脑卒中复发的终点事件,采用logistic回归分析、ROC曲线分析及Kapla-Meier生存分析。结果 3组P波时限及缺血性脑卒中复发率比较,差异有统计学意义(P<0.01)。多因素logistic回归分析显示,进展性房间传导阻滞和既往脑卒中严重程度是缺血性脑卒中复发的危险因素(OR=2.573,95%CI:0.952~7.264,P<0.01;OR=1.098,95%CI:1.059~1.130,P<0.01)。ROC曲线分析显示,进展性房间传导阻滞预测缺血性脑卒中复发的ROC曲线下面积为0.734(95%CI:0.673~0.796,P<0.01),敏感性和特异性分别为59.6%和87.3%。Kapla-Meier生存分析显示,与无房间传导阻滞组和不全性房间传导阻滞组比较,进展性房间传导阻滞组生存率明显减低,差异有统计学意义(P<0.01)。结论进展性房间传导阻滞可能成为预测缺血性脑卒中患者预后的指标。

Objective To investigate the effect of advanced interatrial block on the prognosis of patients with ischemic stroke.Methods A retrospective analysis was performed on 237 patients with ischemic stroke treated in the outpatient and inpatient departments of the First Affiliated Hospital of Nanyang Medical College and the North District of Suzhou Municipal Hospital from January 2019 to January 2021.According to the severity of interatrial block from the first stroke to the end of follow-up, the patients were divided into non-interatrial block group(n=133),partial interatrial block group(n=56) and advanced interatrial block group(n=48).Neurological deficits were assessed according to the National Institutes of Health Stroke Scale.The functional recovery of patients after stroke was evaluated by modified Rankin Scale.The end point events of ischemic stroke recurrence were analyzed.Logistic regression analysis, ROC curve analysis and Kapla-Meier survival analysis were used.Results There was significant difference in the recurrence rate of ischemic stroke and P-wave duration in the 3 groups(P<0.01).Multivariate logistic regression analysis showed that advanced interatrial block and the severity of previous stroke were the risk factors for the recurrence of ischemic stroke(OR=2.573,95%CI:0.952-7.264,P<0.01;OR=1.098,95%CI:1.059-1.130,P<0.01).ROC curve analysis indicated that the area under ROC curve of advanced interatrial block in predicting ischemic stroke recurrence was 0.734(95%CI:0.673-0.796,P<0.01),and the sensitivity and specificity were 59.6% and 87.3%,respectively.Kapla-Meier survival analysis showed that the survival rate of advanced interatrial block group was significantly lower than that of non-interatrial block group and the partial interatrial block group(P<0.01).Conclusion Advanced interatrial block may be a predictive indicator for the prognosis of patients with ischemic stroke.