高龄心房颤动合并大面积脑梗死脑疝形成的危险因素分析

Risk Factors for Herniation in Elderly Patients with Atrial Fibrillation Complicated with Massive Cerebral Infarction

目的 利用Logistic回归和ROC曲线探讨高龄心房颤动合并大面积脑梗死脑疝形成的危险因素以及在此基础上构建脑疝形成的预测模型。方法 回顾性分析2013年1月至2021年1月于福建省老年医院神经内科诊断为心房颤动合并大面积脑梗死的高龄患者63例的病历资料,根据病情转归分为脑疝组和非脑疝组,比较两组的临床资料差异,并利用Logistic回归和ROC曲线探讨此类患者脑疝形成的危险因素。结果 和非脑疝组比较,脑疝组血LDL水平更高(t=4.09,P=0.00);血ALB水平较低(t=11.4,P=0.00),收缩压变异性更高(t=11.4,P=0.00)。Logistic回归分析显示血白蛋白水平、收缩压变异性是高龄心房颤动合并大面积脑梗死脑疝形成的独立危险因素。基于Logistic回归结果,得到回归方程Y=0.24X_(1)-0.683X_(2),并计算ROC曲线下面积为0.939,P=0.00。结论 血ALB和收缩压变异性是高龄心房颤动合并大面积脑梗死出现脑疝形成的危险因素,联合使用这2种指标可有效预测病情,据此及时进行临床干预,改善患者预后。

Objective To explore the risk factors of cerebral herniation in elderly patients with atrial fibrillation complicated by large-area cerebral infarction by using logistic regression and ROC curve,and to construct a prediction model of cerebral herniation on this basis.Methods A total of 63 elderly patients diagnosed with atrial fibrillation complicated with large-area cerebral infarction in the Department of Neurology of Fujian Provincial Geriatric Hospital from January 2013 to January 2021 were retrospectively included.And use logistic regression and ROC curve to explore the risk factors of brain herniation in such patients.The differences in clinical data between the two groups were compared,and the risk factors of brain herniation in these patients were explored by Logistic regression and ROC curve.Results Compared with the non-herniated group,the blood LDL level in the brain herniation group was higher(t=4.09,P=0.00);the blood ALB level was lower(t=11.4,P=0.00),and the systolic blood pressure variability was higher(t=11.4,P=0.00).Logistic regression analysis showed that serum albumin level and systolic blood pressure variability were independent risk factors for senile atrial fibrillation complicated with massive cerebral infarction herniation.Based on the logistic regression results,the regression equation Y=0.24X_(1)-0.683X_(2) was obtained,and the area under the ROC curve was calculated to be 0.939,P=0.00.Conclusion Blood ALB and systolic blood pressure variability are risk factors for the formation of brain herniation in the elderly with atrialfibrillation complicated by large-area cerebral infarction.The combined use of these two indicators can effectively predict the need for timely intervention in clinical practice and improve the prognosis of patients.