慢性心力衰竭合并缺血性脑卒中患者再发脑卒中的危险因素分析

Risk factors of recurrent stroke in patients with chronic heart failure complicated with ischemic stroke

目的探讨慢性心力衰竭(CHF)合并缺血性脑卒中(IS)患者再发脑卒中的相关危险因素。方法选取2021年1月至2023年1月在江苏省苏北人民医院就诊的老年CHF合并IS患者235例,根据左心室射血分数(LVEF)分型分为射血分数减低的心力衰竭(HFrEF)组80例(LVEF<40%)、射血分数中间值的心力衰竭(HFmrEF)组57例(40%≤LVEF<50%)和射血分数保留的心力衰竭(HFpEF)组98例(LVEF≥50%);将随访12个月内再发IS的患者作为再发IS组42例,无再发IS的患者作为无再发IS组193例。比较各组一般资料、实验室检查和临床终点事件等,用多因素logistic回归分析老年CHF合并IS患者再发IS的相关危险因素。结果HFrEF组、HFmrEF组、HFpEF组女性、年龄、吸烟、饮酒、周围血管病、红细胞计数、血红蛋白、红细胞比容、低密度脂蛋白胆固醇、凝血酶原时间、国际标准化比值、B型钠尿肽、LVEF、左心室舒张末期内径、左心室收缩末期内径比较,差异有统计学意义(P<0.05,P<0.01)。与无再发IS组比较,再发IS组糖尿病、凝血酶时间、左心房内径(LAD)、右心房内径显著升高(P<0.05,P<0.01)。多因素logistic回归分析显示,糖尿病(OR=0.251,95%CI:0.196~1.494,P=0.031)和LAD(OR=1.085,95%CI:1.008~1.169,P=0.031)是老年CHF合并IS患者再发IS的独立危险因素。HFrEF组、HFmrEF组、HFpEF组随访时间及随访终点事件比较,差异无统计学意义(P>0.05)。结论糖尿病和LAD是老年CHF合并IS患者再发IS的独立危险因素。

Objective To investigate the risk factors of recurrent stroke in IS patients with CHF.Methods A total of 235 elderly IS patients with CHF admitted to Northern Jiangsu People's Hospital from January 2021 to January 2023 were enrolled in this study.According to LVEF classification,they were divided into reduced ejection fraction HF group(HFrEF,LVEF<40%,80 patients),intermediate ejection fraction HF group(HFmrEF,40%≤LVEF<50%,57 patients),and preserved ejection fraction HF group(HFpEF,LVEF≥50%,98 patients).After all of them were followed up for 12 months,the patients with recurrent IS were assigned into the recurrent IS group(42 patients)and those without into the non-recurrent IS group(193 patients).Their general data,laboratory results,clinical endpoint events and other indicators were compared in the above groups.Multivariate logistic regression analysis was applied to identify the related risk factors for recurrent stroke in elderly patients with CHF and IS.Results There were significant differences in women ratio,age,history of smoking and drinking,peripheral vascular disease,RBC count,hemoglobin,hematocrit,LDL-C,prothrombin time,international standardized ratio,BNP,LVEF,LVEDD and LVESD among the three groups(P<0.05,P<0.01).The recurrent IS group had obviously larger proportion of diabetes mellitus,longer thrombin time,and larger LAD and RAD when compared with the non-recurrent IS group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that diabetes(OR=0.251,95%CI:0.196-1.494,P=0.031)and LAD(OR=1.085,95%CI:1.008-1.169,P=0.031)were independent risk factor for recurrent stroke in elderly patients with CHF and IS.There were no significant differences in follow-up period and incidence of clinical endpoints among the three groups(P>0.05).Conclusion Diabetes and LAD are independent risk factors for recurrent IS in elderly CHF patients with IS.